University of Washington School of Dentistry, Department of Dental Public Health Sciences, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA.
BMC Health Serv Res. 2010 Dec 10;10:336. doi: 10.1186/1472-6963-10-336.
To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists.
The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA.
Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683).
Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.
为了解决美国服务不足地区的牙科劳动力短缺问题，一些州已经立法，使外国牙科学院的毕业生更容易获得牙医执照。然而，外国牙科学院的毕业生在多大程度上能够解决牙科劳动力短缺的问题还不太清楚。此外，外国培训的牙医对改善居住在牙科卫生专业人员短缺地区（HPSAs）和参加公共保险计划（如医疗补助）的弱势患者的牙科保健服务的可及性的潜在影响尚不清楚。本文的目的是初步了解外国培训的牙医的执业行为。作者以华盛顿州为案例研究，以确定外国牙科学院毕业生对改善弱势人群获得牙科保健服务的潜在影响。作者检验了以下假设：a）在所有新获得执照的牙医中，外国培训的牙医比美国培训的牙医更有可能参加医疗补助计划；b）在参加医疗补助计划的新获得执照的牙医中，外国培训的牙医比美国培训的牙医更有可能在牙科 HPSA 中执业。
作者使用牙科执照和医疗补助执照数据来比较新获得执照的、外国培训和美国培训的牙医中参加医疗补助计划的比例以及在牙科 HPSA 中执业的比例。
使用双变量分析，作者发现，参加医疗补助计划的外国培训的牙医比例明显低于美国培训的牙医（分别为 12.9%和 22.8%；P = 0.011）。在参加医疗补助计划的新获得执照的牙医中，外国培训和美国培训的牙医在牙科 HPSA 中执业的比例没有显著差异（P = 0.683）。
使外国培训的牙医更容易获得执照的立法不太可能解决美国的牙科劳动力短缺问题，也不太可能改善弱势人群获得牙科保健服务的机会。在美国许可外国牙科学院的毕业生也会对其他国家的牙科劳动力产生伦理影响。
