Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, USA.
Healthforce Center at UCSF, San Francisco, California, USA.
J Dent Educ. 2022 Sep;86(9):1133-1143. doi: 10.1002/jdd.13072.
Postgraduate dental (PGD) primary care training has grown significantly. This study examines the individual, educational, community, and policy factors that predict practice patterns of PGD-trained dentists.
Individual dentist records from the 2017 American Dental Association Masterfile, with indicators of Medicaid participation and practice in a Federally Qualified Health Center (FQHC), were linked to postdoctoral training, community/practice location, and state policy factors. Generalized logistic models, adjusted for these factors, were used to predict PGD-trained dentists: (1a) serving Medicaid children, (1b) accepting new Medicaid patients, and (2) working in an FQHC.
Individual attributes that predicted serving Medicaid children included all race/gender combinations (vs. White females), and foreign-trained dentists and contractors/employees/associates (vs. practice owners). Black women are most likely to work in an FQHC. Residency attributes that predicted serving Medicaid children and working in an FQHC were Health Resources and Services Administration postdoctoral funding and being community based. Dentists practicing in rural or high-poverty communities were more likely to serve Medicaid children and work at FQHCs. States with higher levels of graduate medical education investment, higher Medicaid rates, and more generous adult dental Medicaid benefits increased the likelihood of serving Medicaid children, while states with more expansive adult dental Medicaid benefits increased the likelihood of working in an FQHC.
Federal training investment in PGD education combined with Medicaid payment and coverage policies can strongly impact access to dental care for vulnerable populations. Yet, oral health equity cannot be achieved without increasing dentist workforce diversity.
牙科学研究生（PGD）初级保健培训显著增长。本研究旨在考察个体、教育、社区和政策因素对 PGD 培训牙医实践模式的预测作用。
从 2017 年美国牙科协会主文件中获取个体牙医记录，其指标包括医疗补助计划（Medicaid）的参与情况和在合格的联邦健康中心（FQHC）的执业情况，与博士后培训、社区/实践地点和州政策因素相关联。采用广义逻辑模型，对这些因素进行调整，以预测 PGD 培训牙医：（1a）为 Medicaid 儿童服务，（1b）接受新的 Medicaid 患者，以及（2）在 FQHC 工作。
个体属性中，预测为 Medicaid 儿童服务的包括所有种族/性别组合（而非白人女性），以及外国培训的牙医和承包商/员工/合伙人（而非诊所所有人）。黑人女性最有可能在 FQHC 工作。预测为 Medicaid 儿童服务和在 FQHC 工作的住院医师属性包括健康资源和服务管理局（HRSA）博士后资助和社区基础。在农村或高贫困社区执业的牙医更有可能为 Medicaid 儿童服务，并在 FQHC 工作。在拥有更高研究生医学教育投资、更高 Medicaid 率和更慷慨的成人牙科 Medicaid 福利的州，为 Medicaid 儿童服务的可能性增加，而在拥有更广泛的成人牙科 Medicaid 福利的州，在 FQHC 工作的可能性增加。
联邦对 PGD 教育的培训投资，加上 Medicaid 的支付和覆盖政策，可以极大地影响弱势群体获得牙科保健的机会。然而，如果不增加牙医劳动力的多样性，就无法实现口腔健康公平。
