J Dent Educ. 72(11): 1290-1295 2008
© 2008 American Dental Education Association
Milieu in Dental School and Practice |
Dental School Applicants by State Compared to Population and Dentist Workforce Distribution
Lauren E. Mentasti, B.S.;
Edward A. Thibodeau, D.M.D., Ph.D.
Key words: dental workforce, dental school applicants, access to care, geographic distribution
Submitted for publication 02/25/08;
accepted 07/10/08
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Abstract
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Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.
Millions of Americans face significant barriers that limit their access to oral health care. One of the major obstacles faced by underserved populations is the distribution and size of the dental workforce. According to a 2002 article by Beazoglou et al.,1 the influences on dental workforce requirements are multifaceted, including productivity, demand for services, the economy, socioeconomic shifts, changes in therapeutic and prevention interventions, oral disease rates, dental fees, the use of allied personnel, and new technologies. While tending to focus on the governing factors of supply and demand, these authors acknowledge that there are large segments of the population that do not receive adequate oral health care. Other factors, such as the aging of dental practitioners and shifts in gender, racial, and ethnic diversity, may also influence the dental workforce.2
Economic or market-based approaches to assessing the adequacy of the dental workforce may be insufficient given that there are unmet oral health care needs in populations with low income, lack of insurance coverage, and geographic or institutional barriers that prevent them from demanding care.2 In 2002, about 63 percent of Americans overall and less than 50 percent of the poor visited a dentist in the past year.3 America’s problems in accessing oral health care have been attributed to the lack of dental health professionals in many areas of the country.4
Previous studies have compared dental school enrollees and graduates to state population and dentist workforce demographics.5,6 However, a major challenge faced by the dental profession is to ensure that there is a sufficient number of qualified dental school applicants who are not only interested in meeting the economic demand for services, but are also dedicated to addressing the oral health needs of populations with limited access to care. The purpose of this study was to evaluate the relationship among the number of dental school applicants, population, and dentists by state in the hopes of better understanding the factors that may influence the distribution of the dental workforce.
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Methods
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The number of dental school applicants by state of residence for the 2005–06 admissions cycle was obtained from the Associated American Dental Schools Application Service (AADSAS) and from the American Dental Education Association (ADEA) for non-AADSAS dental schools located in Georgia, Louisiana, Mississippi, Tennessee, and Texas.6 Data concerning the number of practicing dentists by state were obtained from a report issued by the American Dental Association (ADA) Survey Center for 2003.7 State population data for 2005 were obtained from the U.S. Census Bureau.8
A national average dentist to population ratio, applicant to population ratio, and applicant to dentist ratio were generated and used as a baseline for comparing individual states. States were ranked relative to one another; and the top five states in terms of number of applicants, dentist to population ratios, applicant to population ratios, and applicant to dentist ratios were determined.
States were divided into one of four categories based on applicant to population and dentist to population ratios in comparison to national averages as described in Figure 1
. For each state dental workforce, the number of dentists above or below the national average dentist to population ratio was determined. The relationships between applicants and dentists, applicants or dentists and population, and applicants or dentists and number of dental schools were determined.
Data were analyzed using basic descriptive and inferential statistics in the Statistical Package for the Social Sciences (SPSS) program.
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Results
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In 2005–06, there was a combined total of 9,915 applicants to U.S. dental schools. Table 1 contains a comprehensive list of each state’s number of dental school applicants, applicants to state population ratio, and applicants to dentist ratio. The table also identifies the thirty-four states that have one or more dental schools. Of the remaining sixteen states, all but one (Delaware) have some type of articulation agreement with an out-of-state dental school.5
Table 2 compares those states having the greatest and fewest dental school applicants and the best and worst applicant to dentist, applicant to state population, and dentist to state population ratios. States with the greatest number of applicants were California, Texas, and New York, while Vermont, Rhode Island, and Maine had the fewest total applicants. When compared to the number of dentists in a particular state, North Dakota, Utah, Idaho, and Nevada had the most favorable dental school applicant to practicing dentist ratios. The least favorable ratios are found in Vermont, Hawaii, and Rhode Island. Nationally, the applicant to dentist ratio was about 1 to 16.2 or 9,915 applicants to 160,623 dental practitioners.
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Table 2. Variations in dental school applicants, populations, and dentists by state compared to national averages
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When taking state total population into account, Utah has the best ratio of one dental school applicant for every 7,506 people in the state. In Vermont, this ratio is 1 to 103,842, while nationally it is about 1 to 29,895. The practicing dentist to state population ratio for the country is 1 to 1,851. For Massachusetts, this ratio was better than all other states (1 to 1,334), while Mississippi had the least favorable ratio (1 to 2,839). It is interesting to note that none of the states with the fewest number of applicants have a dental school. Also, of states with the worst applicant to dentist ratios, only one of five states has a dental school (Table 2
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Results in Table 3 show that strong positive correlations (p<0.01) exist between a state’s total number of dental school applicants and total population (r=0.958), number of dentists and population (r=0.752), and number of applicants and dentists (r=0.934). There is also a significant relationship (p<0.01) between the number of applicants or dentists in a state and the presence of one or more dental schools (r=0.794 and r=0.865, respectively).
Nine states had dentist to population and applicant to population ratios better than the national average (Category 1), while for seventeen states both ratios were worse (Category 4). Twelve Category 2 states had a better dentist to population ratio and a worse applicant to population ratio than national averages, while twelve Category 3 states had a better applicant to population ratio and a worse dentist to population ratio (Figure 1).
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Discussion
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Results show that highly populated states produce more applicants and have more dentists than less populous states. However, when considering the adequacy of a state’s dental workforce or dental school applicant pool, it is more useful to relate these demographics to the state population. Our results show that states such as Mississippi, Nevada, New Mexico, and North Carolina have the poorest dentist to state population ratios. Similar results were reported by the National Institute of Dental and Craniofacial Research of the National Institutes of Health, which also noted that many of these same states with workforce deficits have some of the largest underserved populations.4
The thirty states with a dentist to population ratio below the national average also produced fewer than half of the dental school applicants in 2005–06, suggesting that such areas will be producing fewer new dentists that claim legal residency in these states. According to The Economics of Dental Education, the geographic variance in the dental workforce is a direct consequence of the rate at which young people from a given area attend dental school.9 Furthermore, the most likely site for a dentist to begin practice is the community or region in which he or she was raised or attended school.9,10 This concept provides the foundation for state- or county-specific strategies to enhance and maintain their dental workforce, potentially aimed at the dental school education system and the quality and quantity of the dental school applicant pool.
States with relatively few dentists and few applicants are most in need of tactics to improve future access to care. Without intervention, these states may continue to lose dentists as the current workforce matures and retires without replacement. An important strategy to consider may be to increase the number of their potential dental school applicants, assuming that this might translate into an increased number of local dentists in future years. One way to achieve this goal is to foster an interest in the profession at the state collegiate11 and high school levels, perhaps in a coordinated effort to organize predental societies,12 provide shadowing experiences, and assist students in becoming qualified and competitive dental school applicants.13 By working closely with state colleges and universities to promote careers in dentistry, a valuable pipeline can be established.11 States may also wish to consider or continue programs that offer loan or tuition reimbursement to help ensure that recent dental school graduates return to their home state when establishing a practice or to attract new dentists from other areas.14
Nationally, the presence of a dental school is significantly correlated with the number of dental school applicants and dentists in a state. Along with working to cultivate a greater interest in the profession among college undergraduates, states that are fortunate enough to have a dental school can better their dentist to population ratios by increasing the number of accepted dental students from their state. Similarly, to provide a means for state residents to enter the dental profession, most states that lack a dental school have formed some type of agreement with a dental program in another state.5
Initiatives to increase the number of dental school applicants and retain them after graduation may also be useful for all states, as a successful dentist to population ratio does not necessarily ensure the adequate distribution of a state’s workforce. Every state has populations that remain underserved and should consider efforts to target the distribution of dental professionals to those in need. Potential strategies to address this issue include the recruitment of dental applicants from areas that lack access to oral health care, such as rural and geographically isolated locations and urban centers with large diverse populations. Another approach that has been suggested involves subsidizing the income of dentists who establish practices in rural or underserved areas.2 Additionally, states may wish to facilitate the travel of existing providers to counties and areas that do not have a dentist.
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Conclusion
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In order for states to develop strategies to provide optimum oral health care to all residents, a geographical comparison of the dental workforce and dental school applicant pool may be valuable. Based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Many of these same states may also have too few dental school applicants when compared to state population and state dental workforce figures. These states may wish to consider targeted initiatives aimed at increasing the sizes of their applicant pools in order to address local and regional oral health care provider shortages.
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Author Information
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Ms. Mentasti is a D.M.D./M.P.H. Student, University of Connecticut School of Dental Medicine; Dr. Thibodeau is Associate Dean for Admissions, University of Connecticut School of Dental Medicine. Direct correspondence and requests for reprints to Dr. Edward A. Thibodeau, Office of Dental Admissions, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT 06030-3905; 860-679-3748 phone; 860-679-1899 fax; Thibodeau{at}nso.uchc.edu.
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REFERENCES
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- Beazoglou T, Heffley D, Brown LJ, Bailit H. The importance of productivity in estimating need for dentists. J Am Dent Assoc 2002; 133:1399–404.[Abstract/Free Full Text]
- Brown LJ. Adequacy of current and future dental work-force. Chicago: American Dental Association, Health Policy Resources Center, 2005.
- National Center for Health Statistics. Health, United States, 2004, with chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics, 2004.
- Dental, Oral, and Craniofacial Data Resource Center. Oral health U.S., 2002. Bethesda, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health, 2002.
- Byck GR, Kaste LM, Cooksey JA, Chou CF. Dental student enrollment and graduation: a report by state, census division, and region. J Dent Educ 2006; 70(10):123–37.
- Chmar JE, Weaver RG, Ramanna S, Valachovic RW. U.S. dental school applicants and enrollees, 2005 entering class. J Dent Educ 2007; 71(8):1098–123.[Abstract/Free Full Text]
- ADA Survey Center. 2003 dental workforce. Chicago: American Dental Association, 2003.
- Annual estimates of the population for the United States and states, and for Puerto Rico: April 1, 2000 to July 1, 2005. U.S. Bureau of the Census. At: www.census.gov/popest/states/NST-ann-est2005.html. Accessed: December 20, 2006.
- Brown LJ, Meskin LH, eds. The economics of dental education. Chicago: American Dental Association, Health Policy Resources Center, 2004.
- Graham JW. Factors influencing the choice of practice location for recent dental graduates. J Am Dent Assoc 1977; 94(5):821–5.[Abstract]
- Thibodeau EA, Mentasti LE. Characteristics of dental school feeder institutions. J Dent Educ 2004; 68(9):947–53.[Abstract/Free Full Text]
- Mentasti LE, Thibodeau EA. Predental enrichment activities of U.S. colleges and universities. J Dent Educ 2005; 69(8):890–5.[Abstract/Free Full Text]
- Mentasti LE, Thibodeau EA. Nonacademic characteristics of dental school applicants. J Dent Educ 2006; 70(10):1043–50.[Abstract/Free Full Text]
- Loan repayment/forgiveness and scholarship programs database. Association of American Medical Colleges. At: http://services.aamc.org/fed_loan_pub. Accessed: December 20, 2006.
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