title: Exploring the potential for foreign-trained dentists to address workforce shortages and improve access to dental care for vulnerable populations in the United States: a case study from Washington State.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Washington School of Dentistry, Department of Dental Public Health Sciences, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA.
authors.forename: Naseem
authors.initials: N
authors.lastname: Bazargan
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: Peter
authors.initials: P
authors.lastname: Milgrom
mesh_terms: D000328:Adult; D003815:Dentists / Q000191:economics / Q000600:supply & distribution*; D005260:Female; D005551:Foreign Professional Personnel / Q000706:statistics & numerical data*; D006267:Health Education, Dental / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008005:Licensure, Dental / Q000145:classification / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000458:organization & administration; D008507:Medically Underserved Area; D019982:Organizational Case Studies; D011365:Professional Practice Location / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D012051:Reimbursement Mechanisms; D019035:Rural Health Services / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data; D035862:Vulnerable Populations; D014861:Washington