Practice Patterns of Post-Graduate Dental Residency Completers from Select HRSA- Funded Primary Dental Care Training Programs Authors: Ginachukwu Amah, Matthew Jura, Elizabeth Mertz, PhD, MA June 2, 2019 AcademyHealth 2019 Annual Research Meeting Washington D.C.
Landscape • Unlike medicine where physicians complete a residency training in their chosen field, only 41% of of dent ntists w went nt on t on to o pos ost-grad aduat uate dental (P l (PGD) t D) training in 2016.* • Hospital-based programs with a dental training component can draw GM GME funds. However, the dental programs are not tracked as a standalone-funded program, and and m mos ost PGD programs ar are not not hos hospital-bas ased. • HRSA’s Oral Health Training and Workforce Programs include grants for state oral health workforce programs, faculty development, loan repayment, and both pre- and pos ost- doctoral t l train inin ing program ams. o The funding for PGD education programs support pri rimary c care re d dentist stry, which includes General Practice Residencies (GPR), Advanced Education in General Dentistry (AEGD), Pediatric Dentistry (Pedo), and Dental Public Health (DPH). • HRSA also runs both a teaching health center GME (THCGME) and the Children’s Hospital GME program (CHGME). THCGME trains residents in primary care, while the CHGME program trains both general pediatricians and pediatric subspecialists *American Dental Association. 2017-18 Annual Survey of Dental Education. 2018; https://www.ada.org/en/science- research/health-policy-institute/data-center/dental-education. Accessed Mar 7, 2019.
Purpose The purpose of this study is to examine practice patterns of graduates of primary care dental post-graduate training programs with a longstanding history of HRSA funding. To receive HRSA funding for multiple cycles, the PGD education program would have to be strongly aligned with HRSA’s goals and mission, and the grants would support ongoing alignment and development. The study aims are: 1. To assess the impacts of graduates’ training experience on current practice patterns and subsequent patient access to care, and 2. to measure the long-term impact of these programs on improving the capacity of dentists to meet the needs of the underserved. oralhealthworkforce.org
Methods Sample e Sel election • Historical HRSA funding data supplied from HRSA internal records or 1992 to 2003 and pulled from the HRSA Data Warehouse from 1999 to 2018. • Invited: 25 programs from 13 institutions were purposively sampled for geographic distribution, o cumulative average of 17.2 years, compared to the 7.5 years of cumulative funding for all award-receiving institutions. • Accepted: 18 programs at 9 institutions • Completed: 12 programs at 7 institutions Key informa rmant t interviews s • Faculty at participating institutions provided information about their program history, mission and goals. oralhealthworkforce.org
Survey Methods Literature review was conducted to identify prior sample surveys • Survey was customized to each institutional setting, pilot tested and deployed using REDcap with the following sections: o Program Identification o Education o Debt Burden o Activity Since Completion of Training o Opinions of Program o Initial Practice After PGD Training o Current Practice and Appointments o Clinical Care o Patient Information o Respondent Demographics • Contact information was available for 78% of all completers, o Overall response rate to the survey among all completers was 34% o overall response rate among those we contacted was 44% oralhealthworkforce.org
Response Rates Number of Total Weeks Completers with Institution Response Rate Response N in Field Contact Information Institution 1 11 701 60.8% 426 Institution 2 10 515 12.8% 66 Institution 3 4 76 48.7% 37 Institution 4 4 66 10.6% 7 Institution 5 9 129 48.1% 62 Institution 6 14 97 75.3% 73 Institution 7 6 87 66.7% 58 Number of Program Type Response Rate Response N Institutions AEGD 3 18.8% 101 GPR 4 52.3% 392 DPH 2 79.0% 15 Pedo 4 60.4% 221 oralhealthworkforce.org
Comparison of PGD Survey Respondents with All PGD Completers*, 1990-Present 70% 61% 60% 50% 39% 40% 30% 25% 19% 20% 14% 10% 3% 0% Survey Respondents All Dentists *Dentist data comparison, ADA Masterfile, 2019 oralhealthworkforce.org
Additional Degrees Conferred to Respondents by Program Type oralhealthworkforce.org
Satisfaction with Training at Specific PGD Program oralhealthworkforce.org <#>
Total Educational Debt* Upon Completion of Post- Graduate Training by Program Type oralhealthworkforce.org <#> *Educational Debt = undergraduate + graduate + post-graduate
Extent to Which Completers Felt Prepared in Specific Skills From Training oralhealthworkforce.org <#>
Interprofessional Education PROGRAM TYPE AEGD GPR DPH Pedo Total No 64.8 37.7 33.3 23.4 37.1 Yes 35.2 62.3 66.7 76.6 62.9 Total (N) 91 374 12 197 674 oralhealthworkforce.org
HRSA Priority Activities Since Program Completion N % Treating patients insured by Medicaid/CHIP 457 62.7 % Treating patients with special health care needs (e.g., people with developmental disabilities, residents of long-term care/nursing homes, 385 52.8 % medically compromised patients) Dental volunteering providing clinical care (e.g., school clinics, community screenings, Missions of Mercy (MOM), Remote Area Medical (RAM), 344 47.2 % international dental mission trips, etc.) Clinical practice in a setting serving primarily Medically Underserved Areas/Populations (i.e., groups of persons who face economic cultural or 310 42.5 % linguistic barriers to health care) Collaborative practice (e.g., co-treating patients with another health 241 33.1 % profession working in an interprofessional team treating patients) Provide clinical care in a Dental Health Professional Shortage Area (i.e., urban or rural area population groups or medical or other public 216 29.6% facilities with a shortage of primary medical care dental providers) Dental education (e.g., teach continuing education faculty appointment) 206 28.3 % Dental professional leadership (e.g., local dental society, national dental 205 28.1 % organization, appointment to national examination board) Research (e.g., serve in Dental Practice-Based Research Network, participate 87 11.9 % in university-organized research project, other research) <#> Non-clinical public health (e.g., local state or federal public health 55 7.5 % employment or other service policy setting position or committee)
Patient Populations
Respondents’ Mean Percent of Patient Population by Insurance Type 90 80 Mean Percent of Patient Population 70 60 50 40 30 20 10 0 AEGD GPR DPH Pediatrics Total Private Insurance Public Insurance No Insurance Other Insurance oralhealthworkforce.org
Frequency of Nutrition and Substance Use Counseling oralhealthworkforce.org <#>
Limitations • The response rate of 44% in a convenience sample means inferences from these data about comparable program outcomes or national trends cannot be made. • The study design only allows examination of trends and descriptions, not causal factors. • DPH was included as a primary care dental specialty as it existed at the institutions sampled, but the responses are very small, and these findings in particular should be viewed as initial data only. oralhealthworkforce.org <#>
Conclusions • HRSA funded programs as judged against HRSA specific stated goals perform quite well in most priority areas. • Quality of training was highly rated (97.4% of completers reported feeling satisfied) and high likelihood of recommending their PDG training program to others (95.9%). • Completers are more diverse than the pool attending similar PGD programs nationally, particularly among African-American and female completers, adding to the overall diversity of advanced trained dental providers. • Nearly 30% of completers reported practicing in a DHPSA. • Completers participate in Medicaid at a greater rate than all dentists (63% vs. 38% nationally) 24 and see a substantial number of Medicaid patients relative to privately-insured patients. • More than half of completers also report treating patients with special health care needs. oralhealthworkforce.org <#>
Policy Implications • These outcomes and speak to the long-term commitment of HRSA-funded programs to prepare a dental workforce focused on serving the underserved. Further work is needed: • Alignment of Federal Funding Priorities & Workforce Policy • Investigation of Specialty-Specific Trends • Dental Workforce Data Collection oralhealthworkforce.org <#>
Acknowledgements • This work is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $449,821. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the US Government. oralhealthworkforce.org <#>
Questions? • For more information, please email me at: Elizabeth.Mertz@ucsf.edu • Visit us at: oralhealthworkforce.org <#>
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