This "argument" to justify tax dollars for new dental schools has been debunked many times over.
Do you think that graduating an extra 10, 20 or even 30% more dentists a year, particularly with the average indebtedness going up into the hundreds of thousands of dollars a year, is going to induce more graduates to want to go live in the sticks/boonies?
Just because there is a lower dentist to population ratio in a given area does NOT mean those people will all suddenly decide to go to the dentist on a regular basis because there is now one within a 30 minute drive, nor does it mean they will gladly spend hundreds or thousands of dollars on their oral health. Those living in so called "underserved" areas do not generally make oral health a high priority. If it were economically viable for dentists to set up in these rural areas, more would ALREADY be doing it. The fact of the matter is, that in most areas deemed underserved, it is NOT economically viable to practice there.
If the government really wanted a cost efficient method to induce grads to go to these areas, they should simply pay for their educations in return for a period of years practicing in specific areas, with perhaps some further aid in opening an office there. Not much different than the inducements to get doctors into the military. Instead, MILLIONS of taxpayer dollars are wasted to open more schools which only leads to over saturation in the areas PEOPLE WANT TO LIVE IN.
DocJL,
With all due respect, I think you have misunderstood what I was saying; From your post, and more specifically your question (Do you think that graduating an extra...is going to induce more graduates to want to go live in the sticks/boonies?) I believe you are of the opinion that I am in favor of the "dentist shortage" argument, and that that I am a proponent of expanding dental schools.
Let me be clear- I had said that I thought the problem was allocation/concentration of dentists and that EXISTING dentists needed to be incentivized to go to these areas; I've copied and pasted one of the posts I made (post 154 on this thread) to further elaborate:
I agree- I'm not saying that the argument is ethical. It's unethical. I agree with you. This is why I think that NHSC scholarships and loan repayment ought to be significantly expanded. Send new grads out to rural areas for a year or two while helping them with their loans. This ensures a steady stream of new grads rotating through these areas, a solution to the access to care problem, and removes the need for more dental schools.
You said it correctly- the problem is allocation, not number. That's why we need to incentivize people to go rural. Unfortunately, the opportunities aren't great in many rural parts right now. Many residents of these areas have no insurance or are on Medicaid. So a private practice wouldn't be profitable for a dentist with heavy loans. Community health centers here are a good idea.
In case people in the future wonder about my position, let me be clear about it once more:
I believe that this country has more than enough dentists to treat everyone. Currently, there are about 147K dentists in the US (BLS). For a 330M population, that gives us a favorable patient to dentist ratio of ~2200 to 1. But, like I said, the problem is that those dentists are more concentrated in certain parts of the country and less so in other parts of the country. Nothing wrong with the dentists for choosing where they live- but it does mean that more incentives need to be placed in underserved areas.
I believe that access to care is a primary issue, and that expanding loan repayment opportunity and providing dental students with the ability to graduate with reduced debt (via more NHSC scholarships) will be an excellent way to solve two problem: 1) The increasing student debt and 2) shortage of access to care. *(I do think that NHSC scholarships and military scholarships, and even federal loans for dental school, need to have a cut-off point at which they won't fund any more. I don't want the nation's dental schools charging our government $800,000 for a dental education, and seeing non-scholarship dental students in that much debt- this is a separate issue however).
I believe that, in order to make dental practices profitable in these underserved regions, it's about time to start increasing Medicaid reimbursement. Many of the people in rural areas don't have insurance through their workplace, and their low incomes qualify them for this. However, based on what I've read over on DentalTown, people who take Medicaid barely break even on their procedures, and they go through a lot of scrutiny and red tape. If this problem is solved and dentists are provided in these regions, then I think the amount of people who don't utilize dental care will be severely reduced. (This is in reference to your point about people in underserved area not making dental care a priority). I mean, let's not forget. The "Missions of Mercy" in some states are a great example of how many people who lack dental insurance WANT dental care. They just don't have a low-cost pathway to it currently.
In conclusion, I believe that the mechanisms that you described (pay for school in exchange for rural service, help start up practice) are already in place. They just need to be expanded to incentivize more dentists to move there.
. I definitely envy people who get to stay closer to home.
