Collaboration in Civic Spheres

UW Study: Licensing Foreign-Trained Dentists In WA Doesn’t Boost Access For Vulnerable Populations

by Lindsay Crocker February 14th, 2011

SUMMARY: Forty-nine million U.S. residents live in federally-designated dental Health Professional Shortage Areas (HPSAs), typically rural or low-income areas where care is often provided through public health insurance programs such as Medicaid. One potential solution explored has been to continue to recruit and accept foreign-trained dentists for licensing at U.S. dental schools in hopes more of them will opt to work with vulnerable populations in dental HPSAs. A Washington state case study addressing this possibility was recently published – in a one of a family of prominent open-access online medical journals – by University of Washington researchers. The study does not support the hypothesis that foreign-trained dentists licensed in the U.S. are more likely than domestically-trained dentists to choose a practice in a geographic area with a high proportion of Medicaid patients and a low proportion of dentists to population. Factors may include student debt and salary differentials.

BACKGROUND: There is a significant shortage of dentists in the U.S., leaving many areas with little access to dental care. Health Professional Shortage Areas (HPSAs) are regions where the population to dentist ratio is greater than 5,000 to 1. They have become increasingly abundant as a result of the poor distribution of dentists throughout the population. Specifically, low-income, migrant, and prison populations lack adequate ratios of dentists to inhabitants. This discrepancy has led some States to enact legislation to promote the licensing of foreign-trained dentists with the hopes that they will improve access to dental care in HPSAs. In the last 25 years Washington State has relaxed its requirements for granting dental licenses to those who graduated from foreign dental institutions. This year the University of Washington will begin accepting foreign-trained dentists as first- or second-year dental students.

A study of the likelihood of foreign-licensed dentists to provide dental care to vulnerable and underserved populations was done by researchers from the University of Washington School of Dentistry. The authors tracked foreign-trained dentists licensed between September 1, 2006 and September 30, 2008 in Washington state to test two hypotheses:

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 Health Professional Shortage Areas (HPSAs) than U.S.-trained dentists.”

KEY LINK: “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 In Washington State,” BioMed Central Health Services Research, December 10, 2010. Authored by researchers from University of Washington School of Dentistry, Department of Public Health Sciences.


  • Among dentists licensed in Washington state between September 1, 2006 and September 30, 2008, foreign-trained dentists participated in Medicaid at a significantly lower rate than U.S.-trained dentists – 12.9 percent versus 22.8 percent, respectively.
  • Only 20 percent of newly licensed dentists in the study, overall, participated in the Medicaid program. This could cause difficulties for the Washington Medicaid program in the future because one-half of the state is enrolled in Medicaid or without dental insurance.
  • There were no significant differences in practice location, such as in a dental HPSA or rural area versus better-served more urban areas, between foreign- and U.S.-trained dentists in the pool of Washington state licensees tracked for the study.
  • Some possible explanations offered by the authors include the influence of school debt, the income differential for those working at community health centers, which serve Medicaid-enrolled patients, when compared to peers working at an established practice, and the possibility that willingness to treat underserved populations may not differ between foreign- and U.S.-trained dentists.
  • One unexpected finding showed that a high number of foreign-trained dentists were female (58.3 percent). This may affect the likelihood of foreign-trained dentists treating underserved populations.
  • The study’s authors also noted that another possible effect of incentivizing the licensing of foreign-trained dentists in the U.S. could be to create a the “brain drain” in some of the other countries from which they immigrate.

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