Citation: Mertz E, Bates T, Kottek A, Jura M, Werts M, Munson A. Practice Patterns of Postgraduate Trained Dentists in the United States. J. Dent. Educ. Published online September 27, 2022. Doi: 10.1002/jdd.13072.
Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/jdd.13072
Assessing the distribution and organization of the dental workforce is critical to understand how to address poor access to dental care for lower income families. The US currenly lacks a significant supply of dentists who accept Medicaid, or will work in Federally Qualified Health Centers (FQHCs), which impacts communities of color and disabled individuals. There is also evidence that postgraduate dental (PGD) primary care training can increase access to care for underserved populations.
This Journal of Dental Education article examines the individual, educational, community, and policy factors that predict whether PGD-trained dentists serve Medicaid children, accept new Medicaid patients, or work in an FQHC.
Bates T, Jura M, Werts M, Kottek A, Munson A, Vujicic M, Mertz E. Trends in Postgraduate Dental Training in the United States. J. Dent. Educ. Published online September 27, 2022. Doi: 10.1002/jdd.13073.
Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/jdd.13073
Post graduate dental (PGD) training has increased 27% over the last decade (2009-2019). More than 75% of this increase was due to the growth of primary care training. Despite this increase, little is known about factors associated with the pursuit of PGD training and whether or not they vary between different dental specialty fields. There is also evidence that PGD training can influence access to care for underserved populations.
This Journal of Dental Education article examines the individual, institutional, and policy factors that predict the pursuit of PGD training.
Obadoan E, Jura M, Wang S, Werts M, Martiniano R, Muench U, Mertz E. A Longitudinal Cohort Study of Opioid Prescriptions Associated with Non-Surgical Dental Visits Among Oregon and New York State Medicaid Beneficiaries (2014-2016). JADA. February 9 2022. doi: 10.1016/j.adaj.2021.10.011.
Available at: https://jada.ada.org/article/S0002-8177(21)00705-4/fulltext
Studies estimate that approximately one-third of all opioid prescriptions (Rxs) from dentists are associated with nonsurgical dental procedures, which suggests unwarranted opioid use. The authors conducted a retrospective longitudinal cohort study of adult Medicaid beneficiaries using administrative claims data from New York (NY) and Oregon (OR) (2014-2016) to examine opioid Rxs associated with nonsurgical dental visits. The primary outcomes were the number of all opioid Rxs from dentists compared with nondentists, number of opioid Rxs associated with surgical and nonsurgical dental visits, time to subsequent dental visits and visit type, and total dental morphine milligram equivalents (MMEs) received during the 90 days after an opioid-related, nonsurgical dental visit.
Banava S, Obadan-Udoh E, Mertz E. Dental public health post-graduate trainees in the US: Experiences, challenges, and opportunities-A qualitative study. J Pub Health Dent. Published online September 25, 2021. Doi: 10.1111/jphd.12476.
Available at: https://onlinelibrary.wiley.com/doi/10.1111/jphd.12476
Since the 1950’s, health organizations and policymakers have depended on dental public health (DPH) professionals to design and execute local and national oral health strategic plans, and implement community based programs to overcome barriers and disparities. In the US, DPH specialty programs are used to train DPH professionals to increase the available workforce and improve the community’s oral health through engagement in various government and private sectors.
This article explores the DPH post-graduate trainees’ challenges and opportunities during their residency program in the US.
Mertz E, Kottek A, Werts M, Langelier M, Surdu S, Moore J. Dental Therapists in the United States: Health Equity, Advancing. Med Care. October 2021;59:441-48. doi: 10.1097/MLR.0000000000001608.
Available at: https://journals.lww.com/lww-medicalcare/Fulltext/2021/10001/Dental_Therapists_in_the_United_States__Health.8.aspx
Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care.
Osakwe ZT, Kim RS, Obioha CU, Osborne JC, Harun N, Saint-Fleur-Calixte R. Impact of State Scope-of-Practice Laws on Nurse Practitioner-provided Home Visits. Geriatr Nurs. May–June 2021;42(3): 674-680.
Available at: https://www.sciencedirect.com/science/article/abs/pii/S0197457221000811?via%3Dihub
Millions of older Americans receive nurse practitioner (NP)-provided home based primary care (HBPC). Little is known about how state scope-of- practice (SOP) laws may impact use of NP-home visits. Using 2017 Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File (PUF), we examined the impact of state SOP laws on the use of NP-home visits.
Chen C, Chung Y, Broadbent G, Mertz E. Medicare Support for Dental and Podiatry Graduate Medical Education Programs. JAMA Netw Open. 2021;4(5):e2111797. Published online May 27, 2021. Doi: 10.1001/jamanetworkopen.2021.11797.
Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780401?widget=personalizedcontent&previousarticle=2731442
One of the major challenges the oral health workforce faces is those that affect patient access and outcomes. Although Medicare programs provide almost 15 million a year in GME payments to teaching hospitals, there is little information about how the US invests in training the podiatry workforce.
This article evaluates Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018.
Langelier M, Surdu S. Does Education in Oral Health Competencies in Physician Assistant Education Programs Translate to Delivery of Oral Health Services in Clinical Practice? J Physician Assist Educ. 32(2):79-86, June 2021. Published online May 24, 2021. doi: 10.1097/JPA.0000000000000351.
Available at: https://journals.lww.com/jpae/Abstract/2021/06000/Does_Education_in_Oral_Health_Competencies_in.3.aspx
The purpose of this study was to determine the extent to which physician assistants (PAs) are educated in oral health competencies and the relationship of education to providing oral health services to patients.
Kottek A, Hoeft, K, White J, Simmons K, Mertz E. Implementing Care Coordination in a Large Dental Care Organization in the United States by Upskilling Front Office Personnel. Hum Resour Health. 2021;19(1):48. Published online April 7, 2021.
Available at: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00593-0
Care coordination is a strategy used to improve health outcomes and efficiency, but has not been widely adopted in the dental field. To test out care coordination in the field, a large dental accountable care organization participated in a pilot project where they retrained existing administrative staff to coordinate the care of high-risk patients. Following the pilot’s success, a formal dental care advocate (DCA) role was integrated system-wide. The goal of the new DCAs is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team.
This article describes the process of DCA role implementation and assesses staff and clinician perceptions about the role pre- and post-implementation.
Leslie K, Moore J, Robertson C, Bilton D, Hirschkorn K, Langelier M, et al. Regulating health professional scopes of practice: Comparing institutional arrangements and approaches in the US, Canada, Australia and the UK. Hum Resour Health. 2021;19(15). Published online January 28, 2021. doi: 10.1186/s12960-020-00550-3.
Available at: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00550-3
Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals.