Dental Faculty and Fourth Year Student Attitudes on Access to Care and Alternate Workforce Models in Medicine and Dentistry

Aksu, Mert N., and David G. Dunning



The purpose of this project was to pilot a questionnaire to study the attitudes of dental school faculty and fourth year dental students about alternate workforce models in dentistry and medicine as well as their knowledge of workforce demographics and issues affecting access. The students were polled at the end of their fourth year. The data was gathered over a six month period using an on-line survey designed to measure respondents' attitudes about issues facing the dental workforce, including workforce demographics and factors affecting dental workforce shortages and issues affecting access to care.




There have been numerous workforce models proposed to address concerns regarding access to care. Stakeholders involved in solving the issue of access to dental care often propose solutions based on their perceived knowledge of the cause of the access to care problem.  Similar to dentistry, concerns regarding access to care have affected medicine, and changes to the health care delivery team workforce have been introduced to address these access to care issues. It is estimated that less than 50% of the US adult population aged 20 to 64 have a regular annual dental visit, yet until stakeholders agree on the basic premises of the etiology of the problem, a solution will be elusive. Solutions to the dental access to care issue will be impacted and shaped based on stakeholders' attitudes, knowledge, and preconceptions about access to care and the success of similar models in medicine to solve these issues. Various objective reasons have been cited as to why access to care continues to plague dentistry; however, it is unclear as to whether dental students and dental faculty are knowledgeable about these issues. As stakeholders, dental faculty and dental students need to be knowledgeable about issues that may shape solutions to the access to care dilemma. This project used a survey designed to measure attitudes and knowledge about issues surrounding dental workforce models, from both a local and national perspective. The issues regarding access to care looked at the respondents’ attitudes about reimbursement, under represented minorities, expanded duty dental assistants, expanded duty dental hygienists, and the use of mid level providers in dentistry. In comparison, the project looked at the respondents’ knowledge about the demographics of the profession, their perception as to the cause of the access to care issue and what effect Nurse Practitioners and Physician Assistants (NP/Pas) have played in meeting the access to care issue in medicine and the respondents’ perceptions on their impact on the quality of medical care.

The data were segregated to identify if there were any differences between the attitudes of dental faculty and dental students. Each respondent was presented with a thirty question survey, each question was delivered individually and the respondent was not allowed to back track once the question response was recorded. The survey was administered electronically to all respondents through

Data from this pilot project will allow investigators to design a questionnaire to be administered nationally to look for possible regional differences in attitudes and possible regional differences in proposed solutions to address the public’s concern regarding access to care. This study also looked at the perceptions of respondents’ regarding the future place for dentistry in the medical management of the patient and the role of dentistry in academic medical centers. Data from Detroit respondents showed that while 62% felt that there is a shortage of dentists nationally only 32% felt that there was a shortage locally. Over 85% of respondents felt that access to dental care was primarily related to funding, second followed by 50% who felt that access to care was the result of low dental IQ of the general population, thirdly followed by 27% who felt that transportation impacted access to dental care.

There were several interesting results in the findings. Only 56 % of students responding felt that under-represented minority dental graduates were more likely to provide service to underrepresented minority populations, while over 80% of the same population reported dental graduates from rural areas were more likely to return to practice in rural areas than non-rural graduates. Over 78% of student responses agreed that NPs/PAs have increased access to care, however of these same respondents over 65% opposed increasing scope of practice for dental hygienists or dental assistants or the creation of a midlevel practitioner to improve access. Dental faculty responded similarly.




Solutions to the dental access to care issue will be shaped by provider attitudes. Understanding these attitudes is an important step in the process of addressing the access to care issue, because stakeholders do not necessarily have a common perception as to causes and solutions for the access to care crisis. Even objective facts affecting the access to dental care are not well known or understood by the dental faculty and students surveyed. Diligent focused effort on educating the profession on the issues and attitudes of other stakeholders will be important in crafting a solution.