Holding up the Oral Health Safety Net: The Role of Nhsc Alumni Dentists in North Carolina

Uneven distribution of dentists and their low participation the Medicaid program limits access to care in North Carolina (NC). The National Health Service Corps (NHSC) deploys dentists to underserved communities, but long-term retention is not well-documented. We sought to learn how NHSC dentists completing service obligations (19 NHSC alumni) differ from other dentists starting practice between 1990-1999 in NC (50 comparisons) and if NHSC status affects continued work with underserved populations With survey data from all NHSC alumni and 68% of comparisons, difference of means tests and regression models examined effects of dentists' NHSC status, race, motivations, and incentives on current work with underserved populations.. Compared to similar dentists, NHSC alumni were more likely to work in “safety net” settings (84% vs. 23%) and with Medicaid patients (60% vs. 19%); to .be African-American, speak Spanish, want to “provide care in an underserved area,” with distinctive clienteles (children, Hispanic patients) and service styles (more walk-ins, shorter appointments, longer waits). Despite having lower incomes than comparisons ($121K vs. $166K), NHSC alumni have similar workloads, hours, and job satisfaction. Multivariate analyses found participation in Medicaid and work in safety net settings was affected by dentists' race, altruism, financial incentives and previous NHSC participation. The NHSC is an effective federal resource complementing state policies aimed at increasing access in public and private practice settings in NC. To amplify the financial incentive of NHSC loan repayment, dental workforce planners and educators should collaborate to recruit African-Americans and other dentists wanting to work in underserved communities.