Filling the Gaps: Dentist Disparities along the Rural Urban Continuum

This paper examines the distribution of dentists among U.S. counties along the rural-urban continuum. Dentist workforce availability has implications for oral health care access and utilization, which in turn can affect the quality of life, health, and productivity of rural residents. In addition, dentists form part of the non-tradable services sector, and its erosion may affect the vitality of rural economies. Nonmetropolitan counties have significantly lower levels of dentists per 100,000 residents than metropolitan areas and face the prospect of future attrition in the dentist workforce because of an aging workforce and increasing difficulty attracting newly minted dentists who favor more urbanized practice locations. The paper develops spatial econometric models of dentist location to help identify factors amenable to policy intervention. Results indicate that demand factors such as income, private insurance coverage, educational levels, and demographic composition play a role in dentist disparities. Also, private practice dentists tend to cluster near counties with urban areas consisting of at least 10,000 residents, higher net in-commuting, a greater presence of other health care and creative class professionals, and natural amenities. More stringent regulation for dental hygienists also boosts the relative quantity of dentists. Dental schools and public dentists are associated with a greater availability of private practice dentists.