Foreign trained dentists have a challenging time entering and practicing dentistry in the US. And perhaps it should be like this. The American Dental Association (ADA) has been effective since it’s establishment in 1859 at limiting anything that threatens it’s members. In fact, ADA is a role model association with membership close to 80% – this compares favorable to the medical equivalent (American Medical Association) whose membership is 15%!!
Many would argue that it’s easier for a physician to move to the US and start practicing than it is for a dentist even though physicians could, potential, cause much more harm. There’s one state in the US that allows foreign trained dentists to practice in it’s community health centers under the supervision of a US licensed dentist. At first this seems very supportive to foreign trained dentists, however, in implementation these foreign trained dentists earn about half as much as their US licensed counterparts for equivalent work. This sounds more like exploitation.
One state in the US evaluates foreign trained dentists on a case-by-case basis. If a foreign trained dentist’s training is deemed equivalent, once licensure is gained they must work under the general supervision of a US licensed dentist approved by the board. Consider the risk of exploitation here – the foreign trained dentist must practice for three consecutive years under general supervision of one dentist. That dentist has power to limit the types of services authorized. Moreover, general supervision doesn’t even require the supervisor to be physically present.
Another state allows foreign trained dentists to take the hygiene board exams and practice as a hygienist. However, I feel this is a slap in the face of our hygienists. Dental hygiene is a specialized field and I know I couldn’t do a cleaning to the standard of a hygienist – my hygiene team are my preventive specialists. How can a foreign trained dentist whom the state is not willing to license as a dentist be allowed to practice as a hygienist? I suggest this also speaks volumes about how we value prevention in this country………that is…..we don’t.
Finally, it is widely documented that International Dentist programs (an abbreviated program that foreign trained dentists must go through to gain full US licensure) is usually half as long but equally as expensive as a domestic DDS/DMD program. Whether this is reasonable or not is questionable. International Dentist Programs are ultra competitive – only about 2% of applicants gain entry. This leaves a large cohort of talented but frustrated individuals who are underemployed in the US. There are several programs at US dental schools available to foreign trained dentists to strengthen their CV’s – they include observerships and externships and some of them cost as much as $80,000. Again, this sounds like exploitation to me! One could also argue that observerships/externships add little to the strength of an application other than one extra line in the CV. What foreign trained dentists need is training that will walk them through the cultural, social and professional differences between their country and the US. They need a mentor who will help refine CV’s and personal statements and provide feedback on interviewing technique. To our knowledge, these observerships/externships do not offer any such support.
At University of Michigan we are concerned about this issue and have developed a program especially for foreign trained dentists that specifically addresses their needs. This course is provided at cost (our financial goal is to break even….not to make a profit) and more information is provided here.
The goal of this blog is to draw attention to the issue of exploiting vulnerable foreign trained dentists. I believe we should continue to hold high standards for entry in our dental programs across the United States, however, for those that fail to enter….let’s not exploit them. Let’s support them – they are our colleagues. Let’s not charge $80,000 for them to shadow us. Let’s not pay them 50% for equivalent work. Let’s not insult hygienists by allowing them to work only as hygienists. Let’s have a standardized approach to dealing with foreign trained dentists. And let’s be transparent about it.