Imbalance in the geographical distribution of practicing dentists in postgraduate dental training institutions in Taiwan

The relationship between graduation school background and geographical distribution of dentists in Taiwan

Background/purpose

Taiwan's eight dental schools are all located in the western region. This study attempted to analyze the relationship between the geographical distribution of dentists in Taiwan and their graduation school background and to develop several statistical indicators to analyze the geographical distribution of dentists.

Materials and methods

The method of the secondary data analysis was adopted to collect the open information related to the number of the practicing dentists based on their graduation schools and practice locations by cities and counties in Taiwan in January 2023. The data were used to develop several statistical indicators to analyze the geographical distribution of dentists.

Results

There were 16,533 practicing dentists in Taiwan in January 2023. Of the 16,533 dentists, 15,687 (94.88 %) graduated from domestic dental schools and 846 (5.12 %) graduated from foreign dental schools. For the school location, the coefficient of variation, Gini coefficient, population proportion index, and population density index were the largest (168.57 %, 0.47, 10.76 %, and 3927.01 people/square kilometer) in the dentists graduating from the northern dental schools. In overall, the dentists were concentrated in municipalities, cities, and the northern region of Taiwan, especially those graduating from the northern dental schools.

Conclusion

In Taiwan, the geographical distribution of dentists is highly related to their graduation school background. Promoting a balanced distribution of dental enrollment quotas and dental student sources from different geographical locations and inducing the movement of dentists to the dentist-shortage areas may be the more feasible ways to solve the uneven geographical distribution of dentists in Taiwan.

Distributions of dentists and physicians in Taiwan during the Japanese colonial period from 1923 to 1924

Background/purpose

In 1896, the first dentist opened his dental clinic in Taipei City and this also opened a new era of Taiwan's dentistry. This study tried to assess the dentist manpower in Taiwan during the Japanese colonial period from 1923 to 1924, and hence to explore the appearance of Taiwan's early dentistry.

Materials and methods

This study utilized the secondary data analysis to evaluate the numbers and distributions of dentists, physicians, and local practitioners in Taiwan from 1923 to 1924, to find the relationship among them, and further to explore the development of dentists in Taiwan at that period.

Results

The total numbers of dentists and physicians increased from 87 to 882 in 1923 to 97 and 927 in 1924, respectively. Moreover, the total number of local practitioners decreased from 583 in 1923 to 558 in 1924. Their Gini coefficients for dentists, physicians, and local practitioners were 0.18, 0.16 and 0.20 in 1923 and 0.27, 0.05 and 0.19 in 1924, respectively. From 1923 to 1924, dentists and physicians were mainly concentrated in the northern and southern regions of Taiwan, and dentists had more serious uneven distribution problem.

Conclusion

We conclude that the uneven distribution of dentist in Taiwan is an old problem. After a hundred years of development, the number of dentists increases at a higher rate than the number of physicians and there is no shortage of dentists to date in Taiwan. However, the problem of uneven distribution of dentists still exists and is even more serious now.

The training effectiveness of dental trainees in postgraduate year training program for dentists

Background/purpose

Taiwan's two-year postgraduate year training program for dentists (PGYD) has been implemented since 2010. However, there was no relevant study for confirming the training effectiveness of PGYD trainees. This study evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes.

Materials and methods

We adopted the questionnaire survey to collect the views of PGYD trainees on the training effectiveness of PGYD and further evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes.

Results

For the "patient-centered" learning environment and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in dental clinics and district hospitals were more positive than those in medical centers. For the clinical professional ability and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in joint group were more positive than those in single hospital.

Conclusion

We conclude that both hospitals and dental clinics can achieve PGYD training purposes. The smaller training institutions (dental clinics or district hospitals) are better training institution attributes and the joint group is the better training mode to achieve PGYD training purposes. The joint groups with medical centers combining many dental clinics, especially those in remote areas, may be an excellent training mode, because this training mode has the high potential to subsequently balance the distribution of dentists in Taiwan.

Translation and validation of modified dental anxiety scale based on adult Taiwan population

Background

Dental anxiety is associated with negative experiences of dental treatment and dental-visiting behavior. The Modified Dental Anxiety Scale (MDAS) is widely used for assessing dental anxiety. The study aims to establish the psychometric properties of a Chinese version of the MDAS based on the Taiwan sample (i.e., T-MDAS).

Methods

The T-MDAS and dental-visiting behavior and experience were assessed for 402 adult subjects recruited from community and clinical sites. The following psychometric properties were assessed: (a) internal consistency, (b) temporal stability, (c) criterion-related validity (i.e., the association with the score of Index of Dental Anxiety and Fear, IDAF-4C), (d) discrimination validity (i.e., the difference in scores between the subjects with and without a habit of a regular dental visit, and (e) the construct validity from a confirmatory factor analysis (CFA). Results. The T-MDAS showed good internal consistency (Cronbach’s α = 0.88) and temporal stability (ρ = 0.69, p < 0.001). The score was significantly correlated with the score of the IDAF-4C (ρ = 0.76, p < 0.001) and differed between subjects who regularly visited a dentist or not, supporting good criterion-related validity and discrimination validity. Results from CFA supports good construct validity. Furthermore, higher dental anxiety was related to the lack of a regular dental visit, feeling pain during treatment, and feeling insufficient skills and empathy of dentists. A higher proportion of high-dental anxiety subjects in female subjects (8.5%), compared to male subjects (5.0%), was noted.

Conclusions

The T-MDAS is a valid tool for assessing adult dental anxiety. The score is highly associated with dental-visiting behavior and experience of dental patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-02017-w.

Distributions of dental freshmen enrolled by northern, central, and southern dental schools in each city or county and different regions of Taiwan in 2020

Background/purpose

In Taiwan, the uneven distribution and the urban-rural gap of dentists are long-standing problems. Thus, the regional balance of domestic dental schools and their students are very important for the further distribution of practicing dentists. The main purpose of this study was to evaluate the distributions of dental freshmen enrolled by dental schools of general universities in each city or county and different regions of Taiwan in 2020.

Materials and methods

This study mainly collected the number of dental freshmen enrolled by the northern, central, and southern dental schools and further evaluated their distributions in each city or county and different regions of Taiwan in 2020.

Results

The distribution of dental freshmen in Taiwan in 2020 did have a regional imbalance. These dental freshmen were mainly concentrated in municipalities, cities with dental schools, and the northern region of Taiwan. The enrolled dental freshmen tended to choose a dental school which was in the same location as they grew up. We also found that the dental freshmen enrolled by the northern, central, and southern dental schools mostly came from the northern, the northern, and the southern regions of Taiwan, respectively.

Conclusion

We conclude that the dental freshmen are mainly concentrated in municipalities, cities with dental schools, and the northern region of Taiwan. Moreover, the dental freshmen enrolled by the northern or central dental schools mostly come from the northern region of Taiwan and those enrolled by the southern dental schools majorly come from the southern region of Taiwan.

Distributions of dental freshmen and practicing dentists and their correlations in different regions of Taiwan in 2020

Background/purpose

Taiwan is facing the problems of the surplus, the uneven distribution, and the urban-rural gap of dental students and practicing dentists. The main purpose of this study was to evaluate the distributions of dental freshmen and practicing dentists in different regions of Taiwan in 2020.

Materials and methods

We collected the numbers of dental freshmen and practicing dentists in different regions of Taiwan in 2020 for evaluation of their regional distributions in Taiwan and their relationship by the regression analysis.

Results

The numbers of dental freshmen and of practicing dentists per 100,000 people in municipalities were higher than those in non-municipalities (P < 0.01 for practicing dentists only). These corresponding numbers in cities with dental schools were significantly higher than those in cities and counties without dental schools, respectively (all P-values < 0.05). In addition, the coefficients of correlation between the dentist index and the dental student index were R² = 0.7521 (P < 0.05) for municipalities (n = 6), R² = 0.6332 (P < 0.001) for non-municipalities (n = 15), R² = 0.9334 (P < 0.05) for cities with dental schools (n = 4), R² = 0.4925 (P < 0.01) for cities and counties without dental schools (n = 17), and R² = 0.5025 (P < 0.001) for nationwide (n = 21).

Conclusion

The dental freshmen and practicing dentists are still more concentrated in municipalities than in non-municipalities and in cities with dental schools than in cities and counties without dental schools in Taiwan in 2020.

Current practice patterns and training project of orthodontic specialists in Taiwan in 2020

Background/purpose

There were 661 board-certified orthodontic specialists in Taiwan in 2020. This study reported the current practice patterns and training project of orthodontic specialist in Taiwan.

Materials and methods

This study exploited the secondary data analysis and interview to survey the current practice patterns and training project of orthodontic specialists in Taiwan.

Results

Of the 661 orthodontic specialists, there were 84 registered in the medical centers, 44 in the regional hospitals, 7 in the district hospitals, and 526 in the dental clinics, respectively. There were 20 orthodontic specialist training institutions (15 medical centers, 3 regional hospitals, one district hospital, and one dental clinic) that had 218 dentists in orthodontic departments of training institutions and a training capacity of 51 dentists. Of the 20 orthodontic specialist training institutions in Taiwan in 2020, 12 were located in the northern, 4 in the central, and 4 in the southern regions of Taiwan. Moreover, we found none of the training institutions in the eastern and offshore island regions of Taiwan and the number of the orthodontic specialists did increase along with the population and the number of the practicing dentists.

Conclusion

There are three major orthodontic specialist occupation problems in Taiwan: a surplus of the orthodontic specialists in the near future, an uneven distribution of the orthodontic specialists, and a concentration of the orthodontic specialists in the metropolitan areas of the municipalities. Therefore, we suggest that the government and relevant professional groups should propose solutions for these problems as soon as possible.

Regional distributions of overall dentists and institutional dentists in Taiwan in 2019

Background/purpose

Taiwan is facing a huge urban-rural gap in the human resources of dentists between cities and counties. Although the postgraduate year training program for dentists (PGYD) was implemented in Taiwan in 2010, the uneven distribution of dentists is still a serious problem. The purpose of this study was to evaluate the distributions of overall dentists and dental training institutions and their dentists (so-called institutional dentists) in each city and county in 2019 to further analyze the regional distributions of overall dentists and institutional dentists in Taiwan.

Materials and methods

This study collected the numbers of dentists, dental training institutions, and institutional dentists in each city and county in 2019 for evaluating the regional distributions of dentists and institutional dentists in Taiwan.

Results

The numbers of dentists and institutional dentists in municipalities were significantly higher than those in non-municipalities in Taiwan, respectively. The coefficient of variation was greatest for dentists in the single-system institutions (1.72) and program-management institutions (1.87). The coefficients of correlation between the dentist index and institutional dentist index were R² = 0.9805 (P < 0.001) for municipalities, R² = 0.4523 (P < 0.01) for non-municipalities, and R² = 0.7691 (P < 0.001) for nationwide.

Conclusion

The dentist manpower and dental training institutions are concentrated in municipalities of Taiwan. The quantitative and qualitative improvement of collaborating institutions in the PGYD system may have an influence on the distribution of new-entry dentists and contribute to establishment of an effective regional dental health care service.

Distribution of students admitted to dental schools of general universities in Taiwan in 2020

Background/purpose

In Taiwan, the average income of a dentist increases after the implementation of national health insurance in 1995. Thus, the domestic departments of dentistry become a popular choice of university departments for high school graduates. The purposes of this study were to evaluate the distribution of students admitted to dental schools of general universities in each city or county in 2020 and to further compare the differences in regional distributions of dental freshmen accepted by three admission ways in 2020.

Materials and methods

This study collected the number of dental freshmen of general universities in each city or county in 2020 for further evaluating the differences in regional distributions of dental freshmen accepted by three admission ways in 2020.

Results

The distribution of dental freshmen in 2020 did have a big urban-rural gap. These dental freshmen were more concentrated in municipalities than in non-municipalities in Taiwan. The execution of three admission ways did play a role in balancing the urban-rural gap in the distribution of dental freshmen.

Conclusion

The urban-rural gap of the distribution of dental freshmen was not larger than that of dentists. The increased guaranteed enrollment quota of dental freshmen for the high school graduates in the offshore islands do cause unequal opportunities of admission to dental schools. If these extra-enrolled dentists do not return to their hometowns to practice, this may worsen the surplus of dentists and may fail to improve the uneven distribution of dentists in Taiwan.

The changes of the number and regional distribution of dentists and dental institutions 9 years after the implementation of postgraduate year training program for dentists in Taiwan

Background/purpose

In Taiwan, there are three major dentist occupation problems: a surplus of dentists, an uneven regional distribution of dentists, and a concentration of dentists in the metropolitan areas. The purpose of this study was to evaluate the distributions of the population and dentists in each city or county in 2001, 2010 and 2019 to further analyze the changes of regional distributions of dentists 9 years after the implementation of postgraduate year training program for dentists (PGYD) in 2010 in Taiwan.

Materials and methods

This study collected the data of population, the number of dentists in each city or county in 2001, 2010 and 2019, and the numbers of dentists and dental institutions from 2001 to 2019 for evaluating the changes of regional distributions of dentists 9 years after the PGYD implementation in Taiwan.

Results

Nine years after the PGYD implementation, the uneven distribution of dentists persisted. The number of dentists still increased and dentists were more concentrated in municipalities than in non-municipalities in Taiwan. Moreover, the number of dental institutions increased slowly, but dental institutions tended to become larger.

Conclusion

Because the PGYD system is not mandatory, dentists choose their practice locations as driven by the market factors. The increase in the average number of dentists in dental institutions is also driven by the market factors. The market-driven movement of dentists to the people-concentrated municipalities finally persist the imbalance of dentist distribution in Taiwan. This situation also enables the development of large-scale dental institutions in municipalities in Taiwan.