Dental graduate medical costs are a growing investment

Funding for graduate medical education (GME) for dental residents is substantial and growing, according to a study published on May 27 in JAMA Network Open. The Medicare program spends millions of dollars each year supporting dental education programs, despite limited oral healthcare support for Medicare beneficiaries.

The study authors analyzed Medicare funding for GME for dental and podiatry programs, noting that these programs represent a growing public investment that policy may need to address. In 2018, Medicare spent nearly $730 million in payments to GME teaching hospitals to support 4,856 residents, the majority of whom were dental trainees.

"The oral and podiatry health workforces are vital for the health and wellness of the U.S. population, and Medicare GME investments are substantial," wrote the group, led by Dr. Candice Chen, an associate professor at the George Washington University Milken Institute School of Public Health.

The government provides more than $16 billion annually to GME programs, with Medicare alone giving $14.6 billion in 2018. However, dental and podiatry programs are often left out of consideration for the use of these payments. The authors sought to better understand payments and the distribution of those funds.

Chen and colleagues analyzed payments to 1,252 teaching hospitals with dental and podiatry residency positions. The hospitals recorded the number of residents and GME payments. The authors also looked at direct and indirect GME payments and adjusted the dollar amounts for 2018 inflation.

From 1998 to 2018, the number of residents supported by Medicare increased by 40%, from 78,178 trainees in 1998 to 109,395 trainees in 2018. The vast majority of these positions (72%) were for dental training programs. At the same time, payments from Medicare experienced a 2.6-fold increase, rising from roughly $280 million in 1998 to $729 million in 2018.

However, per capita payments to support GME varied greatly by location. Puerto Rico had a Medicare payment of just $0.05 per resident of the territory, while New York netted $14.24 per state resident. Six states received no support at all, the group found.

In the time period analyzed, the number of teaching hospitals with dental and podiatry residency programs also increased. The growth shows the demand for additional dental education, the authors noted.

"The growth of dental residency programs suggests that there is demand for this additional training, and new or expanded residency programs may be an important strategy for states, territories, and the District of Columbia to address oral health workforce needs," they wrote.

The study was not without its shortcomings. The analysis was limited to data submitted by teaching hospitals, and resident positions eligible for payments are not the same as individual residents. It also did not take into account the full public investment in dental and podiatry GME.

Dental and podiatry education should be considered in the debate over GME funding, the authors noted. They called for the Medicare Payment Advisory Commission and National Academy of Medicine to consider these programs when addressing high-value healthcare.

"Dental and podiatry GME represents an important component of this public investment, and targeted reforms can address oral and podiatry workforce quality and distribution," the authors wrote.

They also tasked Medicare and policymakers with ensuring the funding spent on dental and podiatry education reflects access to care.

"Measurement, transparency, and accountability are needed, as are deliberate policy decisions to ensure that this nearly $730 million and growing public investment is targeted to address the nation's oral and podiatry health needs," they concluded.