The Relationship between Dental Schools and the Supply of Dentists in the 47 Prefectures of Japan for a 20-year Period, Analyzed with the Generalized Linear Models (GLIM)

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  • 都道府県の人口10万人当たり歯科医師数の20年間の変化と歯科大学(歯学部)の特性との関連 : 一般化線形モデル(GLIM)分析による検証
  • トドウフケン ノ ジンコウ 10マンニン アタリ シカ イシスウ ノ 20ネンカン ノ ヘンカ ト シカ ダイガク シガクブ ノ トクセイ ト ノ カンレン イッパンカ センケイ モデル GLIM ブンセキ ニ ヨル ケンショウ

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Abstract

From the late 1960s through to the end of the 70s, dental schools were rapidly established throughout Japan as part of a national policy dealing with dentist supply and demand. The number of dental schools in the country increased from 6 to 29 (12 national/public, 17 private) during this period. However, this policy was dramatically reversed in the mid 1980s, when the government switched to a policy of restraint. A 20% reduction in the number of new dentists was achieved, and, beginning in 2004, an effort was made to improve the national dental examinations and restrict the number of successful applicants. However, it is clear that these two methods alone are insufficient to control the number of dentists. That being the case, the purpose of this study was to demonstrate the statistical relationship, in each of the 47 prefectures, between the change in the number of dentists per 100,000 people during a 20-year period (1982-2002), the type of management (national, public, private) of the dental schools, and the geographical characteristics of the dental schools (e.g., average distance from the center of the prefecture). Analyses of the factors affecting the number of dentists in each prefecture were performed using the GLIM (Generalized Linear Models) method developed by P. McCullagh and J. A. Nelder. The future number of dentists in each prefecture was estimated by extrapolation using the linear regression line. Specific measures for regulating the number of dentists are also discussed in this study. The results show that the trend of the number of dentists during these twenty years was nearly linear (r≧0.96) and there was no reduction of the differences among the prefectures. The outcome of the GLIM analyses strongly indicates that the existence of national or public dental schools corresponds to a steep increase in the number of dentists who work at the clinics or hospitals. In other words, national and public dental schools are strong attractive forces for the recruitment of new dentists. However, the extension of this effect to neighboring prefectures was, contrary to expectation, not significant. These results indicate that, in order to fully understand the variety of functions and characteristics of dental schools, more accurate studies on the dynamics of dentist recruitment at each school and municipalities are needed. If the threshold point at which the supply of dentists is considered in excess is fixed at 80 dentists per 100,000 people, about 30% of prefectures will cross the threshold in 10 years, and 50% will cross it in 20 years. Based on these results, we propose that legal measures to disperse post-graduate dental trainees to prefectures with no dental school would be a more effective method of regulating the supply of dentists.

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