AB 2625: Dental Practice Act: foreign dental schools.

The Legislature finds and declares all of the following relating to the shortage or maldistribution of dentists throughout California, including a lack of Latino and Black dental students and licensed dentists in proportion to their population in the state:

(a)California faces a worsening shortage of oral health care access, with nearly 3 million residents unable to obtain routine dental services. More than 2.7 million Californians live in dental health professional shortage areas, a 22.7 percent increase since 2017. Workforce shortages are intensifying due to an aging dentist population, with 42 percent of dentists being over the age of 55. Changes to federal H-1B visa fees, established at $100,000, will disproportionately affect rural regions that rely on H-1B visa dentists.

(b)Rural and underserved areas are disproportionately impacted as rural counties report declining dentist-to-population ratios, with some having fewer than one dentist per 5,000 residents. Only 3 percent of rural dentists accept Medicaid compared to 11 percent of dentists in urban areas, deepening inequities and increasing emergency dental expenditures.

(c)The increasing cost of dental education accentuates the access to oral health care problem as the states dental education costs are among the highest nationally, often exceeding $450,000 at public institutions and $500,000 at private schools. High debt, now averaging more than $305,000, limits graduates ability to work in underserved communities, and loan repayment programs overwhelmingly benefit urban areas over rural regions.

(d)The State Department of Public Healths California Oral Health Plan 20182028 and a study by the Healthforce Center at the University of California at San Francisco (UCSF) identified the following major oral health issues in California:

(1)There are marked oral health disparities in California with respect to race and ethnicity, income, and education. The uneven distribution of the oral care workforce and inadequate infrastructure and capacity in the public health system have presented difficulties in delivering preventive and early treatment for oral care services to millions of Californians.

(2)Approximately 2.2 million Californians live in dental health professional shortage areas, which are largely concentrated in the northern Sierra counties, the central valley, and the Inland Empire.

(e)According to the United States Department of Health and Human Services, rural populations have a higher prevalence of cavities and tooth loss, a lower degree of private dental insurance, and limited access to public dental services. Rural areas often have inadequate public transportation systems, making it very difficult to access dentists outside the proximal area.

(f)A disproportionate number of people living in poverty and the working poor reside in geographically isolated areas with a maldistribution of dentists and a limited number of Medicaid providers. As a result, those who need dental care the most are often the least likely to receive it.

(g)According to the UCSF study, estimates of the total supply of dentists in California do not reflect the supply available to care for medically underserved communities and individuals covered by Medi-Cal, which covers 26 percent of the states population and nearly half (43 percent) of the states children.

(h)In 2016, only 15.7 percent of California dentists participated in Medi-Cal or the Healthy Families Program, the second lowest in the nation.

(i)In 2024, the Little Hoover Commission, after conducting additional reviews of the program, stated that California still ranks among the worst in the nation when it comes to care and treatment of pediatric dental disease.

(j)The racial and ethnic diversity of the workforce is not congruent with Californias population, affecting access to services and culturally appropriate delivery of dental care.

(k)Despite the Latino population comprising approximately 38 percent of the people in California, only 6 percent of practicing dentists are Latino, according to data from the California Health and Human Services Open Data Portal.

(l)Similarly, Black dentists make up 2 percent of the California dentist workforce despite the Black population making up 6 percent of Californias population.

(m)The deficient number of Latino and Black dentists contributes to and accentuates the access to dental care problem as it is well documented that cultural competency in the delivery of oral health effectively addresses societal barriers in accessing and receiving preventative and treatment services.

(n)In 1998, to alleviate the shortage or maldistribution of dentists, the Legislature created a program requiring the Dental Board of California (the board) to evaluate and, if qualified, approve foreign dental schools.

(o)Under this program, the board established an evaluation process conducted by experts in the dental arena to assess curriculum, faculty qualifications, facilities, and other relevant factors to ensure that the schools would provide an education that is equivalent to that of similar accredited institutions in the United States and that would adequately prepare students for the practice of dentistry.

(p)The board approved two foreign dental schools: the University of De La Salle Bajio School of Dentistry (La Salle University) in Guanajuato, Mexico, in 2004, and the State University of Medicine and Pharmacy Nicolae Testemitanu in Moldova (Moldova University) in 2016.

(q)Moldova University has been a center of undergraduate and postgraduate education of doctors and pharmacists since 1945, and of dentistry since 1959.

(r)La Salle University, founded in 1975, is ranked as one of the best dental schools in Mexico.

(s)In order to become approved foreign dental schools, La Salle University and Moldova University underwent extensive approval and evaluation processes conducted by the board that took years to complete.

(t)Graduates from these approved schools were required to pass the same licensure standards as graduates from schools within the United States.

(u)Since the inception of this program, approximately 900 graduates from La Salle University and Moldova University have passed the required California exams and are practicing in California. Many are practicing in low-income, underserved communities, like Yuba City, Madera, Bakersfield, Fresno, and Los Angeles.

(v)Chapter 865 of the Statutes of 2019 (Assembly Bill No. 1519) eliminated the boards authority to approve additional foreign dental schools, and required that, to maintain their status as board-approved schools, La Salle University and Moldova University must successfully complete the international consultative and accreditation process with the Commission on Dental Accreditation of the American Dental Association (CODA) by January 1, 2024.

(w)Moldova University began the CODA accreditation process on March 15, 2021. CODA responded that they would not be conducting reviews of international dental schools in the foreseeable future because of travel restrictions resulting from the COVID-19 pandemic.

(x)Moldova University recently completed and filed with CODA its preliminary accreditation consultation visit application.

(y)La Salle University began the CODA accreditation process in 2007, was denied accreditation in March 2019, and is currently in the process of appealing the decision.

(z)CODA began its process of creating an international school accreditation process in 2005, completed this process in 2006, and began accepting applications in 2007. Documentation from CODA shows that in 2007, 10 international dental programs submitted applications.

(aa)In 2019, CODA approved its first foreign dental school, King Abdulaziz University in Jeddah, Saudi Arabia. The process took approximately 12 years to complete.

(ab)In 2024, CODA approved its second foreign school, Yeditepe University in Istanbul, Turkey. The process took approximately 17 years to complete.