Attractivité des territoires et logique d’installation liée au site de formation : le cas des chirurgiens-dentistes

Abstract

Introduction: The distribution of healthcare services in France is highly heterogeneous. This disparity results in geographical inequalities in access to healthcare and impacts people's health. This is particularly true for dental care. The challenge of regulating the distribution of dental care services calls for a comprehensive examination of the determinants affecting where dentists practice, with a particular focus on the role of training sites.

Objectives: This study aims to analyze the post-university practice location choices of dental surgeons according to their training site.

Materials and methods: Data from France's national regulatory organization for the dental profession-the Ordre National des Chirurgiens-Dentistes (ONCD)-were used for the purpose of this study, and graduates' practice locations were mapped according to their training site. Subsequently, a multivariate analysis was conducted to examine (1) whether graduates remained near their training unit upon completing their studies, and (2) whether certain training units were attractive to graduates trained elsewhere.

Results: Young graduates predominantly establish their practices in a dispersed pattern around more remote training units, and in a highly concentrated pattern around units with nearby training programs. Between 21% and 66% of graduates establish their practices in the same region (department) as their initial training unit. Retention increases with the presence of a coastline (+17%, p=0.030), as does the attractiveness of the area to graduates from outside the department. This attractiveness is also associated with a high local standard of living (+7.3, p=0.000) but decreases with higher rainfall (-8% of external graduates, p=0.000).

Conclusion: The dispersion of graduates depends on the proximity to other training sites and the intrinsic characteristics of the region. While it may not be possible to influence these regional characteristics, increasing the presence of training sites in areas underserved by dentists could prove an effective strategy.