Challenges Faced by Foreign National Dentists

Michael W. Davis, DDS

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BACKGROUND ON INTERNATIONAL DENTAL STUDENTS
A modern dental school program in the United States today may have as much as (or more than) one third of its graduation class consisting of foreign nationals. These students are all lawful residents of the United States. In order to enter a US dental program, each student must demonstrate proficiency in the English language, usually through certified examination through the Test of English as a Foreign Language (also known as TOEFL). This can be a challenging examination for individuals for whom English is not their first language. Most of these students enter US dental programs after initially completing a dental study program in their home nation. These foreign licensed dentists may opt to enter a 2- or 3-year advanced study program in order to obtain their US dental diploma. Approximately half of all US dental schools offer an international dental program to accommodate these foreign students. A minority of others initially take and pass the National Board Dental Examination and enter a US dental specialty residency program. Obviously, this path is far more difficult and highly competitive.

CHALLENGES FOR INTERNATIONAL STUDENTS DIFFER
As dental students, these individuals face a number of challenges, which differ from traditional native dental students. In many cases, they lack a work visa, so it is difficult for them to help to defray many of the education costs by getting part-time employment. These students are typically older, often with the added responsibilities of having a spouse and perhaps even children. The culture, language, and social structure of their home nation may be quite different, and they find themselves struggling to accommodate and to fit into what can be a far different culture.

PRACTICE LOCATIONS AND EXPERIENCES CAN VARY FOR INTERNATIONAL GRADUATES
Upon graduation, some of these dentists wish to return to their country of origin. Others desire to practice in yet another nation. A third group will have acquired the “American Dream” and would like to become lawful citizens and practice in the United States. This third group of graduating dentists faces additional hurdles to reach their career goals. State dental licensure requires that the applicant either be a lawful US citizen (not simply a resident), or have an employer sponsor the applicant via a “green card” work visa. Fortunately, there are many wonderful and experienced practitioners who are willing to offer a helping hand to recently graduating foreign national dentists with employment opportunities. These established and ethical practitioners realize the extraordinary hard work, sacrifices, and challenges (new language, culture differences, stress of relocation, etc) that these doctors faced as international dental students in the process of earning their degree. The discerning practitioner employing these colleagues realizes that these new doctors offer the positive factor of greater diversity in the workplace and rich life experiences—which can enhance understandings and connections with patients. In addition, these international doctors often possess a maturity level far advanced from their chronological age.

If the new doctor is not able to obtain US citizenship through other means, the individual may be placed in highly vulnerable positions by potential unethical employers. In contrast to what was described previously, there are dental practices that will take advantage of these new dentists. These practices may be single offices or larger corporate dental service organizations. Verbal misrepresentations may abound. A desperate doctor seeking a green card employer sponsor may take on a deal that is too good to be true. The new dentist may be placed in a position of ethical clinical compromise by an unscrupulous employer, a situation on which other doctors would normally turn their backs. In effect, these dishonest dental employers work their foreign national doctors like indentured servants, and often beyond the limits of lawful statutes. Clinic profits may take priority over the interests of patients, and the doctor/patient relationship.

After such troubling experiences, and once the doctor has achieved US citizenship, my hope is that the brutality of the former workplace hasn’t corrupted the doctor. Most of these dentists, despite negative experiences, go on to have outstanding careers and make exceptional professional and social contributions to their communities. However, a significant number of outliers go on to dental careers focused on business models of Medicaid, insurance, and consumer fraud. It’s this disturbing group that too often gives other doctors of foreign origin an unfair and unwarranted negative reputation.

CLOSING COMMENTS
The author’s sincere hope is that dental employers that retain foreign national doctors are held to responsible standards of regulatory oversight and enforcement. These precious international graduates (doctors) should never be tacitly or overtly threatened by ethically challenged clinic managers. These doctors should never be forced to choose between obtaining a path to citizenship and a necessity to harm and/or cheat patients, just to benefit their employer. This must stop!

This group of professional dental colleagues who originated from foreign countries are a valuable national treasure. They have made exceptional sacrifices and have generally played by the rules. It benefits the dental profession and the public interest that these colleagues are protected from workplace abuses. If we ignore their challenges, we risk demeaning of the dental profession and degradation of the dental profession in the eyes of the public.


Dr. Davis maintains a private general practice in Santa Fe, NM. He is highly active with state dental association activities inclusive of peer review, and he serves the legal community as an expert dental witness. He can be reached at (505) 988-4448 or via email at mwdavisdds@comcast.net.

Disclosure: Dr. Davis reports no disclosures.

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