The ADA has long advocated for policies that strengthen the dental workforce and improve access to care, including support for federal programs that expand training opportunities in underserved communities. Leaders involved in THCGME said the programs demonstrate how targeted federal appropriations can help sustain dental training programs while building long-term workforce pipelines. 

“Wherever people tend to train is where they tend to set roots,” said Kathryn Rothas, D.D.S., dental director at Whitney M. Young Health Center in Albany, New York, and an ADA spokesperson on workforce issues. “That’s the goal: to not only provide students with one more additional year of this supervised dental practice, but really helping them optimize their transition of being a student to being a professional. And we hope that they’ll stay in an underserved area or in a community health center setting. We recognize that’s not everybody’s goal, but that’s the hope.” 

Expanding training  

The THCGME program, created in 2011, supports residency training in community-based outpatient settings rather than traditional hospital-centered models. While initially focused on medical residencies, the program expanded to include dentistry in 2021 through THCPD startup grants that help health centers launch dental residency programs. 

According to HRSA, the THCGME program currently supports more than 1,254 residents in 88 community-based residency programs nationwide during the 2024-25 academic year. Since the program began, more than 3,090 physicians and dentists have completed training through THCGME-supported programs, including 155 advanced general dentists. 

Teaching health centers receive funding to support resident salaries, faculty and operational costs. The companion THCPD program provides startup grants of approximately $500,000 per awardee to help health centers build residency infrastructure, develop curricula, recruit faculty and obtain accreditation. 

Emily Hawes, PharmD, director of HRSA’s THCGME technical assistance collaborative, said the programs are specifically designed to address workforce shortages in communities with limited access to care. 

“In order to produce a workforce that cares for some of the most rural and underserved patients across our nation, an effective way to do that is to really train them during residency and hook them on that mission,” Dr. Hawes said. “They’re equipped for it, they’re less overwhelmed, and it becomes really meaningful and effective work.” 

Research has consistently shown that health professionals are more likely to practice in underserved communities after training in those settings, she emphasized. That principle has become central to the teaching health center model. 

“Those who receive teaching health center grants are more likely to practice in rural areas, more likely to be in medically underserved settings and more likely to care for those who are underinsured,” Dr. Hawes said. 

A recently published national study of more than 56,000 dentists found that educational and training-related factors were significant predictors of whether dentists ultimately practiced in federally qualified health centers, dental shortage areas and rural underserved communities. 

Building programs from the ground up 

For many health centers, establishing a dental residency program is a complex undertaking. 

Whitney M. Young Health Center was part of the second cohort of health centers to receive THCPD funding. Dr. Rothas said the grant helped the organization prepare for accreditation and build the infrastructure needed to host residents. She and her team had been working since 2022 to get the residency program up and running, and received CODA accreditation in 2025.  

The grants can be used flexibly to meet each organization’s needs, whether through facility upgrades, faculty development, technology investments or recruitment efforts. 

“The [funding allowed us] to invest in whatever we needed to, whether that was updating and investing in newer technologies, whether that was doing some kind of faculty development,” Dr. Rothas said. “It was really kind of free as to how those funds were utilized, as long as it was with the intent of helping get the health center up to snuff for residents.” 

At Valleywise Health Medical Center in Phoenix, Arizona, leaders turned to the THCPD program after deciding to create their own residency following the end of a partnership with another institution. 

“We’re clinicians — we weren’t policy people, we weren’t people who built programs. We were people who treated patients,” said Chris Brendemuhl, D.D.S., chair of the department of dentistry at Valleywise Health Medical Center.  

Dr. Brendemuhl said the planning and development grant, along with technical assistance from HRSA’s collaborative network, provided critical guidance through accreditation and program development. 

“It would have been very difficult for a program even like ours, which is a big health care system, to start a program like this without the guidance of the technical assistance center,” he said. 

Today, Valleywise is operating its first year of an Advanced Education in General Dentistry residency program and preparing for its second cohort of residents. 

Recruitment challenges  

Community health centers face significant obstacles when it comes to recruitment. Unlike physicians, dentists are not universally required to complete residency training after dental school. Outside of states like New York, where residency training is required for licensure, many dental students enter practice immediately after graduation. 

That reality creates challenges for newer residency programs, especially those based in community health centers rather than well-known academic institutions. 

“The teaching health center dental residency program is so new that not many students understand it,” said Huong Le, D.D.S., chief dental officer at Asian Health Services in California. “A lot of students, when they think of residency programs, they think of academic institutions and dental schools.” 

While Asian Health Services offers four in-house dental specialties, Dr. Le said, many do not. This creates a drawback for candidates and an added challenge for community health centers, which are mostly general practice residencies.  

According to Dr. Brendemuhl, many dental students still receive stronger messaging around private practice and corporate dentistry than public health careers. 

“When I went to dental school, there were a lot of negative perceptions or bias against general dentistry residencies or even practice in public health and teaching health centers,” he said. “There was not a whole lot of, ‘This is a really great opportunity to provide high-quality care to a patient population that really needs it.’” 

Geography also presents obstacles. Many teaching health centers are not located near dental schools, making it harder for students to learn about community-based residency opportunities or complete rotations there. Dental schools often face logistical and financial barriers when arranging off-site rotations, including liability agreements, transportation and housing costs for students. 

“There’s a lot of red tape and contractual review that has to be completed just to establish these relationships,” Dr. Rothas said. “And then the school has to put money aside in their budget to pay for students to be in hotel rooms and reimburse their gas to travel, because they usually do three-week long rotations, so they have to live somewhere.” 

The THCPD and THCGME initiatives work to bypass some of those barriers by allowing health centers to directly establish residency programs rather than relying solely on partnerships with dental schools. 

The workforce pipeline 

Health center leaders said the programs are already demonstrating their value as workforce recruitment tools. Asian Health Services, which has hosted dental student externships for more than two decades, has seen many former trainees remain in community health center practice long term. 

“Some of the students that rotated with us and some of the residents that were with us are now our providers, and they have stayed with us for a long time,” Dr. Le said. “Some have stayed with us for 20 years.” 

She estimated that roughly 70% of students and residents who trained with the organization stayed connected to the health center in some capacity, highlighting a pattern in which those who are trained at community health centers often remain with them.   

In addition to clinical experience, health center residency programs expose trainees to integrated care models that combine dental, medical and behavioral health services. 

“These are really integrated care teams, and our dental residents are taught how to be a really significant part of those teams and how to work hand in hand with medical residents,” Dr. Brendemuhl said. 

Leaders also said the programs help residents build confidence in treating medically complex patients and navigating real-world practice settings, equipping them with a broader skillset and deeper comfort with more complex patient cases.  

Financial incentives can also play a role in recruitment. Residents working in community health centers may qualify for loan repayment opportunities through programs such as the National Health Service Corps and Public Service Loan Forgiveness. 

“When you start talking about those kinds of numbers, their jaws always drop,” Dr. Rothas said. “A lot of students had no idea that was an option.” 

Sustainability and continued support 

While many leaders involved in the programs are optimistic, they emphasized that long-term sustainability depends on continued federal investment. 

Launching and maintaining residency programs requires significant financial resources, faculty time and administrative support. Training residents can initially reduce productivity in busy clinical settings, and organizations may wait years before seeing workforce returns on their investments. 

“It takes years to see the [return on investment] of these programs,” Dr. Hawes said. “You’re not going to be as efficient and it’s not going to produce as much revenue as if you were constantly seeing patients.” 

Dr. Le said Asian Health Services has supplemented federal support with fundraising and additional grants to sustain its residency program. 

“We have a five-year plan where we don’t have to worry about funding it,” she said. “It takes a lot. It takes fundraising events, grants and continued support in order to sustain any program we start.” 

The THCGME program itself was recently extended by Congress after being set to expire in January, but advocates noted that additional startup and operational funding will still be necessary to expand the model. 

“For those that have never launched and want to launch [a new program], which is desperately needed because there are not enough rural and underserved dental residency programs, they need startup funding,” Dr. Hawes said. “If we’re going to create opportunities for residencies in these settings, there needs to be more opportunities for startup grants.” 

“When you get out into the community and you’re connecting with people, [that’s] what motivates me and gets me up in the morning and reminds me why I do what I do,” Dr. Rothas said. “By going through a residency at a teaching health center, we hope those are the types of philosophies that will be integrated into new grads.” 

THCGME and THCPD programs are vital to building a stronger workforce pipeline and improving access to care in communities of need. At a time of significant reorganization across the Department of Health and Human Services, preserving these programs is essential to sustaining the oral health infrastructure that helps communities thrive every day.  

As the ADA continues advocating for policies that strengthen the dental workforce and improve access to care, teaching health center leaders said the programs offer an important example of how federal appropriations can help communities build sustainable pipelines of future dentists. 

For more information on launching and sustaining dental residencies, including a detailed roadmap, visit thcgme.org.