When James Mancini closed his private practice in Allegheny County to work in rural Pennsylvania, he saw it as a chance to serve patients who often waited months and made long drives to see a dentist.
That was two decades ago. Now, after 40 years on the job, he’s thinking about retirement.
But the 66-year-old faces a familiar problem: finding a replacement.
Mancini currently works in rural Crawford County as Meadville Medical Center’s director of dental services. Recruitment isn’t as simple as visiting the University of Pittsburgh, one of Pennsylvania’s three dental schools, and pitching the job to graduating students, Mancini said.
“All of them look at me because they don’t know where Meadville is,” he told Spotlight PA.
The challenge reflects a broader trend across rural communities: A shrinking and aging workforce has made it harder to access oral healthcare. As older dentists in these areas make plans to retire, younger professionals aren’t relocating to replace them — saddling patients with long waits and lengthy trips to get treatment. Some forgo care altogether.
Mancini and two other providers treat around 16,000 people annually at Meadville’s two dental centers, which offer exams, cleaning, surgery, X-rays, and more.
In March, 485 patients were treated at Valley Dental Center, the smaller of the two, and 1,085 people went to Meadville Dental Center.
While most patients are local, some travel from neighboring Erie, Mercer, and Venango Counties, and even as far as Clarion and McKean Counties, each more than an hourlong drive.
Mancini understands a far commute. He lives in Allegheny County and makes the 92-mile drive to Crawford County three days a week. When the centers are short-staffed, he hits the road even more.
“This is very rewarding to me,” Mancini said. “This is what I went to dental school for — to help people — and that’s what I’m doing.”
But finding people to work in rural areas isn’t easy. A 2023 legislative study found that just 6% of Pennsylvania dental school graduates in 2019 had plans to work in such a place. Meanwhile, the study reported that 55% of the state’s rural dentists were nearing retirement age. State officials and educators are now trying to address that shortage by building a pipeline of providers who already have ties to rural communities.
A new initiative from the University of Pittsburgh hopes to close that gap by training future dental workers in rural areas. Through a network of regional training centers, Pitt’s School of Dental Medicine will offer degree or certificate programs in general practice residency, dental assisting, and dental hygiene, with online coursework and in-person training at local clinics.
The centers — currently planned for Cambria, Crawford, and McKean Counties — aim to let students train in the field and stay close to home. Providers and policymakers hope to attract people from rural areas who want to stick around and provide oral care.
Pitt plans to open its Crawford and McKean locations this summer.
Each training center will have three general practice residents, 10 hygiene students, and up to eight dental assistants.
Jared Stonesifer, a Pitt spokesperson, told Spotlight PA in an email that the school estimates each training center will treat 4,000 patients in the first year with one class of hygiene students. That number is expected to jump to at least 5,000 in the second year, he added.
“There is great interest and excitement regarding these programs, which give students from rural areas the opportunity to embark on a career in healthcare without having to leave their home communities,” he wrote.
The state Department of Human Services cited the regional training centers as a way to address service gaps in the field in its application for federal Rural Health Transformation Program dollars.
Additionally, officials pointed to Temple University’s rural dental education center and clinic, which will open in rural Schuylkill County this fall. The facility will have capacity for 10 third- and fourth-year dental students during their last two years of training, providing care to those in need.
“If this concept is as successful as I believe it will be, I think it’s going to present a model not just for the rest of Pennsylvania but for the nation,” state Sen. David Argall (R., Schuylkill), who has hosted several policy hearings on expanding education and removing barriers to care, told Spotlight PA.