Does competition affect the clinical decision-making of dentists? A geospatial analysis.

Objectives To investigate the association between dentists' geographic density and perceptions of market competition with clinical decision-making among a representative sample of dentists in Ontario, Canada's most populated province. Methods Competition was quantified using dentist density, defined as the number of dental clinics lying within a one kilometre radius around the respondents' clinic address and by self-reported perceived pressure from other dental clinics. The outcome (clinical decision-making or treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regression. Results Dentists who perceived large competitive pressure from other dentists (OR = 1.63, 95% CI: 1.07-2.49) were relatively more aggressive in their treatment choices. Interestingly, dentists located in very low dentist density areas (OR = 1.31, 95% CI: 1.03-1.68) were also relatively more aggressive in their treatment choices. Conclusion This study is the first to explore the impact of competition on the clinical decision-making of dentists in a Canadian context. It presents a valuable addition to the competition literature and helps to understand current dynamics in the Canadian dental care market.