For Immediate Release
Date: Jun 13th, 2013
Contact: Dr. John Thompson
Something I Wish I Didn't Know!
I learned a long time ago that when you put your head in the sand you can lose your a__ . Well, I was invited to attend a leadership mini-retreat at UK’s College of Dentistry on May 6th. The overall theme was “Options to Improve Oral Health and Dental Workforce in Kentucky’s ARC Region and other Underserved Areas of Kentucky”. There are 12 states that have counties considered to be in Appalachia and of those states; Kentucky has the most economically depressed counties. Many of these eastern counties are projected to lose at least 30% of their population by 2050. This region is our ARC and these facts provide a ground level view of factors that must be considered as the discussions unfolded.
Dr. L. Jackson Brown is a dental economist who has been on staff with the ADA and has been the editor of the Journal of Dental Education. As a PhD. economist with access to the ADA’s surveys of dental practice data, gathered over the past sixty years, he has a unique capacity to interpret macro-economic data. It is his view from 50,000 feet that piqued my attention. I have to admit, Dr. Jack Brown has provided statistical analysis that has challenged my somewhat overly optimistic perspectives.
I did not know that dentistry was not now a growth industry. Dental expenditures are now 0.7% of the entire GDP which represents a real decline that has not been seen in 40 years. Overall the aggregate growth in dental expenditures has been 1.21% since 2000. Physician expenditures have been 3.05% and in general healthcare 3.48%. Dental expenditures have trailed the overall GDP since the 1990’s. Overall, the demand for dental services has declined since 1990. We can only hope that the demands for dental services will trend upward again if this economy ever becomes robust.
Some of the factors cited in the statistical analysis include the fact the profession of dentistry has successfully reduced the incidence of dental disease, specifically caries. The results of fluoridation are now seen in the 55 year old population. We have all witnessed the flattening of demand for dental services. There is an ongoing expansion in dental education. While the graduation numbers from our traditional research universities has remained stable, the new private and proprietary dental schools will expand the dentist workforce from the present 170,000 to 250,000 in 30 years. As if this was not bad enough, there is a decline in the qualified dental applicant pool that is reversing a long standing upward trend.
Each of these four statistical factors has a story of its own. Our success in dental prevention has resulted in a shift in services required. A general dentist in 1955, typically, provided, by procedures, 41% in restorative services and 21% in diagnostic services, but in 2005 only 12% of services are restorative and 56% are diagnostic. As dentists we have also improved our ability to efficiently deliver services since 1955. Our productivity has increased at the rate of 1% per year. We have done this through improved technology and an expansion of the dental workforce. While there are now 170,000 dentists, when our hygienists, dental assistants and other auxiliaries are included that number is about 1,000,000.
Dentists are not retiring their dental licenses as in the past. More are staying in a slowed or part-time practice much longer than in previous decades. This trend, when combined with increased graduation rates from our dental schools and improved productivity, has produced an increase in supply at the same time there is a contraction in demand. If there is a dental pie, the pieces are becoming smaller.
When we look at what is happening in the dental school applicant pool there is another factor of concern. Nationally, the applicant pool for in state admission to state “supported” dental colleges has remained relatively flat, but there are more applications being made from the out of state pool. The result will be a nationalization of dental education and where will they choose to practice? All indications are that the corporatization of dental practice will continue a trend that places out of state dentists in locations of opportunity. This does not generally include underserved or socioeconomically depressed communities.
Corporate dentistry is sustaining a 14% growth rate through all of the economic doldrums. As long as graduating dentists continue to carry excessive educational debt, there will be a steady workforce supply for positions that can guarantee an immediate income for new practitioners. All indications are that they will follow the money to locations of opportunity. There is an additional demographic as well as a generational cultural shift affecting the choice of practice models. Currently 30% of dentists are women and they are the younger demographic of the existing workforce. Dental school classes are now 50% women. Statistically women will have a spouse who is also a professional. They will have less need for business risk and a higher value and more need for “family life”. The same can be said, anecdotally, of today’s male graduates. There are fewer graduates that, today, wish to become sole proprietor dental practitioners. It is now estimated that 58,000 of today’s dental practices will morph into corporate practices.
I was waiting to hear the good news, but the bad news was there wasn’t any. Needless to say when we discussed the microeconomic issues that affect our eastern and far western counties there was a magnification of the above issues combined with a decline in employment, poor overall health literacy and a dismal general economic forecast. The only good news is that I am going to stop here with this diatribe and try to provide a spin to this information.
No one reading this with a doctorate in dental medicine lacks intelligence. What Dr. Brown has provided is information and I am a messenger. Information is power and the lack of information is ignorance. How this information will be processed and then how this information will be used will determine the future of the dental profession. It is obvious that dentistry is changing and we now retain the ability to redirect that change. Dentists are not going to become tradesmen unless we choose to allow the winds of change to provide our course and we don’t hold the rudder. The profession is going to end up in a different port of call and a return to the port of yesterday is not going to happen. The American Dental Association as the true representative of all who practice dentistry is going to have to have a new look and be a strong navigator. There is no way that all dentists are going to agree to the direction the profession takes or the course that is required in the process. I have been a part of a proud profession and I have complete faith that we will choose to be the captain of our fate as we make way through a perfect storm.