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The Future of Dentistry
Part 1 - Historical Data & Projections
By Eric S. Solomon, DDS, MA
Dentistry is going through a transition. As we shall see,
the range of dental services and the mix of dental practice
employees have changed dramatically during the past half century.
We also are experiencing a major shift in the number of dental
care providers. What will the dental practice of the future
look like? Here we will look at historical data and projections
in the hopes that they will provide us with insights into
the dental practice of the future. Our glimpse into the future
has four parts: dental enrollment trends, dental manpower
trends, dental economic trends, and dental practice trends.
From these data, we can draw inferences about the dental practice
of the future.
Dental enrollment is a great place to start our investigation.
Educational programs represent the entry into the profession
for most of the dental health care team. In addition, dental
program graduates are the principal input variable for dental
manpower models. First-year enrollment in dental schools represents
the first step in the future dentist's career. Since 1950,
first-year dental school enrollments have gone through four
distinctly different periods (Figure 1). Between 1950 and
1965, first-year enrollment increased slowly from 3,226 to
3,808 (18 percent); that's an increase of about 1.2 percent
a year. During this period of time, new dental schools were
established. The number of dental schools increased from 42
to 49 (16.7 percent) in 1965 due, in part, to an influx of
federal support. The baby boomer generation attended dental
school between 1965 and 1978. This period is marked by rapid
growth in first-year enrollment, increasing from 3,808 to
6,301 (65.6 percent) - an average annual increase of 5 percent.
New dental schools continued to open, reaching a total of
60 in 1978. During the next period between 1978 and 1989,
the rapid rise in enrollment in the previous decade was matched
with an equally dramatic decline. By 1989, first-year enrollment
had fallen to 3,979 - a decrease of 2,322 students (36.9 percent).
A precipitous drop in the number of applicants to dental schools
and the withdrawal of federal support for enrollment expansion
fueled the decline. By 1989, five dental schools had closed
or were in the process of closing. First-year enrollment has
increased slowly since 1989, rising to 4,618 in 2003 (639
students). That's an average annual increase of 1.1 percent
per year. In comparison, the increase in the U.S. population
during this period was just more than 1.2 percent per year.
During this time, one additional dental school closed and
three new schools opened.
As one might expect, the pattern of dental school graduates
follows that of first-year enrollment (Figure 2) - more than
90 percent of entering dental students complete the program.
Two periods here are noteworthy. During the 10-year period
from 1975 through 1984, the number of dental school graduates
exceeded 5,000 per year, peaking at 5,756 in 1982. In contrast,
between 1990 and 1996, there were fewer than 4,000 graduates
per year. In 2003, there were 4,443 U.S. dental school graduates
- about the same level of graduates experienced during the
early 1970s.
Figure 3 shows dental school graduates and dental hygiene
graduates projected to the year 2020. The number of dental
school graduates is expected to remain fairly constant during
the next 18 years. There are several reasons for this estimate.
It is unlikely that new dental schools will open in the near
future. The three schools that recently opened are located
in high population growth areas, and two of them are in states
that did not previously have a dental school. In addition,
existing dental schools are unlikely to increase their enrollments.
Today, dental schools are in a restricted fiscal condition
because of cutbacks in state funding and the need to control
tuition increases. Enrollment expansion is a costly proposition
because it generally involves the renovation or replacement
of existing facilities. In addition, many schools are focused
on a more pressing problem - maintaining a quality faculty.
As long as the primary site for providing clinical education
is in the dental school, the number of graduates is unlikely
to increase significantly for the foreseeable future.
The trend in dental hygiene graduates mirrors the dental
graduates until 1990. At that point, the number of dental
school graduates stabilizes and hygiene graduates increase
significantly. Between 1990 and 2002, hygiene graduates increase
from 3,953 to 5,693 - an increase of just more than 44 percent.
This trend should continue for at least the next decade. The
demand for dental hygiene services remains high. In addition,
the cost of educating a dental hygienist has decreased because
of a change in the educational setting for the training of
dental hygienists. In 1967, almost 40 percent of dental hygiene
programs were located in dental schools. In 2002, less than
10 percent of the dental hygiene programs were located in
dental schools, and almost 74 percent of the programs were
located in two-year institutions such as community colleges
and technical schools. By 2020, 44 percent more hygienists
than dentists could graduate.
In Figure 4, we compare the projected number of graduates
to the projected number of dental retirees. Until about 2007,
the number of dental graduates exceeds the number of dentists
who retire. Around the year 2007, the number of dental retirees
probably will exceed the number of dental graduates as many
of the baby boomer dentists begin retirement. The graph clearly
shows how the enrollment bulge of the 1970s and early 1980s
is mirrored in the retirement bulge that will take place during
the next 15 to 20 years. Economic conditions will impact the
accuracy of the projected number of retirees. Favorable economic
conditions could result in a higher number of retirees at
an earlier time. Still, poor economic conditions could significantly
reduce the retirement rate of dentists during the next decade.
Dental retirements vs. graduates will impact dental manpower
projections. When the number of retirees exceeds the number
of dental school gradates, it will impact the future of dental
manpower in the United States. The next article in this series
will explore manpower projections and look at the manpower
implications of changes in different segments of the dental
population.
Dental Economics November, 2004
Author: Eric Solomon |
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