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The Future of Dentistry
Part 2 - Manpower and Economic Trends
By Eric S. Solomon, DDS, MA
The first article in this series explored trends in dental
education. We identified the major shifts in dental school
enrollments that were influenced by both demographic and economic
factors. Some of the important findings included the recent
surge in dental hygiene graduates and the relatively stable
level of dental school graduates. Also of great interest is
the prospect of having more dentists retiring than there are
dentists graduating. In this article we will demonstrate the
impact of these enrollment trends on dental manpower levels.
Since 1900, the number of U.S. dentists generally has increased
(Fig. 1). The one exception was during the Great Depression
of the 1920s when the total number of dentists actually fell.
Currently, however, the number of active U.S. dentists has
almost peaked. As the anticipated number of dentists retiring
rises above the number of dental school graduates, the total
number of dentists in the United States will begin a slow
decline. This should occur sometime toward the end of this
decade. Economic conditions will have an impact when this
occurs. Favorable economic conditions will encourage retirements,
and poor economic conditions will discourage them. Irrespective
of economic factors, dentistry will become the only major
health profession with decreasing numbers sometime within
the next decade. Because of relatively stable numbers of dental
school graduates, the total number of active dentists in the
United States should continue to decrease slowly until at
least 2020.
Figure 1 also shows the total number of dentists by gender.
Prior to the 1980s, female dentists were not a large segment
of the dental workforce; fewer than 3 percent of all dentists
in 1980 were female. There has been a rapid increase in female
participation; women currently represent an estimated 19 percent
of the dental workforce. Dental enrollment trends indicate
that female participation should increase to some 30 percent
of the dental workforce in 2020. As females become a larger
segment of the dental workforce, the number of male dentists
necessarily declines. These data indicate that the number
of male dentists probably began to decline around the year
2000.
Not all dentists work full time. Figure 2 shows the number
of dentists by work status (full-time vs. part-time). Full-time
dentists are defined as working at least 30 hours per week.
Historical data indicate that most dentists worked full time
during the first half of the 20th century. In 1975, fewer
than 10 percent of active dentists worked part time. The number
of dentists working part time has increased during the past
quarter century. Currently, an estimated 20 percent of all
active dentists work part time. If current trends persist,
one of four dentists (25 percent) could be working part time
by 2020. This could significantly impact the effective manpower
supply.
Recent data suggest a relationship between gender and work
status. In 1999, female dentists younger than 40 years old
were at least five times more likely to work part time than
their male counterparts (5.6 percent vs. 31.3 percent). Female
dentists between the ages of 40 and 59 were more than three
times more likely to work part time (8.7 percent vs. 28.6
percent). Most dentists who are 60 or older are male, and
about half work part time (46.2 percent). As the number of
female dentists increases, their impact on the dental workforce
will be significant if gender differences in work status persist.
Another relatively recent phenomenon is the growth in the
proportion of dentists who are dental specialists (Fig. 3).
Most of this growth has occurred during the past 30 years.
In 1970, fewer than 10 percent of all active dentists were
specialists. Currently, about 22 percent of dentists are specialists.
This percentage should increase slowly to about 27 percent
by 2020. The number of both dental school graduates and specialty
graduates has stabilized; therefore, it is unlikely that the
proportion of dentists who are specialists will increase beyond
the year 2020. A higher proportion of specialists means there
are fewer general dentists.
In fact, the number of general dentists in the United States
probably started declining sometime around the turn of the
20th century. The declining number of general dentists likely
will continue throughout the projection period. There are
potential consequences of this trend, particularly in the
supply of dentists in non-urban areas. The overwhelming majority
of specialists work in urban areas. As the number of general
dentists decreases, it could have a negative impact on the
supply of dentists in rural areas.
Thus far, we have examined trends in the number of dentists,
but what about the number of dentists in relation to the population?
The distribution of dentists in relation to the population
(dentists per 100,000 people) is dramatically different than
the distribution of dentists (Fig. 4).
The dentist-to-population ratio peaked twice during the 20th
century; once prior to the Great Depression and again in the
late 1980s. Since the late 1980s, the dentist-to-population
ratio has been falling. The rate of decline thus far has been
relatively slow. However, once the actual number of dentists
begins to decline, this rate will increase. By 2020, the dentist-to-population
ratio could be comparable to the ratio experienced during
World War I. Significant changes in dental manpower are underway.
These changes will impact dental economic trends and the practice
of dentistry. In the next article in this series, we will
explore dental economic trends and see how the changes in
dental manpower might influence future economics.
Dental Economics November, 2004
Author: Eric Solomon |
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