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3.14.08 Issue #314 Forward This Newsletter To A Colleague

Scott McDonald
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The Other Shoe: Women in Dentistry

When women started entering the profession as dentists in greater numbers 30 years ago, everyone was thrilled at the benefits of diversity. Equal opportunities for women in the profession have always been considered a virtue. From an individual dental standpoint, this is undeniable and laudable. No one seems to be noticing, as the number of licensed female dentists reaches parity with licensed male dentists, that the way dentistry is practiced is changing.

From our work in helping evaluate locations for dental practices, we have noted some “truisms.” Please note that we have no means to prove these assumptions--this would cost far more time and money than our organization has to do so--but we can see that these truisms are going to have a profound effect:

  1. Female dentists tend to practice fewer years than their male counterparts.
  2. They spend less time in uninterrupted practice, often entering and exiting full-time practice three to six times in their careers.
  3. The retirement age of female dentists is significantly younger than male dentists (which appears to be increasing in many cases).
  4. Female dentists are most abundant in suburban locations near population centers with significant employment.
  5. These female dentists are almost non-existent in rural, low-population, or very urban settings.

Rather than prove these truisms with a table of statistics for every part of the United States, we have seen this pattern in nearly every county or parish that we analyze. 

  1. The primary care provider for children continues to be the mother, regardless of her income or education. Childbirth will always be an interruption of a career path for women who are both anatomical and social. Many demographic and lifestyle indicators point to a trend of professional women wanting to drop off and pick up their careers. They can be both a professional and a mother, but not simultaneously.
  2. Well-educated professionals (such as dentists) tend to marry other well-educated professionals both in and out of healthcare. These well-educated spouses tend to have their own careers that require them to live and work in locations with high employment.
  3. An unmarried female dentist is likely not to want to practice in a site where there are few social prospects (the same as their single-male counterparts) but a married female dentist usually considers where her spouse will work when considering a practice location or associate opportunity. This is much less the case with married male dentists.

If we take, for example, a community about 90 miles west of Richmond, the reality of this trend is visible. In this case, we note several female dentists who are licensed to practice but do not (roughly 5). The population is roughly 65,000 residents (28,678 households) with 52 general dentists. Because this is a city-center (serves many unincorporated rural communities surrounding it), the dentist-to-population ratio for Lynchburg is actually better than these numbers suggest. But, if we note that 10% of this number is dentists out of practice, the ratio drops from one dentist per 1,233 residents to one dentist per 1,383 residents.

The situation is exacerbated as we look at more rural communities. Another city in Virginia is only 17 miles further to the west with four general dentists. With a population of about 6,000 (2,813 households) the ratio of dentists-to-population is only one dentist per 1,500 population. But one of these practices is only open 3 days per week even though there are two female-dentists. Each works a maximum of 1.5 days per week.  Therefore, their practice is not really full-time and the doctors feel their schedule is sufficiently full that they do not seek new patients. More realistically, the ratio of dentists-to-population is one dentist per 2,000 population.

At first, this may appear to be very good news to a dentist coming out of dental school and considering his or her prospects for practice. The net effect is that there are fewer dentists per population. But the reality is a little more complex. Keep in mind that suburban locations have become more crowded as these neighborhoods become more desirable because they are near the home and schools of professionals in the area.

The result is a re-shuffling of dentists and dental need areas. In some locations, there will be an overabundance of dentists, many who do not want to practice continuously over their careers and are happy to associate rather than own. In other locations, there will be a decreasing number of dentists willing and able to serve the population. In this article, we will not discuss the implications of larger migrations of populations (and professionals) to warmer climates and rising economies in the South and West. Still, this continues to “enflame” the effect.

If we were living in a truly free-market society, this would not be a terrible concern.  Eventually, the market would induce dentists to open practices in more rural or very urban locations because there is a natural vacuum (and “nature abhors a vacuum”).  Unfortunately, we live in an age in which State and Federal governments want to “fix things.” The result is a publicly funded dental practice that will be opened in these settings. There may also be pressure upon dental schools, particularly those that are government funded, to produce more dental school graduates. They will assume that the natural response to a market condition like this is to produce more dentists to fill the vacuum. In reality, it may tend to lower dental school standards as a greater percentage of applicants are accepted and raise the pressure to practice in already over-crowded settings.

Scott McDonald is the largest provider of dental marketing research to dental practices.  For more information, demographics@mckenziemgmt.com

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