A Frequent Theme for Discussion

One recurrent theme for discussion (or in some cases a theme of dissatisfaction, whenever groups of dentists come together to discuss the state of the profession) is the matter of dentist manpower in California. Considered in more specific terms, an oversupply of dentists in this state is usually viewed as the condition that encourages the proliferation of managed care or other contract programs that are viewed as negatives in the contemporary practice of dentistry.

The source of the oversupply of manpower is perhaps the most interesting and complex part of the issue. There are a great number of variables that influence the decisions of dentists to locate their practice within this state, which range from the climate, to the ability to challenge the state board examination without a degree from an accredited dental school.

There is one factor that is intriguing to look at more closely because it is more frequently advanced by colleagues as the etiology of the oversupply here in California. It is advanced, not necessarily because of readily available date, but because of a perception, due at least in part to the high visibility of the five California schools of dentistry! It is easy to calculate the total number of graduates from the collective five each year, and conclude that if a portion of that total were not to settle in California each year, the oversupply of dentists would diminish and there would be no further cause for concern.

Too frequently we heard from some dentists in the wake of the announced plan to close Northwester, that such action was the only solution to the manpower oversupply problem. The solution in California seems even more logical to some critics because five schools combine to make a very large target! Some of the other factors that contribute to the problem such as distribution patterns of practicing dentists, are more elusive to cope with in a society that encourages freedom of movement and decision.

Attendance at a recent ADA Conference on the New Dentist provided an opportunity to personally review some recent data and opinions of those within the profession, that may provide a different perspective on the problem. While this information may not be helpful to modifying the present manpower status in California, it provides useful insight into the complexities of the issue and its solution.

As defined by the American Dental Association, a "new dentist" is a dentist who is "less than ten years out of school." While a new dentist is not synonymous with a new graduate (although the latter is part of that category), it is a useful categorization in our view, because those who generally condemn new or recent grad practitioners ad the cause of an oversupply, usually include the entire mass of more recent graduates other than their own personal era of graduation as the focus of their concern. ADA end-of-year data for 1997 shows the total of all dentists in the United States to be 164,940, with 36,786, or 22.3% of that total categorized as "new dentists". Taking these figures as a starting point, one would expect that if the newer dentists were the major factor contributing to oversupply in California, the California new dentists total would exceed this national average. However, this is not the case. The total number of dentists in California was 20,676, with new dentists totaling 4,372, a 21.1% average. While this data shows that almost 1/8 of the dentists in the country are in California, and there are higher percentages of new dentists here than in many states, the location of new graduates in the state over the past 10 years does not appear to be the critical factor. Clearly, there is a migration of dentists from other states and other countries more than 10 years out of school that enlarges the dental manpower pool, although these sources are not nearly as easy to identify or account for as the "new" graduates.

Given that the national average of new dentists is 22.3%, what is the manpower situation outside of California? At the previously referenced ADA Conference, a noted, nationally-based practice management consultant made the statement that there is a shortage of dentists (nationally). In a private conversation, two young dentists practicing together, stated that they had started a practice from scratch in a large eastern state less than three years ago and had built a fee for service patient base of over 3,000 in that period of time. Another dentist reported that many dentists in his area were unable to find candidates available for associateships they were offering. While the purpose of this conference was not to discuss manpower issues, we received the impression that nationally, new dentists were generally satisfied with the state of the profession as it pertained to opportunities to initiate their careers.

Clearly, the situation and the attitudes are different here in California, for both the new dentist and the long-term practitioner. But the information does offer hope that some of the national trends toward undersupply might at some point influence the environment here. As dentists old and new move toward areas of greater need, the often reference "Law of Supply and Demand" should eventually help to balance the dentist:patient ratios in this state. In the meantime, this very complex problem will continue to merit discussion whenever groups of dentists or dental leadership come together.