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Attitudes of Dental Students and Faculty toward Advertising
Attitudes of dental students and faculty toward advertising Irwin A. Shapiro, PhD Robert F. Majewski, DDS
T T h e US Supreme Court in 1977 struck down most restrictions on ad vertising by attorneys and, thereby, opened the door for the removal of similar prohibitions in other profes sions.1 The American Dental Associa tion consented, in a 1979 agreement with the Federal Trade Commission, to eliminate its ethical restrictions on ad vertising by dentists.2 Surveys of the attitudes of profes sionals who were affected by the new perm issibility of advertising were conducted close to the time of the Su preme Court decision. Shim p and Dyer3 queried lawyers in two states. Darling and Bussom4 surveyed den tists, physicians, accountants, and at torneys. Meskin5 asked alumni of the School of Dentistry at the University of Minnesota about their attitudes. Each of these studies produced strong nega tive feelings by professionals toward advertising by their colleagues. Mes kin suggested that a follow-up survey “might demonstrate a significant shift in opinion as dental practitioners ex perience the direct effect of free market advertising.”5 The present survey sought attitudes of a sample of senior dental students and the faculty of the department of re storative dentistry at Tufts University in July 1981. Its purposes were to as certain the feelings toward dentists’ advertising that are held by profes sionals about to embark on their careers and compare them with those of their teachers, many of whom main tain private or faculty practices. Additionally, the research would determine if the advent of several years of promotional advertising by indi 468 ■ I ADA, Vol. 105, September 1982
vidual dentists and dental clinics has changed attitudes compared with the surveys conducted about five years earlier.
Methods Four distinct, yet typical, patientseeking advertisements representing different levels of persuasion, with and without fee listings, were devised from a synthesis of current advertise ments of dental services. The adver tisement in Figure 1 is a simple infor mational announcement. Figure 2 il lustrates persuasive language that might be developed by an advertising agency. Figure 3 lists a dentist’s fees, and Figure 4 combines leader pricing w ith persuasive language. A d d i
tionally, a series of attitude statements concerning the effects of dentists’ ad vertising was presented. Five-point Likert scales, ranging from “strongly approve” to “strongly disapprove” for the sample advertise m ents an d “ stro n g ly agree” to “strongly disagree” for the attitude statements, were used to measure di rection and strength of attitudes. A sample of 100 dental students in their senior year at Tufts (73% re sponded) and all 56 fulltim e and parttime faculty members of the de partment of restorative dentistry (41% responded) was surveyed. The two survey groups received questionnaires that were identical except for the final attitude question and some classifica-
Fig 1 ■ Announcement.
JOHN A. DOE, D.D.S. announces the availability of EVENING AND SATURDAY APPOINTMENTS in addition to regular appointments for FAMILY DENTAL CARE 123 Main Street Tel. 555-1212 Anytown, Mass. for appointment
Fig 2 ■ Persuasion.
ARE YOU AFRAID TO SMILE? Are you embarrassed to show your teeth? Let me help rebuild an important part of your image . .. “YOUR SMILE” JOHN A. DOE, D.D.S. 123 Main Street Anytown, Mass. Tel. 555-1212 now . . . for your future!
B R IE F
REPORTS
Table 1 ■ Approval of advertisements.
tion data. Anonymity of respondents was assured with a mail ballot re sponse.
Results
Response to advertisem ents Table 1 summarizes the attitudes of student and faculty respondents to ward the four advertisements. Figure 1, which was intended to be similar to professional announcements permit ted before the removal of ethical re strictions, was the only message that received a majority of responses in the “ approved” categories. Of the stu dents, 86% reacted positively to this advertisement, as did 78% of the fac ulty. The promotional slant in Figure 2 was disapproved in some degree by 63% of the students and 69% of the faculty. A listing of fees in Figure 3 was disapproved by 74% and 83%, re spectively. The highest disapproval rates, 94% and 100%, belong to the ad vertisement in Figure 4. Although the respondents had different attitudes toward the four advertisements, chisquare analyses did not indicate sig nificant differences between students and faculty in their responses.
Strongly Disapprove disapprove
Strongly approve
Approve
Neutral
no. (%)
no. (%)
no. (%)
no. (%)
no. (%)
22 (30) 11 (48)
6 (8 ) 3 (13)
3 (4 ) 2 (9 )
1 (1) 0
7 (10) 5 (22)
16 (22) 2 (9)
24 (33) 4 (17)
22 (30) 12 (52)
8 (11) 2 (9)
6 (8 ) 1 (4)
19 (26) 5 (22)
35 (48) 14 (61)
0 0
2 (3) 0
11 (15) 6 (26)
58 (79) 17 (74)
Announcement (Fig 1) Students* 41 (56) Facultyt 7 (30) (X2 = 5.24, P < .30)
Persuasion (Fig 2) Students 4 (5) Faculty 0 (X2 = 8.85, P < .10)
Fee listing (Fig 3) Students Faculty
5 (7) 1 (4) (X2 = 1.33, P < .90)
Price promotion (Fig 4) Students Faculty
2 (3) 0
(X2 = 2.54, P
<
*Total n u m b er o f students
.70)
= 73. t
Total n u m b e r of faculty
A ttitudes toward dentists’ advertising Table 2 summarizes the degree of agreement or disagreement with a series of statements concerning adver
Fig 3 ■ Fee listing.
JOHN A. DOE, D.D.S. FAMILY DENTIST Examination $5 Cleaning and X rays $20 Extractions $20 Fillings $10 per surface Other fees explained upon request 123 Main Street Anytown, Mass. Tel. 555-1212 for appointment
Fig 4 ■ Price promotion.
CUSTOM FITTED DENTURES--- $99 and up! A ll other dental services at INFLATION FIGHTING FEES! Credit cards and time payments Call now! JOHN A. DOE, D.D.S.--- 555-1212 123 Main Street Anytown, Mass. 10% DISCOUNT WITH THIS AD!
= 23.
tising by dentists. A substantial pro portion of those surveyed think that advertising will increase the public’s demand for dental services (question 1), yet were divided on whether the cost of advertising would be passed on to patients (question 3). (The other al ternative is that advertising costs would be absorbed by the dentist, though added patient income from successful advertising might more than offset the cost of the advertising.) Three questions dealt with the abil ity of advertising to engender or com municate quality. Question 2, “Adver tising by dentists w ill increase the quality of dental treatment,” was re jected overwhelmingly, as were both question 4, “Advertising by dentists w ill improve the image (prestige] of the profession,” and question 5, “Ad vertising by dentists w ill permit pa tients to make intelligent choices.” W ill new dentists use advertising to develop their practices? One-fifth of the dental student respondents be lieved that advertising would be bene ficial to them personally (question 6), and 28% indicated they plan to adver tise (question 7a). More than one-third of the students were neutral or unde cided on both of these questions. Thus, a majority are not dismissing the pos sibility that they may advertise, al though no indication of the type or ex-
Shapiro-Majewski : ATTITUDES TOWARD ADVERTISING ■ 469
B R IE F
REPORTS
Table 2 ■ Agreement with attitude statements.
Strongly agree
Agree
Neutral
no. (%)
no. (%)
no. (%)
no. (%)
no. (%)
19 (26) 2(9)
3(4) 6(26)
35 (48) 10 (43)
23 (32) 12 (53)
25 (35) 6 (26)
9 (12) 2(9)
26 (37) 6 (26)
30 (42) 16 (70)
12 (17) 2 (9)
24 (34) 6 (27)
28 (37) 13 (59)
26 (36) 5 (22)
17 (24) 7 (30)
14 (19) 9 (39)
1. Advertising by dentists will increase the public’s demand for dental services. Students* 4 (5) Facultyt 2 (9) (X2 = 12.16, P < .02)
33 (45) 8 (35)
14 (19) 5 (22)
2. Advertising by dentists will increase the quality of dental treatment. Students 0 Faculty 0 ( X 2 = 5.15, P < .30)
7 (19) 0
8 (11) 1 (4)
3. Advertising by dentists will increase the cost of dental care to patients. Students 2 (3) Faculty 0 (X2 = 3.47, P < .50)
13 (18) 8 (35)
23 (32) 7 (30)
4. Advertising by dentists will improve the image (prestige) of the profession. Students 0 Faculty 0 (X2 = 6.15, P < .20)
3 (4) 0
12 (17) 1 (4)
5. Advertising by dentists will permit patients to make intelligent choices. Students 0 Faculty 0 (X2 = 3.45, P < .50)
9 (13) 1 (5)
6. Advertising by dentists will be beneficial to me personally. Students 0 Faculty 0 (X2 = 5.65, P < .30)
15 (21) 2 (9)
7a. I plan to advertise my dental services if I enter private practice. Students
2 (3)
18 (25)
Strongly Disagree disagree
28 (38)
8 (11)
17 (23)
7b. I am considering advertising my professional services within the next year. Faculty
0
* Total nu m b e r of students = 73.
0 t
4 (17)
4 (17)
15 (65)
uration of the profession in many communities, there is a substantial un tapped supply of potential patients who do not adequately use dental ser vices. Therefore, if advertising suc ceeds in increasing the total patient pool, it will be of value to society. However, if dental advertising re sorts to misleading and deceptive messages, it certainly w ill be deleteri ous to the status of the profession. A d ve rtisin g by in d iv id u a l and group dental practices has become a growing reality in the few years since the striking of ethical prohibitions. This research concludes that advertis ing messages that go beyond tradi tional announcements of availability of services are overwhelmingly disap proved by the groups surveyed. Many respondents volunteered comments that advertising by individual dentists and dental clinics is demeaning to their professional status and thought that advertising campaigns should be undertaken only by organized den tistry on behalf of all dentists. But den tal services are not a homogeneous commodity, and professionals who avail themselves of the opportunity to advertise may take a share of the mar ket from those who do not. Thus, al though advertising by dentists re mains distasteful for the majority, its increasing appearance may force more dentists, especially those just develop ing their practices, to use advertising campaigns defensively to compete for patients.
Dr. Shapiro is associate professor of manage ment, College of Management Science, Univer sity of Lowell, Lowell, Mass 01854. Dr. Majewski was clinical instructor, department of restorative dentistry, School of Dental Medicine, Tufts U ni versity, Boston; he is now postdoctoral fellow, State University of New York at Buffalo, School of Dentistry. Address requests for reprints to Dr. Shapiro.
Total n u m b er o f faculty = 23.
tent of advertising was elicited. None of the faculty respondents indicated intentions to advertise (question 7b). Chi-square analyses of questions 2 through 6 did not indicate a significant difference between student and fac ulty responses to those individual questions. (The authors have no reason to believe that nonresponse bias affects the internal validity of their data. They do not purport their results to be exter nally valid to other dental students, 470 a JADA, Vol. 105, September 1982
dental faculties, or the profession at large.)
Conclusions The increase in the per capita supply of dentists in the U nited States, coupled with improved technology and dental hygiene, has resulted in un filled appointment books for many dentists.6 In spite of the apparent sat
1. Bates and O ’Steen vs State Bar of Arizona, 433 US 350, 1977. 2. ADA agrees to lift restrictions on advertising by dentists. A d Age 50(19):95, 1979. 3. Shimp, T., and Dyer, R. How the legal pro fession views legal service advertising. J Market ing 42(3):74-81, 1978. 4. Darling, J.R., and Bussom, R.S. A compara tive analysis of the attitudes of dentists toward the advertising of their fees and services. J Dent Ed 41(2):59-67, 1977. 5. Meskin, L.H. Advertising of dental services: a consumer and dentist attitude survey. J A m Coll Dent 45(4):247-53, 1978. 6. Lenido, D. Molar mystery: dentists ponder case of the missing patients as appointments lag. Wall Street Journal 196(72):1 ff, 1980.
T T h e US Supreme Court in 1977 struck down most restrictions on ad vertising by attorneys and, thereby, opened the door for the removal of similar prohibitions in other profes sions.1 The American Dental Associa tion consented, in a 1979 agreement with the Federal Trade Commission, to eliminate its ethical restrictions on ad vertising by dentists.2 Surveys of the attitudes of profes sionals who were affected by the new perm issibility of advertising were conducted close to the time of the Su preme Court decision. Shim p and Dyer3 queried lawyers in two states. Darling and Bussom4 surveyed den tists, physicians, accountants, and at torneys. Meskin5 asked alumni of the School of Dentistry at the University of Minnesota about their attitudes. Each of these studies produced strong nega tive feelings by professionals toward advertising by their colleagues. Mes kin suggested that a follow-up survey “might demonstrate a significant shift in opinion as dental practitioners ex perience the direct effect of free market advertising.”5 The present survey sought attitudes of a sample of senior dental students and the faculty of the department of re storative dentistry at Tufts University in July 1981. Its purposes were to as certain the feelings toward dentists’ advertising that are held by profes sionals about to embark on their careers and compare them with those of their teachers, many of whom main tain private or faculty practices. Additionally, the research would determine if the advent of several years of promotional advertising by indi 468 ■ I ADA, Vol. 105, September 1982
vidual dentists and dental clinics has changed attitudes compared with the surveys conducted about five years earlier.
Methods Four distinct, yet typical, patientseeking advertisements representing different levels of persuasion, with and without fee listings, were devised from a synthesis of current advertise ments of dental services. The adver tisement in Figure 1 is a simple infor mational announcement. Figure 2 il lustrates persuasive language that might be developed by an advertising agency. Figure 3 lists a dentist’s fees, and Figure 4 combines leader pricing w ith persuasive language. A d d i
tionally, a series of attitude statements concerning the effects of dentists’ ad vertising was presented. Five-point Likert scales, ranging from “strongly approve” to “strongly disapprove” for the sample advertise m ents an d “ stro n g ly agree” to “strongly disagree” for the attitude statements, were used to measure di rection and strength of attitudes. A sample of 100 dental students in their senior year at Tufts (73% re sponded) and all 56 fulltim e and parttime faculty members of the de partment of restorative dentistry (41% responded) was surveyed. The two survey groups received questionnaires that were identical except for the final attitude question and some classifica-
Fig 1 ■ Announcement.
JOHN A. DOE, D.D.S. announces the availability of EVENING AND SATURDAY APPOINTMENTS in addition to regular appointments for FAMILY DENTAL CARE 123 Main Street Tel. 555-1212 Anytown, Mass. for appointment
Fig 2 ■ Persuasion.
ARE YOU AFRAID TO SMILE? Are you embarrassed to show your teeth? Let me help rebuild an important part of your image . .. “YOUR SMILE” JOHN A. DOE, D.D.S. 123 Main Street Anytown, Mass. Tel. 555-1212 now . . . for your future!
B R IE F
REPORTS
Table 1 ■ Approval of advertisements.
tion data. Anonymity of respondents was assured with a mail ballot re sponse.
Results
Response to advertisem ents Table 1 summarizes the attitudes of student and faculty respondents to ward the four advertisements. Figure 1, which was intended to be similar to professional announcements permit ted before the removal of ethical re strictions, was the only message that received a majority of responses in the “ approved” categories. Of the stu dents, 86% reacted positively to this advertisement, as did 78% of the fac ulty. The promotional slant in Figure 2 was disapproved in some degree by 63% of the students and 69% of the faculty. A listing of fees in Figure 3 was disapproved by 74% and 83%, re spectively. The highest disapproval rates, 94% and 100%, belong to the ad vertisement in Figure 4. Although the respondents had different attitudes toward the four advertisements, chisquare analyses did not indicate sig nificant differences between students and faculty in their responses.
Strongly Disapprove disapprove
Strongly approve
Approve
Neutral
no. (%)
no. (%)
no. (%)
no. (%)
no. (%)
22 (30) 11 (48)
6 (8 ) 3 (13)
3 (4 ) 2 (9 )
1 (1) 0
7 (10) 5 (22)
16 (22) 2 (9)
24 (33) 4 (17)
22 (30) 12 (52)
8 (11) 2 (9)
6 (8 ) 1 (4)
19 (26) 5 (22)
35 (48) 14 (61)
0 0
2 (3) 0
11 (15) 6 (26)
58 (79) 17 (74)
Announcement (Fig 1) Students* 41 (56) Facultyt 7 (30) (X2 = 5.24, P < .30)
Persuasion (Fig 2) Students 4 (5) Faculty 0 (X2 = 8.85, P < .10)
Fee listing (Fig 3) Students Faculty
5 (7) 1 (4) (X2 = 1.33, P < .90)
Price promotion (Fig 4) Students Faculty
2 (3) 0
(X2 = 2.54, P
<
*Total n u m b er o f students
.70)
= 73. t
Total n u m b e r of faculty
A ttitudes toward dentists’ advertising Table 2 summarizes the degree of agreement or disagreement with a series of statements concerning adver
Fig 3 ■ Fee listing.
JOHN A. DOE, D.D.S. FAMILY DENTIST Examination $5 Cleaning and X rays $20 Extractions $20 Fillings $10 per surface Other fees explained upon request 123 Main Street Anytown, Mass. Tel. 555-1212 for appointment
Fig 4 ■ Price promotion.
CUSTOM FITTED DENTURES--- $99 and up! A ll other dental services at INFLATION FIGHTING FEES! Credit cards and time payments Call now! JOHN A. DOE, D.D.S.--- 555-1212 123 Main Street Anytown, Mass. 10% DISCOUNT WITH THIS AD!
= 23.
tising by dentists. A substantial pro portion of those surveyed think that advertising will increase the public’s demand for dental services (question 1), yet were divided on whether the cost of advertising would be passed on to patients (question 3). (The other al ternative is that advertising costs would be absorbed by the dentist, though added patient income from successful advertising might more than offset the cost of the advertising.) Three questions dealt with the abil ity of advertising to engender or com municate quality. Question 2, “Adver tising by dentists w ill increase the quality of dental treatment,” was re jected overwhelmingly, as were both question 4, “Advertising by dentists w ill improve the image (prestige] of the profession,” and question 5, “Ad vertising by dentists w ill permit pa tients to make intelligent choices.” W ill new dentists use advertising to develop their practices? One-fifth of the dental student respondents be lieved that advertising would be bene ficial to them personally (question 6), and 28% indicated they plan to adver tise (question 7a). More than one-third of the students were neutral or unde cided on both of these questions. Thus, a majority are not dismissing the pos sibility that they may advertise, al though no indication of the type or ex-
Shapiro-Majewski : ATTITUDES TOWARD ADVERTISING ■ 469
B R IE F
REPORTS
Table 2 ■ Agreement with attitude statements.
Strongly agree
Agree
Neutral
no. (%)
no. (%)
no. (%)
no. (%)
no. (%)
19 (26) 2(9)
3(4) 6(26)
35 (48) 10 (43)
23 (32) 12 (53)
25 (35) 6 (26)
9 (12) 2(9)
26 (37) 6 (26)
30 (42) 16 (70)
12 (17) 2 (9)
24 (34) 6 (27)
28 (37) 13 (59)
26 (36) 5 (22)
17 (24) 7 (30)
14 (19) 9 (39)
1. Advertising by dentists will increase the public’s demand for dental services. Students* 4 (5) Facultyt 2 (9) (X2 = 12.16, P < .02)
33 (45) 8 (35)
14 (19) 5 (22)
2. Advertising by dentists will increase the quality of dental treatment. Students 0 Faculty 0 ( X 2 = 5.15, P < .30)
7 (19) 0
8 (11) 1 (4)
3. Advertising by dentists will increase the cost of dental care to patients. Students 2 (3) Faculty 0 (X2 = 3.47, P < .50)
13 (18) 8 (35)
23 (32) 7 (30)
4. Advertising by dentists will improve the image (prestige) of the profession. Students 0 Faculty 0 (X2 = 6.15, P < .20)
3 (4) 0
12 (17) 1 (4)
5. Advertising by dentists will permit patients to make intelligent choices. Students 0 Faculty 0 (X2 = 3.45, P < .50)
9 (13) 1 (5)
6. Advertising by dentists will be beneficial to me personally. Students 0 Faculty 0 (X2 = 5.65, P < .30)
15 (21) 2 (9)
7a. I plan to advertise my dental services if I enter private practice. Students
2 (3)
18 (25)
Strongly Disagree disagree
28 (38)
8 (11)
17 (23)
7b. I am considering advertising my professional services within the next year. Faculty
0
* Total nu m b e r of students = 73.
0 t
4 (17)
4 (17)
15 (65)
uration of the profession in many communities, there is a substantial un tapped supply of potential patients who do not adequately use dental ser vices. Therefore, if advertising suc ceeds in increasing the total patient pool, it will be of value to society. However, if dental advertising re sorts to misleading and deceptive messages, it certainly w ill be deleteri ous to the status of the profession. A d ve rtisin g by in d iv id u a l and group dental practices has become a growing reality in the few years since the striking of ethical prohibitions. This research concludes that advertis ing messages that go beyond tradi tional announcements of availability of services are overwhelmingly disap proved by the groups surveyed. Many respondents volunteered comments that advertising by individual dentists and dental clinics is demeaning to their professional status and thought that advertising campaigns should be undertaken only by organized den tistry on behalf of all dentists. But den tal services are not a homogeneous commodity, and professionals who avail themselves of the opportunity to advertise may take a share of the mar ket from those who do not. Thus, al though advertising by dentists re mains distasteful for the majority, its increasing appearance may force more dentists, especially those just develop ing their practices, to use advertising campaigns defensively to compete for patients.
Dr. Shapiro is associate professor of manage ment, College of Management Science, Univer sity of Lowell, Lowell, Mass 01854. Dr. Majewski was clinical instructor, department of restorative dentistry, School of Dental Medicine, Tufts U ni versity, Boston; he is now postdoctoral fellow, State University of New York at Buffalo, School of Dentistry. Address requests for reprints to Dr. Shapiro.
Total n u m b er o f faculty = 23.
tent of advertising was elicited. None of the faculty respondents indicated intentions to advertise (question 7b). Chi-square analyses of questions 2 through 6 did not indicate a significant difference between student and fac ulty responses to those individual questions. (The authors have no reason to believe that nonresponse bias affects the internal validity of their data. They do not purport their results to be exter nally valid to other dental students, 470 a JADA, Vol. 105, September 1982
dental faculties, or the profession at large.)
Conclusions The increase in the per capita supply of dentists in the U nited States, coupled with improved technology and dental hygiene, has resulted in un filled appointment books for many dentists.6 In spite of the apparent sat
1. Bates and O ’Steen vs State Bar of Arizona, 433 US 350, 1977. 2. ADA agrees to lift restrictions on advertising by dentists. A d Age 50(19):95, 1979. 3. Shimp, T., and Dyer, R. How the legal pro fession views legal service advertising. J Market ing 42(3):74-81, 1978. 4. Darling, J.R., and Bussom, R.S. A compara tive analysis of the attitudes of dentists toward the advertising of their fees and services. J Dent Ed 41(2):59-67, 1977. 5. Meskin, L.H. Advertising of dental services: a consumer and dentist attitude survey. J A m Coll Dent 45(4):247-53, 1978. 6. Lenido, D. Molar mystery: dentists ponder case of the missing patients as appointments lag. Wall Street Journal 196(72):1 ff, 1980.