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Meeting the manpower problem
M eeting the manpower problem
Albert W. Morris * D.D.S., Salisbury, Md..
If the dental manpower shortage pre dicted for 1975 occurs, it will be harmful to the health of the American people and detrimental to the dental profession. The shortage can be prevented by an active recruiting program and the ex pansion of dental school facilities.
News articles predicting manpower short ages by 1975 in the fields of medicine, dentistry, and nursing have publicized the failure of these professions to keep pace percentagewise with the rapidly ex panding population. A recent memorandum from Dr. W il liam H. Stewart, chief, Division of Public Health Methods, to M iss Bertha S. A d kins, Under Secretary of Health, Educa tion, and Welfare, states: T h e ratio of dentists to population in the United States has dropped from 62 to 57 per 100,000 persons since 1940, and w ill drop to 50 per 100,000 by 1975 unless the rate of graduating students increases substantially. T h e 47 dental schools in the United States graduated 3,083 dentists in the academic year 1957-1958. Despite the addition of eight new dental schools since W orld W ar I I and large increases in the number of graduates, the ratio o f dentists to population remains below pre-W orld W ar I I levels. This decline is ex pected to continue. T o regain the current den tist-population ratio, about 2,700 more dental graduates above the number currently pre dicted will be needed in 1975. This calls for
a 75 per cent increase in the number o f dental graduates who, according to present estimates, w ill be graduated during that year.
This statement by Dr. Stewart sum marizes intensive studies covering all sec tions of the United States in considerable detail. A brief survey of available litera ture1' 5 is convincing. However, no pre dictions are made concerning the impact of a dental manpower shortage on the dental profession and on the public. EFFECTS OF A SHORTAGE
Not only will there be more people per dentist, but those people will be better educated and will demand more dental services. The dental practitioner will be affected in the following ways: (1) a greater patient load, (2) shorter appoint ments, (3) longer working hours, (4) lower quality dentistry and (5) lowered efficiency. These changes in dental practice will bring the dentist less satisfaction from greater physical, mental, and emotional exertion. Also, there will be less time for dental meetings, for study and for recrea tion. The shortage will mean higher fees for hurried dentistry for the patients. There will be less time for desired dentist patient understanding. The production line will have to be kept moving to pro vide dental care for the largest number
38/690 • THE JO U R N A L OF THE A M E R IC A N DENTAL A S S O C IA TIO N
of people. Each dentist who attempts to maintain high standards of work and a slower pace must necessarily limit the size of his practice, thus turning away his share of the increased patient load. These patients will add to the burden of other dentists, or they will find that dental treatment is not available to them. Fail ure to meet the dental health needs of a sufficiently large segment of the popula tion will constitute a national health emergency. In that unfortunate circum stance, many things might come to pass. G O V E R N M E N TA L CONTROLS
Socialized dentistry could be forced on the dental profession by a Congress sensi tive to an electorate with dental troubles. Socialized dentistry would serve, at best, to dilute dentistry so it will go around. The state legislature could grant licenses to laboratory technicians and others to practice certain phases of dentistry. Such licensure is an active threat to the profes sion at the present time and in the future it might come to pass. Even without licen sure the illegal practice of dentistry will flourish. Dental education may undergo a drastic speed-up. State boards of dental examiners may be abolished. These changes may be part of a national pro gram designed to supply some kind of manpower to provide some kind of dental treatment on a mass basis for the Ameri can people. These changes coincide all too well with the ideas of those who favor socialized health care. Therefore, it is im perative that the dental profession pre vent the predicted shortage with its dire effects. The advances made in reducing caries by fluoridation, as well as any foreseeable break-through in research, will not offset the need for more dentists. Neither will new developments in high-speed technics nor increased use of auxiliary personnel offset this need. These things will help, but only one thing will prevent the dental manpower shortage.
R E C R U IT IN G
O nly by filling the dental ranks with a sufficient number of recruits can the nec essary dentist-patient ratio be maintained. T o fill the ranks it is necessary to compete with the other professions and scientific pursuits to get a fair share of the qualified high school graduates. O nly by active and effective recruiting can dentistry as a ca reer be sold to more young people. Such a program is broad in application, in volving all levels of organized dentistry. Yet the practicing dentist is in the best position to educate his teen-age patients and their parents to the advantages of a career in dentistry. A dentist’s ability, his office, and his status in the community speak for themselves. A n enthusiastic in terest in encouraging young people to study dentistry can turn many of the pa tients toward dentistry. Every dentist who enlists one recruit is in the long run merely furnishing his own replacement. This is not enough. M an y dentists must recruit two or more students to prevent the predicted shortage in 1975. Tim e is short. The boys and girls in the high school graduating classes of 1961 and 1962 are considering their fu tures now. Today’s nine and ten year old patients will provide the candidates for dental degrees in 1975. Have they been told the story of dentistry? The publicity given to dental health and the profession as a whole during Children’s Dental Health Week is valu able for recruiting purposes. Such infor mation should be focused, in addition, on the students in the first year of senior high school. Biology or other science classes are a desirable audience for dis cussions on dental health and dentistry. Such programs are easily arranged, pos sibly through a patient who is a science teacher. A n interesting and rewarding hour awaits any dentist who brings his knowledge to such a group. Whereas most dentists feel unqualified as teachers, it should be remembered that the word
M O R R IS . . . V O LU M E 61, DECEM BER I960 • 39/691
“doctor” is derived from the Latin word “doceo,” meaning to teach. W ith the aid of films, slides and lecture material from the American Dental Asso ciation it is easy to prepare an hour-long presentation. Question and answer con ferences are informal and popular with students. They require little or no prepa ration. Simple visual aids can provide discussion for a class period. Remarks on dentistry should climax every classroom talk. Better yet, an entire period should be devoted to dentistry as a career. Som e , high schools have a career day each year when conferences are held with repre sentatives from many vocations. Outlines are furnished the speakers as aids in pre senting the facts to the students. Dentistry certainly should be represented at such times. The pamphlets on careers in den tistry and dental hygiene6’7 should be given to interested students whose names should then be referred to their own den tist for further discussions. The existence of high school clubs such as Future Nurses and Future Teachers should indicate the need for active recruiting in dentistry and dental hygiene. Talks before civic groups, and espe cially parent-teacher meetings, on dental health should include an appeal for parents to consider dentistry as a career for their boys and girls. Here, too, it would be desirable to devote an entire program to the latter theme, perhaps showing the American Dental Association film “Careers in Dentistry.” Some local television stations present a series of career programs, one of which could feature a panel of high school stu dents interviewing a dentist. In the past year or two, several magazines carried discussions on dentistry as part of a career series sponsored by a large life insurance company. Publicity that will tell and sell is important. Organized dentistry does have an excellent publicity program, but dentists are slow to move along the road to active recruiting. This should be done at every level of the organization. M ost
important, however, is the personal con tact between the dentist and his young patients and their parents. WOMEN IN DENTISTRY
A recent article8 in t h e j o u r n a l o f t h e pointing to the small percentage of women in den tistry in America as compared to various European countries, urges active recruit ment of women in dentistry. Success in this field would go a long way toward solving the dentist manpower shortage. A n increase in the number of practicing dental hygienists would also aid greatly. Effective recruiting would bring many more women into dentistry as either den tists or hygienists.
AMERICAN DENTAL ASSOCIATION,
EDUCATIONAL FACILITIES
H ow can the students be educated with the inadequate facilities now available if dentists are successful in recruiting large numbers of men and women dental stu dents? A t present they cannot. Applicants to dental schools are turned away each year. However, the building of new den tal schools and the expansion of existing ones will come about only through greatly increased demands for dental education. Recruitment must come first, then the dental facilities will be forced into expan sion and building programs. CONCLUSIONS
1. The dental manpower shortage which has been predicted for 1975 will occur if not prevented by the profession. 2. Effects of such a shortage will be harmful to the health of the American people and detrimental to the profession. 3. A shortage of dentists can lead to socialized dentistry or other governmental regulation. 4. The shortage can be prevented by recruiting.
40/692 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SS O C IA TIO N
5. A n active recruiting program should be carried out in all high schools. 6. Every practicing dentist should re cruit among his young patients. 7. More young women should be brought into dentistry and dental hygiene by increased efforts in recruiting. 8. Necessary expansion of dental school facilities can be forced by the de mands of the capable applicants enlisted through active recruitment.
226 North Division Street
*Member, Maryland State Board of Dental Examiners.
1. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 7, dentists. Washington, D. C., Government Printing Office, 1959. 2. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 8, dental hygienists. Washington, D. C., Government Printing Office, 1959. 3. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 9, physicians, dentists, nurses. Washington, D. C., Govern ment Printing Office, 1959. 4. U. S. Department of Health, Education, and Welfare. Dentists for a growing America. Appendix A, physicians for a growing America. Washington, D. C.. Government Printing Office, October 1959. 5. Smith, Quentin M. The growing shortage of den tists in the United States. Am. J. Pub. Health 48:38 Jan. 1958. 6. American Dental Association, Council on Dental Education. Careers in dentistry. Chicago, American Dental Association, 1958. 7. American Dental Hygienists Association. Careers In dental hygiene. Iowa City, University of Iowa Press, 1959. 8. Talbot, Nell S. Why not more women dentists? J.A.D.A. 60:114 Jan. I960.
R a d ia tio n Hazards • Over the past five years there have been frequent public debates by scientists about the damaging consequences of the exposure o f our store of human genes to atomic radiations. . . . T h e seemingly contradictory statements have probably left more people confused than reassured. . . . This confusion arises partly because there are many sources of such radiation, and it is not clear . . . whether the damage is greater from medical and dental exposures, from industrial hazards or from the fallout occurring after the testing of nuclear weapons. Confusion is even more definitely attributable to the fact that different “ authori ties” in good conscience, can speak reassuring words or raise their voices in alarm, when looking at the same facts. And it is partly because there are so many gaps in our present scien tific knowledge o f how much radiation we are exposed to, internally and externally, how much mutations might result, how harmful these mutations might be, on the average, and what the consequences are to an entire population, as well as to particular individuals, from a given degree of exposure. . . . T here is hope in the fact that mankind has acquired in its evolu tionary progression not only a particular genetic heritage but also a means of passing on knowl edge and of growing in wisdom through experience. . . . Our species will surmount this threat to its continuance even as it has survived the lesser threats o f the past. B ruce W allace and T h . Dobzhanski. R a d ia tio n , Genes and M a n , 1959.
Albert W. Morris * D.D.S., Salisbury, Md..
If the dental manpower shortage pre dicted for 1975 occurs, it will be harmful to the health of the American people and detrimental to the dental profession. The shortage can be prevented by an active recruiting program and the ex pansion of dental school facilities.
News articles predicting manpower short ages by 1975 in the fields of medicine, dentistry, and nursing have publicized the failure of these professions to keep pace percentagewise with the rapidly ex panding population. A recent memorandum from Dr. W il liam H. Stewart, chief, Division of Public Health Methods, to M iss Bertha S. A d kins, Under Secretary of Health, Educa tion, and Welfare, states: T h e ratio of dentists to population in the United States has dropped from 62 to 57 per 100,000 persons since 1940, and w ill drop to 50 per 100,000 by 1975 unless the rate of graduating students increases substantially. T h e 47 dental schools in the United States graduated 3,083 dentists in the academic year 1957-1958. Despite the addition of eight new dental schools since W orld W ar I I and large increases in the number of graduates, the ratio o f dentists to population remains below pre-W orld W ar I I levels. This decline is ex pected to continue. T o regain the current den tist-population ratio, about 2,700 more dental graduates above the number currently pre dicted will be needed in 1975. This calls for
a 75 per cent increase in the number o f dental graduates who, according to present estimates, w ill be graduated during that year.
This statement by Dr. Stewart sum marizes intensive studies covering all sec tions of the United States in considerable detail. A brief survey of available litera ture1' 5 is convincing. However, no pre dictions are made concerning the impact of a dental manpower shortage on the dental profession and on the public. EFFECTS OF A SHORTAGE
Not only will there be more people per dentist, but those people will be better educated and will demand more dental services. The dental practitioner will be affected in the following ways: (1) a greater patient load, (2) shorter appoint ments, (3) longer working hours, (4) lower quality dentistry and (5) lowered efficiency. These changes in dental practice will bring the dentist less satisfaction from greater physical, mental, and emotional exertion. Also, there will be less time for dental meetings, for study and for recrea tion. The shortage will mean higher fees for hurried dentistry for the patients. There will be less time for desired dentist patient understanding. The production line will have to be kept moving to pro vide dental care for the largest number
38/690 • THE JO U R N A L OF THE A M E R IC A N DENTAL A S S O C IA TIO N
of people. Each dentist who attempts to maintain high standards of work and a slower pace must necessarily limit the size of his practice, thus turning away his share of the increased patient load. These patients will add to the burden of other dentists, or they will find that dental treatment is not available to them. Fail ure to meet the dental health needs of a sufficiently large segment of the popula tion will constitute a national health emergency. In that unfortunate circum stance, many things might come to pass. G O V E R N M E N TA L CONTROLS
Socialized dentistry could be forced on the dental profession by a Congress sensi tive to an electorate with dental troubles. Socialized dentistry would serve, at best, to dilute dentistry so it will go around. The state legislature could grant licenses to laboratory technicians and others to practice certain phases of dentistry. Such licensure is an active threat to the profes sion at the present time and in the future it might come to pass. Even without licen sure the illegal practice of dentistry will flourish. Dental education may undergo a drastic speed-up. State boards of dental examiners may be abolished. These changes may be part of a national pro gram designed to supply some kind of manpower to provide some kind of dental treatment on a mass basis for the Ameri can people. These changes coincide all too well with the ideas of those who favor socialized health care. Therefore, it is im perative that the dental profession pre vent the predicted shortage with its dire effects. The advances made in reducing caries by fluoridation, as well as any foreseeable break-through in research, will not offset the need for more dentists. Neither will new developments in high-speed technics nor increased use of auxiliary personnel offset this need. These things will help, but only one thing will prevent the dental manpower shortage.
R E C R U IT IN G
O nly by filling the dental ranks with a sufficient number of recruits can the nec essary dentist-patient ratio be maintained. T o fill the ranks it is necessary to compete with the other professions and scientific pursuits to get a fair share of the qualified high school graduates. O nly by active and effective recruiting can dentistry as a ca reer be sold to more young people. Such a program is broad in application, in volving all levels of organized dentistry. Yet the practicing dentist is in the best position to educate his teen-age patients and their parents to the advantages of a career in dentistry. A dentist’s ability, his office, and his status in the community speak for themselves. A n enthusiastic in terest in encouraging young people to study dentistry can turn many of the pa tients toward dentistry. Every dentist who enlists one recruit is in the long run merely furnishing his own replacement. This is not enough. M an y dentists must recruit two or more students to prevent the predicted shortage in 1975. Tim e is short. The boys and girls in the high school graduating classes of 1961 and 1962 are considering their fu tures now. Today’s nine and ten year old patients will provide the candidates for dental degrees in 1975. Have they been told the story of dentistry? The publicity given to dental health and the profession as a whole during Children’s Dental Health Week is valu able for recruiting purposes. Such infor mation should be focused, in addition, on the students in the first year of senior high school. Biology or other science classes are a desirable audience for dis cussions on dental health and dentistry. Such programs are easily arranged, pos sibly through a patient who is a science teacher. A n interesting and rewarding hour awaits any dentist who brings his knowledge to such a group. Whereas most dentists feel unqualified as teachers, it should be remembered that the word
M O R R IS . . . V O LU M E 61, DECEM BER I960 • 39/691
“doctor” is derived from the Latin word “doceo,” meaning to teach. W ith the aid of films, slides and lecture material from the American Dental Asso ciation it is easy to prepare an hour-long presentation. Question and answer con ferences are informal and popular with students. They require little or no prepa ration. Simple visual aids can provide discussion for a class period. Remarks on dentistry should climax every classroom talk. Better yet, an entire period should be devoted to dentistry as a career. Som e , high schools have a career day each year when conferences are held with repre sentatives from many vocations. Outlines are furnished the speakers as aids in pre senting the facts to the students. Dentistry certainly should be represented at such times. The pamphlets on careers in den tistry and dental hygiene6’7 should be given to interested students whose names should then be referred to their own den tist for further discussions. The existence of high school clubs such as Future Nurses and Future Teachers should indicate the need for active recruiting in dentistry and dental hygiene. Talks before civic groups, and espe cially parent-teacher meetings, on dental health should include an appeal for parents to consider dentistry as a career for their boys and girls. Here, too, it would be desirable to devote an entire program to the latter theme, perhaps showing the American Dental Association film “Careers in Dentistry.” Some local television stations present a series of career programs, one of which could feature a panel of high school stu dents interviewing a dentist. In the past year or two, several magazines carried discussions on dentistry as part of a career series sponsored by a large life insurance company. Publicity that will tell and sell is important. Organized dentistry does have an excellent publicity program, but dentists are slow to move along the road to active recruiting. This should be done at every level of the organization. M ost
important, however, is the personal con tact between the dentist and his young patients and their parents. WOMEN IN DENTISTRY
A recent article8 in t h e j o u r n a l o f t h e pointing to the small percentage of women in den tistry in America as compared to various European countries, urges active recruit ment of women in dentistry. Success in this field would go a long way toward solving the dentist manpower shortage. A n increase in the number of practicing dental hygienists would also aid greatly. Effective recruiting would bring many more women into dentistry as either den tists or hygienists.
AMERICAN DENTAL ASSOCIATION,
EDUCATIONAL FACILITIES
H ow can the students be educated with the inadequate facilities now available if dentists are successful in recruiting large numbers of men and women dental stu dents? A t present they cannot. Applicants to dental schools are turned away each year. However, the building of new den tal schools and the expansion of existing ones will come about only through greatly increased demands for dental education. Recruitment must come first, then the dental facilities will be forced into expan sion and building programs. CONCLUSIONS
1. The dental manpower shortage which has been predicted for 1975 will occur if not prevented by the profession. 2. Effects of such a shortage will be harmful to the health of the American people and detrimental to the profession. 3. A shortage of dentists can lead to socialized dentistry or other governmental regulation. 4. The shortage can be prevented by recruiting.
40/692 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SS O C IA TIO N
5. A n active recruiting program should be carried out in all high schools. 6. Every practicing dentist should re cruit among his young patients. 7. More young women should be brought into dentistry and dental hygiene by increased efforts in recruiting. 8. Necessary expansion of dental school facilities can be forced by the de mands of the capable applicants enlisted through active recruitment.
226 North Division Street
*Member, Maryland State Board of Dental Examiners.
1. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 7, dentists. Washington, D. C., Government Printing Office, 1959. 2. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 8, dental hygienists. Washington, D. C., Government Printing Office, 1959. 3. U. S. Department of Health, Education, and Welfare. Health manpower source book, section no. 9, physicians, dentists, nurses. Washington, D. C., Govern ment Printing Office, 1959. 4. U. S. Department of Health, Education, and Welfare. Dentists for a growing America. Appendix A, physicians for a growing America. Washington, D. C.. Government Printing Office, October 1959. 5. Smith, Quentin M. The growing shortage of den tists in the United States. Am. J. Pub. Health 48:38 Jan. 1958. 6. American Dental Association, Council on Dental Education. Careers in dentistry. Chicago, American Dental Association, 1958. 7. American Dental Hygienists Association. Careers In dental hygiene. Iowa City, University of Iowa Press, 1959. 8. Talbot, Nell S. Why not more women dentists? J.A.D.A. 60:114 Jan. I960.
R a d ia tio n Hazards • Over the past five years there have been frequent public debates by scientists about the damaging consequences of the exposure o f our store of human genes to atomic radiations. . . . T h e seemingly contradictory statements have probably left more people confused than reassured. . . . This confusion arises partly because there are many sources of such radiation, and it is not clear . . . whether the damage is greater from medical and dental exposures, from industrial hazards or from the fallout occurring after the testing of nuclear weapons. Confusion is even more definitely attributable to the fact that different “ authori ties” in good conscience, can speak reassuring words or raise their voices in alarm, when looking at the same facts. And it is partly because there are so many gaps in our present scien tific knowledge o f how much radiation we are exposed to, internally and externally, how much mutations might result, how harmful these mutations might be, on the average, and what the consequences are to an entire population, as well as to particular individuals, from a given degree of exposure. . . . T here is hope in the fact that mankind has acquired in its evolu tionary progression not only a particular genetic heritage but also a means of passing on knowl edge and of growing in wisdom through experience. . . . Our species will surmount this threat to its continuance even as it has survived the lesser threats o f the past. B ruce W allace and T h . Dobzhanski. R a d ia tio n , Genes and M a n , 1959.