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Progress Report on the 1934 Survey of Dental Practice in the Commonwealth of Kentucky*
820
The Journal of the American Dental Association and The Dental Cosmos
each patient and the subdepartments of the dental service through frequent staff conferences, it can be readily appreciated that many clinical data will be accumu lated. Much thought and deliberation must be given to these data to make them intelligible and of value. The time nec essary for the group leader to study his charts in the light of his practical knowl edge can be at his own convenience. Particular emphasis is at present being placed on the point of infection in the oral cavity, i. e., apical, gingival, etc., the type of organism present, when this can be determined, and the reaction, if any, on the part of the patient to treatment as indicated by the blood sugar and urine analysis. It is immediately evident that in col lecting data of this nature, an active co operative dental service, in contrast to the individual dentist’s efforts, eliminates for the investigator much of the deterring economic burden. Instead of innumer able visits by the dentist to the hospital,
exhausting to him both financially and physically, in order to make contact with the physician, make dental clinical exami nations, take dental roentgenograms, and treat and follow up 100 cases, there is but the weekly visit. In addition, by dis tributing the work among the organized staff and giving the oral surgery work to those interested in oral surgery; the work in pathology to those interested in pathology, etc., much of the drudgery of this enterprise is removed. Briefly, it is believed that the Mary Immaculate Hospital Plan is a solution, in degree at least, of this particular economic-moral problem associated with the advancement of hospital dentistry, and that, by it, one phase of hospital dentistry, namely, collecting of clinical data, is made feasible, and the advancement of hospital dentistry is accelerated. BIBLIOGRAPHY
J. J .: Mary Immaculate Plan of Hospital Dental Service, Apollonian, July 1.
St a h l ,
1936.
PR O G R E SS R E P O R T O N T H E 1934 S U R V E Y O F D E N T A L P R A C T IC E IN T H E C O M M O N W E A L T H OF KEN TU CKY* H E wide-spread interest in and dis cussion of the social and economic relations of dentistry led the Ken tucky State Dental Association to appoint a committee on economics for the purpose of studying certain aspects of these rela tionships as they existed in the state. There now exists in the hands of the com mittee data which will be of value to the association if and when plans for health insurance are being considered. Because of the difficulties of interpre tation of the large number of data re
T
*By the Economics Committee of the Ken tucky State Dental Association.
ceived and compiled and the prohibitive cost of a comprehensive report, the find ings and conclusions are herein summa rized. Obviously, the summarizations are not regarded by the committee as consti tuting final proof. They simply indicate what the committee has been able to as certain from its study. DENTAL PRACTITIONERS IN THE STATE
The all-time registration of dentists at the close of the year 1934 was 2,135. Three hundred of these are known to be deceased and 904 licenses have been can celed; which leaves 1,031 eligible for
Dental Economics practice. One hundred and sixty-four of these were practising in other states, 837 licensed dentists remaining located within the state. Thirty of these are not in prac tice and twenty-one limit their practices. The number of general practitioners in actual practice is established at 816. QUESTIONNAIRE RETURNS
Seven hundred and eighty-eight ques tionnaires were sent out and 115 were returned, or 14.5 per cent. This number was reduced to eighty-three for various reasons, approximately 10 per cent of the general practitioners. The numerical geo graphic and age distribution is such as to give a fair cross-section of practice. The following data are based on the medians of the 10 per cent of general practitioners and the totals are based on 816 general practitioners in actual prac tice. EDUCATION
Seventy per cent had three years and 30 per cent had four years of dental edu cation. Eighty-six per cent had four years and 14. per cent, three years of high school training. Fifty-seven per cent had other education. Nine per cent had some med ical education and 47 per cent had post graduate study. DENTAL EDUCATION COSTS
The dental college tuition and fees are $846, or a yearly average of $260. Other costs, such as for living, books and inci dentals, amounted to $2,217, or a yearly cost of $647 and a total yearly cost of $907. The total investment in securing an education for the 816 general practi tioners was $2,500,000. This does not include the loss of income while in col lege, which would more than double this investment. The individual items in the foregoing calculation are as follows: tuition and
821 fees, $846; living costs, $1,354; books and equipment, $406; other costs, $457, and income loss, $3,211; total, $6,274. COSTS OF SECURING STATE LICENSE
The cost per dentist for a state license was $23, a total of $19,000 for the 816 general practitioners. INVESTMENT IN EQUIPMENT
The cost of equipment per dentist is $3,388, a total for the whole number of $2,764,608. This investment must be de preciated for sixteen years, a net value for the year 1934 of $442,328 resulting. The ( item of depreciation is considerable and usually is not considered in costs by the average dentist. Allowances have been made for offices that are not fully equipped. W ere such considered, the investment would be in creased 33 per cent. Forty-three per cent do not have x-ray machines, 40 per cent do not have units and only 20 per cent have gas machines. The following items and amounts enter into the foregoing, designated by rooms, and the percentages of the total are stated: reception room, $132, or 4 per cent; rest room, $62, or 1 per cent; business office, $137, or 3 per cent; lab oratory, $265, or 9 per cent; dark-room, $64, or 2 per cent; x-ray machine, $972, or 22 per cent, and operating room, $1,756, or 59 per cent. This illustrates how much dental equipment exceeds in cost other items entering into the equipment costs for the practice of den tistry. The total investment compiled on the foregoing data represents per dentist $9,847, or a total for the state of $8,035,000. The following percentages prevail for the three major items entering into the investment to get ready for practice: se curing a dental education, 57 per cent;
822
The Journal of the American Dental Association and The Dental Cosmos
state license, 1 per cent, and equipment, 32 per cent. POPULATION AND DENTAL PATIENTS
The population per dentist is 3,204. The average number of patients per den tist for 1934 was 452, or 14 per cent of the population. An estimate, based on fairly reliable information, leads the com mittee to believe that an additional 5 per cent receive dental care from sources other than the office of the general prac titioner; the total receiving dental atten tion being approximately 19 per cent. If the foregoing calculation is fairly accurate, then one-third as many patients are receiving dental attention from other sources as are seeking the services of the general practitioners. Let us assume further that 10 per cent of the population do not need dental at tention and that the incomes of 60 per cent do not permit dental care. (These amounts are liberal.) These deductions, in addition to the foregoing 19 per cent that do receive dental care, leave 10 per cent that need care and can pay for it, but do not have this care. This 11 per cent distributed to the various offices would represent an additional 352 patients, or a total of approximately 800 patients more than could be accommodated. The following estimates are not given for accuracy, as the percentages are not based on sufficient experience. Sixty per cent of the 452 patients, or 271, return each four to ten years for treatment; 12 per cent, or fifty-five, return every three years; 8 per cent, or thirty-six, return every two years; 20 per cent, or ninety, return every year or oftener. The other 100 are transients whose visits are ten years or longer apart. Further research should be made. The facts are available in every practice, needing only compila tion. T he majority of patients are female,
these patients representing 60 per cent of those consulting the dentist. Nine per cent of the negro population receive dental attention. Besides those taken care of in the offices of the fortythree negro dentists, some are treated in approximately 245 offices of the white dentists, the negro patients representing about 4 per cent of the white dentists’ practice. INCOME AND OPERATING COSTS
The gross receipts were $4,500 and operating costs, $2,400; the apparent book profit being $2,100. Against this must be charged 10 per cent as uncol lectible, or a net for the year of $1,890. The actual receipts were $3,052. T w o items of interest reported were charity $198 and services to immediate family of $127; a total o f charity for the whole state from general practitioners of $161,568. This is perhaps exaggerated, but something to think about. A point in passing on dental needs is that dentists’ families perhaps receive the attention needed. A survey of these families would give a nearly true picture of necessary dental care. DENTIST’ S TIM E
The days in the office numbered 288 ; daily office hours, eight; yearly office hours, 2,300; chair hours, 1,205 (perhaps too high). The chair hours represent 52 per cent of the office hours. MISCELLANEOUS DATA
Thirty-five per cent of the dentists have other sources of income. Forty-one per cent own their homes, but 50 per cent of these are mortgaged. Ninety per cent are married, with an average of two chil dren and one other dependent. The median age of the dentists is 41.3 years and the time in practice is sixteen years.
Dental Economics The average practice age of those known to be dead was thirty years. This would indicate that the dentist begins practice at twenty-five years of age and will practice for thirty years, and either dies or retires from practice at the age of fifty-five. These data should help the dentist in his plan of living, assuming obligations and old age planning. The committee suggests that the fol lowing points relative to the foregoing are outstanding: The investment of $8,000,000; the comparatively high operating costs; the dentist’s income; the number of persons receiving dental attention; the frequency with which patients visit the dentist; the large percentage of uncollectible ac counts; the amount of charity; the wide difference between chair hours and office hours; the apparent apathy of the pro fession to economic questions affecting dental practice; the number of patients that could but do not receive dental attention and the number that cannot afford dental care under their present method of budgeting and spending. A recent survey indicated that 40 per cent of the dentists were practicing some form of socialized dentistry. Joseph L. Selden, John T . O ’Rourke, Robert L. Sprau, Chairman, 970 Baxter Ave., Louisville, Ky.
IOW A A PPO INTS DENTAL C ONSULTANT
In January, O. E. Hoffman, D.D.S., was appointed dental consultant in the Division of Child Health of the Iowa State Depart ment of Health. The Oral Hygiene Committee of the Iowa State Dental Society has approved the following preliminary schedule of den tal health education to function in correla tion with the activities of the bureau of
823
dental hygiene through the offices of the state department of health. The program is to be educational in scope and include an extension of the oral hygiene work in Iowa which was started many years ago under the leadership of John G. Hildebrand, Waterloo, Iowa. The Iowa Plan for Dental Health Edu cation, which has proved so effective, is the result of the tireless efforts of pioneers in oral hygiene and today its far-reaching and beneficial activities radiate from the Bureau of Dental Hygiene, Dental College at Iowa City, under the direction of C. L. Drain. It is to extend these dental health edu cational facilities into the preschool, high school and adult groups that the office of dental consultant in the Division of Child Health and Health Education of the Iowa State Department of Health has been es tablished. PRELIMINARY SCHEDULE OF DENTAL HEALTH EDUCATION STATE DEPARTMENT OF HEALTH
I. T o carry out the program of dental health education of the state department of health by means o f: 1. Publications for free distribution 2. Newspaper releases 3. Public lectures 4. Group instruction including classes in motherhood 5. Radio programs 6. Refresher courses for the professions 7. Exhibits. II. T o cooperate with the bureau of dental hygiene in extending dental health education in the elementary schools by: 1. Writing dental items of interest for the monthly publication of the Iowa State Department of Public Instruction. 2. Calling attention of the county and city superintendents of schools to available dental health educational materials re leased by the: a. State department of health b. Bureau of dental hygiene c. Public Relations Committee of the American Dental Association 3. Supplying copies of approved dental
The Journal of the American Dental Association and The Dental Cosmos
each patient and the subdepartments of the dental service through frequent staff conferences, it can be readily appreciated that many clinical data will be accumu lated. Much thought and deliberation must be given to these data to make them intelligible and of value. The time nec essary for the group leader to study his charts in the light of his practical knowl edge can be at his own convenience. Particular emphasis is at present being placed on the point of infection in the oral cavity, i. e., apical, gingival, etc., the type of organism present, when this can be determined, and the reaction, if any, on the part of the patient to treatment as indicated by the blood sugar and urine analysis. It is immediately evident that in col lecting data of this nature, an active co operative dental service, in contrast to the individual dentist’s efforts, eliminates for the investigator much of the deterring economic burden. Instead of innumer able visits by the dentist to the hospital,
exhausting to him both financially and physically, in order to make contact with the physician, make dental clinical exami nations, take dental roentgenograms, and treat and follow up 100 cases, there is but the weekly visit. In addition, by dis tributing the work among the organized staff and giving the oral surgery work to those interested in oral surgery; the work in pathology to those interested in pathology, etc., much of the drudgery of this enterprise is removed. Briefly, it is believed that the Mary Immaculate Hospital Plan is a solution, in degree at least, of this particular economic-moral problem associated with the advancement of hospital dentistry, and that, by it, one phase of hospital dentistry, namely, collecting of clinical data, is made feasible, and the advancement of hospital dentistry is accelerated. BIBLIOGRAPHY
J. J .: Mary Immaculate Plan of Hospital Dental Service, Apollonian, July 1.
St a h l ,
1936.
PR O G R E SS R E P O R T O N T H E 1934 S U R V E Y O F D E N T A L P R A C T IC E IN T H E C O M M O N W E A L T H OF KEN TU CKY* H E wide-spread interest in and dis cussion of the social and economic relations of dentistry led the Ken tucky State Dental Association to appoint a committee on economics for the purpose of studying certain aspects of these rela tionships as they existed in the state. There now exists in the hands of the com mittee data which will be of value to the association if and when plans for health insurance are being considered. Because of the difficulties of interpre tation of the large number of data re
T
*By the Economics Committee of the Ken tucky State Dental Association.
ceived and compiled and the prohibitive cost of a comprehensive report, the find ings and conclusions are herein summa rized. Obviously, the summarizations are not regarded by the committee as consti tuting final proof. They simply indicate what the committee has been able to as certain from its study. DENTAL PRACTITIONERS IN THE STATE
The all-time registration of dentists at the close of the year 1934 was 2,135. Three hundred of these are known to be deceased and 904 licenses have been can celed; which leaves 1,031 eligible for
Dental Economics practice. One hundred and sixty-four of these were practising in other states, 837 licensed dentists remaining located within the state. Thirty of these are not in prac tice and twenty-one limit their practices. The number of general practitioners in actual practice is established at 816. QUESTIONNAIRE RETURNS
Seven hundred and eighty-eight ques tionnaires were sent out and 115 were returned, or 14.5 per cent. This number was reduced to eighty-three for various reasons, approximately 10 per cent of the general practitioners. The numerical geo graphic and age distribution is such as to give a fair cross-section of practice. The following data are based on the medians of the 10 per cent of general practitioners and the totals are based on 816 general practitioners in actual prac tice. EDUCATION
Seventy per cent had three years and 30 per cent had four years of dental edu cation. Eighty-six per cent had four years and 14. per cent, three years of high school training. Fifty-seven per cent had other education. Nine per cent had some med ical education and 47 per cent had post graduate study. DENTAL EDUCATION COSTS
The dental college tuition and fees are $846, or a yearly average of $260. Other costs, such as for living, books and inci dentals, amounted to $2,217, or a yearly cost of $647 and a total yearly cost of $907. The total investment in securing an education for the 816 general practi tioners was $2,500,000. This does not include the loss of income while in col lege, which would more than double this investment. The individual items in the foregoing calculation are as follows: tuition and
821 fees, $846; living costs, $1,354; books and equipment, $406; other costs, $457, and income loss, $3,211; total, $6,274. COSTS OF SECURING STATE LICENSE
The cost per dentist for a state license was $23, a total of $19,000 for the 816 general practitioners. INVESTMENT IN EQUIPMENT
The cost of equipment per dentist is $3,388, a total for the whole number of $2,764,608. This investment must be de preciated for sixteen years, a net value for the year 1934 of $442,328 resulting. The ( item of depreciation is considerable and usually is not considered in costs by the average dentist. Allowances have been made for offices that are not fully equipped. W ere such considered, the investment would be in creased 33 per cent. Forty-three per cent do not have x-ray machines, 40 per cent do not have units and only 20 per cent have gas machines. The following items and amounts enter into the foregoing, designated by rooms, and the percentages of the total are stated: reception room, $132, or 4 per cent; rest room, $62, or 1 per cent; business office, $137, or 3 per cent; lab oratory, $265, or 9 per cent; dark-room, $64, or 2 per cent; x-ray machine, $972, or 22 per cent, and operating room, $1,756, or 59 per cent. This illustrates how much dental equipment exceeds in cost other items entering into the equipment costs for the practice of den tistry. The total investment compiled on the foregoing data represents per dentist $9,847, or a total for the state of $8,035,000. The following percentages prevail for the three major items entering into the investment to get ready for practice: se curing a dental education, 57 per cent;
822
The Journal of the American Dental Association and The Dental Cosmos
state license, 1 per cent, and equipment, 32 per cent. POPULATION AND DENTAL PATIENTS
The population per dentist is 3,204. The average number of patients per den tist for 1934 was 452, or 14 per cent of the population. An estimate, based on fairly reliable information, leads the com mittee to believe that an additional 5 per cent receive dental care from sources other than the office of the general prac titioner; the total receiving dental atten tion being approximately 19 per cent. If the foregoing calculation is fairly accurate, then one-third as many patients are receiving dental attention from other sources as are seeking the services of the general practitioners. Let us assume further that 10 per cent of the population do not need dental at tention and that the incomes of 60 per cent do not permit dental care. (These amounts are liberal.) These deductions, in addition to the foregoing 19 per cent that do receive dental care, leave 10 per cent that need care and can pay for it, but do not have this care. This 11 per cent distributed to the various offices would represent an additional 352 patients, or a total of approximately 800 patients more than could be accommodated. The following estimates are not given for accuracy, as the percentages are not based on sufficient experience. Sixty per cent of the 452 patients, or 271, return each four to ten years for treatment; 12 per cent, or fifty-five, return every three years; 8 per cent, or thirty-six, return every two years; 20 per cent, or ninety, return every year or oftener. The other 100 are transients whose visits are ten years or longer apart. Further research should be made. The facts are available in every practice, needing only compila tion. T he majority of patients are female,
these patients representing 60 per cent of those consulting the dentist. Nine per cent of the negro population receive dental attention. Besides those taken care of in the offices of the fortythree negro dentists, some are treated in approximately 245 offices of the white dentists, the negro patients representing about 4 per cent of the white dentists’ practice. INCOME AND OPERATING COSTS
The gross receipts were $4,500 and operating costs, $2,400; the apparent book profit being $2,100. Against this must be charged 10 per cent as uncol lectible, or a net for the year of $1,890. The actual receipts were $3,052. T w o items of interest reported were charity $198 and services to immediate family of $127; a total o f charity for the whole state from general practitioners of $161,568. This is perhaps exaggerated, but something to think about. A point in passing on dental needs is that dentists’ families perhaps receive the attention needed. A survey of these families would give a nearly true picture of necessary dental care. DENTIST’ S TIM E
The days in the office numbered 288 ; daily office hours, eight; yearly office hours, 2,300; chair hours, 1,205 (perhaps too high). The chair hours represent 52 per cent of the office hours. MISCELLANEOUS DATA
Thirty-five per cent of the dentists have other sources of income. Forty-one per cent own their homes, but 50 per cent of these are mortgaged. Ninety per cent are married, with an average of two chil dren and one other dependent. The median age of the dentists is 41.3 years and the time in practice is sixteen years.
Dental Economics The average practice age of those known to be dead was thirty years. This would indicate that the dentist begins practice at twenty-five years of age and will practice for thirty years, and either dies or retires from practice at the age of fifty-five. These data should help the dentist in his plan of living, assuming obligations and old age planning. The committee suggests that the fol lowing points relative to the foregoing are outstanding: The investment of $8,000,000; the comparatively high operating costs; the dentist’s income; the number of persons receiving dental attention; the frequency with which patients visit the dentist; the large percentage of uncollectible ac counts; the amount of charity; the wide difference between chair hours and office hours; the apparent apathy of the pro fession to economic questions affecting dental practice; the number of patients that could but do not receive dental attention and the number that cannot afford dental care under their present method of budgeting and spending. A recent survey indicated that 40 per cent of the dentists were practicing some form of socialized dentistry. Joseph L. Selden, John T . O ’Rourke, Robert L. Sprau, Chairman, 970 Baxter Ave., Louisville, Ky.
IOW A A PPO INTS DENTAL C ONSULTANT
In January, O. E. Hoffman, D.D.S., was appointed dental consultant in the Division of Child Health of the Iowa State Depart ment of Health. The Oral Hygiene Committee of the Iowa State Dental Society has approved the following preliminary schedule of den tal health education to function in correla tion with the activities of the bureau of
823
dental hygiene through the offices of the state department of health. The program is to be educational in scope and include an extension of the oral hygiene work in Iowa which was started many years ago under the leadership of John G. Hildebrand, Waterloo, Iowa. The Iowa Plan for Dental Health Edu cation, which has proved so effective, is the result of the tireless efforts of pioneers in oral hygiene and today its far-reaching and beneficial activities radiate from the Bureau of Dental Hygiene, Dental College at Iowa City, under the direction of C. L. Drain. It is to extend these dental health edu cational facilities into the preschool, high school and adult groups that the office of dental consultant in the Division of Child Health and Health Education of the Iowa State Department of Health has been es tablished. PRELIMINARY SCHEDULE OF DENTAL HEALTH EDUCATION STATE DEPARTMENT OF HEALTH
I. T o carry out the program of dental health education of the state department of health by means o f: 1. Publications for free distribution 2. Newspaper releases 3. Public lectures 4. Group instruction including classes in motherhood 5. Radio programs 6. Refresher courses for the professions 7. Exhibits. II. T o cooperate with the bureau of dental hygiene in extending dental health education in the elementary schools by: 1. Writing dental items of interest for the monthly publication of the Iowa State Department of Public Instruction. 2. Calling attention of the county and city superintendents of schools to available dental health educational materials re leased by the: a. State department of health b. Bureau of dental hygiene c. Public Relations Committee of the American Dental Association 3. Supplying copies of approved dental