Characteristics of Dentists

The trends in dental education and increases in population and income over time have led to an increase in dental manpower. The most recent available data (Table 3-2) indicate that in 1998 the total number of dentists in the United States was 183,000 whereas the number of active private practitioners was 138,449 (less than 76% of the total). Table 3-2 indicates that the number of people per active private practitioner was 1952. It is estimated that the dentist/population ratio was approximately 58 per 100,000 in 2000 and will be 47 per 100,000 by 2020. According to these estimates, the absolute number of active dentists started to decline in 2001.⁵

Table 3-2 Number of Dentists, Population, and Population/Dentists Ratio in the United States 1998

From American Dental Association: Distribution of dentists in the United States by region and state, 1998, Chicago, 2000, The Association.

Another important trend is the changing gender of the dentist workforce. The number of female dentists is increasing rapidly and accounted for almost 14% of the total number of active private practitioners in 1998.⁶

Table 3-3 shows the distribution of active dentists in private practice by specialty. General practitioners account for approximately 80% of practitioners. This 80/20 split between general practitioners and specialists is the opposite of that in medicine.

Table 3-3 Distribution of Active Private Practitioners by Specialty in the United States, 1991

Data from American Dental Association: Distribution of dentists in the United States by region and state, 1991, Chicago, 1993, The Association.

Table 3-4 presents the distribution of active practitioners across the nine regions of the country. Dentists are in every area, but significant variation in the number of people per dentist among regions exists. The primary determinants of the number of dentists in an area are population and per capita income.⁷

Table 3-5 shows the age distribution of active private practitioners. This table carries an important message regarding the future supply of dental manpower. In the next 10 to 20 years the number of retiring dentists will outpace the new entrants into the profession.

Table 3-5 Age Distribution of Active Private Practitioners in the United States, 1998

From American Dental Association: Distribution of dentists in the United States by region and state, 1998, Chicago, 2000, The Association.

Characteristics of Dental Practices

The organization and characteristics of dental practices play an important role in determining the efficiency of the delivery system. First, the size of a dental practice may have significant consequences on access to dental care, as well as the unit cost or fees of dental services. The presence of economies or diseconomies of scale and the extent of dental markets are the main determinants of the dental practice size.

Table 3-6 indicates that dentists are organized in small-size practices. In fact, almost 96% of all dental practices consist of one-dentist (82.6%) or two-dentist (13.3%) practices. Approximately 4% of all dental practices are considered group practices: three or more dentists who share expenses or revenue. Given that this pattern of dental practice size has persisted for many years, it strongly suggests lack of significant economies of scale with larger practice size. This and additional evidence seem to run contrary to conventional wisdom that larger practices are more efficient than smaller practices.⁸

Table 3-6 Distribution of Active Private Practitioners and Dental Practices by Size

* The total number of practices (110,230) was estimated assuming that the mean number of dentists in the category “three or more dentists” is four.

From the 1998 survey of dental practice, ADA, March 2000.

Table 3-7 offers additional evidence of the relatively small size of dental practices. This table shows the square feet of office space, number of operatories, and number of auxiliary staff members in an average dental practice. It also gives the frequency of use of specific units of equipment. Table 3-8 provides further details regarding the frequency and number of specific types of auxiliary staff members employed by dental practices. Although the average dental practice employs four auxiliaries, the number varies from zero to more than seven auxiliary staff members (Table 3-9).

Table 3-7 Mean Office Space, Number of Operatories, Number of Auxiliaries, and Office Equipment, All Active Private Practitioners, 1998