You can still remember the pride and excitement you felt 20 years ago, when you first opened the doors to your new office. Your young spouse had helped you choose the color scheme. The dental chairs smelled like brand-new car seats. Your pliers glistened, and you smiled every time you filed a new patient’s study casts into your model storage cabinet. You saved every dime you could to pay off your tuition loans. You knew that if you treated people fairly, remained honest, and acted professionally, you would succeed.
Now the memories of those years seem to have lost some of their luster. You still believe you would do it all again, but the competition in your small town is becoming extremely tight. Twenty years ago, you were one of the town’s only 2 orthodontists; now there are 7. Some newcomers have resorted to controversial marketing practices and rogue treatment philosophies. You know you have fewer case starts than you had back then, although you have kept your fees competitive and your office immaculate. It’s true that some of your former referral sources have retired, but your hunch is that there just might be too many orthodontists graduating these days.
A quick Internet search seems to confirm your suspicions. You discover that new residency programs are educating classes comprising dozens of aspiring orthodontists. And there is a strong possibility that more than a dozen new dental schools could soon open their doors. Burdened with debt of hundreds of thousands of dollars, these graduates need to earn—quickly—to survive.
It is high time to take a critical look at the direction that dentistry and orthodontics might be headed. Many of us are old enough to remember an infamous Time magazine article that portrayed the dentist as almost a relic. The point of the article was that as dental decay became controlled, the coincidental overproduction of dentists was leading the profession toward obsolescence. Although no one can argue that the eradication of any disease is a valuable step for humanity, dental leadership was then shortsighted and continued to graduate an overabundance of practitioners. Fortunately, the subsequent actions of organized dentistry, the closure of several dental schools, and professional attrition combined to restrict our numbers. The issue at the time was perceived as a simple supply-and-demand problem: too many dentists and too few patients, coupled with decreasing dental disease.
The problem with oversupply of almost any workforce, however, means more competition for a smaller consumer pool. As competition increases, the possibility of transgression from appropriate ethical behavior increases. Will a young graduate, faced with a monumental education debt and a decreasing potential patient pool, be forced to resort to unethical behavior to make ends meet? Will garish advertising, kickbacks for referrals, and claims of superiority continue to accelerate? Will false or misleading statements continue to proliferate as competing practitioners vie for a “smaller piece of the pie”? In short, will professionalism be undermined for the sake of increased earning power?
One must ask who is—or should be—controlling the number of graduates of our orthodontic specialty programs and our dental schools. Certainly, the rank-and-file practitioner or the struggling faculty member has little control over the number of graduates from our programs each year.
The continued shortage of quality dental educators compounds the problem. As more and more dental schools sprout up to house more and more orthodontic programs, our strained cadre of dental educators will find increasing difficulty in maintaining our educational preeminence. And who but the trusting public suffers most, since they cannot discern the quality of care they receive?
It is time for dental leadership to step forward, put politics aside, and address the dire issue of oversupply. We’ve seen it before, and we cannot let it happen again. Our leadership must find the vision—and the courage—to monitor our ranks before someone or something else does.
The time for a hero is now. The health of our patients depends on it.