EDITORIAL

Dental manpower’s dependence on dental education

R ecent news releases on dental manpower and dental education emphasize once again the critical interdependence between the two. There is no way to increase the number of dentists except through arduous, expensive, and prolonged education in institutions of higher learning. Despite an ever- expanding population that demands an equivalent increase in the number of dentists, the nation’s dental graduates are not increasing at the same rate as the population.

The result is that the 1950 ratio of one dentist for every 1,700 persons is now down to one dentist for every 2,000 persons, despite an actual increase in the number of dentists. The ratio will become even more unfavorable if new schools are not established and if old schools do not increase their undergraduate student enrollment.

A recent estimate in the ADA’s Annual Report on Dental Educatiolz for 1968-1969 reveals that it costs approximately $7,340.00 a year to educate a dental student. Part of this was recovered from tuition and student fees, but the dental schools and their parent universities still had to contribute an average of $2,147.00 each for each student in 1968. In the twenty-three state dental schools that were surveyed, the mean expenditure per student was $8,851.00, the income was $5,166.00, and the subsidy was $3,685.00. The figures for private schools were $5,865.00, $5,219.00, and $637.00, respectively, for each dental student. It is not surprising that universities are not clamoring to open new dental schools or to expand old ones. Clinic income provides about 23 per cent of the cost of dental education, and the balance comes from tuition, private contributions, and state or federal support. It is chiefly on these governmental sources that the schools must rely if dental education is to meet the nation’s dental manpower needs in the future.

Of particular interest in this respect is how well orthodontics is doing in fulfilling the manpower requirements in its specific area of dental practice. The answer is that, relatively, it is doing fairly well. The year 1950 can again be taken as a base. AA0 membership records show that there were 1,115 full-time orthodontists in 1950. The current total reported at the April, 1970, annual AA0 meeting is 4,732-an increase of more than 3,600 additional orthodontists in a 20-year period. The figures are accurate, since virtually every full-time ortho-

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524 Editorial Amer. J. Ortkodont. May1970

dontist aspires to AA0 membership. The manpower increase is far better in orthodontics than in dentistry as a whole.

This increase in orthodontists is due principally to forty-six graduate and postgraduate programs in the dental schools,* although the AAO’s excellent, rigidly supervised preceptorship program contributed more than 200 new specialists before the America,n Dental Bssociation terminated the program on Jan. 1, 1970. The dental schools currently are enrolling approximately 350 orthodontic students each year in their graduate and postgraduate programs. The advanced orthodontic course length varies from 18 to 36 months; this means that, at any given time, the universities are training nearly 700 new ortho- dontists. With the additional graduate programs that are being planned, it is possible that the number of practicing orthodontists will double in another 10 years.

In addition to orthodontics’ yearly enrollment of 350 graduate students, the seven other dental specialties withdraw 450 dentists from general practice each year. It is questionable whether the specialties are justified in taking one fourt,h of each year’s dental graduates when so much general dentistry remains to be done. A frequent statement is that a billion cavities remain unfilled in thr T’nited States; in additio’n, there is need for an uncounted number of crowns, bridges, and partial dentures. These needs must also be met, but the dental man- power shortage is so great that much of this work will have to wait until the schools provide enough dentists to do the job.

Meanwhile, the pressure will become more intense. Like medicine, dentistry is faced with social demands from an impatient public that increasingly relics on Medicare, Medicaid, unions, insurance, prepavment programs, and social workers to solve health needs that a,ctually qualify as a right rather than a privilege reserved for the affluent.

Dental schools arc gra,dually increasing the number of dentists that are graduating each year. In 1968 the total was 3,457, according to the 1968-1969 Annual Report that was compiled jointly by the American Association of Dcn- tal Schools and the ADA Council on Dental Education. This is an increase of 482 over the 2,975 dentists who graduated in 1952, when a new total of forty- t,wo dental schools had been reached. Today there are fifty-two dental schools, but two of them (Saint Louis University and Loyola University in New Orleans) are about to close.

Four new dental schools are scheduled to open by 1972 at various state institutions in Colorado, Florida, Illinois, and New York. In 3968 twenty-three of the nation’s dental schools were associated with private universities. All dental schools, public as well as private, are faced with serious financial prob- lems, and this is a greater hazard for private institutions than for state-sup- ported schools. None of these schools should be permitted to close, for it is much more difficult to finance and staff a new school than it is to maintain an established school.

*University graduate and postgraduate programs in orthodontics, AM. J. ORTHODONTICS 55: 399-403, 1969.

Volume 57 Number 5 Editorial 525

In a cost study on dental education for the fiscal year ending June 30, 1968, the American Association of Dental Schools found that the forty-six reporting schools had expenses of $108,649,227.00. Of this total, $78 million was spent on instruction, $16 million on services, and $14 million on research. The budget for state schools was $65 million; for private schools, $43 million. Four-year tuition costs range from $5,439.00 for state schools to $9,764.00 for private schools. The twenty-three public schools ha.d a total enrollment of 7,361 dental students, and the twenty-three private schools had 7,441 students.

None of these totals will be sufficient to meet aa estimate from the Depart- ment of Health, Education, and Welfare that dentistry will have to double its present capabilities by 1980. Possibly, part of it can be accomplished by dental auxiliaries, but the real solution to the dental manpower problem will come only from a marked increase in the production of dentists, and this can be accomplished only b.y a substantial increase in the funds that the federal govern- ment is willing to allocat,t to dental education.

R. F. D.