The challenge or validation of the concept of an oversupply of dental offices leads to asking if the problem is one of mal-distribution or concentration of dental resources. The number of the under-serviced could balance a discrepancy if we see the demographic as a potential opportunity. However, time suggests the answer is clearly that of oversupply rather than poor demographic distribution of dentists.
CONTRIBUTING SOURCES TO THE ABUNDANT SUPPLY OF DENTISTSIn the past few years, we have seen an abundant supply of dentists, and we ask how has this phenomena evolved? The following sources have contributed to the dental population concentration:
1. Although our domestic dental schools are graduating at a consistent rate, we see increasing numbers of recent graduates. Many Canadian dentists graduating from American and other accredited foreign dental training facilities who return to Canada for their professional careers comprise a large component of this group.
2. Foreign trained dentists accepted into Canadian training enhancement programs qualify for licensure in a number of jurisdictions upon successful completion of the program. This process welcomes many highly skilled practitioners, thus adding to the ratio of the escalating numbers.
3. The number of offices has increased as a result of the growth of offices operating only 2-3 days allowing for owners to associate in other larger practices. Many urban cross street corners have six dental offices in close proximity.
4. Some dentists trained offshore who had successfully operated in their country of origin prefer to open or purchase an existing practice rather than to follow a more traditional route of associateship for a number of years.
5. Ownership of a dental practice has the capability of generating an acceptable ROI. Even though there is a significant benefit in current practice valuations, the investment return on the proceeds of the sale often does not equal the profitability of a viable practice. Mature practitioners are, therefore, not anxious to sell, and they continue to practice well beyond retirement age.
6. The rapid increase in population is another influence of the ratio of dentist to population. Canada, particularly in Ontario, is undergoing one of the largest immigration influxes in the democratic world. The benefits of immigration, however, are diminished by the fact that first generation immigrants sometimes require time to internalize the North American style of preventive and early intervention modalities that native-born Canadians have come to accept as the norm. New Canadians often are reluctant to embrace enrolling in recare programs used in almost all practices. This issue is somewhat compensated by the perception of home-grown Canadians for whom routine dental care is increasingly accepted as part of their healthcare priorities.
7. Finally, the factor that the majority of new job opportunities for the population does not offer access to dental benefits, consequently, influencing the ability of new hires to acquire dental services.
FINDING THE SOLUTIONThe easy part of discussing the overall problem is doing an examination and diagnosis of the issues from a number of prospectives. Diagnosing the pathology is straightforward, but the real difficulty is remediating the problem. Some suggestions are the following:
Regulate the flow of new practitioners to conform to an agreed upon ratio of demands/supply. The difficulty of implementing this is the opposition from the right of the political spectrum who would say that governance is interfering with private enterprise and should just let the free market economy run its course. On the other hand, the left would accuse the profession of limiting access to dental services in order to prop up earnings artificially for dentists without benefit to the public.
The truth probably lies somewhere in the middle; the regulatory suggestion is an equal opportunity offender. If one accepts the thesis that the supply of dental offices outstrips the current demand and that the table could tilt even more in the foreseeable future, practitioners should devise a plan to cope with this reality. It may include a number of adjustments to the patient interface.Educate the existing patient base to appreciate the role that preventive dentistry furthers their general, and specifically, oral health profiles.Increase the focus and concentration of the whole office apparatus to reflect more significantly perceived patient-needs. More explanation of the benefits of the proposed treatment and acknowledgment of the sophisticated modalities employed by most dental facilities help patients appreciate the office’s focus and its benefits to their well-being; for example, the teams’ continuing education commitment. A treatment coordinator, a combination of the administrator and treatment coordinator, or a dentist best offers this type of presentation.Use the existing satisfied patient base as a primary source of increasing the inadequate new patient flow by having the administration professionally and subtly ask patients for referrals from their friends, coworkers, and family.
Offer treatment hours that reflect the patient population needs, not necessarily those of the staff.
Increase efficiency of existing operation to be able to continue offering quality dentistry to a potentially diminishing number of patients by considering amalgamating the physical facilities and sharing staff. This plan would help potentially marginal operations morph an entity via an efficient use of resources.
It is our responsibility to help the general public make wise personal oral care decisions. People appreciate and sometimes make sacrifices to obtain healthcare that they value. Therefore, if we fine-tune our existing operations to address patient needs, we will benefit dental providers and the demographic we serve.