By Trisha E. O'Hehir
Today, there are 166,000 licensed dentists and 120,000 licensed hygienists. During the next 10 years, those numbers will be reversed, and hygienists will outnumber dentists for the first time ever. This reversal in numbers results from a domino effect set in motion several decades ago. The dominos are just beginning to fall and nothing can stop them now.
You know the dominos are falling, so let's take a look at how it all started. We need to go back several decades and plug in a few critical decisions made along the way.
• 1840 — The first dental school was opened in Baltimore and took five students. Dentistry attracted primarily men who remained in the profession for several decades. Up until this time, dentists were trained as apprentices. These preceptor dentists were a valuable source of income to established dentists. (Here is an interesting connection to the present push for preceptorship training for dental hygienists. In 1840, preceptorship training was considered inadequate for dentists. Maybe we should remind dentists of that fact the next time preceptorship training for hygienists is brought up.)
• 1913 — Dental hygiene profession was founded, drawing primarily females who worked only a short time before quitting to raise their families.
• 1960s — This is the decade in which I graduated, and hygienists were in high demand. The number of hygienists was slowly increasing, yet not every dentist could hire a hygienist. There were always patients to see, so we worked under general supervision, allowing the dentist to play golf on Wednesdays — the traditional day off back then. There really was a shortage of hygienists in the 1960s, but it wasn't yet a political issue — not until the 1980s.
• 1970s — The number of dental hygiene schools increased and, therefore, more hygienists graduated and entered the work force each year. However, hygiene careers averaged only five years.
• 1970s — Epidemiological studies reported a huge disparity between the amount of periodontal disease and the number of qualified periodontists to provide care. It was suggested that general dental offices needed to assume more responsibility and since dentists were already so busy, it was only natural that hygienists would begin providing nonsurgical periodontal therapy. Expanded-functions programs flourished in the 1970s, some with a periodontal focus, and others with a restorative focus. Hygienists were taught local anesthesia, root planing, surgical curettage, suturing, application of rubber dam, matrix band and wedge, placing and carving restorations, fabricating and placing temporary crowns, and other restorative procedures. The states with expanded-functions programs (with the exception of Pennsylvania) embraced the broadened role of the hygienist.
A shortage of dentists in rural areas was also reported. Using financial incentives, the federal government planned to solve this problem by increasing the number of dentists. States were offered funding to build new dental schools if they agreed to double enrollment. If memory serves me, Oregon was the only state to turn down the offer. All of the others agreed and soon the market was flooded with twice the number of new dentists looking for work. No one told these new grads they should move to rural areas. No, they all moved to the big cities. Those were the days when young dentists found hygiene salaries better than associateship positions. Despite their lack of dental hygiene skills, many worked as hygienists.
Expanded-functions programs for hygienists and an increase in the overall number of dentists made some dentists very uneasy. They feared the unknown, and were squeezed by the flood of dentists in the market. They feared the potential for dental hygienists to work independently and refer patients to only the best dentists. The reaction was to tighten supervision of hygienists, replacing general supervision with direct supervision.
• 1980s — The dental hygiene shortage became a political issue. In response, many new community college programs opened. Strangely, with a recognized shortage of hygienists, many four-year degree programs were closed during this time. Although often done in the name of cost cutting, controlling our education was seen as a way to preempt independent practice for hygienists.
• 1990s — States began licensing hygienists by credentials, making mobility easier for hygienists and contributing to extended careers. In general, hygienists are remaining in the work force longer. The number of hygienists is steadily increasing. The number of hygienists leaving the field for other work or retirement is considerably smaller than the number of new graduates. Currently, there are 265 dental hygiene schools in the country and only 56 dental schools.
Several dental schools closed and the others reduced enrollment. More female students are accepted each year. The pattern of employment for women dentists is traditionally part-time, which will reduce the work force of dentists in the future. In addition to a reduced work force from new graduates, retirement of the boom-time dentists who graduated in the 1970s is beginning. With fewer dental schools now than in the past, reduced enrollment and more women in the dental ranks, the number of dentists retiring or leaving the field will far outnumber new grads entering the work force.
All these facts point to a reversal, with hygienists outnumbering dentists in the near future. More hygienists means more opportunity. Half the population still doesn't receive regular dental care. Perhaps the growing numbers of hygienists will seize this opportunity. Now is the time to anticipate the change and plan for the future. What do you think the best use of our increasing numbers will be to fight dental disease even more effectively than we do now? I'm interested in your ideas.
Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She also is an international speaker and editor of Perio Reports, a newsletter containing news about periodontics for dental professionals. The Web site for Perio Reports is www.perioreports.com. She can be reached by phone at (800) 374-4290 and by e-mail at [email protected].