Is the current number of grads per year unsustainable for the future of dentistry?

[lwergod]

from 1990 to 2010, the number of grads increased from ~4000 to ~5000. From 2010 to the number of grads/year increased from ~5000 to ~6400.

so from 1990 to 2010, the # of grads/year increased by ~25% over 20 years. In the second 10 year interval the number of grads/year increased by %28.

compare that to population growth in the US, from 1990 to 2010 the population increased from ~250m to ~310m or a 24% increase over 20 years.

and from 2010 to 2020, the population increased from ~310m to ~330m or a 7% increase over 10 years.


In medicine, the number of incoming practicing physicians is not bottlenecked by the number of schools, but rather the number of residencies. The government has not increased number of residencies that much in the last two decades.

is it time to make GPR/AEGD residencies to become mandatory?


Also am I the only one who's noticed that all these new schools are from these "Doctor of Osteopathic Medical" schools? Lecom, AT still, MWU, Western, Roseman, Touro, New England. The avg gpa and dat for these colleges are very sub par too. like a 3.25 oGPA and 18.5 aa.

Why TF are these DO institutions allowed to gain accreditation by the ADA? and with more DO institutions popping up everywhere, will the ADA accredit more of these sketchy private "non-profit" institutions?


just look at how fast the ratio of dentists to population has plummeted in the last decade.

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[ToothJockey]

http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0718_1.pdf

How Many Dentists Are Needed in 2040: Executive Summary

Five background articles in Section 2 of the “Advancing Dental Education in the 21st Century” project examined some of the factors likely to impact the number of dentists needed in 2040: 1) the oral health of the population, 2) changes in the utilization of dental services, 3) new technologies...

www.jdentaled.org

Hell yes! Based on these 2 studies, there's way too many dentists in the workforce and it's increasing. By 2040, there could be a surplus of 32% to 110%, meaning that there could be about twice as many dentists practicing as there are dentists needed. Unfortunately nobody ever talks about these topics in the pre-dent areas.

Student loans are going to get more than doubled by 2040, and salaries are going to get halved. I wonder what that's gonna do to the profession.

 

[lwergod]

also why is the ADA ok with this? are they representing the interests of corporate or the dentists?

looks like a corrupt organization to me.


is it time for residencies to become mandatory to create another bottleneck?

 

[ToothJockey]

This is just my speculation. But huge private equity groups have started investing in dentistry. KKR for example, the 2nd largest PE firm in the world, bought Heartland Dental. I don't think it's unreasonable to believe that these private equity groups have used their money to buy influence within ADA.

And the best thing for private equity/corporate dental would be to have a surplus of dentists graduating so they can drive down salaries and pocket more money for themselves. Supply and Demand, the more dentists there are, the lower the demand for individual dentists, which means dentists lose their negotiating power in contracts. Rememeber, there are multi-millionaires and billionaires with a lot to lose here. Who do you think wins the fight, a lowly dentist or a powerful billionaire?

For example, Heartland dental, the corporate group bought by KKR. They only pay their associate dentists 25% collections or something like that. I'm sure their overhead is no higher than 50% for such a huge operation. That means they pocket 25%+ from every dentist. In the future with more and more dentists, they can reduce the % they pay dentists, maybe lower it to only 20%, and dentists can't do anything about it because there is a surplus of dentists and they have no negotiating power. I'm guessing if corporate dental takes over, dentists will have to form a union or something.

^disclaimer: this is all opinions from a pre-dent

 

[Ladm8]

For the sake of clarity I believe your stats for those schools are way off, these are the handbook stats

Midwestern-AZ	20 AA	3.49
LECOM	19.8 AA	3.53
Western	19.7 AA	3.33
AT	19.6 AA	3.37
Roseman	19.5 AA	3.25
New England	19.1 AA	3.43

Now based off the ADEA study link lets look at changes from 2010-2019
1. total US pop: 308M --> 328M (20M increase)
2. total US dentists: 183K -->200K (17K increase, or looking at it differently 1,683 people per dentist to 1,640 people per dentist so almost the same, not the plummeting you described)
3. total US graduates per year: 5,020 to 6,305
4. total number of dental schools: 58 to 66 (historical average is around 55)
5. programs in the pipeline that I could find: 2 (Cal N State and Texas Tech)

My take: I think the real issue is the skyrocketing tuition combined with stagnating reimbursements, I don't view it as a supply/demand issue.
The applicant pool itself is more competitive than ever and always growing, you could also discuss the increase of women dentists from 23% to 33% in the last 10 years, there's a whole conversation that can be had about how that effects ownership levels vs associating pathways.

I'm not trying to prove/disprove anything but just wanted to put some numbers out there and open the conversation, maybe some practicing dentists could chime in.

 

[giannis]

This is far more complicated than just supply/demand. You're only backing up your ideas with basic microeconomics. You cannot just take anything and put it into this economics model. There are way too many factors and exceptions to dentistry.

Don't overthink it. You've chosen a great profession.

 

[Big Time Hoosier]

The flood of new dental schools will continue for the foreseeable future. At least two new programs I’m aware of are slated to come online: Texas Tech and California Northstate University. Meanwhile the demand for dental services and insurance reimbursement continue to decline.

If you’re entering this profession with $500,000+ in student loans, buckle up!

Big Hoss

 

[Big Time Hoosier]

This is far more complicated than just supply/demand. You're only backing up your ideas with basic microeconomics. You cannot just take anything and put it into this economics model. There are way too many factors and exceptions to dentistry.

Don't overthink it. You've chosen a great profession.

Predent, right?

Big Hoss

 

[giannis]

Predent, right?

Big Hoss

no, MBA you?

 

[morristhecat]

The more there are of us, the easier we are to control. Can't ask for a decent salary or benefits if there is someone desperate for a job who won't ask for either. This is especially true in a saturated area. Couple this with the greed of schools and the naivety of your average pre-dental or medical student, and this prophecy pretty much fulfills itself.

 

[AONLINE]

The flood of new dental schools will continue for the foreseeable future. At least two new programs I’m aware of are slated to come online: Texas Tech and California Northstate University.

Why on earth does California need to add an 8th dental school? Because most Californian kids refuse to move anywhere out-of-state?

 

[lwergod]

Why on earth does California need to add an 8th dental school? Because most Californian kids refuse to move anywhere out-of-state?

As someone not from Cali, hopefully they all stay in Cali lol.


on a serious note, there is no way all these seats are sustainable in the long run. Student loan forgiveness programs (tax bomb, + PLSF) will start reaching their limits. The federal government will start hemorrhaging money and will be forced to change its student loan policy which will lead to many of these new private 'non-profit' schools shutting down.

 

[Utdarsenal]

This is a not-so-simple question and can lead to endless debates.

From the perspective of a dentist (me being able to comfortably feed my family everyday and continue living how I do), yes, the current number of dentists is too much.

From a consumer (patient) perspective, perhaps there aren't enough because the price of health and dental care in the U.S. is very expensive compared to other countries. If there were more, the prices could drop and become more affordable for people.

This is a complicated question but the honest truth (I studied abroad and am familiar with dental industries in other countries), the U.S. has the most protectionist policies in place. Policies that protect dentists within the country and make it a little more difficult for patients.

It's a sensitive topic because we've all been brought up with the idea that as dentist's, we're supposed to be making easy bank. Any possible threat to that (another school opening) is already seen as an attack to our well-being. This is a protectionist mentality. Unfortunately, it gets even more complicated because now everyone is graduating with hundreds of thousands in debt, so there's already an incentive to have to make as much money as possible to pay it all off ASAP, leading even further into the protectionist mentality of "the less competitors, the better for me".

I've noticed that the U.S. tends to have less dentists than other countries in regards to population. My friends in other countries are shocked that I'm booked three weeks in advance in a saturated city.

I personally think there are much bigger problems to worry about (insurances, regulations, tuition) than another school opening. You can't have the best of everything.. think about this for a second. Lets say there were 5 CODA-accredited foreign universities that were charging 10k/tuition a year. Due to this attractive tuition, they receive an influx of applications compared to USC and Harvard who start receiving less because the 80k/year tuition doesn't sound so attractive anymore. Due to other attractive offers, U.S. schools look at themselves in the mirror and think, we have to do something, and start trying to compete tuition-wise. Leading to less debt. BUT, yes, more schools would lead to more dentists and more competition, possibly less pay.. It's difficult to balance everything out. This is what I mean by, "it's complicated"..

 

[dentistrydmd]

I personally think there are much bigger problems to worry about (insurances, regulations, tuition) than another school opening. You can't have the best of everything.. think about this for a second. Lets say there were 5 CODA-accredited foreign universities that were charging 10k/tuition a year. Due to this attractive tuition, they receive an influx of applications compared to USC and Harvard who start receiving less because the 80k/year tuition doesn't sound so attractive anymore. Due to other attractive offers, U.S. schools look at themselves in the mirror and think, we have to do something, and start trying to compete tuition-wise. Leading to less debt. BUT, yes, more schools would lead to more dentists and more competition, possibly less pay.. It's difficult to balance everything out. This is what I mean by, "it's complicated"..

You're making an incorrect assumption that schools care about maintaining the same quality pool of acceptances. Even with more schools, the expensive schools have only continued to increase tuitions, leading to a lower overall quality of applicant, whereas the cheaper schools generally acquire the most competitive applicants. Cost controls don't seem to be on the radar, as the government continues to increase the guarantees for school loans regardless of fees. The universities have no incentive to reduce costs.

 

[1070752]

I love how we complain "there are too many dentists", then also complain "there aren't enough dentists in public health, rural, and providing affordable care". Which one is it?

Fact is, the US and Canada have the strongest protectionist policies for dentists (and all other medical professions) as another poster mentioned. We have it good, trust me. Yes tuition is abnormally high, and a complete scam for what a lot of schools are charging. It will get tougher for new dentists, but things will have to change with the environment and market. We also have to change and adapt if we want to continue to be successful in a changing environment.

 

[LegendaryPanda]

I love how we complain "there are too many dentists", then also complain "there aren't enough dentists in public health, rural, and providing affordable care". Which one is it?

It's possible to have both.

 

[stumpdentist]

I researched not only this but also a change in acceptance rate numbers that I hypothesize may happen for dental schools.

Here's the summary of what I was finding.

The results are in. 7 months after COVID-19 showed up on American shores, we received an update on the impact that the global pandemic has had on your practice, patients, and livelihood.

As the situation with our practices constantly evolve, the data says there may be some troubling times ahead.

THE BIG NUMBERS

Projections show that there will be a 38% reduction in the dental industry in 2020 followed by a 20% reduction in 2021.

The demand for dentistry is not the only problem, but also the looming drop in the supply of dentists. An indirect yet important side effect of these challenging times is the shifting trend in the enrollment of secondary education throughout the country.

The most recent numbers show only an overall 4% drop in undergraduates in college. More importantly we need to look at the statistics when it comes to college freshmen enrollment. After a massive 16.1% drop in high school grads showing up on college campuses, we can expect to see some major changes in dental school applications and acceptance rate in 3 to 4 years. Hey, we can't blame these 18 year olds if they don't want to go to school without the community, dorms, and house parties to go with it.

PROBLEMS ON THE HORIZON

We predict that this decline in college freshmen will have a major impact on the dental industry. Here are a few snags that we foresee coming down the pipeline:

Problem 1:

Dental schools have financial problems- leading to an inability to support the same number of students. Class size declines and the amount of dentists coming out of school decrease significantly. Part-time faculty may be more diffucult to recruit. Especially the doctors that are also balancing a private pratice on the side.

Problem 2:

Dental school tuition increases significantly. This already happened well before we even heard whispers of the unknown virus out of China. As the members of Generation Z come to the time to apply to college and determine their careers, increasing student debt will impact their decision making arguably more than any other generation before. The recently released book Zconomy, written by Jason Dorsey and Denise Villa, brings us some juicy factoids about young people born between approximately 1996 and 2012.

• 66% of Gen Z are worried about accumulating or not being able to pay off student loand debt, and 79% are worried about their future overall.
• 86% of high school aged kids say they plan to go to college, yet half of those are only willing to take on $10,000 or less in student loan debt
• 27% say they are not willing to take on any student loan debt at all.
• After seeing their parents struggle through the Great Recession and Millenials handle large loads of student debt, Gen-Zers will think twice about taken out such a large debt load.

We have seen an unbelieveable increase in average dental school debt among graduates the last few years. The combination of Generazation Z values and spending habits plus the expected continual increase in dental student debt does not bode well for the supply of dentists in the next 20 years.

Problem 3:

Dental schools may struggle, but survive. Less students applying means a less competitive applicant pool. Acceptance rate increases accordingly. This has already occurred in the pharmacy industry and we wouldn't be suprised if it happens for the dental indsutry as well. Take a look at the pharm school acceptance rates since 2003. The latest released acceptance rate of 82.7% (!) allows everyone and their mothers to become a pharmacist.

Check out this content from Paul Tran, a YouTuber that discusses the pharmacist profession.

He discusses a few things that happened to pharmacy schools beginning in the mid 2000s

• Pharmacy schools more than doubled in number in only 10 years
• There were less applicants in 2018 compared to 2007.

ARE DENTISTS THE NEW PHARMACISTS?

Two of the factors that contributed to an increasing acceptance rate for pharmacy schools are appearing in the the dental industry. These include an increase in amount of schools and a decrease in dental school applicants.



According to ADEA data, dental school applicants have decreased from 2016 to 2019 (12,058 to 11,148).

But there is one major difference. The amount of student debt between the two professional schools. Dental school average debt is almost double that of pharmacy school according to the latest graduation data. Additionally, factoring in the debt to income ratios of recent graduated dental and pharmacy students shows that pharmacists are winning the game.

As more dental school seats open and Generation Z turns it's attention away from traditional education and student debt, we have a couple predictions of what could be the consequence.

Less dentists or less competent dentists.

Either way, buckle up. It's going to be rough.

 

[stumpdentist]

I love how we complain "there are too many dentists", then also complain "there aren't enough dentists in public health, rural, and providing affordable care". Which one is it?

Fact is, the US and Canada have the strongest protectionist policies for dentists (and all other medical professions) as another poster mentioned. We have it good, trust me. Yes tuition is abnormally high, and a complete scam for what a lot of schools are charging. It will get tougher for new dentists, but things will have to change with the environment and market. We also have to change and adapt if we want to continue to be successful in a changing environment.

"Things will have to change with the environment and market"

Things won't have to change if there is not a huge change in student loan programs. As long as there is unlimited access to graduate student loans, schools will be able to continue charging whatever they like because someone out there will pay it- contributing to the cycle of crippling student debt.

 

[dentistrydmd]

"Things will have to change with the environment and market"

Things won't have to change if there is not a huge change in student loan programs. As long as there is unlimited access to graduate student loans, schools will be able to continue charging whatever they like because someone out there will pay it- contributing to the cycle of crippling student debt.

The government created this problem. Take away guarantees and tuition will reflect the value that is offered by it and schools will not simply open to profit off the backs of insurmountably indebted students.

 

[PerioDont]

The government created this problem. Take away guarantees and tuition will reflect the value that is offered by it and schools will not simply open to profit off the backs of insurmountably indebted students.

I honestly am very hesitant about recommending dentistry as a career to anyone who can't afford to pay for school, i.e. the vast majority of people.

This is so sad as it can be a truly wonderful profession, but financially it really has gotten to a point where most schools do not make sense to attend if on loans. This is the state of the profession. To be successful as a GP, you then have to taken on another half a million in loans to buy a practice which is a grind to run day to day as well. Then you must spend 15 years of your life paying them both off, and you now in your mid-40s if you are lucky and your kids are now gearing up to go to college. I personally believe that most people would be better off either going PA/MD, nursing, or even dental hygiene if they really love teeth (very few people actually do though in my opinion.)

 

[Ladm8]

I disagree with @stumpdentist, Our profession is not heading where pharmacy is today. Dentists tend to be very protectionist over their profession. The number of dental schools hasn't exponentially increased (I even expect a few to close after this pandemic) while the accepted applicant pool gets more competitive each year. The real problem with dental education is the insane tuition rates, so only go to dental school if you're wealthy or have a solid plan post-graduation to tackle all this.
Don't go to dental school if you're gonna accumulate 500k debt and associate (be a slave to insurers) at ~150k a year, but who am I to guide anyone...

 

[yappy]

I honestly am very hesitant about recommending dentistry as a career to anyone who can't afford to pay for school, i.e. the vast majority of people.

This is so sad as it can be a truly wonderful profession, but financially it really has gotten to a point where most schools do not make sense to attend if on loans. This is the state of the profession. To be successful as a GP, you then have to taken on another half a million in loans to buy a practice which is a grind to run day to day as well. Then you must spend 15 years of your life paying them both off, and you now in your mid-40s if you are lucky and your kids are now gearing up to go to college. I personally believe that most people would be better off either going PA/MD, nursing, or even dental hygiene if they really love teeth (very few people actually do though in my opinion.)

I agree with this. IMO dentistry is solid but the financial cost to enter it is ruining the career. 150k or less in debt is totally doable. However, more often than not people are graduating with substantially more than that.

You don’t have to love teeth to be a dentist/ hygienist; just as a general surgeon doesn’t have to love gall bladder. To enjoy dentistry you should be interested in treating oral disease and malfunction through direct patient care.

Because the cost of entry into MD and PA are much cheaper than dentistry, I agree with you. Students should strongly consider those career routes too.

 

[stumpdentist]

I disagree with @stumpdentist, Our profession is not heading where pharmacy is today. Dentists tend to be very protectionist over their profession. The number of dental schools hasn't exponentially increased (I even expect a few to close after this pandemic) while the accepted applicant pool gets more competitive each year. The real problem with dental education is the insane tuition rates, so only go to dental school if you're wealthy or have a solid plan post-graduation to tackle all this.
Don't go to dental school if you're gonna accumulate 500k debt and associate (be a slave to insurers) at ~150k a year, but who am I to guide anyone...

Absolutely fair points. Dental schools may have not increased exponentially, but there have been ~10 that have opened in the past 10 years. I would argue that this is not insignificant.

And I agree with the insane tuition rates, but your second part of "only go to dental school if you're wealthy or have a solid plan post-graduation" is problematic itself. If the only people going to dental schools are those that can afford it or come from wealth, most likely the patient pool will not be as strong if tuition payments were not a factor.

Organized dentistry has come out many times in the United States saying that the US doesn't have a problem with dental supply, but instead distribution. If only those from wealthy backgrounds are able to go into dentistry, the distribution problem will become even worse.

 

[stumpdentist]

I love how we complain "there are too many dentists", then also complain "there aren't enough dentists in public health, rural, and providing affordable care". Which one is it?

Fact is, the US and Canada have the strongest protectionist policies for dentists (and all other medical professions) as another poster mentioned. We have it good, trust me. Yes tuition is abnormally high, and a complete scam for what a lot of schools are charging. It will get tougher for new dentists, but things will have to change with the environment and market. We also have to change and adapt if we want to continue to be successful in a changing environment.

You can absolutely have "too many dentists" and "not enough dentists in public health, etc." It's actually the situation we are living in right now. The ADA and state dental associations have basically said in the past (I can find the source for this) that we don't have a supply problem, but a distribution problem. There are enough dentists in areas that people want to live, but it's harder to get newly graduated dentists out to rural areas.

And "we do have it good" but I think that it is irresponsible to not tell those considering dentistry the downsides of it all. Medical professions in general have a high burnout rate just like many other high income professions. Providing realistic expectations to those in high school/undergrad considering dental school/dentistry is not disrespect to the profession, but being realistic. When I was in high school/undergrad thinking about going to dental school I "Didn't know what I didn't know" about the debt, stress, and rewards that come with dentistry. Discussing real things with those considering dentistry like:

• Stress doesn't end after dental school when you "made it." There are still going to be times of learning, progress, and budget management for years.
• Student debt is nothing to scoff at. Most likely, you aren't going to be buying your Mercedes or Tesla at age 30.

At the same time, as you said, there are great things about dentistry. There are not many professions (unless you start your own business) where you can be a CEO of 1 to 2 million dollar business in your early 30s

 

[toothstar]

no, MBA you?

from where? mba is no joke, I know we may crap on other degrees but I've met some inept MBAs in charge of some well-endowed private equity/healthcare conglomerates... and my brother, smart in some ways, is a dds/mba and still is a keyesnian

 

[mostlyghostly]

Look at how pharmacy evolved over the years from independently owned pharmacies to corporations with over saturation and decreasing salaries…it’s only a matter of time before history repeats itself with dentistry

 

[alexteethdocman]

Problem 2:

Dental school tuition increases significantly. This already happened well before we even heard whispers of the unknown virus out of China. As the members of Generation Z come to the time to apply to college and determine their careers, increasing student debt will impact their decision making arguably more than any other generation before. The recently released book Zconomy, written by Jason Dorsey and Denise Villa, brings us some juicy factoids about young people born between approximately 1996 and 2012.

• 66% of Gen Z are worried about accumulating or not being able to pay off student loand debt, and 79% are worried about their future overall.
• 86% of high school aged kids say they plan to go to college, yet half of those are only willing to take on $10,000 or less in student loan debt
• 27% say they are not willing to take on any student loan debt at all.
• After seeing their parents struggle through the Great Recession and Millenials handle large loads of student debt, Gen-Zers will think twice about taken out such a large debt load.

​

Problem 3:

Dental schools may struggle, but survive. Less students applying means a less competitive applicant pool. Acceptance rate increases accordingly. This has already occurred in the pharmacy industry and we wouldn't be suprised if it happens for the dental indsutry as well. Take a look at the pharm school acceptance rates since 2003. The latest released acceptance rate of 82.7% (!) allows everyone and their mothers to become a pharmacist.

​

Check out this content from Paul Tran, a YouTuber that discusses the pharmacist profession.

He discusses a few things that happened to pharmacy schools beginning in the mid 2000s

• Pharmacy schools more than doubled in number in only 10 years
• There were less applicants in 2018 compared to 2007.

ARE DENTISTS THE NEW PHARMACISTS?

You raise a few good points here, but you also make some conclusions that I don't exactly agree with.

1) The stats about Gen Z kids willingness to take on debt seems incredibly skewed. What 16 year old kid is going to say that they plan on taking on $50k+ in debt?? At that age, do kids really even comprehend how much debt they have to take on to even go to school these days? I'm sure a few do, but it has to be a small percentage. (And I'm sure the answers are very different coming from 14 year old freshmen vs 18 y/o's preparing to go to college)
Nonetheless, I do think that the debt is out of control and the entire system allowing it to happen is bound to crumble at some point.

2) Pharmacy is not the same as dentistry. We're comparing apples to oranges- besides pharma research, other jobs (like the avg drugstore pharmacist) won't exist in a few years because of increasing technology (online/automated pharmacies). Tech is not much of a threat in dentistry as so much of the work is hands-on and probably can't be 'automated' anytime soon.
Again, I'm not saying matriculation figures aren't changing due to an adapting acceptance system, but pharmacy has problems of its own.

- Just a clueless predent

 

[toothstar]

This is far more complicated than just supply/demand. You're only backing up your ideas with basic microeconomics. You cannot just take anything and put it into this economics model. There are way too many factors and exceptions to dentistry.

Don't overthink it. You've chosen a great profession.

this is such a terrible statement. you make a lot of them

 

[pubhealthdent]

Also am I the only one who's noticed that all these new schools are from these "Doctor of Osteopathic Medical" schools? Lecom, AT still, MWU, Western, Roseman, Touro, New England. The avg gpa and dat for these colleges are very sub par too. like a 3.25 oGPA and 18.5 aa.

Why TF are these DO institutions allowed to gain accreditation by the ADA? and with more DO institutions popping up everywhere, will the ADA accredit more of these sketchy private "non-profit" institutions?

Why would universities that also have osteopathic medicine programs not be allowed to gain accreditation? And how exactly are these schools "sketchy?"

Also those admissions stats are incorrect

 

[Big Time Hoosier]

And how exactly are these schools "sketchy?"

They don’t have football teams. All respectable universities have football teams.

Big Hoss