Oral Health Group
Feature

The Perceived Issue of Oversupply Dentists


May 1, 2015
by Oral Health

Oral Health’s roundtable of dental professionals discuss dentistry as a commodity, the impact of maldistribution and the need for differentiation.


Bokrossy, Kath #2 Nov2014Kathleen Bokrossy, RDH, has been bringing engaging energy to the dental profession for the last 30 years. Kathleen is the founder of D-Sharp Dental Instruments, rdhu, RDH Portfolio Manager and QA Coach where her vision is to help transform the ‘Dental Hygiene Experience’. Kathleen works closely with dental practices to help them grow and to improve the patient experience.

 

Philp, Lisa Feb 2012Lisa Philp is President of Transitions Consulting Group, a full-service coaching company for dentistry. Taking complex data and detail, she simplifies for others to understand, while recognizing patterns of what could work better. Lisa’s mission is to make dentistry simple and fun so professionals will achieve fulfillment in the workplace.

 

elliot mechanicElliot Mechanic, DDS, has been practicing multi-disciplinary, restorative esthetic dentistry in Montreal, Canada since 1979. Dr. Mechanic is the esthetic editor of Canada’s Oral Health magazine and is on the editorial board of Dentistry Today. He also is the co-founder of the Canadian Academy for Esthetic Dentistry.

 

David LindDave Lind is the Principal and Broker of Record of Professional Practice Sales Ltd. (PPS). Prior to joining PPS, David was Senior Vice President, CIT Financial, with overall accountability for the Healthcare business. During his 18 years with CIT/Newcourt, he developed a strong understanding of the personal and professional needs of dentists, particularly as they enter and exit the profession. Dave is an author in The Professional Advisory, which is delivered with Oral Health magazine.

 

Aldo BacciaAldo Boccia, BSc, DDS, is a current member of the Oral Health editorial board. He has been very involved in dentistry for many years and has been President of a number of organizations including West Toronto Dental Society, The Toronto Academy of Dentistry and The American Society of Geriatric Dentistry.

 

Timothy A. Brown head shotTim Brown is the CEO of ROI Corporation and the owner of Profitable Practice book, magazine and CE programs. Tim has been a speaker at over 250 Continuing Education seminars around the world.


 

It has been said that it is not the number of dentists that is the problem, but rather the uneven distribution of dentists and dental offices. Can this maldistribution be resolved and if so, how?

 

Kathleen Bokrossy I am not sure if this maldistrubtion can or should be resolved. There are 10 million Canadians without dental care. I think the issues/pressures and strategies to address it, change dramatically depending on the type of dental care we are talking about. If its emergency care, that uneven distribution is a huge problem because emergency care is all about proximity to a finite number of potential patients, therefore supply will always exceed demand in areas where the offices/potential patients needing urgent care is high. On the other hand, cosmetic dentistry is about postal code or location. Affluent neighborhoods can handle a much higher density of dental offices than low-income neighborhoods that specialize in this form of dentistry.  Preventive dentistry however is where I feel the market has yet to be tapped and can change the maldistribution argument dramatically.   The challenges with current dental office density will go away as a problem, if we can get a higher percentage of people visiting offices at a higher frequency.

Lisa Philp The best way to affect the misdistribution is for graduates to move to rural areas where dentist to patient ratio is healthy of at least 1800-2000 per provider with multiple types of procedures and insurance policies.

Elliot Mechanic I don’t believe that the mal-distribution can be solved.  You can’t force people to live where they don’t want to live. There is a reason why the major urban centers are heavily populated.  People want to live there! Young people today are very sophisticated and selective in their appearance, food choices, and activities.  They want to live in places that suit their lifestyle.

Dave Lind Although it can be said that the current issue facing dentistry is the oversupply of total dentists, the statistics would tell us that it is mostly the mal-distribution of dentists in Ontario that creates the difficulties or challenges relating to practice performance. There is an increased supply of new dentists both from graduation, and from foreign trained dentists. We also find dentists working past the traditional retirement age. This serves to exacerbate the problem. Overall a general practice needs a population to dentist ratio of 1,250 to 1 to be sustainable, (This does not mean 1,250 active patients in a practice as there are patients who are non-compliant or semi active). Overall in Ontario, the ratio of population to dentists fell by approximately 20 percent in the past 10 years to about 1600 people to one dentist, suggesting competitive pressure but not an unmanageable ratio. However the greater issue is that many GTA communities have ratios of 1,100 to one or less, a very challenging ratio. This issue can be resolved if the college recognized that the number of dentists is at or reaching capacity. The issue of oversupply in key regions needs some type of incentive to encourage people from smaller communities in rural Ontario to enter the profession. In the winter/spring 2015 issue of U of T Dentistry magazine, Dr. Dan Haas, Dean, proudly states the average GPA to enter U of T dental school was 3.8. This metric would have to be de-emphasized and replaced with an emphasis on awarding entrance to students from rural communities. I’m told this was done successfully back in the 1970’s with those students returning to their communities to practice.

Aldo Baccia There is no doubt that there is a perceived view of an oversupply, maldistribution or an uneven distribution of dentists and dental offices in Ontario. In Toronto, in 2010, the dentist to patient ratio was 1:1200.  This has placed a tremendous strain on the Toronto dentist to not only gain new patients, but also retain existing patients within the practice.  Today there is no longer six months wait for a regular appoint and a one-week wait for emergencies.  Patients can be seen the same day in most offices.  The busyness of any one practice is not only a result of the increase in the numbers of dentists, but also the decrease in caries incidence in children who are now adults.  The Practice of Dentistry as a Health Care practice has now become a Business!

Dentists have had to be creative and use the latest in technology to retain patients.

The redistribution of dentists and dental practices today would create a great problem and have the fairness commissioners and competition bureaus involved.  The governments of course want to see competition.  They want access to care, patient choices and affordable pricing.  Therefore, at the present time retention of patients appears to be the only solution for continued viability of a dental practice.  Unlike the past two decades, the patient today rarely calls the dental office for an appointment unless it is an emergency.  The dental team constantly calls the patient personally or electronically (computer, etc.).  The dental team provides gimmicks, i.e. Virtual reality games, videos, the latest in technologies, draws, lottery tickets and prizes, and some extensive websites to lure the patients back to the office. The dental practice has truly become a business.  We must take better care of the patients we have. So Retention, Retention, Retention!

 

Tim Brown There are numerous incentives to encourage dentists to depart from the major cities and practice in rural and remote Canada. The largest incentive is the cost of living and the purchase price of the dental practice. Housing costs are 40 to 60 percent lower and purchase prices of dental practices are 30 to 40 percent lower in rural and remote Canada. Therefore, financial incentives are in place and they have been for decades. With this said, the profile of today’s new dentist simply does not embrace the sensibilities of rural and remote communities and lifestyles due to distance from family and cultural centers. Sadly, I predict that maldistribution will not be solved by low cost of living and purchase prices.

 

Is the presumed oversupply of dentists affecting access to care and/or quality of care to patients and if so, how? Will dentistry resort to price wars and discounting? Is this happening already and if so, what if anything, can be done about it?


Kathleen Bokrossy
In any market, oversupply of any service leads to commoditization, which drives prices down, and reduces the level of service since there is less profit to re-invest in the business, whether its training, the latest technology etc. I think every office has one of two choices, either play the commodity game which means you look like everyone else and let pricing/specials differentiate you, or your specialize. You take your greatest strengths and you build on them to differentiate yourself in the market place. The market will pay more for services that they believe will give them a better result, but unless they understand or perceive that difference, they will shop for the lowest price. We have seen this phenomenon over and over as more and more competitors saturate a market.

 

Lisa Philp The oversupply of dentists is affecting access, as there are a lot more choices of what dental practice to choose, how to work out a bargain, is there any discounts or coupons.  This fee bargaining may increase the demand of Canadians who visit the dentist, however it will make it harder for the practice owner to maintain latest courses, materials, technology and treatment regimens.

The oversupply also drives the temptation for the general dentist to keep more procedures in house that they may not have clinical experience to deliver technically which causes shrinkage in the specialty profession. The current wars are with cleanings, scaling and home care aids, etc. The urban startup gets desperate and may have discounts, coupons and free services to attract patients for the initial visit.  The profession would have to band together with collaboration on fee guides, collection ethics and insurance to have any hope of stopping the price wars.

 

Elliot Mechanic I don’t believe that quality of care is an issue of oversupply. It is an issue of mindset, knowledge, and how a dentist chooses to delivery dentistry. For instance if a dentist only offers his patient one option of treatment he is blind to all the other possibilities.  Price wars and discounting are a state of mind! Certain products like Chanel are never discounted, go up in price annually and are never on sale yet people line up to buy them.

 

Dave Lind Yes, it is likely that the quality of care is suffering. Due to increased competition, dentists are being pressured into a more aggressive treatment approach with their patients, in addition to feeling the need to offer services that are possibly beyond their skill level. According to supply demand theory, the natural response to this supply demand change is that pricing will be affected. In dentistry however, it is unclear that the market has the price sensitivity that is common to most markets. This is partially due to the fact that dentistry is largely fee guide driven, and insurance based. Dental consumers are generally unaware of competitive pricing in this industry. There is some pricing pressure from some patient groups, which can be overcome with a focus on developing patient loyalty, through progressive communication, clinical, and relationship strategies.

 

Aldo Baccia The presumed oversupply of dentists or dental practices in larger municipalities has contributed to access to care. A greater number of dental practices are now open seven days per week with daily-extended hours as well.  Some offices are open from 7 a.m. to 11 p.m.    There are no longer waits of up to six months, as was common 30 years ago, to see your dentist.  In most cases you can see a general dentist the same day. However, this fact has not significantly reduced fees to allow lower income patients access to every dental office in Ontario. Today, after four decades of fluoride in our water supply and toothpastes, and with an erosion of welfare and corporate benefits and the increase in dentists, all these has been taken a big bite out of the dental profession.  Up to 1990, a dental practice could survive with 1000 patients.  However, today I feel that at least 2000 patients are required to sustain a dental practice.  After all, only a little more than one-half of the population sees a dentist on a regular basis. In order to keep busy we are seeing many general practitioners performing dental treatments that should be referred to a specialist. We have also begun to see some price reduction for dental services in the GTA.  That in itself is not a problem for a dentist can set his/her own fees and adjust the fees as he/she sees fit for the procedure being performed and or the specific patient.  What we have observed is that the “insured patient” has one set of fees and the “uninsured patient” has another set of fees.  This is unethical and unprofessional and will and has caught the attention of the dental insurance providers and the Royal College of Dental Surgeons of Ontario where fraud and malpractice charges could be pursued.

 

Tim Brown Dentists are not able to advertise prices therefore it’s hard for analysts to determine price discounting but the empirical information and my company’s database verifies the discounting or courtesy fee reductions have been in place for years and they are increasing in the high density communities or where competition is fierce. I predict that rebates, courtesy discounts or out right price wars will increase substantially.


How will the perceived oversupply or maldistribution affect dentists wanting to sell practices in downtown or suburban areas of the GTA that are considered to have “too many dentists”? Will younger or foreign-trained dentists prefer to buy existing, patient-loaded practices and will they pay a premium for them?


Kathleen Bokrossy
Yes, I think that purchasing a loyal patient base is an extremely important consideration for any new dentist looking to buy an existing practice. The challenge is to understand how much of that loyalty is tied to the personality of the selling dentist vs the “experience” they have built around the dental practice.  Because it’s so easy for a client to leave and find a new dentist in an over-supplied market, the purchasing dentist needs to determine how many of the patients he/she will likely be able to retain when the personality.

 

Lisa Philp The selling dentist in GTA would be wise to capitalize now as values are very high and sellers are not enough to supply buyers or group or corporate entities that are willing to pay top dollar. It is critical for the buyer to assess the practice patient count, average revenue per patient and outstanding dentistry to assure a future that will cover debt load of high dollar purchase and that they can replace the production of leaving owner.

Elliot Mechanic Dental practices will always sell in areas where there are patients and people want to live. As proof of that there are always businesses that open up in areas of a perceived oversupply and yet they become the hottest thing.  It is all about how it is presented and delivered.

 

Dave Lind In an oversupplied area, practice buyers are quite prepared to pay significant premiums for practices with a loyal patient base and good new patient flow. Patients are actually more valuable (to a strong breaking point) than in an underserviced area.

 

Aldo Baccia At the present time, and I am not certain for how much longer, the GTA dentists have enjoyed a preferred “sellers” market.  The perceived oversupply of dentists and dental practices has not changed this fact over the past 6-8 years. We continue to graduate Canadian dentists at record numbers and retrain foreign trained dentists at increased numbers.  These dentists are eager to own their own practices.  Because of the economic climate, most of these new dentists realize the difficulty in setting up and starting a new practice in the already saturated GTA.  The financial institutions are all eager to provide loans, and currently at very reasonable rates, so the new dentist prefers to buy an established practice.  These patient-loaded practices have an immediate return on their investments and for this reason the new dentist will continue to purchase established practices in the GTA where more and more of the baby boomer dentists are retiring.

 

Tim Brown For those dentists in the major cities, fair market values and final sale prices have doubled in the last five years and in certain very high-density areas, prices have tripled. Today’s young dentists prefer to buy a fully patient loaded practice and they are willing to pay a substantial premium above appraised value in order to obtain the highly coveted active patient list. Sadly the same value increases do not gravitate to all rural and remote practices but there is modest upward price movement in these areas.

 


How can dentists, especially new graduates or internationally-trained dentists qualified to practice here, be encouraged to practice in less heavily concentrated areas, such as rural areas?


Kathleen Bokrossy
I believe that education is the key to everything. They need to be aware of the challenges and know the risks/rewards of their ultimate decision on where to set up their practice. I have seen some smaller communities do a wonderful job at educating (i.e. marketing) the advantages of living and practicing in their communities. When quality of life is factored into the equation, and the dentist has a realistic understanding of what they are getting into, many of these communities can offer tremendous advantage over practicing in more major, high-density markets.

 

Lisa Philp Practices must differentiate themselves by knowing the business metric performance, shared vision by the entire dental team with a playbook of systems and hyper focus on Patient loyalty, service and retention. They make it their business to know the patients, status and keep them coming back over an over into a welcoming facility with technology and friendly team. The practice must have an identity, brand and digital footprint to be found on the internet and must cater to the Chief Purchasing officer of health care “mom” who wants the dental practice to be easy and convenient to work with and the practice caters to her family and children when needed.

 

Elliot Mechanic There are always people who prefer to live in a rural area with the lifestyle that those areas provide. However, most young people today don’t want to live in Mayberry. Even if you bring them there by gunpoint, they will eventually find a way to escape.

 

Dave Lind The only incentive is economics and education. Currently money is inexpensive and readily available due to low interest rates and strong appetites by the banks serving the dental profession. Therefore, practice buyers are prepared to pay high premiums for a practice to stay in a high demand urban area. The only way that new dentists will want to look at rural areas is through economics and lifestyle. As the gap between prices paid for urban practices versus rural practices widens to the point that buyers feel compelled to consider the rural opportunity due the underlying economics. We have been seeing some evidence of this changing in the last 12 months.

 

Aldo Baccia Encouraging new dental graduates and new retrained dentists to seek a rural practice has proven to be very difficult.  In past years the Admission committees at both faculties encouraged and promoted the acceptance of more dental applicants from rural areas to no avail. Today the Faculties of Dentistry at both universities have outreach programs. Students do a rotation in rural and northern Ontario communities for two weeks at a time providing dental treatment.  This program exposes the student to different approaches to dental treatments and a rural community lifestyle with the intention that some students will return to a rural community after graduation.  A rural dental practice has greatly reduced overhead expenses and therefore a better net profit at the end of the day.  If one likes the lifestyle, it would be an excellent choice for a new graduate or retrained international dentist. I am also of the firm belief that the governments, both provincially and locally, should give incentives to the new or retrained dentist to help finance relocation or a new dental facility for the specific rural community in need of dental services. I know that this was done by different levels of governments 35-45 years ago in Ontario and could be re-instated. This would entice some dentists.

 


How can dentists (current and new grads) differentiate themselves and their practices in today’s competitive environment? Will the dentists who are better at marketing “beat out” better clinicians?

 

Kathleen Bokrossy To me there are two stages to marketing, the marketing that gets the patient in the door the first time, and the marketing that keeps them loyal and gets them to return over and over again, while telling all their friends and family about their experience (i.e. the raving fans). Being a better clinician on its own isn’t enough; especially when the patient has no idea what makes you more skilled and how that skill impacts them in a positive way.  On the other hand, being an awesome marketer and getting new patients in the door isn’t enough either.  Poor clinicians and/or misrepresented marketing, means you won’t be able to retain your patients or get any referrals.  Successful, differentiated practices need all three components, an effective strategy to attract new patients, a wonderful experience while in your care by excellent well trained clinicians, and a strategy to ensure that patients continue to return and tell all their friends and family about how wonderful their experience was.

 

Lisa Philp Yes!! YES!! Eighty-five percent of a dental practice success is based on patients choosing WHOM they will buy from as oppose to WHAT they will buy.  Now is NOT the time for complacency and hope the world knows how good you are.  Go out and tell them how and why.

 

Elliot Mechanic I believe in the coming years, the middle ground of dentistry will disappear.  The majority of successful practices will be marketing dependent and follow the AAA formula. A1=availability A2=affability and A3=ability. Notice how I believe that a dentist’s ability is the last important element in these types of practices.  On the other end of the scape will be the high quality practitioner with exceptional skills delivering to patients requiring and appreciating these services.  However, in the coming decades with better prevention available I believe the needs for these services will decrease reducing the need for these types of practices.

 

Dave Lind This is easily the most important factor today. Although dentists are in competitive situations there are winners and losers. Why does one practice have 2,500 patients, and the practice across the street have only 700 patients? The answer is that successful practices have developed a competitive differential advantage versus their local competition. As in real estate, location is important, a definite marketing and patient retention strategy is the key to success. This opportunity to develop patient loyalty should be the everyday focus of every dental office. This loyalty develops through the staff and up to the dentist, and is a combination of service excellence, clinical skills, communication, and an indication of caring for the needs of that patient. Treating patients well combined with a superior customer service experience will prevail over competitive or pricing pressures in the market.

 

Aldo Baccia In a recent study, Drs. A. Ahmad and C. Quinonez reported that in the GTA the dentists were clustered in communities with high household incomes and so there is a maldistribution of dentists based on household income, household education and the number of immigrants in the community. With today’s unpredictable economic times, job security is uncertain for the average Ontarian.  The breadwinner must provide basic food, clothing and a roof over his/her family.  Dentistry is normally at the bottom of the list of things to attend to unless there is pain involved.  And dentistry is also the last to recover when economic times improve for the family.  We see this time and time again so dental practices notice this slow down and there is very little that can be done. When the Supreme Court permitted advertising and credit card payment for dentistry, there was a scramble for the market share and it continues today.  The marketing of dental practices is now widespread.  Unfortunately, we now see that the better marketers have won over the better clinician. Dental practices are offering free treatments to new patients, gifts for referring patients, lottery tickets and reduced prices.  The experienced and knowledgeable clinician does not usually discount his/her fees and certainly does not advertise his/her fees.

 

Tim Brown The most successful practitioners in the high density and highly competitive areas of Canada are focusing on customer service and outstanding patient experiences. Many years ago those who started to offer evening and weekend hours were successful and attracting patients away from those who maintain traditional hours. However there are so many practices that now offer convenience that that is no longer an effective marketing tool.

 


What role do Canadian dental schools play in the supposed oversupply of dentists? What motivates a school (dental or hygiene) to turn away tuition paying students?

 

Kathleen Bokrossy Students graduating today have excellent technical skill; however they need to be taught the importance of differentiation, the challenges with maldistribution and that marketing is not a bad word. Most dentists become dentists because they want to practice the art of dentistry. Unfortunately a business needs to be built around that endeavor that has the same challenges as any other business, supply, demand, commoditization, the need for marketing, etc. With such a large percentage of dentists graduating and opening up their own business, I am always surprised at how little business training is built into the curriculum.  I believe the dental market is growing, but to participate in that growth, the skills dentists are graduating with need to grow as well.

 

Lisa Philp Canadian dental schools are graduating more new grads from Canada and qualifying students, this combined with out of country trained dds in the USA… there are too many dds supplied into the population at a time when many aspects are preparing what seems like a “Perfect Storm”.  The current dentists (Nine of 10 provinces have over 30 percent of DDS over age of 55) have advanced their age of retirement and holding on to their practices. Young Canadian patients have been exposed to fluoride, which will reduce the need for restorative visits, boomers will lose insurance after leaving work force, and elderly patients with most need find it harder to maintain dental appointments and the hyper competitive environment caused by lack of enough patients in urban centers.

Elliot Mechanic Dental schools are in the business of making money and getting government and corporate grants.  They will do whatever is good for them, as they have to survive as well.

 

Dave Lind People that want to be dentists will do so at all costs. If they have the intelligence and resources, they will go to any length to fulfill their professional dreams. In the U of T article mentioned above, Dean Haas states that only 38 percent of new dentists registered in Ontario in 2012 graduated from the two Ontario dental schools. The rest graduated from the USA or abroad. Their objective in increasing enrollment is to enable some of those students to attend dental school in their home province. If we could only get them to recruit students from rural communities, we would begin to correct the imbalance.

 

Aldo Baccia In the 1990’s, for financial and/or oversupply of dentists in Ontario, the Dental Schools began diminishing enrolment. The impact on the number of dental practices however, was neutralized by the influx of foreign dentists and by Canadians who could not get into Canadian Dental Faculties, attending U.S. schools returned to Ontario to set up practices.  An interesting note that comes from the RCDSO website is that in 2012 there were only 37% of the dentists registered in Ontario that had graduated from the two Ontario dental faculties. Taking these numbers into consideration and for financial gains, the U. of T. Faculty of Dentistry (as well as some Hygiene Colleges) has decided to loosen their admission restriction policies and increase enrolment from 65 to 95 Canadian students.  This places less of a financial burden on a Canadian student trained at home and more financial support to our own Faculty.  Most faculties of dentistry are financially strapped and this move should help here at home. Plus it gives more Canadians an opportunity to get a dental education in Canada where we are fully apprised of the kind of dental education and training the student has received for better care for our Ontario population.  Hygiene Schools have witnessed the same scenario.  If the student cannot get accepted in Ontario they seek admission elsewhere and then return to Ontario after graduation creating an oversupply of hygienists. 

 

 

What about the number of dental hygienists and the oversupply in this profession? What is the impact on employment prospects, wages, job security and the future for dental hygienists in Ontario?

 

Kathleen Bokrossy This subject is very near and dear to my heart. I believe we are in the midst of two competing phenomena’s right now. Commoditization due to maldistribution (which is driving wages lower due to a more competitive market place) and greater public awareness of the positive impact that regular hygiene visits can have on early detection.  This will continue to drive the total number of hygiene visits up per year (i.e. more people visiting their dental office more often).  Fortunately, I believe that the same strategy addresses both issues.  As dental hygienists, you have to combat commoditization through differentiation.  And the best way to differentiate yourself is to be part of the team that actively educates patients and the public on the benefits of regular visits to the dental office.  You move from commodity to asset when you are able to differentiate yourself by actively growing the patient list through the wonderful work we do and the referability you build into your day-to-day patient interaction.  You do that with the attitude, the intention and the on-going learning/development of the skills required to keep you out of the low-priced commodity based world. It’s both a scary and an exciting time.  Scary for the person that wants to sit back and let the world happen to them, exciting for the person that wants to take the initiative, get better, develop their skill, manage their intention and happen to the world.

 

Lisa Philp Dental hygiene has changed dramatically from a serious shortage and high wages and lack of choice for dentists to choose.  Today, there is a vast oversupply; competition between job candidates and existing high wage hygienists must earn their position with proper billing, periodontal care and overall patient service. The hygiene entry wage has declined significantly and for most long term existing hygienist’s wages have been FROZEN forever without question to maintain job security. In our experience at Transitions building current standard of care services, the hygienist today must be open minded, professional and take their role seriously with how they contribute to prevention, periodontal disease and restorative dentistry. The challenge with lower entry wages, frozen current wages and oversupply of hygienists has led to a real fear that scaling and cleanings will become fee reduced and commoditized as part of competition and new patient promo’s by new practices. The dental practice will always be better with a hygienist and as time progress’s the need for a RDH will be high due to the patient generations, reduced dental caries causing a decline in dental restorative needs seen by the Dentist.  This demands the focus be on more preventive and diagnostic care via the hygiene department.


Elliot Mechanic
I personally believe that a hygienist salary should be on par with a highly qualified chair side assistant or front desk personnel.  They are all essential to a thriving dental practice.  Like everybody else dental job security should be based on skill, dependability, and dedication…not winning by default.


Dave Lind
The hygienist population will be regulated by supply and demand. As we have seen in the past several years, there is an oversupply of hygienists due to more private college graduates. This extra hygienist pool didn’t help to increase total provincial hygiene production, but had the effect of creating a wage war, which has reduced the hygienist average pay levels. If the hygienist population continues to increase, there will be continued wage pressure.

 

Aldo Baccia Dental hygienists have experienced the same difficulty in acquiring an education in Ontario and have had to go outside Canada.   Over the past 5-7 years hygienists have had great difficulty in acquiring a full time placement after graduation, as have the dentists.  We have seen an abundance of hygienists unable to secure a full time placement and have had to work in 2-3 different dental offices to achieve full time employment. Hygienists like dentists, graduate with financial debit and require immediate placement to repay school loans. In Ontario the increased number of new hygiene schools has produced an oversupply of hygienists. The hygienist’s hourly rate has dropped in the last 5 years in the GTA and most certainly in the rural areas.  The oversupply impacts on their job security as so many hygienists are presenting themselves in dental offices looking for work.  Therefore the dentists have many choices.  In some dental offices where dentists are not busy we find that the dentist is performing hygiene duties.  This will further impact on the hygienists’ security and future. The effects of the oversupply of dental manpower will have to be observed and analyzed on a regular basis to establish its effects on ethics, professionalism, public trust and access to and cost of dental care to the public.

 

Tim Brown My first suggestion is to implement more formal business training in the third or fourth year of the curriculum such that new graduates will be more capable of making prudent economic decisions. The clinical training must remain the priority, but my informal survey of thousands of dentists since I started in this industry over 35 years ago, confirms that each and everyone of them was seeking more business training during dental school and they all admit that they learned their business skills through trial and error which was not their preference.