The Changing Demographics of Dentistry American Association of Endodontists August 18, 2011

Demand (1) population growth – trends and projections – overall U.S. & broken down by age (2) dental expenditures - total and per-capita – trends and projections (3) dental disease & changes in case mix Before looking at the changing demographics of dentists, we will look briefly at some basic factors related to the demand for dental services.

U.S. Population The figure on the left shows the growth of the U.S. population from 1950 to 2010 and projected growth in the U.S. population from 2010 to 2050. U.S. population grew by 130 million from 1950 to 2000. It is expected to grow by 138 million from 2000 to 2050. The figure on the left shows how the age distribution of the U.S. population has changed over time. The hump moving from left to right represents the baby boomers (the age cohort born between 1946 and 1964). The oldest baby boomers turned 65 this year. The retirement plans of these dentists will have a large impact on dentist workforce. 1990 Source: http://www.census.gov/population/www/projections/downloadablefiles.html Projections based on 2000 Census

Nominal and Real (base=2009) Dental Expenditures (in millions) This slide shows real and nominal dental expenditures over time. Real dental expenditures are adjusted for inflation. From 2008 to 2009 there was a small decrease in total dental expenditures. This was in spite of an increase in the overall population of the U.S. Source: Centers for Medicare and Medicaid Services - National Health Expenditure (NHE) Amounts

Real per Capita and per Patient Dental Expenditure Real per-capita and real per-patient dental expenditures. Real per capita dental expenditures are fairly stable over time. Source: National Health Expenditure (NHE) Amounts by Type of Expenditure and Source of Funds: Calendar Years 1965-2019. The health spending projections were based on the 2008 version of the NHE released in January 2010. 5-year average utilization rate and 3-year average dental market CPI used for projections.

Shifting Patterns of Care The graph is from a 2007 JADA article by Steve Eklund and show the decline in restoration per user over time by patient age. Source: Eklund, S. Trends in Dental Treatment, 1992 to 2007. J Am Dent Assoc, Vol 141, No 4, 391-399.

Shifting Patterns of Care Relative percent of total paid by procedure code grouping - Michigan The next figure is from the same article and shows trends in categories of procedures over time, in terms of percent of total expenditures. Source: Eklund, S. Trends in Dental Treatment, 1992 to 2007. J Am Dent Assoc, Vol 141, No 4, 391-399.

Supply (1) dental school – 1st year enrollment – trends – overall & by gender (2) retirement – average age of retirement (3) productivity – trends, percentage change from previous year, trends in total non-dentist staff (4) Dental Workforce Model – projections – total, dds per pop, age, gender (5) impact of female dentists – over time measured against an all male dentist workforce Now, we shift to supply. First, we will consider the source of new dentists entering the workforce. Then we will consider retirement. I will talk about the importance of productivity.

Actual and Projected Number of First-Year Enrollments Shows the disruption due to government intervention in the marketplace. A steep increase in the 1970s due to capitated funding for dental school, a subsequent steep decline in the 1980s when the funding stopped, and gradual rebound beginning in the 90s. This disruption can also be seen in the number of dental schools that closed during the 1980s and the number of new dental schools that have opened recently. Source: American Dental Association, Survey Center, Surveys of Dental Education; and ADA Dental Workforce Model

First-Year Enrollments, by Gender This slide shows the increase in the proportion of female dental students. Source: American Dental Association, Survey Center, Surveys of Dental Education

Retirement Rates are Falling Retirement rates for each age group are falling over time This means average age of retirement is increasing

Average Retirement Age of Dentists (June 2011 Masterfile/DOD Custom Data Run)

Actual and Projected Number of Dentists Note: Projections are based on 2008 base numbers. Source: 2010 American Dental Association Dental Workforce Model: 2008-2030

Dentist-to-Population Ratio Projections Source: 2010 American Dental Association Dental Workforce Model: 2008-2030

Average Number of Personnel per Independent Dentist, Among Dentists Employing Personnel,1985-2008 Productivity increases due to changes in technology. Another important driver is the increasing utilization of non-dentist staff. The result can be measured at the level of the individual dentist or practice. The overall result is that, over time, fewer dentists can produce the same amount of dental services. Source: American Dental Association, Health Policy Resources Center , Survey of Dental Practice

Actual and Projected Age Distribution of Professionally Active Dentists However, this view can be tempered by a look at U.S. dentist by age cohort. By age, the most productive dentists are 45 to 55 years of age. As shown in this slide dentists in this age range accounted for about 15% of all dentists in 2000. However, in 2015 and 2030, dentists in this age range will account for 10 to 12 percent of all dentists. Source: 2010 American Dental Association Dental Workforce Model: 2008-2030

Reduction in Total Hours Worked Due to Female Dentists Compared to an All Male Dentist Workforce Year Total Hrs 1982 0.7% 1987 1.0% 1991 1.3% 1995 1.6% 2000 2.0% 2010 2.9% 2020 4.6% 2030 5.4%

Number of Professionally Active Endodontists Source: American Dental Association , Survey Center, Distribution of Dentists by Region and State

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