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J Am Dent Assoc, Vol 131, No 12, 1750-1754.
© 2000 American Dental Association |
TRENDS |
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ABSTRACT |
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Methods. Questionnaires were sent to approximately 8,000 dentists nationwide. Samples were drawn for each of the following racial/ethnic groupings: white, black, Hispanic, Native American and Asian. The survey instrument asked questions about personal characteristics, work and private practice issues, household and practice income, and patient characteristics; it also asked for dentists’ opinions. A final adjusted response rate of 57.0 percent was achieved.
Results. The majority of all dentists responded that they were "very satisfied" with their profession, but the survey found variations in patient mix, employment history and provision of free or discounted care.
Conclusions. The survey examined dentists by race/ethnicity to identify differences and similarities. Cultural and ethnic minorities are the fastest growing segment of the U.S. population. As the profession becomes more diverse, practice patterns will affect the overall dental profession.
Practice Implications. Dentists’ racial/ethnic backgrounds may change the provision of care as patient mix varies, with each dentist group treating a specific group of patients in regard to family income, racial/ethnic background and subgroups for whom they offer free or reduced-rate dental care.
Because the demographics of the dentist population are changing, the American Dental Association developed the 1996 Dentist Profile Survey.1 The survey collected information on family and personal concerns, dental practice experiences, work-related issues and ADA membership. Historically, dentistry has been a predominantly white male profession. Of the 152,205 professionally active dentists in the United States in 1996, 125,279 (82.3 percent) were white.2 In 1972/1973, only 7.2 percent of all dental students were nonwhite (that is, Native American, Asian, black or Hispanic). However, the dental population has begun to change. In 1996/1997, enrollments showed that 33.7 percent of the dental student population was nonwhite.3 Asian students made up 67.1 percent of this non-white population.
The survey sample was selected with the use of the Association’s sampling frame of professionally active dentists, which includes all people currently enrolled in, or having graduated from, an accredited dental school in the United States. Professionally active dentists are defined as those dentists whose primary or secondary occupation is private practice (full-time or part-time) or those who work as a dental school faculty/staff member, a member of the armed forces or other federal services, a state or local government employee, a hospital staff dentist, a graduate student/intern/resident or other health/dental organization staff member. Any dentist who was dead, retired, a foreign resident, a current student or not professionally active was removed from the sample. The sample then was broken down according to the following racial/ethnic categories: white; black; Hispanic; Asian and Pacific Islander (Asian in this article); American Indian, Aleut or Eskimo (Native American in this article); other (self-selected option); and missing or unknown race/ethnicity data.
Samples of varying size were drawn from all of the groups except Native American and "other." Because of their small numbers, all Native American and "other" dentists were included in the study. Those dentists in the sample who identified themselves in the survey as a member of a particular race/ethnicity were reclassified and analyzed as such. The final sample contained 7,938 professionally active dentists.
The mail survey was sent in late August 1996, with three follow-up mailings sent to non-respondents in October, November and December 1996. In total, 4,057 dentists completed and returned the survey. Because not all of the dentists included in the sample were able to participate, we calculated an adjusted response rate by deleting people who could not be located, were dead or were practicing outside the United States. The adjusted response rate for the survey was 57.0 percent.
Educational debt.
Responding minority dentist groups (that is, nonwhite) graduated from dental school with an average educational debt ranging between $35,000 and $37,000. White dentists had an average educational debt of $29,849 at graduation from dental school. The general practitioner-to-specialist ratio was consistent among groups of minority dentists, with specialists accounting for about 14 to 16 percent of dentists in each group. Just over 18 percent of white dentists were specialists. All dentists (white and non-white) worked an average of 46 to 47 weeks per year. Of the 37 to 38 hours per week on average spent in the practice, about 31 to 33 hours were spent treating patients.
Issues facing dentists.
Respondents also were asked about the relative importance of a variety of issues that confront dentists in the United States. The issues were presented with the use of a four-point scale ranging from "very important" to "not important" and then ranked by the percentage of "very important" responses. From the list of selected dental issues, all dentists identified "financial stability" as the issue they considered most important. The percentage breakdown of dentists indicating "financial stability" as "very important" is as follows: black dentists, 81.8 percent; Hispanic dentists, 78.0 percent; Asian dentists, 74.4 percent; white dentists, 69.9 percent; and Native American dentists, 64.2 percent.
"Increasing patient base" was rated the second most important issue by 63.3 percent of Asian dentists, 60.9 percent of Hispanic dentists and 49.0 percent of white dentists. Black dentists rated "practice opportunities" as the second most important issue (57.7 percent). Native American dentists indicated that "professional liability" (52.8 percent) was the second most important dental issue facing dentists today.
When asked to rank family and personal issues (selected from a list) in a similar manner, all dentists identified "balancing work and family obligations" as the top issue ("very important"). While "balancing work and family obligations" was the most important dental issue, responses ranged from 89.9 percent for dentists of Hispanic ethnicity to 79.6 percent for Native American dentists. The second most important family and personal issue for all dentists was "financial well-being." The percentage of "very important" responses ranged from 76.5 percent for black dentists to 55.0 percent for Native American dentists.
Career paths of dentists.
Black and Native American dentists were most likely to have had another career before entering dental school (30.6 percent and 30.0 percent of respondents, respectively). Of those who did have a previous career, approximately 23 to 24 percent in both of these groups had been involved in a health-related occupation. In contrast, only 13 to 15 percent of white, Hispanic and Asian dentists had another career before entering dental school. The average age of responding dentists was as follows: black dentists, 47.4 years; white dentists, 46.4 years; Native American dentists, 46.1 years; Asian dentists, 42.8 years; and Hispanic dentists, 42.4 years.
Dentists also were asked about their current dental practice. The majority of all respondents indicated that they had established their current primary practice (that is, they were the original owners). The highest percentage was 67.3 percent for Native American dentists, followed by 64.6 percent for black dentists, 57.5 percent for Hispanic dentists, 55.7 percent for white dentists and 51.0 percent for Asian dentists. The majority of all responding dentists joined their current primary practice as owners (sole proprietor or partner). Three-fourths of Native American dentists and more than 65 percent of white, black and Hispanic dentists began their dental careers as owners; 55.7 percent of Asian dentists started as owners. About 85 percent of white dentists, 83 percent of Native American dentists and 76 percent of black, Hispanic and Asian dentists described their current employment status in their primary practice as an owner. About 42 to 46 percent of all dentists’ current primary practices were incorporated.
We also asked dentists how satisfied they were with their choice of profession and their current primary practice. The majority of all respondents reported that they were "very satisfied" with their choice of profession, with percentages for each group as follows: white dentists, 59.5 percent; black dentists, 58.9 percent; Hispanic dentists, 61.3 percent; Native American dentists, 59.1 percent; and Asian dentists, 55.4 percent. Less satisfaction was expressed about their current primary practices. Only 35.7 percent of black dentists and 39.2 percent of Asian dentists were "very satisfied" with the current primary practice. In comparison, 50.0 percent of Native American dentists, 47.2 percent of white dentists and 44.1 percent of Hispanic dentists reported that they were "very satisfied."
Private practitioners were asked which of the four following statements most accurately reflected the patient workload in their current primary practice: "too busy to treat all patients," "overworked but treated all patients," "not overworked" and "not busy enough." Figure 1
RESULTS
TOP
ABSTRACT
RESULTS
CONCLUSION
REFERENCES
Dentists were asked about the relative importance of a variety of family and personal issues confronting most dental practitioners. The results indicated that similarities and differences exist between various racial/ethnic groups of dentists. 
(page 1751) details dentists’ responses to these statements. The most common response from dentists was "not overworked." White dentists chose this response more frequently (46.4 percent) than did the other racial/ethnic groups. About 8 percent of Native American dentists indicated that they were "not busy enough."
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The findings show that the race/ethnicity of the dentist seems to influence the race/ethnicity of patients.
Patients.
The survey instrument explored the race/ethnicity of patients as well. Our findings show that the race/ethnicity of the dentist seems to influence the race/ethnicity of patients who come to them for treatment (Figure 2, page 1752). White dentists treated white patients primarily (76.6 percent). About 62 percent of black dentists’ patients were black and 27.0 percent were white. Hispanic dentists treated equal percentages of Hispanic and white patients: 45.4 percent and 43.6 percent, respectively. Native American dentists primarily treated white patients (62.7 percent), with Hispanics, Native Americans and blacks each making up about 10 percent of their patient base. Asian dentists also primarily treated whites (47.5 percent) and Asians (25.1 percent).
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(page 1752) details the distribution of average family income of patients according to race/ethnicity. Black and Hispanic dentists reported that they treated the greatest proportion of patients whose annual family incomes were less than $15,000 (25.5 and 24.8 percent of their patients, respectively). White dentists treated the greatest proportion of patients whose annual family incomes were more than $70,000 (17.2 percent of their patients).
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Respondents were asked to indicate (from a list) the sources of new patients for all dentists in their primary practice for the previous 12 months. For all dentist groups, the primary source of new patients was "patients" (that is, their existing patients). The majority of Native American and white dentists specified "patients" as their best source of new patients (58.5 percent and 53.3 percent of new patients, respectively). Other dentist groups reported slightly lower percentages of new patients being referred from existing patients. "Other dentists (general practitioners or specialists)" were cited as the second-best source of new patients by all dentists, with responses ranging from 17.2 percent of new patients for white dentists to 12.8 percent of new patients for Asian dentists. Black and Asian dentists reported that the percentage of new patients from managed care contracts (12.6 percent and 10.5 percent, respectively) was almost equal to the percentage of new patients referred from other dentists. The table (page 1753) shows the average percentages of new patients from all sources.
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CONCLUSION |
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FOOTNOTES |
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REFERENCES |
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TOPABSTRACTRESULTSCONCLUSIONREFERENCES |
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