Current Trends in Practice and Dental Education
(A report based on a presentation to the American Association of Women Dentists, Anaheim, Calif., July 2004)
Recently, we gave a presentation on women in dentistry at the 2004 annual conference of the American Association of Women Dentists in Anaheim, Calif. Dr. Scarbecz was a practicing sociologist and was already interested in the role of women in the workforce prior to becoming a faculty member at the University of Tennessee College of Dentistry. As a clinical faculty member, Dr. Ross had several years of experience encouraging and educating young women and men to be competent clinicians. As a member of the College’s admissions committee, she had interviewed hundreds of prospective students regarding their interest in dentistry. Our joint interests merged in a long-term study of women in the dental profession.
This article is a summary of our AAWD presentation. First, we summarize existing data from a variety of sources to paint a portrait of women in dentistry - their work hours and income compared to that of their male colleagues, and how women balance their professional and family responsibilities. Second, we focus on women in the pipeline - women in dental school. We present the results of our own research: a four-year longitudinal study of dental students. Our goal in presenting at the AAWD conference and in writing this companion article is to provide a “big picture” - the role of women in dentistry, the issues and challenges they face in practice, and the aspirations of future practitioners.
From a sociological perspective, the most interesting aspect of the dental profession is that it is one of the last independent health-care professions in the United States. Fully 76 percent of practicing U.S. dentists are in solo practice. Only 60 percent of physicians are in office-based practices, and of those, only 28 percent are in solo practice.1 It has been suggested that “The private practice of dentistry may provide an ideal laboratory for examining how women can integrate family and career. As the owner of one’s practice, a woman can set the rules to meet her needs.”2
Women in dentistry: practice trends
Currently, women make up about 19 percent of U.S. dentists,3 and the American Dental Association projects that women will be 28 percent of the dental workforce by the year 2020.1 Still, dentistry is behind medicine in that more than 30 percent of U.S. physicians are women.3
Female dentists in the United States are younger than their male colleagues. According to the latest data available, 80 percent are age 44 or under, while more than 60 percent of male dentists are age 45 or older.4 Compared to their male colleagues, women are less likely to be in solo practices and more likely to be employees or independent contractors. Fifty-three percent of female dentists are solo practitioners compared to 75 percent of male dentists, and 29 percent of women are employees or independent contractors compared to 8 percent of men.4 While this discrepancy is in part a function of age differences, women tend to move more slowly into solo practice arrangements than men.
Slightly more than half of all female and male dentists work full-time (between 32 and 42 hours per week). Women are somewhat more likely than men to work part-time: 28 percent vs. 15 percent, and are less likely to work overtime: 16 percent vs. 30 percent. A recent study indicated that marital status does not appear to have an impact on work hours among female dentists. However, having children reduces women’s work hours by nearly one workday per week, on average.5
Gender differences in income are frequent topics of discussion. According to a 1995 ADA survey, nearly two-thirds of female dentists believe that they earn less than their male counterparts, while nearly two-thirds of male dentists believe that there is no gender difference in dentists’ income levels.4 The existing data, however, indicates that the perceptions of female dentists are more accurate than those of their male colleagues.
A comparison of the average income of all female dentists with the average income of all male dentists is not a useful indicator of income inequality, because, as we have indicated, there are substantial gender differences in practice arrangements and experience among U.S. dentists. Still, when comparing the average net annual income of full-time male and female practitioners who have been out of dental school less than 10 years, women earned only 64 percent of what men earn. Additionally, among dentists in all age groups, women who were partners or who were in solo practice only earned 58 percent and 73 percent, respectively, of what men earned in the same practice arrangements. Women as employees only earned 47 percent of what men earn as dental practice employees.4 By comparison, in 1995, the ratio of female to male income among full-time workers in the United States with a bachelor’s degree or a higher level of education was 61 percent.6
A study conducted by Brown and Lazar7 in 1998 attempted to clarify the income picture by focusing solely on women and men who had similar practice characteristics and levels of experience. They analyzed income data from general practitioners who worked full-time, were less than 40 years old, had fewer than 20 years of experience, and who were also partners or sole owners of their practices. In that study, the average difference between male and female dentists in terms of net annual income was approximately $26,000, and the difference in hourly income was approximately $12. Gender was still an important predictor of income for dentists, even after taking into account additional factors such as age, experience, work hours, race, and regional location. The authors hypothesized that having children would reduce women’s net income due to the time required for family activities. The average annual income of male dentists actually increased slightly as their number of children increased. The effect of children on the income of women was more variable. Women with no children earned an annual average of $91,000; with one child, $107,000; and with three or more children, $98,000. Thus, the effect of children on income was inconsistent across gender categories and does not help us to understand why income differences exist between male and female general practitioners.
With respect to balancing the demands of dentistry and home life, women bear the brunt of the burden. According to the 1995 ADA survey, women dentists spent an average of 15 hours a week in “leisure with children,” 11 hours a week in childcare, and nine hours a week in housework.8 Combined, female dentists spent about double the amount of time in these activities than their male colleagues, adding what amounts to a substantial “second shift” of work to their lives.9 Women were also more likely than men to take a leave of absence from work for childrearing and more likely to take longer leaves of absence for that purpose.8
Women in the pipeline
The number of women in the pipeline for a career in dentistry has grown dramatically over the last 30 years. Enrollment of women in U.S. dental schools now stands at 44 percent;10 in 1970, only 1 percent of dental students were women.1 Additionally, women make up a larger proportion of the available candidates for dental school, and they come from a variety of backgrounds. For every 100 bachelor’s degrees earned by men in the United States, women earn 33 more.3 Furthermore, nearly one-third of female dentists had a previous occupation prior to dental school, compared to 15 percent of men. Of those women who had a previous occupation, more than 40 percent were in a dental-related occupation.4
The primary focus of our research has been women in the dental pipeline. We surveyed 430 first-year students from nine geographically dispersed U.S. dental schools in 2000 to 2001. We asked students about their motives for entering dental school and their aspirations regarding postgraduate dental education and practice arrangements. In 2003 to 2004, we resurveyed the same students. We asked these senior dental students about their aspirations regarding postgraduate dental education and practice arrangements, and the factors that influenced their decisions. In the fourth-year survey, 172 students from six of the original nine schools participated. To the best of our knowledge, this constituted the first longitudinal survey of dental students in the United States.
In our analysis of the first-year data, we found that students’ motives for attending dental school appeared to be organized into four distinct areas. The first cluster focused on money issues, and reflected the importance of financial and job security aspects of a dental career to students. The second cluster was a set of people-related motives. Students who gave high ratings to these motives thought that caring for and helping other people were important reasons for attending dental school. The third cluster centered on the notion of flexibility, and suggested that the freedom and flexibility that dentists have in scheduling their work relative to other professions, both health-care-related and otherwise, is important to dental students. The fourth cluster focused on business-related motives for becoming a dentist, and the degree to which students stressed self-employment and being one’s own boss as important reasons for pursuing a dental career.
Our data showed that both women and men found the financial aspects of a dental career equally important as a motive for attending dental school. The perceived flexibility of a dental career was also equally important to both men and women. On the other hand, male students rated business-related motives as being more important in their decision to pursue dental school than did female students. Conversely, female students rated caring or helping motives as more important than did their male counterparts.
When asked about their aspirations following dental school, significant gender differences among first-year students emerged. Despite the fact that first-year students are not likely to have a great deal of in-depth knowledge about dental specialties, with the exception of pediatric dentistry, women were less likely to aspire to postgraduate dental education than men. In fact, the most significant predictor of postgraduate educational aspirations among first-year students was gender. Furthermore, compared to men, women were less likely to see themselves in a solo practice following graduation and more likely to see themselves as an employee or associate in a dental practice.
Thus the primary significance of our first-year data is that women, even upon entry into dental school, were less likely to aspire to postgraduate education or higher-income-producing practice arrangements than were men. One possible explanation for this result may be that women lack sufficient role models - i.e., other women who are small-business owners or independent health-care providers. It is estimated that only 7 percent of all dentists in the United States are women in solo practices,1 so it is conceivable that female dental students have not even encountered women in these roles. Furthermore, other research on women’s aspirations regarding scientific careers11,12 suggests that women get less encouragement and social support for science-oriented careers than men and that women are less likely than men to perceive themselves as similar to people who pursue scientific professions.
Fortunately, our fourth-year data suggests that the experience of dental school has a leveling influence, which effectively erases some of the first-year gender differences. Both male and female fourth-year students perceived themselves to be equally competent as a dentist. Additionally, substantial majorities of both women and men said that, if given the opportunity to reconsider, they would choose a career in dentistry again.
Women in the fourth-year survey were more likely than men to have plans to pursue postgraduate education (45 percent vs. 33 percent), more likely than men to report that they had a mentor in dental school (55 percent vs. 44 percent), and more likely to report that their mentor encouraged them to pursue postgraduate education.
Additional analysis of our fourth-year data indicated that gender was no longer a significant predictor of students’ plans to pursue postgraduate dental education. Also, students’ original first-year predictions regarding the pursuit of postgraduate education did not predict whether, as a fourth-year student, they were actually planning postgraduate education in a dental specialty area. The primary predictors of postgraduate education were, in order of magnitude, dental school grades, marital status, and mentoring. Students who had a dental school mentor and students with grades above the sample median were, respectively, two and five times more likely to pursue postgraduate education. Conversely, married students were four times less likely to plan on postgraduate education than their single colleagues.
The only major gender differences that emerged in the fourth-year data were in students’ predictions of their practice arrangements five years after dental school. A greater percentage of female students than male students (41 percent vs. 16 percent) said that it was “very likely” that they would be in an associate position five years after dental school. Men were more likely than women to say they would be in a solo practice five years after dental school (73 percent vs. 56 percent).
Also of note in the fourth-year data is students’ interest in organized dentistry. Eighty percent of men and 90 percent of women expressed interest in membership in professional dental organizations. Furthermore, greater percentages of women said that they were interested in becoming active in state or national dental organizations, or in their dental school’s alumni organization. Recently, Dr. Marjorie K. Jeffcoat, former editor of the Journal of the American Dental Association and dean of the University of Pennsylvania School of Dental Medicine, expressed concern about the number of women in the “pipeline” for dental leadership positions.13 If our data is any indication, the women who make up the dental class of 2004 are interested in entering that pipeline.
Our research and the research conducted by the ADA in the 1990s suggest that women do and will continue to make up a substantial proportion of the dental workforce. Still, women are at a disadvantage with respect to income, professional autonomy (as defined by practice arrangements), and the burden of a “second shift” of homework and childcare. At the same time, however, our research suggests that the dental school experience levels the playing field for women. Fourth-year female students in our sample expressed greater interest in postgraduate education and becoming active in professional dental organizations than their male colleagues.
Overall, the vast majority of male and female dentists report satisfaction with their profession.4 However, there is still a great deal that is not known about women as dental professionals. Not much is known about the practice characteristics of women dentists including fee structures, patient pools, or practice styles, or how these factors might affect income or patient care. Little is known about the strategies that women dentists use to balance work and family demands, or how successful these strategies are. Indeed, little is known about how women and men in dental careers define success.
However, our research does point to the importance of mentoring. A 2004 report issued by the American Dental Education Association14 suggested that mentoring was important for the development and retention of dental school faculty. The report suggested that mentoring supported the growth and professional development of young dental professionals and provided opportunities to clarify goals, values, and professional choices. The report also suggested that mentors could benefit from the arrangement as well by providing them with the opportunity to stay abreast of new techniques and knowledge, and the opportunity to give back to one’s profession and create a legacy. Given the results of our research, it seems quite likely that mentoring plays no less a role in the general dental profession. Dental professionals, as full- or part-time faculty in dental schools, in their private practices, or via professional dental organizations can be potential mentors to younger colleagues. Young dentists, regardless of gender, are likely to benefit from the experience of having mentors in terms of professional growth, success in their chosen profession, and the provision of improved care.
References
1 Scarbecz M, Ross JA. Gender differences in first-year dental students’ motivation to attend dental school. J Dent Educ Aug. 2002; 66(8):952-61.
2 Niessen LC. Women dentists: 1992 and beyond. J Dent Educ 1992; 56(8):555-60.
3 U.S. Bureau of the Census. 2003 statistical abstract of the United States. Available at www.census.gov/prod/www/statistical-abstract-03.html. Accessed July 15, 2004.
4 American Dental Association. 1995 survey of dentists. A comparison of male and female dentists: work-related issues. 1997; Chicago, IL:ADA.
5 Walton SM, Byck GR, Cooksey JA, Kaste LM. Assessing differences in hours worked between male and female dentists: an analysis of cross-sectional national survey data from 1979 through 1999. J Am Dent Assoc May 2004; 135(5):637-45.
6 U.S. Bureau of the Census. 1997 statistical abstract of the United States. Available at www.census.gov/prod/www/statistical-abstract-us.html. Accessed July 15, 2004.
7 Brown LJ, Lazar V. Differences in net incomes of male and female owner general practitioners. J Am Dent Assoc March 1998; 129(3):373-8.
8 American Dental Association. 1995 survey of dentists. A comparison of male and female dentists: personal and family issues. 1997; Chicago,IL:ADA.
9 Hochschild AR, Machung A. The second shift. 2003; New York:Penguin.
10 Weaver RG. American Dental Education Association. Personal communication. Aug. 2003.
11 Lee JD. Which kids can “become” scientists? Effects of gender, self-concepts, and perceptions of scientists. Soc Psych Q 1998; 61(3):199-219.
12 Lee JD. More than ability: Gender and personal relationships influence science and technology involvement. Soc of Educ Oct. 2002; 75:349-73.
13 Jeffcoat MK. It’s a pipeline issue: women in leadership. J Am Dent Assoc Feb. 2004; 135(2):142,144.
14 Friedman PK, et al. Report of the ADEA President’s Commission on Mentoring. J Dent Educ 2004; 68(3):390-396.
Mark Scarbecz, PhD
Dr. Scarbecz is a sociologist, an associate professor in the Department of Pediatric Dentistry and Community Oral Health, and the director of planning and assessment at the University of Tennessee College of Dentistry. Contact Dr. Scarbecz at [email protected].
Judith A. Ross, DMD, MS
Dr. Ross is an associate professor in the Department of Restorative Dentistry, Operative Division at the University of Tennessee College of Dentistry. She also serves as a clinical group coordinator and as a member of the College of Dentistry’s Admissions Committee.
