Dentists in Space

The average dentist to population ratio nationwide was 64.7 per 100,000 residents in 2007. However, 255 counties across the U.S. did not have a professionally active dentist. The first figure below shows the distribution of both professionally active dentists (i.e., public and non-profit sector dentists plus dentists in private practices) as well as dentists in private practice by rural urban continuum category which runs from low values (counties in highly urbanized metro areas) to high values (non-metropolitan counties with less urbanization).

Source: Health Resources and Services Administration, Area Resource File

A couple of things stand out.  Not surprisingly, dentists like other health professionals are relatively more abundant in more urbanized areas.  The most rural of the continuum categories have fewer than half of the relative number of dentists as the larger metro area categories.  On the other hand, the disparities for dentists in private practice are lower.  These dentists are more responsive to local demand characteristics.

Part of the reason for the lower relative number of private practitioners in more rural areas is the existence of speciality care.  Relatively few dental specialists (e.g., orthodontists, oral surgeons, periodontists, endodontists) operate in rural markets because they must draw from a much wider market diameter to maintain a profitable practice. It makes good business sense for them to locate in more centralized urban locations.  Even after accounting for these specialists, there is still a sizable disparity.  A large reason for the remaining difference is the tendency of dentists like other professionals to locate in commercial areas.  More rural counties have fewer and smaller commercial activity centers.

Source: Health Resources and Services Administration, Area Resource File

Regional dentist disparities have grown over the previous decade for both professionally active and private practice dentists with large metro counties gaining the most dentists on a per capita basis.  Only one rural continuum category (8=”Completely rural or less than 2,500 urban population, adjacent to a metro area”) actually saw a slight decrease in dentists.

 

 

Source: Health Resources and Services Administration, Area Resource File

These disparities are likely to grow worse before they become better.  Non-metro counties, particularly those down the rural-urban continuum, have a much higher percentage of dentists at retirement age (65+ years) and near retirement age (55-64 years) and proportionally few young dentists.

Source: Health Resources and Services Administration, Area Resource File

This pattern may be partly related to changing graduate locational preferences. Recent cohorts of dental school graduates have indicated a strong preference for more urban or suburban practice locations. For instance, only 5.2 percent of recent graduating seniors stated that they intend to practice in areas with fewer than 10,000 residents (Okwuje, Ifie, Eugene Anderson, and Richard W. Valachovic. 2009.  Annual ADEA survey of dental school seniors: 2008 graduating class Journal of Dental Education 73, 8: 1009-1032).  If this trend continues, the price of dental care will need to increase in order to attract more dentists to rural areas absent any policy intervention.