This dentist’s blog [in Japanese] explains there are many dental clinics that struggle while a small proportion do well. He gives some reasons why there seem to be an over- supply of graduates:
- Dentists are traditionally thought of as very wealthy and it is a relatively easy way to own your own business.
- Demand for good dental hygiene has been growing as it becomes more socially desirable to have bright white teeth, not just a healthy mouth. So the explanation is that more students are drawn to the profession to help people.
- There is heterogeneity in the dental clinics and the services they each deliver. Thus it seems to be common to continually switch dentists.
I don’t know how that last point compares to other countries or whether it explains the problems in the industry. The first point can be explained by the push in the 1950s to increase the number of dentists and also the old-boy-network seems to be good at keeping the image idealistic (see Japan Times article below). It seems to be good marketing by the dentist schools that makes the profession seem more glamorous and lucrative than it is.
The number is not that large compared to other countries. Japan had 76 dentists for every 100,000 in the population in 2004, up from 71 in 2002. As of 2002 this was the 27th highest in the world. In 2000, there were only 47 dentists per 100,000 across Australia, 59 dentists per 100,000 in the ACT and 25 dentists per 100,000 in Tasmania! What regulates the supply of dentists and how the state supports dental health across countries clearly has something to do with explaining these disparities.
From the Japan Times article
In 2004, practicing dentists nationwide numbered around 95,000, about 76 for every 100,000 people in the population. The number of dental clinics that year was 67,000, easily outnumbering the 41,000 convenience stores throughout the country.
. . .
It wasn’t always this way. Back in the mid-1950s, Japan faced a shortage of dentists. The government set a target of 50 per 100,000 people, which was achieved by 1980. Six years later, while the number of dentists continued to climb, the government reversed the policy, and started to think about ways of bringing down the number of new grads coming out of dental schools.
But it’s been a futile task. The number of graduates has continued to be on an inexorable rise.
Vested interests are a big stumbling block to the government’s plans. Tuition fees from students aspiring to become dentists have become a lucrative source of revenue for many private medical and dental colleges, which have resisted government directives to lower student admissions. On average, a student pays a total of around ¥40 million in tuition over a 6-year training period.
Resistance also comes from the old-boy networks, as many veteran dentists expect their sons and daughters to take over their practices once they retire.
Meanwhile, compounding the oversupply problem are demographics: The lower birthrate means there are fewer patients in the form of kids and young adults, who tend to require the most involved treatments, such as orthodontic braces. Anyway, research shows that those fewer kids have healthier teeth compared with previous generations, thanks to increased awareness over the importance of dental hygiene.
How can there be increased awareness of dental hygiene importance, yet “fewer kids” with healthier teeth? Is that a typo? Would be interesting if that was the case- dietary changes would be the most likely explanation I guess…
In regards to the major supposition, you would think the social status of dentistry might also be a factor. Obvious free kick politically if you are seen as “for good health” rather than being against it, and it would be a brave politician selling a proposal to reduce the number of health professionals.
Plus it explains much of the constant attraction of dentistry as a future vocation: as my mother often told me, dentists, in terms of “making it” are up there with doctors.
The last sentence says that the kids have healthier teeth…not the clearest sentence from the Japan Times, I agree, but from the previous line which says there are fewer kids now thanks to the aging population and that those kids have healthier teeth.
I have since found out that the policy makers can control the numbers of dentists fairly easily: they reduce the number of dental school seats. They’ve apparently started this process and are able to carry it out without too much opposition from the dental schools etc. the problem of course was too many spots created by the same policy makers before – a case for deregulation and market forces to determine the number of spots?
Yeah the social status of dentists is high. Your mother is right and that is how they are viewed in Japan too but wasn’t it Seinfeld that said those who fail med school go on to become dentists?
A very interesting article. We live within walking distance in Tokyo of at least four dental clinics, which is one more than the number of nearby convenience stores. I’m glad you had good dental care, but a Japanese friend who is licensed to practice dentistry in both the States and Japan some years ago accused his Japanese colleagues of deliberately avoiding fluoride on the grounds that they wanted the business of filling cavities.He implied American dentistry is far better.
But I would guess that medical care in general is cheap. I don’t know about dentistry, but last month I had to go the emergency room of Japanese hospital; it was far cheaper without insurance than an American one would have been. You are also right about inheriting dental practices; another Japanese friend is in such a family. In fact, I think inherited practices are, if not the norm, very common across most or all medical specialties to the point I wonder whether these fourth generation eye doctors (for example) are any good. In my family in the States, I would never have wanted my cousin, an only son, to inherit his father’s pediatric practice. He couldn’t, of course, because he could not get through undergraduate study, let alone medical school.
Wow I just stumbled across your blog via Bing, and I must say, this stuff is great.