This report looks at the challenges, opportunities and trends for dentists.

Commentary in this report draws on research prepared by Access Economics in 2008, which looked at dentists' contribution to Australia's gross domestic product (GDP), dentists' income and practice income, current and projected numbers of dentists practising and general trends in this field. This report also includes case studies from three dentists.

This report shows new trends facing dentists are having a significant effect on the shape of their field:

• Although the number of male dentists outnumbers - and will continue to outnumber - the number of female dentists, the number of female dentists is increasing markedly.
• Between 2008 and 2038 the number of male dentists will increase by seven percent.
• Between 2008 and 2038 the number of female dentists will increase by 116 percent.
• By 2020, it is expected that the proportion of female dentists will tend to 50 percent, with the number of practising female dentists expected to double between 2008 and 2020.
• Dentists in Tasmania earn the highest annual income, according to 2004 figures. Dentists in South Australia earn the lowest annual average income.
• Country dentists earn more than city dentists.
• Male dentists earn more than female dentists although this relates to the fact many female dentists work part-time.
• Australia is recruiting a large number of dentists from overseas, with the number of new dentists from overseas being larger than the number of new domestic dentists entering the workforce each year.

The remainder of this report discusses these trends in more detail.

• In 2007, dentists contributed $3.93 billion to Australia's gross domestic product (GDP), representing 0.38 percent of total GDP.
• Australian Institute of Health and Welfare data shows that in 2006-2007 expenditure on dental services was $5.7 billion.

income

• In 2004 the average net personal income of dentists was $157,950.

income by state

• Dentists in Tasmania earn the highest average annual income, in 2004 earning $224,230. This is despite Tasmania being the state with the lowest household income on average. Access Economics assumes "the fact Tasmanian dentists earn the highest income may be related to the fact country dentists earn more than their city counterparts and Tasmania is also the only state where the majority of people do not live in the capital city".
• Dentists earn the least in South Australia, where in 2004 average annual income was $162,350.

income by gender

• Average annual income for male dentists in 2004 was $172,670.
• Average annual income for females in 2004 was $159,720.

country/city income split

• In 2004 metropolitan dentists earned an average annual income of $170,160.
• In 2004 country dentists earned an average annual income of $173,550.

Income of Australian Dentists, 2004
State	$ net personal income
New South Wales	165,660
Victoria	167,450
Queensland	182,800
South Australia	162,350
Western Australia 177,610	177,610
Tasmania	224,230
ACT	176,520
Location
Metropolitan 170,160	170,160
Country	173,550
Gender
Male	172,670
Female	159,720

Source: Australian Dental Association (2006)

male dentist numbers

• In 1994 there were 6,256 male dentists. In 2008 there were 7,431 male dentists with 7,881 full-time equivalent male dentists. In 2038, male dentists' numbers is projected to be 7,953 with 8,453 full-time equivalents. This equates to a seven percent increase in both head count full-time equivalent figures.

female dentist numbers

• In 1994 there were 1,411 female dentists. In 2008 there were 3,372 female dentists with 2,973 full-time equivalent female dentists. In 2038, female dentists' numbers is projected to be 7,299 with 6,435 full-time equivalents. This equates to a 116 percent increase in both head count and full-time equivalent figures.

total dentist numbers

• In 2008 there were 10,803 dentists with 10,854 full-time equivalent dentists. In 2038, dentists' numbers is projected to be 15,252 with 14,870 full-time equivalents. This equates to a 41 percent increase in head count and a 37 percent increase in terms of full-time equivalent figures.
• The higher number of female dentists to full-time equivalents indicates more females choose to work part-time as dentists than males.
• These figures indicate that while the number of female dentists is increasing and has increased markedly since 1994, dentistry remains a male-dominated industry, although proportionally, more females are joining the industry than males.
• Access Economics projects that the proportion of dentists who are female will tend to 50 percent, with the number of practising female dentists projected to more than double by 2020. In contrast, the number of male dentists is projected to increase by only 25.7 percent by 20201. A substantial increase in the number of dentists per 100,000 population was also projected, from 49.4 dentists in 2005 to 63.2 in 2020, an increase of 27.9 percent.
• Research shows the number of dentist graduates in Australia will more than double by 2014, to around 500 graduates per year. In 2009 there will be an increase in the number of graduates as the first cohort of students will graduate from Griffith University (the first intake of students was in 2005).
• Three new dental schools, James Cook, Charles Sturt and La Trobe, are expected to graduate their first intakes by 2013-14.
• The majority of new dentists entering the Australian workforce each year are not new Australian graduates. Australia is currently recruiting almost as many overseas trained dentists as it is training Australian citizens. Many dentists are also returning to practice after taking time out to have children.
• In terms of sources of recruitment for dentists, between 2005 and 2008:

• 13 percent of dentists entering the workforce were Australian citizens returning from abroad
• 33 percent of dentists entering the workforce were new Australian graduates
• 27 percent of dentists entering the workforce were from overseas
• 27 percent of dentists entering the workforce were returning to practice

1. Teusner D, Chsiopoulos S, Spencer J (2008), Projected demand and supply for dental visits: analysis of the impact of changes in key impacts, Dental Statistics and Research Series No 38, AIHW, Canberra.

• Over the past 40 years, the length of a dental visit has been increasing, as has the number of services supplied at a visit.
• But over this period the number of hours worked per week has remained stable; consequently, the number of visits supplied has declined substantially. This adds up to a six percent shortfall in the number of dentists required to meet this demand, or between 800 and 900 dentists.
• The average male dentist works 40.3 hours per week compared to 33.5 hours per week for females.
• Data from the Australian Institute of Health and Welfare shows the age distribution of female dentists differed substantially from the age distribution of male dentists. In 2005 only 16.2 percent of female dentists were over 50 years of age compared to 43.0 percent of male dentists.
• 90 percent of dentists rent their premises.

Western Australian dentist Dr Fiona Kelly, who only recently sold two dental practices, has seen a marked shift in the way dentists operate since she began practising almost 20 years ago.

Gone are the days of dentists working regular Monday to Friday 8am to 5pm hours. Increasingly, the norm is for dental surgeries to open seven days a week, with many dentists, especially females, working part-time in shifts. Dental practices are also now starting to open seven days a week, with hours extending from 8am to 8pm, a key reason why dentists are starting to work in shifts.

"When I started the tradition was to work 8am to 5pm, but that's changed so that now dentists can pick and choose their hours, working school hours, or working late or early shifts or even weekends," she says.

After selling her practices and taking a rest, Dr Kelly recently began working for two different dental surgeries and was surprised how easy it was for her to find part-time work. "I started looking for work on a Monday and by Tuesday I had a job," she says.

But despite, or perhaps related to, the change in working hours for dentists, Dr Kelly thinks there is a tendency for dentists to overwork. "You can earn a decent salary working part-time in dentistry, you just need to work a little harder. Since I've changed to part-time work my days are much busier with slighter shorter appointments. I take a shorter lunch break and work more hours., eight or nine hours a day three days a week instead of seven hours a day four days a week," she says.

Another big shift, says Dr Kelly, is the increase in the number of females owning dental practices. "When I started there were only a handful of women who owned dental surgeries, but now, lots of women own practices," says Dr Kelly, attributing this change to financial institutions being more inclined now than in the past to loan money to women to buy into practices.

challenges

One of the major challenges in dentistry, says Dr Kelly, is building adequate business skills to successfully run a practice. "When you own a dentist practice you become a small business owner, but you don't learn business skills when you're training to be a dentist and it takes a lot to run a business," she says.

To ensure the business side of her practices ran smoothly, Dr Kelly drew on the services of a business adviser and an accountant. "This cost a lot but they helped develop the business and kept the books in order, looked after GST and paid staff wages," she explains.

changes in practice

According to Dr Kelly, one of the main trends in the dentistry field is the shift toward cosmetic dentistry. "Patients want health and longevity for their teeth, but they also want their teeth to be the best they can be," she says, which is fuelling the trend for teeth whitening and other cosmetic treatments.

"Being a dentist is also now about offering an all-round service and the experience you provide. More and more dentists are offering tea and coffee, or rewards to patients for sending referrals their way.

Some practices are even offering spa-like services, with massages or aromatherapy,"she says.

Conversely, the demand for basic dental services is also still strong. "Some people just want their teeth fixed," she says, attributing this trend to the economic downturn.

Dr Bill O'Reilly, federal president of the Australian Dental Association and president of the NSW chapter of the ADA, sees many challenges facing the dentistry sector, but thinks many of these challenges can be re-positioned as opportunities for the field.

Dr O'Reilly says "on an advocacy level, there are opportunities to increase dialogue with opinion leaders, including politicians at the state and federal level, chiefs of staff at the state and federal level and policy makers in departments of health at the state and federal levels."

"Dental disease is the most prevalent chronic condition, but dental decay and gum disease isn't considered a sexy disease, despite having a significant effect on the economy and on the morbidity of the population. These conditions are in fact preventable and if we start to educate politicians and opinion leaders it will mean the burden on society from these conditions from an economic perspective is significantly eased."

Dr O'Reilly thinks having a co-ordinated approach at the federal and state levels to preventative dentistry, similar to the way awareness about diseases such as breast, skin and prostate cancer is approached, is a key opportunity for the dentistry profession.

There is a correlation between dental care and general health and at the moment, Dr O'Reilly says there are 500,000 Australians who can't access dentists, which is a serious issue given that many can't work because of pain associated with their dental problems, and many can't eat properly, which compromises their nutrition.

"There is an opportunity for Australia to be at the top of the world in preventative dentistry, which is where we once were, although we've slipped slightly," Dr O'Reilly says.

Dr O'Reilly says advances in dental technologies have improved significantly, improving the long-term prognosis for many conditions, enhancing diagnosis of conditions and improving the oral health status of many patients. "The challenge is constant awareness of new technologies so that they assist dentists in better and more quickly diagnosing conditions," he says.

"But the trap is that access to technology is very expensive. Providing treatments that are good from a cosmetic perspective sometimes does not enhance the baseline health of the individual. Some technologies are nothing more than gimmicks that improve fee structures but don't deliver benefits to mouth and general health," Dr O'Reilly explains.

Another key challenge Dr O'Reilly identifies is adequate access for rural, regional and indigenous populations to dental care. "There are acute workforce shortages for these populations and mal-distribution of dentists, that's the fundamental issue facing the profession.

Many dentists in rural and regional Australia are retiring and there are whole swathes of Australia that don't have dentists to provide treatment," he say.

Dr O'Reilly believes there needs to be an awareness of changes to population mix because there is an imperative to ensure public sector dentistry is targeted to rural and remote areas and areas where there is the greatest socio-economic need for dental care.

"The number of dentists going into public sector dentistry is not sustainable to provide services to those with the greatest need. Many public sector dentists also spend most of their day doing emergency dentistry rather than providing holistic care. There are also issues to do with career progression and wages in public sector dentistry."

A positive, however, is that the bulk of new dentists are women and people from a non-English speaking background. "This is fantastic because it reflects the true mix of society," says Dr O'Reilly, who acknowledges this trend is also changing the shape of the dental profession. "Women combine a career with motherhood, which means getting someone to work 8am to 5pm four days a week can be a challenge. Generation Y dentists also place a high value on worklife balance and this dynamic is another issue facing dentists," he says.

A related issue is succession planning for dentists, especially in rural and regional areas. "Good practices with high turnover can't get dentists to buy into them because Gen Y doesn't want to go to rural and regional areas. The high cost of dental equipment also means many younger dentists would prefer to work for someone than have the responsibility of running a practice. Succession planning is a big problem and an area that needs to be more fully explored by dental association," he says.

An oversupply of graduate dentists and the effect of the economic downturn on the dental sector are two of the key trends Dr Harry Sewgoolam believes are impacting dentistry at the moment.

"There are a number of new dentistry schools producing graduates and the Australian Dental Association is reporting that many overseas dental students are attempting Australian university dentist exams. But if overseas students pass exams, there will be an influx of new dentists, which could cause an unemployment situation for dentists," says Dr Sewgoolam.

"Many universities are encouraging full fee paying overseas students from places like Hong Kong, Singapore and Malaysia"

they pay $60,000 a year in fees - which delivers funds to the universities. Twenty years ago, 40 overseas students might sit exams and only two or three would pass. My daughter is in her fourth year of dental school and of 62 students, 30 are from overseas," he says.

Dr Sewgoolam says many of these students, rather than begin practising in their home country, will take out Australian residency, one of the key factors that will contribute to an oversupply of dentists in years to come.

"Out of 30 overseas graduates, around 25 can be expected to take out residency. And even if dentistry schools had a requirement for overseas dental students to go back to their home country, they could still apply to become a migrant," Dr Sewgoolam says, adding that,

"In five years time when new dentistry schools are starting to graduate students, there will be lots of dentists out of work."

"I've heard already that some graduates from overseas are struggling to find work. They might find half a day's work in a number of different practices each week, but not be able to find full-time work," he explains.

Conversely, there is strong demand for dentists in rural areas, something the government has acknowledged by opening new dental schools in regional areas around the country. The idea is that dentists trained in these areas will practise in the rural locations in which they were trained. But Dr Sewgoolam says "experience tells us that even graduates trained in rural areas want to work in city practices".

Effect of the downturn

According to Dr Sewgoolam, the economic downturn is also starting to have an effect on dental practices. "Lots of patients needing crown and bridge work are postponing this work, which is affecting crown and bridge specialists," he says.

The economic downturn is also having an effect on demand for new graduates. "In the past a dentist might hand over new patients to an assistant, but now the senior dentist is taking on new patients to try to combat any potential drop in demand for their services," Dr Sewgoolam explains.

Concurrently, the sharp fall in the Australian dollar in 2008 and the early part of 2009 has increased costs for dentists, many of whom import dental products from overseas.

This report is designed to shine a light on current practices of dentists in Australia.

Most of the data contained in this report was prepared by Access Economics in 2008, which was commissioned by NAB Health to:

• Estimate the value in dollars and as a share of GDP dentists contribute to the economy.
• Estimate the current number of dentists and full-time equivalents by gender out to 2038.
• Estimate changes in average income among dentists.

Case Study data was also obtained from Dr Fiona Kelly, Dr Bill O'Reilly and Dr Harry Sewgoolam.

Thanks to Fiona, Bill and Harry for contributing to this report.

more information

For more information speak with your NAB Health financial specialist or contact:

• Craig Anderson, Managing Partner Victoria
  +61(0)3 9630 9405 or Craig.A.Anderson@nab.com.au
• James Carter, Managing Partner New South Wales
  +61(0)2 9433 1922 or James.M.Carter@nab.com.au
• David Backhurst, Managing Partner Queensland
  +61(0)7 3234 5205 or David.J.Backhurst@nab.com.au
• Les Ryan, Managing Partner South Australia
  +61(0)8 8291 3440 or Les.J.Ryan@nab.com.au
• Mike Beckingham, Managing Partner Western Australia
  +61(0)8 9214 6534 or Mike.P.Beckingham@nab.com.au

visit nab.com.au/health

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