cat bi Fublic reas kop U.S: DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service, National Institutes of Health 4 : " 5 : L 2 ° o STATE DENTIST MANPOWER REPORTS DISCRIMINATION PROHIBITED--Title VI of the Civil Rights Act of 1964 states: ''No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity receiving Federal financial assistance.” There- fore, the dentist manpower data collection system, like every program or activity receiving financial assistance from the Department of Health, Education, and Welfare, must be operated in compliance with this law. For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, I).C. 20402 - Price $5.25 COMPILATION STATE DENTIST MANPOWER REPORTS 1965S =1967 DONALD W. JOHNSON, D.D.S., M.P.H. Deputy Chief, Resource Analysis Branch MARY B. THOMPSON, B.A. Statistician, Resource Analysis Branch U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service - National Institutes of Health Bureau of Health Professions Education and Manpower Training Division of Dental Health - Resource Analysis Branch Bethesda, Maryland 20014 1970 fle cambi See, ddl aided at | I PT RT RTE £7 4 2 pT yarn HEE i Sh da a ti KK co Je [965-67 PUBLIC FOREWORD HEALTH LIBRARY The 49 studies contained in this compilation present the results of a national survey in which the dental profession, the Federal Govern- ment, the American Association of Dental Examiners, and State licens- ing boards cooperated. But the ultimate success of the survey, of course, resulted from the willingness of nearly 80,000 dentists across the Nation to complete and return a detailed questionnaire providing information on their professional characteristics and activ- ities. Although the Division of Dental Health has conducted dental resource studies over a period of years, the urgent need for improving man- power supply to meet increasing demands for care prompted dental manpower surveys on an individual State basis. The value of individ- ual State reports has been attested to in their use by planners of new and expanded dental schools and by developers of training facil- ities for dental auxiliaries. For convenience and wider use, the individual reports were assembled into this single reference volume. At a later date, national and regional summaries based on analyses of data from these State surveys will be published, in conjunction with data from other sources. This compilation provides basic source data that can be utilized in projections of future dental manpower requirements, in planning pro- grams for increasing the dental manpower supply, in the development of new dental care programs, and in the implementation of needed State and Federal dental legislation. It is hoped that these data will be helpful to the dental profession in its efforts to achieve a more adequate manpower supply, and will prove of value to govern- mental agencies and private organizations as well as to individual researchers, health planners, educators, legislators, students, and others concerned with dental manpower. Viron L. Diefenbach, D Assistant Surgeon Gene Director, Division of iii ERIE TTR T— PREFACE Since 1965, the Division of Dental Health, National Institutes of Health, has been working under contract with the American Association of Dental Examiners to develop a national data compilation system designed to collect essential information on the dental manpower sup- ply from all licensed dentists and dental hygienists by questionnaires supplied at the time of their annual or biennial registration with State licensing boards. The initial survey of dentists began with the 1965 registration period, and in 1966 the program was expanded to include a national survey of licensed dental hygienists. In a further expansion of the system, a second nationwide survey of dentists was initiated in 1967. The questionnaires of the first survey, on which this volume is based, gathered information on the location, age, and current professional activity of dentists, their professional background, and selected practice characteristics, including area of specialization and utiliza- tion of auxiliary personnel. As each dentist returned the completed questionnaire to his State examining board, the board, in turn, for- warded all questionnaires to the American Association of Dental Exam- iners. The Association coded the questionnaires and punched the survey data onto cards, which were forwarded to the Division of Dental Health for machine tabulation. The Division then tabulated and analyzed the data, preparing a narrative report for each State. In addition, each participating State was furnished a detailed book of tabulations of the basic statistical data on which the report was based. Because reregistration dates vary among the States, the first survey of dentists was spread over approximately a 2%-year period from December 1964 to July 1967. Questionnaire mailing dates for the States covered in the survey are shown in the accompanying table. All States except Alabama and California participated. Survey response rates averaged about 90 percent for individual States, based on the total number of licensed dentists as reported by the State dental boards. Even though response rates varied from 70 percent to 99 percent, only 8 States fell below 80 percent. Thirty-three States had response rates of 90 percent or more, including 10 States with rates of 95 percent or higher. Every effort was made to obtain as much data as possible concerning dentists who failed to respond to the survey, especially in those States having a relatively low response rate. Information on nonrespondents, including location of the dentists, their ages, dental school attended, and year of graduation, were obtained from the respective State dental boards or from the appropriate annual edition of the American Dental Directory published by the American Dental Association. Date of Dentist Manpower Survey, by State Questionnaire Questionnaire State mailing date L/ State mailing date 1/ *Alaska 12-65 Nebraska 1-67 *Arizona 4-65 *Nevada 12-65 Arkansas 12-65 New Hampshire 11-66 Colorado 11-65 New Jersey 8-65 *Connecticut 12-65 *New Mexico 6-65 Delaware 5-66 New York 2-66 *District of Columbia 10-65 North Carolina 10-66 *Florida 9-65 North Dakota 10-66 Georgia 10-66 Ohio 2-67 Hawaii 11-65 Oklahoma 12-65 Idaho 4-66 Oregon 1-65 Illinois 1-66 Pennsylvania 2-66 Indiana 1-66 *Rhode Island 11-65 Iowa 4-65 South Carolina 12-65 Kansas 10-65 *South Dakota 5-65 Kentucky 11-65 *Tennessee 11-65 Louisiana 12-65 *Texas 5-65 *Maine 11-65 Utah 9-66 *Maryland 12-64 *Vermont 4-65 *Massachusetts 1-65 *Virginia 11-65 Michigan 5-65 Washington 9-65 Minnesota 1-66 *West Virginia 1-65 Mississippi 7-67 Wisconsin 8-66 Missouri 4-66 Wyoming 11-65 Montana 12-66 1l/ Questionnaire mailing dates coincide with mailing dates for license renewal for all States except Georgia, New Hampshire, Ohio, and Texas, which were surveyed by a special mailing a few months after their license renewal dates. %* Reports for States marked with an asterisk were prepared according to the rather detailed outline originally developed. All other State reports, except Oregon with a unique format, were prepared according to a simplified outline. vi Preparation of the individual State reports extended over a period of approximately 3 years, from mid-1966 to mid-1969. The first 17 reports completed prior to November 1967 were prepared according to a rather detailed outline as follows: I. Dentists Licensed in State II. Civilian Dentists Located in State A. Sources of Supply 1. Dental schools 2. Dentists relocating in State B. Personal Characteristics 1. Age 2. Advanced training C. Distribution and Current Status 1. Distribution of dentists 2. Professional status 3. Active dentists in relation to population D. Professional Activity 1. Current employment 2. Activity last year E. Practice Characteristics l. Limited practice 2. Employment of auxiliaries ITI. Out-of-State Civilian Dentists IV. Appendix Tables In order to facilitate the completion of the remaining reports, a sim- plified format was developed which allowed for the coverage of a subject on a single page, with a tabular presentation and the supporting text. A total of 31 State reports were prepared in the new format according to the following general outline. I. Dentists Licensed in State II. Professional Training of Dentists Located in State . III. Distribution of Dentists IV. Age of Dentists V. Active Dentists in Relation to Population VI. Utilization of Auxiliaries VII. Other Survey Findings VIII. Appendix Table In general, the preceding outlines were followed for most States. For some States, however, the outline was modified slightly, in accordance with the findings. For example, in a State with a small number of counties, the county data are presented in the body of the report and the appendix table, where county data usually appear, is omitted. For some of the subjects covered in the reports, such as the utilization vii of auxiliaries, the findings proved to be very similar from State to State, and therefore the supporting text is almost identical, with appropriate changes in figures. Findings relative to other subjects, such as dental school attended and distribution of dentists, often differed considerably from State to State, and consequently the descriptions of data vary according to the survey results. Eight of the State reports contain maps illustrating the distribution of den- tists by county. The Oregon report, with a unique format, features the extensive use of graphic material and the organization of the data differs from all the other reports. Anyone wishing to make combinations or comparisons of State data should keep in mind that there are certain limitations in the compar- ability of data from State to State. One reason for this is the difference in survey dates among the States, since the survey period extended over approximately two and a half years. Other reasons have to do with the difference in response rates, which varied from State to State, and the fact that some of the reports include nonrespondent data, while others do not. In combining State data to form regional or national data, the reader should review the individual State reports to become familiar with the variations just described. Statistics presented in terms of relative proportions--for example, the percentages of dentists employing auxiliaries or limiting their practices to a dental specialty--may be compared among the various States with more confidence than statistics which must be expressed in terms of numbers of dentists, such as the number of active den- tists in relation to population. It is with only minor alteration and renumbering of pages that the State Dentist Reports have been brought together in this volume. The original copy has been used, which accounts for the variation in for- mat among individual reports. The States are presented in alphabet- ical order, and the date of completion of each report is shown in the lower margin of the last text page. Black index strips bearing the State name in white have been added in the upper right-hand corner of the first page, for easy reference. viii State Alaska ceccocccesscccecs Arizona ececceccccccccce Arkansas eceeccccecccccss Colorado ecececccccenss Connecticut ececceccsoscs Delaware eeeecescceccccs District of Columbia .. Florida ececececscccans Georgia eceeccscecsesscco Hawaii ececececccoconcas IdahoOessssesscsessascce I11inoiS ececooeesccsee Indiana ceeecceccescscces Towa ccecececcscoccncas Kansas ceccecsssscccccns Kentucky cececesecccces Louisiana eseeecescecoce Maine ecececececcscccces Maryland .ecceeecesccces Massachusetts .eceeeces Michigan «cecececceccesss Minnesota eeecececcoces MisSSiSSIiPPi cee ceccoscese 75 97 113 121 131 145 159 171 185 199 209 221 239 251 263 275 MiSSOUTL seeeeeccosece ee 287 Montana ce 00000 00000 00 301 CONTENTS State Nebraska cceececcecccss Nevada eeececcccsscecces New Hampshire .ceeceeee New Jersey ececccoessee New MeXiCO ¢scececscccss New YOrk cceececcccccess North Carolina eceececse North Dakota eceececscseo Ohio seececcosescnccaes Oklahoma secccescescece Oregon eesecesecececesce Pennsylvania cecceeceeso Rhode Island ecceceeoees South Carolina .ceceeces South Dakota ccecesseos Tennessee seeccccocccss TEXAS ecececssceccccsnncs Utah ccececccescncennns Vermont ceeeeececcccces Virginia scceecescecces Washington .cecesccceee West Virginia eeccecoss Wisconsin eeceecececcecsse Wyoming e000 00000 00000 ix ALASKA DENTISTS LICENSED IN ALASKA A total of 131 dentists registered with the Alaska Board of Dental Examiners during the 1966 registration period (Table 1). The survey questionnaire was completed by 120 dentists, or 92 percent of all those registering. Only 69 of the responding dentists, or 57 percent, are actually located in Alaska. About 31 percent of the respondents are civilian dentists located in another State, and another 10 percent are on active duty with the Armed Forces. Table l.--Location and Military Status of Dentists Licensed in Alaska Location and All Percent military status dentists dentists Total licensed 131 100 Respondents 120 92 Nonrespondents 11 8 Respondents 120 100 Civilians in Alaska 69 57 Civilians in another State 37 31 On active duty with Armed Forces 12 10 Not reported 2 2 Only seven of the 120 survey respondents are licensed solely in Alaska. Most of the respondents are licensed in just one other State, but 29 hold licenses in two other States, and 15 are licensed in at least three additional States. Altogether, respondents hold nearly 300 licenses--an average of about two and one-half per dentist. Slightly more than two- fifths of the out-of-State licenses are maintained in Washington, Oregon, and California, while the remainder are held in 33 other States. Civilian dentists located in Alaska hold almost as many licenses as civilian respondents located outside the State. Thirty percent of the in-State dentists are licensed in at least two additional States, com- pared to 43 percent of the out-of-State respondents. Civilian Dentists in Alaska Sources of Supply Dental schools.--Dentists in Alaska are graduates of 24 dental schools, including one Canadian school. Almost one-third, or 22, of the State's 69 reporting dentists, however, are graduates of the University of Oregon. The next largest source of supply is the University of Washing- ton which graduated six of the in-State respondents. Fourteen dental schools in the North Central States account for 32 of Alaska's dentists, but only two of these schools, Indiana University and the University of Minnesota, have contributed as many as four graduates to the State. More than half of the dentists in Alaska graduated from dental school after 1955. Dentists relocating in Alaska.--One in every 3 dentists now in Alaska was professionally active as a civilian dentist in another State immedi- ately prior to locating in Alaska. The in-migrant dentists came from eight other States, primarily Washington, Oregon, and Idaho. Almost two- thirds of these dentists relocated during the 1960's. Personal Characteristics Age.--Alaska's dentists, as a group, are very young. The median age of reporting dentists is only 38.7 years. Thirty-seven percent of the State's dentists are under the age of 35 and two-thirds are under 45 years of age (Table 2). At the other end of the age scale, one in every five dentists is 55 years old or over, and one in every 10 has reached the age of 65. Table 2.--Age Distribution Number Percent Cumulative Age of of percent dentists dentists distribution Total 69 100 - Under 30 6 9 9 30 - 34 19 28 37 35 - 44 20 29 66 45 - 54 10 14 80 55 - 64 7 10 90 65 & over 7 10 100 Advanced training.--Seven of the in-State respondents, or 10 percent, reported the completion of one year or more of advanced training beyond their dental degree. All but one of these dentists took clinical train- ing as an intern or resident, and three completed at least one year of advanced academic training. Distribution and Current Status Distribution of dentists.--Alaska has been divided into three areas, as shown in the map on the following page, to pefmit presentation of data on the geographical distribution of dentists .Lt Forty of the State's dentists, almost three-fifths of the total dentist supply, are concen- trated in the South Central and Aleutian Chain area which contains a large part of the southern coastal area as well as the Aleutian Islands. Most of the dentists in this area are located in Anchorage, the largest city in Alaska. Another 19 dentists reside in the Southeastern Panhandle area, which consists of a narrow strip of mainland and an adjacent chain of offshore islands along the southeastern coastline of the State. Den- tists in this area are concentrated in two cities, Juneau and Ketchikan. The Inland and Northern Alaska area, which includes about seven-tenths of the total land area of the State, is the location of 10 of the State's reporting dentists. Practically all of the dentists in this area are located in Fairbanks, the second largest city in Alaska. Hereafter, these three areas will be referred to as the South Central area, the Southeastern area, and the Northern area. Active dentists in relation to population.--Of the 69 civilian dentists responding in the survey, 67 reported that they are active in the pro- fession. Only two regarded themselves as fully retired. Based on these responses, there is one professionally active dentist for every 4,084 persons in Alaska (Table 3). The Southeastern area has the most favor- able population per dentist ratio in the State, with 2,418 persons per active dentist. In the South Central area, which contains 54 percent of the population, the persons-per-dentist ratio is 3,670. The Northern area has the least favorable ratio, 8,570 persons for every active dentist. 1/ Geographic areas in Alaska have been adapted from the State Economic Areas designated in the following publication: Bogue, D. J., and Beale, C. L. Economic Areas of the United States. New York, Free Press of Glencoe, 1961. 1161 p. GEOGRAPHIC AREAS AND NUMBER OF CIVILIAN DENTISTS IN ALASKA INLAND AND NORTHERN AREA 1966 y Fairbanks 2 QQ SOUTHEASTERN PANHANDLE AREA Juneau pe o 7 o 40 dentists Kodiak SOUTH CENTRAL AND Ketchikan I - ALEUTIAN CHAIN AREA < LA Table 3.--Number of Persons Per Active Civilian Dentist Professionally Persons . . Total . Geographic area active ulation per active dentists pop dentist Total 67 273,600 4,084 South Central and Aleutian Chain area 40 146,800 3,670 Southeastern Panhandle area 17 41,100 2,418 Inland and Northern area 10 85,700 8,570 %* Copyright 1965, Sales Management Survey of Buying Power. The above persons-per-dentist ratios underestimate the actual dental force available to the residents of Alaska because dental care is available to approximately 30 percent of the State's population through the services of dentists employed by the Federal Government. The Public Health Service, Division of Indian Health, operates dental care facilities for Alaska Nativest/ , who constitute about 19 percent of Alaska's total population. Military personnel stationed in Alaska, accounting for another 11 percent of the State's population, are provided dental care by the Armed Services. Dentists on duty with the Public Health Service and the Armed Forces are not required to be licensed in the State in which they are assigned and therefore are not likely to be included in this survey. Adjustment of Alaska's population to exclude an estimated 52,000 Alaska Natives and 30,000 military personnel results in a more favorable persons=- per-dentist ratio of 2,850 for the State. Although precise area popula- tion data are not available, this adjustment is known to affect the persons-per-dentist ratios in all three geographic areas. In the Northern and Southeastern areas of the State,the Alaska Native population accounts for one-third and one-fourth of the total inhabitants, respectively. The South Central area, containing the Alaska Defense Command at Anchorage and other large military installations, has a substantial share of the State's military population. Consequently, the persons-per-dentist ratio in each of the three geographic areas is actually more favorable than shown in Table 3. 1/ Alaska Natives include Indians, Eskimos and Aleuts. Practice Characteristics Hours worked per week.--All dentists reporting on their professional activity in Alaska last year indicated that they provided care for patients. Those dentists reporting time spent in patient care worked an average of 41.0 hours per week. About one-fourth of these dentists worked exceptionally long hours, 48 or more. In contrast, 30 percent of the respondents devoted 35 hours or less per week to patient care. Use of auxiliaries.--About nine in every 10 practicing dentists in Alaska reported employment of some type of auxiliary personnel (Table 4). The dental assistant, the most frequently utilized auxiliary, is employed by 82 percent of the dental practitioners. Although employed with con- siderably less frequency, dental hygienists and secretaries are each employed by a rather sizeable proportion, one-third, of the practitioners. Less than one-sixth of all practitioners reported employment of a dental laboratory technician. Table 4.--Dental Practitioners Employing One or More Auxiliaries, by Type of Auxiliary Number Percent Type of auxiliary of of practitioners practitioners Total 67 100 With one or more auxiliaries 60% 90% With assistant 55 82 With hygienist 22 33 With laboratory technician 10 15 With secretary or receptionist 22 33 With other type of personnel 3 4 With no auxiliary 7 10 %* Individual items add to more than total because some dentists employ more than one type of auxiliary. By far the majority of dentists employing dental assistants or secretaries do so on a full-time basis. On the other hand, most of the dental hygien- ists and laboratory technicians are part-time employees. Fourteen practi- tioners reported vacancies for auxiliary personnel, usually for assistants or hygienists. Limited practices.--Seven of the reporting dentists in Alaska limit their practice to a dental specialty, most frequently orthodontics or oral sur- gery. Five of these dentists are located in the South Central area of the State. Out-of-State Civilian Dentists Alaska licenses are maintained by at least 37 civilian dentists located in 14 States. Almost one-third of these out-of-State dentists practice in California. Washington and Oregon are the only other States in which as many as four out-of-State respondents are located. Nine of the out- of-State dentists practiced in Alaska prior to assuming their present location. April 1967. 386-029 O - 70 - 2 PEt ur ARIZONA DENTISTS LICENSED IN ARIZONA Of the 926 dentists who registered with the Arizona State Dental Board in 1965, 846 completed the survey questionnaire, resulting in a response rate of 91 percent (Table 1). Only 61 percent of these respondents were civilian dentists actually located in Arizona. Another thirty-three percent were civilians located in other States, and four percent were on active duty with the Armed Forces. There were only three women dentists included among the respondents, two of them located within the State. Table l.--Location and Military Status of Dentists Licensed in Arizona Location and All Percent of military status dentists dentists Total 926 100 Respondents 846 91 Nonrespondents 80 9 Respondents 846 100 Civilians in Arizona 519 61 Civilians in another State 276 33 On active duty with Armed Forces 34 4 Not reported 17 2 Eighty-five percent of the dentists who responded to the survey hold a license in at least one other State. About four out of five civilian dentists located in Arizona are licensed in one or more additional States--62 percent in one other State and only 17 percent in 2 or more other States. By comparison, 43 percent of the out-of-State civilian dentists hold licenses in at least two States in addition to Arizona. Respondents hold over 1,800 licenses, an average of more than two per dentist. About 30 percent of the out-of-State licenses are held in California, and an additional 20 percent are maintained in other Western States. The remaining half of the out-of-State licenses are held in 33 other States scattered across the Nation. Civilian Dentists in Arizona Sources of Supply Dental schools.--Arizona's dentists graduated from 41 dental schools, including 2 schools (Colorado College and Denver College) which are no longer in existence. Over the years, 16 schools located in the North Central States have been a major source of dentist supply, contributing over one-half of the State's dentists (Table 2). Moreover, the relative contribution of these schools has tended to increase slightly in recent years. While no one school in this part of the country has been an out- standing contributor, three universities in Illinois--Northwestern, Illinois, and Loyola, and three universities in Missouri--Washington, St. Louis, and Missouri at Kansas City, have together trained over one- fourth of the State's dentists. Five other universities in the North Central States--Minnesota, Marquette, Iowa, Creighton, and Nebraska-- have each contributed at least 15 dentists to the State's present supply. Table 2.--School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 519% - 220 184 99 North Central 282 55 57 56 51 Northwestern 43 8 10 8 7 Missouri (Kansas City) 31 6 4 8 6 Minnesota 30 6 4 7 9 Illinois 25 5 3 9 3 12 other schools 153 30 36 24 26 West 139 27 21 27 39 Southern California 68 13 5 14 29 8 other schools 71 14 16 13 10 South 72 14 20 12 4 Baylor 39 8 14 3 1 9 other schools 33 6 6 9 3 Northeast (6 schools) 21 4 2 5 6 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item (see Appendix Table A). 10 Another one-fourth of the State's dentists received their dental degrees from schools in the West. This area's outstanding contributor, the Univer- sity of Southern California, has supplied 13 percent of Arizona's dentists. Three other schools in the West--Oregon, Pacific (Physicians and Surgeons), and California at San Francisco--have contributed an average of 16 dentists each. The proportionate contribution of Southern California has decreased considerably over earlier years, dropping from 29 percent of all dentists in Arizona who received dental degrees prior to World War II to only 5 per- cent of those who graduated since 1955. Schools in the South have contributed 14 percent of the dentist supply, with Baylor University the largest Southern contributor. The increasingly important role of Baylor as a source of dentist supply for the State is demonstrated by the fact that 14 percent of Arizona's dentists who grad- uated during the last 10 years received their dental education at this school, compared to only 1 percent of those graduating prior to World War II. Dentists relocating in Arizona.--One in every three dentists now in Arizona first practiced dentistry in one of 34 other States. The largest share of the 175 in-migrants, 19 percent, came from California, Illinois, Minnesota, and Iowa, the three next largest sources of in-migrants, have together sup- plied one-fourth of the dentists relocating in Arizona. No other State has contributed as many as 10 dentists to the Arizona supply; however, five States--Texas, New Mexico, Washington, Pennsylvania, and Michigan--have each contributed more than five dentists. Personal Characteristics Age.--Dentists in Arizona are very young. Their median age in 1965 was 40.1 years, with almost a third under 35 and fully two-thirds under 45 years of age (Table 3). Only 16 percent were 55 or older, including 6 percent who had reached the age of 65. Table 3.--Age Distribution Number Percent A Cumulative ge of of dentists dentists percent Total 519 100 - Under 30 33 7 7 30 - 34 122 24 31 35 - 39 93 19 50 40 - 44 79 16 66 45 - 49 54 11 77 50 - 54 37 7 84 55 - 59 28 6 90 60 - 64 22 4 94 65 - 69 17 3 97 70 & over 13 3 100 11 Advanced training.--About 18 percent of all dentists in Arizona have received a year or more of advanced training. One of every ten dentists reported he had taken advanced clinical training as an intern or resident. A larger proportion, about 13 percent, completed at least one year of advanced academic training as graduate or postgraduate students, including 9 percent who earned a master's degree after leaving dental school. About 5 percent of all dentists in the State said they had both clinical and academic advanced training. Distribution and Current Status Distribution of dentists.--Eighty-five percent of the dentists in Arizona are located in the State's two metropolitan areas, 62 percent in Phoenix (Maricopa County) and 23 percent in Tucson (Pima County). The remaining 15 percent are in the 12 nonmetropolitan counties in the State (Table 4). Grouping the nonmetropolitan counties by population of the largest central city within each county shows that the number of dentists in a county generally declines as the population of the central city decreases (see Appendix Table B). Of the four counties with central cities having a 10,000-24,999 population, Coconino is the only county with as many as 15 dentists; Yavapai, Cochise, and Yuma each have between 8 and 12 den- tists. None of the four counties having a central city population from 5,000-9,999 has as many as 10 dentists. Of the four counties with central cities under 5,000 only one county has more than 3 dentists. Two counties, Greenlee and Santa Cruz, have no reporting dentists; however, both of these counties are served by practitioners who maintain secondary offices-- one in Greenlee and two in Santa Cruz. Table 4.--Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 14 519 100 Metropolitan areas 2 439 85 Phoenix area 1 319 62 Tucson area 1 120 23 Nonmetropolitan county groups 12 78 15 Central city 10,000-24,999 4 46 9 Central city 5,000-9,999 4 24 5 Central city under 5,000 4 8 1 About 8 percent of Arizona's dentists maintain a second office, usually in the same county as the primary office location. Although the majority of secondary offices are located in either the Phoenix or Tucson metropol- itan areas, eight nonmetropolitan counties had one or more secondary 12 dental offices. In addition to Greenlee and Santa Cruz, the counties with secondary dental offices were Gila (four offices) and Yavapai, Yuma, Navajo, Pinal, and Apache (one office each). Professional status.--Nearly all of the dentists in Arizona (97 percent) reported that they were active in the profession. Only nine of the 519 responding dentists said they were professionally inactive, including eight who were fully retired and one who was engaged in nondental employ- ment. Another seven failed to report their current status. Among the 30 dentists 65 years old or over, only a fifth regarded themselves fully retired. Active dentists in relation to population.--Based on reporting dentists, there was one professionally active dentist for every 3,203 persons in Arizona in 1965 (Table 5). In metropolitan areas, the ratio was one den- tist for every 2,799 persons compared to one for every 5,543 persons in nonmetropolitan counties. On an individual county basis, the range in the number of persons per dentist varied widely (Appendix Table C). Among the 12 counties known to have dentists, Yavapai County had the most favor- able ratio, with one professionally active dentist for every 2,642 persons. At the opposite end of the scale was Apache County with a ratio of 32,000 persons per dentist. Table 5.--Distribution of Professionally Active Dentists Professionally cea Persons . Civilian County group active opulation per dentists Pop dentist All counties 503 1,611.0 3,203 All metropolitan areas 425 1,189.7 2,799 Phoenix area 309 865.0 2,799 Tucson area 116 324.7 2,799 Nonmetropolitan county groups 76 421.3 5,543 Central city 10,000-24,999 46 203.9 4,433 Central city 5,000-9,999 23 151.6 6,591 Central city under 5,000 7 65.8 9,400 Only four counties in the State had dentist-population ratios as favorable as the State average of 3,203. Closely following Yavapai, the metropolitan counties of Maricopa and Pima and the nonmetropolitan county of Mohave each had relatively favorable ratios of about 2,800 persons per dentist. Two counties in the State, Coconino and Gila, had population-per-dentist ratios only slightly higher than the State average, 3,400 and 3,771, respectively. The remaining six counties with reporting dentists had ratios of 4,800 per- sons or more per dentist. In addition to Apache, these counties were Graham (4,800), Navajo (5,288), Cochise (6,000), Yuma (6,900), and Pinal (8,938). 13 The number of active dentists available to the residents of some of the counties may be understated. For example, Apache County, with only one civilian dentist for a population of 32,000 persons, has a population which is 75 percent Indian. Since dentists employed by the Federal Government in such agencies as the Public Health Service, Division of Indian Health, are not required to be licensed in the State in which they are assigned, there are undoubtedly more dentists caring for residents of this county than the survey figures indicate. A larger dental force than is indicated by the survey data is also likely in other counties with large Indian populations, such as Navajo (51 percent Indian) and Coconino (28 percent Indian). Professional Characteristics Current employment.--As might be expected, most dentists who are active in the profession are in private practice. Of the 503 professionally active dentists located in Arizona, 96 percent are primarily self-employed and another 1 percent are employed by other dentists. The remaining 3 percent are engaged in other dental employment, such as working for a State or local government agency. Only 38 dentists, or 8 percent of those professionally active, reported a secondary dental employment. All but two of these dentists are located in the Phoenix or Tucson metropolitan areas. A variety of secondary activ- ities were reported, such as part-time employment in the private practices of other dentists, and employment in governmental or voluntary agencies. Activity last year.--Almost all (about 98 percent) of the dentists report- ing on their professional activity in Arizona last year indicated that they had provided care for patients. Dentists reporting on time spent last year in providing patient care devoted an average of 47.4 weeks to this activity and worked an average of 40.2 hours per week. Almost two- thirds spent at least 40 hours per week at this activity for 48 weeks or more during the year (Table 6). About one dentist in seven worked the equivalent of six days a week (48 hours or more) for at least 48 weeks. Table 6.--Time Spent in Patient Care Last Year Weeks spent Dentists Percent distribution by work week in tent core providing 48 hrs. 41-47 , 35-39 Under P patient care or more hrs. * hrs. 35 hrs. Total 100 16 15 43 14 12 50 weeks or more 45 10 6 22 4 3 48-49 weeks 35 4 7 14 6 4 Less than 48 weeks 20 2 2 7 4 5 14 The amount of time worked last year by dentists in private practice declined sharply with age. Over 70 percent of the dentists under 40 reported they worked at least 40 hours per week for 48 weeks or more. The proportion working this amount of time declines to 55 percent for dentists between 40 and 54 years old, to 42 percent among those 55 to 64, and to only 15 percent for those 65 and over. Limited practices.--Seventy-four dentists in Arizona, about one in seven, reported that they limit their practice to a dental specialty. Orthodon- tics is the principal area of specialization, accounting for about six percent of all practitioners. Another four percent limit their practices to oral surgery, 2 percent to pedodontics, and 3 percent to such special- ties as periodontics, prosthodontics, and endodontics. Ninety-three percent of the limited practitioners are located in the Phoenix and Tucson metropolitan areas. Only five dentists in the non- metropolitan counties reported a limited practice. Use of auxiliaries.--Almost nine of every ten practitioners reported that they employ auxiliary personnel (Table 7). Dental assistants, the most frequently employed auxiliary, are utilized by 84 percent of all practi- tioners, including 76 percent who employ at least one assistant on a full- time basis. Secretaries or receptionists are employed by 38 percent of the dentists with about three-fifths of these dentists utilizing such personnel full time. Only 22 percent of the dentists employ dental hygienists and 10 percent employ dental technicians. A majority of the dentists who employ hygienists or technicians do so only part time. Table 7.--Dental Practitioners Employing One or More Auxiliaries, By Type of Auxiliary Percent of dental practitioners Type of auxiliar Dental With one full- With only y practitioners Total time employee part-time (or more) personnel Total 497 100 82 7 With one or more auxiliaries 441 89 82 With assistant 417 84 76 8 With hygienist 107 22 6 16 With laboratory technician 52 10 2 8 With secretary or receptionist 190 38 23 15 With other type of personnel 14 2 1 1 With no auxiliary 56 11 - - 15 Although dentists in the Phoenix and Tucson metropolitan areas are no more likely to employ auxiliary personnel than are those located in non- metropolitan areas, the use of hygienists is much more common in these counties than in the remainder of the State. About 24 percent of the dentists in Phoenix and 21 percent in Tucson reported the employment of a hygienist, compared with only 12 percent of the dentists located else- where. About one out of six dental practitioners in Arizona reported one or more vacant positions for auxiliary personnel. Vacancies were reported most frequently for dental hygienists and dental assistants. Out-of-State Civilian Dentists There are at least 276 dentists in 28 other States who maintain licenses in Arizona. More than one-half of these out-of-State dentists are located in adjacent States with 45 percent in California and another 10 percent in Utah, New Mexico, Colorado and Nevada. The remaining 45 percent of the out-of-State respondents are located in 20 other States, primarily Illinois, Texas, and Washington. About one in every eight of the out-of-State respondents reported they had formerly been professionally active in Arizona. Nearly half of these out-migrant dentists are presently located in the neighboring State of California. May 1967. 16 Appendix Table A.--Summary Statistics for Arizona Number of dentists Total dentists licensed in Arizona 926 Respondents -- total dentists participating in survey (number not reporting current location or military status - 17) 846 Civilian dentists in Arizonat/ (designated simply as "dentists" in text tables) 519 (number not reporting: age - 21, county location - 2, principal current employ- ment - 7, dental school attended - 5) Professionally active dentists2/ 503 In limited practice3/ 74 Dental practitioners® 497 Located in Arizona last year: Reported professional activity2/ 456 Dentists providing patient careb/ 446 Reported time spent in patient carel/ 382 Dentists in private practic 8 412 Reported time spent in practice?’ 366 Civilian dentists in another State 276 Dentists on active duty in Armed Forces 34 Nonrespondents -- licensed dentists not participating in survey 80 1l/ All responding dentists who currently work in Arizona (excluding those in the Armed Forces) or who are retired and currently live in the State. 2/ All active civilian dentists currently in Arizona -- excludes 8 dentists who are fully retired, 1 who is engaged principally in a nondental activ- ity and 7 who did not report their principal current employment. 3/ Dentists who reported they limited their practice to a dental specialty. 4/ All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 5/ Dentists located in Arizona last year who indicated type(s) of activity in which they engaged. 6/ All dentists who engaged in patient care last year, either as a primary or secondary activity. 7) Dentists reporting both hours and weeks spent in patient care last year. 8/ Dentists who reported they were primarily self-employed both currently and last year. 9/ Dentists reporting both hours and weeks spent last year as a self- employed dentist. 17 Appendix Table B.--Arizona Counties by County Group Metropolitan Areast/ Area and Number of responding County civilian dentists Phoenix area Maricopa 319 Tucson area Pima 120 Nonmetropolitan Counties?’ Area and Number of responding County Central city civilian dentists Central city 10,000-24,999 Cochise Douglas 11 Coconino Flagstaff 15 Yavapai Prescott 12 Yuma Yuma 8 Central city 5,000-9,999 Gila Globe 7 Navajo Winslow 8 Pinal Casa Grande 9 Santa Cruz Nogales - Central city under 5,000 Apache McNary 1 Graham Safford 4 Greenlee Clifton - Mohave Kingman 3 1/ Arizona counties included in the latest 1966 definition of Standard Metropolitan Statistical areas established by the United States Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of the survey data. 2/ Counties not included in SMSA's by definition have been grouped according to the 1960 population of the largest (central) city within each county. 18 Appendix Table C.--County Data Profes- Persons Number of active dentists sionally Population © By age Reporting County . . 1. L1/ per active (in 000's) d . Under 55 years use of entist eq. . dentists 35 years or more auxiliaries All counties 503 1,611.0 3,203 155 69 441 Apache 1 32.1 32,000 - - 1 Cochise 11 66.0 6,000 4 4 9 Coconino 15 51.0 3,400 3 1 12 Gila 7 26.4 3,771 2 7 Graham 3 14.4 4,800 1 - 3 Greenlee - 10.9 - - - - Maricopa 309 865.0 2,799 100 39 275 Mohave 3 8.4 2,800 - 1 2 Navajo 8 42.3 5,288 2 1 7 Pima 116 324.7 2,799 34 17 99 Pinal 8 71.5 8,938 4 Santa Cruz - 11.4 - - - - Yavapai 12 31.7 2,642 4 3 11 Yuma 8 55.2 6,900 - - 8 1l/ Copyright 1965, Sales Management Survey of Buying Power; further reproduction is forbidden. 19 ARKANSAS DENTISTS LICENSED IN ARKANSAS During the 1965 registration period, 861 dentists registered with the Arkansas State Board of Dental Examiners. Seventy percent of the registered dentists were civilians located in Arkansas, 25 percent were civilians located in other States, and 5 percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Arkansas Location and All Percent of military status dentists dentists Total licensed 861 100 Respondents 738 86 Nonrespondents 123 14 Total licensed 861 100 Civilians in Arkansas 602 70 Respondents 526 - Nonrespondents 76 - Civilians in another State 217 25 On active duty with Armed Forces C41 5 Not reported 1 * * Less than one-half of one percent. The survey questionnaire was completed by 738 dentists, 86 percent of the total registered. The data provided by the survey respondents have been supplemented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not respond- ing to the survey. The information for nonrespondents was obtained from records maintained by the Arkansas State Board of Dental Examiners and from the 1966 American Dental Directory published by the American Dental Association. Over three-fifths of the survey respondents (62 percent) hold a license to practice dentistry in one or more other States. Forty-five percent of the dentists located in Arkansas have one other license, while only 6 percent have two or more other licenses. The proportion of out-of- State dentists holding multiple licenses is considerably greater; two- fifths hold two or more licenses in addition to their Arkansas license. Almost four-fifths of the licenses held outside the State were issued by adjacent States, including 25 percent in Missouri, 23 percent in Tennessee, 16 percent in Texas, 6 percent each in Louisiana and Okla- homa, and 2 percent in Mississippi. 21 PROFESSIONAL TRAINING Almost nine in every ten, 86 percent, of the 602 dentists in Arkansas are graduates of dental schools located in four adjacent States-- Tennessee, Missouri, Texas, and Louisiana. The University of Tennes- see, the major contributor, has supplied the State with one-third of its dental force. Furthermore, the contribution of this school has increased in recent years, accounting for more than one-half (55 per- cent) of the dentists graduating since 1955, compared to 22 percent of those who graduated in earlier years. Dental School Attended and Year of Graduation for Dentists in Arkansas Number Year of graduation Dental school of Al After 1041- 1940 or dentists years 1955 1955 earlier Total number 602 1 - 209 210 180 (Percent distribution by school) Schools in adjacent States 518 86 97 83 78 Tennessee 200 33 55 19 25 Missouri (Kansas City) 91 15 18 17 11 Washington (St. Louis) 88 15 12 17 14 Baylor 50 8 6 15 4 St. Louis 42 7 3 8 10 6 other schools 47 8 3 7 14 23 schools in other States 81 14 3 17 22 1/ Dental school attended and year of graduation not available for 3 dentists. Percents based on total for whom data are known. The University of Missouri and Washington University have each pro- vided 15 percent of the Arkansas dentist supply. Baylor and St. Louis Universities have also made notable contributions, having supplied the State with 8 percent and 7 percent of its dentists, respectively. Three other schools in adjacent States, Loyola University at New Orleans, Meharry Medical College, and Vanderbilt University (whose dental school closed in 1926) have each provided 2 percent of the dental force. The remaining 14 percent of the Arkansas dentists received their den- tal degrees from 23 other schools located in more distant States. Only three of these schools--Emory and Northwestern Universities and Loyola University of Chicago--have supplied as much as 2 percent of the State's dentist supply. 22 DISTRIBUTION OF DENTISTS Two-fifths of the 602 dentists in Arkansas are located in the five metro- politan areas of the State. The 2-county Little Rock area has 141 dentists, 23 percent of the total dental force. The Arkansas portion of the inter- state Fort Smith area has the next largest dental force, 8 percent of the dentists, and the Pine Bluff area, with 5 percent, has the third largest supply. The Arkansas parts of two other interstate areas, Memphis and Texarkana, each have 2 percent of the State's dentists, Distribution of Arkansas Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 75 602 100 Metropolitan areas 7 240 40 Little Rock-North Little Rock area 2 141 23 Fort Smith area (Ark. part) 2 48 8 Pine Bluff area 1 29 5 Memphis area (Ark. part) 1 12 2 Texarkana area (Ark. part) 1 10 2 Nonmetropolitan counties 68 362 60 Central city 10,000-49,999 9 142 24 Central city 5,000-9,999 16 103 17 Central city 2,500-4,999 19 79 13 Central city under 2,500 24 38 6 * See Appendix Table for definition of interstate and other metro- politan areas and presentation of individual county data. Three-fifths of the State's dentists (362) are located in the 68 nonmetro- politan counties. The nine counties with central cities of 10,000 or more persons have 142 dentists, almost one-fourth of the State's dental force. Three of these counties--Washington, Union, and Garland--have between 20 and 30 dentists. The 16 counties with central city populations between 5,000 and 9,999 have 103 dentists, one-sixth of the total supply. The re- maining 43 counties, with less than 5,000 persons in their central cities, have among them 117 dentists, about one-fifth of all dentists in the State. While only six of these 43 counties have as many as five dentists, 22 coun- ties have fewer than three dentists, including six counties which have no dentists, according to available information. 23 386-029 O - 70 - 3 AGE DISTRIBUTION OF DENTISTS Dentists in Arkansas are rather young as a group, with a median age of 43.1 years. A full one-fourth of the dentists are under 35, yet an equal proportion are 55 years of age or older, including 13 percent who have reached the age of 65. One-half of all dentists in the State are between 35 and 54, with about one-third between 35 and 44 years of age. Age Distribution of Arkansas Dentists Age Number Percent Cumulative in 1963 densists dentists percent Total 602 1/ 100 - Under 30 54 9 9 30 - 34 96 16 25 35 - 39 77 13 38 40 - 44 114 19 57 45 - 49 66 11 68 50 - 54 40 7 75 55 - 59 34 6 81 60 - 64 34 6 87 65 - 69 30 5 92 70 - 74 32 5 97 75 & over 17 3 100 1/ Includes 8 dentists for whom age is not avail- able. Percents are based on total for whom age is known. The age distribution of dentists is similar throughout the State. Dentists located in the five metropolitan areas, with a median age of 42.6 years, are only slightly younger on the average than are those dentists located in nonmetropolitan counties, where the median age is 43.5 years. 24 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 602 licensed dentists in Arkansas, 573, or 95 percent, are active in their profession, giving Arkansas one professionally active dentist for every 3,218 persons. In metropolitan areas, there is one dentist for every 2,547 persons, while the nonmetropolitan counties have a consider- ably less favorable ratio of one dentist for every 3,655 persons. Number of Persons Per Active Dentist in Arkansas Professionally Persons County group* active Population per dentists dentist All counties 573 1,843,900 3,218 Metropolitan areas 226 575,600 2,547 Little Rock-North Little Rock area 133 302,400 2,274 Fort Smith area (Ark. part) 44 102,900 2,339 Pine Bluff area 28 87,200 3,114 Memphis area (Ark. part) 11 51,300 4,664 Texarkana area (Ark. part) 10 31,800 3,180 Nonmetropolitan counties 347 1,268,300 3,655 Central city 10,000-49,999 134 418,500 3,123 Central city 5,000-9,999 101 362,500 3,589 Central city 2,500-4,999 76 288,200 3,792 Central city under 2,500 36 199,100 5,531 * See Appendix Table for individual county data. Among the metropolitan areas, Little Rock has the best ratio with 2,274 persons per active dentist. The persons-per-dentist ratio of 2,339 for the Arkansas portion of the interstate Fort Smith area (Sebastian and Crawford Counties) is only slightly less favorable. The Pine Bluff area and the Arkansas portion of the interstate Texarkana area (Miller County) have ratios which are considerably higher but still below the average for the State, while the Arkansas portion of the interstate Memphis area (Crittenden County) has the least favorable ratio among the metropolitan areas, 4,664 persons per dentist. Of the 68 nonmetropolitan counties, 17 have ratios better than the State average, while 19 counties have 5,000 or more persons per dentist, includ- ing five with 7,500 or more. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city decreases. The counties with central cities of 10,000 or more population have an average of 3,123 persons per dentist, while counties with fewer than 2,500 inhab- itants in their central cities average over 5,500 persons per dentist. 25 UTILIZATION OF AUXILIARIES Almost nine out of ten responding dental practitioners in Arkansas (i.e., dentists who spend any time working at the chair) employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 83 percent of all practitioners, including 78 percent who employ at least one assistant on a full-time basis. Secre- taries or receptionists are employed by 30 percent of the dentists, with almost two-thirds of these practitioners utilizing such personnel full time. Seven percent of the dentists employ dental hygienists and an equal proportion employ laboratory technicians in their practices. Arkansas Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 511 i 100 84 4 One or more auxiliaries 428 88 84 4 Assistant 405 83 78 5 Hygienist 36 7 4 3 Laboratory technician 38 7 2 5 Secretary or receptionist 145 30 19 11 Other type of personnel 23 4 2 2 No auxiliary 61 12 - - 1/ Includes 22 dentists who did not report on auxiliary utilization. Employment of auxiliaries varies with the age of the dentist and is more common among the younger dentists. Almost all (98 percent) of the den- tists between the ages of 30 and 44 employ auxiliaries. The proportion utilizing auxiliary personnel decreases to 85 percent for dentists 45 to 64 years of age and to only 38 percent among those 65 and over. Some 17 percent of the Arkansas practitioners reported one or more vacant positions for auxiliary personnel. Thirty-eight percent of these dentists indicated vacancies for full-time dental hygienists and 24 percent for full-time dental assistants. 26 3 OTHER SURVEY FINDINGS Ninety-nine percent of the responding professionally active dentists in Arkansas are primarily engaged in private prac- tice, with 97 percent self-employed and 2 percent employed by other dentists. The remaining one percent are engaged in other dental activities, such as employment by govern- mental agencies. Dentists reporting on time spent in providing patient care devoted an average of 39.7 hours per week to this activity for 48.5 weeks during the year preceding the survey. One in every ten dentists worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. Thirteen percent of the survey respondents reported that they had completed one year or more of advanced training after receiving the dental degree. Twenty-seven dentists reported the completion of advanced clinical training as interns or residents, and 46 dentists had completed a year or more of academic training as graduate or postgraduate students. About 9 percent of the responding practitioners reported that they limit their practice to a dental specialty, pri- marily to orthodontics. Almost one in every six of the dentists in metropolitan areas limits his practice, compared to one in every 25 of the dentists in nonmetropolitan coun- ties. Of the responding dentists who are licensed in Arkansas but located in another State, seven in every ten are located in the adjacent States, mostly in Texas, Tennessee, and Missouri. The remainder of the out-of-State dentists are scattered among 21 other States across the Nation. October 1968. 27 8¢ APPENDIX TABLE Selected Data on Dentists in Arkansas, by Location Civilian dentists Persons County group Resp ond- Non- Age in 1965 Profes- Population = per and county Total J respond- Under 55 or sionally (in 000's) active ents 35 more active dentist All counties 602 526 76 150 147 573 1,843.9 3,218 Metropolitan areas 2/ 240 213 27 58 51 226 575.6 2,547 Little Rock-North Little Rock area 141 124 17 34 28 133 302.4 2,274 Pulaski 134 117 17 32 28 126 271.0 2,151 Saline 7 7 - 2 - 7 31.4 4,486 Fort Smith area (Ark. part) 48 43 5 12 12 44 102.9 2,339 Sebastian 44 39 5 12 10 40 81.3 2,033 Crawford 4 4 - - 2 4 21.6 5,400 Pine Bluff area 29 26 3 6 7 28 87.2 3,114 Jefferson 29 26 3 6 7 28 87.2 3,114 Memphis area (Ark. part) 12 10 2 3 3 11 51.3 4,664 Crittenden 12 10 2 3 3 11 51.3 4,664 Texarkana area (Ark. part) 10 10 - 3 1 10 31.8 3,180 Miller 10 10 - 3 1 10 31.8 3,180 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Arkansas, by Location Civilian dentists 1/ Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ERLE respond- Under 55 or sionally (in 000's) active ents 35 more active dentist Nonmetropolitan counties 3! 362 313 49 92 96 347 1,268.3 3,655 Central city 25,000-49,999 49 37 12 12 16 46 97.0 2,109 Garland 24 20 4 6 8 23 47.8 2,078 Union 25 17 8 6 8 23 49.2 2,139 Central city 10,000-24,999 93 83 10 23 23 88 321.5 3,653 Columbia 7 6 1 1 2 7 25.9 3,700 Craighead 19 16 3 7 3 17 49.5 2,912 Mississippi 14 14 - 3 3 14 73.5 5,250 Ouachita 11 8 3 2 4 10 31.0 3,100 Phillips 9 7 2 - 4 8 44.8 5,600 St. Francis 5 5 - 1 1 5 33.7 6,740 Washington 28 27 1 9 6 27 63.1 2,337 Central city 5,000-9,999 103 89 14 30 23 101 362.5 3,589 Arkansas 7 7 - 1 1 7 23.8 3,400 Ashley 6 6 ’ 4 - 6 23.9 3,983 Benton 14 12 2 5 3 13 39.1 3,008 Boone 5 5 - - 2 5 16.3 3,260 Bradley 5 2 3 2 2 4 13.4 3,350 Clark 7 6 1 3 2 7 20.7 2,957 Conway 5 3 2 1 1 5 14.9 2,980 Faulkner 8 7 1 3 2 8 27.7 3,463 Greene 5 5 - 1 2 5 24.3 4,860 Hempstead 4 4 - 1 1 4 18.4 4,600 6¢C APPENDIX TABLE (cont'd.) 0€ Selected Data on Dentists in Arkansas, by Location Civilian dentists / Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ts respond- Under 55 or sionally (in 000's) active ents 35 more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 (cont'd.) Hot Springs 6 6 - 2 1 6 21.2 3,533 Independence 6 5 1 1 - 6 20.5 3,417 Jackson 5 5 - 1 3 5 21.8 4,360 Lee 4 2 2 2 - 4 20.7 5,175 Pope 6 6 - 1 1 6 22.1 3,683 White 10 8 2 2 2 10 33.7 3,370 Central city 2,500-4,999 79 67 12 18 25 76 288.2 3,792 Chicot 8 7 1 2 3 7 18.0 2,571 Clay 4 3 1 1 2 4 20.4 5,100 Cross 4 4 - 1 1 4 18.1 4,525 Dallas 2 2 - - - 2 9.8 4,900 Desha 6 6 - 1 3 5 19.9 3,980 Drew 4 4 - 1 1 4 15.3 3,825 Howard 4 4 - - 2 4 10.3 2,575 Johnson 3 3 - 1 1 3 11.8 3,933 Lafayette 2 1 1 - 1 2 10.1 5,050 Lawrence 5 4 1 - 2 5 16.9 3,380 Little River 2 2 - 1 - 2 8.3 4,150 Logan 4 3 1 2 2 3 15.3 5,100 Lonoke 7 5 2 3 2 7 23.5 3,357 Monroe 3 3 - 1 - 3 17.8 5,933 Nevada 4 2 2 1 1 4 9.7 2,425 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Arkansas, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ents respond- Under 55 or sionally (in 000's) active ents 35 more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 2,500-4,999 (cont'd.) Poinsett 9 8 1 3 9 30.2 3,356 Polk 3 2 1 - - 3 10.8 3,600 Randolph 2 1 1 - - 2 11.6 5,800 Sevier 3 3 - 1 1 3 10.4 3,467 Central city under 2,500 38 37 1 9 36 199.1 5,531 Baxter 2 2 - - - 2 9.6 4,800 Calhoun - - - - - - 5.6 - Carroll 4 4 - 1 1 A 12.0 3,000 Cleburne 5 5 - 1 2 5 8.7 1,740 Cleveland - - - - - - 6.2 - Franklin 2 2 - - 1 1 10.1 10,100 Fulton 1 1 - 1 - 1 6.0 6,000 Grant 1 1 - 1 - 1 8.2 8,200 Izard 1 1 - - - 1 6.3 6,300 Lincoln 1 1 - - - 1 14.7 14,700 Madison 3 2 1 - - 3 8.9 2,967 Marion 1 1 - - - 1 5.3 5,300 Montgomery - - - - - - 4.8 - Newton 1 1 - - - 1 5.0 5,000 Perry - - - - - - 4.7 - Pike 3 3 - - 1 3 7.0 2,333 Prairie 2 2 - 1 1 2 19.5 9,750 1€ APPENDIX TABLE (cont'd.) ce Selected Data on Dentists in Arkansas, by Location Civilian dentists / Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ents respond- Under 55 or sionally (in 000's) active ents 35 more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Scott 2 - 1 2 6.4 3,200 Searcy 1 1 - - 1 7.5 7,500 Sharp - - - - - - 5.4 - Stone = - - - - - 5.8 - Van Buren 3 3 - 1 1 2 6.9 3,450 Woodruff 1 1 - - - 1 13.0 13,000 Yell 4 4 - 2 1 4 11.5 2,875 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Arkansas counties included in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metro- politan areas for presentation of the survey data. For interstate SMSA's--Fort Smith, Memphis, and Texarkana--statistics are presented only for dentists located in the Arkansas portions. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped accord- ing to the 1960 population of the largest (central) city within each county. COLORADO DENTISTS LICENSED IN COLORADO During the 1965 registration period, 1,735 dentists registered with the Colorado State Board of Dental Examiners. A total of 1,684 den- tists responded to the survey, 97 percent of all those registered. Sixty-three percent of the responding dentists are civilians located in Colorado, 29 percent are civilians located in other states, and the remaining 8 percent are on active duty with the armed forces. Location and Military Status of Dentists Licensed in Colorado Location and All Percent of military status dentists dentists Total 1,735 100 Respondents 1,684 97 Nonrespondents 51 3 Respondents 1,684 100 Civilians in Colorado 1,059 63 Civilians in another state 492 29 On active duty with armed forces 133 8 Multiple licensure is fairly common in Colorado, with well over half of the respondents located in the State (57 percent) holding more than one license. Forty-four percent indicated licensure in at least one additional state and 13 percent in two or more other states. Of those dentists registering in Colorado, but located out-of-state, a relatively high proportion--40 percent--are licensed in two or more states other than Colorado. Survey respondents hold a total of some 3,300 licenses, an average of almost two per. dentist. One-third of the licenses held in states out- side of Colorado are held in adjacent states, primarily Nebraska and Kansas, with an additional 23 percent maintained in Missouri and California. The remainder are held in 38 other states scattered across the Nation. 33 PROFESSIONAL TRAINING Almost three-fourths (72 percent) of Colorado's 1,059 dentists graduated from 16 dental schools located in the North Central States. Three den- tal schools in the nearby State of Missouri have provided one-fourth of the total dental force, with the University of Missouri, the principal contributor, supplying 19 percent of Colorado's dentists and the dental schools at St. Louis and Washington Universities together supplying another 6 percent. In addition, two schools in adjacent Nebraska, the University of Nebraska and The Creighton University, have trained 21 per=- cent of Colorado's dentists. The only other school in the North Central States to contribute more than 5 percent of the dental force is North- western University. The College of Dentistry, University of Denver, although closed since 1930, has provided another 18 percent of the State supply. The University of Denver provided almost three-fifths (58 percent) of the dentists in Colorado who graduated prior to World War II. However, the loss of graduates from this school has been largely compensated for by contributions from schools in the North Central States. Dental School Attended and Year of Graduation for Dentists in Colorado Dental school Number Year of graduation attended of All After 1941- 1940 or © dentists years 1955 1955 earlier Total number 1,059 - 371 354 334 (Percent distribution by school) Schools in North Central States 768 72 88 88 39 University of Missouri 198 19 20 25 10 University of Nebraska 128 12 16 16 4 The Creighton University 92 9 14 8 4 Northwestern University 78 7 7 9 6 University of Iowa 44 4 4 4 4 University of Minnesota 40 4 2 4 5 10 other schools 188 17 25 22 6 University of Denver (extinct) 193 18 - - 58 24 schools in other states 98 10 12 12 3 Some 19 percent of the survey respondents, 204 dentists, reported that they had completed one year or more of advanced training after receiving their dental degree. Of the 116 with advanced clinical training, 31 com- pleted a residency and 85 an internship. Among the 128 dentists who reported advanced academic training, 79 earned a master's or other advanced degree, and another 49 received no additional degrees but completed one or more years of postgraduate study. These figures include 40 dentists who completed both academic and clinical training. 34 DISTRIBUTION OF DENTISTS More than three-fourths (77 percent) of all licensed dentists in Colorado are located in the 3 metropolitan areas of the State. The 5-county Denver area has 683 dentists, 64 percent of the 1,059 den- tists in the State. Denver County alone has 432 dentists, while the remaining 4 counties in the area--Adams, Arapahoe, Boulder and Jefferson--each have between 40 and 90 dentists. The Colorado Springs metropolitan area has the second largest dental force, accounting for 9 percent of the State supply. The remaining metro- politan area, Pueblo, has approximately 4 percent of the dentists. Distribution of Colorado Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 63 1,059 100 All metropolitan areas 7 820 77 Denver area 5 683 64 Colorado Springs area 1 91 9 Pueblo area 1 46 4 Nonmetropolitan counties 56 239 23 Central city 10,000-49,999 6 122 12 Central city 2,500- 9,999 16 82 8 Central city under 2,500 34 35 3 *See Appendix Table for definition of metropolitan areas and presentation of individual county data. Slightly less than one-fourth (23 percent) of the dentists are located in the 56 nonmetropolitan counties of the State. More than half of these dentists are concentrated in the six counties with at least 10,000 persons in their central cities--Larimer, Weld, La Plata, Las Animas, Logan and Mesa. The number of dentists per county gener- ally declines as the size of the central city decreases. There are 82 dentists in the 16 counties having between 2,500 and 9,999 persons in their central cities, while less than half that number (35 den- tists) are scattered throughout the 34 counties with central cities of less than 2,500 population. Among these latter very sparsely populated counties, 14 with a combined population of 29,800 had no dentist reporting, while 10 other counties had only 1 dentist per county. 35 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 1,057 dentists who reported their age was 42.3 years. Approximately one-fourth (274) of Colorado's dentists are under 35, and 28 percent (302) are 55 years of age or more. One in every six, or 186 dentists, is 65 years old or over, including 127 who have reached the age of 70. Median Age and Age Distribution of Colorado Dentists, by County Group Percent of dentists Median County group ace Under 35- 45- 55 & & 35 44 54 over All counties 42.3 26 33 13 28 All metropolitan areas 41.8 26 35 12 27 Denver area 42.1 24 35 13 28 Colorado Springs area 40.3 30 36 12 22 Pueblo area 40.7 37 26 9 28 All nonmetropolitan counties 44.1 26 27 14 33 Central city 10,000-49,999 44.6 24 28 15 33 Central city 2,500- 9,999 40.7 29 28 15 28 Central city under 2,500 52.5 26 20 6 48 In metropolitan areas the median age of dentists is 41.8 years, more than two years younger than the 44.1 year median for dentists in the nonmetropolitan counties. In two of the three metropolitan areas, Colorado Springs and Pueblo, the median ages are almost the same, 40.3 and 40.7, respectively. By contrast, the median age in the Denver area is 42.1 years, approximately the same as the average for the State. However, dentists in Denver County itself--the hub of the Denver metro- politan area--have a median age of 45.1 years, considerably older than that of dentists in the four surrounding counties, where the combined median age is 38.0 years. Among the nonmetropolitan county groups, counties with central cities of less than 2,500 persons have the oldest dentists, with a median age of 52.5, about 10 years higher than the median age for the State as a whole. By comparison, the combined median age in counties having central cities with more than 2,500 inhabitants is a much lower 43.7 years. 36 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,059 responding dentists in Colorado, 95 percent (1,007 dentists) are active in their profession, giving Colorado one professionally active dentist for every 1,972 persons. In the metropolitan areas--which have 78 percent of all active dentists and 70 percent of the population--the ratio is one dentist for every 1,780 persons. The remainder of the State--which has 22 percent of the active dentists and 30 percent of the population--has a less favorable ratio of one dentist for every 2,647 persons. Number of Persons per Active Dentist in Colorado Professionally Persons County sroup active Population per y dentists dentist All counties 1,007 1,985,400 1,972 All metropolitan areas 784 1,395,200 1,780 Denver area 652 1,087,200 1,667 Colorado Springs area 87 178,900 2,056 Pueblo area 45 129,100 2,869 Nonmetropolitan counties 223 590,200 2,647 Central city 10,000-~49,999 118 258,700 2,192 Central city 2,500- 9,999 76 209,000 2,750 Central city under 2,500 29 122,500 4,224 Among the metropolitan areas, the 5-county Denver area has the best ratio with 1,667 persons per dentist. Denver County itself has an even more favorable ratio of 1,291, compared to a combined ratio of 2,300 in the four other counties in the area, In the Colorado Springs area the ratio is 2,056, and in the Pueblo area the number of persons per dentist is a rather high 2,869. Among the 56 nonmetropolitan counties of the State, there are 8 counties with persons-~per-dentist ratios under 2,000, yet 13 counties have ratios exceeding 3,000 persons for every dentist, and another 16 have no report= ing active dentists. (In 2 counties, the one reporting dentist is not professionally active.) Generally, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The group of counties with central cities of 10,000 or more population have an aver= age persons~per-dentist ratio of approximately 2,200. In contrast, the counties with central cities having less than 2,500 inhabitants average more than 4,000 persons for every active dentist. 37 UTILIZATION OF AUXILIARIES Slightly more than 8 of every 10 practitioners in Colorado (i.e., dentists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 78 percent of all practitioners, including 72 per=- cent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 28 percent of the dentists, with half of these dentists utilizing such personnel full time. Dental hygienists are utilized by an almost equal number of dentists, primarily on a part-time basis. Seven percent of the dentists employ dental technicians, principally for part-time assistance. Colorado Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time auxiliary part-time (or more) auxiliaries Total 1,000% 100 76 6 One or more auxiliaries 815 82 76 6 Assistant 772 78 72 6 Hygienist 225 23 6 17 Laboratory technician 71 7 2 5 Secretary or receptionist 277 28 14 14 Other type personnel 41 4 1 3 No auxiliary 176 18 - - 1/ Includes 9 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist and is more frequent among younger dentists. Approximately 92 percent of Colorado dentists between the ages of 30 and 44 employ some type of auxiliary. The proportion using auxiliaries decreases to 77 percent among dentists 45 to 64 years of age, and to 49 percent among dentists 65 years and over. Dentists in the early years of their practice generally do not reach peak utilization of assistants until they are 35 years of age and of hygienists until age 40. Although dentists in metropolitan areas are no more likely to employ auxil- iary personnel than are those located in nonmetropolitan counties, the use of hygienists is much more common in metropolitan areas than in the remainder of the State. A relatively high proportion of dentists in metropolitan areas--26 percent--reported employment of a hygienist, as compared to only 11 percent of dentists located elsewhere. 38 OTHER SURVEY FINDINGS / / Ninety-eight percent of the professionally active dentists in Colorado are primarily engaged in private practice, with 97 percent self-employed and one percent employed by another dentist. The remaining two percent are either employed by governmental agencies or are engaged in other dental activ- ities, such as taking advanced training. / 7 Dentists providing patient care in the year prior to the survey devoted an average of 40.3 hours per week to this activity for 47.4 weeks during the year. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. | I~ ~~ About 13 percent of the respondents reported that they limit their practice to a dental specialty, primarily to orthodon- tics, followed by oral surgery and pedodontics. Fourteen percent of the dentists in metropolitan areas limit their practice as compared to 7 percent in nonmetropolitan areas. I~ ~~ Twenty percent of the dentists responding (208) had practiced as civilian dentists in one of 35 other states immediately prior to assuming their present Colorado location. More than half of these dentists came from the North Central States, primarily Nebraska, Illinois, Kansas and Missouri. Thirty-two percent of the 492 dentists licensed in Colorado but located in another state are in one of the seven adjacent states, primarily Nebraska (14 percent). Another 21 percent of the out-of-state dentists are located in California, while the remainder are scattered throughout 32 other states, the District of Columbia, or foreign countries. IZ December 1967. 39 386-029 O - 70 - 4 0% APPENDIX TABLE Selected Data on Dentists in Colorado, by Location Civilian dentists Persons County group Age in 1965 Profes- Population— per and county Total Under 55 years sionally (in 000's) active 35 or over active dentist All counties 1,059 274 302 1,007 1,985.4 1,972 Metropolitan areas> 820 212 222 784 1,395.2 1,780 Denver area 683 168 189 652 1,087.2 1,667 Adams 43 18 2 41 153.3 3,739 Arapahoe 57 17 6 56 138.8 2,479 Boulder 63 17 12 61 90.7 1,487 Denver 432 84 163 409 528.1 1,291 Jefferson 88 32 6 85 176.3 2,074 Colorado Springs area 91 27 20 87 178.9 2,056 El Paso 1 7 20 87 178.9 2,056 Pueblo area 46 17 13 45 129.1 2,869 Pueblo 46 17 13 45 129.1 2,869 Nonmetropolitan counties™ 239 62 80 223 590.2 2,647 Central city 25,000-49,999 73 18 19 69 141.7 2,054 Larimer 41 9 9 38 63.6 1,674 Weld 32 9 10 31 78.1 2,519 Central city 10,000-24,999 49 11 21 49 117.0 2,388 La Plata 8 2 3 8 20. 2,588 Las Animas 4 1 2 4 19.1 4,775 Logan 7 1 3 7 21.1 3,014 Mesa 30 7 13 30 56.1 1,870 7 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Colorado, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population— per and county Total Under 55 years sionally (in 000's) active 35 or over active dentist Nonmetropolitan countiesd’ (cont'd.) Central city 5,000-9,999 50 21 11 47 132.9 2,828 Alamosa 7 4 3 7 10.4 1,486 Fremont 9 4 2 7 20.9 2,986 Huerfano 3 2 1 3 7.7 2,567 Montezuma 2 - - 2 14.8 7,400 Montrose 7 5 1 7 19.7 2,814 Morgan 8 2 1 8 21.7 2,712 Otero 8 1 2 7 24.2 3,457 Prowers 6 3 1 6 13.5 2,250 Central city 2,500-4,999 32 3 12 29 76.1 2,624 Bent 1 - 1 - 7.3 - Chaffee 6 1 3 5 8.6 1,720 Delta 5 - 3 5 15.5 3,100 Garfield 8 1 2 7 12.3 1,757 Gunnison 2 - - 2 5.9 2,950 Lake 2 - - 2 7.4 3,700 Moffat 3 - 1 3 7.6 2,533 Rio Grande 5 1 2 5 11.5 2,300 Central city under 2,500 35 9 17 29 122.5 4,224 Archuleta 2 - 2 1 2.6 2,600 Baca 1 - 1 1 6.3 6,300 Cheyenne 1 - 1 1 2.6 2,600 Clear Creek - - - - 2.8 - Conejos 1 - 1 1 8.6 8,600 Costilla - - - - 3.8 - Crowley - - - - 3.7 - TY APPENDIX TABLE (cont'd.) Selected Data on Dentists in Colorado, by Location Civilian dentists Persons County group Age in 1965 Profes- Population— per and county Total Under 55 years sionally (in 000's) active 35 or over active dentist Nonmetropolitan counties’ (cont'd.) Central city under 2,500 (cont'd.) Custer - - - - 1.2 - Dolores 1 - 1 1 2.0 2,000 Douglas 2 1 - 2 5.6 2,800 Eagle 1 1 - 4.8 - Elbert - - - - 3.5 - Gilpin - - - - 0.7 - Grand 2 - 1 2 3.5 1,750 Hinsdale - - - 0.2 - Jackson - - - - 1.7 - Kiowa - - - - 2.3 - Kit Carson 2 2 - 2 6.9 3,450 Lincoln 2 1 - 2 5.1 2,550 Mineral - - - - 0.4 - Ouray 3 - 3 1 1.8 1,800 Park - - - - 1.8 - Phillips 2 - 1 2 4.3 2,150 Pitkin 1 1 - 1 3.1 3,100 Rio Blanco 4 1 3 3 5.4 1,800 Routt 2 1 - 2 5.7 2,850 Saguache - - - - 4.4 - San Juan - - - - 0.8 - San Miguel 1 - - 1 2.9 2,900 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Colorado, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population— per and county Total Under 55 years sionally (in 000's) active 35 or over active dentist Nonmetropolitan countiesd (cont'd.) Central city under 2,500 (cont'd.) Sedgwick 1 - - 1 4.0 4,000 Summit 1 1 - 1 2.2 2,200 Teller - - - - 2.5 - Washington 1 - - 1 6.6 6,600 Yuma 4 1 2 3 8.7 2,900 1/ Copyright 1965. Sales Management Survey of Buying Power; further reproduction is forbidden. 2/ Colorado counties included in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. 3/ Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. ey EE CONNECTICUT DENTISTS LICENSED IN CONNECTICUT A total of 2,769 dentists registered with the Connecticut Dental Commis- sion in 1966 (Table 1). Of this total, 2,578 completed the questionnaire for an overall response rate of 93 percent. About 70 percent of the responding dentists were civilians located in Connecticut at the time of the survey. Civilians located in other States or abroad accounted for one- fourth of the respondents, and 5 percent were dentists on active duty in the Armed Forces. Table 1.--Location and Military Status of Dentists Licensed in Connecticut Location and All Percent of military status dentists dentists Total licensed 2,769 100 Respondents 2,578 93 Nonrespondents 191 7 Respondents 2,578 100 Civilians in Connecticut 1,799 70 Civilians in another State 647 25 On active duty with Armed Forces 131 5 Not reported 1 * * Less than one half of one percent. The location and military status of the dentists not responding to the survey, as well as certain other items of information, were obtained, when available, from records maintained by the Connecticut Dental Commis- sion or from the 1966 American Dental Directory, published by the American Dental Association. However, because the survey response rate was high, the data presented in the sections which follow will be limited to respond- ing dentists except in those instances where the nonrespondent data are known to differ from the respondent data. Of all the dentists responding, 46 percent are licensed only in Connecti- cut (Table 2). Among those dentists located in Connecticut, 62 percent are licensed only in this State, 31 percent are licensed in one other State and only 7 percent are licensed in 2 or more other States. In con- trast, 32 percent of the out-of-State civilian dentists are licensed in 2 or more States in addition to Connecticut and the State in which they are presently located. 45 Table 2.--Percent of Dentists Holding Licenses in Other States Civilian dentists All Armed Licenses held In Out-of- respondents Connecticut State Forces Total 100 100 100 100 Connecticut only 46 62 - 49 Licensed in 1 other State 41 31 68 45 Licensed in 2 other States 11 6 25 5 Licensed in 3 or more other States 2 1 7 1 Civilian Dentists in Connecticut Sources of Supply Dental schools.--Connecticut's dentists are graduates of 49 dental schools in 24 States, the District of Columbia and Canada. However, four-fifths of the State's dentists are graduates of 14 dental schools located in 5 eastern States--Pennsylvania, Massachusetts, Maryland, New York, New Jersey--and the District of Columbia. Of these schools, Tufts University has made the larg- est single contribution, having trained 15 percent of the State's total den- tist supply (Table 3). As a State, Pennsylvania, whose three dental schools have trained one-fourth of Connecticut's dentists, has been the primary Table 3.--School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 1,799 - 430 665 649 (Percent distribution by school) Tufts 263 15 17 16 12 Maryland 260 14 6 12 22 Pennsylvania 232 13 13 13 13 Temple 190 11 14 11 8 Georgetown 179 10 15 9 8 New York 99 6 6 7 3 Columbia 67 4 2 5 3 Harvard 62 3 3 2 6 St. Louis 58 3 4 4 2 40 other schools 382 21 20 21 23 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table A.) 46 source of dentists for Connecticut. The University of Pennsylvania and Temple University dental schools together account for almost all of Pennsylvania's contribution to the Connecticut dentist supply. Two other eastern dental schools at Maryland University and Georgetown University have also contributed as much as 10 percent of the State's dentists. Of the remaining one-fifth of the Connecticut dentist supply, 19 percent were trained in dental schools in more distant States and one percent were trained in 5 Canadian dental schools. Until World War II the dental school at the University of Maryland was the major training ground for Connecticut's dentists. The postwar decline of this school as a source of Connecticut's dentist supply is reflected in the fact that Maryland graduates account for only one out of every 14 den- tists who are graduates of the past 10 years, compared with about one in 5 of those who graduated prior to World War II. This decline has been com- pensated for by increases from Georgetown, Temple, and Tufts. More than 45 percent of those graduating in the past 10 years are from these schools, as compared with 28 percent of the dentists who graduated prior to World War II. Dentists relocating in Connecticut.--Of the survey respondents now in Connecticut, 232 reported that they had been professionally active as a civilian in another State or abroad immediately prior to assuming their present Connecticut location. Forty-nine percent of these dentists who have relocated in Connecticut came from the three adjacent States-- New York, Massachusetts and Rhode Island. The remaining 51 percent came from 34 other States and the District of Columbia. None of these other States has contributed as many as ten dentists to the Connecticut supply. However, six States--Maryland, Virginia, California, New Jersey, Pennsyl- vania, and Texas--have each contributed more than five dentists. Dentists relocating in Connecticut account for 13 percent of the State's total dentist supply. New York and Massachusetts have contributed the largest share of the total, 4 and 2 percent, respectively. Personal Characteristics Age.--The median age of reporting dentists in Connecticut was a rela- tively high 46.4 years. Nevertheless, there was almost an even dis- tribution of the dentist supply in the age groups which generally represent the most active professional years. As the data in Table 4 indicate, the proportion of the total supply in each of the 5-year age intervals between the ages of 30 and 54 ranged only from 12 to 15 per- cent. 47 Table 4.--Age Distribution Age in Number Percent 1965 of of dentists dentists Total 1,799 100 Under 30 96 5 30 - 34 223 12 35 - 39 243 14 40 - 44 262 15 45 - 49 227 13 50 - 54 231 13 55 - 59 155 9 60 - 64 122 7 65 - 69 101 6 70 - 74 77 4 75 & over 41 2 About one in 8 of all reporting dentists were 65 years old or over, and in this group were 118 dentists who were 70 years old or over including 41 who had reached the age of 75. Although this is a substantial repre- sentation among the respondents of dentists who were well along in years, the supply of older dentists in the State is actually somewhat greater than the survey findings indicate. The median age of dentists not respond- ing in the survey was 51.9 years, or 5 years higher than for the respond- ents. Moreover, almost one-fourth of the nonrespondents were 65 or older, a proportion twice that among respondents. Advanced training.--One year or more of advanced training has been com- pleted by at least 536 dentists in Connecticut (Table 5). Although a larger number reported advanced clinical training than academic training, there are 14 reporting dentists who have earned a second doctorate, 56 who have earned a master's degree, and another 160 who have received no addi- tional degrees but have completed one or more years of postgraduate study. There is a growing tendency among Connecticut dentists to take advanced training after receiving their dental degree. Among dentists under 40 years of age, 35 percent reported that they had completed a year or more of advanced training. This percentage is only slightly higher than that recorded for dentists 40 to 54 years old, but is substantially greater than the 21 percent recorded for dentists 55 and over. 48 Table 5.--Advanced Training Highest level of training Number percent completed dentists dentists Total 1,799 100 With advanced training 536 30 Clinical training Residency completed 87 5 Internship completed 307 17 Academic training Ph.D., M.D., or other doctor's degree 14 1 M.A., M.S., or other master's degree 56 3 Postgraduate 1 year or more (no degree) 160 9 With no advanced training 1,263 70 The differences by age groups are even more striking when academic train- ing is considered. More than one in every 5 dentists under 40 has had a year or more of graduate or postgraduate study, compared to one in every 10 dentists between 40 and 54, and only one in every 17 of those 55 and over. This pattern is less pronounced for clinical training, chiefly because many dentists in the younger age groups are still in the process of completing their internships or residencies. Distribution and Current Status Distribution of dentists.--The State has been divided into three regions for the presentation of data on the geographical distribution of dentists in Connecticut. Counties which share a metropolitan area have been grouped in the same region. For purposes of discussion these three regions have been named the Bridgeport-New Haven, Hartford, and New London regions. The Bridgeport-New Haven region includes New Haven, Fairfield and Litchfield Counties which contain the Bridgeport, New Haven, Waterbury, Stamford, Norwalk and Meriden metropolitan areas. Hartford, Middlesex and Tolland Counties, which contain the Hartford and New Britain metropolitan areas, have been combined to form the Hartford region. Windham County, the only one in the State which does not have a metropolitan area, has been com- bined with New London County, which contains the New London metropolitan area, to form the New London region. Connecticut's dentists are concentrated in only three of the State's eight counties (Table 6). Fairfield County alone has slightly more than one- third of the State's total dentist supply; Hartford and New Haven Counties each have about one-fourth of the supply. Because of this concentration, 49 the Bridgeport-New Haven region contains 63 percent of the State's den- tists, the Hartford region has 31 percent, and the New London region only 6 percent. Table 6.--Distribution by Region and County . Number Percent Region and count of of y dentists dentists All counties 1,799 100 Bridgeport-New Haven region 1,132 63 Fairfield 616 34 New Haven 446 25 Litchfield 70 4 Hartford region 560 31 Hartford 478 26 Middlesex 53 3 Tolland 29 2 New London region 107 6 New London 82 5 Windham 25 1 There are only slight differences in the average ages of dentists in the three counties which together contain most of the State's dentist supply. The median ages of dentists in Fairfield and Hartford Counties are almost the same--45.2 and 45.8 years, respectively (Table 7). In New Haven County the median age is only slightly higher, 47.2 years. In addition, the distribution of dentists among the age groups in each of these three counties is almost the same. Among the other five counties in the State age differences are much more pronounced. For example, 38 percent of the dentists in Tolland County, which is in the Hartford region, are under 35 years of age, and only 13 percent have reached the age of 55. The median age of dentists in Tolland County is only 39.4 years. By contrast, Windham County in the New London region has no reporting dentists under age 35, and 48 percent are 55 years old or over, including 30 percent who are at least 65. The median age of dentists in this county is 54.5 years. 50 Table 7.--Median Age and Age Distribution, by Region and County Percent of dentists Region and county Median Under 35- 40- 45- 55-65 & 2ge 35 39 44 54 64 over All counties 46.4 18 14 15 26 15 12 Bridgeport-New Haven region Fairfield 45.2 18 15 17 24 15 11 New Haven 47.2 18 13 14 25 17 13 Litchfield 50.6 9 9 13 34 16 19 Hartford region Hartford 45.8 19 15 14 25 14 13 Middlesex 49.0 17 13 12 31 21 6 Tolland 39.4 38 14 7 28 10 3 New London region New London 47.7 18 10 14 28 18 12 Windham 54.5 - 13 9 30 18 30 Professional status.--Nearly all dentists reported that they are active in the profession (Table 8). Only 4 percent reported themselves either fully retired or engaged primarily in some type of nondental employment. Table 8.--Professional Activity Status Number Percent Activity status of of dentists dentists Total 1,799 100 Active in profession 1,725 96 Inactive in profession 74 4 In nondental employment 6 Eg Retired 68 4 * Less than one-half of one percent. Although a majority of the retired dentists are in the older age groups, relatively few of the older dentists who responded to the survey consider themselves retired. Of the 219 reporting dentists 65 and over, only one- fourth reported themselves fully retired, but the proportion retired increases with age. Only 17 percent of the group 65 to 69 years old and 23 percent of those 70 to 74 years old are retired. In contrast, 51 44 percent of those 75 and over are no longer professionally active. These proportions may be low, however, since it is probable that a sub- stantial number of the State's retired dentists elected not to return the survey questionnaire. Active dentists in relation to population.--The dentist supply in rela- tion to the population is more favorable in Connecticut than in most other States. There was one professionally active respondent for every 1,615 persons in the State in 1966 (Table 9). Table 9.--Number of Persons Per Active Dentist Professionally Persons Region and county active Population— per active dentists dentist All counties 1,725 2,785,700 1,615 Bridgeport-New Haven region 1,086 1,569,200 1,445 Fairfield 596 722,300 1,212 New Haven 429 716,600 1,670 Litchfield 61 130,300 2,136 Hartford region 538 938,500 1,744 Hartford 459 760,000 1,656 Middlesex 52 98,200 1,888 Tolland 27 80,300 2,974 New London region 101 278,000 2,752 New London 78 205,600 2,636 Windham 23 72,400 3,148 1/ Copyright 1965, Sales Management Survey of Buying Power; further reproduction is forbidden. The three counties in Connecticut which contain most of the dentist sup- ply also have the greatest number of active dentists in relation to the population. Fairfield County, with only 1,212 persons for every active dentist, has the most favorable county ratio. The number of persons per dentist is not too much greater in Hartford and New Haven Counties--1,656 and 1,670, respectively. In the other 5 counties the persons-per-dentist ratios range from a rather favorable 1,888 in the Hartford region's Middlesex County to 3,148 for Windham County in the New London region. Because the ratios in each of the 3 most populous counties are very favorable, the persons-per-dentist ratios for the Bridgeport-New Haven and Hartford regions, which contain these 3 counties, are considerably more favorable than for the New London region where the most populous county, New London, has 2,636 persons per dentist. 52 Professional Activity Current employment.--Almost all of the professionally active dentists in Connecticut are primarily engaged in private practice: 96 percent are self-employed and another 2 percent are employed by practicing dentists. The remaining 2 percent are either employed by governmental agencies or engaged in other dental employment. About one in every eight active den- tists reported a secondary dental activity in addition to his principal professional employment. These dentists reported a variety of secondary activities, such as part-time employment in the private practices of other dentists, and in governmental or voluntary agencies. Activity last year.--All but 6 of the 1,593 dentists who reported on their professional activity in Connecticut last year indicated they had provided care for patients. A few dentists reported more than one type of activity. Teaching in a dental or dental hygiene school was reported by 53 dentists and research activities were reported by 14. Time spent in some other dental activity, such as taking advanced training, was reported by 67 dentists. In terms of total professional time, however, patient care accounted for nearly 99 percent of the time spent in all activities. Dentists reporting on time spent last year in providing patient care devoted an average of 48.0 weeks to this activity and worked an average of 39.8 hours per week. Slightly more than four-fifths reported spending 48 weeks or more at this activity (Table 10). These dentists spent longer hours providing patient care than did those who worked only part of the year, or less than 48 weeks. Seven of every 10 dentists spending 48 weeks or more in patient care worked 40 or more hours per week, while only 5 in every 10 of those working less than 48 weeks spent as much time per week in providing care. Table 10.--Time Spent in Patient Care Last Year Hours spent in Percent Percent distribution by work week . of dentists 50 weeks 48-49 Less than patient care : 32 providing care or more weeks 48 weeks Total 100 45 36 19 48 hours or more 15 8 5 2 41-47 hours 19 9 7 3 40 hours 32 16 12 4 35-39 hours 20 7 8 5 Under 35 hours 14 5 4 5 53 Practice Characteristics Limited practice.--Practices limited to a dental specialty are reported by 228 dentists in Connecticut (Table 11). Orthodontia and oral surgery are the two most frequently reported areas of limited practice. Fair- field County not only has the largest number of limited practitioners, but this count also has a larger proportion of dentists in limited prac- tice than any of the other seven counties in the State. Table 11l.--Limited Practices Dentists Percent of dental practitioners County with ALL Ortho- Oral Perio- limited specialty d . . Other . ontia surgery dontia practices areas All counties 228 14 5 5 1 3 Fairfield 98 18 8 5 2 3 New Haven 62 16 5 7 1 3 Hartford 56 13 5 4 1 3 Other 5 counties 12 6 2 2 1 1 Use of auxiliaries.--Seven of every 10 dental practitioners in Connecticut (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel. The utilization of auxiliaries among practi- tioners in the individual counties varies only slightly. Almost 6 of every 10 practitioners employ at least one auxiliary full time (Table 12). Table 12.--Dental Practitioners Employing One or More Auxiliaries by Type of Auxiliary Percent of dental practitioners Type of auxilia Dental With only With one full- ty practitioners Total part-time time employee personnel (or more) Total 1,706 100 13 57 With one or more auxiliaries 1,138 70 13 57 With assistant 921 56 9 47 With hygienist 370 23 13 10 With laboratory technician 56 4 2 2 With secretary or receptionist 335 20 8 12 With other type of personnel 62 4 2 2 With no auxiliary 498 30 - - 54 The dental assistant, the most frequently utilized auxiliary, is employed by 56 percent of the dentists. Dental hygienists are employed by 23 per- cent of the dentists. By far the majority of the dentists employing assistants do so on a full=time basis, while more than half of those who employ hygienists utilize these auxiliaries only part time. One practi- tioner in 5 employs a secretary or receptionist in his practice, but only one in 25 employs a laboratory technician. Auxiliary utilization varies with the age of the dentist (Table 13). The peak utilization occurs among practitioners between the ages of 35 and 44. About 82 percent of the dentists in this age group employ auxiliaries. In contrast, auxiliaries are utilized by only 41 percent of the practition- ers 65 years old or over. Among the younger dentists who are just start- ing their practices, 58 percent report the employment of one or more auxiliaries. Table 13.--Dental Practitioners Employing Auxiliaries, by Age Percent of age group Age With With With auxiliaries assistants hygienists Under 30 58 48 13 30 - 34 79 65 16 35 - 44 82 68 31 45 - 54 68 59 20 55 - 64 60 41 24 65 & over 41 26 14 About 15 percent of the dental practitioners in Connecticut reported one or more vacant positions for auxiliary personnel. Of these dentists, about 36 percent reported vacancies for full-time dental hygienists, and 28 percent reported vacancies for full-time dental assistants. Three- fourths of the dentists reporting a vacancy already employ at least one auxiliary. Weeks and hours worked.--The data in Table 14 demonstrate the greatly reduced professional activity among older dentists. More than 60 per- cent of the dentists under 45 years report working at least 48 weeks and at least 40 hours per week. The proportion of dentists who report work- ing this amount of time decreases for each of the older age groups to a very low 28 percent among dentists 65 years or older. Probably an even smaller proportion of all dentists 65 and over actually work this amount of time since about two-fifths of these dentists, including those who are . likely to be least active, did not report on time spent in their prac- tices. 55 386-029 O - 70 - 5 Table 14.--Time Spent in Private Practice Last Year, by Age Dentists Percent working reporting time 48 weeks A . . Part year ge spent in practice or more or less than Percent 40 hrs/wk Number 40 hrs/wk of total or more Total 1,260 81 56 44 Under 35 220 90 64 36 35 - 44 411 86 62 38 45 - 54 359 82 55 - 45 55 - 64 176 72 43 57 65 & over 82 59 28 72 Qut-of-State Dentists Connecticut licenses are maintained by at least 647 civilian dentists located in 33 States and the District of Columbia (Table 15). Three- fifths of the out-of-State dentists are located in two of the three adjacent States, primarily in New York, and to a lesser extent in Massachusetts. New Jersey and Florida are the only other States in which at least 5 percent of the out-of-State dentists are currently located. Table 15.--Out-of-State Civilian Dentists, by State Number Percent Present location of of dentists dentists Total 647 100 Adjacent States 401 62 New York 306 47 Massachusetts 84 13 Rhode Island 11 2 Other States 246 38 New Jersey 48 8 Florida 32 5 California 27 4 Maryland 20 3 Pennsylvania 15 2 District of Columbia 13 2 25 other States 91 14 1 56 Eight percent of the out-of-State respondents (52 dentists) reported that they had formerly been professionally active in Connecticut. One half of the dentists who have migrated out of Connecticut are now located in adjacent States, primarily New York, and the other half are in 14 more distant States and the District of Columbia. December 1966. 57 Appendix Table A.--Summary Statistics for Connecticut Number of dentists All licensed dentists 2,769 Respondents -- total dentists participating in survey 2,578 (number not reporting current location or military status - 1) Civilian dentists in Connecti cuts! -- civilian respondents designated simply as ''dentists'" in text tables 1,799 (number not reporting: age - 21, dental school attended - 7, and year of graduation - 55) ‘Professionally active dentists?’ 1,725 Dental practitioners’ 1,706 In limited practice?’ 228 Located in Connecticut last year: Reported professional activity= 1,593 Dentists providing patient care?! 1,587 Reported time spent in patient care’! 1,288 Dentists in private practiced’ 1,558 Reported time spent in practice?’ 1,260 Out-of-State dentists -- civilian respondents not located in Connecticut 647 Dentists on active duty in Armed Forces 131 58 All responding dentists who currently work in Connecticut (excluding those in the Armed Forces) or who are retired and currently live in the State. All active civilian dentists currently in Connecticut--excludes 68 dentists who are fully retired and 6 who are engaged principally in a nondental activity. All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. Dentists who reported they limited their practice to a dental specialty. Dentists located in Connecticut last year who indicated type(s) of activity in which they engaged. All dentists who engaged in patient care last year, either as a primary or a secondary activity. Dentists reporting both hours and weeks spent in patient care last year. Dentists who reported they were primarily self-employed both currently and last year. Dentists reporting both hours and weeks spent last year as a self- employed dentist. DELAWARE DENTISTS LICENSED IN DELAWARE During the 1966 registration period, a total of 223 dentists registered with the Delaware State Board of Dental Examiners. A total of 216 den- tists responded to the survey, 97 percent of all those registered. More than 9 in every 10 of the responding dentists are civilians located in Delaware, 7 percent are civilians located in other States, and 2 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Delaware Location and All Percent of military status dentists dentists Total licensed 223 100 Respondents 216 97 Nonrespondents 7 3 Respondents 216 100 Civilians in Delaware 196 91 Civilians in another State 16 7 On active duty with Armed Forces 4 2 Multiple licensure is quite common in Delaware, with two of every three dentists licensed in the State (65 percent) holding more than one 1i- cense. Of those dentists located in Delaware, 62 percent hold more than one license, with 51 percent licensed in one other State and 11 percent licensed in two or more other States. Among dentists registered in Delaware but located out of State, about one-third hold two or more li- censes in addition to their Delaware license. Almost four-fifths of the out-of-State licenses are held in adjacent States, with 64 percent in Pennsylvania and 15 percent in Maryland and New Jersey. The remainder are held in 15 other States and the District of Columbia. 59 DENTAL SCHOOL ATTENDED Almost three-fourths (73 percent) of Delaware's dentists graduated from three dental schools in the neighboring State of Pennsylvania. Temple University, the principal contributor, has supplied more than half (51 percent) of the dental force, while the University of Pennsylvania has provided another 19 percent. The only other school with a significant contribution is the University of Maryland which has graduated 15 per- cent of Delaware's dentists. Dental School Attended and Year of Graduation for Dentists in Delaware Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 196 1 - 78 64 53 (Percent distribution by school) Temple University 101 51 51 61 41 University of Pennsylvania 37 19 26 14 15 University of Maryland 29 15 5 17 25 Georgetown University 8 4 5 3 4 University of Pittsburgh 5 3 5 2 - 8 3 15 13 other schools 16 8 1/ Year of graduation not available for one dentist. A fairly substantial proportion of Delaware's dentists are recent dental school graduates. Two-fifths have completed their dental education since 1955, compared to slightly over one-fourth who received their dental degrees prior to World War II. There has been some change in the rela- tive contribution of the various schools to the State's dentist supply. The proportionate contributions of Temple University and the University of Pennsylvania have increased over the years, while that of the Univer- sity of Maryland has shown a notable decrease. 60 ADVANCED TRAINING In Delaware a high proportion of survey respondents--approximately three- fifths, or 120 dentists--reported that they had completed one year or more of advanced training after receiving their dental degrees. The vast majority of these dentists reported advanced clinical training, including 103 who completed internships and an additional 9 who completed residen- cies. Of 26 dentists who reported advanced academic training, 13 had earned a master's degree and another 13 had received no additional degrees but had completed one or more years of postgraduate study. Eight- een dentists had completed both clinical and academic training. Advanced Training Completed by Delaware Dentists Highest level of training Number Percent completed dentists dentists Total number 196 100 With advanced training 120 61 With no advanced training 76 39 Clinical training 112 58 Residency completed 9 5 Internship completed 103 53 Academic training 26 14 M.A., M.S., or other master's degree 13 7 Postgraduate 1 year or more (no degree) 13 7 Additional education beyond receipt of the dental degree is more common among dentists in the younger age groups. Of dentists under 40 years of age, 68 percent reported that they had completed some form of advanced training. This percentage is slightly greater, 72 percent, among den- tists 40 to 54 years of age. Of the dentists who are 55 or older, however, only 28 percent reported the completion of one or more years of advanced training. Considering internship training alone, 60 percent of the dentists under 40, and 64 percent of the dentists 40 to 54, have com- pleted an internship, compared to 15 percent of the dentists in the older age group. 61 DISTRIBUTION OF DENTISTS More than four-fifths, 159, of the 196 responding dentists in Delaware are located in New Castle County, which comprises the Delaware portion of the interstate Wilmington metropolitan area. The remaining one-fifth of the dentists are located in the two nonmetropolitan counties of the State. Of these counties, Sussex County has the largest dental force, 22 dentists, or 11 percent of the State supply, while Kent County, with 15 dentists, has only 8 percent. Distribution of Delaware Dentists, by County All Professionally Population LeTSOnS County dentists active (in 000's) per active dentists dentist All counties 196 195 501.3 2,571 Wilmington area , 159 159 346.7 2,181 New Castle County — 159 159 346.7 2,181 Nonmetropolitan counties 37 36 154.6 4,294 Sussex County 22 22 78.2 3,555 Kent County 15 14 76.4 5,457 1/ Population estimates, copyright 1965. Sales Management Survey of Buy- ing Power. 2/ Defined by the U.S. Bureau of the Budget as the Delaware part of the interstate Standard Metropolitan Statistical Area of Wilmington. Almost all, 195, of the dentists in Delaware are active in their profes- sion, giving the State one professionally active dentist for every 2,571 persons. There is one dentist for every 2,181 persons in New Castle County, while the nonmetropolitan counties have a considerably less favor- able ratio of 4,294 persons per dentist. Of the nonmetropolitan counties, Sussex County has the best ratio, with 3,555 persons for every dentist. In Kent County, the ratio is substantially less favorable--5,427 persons per dentist. 62 AGE OF DENTISTS Dentists in Delaware are rather young, as a group, with a median age of 41.0 years. Approximately one-third of the State's dentists are under 35, while only one-fifth are 55 years of age or over, including just 6 percent who have reached the age of 65. Almost half (46 percent) of all dentists in the State are in the age group 35 through 54, with one-fourth between the ages of 35 and 44. Age Distribution of Delaware Dentists Age Number Percent Cumulative in 1965 of of percent dentists dentists Total 196 100 - Under 30 21 11 11 30 - 34 46 23 34 35 - 39 26 13 47 40 - 44 26 13 60 45 - 49 21 11 71 50 - 54 17 9 80 55 - 59 13 7 87 60 - 64 14 7 94 65 - 69 7 4 98 70 & over 5 2 100 Dentists in the Wilmington area (New Castle County) have a median age of 39.5 years, about 6 years younger, on the average, than dentists in the two nonmetropolitan counties, where the median age is 45.8 years. Thirty- seven percent of the dentists in New Castle County are under 35 years of age, and only 16 percent are 55 or older. In contrast, 22 percent of the dentists in the nonmetropolitan counties are under 35, while more than a third (35 percent) are 55 years of age or over. 63 UTILIZATION OF AUXILIARIES Well over four-fifths of the dental practitioners in Delaware (i.e., den- tists who spend any time working at the chair) report that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 72 percent of the dentists, including 64 percent who employ at least one assistant on a full-time basis. Almost 40 percent of the practitioners employ dental hygienists, most often on a part-time basis. Secretaries or receptionists are employed by 51 percent of the practitioners, with more than three-fourths of these dentists uti- lizing such personnel full time. Delaware Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 194 & 100 78 8 One or more auxiliaries 161 86 78 8 Assistant 135 72 64 8 Hygienist 73 39 14 25 Laboratory technician 18 10 4 6 Secretary or receptionist 96 51 40 11 Other type of personnel 11 6 3 3 No auxiliary 27 14 - - 1/ Includes 6 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is less com- mon among dentists in the older age groups. Ninety percent of the dentists under 55 years of age reported the employment of at least one auxiliary. The proportion utilizing auxiliaries decreases to 70 percent among dentists 55 to 64 years of age and to 60 percent among dentists 65 and over. Some 18 percent of the dentists reported one or more openings for auxil- iary personnel. Of these dentists, one-third indicated a need for full- time hygienists, and one-fifth reported vacancies for full-time assistants. Almost all of the dentists reporting vacancies already employ at least one auxiliary. 64 I> I> ~~ ~~ ~~ OTHER SURVEY FINDINGS Of the 195 professionally active dentists in Delaware, 191, or 97 percent, are engaged in private practice. Ninety-three percent are self-employed and 4 percent are employed by other dentists. The remaining 3 per- cent are either employed by the State or local govern- ment or engaged in other dental activities, such as taking advanced training. Ten percent of the active dentists reported at least one part-time dental activity in addition to their principal employment. Employment in State or local health departments was the most frequently reported secondary activity. Teaching at a dental school was the next most frequently reported part-time employ- ment. Dentists who reported on time spent in providing patient care during the year preceding the survey devoted an average of 47.8 weeks to this activity and worked an average of 37.7 hours per week. About 14 percent of the dental practitioners reported that they limit their practices to a dental specialty, primarily orthodontics or oral surgery. Almost all of the dentists who reported limiting their practice are located in the Wilmington metropolitan area. Only 8 percent of the dentists in Delaware have prac- ticed as civilian dentists in another State immediately prior to assuming their present Delaware location. Most of these dentists came from Pennsylvania. July 1968. 65 as “a ge rea sc ape 3 iF ms Cy TT aR Se Frm DIST. OF COLUMBIA DENTISTS LICENSED IN THE DISTRICT OF COLUMBIA Of the 975 dentists who registered with the District of Columbia Board of Dental Examiners in 1965, 964 completed the survey questionnaire, resulting in a response rate of 99 percent (Table 1). Only 68 percent of these respondents are civilian dentists who reported their primary office loca- tion as Washington, D.C., while another 29 percent are civilians who reported their office location outside the District of Columbia. Two- thirds of this latter group maintain their dental offices in the adjacent states of Maryland and Virginia, the overwhelming majority in counties which constitute the Maryland and Virginia portions of the Washington, D.C. metropolitan area. The other civilian dentists outside the District are located in 24 more distant states, the largest numbers in California, Florida and New York. The remaining three percent of the dentists licensed in the District are on active duty with the armed forces. Table 1.--Primary Office Location and Military Status of Dentists Licensed in the District of Columbia Location and All Percent of military status dentists dentists Total 975 100 Respondents 964 99 Nonrespondents 11 1 Respondents 964 100 Civilians in the District of Columbia 655 68 Civilians located elsewhere 275 29 On active duty with armed forces 34 3 Almost 70 percent of the dentists who responded to the survey hold a license to practice dentistry in at least one state in addition to the District of Columbia. Fifty-five percent of the civilian dentists main- taining their dental office in Washington are also licensed in one or more states--37 percent in one state and only 18 percent in two or more states. By comparison, 38 percent of the civilian dentists who hold a license in the District of Columbia, but are currently maintaining their primary office elsewhere hold licenses in at least two states in addition to the District. Respondents hold over 1900 licenses, an average of almost two per dentist. More than one-half of the licenses outside the District are held in the neighboring states of Maryland and Virginia, and an additional 22 percent are maintained in New York, New Jersey, Pennsylvania and Ohio. The remainder are held in 34 other states and Puerto Rico. 67 Civilian Dentists in the District of Columbia Sources of Supply Dental schools.--Dental schools located in the District of Columbia have trained four-fifths of the District's total dentist supply (Table 2). Georgetown University has made the largest contribution, accounting for more than one-half of the total dental force, while Howard University with a smaller contribution, has trained about one-fourth of the dentists. George Washington University graduated 4 percent of the dentists in Washington, D. C. even though its dental school closed in 1921. The remain- ing one-fifth of the District's dentists received their dental degrees from 27 schools in other parts of the Nation. Among these schools, the Univer- sity of Maryland contributed the largest number of dentists, 4 percent of the total supply. The only other schools to contribute as much as 2 percent of Washington's dentists are Temple and Northwestern Universities and the University of Pennsylvania, Table 2.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Pental school of All After 1941- 1940 or attende dentists years 1955 1955 earlier Total number 655" - 131 220 295 (Percent distribution by school) Georgetown 344 52 29 62 56 Howard 157 24 55 21 12 Maryland 27 4 2 2 7 George Washington (Extinct) 26 4 - - 9 Temple 12 2 1 4 1 Northwestern 10 2 1 3 1 Pennsylvania 10 2 1 2 1 23 other schools 67 10 11 6 13 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. For each item where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table.) One-fifth of the District of Columbia's dentists graduated from dental school within the last 10 years. By comparison 45 percent received their dental degrees in 1940 or earlier. In recent years, Howard University has replaced Georgetown University as the primary source of the District's dentist supply. The contribution of Howard University has increased from 12 percent of the graduates before World War II to 55 percent of those who completed their denta education since 1955. 68 Dentists relocating in the District of Columbia.--One in every seven respond- ing dentists who currently maintain a dental office in the District of Columbia practiced elsewhere as a civilian dentist immediately prior to assum- ing his present location. Thirty-four of the 92 in-migrant dentists came from the neighboring states of Maryland and Virginia. Another 12 dentists moved their dental practice to Washington from the State of New York. The remainder came from 22 other states or Puerto Rico. More than one-third of the in- migrants moved their offices to the District during the last 10 years. Personal Characteristics Age and sex.--The median age of dentists in Washington, D. C. is 49.7 years. Twenty-seven percent of all dentists are between 35 and 44 years of age, and a full one-fourth are between 45 and 54 (Table 3). The proportion of den- tists 55 years of age or older, 37 percent, is more than three times as great as the proportion under 35, Seventeen percent of the total, or 111 dentists, are 65 years old or over, and 68 have reached the age of 70. Fourteen of the 655 dentists in Washington are women. Because they are so few in number, data are not presented separately for them. Table 3.--Age Distribution Number Percent Cumulative Age in 1965 of of percent dentists dentists ~ distribution Total 655 100 - Under 30 23 3 3 30 - 34 51 8 11 35 - 39 69 11 22 40 - 44 102 16 38 45 = 49 86 13 51 50 - 54 81 12 63 55 = 59 63 10 73 60 ~- 64 66 10 83 65 - 69 43 7 90 70 = 74 44 7 97 75 & over 24 3 100 Advanced training.--Almost two-fifths of the survey respondents, or 246 den- tists, reported they had completed one year or more of advanced training beyond their dental degree (Table 4). Of the 188 dentists with advanced clinical training, 46 completed a residency and 142 an internship. Among the 107 dentists who reported advanced academic training, 55 earned a master's or other advanced degree and another 52 received no additional degrees but 69 completed one or more years of postgraduate study. These figures include 49 dentists who completed both clinical and academic training. Table 4.-~Advanced Training Highest level of training Number percent completed dentists dentists Total 655 100 With advanced training 246 38 Clinical training only 139 21 Academic training only 58 9 Both clinical and academic training 49 8 With no advanced training 409 62 Additional education beyond receipt of the dental degree is more common among dentists in the younger age groups. Even though many dentists under age 40 are still serving internships or residencies, or are taking graduate or postgraduate courses, 45 percent report that they have completed some form of advanced training. This percentage is only slightly greater than the 43 percent reporting advanced training among dentists 40 to 54 years old, It is considerably greater, however, than the 28 percent recorded for dentists 55 years of age and over. The most striking contrast is in the area of academic training. Twenty-two percent of the dentists under 40 have completed a year or more of graduate or postgraduate study, compared with 15 percent of the dentists in the older age groups. Professional Activity Current status and employment.--Of the 655 respondents in the District of Columbia, 639, or 98 percent reported that they were active in the dental profession. The other 16 dentists regard themselves as fully retired. Based on this count, there is one professionally active dentist for every 1,252 persons in Washington. Eighty-four percent of the professionally active dentists are primarily engaged in private practice, with 82 percent self-employed and two percent employed by another dentist (Table 5). Another 8 percent of the District's dentists are on the staffs of the dental schools at Georgetown and Howard Universities. The remaining 8 percent are either employed by the local government or other agencies such as Group Health Association, or are engaged in other dental activities, including advanced clinical or academic training. 70 Table 5.--Current Employment of Professionally Active Dentists Principal Secondary dentg} employment employment = Type of employment Number Number Percent employed Percent employed of total Total 639 100 140 22 Self-employed 527 82 42 7 Employed by other dentist 10 2 9 1 Staff of dental school 51 8 51 8 Local government 26 4 8 1 Voluntary agency - - 7 1 Other dental employment 25 4 35 5 1l/ Individual items add to more than total because some dentists reported more than one type of secondary employment. More than one in every five active dentists reported one or more second- ary dental activities in addition to his principal professional employment. Of the 140 dentists reporting secondary employment, 51 said they had part- time faculty appointments at the local dental schools. Self-employment was reported by 42 dentists as their secondary dental activity, and 9 dentists reported part-time employment in the private practices of other dentists. A variety of other secondary activities were reported, including employment in government or voluntary agencies and providing dental services in clinics or hospitals. Activity last year.--Of all dentists reporting their professional activity in the District last year, 93 percent said they provided care to patients. These dentists spent 88 percent of the total reported professional time in providing patient care. Sixteen percent of the dentists reported they spent some time in teaching and 3 percent reported some time in research but only 9 percent of the total professional time was spent in these activ- ities. While 6 percent of the dentists spent time in some other dental activity, such as taking additional training, these activities account for only 3 percent of the total professional time. Weeks and hours worked.--Dentists reporting on time spent last year in pro- viding patient care devoted an average of 46.7 weeks to this activity and worked an average of 37.0 hours per week, About two-fifths of the dentists spent at least 40 hours per week at this activity for 48 weeks or more dur- ing the year. The amount of time worked by dentists in private practice last year declined sharply with age. Almost one-half of the dentists under 40 years of age report working at least 48 weeks and at least 40 hours per week. The pro- portion working this amount of time declines to 30 percent for those between 55 and 64, and decreases to only 18 percent among those 65 years old or over. 71 386-029 O - 70 - 6 Practice Characteristics Limited practices.--Among dentists reporting type of practice, 74, or about one in every eight, limit their practices to a dental specialty. Over three-fifths of these dentists reported limiting their practices to one of two specialty areas--35 percent to orthodontics and 27 percent to oral surgery. The next most frequently reported areas of limited practice are periodontics and prosthodontics. Use of auxiliaries.--About 71 percent of the dental practitioners in Washington (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 6). The majority, 61 percent, of the practitioners employ at least one auxiliary full time, while only 10 percent employ part-time auxiliaries exclusively. Dental assistants are the most frequently employed auxiliary, usually on a full time basis. Approximately 62 percent of the practitioners employ an assistant includ- ing 53 percent who do so full time. Secretaries or receptionists are employed by 23 percent of the dentists, and a majority of these dentists employ at least one of them full time. Twenty-one percent of the dentists employ dental hygienists and 7 percent employ technicians. A majority of the dentists who employ hygienists or technicians do so only part time. About 11 percent of the dentists in the District reported one or more vacant positions for auxiliary personnel. Of these dentists, about 45 per- cent reported vacancies for full-time dental assistants, and 21 percent reported vacancies for full-time dental hygienists. Table 6.--Dental Practitioners Employing Auxiliaries, By Type of Auxiliary Percent of dental practitioners Dental With one full- With only practitioners Total time employee part-time (or more) employees Type of auxiliary Total 611 100 61 10 With one or more auxiliaries 426 71 61 10 With assistant 373 62 53 9 With hygienist 128 21 7 14 With laboratory technician 42 7 2 5 With secretary or receptionist 137 23 16 7 With other type personnel 25 4 3 1 With no auxiliary 174 29 - - The use of auxiliaries varies with the age of the dentist. Peak utilization-- about 86 percent--occurs among practitioners between the ages of 45 and 54. In 72 contrast, auxiliaries are utilized by only 46 percent of the practitioners 65 years old or over. Among the dentists under 35, many of whom are just starting their practices, 68 percent report the employment of one or more auxiliaries. October 1967. 73 APPENDIX TABLE: Summary Statistics Used in Text Number of dentists Total dentists licensed in the District of Columbia 975 Respondents -- total dentists participating in survey 964 Civilian dentists in the Districts (designated simply as "dentists" in text tables) 655 (Number not reporting: age - 3, year of graduation - 9, dental school attended - 2) Professionally active dentists2/ 639 Dental practitioners’ 611 In limited practice’ 74 Located in the District last year: Reported professional activity> 603 Dentists providing patient cared’ 560 Reported time spent in patient carel/ 491 Dentists in private practiced’ 493 Reported time spent in practice’ 426 Civilian respondents not located in the District 275 Dentists on active duty in armed forces 34 Nonrespondents -- licensed dentists not participating in survey 17 1/ All responding dentists who currently work in the District (excluding those in the armed forces) or who are retired and currently live in the District. All active civilian dentists currently in the District -- excludes 16 dentists who are fully retired. All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity, Dentists who reported they limited their practice to a dental specialty. Dentists located in the District last year who indicated type(s) of activity in which they engaged. All dentists who engaged in patient care last year, either as a primary or a secondary activity. Dentists reporting both hours and weeks spent in patient care last year. Dentists who reported they were primarily self-employed both currently and last year. Dentists reporting both hours and weeks spent last year as a self- employed dentist. [F Hol[pJ: DENTISTS LICENSED IN FLORIDA During the 1965 registration period, 3,303 dentists registered with the Florida State Board of Dental Examiners (Table 1). All but 29 dentists-- less than one percent of those registering--completed the survey ques- tionnaire. However, among those responding, only 2,272 dentists, or Table l.--Location and Military Status of Dentists Licensed in Florida Location and All Percent of military status dentists dentists Total 3,303 100 Respondents 3,274 99 Nonrespondents 29 1 Respondents 3,274 100 Civilians in Florida 2,272 69 Civilians in another state 770 23 On active duty with Armed Forces 214 7 Not reported 18 1 69 percent, are actually located in Florida. The remainder--about 1,000 dentists in all--are either out-of-state or serving in the armed services. Approximately 23 percent of the respondents are civilians located in another state or abroad, and another 7 percent are on active duty with the Armed Forces. Of all the dentists responding, only 19 percent are licensed solely in Florida (Table 2). The majority--62 percent--are licensed in just one other state, but 16 percent hold licenses in two other states, and 3 per- cent are licensed in at least three additional states. Taken altogether, the licenses held by respondents number more than 6,600--an average of over two per dentist. All out-of-state dentists, simply by virtue of the fact that they are located in another state while still maintaining a Florida license, are multiple license holders. However, multiple licen- sure is almost as common among dentists located in Florida as it is among 75 Table 2.--Percent of Dentists Holding Licenses in Other States All Civilian dentists Armed Licenses held respondents In Florida Out-of-state Forces Total 100 100 100 100 Florida only 19 25 - 23 Licensed in 1 other state 62 60 64 65 Licensed in 2 other states 16 13 27 11 Licensed in 3 or more states 3 2 9 1 those outside the state. Three-fourths of all Florida dentists are li- censed in at least one additional state. Sixty percent hold one other license, 13 percent hold two additional and 2 percent hold three or more other licenses. Civilian Dentists in Florida Sources of Supply Dentists relocating in Florida.--One in every 4 dentists now in Florida was located in another state or abroad immediately prior to assuming his present Florida location (Table 3). Dentists have moved to Florida from 41 states and the District of Columbia as well as from Puerto Rico and several foreign countries. The largest number from any one state are from Georgia, but these ex-Georgians represent only about three percent of all dentists in Florida. New York, Ohio, and Illinois, the three next largest sources of in-migrants, have each contributed another two percent of the state's dentist supply. Although no one state or area accounts for a particularly large propor- tion of the total, more dentists have come to Florida from other states in the South than from any other region. About 4 in-migrant dentists in every 10 were previously located in another Southern state. Three in 10 have come from states in the North Central region and another 2 were previously located in a Northeastern state. Dentists previously located in the West, together with the few who have come from Puerto Rico and foreign nations, account for about 1 in 10. 76 Table 3.--In-migrant Dentists p fous locati Number of Percent of reviou ocation dentists dentists Total 2,272 100 Previously located elsewhere 570 25 South 240 11 Georgia 73 3 Tennessee 23 1 South Carolina 21 1 Texas 20 1 10 other states 103 5 North Central 179 8 Ohio 43 2 Illinois 40 2 Michigan 31 1 Indiana 23 1 10 other states 42 2 Northeast 115 5 New York 47 2 Pennsylvania 31 1 New Jersey 20 1 3 other states 17 1 West 22 1 Foreign 14 1 Never located elsewhere 1,702 75 1/ Includes only dentists whose last previous location as a civilian was in another state or abroad. dentists who have changed their location within Florida In-migrant after once having established a practice in the state and non-Floridians whose initial location was Florida are excluded from this count. Dental schools.--Florida's dentists are graduates of 54 schools, including each of the 46 dental schools in the Nation that graduated dentists in Seven schools which are now extinct and the University of Quebec in 1964. Canada also graduated dentists who are now in Florida. However, over one-half of all dentists in the state are graduates of schools Emory has made the largest single contribu- located in the South (Table 4). tion, having trained more than one-fourth of the state's dentists. Tennessee, 77 Table 4.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Pental school of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 2,272%/ - 883 879 459 (Percent distribution by school) South 1,280 57 54 61 55 Emory 587 26 18 32 35 Tennessee 121 6 8 4 2 Maryland 116 5 6 5 2 Louisville 87 4 3 5 3 Virginia 69 3 5 2 1 Loyola (New Orleans) 63 3 2 4 2 Alabama 54 2 4 2 - Howard 48 2 1 3 2 10 other schools 135 6 6 4 8 North Central 596 26 26 28 27 Northwestern 117 5 2 9 7 Ohio State 87 4 5 2 4 Indiana 60 3 1 4 3 Michigan 57 2 4 2 2 Western Reserve 52 2 2 2 3 Illinois 36 2 1 2 2 Marquette 32 1 2 1 1 10 other schools 155 7 8 5 7 Northeast 349 16 19 10 15 Pennsylvania 82 4 5 2 3 New York University 72 3 3 3 3 Temple 70 3 4 2 2 Pittsburgh 66 3 3 2 4 6 other schools 59 3 3 1 4 West 26 1 2 1 2 Canada 8 * - * 1 * Less than one-half of one percent. 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table A.) 78 Maryland and Louisville have also made significant contributions. Another one-fourth of the dentists received their education in schools in the North Central states and 16 percent attended schools in the Northeast. Dental schools in the Western states account for only one percent of the state's dentist supply. Two-fifths of the state's dentists have been graduated from dental school within the last 10 years. In contrast, only one-fifth are graduates of the years prior to World War II. Within each graduating period, there have been slight changes in the proportion of dentists graduating from schools in each region. Probably the most noteworthy change is the declining role of Emory as a source of dentist supply. A third or more of all dentists in the state who were graduated 10 years ago or earlier received their dental education at Emory. But among graduates of the past 10 years now practicing in Florida, only one-sixth are Emory graduates. Nonetheless, the South as a whole accounts for about the same proportion of recent graduates as it does of those graduating earlier. In-migrant dentists are less likely to have been educated in Southern dental schools than are nonmigrant dentists (Table 5). Six out of 10 of the Table 5.--Year Dental Degree Awarded Nonmigrant and In-migrant Dentists, by Location of Dental School Year of Number Percent of dentists of North Nor th- graduation dentists South Central east West Nonmigrants 1,702 61 23 14 1 After 1955 889 54 25 20 1 1941 - 1955 459 71 22 6 1 1940 & earlier 309 68 18 11 3 In-migrants 570 42 37 19 1 After 1955 202 55 28 16 1 1941 - 1955 210 40 40 19 1 1940 & earlier 146 28 46 23 2 nonmigrant dentists were graduated from Southern dental schools, whereas these same schools trained only 4 out of 10 of the in-migrant dentists. More than one-third of the in-migrants received their dental education in schools in the North Central states and most of the remainder (about one-fifth) attended schools in the Northeast. However, declining proportions of the in-migrant dentists have come from these two regions. The majority of all recently graduated dentists who have moved to Florida after having once been located in some other state are dentists who were graduated from schools in the South. 79 Personal Characteristics Age and sex.--Florida's dentists, as a group, are very young. The median age of reporting dentists was only 40.2 years. Almost one-third were under the age of 35 and fully another third were between the ages of 35 and 44 (Table 6). Perhaps even more important than this very large proportion of young dentists are the small numbers of dentists at the other end of the age scale. Less than 10 percent of Florida's dentists are 60 years old or older including only 5 percent who have reached the age of 65. Table 6.--Age and Sex Number Percent Sex and age of of dentists dentists Total 2,272 100 Male 2,260 99 Female 12 1 Age Under 30 207 9 30 - 34 518 23 35 - 39 377 17 40 - 44 392 18 45 - 49 242 11 50 - 54 162 7 55 - 59 128 6 60 - 64 83 4 65 - 69 60 3 70 - 74 33 1 75 & over 24 1 There are only 12 women dentists included among the respondents. For this reason, data for women will not be shown separately in this report. Advanced training.--About 28 percent of Florida's dentists have had some type of advanced training (Table 7). Although a larger number have had advanced clinical training than academic training, there are 7 dentists who reported they have earned a second doctorate, 121 who have earned a master's degree, and another 178 who have completed one or more years of postgraduate study. 80 Table 7.--Advanced Training Highest level of training Number percent completed dentists dentists Total 2,272 100 With advanced training 637 28 With no advanced training 1,635 72 Clinical training Residency completed 111 5 Internship completed 336 15 Academic training Ph.D., M.D., or other doctorate 7 * M.A., M.S., or other master's degree 121 5 Postgraduate 1 year or more (no degree) 178 8 * Less than one-half of one percent. The data in Table 8 reflect the growing tendency of dentists to seek addi- tional training after receiving their dental degree. While many dentists under 40 are still serving internships and residencies, or are enrolled in school, 30 percent report that they have completed some form of advanced training. This percentage is equal to that recorded for dentists 40 to 54 Table 8.--Advanced Training, by Age Dentists Percent of dentists Age with With With With With advanced advanced academic residenc {nternshi training training training y P Total 637 28 13 5 15 Under 40 328 : 30 . 16 5 15 40 - 54 238 30 13 6 16 2 12 55 & over 56 17 7 years old and is considerably greater than the 17 percent recorded for den- tists 55 and over. The most striking contrast is in the area of academic training. Sixteen percent of the dentists under 40 have completed a year or more of graduate or postgraduate study, compared with 13 percent of the dentists between 40 and 54, and only 7 percent of those 55 and over. The trend is less obvious with respect to clinical training, but chiefly because relatively large numbers of dentists in the younger age groups have not yet completed their internships or residencies. Among dentists 40 to 81 54 years of age, 6 percent have completed residencies and another 16 per- cent have completed internships. These percentages compare with 2 percent and 12 percent, respectively, for dentists 55 years old and over. Distribution and Current Status Distribution of dentists.--Nearly three-quarters of all dentists in Florida are located in the eleven counties which make up the metropolitan areas (Table 9). The Miami area alone has almost as many dentists as all 56 of the nonmetropolitan counties combined. The three southern metropol- itan areas, Miami, Fort Lauderdale, and West Palm Beach, contain 40 percent of the state's dentists, while the Orlando and Tampa areas contain 22 per- cent and the three northern metropolitan areas of Pensacola, Tallahassee, and Jacksonville contain 12 percent. Table 9.--Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 67 2,272 100 All metropolitan areas 11 1,658 74 Miami 1 550 25 Tampa-St. Petersburg 2 343 15 Fort Lauderdale - Hollywood 1 205 9 Jacksonville 1 160 7 Orlando 2 156 7 West Palm Beach 1 145 6 Pensacola 2 63 3 Tallahassee 1 36 2 Nonme tropolitan county groups 56 582 26 Central city 25,000 & over 7 245 11 Central city 10,000-24,999 8 193 9 Central city 5,000- 9,999 11 75 3 Central city 2,500- 4,999 15 52 2 Central city under 2,500 15 17 1 In contrast, the nonmetropolitan areas are served by only 26 percent of the dentists, with 20 percent in the 15 counties with central cities of at least 10,000 persons and the remaining six percent in the 41 counties which have smaller central cities. About the same proportion of in-migrant and nonmigrant dentists are located in the metropolitan areas. However, dentists who were previously located in the Northeastern states have shown a much stronger tendency than other 82 in-migrants to locate in the metropolitan areas, particularly the three southern areas of Miami, Fort Lauderdale, and West Palm Beach (Table 10). Ninety percent of all these Northeasterners are located in the metropolitan areas, with 75 percent concentrated in the three southernmost areas. While dentists from the North Central and Western regions have chosen their locations more or less in the same proportions as the average for all in-migrant dentists, the dentists who come from the Southern states are distributed differently. Southern in-migrants are more likely than other dentists to locate in the nonmetropolitan areas of Florida, and relatively fewer are attracted to the three metropolitan areas in the south of Florida. Where, on the average, 44 percent of all in-migrant dentists have located Table 10.--Florida Location of In-migrant Dentists, by Previous Location In-migrant Percent distribution County group dentists North- North Number Percent east Central South West All counties 570 100 100 100 100 100 All metropolitan areas 429 75 90 78 66 75 Miami 133 23 42 20 17 20 Tampa-St. Petersburg 102 18 10 21 20 22 Fort Lauderdale 77 13 20 20 7 4 West Palm Beach 45 8 13 8 5 7 Orlando 34 6 3 5 7 11 Jacksonville 28 5 2 4 6 9 Pensacola 9 2 - - 4 2 Tallahassee 1 * - - * - Nonmetropolitan county groups 141 25 10 22 34 25 Central city 25,000 & over 58 10 5 13 11 9 Central city 10,000-24,999 47 8 1 5 14 9 Central city under 10,000 36 7 4 4 9 7 * Less than one-half of one percent. their practices in Miami, Fort Lauderdale, and West Palm Beach, only 29 percent of the dentists from the South have done so, and 34 percent of the Southern in-migrants have elected to practice in a nonmetropolitan county, compared with the average of 25 percent for all in-migrants. Dentists in the nonmetropolitan counties tend to be younger than those in the metropolitan areas (Table 11). The median age in 1965 of dentists located in counties with central cities of 2,500 - 4,999 population was only 35.0 years, as compared with a median age of 38.8 years among dentists in the Orlando area, the metropolitan area with the highest percentage of younger dentists. Fort Lauderdale - Hollywood, West Palm Beach and Pensacola are the 83 only other metropolitan areas where the median age of dentists is below the state average of 40.2 years. In every county group, except the Pensacola metropolitan area, the percent of dentists under 30 years exceeds the per- cent of dentists 64 years and over. Furthermore, the proportion of dentists under 35 is more than double the proportion 55 years and over in almost all county groups. The exceptions are the Tampa - St. Petersburg, Pensacola and Tallahassee metropolitan areas and the nonmetropolitan counties with less than 2,500 inhabitants in their central cities. Table 11.--Median Age and Age Distribution, by County Group Median Percent of dentists County group ace Under 30- 35- 45- 55- 65 & g 30 34 44 54 64 over All counties 40.2 9 24 35 18 9 5 All metropolitan areas 40.6 9 21 36 19 10 5 Orlando 38.8 9 32 30 16 10 3 Ft. Lauderdale-Hollywood 39.0 8 21 40 18 9 4 West Palm Beach 39.4 6 25 38 20 6 5 Pensacola 39.5 8 20 40 16 8 8 Tallahassee 40.6 11 19 39 11 17 3 Miami 41.4 10 19 35 22 10 4 Tampa-St. Petersburg 41.6 8 21 34 18 12 7 Jacksonville 41.6 8 19 38 23 6 6 Nonmetropolitan county groups 38.4 11 28 33 14 9 5 Central city 2,500-4,999 35.0 10 40 25 13 10 2 Central city 10,000-24,999 37.8 11 29 36 12 6 6 Central city 5,000-9,999 37.9 16 29 26 11 14 4 Central city 25,000 & over 39.2 11 26 32 17 10 4 Central city under 2,500 39.4 12 17 41 12 6 12 Professional status.--As might be expected from the state's unusually young dentist supply, very few dentists are retired (Table 12). Almost 99 percent of the responding dentists are active in the profession. Only 6 dentists Table 12.--Professional Activity Status Number Percent Activity status of of dentists dentists Total 2,272 100 Active in profession 2,242 99 Inactive in profession 30 1 In nondental employment 6 * Retired 24 1 * Less than one-half of one percent. 84 reported their primary employment to be nondental and only 24 dentists considered themselves fully retired. Although a majority of the retired dentists are in the older age groups, relatively few of the older dentists who responded to the survey consider themselves retired. Of the 117 dentists 65 and over, only 14 (12 percent) reported themselves as fully retired. The proportion who do retire, of course, is greater among the oldest age groups. Whereas only 5 percent of the 65-69 age group are retired, about 18 percent of the 70-74 age group, and 21 percent of those 75 and over are retired. Active dentists in relation to population.--There was one professionally active respondent for every 2,619 persons in Florida in 1965 (Table 13). However, among the 63 counties with professionally active respondents, the number of persons per active dentist ranges from 1,450 for Gilchrist County to over ten times this number, 14,800, in Madison County. The remaining four counties, Glades, Gulf, Liberty, and Wakulla, had no active reporting dentist (see appendix Table B for individual county data). Table 13.--Number of Persons per Dentist Professionally Civilian Persons County group active opulation per dentists pop dentist All counties 2,242 5,871,600 2,619 All metropolitan areas 1,642 3,951,700 2,407 West Palm Beach 145 282,300 1,947 Ft. Lauderdale-Hollywood 205 420,700 2,052 Miami 544 1,120,200 2,059 Tallahassee 36 86,500 2,403 Orlando 155 383,800 2,476 Tampa-St. Petersburg 337 905,400 2,687 Jacksonville 159 517,700 3,256 Pensacola 61 235,100 3,854 Nonme tropolitan county groups 578 1,919,900 3,322 Central city 10,000-24,999 192 572,200 2,980 Central city 25,000 & over 245 737,600 3,011 Central city 5,000-9,999 - 74 266,000 3,595 Central city 2,500-4,999 52 237,200 4,562 Central city under 2,500 15 106,900 7,127 The persons-per-dentist ratios for the eight metropolitan areas differ sharply. They range from 1,947 in the West Palm Beach area to a high 3,854 in Pensacola. Like West Palm Beach, the other two southern areas, Miami and Fort Lauderdale, 85 D A N FLOR ST R DENT I PE ON POPULAT COUNTY 1 965 BY ZZ 2222222222222 TTI. IIIS Z2Z2 2271 yoyo) rove. IIIS vos VIII PAA PAA ZZ TT 2 A CII “PTOI. vesssssemi es © AN - oso. Rv RZ4 NJIACKSON “7 77 / + » + Cc S [} & + 2 $ Cc a ™ < o 0 J 7 o — ss 0 1 | oo t £0 lay © C o o o © 0s 7, A o © Cc o o © cs, © 0 0 o \ I ~ ~ ~ o = [ © 0 c have persons-per-dentist ratios which are considerably better than the state average of 2,619. But the ratios for the Tallahassee and Orlando areas are only slightly more favorable than this average and the ratios for the three remaining metropolitan areas are less favorable than the state average. In the three metropolitan areas containing more than one county, there is the tendency for one of the two counties in each of the areas to have a consider- ably higher ratio than the other. In the Tampa-St. Petersburg area, Pinellas County has a ratio of 2,314, while Hillsborough County has a ratio of 3,192. Where Orange County of the Orlando metropolitan area has a ratio of 2,234, the other county, Seminole, has 4,914 persons for every dentist. In the Pensacola area the contrast is also quite sharp, with Escambia County, con- taining Pensacola, having a ratio of 3,579, and Santa Rosa County, a ratio of 6,940. Similar contrasts exist among the nonmetropolitan counties. Of the 56 non- metropolitan counties, 23 have ratios of over 5,000 persons per dentist, including the 4 counties which are assumed to have no active dentist, while only 7 have ratios better than the state average of 2,619. Both groups of counties whose central cities contain populations of over 10,000 have ratios of about 3,000 persons per dentist. These two groups of counties contain 4 of the 7 nonmetropolitan counties with ratios better than the state average but only 2 of the 23 counties with ratios over 5,000. Among the 3 groups of counties with central cities of less than 10,000 persons, the ratio of per- sons per dentist becomes markedly higher as the size of the central city declines, until for the group of counties without a town of 2,500 persons, there are over 7,000 persons for each dentist. Professional Activity Current employment.--Almost all of the professionally active dentists in Florida are engaged in private practice, 96 percent are self-employed and 2 percent are employed by another dentist (Table 14). Of the remaining Table 14.--Current Employment of Professionally Active Dentists Principal Secondary 1/ employment dental employment= Type of employment Number Percent Number Percent employed reporting of total Total 2,242 100 121 5 Self-employed 2,136 96 111 5 Employed by other dentist 51 2 3 * Employed by state or local government 25 1 4 * Other dental employment 30 1 3 * 1/ Includes private practice, state or local government, voluntary agencies and other such employment. * Less than one-half of one percent. 87 386-029 O-170 -17 two percent, one percent are employed by the state or a local government and one percent are engaged in other dental employment. Only 121 den- tists, or 5 percent of those professionally active, reported a secondary dental employment. Activity last year.--About 98 percent of all dentists reporting on their professional activity in Florida last year provided care for patients (Table 15). Only 3 percent reported any research activity and only 2 per- cent spent some time in teaching. About 5 percent spent time in some other dental activity, in many cases taking additional training. In terms of professional time, however, these latter activities accounted for only very minor fractions of the total time spent in professional pursuits. Barely one-half of one percent of all dentist time was spent in research Table 15.--Professional Activity Last Year Dentists reporting Percent of total Type oF activity last year professional time y Number Percent reported Total 2,083 100% 100 Patient care 2,051 98 98 Research 61 3 * Teaching 43 2 * Other 99 5 2 1/ Individual items add to more than total because some dentists spent time in more than one activity. * Less than one-half of one percent. and teaching combined and less than two percent was spent in such other activities as the receipt of training. Of the dentists who provided patient care last year, the largest number, one-fifth of the total, spent 40 hours a week at this activity for at least 50 weeks of the year (Table 16). Only 13 percent devoted under 35 hours per Table 16.--Time Spent in Patient Care Last Year Dentists Percent of reporting dentists Weeks spent providing 48 hrs. 41-47 35-39 Under in patient care patient care or more hrs, 40 brs. hrs. 35 hrs, Total 100 15 17 40 17 11 50 weeks or more 45 8 8 19 6 4 48 - 49 weeks 35 5 7 13 7 3 40 - 47 weeks 17 2 2 6 4 3 Less than 40 weeks 3 * * 2 * 1 * Less than one-half of one percent. 88 week or worked less than 40 weeks at this activity during the course of the year. An equal percentage of those reporting patient care, however, devoted exceptionally long hours to the treatment of patients. Thirteen percent spent the equivalent of 8 hours a day, six days a week at this activity for 48 weeks or more during the year. Practice Characteristics Limited practices.--Approximately 15 percent of all practicing dentists report they limit their practices to a dental specialty (Table 17). The metropolitan areas, of course, have a disproportionate share of these den- tists. One in every 6 dentists practicing in a metropolitan area limits his practice, whereas in counties which are not part of metropolitan areas, only one in every 10 dentists does so. Among the metropolitan areas, West Palm Beach has the largest proportion of practitioners with limited practices, but the largest numbers of limited practitioners are in the Miami, Tampa- St. Petersburg, and Ft. Lauderdale-Hollywood areas. Pensacola and Tallahassee, on the other hand, have relatively few dentists who limit their practices to a specialty. The most frequent fields of specialization are orthodontics and oral surgery. They account for 5 percent and 4 percent, respectively, of the state's dental practitioners. Table 17.--Limited Practices Dentists Percent of dental practitioners County group with AlL Ortho- Oral Pedo- limited specialty dontics surgery dontics Other practices areas All counties 334 15 5 4 2 4 All metropolitan areas 273 16 5 4 2 5 Miami 100 18 6 4 2 6 Tampa-St, Petersburg 58 18 5 4 3 6 Ft. Lauderdale-Hollywood 30 14 4 4 3 3 West Palm Beach 27 19 6 8 2 3 Jacksonville 24 15 5 2 1 7 Orlando 23 15 3 5 3 4 Pensacola 7 11 5 3 - 3 Tallahassee 4 11 3 5 - 3 Nonmetropolitan counties 59 10 4 3 1 2 Use of auxiliaries.--Over 90 percent of the dental practitioners in Florida (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 18). Moreover, the vast majority, 84 percent, of these dentists employ at least one auxiliary full time, while only 7 percent employ part-time auxiliaries exclusively. The dental assistant, the most 89 frequently employed auxiliary, is employed by 87 percent of the dentists, mostly full-time. Secretaries and receptionists are employed by 44 percent of the dentists, again mostly full-time. The use of part-time employees is Table 18.--Dental Practitioners Employing One or More Auxiliaries, by Type of Auxiliary Percent of dental practitioners With one Dental With only _ Type of auxiliary practitioners Total part-time ful? time ersonnel employee P (or more) Total 2,224 100 7 84 With no auxiliary 188 9 - - With one or more auxiliaries 2,016 91 7 84 With assistant 1,919 87 8 79 With hygienist 646 29 19 10 With laboratory technician 331 15 9 6 With secretary or receptionist 959 44 11 33 With other type of personnel 102 5 3 2 more common for other types of auxiliaries. While 29 percent of all dentists employ dental hygienists and 15 percent employ dental technicians, about one- third, and two-fifths, respectively, of the dentists employing these person- nel do so on a full-time basis. If all reported personnel vacancies were filled, the numbers of full-time hygienists and technicians would be almost doubled. The use of auxiliaries varies with the age of the dentist (Table 19). Over 90 percent of the dental practitioners between the ages of 30 and 54 employ some type of auxiliary. Among dentists 65 years and over, the proportion Table 19.--Dental Practitioners Employing Auxiliaries, by Age Percent of age group Age With With With auxiliaries assistants hygienists Under 30 84 81 20 30 - 34 93 92 23 35 - 44 94 90 36 45 - 54 94 90 36 55 - 64 86 76 21 65 & over 64 48 13 90 using auxiliaries drops to 64 percent. Young dentists who are just start- ing their practices do not reach peak utilization of assistants until they are 30 years of age and of hygienists until age 35. Dentists in metropolitan areas and those in nonmetropolitan counties employ assistants with about the same frequency. However, hygienists and techni- cians are employed slightly more frequently by dentists in metropolitan areas, Weeks and hours worked.--Although 89 percent of all dentists in private practice reported on the amount of time they had spent in their practices in the previous year, the percentage reporting is low for dentists 55 years old and over (Table 20). Since those not responding are likely to be those who are least active, the estimates on time worked by dentists in this age Table 20.--Time Spent in Private Practice Last Year, by Age Dentists Percent working reporting time 48 weeks p art year Age spent in practice or more or less than Percent 40 hrs/wk Number 40 hrs/wk of total or more Total 1,763 89 59 41 Under 40 792 90 67 33 40 - 54 703 92 58 42 55 & over 234 81 37 63 group are probably high. Even so, the percentage of dentists working 48 weeks or more and at least 40 hours per week drops precipitously among the older dentists. Whereas 67 percent of the dentists under 40 years of age and 58 percent of the dentists between 40 and 54 years old report working at least 48 weeks and at least 40 hours per week, only 37 percent of the dentists over 55 years old report working these hours. Out-of-state Civilian Dentists State Location Florida licenses are maintained by at least 770 civilian dentists located in 40 states, the District of Columbia, and several foreign nations (Table 21). Over one-half of these out-of-state dentists are located in other Southern states, primarily in Georgia, Alabama, North Carolina and Tennessee. More than 35 dentists in New York, Illinois and Ohio also hold licenses in Florida. 91 Table 21.,--Out-of-state Dentists, by State Number of Percent of Present location dentists dentists Total 770 100 South 408 53 Georgia 136 18 Alabama 79 10 North Carolina 41 5 Tennessee 36 5 Virginia 22 3 Maryland 21 3 10 other states 73 9 North Central 174 23 Illinois 43 6 Ohio 36 5 Michigan 32 4 Indiana 23 3 7 other states 40 5 Northeast 137 17 New York 59 8 New Jersey 26 3 Pennsylvania 26 3 5 other states 26 3 West 41 5 California 30 4 5 other states 11 1 Foreign 10 1 Age and Professional Status As a group, the out-of-state dentists are even younger than those presently in Florida. While 32 percent of the dentists located in Florida were under 35 in 1965, 40 percent of the out-of-state civilian dentists were in this young age group. Moreover, only 8 percent of the out-of-state dentists were 55 years old or over, as compared with 15 percent of the in-state dentists. Less than one percent of the out-of-state dentists report they are retired. The majority, 85 percent, are in dental practice. About 5 percent are employed in governmental agencies, 4 percent are on the staffs of dental schools and the remaining 6 percent are engaged in other dental activities, primarily serving internships or residencies. 92 Out-Migrant Dentists About one of every seven out-of-state respondents reported they had formerly been located in Florida. These 105 dentists are now located in 26 states, the District of Columbia, and several foreign countries. One-half of these out-migrants are now located in other Southern states=--including 14 in Georgia, 10 in Alabama, 7 in North Carolina and 5 in Maryland. States in other regions which have attracted at least 5 dentists who once were located in Florida include New York, Indiana, California, Illinois and Michigan. Almost two-thirds of the out-of-state respondents who were formerly located in Florida left the state after 1959 (Table 22). The low proportion of out-migrants prior to 1950, 15 percent, may be attributed to the fact that the longer a dentist remains out of state, the less likely he is to renew Table 22.--Year Out-migrant Dentists Left State, by Age in 1965 Age distribution Percent of Under 35- 45- 55 & Year left out-migrants 35 44 54 over Total 100 42 34 15 9 1960 or later 64 40 20 3 1 1950 - 1959 21 2 13 5 1 Before 1950 15 - 1 7 7 his license in the state he has left. However, the proportionately large numbers of out-migrants in the younger age groups reflect, at least in part, the relatively greater mobility of young dentists in relation to older practitioners, Three-fourths of the out-migrants were under 45 years of age in 1965, including over 40 percent who were under 35, while only 9 per- cent had reached 55 years of age. September 1966 93 Appendix Table A.--Summary Statistics Used in Text Number of dentists Total dentists licensed in Florida 3,303 Respondents -- total dentists participating in survey 3,274 (number not reporting current location or military status =- 18) Civilian dentists in Floridal/ (designated simply as "dentists" in next tables) 2,272 (number not reporting: age - 46, year of graduation - 51, county location - 32, dental school attended = 13) Professionally active dentists2/ 2,242 Dental practitioners’ 2,224 In limited practice?’ 334 Located in Florida last year: Reported professional activity 2,083 Dentists providing patient cared’ 2,051 Reported time spent in patient carel/ 1,838 Dentists in private practiced’ 1,975 Reported time spent in practice?’ 1,763 Out-of-state dentists -- civilian respondents not located in Florida 770 ln Is ~ lov ~ ~ loo I~ ~~ 94 All responding dentists who currently work in Florida (excluding those in the armed forces) or who are retired and currently live in the state. All active civilian dentists currently in Florida -- excludes 24 dentists who are fully retired and 6 who are engaged principally in a nondental activity. All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. Dentists who reported they limited their practice to a dental specialty. Dentists located in Florida last year who indicated type(s) of activity in which they engaged. All dentists who engaged in patient care last year, either as a primary or a secondary activity. Dentists reporting both hours and weeks spent in patient care last year. Dentists who reported they were primarily self-employed both currently and last year. Dentists reporting both hours and weeks spent last year as a self-employed dentist, Appendix Table B.--County Data Civilian Profes- Persons Percent of Percent of sionally active dentists practitioners County population pe — rw (in 000's) active dentist Under 55 years using dentists 35 yrs. or more auxiliaries All counties 5,871.6 2,242Y 2,619 32 14 91 Alachua 88.3 34 2,597 26 21 91 Baker 7.8 1 7,800 100 - 100 Bay 75.1 13 5,777 46 8 100 Bradford 13.1 4 3,275 50 - 75 Brevard 155.1 69 2,248 45 7 91 Broward 420.7 205 2,052 29 12 92 Calhoun 7.8 1 7,800 - - 100 Charlotte 19.3 4 4,825 50 - 100 Citrus 11.4 2 5,700 100 - 100 Clay 20.5 5 4,100 40 - 80 Collier 22.2 7 3,171 57 - 100 Columbia 22.2 7 3,171 57 14 71 Dade 1,120.2 544 2,059 28 14 91 DeSoto 13.3 4 3,325 25 25 75 Dixie 4.8 1 4,800 - - 100 Duval 517.7 159 3,256 26 13 91 Escambia 200.4 56 3,579 27 14 89 Flagler 5.2 1 5,200 100 - 100 Franklin 7.4 1 7,400 - 100 - Gadsden 46.3 7 6,614 29 14 100 Gilchrist 2.9 2 1,450 - 50 100 Hamilton 7.8 1 7,800 - - 100 Hardee 13.6 3 4,533 67 - 67 Hendry 10.6 4 2,650 25 25 75 Hernando 13.1 2 6,550 50 - 100 Highlands 25.4 13 1,954 46 31 92 Hillsborough 456.4 143 3,192 35 17 95 Holmes 11.1 1 11,100 - - 100 Indian River 32.3 13 2,485 54 23 100 Jackson 37.3 10 3,730 60 - 70 Jefferson 10.3 2 5,150 50 - 100 Lafayette 3.0 1 3,000 - - - Lake 66.3 20 3,315 30 15 100 Lee 70.0 28 2,500 50 14 93 Leon 86.5 36 2,403 31 19 92 Levy 11.2 1 11,200 - - 100 95 Appendix Table B.--County Data (continued) Civilian Profes- Persons Percent of Percent of sionally active dentists practitioners County population per Under 55 vears { (in 000's) active dentist Under years using dentists 35 yrs. or more auxiliaries Madison 14.8 1 14,800 100 - 100 Manatee 81.6 26 3,138 35 15 88 Marion 61.1 19 3,216 11 11 84 Martin 22.6 7 3,229 71 - 86 Monroe 58.4 15 3,893 27 27 87 Nassau 19.5 3 6,500 33 - 100 Okaloosa 70.6 14 5,043 64 7 100 Okeechobee 8.6 2 4,300 50 50 100 Orange 315.0 141 2,234 43 11 9% Osceola 22.0 4 5,500 50 - . 100 Palm Beach 282.3 145 1,947 30 11 88 Pasco 42,1 9 4,678 33 33 100 Pinellas 449.0 194 2,314 25 18 94 Polk 222.0 63 3,524 32 11 87 Putnam 34.8 7 4,971 29 14 100 St. Johns 32.7 9 3,633 11 33 100 St. Lucie 48.8 12 4,067 42 - 100 Santa Rosa 34.7 5 6,940 60 20 80 Sarasota 94.8 51 1,859 41 12 88 Seminole 68.8 14 4,914 14 29 86 Sumter 13.3 1 13,300 - 100 100 Suwannee 17.1 5 3,420 40 - 100 Taylor 14.5 4 3,625 50 50 75 Union 6.4 1 6,400 - - 100 Volusia 150.2 57 2,635 37 18 95 Walton 16.1 4 4,025 - - 100 Washington 11.6 2 5,800 50 - 100 4 counties with no reporting dentists? 21.6 - - - - - 1/ The total includes 22 dentists who failed to indicate their county location. 2/ There are 3 counties with no professionally active dentists reporting: Glades, "Gulf and Liberty. In addition, there was one county--Wakulla--in which the one responding dentist was reported as professionally inactive. 96 GEORGIA DENTISTS LICENSED IN GEORGIA During the 1966 registration period, 2,362 dentists registered with the Board of Dental Examiners of Georgia. Only 52 percent of these dentists are civilians actually located in Georgia, while 43 percent are civilians located in other States, and 5 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Georgia Location and All Percent of military status dentists dentists Total licensed 2,362 100 Respondents 2,199 93 Nonrespondents 163 7 Total licensed 2,362 100 Civilians in Georgia 1,240 52 Respondents 1,161 - Nonrespondents 79 - Civilians in another State 1,007 43 On active duty with Armed Forces 115 5 The survey questionnaire was completed by 2,199 dentists, 93 percent of all those registered. The data provided by the survey respondents has been supplemented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained either from re- cords maintained by the Board of Dental Examiners of Georgia or from the 1967 American Dental Directory published by the American Dental Associ- ation, Among survey respondents, more than two-thirds (68 percent) hold a li- cense to practice dentistry in one or more other States, Approximately 43 percent of the dentists located in Georgia hold more than one license, with 36 percent licensed in one other State and 7 percent licensed in two or more other States. The proportion of out-of-State dentists holding multiple licenses is considerably greater; 23 percent hold two or more licenses in addition to their Georgia license. Almost seventy percent of the licenses held outside of Georgia are held in adjacent States, in- cluding 32 percent in Florida, 12 percent in Alabama, 10 percent each in North and South Carolina, and 5 percent in Tennessee. 97 PROFESSIONAL TRAINING More than three-fourths (77 percent) of Georgia's dentists graduated from Emory University School of Dentistry. The remainder (23 percent) of the State's dentists received their dental degrees from 41 other schools. Among these schools, the University of Tennessee is the largest contribu- tor, having supplied 5 percent of the State's dentists, while the two next largest contributors, Howard University and Meharry Medical College, have together provided 4 percent of the dentists. Only four other schools-- the Universities of Alabama, Maryland, and Louisville, and Northwestern University--have provided as much as 1 percent of Georgia's dentist supply. Dental School Attended and Year of Graduation for Dentists in Georgia Number Year of graduation penta’ school of ALL After 1941- 1940 or dentists years 1955 1955 earlier 17 Total number 1,240 - 418 464 354 (Percent distribution by school) Emory University 953 77 68 79 84 University of Tennessee 64 5 11 3 1 Howard University 24 2 1 2 2 Meharry Medical College 22 2 * 3 1 38 other schools 172 14 20 13 12 1/ Dental school attended not available for 5 dentists and year of grad- uation for 4 dentists. Percents based on total for whom data are known. * Less than one-half of one percent. The proportion of Emory University graduates in the State dentist supply has decreased somewhat in recent years. Approximately 68 percent of the dentists in the State who graduated since 1955 received their dental edu- cation at Emory, compared to 82 percent of those who graduated in earlier years. At the same time, the proportion of Georgia dentists from the University of Tennessee and from various other out-of-State schools has increased. Approximately 18 percent of the survey respondents, 204 dentists, report- ed that they had completed one or more years of advanced training beyond the dental degree. Among the 143 dentists who reported advanced academic training, 56 had earned a master's or other advanced degree, and another 87 had received no additional degrees but had completed one or more years of postgraduate study. Of the 103 dentists with advanced clinical train- ing, 46 had completed a residency, and 57, an internship. There were 42 dentists who had completed both academic and clinical training. 98 DISTRIBUTION OF DENTISTS Two-thirds of the 1,240 dentists in Georgia are located in the seven met- ropolitan areas of the State. The 5-county Atlanta area alone has 563 dentists, 46 percent of the total dental force. Seven in every 10 of these dentists (393) are in Fulton County, where Atlanta is located. The vast majority of the remaining dentists in this area are in De Kalb Coun- ty (102 dentists) and Cobb County (50 dentists). The Macon and Savannah metropolitan areas have the next largest dental forces, even though each accounts for only 5 percent of the dentist supply. The Georgia portion of the interstate Augusta and Columbus metropolitan areas have 4 percent and 3 percent of the State's dentists, respectively. The remaining two metropolitan areas--Albany and the Georgia portion of the interstate Chat- tanooga area (Walker County)--together account for 3 percent of the den- tist supply. Distribution of Georgia Dentists, by County Group County group Number of Number of Percent of counties dentists dentists All counties 159 1,240 100 Metropolitan areas 13 815 66 Atlanta area 5 563 46 Macon area 2 62 5 Savannah area 1 58 5 Augusta area (Ga. part) 1 54 4 Columbus area (Ga. part) 2 43 3 Albany area 1 25 2 Chattanooga area (Ga. part) 1 10 1 Nonmetropolitan counties 146 425 34 Central city 10,000-49,999 18 204 16 Central city 5,000- 9,999 22 85 7 Central city 2,500- 4,999 41 89 7 Central city under 2,500 65 47 4 * See Appendix Table for definition of interstate and other metropolitan areas and presentation of individual county data. One-third of the State's dentists (425) are located in the 146 nonmetro- politan counties. The 18 counties with central cities of 10,000 or more persons have 204 dentists, 16 percent of the State's dental force. Only nine of the nonmmetropolitan counties have as many as 10 dentists, and just one of these counties, Floyd, has as many as 20 dentists. The 128 counties with fewer than 10,000 persons in their central cities have less than one-fifth of the State's dentist supply. There are 174 dentists in the 63 counties having between 2,500 and 9,999 persons in their central cities, while 47 dentists are scattered among the 65 coun- ties with central cities of less than 2,500 population. While only seven of these 128 counties have as many as five dentists, 95 counties have fewer than three dentists, including 34 (one-fifth of all counties in the State) with no dentists according to available information. 99 AGE OF DENTISTS The median age of dentists in Georgia is 42.7 years. Two-fifths of the State's dentists are under 40 years of age, including 28 percent who are under 35. Thirty-seven percent of the dentists are between 40 and 54 years of age, and 23 percent are 55 or over. About one out of eight, 149 dentists, are at least 65 years of age, including 92 who have reached the age of 70. Age Distribution of Georgia Dentists Number Percent Cumulative Age of of percent dentists dentists distribution Total 1,240% 100 - Under 30 140 11 11 30 - 34 205 17 28 35 - 39 142 12 40 40 - 44 233 19 59 45 - 49 124 10 69 50 - 54 97 8 77 55 - 59 78 6 83 60 - 64 62 5 88 65 - 69 57 5 93 70 - 74 53 4 97 75 & over 39 3 100 1/ Age not available for 10 dentists. Percents based on total for whom age is known. Dentists in the metropolitan areas, with a median age of 41.9 years, are more than two years younger, on the average, than dentists in the non- metropolitan counties, where the median age is 44.2 years. Of the metro- politan areas, the Atlanta area, with a median age of 41.2 years, has the youngest group of dentists. However, the age differences among the coun- ties in this area are quite pronounced, with the older dentists concen- trated in Fulton County, the hub of the area. The median age of dentists in this county is 43.0 years, while dentists in the other four counties in the Atlanta area average about 7 years younger, with a median age of 36.3 years. Among the nommetropolitan counties, those with central cities of less than 2,500 population have the oldest group of dentists, with a median age of 46.8 years--almost four years older than the median age for the State. 100 ACTIVE DENTISTS IN RELATION TO POPULATION Approximately 97 percent (1,199) of the 1,240 dentists in Georgia are ac- tive in their profession, giving the State one professionally. active den- tist for every 3,506 persons. In the metropolitan areas, which have 66 percent of the active dentists and 49 percent of the population, the ratio is one dentist for every 2,588 persons. The remainder of the State, with 34 percent of the active dentists and 51 percent of the population, has a much less favorable ratio of one dentist for every 5,272 persons. Number of Persons per Active Dentist in Georgia Professionally Persons County group* active Population per dentists dentist All counties 1,199 4,203,900 3,506 Metropolitan areas 789 2,042,300 2,588 Atlanta area 544 1,163,500 2,139 Macon area 59 199,000 3,373 Savannah area 58 201,400 3,472 Columbus area (Ga. part) 42 191,300 4,555 Augusta area (Ga. part) 53 148,600 2,804 Albany area 24 88,900 3,704 Chattanooga area (Ga. part) 9 49,600 5,511 Nonmmetropolitan counties 410 2,161,600 5,272 Central city 10,000-49,999 197 722,200 3,666 Central city 5,000- 9,999 84 428,000 5,095 Central city 2,500- 4,999 86 498,700 5,799 Central city under 2,500 43 512,700 11,923 * See Appendix Table for individual county data. Among the metropolitan areas, the Atlanta area has the most favorable ratio, 2,139 persons per dentist. Within this area, Fulton County has an even more favorable ratio of 1,575, compared to a combined ratio of 3,433 in the other four counties. Three other areas--Macon, Savannah, and the Georgia portion of the interstate Augusta area--have ratios under 3,500. Of the three remaining areas, Albany has the best ratio with one dentist for every 3,700 persons, while the Georgia portions of the interstate Columbus and Chattanooga areas have more than 4,500 persons per dentist. Of the 146 nommetropolitan counties, only 19 have persons-per-dentist ratios below 3,500, while 48 counties have more than 6,000 persons per dentist, including 11 with ratios exceeding 10,000. Generally, the ratio of persons per dentist becomes much less favorable as the size of the central city decreases. The counties with 10,000 or more persons in their central cities have an average of 3,666 persons per dentist, while coun- ties with central cities of less than 2,500 average almost 12,000 persons per dentist, 101 UTILIZATION OF AUXILIARIES More than nine-tenths of the responding dental practitioners in Georgia (i.e., dentists who spend any time working at the chair) employ one or more auxiliaries. Dental assistants, the most frequently employed auxil- iary, are utilized by 83 percent of all practitioners, including 78 per- cent who employ at least one on a full-time basis. Forty-seven percent of the dentists employ dental hygienists, with 29 percent utilizing such personnel full time. Secretaries and receptionists are employed by 45 percent of the practitioners, most often on a full-time basis. Georgia Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 1,102%/ 100 87 4 One or more auxiliaries 968 91 87 4 Assistant 886 83 78 5 Hygienist 499 47 29 18 Laboratory technician 98 9 4 5 Secretary or receptionist 480 45 33 12 Other type of personnel 86 8 4 4 No auxiliary 99 9 - - 1/ Includes 35 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist, becoming less frequent among those in the older age groups. Approximately 95 percent of Georgia dentists under 55 years of age employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 83 percent among den- tists 55 to 64 years of age and to 68 percent among dentists 65 or over. Some 13 percent of the responding practitioners in Georgia reported one or more vacancies for auxiliary personnel. Two-fifths of these dentists indicated a need for full-time dental hygienists, and one-fourth have vacant positions for full-time dental assistants. 102 OTHER SURVEY FINDINGS I> ~~ Ninety-four percent of the responding professionally active dentists in Georgia are engaged in private practice, with 93 percent self-employed and one percent employed by an- other dentist. Two percent are on the staff of the dental school and another two percent are employed by governmental agencies. The remaining two percent are engaged in some other dental activity, such as taking advanced training. I~ ~~ Some 15 percent of the dentists reported at least one part- time dental activity in addition to their principal employ- ment. Part-time teaching at a dental school was reported by six percent of the dentists, and employment by govern- mental agencies, by 4 percent. A variety of other secon- dary dental activities were reported, including service with a voluntary agency and employment by another dentist. / 7 Dentists reporting time spent in patient care devoted an average of 40.4 hours a week to this activity for 48.2 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. —7 Fifteen percent of the dental practitioners reported that LJ they limit their practice to a dental specialty, primar- ily to orthodontics. Twenty percent of the dentists in metropolitan areas limit their practice, compared to only 7 percent in nommetropolitan counties. 7 Of the responding dentists who are licensed in Georgia but located in another State, four-fifths are in the ad- jacent States of Florida, Alabama, the Carolinas, or Ten- nessee. The remainder are scattered throughout 30 other States and the District of Columbia, with the largest numbers in California, Mississippi, and New York. August 1968. 103 386-029 O - 70 - 8 701 Selected Data on Dentists in Georgia, by Location APPENDIX TABLE Civilian dentists Persons A nd count Resp ond- Non- Age in 1965 Profes- Population— per rea and c¢ y Total P respond- Under 55 and sionally (in 000's) active ents : : ents 35 over active dentist All counties 1,240 1,161 79 345 289 1,199 4,203.9 3,506 Metropolitan areas? 815 759 56 253 179 789 2,042.3 2,588 Atlanta area 563 524 39 188 112 544 1,163.5 2,139 Clayton 11 9 2 7 1 9 60.5 6,722 Cobb 50 46 4 22 6 48 138.8 2,892 De Kalb 102 100 2 48 8 101 317.4 3,143 Fulton 393 364 29 109 96 379 597.0 1,575 Gwinnett 7 5 2 2 1 7 49.8 7,114 Macon area 62 58 4 15 17 59 199.0 3,373 Bibb 52 48 4 14 17 49 152.2 3,106 Houston 10 10 - 1 - 10 46.8 4,680 Savannah area 58 55 3 16 13 58 201.4 3,472 Chatham 58 55 3 16 13 58 201.4 3,472 Augusta area (Ga. part) 54 50 4 19 16 53 148.6 2,804 Richmond 54 50 4 19 16 53 148.6 2,804 Columbus area (Ga. part) 43 38 9 11 42 191.3 4,555 Chattahoochee - - - - - - 13.4 - Muscogee 43 38 11 42 177.9 4,236 Albany area 25 24 1 6 5 24 88.9 3,704 Dougherty 25 24 1 6 5 24 88.9 3,704 APPENDIX TABLE (cont'd) Selected Data on Dentists in Georgia, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Under 55 and sionally (in 000's) active ents : : ents 35 over active dentist Metropolitan areas?! (cont'd) Chattanooga area (Ga. part) 10 10 - - 5 9 49.6 5,511 Walker 10 10 - - 5 9 49.6 5,511 Nonmetropolitan counties’ 425 402 23 92 110 410 2,161.6 5,272 Central city 25,000-49,999 57 50 7 11 11 55 174.2 3,167 Clarke 19 16 3 4 2 17 50.7 2,982 Floyd 21 17 4 3 4 21 72.2 3,438 Lowndes 17 17 - 4 5 17 51.3 3,018 Central city 10,000-24,999 147 141 6 30 38 142 548.0 3,859 Baldwin 13 13 - 5 1 13 36.2 2,785 Carroll 9 9 - 1 3 9 39.2 4,356 Colquitt 7 6 1 2 2 6 33.6 5,600 Coweta 7 7 - 2 1 7 29.6 4,229 Crisp 5 5 - 1 2 5 17.9 3,580 Decatur 4 3 1 2 - 4 23.8 5,590 Glynn 15 14 1 2 3 15 50.1 3,340 Hall 19 19 - 4 7 19 53.5 2,816 Laurens 7 7 - 2 1 7 33.5 4,786 Spalding 11 11 - 2 3 10 38.4 3,840 Sumter 7 6 1 1 3 7 25.2 3,600 Thomas 12 11 1 1 6 10 37.0 3,700 Troup 15 14 1 2 3 14 46.8 3,343 SOT 901 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Georgia, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population= per Total respond- Under 55 and sionally (in 000's) active ents : : ents 35 over active dentist . 37 ' Nonmetropolitan counties= (cont'd.) Central city 10,000-24,999 (cont'd.) Ware 8 - 1 2 8 35.0 4,375 Whitfield 8 8 - 2 1 8 48.2 6,025 Central city 5,000-9,999 85 83 2 24 21 84 428.0 5,095 Barrow 4 4 - 1 1 4 15.0 3,750 Bartow 8 8 - 3 4 7 31.0 4,429 Ben Hill 4 4 - 1 2 4 13.4 3,350 Brooks 2 2 - - 1 2 14.5 7,250 Bulloch 6 6 - 3 - 6 24.8 4,133 Burke 2 2 - - 1 2 19.4 9,700 Coffee 4 4 - 2 1 4 21.7 5,425 Dodge 2 2 - - - 2 16.1 8,050 Elbert 4 4 - 2 1 4 17.6 4,400 Emanuel 3 3 - 2 - 3 17.2 5,733 Grady 3 3 - - 2 3 17.8 5,933 Newton 5 5 - 1 - 5 21.5 4,300 Peach 2 2 - - - 2 14.9 7,450 Polk 6 6 - 2 2 6 28.6 4,767 Stephens 3 2 1 - 1 3 19.2 6,400 Terrell 3 3 - - - 3 12.4 4,133 Tift 4 3 1 1 1 4 24.0 6,000 Toombs 5 5 - 2 - 5 16.7 3,340 Upson 5 5 - 1 2 5 23.8 4,760 Walton 4 4 - 1 1 4 20.8 5,200 Washington 2 2 - - - 2 18.2 9,100 Wayne 4 4 - 2 1 4 19.4 4,850 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Georgia, by Location Civilian dentists 1/ Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Under 55 and sionally (in 000's) active ents . : ents 35 over active dentist Nonmetropolitan countiesd’ (cont'd.) Central city 2,500-4,999 89 82 7 21 24 86 498.7 5,799 Appling 2 2 - 1 1 2 13.0 6,500 Bacon 1 - 1 1 - 1 8.2 8,200 Berrien 2 2 - - 1 2 11.3 5,650 Bleckley 1 1 - 1 - 1 9.8 9,800 Butts 1 1 - 1 - 1 8.9 8,900 Camden 2 2 - 1 2 10.9 5,450 Chattooga 2 2 - 1 - 2 19.7 9,850 Clinch 1 - 1 - - 1 6.9 6,900 Cook 3 3 - 2 - 3 11.9 3,967 Douglas 3 3 - 1 2 2 18.4 9,200 Early 2 2 - - 1 2 11.8 5,900 Evans 1 1 - - - 1 7.0 7,000 Gordon 4 4 - - - 4 19.5 4,875 Greene 1 1 - - - 1 10.8 10,800 Habersham 7 6 1 2 1 6 18.9 3,150 Haralson 2 2 - - - 2 14.5 7,250 Hart 3 2 1 - 1 3 15.6 5,200 Irwin 1 1 - 1 - 1 8.3 8,300 Jackson 6 6 - 1 3 6 18.5 3,083 Jeff Davis 3 3 - 1 1 3 8.9 2,967 Jenkins 2 2 - - 1 2 8.7 4,350 Lamar 1 1 - 1 - 1 10.3 10,300 Liberty 1 1 - 1 - 1 15.8 15,800 Lumpkin 2 2 - - 1 2 7.5 3,750 Mc Duffie 4 4 - - 2 4 13.3 3,325 LOT 801 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Georgia, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total ents respond- Under 55 and sionally (in 000's) active ents 35 over active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 2,500-4,999 (cont'd.) Macon - - - - - - 12.9 - Meriwether 3 3 - - 1 3 19.4 6,467 Mitchell 3 3 - - - 3 19.0 6,333 Monroe 1 1 - - - 1 10.5 10,500 Morgan 1 1 - - 1 1 9.8 9,800 Pulaski 2 2 - - 1 2 7.9 3,950 Putnam 2 1 1 - - 2 7.9 3,950 Randolph - - - - - - 10.1 - Rockdale 4 3 1 1 1 4 11.3 2,825 Screven 1 1 - - - 1 13.9 13,900 Seminole 2 2 - 1 - 2 6.4 3,200 Tattnall 3 3 - 1 1 3 15.9 5,300 Telfair 2 2 - - 1 2 11.3 5,650 Turner 1 1 - 1 - 1 7.6 7,600 Wilkes 3 3 - 1 1 2 10.5 5,250 Worth 3 2 - 1 3 15.9 5,300 Central city under 2,500 47 46 1 6 16 43 512.7 11,923 Atkinson 1 1 - - 1 5.8 5,800 Baker - - - - - - 4.0 - Banks - - - - - - 6.4 - Brantley - - - - - - 5.8 - Bryan - - - - - - 6.3 - Calhoun 2 2 - - 1 2 6.9 3,450 Candler 1 1 - - - 1 6.2 6,200 Selected Data on Dentists in Georgia, by Location APPENDIX TABLE (cont'd.) Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Under 55 and sionally (in 000's) active ents . . ents 35 over active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Catoosa 2 2 - - 1 1 23.4 23,400 Charlton 2 2 - - 2 2 5.6 2,800 Cherokee 3 3 - - - 3 24.0 8,000 Clay 1 1 - - - 1 4.1 4,100 Columbia 1 1 - - 1 14.9 14,900 Crawford - - - - - - 5.7 - Dade 1 1 - - - 1 9.2 9,200 Dawson - - - - - - 3.5 - Dooly 1 1 - - - 1 10.6 10,600 Echols - - - - - - 1.7 - Effingham - - - - - - 10.6 - Fannin 2 2 - 1 - 2 13.1 6,550 Fayette 1 1 - 1 - 1 8.2 8,200 Forsyth 1 1 - - - 1 12.7 12,700 Franklin 2 2 - 1 2 12.9 6,450 Gilmer 1 1 - - 1 8.5 8,500 Glascock - - - - - - 2.3 - Hancock - - - - - - 9.6 - Harris - - - - - - 11.1 - Heard - - - - - - 4.9 - Henry 3 3 - 1 3 18.5 6,167 Jasper - - - - - - 5.6 - Jefferson 2 2 - - - 2 17.1 8,550 Johnson 2 2 - - 2 2 7.6 3,800 Jones - - - - - - 8.9 - 601 APPENDIX TABLE (cont'd.) 011 Selected Data on Dentists in Georgia, by Location Civilian dentists 1/ Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total ents respond- Under 55 and sionally (in 000's) active ents 35 over active dentist Nonmetropolitan countiesd’ (cont'd.) Central city under 2,500 (cont'd.) Lanier - - - - - - 5.0 - Lee - - - - - - 6.1 - Lincoln - - - - - - 5.6 - Long - - - - - - 4.0 - Mc Intosh 1 1 - - 6.4 6,400 Madison - - - - - - 10.9 - Marion - - - - - - 5.1 - Miller 1 1 - - - 1 6.2 6,200 Montgomery - - - - - - 5.8 - Murray 1 1 - - - 1 10.4 10,400 Oconee - - - - - - 6.0 - Oglethorpe - - - - - - 7.1 - Paulding 1 1 - - - 1 13.6 13,600 Pickens 2 2 - - - 2 9.0 4,500 Pierce 2 1 - - 2 9.2 4,600 Pike - - - - - - 6.7 - Quitman 1 1 - - 1 1 2.3 2,300 Rabun 1 1 - - 1 - 7.5 - Schley - - - - - - 3.5 - Stewart - - - - - - 6.9 - Talbot 1 1 - - 1 1 6.9 6,900 Taliaferro 1 1 - - 1 - 2.9 - Taylor 1 1 - - 1 1 8.0 8,000 Towns 2 2 - - 1 2 4.4 2,200 Treutlen - - - - - - 5.6 - APPENDIX TABLE (cont'd.) Selected Data on Dentists in Georgia, by Location Civilian dentists 1/ Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Under 55 and sionally (in 000's) active ents . . ents 35 over active dentist Nonmetropolitan countiesd’ (cont'd.) Central city under 2,500 (cont'd.) Twiggs - - - - - - 7.8 - Union - - - - - - 6.1 - Warren 1 1 - - - 1 6.9 6,900 Webster - - - - - - 2.9 - Wheeler - - - - - - 4.9 - White 1 1 - 1 - 1 7.2 7,200 Wilcox - - - - - - 7.1 - Wilkinson 1 1 - - - 9.0 - 111 Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Georgia counties included in the latest 1967 definition of Standard Metropolitan Statistical Areas, as defined by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. presented only for dentists located in the Georgia portions. For interstate SMSA's--Columbus, Augusta, and Chattanooga--statistics are Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. rT = ay SETRCTTT 1 TIN Sr gr Aes ERE HP TEC Sa RS te ETE TE i gp ae DE ne estan HAWAII DENTISTS LICENSED IN HAWAII During the 1965 registration period, 590 dentists registered with the Hawaii Board of Dental Examiners. A total of 561 dentists responded to the survey, 95 percent of all those registered. Over three-fourths are civilians located in Hawaii, 18 percent are civilians located in other States, and 5 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Hawaii Location and All Percent of military status dentists dentists Total licensed 590 100 Respondents 561 95 Nonrespondents 29 5 Respondents 561 100 Civilians in Hawaii 429 77 Civilians in another State 102 18 On active duty with Armed Forces 30 5 About 57 percent of the respondents hold a license to practice dentistry in one or more other States. Among the dentists located in Hawaii, 46 percent hold more than one license, with 39 percent licensed in one other State, and 7 percent licensed in two or more other States. Multiple li- censure is considerably more common among responding dentists registering in Hawaii but located out-of-State; more than one-third hold two or more licenses in addition to their Hawaii license. Approximately 35 percent of the licenses held outside of Hawaii are held in California. Another 30 percent are held in two North Central States, Illinois and Missouri. The remaining out-of-State licenses are held in 24 other States and the District of Columbia. 113 Lo Metropolitan area DISTRIBUTION OF DENTISTS IN HAWAII BY COUNTY Honolulu MOLOKAL ul LSI 33 dentists DISTRIBUTION OF DENTISTS More than four-fifths (84 percent) of the 429 responding dentists in Hawaii are located in the Honolulu metropolitan area (Honolulu County). The remaining 16 percent of the dentists are located in the nonmetropoli- tan counties of the State. Of these counties, Hawaii County has the largest dental force, 8 percent of the State supply. Maui and Kauai Counties have 5 percent and 3 percent of the total supply, respectively. Distribution of Hawaii Dentists, by County Total Professionally 1/ Persons eq . Population . County civilian active (in 000's) per active dentists dentists tn dentist All counties 429 417 730.7 1,752 Honolulu metropolitan area 360 350 597.5 1,707 Honolulu County 360 350 597.5 1,707 Nonmetropolitan counties 69 67 133.2 1,988 Hawaii County 33 31 61.1 1,971 Maui County 22 22 44.5 2,023 Kauai County 14 14 27.3 1,950 Kalawao County - - 0.3 - 1/ Population estimates, copyright 1965: Sales Management Survey of Buying Power. Of the 429 dentists in Hawaii, 417 (97 percent) are active in their pro- fession, giving Hawaii one professionally active dentist for every 1,752 persons. There is one dentist for every 1,707 persons in the Honolulu metropolitan area, while the remainder of the State has a less favorable ratio of one dentist for every 1,988 persons. Kauai, Hawaii, and Maui Counties have very similar ratios, between 1,950 and 2,025. 115. AGE DISTRIBUTION OF DENTISTS The median age of dentists in Hawaii is 43.6 years. About one-fifth (21 percent) are under 35, yet more than one-fourth (28 percent) are 55 years of age or older, including 8 percent who have reached the age of 65. Approximately one-half of all dentists in the State are in the age group 35 through 54, with one-third between the ages of 35 and 44. Age Distribution of Hawaii Dentists Number Percent Age in 1965 of of Cumulative dentists dentists percent Total 420%! 100 - Under 30 23 5 5 30-34 66 16 21 35-39 78 18 39 40-44 65 15 54 45-49 43 10 64 50-54 35 8 72 55-59 33 8 80 60-64 49 12 92 65-69 23 5 97 70-74 7 2 99 75 and over 5 1 100 1/ Age not available for 2 dentists. Dentists in the Honolulu metropolitan area, with a median age of 42.9 years, are almost seven years younger, on the average, than dentists in the nonmetropolitan counties, where the median age is 49.5 years. Approx- imately 22 percent of the dentists in Honolulu are under 35, and 25 per- cent are 55 years of age or older. By comparison, only 15 percent of the dentists in nonmetropolitan counties are under 35 years of age, while 39 percent have reached the age of 55. 116 DENTAL SCHOOL ATTENDED Two-thirds of the 429 responding dentists located in Hawaii are graduates of 17 dental schools in the North Central States. Among these schools, the University of Missouri and Northwestern University are the major con- tributors, each having provided 14 percent of Hawaii's dentists. The only other schools in the North Central States to contribute more than 25 of the State's dentists are two Missouri schools, St. Louis and Washing- ton Universities, which have together supplied 15 percent of the dental force. School Awarding Dental Degree, by Year Awarded Number Year of graduation a of AIL After 1941- 1940 or dentists years 1955 1955 earlier Total number 420 - 143 146 137 (Percent distribution by school) North Central States 284 67 78 72 49 Missouri 59 14 15 20 6 Northwestern 58 14 15 13 13 St. Louis 37 9 9 10 7 Washington (St. Louis) 26 6 8 7 3 13 other schools 104 24 31 22 20 Western States 87 20 8 10 45 Southern California 57 13 3 6 32 7 other schools 30 7 5 4 13 Other regions (16 schools) 54 13 14 18 6 1/ Dental school attended not reported by 4 dentists and year of gradua- tion by 3 dentists. Percents are based on data supplied. Another 20 percent of Hawaii's dentists graduated from eight schools lo- cated in Western States, primarily the University of Southern California, which has provided 13 percent of the State's dentists. The remaining 13 percent of Hawaii's responding dentists were trained in 16 dental schools located in other regions of the country. A fairly substantial proportion of Hawaii's dentists are recent dental school graduates. One-third have completed their dental education since 1955, equaling the proportion who received their dental degrees prior to World War II. In recent years, Hawaii's dentists have tended to come increasingly from dental schools in the North Central States. The pro- portionate contribution of these schools has increased from 49 percent of all dentists currently located in the State who graduated before World War II to 78 percent of those who graduated after 1955. At the same time, there has been a considerable decrease in the contribution of schools lo- cated in the West. 117 UTILIZATION OF AUXILIARIES Almost 70 percent of the responding dental practitioners in Hawaii (i.e., dentists who spend any time working at the chair) reported that they em- ploy auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 63 percent of all practitioners, including 57 percent who employ at least one assistant on a full-time basis. Secre- taries or receptionists are employed by 14 percent of the dentists, with about two-thirds of these dentists utilizing such personnel full time. Only 10 percent of the dentists employ dental hygienists and 5 percent employ dental technicians. A majority of the dentists who employ hygien- ists or technicians do so only part time. Hawaii Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 4121 100 62 7 One or more auxiliaries 272 69 62 7 Assistant 250 63 57 6 Hygienist 39 10 3 7 Laboratory technician 18 5 1 4 Secretary or receptionist 57 14 10 4 Other type personnel 16 4 1 3 No auxiliary 123 31 - - 1/ Includes 17 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is more fre- quent among the young dentists. Eighty-one percent of the dental practit- ioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 57 percent among dentists 45 to 64 years old and to only 46 percent among dentists 65 and over. 118 > ~~ July 386-029 O - 70 - 9 OTHER SURVEY FINDINGS One of every six survey respondents, 68 dentists, reported that they had completed one year or more of advanced train- ing since receiving the dental degree. Thirty-nine dentists reported completion of advanced clinical training as resi- dents or interns, and 48 dentists had completed academic training as graduate or postgraduate students. Nineteen dentists had completed at least a year of both academic and clinical training. Ninety-six percent of the responding professionally active dentists in Hawaii are primarily engaged in private prac- tice, with 95 percent self-employed and one percent employed by another dentist. The remaining four percent are either employed by governmental agencies or engaged in other dental activities, such as taking advanced training. Dentists reporting time spent in patient care devoted an average of 41.3 hours per week to this activity for 47.7 weeks during the year preceding the survey. About one dentist in six worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. About 11 percent of the dentists in Hawaii reported that they limit their practice to a dental specialty, primarily orthodontics. Almost all of the dentists who reported limiting their practices are located in the Honolulu metro- politan area. Of the 102 dentists licensed in Hawaii but located out of State, two-thirds are located in California, and 11 per- cent are located in Oregon or Washington. The remaining out-of-State dentists are scattered throughout 15 other States across the Nation. 1968. 119 ba TARE 11817 SAREE CE yep pr ge A EG Sm SARE BUA Bn IDAHO DENTISTS LICENSED IN IDAHO During the 1966 registration period, 573 dentists registered with the Idaho State Board of Dentistry. Fifty-four percent of these dentists were civilians located in Idaho, another 41 percent were civilians located in other states, primarily California, Oregon and Washington, and 5 percent were on active duty in the Armed Forces. Location and Military Status of Dentists Licensed in Idaho Location and All Percent of military status dentists dentists Total licensed 573 100 Respondents 521 91 Nonrespondents 52 9 Total licensed 573 100 Civilians in Idaho 309 54 Respondents 278 - Nonrespondents 31 - Civilians in another state 233 41 On active duty with Armed Forces 30 5 Not reported 1 * * Less than one-half of one percent. The survey questionnaire was completed by 521 dentists, 91 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not respond- ing to the survey. Information on nonrespondents was obtained either from records maintained by the Idaho State Board of Dentistry or from the 1967 American Dental Directory, published by the American Dental Association. 121 DENTAL SCHOOL ATTENDED The dental school at the University of Oregon has been the major con- tributor to the Idaho dental force, having trained almost one-fourth (23 percent) of the total supply. The University of Washington, the next largest contributor, has trained an additional 13 percent of the dentists. The University of Southern California is the only other den- tal school in the West to have supplied more than 5 percent of the State's dental force. One-half of Idaho's dentists are graduates of 15 dental schools in the North Central States. Northwestern University is the largest contrib- utor among these schools, having trained 10 percent of the dentists. Three other schools in the North Central States, Missouri (Kansas City), Washington (St. Louis) and Creighton have each contributed 6 percent. The Universities of Minnesota and Nebraska are the only other schools in the region to contribute as much as 5 percent of the State's den- tists. Dental School Attended and Year of Graduation for Dentists in Idaho Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 309 y/ - 110 122 75 (Percent distribution by school) West 140 46 43 46 51 Oregon 69 23 13 24 35 Washington 40 13 25 11 - Southern California 23 7 2 9 13 5 other schools 8 3 4 2 3 North Central 154 50 52 51 46 Northwestern 30 10 13 11 4 Missouri (Kansas City) 19 6 8 2 11 Washington (St. Louis) 19 6 8 8 - Creighton 17 6 8 5 3 11 other schools 69 22 15 25 28 Other regions (7 schools) 11 4 5 3 3 1/ Dental school attended not available for 4 dentists and year of graduation for 2 dentists. Percents based on known totals. A fairly substantial proportion of Idaho's dentists are recent dental school graduates. More than one-third have completed their dental education since 1955, as compared to less than one-fourth who received their dental degrees prior to World War II. The dental school at the University of Washington, which graduated its first class in 1950, has become the primary source of dentist supply in recent years, providing one-fourth of the State's dentists who graduated after 1955. At the same time the contribution of the University of Oregon has progres=- sively decreased over the years. 122 DISTRIBUTION OF DENTISTS Idaho's dentists are unevenly distributed geographically, with two- thirds of the licensed dentists located in only 8 of the State's 44 counties. The Boise City metropolitan area (Ada County), with 59 den- tists, has 19 percent of the State's supply, and the 7 nonmetropolitan counties with at least 10,000 persons in their central cities have among them 150 dentists, or 48 percent of the total dental force. Three of these nonmetropolitan counties--Bonneville, Bannock and Canyon--have at least 25 dentists, and two other counties--Twin Falls and Nez Perce--have at least 20 dentists. Distribution of Idaho Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 44 309 100 Boise City metropolitan area 1 59 19 Nonmetropolitan counties 43 250 81 Central city 10,000-49,999 7 150 48 Central city 2,500- 9,999 17 73 24 Central city under 2,500 19 27 9 * See Appendix Table for definition of metropolitan area and presentation of individual county data. The 36 nonmetropolitan counties comprising the two groups of counties with less than 10,000 persons in their central cities have one-third of the State's dentist supply. There are 73 dentists in the 17 coun- ties having between 2,500 and 9,999 persons in their central cities, while only 27 dentists are scattered among the 19 counties with central cities of less than 2,500 population. Only seven of these 36 counties have as many as 5 dentists, and 12 have fewer than 2 dentists. 123 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of dentists in Idaho is 43.0 years. Almost one-fourth (70 dentists) are under 35, and more than a third (111 dentists) are between 35 and 44 years of age. On the other hand, a sizeable propor- tion, approximately one-fourth, are 55 or over. About 13 percent of the dentists are at least 65 years of age, including 5 percent who have reached the age of 70. Median Age and Age Distribution, by County Group Percent of dentists Median County group age Under 35- 45- 55 & g 35 44 54 over All counties 43.0 23 36 18 23 Boise City metropolitan area 39.8 30 31 24 15 Nonmetropolitan counties 43.4 21 37 17 25 Central city 10,000-49,999 44.2 18 36 23 23 Central city under 10,000 41.9 25 38 9 28 Dentists in the Boise City metropolitan area, with a median age of 39.8 years, are more than four years younger than dentists in the group of counties with central cities of 10,000 or more persons, where the median age is 44.2 years. Almost one-third of the dentists in Boise City are under 35, while only 15 percent are 55 years of age or older. By comparison, less than one-fifth of the dentists in counties having central cities of 10,000 or more population are under 35 years of age, while almost one-fourth have reached the age of 55. Dentists in the group of counties with central cities of less than 10,000 inhabitants have a median age of 41.9 years, slightly under the State average. Even though one-fourth of these dentists are under the age of 35, a substantial proportion, almost three dentists in every 10, are at least 55 years of age. 124 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 309 licensed dentists in Idaho, 286, or 93 percent, are active in their profession, giving Idaho one professionally active dentist for every 2,439 persons. There is one professionally active dentist for every 1,827 persons in the Boise City metropolitan area, a ratio substantially better than the State average. The group of seven nonmetropolitan counties with 10,000 or more inhabitants in their central cities have one dentist for every 2,034 persons, a ratio slightly higher than that of the Boise City metropolitan area but still considerably below the State average. Among these counties three have persons-per-dentist ratios under 2,000--Nez Perce (1,460), Bonneville (1,886) and Bannock (1,967). Number of Persons per Active Dentist in Idaho Professionally Persons County group¥ active Population per dentists dentist Total 286 697,500 2,439 Boise City metropolitan area 56 102,300 1,827 Nonmetropolitan county groups 230 595,200 2,588 Central city 10,000-49,999 143 290,900 2,034 Central city 2,500- 9,999 66 221,900 3,362 Central city under 2,500 21 82,400 3,924 %* See Appendix Table for individual county data. Persons-per-dentist ratios are much less favorable in the two groups of counties with less than 10,000 persons in their central cities. The 17 counties with central city populations between 2,500 and 9,999 have an average of 3,362 persons per dentist, while the 19 counties with central cities of less than 2,500 inhabitants have an even less favorable ratio of 3,924 persons for every active dentist. Among these 36 counties, 18 have ratios exceeding 3,000 persons per dentist, including five counties with ratios in excess of 5,000. Another six counties have no active dentists, according to available information. 125 UTILIZATION OF AUXILIARIES More than nine out of every ten dental practitioners in Idaho (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel, including 86 percent who employ at least one auxiliary on a full-time basis. The most frequently employed auxiliary is the dental assistant. Eighty-seven percent of the prac=- titioners reported the use of an assistant, including 82 percent who utilize at least one full time. About one-fourth of the dentists employ secretaries or receptionists, usually on a full-time basis. Dental hygienists and laboratory technicians are employed by fewer dentists, usually only part time. Idaho Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time auxiliary part-time (or more) auxiliaries Total 257 100 86 6 One or more auxiliaries 229 92 86 6 Assistant 217 87 82 5 Hygienist 29 12 3 9 Laboratory technician 14 6 1 5 Secretary or receptionist 60 24 16 8 Other type of personnel 6 2 1 1 No auxiliary 20 8 - - 1/ Includes 8 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is less frequent among the older dentists. Ninety-five percent of dental prac- titioners under the age of 55 reported employment of some type of auxiliary. The proportion utilizing auxiliaries decreases to 73 per- cent among dentists 55 to 64 years of age and to 50 percent among dentists 65 and over. About one-fifth of the responding dental practitioners in Idaho reported one or more vacant positions for auxiliary personnel. Of these dentists, about 38 percent indicated vacancies for full-time hygienists and 19 percent for full-time dental assistants. 126 OTHER SURVEY FINDINGS ~~ Multiple licensure is fairly common in Idaho, with three-fifths of the respondents located in the State holding more than one license. Forty-two percent indicated licensure in at least one additional state and 18 percent in two or more other states. Of those dentists registered in Idaho but located in another state, a relatively high proportion--50 percent--are licensed in two or more states other than Idaho. 17 More than one-half of the licenses held in states outside of Idaho are held in the nearby states of California, Oregon and Washington. An additional one-fourth are maintained in two other nearby states, Utah and Montana, and in the more distant states of Missouri, Nebraska and Minnesota. 17 One of every six survey respondents located in Idaho, 45 den- tists, reported that they had completed one year or more of advanced training after receiving their dental degree. Sixteen dentists reported completion of advanced clinical training as residents or interns, and 34 dentists completed academic train- ing as graduate or postgraduate students. Five dentists com- pleted both academic and clinical training. I~ ~~ Dentists reporting on time spent in providing patient care devoted an average of 41.2 hours per week to this activity for 47.6 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. 17 About 9 percent of the practitioners reported they limit their practice to a dental specialty, primarily to orthodontics. Seventeen percent of the dentists in the Boise City metropol- itan area and in Bannock and Bonneville Counties, the two non- metropolitan counties with central cities of 25,000-49,999 population, limit their practices, as compared to only 5 per- cent in the remainder of the State. February 1968. 127 APPENDIX TABLE 8¢C1 Selected Data on Dentists in Idaho, by Location Civilian dentists Persons Area and count Respond- Non- Age in 1965 Profes- Population— per y Total P respond- Under 55 years sionally (in 000's) active ents . . ents 35 years or more active dentist All counties 309 278 31 70 72 286 697.5 2,439 Boise City metropolitan area?’ 59 52 7 17 9 54 102.3 1,827 Ada 59 52 7 17 9 56 102.3 1,827 Nonmetropolitan counties’ 250 226 24 53 63 230 595.2 2,588 Central city 25,000-49,999 57 51 6 10 10 55 105.9 1,925 Bannock 28 26 2 4 5 27 53.1 1,967 Bonneville 29 25 4 6 5 28 52.8 1,886 Central city 10,000-24,999 93 87 6 17 25 88 185.0 2,102 Canyon 28 27 1 6 6 26 60.0 2,308 Kootenai 13 12 1 - 3 13 31.7 2,438 Latah 8 8 - 1 2 8 21.2 2,650 Nez Perce 20 18 2 4 8 20 29.2 1,460 Twin Falls 24 22 2 6 6 21 42.9 2,043 Central city 5,000-9,999 25 23 2 9 5 24 86.7 3,612 Bingham 9 8 1 3 2 9 30.6 3,400 Cassia 6 5 1 3 1 6 16.7 2,783 Elmore 3 3 - - - 3 19.5 6,500 Shoshone 7 7 - 3 2 6 19.9 3,317 Central city 2,500-4,999 48 41 7 10 15 42 135.2 3,219 Bear Lake 3 3 - - 2 3 7.2 2,400 Bonner : 7 6 1 2 3 6 15.9 2,650 Franklin 3 3 - - 1 3 7.8 2,600 Fremont 3 3 - 1 1 2 8.3 4,150 Gem 5 2 3 2 - 4 9.2 2,300 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Idaho, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond=- Under 55 years sionally (in 000's) active ents . . ents 35 years or more active dentist Nonmetropolitan counties (cont'd.) Central city 2,500-4,999 (cont'd.) : Gooding 3 3 - 1 1 2 8.9 4,450 Idaho 4 4 - 1 1 4 14.5 3,625 Jerome 5 3 2 1 3 3 11.6 3,867 Lemhi 2 2 - - - 2 5.6 2,800 Madison 4 4 - - 1 4 9.5 2,375 Minidoka 5 5 - 1 1 5 16.0 3,200 Payette 3 2 1 1 1 3 12.5 4,167 Washington 1 1 - - - 1 8.2 8,200 Central city under 2,500 27 24 3 8 21 82.4 3,924 Adams 2 1 1 2 - 2.8 - Benewah 4 4 - - 1 3 5.9 1,967 Blaine 1 1 - - - 1 4.2 4,200 Boise - - - - - - 1.5 - Boundary 1 1 - - - 1 5.7 5,700 Butte - - - - - - 3.8 - Camas - - - - - - 0.8 - Caribou 4 4 - 2 1 3 6.0 2,000 Clark - - - - - - 0.9 - Clearwater 3 2 2 1 3 8.6 2,867 Custer 1 1 - - 1 2.8 2,800 Jefferson 2 2 - - 1 2 12.2 6,100 Lewis 2 2 - 1 - 1 4.5 4,500 — Lincoln 2 1 - 1 1 3.4 3,400 » Oneida 1 1 - 1 1 3.1 3,100 APPENDIX TABLE (cont'd.) 0&1 Selected Data on Dentists in Idaho, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total hts respond- Under 55 years sionally (in 000's) active ents 35 years or more active dentist Nonmetropolitan counties! (cont'd.) Central city under 2,500 (cont'd.) Owyhee 1 1 - - - 1 6.4 6,400 Power 1 1 - 1 - 1 4.1 4,100 Teton - - - - - - 2.4 - Valley 2 2 - 1 - 2 3.3 1,650 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ The Boise City area, including all of Ada County, is defined as a Standard Metropolitan Statistical Area as established by the U.S. Bureau of the Budget, Office of Statistical Standards. 3/ Counties not included within a SMSA as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. ILLINOIS DENTISTS LICENSED IN ILLINOIS During the 1966 registration period, 8,181 dentists registered with the State of Illinois Department of Registration and Education. Over three-fourths of the registered dentists were civilians located in Illinois, another 18 percent were civilians located in other states, and 5 percent were on active duty in the armed forces. Location and Military Status of Dentists Licensed in Illinois Location and All Percent of military status dentists dentists Total licensed 8,181 100 Respondents 7,071 86 Nonrespondents 1,110 14 Total licensed 8,181 100 Civilians in Illinois 6,316 77 Respondents 5,472 - Nonrespondents 844 - Civilians in another state 1,450 18 On active duty with armed forces 391 5 Not reported 24 * * Less than one-half of one percent. The survey questionnaire was completed by 7,071 dentists, 86 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained either from records maintained by the State of Illinois Department of Registration and Education or from the 1966 American Dental Directory published by the American Dental Association. 131 PROFESSIONAL TRAINING Over four-fifths of Illinois' dentists graduated from dental schools located in Illinois, including 38 percent who received their dental educa- tion at Loyola University, 22 percent who are graduates of the University of Illinois and 21 percent who came from Northwestern University. Ten other dental schools in adjacent states have trained an additional 14 per- cent of Illinois' dentists, including two Missouri schools, St. Louis and Washington Universities, which have between them trained 10 percent of the dentists in the State. School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 6,316=' 6,184 1,231 1,796 3,103 (Percent distribution by school) Schools in Illinois 5,016 81 81 83 80 Loyola University 2,326 38 30 34 43 University of Illinois 1,352 22 37 28 12 Northwestern University 1,338 21 14 21 25 Schools in adjacent states 841 14 12 12 15 St. Louis University 364 6 4 6 7 Washington University 233 4 3 3 4 8 other schools 244 4 5 3 4 37 schools in other states 327 5 7 5 5 1/ Dental school attended not available for 132 dentists and year of graduation for 186 dentists. Percents based on totals for whom the data are known. Only one-fifth of Illinois' dentists graduated from dental school within the last 10 years, while fully one-half graduated before World War II. Although the proportionate contribution of the three Illinois schools com- bined has remained relatively constant through the years, the University of Illinois has gradually replaced Loyola as the primary source of dentist supply, with its proportion increasing from 12 percent of the dentists who graduated before World War II to 37 percent of those who graduated within the last 10 years. Like Loyola, Northwestern has also shown a notable decrease over the years in its relative contribution of dentists to the State. 132 DISTRIBUTION OF DENTISTS Eighty-five percent of the licensed dentists in Illinois are located in the nine metropolitan areas of the State. The 6-county Chicago area has more than seven-tenths of the dental force, 4,555 dentists, the vast majority of whom are located in Cook County. The areas of East St. Louis and Peoria have the next largest dental forces, even though each accounts for only about 3 percent of the State supply. Another 2 percent are located in the Rockford metropolitan area. The five remaining metropol- itan areas, Rock Island-Moline, Springfield, Champaign-Urbana, Decatur and Bloomington-Normal, each have about one percent of Illinois' dentists. Distribution of Dentists Number Number Percent County group¥* of of of counties dentists dentists Total 102 6.316% 100 Chicago metropolitan area 6 4,555 72 Other metropolitan areas 13 815 13 East St. Louis area 2 180 3 Peoria area 3 156 3 Rockford area 2 128 2 Rock Island-Moline area 2 94 1 Springfield area 1 73 1 Champaign-Urbana area 1 73 1 Decatur area 1 57 1 Bloomington-Normal area 1 54 1 Nonmetropolitan counties 83 936 15 Central city 10,000-49,999 19 468 7 Central city 5,000- 9,999 26 270 4 Central city 2,500- 4,999 23 158 3 Central city under 2,500 15 40 1 * See Appendix Table for definition of metropolitan areas and presentation of individual county data. 1/ County location not available for 10 dentists. Only 15 percent of the State's dentists are located in the 83 nonmetro- politan counties. These dentists tend to be concentrated in the counties which contain a relatively large city. One-half of the dentists in non- metropolitan counties are located in the 19 counties with a central city of 10,000 or more population. The 64 counties which do not have a city this large account for only 8 percent of the dentists in the State. 133 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 6,127 dentists for whom age was obtainable is a rather high 51.0 years. Only 26 percent of Illinois' dentists, 1,598, are under 40 years of age, including just 16 percent who are under 35. On the other hand, more than two-fifths, or 2,592 dentists, are 55 years or over. Almost one in every five, or 1,180 dentists, are 65 years old or more, including 634 who have reached the age of 70. Median Age and Age Distribution, by County Group Percent of dentists County group Median Under 40- 55 and age 40 54 over Total 51.0 26 32 42 Chicago metropolitan area 51.4 26 32 42 Other metropolitan areas 47 .3 30 35 35 Champaign-Urbana area 43.3 39 33 28 Springfield area 46.1 28 39 33 Rockford area 46.4 38 31 31 Rock Island-Moline area 47.5 26 34 40 Peoria area 48.0 29 34 37 Bloomington-Normal area 48.1 27 38 35 East St. Louis area 49.3 29 33 38 Decatur area 50.5 20 46 34 Nonmetropolitan counties 52.3 25 30 45 Central city 10,000-49,999 49.7 26 34 40 Central city 5,000- 9,999 53.2 24 29 47 Central city 2,500- 4,999 55.9 22 27 51 Central city under 2,500 61.4 21 11 68 The median age of dentists in metropolitan areas is 50.8 years, slightly lower than the 52.3 year median for dentists in the nonmetropolitan coun- ties. Among the metropolitan areas, Champaign-Urbana has the youngest dentists, with a median age of 43.3 years. Almost 40 percent of the den- tists in this area are under 40 years of age, and only 28 percent are 55 or over. In contrast, dentists in the Chicago area are the oldest as a group, with a median age of 51.4. Only one-fourth of these dentists are under 40, and more than two-fifths have reached the age of 55. Dentist ages in nonmetropolitan counties tend to increase rapidly as the size of the central city decreases. The median age of dentists in counties with central cities of at least 10,000 population is 49.7 years, compared to a median age of 55.9 in counties containing a central city of 2,500-4,999 inhabitants and 61.4 years in counties with less than 2,500 persons in their central cities. 134 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 6,316 dentists in Illinois, 5,994, or 95 percent, are active in their profession, giving Illinois one professionally active dentist for every 1,777 persons. There is one dentist for every 1,536 persons in the Chicago metro- politan area, while the remainder of the State has a much less favorable ratio of one dentist for every 2,400 persons. Number of Persons per Active Dentist Professionally Persons County group active Population per dentists dentist Total 5,99 10,649,400 1,777 Chicago metropolitan area 4,323 6,641,800 1,536 Other metropolitan areas 770 1,834,200 2,382 Bloomington-Normal area 48 88,800 1,850 Rockford area 122 251,100 2,058 Champaign-Urbana area 67 144,600 2,158 Springfield area 68 151,900 2,234 Peoria area 148 332,400 2,246 Decatur area 54 125,900 2,331 Rock Island-Moline area 88 209,800 2,384 East St. Louis area 175 529,700 3,027 Nonmetropolitan counties 896 2,173,400 2,426 Central city 10,000-49,999 450 1,034,600 2,299 Central city 5,000- 9,999 260 629,800 2,422 Central city 2,500- 4,999 150 401,400 2,676 Central city under 2,500 36 107,600 2,989 Cook County, the hub of the Chicago metropolitan area, has the best ratio in the State, 1,487 persons per active dentist, while the other five coun- ties in this area have an average persons-per-dentist ratio of 1,788. Among the metropolitan areas, exclusive of Chicago, only Bloomington-Normal, with 1,850 persons per dentist, has a ratio under 2,000. In six of the metropolitan areas, the ratios range between 2,000 and 2,400, and in one area, East St. Louis, the number of persons per dentist exceeds 3,000. Among the 83 nonmetropolitan counties of the State, there are 18 counties with persons-per-dentist ratios under 2,000, yet 23 counties have ratios exceeding 3,000 persons for every dentist. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The group of counties with central cities of 10,000 or more population have an average persons-per-dentist ratio of approximately 2,300, while counties with central cities of less than 2,500 inhabitants average nearly 3,000 persons per dentist. 135 UTILIZATION OF AUXILIARIES A little over three-fifths of the responding practitioners in Illinois (i.e. dentists who spend any time working at the chair) reported that they employ auxiliary personnel. Dental assistants, the most frequently employed auxil- iary, are utilized by 54 percent of all practitioners, including 46 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 20 percent of the dentists with about two- thirds of these dentists utilizing such personnel full time. Only 8 percent of the dentists employ dental hygienists and 5 percent employ dental techni- cians. Dentists are more likely to employ hygienists and laboratory techni- cians on a part-time basis compared to other auxiliary personnel. Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliar Dental With one full- With only y practitioners Total time employee part-time (or more) personnel Total 5,201 100 53 9 With one or more auxiliaries 3,102 62 53 9 With assistant 2,713 54 46 8 With hygienist 411 8 3 5 With laboratory technician 254 5 2 3 With secretary or receptionist 988 20 13 7 With other type of personnel 102 2 1 1 With no auxiliary 1,917 38 - - 1/ Includes 182 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with age of dentists and is more frequent amon young dentists. Eighty percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxil- iaries decreases to 57 percent among dentists 45 to 64 years old and to 33 percent among dentists 65 and over. Dentists in the early years of their practice generally do not reach peak utilization of assistants until they ar 30 years of age and of hygienists until age 35. 136 OTHER SURVEY FINDINGS *%%Ninety-four percent of the responding professionally active dentists in Illinois are primarily engaged in private practice. Two percent are on the staffs of dental schools, another two percent are employed by governmental agencies, and the remainder are engaged in other den- tal activities, such as taking advanced training. *%%At least one part-time dental activity in addition to their principal employment was reported by 11 percent of the dentists. Part-time teaching in a dental school was the most frequently reported second- ary employment. A variety of other secondary dental activities were reported, including employment by another dentist and serving in voluntary agencies. *%%Dentists reporting time spent in providing patient care devoted an average of 40.3 hours per week to this activity for 47.0 weeks during the year preceding the survey. About one dentist in six worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. *%%About 9 percent of the practitioners reported they limit their prac- tices to a dental specialty, primarily orthodontics or oral surgery. Only 5 percent of the dentists in nonmetropolitan counties limit their practices, compared to 9 percent in the Chicago metropolitan area and 12 percent in the eight other metropolitan areas combined. *%%0ne-fourth of the 1,193 responding civilian dentists who are licensed in Illinois but located in another state are in one of the five adjacent states, primarily Missouri and Wisconsin. Another 30 per- cent of the out-of-state dentists are located in California or Florida, and the remainder are scattered in 39 other states and the District of Columbia. *%%¥About one out of every five out-of-state dentists reported that they had been professionally active in Illinois immediately prior to assuming their present location in another state. More than two- fifths of the 249 out-migrant dentists are now located in California or Florida, and the remaining three-fifths moved to 32 other states, primarily those adjacent to Illinois. November 1967. 137 8¢1 APPENDIX TABLE Selected Data on Dentists in Illinois, by Location Civilian dentists / Persons Area and count Respond- Non- Age in 1965 Profes- Population— per y Total pe respond- Percent Percent sionally (in 000's) active ents ents under 40 55 or more active dentist All counties 6,316 5,472 844 26 42 5,99 10,649 .4 1,777 All metropolitan areas?’ 5,370 4,661 709 26 42 5,093 8,476.0 1,664 Chicago area 4,555 3,957 598 26 43 4,323 6,641.8 1,536 Cook 3,824 3,316 508 23 46 3,615 5,376.1 1,487 Du Page 235 204 31 45 23 227 375.6 1,655 Kane 155 139 16 29 34 151 231.6 1,534 Lake 191 168 23 38 30 184 341.7 1,857 McHenry 54 46 8 40 25 51 98.5 1,931 Will 96 84 12 40 29 95 218.3 2,298 East St. Louis areas’ 180 161 19 29 38 175 529.7 3,027 Madison 93 85 8 33 35 91 244.7 2,689 St. Clair 87 76 11 24 42 84 285.0 3,393 Peoria area 156 135 21 29 37 148 332.4 2,246 Peoria 109 96 13 28 39 103 196.7 1,910 Tazewell 38 30 8 30 33 36 109.6 3,044 Woodford 9 9 - 33 33 9 26.1 2,900 Rockford area 128 111 17 35 33 122 251.1 2,058 Winnebago 115 102 13 38 32 109 229.2 2,103 Boone 13 9 4 8 46 13 21.9 1,685 Rock Island-Moline area! 94 85 9 28 41 88 209.8 2,384 Rock Island 68 63 5 26 40 64 158.6 2,478 Henry 26 22 4 31 46 24 51.2 2,133 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Illinois, by Location Civilian dentists Persons Area and count Respond— Non- Age in 1965 Profes- Population— per y Total po respond- Percent Percent sionally (in 000's) active ents under 40 55 or more active dentist All metropolitan areas?! (cont'd.) Springfield area 73 56 17 28 32 68 151.9 2,234 Sangamon 7 56 17 28 2 68 151.9 2,234 Champaign-Urbana area 73 63 10 39 29 67 144.6 2,158 Champaign 7 63 10 39 29 67 144.6 2,158 Decatur area 57 49 8 20 34 54 125.9 2,331 Macon 57 49 8 20 34 54 125.9 2,331 Bloomington-Normal area S54 44 10 27 35 48 88.8 1,850 McLean 54 44 10 27 5 48 88.8 1,850 All nonmetropolitan counties 936 801 135 24 45 896 2,173.4 2,426 Central city 25,000-49,999 164 140 24 26 34 159 385.5 2,424 Adams 30 23 7 28 34 29 70.3 2,424 Kankakee 41 37 4 27 41 38 101.5 2,671 Knox 23 21 2 32 32 22 64.8 2,945 Stephenson 31 24 7 24 31 31 48.4 1,561 Vermilion 39 35 4 21 31 39 100.5 2,577 Central city 10,000-24,999 304 258 46 26 43 291 649.1 2,231 Coles 25 21 4 21 38 25 43.9 1,756 De Kalb 26 21 5 16 44 25 61.9 2,476 6€1 71 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Illinois, by Location Civilian dentists / Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Percent Percent sionally (in 000's) active ents ents under 40 55 or more active dentist All nonmetropolitan counties? (cont'd.) Central city 10,000-24,999 (cont'd.) Fulton 14 13 1 23 31 14 41.1 2,936 Jackson 25 22 3 32 36 25 44.6 1,784 Jefferson 15 13 2 14 64 14 30.6 2,186 La Salle 56 45 11 37 37 54 115.3 2,135 Lee 21 17 4 14 57 21 39.8 1,895 Logan 12 10 2 8 50 11 34.9 3,173 McDonough 13 11 2 33 42 12 29.3 2,442 Marion 17 13 4 29 41 16 38.5 2,406 Morgan 23 21 2 27 45 20 37.4 1,870 Warren 11 9 2 45 27 11 21.5 1,954 Whiteside 26 25 1 23 35 26 64.4 2,477 Williamson 20 17 3 25 65 17 45.9 2,700 Central city 5,000-9,999 270 231 39 24 47 260 629.8 2,422 Alexander 4 2 2 50 50 3 14.3 4,767 Bureau 16 16 - 20 53 16 37.4 2,338 Cass 9 7 2 11 33 9 14.2 1,578 Christian 15 14 1 23 38 15 36.4 2,427 Clay 4 4 - - 75 4 15.2 3,800 Crawford 10 8 2 22 67 10 20.6 2,060 De Witt 8 7 1 29 57 8 17 .4 2,175 Edgar 10 9 1 33 11 9 22.1 2,456 Effingham 14 12 2 29 50 13 23.7 1,823 Fayette 10 7 3 33 44 9 20.8 2,311 Franklin 16 13 3 50 36 16 36.1 2,256 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Illinois, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population per Total ents respond- Percent Percent sionally (in 000's) active ents under 40 55 or more active dentist All nonmetropolitan counties (cont'd.) Central city 5,000-9,999 (cont'd.) Grundy 12 10 2 18 64 12 23.7 1,975 Iroquois 11 9 2 30 50 11 34.2 3,109 Jersey 5 5 - 20 60 5 18.0 3,600 Lawrence 7 5 2 43 29 5 17.6 3,520 Livingston 16 15 1 12 56 16 41.5 2,594 Macoupin 19 18 1 21 53 19 43.1 2,268 Massac 5 5 - 40 40 5 14.7 2,940 Montgomery 12 11 1 18 64 11 30.6 2,782 Ogle 20 15 5 21 37 19 40.4 2,126 Perry 8 8 - 25 50 8 18.0 2,250 Richland 10 9 1 22 22 10 15.9 1,590 Saline 15 12 3 20 47 14 23.2 1,657 Wabash 4 3 1 25 75 3 13.5 4,500 Wayne 4 3 1 - 67 4 18.6 4,650 White 6 4 2 20 40 6 18.6 3,100 Central city 2,500-4,999 158 = 138 20 21 52 150 401.4 2,676 Bond 8 5 3 14 71 7 13.9 1,986 Carroll 10 9 1 20 50 10 19.8 1,980 Clark 6 6 - 33 50 6 16.1 2,683 Clinton 8 4 4 - 75 6 24.5 4,083 Douglas 10 8 2 30 40 10 20.5 2,050 Ford 7 7 - 14 43 6 16.9 2,817 Greene 6 5 1 17 33 6 16.8 2,800 Hamilton 3 3 - - 67 3 8.9 2,967 1 wl APPENDIX TABLE (cont'd.) Selected Data on Dentists in Illinois, by Location Civilian dentists 1/ Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total respond- Percent Percent sionally (in 000's) active ents . . ents under 40 55 or more active dentist All nonmetropolitan counties? (cont'd.) Central city 2,500-4,999 (cont'd.) Hancock 10 9 1 10 70 9 24.0 2,667 Jasper 3 3 - - 50 2 10.8 5,400 Jo Daviess 7 7 - 14 57 7 21.8 3,114 Kendall 8 7 1 62 25 8 20.0 2,500 Mason 6 6 - 50 33 6 15.1 2,517 Mercer 4 3 1 25 25 4 17.1 4,275 Monroe 8 7 1 43 29 8 16.5 2,062 Moultrie 7 6 1 43 29 7 13.7 1,957 Piatt 5 4 1 - 60 5 15.4 3,080 Pike 7 7 - - 71 7 19.8 2,828 Randolph 11 11 - 18 54 11 29.1 2,645 Schuyler 3 2 1 33 33 2 8.3 4,150 Shelby 7 7 - - 100 6 22.9 3,817 Union 7 5 2 14 57 7 16.4 2,343 Washington 7 7 - 29 57 7 13.1 1,871 Central city under 2,500 40 34 6 21 68 36 107.6 2,989 Brown 4 3 1 - 50 3 5.8 1,933 Calhoun 2 2 - - 100 2 5.5 2,750 Cumberland 4 3 1 25 75 2 9.6 4,800 Edwards 3 3 - 67 - 3 7.3 2,433 Gallatin 1 1 - 100 - 1 6.6 6,600 Hardin 1 1 - - 100 1 5.2 5,200 Henderson 1 1 - > 100 1 8.1 8,100 Johnson 4 3 1 25 75 3 6.2 2,067 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Illinois, by Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population— per Total ents respond- Percent Percent sionally (in 000's) active ents under 40 55 or more active dentist All nonmetropolitan counties>’ (cont'd.) Central city under 2,500 (cont'd.) Marshall 7 6 1 43 57 7 13.4 1,914 Menard 4 4 - - 75 4 9.1 2,275 Pope 1 1 - a 100 1 3.4 3,400 Pulaski 1 1 - - - 1 9.1 9,100 Putnam 1 - 1 - 100 1 4.5 4,500 Scott 3 2 1 - 100 3 5.9 1,967 Stark 3 3 - - 100 3 7.9 2,633 Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Illinois counties included in the latest 1967 definition of Standard Metropolitan Statistical Areas, as estab- lished by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's statistics are presented only for dentists located in the Illinois portion of the SMSA. Illinois part of the St. Louis SMSA. Illinois part of the Davenport-Rock Island-Moline SMSA. Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. NOTE: County location not available for 10 dentists. evi “fe cer Ra Ra INDIANA DENTISTS LICENSED IN INDIANA During the 1965 registration period, 2,823 dentists registered with the Indiana State Board of Dental Examiners. Of these dentists, 76 percent were civilians located in Indiana, another 20 percent were civilians lo- cated in other states, and 4 percent were on active duty with the Armed orces. The survey questionnaire was completed by 2,532 dentists, 90 percent of all those registered. The data provided by the survey respondents has been supplemented when obtainable, by information on location, age, dental school attended and year of graduation for dentists not respond- ing to the survey. Information on nonrespondents was obtained either from records maintained by the Indiana State Board of Dental Examin- ers or from the 1966 American Dental Directory, published by the American Dental Association. Location and Military Status of Dentists Licensed in Indiana Location and All Percent of military status dentists dentists Total licensed 2,823 100 Respondents 2,632 90 Nonrespondents 291 10 Total licensed 2,823 100 Civilians in Indiana 2,142 76 Respondents 1,976 Nonrespondents 166 Civilians in other states 563 20 On active duty with Armed Forces 118 4 About one-third of all survey respondents hold a license to practice den- tistry in one or more other states. Only 17 percent of the dentists lo- cated in Indiana hold more than one license, with 15 percent licensed in one other state and a mere 2 percent licensed in two or more other states. The proportion of out-of-state dentists holding multiple licenses is considerably greater; 23 percent hold two or more licenses in addi- tion to their Indiana license. 145 PROFESSIONAL TRAINING More than three-fourths of Indiana’s 2,142 dentists graduated from Indiana University School of Dentistry. Another 15 percent of the dentists are grad- uates of 9 dental schools located in adjacent states. Among these schools, Loyola University of Chicago and Northwestern University are the largest contributors, each having trained approximately 5 percent of the State's dentist supply. The University of Louisville is the only other school to contribute as much as 3 percent of the dental force. The remaining 9 per- cent of the State's dentists are graduates of 29 other dental schools located in more distant states. Dental School Attended and Year of Graduation for Dentists in Indiana Number Year of graduation Dental school of All After 1941-1940 or attended dentists years 1955 1955 earlier - Total number 2,142 566 659 909 (Percent distribution by school) Indiana University 1,624 76 84 72 75 Schools in adjacent states 328 15 8 17 18 Loyola University of Chicago 109 5 3 7 5 Northwestern University 97 5 1 5 6 7 other schools 122 5 4 5 7 29 schools in other states 182 9 8 11 7 _1/ Dental school attended and year of graduation not available for 8 dentists. Percents are based on data supplied. The proportionate contribution of Indiana University to the State dentist supply has increased somewhat in recent years. Approximately 84 percent of the dentists in the State who graduated since 1955 received their dental education at this school, compared to 74 percent of those who graduated in earlier years. At the same time, the contribution of schools in adjacent states has declined considerably. Some 17 percent of the survey respondents, 340 dentists, indicated that they had taken some type of advanced training after receiving their dental degree. Of 174 dentists reporting advanced clinical training, 108 had com- pleted an internship and 66 a residency. Among the 232 dentists who have had advanced academic training, 126 reported having earned a master’s or other advanced degree, and another 106 dentists received no additional degrees but completed one or more years of postgraduate study. A total of 66 dentists completed both academic and clinical training. 146 DISTRIBUTION OF DENTISTS Almost seven in every ten of the 2,142 dentists in Indiana are located in the 11 metropolitan areas of the State. The 8-county Indianapolis area alone has 592 dentists, 27 percent of the total dental force. The vast ma- jority of these dentists, more than four-fifths, are in Marion County, where Indianapolis is located. The Gary-Hammond area has the second largest dental force, with 249 dentists, or 12 percent of the total supply. The metropolitan areas of South Bend and Fort Wayne have the third and fourth largest dental forces in the State, with 7 and 6 percent, respectively. The Indiana portion of the interstate Evansville area and the Terre Haute area each have 4 percent of the State's dentist supply. The remaining five metropolitan areas—Lafayette, Anderson, Muncie, and the Indiana por- tions of the interstate Louisville and Cincinnati areas—have among them 185 dentists, 9 percent of the total supply. Distribution of Indiana Dentists, by County Group Number Number Percent County group™ of of of counties dentists dentists All counties 92 2,142 100 Metropolitan areas 25 1,471 69 Indianapolis area 8 592 27 Gary-Hammond-E. Chicago area 2 249 12 South Bend area 2 148 7 Fort Wayne area 1 122 6 Evansville area (Ind. part) 2 96 4 Terre Haute area 4 79 4 5 other areas 6 185 9 Nonmetropolitan counties 67 671 31 Central city 25,000-49,999 6 217 10 Central city 10,000-24,999 14 179 8 Central city 5,000- 9,999 17 135 6 Central city under 5,000 30 140 7 * See Appendix Table for complete listing and definition of metropolitan areas, explanation of interstate areas, and presentation of individual county data. Approximately one-third of Indiana’s dentists are located in the 67 non- metropolitan counties of the State. The 20 counties with central cities of 10,000 or more persons have 396 dentists, almost one-fifth of the State's dental force. Two of these counties—Elkhart and La Porte—have at least 50 dentists, and four—Grant, Howard, Monroe,and Wayne—have between 25 and 30 dentists. The 47 counties with less than 10,000 per- sons in their central cities have 13 percent of the dentist supply. Only 8 of these counties have as many as 10 dentists, while 18 have fewer than entists. 147 NUMBER OF PERSONS PER DENTIST IN INDIANA, BY COUNTY MICHIGAN Gary-Hammond E. Chicago PEERS PEARSE POEL RISRKXHKS ““louro p & PRRRHKKS Ecol 22% ILLINOIS SXIRAK SHI RRX] ERR — — Lill Cincinnati v \ EL Voy ii ’ KERTVCRY Metropolitan areas === Out-of-state portion of interstate metropolitan area Persons per dentist: BX under 2,500 ENTUCKY 2,500 - 3,500 2 * \ J 3,500 - 5,000 === [J over 5,000 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 2,142 licensed dentists in Indiana, 2,013, or 94 percent, are active in their profession, giving Indiana one professionally active dentist for every 2,449 persons. There is one dentist for every 2,189 persons in the metro- politan areas, while the remainder of the State has a less favorable ratio of one dentist for every 3,033 persons. Number of Persons per Active Dentist in Indiana County aroup * Professionally Persons y group active Population per dentists dentist All counties 2,013 4,929,800 2,449 Metropolitan areas 1,393 3,049,200 2,189 Indianapolis area 549 1,021,600 1,861 Gary-Hammond-E. Chicago area 240 627,800 2,616 South Bend area 144 283,600 1,969 Fort Wayne area 117 259,800 2,221 Evansville area (Ind. part) 93 189,900 2,042 Terre Haute area 73 169,200 2,318 5 other areas 177 497,300 2,810 Nonmetropolitan counties 620 1,880,600 3,033 Central city 25,000-49,999 205 516,100 2,518 Central city 10,000-24,999 167 506,100 3,031 Central city 5,000- 9,999 125 421,100 3,369 Central city under 5,000 123 437,300 3,655 * See Appendix Table for individual county data. Among the metropolitan areas, the 8-county Indianapolis area has the most favorable ratio with 1,861 persons per active dentist. Marion County, the hub of the area, has the best ratio in the State, some 1,600 persons per active dentist, while the other seven counties in the area have considerably higher ratios averaging more than 3,000 persons per dentist. Among the other metropolitan areas, only South Bend, with 1,969 persons per dentist, has a ratio under 2,000. The ratios for the Evansville and Lafayette areas, however, are only slightly higher—2,042 and 2,036, respectively. In four areas—Fort Wayne, Terre Haute, Anderson and Gary-Hammond—the ratios range between 2,200 and 2,600. The remaining three areas—Muncie and the Indiana parts of the Louisville and Cincinnati areas—have ratios in excess of 3,300 persons per dentist. Among the 67 nonmetropolitan counties, there are 11 with persons-per dentist ratios under 2,500, yet 22 counties have ratios exceeding 4,000 per- sons per dentist, including one county with no active dentist. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The group of counties with central cities of 25,000 or more population have an average persons-per-dentist ratio of approximately 2,500, while counties with central cities of less than 5,000 inhabitants aver- age over 3,500 persons per dentist. 149 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 2,131 dentists for whom age was obtainable is 46.6 years. Approximately one-third of Indiana’s dentists (689) are under 40 years of age, including 20 percent who are under 35. On the other hand, 36 percent (773) are 55 years or over. About one in every six, or 388 den- tists, are 65 years old or more, including 211 who have reached the age of 70. Median Age and Age Distribution of Indiana Dentists, by County Group Percent of dentists Median Under 40- 55 & County group age 40 54 over All counties 46.6 32 32 36 Metropolitan areas 45.5 34 31 35 Indianapolis area 44.4 38 29 33 Gary-Hammond-E. Chicago area 46.1 36 29 35 South Bend area 47.5 27 37 36 Fort Wayne area 43.2 40 28 32 Evansville area (Ind. part) 44.3 31 40 29 Terre Haute area 52.1 18 37 45 5 other areas 46.9 30 34 36 Nonmetropolitan counties 48.8 29 31 40 Central city 25,000-49,999 45.5 34 35 31 Central city 10,000-24,999 51.7 22 32 46 Central city 5,000 - 9,999 51.0 24 33 43 Central city under 5,000 49.0 32 25 43 The median age of dentists in metropolitan areas is 45.5 years, more than three years below the median of 48.8 years for dentists in nonmetropolitan counties. Among the metropolitan areas, Fort Wayne has the youngest den- tists, with a median age of 43.2 years. Two-fifths of the dentists in this area are less than 40 years of age, including 28 percent who are under 35. The Indianapolis and Evansville areas have relatively young dentists, with median ages about two years below the average for the State. Dentists in the Terre Haute area are the oldest as a group, with a median age of 52.1 years. Only 18 percent of these dentists are under 40, while 45 percent have reached the age of bb. Among the nonmetropolitan counties, younger dentists tend to be concen- trated in counties with large central cities. The median age of dentists in counties with central cities of 25,000 or more population is 45.5 years, the same as the median for all metropolitan areas combined. Dentists in the non- metropolitan counties with smaller central cities, however, are on the aver- age about 5 years older, with a median age of over 50 years. 150 UTILIZATION OF AUXILIARIES More than three-fourths of the responding dental practitioners in Indiana (i.e., dentists who spend any time working at the chair) report that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 71 percent of the dentists, including 65 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 27 percent of the dentists, with two-thirds of these dentists utilizing such personnel full time. Only 14 percent of the dentists employ den- tal hygienists and 6 percent employ dental laboratory technicians. A majority of the practitioners who employ hygienists or technicians do so only part time. Indiana Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 1,845 100 71 6 One or more auxiliaries 1,372 77 71 6 Assistant 1,267 71 65 6 Hygienist 241 14 5 9 Laboratory technician 111 6 2 4 Secretary or receptionist 480 27 18 9 Other type of personnel 36 2 1 1 No auxiliary 403 23 --- --= 1 Includes 70 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist and tends to be more fre- quent among younger dentists. Ninety percent of Indiana dentists under the age of 45 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 73 percent among dentists 45 to 64 years old and to only 40 per- cent among dentists 65 and over. Young dentists just starting their practices do not reach peak utilization of assistants until they are at least 30 years of age and of hygienists until age 35. About 15 percent of the dental practitioners in Indiana reported one or more vacant positions for auxiliary personnel. Of those reporting vacancies, 38 per- cent indicated a need for full-time hygienists and 27 percent reported vacancies for full-time dental assistants. More than nine of every 10 dentists reporting a vacancy already employ one or more auxiliaries. 151 386-029 O - 70 - 11 152 OTHER SURVEY FINDINGS Ninety-four percent of the responding professionally active dentists in Indiana are primarily engaged in private practice. Two percent are on the staff of the dental school, another two percent are employed by government agencies, and the remaining two percent are engaged in other dental activities, such as taking advanced training. At least one part-time dental activity in addition to their principal employment was reported by 11 percent of the dentists. Part-time teaching in a dental school was the most frequently reported secondary employment. A variety of other activities were reported, including employment by another dentist and working in voluntary agencies. Dentists reporting time spent in patient care devoted an average of 40.0 hours per week to this activity for 47.3 weeks during the year preceding the survey. About one den- tist in eight worked the equivalent of 6 days a week, 48 hours or more, for at least 48 weeks. About 13 percent of the dentists in Indiana reported that they limit their practice to a dental specialty, primarily orthodontics or oral surgery. Dental specialists are more likely to be located in a metropolitan area than in a non- metropolitan county. One in every 7 dentists practicing in a metropolitan area limits his practice, whereas in non- metropolitan counties only one in every 12 dentists does so. Of the 563 dentists licensed in Indiana but located out-of- state, more than one-third are located in the adjacent states of Illinois, Kentucky, Michigan,or Ohio. An additional 26 percent are in California or Florida. The remaining out-of- state dentists are scattered throughout 33 other states and the District of Columbia. May 1968. APPENDIX TABLE Selected Data on Dentists in Indiana, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population_1/ per and county Total ents respond- Under 55 years sionally (in 000s) active ents 40 or more active dentist All counties 2,142 1,976 166 689 773 2,013 4,929.8 2,449 2 Metropolitan — 1,471 1,359 112 498 506 1,393 3,049.2 2,189 Indianapolis area 592 543 49 221 197 549 1,021.6 1,861 Boone 10 10 -- 4 3 10 28.3 2,830 Hamilton 16 16 “= 8 4 15 441 2,940 Hancock 1 10 1 2 6 9 30.7 3,411 Hendricks 16 16 “= 6 6 15 45.6 3,040 Johnson 18 18 -- 8 5 17 50.5 2,971 Marion 503 457 46 186 166 468 748.3 1,599 Morgan 8 8 --- 4 3 8 38.0 4,750 Shelby 10 8 2 3 4 7 36.1 5,157 Gary-Hammond-E. Chicago area 249 235 14 89 88 240 627.8 2,616 Lake 225 21 14 77 86 216 556.2 2,575 Porter 24 24 “= 12 2 24 71.6 2,983 South Bend area 148 135 13 40 53 144 283.6 1,969 Marshall 14 14 == 5 5 13 32.7 2,515 St. Joseph 134 121 13 35 48 131 250.9 1,915 Fort Wayne area 122 108 14 49 39 117 259.8 2,221 Allen 122 108 14 49 39 117 259.8 2,221 Evansville area (Ind. part) 96 93 3 30 28 93 189.9 2,042 — Vanderburgh 88 86 2 26 26 86 166.5 1,936 3 Warrick 8 7 1 4 2 7 23.4 3,343 761 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Indiana, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population per and county Total ents respond- Under 55 years sionally (in 000s) active ents 40 or more active dentist Metropolitan areas Z/ (cont’d.) Terre Haute area 79 73 6 14 36 73 169.2 2,318 Clay 7 4 3 “= 3 7 24.0 3,429 Sullivan 8 8 “= 3 3 7 21.0 3,000 Vermillion 6 5 1 --- 5 5 16.3 3,260 Vigo 58 56 2 11 25 54 107.9 1,998 Anderson area 56 53 3 15 20 55 131.6 2,393 Madison 56 53 3 15 20 55 131.6 2,393 Louisville area (Ind. part) 36 36 - 9 12 34 121.0 3,559 Clark 17 17 = 5 7 16 67.1 4,194 Floyd 19 19 “= 4 5 18 53.9 2,994 Muncie area 36 33 3 11 11 35 118.4 3,383 Delaware 36 33 3 11 11 35 118.4 3,383 Lafayette-West Lafayette area 50 43 7 19 18 47 95.7 2,036 Tippecanoe 50 43 7 19 18 47 95.7 2,036 Cincinnati area (Ind. part) 7 7 --- 1 4 6 30.6 5,100 Dearborn 7 7 -- 1 4 6 30.6 5,100 . . 3/ Nonmetropolitan counties 671 617 54 191 267 620 1,880.6 3,033 Central city 25,000-49,999 217 198 19 74 67 205 516.1 2,518 Elkhart 56 48 8 21 16 55 115.2 2,095 Grant 25 24 1 9 7 24 80.2 3,342 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Indiana, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population y per and county Total ents respond- Under 55 years sionally (in 000’s) active ents 40 or more active dentist Nonmetropolitan counties (cont’d.) Central city 25,000-49,999 (cont’d.) Howard 29 26 3 8 10 25 75.9 3,036 La Porte 50 48 2 12 20 47 102.9 2,189 Monroe 29 25 4 16 5 28 64.8 2,314 Wayne 28 27 1 8 9 26 77.1 2,965 Central city 10,000-24,999 179 163 16 39 81 167 506.1 3,031 Bartholomew 23 22 1 12 10 23 52.8 2,296 Cass 15 15 -- 1 8 13 41.8 3,215 Clinton 10 9 1 1 5 10 31.6 3,160 Daviess 9 7 2 2 4 9 26.4 2,933 Fayette 8 8 -- 1 4 8 24.1 3,013 Henry 18 16 2 2 10 17 50.0 2,941 Huntington 11 11 -- 2 5 9 35.0 3,889 Jackson 12 9 3 3 6 12 31.3 2,608 Jefferson 8 7 1 1 2 8 24.5 3,063 Knox 21 17 4 7 8 18 42.1 2,339 Lawrence 12 1 1 1 3 10 36.8 3,680 Miami 13 12 1 = 10 13 41.9 3,223 Montgomery 9 9 -- 3 2 9 329 3,656 Wabash 10 10 - 3 4 8 34.9 4,363 Central city 5,000-9,999 135 128 7 33 58 125 421.1 3,369 Adams 8 8 --- 3 2 7 25.9 3,700 Blackford 5 5 -- 1 3 5 15.3 3,060 Decatur 6 5 1 3 3 5 21.2 4,240 G De Kalb 10 9 1 3 3 9 29.2 3,244 9¢1 APPENDIX TABLE (Cont'd.) Selected Data on Dentists in Indiana, by Location Civilian dentists Persons County group Respond- Non- __Agein 1965 Profes- Population u per and county Total ents respond- Under 55 years sionally (in 000’s) active ents 40 or more __active dentist . . 3/ Nonmetropolitan counties™ (cont’d.) Central city 5,000-9,999 (cont’d.) Dubois 11 10 1 2 4 10 28.7 2,870 Gibson 10 10 —-- 2 5 10 29.4 2,940 Greene 9 9 -- 4 3 9 25.9 2,878 Jay 6 5 1 1 2 5 23.1 4,620 Kosciusko 17 15 2 5 6 16 44.1 2,756 Noble 7 7 - 1 3 6 29.4 4,900 Perry 6 6 -- 4 6 17.5 2,917 Posey 6 6 --- 1 3 6 19.0 3,167 Putnam 6 5 1 2 3 6 25.6 4,267 Randolph 10 10 --- 2 5 9 28.3 3,144 Rush 5 5 2 2 5 20.3 4,060 Tipton 6 6 --- 4 4 16.1 4,025 Wells 7 7 1 3 7 22.1 3,157 Central city 2,500-4,999 107 99 8 36 46 95 326.0 3,432 Carroll 3 3 2 1 3 17.4 5,800 Fountain 10 9 1 5 4 8 18.7 2,338 Franklin 4 3 1 2 2 3 16.8 5,600 Fulton 8 7 1 2 5 8 17.0 2,125 Harrison 3 3 -- --- 2 3 19.3 6,433 Jasper 7 7 --- 3 2 7 19.2 2,743 Jennings 3 3 --- 1 1 3 18.4 6,133 Martin 4 3 1 1 3 3 10.6 3,633 Orange 6 6 -- 3 1 5 17.2 3,440 Owen 3 3 1 1 2 11.3 5,650 Parke 5 5 2 1 5 15.0 3,000 Pike 2 2 - 1 -- 2 12.3 6,150 Ripley 8 8 3 4 8 21.7 2,713 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Indiana, by Location Civilian dentists Persons County group Respond- Non- Age in _1965 Profes- Population per and county Total ents respond- Under 55 years sionally (in 000’s) active ents 40 or more active dentist Nonmetropolitan counties? (cont’d.) Central city 2,500-4,999 (cont'd.) Scott 4 4 - --- 1 3 14.9 4,967 Starke 4 4 == 1 2 4 17.9 4,475 Steuben 7 6 1 2 3 6 17.9 2,983 Washington 5 4 1 3 1 4 18.2 4,550 White 10 9 1 2 5 9 20.4 2,267 Whitley 1 10 1 2 7 9 21.8 2,422 Central city - under 2,500 33 29 4 9 15 28 111.3 3,975 Benton 6 6 == 2 4 5 11.7 2,340 Brown 3 2 1 2 1 3 7.2 2,400 Crawford 2 2 -- -- 1 1 8.0 8,000 Lagrange 5 4 1 2 1 5 17.9 3,580 Newton 3 3 == --- 2 3 11.6 3,867 Ohio 1 1 —- “= 1 1 4.1 4,100 Pulaski 4 4 -.- 2 1 4 12.3 3,075 Spencer 4 4 -- --- 1 4 16.2 4,050 Switzerland 2 --- 2 --- 1 1 7.1 7,100 Union 3 3 -- 1 2 1 6.9 6,900 Warren -- a --- -- --- -— 8.3 --- _1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/Indiana counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of survey data. For interstate SMSA’s statistics are presented only for dentists located in the Indiana portion of the Evansville SMSA, Louisville SMSA, and Cincinnati SMSA. p= 3/Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city 4 within each county. [0)1}17a DENTISTS LICENSED IN IOWA During the 1965 registration period, 2,211 dentists registered with the Towa State Board of Dental Examiners. A total of 2,030 dentists responded to the survey, 92 percent of all those registered. Sixty-six percent of the responding dentists are civilians located in Iowa, and 27 percent are civilians located in other States. Five percent of the responding dentists are on active duty with the Armed Forces, and the remaining 2 percent did not report their location or military status. Location and Military Status of Dentists Licensed in Iowa Location and All Percent of military status dentists dentists Total licensed 2,211 100 Respondents 2,030 92 Nonrespondents 181 8 Respondents 2,030 100 Civilians in Iowa 1,340 66 Civilians in another State 553 27 On active duty with Armed Forces 105 5 Not reported 32 2 About 42 percent of the respondents hold a license to practice dentistry in one or more other States. Almost one-fifth of the dentists located in Towa hold more than one license, with 15 percent licensed in one other State and only 3 percent licensed in two or more other States. Multiple licensure is considerably more common among responding dentists located in other States, with more than one-fourth holding two or more licenses in addition to their Iowa license. 159 PROFESSIONAL TRAINING Four-fifths of Iowa's dentists graduated from the University of Iowa College of Dentistry. Another 18 percent are graduates of 10 dental schools located in adjacent States. The principal contributor among these schools, Creighton University, has supplied 9 percent of the State's dental force. The next two largest contributors are Northwestern and St. Louis Universities, each having supplied 2 percent of the den- tists. The only other schools to contribute as much as one percent of the dental force are Loyola University of Chicago and the Universities of Minnesota and Missouri. Only one-fifth of Iowa's dentists graduated from dental school within the last 10 years. In contrast, a very large proportion--about one- half--graduated before World War II. The overall proportionate contribu- tions of both the University of Iowa and the 10 schools in adjacent States have shown virtually no change over the years. School Awarding Dental Degree, By Year Awarded Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total 1,340 - 254 393 655 (Percent distribution by school) University of Iowa 1,071 80 80 77 82 Schools in adjacent States 242 18 19 20 17 Creighton University 124 9 10 10 9 9 other schools 118 9 9 10 8 15 schools in other areas 21 2 1 3 1 1/ Dental school not reported by 6 dentists and year of graduation by 38 dentists. Percents based on data supplied. Almost 16 percent of the survey respondents, or 217 dentists, reported they had completed one year or more of advanced training beyond receipt of the dental degree. Of these dentists 120 received advanced clinical training as interns or residents and 148 completed one year or more of advanced academic work as graduate or postgraduate students. These figures include 51 dentists who completed both academic and clinical training. 160 DISTRIBUTION OF DENTISTS Almost 40 percent of the licensed dentists in Iowa are located in the seven metropolitan areas of the State. The Des Moines metropolitan area has the largest number of dentists, 163, or 12 percent of the State sup- ply. The Cedar Rapids metropolitan area has the second largest dental force, 6 percent of the total, and the areas of Davenport and Waterloo each have 5 percent. Of the three remaining metropolitan areas, Sioux City and Dubuque each have 4 percent of the dentists and the Council Bluffs area has 3 percent. Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 98 1,340 100 All metropolitan areas* 7 521 39 Des Moines area 1 163 12 Cedar Rapids area 1 82 6 Davenport area 1 66 5 Waterloo area 1 63 5 Sioux City area 1 57 4 Dubuque area 1 55 4 Council Bluffs area 1 35 3 Nonmetropolitan county groups¥ 91 819 61 Central city 10,000-49,999 13 314 24 Central city 5,000-9,999 28 240 18 Central city 2,500-4,999 31 179 13 Central city under 2,500 19 86 6 * See Appendix Table for definition of metropolitan areas and presenta- tion of individual county data. The 91 nonmetropolitan counties of the State have a substantial share, over three-fifths, of Iowa's dentist supply. Almost one-fourth of the State's dentists are located in the 13 counties that have 10,000 or more persons in their central cities. Johnson County, where the University of Iowa College of Dentistry is located, has the largest number of dentists of any nonmetropolitan county. Other counties in this group with sub- stantial numbers of dentists are Des Moines, Cerro Gordo, Clinton, Story, and Webster. The 28 counties with central cities of 5,000-9,999 inhab- itants have among them 240 dentists, almost one-fifth of the State supply. Another one-fifth of Iowa's dentists are located in the 50 counties with less than 5,000 persons in their central cities. 161 AGE OF DENTISTS AND DIFFERENCES IN AGE BY AREA With slightly more than one-half of the dentists in Iowa over 50 years of age, the median age of Iowa dentists reporting in the survey was 50.2 years. About one-sixth of the State's dentists are under 35, yet more than two-fifths are 55 years of age or older. Almost one in every four, or 298 dentists, are 65 years of age or older and 166 dentists have reached the age of 70. Age Distribution Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 1,340 100 - Under 30 46 4 4 30 - 34 151 12 16 35 - 39 146 11 27 40 - 44 170 13 40 45 - 49 126 10 50 50 - 54 100 8 58 55 - 59 106 8 66 60 - 64 141 11 77 65 - 69 132 10 87 70 - 74 81 6 93 75 and over 85 7 100 1/ Age not available for 56 dentists. Percents based on total for whom age was reported. The median age of dentists in metropolitan areas is 48.4 years, about three years younger than the median of 51.3 years for dentists in the nonmetropolitan counties. Among the metropolitan areas, Des Moines has the youngest dentists, with a median age of 44.7 years. One-third of the dentists in this area are under 40 years of age, and only one-fifth are 65 or over. In contrast, dentists in the Sioux City area are the oldest as a group, with a median age of 56.9. Less than one-fifth of these den- tists are under 40, while fully one-third have reached the age of 65. Median dentist ages in nonmetropolitan counties tend to increase as the size of the central city decreases. The median age of dentists in the counties with central cities of at least 10,000 population is 48.0 years, compared to a median age of 55.6 years in counties with less than 5,000 persons in their central cities. Considering the nonmetropolitan counties individually, Johnson County is notable because of its young dentists; their median age is 42.5 years, almost nine years below the median age for all nonmetropolitan counties combined. 162 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,340 responding dentists in Iowa, 1,257, or 94 percent, are active in their profession, giving Iowa one professionally active dentist for every 2,242 persons. In the seven metropolitan areas combined there is one professionally active dentist for every 2,000 persons, a ratio some- what better than the 2,396 persons per dentist in the nonmetropolitan counties. Number of Persons Per Active Dentist Professionally Persons County group active Population per dentists dentist All counties 1,257 2,818,300 2,242 All metropolitan areas 489 977,900 2,000 Dubuque area 51 84,000 1,647 Des Moines area 153 286,300 1,871 Cedar Rapids area 78 148,500 1,904 Sioux City area 56 110,200 1,968 Waterloo area 60 131,100 2,185 Davenport area 57 128,900 2,261 Council Bluffs area 34 88,900 2,615 Nonmetropolitan county groups 768 1,840,400 2,396 Central city 10,000-49,999 295 562,200 1,906 Central city 5,000-9,999 226 559,900 2,477 Central city 2,500-4,999 169 474,400 2,807 Central city under 2,500 78 243,900 3,127 Among the metropolitan areas, Dubuque has the best ratio, with one dentist for every 1,647 persons. The persons-per-dentist ratios for the Des Moines, Cedar Rapids and Sioux City areas, all under 2,000, are only slightly less favorable. The ratios for the Waterloo and Davenport areas are very close to the average for the State, while the Council Bluffs area has 2,615 per- sons per dentist, the least favorable ratio among the metropolitan areas. Among the 91 nonmetropolitan counties of the State, there are 18 counties with persons-per-dentist ratios under 2,000, yet 36 counties have ratios exceeding 3,000 persons for every dentist. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The group of counties with central cities of 10,000 or more population have an average of 1,906 persons per dentist, a ratio more favorable than in four of the seven metropolitan areas. In contrast, the counties with central cities of less than 2,500 inhabitants average 3,127 persons for every active dentist. 163 UTILIZATION OF AUXILIARIES Almost three out of every four dental practitioners in Iowa (i.e., den- tists who spend any time working at the chair) reported they employ auxil- iary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 69 percent of all practitioners, including 61 percent who employ at least one assistant on a full-time basis. Secretaries or recep- tionists are employed by 24 percent of the dentists, with over half of these dentists utilizing such personnel full time. Only 10 percent of the dentists employ dental hygienists and four percent employ dental techni- cians. About half of the dentists who employ hygienists or technicians do so only part time. Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Dental With one full- With only practitioners Total time employee part-time (or more) personnel Type of auxiliary Total 1,245 100 67 7 With one or more auxiliaries 927 74 67 7 With assistant 854 69 61 8 With hygienist 119 10 5 5 With technician 44 4 2 2 With secretary or receptionist 293 24 14 10 With other type of personnel 45 4 1 3 With no auxiliary 318 26 - - The use of auxiliaries varies with the age of the dentist and is more fre- quent among the young dentists. Eighty-nine percent of the dental practi- tioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 76 percent among dentists 45 to 64 years old and to 49 percent among dentists 65 and over. Dentists in the early years of their practice generally do not reach peak utilization of assistants until they are 30 years of age and of hygienists until age 40. 164 OTHER SURVEY FINDINGS *%*Ninety-five percent of the professionally active dentists in Towa are primarily engaged in private practice. Another three percent are on the staff of the dental school and the remaining two percent are either employed by State or local government agencies or are engaged in other dental activ- ities, such as taking advanced training. **¥*Dentists providing patient care in the year prior to the survey devoted an average of 41.3 hours per week to this activity for 47.3 weeks during the year. About one dentist in eight worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. *%¥%About 12 percent of the responding practitioners reported they limited their practice to a dental specialty, primar- ily to orthodontics, followed by oral surgery and pedodon- tics. Eighteen percent of the dentists in metropolitan areas limit their practice, compared to 9 percent in the nonmetropolitan areas. ***Thirty percent of the 553 civilian dentists licensed in Iowa but located in another State are in one of the six adjacent States, primarily Nebraska and Illinois. Another 28 percent of the out-of-State dentists are located in California or Colorado, and the remainder are scattered in 34 other States and the District of Columbia. ***About one out of every five out-of-State dentists reported that they had been professionally active in Iowa immediately prior to assuming their present location in another State. More than one-third of the 124 out-migrant dentists are now located in California or Arizona, and the remaining two- thirds are in 26 other States, primarily those States adjacent to Iowa. November 1967. 165 991 Selected Data on Dentists in Iowa, by Location APPENDIX TABLE Civilian dentists 1/ Persons County group Age in 1965 Profes- Population— per and county Total Under 55 years sionally (in 000's) active 40 or over active dentist All counties 1,340 343 545 1,257 2,818.3 2,242 Metropolitan aveass’ 521 137 200 489 977.9 2,000 Des Moines area 163 52 56 153 286.3 1,871 Polk 163 52 56 153 286.3 1,871 Cedar Rapids area 82 22 29 78 148.5 1,904 Linn 82 22 29 78 148.5 1,904 3 Davenport area 66 15 27 57 128.9 2,261 Scott 66 15 27 57 128.9 2,261 Waterloo area 63 15 25 60 131.1 2,185 Black Hawk 63 15 25 60 131.1 2,185 4/ Sioux City area” 57 10 29 56 110.2 1,968 Woodbury 57 10 29 56 110.2 1,968 Council Bluffs area’ 35 8 13 34 88.9 2,615 Pottawattamie 35 8 13 34 88.9 2,615 Dubuque area 55 15 21 51 84.0 1,647 Dubuque 55 15 21 51 84.0 1,647 Nonmetropolitan counties?’ 819 206 345 768 1,840.4 2,396 Central city 25,000-49,999 209 70 65 194 306.1 1,578 Cerro Gordo 30 9 9 30 51.0 1,700 Clinton 28 7 9 26 57.6 2,215 Des Moines 34 11 11 32 45.4 1,419 Johnson 77 32 24 67 56.7 846 Wapello 16 6 5 16 46.4 2,900 Webster 24 5 7 23 49.0 2,130 6L 7 Uo = U LOU Joo L91 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Iowa, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population™ per and county Total Under 55 years sionally (in 000's) active 40 or over active dentist Nonmetropolitan counties®/ (cont 'd.) Central city 10,000-24,999 105 21 48 101 256.1 2,536 Boone 9 1 3 9 27.8 3,089 Jasper 13 2 8 13 36.3 2,792 Lee 15 3 5 15 44.4 2,960 Mahaska 11 3 6 11 23.0 2,091 Marshall 18 6 8 16 38.2 2,388 Muscatine 14 1 7 14 34.3 2,450 Story 25 5 11 23 52.1 2,265 Central city 5,000-9,999 240 58 104 226 559.9 2,477 Appanoose 4 - 1 4 15.2 3,800 Bremer 8 4 4 8 21.6 2,700 Buchanan 8 1 3 7 22.4 3,200 Buena Vista 13 4 6 12 21.1 1,758 Carroll 9 2 4 8 23.8 2,975 Cass 5 1 2 5 17.8 3,560 Cherokee 12 3 5 10 18.7 1,870 Clay 12 4 3 12 18.6 1,550 Dallas 9 1 4 8 23.9 2,988 Emmet 6 2 3 6 15.0 2,500 Fayette 10 1 6 10 28.6 2,860 Floyd 13 4 5 12 21.0 1,750 Hamilton 6 2 3 5 20.2 4,040 Hardin 12 5 4 12 22.8 1,900 Henry 9 1 2 9 17.9 1,989 Jackson 5 2 1 5 21.4 4,280 Jefferson 5 2 2 5 15.5 3,100 Kossuth 9 1 7 8 25.3 3,163 Lucas 4 - 3 3 10.3 3,433 Marion 15 1 8 14 26.0 1,857 Montgomery 8 1 2 8 13.8 "1,725 891 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Iowa, by Location Civilian dentists Persons County group Age in 1965 Profes- Populatiom— per and county Total Under 55 years sionally (in 000's) active 40 or over active dentist Nonmetropolitan counties?’ (cont 'd.) Central city 5,000-9,999 (cont'd.) Page 12 2 5 11 20.1 1,827 Plymouth 13 3 6 12 24,2 2,017 Poweshiek 6 2 3 6 19.1 3,183 Union 7 1 4 6 13.2 2,200 Warren 5 3 1 5 21.9 4,380 Washington 6 2 3 6 19.0 3,167 Winneshiek 9 3 4 9 21.5 2,389 Central city 2,500-4,999 179 41 90 169 474.4 2,807 Allamakee 8 - 5 7 16.0 2,286 Audubon 3 1 - 3 10.6 3,533 Benton 5 1 2 5 23.5 4,700 Cedar 6 1 2 6 18.0 3,000 Chickasaw 5 1 2 5 14.9 2,980 Clarke 2 - 1 2 7.7 3,850 Crawford 5 3 1 5 18.4 3,680 Davis 3 - 1 3 8.8 2,933 Delaware 3 1 2 3 18.8 6,267 Dickinson 8 2 4 7 12.4 1,771 Franklin 4 - 4 3 15.1 5,033 Greene 3 1 - 3 14.1 4,700 Harrison 8 1 6 6 17.1 2,850 Howard 5 2 2 5 12.6 2,520 Humboldt 6 2 2 6 13.1 2,183 Jones 7 1 2 7 20.8 2,971 Lyon 5 - 3 5 14.4 2,880 Madison 4 1 2 4 11.9 2,975 Mills 7 2 3 4 12.6 3,150 Mitchell 9 - 6 9 14.1 1,567 Monona 6 1 4 6 13.4 2,233 Monroe 3 1 2 3 9.8 3,267 691 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Iowa, by Location Civilian dentists Persons County group Age in 1965 Profes- Population per and county Total Under 55 years sionally (in 000's) active 40 or over active dentist Nonmetropolitan counties?’ (cont'd.) Central city 2,500-4,999 (cont'd.) O'Brien 9 4 3 9 18.8 2,089 Osceola 3 1 2 3 10.0 3,333 Palo Alto 3 - 2 3 14.6 4,867 Sac 8 1 5 8 16.9 2,113 Shelby 3 2 - 3 16.0 5,333 Sioux 12 4 7 12 26.6 2,217 Tama 9 3 6 8 21.1 2,638 Winnebago 7 3 3 7 12.8 1,829 Wright 10 1 6 9 19.5 2,167 Central city under 2,500 86 16 38 78 243.9 3,127 Adair 3 - 1 2 10.2 5,100 Adams - - - - 7.0 - Butler 3 1 1 3 17.3 5,767 Calhoun 7 - 3 7 15.9 2,271 Clayton 9 - 2 9 21.7 2,411 Decatur 4 2 2 4 9.8 2,450 Fremont 2 - - 2 9.8 4,900 Grundy 5 3 - 5 14.2 2,840 Guthrie 6 1 4 4 13.2 3,300 Hancock 5 1 2 5 14.5 2,900 Ida 4 - 2 4 9.9 2,475 Iowa 11 3 8 10 16.6 1,660 Keokuk 5 1 4 4 15.0 3,750 Louisa 2 - 1 2 10.1 5,050 Pocahontas 6 1 2 6 13.9 2,317 Ringgold 3 - 2 2 7.3 3,650 Taylor 2 1 1 2 9.5 4,750 0L1 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Iowa, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population™ per and county Total Under 55 years sionally (in 000's) active 40 or over active dentist 6/ Nonmetropolitan counties— (cont'd.) Central city under 2,500 (cont'd.) Van Buren 3 - 1 2 9.3 4,650 Wayne 3 1 1 2 9.0 4,500 Worth 3 1 1 3 9.7 3,233 1/ Copyright 1965. Sales Management Survey of Buying Power; further reproduction is forbidden. 2/ Iowa counties included in the latest 1967 definition of Standard Metropolitan Statistical areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's, statistics are presented only for dentists reporting their location in the Iowa por- tion of the SMSA. 3/ Iowa part of the Davenport-Rock Island-Moline SMSA. 4/ Towa part of the Sioux City SMSA. 5/ Iowa part of the Omaha SMSA. 6/ Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. KANSAS DENTISTS LICENSED IN KANSAS During the 1965 registration period, 1,827 dentists registered with the Kansas Board of Dental Examiners. Fifty-five percent of these dentists were civilians located in Kansas, another 40 percent were civilian den- tists located in other States, and five percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Kansas Location and INE Percent of military status dentists dentists Total licensed 1,827 100 Respondents 1,455 80 Nonrespondents 372 20 Total licensed 1,827 100 Civilians in Kansas 1,003 55 Respondents 884 - Nonrespondents 119 - Civilians in another State 738 40 On active duty with Armed Forces 86 5 The survey questionnaire was completed by a total of 1,455 dentists, for an overall response rate of 80 percent. However, the response rate of dentists actually located in Kansas was somewhat higher, 88 percent, since nonresponse was more common among dentists located outside the State or on active duty with the Armed Forces. The data provided by the survey respondents has been supplemented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not responding to the survey. Informa- tion on nonrespondents was obtained from records maintained by the Kansas Board of Dental Examiners and from the 1966 American Dental Directory published by the American Dental Association. 171 PROFESSIONAL TRAINING More than four-fifths (82 percent) of Kansas' 1,003 dentists graduated from the University of Missouri at Kansas City. Another 10 percent are graduates of six other dental schools located in adjacent States, includ- ing 3 percent each from The Creighton University and St. Louis University, and 2 percent from the University of Nebraska. Three other schools in adjacent States (two of them now extinct) have together provided 23 den- tists, 2 percent of the State supply. The remaining 8 percent of Kansas' dentists obtained their dental degrees from 23 other schools located in more distant States. Dental School Attended and Year of Graduation for Dentists in Kansas Dental school Number Year of graduation ie ed of All After 1941- 1940 or attende dentists years 1955 1955 earlier Total number 1,003 - 279 314 399 (Percent distribution by school) Schools in adjacent States 919 92 92 93 92 Missouri (Kansas City) 817 82 85 82 80 Creighton University 33 3 3 4 3 St. Louis University 29 3 * 3 5 University of Nebraska 17 2 2 1 2 3 other schools 23 2 2 3 2 23 schools in-other States 75 8 8 7 8 1/ Dental school attended not available for 9 dentists and year of gradu- ation for 11 dentists. Percents based on known totals. * Less than one-half of one percent. Only about one-fourth (28 percent) of the State's dentists have graduated from dental school since 1955, as compared to a full two-fifths (40 per- cent) who received their dental degree prior to World War II. There has been virtually no change over the years in the overall proportion of den- tists graduating from the schools in adjacent States. Approximately 13 percent of the survey respondents, 112 dentists, reported that they had completed one or more years of advanced training after re- ceiving the dental degree. Of 83 dentists with advanced academic training, 56 received a master's or other advanced degree, while another 27 received no additional degree but reported the completion of one or more years of advanced work at the postgraduate level. Of the 62 dentists with advanced clinical training, 35 had completed an internship, and 27, a residency. There are 33 dentists who had taken both academic and clinical training. 172 DISTRIBUTION OF DENTISTS Slightly more than two-fifths of the 1,003 dentists in Kansas are located in the three metropolitan areas of the State. Two metropolitan areas-- the Kansas portion of the interstate Kansas City area and the Wichita area--each have about one-sixth (17 percent) of the State's dentists. The remaining metropolitan area, Topeka, contains 8 percent of the State supply. Distribution of Kansas Dentists, by County Group Number Number Percent County group® of of of counties dentists dentists All counties 105 1,003 100 Metropolitan areas 5 422 42 Kansas City area (Kansas part) 2 174 17 Wichita area 2 171 17 Topeka area 1 77 8 Nonmetropolitan counties 100 581 58 Central city 10,000-49,999 20 288 29 Central city 2,500-9,999 34 193 19 Centrgl city under 2,500 46 100 10 * See Appendix Table for definition of interstate and other metropolitan areas and presentation of individual county data. Almost three-fifths of the State's dentists (581) are located in the 100 nonmetropolitan counties. One-half of these dentists are located in the 20 counties with 10,000 or more persons in their central cities. Three of these counties--Douglas, Reno, and Saline--have between 20 and 30 den- tists each, and another 12 have at least 10 dentists each. The remaining one-half of the State's nonmetropolitan dentists are scat- tered among the 80 counties with central cities of less than 10,000 per- sons. The 34 counties with central city populations between 2,500 and 9,999 have 193 dentists, almost one-fifth of the total supply. The re- maining 46 counties, with less than 2,500 persons in their central cities, have among them 100 dentists, about one-tenth of all dentists in the State. While only 17 of these 80 counties have more than five dentists, 49 have no more than three dentists, including 13 with one dentist, and six counties with no dentist, according to available information. 173 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 1,003 responding dentists in Kansas is 45.3 years. Although about one-third (318) of the dentists are under 40 years of age, a sizeable proportion, some two-fifths, are 55 years or over. Almost one in every four, or 230 dentists, are 65 years old or more, including 161 who have reached the age of 70. Median Age and Age Distribution of Kansas Dentists, by County Group Percent of dentists County group Hedian Under 40- 55 and ag 40 54 over All counties 45.3 32 30 38 Metropolitan areas 42.8 37 37 26 Kansas City area (Kansas part) 40.7 47 33 20 Wichita area 43.6 32 41 27 Topeka area 46.0 26 37 37 Nonmetropolitan counties 51.2 28 25 47 Central city 10,000-49,999 46.7 32 29 39 Central city 2,500-9,999 57.8 24 21 55 Central city under 2,500 54.2 27 23 50 The median age of dentists in metropolitan areas is 42.8 years, more than eight years below the median of 51.2 years for dentists in nonmetropolitan counties. The youngest group of dentists is found in the Kansas City area, where the median age is 40.7 years. Almost half (47 percent) of the dentists in this area are under 40 years of age, while one in every five is 55 or over. The Topeka area has the oldest group of dentists, with a median age of 46.0 years. About one-fourth of these dentists are under 40, while almost two-fifths are 55 or older. Among nonmetropolitan counties, older dentists tend to be concentrated in those counties with less than 10,000 persons in their central cities. The median age of dentists in counties with central cities of 10,000 or more is 46.7 years, almost 10 years less than the median of 56.5 for dentists in counties with smaller central cities. 174 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,003 licensed dentists in Kansas, 937, or 93 percent, are active in their profession, giving the State one professionally active dentist for every 2,421 persons. There is one dentist for every 2,290 persons in the metropolitan areas, while the remainder of the State has a slightly less favorable ratio of one dentist for every 2,519 persons. Number of Persons Per Active Dentist in Kansas Professionally Persons County group® active Population per dentists dentist All counties 937 2,268,700 2,421 Metropolitan areas 399 913,600 2,290 Kansas City area (Kansas part) 166 378,700 2,281 Wichita area 160 383,400 2,396 Topeka area 73 151,500 2,075 Nonmetropolitan counties 538 1,355,100 2,519 Central city 10,000-49,999 272 663,400 2,439 Central city 2,500-9,999 173 412,100 2,382 Central city under 2,500 93 279,600 3,006 * See Appendix Table for individual county data. Among the metropolitan areas, the Topeka area has the best ratio, with one dentist for every 2,075 persons. The Kansas City and Wichita metro- politan areas have slightly less favorable ratios of 2,281 and 2,396 persons per dentist, respectively. Among the 100 nonmetropolitan counties of the State, 14 have persons-per- dentist ratios under 2,000, yet there are 37 counties with ratios of more than 3,000, including 21 with ratios in excess of 4,000 persons per den- tist. The least favorable ratio of persons per dentist is found in those counties with less than 2,500 persons in their central cities. The groups of counties with central cities of 2,500 or more inhabitants aver- age about 2,400 persons per dentist, while counties with central cities of less than 2,500 have a ratio of about 3,000. 175 UTILIZATION OF AUXILIARIES Four of every five dental practitioners in Kansas (i.e., dentists who spend any time working at the chair) reported the employment of one or more auxiliary personnel. Dental assistants, the most frequently em- ployed auxiliary, are utilized by 76 percent of the practitioners, including 70 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by approximately 30 percent of the dentists, with about two-thirds of these dentists utiliz- ing such personnel full time. Only 15 percent of the dentists employ dental hygienists,and 7 percent employ dental technicians. Kansas Dentists Employing Auxiliaries, by Type of Auxiliary ’ Percent of dental practitioners Type of auxiliary Dental With one full- With only emp loyed practitioners Total time employee part-time (or more) employees Total 856% 100 76 4 One or more auxiliaries 677 80 76 4 Assistant 638 76 70 6 Hygienist 125 15 8 7 Laboratory technician 63 7 3 4 Secretary or receptionist 247 29 21 8 Other type of personnel 24 3 1 2 No auxiliary 165 20 - - 1/ Includes 14 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is less frequent among older dentists. Ninety-one percent of dental practitioners under the age of 55 reported employment of some type of auxiliary. The proportion utilizing auxiliaries decreases to 76 percent among dentists 55 to 64 years of age and to 48 percent among dentists 65 and over. Some 14 percent of the responding dentists in Kansas reported one or more vacancies for auxiliary personnel. Of those reporting vacancies, slightly more than one-third indicated a need for full-time dental assistants, and almost one-third reported vacancies for full-time dental hygienists. Nine of every 10 dentists reporting a vacancy already employ one or more auxil- iaries. 176 I~ ~ I ~~ I~ ~~ OTHER SURVEY FINDINGS Multiple licensure is fairly common in Kansas, with one-half of the respondents located in the State holding more than one license. Forty-three percent indicated licensure in at least one additional State and 7 percent in two or more other States. The proportion of out-of-State dentists holding mul- tiple licenses is considerably greater; 35 percent hold two or more licenses in addition to their Kansas license. About 70 percent of the licenses held outside the State were issued by adjacent States, including 45 percent in Missouri, 12 per- cent in Oklahoma, 10 percent in Colorado, and 2 percent in Nebraska. Ninety-seven percent of the responding professionally active dentists located in Kansas are primarily engaged in private practice, with 96 percent self-employed and 1 percent em- ployed by other dentists. The remaining three percent are either employed by governmental agencies or are engaged in other dental activity, such as taking advanced training. Dentists reporting on time spent in providing patient care devoted an average of 40.5 hours per week to this activity for 47.5 weeks during the year preceding the survey. About one in every six dentists worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. About 8 percent of the responding practitioners reported that they limit their practice to a dental specialty, primarily orthodontics or oral surgery. Almost 12 percent of the den- tists in metropolitan areas limit their practices, compared to only 5 percent of the dentists in nonmetropolitan counties. About seven of every ten responding dentists who are licensed in Kansas but located elsewhere are in adjacent States, mostly in Missouri, Oklahoma, and Colorado. Another 7 percent are located in California, while the remainder are scattered throughout 30 other States, the District of Columbia, and foreign countries. December 1968 177 8.1 APPENDIX TABLE Selected Data on Dentists in Kansas, By Location Civilian dentists Persons Area and count Respond- Non- Age in 1965 Profes- Population— per y Total P respond- Under 55 or sionally (in 000's) active ents : : ents 40 more active dentist All counties 1,003 884 119 318 375 937 2,268.7 2,421 Metropolitan areas2’ 422 363 59 155 108 399 913.6 2,290 Wichita area 171 149 22 55 45 160 383.4 2,396 Sedgwick 157 135 22 53 42 146 345.3 2,365 Butler 14 14 - 2 3 14 38.1 2,721 Kansas City area (Kansas part) 174 148 26 80 35 166 378.7 2,281 Johnson 96 81 15 50 14 91 178.9 1,966 Wyandotte 78 67 11 30 21 75 199.8 2,664 Topeka area 77 66 11 20 28 73 151.5 2,075 Shawnee 77 66 11 20 28 73 151.5 2,075 Nonmetropolitan counties 581 521 60 163 267 538 1,355.1 2,519 Central city 25,000-49,999 78 74 4 29 22 74 165.5 2,236 Douglas 23 22 1 7 7 20 46.8 2,340 Reno 29 27 2 11 8 28 61.9 2,211 Saline 26 25 1 11 7 26 56.8 2,185 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kansas, By Location 6L1 Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population=" per Total respond- Under 55 or sionally (in 000's) active ents . . ents 40 more active dentist Nonmetropolitan counties’ (cont'd.) Central city 10,000-24,999 210 186 24 62 91 198 497.9 2,515 Atchison 7 7 - 3 3 6 20.4 3,400 Barton 18 18 - 6 9 18 35.0 1,944 Cowley 17 15 2 2 9 16 38.0 2,375 Crawford 16 12 4 4 9 13 37.3 2,869 Ellis 11 8 3 3 5 9 22.4 2,489 Finney 8 7 1 2 2 8 17.6 2,200 Ford 7 7 - 2 2 7 21.8 3,114 Franklin 10 9 1 4 5 10 20.7 2,070 Geary 10 8 2 3 5 9 30.4 3,378 Harvey 14 12 2 2 7 13 26.3 2,023 Labette 12 10 2 2 6 12 26.4 2,200 Leavenworth 18 16 2 8 3 18 49.0 2,722 Lyon 14 12 2 4 7 13 26.6 2,046 Montgomery 19 16 3 5 10 18 44.7 2,483 Neosho 7 7 - 2 2 6 19.3 3,217 Riley 14 14 - 6 4 14 43.8 3,129 Seward 8 8 - 4 3 8 18.2 2,275 Central city 5,000-9,999 84 71 13 17 46 75 155.1 2,068 Allen 7 6 1 - 5 7 17.2 2,457 Bourbon 6 6 - 1 3 5 16.2 3,240 Cloud 8 6 2 2 5 7 14.4 2,057 Dickinson 12 11 1 4 8 11 23.0 2,091 McPherson 16 14 2 3 9 15 24.4 1,627 081 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kansas, By Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population=' per Total nes respond- Under 55 or sionally (in 000's) active ents 40 more active dentist Nonmetropolitan counties’ (cont'd.) Central city 5,000-9,999 (cont'd.) Pawnee 5 5 - 1 4 5 10.5 2,100 Pratt 12 8 4 1 5 8 12.1 1,512 Russell 6 3 3 - 2 5 11.8 2,360 Sumner 12 12 - 5 5 12 25.5 2,125 Central city 2,500-4,999 109 100 9 28 59 98 257.0 2,622 Anderson 2 2 - - 1 2 8.9 4,450 Barber 4 1 3 1 3 2 8.4 4,200 Brown 9 9 - 2 7 8 14.6 1,825 Cherokee 6 6 - 3 1 6 22.3 3,717 Clay 7 6 1 2 4 5 10.7 2,140 Grant 2 1 1 1 1 1 5.7 5,700 Greenwood 4 4 - 1 3 4 10.8 2,700 Harper 4 4 - 1 1 4 9.4 2,350 Jackson 2 2 - - 2 2 10.1 5,050 Kingman 4 4 - 1 3 4 10.6 2,650 Marshall 9 9 - 5 2 9 15.5 1,722 Miami 9 9 - 3 4 8 20.2 2,525 Mitchell 6 6 - - 5 6 8.8 1,467 Morris 2 2 - 1 1 2 7.2 3,600 Norton 5 3 1 2 4 8.6 2,150 Phillips 5 5 - 1 3 5 9.6 1,920 Republic 4 4 - 1 3 4 9.4 2,350 Rice 4 3 1 1 4 13.5 3,375 181 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kansas, By Location Civilian dentists Persons Area and county Respond- Non- Age in 1965 Profes- Population=" per Total respond- Under 55 or sionally (in 000's) active ents . . ents 40 more active dentist Nonmetropolitan counties’ (cont'd.) Central city 2,500-4,999 (cont'd.) Rooks 2 2 - 1 2 9.3 4,650 Scott 2 2 - - - 2 5.6 2,800 Sherman 3 3 - - 2 3 6.7 2,233 Stevens 2 2 - - 1 2 bob 2,200 Thomas 4 4 - 1 2 3 7.3 2,433 Trego 2 2 - 1 1 2 5.3 2,650 Wilson 6 5 1 - 5 4 14.1 3,525 Central city under 2,500 100 90 10 27 49 93 279.6 3,006 Chase 2 1 1 - 2 1 3.7 3,700 Chautaugua 3 2 1 - 2 2 5.6 2,800 Cheyenne 1 1 - - 1 1 4.7 4,700 Clark 2 1 1 1 2 3.5 1,750 Coffey 2 2 - - 1 2 8.1 4,050 Comanche 1 1 - - 1 1 3.0 3,000 Decatur 2 1 1 - 2 2 6.0 3,000 Doniphan 1 1 - 1 1 10.1 10,100 Edwards 2 2 - 1 1 2 5.1 2,550 Elk 2 2 - - 1 2 4.7 2,350 Ellsworth 5 5 - 2 3 5 8.2 1,640 Gove 1 1 - - - 1 4.3 4,300 Graham 2 2 - 1 1 2 5.5 2,750 Gray 1 1 - - - 1 4.5 4,500 Greeley 2 1 1 1 1 1 2.1 2,100 ¢81 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kansas, By Location Civilian dentists Persons Non- Age in 1965 Profes- Population" per Area and county Total Respond- respond- Under 55 or sionally (in 000's) active ents . : ents 40 more active dentist Nonmetropolitan counties (cont'd.) Central city under 2,500 (cont'd.) Hamilton 2 2 - 1 1 3.2 1,600 Haskell - - - 3.5 - Hodgeman 1 - - - - 3.1 - Jefferson 3 3 - 1 2 3 11.3 3,767 Jewell 3 3 - 1 2 3 7.0 2,333 Kearny - - - - - - 3.1 - Kiowa 2 2 - 2 - 2 4.7 2,350 Lane 1 1 - 1 - 1 3.2 3,200 Lincoln 2 2 - - 1 2 5.9 2,950 Linn - - - - - - 8.1 - Logan 2 2 - 2 - 2 4.4 2,200 Marion 8 8 - 2 4 8 15.0 1,875 Meade 1 1 - - - 1 5.7 5,700 Morton 3 3 - 1 1 3 3.9 1,300 Nemaha 6 4 2 3 2 5 13.1 2,620 Ness 1 - 1 - - 1 5.8 5,800 Osage 5 5 - 1 2 4 13.3 3,325 Osborne 3 3 - - 2 2 7.2 3,600 Ottawa 5 5 - 2 1 5 7.0 1,400 Pottawatomie 3 3 - 1 1 3 12.0 4,000 Rawlins 1 1 - - 1 1 5.1 5,100 Rush 4 4 - - 3 4 5.9 1,475 Sheridan 2 2 - 1 1 2 4.3 2,150 Smith 3 2 1 1 2 3 7.9 2,633 €1- 0L - O 620-98¢ £81 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kansas, By Location Civilian dentists Persons Non- Age in 1965 Profes- Population— per Area and county Total Respond- respond- Under 55 or sionally (in 000's) active ents . . ents 40 more active dentist Nonmetropolitan countiesd (cont'd.) Central city under 2,500 (cont'd.) Stafford 3 3 - - 2 3 7.3 2,433 Stanton - - - - - - 2.2 - Wabaunsee 1 1 - - 1 1 6.5 6,500 Wallace - - - - - - 2.2 - Washington 4 4 - 1 1 4 10.8 2,700 Wichita - - - - - - 2.8 - Woodson 2 2 - - 1 5.0 2,500 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Kansas counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For the interstate Kansas City SMSA, statistics are presented only for dentists located in the Kansas portion. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. TEE oye qa Freena mr Rr ror gee pewE rg ee re som pn oo Tr man ve nN Bat He a A dbl KENTUCKY DENTISTS LICENSED IN KENTUCKY During the 1965 registration period, 1,494 dentists registered with the Ken- tucky State Board of Dental Examiners. A total of 1,366 dentists responded to the survey, 91 percent of all those registered. Three-fourths of the re- sponding dentists are civilians located in Kentucky, 19 percent are civilians located in other states, and 6 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Kentucky Location and All Percent of military status dentists dentists Total 1,494 100 Respondents 1,366 91 Nonrespondents 128 9 Respondents 1,366 100 Civilians in Kentucky 1,024 75 Civilians in another state 254 19 On active duty with Armed Forces 87 6 Not reported 1 * * Less than one-half of one percent. Approximately one-third of the survey respondents hold a license to practice dentistry in one or more other states. About one-fifth of the dentists lo- cated in Kentucky hold more than one license, with 15 percent licensed in one other state and 4 percent licensed in two or more other states, Multiple licensure is much more common among out-of-state dentists; 21 percent hold two or more licenses in addition to their Kentucky license. More than half of the licenses held outside of Kentucky are held in one of the seven adjacent states, primarily Indiana, Ohio, Tennessee and West Virginia. Of more distant states, the most frequently reported were Florida and New York. 185 PROFESSIONAL TRAINING The dental school at the University of Louisville has through the years supplied the vast majority of Kentucky's dentists, having trained more than four-fifths of the 1,024 responding dentists located in the State. Furthermore, the relative contribution of this school has increased in recent years, accounting for 9 out of every ten dentists in the State who graduated after 1955, compared to 78 percent of those graduating prior to World War II. The new College of Dentistry at the University of Kentucky, which opened in 1962, had not graduated its first class at the time of the survey. Dental School Attended and Year of Graduation for Dentists in Kentucky Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 1,024 - 290 409 325 (Percent distribution by school) University of Louisville 839 82 89 81 78 Schools in adjacent states 135 13 6 13 20 The Ohio State University 24 2 1 1 5 St. Louis University 22 2 1 2 4 12 other schools 89 9 4 10 11 24 more distant schools 50 5 5 6 2 Fourteen schools in adjacent states have provided another 13 percent of Kentucky's dentists, even though the relative contribution of these schools has declined substantially through the years. While none of these schools has supplied a large number of dentists, Ohio State and St. Louis Universities have together trained 4 percent of the total den- tal force. Some 16 percent of the survey respondents, 167 dentists, reported that they have completed one year or more of advanced training since receiv- ing their dental degree. Of the 116 dentists who reported advanced academic training, 58 earned a master's or other advanced degree and an equal number received no additional degree but completed one or more years of postgraduate study. Among the 105 dentists with advanced clinical training, 43 completed a residency and 62, an internship. There are 43 dentists who completed both clinical and academic training. 186 DISTRIBUTION OF DENTISTS More than one-half (54 percent) of the licensed dentists in Kentucky are located in the five metropolitan areas of the State. Approximately one- third of the total supply is concentrated in Jefferson County, which constitutes the Kentucky portion of the interstate metropolitan area of Louisville. The Lexington area has the second largest dental force, 11 percent of the State's supply. Another 7 percent of the dentists are located in the Kentucky portion of the interstate Cincinnati area, which contains the city of Covington. The Kentucky parts of two other interstate areas, Huntington-Ashland and Evansville, have 3 percent and 1 percent of the dentist supply, respectively. Distribution of Kentucky Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 120 1,024 100 Metropolitan areas 7 548 54 Louisville area (Ky. part) 1 326 32 Lexington area 1 108 11 3 other areas 5 114 11 Nonmetropolitan counties 113 476 46 Central city 10,000-49,999 11 166 17 Central city 2,500- 9,999 43 200 19 Central city under 2,500 59 110 10 * See Appendix Table for definition of interstate and other metropolitan areas and presentation of individual county data. More than 45 percent of Kentucky's dentists are located in the 113 non- metropolitan counties of the State. The 11 counties with central cities of 10,000 or more persons have 166 dentists, 17 percent of the State's dental force. Four of these counties--Daviess, McCracken, Christian and Warren--have 20 or more dentists. The 102 counties with less than 10,000 persons in their central cities have almost 30 percent of the State's dentist supply. None of these counties, however, have large numbers of dentists. There are 200 den- tists distributed throughout the 43 counties having between 2,500 and 9,999 persons in their central cities, and 110 dentists scattered among the 59 counties with central cities of less than 2,500 population. Only 22 of these 102 counties have as many as 5 dentists, while 64 have no more than 3 dentists, including 21 with only one dentist, and 7 counties that have no dentists, according to available information. 187 NUMBER OF PERSONS PER DENTIST IN KENTUCKY, BY COUNTY ~~ h- : - 2 Huntington = INDIANA Louisville wu tand Evansville 7 ( ul J - Pa ILLINOIS VIRCIWIA Persons per dentist: Under 3,500 TENNESSEE 3,500 - 4,999 5,000 and over Metropolitan areas = Out-of-State portion i = of interstate metropolitan areas ACTIVE DENTISTS IN RELATION TO POPULATION 0of the 1,024 responding dentists in Kentucky, 990, or 97 percent, are active in their profession, giving Kentucky one professionally active dentist for every 3,141 persons. In the metropolitan areas--which have 54 percent of the State's active dentists and only 37 percent of its population--the ratio is one dentist for every 2,150 persons. The remainder of the State--with 46 percent of the active dentists and 63 percent of the population-=has a con- siderably less favorable ratio of one dentist for every 4,288 persons. Number of Persons per Active Dentist in Kentucky Professionally Persons County group¥* active Population per dentists dentist Total 990 3,109,800 3,141 Metropolitan areas 531 1,141,500 2,150 Louisville area (Ky. part) 316 665,700 2,107 Lexington area 107 146,100 1,365 3 other areas 108 329,700 3,053 Nonmetropolitan counties 459 1,968,300 4,288 Central city 10,000-49,999 159 470,100 2,957 Central city 2,500-9,999 193 907,400 4,702 Central city under 2,500 107 590,800 5,521 * See Appendix Table for data pertaining to individual metropolitan areas and counties. Among the metropolitan areas, Lexington, where the University of Kentucky College of Dentistry is located, has the best ratio with 1,365 persons per active dentist. Jefferson County, the hub of the interstate Louisville area, has a somewhat less favorable ratio of 2,107 persons for every dentist. Of the remaining three areas, each of which constitutes the Kentucky portion of a larger interstate metropolitan area, Huntington-Ashland (Boyd County) has the best ratio, one dentist for 1,597 persons, while Cincinnati (Boone, Campbell and Kenton Counties) and Evansville (Henderson County) have far less favorable ratios of 3,624 and 4,275, respectively. Among the nonmetropolitan counties, there are 16 with persons-per-dentist ratios under 3,000, yet 64 counties have ratios exceeding 4,000 persons-per- dentist, including 27 counties with ratios over 6,000. Generally, the ratio of persons per dentist becomes much less favorable as the size of the central city decreases. The group of counties with central cities of 10,000 or more inhabitants have an average persons-per-dentist ratio of approximately 3,000, while counties with central cities of less than 2,500 average over 5,500 persons per dentist. 189 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of dentists in Kentucky is 44.7 years. Almost one-fifth of the responding dentists are under 35, and another third are between 35 and 44 years of age. On the other hand, a substantial proportion, more than one-fourth are 55 or over. About 11 percent of the dentists (119) are at least 65 years of age, including 72 who have reached the age of 70. Age Distribution of Kentucky Dentists Age in Number of Percent of Cumulative 1965 dentists dentists . percent distribution Total 1,024 v 100 - Under 30 62 6 6 30-34 130 13 19 35-39 152 15 34 40-44 177 17 51 45-49 141 14 65 50-54 91 9 74 55-59 77 8 82 60-64 74 7 89 65-69 47 4 93 70-74 29 3 96 75 and over 43 4 100 1/ One dentist did not report age. The median age of dentists in metropolitan areas is 44.4 years, only slightly below the median of 45.1 years in nonmetropolitan counties. Among individual metropolitan areas, however, age differences are rather pronounced. The median age of dentists in the Louisville area is 45.0 years, about the same as the median for the State as a whole. Only 17 percent of these dentists are under 35, while 28 percent have reached the age of 55. On the other hand, dentists in the Lexington area average about 5 years younger, with a median age of 40.0 years. More than one-fourth of the dentists in this area are under 35 years of age, and only 20 percent are 55 or older. 190 UTILIZATION OF AUXILIARIES More than four-fifths of the dental practitioners in Kentucky (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 74 percent of all practitioners, including 67 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 26 percent of all practitioners, with about two-thirds of these dentists utilizing such personnel full time. Eleven percent of the practitioners employ dental hygienists and 7 percent employ laboratory techni- cians. Slightly more than one-half of the dentists who employ hygienists or technicians do so only part time. Some 16 percent of the responding dental practitioners in Kentucky reported one or more vacant positions for auxiliary personnel. Vacancies for dental hygienists were the most frequently reported. Kentucky Dentists Employing Auxiliaries, by Type of Auxiliary Percent of Dental Practitioners ype of Dental With one full- With only auxiliary practitioners Total time employee part-time emp loyed wp P mp Loy (or more) employees Tetal 954 1 100 74 8 One or more auxiliaries 762 82 74 8 Assistant 687 74 67 7 Hygienist 106 11 5 6 Laboratory technician 64 7 3 4 Secretary or receptionist 246 26 17 9 Other type of personnel 33 4 1 3 No auxiliary 170 18 - - 1/ Includes 22 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is less common among the older dentists. Eighty-eight percent of dental practitioners under the age of 55 reported employment of some type of auxiliary. The proportion utilizing auxiliaries decreases to 72 percent among dentists 55 to 64 years of age and to 48 percent among dentists 65 and over. Although dentists in metropolitan areas are no more likely to employ auxil- iary personnel than are those located in nonmetropolitan counties, the use of hygienists is much more common in metropolitan areas than in the remainder of the State. About 15 percent of the dentists in metropolitan areas report the employment of hygienists, compared to only 7 percent of those in nonmetropol- itan counties. 191 192 OTHER SURVEY FINDINGS Ninety-two percent of the professionally active dentists in Kentucky are primarily engaged in private practice, with 91 percent self-employed and one percent employed by another dentist. Five percent are on the staff of a dental school, another two percent are employed by governmental agencies, and the remaining one percent are engaged in other dental activities, such as taking advanced training. At least one part-time dental activity in addition to their principal employment was reported by 13 percent of the den- tists. Employment in State or local health departments was the most frequently reported secondary activity. Teaching at a dental school was the next most frequently reported part- time employment. Dentists reporting time spent in providing patient care de- voted an average of 39.7 hours per week to this activity for 47.9 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. About 11 percent of the practitioners reported they limit their practices to a dental specialty, primarily orthodon- tics or oral surgery. The metropolitan areas have a large share--about four-fifths--of the dentists who limit their practices. While one in every 6 dentists practicing in a metropolitan area limits his practice, in nonmetropolitan counties only one in every 25 dentists does so. Of the 254 responding dentists licensed in Kentucky but located out of the State, approximately one-half are in adjacent states, primarily Indiana and Ohio. Another one- fourth of the out-of-state dentists are located in Florida, California or New York, and the remainder are scattered among 25 other states and the District of Columbia. May 1968. £61 Selected Data on Dentists in Kentucky, by Location APPENDIX TABLE Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist All counties 1,024 192 270 990 3,109.8 3,141 Metropolitan areas 2 548 102 149 531 1,141.5 2,150 Louisville area (Ky. part) 326 56 92 316 665.7 2,107 Jefferson 326 56 92 316 665.7 2,107 Cincinnati area (Ky. part) 73 12 23 67 242.8 3,624 Boone 7 2 1 6 25.2 4,200 Campbell 21 1 8 19 91.1 4,795 Kenton 45 9 14 42 126.5 3,012 Lexington area 108 28 21 107 146.1 1,365 Fayette 108 28 21 107 146.1 1,365 Huntington-Ashland area (Ky. part) 33 5 10 33 52.7 1,597 Boyd 33 5 10 33 52.7 1,597 Evansville area (Ky. part) 8 1 3 8 34.2 4,275 Henderson 8 1 3 8 34.2 4,275 Nonmetropolitan counties 3 476 90 121 459 1,968.3 4,288 Central city 25,000-49,999 77 14 19 73 183.7 2,516 Daviess 30 3 5 29 75.0 2,586 McCracken 26 5 9 23 60.4 2,626 Warren 21 6 5 21 48.3 2,300 761 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kentucky, by Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 10,000-24,999 89 15 18 86 286.4 3,330 Barren 7 - 3 6 28.4 4,733 Bell 9 1 2 8 32.0 4,000 Christian 22 5 3 22 65.9 2,995 Clark 6 - 1 6 22.1 3,683 Franklin 14 3 3 14 33.3 2,379 Graves 8 3 2 8 29.6 3,700 Hopkins 10 1 1 10 39.0 3,900 Madison 13 2 3 12 36.1 3,008 Central city 5,000-9,999 91 17 23 89 365.7 4,109 Bourbon 4 - 1 3 18.3 6,100 Boyle 7 - 4 6 21.4 3,567 Caldwell 4 1 - 4 13.0 3,250 Calloway 8 2 - 8 22.0 2,750 Hardin 8 1 4 8 74.9 9,363 Harrison 4 1 2 4 13.7 3,425 Logan 5 1 - 5 20.6 4,120 Mason 5 - 1 5 18.5 3,700 Mercer 3 1 - 3 15.0 5,000 Montgomery 4 1 1 4 13.6 3,400 Perry 7 - 1 7 31.2 4,457 Pulaski 8 - 2 8 33.3 4,163 Scott 5 2 1 5 16.1 3,220 Simpson 5 1 2 5 12.3 2,460 Taylor 7 3 3 7 17.1 2,443 Whitley 7 3 1 7 24.7 3,529 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kentucky, by Location G61 Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 2,500-4,999 109 17 32 104 541.7 5,209 Allen 3 - 1 2 11.6 5,800 Anderson 2 1 1 2 8.4 4,200 Carroll 3 1 1 3 7.8 2,600 Estill 2 - - 2 11.9 5,950 Floyd 5 - 2 4 38.1 9,525 Fulton 4 - 2 4 10.1 2,525 Garrard 3 - 2 3 9.7 3,233 Grayson 1 - - 1 15.2 15,200 Greenup 6 - 2 5 30.1 6,020 Harlan 7 1 5 6 43.0 7,167 Jessamine 4 1 2 4 13.7 3,425 Johnson 5 1 1 5 17.9 3,580 Knox 3 1 1 3 24.4 8,133 Laurel 5 1 1 5 25.6 5,120 Letcher 3 - - 3 27.1 9,033 Marion 6 1 2 5 17.3 3,460 Marshall 5 - - 5 18.3 3,660 Muhlenberg 5 1 1 5 26.1 5,220 Nelson 6 3 - 6 22.7 3,783 Pendleton 2 - 1 2 10.0 5,000 Pike 6 - 1 6 64.6 10,767 Rowan 4 - 1 4 13.3 3,325 Shelby 5 2 - 5 20.0 4,000 Union 4 2 1 4 14.4 3,600 Wayne 3 - 1 3 14.6 4,867 Webster 3 - 2 3 13.6 4,533 Woodford 4 1 1 4 12.2 3,050 961 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kentucky, by Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 110 27 29 107 590.8 5,521 Adair 4 4 13.7 3,425 Ballard - - - 8.1 - Bath 1 - - 1 8.7 8,700 Bracken - - - - 6.9 - Breathitt 3 1 - 3 13.8 4,600 Breckinridge 3 - 1 3 14.6 4,867 Bullitt 3 1 - 3 17.9 5,967 Butler 1 1 - 1 8.9 8,900 Carlisle 1 - 1 1 5.3 5,300 Carter 4 1 2 4 21.0 5,250 Casey 2 1 - 2 13.6 6,800 Clay 3 1 1 3 20.8 6,933 Clinton 1 - - 1 8.8 8,800 Crittenden 1 - - 1 7.8 7,800 Cumberland 2 - - 2 7.2 3,600 Edmonson 1 1 - 1 7.5 7,500 Elliott 2 - 1 2 6.7 3,350 Fleming 3 - 1 3 10.3 3,433 Gallatin 1 - 1 1 3.5 3,500 Grant 2 1 1 2 9.3 4,650 Green 4 - - 4 11.3 2,825 Hancock 1 1 - 1 5.5 5,500 Hart 3 1 1 3 13.3 4,433 Henry 4 1 3 3 11.0 3,667 Hickman 1 - - 1 6.3 6,300 Jackson 1 - 1 - 9.7 - APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kentucky, by Location L61 Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Knott 2 2 - 2 16.3 8,150 Larue 2 - - 2 10.6 5,300 Lawrence 3 - - 3 11.7 3,900 Lee 1 - - 1 7.4 7,400 Leslie 1 - 1 9.8 9,800 Lewis 2 - 1 2 12.9 6,450 Lincoln 2 - 1 2 15.7 7,850 Livingston - - - - 7.5 - Lyon 2 - 2 2 5.7 2,850 McCreary 3 1 - 2 11.6 5,800 McLean 2 1 1 2 9.1 4,550 Magoffin 1 - 1 1 10.0 10,000 Martin 1 - - 1 9.6 9,600 Meade 1 - - 1 21.6 21,600 Menifee - - - - 4.1 - Metcalfe 1 - - 1 7.7 7,700 Monroe 3 - - 3 10.9 3,633 Morgan 2 - 1 2 10.1 5,050 Nicholas 2 2 - 2 6.2 3,100 Ohio 3 1 1 3 16.4 5,467 Oldham 3 2 1 3 14.0 4,667 Owen 2 1 - 2 7.8 3,900 Owsley - - - - 4.6 - Powell - - - - 6.7 - Robertson 1 - - 1 2.3 2,300 Rockcastle 4 1 1 4 11.8 2,950 Russell 4 1 - 4 9.9 2,475 861 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Kentucky, by Location Civilian dentists / Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Spencer 1 1 - 1 5.5 5,500 Todd 3 - 1 3 11.1 3,700 Trigg 1 - - 1 8.7 8,700 Trimble - - - - 5.1 - Washington 4 1 2 4 10.9 2,725 Wolfe 1 - 1 1 6.0 6,000 Copyright 19 65. Sales Management Survey of Buying Power. Further reproduction is forbidden. Kentucky counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of survey data. For interstate SMSA's-- Cincinnati, Huntington-Ashland, and Evansville-=-statistics are presented only for Louisville, dentists loc ated in the Kentucky portions. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. EEE Ke IVTEV-N\ DENTISTS LICENSED IN LOUISIANA During the 1965 registration period, 1,726 dentists registered with the Louisiana State Board of Dentistry. Over three-fourths of the registered dentists were civilians located in Louisiana, another 18 percent were civilians located in other States, and 6 percent were on active duty in the Armed Forces. Location and Military Status of Dentists Licensed in Louisiana Location and All Percent military status dentists dentists Total licensed 1,726 100 Respondents 1,287 75 Nonrespondents 439 25 Total licensed 1,726 100 Civilians in Louisiana 1,309 76 Respondents 970 - Nonrespondents 339 - Civilians in another State 307 18 On active duty with Armed Forces 108 6 Not reported 2 * * Less than one-half of one percent. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained either from records maintained by the Louisiana State Board of Dentistry or from the 1966 American Dental Directory published by the American Dental Association. 199 386-029 O - 70 - 14 PROFESSIONAL TRAINING Almost four-fifths of Louisiana's dentists graduated from dental schools located in Louisiana, including over 70 percent who received their dental degrees from Loyola University. Loyola has consistently graduated the largest number of dentists in Louisiana with the proportion increasing from 54 percent of the dentists who graduated before World War II to 80 percent of those who graduated within the last 10 years. Fourteen other dental schools in the South have trained an additional 16 percent of Louisiana's dentists. Principal contributors among these schools have been Emory and Baylor Universities, Meharry Medical College and the University of Tennessee. School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation ttended of All After 1941- 1940 or attence dentists years 1955 1955 earlier Total number 1,300 388 422 447 (Percent distribution by school) Schools in the South 1,201 94 93 93 94 Loyola (New Orleans) 911 71 80 81 54 Tulane (extinct) 94 7 - - 21 Emory 52 4 2 1 8 Meharry 32 3 1 4 2 Baylor 28 2 3 3 1 Tennessee 23 2 4 1 * 10 other schools 61 5 3 3 8 26 schools in other regions 86 6 7 7 6 1/ Dental school attended not available for 22 dentists and year of graduation for 52 dentists. Percents based on totals for whom the data are known. %* Less than one-half of one percent. About eighteen percent of the survey respondents, or 171 dentists, reported they had completed one year or more of advanced training beyond receipt of the dental degree. One hundred and ten dentists have received advanced clinical training as interns or residents and 91 have completed at least one year of advanced academic work as graduate or postgraduate students. These figures include 30 dentists who completed both academic and clinical training. 200 DISTRIBUTION OF DENTISTS Almost 70 percent of the licensed dentists in Louisiana are located in the six metropolitan areas of the State. The New Orleans area alone has 500 dentists, about 38 percent of all the dentists in the State. The Shreve- port metropolitan area is the location of another 150 dentists, 12 percent of the State's supply. The four remaining metropolitan areas, Baton Rouge, Lake Charles, Monroe and Lafayette, have among them 19 percent of Louisiana's dentists. Distribution by Parish Group Number Number Percent Parish group of of of parishes dentists dentists All parishes 64 1,309 100 All metropolitan areas 10 903 69 New Orleans 4 501 38 Shreveport 2 151 12 Baton Rouge 1 121 9 Lake Charles 1 58 4 Monroe 1 40 3 Lafayette 1 32 3 Nonmetropolitan parishes 54 406 31 Central city 10,000-49,999 15 242 18 Central city 5,000-9,999 14 76 6 Central city 2,500-4,999 14 62 5 Central city under 2,500 11 26 2 Less than one-third of the State's dentists are located in the 54 non- metropolitan parishes. These dentists tend to be concentrated in the parishes which contain a relatively large city. Three-fifths of the den- tists in nonmetropolitan parishes are located in the 15 parishes with a central city of 10,000 or more population. The 39 parishes which do not have a city this large account for only 13 percent of the dentists in the State. (See Appendix Table for presentation of individual parish data.) 201 AGE OF DENTISTS With slightly more than one-half of the dentists under 45 years of age, the median age of dentists in Louisiana is 44.4 years. One-fourth of the State's dentists are under 35 and more than one-fourth are 55 years of age or older. About one in every eight, or 152 dentists, are 65 years old or over, and 88 have reached the age of 70. Age Distribution Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 1,300 100 - Under 30 126 10 10 30 - 34 194 15 25 35 - 39 155 12 37 40 - 44 172 14 51 45 - 49 159 13 64 50 - 54 110 9 73 55 - 59 107 9 82 60 - 64 81 6 88 65 - 69 64 5 93 70 - 74 45 4 97 75 & over 43 3 100 1/ Age not available for 53 dentists. Percents based on total for whom age is known. There are marked differences in the median ages of dentists in the metro- politan areas and in the nonmetropolitan parish groups. The median age of dentists in both the New Orleans and Shreveport metropolitan areas is about 45 years, compared to slightly over 40 years for dentists in the Lake Charles and Lafayette areas. Among the nonmetropolitan parishes, those with central cities of less than 2,500 inhabitants have the oldest group of dentists, with a median age of approximately 52 years--almost eight years higher than the median age of all dentists in the State. 202 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,309 dentists in Louisiana, 1,249, or 95 percent, are active in their profession, giving Louisiana one professionally active dentist for every 2,815 persons. The six metropolitan areas have proportionately more of the State's dentists than of its population--69 percent of the active dentists compared with only 55 percent of the population. As a result of this uneven distribution of dentists in relation to population, there is one dentist for every 2,234 persons in the metropolitan areas, while the remainder of the State has a less favorable ratio of one dentist for every 4,149 persons. Number of Persons Per Active Dentist Professionally Persons Parish group active Population per dentists dentist All parishes 1,249 3,515,800 2,815 All metropolitan areas 870 1,943,500 2,234 New Orleans 480 997,400 2,078 Shreveport 142 306,500 2,158 Baton Rouge 119 261,900 2,201 Lake Charles 58 169,200 2,917 Monroe 39 115,000 2,949 Lafayette 32 93,500 2,922 Nonmetropolitan parishes 379 1,572,300 4,149 Central city 10,000-49,999 228 822,000 3,605 Central city 5,000-9,999 71 337,400 4,752 Central city 2,500-4,999 56 272,600 4,868 Central city under 2,500 24 140,300 5,846 Among the metropolitan areas, New Orleans has the best ratio, with one dentist for every 2,078 persons. The persons-per-dentist ratios for Shreveport and Baton Rouge, both approximately 2,200, are only slightly less favorable. The remaining three metropolitan areas, Lake Charles, Monroe and Lafayette, have ratios of about 2,900 persons per dentist, a little above the State average. In the nonmetropolitan parishes of the State, the ratio of persons per dentist generally becomes less favorable as the size of the central city declines. The group of parishes with central cities of 10,000 or more population have an average persons-per-dentist ratio of 3,605, the most favorable ratio among the parish groups, but still considerably exceeding the ratio for the State as a whole. In contrast, the parishes with cen- tral cities of less than 2,500 inhabitants average 5,846 persons for every active dentist. 203 UTILIZATION OF AUXILIARIES Almost eight of every 10 dental practitioners in Louisiana (i.e., dentists who spend any time working at the chair) reported that they employ auxil- iary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 71 percent of all practitioners, including 65 percent who employ at least one assistant on a full-time basis. Secretaries or recep- tionists are employed by 29 percent of the dentists with about two-thirds of these dentists utilizing such personnel full time. Only 12 percent of the dentists employ dental hygienists and 7 percent employ dental techni- cians. A majority of the dentists who employ hygienists or technicians do so only part time. Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Dental With one full- With only practitioners Total time employee part-time (or more) personnel Type of auxiliary Total respondents 9201/ 100 72 7 With one or more auxiliaries 733 79 72 7 With assistant 654 71 65 6 With hygienist 108 12 5 7 With technician 67 7 2 5 With secretary or receptionist 271 29 19 10 With other type of personnel 35 4 2 2 With no auxiliary 191 21 - - 1/ Includes 5 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is more fre- quent among the young dentists. Ninety percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. The propor- tion utilizing auxiliaries decreases to 76 percent among dentists 45 to 64 years old and drops to 44 percent among dentists 65 and over. Although dentists in the metropolitan areas are no more likely to employ auxiliary personnel than are those located in nonmetropolitan parishes, the use of hygienists is much more common in the metropolitan areas than in the remainder of the State. About 15 percent of the dentists in the metropol- itan areas report the employment of a hygienist, compared to only 5 percent of the dentists located elsewhere. 204 HIGHLIGHTS OF OTHER SURVEY FINDINGS ***Ninety-six percent of the 1,249 professionally active dentists in Louisiana are primarily engaged in private practice. Another two percent are on the staff of the dental school, and the remaining two percent are either employed by State or local government agencies or are engaged in other dental activities, such as taking advanced training. **%Dentists providing patient care devoted an average of 40.5 hours per week to this activity for 48.5 weeks during the year preced- ing the survey. About one dentist in six worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. *%%About 12 percent of the practitioners reported they limit their practices to a dental specialty, primarily to orthodontics or oral surgery. Nine-tenths of the dentists who reported limiting their practices are located in the State's metropolitan areas. The New Orleans area alone has over three times as many dentists with limited practices as all 54 nonmetropolitan parishes com- bined. #*%Six percent of the respondents, 59 dentists, practices as a civilian dentist in one of 22 other States or the District of Columbia immediately prior to assuming their present Louisiana location. Three in every 10 of these dentists came from the adjacent States of Texas, Mississippi, and Arkansas. *%%Almost one-half of the 307 civilian dentists licensed in Louisiana but located in another State were in the nearby States of Texas, Mississippi, or Florida. The remaining out-of-State dentists were scattered among 33 other States, the District of Columbia or foreign countries. September 1967. 205 APPENDIX TABLE 90¢ Selected Data on Dentists in Louisiana, By Location Civilian dentists 1/ Persons Parish group Respond= Non- Age in 1965 Profes=- Populatiomr= per and parish Total p respond- Under 55 years sionally (in 000's) active ents ents 35 or more active dentist All parishes 1,309 970 339 320 340 1,249 3,515.8 2,815 All metropolitan ——— 903 665 238 224 227 870 1,943.5 2,234 New Orleans area 501 355 146 120 132 480 997.4 2,078 Jefferson 82 63 19 34 8 81 250. 3,09 Orleans 399 275 124 77 123 380 663.5 1,746 St. Bernard 3 3 - 1 - 3 39.1 13,033 St. Tammany 17 14 3 8 1 16 44,2 2,762 Shreveport area 151 108 43 34 47 142 306.5 2,158 Bossier 7 4 3 - 1 7 64.3 9,186 Caddo 144 104 40 34 46 135 242.2 1,79 Baton Rouge area 121 92 29 35 25 119 261.9 2,201 East Baton Rouge 121 92 29 35 25 11 261.9 2,201 Lake Charles area 58 48 10 20 Zz 58 169.2 2,917 Calcasieu 58 48 10 20 7 58 169.2 2,917 Monroe area 40 33 7 7 13 39 115.0 2,949 Ouachita 40 33 7 7 13 39 115.0 2,949 Lafayette area 32 29 3 8 3 32 93.5 2,922 Lafayette 32 29 3 8 3 2 93.5 2,922 All nonmetropolitan parishes>’ 406 305 101 9 113 379 1,572.3 4,149 Central city 25,000-49,999 66 48 18 16 17 62 179.1 2,889 Iberia 19 15 4 6 5 18 56.9 3,161 Rapides 47 33 14 10 12 44 122.2 2,777 JAVA Selected Data on Dentists in Louisiana, By Location (cont'd.) Civilian dentists 1 Persons Parish group Respond- Non- Age in 1965 Profes- Population=/ per and parish Total J respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist All nonmetropolitan parishes (cont'd.) Central city 10,000-24,999 176 138 38 42 43 166 642.9 3,873 Acadia 14 11 3 3 3 14 51.3 3,664 Jefferson Davis 10 8 2 3 3 9 31.4 3,489 Lafourche 21 18 3 7 3 21 62.1 2,957 Lincoln 7 6 1 1 2 5 30.0 6,000 Morehouse 6 5 1 1 3 6 34.4 5,733 Natchitoches 6 4 2 1 2 6 34.8 5,800 St. Landry 22 16 6 7 7 22 83.8 3,809 St. Mary 15 11 4 5 4 13 55.5 4,269 Tangipahoa 17 14 3 2 4 16 62.7 3,919 Terrebonne 19 16 3 6 4 19 68.9 3,626 Vermilion 12 8 4 3 2 10 39.9 3,990 Washington 13 10 3 1 4 12 46.9 3,908 Webster 14 11 3 2 2 13 41.2 3,169 Central city 5,000-9,999 76 53 23 18 27 71 337.4 4,752 Allen 8 5 3 2 3 8 20.3 2,538 Ascension 8 4 4 4 2 7 30.6 4,371 Avoyelles 11 7 4 2 7 10 37.4 3,740 Beauregard 5 3 2 2 1 5 19.7 3,940 De Soto 4 3 1 - 1 3 24.1 8,033 East Carroll 4 4 - - 2 4 13.5 3,375 Evangeline 7 3 4 1 1 6 31.7 5,283 Iberville 9 7 2 2 1 9 31.4 3,489 Livingston 5 5 - 3 1 5 30.2 6,040 Madison 2 1 1 1 1 2 15.8 7,900 St. John the Baptist - - - - - - 20.2 - St. Martin 7 5 2 1 4 6 30.3 5,050 West Baton Rouge 1 1 - - 1 1 16.3 16,300 Winn 5 5 - - 2 5 15.9 3,180 Central city 2,500-4,999 62 46 16 18 16 56 272.6 4,868 Bienville 5 3 2 1 2 4 15.7 3,925 Cameron - - - - - - 7.2 - Claiborne 8 5 3 2 4 6 17.0 2,833 80¢ Selected Data on Dentists in Louisiana, By Location (cont'd.) Civilian dentists Persons Parish group Respond- Non- Age in 1965 Profes- Population per and parish Total ents respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist All nonmetropolitan parishes (cont'd.) Central city 2,500-4,999 (cont'd.) Concordia 6 5 1 4 - 6 23.3 2,883 Franklin 4 2 2 1 - 4 24.6 6,150 Jackson 3 1 2 - 1 2 16.0 8,000 Plaquemines 3 3 - 1 - 3 26.4 8,800 Pointe Coupee 4 4 - 1 1 3 22.8 7,600 Richland 6 5 1 - 3 6 22.6 3,767 Sabine 3 2 1 1 1 3 17.4 5,800 St. Charles 8 7 1 3 1 8 24.9 3,112 St. James 4 4 - 2 2 4 19.8 4,950 Union 4 3 1 1 - 4 17.0 4,250 Vernon 4 2 2 1 1 3 17.9 5,967 Central city under 2,500 26 20 6 2 10 24 140.3 5,846 Assumption 7 4 3 - 4 7 18.3 2,614 Caldwell 2 2 - - - 2 8.4 4,200 Catahoula 3 2 1 2 2 11.2 5,600 East Feliciana 2 1 1 1 1 20.7 20,700 Grant 2 1 1 - 1 2 12.9 6,450 La Salle 6 6 - - 2 6 13.1 2,183 Red River 1 1 - - - 1 8.9 8,900 St. Helena - - - - - - 9.2 - Tensas - - - - - - 11.2 - West Carroll 1 1 - - - 1 13.0 13,000 West Feliciana 2 2 - 1 - 2 13.4 6,700 Copyright 1965. Louisiana parishes included in the latest 1966 definition of Standard Metropolitan Statistical areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metro- politan areas for the presentation of the survey data. Parishes not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each parish. Sales Management Survey of Buying Power; further reproduction is forbidden. MAINE DENTISTS LICENSED IN MAINE A total of 435 dentists registered with the Board of Dental Examiners of the State of Maine during the 1965 registration period (Table 1). The survey questionnaire was completed by 405 dentists, or 93 percent of all those registering. A large proportion of the responding dentists--89 per- cent--are civilians located in Maine. Civilian dentists located in other States account for another 9 percent of the respondents. Nearly one-half of these out-of-State dentists reside in Massachusetts, slightly more than one-fifth are located in New Hampshire or New York, and the remainder are scattered among 8 other States. Table l.--Location and Military Status of Dentists Licensed in Maine Location and All Percent of military status dentists dentists Total licensed 435 100 Respondents 405 93 Nonrespondents 30 7 Respondents 405 100 Civilians in Maine 360 89 Civilians in another State 36 9 On active duty with Armed Forces 9 2 Civilian Dentists in Maine Sources of Supply Dental schools.--More than one-half of Maine's dentists are graduates of the two New England Schools of Dental Medicine at Tufts University and Harvard University (Table 2). Through the years Tufts University has been the primary source of Maine's dentist supply and its contribution has increased slightly since 1955 as compared with the years prior to World War II. Harvard's relative contribution to the Maine supply, on the other hand, has declined greatly during the post-war years. Graduates of 10 other eastern dental schools in Pennsylvania, Maryland, New York, the District of Columbia and New Jersey account for another 30 percent of the dentists in Maine. The University of Maryland has been the primary contributor among these ten schools to the Maine supply. However, proportionately fewer of Maine's dentists who have graduated from dental school in recent years attended Maryland than did those grad- uating in 1940 or earlier. 209 Table 2.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Dental school of ATT After 1941- 1940 or attence dentists years 1955 1955 earlier Total number 360%/ 360 80 140 133 (Percent distribution by school) Tufts 164 46 48 50 41 Harvard 41 11 3 8 19 Maryland 32 9 4 6 15 Pennsylvania 22 6 7 5 7 Georgetown 14 4 5 6 2 Temple 14 4 6 1 6 Montreal 12 3 4 4 3 20 other schools 61 17 24 21 7 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown they are based on data supplied by dentists respond- ing to the item (see Appendix Table A). Another 4 percent of the State's dentists are graduates of 3 Canadian dental schools, primarily the Universite de Montreal. The remainder of Maine's dentists--about a twelfth of the total--received their dental education in 12 schools located in 8 other States. Dentists relocating in Maine.--One in every eight dentists now located in Maine reported previous professional locations as civilians in other States. Almost one-half of the 42 dentists relocating in Maine moved from Massachusetts or New York. The remainder came from 16 other States and the District of Columbia. Personal Characteristics Age.--The median age in 1965 of Maine's reporting dentists was a rela- tively high 47.1 years. More than one-half of the State's dentists are between the ages of 35 and 54, including 3 in every 10 who are in the 35 to 44 age group (Table 3). Dentists who are 55 or over number twice as many as those who are under 35 years of age. Included in this older age group are 67 reporting dentists who are 65 or older. 210 Table 3.--Age Distribution in 1965 Number Percent Age of of dentists dentists Total 360 100 Under 30 12 3 30 - 34 42 12 35 - 39 39 11 40 ~ 44 69 19 45 - 49 41 11 50 - 54 43 12 55 - 59 22 6 60 - 64 24 7 65 - 69 25 7 70 - 74 29 8 75 & over 13 4 Advanced training.--One or more years of advanced training has been com- pleted by at least 62 dentists in Maine (Table 4). Twelve percent have received advanced clinical training as interns and residents, and 7 per- cent have completed at least one year of advanced academic work as grad- uate or postgraduate students. Table 4.--Advanced Training Highest level of training Number Percent completed dentists dentists With advanced training 62 17 Clinical training only 36 10 Academic training only 19 5 Both clinical and academic 7 2 Clinical training Residency completed 14 4 Internship completed 29 8 Academic training M.A., M.S., or other advanced degree 8 2 Postgraduate 1 year or more (no degree) 18 5 211 There is a growing tendency for younger dentists to seek additional train- ing beyond the dental degree, particularly advanced academic work. About 13 percent of the dentists under 40 years of age have had a year or more of graduate or postgraduate study as compared with only 7 percent of those 40 to 54 years old and 4 percent of those 55 and over. Multiple licensure.--About one-third of the dentists located in Maine are also licensed to practice dentistry in other States. However, only 16 of the State's 121 dentists who reported multiple licensure are registered to practice in more than one other State in addition to Maine. Two-thirds of all dentists holding out-of-State licenses are licensed to practice in Massachusetts. Maine dentists are also registered in 18 other States, primarily New York and New Hampshire. Distribution and Current Status Distribution of dentists.--Slightly more than three-fourths of the 360 reporting dentists are located in only 6 of the State's 16 counties (Table 5). Cumberland County, a portion of which makes up the Portland metropolitan area, has the largest number of dentists, almost 30 percent of the State's supply. Three other counties--Kennebec, Androscoggin and York--in the southern coastal area of the State also contain sizeable numbers of dentists, each about 10 percent of the total in the State. The State's other metropolitan area, the Lewiston-Auburn area, makes up a part of Androscoggin County. Penobscot County in the Maine Woods area has the second largest number of dentists of any county. Aroostook County, the northernmost county in the State, is the only other county with at least 20 dentists. Of the other 10 counties, Oxford and Somerset Counties in the Maine Woods area and Hancock and Knox Counties on the northeast coast have 10 or more dentists (see Appendix Table B for indi- vidual county data). Table 5.--Distribution by County Number Percent County of of dentists dentists All counties 360 100 Cumberland 103 29 Penobscot 41 11 Kennebec 38 11 Androscoggin 36 10 York 33 9 Aroostook 21 6 10 other counties 88 24 212 Active dentists in relation to population.--Of the 360 respondents in Maine, 356 reported that they were active in the dental profession. The other four dentists, who are all 65 years old or over, regarded them- selves as fully retired. Based on this count, there was one profession- ally active dentist for every 2,790 persons in Maine in 1965. Cumberland County has the most favorable county ratio, only 1,844 per- sons per active dentist (Table 6). Kennebec County and Androscoggin County have the next most favorable ratios--2,403 and 2,442 persons per dentist, respectively. The other 3 most populous counties--Aroostook, Penobscot and York Counties--each have persons-per-active-dentist ratios less favorable than the State, which averages 2,790 persons per dentist. Table 6.--Number of Persons Per Dentist Professionally Persons County active Population per dentists dentist All counties 356 993,200 2,790 Cumberland 103 189,900 1,844 Penobscot 40 134,100 3,353 Kennebec 38 91,300 2,403 Androscoggin 36 87,900 2,442 York 33 102,700 3,112 Aroostook 20 108,700 5,435 10 other counties 86 278,600 3,240 The other 10 counties in Maine each have smaller populations and fewer den- tists. The extremes in persons-per-dentist ratios in these counties occur in two adjoining counties on the northeast coast. Knox County has the most favorable ratio with 2,618 persons per dentist and Waldo County has the least favorable ratio of 5,750 (see Appendix Table C for individual county data). In addition to Knox County, another northeast coast county, Hancock, as well as Piscataquis County in the Maine Woods area also have fewer persons per dentist than the State on the average. Each of the other 6 counties in Maine have fewer than 4,000 persons per active dentist. Professional Activity Current employment.--Nearly all the professionally active dentists in Maine are primarily engaged in private practice: 97 percent are self- employed and one percent are employed by another dentist. The other 2 per- cent are employed by governmental agencies, or are engaged in other dental employment. One in every ten dentists who are professionally active also report that they are engaged in a part-time dental activity in addition to their primary professional employment. 213 Activity last year.--All dentists, except two, who reported on their professional activity last year, stated that they provided care for patients. Dentists reporting time spent in patient care devoted an aver- age of 46.8 weeks during the year to this activity and worked an average of 39.8 hours per week. A few dentists reported more than one type of professional activity. About 5 percent of the active dentists reported they were engaged in teaching or research, or they were taking advanced training. However, less than one percent of the total professional time was spent in all activities other than patient care. Of the dentists who provided patient care last year, the largest propor- tion, 57 percent, spent 40 hours or more per week at this activity for at least 48 weeks of the year (Table 7). Dentists who spent the least amount of time in patient care, less than 48 weeks a year and less than 40 hours per week, accounted for only 14 percent of all dentists engaged in this activity. Table 7.--Time Spent in Patient Care Last Year Weeks spent in Percent of Percent distribution by work week > SP dentists providing 48 hours 41-47 Under patient care . 40 hours patient care or more hours 40 hours Total 100 18 19 31 32 50 weeks or more 41 9 9 13 10 48 - 49 weeks 34 6 7 13 8 Less than 48 weeks 25 3 3 5 14 The amount of time worked by dentists in private practice last year declined sharply with increasing age. Slightly less than 8 in 10 den- tists under 35 years of age report working at least 48 weeks and at least 40 hours per week. The proportion working this amount of time declines to 6 in 10 dentists for those between 45 and 54 years old and then decreases sharply to less than 3 in 10 dentists among those 65 years old or over. 214 Practice Characteristics Limited practices.--A total of 28 dentists, or one in every 12 dentists in Maine, report limiting their practice to a dental specialty. Practices limited to orthodontia or oral surgery are reported by almost all of these dentists. Two-thirds of the dentists in limited practice are located in either Cumberland or Penobscot Counties. Use of auxiliaries.--Dental auxiliaries are employed by more than four- fifths of the dental practitioners, including approximately 75 percent who employ at least one auxiliary full time (Table 8). Almost three- fourths of the practitioners employ dental assistants, mostly on a full- time basis. Dental hygienists are employed by 17 percent of the practitioners, including 8 percent who employ one full time. About one in 11 practitioners employ laboratory technicians in their practices, and slightly more than half of these dentists employ full-time techni- cians. Table 8.--Dental Practitioners Employing One or More Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliar Dental With one full- With only y practitioners Total time employee part-time (or more) personnel Total 354 100 75 7 With one or more auxiliaries 283%/ 82 75 7 With assistant 253 73 65 8 With hygienist 60 17 8 9 With laboratory technician 32 9 5 4 With secretary or receptionist 69 20 16 4 With other type of personnel 10 3 2 1 With no auxiliary 64 18 - - 1l/ Individual items add to more than the total because some dentists employ more than one type of auxiliary. Young dentists are considerably more likely to employ auxiliary personnel than are their older colleagues. Over 90 percent of the dental practi- tioners under 40 years of age employ one or more auxiliaries. But among dentists 55 years or older, the proportion using auxiliaries drops to approximately 62 percent. 386-029 O - 70 - 15 215 A large proportion of the dentists in each of the 16 counties utilize auxiliary personnel in their practices. In 11 of the counties four- fifths or more of the practitioners employ auxiliaries. In the 6 counties which have the largest numbers of dentists the proportion of practitioners with auxiliary personnel ranges from a low 77 percent in Penobscot and Androscoggin Counties to a high 85 percent in Cumberland County. December 1966. 216 Appendix Table A.--Summary Statistics for Maine Number of dentists All licensed dentists 435 Respondents -- total dentists participating in survey 405 Civilian dentists in Mainet/ -- civilian respondents designated simply as ''dentists' in text tables 360 (number not reporting: age - 1, year of graduation - 7) Professionally active dentists>/ 356 Dental practitioners>’ 354 In limited practice 28 Located in Maine last year: Reported professional activity>! 332 Dentists providing patient cared 330 Reported time spent in patient care’! 281 Dentists in private practiced! 329 Reported time spent in practice 280 Out-of-State dentists -- civilian respondents not located in Maine 36 Dentists on active duty with Armed Forces 9 Nonrespondents -- licensed dentists not participating in survey 30 1/ All responding dentists who currently work in Maine (excluding those in the Armed Forces) or who are retired and currently live in the State. 2/ All active civilian dentists currently in Maine--excludes four den- tists who are fully retired. 3/ All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 4/ Dentists who reported they limited their practice to a dental specialty. 5/ Dentists located in Maine last year who indicated type(s) of activity © ® in which they engaged. All dentists who engaged in patient care last year, either as a primary or a secondary activity. Dentists reporting both hours and weeks spent in patient care last year. Dentists who reported they were primarily self-employed both currently and last year. Dentists reporting both hours and weeks spent last year as a self- loyed dentist. employed dentis 217 / Appendix Table B.--Maine Counties, by Geographical Areal’ Number of responding County Central city? civilian dentists Southern Coastal area Cumberland Portland 103 Kennebec Augusta 38 Androscoggin Lewiston 36 York Biddeford 33 Sagadahoc Bath 7 Maine Woods area Penobscot Bangor 41 Oxford Rumford 15 Somerset Skowhegan 10 Franklin Farmington 8 Piscataquis Dover-Foxcroft 6 Northeast Coast area Hancock Ellsworth 12 Knox Rockland 11 Washington Calais 8 Lincoln Boothbay Harbor 6 Waldo Belfast 5 Aroostook area Aroostook Presque Isle 21 1/ The geographical areas in Maine have been adapted from the State Economic Areas designated in the publication: Donald J. Bogue and Calvin L. Beale, "Economic Areas of the United States." New York, The Free Press of Glencoe, Inc., 1961. 2/ The largest (central) city in each county according to the 1960 population. 218 Appendix Table C.--County Data Percent of Counties with Professionally Persons Percent of practi- responding . Population per active dentists . active tb (in 000's)L active Under 55 years tioners dentists entists dentist 40 years or more using auxiliaries Total 356 993.2 2,790 26 31 82 Androscoggin 36 87.9 2,442 36 36 77 Aroostook 20 108.7 5,435 15 20 80 Cumberland 103 189.9 1,844 28 30 85 Franklin 7 19.7 2,814 29 43 86 Hancock 12 32.3 2,692 25 33 80 Kennebec 38 91.3 2,403 11 26 84 Knox 11 28.8 2,618 27 45 82 Lincoln 6 18.6 3,100 50 33 67 Oxford 15 44 4 2,960 20 33 86 Penobscot 40 134.1 3,353 25 20 77 Piscataquis 6 16.7 2,783 33 33 83 Sagadahoc 7 23.7 3,386 43 14 86 Somerset 10 39.6 3,960 40 20 90 Waldo 4 23.0 5,750 50 50 100 Washington 8 31.8 3,975 12 75 63 York 33 102.7 3,112 24 33 79 1/ Copyright 1965 Sales Management Survey of Buying Power; further reproduc- tion is forbidden. 219 rr Tn rer Ter sees a 1 gem re pee MARY LAND DENTISTS LICENSED IN MARYLAND A total of 2,130 dentists registered with the Maryland State Board of Dental Examiners in January 1965 (Table 1). Of this total, 1,982 com- pleted the questionnaire, for an overall response rate of 93 percent. The response rate for dentists actually located in Maryland was somewhat higher, since nonresponse was more frequent for those who were outside Table 1.--Location and Military Status of Dentists Licensed in Maryland Location and All Percent of military status dentists dentists Total 2,130 100 Respondents 1,982 93 Nonrespondents 148 7 Respondents 1,982 100 Civilians in Maryland 1,312 66 Civilians in another State 513 26 On active duty with Armed Forces 149 8 Not reported 8 * * Less than one-half of one percent. the State or on active duty with the Armed Forces. As it was, an extremely large number of those responding are located outside Maryland. More than 500 are in another State or abroad and another 150 are on active duty with the Armed Forces. Together, these two groups of dentists represent about a third of all licensed respondents. Table 2.--Percent Holding Licenses in Other States Civilian dentists Licenses held res A In Qut-of- armed esp Maryland State Total 100 100 100 100 Maryland only 49 68 - 55 Licensed in 1 other State 37 25 68 34 Licensed in 2 other States 11 6 24 10 Licensed in 3 or more States 3 1 8 1 221 Of all dentists responding, about half hold a license in one or more addi- tional States. About 11 percent are licensed in two other States and 3 percent are licensed in three or more States. As a result, the total number of State licenses held by the respondents exceeds 3,300. Although the majority of those holding multiple licenses are currently located out- side the State, multiple licensure is also common among Maryland's den- tists. Nearly a third of all dentists located in Maryland are licensed in one other State, 6 percent in two others, and 1 percent in three or more other States. Civilian Dentists in Maryland Sources of Supply Dental schools.--Graduates of 40 dental schools are represented among od ald . . . Maryland's dentists, including graduates of two Canadian schools and of one dental school, George Washington, which is no longer in existence. However, the great majority of Maryland's dentists--68 percent--are grad- uates of the School of Dentistry of the University of Maryland. Of the Table 3.--School Awarding Dental Degree, by Year Awarded Percent of dentists Dental school Number Year of graduation attended dentis ce Total After 1941- 1940 or 1955 1955 earlier Total 1,312%/ - 29 40 31 Maryland 892 68 60 63 82 Georgetown 152 12 16 15 4 Howard 81 6 11 5 4 Pennsylvania 28 2 2 2 2 Emory 18 1 - 2 1 Pittsburgh 17 1 2 1 1 Temple 16 1 1 2 1 Meharry 10 1 1 1 1 Other schools 98 8 7 9 4 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table A). remainder, 24 percent are accounted for by the seven out-of-State schools which have produced 10 or more of Maryland's dentists. Those in the District of Columbia, notably Georgetown, and in Pennsylvania have long 222 been the principal out-of-State sources of supply, and in recent years have accounted for an increasing percent. About 32 percent of those graduating within the last 10 years are from these schools, as compared with 12 percent for those who were graduated prior to World War II. Dentists relocating in Maryland.--Maryland has relatively few in-migrant dentists. Only 14 percent of all dentists currently located in Maryland report that they had previously been located elsewhere (Table 4). The largest number had moved from the District of Columbia and nearby Pennsyl- vania and Virginia. Among the 31 more distant States whose dentists migrated to Maryland, New York contributed the largest number. Among Table 4.--In-Migrant Dentists Last previous location Bunber of Percent of ast p dentists dentists Total 1,312 100 Previously located elsewhere 187 14 District of Columbia 40 3 Pennsylvania 19 1 New York 12 1 Virginia 11 1 Other 105 8 Never located elsewhere 1,125 86 other States accounting for five or more were North Carolina and New Jer- sey (eight each), Kentucky and Florida (seven), Massachusetts (six), and Michigan and Illinois (five each). Ten dentists reported that they had previously been located in a foreign country. Personal Characteristics Age and sex.--Only 5 of the 1,312 civilian dentists responding in the sur- vey are women. Since they are so few, data will not be shown separately for them. Ages from 26 to 88 were reported by dentists responding in the survey. Overall, however, Maryland's dentists are a relatively young group. The median reported age was 43.7. Twenty percent were under 35 years old and 17 percent were between 35 and 39 years of age. Nonetheless, there was also a substantial representation of dentists who were well along in years. Thirteen percent--168 dentists--were 65 years old or over, and in this group were 96 who were 70 years old or over, including 44 who had reached 75 years of age. 223 Table 5.--Sex and Age Sex and Number of Percent of age dentists dentists Total 1,312 100 Male 1,307 100 Female 5 * Age Under 30 64 5 30 - 34 199 15 35 - 39 226 17 40 - 44 226 17 45 - 49 149 12 50 - 54 126 10 55 = 59 80 6 60 - 64 70 5 65 - 69 72 6 70 - 74 52 4 75 & over Ll, 3 * Less than one-half of one percent. Advanced training.--Approximately 28 percent of Maryland's dentists have had some kind of advanced training. Although the number completing advanced academic work is less than the number who have served internships or residencies, Maryland's dental force numbers among its members 14 den- tists who have earned an additional doctorate. In addition, 47 dentists Table 6.--Advanced Training Highest level Number Percent of training of of completed dentists dentists Total 1,312 100 With advanced training 369 28 With no advanced training 943 72 Clinical training Residency completed 75 6 Internship completed 215 16 Academic training Ph.D., M.D., or other doctors 14 1 M.A., M.S., or other masters 47 4 Postgraduate 1 year or more (no degree) 104 8 224 have earned a master's degree since leaving dental school, and another 104, although they hold no advanced degree, have completed one year or more of academic work at the postgraduate level. The data in Table 7 reflect the growing tendency for dentists to seek training beyond receipt of their dental degree. The percentage of den- tists reporting advanced academic training amounts to 17 percent for those under 40 years old, and declines to 12 percent for those 40 to 54 years of age and to only 7 percent for those 55 and over. Residencies show the same pattern by age. This explains, in part, the relatively low figure Table 7.--Advanced Training, by Age Age Number Percent of dentists of with With With With With dentist givanced ginance aca teRic residency internship training training training Total 369 28 13 6 16 Under 40 149 30 17 7 15 40 - 54 171 34 12 6 23 55 & over 48 15 7 2 8 for those under 40 completing only an internship. However, most of the explanation lies in the fact that a relatively larger percentage of the younger members of this group are on active duty with the Armed Forces. In addition, many civilian dentists in this age group are still in the process of training. Distribution and Current Status Distribution of dentists.--Most of Maryland's dentists are located in the State's two major metropolitan centers. The Baltimore area, consisting of Baltimore City and four suburban counties, accounts for 54 percent of the State's total dental force (Table 8). The two suburban counties of Table 8.--Distribution by County Group County grou Number of Number of Percent of y group counties dentists dentists All counties 24 1,312 100 Baltimore metropolitan areas 5 711 54 Washington, D.C. suburbs 2 392 30 Nonmetropolitan county groups Central city 25,000-49,999 2 59 5 Central city 10,000-24,999 3 56 4 Central city 5,000-9,999 4 52 4 Central city 2,500-4,999 3 15 1 Central city under 2,500 5 20 2 Note: Seven dentists failed to indicate their county location. 295 the Washington, D.C. metropolitan area--Montgomery and Prince Georges-- account for another 30 percent. Dentists in the remainder of the State tend to be concentrated in the counties which contain a relatively large city. More than half of the 16 percent who are located in the 17 coun- ties which are not part of a metropolitan area are in the 4 counties of the State with a central city of 10,000 or more population. The 12 coun- ties which do not have a city this large account for only 7 percent of the dentists although more than 11 percent of the population reside there. There are marked differences in the age distribution of dentists in the various county groups. A relatively large concentration of older dentists exists, for example, in the Baltimore area, but there are practically none in the two suburban Washington, D.C. counties (Table 9). The median age of Baltimore area dentists is 46.5, compared with 39.9 for those in the Washington area. Long-established dentists, of course, tend to be located Table 9.--Median Age and Age Distribution, by County Group Percent of dentists County group Median moa —70- 55- 65- 75 and 2ge 40 54 64 74 over All counties 43.7 37 38 12 10 3 Baltimore metropolitan areas 46.5 31 37 15 12 5 Washington, D.C. suburbs 39.9 51 41 5 3 * Nonmetropolitan county groups Central city 25,000-49,999 44 4 32 39 17 7 5 Central city 10,000-24,999 47.2 28 43 9 18 2 Central city 5,000-9,999 43.1 40 33 10 10 7 Central city 2,500-4,999 42.5 40 46 7 7 - Central city under 2,500 51.3 37 21 16 21 5 * Less than one-half of one percent. in the central sections of metropolitan areas and Baltimore is no excep- tion. Most of the older dentists are to be found in Baltimore City. However, there are relatively few young dentists in the suburban Baltimore counties as compared with the Washington suburbs. Only 46 percent of the dentists in the four outlying counties of the Baltimore area are under 40 years old, compared with better than half of those in Montgomery and Prince Georges Counties. Among the counties which lie outside the metropolitan areas, those in the smallest size class--counties with no city of more than 2,500 residents-- have relatively the largest number of older dentists. Twenty-six percent are 65 years old or over and about 42 percent are 55 or more. However, 226 dentists under 40 constitute the same percent of dentists in these coun- ties as they do in the State as a whole. By contrast, the 5 nonmetropol- itan counties with the largest central cities--those with a town of at least 10,000--have relatively few dentists under 40 as compared with the State average. About 10 percent of the dentists in Maryland maintain a second office location. Of these dentists, slightly less than half reported their second office in a county different from the one in which their primary office is located. By far, the majority of second offices are located in the two metropolitan areas of the State. Professional status.--Nearly all dentists reported that they are active in the profession (Table 10). Only 3 percent reported themselves wholly Table 10.--Professional Activity Status oo. Number Percent Activity status of dentists of dentists Total 1,312 100 Active in profession 1,271 97 Inactive in profession 35 3 In nondental employment 7 1 Retired 28 2 Status not reported 6 % * Less than one-half of one percent. retired or as engaged primarily in some type of nondental employment. Although most of the retired dentists were in the older groups, relatively few older dentists responding in the survey regarded themselves as fully retired (Table 11). Three in every 4 of those 75 years old and over, for example, reported that they are still in practice. A larger share of these dentists are located in the nonmetropolitan counties. Table 11.--Status Reported by Dentists 65 Years and Over Ace Number of Fully Still 8 dentists retired active Total 168 19 149 65 - 69 72 - 72 70 - 74 52 8 Lt 75 & over 44 11 33 227 Active dentists in relation to population.--There was one professionally active respondent for every 2,710 persons in Maryland in 1965 (Table 12). The number of persons per active dentist ranged from 1,656 in Montgomery County to more than 9,000 in Charles and Somerset Counties (see Appendix Table B for individual county data). Including Montgomery County, only 5 counties within the State had dentist-population ratios as favorable as Table 12.-=-Distribution of Dentists Professionally eas Persons . Civilian Type of area active ulation per dentists pop dentist All areas 1,271 3,444,300 2,710 Baltimore metropolitan area 678 1,823,900 2,690 Washington, D.C. suburbs 388 878,500 2,264 Nonmetropolitan county groups Central city 25,000-49,999 58 187,000 3,224 Central city 10,000-24,999 55 163,400 2,971 Central city 5,000-9,999 51 215,000 4,216 Central city 2,500-4,999 14 62,400 4,457 Central city under 2,500 20 114,100 5,705 the State average. These were Baltimore City (1,919), Allegany (2,669), Talbot (2,550) and Wicomico (2,705). By contrast, there were 11 counties with ratios well in excess of one dentist to 4,000 persons. As the data in Table 12 reveal, the ratio varied with the size of the population cen- ter, the metropolitan areas having the most favorable ratios and the smaller counties having progressively fewer dentists in relation to popula- tion. The one exception is the group of counties with a central city of 10,000 to 25,000 residents. However, since a relatively large number of the dentists in this group of counties are in the older age groups, the dentist-population ratio probably tends to overstate the amount of dental service available. Professional Activity Current employment.--As might be expected, self-employment predominates among dentists who are active in the profession--about 91 percent are engaged primarily in private practice, and another 2 percent maintain a private practice as a secondary activity (Table 13). In addition, 3 per- cent are employed in the private practices of other dentists as their principal employment and another 3 percent hold a position of this type as a supplement to their primary employment. Most of the latter group are dentists in practice for themselves who work for another dentist on a part- time basis. 228 Table 13.--Current Employment of Professionally Active Dentists Principal Percent with other dental Type of employment employment employment Number Percent Total! Private Dental Other employed practice school Total 1,271 100 18 52/ 4 10 Self-employed 1,160 91 14 2 4 10 Employed by other dentists 36 3 1 * * * On staff of dental schools 26 2 1 1 * * Employed by State or local government 23 2 1 1 * * Employed by Federal Government 8 1 * * - - Other dental employment 18 1 * * - - 1/ Columns add to more than total because some dentists reported more than one other dental employment. 2/ Includes 2 percent who maintain own practices and 3 percent who are employed in practices of other dentists. * Less than one-half of one percent. Only 6 percent of all professionally active dentists are primarily engaged in some other type of activity. Two percent are teaching either at the School of Dentistry in Baltimore or in one of the Washington dental schools, 2 percent are State or local government employees, one percent work for the Federal Government, and the remaining one percent are engaged in some other kind of dental employment. Activity last year.--About 97 percent of all dentists reporting on their professional activity in Maryland last year indicated that they had provided care for patients (Table 14). When measured in terms of professional time, patient care accounted for nearly 95 percent of the total time devoted to dental activities in Maryland in that year. Although there were 98 dentists-- 8 percent of the total--who had engaged in teaching either on a full or part- time basis during the year, teaching accounted for less than 3 percent of the professional time, and research, while claiming the attention of about 3 per- cent of the dentists, accounted for only 1 percent of all professional time. The time spent in all other dental activities, principally in the receipt of training, accounted for less than 2 percent of the total, though nearly 5 per- cent of the dentists reported that they had devoted at least some time to some other type of professional activity. 229 Table l4.--Distribution of Professional Activity Last Year tod Located in Maryland Percent of Type of activity last year total professional P Number Percent time reported Total 1,171% 100%/ 100 Patient care 1,141 97 95 Teaching 98 8 3 Research 36 3 1 Cther 53 5 2 1l/ Individual items add to more than total because some dentists spent time in more than one type of activity. Dentists reporting on time spent last year in providing patient care devoted an average of 47.5 weeks to this activity and worked an average of 40.4 hours per week. The figures in Table 15 on weeks and hours per week show that large numbers of reporting dentists devoted exceptionally long hours to this activity. About one in every 6 reporting dentists spent the equivalent of 8 hours or more per day six days per week, for 48 or more weeks during the year. Table 15.--Time Spent in Patient Care Last Year coe Dentists Percent of total Weeks of activity providing 78 Tes A147 35-39 Under reported patient ore hrs. 40 hrs, hrs. 35 hrs. care Total reporting time spent 100 19 18 28 19 16 50 weeks or more 44 9 9 13 8 5 48-49 weeks 34 7 6 11 6 4 40-47 Weeks 16 2 2 3 4 5 Less than 40 weeks 6 1 1 1 1 2 Dentists under 30 years of age, many of whom were just establishing their practices, put in the longest work week--45.7 hours on the average--and devoted the fewest weeks of the year to this activity of any group. By contrast, dentists 65 years old or over, worked the shortest number of hours--32.9 on the average--and devoted almost as many weeks to this activity as most younger dentists. In general, average hours per week dropped off fairly consistently with advancing age but weeks worked tended to hover around 48 weeks for most of the age groups. 230 Practice Characteristics Limited practices.--Approximately 12 percent of the dental practitioners-- 156 dentists--reported that they limit their practices to a dental specialty (Table 16). Specialization is almost as common in the counties outside the metropolitan areas as it is within, with 9 percent of those located in the nonmetropolitan counties reporting that they limit their practices as com- pared with 13 percent of those in the Baltimore and Washington areas. These totals may represent an overcount of those who practice one specialty exclu- sively. The question which appeared on the questionnaire referred specifi- cally to a single area of practice, but many dentists who limit their practices to combinations of two specialty areas (for example, prosthodontics and oral surgery or orthodontics and pedodontics) checked both items, and there is some evidence that not all cases of this type were identified in editing. However, there is no doubt that orthodontics and oral surgery are the principal areas of specialization. Table 16.--Limited Practices Percent of dental practitioners Location Limited All Ortho- Oral Pedo- . specialty . . Other practice dontics surgery dontics areas All areas 156 12 5 4 1 2 Baltimore metropolitan area 87 13 5 4 1 3 Washington, D.C. suburbs 52 13 7 4 1 1 Nonmetropolitan counties 15 9 2 4 1 2 Use of auxiliaries.--Less than 3 in 4 dental practitioners (i.e., dentists working any time at the chair) reported that they employ auxiliary personnel (Table 17). Nearly all who do so, however, report that they employ at least one auxiliary on a full-time basis. Only 8 percent report that they employ part-time personnel exclusively. Of the various types of personnel, dental Table 17.--Dentists Employing 1 or More Auxiliaries, by Type of Auxiliary Percent of dental practitioners Dental With only With one Type of auxiliary practitioners Total part-time full-time employee personnel (or more) Total 1,253 100 8 63 With no auxiliary 360 29 - - With one or more auxiliaries 893 71 8 63 With assistant 773 62 7 55 With hygienist 120 10 7 3 With laboratory technician 63 5 3 2 With secretary or receptionist 323 26 7 19 With other type of personnel 56 4 2 2 231 386-029 O - 70 - 16 assistants are those most frequently employed. About 62 percent of all practitioners employ an assistant, including 55 percent who use one full time. A fourth of all practitioners employ secretaries and receptionists, and by far the majority employ at least one on a full-time basis. By con- trast, dental hygienists and laboratory technicians are only infrequently employed, and most dentists employ them only on a part-time basis. One dentist in 10 uses a hygienist in his dental practice and one in 20 employs a laboratory technician. Dental practitioners in the Baltimore area are less likely to use auxil- iaries than are other dentists in the State (Table 18). Only 66 percent report the employment of an auxiliary, compared with 77 percent for den- tists located elsewhere. Only the use of dental laboratory technicians is more common in Baltimore than in the remainder of the State. Dental hygienists are much more frequently employed in suburban Washington, D.C., and dental assistants are more widely employed both in suburban Washington and in the nonmetropolitan counties. Dentists in the latter group of counties more frequently employ a full-time assistant than do those in either of the metropolitan areas. Table 18.--Dentists Employing Auxiliaries, by Location of Dentist Percent of dental practitioners Type of auxiliary Baltimore Washington, D.C. Other metro area suburbs counties With one or more auxiliary employees 66 77 77 With assistant 56 69 69 With hygienist 6 19 4 With technician 6 5 1 With one full-time employee or more 59 66 72 With full-time assistant 51 58 65 With full-time hygienist 2 7 2 With full-time technician 2 2 1 Table 19 presents the overall rate of auxiliary utilization for dentists of various ages in these three major areas of the State, and for the State as a whole. In all areas, peak utilization occurs among dentists 40 to 54 years of age, and it is highest for dentists of this age who are located in the nonmetropolitan counties of the State. The rate for dentists in this age Table 19.--Dentists Employing Auxiliaries, by Location and Age of Dentist Percent of dental practitioners Age of dentist All Baltimore Washington, D.C. Other areas metro area suburbs counties With one or more auxiliaries 71 66 77 77 Under 40 75 71 77 87 40-54 81 78 83 86 55 or over 47 46 50 52 232 group ranges from Baltimore's 78 percent to 83 percent for the Washington suburbs and 86 percent in the remainder of the State. Rates for dentists under 40 are only slightly lower, but for dentists 55 and over they fall to around the 50 percent level. Again, however, they are lowest in the Baltimore area and highest for dentists in the nonmetropolitan counties. Almost 12 percent of the dentists in Maryland reported one or more vacant positions for auxiliary personnel. Approximately two-thirds of the vacan- cies were for hygienists and assistants. Most dentists reporting a hygienist vacancy did not currently employ a hygienist whereas most den- tists desiring to employ an assistant were already utilizing at least one assistant. Weeks and hours worked.--Although approximately 86 percent of all dentists who were in private practice in Maryland in the previous year reported on both the number of weeks and hours they had worked during that year, the percent reporting was a low 65 percent for those 65 years old and over. Since those not responding were likely to be those who are least active, the estimates on time worked by dentists in this age group are probably high. Even so, the figures presented in Table 20 show how activity tapers off among older dentists. Only a third of those 65 years old and over reported that they worked an average of 40 hours or more for 48 weeks or more out of the year. Table 20.--Time Spent in Practice Last Year, by Age Dentists reporting time Ace group SRent in private practice Percent working ge group Number Percent 48 weeks or more Part year or less of total 40 hrs/wk or more than 40 hrs/wk Total 906 86 53 47 Under 35 161 94 58 42 35 - 44 355 89 56 44 45 - 54 220 86 50 50 55 - 64 94 81 54 46 65 & over 73 65 33 67 However, if reporting older dentists are representative of all those in practice, then those older dentists who practice in small communities are much more likely to devote this amount of time to their dental practices than are older dentists who practice elsewhere. Table 21 presents data for several county groups on the weeks and hours spent in dental practice by dentists in three broad age groupings. Among dentists 60 years old or over who reported from counties where every town had a population of less than 10,000, approximately 55 percent had devoted 48 weeks to their dental practices for an average of 40 hours or more each week. This was a con- siderably larger percentage than in any other group of counties. 233 Table 21.--Time Spent in Practice, by County Group and Age Percent working 40 hrs/wk or more for 48 weeks or more County group All Under 35- 60 and ages 35 59 over All areas 53 58 54 39 Baltimore metropolitan area 53 60 54 42 Washington, D.C. suburbs 53 55 54 31 Nonmetropolitan counties Central city 10,000-49,999 51 69 52 31 Central city under 10,000 54 62 53 55 Qut-of-State Dentists State Location There are dentists in 33 States, the District of Columbia, and Puerto Rico who maintain an active license in Maryland. Most of these out-of- State dentists are in nearby States--28 percent are in the District of Columbia and another 21 percent are in States adjacent to Maryland (Table 22). Table 22.--Out-of-State Dentists, by State . Number of Percent of State location dentists dentists Total 513 100 District of Columbia 143 28 Florida 47 10 New Jersey 45 9 New York 35 7 Virginia 35 7 Pennsylvania 29 6 West Virginia 23 5 California 17 4 Connecticut 17 4 Delaware 14 3 Massachusetts 14 3 North Carolina 11 2 23 other States and Puerto Rico 62 13 234 Only 2 percent report that they are retired. By far the majority (77 per- cent) are in dental practice. Some 8 percent of the dentists are engaged in other dental activity which consists primarily of individuals serving internships or residencies while about 5 percent are on the faculties of out-of-State dental schools. Out-migrant Dentists About 1 in every 10 out-of-State respondents reported they had formerly been located in Maryland. Over one-half of these dentists are now located in the District of Columbia and adjacent States--16 dentists in the District, 6 in West Virginia and 5 each in Pennsylvania and Virginia. Florida has also attracted 6 dentists once located in Maryland. The remaining 24 out-migrant dentists are in 13 other States. The greatest out-migration among reporting dentists has occurred in recent years, in 1960 or later (Table 23). About two-thirds of this group were under 40 years of age in 1965, reflecting at least in part the relatively Table 23.--Year Out-migrant Dentists Left State, by Age in 1965 Age distribution Percent of Year left . Under 40- 50 and out-migrants 40 49 over Total 100 40 33 27 1960 or later 44 30 11 3 1950 - 1959 37 8 19 10 Before 1950 19 2 3 14 greater mobility of young dentists in relation to older practitioners. The low proportion of out-migrants prior to 1950, 19 percent, can be attributed to the fact that the longer a dentist remains out of State, the less likely he is to renew his license in the State he has left. April 1966 235 Appendix Table A.--Summary Statistics Used in Text Number of dentists Total dentists licensed in Maryland, January, 1965 2,130 Respondents -- total dentists participating in survey 1,982 (number not reporting current location or military status - 8) Civilian dentists in Marylandl/ (designated simply as 1,312 "dentists" in text tables) (number not reporting: age - 4, county loca- tion - 7, principal current employment - 6) Professionally active dentists?! 1,271 In limited practice= 156 Dental practitioners 1,253 Located in Maryland last year: 5/ Reported professional activity= 1,171 Dentists providing patient careb/ 1,141 Reported time spent in patient carel/ 974 Dentists in private practice= 1,059 Reported time spent in practice?/ 906 Out-of-State dentists -- civilian respondents not located in Maryland 513 1/ All responding dentists who currently work in Maryland (excluding those in the Armed Forces) or who are retired and currently live in the State. 2/ All active civilian dentists currently in Maryland -- excludes 28 dentists who are fully retired, 7 who are engaged principally in a nondental activ- ity, and 6 who did not report their principal current activity. 3/ Dentists who reported they limited their practice to a dental specialty. 4/ All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 5/ Dentists located in Maryland last year who indicated type(s) of activity in which they engaged. 6/ All dentists who engaged in patient care last year, either as a primary or secondary activity. 7/ Dentists reporting both hours and weeks spent in patient care last year. 8/ Dentists who reported they were primarily self-employed both currently and last year. 9/ Dentists reporting both hours and weeks spent last year as a self- 236 employed dentist. Appendix Table B.--County Data Civilian Active Persons Percent of active dentists County population civilian per Under 55 years Using (in 000's) dentists=/ dentist 40 or more auxiliaries All counties 3,444.3 1,271 2,710 38 23 71 Allegany 85.5 32 2,669 31 28 81 Anne Arundel 247.3 55 4,496 45 22 69 Baltimore 549.0 109 5,037 44 15 68 Baltimore City 925.1 485 1,919 26 35 66 Calvert 18.7 4 4,675 25 75 33 Caroline 19.2 6 3,200 20 60 83 Carroll 57.6 21 2,743 48 19 67 Cecil 55.8 8 6,975 25 50 63 Charles 36.7 4 9,175 50 25 100 Dorchester 31.0 7 4,429 14 43 71 Frederick 78.3 28 2,796 43 25 78 Garrett 22.0 4 5,500 75 0 50 Harford 89.5 25 3,580 44 16 69 Howard 44.9 8 5,613 75 12 43 Kent 18.1 5 3,620 40 20 100 Montgomery 412.3 249 1,656 48 9 78 Prince Georges 466.2 139 3,354 55 6 77 Queen Annes 17.5 2 8,750 0 50 100 St. Mary's 44.2 8 5,525 50 25 100 Somerset 19.6 2 9,800 100 0 100 Talbot 25.5 10 2,550 40 30 80 Washington 101.6 26 3,908 35 27 77 Wicomico 54.1 20 2,705 14 29 72 Worcester 24.7 7 3,529 29 0 86 1/ Excludes dentists reporting themselves wholly retired or engaged exclusively in nondental employment (and those who failed to indicate the nature of their current activity). The total includes seven den- tists who failed to indicate their county location. 237 MASSACHUSETTS DENTISTS LICENSED IN MASSACHUSETTS 0f the 3,953 dentists who registered with the Board in January 1965, a total of 3,620, or 92 percent, completed the questionnaire (Table 1). About 87 percent of the responding dentists were civilians located in Massachusetts at the time of the survey. Civilians located in other States accounted for 9 percent of the respondents, and 4 percent were dentists on active duty with the Armed Forces. Only 33 of the respond- ing dentists were women, and all but 5 were located within the State. Table 1l.--Location and Military Status of Dentists Licensed in Massachusetts Location and All Percent of military status dentists dentists Total licensed 3,953 100 Respondents 3,620 92 Nonrespondents 333 8 Respondents 3,620 100 Civilians in Massachusetts 3,159 87 Civilians in another State 327 9 On active duty with Armed Forces 132 4 Not reported 2 %* * Less than one-half of one percent. For the 333 dentists not responding to the survey, location and military status, as well as certain other items of information, were obtained from the 1966 American Dental Directory, published by the American Dental Association, and from records maintained by the Commonwealth of Massachu- setts Board of Registration of Dental Examiners. Because the survey response rate was high, the data presented in this report are limited to responding dentists with the exception of the discussion of age of the dentists where the nonrespondent data are known to differ from the respondent data. Almost three-fourths (73 percent) of the responding dentists are licensed only in Massachusetts. Twenty-one percent are licensed in just one other State, and 6 percent are licensed in two or more additional States. In total, the number of licenses held by Massachusetts respondents exceeds 4,800. For civilian dentists actually located in the State, the percent- age licensed only in Massachusetts is a high 81 percent. Multiple licensure is more common among civilian dentists who are located in other 239 States. While licenses are held in two or more other States by only 3 percent of the in-State dentists, over one-third of all out-of-State dentists are licensed in at least two other States in addition to Massachusetts. Civilian Dentists in Massachusetts Sources of Supply Dental schools.--The two dental schools in Massachusetts have trained two-thirds of the State's total dentist supply (Table 2). Tufts Univer- sity has made the largest contribution, accounting for more than half of the total dental force, while Harvard University, with a considerably smaller contribution, has trained about one-sixth of the dentists. Another one-fifth of the dental force are graduates of 9 dental schools located in 3 Eastern States--New York, Pennsylvania, Maryland--and the District of Columbia. Among these schools, the University of Maryland and Georgetown University are the major contributors, having between them trained one of every 10 dentists in the State. Other dental schools in these States which have made important contributions to the Massachu- setts dentist supply include the University of Pennsylvania, followed by Table 2.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Dental school of AIT After 1941- 1940 or dentists years 1955 1955 earlier Total number 3,150 - 785 1,087 1,268 (Percent distribution by school) Tufts 1,641 52 48 54 54 Harvard 496 16 7 9 27 Maryland 186 6 7 5 6 Georgetown 143 4 9 5 1 Pennsylvania 118 4 5 5 2 New York University 62 2 3 3 * Temple 61 2 3 2 1 44 other schools 437 14 18 17 9 * Less than one-half of one percent. 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. For each item where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table A.) 240 New York and Temple Universities. The remaining one-eighth of Massachu- setts dentists are graduates of 40 other dental schools, including 6 Canadian schools, and 2 schools (Barnes and Ohio Colleges) which are no longer in existence. Schools in the North Central States have contributed a large proportion of these dentists, led by Loyola University of Chicago, St. Louis University, and Northwestern, which account for about 43 den- tists each. The only other school to contribute as many as 35 of the State's dentists is McGill University in Montreal. One-fourth of the State's dentists have graduated from dental school within the last 10 years. By comparison, a full 40 percent were graduates during the years prior to World War II. The proportionate contribution of the various schools to the Massachusetts dentist supply has changed over the years. The two dental schools in Massachusetts trained four-fifths of the graduates prior to 1941, but only 55 percent of the dentists who are graduates of the past 10 years. The sharpest decline has occurred in the role of Harvard University as a source of dentist supply. Over one-fourth of all dentists in the State who were graduated prior to World War II com=- pleted their dental education at Harvard University; but among graduates of the past 10 years now located in Massachusetts, only one of every 14 are Harvard graduates. The contribution of Tufts University has decreased slightly from 54 percent of the dentists graduating prior to 1955 to 48 per- cent of those who graduated in later years. The reduced contribution of the Massachusetts schools has been partially compensated for by increases from other eastern schools in New York, Pennsylvania, Maryland and the District of Columbia. About 29 percent of those dentists graduating in the past 10 years are from these schools in contrast to 12 percent of those who graduated prior to World War II. A small increase has also taken place in the proportion of graduates from dental schools located in the North Central States. These schools have supplied 10 percent of the State's dentists since 1955, compared to 4 percent of the graduates prior to 1941. Dentists relocating in Massachusetts.--Only 127, or 4 percent, of the den- tists in Massachusetts reported practicing as a civilian in another State immediately prior to assuming their present location in Massachusetts. The nearby States of New York, Pennsylvania, Rhode Island, and Connecticut have together contributed almost one-half (46 percent) of these dentists. The remaining in-migrants were formerly located in 24 other States, the District of Columbia or abroad. More than 30 percent of the in-migrant dentists came to Massachusetts in 1960 or later, and another 35 percent moved to the State during the 1950's. Personal Characteristics Age.--The median age of reporting dentists was 47.1 years. The propor- tion of dentists 55 years of age or older was almost twice as great as the proportion under 35 (Table 3). One-fifth of the total supply--654 dentists--were 65 years old or over, and in this group were 370 who were at least 70 years old, including 163 who had reached the age of 75. 241 Table 3.--Age Distribution . Number Percent Age in 1965 of of dentists dentists Total 3,159 100 Under 35 577 18 35 - 39 388 12 40 - 44 436 14 45 - 49 401 13 50 - 54 259 8 55 - 59 176 6 60 - 64 242 8 65 - 69 284 9 70 & over 370 12 Dentists not responding to the survey were older than the respondents, with a median age more than 7 years higher--54.9 years. Moreover, better than one-third of the nonrespondents were 65 or over, a proportion con- siderably greater than among respondents. Presumably, a substantial number of retired dentists elected not to return the survey questionnaire. Advanced training.--Almost 30 percent of Massachusetts' dentists have taken one or more years of advanced clinical or academic training (Table 4). By far the greatest proportion, 15 percent, have taken clinical training as an intern or resident, while 7 percent reported academic training as a graduate or postgraduate student. Another 7 percent reported completion of both clinical and academic training. Table 4.--Advanced Training Highest level of training Number Fercent completed dentists dentists With advanced training 927 29 Clinical training only 473 15 Academic training only 226 7 Both clinical and academic 228 7 Clinical training Residency completed 166 5 Internship completed 535 17 Academic training Ph.D., M.D., or other doctor's degree 29 1 M.A., M.S., or other master's degree 102 3 Postgraduate 1 year or more (no degree) 323 10 242 The State's young dentists are more likely than their older colleagues to seek additional training after receiving their dental degrees. Differ- ences by age groups are particularly striking when academic training is considered. Almost one in every four dentists under 40 has had a year or more of graduate or postgraduate study, compared with one of every 7 den- tists between 40 and 54, and only one in every 16 of those 55 and over. Distribution and Current Status Distribution of dentists.--Massachusetts has been divided into five regions for the presentation of data on the geographical distribution of dentists. The regional division is based on health service areas as pre- viously developed by the Public Health Service for analyzing the distribu- tion of health services. These boundaries coincide with Rand McNally trading areas, determined by consideration of such factors as physiography, population, economic activities, and transportation. The five regions have been named Boston, Springfield, Worcester, New Bedford, and Pittsfield, based on the largest city contained in each region. Over 70 percent of the 3,159 reporting dentists in Massachusetts are con- centrated in the 5-county Boston region (Table 5). Two counties in this region, Middlesex and Suffolk, together have 43 percent of the State's dentists. Another 23 percent are located in Essex and Norfolk Counties, while only 5 percent are located in Plymouth County. The Springfield region, composed of Hampden, Hampshire and Franklin Counties, has 10 per- cent of the dentist supply. Another 10 percent of the State's dentists are located in the one-county Worcester region. The New Bedford region, formed by Bristol, Barnstable, Dukes and Nantucket Counties, has only 7 percent of the dentist supply. The remaining 2 percent of Massachusetts’ dentists are located in the Pittsfield region, which consists of Berkshire County. Table 5.--Distribution of Dentists by Region and County Region and Number Region and Number county dentists county dentists Boston region 2,228 Worcester region 310 Middlesex 710 Worcester 310 Suffolk 636 Norfolk 373 New Bedford region 226 Essex 351 Bristol 165 Plymouth 158 Barnstable 57 Dukes 2 Springfield region 317 Nantucket 2 Hampden 240 Hampshire 43 Pittsfield region 78 Franklin 34 Berkshire 78 243 Geographical differences in age.--The median age of dentists by region varies slightly, ranging from 45.6 in Springfield to 48.7 in Worcester (Table 6). Age differences among individual counties within the regions, however, are much more pronounced. For example, the median age of den- tists in Suffolk County is 52.6 years. Moreover, only 16 percent of the county's dentists are under age 35, and 47 percent are 55 years old or over, including 30 percent who are at least 65. As the central section of the Boston metropolitan area, Suffolk County represents the location of long-established dentists who tend to be concentrated in the hub of large metropolitan areas. By contrast, the median age of dentists in Plymouth County, in the same region, is 43.0 years; 29 percent of its dentists are under 35 years of age, and only 30 percent have reached the age of 55. Similarly, dentists in the remaining three counties of the Boston region are considerably younger than those located in the city of Boston. In the Springfield region, Franklin County has the youngest dentists, with a median age of 44.3 years. By comparison, dentists in Hampshire County are, on the average, more than six years older--50.8 years. An even sharper contrast in age distribution is presented by counties in the New Bedford region. The median age of dentists in Bristol County is 45.5 years and only 26 percent have reached the age of 55. In Barnstable County, however, the median age is 60.0 years and 54 percent of the dentists are 55 or older. Table 6.--Median Age by Region and County Region and Median Region and Median county age county age Boston region 47.0 Worcester region 48.7 Plymouth 43.0 Worcester 48.7 Middlesex 44.4 Norfolk 45.6 New Bedford region 47.0 Essex 47 .2 Bristol 45.5 Suffolk 52.6 Barnstable 60.0 Dukes * Springfield region 45.6 Nantucket * Franklin 44.3 Hampden 45.1 Pittsfield region 48.2 Hampshire 50.8 Berkshire 48.2 * Median not shown because of small number of dentists. Professional status.--Nearly all dentists in Massachusetts are active in the profession. Only 3 percent reported themselves either fully retired or engaged primarily in some type of nondental employment. As would be expected, a majority of the retired dentists are in the older age groups, but most of the older dentists who responded to the survey are at least partially active. Even among dentists 75 years old and over, only one- fifth reported that they are fully retired. 244 Active dentists in relation to population.--Based on the activity status of responding dentists, there was one professionally active dentist for every 1,766 persons in Massachusetts in 1965. The Boston region, with 1,629 persons per dentist, has the most favorable ratio in the State. At the other extreme, the New Bedford region has the least favorable ratio, with 2,388 persons for every active dentist (Table 7). There is much greater variation in the ratios among the individual coun- ties. Suffolk County, with 1,219 persons per dentist, has the most favor- able ratio in the Boston region as well as in the State. However, since a relatively large number of the dentists in this county are in the older age groups, the ratio probably tends to overstate the amount of dentist manpower available. The number of persons per dentist increases to 1,567 in Norfolk County and 1,735 in Essex County. The two remaining counties in this region, Plymouth and Middlesex, have still higher ratios of 1,897 and 1,916 which exceed the average for the State. In the Springfield region the number of persons per dentist varies from a relatively favor- able ratio of 1,635 in Franklin County to ratios of 1,989 and 2,607 in Hampden and Hampshire Counties which exceed the State average. The den- tist manpower available for Hampshire County is actually less favorable than suggested by its ratio since the dentists in this county are older as a group than the dentists in all but two counties in the State. In the 4-county New Bedford region, only Barnstable County has a persons-per=- dentist ratio more favorable than the State average. However, the dental service available in this county, as expressed by the ratio of 1,632 per- sons per dentist, tends to be overstated since a very large proportion of the dentists are in the older age groups. Although the 1,800 persons per dentist in Nantucket County only slightly exceeds the average for the State, the ratios of 2,631 and 2,900 in Bristol and Dukes Counties are the highest persons-per-dentist ratios in the State. The l-county Table 7.--Persons Per Dentist by Region and County . Persons . Persons Region and Region and county per county per dentist dentist Boston region 1,629 Worcester region 2,001 Suffolk 1,219 Worcester 2,001 Norfolk 1,567 Essex 1,735 New Bedford region 2,388 Plymouth 1,897 Barnstable 1,632 Middlesex 1,916 Nantucket 1,800 Bristol 2,631 Springfield region 2,035 Dukes 2,900 Franklin 1,635 Hampden 1,989 Pittsfield region 1,921 Hampshire 2,607 Berkshire 1,921 245 Worcester region has 2,001 persons per dentist and the Pittsfield region, consisting of Berkshire County, has 1,921, both of which are less favor- able than the average for the State. Professional Characteristics Current employment.--Of the 3,047 responding dentists who reported that they were professionally active at the time of the survey, 93 percent are primarily engaged in private practice, including 91 percent who are self- employed and 2 percent who are employed by another dentist. Another 2 percent of the State's dentists are on the staffs of the dental schools at Harvard and Tufts Universities. The remaining 5 percent are either employed by Federal, State or local government agencies, or are engaged in other dental activities, including advanced clinical or academic train- ing. Almost one in every five active dentists reported one or more secondary dental activities in addition to his principal professional employment. Part-time teaching in a dental school was the most frequently reported secondary employment. A variety of other secondary dental activities were reported, such as part-time employment in the practices of other dentists, providing dental care in hospitals, clinics, or schools, and serving as consultants to the Veterans Administration. Activity last year.--About 97 percent of the dentists in Massachusetts who reported on their professional activity last year indicated they had provided care for patients. This activity accounts for 95 percent of the total reported professional time. About 11 percent of the dentists reported they spent some time in teaching and 3 percent reported some time in research, but only 2 percent of professional time was spent in these activities. Approximately 7 percent devoted some time to other dental activities, such as taking advanced training, but only 3 percent of profes- sional time was spent in these activities. Weeks and hours worked.--More than half of the dentists reporting on time spent last year in providing patient care spent at least 40 hours per week at this activity for 48 weeks or more during the year. Furthermore, almost one dentist in seven worked the equivalent of six days a week (48 hours or more) for at least 48 weeks. The amount of time worked by dentists in private practice last year declined sharply with increasing age. Two-thirds of the dentists under 35 years of age report working at least 48 weeks and at least 40 hours per week. The proportion working this amount of time declines to 56 per- cent for those between 45 and 54 years old and decreases sharply to 27 per- cent among those 65 years old or over. Probably an even smaller proportion of all dentists 65 and over actually work this amount of time since about one-third of these dentists, including those who are likely to be least active, did not report on time spent in their practices. 246 Limited practice.--About one dentist in every eight reported that his practice is limited to a dental specialty, primarily orthodontia and oral surgery. Of the 354 specialists in the State, 269, or three-fourths, are located in the Boston region. Among individual counties in the State, Norfolk and Suffolk in the Boston region have the highest proportion of dentists who are specialists, 16 percent in each county. Specialization occurs least frequently in Hampshire and Barnstable Counties, where only 8 and 9 percent, respectively, of the dentists reported limiting their practices. Use of auxiliaries.--Sixty-three percent of the dentists in Massachusetts employ one or more auxiliaries. Almost all who do so, however, employ at least one on a full-time basis. Only 7 percent reported that they employ part-time personnel exclusively. Dental assistants are more frequently employed than any other type of auxiliary, being utilized by 54 percent of all dental practitioners. Dental hygienists are employed by 22 per- cent of the dentists. By far the majority of the dentists employing assistants do so on a full-time basis, while more than half of those who employ hygienists utilize these auxiliaries only part time. One practi- tioner in 5 employs a secretary or receptionist, but only one in 25 employs a laboratory technician in his office. By region, the proportion of dentists employing auxiliaries varies only from 62 percent in the Boston region to 66 percent in the Pittsfield and Springfield regions. Individual county differences are more pronounced, however (see Appendix Table B). Hampden County in the Springfield region has the highest proportion of dentists using auxiliaries--71 percent. Bristol County in the New Bedford region has an almost equal proportion, with 70 percent. The same region contains the county with the lowest proportion in the State--Barnstable, where only 43 percent of the dentists employ auxiliaries. Auxiliary utilization also varies with the age of the dentist. The peak utilization occurs among practitioners between the ages of 35 and 44. About 78 percent of the dentists in this age group employ auxiliaries. In contrast, auxiliaries are utilized by only 36 percent of the practi- tioners 65 years old or over. Similarly, among the dentists under the age of 30 who are just starting their practices, only 41 percent report the employment of one or more auxiliaries. About 9 percent of the responding dentists in Massachusetts reported one or more vacant positions for auxiliary personnel. Of these dentists, about 32 percent reported vacancies for full-time hygienists and 24 per- cent reported vacancies for full-time dental assistants. Nine of every 10 dentists reporting a vacancy already employ at least one auxiliary. 247 386-029 O - 70 - 17 Out-of-State Dentists Massachusetts licenses are maintained by at least 327 civilian dentists located in 33 States, the District of Columbia and Puerto Rico. Fifty- one percent of these out-of-State dentists are located in the five adjacent States of New York, Connecticut, Rhode Island, New Hampshire, and Vermont (Table 8). Maine, New Jersey, Pennsylvania, Florida, and California are the only nonadjacent States in which more than 10 of the out-of=-State dentists are currently located. One half of all out-of-State dentists graduated from dental schools located in Massachusetts--39 per- cent from Tufts University and 11 percent from Harvard University. Table 8.--Out-of-State Civilian Dentists, by Present Location Number Percent Present location of of dentists dentists Total 327 100 Adjacent States 167 51 New York 53 16 Connecticut 42 13 Rhode Island 34 11 New Hampshire & Vermont 38 11 Nonadjacent States 160 49 Out-of-State dentists are younger than those presently in Massachusetts. While as many as one-half of the out-of-State dentists are under 35 years of age, less than one-fifth of the dentists in Massachusetts are in this young age group. Furthermore, only 13 percent of the out-of-State den- tists are 55 years old or over, compared with 35 percent of the in-State dentists. Only 47 dentists, or 14 percent of the out-of-State respondents, reported that they had formerly been professionally active in Massachusetts. Of these dentists, about one-half are now located in adjacent States, and the other half are in 10 more distant States and the District of Columbia. Among the 47 out-migrant dentists who still maintain a license in Massachu- setts, approximately three out of every five reported leaving the State after 1960. Although this proportion appears high, it is probably over- stated because dentists who moved from the State in recent years are more likely to renew their license than dentists who have been out of Massachu- setts for a longer period of time. June 1967. 248 Appendix Table A.--Summary Statistics for Massachusetts Number of dentists All licensed dentists 3,953 Respondents -- total dentists participating in survey 3,620 (number not reporting current location or military status =- 2) Civilian dentists in Massachusettsl/ -- civilian respondents designated simply as ''dentists' in text tables 3,159 (number not reporting: age - 26, principal current employment - 6) Professionally active dentists?! 3,047 Dental practitionerss/ 2,959 In limited practice®/ 354 Located in Massachusetts last year: Reported professional activity! 2,689 Dentists providing patient cared’ 2,605 Reported time spent in patient carel/ 2,101 Dentists in private practiced’ 2,485 Reported time spent in practice?/ 1,978 Out-of-State dentists -- civilian respondents not located in Massachusetts 327 Dentists on active duty in Armed Forces 132 Nonrespondents -- licensed dentists not participating in survey 333 All responding dentists who currently work in Massachusetts (excluding those in the Armed Forces) or who are retired and currently live in the State. All active civilian dentists currently in Massachusetts -- excludes 92 dentists who are fully retired, 14 who are engaged principally in a non-dental activity, and 6 who did not report their principal current activity. All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. Dentists who reported they limited their practice to a dental specialty. Dentists located in Massachusetts last year who indicated type(s) of activity in which they engaged. All dentists who engaged in patient care last year, either as a primary or secondary activity. Dentists reporting both hours and weeks spent in patient care last year. Dentists who reported they were primarily self-employed both currently and last year. Dentists reporting both hours and weeks spent last year as a self- employed dentist. 249 Appendix Table B.--Selected Data for Massachusetts Counties Percent of active dentists Professionally Populatjon Persons By ane Using County active (000) per active Under 55 years auxili- dentists dentist 40 d . vears and over aries Total 3,047 5,380.6 1,766 32 32 63 Barnstable 50 81.6 1,632 24 47 43 Berkshire 76 146.0 1,921 14 28 66 Bristol 156 410.4 2,631 23 22 70 Dukes 2 5.8 2,900 - - 50 Essex 344 596.7 1,735 34 33 66 Franklin 34 55.6 1,635 32 21 61 Hampden 230 457.5 1,989 32 25 71 Hampshire 42 109.5 2,607 29 43 45 Middlesex 689 1,319.8 1,916 38 28 64 Nantucket 2 3.6 1,800 - 50 - Norfolk 362 567.2 1,567 37 24 68 Plymouth 147 278.8 1,897 47 27 65 Suffolk 612 745.8 1,219 24 46 53 Worcester 301 602.3 2,001 28 38 64 1/ Copyright 1965, Sales Management Survey of Buying Power; further reproduc- tion is forbidden. 250 MICHIGAN DENTISTS LICENSED IN MICHIGAN During the 1965 registration period, 5,010 dentists registered with the Michigan State Board of Dentistry. Eighty-one percent of these dentists are civilians located in Michigan, another 14 percent are civilians lo- cated in other states, and 5 percent are on active duty with the Armed Forces. Survey questionnaires were completed by 4,860 dentists, 97 percent of all those registered. For nonrespondents, data as to location, age, dental school attended, and year of graduation has been obtained, where possible from records of the Michigan State Board of Dentistry or from the 1966 American Dental Directory, published by the American Dental Association. 3 Location and Military Status of Dentists Licensed in Michigan Location and All Percent of military status dentists dentists Total licensed 5,010 100 Respondents 4,860 97 Nonrespondents 150 3 Total licensed 5,010 100 Civilians in Michigan 4,039 81 Respondents 3,938 - Nonrespondents 101 - Civilians in another state 712 14 On active duty with Armed Forces 257 5 Not reported 2 * * Less than one-half of one percent. About one-fourth of all survey respondents hold a license to practice dentistry in one or more other states. Only 13 percent of the dentists located in Michigan hold more than one license, with 11 percent licensed in one other state and a mere 2 percent licensed in two or more other states. Multiple licensure is much more common among dentists register- ing in Michigan but located out of State; 21 percent hold two or more licenses in addition to their Michigan license. 251 DENTAL SCHOOL ATTENDED The great majority of Michigan's dentists--8 of every 10--have graduated from one of the two in-state dental schools. The University of Michigan, the majo: contributor, has supplied almost 2,100 dentists, or more than half the total dental force. The University of Detroit, even though its contribution is con- siderably smaller, has nevertheless trained more than one-fourth of the den- tists. In addition, 15 schools in other North Central States have together trained 14 percent of Michigan's dentists. Among these schools, Marquette, Northwestern,and Loyola Universities have been the largest contributors, pro- viding a total of about 400 dentists, or 10 percent of the Michigan dental force. Dental School Attended and Year of Graduation for Dentists in Michigan Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 4,039 1 1,097 1,445 1,404 (Percent distribution by school Schools in Michigan 3,216 80 88 81 74 University of Michigan 2,084 52 45 45 65 University of Detroit 1,132 28 43 36 9 Schools in other North Central States 573 14 9 12 21 Marquette University 163 4 3 3 7 Northwestern University 124 3 1 3 5 Loyola University of Chicago 111 3 2 3 4 12 other schools 175 4 3 3 5 28 schools located elsewhere 215 6 3 7 5 1/ Dental school attended not available for 35 dentists and year of gradu- ation for 93 dentists. The proportionate contribution of in-state dental schools to the Michigan den- tist supply has increased somewhat in recent years. These two schools have provided almost 90 percent of the dentists in the State who graduated since 1955, compared to 74 percent of those who completed their dental education prior to World War II. At the same time,- the contribution of other schools in the North Central States has declined considerably. The University of Detroit has contributed substantially to the Michigan den- tist supply since its establishment in the mid-1930's. Since that time there has been some decrease in the relative contribution of the University of Michigan. As a result, the contributions of the two schools have become ap- proximately equal in recent years--43 percent and 45 percent, respectively, among dentists who graduated after 1955. 252 DISTRIBUTION OF DENTISTS More than eight in ten of the 4,039 dentists in Michigan are located in the 11 metropolitan areas of the State. The 3-county Detroit area alone has 2,125 dentists, over half of the total dental force. While a substantial majority of these dentists (1,511) are in Wayne County, where Detroit is located, the other two counties in the area (Oakland and Macomb) also have a sizable number of dentists, 419 and 195, respectively. The Grand Rapids metropolitan area has the second largest dental force, but comprises only 7 percent of the State supply. The next largest dental forces are found in the Flint area, which has 5 percent of the dentists, and in the Ann Arbor and Lansing areas, which have 4 percent each. The areas of Kalamazoo, Saginaw, Muskegon,and Jackson each account for approximately 2 percent of the State's dentists. The remaining two metropolitan areas--Bay City and the Michigan portion of the interstate Toledo area (Monroe County)--each have about one percent of the total supply. Distribution of Michigan Dentists, by County Group Number Number Percent County group® of of of counties dentists dentists All counties 83 4,039 100 Metropolitan areas 17 3,287 81 Detroit area 3 2,125 52 Grand Rapids area 2 267 7 Flint area 2 185 5 Ann Arbor area 1 177 4 Lansing area 3 160 4 6 other areas 6 373 9 Nonmetropolitan counties 66 752 19 Central city 10,000-49,999 15 380 10 Central city 5,000 - 9,999 16 195 5 Central city - under 5,000 35 177 4 * See Appendix Table for complete listing and definition of metropolitan areas and presentation of individual county data. Only 19 percent of Michigan's dentists are located in the 66 nonmetropolitan counties of the State. One-half of these dentists are located in the 15 counties with central cities of 10,000 or more persons. Two of these coun- ties--Calhoun and Berrien--have more than 60 dentists, and three--St. Clair, Midland,and Lenawee--have at least 30 dentists. Only three of the counties in this group have fewer than 10 dentists. The 51 counties with less than 10,000 persons in their central cities have 9 percent of the dentist sup- ply. Only 12 of these counties have more than 10 dentists, while 18 have fewer than 5 dentists. 253 AGE OF DENTISTS AND DIFFERENCES IN AGE BY AREA With slightly more than one-half of the dentists under 45 years of age, the median age of dentists in Michigan is 44.3 years. Over one-third of the State's dentists are under 40 years of age, including 20 percent who are under 35. On the other hand, 30 percent are 55 years of age or older. Over 500 dentists, 13 percent of the total, are 65 or over, including 224 who have reached the age of 70. Age Distribution of Michigan Dentists Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 4,039 1/ 100 - Under 30 238 6 6 30 - 34 568 14 20 35 - 39 606 15 35 40 - 44 647 16 51 45 - 49 389 10 61 50 - 54 301 8 69 55 = 59 351 9 78 60 - 64 336 9 87 65 - 69 282 7 94 70 & over 224 6 100 1/ Age not available for 97 dentists. Percents based on total for whom age is known. The median age of dentists in metropolitan areas is 44.0 years, more than two years younger than the median of 46.3 years for dentists in the non- metropolitan counties. Median ages vary considerably among the metropolitan areas. The areas of Lansing and Ann Arbor have the youngest dentists, with median ages of 42.2 and 42.7 years, respectively, while the oldest dentists are found in the Bay City area, where the median age is 46.3 years. The Kalamazoo and Grand Rapids areas have the next oldest dentists, with median ages of approximately 45 years. In the Detroit area, the median age is 44.2 years, approximately equal to the State average. Age differences among the counties in the Detroit area are quite pronounced, with older dentists concentrated in Wayne County, the hub of the area. The median age of dentists in this county is 46.4 years, while dentists in Oakland County average about 4 years younger, with a median age of 42.2 years, and those located in Macomb County have a still lower median age of 38.4 years. 254 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 4,039 licensed dentists in Michigan, 3,897, or 96 percent, are active in their profession, giving Michigan one professionally active dentist for every 2,120 persons. There is one dentist for every 1,992 persons in the metropolitan areas, while the remainder of the State has a less favorable ratio of one den- tist for every 2,681 persons. Number of Persons per Active Dentist in Michigan Professionally Persons County group* active Population per dentists dentist All counties 3,897 8,259,700 2,120 Metropolitan areas 3,178 6,332,100 1,992 Detroit area 2,054 3,969,900 1,933 Grand Rapids area 259 493,400 1,905 Flint area 181 456,100 2,520 Ann Arbor area 169 190,000 1,124 Lansing area 155 323,700 2,088 6 other areas 360 899,000 2,497 Nonmetropolitan counties 719 1,927,600 2,681 Central city 10,000-49,999 370 909,700 2,459 Central city 5,000- 9,999 182 505,500 2,777 Central city - under 5,000 167 512,400 3,068 * See Appendix Table for data pertaining to individual metropolitan areas and counties. The 3-county Detroit metropolitan area has a persons-per-dentist ratio of 1,933. Both Wayne County, the hub of the area, and Oakland County have ratios of approx- imately 1,860, while Macomb County has a somewhat less favorable ratio of 2,600. The best ratio in the State, 1,124 persons per dentist, is found in the Ann Arbor area, where the University of Michigan School of Dentistry is located. Among the other metropolitan areas, three have ratios more favorable than the State aver- age-=Grand Rapids, Kalamazoo, and Lansing. Two metropolitan areas--Jackson and Saginaw--have persons-per-dentist ratios between 2,200 and 2,500, and three areas--Flint, Muskegon,and Bay City--have ratios between 2,500 and 2,900. The remaining area, Monroe County, an outlying county in the Toledo metropolitan area, has a persons-per-dentist ratio exceeding 4,500. Of the 66 nonmetropolitan counties of the State, 15 have persons-per-dentist ratios under 2,000. Yet there are 30 counties with ratios of more than 3,000, including 15 with ratios in excess of 4,000 persons per dentist, and 3 counties that have no dentists, according to available information. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The group of counties with central cities of 10,000 or more inhabit- ants have an average ratio of 2,459, while counties with central cities of less than 5,000 population average over 3,000 persons per dentist. 255 UTILIZATION OF AUXILIARIES More than eight out of ten dental practitioners in Michigan (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel, including 71 percent who employ at least one auxiliary on a full- time basis. The most frequently employed auxiliary is the dental assistant. Three-fourths of the practitioners reported the use of an assistant, includ- ing 64 percent who utilize at least one full time. About one-fourth of the dentists employ secretaries or receptionists, usually on a full-time basis. Only 19 percent employ dental hygienists,and 7 percent employ dental labora- tory technicians, usually only part time. Michigan Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 3,743 100 71 11 One or more auxiliaries 3,016 82 71 11 Assistant 2,729 75 64 11 Hygienist 701 19 7 12 Laboratory technician 245 7 2 5 Secretary or receptionist 879 24 15 9 Other type of personnel 85 2 1 1 No auxiliary 643 18 - - 1/ Includes 84 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist and tends to be more common among younger dentists. Ninety percent of Michigan dentists between the ages of 30 and 44 employ some type of auxiliary. The proportion using auxiliaries decreases to 80 percent among dentists 45 to 64 years old and to only 52 percent among dentists 65 and over. Young dentists who are just starting their practices do not reach peak utilization of assistants until they are at least 30 years of age,and of hygienists,until age 35. Some 18 percent of the dental practitioners in Michigan reported one or more vacant positions for auxiliary personnel. Of those reporting vacancies, 34 percent indicated a need for full-time hygienists, and 24 percent reported vacancies for full-time dental assistants. 256 OTHER SURVEY FINDINGS /”7] One of every six survey respondents, 632 dentists,reported that they had completed one year or more of advanced training since receiving the dental degree. Of 499 dentists with advanced academic training, 329 reported having a master's or other advanced degree, and another 170 dentists received no additional degrees but completed one or more years of postgraduate study. Among the 246 dentists reporting advanced clinical training, 130 had completed an internship and 116 a residency. There were 113 dentists who had completed at least a year of both academic and clinical training. 7 Ninety-five percent of the responding professionally active dentists in Michigan are primarily engaged in private practice, with 94 per- cent self-employed and one percent employed by another dentist. Two percent are on the staffs of dental schools, another one percent are employed by governmental agencies, and the remaining two percent are engaged in other dental activities, such as taking advanced training. [7 At least one part-time dental activity in addition to their principal employment was reported by 9 percent of the dentists. Part-time teaching in a dental school was the most frequently reported second- ary employment. A variety of other secondary activities were reported, such as part-time employment by a governmental agency, employment in the private practice of another dentist, and assistance to a volun- tary agency. /”7 Dentists reporting time spent in patient care devoted an average of 39.6 hours per week to this activity for 47.2 weeks during the year preceding the survey. About one dentist in eight worked the equiv- alent of 6 days a week, 48 hours or more, for at least 48 weeks. /~7 About 11 percent of the dentists in Michigan reported that they limit their practice to a dental specialty, primarily orthodontics or oral surgery. Dental specialists are more likely to be located in a metro- politan area than in a nonmetropolitan county. While one in every nine dentists practicing in a metropolitan area limits his practice, in nonmetropolitan counties only one in every 17 dentists does so. 7 Of the 712 dentists licensed in Michigan but located out of State, approximately 22 percent are located in the neighboring states of Ohio, Illinois, Wisconsin,and Indiana. The remaining out-of-state dentists are scattered throughout 43 other states, with the largest numbers in California and Florida. April 1968. 257 8G¢C APPENDIX TABLE Selected Data on Dentists in Michigan, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total °C io respond- Percent Percent sionally (in 000's) active © ents under 35 55 & over active dentist All counties 4,039 3,938 101 20 30 3,897 8,259.7 2,120 Metropolitan areas 2/ 3,287 3,199 88 20 29 3,178 6,332.1 1,992 Detroit area 2,125 2,062 63 20 30 2,054 3,969.9 1,933 Macomb 195 191 4 34 13 192 502.7 2,618 Oakland 419 407 12 23 20 407 758.7 1,864 Wayne 1,511 1,464 47 18 35 1,455 2,708.5 1,862 Grand Rapids area 267 260 7 19 30 259 493.4 1,905 Kent 222 216 6 18 32 214 387.0 1,808 Ottawa 45 44 1 26 19 45 106.4 2,364 Flint area 185 184 24 29 181 456.1 2,520 Genesee 171 171 - 25 29 167 412.0 2,467 Lapeer 14 13 1 14 29 14 44.1 3,150 Lansing area 160 157 23 23 155 323.7 2,088 Clinton 9 9 - 22 33 9 43.2 4,800 Eaton 22 22 - 32 27 20 53.2 2,660 Ingham 129 126 3 21 21 126 227.3 1,804 Saginaw area 87 84 3 18 28 83 200.3 2,413 Saginaw 87 84 3 18 28 83 200.3 2,413 Ann Arbor area 177 172 5 25 23 169 190.0 1,124 Washtenaw 177 172 5 25 23 169 190.0 1,124 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Michigan, by Location Civilian dentists Persons County group Respond- Non=- Age in 1965 Profes- Population = per and county Total op respond- Percent Percent sionally (in 000's) active ents under 35 55 & over active dentist Metropolitan areas 2/ (cont'd.) Kalamazoo area 97 94 3 20 27 92 180.2 1,959 Kalamazoo 97 94 3 20 27 92 180.2 1,959 Muskegon-Muckegon Heights area 64 64 - 15 23 63 160.3 2,544 Muskegon 64 64 - 15 23 63 160.3 2,544 Jackson area 61 60 1 20 29 60 137.4 2,290 Jackson 61 60 1 20 29 60 137.4 2,290 Bay City area 40 38 2 21 44 39 111.0 2,846 Bay 40 38 2 21 44 39 111.0 2,846 Toledo area (Mich. part) 24 24 - 13 22 23 109.8 4,774 Monroe 24 24 - 13 22 23 109.8 4,774 Nonmetropolitan counties 3/ 752 739 13 20 36 719 1,927.6 2,681 Central city 25,000-49,999 142 138 4 21 31 138 314.8 2,281 Calhoun 65 62 3 23 37 63 147.0 2,333 Midland 33 32 1 27 27 32 56.4 1,763 St. Clair 44 44 - 14 26 43 111.4 2,591 Central city 10,000-24,999 238 235 3 18 31 232 594.9 2,564 Alpena 14 14 - 31 31 13 30.0 2,308 Berrien 64 64 - 16 25 64 160.2 2,503 6S¢C 09¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Michigan, by Location Civilian dentists / Persons County group Respond- Non=- Age in 1965 Profes- Population =~ per and county Total ehtS respond- Percent Percent sionally (in 000's) active ents under 35 55 & over active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 10,000-24,999 (cont'd.) Chippewa 12 12 - 9 36 12 36.7 3,058 Delta 14 14 - 29 29 14 34.6 2,471 Gogebic 6 5 1 17 67 6 23.0 3,833 Grand Traverse 22 21 1 9 41 22 35.8 1,627 Isabella 13 13 - 31 54 12 36.5 3,042 Lenawee 34 34 - 12 29 31 78.0 2,516 Marquette 26 25 1 19 35 26 61.0 2,346 Menominee 3 3 - 67 33 3 24.4 8,133 Shiawassee 22 22 - 29 19 21 56.0 2,667 Wexford 8 8 - - 25 8 18.7 2,338 Central city 5,000-9,999 195 193 2 24 37 182 505.5 2,777 Barry 8 8 - 50 25 8 30.0 3,750 Branch 15 14 1 13 40 12 35.3 2,942 Cass 8 8 - 43 43 7 38.2 5,457 Cheboygan 6 6 - - 67 5 14.2 2,840 Dickinson 12 12 - - 50 12 24.3 2,025 Emmet 10 10 - 40 30 9 16.1 1,789 Gratiot 11 11 - 18 9 10 38.0 3,800 Hillsdale 8 8 - 25 63 8 34.2 4,275 Houghton 10 9 1 13 50 10 34.6 3,460 Ionia 19 19 - 6 33 17 44.6 2,624 Manistee 13 13 - 38 23 13 19.5 1,500 Mason 12 12 - 27 36 12 22.0 1,833 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Michigan, by Location Civilian dentists Persons Respond- Non- Age in 1965 Profes- Population — per Total ents respond- Percent Percent sionally (in 000's) active ents under 35 55 & over active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 (cont'd.) Mecosta 8 8 - 38 - 8 21.9 2,738 Montcalm 15 15 - 43 50 14 38.0 2,714 St. Joseph 20 20 - 20 50 18 43.0 2,389 Van Buren 20 20 - 30 30 19 51.6 2,716 Central city 2,500-4,999 108 105 3 19 43 103 292.5 2,840 Alger 2 2 - - 50 2 9.0 4,500 Allegan 14 13 1 21 29 14 58.4 4,171 Charlevoix 9 9 - 22 33 8 14.1 1,763 Huron 14 14 - 21 43 11 34.5 3,136 Iron 10 10 - 20 50 10 16.8 1,680 Livingston 18 17 1 22 50 17 41.1 2,418 Luce 4 4 - 25 50 4 7.5 1,875 Mackinac 6 6 - - 33 6 11.1 1,850 Newaygo 7 7 - 29 29 7 25.4 3,629 Otsego 7 6 29 57 7 8.6 1,229 Presque Isle 3 3 - 67 3 13.2 4,400 Schoolcraft 5 5 - 20 80 5 8.4 1,680 Tuscola 9 9 - - 25 9 44.4 4,933 Central city - under 2,500 69 68 16 43 64 219.9 3,436 Alcona 2 2 - 100 1 6.2 6,200 Antrim 7 7 - - 57 6 10.5 1,750 Arenac 4 4 - 50 50 4 9.6 2,400 Baraga 2 2 - - - 2 7.3 3,650 19¢ 29¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Michigan, by Location Civilian dentists Persons Respond- Non- Age in 1965 Profes- Population = per Total ones respond- Percent Percent sionally (in 000's) active ents under 35 55 & over active dentist Nonmetropolitan counties 3/ (cont'd.) Central city - under 2,500 (cont'd.) Benzie 6 6 - - 83 6 7.9 1,317 Clare 5 5 - 20 40 5 12.5 2,500 Crawford 3 3 - - 33 3 5.4 1,800 Gladwin 2 2 - - 100 2 10.5 5,250 Tosco 7 7 - 29 43 7 22.3 3,186 Kalkaska - - - - - - 4.4 - Keweenaw - - - - - - 2.4 - Lake - - - - - - 5.3 - Leelanau 2 2 - 50 - 2 9.8 4,900 Missaukee 1 1 - - - 1 6.4 6,400 Montmorency 1 1 - 100 - 1 4.3 4,300 Oceana 6 6 - 17 17 6 16.6 2,767 Ogemaw 2 2 - - 50 1 9.3 9,300 Ontonagon 2 2 - - - 2 11.1 5,550 Osceola 5 4 1 ‘ 20 40 4 13.7 3,425 Oscoda 3 3 - 33 67 3 3.7 1,233 Roscommon 3 3 - - 100 2 7.5 3,750 Sanilac 6 6 - 17 17 6 33.2 5,533 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Michigan counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of survey data. For the interstate Toledo SMSA, statistics are presented only for dentists located in the Michigan portion. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. MINNESOTA DENTISTS LICENSED IN MINNESOTA During the 1966 registration period, 3,594 dentists registered with the Minnesota Board of Dental Examiners. A total of 3,243 dentists responded to the survey, 90 percent of all those registered. Slightly more than two-thirds of the responding dentists are civilians located in Minnesota, 25 percent are civilians located in other States, and 6 percent are on active duty with the Armed Forces. There were 36 women dentists included among the respondents, 23 of them located within the State. Location and Military Status of Dentists Licensed in Minnesota Location and All Percent of military status dentists dentists Total licensed 3,59 100 Respondents 3,243 90 Nonrespondents 351 10 Respondents 3,243 100 Civilians in Minnesota 2,221 69 Civilians in another State 815 25 On active duty with Armed Forces 196 6 Not reported 11 * % Less than one-half of one percent. About 37 percent of the respondents hold licenses to practice dentistry in one or more other States. Only 15 percent of the dentists located in Minnesota have more than one license, with 13 percent licensed in one other State and a mere 2 percent licensed in two or more other States. The proportion of responding out-of-State dentists holding multiple licenses is considerably greater; approximately 23 percent hold two or more licenses in addition to their Minnesota license. Over one-third (36 percent) of the licenses held outside of Minnesota were issued by adjacent States, including 12 percent in Wisconsin, 10 percent in North Dakota, 8 percent in South Dakota, and 6 percent in Iowa. Another 14 percent of the out-of-State licenses are maintained in California, and the remainder are held in 43 other States and the District of Columbia. 263 386-029 O - 70 - 18 PROFESSIONAL TRAINING Almost nine in every ten of Minnesota's 2,221 responding dentists graduated from the University of Minnesota School of Dentistry. Nearly all of the remainder graduated from 14 schools in other North Central States, includ- ing 3 percent from Marquette University, 2 percent each from Northwestern and Creighton Universities, and 1 percent from Loyola University of Chicago. Only 19 dentists are graduates of schools located in more distant States. Dental School Attended and Year of Graduation for Dentists in Minnesota Dental school Number Year of graduation ttended of All After 1941- 1940 or a dentists years 1955 1955 earlier Total number 2,221 - 540 605 1,073 (Percent distribution by school) University of Minnesota 1,951 88 87 92 86 Schools in other North Central States 250 11 12 7 13 Marquette University 69 3 5 3 2 Northwestern University 41 2 * * 3 Creighton University 40 2 1 1 3 Loyola University (Chicago) 31 1 1 1 2 10 other schools 69 3 5 2 3 11 schools in other States 19 1 1 1 1 1/ Dental school attended not available for 1 dentist and year of graduation for 3 dentists. Percents based on known totals. * Less than one-half of one percent. About one-fourth (24 percent) of the State's dentists have graduated from dental school since 1955. In contrast, almost half (49 percent) received their dental degrees prior to World War II. Over the years, Minnesota's own dental school has consistently contributed the vast majority of the State's dentists. Approximately 14 percent of the survey respondents, 306 dentists, reported that they had completed one or more years of advanced training after receiv- ing the dental degree. Of 230 dentists with advanced academic training, 143 received a master's or other advanced degree, while another 87 received no additional degrees but completed one or more years of advanced work at the postgraduate level. Of the 133 dentists with advanced clinical training, 89 had completed an internship, and 44, a residency. There are 57 dentists who have taken both academic and clinical training. 264 DISTRIBUTION OF DENTISTS Three-fifths of the 2,221 responding dentists in Minnesota are located in the three metropolitan areas of the State. The 5-county Minneapolis- St. Paul area alone has 1,176 dentists, 53 percent of the State supply. More than nine-tenths of these dentists are concentrated in Hennepin and Ramsey Counties, where the twin cities of Minneapolis and St. Paul are located. Another 6 percent of the State's dental force, 127 dentists, are located in the Duluth area (St. Louis County), while the remaining 1 percent are found in the Moorhead area (Clay County). Distribution of Minnesota Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 87 2,221 100 Metropolitan areas 7 1,324 60 Minneapolis-St. Paul area 5 1,176 53 Duluth area 1 127 6 Moorhead area 1 21 1 Nonmetropolitan counties 80 897 40 Central city 10,000-49,999 13 369 16 Central city 5,000-9,999 19 220 10 Central city 2,500-4,999 23 169 8 Central city under 2,500 25 139 6 * See Appendix Table for definition of metropolitan areas and presentation of individual county data. Forty percent (897) of the responding dentists are located in the 80 non- metropolitan counties of the State. The 13 counties with central cities of 10,000 or more persons have 369 dentists, about one-sixth of the total dental force. Two of these counties--Olmsted and Stearns--have more than 40 dentists each, while nine other counties have at least 20 dentists each. The 67 counties with central city populations under 10,000 have one-fourth (528) of the State's supply of dentists. Among these 67 coun- ties, 19 have 10 or more dentists each, yet 15 have fewer than five den- tists. 265 AGE OF DENTISTS The median age of dentists in Minnesota is 49.4 years. Three of every ten dentists (673) are under 40 years of age, and an almost equal propor- tion, 29 percent, are between 40 and 54 years of age. On the other hand, a substantial portion, more than two-fifths, are 55 or over. About one- fourth of the dentists (522) are at least 65 years of age, including 280 who have reached the age of 70. Age Distribution of Minnesota Dentists Number Percent Age in of of Cumulative 1965 dentists dentists percent Total 2,221 1/ 100 - Under 30 162 7 7 30 - 34 307 14 21 35 - 39 204 9 30 40 - 44 278 13 43 45 - 49 175 8 51 50 - 54 180 8 59 55 - 59 178 8 67 60 - 64 206 9 76 65 - 69 242 11 87 70 - 74 172 8 95 75 & over 108 5 100 1/ Age not available for 9 dentists. Percents based on total for whom age is known. Dentists in the metropolitan areas, with a median age of 49.0 years, are only slightly younger than dentists in the nonmetropolitan counties, where the median age is 50.2 years. Median ages of dentists in the Minneapolis- St. Paul and Duluth metropolitan areas are quite similar, about 49 years, while the youngest group, with a median age of 40 years, is found in the Moorhead area. Median ages of dentists in nonmetropolitan counties tend to increase as the size of the central city decreases. The median age of dentists in counties with central cities of at least 10,000 population is 48.8 years, compared to 51.9 years in counties with central cities of less than 2,500 inhabitants. 266 ACTIVE DENTISTS IN RELATION TO POPULATION 0f the 2,221 responding dentists in Minnesota, 93 percent (2,068 dentists) are active in their profession, giving the State one professionally active dentist for every 1,741 persons. In the metropolitan areas, there are 1,532 persons per dentist, while the nonmetropolitan counties have a some- what higher ratio of 2,051. Number of Persons per Active Dentist in Minnesota Professionally Persons County group® active Population per dentists dentist All counties 2,068 3,600,500 1,741 Metropolitan areas 1,234 1,890,000 1,532 Minneapolis-St. Paul area 1,090 1,609,600 1,477 Duluth area 123 238,300 1,937 Moorhead area 21 42,100 2,005 Nonmetropolitan counties 834 1,710,500 2,051 Central city 10,000-49,999 341 579,200 1,698 Central city 5,000-9,999 212 447,300 2,110 Central city 2,500-4,999 158 369,900 2,341 Central city under 2,500 123 314,100 2,554 * See Appendix Table for individual county data. Among the metropolitan areas, the 5-county Minneapolis-St. Paul area has the best ratio with 1,477 persons per dentist. Hennepin County itself, where Minneapolis is located, has an even more favorable ratio of 1,287, compared to 1,491 persons per dentist for Ramsey County (St. Paul) and to a combined ratio of 2,755 in the other three counties in the area. The Duluth area has a ratio of 1,937, slightly higher than the State average, while the Moorhead area has the least favorable of the metropolitan ratios. Of the 80 nonmetropolitan counties, 24 have persons-per-dentist ratios under 2,000, yet 12 counties have ratios of 3,000 or more persons for every dentist. Generally, persons-per-dentist ratios become less favor- able as the size of the central city decreases. Counties with 10,000 or more inhabitants in their central cities have an average of 1,698 persons per dentist, while counties with central cities under 2,500 average one active dentist for every 2,554 persons. 267 UTILIZATION OF AUXILIARIES Almost 8 of every 10 practitioners in Minnesota (i.e., dentists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 71 percent of the dentists, including 62 per- cent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 25 percent of the dentists, half of whom employ at least one full time. Dental hygienists are employed by 17 per- cent of the practitioners, and laboratory technicians by 3 percent. The majority of dentists who employ hygienists or technicians do so only part time. Minnesota Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners e of auxilia Dental With one full- With only Typ ty practitioners Total time employee part-time (or more) employees Total 2,033 100 68 10 One or more auxiliaries 1,522 78 68 10 Assistant 1,39 71 62 9 Hygienist 324 17 6 11 Laboratory technician 68 3 1 2 Secretary or receptionist 497 25 12 13 Other type of personnel 64 3 1 2 No auxiliary 435 22 - - 1/ Includes 76 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist and tends to be more common among younger dentists. Approximately 90 percent of the practitioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 77 percent among den- tists 45 to 64 years of age and to 49 percent among dentists 65 or over. Although dentists in metropolitan areas are no more likely to employ auxiliary personnel than those in nonmetropolitan counties, the utiliza- tion of hygienists is much more common in metropolitan areas than in the remainder of the State. About 21 percent of the dentists in metropolitan areas report the employment of a hygienist, compared to only 9 percent of the dentists located elsewhere. 268 I~ ~~ I ~~ OTHER SURVEY FINDINGS Ninety-six percent of the professionally active dentists in Minnesota are primarily engaged in private practice, with 93 percent self-employed and 3 percent employed by another den- tist. The remaining 4 percent are either on the staff of the dental school, employed by a governmental agency, or engaged in other dental activities, such as taking advanced training. At least one part-time dental activity in addition to their principal employment was reported by 10 percent of the den- tists. Part-time teaching in a dental school was the most frequently reported secondary employment. A variety of other dental activities were reported, such as part-time employment by State or local government, employment in the private practice of another dentist, and assistance to vol- untary agencies. Dentists providing patient care in the year prior to the sur- vey devoted an average of 39.7 hours per week to this activ- ity for 47.1 weeks during the year. About one dentist in eight worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. About 8 percent of the respondents reported that they limit their practice to a dental specialty, primarily to orthodon- tics, followed by oral surgery, and pedodontics. About one in every ten dentists in metropolitan areas limits his prac- tice as compared to one in every 25 in nonmetropolitan coun- ties. Twenty-nine percent of the 815 responding dentists licensed in Minnesota but located in another State are in the four adjacent States, primarily North Dakota and Wisconsin. Another 19 percent of the out-of-State dentists are located in California, while the remainder are scattered throughout 38 other States, the District of Columbia, Puerto Rico, and foreign countries. December 1968. 269 0.2 APPENDIX TABLE Selected Data on Dentists in Minnesota, By Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist All counties 2,221 673 906 2,068 3,600.5 1,741 Metropolitan areas 2/ 1,324 399 526 1,234 1,890.0 1,532 Minneapolis-St. Paul area 1,176 348 468 1,090 1,609.6 1,477 Anoka 42 25 4 42 110.6 2,633 Dakota 38 18 6 38 98.8 2,600 Hennepin 753 211 309 694 892.9 1,287 Ramsey 322 88 144 296 441.2 1,491 Washington 21 6 5 20 66.1 3,305 Duluth area 3/ 127 41 54 123 238.3 1,937 St. Louis 127 41 54 123 238.3 1,937 Moorhead area &/ 21 10 4 21 42.1 2,005 Clay 21 10 4 21 42.1 2,005 Nonmetropolitan counties’ 897 274 380 834 1,710.5 2,051 Central city 25,000-49,999 146 51 53 138 206.7 1,498 Mower 31 6 11 31 49.6 1,600 Olmsted 67 31 21 64 70.0 1,094 Stearns 48 14 21 43 87.1 2,026 1.2 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Minnesota, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 10,000-24,999 223 65 93 203 372.5 1,835 Blue Earth 36 10 14 34 45.8 1,347 Brown 20 7 8 17 28.9 1,700 Crow Wing 20 7 7 19 33.1 1,742 Freeborn 15 3 6 15 39.4 2,627 Goodhue 22 6 11 22 33.7 1,532 Kandiyohi 21 8 6 15 30.9 2,060 Otter Tail 21 4 10 18 50.2 2,789 Rice 28 9 14 25 40.5 1,620 Steele 17 6 6 16 27.1 1,694 Winona 23 5 11 22 42.9 1,950 Central city 5,000-9,999 220 65 95 212 447.3 2,110 Becker 12 3 7 11 23.8 2,164 Beltrami 11 4 4 11 24.1 2,191 Carlton 13 6 4 13 29.1 2,238 Chippewa 6 1 4 6 16.4 2,733 Douglas 14 4 6 13 22.1 1,700 Itasca 17 2 7 16 37.7 2,356 Koochiching 7 - 3 7 17.8 2,543 Lyon 13 4 7 13 23.1 1,777 McLeod 17 6 8 16 25.6 1,600 Martin 14 2 10 14 26.8 1,914 Meeker 9 2 3 8 19.4 2,425 Morrison 12 6 3 11 27.7 2,518 [AKA APPENDIX TABLE (cont'd.) Selected Data on Dentists in Minnesota, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 (cont'd.) Nicollet 11 2 6 11 23.4 2,127 Nobles 9 - 4 9 23.7 2,633 Pennington 8 3 4 8 12.5 1,563 Pipestone 9 2 3 9 13.7 1,522 Polk 15 6 5 13 37.6 2,892 Scott 15 8 4 15 26.1 1,740 Waseca 8 4 3 8 16.7 2,088 Central city 2,500-4,999 169 46 75 158 369.9 2,341 Benton 5 2 2 4 18.1 4,525 Big Stone 5 - 3 4 9.2 2,300 Carver 14 6 7 11 23.9 2,173 Cottonwood 8 3 2 8 15.5 1,938 Faribault 11 2 8 11 23.7 2,155 Fillmore 14 1 8 13 23.3 1,792 Houston 7 3 3 7 17.1 2,443 Hubbard 4 1 1 4 9.8 2,450 Isanti 7 2 4 7 14.1 2,014 Jackson 8 3 4 8 15.0 1,875 Lake 7 1 2 6 15.4 2,567 LeSueur 13 3 7 10 20.3 2,030 Pope 6 1 4 6 12.1 2,017 Redwood 9 - 4 9 21.4 2,378 Rock 5 1 1 5 11.8 2,360 Sherburne 5 3 2 4 14.1 3,525 €LT APPENDIX TABLE (cont'd.) Selected Data on Dentists in Minnesota, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 5/ (cont'd.) Central city 2,500-4,999 (cont'd.) Stevens 6 2 1 6 11.6 1,933 Swift 6 1 3 6 14.8 2,467 Todd 9 3 2 9 23.4 2,600 Wabasha 7 3 2 7 17.5 2,500 Wadena 4 - 3 4 12.4 3,100 Watonwan 5 4 1 5 14.6 2,920 Wilkin 4 1 1 4 10.8 2,700 Central city under 2,500 139 47 64 123 314.1 2,554 Aitkin 4 2 2 4 12.0 3,000 Cass 5 - 5 5 16.6 3,320 Chisago 8 4 3 7 13.8 1,971 Clearwater 4 2 2 3 8.6 2,867 Cook 1 - 1 1 3.6 3,600 Dodge 4 1 2 3 13.9 4,633 Grant 5 1 3 5 8.9 1,780 Kanabec 5 3 2 3 9.4 3,133 Kittson 4 2 1 4 8.1 2,025 Lac Qui Parle 6 2 4 5 13.6 2,720 Lake of the Woods 2 1 1 1 4.2 4,200 Lincoln 4 2 - 4 9.6 2,400 Mahnomen 1 - - 1 6.6 6,600 Marshall 5 1 2 5 14.2 2,840 Mille Lacs 9 4 4 5 15.0 1,875 Murray 4 2 2 3 14.6 4,867 LT APPENDIX TABLE (cont'd.) Selected Data on Dentists in Minnesota, By Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 5/ (cont'd.) Central city under 2,500 (cont'd.) Norman 4 1 1 4 11.0 2,750 Pine 6 4 1 6 17.2 2,867 Red Lake 2 - 1 2 5.7 2,850 Renville 10 1 6 10 23.7 2,370 Roseau 5 1 2 3 12.0 4,000 Sibley 7 3 3 7 16.2 2,314 Traverse 3 1 2 3 7.4 2,467 Wright 18 4 7 16 32.7 2,044 Yellow Medicine 13 5 7 10 15.5 1,550 2/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Minnesota counties included in the latest 1968 definition of Standard Metropolitan Statisti- cal Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's, statistics are presented only for dentists located in the Minnesota portion of the SMSA. Minnesota part of the Duluth-Superior SMSA. Minnesota part of the Fargo-Moorhead SMSA. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. MISSISSIPPI DENTISTS LICENSED IN MISSISSIPPI During the 1967 registration period, 886 dentists registered with the Mississippi State Board of Dental Examiners. Sixty-two percent of the registered dentists were civilians located in Mississippi, 32 percent were civilians located in other States, and 6 percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Mississippi Location and All Percent of military status dentists dentists Total licensed 886 100 Respondents 846 95 Nonrespondents 40 5 Total licensed 886 100 Civilians in Mississippi 551 62 Respondents 513 - Nonrespondents 38 - Civilians in another State 281 32 On active duty with Armed Forces 54 6 The survey questionnaire was completed by 846 dentists, 95 percent of the total registered. Data provided by survey respondents has been supplemented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained from records maintained by the Mississippi State Board of Dental Examiners and from the 1968 American Dental Directory published by the American Dental Association. Two-thirds (66 percent) of the survey respondents hold licenses to prac- tice dentistry in one or more other States. Forty-two percent of the dentists located in Mississippi have one other license, while only 6 percent have two or more other licenses. The proportion of out-of-State dentists holding multiple licenses is considerably greater; slightly over one-fourth hold two or more other licenses. Almost three-fifths of the licenses held outside the State were issued by adjacent States, including some 20 percent each in Alabama and Tennessee, 18 percent in Louisiana, and 2 percent in Arkansas. 275 PROFESSIONAL TRAINING More than nine in every 10 of Mississippi's 551 dentists are graduates of 12 dental schools located in the South. The largest contributor is the University of Tennessee, which has supplied slightly over two-fifths of the State's dental force. Loyola University (New Orleans) and Emory University have also made important contributions, having provided 21 per- cent and 17 percent, respectively, of the total supply. Only two other schools in this part of the country, Meharry Medical College and the University of Alabama, have contributed as much as 2 percent of Missippi's dentists. Fifteen schools located in other regions have provided the remaining 8 percent of the dentists. Of these schools, Northwestern University is the largest contributor, having graduated 4 percent of the State's supply. The overall proportionate contribution of the University of Tennessee to Mississippi's dentist supply has increased substantially over the years, from one-fifth of the dentists in the State who graduated prior to World War II to three-fifths of those receiving their dental education since 1955. At the same time, the contribution of Emory University has shown a notable decrease. Dental School Attended and Year of Graduation for Dentists in Mississippi Number Year of graduation Dental school of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 551 - 195 225 131 (Percent distribution by school) Schools in the South 509 92 98 89 88 Tennessee 233 42 60 40 19 Loyola (New Orleans) 117 21 26 23 12 Emory 94 17 5 13 42 9 other schools 65 12 7 13 15 Schools in other regions 42 8 2 11 12 Northwestern 21 4 1 6 5 14 other schools 21 4 1 5 7 Approximately 12 percent of the survey respondents, 63 dentists, reported that they had completed one year or more of advanced training after receiv- ing their dental degree. Of the 44 dentists who reported advanced academic training, 17 had earned a master's or other advanced degree, while 27 had received no additional degrees but had completed one or more years of post- graduate study. Of the 31 dentists with advanced clinical training, 20 had completed an internship, and 11, a residency. Twelve dentists had com- pleted both academic and clinical training. 276 DISTRIBUTION OF DENTISTS Slightly over one-fourth of the 551 dentists in Mississippi are located in the two metropolitan areas of the State. The two-county Jackson area has 105 dentists, approximately 20 percent of the total dental force, while the Biloxi-Gulfport area contains 8 percent. Distribution of Mississippi Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 82 551 100 Metropolitan areas 3 150 27 Jackson area 2 105 19 Biloxi-Gulfport area 1 45 8 Nonmetropolitan counties 79 401 73 Central city 25,000-49,999 5 93 17 Central city 10,000-24,999 10 121 22 Central city 5,000-9,999 16 80 15 Central city 2,500-4,999 16 51 9 Central city under 2,500 32 56 10 * See Appendix Table for definition of metropolitan areas and presentation of individual county data. Almost three-fourths (401) of the State's dentists are located in the 79 nonmetropolitan counties. The 15 counties with central cities of 10,000 or more persons have 214 dentists, some two-fifths of the State's dental force. Two of these counties--Forrest and Lauderdale--have more than 20 dentists each, while seven other counties have at least 15 dentists each. The 64 counties with fewer than 10,000 persons in their central cities have one-third of the State's dentist supply. There are 131 dentists in the 32 counties having between 2,500 and 9,999 persons in their central cities, while 56 dentists are scattered among the 32 counties with cen- tral cities of less than 2,500 population. While only 12 of these 64 counties have as many as five dentists, 29 counties have fewer than three dentists. 277 AGE DISTRIBUTION OF DENTISTS The median age of dentists in Mississippi is 41.9 years. Almost three in every 10 (28 percent) of the dentists are under 35 years of age, while only 16 percent are 55 years of age or older. Well over half of all den- tists in the State are between 35 and 54, with about one-third between 35 and 44 years of age. Age Distribution of Mississippi Dentists Age in Rauber Percent Cumulative 1965% of of percent dentists dentists Total 5511 100 - Under 30 62 12 12 30 - 34 85 16 28 35 - 39 93 17 45 40 - 44 86 16 61 45 - 49 81 15 76 50 - 54 45 8 84 55 - 59 41 7 91 60 - 64 24 4 95 65 & over 30 5 100 1/ Includes 4 dentists for whom age is not available. Percents are based on total for whom age is known. * Age computed to 1965 to enable comparison among all States surveyed. The age distribution of dentists is similar throughout the State. Den- tists located in the two metropolitan areas, with a median age of 41.4 years, are about a year younger, on the average, than dentists located in nonmetropolitan counties, where the median age is 42.3 years. 278 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 551 dentists in Mississippi, 541, or 98 percent, are active in their profession, giving the State one professionally active dentist for every 4,096 persons. In the metropolitan areas, there are 2,574 persons per dentist, with the Jackson area having the better ratio of 2,358, while the Biloxi-Gulfport area has only one dentist for every 3,089 persons. Number of Persons Per Active Dentist in Mississippi Professionally Persons County group® active Population per dentists dentist All counties 541 2,216,100 4,096 Metropolitan areas 149 383,500 2,574 Jackson area 105 247,600 2,358 Biloxi-Gulfport area 44 135,900 3,089 Nonmetropolitan counties 392 1,832,600 4,675 Central city 25,000-49,999 91 310,100 3,408 Central city 10,000-24,999 118 438,200 3,714 Central city 5,000-9,999 78 385,000 4,936 Central city 2,500-4,999 50 297,100 5,942 Central city under 2,500 55 402,200 7,313 % See Appendix Table for individual county data. The 79 nonmetropolitan counties average a less favorable ratio of 4,675 persons per dentist. Fifteen of these counties have ratios under 4,000, while an equal number have ratios of 8,000 or more, including 7 counties with over 10,000 persons per dentist. In addition, there are six counties which have no active dentists, according to available information. In nonmetropolitan counties, the ratios of persons per dentist generally become much less favorable as the size of the central city decreases. Counties with central city populations of 25,000 to 49,999 persons average some 3,400 persons per dentist, while counties with 5,000 to 9,999 inhab- itants in their central cities have only one dentist for every 4,900 persons. The group of counties with central city populations of less than 2,500 has the least favorable ratio--7,300 persons per dentist. 279 386-029 O - 70 - 19 UTILIZATION OF AUXILIARIES Eighty-six percent of Mississippi's responding practitioners (i.e., den- tists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 81 percent of the dentists, including 75 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 28 percent of the dentists, more than two-thirds of whom employ at least one full time. Dental hygienists are employed by 8 percent of the practitioners, and laboratory technicians by 7 percent. Hygienists and laboratory technicians are more likely to be employed on a part-time basis than are other auxiliary person- nel. Mississippi Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only emp loyed practitioners Total time employee part-time (or more) employees Total 488% 100 81 5 One or more auxiliaries 422 86 81 5 Assistant 394 81 75 6 Hygienist 41 8 4 4 Laboratory technician 34 7 3 4 Secretary or receptionist 135 28 20 8 Other type of personnel 24 5 2 3 No auxiliary 66 14 - - 1/ Includes 12 dentists who did not report on auxiliary utilization. Employment of auxiliaries varies with the age of the dentist and is more common among younger dentists. Almost 95 percent of the practitioners between the ages of 30 and 44 employ some type of auxiliary. The propor- tion utilizing auxiliaries decreases to 82 percent among dentists 45 to 64 years of age and to 48 percent among dentists 65 or over. About one-fifth of all Mississippi practitioners reported one or more vacant positions for auxiliary personnel. Forty percent of these dentists indicated vacancies for full-time dental hygienists and 34 percent for full-time dental assistants. 280 OTHER SURVEY FINDINGS Ninety-six percent of the responding professionally active dentists in Mississippi are primarily engaged in private practice, with 94 percent self-employed and 2 percent employed by another dentist. The remaining 4 percent are either employed by a governmental agency, or are engaged in other dental activities, such as taking advanced training. I~ ~~ Dentists reporting on time spent in providing patient care devoted an average of 40.7 hours per week to this activity for 48.3 weeks during the year prior to the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. IZ I~ ~~ Eight percent of the respondents reported that they limit their practice to a dental specialty, primarily to orthodontics, followed by oral surgery, and pedodontics. About one in every six dentists in metropolitan areas limits his practice as compared to one in every 20 in nonmetropolitan counties. / 7 Seven percent of the responding dentists had practiced as civilian dentists in one of 14 other States prior to assuming their present Mississippi location. More than half of these dentists came from other Southern States, primarily Louisiana and Tennessee. I~ ~~ Of the 281 dentists who are licensed in Mississippi but located in another State, more than three of every five are located in adjacent States, principally in Alabama, Louisiana, and Tennessee. Another 16 percent are in the nearby States of Georgia, Florida, and Texas, while the remainder are scattered among 18 other States and the District of Columbia. March 1969. 281 ¢8¢ APPENDIX TABLE Selected Data on Dentists in Mississippi, by Location Civilian dentists Persons County group R nd- Non- Age in 1965 Profes- Population— per and county Total espo respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist All counties 551 513 38 147 95 541 2,216.1 4,096 Metropolitan areas?’ 150 138 12 34 22 149 383.5 2,574 Jackson area 105 100 5 25 14 105 247.6 2,358 Hinds 101 96 5 24 13 101 210.4 2,083 Rankin 4 4 - 1 1 4 37.2 9,300 Biloxi-Gulfport area 45 38 7 9 8 44 135.9 3,089 Harrison 45 38 7 9 8 44 135.9 3,089 Nonmetropolitan counties 401 375 26 113 73 392 1,832.6 4,675 Central city 25,000-49,999 93 82 11 22 13 91 310.1 3,408 Forrest 23 20 3 6 1 23 56.8 2,470 Jones 15 15 - 5 3 15 60.1 4,007 Lauderdale 22 20 2 3 5 22 70.2 3,191 Warren 15 13 2 3 3 14 44.4 3,171 Washington 18 14 4 5 1 17 78.6 4,624 Central city 10,000-24,999 121 116 5 36 22 118 438.2 3,714 Adams 11 11 - 4 1 11 38.7 3,518 Alcorn 9 9 - 2 2 9 25.9 2,878 Bolivar 9 8 1 3 1 9 53.1 5,900 Coahoma 11 11 - 3 4 10 46.2 4,620 £8¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Mississippi, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Nonmetropolitan countiess’ (cont'd.) Central city 10,000-24,999 (cont'd.) Jackson 19 19 - 7 4 19 69.2 3,642 Lee 15 15 - 3 2 15 41.9 2,793 Leflore 15 14 1 4 1 15 46.0 3,067 Lowndes 15 14 1 5 5 15 51.4 3,427 Pike 10 8 2 2 2 8 34.9 4,363 Yazoo 7 7 - 3 - 7 30.9 4,414 Central city 5,000-9,999 80 75 5 21 16 78 385.0 4,936 Attala 5 5 - 3 - 5 20.2 4,040 Clay 4 4 - - 1 4 19.7 4,925 Grenada 4 4 - 2 4 18.6 4,650 Hancock 3 2 1 1 - 3 15.7 5,233 Lafayette 6 5 1 - 2 6 21.3 3,550 Lincoln 6 5 1 - 1 6 26.2 4,367 Madison 6 5 1 1 3 6 32.8 5,467 Marion 5 5 - 2 - 5 21.5 4,300 Marshall 4 4 - 1 1 4 24.4 6,100 Monroe 7 7 - 3 1 6 33.6 5,600 Neshoba 3 2 - 2 3 19.3 6,433 Oktibbeha 5 5 3 - 5 27.7 5,540 Pearl River 7 7 - 1 3 6 24.0 4,000 Sunflower 7 7 - 2 2 7 42.7 6,100 Union 4 4 - 1 - 4 18.8 4,700 Winston 4 4 - 1 - 4 18.5 4,625 487 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Mississippi, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population=" per and county Total ents respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist Nonmetropolitan countiesd’ (cont'd.) Central city 2,500-4,999 51 49 2 16 11 50 297.1 5,942 Chickasaw 3 3 1 - 3 16.5 5,500 Claiborne 2 2 - 1 1 2 9.7 4,850 Copiah 6 6 - 2 1 6 26.1 4,350 Holmes 4 4 - - 1 4 25.2 6,300 Humphreys 2 2 - 1 1 2 18.1 9,050 Montgomery 1 1 - 1 - 1 13.0 13,000 Newton 4 4 - 1 1 4 18.5 4,625 Panola 5 5 - 2 - 5 28.4 5,680 Prentiss 4 3 1 2 - 4 17.9 4,475 Quitman 2 2 - - - 2 19.7 9,850 Scott 4 3 1 1 1 3 21.5 7,167 Tallahatchie 2 2 - - 1 2 21.9 10,950 Tate 3 3 - 1 1 3 18.9 6,300 Tippah 4 4 - 1 2 4 14.5 3,625 Wayne 3 3 - 2 1 3 15.9 5,300 Yalobusha 2 2 - - - 2 11.3 5,650 Central city under 2,500 56 53 3 18 11 55 402.2 7,313 Amite 1 1 - 1 - 1 14.9 14,900 Benton - - - - - - 7.6 - Calhoun 4 4 - 2 - 4 15.5 3,875 Carroll - - - - - - 9.8 - Choctaw 1 1 - - - 1 7.4 7,400 Clarke 1 1 - - - 1 16.0 16,000 G8¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Mississippi, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total respond- Under 55 years sionally (in 000's) active ents . : ents 35 or more active dentist Nonmetropolitan countiess! (cont'd.) Central city under 2,500 (cont'd.) Covington 2 2 - - - 2 13.3 6,650 De Soto 3 3 - 1 - 3 24.3 8,100 Franklin 1 1 - 1 - 1 8.8 8,800 George 3 3 - - 3 11.2 3,733 Greene - - - - - - 8.4 - Issaquena - - - - - - 2.6 - Itawamba 3 2 1 1 1 3 14.7 4,900 Jasper 1 1 - - 1 16.4 16,400 Jefferson 1 - 1 - - 1 9.7 9,700 Jefferson Davis 2 2 - - - 2 12.8 6,400 Kemper - - - - - - 10.9 - Lamar 1 1 - - - 1 14.4 14,400 Lawrence 2 2 - 1 1 2 9.1 4,550 Leake 2 2 - - - 2 17.1 8,550 Noxubee 2 2 - - 1 2 16.2 8,100 Perry - - - - - - 8.6 - Pontotoc 3 3 - 1 - 3 16.6 5,533 Sharkey 1 1 - - 1 1 9.9 9,900 Simpson 5 5 - 2 1 5 20.3 4,060 Smith 3 3 - 1 1 3 13.7 4,567 Stone 2 2 - 2 - 2 6.7 3,350 Tishomingo 3 2 1 2 1 2 14.0 7,000 Tunica 1 1 - - - 1 15.6 15,600 98¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Mississippi, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population= per and county Total respond- Under 55 years sionally (in 000's) active ents . : ents 35 or more active dentist Nonmetropolitan counties’ (cont'd.) Central city under 2,500 (cont'd.) Walthall 2 2 - 1 1 2 12.8 6,400 Webster 2 2 - 1 1 2 10.1 5,050 Wilkinson 4 4 - 1 - 4 12.8 3,200 1/ 2/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Mississippi counties included in the latest 1968 definition of Standard Metropolitan Statis- tical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. ; LY IRN{elV1 a] | DENTISTS LICENSED IN MISSOURI During the 1965 registration period, 4,127 dentists registered with the Missouri Dental Board. Of these dentists, only 52 percent were civilians actually located in Missouri, while 42 percent were civilians located in other states, and 6 percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Missouri Location and All Percent of military status dentists dentists Total licensed 4,127 100 Respondents 3,693 89 Nonrespondents 434 11 Total licensed 4,127 100 Civilians in Missouri 2,146 52 Respondents 1,982 - Nonrespondents 164 - Civilians in another state 1,750 42 On active duty with Armed Forces . 230 6 Not reported 1 %* * Less than one-half of one percent. The survey questionnaire was completed by 3,693 dentists, 89 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended,and year of graduation for dentists not respond- ing to the survey. Information on nonrespondents was obtained either from records maintained by the Missouri Dental Board or from the 1966 American Dental Directory, published by the American Dental Association. Among the survey respondents, approximately three of every five (58 per- cent) hold a license to practice dentistry in one or more other states. About 28 percent of the dentists located in Missouri hold more than one license, with 23 percent licensed in one other state and 5 percent li- censed in two or more other states. The proportion of out-of-state den=- tists holding multiple licenses is considerably greater; 27 percent hold two or more licenses in addition to their Missouri license. Approximate- ly three-fifths of the licenses held outside of Missouri are held in adjacent states, including 27 percent in Kansas, 14 percent in Illinois, 8 percent in Oklghoma,and 5 percent in Arkansas. 287 PROFESSIONAL TRAINING The great majority of Missouri's dentists--more than 9 of every 10--have graduated from one of the three in-state dental schools. The University of Missouri at Kansas City and St. Louis University each have provided approximately one-third of the State's dental force, while Washington University has contributed another 21 percent. In addition, ten schools in adjacent states have together supplied five percent of Missouri's den- tists. Among these schools, Meharry Medical College (Nashville) and the University of Tennessee have been the largest contributors, although each has provided only one percent. The remaining 3 percent were trained in schools scattered throughout 15 other states. Relatively few of Missouri's dentists are recent dental school graduates. Only 20 percent of the dental force graduated from dental school after 1955, while more than 50 percent of the State's dentists graduated during the years prior to World War II. The overall proportionate contribution of the University of Missouri to the State's dental supply has increased substantially over the years, while the contributions of St. Louis Univer- sity and Washington University have shown notable decreases. Approxi=- mately one-half of the dentists in the State who graduated since 1955 received their dental education at the University of Missouri. Dental School Attended and Year of Graduation for Dentists in Missouri Dental school Number Year of graduation t tended of All After 1941- 1940 or a dentists years 1955 1955 earlier Total number 2,146 Yo 41 ss 1,114 (Percent distribution by school) Schools in Missouri 1,968 92 89 94 92 Univ. of Missouri at Kansas City 792 37 48 38 31 St. Louis University 733 34 24 38 36 Washington University 443 21 17 18 24 31 other schools 171 8 11 6 8 1/ Dental school attended not available for 7 dentists and year of graduation for 5 dentists. Percents based on known totals. Some 14 percent of the survey respondents (281 dentists) reported that they had completed one year or more of advanced training after receiving the dental degree. About 200 dentists reported completion of advanced academic training as graduate or postgraduate students, and 128 dentists completed advanced clinical training as residents or interns. There are 47 dentists who completed both academic and clinical training. Advanced training, particularly advanced academic work, is more common among younger dentists. Some 24 percent of survey respondents under 40 years of age reported a year or more of graduate or postgraduate study, as compared with 17 percent of those 40 to 54 years,and only 6 percent of those 55 and over. 288 DISTRIBUTION OF DENTISTS Approximately three-fourths of the licensed dentists in Missouri are located in the 4 metropolitan areas of the State. The St. Louis area alone has 962 dentists, 45 percent of all dentists in the State. The city of St. Louis together with St. Louis County has 903 of these den- tists, while the three other counties in the area have only 59 den- tists. The 4-county Kansas City area has the second largest dental force, some 500 dentists, accounting for 23 percent of the State supply. About nine-tenths of these dentists are concentrated in Jackson County, where Kansas City is located. The two remaining metropolitan areas, Springfield and St. Joseph, have 4 percent and 2 percent of Missouri's dentists, respectively. Distribution of Missouri Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 114 2,146 100 Metropolitan areas 10 1,583 74 St. Louis area (Mo. part) 4 962 45 Kansas City area (Mo. part) 4 499 23 Springfield area 1 83 4 St. Joseph area 1 39 2 Nonmetropolitan counties 104 563 26 Central city 10,000-49,999 13 190 9 Central city 2,500- 9,999 42 251 11 Central city under 2,500 49 122 6 * See Appendix Table for definition of interstate and other metropol- itan areas and presentation of individual county data. Slightly more than one-fourth (563) of Missouri's dentists are located in the 104 nonmetropolitan counties of the State. The 13 counties with central cities of 10,000 or more persons have 190 dentists, almost 10 percent of the State's dental force. Jasper County, with approximately 40 dentists, has the largest dental force of any nonmetropolitan county. The only other nonmetropolitan counties with as many as 20 dentists are Boone and Cole. The 91 counties with less than 10,000 persons in their central cities have one-sixth of the State's dentist supply. There are 251 dentists in the 42 counties having between 2,500 and 9,999 persons in their central cities, while 122 dentists are scattered among the 49 counties with cen- tral cities of less than 2,500 population. While only seven of these 91 counties have as many as 10 dentists, more than half (48) have no more than 3 dentists, including 12 with only one dentist,and four counties that apparently have no dentists. 289 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 2,128 dentists for whom age was obtainable is a rather high 51.5 years. Only 25 percent of Missouri's dentists (536) are under 40 years of age, including just 16 percent who are under 35. On the other hand, more than two-fifths, or 925 dentists, are 55 years or over. Almost one in every four, or 510 dentists, are 65 years old or more, including 307 who have reached the age of 70. Median Age and Age Distribution of Missouri Dentists by County Group Percent of dentists County group Median Under 40- 55 & age 40 54 over All counties 51.5 25 31 44 Metropolitan counties 50.9 26 32 42 St. Louis area (Mo. part) 52.6 23 33 44 Kansas City area (Mo. part) 52.2 31 31 38 Springfield area 43.9 37 33 30 St. Joseph area 61.1 21 23 56 Nonmetropolitan counties 53.5 22 30 48 Central city 10,000-49,999 48.6 27 35 38 Central city 2,500- 9,999 55.5 18 31 51 Central city under 2,500 63.2 23 21 56 The median age of dentists in metropolitan areas is 50.9 years, some= what lower than the median of 53.5 years for dentists in nonmetropol- itan counties. Median ages of dentists in the St. Louis and Kansas City areas are quite similar, about 52 years. Dentists in the Spring- field area are the youngest as a group, with a median age of 43.9. More than 35 percent of the dentists in this area are under 40 years of age, and less than one-third are 55 or older. Dentists in the St. Joseph area are the oldest as a group, with a median age of 61.1 years. Only one-fifth of these dentists are under 40, while well over half have reached the age of 55. Dentist ages in nonmetropolitan counties tend to increase rapidly as the size of the central city declines. The median age of dentists in counties with central cities of at least 10,000 population is 48.6 years, compared to a median age of 55.5 in counties containing a cen- tral city of 2,500-9,999 inhabitants, and 63.2 years (almost 12 years above the State average) in counties with less than 2,500 persons in their central cities. 290 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 2,146 dentists in Missouri, 1,975, or 92 percent, are active in their profession, giving Missouri one professionally active dentist for every 2,271 persons. In the metropolitan areas--which have 74 percent of all active den- tists and 62 percent of the population--the ratio is one dentist for every 1,889 persons. The remainder of the State--which has 26 percent of the active dentists and 38 percent of the population--has a less favorable ratio of one dentist for every 3,381 persons. Number of Persons per Active Dentist in Missouri Professionally Persons County group¥* active Population per dentists dentist All counties 1,975 4,484,800 2,271 Metropolitan areas 1,470 2,777,200 1,889 St. Louis area (Mo. part) 886 1,728,600 1,951 Kansas City area (Mo. part) 470 824,100 1,753 Springfield area 77 136,300 1,770 St. Joseph area 37 88,200 2,384 Nonmetropolitan counties 505 1,707,600 3,381 Central city 10,000-49,999 179 485,200 2,711 Central city 2,500- 9,999 220 760,600 3,457 Central city under 2,500 106 461,800 4,357 * See Appendix Table for individual county data. Among the metropolitan areas, the 4-county Kansas City area has the best ratio with 1,753 persons per active dentist. Jackson County, the hub of the area, has the best ratio in the State, 1,584 persons per active dentist, while the other three counties in the area have a considerably higher aver- age persons-per-dentist ratio of 3,035. The 4-county St. Louis area has a ratio of 1,951 persons per dentist, slightly less favorable than that of the Kansas City area. St. Louis County together with the city of St. Louis has the best ratio in the area, with one dentist for every 1,848 persons, while the remaining three counties have a much higher average ratio of 3,509 per- sons per dentist. The Springfield area has a ratio comparable to that of the Kansas City area, 1,770 persons per dentist. The ratio of one dentist for every 2,384 persons in the St. Joseph area is the least favorable among the metropolitan areas. Among the nonmetropolitan counties there are 16 with persons-per-dentist ratios under 2,500, yet 37 counties have ratios exceeding 4,000 persons per dentist, including 19 counties with ratios over 6,000. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city decreases. The group of counties with central cities of 10,000 or more population have an average persons-per-dentist ratio of approximately 2,700, while counties with central cities of less than 2,500 inhabitants average over 4,300 persons per dentist. 291 UTILIZATION OF AUXILIARIES Almost three-fourths of the responding practitioners in Missouri (i.e., den- tists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 65 percent of all practitioners, includ- ing 59 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 25 percent of the dentists, with slightly over two-thirds of these dentists utilizing such personnel full time. Dental hygienists and laboratory technicians are utilized with con=- siderably less frequency, each of these auxiliaries being employed by only 8 percent of the dentists. Hygienists and technicians are more likely to be employed on a part-time basis than are other auxiliary personnel. Missouri Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time auxiliary part-time (or more) auxiliaries Total 1,801 L 100 66 6 With one or more auxiliaries 1,238 72 66 6 Assistant 1,122 65 59 6 Hygienist 143 8 4 4 Laboratory technician 136 8 3 5 Secretary or receptionist 427 25 17 8 Other type of personnel 30 2 1 1 With no auxiliary 488 28 - - 1/ Includes 75 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist and tends to be more frequent among younger dentists. Eighty-six percent of Missouri dentists between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 73 percent among dentists 45 to 64 years old and to only 38 percent among dentists 65 and over. Young dentists just starting their practices do not reach peak utilization of assistants until they are at least 30 years of age and of hygienists until age 35. About 14 percent of the responding dentists in Missouri reported one or more vacant positions for auxiliary personnel. Of those reporting vacancies, one- third indicated a need for full-time hygienists and one-third reported vacan- cies for full-time dental assistants. Nine of every 10 dentists reporting a vacancy already employ one or more auxiliaries. 292 ny ~~ OTHER SURVEY FINDINGS Ninety-four percent of the responding professionally active dentists in Missouri are primarily engaged in private prac=- tice, with 93 percent self-employed and one percent emp loyed by another dentist. Three percent are on the staffs of den- tal schools, another one percent are employed by governmental agencies, and the remaining two percent are engaged in other dental activities, such as taking advanced training. At least one part-time dental activity in addition to their principal employment was reported by 12 percent of the den- tists. Part-time teaching in a dental school was the most frequently reported secondary employment. A variety of other secondary dental activities were reported, including employment by another dentist and working in governmental agencies. Dentists reporting time spent in patient care devoted an average of 39.4 hours per week to this activity for 47.6 weeks during the year preceding the survey. About one den- tist in seven worked the equivalent of 6 days a week, 48 hours or more, for at least 48 weeks. About 13 percent of the practitioners reported they limit their practice to a dental specialty, primarily orthodon- tics or oral surgery. The metropolitan areas have a large share--about nine-tenths--of the dentists who limit their practices. One in every 7 dentists practicing in a metro- politan area limits his practice, whereas in nonmetropolitan counties, only one in every 25 dentists does so. Of the 1,750 dentists licensed in Missouri but located out- of-state, approximately one-third were located in the adjacent states of Kansas and Illinois. The remaining out- of-state dentists are scattered throughout 45 other states, the largest numbers being in the nearby states of Arkansas, Colorado and Oklahoma, and the more distant state of Cali- fornia. March 1968. 293 %76¢ APPENDIX TABLE Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total oe respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist All counties 2,146 1,982 164 25 44 1,975 4,484.8 2,271 Metropolitan areas 2/ 1,583 1,443 140 26 42 1,470 2,777.2 1,889 St. Louis area (Mo. part) 962 869 93 23 44 886 1,728.6 1,951 Franklin 20 19 1 25 55 19 48.3 2,542 Jefferson 22 20 - 2 32 41 19 78.1 4,111 St. Charles 17 16 1 39 24 17 66.6 3,918 St. Louis County & St. Louis City 903 814 89 22 45 831 1,535.6 1,848 Kansas City area (Mo. part) 499 464 35 31 38 470 824.1 1,753 Cass 9 9 - 33 56 9 34.5 3,833 Clay 42 41 1 48 19 40 105.6 2,640 Jackson 442 408 34 30 39 415 657.2 1,584 Platte 6 6 - 33 33 6 26.8 4,467 Springfield area 83 75 8 37 30 77 136.3 1,770 Greene 83 75 8 37 30 77 136.3 1,770 St. Joseph area 39 35 4 21 56 37 88.2 2,384 Buchanan 39 35 4 21 56 37 88.2 2,384 0% - 0L - O 6%0-98¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non=- Age in 1965 Profes- Population — per and county Total po respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist Nonmetropolitan counties 3/ 563 539 24 22 48 505 1,707.6 3,381 Central city 25,000-49,999 106 104 2 25 40 99 229.6 2,319 Boone 25 24 1 28 32 24 61.2 2,550 Cape Girardeau 19 19 - 26 42 17 44.9 2,641 Cole 23 22 1 30 43 22 43.6 1,982 Jasper 39 39 - 21 41 36 79.9 2,219 Central city 10,000-24,999 84 77 7 30 35 80 255.6 3,195 Adair 10 10 - 40 40 10 20.6 2,060 Audrain 7 6 1 29 14 7 27.2 3,886 Butler 12 11 1 36 25 11 33.9 3,082 Callaway 6 4 2 - 50 6 24.0 4,000 Marion 13 13 - 31 46 12 29.5 2,458 Pettis 12 9 3 33 33 10 38.8 3,880 Phelps 9 9 - 22 33 9 27.2 3,022 Randolph 7 7 - 14 28 7 21.7 3,100 Scott 8 8 - 38 25 8 32.7 4,088 Central city 5,000-9,999 133 130 3 22 49 116 419.6 3,617 Cooper 6 5 1 33 67 3 14.9 4,967 Dunklin 9 9 - 22 56 9 37.2 4,133 Grundy 8 8 - 25 75 5 12.0 2,400 Henry 8 8 - 25 38 7 19.0 2,714 Howell 5 5 - 20 - 5 21.6 4,320 Johnson 7 7 - 28 28 6 32.9 5,483 Laclede 11 10 1 18 73 8 19.0 2,375 G6¢ 96¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ents respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist Nonmetropolitan counties (cont'd.) Central city 5,000-9,999 (cont'd.) Linn 6 6 - - 83 6 15.8 2,633 Livingston 6 6 - 33 33 6 15.3 2,550 Mississippi 4 3 50 50 3 19.7 6,567 Newton 10 10 - 20 50 9 30.8 3,422 Nodaway 7 7 - 14 57 7 22.4 3,200 Pemiscot 6 6 - 17 33 5 34.8 6,960 Perry 5 5 - 20 60 5 14.5 2,900 St. Francois 14 14 - 14 50 14 37.0 2,643 Saline 11 11 - 18 36 9 25.3 2,811 Stoddard 5 5 - 20 20 4 27.8 6,950 Vernon 5 5 - 40 60 5 19.6 3,920 Central city 2,500-4,999 118 112 6 15 53 104 341.0 3,279 Barry 10 9 20 60 10 17.7 1,770 Barton 7 7 - - 86 7 10.5 1,500 Bates 6 6 - - 50 5 15.2 3,040 Carroll 5 5 - - 40 3 13.1 4,367 Cedar 3 3 - - 67 3 8.5 2,833 Clinton 5 4 1 - 20 4 11.5 2,875 Dent 4 4 - - 50 3 10.3 3,433 Gasconade 4 3 1 - 50 4 12.0 3,000 Harrison 4 4 - - 50 4 10.4 2,600 Howard 4 4 - - 50 3 20.4 3,467 Lafayette 10 10 - 20 40 8 25.3 3,162 APPENDIX TABLE (cont 'd.) Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total ents respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist Nonmetropolitan counties (cont'd.) Central city 2,500-4,999 (cont'd.) Lawrence 10 10 - 10 70 9 23.1 2,567 Lewis 3 3 - - 67 2 11.0 5,500 Macon 6 6 - 33 50 6 15.6 2,600 Madison 3 3 - 33 33 3 8.9 2,967 Miller 2 2 - 50 - 2 13.8 6,900 Moniteau 3 3 - 67 - 3 10.3 3,433 New Madrid 2 2 - 50 100 2 27.9 13,950 Pike 6 5 17 50 5 16.6 3,320 Polk 3 3 - - 3 12.7 4,233 Ray 5 5 - 20 60 4 16.1 4,025 Ste. Genevieve 4 4 - - 75 4 12.4 3,100 Washington 2 2 - 50 50 2 14.2 7,100 Wright 7 5 2 20 71 5 13.5 2,700 Central city under 2,500 122 116 6 23 56 106 461.8 4,357 Andrew 1 1 - - - 1 10.7 10,700 Atchinson 4 3 1 67 50 4 8.5 2,125 Benton 4 4 - - 100 4 8.6 2,150 Bollinger 1 1 - - 100 1 8.5 8,500 Caldwell 3 3 - - 100 2 8.3 4,150 Camden 2 2 - 50 50 2 9.6 4,800 Carter 0 0 - - - 0 3.6 - Chariton 6 5 - 33 5 11.6 2,320 Christian 3 3 - 33 33 3 12.3 4,100 L62T 86¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population — per and county Total nts respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist Nonmetropolitan counties (cont'd.) Central city under 2,500 (cont'd.) Clark 2 2 - 50 50 1 8.6 8,600 Crawford 3 3 - 33 33 2 13.2 6,600 Dade 3 3 - - 100 3 6.9 2,300 Dallas 1 1 - - - 1 8.7 8,700 Daviess 3 3 - 33 67 3 8.8 2,933 DeKalb 2 1 1 - 50 1 6.8 6,800 Douglas 3 1 2 - 67 3 8.4 2,800 Gentry 3 3 - 33 67 2 7.7 3,850 Hickory 1 1 - - 100 1 4.1 4,100 Holt 2 2 - 50 50 2 7.2 3,600 Iron 4 4 - 50 50 2 7.3 3,650 Knox 4 4 - 25 75 3 6.1 2,033 Lincoln 4 4 - - 100 4 15.3 3,825 McDonald 2 2 - - - 2 10.7 5,350 Maries 1 1 - - - 1 7.2 7,200 Mercer 3 3 - - 100 1 5.1 5,100 Monroe 3 3 - 33 67 3 10.3 3,433 Montgomery 3 3 - - 67 3 10.9 3,633 Morgan 3 3 - 33 - 3 9.0 3,000 Oregon 1 1 - - 100 1 8.8 8,800 Osage 1 1 - 100 - 1 10.7 10,700 Ozark 3 3 - 33 67 3 5.8 1,933 Pulaski 6 5 1 17 50 4 57.0 14,250 Putnam 3 3 - - 67 2 6.0 3,000 > © APPENDIX TABLE (cont'd.) Selected Data on Dentists in Missouri, by Location Civilian dentists Persons County group Respond- Non=- Age in 1965 Profes- Population — per and county Total ents respond- Percent Percent sionally (in 000's) active ents Under 40 55 or more active dentist Nonmetropolitan counties (cont'd.) Central city under 2,500 (cont'd.) Ralls 0 0 - - - 0 7.7 - Reynolds 1 1 - 100 - 1 4.5 4,500 Ripley 2 2 - 100 - 2 8.0 4,000 St. Clair 3 3 - 33 33 3 7.4 2,467 Schuyler 0 0 - - - 0 4.6 - Scotland 1 1 - 100 - 1 6.0 6,000 Shannon 0 0 - - - 0 6.4 - Shelby 3 3 - - 67 3 8.6 2,867 Stone 2 2 - - 100 2 7.5 3,750 Sullivan 1 1 - 100 - 1 7.6 7,600 Taney 9 9 - 22 56 8 10.3 1,288 Texas 5 5 - 40 40 4 17.2 4,300 Warren 1 1 - - - 1 9.3 9,300 Wayne 2 2 - 50 50 2 7.9 3,950 Webster 3 3 - - 67 3 13.2 4,400 Worth 1 1 - - 100 1 3.3 3,300 1/ Copyright 1965. for the presentation of survey data. presented only for dentists located in the Missouri portions. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Missouri counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, by the U.S. Bureau of the Budget, Office of Statistical Standards, as established have been grouped as metropolitan areas For the interstate St. Louis and Kansas City SMSA's, statistics are rw 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped accord- ing to the 1960 population of the Largest (central) city within each county. 5 £ Spfesn i peme y greisg 3 sant ma me § m e aes ge MONTANA DENTISTS LICENSED IN MONTANA During the 1966 registration period, 532 dentists registered with the Montana State Board of Dental Examiners. A total of 500 dentists respon- ded to the survey, 94 percent of all those registered. Sixty-two percent of the responding dentists are civilians located in Montana, 32 percent are civilians located in other states, and 6 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Montana Location and All Percent of military status dentists dentists Total 532 100 Respondents 500 94 Nonrespondents 32 6 Respondents 500 100 Civilians in Montana 309 62 Civilians in another state 161 32 On active duty with Armed Forces 30 6 Multiple licensure is quite common in Montana, with more than three- fifths of the respondents located in the State holding more than one license. Forty-two percent indicated licensure in one additional state and 19 percent in two or more other states. Of those dentists register- ing in Montana, but located out of state, a relatively high proportion-- 38 percent--are licensed in two or more states other than Montana. Survey respondents hold a total of some 1,000 licenses, an average of two per dentist. Two-fifths of the licenses held in states outside of Montana are held in the Western States of California, Oregon, Washington, and Idaho. Another one-fourth are held in the North Central States of Minnesota, Illinois, and Wisconsin. 301 PROFESSIONAL TRAINING More than four-fifths (83 percent) of Montana's dentists are graduates of 12 dental schools located in the North Central States. The largest con- tributor among these schools is the University of Minnesota, which has supplied almost one-fourth of the State's dental force. Northwestern and Marquette Universities have also made important contributions, each having provided 11 percent of the total supply. Other schools in this part of the Country to contribute as many as 20 of Montana's dentists are Creigh- ton University and Loyola University of Chicago. Fourteen schools located in other regions have provided the remaining 17 percent of the dentists in Montana. The only one of these schools to contribute a substantial number of dentists, however, is the University of Oregon, which has graduated 9 percent of the State's supply. Dental School Attended and Year of Graduation for Dentists in Montana Number Year of graduation Dental school of AIT After 1941- 1940 or dentists years 1955 1955 earlier Total number 300%/ - 93 109 106 (Percent distribution by school) Schools in North Central States 257 83 80 86 83 Minnesota 71 23 18 19 30 Northwestern 35 11 9 14 11 Marquette 35 11 15 5 14 Creighton 29 9 13 11 5 Loyola (Chicago) 22 8 3 12 6 7 other schools 65 21 22 25 17 Schools in other states 52 17 20 14 17 Oregon 29 9 7 5 15 13 other schools 23 8 13 9 2 1/ Year of graduation not available for one dentist. Some 13 percent of the survey respondents, 39 dentists, reported that they had completed one year or more of advanced training after receiving their dental degree. Of the 21 dentists with advanced clinical training, 5 had completed a residency and 16 an internship. Of the 25 dentists who re- ported advanced academic training, 14 had earned a master's or other advanced degree, and another 11 had received no additional degrees but had completed one or more years of postgraduate study. Seven dentists had completed both academic and clinical training. 302 DISTRIBUTION OF DENTISTS Montana's dentists are unevenly distributed geographically, with two- thirds of the licensed dentists located in only 9 of the State's 56 coun- ties. The two metropolitan areas, Billings (Yellowstone County) and Great Falls (Cascade County), have 28 percent of the dentists, 14 percent each. The 7 nonmetropolitan counties with at least 10,000 persons in their central cities have among them 119 dentists or 38 percent of the total dental force. Three of these nonmetropolitan counties--Missoula, Silver Bow, and Flathead--have more than 20 dentists, and two other coun- ties--Gallatin and Lewis and Clark--have at least 10 dentists. Distribution of Montana Dentists, by County Group Number Number Percent County group#* of of of counties dentists dentists All counties 56 309 100 Metropolitan areas 2 86 28 Billings area 1 44 14 Great Falls area 1 42 14 Nonmetropolitan counties 54 223 72 Central city 10,000-49,999 7 119 38 Central city 2,500- 9,999 15 60 20 Central city under 2,500 32 44 14 * See Appendix Table for definition of metropolitan areas, and presen- tation of individual county data. The 47 nonmetropolitan counties comprising the two groups of counties with fewer than 10,000 persons in their central cities have approximately one-third of the State's dentist supply. There are 60 dentists in the 15 counties having between 2,500 and 9,999 persons in their central cities, while only 44 dentists are scattered among the 32 counties with central cities of less then 2,500 population. Only 9 of these 47 coun- ties have as many as 5 dentists, and 21 counties have fewer than 2 dentists. 303 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of Montana dentists is 43.4 years. One-fourth (76 dentists) are under 35, and almost a third (95 dentists) are between 35 and 44 years of age. On the other hand, a substantial proportion, approximately one- fourth, are 55 or over. Twelve percent (37 dentists) are at least 65 years of age, including 22 dentists who have reached the age of 70. Median Age and Age Distribution of Montana Dentists by County Group Percent by age in 1965 County group Median Under 35- 45- 55 & & 35 44 54 over All counties 43.4 25 31 18 26 Metropolitan areas 43.5 20 36 23 21 Billings area 44.4 16 36 27 21 Great Falls area 42.8 24 36 19 21 Nonmetropolitan counties 43.3 26 29 16 29 Central city 10,000-49,999 42.8 25 34 15 26 Central city 2,500- 9,999 41.2 28 27 20 25 Central city under 2,500 47.5 27 18 14 41 Some variation is to be found in the median ages of dentists in the indi- vidual metropolitan areas and in the nonmetropolitan county groups. Of the two metropolitan areas, Billings has the oldest group of dentists, with a median age of 44.4. The median age of dentists in the Great Falls area is 42.8 years, the same as the median for dentists in the group of nonmetropolitan counties with central cities of 10,000 or more population. Dentists in the group of nonmetropolitan counties with central city popu- lations between 2,500 and 9,999 have a median age of 41.2 years, about 2 years under the State average. In the counties with fewer than 2,500 persons in their central cities, however, dentists are considerably older as a group, with a median age of 47.5 years. While more than one-fourth are under the age of 35, a substantial proportion, 41 percent, are at least 55 years of age. 304 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 309 responding dentists in Montana, 96 percent (296) are active in their profession, giving Montana one professionally active dentist for every 2,426 persons. The two metropolitan areas, Billings and Great Falls, have similar ratios, averaging 2,047 persons per dentist. The seven nonmetropolitan counties with 10,000 or more inhabitants in their central cities average one dentist for every 1,958 persons, a ratio slightly better than that of the metropolitan areas, and considerably more favorable than the State average. Among these counties, three have persons-per-dentist ratios under 1,900--Missoula (1,467), Flathead (1,700), and Silver Bow (1,868). Number of Persons per Active Dentist in Montana Professionally Persons County group* active Population per dentists dentist All counties 296 718,100 2,426 Metropolitan areas 83 169,900 2,047 Billings area 42 86,100 2,050 Great Falls area 41 83,800 2,044 Nonmetropolitan counties 213 548,200 2,574 Central city 10,000-49,999 116 227,100 1,958 Central city 2,500- 9,999 56 175,600 3,136 Central city under 2,500 41 145,500 3,549 * See Appendix Table for individual county data. Persons-per-dentist ratios are much less favorable in the two groups of counties with less than 10,000 persons in their central cities. The 15 counties with central city populations between 2,500 and 9,999 have an average of 3,136 persons per dentist, while the 32 counties with central cities of fewer then 2,500 inhabitants have an even less favorable ratio of 3,549 persons for every active dentist. Among these 47 counties, 13 have ratios exceeding 3,500 persons per dentist, including 8 counties with ratios in excess of 4,000. Another 12 counties have no active den- tists, according to available information. 305 UTILIZATION OF AUXILIARIES More than four-fifths of the dental practitioners in Montana (i.e., den- tists who spend any time working at the chair) reported that they employ auxiliary personnel, including 76 percent who employ at least one auxil- iary on a full-time basis. The most frequently employed auxiliary is the dental assistant. Three-fourths of the practitioners reported the use of an assistant, including 69 percent who utilize at least one full time. Approximately one-fourth of the dentists employ secretaries or reception- ists, usually on a full-time basis. Dental hygienists and laboratory technicians are employed by fewer dentists, usually only part time. Montana Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 2921/ 100 76 8 With one or more auxiliaries 238 84 76 8 Assistant 217 76 69 7 Hygienist 34 12 2 10 Laboratory technician 9 3 1 2 Secretary or receptionist 74 26 17 9 Other type of personnel 5 2 * 2 With no auxiliary 46 16 - - 1/ Includes 8 dentists who did not report on auxiliary utilization. * Less than one-half of one percent. The use of auxiliaries varies with the age of the dentist and is less common among the older dentists. Ninety-one percent of the dental prac- titioners under the age of 55 reported employment of some type of auxil- iary. The proportion utilizing auxiliaries decreases to 66 percent among dentists 55 to 65 years of age and to 46 percent among dentists 64 and over. Some 17 percent of the dental practitioners in Montana reported one or more vacant positions for auxiliary personnel. Of these dentists, 35 per- cent indicated vacancies for full-time hygienists and 27 percent for full- time dental assistants. 306 IZ J I~ ~~ OTHER SURVEY FINDINGS Almost all (99 percent) of the professionally active dentists in Montana are engaged in private practice. Dentists reporting on time spent in providing patient care devoted an average of 40.3 hours per week to this activity for 48.1 weeks during the year preceding the survey. About one dentist in nine worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. Approximately 10 percent of the dental practitioners reported that they limit their practice to a dental specialty, primarily orthodontics, with oral surgery and pedodontics the next most common specialties. Twenty percent of the dentists in metro- politan areas limit their practices, as compared to only six percent in nonmetropolitan counties. Over two-fifths (43 percent) of the 161 civilian dentists 1li- censed in Montana but located in another state are in one of the Pacific Coast states of Washington, Oregon, or California. Another 17 percent are located in adjacent states, primarily Idaho and Wyoming, and the remainder are scattered in 19 other states across the Nation. About one out of five out-of-state dentists reported that they had been professionally active in Montana immediately prior to assuming their present location in another state. One-half of the out-migrant dentists are now located in Washington, Oregon, or California. June 1968. 307 80¢ APPENDIX TABLE Selected Data on Dentists in Montana, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist All counties 309 76 82 296 718.1 2,426 Metropolitan areas 2/ 86 17 18 83 169.9 2,047 Billings area 44 7 9 42 86.1 2,050 Yellowstone 44 7 9 42 86.1 2,050 Great Falls area 42 10 9 41 83.8 2,044 Cascade 42 10 9 41 83.8 2,044 Nonmetropolitan counties 3’ 223 59 64 213 548.2 2,574 Central city 25,000-49,999 58 18 14 58 95.1 1,640 Missoula 33 10 5 33 48.4 1,467 Silver Bow 25 8 9 25 46.7 1,868 Central city 10,000-24,999 61 12 17 58 132.0 2,276 Deer Lodge 2 - - 2 19.3 9,650 Flathead 22 5 8 20 34.0 1,700 Gallatin 13 3 1 13 28.2 2,169 Hill 8 2 4 8 20.5 2,563 Lewis and Clark 16 2 4 15 30.0 2,000 Central city 5,000-9,999 27 5 8 25 78.5 3,140 Custer 5 1 2 5 14.0 2,800 Dawson 5 1 1 5 13.6 2,720 Fergus 5 2 2 5 14.8 2,960 Park 7 - 3 5 13.6 2,720 Valley 5 1 - 5 22.5 4,500 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Montana, by Location 60€ Civilian dentists 1/ Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 2,500-4,999 33 12 7 31 97.1 3,132 Beaverhead 5 2 2 4 7.5 1,875 Big Horn 2 1 - 2 10.4 5,200 Glacier 5 1 2 5 12.9 2,580 Lincoln 4 2 1 4 14.1 3,525 Musselshell 1 1 - 1 4.8 4,800 Pondera 3 - 1 2 8.2 4,100 Powell 3 1 1 3 7.4 2,467 Richland 3 1 - 3 10.8 3,600 Roosevelt 4 2 - 4 12.7 3,175 Toole 3 1 - 3 8.3 2,767 Central city under 2,500 44 12 18 41 145.5 3,549 Blaine 2 1 1 2 8.1 4,050 Broadwater - - - - 2.8 - Carbon 3 1 1 3 7.8 2,600 Carter - - - - 2.3 - Chouteau 2 1 - 2 7.5 3,750 Daniels 1 1 - 1 3.7 3,700 Fallon 2 1 1 2 4.3 2,150 Garfield - - - - 1.9 - Golden Valley - - - - 1.1 - Granite 1 - 1 3.0 3,000 Jefferson - - - 4.4 - Judith Basin - - - - 3.1 - Lake 5 1 1 5 13.2 2,640 Liberty - - - - 2.7 - McCone 1 - - 1 3.3 3,300 01€ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Montana, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Madison 1 - 1 1 4.9 4,900 Meagher 2 1 1 2 2.9 1,450 Mineral 1 1 - 1 3.4 3,400 Petroleum - - - - 0.8 - Phillips 1 - - 1 6.0 6,000 Powder River - - - - 2.5 - Prairie 1 - 1 - 2.3 - Ravalli 7 1 4 6 12.1 2,017 Rosebud 2 2 - 2 6.0 3,000 Sanders 1 - - 1 6.9 6,900 Sheridan 3 1 1 3 6.6 2,200 Stillwater 2 - 1 2 5.5 2,750 Sweet Grass 2 - 2 2 3.2 1,600 Teton 2 - 1 2 7.4 3,700 Treasure - - - - 1.3 - Wheatland 1 - - 1 2.8 2,800 Wibaux 1 - 1 - 1.7 - Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Montana counties included in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. NEBRASKA DENTISTS LICENSED IN NEBRASKA During the 1967 registration period, 1,482 dentists registered with the Nebraska Board of Dental Examiners. A total of 1,350 dentists responded to the survey, 91 percent of all those registered. Sixty-four percent of the respondents are civilian dentists located in Nebraska, 32 percent are civilian dentists located in other States, and 4 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Nebraska Location and All Percent of military status dentists dentists Total licensed 1,482 100 Respondents 1,350 91 Nonrespondents 132 9 Respondents 1,350 100 Civilians in Nebraska 861 64 Civilians in another State 436 32 On active duty with Armed Forces 53 4 More than one-half (55 percent) of the survey respondents are licensed to practice dentistry in one or more other States. Approximately three of every ten dentists located in Nebraska hold more than one license, with 26 percent licensed in one other State and 5 percent licensed in two or more other States. Multiple licensure is considerably more com- mon among dentists registered in Nebraska but located out-of-State, with about 30 percent having two or more licenses in addition to their Nebraska license. Fifty-five percent of the out-of-State licenses are held in adjacent States, including 25 percent in Colorado, 15 percent in Iowa, and 15 per- cent in South Dakota, Wyoming, Kansas, and Missouri. The remainder are held in 32 other States throughout the Nation, with the largest propor- tion (12 percent) in California. 311 386-029 O - 70 - 21 PROFESSIONAL TRAINING More than nine-tenths of the 861 responding dentists in Nebraska are graduates of the two dental schools located in the State. The College of Dentistry at the University of Nebraska, the largest contributor, has graduated approximately one-half (52 percent) of the State's dental force. The Creighton University School of Dental Science has trained approxi- mately two-fifths (42 percent) of the total dentist supply. The remaining 6 percent obtained their dental degrees from 14 out-of-State schools. Of these, the University of Missouri is the only school to have contributed as much as 2 percent of the State's dental force. Dental School Attended and Year of Graduation for Dentists in Nebraska Number Year of graduation Dental school of ATI After 1941- 1940 or a © dentists years 1955 1955 earlier Total number g61%/ 198 239 419 (Percent distribution by school) Schools in Nebraska 807 94 94 98 92 University of Nebraska 445 52 58 53 49 The Creighton University 362 42 36 45 43 14 schools in other States 52 6 6 2 8 1/ Dental school attended not available for 2 dentists and year of grad- uation for 5 dentists. Percents based on known totals. Relatively few of Nebraska's dentists are recent dental school graduates. Less than one-fourth (23 percent) of all dentists in the State have grad- uated since 1955, while almost one-half (49 percent) received their dental degrees prior to World War II. The overall proportion of the State's den- tists graduating from the two in-State schools has remained relatively constant through the years; however, there has been a slight increase in the proportion graduating from the University of Nebraska, while the pro- portionate contribution of Creighton University has decreased somewhat. Fourteen percent (119) of the survey respondents reported the completion of one or more years of advanced training after receiving their dental degree. Of 60 dentists reporting advanced clinical training, 50 had com- pleted internships, and 10 had completed residencies. Seventy-one den- tists reported advanced academic training, including 50 dentists who had received a master's or other advanced degree, and 21 who had received no additional degrees but had completed at least a year of postgraduate study. Twelve dentists had completed both academic and clinical training. 312 DISTRIBUTION OF DENTISTS Approximately 47 percent of the responding dentists in Nebraska are located in the metropolitan areas. The Nebraska portion of the inter- state Omaha area (Douglas and Sarpy Counties) has the largest number of dentists, 263, or 31 percent of the State supply. About nine-tenths of these dentists are concentrated in Douglas County, where Omaha is located. The second largest dental force, 16 percent of the State supply, is found in the Lincoln metropolitan area (Lancaster County). Distribution of Nebraska Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 93 861 100 Metropolitan areas 4 404 47 Omaha area (Nebr. part) 2 263 31 Lincoln area 1 138 16 Sioux City area (Nebr. part) 1 3 xk Nonmetropolitan counties 89 457 53 Central city 10,000-49,999 9 166 19 Central city 2,500-9,999 25 166 19 Central city under 2,500 55 125 15 * See Appendix Table for definition of interstate and other metropolitan areas and presentation of individual county data. *% Less than one-half of 1 percent. More than one-half (457) of the State's dentists are located in the 89 nonmetropolitan counties. The nine counties with central city populations of 10,000 or more have 166 dentists, about one-fifth of the State's total dental force, while the 25 counties having central city populations between 2,500 and 9,999 have another fifth. The remaining 15 percent (125 dentists) are scattered among the 55 counties having fewer than 2,500 persons in their central cities. Of the 89 nonmetropolitan counties, only 13 have as many as 10 dentists, while 55 counties have under five, including 11 counties which have no dentists, according to available information. 313 AGE DISTRIBUTION OF DENTISTS The median age of dentists in Nebraska is 50.1 years. About 29 percent of the dentists are under 40 years of age, and an almost equal proportion are between 40 and 54. On the other hand, a substantial portion, more than two-fifths, are 55 or over. Almost one-fourth (208) are at least 65 years of age, including 120 who have reached the age of 70. Age Distribution of Nebraska Dentists Number Percent Age of of Cumulative in 1965% dentists dentists percent Total 861 100 - Under 30 61 7 7 30 - 34 100 12 19 35 - 39 84 10 29 40 - 44 117 13 42 45 - 49 67 8 50 50 - 54 57 7 57 55 - 59 77 9 66 60 - 64 90 10 76 65 - 69 88 10 86 70 - 74 75 9 95 75 & over 45 5 100 * Age computed to 1965 to enable comparison among all States surveyed. Dentists in the metropolitan areas, with a median age of 45.1 years, are more than 10 years younger, on the average, than are dentists in the non- metropolitan counties, where the median age is 55.5 years. Slightly more than one-third of the dentists in metropolitan areas are under 40 years of age, while an almost equal proportion are 55 or over. In contrast, only one-fourth of the dentists in nonmetropolitan counties are under 40 years of age, while fully .one-half are 55 or over. The median ages of dentists in the Nebraska portion of the interstate Omaha metropolitan area and in the Lincoln area are somewhat similar, 44.6 and 46.1 years, respectively. Median ages in nonmetropolitan coun- ties tend to increase as the size of the central city decreases. The median age of dentists in the counties with central cities of at least 10,000 population is 53.5 years, compared to a median age of 60.2 years in counties with fewer than 2,500 persons in their central cities. 314 ACTIVE DENTISTS IN RELATION TO POPULATION More than nine in every ten, 95 percent, of the 861 dentists in Nebraska are active in their profession, giving the State one professionally active dentist for every 1,785 persons. Metropolitan areas have one dentist for every 1,565 persons, while nonmetropolitan counties have a somewhat higher ratio of 1,983. The best ratio among the metropolitan areas is found in Lincoln, which has one dentist for every 1,298 persons. The Nebraska portion of the Omaha area has a somewhat higher ratio of 1,673. Dakota County, which constitutes the Nebraska part of the interstate Sioux City area, has a rather high ratio of 4,333 persons per dentist. Number of Persons Per Active Dentist in Nebraska Professionally Persons County group® active Population per dentists dentist All counties 820 1,464,000 1,785 Metropolitan areas 387 605,500 1,565 Omaha area (Nebr. part) 251 419,900 1,673 Lincoln area 133 172,600 1,298 Sioux City area (Nebr. part) 3 13,000 4,333 Nonmetropolitan counties 433 858,500 1,983 Central city 10,000-49,999 159 271,800 1,709 Central city 2,500-9,999 156 304,000 1,949 Central city under 2,500 118 282,700 2,396 * See Appendix Table for individual county data. Twenty-seven of the 89 nonmetropolitan counties in the State have persons- per-dentist ratios below the average for the State, including 13 counties with ratios under 1,500. On the other hand, 28 counties have ratios exceeding 2,500 persons per dentist, including 9 with 4,000 or more per- sons per dentist. When counties are grouped according to the population of central city, the persons-per-dentist ratios generally increase as the size of the central city decreases. Counties with central city popula- tions of 10,000 or more have an average ratio of 1,709 persons per dentist, while counties with fewer than 2,500 inhabitants in their central cities have 2,396 persons per dentist. 315 UTILIZATION OF AUXILIARIES Four-fifths of Nebraska's responding dental practitioners (i.e., dentists who spend any time working at the chair) employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 73 percent of the dentists, including 65 percent who employ at least one assistant on a full-time basis. About 27 percent of the practitioners employ secretaries or receptionists, with more than three-fifths of these dentists utilizing such personnel full time. Dental hygienists and laboratory technicians are employed by 9 percent and 6 percent of the dentists, respectively. These auxiliaries are most often employed only part time. Nebraska Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 809 100 72 8 One or more auxiliaries 615 80 72 8 Assistant 566 73 65 8 Hygienist 67 9 4 5 Laboratory technician 50 6 1 5 Secretary or receptionist 208 27 17 10 Other type of personnel 16 2 1 1 No auxiliary 156 20 - - 1/ Includes 38 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist and is more common among the younger dentists. Approximately 95 percent of the practitioners between the ages of 30 and 44 employ auxiliaries. This proportion decreases to 80 percent for dentists 45 to 64 years of age and to only 50 percent for those 65 and over. One of every seven dental practitioners reported a vacant position for auxiliary personnel. About one-third of these dentists indicated vacan- cies for full-time dental assistants, and one-third had vacancies for full-time dental hygienists. 316 OTHER SURVEY FINDINGS I ~~ Ninety-three percent of the dental practitioners in Nebraska are primarily engaged in private practice, with 92 percent self-employed and 1 percent employed by other dentists. Four percent are on the staffs of dental schools, 2 percent are employed by governmental agencies, and the remaining 1 per- cent are engaged in some other dental activity, such as taking advanced training. I ~~ About 12 percent of the dentists reported at least one second- ary dental activity in addition to their principal employment. Part-time teaching at a dental school was reported by 6 percent of the dentists. Various other activities were reported, including employment by local government and assistance to voluntary agencies. / 7 Dentists providing patient care during the year preceding the survey devoted an average of 39.6 hours a week to this activ- ity for 47.1 weeks. About one dentist in six worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks during the year. / / Twelve percent of the responding dental practitioners reported that they limit their practice to a dental specialty, most commonly to orthodontics, oral surgery, or pedodontics. Twenty percent of the dentists in metropolitan areas limit their practice, compared to only 6 percent of those in non- metropolitan counties. / / Almost one-half (47 percent) of the dentists licensed in Nebraska but located in another State were in the six adjacent States, with the largest proportion, 23 percent, in Colorado. The remainder of the out-of-State dentists were located in 30 more distant States, primarily in California, which had 18 percent. March 1969. 317 81¢ APPENDIX TABLE Selected Data on Dentists in Nebraska, By Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist All counties 861 245 375 820 1,464.0 1,785 Metropolitan areas 2/ 404 135 142 387 605.5 1,565 Omaha area (Nebr. part) 263 88 93 251 419.9 1,673 Douglas 244 74 92 232 381.9 1,646 Sarpy 19 14 1 19 38.0 2,000 Lincoln area 138 47 47 133 172.6 1,298 Lancaster 138 47 47 133 172.6 1,298 Sioux City area (Nebr. part) 3 - 2 3 13.0 4,333 Dakota 3 - 2 3 13.0 4,333 Nonmetropolitan counties 3/ 457 110 233 433 858.5 1,983 Central city 25,000-49,999 24 4 9 24 37.5 1,563 Hall 24 4 9 24 37.5 1,563 Central city 10,000-24,999 142 35 69 135 234.3 1,736 Adams 19 6 8 18 29.9 1,661 Buffalo 16 4 7 16 26.8 1,675 Dodge 17 3 6 16 36.4 2,275 Gage 20 3 14 16 26.7 1,669 Lincoln 13 4 6 13 29.1 2,238 Madison 19 6 12 19 25.5 1,342 Platte 16 6 6 15 26.3 1,753 Scotts Bluff 22 3 10 22 33.6 1,527 61€ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Nebraska, By Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 92 24 47 87 152.2 1,749 Box Butte 11 2 7 9 11.5 1,278 Cass 6 1 4 6 18.3 3,050 Cheyenne 6 2 3 5 16.1 3,220 Dawes 5 2 1 5 9.4 1,880 Dawson 15 4 9 14 19.5 1,393 Jefferson 6 1 3 6 10.6 1,767 Otoe 11 2 5 10 16.9 1,690 Phelps 4 1 2 4 10.2 2,550 Red Willow 8 4 3 8 13.5 1,688 Richardson 8 1 5 8 12.6 1,575 York 12 4 5 12 13.6 1,133 Central city 2,500-4,999 74 17 34 69 151.8 2,200 Cherry 6 1 2 4 8.1 2,025 Colfax 6 3 3 5 9.4 1,880 Cuming 4 1 1 4 12.0 3,000 Custer 9 1 4 7 15.3 2,186 Hamilton 3 1 1 3 8.6 2,867 Holt 8 2 5 8 13.1 1,638 Keith 6 2 1 6 8.3 1,383 Kimball 4 1 3 4 9.7 2,425 Nemaha 3 1 1 3 8.4 2,800 Nuckolls 4 1 2 4 7.6 1,900 Saline 5 1 3 5 11.8 2,360 Saunders 6 1 4 6 17.3 2,883 0ze APPENDIX TABLE (cont'd.) Selected Data on Dentists in Nebraska, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 37 (cont'd.) Central city 2,500-4,999 (cont'd.) Washington 5 - 2 5 12.4 2,480 Wayne 5 2 5 9.8 1,960 Central city under 2,500 125 30 74 118 282.7 2,396 Antelope 5 1 3 5 9.6 1,920 Arthur 1 1 1 0.6 600 Banner - - - - 1.3 - Blaine - - - - 0.9 - Boone 4 - 3 4 8.4 2,100 Boyd 1 1 - 1 4.3 4,300 Brown 3 1 2 3 4.0 1,333 Burt 5 - 4 5 9.6 1,920 Butler 4 - 3 2 9.7 4,850 Cedar 4 - 3 4 13.2 3,300 Chase 3 1 2 3 3.9 1,300 Clay 4 4 4 8.7 2,175 Deuel 2 - 1 2 3.0 1,500 Dixon 4 1 3 4 7.6 1,900 Dundy 4 1 3 4 3.1 775 Fillmore 3 1 2 3 9.3 3,100 Franklin 3 - 3 3 4.8 1,600 Frontier 1 - 1 1 3.9 3,900 Furnas 4 1 1 4 7.1 1,775 Garden 1 - 1 1 3.2 3,200 Garfield 1 1 - 1 2.6 2,600 1c¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Nebraska, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Gosper 1 - 1 1 2.3 2,300 Grant - - - - 0.9 - Greeley 1 - 1 1 4.1 4,100 Harlan 4 1 3 4 4.2 1,050 Hayes - - - - 1.8 - Hitchcock 1 - 1 1 4.3 4,300 Hooker 1 - 1 1 1.1 1,100 Howard 2 1 - 2 6.1 3,050 Johnson 4 1 2 4 5.8 1,450 Kearney 2 1 1 2 6.6 3,300 Keya Paha - - - - 1.5 - Knox 7 3 2 6 12.6 2,100 Logan - - - - 1.0 - Loup - - - - 1.0 - McPherson oo. - - - 0.7 - Merrick 4 3 4 8.2 2,050 Morrill 2 - 1 2 6.4 3,200 Nance 2 - 1 2 5.2 2,600 Pawnee 1 - 1 1 4.7 4,700 Perkins 1 1 - 1 3.9 3,900 Pierce 2 1 1 2 8.3 4,150 Polk 7 2 4 6 6.8 1,133 Rock 1 1 - 1 2.4 2,400 Seward 8 4 3 6 13.7 2,283 Sheridan 3 1 1 3 8.8 2,933 ect APPENDIX TABLE (cont'd.) Selected Data on Dentists in Nebraska, By Location Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Sherman 2 1 1 1 4.9 4,900 Sioux - - - - 2.4 - Stanton 1 1 - 1 5.4 5,400 Thayer 2 - 1 2 8.4 4,200 Thomas - - - - 1.0 - Thurston 2 1 1 2 6.6 3,300 Valley 4 3 4 6.1 1,525 Webster 3 - 1 3 5.6 1,867 Wheeler - - - - 1.1 - Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Nebraska counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's--Omaha and Sioux City--statistics are presented only for dentists located in the Nebraska portions. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. NEVADA DENTISTS LICENSED IN NEVADA During the 1965 registration period, 242 dentists registered with the Nevada Board of Dental Examiners (Table 1). The survey questionnaire was completed by 192 dentists, or 79 percent of all those registering. For dentists not responding to the survey, certain items of information, such as state and county location, dental school attended, and age, were obtained either from records maintained by the Nevada Board of Dental Examiners or from the 1966 American Dental Directory published by the American Dental Association, This report includes information for both respondents and nonrespondents unless otherwise indicated. (See Appendix Table A.) Table 1l.--Location and Military Status of Dentists Licensed in Nevada Location and All percent military status dentists dentists Total licensed 242 100 Respondents 192 79 Nonrespondents 50 21 Total licensed 242 100 Civilians in Nevada 177 73 Respondents 140 - Nonrespondents 37 - Civilians in another state 57 24 On active duty with armed forces 8 3 Only 73 percent of the 242 dentists licensed in Nevada are civilians actually located in the State. Almost one-fourth of the registered dentists are civilians located in other states, and three percent are on active duty in the armed forces. About two-fifths of the 57 out-of- state civilian dentists reside in California, another one-fifth are located in Utah, and the remainder are scattered among 14 other states. 323 Civilian Dentists in Nevada Sources of Supply Dental schools.--More than one-half (54 percent) of Nevada's 177 den- tists are graduates of 14 schools located in the North Central States (Table 2). Major contributors among these schools are Northwestern, Marquette, Washington, and Loyola Universities, having together trained one of every four dentists in the State. Other schools in this part of the Country to contribute as many as six of Nevada's den- tists are St. Louis University and the Universities of Missouri (Kansas City), Nebraska, and Minnesota. Table 2.--School Awarding Dental Degree, by Year Awarded Number Year of graduation pental school of All After 1955 or dentists vears 1955 earlier Total number 177L/ 177 83 93 (Percent distribution by school) North Central 95 54 63 45 Northwestern 18 10 11 9 Marquette 12 7 11 3 Washington (St. Louis) - 10 6 7 4 Loyola (Chicago) 10 6 7 4 10 other schools 45 25 27 25 West 59 33 24 42 Southern California 18 10 7 13 Oregon 15 9 9 8 Pacific (Physicians & Surgeons) 11 6 2 10 California (San Francisco) 11 6 2 10 2 other schools 4 2 4 1 South and Northeast 23 13 13 13 (17 schools) 1l/ Includes one dentist for whom year of graduation is not avail- able. Another one-third of the State's dentists graduated from six schools located in Western States. Schools in California have contributed a large proportion of these dentists, led by the University of Southern California, which has supplied 10 percent of the dentist supply. Two other California schools, the University of the Pacific (Physicians and Surgeons) and the University of California (San Francisco), have each contributed about 6 percent of Nevada's dental force. Among schools in other Western States, the University of Oregon is the major 324 contributor, having trained 9 percent of the State's dentists. Seven- teen schools located in the South and Northeast regions of the Nation have provided the remaining 13 percent of the dentists in Nevada. Over the years there has been a notable change in the source of Nevada's dentists. Traditionally, schools in the North Central States and the West have contributed about equally to the dental force. Since 1955, however, schools in the West have shown a rather marked decrease in the proportion they have contributed and schools in the North Central States have shown an increase to the point where North Central schools have contributed well over twice as many dentists as have schools in the West during this period. Dentists relocating in Nevada.--One-fourth of the dentists responding to the survey reported practicing as a civilian in another state imme- diately prior to assuming their present location in Nevada. The adjacent states of California, Utah and Idaho have together contributed 15 dentists, or about two-fifths of the 35 in-migrants. The remaining 20 dentists have come from 12 more distant states. Dentists coming to Nevada from other states have, on the whole, located in Nevada rather recently. Nearly three-quarters of the in-migrant dentists have come to Nevada since 1950 and about two-fifths moved to the State during the 1960's. Personal Characteristics Age .--The dentists in Nevada represent a relatively young group with a median age of 39.4 years (Table 3). Almost one-third of the dentists are under 35 years of age, and another 37 percent are between the ages of 35 and 44. In contrast, only ll percent are 60 years old or over. Table 3.--Age Distribution Number Percent Cumulative Age of of dentists dentists percent Total 177% 100 - Under 30 13 7 7 30 - 34 44 25 32 35 - 39 35 20 52 40 - 44 30 17 69 45 - 49 17 10 79 50 - 54 12 7 86 55 - 59 5 3 89 60 - 64 11 6 95 65 & over 9 5 100 1/ Includes one dentist for whom age is not available. 325 Advanced training.--Almost one-fifth of the 140 responding dentists have completed one year or more of advanced training. The percent- age of dentists in Nevada who completed clinical training about equals the percentage who completed graduate or postgraduate academic work. Eight percent have had advanced clinical training as an intern or resident and 7 percent have earned a master's degree or completed at least one year of postgraduate study. Another 4 percent reported completion of both clinical and academic training. Multiple licensure.--Eighty percent of the responding dentists located in Nevada hold more than one license to practice dentistry, including 53 percent who are licensed in one state in addition to Nevada, 21 percent in two other states, and 6 percent in three or more other states. Approximately one-half of the dentists holding out-of-state licenses are licensed to practice in California, 17 per- cent in Utah and 11 percent in Oregon. Nevada dentists are also licensed to practice in 22 additional states. Distribution and Current Status Distribution of dentists.--A large proportion of Nevada's dentists, about 85 percent, are located in Clark and Washoe Counties, the two counties that comprise the metropolitan areas of Las Vegas and Reno, respectively (Table 4). The Las Vegas area, with 46 percent of Nevada's dentists, has a slightly larger proportion than does the Table 4.--Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 17 177 100 All metropolitan areast/ 2 151 85 Las Vegas area 1 81 46 Reno area 1 70 39 Nonme tropolitan county groupes’ 15 26 15 Central city 5,000-9,999 2 12 7 Central city 2,500-4,999 4 9 5 Central city under 2.500 9 5 3 1l/ Standard Metropolitan Statistical Areas as established by the U.S. Bureau of the Budget, Office of Statistical Standards. 2/ Counties not included within a SMSA, grouped according to the 1960 population of the largest (central) city within each county. 326 Reno area with 39 percent. The remaining 15 percent of the State's dentists are located in the 15 nomnmetropolitan counties of the State. Of the 26 dentists located in nonmetropolitan counties, 12 are located in the two counties with central cities of 5,000=9,999 population, 5 in Elko and 7 in Ormsby. Of the four counties with 2,500-4,999 persons in their central cities, Humboldt is the only county with as many as 3 dentists. The remaining three counties-- Churchill, Mineral, and White Pine--have 2 dentists each. Only two of the nine counties with less than 2,500 persons in their central cities have dentists, Douglas County (3 dentists) and Lyon County (2 dentists). The remaining seven counties in this group--Esmeralda, Eureka, Lander, Lincoln, Nye, Pershing and Storey--have no civilian dentists according to available information. There are differences in the age distribution of dentists between the two metropolitan areas, and between the metropolitan areas and the nonmetropolitan county groups. Dentists in the Reno metropolitan area, with a median age of about 41 years, are older as a group than their colleagues in the Las Vegas area, with a median age of 38. Almost four of every five dentists in the Las Vegas area are under 45 years of age, compared to three out of five in the Reno area. The two metropolitan areas taken together have a younger group of dentists, on the average, than do the nonme tropolitan counties. Dentists in the metropolitan areas have a median age of 39, compared with a median age of 42 for the nonme tropolitan county groups com- bined. Furthermore, the proportion of dentists 55 years of age or older in the nonmetropolitan counties, one dentist in every four, is twice as great as the proportion of similar age in the metropolitan areas. Active dentists in relation to population.--Based on available information, all but one of the 177 dentists in the State were profes- sionally active at the time of the survey, resulting in a ratio of one active dentist for every 2,274 persons (Table 5). In metropolitan areas, the ratio is one dentist for every 2,127 persons compared to one for every 3,127 persons in nonmetropolitan counties. Furthermore, the ratios for the two metropolitan areas differ considerably. While the Las Vegas area has one dentist for every 2,635 persons, a ratio in excess of the State average, the Reno area has a more favorable ratio of 1,530 persons per dentist. Among the nonmetropolitan county groups there is a sharp increase in the persons-per-dentist ratio as the size of the central city decreases. The ratio is 1,942 in the two counties with a central city size of 5,000-9,999 persons while in the counties with fewer than 2,500 persons in their central cities, the ratio is 5,100. 327 386-029 O - 70 - 22 Table 5.--Number of Persons per Active Dentist Professionally / Persons County group active Population per dentists dentist All counties 176 400,300 2,274 All metropolitan areas 150 319,000 2,127 Las Vegas area 81 213,400 2,635 Reno area 69 105,600 1,530 Nonmetropolitan county groups 26 81,300 3,127 Central city 5,000-9,999 12 23,300 1,942 Central city 2,500-4,999 9 32,500 3,611 Central city under 2,500 5 25,500 5,100 1/ Copyright 1965, Sales Management Survey of Buying Power; further reproduction is forbidden. Among the eight nonmetropolitan counties known to have dentists, Douglas and Ormsby Counties have the most favorable ratios, with one dentist for every 1,500 and 1,529 persons, respectively. Humboldt County, with 2,167 persons per dentist, is the only other nonmetropol- itan county with a ratio more favorable than the State average. The ratio for Elko County, one dentist for every 2,520 persons, slightly exceeds the average for the State. The remaining four counties in which dentists are located have ratios in excess of 3,000 persons per dentist. These counties are Mineral (3,300), Lyon (3,700), Churchill (4,800), and White Pine (4,900). Professional Activity Current employment.--Almost all, 96 percent, of the responding dentists in Nevada are engaged primarily in private practice; 95 percent are self-employed and 1 percent are employed by another dentist. Most of the dentists who are not in private practice work for a state or local health agency. A small proportion of the dentists, 6 percent, reported that they were employed in a part-time dental activity in addition to their primary professional employment. These dentists reported a variety of second- ary dental activities, most frequently employment in a government agency. Activity last year.--All but 5 of the dentists reporting their profes- sional activity during the previous year indicated that they provided care to patients. Dentists reporting time spent in patient care 328 devoted an average of 47.1 weeks during the year to this activity and worked an average of 39.3 hours per week. About one dentist in every ten engaged in a professional activity other than patient care, usually taking advanced training. Practice Characteristics Limited practices.--Twenty-four dentists in Nevada, about one in six, reported that they limit their practice to a dental specialty. Seven of these dentists report specialization in orthodontics, five in pedo- dontics, four each in prosthodontics and periodontics, and two each in oral surgery and oral pathology. All but one of the dentists who reported limiting their practices are located in the State's two metro- politan areas. While one in every four dentists in the Reno area limits his practice, only one in every seven practitioners located in the Las Vegas area does so. Use of auxiliaries.--About 19 of every 20 dental practitioners in Nevada (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 6). The vast majority of the practitioners, 90 percent, employ at least one auxiliary full time, while only 4 percent employ part-time auxiliaries exclusively. Dental assistants are the most frequently employed auxiliary--usually on a full-time basis. Approximately 88 percent of the practitioners employ an assistant, including 83 percent who do so full time. Secretaries or receptionists are employed by almost 50 percent of the dentists, and Table 6.--Auxiliary Utilization by Dental Practitioners Percent of dental practitioners Dental With one With only Type of auxiliary practi 1/ Total full-time part-time tioners™ employee 1 (or more) personne Total 138 100 90 4 With one or more auxil- 130 94 90 4 iaries With assistant 122 88 83 5 With hygienist 39 28 6 22 With laboratory technician 12 9 2 7 With secretary or receptionist 68 49 35 14 With other type of personnel 7 5 1 4 With no auxiliary 8 6 = - 1l/ Based on respondents only. 329 a majority of these dentists utilize at least one of them full time. Dental hygienists and laboratory technicians are much less frequently employed by dentists in Nevada than are assistants and secretaries, and they are more likely to be employed on a part-time basis. While 28 percent of the practitioners employ dental hygienists and 9 percent employ dental technicians, about four-fifths and three-fourths, respectively, of the dentists employing these personnel do so on a part-time basis. July 1967. 330 Appendix Table A.--Summary Statistics for Nevada Total Responding Nonresponding dentists _dentists dentists Total dentists licensed in Nevadat/ 242 192 50 Civilian dentists in Nevada?’ -- (designated simply as ''dentists" in text tables) 177 140 37 Professionally active dentists>’ 176 140 36 Dental practitioners - 138 - In limited practice>’ - 24 - Located in Nevada last year: Reported professional activity? - 122 - Dentists providing patient carel/ - 117 - Reported time spent in patient cared’ - 101 - Civilian dentists in another state 57 44 13 Dentists on active duty in armed forces 8 8 - Data for nonresponding dentists were obtained from the Nevada Board of Dental Examiners and from the 1966 American Dental Directory published by the American Dental Association. All dentists who currently work in Nevada (excluding those in the armed forces) or who are retired and currently live in the State. Data are not available for the following: year of graduation - 1, age - 1. All active civilian dentists currently in Nevada--excludes 1 dentist who is fully retired. All responding dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. Dentists who reported they limited their practice to a dental specialty. Dentists located in Nevada last year who indicated type(s) of activity in which they engaged. All responding dentists who engaged in patient care last year, either as a primary or a secondary activity. Dentists reporting both hours and weeks spent in patient care last year. 331 . Tr gn NEW HAMPSHIRE DENTISTS LICENSED IN NEW HAMPSHIRE During the 1966 registration period, 508 dentists registered with the New Hampshire Dental Board. Of these dentists, 60 percent are civilians lo- cated in New Hampshire, 35 percent are civilians located in other states, and 5 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in New Hampshire Location and All Percent of military status dentists dentists Total licensed 508 100 Respondents 473 93 Nonrespondents 35 7 Total licensed 508 100 Civilians in New Hampshire 305 60 Respondents 280 - Nonrespondents 25 = Civilians in another state 178 35 On active duty with Armed Forces 25 5 The survey questionnaire was completed by 473 dentists, 93 percent of all those registered. Data provided by the survey respondents have been sup- plemented, when obtainable, by information on location, age, dental school attended, and year of graduation for dentists not responding to the sur- vey. Information on nonrespondents was obtained either from records main- tained by the New Hampshire Dental Board or from the 1967 American Dental Directory, published by the American Dental Association. Among the survey respondents, approximately two of every three hold 1li- censes to practice dentistry in one or more other states. About 47 per- cent of the dentists located in New Hampshire hold more than one license, with 36 percent licensed in one other state and 11 percent licensed in two or more other states. Multiple licensure is much more common among dentists who are not located in New Hampshire but maintain a license in the State; 34 percent hold two or more licenses in addition to their New Hampshire license. 333 PROFESSIONAL TRAINING Three-fifths of New Hampshire's dentists are graduates of the two New England dental schools at Tufts University and Harvard University. Through the years Tufts University has been the primary source of New Hampshire's dentists, and its contribution has steadily increased since World War II. Harvard's relative contribution to the New Hampshire supply, on the other hand, has declined greatly during the post-war years. Graduates of 11 other eastern dental schools in Maryland, Pennsylvania, the District of Columbia, New York and New Jersey account for another 26 per- cent of the dentists in New Hampshire. Among these schools, the University of Maryland and Georgetown University have been the primary contributors. However, the role of Maryland as a source of supply has declined through the years, while that of Georgetown has shown a considerable increase. Another 6 percent of the State's dentists are graduates of dental schools located in Illinois, primarily Loyola University of Chicago. The remainder of New Hampshire's dentists received their dental education in 12 schools located in 10 other states and Canada. Dental School Attended and Year of Graduation for Dentists in New Hampshire Number Year of graduation Dental school of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 305% - 86 117 97 (Percent distribution by school) Tufts 154 50 55 51 46 Harvard 29 10 1 8 20 Maryland 23 8 3 9 9 Georgetown 17 6 10 6 1 Loyola (Chicago) 13 4 6 5 2 22 other schools 66 22 25 21 22 * Dental school attended not available for 3 dentists and year of gradu- ation for 5 dentists. Percents based on known totals. More than one-fifth of the 280 in-state survey respondents, 60 dentists, reported that they had completed one year or more of advanced training after receiving the dental degree. Forty-six dentists have received advanced clinical training as interns or residents, and 26 have completed at least one year of advanced academic work as graduate or postgraduate students. Twelve dentists had completed both academic and clinical train- ing. 334 DISTRIBUTION OF DENTISTS Almost three-fifths (59 percent) of the licensed dentists in New Hampshire are located in only 3 of the State's 10 counties. Hillsborough County, which contains most of the Manchester metropolitan area, has the largest number of dentists, 32 percent of the State's supply. Thirteen percent of the dental force is located in Merrimack County, which contains the small remaining portion of the Manchester metropolitan area. A similar percent- age is located in Rockingham County, which contains the New Hampshire fragment of the interstate Lawrence-Haverhill metropolitan area. Distribution of New Hampshire Dentists, by County Number Percent County of of dentists dentists All counties 305 100 Hillsborough* 98 32 Rockingham 44 14 Merrimack® 40 13 Strafford 31 10 Grafton 26 9 Cheshire 20 7 Belknap 14 5 Sullivan 13 4 Coos 10 3 Carroll 9 3 * Contains a portion of a Standard Metropolitan Statistical area, as defined by the U.S. Bureau of the Budget, Office of Statistical Standards. Of the seven other counties, which are entirely nonmetropolitan in charac- ter, Strafford County, with 10 percent of the State supply, has the larg- est number of dentists. Only two other counties, Grafton and Cheshire, have as many as 20 dentists, accounting for 9 percent and 7 percent of the total dental force, respectively. The remaining four counties--Belknap, Sullivan, Coos and Carroll--together have 15 percent of the State's den- tist supply. 335 AGE DISTRIBUTION OF DENTISTS BY COUNTY The median age of dentists in New Hampshire is 44,2 years, Almost one- fourth of the State's dentists are under 35, and 29 percent are between 35 and 44 years of age. On the other hand, a substantial proportion, 26 percent, are 55 or over, About 14 percent of the dentists (42) are at least 65 years of age, including 27 who have reached the age of 70. Age Distribution of New Hampshire Dentists by County Age in 1965 County Total Under 35- 45- 55 & 35 44 54 over All counties 305% 71 88 63 79 Hillsborough 98 25 28 19 23 Rockingham 44 14 17 9 4 Merrimack 40 11 11 8 9 Strafford 31 8 8 7 8 Grafton 26 4 6 6 10 Cheshire 20 5 4 3 8 Belknap 14 2 4 3 5 Sullivan 13 1 5 1 6 Coos 10 1 3 4 2 Carroll 9 - 2 3 4 * Includes 4 dentists for whom age is not available, Dentists' ages vary considerably among individual counties, Hillsborough, Rockingham, and Merrimack have the youngest groups of dentists, with med- ian ages of 41 to 43 years, Moreover, some 27 percent of the dentists in these counties are under the age of 35, and only one-fifth are 55 years of age or older. In contrast, dentists in Grafton and Carroll Counties aver- age at least seven years older, with median ages exceeding 50 years. Only 11 percent of the dentists in these two counties combined are under 35 years old, while 40 percent have reached the age of 55. 336 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 305 dentists in New Hampshire, 284, or 93 percent, are active in their profession, giving New Hampshire one professionally active dentist for every 2,242 persons. Individual county ratios range from a relatively favorable count of one dentist for every 1,913 persons in Carroll County to a considerably less favorable ratio of 3,640 persons per dentist in Coos County. Number of Persons per Active Dentist in New Hampshire Professionally Persons County active Population¥® per dentists dentist All counties 284 636,600 2,242 Hillsborough 94 191,000 2,032 Rockingham 42 109,900 2,617 Merrimack 36 70,700 1,964 Strafford 27 62,200 2,304 Grafton 24 49,000 2,042 Cheshire 18 45,000 2,500 ‘Belknap 13 29,200 2,246 Sullivan 12 27,900 2,325 Coos 10 36,400 3,640 Carroll 8 15,300 1,913 * Copyright 1965. Sales Management Survey of Buying Power, Further reproduction is forbidden. In addition to Carroll, only one other county--Merrimack--has a ratio under 2,000. Hillsborough and Grafton Counties have the next most favor- able ratios--2,032 and 2,042, respectively. Belknap County, with one dentist for every 2,246 persons, has a ratio approximately equal to the State average. Strafford and Sullivan Counties have ratios just over 2,300 persons per dentist, slightly less favorable than the State aver- age, while Cheshire and Rockingham Counties have ratios of 2,500 and 2,617, respectively. 337 UTILIZATION OF AUXILIARIES Eight out of every ten responding dental practitioners in New Hampshire (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 72 percent of all practitioners, in- cluding 66 percent who employ at least one assistant on a full-time basis. Almost one-third of the practitioners employ dental hygienists, most often on a part-time basis, Secretaries or receptionists are employed by 24 percent of the practitioners, with about four-fifths of these dentists utilizing such personnel full time. Only 5 percent employ laboratory technicians in their practices. New Hampshire Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 256% 100 75 6 One or more auxiliaries 202 81 75 6 Assistant 180 72 66 6 Hygienist 81 32 12 20 Laboratory Technician 12 5 1 4 Secretary or receptionist 59 24 19 5 Other type of personnel 9 4 3 1 No auxiliary 48 19 - - * Includes 6 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist, and tends to be more frequent among younger dentists, Ninety percent of New Hampshire dentists between the ages of 30 and 44 employ some type of auxiliary. The proportion using auxiliaries decreases to 76 percent among dentists 45 to 64 years old and to only 43 percent among dentists 65 and over. Young dentists who are just starting their practices do not reach peak utiliza- tion of assistants until they are at least 30 years of age, and of hygien- ists, until age 35. One-fifth of the dental practitioners in New Hampshire reported one or more vacant positions for auxiliary personnel. Of those reporting vacan- cies, 30 percent indicated a need for full-time hygienists, and 20 percent reported vacancies for full-time dental assistants. 338 OTHER SURVEY FINDINGS / | Ninety-seven percent of the responding active dentists in New Hampshire are primarily engaged in private practice, with 96 percent self-employed and one percent employed by another dentist. The remaining 3 percent are either em- ployed by a governmental agency or are engaged in other dental activities, such as taking advanced training. / | Dentists reporting on time spent in providing patient care devoted an average of 39.6 hours per week to this activity for 47.4 weeks during the year preceding the survey. One in every nine dentists worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. / | About 8 percent of the responding practitioners reported that they limit their practice to a dental specialty, primarily to oral surgery or orthodontics. / | More than one-third of the 473 responding dentists who hold licenses in New Hampshire are located in another state. Eighty-four percent of these out-of-state dentists are cur- rently located in the neighboring states of Massachusetts, Maine, Vermont, Connecticut, or New York. / | About one in every eight out-of-state dentists reported that they had been professionally active in New Hampshire immediately prior to assuming their present location, Fifteen of these 21 out-migrant dentists are located in the three adjacent states--Massachusetts, Vermont and Maine, June 1968. 339 oo oo Caw gee mye ape at NEW JERSEY DENTISTS LICENSED IN NEW JERSEY During the 1965 registration period, 5,604 dentists registered with the New Jersey State Board of Dentistry. Three-fourths of the registered dentists were civilians located in New Jersey, another 20 percent were civilians located in other States, primarily New York, Pennsylvania, and Delaware, and 5 percent were on active duty in the Armed Forces. Location and Military Status of Dentists Licensed in New Jersey Location and All Percent of military status dentists dentists Total licensed 5,604 100 Respondents 5,148 92 Nonrespondents 456 8 Total licensed 5,604 100 Civilians in New Jersey 4,185 75 Respondents 3,873 - Nonrespondents 312 - Civilians in another State 1,131 20 On active duty with Armed Forces 278 5 Not reported 10 * * Less than one-half of one percent. The survey questionnaire was completed by 5,148 dentists, 92 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not respond- ing to the survey. Information on nonrespondents was obtained either from records maintained by the New Jersey State Board of Dentistry or from the 1966 American Dental Directory published by the American Dental Association. 341 PROFESSIONAL TRAINING More than four-fifths of New Jersey's dentists are graduates of 10 den- tal schools located in 3 eastern states--Pennsylvania, New York, Maryland--and the District of Columbia. Two dental schools in Pennsyl- vania, Temple University and the University of Pennsylvania, which have between them graduated 44 percent of the dentists in New Jersey, have long been the primary sources of the State's dentist supply. The den- tal schools of New York and Georgetown Universities and the University of Maryland have also been major contributors of dentists to New Jersey, New York University alone supplying one of every eight dentists in the State. New Jersey's two new dental schools at Fairleigh Dickinson University and the New Jersey College of Medicine and Dentistry have together supplied 5 percent of the State's dentists. The remaining 13 percent of the dentists were trained in 33 other dental schools scat- tered among 21 states. School Awarding Dental Degree, By Year Awarded Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 4,185L/ - 1,042 1,355 1,693 (Percent distribution by school) Temple 906 22 25 25 17 Pennsylvania 902 22 19 22 23 New York 516 12 12 13 12 Maryland 464 11 6 9 16 Georgetown 254 6 6 7 5 Columbia 182 4 3 4 6 Fairleigh Dickinson 116 3 11 - - Tufts 81 2 2 2 2 New Jersey College 79 2 7 - - Pittsburgh 79 2 1 2 2 Howard 79 2 2 3 1 34 other schools 512 12 6 13 16 1/ Dental school attended not available for 15 dentists and year of graduation for 95 dentists. Percents based on totals for whom the data are known. While the proportionate contribution of the various schools has remained relatively constant through the years, the growing role of New Jersey's new dental schools in supplying dentists for the State has recently 342 PROFESSIONAL TRAINING (cont'd.) affected the relative contribution of other schools. Although their first classes were not graduated until 1960, the new schools in New Jersey have already become substantial sources of dentist supply. Their graduates account for 37 percent of the dentists in the State who have completed their dental education in the years since these schools produced their first graduating classes, At the same time, the proportion has declined somewhat among the five schools which have traditionally been the major contributors--Temple, Pennsylvania, New York, Maryland and Georgetown--with these schools accounting for about one-half of the dentists who are graduates of the years since 1960 compared to three-fourths of those graduated prior to that time. Almost a third of the survey respondents, or 1,240 dentists, reported they had completed one year or more of advanced training beyond receipt of the dental degree. Of the 974 dentists with advanced clinical training, 186 completed a residency and 788 an internship. Among the 474 dentists who reported advanced academic training, 161 earned a master's or other advanced degree, and another 313 received no additional degrees but completed one or more years of postgraduate study. These figures include 208 dentists who completed both academic and clinical training. Advanced Training Highest level of advanced Number Percent training completed of of dentists dentists Total respondents 3,873 100 With advanced training 1,240 32 Clinical training only 766 20 Academic training only 266 7 Both clinical and academic training 208 5 With no advanced training 2,633 68 There is a growing tendency for young dentists to seek additional train- ing beyond the dental degree, particularly advanced academic work. About 18 percent of the dentists under 40 years of age have had a year or more of graduate or postgraduate study as compared with 13 percent of those 40 to 54 years old and only 6 percent of those 55 and over. 343 386-029 O - 70 - 23 DISTRIBUTION OF DENTISTS More than four-fifths of the licensed dentists in New Jersey are located in the 8 metropolitan areas of the State. The Newark area alone has over 1,400 dentists, about one-third of all the dentists in the State. The Paterson-Clifton-Passaic metropolitan area is the location of another 933 dentists, 22 percent of the State's supply. The New Jersey portion of the Philadelphia area, containing the city of Camden, and the Jersey City area have the third and fourth largest dental forces, each accounting for about 9 percent of New Jersey's dentists. The Trenton and Atlantic City areas taken together account for only 6 percent of the dentist supply. Distribution by Area Number Number Percent Area of of of counties dentists dentists All counties 21 4,185 100 All metropolitan areas* 13 3,413 82 Newark area 3 1,409 34 Paterson-Clifton-Passaic area 2 933 22 Philadelphia, Pa. area - N.J. part 3 381 9 Jersey City area 1 369 9 Trenton area 1 179 4 Atlantic City area 1 99 2 Allentown-Bethlehem~Easton, Pa. area - N.J. part 1 24 1 Wilmington, Del. area - N.J, part 1 19 1 Nonmetropolitan counties* 8 772 18 Monmouth County 1 240 6 Middlesex County 1 233 5 Other counties 6 299 7 * See Appendix Table for definition of metropolitan areas and presenta- tion of individual county data. Less than 20 percent of the dentists are located in the 8 nonmetropolitan counties. Some of these counties, however, have fairly large numbers of dentists. Of the State's 772 dentists in nonmetropolitan counties, 240, or almost one-third, are located in Monmouth County and another 233 den- tists are located in Middlesex County. The counties of Somerset, Ocean and Cumberland each have between 50 and 100 dentists, and the remaining three counties, Sussex, Cape May and Hunterdon, have between 20 and 30 dentists. 344 AGE OF DENTISTS With slightly more than one-half of the dentists under 47 years of age, the median age of dentists in New Jersey is 46.6 years. Only 21 percent of the State's dentists are under 35, but almost one-third are 55 years of age or older. About one in every eight, or 500 dentists, are 65 years old or over, and 217 have reached the age of 70. Age Distribution Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 4,185 100 - Under 30 290 7 7 30 - 34 592 14 21 35 - 39 539 13 34 40 - 44 505 12 46 45 ~ 49 452 11 57 50 - 54 456 11 68 55 - 59 459 11 79 60 - 64 354 9 88 65 - 69 284 7 95 70 - 74 134 3 98 75 and over 83 2 100 1/ Age not available for 37 dentists. Percents based on total for whom age is known. There are marked differences in the median ages of dentists in the metro- politan areas and in the nonmetropolitan counties. Among the metropolitan areas, the Jersey City area has the oldest dentists, with a median age of 55, about 5 years above the median in the Atlantic City area, which has the next oldest dentists. In contrast, dentists in the New Jersey portion of the Philadelphia area are young as a group, with a median age of 43 years, Dentists in the nonmetropolitan counties have a median age of 44 years compared to 47 years for those in all metropolitan areas combined. Among the individual nonmetropolitan counties, the median ages range from 49 years in Cumberland and Sussex Counties to a low of 39 years in Somerset County. 345 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 4,185 dentists in New Jersey, 4,069, or 97 percent, are active in their profession, giving New Jersey one professionally active dentist for every 1,634 persons. There is one dentist for every 1,561 persons in the metropolitan areas, while the remainder of the State has a slightly less favorable ratio of one dentist for every 1,955 persons. Number of Persons Per Active Dentist Professionally Persons Area active Population per dentists dentist All areas 4,069 6,648,100 1,634 All metropolitan areas 3,314 5,171,700 1,561 Newark area 1,362 1,815,100 1,333 Paterson-Clifton-Passaic area 907 1,332,600 1,469 Philadelphia, Pa. area - N.J. part 373 845,100 2,266 Jersey City area 359 595,700 1,659 Trenton area 175 281,600 1,609 Atlantic City area 95 170,500 1,795 Allentown-Bethlehem-Easton, Pa. area - N.J. part 24 67,700 2,821 Wilmington, Del. area = N.J. part 19 63,400 3,337 Nonmetropolitan counties 755 1,476,400 1,955 Monmouth County 238 382,000 1,605 Middlesex County 229 508,500 2,221 6 other counties 288 585,900 2,034 Among the metropolitan areas, Newark has the best ratio, with one dentist for every 1,333 persons. The persons-per=-dentist ratio for Paterson- Clifton-Passaic, 1,469, is only slightly less favorable, Jersey City and Trenton have ratios very close to the State average, 1,659 and 1,609, respectively, while Atlantic City, with one dentist for every 1,795 per- sons, has a ratio that somewhat exceeds the State average. The remaining three metropolitan areas, all of which are outlying counties of larger interstate metropolitan areas, have persons-per-dentist ratios in excess of 2,200. Among the nonmetropolitan counties of the State, only Monmouth County, with one dentist for every 1,605 persons, has a ratio as favorable as the State average. Ocean and Somerset Counties have ratios of about 1,800 persons per dentist, a little above the average for the State. The remaining five non- metropolitan counties, Middlesex, Cumberland, Sussex, Cape May and Hunterdon, all have more than 2,000 persons for every active dentist. 346 UTILIZATION OF AUXILIARIES About two-thirds of the responding dental practitioners in New Jersey (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel. Dental assistants, the most frequently employed auxil- iary, are utilized by 59 percent of all practitioners, including 51 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 15 percent of the dentists with about two- thirds of these dentists utilizing such personnel full time. Only 9 percent of the dentists employ dental hygienists and 4 percent employ dental techni- cians. Dentists are more likely to employ hygienists and laboratory techni- cians on a part-time basis compared to other auxiliary personnel. Dental Practitioners Employing Auxiliaries, By Type of Auxiliary Percent of dental practitioners Type of Dental With one full- With only auxiliary practitioners Total time employee part-time (or more) personnel Total 3,746%/ 100 57 9 With one or more auxiliaries 2,415 66 57 9 With assistant 2,178 59 51 8 With hygienist 326 9 4 5 With laboratory technician 148 4 2 2 With secretary or receptionist 560 15 10 5 With other type personnel 109 3 2 1 With no auxiliary 1,253 34 - - 1/ Includes 78 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is more fre- quent among the young dentists. Eighty percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. The propor- tion utilizing auxiliaries decreases to 61 percent among dentists 45 to 64 years old and drops to 36 percent among dentists 65 and over. Peak utiliza- tion of both hygienists and dental assistants occurs between the ages of 35 and 44. 347 OTHER SURVEY FINDINGS ***Ninety-seven percent of the responding professionally active dentists in New Jersey are primarily engaged in private practice. Another one percent are on the staffs of dental schools, and the remaining two percent are either employed by governmental agencies or are engaged in other dental activities, such as taking advanced training. **%At least one part-time dental activity in addition to their principal employment was reported by 20 percent of the dentists. Part-time teaching in a dental school was the most frequently reported secondary employment. Other types of secondary dental activity reported by the dentists include employment by another dentist and serving in school dental health programs, *¥%Dentists reporting time spent in providing patient care devoted an average of 39.5 hours per week to this activity for 47.7 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. **kAbout 13 percent of the practitioners reported they limit their prac- tices to a dental specialty, primarily to orthodontics or oral surgery. More than eighty percent of the dentists who reported limiting their practices are located in the State's metropolitan areas. *%*Seven percent of the respondents, 271 dentists, practiced as a civil- ian dentist in one of 21 other states or the District of Columbia immediately prior to assuming their present New Jersey location. Nearly nine in every ten of these dentists came from the adjacent states of New York and Pennsylvania. *¥%kTyo-thirds of the 1,131 civilian dentists licensed in New Jersey but located in another state are in the adjacent states of New York, Pennsylvania or Delaware. The remaining out-of-state dentists are scattered among 37 other states, the District of Columbia or foreign countries. October 1967. 348 APPENDIX TABLE Selected Data on Dentists in New Jersey, by Location Civilian dentists Persons Non- Age in 1965 Profes- . Area and County Respond- . Population™ per Total respond- Percent Percent sionally . ' . ents i (in 000's) active ents under 35 55 or more active dentist All counties 4,185 3,873 312 21 32 4,069 6,648.1 1,634 All metropolitan areas’ 3,413 3,154 259 20 33 3,314 5,171.7 1,561 Newark area 1,409 1,308 101 18 35 1,362 1,815.1 1,333 Essex 779 727 52 13 42 752 956.6 1,272 Morris 207 190 17 33 22 198 303.1 1,531 Union 423 391 32 20 29 412 555.4 1,348 Paterson-Clifton-Passaic area 933 870 63 23 27 907 1,332.6 1,469 Bergen 644 603 41 25 25 631 888.3 1,408 Passaic 289 267 22 19 33 276 444.3 1,610 Philadelphia, Pa. area - N.J. part 381 348 33 26 21 373 845.1 2,266 Burlington 100 94 6 34 12 99 266.5 2,692 Camden 228 203 25 25 24 223 433.1 1,942 Gloucester 53 51 2 17 25 51 145.5 2,853 Jersey City area 369 333 36 11 51 359 595.7 1,659 Hudson 369 333 3 1 51 359 595.7 1,659 Trenton area 179 167 12 20 28 175 281.6 1,609 Mercer 179 167 12 20 28 175 281.6 1,609 Atlantic City area 99 88 11 18 39 95 170.5 1,795 Atlantic 99 88 11 18 39 95 170.5 1,795 Allentown-Bethlehem-Easton, Pa. area - New Jersey part 24 24 z 17 29 24 67.7 2,821 Warren 24 24 - 17 29 24 67.7 2,821 6%¢ 0s¢ APPENDIX TABLE (Cont'd.) Selected Data on Dentists in New Jersey, by Location Civilian dentists 1 Persons Ar nd Count Resp ond- Non- Age in 1965 Profes- Populations! per ca a ounty Total pe respond- Percent Percent sionally (in 000's) active ents under 35 55 or more active dentist All metropolitan areas’ (Cont'd.) Wilmington, Delaware area - New Jersey part 19 16 3 S 32 19 63.4 3,337 Salem 19 16 3 5 32 19 63.4 3,337 All nonmetropolitan counties’ 772 719 53 29 27 755 1,476.4 1,955 Cape May 26 22 4 23 35 24 55.0 2,292 Cumberland 52 47 5 17 33 51 118.4 2,322 Hunterdon 24 22 2 21 38 23 59.8 2,600 Middlesex 233 221 12 27 24 229 508.5 2,221 Monmouth 240 225 15 32 28 238 382.0 1,605 Ocean 78 68 10 29 29 72 130.1 1,807 Somerset 92 89 3 35 23 92 166.2 1,807 Sussex 27 25 2 33 37 26 56.4 2,169 1l/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ New Jersey counties included in the latest 1967 definition of Standard Metropolitan Statistical areas, as estab- lished by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's statistics are presented only for dentists located in the New Jersey portion of the Philadelphia SMSA, Allentown-Bethlehem-Easton SMSA, and Wilmington SMSA. 3/ Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget. NEW MEXICO DENTISTS LICENSED IN NEW MEXICO A total of 425 dentists registered with the New Mexico Board of Dental Examiners during the 1965 registration period (Table 1). The survey ques- tionnaire was completed by 381 dentists, for an overall response rate of 90 percent. Of the responding dentists, only 255, or 67 percent, were civilians actually located in New Mexico. Civilians located in other States account for another 28 percent of the respondents, and an additional 4 per- cent were dentists on active duty in the Armed Forces. There were only two women dentists included among the respondents, both of them located within the State. Table l.--Location and Military Status of Dentists Licensed in New Mexico Location and All Percent of military status dentists dentists Total licensed 425 100 Respondents 381 90 Nonrespondents 44 10 Respondents 381 100 Civilians in New Mexico 255 67 Civilians in another State 108 28 On active duty with Armed Forces 16 4 Not reported 2 1 More than four out of every five dentists responding in the survey hold a license in at least one other State (Table 2). Multiple licensure is extremely common among dentists located in New Mexico. Three-fourths of the civilian in-State dentists are licensed in at least one additional State--60 percent in one other State and 15 percent in 2 or more other States. By comparison, 40 percent of the out-of-State civilian dentists hold licenses in 2 or more States in addition to their licenses in New Mexico and the State in which they are presently located. Table 2.--Percent of Dentists Holding Licenses in Other States Civilian dentists Licenses held res Ae In Out=-of- armed P New Mexico State Total 100 100 100 100 New Mexico only 18 25 - 25 Licensed in 1 other State 60 60 60 63 Licensed in 2 other States 17 13 28 6 Licensed in 3 or more other States 5 2 12 6 351 Civilian Dentists in New Mexico Sources of Supply Dental schools.--Graduates of 37 dental schools are represented among New Mexico's dentists, including 3 dental schools (Colorado College, San Fran- cisco College of Medicine and Surgery, and Tulane University) which are no longer in existence. Well over one-half of the State's dentists are grad- uates of schools located in the North Central States (Table 3). The Univer- sity of Missouri at Kansas City has made the largest single contribution, having trained almost one-fourth of all dentists in the State. Creighton and Indiana Universities, and Loyola University of Chicago have also made significant contributions. Another one-fourth of the dentists received their dental education in schools in the South. Among Southern schools, Baylor University has been the outstanding contributor, supplying 17 per- cent of the State's dentists. Schools in the West have contributed 12 per- cent of the dentist supply, with the University of Southern California the largest Western contributor. Dental schools in the Northeast account for only 5 percent of the total. Table 3.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Dental school of AIT After 1941- 1940 or attence dentists years 1955 1955 earlier Total number 255L/ - 95 93 60 (Percent distribution by school) North Central 146 58 54 54 69 Missouri (Kansas City) 56 23 30 14 20 Creighton 13 5 6 8 - Indiana 11 4 1 2 14 Loyola of Chicago 9 4 2 2 8 Northwestern 8 3 3 3 3 Washington (St. Louis) 8 3 3 3 3 Marquette 8 3 1 7 2 8 other schools 33 13 8 15 19 South 64 25 29 29 14 Baylor 43 17 20 19 7 9 other schools 21 8 9 10 7 West 29 12 11 10 15 Southern California 8 3 1 7 - 6 other schools 21 9 10 3 15 Northeast 13 5 6 7 2 17 Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item. (See Appendix Table A.) 352 Both the University of Missouri at Kansas City and Baylor University have played an increasingly important role in recent years in supplying den- tists for the State. Together, they account for half of all dentists in the State who have completed their dental education within the past ten years. By contrast, graduates of these schools make up only 27 percent of all dentists in the State who finished dental school in the years prior to World War II. The proportionate contribution of Indiana Univer- sity and Loyola University of Chicago has decreased considerably over earlier years. Together, these two schools account for 22 percent of all dentists graduated prior to World War II, but for only 3 percent of those graduated since 1955. Dentists relocating in New Mexico.--Only about one out of five dentists (22 percent) presently in New Mexico reported previous professional loca- tions as civilians in other States. One-fourth of these dentists who have migrated into New Mexico were previously located in Texas. Another 18 percent of the in-migrant dentists moved from 3 other adjacent States-- Colorado, Oklahoma, and Arizona. Although dentists have come to New Mexico from 19 other States, most of these States account for only one dentist each, and none for more than 3. Personal Characteristics Age.--Dentists in New Mexico are relatively young--their median age in 1965 was only 42.0 years. Three-fifths of the State's dentists were under 45 years of age, including 26 percent who were under 35 (Table 4). Only 5 percent were 65 years old or over. Table 4.--Age Distribution Number Percent Cumulative Age of of percent dentists dentists distribution Total 255 100 - Under 30 19 8 8 30 - 34 44 18 26 35 - 39 41 17 43 40 - 44 41 17 60 45 - 49 34 14 74 50 - 54 16 7 81 55 - 59 17 7 88 60 - 64 16 7 95 65 - 69 8 3 98 70 & over 5 2 100 353 Advanced training.--One of every six dentists in New Mexico reported the completion of a year or more of advanced training (Table 5). About 8 per- cent of the State's dentists have taken clinical training. A larger pro- portion, or about 13 percent, have completed at least one year of advanced academic training, including 6 percent of the dentists who reported earn- ing a master's degree since leaving dental school. Both clinical and academic training have been taken by about 5 percent of all dentists in the State. Table 5.--Advanced Training Number Percent Highest level of training completed of of dentists dentists With advanced training 40 16 Clinical training only 8 3 Academic training only 21 8 Both clinical and academic 11 5 Clinical training Residency completed 9 4 Internship completed 10 4 Academic training M.A., M.S., or other advanced degree 14 6 Postgraduate 1 year or more (no degree) 18 7 Distribution and Current Status Distribution of dentists.--The largest concentration of responding den=- tists in New Mexico is in the Albuquerque metropolitan area (Bernalillo County). More than two-fifths of the State's licensed civilian dental force is located in this single county (Table 6). The remaining 56 per- cent of the dentists in the State are located in nonmetropolitan counties. However, of the 31 nonmetropolitan counties in the State, 7 have no reporting dentists. Table 6.--Distribution by County Group and Age in 1965 Number Number Percent of dentists County group of of All Under 35- 45- 55 & counties dentists ages 35 44 54 over All counties 32 255 100 26 34 21 19 Albuquerque metropolitan area 1 113 44 27 34 20 19 Nonmetropolitan county group Central city 25,000-49,999 5 72 28 28 28 23 21 Central city 10,000-24,999 6 40 16 23 44 20 13 Central city 5,000-9,999 7 20 8 16 42 26 16 Central city under 5,000 13 10 4 33 23 11 33 354 If the nonmetropolitan counties are grouped according to the population of the largest (central) city within each county, the number of dentists in a county generally declines as the population of the central city decreases (see Appendix Table B). Of the 5 counties with central cities of 25,000- 49,999 population, Santa Fe is the only county with more than 20 dentists. The remaining 4 counties--Chaves, Dona Ana, Eddy, and Lea--have between 10 and 14 dentists. In the 6 counties with central cities of 10,000-24,999 population, only Curry and San Juan Counties have 10 or more dentists, while each of the other 4 counties in this group has less than 6 reporting dentists. Among the 7 counties with 5,000-9,999 persons in their central cities, only San Miguel has as many as 5 dentists. The majority of the 13 counties in the smallest size category (counties with central cities of under 5,000 inhabitants) have no reporting dentists at all and those with licensed civilian dentists have 3 or fewer dentists per county. As the data in Table 6 indicate, each of the county groups in New Mexico has a substantial representation of young dentists. In the Albuquerque metropolitan area, 61 percent of the dentists are under 45 years of age, including 27 percent who are under 35. Among the nonmetropolitan county groups, the one with central cities of 10,000-24,999 inhabitants had the youngest reporting dentists. Sixty-seven percent were under 45, and only 13 percent were 55 years old or over. Some variation exists in the age distribution of reporting dentists in the remaining county groups, but in all cases at least 56 percent were under the age of 45. Active dentists in relation to population.--Of the 255 responding civilian dentists in New Mexico, 252 reported that they were professionally active at the time of the survey. Based on this count, there was one profession- ally active dentist for every 4,116 persons in New Mexico in 1965 (Table 7). By county size group, the number of persons per dentist in the nonmetropol- itan areas range from 4,114 in the 5 counties with 25,000 or more persons in their central cities to 10,780 in the 13 counties with central cities of less than 5,000 residents. Among the 25 counties known to have dentists, Santa Fe County had the most favorable ratio, with one professionally active dentist for every 2,104 persons. At the opposite end of the scale, and differing by more than 10,000 persons, was Valencia County with a ratio of 13,367 persons per dentist (see Appendix Table C for individual county data). Table 7.--Distribution of Professionally Active Dentists Professionally Persons County group active Population per dentists dentist All counties 252 1,037,300 4,116 Albuquerque metropolitan area 110 310,500 2,823 Nonmetropolitan county group Central city 25,000-49,999 72 296,200 4,114 Central city 10,000-24,999 40 217,200 5,430 Central city 5,000-9,999 20 105,600 5,280 Central city under 5,000 10 107,800 10,780 355 As the map on the following page indicates, only 8 of the 25 counties with reporting dentists had dentist-population ratios as favorable as the State average of 4,116. The metropolitan county of Bernalillo ranked second in the State with a ratio of one dentist for every 2,823 persons, and Los Alamos County ranked third, with a ratio of one for every 3,060. The num- ber of persons per dentist in the remaining 5 counties with better than average ratios ranged from 3,400 in Colfax County to 3,886 in Eddy County. One county--Lincoln--had a ratio (4,150 persons per dentist) that is only slightly higher than the State average. Of the remaining counties with reporting dentists, however, there were 8 counties with ratios in excess of one dentist per 8,000 persons. In addition to Valencia County, they included McKinley (8,320), Rio Arriba (8,567), Taos (8,650), Otero (8,675), Roosevelt (8,850), Socorro (10,330), and Quay (13,100). The counties without reporting dentists are not necessarily without the services of a dentist. For example, Sandoval County, from which no active dentist reported, has an Indian population which accounts for more than 20 percent of its total inhabitants. Since dentists employed by the Federal Government in such agencies as the Division of Indian Health of the Public Health Service are not required to be licensed in the State in which they are assigned, there is every likelihood that the survey results under- estimate the dental force available to the residents of this county. This is also true of some of the counties with reporting dentists. A case in point is McKinley County, with 5 reporting dentists serving a population of over 41,000. Since 28 percent of its residents are Indian, the dental force available to the community is undoubtedly greater than the survey figures indicate. Professional Activity Current employment.--As might be expected, self-employment predominates among dentists who are active in the profession. Of the 252 profession- ally active dentists located in New Mexico, 95 percent are primarily in private practice. The remaining 5 percent includes 2 percent who are primarily employed by other dentists, another 2 percent employed by a government agency, and one percent engaged in other dental employment. Only 17 dentists, or 7 percent of those professionally active, reported a secondary dental employment. Nine of these dentists, seven of whom are located in Bernalillo County, engage in work with a voluntary agency as their secondary activity. Other dentists reported that they teach part time at the dental hygiene school in Albuquerque or work for a government agency. Activity last year.--All but one dentist reporting on their professional activity in New Mexico last year indicated that they had provided care for patients. Dentists reporting on time spent last year in providing patient care devoted an average of 47.4 weeks to this activity and worked an average 356 CoO ME XI NEW I 96 5 ST DENT COUNTY N PER BY 0 | POPULAT 5 Iz | | | anoews | N = = TI, 7777, 71, /7r7 LAA 7727,7,7)3 loz 2 | | oames 183 < = {ccna YOAKUM 5% HARTLEY GLonam ToT E 4,999 Gl TT 0,0, aaa aa eee LL ly 10000000077, 700070 0.0 NE 0,07 10,70,%,72207 7, 52,2724% 7s Z 10 7,, L02770202,00%507 I 0 00000,0 00,0000 7 5,070,070 eases: 100,00 0,00 0005007 1747,77 roy 7 z / 7’ 7, Vo ewww 7, 100,05000,, 77/7 V/ 1000,24 770,777 0,00 aes. T0p00707,5057727 172,02270,,777,, 7 2077,7 ross ’ lps 0777, lr 242 /) IA AVIA so ero TREE emi: 4 ’, 1,007,070 7,7 77, ya 7 (ZZZ2 222222222 24 107 NIAAA a. 7%, 7 0,577 - il 7 As yess NZ." Ld ZZ ZZ 2 ZZ 22222222 CN a TTS . OTITIS z “0 os rrr vrei < / 77 y 7/7 fooaesssssssssss 8 » 2.77.7,27, 7277, 777,777,077, Ea 4,000 - lrr770,%7,717,77,57, 277070, 70.77 7s, v1 0%,577,0004 7,7 777, 72,0 7477,,77, / ze 1. 7.507%, 7/7, 777 77 yl 3,000 - 3,999 Novrvrsovvosros Hy ZZ 2 22222222 Norovvovovors. of rrrrrrvrrs. - I vss vt, VIII. 4 SEZ xs : persons per dentist ( C eosin NNN AN N\A NAMM NNW Naw AN NWN NO DAN WM NAN NUON ON WN NAY aN IGUEL NN URDALUPE \ \ 5,000 & over no dentists 727, 700 0s sy NAAR AA IAD AAAI 7, = 0000000000457 7,70 | ole27500,7:,7272, M 007/00, 724,052,07% 7 ° a, 0774,2747/,77 > G,00770,774557,05 77002 S < FZ nl 7 744, m Ly 777 / 2777 07777 o «V0 007%,7000, z 207,07 . 105057, - ° 777 z E NANI 2,7 ™ S17 r227,%,%7 77,7 fz d Sr 772577 X00 88 TL 0y 7775777 BY SO RAL NAA" 7, 2,007: 1 777 : Ar 724,0,%02,7,77 7, 17,000 0 7,77 S “N22 0707,74,7.2.72, AY 00 7004577 V7, 7,7 © / 7722,72,7% 15000 71/77 AVIA; c 100000, 7, 270.277 7,7% D7, 702740%72,,0.7% (7 00000000 Ns 3 7/77, 22,77,5% ! 7000 1005727740707; WIN 7, 7 y 7 1200,00777077. : 7 000 0h, AAI 77 /, ‘ V2, 77,7777 rs, | / 2’, / 777, 2,000,077 2, z 7 7 77257570722, 7, LL tks 77,7277, 2, 0000007, 117,0507,74,0 2244577, 7,7, l,l) 3 / LNs, 2 7,0 2 2% 27, 1000.00 A 777 ~ Lote ° 5 750 100,002,770, 074 7 0 7 7% 0 7, Ls 2s ‘ = 7000s, 8,077,0 Yr, 77077, oss > 100,07. 872,50004,50000 70740, 77, : tl Js 77 //, 77 - V7 ores = OTITIS 77 ya 77," / Vy. y - TITS IITA| / V7 7,777 7, Cees 1 XA £7 EA SOI ITI TTS | ‘//7, 7 v7 7 , 7 7 2 TTT | 000) in. |, oy nein ~~ sossossessssem ls 0, ” 7, /, RIZZI ZZ ZZ INEZ ZZ ZZ ZZ ZZ ZZ Aes 2 7/7. 7, 2222222222 rl NN 7 % yo 7 7 /, ys CTT. // 7 ’ / 7 SOT TTT TIT IITIS yy v7, , 7,7 /y/ 7, III IIIS A 777%, 7 7, . (ZZ 722 ZZ 2222227222 2s 77,7 7” 77 y. / sossssTvvTsIIm Sy), Zl _ : |FEE 1, vor TTI III IIIT / Sp srs 7 HH = 7 / / . 222A Me Re I RAIA 7727 / Se (00 0104 0 7 — 2. 7.7, 2200.27.77, 5 ” 2 7 x 3 S 3 < 2 [ree ZL Lily /, = 3 YNOZIYYV | 2 of 38.2 hours per week. The figures in Table 8 show that one-half of the reporting dentists spent at least 40 hours per week at this activity for 48 or more weeks during the year. Furthermore, almost one dentist in ten worked 48 or more hours per week for this number of weeks. Table 8.--Time Spent in Patient Care Last Year Weeks spent in Percent of Percent distribution by work week . dentists 48 hours 41-47 35-39 Under patient care Cas 40 hours providing care or more hours hours 35 hours Total reporting time spent 100 10 14 38 22 16 50 weeks or more 44 6 8 18 7 5 48-49 weeks 32 3 3 12 8 6 40-47 weeks 19 1 2 6 6 4 Less than 40 weeks 5 - 1 2 1 1 Practice Characteristics Limited practice.--Approximately 16 percent of the reporting dentists in New Mexico limit their practices to a dental specialty. Almost one-half of these dentists report their practices are limited to orthodontia. Fifty-nine percent of the dentists limiting their practices are located in the Albuquerque metropolitan area (Bernalillo County), where one in every five dentists reported limiting his practice. Specialization is even more common in Santa Fe County, however, where one-fourth of the dentists are limited practitioners. Use of auxiliaries.--Almost nine out of ten of the dental practitioners report that they employ auxiliary personnel (Table 9). Dental assistants are the most frequently employed auxiliary. Eighty-six percent of all practitioners employ assistants, including 82 percent who employ at least one assistant on a full-time basis. Secretaries and receptionists are employed by 44 percent of the dentists, with about two-thirds of these dentists employing such personnel on a full-time basis. Only 16 percent of the dentists employ hygienists and 12 percent employ dental technicians. A majority of the dentists who employ hygienists or technicians do so only part time. Although dentists in the Albuquerque metropolitan area are no more likely to employ auxiliary personnel than are those located in the nonmetropolitan areas, the use of hygienists is much more common in this county than in the remainder of the State. About 24 percent of the dentists in the Albuquer- que area report the employment of a hygienist, compared with only 11 per- cent of the dentists located elsewhere. 358 Table 9.--Auxiliary Utilization by Dental Practitioners of auxiliar Number of Percent of Type a y practitioners practitioners Total 248 100 With one or more auxiliaries 211 88 With assistant 206 86 With hygienist 39 16 With laboratory technician 28 12 With secretary or receptionist 106 44 With other type of personnel 10 4 With no auxiliary 28 12 The use of auxiliaries varies with the age of the dentist. Over 90 per- cent of the dental practitioners under age 55 employ some type of auxil- iary. Among dentists 55 years of age and over, the proportion using auxiliaries drops to approximately 65 percent. Almost one-fifth of the dental practitioners in New Mexico who are cur- rently without auxiliaries report one or more vacant positions for auxil- iary personnel. The proportion reporting one or more vacancies among dentists currently employing auxiliaries was 15 percent. More than half of all vacancies were for hygienists. Most dentists reporting a hygienist vacancy did not currently employ this type of auxiliary personnel. Out-of-State Civilian Dentists There are at least 108 civilian dentists in 27 other States who maintain licenses in New Mexico. More than one-third of these out-of-State den- tists are located in the adjacent States--26 percent are in Texas and another 10 percent are in Arizona, Oklahoma, and Colorado. The remaining Table 10.--Present Location of Out-of-State Civilian Dentists Number Percent Present location of of dentists dentists Total 108 100 Texas 28 26 California 18 17 Kansas 11 10 Missouri 6 5 23 other States 45 42 359 386-029 O - 70 - 24 64 percent of the out-of-State respondents are located in 23 other States, primarily in California and Kansas. About one of every six out-of-State respondents reported they had formerly been professionally active in New Mexico. Nearly half of these out-migrant dentists are presently located in the neighboring State of Texas. December 1966. 360 Appendix Table A.--Summary Statistics for New Mexico Number of dentists All licensed dentists 425 Respondents -- total dentists participating in survey 381 (number not reporting current location or military status - 2) Civilian dentists in New Mexicor/ -- civilian respondents designated simply as ''dentists'" in text tables 255 (number not reporting: age - 14, dental school attended - 3, and year of graduation - 7) Professionally active dentists2/ 252 In limited practice>’ 37 A xy Dental practitioner 248 Located in New Mexico last year: Reported professional activity! 225 Dentists providing patient cared’ 224 Reported time spent in patient caret! 191 Civilian dentists in another State 108 Dentists on active duty in Armed Forces 16 Nonrespondents -- licensed dentists not participating in survey 44 1/ Le 2 © EE N All responding dentists who currently work in New Mexico (excluding those in the Armed Forces) or who are retired and currently live in the State. All active civilian dentists currently in New Mexico -- excludes 3 dentists who are fully retired. Dentists who reported they limit their practice to a dental specialty. All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. Dentists located in New Mexico last year who indicated type(s) of activity in which they engaged. All dentists who engaged in patient care last year, either as a primary or secondary activity. Dentists reporting both hours and weeks spent in patient care last year. 361 Appendix Table B.--New Mexico Counties by County Group Metropolitan Arvear/ Number of responding County civilian dentists Albuquerque area Bernalillo 113 Nonmetropolitan Counties County group Central city Central city 25,000-49,999 Chaves Roswell Dona Ana Las Cruces Eddy Carlsbad Lea Hobbs Santa Fe Santa Fe Central city 10,000-24,999 Curry Clovis Los Alamos Los Alamos McKinley Gallup Otero Alamogorda San Juan Farmington Valencia Grants Central city 5,000-9,999 Colfax Raton Grant Silver City Luna Deming Quay Tucumcari Roosevelt Portales San Miguel Las Vegas Socorro Socorro Central city 2,500-4,999 362 Hidalgo Lordsburg Sandoval Bernalillo Sierra Truth or Consequences Union Clayton Number of responding civilian dentists 13 12 14 10 23 _uNdDRFRrWLWESRS Www, =o Appendix Table B.--New Mexico Counties by County Group (continued) , 2 Nonmetropolitan Counties=/ Number of responding County group Central city civilian dentists Central city under 2,500 Catron Reserve - De Baca Fort Sumner - Guadalupe Santa Rosa - Harding Roy - Lincoln Ruidoso 2 Mora Wagon Mound - Rio Arriba Espanola 3 Taos Taos 2 Torrance Mountainair - 1/ The Albuquerque area, including all of Bernalillo County, is defined as a Standard Metropolitan Statistical Area as established by the U.S. Bureau of the Budget, Office of Statistical Standards. 2/ Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. 363 Appendix Table C.--Selected Data for New Mexico Counties Counties with Profes- PErnoms Number of active dentists . sionally Population By age Reporting responding . v1 per . N active (in 000's) Under 55 years use of active dentists d . dentist thd od entists 35 years or more auxiliaries All counties 252 1,037.3% 4,116 63 43 211 Bernalillo 110 310.5 2,823 29 18 90 Chaves 13 69.5 5,346 3 4 10 Colfax 4 13.6 3,400 1 1 3 Curry 10 37.4 3,740 4 2 10 Dona Ana 12 69.7 5,808 4 - 12 Eddy 14 54.4 3,886 5 3 11 Grant 4 18.4 4,600 - - 4 Hidalgo 1 4.8 4,800 - - 1 Lea 10 54.2 5,420 2 9 Lincoln 2 8.3 4,150 1 - 1 Los Alamos 5 15.3 3,060 1 - 5 Luna 3 10.4 3,467 1 - 3 McKinley 5 41.6 8,320 1 - 5 Otero 4 34.7 8,675 - - 4 Quay 1 13.1 13,100 1 - 1 Rio Arriba 3 25.7 8,567 1 1 3 Roosevelt 2 17.7 8,850 - - 2 San Juan 13 48.1 3,700 3 2 11 San Miguel 5 22.1 4,420 - 2 4 Santa Fe 23 48.4 2,104 5 5 18 Sierra 1 6.9 6,900 - 1 - Socorro 1 10.3 10,300 - - - Taos 2 17.3 8,650 - 1 1 Union 1 5.9 5,900 1 - - Valencia 3 40.1 13,367 - 1 3 1/ Copyright 1965, Sales Management Survey of Buying Power; further reproduction is forbidden. 2/ Includes 38,900 persons in Catron, De Baca, Guadalupe, Harding, Mora, Sandoval and Torrance Counties which have no responding dentists. 364 NEW YORK DENTISTS LICENSED IN NEW YORK During the 1966 registration period, 15,397 dentists registered with the -New York State Board of Dental Examiners. A total of 14,929 den- tists responded to the survey, 97 percent of those registered. A large proportion of the responding dentists, 87 percent, are civilians located in New York State, 10 percent are civilians located in other states, and approximately 3 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in New York Location and All Percent of military status dentists dentists Total 15,397 100 Respondents 14,929 97 Nonrespondents 468 3 Respondents 14,929 100 Civilians in New York 12,891 87 Civilians in another state 1,470 10 On active duty with Armed Forces 508 3 Not reported 60 * *Less than one-half of one percent. Multiple licensure is not too common among New York dentists. Less than one-fourth of all respondents hold a license to practice dentistry in one or more other states. Only 13 percent of the dentists located in New York hold more than one license, with 11 percent licensed in one other state and a mere 2 percent licensed in two or more other states. The proportion of out-of-state dentists holding multiple licenses is considerably greater; 25 percent hold two or more licenses in addition to their New York license. Two-thirds of the licenses held outside of New York are held in adja- cent states, including 28 percent in New Jersey, some 15 percent each in Pennsylvania and Connecticut, and approximately 9 percent in Massa- chusetts. An additional 10 percent of the licenses are maintained in California and Florida. 365 PROFESSIONAL TRAINING Over three-fifths of New York's 12,891 dentists are graduates of in-state dental schools. New York University has made the largest contribution, over 4,700 dentists, or almost 40 percent of the total dental force. The two remaining in-state schools, Columbia University and the State Univer- sity of New York at Buffalo, with considerably smaller contributions, have each trained approximately 12 percent of the dentists. Dental School Attended and Year of Graduation for Dentists in New York Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 12,891 - 2,523 4,658 2,705 (Percent distribution by school) Schools in New York 8,038 63 62 54 69 New York University 4,739 37 39 34 38 Columbia 1,714 14 8 8 19 New York (Buffalo) 1,585 12 15 12 12 Schools located elsewhere 4,849 37 38 46 31 Pennsylvania 1,467 12 10 11 13 Georgetown 450 3 7 5 1 Tufts 443 3 4 2 4 Temple 296 2 3 4 1 Pittsburgh 253 2 1 5 * Maryland 200 2 1 2 1 38 other schools 1,740 13 12 17 11 Less than one-half of one percent. 1/ Dental school attended not available for 4 dentists and year of gradua- tion for 5 dentists. Schools in adjacent states have provided another one-fifth of New York's dentists. Among these schools, the University of Pennsylvania has been the principal contributor, supplying almost 1,500 dentists, or 12 percent of the total dental force. Two other Pennsylvania schools, Temple University and the University of Pittsburgh, have between them provided 4 percent of the dentist supply. More than 400 dentists, about 3 percent of the State's supply, were trained at Tufts University in Massachusetts. Among the more distant schools, the largest contributors are Georgetown University in the District of Columbia and the University of Maryland, which have supplied 3 percent and 2 percent of the State's dentists, respec- tively. The only other schools to provide as many as 150 of New York den- tists are three schools in the North Central States, St. Louis University, Western Reserve and Illinois. Approximately 180 New York dentists were trained in Canadian schools, principally McGill University. 366 PROFESSIONAL TRAINING (cont'd.) Relatively few of New York's dentists are recent dental school graduates; only 20 percent of the dental force graduated from dental school after 1955. By comparison, more than 40 percent of the State's dentists were graduates during the years prior to World War II. The relative contribution of New York University and the State University at Buffalo have remained fairly constant through the years, while the proportion of Columbia University graduates has decreased considerably since World War II. In New York a relatively high proportion of survey respondents--approximately one-third, or 4,160 dentists--reported that they had completed one year or more of advanced training after receiving their dental degrees. Of the 3,105 dentists with advanced clinical training, 592 completed a residency and 2,513 an internship. Among the 1,749 dentists who reported advanced academic training, 116 earned a second doctorate, 437 earned a master's de- gree and another 1,196 received no additional degrees but completed one or more years of postgraduate study. These figures include 694 dentists who completed both academic and clinical training. Advanced Training Completed by New York Dentists Highest level of training Number percent completed dentists dentists Total respondents 12,891 100 With advanced training 4,160 32 With no advanced training 8,731 68 Clinical training 3,105 24 Residency completed 592 5 Internship completed 2,513 19 Academic training 1,749 13 Ph.D., M.D., or other doctorate 116 1 M.A., M.S., or other master's degree 437 3 Postgraduate 1 year or more (no degree) 1,196 9 There is a growing tendency for young dentists to seek additional training beyond the dental degree. Twenty percent of all New York dentists under 40 years of age have a year or more of academic training as compared with 15 percent of those 40-54 years old and only 7 percent of those 55 and over. Residencies show the same pattern by age, but the trend varies somewhat with respect to internships. Twenty-one percent of the dentists under 40 years of age reported completion of an internship. This percentage is slightly lower than that recorded for dentists 40 to 54 years old, but is considerably greater than the 12 percent recorded for dentists 55 and over. 367 DISTRIBUTION OF DENTISTS A very high percentage of all licensed dentists in New York--92 percent-- are located within the State's seven metropolitan areas. The 9-county New York metropolitan area alone contains approximately three-fourths of the State's total dental force. Furthermore, one of every two dentists in the State (6,994 dentists) are actually located within the 5 boroughs of New York City--Manhattan, Brooklyn, Queens, Bronx and Richmond (Staten Island) --while another 2,613 dentists are found in the remaining 4 counties of the New York metropolitan area. Within New York City itself, approximately & of every 10 dentists are located in Manhattan, 3 in Brooklyn, 2 in Queens, and 1 in the Bronx (relatively few are located in Richmond). Among the other counties in the New York metropolitan area, Nassau County has the largest number of dentists, almost 1,200, followed by Westchester with more than 750 dentists. Distribution of New York Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists Total 62 12,891 100 New York metropolitan area 9 9,607 75 New York City 5 6,994 54 Other counties 4 2,613 21 Other metropolitan areas 17 2,236 17 Buffalo area 2 778 6 Rochester area 4 509 4 Albany-Schenectady-Troy area 4 365 3 Syracuse area 3 300 2 Utica-Rome area 2 158 1 Binghamton area (N.Y. part) 2 126 1 Nonmetropolitan counties 36 1,048 8 Central city 25,000-49,999 9 550 4 Central city 10,000-24,999 13 310 3 Central city under 10,000 14 188 1 *See Appendix Table for definition of metropolitan areas and presentation of individual county data. Of the other metropolitan areas, Buffalo has the largest dental force, al- though it accounts for only 6 percent of the State supply. The next largest dental forces are found in the Rochester and the Albany-Schenectady-Troy areas, which account for 4 percent and 3 percent of the State's dentists, respectively. The remaining three metropolitan areas, Syracuse, Utica- Rome and Binghamton, together account for 4 percent of the dentist supply. Only 8 percent of New York's dentists are located in the 36 nonmetropolitan counties of the State. More than one-half of these dentists are located in the 9 counties with central cities of 25,000 or more persons. 368 AGE DISTRIBUTION OF DENTISTS BY AREA Dentists in New York have a rather high median age of 48.9 years. Only 25 percent, or 3,221, of the State's dentists are under 40 years of age, includ- ing just 16 percent who are under 35. On the other hand, well over one-third, or 4,568 dentists, are 55 years of age or older. About one in every six, or 2,037 dentists, are 65 years old or over, including 946 who have reached the age of 70. Median Age and Age Distribution of New York Dentists, by County Group Percent of dentists Median County group age Under 40-54 55 & 40 over Total 48.9 25 40 35 New York metropolitan area 49.5 23 40 37 New York City (5 boroughs) 51.8 20 38 42 4 other counties 45.0 32 46 22 Other metropolitan areas 46.2 31 38 31 Buffalo area 47.4 29 35 36 Rochester area 44.6 37 35 28 Albany-Schenectady-Troy area 46.1 28 43 29 Syracuse area 44.5 32 44 24 Utica-Rome area 45.7 28 45 27 Binghamton area (N.Y. part) 47.5 32 36 32 Nonmetropolitan counties 48.5 26 39 35 Central city 25,000-49,999 47.0 29 39 32 Central city 10,000-24,999 49.8 22 39 39 Central city under 10,000 51.2 21 41 38 Some variation is to be found in the median ages of dentists in the individ- ual metropolitan areas and in the nonmetropolitan county groups. Among the metropolitan areas, Rochester and Syracuse have the youngest dentists, with median ages of 44.6 and 44.5 years, respectively. The New York metropolitan area has the oldest dentists, with a median age of 49.5 years. Age differ- ences among the components of this area, however, are even more pronounced. The median age of dentists in New York City is 51.8 years, with that of Man- hattan Borough a high 54.4 years and the average of the remaining 4 boroughs 50.4 years. Dentists in the four other counties comprising the New York metropolitan area are considerably younger, with a median age of 45.0 years. Dentist ages in nonmetropolitan counties tend to increase as the size of the central city declines. The median age of dentists in counties with central cities of at least 25,000 population is 47.0 years, compared to a median age of 49.8 years in counties containing a central city of 10,000-24,999 inhabi- tants and 51.2 years in counties with less than 10,000 persons in their cen- tral cities. 369 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 12,891 responding dentists in New York, 12,427, or 96 percent, are active in their profession, giving New York one professionally active den- tist for every 1,424 persons. There is one dentist for every 1,212 persons in the New York metropolitan area, while the remaining 6 metropolitan areas have a somewhat less favorable ratio of one dentist for every 1,904 persons and the nonmetropolitan counties have an even less favorable ratio of 2,334 persons per dentist. Number of Persons per Active Dentist in New York State Professionally Persons County group* active Population per dentists dentist Total 12,427 17,696,500 1,424 New York metropolitan area 9,252 11,216,600 1,212 New York City (5 boroughs) 6,716 7,829,900 1,166 4 other counties 2,536 3,386,700 1,335 Other metropolitan areas 2,162 4,115,900 1,904 Buffalo area 749 1,403,600 1,874 Rochester area 497 788,000 1,586 Albany-Schenectady-Troy area 350 691,400 1,975 Syracuse area 294 611,000 2,078 Utica-Rome area 153 354,100 2,314 Binghamton area (N.Y. part) 119 267,800 2,250 Nonmetropolitan county groups 1,013 2,364,000 2,334 Central city 25,000-49,999 530 1,071,800 2,022 Central city 10,000-24,999 302 848,800 2,811 Central city under 10,000 181 443,400 2,450 *See Appendix Table for individual county data. New York City has a comparatively favorable ratio of 1,166 persons, while the other 4 counties in the New York metropolitan area have an average persons-per-dentist ratio of 1,335. Within New York City itself, Manhattan has a low ratio of 622, while the remaining 4 boroughs have ratios similar to each other, ranging between 1,444 and 1,671. Among the metropolitan areas exclusive of New York, Rochester has the best ratio, 1,586 persons per dentist, while the Utica-Rome area has the least favorable ratio of one dentist for every 2,314 persons. Ratio differences among individual coun- ties within the metropolitan areas are more pronounced. For example, while the persons-per-dentist ratio in the 4-county Albany-Schenectady-Troy area is 1,975, the individual county ratios within the area range from 1,548 in Schenectady County to 3,856 in Saratoga County. Among the 36 nonmetropolitan counties of the State, Dutchess County has the most favorable ratio, with one dentist for every 1,599 persons. In addition to Dutchess, 6 other counties have ratios under 2,000 persons per dentist. On the other hand, there are 16 counties with ratios over 2,500, including 8 with ratios in excess of 3,000 persons per dentist. By county grouping according to size of central city, the most favorable ratios are found in the 9 counties with more than 25,000 persons in their central cities. 370 UTILIZATION OF AUXILIARIES Over three-fifths of the responding dentists in New York State reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 53 percent of all practitioners, including 43 percent who employ at least one assist- ant on a full-time basis. Secretaries or receptionists are employed by 19 percent of the dentists, with more than two-thirds of these dentists utilizing such personnel full time. Fourteen percent of the dentists employ dental hygienists, with half of these dentists utilizing such personnel on a full-time basis. Only 4 percent of the dentists employ laboratory technicians, principally for part-time assistance. New York Dentists Employing Auxiliaries, by Type of Auxiliary Percent of Dental Practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time auxiliary part-time (or more) auxiliaries Total 12,281 100 51 11 One or more auxiliaries 7,445 62 51 11 Assistant 6,312 53 43 10 Hygienist 1,718 14 7 7 Laboratory technician 541 4 1 3 Secretary or receptionist 2,190 19 13 6 Other type personnel 258 2 1 1 No guxiliaries 4,585 38 - - 1/ Includes 251 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist and tends to be more frequent among younger dentists. Seventy-six percent of New York dentists between the ages of 30 and 44 employ some type of auxiliary. The proportion using auxiliaries decreases to 59 percent among den- tists 45 to 64 years old and to only 38 percent among dentists 65 and over. Young dentists who are just starting their practices do not reach peak utilization of assistants until they are 30 years of age and of hygienists until age 35. Dentists in the New York metropolitan area are less likely to employ auxiliary personnel than are those located in the remainder of the State. Auxiliaries are employed by 59 percent of the dentists in the New York metropolitan area as compared to 71 percent of those in other areas of the State. In the New York metropolitan area one-half of the dentists employ an assistant and only 10 percent employ a hygienist. In contrast, three-fifths of the dentists located in the remainder of the State employ at least one assistant and 27 percent report employ- ment of a hygienist. 371 = > = ~~ > ~~ ~~ 372 OTHER SURVEY FINDINGS Ninety-five percent of the professionally active dentists in New York are primarily engaged in private practice, with 93 percent self- employed and 2 percent employed by another dentist. One percent of the dentists are on the staff of a dental school, and another 2 per- cent are employed by governmental agencies. The remaining 2 percent are engaged in other dental activities, such as taking advanced training. At least one part-time dental activity in addition to their principal employment was reported by 19 percent of the New York dentists. Part- time teaching in a dental school was the most frequently reported type of secondary employment, followed by employment in a State or local government agency. A variety of other secondary dental activi- ties were reported, including employment by another dentist, and serving in voluntary agencies. Dentists reporting time spent in providing patient care devoted an average of 39.2 hours per week to this activity for 47.4 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. About 11 percent of the practitioners reported they limit their prac- tice to a dental specialty, primarily orthodontics or oral surgery. Other specialty areas frequently reported were periodontics, prostho- dontics and endodontics. There is very little difference in the pro- portion of dentists limiting their practice in the New York metro- politan area and in the remainder of the State. Of the 1,470 dentists licensed in New York but located in another state at the time of the survey, one-third were in New Jersey and 28 percent were located in the other adjacent states of Connecticut, Massachusetts, Pennsylvania and Vermont. The remaining out-of-state dentists were located in 43 other states, predominantly California and Florida. January 1968. APPENDIX TABLE Selected Data on Dentists in New York, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist All counties 12,891 25 35 12,427 17,696.5 1,424 2/ Metropolitan areas 11,843 25 35 11,414 15,332.5 1,343 New York area 9,607 23 37 9,252 11,216.6 1,212 New York City 6,994 20 42 6,716 7,829.9 1,166 Bronx 894 18 43 864 1,426.6 1,651 Kings (Brooklyn) 1,892 19 43 1,808 2,618.6 1,448 New York (Manhattan) 2,654 18 49 2,541 1,580.7 622 Queens 1,402 27 29 1,357 1,960.0 1,444 Richmond (Staten Island) 152 39 28 146 244.0 1,671 Other counties in New York area 2,613 32 22 2,536 3,386.7 1,335 Nassau 1,181 25 18 1,151 1,471.3 1,278 Rockland 155 49 23 147 171.0 1,163 Suffolk 509 49 19 497 845.3 1,701 Westchester 768 29 30 741 899.1 1,213 Buffalo area 778 29 36 749 1,403.6 1,874 Erie 677 29 37 651 1,144.1 1,757 Niagara 101 30 30 98 259.5 2,648 Rochester area 509 37 28 497 788.0 1,586 Livingston 20 30 30 19 45.8 2,411 Monroe 452 39 28 443 632.6 1,428 Orleans 14 14 57 13 36.3 2,792 Wayne 23 30 22 22 73.3 3,332 €LE LE APPENDIX TABLE (Cont'd) Selected Data on Dentists in New York, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Albany-Schenectady-Troy area 365 28 29 350 691.4 1,975 Albany 182 30 31 172 289.1 1,681 Rensselaer 53 25 23 51 148.0 2,902 Saratoga 26 27 27 25 96.4 3,856 Schenectady 104 27 29 102 157.9 1,548 Syracuse area 300 32 24 294 611.0 2,078 Madison 20 35 30 20 58.9 2,945 Onondaga 250 32 23 244 461.5 1,891 Oswego 30 33 27 30 90.6 3,020 Utica-Rome area 158 28 27 153 354.1 2,314 Herkimer 21 10 38 20 69.1 3,455 Oneida 137 31 25 133 285.0 2,143 Binghamton area (New York part) 126 32 33 119 267.8 2,250 Broome 114 32 32 108 226.4 2,096 Tioga 12 25 42 11 41.4 3,764 3/ Nonmetropolitan counties 1,048 26 35 1,013 2,364.0 2,334 Central City 25,000-49,999 550 29 32 530 1,071.8 2,022 Cayuga 33 24 33 31 75.9 2,448 Chautauqua 68 32 28 68 150.9 2,219 Chemung 54 37 31 51 103.3 2,025 Dutchess 127 34 33 122 195.1 1,599 Jefferson 41 34 29 39 89.2 2,287 Mongtomery 24 17 38 24 56.2 2,342 Orange 106 26 29 102 200.2 1,963 Tompkins 35 29 31 33 69.8 2,115 Ulster 62 21 37 60 131.2 2,187 SZ - OL - O 620-98¢ APPENDIX TABLE (Cont'd) Selected Data on Dentists in New York, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Central City 10,000-24,999 310 22 39 302 848.8 2,811 Cattaraugus 35 20 49 35 81.5 2,329 Clinton 25 28 32 24 81.8 3,408 Columbia 19 21 32 19 49.3 2,595 Cortland 14 21 21 14 43.0 3,071 Franklin 18 17 56 18 44,6 2,478 Fulton 18 17 56 16 51.6 3,225 Genesee 20 35 30 20 57.2 2,860 Ontario 23 22 26 23 72.0 3,130 Otsego 23 26 39 22 52.4 2,382 St. Lawrence 35 23 43 34 119.1 3,503 Steuben 36 22 42 34 100.7 2,962 Warren 26 12 31 25 46.5 1,860 Washington 18 28 39 18 49,1 2,728 Central City 5,000-9,999 165 20 39 159 377.6 2,375 Allegany 14 29 50 14 43.9 3,136 Chenango 14 21 21 14 45,2 3,229 Delaware 18 17 44 16 43.1 2,69 Essex 20 15 45 19 35.4 1,863 Greene 18 17 39 17 32.5 1,912 Putnam 18 33 17 18 42.0 2,333 Seneca 15 27 13 15 33.3 2,220 Sullivan 24 17 58 24 47.4 1,975 Wyoming 13 15 38 12 35.8 2,983 Yates 11 9 64 10 19.0 1,900 GLE APPENDIX TABLE (Cont'd) w ~ aN Selected Data on Dentists in New York, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Central City 2,500-4,999 21 29 29 20 61.5 3,075 Lewis 5 40 20 5 23.6 4,720 Schoharie 9 11 33 8 22.5 2,813 Schuyler 7 43 29 7 15.4 2,200 Central City under 2,500 2 50 50 2 4.3 2,150 Hamilton 2 50 50 2 4.3 2,150 Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden, New York counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For the interstate Binghamton SMSA, statistics are presented only for dentists located in the New York portion. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. NORTH CAROLINA DENTISTS LICENSED IN NORTH CAROLINA During the 1966 registration period, 1,574 dentists registered with the North Carolina State Board of Dental Examiners. Ninety percent of these dentists, 1,410, responded to the survey. Almost nine in every ten (89 percent) of the survey respondents are civilian dentists located in North Carolina, another 5 percent are civilians located in other States, primarily Virginia, Florida, and South Carolina, and the remaining 6 per- cent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in North Carolina Location and All Percent of military status dentists dentists Total licensed 1,574 100 Respondents 1,410 90 Nonrespondents 164 10 Respondents 1,410 100 Civilians in North Carolina 1,262 89 Civilians in another State 69 5 On active duty with Armed Forces 79 6 Approximately one-half (48 percent) of the survey respondents hold 1li- censes to practice dentistry in one or more other States. Forty-five percent of the dentists located in North Carolina have at least one other license, with 38 percent licensed in one other State, and 7 percent in two or more other States. Multiple licensure is more common among dentists licensed in North Carolina but located in another State; one- third of these dentists have two or more licenses in addition to their North Carolina license. Seven of every ten out-of-State licenses were issued by adjacent States, with 26 percent in Georgia, 23 percent in Virginia, 15 percent in South Carolina, and 6 percent in Tennessee. The remainder are held in 32 other States and the District of Columbia. 377 PROFESSIONAL TRAINING Three-fifths of the 1,262 responding dentists in North Carolina are grad- uates of the dental schools located at the University of North Carolina and Emory University, each school having contributed approximately 30 per- cent of the State's dental force. Since the mid-1950's, however, when the first students graduated from the School of Dentistry at the Univer- sity of North Carolina, this school has become the primary source of dentists for the State, accounting for 3 of every 4 dentists (74 percent) who completed their dental education since that time. Concurrently, the contribution of Emory University has declined sharply, from more than two- fifths (42 percent) of the State's dentists graduating in 1955 or earlier to only 4 percent of those graduating in recent years. Dental School Attended and Year of Graduation for Dentists in North Carolina Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 1,262 - 446 475 341 (Percent distribution by school) University of North Carolina 387 31 74 12 - Emory University 360 29 4 30 57 Medical College of Virginia 150 12 4 18 12 University of Maryland 92 7 3 9 11 University of Tennessee 42 3 3 6 * Howard University 36 3 2 3 4 Meharry Medical College 31 2 1 2 5 University of Louisville 20 2 1 3 1 32 other schools 144 11 8 17 10 * Less than one-half of one percent. The dental schools at the Medical College of Virginia and the University of Maryland have provided almost one-fifth of North Carolina's dentists, accounting for 12 percent and 7 percent, respectively. However, the rela- tive contribution of these two schools has also decreased considerably since the in-State school began providing dentists. The remaining 21 per- cent of the dentists in North Carolina are graduates of 36 other dental schools. Among these, the University of Tennessee and Howard University have each contributed 3 percent of the State's dentists, while Meharry Medical College and the University of Louisville have each provided 2 per- cent. 378 DISTRIBUTION OF DENTISTS Approximately 48 percent of the 1,262 dentists in North Carolina who re- sponded to the survey are located in the seven metropolitan areas of the State. The Greensboro- Winston-Salem-High Point area has the largest number of dentists, 186, or 14 percent of the State supply. The Charlotte area, with 10 percent of the dentists, has the second largest dental force, while the areas of Durham and Raleigh have 8 percent and 7 percent, re- spectively. Of the remaining three areas, Asheville has 5 percent of the dentists and Fayetteville and Wilmington have 2 percent each. Distribution of North Carolina Dentists, by County Group Number Number Percent County group®* of of of counties dentists dentists All counties 100 1,262 100 Metropolitan areas 13 607 48 Greensboro - Winston-Salem-High Point area 4 186 14 Charlotte area 2 128 10 Durham area 2 105 8 Raleigh area 1 85 7 Asheville area 1 57 5 Fayetteville area 1 26 2 Wilmington area 2 20 2 Nonmetropolitan counties 87 655 52 Central city 10,000-49,999 24 372 30 Central city 5,000-9,999 18 163 13 Central city 2,500-4,999 12 51 4 Central city under 2,500 33 69 5 * See Appendix Table for definition of metropolitan areas and presentation of individual county data. More than one-half (52 percent) of North Carolina's dentists are located in the State's 87 nonmetropolitan counties. The 24 counties with central city populations of 10,000 or more have 372 dentists, 30 percent of the State supply. Another 13 percent of the dentists are located in the 18 counties having populations between 5,000 and 9,999 in their central cities, while the remaining 45 counties with central cities of under 5,000 have only 9 percent of the State's dentists. Of the 87 nonmetropolitan counties, only five have more than 20 dentists and 19 have between 10 and 20, while 38 counties have fewer than five dentists, including eight which have no dentists, according to survey response. 379 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of the 1,262 responding dentists in North Carolina is 42.4 years. About one-fourth (305) of the dentists are under 35 years of age, and more than a third (452) are between 35 and 44. Almost one-fifth (234) of the dentists are 45-54 years of age, while an equal proportion are 55 or over. One in every eight, 152 dentists, are 65 years old or more, in- cluding 82 dentists who have reached the age of 70. Median Age and Age Distribution of Dentists in North Carolina, by County Group Median Percent of dentists County group Under 35- 45- 55 & age 35 44 54 over All counties 42 4 24 36 19 21 Metropolitan areas 41.4 27 37 16 20 Durham area 39.6 35 33 19 13 Fayetteville area 40.8 31 38 19 12 Raleigh area 41.2 27 36 19 18 Greensboro-Winston-Salem- High Point area 41.7 25 37 15 23 Charlotte area 42.0 24 38 15 23 Asheville area 42.3 21 41 12 26 Wilmington area 43.8 25 30 20 25 Nonmetropolitan counties 43.2 22 35 21 22 Central city 10,000-49,999 42,6 22 39 18 21 Central city 5,000-9,999 43.6 22 32 23 23 Central city 2,500-4,999 44.2 20 33 25 22 Central city under 2,500 47.1 23 23 23 31 The median age of dentists in the metropolitan areas is 41.4 years, almost two years below the median of 43.2 for dentists in nonmetropolitan coun- ties. The youngest group of dentists is in the Durham area, where the median age is 39.6 years. More than one-third (35 percent) of the den- tists in this area are under 35 years of age, while only one in every eight is 55 or over. The Wilmington area has the oldest group of dentists, with a median age of 43.8 years. One-fourth of these dentists are under age 35 and an equal proportion are 55 or older. Among the nonmetropolitan county groups, the median ages tend to increase as the size of the central city decreases. The median age of dentists in counties with central cities of 10,000 or more is 42.6 years, compared to 47.1 years for dentists in the group of counties with central city popula- tions under 2,500. 380 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,262 responding dentists in North Carolina, 1,238, or 98 percent, are active in their profession, giving the State one professionally active dentist for every 3,881 persons. In the metropolitan areas--which have 48 percent of all active dentists and only 35 percent of the population--the ratio is one dentist for every 2,848 persons. The remainder of the State-- which has 52 percent of the active dentists and 65 percent of the popula- tion--has a much less favorable ratio of one dentist for every 4,828 persons. Number of Persons per Active Dentist in North Carolina Professionally Persons County group¥* active Population per dentists dentist All counties 1,238 4,805,200 3,881 Metropolitan areas 592 1,686,300 2,848 Durham area 103 166,400 1,616 Raleigh area 82 181,600 2,215 Asheville area 54 136,300 2,524 Charlotte area 127 357,700 2,817 Greensboro -Winston-Salem- High Point area 181 572,300 3,162 Wilmington area 20 95,600 4,780 Fayetteville area 25 176,400 7,056 Nonmetropolitan counties 646 3,118,900 4,828 Central city 10,000-49,999 366 1,655,000 4,522 Central city 5,000-9,999 160 722,200 4,514 Central city 2,500-4,999 51 272,900 5,351 Central city under 2,500 69 468,800 6,794 * See Appendix Table for individual county data. The best ratio among the metropolitan areas, 1,616 persons per dentist, is found in the Durham area, which includes Orange County where the University of North Carolina School of Dentistry is located. The Raleigh area has the next best ratio, one dentist for every 2,215 persons. Three other areas-- Asheville, Charlotte, and Greensboro- Wins ton-Salem- High Point--also have ratios considerably below the State average, while the Wilmington and Fayetteville areas have much higher ratios. Among the 87 nonmetropolitan counties, only eight have persons-per-dentist ratios under 3,000, while 36 have more than 5,000 persons for every dentist, including 13 counties which have only one dentist for every 8,000 or more persons. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city decreases. Counties with central cities of 5,000 or more population have an average persons-per-dentist ratio of approx- imately 4,500, while those counties with central cities of fewer than 2,500 inhabitants average nearly 6,800 persons per dentist. 381 UTILIZATION OF AUXILIARIES Nine of every ten dental practitioners in North Carolina (i.e., dentists who spend any time working at the chair) reported the employment of one or more auxiliary personnel. Dental assistants, the most frequently em- ployed auxiliary, are utilized by 85 percent of the practitioners, includ- ing 79 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 39 percent of the dentists, three-fourths of whom employ at least one full time. Only 14 percent of the dentists employ dental hygienists and 6 percent employ laboratory technicians. A majority of the dentists who employ hygienists or techni- cians do so only part time. North Carolina Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 1,207 1 100 85 5 One or more auxiliaries 1,063 90 85 5 Assistant 1,008 85 79 6 Hygienist 162 14 6 8 Laboratory technician 74 6 2 4 Secretary or receptionist 460 39 29 10 Other type of personnel 36 3 1 2 No auxiliary 122 10 - - 1/ Includes 22 dentists who did not report on auxiliary utilization. The utilization of auxiliaries varies with the age of the dentist and is less common among the older dentists. Ninety-four percent of the dentists under age 55 report the employment of at least one auxiliary. The propor- tion utilizing auxiliaries decreases to 82 percent for those dentists 55-64 years of age and to only 62 percent for dentists 65 and over. Almost one-fourth of the dental practitioners in North Carolina reported one or more vacancies for auxiliary personnel. Of these dentists, 45 per- cent indicated vacant positions for full-time dental hygienists and 21 percent, for full-time dental assistants. 382 OTHER SURVEY FINDINGS I= ~~ About 16 percent (201 dentists) of the respondents reported that they had completed one or more years of advanced train- ing after receiving the dental degree. A total of 131 den- tists have completed at least one year of advanced academic work as graduate or postgraduate students, and 97 dentists have received advanced clinical training as interns or resi- dents. There are 27 dentists who have completed both academic and clinical training. Approximately 93 percent of the professionally active den- tists in North Carolina are primarily in private practice. Three percent are on the staff of the dental school, and another 3 percent are employed by a governmental agency. The remaining 1 percent are engaged in some other dental activity, such as taking advanced training. 3 Dentists reporting on time spent in patient care devoted an average of 38.5 hours per week to this activity for 47.7 weeks during the year preceding the survey. About one den- tist in ten worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. 3 [7 Twelve percent of the practitioners reported that they limit their practice to a dental specialty, including 4 percent in orthodontics, 3 percent in oral surgery, 2 percent in perio- dontics, and the remaining 3 percent in four other areas. A large proportion (49 percent) of the dental practitioners in the Durham metropolitan area reported a dental specialty, compared to 14 percent of the dentists in other metropolitan areas and only 4 percent of those in nonmetropolitan counties. December 1968. 383 %8¢ APPENDIX TABLE Selected Data on Dentists in North Carolina, By Location Responding civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist All counties 1,262 305 271 1,238 4,805.2 3,881 Metropolitan areas 2/ 607 162 124 592 1,686.3 2,848 Greensboro-Winston-Salem- High Point area 186 46 43 181 572.3 3,162 Forsyth 74 18 21 72 210.2 2,919 Guilford 92 21 20 89 272.2 3,058 Randolph 15 5 1 15 66.8 4,453 Yadkin 5 2 1 5 23.1 4,620 Charlotte area 128 31 30 127 357.7 2,817 Mecklenburg 118 29 25 117 311.9 2,666 Union 10 2 5 10 45.8 4,580 Raleigh area 85 23 15 82 181.6 2,215 Wake 85 23 15 82 181.6 2,215 Fayetteville area 26 8 3 25 176.4 7,056 Cumberland 26 8 3 25 176.4 7,056 Durham area 105 37 13 103 166.4 1,616 Durham 50 13 10 48 119.5 2,490 Orange 55 24 3 55 46.9 853 Asheville area 57 12 15 54 136.3 2,524 Buncombe 57 12 15 54 136.3 2,524 G8¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Carolina, By Location Responding civilian dentists / Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Metropolitan areas 2/ (cont'd.) Wilmington area 20 5 20 95.6 4,780 Brunswick 2 1 - 2 20.7 10,350 New Hanover 18 4 5 18 74.9 4,161 Nonmetropolitan counties =! 655 143 147 646 3,118.9 4,828 Central city 25,000-49,999 89 19 17 87 376.9 4,332 Alamance 24 5 7 23 91.4 3,974 Gaston 32 10 2 32 135.2 4,225 Wayne 19 3 4 19 90.5 4,763 Wilson 14 1 4 13 59.8 4,600 Central city 10,000-24,999 283 62 61 279 1,278.1 4,581 Cabarrus 20 3 9 20 71.6 3,580 Caldwell 7 3 1 7 52.4 7,486 Catawba 24 3 3 24 80.5 3,354 Cleveland 14 4 2 14 67.6 4,829 Craven 16 3 3 16 63.8 3,988 Davidson 16 6 4 16 87.1 5,444 Edgecombe 8 2 3 8 55.5 6,938 Halifax 8 1 3 8 59.0 7,375 Iredell 22 3 4 21 65.6 3,124 Lee 10 3 2 10 28.7 2,870 Lenoir 18 2 6 16 58.4 3,650 Nash 13 1 3 13 62.3 4,792 98¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Carolina, By Location Responding civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 10,000-24,999 (cont'd.) Onslow 12 5 2 12 101.7 8,475 Pasquotank 9 2 2 8 26.1 3,263 Pitt 17 6 2 17 74.1 4,359 Robeson 14 5 2 14 90.0 6,429 Rockingham 17 4 5 17 72.1 4,241 Rowan 23 5 4 23 86.5 3,761 Stanly 7 1 - 7 42.8 6,114 Vance 8 - 1 8 32.3 4,038 Central city 5,000-9,999 163 36 37 160 722.2 4,514 Beaufort 8 4 2 8 35.7 4,463 Burke 15 8 1 15 56.8 3,787 Carteret 5 - 3 5 34.7 6,940 Granville 8 4 1 7 33.6 4,800 Harnett 9 2 2 9 48.6 5,400 Haywood 17 1 5 17 40.7 2,39 Henderson 13 3 2 13 38.8 2,985 Johnston 12 4 4 12 61.6 5,133 Lincoln 6 1 2 5 29.4 5,880 Martin 3 - 1 3 26.7 8,900 Moore 11 2 4 10 38.5 3,850 Person 6 1 2 6 27.3 4,550 Richmond 8 - 1 8 38.8 4,850 Rutherford 9 2 1 9 44.6 4,956 L8€ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Carolina, By Location Responding civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 (cont'd.) Sampson 6 - 1 6 47.3 7,883 Scotland 4 1 - 4 24.6 6,150 Surry 14 1 4 14 49.4 3,529 Wilkes 9 2 1 9 45.1 5,011 Central city 2,500-4,999 51 10 11 51 272.9 5,351 Anson 3 - 1 3 24.0 8,000 Chatham 6 2 1 6 27.4 4,567 Chowan 4 1 2 4 11.3 2,825 Columbus 7 1 1 7 48.1 6,871 Currituck - - - - 6.7 - Franklin 3 - - 3 27.6 9,200 Hertford 6 1 - 6 23.2 3,867 Hoke 2 - 1 2 16.6 8,300 McDowell 6 1 1 6 27.3 4,550 Mitchell 5 1 2 5 13.3 2,660 Transylvania 3 2 - 3 16.8 5,600 Washington 2 1 1 2 13.5 6,750 Watauga 4 - 1 4 17.1 4,275 Central city under 2,500 69 16 21 69 468.8 6,794 Alexander 2 - - 2 16.1 8,050 Alleghany 1 1 - 1 7.6 7,600 Ashe 4 1 2 4 18.7 4,675 88¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Carolina, By Location Responding civilian dentists 1/ Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Avery 2 1 - 2 11.4 5,700 Bertie 1 - 1 1 23.4 23,400 Bladen 2 2 - 2 28.4 14,200 Camden - - - - 5.7 - Caswell 2 1 1 2 19.4 9,700 Cherokee 3 - 1 3 15.4 5,133 Clay - - - - 5.3 - Dare 1 - - 1 6.3 6,300 Davie 3 - 3 17.3 5,767 Duplin 7 3 7 39.8 5,686 Gates - - - - 9.1 - Graham - - - - 6.3 - Greene 1 - 1 1 16.1 16,100 Hyde - - - - 5.4 - Jackson 4 - 2 4 17.1 4,275 Jones - - - - 11.0 - Macon 5 2 2 5 14.3 2,860 Madison 2 - - 2 15.6 7,800 Montgomery 5 1 1 5 18.9 3,780 Northampton 4 1 2 4 26.1 6,525 Pamlico - - - - 9.7 - Pender 1 - 1 1 18.5 18,500 Perquimans 3 1 . 3 9.0 3,000 Polk 5 2 1 5 11.3 2,260 68€ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Carolina, By Location Responding civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 35 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 (cont'd.) Stokes 4 1 1 4 22.6 5,650 Swain 3 1 1 3 7.8 2,600 Tyrrell 1 - - 1 4.3 4,300 Warren 2 - 1 2 18.0 9,000 Yancey 1 - - 1 12.9 12,900 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ North Carolina counties included in the latest 1968 definition of Standard Metropolitan Sta- tistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. NORTH DAKOTA DENTISTS LICENSED IN NORTH DAKOTA During the 1966 registration period, 370 dentists registered with the North Dakota State Board of Dental Examiners. Sixty-nine percent of the registered dentists were civilians located in North Dakota, 27 percent were civilians located in other States, and 4 percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in North Dakota Location and All Percent of military status dentists dentists Total licensed 370 100 Respondents 275 74 Nonrespondents 95 26 Total licensed 370 100 Civilians in North Dakota 256 69 Respondents 183 - Nonrespondents 73 - Civilians in another State 99 27 On active duty with Armed Forces 15 4 The survey questionnaire was completed by 275 dentists, 74 percent of the total registered. Data provided by survey respondents has been supple- mented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not responding to the sur- vey. Information on nonrespondents was obtained from records maintained by the North Dakota State Board of Dental Examiners or from the 1967 American Dental Directory, published by the American Dental Association. About four-fifths of the survey respondents (79 percent) hold a license to practice dentistry in one or more other States. Sixty percent of the dentists located in North Dakota have one other license, while only 10 per- cent have two or more other licenses. The proportion of out-of-State dentists holding multiple licenses is considerably greater; two-fifths hold two or more licenses in addition to their North Dakota license. Almost one-half of the licenses held in States outside of North Dakota are held in Minnesota, with an additional 16 percent maintained in Illinois and Wisconsin, and 5 percent in California. The remainder are held in 21 other States scattered across the Nation. 391 386-029 O - 70 - 26 PROFESSIONAL TRAINING More than nine in every 10 of North Dakota's 256 dentists are graduates of 13 dental schools located in the North Central States. The largest contributor among these schools is the University of Minnesota, which has supplied almost half (46 percent) of the State's dental force. Marquette and Northwestern Universities and Loyola University of Chicago have also made important contributions, having provided among them 30 percent of the supply. The University of Missouri is the only other dental school to have supplied as much as 5 percent of the State's dentists. Only about one-fourth (24 percent) of North Dakota's dentists graduated from dental school since 1955. In contrast, some 45 percent received their dental degrees prior to World War II. The proportional contribution of the University of Minnesota has increased in recent years from 42 per- cent of the dentists who graduated in 1955 or earlier to 57 percent of those graduating since that time. Dental School Attended and Year of Graduation for Dentists in North Dakota Dental school Number Year of graduation ttended of All After 1941- 1940 or attence dentists years 1955 1955 earlier Total number 256% - 61 73 114 (Percent distribution by school) Schools in North Central States 231 92 93 88 93 University of Minnesota 114 46 57 42 43 Marquette University 30 12 11 8 15 Loyola University of Chicago 25 10 11 4 12 Northwestern University 21 8 3 12 9 9 other schools 41 16 11 22 14 12 schools located elsewhere 21 8 7 12 7 1/ Dental school attended not available for 4 dentists and year of graduation for 8 dentists. Percents based on known totals. Some 11 percent of the survey respondents, 20 dentists, reported that they had completed one or more years of advanced training after receiving the dental degree. Of these dentists, 16 had completed one year or more of advanced academic work as graduate or postgraduate students, and seven had received advanced clinical training as residents or interns. Three dentists had completed both academic and clinical training. 392 DISTRIBUTION OF DENTISTS North Dakota's dentists are unevenly distributed geographically with 70 percent of the dentists located in only 14 of the State's 53 counties. The Fargo metropolitan area (Cass County), with 32 dentists, has 12 per- cent of the State's supply. Distribution of North Dakota Dentists, By County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 53 256 100 Fargo metropolitan area 1 32 12 Nonmetropolitan counties 52 224 88 Central city 10,000-49,999 6 100 39 Central city 2,500-9,999 7 48 19 Central city under 2,500 39 76 30 * See Appendix Table for definition of metropolitan area and presentation of individual county data. The six nonmetropolitan counties with at least 10,000 persons in their central cities have among them 100 dentists, or approximately 40 percent of the total dental force. Three of these nonmetropolitan counties-- Grand Forks, Ward, and Burleigh--have between 20 and 25 dentists each. The seven counties with central city populations between 2,500 and 9,999 have 48 dentists, about one-fifth of the total supply. Thirty percent (76) of North Dakota's dentists are scattered among the 39 counties with less than 2,500 inhabitants in their central cities. Only three of these 39 counties have as many as five dentists, while 27 counties have fewer than three dentists each, including eight which have no dentists, according to available information. 393 AGE DISTRIBUTION OF DENTISTS BY AREA The median age of dentists in North Dakota is 48.4 years. Approximately 30 percent (71) of the dentists are under 40 years of age, and an almost equal proportion are between 40 and 54 years of age. On the other hand, a substantial portion, more than two-fifths, are 55 or over. Some 17 per- cent of the dentists are at least 65 years of age, including 12 percent who have reached the age of 70. Median Age and Age Distribution of North Dakota Dentists . Percent of dentists Median Smt nb County group age Under 40- 55 & 8 40 54 over All counties 48.4 29 30 41 Fargo metropolitan area 43.8 36 32 32 Nonmetropolitan counties 49.0 28 30 42 Central city 10,000-49,999 48.0 27 32 41 Central city 2,500-9,999 47.5 34 28 38 Central city under 2,500 52.0 26 28 46 Dentists in the Fargo metropolitan area have a median age of 43.8 years, more than four years younger than the average for the State. Slightly over one-third of these dentists are under 40 years of age, while another one-third are 55 years or more. The median ages of dentists average 48.0 years in the two groups of non- metropolitan counties with 2,500 or more persons in their central cities. By contrast, the median age of dentists in counties with central city populations of less than 2,500 is 52.0 years, some 4 years above the State average. In this latter group, only about one-fourth of the dentists are under 40 years of age, while almost one-half are 55 years or more. 394 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 256 licensed dentists in North Dakota, 236, or 92 percent, are active in their profession, giving North Dakota one professionally active dentist for every 2,714 persons. There is one professionally active den- tist for every 2,271 persons in the Fargo metropolitan area, a ratio con- siderably better than the State average. Number of Persons Per Active Dentist in North Dakota Professionally Persons County group¥ active Population per dentists dentist All counties 236 640,400 2,714 Fargo metropolitan area 31 70,400 2,271 Nonmetropolitan counties 205 570,000 2,780 Central city 10,000-49,999 95 218,800 2,303 Central city 2,500-9,999 42 102,800 2,428 Central city under 2,500 68 248,400 3,653 * See Appendix Table for individual county data. The six nonmetropolitan counties with 10,000 or more persons in their central cities have one dentist for every 2,303 persons, a ratio quite similar to the Fargo metropolitan area. The seven counties with central city populations between 2,500 and 9,999 have a slightly higher persons- per-dentist ratio of 2,428. The 39 nonmetropolitan counties with less than 2,500 persons in their central cities have a much less favorable persons-per-dentist ratio of 3,653, due in part to eight counties which have no active dentists. Among the remaining 31 counties, 17 have ratios exceeding 3,000 persons per dentist, including eight counties with ratios in excess of 5,000. 395 UTILIZATION OF AUXILIARIES More than four-fifths of North Dakota's responding practitioners (i.e., dentists who spend any time working at the chair) employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 74 percent of all dentists, with 67 percent employing full-time assistants. More than one in every four practi- tioners reported the employment of a secretary or receptionist, usually on a full-time basis. Nine percent of the dentists employ dental hygien- ists, and 4 percent employ laboratory technicians in their practices. North Dakota Dentists Employing Auxiliaries, By Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time (or more) employees Total 172% 100 76 5 One or more auxiliaries 138 81 76 5 Assistant 125 74 67 7 Hygienist 16 9 6 3 Laboratory technician 7 4 - 4 Secretary or receptionist 46 27 16 11 Other type of personnel 3 2 - 2 No auxiliary 32 19 - - 1/ Includes 2 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist and is less common among older dentists. Ninety-four percent of the dental practi- tioners under age 55 employ at least one auxiliary, as compared to approxi- mately 58 percent of those dentists 55 years of age or older. Young dentists just starting their practices do not reach peak utilization of assistants until they are at least 30 years of age, and of hygienists, until age 35. 396 OTHER SURVEY FINDINGS N ~ Ninety-six percent of the responding professionally active dentists in North Dakota are primarily engaged in private practice, with 95 percent self-employed and 1 percent employed by other dentists. The remaining 4 percent are employed in governmental agencies or are engaged in other dental activities, such as taking advanced training. I~ ~~ Dentists reporting on time spent in providing patient care devoted an average of 38.8 hours per week to this activity for 46.3 weeks during the year preceding the survey. / / Seven percent of the respondents reported that they limit their practice to a dental specialty, primarily to ortho- dontics and to oral surgery. About one in every five dentists in the Fargo metropolitan area limits his prac- tice as compared to one in every 20 in nonmetropolitan counties. I ~~ Fourteen percent of the responding dentists had practiced as civilian dentists in other States immediately prior to assuming their present North Dakota location. Half of these dentists came from Minnesota, while the remainder came from more distant States, principally Wisconsin and Illinois. I> ~ Of the dentists who are licensed in North Dakota but lo- cated in other States, about one-fourth are located in Minnesota and another 16 percent are in California, while the remainder are scattered among 20 other States across the Country. April 1969. 397 86¢€ APPENDIX TABLE Selected Data on Dentists in North Dakota, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total ~¢°P respond- Under 55 yrs. sionally (in 000's) active ents . . ents 40 or more active dentist All counties 256 183 73 71 100 236 640.4 2,714 Fargo metropolitan area?’ 32 23 9 11 10 31 70.4 2,271 Cass 32 23 9 11 10 31 70.4 2,271 Nonmetropolitan countiess’ 224 160 64 60 90 205 570.0 2,780 Central city 25,000-49,999 68 47 21 15 27 64 144.8 2,262 Burleigh 21 12 9 5 6 21 37.8 1,800 Grand Forks 24 16 8 3 11 23 54.0 2,348 Ward 23 19 4 7 10 20 53.0 2,650 Central city 10,000-24,999 32 21 11 10 11 31 74.0 2,387 Morton 7 3 4 3 2 7 21.9 3,129 Stutsman 15 11 4 5 6 14 25.9 1,850 Williams 10 7 3 2 3 10 26.2 2,620 Central city 5,000-9,999 42 33 9 14 16 37 85.0 2,297 Barnes 11 9 2 3 3 9 16.7 1,856 Ramsey 8 7 1 2 6 7 12.9 1,843 Richland 8 8 - 2 2 7 18.4 2,629 Stark 8 5 3 5 3 8 19.5 2,438 Walsh 7 4 3 2 2 6 17.5 2,917 Central city 2,500-4,999 6 5 1 2 2 5 17.8 3,560 Bottineau 3 2 1 - 2 2 10.9 5,450 Pierce 3 3 - 2 - 3 6.9 2,300 66€ APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Dakota, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population per and county Total respond- Under 55 yrs. sionally (in 000's) active ents . . ents 40 or more active dentist Nonmetropolitan counties’ (cont'd.) Central city under 2,500 76 54 22 19 34 68 248.4 3,653 Adams 2 - 2 - 1 2 4.2 2,100 Benson 3 3 - - 2 3 8.8 2,933 Billings - - - - - - 1.4 - Bowman 1 1 - - - 1 4.2 4,200 Burke - - - - - - 5.4 - Cavalier 2 1 1 1 1 1 9.3 9,300 Dickey 2 1 1 - 2 2 7.7 3,850 Divide 4 4 - 1 1 4 5.3 1,325 Dunn 1 1 - - 1 1 5.9 5,900 Eddy 1 - 1 - - 1 4.8 4,800 Emmons 2 1 1 - 1 2 7.8 3,900 Foster 3 3 - 1 2 2 5.4 2,700 Golden Valley 1 - 1 - 1 1 2.9 2,900 Grant 1 - 1 1 - 1 5.8 5,800 Griggs 3 2 1 1 1 3 4.8 1,600 Hettinger 2 1 1 2 - 2 5.9 2,950 Kidder 1 1 - - 1 1 4.9 4,900 La Moure 5 5 - 1 2 4 8.2 2,050 Logan - - - - - - 4.9 - McHenry 2 2 - 2 - 2 10.4 5,200 McIntosh 2 1 1 1 1 2 6.3 3,150 McKenzie 1 1 - - - 1 7.5 7,500 McLean 3 1 2 - 2 2 12.1 6,050 Mercer 2 - 2 - 1 1 6.1 6,100 Mountrail 4 3 1 2 2 4 10.4 2,600 00% APPENDIX TABLE (cont'd.) Selected Data on Dentists in North Dakota, By Location Civilian dentists 1/ Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total LCE respond- Under 55 yrs. sionally (in 000's) active ents 40 or more active dentist Nonmetropolitan counties?’ (cont'd.) Central city under 2,500 (cont'd.) Nelson 1 1 - - 1 1 6.5 6,500 Oliver - - - - - - 2.5 - Pembina 4 3 1 - 3 3 12.3 4,100 Ransom 3 1 2 2 - 3 7.6 2,533 Renville 2 2 - - 1 2 4.3 2,150 Rolette 3 3 - 2 1 3 10.5 3,500 Sargent - - - - - - 6.5 - Sheridan 1 1 - 1 - 1 3.9 3,900 Sioux - - - - - - 3.7 - Slope - - - - - - 1.7 - Steele - - - - - - 4.5 - Towner 2 1 1 - 1 2 5.2 2,600 Traill 7 5 2 - 3 5 10.1 2,020 Wells 5 5 - 1 2 5 8.7 1,740 Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. North Dakota part of the interstate Fargo-Moorhead Standard Metropolitan Statistical area, as established by the U.S. Bureau of the Budget, Office of Statistical Standards. Statistics are presented only for dentists located in the Fargo area (Cass County). Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. OHIO DENTISTS LICENSED IN OHIO During the 1967 registration period, some 5,000 dentists registered with the Ohio State Dental Board. Of these dentists, 92 percent were located in Ohio, and 8 percent were located in other States. Ohio dentists on active duty with the Armed Forces were not included in the survey, since they are exempted from annual registration requirements while on active military duty. Location of Dentists Licensed in Ohio Location All Percent of ato dentists dentists Total licensed 4,999 100 Respondents 4,178 84 Nonrespondents 821 16 Total licensed 4,999 100 Dentists in Ohio 4,579 92 Respondents 3,850 - Nonrespondents 729 - Dentists in another State 420 8 The survey questionnaire was completed by 4,178 dentists, 84 percent of all those registered. The information provided by these survey respon- dents has been supplemented, when possible, by data on location, age, dental school attended, and year of graduation for dentists not responding to the survey. This information was obtained from records maintained by the Ohio State Dental Board or from the 1968 American Dental Directory, published by the American Dental Association. Multiple licensure is not too common among dentists registered in Ohio; only one-fifth hold a license to practice dentistry in one or more other States. Of those dentists located in the State, about 14 percent have more than one license, including 12 percent with just one other license and a mere 2 percent with two or more other licenses. The proportion of out-of-State dentists having multiple licenses is considerably greater; 22 percent hold two or more licenses in addition to the one held in Ohio. 401 DENTAL SCHOOL ATTENDED Four-fifths of Ohio's dentists graduated from in-State schools, including the dental schools at Ohio State and Case Western Reserve Universities and two other schools which are no longer in existence. One-half of the State's dental force--some 2,300 dentists--are graduates of Ohio State University. This school has consistently graduated the largest number of Ohio's dentists, with the proportion increasing from 38 percent of all dentists graduating prior to World War II to 62 percent of those gradu- ating since 1955. Over one-fourth of the State's dentists--27 percent-- are graduates of Case Western Reserve University, which over the years has trained a relatively constant proportion of Ohio's dental force. Three percent of the dentists are graduates of two extinct schools, the Cincinnati and Ohio Colleges of Dental Surgery. Dental School Attended and Year of Graduation for Dentists in Ohio Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 4,579 - 1,407 1,461 1,711 (Percent distribution by school) Schools in Ohio 3,642 80 84 82 75 Ohio State University 2,276 50 62 52 38 Case Western Reserve University 1,223 27 22 30 28 2 other schools (extinct) 143 3 - - 9 Schools in other States 937 20 16 18 25 University of Louisville 111 2 2 2 3 University of Pittsburgh 105 2 2 2 3 St. Louis University 92 2 1 2 2 University of Indiana 88 2 1 1 3 Loyola University (Chicago) 85 2 1 2 2 Northwestern University 74 2 1 2 2 38 other schools 382 8 8 7 10 One-fifth of the State's dentists obtained their dental degree from 44 schools located in other States. Of these dentists, 9 percent, or 403, graduated from eight schools located in adjacent States, primarily the Universities of Louisville, Pittsburgh, and Indiana. The remaining 11 percent, 534 dentists, are graduated of dental schools located in more distant States, mainly St. Louis and Northwestern Universities, and Loyola University of Chicago. 402 DISTRIBUTION OF DENTISTS More than four-fifths (84 percent) of Ohio's dentists are located in the 16 metropolitan areas of the State. The Cleveland area has the largest dental force, over 1,200 dentists, about one-fourth of all dentists in the State. The Columbus area and the Ohio portion of the interstate Cincinnati area have the next largest dental forces, 11 percent and 10 per- cent, respectively. Seven percent of the dentists are located in the Dayton area, while the Akron area and the Ohio portion of the interstate Toledo area have 6 percent each. The Youngstown-Warren and Canton areas have 5 percent and 4 percent of the State's dentists, respectively. The remaining eight metropolitan areas have a combined total of 402 dentists, 9 percent of the total dentist supply. Distribution of Ohio Dentists, by County Group Number Number Percent County group¥* of of of counties dentists dentists All counties 88 4,579 100 Metropolitan areas 31 3,857 84 Cleveland area 4 1,231 26 Columbus area 3 529 11 Cincinnati area (Ohio part) 3 442 10 Dayton area 4 319 7 Akron area 2 290 6 Toledo area (Ohio part) 2 259 6 Youngstown-Warren area 2 224 5 Canton area 1 161 4 8 other areas 10 402 9 Nonmetropolitan counties 57 722 16 Central city 10,000-49,999 28 545 12 Central city under 10,000 29 177 4 * See Appendix Table for definition of interstate and other metro- politan areas and for presentation of individual county data. Only 16 percent (722) of Ohio's dentists are located in the State's 57 nonmetropolitan counties. Three-fourths of these dentists are concen- trated in the 28 counties with 10,000 or more persons in their central cities, while the 29 counties with central city populations under 10,000 have only 4 percent of all dentists in the State. 403 AGE OF DENTISTS The median age of dentists in Ohio is 44.4 years. A full one-fourth of the State's dentists are under 35 years of age, but almost one-third are 55 or older. More than two-fifths (43 percent) of the dentists are between 35 and 54 years of age, with 27 percent between 35 and 44. Fifteen percent, or 679 dentists, are 65 or older, including 316 dentists who have reached age 70. Age Distribution of Ohio Dentists Number Percent Cumulative . Age * of of percent in 1965 dentists dentists distribution Total 4,579 100 - Under 30 439 10 10 30 - 34 673 15 25 35 - 39 556 12 37 40 - 44 673 15 52 45 - 49 394 9 61 50 - 54 296 7 68 55 - 59 379 8 76 60 - 64 426 9 85 65 - 69 363 8 93 70 - 74 202 4 97 75 & over 114 3 100 * Age computed to 1965 to enable comparison among all States. 1/ Age not available for 64 dentists. Percents are based on total for whom age is known. Dentists in the metropolitan areas, with a median age of 44.2 years, are only slightly younger than dentists in the nonmetropolitan counties, where the median age is 45.4 years. Among the metropolitan areas, Dayton and Columbus have the youngest groups of dentists, with median ages of approxi- mately 41 years. About 46 percent of the dentists in these areas are under 40 years of age, while only 23 percent are 55 or older. The Cleveland area, with a median age of about 49 years, has the oldest dentists as a group. Less than one-third of the dentists in this area are under 40 years of age, while slightly more than two-fifths are 55 or older. In nonmetropolitan counties, dentist ages tend to increase as the popula- tion of the central city decreases. The overall median age for dentists in counties with central city populations over 10,000 is 44.9 years, while dentists in counties with smaller central cities have a median age of 47.5 years. 404 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 4,579 dentists in Ohio, 4,409, or 96 percent, are professionally active, giving the State one active dentist for every 2,375 persons. The 16 metropolitan areas combined have 2,178 persons per dentist, while the nonmetropolitan counties have a considerably less favorable ratio of 3,429. Number of Persons Per Active Dentist in Ohio Professionally Persons County group¥* active Population per dentists dentist All counties 4,409 10,471,200 2,375 Metropolitan areas 3,714 8,088,000 2,178 Cleveland area 1,182 2,020,500 1,709 Columbus area 516 857,700 1,662 Cincinnati area (Ohio part) 423 1,110,700 2,626 Dayton area 308 810,100 2,630 Akron area 274 662,500 2,418 Toledo area (Ohio part) 248 563,000 2,270 Youngstown-Warren area 218 548,300 2,515 Canton area 153 363,900 2,378 8 other areas 392 1,151,300 2,937 Nonmetropolitan counties 695 2,383,200 3,429 Central city 10,000-49,999 526 1,672,000 3,179 Central city under 10,000 169 711,200 4,208 * See Appendix Table for data pertaining to other metropolitan areas and individual counties. Among the metropolitan areas, the 3-county Columbus area has the best ratio with 1,662 persons per active dentist. Franklin County, the hub of the area, has the best county ratio in the State, 1,575 persons per dentist. The 4-county Cleveland area, with 1,709 persons per dentist, is the only other metropolitan area with a ratio under 2,000. However, the ratios for the Ohio portion of the interstate Toledo area and the Mansfield area are below the average for the State, 2,270 and 2,275, respectively, while that of the Canton area is essentially the same as the State average. In five areas--Akron, Youngstown-Warren, Dayton, and the Ohio portions of the inter- state areas of Wheeling and Cincinnati--the ratios range between 2,400 and 2,600, while the areas of Springfield, Lorain-Elyria, and Steubenville- Weirton (Ohio part) have between 2,700 and 2,900 persons per dentist. The remaining three areas--Lima, Hamilton-Middletown, and Huntington-Ashland (Ohio part) have more than 3,400 persons for every active dentist. Among the 57 nonmetropolitan counties, only one, Erie, with one dentist for every 2,248 persons, has a ratio below the State average, and just three others have ratios under 2,500. There are 11 other counties with persons- per-dentist ratios under 3,000, yet 15 counties have more than 5,000 persons per dentist, including three with only one dentist for every 10,000 or more persons. 405 UTILIZATION OF AUXILIARIES Almost four-fifths of Ohio's responding practitioners (i.e., dentists who spend any time working at the chair) reported the employment of one or more auxiliaries. The dental assistant, the most widely utilized auxil- iary, is employed by 71 percent of the practitioners, including 63 per- cent who employ at least one assistant on a full-time basis. Secretaries and receptionists are employed by 29 percent of the dentists, with more than two-thirds utilizing such personnel full time. Dental hygienists are employed by 18 percent of the dentists, and laboratory technicians, by 7 percent; these auxiliaries are most often employed part-time only. Ohio Dentists Employing Auxiliaries, By Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only emp loyed practitioners Total time employee part-time (or more) employees Total 3,674% 100 71 8 One or more auxiliaries 2,831 79 71 8 Assistant 2,523 71 63 8 Hygienist 638 18 8 10 Laboratory technician 256 7 2 5) Secretary or receptionist 1,042 29 20 9 Other type of personnel 130 4 2 2 No auxiliary 731 21 - - 1/ Includes 112 dentists who did not report on auxiliary utilization. Auxiliary utilization varies with the age of the dentist and tends to be more common among the younger dentists. Approximately 90 percent of the practitioners under 45 years of age employ some type of auxiliary. This proportion decreases to 73 percent for dentists 45 to 64 years of age and to only 48 percent for those 65 and over. Sixteen percent of the dentists reported one or more vacant positions for auxiliary personnel. Two-fifths of these dentists had vacancies for full-time dental hygienists, and one-fourth reported vacancies for full- time dental assistants. 406 OTHER SURVEY FINDINGS [7 Approximately one of every four survey respondents (889 dentists) reported that he had completed one or more years of advanced train- ing after receiving the dental degree. Of 605 dentists taking advanced clinical training, 442 had completed an internship, and 163, a residency. Of 468 dentists reporting advanced academic training, 214 had received a master's or other advanced degree and 254 had received no additional degrees but had completed at least one year of study at the postgraduate level. A total of 184 den- tists reported the completion of both academic and clinical train- ing. [7 Ninety-six percent of the responding professionally active dentists in Ohio are primarily engaged in private practice, with 95 percent self-employed and 1 percent employed by other dentists. The remaining 4 percent are employed by governmental agencies or are engaged in other dental activities, such as taking advanced train- ing. / / Twelve percent of the responding active dentists reported at least one part-time dental activity in addition to their principal employ- ment. Part-time teaching in a dental school was the most frequently reported secondary activity, followed by employment in a State or local government agency. Various other activities were reported, including employment by other dentists and serving in a voluntary agency. 3 About 14 percent of the responding dental practitioners reported that they limit their practice to a dental specialty, primarily to orthodontics and oral surgery. Dentists in metropolitan areas are almost twice as likely to limit their practices as are those in nonmetropolitan counties. I ~~ Of the 420 dentists licensed in Ohio but located in another State, one-fourth are in the five adjacent States, primarily, Pennsylvania, Kentucky, and Michigan. Twenty percent of the out-of-State dentists are located in Florida, 14 percent are in California, and 7 percent in New York. The remainder are scattered among 31 other States, the District of Columbia, and foreign countries. April 1969. 407 386-029 O - 70 - 27 80% APPENDIX TABLE Selected Data on Dentists in Ohio, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total “ooP© respond- Under 55 yrs. sionally (in 000's) active ents . . ents 40 or more active dentist All counties 4,579 3,850 729 1,668 1,484 4,409 10,471.2 2,375 Metropolitan areas 3,857 3,233 624 1,425 1,247 3,714 8,088.0 2,178 Cleveland area 1,231 1,017 214 374 494 1,182 2,020.5 1,709 Cuyahoga 1,109 918 191 319 469 1,063 1,719.3 1,617 Geauga 13 9 4 7 4 12 57.4 4,783 Lake 78 62 16 35 12 77 170.4 2,213 Medina 31 28 3 13 9 30 73.4 2,447 Cincinnati area (Ohio part) 442 376 66 176 143 423 1,110.7 2,626 Clermont 14 13 1 9 5 14 97.9 6,993 Hamilton 413 352 61 160 135 395 933.2 2,363 Warren 15 11 4 7 3 14 79.6 5,686 Columbus area 529 449 80 241 127 516 857.7 1,662 Delaware 12 12 - 6 2 12 39.0 3,250 Franklin 507 427 80 233 122 495 779.8 1,575 Pickaway 10 10 - 2 3 9 38.9 4,322 Dayton area 319 277 42 147 73 308 810.1 2,630 Greene 35 33 2 17 6 34 111.6 3,282 Miami 23 21 2 5 6 23 78.5 3,413 Montgomery 255 218 37 124 60 245 585.0 2,388 Preble 6 5 1 1 1 6 35.0 5,833 Akron area 290 235 55 99 90 274 662.5 2,418 Portage 28 25 3 11 7 27 106.6 3,948 Summit 262 210 52 88 83 247 555.9 2,251 60% APPENDIX TABLE (cont'd.) Selected Data on Dentists in Ohio, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total —ooP respond- Under 55 yrs. sionally (in 000's) active ents . : ents 40 or more active dentist Metropolitan areas?’ (cont'd.) Toledo area (Ohio part) 259 227 32 100 87 248 563.0 2,270 Lucas 238 208 30 92 81 227 483.8 2,131 Wood 21 19 2 8 6 21 79.2 3,771 Youngstown-Warren area 224 180 44 87 63 218 548.3 2,515 Mahoning 149 116 33 54 44 144 316.8 2,200 Trumbull 75 64 11 33 19 74 231.5 3,128 Canton area 161 140 21 52 48 153 363.9 2,378 Stark 161 140 21 52 48 153 363.9 2,378 Lorain-Elyria area 92 75 17 41 23 92 251.9 2,738 Lorain 92 75 17 41 23 92 251.9 2,738 Hamilton-Middletown area 61 53 8 25 20 61 220.5 3,615 Butler 61 53 8 25 20 61 220.5 3,615 Lima area 52 47 5 15 17 50 170.2 3,404 Allen 36 34 2 10 9 36 110.6 3,072 Putnam 6 3 3 1 3 4 29.8 7,450 Van Wert 10 10 - 4 5 10 29.8 2,980 Springfield area 56 44 12 17 20 52 139.8 2,688 Clark 56 44 12 17 20 52 139.8 2,688 Mansfield area 59 47 12 22 13 56 127.4 2,275 Richland 59 47 12 22 13 56 127.4 2,275 (8 Selected Data on Dentists in Ohio, By Location APPENDIX TABLE (cont'd.) Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total a respond- Under 55 yrs. sionally (in 000's) active ents 40 or more active dentist Metropolitan areas?’ (cont'd.) Steubenville-Weirton area(Ohio part) 37 28 9 14 14 36 101.2 2,811 Jefferson 37 28 9 14 14 36 101.2 2,811 Wheeling area (Ohio part) 32 26 6 10 12 32 81.9 2,559 Belmont 32 26 6 10 12 32 81.9 2,559 Huntington-Ashland area (Ohio part) 13 12 1 5 3 13 58.4 4,492 Lawrence 13 12 1 5 3 13 58.4 4,492 Nonmetropolitan counties 722 617 105 243 237 695 2,383.2 3,429 Central city 25,000-49,999 181 157 24 66 63 173 534.4 3,089 Erie 35 32 3 10 10 33 74.2 2,248 Fairfield 26 22 4 13 7 26 68.4 2,631 Hancock 20 18 2 9 4 20 58.5 2,925 Licking 34 26 8 15 11 32 100.1 3,128 Marion 20 19 1 8 5 20 64.8 3,240 Muskingum 22 18 4 8 13 21 82.4 3,924 Scioto 24 22 2 3 13 21 86.0 4,095 Central city 10,000-24,999 364 315 49 116 113 353 1,137.6 3,223 Ashland 15 12 3 1 5 15 41.7 2,780 Ashtabula 31 29 2 10 13 30 100.4 3,347 Athens 13 13 - 4 5 12 51.9 4,325 Champaign 6 5 1 1 2 6 31.3 5,217 Columbiana 30 25 5 6 11 29 110.4 3,807 Coshocton 9 8 1 3 1 9 32.6 3,622 11% APPENDIX TABLE (cont'd.) Selected Data on Dentists in Ohio, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per respond- Under 55 yrs. sionally (in 000's) active ents 40 or more active dentist and county Total ents Nonmetropolitan countiess’ (cont'd.) Central city 10,000-24,999 (cont'd.) Crawford 15 15 - 5 3 15 50.8 3,387 Darke 8 7 1 2 2 8 47.6 5,950 Defiance 15 14 1 5 7 14 34.1 2,436 Fayette 10 9 1 3 4 9 25.9 2,878 Guernsey 17 14 3 4 9 16 38.5 2,406 Huron 18 17 1 4 7 18 51.4 2,856 Knox 14 11 3 7 2 14 40.5 2,893 Logan 14 9 5 4 3 14 36.6 2,614 Ross 19 16 3 5 6 18 64.5 3,583 Sandusky 22 18 4 11 6 22 61.8 2,809 Seneca 26 20 6 9 7 26 62.4 2,400 Shelby 7 7 - 4 1 7 36.0 5,143 Tuscarawas 30 27 3 12 9 28 79.9 2,854 Washington 16 13 3 6 4 16 55.1 3,444 Wayne 29 26 3 10 6 27 84.2 3,119 Central city 5,000-9,999 108 86 22 37 35 104 368.8 3,546 Auglaize 11 11 - 5 2 10 38.8 3,880 Clinton 10 9 1 4 2 9 32.1 3,567 Gallia 9 8 1 3 5 8 26.9 3,362 Hardin 9 8 1 5 3 9 30.1 3,344 Henry 7 3 4 3 2 7 26.8 3,829 Highland 8 6 2 3 - 8 30.5 3,812 Hocking 6 5 1 - 2 6 20.4 3,400 Jackson 7 7 - 1 2 7 30.1 4,300 [AN APPENDIX TABLE (cont'd.) Selected Data on Dentists in Ohio, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total enCs respond- Under 55 yrs. sionally (in 000's) active ents 40 or more active dentist Nonmetropolitan countiess’ (cont'd.) Central city 5,000-9,999 (cont'd.) Madison 8 7 1 2 5 7 28.6 4,086 Mercer 12 11 1 2 4 12 34.6 2,883 Ottawa 9 5 4 4 3 9 38.2 4,244 Williams 12 6 6 5 5 12 31.7 2,642 Central city 2,500-4,999 60 50 10 23 20 57 289.4 5,077 Brown 5 5 - 1 3 5 26.6 5,320 Carroll 1 1 - - - 1 21.7 21,700 Fulton 9 7 2 5) 2 9 31.0 3,444 Harrison 2 1 1 1 - 2 17.4 8,700 Holmes 6 5 1 3 2 6 22.9 3,817 Meigs 3 3 - 2 - 3 21.6 7,200 Monroe 3 2 1 1 1 3 15.1 5,033 Morrow 4 3 1 1 1 4 20.4 5,100 Paulding 3 3 - 2 1 3 17.6 5,867 Perry 7 6 1 2 4 5 27.2 5,440 Pike 4 3 1 1 1 3 21.6 7,200 Union 7 6 1 3 2 7 23.9 3,414 Wyandot 6 5 1 1 3 6 22.4 3,733 E1Y APPENDIX TABLE (cont'd.) Selected Data on Dentists in Ohio, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total p respond- Under 55 yrs. sionally (in 000's) active ents . . ents 40 or more active dentist Nonmetropolitan counties’ (cont'd.) Central city under 2,500 9 9 - 1 6 8 53.0 6,625 Adams 2 2 - - 2 1 19.7 19,700 Morgan 4 4 - - 3 4 12.7 3,175 Noble 2 2 - 1 1 2 10.5 5,250 Vinton 1 1 - - - 1 10.1 10,100 1/ 2/ Copyright 1965. Sales Management Survey of Buying Power. Ohio counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. Statistics presented for the interstate areas of Cincinnati, Toledo, Steubenville-Weirton, Wheeling and Huntington-Ashland include only those dentists located in the Ohio portion of the SMSA. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. OKLAHOMA DENTISTS LICENSED IN OKLAHOMA During the 1965 registration period, 1,348 dentists registered with the Oklahoma Board of Governors of Registered Dentists. A total of 1,209 dentists responded to the survey, 90 percent of all those registered. Sixty-nine percent of the responding dentists are civilians located in Oklahoma, 25 percent are civilians located in other states, and 5 per- cent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Oklahoma Location and All Percent of military status dentists dentists Total 1,348 100 Respondents 1,209 90 Nonrespondents 139 10 Respondents 1,209 100 Civilians in Oklahoma 840 69 Civilians in another state 299 25 On active duty with Armed Forces 62 5 Not reported 8 1 Multiple licensure is quite common in Oklahoma, with almost two of every three dentists licensed in the State (64 percent) holding more than one license. Fifty-one percent of the dentists located in Oklahoma hold more than one license, with 41 percent licensed in one other state and 10 percent licensed in two or more other states. Multiple licensure is much more common among dentists registered in Oklahoma but located out of state; 36 percent hold two or more licenses in addition to their Oklahoma license. Almost three-fourths of the licenses held in states outside of Oklahoma are held in adjacent states, predominantly Missouri, Kansas, and Texas. The remainder are held in 36 other states scattered across the Nation. 415 PROFESSIONAL TRAINING Almost four-fifths of Oklahoma's dentists graduated from dental schools in adjacent states. The majority, 62 percent, graduated from dental schools in neighboring Missouri. Of these, the principal contributor has been the University of Missouri at Kansas City, which has provided half of the State's dentists, while Washington and St. Louis Universities have together supplied twelve percent. Baylor University, the only other major source of dentist manpower, has provided 15 percent of the State's dentists. The remaining 22 percent of Oklahoma's dentists are graduates of 30 other dental schools located in more distant states. Among these, the Univer- sity of Tennessee, the largest contributor, has supplied only 42 dentists, 5 percent of the dental force, while Northwestern University has provided 2 percent. In addition, the Universities of Iowa and Nebraska, Loyola University (New Orleans), and Meharry Medical College have each contrib- uted approximately 1 percent of the total. Dental School Attended and Year of Graduation for Dentists in Oklahoma Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number gu0L/ - 243 296 297 (Percent distribution by school) Missouri (Kansas City) 420 50 47 50 53 Baylor 129 15 19 20 8 Washington (St. Louis) 59 7 6 10 6 Tennessee 42 5 13 2 1 St. Louis 38 5 4 2 7 31 other schools 150 18 11 16 25 1/ Dental school attended for 2 dentists and year of graduation for 4 dentists not available. Percents based on known totals. Some 16 percent of the survey respondents, 137 dentists, reported that they had completed one year or more of advanced training after their dental degree. Of the 71 dentists with advanced clinical training, 27 had completed a residency, and 44 an internship. Among the 96 dentists who reported advanced academic training, 61 had earned a master's or other advanced degree, and another 35 had received no additional degree but had completed one or more years of postgraduate study. These figures include 30 dentists who had taken both academic and clinical training. 416 DISTRIBUTION OF DENTISTS Over one-half (55 percent) of the 840 responding dentists in Oklahoma are located in the 4 metropolitan areas. The 3-county Oklahoma City area has 241 dentists, 29 percent of all dentists in the State. The majority of these dentists (210) are concentrated in Oklahoma County, where Oklahoma City is located, while the two other counties, combined, have only 31 dentists. The 3-county Tulsa area has the second largest dental force (189 dentists), 23 percent of the State supply, with nine-tenths of these dentists located in Tulsa County. The two remaining metropolitan areas, Lawton and the Oklahoma portion of the interstate Ft. Smith area, have 2 percent and 1 percent of Oklahoma's dentists, respectively. Distribution of Oklahoma Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 77 840 100 Metropolitan areas 9 459 55 Oklahoma City area 3 241 29 Tulsa area 3 189 23 Lawton area 1 20 2 Ft. Smith, Ark. area (Okla. part) 2 9 1 Nonmetropolitan counties 68 381 45 Central city 10,000-49,999 16 217 25 Central city 5,000- 9,999 17 90 11 Central city under 5,000 35 74 9 * See Appendix Table for definition of metropolitan areas and presenta- tion of individual county data. Forty-five percent (381) of Oklahoma's dentists are located in the 68 nonmetropolitan counties of the State. The 16 counties with central cities of 10,000 or more persons have 217 dentists, or about one-fourth of the State's dental force. Of these, four counties--Garfield, Musko- gee, Washington, and Kay--have more than 20 dentists, while five other counties--Carter, Okmulgee, Payne, Pittsburg, and Stephens--have between 10 and 20 dentists. The 52 counties with central cities of fewer than 10,000 inhabitants have about one-fifth of the State's dentist supply. There are 90 dentists located in the 17 counties having populations from 5,000 to 9,999 in their central cities, while 74 dentists are scattered among the 35 coun- ties with central cities of less than 5,000. Among these 52 counties, only 8 have more than 5 dentists, while 23 have fewer than 3 dentists. 417 AGE DISTRIBUTION OF DENTISTS BY AREA With slightly more than one-half of the State's dentists under 45 years of age, the median age of Oklahoma dentists is 44.6 years. Only 21 per- cent of the dentists (175) are under 35, while almost one-third (272 den- tists) are 55 or older. About one in every six, or 141 dentists, are 65 years old or more, and 97 have reached the age of 70. Median Age and Age Distribution of Oklahoma Dentists by County Group Percent of dentists County group Median Under 35- 45- 55 & g 35 44 54 over All counties 44.6 21 31 16 32 Metropolitan areas 43.1 23 34 16 27 Nonmetropolitan counties 48.1 19 26 16 39 Central city 10,000-49,999 46.1 17 30 18 35 Central city 5,000- 9,999 51.3 22 22 12 44 Central city under 5,000 54.3 19 18 15 48 In metropolitan areas, the median age of dentists is 43.1 years, a full five years lower than the median of 48.1 years for dentists in nonmet- ropolitan counties. There is very little difference in age distribution among the metropolitan areas. The youngest dentists as a group are found in the Oklahoma City and Lawton areas, where the median ages are quite similar, slightly over 42 years. In the Tulsa area, the median age is approximately one year older, 43.5 years. There are greater differences in age among the nonmetropolitan county groups, with median ages tending to increase rapidly as the size of the central city declines. The median age of dentists in counties with cen- tral cities of 10,000-49,999 inhabitants is 46.1 years, with 35 percent of these dentists 55 years of age or more. By comparison, in counties with central cities under 5,000, the median age is 54.3 years, almost 10 years above the State average, since almost half of the dentists (48 per- cent) are 55 years of age or older. 418 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 840 responding dentists in Oklahoma, 94 percent (787) are active in their profession, giving Oklahoma one professionally active dentist for every 3,064 persons. The 4 metropolitan areas together have 2,785 persons per active dentist, while the nonmetropolitan counties have a less favorable ratio of 3,400 persons per dentist. Number of Persons per Active Dentist in Oklahoma Professionally Persons County group®* active Population per dentists dentist All counties 787 2,411,200 3,064 Metropolitan areas 430 1,197,400 2,785 Oklahoma City area 226 590,800 2,614 Tulsa area 178 455,500 2,559 Lawton area 19 107,700 5,668 Ft. Smith, Ark. area (Okla. part) 7 43,400 6,200 Nonmetropolitan counties 357 1,213,800 3,400 Central city 10,000-49,999 203 614,400 3,027 Central city 5,000- 9,999 84 284,300 3,385 Central city under 5,000 70 315,100 4,501 * See Appendix Table for individual county data. Among the metropolitan areas, the 3-county Tulsa area has the best ratio, with 2,559 persons per dentist. Tulsa County itself has an even more favorable ratio of 2,373, compared to a combined ratio of 4,438 for the other two counties in that area. The ratio of the Oklahoma City area is 2,614 persons per dentist, quite similar to that of the Tulsa area. How- ever, the ratios of the Lawton and Ft. Smith areas are considerably less favorable, 5,668 and 6,200, respectively. Among the 68 nonmetropolitan counties, there are 11 counties with persons- per-dentist ratios under 2,500, yet 26 counties have ratios over 4,000, including eight with ratios in excess of 6,000 persons per dentist. An- other six counties have no active dentists, according to available information. 419 UTILIZATION OF AUXILIARIES Almost 9 of every 10 Oklahoma dental practitioners (i.e., dentists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 83 percent of all practitioners, including 77 percent who employ at least one assistant on a full-time basis. Secre- taries or receptionists are employed by 32 percent of the dentists, with almost three-fourths of these dentists utilizing them full time. Only 16 percent of the dentists employ dental hygienists, and 6 percent employ dental technicians. A majority of the dentists who employ hygienists or technicians do so on a part-time basis. Oklahoma Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliar Dental With one full- With only yp y practitioners Total time employee part-time (or more) employees Total 784%! 100 83 5 One or more auxiliaries 676 88 83 5 Assistant 639 83 77 6 Hygienist 121 16 7 9 Laboratory Technician 47 6 2 4 Secretary/Receptionist 247 32 23 9 Other type of personnel 14 2 1 1 No auxiliary 95 12 = - 1/ Includes 13 dentists who did not report on auxiliary utilization. Use of auxiliaries varies with the age of the dentist, becoming less fre- quent among dentists in the older age groups. Approximately 96 percent of Oklahoma dentists under age 45 employ some type of auxiliary. The propor- tion using auxiliaries decreases to 87 percent among dentists 45 to 64 years of age, and to 52 percent among dentists 65 and over. Although dentists in nonmetropolitan counties are almost as likely to em- ploy auxiliaries as are those located in metropolitan areas, the use of dental hygienists is. considerably more common in metropolitan areas than in the remainder of the State. About 21 percent of the dentists in metro- politan areas report the employment of a hygienist, compared to only 9 percent of dentists located elsewhere. 420 OTHER SURVEY FINDINGS J Ninety-eight percent of the professionally active dentists in Oklahoma are primarily engaged in private practice. The remaining two percent are either employed by governmental agencies or are engaged in other dental activities, such as taking advanced training. J Dentists providing patient care in the year prior to the survey devoted an average of 39.8 hours per week to this activity for 48.1 weeks during the year. About one dentist in eight worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. I~ ~~ About 10 percent of the respondents reported that they limit their practice to a dental specialty, primarily to orthodon- tics, followed by oral surgery and pedodontics. Fifteen per- cent of the dentists in metropolitan areas limit their prac- tice as compared to 4 percent in nonmetropolitan counties. J Only seven percent (60) of the responding dentists have prac- ticed as civilian dentists in one of 18 other states immed- iately prior to assuming their present Oklahoma location. More than half of these dentists came from adjacent states, primarily Kansas, Missouri, and Texas. / / Two-thirds of the 299 dentists licensed in Oklahoma but located in other states are in one of the six adjacent states, predominantly Texas, Kansas, and Missouri. The remainder are scattered throughout 26 other states across the Country. June 1968. 421 cy APPENDIX TABLE Selected Data on Dentists in Oklahoma, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist All counties 840 282 272 787 2,411.2 3,064 Metropolitan areas 2/ 459 173 122 430 1,197 .4 2,785 Oklahoma City area 241 98 63 226 590.8 2,614 Canadian 9 3 3 8 24.2 3,025 Cleveland 22 9 4 21 50.1 2,386 Oklahoma 210 86 56 197 516.5 2,622 Tulsa area 189 65 51 178 455.5 2,559 Creek 11 3 4 11 39.0 3,545 Osage 5 2 3 5 32.0 6,400 Tulsa 173 60 44 162 384.5 2,373 Lawton area 20 9 4 19 107.7 5,668 Comanche 20 9 4 19 107.7 5,668 Fort Smith area (Okla. part) 9 4 7 43.4 6,200 Le Flore 4 - 3 3 26.3 8,767 Sequoyah 5 1 1 4 17.1 4,275 Nonmetropolitan counties 3/ 381 109 150 357 1,213.8 3,400 Central city 25,000-49,999 68 21 24 65 165.7 2,549 Garfield 24 7 11 22 55.8 2,536 Muskogee 21 6 5 21 62.1 2,957 Washington 23 8 8 22 47.8 2,173 82 - OL - O 620-98¢ ecy APPENDIX TABLE (cont'd.) Selected Data on Dentists in Oklahoma, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population — per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 10,000-24,999 149 40 51 138 448.7 3,251 Bryan 6 1 2 5 22.2 4,440 Carter 15 3 7 14 41.2 2,943 Grady 6 1 3 6 28.2 4,700 Jackson 10 5 3 9 34.0 3,778 Kay 22 6 8 19 52.6 2,768 Okmulgee 17 6 5 16 35.5 2,219 Ottawa 9 3 3 9 26.8 2,978 Payne 16 3 6 15 43.1 2,873 Pittsburg 11 2 3 11 31.3 2,845 Pontotoc 8 1 3 8 29.2 3,650 Pottawatomie 10 5 2 9 40.4 4,489 Seminole 8 1 4 6 23.7 3,950 Stephens 11 3 2 11 40.5 3,682 Central city 5,000-9,999 90 29 39 84 284.3 3,385 Beckham 9 2 7 9 16.0 1,778 Caddo 5 1 3 5 25.8 5,160 Cherokee 4 2 - 4 17.2 4,300 Choctaw 3 1 1 3 13.7 4,567 Craig 5 2 3 4 15.4 3,850 Custer 7 2 4 7 21.2 3,029 Garvin 8 3 1 8 27.7 3,463 Hughes 3 2 1 3 12.8 4,267 Kiowa 4 - 3 3 13.0 4,333 Logan 4 1 3 3 17.0 5,667 Mayes 3 - - 3 20.2 6,733 TY APPENDIX TABLE (cont'd.) - Selected Data on Dentists in Oklahoma, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 (cont'd.) Noble 4 1 3 3 9.7 3,233 Rogers 6 3 2 6 21.1 3,517 Texas 7 3 4 6 14.3 2,383 Tillman 3 1 - 3 13.4 4,467 Woods 5 1 2 5 11.5 2,300 Woodward 10 4 2 9 14.3 1,589 Central city 2,500-4,999 47 14 23 43 191.7 4,458 Atoka 2 - 1 1 8.8 8,800 Blaine 4 1 2 4 10.9 2,725 Cotton 1 - 1 - 6.9 - Greer 3 1 2 3 7.7 2,567 Harmon 2 1 1 2 5.0 2,500 Kingfisher 6 2 4 5 9.5 1,900 Lincoln 6 1 3 6 17.2 2,867 McClain 2 1 - 2 11.8 5,900 McCurtain 3 1 1 3 23.5 7,833 McIntosh 2 - - 2 10.2 5,100 Marshall 2 1 1 2 6.8 3,400 Murray 2 - 1 2 10.5 5,250 Nowata 3 1 2 2 10.0 5,000 Okfuskee - - - - 9.8 - Pawnee 3 1 2 3 9.7 3,233 Wagoner 4 2 1 4 15.2 3,800 Washita 2 1 1 2 18.2 9,100 acy APPENDIX TABLE (cont'd.) Selected Data on Dentists in Oklahoma, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population = per and county Total Under 55 years sionally (in 000's) active 40 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 27 5 13 27 123.4 4,570 Adair 1 - - 1 12.3 12,300 Alfalfa 3 - 3 3 7.3 2,433 Beaver - - - - 6.8 - Cimarron 1 - - 1 4.4 4,400 Coal - - - - 4.6 - Delaware 3 - 1 3 12.5 4,167 Dewey - - - - 4.9 - Ellis 2 - 1 2 4.7 2,350 Grant 4 - 3 4 6.9 1,725 Harper 1 - 1 5.9 5,900 Haskell 1 - - 1 7.6 7,600 Jefferson 2 - 2 2 7.0 3,500 Johnston 1 - 1 1 7.5 7,500 Latimer 1 - - 1 7.0 7,000 Love 1 1 - 1 5.2 5,200 Major 4 2 1 4 6.7 1,675 Pushmataha 2 1 1 2 7.9 3,950 Roger Mills - - - - 4.2 - Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Oklahoma counties in the latest 1967 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards. have been grouped as metropolitan areas for the presentation of survey data, For the interstate Fort Smith SMSA, statistics are presented only for dentists located in the Oklahoma portion. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. SEES I TOI BRT Survey highlights More than 2,300 dentists registered with the Oregon State Board of Dental Examiners during its 1965 registration period. Three fifths of those registering, about 1,390 dentists, were civilians located in Oregon. T wo thirds of the 870 civilian dentists licensed in Oregon but located in another state were in the neighboring states of Wash- ington and California. Slightly more than four in every five of the dentists in Oregon received their dental degrees from the University of Oregon. Advanced professional training beyond their dental degrees was reported by one in every six Oregon dentists. Proportionately more of those who graduated from dental school after 1940 had taken advanced training than those graduated prior to that time. Seven in every ten dentists in Oregon were located in one of the state’s three metropolitan areas—53 percent in the Portland area, 9 percent in the Eugene area and 8 percent in the Salem area. The median age in 1965 of all Oregon dentists was 44.1 years. However, Portland area dentists on the average were more than 2 years older than those in the remainder of the state. o At the time of the survey about 1,300 dentists, 94 percent of nN ~ all those in the state, were active in their profession. The active dentists were somewhat unevenly distributed among the population residing in Oregon. The 3-county Portland metro- politan area had 52 percent of the state’s active dentists as com- pared with only 41 percent of the population. Conversely, the remaining 33 counties in the state, with 59 percent of the popu- lation, had only 48 percent of the dentists. As a result, the Portland area had one active dentist for every 1,164 residents, while the remainder of the state had a comparatively less favor- able ratio, or one dentist for every 1,793 persons. A most ninety-five percent of the professionally active dentists were primarily in private practice. About one half of the remain- ing active dentists were on the staff of the dental school. Ore in every ten practitioners reported they limited their prac- tices to a dental specialty, primarily to orthodontics or oral surgery. A most one half of the self-employed practitioners devoted at least 48 weeks of the year to their practice and worked 40 hours or more per week. However, proportionately twice as many den- tists under 35 years of age (6 in every 10) spent this amount of time in practice as did those 55 years or older (only 3 in every 10). Auxiliaries were employed by 73 percent of the practicing dentists. Utilization of auxiliaries varied according to the age of the dentist and was most frequent among dentists between the ages of 35 and 54 (4 out of 5 employed at least one auxiliary). A most 70 percent of the practitioners employed dental as- sistants, almost always on a full-time basis. Dental hygienists, on the other hand, were employed by only 15 percent of the practicing dentists, most frequently on a part-time basis. o py) m () ©) 2 8TY The survey A nationwide program is being conducted by the American Association of Dental Examiners under a coniract with the Di- vision of Dental Health, U.S. Public Health Service to assist states in developing information about their professional and aux- iliary manpower. As a part of the national program, a study was undertaken in 1965 by the Oregon State Board of Dental Exam- iners to develop needed information about the characteristics of dentists licensed in Oregon. The preparation and publication of this report, which summarizes the results of the study conducted by the Oregon Board, has been made possible through the co- operation of the American Association of Dental Examiners and the Resource Analysis Branch of the Division of Dental Health. The Oregon State Board of Dental Examiners registered more than 2,300 dentists during its 1965 registration period. Almost three fifths of those registering, about 1,390 dentists, were civilians located in Oregon. Oregon licenses were also held by 870 civilian dentists located in other states or abroad and by 70 dentists on active duty in the armed forces. The Oregon Board sent each licensed dentist a survey question- naire with the 1965 registration form. Of all dentists registering, 73 percent returned the questionnaire. However, proportion- ately more of the dentists actually located in Oregon participated in the survey—1,072 dentists or 77 percent returned their ques- tionnaires. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not responding to the survey. This information was obtained either from records of the Oregon Board or from the 1966 American Dental Directory published by the American Dental Association. 6TY Civilian dentists licensed in Oregon Two thirds of the civilian dentists licensed in Oregon but located in another state were in the neighboring states of Wash- ington and California. Eighty-one of the 603 out-of-state respon- dents reported they had been practicing as a civilian in Oregon before moving to their present lccation in another state. Of the dentists reporting such a relocation, 44 percent were in California at the time of the survey and 35 percent were in Washington. Many of the responding dentists located in Oregon when the survey was conducted also indicated either present or past pro- fessional ties to Washington or California. Of the 408 Oregon dentists who reported they were also licensed to practice in an- other state, 45 percent maintained licenses in Washington and 20 percent in California. In addition, 145 dentists reported that im- mediately prior to coming to their present Oregon location they had been established professionally as a civilian in another state. Nineteen percent of these dentists had moved to their present Oregon location from Washington and 17 percent had come from California. LOCATION OF DENTISTS LICENSED IN OREGON: 1965 NUMBER OF DENTISTS 1,000 or More 100 - 999 10 - 99 Less than 10 & Professional training of Oregon dentists DENTAL SCHOOL ATTENDED BY OREGON DENTISTS Number of Dentists 250 200 | 150 | 100 AND YEAR DENTAL DEGREE WAS AWARDED OTHER SCHOOLS UNIVERSITY OF OREGON 1915& 16- 21- 26- 31- 36- 41- 46- 51- 56- 61- Earlier 20 25 30 35 40 45 50 55 60 64 Year Degree Awarded The majority of the dentists in Oregon received their dental degrees from the University of Oregon. This one school has trained slightly more than four fifths of the 1,385 dentists in the state. The University of Oregon has been graduating dentists since before the turn of the century and, as a result, has been the major contributor to the state’s dentist supply through the years. While only 18 percent of the Oregon dentists received their dental education at schools in other states, they were awarded their dental degrees by 41 different schools. The five dental schools in the adjacent states of California and Washington were attended by only one percent of the Oregon dentists. The University of Minnesota and Northwestern University were the most frequently attended out-of-state schools. One half of all the dentists in Oregon received their dental degrees after 1950. Relatively more of these dentists attended out- of-state schools than did those who completed their dental educa- tion in earlier years. While 85 percent of all the dentists com- pleting dental school in 1950 or earlier attended the University of Oregon, only 78 percent of those graduating after that year received their degrees from the Oregon school. TE There is a growing tendency among Oregon dentists to take professional training beyond their dental degrees. In total, one in every six dentists reported they had taken one or more years of advanced professional training. Yet, 18 percent of those graduated from dental school after 1940, as compared with only 11 percent who completed dental school in 1940 or earlier, had continued their training. A few Oregon dentists (3 percent) reported taking both ad- vanced academic and clinical training, but in total, 12 per cent had taken academic training, 2 percent had completed both intern- ships and residencies and 5 percent had completed their intern- ships only. More than one half of those who continued their academic training earned at least a master’s degree in addition to their doctor’s degree in dentistry. HIGHEST LEVEL OF ADVANCED PROFESSIONAL TRAINING COMPLETED BY OREGON DENTISTS (Percent of Dentists) Residency Advanced and/or Internship Academic Training A 3 J Se 0 No Advanced Professional Training 7 ® Location and age of Oregon dentists Seven in every ten of the 1,385 licensed dentists in Oregon were located in the state’s three metropolitan areas: Portland, Eugene and Salem. More than half (about 740) of all the dentists in the state are in the Portland area alone, including 43 percent in Multnomah County, and 5 percent each in Clackamas and Wash- ington Counties. Lane County, which is defined as the Eugene DISTRIBUTION OF OREGON DENTISTS: 1965 (Plotted by County) Eastern Oregon Willamette Valley Area _\ Western Oregon [] METROPOLITAN AREA EACH DOT EQUALS 2 DENTISTS metropolitan area, was the location of 120 dentists, or 9 percent of all those in the state. The 2-county Salem area had almost as many dentists, seven percent in Marion County and one percent in Polk County. In total, Oregon’s Willamette Valley area contained more than three fourths of the state’s dentist supply. In addition to the dentists in the three metropolitan areas, another 6 percent were located in the Valley’s four nonmetropolitan counties (Linn, Ben- ton, Hood River and Yamhill). By comparison, only 14 percent were in Western Oregon, which is defined to include the six coastal counties of Clatsop, Coos, Curry, Douglas, Lincoln, and Tillamook, as well as the three inland counties of Columbia, Josephine and Jackson. Eastern Oregon, which includes the remaining 17 coun- ties in the state, had only 10 percent of the state’s dentists. Among the four nonmetropolitan counties in the Willamette Valley, the largest number of dentists were located in Linn and Benton Counties, which are situated between the Salem and Eugene areas. Each of these two counties had about 30 dentists, or three times as many as in the Salem area’s Polk County, the metropolitan county with the least number of dentists. By far the greatest number of dentists in Western Oregon were located in Jackson County which had more than 60 dentists. Coos and Douglas Counties, with about 25 dentists each, were the only other counties in the Western section with more than 20 dentists. Among the Eastern Oregon counties only Klamath and Deschutes Counties had as many as 20 dentists. Two of the remaining 15 counties in the Eastern section, Sherman and Wheeler Counties, apparently had no licensed dentists. » Ww w AGES OF OREGON Under 30 70 & Over 35-39 With more than one half of the dentists under 45 years of age in 1965, the median dentist age in Oregon was 44.1 years. One third of the dentists were between the ages of 35 and 44, a figure considerably higher than for either the 45 to 54 or 55 to 64 years age group. Dentists in the youngest age groups, that is, under 35 years, outnumbered those who were 65 years or older. The average dentist age varied somewhat among the various areas of the state. The Portland area, where about one half of the dentists were located, had proportionately fewer young dentists than did either of the other two metropolitan areas or the group of nonmetropolitan counties. The median age of the Portland area’s dentists, therefore, was older—45.2 years, as compared with DENTISTS: 1965 Portland Area Salem Area Nonmetropolitan Counties 43.1 for the nonmetropolitan counties, 42.7 for the Eugene area and only 41.6 for the Salem area. The ages of dentists also varied among individual counties, sometimes considerably. For example in the 3-county Portland area, Multnomah County, which contains the city of Portland, had relatively more older dentists than young ones, while the suburban counties of Clackamas and Washington had relatively more young dentists. In Multnomah County there were 2 dentists aged 55 or older for every dentist under 35. In contrast, Clack- amas County had 3 dentists under 35 for every 2 dentists 55 and over, and Washington County had 3 dentists in the younger age group for each dentist in the older group. & Active dentists in relation to the Oregon population At the time of the survey about 1,300 dentists were active in their profession in Oregon. These dentists represented 94 percent of all those in the state. Another 4 percent were retired, while only a negligible number were active in nondental activities. The pro- fessional status of 2 percent of the dentists was not obtainable. The concentration of dentists in the metropolitan areas resulted in a somewhat uneven distribution of the active dentists among DISTRIBUTION OF DENTISTS AND POPULATION, BY AREA: 1965 ACTIVE DENTIST Percent of State Total Portland Eugene Salem Nonmetropolitan Metropolitan Areas Counties the state’s population. The Portland metropolitan area had pro- portionately more dentists than population—52 percent of the state’s active dentists as compared with only 41 percent of the population. As a result of this disproportionate distribution of dentists and population, there was one dentist for every 1,164 persons residing in the Portland area, while the remainder of the state had a less favorable ratio of one dentist for every 1,793 per- sons. The ratios for the Salem and Eugene metropolitan areas were virtually the same, 1,556 and 1,559 respectively, but less favorable than for the Portland area. If all three metropolitan areas are considered together, they had 69 percent of the active dentists and 60 percent of the population, or 1,263 persons per dentist as compared to an average of 1,944 persons for every active dentist in the nonmetropolitan counties. The nonmetropolitan ratio, however, varied only slightly among the three geographical sections of the state—ranging from an aver- age of 1,894 persons per dentist in the 4 nonmetropolitan counties in the Willamette Valley area to only 1,914 persons in Eastern Oregon and 1,990 persons in Western Oregon. The persons-per-active dentist ratios varied considerably more among individual counties. Among the six metropolitan counties the population per dentist ranged from 1,017 in the Portland area’s Multnomah County to 2,960 in the Salem area’s Polk County. Two counties in Eastern Oregon had the extremes in persons- per-active dentist ratios among the state’s 28 nonmetropolitan counties which had professionally active dentists. Crook County had the most favorable ratio of 1,188 persons while the state’s least favorable ratio of 5,450 occurred in Jefferson County. How- ever, in more than two thirds of the nonmetropolitan counties the ratios were between 1,500 and 2,499 persons. 1965 NUMBER OF PERSONS PER ACTIVE DENTIST FOR OREGON COUNTIES: EASTERN OREGON 3) WESTERN OREGON WILLAMETTE VALLEY AREA \ \ Metropolitan Nonmetropolitan 6000 5400 | | o o o < ™ §s1jua@ @AldY 43d suosiad jo JaqunN 2400 1800 1200 600 | 435 & Professional characteristics of Oregon dentists Percent of Reported Total 100 95 904 25 20 PROFESSIONAL ACTIVITY IN 1964 DENTISTS ACTIVE LAST YEAR ANNUAL PROFESSIONAL TIME Patient Care Teaching Research Other Dental Activities Almost all of the dentists who reported on their professional activities in Oregon during the year preceding the survey indi- cated that they spent at least a portion of their time in providing dental care to patients. On the average, they spent 38.3 hours per week at this activity for 46.8 weeks during the year. Total time spent by these dentists in patient care accounted for 92 percent of the aggregate professional time reported for the year by all active dentists. Professional activities other than patient care were also re- ported by some Oregon dentists; however, only 8 percent of the total professional time during the year was spent in all activities other than patient care. Nine percent of the dentists were teaching either in the dental school or in one of the schools in Oregon which train dental assistants and six percent were engaged in dental research. Other dental activities were reported by six per- cent of the dentists, including those who were taking advanced professional training, serving as consultants to the Veterans Ad- ministration and other organizations, or serving in official capac- ities in various state-wide and local dental organizations. Almost all of the dentists who were professionally active at the time of the survey reported that they were primarily in private practice—ninety-three percent were self-employed and one percent were employed by other dentists. About one half of the remaining dentists who were not primarily in private practice were on the staff of the dental school. About one in every ten active dentists indicated they were engaged in more than one type of dental employment. For ex- ample, one in every twenty-five active dentists was primarily engaged in his own practice but also was a member of the dental school faculty. Ley By far the majority of the dentists were in general practice. However, one in every ten reported that they limited their prac- tices to a dental specialty, primarily orthodontics or oral surgery (each was reported by 3 percent of the dentists). Limited prac- tices were more frequently reported by dentists in the Salem metropolitan area than by those in other sections of the state. Seventeen percent of the Salem area dentists reported limiting their practices as compared with 12 percent of the dentists in the Portland area, and only 9 percent in the Eugene area and 4 per- cent in the nonmetropolitan counties. Almost one half (47 percent) of the self-employed practitioners devoted at least 48 weeks of the year to their practices and worked 40 hours or more per week. However, proportionately more younger dentists than older dentists spent this much time in their practices. For example, almost 6 of every 10 dentists under 35 years of age spent 40 hours or more for at least 48 weeks in the year in their practices, while only about 3 in every 10 dentists 55 years or older practiced this amount of time. Furthermore, another 3 in every 10 dentists in this older age group not only practiced less than 48 weeks of the year but also spent less than 40 hours a week in their practices, whereas only 1 in every 20 dentists under age 35 spent so little time in practice. TIME SPENT IN PRIVATE PRACTICE IN 1964 Less than 48 weeks and 40 hours or more per week 48 weeks or more 4Q hours or more Less than 48 weeks Less than 4Q hours A8 weeks or more Less than 40 hours ALL REPORTING DENTISTS DENTISTS UNDER 35 DENTISTS 55 OR OVER ¢ Utilization of auxiliaries by Oregon dentists Percent of Dental Practitioners 90 60 30 Q | | | J Under 30- 35- 45- 55- 65 & 30 34 44 54 64 Older UTILIZATION OF AUXILIARIES BY AGE OF DENTAL PRACTITIONERS: 1965 WITH ONE OR MORE AUXILIARIES Sd WITH DENTAL ASSISTANTS « WITH DENTAL HYGIENISTS Ns o NS o Sa = wt, D/ LABORATORY TECHNICIANS 2 ,, «4 frome WITH DENTAL Yuga Age Group Almost three fourths of all practicing dentists employed one or more auxiliaries, yet the utilization of auxiliaries varied consider- ably according to the age of the dentist. About four fifths of those between the ages of 35 and 54 utilized at least one auxiliary in their practices. Among the younger and older dentists, however, the use of auxiliaries was less frequent—about 7 of every 10 dentists under 35 years old employed an auxiliary, while only slightly more than one half of those 55 years or older did so. A somewhat similar age pattern occurred in the utilization of each type of auxiliary. However, many more dentists in every age group employed dental assistants than any other type of person- nel. Almost 70 percent of all the dental practitioners utilized dental assistants in their practices as compared with only 19 per- cent with secretaries or receptionists, 15 percent with dental hygienists and 7 percent with dental laboratory technicians. Not only did more dentists employ dental assistants in their practices than any other type of auxiliary, but they also more frequently employed them full time. Among dentists with assist- ants, 95 percent employed at least one full time. By comparison, the dental hygienist, the auxiliary least likely to be employed full time, was utilized full time by only 18 percent of the dentists who employed a hygienist in their practices. The utilization of dental assistants and laboratory technicians was somewhat less frequent in the Portland area than in the remainder of the state. However, dental hygienists were employed by a larger proportion of the Portland area dentists than by those in other areas. 62 - 0L - O 630-98¢ 6€Y Appendix tables Table 1.—Survey Response Licensed dentists Survey respondents Percent Military status and location Number Percent Number of total Total dentists .......................... cc... 0... 2,329! 100 1,697* 73 Civilian dentists in Oregon ..................c. vero... 1,385 60 1,072 7 Civilians in another state ................................. 867 37 603 70 On active duty in armed forces ............................ 71 3 16 23 1 Total includes 6 dentists whose status was not obtainable. Table 2.—Dental School Attended, by Year Dental Degree was Awarded Year dental degree was awarded Number of All After 1941- 1940 or Dental school attended dentists years 1950 1950 earlier Total number ..................................... 1,385 — 671 260 420 (Percent distribution by school) University of Oregon ................c.cuiuiiininennnnnn.. 1,087 82 : 78 83 86 University of Minnesota ...................coiiuuinenen... 45 3 5 2 3 Northwestern University ...................cccoiuuinenin.. 37 3 3 3 2 The Creighton University .................ccouuuuinuneen.. 23 2 3 1 1 State University of Towa .............couuiiiiinnunnnnn... 14 1 1 1 1 Loyola University of Chicago ............oouiuuunununon. 13 1 1 1 1 Marquette University ..............oiiiinniinnnnennnnnn.. 12 1 2 —_ 1 35 other dental schools .................................. 96 7 7 9 5 Note: Individual items presented in tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire, or, in the case of nonrespondents, because data were not obtainable for all dentists. For each item where percentages are shown, they are based on the number of dentists for whom the data are known. oY Table 3.—Location of Dentists in Oregon, by Selected Characteristics Licensed dentists Population Survey respondents : Percent of —Agein 1965 Profes- Per practitioners Area and county Under 55 years sionally Total 2 active using Total 35 or more activel (in 000’s) dentist Total auxiliaries All areas ................... 1,385° 264 349 1,299 1,907.0 1,468 1,072 73 Willamette Valley area ................ 1,053 201 277 980 1,290.5 1,317 800 71 Metropolitan areas* .................. 967 182 258 897 1,133.3 1,263 734 71 Portland metropolitan area ......... 737 132 217 671 781.2 1,164 560 69 Clackamas .............c.cvuun. 74 21 14 69 125.6 1,820 50 63 Multnomah ..................... 595 91 196 538 547.3 1,017 457 69 Washington .................... 68 20 7 64 108.3 1,692 53 76 Salem metropolitan area ........... 110 22 19 108 168.1 1,556 76 77 Marion .........iiiii 100 20 16 98 138.5 1,413 67 78 Polk .......c 10 2 3 10 29.6 2,960 9 67 Eugene metropolitan area .......... 120 28 22 118 184.0 1,559 98 79 Lane ........0iiiiiiiiiinnnns 120 28 22 118 184.0 1,559 98 79 Nonmetropolitan counties ............ 86 19 19 83 157.2 1,894 66 72 Benton .........coiiiiiiiiinann. 29 8 6 29 46.4 1,600 21 67 Hood River ..................... 9 1 4 7 13.7 1,957 6 60 Linn «o.oo ee 30 8 3 30 63.8 2,127 27 74 Yamhill ........................ 18 2 6 17 33.3 1,959 12 83 7% Table 3.—Location of Dentists in Oregon, by Selected Characteristics (cont’d) Licensed dentists Population Survey respondents —Agein 1965 Profes- Per practitioners Area and county Total UBT Crear Sony (in000's) dentist Total auxiliaries Western Oregon ...................... 187 37 43 178 354.3 1,990 154 79 Clatsop ............cciiviiiin. 18 2 6 16 25.0 1,562 12 92 Columbia ..................... 10 2 4 9 22.5 2,500 8 75 COOS «ove 25 2 5 23 56.4 2,452 22 84 Curry ....ovviiiiii iii 7 1 4 6 15.1 2,517 5 75 Douglas ....................... 27 4 5 27 73.8 2,733 22 86 Jackson ....................... 64 19 10 63 86.0 1,365 56 74 Josephine ..................... 17 4 17 33.2 1,953 12 83 Lincoln ....................... 10 1 3 9 25.1 2,789 9 75 Tillamook ..................... 9 2 4 8 17.2 2,150 8 71 Eastern Oregon ...................... 141 25 28 137 262.2 1,914 114 73 Baker ............... LL. 10 — 4 10 16.9 1,690 8 50 Crook ........coviiiiiiiinnnn.. 8 1 1 8 9.5 1,188 6 60 Deschutes ..................... 21 7 5 20 25.0 1,250 20 72 Gilliam ....................... 2 1 — 2 3.1 1,550 2 50 Grant ................. 0... 4 — 2 4 7.3 1,825 4 33 Harney ....................... 3 1 1 3 7.0 2,333 3 100 Jefferson ...................... 2 —_ a 2 10.9 5,450 2 100 Klamath ...................... 31 5 4 31 49.1 1,584 21 71 Lake ............... il. 3 1 — 3 7.4 2,467 2 50 Malheur ......... Cee 11 3 3 11 23.6 2,145 8 86 Morrow ..................... 2 1 — 2 49 2,450 2 100 [A Table 3.—Location of Dentists in Oregon, by Selected Characteristics (cont'd) Licensed dentists Population Survey respondents —Agein 1965 Profes- Per Pr Area and county Total UR DoTeas Seteel (in0o0s) dentist Total auriiagies Eastern Oregon (cont’d.) Sherman .................... . — — — — 85 — — — Umatilla ...................... 18 1 3 16 44.1 2,756 16 64 Union ........................ 10 — 1 18.2 2,022 9 75 Wallowa ...................... 4 2 1 4 6.9 1,725 3 100 Wasco .........iiiiiiiii., 12 3 12 22.3 1,858 8 100 Wheeler ...................... — — — — 2.5 — — — 1 Includes all responding dentists who reported they were professionally active in Oregon at the time of the survey and all nonrespondents known to be under 70 years of age. 2 Copyright 1965, Sales Management Survey of Buying Power; further reproduction is forbidden. 3 Includes four dentists who failed to give their county location. 4 Oregon counties included in the latest 1966 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Stand- ards, have been grouped as metropolitan areas for the presentation of survey data. Statistics are presented only for dentists in the Oregon portion of the interstate Portland SMSA. ey Table 4.—Age in 1965, by Location Remainder of state Portland Age in 1965 areas me an Total see Sven’ counties Number of dentists ................ 1,385 737 644 120 110 414 Percent of dentists ................ 100 100 100 100 100 100 Under35 ............................. 21 19 22 26 21 21 35-44 33 30 36 30 40 37 45-54 19 19 20 23 20 19 55-64 13 15 11 12 10 10 65 and over .......................... 14 17 11 9 9 13 Medianage ......................... 44.1 45.2 429 42.7 41.6 43.1 Table 5.—Selected Practice Characteristics, by Age of Dentist Percent of dentists in age group Practice characteristics Under 35-44 45-54 55 and Dental practitioners ..................... 100 100 100 100 With one or more auxiliaries ................ 71 81 80 53 With dental assistants ................... 68 79 78 48 With dental hygienists ................... 11 22 18 5 Dentists reporting time in private practice .. 100 100 100 100 48 weeks or more: 40 hours or more per week ............... 59 53 41 28 Less than 40 hours per week ............. 20 23 30 34 Less than 48 weeks: 40 hours or more per week ............... 16 14 16 9 Less than 40 hours per week .............. 5 10 13 29 77% Table 6.—Professional Characteristics Number of Percent of Number of Percent of Professional characteristics Professional characteristics dentists dentists dentists dentists Professional activity Time spent in private practice Total reporting activity® ............ 956 100 Total reporting time spent* .......... 760 100 Patient care ....................... 917 96 Teaching ..........oooeeneeeeeennn. 87 9 48 weeks or more: Research ...............ooveuuennn. 58 6 40 hours or more per week .......... 358 47 Other activity ..................... 56 6 Less than 40 hours per week ......... 193 25 Professional employment Less than 48 weeks: Professionally active dentists reporting 40 hours or Wore per week .......... 106 14 type of employment? .............. 1,015 100 Less than 40 hours per week ......... 103 14 Self-employed ..................... 944 93 .. ei. Employed by another dentist ........ 13 1 Auxiliary utilization On staff of dental school . ........... 33 3 Total reporting utilization® .......... 982 100 Employed by state or local government 10 1 With one or more auxiliaries ........ 713 73 Other dental employment ........... 15 2 With dental assistant ............... 682 69 With dental hygienist ............... 147 15 Limited practices With dental laboratory technician . ... 72 7 . . With secretary or receptionist ....... 187 19 Total reporting type of practice® ..... 830 100 With other type of personnel ........ 17 9 With limited practices .............. 81 10 In orthodontics .................... 29 3 In oral surgery .................... 21 3 In pedodontics ..................... 16 2 In other specialty areas ............. 15 2 1 Dentists active during the year preceding the survey who indicated the type of professional activity in which they engaged. Some dentists reported more than one type activity. 2 Professionally active respondents who reported their type of employment at the time of the survey. 3 Dentists who indicated whether or not they limited their practices to a dental specialty. 4 Dentists primarily self-employed, both at the time of the survey and during the preceding year, who reported both hours and weeks spent during the year as a self-employed entist. 5 Dentists practicing at the chair at the time of the survey who indicated whether or not they utilized auxiliaries. September 1967. ~ PENNSYLVANIA | DENTISTS LICENSED IN PENNSYLVANIA During the 1966 registration period, 7,934 dentists registered with the Pennsylvania Dental Council and Examining Board. A total of 7,754 den- tists responded to the survey, 98 percent of all those registered. Eighty percent of the responding dentists are civilians located in Pennsylvania, 15 percent are civilians located in other states, and 5 percent are on duty with the Armed Forces. There were 116 women dentists included among the respondents, 94 of them located within the State. Location and Military Status of Dentists Licensed in Pennsylvania Location and All Percent of military status dentists dentists Total 7,934 100 Respondents 7,754 98 Nonrespondents 180 2 Respondents 7,754 100 Civilians in Pennsylvania 6,162 80 Civilians located in other states 1,149 15 On active duty with Armed Forces 422 5 Not reported 21 * * Less than one-half of one percent. Multiple licensure is not too common among Pennsylvania dentists. Only a little over one-fourth of all respondents hold a license to practice dentistry in one or more other states. Only 13 percent of the dentists located in Pennsylvania hold more than one license, with 11 percent licensed in one other state and a mere 2 percent licensed in two or more other states. Multiple licensure is much more common among dentists registering in Pennsylvania but located out-of-state; 20 percent hold two or more licenses in addition to their Pennsylvania license. Two-thirds of the licenses held outside of Pennsylvania are held in ad- jacent states, including 33 percent in New Jersey, 21 percent in New York and some 5 percent each in Ohio and Maryland. More distant states frequently reported were Florida and California. 445 PROFESSIONAL TRAINING Over 90 percent of Pennsylvania's 6,162 dentists are graduates of three in-state dental schools. The University of Pittsburgh and Temple Univer- sity have together provided almost three-fourths of the State's dentists, each contributing more than one-third of the total supply. The University of Pennsylvania, with a corsiderably smaller contribution, has trained approximately one-fifth of the dentists. The remaining 8 percent of Pennsylvania's dentists were trained in 42 out- of-state schools. Among these schools, the University of Maryland, the largest contributor, has supplied only about 100 dentists, or two percent of the dental force. The only other schools to provide as much as one per- cent of Pennsylvania's dentist supply are two schools in the District of Columbia, Georgetown and Howard Universities. Dental School Attended and Year of Graduation for Dentists in Pennsylvania Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 6,162 L/ - 1,230 1,874 3,051 (Percent distribution by school) Schools in this State 5,698 92 92 93 93 Pittsburgh 2,372 38 42 35 40 Temple 2,149 35 32 39 33 Pennsylvania 1,177 19 18 19 20 42 schools located elsewhere Lb64 8 . 8 7 7 1/ Year of graduation not available for 7 dentists. Only one-fifth of the State's dentists graduated from dental school within the last 10 years. In contrast, a full 50 percent received their dental degrees during the years prior to World War II. There has been virtually no change over the years in the overall proportion of dentists graduating either from Pennsylvania's own dental schools or from out-of-state schools. In Pennsylvania approximately one-fifth of the survey respondents, or 1,270 dentists, reported that they had completed one year or more of advanced training after receiving their dental degrees. Of the 864 dentists with advanced clinical training, 267 completed a residency and 597 an intern- ship. Among the 659 dentists who reported advanced academic training, 240 earned a master's or other advanced degree and another 419 received no additional degrees but completed one or more years of postgraduate study. A total of 253 dentists completed both academic and clinical training. 446 DISTRIBUTION OF DENTISTS More than four-fifths of the 6,162 responding dentists in Pennsylvania are located in the State's 13 metropolitan areas. The Pennsylvania por- tion of the Philadelphia area alone has almost 2,300 dentists, 37 percent of all the dentists in the State. Furthermore, one of every five dentists in the State (1,259) is actually located within Philadelphia County. Two of the remaining four counties in the Philadelphia area, Montgomery and Delaware, have 350 to 400 dentists, while Bucks and Chester Counties have 100 to 150 dentists. The 4-county Pittsburgh metropolitan area has 22 percent of the dental force, or 1,355 dentists. Three-fourths of these dentists (1,023) are in Allegheny County, where Pittsburgh is located. Distribution of Pennsylvania Dentists Number Number Percent Area¥* of of of counties dentists dentists Total 67 6,162 100 All metropolitan areas 25 5,147 84 Philadelphia area (Pa. part) 5 2,274 37 Pittsburgh area 4 1,355 22 11 other areas 16 1,518 25 Nonmetropolitan counties 42 1,015 16 Central city 10,000-49,999 19 736 12 Central city under 10,000 23 279 4 * See Appendix Table for complete listing and definition of metropolitan areas, including explanation of interstate areas, and presentation of individual county data. Of the other metropolitan areas, Allentown-Bethlehem-Easton has the largest dental force, although it accounts for only 4 percent of the State supply. The next largest dental forces are found in the Wilkes- Barre - Hazleton, Harrisburg and Reading areas, each of which accounts for 3 percent of the State's dentists. Five of the remaining metropol- itan areas--Lancaster, Scranton, York, Erie and Johnstown--each have approximately 2 percent of Pennsylvania's dentists. Only 16 percent of the State's dentists are located in the 42 nonmetro- politan counties. Three-fourths of these dentists are located in the 19 counties with central cities of 10,000 or more persons. The 23 counties which do not have a city this large account for only 4 percent of the dentists in the State. 447 AGE DISTRIBUTION OF DENTISTS BY AREA With slightly more than one-half of the dentists 50 years of age or older, the median age of dentists in Pennsylvania is 50.3 years. On- ly 15 percent of the State's dentists are under 35, but more than two and a half times this proportion, 41 percent, are 55 years of age or older. Nearly 1,000 dentists are 65 years old or over, includ- ing more than 400 who have reached the age of 70. Age Distribution of Pennsylvania Dentists . Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 6,162 1/ 100 - Under 30 316 5 5 30 - 34 634 10 15 35 - 39 688 11 26 40 - 44 783 13 39 45 - 49 613 10 49 50 - 54 585 10 59 55 - 59 732 12 71 60 - 64 817 13 84 65 - 69 543 9 93 70 - 74 294 5 98 75 & over 144 2 100 1/ Includes 13 dentists who did not report age. In metropolitan areas the median age of dentists is 49.9 years, more than two years younger than the 52.3 year median for dentists in the nonmetropolitan counties. Median ages vary considerably among the metropolitan areas. The areas of Allentown-Bethlehem-Easton and Lancaster have the youngest dentists, with median ages under 46 years. The oldest dentists are found in the Altoona, Scranton and Wilkes- Barre - Hazleton areas, where the median ages are 54 years or more. In the Pittsburgh area, the median age is 51.4 years, approximately one year older than the State average, while dentists in the Phila- delphia area have a median age about equal to the State average, 49.8 years. Age differences among the counties in the Philadelphia area are quite pronounced, with older dentists concentrated in the hub of the area. The median age of dentists in Philadelphia County itself is 53.0 years. By contrast, dentists in the four other counties comprising the Pennsylvania part of the Philadelphia area are considerably younger, with a median age of 45.0 years. 448 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 6,162 responding dentists in Pennsylvania, 5,936, or 96 percent, are active in their profession, giving Pennsylvania one professionally active dentist for every 1,967 persons, The 13 metropolitan areas together have 1,869 persons per active dentist, while the 42 nonmetro- politan counties have a somewhat higher ratio of 2,467 persons per den- tist. Of the principal metropolitan areas, Philadelphia has the more favorable ratio of 1,734 persons per dentist compared to a ratio of 1,907 in the Pittsburgh area. Number of Persons per Active Dentist in Pennsylvania Professionally Persons Area* active Population per dentists dentist Total 5,936 11,676,800 1,967 All metropolitan areas 4,959 9,266,500 1,869 Philadelphia area (Pa. part) 2,201 3,816,000 1,734 Pittsburgh area 1,284 2,448,100 1,907 11 other areas 1,474 3,002,400 2,037 Nonmetropolitan counties 977 2,410,300 2,467 Central city 10,000-49,999 707 1,718,700 2,431 Central city under 10,000 270 691,600 2,561 % See Appendix Table for data pertaining to individual metropolitan areas and counties. In the 5-county Philadelphia metropolitan area, the persons~-per-dentist ratios range from 1,519 in Montgomery County to 2,460 in Bucks County. Philadelphia County itself has one dentist for every 1,689 persons. In the Pittsburgh metropolitan area, Allegheny County, the hub of the area, has the most favorable ratio--1,717, while the three other counties in the area all have similar ratios which average about 2,500 persons per dentist. Among the other metropolitan areas, four have ratios more favorable than the State average--Scranton, Wilkes-Barre - Hazleton, Allentown-Bethlehem- Easton and Reading. Three metropolitan areas--Harrisburg, Erie and Lancaster--have ratios between 2,100 and 2,300, and three other areas-- Altoona, York and Johnstown--have ratios between 2,300 and 2,500. The remaining area, Susquehanna County, an outlying county in the Binghamton, New York metropolitan area, has a persons-per-dentist ratio exceeding 3,000. Of the 42 nonmetropolitan counties of the State, only five have persons- per-dentist ratios under 2,000. There are 20 counties with ratios of more than 2,500, including 9 counties with ratios in excess of 3,000 persons per dentist. 449 UTILIZATION OF AUXILIARIES Almost three-fifths of the dental practitioners in Pennsylvania (i.e., den- tists who spend any time working at the chair) employ auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 46 percent of the dentists, including 39 percent who employ at least one on a full-time basis. Secretaries or receptionists are employed by 17 percent of the practitioners, with about two-thirds of these dentists utilizing such personnel full time. Only 10 percent of the dentists employ dental hygienists and 5 percent employ dental technicians. Hygienists and labor- atory technicians are more likely to be employed on a part-time basis than are other auxiliary personnel. Pennsylvania Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliar Dental With one full- With only P y practitioners Total time employee part-time (or more) employees Total 5,810 L/ 100 48 8 One or more auxiliaries 3,152 56 48 8 Assistant 2,596 46 39 7 Hygienist 562 10 5 5 Laboratory technician 257 5 2 3 Secretary or receptionist 953 17 12 5 Other type of personnel 204 4 2 2 No auxiliaries 2,446 44 - - 1/ Includes 212 dentists who did not report on auxiliary utilization. The use of auxiliaries varies with the age of the dentist and is more fre- quent among the young dentists. Approximately 73 percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 51 percent among dentists 45 to 64 years old and to 31 percent among dentists 65 and over. Dentists in metropolitan areas employ auxiliaries with about the same fre- quency as those located in nonmetropolitan counties. Even though the proportion of dentists utilizing auxiliaries in the Philadelphia area approx- imates the State average, differences among individual counties within the area are rather pronounced. In Philadelphia County only 43 percent of the dentists employ auxiliaries, compared to 66 percent in the four other coun- ties comprising the Pennsylvania part of the Philadelphia metropolitan area. 450 OTHER SURVEY FINDINGS 17 Ninety-five percent of the professionally active dentists in Penn- sylvania are primarily engaged in private practice. Two percent are on the staffs of dental schools. The remaining three percent are either employed by government agencies or are engaged in other dental activities, such as taking advanced training. /"/ At least one part-time dental activity in addition to their princ- ipal employment was reported by 18 percent of the Pennsylvania dentists. Part-time teaching in a dental school was the most frequently reported type of secondary employment, followed by employment in a State or local government agency. A variety of other secondary dental activities were reported, including employ- ment by another dentist and serving in voluntary agencies. 7 About 10 percent of the practitioners reported they limit their practice to a dental specialty, primarily to oral surgery and ortho- dontics. Some 12 percent of the dental practitioners in both the Philadelphia and Pittsburgh areas limit their practices, compared to 10 percent of those in other metropolitan areas and only 6 per- cent of those located in nonmetropolitan counties. ~~ | Dentists providing patient care during the year prior to the survey devoted an average of 40.0 hours a week to this activity for 47.6 weeks. About one dentist in six worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. / 7 Of the 1,149 dentists licensed in Pennsylvania but located in another state at the time of the survey, one-third were in New Jersey and 26 percent were located in the other adjacent states of New York, Maryland, Ohio, West Virginia and Delaware. The remaining out-of- state dentists were located in 37 other states, predominantly Florida and California. February 1968. 451 sy Selected Data on Dentists in Pennsylvania, by Location APPENDIX TABLE Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist All counties 6,162 27 41 5,936 11,676.8 1,967 Metropolitan areas 2 5,147 27 40 4,959 9,266.5 1,869 Philadelphia area (Pa. part) 2,274 26 39 2,201 3,816.0 1,734 Bucks 146 43 17 146 359.1 2,460 Chester 124 36 27 121 235.0 1,942 Delaware 354 26 30 343 600.1 1,750 Montgomery 391 34 26 383 581.8 1,519 Philadelphia 1,259 20 47 1,208 2,040.0 1,689 Pittsburgh area 1,355 29 46 1,284 2,448.1 1,907 Allegheny 1,023 29 46 969 1,663.5 1,717 Beaver 98 29 49 95 212.9 2,241 Washington 81 35 41 78 211.7 2,714 Westmoreland 153 26 52 142 360.0 2,535 Allentown-Bethlehem-Easton area (Pa. part) 252 32 29 246 451.4 1,835 Lehigh 143 36 24 139 241.5 1,737 Northampton 109 26 36 107 209.9 1,962 Wilkes-Barre - Hazleton area 193 22 48 189 324.8 1,719 Luzerne 193 22 48 189 324.8 1,719 Harrisburg area 192 27 37 185 395.1 2,136 Cumberland 59 31 36 56 139.2 2,486 Dauphin 125 27 38 122 228.5 1,873 Perry 8 - 38 7 27.4 3,914 £€ay APPENDIX TABLE (cont'd.) Selected Data on Dentists in Pennsylvania, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Metropolitan areas 2/ (cont'd.) Reading area 152 28 38 150 284.1 1,894 Berks 152 28 38 150 284.1 1,894 Lancaster area 138 28 30 134 299.7 2,237 Lancaster 138 28 30 134 299.7 2,237 Scranton area 138 21 51 134 224.0 1,672 Lackawanna 138 21 51 134 224.0 1,672 Erie area 128 27 41 125 266.5 2,132 Erie 128 27 41 125 266.5 2,132 York area 136 29 32 131 310.5 2,370 Adams 17 41 35 15 55.8 3,720 York 119 28 31 116 254.7 2,196 Johnstown area 118 22 47 112 276.0 2,464 Cambria 95 20 51 90 200.7 2,230 Somerset 23 26 30 22 75.3 3,423 Altoona area 61 25 56 58 136.7 2,357 Blair 61 25 56 58 136.7 2,357 Binghamton, N Y. area (Pa. part) 10 20 40 10 33.6 3,360 Susquehanna 10 20 40 10 33.6 3,360 SY APPENDIX TABLE (cont'd.) Selected Data on Dentists in Pennsylvania, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties 3/ 1,015 26 45 977 2,410.3 2,467 Central city 25,000-49,999 216 27 40 211 458.5 2,173 Lawrence 51 29 45 48 117.3 2,444 Lebanon 43 33 35 43 94.2 2,191 Lycoming 51 22 37 51 113.6 2,227 Mercer 71 27 41 69 133.4 1,933 Central city 10,000-24,999 520 24 47 496 1,260.2 2,541 Butler 50 18 58 47 123.6 2,630 Centre 39 23 44 39 88.1 2,259 Clearfield 25 24 48 25 79.4 3,176 Clinton 9 33 44 9 38.0 4,222 Columbia 27 30 37 25 53.3 2,132 Crawford 37 22 46 35 77.5 2,214 Fayette 57 12 56 57 160.3 2,812 Franklin 36 28 31 34 95.5 2,809 Indiana 35 37 46 34 74.6 2,194 McKean 26 23 39 25 53.5 2,140 Mifflin 21 29 33 20 44.7 2,235 Northumberland 36 19 47 34 98.4 2,894 Schuylkill 72 22 58 65 160.9 2,475 Venango 33 33 42 30 65.4 2,180 Warren 17 29 41 17 47.0 2,765 0€ - 0L - O 620-98¢ APPENDIX TABLE (cont'd.) Selected Data on Dentists in Pennsylvania, by Location Civilian dentists 1 Persons County group Age in 1965 Profes- Population — per and county Total Percent Percent sionally (in 000's) active under 40 55«0r more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city 5,000-9,999 187 27 42 182 459.1 2,523 Armstrong 25 24 56 24 79.0 3,292 Bradford 21 33 43 21 56.4 2,686 Carbon 23 30 30 23 50.7 2,204 Elk 15 - 53 13 38.7 2,977 Greene 11 27 46 11 36.6 3,327 Huntingdon 19 21 37 18 38.7 2,150 Jefferson 20 45 30 20 45.5 2,275 Monroe 17 35 35 17 41.9 2,465 Montour 10 20 50 9 17.1 1,900 Union 10 20 40 10 26.6 2,660 Wayne 16 25 44 16 27.9 1,744 Central city 2,500-4,999 68 32 53 64 168.9 2,639 Bedford 19 32 42 17 43.1 2,535 Cameron 4 - 100 4 7.9 1,975 Clarion 17 29 65 17 37.0 2,176 Potter 6 33 67 5 16.4 3,280 Snyder 11 36 36 10 27.4 2,740 Tioga 11 46 46 11 37.1 3,373 qaqY 95% APPENDIX TABLE (cont'd.) Selected Data on Dentists in Pennsylvania, by Location Civilian dentists 1 Persons County group Age in 1965 Profes=~ Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties 3/ (cont'd.) Central city under 2,500 24 29 33 24 63.6 2,650 Forest 1 - 100 1 4.3 4,300 Fulton 4 25 - 4 10.7 2,675 Juniata 3 - 67 3 16.2 5,400 Pike 4 25 25 4 9.5 2,375 Sullivan 1 - - 1 6.0 6,000 Wyoming 11 46 36 11 16.9 1,536 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Pennsylvania counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. For interstate SMSA's, statis- tics are presented only for dentists reporting their location in the Pennsylvania portion of the Philadelphia SMSA, Allentown-Bethlehem-Easton SMSA, and Binghamton SMSA. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. RHODE ISLAND DENTISTS LICENSED IN RHODE ISLAND During the 1965 registration period, a total of 537 dentists registered with the Rhode Island Department of Health, Board of Examiners in Den- tistry (Table 1). A large proportion of these dentists, 86 percent, are civilians located in Rhode Island; another 10 percent are civilians located in other States, and only 3 percent are on active duty in the Armed Forces. Almost two-thirds of the 53 out-of-State civilian den- tists are located in adjacent States, 30 in Massachusetts and 4 in Con- necticut. Table l.--Location and Military Status of Dentists Licensed in Rhode Island Location and All Percent military status dentists dentists Total licensed 537 100 Respondents 497 93 Nonrespondents 40 7 Total licensed 537 100 Civilians in Rhode Island 463 86 Respondents 429 - Nonrespondents 34 - Civilians in another State 53 10 On active duty with Armed Forces 17 3 Not available 4 1 The survey questionnaire was completed by 497 dentists, 93 percent of all those registered. Certain items of information--State and county location, age, dental school attended, and year of graduation--were obtained for nonrespondents from records maintained either by the Rhode Island Department of Health, Board of Examiners in Dentistry, or from the 1966 American Dental Directory published by the American Dental Association. This report includes information on both respond- ents and nonrespondents unless otherwise indicated. (See Appendix Table A.) 457 Of all dentists responding to the survey, almost two in every five hold a license in one or more States in addition to Rhode Island. About one- fourth of the dentists located in Rhode Island are licensed in one other State, but only 5 percent are licensed in two or more other States. By comparison, out-of-State respondents tend to have a considerably larger number of licenses, with 32 percent holding two or more licenses in addition to the one held in Rhode Island. Civilian Dentists in Rhode Island Age.--The median age of dentists in Rhode Island is a rather high 48.1 years. Three in every 10 of the State's dentists are 45 to 54 years of age and another 30 percent are 55 years old or over, including 11 percent who are at least 65 years of age. In contrast, only 12 percent of the dentists are under age 35 (Table 2). Table 2.--Age Distribution Number Percent Age of of dentists dentists Total 463%! 100 Under 35 53 12 35 - 44 122 28 45 - 54 133 30 55 - 64 85 19 65 - 74 31 7 75 & over 18 4 1/ Includes 21 dentists for whom age is not available. A relatively large proportion of survey nonrespondents are in the older age groups. Almost 40 percent of the nonresponding dentists are 65 years of age or older, but only 9 percent of the respondents are in this age group. Moreover, the median age of dentists not responding to the survey is 59.4 years, almost 12 years higher than for respondents. Dental schools.--As would be expected because of their high median age, relatively few of Rhode Island's dentists are recent dental school grad- uates. Only 16 percent of the State's dental force graduated from dental school within the past 10 years, which contrasts sharply with the 41 per- cent of the dental force graduating prior to World War II. 458 More than four of every five dentists currently located in Rhode Island are graduates of eight dental schools located in three States--Massachu- setts, Pennsylvania, Maryland--and the District of Columbia. The two dental schools located in Massachusetts have trained about 43 percent of the State's total dentist supply (Table 3). Tufts University has made the largest contribution, accounting for about one-third of the total dental force, while Harvard University, with a considerably smaller con- tribution, has trained slightly more than one-tenth of the dentists. Other schools making important contributions are the University of Maryland and Georgetown University, which have supplied Rhode Island with 17 percent and 11 percent of its dentists, respectively. The only other schools in these States to contribute as many as 20 dentists to the Rhode Island dentist supply are the University of Pennsylvania and Temple University. Table 3.--Dental School Attended Dental school Number Percent attended of of dentists dentists Total number 463 100 Tufts 148 32 Maryland 77 17 Harvard 50 11 Georgetown 49 11 Temple 30 6 St. Louis 28 6 Pennsylvania 24 5 Other schools 57 12 The remaining 17 percent of the State's dentists were trained in 20 other dental schools, including 3 in Canada. Among these schools, St. Louis University has contributed the largest number of graduates, about 6 percent of the total supply. Advanced training.--About 28 percent of the respondents, or 121 den- tists, reported they had completed one year or more of advanced train- ing beyond the dental degree (Table 4). Of the 94 dentists with advanced clinical training, 19 had completed a residency and 75 an internship. Among the 46 dentists who reported advanced academic training, 16 had earned a master's or other advanced degree, and another 30 received no additional degrees but had completed one or more years of postgraduate study. 459 Table 4.--Advanced Training Number Percent Type of advanced training of of dentists dentists Total 429Y/ 100 With advanced training 121 28 Clinical training only 75 18 Academic training only 27 6 Both clinical and academic training 19 4 With no advanced training 308 72 1l/ Includes survey respondents only. Distribution of dentists.--For the presentation of data on the geograph- ical distribution of dentists, Rhode Island has been divided into two areas as defined in "Economic Areas of the United States," by Donald J. Bogue and Calvin L. Beale. The Providence area includes the three counties of Providence, Kent and Bristol, and the Lower Narragansett Bay area consists of Washington and Newport Counties. About 9 in every 10 of the 463 dentists in Rhode Island are concentrated in the Providence area (Table 5). Providence County alone is the loca- tion of three-fourths of the State's dentists. Another 11 percent are located in Kent County, while only 3 percent are located in Bristol County. The remainder of the State's dentists are located in the Narragansett Bay area, 7 percent in Newport County and 5 percent in Washington County. Table 5.--Distribution by Area and County Number Percent Area and county of of dentists dentists All counties 463 100 Providence area 408 88 Providence 342 74 Kent 52 11 Bristol 14 3 Lower Narragansett Bay area 55 12 Newport 33 7 Washington 22 5 460 There is only a slight difference in the average age of dentists in the two geographic areas. The median age of dentists in the Lower Narragan- sett Bay area is 48.8 years, while dentists in the Providence area are on the average about one year younger, with a median age of 47.9 years. Although the median ages of dentists in the two counties which comprise the Lower Narragansett Bay area are virtually the same, there is a notable age difference among dentists in the counties making up the Providence area. In Providence County the median age of dentists is 49.1 years, with only 10 percent of the dentists under age 35 and 33 percent 55 years old or over. This county, containing the city of Providence, represents the location of long-established dentists who tend to be con- centrated in the hub of large metropolitan areas. By contrast, the median age of dentists in the counties of Kent and Bristol, combined, is 42.9 years, with 20 percent of the dentists under 35 years of age and only 17 percent 55 or older. Active dentists in relation to population.--During the 1965 registration period approximately 450 dentists in Rhode Island were active in their profession. These dentists represented 97 percent of all those in the State. The remaining 3 percent include responding dentists who reported themselves fully retired and nonresponding dentists who are known to be 70 years of age or older. Based on these data, Rhode Island had one professionally active dentist for every 2,007 persons in 1965 (Table 6). Table 6.--Number of Persons Per Active Dentist Professionally 1 Persons Area and county active Populations’ per dentists dentist All counties 451 905.2 2,007 Providence area 399 749.0 1,877 Providence 334 580.5 1,738 Kent 51 127.3 2,496 Bristol 14 41.2 2,943 Lower Narragansett Bay area 52 156.2 3,004 Newport 30 91.7 3,057 Washington 22 64.5 2,932 1/ Copyright 1965, Sales Management Survey of Buying Power. Further reproduction is forbidden. 461 The number of persons per active dentist in the Providence area is about 1,880 compared to a less favorable ratio of 3,000 in the Lower Narragan- sett Bay area. Within the Providence area, Providence County has the most favorable ratio of 1,740 persons per dentist, Kent County ranks second with a ratio of 2,500 and Bristol County has 2,940 persons per dentist, the highest ratio in the 3-county area. In the Lower Narragan- sett Bay area, Washington and Newport Counties have similar persons-per- dentist ratios, 2,930 and 3,060, respectively. Professional activity.--Of the 424 responding dentists who reported that they were professionally active at the time of the survey, 97 percent were primarily engaged in private practice, with 96 percent self-employed and one percent employed by another dentist. Of the remaining dentists, 2 percent were employed by a government agency and one percent were engaged in other dental activities, such as taking advanced training. About one out of every five dentists reported that they were employed in a part-time dental activity in addition to their primary professional employment. These dentists reported a variety of secondary dental activ- ities, including employment in a government agency, teaching, and working for a voluntary agency. Almost all dentists who reported on their professional activity in Rhode Island last year indicated they had provided care for patients, devoting an average of 40.4 hours per week to this activity for 48.5 weeks during the year. Only 8 percent of the dentists worked less than 40 hours per week for less than 48 weeks. On the other hand, a substan- tial number of dentists worked exceptionally long hours. One dentist in every five spent the equivalent of a 6-day week (48 hours or more) in patient care for at least 48 weeks during the year. Practice characteristics.--Thirty-nine practicing dentists, or about 10 percent, reported that they limit their practice to a dental specialty. Almost all of the limited practitioners are concentrated in the Providence area including 33 in Providence County and 3 in Kent County. Orthodontics and oral surgery are the two most frequently reported specialty areas, accounting for about two-thirds of the dentists who limit their practices. The next most frequently reported areas of limited practice are perio- dontics and prosthodontics. About 68 percent of the dental practitioners in Rhode Island (i.e., den- tists who spend any time working at the chair) report that they employ auxiliary personnel. The dental assistant, the most frequently utilized auxiliary, is employed by about 60 percent of the dentists. Dental hygienists and secretaries are utilized with considerably less frequency, each of these auxiliaries being employed by about one-sixth of the 462 dentists. Only one practitioner in 12 employs a laboratory technician in his practice. Employment of auxiliaries varies with the age of the dentist, becoming less frequent among dentists in the older age groups. Auxiliaries are employed by one-half of the dental practitioners in the age group 55 through 64, compared to more than three-fourths of the practitioners under age 55. An even lower proportion, only one-third, of the practi- tioners 65 years old or over employ auxiliaries. August 1967. 463 Appendix Table A.--Summary Statistics for Rhode Island Non- Total Responding responding dentists dentists dentists Total dentists licensed in Rhode Island 537%/ 497% 40%/ Civilian dentists in Rhode Island>/ (designated 463 429 34 simply as "dentists" in text tables) Professionally active dentists? 451 424 27 Dental practitioners?’ - 420 - In limited practice? - 39 - Located in Rhode Island last year: Reported professional activityl - 411 - 8/ - 403 - Dentists providing patient care— Reported time spent in patient care? - 300 - Civilian dentists in another State 53 47 6 Dentists on active duty in Armed Forces 17 17 - 1/ Includes 4 dentists not reporting current location or military status. 2/ Data for nonresponding dentists were obtained from the Rhode Island Department of Health, Board of Examiners in Dentistry, and from the 1966 American Dental Directory published by the American Dental Association. 3/ All dentists who currently work in Rhode Island (excluding those in the Armed Forces) or who are retired and currently live in the State. Data are not available for the following: year of graduation - 16, age - 21. 4/ Includes all responding dentists who reported they were professionally active in Rhode Island at the time of the survey and all nonrespondents known to be under 70 years of age. 5/ All responding dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 6/ Dentists who reported they limited their practice to a dental specialty. 7/ Dentists located in Rhode Island last year who indicated type(s) of activity in which they engaged. 8/ All responding dentists who engaged in patient care last year, either as a primary or a secondary activity. 9/ Dentists reporting both hours and weeks spent in patient care last year. 464 SOUTH CAROLINA DENTISTS LICENSED IN SOUTH CAROLINA During the 1965 registration period, 963 dentists registered with the South Carolina State Board of Dental Examiners. Of these dentists, 57 per- cent were located in the State, 37 percent were located in other States, and 6 percent were on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in South Carolina Location and All Percent of military status dentists dentists Total licensed 963 100 Respondents 697 72 Nonrespondents 266 28 Total licensed 963 100 Civilians in South Carolina 551 57 Respondents 462 - Nonrespondents 89 - Civilians in another State 357 37 On active duty with Armed Forces 55 6 The survey questionnaire was completed by 697 dentists, 72 percent of the total registered. However, the response rate of dentists actually located in South Carolina is considerably higher, 84 percent. Information pro- vided by the survey respondents has been supplemented, when possible, by data on location, age, dental school attended, and year of graduation for dentists not responding to the survey. This information was obtained from records maintained by the South Carolina State Board of Dental Examiners or from the 1966 American Dental Directory, published by the American Dental Association. Multiple licensure is fairly common among dentists registered in South Carolina; 68 percent of the respondents hold a license to practice den- tistry in one or more other States. About 48 percent of the dentists located in the State have one other license, but only 8 percent have two or more other licenses. The proportion of out-of-State dentists holding multiple licenses is considerably greater; more than two-fifths have two or more licenses in addition to the one held in South Carolina. 465 DENTAL SCHOOL ATTENDED Nine in every ten of the 551 dentists located in South Carolina are grad- uates of 15 dental schools located in the South. Emory University, the largest contributor, has graduated 38 percent of the State's dentists, and the Medical College of Virginia has supplied 17 percent. The Univer- sities of Louisville and Maryland have each provided the State with 8 per- cent of its dental force, while the University of Tennessee and Meharry Medical College have trained 6 percent and 5 percent, respectively. Nine other schools in the South have supplied about 9 percent of South Carolina's dentists, including 4 percent who graduated from the University of North Carolina. The remaining dentists (9 percent) are graduates of 19 dental schools located in other parts of the Nation. Dental School Attended and Year of Graduation for Dentists in South Carolina Dental school Number Year of graduation tended of All After 1941- 1940 or ence dentists years 1955 1955 earlier Total number 5511 - 217 202 123 (Percent distribution by school) Schools in the South 503 91 94 91 86 Emory University 207 38 17 46 61 Medical College of Virginia 97 17 30 15 1 University of Louisville 43 8 11 9 - University of Maryland 42 8 8 9 6 University of Tennessee 36 6 10 5 2 Meharry Medical College 26 5 2 2 13 9 other schools 52 9 16 5 3 19 schools in other regions 48 9 6 9 14 1/ Year of graduation not available for 9 dentists. Percents are based on total for whom data are known. The proportionate contribution of dental schools in the South to the State's dentist supply has remained relatively constant through the years. However, the role of Emory University as the major supplier of dentists to South Carolina has declined substantially since 1955. Prior to that time more than one-half (52 percent) of all dentists in the State were graduates of Emory; in contrast, less than one-fifth of the State's den- tists graduating since 1955 came from this school. The contribution of the Medical College of Virginia to the State's total supply has increased from 9 percent of all dentists in South Carolina who graduated in 1955 or earlier to 30 percent of all those graduating since that time. 466 DISTRIBUTION OF DENTISTS Dentists in South Carolina are unevenly distributed geographically, with slightly more than three-fifths located in only seven of the State's 46 counties. Three of these counties--Richland, Greenville, and Charleston-- are located in metropolitan areas and have 65 or more dentists each. The remaining four counties--Spartanburg, Florence, Anderson, and York--are nonmetropolitan, but each has a central city of 10,000 or more inhabitants, and has between 20 and 45 dentists. Forty-seven percent of the 551 dentists in South Carolina are located in the four metropolitan areas of the State. The Columbia area has 96 den- tists, 18 percent of the total supply. The Greenville area,with 83 den- tists, has 15 percent; and the Charleston area,with 66 dentists, has 12 percent. The South Carolina portion of the interstate Augusta area con- tains only 2 percent of the State's dentist supply. Distribution of South Carolina Dentists, by County Group Number Number Percent County group of of of counties dentists dentists All counties 46 551 100 Metropolitan areas 7 257 47 Columbia area 2 96 18 Greenville area 2 83 15 Charleston area 2 66 12 Augusta area (S.C. part) 1 12 2 Nonmetropolitan counties 39 294 53 Central city 25,000-49,999 3 89 16 Central city 10,000-24,999 7 89 16 Central city 5,000-9,999 15 81 15 Central city under 5,000 14 35 6 The 39 nonmetropolitan counties have more than one-half of the State's total dental force. The 10 counties which have 10,000 or more persons in their central cities have 178 dentists, almost one-third of the total supply. Fifteen percent are located in the 15 counties having between 5,000 and 9,999 inhabitants in their central cities, and the remaining 6 percent are located in the 14 counties with central city populations under 5,000. 467 AGE OF DENTISTS South Carolina's dentists are relatively young as a group, with a median age of 41.5 years. Thirty-one percent of the dentists are under 35 years of age, and an almost equal proportion are between 35 and 44. Slightly more than one-fourth of the State's total dental force is between 45 and 64 years of age, while only one-tenth (54 dentists) are 65 years of age or older. Of these, 6 percent, or 34 dentists, are at least 70 years of age. Age Distribution Age in Number Percent Cumulative 1965 of of percent dentists dentists distribution Total 551 100 - Under 30 77 14 14 30 - 34 95 17 31 35 - 39 71 13 44 40 - 44 106 19 63 45 - 49 66 12 75 50 - 54 31 6 81 55 - 59 21 4 85 60 - 64 29 5 90 65 - 69 20 4 94 70 - 74 19 3 97 75 & over 15 3 100 The age distribution of dentists by area is similar throughout the State. The median age and proportion of dentists in each age group are essen- tially the same in the metropolitan areas as in the nonmetropolitan counties. 468 ACTIVE DENTISTS IN RELATION TO POPULATION With 537 of the 551 dentists in South Carolina active in their profession, the State has only one professionally active dentist for every 4,748 per- sons. In the metropolitan areas, which have 38 percent of the State's population and 47 percent of its dentists, the ratio is a high 3,887. The remainder of the State, with 53 percent of the dentists and 62 percent of the population, has an even higher ratio of 5,498 persons per dentist. Number of Persons Per Active Dentist in South Carolina Professionally Persons County group active Population per dentists dentist All counties 537 2,549,800 4,748 Metropolitan areas 250 971,800 3,887 Columbia area 93 296,500 3,188 Greenville area 82 277,600 3,385 Charleston area 63 303,000 4,810 Augusta area (S.C. part) 12 94,700 7,892 Nonmetropolitan counties 287 1,578,000 5,498 Central city 25,000-49,999 86 344,800 4,009 Central city 10,000-24,999 85 390,600 4,595 Central city 5,000-9,999 81 579,000 7,148 Central city under 5,000 35 263,600 7,531 Among metropolitan areas, the best ratios are found in the Columbia and Greenville areas, with 3,188 and 3,385, respectively. The Charleston area has 4,810 persons per dentist, and the South Carolina portion of the inter- state Augusta area has 7,892. Within the Columbia metropolitan area, Richland County, with 2,782 persons per dentist, has the most favorable ratio in the State and is the only one of the 46 counties with fewer than 3,000 persons per dentist. Of the 39 nonmetropolitan counties, only 11 have persons-per-dentist ratios under 5,000, while 24 counties have 6,000 or more persons per den- tist, including 10 counties with ratios in excess of 10,000, and one county which has no dentist according to available information. When counties are grouped according to the population of their central cities, the persons-per-dentist ratios increase considerably as the population of the central city decreases. Counties with central city populations be- tween 25,000 and 49,999 average some 4,000 persons per dentist, while counties with fewer than 5,000 persons in their central cities have an average of only one dentist for every 7,500 persons. 469 UTILIZATION OF AUXILIARIES Almost nine-tenths of South Carolina's dental practitioners (i.e., den- tists who spend any time working at the chair) reported the employment of one or more auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 83 percent of the dentists, with practically all of them employing at least one assistant on a full-time basis. Secretaries or receptionists are employed by slightly more than one-third of the dentists, three-fourths of whom employ at least one full time. Dental hygienists are employed by 13 percent of the dentists, and laboratory technicians, by 7 percent. These auxiliaries are most often employed part-time. Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of Dental With one full- With only auxiliary practitioners Total time employee part-time (or more) employees Total 451% 100 86 3 One or more auxiliaries 396 89 86 3 Assistant 370 83 80 3 Hygienist 59 13 5 8 Laboratory technician 32 7 2 5 Secretary/receptionist 152 34 25 9 Other type personnel 29 7 4 3 No auxiliary 48 11 - - 1/ Includes 7 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist, becoming less frequent among dentists in the older age groups. Ninety-four per- cent of the practitioners under 55 years of age employ some type of auxiliary. This proportion decreases to 70 percent for dentists 55 to 64 years of age, and to only 55 percent for dentists 65 and over. Approximately one-fifth of the responding practitioners reported one or more vacant positions for dental auxiliaries. Of these dentists, 45 per- cent indicated a need for full-time hygienists, and 21 percent, for full- time assistants. 470 OTHER SURVEY FINDINGS [7 About one in every six (78) dentists in South Carolina reported the completion of one year or more of advanced training after receiving their dental degree. Of 45 dentists with advanced clinical training, 13 had completed a residency, and 32, an internship. Among the 46 dentists who had completed advanced academic training, 24 had earned at least a master's degree, and another 22 had completed one or more years of study at the postgraduate level. There were 13 dentists who had completed both academic and clinical training. [7 Ninety-six percent of the responding professionally active den- tists are primarily engaged in private practice. Two percent are employed by governmental agencies, and another two percent are engaged in some other dental activity, such as taking advanced training. Only 8 percent of the dentists reported a secondary dental employment, such as service with a voluntary agency or employment by State or local government. [7 Dentists reporting on time spent in patient care during the year preceding the survey devoted an average of 40.5 hours per week to this activity for 48.0 weeks. About one dentist in eight reported working the equivalent of six days a week, 48 hours or more, for at least 48 weeks. I~ ~~ About 10 percent of the dental practitioners reported that they limit their practice to a dental specialty, primarily to ortho- dontics and oral surgery. Fourteen percent of the dentists in metropolitan areas have limited practices as compared to 6 per- cent in the remainder of the State. 3 Approximately three-fifths of the 357 dentists who are licensed in South Carolina but located in another State are in the two adjacent States--33 percent in North Carolina and 25 percent in Georgia. Ten percent of the out-of-State dentists are in Florida, and 5 percent are in Virginia. The remainder are located in over 20 other States throughout the Nation. June 1969. 471 386-029 O - 70 - 31 LY APPENDIX TABLE Selected Data on Dentists in South Carolina, By Location Civilian dentists Persons County group Resp on- Non- Age in 1965 Profes- Population— per and county Total d P respon- Under 55 yrs. sionally (in 000's) active ents . . dents 35 or more active dentist All counties 551 462 89 172 104 537 2,549.8 4,748 Metropolitan areas?’ 257 221 36 82 44 250 971.8 3,887 Charleston area 66 59 7 17 14 63 303.0 4,810 Charleston 65 59 6 17 14 62 252.6 4,074 Berkeley 1 - 1 - - 1 50.4 50,400 Columbia area 96 81 15 33 18 93 296.5 3,188 Lexington 11 10 1 6 1 11 68.4 6,218 Richland 85 71 14 27 17 82 228.1 2,782 Greenville area 83 75 8 25 10 82 277.6 3,385 Greenville 72 65 7 21 9 71 228.8 3,223 Pickens 11 10 1 4 1 11 48.8 4,436 Augusta area (S.C. part) 12 6 6 7 2 12 94.7 7,892 Aiken 12 6 6 7 2 12 94.7 7,892 Nonmetropolitan counties 294 241 53 90 60 287 1,578.0 5,498 Central city 25,000-49,999 89 69 20 29 21 86 344.8 4,009 Anderson 24 18 6 10 5 24 101.7 4,238 Spartanburg 43 33 10 10 11 42 160.8 3,829 York 22 18 4 9 5 20 82.3 4,115 €LYy APPENDIX TABLE (cont'd.) Selected Data on Dentists in South Carolina, By Location Civilian dentists Persons County group Respon- Non- Age in 1965 Profes- Population— per and county Total d respon- Under 55 yrs. sionally (in 000's) active ents . ; dents 35 or more active dentist Nonmetropolitan countiesd’ (cont'd.) Central city 10,000-24,999 89 75 14 29 16 85 390.6 4,595 Cherokee 5 4 1 1 1 4 35.3 8,825 Florence 26 25 1 14 6 26 90.9 3,496 Georgetown 9 8 1 1 - 9 35.6 3,956 Greenwood 17 12 5 4 4 15 45.5 3,033 Orangeburg 15 14 1 5 2 15 68.5 4,567 Sumter 14 10 4 4 3 13 85.5 6,577 Union 3 2 1 - - 3 29.3 9,767 Central city 5,000-9,999 81 66 15 21 18 81 579.0 7,148 Abbeville 2 1 1 - 1 2 20.9 10,450 Beaufort 4 4 - 2 - 4 53.0 13,250 Chester 4 2 2 - 3 4 30.0 7,500 Chesterfield 6 5 1 2 - 6 32.6 5,433 Colleton 4 4 - 1 1 4 27.5 6,875 Darlington 10 8 2 5 2 10 55.4 5,540 Dillon 5 4 1 2 2 5 30.4 6,080 Horry 10 8 2 3 1 10 77.7 7,770 Kershaw 8 4 4 2 3 8 34.1 4,263 Lancaster 4 3 1 - 1 4 41.9 10,475 Laurens 6 5 1 - 1 6 47.9 7,983 Marion 4 4 - - - 4 31.4 7,850 Marlboro 2 2 - 1 - 2 26.9 13,450 Newberry 5 5 - 1 - 5 28.6 5,720 Oconee 7 7 - 2 7 40.7 5,814 LY APPENDIX TABLE (cont'd.) Selected Data on Dentists in South Carolina, By Location Civilian dentists Persons County group Respon- Non- Age in 1965 Profes- Population— per and county Total respon- Under 55 yrs. sionally (in 000's) active dents . . dents 35 or more active dentist Nonmetropolitan countiess’ (cont'd.) Central city 2,500-4,999 22 20 5 4 22 169.5 7,705 Allendale 1 1 - - - 1 11.2 11,200 Bamberg 4 4 - 2 - 4 15.6 3,900 Barnwell 4 4 - - 1 4 17.7 4,425 Clarendon 3 2 1 1 1 3 28.4 9,467 Edgefield 1 - 1 - - 1 15.3 15,300 Fairfield 2 2 - 1 1 2 20.1 10,050 Lee 2 2 - 1 - 2 21.2 10,600 Williamsburg 5 5 - - 1 5 40.0 8,000 Central city under 2,500 13 11 2 6 1 13 94.1 7,238 Calhoun 1 1 - 1 - 1 11.1 11,100 Dorchester 5 4 1 2 - 5 30.2 6,040 Hamp ton 5 4 1 3 - 5 17.0 3,400 Jasper - - - - - - 13.8 - McCormick 1 1 - - - 1 8.1 8,100 Saluda 1 1 - - 1 1 13.9 13,900 1/ Copyright 1965. Sales Management Survey of Buying Power. 2/ South Carolina counties included in the latest 1968 definition of Standard Metropolitan Sta- tistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Stan- dards, have been grouped as metropolitan areas for presentation of the survey data. For the interstate Augusta SMSA, statistics are presented only for dentists located in the South Carolina portion of the area. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. SOUTH DAKOTA DENTISTS LICENSED IN SOUTH DAKOTA A total of 426 dentists registered with the South Dakota Board of Dental Examiners in 1965 (Table 1). Of this total, 362 completed the question- naire, for an overall response rate of 85 percent. About two-thirds of the responding dentists were civilians located in South Dakota at the time of the survey. Civilians located in other States accounted for 28 percent of the respondents and 4 percent were dentists on active duty in the Armed Forces. Table 1.--Location and Military Status of Dentists Licensed in South Dakota . os All Percent of Location and military status dentists dentists Total 426 100 Respondents 362 85 Nonrespondents 64 15 Respondents 362 100 Civilians in South Dakota 239 66 Civilians in another State 102 28 On active duty with Armed Forces 13 4 Not reported 8 2 Of the 102 civilian out-of-State dentists, more than one-half were located in States adjoining South Dakota. There were respondents from every adjoining State except Wyoming. The remaining 48 out-of-State respondents were located in 16 other States scattered across the Nation and in one foreign country. About one-fifth of the 102 dentists were formerly lo- cated in South Dakota, and all but a few have left the State since 1955. Of all dentists responding, nearly three-fourths hold a license in one or more additional States (Table 2). As a result, the total number of State licenses held by the 362 respondents exceeds 700. Multiple licenses are held by almost two-thirds of South Dakota's dentists, including 53 percent who are licensed in one other State and 11 percent in 2 or more other States. 475 Table 2.--Percent of Dentists Holding Licenses in Other States Civilian dentists Licenses held ros A In Out-of- armed P South Dakota State Total 100 100 100 100 South Dakota only 26 36 - 23 Licensed in 1 other State 56 53 63 62 Licensed in 2 other States 14 10 26 15 Licensed in 3 or more other States 4 1 11 - Civilian Dentists in South Dakota Sources of Supply Dental schools.--Graduates of 17 dental schools are represented among South Dakota's dentists, including one dental school, Detroit College, which is no longer in existence (Table 3). However, more than three-fifths of the dentists are graduates of four dental schools in three adjacent States--University of Minnesota (23 percent), Creighton University (18 per- cent), University of Iowa (13 percent), and University of Nebraska (7 per- cent). Three dental schools in Illinois, notably Northwestern and Loyola in Chicago, have contributed another 27 percent of South Dakota's dentists. Marquette is the only other school to have graduated 10 or more of the State's dentists. Table 3.--School Awarding Dental Degree by Year Awarded Number Year of graduation Regia gece of Al After 1941-1940 or dentists y 1955 1955 earlier Total 239%/ - 48 77 111 (Percent distribution by school) Minnesota 56 23 40 22 18 Creighton 44 18 17 24 13 Northwestern 37 16 4 16 21 Iowa 30 13 8 5 20 Loyola (Chicago) 21 9 - 12 11 Nebraska 16 7 13 9 3 Marquette 10 4 8 4 3 Other schools 25 10 10 8 11 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists respond- ing to the item (see Appendix Table A). 476 The University of Minnesota, which through the years has contributed a significant portion of dentists to the State, has since 1955 graduated 40 percent of the new dentists in South Dakota. Northwestern and Iowa together supplied over two-fifths of the State's dentists graduating prior to World War II, but only 12 percent of those graduated since 1955. Dentists relocating in South Dakota.--Less than one-fifth of all dentists currently located in South Dakota reported they had previously been located elsewhere (Table 4). Over three-fifths of these in-migrant den- tists had moved from Minnesota and three other adjacent States. The greatest in-migration took place during the years 1945-1959. Table 4.--In-migrant Dentists Number Percent Last previous location of of dentists dentists Total 239 100 Previously located elsewhere 44 18 Minnesota 12 5 Iowa 7 3 Nebraska 6 2 Other 19 8 Never located elsewhere 195 82 Personal Characteristics Age and sex.--The median age of dentists reporting their age was rela- tively high--48.6 years. Even so, almost one-third of the dentists were between 35 and 45 years of age (Table 5). Only 11 percent of the den- tists were younger. A substantial number of the State's dentists were well along in years. Over one-fourth--58 dentists--were 65 years old and over, and in this group were 34 who were 70 years old or over, including 15 who had reached 75 years of age. Only 2 of the 239 civilian dentists responding in the survey are women. Since they are so few, data will not be shown separately for them. 477 Table 5.--Age and Sex Number Percent Sex and age of of dentists dentists Total 239 100 Male 237 99 Female 2 1 Under 30 8 3 30 - 34 18 8 35 - 39 31 14 40 - 44 40 18 45 - 49 22 10 50 - 54 14 6 55 - 59 18 8 60 - 64 17 7 65 - 69 24 11 70 - 74 19 8 75 & over 15 7 Advanced training.--Eleven percent of South Dakota's dentists reported some kind of advanced training (Table 6). Only 6 percent have had advanced clinical training, whereas 8 percent have completed at least one year of advanced academic training, including 5 percent who have earned a master's degree since leaving dental school. of the 27 dentists with advanced training graduated from dental school since 1950. Table 6.--Advanced Training Over one-half Highest level of training Number percent completed dentists dentists Total 239 100 With advanced training 27 11 With no advanced training 212 89 Clinical training Residency completed 4 2 Internship completed 9 4 Academic training M.A., M.S., or other masters 13 5 Postgraduate 1 year or more (no degree) 7 3 478 Distribution and Current Status Distribution of dentists.--The largest concentration of dentists in South Dakota is in the Sioux Falls metropolitan area (Minnehaha County) and in Pennington County, the one nonmetropolitan county with a central city of 25,000-49,999 residents (Table 7). Almost one-third of the State's licensed civilian dental force is located in these two counties. Another one-fifth of the dentists are in six counties with central cities of 10,000-24,999 population. The number of dentists per county steadily declines among the county groups as the size of the county's central city decreases. Among the 44 counties in the smallest size category (counties with central cities of under 2,500 inhabitants) those with licensed civil- ian dentists have fewer than 2 dentists per county. Sixteen of these counties had no dentists reporting. However, not all of these counties were necessarily without the services of a dentist. For instance, one-half Table 7.--Distribution, by County Group Percent of dentists . Number Number County size By age of of category counties dentists Total Under &45- 65 & 45 64 over Total 67 239 100 43 31 26 Sioux Falls metropolitan area 1 39 16 52 31 17 Nonmetropolitan county groups Central city 25,000-49,999 1 32 14 67 23 10 Central city 10,000-24,999 6 51 21 38 21 42 Central city 5,000-9,999 4 27 11 30 37 33 Central city 2,500-4,999 11 32 14 42 32 26 Central city under 2,500 44 58 24 35 43 22 of the counties from which no dentists reported have relatively large Indian populations, and since dentists employed by the Federal Government in such agencies as the Division of Indian Health of the Public Health Service are not required to be licensed in the State in which they are assigned, there is every likelihood that the survey results underestimate the dental force available to the residents of these counties, and perhaps also to those of a few of the counties with reporting dentists. As the data in Table 7 reveal, there are marked differences in the age distribution of reporting dentists in the various county groups. A rela- tively large percentage of the dentists in the two county groups with medium-sized central cities (5,000-24,999 inhabitants) are 65 years old or over. By contrast, in Minnehaha and Pennington counties 52 and 67 percent, 479 respectively, of the dentists were under 45 years of age in 1965. Of the 51 counties with reporting dentists, 35 have no dentists under 35 years of age. Included in this total are 17 counties with no dentist under 45 years old and 9 with no dentist under 40. Professional status.--Of the 239 civilian dentists in South Dakota, 231 reported that they were professionally active at the time of the survey. Two dentists regarded themselves as fully retired and the remaining 6 did not report on their current status. There was one professionally active responding dentist for every 3,060 persons in South Dakota in 1965 (Table 8). The sole dentist reporting from Jackson County was not professionally active, raising to 17 the number of counties that must be assumed to be without a dentist. Among remaining counties, the number of persons per active dentist ranged from 1,670 in Davison County to 8,100 in McCook County (see Appendix Table B for individual county data). Of the 50 counties with dentists who were professionally active, 20 had dentist-population ratios as favorable as the State average. In addition to McCook County, there were 6 counties with ratios in excess of one dentist per 5,000 persons--Deuel (6,400), Marshall (6,000), Spink (5,800), Edmunds (5,400), Dewey (5,300), and Charles Mix (5,050). Table 8.--Distribution of Professionally Active Dentists . Professionally eas Persons County size . Civilian category active population per dentists dentist Total 231 706,800 3,060 Sioux Falls metropolitan area 37 99,200 2,681 Nonmetropolitan county group Central city 25,000-49,999 32 76,400 2,388 Central city 10,000-24,999 49 132,300 2,700 Central city 5,000-9,999 26 58,400 2,246 Central city 2,500-4,999 31 106,000 3,419 Central city under 2,500 56 234,500 4,188 480 Professional Activity As might be expected, self-employment predominates among dentists who are active in the profession. Of the 231 professionally active dentists licensed in South Dakota, 96 percent are primarily in private practice. The remaining few dentists are either employed by another dentist or by a governmental agency. All but one dentist reporting on their professional activity in South Dakota last year indicated that they had provided care for patients. Dentists reporting on time spent last year in providing patient care devoted an average of 47.2 weeks to this activity and worked an average of 40.4 hours per week. The figures in Table 9 show that one in every ten reporting dentists spent the equivalent of 8 hours or more per day at this activity six days per week, for 48 or more weeks per year. Table 9.--Time Spent in Patient Care Last Year eo. Dentists Percent of total Weeks of activity providing zer=79775— 70 35-30 Under 35 reported patient or more hours hours hours hours care Total reporting time spent 100 14 19 36 20 11 50 weeks or more 34 5 6 14 7 2 48 - 49 weeks 37 5 8 14 7 3 40 - 47 weeks 24 4 4 6 5 5 Less than 40 weeks 5 - 1 2 1 1 Practice Characteristics Limited practices.--Only 13 of the dentists in South Dakota reported that they limit their practices to a dental specialty. Almost one-half of these dentists reported their specialty area in orthodontics. Specializa- tion was most common in Minnehaha and Pennington Counties where over 10 per- cent of the dentists reported limited practices. Use of auxiliaries.--Four in every five dental practitioners report that they employ auxiliary personnel of some type (Table 10). Dental assistants are the most frequently employed auxiliary. Almost 75 percent of all practitioners employ assistants, including 68 percent who employ one or more full time. Twelve percent of the practitioners employ hygienists, while only five percent employ a laboratory technician. A majority of the dentists who employ hygienists or technicians do so only part time. 481 Table 10.--Dental Practitioners Employing One or More Auxiliaries, by Type of Auxiliary Dental Type of auxiliary practitioners Number Percent Total 231 100 With no auxiliary 48 21 With one or more auxiliaries 183 79 With assistant 170 74 With hygienist 28 12 With laboratory technician 12 5 With secretary or receptionist 58 25 With other type of personnel 9 4 The use of auxiliaries varies with the age of the dentist (Table 11). Well over 90 percent of the dental practitioners under age 35 and between the ages of 45 and 54 employed some type of auxiliary. Among dentists 65 years and over, the proportion using auxiliaries dropped to approxi- mately 50 percent. Peak utilization of dental assistants occurs among dentists under 45 years of age. By contrast, a larger proportion of the dentists aged 55-64 employed hygienists than in any other age group. Table 1l.--Percent of Dental Practitioners Employing Auxiliaries, by Age Percent of age group Age With With With auxiliaries assistants hygienists Under 35 96 88 15 35 - 44 88 88 13 45 - 54 92 83 11 55 - 64 76 71 18 65 & over 51 40 7 Twenty-three percent of the dental practitioners in South Dakota reported one or more vacant positions for auxiliary personnel. Approximately 47 percent of the vacancies were for hygienists, and another 21 percent were for assistants. Most dentists reporting a hygienist vacancy did not currently employ a hygienist, whereas most dentists desiring to employ an assistant were already utilizing at least one assistant. April 1966. 482 Appendix Table A.--Summary Statistics Used in Text Number of dentists Total dentists licensed in South Dakota 426 Respondents -- total dentists participating in survey 362 (number not reporting current location or military status - 8) Civilian dentists in South Dakotas! (designated simply 239 as "dentists" in text tables) (number not reporting: age - 13, principal cur- rent employment - 6, year of graduation - 3) 2 Professionally active dentistsY 231 In limited practices 13 Dental practitioners 231 Located in South Dakota last year: Reported professional activity 206 Dentists providing patient cared! 205 Reported time spent in patient caret! 172 Dentists in private practiced 205 Reported time spent in practice 169 Out-of-State dentists -- civilian respondents not located in South Dakota 102 1/ All responding dentists who currently work in South Dakota (excluding those in the Armed Forces) or who are retired and currently live in the State. 2/ All active civilian dentists currently in South Dakota--excludes 2 den- tists who are fully retired and 6 who did not report their principal current activity. 3/ Dentists who reported they limited their practice to a dental specialty. 4/ All dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 5/ Dentists located in South Dakota last year who indicated type(s) of activity in which they engaged. 6/ All dentists who engaged in patient care last year, either as a primary or secondary activity. 7/ Dentists reporting both hours and weeks spent in patient care last year. 8/ Dentists who reported they were primarily self-employed both currently and last year. 9/ Dentists reporting both hours and weeks spent last year as a self-employed dentist. 483 78% Appendix Table B.--County Data Civilian Professionally Persons Civilian Professionally Persons oun ulation active er oun ulation active er C t lati t 1 C t lat t 1 (in 000's) dentists dentist=/ (in 000's) dentists dentist=/ All counties 706.8 231 3,060 Jones 1.9 1 1,900 ingsb . 1 Aurora 4.6 1 4,600 Kingsbury 8.7 > »740 Lake 11.7 3 3,900 Beadle 23.4 7 3,343 Lawrence 17.3 8 2,163 Bon Homme 9.1 4 2,275 . . Lincoln 12.2 3 4,067 Brookings 21.1 6 3,517 McCook 8.1 1 8,100 Brown 34.7 11 3,155 McPherson 5.2 2 2,600 Brule 6.3 2 3,150 Marshall 6.0 1 6,000 Butte 8.7 3 2,900 . Meade 12.4 4 3,100 Charles Mix 10.1 2 5,050 . Miner 4.9 1 4,900 Clay 10.7 5 2,140 . . Minnehaha 99.2 37 2,681 Codington 21.4 12 1,783 Moody 8.7 2 4,350 Custer 4.6 1 4,600 4 . ’ Pennington 76.4 32 2,388 Davison 16.7 10 1,670 . Perkins 5.0 2 2,500 Day 9.8 5 1,960 Potter 5.0 2 2,500 Deuel 6.4 1 6,400 Roberts 12.5 3 4,167 Dewey 5.3 1 5,300 . Spink 11.6 2 5,800 Douglas 4.9 1 4,900 Stanley 4.9 1 4,900 Edmunds 5.4 1 5,400 Tri 8.6 2 4300 Fall River 10.8 5 2,160 PP : ’ Turner 10.7 6 1,783 Grant 9.7 3 3,233 . Union 9.8 3 3,267 Gregory 6.8 2 3,400 ’ Walworth 8.3 3 2,767 Haakon 3.3 L 3,300 Yankton 18.7 10 1,870 Hamlin 5.9 3 1,967 : > Hand 6.6 2 3,300 17 counties Hanson 4.4 1 4,400 with no Hughes 15.0 3 5,000 reporting Hutchinson 10.9 3 3,633 dentistsZ/ 59.9 - -- Hyde 2.5 1 2,500 1l/ In a few counties which have a relatively large Indian population, such as Charles Mix and Dewey Counties, the ratios presented above are slightly less favorable than if computed only for the non- Indian population. 2/ There are 16 counties with no civilian dentists reporting: Bennett, Buffalo, Campbell, Clark, Corson, Faulk, Harding, Jerauld, Lyman, Mellette, Sanborn, Shannon, Sully, Todd, Washabaugh and Ziebach. In addition, there was one county--Jackson--in which the one responding civilian dentist was reported as professionally inactive. LEI SNES DENTISTS LICENSED IN TENNESSEE During the 1965 registration period, 2,103 dentists registered with the Tennessee Board of Dental Examiners (Table 1). Sixty-nine percent of the registered dentists were civilians located in Tennessee, another 29 percent were civilians located in other states, and only 2 percent were on active duty in the armed forces. Table 1.--Location and Military Status Location and All percent military status dentists dentists Total licensed 2,103 100 Respondents 1,886 90 Nonrespondents 217 10 Total licensed 2,103 100 Civilians in Tennessee 1,455 69 Respondents 1,355 - Nonrespondents 100 - Civilians in another state 600 29 On active duty with armed forces 43 2 Not reported 5 * * Less than one-half of one percent. The survey questionnaire was completed by 1,886 dentists, 90 percent of all those registered. The response rate of the 1,455 civilian dentists actually located in Tennessee was even higher, 93 percent, with 1,355 of these dentists replying. Certain items of information--state and county location, age, dental school attended, and year of graduation-- were obtained on nonrespondents either from records maintained by the Tennessee Board of Dental Examiners or from the 1966 American Dental Directory published by the American Dental Association. Tables in this report include information on both respondents and nonrespondents unless otherwise indicated. Of all dentists responding to the survey, over half (56 percent) hold a license solely in Tennessee, 35 percent are licensed in one other state, and 9 percent hold licenses in two or more additional states. Multiple licensure is not as common among civilian respondents located in Tennessee as among those located in other states. Three-fourths of the civilian in-state dentists are licensed just in Tennessee, 20 percent are licensed in one other state, and only one in every 20 hold licenses in two or more other states. By comparison, almost one in every four 485 of the out-of-state civilian respondents holds two or more licenses in addition to the one held in Tennessee. Civilian Dentists in Tennessee Sources of Supply Dental schools.--More than 85 percent of Tennessee's dentists graduated from dental schools located in Tennessee, including those schools at the University of Tennessee and Meharry Medical College and those formerly in existence at Vanderbilt University and the University of West Tennes- see (Table 2). Over three-fourths of the State's dentists received their dental degrees from the University of Tennessee. This one school has consistently graduated the largest number of dentists in Tennessee, with the proportion increasing from 56 percent of the dentists who grad- uated prior to World War II to 90 percent of those who graduated within the last 10 years. The relative contribution of Meharry Medical College has declined from 6 percent of the total supply before 1940 to only 2 percent since 1955. Vanderbilt University graduated 6 percent of the dentists in the state, even though its dental school closed in 1926. Table 2.--School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation oO renged ? of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 1,455 - 372 625 408 (Percent distribution by school) South 1,382 95 96 9% 95 Tennessee 1,101 76 91 80 56 Vanderbilt (extinct) 85 6 - - 20 Meharry 57 4 2 3 6 Emory 56 4 * 4 7 Louisville 51 3 1 5 3 7 other schools 32 2 2 2 3 Other regions 69 5 4 6 5 (20 schools) 1l/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire, or, in the case of non- respondents, due to the data not being obtainable for all dentists. For each item where percentages are shown, they are based on the number of dentists for whom the data are known. (See Appendix Table A.) * Less than one-half of one percent. 486 Eight other dental schools in the South have trained an additional 9 percent of Tennessee's dentists. Principal contributors among these schools have been Emory University and the University of Louisville. However, the contribution of these 8 dental schools has declined from 12 percent of the graduates prior to 1941 to about 3 percent of those who completed their dental education during the last 10 years. The remaining 5 percent of the dentists in Tennessee received their dental degrees from 20 schools in other regions of the Nation with only one school, Northwestern University, supplying as much as 1 percent of the State's dentists. Dentists relocating in Tennessee.--Seven percent of the respondents practiced as civilian dentists in one of 26 other states or the District of Columbia immediately prior to assuming their present Tennessee location. Almost three-fourths of the 92 in-migrant den- tists came from another Southern state including 1 in every 4 who moved to Tennessee from Virginia or Alabama, and 1 in every 7 who came from Arkansas or Texas. Personal Characteristics Age .--The median age in 1965 of dentists licensed in Tennessee was 42.9 years. Half of the State's dentists are between 35 and 54, including one in every three who is in the 35 to 44 age group (Table 3). Den- tists 55 years of age or older slightly outnumber those under 35. Almost one in every eight, or 169 dentists, is 65 years old or over, and 89 have reached the age of 70. Table 3.--Age Distribution Number Percent Age in 1965 of of dentists dentists Total 1,455 100 Under 35 348 24 35 - 44 478 33 45 - 54 252 17 55 - 64 196 14 65 & over 169 12 A relatively large proportion of survey nonrespondents are in the older age groups. Fully one-fourth of the nonresponding dentists are 65 years of age or older, but only 10 percent of the respondents are in this age group. Moreover, the median age of dentists not responding to the survey is 46.4 years, almost 4 years higher than that for respondents. 487 386-029 O - 70 - 32 Advanced training.--Eighteen percent of the survey respondents, or 240 dentists, reported they had completed one year or more of advanced training (Table 4). The number of dentists who completed clinical training almost equals the number who completed graduate or postgraduate academic work. In advanced clinical training, 51 dentists completed a residency and 90 an internship. Among the dentists who reported advanced academic training, 10 had earned a second doctorate, 64 a master's degree, and another 79 received no additional degrees but had completed one or more years of postgraduate study. These figures include 54 dentists who completed both clinical and academic training. Table 4 .,--Advanced Trainings! Number Percent Type of advanced training of of dentists dentists Total 1,355 100 With advanced training 240 18 Clinical training only 87 7 Academic training only 99 7 Both clinical and academic training 54 4 With no advanced training 1,115 82 1/ Includes survey respondents only. Additional education beyond receipt of the dental degree is more common among dentists in the younger age groups. Twenty-two percent of the den- tists under 40 years of age have had a year or more of advanced training, compared with 17 percent of those 40 to 54 years old and 12 percent of those 55 and over. The growing tendency for young dentists to seek addi- tional training is most pronounced in the academic areas. Distribution and Current Status Distribution of dentists.--Dentists in Tennessee are unevenly distrib- uted geographically, with slightly more than 70 percent located in only 10 of the State's 95 counties. Six of these 10 counties, each of which has 20 or more dentists, are located in metropolitan areas. The remain- ing four are nonmetropolitan counties, i.e., they have central cities of less than 50,000 population, and they are not part of a multi-county grouping with a central city of 50,000 or more. Appendix Table B lists individual counties by size of central city and presents selected data for the dentists in each county. More than three-fifths of the dentists in Tennessee are located in the four metropolitan areas of the State (Table 5). The greatest concentra- tion of dentists, almost 400, is in Shelby County which constitutes the 488 Tennessee portion of the Memphis interstate metropolitan area. The metro- politan areas of Nashville and Knoxville, which contain three counties each, have the second and third largest dental forces. The Tennessee por- tion of the Chattanooga interstate metropolitan area, Hamilton County, has the fourth largest dentist supply in the State. Table 5.--Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 95 1,455 100 All metropolitan areas 8 920 63 Memphis area 1 391 27 Nashville area 3 230 16 Knoxville area 3 183 12 Chattanooga area 1 116 8 Nonmetropolitan counties 87 535 37 Central city 10,000-49,999 14 253 18 Central city 5,000-9,999 17 131 9 Central city 2,500-4,999 21 90 6 Central city under 2,500 35 61 4 Some of the nonmetropolitan counties have fairly large numbers of den- tists. For example, of the 14 counties containing a central city of 10,000 or more people, Sullivan County has 57 dentists and 3 other coun- ties--Madison, Washington and Montgomery--each have more than 20 dentists. By contrast, only 4 of the 73 counties without a city of this size have as many as 10 dentists. All 4 of these counties are in the group of 17 counties with central cities of 5,000-9,999 inhabitants. The 21 counties with central cities of 2,500-4,999 population include 14 with fewer than 5 dentists. None of the 35 counties with less than 2,500 persons in their central cities have as many as 5 dentists, and 4 of these counties--Clay, Meigs, Pickett, and Van Buren--have no dentists according to available information. The age distribution of dentists is similar throughout the State. The median age and the proportion of dentists in each age group is almost identical in the metropolitan and nonmetropolitan areas. Active dentists in relation to population.--During the 1965 registration period about 1,400 dentists in Tennessee were active in their profession. These dentists represented 96 percent of all those in the State. The remaining 4 percent included 26 responding dentists who were retired, 12 engaged principally in a nondental activity, and 13 nonresponding den- tists who are known to be 70 years of age or older. Based on these counts, Tennessee had one professionally active dentist for every 2,663 ersons in 1965 (Table 6). persons in (Table 6) 489 Table 6.--Number of Persons Per Dentist Professionally Persons County group active Population per dentists dentist All counties 1,404 3,738,800 2,663 All metropolitan areas 889 1,855,800 2,088 Memphis area 376 708,100 1,883 Nashville area 223 501,600 2,249 Knoxville area 179 389,000 2,173 Chattanooga area 111 257,100 2,316 Nonmetropolitan counties 515 1,883,000 3,656 Central city 10,000-49,999 247 705,900 2,858 Central city 5,000-9,999 124 447,700 3,610 Central city 2,500-4,999 85 398,500 4,688 Central city under 2,500 59 330,900 5,608 The four metropolitan areas have proportionately more of the State's den- tists than of its population--63 percent of the State's active dentists as compared with only 50 percent of the population. As a result of this dis- proportionate distribution of dentists in relation to population, there is one dentist for every 2,088 persons in the metropolitan areas, while the remainder of the State has a less favorable ratio of one dentist for every 3,656 persons. Each of the four metropolitan areas also has a more favor- able persons-per-dentist ratio than any of the nonmetropolitan county groups. The Memphis metropolitan area has the best persons-per-dentist ratio in the State, 1,883. The persons-per-dentist ratios in the other three metropolitan areas are slightly less favorable--2,173 in the Knox- ville area, 2,249 in the Nashville area, and 2,316 in the Chattanooga area. In both of the three-county metropolitan areas, there is a considerably better persons-per-dentist ratio in the county with the largest population than in the other two counties. In the Knoxville area, Knox County has a ratio of 1,906, while the ratio for Blount County is 2,790 and for Anderson County, 3,442. In the Nashville area the contrast is also quite sharp with Davidson County, containing Nashville, having a ratio of 2,126 compared with 3,538 in Wilson County and 3,750 in Sumner County. (See Appendix Table B for individual county data.) Among the nonmetropolitan counties of the State, the group of counties with central cities of 10,000-49,999 population have an average of 2,858 persons per dentist. Of the 14 counties in this group, 5 have ratios better than the State average--Sullivan (2,239), Madison (2,304), Washington (2,515), Dyer (2,527), and Green (2,624). Six of the remaining 9 counties have relatively favorable ratios of fewer than 3,500 persons per dentist. 490 On the average, there are 4,392 persons per dentist in the three groups of nonmetropolitan counties with central cities under 10,000 population. In general, the ratio of persons per dentist becomes less favorable as the size of the central city declines. The average ratio increases from 3,610 persons per dentist in the group of counties with central cities between 5,000-9,999 population to 4,688 among the counties with 2,500-4,999 per- sons in their central cities and to 5,608 persons per dentist among the counties with fewer than 2,500 persons in their central cities. Only 5 of the 73 counties with central cities under 10,000 population have ratios better than the State average, while many of these counties have consider- ably less favorable ratios. For example, 5 of the 17 counties with 5,000- 9,999 persons in their central cities have ratios exceeding 5,000 persons per dentist. Ten of the 21 counties with central cities between 2,500- 4,999 persons also have ratios over 5,000, including 3 counties with ratios over 7,500--Monroe (7,567), Hawkins (7,625), and Chester (8,900). Among the 35 counties with central cities of less than 2,500 persons, which account for over one-third of all counties in the State, 21 have ratios in excess of 5,000 persons per dentist, including the 4 counties which are assumed to have no dentist. Seven of these counties have more than 7,500 persons per dentist--Decatur (7,800), Cannon (8,100), Lake (8,500), Grundy (10,900), Wayne (11,000), Fayette (11,650), and Morgan (13,700). Professional Activity Current employment.--Of the 1,317 responding dentists who reported that they were professionally active at the time of the survey, 92 percent were primarily engaged in private practice with 91 percent self-employed and one percent employed by another dentist (Table 7). About four per- cent are on the staffs of dental schools at the University of Tennessee and Meharry Medical College and the remaining four percent are either employed by Federal, State or local government agencies or engaged in other dental employment. Table 7.--Current Employment of Professionally Active Dentistst/ Principal Secondary employment emp loyment2/ Type of employment Number Percent Number Percent employed employed of total Total 1,317 100 161 12 Self-employed 1,203 91 20 2 Employed by other dentist 17 1 3 * On staff of dental school 48 4 54 4 Employed by State or local government 23 2 52 4 Employed by Federal Government 7 1 - - Voluntary agency - - 12 1 Other dental employment 19 1 29 2 1/ Includes survey respondents only. 2/ Individual items add to more than total because some dentists reported more than one type of secondary employment. %* Less than one-half of one percent. 491 About 160 dentists reported at least one part-time dental activity in addition to their principal employment. Fifty-two of these dentists said they were employed by the State or local governments on a part- time basis providing dental services in hospitals and local health clinics. The number of dentists so employed is more than twice the number reporting their principal employment as working for these governmental agencies. Part-time faculty appointments at the two den- tal schools were reported by 54 dentists, which slightly exceeds the number of dentists reporting dental school appointments as their principal employment. Other types of secondary dental activity reported by the dentists include self-employment and employment by voluntary agencies. Activity last year.--Of all dentists reporting their professional activity in Tennessee last year, 95 percent said they provided care to patients. These dentists spent 92 percent of the total reported professional time in providing patient care. Eight percent of the dentists reported they spent some time in teaching and 2 percent reported some time in research, but only 5 percent of total profes- sional time was spent in these activities. While 6 percent of the dentists spent time in some other dental activity, such as taking additional training, only 3 percent of the total professional time was spent in these activities. Of the dentists who provided patient care, 85 percent reported having spent 48 weeks or more at this activity in the previous year. Den- tists who worked all year (48-52 weeks) spent longer hours providing patient care than did those who worked only part of the year. Almost 8 of every 10 dentists spending 48 weeks or more in patient care worked 40 or more hours per week, while only 6 of every 10 working less than 48 weeks spent as many hours each week providing care. Practice Characteristics Limited practices.--Among dentists reporting type of practice, 135, or slightly more than ome in every 10, limit their practices to a dental specialty. Almost two-thirds of these dentists reported limiting their practices to one of two specialty areas--38 percent in orthodontics and 27 percent in oral surgery. The metropolitan areas have a disproportionate share of the dentists with limited practices. Over four-fifths of the dentists who reported limiting their practices are located in the State's metro- politan areas. One in every 7 dentists practicing in a metropolitan area limits his practice, whereas in counties which are not part of metropolitan areas, only one in every 20 dentists does so. The Memphis area alone has over one-third of the State's dentists with limited practices, and almost twice as many as all 87 nonmetropolitan counties combined. 492 Use of auxiliaries.--About 86 percent of the dental practitioners in Ten- nessee (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 8). The vast majority, 80 per- cent, of the practitioners employ at least one auxiliary full time, while only 6 percent employ part-time auxiliaries exclusively. Dental Assist- ants are the most frequently employed auxiliary--usually on a full-time basis. Approximately 79 percent of the practitioners employ an assistant, including 72 percent who do so full time. Secretaries or receptionists are employed by 30 percent of the dentists, and a majority of these den- tists employ at least one of them full time. Dental hygienists and labor- atory technicians are much less frequently utilized by dentists in Tennes- see than are assistants and secretaries, and they are more likely to be employed on a part-time basis. While 16 percent of all dentists employ dental hygienists and 6 percent employ dental technicians, over one-half and four-fifths, respectively, of the dentists employing these personnel do so on a part-time basis. Table 8.--Dental Practitioners Employing Auxiliaries, by Type of Auxiliaryl/ Percent of dental practitioners Type of auxilia Dental With one full- With only ty practitioners Total time employee part-time (or more) personnel Total 1,276 100 80 6 With one or more auxiliaries 1,079 86 80 6 With assistant 996 79 72 7 With hygienist 203 16 7 9 With laboratory technician 76 6 1 5 With secretary or receptionist 376 30 20 10 With other type personnel 72 6 2 4 With no auxiliary 181 14 - - 1/ Includes survey respondents only. The use of auxiliaries varies with the age of the dentist and is more frequent among the young dentists. Ninety-one percent of the dental practitioners between the ages of 30 and 44 employ some type of auxil- iary. However, the proportion of practitioners utilizing auxiliaries decreases to 84 percent among dentists 45 to 64 years old and drops to 62 percent among dentists 65 and over. 493 Although dentists in the metropolitan areas are no more likely to employ auxiliary personnel than are those located in the nonmetropolitan areas, the use of hygienists is considerably more common in the metropolitan areas than in the remainder of the State. About 20 percent of the den=- tists in the metropolitan areas report the employment of a hygienist, compared with only 9 percent of the dentists located elsewhere. About 16 percent of the responding dentists in Tennessee reported one or more vacant positions for auxiliary personnel. Vacancies were reported most frequently for dental hygienists and dental assistants. Out-of-State Civilian Dentists At the time of the survey, Tennessee licenses were maintained by 483 civil- ian respondents located in 38 States and the District of Columbia. Over three-fourths of these out-of-State dentists are located in Southern States and almost two out of every five are in Florida, Arkansas, or Mississippi. Georgia, North Carolina, Alabama, and Texas are the only other States in which at least five percent of these dentists are currently located. Three in every four of the out-of-State dentists are graduates of the dental school at the University of Tennessee. Almost one in every five out-of-State respondents reported they had been professionally active in Tennessee immediately prior to assuming their present location in another State. Sixty of the 85 reporting out-migrant dentists moved to another Southern State, most frequently Florida, Georgia, or North Carolina, and the remaining 25 dentists moved to 15 other States scattered across the Nation. June 1967. 494 Appendix Table A.--Summary Statistics for Tennessee Total Responding Nonresponding dentists dentists dentists Total dentists licensed in Tennessee 2,103 1,886 2172/ Civilian dentists in Tennessee>’ (designated simply as 'dentists' in text tables) 1,455 1,355 100 Professionally active dentists 1,404 1,317 87 Dental practitioners’ - 1,276 - In limited practice - 135 - Located in Tennessee last year: Reported professional activity - 1,273 - Dentists providing patient care! - 1,205 - Reported time spent in patient care? - 933 - Civilian dentists in another State 600 483 117 Dentists on active duty in Armed Forces 43 43 - 1/ Includes 5 dentists not reporting current location or military status. 2/ Data for nonresponding dentists were obtained from the Tennessee Board of Dental Examiners, and from the 1966 American Dental Directory published by the American Dental Association. 3/ All dentists who currently work in Tennessee (excluding those in the Armed Forces) or who are retired and currently live in the State. Data are not avail- able for the following: year of graduation - 50, age - 12, dental school attended - 4. 4/ Includes all responding dentists who reported they were professionally active in Tennessee at the time of the survey and all nonrespondents known to be under 70 years of age. 5/ All responding dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 6/ Dentists who reported they limited their practice to a dental specialty. 7/ Dentists located in Tennessee last year who indicated type(s) of activity in which they engaged. 8/ All responding dentists who engaged in patient care last year, either as a primary or a secondary activity. 9/ Dentists reporting both hours and weeks spent in patient care last year. 495 96% Appendix Table B.--Selected Data on Dentists in Tennessee, by Location Civilian dentists / Persons County group Respond - Non- Age in 1965 Profes- Populatiom= per and county Total P respond- Under 55 years sionally (in 000's) active ents ents 35 or more active dentist All counties 1,455 1,355 100 348 365 1,404 3,738.8 2,663 Metropolitan areas? 920 859 61 222 232 889 1,855.8 2,088 Memphis area 391 374 17 93 96 376 708.1 1,883 Shelby 391 374 17 93 96 376 708. 1,883 Nashville area 230 205 25 55 61 223 501.6 2,249 Davidson 212 189 23 EY 59 205 435, 2,126 Sumner 10 9 5 1 10 37.5 3,750 Wilson 8 7 1 3 1 8 28.3 3,538 Knoxville area 183 174 9 46 44 179 389.0 2,173 Knox 142 134 8 36 37 139 265. 1,906 Blount 21 20 1 4 5 21 58.6 2,790 Anderson 20 20 - 6 2 19 65.4 3,442 Chattanooga area 116 106 10 28 31 111 257.1 2,316 Hamilton 116 106 10 28 31 111 257.1 2,316 Nonme tropolitan counties>’ 535 496 39 126 133 515 1,883.0 3,656 Central city 25,000-49,999 112 105 7 27 21 111 257.8 2,323 Madison 28 27 1 7 6 28 64.5 2,304 Sullivan 57 54 3 16 7 56 125.4 2,239 Washington 27 24 3 4 8 27 67.9 2,515 Central city 10,000-24,999 141 131 10 35 35 136 448.1 3,295 Bedford 7 7 - 1 3 7 23.8 3,400 Bradley 11 11 - 2 3 11 43.9 3,991 Carter 10 9 1 3 5 7 41.1 5,871 Coffee 12 11 1 3 2 11 31.3 2,845 L6Y Appendix Table B.--Selected Data on Dentists in Tennessee, by Location - (continued) Civilian dentists 1 Persons County group Respond- Non- Age in 1965 Profes- Population’ per and county Total ents respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist Central city 10,000-24,999 (continued) Dyer 11 10 1 2 4 11 27.8 2,527 Greene 17 16 1 5 7 17 44.6 2,624 Hamblen 12 11 1 3 1 12 41.1 3,425 McMinn 8 7 1 1 3 7 34.5 4,929 Maury 13 12 1 3 1 13 41.8 3,215 Montgomery 22 20 2 6 4 22 61.2 2,782 Rutherford 18 17 1 6 2 18 57.0 3,167 Central city 5,000-9,999 131 117 14 26 47 124 447.7 3,610 Campbell 5 5 - 1 2 5 24.8 4,960 Cocke 4 4 - 1 2 4 23.5 5,875 Dickson 5 5 - 1 1 5 18.8 3,760 Gibson 14 13 1 3 4 14 43.1 3,079 Giles 6 5 1 1 2 6 20.5 3,417 Haywood 4 4 - - 1 4 22.2 5,550 Henry 12 9 3 3 6 11 22.0 2,000 Lawrence 7 6 1 1 2 7 27.9 3,986 Lincoln 7 6 1 - 3 6 23.1 3,850 Marshall 3 3 - - 1 3 16.4 5,467 Obion 8 8 - 3 3 8 25.9 3,238 Putnam 11 10 1 2 5 9 30.9 3,433 Roane 19 16 3 5 6 18 42.6 2,367 Robertson 8 7 1 1 3 7 27.3 3,900 Tipton 5 5 - 1 1 5 27.9 5,580 Warren 8 8 - 2 3 8 25.1 3,138 Williamson 5 3 2 1 2 4 25.7 6,425 86% Appendix Table B.--Selected Data on Dentists in Tennessee, by Location - (continued) Civilian dentists 1 Persons County group Respond- Non- Age in 1965 Profes- Population=/ per and county Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Central city 2,500-4,999 90 86 4 22 15 85 398.5 4,688 Benton 4 4 - 1 1 3 10.2 3,400 Carroll 5 4 1 - 5 21.9 4,380 Chester 1 1 - - - 1 8.9 8,900 Cumberland 3 3 - - - 3 19.2 6,400 Franklin 6 6 - 1 1 6 25.6 4,267 Hardeman 4 4 - 1 2 4 20.6 5,150 Hardin 3 3 - 1 - 3 17.5 5,833 Hawkins 4 4 - 1 1 4 30.5 7,625 Henderson 5 5 - 2 1 4 15.5 3,875 Humphreys 3 3 - - 1 3 11.8 3,933 Jefferson 7 7 - 2 - 7 22.4 3,200 Lauderdale 4 4 - 2 - 4 20.3 5,075 Louden 7 7 - 1 1 7 24.0 3,429 Marion 3 3 - 1 - 3 21.3 7,100 Monroe 3 2 1 - 1 3 22.7 7,567 Overton 3 3 - - 1 2 13.4 6,700 Rhea 4 3 1 - - 4 15.7 3,925 Sevier 6 6 - 3 - 6 24.6 4,100 Unicoi 3 2 1 - 1 2 14.6 7,300 Weakley 8 8 - 2 3 7 22.6 3,229 White 4 4 - 2 1 4 15.2 3,800 Central city - Under 2,500 61 57 4 16 15 59 330.9 5,608 Bledsoe 1 1 - - 1 1 7.4 7,400 Cannon 1 1 - 1 - 1 8.1 8,100 Cheatham 2 2 - - - 2 9.5 4,750 Claiborne 4 4 - 1 2 4 16.7 4,175 Appendix Table B.--Selected Data on Dentists in Tennessee, by Location - (continued) Civilian dentists 1 Persons County group Respond- Non- Age in 1965 Profes- Population’ per and county Total respond- Under 55 years sionally (in 000's) active ents i . ents 35 or more active dentist Central city - under 2,500 (continued) Clay - - - - - - 6.7 - Crockett 3 3 - 1 1 3 13.6 4,533 Decatur 1 1 - - 1 1 7.8 7,800 DeKalb 4 3 1 1 1 4 10.4 2,600 Fayette 2 1 1 - 1 2 23.3 11,650 Fentress 2 2 - 1 - 2 12.6 6,300 Grainger 2 2 - - - 2 12.1 6,050 Grundy 1 1 - - - 1 10.9 10,900 Hancock 1 1 - - 1 1 7.1 7,100 Hickman 2 2 - - 1 2 11.2 5,600 Houston 1 1 - - - 1 4.6 4,600 Jackson 2 2 - 2 - 2 7.8 3,900 Johnson 3 3 - - - 3 10.0 3,333 Lake 2 2 - 1 1 1 8.5 8,500 Lewis 2 2 - - - 2 6.3 3,150 McNairy 4 3 1 1 3 16.9 5,633 Macon 2 2 - - 1 2 11.5 5,750 Meigs - - - - - - 4.7 - Moore 1 1 - 1 - 1 3.3 3,300 Morgan 1 1 - - - 1 13.7 13,700 Perry 1 1 - - - 1 4.7 4,700 Pickett - - - - - - 4.0 - Polk 2 2 - 1 1 2 11.2 5,600 Scott 2 2 - 1 - 2 14.5 7,250 Sequatchie 3 3 - 1 - 3 6.0 2,000 66% 00s Appendix Table B.--Selected Data on Dentists in Tennessee, by Location - (continued) Civilian dentists 1 Persons County group Respond- Non- Age in 1965 Profes- Population’ per and county Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Central city - under 2,500 (continued) Smith 2 2 - - 2 11.1 5,550 Stewart 2 2 - - 1 2 7.2 3,600 Trousdale 2 1 - 1 2 4.6 2,300 Union 2 2 - - - 2 8.4 4,200 Van Buren - - - - - - 3.5 - Wayne 1 1 - 1 - 1 11.0 11,000 1l/ Copyright 1965. Sales Management Survey of Buying Power; further reproduction is forbidden. Tennessee counties included in the latest 1966 definition of Standard Metropolitan Statistical areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of the survey data. For interstate SMSA's, statistics are presented only for dentists located in the Tennessee portion of the Memphis SMSA and Chattanooga SMSA. Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. LID, DENTISTS LICENSED IN TEXAS A total of 4,180 dentists registered with the Texas State Board of Dental Examiners during the 1965 registration period (Table 1). About 86 percent of the registered dentists were civilians located in Texas at the time of the survey. Civilians located in other states or abroad accounted for only 5 percent of all dentists, and 7 percent were on active duty in the armed forces. Information on location or military status was not available for the remaining 2 percent of the dentists licensed in Texas at the time of the survey. Table l.~--Location and Military Status Location and All Percent of military status dentists dentists Total licensed 4,180 100 Respondents 2,923 70 Nonrespondents 1,257 30 Total licensed 4,180 100 Civilians in Texas 3,610 86 Respondents 2,518 - Nonrespondents 1,092 - Civilians in another state 227 5 On active duty with armed forces 279 7 Not reported 64 2 The survey questionnaire was completed by 2,923 dentists, or 70 percent of all those registered. The response rate of the 3,610 civilian dentists located in Texas was the same, with 2,518 of these dentists completing the questionnaire. For dentists not responding to the survey, certain items of information--state and county location, military status, dental school attended, year dental degree granted, age and professional status--were obtained from records maintained by the Texas State Board of Dental Examiners, or from the 1965 American Dental Directory, published by the American Dental Association, Relatively few dentists registered in Texas also maintain licenses in other states, In total, the number of licenses held by the 2,923 respondents is approximately 3,700. An estimate of the total number held by all dentists registered in Texas, assuming a similar occurrence of multiple licensure among nonrespondents, would be about 5,300, Of all dentists responding, 501 nearly four fifths (79 percent) are licensed only in Texas (Table 2). For dentists actually located in Texas, the percentage licensed only in Texas is a high 84 percent. More than three fourths of the dentists on active duty in the Armed Forces hold licenses only in Texas. Among the out-of-state dentists, 71 percent maintain licenses only in Texas in addition to their state of location. Table 2.--Percent of Dentists Holding Licenses in Other States All Civilian dentists Licenses held In OQut-of- Armed respondents Forces Texas state Total 100 100 100 100 Texas only 79 84 - 77 Licensed in 1 other state 16 13 71 18 Licensed in 2 other states 4 2 24 Licensed in 3 or more other states 1 1 5 Civilian Dentists in Texas Sources of Supply Dental schools.--Graduates of 50 dental schools are represented among Texas dentists, including graduates of one Canadian school and of six dental schools which are no longer in existence. However, the great majority of Texas dentists, respondents and nonrespondents alike, are graduates of the dental schools at Baylor University and the University of Texas. These two Texas schools have contributed 79 percent of the state's total dentist supply (Table 3). About 89 percent of those graduating within the past 10 years are from these two schools, as com- pared with 64 percent of those who were graduated prior to World War II. Practically all of the increase, though, has taken place among graduates of the University of Texas, which has supplied 51 percent of the state's dentists graduating since 1955. In contrast, the proportion of Univer- sity of Texas graduates among those who completed dental school prior to World War II is 27 percent. 502 Table 3.--School Awarding Dental Degree, by Year Avardedt/ Dental school Number Year of graduation S rended of All After 1941- 1940 or attende dentists years 1955 1955 earlier Total number 3,6102/ - 1,107 1,414 967 (Percent distribution by school) Baylor 1,423 40 38 43 37 Texas 1,384 39 51 38 27 Missouri at Kansas City 78 2 2 2 3 Meharry 63 2 * 2 4 Loyola (New Orleans) 56 2 1 1 2 St. Louis University 52 1 1 2 2 44 other schools 489 14 7 12 25 1/ Includes data obtainable for nonresponding dentists. 2/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire, or, in the case of nonrespondents, due to the data not being obtainable for all dentists. For each item where percentages are shown, they are based on the number of dentists for whom the data are known. (See Appendix Table A) * Less than one-half of one percent. The two dental schools in Texas and 15 other schools in the South have together contributed 88 percent of the state's dentist supply. Eighteen schools in the North Central States account for 1C percent of all den- tists. However, the proportion of the state's dentists graduating from these schools has declined substantially in recent years, from a high of 15 percent of the graduates prior to 1941 to a low of 6 percent among those who completed their dental education during the last 10 years. Fourteen dental schools in the Western and Northeastern States combined account for only 2 percent of the state's dentist supply. Dentists relocating in Texas.--Texas has relatively few active dentists migrating into the state. Only 4 percent of the responding dentists currently located in Texas report previous professional locations as civilians in other states. About one dentist in every four who has moved to Texas came from one of the four adjacent states. The remainder came from 21 other states or abroad. Approximately one-half of the den- tists reporting migration into Texas relocated prior to 1950, and about 30 percent moved to the state during the 1960's. 503 386-029 O - 70 - 33 Personal Characteristics Age.--Texas dentists, on the average, are relatively young, with a median age in 1965 of 43.0 years. The distribution of dentists by age groups indicates that one fourth were under the age of 35, a third were between the ages of 35 and 44, and a fifth were aged 45 to 54 years (Table 4). Even though only 9 percent of the dentists were 65 years old or over, this group represented a substantial number, 319 dentists, including 107 who were 70 to 74 years old and 65 who had reached 75 years of age. Table 4.--Age Distribution’ Number Percent Age in 1965 of of dentists dentists Total 3,610 100 Under 30 226 7 30 - 34 596 18 35 - 39 525 15 40 - 44 615 18 45 - 49 423 12 50 - 54 252 7 55 ~ 59 241 7 60 - 64 228 7 65 ~ 69 147 4 70 = 74 107 3 75 and over 65 2 1/ Includes data obtainable for nonresponding dentists. The age distribution of dentists responding to the survey was similar to that of all dentists, The median age of respondents was only slightly lower--42,0 years as compared to 43.0 for all dentists. This difference is probably due to the likelihood that nonresponse was more frequent among the older, less active dentists. Advanced training.--Of the survey respondents, 424 dentists, or 17 percent, reported completion of a year or more of advanced training (Table 5). Nine percent have taken advanced clinical training as compared with 11 percent who have completed at least one year of advanced academic training, including 5 percent who have earned a master's degree since leaving dental school. There are 15 dentists who reported they have earned a second doctorate, 504 Table 5.,--Advanced Training Number Percent Highest level of training completed of of dentists dentists Total 2,518 100 With advanced training 424 17 Clinical training only 143 6 Academic training only 197 8 Both clinical and academic 84 3 Clinical training Residency completed 78 3 Internship completed 149 6 Academic training Ph.D., M.D., or other doctor's degree 15 1 M.A., M.S., or other master's degree 124 5 Postgraduate 1 year or more (no degrec) 142 5 The growing tendency for dentists to seek training beyond receipt of their dental degree is especially apparent with regard to academic training. Thirteen percent of the dentists under 40 reported completion of a year or more of graduate or postgraduate study, compared with 11 percent of the dentists between 40 and 54, and only 5 percent of those 55 and over. Residencies show the same pattern by age. The trend does not hold true with respect to internships, but chiefly because many dentists in the younger age groups are still in the process of training. Distribution and Current Status Distribution of dentists.--The dentists in Texas are concentrated in the more densely populated areas of the state, More than three of every four civilian dentists are located in only 35 of the state's 254 counties. These 35 counties make up the 21 metropolitan areas in Texas. However, even among the metropolitan areas, the number of dentists varies considerably--from well over 700 dentists in the Houston area to fewer than 10 dentists in the Laredo area (Table 6). The four largest metropolitan areas--the Houston, Dallas, Fort Worth and San Antonio areas--have more than one-half of the state's total dentist supply. The Houston area alone has more than one-fifth of the dentists. The Dallas area contains 16 percent of the dentists, while the Fort Worth and San Antonio areas each contains 7 percent. While another 505 27 percent of the dentists in Texas are scattered among the remaining 17 metropolitan areas in the state, relatively large numbers of dentists are located in the Beaumont-Port Arthur, Austin, Corpus Christi and El Paso areas as compared with the other 13 areas. Table 6.,--Distribution of Dentists by Metropolitan Areal Number Number Area of Area of dentists dentists All counties 3,610 Galveston-Texas City 54 In metropolitan areas 2,810 Wichita Falls 34 Abilene 53 Houston 759 Waco 51 Dallas 596 Tyler 47 Fort Worth 254 . San Angelo 31 San Antonio 245 Odessa 27 Beaumont-Port Arthur 123 Midland 26 Austin 120 Brownsville-Harlingen 23 Corpus Christi 96 Texarkana 22 El Paso 93 Laredo 6 Amarillo 67 Lubbock 63 Nonmetropolitan counties 800 1/ Includes nonresponding dentists. Dentists are rather sparsely distributed in the nonmetropolitan areas of the state, Altogether the 219 nonmetropolitan counties in Texas have only 22 percent of the state's dentist supply. By comparison, the Houston metropolitan area alone has nearly as many dentists as all of the nonmetropol- itan counties combined. There are very few dentists in almost every one of these counties. For example, at least seven in every ten nonmetropolitan counties have fewer than five dentists, including 2 in every ten which apparently have no dentists at all. However, there are a few nonmetropolitan counties which have fairly sizeable numbers of dentists when compared with some counties included in metropolitan areas. Because of the large number of counties and metropolitan areas in Texas, the state has been divided into four regions to permit a more detailed examination of the geographical distribution of dentists within the state. The regional distribution of civilian dentists responding to the survey was substantially the same as that for all civilian dentists in the state, The map on the following page outlines the boundaries of each of the regions and indicates 506 REG I ONS A ND MOE TROPOL I TAN E A AREAS Frscone | (HARTLEY [MOORE [ROBERTS HEMPHILL amarillo coe rf meee OFA Siw [ARMSTRONG [DONLEY [COLUINGS- a Pore eS A North Central Texas eo TE a I i" [ isaness ; rom fest lubbock Poh texarkana Texas wichita falls Ro rKa OCHRAN [HOCKLEY [CRosaY [DICKENS (XING [KNOT [BAYLOR uoNTAGUE Cooke [cRavson FANNIN dallas Gen ——k ET oo rove frioeor | Rc [ve or es | 3 2h: = : 8 abilene rar A fexves AWSON [SoRGEN TRAY FiSnER Wo [STEPRENS Lorton de oFsvOR amon fort ae ll SL tyler |S worth = [ANoRTwS a RowARs [WiCRECL [WOUAN ATCARAN JEASTLAN A PANGLA —— odessa Sous SRE eo Avaneo 7S CI pr ASSCOCK [STERLING Te INEL! COLEMAN. [BROW OMANCHE BOSQUE INDERSON Sa BJ REET reeved san angelo waco essrome Lcsrone = wo a — L Bron . en - : Goran Ir ame , Coven micland Bode A Bo © feo ais ov Carsaas > Estson a [SCHLEICHI [NENARD (srl ‘MADISON TYLER i ower [. beaumont- Ro Gm Fearn AN Bs ton port arthur 177 0AviS) — S— austin at tro [TeamtLL p BURLESON FARDIN frcwaren - pe & ron [VAT VERDE [COWARDS KERR Wars ae waLLER . en sor Vw coma (CALOWELL sr A [KINNEY [UVALDE [MEDINA GONZALES LAVACH wikson WHARTON | t n : alveston- prascost : Qacnson exas cit u a © san antonio Fof— y Cannes cron Como OiMmiT [LASALLE [WcMULLEN BEE Cano (ealC OP pUS / laredo Christ if East Texas iE ARARTSAS SUVA Iw WELLS. xe: [Din Woe Keneor brownsville- ATR. 7woateo | har lingen: san benito South Texas metropolitan areas the metropolitan areas and nonmetropolitan counties contained in each, Regional variations in dentist supply and selected dentist characteristics are presented tabularly in Appendix Table B and are discussed on the following pages. Similar data for individual counties are presented in Appendix Table C. When the geographical distribution of dentists in Texas is viewed regionally it becomes apparent that the dentists are concentrated in the more populous regions of East and North Central Texas. Sixty-nine percent of the state's dentists are located in the 105 counties which make up these two regions=-- 56 percent in the 9 metropolitan areas and 13 percent in the 87 nonmetropolitan counties, The other 31 percent of the state's dentists are located in one of the 149 counties which make up West or South Texas--22 percent in the 12 metropolitan areas and only 9 percent in the 132 nonmetropolitan counties. Primarily because of the concentration of dentists in the Houston metropolitan area, East Texas has the largest share, 36 percent, of the state's dentist supply. In addition to the Houston area, the Beaumont-Port Arthur, Galveston-Texas City, Tyler and Texarkana areas are also included in East Texas and these four areas together contain 7 percent of the total dentist supply. The region's 56 nonmetropolitan counties, about one-fourth of all the counties so classified, contain another 8 percent of the state's dentists, One-half of the region's nonmetropolitan counties have five or more dentists. Gregg County has the largest nonmetropolitan dental force in the region, The location of the Dallas and Fort Werth metropolitan areas in North Central Texas contributes to the substantial number of dentists in this region, which has the second largest dentist supply in the state. One-third of the state's dentists are located in this region, including 23 percent who are located in either the Dallas or Fort Worth area. Another five percent of the state's dentists are in the Austin and Waco metropolitan areas. Even though only 31 of the state's 219 nonmetropolitan counties are included in North Central Texas, the dentists located in these counties account for another 5 percent of the total dentist supply. Almost one-half of these counties have five or more dentists, including Bell and Grayson counties which have dental forces larger than either Collin, Denton or Ellis counties in the Dallas metropolitan area, or Johnson County in the Fort Worth area. Another 19 percent of the state's dentists are located in West Texas. By far the majority of these dentists are in one of the region's eight metropolitan areas. The El Paso area has the largest number of dentists. The Amarillo, Lubbock, Wichita Falls and Abilene areas each have substantially more dentists than do either the San Angelo, Odessa or Midland areas. Almost one-half (107 counties) of the state's nonmetropolitan counties are in West Texas, but over two-thirds of the state's 46 nonmetropolitan counties which apparently have no dentists are in this region. However, there are in total 508 a relatively large number of dentists in the region's 76 nonmetropolitan counties which have dentists and these account for 7 percent of the state's total dentist supply. Nevertheless, only 13 of these nonmetropolitan counties have as many as 5 dentists. South Texas has the smallest share, only 12 percent, of the state's supply of dentists. Over one-half of the region's dentists are located in the San Antonio area. The Corpus Christi area also has a substantial number of dentists as compared with the Brownsville-Harlingen-San Benito area. The Laredo area, which has fewer dentists than any of the other metropolitan areas in the state, is also located in this region. Only four of the region's 25 nonmetropolitan counties have as many as 5 dentists, including Hidalgo County which has the largest supply of dentists. (Since the tabulation of these survey data Hidalgo County has been designated the McAllen-Pharr=- Edinburg metropolitan area.) About 8 percent of the dentists who responded to the survey reported that they maintain a second office location. Of these dentists, about 4 out of 10 maintain their second office in a county different from the one in which their primary office is located. Almost one-half of the reported second offices are located in one of the four largest metropolitan areas-- Houston, Dallas, Fort Worth and San Antonio. Geographical differences in age.--On the average dentists in the metropolitan areas of Texas are slightly younger than those located in nonmetropolitan counties. There are marked differences in the average ages of dentists in each of the 21 metropolitan areas. The Amarillo area has the youngest dentists. Their median age is 40.0 years, compared to the state average of 43.0 (Table 7). Almost one-third of the dentists in this area are under 35 years old (Appendix Table B). The average dentist in three of the four largest metropolitan areas--Dallas, Fort Worth and Houston--is also younger than the average dentist in the state. At the other extreme, dentists in the San Angelo area are the oldest, with a median age of 49.2 years, and only 19 percent under 35. The median age of dentists in the Laredo and Waco areas also considerably exceeds that of the state as a whole, 509 Table 7.--Median Age by Metropolitan Areal! Median Median Area Area age age All counties 43,0 Abilene 43,2 In metropolitan areas 42.6 Astin 43.4 Tyler 43,6 Amarillo 40,0 El Paso 43,7 Midland 41.0 San Antonio 43.8 Dallas 41.6 . Wichita Falls 43.9 Brownsville-Harlingen 41.7 Galveston-Texas City 44 4 Odessa 41.8 Corpus Christi 44.5 Fort Worth 42,1 Laredo 45.0 Houston 42,2 Waco 45.0 Beaumont-Port Arthur 43.1 San Angelo 49.2 Lubbock 43,1 8 * Texarkana 43,1 Nonmetropolitan counties 44.3 1/ Includes data obtainable for nonresponding dentists, East and North Central Texas not only have disproportionately large shares of the dentist supply, but they also have the youngest dentists. The median ages in 1965 of dentists located in these two regions were 42.6 and 42.5 years, respectively. Dentists in West Texas were on the average a full year older--43,6--and those in South Texas approximately two years older=--44.4, Twenty-five percent of the dentists in East Texas were under 35 years of age, while only 22 percent were 55 or older. On the other hand, in South Texas only 21 percent were under 35, and 27 percent had reached the age of 55. Within each of the four regions, dentists located in the nonmetropolitan counties were on the average older than those in metropolitan areas. This difference was most pronounced among dentists in South and North Central Texas. Professional status.~-Nearly all (96 percent) of the dentists in Texas are known to be active in their profession. One percent either reported themselves retired or engaged in nondental employment, or in the case of nonrespondents were classified as professionally inactive on the basis of information available to the State Board. The professional status was not obtainable for the remaining 3 percent of the dentists (28 respondents and 94 nonrespond= ents). However, since there are indications that the percentage of older dentists is relatively high among the nonrespondents, this group may include a proportionately greater number of retirees than the respondents. 510 Almost all of the dentists who are known to be retired are in the older age groups. Even so, relatively few of the 292 dentists 65 years old and over, for whom professional status was obtainable, were retired. Of these dentists only 5 percent considered themselves as fully retired. Among those 75 and over, 90 percent are still active in the profession, Active dentists in relation to population.--There was one professionally active dentist for every 3,034 persons in Texas in 1965, based on the count of dentists who are known to be active in the state (Table 8). In general, the dentist supply in relation to the population is more favorable in the metropolitan areas of the state than in the nonmetropolitan areas. On the average, there are 2,668 persons for every active dentist in the metropolitan areas as compared with an average ratio of 4,321 for nonmetropolitan counties, Table 8.,--Persons per Dentist by Metropolitan Areal! Persons Persons Area per Area per dentist dentist All counties 3,034 Midland 2,946 Galveston-Texas City 2,996 In metropolitan areas 2,668 Corpus Christi 3,004 Tyler 1,955 ; Amarillo 3,013 Austin 2,083 Texarkana 3,130 Dallas 2,287 3,180 San Angelo 2,303 Waco s1 = ’ San Antonio 3,423 Houston 2,315 Odessa 3,522 Fort Worth 2,616 El Paso 3,863 Abilene 2,680 Brownsville-Harlingen 6,796 Wichita Falls 2,712 Laredo 11.350 Beaumont-Port Arthur 2,751 ’ Lubbock 2,921 Nonmetropolitan counties 4,321 1/ Includes data obtainable for nonresponding dentists. The persons=-per=-dentist ratios for individual metropolitan areas and nonmetropolitan counties differ sharply. In the 21 metropolitan areas these ratios range from 1,955 in the Tyler area to a high 11,350 in the Laredo area. Even so, 14 of the 21 areas have ratios more favorable than the state average of 3,034, Among the nonmetropolitan counties which are known to have active dentists, the persons-per=-dentist ratios range from a very favorable 1,750 in Shackelford County in West Texas to a most unfavorable 16,900 in South Texas' Maverick County. Only 30 of the 171 nonmetropolitan counties with active dentists have fewer than 3,000 persons per dentist, 511 Not only are the majority of the state's dentists located in East and Nerth Central Texas, but there are also, on the average, more dentists in relation to the population in these two regions than in either West or South Texas, East and North Central Texas, which have almost the same number of dentists, average almost the same number of persons in the population per active dentist--2,726 and 2,643, respectively. For every active dentist in West Texas there are about 3,542 persons. South Texas with 4,236 persons per dentist has the least favorable regional ratio. To varying degrees within each of the four regions the persons in metropolitan areas are served by relatively more dentists than are those in the nonmetro~ politan counties. For example, in West Texas there are, on the average, 3,091 persons per dentist in the metropolitan areas as compared with a ratio of 4,312 for the nonmetropolitan counties, a difference of only 1,221 persons per dentist (Appendix Table B). The difference between the metropolitan and nonmetropolitan ratios is not too much greater in East and North Central Texas--1,379 and 1,694, respectively. However, in South Texas there are 3,345 more persons for each active dentist in the nonmetropolitan counties than in the metropolitan areas. There is alse considerable variation among the regions in the proportion of individual counties which have favorable persons-per-active dentist ratios. If the state ratio of 3,034 is used as a standard for determining the favor= ability of the ratio for each Texas county, 45 of the 254 counties in the state have relatively favorable ratios, that is, less than 3,000 persons per active dentist, In addition to these 45 counties, the map on the following page also identifies the 160 counties with less favorable ratios, as well as the 49 counties which, according to available information, have no active dentists, Among the four regions North Central Texas has the highest proportion of counties (26 percent) with less than 3,000 persons per dentist, Ome~half of this region's metropolitan counties have favorable ratios, However, only two counties, Dallas and Denton, in the 4~county Dallas metropelitan area and only Tarrant County in the 2~county Fort Worth area are in this category. West Texas and East Texas have about the same proportion of counties with favorable ratios, 19 and 15 percent respectively. Only 4 of the 10 counties in East Texas' metropolitan areas are included in this group. Of the 5 counties in the Houston area of East Texas only Harris County has fewer than 3,000 persons per dentist. In West Texas 6 of the ll metropolitan counties and 17 of the 107 nonmetropolitan counties are included in the group of counties with favorable ratios, Only 2 of the 31 South Texas counties have persons-per-active dentist ratios more favorable than the state average. 512 FOPULATI ON PER DENT I &T IN TEXAS BY COUNTY: I 9 65 North Central Texas Brewster persons per dentist: under 3,000 BE 3,000 & over no dentists [7] Professional Activity Current employment.--Of the 2,473 responding dentists who reported that they were professionally active at the time of the survey, 96 percent are primarily engaged in private practice: 95 percent are self-employed and one percent are employed by another dentist (Table 9). Another one percent of the state's dentists are on the staffs of the dental schools at Baylor University and the University of Texas. The remaining 3 per- cent are either employed by Federal, state or local government agencies, or are engaged in other dental employment. Table 9.--Current Employment of Professionally Active Dentists oe Number Type of principal employment employed Percent Total 2,473 100 Self-employed 2,342 95 Employed by other dentists 21 1 On staff of dental schools 34 1 Employed by state or local government 22 1 Employed by Federal Government 7 * Other dental employment 47 2 %* Less than one-half of one percent. Almost one in every ten active dentists reported one or more secondary dental activities in addition to his principal professional employment. Part-time teaching in a dental school was the most frequently reported secondary employment. Over two-fifths of those with secondary employ- ment reported a faculty appointment. About one in every seven of these dentists, most of whom are primarily in practice for themselves, are employed in the private practices of other dentists on a part-time basis. A variety of other secondary dental activities were reported, such as serving as consultants to the Veterans Administration or the Armed Forces, and providing dental care for patients in hospitals, handicapped persons or children in orphan homes. Activity last year.--Among dentists responding to the survey, 2,331 reported on their professional activity in Texas last year. Of these, 98 percent said they provided care to patients (Table 10). The time spent by these dentists accounted for 95 percent of all time devoted to professional activities in Texas for the year. Six percent of the den- tists reported they spent some time in teaching, but only 2 percent of 514 total professional time was spent at this activity. While 2 percent of the dentists were engaged in research activities and 3 percent spent time in some other dental activity, such as taking additional training, only 3 percent of the total reported professional time was spent in these two types of activities. Table 10.--Professional Activity Last Year Dentists reporting Percent of total e ctivi activity last year i i Type of activity activity _ast yea professional time Number Percent Total 2,331 100% 100 Patient care 2,276 98 95 Teaching 135 6 2 Research 38 2 1 Other 73 3 2 1l/ Individual items add to more than total because some dentists spent time in more than one activity. Dentists reporting on time spent last year in providing patient care devoted an average of 47.8 weeks to this activity and worked an average of 40.6 hours per week. Three-fifths of these dentists spent 40 hours or more a week at this activity for at least 48 weeks of the year (Table 11). Only 16 percent devoted under 35 hours per week or worked less than 40 weeks at this activity during the course of the year. Excep- tionally long hours were devoted to the treatment of patients by 15 per- cent of the dentists, who spent the equivalent of 8 hours a day, 6 days a week at this activity for 48 weeks or more during the year. Table 1l1.--Time Spent in Patient Care Last Year Weeks spent in Percent of Percent distribution by work week . dentists 48 hours 41-47 35-39 Under patient care 1s 40 hours providing care or more hours hours 35 hrs. Total reporting time spent 100 17 20 34 17 12 50 weeks or more 52 11 11 18 7 5 48 - 49 weeks 29 4 6 10 6 3 40 - 47 weeks 14 1 2 5 3 3 Less than 40 weeks 5 1 1 1 1 1 515 Practice Characteristics Limited practices.--Dentists reporting that they limit their practices to a dental specialty number 372, or approximately 16 percent of the respondents, Over two-thirds of these dentists reported limiting their practices to one of two specialty areas--43 percent in orthodontics and 25 percent in oral surgery. More than 9 of every 10 dentists who reported that their practices are limited are located in one of the state's metropolitan areas. Nineteen percent of the dentists in the metropolitan areas reported limited practices, whereas only 6 percent of the dentists in the nonmetropolitan counties limit their practices. Among the metropolitan areas, Lubbock and Wichita Falls have the largest proportions of practitioners with limited practices. One quarter of the dentists in these areas reported limiting their practices. Even though proportionately fewer dentists in the four largest metropolitan areas are specialists, there are large numbers of specialists in the Houston Dallas, Fort Worth and San Antonio areas. Use of auxiliaries.--About 89 percent of the dental practitioners in Texas (i.e., responding dentists who reported they spend any time working at the chair) say that they employ auxiliary personnel (Table 12). The vast majority, 83 percent, of the practitioners employ at least one auxiliary full time, while only 6 percent employ part-time auxiliaries exclusively. Of the various types of personnel, dental assistants are those most frequently employed. Approximately 84 percent of the practitioners employ an assistant, including 78 percent who use one full time. Almost one-third of all practitioners employ secretaries or receptionists, and the majority employ at least one on a full-time basis. Dental hygienists and laboratory technicians are much less frequently utilized by dentists in Texas, and they are more likely to be employed on a part-time basis than are assistants and secretaries. Table 12.--Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners £ $14 Dental With only With one full- Type of auxiliary practitioners Total part-time time employee personnel (or more) Total 2,467 100 6 83 With no auxiliary 273 11 - - With one or more auxiliaries 2,19 89 6 83 With assistant 2,079 84 6 78 With hygienist 357 14 7 7 With laboratory technician 217 9 6 3 With secretary or receptionist 777 31 8 23 With other type of personnel 101 4 2 2 516 The use of auxiliaries varies with the age of the dentist (Table 13). Well over 90 percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. Among dentists 65 years old and over, the proportion using auxiliaries drops to 60 percent. Den=- tal practitioners reach peak utilization of assistants between the ages of 30 and 44, but they are between the ages of 35 and 54 before maximum utilization of hygienists is attained. Table 13.--Dental Practitioners Employing Auxiliaries, by Age Percent of age group Age With With With auxiliaries assistants hygienists Under 30 86 84 8 30 - 34 95 91 13 35 - 44 95 92 17 45 - 54 91 87 16 55 - 64 79 69 14 65 & over 60 49 7 Dentists in metropolitan areas employ auxiliaries only slightly more frequently than do those in nonmetropolitan counties. On the average, 90 percent of the dental practitioners in the metropolitan areas employ some type of auxiliary personnel. Moreover, in each of the individual 21 metropolitan areas at least four-fifths of the dentists utilize auxiliaries. On the average, 86 percent of the practitioners in the nonmetropolitan counties utilize auxiliaries. In most of the individual nonmetropolitan counties the employment of dental auxil- iaries is quite frequent. Practitioners in metropolitan areas and in nonmetropolitan counties employ assistants and laboratory technicians at about the same rate. In metropolitan areas 85 percent of the dentists employ assistants and 9 percent employ technicians, while in nonmetropolitan counties 81 percent employ assistants and 7 percent employ technicians. The most pronounced difference is in the utilization of hygienists--16 per- cent of the practitioners in the metropolitan areas employ these auxiliaries, compared to only 8 percent of the dentists located in non- metropolitan counties. About 14 percent of the responding dentists in Texas reported one or more vacant positions for auxiliary personnel. Of those reporting vacancies, about 35 percent indicated a need for full-time hygienists and 33 percent stated a desire for full-time dental assistants. Nine of every 10 dentists reporting a vacancy already employ an auxiliary. 517 Weeks and hours worked,--Although 88 percent of all responding dentists who were in private practice reported on the amount of time they had spent in their practices in the previous year, the percentage reporting is low for dentists 55 years old and over, Since those not responding are likely to be those who are least active, the estimates on time worked by dentists in this age group are probably high. Even so, the figures in Table 14 demonstrate the greatly reduced activity among older dentists. Thus, about 64 percent of the dentists under 45 report working at least 48 weeks and at least 40 hours " per week. In comparison 52 percent of the dentists between 55 and 64, and only 35 percent of those 65 and over, report working this amount of time, Table l4.--Time Spent in Private Practice Last Year, by Age Dentists Percent working reporting time 48 weeks Part year Age spent in practice or more or less than Percent 40 hrs/wk s Number 40 hrs/wk of total or more Total 1,952 88 60 40 Under 35 459 93 63 37 35 - 44 738 92 65 35 45 - 54 394 89 58 42 55 - 64 219 83 52 48 65 & over 94 64 35 65 Qut-of-state Civilian Dentists Texas licenses are maintained by at least 227 civilian dentists located in 33 states, the District of Columbia, and in foreign countries. Thirty-five percent of these out-of-state dentists are located in the four adjacent states, primarily in Oklahoma (Table 15). Missouri, California, and Illinois are the only more distant states in which more than 10 of the out-of-state dentists are currently located. Approximately 43 percent of the out-of-state dentists are graduates of Baylor University or the University of Texas. 518 Table 15.--Out-of-State Civilian Dentists, by Present Locationl/ Number Percent Present location of of dentists dentists Total 227 100 Adjacent states 80 35 Oklahoma 42 19 New Mexico 16 7 Louisiana 12 5 Arkansas 10 4 Nonadjacent states 147 65 Missouri 14 6 California 13 6 Illinois 12 5 Ohio 10 4 26 other states and abroad 98 44 1l/ Includes nonresponding dentists. The out-of-state dentists are younger than those presently in Texas. While only 25 percent of the dentists located in Texas were under 35 years of age in 1965, 37 percent of the out-of-state dentists were in this young age group. Furthermore, only 16 percent of the out-of- state dentists were 55 years old or over, as compared with 23 percent of the in-state dentists. Of the 227 out-of-state dentists, 154, or 68 percent, responded to the survey. Ninety-eight percent of these respondents reported that they are professionally active. The majority, 80 percent, are in private practice. About 9 percent are employed by governmental agencies, 3 percent are on the staffs of dental schools and the remaining 6 per- cent are engaged in other dental activities, such as taking advanced training. About one of every five out-of-state respondents reported they had formerly been professionally active in Texas immediately prior to assuming their present location in another state. Almost one-third of the 32 reporting out-migrant dentists are now located in one of the four adjacent states--Arkansas, Louisiana, Oklahoma and New Mexico--and the remaining two-thirds are scattered in 16 other states across the Nation. 519 386-029 O - 70 - 34 Appendix Table A.--Summary Statistics for Texas Total Responding Nonresponding 520 dentists dentists dentists Total dentists licensed in Texas 4,180 2,923 1,257%/ Civilian dentists in Texas (designated simply as "dentists" in text tables) 3,610 2,518 1,092 Professionally active dentists> 3,454 2,473 981 Dental practitioners®/ - 2,467 - In limited practice?’ - 372 - Located in Texas last year: Reported professional activityd/ - 2,331 - Dentists providing patient carer! - 2,276 - Reported time spent in patient cared! - 2,022 - Dentists in private practice? - 2,212 - . . . ot9/ Reported time spent in practic - 1,952 - Civilian dentists in another State 227 154 73 Dentists on active duty in Armed Forces 279 187 92 1/ Data for nonresponding dentists were obtained from the Texas State Board of Dental Examiners, and from the 1965 American Dental Directory published by the American Dental Association. 2/ All dentists who currently work in Texas (excluding those in the Armed Forces) or who are retired and currently live in the State. Data are not available for the following: year of graduation - 122, age - 185, dental school attended - 65. 3/ All active civilian dentists currently in Texas--excludes 25 dentists who are fully retired, 9 who are engaged principally in a nondental activity, and 122 whose principal current activity is unknown. 4/ All responding dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 5/ Dentists who reported they limited their practice to a dental specialty. 6/ Dentists located in Texas last year who indicated type(s) of activity in which they engaged. 7/ All responding dentists who engaged in patient care last year, either as a primary or secondary activity. 8/ Dentists reporting both hours and weeks spent in patient care last year. 9/ Dentists who reported they were primarily self-employed both currently and last year. 10/ Dentists reporting both hours and weeks spent last year as a self-employed dentist. [¥49 Appendix Table B.--Selected Data for Metropolitan Areas, by Region . Number .. ... . 1/Percent distribution by age Professionally Persons lian dentists Y ag y eppEon and of Civilian dentists Under 35- 45- 55- 65 & active 1/ per active oP counties Number Percent 35 44 54 64 over dentists™ dentist All counties 254 3,610 100 24 33 20 14 9 3,454 3,034 East Texas 66 1,306 36 25 33 20 13 9 1,242 2,726 Metropolitan areas 10 1,005 28 25 34 21 12 8 955 2,407 Houston 5 759 21 25 34 20 13 8 714 2,315 Beaumont-Port Arthur 2 123 3 21 37 19 12 11 121 2,751 Galveston-Texas City 1 54 2 24 29 27 10 10 53 2,996 Tyler 1 47 1 29 26 13 16 16 47 1,955 Texarkana 1 22 1 33 24 38 5 - 20 3,130 Nonmetropolitan counties 56 301 8 27 29 18 16 10 287 3,786 North Central Texas 39 1,200 33 24 35 19 13 9 1,153 2,643 Metropolitan areas 8 1,021 28 25 35 19 13 8 981 2,390 Dallas 4 596 16 27 37 19 11 6 573 2,287 Fort Worth 2 254 7 23 36 17 13 11 243 2,616 Austin 1 120 3 27 27 23 16 7 115 2,083 Waco 1 51 2 16 34 24 20 6 50 3,180 Nonmetropolitan counties 31 179 5 16 36 18 16 14 172 4,084 South Texas 31 444 12 21 32 20 16 11 428 4,236 Metropolitan areas 6 370 10 21 33 20 15 11 355 3,666 San Antonio 2 245 7 22 33 18 14 13 233 3,423 Corpus Christi 2 96 2 18 34 26 14 8 93 3,004 Brownsville-Harlingen-San Benito 1 23 1 27 32 18 23 - 23 6,796 Laredo 1 6 * 34 17 17 16 16 6 11,350 Nonmetropolitan counties 25 74 2 18 25 20 23 14 73 7,011 [449 Appendix Table B.--Selected Data for Metropolitan Areas, by Region (continued) Region and Number (iyilian dentistsl/ Percent distribution by age Professionally Persons . litan area of ———————— Under 35- 45- 55- 65 & active per active metropolitan ar counties Number Percent 35 44 54 64 over dentistsl/ dentist West Texas 118 660 19 24 31 20 15 10 631 3,542 Metropolitan areas 11 414 12 23 35 20 11 11 398 3,091 El Paso 1 93 3 19 36 19 12 14 92 3,863 Amarillo 2 67 2 31 35 20 6 8 61 3,013 Lubbock 1 63 2 28 31 29 6 6 62 2,921 Wichita Falls 2 54 1 25 31 18 16 10 52 2,712 Abilene 2 53 1 16 38 16 14 16 50 2,680 Odessa 1 27 1 20 48 28 - 4 27 3,522 Midland 1 26 1 21 46 21 8 4 24 2,946 San Angelo 1 31 1 19 23 13 26 19 30 2,303 Nonmetropolitan counties 107 246 7 246 26 20 20 10 233 4,312 * Less than one-half of one percent. 1/ Includes respondents and nonrespondents. Appendix Table C.--County Data by Region and Metropolitan Area Civilian dentistst/ Professionally . . active dentists 2/ Persons Region, metropolitan area Population= Non- Non- ' per active and county Respon- Respon- (in 000's) Total d respon- Total respon- dentist ents dents dents dents Total 3,610 2,518 1,092 3,454 2,473 981 10,480.9 3,034 East Texas 1,306 863 443 1,242 849 393 3,385.5 2,726 Metropolitan .counties Houston area Brazoria 29 21 8 27 20 7 91.1 3,374 Fort Bend 7 5 2 7 5 2 45.3 6,471 Harris 705 459 246 664 453 211 1,451.6 2,186 Liberty 9 6 3 8 6 2 34.0 4,250 Montgomery 9 8 1 8 7 1 30.8 3,850 Beaumont-Port Arthur area Jefferson 105 71 34 103 70 33 267.7 2,599 Orange 18 9 9 18 9 9 65.2 3,622 Galveston-Texas City area Galveston 54 34 20 53 33 20 158.8 2,996 Tyler area Smith 47 30 17 47 30 17 91.9 1,955 Texarkana area Bowie 22 15 7 20 15 5 62.6 3,130 Nonmetropolitan counties Anderson 7 4 3 7 4 3 28.4 4,057 Angelina 13 9 4 13 9 4 42.4 3,262 Austin 4 3 1 4 3 1 13.3 3,325 Bastrop 2 2 - 2 2 - 15.8 7,900 Brazos 15 15 - 15 15 - 48.2 3,213 €Cs 72s Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentistsy/ Professionally Region, metropolitan area active dentists Population’ Persons and count Non Non- . Y er active y Total Respon= respon- Total Respon- respon- (in 000's) PF fentist ents dents dents dents East Texas (cont'd.) Nonmetropolitan counties (cont'd.) Burleson 3 3 - 2 2 - 10.4 5,200 Caldwell 6 4 2 6 4 2 16.1 2,683 Calhoun 5 4 1 5 4 1 20.0 4,000 Camp 2 2 - 2 2 - 7.4 3,700 Cass 5 5 - 5 5 - 21.9 4,380 Chambers 6 5 1 6 5 1 11.5 1,917 Cherokee 13 6 7 11 6 5 30.7 2,791 Colorado 5 3 2 3 2 1 18.8 6,267 Fayette 3 2 1 3 2 1 18.8 6,267 Franklin 1 - 1 1 - 1 4.5 4,500 Freestone - - - - - - 11.2 - Gonzales 4 4 - 4 4 - 16.3 4,075 Gregg 38 22 16 38 22 16 75.4 1,984 Grimes 3 2 1 2 2 - 11.6 5,800 Hardin 5 1 4 5 1 4 28.0 5,600 Harrison 11 8 3 10 8 2 45.4 4,540 Henderson 7 5 2 7 5 2 23.3 3,329 Hopkins 5 3 2 5 3 2 18.0 3,600 Houston 7 3 4 6 2 4 17.8 2,967 Jackson 5 3 2 4 3 1 14.5 3,625 Jasper 6 2 4 6 2 4 23.1 3,850 Lavaca 5 1 4 5 1 4 19.2 3,840 Lee 2 2 - 2 2 - 8.3 4,150 Leon - - - - - - 9.0 - Madison 2 1 1 2 1 1 6.1 3,050 Appendix Table C.--County Data by Region and Metropolitan Area (continued) sens 1 Professionally Region, metropolitan area Civilian dentists! active dentists P lati n2/ Persons and county Non- Non- opu atio per active Respon=- Respon= (in 000's) dentist Total a respon- Total respon- ents dents dents dents East Texas (cont'd.) Nonmetropolitan counties (cont'd.) Marion 1 - 1 1 - 1 7.0 7,000 Matagorda 7 7 - 7 7 - 27.8 3,971 Morris 2 2 - 2 2 - 12.1 6,050 Nacogdoches 9 7 2 9 7 2 28.0 3,111 Newton - - - - - - 10.2 - Panola 4 3 1 3 3 - 15.7 5,233 Polk 4 2 2 4 2 2 13.8 3,450 Rains - - - - - - 2.3 - Red River 2 1 1 2 1 1 14.1 7,050 Robertson 3 2 1 3 2 1 14.5 4,833 Rusk 7 6 1 7 6 1 34.2 4,886 Sabine 1 1 - 1 1 - 6.7 6,700 San Augustine 2 2 - 2 2 - 7.2 3,600 San Jacinto - - - - - - 5.6 - Shelby 5 3 2 4 3 1 19.2 4,800 Titus 7 6 1 7 6 1 16.7 2,386 Trinity 1 - 1 1 - 1 6.4 6,400 Tyler 2 2 - 2 2 - 10.2 5,100 Upshur 6 4 2 6 4 2 19.4 3,233 Van Zandt 4 2 2 3 1 2 17.4 5,800 Victoria 17 13 4 17 13 4 53.6 3,153 Walker 5 5 - 5 5 - 22.6 4,520 Waller 1 1 - 1 1 - 13.1 13,100 Washington 7 3 4 6 3 3 18.4 3,067 Wharton 10 7 3 9 7 2 38.9 4,322 Wood 4 2 2 4 2 2 16.0 4,000 62S 9¢s Appendix Table C.,--County Data by Region and Metropolitan Area (continued) Civilian dentistst/ Professionally Region, metropolitan area N active dentists Population?’ Persons and county T Respon- on- Respon- on- (in 000's) per active otal respon- Total respon- dentist dents dents dents dents North Central Texas 1,200 877 323 1,153 864 289 3,047.2 2,643 Metropolitan counties Dallas area Collin 16 9 7 14 9 5 44,1 3,150 Dallas 551 386 165 531 383 148 1,166.0 2,196 Denton 19 15 4 19 15 4 55.9 2,942 Ellis 10 10 - 9 9 - 44,6 4,956 Fort Worth area Johnson 9 7 2 8 6 2 38.0 4,750 Tarrant 245 179 66 235 177 58 597.7 2,543 Austin area Travis 120 89 31 115 88 27 239.5 2,083 Waco area McLennan 51 41 10 50 40 10 159.0 3,180 Nonmetropolitan counties Bell 23 19 4 21 17 111.9 5,329 Bosque 3 3 - 3 3 - 10.3 3,433 Burnet 3 3 - 3 3 - 8.7 2,900 Comanche 2 2 - 2 2 - 12.3 6,150 Cooke 9 6 3 8 5 23.9 2,988 Coryell 3 3 - 3 3 - 35.6 11,867 Delta - - - - - - 4,7 - Eastland 3 1 2 3 1 2 17.6 5,867 Erath 5 3 2 5 3 2 15.3 3,060 Falls 4 4 - 4 4 - 19.1 4,775 Fannin 3 3 - 3 3 - 20.8 6,933 Grayson 23 17 6 22 17 5 75.0 3,409 Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentistst/ Professionally Region, metropolitan area N gctive dentists Population’ persons and county Respon- on- Respon- Non- (in 000's) per active Total respon- Total respon- dentist dents dents dents dents North Central Texas (cont'd.) . Nommetropolitan counties (cont'd.) Hamilton 4 3 1 4 3 1 7.4 1,850 Hill 6 4 2 6 4 2 20.5 3,417 Hood 2 1 1 2 1 1 5.5 2,750 Hunt 12 9 3 12 9 3 39.1 3,258 Jack 1 1 - 1 1 - 7.2 7,200 Kaufman 7 7 - 7 7 - 29.5 4,214 Lamar 13 10 3 12 10 2 32.8 2,733 Lampasas 2 1 1 2 1 1 9.3 4,650 Limestone 8 6 2 8 6 2 18.3 2,288 Milam 5 4 1 5 4 1 20.7 4,140 Mills 1 1 - 1 1 - 3.7 3,700 Montague 4 3 1 4 3 1 13.8 3,450 Navarro 7 5 2 6 4 2 34.1 5,683 Palo Pinto 6 4 2 6 4 2 21.1 3,517 Parker 6 5 1 5 5 - 23.3 4,660 Rockwall - - - - - - 5.7 - Somervell - - - - - - 2.6 - Williamson 10 10 - 10 10 - 35.2 3,520 Wise 4 3 1 4 3 1 17.4 4,350 South Texas 444 303 141 428 294 134 1,813.2 4,236 Metropolitan counties San Antonio area Bexar 235 159 76 223 153 70 766.6 3,438 Guadalupe 10 7 3 10 7 3 31.0 3,100 LTS 8¢S Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentis esl! Professionally , active dentists 2/ Persons Region, metropolitan area Non- None Population ti and county Respon- on Respon- (in 000's) per active Total respon- Total respon- dentist dents dents dents dents South Texas (cont'd.) Metropolitan counties (cont'd.) Corpus Christi area Nueces 89 62 27 86 60 26 236.1 2,745 San Patricio 7 4 3 7 4 3 43.3 6,186 Brownsville-Harlingen- San Benito area Cameron 23 16 7 23 16 7 156.3 6,796 Laredo area Webb 6 4 2 6 4 2 68.1 11,350 Nonmetropolitan counties Aransas 1 - 1 1 - 1 8.2 8,200 Atascosa 4 2 2 4 2 2 18,2 4,550 Bee 4 4 - 4 4 - 25,2 6,300 Brooks 1 - 1 1 - 1 8.2 8,200 De Witt 7 7 - 7 7 - 19.6 2,800 Dimmit - = - - - - 9.7 - Duval - - - - - - 12.3 - Frio 2 1 2 1 10.0 5,000 Goliad 1 - 1 1 - 1 5.0 5,000 Hidalgo 26 15 11 25 14 11 196.9 7,876 Jim Hogg 1 1 - 1 1 - 4.9 4,900 Jim Wells 6 5 6 5 38.2 6,367 Karnes 3 3 - 3 3 - 13.9 4,633 Kenedy - - - - - - 0.9 - Kleberg 8 8 - 8 8 - 31.3 3,913 6CS Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentistes/ Professionally Persons Region, metropolitan area active dentists Po ulation? or active and county Non- Non- oP 1 P . Respon- Respon- (in 000's) dentist Total 4 respon- Total respon- ents dents dents dents South Texas (cont'd.) Nonmetropolitan counties (cont'd.) La Salle - - - - - - 5.3 - Live Oak 1 1 - 1 - 7.2 7,200 McMullen - - - - - - 1.0 - Maverick 1 - 1 1 - 1 16.9 16,900 Refugio 2 1 1 2 1 1 11.3 5,650 Starr - - - - - - 18.6 - Willacy 2 2 - 2 2 - 18.7 9,350 Wilson 2 1 1 2 1 1 12.6 6,300 Zapata - - - - - - 4.4 - Zavala 2 - 2 2 - 2 13.3 6,650 West Texas Metropolitan counties El Paso area El Paso 93 67 26 92 67 25 355.4 3,863 Amarillo area Potter 59 42 17 53 39 14 134.3 2,534 Randall 8 8 - 8 8 - 49.5 6,188 Lubbock area Lubbock 63 40 23 62 40 22 181.1 2,921 Wichita Falls area Archer - - - - - - 5.7 - Wichita 54 46 8 52 45 7 135.3 2,602 Abilene area Jones 5 3 2 4 2 2 18.1 4,525 Taylor 48 35 13 46 33 13 115.9 2,520 0€s Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentists Professionally active dentists 2/ Persons Region, metropolitan area Population— . Non=- Non- . ' per active and county Respon- Respon- (in 000's) . Total respon- Total respon- dentist dents dents dents dents West Texas (cont'd.) Metropolitan counties Odessa area Ector 27 19 8 27 19 8 95.1 3,522 Midland area Midland 26 14 12 24 14 10 70.7 2,946 San Angelo area Tom Greene 31 24 7 30 23 7 69.1 2,303 Nonmetropolitan counties Andrews 2 2 - 2 2 - 13.5 6,750 Armstrong - - - - - - 1.8 - Bailey 3 1 2 3 1 2 9.8 3,267 Bandera 2 - 2 2 - 2 3.7 1,850 Baylor 2 1 1 2 1 1 5.4 2,700 Blanco 1 1 - 1 1 - 3.5 3,500 Borden - - - - - - 1.1 - Brewster 1 1 - 1 1 - 6.0 6,000 Briscoe - - - - - - 3.6 - Brown 9 9 - 9 9 - 24.9 2,767 Callahan 2 1 1 1 1 - 8.3 8,300 Carson - - - - - - 8.1 - Castro 2 - 2 2 - 2 10.7 5,350 Childress 3 3 - 3 3 - 7.2 2,400 Clay 1 - 1 1 - 1 7.7 7,700 Cochran 1 1 - 1 1 - 7.7 7,700 Coke - - - - - - 3.4 - Coleman 4 4 - 4 4 - 12.2 3,050 Appendix Table C,--County Data by Region and Metropolitan Area (continued) eas 1/ Professionally . ji Civilian dentiste® active dentists 2/ Persons Region, metropolitan area N — Population= on- Non ' per active and county Respon- Respon~- (in 000's) : Total 4 respon- Total respon- dentist ents dents dents dents West Texas (cont'd.) Nonmetropolitan counties (cont'd.) Collingsworth 2 2 - 1 - 5.1 5,100 Comal 10 6 4 10 6 4 21.4 2,140 Concho - - - - - - 4.0 - Cottle 2 - 2 1 - 1 3.4 3,400 Crane 1 1 - 1 1 - 4,5 4,500 Crockett 2 2 - 2 2 - 3.7 1,850 Crosby 2 2 - 2 2 - 10.7 5,350 Culberson - - - - - - 3.3 - Dallam 2 1 1 1 1 - 5.7 5,700 Dawson 3 3 - 3 3 - 21.3 7,100 Deaf Smith 4 2 2 4 2 16.0 4,000 Dickens 1 1 - 1 1 - 4.1 4,100 Donley - - - - - - 3.7 - Edwards - - - - - - 2.1 - Fisher 1 - 1 1 - 7.0 7,000 Floyd 3 3 - 3 3 - 13.7 4,567 Foard - - - - - - 2.6 - Gaines 2 2 - 2 2 - 13.7 6,850 Garza 1 1 - 1 1 - 6.7 6,700 Gillespie 4 2 2 4 2 2 9.9 2,475 Glasscock - - - - - - 1.1 - Gray 15 8 7 13 8 5 34.2 2,631 Hale 11 4 7 11 4 7 42.9 3,900 wn Hall 2 2 - 2 2 - 5.9 2,950 “ Hansford 2 2 - 2 2 - 7.2 3,600 [439 Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentistsl/ Professionally . active dentists 2/ Persons Region, metropolitan area Non- None Populatiomr— . per active and county Respon- Respon- (in 000's) Total a respon- Total respon- dentist ents dents dents dents West Texas (cont'd.) Nonmetropolitan counties (cont'd.) Hardeman 1 1 - 1 1 - 7.5 7,500 Hartley 1 1 - 1 1 - 2.3 2,300 Haskell 2 2 - 2 2 - 10.0 5,000 Hays 6 4 2 6 4 2 20,6 3,433 Hemphill 1 1 - 1 1 - 2,7 2,700 Hockley 3 3 - 3 3 - 24,0 8,000 Howard 14 11 3 13 11 2 44,8 3,446 Hudspeth - - - - - - 2.8 - Hutchinson 9 7 2 9 7 2 35.5 3,944 Irion - - - - - - 1.0 - Jeff Davis - - - - - - 1.4 - Kendall - - - - - - 6.1 - Kent - - - = - - 1.5 - Kerr 8 4 8 20.4 2,550 Kimble 1 - 1 - - - 3.5 - King - - - - - - 0.5 - Kinney - - - - - - 2.3 - Knox 2 2 - 2 2 - 6.7 3,350 Lamb 5 5 - 5 5 - 24.3 4,860 Lipscomb - - - - - - 3.3 - Llano 1 - 1 - 5.2 5,200 Loving - - - - 0.3 - Lynn 2 2 - 2 2 - 12.8 6,400 McCulloch 2 2 - 2 2 - 7.7 3,850 Martin - - - - - - 4.9 - Appendix Table C.--County Data by Region and Metropolitan Area (continued) 1 Professionally Civilian dentils tl/ active dentists 2/ Persons Region, metropolitan area None Non- Population— 1 and county Respon- on Respon- on (in 000's) per active Total d respon- Total respon- dentist ents dents dents dents West Texas (cont'd.) Nonmetropolitan counties (cont'd.) Mason 1 1 - 1 1 - 3.1 3,100 Medina 2 2 - 2 2 - 19.7 9,850 Menard 1 - 1 1 - 1 2.4 2,400 Mitchell 4 2 2 4 2 2 92.9 2,475 Moore 3 3 - 3 3 - 13.5 4,500 Motley - - - - - - 2.3 - Nolan 7 7 - 6 6 - 18.3 3,050 Ochiltree 3 1 3 1 11.1 3,700 Oldham - - - - - - 2.0 - Parmer 1 1 - 1 1 - 11.4 11,400 Pecos 3 3 - 3 3 - 12.9 4,300 Presidio 1 1 - 1 1 - 4.7 4,700 Reagan - - - - - - 3.1 - Real - - - - - - 1.9 - Reeves 4 4 - 4 4 - 17.7 4,425 Roberts 1 - 1 - - - 1.1 - Runnels 4 3 1 4 3 1 14.1 3,525 San Saba 2 1 1 2 1 1 7.4 3,700 Schleicher - - - - - - 2,7 - Scurry 4 4 - 4 4 - 18.7 4,675 Shackelford 2 1 1 2 1 1 3.5 1,750 Sherman - - - - - - 2,7 - Stephens 3 2 1 3 2 1 8.0 2,667 Sterling - - - - - - 1.1 - w Stonewall - - - - - - 2,7 - eS Appendix Table C.--County Data by Region and Metropolitan Area (continued) Civilian dentists! Professionally , i active dentists 2/ Persons Region, metropolitan area Population— . Non- Non- ' per active and county Respon- Respon- (in 000's) Total respon- Total respon- dentist dents dents dents dents West Texas (cont'd.) Nonmetropolitan counties (cont'd.) Sutton 1 1 - 1 1 - 3.8 3,800 Swisher 3 3 - 3 3 - 11.7 3,900 Terrell - - - - - - 2.4 - Terry 4 2 2 2 2 - 17.6 8,800 Throckmorton - - - - - - 2.4 - Upton 1 1 - 1 1 - 5.6 5,600 Uvalde 4 1 4 1 17.0 4,250 Val Verde 5 5 - 5 5 - 28.0 5,600 Ward 4 4 - 4 4 - 13.6 3,400 Wheeler 1 1 - 1 1 - 6.8 6,800 Wilbarger 6 4 2 5 4 1 16.6 3,320 Winkler 2 1 1 2 1 1 13.4 6,700 Yoakum 1 1 - 1 1 - 8.7 8,700 Young 7 5 2 7 5 2 16.6 2,371 1/ The number of dentists indicated for each county includes responding dentists reporting location in that county and nonresponding dentists who according to obtainable information were located in that county. Based on this information 47 counties apparently had no civilian dentists in 1965. 2/ Copyright 1965. Sales Management Survey of Buying Power; further reproduction is forbidden. (VAAN, DENTISTS LICENSED IN UTAH During the 1966 registration period, 1,094 dentists registered with the Utah Department of Registration. Fifty-five percent of these dentists are civilians located in Utah, 42 percent are civilians located in other States, and 3 percent are on active duty with the Armed Forces. The survey questionnaire was completed by 882 dentists, 81 percent of the total registered. Information provided by the survey respondents has been supplemented, when possible, by data on location, age, dental school attended, and year of graduation for dentists not responding to the sur- vey. This information was obtained either from records maintained by the Utah Department of Registration or from the 1967 American Dental Directory published by the American Dental Association. Location and Military Status of Dentists Licensed in Utah Location and All Percent of military status dentists dentists Total licensed 1,094 100 Respondents 882 81 Nonrespondents 212 19 Total licensed 1,094 100 Civilians in Utah 598 55 Respondents 480 - Nonrespondents 118 - Civilians in another State 466 42 On active duty with Armed Forces 30 3 Approximately three-fourths of the survey respondents hold licenses to practice dentistry in one or more other States. Of the responding den- tists located in Utah, over one-half have more than one license, with 42 percent licensed in one other State and 11 percent licensed in at least two other States. Multiple licensure is considerably more common among out-of-State dentists. Three in every ten (31 percent) hold two or more licenses in addition to their Utah license. Survey respondents hold a total of 1,755 licenses, an average of almost two per dentist. Almost one-half of the licenses held outside of Utah were issued by the State of California. The remainder are held in 26 other States across the Nation. 535 386-029 O - 70 - 35 DENTAL SCHOOL ATTENDED Approximately three-fifths (57 percent) of the 598 dentists in Utah ob- tained their dental degrees from 14 schools located in the North Central © States. Northwestern University, the major contributor, has provided one-fifth (21 percent) of the State's dentists. The University of Mis- souri has trained 12 percent, while Loyola University of Chicago and Washington University at St. Louis have each provided 6 percent. Case Western Reserve University is the only other school in the North Central States to have provided as many as 20 of Utah's dentists. Dental School Attended and Year of Graduation for Dentists in Utah Dental school Number Year of graduation ttended of All After 1941- 1940 or attende dentists years 1955 1955 earlier Total number 598L/ - 211 222 161 (Percent distribution by school) Schools in North Central States 339 57 69 51 49 Northwestern 126 21 24 21 18 Missouri 69 12 13 12 9 Loyola (Chicago) 37 6 6 3 11 Washington (St. Louis) 37 6 9 6 2 10 other schools 70 12 17 9 9 Schools in Western States 214 36 22 44 43 Southern California 82 14 4 18 21 Oregon 54 9 5 14 8 5 other schools 78 13 13 12 14 11 schools in other States 44 7 9 5 8 1/ Dental school attended not available for 1 dentist and year of grad- uation for 4 dentists. Percents based on known totals. Seven schools located in the Western States have graduated 36 percent of the dentists in Utah. The University of Southern California has contrib- uted the largest proportion of these dentists, 14 percent of the State total, and the University of Oregon has contributed 9 percent. Only two other schools in the West--the University of California at San Francisco and the University of Washington--have supplied as many as 20 of the State's dentists. The remaining 7 percent are graduates of 11 schools located in the Southern or the Northeastern States. 536 DISTRIBUTION OF DENTISTS More than four-fifths (82 percent) of the 598 dentists in Utah are lo- cated in the three metropolitan areas of the State. The 2-county Salt Lake City area alone has 336 dentists, almost three-fifths of the total dental force. Nine of every ten (297) of these dentists are in Salt Lake County, with the remaining 39 in Davis County. The Ogden and Provo-Orem metropolitan areas have 14 percent and 11 percent of the State's dentist supply, respectively. Distribution of Utah Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 29 598 100 Metropolitan areas 4 486 82 Salt Lake City area 2 336 57 Ogden area 1 86 14 Provo-Orem area 1 64 11 Nonmetropolitan counties 25 112 18 Central city 10,000-24,999 2 42 7 Central city 5,000-9,999 4 31 5 Central city 2,500-4,999 5 19 3 Central city under 2,500 14 20 3 * See Appendix Table for definition of metropolitan areas and presentation of individual county data. Only 18 percent of Utah's dentists are located in the 25 nonmetropolitan counties. Almost two-fifths of these dentists are located in the two counties--Cache and Box Elder--with central city populations between 10,000 and 24,999. The 23 counties with fewer than 10,000 persons in their central cities have 11 percent of the State's supply of dentists. There are 50 dentists in the nine counties having between 2,500 and 9,999 persons in their central cities, while only 20 are scattered among the 14 counties with central city populations under 2,500. Only six of these 23 counties have as many as five dentists, while 11 have fewer than three, including five counties with no dentists, according to available information. 537 AGE DISTRIBUTION Dentists in Utah are rather young as a group, with a median age of 42.3 years. About one-fourth (23 percent) of the dentists are under 35 years of age,and an almost equal proportion are 55 or older. Over one-half of the dentists (55 percent) are between 35 and 54 years of age, with 38 percent between 35 and 44. Approximately 13 percent, or 79 dentists, are 65 or older, including 48 who have reached age 70. Age Distribution of Utah Dentists Age In Number percent Cumulative dentists dentists percent Total 508%/ 100 - Under 30 37 6 6 30 - 34 100 17 23 35 - 39 104 18 41 40 - 44 121 20 61 45 - 49 74 13 74 50 - 54 25 4 78 55 - 59 16 3 81 60 - 64 36 6 87 65 - 69 31 5 92 70 - 74 28 5 97 75 & over 20 3 100 1/ Age not available for 6 dentists. Percents based on total for whom age is known. The overall median age of dentists in the metropolitan areas is about equal to the median age of those in the nonmetropolitan counties. Among metropolitan areas, dentists in the Salt Lake City area are slightly younger, on the average, than dentists in the Ogden and Provo-Orem areas. 538 ACTIVE DENTISTS IN RELATION TO POPULATION Of 598 licensed dentists in Utah, 553, or 92 percent, are active in their profession, giving the State one professionally active dentist for every 1,805 persons. In the metropolitan areas, there is one dentist for every 1,676 persons, while the nonmetropolitan counties have a considerably higher ratio of 2,387 persons per dentist. Number of Persons Per Active Dentist in Utah Professionally Persons County group* active Population per dentists dentist All counties 553 998,000 1,805 Metropolitan areas 453 759,300 1,676 Salt Lake City area 312 519,700 1,666 Ogden area 82 121,600 1,483 Provo-Orem area 59 118,000 2,000 Nonmetropolitan counties 100 238,700 2,387 Central city 10,000-24,999 38 75,400 1,984 Central city 5,000-9,999 28 60,600 2,164 Central city 2,500-4,999 16 38,800 2,425 Central city under 2,500 18 63,900 3,550 * See Appendix Table for individual county data. Among the three metropolitan areas, Ogden has the best ratio with 1,483 persons per dentist. The 2-county Salt Lake City area has the next best ratio, 1,666, while the Provo-Orem area has 2,000 persons for every den- tist. Among the 25 nonmetropolitan counties, six have ratios under 2,000, while nine have more than 3,000 persons per dentist. When counties are grouped according to the size of their central city, the ratio of persons per dentist generally becomes less favorable as the size of the central city decreases. The group of counties with central city populations between 10,000 and 24,999 has an average of 1,984 persons per dentist, while counties with fewer than 2,500 inhabitants in their central cities aver- age one active dentist for every 3,550 persons. 539 UTILIZATION OF AUXILIARIES Slightly more than four-fifths of Utah's responding dental practitioners (i.e., dentists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 76 percent of the dentists, with 70 percent employing full-time assistants. One in every six practitioners reported the employment of a secretary or receptionist, usually on a full-time basis. Dental hygienists are utilized by about 10 percent of the dentists, and laboratory technicians,by 6 percent. Very few dentists have full-time hygienists or laboratory technicians. Utah Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed practitioners Total time employee part-time ~ (or more) employees Total 4e1Y/ 100 74 7 One or more auxiliaries 364 81 74 7 Assistant 343 76 70 6 Hygienist 45 10 2 8 Laboratory technician 28 6 * 6 Secretary or receptionist 72 16 10 6 Other type of personnel 11 2 1 1 No auxiliary 86 19 - - 1/ Includes 11 dentists who did not report on auxiliary utilization. %* Less than one-half of 1 percent. Utilization of auxiliaries varies with the age of the dentist and is less common among the older dentists. Approximately 86 percent of the dental practitioners under age 55 employ at least one auxiliary, as compared to 50 percent of those dentists 55 years of age or older. Young dentists just starting their practices do not reach peak utilization of assistants until they are at least 30 years of age, and of hygienists, until age 35. 540 I~ ~~ OTHER SURVEY FINDINGS Almost all (98 percent) of the responding professionally active dentists in Utah are engaged in private practice, with 97 percent self-employed and one percent employed by other dentists. The remaining 2 percent are employed by a governmental agency or are engaged in some other dental activity, such as taking advanced training. Approximately 15 percent (71) of the survey respondents reported that they had completed one or more years of advanced training after receiving the dental degree. Fifty-four dentists reported the completion of a year or more of advanced academic training as graduate or post- graduate students, and 24 dentists had completed clinical training as interns or residents. Dentists reporting on time spent in providing patient care during the year preceding the survey devoted an aver- age of 43.2 hours per week to this activity for 48.0 weeks. One in every four dentists worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. Ten percent of the responding dental practitioners re- ported that they limit their practice to a dental specialty, primarily to orthodontics. Practically all of the limited practitioners are located in the three metropolitan areas and in the two nonmetropolitan counties with central city populations between 10,000 and 24,999. Of the responding dentists who are licensed in Utah but located in other States, more than three-fifths are lo- cated in California. The remaining out-of-State dentists are located in 25 other States, notably in Oregon, Idaho, Nevada and Arizona. March 1969. 541 hs APPENDIX TABLE Selected Data on Dentists in Utah, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total P respond- Under 55 & sionally (in 000's) active ents . . ents 35 over active dentist All counties 598 480 118 137 131 553 998.0 1,805 Metropolitan areas™ 486 387 99 109 103 453 759.3 1,676 Salt Lake City area 336 272 64 77 66 312 519.7 1,666 Davis 39 34 5 10 5 37 82.3 2,224 Salt Lake 297 238 59 67 61 275 437 .4 1,591 Ogden area 86 65 21 22 21 82 121.6 1,483 Weber 86 65 21 22 21 82 121.6 1,483 Provo-Orem area 64 50 14 10 16 59 118.0 2,000 Utah 64 50 14 10 16 59 118.0 2,000 Nonmetropolitan counties’ 112 93 19 28 28 100 238.7 2,387 Central city 10,000-24,999 42 34 8 10 7 38 75.4 1,984 Box Elder 17 15 2 5 2 15 34.5 2,300 Cache 25 19 6 5 5 23 40.9 1,778 Ens APPENDIX TABLE (cont'd.) Selected Data on Dentists in Utah, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population=" per and county Total respond- Under 55 & sionally (in 000's) active ents . . ents 35 over active dentist Nonmetropolitan countiesd’ (cont'd.) Central city 5,000-9,999 31 26 5 7 12 28 60.6 2,164 Carbon 7 6 1 - 5 6 19.5 3,250 Iron 8 7 1 - 4 6 11.3 1,883 Tooele 5 5 - 1 1 5 19.3 3,860 Washington 11 8 3 6 2 11 10.5 955 Central city 2,500-4,999 19 17 2 4 5 16 38.8 2,425 Grand 5 5 - 1 1 4 7.8 1,950 Juab 1 1 - - 1 1 3.9 3,900 Sevier 5 4 1 1 1 4 9.9 2,475 Uintah 4 3 1 - 1 3 12.1 4,033 Wasatch 4 4 - 2 1 4 5.1 1,275 Central city under 2,500 20 16 4 7 4 18 63.9 3,550 Beaver 3 1 2 1 2 3 4.1 1,367 Daggett - - - - - - 1.5 - Duchesne 2 2 - 1 - 2 6.7 3,350 Emery - - - - - - 5.1 - Garfield 1 1 - 1 - 1 3.3 3,300 Kane 1 1 - - - 1 2.7 2,700 Millard 3 2 - 2 7.2 3,600 APPENDIX TABLE (cont'd.) 7s Selected Data on Dentists in Utah, By Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total respond- Under 55 & sionally (in 000's) active ents . ents 35 over active dentist Nonmetropolitan counties’ (cont'd.) Central city under 2,500 (cont'd.) Morgan 1 1 - - - 1 2.9 2,900 Piute - - - - - - 1.3 - Rich - - - - - - 1.7 - San Juan 3 3 - 2 - 3 10.8 3,600 Sanpete 4 4 - 1 - 4 9.9 2,475 Summit 2 1 1 1 1 5.2 5,200 Wayne - - - - - - 1.5 - 1/ Copyright 1965. Sales Management Survey of Buying Power. 2/ Utah counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. 3/ Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the latest 1960 population of the largest (central) city within each county. VERMONT DENTISTS LICENSED IN VERMONT A total of 252 dentists registered with the Vermont Board of Dental Examiners in 1965 (Table 1). Of this total, 218 completed the question- naire, for an overall response rate of 87 percent. The response rate for dentists actually located in Vermont was somewhat higher, since non- response was more frequent for those who were outside the State or on active duty with the Armed Forces. Table l.--Location and Military Status of Dentists Licensed in Vermont . Number Percent Location and of of military status dentists dentists Total 252 100 Respondents 218 87 Nonrespondents 34 13 Respondents 218 100 Civilians in Vermont 157 72 Civilians in another State 48 22 On active duty with Armed Forces 10 5 Not reported 3 1 As it was, more than a fourth of those responding are located outside the State. Nearly 50 are in another State or abroad and 10 dentists are on active duty with the Armed Forces. Of those located in another State, only five reported that they had formerly been located in Vermont. Nearly 400 individual State licenses are held by dentists responding in the survey. About three-fifths of all licensed respondents hold licenses in one or more additional States. This total includes 12 percent who are licensed in two other States and 5 percent who hold licenses in three or more additional States. Table 2.--Percent Holding Licenses in Other States Licensed Civilian dentists Armed Li hel icenses held dentists In Vermont Out-of-State Forces All respondents 100 100 100 100 Vermont only 41 52 - 60 Licensed in 1 other State 42 38 56 30 Licensed in 2 other States 12 8 31 - Licensed in 3 or more States 5 2 13 10 545 Although the majority of State licenses are held by dentists located out- side the State, multiple licensure is very common among Vermont's own dentists as well. Nearly half of all dentists located in Vermont are licensed in one or more additional States--38 percent in one other State, 8 percent in two others, and 2 percent in three or more States. Civilian Dentists in Vermont Sources of Supply Dental schools.--Graduates of 23 dental schools are represented among Vermont's dentists, including graduates of one Canadian school. Almost half of all dentists in the State, however, are graduates of Tufts (31 per- cent) or of Maryland (15 percent). Pennsylvania and McGill, with 11 grad- uates each, account for another 14 percent of the total. Of the remainder, 22 percent are accounted for by the five remaining schools--Georgetown, Temple, New York, Harvard and Nebraska--which have contributed 5 or more dentists to the State. In recent years Georgetown has joined Tufts and Maryland as one of the principal sources of the State's dentists. These three schools account for about 73 percent of all Vermont dentists who are graduates of the last 10 years. Table 3.--School Awarding Dental Degree, by Year Awarded Number Year of graduation Dental school of sears After 1941- 1940 or dentists 1955 1955 earlier Total number 157%/ - 32 63 59 (percent distribution by school) Tufts 48 31 44 29 25 Maryland 24 15 13 13 15 Pennsylvania 11 7 3 11 5 McGill 11 7 - 11 7 Georgetown 9 6 16 3 3 Temple 7 4 9 6 - New York 7 4 3 5 5 Harvard 6 4 - 2 8 Nebraska 6 4 - 2 8 Other schools 25 17 12 18 24 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item. 546 Dentists relocating in Vermont.--Vermont has a relatively large number of dentists who have relocated from another State. About a fourth of all dentists currently located in Vermont report that they had previously been located elsewhere (Table 4). Nearly a third of these in-migrant dentists had moved from Massachusetts or other New England States. Among the 16 other States surrendering dentists to Vermont, only New York and New Jersey contributed a significant number. Table 4.--In-migrant Dentists Number Percent Last previous location of of dentists dentists Total 157 100 Previously located elsewhere 41 26 Massachusetts 6 4 New Jersey 5 3 New York 5 3 Other 25 16 Never located elsewhere 116 74 Personal Characteristics Age and sex.--Vermont's dentists ranged in age from 27 to 86 in 1965. Their median age was 46.8. Approximately 30 percent of all dentists in Vermont were 55 years old or over (Table 5). Fifteen percent had Table 5.--Sex and Age Number Percent Sex and ae of od dentists dentists Total 157 100 Male 154 99 Female 3 1 Age Under 30 5 3 30 - 34 15 10 35 - 39 24 16 40 - 44 26 17 45 - 49 24 16 50 - 54 12 8 55 - 59 17 11 60 - 64 7 4 65 - 69 13 8 70 - 74 4 3 75 & over 7 4 547 reached 65 years of age. Included among the 24 dentists who made up the group were 11 dentists who were 70 years old or over, seven of whom had reached 75 years of age. Only 3 of the 157 civilian dentists located in the State were women. Because they are so few in number, data are not presented separately by sex. Advanced training.--Approximately 28 percent of Vermont's dentists have had some kind of advanced training (Table 6). Twenty-three percent have had advanced clinical training and 9 percent have completed at least one year of advanced academic training. Table 6.--Advanced Training Highest level of training Number Fereent completed dentists dentists Total 157 100 With advanced training 44 28 With no advanced training 113 72 Clinical training Residency completed 5 3 Internship completed 31 20 Academic training Ph.D., M.D., or other doctors 1 1 M.A., M.S., or other masters 2 1 Postgraduate 1 year or more (no degree) 11 7 Distribution and Current Status Distribution of dentists.--The largest concentration of dentists in Vermont is in Chittenden County, the largest county in the State (Table 7). Twenty- five percent of the State's dental force are located in this county, most of them in the city of Burlington. The four other counties in the State which contain a city of 10,000 or more residents--Rutland, Washington, Windham, and Bennington counties-- account for 43 percent of the State's total dental force. About 26 per- cent are located in the five counties with central cities of from 5 to 10 thousand population. Only six percent are located in counties in which all towns have fewer than 5,000 residents. One of the four counties in this size category--Grand Isle--has no dentists reporting. 548 Table 7.--Distribution, by County Group Number Total dentists Age distribution County size category of ————————— Under 40- 55 & counties Number Percent 40 54 over All counties 14 157 100 29 40 31 Central city 25,000-49,999 1 39 25 38 49 13 Central city 10,000-24,999 4 67 43 27 40 33 Central city 5,000-9,999 5 40 26 23 31 46 Central city under 5,000 4 10 6 30 50 20 Active dentists in relation to population.--Nearly all dentists in Vermont report that they are active in the profession. About 92 per- cent are engaged in private practice and one percent are in other dental employment. The remaining 7 percent are either fully retired or are engaged exclusively in some nondental employment. Overall, there was one professionally active dentist for every 2,695 persons in the State (Table 8). Table 8.--Distribution of Active Dentists Active Civilian Persons County size category civilian . per dentists population dentist Total 147 396,200 2,695 Central city 25,000-49,999 38 80,500 2,118 Central city 10,000-24,999 62 146,200 2,358 Central city under 10,000 47 169,500 3,606 There are four counties in the State with dentist-population ratios more favorable than the State average. By county size group, the ratios range from 2,118 in Chittenden County to an average of 2,358 for counties containing a city of 10,000 to 24,999 and to 3,606 for counties which lack a city of 10,000 or more. 549 Practice Characteristics Use of auxiliaries.--Three in every 4 dentists in active practice report that they employ auxiliary personnel of some type (Table 9). Of the various types of personnel, dental assistants are those most frequently employed. About 63 percent of all practitioners employ an assistant. More than a fourth of all practitioners employ dental hygienists and about a fifth have a secretary or receptionist. Table 9.--Dentists Employing One or More Auxiliaries, by Type of Auxiliary Active Type of auxiliary practitioners Number Percent Total 147 100 With no auxiliary 35 24 With one or more auxiliary 112 76 Number of dentists With assistant 93 63 With hygienist 41 28 With laboratory technician 8 5 With secretary or receptionist 28 19 With other type of personnel 6 4 Laboratory technicians are much less frequently used in dental practice. Only 1 dentist in 20 has a laboratory technician. The use of auxiliaries varies strikingly with the age of dentists (Table 10). The percent with an auxiliary of any type ranges from 40 percent Table 10.--Percent of Dentists Employing Auxiliaries, by Age Percent of age group Age With With With auxiliaries assistants hygienists Under 40 93 81 42 40 - 49 84 76 35 50 - 59 67 48 19 60 & over 40 23 3 550 for those 60 and over to 93 percent for dentists under 40 years old. The percent employing dental assistants ranges from 23 percent for the older group to 81 percent for those under 40. The comparable range for dental hygienists is from three percent for older dentists to 42 percent for the youngest group. Weeks and hours worked.--Of all dentists in practice in Vermont in 1965 (either as self-employed practitioners or as employees of other practic- ing dentists) a total of 139 reported that they had provided patient care in Vermont in the previous year. Approximately 79 percent of this group (110 dentists) reported on the number of weeks and hours they had worked during that year. The percent reporting was relatively low, however, for those 55 years old and over and, since those not respond- ing were likely to be those who are least active, the estimates on time worked by dentists in the upper age range are probably high. Even so, the figures presented in Table 11 show how activity tapers off among older dentists. Only about three-fifths of those 55 to 64 years old reported that they worked an average of 40 hours or more for 48 weeks or more out of the year, and for those 65 years and over, this fraction dropped to two-fifths. Table 1l.--Patient Care Activity Last Year, by Age Percent of those reporting Age group umber recent 48 weeks or more Part year or less P 8 P & 40 hrs/wk or more than 40 hrs/wk Total 110 79 63 37 Under 45 58 88 67 33 45 - 54 30 94 63 37 55 - 64 12 55 58 42 65 & over 10 59 40 60 April 1966. 551 386-029 O - 70 - 36 Appendix Table A.--County Data Civilian Active Persons Percent of active dentists County population civilian per Under 55 years Using (in 000's) dentists dentist 40 or more auxiliaries All counties 396.2 147 2,695 30 10 76 Addison 20.4 7 2,914 14 14 71 Bennington 25.5 11 2,318 36 18 73 Caledonia 22.1 4 5,525 25 - 75 Chittenden 80.5 38 2,118 37 5 79 Essex 5.9 2,950 - 50 50 Franklin 29.2 8 3,650 38 - 50 Grand Isle 2.7 - - - - - Lamoille 10.9 3 3,633 - - 33 Orange 15.5 5 3,100 60 - 100 Orleans 19.6 3 6,533 - 33 33 Rutland 47.6 20 2,380 35 5 80 Washington 42.9 15 2,860 20 20 73 Windham 30.2 16 1,888 25 19 94 Windsor 43.2 15 2,880 27 - 80 552 VIRGINIA DENTISTS LICENSED IN VIRGINIA During the 1965 registration period, 2,325 dentists registered with the Virginia State Board of Dental Examiners (Table 1). Sixty-eight percent of the registrants are civilians located in Virginia, another 25 percent are civilians located in other States, and 7 percent are on active duty in the Armed Forces. Table l.--Location and Military Status Location and All percent military status dentists dentists Total licensed 2,325 100 Respondents 2,232 96 Nonrespondents 93 4 Total licensed 2,325 100 Civilians in Virginia 1,580 68 Respondents 1,527 - Nonrespondents 53 - Civilians in another State 572 25 On active duty with Armed Forces 168 7 Not reported 5 * * Less than one-half of one percent. The survey questionnaire was completed by 2,232 dentists, 96 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location, age, dental school attended and year of graduation for dentists not respond- ing to the survey. Information on nonrespondents was obtained either from records maintained by the Virginia State Board of Dental Examiners or from the 1966 American Dental Directory published by the American Dental Association. Of all dentists responding to the survey, about 48 percent hold a license to practice dentistry in one or more other States. Almost one-third of the dentists located in Virginia hold more than one license, with 24 per- “cent licensed in one other State and only 7 percent licensed in two or more other States. The proportion of out-of-State respondents holding 553 multiple licenses is considerably greater; more than one-fourth hold two or more licenses’in addition to their Virginia license. Civilian Dentists in Virginia Sources of Supply Dental schools.--The great majority of Virginia's dentists, 63 percent, are graduates of the Medical College of Virginia (Table 2). Another 22 percent are graduates of 10 dental schools located in 5 adjacent States--Maryland, West Virginia, Kentucky, Tennessee, North Carolina-- and the District of Columbia. Among these schools, Georgetown University, the University of Maryland and Howard University have made notable con- tributions to Virginia's dental force, having together supplied the State with 16 percent of its dentists. Other schools in these States contribut- ing as many as 20 dentists to the Virginia supply are the University of Tennessee and Meharry Medical College. The remaining 15 percent of the State's dentists are graduates of 37 dental schools located in 17 more distant States and Canada. Emory and Northwestern Universities and the University of Pennsylvania are the largest contributors among these schools. Table 2.--Dental School Attended Dental school Number Percent ttended of of a dentists dentists Total 1,580 100 Medical College of Virginia 986 63 Schools in surrounding area 343 22 Georgetown University 105 7 University of Maryland 80 5 Howard University 67 4 University of Tennessee 28 2 Meharry Medical College 25 2 5 other schools 38 2 37 more distant schools 243 15 1l/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire, or, in the case of nonrespondents, due to the data not being obtainable for all dentists. For each item where percentages are shown, they are based on the number of dentists for whom the data are known. (See Appendix Table A.) 554 In recent years Virginia's dentists have tended to come increasingly from either the State's own dental school or other schools located nearby. The proportionate contribution of the Medical College of Virginia to the State's total supply has increased slightly from 60 percent of all den- tists currently located in the State who graduated before World War II to 67 percent of those who graduated within the last 10 years. Similarly, there has been a modest increase in the contribution of dental schools in adjoining States and the District of Columbia. Conversely, the proportion of dentists who received their dental degrees from schools in more distant States or in Canada has declined from 21 percent among graduates during the period before World War II to only 10 percent among those completing their dental education during the past 10 years. Dentists relocating in Virginia.--Six percent of the respondents practiced as civilian dentists in one of 25 other States, the District of Columbia or Puerto Rico immediately prior to assuming their present Virginia loca- tion. More than one-half of the 93 in-migrant dentists came from another Southern State, including one in every four who moved to Virginia from North Carolina or West Virginia and one in every seven who came from Maryland or the District of Columbia. Personal Characteristics Age.--Virginia's dentists are a relatively young group, with a median age of 42.4 years. Slightly over one-fourth of the dentists are under the age of 35, a third are between 35 and 44, and a fifth are 45 to 54 years of age (Table 3). Although only 9 percent of the dentists are 65 years old or over, this group of 142 dentists includes 44 who are 70 to 74 years old and 25 who have reached the age of 75. Table 3.--Age Distribution Number Percent Age in 1965 of of dentists dentists Total 1,580 100 Under 35 412 26 35 - 44 513 33 45 - 54 320 20 55 - 64 183 12 65 & over 142 9 A relatively large proportion of survey nonrespondents are in the older age groups. About 22 percent of the nonresponding dentists are 65 or over, more than twice the proportion of respondents in this age group. Moreover, the median age of dentists not responding to the survey is 45.0 years, almost 3 years higher than that of respondents. 555 Advanced training.--Twenty percent of the survey respondents, about 300 dentists, reported they had completed one year or more of advanced train- ing beyond their dental degree. Of the 189 dentists with advanced clinical training, 60 completed a residency and 129 an internship. Among the 183 dentists who reported advanced academic training, 78 earned a master's or other advanced degree, and another 105 received no additional degrees but completed one or more years of postgraduate study. The pre- ceding figures include 70 dentists who completed both clinical and academic training. Distribution and Current Status Distribution of dentists.--Virginia's dentists are unevenly distributed geographically, with two-thirds of the dental force concentrated in the six metropolitan areas of the State (Table 4). These metropolitan areas, which include 11 counties and 13 independent cities, are based on Stand- ard Metropolitan Statistical areas as established by the U.S. Bureau of the Budget. For example, the Richmond area includes Henrico, Chester- field and Hanover Counties and the independent cities of Richmond and Colonial Heights. Appendix Table B specifies the counties and independent cities included in each metropolitan area. Table 4.--Distribution and Median Age Number Percent Area of of Median dentists dentists age Total 1,580 100 42 4 All metropolitan areas 1,048 66 41.8 Northern Virginia area 314 20 39.1 Richmond area 289 18 43.4 Norfolk-Portsmouth area 216 14 42.7 Roanoke area 93 6 44.2 Newport News-Hampton area 87 5 40.6 Lynchburg area 49 3 43.3 All nonmetropolitan areas 532 34 43.5 Central city 10,000-49,999 258 16 43.4 Central city 2,500-9,999 153 10 42.9 Central city under 2,500 121 8 42 4 The greatest concentration of dentists, one-fifth of all those in the State, is in the Northern Virginia area, which comprises the Virginia part of the Washington, D.C. metropolitan area. The Richmond metro- politan area has the second largest dental force in the State, 556 18 percent of the total supply, and the Norfolk-Portsmouth area, with 14 percent of the total, has the third largest dentist supply. The three remaining metropolitan areas--Roanoke, Newport News-Hampton, and Lynch- burg--account for another 14 percent of the State's dentists. The remaining one-third of the State's dentists are located in the 85 counties and 21 independent cities not included within a Standard Metro- politan Statistical area. Because the independent city frequently is the center of health services for a county, each independent city has been combined with a county for presentation of the survey data. For example, Albemarle County and the independent city of Charlottesville have been combined to form one nonmetropolitan area. See Appendix Table B for combinations of counties and independent cities forming other nonmetropol- itan areas. The 85 nonmetropolitan areas listed in the table consist of 19 counties combined with one or more independent cities and 66 single counties. If the nonmetropolitan areas are grouped according to the population of the central (largest) city located within the area, the number of dentists in an area generally declines as the population of the central city decreases. Sixteen percent of the State's dentists are located in the group of 13 nonmetropolitan areas with central cities of at least 10,000 persons. Only one of these areas has less than 10 dentists, three areas have at least 30 dentists, and another four areas have 20 or more. Ten percent of the dentists are located in the group of 20 nonmetropolitan areas with central cities of 2,500-9,999 population. Among these areas, five have at least 10 dentists and only three have less than 5 dentists. The remaining 8 percent of the State's dental force, or 121 dentists, are scattered among 52 single counties with less than 2,500 persons in their central cities. Only one county in this group has as many as 10 dentists, and 32 counties have no more than 2 dentists, including 9 counties--Amelia, Buckingham, Charles City, Craig, Cumberland, King and Queen, Rappahannock, Stafford and Surry--which have no dentists according to available informa- tion. Geographical differences in age.--The median age of dentists in metropol- itan areas is 41.8 years, almost two years younger than the median of 43.5 years for dentists in the nonmetropolitan areas (Table 4). Furthermore, there are even greater differences in age among the metropolitan areas. Northern Virginia has the youngest dentists, with a median age of 39.1 years. Almost one-third of the dentists in this area are under 35 years of age, and only 3 percent are 65 or over. Newport News-Hampton also has relatively young dentists, with a median age of 40.6 years. As a group dentists in the Roanoke area are the oldest, with less than one-fourth under 35 and 12 percent having reached the age of 65. 557 Active dentists in relation to population.--Ninety-eight percent, or 1,551, of the licensed dentists in Virginia were active in their profession at the time of the survey. The remaining two percent includes 24 responding den- tists who are retired or engaged principally in a nondental activity, and 5 nonresponding dentists known to be 70 years of age or older. Based on these data, Virginia had one professionally active dentist for every 2,799 persons in the State in 1965. The six metropolitan areas in Virginia together have 66 percent of the State's active dentists, and only 57 percent of its population. This dis- proportionate distribution of dentists in relation to population results in a persons-per-active dentist ratio of 2,388 for the metropolitan areas, compared to an average of 3,614 for the nonmetropolitan areas (Table 5). Among the metropolitan areas, Richmond has the most favorable persons-per- dentist ratio, 1,784. The Roanoke, Northern Virginia and Lynchburg areas also have fewer persons per dentist than the State average--1,999, 2,375, and 2,455, respectively. The remaining two metropolitan areas, Norfolk- Portsmouth and Newport News-Hampton, each have one dentist for approxi- mately 3,100 persons. Table 5.--Number of Persons Per Dentist Professionally Persons Area active Population per dentists dentist Total 1,551 4,341,600 2,799 Metropolitan areas 1,031 2,462,300 2,388 Richmond area 283 504,800 1,784 Roanoke area 89 177,900 1,999 Northern Virginia area 312 740,900 2,375 Lynchburg area 49 120,300 2,455 Newport News-Hampton area 85 259,300 3,051 Norfolk=-Portsmouth area 213 659,100 3,094 Nonmetropolitan areas 520 1,879,300 3,614 Central city 10,000-49,999 253 710,000 2,806 Central city 2,500-9,999 149 520,400 3,493 Central city under 2,500 118 648,900 5,499 Among the nonmetropolitan areas with active dentists, the persons-per- dentist ratios range from 1,400 in Highland County to 15,200 in Patrick County. The average ratio for nonmetropolitan areas, when grouped accord- ing to size of central city, increases as the size of the central city decreases. The group of 13 nonmetropolitan areas with central cities of 10,000-49,999 population have a ratio of 2,806, a figure comparable to the average for the State. Frederick County combined with the independent city 558 of Winchester, with one dentist for every 1,990 persons, is the only area in this group with a ratio under 2,000. In contrast, there are two areas having more than 4,000 persons per dentist, Pulaski County with a ratio of 4,650 and the combined area of Washington County and the independent city of Bristol with a ratio of 4,842. The 20 nonmetropolitan areas with 2,500 to 9,999 persons in their central cities together have a persons- per-dentist ratio of 3,493. Among these areas, only Warren County, with one dentist for every 1,611 persons, has a ratio less than 2,000. Three of the areas in this group, Mecklenburg, Page and Bedford Counties, have ratios in excess of 5,000 persons per dentist. The remaining 52 nonmetropolitan areas in the State, consisting of single counties with central cities of less than 2,500 population, have the high- est average ratio, 5,499. Only four of these counties have ratios under 2,000--Highland, Middlesex, Essex, and Northampton. Exclusive of 9 coun- ties which apparently have no dentists, 24 counties have more than 5,000 persons per dentist, including 7 with ratios of 10,000 or more. In addi- tion to Patrick, these counties are Floyd (10,000), Northumberland (10,200), Westmoreland (11,400), Louisa (13,000), Caroline (13,300), and Lunenburg (13,700). Professional Activity Current employment.--Ninety-three percent of the 1,503 responding dentists who reported that they were professionally active at the time of the sur- vey are primarily engaged in private practice, with 92 percent self-employed and one percent employed by another dentist (Table 6). About two percent are on the staff of the dental school at the Medical College of Virginia and another three percent are employed by governmental agencies. The remaining two percent are engaged in some other dental activity, such as taking advanced training. Table 6.--Current Employment of Professionally Active Dentists Principal Secondary 1/ Type of employment emp loymen t= employment Number Number Percent employed Percent employed of total Total 1,503 100 155 10 Self-employed 1,379 92 6 * Employed by other dentist 20 1 9 1 Staff of dental school 28 2 68 5 State or local government 46 3 35 2 Federal government 8 * - - Voluntary agency - - 18 1 Other dental employment 30 2 26 2 1/ Individual items add to more than total because some dentists reported more than one type of secondary employment. * Less than one-half of one percent. 559 At least one part-time dental activity in addition to their principal em- ployment was reported by 155 dentists. Sixty-eight of these dentists said they were employed part-time on the staff of the dental school. The num- ber of dentists so engaged is more than twice the number reporting their principal activity as a faculty appointment. Another 35 dentists reported working part-time for a State or local government agency, which almost equals the number reporting government employment as their principal activ- ity. Other secondary activities less frequently reported include employ- ment by another dentist and working for a voluntary agency. Activity last year.--Of all dentists reporting their professional activity in Virginia last year, 96 percent said they provided care for patients. An equal percentage of total professional time was spent in providing patient care. Seven percent of the dentists reported they spent some time in teaching and one percent reported some time in research, but only 2 per- cent of total professional time was spent in these activities. While 5 per- cent of the dentists spent time in some other dental activity, such as taking additional training, only 2 percent of the total professional time was spent in these activities. Dentists reporting on time spent last year in providing patient care devoted an average of 47.7 weeks to this activity and worked an average of 39.7 hours per week. Dentists who worked all year spent longer hours pro- viding patient care than did those who worked only part of the year. Almost 70 percent of the dentists spending 48 weeks or more in patient care worked 40 or more hours per week, while only a little over one-half of those working less than 48 weeks spent as many hours each week providing care. The amount of time worked last year by dentists in private practice declined sharply with age. Over 60 percent of the dentists under 40 years of age reported they worked at least 40 hours per week for 48 weeks or more. The proportion working this amount of time declines to 55 percent for dentists between 40 and 54 years old, and to only 38 percent for those 55 and over. Practice Characteristics Limited practices.--Among dentists reporting type of practice, 179, or about one in every seven, limit their practices to a dental specialty. Two-thirds of these dentists reported limiting their practices to one of two specialty areas--40 percent to orthodontics and 27 percent to oral surgery. The metropolitan areas have a large share--over four-fifths--of the den- tists who limit their practices. One in every 6 dentists practicing in a metropolitan area limits his practice, whereas in nonmetropolitan areas, only one in every 17 dentists does so. In both the Northern Virginia and Richmond areas, one dentist in every five limits his practice to a 560 specialty. These two metropolitan areas taken together have over one- half of the State's limited practitioners and over three times as many as all nonmetropolitan areas combined. Use of auxiliaries.--About 88 percent of the dental practitioners (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 7). The vast majority, 81 percent, of the practitioners employ at least one auxiliary full time, while only 7 percent employ part-time auxiliaries exclusively. Dental assistants are the most frequently employed auxiliary, usually on a full-time basis. Approximately 80 percent of the practitioners employ an assistant, including 73 percent who do so full time. Secretaries or receptionists are employed by 31 percent of the dentists, and a majority of these den- tists employ at least one of them full time. Dental hygienists and labor- atory technicians are much less frequently employed than are assistants and secretaries, and they are more likely to be employed on a part-time basis compared to other auxiliary personnel. While 12 percent of all dentists employ dental hygienists and 5 percent employ dental technicians, about three-fifths and two-fifths, respectively, of the dentists employ- ing these auxiliaries do so on a part-time basis. Table 7.--Dental Practitioners Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of Dental With one full- With only auxiliary practitioners Total time employee part-time (or more) personnel Total 1,465 100 81 7 With one or more auxiliaries 1,242 88 81 7 With assistant 1,136 80 73 7 With hygienist 174 12 5 7 With laboratory technician 69 5 3 2 With secretary or receptionist 440 31 22 9 With other type personnel 41 3 1 2 With no auxiliary 172 12 - - The use of auxiliaries varies with the age of the dentist and is more fre- quent among young practitioners. Ninety-three percent of the dental practitioners between the ages of 30 and 44 employ some type of auxiliary. However, the proportion of practitioners utilizing auxiliaries decreases to 87 percent among dentists 45 to 64 years old and drops to 60 percent among dentists 65 and over. Although dentists in the nonmetropolitan areas are almost as likely to employ auxiliaries as are those located in the metropolitan areas, the use of dental hygienists is considerably more common in the metropolitan areas 561 than in the remainder of the State. About 18 percent of the dentists in the metropolitan areas report the employment of a hygienist, compared to only 4 percent of dentists located elsewhere. There are also consider- able differences among the metropolitan areas in the frequency with which hygienists are employed. In the Northern Virginia area, more than one- third of the practitioners employ at least one hygienist, compared to only 11 percent of the dentists in the Norfolk-Portsmouth area and 8 percent of those in the Richmond area. Out-of-State Civilian Dentists Virginia licenses are maintained by at least 572 dentists located in 35 other States, the District of Columbia or Puerto Rico. Approximately one-half of the out-of-State dentists are located in adjacent States and the District of Columbia, including 23 percent who are currently located in North Carolina and 12 percent located in the District. An additional one-fourth of these dentists are located in other Southern States, the largest number in Florida. Forty-three percent of the out-of-State den- tists completed their dental education at the Medical College of Virginia, and another 17 percent are graduates of dental schools in the District of Columbia. About one in every seven out-of-State respondents reported that they had been professionally active in Virginia immediately prior to assuming their present location in one of 24 other States or the District of Columbia, most frequently North Carolina, the District, or West Virginia. October 1967. 562 Appendix Table A.--Summary Statistics for Virginia Total Responding Nonresponding dentists dentists dentists Total dentists licensed in Virginia 2,325L/ 2,232L/ 932/ Civilian dentists in Virginia>/ (desig- nated simply as 'dentists" in text tables) 1,580 1,527 53 Professionally active dentistse/ 1,551 1,503 48 Dental practitioners>’ - 1,465 - In limited practice? - 179 - Located in Virginia last year: Reported professional activityl/ - 1,372 - Dentists providing patient care?! - 1,320 - Repog ed time spent in patient care— - 1,094 - Dentists in private practicet - 1,238 - Reported time spent in prac- tice== - 1,204 - Civilian dentists in another State 572 539 33 Dentists on active duty in Armed Forces 168 161 7 1l/ Includes 5 dentists not reporting current location or military status. 2/ Data for nonresponding dentists were obtained from the Virginia Board of Dental Examiners, and from the 1966 American Dental Directory pub- lished by the American Dental Association. 3/ All dentists who currently work in Virginia (excluding those in the Armed Forces) or who are retired and currently live in the State. Data are not available for the following: year of graduation - 47, age - 10, dental school attended - 8. 4/ Includes all responding dentists who reported they were professionally active in Virginia at the time of the survey and all nonrespondents known to be under 70 years of age. 3/ All responding dentists practicing at the chair, that is, dentists who work as clinicians either as primary or secondary activity. 6/ Dentists who reported they limited their practice to a dental specialty. 7/ Dentists located in Virginia last year who indicated type(s) of activ- ity in which they engaged. 8/ All responding dentists who engaged in patient care last year, either as a primary or a secondary activity. 9/ Dentists reporting both hours and weeks spent in patient care last year. 10/ Dentists who reported they were primarily self-employed both currently and last year. 11/ Dentists reporting both hours and weeks spent last year as a self- employed dentist. 563 79% Appendix Table B.--Selected Data on Dentists in Virginia, by Location Civilian dentists 1 Persons Area group Respond- Non- Age in 1965 Profes- Population per and area Total Pp respond- Under 55 years sionally (in 000's) active ents . ents 35 or more active dentist All areas 1,580 1,527 53 412 325 1,551 4,341.6 2,799 Metropolitan areas2/ 1,048 1,012 36 283 193 1,031 2,462.3 2,388 Northern Virginia area 314 307 7 98 28 312 740.9 2,375 (Arlington, Fairfax, Prince William and Loudoun Counties and Alexandria%*, Falls Church¥* and Fairfax¥) Richmond area 289 273 16 76 65 283 504.8 1,784 (Henrico, Chesterfield and Hanover Counties and Richmond¥ and Colonial Heights¥) Norfolk-Portsmouth area 216 213 3 52 42 213 659.1 3,094 (Norfolk*, Portsmouth¥, Chesapeake®* and Virginia Beach¥) Newport News-Hampton area 87 82 5 27 19 85 259.3 3,051 (York County and Newport News* and Hampton¥) Roanoke area 93 88 5 21 29 89 177.9 1,999 (Roanoke County and Roanoke*) Lynchburg area 49 49 - 9 10 49 120.3 2,455 (Campbell and Amherst Counties and Lynchburg¥) * Independent city. G9¢ Appendix Table B.-=-Selected Data on Dentists in Virginia, by Location (cont'd.) Civilian dentists 1 Persons Area group Respond- Non- Age in 1965 Profes- Populations/ per and area Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Nonmetropolitan areas>/ 532 515 17 129 132 520 1,879.3 3,614 Central city 25,000-49,999 91 86 5 20 23 920 235.7 2,619 Albemarle County and Charlottesville¥* 30 29 1 7 5 30 65.2 2,173 Dinwiddie County and Petersburg 29 27 2 7 7 28 62.4 2,229 Pittsylvania County and Danville¥* 32 30 2 6 11 32 108.1 3,378 Central city 10,000-24,999 167 165 2 41 40 163 474.3 2,910 Alleghany County and Covington¥* and Clifton Forge¥* 10 10 - 3 3 10 27.9 2,790 Augusta County and Waynesboro% and Staunton¥ 33 33 - 9 8 33 80.9 2,452 Frederick County and Winchester* 21 21 - 4 6 20 39.8 1,990 Henry County and Martinsville* 23 23 - 7 4 23 64.8 2,817 Nansemond County and Suffolk¥ 14 13 1 4 5 14 47.2 3,371 Prince George County and Hopewell%* 12 12 - 2 2 12 40.0 3,333 Pulaski County 8 8 - 1 2 6 27.9 4,650 Rockingham County and Harrisonburg# 21 21 - 6 5 21 57.8 2,752 Spotsylvania County and Fredericksburg¥* 12 11 1 2 3 12 29.9 2,492 Washington County and Bristol* 13 13 - 3 2 12 58.1 4,842 Central city 5,000-9,999 105 101 4 25 29 102 345.9 3,391 Bedford County 5 5 - 2 1 5 31.6 6,320 Carroll County and Galax¥* 11 11 - 1 4 9 29.2 3,244 %* Independent city. 994 Appendix Table B.--Selected Data on Dentists in Virginia, by Location (cont'd.) Civilian dentists 1 Persons Area grou Respond- Non- Age in 1965 Profes- Populations! per a group Total P respond- Under 55 years sionally (in 000's) active and area ents . . ents 35 or more active dentist Central city 5,000-9,999 (cont'd.) Greensville County 5 5 - - 3 5 16.5 3,300 Halifax County and South Boston®* 10 8 2 - 5 10 40.0 4,000 James City County and Williamsburg# 8 8 - 2 3 8 23.0 2,875 Montgomery County and Radford#* 14 13 1 3 3 14 44.9 3,207 Rockbridge County and Buena Vista® 9 9 - 3 1 9 31.1 3,456 Smyth County 8 8 - 1 1 8 32.0 4,000 Southampton County and Franklin® 7 7 - - 3 7 21.6 3,086 Warren County 9 9 - 4 2 9 14.5 1,611 Wise County and Norton¥* 10 10 - 4 1 10 40.2 4,020 Wythe County 9 8 1 3 2 8 21.3 2,662 Central city 2,500-4,999 48 48 - 13 11 47 174.5 3,713 Fauquier County 9 9 = 2 2 9 25.4 2,822 Giles County 4 4 - 1 - 4 16.3 4,075 Mecklenburg County 6 6 - 2 1 6 32.3 5,383 Nottoway County 5 5 - 2 1 5 15.0 3,000 Orange County 4 4 - - 1 4 13.0 3,250 Page County 3 3 - 1 - 3 15.6 5,200 Prince Edward County 7 7 - 1 4 6 13.4 2,233 Tazewell County 10 10 - 4 2 10 43.5 4,350 Central city under 2,500 121 115 6 30 29 118 648.9 5,499 Accomack County 5 5 - - 3 5 29.1 5,820 Amelia County - - - - - - 7.7 - Appomattox County 2 1 1 - - 2 10.2 5,100 Bath County 1 1 - - - 1 4.9 4,900 Bland County 1 1 - 1 - 1 5.8 5,800 * Independent city. LE - OL - O 620-98¢ Appendix Table B.--Selected Data on Dentists in Virginia, by Location (cont'd.) AH Civilian dentists 1 Persons Area group Respond- Non- e in 1965 Profes- Population’ per and area Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Central city under 2,500 (cont'd.) Botetourt County 2 2 - - 1 2 17.0 8,500 Brunswick County 3 3 - - 1 3 17.9 5,967 Buchanan County 4 3 1 2 4 37.3 9,325 Buckingham County - - - - - - 10.2 - Caroline County 2 2 - - 1 1 13.3 13,300 Charles City County - - - - - - 5.9 - Charlotte County 2 2 - 2 - 2 13.9 6,950 Clarke County 2 2 - 1 - 2 8.3 4,150 Craig County - - - - - - 3.2 - Culpeper County 5 5 - 1 1 5 16.0 3,200 Cumberland County - - - - - - 5.9 - Dickenson County 3 3 - - 1 3 18.6 6,200 Essex County 4 4 - 1 4 6.8 1,700 Floyd County 1 1 - - - 1 10.0 10,000 Fluvanna County 2 2 - - 1 2 7.3 3,650 Franklin County 5 5 - 1 1 5 27.5 5,500 Gloucester County 4 4 - 2 1 4 12.7 3,175 Goochland County 2 1 1 - - 2 10.3 5,150 Grayson County 2 2 - 1 1 2 16.7 8,350 Greene County 1 1 - 1 - 1 4.7 4,700 Highland County 2 2 - 1 - 2 2.8 1,400 Isle of Wight County 4 3 1 1 1 4 18.2 4,550 King and Queen County - - - - - - 5.7 - King George County 1 1 - 1 - 1 8.0 8,000 King William County 3 2 - 1 3 7.6 2,533 Lancaster County 3 3 1 1 3 9.0 3,000 Lee County 3 3 - - 1 3 25.6 8,533 Louisa County 1 1 - - - 1 13.0 13,000 Lunenburg County 1 1 - - - 1 13.7 13,700 ‘Madison County 3 3 - 2 - 3 8.5 2,833 1 1 1 7.2 Mathews County 7,200 896¢ Appendix Table B.--Selected Data on Dentists in Virginia, by Location (cont'd.) Civilian dentists 1 Persons Area group Respond- Non- Age in 1965 Profes- Populations’ per and area Total respond- Under 55 years sionally (in 000's) active ents . . ents 35 or more active dentist Central city under 2,500 (cont'd.) Middlesex County 4 4 - - 1 4 6.1 1,525 Nelson County 5 5 - 1 1 5 12.6 2,520 New Kent County 1 1 - - 1 1 4.8 4,800 Northampton County 10 10 - 1 1 9 16.8 1,867 Northumberland County 1 1 - - - 1 10.2 10,200 Patrick County 1 1 - 1 - 1 15.2 15,200 Powhatan County 1 1 - 1 - 1 7.7 7,700 Rappahannock County - - - - - - 4.9 - Richmond County 1 1 - 1 - 1 6.4 6,400 Russell County 3 2 1 1 3 27.6 9,200 Scott County 6 6 2 2 6 24.9 4,150 Shenandoah County 9 9 - 3 1 8 22.1 2,762 Stafford County - - - - - - 19.2 - Surry County - - - - - - 6.2 - Sussex County 3 3 - 2 3 12.3 4,100 Westmoreland County 1 1 - - - 1 11.4 11,400 Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. Virginia counties and independent cities included in the latest 1967 definition of Standard Metropolitan Statistical areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for the presentation of the survey data. Statistics are presented only for dentists located in the Virginia portion of the Washington, D.C. SMSA. Nonmetropolitan areas have been grouped according to the 1960 population of the largest (central) city in each area. Independent cities have been combined with the counties in which they are located or, in the case of those bordering two counties, with an adjacent county. These combinations are based on those used in Sales Management and other publications. WASHINGTON DENTISTS LICENSED IN WASHINGTON During the 1965 registration period, 2,760 dentists registered with the Washington State Board of Dental Examiners. About 71 percent of the registered dentists were civilians located in Washington, 27 percent were civilians located in other states and 2 percent were on active duty with the armed services. Of the 734 dentists licensed in Washington but located in other states at the time of the survey, more than one-third were in California and another one-fourth were located in Oregon. Location and Military Status of Dentists Licensed in Washington Location and All Percent of military status dentists dentists Total licensed 2,760 100 Respondents 2,085 76 Nonrespondents 675 24 Total licensed 2,760 100 Civilians in Washington 1,968 71 Respondents 1,531 - Nonrespondents 437 - Civilians in other states 734 27 On active duty with armed services 48 2 Not reported 10 * * Less than one-half of one percent. The survey questionnaire was completed by 2,085 dentists, 76 percent of all those registered. The data provided by the survey respondents has been supplemented, when obtainable, by information on location as well as age, dental school attended and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained either from records maintained by the Washington State Board of Dental Examiners or from the 1966 American Dental Directory published by the American Dental Association. 569 PROFESSIONAL TRAINING More than two-thirds of the 1,968 dentists in Washington are graduates of the dental schools located at the University of Washington and the Univer- sity of Oregon, each school having contributed approximately one-third of the dental force. Since 1950, however, when the University of Washington graduated its~first class, this school has become the primary source of dentists, accounting for two of every three dentists in the State who com- pleted their dental education during the ensuing years. In contrast, the University of Oregon's contribution has declined sharply from 64 percent of Washington dentists graduating prior to 1950 to 10 percent of those gradu- ating since that time. Dentists who graduated from other schools located in the West account for only four percent of the State supply. Almost one-fourth of Washington's dentists are graduates of 18 schools in the North Central States. Among these schools, Northwestern University and the University of Minnesota have been the principal contributors, each sup- plying approximately 4 percent of the total dental force. The relative contribution of schools in the North Central States has decreased somewhat since Washington's own dental school began providing dentists for the State. Dental School Attended and Year of Graduation of Dentists in Washington Number Year of graduation Dental school of All 1950 and Prior to attende dentists years later 1950 Total number 1,968% 1,904 976 928 (Percent distribution by school) West 1,409 73 77 69 University of Washington 636 33 65 - University of Oregon 700 36 10 64 7 other schools 73 4 2 5 North Central 432 23 19 26 Northwestern University 77 4 3 5 University of Minnesota 76 4 2 6 Marquette University 50 3 3 2 15 other schools 229 12 11 13 Other regions (26 schools) 81 4 4 5 1/ Dental school attended not available for 46 dentists and year of gradu- ation for 26 dentists. Percents are based on known totals. About 15 percent of the survey respondents, or 232 dentists, reported they had completed one year or more of advanced training beyond receipt of their dental degree. A total of 125 dentists have received advanced clinical training as interns or residents and 150 have completed at least one year of advanced academic work as graduate or postgraduate students. These figures include 43 dentists who completed both academic and clinical training. 570 DISTRIBUTION OF DENTISTS More than seven-tenths of all licensed dentists in Washington are located in the four metropolitan areas of the State. The Seattle-Everett area alone has one-half of the dental force, 974 dentists, with the vast major- ity (863) located in King County, which contains Seattle, and the remainder (111) located in Snohomish County, containing the city of Everett. The adjacent Tacoma area and the more distant Spokane area have the next larg- est dental forces, each accounting for about one-tenth of the State's dentists. The Vancouver area (Clark County), which is part of the larger interstate Portland metropolitan area, accounts for 3 percent of Washing- ton's dentist supply. Distribution of Washington Dentists, by County Group 1/ Number Number Percent County group— of of of counties dentists dentists All counties 39 1,9682 100 All metropolitan areas 5 1,411 72 Seattle-Everett area 2 974 50 Spokane area 1 201 10 Tacoma area 1 181 9 Vancouver area 1 55 3 All nonmetropolitan counties 34 550 28 Central city 10,000-49,999 13 401 20 Central city under 10,000 21 149 8 1/ See Appendix Table for definition of metropolitan areas and presentation of individual county data. 2/ County location not available for 7 dentists. Some 28 percent of the State's dentists are located in the 34 nonmetro- politan counties. Almost three-fourths of these dentists are concentrated in the 13 counties with at least 10,000 persons in their central cities. Some of these counties have fairly substantial dental forces. Yakima County, for example, has 70 dentists, and three other counties--Whatcom, Thurston and Kitsap--each have more than 40 dentists. Only 3 of the remain- ing counties in this group have less than 20 dentists. The 21 counties with central cities of less than 10,000 population have only 8 percent of the State's dentists. Among these counties, only 2 have more than 20 dentists, while 15 have less than 10, including 7 counties with fewer than 3 dentists. 571 AGE OF DENTISTS With more than one-half of the dentists under 45 years of age, the median age of dentists in Washington is 44.0 years. One-fifth of the State's dentists are under 35, yet over one-fourth are 55 years of age or older. Fifteen percent, or 272 dentists, are at least 65 years old, including 145 who have reached the age of 70. Slightly more than one-half of all dentists in the State are in the age group 35 through 54, with one-third between the ages of 35 and 44. Age Distribution of Washington Dentists Age in Number Percent Cumulative 1965 of of percent dentists dentists distribution Total 1,968 100 - Under 30 106 6 6 30 - 34 273 14 20 35 - 39 293 16 36 40 - 44 332 18 54 45 - 49 214 11 65 50 - 54 144 8 73 55 - 59 119 6 79 60 - 64 116 6 85 65 - 69 127 7 92 70 - 74 90 5 97 75 & over 55 3 100 1/ Age not available for 99 dentists. Percents based on known totals. Median age and proportion of dentists in each age group are almost iden- tical in the metropolitan and nonmetropolitan areas. There is more variation in age, however, among the individual counties. 572 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 1,968 dentists in Washington, 1,858, or 94 percent, are active in their profession, giving Washington one professionally active dentist for every 1,645 persons. There is one dentist for every 1,471 persons in the metropolitan areas, while the remainder of the State has a less favorable ratio of 2,115 persons per active dentist. Number of Persons per Active Dentist in Washington 1/ Professionally Persons County group— active Population per dentists dentist All counties 18582 3,055,900 1,645 All metropolitan areas 1,338 1,968,600 1,471 Seattle-Everett area 926 1,223,000 1,321 Spokane area 189 293,400 1,552 Tacoma area 171 348,900 2,040 Vancouver area 52 103,300 1,987 Nonmetropolitan county group 514 1,087,300 2,115 Central city 10,000-49,999 375 770,800 2,055 Central city under 10,000 139 316,500 2,277 1/ See Appendix Table for individual county data. 2/ County location not available for 6 dentists. The Seattle-Everett metropolitan area has a ratio of one dentist for every 1,321 persons, with King County having the best ratio in the State--1,242 persons per dentist--while Snohomish County has a less favorable ratio of 1,938. The nearby Tacoma area (Pierce County) has one dentist for every 2,040 persons, a ratio similar to that of Snohomish County. The Spokane area has a somewhat better ratio, 1,552 persons per dentist, which compares favorably with the State average. Among the nonmetropolitan counties of the State, the group of 13 counties with central cities of 10,000 or more population has an average of 2,055 persons per dentist, a ratio slightly more favorable than the average of 2,277 persons per dentist found in the group of 21 counties with central cities of less than 10,000 population. The range in individual county ratios is considerably greater; 12 counties have persons-per-dentist ratios under 2,000, yet 7 counties have ratios exceeding 3,000 persons per dentist, including 3 counties with ratios over 4,000 and 1 county with no dentist. 573 UTILIZATION OF AUXILIARIES Eighty-eight percent of the responding dental practitioners in Washington (i.e., dentists who spend any time working at the chair) reported they employ auxiliary personnel. Dental assistants, the most frequently employed auxil- iary, are utilized by 83 percent of all practitioners, including 75 percent who employ at least one assistant on a full-time basis. Secretaries or receptionists are employed by 28 percent of the dentists with about three- fifths of these dentists utilizing such personnel full time. Twenty-one per- cent of the dentists employ dental hygienists and 14 percent employ dental technicians. A majority of the dentists who employ hygienists or technicians do so only part time. Washington Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time employee part-time (or more) employees Total 1,447% 100 81 7 One or more auxiliaries 1,223 88 81 7 Assistant 1,149 83 75 8 Hygienist 286 21 4 17 Laboratory technician 185 14 4 10 Secretary or receptionist 395 28 17 11 Other type of personnel 58 4 1 3 No auxiliary 166 12 - - 1/ Includes 58 dentists who did not report on auxiliary utilization. Employment of auxiliaries varies with the age of the dentist, becoming less frequent among dentists in the older age groups. Approximately 95 percent of Washington dentists between the ages of 30 and 44 employ some type of auxil- iary. The proportion using auxiliaries decreases to 85 percent among dentists 45 to 64 years of age, and to 58 percent among dentists 65 and over. Although dentists in metropolitan areas are no more likely to employ auxiliary personnel than are those located in nonmetropolitan counties, the use of hygienists is much more common in metropolitan areas than in the remainder of the State. About 24 percent of the dentists in metropolitan areas report the employment of hygienists, compared to only 11 percent of those in nonmetropol- itan counties. 574 OTHER SURVEY FINDINGS *%% Ninety-six percent of the professionally active dentists in Washington are primarily engaged in private practice. Another two percent are teaching in a dental school, and the remaining 2 percent are either employed by government agencies or are engaged in other dental activities, such as taking advanced training. %%% At least one part-time dental activity in addition to their principal employment was reported by 11 percent of the den- tists. Nearly one-half of these dentists are on the faculty of a dental school on a part-time basis. The remainder reported a variety of secondary activities, such as part- time employment by a governmental agency, employment in the private practice of another dentist and assistance to a vol- untary agency. %%% Dentists reporting time spent in providing patient care devoted an average of 39.5 hours per week to this activity for 47.9 weeks during the year preceding the survey. About one dentist in seven worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks. *%% About 13 percent of the practitioners reported that they limit their practices to a dental specialty, most frequently ortho- dontics, with pedodontics and prosthodontics the next most frequent areas. Dentists in the metropolitan areas are some- what more likely to limit their practices to a dental specialty than are those in the nonmetropolitan counties. %*%% Sixteen percent of the respondents, 244 dentists, practiced as civilian dentists in one of 40 other states immediately prior to assuming their present Washington location. More than one- third of these dentists moved to Washington from California or Oregon, and another 22 percent came from the North Central States. %*%% Almost 40 percent of the dentists located in Washington are also licensed to practice dentistry in other states. One-third of all out-of-state licenses are held in Oregon and another one-fifth are held in California. Washington dentists are also licensed in 36 other states, primarily the North Central States of Minnesota, Illinois and Iowa. January 1968. 575 9LS APPENDIX TABLE Selected Data on Dentists in Washington, by Location Civilian dentists Persons County group Respond- Non- A in 1965 Profes~ Population— per and County Total P respond- Under 55 years sionally (in 000's) active ents ents 35 or more active dentist All counties 1,968 1,531 437 308 383 1,858 3,055.9 1,645 Metropolitan areas> 1,411 1,100 311 218 276 1,338 1,968.6 1,471 Seattle-Everett area 974 745 229 154 180 926 1,223.0 1,321 King 863 660 203 131 161 821 1,019.5 1,242 Snohomish 111 85 26 23 19 105 203.5 1,938 Tacoma area 181 155 26 30 45 171 348.9 2,040 Pierce 181 155 26 30 45 171 348.9 2,040 Spokane area 201 152 49 24 38 189 293.4 1,552 Spokane 201 152 49 24 38 189 293.4 1,552 Vancouver areas’ 55 48 7 10 13 52 103.3 1,987 Clark 55 48 7 10 13 52 103.3 1,987 Nonmetropolitan counties 550 424 126 85 107 514 1,087.3 2,115 Central city 25,000-49,999 157 130 27 32 24 148 302.0 2,041 Kitsap 41 35 6 11 4 39 81.3 2,085 Whatcom 46 38 8 9 13 43 71.2 1,656 Yakima 70 57 13 12 7 66 149.5 2,265 Central city 10,000-24,999 244 183 61 33 47 227 468.8 2,065 Benton 28 17 11 2 2 28 67.8 2,421 Chelan 30 19 11 3 6 28 41.1 1,468 Clallam 19 14 5 - 4 16 31.8 1,988 Cowlitz 24 20 4 3 5 23 60.8 2,643 Franklin 9 5 4 3 - 9 24.7 2,744 Grant 20 17 3 6 2 19 50.0 2,632 LLS Selected Data on Dentists in Washington, by Location APPENDIX TABLE (cont'd.) Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population— per and county Total J respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist Nonmetropolitan counties (cont'd.) Central city 10,000-24,999 (cont'd.) Grays Harbor 25 21 4 3 7 23 55.3 2,404 Thurston 45 36 9 8 12 42 60.0 1,429 Walla Walla 28 22 6 3 5 25 43.7 1,748 Whitman 16 12 4 2 4 14 33.6 2,400 Central city 5,000-9,999 79 57 22 6 18 76 157.7 2,075 Asotin 6 5 1 2 - 6 13.9 2,317 Jefferson 4 2 2 - 1 4 9.7 2,425 Kittitas 11 8 3 1 2 11 21.9 1,991 Lewis 21 16 5 2 7 21 42.0 2,000 Mason 8 3 5 - 1 6 16.8 2,800 Skagit 29 23 6 1 7 28 53.4 1,907 Central city 2,500-4,999 54 40 14 12 13 48 108.7 2,265 Adams 6 4 2 1 2 6 11.4 1,900 Columbia 1 1 - - - 1 4.4 4,400 Island 10 8 2 4 2 9 21.8 2,422 Klickitat 8 5 3 1 3 4 14.1 3,525 Okanogan 13 10 3 2 1 13 25.9 1,992 Pacific 10 9 1 4 4 9 13.7 1,522 Stevens 6 3 3 - 1 6 17.4 2,900 Central city under 2,500 16 14 2 2 5 15 50.1 3,340 Douglas 3 3 - 1 - 3 14.8 4,933 Ferry - - - - - - 3.8 - Garfield 2 1 1 - 1 2 2.8 1,400 Lincoln 4 3 1 1 1 4 10.8 2,700 APPENDIX TABLE (cont'd.) 8LS Selected Data on Dentists in Washington, by Location Civilian dentists 1 Persons County group Respond- Non- Ace in 1965 Profes- Population— per and county Total ents respond- Under 55 years sionally (in 000's) active ents 35 or more active dentist Nonmetropolitan counties (cont'd.) Central city under 2 500 (cont'd.) Pend Oreille 2 2 - - 2 2 6.7 3,350 San Juan 2 2 - - - 2 2.7 1,350 Skamania 2 2 - - 1 1 5.3 5,300 Wahkiakum 1 1 - - - 1 3.2 3,200 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Washington counties included in the latest 1967 definition of Standard Metropolitan Statistical areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. 3/ Tor the interstate Portland SMSA, statistics are presented only for dentists located in the Washington portion (Clark County), herein designated as the Vancouver area. 4] Counties not included within a SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. WEST VIRGINIA DENTISTS LICENSED IN WEST VIRGINIA A total of 822 dentists registered with the West Virginia Board of Den- tal Examiners during the 1965 reregistration period (Table 1). The survey questionnaire was completed by 759 dentists, or 92 percent of all those registering. However, among those responding, only 556 den- tists, or 73 percent, are actually located in West Virginia. Another Table l.--Location and Military Status of Dentists Licensed in West Virginia Location and All Percent of military status dentists dentists Total licensed 822 100 Respondents 759 92 Nonrespondents 63 8 Respondents 759 100 Civilians in West Virginia 556 73 Civilians in another State 158 21 On active duty with Armed Forces 45 6 21 percent of the respondents are civilian dentists located in another State or abroad and the remaining 6 percent are on active duty with the Armed Forces. The 759 responding dentists hold a total of more than 1,250 licenses in all States. A relatively large proportion, three-fifths, of the dentists located in West Virginia hold only the one State license (Table 2). The proportion of dentists on active duty in the Armed Forces who are licensed only in West Virginia is almost as large. Multiple licensure occurs most frequently among the civilian dentists who are located in other States. While licenses are held in 2 or more other States by only 4 percent of the civilian in-State dentists and 13 percent of the dentists in the Armed Forces, licenses are held in 2 or more additional States by 29 percent of the civilian dentists who are located outside the State. 579 Table 2.--Percent of Dentists Holding Licenses in Other States All Civilian dentists Armed Licenses held In West Out-of- respondents Virginia State Forces Total 100 100 100 100 West Virginia license only 46 58 - 54 Licensed in 1 other State 44 38 71 33 Licensed in 2 other States 9 3 25 13 Licensed in 3 or more other States 1 1 4 - Civilian Dentists in West Virginia Sources of Supply Dental schools.--West Virginia's dentists are graduates of 30 dental schools. More than three-fourths of all dentists in the State were graduated from 10 dental schools located in adjacent States--Kentucky, Maryland, Ohio, Pennsylvania, and Virginia--including two schools (The Cincinnati College of Dental Surgery and the Ohio College of Dental Surgery) which are no longer in existence. The dental school at the University of Maryland, which has graduated one-fourth of the dentists in West Virginia, has long been the primary source of the State's dentist supply (Table 3). However, the propor- tion of the State's dentists graduating from Maryland has declined substantially in recent years, and chiefly because of the growing role of West Virginia's new school of dentistry in supplying dentists for the State. Although the first class at West Virginia was not graduated until 1961, graduates of this school account for 3 percent of all dentists located in the State. In fact, the new school is rapidly becoming West Virginia's primary source of dentist supply. Its graduates account for three of every five dentists in the State who have completed their dental educa- tion in the years since West Virginia produced its first graduating class. However, because many graduating dentists seek advanced training or enter the Armed Forces prior to establishing their practices, the contribution of these first few graduating classes to the State's den- tist supply will not be fully determined for a few more years. 580 Table 3.--School Awarding Dental Degree, by Year Awarded Dental school Number Year of graduation of All After 1941- 1940 or attended dentists years 1955 1955 earlier Total number 556% - 556 89 248 218 (Percent distribution by school) Maryland 139 25 20 30 22 Pittsburgh 95 17 17 19 15 Louisville 74 13 14 11 16 Ohio College (extinct) 37 7 - - 17 Northwestern 33 6 2 10 3 Virginia 27 5 14 4 2 Ohio State 20 4 2 4 4 West Virginia 19 3 22 - - Indiana 14 3 - 1 6 Emory 10 2 - 2 2 20 other schools 84 15 9 19 13 1/ Individual items in this and succeeding tables may not add to the totals shown due to the failure of some responding dentists to reply to all items on the questionnaire. Where percentages are shown, they are based on data supplied by dentists responding to the item (see Appendix Table A). The dental schools of the Universities of Pittsburgh and Louisville have also been major contributors of dentists to West Virginia, and their proportionate contribution has remained relatively constant through the years. One other school--the College of Dentistry of The Medical Col- lege of Virginia--has also become a relatively important source of dentists in recent years. The remainder of the State's dentists--about a fifth in all--are gradu- ates of 19 dental schools located in 12 more distant States and the District of Columbia. Northwestern, Indiana, and Emory Universities have contributed the greatest number of these dentists. Dentists relocating in West Virginia.--One in every 8 dentists currently in West Virginia was located as a civilian in another State or abroad immediately prior to assuming his present West Virginia location. Of the 67 immigrant dentists, 28, or 42 percent, moved to West Virginia from one of the 5 adjacent States. The remainder came from 24 other States, the District of Columbia or abroad. More than one-half of the inmigrant dentists located in West Virginia during the 1950's, and about a quarter moved to the State in 1960 or more recently. 581 Personal Characteristics Age and sex.--West Virginia's dentists, as a group, are not very young. The median age in 1965 of reporting dentists was 47.6 years. Less than one-fourth of the dentists were under 40 years of age, while slightly over one-third were at least 55 years old, including one-fifth who were aged 65 and over (Table 4). There are only 5 women dentists included among the respondents. For this reason, data for women will not be shown separately in this report. Table 4.--Age Distribution Number Percent Age of of dentists dentists Total 556 100 Under 30 18 30 - 34 47 35 - 39 65 12 40 - 44 116 21 45 - 49 62 11 50 - 54 61 11 55 - 59 34 6 60 - 64 46 8 65 - 69 50 9 70 - 74 36 7 75 & over 21 4 Advanced training.--About 15 percent of all dentists in the State have completed one year or more of advanced training. The majority--11 per- cent of the total--have had advanced clinical training as interns or residents (Table 5). Although advanced academic education is somewhat less common, more than half of those who have advanced training (8 percent of the State's den- tal force) have completed at least one year of academic work beyond their dental degree. Four percent of all dentists in the State have had both advanced clinical training and a year or more of graduate or postgraduate academic work. 582 Table 5.--Advanced Training Number Percent Highest level of training completed of of dentists dentists With advanced training 82 15 Clinical training only 38 7 Academic training only 23 4 Both clinical and academic 21 4 Clinical training Residency completed 20 4 Internship completed 39 7 Academic training Ph.D., M.D., or other doctor's degree 1 * M.A., M.S., or other master's degree 18 3 Postgraduate 1 year or more (no degree) 25 4 *Less than one-half of one percent. Among dentists under 40 years of age, 21 percent report having received a year or more of advanced training. In contrast, only 16 percent of those aged 40 to 54, and 9 percent of those 55 years or older report having had this much advanced education. The tendency for younger dentists to seek more training is especially marked in the case of advanced academic work. One in every 6 dentists under 40 years of age has had a year or more of graduate or postgraduate study as compared with one in every 30 of those 55 years old or more. Distribution and Current Status Distribution of dentists.--West Virginia's dentists are unevenly distributed geographically, with 71 percent of the reporting dentists located in only 13 of the State's 55 counties. Four of these 13 counties, each of which has 10 or more dentists, are located in metropolitan areas. The remaining nine are nonmetropolitan counties, i.e., they have central cities of less than 50,000 population, and they are not part of a multi-county grouping with a central city of 50,000 or more. (Appendix Table B lists individual counties by size of central city and shows the number of reporting dentists in each county.) More than two-fifths of all responding dentists are located in the four metropolitan areas of West Virginia (Table 6). The greatest concentration of dentists, 18 percent of all respondents, is in Kanawha County, which comprises the Charleston metropolitan area. The Huntington, Wheeling and 583 386-029 O - 70 - 38 Table 6.--Distribution by County Group Number Number Percent County group of of of counties dentists dentists All counties 55 556 100 All metropolitan areas 7 232 42 Charleston area 1 99 18 Huntington area 2 68 12 Wheeling area 2 46 8 Weirton area 2 19 4 Nonmetropolitan county groups 48 324 58 Central city 25,000-49,999 3 77 14 Central city 10,000-24,999 4 82 15 Central city 5,000- 9,999 10 60 11 Central city 2,500- 4,999 8 58 10 Central city under 2,500 23 47 8 Note: See Appendix Table B for a listing of counties within each county group and the number of dentists located in each county. Weirton areas=--each of which is a part of a larger interstate metropolitan area--account for 24 percent of the State's dentist supply. Cabell County, one of the two counties constituting the Huntington area, has the second largest dental force in the Btate, and Ohio County, in the Wheeling area, has the third largest. Many of the nonmetropolitan counties in the State also have fairly sizable numbers of dentists. Each of the three counties with central cities of 25,000-49,999 persons-~Harrison, Wood and Marion--has a larger dental force than the Weirton area, for example. And, Monongalia County, one of the State's 4 nonmetropolitan counties with central cities of 10,000-24,999 population, has the fourth largest number of dentists of any county in the State. The fact that this county is the site of the dental school contributes, at least in part, to the large number of reporting dentists located there. Among counties containing a city of 10,000 or more people, only Berkeley County has fewer than 10 responding dentists. By contrast, only 3 of the 41 counties without a city of this size (McDowell, Fayette, and Greenbriar) have as many as 10 reporting dentists. Among the 23 counties with fewer than 2,500 persons in their central cities, three--Calhoun, Clay and Monroe--have no reporting dentists, None of the remaining 20 counties in this group has more than 6 reporting dentists, 584 There are marked differences in the age distribution of reporting dentists in the various county groups and also among the individual counties. On the average, dentists are younger in the Charleston area, in the two groups of nonmetropolitan counties with central cities of 10,000 or more population, and in counties with central cities of less than 2,500 persons (Table 7). Of the 52 counties with reporting dentists, 24 have no dentists under 35 years of age. Furthermore, 17 of these counties have no dentists under 40 years old and 7 have none under 45, At least one half of the dentists in 19 counties reported they were 55 years of age or older. Table 7.--Median Age and Age Distribution, by County Group Percent of dentists County group Median Under 35- 45- 55- 65 & 8 35 44 54 64 over All counties 47.6 12 33 22 14 19 All metropolitan areas 47.5 10 34 24 13 19 Charleston area 45.6 12 37 24 14 13 Huntington area 48.0 10 35 22 12 21 Wheeling area 49.2 7 33 22 15 23 Weirton area 50.8 10 21 32 5 32 Nonmetropolitan county groups 47.6 13 32 21 15 19 Central city 25,000-49,999 47.2 12 32 17 18 21 Central city 10,000-24,999 45.0 9 40 27 11 13 Central city 5,000- 9,999 51.4 15 22 26 12 25 Central city 2,500- 4,999 50.0 14 26 17 19 24 Central city under 2,500 45.8 15 34 15 19 17 The counties making up the Weirton area have the largest concentration of older dentists, with almost a third of all dentists in this area reporting that they were 65 years old or over in 1965. Counties with central cities ranging from 2,500 to 10,000 also have relatively large numbers of dentists who are 65 years old or over. In these counties, one in every four dentists reported having reached this age. Professional status.--Of the 556 civilian dentists in West Virginia, 538, or 97 percent, reported that they were professionally active at the time of the survey. Fourteen dentists regard themselves as fully retired, 2 are engaged in nondental employment and the remaining 2 did not report their current status. Even though almost all of the retired dentists are in the older age groups, relatively few of the older dentists who responded to the survey consider themselves retired. Of the 106 dentists 65 years and over, only 10 percent reported themselves as fully retired. 585 1 965 COUNTY : BY v R G N I N WE T ST DENT P ER ON POPULAT WASHINGTON y MARYLAND KINGHAM VIRGINIA BELMONT OHIO monroe f+ on, WASHINGT FOTOS ros sys Ta persons per dentist: we NN [] 2,500 3,499 under 2,500 - 3,500 - 4,999 5,000 & over no dentists WASHINGTON 5 VINVATASNNId 5 GREENE NORTHERN PART OF WEST VIRGINIA MONROE IIIS TTI /7r7 7 hr 72777 7 VIRGINIA KENTUCKY Bano TAZEWELL Active dentists in relation to population.--In general, there are fewer persons per active dentist in the metropolitan areas than in the nonmetropolitan county groups--the persons-per-dentist ratios range from 2,151 in the Huntington area to 5,730 for the group of counties with less than 2,500 persons in their central cities (Table 8). Table 8,--Number of Persons per Active Dentist Professionally Persons Civilian County group active opulation PeT active dentists PoP dentist All counties 538 1,780,800 3,310 All metropolitan areas 221 572,400 2,590 Charleston area 93 251,600 2,705 Huntington area 68 146,300 2,151 Wheeling area 43 102,300 2,379 Weirton area 17 72,200 4,247 Nonmetropolitan county groups 317 1,208,400 3,812 Central city 25,000-49,999 75 211,200 2,816 Central city 10,000-24,999 81 223,800 2,763 Central city 5,000~ 9,999 59 255,700 4,334 Central city 2,500- 4,999 56 254,100 4,538 Central city under 2,500 46 263,600 5,730 The ratios of the 52 counties with professionally active reporting dentists vary considerably more than the data for county groups indicate. Monongalia County has the most favorable ratio with one professionally active dentist for every 1,531 persoms, while Putnam County with 12,400 persons for every responding dentist has the least favorable ratio (see Appendix Table C for individual county data). However, if the dentists who reported they are primarily associated with the West Virginia University, School of Dentistry are excluded, the relationship of population to dentists in Monongalia County becomes less favorable, with an adjusted ratio of one dentist to every 2,755 persons. On this basis, Ohio and Cabell Counties have the most favorable ratios, with 1,727 and 1,759 persons, respectively, for every active dentist. In addition to these 3 counties, there are only 15 other counties with fewer persons per dentist than the State average of one professionally active respondent for every 3,310 persons in West Virginia. In many of the remaining 34 counties with reporting active dentists, the persons-per-dentist ratio 1s considerably less favorable than the State average. In addition to Putnam County, there are 19 counties with ratios in excess of 5,000 persons per active dentist, including 6 counties with more than 8,000 persons per dentist--Boene (8,267), Morgan (8,300), Gilmer (8,900), Lewis (10,050), Lincoln (10,100) and Ritchie (10,200). 587 Professional Activity Current employment.--Almost all of the professionally active dentists in West Virginia are primarily engaged in private practice: 94 percent are self-employed and 1 percent are employed by another dentist (Table 9). About 3 percent of the State's dentists are on the staff of the dental school at the University of West Virginia and the remaining 2 percent are either employed by federal, State or local government agencies, or are engaged in other dental employment. Table 9.--Currert Employment of Professionally Active Dentists Principal Secondary employment . employment Type of principal employment Nomber . Nomber Percent employed ercent reporting of total Total 538 100 35 7 Self-employed 502 9 30 6 Employed by other dentists. 6 1 1 * On staff of dental schools 17 3 1 * Employed by State or local government 5 1 3 1 Other dental employment 8 1 - - *Less than one-half of one percent. A small proportion of the active dentists, 7 percent, reported that they were employed in a part-time dental activity in addition to their primary professional employment. Most of these dentists who engaged in part-time secondary employment are private practitioners. Even though they are few in number, these dentists reported a variety of secondary dental activities. For instance, about one-half reported part-time employment in a governmental health agency providing such services as dental consultation te the Veterans Administration hospitals and patient care in local health clinics. Other dentists reported that they teach part-time at the dental school or in one of the State's dental hygiene training programs, A few are employed by private organizations, primarily voluntary agencies. Activity last year.--Of all dentists reporting on their professional activity in West Virginia last year, 97 percent said they provided care to patients (Table 10). These dentists spent 95 percent of the total reported professional time in providing patient care. Six percent of the dentists reported they spent some time in teaching, but only 3 percent of total professional time was spent at this activity. While two percent of the dentists were engaged in research activities and three percent spent time in some other dental activity, such as taking additional training, only two percent of the total reported professional time was spent in these two types of activities. 588 Table 10.-~-Professional Activity Last Year Dentists reporting Type of activity activity last year Number Percent Percent of total professional time Total s00t/ 100% 100 Patient care 485 97 95 Teaching 29 6 3 Research 11 2 1 Other 15 3 1 1/ Individual items add to more than total because some dentists spent time in more than one type of activity. Of the dentists who provided patient care, slightly more than four-fifths reported having spent 48 weeks or more at this activity in the previous year (Table 11). Dentists who worked all year (48-52 weeks) spent longer hours providing patient care than did those who worked only part of the year. Seven of every 10 dentists spending 48 weeks or more in patient care worked 40 or more hours per week, while only 5 in every 10 working less than 48 weeks spent as much time providing care. Table 1l.--Time Spent in Patient Care Last Year Percent of Weeks spent in dentists patient care providing 48 hours 41-47 35-39 Under patient care OF more hours 40 hours hours 35 hours Percent distribution by work week Total 100 16 16 35 18 15 50 weeks or more 48 8 8 18 8 6 48-49 weeks 33 6 6 11 7 3 40-47 weeks 14 2 2 4 2 4 Less than 40 weeks 5 * * 2 1 2 *Less than one-half of one percent. Practice Characteristics Limited practices.--Only one in every ten dentists in West Virginia reported that they limit their practices to a dental specialty. Over two-thirds of these dentists reported their practices are limited to one of two specialty areas~--38 percent in oral surgery and 30 percent in orthodontics. Specializa- tion is more common in the metropolitan areas where 14 percent of the dentists reported limited practices than in the nonmetropolitan areas where only 6 percent of the dentists limited their practices. 589 Use of auxiliaries.--Almost three-fourths of the dental practitioners in West Virginia (i.e., dentists who spend any time working at the chair) report that they employ auxiliary personnel (Table 12). The majority of the practitioners, 64 percent, employ dental assistants, while the next most frequently employed personnel, secretaries and receptionists, are employed by only 21 percent. Both types of auxiliaries are employed on a full-time basis by most of the dentists. Dental hygienists and laboratory technicians are much less frequently utilized by practitioners in West Virginia. Not only are these auxiliaries employed by proportionately fewer dentists, but they are more frequently employed on a part-time basis than are assistants and secretaries. Table 12,-~Auxiliary Utilization by Dental Practitioners Type of auxilia Number of Percent of P ry practitioners practitioners Total 524 100 With one or more auxiliaries 3g1L/ 73%/ With assistant 336 64 With hygienist 64 12 With laboratory technician 20 4 With secretary or receptionist 110 21 With other type of personnel 18 3 With no auxiliary 143 27 1/ Individual items add to more than total because some dentists employ more than one type of auxiliary. Auxiliary utilization varies according to the age of the dentist and is greatest among the young dentists. About 85 percent of the dental practi- tioners between the ages of 35 and 44 employ auxiliaries. In contrast, auxiliaries are utilized by only 46 percent of the practitioners 65 years or older. In general, the location of the dentist dees not greatly influence the degree of auxiliary utilization. Among the county groups, the percent of practi- tioners employing auxiliaries ranges only from 76 percent of those in metropolitan areas to 68 percent of those in the nonmetropolitan county group with central cities of 25,000-49,999. As the data in Appendix Table C indicate, a proportionately large number of dentists in most counties utilize auxiliary personnel. About 13 percent of the dental practitioners in West Virginia reported one or more vacant positions for auxiliary personnel. About 37 percent of the dentists reported vacancies for full-time hygienists and 36 percent reported vacancies for full-time dental assistants. Four of every five dentists reporting a vacancy already employ an auxiliary. 590 Qut-of~- tate Civilian Dentists State Location West Virginia licenses are maintained by at least 158 civilian dentists located in 23 States, the District of Columbia and Puerto Rico (Table 13). About three-fifths of these out~of-State dentists are located in the five adjacent States, primarily in Virginia and Maryland. Florida is the only more distant State in which at least ten percent of the out-of-State dentists are currently located. Table 13.,--Out-of-State Civilian Dentists, by Present Location Number Percent Present location of of dentists dentists Total 158 100 Adjacent States 94 60 Kentucky 9 6 Maryland 23 15 Ohio 18 11 Pennsylvania 16 10 Virginia 28 18 Nonad jacent States 64 40 California 7 4 Florida 16 10 North Carolina 8 5 16 other States 33 21 A large proportion of the out-of-State dentists are graduates of dental schools at the Universities of Maryland and Pittsburgh (24 percent and 17 percent, respectively). However, 14 percent of all out-of-State civilian dentists are graduates of the West Virginia University, Scheol of Dentistry, and these dentists account for almost all of the out-of-State dentists who have completed their dental education in the last few years. Age and Professional Status As a group, the out-of-State civilian dentists are younger than those presently in West Virginia. While only 23 percent of the dentists located in West Virginia were under 40 years of age in 1965, 52 percent of the out-of-State civilian dentists were in this young age group. Furthermore, only 5 percent of the out-of-State dentists were 65 years old or over, as compared with 591 20 percent of the in-State dentists. However, the relatively low proportion of older out-of-State dentists may be attributed, at least in part, to the fact that as a dentist becomes more established he is less likely to maintain a license in a State in which he is not practicing. Ninety-nine percent of the out-of-State dentists report that they are professionally active. The majority, 78 percent, are in private practice. About 12 percent are employed in governmental agencies, 3 percent are on the staffs of dental schools and the remaining 5 percent are engaged in other dental activities, such as taking advanced training. Outmigrant Dentists Almost three of every ten out-of-State respondents reported that they had formerly been located in West Virginia. (Because these figures include only civilian dentists who were professionally active in West Virginia immediately prior to assuming their present location in another State, they do not reflect those residents of West Virginia who chose to establish their practices in other States immediately following completion of their dental education.) About three-fifths of the 44 reporting outmigrant dentists are now located in five States--Virginia, Florida, Ohio, Pennsylvania and California--and the remaining two-fifths are scattered in 11 other States and the District of Columbia. October 1966. 592 Appendix Table A.=~Summary Statistics for West Virginia Number of dentists All licensed dentists 822 Respondents == total dentists participating in survey 759 Civilian dentists in West Virginia == civilian respondents designated simply as "dentists" in text tables 556 (number not reporting: principal current employment = 4, year of graduation = 1, school of graduation = 4) Professionally active dentists? 538 In limited practice? 50 Dental practitioners 524 Located in West Virginia last year: Reported professional activity? 500 Dentists providing patient care®/ 485 Reported time spent in patient carel! 374 Out-of-State dentists == civilian respondents not located in West Virginia 158 Dentists on active duty in Armed Forces 45 Nonrespondents == licensed dentists not participating in survey 63 1/ All responding dentists who currently work in West Virginia (exclud- ing those in the Armed Forces) or who are retired and currently live in the State. 2/ All active civilian dentists currently in West Virginia--excludes 14 dentists who are fully retired and 4 who did not report their princi- pal current activity. 3/ Dentists who reported they limited their practice to a dental specialty. 4/ All dentists practicing at the chair, that is, dentists who work as cliniciang either as primary or secondary activity. 5/ Dentists located in West Virginia last year who indicated type(s) of activity in which they engaged. 6/ All dentists who engaged in patient care last year, either as a primary or secondary activity. 1/ Dentists reporting both hours and weeks spent in patient care last year, 593 Appendix Table B.==West Virginia Counties by County Group 1/ Metropolitan Areas™ Number of responding County group civilian dentists Charleston area Kanawha 99 Huntington area Cabell 61 Wayne 7 Wheeling area Ohio 40 Marshall 6 Weirton area Hancock 14 Brooke 5 Nonmetropolitan Counties? Number of responding County group Central City civilian dentists Central city 25,000~49,999 Harrison Clarksburg 29 Marion Fairmont 22 Wood Parkersburg 26 Central city 10,000-~24,999 Berkeley Martinsburg 8 Mercer Bluefield 16 Monongalia Morgantown 36 Raleigh Beckley 22 Central city 5,000-9,999 Lewis Weston 2 McDowell Welch 11 Mason Point Pleasant 6 Mineral Keyser 6 Mingo Williamson 7 Randolph Elkins 9 Summers Hinton 2 Taylor Grafton 4 Upshur Buckhannon 5 Wetzel New Martinsville 8 594 Appendix Table B.-~West Virginia Counties by County Group (continued) Nonmetropolitan Countieg™ 2/ Number of responding County group Central City civilian dentists Central city 2,500-4,%J9 Fayette Oak Hill 11 Greenbrier White Sulphur Springs 10 Jackson Ravenswood 8 Logan Logan 9 Nicholas Richwood 5 Preston Kingwood 4 Roane Spencer 6 Wyoming Mullens 5 Central city under 2,500 Barbour Philippi 3 Boone Masison 3 Braxton Cassaway 2 Calhoun Grantstown - Clay Clay - Doddridge West Union 2 Gilmer Glenville 1 Grant Petersburg 2 Hampshire Romney 4 Hardy Moorefield 3 Jefferson Charles Town 6 Lincoln Hamlin 2 Monroe Peterstown - Morgan Bath 1 Pendleton Franklin 3 Pleasants St, Marys 2 Pocahontas Marlinton 2 Putnam Hurricane 2 Ritchie Pennsboro 1 Tucker Parsons 2 Tyler Sistersville 3 Webster Addison 2 Wirt Elizabeth 1 1/ West Virginia counties included in the latest 1966 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropoli= tan areas for the presentation of the survey data, For interstate SMSA's, statistics are presented only for dentists reporting their location in the West Virginia portion of the Huntington=Ashland SMSA, Wheeling SMSA, and Steubenville=Weirton SMSA, 2/ Counties not included within a SMSA, as defined by the U,S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. 595 Appendix Table C,=~Selected Data for West Virginia Counties Number of active dentists Counties Professionally Civilian Persons By age Using with responding active populati n per active Under 55 years auxili- active dentists dentists (000) dentist 40 years and over aries Total 538 1,780.84 3,310 129 170 381 Barbour 3 13.7 4,567 1 1 2 Berkeley 8 35.3 4,412 2 1 7 Boone 3 24.8 8,267 1 - 3 Braxton 2 13.9 6,950 - 1 1 Brooke 4 29.9 7,475 3 - 2 Cabell 61 107.3 1,759 17 19 47 Doddridge 1 7.6 7,600 - - 1 Fayette 11 54.0 4,909 5 4 9 Gilmer 1 8.9 8,900 - 1 1 Grant 2 8.2 4,100 1 1 1 Greenbrier 8 32.3 4,038 5 3 6 Hampshire 4 10.3 2,575 1 2 1 Hancock 13 42,3 4,254 1 5 9 Hardy 3 8.8 2,933 - 1 2 Harrison 28 72.2 2,579 9 10 18 Jackson 8 20.0 2,500 3 5 6 Jefferson 6 19.3 3,217 1 2 5 Kanawha 93 251.6 2,705 22 22 75 Lewis 2 20.1 10,050 - 1 2 Lincoln 2 20.2 10,100 1 - 2 Logan 9 51.8 5,756 2 4 7 McDowell 11 59.0 5,364 3 5 5 Marion 21 60.4 2,876 2 11 11 Marshall 6 38.4 6,400 - 3 1 Mason 5 24,9 4,980 1 1 4 Mercer 16 65.3 4,081 3 3 12 Mineral 6 22.9 3,817 1 2 6 Mingo 7 36.4 5,200 1 4 4 Monongalia 36 55.1 1,531 9 9 16 Morgan 1 8.3 8,300 - - 1 Nicholas 5 22.4 4,480 - - 5 Ohio 37 63.9 1,727 9 12 27 Pendleton 3 7.5 2,500 - 2 2 Pleasants 2 7.5 3,750 - 1 1 Pocahontas 2 9.0 4,500 0 0 2 596 Appendix Table C.=-~Selected Data for West Virginia Counties (continued) Number of active dentists Counties Professionally Civilian Persons By age Using with responding active population per active Under 55 years auxili- active dentists dentists (000 dentist 40 years and over aries Preston 4 25.4 6,350 - 2 3 Putnam 2 24.8 12,400 1 - 2 Raleigh 21 68.1 3,243 5 5 20 Randolph 9 27.3 3,033 2 2 8 Ritchie 1 10.2 10,200 - 1 1 Roane 6 14.6 2,433 2 3 1 Summers 2 14.0 7,000 - - 1 Taylor 4 13.4 3,350 2 1 4 Tucker 2 6.5 3,250 ~- 1 1 Tyler 3 9.9 3,300 1 1 2 Upshur 5 17.8 3,560 - 1 3 Wayne 7 39.0 5,571 1 3 4 Webster 2 11.9 5,950 1 - 1 Wetzel 8 19.9 2,488 3 4 4 Wirt 1 4,0 4,000 ~- 1 - Wood 26 78.6 3,023 6 7 21 Wyoming 5 33.6 6,720 1 3 1 Ll/ Copyright 1965, Sales Management Survey of Buying Power; further reproduc= tion is forbidden. 2/ Includes the 28,300 persons in Calhoun, Clay and Monroe Counties which have no responding dentists, 597 WISCONSIN DENTISTS LICENSED IN WISCONSIN During the 1966 registration period, 3,457 dentists registered with the Wisconsin Board of Dental Examiners. A total of 3,176 dentists responded to the survey, 92 percent of all those registered. Seventy-one percent of the respondents are civilian dentists located in Wisconsin, another 21 percent are civilians located in other States, and 8 percent are on active duty with the Armed Forces. Location and Military Status of Dentists Licensed in Wisconsin Location and All Percent of military status dentists dentists Total licensed 3,457 100 Respondents 3,176 92 Nonrespondents 281 8 Respondents 3,176 100 Civilians in Wisconsin 2,255 71 Civilians in another State 666 21 On active duty with Armed Forces 255 8 About 35 percent of the respondents hold licenses to practice dentistry in one or more other States. Only 16 percent of the dentists located in Wisconsin have more than one license, with 14 percent licensed in one other State and 2 percent licensed in two or more other States. The pro- portion of responding out-of-State dentists holding multiple licenses is considerably greater; approximately 22 percent hold two or more licenses in addition to their Wisconsin license. Almost one-half (49 percent) of the licenses held outside of Wisconsin were issued by adjacent States, including 21 percent in Illinois, 13 per- cent in Minnesota, 11 percent in Michigan, and 4 percent in Iowa. The remaining out-of-State licenses are maintained in 41 other States, includ- ing 11 percent in California, and 4 percent each in Florida and Colorado. 599 386-029 O - 70 - 39 PROFESSIONAL TRAINING Four-fifths of Wisconsin's 2,255 responding dentists graduated from the School of Dentistry at Marquette University. Another 15 percent are graduates of seven dental schools located in adjacent States, including 5 percent from Northwestern University, 4 percent from the University of Minnesota, and 3 percent from Loyola University of Chicago. Two other schools in adjacent States, the Universities of Illinois and Iowa, have together provided about 50 dentists, 2 percent of the State supply. The remaining 4 percent of Wisconsin's dentists obtained their dental degrees from 25 other schools located in more distant States. Among these, St. Louis and Creighton Universities are the only schools to have supplied as many as 10 dentists to the State's dental force. Dental School Attended and Year of Graduation for Dentists in Wisconsin Number Year of graduation Dental school of ATT After 1941- 1940 or dentists years 1955 1955 earlier Total 2,255 1 - 477 781 986 (Percent distribution by school) Marquette University 1,826 81 83 81 80 Schools in adjacent States 349 15 13 14 18 Northwestern University 109 5 3 "5 6 University of Minnesota 99 4 3 4 5 Loyola University (Chicago) 76 3 2 2 5 4 other schools 65 3 5 3 2 25 other schools 80 4 4 5 2 1/ Year of graduation not available for 11 dentists. Percents based on known totals. About one-fifth (21 percent) of the State's dentists have graduated from dental school since 1955. In contrast, more than two-fifths (44 percent) received their dental degrees prior to World War II. There has been virtually no change over the years in the overall proportion of dentists graduating from Wisconsin's own dental school, or from out-of-State schools. Approximately 11 percent of the survey respondents, 257 dentists, reported they had completed one or more years of advanced training after receiving the dental degree. Of 181 dentists taking advanced academic training, 98 received at least a master's degree, while another 83 received no addi- tional degree but reported the completion of one or more years of advanced work at the postgraduate level. Of the 132 dentists with advanced clinical training, 83 had completed an internship, and 49 a residency. There are 56 dentists who have taken both academic and clinical training. 600 DISTRIBUTION OF DENTISTS Over one-half (54 percent) of the dentists in Wisconsin are located in the six metropolitan areas of the State. The 4-county Milwaukee area alone has 838 dentists, 37 percent of the total dentist supply. More than four-fifths of these dentists (704) are concentrated in Milwaukee County, and another 92 dentists are located in Waukesha County. The Madison metropolitan area has the next largest dental force in the State, with 8 percent of the dentists. The areas of Racine and Green Bay each have 3 percent of the State's dentists, while the remaining two areas, Kenosha and Superior, have 2 percent and 1 percent, respectively. Distribution of Wisconsin Dentists, by County Group Number Number Percent County group® of of of counties dentists dentists All counties 72 2,255 100 Metropolitan areas 9 1,228 54 Milwaukee area 4 838 37 Madison area 1 171 8 Racine area 1 72 3 Green Bay area 1 71 3 Kenosha area 1 53 2 Superior area 1 23 1 Nonmetropolitan counties 63 1,027 46 Central city 10,000-49,999 15 582 26 Central city 5,000-9,999 15 236 10 Central city under 5,000 33 209 10 %* See Appendix Table for definition of metropolitan areas and presentation of individual county data. The 63 nonmetropolitan counties have a substantial share (46 percent) of the Wisconsin dentist supply. The 15 counties having 10,000 or more per- sons in their central cities have 582 dentists, about one-fourth of the total dental force. Five of these counties--Winnebago, Rock, Outagamie, La Crosse, and Sh~boygan--each have more than 50 dentists. The 48 coun- ties with centrsi city populations under 10,000 have one-fifth (445) of the State's svuply of dentists. Among these 48 counties, 19 have 10 or more dentist., yet 11 have fewer than five dentists. 601 AGE OF DENTISTS BY AREA The median age of dentists in Wisconsin is 47.4 years. Three of every ten (690 dentists) are under 40 years of age, and two-thirds of these are under age 35. An almost equal proportion, 32 percent, are between 45 and 54 years of age, while 37 percent are 55 or over. About 18 percent of the dentists (412) are at least 65 years of age, including 198 who have reached the age of 70. Median Age and Age Distribution of Wisconsin Dentists, by County Group Percent of dentists County group Median Under 40- 55 & 8 40 54 over All counties 47 .4 31 32 37 Metropolitan areas 46.9 33 31 36 Milwaukee area 48.0 31 30 39 Madison area 43.7 39 36 25 Racine area 48.2 26 40 34 Green Bay area 45.3 39 27 34 Kenosha area 45.3 36 34 30 Superior area 44.2 39 13 48 Nonmetropolitan counties 48.0 28 32 40 Central city 10,000-49,999 47 .4 29 34 37 Central city 5,000-9,999 48.9 23 34 43 Central city under 5,000 53.6 25 26 49 Dentists in the metropolitan areas, with a median age of 46.9 years, are only slightly younger than dentists in the nonmetropolitan counties, where the median age is 48.0 years. Among the metropolitan areas, Milwaukee and Racine have the oldest dentists as a group, with median ages of 48.0 and 48.2, respectively. The youngest group of dentists is found in the Madison area where the median age is 43.7 years. Almost two-fifths of these dentists are under 40 years of age, while only one-fourth are 55 or over. Among the nonmetropolitan counties, those with central cities of less than 5,000 persons have the oldest group of dentists, with a median age of 53.6 years--more than six years higher than the median for all den- tists in the State. Only one-fourth of these dentists are under 40 years of age, while almost one-half are 55 and older. 602 ACTIVE DENTISTS IN RELATION TO POPULATION Of the 2,255 dentists in Wisconsin, 2,100, or 93 percent, are active in their profession, giving the State one professionally active dentist for every 2,007 persons. In the metropolitan areas there are 1,841 persons per dentist, while the nonmetropolitan counties have a somewhat higher ratio of 2,210. Number of Persons per Active Dentist in Wisconsin Professionally Persons County group¥* active Population per dentists dentist All counties 2,100 4,215,300 2,007 Metropolitan areas 1,153 2,122,500 1,841 Milwaukee area 783 1,409,800 1,801 Madison area 164 261,000 1,591 Racine area 66 157,200 2,382 Green Bay area 67 138,100 2,061 Kenosha area 52 112,400 2,162 Superior area 21 44,000 2,095 Nonmetropolitan counties 947 2,092,800 2,210 Central city 10,000-49,999 541 1,088,600 2,012 Central city 5,000-9,999 : 216 479,200 2,219 Central city under 5,000 190 525,000 2,763 * See Appendix Table for individual county data. Among the metropolitan areas, Madison has the best ratio of 1,591 per- sons per dentist, while Milwaukee has the next best, with 1,801 persons. Two areas--Green Bay and Superior--have ratios slightly higher than the State average (2,061 and 2,095, respectively), while the Kenosha and Racine areas have the least favorable of the metropolitan ratios. Of the 63 nonmetropolitan counties, 16 have persons-per-dentist ratios below the average for the State, while 15 have more than 3,000 persons for every dentist, including three counties with ratios of 5,500 or more. Generally, persons-per-dentist ratios become less favorable as the size of the central city decreases. The counties with 10,000 or more inhabitants in their central cities have an average of 2,012 per- sons per dentist. In comparison, the counties with central cities under 5,000 average about one active dentist for every 2,763 persons. 603 UTILIZATION OF AUXILIARIES / Almost three out of every four dental practitioners in Wisconsin (i.e., dentists who spend any time working at the chair) reported that they employ auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 66 percent of the dentists, including 59 percent who employ at least one assistant on a full-time basis. Twenty-four percent of the dentists employ secretaries or receptionists, with about three-fifths of these dentists utilizing such personnel full time. Dental hygienists are employed by 20 percent of the practitioners, and laboratory technicians by 5 percent. The majority of the dentists who employ hygienists or technicians do so only part time. Wisconsin Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only . practi- . . employed by dentists . Total time employee part-time tioners (or more) employees Total 2,078 1/ 100 66 8 One or more auxiliaries 1,459 74 66 8 Assistant 1,298 66 59 7 Hygienist 404 20 7 13 Laboratory technician 96 5 1 4 Secretary or receptionist 476 24 14 10 Other type of personnel 58 3 1 2 No auxiliary 512 26 - - 1/ Includes 107 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist and tends to be more common among the younger dentists. More than 85 percent of the practitioners between the ages of 30 and 44 employ some type of auxiliary. The proportion utilizing auxiliaries decreases to 68 percent among dentists 45 to 64 years of age, and to 46 percent among dentists 65 and over. About 16 percent of the Wisconsin practitioners reported one or more vacant positions for auxiliary personnel. Of these dentists, more than one-third had vacant positions for full-time hygienists, and one-fourth reported vacancies for full-time dental assistants. 604 OTHER SURVEY FINDINGS // Ninety-five percent of the professionally active dentists in Wisconsin are primarily engaged in private practice, with 94 percent self-employed and 1 percent employed by another dentist. Two percent are employed by governmental agencies, another 1 percent are on the staff of a dental school, and the remaining 2 percent are engaged in some other dental activity, such as taking advanced training. 3 About one dentist in nine reported at least one part-time dental activity in addition to his principal employment. Part-time teaching in a dental school was the most fre- quently reported secondary activity. Various other activ- ities were reported, including employment by the State or local government and assistance to a voluntary agency. /] Dentists providing patient care during the year preceding the survey devoted an average of 40.2 hours a week to this activity for 47.6 weeks. About one dentist in eight worked the equivalent of six days a week, 48 hours or more, for at least 48 weeks during the year. [7 Approximately 8 percent of the practitioners reported that they limit their practice to a dental specialty, primarily to orthodontics. More than one in every ten dentists in metropolitan areas limits his practice as compared to only one in every twenty of the dentists in nonmetropolitan counties. 3 One-fifth of the survey respondents (666 dentists) were located in another State at the time of the survey. About 35 percent of these out-of-State dentists were in adjacent States, primarily Illinois. The other out-of-State den- tists were scattered among 43 more distant States, with the largest number located in California. October 1968. 605 909 Selected Data on Dentists in Wisconsin, by Location APPENDIX TABLE Civilian dentists Persons County group Age in 1965 Profes- Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist All counties 2,255 31 37 2,100 4,215.3 2,007 Metropolitan areas 2/ 1,228 33 36 1,153 2,122.5 1,841 Milwaukee area 838 31 39 783 1,409.8 1,801 Milwaukee 704 28 41 660 1,116.6 1,692 Ozaukee 18 50 11 18 45.6 2,533 Washington 24 33 33 23 52.2 2,270 Waukesha 92 48 26 82 195.4 2,383 Madison area 171 39 25 164 261.0 1,591 Dane 171 39 25 164 261.0 1,591 Racine area 72 26 33 66 157.2 2,382 Racine 72 26 33 66 157.2 2,382 Green Bay area 71 39 34 67 138.1 2,061 Brown 71 39 34 67 138.1 2,061 Kenosha area 53 36 30 52 112.4 2,162 Kenosha 53 36 30 52 112.4 2,162 Superior area 2 23 39 49 21 44.0 2,095 Douglas 23 39 49 21 44.0 2,095 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Wisconsin, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population = per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties 4/ 1,027 28 40 947 2,092.8 2,210 Central city 25,000-49,999 440 33 34 410 823.9 2,010 Eau Claire 34 35 32 33 61.8 1,873 Fond Du Lac 35 26 46 32 75.8 2,369 La Crosse 55 35 27 51 74.7 1,465 Manitowoc 36 44 33 34 77.5 2,279 Marathon 39 28 31 38 92.6 2,437 Outagamie 59 44 25 56 111.3 1,988 Rock 61 31 41 57 124.5 2,184 Sheboygan 53 19 42 A 89.7 2,039 Winnebago 68 37 32 65 116.0 1,785 Central city 10,000-24,999 142 25 39 131 264.7 2,021 Ashland 10 50 30 8 17.4 2,175 Chippewa 21 24 29 20 46.3 2,315 Dodge 36 17 53 33 65.8 1,99 Marinette 20 5 45 19 34.1 1,795 Portage 16 31 36 15 37.9 2,527 Wood 39 33 31 36 63.2 1,756 Central city 5,000-9,999 236 23 43 216 479.2 2,219 Barron 19 21 47 19 33.9 1,784 Columbia 21 14 52 19 38.1 2,005 Crawford 6 33 50 6 15.7 2,617 L09 809 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Wisconsin, by Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties al (cont'd.) Central city 5,000-9,999 (cont'd.) Door 7 29 43 5 20.6 4,120 Dunn 11 27 36 10 25.6 2,560 Grant 21 19 48 21 45.7 2,176 Green 17 12 47 15 26.7 1,780 Jefferson 26 19 42 24 54.5 2,271 Langlade 14 14 64 9 19.0 2,111 Lincoln 8 25 38 8 22.4 2,800 Monroe 13 31 39 13 31.1 2,392 Oneida 14 36 36 12 22.8 1,900 Sauk 17 24 47 15 35.3 2,353 Shawano 14 7 57 13 31.4 2,415 Walworth 28 36 18 27 56.4 2,089 Central city 2,500-4,999 147 25 52 132 347.8 2,635 Calumet 5 40 60 5 23.9 4,780 Clark 17 29 47 15 31.0 2,067 Green Lake 8 12 50 7 15.7 2,243 Iowa 5 20 60 4 19.7 4,925 Iron 3 33 67 3 7.4 2,467 Jackson 5 20 60 4 14.7 3,675 Juneau 6 - 83 4 16.9 4,225 Kewaunee 11 18 82 9 18.7 2,078 Oconto 8 38 50 7 24.2 3,457 609 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Wisconsin, by Location Civilian dentists Persons County group Age in 1965 Profes- Population — per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties 4/ (cont'd.) Central city 2,500-4,999 (cont'd.) Pierce 11 9 27 11 23.0 2,091 Price 7 - 57 6 13.4 2,233 Richland 7 29 43 6 17.1 2,850 Rusk 5 40 20 5 13.9 2,780 St. Croix 14 36 43 13 30.7 2,362 Taylor 5 20 60 5 17.5 3,500 Vernon 11 27 55 10 24.6 2,460 Waupaca 19 32 47 18 35.4 1,967 Central city under 2,500 62 27 42 58 177.2 3,055 Adams 1 - - 1 7.4 7,400 Bayfield 2 - 50 2 11.0 5,500 Buffalo 3 - 33 3 14.0 4,667 Burnett 2 - 50 2 8.7 4,350 Florence - - - - 3.2 - Forest 5 20 60 5 6.9 1,380 Lafayette 5 20 40 4 18.1 4,525 Marquette 1 - 100 1 8.4 8,400 Menomonee - - - - 2.7 - Pepin A 25 75 4 7.2 1,800 Polk 15 40 27 13 24.9 1,915 Sawyer 5 20 60 4 9.0 2,250 Trempealeau 9 22 44 9 23.3 2,589 019 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Wisconsin, by Location Civilian dentists 1/ Persons County group Age in 1965 Profes- Population — per and county Total Percent Percent sionally (in 000's) active under 40 55 or more active dentist Nonmetropolitan counties &f (cont'd.) Central city under 2,500 (cont'd.) Vilas 5 60 40 5 9.3 1,860 Washburn 2 - - 2 9.7 4,850 Waushara 3 67 33 3 13.4 4,467 Further reproduction is forbidden. Copyright 1965. Sales Management Survey of Buying Power. Wisconsin counties included in the latest 1968 definition of Standard Metropolitan Statistical Areas, as established by the U.S. Bureau of the Budget, Office of Statistical Standards, have been grouped as metropolitan areas for presentation of the survey data. Wisconsin part of the Duluth-Superior SMSA. Statistics are presented only for dentists located in the Wisconsin portion of the area. Counties not included within an SMSA, as defined by the U.S. Bureau of the Budget, have been grouped according to the 1960 population of the largest (central) city within each county. WYOMING DENTISTS LICENSED IN WYOMING During the 1965 registration period, 265 dentists registered with the Wyoming Board of Dental Examiners. Fifty-seven percent of these dentists were civilians located in Wyoming, and another 37 percent were civilian dentists located in other States. Five percent of the registered dentists were on active duty with the Armed Forces, and the remaining one percent did not report their location or military status. Location and Military Status of Dentists Licensed in Wyoming Location and All Percent of military status dentists dentists Total licensed 265 100 Respondents 204 77 Nonrespondents 61 23 Total licensed 265 100 Civilians in Wyoming 153 57 Respondents 130 - Nonrespondents 23 - Civilians in another State 97 37 On active duty with Armed Forces 13 5 Not reported 2 1 The survey questionnaire was completed by a total of 204 dentists, for an overall response rate of 77 percent. However, the response rate of den- tists actually located in Wyoming was somewhat higher, 85 percent, since nonresponse was more frequent among dentists located outside the State or on active duty with the Armed Forces. The data provided by the survey respondents has been supplemented, when possible, by information on location, age, dental school attended, and year of graduation for dentists not responding to the survey. Information on nonrespondents was obtained from records maintained by the Wyoming Board of Dental Examiners and from the 1966 American Dental Directory pub- lished by the American Dental Association. 611 PROFESSIONAL TRAINING More than four-fifths (83 percent) of Wyoming's dentists are graduates of 12 dental schools located in the North Central States. Two dental schools in adjacent Nebraska--Creighton University and the University of Nebraska-- have been the major contributors, providing 21 percent and 15 percent of the State's dentists, respectively. The next largest contributors--the University of Missouri, Northwestern University, and Washington University at St. Louis--have each provided 8 percent of Wyoming's dentists. Four other schools in these States--the Universities of Iowa and Minnesota, St. Louis University, and Loyola University of Chicago--have each provided 5 percent of the State's dental force. Another 14 percent of the State's dentists graduated from five schools lo- cated in Western States. The dental school at the University of Denver, although closed since 1930, is the only one of these schools to have con- tributed as much as 5 percent of Wyoming's dentist supply. Dental School Attended and Year of Graduation for Dentists in Wyoming Dental school Number Year of graduation attended of All After 1941- 1940 or dentists years 1955 1955 earlier Total number 153 Y - 45 46 60 (Percent distribution by school) North Central States 128 83 81 89 80 Creighton University 33 21 18 26 22 University of Nebraska 23 15 18 17 8 University of Missouri 13 8 2 9 13 Northwestern University 12 8 7 2 13 Washington University (St. Louis) 12 8 11 7 7 7 other schools 35 23 25 28 17 Western States (5 schools) 20 14 16 4 18 Other States (5 schools) 5 3 3 7 2 1/ Year of graduation not available for 2 dentists. Some 13 percent of the survey respondents (17 dentists) reported that they had completed one or more years of advanced training after receiving their dental degree. Eleven dentists had received advanced clinical training as interns or residents and nine had completed at least one year of advanced academic work as graduate or postgraduate students. Three dentists had completed both academic and clinical training. 612 DISTRIBUTION OF DENTISTS Approximately three-fifths, 89, of the 153 dentists in Wyoming are lo- cated in only five of the State's 24 counties. The two counties with the largest central cities--Laramie, which contains the city of Cheyenne, and Natrona, where Casper is located--have 18 and 19 percent of the dentist supply, respectively. Another 21 percent (32 dentists) are located in the three counties having central cities of 10,000-24,999 persons, includ- ing 8 percent each in Albany and Sheridan Counties and 5 percent in Sweetwater County. Distribution of Wyoming Dentists, by County Group Number Number Percent County group* of of of counties dentists dentists All counties 24 153 100 Central city 25,000-49,999 2 57 37 Laramie County 1 28 18 Natrona County 1 29 19 Central city 10,000-24,999 3 32 21 Central city 5,000-9,999 3 24 16 Central city 2,500-4,999 8 26 17 Central city under 2,500 8 14 9 * See Appendix Table for presentation of individual county data. The 19 counties with central city populations under 10,000 have about two- fifths (42 percent) of the State's dentist supply. The 11 counties with central cities having between 2,500 and 9,999 inhabitants have one-third of Wyoming's dental force, while the eight counties with less than 2,500 persons in their central cities have only one-tenth of the dentist supply. Of these 19 counties, only Fremont has as many as 10 dentists, while 13 counties have fewer than five dentists. 613 AGE DISTRIBUTION OF DENTISTS The median age of dentists in Wyoming is 46.3 years. Slightly more than one-third (53 dentists) are under 40 years of age, including 23 percent who are under 35. Another one-third of the dentists are between 40 and 54 years of age, while an almost equal proportion are 55 or over. About one in every seven dentists (l4 percent) are at least 65 years of age. Age Distribution of Wyoming Dentists Number Percent Cumulative Age in 1965 of of percent dentists dentists distribution Total 153 100 - Under 30 9 6 6 30 - 34 26 17 23 35 - 39 18 12 35 40 - 44 19 13 48 45 - 49 14 9 57 50 - 54 16 11 68 55 - 59 19 13 81 60 - 64 8 5 86 65 - 69 11 7 93 70 - 74 6 4 97 75 & over 5 3 100 1/ Age not available for 2 dentists. Percents are based on the total for whom age is known. There are some variations in the median ages of dentists by county group. Dentists in Laramie and Natrona Counties, whose central cities have more than 25,000 persons, are on the average about 45 years of age, while den- tists in the three counties with 10,000-24,999 persons in their central cities (Albany, Sheridan, and Sweetwater) have a combined median age of 47 years. Dentists in the 19 counties with central city populations under 10,000 are the oldest as a group, with a median age of approximately 49 years. 614 ACTIVE DENTISTS IN RELATION TO POPULATION Approximately 97 percent of the 153 dentists in Wyoming are active in their profession, giving the State one professionally active dentist for every 2,370 persons. Of the two largest counties, Natrona has the more favorable ratio, 2,064 persons per dentist, while Laramie County has a somewhat higher ratio of 2,496. The three counties having between 10,000 and 24,999 persons in their central cities average one active dentist for every 1,881 persons, a ratio considerably better than the average for the State as a whole. Sheridan and Albany Counties have 1,533 and 1,823 per- sons per dentist, respectively, while Sweetwater County has a much higher ratio of 2,700. Number of Persons per Active Dentist in Wyoming Professionally Persons County group* active Population per dentists dentist All counties 148 350,800 2,370 Central city 25,000-49,999 55 125,200 2,276 Laramie County 27 67,400 2,496 Natrona County 28 57,800 2,064 Central city 10,000-24,999 31 58,300 1,881 Central city 5,000-9,999 22 53,700 2,441 Central city 2,500-4,999 26 70,600 2,715 Central city under 2,500 14 43,000 3,071 * See Appendix Table for individual county data. Among the 19 counties in the State with central city populations under 10,000, there are five with persons-per-dentist ratios below the average for the State, yet seven counties have ratios of 3,000 or more, including two counties with 4,000 or more persons for every dentist. Generally, the ratio of persons per dentist becomes less favorable as the size of the central city decreases. The group of counties having 5,000-9,999 inhab- itants in their central cities have an average of 2,441 persons for every dentist. In comparison, the eight counties with central city populations under 2,500 average one dentist for every 3,071 persons. 615 386-029 O - 70 - 40 UTILIZATION OF AUXILIARIES Eighty-five percent of the responding dental practitioners in Wyoming (i.e., dentists who spend any time working at the chair) reported that they employ some type of auxiliary personnel. Dental assistants, the most frequently employed auxiliary, are utilized by 79 percent of the den- tists, including 77 percent who employ at least one on a full-time basis. Secretaries or receptionists are employed by 28 percent of the practi- tioners, with about one-half of these dentists using such personnel full time. Laboratory technicians and dental hygienists are employed by 19 percent and 12 percent of the dentists, respectively. The majority of the dentists who employ technicians or hygienists do so only part time. Wyoming Dentists Employing Auxiliaries, by Type of Auxiliary Percent of dental practitioners Type of auxiliary Dental With one full- With only employed by dentists practitioners Total time employee part-time (or more) emp loyees Total 126 100 83 2 One or more auxiliaries 105 85 83 2 Assistant 98 79 77 2 Hygienist 15 12 1 11 Laboratory technician 23 19 4 15 Secretary or receptionist 35 28 14 14 Other type of personnel 1 1 - 1 No auxiliary 19 15 - - 1/ Includes 2 dentists who did not report on auxiliary utilization. Utilization of auxiliaries varies with the age of the dentist and is less common among the older dentists. Approximately 93 percent of all practi- tioners under 55 years of age reported the employment of at least one auxiliary. The proportion employing auxiliary personnel decreases to 70 percent for dentists 55-64 years of age and to 57 percent for those den- tists who are 65 and over. About 18 percent of the responding dental practitioners in Wyoming re- ported one or more vacancies for auxiliary personnel. Almost two-thirds of these dentists had vacant positions for dental hygienists. 616 3 3 3 OTHER SURVEY FINDINGS Three-fourths of the survey respondents reported that they are licensed to practice dentistry in at least one State in addition to Wyoming. More than three-fifths of the in-State respondents hold more than one other license, including 12 percent who have two or more other licenses. Multiple licensure is more common among respondents who are licensed in Wyoming but located in another State; one-half of these dentists hold two or more licenses in addition to a Wyoming license. More than two-fifths of the licenses held outside Wyoming are held in three of the six adjacent States, with 24 percent in Nebraska, 12 percent in Colorado, and 8 percent in Montana. Four other States--California, Missouri, Minnesota, and Oregon--account for a third of the out-of-State licenses. Ninety-eight percent of the professionally active dentists in Wyoming are primarily engaged in private practice, with 96 percent self-employed and 2 percent employed by another dentist. The remaining 2 percent are employed by governmental agencies, or are engaged in some other dental activity, such as taking advanced training. Only 6 percent of the respondents reported that they limit their practice to a dental specialty, including 3 percent each in ortho- dontics and oral surgery. The majority of the dentists in limited practice are located in Laramie and Natrona Counties. Of the responding dentists who are licensed in Wyoming but located in another State, almost three-fifths are concentrated in five States, including 17 percent in California, 15 percent in Nebraska, 12 percent in Colorado,and 7 percent each in Oregon and Arizona. The remaining out-of-State dentists are scattered throughout 14 other States, with the largest numbers in Montana, South Dakota, and Missouri. One in every four of the out-of-State respondents reported that they had been professionally active in Wyoming immediately prior to assuming their present location in another State. More than one- half of these out-migrant dentists are currently located in adja- cent States, primarily Nebraska and Colorado. October 1968. 617 819 APPENDIX TABLE Selected Data on Dentists in Wyoming, by Location Civilian dentists Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total respond- Under 55 years sionally (in 000's) active ents ents 40 or more active dentist All counties 2/ 153 130 23 53 49 148 350.8 2,370 Central city 25,000-49,999 57 50 7 19 16 55 125.2 2,276 Laramie 28 26 2 11 8 27 67 .4 2,496 Natrona 29 24 5 8 8 28 57.8 2,064 Central city 10,000-24,999 32 28 4 12 11 31 58.3 1,881 Albany 13 13 - 6 4 13 23.7 1,823 Sheridan 12 11 1 3 4 12 18.4 1,533 Sweetwater 7 4 3 3 3 6 16.2 2,700 Central city 5,000-9,999 24 17 7 7 9 22 53.7 2,441 Carbon 6 5 1 - 4 5 14.8 2,960 Fremont 11 8 3 5 2 11 29.3 2,664 Washakie 7 4 3 2 3 6 9.6 1,600 Central city 2,500-4,999 26 22 4 9 10 26 70.6 2,715 Campbell 2 1 1 1 1 2 6.4 3,200 Converse 3 2 1 1 2 3 6.6 2,200 Goshen 4 4 - - 1 4 11.5 2,875 Hot Springs 2 2 - 2 - 2 6.9 3,450 Johnson 2 1 1 1 - 2 5.8 2,900 Park 7 6 1 2 3 7 17.5 2,500 Uinta 5 5 - 1 3 5 7.5 1,500 Weston 1 1 - 1 - 1 8.4 8,400 620-98€ - O 0L61 : IDIAJIO ONLLNI¥d LNIAWNYIAOD °S ‘nN 619 APPENDIX TABLE (cont'd.) Selected Data on Dentists in Wyoming, by Location Civilian dentists 1/ Persons County group Respond- Non- Age in 1965 Profes- Population = per and county Total erLLE respond- Under 55 years sionally (in 000's) active ents 40 or more active dentist Central city under 2,500 14 13 6 3 14 43.0 3,071 Big Horn 5 5 2 1 5 11.3 2,260 Crook - - - - - - 4.7 - Lincoln 3 3 - 2 - 3 9.0 3,000 Niobrara 2 1 1 1 - a 2 3.3 1,650 Platte 2 2 - 1 2 6.8 3,400 Sublette 1 1 - - 1 1 4.3 4,300 Teton 1 1 - - 1 3.2 3,200 Yellowstone National Park - - - - - - 0.4 - 1/ Copyright 1965. Sales Management Survey of Buying Power. Further reproduction is forbidden. 2/ Counties have been grouped according to the 1960 population of the largest (central) city within each county. yr ee sg vn ye B - 36 oan ee re pen mans i Et . 5 8 in . ‘ t i - . bo * ‘ . CART EES ye TT rR . rn a 1 ~ . } 1 A So i . ) ) . } i ¥ . U.C. BERKELEY LIBRARIES MIAN (029398255