How Many Is Enough?
Is the current number of orthodontists adequate to meet the present demand for their services, and will it remain so in the foreseeable future?
The answer to the first part of the question is, "Yes. The present supply of orthodontists is adequate to accommodate the present demand." This is confirmed by the JCO Orthodontic Practice Studies, which show that the majority of orthodontists report not being busy enough and indeed feel they could accept an average of 50 additional patients with no increase in office facilities or number of employees.
In the 1960s, the AAO conducted a study that turned up the stunning news that the number of orthodontists was increasing while the number of potential child patients was decreasing. Partly in response to these data, graduate orthodontic department class sizes were reduced. Through the baby bust and the echo boomlet, the number of orthodontists nevertheless continued to increase, due to the relative youth of orthodontists and the amount by which the annual number of orthodontic graduates exceeded the number of practitioners who retired or died. As that gap has narrowed, we have approached and may already have reached zero orthodontic population growth. The relationship of the number of orthodontists to the number of potential orthodontic patients in the population is still a fundamental factor in studies by those who are concerned with maintaining a supply of orthodontists adequate to meet future demand, since it takes some time to create an orthodontist.
What are the Census Bureau's expectations for population increases?
According to the most recent Census Bureau report, the population of the United States--presently 261 million--is expected to reach 276 million by the year 2000, 300 million by 2010, 350 million by 2030, and 392 million by 2050. This has provoked some speculation about the number of new orthodontists who will be needed to service the projected number of people. In the past, the Census Bureau has used mathematical models that have been wildly out of touch with the much lower actual fertility rates. However, if one factors 50 additional patients into the average practice, the present number of orthodontists could service even the Census Bureau's projected population up to the year 2010, assuming demand for orthodontic treatment remained at the present level.
Will population increases result in increased demand for orthodontic treatment?
Births in the United States during the 1990s have exceeded 4 million a year, and this rate is likely to continue for several more years. On that basis alone, there should be an increase of 5-10 patients per year in the average practice.
One contributor to future population totals is the increasing longevity of Americans. Currently, 13% of the population is 65 and older. By the year 2050, the figure is projected to be 20%. Unless we develop a geriatric orthodontic sub-specialty, that source of population growth will be meaningless to orthodontists.
It is an unfortunate characteristic of our society that a growing number of people are living below the poverty level. The number is now 39.3 million--15% of the population--and appears to be increasing by about a million a year as poverty spreads and as the poverty line is raised. Although the poverty level as defined in the United States (currently $14,763 for a family of four) would be the envy of 95% of the world population, it is a level that does not generally permit the purchase of orthodontic treatment.
A relatively small, but significant, source of increased population is the number of immigrants--legal and illegal. This is not a group that can be expected to be strongly involved in orthodontic treatment soon.
One population factor that has received little consideration is the growing group of people who have received orthodontic treatment once and are not likely to be candidates for a second course of treatment. If something more than 1% of the population is treated each year, a goodly percentage of eligibles has been used up over the past 30-40 years. Speeding up treatment with improved techniques is likely to continue, so that eligible patients will be used up even faster.
Are there other factors that could affect the adequacy of the supply of orthodontists?
Although the JCO Orthodontic Practice Studies have shown a steady increase in the delegation of tasks to trained auxiliaries, the percentages seemed to level off in the 1993 Study at a point at which few of the basic tasks were routinely delegated by a majority of practices. There is, therefore, a large potential to expand the duties of auxiliary personnel, depending on state laws, and a large potential for the average practice to treat many more patients.
If there were a universal national health scheme that included orthodontic treatment for a large enough number of people, or if state welfare programs were greatly expanded, or if private insurers were to increase orthodontic benefits for a large enough number of people, there might be an inadequate supply of orthodontists to handle the increased demand. The likelihood of any of these is too remote to be a consideration at this time. In fact, nearly half of present orthodontic patients have insurance benefits, and that has not changed the busyness of orthodontists.
If a law were passed requiring that orthodontic treatment be performed only by specialists, there could be a considerable influx of patients into orthodontic offices. However, this is extremely unlikely, and even if it did happen, it would be accompanied by demands for training more orthodontic specialists and would likely result in an oversupply.
With the apparent leveling off of the number of orthodontists and with the increased capacity of orthodontic offices delegating more tasks to capable employees using more efficient techniques, it is a safe bet that the present number of orthodontists can handle the projected orthodontic case load for the foreseeable future. If we keep looking at orthodontists' busyness, we can monitor future needs more effectively than by any other method.