WHY IS THERE A CRISIS FOR DENTISTS IN INDIA, WITH 1.3 BILLION PEOPLE AND 32 TEETH EACH?

Updated: Dec 29, 2020


Picture credits - @zianaart


ARE YOU A DENTIST STRUGGLING IN INDIA? HAVE YOU LOST YOUR FAITH IN DENTISTRY AS A PROFESSION??

  • Are you a newly qualified dentist who is wondering if you’ve made the right choice?

  • Are you debating between opening a practice or investing in a post-graduation?

  • Are you considering going abroad to establish practice or pursue post-graduation and face challenges there?

If these are your concerns and you are struggling to make up your mind -. I can help. The first thing we need is to understand current dental demographics in India and  the world,  so that you can make an informed decision. Everyone needs to make their own choices, as each of your situations is completely unique to you.


UNDERSTANDING INDIAN DENTISTRY


Let’s begin with understanding some facts, since it’s important to know what the problem is before you can possibly correct it. According to data provided on Indeed and other similar job seeker websites, Dentistry in India pays badly when compared to other professions. 


A couple of years ago, I witnessed a situation where a person was applying for the position of a  government peon in India- the applicant’s degree was BDS! This predicament was what sparked my interest in helping others who might face similar problems. I believe that everyone has a ‘calling’ and this is when I recognised mine. Eventually, it led to the creation of this website, in the hopes that I could help even a few people out of their situation.


Unfortunately, as you can see from the above figures- India is not the best place that you can work for a salary. So what then is the best way to succeed in your Dentistry practice? I have one piece of advice for you in this regard- upskill. Make a record of your skill sets and then find a way to bargain for your share in the business. Here in the UK, as an associate, we get around 40 - 50 % of gross earnings, which of course depends on what you bring to the table in terms of skills and experience. It keeps you motivated and committed to the practice of dentistry and is in turn a benefit for all concerned. 


Initially,as a newly qualified dentist - being salaried is probably the only way to start. You have to bear in mind that it requires a lot of hard work in order to break out of the salary market. It’s useful to have a written plan for improvement and a clear idea of what you plan to do and how committed you are in investing yourself. Proving to be an indispensable part of the practice and business, shows practice owners that they have a huge advantage in keeping you. These are the things that will ultimately prove to be a game-changer for you.  Having a new dental clinic in the same area is not necessarily a good strategy. It could be a waste of resources, unless you calculate and understand the need for one.



WHAT IS A GOOD DENTIST TO POPULATION RATIO?


From what I have read and according to WHO, the recommendation for dentist to population ratio in developing countries is 1:7,500  (which is 1.3: 10,000). India has a ratio of 1.9:10000. So it is slightly above target for a developing country, but there is a huge variation even within this. Like most countries, dentists prefer to practise in urban areas with a higher standard of living, with 70% of the dentists practising in the cities, and only about  30% are providing care for the semi-urban and rural of the population. So the competition for dentists practising in the cities are almost > 5 dentists per 1000 people compared  to < 1 dentist per 1,00,000 to almost < 1 per 2,50,000 people in some rural areas.


Also within India, there are huge differences in the number of dentists in few states such as Karnataka where the dentist to population ratio is 1:2,130 and Kerala where it is 1:3,388, which is very unfavourable for dentists. It is almost as high as recommended in developed countries where the patients have a routine 6 monthly cleans and checks and x-rays done every 2 years for risk assessment, and teeth are well maintained unlike in India where mostly emergency repair work is done- although the trends are changing as esthetic dentistry and ‘want dentistry ‘ rather than ‘need dentistry ‘ is taking shape.


In the UK/USA, it is considered that you need about 2000 active patients to keep a dentist schedule full for a 32 hour week. Though when you are trying to figure this out, remember that not everyone goes to the dentist and some only go in an emergency. So a dentist to population ratio will need to be higher for you to have a comfortable, thriving practice.




HISTORY OF INDIAN DENTISTRY


For us to understand what's the current situation we need to understand where it all started from and we are exactly 100 years into the dental profession in India.


In 1920, the first dental college of India was founded by  Rafiuddin Ahmed in Calcutta, called Dr R. Ahmed Dental College and Hospital, later renamed as 'The Calcutta Dental College', where he remained its principal until 1950. His other major contributions to the Indian dental field was that,  in 1925, he established the Indian Dental Journal and served as its editor until 1946. In 1946, he established The Bengal Dental Association, which was later renamed as the Indian Dental Association.


For the first three years, the dental college had only 11 students, one of whom was Fatima Jinnah, sister of Mohamed Ali Jinnah, and also called the ‘Mother of the nation’  in Pakistan. Following this, many new colleges were established and in around 1970 there was a record of 8,000 dentists in India. Then this number slowly rose to 30,500 produced every year in 2010, which has now reduced.


According to DCI in June 2020, there are 313 dental colleges in India, only 40 among them are government-run, with 26,949 seats for BDS, and 6,228 MDS seats in 269 dental colleges. The number of registered dentists breakdown according to states, given as a table below is quite interesting. The number of dentists corresponds directly to the number of dental colleges in that state, and the worst cities to be in as a dentist are - Chennai, Mumbai and Bangalore, unless you want to be a faculty. 


The total No of registered faculty is 34,520

The total No of hygienists is 3,533, with maximum registration in Uttar Pradesh.


DENTAL DEMOGRAPHICS OF THE WORLD


Dentistry was initially practised by barbers in China and France. They were divided into two groups: lay barbers and guild barbers. Guild barbers were more qualified and educated dental surgeons, while lay barbers were qualified to deal with less complicated hygienic services like tooth extraction and shaving.


Let us compare the Indian demographics to that of the other countries and the numbers to help you understand your competition in the other countries that you would like to work in. Most values are taken from the WHO website and its prints mostly recorded from 2016 - 2020 or directly from each country’s respective dental council.



Number of dentists - WHO  ( https://apps.who.int/gho/data/node.main.HWFGRP_0060?lang=en )


Number of physicians.- WHO (https://apps.who.int/gho/data/node.main.HWFGRP_0020?lang=en -)



To summarise, the total number of dentists adding all on the lists from the WHO table of the 192 countries mentioned, is around 2,612,543, so there are around 2.6 million dentists in the world. The number of dentists per 10,000 is in the range of 5 - 6 in most of the developed countries, so it is much more than in India, which is around 2 /10,000. But most developed countries have put in place a system of recall and maintenance which is very beneficial for the patients too - as losing one's teeth can be devastating and expensive, and this is the route that all dentists should collectively try and achieve, instead of competitive rates / unethical advertising.


Many countries in Africa, Asia and Latin-America have a shortage of dental professionals and the capacity of the systems is limited to pain relief or emergency care. In Africa, the dentist to population ratio is approximately 1:1,50,000 compared to about 1:2000 in the majority of developed countries.


China has the maximum number of dentists, followed by India, Brazil and America, also quite reflective of the population. The highest number per 10,000 is in Egypt which is 20, followed by Cuba and Brazil. So this will give you an idea of what countries to avoid for emigration. I have listed all the countries that I  thought you might be interested in, but the whole list is also linked below the table.


According to the WHO website - oral diseases affect3.9 billion people worldwide, with untreated tooth decay (dental caries) impacting almost half of the world’s population (44%), making it the most prevalent of all the 291 conditions included in the Global Burden of Disease Study.


Globally, between 60–90% of schoolchildren and nearly 100% of adults have tooth decay, often leading to pain and discomfort. Severe periodontal (gum) disease, which may result in tooth loss, is found in 15–20% of middle-aged (35–44 years) adults and about 30% of people aged 65–74 years have no natural teeth, a burden expected to increase in the light of ageing populations.


Oral conditions are the fourth most expensive to treat. In the United States alone, US$110 billion are spent yearly on oral healthcare. In the European Union, annual spending on oral healthcare was estimated at €79 billion in the years 2008-2012, which is more than the money invested in the care of cancer or respiratory diseases.


So with all this in mind, I do not think dentists have anything to worry about and there is going to be work for all, wherever on the planet, they may be. It's how we make ourselves stand out and improve and how we help the people we serve, with better preventive and restorative methods, that matters. A stabilised list of patients, with routine recalls, and with the few cosmetic treatments/implants/orthodontics (the real money makers) is all you would need to live a fairly good life.


So cheer up and with your head high, be proud to be a dentist, who can put a smile on everyone's face -LITERALLY!!



References


1.Dental salary (https://www.indeed.co.in/salaries/dentist-Salaries)


2.No of dentist according to state (http://dciindia.gov.in/DentistRegistered.aspx)


3.No of Hygienist/– in India  (http://dciindia.gov.in/ViewHygienstMechanics.aspx)


4.Who statistics (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/dentists


https://www.who.int/gho/publications/world_health_statistics/EN_WHS2014_Part3.pdf


5. Oral Health Statistics WHO (https://www.who.int/news-room/fact-sheets/detail/oral-health)


6. Lack of dentist in rural areas - Bhat.et al - 2008 ( M. Oral health status and treatment needs of a rural Indian fishing community. West Indian Med J. 2008) Tandon .et.al - 2004 (S. Challenges to the oral health workforce in India. J Dent Educ 2004)

and 


7. Rural outreach programmes do well due to lack of dentists (Vashisth,-2012-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514936/)










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Ishara Hameed Riz

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