Gender shift - The changing face of dentistry

"I MUST say it is a nice change to have a young lady as my dentist.”

These were the words of a recent elderly patient of mine. He had been attending the practice, which I had just joined, since he was a young man.

As I mused over his comment, I thought back to the changes the practice had undergone over the years and discovered that there had indeed only ever been male dentists here. Yet within the last two years, the practice now has a female dentist majority.

This gender shift is reflected more widely across the profession and is changing the face of the dental workforce, raising many questions along the way.

Men only

Things have come a long way since the late 19th century when only men were allowed to qualify as dentists. The 1897 census in England counted 116 women dentists, but none held a Licence in Dental Surgery (LDS). Just two years previous in 1895 Lilian Murray (later Lindsay) attained her LDS in Edinburgh, becoming Britain’s first qualified female dentist.

But her career path was not easy. She had first applied to the National Dental Hospital in London but was refused entry to the building to attend her interview for fear of distracting the male students. Needless to say her admission to study there was also declined.

Fortunately Lilian was welcomed north of the border and she went on to graduate with honours from the Royal College of Surgeons of Edinburgh. It wasn’t until 17 years later that women were finally allowed to sit dental examinations in England.

Even though women dentists gradually became a more accepted presence, research shows that as late as the 1960s they were still being encouraged to enter certain branches of dentistry. Fields such as maternity, child welfare and school health services were considered more suited to women.

Women on the rise

Since then, things have changed significantly. A study of the career development of male and female dentists published in the British Dental Journal in 2000 showed that in 1975 up to a quarter of new dentists were female. Today more than half of UK dental students are female and by 2020 it is estimated that over half the dental workforce will be female. This is also true outside the UK, with an upward trend in female dentists worldwide.

As a young female dentist, I wonder how this gradual feminisation of dentistry will impact our futures, and the significant consequences it will have for the wider workforce.

The NHS Dental Statistics for England 2012/13 report revealed significant gender differences in relation to the age of dental professionals, hinting at how the profession is likely to change in the years ahead. The under-35 age group is largely female (56.1 per cent) while the majority (76.4 per cent) of dentists aged over 55 are male.

In the past, dentistry’s big decision-makers have overwhelmingly been older men but it is notable that the General Dental Council has appointed its first female chief executive, Evlynne Gilvarry. Of all the 128 British Dental Association presidents since 1880, only five have been women, the first being Lilian Lindsay in 1946.

The increasing number of female dentists makes it imperative that women be recognised as vital for the future workforce.

Planning for change

GDC figures of the current specialist lists show that although female dentists represent the majority in dental public health, paediatric dentistry and special care dentistry, men continue to dominate all other specialist fields. What will happen once this predominantly older male cohort of dentists retires?

The increasing number of female dentists makes it imperative that women be recognised as vital for the future workforce. But will training pathways need to be restructured to accommodate the different needs of female dentists? Should they be?

In a recent Q&A with MDDUS Summons magazine, the BDA’s Judith Husband said: “Research has consistently demonstrated women dentists tend to see fewer patients, spend more time with patients, are less likely to own practices and will take career breaks. Society and legislation have moved to support both partners in relationships with caring responsibilities with paternity leave.

“The generally accepted trend is that the profession will be less productive in terms of volume of clinical work and this has a significant impact for workforce planning.”

Flexibility

A survey examining the contribution of women dentists to the workforce (carried out by JJ Murray and printed in the BDJ in 2002) reported that the introduction of part-time and flexible training opportunities enabled women to pursue the same goals as male colleagues, but the research confirmed that there were still few women reaching senior positions.

Some of the survey’s respondents remarked that for women dentists there was little flexibility in university clinical posts and career pathways, which remain based on traditional male working patterns.

The survey noted: “The training pathways and the necessity for substantial research and postgraduate qualifications to reach the highest posts were considered obstacles when combined with raising a family.” Perhaps some of the prejudices we have seen historically from Lilian Lindsay’s days continue to persist?

JJ Murray’s survey of 4,500 women dentists also revealed almost half of them work full-time and half part-time, with the main reason for part-time work being caring for children. A 2006 study in the BDJ called The feminisation of the orthodontic workforce found female dentists took more career breaks than men with breaks lasting an average of nine months compared to men’s four month breaks. As a result, women dentists who take a career break can be expected to have a working life 25 per cent shorter than a dental practitioner who does not take a career break.

There have been many high profile comments on the “feminisation” issue in medicine. Critics have raised concerns over the impact of largescale part-time working which they say will require greater investment in training. Other more positive comments have come from the likes of the Academy of Medical Royal Colleges who believe the NHS should view the changing nature of the medical workforce as an opportunity rather than a threat, adding that “opportunities for flexible working are increasingly sought by and benefit both male and female doctors.”

At some point, I will likely consider taking time out of my career to have children, and thus be a part of these statistics. Changes including the planned new UK laws for shared parental leave and pay may level out some of the potential imbalance but more will no doubt have to be done.

There are also knock-on effects in financial terms for future dentists. The BDA estimates that dental students who have begun their courses in 2013/14 can expect to face debts as high as £60,000 at the end of their studies. How will this affect these future graduates, considering half of them are likely to be working part time? Will women struggle to re-coup the financial investment they have made in building up their skills?

The reasons why more women are entering dentistry aren’t clear but the so-called feminisation of the workforce shows no signs of slowing down. It seems the profession will have to get used to seeing a greater number of “young lady” dentists in future.

Sources:

• BDJ, Women and the world of dentistry

• BDJ, A study of the career development of male and female dental practitioners

• BDJ, A review of the contribution of women dentists to the workforce, JJ Murray

Sameera Teli is a dentist and editor of SoundBite