COVID-19 has hit dentistry with a force never felt before, much like the effect of the pandemic on other sectors and on society as a whole. In March 2020, the New York Times identified dentistry as one of the professions and settings most at risk for the spread of the coronavirus.1 Almost overnight, dental practices across the country closed their offices and sent their teams home. Employment in dentistry in April 2020 fell to 44% of what it was in January 2020.2 Without the relatively quick action taken by Congress to implement measures such as the Paycheck Protection Program, which 92% of private firms took advantage of, employment would likely have fallen even further.
But dentistry bounced back. The profession was undoubtedly well prepared to prevent the spread of disease by applying, adapting and amplifying the fundamental concepts of infection control to keep patients and staff safe and to return to work.3 As the shutdown slowly eased, the level of employment in dental practices rebounded to 90% of pre-pandemic levels in June and 100% by the end of the year.2 At the end of October 2021, dentistry is showing employment levels that to go past what they were before the pandemic.2 Because of its resilience, dentistry is reaping the rewards of continued job growth.
The volume of patients in the practices must follow, now that we have so many dental staff in the practice, right? Perhaps surprisingly, this is not the case. In October 2021, patient volume in dental offices was 90% of pre-pandemic levels, on average, nationally.4 There has been a consistent gap between employment level and patient volume since mid-2020, where patient volume lags at least 14% and up to 25% behind the level of use.4
Further reading: 5 Reasons Dentists Retire 7 Years Later Than the Average American (And How to Fix It)
Dentistry may have “fully recovered” in terms of employment levels – the sheer number of employees in dental practices – but those employment numbers are no longer sufficient to meet the new demands of dental practice. . Practices are understaffed. Four in 10 practice owners said they were trying to recruit dental assistants, and nearly a third were recruiting dental hygienists in August 2021.5 Almost all of these hiring dentists report significant difficulty in filling vacancies.5 These vacancies naturally reduce practices’ capacity, hampering practices’ ability to accommodate patients with the same frequency seen through 2020. Staffing shortages have created a bottleneck in the recovery from the COVID pandemic -19 in dentistry (Figure 1).
Where did the dental team go? As of August 2021, approximately 15 months into the pandemic, approximately 5% of hygienists who were working before the pandemic had still not returned to work.6 The majority of these departures were voluntary, driven by concerns related to the ongoing pandemic or workplace safety.6 With the widespread availability of COVID-19 vaccines and declining infection rates nationwide, it looks like a rebound in the workforce is imminent. Yet the shortage of dental hygienists is expected to persist into next year. While some are slowly returning to work, a small number of hygienists who left the workforce at the start of the pandemic have eventually retired or left the profession permanently. This loss of experienced labor is unlikely to be quickly replaced by the influx of hygienists, as first-year enrollment in dental hygiene programs in fall 2020 is down nearly 7% from the previous year.seven Even if enrollment rebounds, it will be years before these new hygienists are qualified to enter the workforce.
The main challenges that dental practices face in the short term are all related to staffing. Patients know dental offices are safe and ready to resume “normal” life activities. And now? Practices need to think creatively not only about recruitment, but also about staff retention. Are the pay rates sufficient to compete with the many other dentists hiring in this new market? Is cross-training needed as an interim solution to broaden the skills of your existing team? Is it time to promote flexibility of skills and implement solutions such as teledentistry? Are there professional development opportunities that foster a sense of fulfillment, camaraderie, and growth at work? Does the staff know that they are an essential link in the operation? The data shows this very clearly.
Labor shortage cycles take time to resolve. We will continue to monitor this in the months to come. At the American Dental Association, we look forward to continued collaborations with colleagues in dental hygiene and dental assisting to better understand the complex issues involved. You will know how things are going in your own practice before you get along with the national perspective. Innovation will be needed; we are about to meet this workforce challenge in dentistry.
Editor’s note: This article originally appeared in the January 2022 print edition of Dental economy.
- Gamio L. Workers most at risk from coronavirus. New York Times. March 15, 2020. https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html
- Current employment statistics. United States Department of Labor, Bureau of Labor Statistics. https://www.bls.gov/ces/
- Araujo MWB, Estrich CG, Mikkelsen M, et al. COVID-2019 among dentists in the United States: a 6-month longitudinal report of cumulative prevalence and incidence. J Am Dent Assoc. 2021;152(6):425-433. doi:10.1016/j.adaj.2021.03.021
- Economic impact of COVID-19 on dental practices, week of October 11, 2021, results. ADA Health Policy Institute. https://www.ada.org/resources/research/health-policy-institute/impact-of-covid-19
- Economic impact of COVID-19 on dental practices, week of August 116, 2021, results. ADA Health Policy Institute. https://www.ada.org/resources/research/health-policy-institute/impact-of-covid-19
- Economic impact of COVID-19. Results for dental hygienists, week of August 16, 2021. ADA Health Policy Institute and American Dental Hygienists’ Association. https://www.ada.org/resources/research/health-policy-institute/impact-of-covid-19/dental-hygiene-results
- Allied Dental Training Survey, 2020-21. ADA Health Policy Institute. https://www.ada.org/resources/research/health-policy-institute/dental-education