Dentistry, long seen as a bastion of stern older men in white coats, is moving inexorably toward becoming a profession in which women comprise a majority of practitioners, not just hygienists and support staff. What might this portend? Dr. Barbra Bluestone Rothschild, a bioethicist and medical futurist at Columbia University, offers some thoughts.
SPECULATION ABOUT something as complex as modern medicine can be a mug’s game. There are just too many variables for predictions to be credible. Yet regarding the future of dentistry, one thing is certain: Not tomorrow, not next year, but before long, a majority of dentists will be women. Although just 32.3 percent of current practitioners are female, according to the American Dental Association’s Health Policy Institute, women have been a majority of U.S. dental students for several years.
The trend is clear, and the impact of this shift—from a profession in which women played a minor role at best to one in which they’ll increasingly call the shots—will be seismic. How will the doctors and patients of tomorrow experience it?
“Diversity in a profession significantly improves a person’s chance of finding a provider that they can communicate with and feel comfortable and trust,” says Dr. Barbra Bluestone Rothschild, an internist, bioethicist and lecturer at Columbia University’s School of Professional Studies. “Ultimately that may improve health outcomes.”
It is of course facile to assume that simply because an industry almost axiomatically male since its earliest days is becoming more female, it will be more caring, more thoughtful or more concerned with patient welfare. Indeed, “I would hope delivery of care would be the same,” Dr. Bluestone Rothschild observes. “Though theoretically it may improve access to care, as historically women are more likely to accept Medicaid.”
In addition to her work at Columbia, Dr. Bluestone Rothschild is also a visiting scholar at the Hastings Center in Garrison, New York, studying the moral component that undergirds health-care finance decision making. That, to her, might be the most important decision made by a more feminine dental profession: how to allocate scarce resources.
“The continuing discussions around health care as a human right will have an effect on medicine and oral medicine,” she says. “We are a wealthy country, and we must decide where that wealth is best spent. My mom was a dental hygienist in the 1960s and ’70s and saw many, many children in Appalachia with rotten teeth. Spending resources to prevent that seems to me an important priority for a wealthy country. We have come a long way, but the discussion of assuring everyone access to basic oral health remains important.”
Diversity in a profession significantly improves a person’s chance of finding a provider they feel comfortable with.”
Other stark changes that will be felt throughout dentistry in the decades ahead will likewise make a strong impact on other disciplines. For the most part, Dr. Bluestone Rothschild regards that favorably. “The advent of artificial intelligence and machine learning into health care may, if used well, decrease errors, improve efficiency and perhaps even give providers more time to do what they should do best: get to know their patients in order to assist them in making health-care decisions that reflect their values,” she says.
She’s concerned about the propensity of dentists and other medical professionals to feel like pawns in a smothering, impersonal system, however. “There is quite a bit of moral distress [among] health-care providers today. The ethos is not positive—providers feel overworked, underappreciated and left adrift to face complex social situations,” she says, citing the opioid crisis—in which dentists have played no small role—as illustrative. “I haven’t seen much in the way of addressing this, and we will lose smart students to other professions if this continues.”
She’s no reflexive doomsayer, though. The future of dentistry will be altered not just by the presence of more women, but by “big data, artificial intelligence and other rapidly advancing new technologies,” she says. That will require sturdy ethics among the majority-female dentists of tomorrow. But Dr. Bluestone Rothschild professes optimism: “Watching the electorate get motivated and educate themselves about health care and health-care economics is very exciting. It may be the way to ensure the type of high-quality health care outcomes we deserve.”