Competition taking a bite out of dentistry schools’ tuition schemes
Recently, the Japan Medical Association protested the government’s desire to increase the number of medical schools as a means of solving the doctor shortage. The JMA says that more physicians will undermine the pay potential of all doctors and points to the situation of dentists, whose average salaries have decreased markedly in recent years due to a glut.
In a society aging as rapidly as Japan’s is, you can never have too many doctors, but dentists? As a medical practice, dentistry tends to be self-defeating. The better job dentists do in promoting oral hygiene, the less there is for them to do. Like America in the ’50s and ’60s, Japan became more aware of dental health in the ’80s and ’90s and people spent more money on their teeth and those of their children. Such a development had two outcomes: More young people turned to dentistry as a career, and people’s teeth became healthier. Since the latter meant that people required less capital-intensive dental work in the long run, dentists on the whole made less money, especially since their numbers grew as the years progressed.
Consequently, fewer students are opting for careers in dentistry, which is bad news for dentistry schools, especially private ones. According to a recent article in the Asahi Shimbun, the number of university students who said they “wanted to enter dentistry” dropped below 10,000 for the first time in 2008. A year later that number had plummeted to less than 5,000. This year, the number of applicants to the nation’s 17 private dentistry schools is less than the number of openings.
The main reason is the dentist glut. In 1998, there were 69.6 dentists for every 100,000 Japanese people. Ten years later the number had increased to 77.9. News of this increase got around, and apparently fewer young people, even when taking into consideration the drop in university enrollment in general, opted for dentistry as a field of study. Some experts point to the fact that university medical departments increased the number of openings to 8,923 in 2011, thus offering more of a reason for students to choose general medicine over dentistry.
In any case, going to dentistry school is pretty expensive, so to attract applicants private institutions are being forced to reduce tuition. The average tuition for six years of dentistry school starting in 2011, according the Association of Private Dentistry Universities, is about ¥29 million, a decrease of more than 10 percent since the 2007-2008 term. The trend started in 2010, when three schools lowered tuition just before the entrace examination period. Eight other schools have followed the trend and three others have announced they will cut tuition starting in 2012. (Note that these reductions have no effect on current students, who have to pay the old, higher tuitions)
The Asahi cites the situation of the Matsumoto Dentistry School in Nagano Prefecture as a prime example of the trend. One of the most expensive schools in Japan, Matsumoto, until 2008, charged ¥57 million for six years, and then reduced the fee to ¥52 in 2009. From there the charges dropped to ¥32 million in 2010, and in 2012 the school announced it will cut tuition further to ¥20.48 million, almost a third of what it was four years earlier. In 2008, Matsumoto had openings for 113 students, but only 40 ended up enrolling, half the number that did so in 2007. Since then the school has only managed about 40 new students a year.
Another private school, Ohu University in Koriyama, Fukushima Prefecture (the alma mater of top-selling vocal pop group Greeeen), decreased its tuition by ¥5.5 million to ¥21.75 million in 2011 because only 24 students enrolled, a quarter of the number of openings. Since the school is afraid that the nearby nuclear accident will make it unattractive to potential dentistry students, they had to reduce tuition even more than average, even though they are heavily in debt following extensive investment for new equipment and facilities.
According to government statistics, dentists on average earned ¥5.8 million in 2010, down from ¥9 million in 2005. It requires about ¥50 million to open a dental practice in Japan. The dentist glut became well known several years ago when the media reported that the number of dentist offices had surpassed the number of convenience stores. Ironically, a lot of new dental practices seem to be taking over abandoned convenience stores for their facilities since the rent is cheaper than it is for conventional office space.
One solution to the oversupply of dentists would be to allow national insurance to be used for certain oral treatment. In principle, national insurance can only be used to “cure” medical problems, so filling cavities and other repair work is covered, but not orthodontia, which is still considered “cosmetic.” In the developed West, especially America, where braces are practically ubiquitous among adolescents, orthodontia is related to long-term health, since straight teeth mean a more natural bite and a more natural bite means longer-lasting teeth. If the health ministry approved orthodontia for national insurance, as well as other oral treatments, it could bring more people into dentists’ offices.
As it stands, some dentists already blur the line. Our present dentist allows us to use our national insurance for routine cleaning, whereas our previous dentist said it wasn’t allowed. Apparently, it’s a matter of interpretation.