J Dent Educ. 70(6): 667-675 2006
© 2006 American Dental Education Association
Milieu in Dental School and Practice |
A Historical Perspective on the University of Nebraska Medical Center’s College of Dentistry Class of 1961
Mary S. Willis, Ph.D.;
Roshan A. Badakhsh, B.S.
Key words: dental practice trends, dental education, dental class cohort
Submitted for publication 01/17/06;
accepted 03/15/06
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Abstract
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We conducted a retrospective analysis of the University of Nebraska Medical Center (UNMC) College of Dentistry (COD) Class of 1961 to glean information that might be useful in the design of dental education programs in Nebraska and elsewhere. We scanned annual class newsletters, demographic statistics for students entering the UNMC dental program for each decade from 1961 to 2001, and UNMC COD alumni data for patterns and themes among thirty-two dental professionals. Eighty-four percent of those contacted provided responses to a survey. We found that, like current dental cohorts nationwide, the UNMC COD Class of 1961 is mostly of European ancestry (non-Hispanic) and male. But in contrast to current dental college graduates, the UNMC Class of ’61 were able to rely upon self-employment and spousal and/or military support (GI Bill) to cover the costs of their dental education. They also were more likely to enter dental school before completion of an undergraduate degree and have a substantial work history before entering the UNMC dental program. Although the most common reason for attending dental school related to independence and financial security, "time with family" and "family vacations" were the next most important reasons cited for becoming dental professionals. Among ’61 graduates, the average number of years spent in the dental profession is thirty-seven years. Despite the notable changes in dental technology and the continual need for updating knowledge and skill, eight members of the UNMC COD Class of 1961 continue to practice dentistry. Most maintain contact with other class members, providing support to former classmates and maintaining an identity with their alma mater, the University of Nebraska.
The practice of dentistry has changed dramatically in fifty years, moving from a curative process to a more preventive and esthetic one, requiring a greater knowledge base and an increasing application of pharmacology.1–5 Although we know much about general trends within the dental profession over five decades and have annual demographic data for U.S. dental graduates, little is known about longitudinal factors for specific cohorts, particularly those graduating before 1970. Because the planning and design of dental education programs can be enhanced using knowledge of alumni experiences throughout the career cycle, we were approached by a member of the Class of 1961 to conduct a cohort analysis. Typically, cohort data are difficult to locate, and information about actual career outcomes is seldom available. This analysis is unique because we could assess factors for an entire class in greater detail; all entered the University of Nebraska Medical Center (UNMC) College of Dentistry (COD) in 1957 and were awarded a D.D.S. in 1961. The study was possible because, from graduation to present, most ’61 graduates have maintained close contact through a variety of social mechanisms. An annual newsletter has been produced, containing personal and professional information, beginning in 1962. In addition, we were able to examine personal, educational, and professional histories through survey data and make subsequent comparisons with recent UNMC graduates of the College of Dentistry, as well as those from programs nationwide. From the outset we knew that the Class of 1961 had experienced successful dental careers; however, the factors related to this achievement were unclear. Our goal in conducting this study was to highlight patterns for this cohort and examine results in relationship to dental education issues nationwide.
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Methods
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The 1961 graduating class of the UNMC COD was assessed using multiple sources. First, the majority of graduates have maintained a connection to the UNMC COD alumni association. Also, a class roster, which members (and their spouses) have maintained, was used. They continually update contact information and attend class reunions every two to five years. But most importantly, one class member, Dr. Albert Jerman, began writing a newsletter just one year after graduation. Dr. Jerman provided copies of each annual newsletter produced since June 10, 1962, and these newsletters were examined for themes and patterns. Next, using available data and literature published within dental journals, a questionnaire and an associated informed consent procedure were constructed. After submitting an Institutional Review Board (IRB) proposal and receiving approval to conduct the project, materials were mailed to members of the 1961 class for which contact information was available.
In all, thirty-two households received the questionnaire and associated IRB materials. Twenty-seven members of the Class of 1961, or their spouses, completed and returned a questionnaire and informed consent form, representing a response rate of 84 percent. The questionnaire topics covered demographic, educational, and professional areas—all subjects spanning the majority of each individual’s exposure to dentistry and dental practice. Participants completed the questionnaire within six months. To supplement the data obtained from the Class of 1961, the College of Dentistry was contacted to provide comparative data for classes entering the UNMC dental program in the four decades following those that entered in 1957 (and graduated in 1961). Thus the available data for classes entering each decade after the ’61 graduates began dental school, i.e., 1957 through 1997, supplemented the ’61 class analysis. Also, the UNMC COD Dental Alumni Association provided data for cohorts by decade, 1961 to 2001, concerning current practice location for graduates. Finally, we examined the UNMC Class of 1961 in relationship to the nationwide graduates of 2001 who completed the annual survey from the American Dental Education Association (ADEA).
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Results
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Comparative Class Data, 1957–97
The number of applicants to the UNMC COD has more than doubled from 1967 (323 applicants) to1997 (784 applicants), while acceptance rates appear to be decreasing over time (Table 1
). For example, although 23 percent of applicants were accepted in 1977, just 7 percent were admitted in 1997. Yet when we compare the actual number of entrants in 1957, thirty-five (the cohort that then graduated in 1961), to those entering in 1997 (and graduating in 2001), there is a difference of just eight student entrants. Thus annual class size remains low despite a much larger number of applicants, 784, in 1997. Although there were no female applicants to the class of 1957, nearly 30 percent of those applying to the UNMC COD in 1997 were female. Also, women made up 35 percent of the UNMC COD entering class in 1997. By contrast, there were no minority entrants in 1957, and the same is true for 1997. There were no marked rate differences for female and minority entrants for the intervening years from 1957 to 1997.
Although class members entering dental school in 1957 included individuals with military experience, such experience was nonexistent among entrants for each subsequent decade through 1997 (Tables 1
and 2). In addition, first-year dental students in 1997 were, on average, one year older than those that entered the College of Dentistry in 1957: 23.9 versus 22.5 years of age, respectively. Although data for the age at entrance were not available for students entering the UNMC College of Dentistry in 1967 and 1977, the mean age at entrance for classes in 1957, 1987, and 1997 was 23.7 years. Also, many more students entered dental school having completed an undergraduate degree: 63 percent in 1997 versus 26 percent in 1957 (Table 1).
The Class of 1961
All members of the UNMC COD class entering dental school in 1957 and graduating in 1961 were male and of European-Caucasian ancestry (Table 1). Nineteen of the twenty-seven participants in this cohort study, or 70 percent, were born or grew up in Nebraska. All but five respondents indicated that they grew up in middle-class families (Table 3) (i.e., family income was between $20,000 and $60,000 per year based upon respondent recollections). One ’61 respondent noted that household income placed his family in the upper socioeconomic class (i.e., family income exceeds $62,000 per year), while four reported that their families were in the lowest socioeconomic strata.
Although mothers of five graduates from the Class of 1961 worked throughout their sons’ dental school education, as machine operators, cooks, teachers, and store clerks, all other mothers of respondents were noted to be "homemakers" while their sons were attending dental college (Table 3). Two mothers had earned college degrees and were employed as school teachers, while three other mothers held teaching credentials but did not pursue a career in teaching. Fathers had an array of professions, from white collar professions to blue collar trades. For example, three were dentists, one was a Ph.D. level university professor, and one was a chiropractor. There were also bankers, pharmacists, newsmen, and store owners among them. However, most fathers of respondents were laborers including farmers, clerks, auto mechanics, railroad workers, painters, factory workers, and plumbers (Table 3).
In all, nearly half of the respondents, approximately 44 percent, indicated a close family connection as the reason that they applied to dental school. Five of the ’61 class respondents had family members (e.g., father, uncle, cousin) who were dentists, while one participant’s family owned a dental products business. Thus, 22 percent of the survey respondents had a clear family connection to dentistry. Another three respondents received encouragement to enter the dental profession through a family dentist, while three respondents noted that a family friend in the dental profession encouraged their pursuit of dentistry. Twenty-three of the twenty-seven respondents (85 percent) attended a Nebraska educational institution prior to attending dental college. Nearly half of the twenty-seven participants (thirteen or 48 percent) attended the University of Nebraska at Lincoln for some or all of their undergraduate education. Sixteen respondents did not earn a degree prior to earning a D.D.S., two earned AA degrees before dental school, and nine had received B.A. or B.S. degrees just before entering the UNMC COD (Table 1).
Forty-four percent of the respondents from the Class of 1961 paid for their dental education through the GI bill and/or other kinds of (other than military) scholarships and loans (Table 3). Seven respondents (26 percent) paid for their education using a single source, including spousal support, family assistance, or their own labor. Finally, eight respondents (30 percent) used a combination of sources to cover the costs of dental education. Nearly all (23/27; 85 percent) were married during their dental college training or just after graduation from the UNMC COD. Similarly, only three study participants did not have military experience at some point in their life, i.e., before, during, or after their dental school education (Table 2). In all, twenty-four of twenty-seven study participants (89 percent) completed military service, and of these, ten served prior to entering dental school. By contrast, fifteen respondents (56 percent), including one that had also served in the military prior to dental school, practiced dentistry within the armed forces beginning just after their dental school education was completed. No military experience was documented for the comparative classes entering the University of Nebraska Medical Center College of Dentistry in each decade from 1967 to 1997. Nevertheless, it is likely that after the end of the Vietnam War in 1975 and the draft, fewer students would have had access to military-related educational financing, regardless of whether they used other government-subsidized loans to cover educational costs.
Dental Careers
Just 35 percent of the respondents (twelve of thirty-five) practiced in Nebraska after completing dental school. Twenty-two graduates moved to another state within several years of completing their education and have not returned to Nebraska other than for social activities (Table 4). The number of graduates who remained in Nebraska to practice after graduation has remained low: 37 percent or less of each class for each decade from 1961 through 1991. Although 42 percent of the Class of 2001 has remained in Nebraska to practice dentistry, still more than 50 percent practice dentistry outside of the state.
Forty-one percent of the Class of ’61 had a spouse work within their dental practice at some point in their dental career (Table 5). Most owned their practices (24/27; 89 percent), while one respondent practiced his entire career within the military, another became a dental professor at the UNMC COD after working in a private practice, and another had health problems that prevented him from practicing dentistry. Similarly, 85 percent conducted charitable work within the community, accepting "Medicaid/Temporary Assistance to Needy Families" patients, working at charity clinics and U.S. reservations, conducting school exams, providing overseas mission assistance or assisting the mentally handicapped with dental needs. Six lineal relatives, i.e., those biologically related, are now practicing dentistry because of a father, uncle, grandfather or brother who graduated in 1961. Eight members of the Class of 1961 are still practicing dentistry, two passed away while active in the dental profession, and eight retired between 2000 and the present. The mean dental career span for the Class of 1961 was thirty-seven years, with 1010 years of combined dental practice accumulated by the twenty-seven respondents. Fifty-six percent of respondents indicated that the dental profession has changed dramatically during the course of their dental practices, particularly with regard to technology. Also, an increase in cosmetic procedures was suggested as a significant change within the dental profession by seven respondents (Table 6).
Twenty-one (78 percent) of the twenty-seven respondents expressed that they are now part of the upper socioeconomic class. Of the twenty-one respondents who marked "upper class" for their current socioeconomic standing, all but one indicated that, as a dentist, he had moved to the upper class from a lower (four of twenty-seven) or middle (seventeen of twenty-seven) socioeconomic status experienced during childhood. Six respondents (22 percent) indicated that they were currently in the middle socioeconomic class, and similarly, they were a part of the middle class during childhood. Although the largest number of respondents marked "independence" as the reason they became a dentist, thirteen of twenty-seven noted that a good income was almost as important (Table 6). Forty-four percent of respondents noted that time with family, as well as the ability to take family vacations, was a significant factor in their decision to become a dentist. Thirty-seven percent indicated that helping others was a primary reason for selecting the dental profession as their career.
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Discussion
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Despite the increasing numbers of applicants through time, the class size at the UNMC COD remains relatively unchanged from 1957 to present; thirty to forty new students have been accepted each year. A relatively small class size remains true despite the increasing numbers of applicants through time. However, the UNMC COD Class of 1961 exemplifies a number of illuminating contrasts when compared with respondents of a 2001 survey involving fifty-five U.S. dental programs administered annually by the American Dental Education Association (ADEA). For example, the ’61 UNMC graduates were all male and of European/Non-Hispanic ancestry. Nearly forty-five years later, 62.5 percent of U.S. graduates from dental college programs were male, and 10.4 percent indicated that their primary ethnic identity was Native American/Alaska Native, Black/ African American, or Hispanic/Latino.6 In contrast, the UNMC COD Class of 2001 had a male-to-female ratio of 3 to 1, but no minority graduates. Class composition at the UNMC COD from 1961 to present remains relatively unchanged, with the exception of an increase in female entrants and subsequent graduates.
On average, the UNMC COD Class of 1961 was younger at the time that they entered dental school, just 22.5 years, than students graduating either from UNMC or dental college programs nationwide in 2001.6 However, fewer of those graduating in 1961 from the UNMC COD had received undergraduate degrees prior to beginning dental school. This may partially account for the difference in age at entrance. Although family income levels, and hence socioeconomic status, are difficult to compare between 1957 and 1997 (the year most 2001 graduates would have entered a four-year dental education program), one striking difference concerns the mother’s employment and parental education levels. Few mothers of UNMC COD graduates in 1961 had postsecondary education, and most were noted to be "homemakers" by survey respondents. This is in dramatic contrast to those graduating from dental programs throughout the United States in 2001; 67 percent of mothers and 77 percent of fathers were college graduates or had some education beyond high school.6 Higher parental education levels are implied for more recent cohorts in that fewer parents held "blue collar" positions that required physical labor compared to the parents of UNMC COD ’61 graduates. More parents of those graduating in 2001 were engaged in "white collar" professions that required education and generally placed the family in a higher socioeconomic level. For example, less than 30 percent of the 2001 graduates from all U.S. dental programs had family income levels below $50,000 per year, while nearly 50 percent of the 2001 dental graduates from throughout the United States had family incomes at or above $70,000 per annum.6 Graduates of the UNMC COD Class of 1961 classified themselves as "middle class" from childhood to the time they entered dental school, although four (15 percent) indicated that their families were of the lowest socioeconomic level. Again, the kinds of positions held among most fathers of ’61 students were positions requiring manual labor and/or limited postsecondary education.
Just under half of the respondents (44 percent) from the UNMC COD graduating class of 1961 noted that a family member, family dentist, or family friend who was a dentist encouraged their entrance into dental school. An even larger percentage, 64.5 percent, of the 2001 graduate respondents of the annual ADEA survey reported that a family member, friend, or dentist influenced their career choice.6 This increasing correlation between a family connection to dentistry and one’s subsequent choice of a dental career implies that the most effective way to increase the number of dental professionals from a particular target population, e.g., women, minorities, and rural practitioners in the dental profession, is to immediately increase recruiting, acceptance, and retention mechanisms for such applicants. Females, minorities, and rural practitioners can then serve as role models for these same segments of society, thereby increasing the number of practicing dentists from underrepresented populations and creating continued interest in the dental professions.
The GI Bill contributed to dental education costs for at least half of the graduates from the UNMC COD Class of 1961. All but three (11 percent) had military experience, a likely factor among this ’61 cohort due to the timing of the Korean (1950–53) and Vietnam wars (1954–75). Also, all class members had a work history prior to entering dental college, mostly centered on physical labor and including farming. Nevertheless, tuition rates were proportionally lower in 1961, and respondents left dental school with minimal or no debt as they began to practice. By contrast, students graduating in 2001 have more than doubled their level of indebtedness in the single decade from 1990 to 2001, with 96.8 percent using student loans to finance their dental education and nearly 56 percent owing more than $100,000 at the completion of their dental degree.6 Such financial constraints are cited as one of the most profound threats to dental education.5 Given the current military engagement by U.S. forces, perhaps present and future dental students could use military service as a mechanism for covering some, if not all, of the costs of a dental education. Certainly, the need for dental professionals is likely to increase during a military conflict.7 Also, a military connection to cover dental school costs might help to increase representation among all segments of society and, as occurred in 1961, allow those from a lower socioeconomic status to participate in the dental profession and raise their future economic status. Clearly, military service in the World War II era allowed males who were economically disadvantaged to increase job-related skills and continue educational training.8 Also, the impact of the GI Bill was still evident more than two decades after military service was completed.8 Similarly, veterans’ benefits for those who served in the Korean War, as well as the Vietnam War, have been linked to nearly 1.4 additional years of education and at least 6 percent higher earnings than might have been possible without the additional education funded in full, or in part, through the GI Bill.9 This kind of sponsorship for extended education is particularly important because recruiting under-represented minorities into dental college programs nationwide remains a challenge.10,11
A larger percentage of UNMC COD graduates are now practicing dentistry in Nebraska after graduation, up from 35 percent in 1961 to 42 percent in 2001. Still, the percentage of UNMC COD graduates from each decade, 1961–2001, that practice in Nebraska is below 50 percent. In addition, as is true among 2001 graduates in Nebraska and throughout the United States, ’61 dental graduates were less likely to practice in rural areas even if they remained in the state to practice.6,12 This is surprising given that labor and occupancy costs are often lower compared to urban practices, and in general, there is a shortage of dentists in the U.S. Midwest.13 That shortage is particularly acute in Nebraska where seventeen of the state’s ninety-three counties have no dentists in practice, another fifty-three counties have been designated as "dental shortage areas," and 31.1 percent of the state’s practicing dentists have indicated that they will retire by 2009.12 Perhaps incentive programs to increase the practice of dentistry in rural areas could be designed by regional and state-based initiatives in collaboration with public and private dental college programs to address these current and future shortages nationwide.
Compared to graduates of the twenty-first century, more ’61 graduates began to practice dentistry immediately after graduation and often set up private practices. Perhaps the higher debt of recent graduates makes the startup in a private practice less likely. Also, wives of ’61 graduates often contributed to their husband’s dental practice, managing an office, providing dental hygiene support, and acting as receptionists. One reason for this might be that most of the ’61 graduates were married (85 percent) during dental school, whereas among 2001 graduates nationwide, less than half (41 percent) were married at the time of graduation. This trend, marrying later in one’s life, is true throughout the United States, where the median age at first marriage for males was 22.6 in 1957 but 26.8 in 1997.14 Certainly, the spouses have been central to the dental careers of the ’61 graduates and have always been active participants in social events surrounding class reunions and newsletters. In contrast, spouses of recent graduates tend to have career aspirations outside of dentistry, and that means a more diversified job market is required, i.e., an urban rather than a rural setting.13
Although there are no comparative data among more recent cohorts, the UNMC COD Class of 1961 provided a high percentage of charitable work to their communities during the course of their 37+ years of dental practice. This is consistent with the claim made by more than a third (37 percent) of the respondents from the Class of 1961 that "helping others" was a significant factor in their decision to enter the dental profession. Like the graduates of the twenty-first century, ’61 graduates felt that dentistry would provide independence and a good income; however, members of the Class of ’61 also noted that time with family and vacations were significant in their decision to pursue dentistry. Many ’61 respondents had children during or just after they completed dental school, and a central topic in newsletters from ’61 to present has involved children and grandchildren. Nevertheless, on average, the graduates of 1961 were two years older at retirement (sixty-four versus sixty-two) than their counterparts throughout the United States.15 One common change noted by ’61 graduates, as they reflected on their dental practice and careers, was the shift toward "aesthetic" dentistry, a trend experienced in many world regions.16
The UNMC COD Class of 1961 have maintained a consistent connection to their dental college and cohort. The 40+ years of continual contact are likely the result of one class member ensuring that information was gathered and distributed annually. In addition, all but a few of the members of the class of ’61 have contributed at some point in time to this networking effort—hosting reunions, submitting information, and providing financial and/or emotional support. The success of the ’61 graduates is likely to have been enhanced by this network; all indicated the importance of maintaining contact and the increasing value of this professional and social network to their lives. This kind of class connection might be facilitated by dental alumni associations to ensure the creation of long-term relationships and commitments among future dental cohorts and strengthen professional and material support for a given dental school program.
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Conclusions
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Based upon a comparative analysis of dental graduates from the UNMC COD Class of 1961 to those graduating each decade thereafter, and to the nationwide cohort of graduates from 2001, ’61 graduates were more likely to open private practices and leave dental school debt-free. They were also homogeneous in composition: male, of European ancestry, slightly younger at entrance to dental school (twenty-two years old), and married. They were more likely to have worked prior to dental school, come from lower socioeconomic backgrounds than their current counterparts, and used their own financial resources along with the GI Bill to pay for their dental education. Graduates of the UNMC COD Class of 1961 practiced dentistry, on average, for thirty-seven years and provided a substantial amount of charitable contributions to their communities. Despite practice location, they continue to identify with the University of Nebraska and maintain social relationships with dental school classmates. They came to dentistry because of a personal connection and, like today’s graduates, perceived that dentistry would provide independence and financial stability. By contrast, family was also a central factor in the decision of 1961 graduates of the UNMC COD to go to dental school.
Their path to dental school and subsequent career experiences are instructive and highlight mechanisms for strengthening future dental college cohorts that could include more women and minorities, and hence expand the numbers of professionals from all segments of society and likely increase the number of those who receive dental care.
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Acknowledgments
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The authors wish to thank the 1961 graduates of the University of Nebraska Medical Center College of Dentistry (UNMC COD) and their spouses for contributing to this study. A special thanks to Drs. Ted Anderson and Al Jerman for their enthusiasm, interest, and devotion to their classmates and this project. Also, thanks go to the dean of the UNMC COD, Dean John W. Reinhardt, and the COD administrative staff for providing demographic data. Glenda M. Canfield was especially helpful in the data-gathering process. Finally, we thank three anonymous reviewers for their thoughtful editing and substantive contributions to this manuscript.
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Footnotes
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Dr. Willis is Assistant Professor, Department of Anthropology and Geography, University of Nebraska-Lincoln; Ms. Badakhsh is an M.P.H. Student, Department of Community Health Sciences, Tulane University, New Orleans, Louisiana. Direct correspondence and requests for reprints to Dr. Mary S. Willis, Department of Anthropology and Geography, University of Nebraska-Lincoln, 928 Oldfather Hall, Lincoln, NE 68588-0368; 402-472-9677 phone; 402-472-9642 fax; mwillis2{at}unl.edu.
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Abstract
Methods
