“Dentist Shortage in the Netherlands: Need for Innovative Solutions”

“There is no dentist in a village further on,” says dentist Chris Wouters from Fijnaart in Brabant. “A dentist has also stopped in Willemstad, he has no follow-up. And a practice has also stopped in another village nearby. I see it all around me. I also know a dentist who has had his practice for sale for six years but no one comes.”

Wouters is 68 years old and still enjoys working in his practice in Fijnaart, but he also knows that he cannot easily sell his practice if he wants to stop. “So yes, I’m stretching it, my working life. And luckily I still like it. But if I could have surrendered the practice, I would have.”

It appears that not every dentist has the enthusiasm to continue working after retirement age figures from the Capacity Body. This foundation advises the cabinet on the number of training places required for the various medical courses. In its latest report, the foundation calculates that more dentists quit than join.

Need more training places

Every year, about 220 students graduate from dentistry, while it is expected that 41.5 percent of the approximately 10,000 dentists who are now there will retire in the next ten years. That is why the Ability Body recommends increasing the number of study places for dentists to 375, instead of the current 240 places. This is not the first time that the body has issued this advice: in 2009 there was already a plea for more training places and this advice has been regularly repeated over the years.

The responsible ministers are currently reviewing the advice and expect to respond by mid-May. Earlier, ministers Ernst Kuipers (VWS) and Robbert Dijkgraaf (OCW) already agreed a chamber letter indicated that the shortages are worrying, but that 100 additional training places will cost 26.3 million euros per year on a structural basis. “These resources are not available without cutbacks,” they write.

Shortage differs per province

This map shows how many dentists there are per 100,000 inhabitants in your province:

Diploma obtained abroad

“When I started 40 years ago there was a surplus of dentists”, Wouters remembers. But he has seen for ten years that things are going in the wrong direction in his region. “The association of dentists in this region already warned the government. If you don’t train more people, you will be short of people.”

In recent years, the shortages have mainly been filled by dentists who have obtained their diploma abroad. This concerns about 22 percent of all dentists, according to figures from the professional organization KNMT. In Zeeland, where the shortages are greatest, this is even 49 percent. “However, their arrival is not a structural solution to the dentist shortage,” the organization adds. “It is expected that about 40 percent will stay in the Netherlands for less than 5 years.”

Training alone is no longer enough

According to Albert Feilzer, professor of general dentistry at the UvA and the VU, this problem has been postponed for so long that simply training more dentists is no longer enough. He points out that the training courses need time to scale up and that the training to become a dentist takes six years. “Then you’ll be eight years later.” And even if we increase the number of places by 2024, it will take at least 2040 before there are enough dentists.

Feilzer therefore argues for more innovative solutions, such as lateral entry pathways for medical doctors, for example, of which there is now a surplus. Another possible solution, he believes, is to train dental hygienists in further education to become child dental carers. All this is necessary to ensure that oral care remains accessible to people.

Feilzer points out that currently 20 to 30 percent of the Dutch never visit the dentist, largely because of the costs. The disappearance of dentists will only take care even further away for large groups of people. “You already have an awful lot of patients who are untreated at the moment,” he says.

“I have great difficulty with the fact that there are people who want to go to the dentist, but cannot go there because of the costs. Care must be accessible, but apparently that does not apply to oral care.”