A study of the marketing of selected professional services with particular reference to the Florida dental profession

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Title:
A study of the marketing of selected professional services with particular reference to the Florida dental profession
Added title page title:
Professional services with particular reference to the Florida dental profession
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xv, 210 leaves. : illus. ; 28 cm.
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English
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Dimbath, Merle Frederick, 1939-
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Subjects / Keywords:
Dentistry -- Florida   ( lcsh )
Economics and Business Administration thesis Ph. D
Dissertations, Academic -- Economics and Business Administration -- UF
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bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis -- University of Florida.
Bibliography:
Bibliography: leaves 190-193.
General Note:
Manuscript copy.
General Note:
Vita.

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Table of Contents
    Title Page
        Page i
        Page ii
    Dedication
        Page iii
    Acknowledgement
        Page iv
    Table of Contents
        Page v
        Page vi
    List of Tables
        Page vii
        Page viii
        Page ix
        Page x
        Page xi
        Page xii
        Page xiii
        Page xiv
    List of Illustrations
        Page xv
    Chapter 1. Introduction
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
    Chapter 2. The conceptual framework
        Page 15
        Page 16
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        Page 39
        Page 40
        Page 41
        Page 42
    Chapter 3. The market for dental services
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
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    Chapter 4. Market segmentation
        Page 72
        Page 73
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        Page 76
        Page 77
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        Page 104
        Page 105
    Chapter 5. The marketing mix
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
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        Page 160
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    Chapter 6. Summary and conclusions
        Page 162
        Page 163
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        Page 188
        Page 189
    Bibliography
        Page 190
        Page 191
        Page 192
        Page 193
    Appendix
        Page 194
        Page 195
        Page 196
        Page 197
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        Page 208
        Page 209
    Biographical sketch
        Page 210
        Page 211
Full Text













A STUDY OF THE MARKETING OF SELECTED

PROFESSIONAL SERVICES WITH

PARTICULAR REFERENCE TO THE

FLORIDA DENTAL PROFESSION









By
MERLE FREDERICK DIMBATH


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY












UNIVERSITY OF FLORIDA


August, 1964


































Copyright by

MERLE FREDERICK DIMBATH

1964




































To my wife, Joyce

and

my son, Merle, Jr.














ACKNOWLEDGEMENTS


The author wishes to express his sincere gratitude to the members

of his supervisory committee for their interest and counsel in the

writing of this dissertation. The committee was composed of Dr. J. D.

Butterworth, Chairman; Dr. Frank Goodwin, Dr. R. H. Blodgett, Dr. C. A.

Matthews, and Dr. John H. James. A special word of appreciation is ex-

tended to Dr. Butterworth who gave of his time to advise the author in

the writing and development of each chapter, and to Dr. Frank Goodwin

who was exceptionally helpful in the preparation and execution of orig-

inal research.

To the members of the Florida Academy of Dental Practice Admini-

stration and their President, Dr. Andrew A. Henry, the author is deeply

thankful for their assistance and cooperation in the gathering of the

data used in this dissertation. This study would have been impossible

to conduct without their support.

The author would also like to thank the members of the staff of

the Bureau of Economic and Business Research, University of Florida,

for their help in the monumental task of tabulating the data obtained

from the original research.















TABLE OF CONTENTS


Page

ACKNOWLEDGEMENTS ......... ....................... iv

LIST OF TABLES ........... ....................... vii

LIST OF ILLUSTRATIONS .......... .................... xv

Chapter
I. INTRODUCTION

The Importance of Services
Services: A Marketing Void
Goods and Services
Hypothesis
Selected Professional Services
Methodology

II. THE CONCEPTUAL FRAMEWORK .... ............... ... 15

Dentists: Monopolistic Competitors
The Objective of Dentists
Marketing Strategy
The Marketing Mix
The Optimum Mix

III. THE MARKET FOR DENTAL SERVICES ... ............ ... 43

Introduction
Consumption Patterns, by Sex
Consumption Patterns, by Region
Consumption Patterns, by Residence
Consumption Patterns, by Family Income
Consumption Patterns, by Age Group
Consumption by Type of Service
Subjective Determinents of Consumption
Dental Patient Turnover
Patronage Motives
Negative Patronage Motives

IV. MARKET SEGMENTATION ..... ................. ... 72

Introduction
Geographical Segmentation
Segmentation by Age and Sex















TABLE OF CONTENTS--Continued


Chapter Page

Segmentation by Economic Factors
Other Methods of Segmentation
Reasons for Exclusive Segmentation

V. THE MARKETING MIX ...... .................. ... 106

Introduction
Product
Place
Promotion
Period of Time
Price

VI. SUMMARY AND CONCLUSIONS ..... ................ ... 162

Summary
Conclusions

BIBLIOGRAPHY ........ ......................... ... 190

APPENDIX .......... .......................... ... 195

BIOGRAPHICAL SKETCH ....... ..................... ... 210

















LIST OF TABLES


Page


. . 20


. . . 24


. . . 39


oe 40


. . . 46


. . . . 48


. . . . 49


Table


1. What Florida Dentists Regard as the One Major
Advantage of Their Profession, in Percentages

2. The Reasons That Florida Dentists Chose Their
Profession, in Percentages .........

3. Monthly Retirement Income Desired by Florida
Dentists, in Percentages ..........


4. Desire for Son to be Dentist by Net Income
in 1962, in Percentages ........

5. Desire for Son to be Dentist by Desired
Monthly Retirement Income of Florida
Dentists, in Percentages .......

6. A Hypothetical Price Demand Schedule
for Fillings .............

7. A Hypothetical Promotion Demand Schedule
for Fillings ............

8. Private Consumer Expenditures for Dental
Care in the United States, 1948,1962

9. Time Interval Since Last Dental Visit,
Per Cent Distribution by Sex......


10. Frequency of Dental Visits,
Per Cent Distribution by Sex ....

11. Number of Dental Visits Per Person Per
Year by Region and Sex ..........

12. Time Interval Since Last Dental Visit,
Per Cent Disbribution by Region . .

13. Frequency of Dental Visits, Per Cent
Distribution by Region .. .......

14. Time Interval Since Last Dental Visit,
Per Cent Distribution by Residence


vii


O 8 O O Q


O Q O e O













15. Frequency of Dental Visits, Per Cent
Distribution by Residence ... ............. ... 53

16. Time Interval Since Last Dental Visit,
Per Cent Distribution by Family Income ...... 54

17. Frequency of Dental Visits,
Per Cent Distribution by Family Income ... ...... 54

18. Number of Dental Visits Per Person
Per Year by Age and Family Income ........... ... 56

19. Time Interval Since Last Dental Visit,
Per Cent Distribution by Age Group ........ 57

20. Frequency of Dental Visits, Per Cent
Distribution by Age Group ....... ........58

21. Per Cent Distribution of Dental
Visits by Type of Service and by Age ....... 59

22. Reasons Given by Respondents For Not Going
to the Dentist, in Percentages .......... ... 61

23. Reasons Why Respondents Did Not Obtain
Needed Dental Care, in Percentages ........ 62

24. Number of Years Florida Patients Have
Been Going to Their Present Dentist, in Percentages 64

25. Reasons Why Florida Patients Selected
Their Present Dentist, in Percentages ....... ... 66

26. Reasons Why Florida Patients Left Their
Last Dentist, in Percentages .. ........... ... 68

27. How Florida Patients Feel About Dental
Fees, in Percentages by Age Group ........... ... 70

28. The Distribution of Florida Population and Dentists
Among the Seven Standard Metropolitan Statistical
Areas and Selected Population Characteristics in
Each Area, in Percentages ... ............. ... 73

29. Percentage Distribution of Total Population,
Personal Income, and Dentists Among Selected
Florida Counties ..... ................ ..75

30. Per Capita Personal Income and Population
Per Dentists in Selected Florida Counties . . 77


viii


Page


Table












31. Percentage Distribution of Population, Personal
Income, and Dentists Among Florida Counties
Grouped According to Per Capita Personal Income . 78

32. Factors That Influenced the Distribution of Dentists
in Selected Florida Counties, in Percentages . 79

33. Factors That Influenced the Distribution of Florida
Dentists and Their 1962 Gross Income,
in Percentages ......... .................. 81

34. The Age of Florida Dentists and the Factors That
Influenced Their Distribution, in Percentages . 82

35. Population Per Dentist and Attitudes of Dentists
Concerning Shortage of Dentists in Selected
Florida Counties, in Percentages ......... 83

36. Population Per Dentist and Attitudes Concerning
Competition for Patients of Florida Dentists
in Selected Counties, in Percentages ....... 84

37. Gross Income of Florida Dentists and Their Attitudes
Concerning Competition for Patients and Shortage
of Dentists, in Percentages ... ............ ... 85

38. Types of Patients Most Preferred and Least Preferred
by Florida Dentists, Breakdown by Sex and Age,
in Percentages ...... .................. ... 87

39. Types of Patients Preferred Least According to
Types of Patients Preferred Most by Florida
Dentists, in Percentages ... ............. ... 88

40. Number of Dental Visits Per Person Per Year in
the South, by Sex and Age ... ............. ... 90

41. Types of Patients Preferred Most by Florida Dentists
According to Age of Dentists, in Percentages . 90

42. Types of Patients Preferred Least by Florida Dentists
According to Age of Dentist in Percentages . 92

43. Types of Patients Preferred Most by Florida Dentists
According to Gross Income of Dentist in
Percentages ...... .................... .... 92

44. Types of Patients Preferred Least by Florida Dentists
According to Gross Income of Dentist in
Percentages .......... .................... 93


Page


Table













45. Approximate Annual Family Income for the Majority
of Florida Dental Patients as Estimated by
Florida Dentists, in Percentages ......... 94

46. Gross Income of Florida Dentists and Their Estimates
Concerning the Annual Family Income for the
Majority of Their Patients, in Percentages . . 95

47. Gross Income of Florida Dentists and Their Use of
High Fee Quotations to Exclude Undesired
Patients, in Percentages .... .............. 96

48. Annual Family Income for the Majority of Florida
Dental Patients as Estimated by Dentists and the
Highest Fee Which Florida Dentists Have Charged
Three of Their Patients Within the Past Year,
in Percentages .................. 97

49. Types of Patients Most Preferred by Florida Dentists
and the Highest Fee Charged at Least Three
Patients Within the Past Year, in Percentages . 98

50. Types of Patients Least Preferred by Florida Dentists
and the Use of High Fee Quotations to Exclude
Undesired Patients, in Percentages ........ 99.

51. Gross Income of Dental Specialists and All Florida
Dentists, in Percentages ............. 101

52. Age of Florida Dentists and Other Methods of Market
Segmentation, in Percentages .. ........... ... 101

53. Age of Florida Dentists and Their Reasons for
Seeking to Exclude Some Market Segments From
Their Practices, in Percentages .. .......... ... 103

54. What Florida Dentists Regard as the Main Reason
Patients Selected Them and the Characteristic
About Their Practice That is Uniquely Desirable
From the Viewpoint of the Patient, in Percentages 107

55. What Florida Dentists Regard as the Characteristic
About Their Practice Uniquely Desirable From the
Viewpoint of Their Patients and Dentists'
Attitudes Concerning Competition With Other
Dentists for Patients, in Percentages .. .......111

56. Gross Incomes of Florida Dentists and What They
Regard as the Characteristic About Their Practice
Uniquely Desirable From the Viewpoint of Their
Patients, in Percentages ... ............. ... 112


Page


Table












57. Gross Income of Florida Dentists and the Number of
Years They Have Practiced Dentistry,
in Percentages ..... ............. . . . 113

58. Gross Income of Florida Dentists and the Number of
Years of Dental Training They Had,
in Percentages .................. 114

59. Gross Income of Florida Dentists and the Amount of
Their Investment in Dental Office and Equipment,
in Percentages . ............... . 115

60. Gross Income of Florida Dentists and Their Attitude
Concerning Their Quality as a Dentist, in
Percentages .......... .................... 116

61. The Number of Years Florida Dentists Have Been
Practicing Dentistry and Their Regular Fee For
a Simple Extraction and a One Surface Alloy
Filling, in Percentages ... .............. 118

62. The Number of Years of Dental Training Florida
Dentists Had and Their Regular Fee For a Simple
Extraction and a One Surface Alloy Filling,
in Percentages ..... .................. ... 119

63. Florida Dentists' Investment in Dental Office and
Equipment and Their Regular Fee for a Simple
Extraction and a One Surface Alloy Filling,
in Percentages ........................ .... 120

64. The Number of Years Florida Dentists Have Been
Practicing Dentistry and the Number of Years
They Have Been Practicing in Florida,
in Percentages ......... .................. 121

65. The Number of Years Florida Dentists Have Been
Practicing in Florida and the Number of
Different Geographical Areas Practiced in
Florida, in Percentages .... .............. 122

66. The Number of Different Areas in Florida Where
Florida Dentists Have Practiced and the Factors
That They Considered in Selecting the Community
in Which They Now Practice, in Percentages . . 122

67. Factors That Influenced Selection of Dental Office
Location of Florida Dentists and Size of Commumity,
in Percentages ...... .................. ... 124


Page


Table













68. Community Size of Office Location and 1962 Gross
Income of Florida Dentists, in Percentages . . 124

69. Factors That Influenced Selection of Dental Office
Location and 1962 Gross Income of Florida
Dentists, in Percentages ... ............. ... 125

70. Factors That Influenced the Selection of Dental
Office Location and Age of Florida Dentists,
in Percentages ........ .................. 126

71. Florida Dentists Who Believe That Their Office
Location is the Main Reason Their Patients
Selected Them and the Factors That Influenced
the Choice of the Present Address of the Office,
in Percentages ............................ 127

72. The Office Location of Florida Dentists and Their
Regular Fee for a Simple Extraction and a One
Surface Alloy Filling, in Percentages ......... ... 128

73. Florida Dentists Attitude Concerning a Shortage of
Dentists in Florida and Dental Ethics Controlling
Advertising and Promotion, in Percentages . . 130

74. Florida Dentists Attitude Concerning Their Quality
as a Dentist and Dental Ethics Controlling
Advertising and Promotion, in Percentages ..... 131

75. The Gross Income of Florida Dentists and Their
Attitudes Concerning Dental Ethics Controlling
Advertising and Promotion, in Percentages . . 132

76. The Gross Income of Florida Dentists and Their
Attitude Concerning Conversation About Dentistry
in Social Gatherings, in Percentages ....... 134

77. The Gross Incomes of Florida Dentists and the Number
of Talks Given to Nondental Groups in the Past
Year, in Percentages ................... 135

78. The Number of Dental Talks Given by Florida Dentists
to Nondental Groups in the Past Year and Dentists
Attitudes Concerning Competition for Patients,
in Percentages ........ .................. 136

79. The Efforts Regularly Used by Florida Dentists to
Educate Their Patients and Their Attitudes Con-
cerning Competition for Patients, in Percentages 138


Page


Table











80. The Efforts Regularly Used by Florida Dentists to
Educate Their Patients and Their Fees for a Simple
Extraction and a One Surface Alloy Filling, in
Percentages ...... ................... ... 139

81. The Number of Hours Devoted Weekly by Florida
Dentists to Their Practice and What They Consider
About Their Practice to be Desirable From the
Patients Viewpoint, in Percentages ........ 141

82. The Age of Florida Dentists and the Number of Hours
Devoted Weekly to Their Practices, in Percentages 143

83. The Gross Income of Florida Dentists and the Number
of Hours Devoted Weekly to Their Practice,
in Percentages ....... ............. 144

84. Community Size of Office Location of Florida Dentists
and the Methods Used in Setting Fees,
in Percentages ...... .................. ... 146

85. The Age of Florida Dentists and the Methods Used
in Setting Fees, in Percentages ............ 147

86. The Methods Used by Florida Dentists in Setting Fees
and Their Regular Fee for a Simple Extraction and
a one Surface Alloy Filling, in Percentages . . 148

87. The Gross Income of Florida Dentists and the Methods
Used in Setting Fees, in Percentages ....... ... 150

88. The Gross Income of Florida Dentists and Their
Regular Fee for A Simple Extraction and a One
Surface Alloy Filling, in Percentages . . . 151

89. Gross Income of Florida Dentists and the Largest
Fee They Have Collected From at Least Three
Patients in the Past Year, in Percentages .. ..... 152

90. The Regular Fee Charged by Florida Dentists for a
Simple Extraction and a One Surface Alloy Filling
in Selected Florida Counties, in Percentages . 153

91. The Percentage Increase in Fees by Florida Dentists
and Their Attitudes Concerning Competition
in Percentages ...... .................. ... 155

92. Five Year Percentage Increase in Fees by Florida
Dentists and the Five Year Percentage Change
in Gross Income, in Percentages ......... 157


xiii


Table


Page










Table Page

93. The Credit Policy of Florida Dentists and the Methods
Used in Setting Fees, in Percentages ....... ... 159

94. Gross Income of Florida Dentists and Their Policy
Regarding the Granting of Credit to Patients,
in Percentages ........ .............. ... 161

95. The Number of Mail Questionnaires Returned from
Each Florida County ...... ................ ... 206

96. The Distribution of Mail Questionnaire Returns
and Florida Dentists Among Selected Florida
Counties, in Percentages ... ............. ... 207

97. Selected Characteristics of Dentists in Mail
Questionnaire Sample ... ......... ......208

98. Selected Characteristics of Dentists in Personal
Interview Sample .. ........ ... ......... ... 209


xiv














LIST OF ILLUSTRATIONS


Figure Page

1. Hypothetical Price Demand Curves .. .......... 36

2. Hypothetical Nonprice Demand Curves .. ......... ... 36


xv














CHAPTER I


INTRODUCTION

The Importance of Services

A front page article in the December 9, 1963, issue of the Wall

Street Journal reported that some significant revisions are planned

for the Consumer Price Index of the Department of Labor. Besides

broadening the coverage of the index, it was also announced that

"weights assigned such service items as education, medical and personal

care, and housing . will be increased."' This revision in the

"cost of living" index reflects the growing importance of expenditures

for services in the post World War II economy of the United States.

To illustrate, in 1948 expenditures for services composed 32 per cent

of all spending. By 1956 this figure had risen to 37 per cent and for

the years 1961 through 1963 the proportion of spending for services has

remained at 41 per cent. Spending for services now exceeds $150 billion

annually.2

In 1961, the average American family spent 80 per cent more on

medical care than it did eleven years earlier.3

Expenditures for services are important not only because of their


1"Consumer Price Index Revisions Could Affect Pay of Many
Workers," The Wall Street Journal, December 9, 1963, p. 1.
2"Share of Dollar Spent on Services Like Rent, Repairs Ends
Big Rise," The Wall Street Journal, October 24, 1963, p. 1.
3"Spending More On Luxuries," Business Week (May 23, 1964), p. 25.

1







2

growing share of all spending, but also because of possible contribu-

tions to inflationary pressures resulting from such spending.

The main inflationary factor is not a wage price spiral so much
as the fact that service businesses (mostly small), along with
landlords, doctors and dentists, keep pushing up prices of "non-
goods" services, utilities, rents, and transportation fares.
. productivity rises more slowly in the service field than
in manufacturing, the service field has to raise wages as
industrial wages rise, and the result of higher wages without
higher productivity is higher prices.4

Empirical evidence lends support to such charges. The prices of

services have increased every year since 1945 regardless of economic

conditions. During the postwar period to 1959, the Consumer Price Index

rose 29 per cent while the price index of all services increased by over
5
50 per cent. And there is reason to believe that this condition still

persists. For example, it was announced that the Consumer Price Index

hit a new record high of 107.2 per cent in October, 1963. "rhe October

index was up from the 106.0 per cent of a year earlier chiefly because

of higher costs of services, particularly housing and medical care.

The evidence clearly indicates the importance of services in our present

economy.

Services: A Marketing Void

In their book Principles of Marketing, Beckman, Maynard, and

Davidson make the following point: "At any given time, the importance


4Dale Edsin, "Blame the Non Goods," Managerial Marketing: Per-
spectives and Viewpoints, ed. Eugene Kelly and William Lazer (lRomewood,
Ill.: Richard D. Irwin, Inc., 1958), pp. 60-61.
5Charles M. Hewitt and James M. Patterson, "Wanted: Innovations
in Pricing of Services," Business Horizons, Summer 1961, pp. 93-94.
6"Consumer Price Index Hit Record 107.2% in October," The Wall
Street Journal, December 2, 1963, p. 7.










and magnitude of the marketing task may be approximated by a number of

quantitative measures, including the following:

1. Personal consumption expenditures, which is the end result of
marketing efforts.

2. Volume of trade transacted.7

The authors went on to list three additional measures, but in light of

the above two measures a statement that follows the above quotation on

the same page of the book is noteworthy: "Accordingly, it is not in-

tended to deal in this volume with the marketing of services other than

those that are performed as a part of the marketing of tangible goods

and therefore incidental thereto."'8 Writing, as they did, at a time

when over one-third of consumer spending went for services, such a

position is subject to question. It is true, of course, that much of

the spending for services was connected with the marketing of tangible

goods. But such a view of marketing ignores the consumption of services

as the primary source of consumer satisfaction.

Beckman, Maynard, and Davidson cannot alone be criticized for

ignoring the marketing of services. Writers in marketing have as a

group concentrated their efforts on the marketing of physical goods.

William J. Shultz in his 600 page book American Marketing devoted about
9
three pages to the marketing of business and personal services. E. J.

McCarthy also pointed out that "Although very significant in the total

7Theodore Beckman, Harold Maynard, and William Davidson, Princi-
ples of Marketing, 6th ed. (New York: The Ronald Press Company, 1957),
p. 23.
8Ibid.

9William J. Shultz, American Marketing (San Francisco: Wadsworth
Publishing Company, Inc., 1961), pp. 292-294.








4

economy, the marketing of services has usually been ignored because so

many different services are involved and they are usually supplied by

small firms or individuals. In the aggregate, however, they are quite

important.''I For whatever the reason, a search of marketing literature

reveals that relatively little attention or study has been given to the

marketing of services.

Goods and Services

The output of the economy is classified a number of ways, depend-

ing on the point of view. Economists may divide the output into such

broad categories as goods and services, capital goods and consumer goods,

hard goods and soft goods, or durable goods and non-durable goods.

Accountants often use such terms as "finished goods" and "goods in pro-

cess." Marketing has also contributed its share of adjectives with such

classifications as consumer goods and industrial goods, convenience

goods, shopping goods, and impulse goods. Leo V. Aspinwall developed a

three fold classification of red goods, orange goods, and yellow goods

based on the five factors of replacement rate, gross margin, adjustment,
11
time of consumption, and searching time.

Although not always specifically stated, most classifications of

goods usually refer to tangible products. Accordingly, most economic

and marketing thought has concentrated on the input and output problems

of firms dealing with physical goods. Whether existing economic and

10E. J. McCarthy, Basic Marketing: A Managerial Approach (Home-
wood, Ill.: Richard D. Irwin, Inc., 1960), p. 46.
11Leo V. Aspinwall, "The Characteristics of Goods Theory,"
Managerial Marketing: Perspectives and Viewpoints, ed. William Lazer
and Eugene Kelley (Homewood, Ill.: Richard D. Irwin, Inc., 1962),
pp. 633-643.









marketing concepts that have been developed with reference to physical

goods can be applied with equal usefulness to firms producing and

selling services is something that largely has either been assumed or

ignored.

There is, however, no definitional reason to exclude services

from the application of existing economic and marketing concepts. "A

good is therefore anything which has utility, that is, anything to

which the individual attributes a power to satisfy some want or other.

Goods include both material objects, such as articles of food or

clothing, and nonmaterial items such as the services of actors or

barbers."12 Alfred Marshall in his classic work Principles of Economics

made the following point: "All wealth consists of desirable things;

that is, things which satisfy human wants directly or indirectly . .

to represent all desirable things, or things that satisfy human wants,

we may use the term goods for that purpose. Desirable things or goods

are Material, or Personal and Immaterial.',13 In a later chapter,

Marshall points out that "Consumption may be regarded as negative pro-

duction. Just as man can produce only utilities, so he can consume

nothing more. He can produce services and other immaterial products,

and he can consume them." 14 McCarthy provides a marketing point of view

of this situation. "Services will be included as a type of product,

although an intangible one. Most of this text will be concerned with

12Ralph H. Blodgett, Our !xpanding Econo (New York: Rinehart
and Company, Inc., 1955), p. 24.
13Alfred Marshall, Principles of Economics, 8th ed. (New York:
The McMillan Company, 1948), p. 54.
14Ibid., p. 64.











tangible products, but the ideas, perhaps with slight modification,

will apply to intangible products."'15 This statement introduces the

hypothesis of this dissertation.

Hypothesis

Is it correct to assume that the existing body of marketing

thought which has been developed mainly through study and analysis of

physical or tangible products can be applied, in whole or in part, to

intangible goods? The purpose of this dissertation will be to sub-

stantiate what many marketers have assumed, and to consider what others

have ignored. Positively stated, the hypothesis is this: The existing

body of economic and marketing thought although usually concerned with

tangible goods can also be employed in the study of intangible goods.

The objective is to make a contribution to knowledge, not by develop-

ing a new theory, but by expanding the application of existing thought.

As Frank Knight said in the preface of his book Risk, Uncertainty and

Profit, ". its object is refinement, not reconstruction."16

Selected Professional Services

Economists and marketers have found it necessary to divide their

subject matter into relatively homogeneous parts in order to facili-

tate study. Such division can take many forms such as the economic di-

vision of pure competition and pure monopoly, or, as already mentioned,

the various classifications of goods which marketers have employed.

Such analysis and classification is necessary so that the voluminous

15E. J. McCarthy, op. cit.

16Frank Knight, Risk, Uncertainty, and Profit (Boston & New York:
Houghton Mifflin Company, 1921), author's preface.










facts of economic life can be reduced to manageable proportions.

This same technique of classification and selection will be

necessary in attempting to apply exisiting concepts to the marketing

of services. To illustrate, in order to collect and report data on

services the U. S. Department of Conmerce has established 53 different

service categories.17 It would be difficult to attempt to include all

sellers of services from the shoe shine boy to the brain surgeon in a

single application of existing thought because of the great number of

facts and details involved. Therefore, some method of dividing or

classifying services will be used and then one of these classes will

be selected for study. Since services may be regarded as intangible

goods or products, perhaps existing classifications of tangible goods

can be applied, completely or partially, to intangible goods.

Marketing authorities have frequently employed a three fold

classification of consumer goods in their analysis of consumer buying

behavior. This classification, originally made by M. T. Copeland, is

as follows:

Convenience goods. These are goods which will ordinarily be
purchased at frequent intervals, at the most accessible place,
and at a small price per unit. Since the value per unit is low,
purchasers are not willing to spend much time or effort in making
the purchase. Rather (and with some exceptions) they will buy
from the nearest source of supply. Many convenience goods are
bought on impulse.

Shopping goods. Shopping goods are those in the purchase of
which one wants to compare values, prices, and styles. Ordi-
narily, these goods are of higher price per unit than convenience
goods, and the potential purchaser will make a special trip to

17William Regan and Cornelis Visser, "The Elusive Service Market,"
Managerial Marketing: Perspectives and Viewpoints, ed. William Lazer
and Eugene Kelley (Homewood, Ill.: Richard D. Irwin, Inc., 1962),
p. 153.










several stores to inspect them before arriving at the final
decision. Because these goods are relatively expensive, and
since time and effort are, by definition, required before the
purchase is made, sales to each shopper are relatively in-
frequent.

Specialty goods. Specialty goods are usually of a high unit
price and are not frequently purchased. In selling such goods,
emphasis is placed on style, quality, exclusiveness, or some
factor other than price. These factors are so important that
they induce people to go out of their way, if necessary, in
order to purchase these articles and to buy without shopping.
The shop that handles specialty goods chiefly tries to build
up a reputation or an atmosphere around it that 1ill lift it
above price competition and quality comparison.18

Without having to significantly modify the basic definitions,

these three classifications appear to be fully applicable to both

tangible and intangible goods. In applying the convenience classi-

fication to services, such utilities as electricity and telephone

service come to mind in addition to other services of a more personal

nature such as dry cleaning and diaper service. These services are

usually purchased frequently, at a relatively low per unit cost, and

with minimum time and effort expended by the consumer. Also, there

are many services which may readily be classified as "shopping"

services. The services of a barber or beautician are a case in

point. Men and women may very well shop and compare at different

establishments before finally deciding where to patronize regularly.

Television and automotive repair are similar examples. The car owner

may obtain several estimates before having his car painted or repaired.

In the specialty classification, the services rendered by members

18C. W. Barker, I. D. Anderson, and J. D. Butterworth, Principles
of Retailing (New York: McGraw-Hill Book Company, Inc., 1956), p. 49.










of various professions are good examples. For present purposes, a

profession may be defined as "a vocation or occupation requiring

advanced training in some liberal art or science, and usually in-

volving mental rather than manual work, as teaching, engineering,

writing, etc.; especially, medicine, law, or theology."'19 The re-

lationship between the buyer and seller of professional services is

such that style, quality, exclusiveness are important factors. The

patient who prefers a certain doctor will go out of his way to be

treated by that particular doctor. The reputation of the individual

professional person is very important.

The scope of this dissertation has now been partially defined.

The general subject matter will be the marketing of specialty in-

tangible goods--professional services. But as indicated in the title,

the marketing of "selected" professional services will be the specific

area of study. The purpose of selection is to further narrow the

scope of study so that the professional services under consideration

will have desired homogeneous characteristics. Frank Knight provides

a good explanation of this point:

Analysis and abstraction are virtually synonyms. The value of
the method depends on the fact that in large groups of problem
situations certain elements are conmion and are not merely
present in each single case, but in addition are both few in
number and important enough largely to dominate the situation.
The laws of these few elements, therefore, enable us to reach
an approximation to the law of the situation as a whole.20

19Webster's New Twentieth Century Dictionary of the English
Language, 2nd ed. (Cleveland and New York: The World Publishing
Company, 1961).
20Frank Knight, op. cit., pp. 3-4.








10

The professional services selected for study in this dissertation

will, accordingly, have certain common elements or characteristics

which dominate the marketing situation. These characteristics are as

follows:

1. The selected professional services are governed by a code of
ethics which restricts advertising and promotion by members
of the profession.

2. The selected professional services are sold by members of the
profession who operate their private practices for personal
rewards and who rely upon the receipt of fees to cover all
costs of operation.

3. The relationship between buyer and seller of the selected
professional services is a close, personal one based upon
trust and confidence.

4. The selected professional services are sold to ultimate con-
sumers or the general public as opposed to industrial, com-
mercial, or institutional buyers.

5. Except where limited by law or ethics, the sellers of the
selected professional services have freedom of enterprise to
establish their practices where they choose and to operate
them as they desire.

On the basis of these characteristics or common elements, this

dissertation will be concerned with the marketing of services to ulti-

mate consumers by such professionals as medical doctors, dentists, and

lawyers. In this dissertation, the dental profession in Florida will

be the specific subject of study.

To recapitulate, the output of the economy may be divided into

tangible and intangible goods. The division of intangible goods con-

sists of several categories, one of which is professional services.

Professional services are rendered by such people as medical doctors,

dentists, lawyers, clergymen, teachers, certified public accountants,

architects, and so forth. From this group of professional people








11

there can be selected certain professions which have in common the

characteristics that were listed on page 10. Such selected profes-

sional services constitute the broad limits of the scope of this

dissertation; however, dentistry in general, and Florida dentists in

particular, will be the specific subject of study.

Methodology

Although each selected professional service has its own area of

concern regarding the satisfaction of human wants and needs, all have

essentially the same relationship between buyer and seller. This point

is explained by the common elements which govern the marketing activi-

ties of these services as discussed above. Therefore, thorough in-

vestigation of the marketing situation of one of these professional

services will provide an approximation to the marketing situation of

all of them. There will be individual differences to be sure, but

generalizations which can be applied to the marketing of all selected

professional services are the object of study. A principle or gener-

alization that explains a particular aspect of the marketing of dental

services should, in most cases, explain a similar aspect of the mar-

keting of legal services or some other selected professional service.

This condition is, of course, subject to the limitations and defini-

tions which were presented in the previous sections.

In order to provide this desired approximation, the dental pro-

fession in Florida will be analyzed from a marketing point of view.

Dentistry in general will be examined in so far as information is

available, but original research will be directed at Florida dentists.

Thus, Florida dentists will provide an example or a case in point








12

regarding the marketing of selected professional services.

Florida dentists were chosen as the object of research because of

the personal experience of the author in previous dental research con-

ducted for the Florida Academy of Dental Practice Administration.

This previous research was a study of the attitudes of dental patients

in Florida and both mail questionnaires and personal interviews were

used to obtain information. As this dissertation was being written,

a survey of Florida dentists was conducted under the sponsorship of

the Dental Academy. Again, this writer was a participant in this

survey of dentists. The experience obtained from these two projects

provided the author with valuable insight into the nature of Florida

dentistry. In addition to these two studies, personal group depth

interviews were conducted by the author with several groups of dentists

throughout the state. A detailed description of this research is con-

tained in the Appendix.

So that meaning may be given to the data collected from original

research and from existing sources, a theoretical structure will be

used in the approach to the study of marketing dental services. Den-

tists will be viewed as monopolistic competitors selling a differen-

tiated service "product." Because of the very personal nature of the

service and because of individual differences among dentists, no two

dentists provide exactly identical services. Each has his own unique

style, technique, personality, or some other factor which differen-

tiates his service from that of other dentists. Patients accordingly

desire the service of one particular dentist and a certain patient

loyalty is established not unlike the brand loyalty enjoyed by some








13

manufactured goods. This point is discussed in Chapter III.

Even the office in which the dentist carries on his practice can

be a source of differentiation. Chamberlin in his The Theory of Mono-

polistic Competition explains the concept of differentiation the fol-

lowing way:

A general class of product is differentiated if any significant
basis exists for distinguishing the goods (or services) of one
seller from those of another. Such a basis may be real or
fancied . Where such differentiation exists, even though
it be slight, buyers will be paired with sellers, not by chance
and random (as under pure competition), but according to their
preferences. Differentiation may be based upon certain charac-
teristics of the product itself or it may also exist with re-
spect to the conditions surrounding its sale.20

Chapter II will develop at length the theory of monopolistic com-

petition as it applies to denistry. The market for dental care and the

various demand factors in the consumption of dental care will be pre-

sented in Chapter III. Such subjects as consumer characteristics and

patronage motives will be discussed. The methods used by Florida

dentists to segment their markets will be covered in Chapter IV.

Market segmentation by age, sex, income, and other factors as they

apply to Florida dentists will be analyzed. This chapter is presented

as a discussion of the first step involved in developing a marketing

strategy, namely the establishing of market targets or objectives.

The development of an appropriate marketing mix is the second step in

the creation of marketing strategy and this is the subject of

Chapter V. The marketing mix elements of product, place, promotion,

period, and price will be studied as they apply to the marketing of

20E. H. Chamberlin, The Theory of Monopolistic Competition,
(Cambridge: Harvard University Press, 1948), p. 56.









14

dental care. Chapter VI will be the concluding chapter of the dis-

sertation. The findings presented in the previous chapters will be

summarized and conclusions will be drawn. Chapter VI will present

the answer to the question that was raised in the hypotheses: Can the

existing body of economic and marketing thought, although customarily

concerned with tangible goods, also be employed in the study of the

marketing of intangible goods as represented by professional services,

specifically dental care?














CHAPTER II


THE CONCEPTUAL FRAMEWORK

Dentists: Monopolistic Competitors

There are many buyers and sellers of dental services. Although

for every Florida dentist there are over 2,000 people, in urban areas

a patient can usually choose from numerous sellers of dentistry. For

example, in Dade County there are 616 dentists, 165 in Duval County,
1
and 156 in Orange County. Numerically speaking, the relationship

between buyers and sellers of dental service products is one that

resembles the pure competition of economic theory. Also, it is un-

likely that any dentist in an urban area would have a practice of

sufficient size to dominate the marketing situation and therefore

control the activities of rival sellers in the same market. As such,

dentists as private individual practitioners are generally limited in

the market power they can exercise. The entrance or exit of a single

dentist from the profession or industry is unlikely to have perceptible

influence on the relationship between buyers and the remaining sellers

of dentistry. Conversely, it is unlikely that any one buyer will be

so important as to significantly change the financial position or

strength of established dentists in the event of a change in buying

habits. In the general case it can be concluded that no one buyer or

1 American Dental Association, Bureau of Economic Research and
Statistics, Distribution of Dentists in the United States by States,
Region. District and County (Chicago: American Dental Association,
1963), p. 11.








16

seller of dental services, because of size, can exert significant in-

fluence on the terms of sale in the market. However, the terms of sale

are influenced by such factors as different pricing policies among

dentists (Chapter V).

The service product which a dentist sells is related to the most

perishable of all goods--time. Lincoln once said that a lawyer's time

and advice are his stock in trade, and in many respects this applies

to dentists as well. The dentist either sells his service now or

never. Of course, a given patient can be treated today, tomorrow, or

next week, but a dentist cannot stock pile unfilled appointment

schedules for sale in peak periods of demand. Thus, in the short

period the dentist is faced with the problem of disposing of a fixed

stock of highly perishable appointment schedules in which he sells his

service product. For the dentist, as in economic theory, in the short

period there is little opportunity for a seller to improve his position.

He generally reacts to market conditions by deciding to sell or not to

sell. Consequently, since there is little to be said about possible

marketing considerations in the short period, we will be concerned

mainly with the intermediate and long run periods.

In the intermediate period, the dentist is still faced with the

problem of perishability, but now there is time enough to permit some

adjustment of supply to demand conditions. The adjustment is accom-

plished through changes in the rate of output of existing fixed capi-

tal. In the case of the dentist, a hygienist may be hired to clean

teeth thus relieving the dentist of this operation so that his at-

tention may be directed at other, more complicated, cases. Other

staff members may be added in other capacities thereby increasing the








17

total number of units of service product that can be sold. There is

also the possibility that within a given calendar period more hours

could be added to the appointment schedule which could increase the

quantity of service products to be supplied.

In the long run, all factors in the supply are variable. The

individual dentist or firm could make additions to the capital plant

that would permit a greater number of patients to be served. More

dental chairs and equipment could be purchased and more dental

hygienists, assistants, secretaries, and technicians could be hired.

High speed drills may be installed and the dentist could construct

his own laboratory to handle all of his needs. Also in the long run

we should not overlook the possibility of the dentist himself improv-

ing his own productive capacity through new skills and techniques

acquired at various professional meetings and short courses and

general improvement with experience.

In the long run there is also time for industry or profession

capacity to expand or contract through the entrance or exit of firms

or dentists. As already indicated, much of this expansion may re-

sult from increasing the capacity of existing firms. But as economic

theory teaches, most of the adjustment of supply to demand is usually

accomplished by changing the number of firms within a certain range of

size. We would expect this same conditon to prevail in dentistry since

the firms in question are centered around the capacities of the indi-

vidual dentist.

There are probably few, if any, good substitutes for proper

dental treatment especially if one is suffering with a tooth ache.

For this reason, the industry demand curve is likely to be highly








18

price inelastic. But in considering the nature of the demand for

individual firms in the industry, we cannot assume that firm demand

is as inelastic as industry demand. In fact, under conditions of

pure competition firm demand would be perfectly elastic. But this

conclusion rests, in part, on the assumption that all firms in the

industry are selling identical service products. There are indivi-

dual differences in personality, technique, physical facilities and

surroundings, quality of work, and so forth. Also, dentists sell not

just one type of product but many types of dental products such as

fillings, extractions, and dental plates. Variations in these pro-

ducts exist according to the individual characteristics of the den-

tist selling them and the demand elasticities of these products vary

depending on the product type. For example, the demand for fillings

may very well be more elastic than the demand for extractions. The

point is, no two dentists sell exactly the same good. Differences do

exist that are either real or imaginary, tangible or intangible,

physical or psychological. In economic and marketing terminology, the

products are said to be differentiated.

The introduction of differentiated products into a market made

by many buyers and sellers forces some modification in our conclusion

regarding the competitive situation. Buyers are no longer indifferent

as to whom they patronize, but instead they will purchase according to

personal preferences, since the service product of one dentist is not

considered as a perfect substitute for that of another. As Alderson

points out: "The processes of exchange in the market place are

directed toward matching up segments of supply and demand to provide








19

the best fit.''2 The demand curves facing individual firms will not

be perfectly price elastic. Rather they will be negatively sloped con-

taining both elastic and inelastic sections. With different products,

firms will also have similar, but not identical cost curves. This

factor and other market conditions will result in variations in price

among the firms for comparable products. Dentists, therefore, are not

pure competitors according to economic theory, but, to use E. H.

Chamberlin's term, they are monopolistic competitors.3


The Objective of Dentists

In the previous section, we assumed the customary objective of

maximization of income. However, in studying a profession such as

dentistry where public service is an important aspect of the product

in question, a critical examination of this assumption is in order.

As is shown in Table 1, dentists often mention the feeling of personal

satisfaction they receive from their practices as part of the reward

for being in the profession. Such considerations may lead one to

believe that the principle of income maximization is not fully appli-

cable in this case.

However, our conception of income is not limited to monetary

receipts. As Boulding points out "there are both monetary and non-

monetary advantages to be derived from employment."4 We are, in

2Wroe Alderson, Marketing Behavior and Executive Action (Home-
wood, Illinois: Richard D. Irwin, Inc., 1957), po 102.
3For a thorough development of the theory of monopolistic com-
petition see E. H. Chamberlin, The Theory of Monopolistic Competition,
6th ed. (Cambridge: Harvard University Press, 1948).
4Kenneth Boulding, Economic Analysis, 3rd ed. (New York: Harper
and Brothers, 1955), p. 182.








20

TABLE 1

WHAT FLORIDA DENTISTS REGARD AS THE ONE MAJOR ADVANTAGE
OF THEIR PROFESSION, IN PERCENTAGES


MAJOR ADVANTAGE PER CENT


Satisfaction of personal creativity .... ............. ....30
Being one's own boss ................ ...... .28
Feeling of public service ............. .............. 12
Attractive working conditions and hours ...... ............ 4
Pleasure in doing precision work ....... ............... 4
Intellectual challenge .......... .................... 3
Satisfaction of being an expert ........ ................ 3
Compensation ................ ............. 2
Association with many types of people ...... ............. 2
High regard commnity has for dentist .... ............. ...1
Other answers, indefinite answers, no response ........... .11


Source: Unless otherwise indicated, tables presented in this
dissertation came from the survey of Florida dentists which the
author conducted for the Florida Academy of Dental Practice Admini-
stration. A description of this survey is contained in the Appendix.


effect, concerned with the maximization of total income which includes

both money and psychic income. Conversely, there are both monetary

and nonmonetary costs incurred by the dentist.

Psychic costs are incurred to receive psychic benefits. Sub-
Jective satisfaction which is derived from the utility obtained
from various segments of real income items is purchased by the
disutility of supplying real cost items.5

In the operation of his practice, a dentist will seek to maxi-

mize his total income which consists of money and psychic income.

it will no longer be true that the money value of output will

be at a maximum . instead the sum of the money value of output and


5Brian Dixon, Price Discrimination and Marketing Management
(Ann Arbor: University of Michigan Bureau of Business Research, 1960),
p. 10.








21

the monetary equivalent of nonmonetary returns will be at a maximum."6

Some insight into the monetary equivalent of psychic income can

be obtained from the alternative cost concept. Suppose that a dentist

could earn $35,000 a year by practicing in Detroit but that for personal

reasons he prefers to practice in Fort Lauderdale where his annual in-

come is $25,000. This $10,000 differential could be considered as the

monetary equivalent of the psychic income derived from practicing in

a tropical climate. Later, data will be presented concerning the

extent that such personal or psychic income factors enter into the

maximization plans of dentists.

Geographical preferences are not the only source of psychic costs

and income. Such costs are also involved in the treatment of many

patients. The degree of responsibility involved and the mental and

nervous strain experienced by a dentist varies from patient to patient.

This factor is so important to many dentists that they themselves place

a monetary value on it and include such costs in the fees they charge

their patients. (See the discussion on pricing in Chapter V.) In

these instances, psychic costs are reflected in the money income of the

firm. Such a translation of psychic cost into a monetary equivalent

is perfectly consistent with the principle of income maximization.

Because income and costs are composed of both money and psychic

factors, there appears to be no reason why the principle of income

maximization should not hold in the case of dentistry. The problem

6George J. Stigler, The Theory of Price, rev. ed. (New York:
The MacMillan Company, 1952), p. 106.








22

lies not in principle, but in the practice of trying to measure non-

monetary factors. No attempt will be made to precisely measure psychic

costs and income associated with dental practice. But there will be

an attempt to show how some of these nonmonetary considerations enter

into the marketing activities of dental firms.

The importance of monetary considerations in the practice of

dentistry should not, however, be minimized. Dentists, when asked,

stated various reasons why they selected their profession as shown in

Table 2. The emphasis on the influence of other dentists or relatives


TABLE 2

THE REASONS THAT FLORIDA DENTISTS CHOSE THEIR
PROFESSION, IN PERCENTAGES


REASONS PER CENT


Close relative was a dentist ...... ................. ..24
Had aptitudes for dentistry ....... ................. .47
Influence of family dentist ....... ................. ..26
Had hobbies that led to dentistry ...... .............. 9
Promise of high monetary reward ..................... 9
Influence of family, relatives, friends ... ........... 6
Preferred dentistry over medicine .... .............. 2
Wanted to be own boss .. .. ................... 4
Influence of other dental friends .... .............. 3
Employment experience .......... .................... 2
Other personal or economic reasons ........ ........... 4
Other reasons ............. ...................... 4



or on the personal qualities of the individual may be the result of a

reluctance to admit financial desires and aspirations. Whatever the

reason for selecting the profession, it is clear from the data pre-

sented in Table 3 that monetary considerations are important to

dentists currently practicing. Two-thirds of Florida dentists want








23

TABLE 3

MONTHLY RETIREMENT INCOME DESIRED BY FLORIDA
DENTISTS, IN PERCENTAGES


INCOME NET INCOME IN 1962
DESIRED Under $10,000- $20,000- $30,000- All
$10,000 19,999 29,999 and up Dentists


Under
$400 3 5 3 2 3
$400 10 10 5 1 9
$500 24 22 12 16 18
$600 23 23 26 14 21
$700 12 10 18 7 12
$800 10 9 8 13 9
$900 or more 15 16 22 45 22



a retirement income of at least $300 a month and it is also noteworthy

that desired retirement incomes increase as the level of current

annual net income rises. For example, only 15 per cent of the dentists

with net incomes under $10,000 desire a monthly retirement income of

$900 or more. This proportion reaches 45 per cent for dentists with

net incomes of $30,000 or more.

Income may also influence the satisfaction which -a dentist feels

he derives from his profession. If we make the reasonable assumption

that the desire of a dentist for his son to enter the dental pro-

fession reflects the satisfaction which the father derives from dental

practice, then income is significant as revealed in Table 4. Fifty-

five per cent of the dentists earning a net income of under $10,000

annually expressed the desire for their son to be a dentist. This

percentage increases steadily as net income rises and reaches a high

of 79 per cent for dentists in the $30,000 or higher group.










TABLE 4

DESIRE FOR SON TO BE DENTIST BY NET INCOME IN 1962
OF FLORIDA DENTISTS, IN PERCENTAGES


NET INCOME DESIRE SON TO BE DENTIST
1962 YES NO UNCERTAIN NO RESPONSE


Under
$10,000 55 15 27 3
$10,000-
19,999 66 14 18 1
$20,000-
29,999 71 8 19 1
$30,000-
and up 79 7 14 0

All dentists 66 11 21 13



Financial aspirations for the future as reflected in desired

monthly retirement income also bears a relationship to a dentist's

desire for his son to be a dentist (Table 5). Less than half of the


TABLE 5

DESIRE FOR SON TO BE DENTIST BY DESIRED MONTHLY RETIREMENT
INCOME OF FLORIDA DENTISTS, IN PERCENTAGES


DESIRED MONTHLY DESIRE SON TO BE DENTIST
RETIREMENT YES NO UNCERTAIN NO RESPONSE
INCOME


$300 or less 48 27 24 0
$400 58 16 25 1
$500 61 11 26 2
$600 67 11 20 2
$700 71 10 18 1
$800 69 10 20 1
$900 or more 72 9 19 0
All dentists 66 11 21 13








25

dentists desiring retirement income of $300 or less a month expressed

the desire for their son to enter dentistry. This proportion rises as

desired monthly retirement increases and reaches a high of 72 per cent

for dentists in the $900 or higher group. It seems clear that finan-

cial success influences and motivates current members of the dental

profession and future members as well.


Marketing Strategy

For monopolistic competitors the differentiation of the product

is critical. This is the condition that calls for variation in the

output policies among the firms in the industry. As such, monopolistic

competitive firms take an active interest in the nature and scope of

these differences. In striving to compete with close, but not perfect,

substitutes in the market, a firm will explore all possible oppor-

tunities for differentiation that will give it an advantage over rival

products. Alderson refers to this activity as a search for "differen-

tial advantage."7 It is this situation that gives rise to marketing

activities since a seller cannot assume or take his market for granted.

The volume of his sales depends in part upon the manner in which
his product differs from that of his competitors. Where the
possibility of differentiation exists sales depend upon the skill
with which the good is distinguished from others and made to
appeal to a particular group of buyers.8

According to A. R. Oxenfeldt, market strategy consists of two

parts: First, the market target or objectives must be defined.

"These market objectives are best expressed as customer types--

7Wroe Alderson, op. cit., p. 102.

8E. H. Chamberlin, The Theory of Monopolistic Competition, 6th
ed. (Cambridge: Harvard University Press, 1948), pp. 71-72.








26

narrowly defined--whose patronage the business will try especially to

win." The second step involves the composition of the appropriate
9
appeal to the selected market segment or segments.

The purpose of first defining the market targets or objectives is

to provide the firm with a sense of direction. "Before mental and

physical activity can be utilized intelligently, it must be directed

toward some purpose or goal. In fact, an objective has an inherent

power within itself to stimulate action."I0 In order to identify and

select possible market targets, the total market is segmented into

relatively homogeneous parts defined according to desired consumer

characteristics. "The strategy of market segmentation suggests a con-

tinuous policy of looking for differences, geographical or otherwise,

in the total market, and the continuous exploitation of these dif-

ferences."11 Market segmentation may be viewed as the divide-and-

conquer step in marketing strategy. All firms practice market segmen-

tation, either by design or default.12

Once the market target is selected, the second step in the de-

velopment of the strategy involves a method of attack.

But a firm must not attempt to be all things to all customers;
most firms have to confine their basic objectives to some
particular parts or segments of the market. The point is that

9Brian Dixon, op. cit., p. 102.

10George R. Terry, Principles of Management (Homewood, Illinois:
Richard D. Irwin, Inc., 1960), p. 7.
11S. H. Britt and H. W. Boyd, Jr., Marketing Management and
Administrative Action (New York: McGraw-Hill Book Company, Inc., 1963),
p. 88.
12Ibid., p. 95.








27

different segments of the market have different wants and needs,
thereby requiring a firm to employ varying kinds and amounts of
resources to service these wants and needs.13

The method of attack which employs varying kinds and amounts of re-

sources so as to effectively cater to the selected market targets is

often referred to as the marketing mix. The main problem concerns the

development of a marketing mix which will successively meet the re-

quirements of the market target.

In the selection of the proper marketing mix, writers on the

subject have often used the four "P's" of product, price, place and

promotion in discussing the elements which comprise the mix. All

elements of the mix contribute to the differentiation qualities of the

seller's goods.

Without homogeneity, the firm will be using all available
techniques in its . mix to sell the product. It will not
be selling just a physical product, but a "bundle" of stimuli
which are designed to fit the maximizing desires of the
potential purchasers.14

The purpose of differentiating the product is to appeal to the selected

market segments and to gain a competitive or differential advantage

over rival sellers in the same market segment. In the latter case

where there are multiple product offerings in the same market segment,

some writers have concluded that differences among rival products may

be slight and that there may be a tendency for all products to cluster

around the most successful types. According to Boulding, in this

situation the principle of minimum differentiation holds: 'make your

13Ibid., p. 35.

14Brian Dixon, op. cit., p. 17.








28

product as like the existing products as you can without destroying

the differences." 15

If we use the term "product" in the broad sense of being the

entire "bundle of stimuli" which the firm sells, then all elements

of the marketing mix are subject to differentiation which collectively

compose the total differentiation with which a firm hopes to cater to

the selected market segments. In this sense, we may speak of product,

price, place, and promotion differentiation.

Market segmentation and product differentiation are not alterna-

tive marketing strategies as has been suggested.16 "The opposite of

market segmentation could be called market aggregation." 17 Market

segmentation and product differentiation are, instead, the two main

steps in the development of marketing strategy. Market segmentation

is the first step concerned with narrowly defining the market targets

and objectives while product differentiation is the second step con-

cerned with formulating the marketing mix which will best appeal to

the selected market targets. The segmentation and differentiation

activities of Florida dentists, either by design or default, is the

subject matter of this dissertation.

15Kenneth Boulding, op. cit., p. 633.

16For example, see Wendell R. Smith, "Product Differentiation
and Market Segmentation as Alternative Marketing Strategies,"
Managerial Marketing: Perspectives and Vi~woints, ed. Eugene J.
Kelley and William Lazer (Homewood, Illinois% Richard D. Irwin, Inc.,
1958), pp. 282-288.
17Ibid., p. 87.








29

The Marketing Mix

Under conditions of pure competition the buyers and sellers in

a given market at a given time deal in identical products. The

offering of one seller is a perfect substitute for the offering of

another; the only form of competition that prevails is one of price.

But for the monopolistic competitor, the product is no longer a con-

stant, but a variable element in the marketing mix subject to dif-

ferentiation. As Chamberlin explains:

As for products in the narrower sense, evidently consumers'
goods may be of different materials, design, or standards of
workmanship, whether we are speaking of furniture, clothing,
or household equipment. The preparation of food for sale,
whether by canning, baking, or other type of manufacture for
consumption at home, or by cooking and serving in a restaurant,
affords infinite possibilities of variation with respect to the
selection of ingredients, their quality, and the manner in which
they are combined and prepared. The perfect and infinite
variability of such products as services--public utility, pro-
fessional, and personal--is evident. In the case of barber
shops, beauty parlors, laundries, cleaning establishments,
etc., the quality of what is sold is a major element in the
consumer's decision to buy from one seller rather than
another--his choice is made as much on the basis of product
as of price, and probably much more so.18

For the dentist the product element in his marketing mix consists

of the personal service he is able to render his patients. Intelli-

gence, manual dexterity, attitude, training, and experience are some

of the factors that determine the relative quality of his product as

compared with those of his rivals. Objective measurement of the

quality of an intangible good is practically impossible. But by making

a few plausible assumptions regarding measurable factors that determine

quality, we can perhaps get an approximation of relative qualitative

18E. H. Chamberlin, Towards A More General Theory of Value (New
York: Oxford University Press, 1957), p. 114.










differences among dentists.

Let us assume that the quality of service which a dentist is able

to render depends, at least in part, on the following three factors:

the number of years of professional dental school education, the number

of years of practical experience, and the total investment in the

dental office and equipment. The assumption is that the greater the

number of years of professional training and experience and the

greater the investment in facilities, the greater the quality of the

service performed. This assumption is not expected to hold in all

cases, but it should provide a basis for approximating the relative

quality of dental service products. These differences in quality, in

turn, are a source of product differentiation which is an important

element in the marketing mix. Other possible differentiating charac-

teristics of dental services will also be studied.

Variations in the quality of the products may be reflected in the

prices at which they are sold. "To a very considerable extent the

scheme of prices is the result of conditons unique to each product and

to the market."19 The element of price is the second "P" in the mar-

keting mix of Florida dentists. Since dental services are a specialty

good, variations in price within a given market are to be expected.

This is especially true since the products are differentiated and are

not perfect substitutes. Just as products may be differentiated, so

may their prices. When a seller charges different prices for the same

good when sold to different buyers, this practice is usually referred

19E. H. Chamberlin, The Theory of Monopolistic Competition, 6th
ed. (Cambridge: Harvard University Press, 1948), p. 82.








31

to as price discrimination and it is not unusual to find this done by

the various professions.20 Such a pricing policy is clearly related

to the first step in developing a marketing strategy--market segmen-

tation. "It is necessary for an imperfectly competitive seller to be

able to classify customers and thus to separate the market for the

product into segments in order to be able to engage in discriminatory

pricing." 21

Other aspects of pricing are relevant to the study. For example,

the various methods used in the determination of prices or fees for

dental services as well as credit terms extended to customer patients

are part of pricing policy. Then too, the variations or similarities

in prices that exist in the same market area for close substitutes

provide insight into the degree that price or nonprice competition is

practiced. In connection with this, the difference in fees which

dentists in a particular market charge their patients for similar

services is a subject that will be discussed in Chapter V.

Promotion is the third element in the marketing mix which con-

tributes to the total differentiation of the product. For the purpose

of this dissertation, promotion is defined as any activity or effort

that a dentist may ethically undertake that could improve the position

or slope of his demand curve while (conceptually) holding the other

elements of the mix constant. The basic functions of promotion are,

20Brian Dixon, op. cit., p. 36.

21C. L. Allen, J. M. Buchannan, and M. R. Colberg, Prices, Income,
and Public Policy (New York: McGraw-Hill Book Company, Inc., 1954),
p. 88.








32

according to McCarthy, to inform, persuade, and remind; it is

important to note that reminder advertising is often used for

specialty goods.22

Promotion is not limited to paid advertising on various com-

mercial communication media (which is prohibited by dental ethics),

but includes all types of public relations, publicity, and personal

salesmanship by the seller. Although this particular element of the

marketing mix is prevented from being fully exploited by the dental

profession, there are several public relations and "patient education"

activities conducted by dentists which are promotional in nature.

Chamberlin in developing the theory of monopolistic competition

also considered the factor of geographical location. The element of

location or place is the fourth "P" in the marketing mix and it too is

subject to differentiation. "The availability of a commodity at one

location rather than another being of consequence to purchasers we may

regard these goods as differentiated spatially ... 23 In another

book, Chamberlin elaborated on this idea:

In general people do take space into account in some degree in
deciding whether to buy at all, so that if the product is too
far away and it is too much trouble to obtain it they will do
without it. For this reason, a single seller will sell more if
he locates at the center of the line than if he locates anywhere
else. Convenience is maximized at that point (more generally,
the discrepancy between products and wants is minimized) and
just as demand is greater at a lower price, so it is greater if
convenience is increased.24

22E. J. McCarthy, Basic Marketin: A Managerial Approach (Home-
wood, Illinois: Richard D. Irwin, Inc., 1960), pp. 490-492.
23E. H. Chamberlin, The Theory of Monopolistic Competition, 6th
ed. (Cambridge: Harvard University Press, 1948), p. 62.
24E. H. Chamberlin, Towards A More General Theory of Value,
(New York: Oxford Univeristy Press, 1957), p. 128.








33

The location or place of the dentist office will, therefore, be

a subject of study. Attention will be given to those factors such as

population, income, and geography that apparently determine the spatial

distribution of dentists. The degree in which a location was selected

for such marketing considerations as customer convenience as opposed

to its ability to provide psychic income for the dentist will be a

matter of particular interest.

The four elements of product, price, promotion, and place are

generally considered as being the main ingredients in the marketing

mix which comprises the operational aspect of marketing strategy. How-

ever, there is a fifth "P" which is of sufficient importance in this

present study to warrant a separate classification. This is the ele-

ment of period or point in time. The recognition of time as an ele-

ment in the marketing mix appears consistent with the traditional con-

cern of marketing about time, place, and ownership ability. Such

recognition also reflects recent concern among marketing people with

temporal as well as financial and physical limitations upon consump-

tion.25

The importance of the time factor has received attention by

several writers. For example, J. M. Clark in his Competition As A

Dynamic Process makes the following point: ". . demand curves,

drawn to represent the relation of volume of sales to prices as a sole

variable, necessarily neglect the vitally important factor of time

25"The New Strategy: Try To Beat The Clock," Business Week,
(February 1, 1964), pp. 50-51.








34

... ,,26 Brian Dixon develops the concept of "temporal product

differentiation" in his book Price Discrimination and Marketing

Management.27 As an element in the marketing mix, we are concerned

with the management of the time factor by the firm and the extent to

which period differentation contributes to the objectives of the

dental firm. From the point of view of the dentist, the number of

hours worked per week would be significant. From the point of view

of the patient customer, the promptness or delay in obtaining an

appointment would be a factor in the service product bought from the

dentist.

The Optimum Mix

The individual firm operating under conditions of monopolistic

competition faces the task of deciding what combination of product,

price, promotion, place, and period will best cater to the selected

market segment. This requires a search for the optimum mix that will

maximize firm income (both money and psychic). This task is especially

difficult since the elements of the mix are not perfect substitutes

for each other and must be used in some combination, whether by

design or default.

The most efficient combination of factors will always be sought
for any given total expenditure . . Every factor will nor-
mally be used within the stage of diminishing returns for that
factor; that is, under conditions such that increased outlay for
it alone (the others remaining constant) would give an increase
in sales less than proportionate to the increased expenditures.

26J. M. Clark, Competition As A Dynamic Process (Washington:
The Brookings Institution, 1961), p. 216.
27Brian Dixon, op. cit., p. 42.








35

Within this stage, the more expensive factors will be econo-
mized more than those less expensive, and the relative price
of the factors being given, there will be one combination
which represents the most effective employment of a given
total expenditure. To discover this combination will be the
goal of the business man's calculations so far as proportion-
ality is concerned.28

The law of demand as presented in economic theory holds that

there is an inverse relationship between the price of a good and the

quantity of it demanded. All other elements such as product or place

are taken as given or assumed with the only variable being price.

Since the quantity demanded of a good is a function of its price, the

locus of the point that traces all possible combinations of price and

quantity under given market conditions provides the familiar negative

sloping demand curve. With every change in price there is a corre-

sponding change in quantity demanded and the degree of this change is

referred to as elasticity. Price elasticity, then, is the ratio of the

proportional change in quantity sold to the proportional change in

price.

The customary price demand curve is presented in Figure 1. Under

the market conditions represented by demand curve Dl, quantity OQI

will be sold at price OP11 Now let us suppose that, with price

elasticity relationships remaining the same, the firm undertakes

promotional activities that cause D to shift to the right and assume

the new position D Now the quantity sold at price OP increases from

OQI to OQ2. Thus, a given promotional effort resulted in an increase

in the amount sold. The additional sales from OQ1 to OQ2 is a measure

28E. H. Chamberlin, The Theory of Monopolistic Competition, 6th
ed. (Cambridge: Harvard University Press, 1948), pp. 131-132.


































Figure 1.--Hypothetical Price Demand Curves


Figure 2.--Hypothetical Nonprice Demand Curves








37

of the response of quantity demanded to promotion and we may refer to

this relationship as promotional elasticity. ". . promotional

elasticity is essentially the same as our previous description of price

elasticity. That is, it is the amount of response elicited by a given

expenditure of promotional effort at a given point in time."29 If we

consider only the relationship between promotional effort and quantity

demanded while holding other elements constant, then we would have a

sales or demand curve such as that shown in Figure 2. Considering only

the relation between promotion and quantity, market conditions repre-

sented by curve DI will see quantity OQ1 demanded at promotion OP. The

ratio of quantity demanded to promotional effort at any point or arc

along curve DI is a measure of the degree of promotional elasticity.

Let us relax the assumption that price is held constant and in-

ject the possibility of a decline in price. The new lower price is

represented by a shift to the right of the nonprice or promotion de-

mand curve to the position depicted by curve D At the same promo-

tional effort OP the quantity sold would increase from OQ1 to OQ2.

Thus, both price and promotion (and any other elemental change) can

result in a shift in the demand curve while holding the other elements

in the marketing mix constant.

There is no reason to limit the concept of elasticity to price

and promotion. We may also consider the possibility of place, pro-

duct, and period elasticity. For example, let us assume that the OY

axis in Figure 2 represents increasingly desirable places of business

at each successively higher position on the scale. The term


29Brian Dixon, op. cit., p. 17.








38

"desirable" here means that each higher and better place results in

greater quantities sold. In Figure 2 place OP under demand conditions

D1 would see quantity OQ1 sold. Now if price were lowered or promotion

expanded so that the demand curve would shift to the right to D2 then

quantity OQ2 would be sold at place OP.

As another example, let us assume that each higher position on

the OY axis represents a greater number of time units with the corre-

sponding result that more will be sold at each greater number of time

units. At period OP quantity OQ1 will be demanded under conditions of

curve D Now if we assume that the firm produces a better product

(better in the sense that more sales are forthcoming) then the demand

curve will take the position D2 and quantity OQ2 will be sold during

period of time OP.

With quantity sold not only a function of price, but also a

function of product, place, promotion, and period the question arises:

What will determine the optimum marketing mix? The key to the solu-

tion of this problem lies in the concept of elasticity. Let us first

examine price elasticity while holding the other four elements con-

stant. We will assume that we are concerned with the demand for ex-

tractions that one dentist will face. Table 6 presents a hypothetical

demand schedule for fillings with quantity demanded being a function

of price.

As expected, the number of fillings demanded increases as the

price per filling is decreased. The significant factor for purposes

of maximization is the behavior of filling revenue. Notice that

revenue increases to a maximum of $150 at a price of $5 and a quantity

demanded of 30. As long as revenue was increasing as price declined,








39

TABLE 6

A HYPOTHETICAL PRICE DEMAND SCHEDULE FOR
FILLINGS


PRICE PER QUANTITY OF TOTAL
FILLING FILLINGS FILLING
DEMANDED REVENUE


$10 10 $100
9 12 108
8 15 120
7 19 133
6 24 144
5 30 150
4 37 148
3 45 135
2 54 108



demand was relatively price elastic. However, when revenue decreased

with each decline in price, the demand for fillings was relatively

price inelastic. Total revenue was maximized at the point of unitary

price elasticity. As far as the element of price is concerned in the

marketing mix, a price per filling of $5 appears to be optimum choice

of our example.

With the optimum price determined the problem of selecting the

marketing mix is partially solved. But some optimum choice of the

other four elements must still be made. The concept of elasticity is

equally useful for making the best possible choices concerning the

other elements. The element of promotion will be used to illustrate

this point with the aid of Table 7 which presents a hypothetical re-

lationship between the number of additional fillings demanded at

various levels of promotional effort. As before, all other elements

are held constant. In this example, price remains constant at $5 per










filling and each unit of promotional effort costs $15.


TABLE 7

A HYPOTHETICAL PROMOTION DEMAND SCHEDULE
FOR FILLINGS


ADDITIONAL FILLINGS UNITS OF TOTAL GROSS NET
DEMANDED AT $5 PROMOTION PROMTION REVENUE REVENUE
PER FILLING EFFORT EXPENDITURE


6 3 $45 $30 -$15
11 4 60 55 5
16 5 75 80 5
21 6 90 105 15
25 7 105 125 20
29 8 120 145 25
31 9 135 155 20
33 10 150 165 15



Table 7 reveals that generally the quantity of fillings demanded

increases with each additional unit of promotion. It is important to

note that when analyzing the relationship between quantity demanded and

the nonprice elements of promotion, place, product, and period, changes in

total cost are involved. It will be convenient to think of these costs

as reductions in revenue in studying the problem of optimn choice.

This is the procedure that Boulding used in his discussion of "selling

costs." 50 Hence, the critical figure will be net revenue rather than

gross revenue in the analysis of elasticity of nonprice elements.

Net revenue in Table 7 reaches a maximum of $25 at a promotion

expenditure of $120 on 8 units of promotion which resulted in 29 addi-

tional fillings sold. As long as net revenue was increasing, demand

50Kenneth Boulding, op. cit., pp. 772-784.







41

was relatively promotional elastic. As net revenue declined with

additional promotional effort, demand was relatively promotional in-

elastic. The optimum level of promotion is at the point of unitary

elasticity where net revenue reached a maximum of $25.

The other three elements of the marketing mix--product, place

and period--were shown in the discussion of Figure 2 to have the same

type of positive sloping demand curve as does the element of promotion.

By presenting hypothetical data, the elasticity concept could be

demonstrated for these nonprice elements as it was for promotion.

But in all cases, the conclusion would be the same. The optimum

position on the place, product, and period demand curves would be the

point where net revenue was at a maximum. This is also the position

of unitary elasticity.

The conceptual solution to the problem of selecting the proper

marketing mix should now be clear. The firm operating under condi-

tions of monopolistic competition will seek to arrange the elements of

the mix in such a way so that all are at a position of unitary elas-

ticity on their respective demand curves. This conclusion is presented

as the expected tendency in the long run. The data presented in later

chapters will not show all dentists operating under conditions of some

optimum. Dentists, like other firms, function in the short, inter-

mediate, and long periods simultaneously. Also, it was pointed out

earlier that there are both monetary and nonmonetary factors in-

fluencing marketing strategy which prevent accurate interpretation of

observed and recorded dental practices. Another problem is the fact

that dentists receive very little training in business or practice

administration and, consequently, they may not be achieving the degree








42

of maximization possible simply because of ignorance. But if our

conceptual framework is correct, we should expect to observe or detect

tendencies in the marketing of dental services that are consistent

with the theory as presented.














CHAPTER III


THE MARKET FOR DENTAL SERVICES

Introduction

Dental diseases are probably the most common of all human

afflictions with fewer than five persons out of 100 escaping the
1
attack of dental decay sometime during their lifetime. It is

estimated, for example, that the 180 million people in the United

States in the year 1960 had accumulated at least 700 million un-

filled cavities. "Armed Forces recruits have shown an average'of

more than 13 decayed teeth and almost four teeth lost or indicated

for extraction.'2 The attack of dental decay on the teeth is re-

lentless. Once the permanent teeth have appeared in the mouth, they

are continuously subject to dental decay until the individual either

runs out of teeth or time.3

Teeth which survive the attack of dental decay are still sub-

ject to periodontal disorders or diseases of the gums. Diseases of

supporting bone and gingival tissues afflict around 50 per cent of the

population by the age of 50 and close to 100 per cent of the popula-
4
tion by age 65. The mortality of teeth caused by this disease

1The Conmmission on the Survey of Dentistry in the United States,
Byron S. Hollinshead, Director, The Survey of Dentistry (Washington:
American Council on Education, 1961), p. 13.
2Ibid., pp. 5-6.

3Ibid., p. 15.

4 =., p. 6.







44

perhaps indicates the scope of the problem. For the population as a

whole, periodontal diseases are the reason for half of the tooth ex-

tractions; for people 45 years of age and older, about 80 per cent of

the extractions are performed because of this trouble.5

"Cancer arising in the oral cavity comprises about 4 per cent of

all malignant tumors, but the problem is a greater one than this pro-

portional incidence would suggest because cancer of the mouth is a

more vicious and certain killer than are many malignant tumors

occurring in other anatomical areas. Even in areas of the United

States where the best medical care is available, the cure rate for
7
mouth cancer does not exceed 30 per cent. Approximately 5,000 deaths

a year are due to oral cancer which is a disease that predominates

among males of middle age or older.8 Since the early symptoms of

mouth cancer are very often considered by patients to be minor dental

problems, the early detection of this disease is most likely to occur

in the dentist's office.9

Despite the high prevalence and seriousness of dental disorders,

the problem is aggravated by the wide disparity between the need for

care and the demand for service. This neglect is illustrated by the

5Ibid., p. 16.

6Lester R. Cahn and Danely P. Slaughter, Oral Cancer: A I4nograph
for the Dentist (New York: American Cancer Society, Inc., 1962), p. 111.
7Ibid.

8Byron S. Hollinshead, op. cit., p. 19.

9Ibid.







45

fact that only an estimated 40 per cent of all Americans receive

adequate dental care.10 This problem will be treated in greater de-

tail later in this chapter.

Although this disparity between potential and actual demand for

dental care does exist, the market for dental services is'large and

expanding. It is estimated that prior to 1930 only 20 to 25 per cent

of the total population visited a dentist in the course of a year.
11
By 1952 this figure had risen to better than 40 per cent. Today

Americans make over 258 million visits to the dentist each year

which results in an annual private expenditure of more than $2

billion.

The post World War II growth in consumer expenditures for dental

care is illustrated in Table 8. In current dollars, total expendi-

tures increased by 142 per cent between 1948 and 1962; per capita

expenditures increased by 92 per cent. In constant 1962 dollars,
12
these percentage increases are 72 and 36 respectively. It is im-

portant to note that per capita figures represent average expendi-

tures per person per year, regardless of whether or not the individual

had any expenditures. If only the 40 per cent of the population which

visits a dentist at least once a year were included in the computation,

on this basis per capita expenditures for 1962 would be $29.78.13

10Ibid., p. 6.

11Ibid., p. 31.

12"Dental Expenditures, Utilization, and Prepayment," Blue Cross
Reports, I, No. 2 (Chicago: Blue Cross Association, Sept.-Oct. 1963),
pp. 3-5.
13Ibid.







46

TABLE 8

PRIVATE CONSUMER EXPENDITURES FOR DENTAL CARE
IN THE UNITED STATES, 1948-1962


YEAR TOTAL EXPENDITURES PER CAPITA
(in millions) Current


1962 $2,202 $11.98
1961 2,108 11.63
1960 2,008 11.27
1959 1,894 10.85
1958 1,850 10.79
1957 1,737 10.31
1956 1,625 9.83
1955 1,508 9.29
1950 961 6.40
1948 900 6.20


Source: Louis S. Reed and Dorothy P. Rice, "Private Consumer
Expenditures for Medical Care and Voluntary Health Insurance, 1948-
62," Social Security Bulletin, XXVI, No. 12 (Washington: U. S.
Government Printing Office, December 1963), pp. 4-7.


The population of Florida as of July 1, 1962, was estimated to be

approximately 5,300,000.14 Due to the universal occurrence of dental

disease, this population figure represents the potential number of

customers for dental care in the State of Florida. The actual demand

for dental care is reflected in the number of dental appointments

which, for the South, is shown in Table 9 to average one appointment

per person per year. Therefore, a rough estimate would place the

number of dental appointments in Florida at greater than 5 million

14John N. Webb and Madelyn L. Kafoglis, "Population and Employ-
ment: Changes and Prospects," Statistics of Personal Income, Popula-
tion, Eployment and Construction for Florida Counties, State
Economic Studies No. 15 (Gainesvillet Bureau of Economic and Busi-
ness Research, University of Florida, May 1963), p. 24.







47

annually. Using the 1962 national per capita figure of $11.98 the

estimated annual expenditure for dental care in Florida is approxi-

mately $63 million. The following pages will present an analysis of

the characteristics and motivations of the consumers of dental care.


TABLE 9

TIM INTERVAL SINCE LAST DENTAL VISIT, PER
CENT DISTRIBUTION BY SEX


TIME INTERVAL MALE FEMALE BOTH


Less than 6 months 21.4 24.2 22.8
6 11 months 13.3 14.3 13.8
1 year 14.1 13.9 14.0
2 4 years 14.6 14.1 14.3
5 years or more 14.4 14.7 14.6
Never 19.3 16.9 18.1
Unknown 2.9 1.9 2.4


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States, July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 12.


Consumption Patterns, by Sex

Most people do not follow the traditional advice of "see your

dentist twice a year." Table 9 reveals that for around half of the

population over one year has passed since they last visited their

dentist. And it is significant to note that 18 per cent have never

been to a dentist, and another 14.6 per cent report that at least five

years have passed since their last visit to a dentist.

Females appear to take better care of their teeth than do males.

For 52.4 per cent of the females the time interval since the last

dental visit is one year or less, while only 48.8 per cent of the







48

males visited their dentist within a year. Also, over 19 per cent of

all males have never been to a dentist compared to 16.9 per cent of the

female population who have never visited a dentist.

Table 10 illustrates the greater consumption by females of dental

services by presenting data on frequency of purchase. Females are

more likely to visit a dentist at least twice annually than in the case

for males. Twenty-six per cent of all females visit their dentist at

least two times a year while only 21.6 per cent of the males can claim

this. About the same proportion of males and females visit their

dentist once a year, but for multiple visits, women are consistently

ahead of the men, percentage-wise.


TABLE 10

FREQUENCY OF DENTAL VISITS, PER CENT
DISTRIBUTION BY SEX


FREQUENCY DURING MALE FEMALE BOTH
YEAR


0 visits 61.7 57.7 59.7
1 visit 15.8 15.7 15.8
2 visits 10.0 11.1 10.6
3 visits 3.6 4.4 4.0
4 or more 8.0 10.7 9.4
Unknown 0.8 0.5 0.7


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States. July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 25.


The average number of dental visits per person per year by region

and sex is shown in Table 11. In every region of the country women

have a higher annual average number of visits than do the men. For







49

TABLE 11

NUMBER OF DENTAL VISITS PER PERSON PER
YEAR BY REGION AND SEX


REGION MALE FEMALE BOTH


Northeast 1.8 2.4 2.1
North Central 1.3 1.7 1.5
South 0.9 1.1 1.0
West 1.3 2.0 1.7
All areas 1.3 1.7 1.5


Source: U. S. National Health Survey, Dental Care: Volume of
Visits. United States, July 1957-June 1959, Health Statistics Series
B, No. 15 (Washington: U. S. Government Printing Office, 1960), p. 15.


the nation as a whole, the annual average number of visits to the

dentist is 1.5. The average for females is 1.7 while the average for

males is only 1.3. By all indication, females are greater consumers

of dental service products than are males.


Consumption Patterns, by Region

Table 10 revealed that there are variations in the annual average

number of dental visits according to region as well as by sex. The

South is the region with the lowest average number of visits per per-

son per year--l.O. The Northeast has the highest annual per capita

average with 2.1 visits per person.

This regional variation in the consumption of dental services is

reflected in the time interval since the last dental visit as presented

in Table 12. The Northeast exhibits generally a greater concern for

dental care than does any other region. The South is particularly low

in dental care consumption with 25 per cent of its people having never

gone to the dentist. This is twice the percentage for this same group







50

in the Northeast. Over 57 per cent of the people in the Northeast have

visited a dentist within the past year compared to 53 per cent in the

West, 52 per cent in the North Central region, and about 43 per cent

in the South.


TABLE 12

TIME INTERVAL SINCE LAST DENTAL VISIT, PER
CENT DISTRIBUTION BY REGION


REGION
TIME INTERVAL NORTH- NORTH SOUTH WEST ALL
EAST CENTRAL


Less than 6 months 27.2 23.6 18.0 23.9 22.8
6 11 months 15.7 14.4 11.2 14.8 13.8
1 year 14.2 14.4 13.4 14.3 14.0
2 4 years 14.0 14.4 14.4 14.6 14.3
5 years or over 13.9 15.3 15.2 12.6 14.6
Never 12.6 15.5 25.1 17.7 18.1
Unknown 2.5 2.2 2.7 2.1 2.4


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits. United States, July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 16.


The frequency or number of annual visits to the dentist Is shown

by region in Table 13. For the nation as a whole, 59.7 per cent of the

people make no visits to the dentist in a year. But note that the

South is the only region that exceeds this percentage while the other

three regions are below the national average. For multiple visits,

the Northeast leads the nation with over 30 per cent of its population

making two or more visits annually to the dentist followed by the West

with 26 per cent, the North Central with about 24 per cent, and the

South with only 17.8 per cent. There does appear to be definite








51

regional difference in the consumption of dental services with the

Northeast being the area of greatest per capita consumption while the

South has the lowest level of consumption.


TABLE 13

FREQUENCY OF DENTAL VISITS, PER CENT DISTRIBUTION
BY REGION


FREQUENCY REGION
DURING YEAR NORTH- NORTH SOUTH WEST ALL
EAST CENTRAL

0 visits 54.0 58.7 66.8 56.6 59.7
1 visit 15.0 17.1 14.7 16.6 15.8
2 visits 11.6 11.1 8.7 11.4 10.6
3 visits 4.8 4.0 3.1 4.5 4.0
4 or more 14.0 8.5 6.0 10.2 9.4
Unknown 0.6 0.6 0.8 0.6 0.7


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States. July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 29.


Consumption Patterns, by Residence

The fact that the South has traditionally had a large rural popu-

lation may be a partial explanation for the relatively low consumption

of dental services in that region. To examine this possibility,

Tables 14 and 15 present data on the consumption of dental services

by residence. Table 14 reveals that 24.9 per cent of the rural farm

population have never been to a dentist. This is very close to the

25.1 per cent for the South that have never visited a dentist as re-

ported in Table 12. Over 24 per cent of the urban population have

been to the dentist within the past 6 months while only 17.2 per cent

of the rural farm population are in this group. Fifty-three per cent







52

of the urban residents have visited the dentist within the past year

while less than 41 per cent of the farm population have visited a

dentist during this same time.


TABLE 14

TDME INTERVAL SINCE LAST DENTAL VISIT, PER CENT
DISTRIBUTION BY RESIDENCE


TIME INTERVAL RESIDENCE
URBAN RURAL NONFARM RURAL FARM ALL


Less than 6 months 24.4 21.7 17.2 22.8
6 11 months 14.3 14.0 10.2 13.8
1 year 14.3 13.9 13.3 14.0
2 4 years 14.3 14.0 15.0 14.3
5 years and over 14.4 13.8 16.9 14.6
Never 15.7 20.2 24.9 18.1
Unknown 2.4 2.3 2.4 2.4


Source: U. S. National Health Survey, Dental Cars: Interval and
Frequency of Visits, United States, July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), P. 14.


Table 15 shows that both the rural nonfarm and the rural farm

populations exceed the national average for the per cent that have

made no visits to the dentist during the past year. Also, over 26 per

cent of the urban residents have made two or more visits to their

dentist within the past year while the percentages for the rural

residents are several points lower for this frequency. People in

urban communities definitely have a higher consumption of dental

services than do residents in rural communities.







53

TABLE 15

FREQUENCY OF DENTAL VISITS, PER CENT
DISTRIBUTION BY RESIDENCE


FREQUENCY RESIDENCE
DURING YEAR URBAN RURAL NONFARM RURAL FARM ALL


0 visits 57.7 60.8 67.4 59.7
1 visit 15.5 16.4 15.3 15.8
2 visits 11.0 10.4 8.5 10.6
3 visits 4.2 3.9 3.1 4.0
4 or more 10.9 7.9 5.0 9.4
Unknown 0.7 0.6 0.6 0.7


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States, July 1957-June' 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 27.


Consumption Patterns, by Family Income

Another important determinent in the demand for dental services

is income (Table 16). For the time interval of less than six months

since the last dental visit, the percentages increase steadily with

each rise in income. Almost 35 per cent of those living in families

with an annual income of $7,000 or more have visited their dentist

within the past six months, but for families with under $2,000 of

income the figure is not quite 12 per cent. Also, nearly one-fourth

of those with incomes of under $2,000 have never visited a dentist

while only 10 per cent with incomes of at least $7,000 have never

received dental care.

People with higher family incomes are also likely to visit their

dentist more frequently during the year than is the case for lower

income families (Table 17). More than 78 per cent of the families

with annual incomes under $2,000 report that their members have made









TABLE 16

TIME INTERVAL SINCE LAST DENTAL VISIT, PER CENT
DISTRIBUTION BY FAMILY INCOME


TIME FAMILY INCOME
INTERVAL UNDER $20000- $4,000- $7,000 INCOME ALL
$2,000 3,999 6,999 & OVER UNKNOWN


Less than 6 months 11.7 16.8 24.5 34.7 21.4 22.8
6 11 months 7.3 11.3 15.5 18.9 11.1 13.8
1 year 10.7 14.3 15.1 14.6 12.9 14.0
2 4 years 15.6 16.2 14.3 11.5 14.4 14.3
5 years or over 27.6 16.5 11.0 8.8 16.5 14.6
Never 24.0 22.5 18.0 10.0 15.3 18.1
Unknown 3.2 2.3 1.6 1.6 8.5 2.4


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States, July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 19.


TABLE 17

FREQUENCY OF DENTAL VISITS, PER CENT
DISTRIBUTION BY FAMILY INCOME


FREQUENCY FAMILY INCOME
DURING UNDER $2,000- $4,000- $7,000 INCOME ALL
YEAR $2,000 3,999 6,999 & OVER UNKNOWN


0 visits 78.3 68.9 56.5 42.2 62.4 59.7
1 visit 10.5 13.9 16.9 19.7 14.4 15.8
2 visits 4.6 7.2 11.3 17.1 9.1 10.6
3 visits 2.1 3.0 4.5 5.8 2.9 4.0
4 or more 3.8 6.5 10.4 14.6 8.4 9.4
Unknown 0.7 0.5 0.4 0.5 2.8 0.7


Source: U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits. United States. July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 32.








55

no visits within the past year while the corresponding figure for

families with incomes of $7,000 or more is 42.2 per cent. It is

significant to note that only 24 per cent of the total population see

their dentist at least twice a year which is the traditional sug-

gestion of the dental profession. The importance of income on frequency

of consumption of dental care is easily seen by observing the steady

increase in the percentages as incomes rise for those making one, two,

three, or four or more dental visits during the year. For example,

the proportion of people in families of under $2,000 in income making

three visits a year to the dentist is only 2.1 per cent; this figure

rises to 3.0 per cent and 4.5 per cent for the next two higher income

groups respectively and reaches a high of nearly 6 per cent for

families with incomes of $7,000 or more.

Family income affects the consumption of dental services of

every member of the family, regardless of age. This fact is demon-

strated in Table 18 which shows the annual average number of dental

visits by family income and age groups. Table 18 shows, as did

Table 11, that the national average is 1.5 visits per person per year.

But there is considerable variation around the mean. Young people

between the ages of 18 and 24 whose families have incomes of at least

$7,000 annually see their dentist an average of 3.3 times a year--

the highest average shown in the table. On the other hand, many age

and income groups average less than one dental visit each year. The

conclusion seems clear: The consumption of dental services varies

directly with income.








56

TABLE 18

NUMBER OF DE1TAL VISITS PER PERSON PER YEAR
BY AGE AND FAMILY INCO14E


FAMILY INOME
AGE GROUP UNDER $2000- $4,000- $7,000 IICM ALL
$2,000 3,999 6,999 & OVER UKNOKMW


0 4 0.0 0.2 0.3 0.5 0.2 0.3
5 14 0.7 0.9 1.9 3.1 1.6 1.8
15 24 1.2 1.7 2.3 3.3 2.4 2.2
25 44 0.8 1.2 1.8 2.5 1.5 1.8
45 64 0.8 1.1 1.6 2.4 1.1 1.5
65 and over 0.5 0.9 1.0 1.1 1.0 0.8
All ages 0.7 1.0 1.6 2.5 1.4 1.5


Source: U. S. National Health Survey, .Dental Carl Volume of
Visits, United States. July 1957-June 1959, Health Statistics Series
B, No. 15 (Washington: U. S. Government Printing Office, 1960), p. 17.

Consumtion Patterns1 by Ate Groups


An examination of Table 18 will reveal that the consumption of

dental services also varies among the different age groups. The age

group with the lowest average number of annual visits to the dentist

are children four and under with an average of 0.3. The greatest con-

sumption is by young people 15 through 24 years of age with over two

visits as their national average. Note also that this age group is

consistently the one of greatest consumption of dental care, regard-

less of income.

The high level of consumption by the 15 to 24 year olds is

clearly evident in Table 19 which shovs that nearly 31 per cent of

this group have been to their dentist within the past six months.

This is the highest percentage for any age group during that particular

time interval. For all patients having gone to the dentist during the








57

TABLE 19

TIME INTERVAL SINCE LAST DENTAL VISIT, PER CENT
DISTRIBUTION BY AGE GROUP


TINE INTERVAL AGE GROUP
0-4 5-14 15-24 25-44 45-64 65+ ALL


Less than 6 months 5.9 30.7 30.9 26.2 20.4 10.6 22.8
6 11 months 2.5 17.4 18.3 17.9 11.9 5.6 13.8
1 year 1.7 14.8 18.9 19.0 13.5 7.7 14.0
2 4 years 0.3 7.6 16.1 19.8 19.9 15.4 14.3
5 years and over 1.1 4.2 12.1 29.4 52.2 14.6
Never 89.1 27.6 9.0 2.5 1.7 2.4 18.1
Unknown 0.5 0.8 2.6 2.5 3.2 6.1 2.4


Sources U. S. National Health Survey, Dental Care: Interval and
Frequency of Visits, United States. July 1957-June 1959, Health
Statistics Series B, No. 14 (Washington: U. S. Government Printing
Office, 1960), p. 16.


past year, the 15 to 24 group is again ahead with 68.1 per cent fol-

lowed by the 25 to 44 year olds with 63.1 per cent and reaching a low

of 10.1 per cent for children four and under. There is also some

tendency for time intervals to increase with age. For example,

patients who have not been to a dentist in five or more years account

for just over 1 per cent of the 5 to 14 age group but this percentage

increases steadily with age reaching a high of 52.2 per cent for

people 65 and older.

The high consumption of dental services by young people is re-

flected in their frequency of dental visits as shown in Table 20.

People 15 to 24 years of age have the highest percentage of those going

to the dentist four or more times during the year. The figure for this

group is 15 per cent while the age groups just under and just over the

15 to 24 group have over 11 per cent of their members with a frequency








58

TABLE 20

F.UQUUC OF DENTAL VISITS, 0PE CENT
D TREWTION BY MGE GAOUP


DURIN ZAR 0-4 5-14 15-24 33-44 45-64 63+ ALL


0 visits 90.7 47.8 46.7 51.5 63.5 81.2 59.7
1 visit 5.6 20.1 19.0 18.9 14.4 7.9 13.8
2 visits 1.7 14.7 12.7 12.6 9.9 4.6 10.6
3 visits 0.5 5.4 5.3 5.1 3.4 1.8 4.0
4 or more 1.0 11.6 15.0 11.3 8.1 4.0 9.4
Unknown 0.5 0.4 1.2 0.6 0.7 0.6 0.7


Source: U. S. National Health Survey, SI-- In -lsaw
Frgaeuscy of Vistt. UnItId Sts. tJuly it -Ju7 19590 Hlth
Statistics Sert B, No. 14 (Washington: U. S. oven t Printing
Office, 1960), p. 25.


of 4 or more visits per year. The youngest and the oldet age groups

have relatively low levels of consumption. Almost 91 par cent of

children four and under and 81.2 per cent of adults 65 and older make

no dental visits in a 12 months period. Teenagers and young adults

tend to consume greater quantities of dental care than do the very

young or the very old.


Cou Wtion by Tne of farvte

Table 18 reveled that young people consume the greatest amounts

of dental care in every level of family iscome. An indication of the

reason why this particular group consumes more dental services than do

other groups can be obtained from Table 21. This table presents a per

cent distribution of dental visits by type of service and by age.

Fillings account for 43 per cent of all dental service products sold

but they comprise 54.5 per cent of all services sold to patients 15 to








59

TABLE 21

PER CUT DISTRIBION OF DENTAL VISITS
BY TYPE OF SERVICE AND NY AGE


TYPE OF SERVICE AGE g... .
0-4 5-14 15-24 25-4 45-64 95+ ALL


Fillings 43.7 49.9 54.5 42.3 32.3 16.7 43.0
Extractions 8.2 12.2 18.5 19.4 17.3 21.9 17.0
Cleaning and
examination 30.6 18.1 11.9 19.4 18.4 15.7 17.7
Straightening 9.2 4.7 1.2 0.3 3.4
Gum treatment 0.6 0.9 2.5 1.9 1.1 1.5
Denture work 1.1 1.4 3.7 6.7 19.0 34.5 8.6
Other and unknown 22.2 12.6 8.4 13.1 13.1 12.1 12.3


Source: U. S. National Health Survey, Vojj lmo of
Visits& United Stites, July 1957-Je 1959, Health Statistics Series
B, No. 15 (Washington: U. S. Government Printing Office, 1960), p. 24.


24 years of age. Less than 17 per cent of the visits to the dentist

by patients 65 and older are for fillings.' For this group, denture

work is the main purpose accounting for 34.5 per cent of the visits.

For all groups, extractions are the purpose for 17 per cent of the

visits and after age 15 the percentage of visits for this reason

clusters around this figure. Fillings are the reason for more dental

visits than any other reason, and for people in their teen's and

early twenties their percentage of visits for this purpose exceeds the

national average. The percentage of visits for denture work, however,

increases significantly after a person reaches the age of 45. The

types of dental care needed does appear to change over the period of

the life cycle and this factor in turn influences the quantity of

dental services which a person will buy during a particular age.








60

SubjSet1ve Deteru4WIt ofL OuPR ti

The market for dental services is an original dmnd in that a

need arises because of disease. But as already demonstrated in the

preceding pages, there is a considerable gap between actual need and

market demand. Relatively low family incomes are at least a partial

explanation of this wide difference between need and demand. But

was pointed out in the discussion of Table 16, as many as 10 per cent

of the people with families with annual incomes of $7,000 or sore have

never visited a dentist.

Low family incomes or high dental costs are not the only de-

terrents to greater consumption of dental care. A study of the St.

Louis Labor Health Institute was made by the Public Health Service.

The dental clinic of the Labor Health Institute provides dental service

without charge (except for orthodontics and a small charge for dentures)

for embers of the Teamsters Union and their families. During the

study year only 41 per cent of the families used the clinics. Among

individual members of these families, the utilization rate was even

lower, only 27 per cent. In New York City, 12 per cent of a group of

parents remained unconvinced of the necessity of taking their children

to the dentist even after considerable urging by teachers and despite

the availability of free clinics.15

Such findings lead Dr. Hollinshead to remark:

It is obvious that the attitudes and values of each individual
and his knowledge about dental health partly determine whether
he purchases dental care for himself and his family in prefer-
ence to the goods and other services which compete for his

15Ibid., p. 24.








61

attention and money. These factors have a direct
relationship to the demand for dental servics.16

Why is it that people do not go to the dentist more often?

Table 22 provides some of the answers to this question. It is


TABUE 22

REASONS GIVD BY RESPONDENTS FOR NOT GOING TO
THE DENTIST, IN PRRCZAMIS


REASONS FOR NOT GOING
PER CENT


Have false teeth, dentures, plates ... ............ ...29
Do not have any teeth ........... ........... 7
Teoth are so bad. not worthwhile to go ... .......... 4
Teeth are all right, no trouble, no need to go ... ...... 27
Negligence, laziness, keep putting it off .. ........ 16
Cannot afford it, cost too much, do not like
to spend the money .............. ..... 14
Do not like to go, afraid of dentists, hurts too
Much ............. ... ............... 9
Too busy'to go, do'not'have ti e'to spare ... ..... 6
Do not know any good dentist, dentist too far away . . 3
Miscellaneous reasons, too old, too sick, do not know . 4


Source: The Comission on the Survey of Dentistry in the United
States, Byron S. Hollinshead, Director, The Sug=e of Dentistry
(Washington: American Council on Education, 1961), p. 27.


interesting to note that, in spite of the relationship between income

and consumption of dental services, financial reasons were mentioned

only 14 per cent of the time by respondents. A larger proportion, 27

per cent, performed their own diagnosis and concluded that they had no

reason to go. What is even more striking is the fact that the largest

proportion, 29 per cent, do not go to the dentist more frequently

16Ibid., p. 24.








62

because of their present condition which is the result of past

neglect. These people feel no need for more frequent visit because

they have false teeth, dentures, or plates. Another 7 per cent are

in a similar position; they do not go because they have no teeth at

all.

Turning now to Table 23 we consider some of the reasons people

give for not obtaining needed dental care even when such need is re-

cognized. Financial reasons are more common here than in Table 22


TABLE 23

REASONS WHY RESPONDENTS DID NOT OBTAIN NEEDED
DENTAL CARE, IN PERCENTAGES


REASONS FOR NOT OBTAINING PER CElT NOT
OBTAINING CARE


Cannot afford it, cost too much,
do not like to spend the money ..... .............. .34
Negligence, laziness, keep putting it off ............. .33
Spouse does not believe ing oing ....... .............. 5
Did not think condition was serious.. ..... ............ 6
Do not like to go, afraid to go, hurts too much ........ ..21
Too busy to go, did not have time to spare .... .......... 12
Did not know a good dentist, hard to get appointment ........ 7
Miscellaneous, too old, too sick, do not know .......... ..10


Source: The Commission on the Survey of Dentistry in the United
States, Byron S. Hollinshead, Director, The Survey of Dentistry
(Washington: American Council on Education, 1961), p. 28.


but they still account for only 34 per cent of the people. Almost as

important is simple procrastination; negligence, laziness, or keep

putting it off were reasons mentioned by 33 per cent. Another 21 per

cent just do not like to go to the dentist.

There does not appear to be any one overriding reason why people







63

do not go to a dentist more often or why people do not obtain needed

dental care. Financial reasons are mentioned frequently, but general

indifference, or ignorance seem to be more significant. Many people

apparently do not have a feeling of urgency or importance regarding

their dental health. It seem probable that promotional effort

directed at educating the public as to the importance of dental

health could increase the demand for dental services. Such educa-

tional activities of dentists will be a subject of study included in

Chapter V.


Dental Patienj Turnover

Up to this point in the discussion of the market for dental

services, attention has been directed mainly at the national situation.

For the remainder of this chapter some particular characteristics of

Florida dental patients will be presented. We will begin by examining

the problem of patient turnover using the data presented in Table 24.

From the table it appears that Florida dentists can generally

expect to lose about half of their present patients within the next

five years. In fact, nearly 25 per cent of all respondents stated

that they had been going to their present dentist for only two years.

The 18 to 24 age group deserves comment. This group apparently

changes dentists more frequently than does any other group. This is,

no doubt, at least partly the result of new family formations and the

establishing of new homes. Fifty per cent of this group change den-

tists within a three year period. With the exception of the youngest

age group, the proportion of Florida patients changing dentists within

five years declines with each older age group. Even so, the percentage










of patients over fifty years of age who change dentists within five

years is 43 per cent.


TABLE 24

NUMBER OF YEARS FLORIDA PATIENTS HAVE BEE GOING
TO THEIR PRESENT DENTIST, IN PZEIRCAGES


NUMBER OF YEARS AGE GROUP
0-17 18-24 25-50 OVER 50 ALL


1 23 21 14 13 14
2 9 21 10 9 10
3 9 10 7 6 7
4 5 5 7 6 6
5 9 3 9 9 9

Totals 55 60 47 43 46


Source: F. Goodwin, R. Stanley, and M. F. Dimbath, Survey of
Dental Patients' Attitudes (Gainesville: Florida Surveys, 1963), p. 25.


At the other extreme, there is a noticeable lack of patients who

continue with the same dentist for a long length of time. The Survey

of Dental Patients' Attitudes found that only 11 per cent of all
17
patients had been going to the same dentist for over 10 years.

Since about half of all dental patients will be selecting a different

dentist within the next five years, it is appropriate at this point to

examine how a patient selects a dentist.


Patronage Mot iv

Patronage motives may be defined as "motives which determine Just

17F. Goodwin, R. Stanley, and M. F. Dimbath, SgUe f Dnal
Patients' Attitudes (Gainesville: Florida Surveys, 1963), p. 26.








65

where or from whom purchases will be made . . Appeals to these

do not tend so much to arouse a desire for an article as to persuade

the customer to buy from one of several possible sources..18 Table 25

on the next page presents data on the patronage motives of Florida

dental patients.

A reputation for good dental work was given by 70 per cent of

all respondents as a reason why they selected their present dentist;

28 per cent gave this as their main reason. Almost as important is

the recwmendation by someone else. Again nearly 70 per cent indicated

this as a reason with 24 per cent stating this as their main reason.

These two reasons appear to be the principle patronage motive, in the

purchase of dental care in Florida.

While no other reason was selected by any significant proportion

as being a main motive or reason, there are other reasons that are at

least contributing factors in the selection process. For example,

33 per cent report that a convenient location was a motivation for

going to their present dentist. The ability to get an appointment

without waiting too long is a patronage motivation indicated by 16 per

cent of patient respondents. An emergency appointment, while indi-

cated as a reason by only 14 per cent, is a main reason for 2 per

cent.

The attitude survey also uncovered some significant differences

within the classifications of sex and age.19 Women tend to rate an

18Theodore N. Beciman, Hearold R. Maynard, and William R. Davidson.
Principles of NarketMnl, 6th ed. (New York: The Ronald Press Company,
1957), p. 70.
19F. Goodwin, R. Stanley, and K. F. Diubath, 09. C~t.0 p. 30.








66

TABLE 25

REASONS WH FLORIDA PATIENTS SEL E THEIR
PRESENT DENTIST, IN _ECENTAGES


REASONS FOR SELECTING INDICATED AS INDICATED AS
PRESENT DENIST A IMSO MAIN REASON


Reputation for good work 70 28
Recommended by someone 69 24
Convenient location 33 3
Appointment without long wait 16 0
Adequate parking 15 0
Attractive office 14 0
Emergency appointment 14 2
Reputation for reasonable fees 14 1
Reputation for little pain 12 0
Belonged to sae organization 6 1
Liked his wife 2 0
Yellow pages of telephone directory 2 0
Other reasons 10 2
No main reason 39


Source: F. Goodwin, R. Stanley, and M. F. Dimibth, o
Dental Patients' Attitude* (Gainesville: Florida Surveys, 1963), p. 28.


attractive office, convenient location, and a reputation for causing

little pain as more important in patronage considerations than do men.

men, more so than women, reported that membership in the seins orgai-

zation was a reason for selecting their present dentist, and to a

lesser degree reasonable fees, adequate parking space, and mergency

appointments. The recomendation of others is more important for

patients under 25 than for older patients. The age group 18 to 24,

which no doubt represents many young married couples, are exceptionally

concerned with a reputation for reasonable fees. Also, this age group

more than any other selected their dentist by looking in the yellow

pages of the telephone directory. But even for this group this method








67

accounts for only 4 per cent of the reasons given. Patients under 25

are definitely more worried about pain than are the older patients,

and younger patients are more likely to follow the recommdations of

relatives than is the case for older patients.


Neative Patronage &otim

It was pointed out previously that about one-half of all Florida

dental patients within the next five years will leave their present

dentist in search for a new one. Having examined in sae detail the

various positive motives that influence the selection of a dentist, it

is appropriate at this point to explore the different reasons why

patients find it desirable to change dentists.

Table 26 provides a good indication as to the high degree of

population mobility in Florida. Forty per cent of all respondents in

the Survey of Dental Patients' AttigjMs stated that one reason they

had changed dentists was that the patients themselves had moved. So

other single reason was indicated as being so important. Note also

that for 35 per cent moving to a different address was their main rea-

son for changing dentists. This fact reveals that for most of the

patients changing dentists because of moving, their new address is too

distant from their former address to permit continued patronage at the

same dentist.

But mobility is not confined to patients alone. Another 10 per

cent reported that they were forced to seek out a new seller of

dentistry because the dentist that they had been patronizing either

moved, died, or retired. When this situation occurred, it was indeed

a significant influence as indicated by the fact that for 8 per cent








68

TABLE 26

REASONS WY FWRIDA PATIENTS LEFT THEIR LAST
DfRTIST, IN linaru S


REASO FOR LEAVING INDICATED AS IDICATD AS
A REASON MAIN REASON


Patient moved 40 35
Fees too high 15 8
Careless or unsatisfactory work 14 6
Dentist moved, died, or retired 10 8
Inconvenient location 9 2
Patient did not personally like dentist 6 1
Patient was kept waiting too long 6 1
Too hard to get an appointment 5 1
Dental equipment was old 4 0
Not enough parking space 4 0
Dentist worked too rapidly or too slowly 3 0
Office was uncomfortable or unattractive 2 0
Other reasons Il 4
No main reason 34


Source: F. Goodwin, R. Stanley, and M. F. Dimbath, Survey of
Dental Patients' Attitudes (Gainesville: Florida Surveys, 1963), p. 40.


this was their main motive for changing dentists. Thus, for 43 per

cent of all respondents, the main reason why they changed dentists was

due to factors other than unsatisfactory buyer-seller relationships.

While the above causes of losing patients are beyond the control of

the dentist, it is clear that every seller of dental care wast be

alert to the possibilities of adding new patients to compensate for

losing other patients. In Chapter V, we will examine the efforts of

dentists in Florida to strengthen their competitive position.

The remaining discussion of Table 27 can be treated from the

point of view of the marketing mix by using the classifications of

product, price, place, promotion, and period. The element of place








69

has already been examined under our discussion of dentist and patient

mobility. In addition, however, it should be noted that for 9 per

cent of the respondents an inconvenient location was a reason they

left their last dentist and for 2 per cent this was the main factor.

When this finding is coupled with the fact that a convenient location

was a reason that 33 per cent selected their present dentist (as

revealed in Table 25) it is clear that the elnut of place is im-

portant in the dental marketing mix.

Since dental care is a specialty good, quality of rork is

exceptionally important. Fourteen per cent indicated that "careless

or unsatisfactory work" was a reason why they left their last deatist

and 6 per cent said this was their main reason. And in the selection

process, a reputation for good work was shown in Table 25 to be the

most important factor with 70 per cent indicating this as a reason.

Other reasons in Table 26 that pertain to product quality are old

dental equipment which is a reason for leaving a dentist for 4 per

cent of the patients and the comlaint that the dentist worked either

too rapidly or too slowly which was mentioned by 3 per cent of re-

spondents. In Table 25, the qualitative factor of "reputation for

little pain" was shown to be a patronage motive for 12 per cent.

The pricing policies of Florida dentists will be exmined in

Chapter V, but at this point it is interesting to note that high fees.

are the most cmmon non-obility reason why patients left their last

dentist. Fifteen per cent of respondents indicated this as a resomn

and 8 per cent said it was their main reason. Also, 14 per cent oma-

sidered a reputation for reasonable fees in the selection of their










present dentist (Table 25).

Patients' attitudes about dental fees apparently change somewhat

over a period of a life time. Table 27 show that the proportion of

patients who feel that fees are much too high increases from 17 per


TABLE 27

H)W FLORIDA PATIENTS FEEL ABOUT DEETAL FEU,
IN PER ENTAGES BY AGE GROUP


OPINION AGES
0-17 18-24 25-30 OVX 50 ALL


Reasonable 25 22 21 13 21
A little too high 52 53 47 42 46
Much too high 17 16 22 31 25
Unpredictable 9 10 9 6 8


Source: F. Goodwin, R. Stanley, and M. F. Dimbath, Srvey of
Dental Patiepts' Attitudes (Gainesville: Florida Surveys, 1963), p. 35.


cent for the youngest age group to a high 31 per cent for the oldest

age group. For all patients, 71 per cent think that the price of

dental care is either a little too high or much too high. Fewer than

one out of every four believes that dental fees are reasonable. In

personal interviews among Florida patients the question of fees often

aroused strong negative expressions from respondents. The element of

pricing in the marketing mix is a major problem for sellers of dental

services just as it is for sellers of other products.

The element of time or period is an influence in the market for

dental care. Table 26 shows that 6 per cent of respondents left their

last dentist at least partly because they were kept waiting too long

for an appointment. Another 5 per cent left their last dentist, at










least in part, because it was too hard for them to get an appointment.

On the other hand, in Table 25 we see that the ability to get an

emergency appointment was a reason 14 per cent of respondents selected

their present dentist and an appointment without waiting too long was

a reason 16 per cent selected their present dentist. It will be shown

in latter chapters that Florida dentists definitely use an appoint-

ment strategy in their marketing mix.

The element of promotion has already been mentioned in an edu-

cation sense on page 63. However, other aspects of promotion are im-

portant marketing considerations for dentists even though this ele-

ment is limited by dental ethics. For example, in Table 26 we see

that 6 per cent of respondents left their last dentist because of

personality problems. This may very well reflect a weakness of per-

sonal salesmanship on the part of the seller of dental care. The per-

sonal salesmanship factor is also revealed in the selection of a

dentist. In Table 25 we see that 6 per cent of respondents selected

their dentist because he belonged to the same organization. Another

2 per cent saw the dentist listed in the telephone directory. At the

risk of combining the elements of place and promotion, it could be

said that such things as an attractive office, adequate parking space,

and convenient location have promotional qualities. Thus, educational

and noneducational promotion are considerations in the marketing of

dental services.

The various determinants of demand for dental care and the dif-

ferences in patronage motives among patients make the market for dental

services very complex. The marketing strategies which Florida dentists

employ to capture a share of this multi-million dollar market will be

the subject of the next two chapters.














CHAPTER IV


MARKET SEGMENTATION

Introduction

The first major step in the development of a marketing strategy

consists of defining the market targets which will serve as the mar-

ket objectives of the firm (see page 25). This step involves the

segmentation of the total market into relatively homogeneous parts

according to desired consumer characteristics. This chapter will

therefore be concerned with the market segmentation activities of

Florida dentists.

The characteristics of the consumers of dental care, which were

examined in Chapter III, provides important background material for

the study of dental marketing strategy because such characteristics

influence the composition of market segments and the marketing mixes

needed to effectively cater to the selected market targets. And there

is some indication that these consumer characteristics do influence

the marketing segmentation decisions of Florida dentists. For

example, it was revealed in the last chapter that urban residents are

greater consumers of dental care than are rural residents. In con-

nection with this it is interesting to note that in 1960, 74 per cent

of the population of Florida were urban residents while 92 per cent

of the dentists in the state lived in urban areas.

Other consumer types that were noted to be relatively high con-

sumers of dental care were females, young people age 15 through 24,

72








73

and people coming from families with annual incomes of $7,000 or more.

Table 28 presents the composition of Florida's Standard Metropolitan

Statistical Areas according to these three characteristics and the


TABLE 28

THE DISTRIBUTION OF FLORIDA POPULATION AND DWTISTS
AHNG THE SEVEN STANDARD METPOLITAN STATISTICAL
AREAS AND SELECTED POPULATION CHARACTERISTICS
IN EACH AREA, IN PERCENTAGES


PER CENT OF STATE PER ClT OF SMSA
POPULA- DEN- POPULATION POPULATION FAMILES
SMSA TION TISTS COMPOSED 15-24 WITR
OF YEARS OF $7,000
FEMALES AGE INCOME


Miami 18.9 27.9 51.1 11.7 8.5
Tampa-
St. Petersburg 15.6 18.1 51.8 10.9 6.6
Jacksonville 9.2 7.1 50.9 14.5 7.7
Fort Lauderdale-
Hollywood 6.7 8.7 51.4 10.8 8.0
Orlando 6.4 7.1 50.6 13.4 7.8
West Palm Beach 4.6 6.6 50.7 11.4 na
Pensacola 4.1 0.8 49.9 17.0 na

Florida 100.0 100.0 50.8 12.9 6.9


LEGEND: na Not available

Source: U. S. Department of Commerce, Bureau of the Census, U.
S. Census of Population 1960, Florida Detailed Chargctsristics,
(Washington: U. S. Government Printing Office, 1960).


proportion of the state's population and dentists which reside in these

areas. Note that no one of the three characteristics appear to be a

major determinant in the distribution of dentists. For example, Miami

contains 28 per cent of the dentists as opposed to 19 per cent of the

total population while the proportion of the families in Miami with








74

incomes of $7,000 or more is above the state average and the pro-

portion of young people age 15 to 24 is below the state average.

Jacksonville, on the other hand, contains a lower proportion of

total dentists than it does of population although 14.5 per cent of

its population is 15 to 24 years of age compared to 12.9 per cent

for the state and nearly 8 per cent of its families have incomes of

$7,000 or more on an annual basis. From the information contained

in Table 28, it seems clear that dentists locate in market areas for

reasons not exclusively determined on objective considerations of con-

sumer characteristics. In the pages ahead, the various factors which

influence the market segmentation decisions of Florida dentists will

be examined.


Geographical Segmentation

The spatial distribution of Florida dentists represents the

initial marketing decision that most dentists make. Nhen a dentist

decides to locate in some particular conamity he is also broadly

defining his geographical market target. It is difficult to separate

the geographical aspect of market segmentation from the element of

place in the marketing mix since both concern location. In this sec-

tion, attention will be directed primarily at the factors which

appear to influence the spatial distribution of Florida dentists and

the competitive results of this distribution. A detailed analysis of

the influences and competitive results of dental office location will

be saved for Chapter V.

Like other sellers of goods and services, dentists locate their

retail outlets where potential customers are. If the maximization of










money income was the sole motive influencing the geographical segmen-

tation decisions of Florida dentists a high correlation between the

distributions of population, income, and dentists would be expected.

A review of Table 29 will show that there is a tendency for dentists

to scatter according to the distribution of population and income.


TABLE 29

PERCENTAGE DISTRIBUTION OF TOTAL POPULATION,
PERSONAL INCOME, AND DENTISTS AMDNG
SELECTED FLORIDA COUNTIES


COUNTY PERCENTAGE DISTRI3UTION
POPULATION PERSONAL INC .E DETISTS


Dade 19.1 22.4 24.2
Duval 9.0 10.7 6.5
Hillborough 7.7 7.7 6.0
Pinellas 7.5 7.1 10.8
Broward 7.0 6.2 10.3
Orange 5.3 6.5 6.1
Palm Beach 4.7 5.2 6.0
Polk 3.8 4.2 2.8
Escambia 3.4 3.3 2.0
Brevard 2.6 2.7 1.6
Volusia 2.5 2.2 2.9


Source: John N. Webb and Madelyn L. Kafoglis, "Population and
Employment: Changes and Prospects," Statistics of Personal Income,
Population, Employment and Construction for Florida Counties, State
Economic Studies No. 15 (Gainesville: Bureau of Economic and Busi-
ness Research, University of Florida, May 1963); American Dental As-
sociation, Bureau of Economic Research and Statistics, Distribution
of Dentists in the United States, by States, Region, District and
County (Chicago: American Dental Association, 1963).


Dade County, for example, has 19.1 per cent of Florida's population,

22.4 per cent of its personal income, and 24.2 per cent of Florida

dentists. Dade County has more population, personal income, and


dentists than any other Florida county.











But the fact that Dade County ranks number one in all three

groups does not mean that dentists segment their markets strictly

according to population and income. In Table 29 the counties are

presented in order of their population rank and a glance down the

columns will reveal that there are several variations in the per-

centages of population, income, and dentists. Note that Pinellas

County which ranks fourth in population and income is number two in

the distribution of dentists. Hillsborough County which is number

three in income and population rank, and Palm Beach County which

ranks seventh on both population and income, both contain 6 per cent

of Florida's dentists.

These relationships can be explained partially by the nature of

the data for dentists. The percentage distribution for dentists is

computed on the basis of all dentists living in the county. This

includes retired dentists which may account for the relatively high

proportions contained in such counties as Pinellas and Palm Beach.

But this does not account entirely for the differences in population,

income, and dentists distribution. Table 30 presents the same

counties ranked according to per capita personal income with the

corresponding population per dentists figure for each county. It is

important to keep in mind that a relatively high population per den-

tist figure indicates a relatively low proportion of dentists. The

significance of this fact is that in counties with high per capita

incomes one would expect to find a relatively low population per

dentist ratio.

Table 30 shows that Orange County in 1962 had the highest per

capita personal income but that Broward County had the lowest








77

TABLE 30

PER CAPITA PERSONAL INCOME AND POPULATION PER
DENTISTS IN SELECTED FLORIDA COUNTIES


COUNTY PER CAPITA POPULATION PER
INCOME 1962 DENTIST 1963


Orange $2,436 1,856
Duval 2,377 2,912
Dade 2,373 1,649
Brevard 2,350 3,067
Palm Beach 2,244 1,618
Polk 2,131 2,954
Hillsborough 1,965 2,788
Escambia 1,875 3,552
Pinellas 1,867 1,492
Broward 1,753 1,398
Volusia 1,739 1,824

Florida 1,990 2,094


Source: John N. Webb and Madelyn L. Kafoglis, "Population and
Employment: Charges and Prospects," Statistics of Personal Income,
Population, Employment and Construction for Florida Counties, State
Economic Studies No. 15 (Gainesville: Bureau of Economic and Busi-
ness Research, University of Florida, May 1963); American Dental As-
sociation, Bureau of Economic Research and Statistics, Distribution
of Dentists in the United States, by States, Region. District and
County (Chicago: American Dental Association, 1963).


population per dentist ratio. Duval County, which ranks number two in

per capita personal income, has a relatively high population per den-

tist. The counties of Orange, Duval, Dade, Brevard, Palm Beach, and

Polk all have per capita incomes higher than the $1,990 for Florida,

but of these six counties only Orange, Dade, and Palm Beach have a

lower population per dentist than the 2,094 ratio for Florida.

Wylie Kilpatrick of the Bureau of Economic and Business Research

at the University of Florida did a study of the need for dentists in

Florida and some of his findings are presented in Table 31. The








78

TABLE 31

PERCENTAGE DISTRIBUTION OF POPULATION, PERSONAL
INCOME, AND DENTISTS AMDNG FLORIDA
COUNTIES GROUPED ACCORDING TO
PER CAPITA PERSONAL INCOME


PER!CAPITA NUMBER OF PER CENT OF FLORIDA
INCOME GROUP COUNTIES PO PULAT ION PERSONAL DENTISTS
INCOME


Over $2,000 11 48.0 56.6 55.8
$1,801-2,000 9 28.9 27.0 29.3
$1,601-1,800 9 8.5 7.2 7.1
$1,401-1,600 8 5.4 4.0 3.7
$1,201-1,400 10 4.7 2.9 2.3
$1,001-1,200 10 2.1 1.2 0.9
$1,000 and under 10 2.4 1.1 0.9


Source: Wylie Kilpatrick, Memorandum on Future Demand for
Dentists in Florida (Bureau of Economic and Business Research,
University of Florida, 1963), p. 30.


eleven counties in the per capita income group of over $2,000 con-

tained 48.0 per cent of the state population, 56.6 per cent of the

personal income, and 55.8 per cent of Florida dentists. At the other

extreme, the ten counties with per capita income of $1,000 or under

contained 2.4 per cent of the population, 1.1 per cent of the personal

income, and 0.9 per cent of the dentists. Table 31 confirms the

findings obtained from Tables 29 and 30: There is a relationship

between the distribution of population, personal income, and dentists

among Florida counties although the variations in the percentages sug-

gest that there are other factors at work in the spatial distribution

of Florida dentists.

What are some of these other factors influencing the market

segmentation decisions of Florida dentists? Florida dentists were










asked, "What factors did you consider in selecting the counmmity in

which you now practice?" The results of this question were divided

into three categories and tabulated by county as shown in Table 32.

Multiple answers were permitted, therefore the percentages for each

county exceeds 100.


TABLE 32

FACTORS THAT INFLUENCED THE DISTRIBUTION OF DENTISTS
IN SELECTED FLORIDA COUNTIES, IN PERCITAGES


FACTORS THAT INFLUENCED DENTISTS
COUNTY PERSONAL PROFESSIONAL ECONOMIC OR MARKET-
CONSIDERATIONS CONSIDERATIONS ING CONSIDERATIONS


Dade 65 6 39
Duval 76 8 28
Hillsborough 63 6 31
Pinellas 77 6 34
Broward 79 7 31
Orange 77 9 24
Palm Beach 79 11 42
Polk 65 8 50
Escambia 89 4 30
Brevard 48 4 69

All counties 73 6 38



Generally speaking, personal considerations are the dominant fac-

tor influencing the spatial distribution of Florida dentists. Per-

sonal considerations include such responses as "near the water,"
"good hunting and fishing," "liked the climate," "where I wanted to

live," "good place to raise a family," "my wife liked it here." In

personal interviews with 15 Florida dentists the subject of how they

decided to locate where they did was explored in depth. Dentists were

asked specifically what advice they received in dental school concern-








80

ing the location of their practices. The advice often given is:
'$go where your wife wants to go, or go where you want to live."

In light of this finding, the heavy weight given to personal con-

siderations is not surprising.

Factors of an economic or marketing nature consisted of such

replies as "good economic conditions," "favorable dentist to popu-

lation ratio,"' apidly growing population," "good location for den-

tal practice," "suggested by dental supply house." In the course of

personal interviews it was noted that younger dentists were more

likely to consider economic or marketing considerations due to more

emphasis on this subject in dental schools during recent years.

Dentists interviewed reported that dental supply houses are often

very influential in the location of new dentists although one re-

spondent reported that he has known of cases where dentists were

located across the street from each other as a result of dental

supply house advice.

Professional considerations are relatively minor in their in-

fluence on dental market segmentation. Answers of this nature in-

cluded such statements as "dentistry on a high level," "dentists of

similar interests," "professional climate," "professional opportuni-

ties." Six per cent of the 943 respondents indicated that profes-

sional considerations were an influencing factor in their decision to

locate in their present community. Among respondents in different

counties there is considerable variation with 11 per cent for Palm

Beach County and only 4 per cent for Brevard and Escambia counties.

Table 33 presents a cross tabulation between the gross income

of Florida dentists and the three factors that influenced their








81

geographical distribution. One might expect that dentists with

higher gross incomes give greater consideration to economic or

marketing factors. There is, indeed, some indication of this with

29 per cent of dentists with under $20,000 of gross income so in-

dicating, while the percentage increases steadily as income increases

and reaches a high of 42 per cent for dentists in the $50,000 gross

income range. But the percentage considering personal factors also

tends to increase as gross income rises. Apparently, dentists in the

higher income ranges give more consideration to both personal and

economic factors than do dentists in the lower income ranges.


TABLE 33

FACTORS THAT INFLUENCED THE DISTRIBUTION OF FLORIDA
DENTISTS AND THEIR 1962 GROSS INCOME,
IN PERCENTAGES


GROSS INCOME FACTORS THAT INFLUENCED DENTISTS
PERSONAL PROFESSIONAL ECONOMIC OR
MARKETING


Under $20,000 72 1 29
$20,000-29,999 77 8 35
$30,000-39,999 75 6 38
$40,000-49,999 74 8 39
$50,000-59,999 79 4 42
$60,000 and over 81 5 33
Income unknown 61 8 42

All dentists 73 6 38



There is a clearer relationship between the age of the dentists

and the factors that influenced their geographical distribution. In

Table 34 there is revealed a definite tendency for younger dentists to

give greater consideration to economics and marketing in their market








82

segmentation while older dentists place heavier emphasis on personal

considerations. This is, no doubt, a reflection of the stress which

dental schools are beginning to give to problems of dental practice

management which was mentioned previously. Younger dentists also give

more attention to professional considerations than do the older

members of the profession.


TABLE 34

THE ACE O FLORIDA DENTISTS AND THE FACTORS THAT
INFLUENCED THEIR DISTRIBUTION, IN PERCENTAGES


AGE GROUP SAMPLE FACTORS
SIZE PERSONAL PROFESSIONAL MARKETING


25 34 339 72 8 44
35 49 421 75 7 37
50 and older 145 76 1 26
Age unknown 38 63 8 32

All dentists 943 74 6 38



In light of the varying population to dentist ratios among counties

and the various factors that influenced the present spatial distribu-

tion of Florida dentists, the question of dentists' attitudes concern-

ing the relationship between the supply of and demand for dental serv-

ices may well be raised at this point. To gain some insight into

this situation, Florida dentists were asked: "Do you believe that there

is a shortage of dentists in Florida?" The response to this question

is presented in Table 35. Note that 78 per cent of all respondents

gave a negative answer to this question, while only 7 per cent re-

plied "yes." However, the proportion of dentists holding a negative

opinion to this question varies from county to county, and this








83

TABLE 35

POPULATION PER DENTIST AND ATTITUDES OF DENTISTS
CONCERNING SHORTAGE OF DENTISTS IN SELECTED
FLORIDA COUNTIES, IN PERCENTAGES


COUNTY POPULATION ATTITUDES CONCERNING SHORTAGE
PER DENTIST YES NO UNCERTAIN NO RESPONSE


Dade 1,649 7 80 11 1
Duval 2,912 9 75 14 1
Hillsborough 2,788 6 67 27 0
Pinellas 1,492 7 81 10 1
Broward 1,398 3 86 8 2
Orange 1,856 4 87 8 1
Palm Beach 1,618 8 85 8 0
Polk 2,954 15 69 11 4
Escambia 3,552 4 81 15 0
Brevard 3,067 9 69 22 0

Florida 2,094 7 78 13 1



variation corresponds to changes in the population per dentist for

each county. In Table 35 the counties of Dade, Pinellas, Broward,

Orange, and Palm Beach have lower populations per dentist than the

2,094 for the state as a whole. The dentists in these counties also

registered a higher percentage of negative responses concerning a

shortage of dentists in Florida than the 78 per cent for all Florida

dentists. Conversely, the counties of Duval, Hillsborough, Polk,

Escambia, and Brevard have higher populations per dentist than does

Florida. With the one exception of Escambia, these counties also

have a negative response concerning a shortage of dentists that is

lower than the 78 per cent for the state.

Table 36 approaches directly the question of competition among

dentists in Florida. In reply to the question "Do you consider your-

self in competition with other dentists for patients?" 29 per cent








84

TABLE 36

POPULATION PER DENTIST AND ATTITUDES CONCERNING
COMPETITION FOR PATIENTS OF FLORIDA DEiTISTS
IN SELECTED COUNTIES, IN PERCENTAGES


COUNTY POPULATION IN COMPETITION FOR PATIENTS
PER DENTIST YES NO UNCERTAIN NO RESPONSE


Dade 1,649 40 49 9 1
Duval 2,912 20 68 11 1
Hillsborough 2,788 21 69 6 4
Pinellas 1,492 21 72 6 0
Broward 1,398 34 57 9 0
Orange 1,856 33 52 13 1
Palm Beach 1,618 38 50 10 2
Polk 2,954 23 65 11 0
Escambia 3,552 33 56 11 0
Brevard 3,067 34 57 9 0

Florida 2,094 29 61 9 1



said "yes" while 61 per cent said "no." Once again, a comparison

between populations per dentist and attitudes proves interesting. The

five counties listed that have below average populations per dentist

have generally a higher percentage of dentists who consider them-

selves in competition for patients than the 29 per cent for Florida.

The one exception is Pinellas County where there is probably a rela-

tively high proportion of retired dentists which tends to depress the

population per dentist ratio. On the other hand, of the five listed

counties with above average populations per dentist, three counties

have a higher than average proportion of dentists who feel that they

are not in competition with other dentists for patients. Brevard and

Escambia counties are exceptions. Both of these counties have over

3,000 persons per dentist and yet one-third of the dentists in both

counties consider themselves in competition for patients. The nature








85

of the data may explain part of this fact. Both of these counties

have large military establishments which swell the population

figures although the dentists under consideration are civilians.

The relationship between the gross incomes of dentists and their

attitudes concerning a shortage of dentists and competition for

patients is presented in Table 37. The percentage of dentists who


TABLE 37

GROSS INCOME OF FLORIDA DENTISTS AND THEIR ATTITUDES
CONCERNING COMPETITION FOR PATIENTS AND SHORTAGE
OF DENTISTS, IN PERCENTAGES


COMPETE WITH SHORTAGE OF
GROSS INCOME OTHER DENTISTS DENTISTS IN
FOR PATIENTS FLORIDA


Under $20,000 26 6
$20,000-29,999 35 9
$30,000-39,999 32 7
$40,000-49,999 26 9
$50,000-59,999 25 10
$60,000 and over 30 6



feel that they are competing for patients declines as incomes increase

from $20,000 to $59,999. At the extremes, however, we find that only

26 per cent of the dentists with gross incomes of less than $20,000

consider themselves in competition for patients while 30 per cent of

the dentists with gross incomes of $60,000 or more share this view.

At the same time, 6 per cent of the dentists with gross incomes of

under $20,000 or greater than $60,000 feel that there is a shortage of

dentists in Florida. In view of the somewhat mixed relationship be-

tween gross incomes and attitudes concerning competition and shortage

of dentists, it appears that the population per dentist is a stronger