|Year : 2015 | Volume
| Issue : 2 | Page : 53-59
Risk-averse purchasing behavior of female dentists and innovation in dental practice
James J McGrath, Edward F Rossomando
Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Connecticut, USA
|Date of Web Publication||10-Jun-2015|
James J McGrath
11 Cannonball Road, North Haven, Connecticut - 06473
Source of Support: None, Conflict of Interest: Edward F. Rossomando has editorial involvement with Dental Hypotheses.
Introduction: The aim of this study was to see if there was any correlation between the variables of age, gender, practice location and longevity, and type of practice on the risk-taking behavior of dentists in Connecticut. Risk-taking behavior was defined as the willingness to adopt new technologies. A questionnaire was used to gather data, and a series of questions were then posed to estimate the degree to which the responding dentists would be willing to implement the technology into their practices. Materials and Methods: Three hundred Connecticut dentists were randomly selected from a list of dentists that was provided by Benco Dental Supply Company. A questionnaire was written and mailed to all 300 dentists with a return envelope inside. One hundred twenty-nine dentists responded. The questionnaire contained questions to gather demographic information about the respondents. It posed a hypothetical situation that described a new imaging technology that was recently brought into the market. The only differences between this technology and current imaging machines were that it did not emit any radiation, and it was twice as expensive as comparable imaging technologies. A risk score was calculated based on the responses to the three main questions. Those who would adopt the technology quickly or immediately received higher risk scores, and those who would wait or would not buy the technology at all received low risk scores. The data were then analyzed with SPSS software to detect if there were statistically significant differences between different groups of dentists. Results: Male dentists were found to have higher risk scores than their female counterparts. Men in the 30-39-years age range had the highest risk scores, while women in this age range had the lowest. As age increased, the difference between the sexes decreased. Specialists were found to have higher risk scores compared to general dentists of the same gender; however, male general dentists still had higher risk scores than female specialists and general practitioners. Risk score also correlated with population density. As the population density of the practice location increased, so did the average risk score of the responding dentist. Conclusions: The results of this study provide evidence that there is a potential correlation of age, gender, practice location, and type of practice with the risk propensity of the responding dentist. There was less of a relationship found between practice longevity and risk score. Unfortunately, the sample size was too small to provide statistically significant correlations. Further research would be needed to explore these potential relationships, by surveying a larger population.
Keywords: Age, dental innovation, gender, innovation, location, new technology, population density, risk, technology
|How to cite this article:|
McGrath JJ, Rossomando EF. Risk-averse purchasing behavior of female dentists and innovation in dental practice. Dent Hypotheses 2015;6:53-9
| Introduction|| |
During the first decade of the 21st century, the dental profession witnessed the introduction of digital-based technology into the dental office. Innovations such as computer-aided design and computer-aided manufacturing (CAD/CAM), cone beam technology, x-rays, lasers, and digital x-rays entered the market and are now becoming the standard of care. , These innovations, however, are expensive and often cost above $100,000. For many dentists, particularly those in solo practice, the purchase of these technologies could present a significant financial risk.
This pilot study explores the importance of financial risk in equipment-purchasing behavior. Three hundred Connecticut dentists were asked if they would purchase a new imaging technology that costs twice as much as comparable x-ray imaging machines. The only difference was that the new imaging technology would not emit any radiation. Because women are thought of as more cautious investors than men, it was hypothesized that women dentists would be less likely to take a financial risk and purchase the new, expensive equipment.
The continued flow of innovation from the research laboratory to the marketplace depends on the purchase of new products. When new products are purchased, the cycle of innovation continues and encourages manufacturers to bring new products to market. Without their purchase, the flow of new products ceases and the profession stagnates. This study aimed to evaluate any potential relationship between the variables of dentist age, gender, location, practice longevity, and type of dentist on the basis of their propensity to accept financial risk through the purchase of a new dental imaging technology.
| Materials and Methods|| |
The study population was selected using the mailing list provided to us by the Benco Company (Wallingford, CT), who continuously surveys dental professionals for marketing and buying habits. Three hundred dentists were randomly selected from the list of dentists registered with Benco Company in Hartford County in the state of Connecticut (the towns of Avon, Bristol, East Hartford, Hartford, West Hartford, and Farmington). The questionnaire was mailed with a prepostage return envelope. The ethical integrity of this study was preserved by anonymous data-gathering and subject selection, as well as by efforts taken to achieve informed consent and reduce the effect of author bias on the interpretation of the data.
The questionnaire was brief in an effort to improve the response rate and consisted of four demographic questions: Age, gender, longevity of practice, and geographic location of the practice. The questionnaire had questions relating to the adoption of a hypothetical new imaging technology. It was presented as follows: "Hypothetically speaking, a new imaging technology has been brought to the market. While this new technology works as well as current x-ray machines, one difference is that it does not expose the patient or anyone in the office to radiation. However, the cost of the new technology is twice that of comparable x-ray machines on the market." Three questions were then posed, as described in [Table 1].
|Table 1: Survey questions to determine risk propensity and demographic information|
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To compare data from different practice locations, it is important to define each area. For example, urban areas are usually extremely dense areas in terms of population, and contain more than 1,600 housing units per square mile. Suburban areas are frequently large communities on the outskirts of cities. They are less dense than urban areas and are often heavily residential. They contain 65-1,600 housing units per square mile. Rural areas are settled places outside of towns and cities that have less of a population density than both urban and suburban environments. Rural areas typically contain fewer than 16 housing units per square mile. Exurban locations are those in which most of the community members commute outside of the area to make their living. They usually occur near a metropolitan area and contain 16-64 housing units per square mile. 
SPSS 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used to analyze the data. An unpaired t-test was done to compare the risk scores of male and female dentists. In total, there were 19 female respondents, 84 male respondents, and 26 respondents who did not specify their gender.
Calculation of respondent risk
The responses from each respondent were used to calculate a "risk" score as follows: Those who responded "yes" to question 1 were awarded 2 points. A "no" response was assigned 0 points. Question 2, which could only be answered if "no" was chosen for question 1, was worth a maximum of 10 points. Points were prorated based on the number of years the respondent would wait before adopting the technology. A delay of 0 or 1 year would receive the maximum 10 points. A delay of 2 years would receive 9 points, and so on [Figure 1]. Note that if the respondent indicated that they would never adopt the technology, 0 points were assigned for this question. As illustrated in [Figure 1], if the respondent circled "yes" to question 1, specifying that they would purchase the technology when it first came out, the respondent was directed to omit question 2 and proceed to question 3 [Figure 1]. As shown in [Figure 1], responses to question 3 were given in percentages. Accordingly, if a dentist wrote a value 91-100%, meaning they would wait until almost all of their colleagues adopted the technology, they were awarded 1 point [Figure 1]. However, if the dentist only needed 0-10% of their colleagues to acquire the technology, the dentist received 10 points, the maximum for the question. Responses of intermediate percentages were assigned points appropriately as shown in [Figure 1]. Each respondent's points were totaled as follows: P1 + P2 + P3 = PT. PT was converted to a risk score and expressed as a percent by dividing by 22 (an arbitrary normalizer), and multiplied by 100 ([PT/22]*100) [Figure 1].
| Results|| |
When comparing the age and risk, it was apparent that there were distinct differences between male and female dentists. [Figure 2] illustrates how male dentists in the 30-39-year age cohort had nearly a 40 percentage point increase in risk score compared to their female counterparts. As age increased, this difference decreased significantly, until dentists in the 50-59-year age range had nearly a tenfold-smaller difference in risk scores. At all age ranges, male dentists had higher risk scores. Also, as the age of the female dentists increased, so did their risk scores. This trend was not apparent in male dentists. For men, it appears that the risk scores decreased and were generally more stable over time.
Specialists were shown to have higher risk scores compared to general dentists. [Figure 3] shows that men in this study reported higher risk scores than their female general and specialist counterparts. Also, the risk score was relatively constant for women, regardless of whether they were general dentists or specialists. However, male specialists had risk scores that averaged over 6 percentage points greater than male general dentists.
The results in [Figure 4] show that the average risk scores for dentists who practiced in urban areas were higher than all other locations, and that those practicing in exurban areas had the lowest risk scores. The data followed the general trend that as population density increased, so did the risk scores. This partially agreed with our hypothesis. Only the exurban environment data differed from the predictions. Because of the vast differences between these environments, it is possible that other factors besides population density heavily contributed to the findings in [Figure 4].
|Figure 4: Risk as a function of geographic location of a dental practice|
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The results in [Figure 5] show a gradual increase in risk-taking, with longevity of the practice until a maximum in the 30-39-years range. Afterward, there was a decline of about 5% in the 40s and about 30 percentage points in the 50s. At 60+ years in practice, the highest risk was observed, of over 75%.
The results of the unpaired t-test comparing male and female dentists were insignificant at an alpha value of .05 (P value = .31). The P values for the subcategories were also insignificant because of the large discrepancy in the amount of male and female respondents. When comparing male and female general dentists, for example, there were 62 male and 16 female general dentists who responded, and the unpaired t-test had a P value of .40. While the data suggest certain trends, statistical significance was not found. A much larger sample size would be needed to improve the validity of the data.
| Discussion|| |
The process of innovation is expensive. Moving a discovery from the research laboratory to the marketplace requires a significant investment. It has been estimated to take about two decades for new technologies to adequately penetrate private practice.  For the process to continue, the products that emerge from the research pipeline must be advertised correctly and purchased in sufficient quantities.
Since the turn of the century, the equipment emerging from the product pipeline has been particularly expensive. For example computer-aided design and computer-aided manufacturing (CAD/CAM), cone beams, lasers, and digital x-ray equipment can cost $100,000 and more. Clearly, for some dentists, these prices represent a significant investment, and the decision to acquire this equipment involves a significant risk. For any profession to advance, innovation must be introduced and accepted. Someone must take the risk in order to advance the standard of care and ultimately provide better outcomes for the consumer.
Everett Rogers, a Professor of Communication Studies, developed a theory to explain how new technologies are adopted by members of society. He stratified people into groups based on their propensity to adopt new technology. Those people who are quick to take risks and are the first ones to implement new technologies were defined by him as "innovators."  Conversely, he classified those who were the last ones to adopt new technology and would wait for others to try it first before taking any risk themselves, as "laggards." There were several intermediate groups, but Rogers predicted that the relative size of each of these groups was similar for any new technological advancement. The results of this study suggest that when money is involved, female dentists in the 30-39-year-old range would correlate more closely with the "laggard" and "late majority" groups that Rogers described. In contrast, the majority of the men would fit best in the "early adopter" and "innovator" categories. In general, dentists have been found to be more innovative than the average person because of an increase in the prevalence of characteristics of innate curiosity, sophistication, discretionary income, and practice isolation. 
This gender difference in the context of financial risk is consistent with what is almost axiomatic in the world of finance: Women are more cautious investors than men. Hence, the title of the book on investing: Warren Buffet Invests Like a Girl: And Why You Should, Too. This book describes the fact that women tend to be more cautious investors than men, do more research, and keep their emotions stable in the financial realm to improve long-term success.  Psychological studies have supported this point of view and have shown that men tend to be overconfident when it comes to investing. This results in men trading roughly 45% more frequently than women, and as a consequence they have a greater reduction in returns per year.  However, some would argue that the differences are more heavily influenced by wealth constraints and investment knowledge than by gender. 
Dental technology innovation and incorporation has also become a serious issue in dental schools across the USA. Many schools do not have the financial resources to be able to stay on the "cutting edge." Apart from the financial risk factor, it also can take extended periods of time to be able to train the faculty in how to use new technologies. Dental distributers and manufacturers have recognized these barriers to the advancement of the field, and have offered equipment donations and continuing education programs. However, these efforts have had mixed results. 
There are similarities between purchasing expensive equipment and investing. In both cases there is a level of uncertainty in making the decision - risk is involved. In both cases the level of risk can be reduced by careful evaluation of the benefits and detrimental elements of a decision. However, there are differences as well. A significant difference is that if the assumed amount of risk is high, the purchase of stocks, the investment, can be postponed; in contrast, in some cases, the purchase of new equipment cannot. For example, if a dental practice is located in a competitive geographic area, failure to acquire the equipment early can result in patients migrating to a different practice that can offer a new dental service because of its acquisition of emergent technology.
Our results support this explanation. The average risk scores for dentists in urban areas (1,600 housing units/square mile) were higher than in all other locations, and those in exurban areas (16-64 housing units/square mile) had the lowest risk scores. These data suggest that risk-taking is positively correlated with population density. One way to lower risk is to wait until others adopt the technology first. This gives a potential buyer time to see how a technology performs in a clinical setting, and if there are any unforeseen drawbacks. Women dentists in the 30-39-year-old age range responded that they would, on average, wait longer than men to purchase the hypothetical new technology that was proposed in this study. As age increased, the risk-averse behavior of women declined, and by the 50-59-year age range, the risk-taking behavior of both men and women was about the same.
The level of risk a dentist is willing to accept may be related to not only the age and gender of the dentist, but also to the age of the practice. Dentists working in an established practice may be more financially secure, and therefore may be willing to take more risks. In this study, a gradual increase in risk was found as longevity of the practice increased, until a peak of risk-taking behavior for practices in business for 30-39 years. For practices in business for 40-49 years, there was a decline of about 5%. Dentists that responded from practices in business for 50-59 years had even lower risk-taking behaviors. Surprisingly, the highest risk behaviors were observed in dentists from practices that were in business for over 60 years.
Our results also showed that the risk scores were similar between female general dentists and those in specialty practices, with female specialists being found to accept slightly more risk. In contrast, men in both types of practices took more risks than women. However, male specialists had risk scores that averaged over 6 percentage points greater than male general dentists. A study that researched the diffusion of rotary nickel-titanium technology in dentistry found similar results. They found that endodontists had significantly higher levels of technology adoption than general dentists. For those that did not adopt the technology, the biggest reason was a lack of perceived advantage.  This difference between specialists and general dentists can possibly be explained by the increased salaries of specialists, which allow for more financial risk-taking when it comes to buying new equipment.
Why might young women in the age range of 30-39 years be less willing to make the purchase than women 40 years of age and older? A purchase represents a decision about a financial risk. We have already noted that women require more information than men to take financial risks. Our results suggest that women in this age group may have issues with decision-making. This conclusion is not new. In fact, Sheryl Sandberg, Chief Operating Officer at Facebook, has compared decision-making by men and women in her book Lean In: Women, Work, and the Will to Lead. Through first-person accounts and stories from prominent businesswomen, Ms. Sandberg shows how women often make decisions such as accepting the first offer made for a position, including the salary, whereas men in the same situation will negotiate about the position and, most importantly, about the salary.  In contrast, women in chief executive officer (CEO) positions note that as they develop confidence, they also learn to negotiate before making decisions. Our finding that women over 40 years of age take more risk suggests that attaining success with operating a dental practice may be due to a greater acquisition of confidence that comes with years of experience. This would explain the findings that show that the risk-taking behaviors of older female dentists are generally similar to men of the same age.
Purchasing of new products by dentists is crucial to the advancement of the profession. Improvements can be made to make dental care more accessible and comfortable, considering the recent decline in dental care utilization. In fact, 2011 saw a decrease in dental visits by working-age adult Americans (ages 18-64), compared to those in the years 2000-2004.  This can be attributed to many factors, including financial hardships and decreasing caries prevalence.  Purchasing is important to maintain the flow of innovations from the research laboratory to the marketplace. Failure to purchase results in stagnation in the flow of capital back to the manufacturers, and could hinder the production and support of research and development programs. Therefore, the purchasing behavior of different groups becomes important to the flow of capital and eventually to the continued advancement of the dental profession. Clearly, the risk-averse purchasing behavior of young female dentists could slow the acceptance of innovations into dental practice. The information from this and future studies can help the producers of dental technologies better understand how to effectively market their products, in order to facilitate the integration of new dental technologies that can potentially revolutionize the industry and provide a higher standard of dental care.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]