If Dental Colleges were Dentist-Producing Factories …

Farhan Raza Khan   BDS, MS, MCPS, FCPS

A factory is a place where products are manufactured from the raw materials. For any factory to prosper, there are few pre-requisites:

• It produces goods that are in demand by the public
• There must be some rules and regulation framework under which it operates
• Quality control mechanism
• Economic sustainability of the production
• A mission and vision statement for it to aspire its goals
• Warranty and after sales service of its products

Taking this analogy forward, a dental college is a place where future dentists are produced. In other words, dental institutions are dentist producing factories.1 Therefore, it would be interesting to apply the above principles on these institutions. Let’s discuss this.


Pakistan is a country with an estimated population of over 190 million. The numbers of registered dentists are less than 18,000 which make the dentist to population ratio > 1:10,000. It means that there is a lot of room for the factories (dental colleges) to pump out their products (dentists) into the market. However, the catch here is that most of the dentists are based in the 10 big cities of Pakistan (Karachi, Lahore, Islamabad, Multan, Faisalabad, Peshawar, Abbottabad, DG Khan, Hyderabad and Quetta) showing virtually no interest to work in the rural settings. Therefore, a significantly skewed distribution of providers makes an even supply of the product (dentists) to the needy (patients residing in rural Pakistan) impossible.


With bodies like PMDC, CPSP, HEC and PHC, the stringent rules and regulations are there to regulate the profession. These bodies carry out all the checks and balances regarding the quality assurance and assessment of the final product (graduating dentist). This ensures that dentist once graduated possess all the right competencies to practice independently and serves as a safe and ethical practitioner.

Consultant & Head of Dentistry, Aga Khan University, Karachi, Pakistan



Efficient factories do not initiate quality assessment at the end of manufacturing; rather, they evaluate their quality of their product throughout every stage of production until completion. If a dental college is to work efficiently then it must build the culture of self-assessment. A culture where quality is the responsibility of everyone, not just the faculty, but the entire dental team including surgery assistants and students. Students who self-assess are likely to identify their own weaknesses and seek help for the improvement. Traditional education model pushes the students to hide their lack of knowledge in weak areas and focus on just passing the exam. A cultural change in dental colleges is needed where students and teachers see each other as team member and where reflective practice is done and where quality in education and patient service should be the ultimate goal.


The dental education is an expensive business for the students and the institution. Dental materials, consumables and equipment are costly. Students are beginner in the profession who work slowly and inefficiently compared to experienced dentists; thus undergraduate students may not serve as productive clinical service provider and/ or revenue generator for the dental college. Thus, relying on dental students to run a dental service based institution would be a poor business model. Some financial experts recommend applying the Pareto’s principle of 80:20 on all business models. This model implies an unequal relationship between inputs and outputs. However, allocating 80% resources to 20% students or faculty is not academically justified. Similarly, allocating more money to certain groups of patients would create ethical problems in healthcare.2


A mission statement defines the organization’s business, its objectives and its approach to achieve those objectives. A vision statement describes the desired future position of the organization. The mission and vision statements are often combined to provide a statement of the organization purposes, goals and values. All dental colleges should have well-defined mission and vision statements. The institution should facilitate students, interns and faculty to achieve those goals. Lack of such mission and vision will make dental colleges into unregulated factories that produce dentists without knowing how their product will function later on.


If dental colleges produce professionally competent clinicians who possess the noble attributes of life-long learning, self-assessment and ethical practices as the primary motto then the public at large will certainly develop a high level trust on their dentists. This trust is the “warranty” that patients will get the best possible care from their dentist. For after sales service, the dental institution should ensure that they regularly offer continuing dental education or continuing professional development session. These CDE/ CPD courses will ensure that the products of the dental factories (i.e. dentists) will remain professionally updated throughout their career.


  1. Nalliah RP. Five practices of efficient factories applied to dental education. J Investig Clin Dent. 2015; 6: 81-4.
  2. Zupancic JA, Dukhovny D. Resource distribution in neonatology: beyond the Pareto principle. Arch Dis Child Fetal Neonatal Ed. 2015; 100: F472-3.