“Sir, where are you going?” 
“Uday Samudra, Kovalam.”
“I will take you. How much will you pay?”
“How much do you charge?”

The bargaining began.

It was around 5.00 a.m. Dr. Philip Mathew, Dr. Mathew Sam, and I had just arrived at Thiruvananthapuram Central Railway Station by an early-morning train. The station was only beginning to awaken. The streets outside were relatively quiet, but there was already considerable activity among the auto-rickshaw drivers.

We had been approached by a group of them as soon as we came out of the station.
“Come with me, sir. I will take you.”

Another driver intervened.
“No, no. I will take them.”

The discussion soon became a negotiation over the fare.We decided to use Uber instead. While we were waiting for the car adjacent to a 'kovil ' (a small temple ) not far away, another auto rickshaw driver approached us.
“Sir, I can take you.”
“We have already booked an Uber.”

He moved away reluctantly. Then something unexpected happened. There was another auto rickshaw parking facility close to where we were waiting. When another driver attempted to enter that area, a quarrel broke out between the drivers. It was only then that I looked around carefully. There were many auto-rickshaws—but very few passengers. It was 5.10 in the morning. The number of potential passengers was limited, while the number of drivers waiting for them seemed disproportionately large. Each driver was looking for the same scarce commodity: a passenger. Suddenly, the quarrel assumed a different meaning for me. It was not merely an argument between the auto-rickshaw drivers. It was a demonstration of what happens when supply exceeds demand. As we drove towards Kovalam, another thought came to my mind. We were travelling to attend the 22nd State Conference of the Association of Oral and Maxillofacial Surgeons of India (AOMSI). And suddenly, the auto-drivers became a metaphor for our own profession.

From less than 30 to more than 300:
I still remember the early days of our State AOMSI conferences. At the first State Conference at Ernakulam, the number of delegates was fewer than 30. Today, at the 22nd State Conference, registration has crossed 300. That is a remarkable transformation. It reflects the tremendous growth of Oral and Maxillofacial Surgery (OMFS) in Kerala. It tells us that the specialty has become more visible, more attractive, and more academically vibrant. The increasing number of young surgeons attending conferences, presenting papers, participating in discussions, and pursuing advanced training is, in itself, a matter of satisfaction. While listening to scientific deliberations in the conference hall, yet another question came to my mind: Have we reached a stage where the number of professionals is growing faster than the opportunities available to
them? And if so, what should we call this phenomenon?
Is it professional inflation?
Academic inflation?
Professional overcrowding?
Or simply the natural consequence of a successful profession expanding?
Perhaps it is a little of all these.

When more does not always mean better.
There was a time when becoming a dentist was itself a significant achievement. Dental colleges were few and seats were limited. A postgraduate degree was even more difficult to obtain. Specialists were relatively uncommon, and their services were in high demand. Over the decades, the situation has changed dramatically. The number of dental colleges in Kerala has increased to 26. The number of undergraduate seats increased to nearly 2000. Private institutions have become major providers of dental education. Postgraduate programmes expanded. There are more than 35,000 registered dentists in Kerala. This expansion has undoubtedly brought benefits. More dentists mean greater geographical availability of dental care. More specialists mean greater access to specialized treatment. Greater academic activity promotes research, innovation, and professional development. But every expansion carries a potential downside. When the number of professionals grows substantially faster than the population's ability or willingness to utilize their services, competition intensifies. The question then changes from: “How can I serve more patients?” to: “Where will my patients come from?”

The economics behind the metaphor:
The auto-rickshaw analogy is perhaps simplistic, but the economic principle is real. If there are ten passengers and ten autos, there is a reasonable balance. If there are ten passengers and fifty autos, each driver has to compete for the same passenger. The drivers may reduce their fares. They may wait longer. They may move from one location to another. They may advertise. They may offer additional conveniences. And, unfortunately, competition can sometimes become unhealthy.

Dentistry is not an auto-rickshaw service, of course. A dental professional is a highly trained healthcare provider. Human health cannot and should not be reduced to a simple market equation. Yet professionals also function within an economic environment. Dental clinics have rent, salaries, equipment costs, consumables, and regulatory licences and requirements. Young specialists may have educational loans and family responsibilities. When opportunities become limited, financial pressure can influence professional behaviour. That is where we need to be careful.

Is academic inflation already visible?
There is another dimension to the issue of academic inflation. A qualification that once
distinguished a professional may gradually become almost routine when large numbers possess the same qualification. This does not mean that the qualification has lost its academic value. An MDS remains a demanding postgraduate qualification. Fellowship programmes, diplomas, certificates, workshops and continuing education courses can all contribute meaningfully to professional development. But the proliferation of qualifications can create a paradox.

We may end up with increasingly qualified professionals competing for an increasingly limited number of opportunities. The result may be a phenomenon familiar in many professions: More degrees, but not necessarily more professional security. This should concern educators as much as the practitioners. The responsibility of a dental educational institution should not end with producing graduates and postgraduates. We must also ask whether the educational system is preparing young professionals for the realities of the world in which they will practise.

The changing face of Oral and Maxillofacial Surgery:
For Oral and Maxillofacial Surgery, the situation is particularly interesting. This specialty has expanded enormously. We now have expertise in trauma, orthognathic surgery, pathology, oncology, reconstructive surgery, implantology, craniofacial surgery, temporomandibular joint surgery, salivary gland disorders, endoscopy and minimally invasive procedures. Technology has transformed what was considered impossible. The current conference itself demonstrates the breadth of our specialty. Topics such as sialendoscopy, endoscopic cranio-maxillofacial procedures and minimally invasive orthognathic surgery would have sounded unfamiliar to many of us several decades ago. This is progress. But progress also creates expectations. The young surgeon entering the profession today may require not merely an MDS degree, but continuous updating, technological competence, communication skills, ethical awareness, academic ability and perhaps subspecialty expertise. The professional journey no longer ends with obtaining a postgraduate degree. In many ways, it begins there.

Will we quarrel like the auto drivers?
That early-morning incident left me with an uncomfortable thought. If the number of professionals continues to increase while the number of patients requiring services does not increase proportionately, competition will inevitably intensify. God forbid that a quarrel between auto-rickshaw drivers becomes a metaphor for competition within the dental fraternity. We should never allow professional competition to become hostility. A colleague is not an obstacle to our success. Another surgeon's success does not necessarily diminish ours. Another dental clinic opening nearby need not be regarded as an invasion. Our profession must retain the spirit of collegiality that has traditionally distinguished healthcare from many purely commercial occupations. Competition can encourage excellence. But competition without professional ethics can damage everyone.

Perhaps the problem is not too many dentists:
However, there is another side to the argument. Perhaps the problem is not simply that we have too many dentists. Perhaps we have not yet learned how to distribute dental services appropriately. India continues to have enormous unmet oral-health needs. Large sections of the population still do not receive regular preventive dental care. Rural and semi-urban communities may have limited access to specialists. Awareness of oral cancer, periodontal disease, preventive dentistry and geriatric oral healthcare remains inadequate in many communities. Therefore, it would be wrong to conclude that the mere increase in the number of dentists is the problem. The real question may be: Are our professionals and services distributed evenly and utilized in the right way? If there are too many specialists concentrated in a few urban centres while large populations elsewhere remain underserved, the apparent “oversupply” may actually be a problem of maldistribution. This distinction is important.

From competition to collaboration:
The answer may lie partly in changing the way we think about professional success. Instead of asking: “How can I get more patients than the dentist next door?” we should ask: “How can we collectively improve the oral health of the population we serve?” That requires collaboration. General dentists and specialists should work together. Hospitals and dental colleges should collaborate. Senior professionals should mentor younger colleagues. Professional organizations should create meaningful opportunities for continuing education, research, and networking. Academia and clinical practice should communicate more closely. And perhaps most importantly, we should encourage young professionals to think beyond the conventional model of private practice. There are opportunities in research, public health, digital dentistry, dental technology, forensic dentistry, healthcare administration, medical writing and several emerging areas. The profession is changing. Our definition of a successful dental career must change with it.

How can the senior generation contribute?
Those of us who entered the profession decades ago have witnessed an extraordinary transformation. We practised when equipment was simpler, technology was limited and many procedures now considered routine were still developing. The younger generation has advantages that we could hardly have imagined. They have sophisticated imaging, digital planning, artificial intelligence, advanced biomaterials, minimally invasive techniques, three dimensional printing, modern implant systems and access to an enormous body of scientific literature. But they also face pressures that were less pronounced in our generation. The senior generation therefore has an important responsibility. We should not merely tell young professionals how dentistry used to be. We should help them understand how dentistry is evolving. Mentorship, ethical guidance and sharing of experience may be among the most valuable contributions senior professionals can make.

A profession must grow without losing its soul:
There is a danger in viewing dentistry entirely through the lens of economics. Healthcare is not simply a marketplace. A patient is not merely a customer. A surgeon is not merely a service provider. A dental college is not merely a seat-producing institution. At its heart, dentistry remains a profession based on trust, competence, compassion and service. If professional numbers increase but these values remain strong, the profession need not deteriorate. Indeed, a larger professional community can become a greater force for good. Three hundred delegates at a state conference are not necessarily three hundred competitors. They can be three hundred colleagues. Three hundred teachers. Three hundred researchers. Three hundred mentors. Three hundred potential contributors to better oral healthcare. The difference lies in how we choose to see one another.

Looking beyond the railway station:
On my return journey from Thiruvananthapuram to Kottayam, I kept thinking about those auto rickshaw drivers. They were all waiting for the same purpose. For a passenger. But perhaps the larger lesson was not that there were too many autos. It was a sign that a system must constantly adapt when circumstances change. Our profession too must adapt. The number of dental professionals has escalated. Technology has changed. Patient expectations have changed. Healthcare economics has changed. The role of specialists has changed. And the profession must change with them. The answer is not to stop progress. Nor is it to fear the growing number of young professionals. Instead, we must create new avenues, improve distribution of services, strengthen public oral-health programmes, encourage innovation, promote ethical practice and ensure that education remains aligned with real healthcare needs. Most importantly, we must preserve professional fraternity.

So, perhaps the lesson from that early morning encounter is not that we have too many autos. It is that we must build more roads, discover new destinations and learn to travel together. The future of our profession need not be a struggle for new patients. Perhaps that is the real difference between professional inflation and professional evolution. Numbers may increase—but whether they become a challenge or an opportunity depends on what we do with them.

When the road becomes crowded, let us not compete for the same destination; let us create new avenues and discover new horizons.

(Author’s Note: With due respect to our hard-working auto-rickshaw drivers, the opening incident is used purely as a metaphor for professional competition and is not intended to offend.