IMPRESSIONS
By Dr . Bruce R . Terry Editor
The Evolution of the Dental Practice
Not long ago I read an editorial in the ADA News by the editor of the Chicago Dental Society ( July 15 , 2013 MyView , “ Yes , I still believe ”, By Walter F . Lamacki , D . D . S .).
I found the comments particularly interesting . A young dentist responded to the article with a letter to the editor claiming how difficult it was for him to survive as a young dentist in a highly competitive area of suburban Chicago . He doesn ’ t earn the national average enjoyed by other dentists as published by the ADA . In fact , he says that none of his peers are making that kind of money .
These comments are particularly important in today ’ s dental field and may form the basis of future practice trends . The high cost of tuition has forced many graduating dentists to opt into corporate dentistry rather than start their own practice or purchase an existing practice . When I started my career more than 25 years ago , it was assumed that you either opened your own practice or you were hired as an associate with a track toward partnership / ownership . While this still happens today , the trend is moving away from this model and toward the direction of leaving dental school for a GPR and then on to a corporate dental entity paying a salary , malpractice and health insurance for the young dentist .
These comforts are very attractive to the new dentist . Who wouldn ’ t want to have the security of a job in a practice with staff and patients managed by others ? The dentist does not have to manage the
staff , they don ’ t have to market the practice . Their sole responsibility is to generate revenue . And that is where some of the problems begin .
This dentist in Chicago is hardly unique . As I speak with new graduates working in my area of suburban Philadelphia , I hear the very same comments . Young dentists are more comfortable with the idea of working for a large company that can guarantee salary and benefits , but what they don ’ t like is the pressure to produce revenue .
At the very same time , practices are being sold to corporate groups to expand their brand and acquire existing patients . The sellers are usually dentists in their 50s or 60s looking to give up ownership either to retire entirely or to work without the headaches of ownership . So the forces at work here are coming from the younger and older generations and the momentum is gaining .
Don ’ t get me wrong . I appreciate the idea that business people run businesses better than dentists . A well-educated business person understands management of costs and the importance of revenue . A large business can reduce costs by negotiating contracts with suppliers and providing benefits for competent employees . Dentists , on the other hand , are neither as well versed in nor as able to provide the same level of purchasing power or benefits within their small business model . Those of us that have done well might want to claim we are good business people , but I would tell you that for me it ’ s more luck than anything else . I have no formal business training . I have never taken a management class .
What we as solo practitioners or practice owners have that young employees don ’ t is “ skin in the game .” We have our reputations , our names . When we start our own practice we are invested in that business . We live and take ownership of
the dental health of our patients . We feel responsible for dental problems and unsuccessful outcomes . We deal with the compliments and the criticism . We enjoy the freedoms of ownership but deal with the daily problems . An employee dentist can move freely to the next opportunity if they don ' t care about building a reputation and a practice of loyal patients . A solo practice owner has to spend a great deal of time , money and emotion building a reputation and patient base and is much less likely to walk away .
A dentist employee of a large corporate dental company feels the freedom of not being responsible . The practice is responsible . The dentist comes in and provides a service and is compensated by the corporation . If the equipment doesn ’ t work or the staff have issues the dentist lets the corporation manage the problems . The corporate dentist must deal with the pressure to produce even when that pressure may conflict with the values of the dentist . Yes , many practice owners also push the limits of production for revenue , but this is their own choice and not forced upon them beyond their level of comfort . Many new dentists gain speed and expertise over time and can ’ t begin their career producing dentistry at the volume of a seasoned veteran .
Does that mean that dentists should all have a dental MBA ? Perhaps that wouldn ’ t be a bad idea . Since many of us feel offended by the idea of a business model where the owners are not dentists but hire dentists to work for them , it may help ease the pain of what ’ s coming . How are solo practitioners supposed to compete with multi-office practices run by professionals ?
Some dental magazines have featured articles about how dentists can profit from purchasing the practice of a competitor or of a practice outside their own location . Having a second or third office can bring
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