Without question, attendance and sponsorship at dental meetings have been in decline over the past several years. Yet the number of doctors in the practice of dentistry has seen steady increases. What factors are generating this reduced demand, and what are its implications about the future?
Since the recession of 2007-2008, incomes for dentists have plateaued or, in numbers of demographics, seen a decline. During this same period, student loan debt has increased exponentially. Graduating dentists today may have a student loan burden exceeding $500,000 or more, none of which is dischargeable in bankruptcy. Further, insurance fee schedules have remained static, or have been in decline in relative dollar terms, for more than a decade.
Doctors of former generations who may have provided care within a four-day clinical work week today often work more than 40 hours per week, exclusive of administrative duties. These are the financial demands and realities of debt repayment, lowered profit margins, lowered insurance fee schedule remuneration, and employment within corporate healthcare.
Essential clinical methods and materials are rapidly evolving and expanding at the same time. Physical and emotional demands on modern dentists seem beyond exhausting. One may reasonably ask, under these circumstances, what dentist has the time or energy for dental meetings?
Competing for a niche in postgraduate dental education are online courses and online study clubs. A great many online courses qualify for Continuing Education Recognition Program (CERP) accreditation and are valid for mandatory education of dental license renewal. This education may be taken at home, or in any convenient place or time.
Online study clubs such as Dentaltown, International Dental Forum, and DentalNexus offer immediate education, camaraderie, and answers to pressing questions on practice management, patient management, clinical problem solving, and regulatory concerns. Dentistry Today offers clinical articles that can be read for continuing education (CE) credit at DentalCEToday.com as well.
One particular dental service organization (DSO) is unique within the industry in acquiring some high-end practices focused on advanced dental aesthetics and cutting-edge occlusion principles. Most dentists, and certainly recent graduates, are ill-equipped to enter a senior clinical staff position in more exclusive Heartland Dental practices.
By acquiring such highly profitable but special practices, Heartland Dental requires very highly trained and motivated doctors. But once the selling dentists retire, how can Heartland maintain their level of quality, clinical production output, and profit margins? Heartland must solve some distinctive problems, unlike most companies in the DSO industry. And its answer has been through in-service educators like Marvin Berlin, DDS, of McKinney, Texas.
“Heartland is huge on continuing education. Our doctors typically have tripled the CE hours that your average solo doctor has, and four to five times that of the average DSO doc. We have more and more of our doctors receiving Fellowships and Masterships in the Academy of General Dentistry every year. This year, I think we had 16, and that number is growing every year,” said Berlin.
“A majority of our CE is provided in-house, where we cherry-pick the best-of-the-best presenters in the country and bring them in to teach our doctors. I think that’s what makes our programs unique. In a typical month, we’ll have 25 to 30 CE events across the country,” Berlin said.
“This week, looking at my calendar, we have Implant Symposium, Endo, Invisalign, Business of Dentistry, Communications, plus we have our Aesthetic Continuum going on where we are training nearly 100 doctors hands-on with live 10-unit veneer cases. I’m the director of that program,” Berlin said.
“Also, we have our huge annual meeting where we bring in the really big boys: Dave Ramsey, Tony Robbins, Lou Holtz, etc. It’s an awesome weekend. We all still go to Chicago Mid-Winter, American Academy of Cosmetic Dentistry (AACD) annual, American Dental Association (ADA) annuals, etc, as well,” Berlin said.
Heartland operates a vast array of dental practices in its wide focus of dental care. It’s impractical to assume most are primarily centered on an elite practice model. However, unlike nearly any other DSO, a number certainly are.
“One way the ADA is doing things differently is by working with other dental organizations to create more impactful meetings,” said Catherine H. Mills, CMP, vice president, conferences and continuing education at the ADA.
“In 2019, the ADA will collaborate with the World Dental Federation, California Dental Association, and the San Francisco Dental Society to host the FDI World Dental Congress along with ADA 2019. In addition, the ADA and Florida Dental Association are holding a joint meeting in 2020. We believe this approach makes sense for meeting organizers and attendees alike. You can read more about upcoming combined meetings here,” Mills said.
“In order to maintain relevancy and best serve ADA members and other meeting attendees, the ADA is continuously evaluating what unique value our organization brings to the table and building our meetings around these strengths,” Mills said.
American Academy of Cosmetic Dentistry
“The AACD Annual Scientific Session always has strong, positive energy,” said JA Reynolds, president of the American Academy of Cosmetic Dentistry (AACD).
“First-time attendees are routinely impressed by the wealth of happy, energetic, and encouraging fellow attendees with whom they can network. The quality of the education, from foundational to advanced, and the plethora of hands-on workshops hold the interest of attendees of all ages and backgrounds. In addition, a team track in cosmetic dentistry is now being offered at our meetings, acknowledging the value we place in staff training,” Reynolds said.
“Accredited members have strong allegiance to the Academy and form a stable and consistent framework for meeting attendance. The accreditation process forms a solid mentoring opportunity in which to grow younger dentists into tomorrow’s leaders and trendsetters. It represents an educational journey unique to the AACD and its Annual Scientific Session,” Reynolds continued.
“Moving forward, the Academy plans to consciously build on what has always made their meetings such a success—networking opportunities, strong, innovative continuing education, and creating a top-notch experience for the attendees. We learn from each other, and we are looking to parlay the networking opportunities of social media into a meeting format so that we can share, grow, and all be the best we can be,” Reynolds said.
“It is important not to become complacent,” Reynolds said. “Continue to evolve, innovate, and stay relevant. Attendees expect nothing less, and your meeting is a reflection of your commitment to serve their needs. Embrace excellence and welcome those in search of it. Look to the future, not to the past, as the AACD has done for over 30 years and owes much of its success to these principles.”
For increasing numbers of doctors who practice under compromised models imposed by a Medicaid fee schedule, a discounted insurance plan, certain DSO models, challenged demographics, or dental health maintenance organization (DHMO) paradigms, dental educational meetings may offer little value beyond the companionship of colleagues.
Clinical importance is placed on rapid production of a relatively small number of routine clinical procedures to best impact the fiscal bottom line. Emphasis is on maximal completed repetitions in an allotted time frame.
By contrast, many advanced clinical skills can best be acquired with hands-on and “over-the-shoulder” educational programs. CE is vital in specific demographics to expand a practitioner’s growing services offered and, most importantly, accepted care by the public.
Heartland Dental’s future for its segment of advanced practices depends on both in-house and outside CE. Its element of elite specific practices requires a continual wellspring of highly educated and motivated doctors. Placing minimally skilled dentists in highly demanding clinical settings is a recipe for financial disaster. Heartland seems to understand a lucrative cash flow depends on talented and well-trained clinicians for certain isolated higher-end demographics.
The ADA has decided to combine and coordinate dental meetings with other organizations to maintain and expand attendance and interest. More CE, and of a wider variety, can be offered to entice maximal turnout. This is a bold, innovative move by the ADA, which is too often averse to change.
The AACD takes a position of fostering networking among like-minded practitioners. Mentoring of colleagues is encouraged. Striving for excellence is its model. The AACD doesn’t seem to want to be all things to all people. Rather, it wants to be at the pinnacle for patient care.
Let’s flat out admit the current reality. Dental meetings and CE make little sense for a large percentage of dentists. Yes, CE is mandatory for licensure renewal. However, little of the CE will ever be put to practical clinical use. These doctors are simply not engaged in much more than rote, repetitive, often assembly-line patient treatments. One can’t blame them, as their employment environment may support little else.
The polar opposite is practitioners who push themselves to acquire “every tool possible, to add in their clinical toolbox.” These doctors are highly rewarded on numbers of levels for their acquisition of additional advanced clinical skills. They are at the cutting edge of current methods and materials. These doctors are the “drivers” of dental meetings. Many also encourage staff attendance.
I expect the monster-sized dental meetings of the past to be few and far between. Modern meetings will continue to be highly focused, and with more limited and interested attendees. These meetings may be offered in-house for a corporate dental group. They may have a handful of sponsors or even a single sponsor that is limited in educational focus (eg, dental implants, digital technology, types and uses for dental ceramics, prep designs for bonded onlays, uses of dental lasers, etc). If the meeting lacks an interesting presenter or presenters, and/or relevant topics, few will attend.
A risk for in-house education with corporate dentistry is promotion of therapies of minimal to no clinical value that are primarily designed to impact the economic bottom line. Those doctors operating in a bubble limited to DSO dentistry may not be positioned to challenge the merits of dubious patient treatments. The interests of the company may not always comport with the patient’s best interests. Thus, many of these DSOs target recent graduates as well as undergrad dental students for employment. These doctors are vulnerable targets because of a mountain of debt and very limited clinical knowledge and experience.
Internet access to CE and study clubs will continue to expand, as doctors face increasing economic pressure. Travel to CE, lodging, and meals become elevated barriers in terms of costs and downtime from earning a living. Also look for dental CE podcasts to assume additional prominence.
“Education is the most powerful weapon which you can use to change the world.”
― Nelson Mandela
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at email@example.com or smilesofsantafe.com.
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