There is a growing dilemma in the United States. The face of dentistry is changing, and our profession is in jeopardy of losing the identity it has created over its history. Since the Great Recession, significant things occurred that have brought us to our present state. Following that economy shock in 2008, a tremendous ripple effect slowed the forward progress of private practice dentistry nationwide. In addition, the growing debt of recent dental graduates altered the ability of the next generation of dentists to follow in the footsteps of the older and experienced dentists who, historically, have enjoyed independent and successful dental practices. Finally, dentists are facing challenging trends in today’s marketplace. Reduced reimbursement allowances put pressure on practice profits. If we are not careful, the successful model of American dentistry may forever be affected. Some might even argue that it is too late to save the private practice model as we once knew it, and still know it, in many practices.
Let’s examine these issues more closely.
The Private Practice Model
For generations, the private practice model in dentistry has been alive and well. Passing on wisdom, clinical knowledge, and business experience to the next generation of dentists through associateship and mentorship programs has been a great way of continuing quality of care in dental practices. The transfer of practice ownership through a buy/sell agreement allowed for the personalized mentorship of a new graduate. This allowed new clinicians to learn about not only clinical experience in treatment planning and case management but also more advanced and predictable approaches and techniques that could be used to solve many of the clinical challenges that they would almost certainly have to successfully handle. In addition, the associate could finally learn more about how to develop practice management skills, gain experience in leading a dental team, and learn how to manage a dental business. This model of conveyance of knowledge is so important in the progress of quality dental care.
After being in private practice for more than 30 years, I strongly believe there are 4 very important basic things a dentist needs to have to start his or her journey to become a successful dentist:
1. Excellent verbal skills, in order to develop solid and long-term relationships with your patients.
2. A great chairside manner in talking with and guiding your patient through what he or she might often perceive to be scary/difficult procedures.
3. The knowledge and skill to consistently administer painless local anesthetic injections.
4. The skills required to avoid inflicting pain and undue discomfort during dental procedures.
Two of these are related to knowledge in practice management skills, and the other 2 are learned and practiced clinical skills. Learning to develop these essential requirements for success are, in part, some of the benefits of participating in an associateship/mentorship program.
The Great Recession of 2008
Since the Great Recession, there has been a domino effect with negative consequences for private dental practices. From 2008 to 2012, critical performance measures (such as practice revenue collections, the number of patient visits, and a doctor’s gross production) plunged during the height of the financial crisis. In addition, patient no-shows and lower case acceptance contributed vastly to the financial downturn of dental practices. Between 2008 and 2010, doctors’ gross production dropped considerably.1 Therefore, one of the outcomes of this crisis was that many owner-dentists stopped taking in associates, opting to do procedures on their own to make up for the lost gross revenue and the resulting drop in net profit. Finally, many doctors had to postpone their retirement timelines, pushing them back about 4 to 5 years.2 Unfortunately, the Great Recession contributed to the lack of associateship programs available for dental school graduates.
The Dental School Debt Conundrum
Dental school graduates rely greatly on being able to transition their schooling years to working years. These graduates need to find work to be able to pay back the incredible student debt that they have accumulated. According to the American Dental Education Association, the average dental school debt for the graduating Class of 2016 was $261,149. If the borrower of this debt borrowed at a Grad PLUS rate of 6.31%, this person would face a monthly payment of $2,940.3 And it just keeps increasing: The American Student Dental Association (ASDA) stated that 2017’s dental students graduated with an average dental school debt of $287,331. Thus, one can easily understand that there is a high importance of finding work as a dentist right out of dental school.
In facing this monthly debt, along with the lack of associateship opportunities that these recent graduates have to choose from, many have turned to alternative work opportunities. The corporate dental organizations have increased in popularity with recent grads because they immediately employ recent graduates, helping them gain immediate income to pay back their debt. Regardless of what the recent dental school graduate desired or had probably visualized in a career in dentistry, this alternative has been a popular choice.
Provider vs Practitioner
Dental Service Organizations (DSOs) offer an immediate and a reasonably high income to the dentist provider. These providers are delivering dental services in a different way than a private practitioner does. In a majority of cases, they are most likely not able to control all the factors that go into providing the highest level of care. This is one of the differences between a DSO dentist and a private practitioner. A dental provider who works for a DSO does not learn much of anything about quality practice management or business management. Another difference is the inability to provide the best customer satisfaction and experience for his or her patients. The control to provide optimal comprehensive dental care, patient experiences, and patient satisfaction is important to the development of a dental practitioner. Many of these skills are learned during an associateship program; however, without this vital experience, how will young clinicians be able to shape and develop their own careers? How can they learn about developing comprehensive treatment plans for their patients? How can they learn how a successful dental business works? And finally, how can they learn what it takes to create optimal patient experiences that will maximize overall patient satisfaction?
Meeting the Needs of the Next Generation of Dentists
To create a highly successful dental practice, 3 practice-building elements—clinical knowledge and skills, practice management knowledge and skills, and business development skills—must be applied on a daily basis. You can be the best clinical dentist in your area; however, if you don’t develop a great dental team, you will never be able to create the practice of your dreams. There are a good number of excellent continuing education programs from which to learn more about cosmetic dentistry, restorative dentistry, implant dentistry, etc. However, it is also important to be mentored on how to treat and manage your patients and to learn to work with and lead a dental team. In addition, it’s imperative to learn how to develop your career as well as how to manage the business of a dental practice.
To meet the needs of mentoring the next generation of dentists, the new Pan Pacific Dental Academy (PanPAC) was created. The mission of PanPAC is to not only teach dentists and other dental professionals around the world about predictable clinical dentistry but also to teach and mentor the professional on matters related to practice management and successful business development. For those interested, PanPAC will hold its second annual conference from September 12 to September 14, 2019, in Honolulu.
In 2007, I was fortunate to have won the coveted National Cosmetic Dental Practice of the Year award by Contemporary Esthetics. Therefore, I know what it takes to build a highly successful private practice. Now, after 30 years in private practice, it is time to share my “Secrets of Success” with the next generation of dental professionals. The PanPAC team is ready to mentor the next generation of dentists and dental professionals.
In addition to our annual PanPAC meeting, we are debuting our new website (panpacdental.com) in June 2019, which will feature portals to continuing education videos on clinical, practice management, and business development topics. In addition, it will have a variety of practice management forms and teach the verbal skills needed to help solve problems that happen on a daily basis in the dental practice. Finally, it will have an interactive chat room for members to get advice from the PanPAC team on all facets of private practice. The educational website will provide continued e-learning between the annual conferences. This PanPAC experience will accelerate the learning of its members and provide the knowledge needed to develop a successful dental private practice.
As the dental profession changes, we must change too. The need for mentorship is critical in providing young dental graduates with what they need to be truly successful and happy in their dental careers. This great professional tradition of mentoring the next generation of dentists is vital to providing quality dental work and patient experiences in our communities. In my humble opinion, without a passion for mentorship programs, dentistry is in danger of morphing into a model that is less than what both patients and doctors want and deserve.
- Sikka V, Savin G. The impact of the financial crisis on the US dental industry. Dent Econ. 2014;104:40.
- Levin RP. Data bites: more dentists plan on working longer. Dentistry IQ. March 14, 2017. https://www.dentistryiq.com/articles/apex360/2017/03/data-bite-according-to-dentist-retirement-data-more-dentists-plan-on-working-longer.html. Accessed February 9, 2019.
- Kirkham E. Is becoming a dentist worth $261,149 in debt? Student Loan Hero Inc. April 3, 2018. https://studentloanhero.com/featured/dental-school-debt-worth-it/. Accessed February 9, 2019.
Dr. Okuda practices in Honolulu. He is a past national president (2002 to 2003), board-accredited member, and board-accredited Fellow of the American Academy of Cosmetic Dentistry (AACD). He has been an international speaker for more than 22 years and has authored numerous articles on cosmetic and restorative dentistry topics around the world. Dr. Okuda is a Fellow of both the International College of Dentists and International Congress of Oral Implantologists. He is also the aesthetic dentistry expert of the National Dental Advisory Board of the AGD and the aesthetic columnist for General Dentistry. Since 2007, Dr. Okuda has been listed in Dentistry Today’s Leaders in CE. He is the cofounder of the Give Back a Smile program, the national charitable foundation of the AACD, which helps survivors of domestic violence throughout the nation to restore their smiles and lives. He can be reached at okudacosmeticdentistry.com or on Facebook at facebook.com/drwynnokuda.
Disclosure: Dr. Okuda is the founder and owner of the Pan Pacific Dental Academy.