Where Have All the Dentists Gone?
A question laboratory owners may be asking in coming years
Daniel Alter MSc, MDT, CDT
Every prudent business owner needs to assess his or her current practices and look beyond the horizon in order to remain viable in today’s very competitive environment. Owners and managers of dental laboratories must follow the same methodology and attempt to remain abreast of dental landscape trends and the effects of those trends not only on their clientele but ultimately on their businesses. Recently, Inside Dental Technology conducted an informal survey of practicing dentists to gain a better understanding of the dental landscape and attempt to tease out relevant trends and their potential effects on dental laboratories. One of the trends identified was the smaller number of younger dentists entering into private-sole ownership dental practices, including those who purchased an existing practice or started their own new practice. Historically, sole-ownership dental practices have been the business model that dental laboratories have marketed to in order to gain new clientele, but will this still be the most advantageous business model in the years to come? Or, are there shifts in dental practice models that dental laboratories need to understand to ensure their efforts are appropriately expensed to gain the biggest return on their marketing investment?
The Student Debt Factor
One of the major factors impacting the changing dental practice landscape is dental student debt. On the rise for several years, the average senior student indebtedness for the 2014 graduating class was $258,125, which was significantly higher than the debt incurred by dental students of 5 and 10 years earlier: $208,921 and $155,234, respectively.1
“Debt can affect the career paths of young dentists and the places they are able to work,” Rebecca Stone writes in a 2015 article in Mentor magazine. “It can limit their ability to open private practices or invest in expensive technology. Ultimately, it shapes the customer base and the practice scenarios into which sales professionals must sell.”2
Now, with a significant amount of debt among dental school graduates, dental school seniors must make hard decisions as to their career paths, practice selection, and demographic locations. These decisions will potentially alter the current dental landscape and could similarly change the business model by which dental laboratories attain their clientele. A 2013 study commissioned by the American Dental Association (ADA) indicated that half of the dental students interviewed said student loan debt had a significant influence on their post-graduation career choices.2 A survey of dental school seniors conducted in 2014 by the American Dental Education Association (ADEA) corroborated the ADA findings, with a majority reporting their career path choices included joining an associate private practice (61.2%), group practice (18.8%), or corporate group practice (27.2%) in lieu of establishing a new private practice (5.0%).2,3 Stone supports these findings and adds that dental school graduates today are said to be three times more likely to seek employment in a large group practice model than they were 10 years ago.4
An interview with Bryan Cook, PhD, Senior Vice President for Educational Research and Analysis for the ADEA, provided more insight on the current state of the dental landscape. The ADEA is currently reviewing and learning more about the emerging practice option of DSOs and corporate dentistry for its graduates, and considering how to best advise them while they enter the profession.
“There is clearly an impact of student debt on their career paths,” Cook says. “However, further survey and analysis is required to truly identify a cause and effect, and tease out other variables that contribute to career path choices.”
Nevertheless, Cook went on to acknowledge that there is a change taking place within the profession. Although there are programs in place to assist dental graduates with their student loan burden, and the ADEA does inform students on the matter, Cook explains, “DSOs do offer some financial incentives, loan repayment, salary, and benefits to contracting with particular DSOs; furthermore, different DSOs offer different packages.”
The ADEA Survey of Dental Seniors found that 11% of 2015 graduating seniors have already contracted with DSOs and intend on working for them immediately after graduation.
“The recent increase in newly graduating dentists joining DSOs is attributed to a new opportunity for the graduates, which provides an alternative option to those who perhaps are looking for an employment path and have less of a desire for the traditional entrepreneurial path of opening their own practice,” Cook says. “We are trying to figure out that and what’s driving the new career decisions, so that we can best advise our seniors.”
Where New Dentists are Practicing
Dental graduate debt may also creep into the demographic distribution of new solo and existing group dental practices.
“Dentists who graduated with higher debt were less likely to specialize and were more likely to enter private practice over other primary occupations, which usually have lower salaries,” according to a 2015 Journal of the American Dental Association article. “These results are consistent with students deciding to accept relatively high-paying jobs immediately after graduation to increase their ability to repay their debt quickly.”4
Such findings would appear to indicate that dental school graduates are more likely to seek employment in highly populated urban areas or with dental business models that offer greater earning power. This is consistent with studies of Americans living in rural areas who report difficulty attaining dental care providers in comparison to their urban counterparts who have a saturated demographic.5
“There are so many factors that affect dental students’ choice for a certain location,” Cook says. “Not to say that the debt isn’t a factor, but family, community, and network connections are also a variable when dental graduates seek a location to practice.”
Conclusion
One segment of dentistry that student debt is not impacting is the robust numbers of students enrolling in dental school programs. Today’s enrollment numbers are trending upward to levels similar to those of 1980, when 6,000-plus students were accepted into dental school programs. Additionally, the emergence of 11 new dental schools since 1997—and nine since 2008—indicates a “de-aging” of the dental workforce in coming years.6,7
Trends such as these genuinely impact the way we do business and how dental laboratories will do business for years to come. Truly understanding the dental landscape as it affects our clientele, current and future, will equip dental laboratory owners and managers with the knowledge they need to best target, attain, maintain, and retain their accounts. Armed with knowledge concerning what challenges dentists face and how those challenges impact the business decisions they make, dental laboratories can position themselves as not only a resource but also a solutions provider fostering relationships of support and partnership. Ultimately, a solutions-oriented strategy will lead businesses to the best competitive advantage to grow and succeed. Marketing efforts and sales initiatives can gain better effectiveness with a clearer understanding, empowered with strategically planned and executed efforts, leading to a gain for the best results.
Elevate and empower with knowledge.
References
1. Amerian Dental Education Association. (February 2015). ADEA Survey of Dental School Seniors, 2014 Graduating Class Tables Report. Washington, D.C.: ADEA.
2. Stone R. Conquering the Mountain of Student Debt. Mentor. 2015;6(12):20-22,24-25.
3. Diringer J, Phipps K, Carsel B. Critical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape. San Luis Obispo, CA: Diringer and Associates; 2013.
4. Nicholson S, Vujicic M, Wanchesk T, Ziebert A, Menezes A. The effect of education debt on dentists' career decisions. J Am Dent Assoc. 2015;146(11):800-7.
5. Vujicic M. Where do dental school graduates end up locating? J Am Dent Assoc. 2015;146(10):775.
6. Vujicic M. The "de-aging" of the dentist workforce. J Am Dent Assoc. 2016;147(10):843-5.
7. Health Policy Institute. Trends in U.S. Dental Schools. American Dental Association website. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIgraphic_0416_1.pdf?la=en. Accessed November 1, 2016.
