I lecture quite frequently at various dental and orthodontic programs, and it seems that over the most recent 5-7 years there has been a major change in the dental seniors and the orthodontic residents in their perception of their future and their perception of the future of their chosen profession.  While there are notable exceptions, it appears to me that the majority of todays’ graduates have either lost, or have never had, confidence that the fee for service, private practice of general, pediatric, or orthodontic dentistry has much of a future.  They are telling me that they are having a terrible time finding an associateship, that they are convinced they cannot just hit the street in their chosen location and start a practice from scratch, and that the offers from corporate dentistry and orthodontics are looking increasingly attractive.  In fact, in two of the most recent four schools I have lectured at, more than half of the students/residents have already committed to corporate employment “just until they can get their feet on the ground and get started repaying their student debt.”  However, they each state they want to be in private practice within three years.

These young dentists have stars in their eyes!  That’s normal I suppose, but after these guys (male and female) have become comfortable with the $125,000 to $300,000 per year the corporates are offering them as starting wages, I believe it is unlikely that more than a few will have the courage to walk away from corporate, borrow more money from their bank for a practice purchase or for equipping a practice from scratch and, essentially, start over.  It’s a shame though because almost all reading this have personal experience of knowing that the freedom, the quality of life, and the net income from the fee for service private practice of dentistry/orthodontics is extremely rewarding, and far more rewarding than could ever be obtained by working as an employee doctor at corporate.

I spoke with my friend Dr. Steve Persichetti a few days ago.  He has a private dental practice and also runs the Practice Management courses at the OHSU (Oregon) dental school.  A banker had discussed with him a short time earlier the loans the bank is making to physicians who are borrowing money to start new practices.  After hearing that I called a friend at US Bank here in Portland who said that while the bank is not into that sort of lending like many other banks, he knew that type of lending was common and was increasing.  This all sounds pretty normal and perhaps uninteresting until you learn that many times these are not young doctors, just out of school or their residency.  These loans are often to “senior” doctors who have been “fired” from their corporate practices.

For some years it has not been uncommon for the large corporate hospital groups to purchase the private practices of GP and specialist practices within their market area and then hire back those physicians as 1099 contract employees who are then able to continue to practice medicine in their own offices and buildings, without the hassles and overhead worries of “management.”  Unfortunately what seems to be happening is that now the corporate hospitals are able to hire new, younger doctors just out of their residency, with a rate of pay substantially less than the groups are paying the doctors whose practices they purchased.  So, the “senior” doctor aged 50-55, with plans to work another 10-15 years, is laid off and hence the need to start again from scratch.

I have no idea how widespread of an issue this is in medicine but I can easily see this being a major issue in corporate dentistry.  Corporate dentistry is interested in one thing – the greatest possible level of profitability!  Consider the following excerpt from a web page I just obtained this morning for a corporate dental and orthodontic provider with more than 50 locations in Oregon, Idaho, and Washington.

“New patients are generally able to obtain their initial appointment within 30 days of their call to the Appointment Center.  Hygiene appointments generally have a wait-time of 45 days.  Restorative treatment appointments generally have a wait-time of 60 days.  These wait-times are averages…..”

I hate to think of what the wait-times must be for their more comprehensive cases!  Yes this is corporate dentistry.  This wait-time policy clearly shows, to me, that this dental company is far more interested in high volume profit than they are in the quality of their patient care.  And before someone from this outfit gives me Hell about slamming their quality of care, please understand I am speaking of their quality of their service to their patients, which is a huge part of the overall quality of care.

From my point of view, if a person is going to invest four years (+) at University, another four years at dental school, and then sometimes another two-three years in a residency program, they should want to be more than a dental “mechanic” working for wages under a corporate taskmaster.  The financial, social, and personal rewards of the fee for service, private practice of dentistry and orthodontics far exceed anything that could ever happen in the corporate world.

Corporate dentistry and orthodontics may look attractive to some doctors and it may appear threatening to others, but it is here to stay and it is not a threat to the quality fee for service doctor in private practice.  Corporate goes after a high volume of patients, signs up for every PPO on the planet, does retail advertising including direct mail, billboards, television, etc., and attracts large quantities of low end, low dental IQ patients who are looking for a deal.  In the business world that works and corporate dentistry is profitable….. for the owners.  The fee for service practitioner is looking for a lower number of high dental IQ patients who will value the greater quality of care, who will say “Yes” to their diagnoses and treatment plans, who will pay their bill, and who will send their friends.  The fee for service private practitioner is not threatened and does not (or at least certainly should not) compete with corporate.  You are both seeking and serving entirely different markets.  Again though, the fee for service doctor will always have a greater level of net profitability and a far greater quality of life.

We are rapidly losing dental and orthodontic insurance and most of the little that will remain will be low fee PPO plans that the corporate practices will gobble up.  I say “Good Riddance!”  As I have written recently, the decline in dental insurance will, over the long term, be a wonderful thing for the fee for service practitioner.  Remember doctors, it was only 30-35 years ago when there was almost no such thing as dental or orthodontic insurance and, believe it or not, dentists did just fine way back then.