DENTISTRY DROPS TO #70

2024 US News and World Report Rankings Best Jobs – DENTISTRY DROPS TO #70

WHAT? Dentistry was a perennial top 5 pick for years. What happened to fall precipitously to such a low level. This fall didn’t happen overnight. Let’s unpack.

STRESS

Dentistry ranks high in the stress category both mentally and physically.

Educational Process: The Beginning!

The educational process is grueling. It piles on didactic rigors along with the clinical requirements. Those admitted to dental schools are inherently competitive. These students are accustomed to being the top dog. They now find themselves battling for grades with other ultra-high achievers. When I attended dental school, the students were required to do much of their own lab work waxing and casting crowns and fabricating dentures and partials as well as all the above. I actually enjoyed the lab work. Today students do not have to do much in the way of lab work yet they are far more stressed out.

Everyone handles stress differently. Many dental students really have no idea what they are getting themselves into. By the time reality hits them square in the face it’s too late. They have already invested their undergraduate years in a narrowly focused science-based curriculum. Once in dental school, students don’t really get to provide clinical care until their sophomore year. This is year 6, of the 8 required on average to attain the DDS degree. Much of this year 6 is performing dentistry on manikins. The actual human treatment begins in earnest year 7, the junior year. Basically, you don’t really get to experience what it is like to perform dental care on humans until year 7. This is crazy!

Everyone reacts differently to wielding a handpiece, mouth mirror, and dental instruments on a living breathing human being. Some dentists have better hands than others. Some develop faster but everyone eventually gets there. There are stories of dental students leaving school their junior year because they feel frustrated with trying to adapt to providing clinical care. They struggle with the adjustment. They only wish they knew what they were getting themselves into prior to beginning the long journey. I know of recent graduates who left other professions like law and wealth management for dental school only to return to those fields with DDS after their names. A tremendous waste of time and energy!

University of Iowa College of Dentistry 83-87

I enjoyed dental school. The faculty and administration were superb. We received a ton of clinical repetitions and were required to perform our own lab work. Iowa ranked in the top 3 dental schools in the country while I attended. It was quite a load, however, I felt well prepared to enter private practice. The clinical dentistry was the easy part for me as a private practice owner. It was a great time to be a Hawkeye as a student in Iowa City in the 80’s with Hayden Fry, Tom Davis, Dan Gable and Vivian Stringer leading their teams. I will always remember Kinnick stadium shaking when we beat Michigan on a Rob Houghtlin field goal.

FEWER CLINICAL EXPERIENCES TODAY!

I speak with dentists and educators all over the US. Dentists are getting far fewer procedural repetitions today on human beings. The public is unaware. Students have no idea; yet they shell out $300,000 to 600,000 to attain their DDS degree, graduating with very little clinical experience. Some schools are better than others, however many fall short in providing the necessary clinical reps. Board examinations to judge clinical competency are performed on manikins in many cases. These graduates are now newly minted licensed dentists and are expected to practice quality standards of care on their patients. This is absolutely appalling to me that we saddle these young professionals with a massive debt load while providing little in the way of acceptable clinical education. I believe the pre-dental curriculum should be no more than 2.5-3 years in length and the clinical education should begin immediately the freshman year of dental school, with all students required to attend a general practice residency following graduation. Students have got to work on human patients complete with a tongue and cheeks. It is the only decent thing to do.

NO MENTION OF THE BUSINESS OF DENTISTRY

All dentists I speak with wish they had more education with respect to the business of dentistry. They have to pay back enormous sums of debt, practice efficiently, provide quality standards of care, hire, lead and manage staff, meet payroll and navigate the ever changing marketing landscape. How do I manage overhead with costs skyrocketing? What is a profit and loss report? How do I read a balance sheet? How do I effectively schedule and present a case? How do I manage debt, lease agreements etc.? What about retirement planning?

DENTAL INSURANCE

Students are rarely taught anything with respect to dealing with dental insurance. They don’t even understand it and most have never even filled out an insurance form in school. Deductibles, copays, insurance maximums, prior authorizations and EOB’s are foreign to them when they get into private practice. What are PPO’s? What are these 25-50% discounts that I must accept?

DELTA DENTAL: THE ELEPHANT IN THE ROOM

Delta dental is no longer writing premiere policies for new graduates in most states. Wow, the young dentists with the most debt can’t get adequate reimbursement. This pushes dentists to PPO participation with 40-50% discounts that are crushing practices. Those older dentists who have been premiere dentists now have to accept 20-25% discounts to their fees. It’s no wonder dentistry has sunk to 70. Dentistry is far too difficult and demanding to not receive adequate pay.

Insurance companies took advantage of Covid. It gave them the excuse to reduce reimbursements. Hey we are all paying more for goods and services from groceries to travel and everything in between. Dentists cannot absorb these discounts and run a business. Their expenses have gone through the roof as well. I tell dentists that they must communicate this to their patients that they cannot be in network and still stay in business.

The reality is that the patient does not really pay that much more to the out of network practice. The insurance company has to pay far more. It’s all about perception and marketing and insurance companies do a better job. Health insurance has conditioned the consumer. Life is about choices. Look at your PPO participation and determine how to proceed. It is no wonder more dentists are finally opting out of insurance networks. Young doctors just entering practice should never go down that rabbit hole. You can see fewer patients and enjoy practicing more. Refuse to jump on the treadmill.

Warren Buffet has said he will never invest in a company that doesn’t have pricing power. Think about that. Warren has a lot of insurance companies in his stable.

Health insurance is required to pay out 80% of premium dollars for treatment. There is no requirement for dental insurers. Most pay out only 40-50% of premium for care. Are you aware that Delta Dental has an investment arm that gives money to larger practices. They are effectively picking the winners and losers. Dental insurance today is very expensive for the patient. In many cases it really doesn’t pay. Patients are beginning to recognize this. Only 7% of dental insurance patients ever use their yearly maximum. These annual maximums are still $1000-$1500 dollars.

Delta Dental developed by dentists for dentists! Really? You be the judge. Disruption will find its way to this industry too. Dentists are the only ones that can provide the care. TAKE BACK YOUR PROFESSION!!!

NO MENTION OF REGULATION IN SCHOOL

I remember when I graduated, I went right into private practice; a scratch start. I was grateful to have had an executive director at my dental board who patiently helped me with my questions. Connie Price, your compassion was appreciated. You knew that inexperienced young Dr. James was conscientious and doing his best to learn the regulatory ropes. The majority of dentists are doing their very best to comply with the myriad of regulations. The regulations should be addressed in the dental school curriculum.

On many of the profession’s online message boards young graduates echo this common theme. They wish they would have received more knowledge with regards to insurance, regulation and the business of dentistry while they were in school. Until only recently dental schools are allowing speakers to talk about money and business with students. My presentation to students titled Dental Biz at Creighton and the University of Iowa was applauded by the students and faculty alike.

CRUSHING DEBT LOAD

You all know about the enormous student debt. Doctors are losing 8 of their primary earning years and 1 compounding of retirement savings. They are leaving school with $300,000 $600,000 in debt for a DDS degree. Become a specialist and add a couple hundred thousand dollars more. In order to adequately service this debt, you will need to own a practice. A new clinic will cost $450-$500 sq. foot. Equipment will run $50,000-$60,000 per op. Add lifestyle debt and you have quite a hole to dig out of. You must gain the knowledge to hit the ground running. In my course bundle I discuss how you can achieve a well-managed and profitable practice. This 3 online course program is downloadable and teaches fundamentals; and is being offered to the first 1000 docs for the student discount of JUST $349 and is guaranteed to help you net $500 -$600K. Your ROI on this is crazy! If you choose not to spend $349 after investing hundreds of thousands for your dental education, I can’t help you. You will be destined to relive continued trial and error and more than likely practice into your 70’s.

This testimony from an attendee of my lecture stated: ”It is hard coming out of school. You don’t know the ins and outs of private practice at all! It took me many years to figure it out on the fly.” – Dentist Cedar Rapids

Dental schools should pay the $349 and give this info to their students in their senior year. They can afford it. Instead, the academics try to teach what they have never experienced.

DENTAL BOARDS

These boards are charged with protecting the public and governing the profession. The majority of state boards have just 5 dentists, a couple of hygienists and a couple of public members. They are allowed to serve many multiple terms. In Iowa, three 3 year terms are allowed. A member can effectively serve ¼ to ⅓ of their career, 9 consecutive years in this capacity. This is far too long, in my opinion. I’d like to see twice as many dentists and hygienists serve on these boards and the term should be no more than two 3 year terms or 6 years in succession. More dentists should be able to serve and I believe they should be voted on by their peers. In my opinion there should be 10-15 dentists serving on state dental boards.

Delays in Obtaining State Licensing is Rampant

Today the board workload has increased exponentially. Dentists across the U.S. are having to wait months to obtain their licenses. Boards meet monthly. Calls often go to answering machines only to be returned several days or weeks later. Many personnel are working from home. Our profession deserves better!

Epidemic of Complaints to Dental Boards! Dentists are their own worst enemies!

There is an epidemic of complaints from patients and dentists today. I have heard from numerous insurance agents in professional liability who report dentists throwing each other under the bus. Dentistry is a profession that requires performing clinical procedures. Constant evaluation occurs at recall. Dentists see each other’s dentistry and often judge the care. They do this without knowing the circumstances that the previous dentist tried to render treatment. The constant criticism of each other needs to stop. I have heard dental students criticizing the work of seasoned practitioners. When I hear this, I correct them and remind them that you never raise yourself up by speaking poorly of someone else. The attempt to discredit each other only lessens the profession. You don’t hear this blatant criticism in other professions.

Dentists: Run Through the Ringer!

Ten percent of dentists each year have a complaint levied against them

I hear from dentists who are literally run through the ringer when any accusation is made. A patient can complain of discomfort after a filling, a staff person can make a complaint, or a dentist makes a negative comment about another dentist in front of a patient or initiates a complaint on their own. Any complaint begins a cascading of investigation, subpoenas, and hearings etc. Lawyers get involved. This is very upsetting to the licensed doctor. These investigations can drag on for a year. Heaven forbid you call to find out the status of a complaint. I remember calling on a dental assistant’s licensing exam to determine her passing only to be told they could not release the information.

Reform is Needed

I understand that there are those occasions when dentists should be sanctioned but it would be helpful if those boards could act in a more expeditious manner. Dentists are doing their best to comply with regulations. Start educating the dental students before they are licensed. The boards have got to get these dentists licensed quickly and board matters addressed in a more timely fashion. Licensed professionals deserve better!!

THE REALITY OF PRIVATE PRACTICE

The mouth is a tough environment in which to work.

Dentistry is demanding. It exerts a physical and mental toll. You have to be able to work at an efficiency and speed that allows you to earn a sufficient profit after expenses. You must do this while providing quality treatment. You are working on patients who are stressed. Studies show this directly affects the dentist by elevating their blood pressure.

Health care is the only industry where production is frowned upon. Dentists with large patient bases are typically the most productive. Some doctors are able to work more efficiently and frankly harder than others. I had some dentists say they did not want to work at a fast pace. While that is their choice, they often make disparaging comments about their successful competitors out of their jealousy. This is unfortunate. In all other industries production is celebrated.

Things are Changing

Advertisements for medical and hospital groups now tout their number of performed procedures. This has come about out of necessity to be able to produce at a high level just to stay profitable.

SELLING

You must be able to get patients to accept your treatment. Yes, you are selling. You are also selling yourself in public to get the patient in the door. Most dentists are introverted. They can be the best clinician but will never get the patient in the door. The patient will often go to the dentist with superior people skills. Remember people buy from who they like. Combine good people skills with a quality clinician and you have a very successful practice.

MANAGING STAFF

You will have to manage staff whether you own or are an associate. I assembled and developed an excellent long tenured staff. This was not without challenges. My advice is to hire for attitude and train, train and train. This requires strong leadership. Employment law is extremely complex. You had better be very careful with how you address staff issues today. It is better to take time and hire the right person however dentists are having a difficult time finding staff to work in dentistry. People can work from home without the licensing regulations and get paid far more in way of salary and benefits.

The Jealous Colleague

If you are fortunate to have a measure of success you will draw criticism. You see that with competitors in most businesses today. Remember 20% in any field are doing 80% of the business. Focus on YOUR practice NOT your competitor. The more they concern themselves with you the farther they fall behind.

We Need To Help Each Other

Why not help each other succeed. I have attended a practice valuation study club for ten years.

This group consists of some of the most successful practice brokers in the country. They share and help each other out. They look at life from a place of abundance not scarcity. The more they give of themselves, the more they get in return. I have seen this as well with the folks in the real estate profession. I just secured my license. What an incredibly positive, helpful and generous group! It was refreshing.

Health Issues

Take care of your health! The exposure to chronic stress each and every day can lead to health problems. Heart trouble, cancer, musculoskeletal, neck and back pain, neurological and substance abuse are prevalent. Watch your diet, and get in the weight room. Cardio is important but weight training and a healthy diet is the ticket to enjoying your retirement years. Reduce your stress.

DENTAL ASSOCIATIONS

Please step up to the plate and help your members. Look at the attendance at state meetings. The attendance has declined each year for the past 25 years. Very few attend the district meetings. Politics has taken over. Join and gain a seat at the table. Power is currently in the hands of a few. If you are waiting for the association to help you will be waiting a long time. I remember trying to initiate a school sealant program and a small few within the association felt threatened and put up roadblocks. Eventually the University was able to begin one but that has since been discontinued. It matters less who gets the credit.

Dentists are on an Island

It’s the independence factor. Dentists are accustomed to going it alone. This makes it hard for them. I urge all dentists to have a network of colleagues to share their trials and tribulations. Practice your faith. I begin each day with a devotional and regularly attend worship service.

During the pandemic when my church was shuttered, Hope Lutheran Church in West Des Moines live streamed. Pastor Mike and staff were a welcome respite. Remember you are not alone. My Faith has carried me through this life. I urge all of you to begin each day being grateful for where you are in your journey. Mind your thoughts. Live in the present and look to the future. Find a hobby or two. It takes your mind off the day to day. Don’t bring your work home. It isn’t fair to continually gripe to your family. Enjoy your family! Before you know it, your kids will be grown.

Stop Complaining! You Chose This Field

As a Student, I remember a group of dental students complaining about all the dental school work. I was in that group of a dozen freshman students. An upperclassman came over to us and told us to shut up. He said: “You chose to do this and he didn’t want to hear it.” That upperclassman was right, life is about choices!

Find a good Mentor

When I graduated, I had a lot of senior doctors who took me under their wing and welcomed me to the profession. I would later extend the favor to other young docs. This is hardly done any more. Competition has divided the profession. Please welcome these young members of our profession and offer to mentor them. There is plenty of work to go around. They need our help more than ever.

Share a post on the Mentoring Dentist

Please share a post of a clinical or practice management tip on this site. You will be helping the next generation. My colleagues ask why I expend all the time and energy in this mission when I should be enjoying retirement? I assure them I am enjoying the youth of my retirement years, but I feel an obligation to give back to a profession that has been good to me. I am most happy when I am contributing and have a purpose to help others. If this mission gains traction; great, if not then I will focus on enjoying my remaining time knowing that I did try to help the next generation. This journey is a challenging one to say the least.

Economic Proposition

Dentistry’s income is not what it once was. Don’t get me wrong, it provides a nice income but that income has stagnated for 20 plus years when you take into account inflation. Dentists are losing ground. Everyone in your office is earning more; EXCEPT YOU! Heck hygienists have moved up in the rankings. Hygienists rank #24, way ahead of dentists.

In my Xtreme Hygiene program you will learn how you can have a profitable hygiene department and show the hygienist how he/ she can earn more while providing excellent care for your patients. A win/ win for all. Much of the material is from my Periodontal Standard of Care lecture that got me recognized by Dentistry Today as a top Clinician in Continuing

Education. 90% OF NON-SURGICAL PERIODONTAL THERAPY CAN AND SHOULD BE TREATED BY THE GENERAL DENTIST. ONLY 30% OF DENTISTS REGULARLY FULL MOUTH PROBE AND CHART. Stress prevention services like sealants. Dentistry was built on prevention, and this should be the cornerstone of a profitable practice. Insurance companies are reducing reimbursements. Delta is no longer writing new premier policies. Wow, the young dentists with the most debt can’t get adequate reimbursement. PPO plans with 25-50% fee reductions are crushing dental practices. Combining the low reimbursements with increasing overhead, it’s no wonder dentistry has sunk to #70. Dentistry is way too hard to not receive adequate pay. There are more dentists who are opting out of the insurance network.

PERFECT STORM: INCREASING COMPETITION

There are more dental schools than at any other time in history. The owner of the largest DSO is opening a school to churn out grads to work for him. Dentists are practicing longer. Age 70-72 is the average retirement age for dentists today.

Increased competition, low reimbursements, higher overhead, and difficulty in finding staff is the perfect storm in our profession. DSO’s and Dental Insurers are the big contributors to dental schools. The deck is stacked.

KNOW WHEN TO EXIT

If you love practicing, continue and simply retire in practice by reducing your days worked. Greg Stanley of Whitehall Management coined the RETIRE IN PRACTICE idea. Greg passed away unexpectedly earlier this year. I am grateful for his wisdom. Many dentists find they can earn as much in 3 days as 4. Heck most people work from home these days and can come for an appointment whenever. I remember offering the occasional evening appointments. Dentists deserve work-life balance. Your staff will demand it. Become more efficient and work less.

MY PERFECT NUMBER

32 Teeth in the Mouth. #32 Norse Football Number. 32 Years in Private Practice.

I knew it was time to retire at age 59. God had Blessed me with a wonderful practice, a loving family and a fine career. I was fortunate to leave before Covid. I miss the patients the most! They were like family! I poured my soul into my practice! I worked extremely hard. I ate, slept and drank dentistry!

I put 42 years in 32. I was tired and ready to be done. Don’t wait too long to hang up the handpiece. By age 60 we have on average 1000 weeks of decent health left to get around and enjoy life. Start enjoying the youth of your retirement years. When I’m not out helping dentists buy or sell a practice or contributing on this site, you can find me in a weight room or enjoying my growing family or taking in the Iowa countryside hunting and fishing and enjoying the solitude! Find your peace.

Dentists want out more than ever

I speak with many dentists, young and old who want to retire ASAP.

I never thought that way when I was young. I spoke with a young dentist a couple years ago at the gym and I asked him how his new practice was going. He shared with me his challenges and frustrations and said many nights he just needed to polish off a bottle of wine. This guy was 5 years out of school. He had a fine practice and a beautiful clinic, but I could sense his stress.

ENJOY THE JOURNEY

A bigger practice isn’t always better. You don’t need multiple practices. Managing multiple practices is hard to do. Believe me, I know! Stop chasing the money and comparing yourself to others. Run your own race. Focus on providing excellent care to your patients and taking care of your staff and the rest will take care of itself! Lighten up and have some fun!! You can own your practice. Get off the DSO treadmill! Do what makes you happy!

Life is too short to work in a career that makes you miserable. If you hate dentistry, get out! There is another field for you. Go find it! We as a profession should have done a better job of communicating the realities. You should have been made aware of the realities good and bad before you ever embarked on your pre-dental curriculum.

Dentistry Can Be A Wonderful Career

I love this profession! I loved being an owner dentist and helping my patients!

We all need to do our part to restore dentistry to its lofty spot in the rankings. I hope you find pleasure and satisfaction in this profession. I am here to help any way I can.

Be Blessed!

Brian James DDS