CHAPTER 1
Career Planning
Don’t confuse having a career with having a life.
Hillary Clinton
Dentists have many professional options to use their skills and training. Some involve ownership, while others are employee situations. In this book, we only discuss practice‐related options. The opportunities include:
- Employment
- Private sector
- Private associateship (non‐owner)
- Corporate employee (non‐owner)
- Industrial research
- Corporate support
- Public sector
- Military/Veterans Affairs
- Public health patient care settings
- Dental education
- Private sector
- Ownership
- Private solo practice (owner)
- Private group practice (owner)
CHARACTERISTICS OF DENTAL PRACTICES
Dental practices are unlike many other service businesses. Most dentists are still in individual practices, with few colleagues with whom to confer. They must personally deliver the service, which involves hard physical work. They cannot delegate most procedures and must be personally present for the procedures that they do delegate. This means there is little managerial leverage, so the dentist cannot play golf while the office operates. There is no managerial progress. Someone cannot work their way up the management line to become a regional manager or vice president. Most new graduates come to the workplace with high educational debt and must include that in their practice debt finance plan. Dentists’ earnings typically peak at 45–50 years of age. After that, the physical nature of the work causes them to decrease the number of patient visits. Often dentists then look to add associates or plan to sell their practices. The question is whether to sell at the peak of the income‐generating potential (and therefore at the highest price) or to “milk the cow” and take income from the practice as they continue to slow down.
COMMON MYTHS ABOUT DENTISTRY
There are several misconceptions about dentistry that will influence career choices.
DENTISTRY IS EASY MONEY
Many people outside the profession view dentistry as an easy way to make a lot of money. Although dentistry is still one of the more lucrative professions, those in the profession know it is not easy to make money. Dentistry is physically demanding work. Dentists often work long hours in contorted positions to make patients comfortable. Back and neck problems, repetitive motion injuries, and eye strain are common problems of seasoned dental practitioners. Dentistry is also emotionally demanding work. Many patients fear dental procedures or have unrealistic expectations about their desired outcomes. Staff members may have personal problems or interpersonal disagreements that affect the work environment.
A DENTIST MAKES MORE MONEY OWNING A PRACTICE
Dentists might make more money if they own their practice. Practice ownership requires knowledge, skills, and abilities that not all dentists have. Additionally, owner–dentists need to spend time and emotional energy to operate the business side of effective practice. Not all dentists want to do this. Some are excellent clinicians but do not want the extra problems of ownership. They want to treat patients, not worry if the hygienist and assistant have interpersonal problems or fret about the changes in a local employer’s dental insurance plan. These dentists are best off working for someone else, letting the owners worry about the management of the practice. They can make more money treating patients if they work with someone good at managing a practice or a network of practices. Someone who is excellent clinically, behaviorally, and managerially and loves all aspects of running a practice can make more money owning it.
BIGGER IS BETTER
Many dentists believe that a bigger practice is better. Personal wants, needs, and desires might lead someone to a smaller, more personal practice better suited to their temperament. A larger practice is not necessarily a more lucrative practice. Profits come from using the practice’s resources to the maximum amount possible, regardless of size. A small practice can be as profitable as a large one. However, an extensive, well‐run practice does have some advantages if the owner has the managerial expertise to make this larger and more complex business entity use all its resources effectively. A larger practice might show a higher profit if well run. A bigger practice may weather economic downturns more easily. When sold, larger, more profitable practices bring a higher price, although sometimes finding a buyer for these large practices is difficult.
STUDENT DEBT MAKES IT IMPOSSIBLE FOR A DENTIST TO BORROW MONEY TO BUY A PRACTICE
Dental graduates are carrying higher levels of student debt than before. Changes in the student loan programs have made it more difficult to consolidate these loans at low interest rates. Tax law changes have limited the amount of student loan interest graduates can deduct. Nevertheless, dentistry is still one of the higher‐income professions. Banks and other lenders who make start‐up and buy‐out loans to dentists understand these problems. They will work with dentists to develop loan packages if the practice can support the cash flow needed to pay all expenses, including student loans. Not all practices will be profitable enough at a price that can support the cash flow required to make all the payments, however. This can result from the practice price being set too high, high overhead in practice, or the financial characteristics of the potential buyer. A graduate who does not have a high loan burden or who has a spouse who earns a significant income may show cash‐flow needs that are much lower. This dentist may qualify to borrow for a practice purchase when someone else would not.
PUBLIC HEALTH IS FOR DENTISTS WHO CANNOT MAKE IT IN PRIVATE PRACTICE
It has become part of the professional culture that “good” dentistry is exquisitely done (expensive) reconstructive dentistry. True, dentists in the public care sector may not do much complex reconstructive dentistry because the organization’s purpose is to provide more basic services to a larger clientele. This does not make dentistry or the dentist’s application of their hard‐earned skills of less quality or less critical. The public sector provides valuable services to a large segment of the population. Many dentists find satisfying and rewarding careers by devoting their skills to this style of practice.
A DENTIST DOES NOT HAVE TO TAKE INSURANCE PLANS IN PRACTICE
If a dentist is in a private ownership position, they make all the management decisions. Long‐term, insurance‐free practice is the goal of many practitioners. However, most do not get there. It takes a combination of location, clientele, management, clinical expertise, and time to develop a practice that does not participate in dental insurance plans. Someone may take plans in the short term with the aim to wean off them as they build a private clientele. As the economic environment and insurance industry change, more practices find the need to participate in insurance plans.
A DENTIST WILL BE IN THE SAME OFFICE THEIR ENTIRE CAREER
This used to be more accurate than it is today. In the past, the graduate would open or buy a practice and then build it over the years, and they would be in an ownership position immediately after graduation. New graduates today may work in several professional situations before arriving at their final practice setting. With the increasing number of employment opportunities, many dentists never reach an ownership situation, choosing to do clinical work in non‐ownership positions for their entire careers. The old notion that private practice is the only good form of dentistry is dying out.
CAREER PATHS
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