Chapter 23

Career Planning

Don’t confuse having a career with having a life.

Hillary Clinton

Characteristics of Dental Practice

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 can not delegate most procedures and must be personally present for the procedures that are delegated. This means that there is little managerial leverage, so the dentist cannot play golf while the office operates. There is no managerial progress. The dentist can not work his or her way up the management line to become 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 to 50 years of age. After that, the physical nature of the work causes them to decrease patient visits. Often dentists then look to add associates or plan to sell their practices. Their quandary 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 that 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 that it is not an easy way to make money. Dentistry is physically demanding work. Dentists often work long hours and in contorted positions to try 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 are fearful of dental procedures or have unrealistic expectations about the outcomes they want. 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 own 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 an 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 are having interpersonal problems or fret about the changes in a local employer’s dental insurance plan. These dentists are best off working for someone, letting the owners worry about the management of the practice. If they work with someone who is good at managing a practice or a network of practices, they can make more money treating patients. The dentist who is excellent clinically, behaviorally, and managerially, and loves all aspects of running a practice can make more money owning his or her own practice.

Bigger Is Better

Many dentists believe that a bigger practice is better. Personal wants needs and desires might lead a dentist to a smaller, more intimate practice that is a better fit for his or her temperament. A larger practice is not necessarily a more lucrative practice. Profits come from using the resources of the practice to the maximum amount possible, regardless of the size. A small practice can be as profitable as a large one. However, a large, 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 of 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 that 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 of the payments. This can be the result of the practice price being set too high, high overhead in the practice, or 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 another dentist would not.

Public Health Is for Dentists Who Can Not 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 a significant amount of complex reconstructive ­dentistry because the organization’s purpose is to provide more basic services to a larger clientele. This in no way makes the dentistry or the dentist’s application of their hard-earned skills any less quality or less important. 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

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