Table of Contents

Implants

Inside Dentistry

November/December 2006, Volume 2, Issue 9
Published by AEGIS Communications

The Dental Career Path: Did You Choose the Right Profession?

Forty-two years ago, Hermey the Misfit Elf from the animated seasonal classic Rudolph the Red-Nosed Reindeer wanted to be a dentist. One of the outcasts on the “Island of Misfit Toys,” his professional dream was the brunt of jokes and the cause of laughter among his companions.

Well, he who laughs last laughs best. Be a toy maker or be a dentist? Considering the many changes that have shaped and benefited the profession since 1964—and especially given the new millennium’s awareness of and respect for what modern dentistry can do—Hermey did, in fact, choose the right profession. And he probably laughed himself all the way to the bank, too.

“There are very few doctors in the country who can’t do well today in dentistry,” explains Roger P. Levin, DDS, chief executive officer of Levin Group. “Those who are doing well often become motivated to do better—to reach their potential—and they are doing excellent dentistry. So, the income potential in dentistry has never been higher.”

According to the American Dental Association (ADA), in 2003, the average earnings for a general dental practitioner who owned his or her practice was $177,340. The average earnings for a specialist was $300,200. What’s more, the average income of a dentist ranked in the highest 5% of US family incomes.1 Compare those figures to what some counterparts in the medical field are earning and, well, Hermey’s choice really wasn’t bad at all.

“The profession is in one of those great dynamic states. There is genuine excitement about advances in science and technology and the oral-systemic health connection, which is fueling—in part—a new understanding about the role of the dental professional in an individual’s overall health,” observes Dominick DePaola, DDS, PhD, president and chief executive officer of The Forsyth Institute. “This excitement about the profession is even reflected in the income of dentists, which is probably at its highest peak ever. So, it’s the ideal profession to be in right now, with an enormous, continuing upside potentially in terms of health and wealth.”

In fact, from 2000 to 2002, the average income for dentists (both general practitioners and specialists combined), increased steadily. In 2000, the average income was $183,050; in 2001, it was $191,690; and in 2002, the average income was $193,980.2

So, if you had to decide upon your profession all over again, would dentistry still be your choice? Although the answer is very much based on personal experience, it might also be qualified with basic comparisons to other professions. Regardless, a look at today’s dentistry and what’s in store for the future suggests it’s a profession that’s not in a Golden Era, but rather a Platinum one. Here’s the Inside look at some of the factors—a consumer emphasis on esthetics, remarkable advancements in technology, breakthroughs in research, and changing population demographics—that are making dentistry the “primo” profession.

The Profession-at-a-Glance
Obviously, it took a great deal of time and effort to get you to where you are today. Dentistry requires 4 years of predoctoral education in a program accredited by the ADA’s Commission on Dental Accreditation; passing the National Board Dental Examination (Parts I and II); and passing a state or regional clinical examination in order to obtain licensure and practice as a general practitioner.3 No postgraduate education is necessary except in the state of Delaware, which requires a 1-year general practice residency. However, to practice as a specialist, education programs of 2 to 4 years are required, and General Practice Residencies (GPR) and Advanced General Dentistry Education (AEGD) programs are also available.3

Based on 2004 statistics, dentists held approximately 150,000 jobs that were distributed among general practitioners and specialists (Table).4 The US Department of Labor Bureau of Labor Statistics says that most dentists work between 4 and 5 days a week for between 35 and 40 hours.4 Some dentists may work evenings and weekends to accommodate their patients’ needs, and most are solo practitioners.4 Of dentists in private practice, 78% are sole proprietors and 14% belong to a partnership.

Levin explains that most dentists want to own their practice and don’t mind working “alone.” Those working 3.5 to 4.5 days a week, on average, may also teach, he says. Where dentists may be “shifting” in terms of their practices is in their focus, such as from general dentistry to doing more implants.

“What we are noticing is niche interest in practices,” Levin says. “A dentist will want to focus more on one area, take his or her CE courses in that area, and then cultivate more patients in that area.”

When first establishing their own practices, some dentists may work longer hours; more experienced dentists may work fewer hours. The Bureau notes that many continue in part-time practice beyond their usual retirement age.4

“My partner and I both work a 4-day work week,” explains Paul G. Kost, DMD, a dentist in Lawrenceville, NJ. “We are able to refer specific procedures between each other—for example, my partner excels in endodontics—and there are many efficiencies that we share, such as office space, staffing, and emergency calls. This situation has enabled us to work the way we do and still offer a lot of access to patients.”

My Profession Looks Different Than Yours

Yes, there are similarities between dentistry and medicine in terms of what it takes to get there, but there are also significant differences. For example, physicians are not required to take a clinical examination for licensure, whereas dentists are.3 However, medical professionals must complete from 1 to 3 years of graduate medical education before they’re eligible for full, unrestricted licensure. What’s more, dentistry does not have a comprehensive assessment process comparable to medicine’s Post Licensure Assessment System.3

Once upon a time, physicians of all types earned more—perhaps a lot more—than dentists. Today, the gap has narrowed to the point that there are many dentists out-earning their primary care colleagues on the medical side. While medical specialists can still earn significant incomes, dental specialists are also in a position to out-earn many physicians.

The Bureau of Labor Statistics notes that based on 2005 data, the mean annual wage for those professionals listed in the Physician/Surgeon/All Other category was $138,910.5 The same year, the mean annual wage for Family and General Practitioners was $140,370, and for Internists, $156,550. Number of years in practice and geographic location contribute to earning potential.

But, equally important, some dentists also are experiencing a greater professional satisfaction level that’s derived from delivering high-quality, personalized care in a setting that medical managed care may not allow. At this point in time, dentists are in a position in which they are not overly burdened by the insurance industry—meaning, reimbursements—in the same way that their medical counterparts are, DePaola says.

In this regard, Chris Stevens, DDS, a general dentist in Sun Prairie, Wisconsin, finds that dentistry is a health care field that provides the independence and autonomy that many professionals desire. Stevens began as a general practitioner but later became interested in and studied craniofacial pain and complex/ comprehensive restorative processes. He now also lectures and teaches the techniques he uses in his practice.

“When I hear my friends in medicine complain about reimbursements, hours, and lack of control over their practice, it makes my decision to practice dentistry even sweeter,” Kost admits. He was accepted into medical school at the age of 16 but decided on a career in dentistry instead. Now having been in dental practice for 21 years, Kost says his satisfaction level is extremely high and his motivation is the excitement his patients experience when the final treatment results match their expectations.

Based on those dentists with whom his firm consults—as well as those he interacts with personally during seminars and lectures—Levin classifies dentists into three levels based on their performance and satisfaction. The first level encompasses dentists who are not doing very well; they may be earning a living, but their practices aren’t where they would like them to be. The second level represents the dentist who is doing well financially—which would be the majority of dentists out there, Levin says—and for them, the issue is reaching their full potential. The third level includes those dentists who have phenomenal practices, are doing extremely well financially, and are now looking to re-systemize the practice in order to best deal with stress, create a smoother work flow, and enhance profitability.

From Needs To Wants & Other Changes

The ADA says the increase in dentists’ incomes in recent years can be attributed to three key factors: general inflation, increased productivity, and an increased demand for dental services that’s being driven by greater per-capita income and a higher overall educational level of the population. In terms of the latter point, in particular, Kost notes that patients now have a greater knowledge base—most likely from information that’s available on the Internet—so they are asking for more types of procedures than before.

“Personal income has gone up for dentists, which is wonderful,” Levin observes. “The supply and demand in dentistry is good.”

In fact, according to Robert W. Baird & Co, Inc, a global investment research and banking firm that analyzes the dental industry, the US dental market is being driven by a strong and consistent demand for products and services.6 Growth is projected to continue in the 5% to 7% range between 2006 and 2015, and increasing demand for specialty and esthetic dentistry on the part of patients will contribute to this trend.6

“Patients have availed themselves of sources of information for learning about the options that are possible today, so they come into the dental office much more informed,” Kost says. “By offering the technologies and services that patients see in other marketing sources, we can basically fill the void created by their new wants.”

Stevens, who’s been practicing dentistry for more than 25 years, cites the information age among the biggest contributors to changes in dentistry, with effects similar to those observed by Kost. In particular, he recognizes that there is more of a want for dentistry than a need these days.

“People are savvier about what they’re looking for,” Stevens says. “They are asking about procedures they want instead of us telling them about procedures they need, and that is very encouraging. People are more accepting of dentistry when they are getting what they want.”

However, what’s happening in terms of the public’s demand for basic, advanced, and wants-based dental care is partially the result of specific demographic changes that aren’t likely to ease up any time soon. For example, the greatest demographic changes include the aging of the population and an increase in minorities. In terms of oral health implications, DePaola notes for example that oral cancer is much more prevalent in African American populations than Caucasian populations, and the Latino community has a higher proportion of people with diabetes who in turn may experience complications from periodontal disease.

Additionally, the ADA says the population in the Sun Belt is growing faster than the population in other parts of the country. The population, overall, is becoming more urban, although the non-metropolitan population is also growing.

“Patient needs are changing because the demographics of society continue to change,” explains DePaola. “People are living longer. Populations that are elderly are getting larger. Minority populations that have special needs are increasing in proportion.”

Why Dentistry’s Taking Center Stage

An example of the effect of this changing demographic is the increased demand for cosmetic dentistry. This, DePaola says, has been fueled in part by baby boomers who want to continue to look young, feel vibrant, and maintain a healthier lifestyle. Maintaining their dental health—and appearance—is part of that process.

However, going hand-in-hand with this youthful lifestyle is an overriding desire to live longer, and that feeds an awareness of systemic disease. DePaola says this segment of the population is aware of their risk factors for disease more than ever before.

“All of the services now available in dentistry—such as cosmetics and implants—are being seriously considered by more patients as solutions to staying healthy,” Levin says. “Consumer awareness of dentistry has risen dramatically, and the public is beginning to get more interested in dentistry as a result of corporate and organizational advertising and public relations campaigns—such as those from the American Academy of Cosmetic Dentistry.”

But what’s also contributing to greater personal and professional satisfaction among dentists—as well as an elevated sense of respect for dentistry as a profession—is the fact that dentistry is moving from being a surgical profession to a healing profession. Clinicians are assuming the diagnostic, intervention, management, and prevention responsibilities that accompany that status.

“One of the anecdotal things that has been said for a long time is that if a patient doesn’t have good oral health, then their systemic health falls greatly behind, whether it’s a loss of dentition—which interferes with digestion, or an inability to communicate or survive in a social world,” explains Scott Dr. Benjamin, DDS, a practicing dentist from Sidney, New York. “I am really excited about dentistry’s ability to enhance a patient’s quality of life because we are able to see more than we ever have and much earlier than we ever could.”

For example, Benjamin notes that because technologies have now been incorporated into the dental practice that enable early diagnostics and interventions, clinicians can make reversible changes to the oral environment. These may include remineralizing the effects of carious breakdowns or discovering potentially malignant diseases before the situation requires an invasive or life-changing process for the patient.

How To Stay Satisfied

Stevens speculates that those who are having difficulty in dentistry are probably those who don’t search for education. A teacher himself, he finds his own need to be well-versed and up-to-date a source of “fuel and excitement” as much as the teaching role.

Given the opportunities facing the profession today (See Today’s Challenges Equate to Tomorrow’s Opportunities, page 56), pursuing additional professional avenues in dentistry might be what the doctor ordered if you’re feeling less than satisfied. According to Gerard Kugel, DMD, MS, PhD, the associate dean for research at Tufts University School of Dental Medicine and a practicing dentist, clinicians who are not satisfied in their careers need to take a step back and reflect on why that may be. Perhaps they are “standing still” and really need to get their feet moving in a new dental direction, he says.

“My sense of people who are not satisfied with their careers is that they should be more involved with organized dentistry and continuing education,” Kugel suggests. “It might be helpful to look at what they feel is deficient and try to improve those clinical skills to make their practices more exciting.”

He explains that there isn’t a minute that goes by that he isn’t considering what else he himself could learn, whether about occlusion, conscious sedation, or implants, for example. Taking a class in an area that you’re not strong in, Kugel says, is a great way to reinvigorate yourself.

Levin also notes that dissatisfaction can result from the frustrations associated with just running a practice. In particular, he says that dentists are more tired than ever before because they’re seeing more volume than ever before.

“What’s happening is counter-intuitive,” Levin says. “The business side of the practice and the pressure to earn enough money to fund lifestyles is creating tremendous stress. This depletes satisfaction at a time when we can be doing a better job than ever before.”

Conclusion

According to the ADA, advancements in dental technology (eg, digital radiography, laser systems, and informatics) will enable dentists to provide more effective treatments and practice more effectively.1 Simultaneously, new information about the relationship of oral health to general health will make dentistry an important health care profession for the future—both as a career and in terms of patient perception.1

“We are in one of those interesting and remarkably exciting areas where dental professionals have the capabilities of dealing with colleagues in the medical profession in ways we’ve never dealt with them before,” DePaola believes. “We’ve become much more a part of the fabric of the health care profession than just standing on the outside looking in.”

At the same time, increasing numbers of older adults will keep their teeth longer, there will be greater awareness of oral health care, and a greatly increased demand will develop for cosmetic services (eg, bonding).1 Combined, these factors will create a positive, vibrant future for dental professionals and those who choose to pursue a career in this area of health care.

“I think it’s just a wonderful time to be in dentistry,” believes Stevens. “There are so many opportunities to help individuals at all levels—from individuals who need urgent care to those who need comprehensive oral rehabilitation. Any level of quality care can truly impact our patients.”

So, did you choose the right profession? Based on our experts’ insights, we’d say “yes!” There’s incredible potential for professional satisfaction by delivering quality care. Clearly, compared to other health care professions, there’s excellent income and lifestyle potential. From a demographic standpoint, dentistry is a tremendously strong profession that will continue to do well moving forward.

“I think this is probably one of the single best professional industries that someone can go into,” Levin asserts. “With the right planning as early as possible in as many personal and professional areas as possible, dentists can have successful and rewarding careers for a long time.”


1 American Dental Association. www.ada.org/public/education/careers/dentistry_fact.asp

2 American Dental Association Survey Center. 2003 Survey of Dental Practice.

3 Dental and Medical Education and Licensure in the United States: A Comparison. American Dental Association Council on Dental Education and Licensure. December 2001.

4 US Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook, 2006-07 Edition. www.bls.gov.

5 www.bls.gov

5 Wong SS. Dental Industry: The Wall Street View. Dental Trade Alliance Annual Meeting; July 2006.

SIDEBAR 1

Today’s Challenges Equate to Tomorrow’s Opportunities
The demand for qualified dental professionals is increasing. The American Dental Association (ADA) projects that large numbers of dentists will retire in the next 20 years and new dentists will be needed in private practice, as educators and researchers, and in public health dentistry.1 Research must continue and move forward, dental schools are in need of more faculty and students, and as society changes and reshapes its needs and wants, the dental profession must continue to evolve in order to satisfy those demands. Without question, regardless of which area of professional dentistry you chose, promising possibilities await you.

IN PRIVATE PRACTICE

The US Department of Labor Bureau of Labor Statistics says that employment for dentists is projected to grow about as fast as average for all occupations through 2014, and most positions will result from the need to replace the large number of dentists expected to retire in the near future. Overall, job prospects should be good for the dental profession, with new dentists assuming responsibilities for established practices or starting their own.

“I think the future of dentistry, in my opinion, is very bright,” believes Paul G. Kost, DMD, a dentist from Lawrenceville, NJ. In fact, he’s so positive about his chosen profession that he actively encourages high school students to consider dentistry as a career. “Some of those students have come to our practice for internships and worked summers in our office to get a feel for what dentistry is truly like. Many of them are now dentists today.”

Chris Stevens, DDS, is another example of a dental professional who has taken the time in his years of practicing to mentor and encourage others to consider dentistry as a profession. Throughout the years, numerous individuals have “job shadowed” at his practice—whether at the high school or college level. To date, between 8 and 12 individuals have entered the dental profession as a result of those efforts, he says.

IN THE CLASSROOM

“It is very difficult to recruit faculty into dental education, and it’s very interesting,” says Dominick DePaola, DDS, PhD, a former dean at such dental schools as the University of Texas Health Science Center at San Antonio Dental School, Baylor College of Dentistry, and the New Jersey Dental School. “With all of the great scientific advances taking place today, it’s probably the most exciting time in history to be a dental school faculty member.”

There are breakthroughs surrounding our understanding of the human genome and how that knowledge can be applied to molecular medicine. The use of saliva as a diagnostic and preventive tool is becoming reality. Dental schools need to incorporate these new scientific technologies into the curriculum, DePaola says, so that they become a part of the thinking and utility of tomorrow’s practitioners.

“The greatest challenge facing the dental profession is trying to be as contemporary as it can be,” DePaola asserts.

Therefore, in today’s classrooms, students are learning from not only dentists, but from pharmacists, registered nurses, physicians, and others largely due to the fact that it creates a more well-rounded atmosphere and an enriched curriculum. At some schools, traditionally “medical” departments are now reporting to the dental school in order to better integrate new models of care and disease prevention.

According to Gerard Kugel, DMD, MS, PhD, associate dean of research for Tufts University School of Dental Medicine, dental school students today must also realize that graduation is—in some ways—the beginning of a new era of their education, not the end of it. The 4-year dental school curriculum has even more material in it today than it did 30 years ago, which suggests a profession that is dynamic and progressive.

“Graduates should look forward to a lifetime of education and embrace that fact,” Kugel says. “How disappointing would it be if you had a career in which you graduated from a 4-year college and never had to learn anything else? You’d be bored. I like the idea that we have to keep learning, and students need to be aware of that.”

What’s more, Kugel says, more and more dental schools are teaching students how to be business people as well as dentists. A traditional complaint of graduates was that they didn’t learn how to run the business of their practices.

“So, not only is it important for dentists to understand technology and their treatment options, but they also need to have a sense of how to manage a business,” Kugel explains. “I think schools are certainly doing a better job of emphasizing the importance of the business aspects of dentistry, too.”

IN RESEARCH ENDEAVORS

Dental schools also have a responsibility to teach students the importance of research and most often play a role in furthering the advancements available to the profession. Continuing the scientific endeavors requires support in order to translate discoveries into practice so that, ultimately, patients benefit.

DePaola says that it still takes about 17 years for an average discovery to reach the practitioner’s hands. “The good news is that we have unbelievable opportunities for new growth in science and technology,” he explains.

IN PROVIDING BETTER ACCESS TO CARE

Not only are many in dentistry seeking out ways to support the educational infrastructure of the profession, but they’re also working to enhance access to dental care for those who are underserved. Today, that endeavor involves reform and coordination of multiple agencies, including government, not-for-profit, and public schools. Today’s changing demographics serve as a reminder of the need for concern and consideration. Oral health conditions that go unchecked or untreated will affect the population’s overall health and quality of life in the years to come. The level of insufficient dental benefits (through services such as Medicare and Medicaid) is increasing, and economically depressed areas of the country are suffering from a lack of available dental professionals. Members of the private and public sectors of dentistry must continue to work together to make oral care resources available to those who need them most.

1 www.ada.org/public/education/careers/dentistry_fact.asp

SIDEBAR 2

Technology & Dentistry’s Twist of Fate

Technology has infiltrated all aspects of today’s society—corporate America, home life, education, you name it. Thankfully, dentistry is no different, and innovative technologies and their application to oral health are making it easier than ever to provide enhanced care to patients. In fact, in many respects, the technologies and innovations in today’s practice have moved dentistry away from being a surgical profession to being a healing profession.

“The new diagnostic technologies that have come into dentistry basically enable clinicians to discover, detect, and manage oral diseases at the earliest possible stages—anything from caries to oral cancer,” explains Scott D. Benjamin, DDS, a practicing dentist from Sidney, New York. “These are probably the most rewarding to have hit dentistry because they have the potential to drastically improve the quality of care with minimal involvement, rather than requiring an extensively involved case.”

As Inside Dentistry has reported previously, the use and incorporation of new tools and technology is encouraged and expected, but a healthy dose of due diligence is also necessary. Rather than abandoning old techniques and equipment for new procedures, it’s important to take into consideration what benefits the technology brings forward and what others have experienced with the product, as well as what research has concluded.

“The key to integrating technology,” Benjamin explains, “is ensuring that it improves the quality of care or the efficiency with which quality care is delivered to patients. That is where all technology needs to be. If it doesn’t serve those functions, then it doesn’t do anything except drive up the cost of care.”

But perhaps the biggest change to result from all of dentistry’s technological developments is the change of choice—the choice of how to approach treatment. Whether a patient is receiving all-ceramics or a porcelain-fused-to-metal restoration for a specific indication is just an example of the many options to be considered compared to just 10 years ago. Similarly, the choice of what type of antibiotic or local anesthetic to use is a product of technology.

“One of the biggest things to change in the profession is the variety of materials available,” observes Chris Stevens, DDS, a practicing dentist and lecturer from Sun Prairie, Wisconsin. “The materials that I have today—adhesive systems, restorative systems—are just fabulous compared to what I had when I started practicing. Certainly we thought we had some good products, but the people who developed the enhancements we have today have done dentistry and our patients a wonderful service.”

Computers in the office and operatories, digital radiography, intraoral imaging, and CAD/CAM chairside restorations have all changed the face of dentistry dramatically in as little as 20 years. But with those changes, emphasizes Gerard Kugel, DMD, MS, PhD, comes a need for education in the appropriate use and application of that technology.

“New technology opens up tremendous opportunities, such as being able to provide an all-ceramic crown while a patient is sitting in the chair,” he explains. “But that opportunity requires the clinician to learn how to use that technology, so there is a need for the dentist to absorb more information.”

SIDEBAR 3

The Inside Look FROM...
Issue after issue, the feature presentations in Inside Dentistry deliver coverage of relevant topics specifically affecting the dental profession, as well as oral health care in general. The publishers and staff could not bring the underlying concerns surrounding these timely issues to the forefront without the insights shared by our knowledgeable and well-respected interviewees. For their collective generosity of time and perspectives, we extend our sincere gratitude.

Academia

Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine
gerard.kugel@tufts.edu

Research

Dominick DePaola, DDS, PhD
President & Chief Executive Officer
The Forsyth Institute
ddepaola@forsyth.org
Private Practice

Scott D. Benjamin, DDS
Sidney, NY
SBenjamin@DentalAIM.com

Paul G. Kost, DMD
Lawrenceville, NJ
paulkost@aol.com

Christopher Stevens, DDS
Sun Prairie, WI
cjs@thebestsmiles.net

Industry Analyst

Roger P. Levin, DDS
CEO
Levin Group
rlevin@levingroup.com

Acknowledgment

The author would like to thank Merissa K. Petrosino, a researcher and writer for Crème della Crème Copywriting & Communication, for her invaluable contributions to this presentation.