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Practice setting may determine dentists' satisfaction, research shows

July 30, 2015

By Kelly Soderlund

Big or small, there are pros and cons to working in various dental practice settings, and dentists measure their career satisfaction in different ways.

The ADA Health Policy Institute released a study analyzing dentists' job satisfaction within different practice settings, finding that those working in small group settings reported the highest overall career satisfaction.

Dentists working in large group settings reported more satisfaction with income and benefits than dentists in solo practices, as well as less stress compared to dentists in solo or small practices, according to "Practice Settings and Dentists' Job Satisfaction," which was published in the August issue of the Journal of the American Dental Association. The authors, Anthony T. Lo Sasso, Ph.D., a professor at the University of Illinois at Chicago School of Public Health; Rebecca L. Starkel, ADA senior research analyst; Matthew N. Warren, ADA manager of forecasting and analytics; Dr. Albert Guay, ADA chief policy advisor emeritus; and Marko Vujicic, Ph.D., ADA chief economist and vice president, believe this study comparing the levels of dentists' satisfaction in different practice settings is the first of its kind.

HPI also released two additional studies on group practices, with one finding differences among two types of large group practice settings and the other discussing the growth in large dental practices' market share.

The results were based on survey responses from 2,171 dentists from large group, small group and solo practices who answered questions about their satisfaction with income, benefits, hours worked, clinical autonomy, work-life balance, emotional exhaustion and overall satisfaction. Each practice setting has characteristics that could lead to dentists feeling more or less satisfied, according to the study.

"In large practice settings, providers may lose autonomy and feel enhanced pressure to produce revenue when making treatment decisions," according to the authors. "They may have less flexible hours and schedules that could cause dissatisfaction. Conversely, they may benefit from administrative assistance, which can allow for having more predictable income and hours. Dentists working in solo or small group practices may have more autonomy; however, they are not immune to pressures to produce revenue, and they may have to perform more administrative tasks on top of their clinical duties. Running a small business may not suit every dentist; the burdens of financing, fixed costs and reimbursement could lead to dissatisfaction even among dentists in solo practice."

The authors believe that knowing what to expect in different practice settings may help dentists choose the best one for them or it could help manage their expectations if their choices are limited.

"Maintaining satisfaction with one's practice setting may be one way for a dentist to perform at his or her best, both clinically and interpersonally," the authors wrote. "Each setting has advantages and disadvantages; the 'best' practice setting for a dentist depends on that dentist's personal preferences."

HPI released a companion research brief, "Job Satisfaction Among Dentists Varies by Type of Large Group Practice Setting," that showed that dentists who work in a large group practice contracted with a dental management organization were less satisfied and reported lower incomes.

This was compared to their peers working in large group practices owned and operated by dentists. Nearly one-third of dentists under a management company reported incomes between $100,000 and $149,999, while one-fifth of dentists in practices owned and operated by dentists reported incomes of $300,000 or more, according to the research brief.

The authors emailed a survey to 5,208 dentists, receiving responses from 183 dentists in dentist-owned and -operated practices; 655 dentists under a dental management company; and 27 from other types of large group practices.

The results also showed that dentists in large group practices operated by a dental management company reported they spent, on average, one hour less per week on nonclinical tasks.

"Earning a lower salary has the potential to decrease satisfaction, whereas spending less time on nonclinical tasks could increase satisfaction," the authors wrote. "Depending on which aspect is more important to a given dentists, the dentist may decide one type of practice setting is a better fit or him/her than the other."

Dentists who worked for a practice that contracted with a dental management organization were more likely to report that they feel emotionally drained from dentistry and the experience of working in their primary practice has changed how they feel about dentistry in a negative way.

"They were less likely than (dentists in a dentist-owned practice) to agree that they would make the same decision to go into dentistry, knowing what they know now and that their current practice situation was what they envisioned when they chose to become a dentist," the authors wrote.

There were some similarities between the two groups. Both categories of dentists had a similar likelihood to feel stressed at work and to be satisfied with the care delivered in the practice. They also both reported similar levels of satisfaction with working hours, schedules and overall work/life balance.

A third study, "Very Large Dental Practices Seeing Significant Growth in Market Share," found that from 2002 to 2012, market share increased for dental practices with 20 employees or more, while dental practices with fewer than five employees experienced a decline in market share.

During the same period, large group practices also saw increases in number of establishments, number of employees and annual receipts.

Market penetration of very large practices, with 500 employees or more, varies by state, with a low of none in seven states to a high of 7 percent in Florida.

To read the JADA study, visit JADA.ADA.org. To read the companion research briefs, visit ADA.org/researchbriefs.