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New Dentist Committee studies group practice models

April 09, 2012

By Karen Fox, ADA News staff

Some see new dentists and their unique needs as one of the factors driving the growth of large group practices, and the ADA New Dentist Committee wants to know how the ADA can be relevant to dentists in this career type.

To find out, the committee held a mega issue discussion during its January meeting titled, What are the Opportunities and Challenges of Corporate Dentistry for New Dentists Today?
"The ADA is relevant and important for all dentists in this practice setting."Dr. Ruskin:

“New dentists are seeking employment opportunities with flexibility, mobility and practice management experience early in their careers, and this is a very fast growing option,” said Dr. Danielle Ruskin, chair of the ADA New Dentist Committee.

“I believe that whatever practice setting a dentist chooses we all could find common ground on the need for advocacy and the desire for all new dentists to provide quality patient care,” said Dr. Ruskin. “We understand why people make this career choice, and we’d like to find out what the ADA can do to help them. The ADA is relevant and important for all dentists in this practice setting.”

The New Dentist Committee identified a number of reasons why large group dental practices may appeal to new graduates:

  • Student indebtedness is a barrier to early practice ownership.
  • Traditional practices are not absorbing new graduates due to the recession. There are fewer jobs for new grads, but large group practices are hiring.
  • There are more dual profession families, and married professionals may require mobility that practice ownership does not allow.
  • Other lifestyle choices are being considered, such as the desire to help others, and the quest for work/life balance leads to practice choices that do not focus on the responsibility of growing a small business.

New dentists who have experience working with large group practices were invited to give their perspectives at the New Dentist Committee meeting in January.

Dr. Heather Maupin, a Plainfield, Ind., dentist and member of the ADA New Dentist Committee who graduated from Indiana University School of Dentistry in 2004, found many benefits to this career option, such as mobility in the early years and the ability to build leadership and practice management skills. She worked for two different groups—one for five years, the other for only a few weeks—and launched her own start-up practice two years ago.

The experience gave her the recognition that private practice was her ultimate goal. “It was good for me at the time. I stayed longer than I wanted to but I don’t regret it,” said Dr. Maupin. “They taught me to run a practice.”

Among the advantages, Dr. Maupin said she had opportunities to pursue continuing education in sedation dentistry and Invisalign. The practices she worked for also required her to review financial documents and supply inventories—compelling her to make decisions about running a practice that she didn’t learn in dental school.

“I think that for new dentists coming out and considering working for a large group practice, you really need to ask questions about contracts and expectations,” said Dr. Maupin. “There were times when I felt like I was being scrutinized about production and it wasn’t my experience that I could leave the pressures of the practice at the end of the day either.”

Dr. Frank Henrich of Tulsa, Okla., was another panelist at the New Dentist Committee meeting. Dr. Henrich came into dentistry as a second career—his first was as a medical technologist—and graduated in 2009 from the Virginia Commonwealth University School of Dentistry. He is married with three children, the youngest born the same month that he graduated from VCU.

Coming out of school more than $200,000 in debt as a father of three children was a “huge weight,” he said. Dr. Henrich thinks people don’t understand how necessary an option large group practices are for new graduates.

“I wasn’t looking for a position for just a couple of days a week; I needed steady income,” said Dr. Henrich. “From my experience, group practices provide that safety net to graduates. You can treat patients and have a decent income.”

A large group practice was not his first option, he said. He tried to purchase a practice in 2009 in the midst of the financial market collapse, but securing funding became an obstacle. He now works for MyDentist Corp., a company with group practices in Oklahoma, Missouri and Texas.

There are drawbacks, he said. “I would prefer to limit the number of insurance plans that are accepted, but I don’t have control over that,” said Dr. Henrich. Also, he’s compensated based on what the company collects; not the treatment he provides.

On the plus side, the company provides opportunities for continuing education and he is honing his clinical skills and becoming accustomed to seeing patients with more frequency—as opposed to dental school where he saw one patient every three or four hours. Most of all, he has access to experienced doctors who offer him advice and help with treatment planning, and “I can focus on seeing patients and writing treatment plans and not worry about billing and hiring staff,” he said.

Dr. Henrich would eventually like to own his own practice, but “the way the economy is going, group practice is always going to be an option. I think the cost of tuition is really out of control compared to opportunities there are nowadays. I don’t think people really understand the reality of it all. We need to make a living,” he said.

The third panelist was Dr. Nima Aflatooni of Elk Grove, Calif., a general dentist and 2010 graduate of the University of the Pacific Arthur A. Dugoni School of Dentistry. He practices part time at Pacific Dental Services, a large group practice with 270 offices in California, Nevada, Arizona, Colorado, Texas, New Mexico, Utah and Oregon, and also in his father’s practice. He believes there are many opportunities for the dental profession and group practices to collaborate, to the benefit of both entities.

“The ADA and societies should engage large group practices to encourage ethical conduct,” said Dr. Aflatooni, who is working with the Sacramento Dental Society to help group practice dentists become more involved in organized dentistry. “There have been a lot of changes at Pacific Dental Services and part of it is getting the company to be less isolated from the dental community.”

He’s been with the company for a year and a half and while his long-term plans are as yet undetermined, he’s pleased with the decision he’s made to practice in a large group.

“They contract with insurance at lower rates than private practices, and compensation is tied into production, so those are drawbacks, but this was one of the best opportunities I had,” said Dr. Aflatooni. “I don’t know of many new dentists who were able to buy practices, but to start out on your own is pretty difficult. Working for a corporation, you get experience and earn income. In some ways, this is one of the best and most realistic options for a new graduate. The exposure to new technologies and ownership opportunities also make it very appealing.”

“Large group practice is an important topic for new dentists because this is a rapidly growing practice setting that many new dentists or soon-to-be new dentists will be working in,” said Dr. Jennifer Enos, a member of the New Dentist Committee who is chairing an NDC workgroup devoted to studying the issue of large group practice. “Unique opportunities and challenges exist in this practice setting and we want these dentists to know that the ADA is still a valuable resource for them. They need to know that we are their advocate and support them.”

Large group practices may continue to grow; however, many believe that dentists remain committed to private practice.

“I think this is a stepping stone for most new grads,” said Dr. Maupin. “Most of the ones I’ve known who have gone into this type of practice have done it for only a couple of years. Some people go in looking for an opportunity to get their speed up and obtain some practice management experience. It’s not usually a lifelong commitment. You don’t own that practice.”

So are more young dentists opting for large group practice early in their careers, earning income to pay down loans with the expectation of eventually practicing on their own? Or do they prefer the work/life balance that these practices offer? Does a sluggish economy make new dentists less likely to strike out on their own? The New Dentist Committee wants to find out.

At its meeting, the committee took steps to study large dental group practice and its effect on new dentists. They recommended that the next ADA Survey of New Dentist Occupations and other surveys include questions on group practice dentistry to identify the percentage of dentists practicing in these settings and establish benchmarks for this career option. The committee also appointed the workgroup chaired by Dr. Enos to contact new dentists working in large group practices to obtain information regarding the value of ADA membership, “and help ensure that we are providing the tools to help them succeed,” said Dr. Enos.