By Dr. Desiree Yazdan
Dentistry has seen some tumultuous times lately, with new regulations, a shifting economy, and cutting-edge technologies all changing the single-practitioner drill-and-fill model. Perhaps that?s why?US News &?World Report?and CNNMoney/PayScale have released a pair of ?Best Jobs? reports, with similar pay and job growth expected, but drastically different overall rankings for the profession.
US News &?World Report?called dentistry the number one job overall and the ninth best job in terms of pay. According to its figures, dentists enjoy a $152,700 median salary and a 0.1% unemployment rate, along with an 18% employment growth rate between 2014 and 2024, with 23,300 new openings expected. The researchers also noted dentistry?s average stress level and agreeable work-life balance in calling it the top profession.
CNNMoney and PayScale?s annual list of the?top 100 careers?in the United States also cited its 18% employment growth rate and estimated its median pay at a similar $151,000 figure, but ranked dentistry in 44th?place. In compiling their rankings, CNNMoney and PayScale recognized today?s stronger job market, opportunities for advancement, job satisfaction, and overall job availability and growth in addition to pay. Stress and whether or not a profession is ?meaningful? were factors as well.
?Dentistry is a business that allows you to work only a few days a week and make a great living, which leaves more time for you to spend with your family. It?s also great because of how much you interact with people. Nowadays so many jobs are computer based, and with dentistry you have to actually be there and you get to work with people,? said?Desiree Yazdan, DDS, MS, an aesthetic dentist at the?Center for Reconstructive Dentistry?in Newport Beach, Calif.
?Of course, one of the most valuable aspects is that you get to make a difference in someone?s life on a daily basis,? Yazdan added. ?Whether it?s a small filling, or a full-mouth reconstruction, as a dentist you are creating a healthier oral cavity for your patients, and they are benefitting from you in one way or another.?
?We have so many tools to make dentistry efficient, predictable, and pain-free,? said?Rico D. Short, DMD, an author and clinician practicing in Smyrna, Ga. ?As an endodontist, I love instantly getting patients out of pain who have been hurting for days or even weeks. They are so shocked that a root canal can be done virtually pain-free and so fast.?
Generally, dentistry can expect growth in the years ahead. The?ADA reports?that dental spending increased again in 2015, indicating that the profession is rebounding from the flat years of the Great Recession. National dental care expenditures were $117.5 billion in 2015, compared to $114 billion in 2014 and $113.3 billion in 2013. Dental expenditures accounted for 3.7% of overall national health expenditures, down from 2000?s peak of 4.5% but still comparable to recent years.
The ADA notes that the increase could be the result of increased dental care utilization among children and adults covered by the recent Medicaid expansion. Dental expenditures financed by public sources have risen from 2% in 1990 to 12% in 2015, with a significant decrease in out-of-pocket spending since its peak in 2008. This shift in public funding also may reflect reduced private dental benefits, which are having an effect on the profession as well.
?Today?s economy has really changed dentistry,? said Yazdan. ?More people are becoming educated about the importance of oral health. However, people today are so worried that they may not have enough discretionary income to pay for needed dental bills because their insurance doesn?t really cover anything anymore, so they do not want to or have the funds for dentistry like they used to.?
As a result, there are still many people who don?t see their dentists for routine exams and care.?One recent survey?from Delta Dental indicated that 41% of Americans would like to see their dentist more often. But many people who ignore minor infections, pain, and other issues often see those problems get much worse before finally making an appointment or, worse,?visiting their local emergency room?for care. Of course, dentists want to change this mindset.
?The scope of dentistry has changed to more of a needs-based situation that caters to the immediate pain or emergency,? said Yazdan. ?We have tried to take this and turn it into a preventive approach to avoid the pain, emergency, loss of teeth, and infection that comes along with real neglect. We are on a mission to educate patients and give them the tools to get and keep their teeth and gums health so that in the long run they spend less money and save their teeth.?
?The need for dental treatment is pervasive. One half of the population in the United States does not seek regular dental treatment,? said?Craig S. Kohler, DDS, MBA, who has been practicing in Chicago for more than 30 years. ?It is a very personal health experience that takes careful diagnostic abilities and technical expertise. There will always be a demand for the competent, caring professional that helps people through some of the difficult health moments of their lives.?
In the years ahead, though, the person providing that care may have some different training. Today?s typical practice is staffed by dentists, dental hygienists, and dental assistants. But some states are now considering mid-level providers often known as dental therapists who would be allowed to perform procedures such as restorations and extractions themselves under the supervision of a licensed dentist. These proposals have drawn both controversy and concern.
?I?m optimistic about dentistry yet somewhat pessimistic about the future of dental care delivery,? said?Gigi Meinecke, DMD, a private practitioner in Potomac, Md. ?The practice of dentistry is and will likely continue to be exciting due to innovation and technology advances. However, if legislators and others outside the dental industry continue to push for changes to the classic model of the dentist-led team, in my opinion, the quality we?ve come to know and expect from dentistry will change, and as a result the career path will be less desirable.?
Maine, Minnesota, and Vermont all allow mid-level dental providers, while Washington and Oregon have authorized access to mid-level dental providers for native tribes while considering their use statewide. Alaska native tribes also have authorized dental therapy. According to the?Pew Charitable Trusts, Arizona, Hawaii, Kansas, Massachusetts, New Hampshire, New Mexico, North Dakota, and Texas are exploring dental therapy?s authorization.
The?ADA?opposes the authorization of non-dentists to perform surgical procedures. While the organization acknowledges challenges in providing dental care to everyone, it notes that the number of dentists practicing per 100,000 people has climbed more than 4% from 2003 to 2013 and expects that number to increase 1.5% from 2013 to 2018 and 2.6% by 2033. The ADA, then, believes there are enough dentists to meet the nation?s needs, and efforts should focus on connecting patients to available resources. But insurance companies may have their say, too.
?Presently, I don?t see insurance affecting the dentist-led team. But if legislators are successful in creating a mid-level provider, it?s nearly guaranteed that insurance companies will prefer reimbursing at a much lower level to a provider with less education. This could create a system where a licensed dentist sits at a computer reviewing treatment plans all day, possibly not even in the dental office, never interacting with patients, while a mid-level provider with less education performs the procedures,? Meinecke said.
Teledentistry programs already are emerging across the country, where hygienists and dental therapists perform care at schools and other community locations and then use digital communications to connect with supervising dentists. After conducting a 6-year study of its own programs, the?Arthur A. Dugoni School of Dentistry?reports that it can be an effective delivery system. Yet Meinecke urges caution as more practices adopt the model?s methods.
?In my view, this is much less desirable for both the patient and the doctor on many levels,? Meinecke said. ?It could create incentive for large-volume practices with multiple ?technicians? churning out lots of treatment. Quality usually takes a backseat to quantity in those situations. This is bad for patients, and career satisfaction for the dentist would ultimately go down.?
Such factors are just additional roadblocks on the journey to a satisfying career. These days, the average graduating dentist carries?an average of $255,567?in student loan debt. As a result, nearly 50% of today?s graduates join corporate-owned practices instead of starting their own. And while the ADA says that incomes for dentists?are holding steady?after years of losses, the rise of corporate dentistry may play a role there, too.
?There is an economic impact from the cost of dental education, which makes it more difficult for dentists to establish their own practice,? said?Bobby Haney, DDS, who no longer practices clinically and now works exclusively in practice management, consulting, and coaching. ?This is a big factor in the rapid growth of corporate dental practices and has most definitely lowered income for dentists.?
?Dentistry is a great profession that contributes to the well-being of society. The salary reflects the challenges and difficulties dentists experience as they do a personal service for each patient,? said Kohler. ?However, there will be fewer solo practitioners as corporate dental groups expand and the cost of new technology becomes difficult to purchase as an individual practitioner.?
Yet these challenges don?t seem to have dissuaded the next generation of dentists from taking up the profession, as they see work that can provide a living for decades into the future.
?The future of dentistry is very bright. People are living longer, and so are their teeth. Who really wants the old pull-out dentures? Not many. In fact, there are many patients getting orthodontics into their fifties and sixties!? said Short. ?As an ADA Success Speaker, I get to travel to many dental schools and talk to the students. They are really smart, enthusiastic, and tech savvy. Dentistry will just continue to get better and better.?
Despite all of obstacles that dentistry faces now and will face in the years ahead, many clinicians remain committed to the profession and see value in both what it gives to the patient and to the practitioner.
?Dentistry is and has classically been a great career path, since it has provided the 4 essential ingredients that create a rewarding career: flexibility, variety, community?the ability to help people?and opportunity,? said Meinecke.
?There are very few careers that combine compassion for the individual, artistic capability to improve the lives of their patients, and the ability to improve the oral and general health of people,? said Kohler. ?The dentist has a unique experience of knowing and providing for the same people for years. I love being a dentist.?
?It is still a rewarding profession both personally and economically. Income levels are still high compared to other professions, and there is always the joy of providing life-changing service to our fellow human beings,? said Haney. ?In short, dentistry is changing in many ways but remains a wonderful and challenging career choice.?