Joseph Denning, DDS
There is a specter haunting dentistry: the specter of commoditization. I don’t know about you, but when I hang out at dental meetings or social gatherings, or browse Facebook dental forums, I see some disturbing trends. We are a group of people who—I know this is a gross generalization—have gotten pretty good at feeling sorry for ourselves. This growing list of laments should sound familiar to you: PPO reimbursements are going down, student loans are insurmountable, the appointment book has never been so empty, and so on. In essence, what I hear everyone saying is, “Dentistry is not what it used to be.” And it’s true. So let’s just get over it! Only after we have acknowledged that things are never going back to the way that they once were can we begin to gain control over the direction that our profession is heading.
Dentists are making less money on average than they were about a decade ago. According to Marko Vujicic, PhD, the chief economist and vice president of the American Dental Association’s Health Policy Institute, “After adjusting for inflation, the average annual net income of general practice dentists was $174,780 in 2014, compared with $219,738 in 2005.”1 This is no surprise when you consider that insurance reimbursement rates decreased by 10.4% nationally from 2005 to 2014.1
Also, it is common knowledge that dentists are graduating with more debt. When the American Dental Education Association surveyed the class of 2016, the average debt per graduating senior was $261,149.2 This means that if a 25-year repayment plan with a 6% interest rate is chosen, the average dentist graduating today will have a monthly payment of $1,682.59 and pay more than half a million dollars for the total cost of the loan before repayment is finished. In short, this is a perfect storm hitting the next generation of dentists.
My fellow classmates and I graduated and went off to our respective residencies full of pride that we had picked the best profession in the world. Then we all hit a brick wall. The first time I remember noticing that there was a problem was when I ran into a classmate who was two years ahead of us. I asked her how things were going, and she told me that she was doing OK and working at four different offices to scrape together a full workweek.
The dental services organization (DSO) industry has capitalized on this phenomenon. I have friends who have had great experiences working with DSOs and others who have reported just the opposite. Guess what? The same is true among those of us who have had associateships in small offices. One particular model of practice is not the problem; it is the commoditization of dentistry that is overtaking our entire profession.
I don’t care where I buy a pair of shoes, a pack of gum, or any other commodity for that matter. I buy it wherever I can get it cheapest and with the most convenience. Dental services have also become commoditized. Why go to a board-certified orthodontist when you can get braces in the mail? If we don’t clearly demonstrate our value to our patients and the public at large, this is just the beginning of DIY dentistry.
Of all the obstacles faced by dentists, the commoditization of dental services poses the greatest existential threat. Loans can be consolidated and refinanced. Banks understand that new grads will have educational debt and, in most cases, are still happy to lend to dentists. Lower PPO reimbursement rates can be mitigated with more efficient systems and technologies. But what can we do when dental services become commoditized, and we can only compete on two criteria—convenience and price? This is a race to the bottom, folks, and it’s a race no one should want to win.
If we want to take back control of our lives and the quality of our profession, it must begin with each of us as individual clinicians. We need to start asking ourselves one question every day: “What is the one compelling reason patients should come to see us instead of the other choices they have in the marketplace?” If they are our patients just because we accept their insurance plans, this will not be a compelling enough reason for them to stay with us when price or convenience is challenged. If we don’t know why our patients should come to see us specifically, then how can we expect them to know? Furthermore, how can we expect them to see our dentistry as any different from all of the other products and services that they shop around for?
“What is the one compelling reason patients should come to see us instead of the other choices they have in the marketplace?” This is a question that, once answered, allows us to focus our actions, behaviors, and priorities as small business owners. The answer to this question should be deeply personal for each of us, as varied and unique as all of our personalities. If we want to achieve the professional and personal life we all made such grueling sacrifices to obtain, then we must provide a unique and extraordinary value offering to our patients. Your services will no longer be commoditized when you define them yourself.
1. Vujicic M. Why are payment rates to dentists declining in most states? J Am Dent Assoc. 2016;147(9):755-757.
2. Dental Student Debt. American Student Dental Association website. https://www.asdanet.org/index/get-involved/advocate/issues-and-legislative-priorities/Dental-Student-Debt. Published 2017.
Joseph Denning, DDS, obtained his doctorate in dental surgery from Stony Brook School of Dental Medicine in 2011. He completed his general practice residency at New York Hospital of Queens in 2012. He is active in both the third and fourth districts of the New York State Dental Association, where he has served as the new dentist chairperson. He currently practices in Albany, New York, and focuses on sedation and implant dentistry. He can be reached at (917) 215-7847 or JPD241@aol.com.