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Consider practicing in a small town

July 1, 2011
As one who grew up in a small town, what is happening to dentistry in small town America makes me sad.

Bill Avery, DDS, PhD

For more on this topic, go to and search using the following key words: small town dental practice, rural, urban, lifestyle, quality of life, Bill Avery, DDS.

As one who grew up in a small town, what is happening to dentistry in small town America makes me sad. All across the country we are seeing a dramatic demographic shift away from rural areas as older dentists retire and younger dentists choose not to live in small towns.

Although the number of dentists retiring has been slowed somewhat by the current economy, dentistry has moved into that phase where more dentists are retiring than are coming out of dental schools.

In discussing the issue with colleagues at ADS Transitions, the shortage of dentists does not seem to be much of a problem in large cities; the crisis lies mainly in rural areas.

Because of the problem of finding a buyer, many dentists who want to retire from their small town practices are finding it necessary to discontinue practicing dentistry and close their practices, leaving those communities without dental care.

In my home state of New Mexico, there are counties with no dental services at all. At the same time, we are seeing a yearly increase in the number of dentists in the large metropolitan areas.

A dentist who made the move

A dentist from Utah recently contacted me and said there are too many dentists in the area where he lives. His practice had reached a plateau and would not grow beyond that point. He was thinking about moving to my state and was interested in the Albuquerque area.

I asked if he had considered relocating to a smaller community. He said he and his wife had discussed it, and they were willing to consider it. He ended up purchasing a practice in a small town with a population of about 35,000. He is currently as busy as he wants to be, has become an integral part of the community, and his family loves living in a small town. Sadly, this is not typical.

Rural practices and lifestyle have a number of benefits over urban practices and lifestyle:

  • Rent and office costs are often less
  • Employee salaries are less
  • There is less competition
  • Cost of housing is usually less
  • Fees are generally comparable to urban fees

Some people have the mistaken idea that rural practices have old equipment and only provide extractions, dentures, and a few amalgams. The truth is, most rural practices are in nice facilities, have top equipment, and perform all the up-to-date dental procedures that any urban practices do.

If the dental community does not step up and do something to improve rural access to dental care in America, the government is going to do it for us, and the results won’t be pretty.

The New Mexico state legislature and other state legislatures are trying to pass bills that will allow auxiliaries with a minimum of two years of training to do procedures such as local anesthesia, restorations, and extractions.

Fortunately, the bill was tabled in New Mexico before the end of this last session, but it is not dead. It will be resurrected next year. If it passes, dentistry as a profession will suffer the consequences.

I know many dentists who practice in rural towns, and none of them have told me that they have ever regretted the decision to work and live in a small community. I would encourage any young dentist looking for an opportunity to get started in the profession to give some serious thought to a rural community, where a dentist can have a successful practice and enjoy an excellent quality of life.

Bill Avery, DDS, PhD, spent 20 years practicing periodontics. For the last 19 years, he has been helping colleagues transition their dental practices, mainly in New Mexico and portions of west Texas. Dr. Avery is a member of ADS Transitions and can be reached at (505) 821-0015 or (888) 419-5590, ext. 505 or through the ADS website at

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