Spring 2013 - Tufts University School of Dental Medicine

ver the past 25 years, there has been a 10 percent increase in
the number of dentists practicing in groups, from 25 percent to 35 percent, according to the
ADA. Among specialists, that number has increased from 32 to 42 percent. The very largest
group practices—those with anywhere from 20 to more than 200 locations—could account for
up to 11 percent of the total dental market share by 2015, the ADA estimates.
From a financial standpoint, large group practices make sense. They allow for reduced capital
and operating costs and benefit from economies of scale: volume discounts with suppliers
and labs, lower overhead and more attractive reimbursement rates from insurance companies.
A chain offers opportunities for widespread advertising and marketing. And having specialists
within the group means that outside referrals don’t drain revenue from the practice.
But the real efficiency, says Samuel Shames,
D75, managing partner at Gentle Dental of
Massachusetts and director of practice management
at Tufts School of Dental Medicine,
“is that talented dentists are spending time
in the office doing what they do best—dentistry—and
not spending 20 to 25 percent of
their time doing other stuff.”
It’s that other stuff—the tasks of managing
a business—that can turn dentists,
particularly younger ones, away from solo
practice.
“When you’ve been studying science and
dentistry for eight to 10 years straight, you
can emerge with no perspective as a business
owner. And dentistry is a business,”
says Joey Pedram, DG11, a pediatric specialist
who works for the Pacific Dental chain in
Southern California.
At first, David Goldberg, D92, a periodontist,
took the traditional route, buying into a
practice. He discovered that networking to
find patients and establishing relationships
with referring dentists to build his part of the
business was as stressful—maybe more so—
than repairing gums and bone. Two years in,
he started working part-time at Gentle Dental
of Massachusetts. “I quickly learned that as a
specialist [in a group practice], I no longer
had to beg to get patients,” he says. Goldberg
eventually left solo practice and became a
partner with Gentle Dental, where he now
oversees periodontics for all locations.
Then there’s the cost of dental care. “The
ADA is beginning to see that price sensitivity
has become more important” for patients,
O’Loughlin says, as the number of people
who have third-party dental coverage has
declined, according to recent surveys. “As
consumerism increases among the public,
more and more patients look to cost as well
as quality of care,” she says.
And convenience, of course. “Americans
want everything under one roof,” says
Shames. “They don’t want to leave Target to
buy their groceries, and they don’t want to
bounce from a general dentist to an endodontist
to an oral surgeon. Today’s public
is demanding multispecialty practices and
extended hours.”
t
he growth in larger practices
began with the spread of
employer-provided dental insurance
in the 1970s, and received a boost in
1979, when the Federal Trade Commission
lifted the ban on advertising by dentists.
Not long after, in 1981, Shames and his
partner, Ronald Weissman, started Gentle
Dental. Shames had been bringing specialists
into his solo practice—“I was sick of
patients saying, ‘Can’t you do it here’ ”—
and liked the idea of a multispecialty group.
Weissman, meanwhile, was interested in
how advertising and marketing could help
expand a dental practice.
It took some time for multispecialty
practices to take hold with patients, both for
Gentle Dental and its counterparts around
the country. It also took time for these large
group practices to be accepted within the
profession. Robert Girschek, D92, a partnerowner
of Gentle Dental who is based at the
Waltham, Mass., location, started working
for the group as a hygienist while a student
at Tufts and then joined the dental staff after
graduation. “In 1992, it was still early on,
and, as we’ll all admit, we were shunned by
most dentists,” Girschek says. “But I thought
it was an interesting model.” Gentle Dental’s
growth reflects the industrywide trend. The
company, in which the dentist-partners share
equity, now has 26 locations in Massachusetts
and one in New Hampshire.
There are several models of group practice.
State practice acts vary on the specifics
of whether nondentists can own a dental
practice, or what role a non-dentist can play
in the operation of a practice.
Group practices appear to be particularly
attractive to new graduates. According to a
2012 study of trends in group practice that
appeared in the Journal of Dental Education,
dentists who had completed their education
less than 10 years prior were three times
more likely to work for a larger company.
A big driver is economics. Dentists are
leaving school with increasing amounts
of debt—the American Dental Education
Association puts the average student debt
at $203,000. In addition, since the start of
the recession, small private practices have
not been hiring new graduates at the rates
they once were, according to the ADA’s New
Dentist Committee. The economic downturn
has also cut into the number of older dentists
who are retiring—and that, in turn, has created
a seller’s market for practices and raised
prices for new graduates looking to buy.
But the appeal of group practice is about
much more than money, says O’Loughlin.
Young dentists, both male and female, like the
quality of life that large group practices provide.
“The Millennial Generation seeks balance
in life,” she says. “They are different from
previous generations—employers have been
talking about that for a number of years.”
Still, more women than men do work
in large group practices, according to the
2012 journal study. “When you talk to
woman dentists, the most compelling thing
for them is time,” O’Loughlin says. “They
really value their time as much, or more,
than money, especially when they’re in the
position of bearing children and raising
children. Many women dentists are married
to other professionals. When you have two
16 tufts dental medicine spring 2013