Spring 2013 - Tufts University School of Dental Medicine

actively engaged professionals, they really
value their time, want time off together.”
When Nicholas Miller, D08, graduated
from Tufts, he wasn’t sure whether he wanted
to stay in the Boston area or return to his
native Michigan. Either way, he needed a job.
Through another Tufts alumnus, he got in
touch with the Aspen Dental chain.
“I was very honest with them about what
my goals were,” says Miller. Among them
was a steady income that would allow him
to start paying back his loans while living
a comfortable life. Working as an associate
moving among three Aspen offices in suburban
Boston, he was able to do just that.
When he returned to Michigan in 2010
and started looking into buying his own
practice, he weighed the choice of setting
out on his own, or buying into the Aspen
network. With private practices in the
Grand Rapids area running anywhere from
$400,000 to $1 million, Miller says, “I think
it’s fair to say that Aspen’s price was two to
three times less than purchasing a private
office with comparable revenue.” Aspen also
helped provide an attractive financing package
through an outside lender, he said.
In July 2010, Miller purchased an existing
Aspen office. In the three years since,
he bought another existing office and a
start-up. “I manage the
clinical end, and Aspen
manages the business,”
he says. “I own the dental
practices and, along with
my team of dentists, make
all the clinical decisions in
our offices. What Aspen
provides is the business
framework—professional
training, accounting services,
marketing strategy,
insurance operations,
facilities management,
human resources, at my discretion.
“It has given me work-life balance. I am
able to go to work and concentrate on my
patients and not worry about making sure
that the mortgage payment is sent out or
ordering supplies. Then I can go home and
continue to have a life.”
Those feelings are shared by dentists
further along in their careers, too. “I like
to pick and choose my headaches,” says
Girschek, of Gentle Dental. “The older I get,
the more quality of life is important.”
Goldberg, the periodontist, says, “One
of the things that stresses dentists out” is
getting stuck on how to handle a difficult
clinical case. “In a group practice, when
you have the benefit of specialists working
with you, the whole thing is more synergistic—you
have more minds working on the
same problem.”
R
ecently, more private equity
firms and other corporate entities
have invested in dental
chains because their rapid growth makes
them attractive in a sluggish economy.
Some of these companies have come under
scrutiny by various state and federal regulators
regarding the extent to which the nondentist
investors are involved in clinical
decision-making, or, in some cases, in connection
with Medicaid abuses.
Perhaps publicity from those cases has,
to some extent, cast a shadow over the entire
segment of the industry—unfairly so, say
O’Loughlin, of the ADA, and others.
“You can’t generalize that that behavior
happens just in corporate practices,”
O’Loughlin says. “It happens anywhere people
are not following the rules. It’s important
people don’t make broad assumptions.
If you’ve seen one DMSO [dental services
management organization], you’ve seen one
DMSO. Members of ADA agree to adhere
to the ADA Code of Ethics that puts the
patient’s best interest at the center of the
doctor-patient relationship, and that code
holds for an ADA member regardless of his
or her career path,” she says.
Miller, the Aspen owner in Michigan,
says it’s important to confront such assumptions.
“Sometimes dental service organizations,
they do have a stigma,” he says. Both
he and Pedram, of Pacific Dental, stress that
they oversee all clinical decisions in their
offices. “I have complete autonomy,” Miller
says. “Aspen has never told me how to treat
a patient.”
Another assumption, says Shames, of
Gentle Dental, is that large groups place
inordinate pressure on their dentists to
perform procedures to generate revenue.
Private practice owners, he points out, aren’t
immune to that. “If you buy a practice for
$800,000 and have payroll to meet every
week and rent and loans to repay, there is
much more pressure to produce,” he says.
Traditionally, large chains have seen
high turnover, as young dentists gain
experience and go off to establish their
own practices. Whether that will change
in this fluid economic climate is unknown.
O’Loughlin says the ADA is interested in
collecting more data about turnover rates
as well as other aspects of the large group
practice phenomenon.
Pedram, who splits his time between
working at Pacific Dental and as an associate
in a private pediatric practice, says his
“
americans want everything under one
rooF. 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.
”
—Samuel Shames, D75
dual experience has allowed him to assess
the benefits and drawbacks of each. While
he’s not sure what direction he’ll go in, he
makes this observation: “In a few years, if
I finally want to open my own practice, the
way it’s going now, competing against these
corporations is going to be tough.” tDm
Helene Ragovin, the editor of this magazine,
can be reached at helene.ragovin@tufts.edu.
spring 2013 tufts dental medicine 17