Is Being a Dentist Worth It?
This project was inspired by a blog post authored in 2014 titled “Dentistry Sucks”. The post has accumulated more than a thousand comments and I discovered it during a Google search when I was trying to connect with others who find this career choice particularly challenging. I enjoy practicing dentistry, but do feel that I knew too little about the profession prior to committing to applying to dental school. My hope is that my writing here will provide some clarity to applicants, and provide some support to dentists with similar experiences.
I graduated in 2015 and have been practicing clinically full-time for more than five years at the time of this writing. It is likely important to also note that I started this project in December of 2020 and the pandemic’s effects on our profession have been significantly negative thus far. Below is a list that I wish I had read prior to deciding to become a dentist.
Dentistry is a lonely profession. What I mean by this, is that the majority of dentists practice alone and lack a structured support system. The typical dental office consists of one receptionist, two assistants, and one dental hygienist who support the sole general dentist in the practice. Since there are no other doctors in the practice, the dentist can feel quite isolated from other healthcare professionals during most of the workweek. The feeling of isolation can be quite surprising after graduating from dental school. Since most of us had spent our entire academic careers surrounded by like-minded young scholars, the sudden lack of competition, support, and comradely can be saddening.
From personal experience, what I miss most about dental school is the comradely that’s built as the group grows together.
With that said, there are opportunities to work in a group practice setting within our profession.
I will put it simply. The cost of becoming a dentist is extraordinarily high. It was expensive in 2010, but the increases in the cost to become a dentist have been so steep over the last decade that it is difficult to recommend the profession to anyone in their twenties without financial support from their family. It is difficult to repay student debt that exceeds 1.5x your annual compensation, and it becomes very difficult to pay off student debt that exceeds 2x your annual compensation. Unfortunately, many dental schools costs more than 3 times a young dentist’s compensation. At 3+ times your annual compensation, it becomes almost impossible to repay your student loans and pursue other goals such as starting a family, buying a home, and saving for retirement.
Many dentists are unable to retire in their sixties. Dentistry used to be a profession that supported a certain lifestyle commonly associated with early retirement. Early retirement from clinical dentistry is reasonable because dentistry is physically demanding. Many of us suffer from neck and back pain due to contorting ourselves into odd positions that we hold for long periods as we try to accommodate our patients.
While many people delay retirement due to a variety of factors, I have noticed many dentists working into their early seventies because they’re unable to retire. Of course, I am not aware of everyone’s financial situation, but from what I can gather the most common reasons for delayed retirement from dentists are:
- Delaying retirement savings in exchange for servicing debt.
- Lack of benefits that incentivize retirement savings.
- Divorce (see stress)
- Poor lifestyle choices
A job as a general dentist is often referred to as an “associateship” in the private sector. Since most private offices are small businesses, many (dare I say, most) dental offices cannot support a full-time associate dentist. This means that new dentists often spend the first few years of their careers working multiple part-time jobs as they search for an office that actually has the systems in place to provide a robust enough patient flow to support a second full-time general dentist.
Since dental practices are often small businesses, most associate dentists lack access to benefits similar to the ones pharmacists and physicians enjoy. The typical associate does not have access to medical, dental, or vision insurance. Most associates do not have access to a 401k or other tax-deferred retirement plan, and it’s rare for associates to be offered any paid time off (PTO).
After a few years of searching for a decent associateship where they can make enough money to pay down their student loans, many young dentists realize that they are going to have to buy their own practice if they desire stability. Unfortunately, acquiring or starting a practice often means more debt.
Good Associateships are Hard to Find
Of all the things that surprised me after becoming a dentist, I think that this is the most damning. Finding a good job as a dentist is very difficult and the job market is grossly misrepresented by academic institutions. Many people start their own practices, not because they have an entrepreneurial vision, but because it’s the only way to secure a good job without moving to a new city or state.
The cost of becoming a dentist does not always stop at graduation. For most of us, acquiring or starting a practice is not necessarily something we hope to do one day, it is something we have to do to be treated well, paid fairly, and practice with autonomy. Dental practices are typically sold between sixty and ninety percent of a 3-year average of collections. So if a practice is collecting $750,000, it will likely cost $450,000 to $695,000 to acquire. With an average overhead of 60%, a practice collecting $750,000 should provide a net income of $280,000 before servicing the loan to acquire the practice which is typically a 10-year note. Note that overhead typically rises as collections decrease. So while a practice collecting $750,000 may net 40%, a practice collecting $300,000 per year, may only break even.
More debt, more stress. Dentistry is an extremely stressful profession. The cost to go to school coupled with the costs to acquire a practice buries most of us under huge sums of debt. For some people, the volume of money they owe to others is so stressful, it can ruin the rest of their lives. Aside from the financial burdens of dentistry, it should not be understated how much impact the clinical work has on us.
The human mouth is small. Many dentists choose the profession because they like to work with their hands. I built furniture in high school and enjoyed woodworking. As a child, I built models and toy race cars. Building things is a passion of mine and is one of the many things that drew me to the field. However, most of us have no experience working within such a defined space, and this space presents many challenges most notably its attachment to very anxious people.
People Hate Dentists
I’ve always liked my dentist, but most people seem to hate us. Since my experiences with dentistry had always been positive before dental school, I did not realize that such a large part of the population despises how our services are delivered. I suppose I could have read more articles that paint dentists in a negative light and read between the lines. However, even if I had read more about how people feel about our profession, it is not possible to understand that the anxiety our patients feel when they are with us is contagious until you start practicing. While we try our best to help each cope with their feelings towards our treatment, it is mentally draining to help almost every patient through each procedure every day. This is one of the main reasons why dentists rarely have the mental capacity to work 5 clinical days a week for the majority of their careers.
Insurance is Crushing Our Patients (and Our Businesses)
Dental insurance is not like health insurance. Dental insurance is not insurance at all. With regards to our patients, dental insurance usually has an annual maximum benefit. Most annual maximums are between $1,500 and $2,000 per calendar year and come coupled with all sorts of exclusions and restrictions bundled into their contracts. Unfortunately, the annual maximums have not been increased since the 1970s, so the value of dental insurance has decreased significantly over the last 4 decades despite increases in premiums. This hurts both the dentist and the patient as the patient has more out of pocket costs and has to understand that insurance covers very little of their treatment.
Constantly explaining why someone’s insurance doesn’t cover a recommended procedure is another source of stress, and another reason for patients to dislike us.
Teeth are remarkably sensitive. If you’ve ever been to the beach and found a grain of sand in your mouth, you understand how sensitive your teeth can be. Likewise, if you’ve ever had a small hair (maybe the size of an eyelash) in your mouth, you know that the smallest of things are incredibly uncomfortable in the oral cavity. This sensitivity is amplified with dentistry. When fillings are not smooth, or just a tiny bit high, or over-bulked, under-contoured, or otherwise just not quite right, our patients can tell. Fillings are challenging to place (white fillings have to be placed in the absence of moisture, even though we work in a wet environment), and if the filling is too deep, too wide, too narrow, too tall, or too rough our patients notice. Every appointment requires intense focus, and the accuracy of our work matters down to microns for most of our procedures.
Many of our patients are experiencing discomfort in one way or another. It is incredibly rewarding to be able to help alleviate our patients’ symptoms, but the consistency of the complaints can be draining. Managing someone who comes into your practice who is experiencing a lot of discomfort can be extremely disruptive for you, your staff, and your scheduled patients. When you’re late, your patients notice, and some of them can become quite upset by the inconvenience despite your best efforts to manage an emergency and remain on schedule.
Delivering Bad News
When you think about it, nobody wants to pay for dental care even though most people want to keep their teeth. This means dentists are delivering bad news all day long. Every time a dentist diagnoses decay or recommends a crown, it’s news patients don’t want to hear. Even if patients are experiencing pain associated with one of their teeth that requires a root canal to resolve, delivering the news that you can fix their problem with a root canal is sub-optimal to the patient. Constantly delivering bad news and seeing its effects on people is tiring, and maintaining empathy for a thirty or forty-year career can be challenging as dentists try to protect themselves from the emotional toll of the profession.
Many vendors with “dental” in their name see their customers as nothing more than dumb piles of cash. There is a perception that all dentists are wealthy and can afford to overpay for services that are drastically cheaper outside of our profession. What is true is that dentists are tired and short on time, so vetting companies and doing thorough research about each service you need can be difficult to do.
Just understand that if you want “dental XYZ”, be prepared to overpay and be pressured into signing a long-term contract…and this happens for all sorts of services that we need to operate our practices.
Owners and Brokers
Buying a dental practice can be remarkably difficult, and many dentists find themselves victims of borderline fraud after the transition takes place. The practices are often laughably misrepresented by the seller and his team. When you go to buy a practice many firms advertise themselves as “dual representation”, claiming that they can represent both sides of the deal without bias, which is absolutely impossible.
When you are ready to buy an office, be prepared to be declined access to the practice’s financials. Is there any other industry that expects a potential buyer to make an offer on a business without access to the P&L and general ledger?