Looking for the Right Balance between Dentist as Manager and Dentist as Care Provider.

In the quest to understand the implications of separating management and treatment, we must first examine the forces driving management decisions. By defining ownership and equity interest, we are able to isolate a critical factor in the decision-making process. Evaluating the spectrum of the different models of dentistry gives us insight into potential advantages as well as disadvantages that can arise. In private practice, an owner typically wants to see the business grow over a lifetime, while, on the other end of the spectrum, corporate dental companies may be prioritizing dividends, investment returns through speedy packaged sales, or other means of reporting progress to investors. Interestingly, each model of dentistry has shown strength and growth, but there is no clear path to what is deemed ideal.

Private practice of prosthodontists in the United States: results from the 2008 & 2011 surveys of prosthodontists.

PURPOSE: The purpose of this article is to review data and results from past surveys of prosthodontists sponsored and conducted by the American College of Prosthodontists. Surveys were conducted in 2002, 2005, 2008, and 2011. Selected survey results are examined for prosthodontists in private practice. MATERIALS AND METHODS: Results from past surveys of prosthodontists were statistically examined and used to estimate several characteristics of the current population of practicing prosthodontists. The selected characteristics included age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (e.g., gross receipts, expenses in the practice, and net income of prosthodontists). While the most recent survey was conducted in 2011, the results reported by respondents are for the previous year, 2010. RESULTS: The average age of a private practicing prosthodontist in 2010 reached 53 years; 26 years since graduation from dental school and 20 years since completion of residency; an average of 13 years in their current practice. Sixty percent were in solo practice. The mean number of hours per week in the practice was 35 hours, and practicing prosthodontists treated an average of 35 patient visits per week. The patient was the single largest source of referrals, while general practitioners were a close second. The largest percentage of time spent treating patients was for fixed prosthodontics (21%), which declined from a mean of 24.1% in 2007. The mean amount of gross billings in 2010 was $721,970, which was a decline from 2007. Average total practice expenses were $538,230, and the mean net earnings of prosthodontists in private practice were $238,010. CONCLUSION: Changes have occurred since the last survey of prosthodontists in 2008 (with results for the year 2007). The prosthodontist private practice industry, not unlike dentistry as a whole, has undergone economic challenges that have affected the private practice of prosthodontists.

There are a lot of ways to go.

There is much more to transitioning well out of dentistry than maximizing the economic value of the practice. The full spectrum of professional and personal values, and where each dentist is in his or her life, must be considered. The same is true for the staff and the patients, especially for mature family-oriented practices. A case is worked out in detail, showing that the wisest thing to do in some cases is to gradually wind down a practice and stop without selling at all.

Practice transition with intelligence and grace.

Viable practices change with the professional and personal needs of dentists and with trends in society. There is no single way for transitioning out of practice--concluding a direct sale, remaining as an associate, and even purchasing a new practice to better match one's more mature lifestyle and practiced preferences. Changing ratios of dentists to patients currently favor a seller's market and emergence of corporate models provide new options. An analysis is given of the Canadian practice market. Planning advice is also offered.

Practice transitions--past, present, and future.

Until the 1960s, the value of a practice upon the retirement of the dentist was considered to be nil. In the next several decades, the value of a practice as a going business concern was recognized and formulas based on productivity were used to establish the sales price of "walkaway" practice transitions. Increasingly creative means, such as pre-sale, deferred pre-sale, shareholder process, incremental practice sale, and practice mergers have been created to make practice transitions more flexible, thereby maximizing the financial value of transitions. Dentists at the beginning of their careers will have an increasing range of opportunities in the future, with various combinations of financial security, freedom from manage- ment concerns, control over the practice, and accumulation of equity. Those in the 45- to 55-year age range should be planning in detail for their transition. Those older than 55 should begin exercising their plans since the future will involve much longer transitions.

Desired characteristics of a potential oral and maxillofacial surgery practice associate: a Connecticut survey response.

PURPOSE: The goal of the survey was to identify the desired characteristics of recently graduated oral surgeons entering private practice in Connecticut and compare these results to a similar study conducted earlier in New Jersey. MATERIALS AND METHODS: An anonymous survey was mailed to all active members of the Connecticut Society of Oral and Maxillofacial Surgeons in February 2010. The response rate for the survey was 63%, with 69 of 110 surveys returned. CONCLUSIONS: The most valued characteristics of a new associate included board certification; clinical competence in dentoalveolar surgery, anesthesia, and implant surgery; and personal character. These results paralleled the results of the New Jersey survey.

Dental ethics case 19: What are my ethical responsibilities when I suspect a colleague of substance abuse?

The situation described in this case scenario is an unwelcome one and can often lead to a breakdown in the relationship between professional colleagues. Many of these must be handled by scrupulous adherence to basic ethical principles. Where such conflicts do arise, every effort should be made to contain them in a manner which: avoids placing patients at risk; maintains the continuity of patient care and safeguards their rights and the quality of the dental care they receive; avoids bringing the profession into disrepute; maintains public confidence in the profession; treats professional colleagues as we would wish to be treated ourselves.

Writing off the copayment.

Three dentists who have been involved in teaching ethics comment on a case where an associate discovers that the 40% of collections she was expecting as compensation is being reduced because of the practice in the office of routinely writing off patient copays. The commentators note legal requirements and professional codes, but generally seek alternatives that do not require that patients pay the amount agreed by insurance contracts.

Motivational factors and future life plans of orthodontic residents in the United States.

INTRODUCTION: The purposes of this study were to investigate factors influencing career choice and identify future life plans of orthodontic residents in the United States. METHODS: Program chairs and directors of all 65 orthodontic residency programs in the United States were contacted by e-mail and telephone for permission to e-mail their residents and invite them to take part in on online survey. A total of 335 residents from 37 programs were invited to complete an anonymous 57-item questionnaire in May 2007. Data were categorized, and basic statistics including chi-square comparative analyses were performed. RESULTS: A total of 136 (40.60%) residents completed the survey. A "passion for orthodontics" emerged as the most important factor (20.29%) influencing the decision to pursue orthodontics as a career, followed by "intellectual stimulation or challenge" (18.12%). Most residents decided to become an orthodontist before they were in dental school (44.93%). Most residents (89.05%) plan to engage in private practice, and only 2 intend to pursue primarily an academic career. The average resident debt was $165,226 at the end of their program. CONCLUSIONS: The decision to become an orthodontist is often made early in life, before dental school, and a passion for orthodontics is the motivational factor. Residents plan to enter private practice and not pursue a career in academia. The current shortage of academics and orthodontic researchers will not be resolved from the current pool of orthodontic residents. A possible solution to the academic crisis is to change the selection criteria in programs to accept orthodontic residents who develop a passion for orthodontics while in dental school or to recruit primary researchers and teachers to the specialty. Residents plan to practice in an urban setting. Rural and underserviced areas will probably continue to experience shortages of orthodontists in the future.

Private practice of prosthodontists: current conditions of practice in the United States.

PURPOSE: The purpose of this article is to examine data and results from the 2008 Survey of Prosthodontists. Survey results are used to examine current trends and characteristics of prosthodontists in private practice. MATERIALS AND METHODS: Characteristics of prosthodontists and conditions of private practice are based on surveys conducted in 2002, 2005, and 2008 sponsored by the American College of Prosthodontists. Survey results are used to estimate several characteristics including age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists). RESULTS: The average age of a private-practicing prosthodontist reached 51 years in 2007; 12.3 is the number of years in the current practice; and most prosthodontists (71%) are solo private practitioners. The average amount of time per week by prosthodontists in the practice averaged 36.1 hours, and prosthodontists treated an average of 44.1 patient visits per week. The largest source of patient referrals is the patient themselves. The largest percentage of a prosthodontist's treatment time is spent rendering procedures in fixed prosthodontics, but this percentage has declined since 2001. In 2007, the average gross billings of a practicing prosthodontist reached $805,675; average total practice expenses were $518,255; the mean net earnings of practitioners were $268,930. CONCLUSION: In 2007, prosthodontists in private practice paid out about $1.4 billion in practice expenses to provide $2.2 billion dollars in prosthodontic care. Based on survey results from 2007 and the previous 6 years, specialization in prosthodontic care continues to be an economically attractive and productive healthcare profession in the United States.

Mapping dental establishments in New York State just before the recession.

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

A survey on orthodontic retention procedures in The Netherlands.

The objective of this study was to survey retention procedures used in orthodontic practices in The Netherlands. A questionnaire was sent to all 279 orthodontists working in The Netherlands. The questionnaire consisted of six parts, mainly containing multiple-choice questions. Information as to background data on the individual orthodontist, retention in general, frequency of different types of removable or bonded retainers that were used, retention protocol, and the type and size of the wire used for bonded retainers was assessed. All statistical analyses were performed using Statistical Package for Social Sciences version 12.0.1. Tests for the relationship between two items were based on the chi-square test. The overall response rate was 91 per cent. Most orthodontists placed a bonded retainer in the upper and lower arch, except when the upper arch was expanded during treatment or when extractions were performed in the upper arch, in which case they placed a removable retainer. Opinions varied with regard to how many hours the removable retainers should be worn and the duration of the retention phase. Contraindications for bonded retainers were given by 96 per cent of the orthodontists, with poor oral hygiene being the most commonly mentioned. As far as bonded retainers were concerned, 84 per cent of the orthodontists preferred permanent retention. Fifty-nine per cent of the orthodontists believed that a practice guideline for retention after orthodontic treatment needs to be developed, which was confirmed by the varied responses in this survey.

The legal business of dentistry.

Upon graduation and licensure, most dentists anticipate going into the profession of providing dental heath care to patients in an office or clinic setting. The profession is also the business of dentistry. Failure to appreciate documentation requirements for the business of dentistry can result in legal battles that are time-consuming and emotionally draining. This article provides an introduction, issue spotting, and tips to avoid those legal battles.

Career choices on graduation--a study of recent graduates from University College Cork.

INTRODUCTION: Irish dental graduates are eligible to enter general dental practice immediately after qualification. Unlike their United Kingdom counterparts, there is no requirement to undertake vocational training (VT) or any pre-registration training. VT is a mandatory 12-month period for all UK dental graduates who wish to work within the National Health Service. It provides structured, supervised experience in training practices and through organised study days. AIMS: This study aimed to profile the career choices made by recent dental graduates from UCC. It aimed to record the uptake of VT and associate posts, and where the graduates gained employment. METHODOLOGY: A self-completion questionnaire was developed and circulated electronically to recent graduates from UCC. An existing database of email addresses was used and responses were returned by post or by email. A copy of the questionnaire used is included as Appendix 1. RESULTS: Questionnaires were distributed over an eight-week period and 142 were returned, giving a response rate of 68.90%. Responses were gathered from those who graduated between 2001 and 2007; however, the majority came from more recent classes. Overall, the majority of graduates took up associate positions after qualification (71.8%) with smaller numbers undertaking VT (28.2%). Increasing numbers have entered VT in recent years, including 54.3% from the class of 2007. Overall, the majority of graduates initially took up positions in England (43%); however, in recent times more have been employed in Scotland. Subsequent work profiles of the graduates illustrate that the majority are now working as associates in general practice (51.4%) and in Ireland (54.2%). CONCLUSIONS: There has been an increase in the proportion of UCC graduates undertaking VT. Graduates tended to move away from Ireland initially to gain employment. There has been a shift away from employment in England towards Scotland where the majority of new UCC graduates are now initially employed. The majority of graduates returned to Ireland for employment after the initial move away.