Business Basics for Dentists E-Book

James L. Harrison

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1474

Veröffentlichungsjahr: 2023

Beschreibung

Business Basics for Dentists Concise yet comprehensive overview of business management principles tailored for dental practices, with strategies to apply the core concepts to achieve success Rather than presenting a rote checklist of steps for success, Business Basics for Dentists, Second Edition describes business, economic, marketing, and management principles and explains how to apply them to dental practice. Now fully updated throughout, this book provides the essential elements of a business course--management principles, economics, business finance, and financial analysis--without getting bogged down in too much detail. Dental students and new practitioners will learn how to use the core strategic and operational business philosophies to develop an effective dental practice. The business management principles are related to various aspects of running and managing a dental practice, including office communications, billing, inventory, and marketing. All aspects of practice transition are approached, including career opportunities, buying a practice, starting a new practice, multi-practitioner arrangements, practice valuation, and planning and developing a practice. The book also covers personal financial planning to ensure that the dentist is also planning for their finances and retirement beyond the bounds of the practice. Business Basics for Dentists, Second Edition covers: * Personal money management and insurance needs, reducing the personal tax burden, estate planning, and securing financing * Business entities, basic economics, the legal environment of the dental practice, financial statements, and business taxes and tax planning * Management principles, planning the dental practice, financial analysis, and control in the dental office, maintaining production and collections, and gaining case acceptance * Generating patients for the practice, controlling costs, promoting staff effectiveness, and maintaining daily operations Focusing on the transition period from a dental student, through corporate employee, to ownership, Business Basics for Dentists is a valuable tool for dental students and professionals seeking to further their career path through actionable advice from experts in the field.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

Preface

SECTION 1: Career Planning

CHAPTER 1: Career Planning

CHARACTERISTICS OF DENTAL PRACTICES

COMMON MYTHS ABOUT DENTISTRY

CAREER PATHS

LOCATION DECISIONS

PROFESSIONAL HISTORY

CAREER PLANNING PATHWAYS

CHAPTER 2: Employment Opportunities

GOVERNMENT EMPLOYMENT

PRIVATE PRACTICE/ASSOCIATE ARRANGEMENTS

WORKING FOR CORPORATE NETWORK PRACTICES

METHODS OF EMPLOYEE COMPENSATION

EMPLOYMENT CONTRACTS

PREPARING FOR EMPLOYMENT

CHAPTER 3: Practice Ownership

CHARACTERISTICS OF PRACTICE OWNERSHIP

MAKING MONEY IN DENTISTRY

INDIVIDUAL PRACTICE OWNERSHIP

SOLO GROUP PRACTICES

TRUE GROUP PRACTICES

FRANCHISES AS OWNERSHIP

CHAPTER 4: Practice Transitions

STARTING A DENTAL PRACTICE (DE NOVO)

BUYING AN EXISTING PRACTICING (BUY‐OUT)

CHAPTER 5: Valuing Practices

WHY VALUE A PRACTICE?

GENERAL RULES OF PRACTICE VALUATION

METHODS OF VALUING ASSETS

METHODS OF PRACTICE VALUATION

VALUING CORPORATE PRACTICES

VALUING SPECIALTY PRACTICES

TAX IMPLICATIONS OF PRACTICE SALES

CHAPTER 6: Securing Financing

SOURCES OF LOANS

CREDIT UNIONS

EFFECT OF CREDIT RATING

TYPES OF PROFESSIONAL DEBT

TAX IMPLICATIONS OF DEBT

NEGOTIATING WITH LENDERS

SECTION 2: Personal Financial Management

CHAPTER 7: Personal Money Management

PERSONAL MONEY MANAGEMENT

PERSONAL LIFESTYLE ISSUES

FAMILY BUDGET

HOW TO IMPROVE SPENDING HABITS

DEVELOPING PERSONAL SAVINGS

PERSONAL BANKING

MANAGING CREDIT

DEBT MANAGEMENT

FINANCIAL PLANNING PHASES

CHAPTER 8: Personal Insurance Needs

UNDERSTANDING INSURANCE

MEDICAL INSURANCE

DISABILITY (INCOME) INSURANCE

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

LIFE INSURANCE

AUTOMOBILE INSURANCE

HOMEOWNER'S INSURANCE

PERSONAL EXCESS LIABILITY INSURANCE

TAX CONSEQUENCES OF PERSONAL INSURANCE

CHAPTER 9: Retirement Planning

COMPONENTS OF A RETIREMENT PLAN

PRINCIPLES OF RETIREMENT SAVINGS

FACTORS THAT DETERMINE PEOPLE'S ABILITY TO REACH RETIREMENT GOALS

COMMON TYPES OF RETIREMENT PLANS

RULES FOR OFFICE RETIREMENT PLANS

TAKING MONEY AT RETIREMENT

STAGES IN RETIREMENT PLANNING

EXAMPLE STRATEGIES

CHAPTER 10: Personal Taxes

FEDERAL INCOME TAXES

TAX RATES

COMPONENTS OF FORM 1040

ALTERNATIVE MINIMUM TAX

ISSUES FOR THE SELF‐EMPLOYED DENTIST

TAX PLANNING FOR THE INDIVIDUAL

TAX AUDITS

CHAPTER 11: Estate Planning

PURPOSE OF ESTATE PLANNING

THE ELEMENTS OF AN ESTATE PLAN

METHODS OF PROPERTY TRANSFER

GENERAL ESTATE PLANNING ISSUES

SECTION 3: Business Foundations

CHAPTER 12: Basic Economics

LAWS OF SUPPLY AND DEMAND

MICROECONOMICS: THE INDIVIDUAL BUYER AND SELLER

MACROECONOMICS: THE BIG PICTURE

FISCAL AND MONETARY POLICY

CHAPTER 13: Business Entities

ENTITY DECISION POINTS

TYPES OF BUSINESS ENTITIES

WHEN TO USE THE VARIOUS ENTITIES

CHAPTER 14: The Legal Environment of the Dental Practice

THE SOURCE OF LAWS

RESOLVING DISPUTES

CRIMINAL LAW

CIVIL LAW

EMPLOYMENT (LABOR) LAW

CONSUMER PROTECTION LAWS

LAWS REGULATING THE DENTAL PROFESSION

WHAT TO DO IF SUED

CHAPTER 15: Financial Statements

PERSONAL FINANCIAL FORMS

BUSINESS FINANCIAL FORMS

PRO‐FORMA STATEMENTS

CHAPTER 16: Basics of Business Finance

TIME VALUE OF MONEY

CAPITAL BUDGETING

BORROWING MONEY

LEASE–PURCHASE DECISIONS

CHAPTER 17: Business Taxes and Tax Planning

THE BASIC BUSINESS INCOME TAX FORMULA

PRINCIPLES OF BUSINESS TAXATION

EMPLOYER TAXES

OTHER BUSINESS TAXES

EFFECT OF BUSINESS ENTITY

BUSINESS TAX PLANNING

CHAPTER 18: Management Principles

CHARACTERISTICS OF DENTAL PRACTICE

CHARACTERISTICS OF SUCCESSFUL BUSINESS OWNERS

DEFINITION OF DENTAL PRACTICE MANAGEMENT

ROLES OF THE OWNER–DENTIST

CHAPTER 19: Planning the Dental Practice

PRACTICE STAGES

THE ENVIRONMENT OF DENTAL PRACTICE

THE BUSINESS PLAN

SECTION 4: Dental Office Success Factors

CHAPTER 20: Financial Analysis and Control in the Dental Office

THE FINANCIAL CONTROL PROCESS

PROFITABILITY ANALYSIS

CRITICAL SUCCESS FACTORS

CHAPTER 21 Maintaining Production

Part 1: Duty Delegation

TYPES OF DENTAL STAFF MEMBERS

LEVELS OF SUPERVISION

LABOR SUBSTITUTION

PRINCIPLES OF DUTY DELEGATION

STEPS IN DELEGATING IN THE DENTAL OFFICE

USING DELEGATION IN THE DENTAL PRACTICE

Part 2: Scheduling Patients

PURPOSES

PREREQUISITES

TREATMENT TIME CODES

EXAMPLE SCHEDULE

APPOINTMENT ISSUES

Part 3: Dental Fee Policy

PROFESSIONAL FEE OBJECTIVES

FEE‐SETTING METHODS

IMPLICATIONS FOR DENTAL PRACTICE

RAISING FEES

CHAPTER 22: Maintaining Collections

Part 1: Patient Financial Policies

ELEMENTS OF A FINANCIAL POLICY

PRESENTING FINANCIAL PLANS

EFFECT OF FINANCIAL POLICIES

Part 2: Office Collection Policies

ACCOUNTS RECEIVABLE

BILLING SYSTEMS

COLLECTION POLICY

COLLECTION TECHNIQUES

DELINQUENT ACCOUNTS

OUTSIDE COLLECTION METHODS

KEYS FOR EFFECTIVE COLLECTIONS IN THE OFFICE

CHAPTER 23: Generating Patients for the Practice

Part 1: Generating New Patients

DEFINING MARKETING

WHY DENTISTS MARKET

WHAT DENTISTS MARKET

WHY CONSUMERS BUY

MARKETING PLAN DEVELOPMENT

MARKETING STRATEGIES

FINANCIAL IMPACTS OF MARKETING

Part 2: Managing Continuing Care

VALUE OF PREVENTIVE SERVICES

PERIODIC MAINTENANCE MANAGEMENT

CHAPTER 24: Gaining Case Acceptance

Part 1: Communication in the Office

THE COMMUNICATION PROCESS

METHODS OF ORAL COMMUNICATION

NON‐VERBAL COMMUNICATION

SCRIPTS

WRITTEN COMMUNICATION

COMMUNICATION ISSUES IN THE DENTAL OFFICE

Part 2: Case Presentation and Acceptance

TYPES OF CONSUMER PURCHASES

PATIENT TREATMENT ACCEPTANCE DECISION POINTS

STEPS IN CASE PRESENTATION

CHAPTER 25: Controlling Costs in the Practice

TYPES OF COSTS

DENTAL OFFICE COST ALLOCATION

COMMON COST CATEGORIES

BREAK‐EVEN ANALYSIS

WHAT IF…? ANALYSIS

SPECIFIC COST‐CONTROL TECHNIQUES

CHAPTER 26: Promoting Staff Effectiveness

Part 1: Selecting and Hiring Employees

ATTRACTING THE BEST APPLICANTS

SELECTING THE BEST OF THE APPLICANTS

THE HIRING DECISION

PROBATIONARY PERIOD

INTEGRATING THE NEW EMPLOYEE INTO THE OFFICE

Part 2: Compensating Employees

HOW TO SET STAFF COMPENSATION LEVELS

STAFF PAY

BENEFITS

PROCESSING STAFF PAYCHECKS

THE COST OF A STAFF MEMBER LEAVING

Part 3: Motivating Employees to Perform Well

LEADERSHIP

WHY PEOPLE WORK

THE WORK ENVIRONMENT

EMPLOYEE MOTIVATION CONCEPTS

INCENTIVE PLANS: USING MONEY TO MOTIVATE

Part 4: Assessing Employee Performance

PERFORMANCE APPRAISAL AND REVIEWS

DISCIPLINING EMPLOYEES

TERMINATING EMPLOYEES

CHAPTER 27: Maintaining Daily Operations

Part 1: Office Operations

EFFICIENCY AND EFFECTIVENESS

CAPACITY

INCREASING PATIENT VISITS

WAYS TO BECOME MORE EFFICIENT

Part 2: Office Accounting Systems

ACCOUNTING FOR INCOME

RECORDING EXPENSES: PAYMENTS TO OTHERS

PETTY CASH AND CASH CONTROL

Part 3: Instrument Management Procedures

CENTERS FOR DISEASE CONTROL AND PREVENTION

TYPES OF PATIENT CARE ITEMS

DENTAL OFFICE REQUIREMENTS

STERILIZATION AND DISINFECTION PROCEDURES

OTHER OFFICE INSTRUMENT ISSUES

Part 4: Office Supply and Lab Management

INVENTORY SYSTEMS

LABORATORY CASE MANAGEMENT

Part 5: Dental Insurance Management

PAYMENT MECHANISMS

POLICY LIMITATIONS

METHOD OF REIMBURSEMENT

OTHER INSURANCE TERMS

CHARACTERISTICS OF THIRD‐PARTY PLANS

GOVERNMENT PAYMENT PLANS

PROCESSING INSURANCE CLAIMS

THE AMERICAN DENTAL ASSOCIATION INSURANCE FORM

FILING INSURANCE CLAIMS

HOW TO MANAGE INSURANCE PLANS IN THE OFFICE

CHAPTER 28: Managing Risk in the Office

Part 1: Office Risk Management

THE RISK MANAGEMENT PROCESS

OFFICE INSURANCES

PROFESSIONAL RISK MANAGEMENT

PATIENT TREATMENT RECORDS

AVENUES OF RESOLUTION OF POOR WORK OR POOR OUTCOME

MALPRACTICE INSURANCE

NATIONAL PRACTITIONER DATA BANK

INFORMATION SECURITY AND MANAGEMENT

Part 2: Regulatory Compliance

LICENSES AND REGISTRATIONS

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION AND THE DENTAL OFFICE

HIPAA IN THE DENTAL OFFICE

MEDICAL WASTE DISPOSAL

RADIOGRAPHIC MACHINES

Part 3: Quality Assurance

QUALITY ASSURANCE TERMINOLOGY

HISTORY OF QUALITY ASSESSMENT AND QUALITY ASSURANCE IN DENTISTRY

CURRENT FOCUS ON QUALITY ASSESSMENT AND ASSURANCE ACTIVITIES

QUALITY ASSESSMENT REVIEWS IN DENTISTRY

Index

End User License Agreement

List of Tables

Chapter 9

Table 9.1 Example Individual Retirement Account (IRA) strategies.

Chapter 16

Table 16.1 Future value of a single present amount.

Table 16.2 Present value of a future amount.

Table 16.3 Annuity monthly payment factor.

Table 16.4 Future value of an annuity.

Chapter 21c

Table 21.1 The effect of fees on practice profitability.

List of Illustrations

Chapter 1

FIGURE 1.1 Career pathway flowchart for dental graduates.

Chapter 9

FIGURE 9.1 Risk and reward. (a) Low‐risk investment. (b) High‐risk investmen...

Chapter 12

FIGURE 12.1 A demand curve.

FIGURE 12.2 A supply curve.

FIGURE 12.3 Market equilibrium.

FIGURE 12.4 The business cycle.

Chapter 21b

FIGURE 21.1 Example schedule.

Chapter 22a

FIGURE 22.1 Losses from slow accounts.

Chapter 25

FIGURE 25.1 Fixed costs.

FIGURE 25.2 Step‐fixed costs.

FIGURE 25.3 Variable costs.

FIGURE 25.4 Total costs.

FIGURE 25.5 Break‐even analysis.

Chapter 27c

FIGURE 27.1 Instrument processing cycle.

Chapter 27d

FIGURE 27.2 Ideal inventory system.

FIGURE 27.3 Realistic inventory system.

Chapter 27e

FIGURE 27.4 Tracking reimbursement rates over time.

Chapter 28a

FIGURE 28.1 Risk assessment matrix.

Guide

Cover Page

Title Page

Copyright Page

Preface

Table of Contents

Begin Reading

Index

Wiley End User License Agreement

Pages

iii

iv

vii

viii

1

2

3

4

5

6

7

8

9

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

161

162

163

164

165

166

167

168

169

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

204

205

206

207

208

209

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

239

240

241

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

260

261

262

263

264

265

266

267

268

269

270

271

272

273

274

275

276

277

278

279

280

281

283

284

285

286

287

288

289

290

291

292

293

294

295

296

297

298

299

300

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

319

320

321

322

323

324

325

326

327

328

329

330

331

332

333

334

335

337

338

339

340

341

342

343

344

345

346

347

348

349

350

351

352

353

354

355

356

357

358

359

360

361

362

363

364

365

366

367

369

370

371

372

373

374

375

376

377

378

379

380

381

382

383

384

385

386

387

388

389

390

391

392

393

394

395

396

397

398

399

400

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

417

418

419

420

421

422

423

424

425

426

427

428

429

430

431

432

433

434

435

436

437

438

439

440

441

442

443

444

445

446

447

448

449

450

451

453

454

455

456

457

458

459

460

461

462

463

Business Basics for Dentists

SECOND EDITION

James L. Harrison

University of LouisvilleLouisville, KY, USA

David O. Willis

University of Louisville (Retired)Louisville, KY, USA

Charles K. Thieman

Healthcare Practice Consultants, LLCLouisville, KY, USA

Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.

Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

For general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at (800) 762‐2974, outside the United States at (317) 572‐3993 or fax (317) 572‐4002.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic formats. For more information about Wiley products, visit our web site at www.wiley.com.

Library of Congress Cataloging‐in‐Publication Data:Names: Willis, David O., author. | Harrison, James L. (Dentist), author. | Thieman, Charles K., author.Title: Business basics for dentists / James L. Harrison, David O. Willis, Charles K. Thieman.Description: Second edition. | Hoboken, NJ : Wiley‐Blackwell, 2024. | David O. Willis’s name appear first in the previous edition.Identifiers: LCCN 2023014965 (print) | LCCN 2023014966 (ebook) | ISBN 9781119892854 (paperback) | ISBN 9781119892861 (adobe pdf) | ISBN 9781119892878 (epub)Subjects: MESH: Practice Management, Dental Classification: LCC RK58 (print) | LCC RK58 (ebook) | NLM WU 77 | DDC 617.0068–dc23/eng/20230727LC record available at https://lccn.loc.gov/2023014965LC ebook record available at https://lccn.loc.gov/2023014966

Cover Design: WileyCover Images: © Aja Koska/Getty Images; NESPIX/Shutterstock

Preface

Surveys of new dental practitioners consistently rate practice management as the area where they were least prepared and found the most problems in practice. Dental schools do an excellent job of preparing graduates to handle dentistry's technical and patient treatment aspects. However, they do a less than excellent job preparing graduates to run a dental practice.

This problem comes from several sources. Most students do not enter dental school with a business background. They have taken scientific‐based courses to prepare them for the rigorous dental curriculum and have not taken a business class in their predental curriculum. Many students have never had a dental‐related job in the private sector. They depend on the professional mentoring of the faculty to prepare them for the world of dental practice.

Students are concerned with the immediate needs of learning dentistry, completing clinical requirements, and passing licensing exams – and that is where their efforts should go to their most immediate and pressing needs. They cannot run a successful dental practice until they graduate from dental school and earn a dental license.

National boards have tested students on fundamental scientific and clinical knowledge for years, not on how to operate a successful practice. Because many dental schools teach, in part, to prepare their students to pass these boards, curriculum time and faculty efforts are heavily weighted toward preparing students for this important milestone.

The economic environment of dental practice is changing rapidly, and educators have not kept up. In years past, if the new graduate knew dental techniques and treated their patients well, practice success was virtually assured. Today, new practitioners face a bewildering array of insurance plans, consumerism, corporate practices, large student debt payments, and regulatory requirements. In the face of this uncertain future, graduates want additional information to help them compete effectively in the new reality.

This book is primarily for dental students about to graduate, new graduates (in both private practice and other clinical settings), and recent graduates who have been out of school for five years or less. It is not written for well‐established dentists who have practiced for 20 years, although they may find pearls to apply in their practices. Instead, the essential business information that new practitioners can apply in their practice situation to compete effectively is presented. It is not intended to be specific management advice for every management problem – readers should consult with accountants, management consultants, or mentors about specific problems – but if the issues can be understood, then the dentist will communicate more effectively with advisors and will understand and implement solutions and advice more effectively.

A dental practice is a small business that responds to business concepts and rules like any other small business. The only difference is that dentists sell dental services, not hardware, clothing, electronics, or automobiles. So it is essential to understand a business principle and then apply it to dental practices. In this way, a practitioner in New York City or Mayfield, Kentucky, can use the same business principle in different‐looking practices.

The numbers given as examples or illustrations represent the United States as a whole. Some areas, especially large urban areas, have higher costs and fees than other small towns and rural areas. For example, typical wage rates for hygienists in large urban areas are currently $60 per hour; in many small to mid‐sized towns, rates for hygienists are $35 per hour. Likewise, the fees charged are also generally higher in those urban areas. Therefore, the numbers shown may not represent a practice situation exactly, but the business concept behind the example is valid regardless of the practice area.

This book surveys the topics of operating a dental practice. As such, it is only an introduction to each of the topics. For example, although several pages are devoted to the methods of valuing a dental practice, experts have written entire manuals and even entire books on this subject alone. Other excellent texts, websites, and how‐to manuals cover this book's topics. For example, the American Dental Association produces an excellent series of books that cover practice transitions, regulatory compliance, and many other management topics in a level of detail that cannot be put into one book. This book is only a starting place for studying management in the office.

This second edition has added more information about career planning. We have found that fewer graduates are directly entering private dental practice. As the practice world moves to more network practices, new graduates find more professional opportunities in those networks. Many use them as a stepping stone to an eventual private situation; others use them as a lifelong career option. Either way, the graduate still needs the information presented here to be a more effective employee.

We intend this book to be a text and a reference book. If the reader is a student, they may be required to read specific chapters to pass a test or course. A practitioner who has a problem with staff interactions in the office may pick up the book and read the chapter on how to motivate employees. Either way, the intention is to understand how business people think about problems and develop specific solutions to management problems. We hope that you find the information helpful in that regard.

James L. Harrison

David O. Willis

Charles K. Thieman

SECTION 1Career Planning

Career development is becoming more critical for dental graduates in today's economic climate. Many students leave dental school with hundreds of thousands of dollars of student debt. Not only does the graduate need immediate income to make student loan payments, but the significant debt levels may also hinder their ability to secure loans at favorable rates. The increase in corporate and franchise practices provides immediate employment opportunities and increases competition in the local marketplace for start‐up practices. Solo practitioners, who face increased competition as well, are often reluctant to take on an associate in the traditional role of owner and mentor. The complex dental insurance world makes practices less profitable than in the past, leading to further cash‐flow problems for young practitioners.

Because of these economic constraints, graduates need to plan their career development. In the past, the simple answer was to “set up my practice.” The plan may involve working in a corporate practice for several years to increase clinical and management skills or working in a public health setting to gain some student loan relief and build clinical skills. Most graduates still aim to practice ownership (solo or group), but now they must take an often‐winding road to reach their goal. This section provides a way to plan a career in clinical dentistry. (In this book, we do not look at opportunities in industry or academia, only the various clinical practice opportunities.)

There are two general categories of income generation for new dentists. First, they can work for someone else (get a job). This option allows immediate income generation, but does not always provide long‐term professional security. They can find employment with a private practicing owner‐dentist as an associate dentist, with a Dental Management Service Organization (DMSO) as an employee dentist, or with the government through the public health or military systems. The second option is to own all or part of a practice. This option provides long‐term security, but is often expensive and risky to establish. Here the graduate can buy an existing practice (buy‐out), start a practice from scratch (cold start), or buy into an existing practice (buy‐in) in a partnership arrangement. This section of the book examines each of these possibilities.

CONCERNS OF THE CAREER DEVELOPMENT PROCESS

The career planning process is concerned with three major concerns:

Establishing short‐ and long‐term career goals

Everyone has a personal long‐term career goal, and each of us takes a different path to reach those goals. Our short‐term goals contribute to achieving our long‐term career goals, and personal wants, needs, desires, and circumstances affect our career goals.

Understanding the difference between employment and ownership positions

Employment and practice ownership are two different concerns, and each has advantages and disadvantages that become decisive factors in career planning.

Planning for career transitions

As professionals move through their careers, they must be sure that the transitions from one phase to the next are well planned. Otherwise, they may have made early decisions that either support or decrease the likelihood of making the next step in the plan a success.

OBJECTIVES OF THE CAREER DEVELOPMENT PROCESS

Given these three main concerns, we group the career development process's objectives into this section's major chapters. The issues that dentists should examine in their career planning process include the following:

Chapter 1

:

Career Planning

Everyone needs to examine their personal wants, needs, desires, and abilities when developing a comprehensive career plan. They also must make a realistic appraisal of opportunities and roadblocks that affect the process.

Chapter 2

:

Employment Opportunities

Many new graduates will enter directly into employment situations, whether in private practice (associateship), corporate, or government situations. To be successful, they must understand the nature of employment and the advantages of each type of employment position. They may use these situations as stepping stones to fulfillment of their long‐term goal.

Chapter 3

:

Practice Ownership

An ownership position (either solo or in a group) has an entirely different purpose from an employment position. The owner is trying not only to make an income from the practice, but also to build personal wealth by increasing the value of the practice. These are generally “destination”‐type opportunities, and most owners plan to be in their practice for their careers.

Chapter 4

:

Practice Transitions

Practice transitions involve changing employment or ownership positions, which may include starting a new practice, buying out an existing practice, or buying into an existing one. How a person goes about the process has important implications for financing and planning.

Chapter 5

:

Valuing Practices

If someone purchases all or part of a practice, they need to set a value so that they can borrow money to pay for the practice without placing a significant burden on the practice's cash flow. Therefore, the buyer needs to achieve a value that is consistent with business norms and will enable them to pay off the practice acquisition loan promptly.

Chapter 6

:

Securing Financing

When someone locates a practice to purchase and has a reasonable value associated with it, they need to find a lender who will lend them the money required for the purchase. Terms may differ for different lenders, and understanding these differences can help borrowers decide and negotiate an advantageous financing package.

CHAPTER 1Career Planning

Don't confuse having a career with having a life.

Hillary Clinton

GOAL

This chapter aims to describe specific career planning decision points and processes.

LEARNING OBJECTIVES

After the completion of this chapter, the student will be able to:

Describe the characteristics of dental practice as a career.

Define professional options available to the new dental graduate.

Describe career choice points that affect the career path.

Describe personal and professional factors that affect the location decision.

KEY TERMS

career decision points

career path

Dentists have many professional options to use their skills and training. Some involve ownership, while others are employee situations. In this book, we only discuss practice‐related options. The opportunities include:

Employment

Private sector

Private associateship (non‐owner)

Corporate employee (non‐owner)

Industrial research

Corporate support

Public sector

Military/Veterans Affairs

Public health patient care settings

Dental education

Ownership

Private solo practice (owner)

Private group practice (owner)

CHARACTERISTICS OF DENTAL PRACTICES

Dental practices are unlike many other service businesses. Most dentists are still in individual practices, with few colleagues with whom to confer. They must personally deliver the service, which involves hard physical work. They cannot delegate most procedures and must be personally present for the procedures that they do delegate. This means there is little managerial leverage, so the dentist cannot play golf while the office operates. There is no managerial progress. Someone cannot work their way up the management line to become a regional manager or vice president. Most new graduates come to the workplace with high educational debt and must include that in their practice debt finance plan. Dentists' earnings typically peak at 45–50 years of age. After that, the physical nature of the work causes them to decrease the number of patient visits. Often dentists then look to add associates or plan to sell their practices. The question is whether to sell at the peak of the income‐generating potential (and therefore at the highest price) or to “milk the cow” and take income from the practice as they continue to slow down.

COMMON MYTHS ABOUT DENTISTRY

There are several misconceptions about dentistry that will influence career choices.

DENTISTRY IS EASY MONEY

Many people outside the profession view dentistry as an easy way to make a lot of money. Although dentistry is still one of the more lucrative professions, those in the profession know it is not easy to make money. Dentistry is physically demanding work. Dentists often work long hours in contorted positions to make patients comfortable. Back and neck problems, repetitive motion injuries, and eye strain are common problems of seasoned dental practitioners. Dentistry is also emotionally demanding work. Many patients fear dental procedures or have unrealistic expectations about their desired outcomes. Staff members may have personal problems or interpersonal disagreements that affect the work environment.

A DENTIST MAKES MORE MONEY OWNING A PRACTICE

Dentists might make more money if they own their practice. Practice ownership requires knowledge, skills, and abilities that not all dentists have. Additionally, owner–dentists need to spend time and emotional energy to operate the business side of effective practice. Not all dentists want to do this. Some are excellent clinicians but do not want the extra problems of ownership. They want to treat patients, not worry if the hygienist and assistant have interpersonal problems or fret about the changes in a local employer's dental insurance plan. These dentists are best off working for someone else, letting the owners worry about the management of the practice. They can make more money treating patients if they work with someone good at managing a practice or a network of practices. Someone who is excellent clinically, behaviorally, and managerially and loves all aspects of running a practice can make more money owning it.

BIGGER IS BETTER

Many dentists believe that a bigger practice is better. Personal wants, needs, and desires might lead someone to a smaller, more personal practice better suited to their temperament. A larger practice is not necessarily a more lucrative practice. Profits come from using the practice's resources to the maximum amount possible, regardless of size. A small practice can be as profitable as a large one. However, an extensive, well‐run practice does have some advantages if the owner has the managerial expertise to make this larger and more complex business entity use all its resources effectively. A larger practice might show a higher profit if well run. A bigger practice may weather economic downturns more easily. When sold, larger, more profitable practices bring a higher price, although sometimes finding a buyer for these large practices is difficult.

STUDENT DEBT MAKES IT IMPOSSIBLE FOR A DENTIST TO BORROW MONEY TO BUY A PRACTICE

Dental graduates are carrying higher levels of student debt than before. Changes in the student loan programs have made it more difficult to consolidate these loans at low interest rates. Tax law changes have limited the amount of student loan interest graduates can deduct. Nevertheless, dentistry is still one of the higher‐income professions. Banks and other lenders who make start‐up and buy‐out loans to dentists understand these problems. They will work with dentists to develop loan packages if the practice can support the cash flow needed to pay all expenses, including student loans. Not all practices will be profitable enough at a price that can support the cash flow required to make all the payments, however. This can result from the practice price being set too high, high overhead in practice, or the financial characteristics of the potential buyer. A graduate who does not have a high loan burden or who has a spouse who earns a significant income may show cash‐flow needs that are much lower. This dentist may qualify to borrow for a practice purchase when someone else would not.

PUBLIC HEALTH IS FOR DENTISTS WHO CANNOT MAKE IT IN PRIVATE PRACTICE

It has become part of the professional culture that “good” dentistry is exquisitely done (expensive) reconstructive dentistry. True, dentists in the public care sector may not do much complex reconstructive dentistry because the organization's purpose is to provide more basic services to a larger clientele. This does not make dentistry or the dentist's application of their hard‐earned skills of less quality or less critical. The public sector provides valuable services to a large segment of the population. Many dentists find satisfying and rewarding careers by devoting their skills to this style of practice.

A DENTIST DOES NOT HAVE TO TAKE INSURANCE PLANS IN PRACTICE

If a dentist is in a private ownership position, they make all the management decisions. Long‐term, insurance‐free practice is the goal of many practitioners. However, most do not get there. It takes a combination of location, clientele, management, clinical expertise, and time to develop a practice that does not participate in dental insurance plans. Someone may take plans in the short term with the aim to wean off them as they build a private clientele. As the economic environment and insurance industry change, more practices find the need to participate in insurance plans.

A DENTIST WILL BE IN THE SAME OFFICE THEIR ENTIRE CAREER

This used to be more accurate than it is today. In the past, the graduate would open or buy a practice and then build it over the years, and they would be in an ownership position immediately after graduation. New graduates today may work in several professional situations before arriving at their final practice setting. With the increasing number of employment opportunities, many dentists never reach an ownership situation, choosing to do clinical work in non‐ownership positions for their entire careers. The old notion that private practice is the only good form of dentistry is dying out.

CAREER PATHS

Dentists now talk about career paths in which they have an ultimate, long‐term goal but may take several steps to reach it. Short‐term goals then support long‐term goals. Each step in the short term should support the long‐term intention. For example, the traditional path would be to finish dental school, go directly into a pediatric dentistry residency, and then open a practice. A new graduate who has high student debt may take a different career path. In this path, someone may graduate and join a public health practice that offers loan forgiveness. They can build speed and confidence while working with young patients in the clinical setting. They then attend residency and join a group pedodontic practice. Career paths are different for everyone depending on their circumstance. Graduates with an immediate family member who has a career in dentistry or other healthcare profession are at an advantage. They generally have a deeper understanding of a healthcare career and often have a built‐in entry into a practice situation. Graduates with a history of working in private industry or government use that knowledge to their advantage.

Each person makes career path decisions based on their situation at the time of the decision. Specific decision points direct and influence decisions. These include the following.

THE DESIRE FOR INCOME

If someone desires a high income (as opposed to an adequate income), then a long‐term plan should include a private practice ownership option. Specialist dentists' incomes are higher than generalists'. Short‐term options might include associateships or military practice to build skills and knowledge while someone pays down debt and accumulates assets. If a high income does not drive a person's professional needs, other desires can be driving forces.

DEBT LOAD

If a dentist has a small or no student debt at graduation, then they are in the fortunate position of being able to take on debt for a practice purchase or personal needs. Heavy student debt may limit practice options to those showing excellent cash flow. Short term, a graduate might need to practice in an associateship or corporate practice for several years to pay down debt, or find a public health practice that includes loan payment or forgiveness.

THE DESIRE TO BE THE BOSS

Most dental students claim to want to “be their own boss,” but when they face the reality of the debt load, managing the business, and the extra time necessary, many decide that the trade‐offs are not worth it. Part of the old culture of the profession was that the ultimate form of professional effort was a private individual practice, and that notion has changed. Currently, many corporate and public practices use the entirety of someone's professional skill, care, and expertise without practice ownership. If someone is fiercely independent and wants to make or break it on their skills, then private practice is the place.

THE DESIRE TO LIVE IN DIFFERENT LOCATIONS

Some people enjoy the idea of moving and living in different places. Others know where they want to settle and live the rest of their lives. If someone fits into the first group, then practice ownership is a problem. Practice ownership is a long‐term commitment, and it takes many years to fully recover the investment (time and financial) that someone makes when establishing a practice. They may not find a willing buyer for a practice when they want to sell it or have licensing problems in a new location. Network practices, the military, and public health practices are all more conducive to moving to different areas and experiencing different cultures.

THE DESIRE FOR PERSONAL OR FAMILY TIME

Some people love dentistry and would do it 24 hours a day if they could. Others enjoy time away from the office for personal or family activities. Some like to take time every week, while others prefer to take periodic time off for travel or other similar activities. Where a person falls on this continuum is also essential in helping to decide career points. It is not easy to take much time off in an individual ownership position and maintain a high income. Patients want work done, staff members want to get paid, and income stops when the dentist is not there. They can set their hours and take time during the week, but taking many extended blocks is more of a problem. It is easier to take time in a group practice where others can cover for a dentist and share costs. The easiest way to take blocks of time is to work in an employment situation with guaranteed time off (such as military or public health). Often, people in this situation will work more hours during the week but will have the flexibility of blocks of vacation time.

OTHER DECISION POINTS

There are many other career decision points. If someone enjoys doing research, they obviously will be in a situation in industry or academia where they can do this activity, and where someone wants to live influences the path as well. If a dentist wants to live in a specific rural area, the only option may be private ownership. Some people prefer working in an organization with many other people; some prefer working alone.

LOCATION DECISIONS

Regardless of the specific career option, the dentist's first decision is where they want to live. Several factors contribute to this decision.

PROFESSIONAL FACTORS

The single most important professional factor is the dentist‐to‐population ratio. This ratio describes the number of dentists to treat a given population in the area. It is an indicator of the potential viability of a dental practice. It is usually expressed as a ratio such as “1 : 2300,” which says that there is one dentist for every 2300 people in the service area. There may be a need to modify the ratio because it is a general number. The dentist should check that the ratio represents the area in which they are interested. (The numbers may be for the entire county or part of an urban area.) Moreover, the ratio includes both specialists and generalists. If the dentist is a generalist, they probably want to take the specialists in the area out of the equation. The ratio also includes a simple count of all licensed dentists. This includes retired, part‐time, and non‐practicing dentists. If the dentist can, they should play with the numbers to arrive at the number of full‐time equivalent (FTE) generalists per population. (Someone who practices half‐time represents 0.5 FTE dentists.)

Healthy ratios are generally between 1 : 1800 and 1 : 2500. The military has traditionally believed that one dentist can treat 800 soldiers (but the military has 100% utilization). Higher‐income areas tolerate lower ratios as people buy more dental services. Rural areas traditionally have a lower utilization rate than urban areas. A ratio of 1 : 2500 or 1 : 3000 may be required in these areas to suggest enough patients. The dentist can get these ratios from the American Dental Association (ADA), which has several publications that summarize economic factors for dentists across the country. In smaller communities, the graduate can get a phone book and talk to people in the area. The dentist can probably develop an accurate ratio with information from the local chamber of commerce.

The number and type of other dentists in the area are deciding factors. The potential practitioner should feel comfortable with the professional community they will work within, the local dental society, and civic organizations. They should also be sure there are adequate specialists for referral and consider staff availability. A new practitioner may need to train staff, or there may be training programs nearby.

PERSONAL FACTORS

Personal desires are probably the most important practice location decision. The dentist should decide where they want to live and move there. If they are not personally satisfied, then even excellent professional opportunities will not compensate for their lack of personal fulfillment. The dental practitioner should also consider their aspirations, career, and life plans. They should decide their preferred lifestyle. Each person has preferences for climate, culture, and recreational opportunities. Some want a rural lifestyle where hunting, fishing, and hiking opportunities abound. Others would not live anywhere that does not have an entire arts community and excellent country clubs. Everyone must reconcile their preferred practice pattern with their preferred personal style. They may want a crown and bridge–style practice but prefer a remote rural location. The two might not be compatible. Therefore, everyone must be realistic in their assessments.

The next most significant factor in dentists' general location decisions is spouse and family desires. Where someone wants to go is only part of the lifestyle decision, and if they are married the spouse is generally involved in the decision process. A professional or working spouse needs personal growth opportunities as much as the dentist does.

ECONOMIC FACTORS

Once someone has decided on one or several general areas to live in, they should then look at the area's economy. As a service provider, a dentist depends on other businesses to provide employment so that people have money and insurance to afford dental care.

The dentist should examine the economic base of the area. They should find out the sources of income for people in the area. Primary industries, such as mining, farming, and manufacturing, bring money into the local economy. (Each primary industrial dollar circulates eight times in a local economy before dissipating.) From there, the money flows to the secondary industries that support the primary industries, such as construction and retail stores. Tertiary industries, such as dentistry, provide services to the employees of other industries. The dentist should look for broad‐based primary industries in the selected location. Several industries in a town provide a strong economy. The dentist should be prepared for a boom‐and‐bust economy if the area has a single primary industry (such as one large manufacturing plant or a mining‐based economy). Everyone has money when the mines (or other primary industries) are busy. If the mines shut down, miners do not buy shoes or build houses, and construction workers and sales people do not go to the dentist. In contrast, a well‐diversified primary industrial base can absorb an individual sector shutdown without leading to a general economic collapse.

Several indicators help to gauge the economic health of a community. Most patients consider dental care a deferrable expense rather than a medical necessity. As such, it is highly dependent on disposable income. (Disposable, or discretionary, income is what is left over after people have paid for necessities, such as food, housing, and clothing.) Higher disposable incomes generally mean a better dental economic location. Economic growth in an area means that people's incomes are growing and more people are moving into the area. These people will need a dentist. High‐growth areas are also good locations. Some areas have a high turnover rate (people move frequently), while others are more stable. It is easier to establish a practice in an area with a high turnover than to break into a stable area where most people already have a dental provider. However, in the high turnover area, the practitioner will need to continually grow the practice as patients they previously attracted leave through the revolving door.

There are many places to find this information. A call to the local chamber of commerce is an excellent place to start. The chamber's job is to encourage commerce in the area. They already have much information about the potential town. Census data is helpful for comparisons. The problem with census data is that it is usually old by the time a person can get to it. Many states have state data banks that the dentist can call to find the information needed. Additionally, much of this information is readily available on the Internet.

PROFESSIONAL HISTORY

The dentist's professional history may limit their options or allow a particular option to be realistic.

DEBT LOAD

A person's debt load (especially student debt) influences whether an option is acceptable. Bankers have regulators and overseeing committees they must satisfy. If the dentist has so much debt that they are at risk of not being able to make the regular payments on some of their loans, the bank may not loan additional money for a practice.

PRODUCTION HISTORY

The practitioner must show that they can handle the volume of a practice that leads to adequate profit and cash flow. If someone is looking at a practice that needs to generate $900 000 annually to meet projections, the practitioner must show that they can do that much dentistry. Suppose they had previously been an associate generating $800 000 annually or in an Advanced Education in General Dentistry (AEGD) or military practice where they generated significant production. In that case, a lender could infer that they could reasonably handle the practice, but not so with a new graduate who was busy treating two patients daily.

PRACTICE CHARACTERISTICS

The characteristics of the practice the dentist is considering establishing or purchasing influence the viability of the option. If a practice has a large contingent of discounted insurance plan patients, the dentist will have to produce even higher amounts of dentistry to see adequate cash flow through the practice. Lower levels of discounted insurance participation lead to higher margins, but less dentistry is being done. In these practice opportunities, the dentist must have a marketing plan to generate the private‐pay patients required for profitability.

CASH‐FLOW PROJECTIONS

These factors all come together in the cash‐flow projection. Suppose the practitioner can show through a realistic cashflow projection that they can service the practice debt, generate an income to live on (including personal debt payments), and pay taxes. In that case, the practice option is viable, and if not, then it is not a viable option at this point.

CAREER PLANNING PATHWAYS

Given these decision factors, we provide the career pathway flowchart in Figure 1.1 as a helpful way to think about career paths. We discuss each option in more detail in later chapters of this section.

The first and most crucial task for any dental student is to finish dental school. Until a person does this, no other career decision has any meaning. That is not to say that they should wait until graduation to begin making these plans. Some dental students cannot see that there is a life after dental school with no fixed curriculum, where everyone makes the same choices. For these reasons, we discuss making decisions after graduation, but not waiting until after graduation to make the decisions.

FIGURE 1.1 Career pathway flowchart for dental graduates.

GRADUATE TRAINING

The initial decision point after graduation is whether to pursue graduate training or move directly to a practice option. Graduate training may take the form of additional general training or specialty training. Regardless, this only delays the career decision for several years.

Advanced Training in General Dentistry

There are two options for general dentistry training after dental school: AEGD and general practice residencies (GPRs). AEGD programs focus primarily on dental treatment. They generally occur in a dental school environment and are the halfway point between dental students and practicing dentists. If someone feels they need time to become a more competent technical dentist before going into practice, an AEGD may benefit them. AEGDs usually do not require participants to be on call, and the dentist will not get the same level of medical/hospital experience as they might in a GPR. GPR programs are frequently held in medical facilities. These programs concentrate on dentistry as it relates to whole‐body medicine. As such, participating dentists are included in medical rotations, sometimes functioning almost as overflow physicians at some time in the program. Like being a physician, most require participants to have on‐call shifts. Because GPRs do not focus exclusively on dentistry, participants gain a wide variety of exposure and experiences. These experiences are beneficial for those considering oral surgery and emergency care specialties.

Specialty Training

A dental specialty is an area of dentistry that the ADA has formally recognized through its National Commission on Recognition of Dental Specialties. Currently, there are 12 dental specialties recognized by the National Commission. This commission sets standards for recognition and policy guidelines for its Boards and Organizations. They all require the completion of an advanced education program. These are:

Dental Public Health

Endodontics

Oral and Maxillofacial Pathology

Oral and Maxillofacial Radiology

Oral and Maxillofacial Surgery

Orthodontics and Dentofacial Orthopedics

Pediatric Dentistry

Periodontics

Prosthodontics

Dental Anesthesiology

Oral Medicine

Orofacial Pain

The graduate needs to research the specialty they are considering. Dental specialties have associations where professionals can meet, network, and discuss their work. If someone is interested in a dental specialty, there are few better places to look than the corresponding professional association. They should spend time shadowing and talking to mentors about the specialty to ensure it fits their desires and interests. This can also give insight into the daily life of a specialist. Internships/externships are usually done in an academic or hospital setting. This offers insight into a typical day in residency and often goes more in depth into the different treatments and procedures.

Graduates should consider the economic effect the delay will have on starting their careers. Most specialty programs do not pay residents, and most practitioners must pay tuition to attend. (Hospital‐based residencies, such as a GPR or oral and maxillofacial surgery, generally pay a modest stipend.) So, income will be lost for two to four years while the graduate completes the program. However, this may be offset by the higher income levels many specialty practitioners earn.

EMPLOYEE OR OWNER POSITION

The next central decision point is whether to become an immediate owner of a practice or to work as an employee, long or short term. This may be a decision that is made for the graduate. As already described, there may not be a purchase opportunity, or the graduate may not be in a financial or experience position to own a practice. Many graduates use employment (government, private, or corporate) as a stepping stone, building clinical and managerial skills while paying down debt and building financial assets. After several years, they may be in a better financial position and purchase a whole or part interest in a practice. Others may use the employment situation as a career option. When someone is in an ownership position, they may loop back to an employee situation by selling their practice, often to a corporate entity, and working for that corporation.

CHAPTER 2Employment Opportunities

A man's got to know his limitations.

Harry Callahan, Magnum Force

GOAL

The goal of this chapter is to describe common issues in employment situations for dentists.

LEARNING OBJECTIVES

At the completion of this chapter, the student will be able to:

Describe standard methods of compensation for dentists.

Describe standard associate‐owner arrangements in dentistry.

Differentiate between an employee and an independent contractor.

Describe the advantages and disadvantages of working as an associate in private practice.

Describe the advantages and disadvantages of working for a corporate practice.

KEY TERMS

arbitration

associateship

associateship contract

BSA (business service agreement)

buy or sell provision

career benefits

claims‐made policy

commission

DGP (dental group practice)

direct pay

dispute resolution

DMSO (dental management service organization)

draw against future earnings

employee benefits

employee dentist

employee insurances

employee status

employment contract

government employment

incidents of ownership

independent contractor

mediation

military

non‐competition agreement

non‐disclosure agreement

non‐solicitation provision

paid time off

percentage of collections

percentage of production

public health

restrictive covenant

salary

tail coverage

termination for cause

total compensation

variable commission

wage

Many new dental graduates take employment positions initially out of dental school. This may be to hone clinical skills, pay down debt or build assets, improve practice management knowledge, or because they do not want the involvement of practice ownership. Regardless of the reason, the critical point about employment is that the dentist is there to make money for the employer, whether a private practitioner, network practice, or governmental organization. If the dentist does not make money for the employer, they will not be there long. The dentist should understand that employee positions are not about them but about the organization. The dentist is valuable so long as they contribute to what the organization does.

GOVERNMENT EMPLOYMENT

MILITARY

One option for employment is to become a dentist in the Armed Forces. The US Army, Navy, and Air Force all recruit dentists to serve as commissioned officers in their Dental Corps. Both active duty and reserve components recruit dentists with a US dental degree and a license to practice dentistry. Students may also be eligible for special programs covering tuition and providing a monthly wage while in dental school. Graduates will serve in the military as dentists for a set time, depending on the program.

Dental Corps members are responsible for the dental health of military personnel and their family members. Many dentists are stationed stateside in the medical clinics of military bases, and others are assigned tours of duty at US military bases worldwide. Responsibilities may include the emergency medical treatment of service members in deployed places near combat or participating in humanitarian missions in the United States and overseas.

As a military member, a dentist will be eligible for all the benefits and privileges that any other service member enjoys (Box 2.1). Military dentists work at modern dental facilities, use modern technology, spend quality time with patients, and maintain a flexible schedule. Additional bonuses and retention incentives are available to dentists.

The Health Professions Scholarship Program (HPSP) is a program that a dental student can apply for that will pay for three years at an American Dental Association–accredited program (DMD/DDS). This scholarship covers tuition, books, equipment, supplies, and a monthly stipend (income). Since the military pays for schooling, it requires a minimum four‐year commitment to military service upon graduation.

BOX 2.1 CURRENT EMPLOYEE BENEFITS OF MILITARY DENTISTS

Medical, dental, and life insurance

Substantial retirement plans

Housing allowances

30 days paid vacation each year

Signing bonus

Health professions loan repayment

Special pay incentives

Advanced training opportunities

Dental officer retention bonus

The military reserve Dental Corps employs dentists in the armed services. Some reservists are former active‐duty service members, and others have only served in the reserve Corps. There are several scholarship and loan forgiveness programs for Corps participants. Reservists can maintain active employment in the civilian world, using the reserves as part‐time employment. The reserve dentist should remember that they can be called to active duty at any time and with very short notice. This might be a problem, especially for a dentist who owns a solo private practice.

PUBLIC HEALTH

The uniformed dental officers of the United States Public Health Service Commissioned Corps serve in the Indian Health Service, the United States Coast Guard, the Federal Bureau of Prisons, and the National Health Service Corps. The Commissioned Corps is governed by the Surgeon General and falls under the Department of Health and Human Services rather than the Department of Defense. Even though the Commissioned Corps is not an armed service, officers may be called to assist in public health response to man‐made and natural disasters. Officers enjoy the same benefits as their military counterparts.