Good AGD, Academy of General Dentistry, article about new dentists starting out. And, no, it doesn't discuss salary. New dentists discuss their choice of running a practice and/or becoming an associate. Many of you might find it interesting. The dental student debt figure discussed in this article will be inaccurate for many who graduated even in 1998, it is based on ADA survey, and should be taken with a grain of salt. My theory on most surveys.
What to expect as an associate For many new dentists associateship is first step toward ownership
By Jennifer Garvin
Long hours. New surroundings. Staggering debt.
Nearly 4,000 students will graduate from dental schools this year, and according to a 2002 survey by the American Dental Association (ADA), more than 74 percent of those new dentists will begin their careers as associates. The reasons for this are twofold: opening up a solo practice is expensive and by working as an associate, young dentists are able to gain valuable experience and save money at the same time.
The transition from the comfortable cocoon of the classroom into private practice can be nerve-wracking for a new graduate. One young dentist interviewed joked that it's like "being thrown to the dogs." Although students spend the latter part of their schooling working on patients in clinical settings, nothing can quite prepare you for when you're on your own for the first time.
"I can still remember my first patient, my very first day," said Jason Hartman, DDS, a 2000 graduate from the University of Michigan School of Dentistry. "I was by myself because [the owner] was on vacation and I was sweating bullets. You learn quick."
Dr. Hartman, who now practices in Bay City, Mich., knew early on he would work as an associate after graduation.
"I didn't feel like I was ready to up and buy a practice or open one on my own," he said. "I wanted someone to show me the ropes, not only in dentistry, but on the business side as well."
Dr. Hartman's reasoning is common. Many dental students rely on student loans to put them through four years of schooling. According to an ADA survey the average debt in 1998 was $84,000, not including undergraduate loans. The thought of accruing more debt is daunting.
"To start a practice just out of school was too scary," agreed Eric Bloom, DDS.
Although Dr. Bloom recently opened his own practice in Illinois, he continues to work part time as an associate. Since graduating from the University of Iowa College of Dentistry in 1997, he has worked nonstop for several practices, including a stint at a managed-care company. In all, he works six days a week between the two practices, usually 10 or more hours a day. While he's ecstatic about his own practice, Dr. Bloom said he recognizes the positives of working for an established business.
"There's security there," he said. "The practice I'm at [part time] is very busy so I always know my schedule is going to be full. We have three hygienists and you stay busy. You know you're going to get paid and I'm getting paid on production, so you like to be busy."
Dr. Bloom has also had the benefit of working for a dentist that helped him get started.
"He's a great guy and you could always ask him questions and he'd give you the answer," he said. "I'm lucky to have somebody who's been through it before and who helps me avoid some pitfalls."
On the downside, associates sometimes find themselves conforming to their owner's ways before developing a technique of their own.
"You have to use the materials and supplies that that dentist uses," Dr. Bloom said. "You have to do the procedures they do."
It takes time
John Gammichia, DMD, is a recent owner. He became partners with his father about four months ago. Dr. Gammichia toiled as an associate for eight years before becoming an owner. In the beginning, he remembers feeling discouraged when he would talk to an old classmate or read something in a publication where new graduates we're talking about how great everything was. Meanwhile, he was thinking to himself, "this is not as easy as I imagined."
Those experiences prompted him to begin lecturing on the subject.
"People are going to dental school and they have no idea what it's all about," he said. "I had just survived my fifth year of practice and remember sitting back in the office and thinking about what a huge, roller coaster ride I had been on. One of the reasons I was lecturing was to let young dentists know that the light at the end of the tunnel was indeed a train coming at them."
Dr. Gammichia now travels about 15 times a year to speak to dental students and young dentists about what to expect during the first five years out of school. He said he knew "maybe one person" who scored a home run with their first associateship.
"I'm out eight years and I'm still struggling. I heard someone say that they put 26 units in and it was a piece of cake. For me, that's like 60 appointments. Now, when I hear someone say that, I know there is a possibility they could be stretching the truth."
Dr. Gammichia suggests keeping in touch with classmates or joining dental study clubs as ways of coping with the transition.
"The hard part is balance because now I have a family," said Dr. Gammichia, who is married with three children.
Plan ahead
Chris Chung is a third-year student at the University of California School of Dentistry-San Francisco. Despite being more than a year away from graduation, he already knows he will enter the workforce as an associate in 2005.
"I've weighed the options and starting my own practice is just not financially feasible," he said. "I want to build up my speed. The time we get in school isn't enough for you to be confident to do all the various kinds of procedures that a general dentist needs to be able to do.
Mr. Chung expects the grunt work to continue as an associate and said he is willing to "work his way up" in a practice. He hopes to earn a salary based on production, rather than a flat fee, so that he will be motivated to perform.
"Ideally it would be great to get an associateship where I can build a practice within a practice," he said.
Of course, not everyone becomes an associate after graduation. Kim Rauk, DDS, completed her degree in 2003 at the University of Minnesota. Although she considered working as an associate, more and more she found herself leaning toward opening a solo practice.
Dr. Rauk, who is from a small Minnesota town, knew she wanted to practice dentistry in a country setting. But when she started inquiring at various dental practices in rural areas, she found no one interested in taking on a partner or selling their practices.
So in January she opened her own practice.
"A lot of my classmates are asking me, ‘how did you start?"
"I always knew I was going to leave the metro area," she said. "My husband and I are both from smaller communities and we knew we eventually wanted to live in the country. We thought we'd have to stay in the city to make some money the first year…but this has worked out."
Dr. Hartman plans eventually to own his own practice, but is in no hurry to do so now.
"I enjoy working as an associate," he said. "There are some days when I wish I had my own practice, but I can go home and not worry about paying the bills."
He especially enjoys having another dentist there if the patient requires a second opinion.
"We have an interesting relationship. Even though there is an age difference (Hartman's boss is 56) we share the same practice philosophy," he said. "We do some things differently, but he does it his way and I do it mine. We rarely disagree.
Dr. Gammichia stresses to young dentists to take pride in their work as they slowly build a reputation.
"You don't have much except your signature," he said. "I don't care how young you are, you're building a reputation. The smallest thing you do, take pride in it because there's a lot of people you don't know that will see your work. I felt really honored when my lab technician referred his wife to my office. All because I spend that extra couple of seconds making the prep and impression right on."
Jennifer Garvin is the Staff Writer at AGD Impact. She can be reached at
[email protected].
AGD Impact: June, Volume 32, Number 6