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Dentist Incomes Are Falling

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drsushant's picture
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US dentists' incomes have been dropping steadily since 2005, mainly because Americans are using less dental care, according to a report published in the May issue of the Journal of the American Dental Association.

"That was one of the surprising results," lead author Marko Vujicic, PhD, an American Dental Association (ADA) economist, told Medscape Medical News.

Independent general practitioners' average real net income peaked at $217,850 in 2005 and fell to $192,680 in 2009, the most recent year for which data are available, according to researchers for the ADA. Before that, dentists' incomes had gone up almost every year since 1981, they said.

Dr. Vujicic and colleagues found a number of factors that helped explain the change in income, including a lower portion of the population getting dental care, fewer dental visits per patient, an increase in the number of dentists per capita, an increase in expenses for dental practices, and a lower percentage of billings collected.

The researchers focused on independent general dentists, who make up the vast majority of dentists in the United States.

The authors write that they drew on several sources for these findings. Information about dentists' real net income was derived from the ADA's annual Survey of Dental Practice, a random sample of about 4000 to 7000 dentists in private practice. They used statistical methods to make sure that the results were not skewed by trends in demographic factors such as age, sex, geographical region, and location (urban or rural).

They also drew on US Census Bureau data to find out whether the number of dentists was changing in relation to the general population, and they used the Medical Expenditure Panel Surveys from the US Agency for Healthcare Research and Quality to calculate the percentage of the population who had seen a dentist each year.

Fewer Patients, and They Are Visiting Dentists Less Often

A smaller portion of the US population is seeing a dentist annually, the researchers found, going from 40.6% in 2005 to 38.6% in 2009, or a 2.7% decline per year.

In addition, people who do go to the dentist are not going as often. The number of visits per patient fell from 2.0 in 2005 to 1.9 in 2009, for a 1.1% annual decrease. That trend started in 2002, the authors note.

Put together, these 2 trends meant a drop in the total number of dental visits in the United States from 240 million in 2007 to 226 million in 2009.

The researchers also found that dentists were not lowering their fees: Gross billings per dental visit increased from $170.35 in 2005 to $176.72 in 2009. However, the authors did identify a few other factors pushing down dentists' incomes:

Collection rates dropped from 94.3% in 2005 to 93.3% in 2009, part of a general slide taking place since at least 1996.
The number of people per dentist in the country fell from 2274 in 2005 to 2246 in 2009. However, this amounted to only a 0.3% annual increase.
Likewise, expenses per owner increased, but only 0.8% annually from 2005 to 2009.
Most of the drop in dentists' income came from the decline in the number of dental visits, Dr. Vujicic said. "The fact that this trend has been happening since 2003 was a surprise. Seeing a dentist is an important part of maintaining oral health, so it's a concern to the ADA."

One reason why Americans are getting less dental care is that their oral health has improved as a result of the wider use of fluoride and other preventive measures, Dr. Vujicic said. "But it's unlikely that it's all due to improved oral health." Another ADA study found that an increasing number of Americans say they cannot afford the dental care they need, he said.

Jeff Johnson, an analyst for Robert W. Baird investment company, told Medscape Medical News these trends have been reflected in the dental industry in general.

Although patients need fewer restorations, the dental products market continued to flourish because many practitioners began offering more cosmetic procedures such as whitening, implants, and clear plastic aligners, said Johnson. The market flattened from 2008 to 2010, when fewer patients could afford cosmetics.

However, there was some growth for dental suppliers again in 2011, Johnson said, and he sees grounds for optimism for dentists as well as dental companies. A Baird survey of 285 dentists found a small overall increase in profitability for their practices in the past 6 months — the first increase in years.

Dr. Vujicic, too, said a fourth-quarter 2011 ADA survey of dentists' outlooks found that they were more optimistic about their business prospects than in the same quarter of 2010.

"A Sink-or-Swim Professional Economy"

So what happens next?

The researchers found that conflicting factors make predictions difficult.

Since 2008, several states have cut Medicaid dental benefits, and some employers cut back on health benefits, leaving fewer people with dental insurance, said the researchers, citing data from the National Association of Dental Plans.

Healthcare reform legislation could put downward pressure on fees, as could the expansion of programs that license dental therapists to do procedures previously reserved for dentists.

New dental schools are scheduled for opening in coming years, and if dentists' incomes (including those from investments) continue to stagnate, some may put off their retirement, decreasing the number of patients per dentists.

However, lower income for dentists might reduce the number of applicants to dental schools.

The attitudes of patients also are shifting, Bassim Michael, an accountant whose clients include many dentists around the country, told Medscape Medical News. "Patients are way more educated," he said. "They can go onto WebMD or Google and can get an idea of what their problem is, and they can shop around. So there is increased competition, and that's putting pressure on dentists."

To survive in these times, dentists need to do more marketing and invest in the latest technology, he said.

For example, he recommended search engine optimization for Web sites and social media for marketing. He said dentists also should encourage patients who like them to post online reviews.

In addition, he recommended purchasing new equipments such as intraoral scanners and milling systems and digital and panoramic radiography so dentists can diagnose and treat conditions they might have missed in the past.

"I believe this is a sink-or-swim professional economy now," he said. "Those dentists who are aware of these changes and are proactive and make updates in their practices are realizing huge returns."

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siteadmin's picture
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Dentist Incomes Are Falling

 wondering whther incomes of Indian dentists is rising. the incomes have to rise at least 10% per year to keep up with inflation. 

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siteadmin's picture
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Dentist Incomes Are Falling

 the petrol price hile bomb will now further fuel inflation and reduce the incomes of the dentists. I doubt whether practices will be able to pass on the price hike to the ultimate recipients i.e the patients.The opposition will raise a hue and cry and then the govt will rollback the price hike to some extent and then as usual everything will be forgotten.The cascading effects on the economy will be felt for a few quarters.bad times indeed

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siteadmin's picture
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Dentist Incomes Are Falling

 finally govt reduced the price by 2 rupees. The TV headlines screamed of petrol price reduction !!!!!

whereas in effect the price has gone up by 5 rupees.

Politicians can get away with anything.

in my practice management survey I had found that most dentists reported that their incomes are stagnant. Which means that dentists are in effect earning less every year.

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drmithila's picture
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Dentist Incomes Are Falling

 Prices all aorund us are rising, but if any dentist decides to raise charges,, every patient complains...how would one suffice material cost and other clinic expenditures?

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DrAnil's picture
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Dentist Incomes Are Falling

 Every dentist has to revise his charges over a certain period of time. It just plain insane to keep the charges constant over decades. And patients must understand this. Patients will complain. But dentists have to be stern and explain the change in charges to the patients.

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Dentist Incomes Are Falling

Dentists are unhappy at a 41-year-old legislation that requires them to have more than one annual practising certificates (APCs) if they want to work in more than one clinic.
Speaking on condition of anonymity, a senior dentist from Subang Jaya said that the APCs were becoming a burden to many dentists, especially the young ones.
“You see, when a dentist takes leave, they may ask for another dentist to do a locum for them in their absence.
“The problem is, even if the dentist already has an existing APC, they will be required to apply for another one just because they are going to work for a while at the new clinic,” said the dentist.
According to the Dental Act 1971, a dentist must obtain an APC from the Oral Health Division of the Health Ministry for a fee of RM50 and it is renewable every year. The licence would also indicate address of the clinic the dentist would be serving.
However, if the dentist was planning to serve in another clinic on top of the existing one, they would be required to apply for another APC with the new address and charged the same fee.
Calling it illogical, the dentist of over 20 years said the law affected mostly the young dentists, as they would normally do locums in various clinics before establishing their own private practice.
“They don’t have the resources to set up their own clinics. So they become locums first and serve in many clinics and they have to get APCs for each clinics they serve,” said the dentist.
The dentist added that it was time for the Malaysian Dental Council (MDC) to look into the matter and resolve the matter soon.
Another dentist from Puchong said that she herself owned eight APCs as she does locum for several clinics owned by her friends.
“I know dentists who have more than 20 APCs. Imagine how much money the ministry is getting from this,” said the dentist who also claimed anonymity.
Even specialists not spared
She likened it to someone taking a test for driver’s licence saying, “It’s like having to apply for licence for every type of car your drive. It’s ridiculous. Even specialists are not spared.”
On arguments that it was to monitor dentists’ conduct, she said that if an owner of a clinic hires a locum, the owner should be responsible if any problems arise.
“Besides, you can track down an errant dentist because he or she is registered with the MDC,” she said.
Another dentist Dr V Nedunchelian said that it would best if the ministy just added the additional clinic addresses into the APC at no cost.
He added that under the Private Healthcare Facilities and Services Act 2006, the owner of the clinic would be held responsible if any dentist hired gets entangled in a malpractice allegation.
“Besides, we renew our APC annually. Just add the name of the new clinic address on top of the existing one. No need to charge additional fee,” said Nedunchelian who himself has three APCs.
Whether anyone had lodged a complaint over the matter, all three dentists said no one had done so.
“We are afraid that the ministry may take action against us for highlighting the matter,” said the dentist from Subang Jaya.
Despite numerous attempts, FMT failed to reach Health Ministry director-general Hasan Abdul Rahman for comments.

 

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findadentist's picture
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Dentist Incomes Are Falling

It been a serious issue from some day and need to be solved other wise it will be difficult to find dentist easily.

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