Past, Present, Future of Prosthodontics

Past, Present, Future of Prosthodontics

The business of the specialty of Prosthodontics has never been more difficult or competitive. Using data from an ADA Research Brief:

Munson B, Vujicic M. “Supply of dentists in the United States is likely to grow”. Health Policy Institute Research Brief. American Dental Association. October 2014.
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_1.ashx

Our specialty is only about 47 years old. Prior to Prosthodontics, there were a few very talented General Dentists in each city that other dentists referred to for complex patient treatments. In the beginning of our specialty, when there were very few of us, less aggressive general dentists would send patients to us for larger treatments. Prosthodontics enjoyed a small run as a referral specialty for about 20 years from 1975 to 1995. As you view the graphs below, you would think that with the ever expanding number of general dentists and the very small growth rate of Prosthodontists the number of referrals would be increasing, not decreasing. With upwards of 140,000 dentists and only about 2,000 private practice Prosthodontists one would think that our demand would overwhelm our offices with more referrals than we could ever handle. For most Prosthodontists, especially the younger graduates this is simply not the case.

Every year our industry adds approximately 6,300 new dentists through dental school graduates, incoming foreign dentists, relicensing and unretiring (dentists coming back to practice from previous retirement). Contrast that number with approximately 4,300 fewer dentists due to retirement, death and lost licensure. This produces a net +/- 2,000 new competitors, nationwide.

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The ADA continues to support the notion that there are too few dentists in the United States. They declare that we are “underserved” at a ratio of 60.2 dentists per 100,000 (1,661 patients per dentist). When considering the yellow line in the first graph, it is clear that some leaders believe we need even more dentists added to the current workforce. This yellow line represents an increase of 1,000 additional dentists per year over the current number.

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The data has several intentional omissions:

  1. The “underserved” designation may be true for rural American but it is far from true for urban American, especially those cities with dental schools. The study does not discuss the severe oversaturation of larger cities in the U.S. but I would venture a guess that it is close to double the ratio, somewhere around 120 dentists per 100,000 or, 833 patients per dentist.
  2. Other studies suggest that as many as 35% of the U.S. population do not go to the dentist. So, the 60.2/100,000 now becomes 60.2/65,000 or, 1080 patients per dentist. In Urban American that puts our ratio around 120/65,000 or, 541 patients per dentist.
  3. Increasing the total number of schools and dental students with the hope that more will move to underserved, rural areas is nothing less than a hopeless and irresponsible solution.

Other key points which make the plight of the solo or small office practitioner more bleak are:

  1. Corporate dental organizations are spending hundreds of millions of dollars per year to bring PPO patients to their locations. They have perfectly positioned themselves for high volume success. This dilutes the patients that are available for smaller offices that spend little or no money on marketing. Whether you participate in the PPO system or not, many of your potential patients are being absorbed in these office where their Prosthodontic needs are being dumbed down or overlooked.
  2. General dentists have become more aggressive in treating patients that should be referred to specialists. With each graduating class, all dental specialists agree that the average general dentist is far less likely to refer. Whether doing it themselves or bringing in a “specialist” many general dentists are unwilling to refer production out.
  3. The specialty of Prosthodontics has never really enjoyed a Golden Age of dental referrals. With few exceptions, whether because of very small number of specialists, poor visibility or poor promotion most Prosthodontists do not have enough dentist-generated referrals to support a financially successful practice.
  4. The ADA will continue to attempt to justify more new dental schools and larger dental school classes through flawed data. Whether by way of fewer insured, access to care or simply showing inflated data like the above. One must wonder why the ADA continues this trend of more dentists.

The summary of all the above data and opinions is that our potential patient pool is smaller than ever due directly to more competition. In order to compete, succeed and thrive, a Prosthodontist must find ways to bring new patients into the practice and/or get more patients to say yes to treatment. There are a variety of ways to do this:

  1. Improved Conversion Rate
  2. Internal Marketing
  3. External Marketing
  4. Study Club
  5. Physician referrals
  6. PPO plans

As it gets more difficult to compete with all the people claiming they can do the work of a prosthodontist we must change the way we think about our business. “If you want something you’ve never had, you must do something you’ve never done”.

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