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Practice ownership decline has hastened and is now irreversible, says HPI

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Dentistry in the US is transitioning away from an owner-dentist model, according to Dr Marko Vujicic of the ADA Health Policy Institute. (Image: luis abrantes/Shutterstock)

CHICAGO, US: There has been an acceleration of the trends that are contributing to the gradual disappearance of solo private dental practices in the US and a decrease in practice ownership, according to the latest data from the American Dental Association (ADA) Health Policy Institute (HPI). In a March webinar, HPI presented its latest research on the changing dental workforce, and moderator Dr Marko Vujicic, chief economist and vice president of HPI, said that the trends that are driving change in practice models are accelerating and are no longer reversible.

In the webinar, which focused on dentistry in the US, HPI data showed that practice ownership is declining for dentists working in the private dental sector. In 2005, 84.7% of dentists owned their clinic, but this had decreased to 73.0% by 2021. Last year, 59.6% of women dentists owned the clinic where they worked, compared with 68.1% in 2005, and 80.3% of male dentists were practice owners in 2021, compared with 88.5% in 2005.

The decrease in practice ownership occurred across all age groups during the 16-year period covered by the HPI data. Just over 25.0% of dentists aged under 30 owned a private dental practice in 2005, and this had dropped to 9.5% by 2021. In the 30–34 age group, ownership decreased from 55.0% in 2005 to 34.2% in 2021. Dentists aged 45–54 were most likely to own a private dental clinic, and ownership rates among this age group decreased from 93.9% in 2005 to 88.6% in 2021.

HPI Senior Research Analyst Bradley Munson pointed out that there was evidence of accelerating change owing to the levels of practice ownership decreasing more quickly across the age groups, and Dr Vujicic stated “We are convinced that these trends are actually going to amplify in the coming years.”

Changing demographic and lifestyle factors leading to decrease in dental practice ownership

Dr Vujicic said that practice ownership was decreasing as a result of trends that had already been prevalent but that had accelerated in recent years. These trends include women accounting for a greater percentage of the dental workforce, a workforce that is significantly decreasing in age and a greater likelihood of dentists practising in groups.

Dr Vujicic said that the workforce was currently split between younger dentists and those who are at or nearing retirement age, and that this would lead to the dental workforce becoming significantly younger within the next five to ten years. “We are in a period now [in which] there is a bulge of retirement-aged dentists and that retirement volume is really high. And behind that there is also a bulge of really young dentists that are coming out of dental school and are early career stage,” Dr Vujicic explained.

“All of these trends that we are seeing, they are about to accelerate big time”

The number of dentists per capita increased between 2001 and 2015 but has since levelled off at around 61 dentists per 100,000 inhabitants. The data showed, however, that retirement rates increased in the last five years. In 2021, the number of dentists aged 55 or over who left the workforce was 6,641 (9% of that age group), up from 5,228 in 2020 and 5,254 in 2019. Despite this elevated rate of retirement, HPI expects that the number of dentists per capita will increase to 67 per 100,000 inhabitants by 2040, assuming that population growth in the US remains at its current historic low and that dental schools currently in operation continue to produce dental graduates.

Dr Vujicic said that the COVID-19 pandemic had not significantly affected retirement rates. “Maybe people retired a year earlier—two years, three years or five years earlier—but that doesn’t affect the long-term projections for the workforce,” he said.

Women dentists have historically been less likely to own a private dental clinic, and their share of the dental workforce has increased in recent years. In 2020, women dentists accounted for 34.5% of the workforce, and HPI expects this to increase to just under half (49.4%) by 2040.

Additionally, HPI data showed that the share of dentists in private practice who operated a solo dental clinic declined from 66.5% in 2001 to 46.2% in 2021. This decrease was prevalent across all age groups but was particularly pronounced among younger dentists.

Finally, steady growth in the US dental sector of dental support organisations (DSOs) was found to be contributing to a decline in the rates of practice ownership. In 2017, 8.8% of dentists were affiliated with a DSO and this increased to 10.4% in 2019. Citing research conducted by the American Dental Education Association (ADEA), Dr Vujicic said that 30% of dentists who graduated in 2020 said that they planned to join a DSO, up from 12% in 2015.

Dr Vujicic commented: “All of these trends that we are seeing, they are about to accelerate big time, the decline in ownership, the decline in solo practice and the growth of groups and DSOs […] We are at a point where, in the next five years, there is going to be a big exodus of that boomer-age dentist population.”

He explained that student debt was having some impact on rates of practice ownership, but that it was not a significant factor compared with other demographic, lifestyle and generational shifts. “There are all sorts of massive generational shifts that are driving this, and it is a mistake to think that easing the debt burden is going to reverse these trends. I want to say something even stronger: these trends are not reversible.”

He concluded: “Dentistry is heading exactly down the path of every other healthcare occupation that has gone through this transition. Away from business owner, solo practice, towards working in groups […] and this is not something that is going to change.”

The HPI webinar, titled “The changing dental workforce”, is available on demand on the ADA website.

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