BY MARKO VUJICIC AND RACHEL MORRISSEY
For most of dentistry’s history in the U.S., being a practice owner was an essential part of being a dentist. The traditional career path was clear: graduate, associate with an established practice for a few years, and then buy in or build a practice of your own. Practice ownership was the marker of success and stability. Most dentists still follow this path. But for younger dentists, the timing of when they get into practice ownership has shifted.
For decades, the American Dental Association has surveyed the U.S. dentist workforce to collect information about their occupation (including ownership status) and basic demographic information. We use the term “practice ownership” here to include dentists who fully own their own practice as well as those who are partners or shareholders in other practice types, such as group practices and dental support organizations (DSOs).
To get a better understanding of how practice ownership has played out for dentists generationally, we looked at survey data from over 55,0000 unique dentists who graduated from dental school between 1991 to 2020 and reported ownership status at least once in their career. To track practice ownership over the career span, we grouped dentists into six graduation cohorts, starting with the classes of 1991-1995 and ending with the classes of 2016-2020. We then looked at practice ownership rates at different career stages for each of these cohorts.
Dentists who graduated from dental school in the early 1990s through the early 2010s show strikingly similar patterns in practice ownership. For these cohorts, ownership was achieved relatively quickly. By the time they had completed their first decade in the workforce, more than three out of five dentists who graduated in the early 1990s through 2010 were practice owners. Although dentists who graduated before 2006 were more likely to be owners at the very early career stage, by the 15 to 19 years of experience stage these differences narrow. The practice ownership rate was 89% for the 1991-1995 cohort compared to 81% for the 2006-2010 cohort.
By contrast, dentists graduating in 2011 or later are following a very different career trajectory than their predecessors. While 63% of dentists from the 2006-2010 graduating classes were owners five to nine years out of dental school, only 33% of the 2011-2015 graduating classes were owners at the same career stage. Thus, there is a significant decline in practice ownership rates in the early career stage for newer graduates. However, as these newer graduates move into the next career phase, their practice ownership rates catch up to their predecessors.
Gender adds yet another layer to the story. Across all graduation cohorts, and all career stages, men are more likely than women to own a practice. The gender gap is largest in the early career stage, and then gradually diminishes toward the later career stages. For the newest cohorts of dental school graduates, the rate of ownership for men was 30% compared to 14% for women early in their careers. One thing to note is that while the levels differ, the shapes of the trend lines across the career span are similar for both genders. Practice ownership generally rises over time but starts at a much lower level for more recent graduates.
Why is practice ownership in the early career stage dropping for younger dentists? While there is no definitive research, we think several forces are at play. Educational debt might steer new dentists away from pursuing practice ownership right out of the gate. Some younger dentists may value flexibility or reduced administrative burden and may not see ownership as immediately appealing or conducive to work-life balance. The changing demographics of the dental workforce, where now the majority of dental school graduates are women, is another factor at play.
While some version of practice ownership still seems to be the end point for most dentists, it is clearly no longer the quick step it was a generation ago. We also caution that for the newest cohort of dental school graduates we have only limited data—for the first 10 years of their career. There is clearly something quite different about this cohort, and it remains to be seen if their “catch up” rate is indeed as quick as the cohort before. We will update the data as they become available. Stay tuned.
