Trends in Prosthodontics: A Q&A with Dr. Douglas G. Benting

Prosthodontists are playing a larger role in dental care.

And as demographics and technologies have changed, so has the profession. Recently, the American College of Prosthodontists (ACP) reviewed surveys of members and nonmembers alike from 2008, 2011, and 2014 to chart the specialty’s evolution and found some revealing trends.

For example, prosthodontists currently spend 21% of their time treating patients for fixed prosthodontics, which is down from the 24.1% reported in 2007. Also, 2013’s mean amount of nominal gross billings was $654,270, which was lower than the mean gross billings in 2007 and 2010.

Douglas G. Benting, DDS, co-authored a study on the survey with Dr. Kent Nash for the ACP’s Journal of Prosthodontics. The full report, “Private Practice of Prosthodontists in the United States: Results from the 2008, 2011, and 2014 Surveys of Prosthodontists,” is now available online. Below, he discusses some key trends with Dentistry Today.

Q: The 2013 nominal gross billings were lower than the 2007 and 2010 gross billings. What could be causing this decrease?

A: A couple of trends from the data could help provide insight to the decrease in nominal gross billings. One trend is the decline in the average number of patient visits per week, which was 44.1 in 2007 and 33.3 in 2013. Also, an increasing number of prosthodontists are spending less than 30 hours per week treating patients. Gross billings are sensitive to the number of patients electing to move forward with treatment as well as the amount of treatment for each patient.

Q: How have net earnings changed throughout the years?

A: With an estimated 4,000 prosthodontists in the United States today, this is an important question. The trend in nominal net earnings is based on the gross billings of private practice prosthodontists.

It is interesting to see that the nominal net earnings were the highest in the 2007 survey immediately preceding the “Great Recession” starting in 2008. The data show a low point with the 2010 survey and have shown an increase in nominal net earnings in the 2013 survey. It appears that the trends are moving in the right direction with the net earnings increasing, and I look forward to seeing the results of the 2017 survey.

Another factor that contributes to changes in net earnings relates to a general shift away from an ownership position in a private practice with an increase in “employees” and “independent contractors” working in the private practice setting. Prosthodontists working as non-owners typically earn less than non-owner providers.

Q: How has the average workweek changed for prosthodontists?

A: The average of hours per week in the office reported in the survey was 35.7 in 2013, 34.6 in 2010, and 36.1 in 2007. The average hours treating patients per week reported was 27.6 in 2013, 30.0 in 2010, and 30.3 in 2007.

I believe the change in the number of hours worked, specifically the decrease in the number of hours treating patients, relates to a general decrease in patient utilization similar to dentistry as a whole during this time period.

As a prosthodontist in private practice, there is an increasing challenge that presents as a result of the increasing complexity of treatment needs for prosthodontic patients. The time involved in followup with the healthcare providers involved in restoring dental health and chewing function is critical to the success of the treatment while limiting the amount of time available for chairside treatment.

Also, time away from direct patient treatment is required to remain current in the technological advancements in digital dentistry, and the techniques and characteristics of biocompatible dental materials require a commitment to evaluate, follow the trends, and integrate into private practice. Certainly, we are all limited by time, and I look forward to watching this trend in future surveys.

Q: What effect has corporate dentistry had on prosthodontics practices?

A: In my opinion, it has provided a model of what could work for private practices with multiple providers. The surveys show 71% of prosthodontists practiced alone in 2007, which decreased to 52% in 2013, although most practiced as either a one- or 2-doctor practice.

The other interesting point taken from the survey relates to how the percentage of respondents describing themselves as employees in their primary practice increased from 15% in 2007 and doubled to 32% in 2013. A multiprovider corporate dental practice has the potential to provide the opportunity for a prosthodontist to work in a team-oriented environment on-site. It is a trend to follow in future surveys related to prosthodontists in a private practice setting.

According to the ACP’s position statement on the topic, there is not a “clear distinction between the terms private practice and corporate dentistry.” A dental management organization (DMO) or a dental service organization (DSO) is often described in conjunction with “corporate dentistry,” which could also include professional limited liability corporations or professional corporations more typical of a prosthodontist in private practice. Larger-scale practices that may or may not be associated with either a DMO or DSO will continue to have influence on the decisions made in a private practice setting.

Q: Has there been a change in the number of female prosthodontists throughout the years? If so, what could be causing this change?

A: In our study, 18% of private practice prosthodontists today are women. This number has remained constant throughout our surveys (2007, 2010, 2013). This consistency is mirrored in the Surveys of Advanced Dental Education by the ADA, where enrollment based on gender has remained relatively constant at about 40% female every year between 2007 and 2012. A 2007 study in the Journal of Dental Education showed that between 1998 and 2006, the number of practicing female prosthodontists rose by nearly 40%.

An important factor to instigate change is the availability of mentors, specifically female mentors who can connect and inspire our next generation. It is happening, and the increasing number of women who have access to a mentor in dental school could encourage more women to move forward with a career as a prosthodontist.

The ACP has benefitted from having women in leadership positions on the board of directors. Recently, Dr. Lily T. Garcia served as president as well as chair for the American Dental Education Association (ADEA). ACP’s next president will be board certified prosthodontist Dr. Susan E. Brackett. Women in visible and influential leadership positions provide exposure as to what is possible, and that includes a career in prosthodontics.

Q: Finally, the study reports that the single largest source of referrals is the prosthodontist’s own patients. How has the Internet affected new patient generation?

As a board-certified prosthodontist in private practice in Arizona, I know firsthand how many new patients seek out my care as a prosthodontist on the recommendation of one of my patients today. Word of mouth matters in healthcare.

Search engine optimization, marketing, and public relations outreach all help patients become more informed about oral health options. In the era of the informed patient, our patients increasingly take on a larger role in learning about potential treatment options and selecting where to go for that treatment.

The Internet, along with social media, provides the opportunity for patients to research and select a provider based on consumers’ recommendations. Patients can see and select an environment that fits prior to making an appointment to discuss options with the prosthodontist.

The Internet can help to set the tone for expectations related to the desired treatment, allowing for an informative and effective discussion while with the prosthodontist. Prosthodontists don’t fear second opinions or patient questions, and we believe that an informed patient helps improve outcomes.

My practice launched a Facebook page, and the ACP’s consumer website—gotoapro.org—helps patients find their local prosthodontist by zip code or procedure.

A recent USA Today story about jobs and teeth featuring 2 prosthodontists received more than 2,600 Facebook likes, and it spread like wildfire online. After reading the story in Kentucky, a new patient went online and found a local prosthodontist by zip code on gotoapro.org. The patient then called to make an appointment to discuss options to replace his missing teeth.

The ACP’s position statement on dental implants provides questions patients can print and bring to an appointment. Patients post #dentistselfies. Today, private practices in dentistry can connect with consumers online and beyond.