I got in contact with Dr. K in late November. Originally from New York City, Dr. K moved to Ann Arbor for undergrad and decided to stay for dental school. In her early 30’s, she is currently in the process of buying a practice on the east side of Ann Arbor. 

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“After I graduated from Michigan with my bachelor’s degree, I moved back home for a year and worked as an assistant in a dental office in New York. After that year, I knew I wanted to be back in the Midwest. The pace is slower and the patients are nicer.”

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I know from conversations with other dentists that dental schools do a terrible job teaching about practice management and ownership. I asked Dr. K how she is managing buying a practice.

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“Podcasts and books. Michigan didn’t teach me shit about the business side of dentistry. They only teach you the clinical side. I had to take it upon myself. Every commute to and from work since I graduated I’ve listened to other dentists and learned from them.”

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“There are quite a few ways dentists can be employed. Why did you choose practice ownership?” I asked.

 

“I’ve always been interested in entrepreneurship. And when I graduated from dental school I was hundreds of thousands of dollars in debt. The way dental reimbursement is set up now, practice ownership is really the only way to go.”

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I asked her to elaborate on the insurance side of dentistry, as I am very unfamiliar with that side of it. 

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“Of course! And don’t worry, it took me a few years to get comfortable with it. So most people here in Ann Arbor have private dental insurance. I have a contract with the insurance company with set rates for every procedure I do. I get reimbursed from the insurance company and whatever they don’t pay, the patient pays for. And if they don’t have insurance, everything is out of pocket.”

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“What about medicare and medicaid?” 

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“They’re shit. They offer hardly any coverage for the patient and almost no reimbursement for the dentist. Here, I only accept one type of private insurance. I don’t take any government insurance. It isn’t worth my time. Now if I had a wealthy husband and wasn’t worried about supporting myself, I would. But I am single and paying off student loans. I can’t afford to accept Medicare or Medicaid.”

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This is the first time a dentist had been honest with me. Every other dentist I’ve asked recites the same spiel that they took an oath to serve people and will do anything and everything they can do to uphold that promise. While that was true for Dr. K, she also prioritized her wellbeing and lifestyle. 

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“It's unfortunate that our government makes it this way. When they expand Medicare and Medicaid coverage, it looks great, right? More people have insurance and are able to seek care. But they forget about the providers. The providers still aren’t getting paid a fair amount for their time, facilities, and work. I can’t afford someone with Medicaid in my chair. I’d lose money on them. The system makes it hard for any dentist to treat underprivileged patients. Why would I take in someone who will only pay me $30 when I could easily have someone in there that will pay me $200. It is sad but it’s the reality of dentistry.”

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“Insurance policies changing has only made dentistry more exclusive and tailored towards wealthier people. Because so many accredited dentists don’t accept government insurance, patients who cannot afford private insurance are forced to either disregard their oral health or go to free clinics. These clinics are notoriously staffed with young dentists with little experience. This can often lead to even more problems with shoddy dental work.”

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Eye-opening to say the least. I was unaware how much insurance impacted the quality of dental care. I could tell Dr. K seemed frustrated. Dentistry should only be about patient care, not money. But that isn’t the reality today.

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“Hopefully by the time you graduate the government will have gotten their shit together or I’ve found a wealthy husband.” she laughed.

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“It is unfair to both the patient and the provider. Dentistry and oral care has become much more of a business than a human right. I care deeply for my patients and their overall health. Maybe one day I will be able to treat underprivileged patients. But until then, I’ve got loans to pay off.”

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"Whatever you decide to do in the future, make sure you have good dental insurance."

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