Howard Speaks No ‘Hero’-dontists Here by Dr. Howard Farran

Dentaltown Magazine

Adding a specialty can be great for your mindset—if it’s performed enough to be profitable. Otherwise, first you’ve gotta improve the practice you have

by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

We have dentists from 218 countries registered on Dentaltown, and I think every one of them should read Paul Starr’s Pulitzer Prize-winning book, The Social Transformation of Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. I consider it the definitive history of the American health care system—including the roles that government, insurance and other entities provided—and I see its principles rolling out in major ways in countries such as Brazil, China and India, which are going through dilemmas today that the U.S. experienced over the past century.

But I don’t want to talk about the rise of the sovereign profession in this column—I want to talk about the rise of specialty dentistry and what it means to your business.

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Economics and specialization

In 1900, there was no such thing as a medical specialist: Your one doctor delivered your babies, amputated your infected feet, and fixed your eyes, ear, nose and throat. He did everything … and the results were not very good.

There’s economic value in specialization, however—something Adam Smith, the “father of modern economics,” understood. If someone only grows wheat, for example, they’ll do it better, faster, easier and at lower cost and higher quality than someone who’s also spending time working as a plumber or a carpenter.

Between 1900 and 2000, the medical profession created 58 specialties, and dentistry created nine (and this year we just added dental anesthesiology). Over the same amount of time, health care went from accounting for just 1% of the U.S. gross domestic product to 14% (and coming up on 2020, it’s up to 17%).

Meanwhile, I see way too many dentists talking about doing all of their work and referring nothing.

Stick to what you know—and can profit at

First of all, following that model means you think the best idea is to go back to what they were doing 120 years ago, and that’s usually never a good idea. There are thousands of health care journals published each month, and you don’t have the time to read all those and keep up to date on everything.

Also, let’s talk about economics:

The average net income for a general practitioner dentist is $197,000, and is drifting downward, while the average for a specialist is $320,000, and not dropping.

Dentists who own their practices average $244,000 a year, while dentists who are employees average $147,000.

So just from a macroeconomic level, it’s better to be a specialist than a practitioner in the U.S., and it’s better to own your own practice than to be an employee.

That said, specialists are also doing repetitive tasks from the ages of 25 to 65, and 40 years of doing the same thing over and over again usually doesn’t end in a healthy result. That’s why pretty much every practice management consultant I’ve interviewed in my Dentistry Uncensored podcasts recommends that general dentists add a specialty every five years.

There’s a condition, which I refer to as “Howard’s Rule of 52”: If you don’t do the procedure—sleep apnea treatment, placing implants, Invisalign, whatever—at least once a week, you’ll never meet critical mass to do it well enough, and it will never put you in the profit zone for it. (Plus, follow the guideline of treating other people as you want to be treated—I’ve had only one surgery, a vasectomy, and I certainly wouldn’t have wanted it performed by a doctor who’d only done it twice!)

That doesn’t mean you shouldn’t take CE!

In psychology, we’ve all observed someone who gets really, really into that new specialty, and they spend all their spare time dedicated to something that’s not even 1% of their practice growth. But it’s intoxicating to sit next to other dentists at the continuing education courses who are optimistic! That said, the most important economic thing you might learn at a seminar could be something that applies to your bread-and-butter dentistry, or maybe one of the business functions of marketing, HR or payroll.

I do think that the fundamental base of a long, happy, prosperous career correlates first to the hours of CE you take. Dentists who earn their FAGD, MAGD or diplomate standing in an association always seem happier and more fulfilled, and they’re making more money.

Select what you do and do it well—and profitably

If you’re not in the profit zone being a general dentist—doing cleanings, exams, X-rays, fillings, crown and bridge, and routine endo—you have to fix that first. You can’t say, “Well, this all loses money, so now I have to learn these other procedures.” That would be like an Italian restaurant going bankrupt and saying, “We’re not making money off pizza and lasagna and spaghetti, but if we add osso bucco it’s going to fix all our problems.” At the base of your foundation, you have to have your business running profitably. Watch my program Dr. Farran’s 30-Day Dental MBA and get your house in order.

I want you to add the specialty to keep from avoiding burnout, but I need you to know that it’s all fun and games until you follow the Rule of 52 and start making money on it. I’ve seen this so many times: Dentists enter all kinds of specialty work and have a ball for five years, then decide they don’t want to do it anymore. None of them regrets having the knowledge, none of them regrets having that skill set in the toolbox for the rare time they need it … but over their practice, they decided they’d rather just not do it.

It scares me to see people on Dentaltown message boards just trying to figure out how they can get out of dentistry and retire as quickly as they can. Let’s take away retirement from reality. You’re not retired today. You’re not going to retire until a future time—it could be around the corner, it could be five years, 10 years, it could be decades. The more fundamental question is, why do you want to retire right now?

If you say you don’t like some of your staff, replace the staff. If you don’t like doing molar endo, send it to an endodontist. If you say that you’re not making money and your overhead’s too high, fix your overhead. Get profitable. Get staff that’s happy. Do procedures you like!

But if things start feeling monotonous, don’t think for a second that we’re going to go back 120 years to the time when we had no specialties. The “hero”-dontist is for your mind, not the long-term strategy for the rise of the American health care system.



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