Howard Speaks: Will Dentistry End Up Like Pharmacy? by Dr. Howard Farran, DDS, MBA

by Dr. Howard Farran, founder, CEO and editor-in-chief of Dentaltown magazine

It used to be that a dental degree meant freedom. You hung a shingle, built relationships, treated families, and eventually handed your practice to a protégé who’d carry on your legacy. Now? Most new grads are heading straight into corporate dentistry, and many may never leave.

The profession is shifting, and not by accident. With student debt levels soaring past half a million, dental school curriculums devoid of real-world business training, and private practices selling to DSOs at record pace, the “safe” route of corporate employment has become the default. But it’s a trap. As one dentist bluntly put it, “Your boss will pay you just enough to kill your dreams of ownership.”

The parallels with pharmacy are striking. Pharmacists once had cushy, respected jobs. Now, they fill quotas under relentless corporate pressure for per diem wages and no benefits. Dentistry’s heading in that direction, unless the next generation acts differently.

So, what’s the advice from the frontlines?
First, learn the business side early. Clinical chops alone won’t save you. Ownership is still possible, but it requires hustle, risk tolerance, and the ability to differentiate yourself. Patients may not always understand clinical nuance, but they know when they’re treated like a number. That’s where private practice shines.

Patients still crave relationships, especially in an era of musical-chair providers and aggressive upselling. Blue-collar patients in middle America can smell corporate dentistry from the waiting room. They don’t want five referrals or a $5,000 treatment plan for a chipped tooth. They want a doc who knows their name and fixes their problem.

Funny enough, the best practice growth today isn’t from soccer moms chasing “free” cleanings. It’s from neglected patients finally ready to fix their mouth, patients who don’t care if you’re in-network but do care that you won’t judge them. Practices that market to this “other 50%” of the population, the ones who rarely go to the dentist, are thriving. They don’t need extended hours. They need empathy, clarity, and results.

And while DSOs push expanded hours, many docs have learned the hard way: weekend appointments are a mirage. No-shows spike, production tanks, and staff hate it. Quality patients, the ones with big cases and realistic expectations, come at 10 am on a Tuesday. The rest? Let the DSO associate handle them at 8 pm on a Saturday.

Still, the corporate machine marches on. DSOs come in many flavors now, some masquerading as “private” by keeping the old practice name. Some push lasers and onlays on every patient. Others run like Medicaid mills. The throughline? Most associate docs report pressure to upsell and the loss of clinical autonomy.

What’s the path forward?
Own your practice or partner with someone who shares your values. Drop the worst PPOs. Stop trying to compete on price. Focus on outcomes, experience, and trust. Patients are more discerning than we think, and loyalty still exists, it just has to be earned.

Dentistry is not dead. It’s just dividing. There’s Walmart, and there’s Nordstrom. Be the Nordstrom. You won’t see everyone, but the ones who choose you will stay.

And remember: no one is coming to save you. Not your dental school, not your DSO, not Delta Dental, not the ADA, and not your CE junket. But that’s the good news. Because if you take control, clinically, financially, and philosophically, you can still have the career you dreamed of when you first picked up a handpiece.