What Medicine Is Teaching Dentistry About Ownership, Prices, AI, and Autonomy
Dentistry does not need to become medicine to learn from it. In fact, the most useful lesson may be to study what happened to physicians before the same economic forces reshape dental practice.
The 2026 Doximity Physician Compensation Report describes a profession that remains highly paid but increasingly uneasy. Physician compensation rose again in 2025, yet 76 percent of surveyed physicians said they would accept lower pay for greater autonomy or better work life balance. More than eight in ten reported feeling overworked, and 46 percent of overworked physicians were considering early retirement. At the same time, 81 percent said they would still choose medicine again.
That contradiction matters. Many physicians are not simply asking for more money. They want greater control over how they work, how much they work, and how much bureaucracy stands between them and the patient. Dentists should pay attention because income is only one form of professional wealth.
Medicine also demonstrates how strongly payment systems shape behavior. Doximity reported average neurosurgeon compensation above $829,000, while family medicine averaged about $325,000 and general pediatrics about $274,000. Surgical specialists earned roughly 90 percent more than primary care physicians. Yet internal medicine ranked first in recruiting demand.
That is not a simple supply and demand story. It is partly a reimbursement story.
Healthcare does not price every hour of professional judgment equally. Procedures are easy to code, measure, bill, and assign a fee. Prevention, diagnosis, coordination, counseling, and long term disease management are harder to monetize. A system can therefore desperately need internists while paying many procedural specialists far more.
Dentistry operates inside the same logic. A periodontal diagnosis, a difficult treatment conversation, a carefully sequenced treatment plan, or a hygiene visit that prevents future disease may create enormous value without looking impressive on today’s production report.
The danger is confusing what is measurable with what is valuable.
A major 2025 study in The Quarterly Journal of Economics showed just how strongly financial incentives affect physician behavior. Researchers linked physician records with federal tax data, Medicare billing, Social Security data, and medical training records. When Medicare reimbursement increased, physicians responded. A 10 percent increase in payment rates was associated not only with higher income, but also with more RVUs, more procedures, and more patients receiving the better paid services.
Change the price and behavior changes.
That is not an accusation of greed. It is economics. Dentists respond to incentives too. Change PPO reimbursement, hygiene compensation, associate bonuses, scheduling rules, or same day treatment incentives, and behavior follows. Sometimes those changes improve efficiency. Sometimes they quietly encourage rushed diagnosis, unnecessary volume, or treatment planning that serves the compensation system better than the patient.
Leadership therefore requires more than creating incentives. It requires anticipating what those incentives will produce.
The same physician study found something else dentists should notice. The highest earning physicians were not simply receiving larger salaries. Business income and ownership played a major role. Physician earnings tended to increase as practices grew from solo offices into small groups, then declined again in very large organizations. Among middle aged physicians, earnings peaked around groups of roughly eight to ten doctors.
That does not prove there is a perfect practice size. It suggests something more important. Scale can create efficiencies, but the clinician does not automatically capture the value created by scale.
That is where dentistry’s ownership debate becomes more interesting than the usual private practice versus DSO argument. ADA Health Policy Institute data show that about 72.5 percent of dentists were practice owners in 2023, down from 84.7 percent in 2005. In 2024, 16 percent of dentists were DSO affiliated. Among dentists less than ten years out of school, however, DSO affiliation was already 27 percent.
Younger dentists are clearly practicing differently.
But private practice is not disappearing. ADA data suggest many younger dentists are delaying ownership rather than abandoning it. The likely future is not simply DSOs replacing private practice. It is ownership becoming more diverse, including partnerships, doctor owned groups, DSO supported practices, minority equity models, and multi location organizations.
The more important question is who controls the incentives.
A well run group can centralize recruiting, HR, compliance, billing, purchasing, technology, and marketing while preserving clinical judgment. A poorly run solo office can bury its owner in staffing problems, payroll, PPO frustration, cybersecurity, compliance, and weekend bookkeeping.
Scale is not automatically the enemy. Independence is not automatically freedom.
The real issue is whether operational systems support the doctor patient relationship or slowly replace it.
Medicine shows what can happen when the balance tips. Physicians increasingly describe their work through RVUs, productivity targets, inbox burden, prior authorization, documentation requirements, and staffing ratios. Many remain highly compensated, yet large numbers would trade income for time and autonomy.
Dentistry should not assume that high income protects a profession from burnout.
The financial pressure is already visible. ADA data put average private practice general dentist net income around $215,000 in 2025, while average gross billings approached $966,000. Inflation adjusted GP income has faced long term pressure, and over a recent five year period practice expenses rose faster than revenues.
That explains a feeling familiar to many dentists. Production can rise while the owner feels poorer.
A patient sees a crown fee. The dentist sees payroll, hygiene wages, laboratory bills, software, supplies, rent, merchant fees, equipment, PPO write offs, no shows, remakes, taxes, and the cost of keeping enough people in the building to deliver the crown safely.
Revenue is not income.
The same confusion appears in medicine. The United States spent $5.3 trillion on healthcare in 2024. Hospitals accounted for about $1.6 trillion, physician and clinical services roughly $1.1 trillion, and prescription drugs about $467 billion. Yet comprehensive tax research estimated physician personal income at roughly 8.6 percent of national healthcare spending.
Physician pay matters, but it does not explain America’s healthcare bill.
KFF’s international comparisons make the larger issue clearer. Americans spend far more per person on healthcare than residents of similar wealthy nations, but they generally do not use twice as much care. Americans have fewer physician visits, fewer hospital admissions, shorter hospital stays, and lower inpatient use for many major procedures.
What Americans frequently do is pay much more each time the healthcare system does something.
Healthcare spending is price multiplied by quantity, and much of America’s difference is on the price side.
Dentists live with a smaller version of the same problem. Two dentists can perform the same crown in the same city with similar materials and clinical quality while receiving very different reimbursement. One contract may produce a healthy margin. Another may barely cover overhead.
The dentistry did not change. The price did.
That should influence how dentists think about case acceptance. Patients are not simply deciding whether they want treatment. They are deciding whether the value they perceive justifies the price they personally face.
When insurance makes prices confusing, patients become suspicious. When teams talk as though insurance determines what treatment is appropriate, patients confuse coverage decisions with clinical decisions. When a large treatment plan appears without explanation, sequencing, alternatives, or financial clarity, excellent dentistry can feel like an unexplained bill.
The practical answer is not better salesmanship. It is better translation.
Show patients what you see. Explain the disease. Separate what is urgent from what can wait. Present reasonable alternatives. Explain insurance without letting the insurance company become the treatment planner. Make financing understandable before the patient reaches the front desk overwhelmed by a number.
Case acceptance improves when uncertainty falls.
Artificial intelligence now enters this story. Doximity found that 66 percent of physicians were already using AI daily or weekly for clinical or administrative work. Most did not believe AI was replacing the physician. They believed it was changing the work. Twenty percent had already encountered higher productivity expectations because of AI.
Dentistry will face the same question.
If AI writes notes faster, drafts insurance narratives, summarizes medical histories, analyzes images, prepares patient education, improves scheduling, or reduces administrative labor, who receives the benefit?
A practice can use that saved time to push more patients through the schedule. Or it can return some of that time to diagnosis, patient conversation, treatment planning, training, and better clinical execution.
Technology does not make that decision. Leadership does.
That may be medicine’s most important lesson for dentistry. The future will not be determined simply by whether a dentist adopts AI, joins a DSO, drops PPOs, remains solo, or grows to ten offices. It will be determined by how those choices change incentives inside the practice.
If the system rewards speed without judgment, speed wins. If it rewards production without outcomes, production wins. If it rewards case acceptance without trust, pressure enters the conversation. If it rewards efficiency while protecting clinical autonomy, both patients and dentists can benefit.
Dentistry still has something much of medicine has surrendered. A large share of dentists still control the schedule, the team culture, the treatment philosophy, the patient relationship, and the economic engine.
How much of that control are we willing to trade away before we realize what it was worth?
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