Location, Location, Location: Where Should You Practice?
Introduction
You’ve received your diploma and are preparing to take the state dental board examinations. Now the question is, in which state do you wish to practice?
New dentists choose a practice locale based on many variables. This report discusses some of these variables, including distribution of dentists by region; location evaluation; state testing and licensure; and federal, public health and academic opportunities.
The logistics and finances needed to open a solo practice after graduation can make this an impractical option for many new dentists. Instead, many new graduates decide to work with other dentists as associates while they become established and begin to repay their educational debt. In addition, associateships can be a good way to learn practice management skills for operating a business.
One source of information on how to build a practice is the ADA’s Council on Dental Practice. The council holds seminars throughout the country and publishes instruction booklets on practice management. Contact the Council on Dental Practice at Ext. 2908 for information on seminars, and obtain a copy of the ADA Catalog (1-800-947-4746) for a list of publications designed to help dentists build their practices.
For those who wish to join a practice, information about regional associateship opportunities is helpful. There are many sources for this information, including the classified advertising section of The Journal of the American Dental Association and classified advertising in the publications of state and local dental associations and societies throughout the country. The state dental groups, known as the constituent societies of the ADA, and the local dental groups within each state, known as the component societies of the ADA, can be reached by contact the ADA’s Department of Dental Society Services at Ext. 2600 or visiting the Dental Organizations content area.
Perhaps you’d be interested in statistics on the shortage of health professionals by state and county. These data are available by contacting the Division of Shortage Designation, Bureau of Primary Health Care, Health Resources and Services Administration, 4350 East-West Highway, 9th Floor, Room 9-1D3, Bethesda, Md. 20814
(1-800-400-2742, option 2).
One thing is certain: A decision made now will affect your career for many years to come, so investing some time and money in research is advised. Whether you are considering joining a group practice as an associate or are searching for a region in which to purchase a dental practice, buy in as a partner or open a new dental practice, demographic information is vital to your decision-making process. This information includes
- dentists by state and region;
- number of professionally active dentists;
- licensure requirements for each state;
- average net income of dentists by region;
- expanded functions of hygienists and assistants;
- general population household and per capita income;
- regional levels of education and occupations;
- state-by-state income, sales and use taxes.
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Distribution of Dentists
The density of dentists by region and state is something to consider when you’re deciding where to begin practicing. The most recent information comes from the Survey Center’s Distribution of Dentists in the United States by Region and State, 2001, and is summarized in Figure 1. This figure illustrates the location of 168,556 professionally active dentists in the United States (not including U.S. territories such as Guam). Active dentists include clinical practitioners, dental school faculty or staff, armed forces dentists, governmentemployed dentists, interns, residents and other health or dental organization staff members.
Figure 1. A. Professionally active dentists in the United States, 2001.
B. Estimated number of U.S. residents, 2001.
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In 2001, the Pacific region (Alaska, California, Hawaii, Oregon and Washington) had the highest distribution of professionally active dentists at 31,270; the East South Central region (Alabama, Kentucky, Mississippi and Tennessee) had the lowest at 8,300. This information becomes more valuable in the context of the U.S. resident population.
At the time of the survey, the Pacific region had an estimated population of 45,821,000 and the East South Central region had an estimated population of 17,128,000. Comparable data on population and trends for all regions and states from population reports of the Bureau of the Census, U.S. Department of Commerce, are included in the ADA’s Facts About the States: For the Dentist Seeking a Location. This publication also includes population and per capita income data.
Return to Top Evaluating Locations
There are many more variables besides regional statistics to consider when selecting a practice location. Assessing certain economic parameters may take some digging. The effort is worthwhile, however, because only by thoroughly investigating a particular area can you obtain an accurate picture of the demand for dentists.
To narrow your search to a handful of communities, obtain chamber of commerce pamphlets that detail each community’s economics: growth, taxes and cost of living. Per capita income and retail sales suggest residential spending patterns and are itemized by state in the Federal Reserve Bank’s economic statistics reports and the Bureau of Labor Statistics’ abstracts, available in your local public library or accessible by interlibrary loan.
A city’s newspaper can provide a great deal of information on apartment and retail vacancy and rental rates, as well as on home prices. Also, the number of “want ads” in a newspaper reflects the area’s job opportunities and growth. Articles on local employment status and the business community also offer insight, not to mention reports on crime and politics. The newspapers from larger cities are available in many public libraries, as well as online; for smaller communities, they can be obtained by subscription.
Digesting dental practice statistics on a state and county population (available from the ADA Survey Center) and obtaining information by contacting key sources in a particular community by phone, fax, mail and e-mail will help narrow your list of potential practice locations. To reach a final decision, however, it is advisable to travel to the communities on your list of finalists. This is the only way to introduce yourself to area dentists, laboratories and supply houses in the community to obtain nonpublished information. Sometimes, conversations with others in the dental community can provide perspective on a community’s demand for dental care vs. the supply of dentists.
When considering a potential practice location, new dentists often ask a logical question: Where are there shortages of dentists? In fact, a listing of such areas is published each year by the federal government. The government uses a dentist-to-population ratio that exceeds 1:5,000 as its primary criterion for designating an area as dentally underserved. Other factors include percentage of the population at or below the federal poverty level, extent of community water fluoridation and estimated travel time required to obtain basic goods and services.
There are roughly 900 such areas or locations around the country. However, entities such as correctional facilities or migrant centers also may be listed as being dentally underserved, and these areas are usually counties or parts of counties that typically are either rural or inner-city locations. They often are economically depressed and are underserved for a variety of services in addition to dental care. For more information about dental professional shortage areas, you can call the Division of Shortage Designation, Bureau of Primary Health Care, Health Resources and Services Administration of the U.S. Public Health Service at 1-800-400-2742, option 2.
Other factors that affect the future of a community’s supply of dentists are the percentage of practitioners who will be retiring soon and the percentage who work part time vs. full time.
Another consideration is an assessment of the area residents. If a community has a high percentage of retirees, a prosthodontist may be needed if there aren’t already too many in the area. By the same token, younger, rapidly expanding communities need pediatric dentists.
What is the proximity of the nearest dental school? This may affect, to some degree, the supply of dental services provided to the community. Dental school clinics that offer reduced-fee services to the community probably have little impact on nearby dentists in private practice. Yet, the constant supply of new dentists in proximity to the school may affect local dentists.
By contacting local dental societies and state dental associations, you may tap into additional information about an area’s practices for sale, possible office locations, the economy and professional contacts for new dentists.
While you’re visiting a potential practice location, check into public transportation. Most of your patient base will be within a 30-minute transportation radius. Is the transportation surrounding the potential practice location safe and convenient so that all residents can reach your office? Try it for yourself.
While you’re on site, also investigate the ease of leasing or purchasing affordable office space. Legal advice will be necessary to draw up a bill of sale or when agreeing on a lease. There are clauses that should be included to protect you in the event you want to sublease or expand into adjacent space, as well as for plumbing and wiring considerations.
Financing will be necessary through a bank in the community. Stop by and establish credit and investigate the process of borrowing start-up capital. Should you decide to move to the community, will a bank let you borrow enough to supply all the operating capital you’ll need to cover office rental or purchase, equipment and supplies, wages and other expenses—for a bare minimum of three months?
Don’t forget that you’ll need some help in the office. Find out if there’s a qualified supply of labor in the area. As a test, consider advertising in the local newspaper for prospective employees. Gauge the number of qualified respondents and their current salaries and salary expectations. Information on national average wages of dental hygienists, assistants and other dental practice staff is available from the ADA Survey Center.
Once you’ve decided on a practice location, the final considerations are zoning restrictions if you’re building an office or a home office, and practice valuation if you’re purchasing an established practice. The process of practice valuation involves professional advice on what you are purchasing—the building, the equipment, the patient list and more. Dental practice valuation consultants have quantifiable ways of determining a dental practice’s value. The local dental society or state dental association should be able to help you find practice valuation experts who can help. These experts sometimes advertise in dental association journals. For more information on practice valuation, you can obtain books and articles from the ADA Department of Library Services at Ext. 2653—or you can contact the Council on Dental Practice at Ext. 2895 for the Directory of Dental Practice Appraisers and Brokers.
Return to Top Testing and Licensure
Before you can practice dentistry, you must meet educational requirements and pass written and clinical examinations to obtain a license to practice. Dental licensure protects the public from receiving substandard care from unqualified people, and it maintains high standards for the profession. This report provides general information; for specific state-by-state requirements, you’ll need more specific information, which can be obtained from sources listed here.
Nearly all states require a diploma from an accredited dental school and all states require evidence that you have passed parts I and II of the written national board dental examinations, as well as a state or regional clinical examination. Most of the states belong to one of four regional testing agencies that administer these examinations. Those that do not belong to a regional agency administer their own examinations through their state board of dental examiners.
The written examination tests dental school graduates for a satisfactory level of theoretical knowledge of basic biomedical and dental science.
The clinical examination requires the candidate to perform dental procedures on a patient. Depending on the state, the results of a clinical examination administered by a regional testing service may be valid for only a limited time. Other states limit the number of times a candidate may retake a clinical examination.
Information about the national board testing program, certification forms for students enrolled in foreign dental schools and national board applications can be obtained by contacting the Joint Commission on National Dental Examinations, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611 (Ext. 2678). The American Association of Dental Examiners (Ext. 7464) maintains a list of state testing agencies and dental examining board administrators. This list can be obtained at www.aadexam.org (state boards). Click on “links” to reach individual state boards.
Information on dental board examinations and licensure can be found in Dental Boards and Licensure Information for the New Graduate. This publication can be obtained at ADA.org or from the ADA Office of Student Affairs (Ext. 7470).
Facts on Dental Licensure provides information on state and regional clinical testing agencies, license recognition and continuing education. It is available from the ADA Council on Dental Education and Licensure (Ext. 2717).
In certain states, specialists need to get a license or certificate or pass a specialty examination. For further information about specialty credentialing, contact the ADA Council on Dental Education and Licensure (Ext. 2694) or the ADA Department of State Government Affairs (Ext. 2525).
It is not uncommon for a dental student to become licensed in his or her state of residence and then decide to relocate. In this case, the new dentist would have to become licensed in the state of relocation or obtain licensure by credentials. Licensure by credentials is a term used to describe issuing a license on the basis of a dentist’s qualifications and performance record in place of written and clinical examinations. This method of licensure, however, usually is available only to dentists who have been in practice for a specified time, usually a minimum of five years.
The ADA believes that the public is protected just as much by an evaluation of a practicing dentist’s theoretical knowledge and clinical skill that is based on qualifications and performance record as it is by regional or state board testing. The Survey Center’s Facts About the States 2001: For the Dentist Seeking a Location and the Office of Student Affairs (Ext. 7470) are sources of information on general licensure and licensure by credentials.
As a new dentist, you also should be aware of the functions that you legally can delegate to dental hygienists and chairside assistants. Regardless of their experience, dental hygienists and chairside assistants must perform only the functions that comply with the legal provisions operating in their licensing jurisdiction. To learn more about the functions you can legally delegate to your dental hygienists and chairside assistants, ask for the latest copy of the Survey of Legal Provisions for Delegating Functions to Chairside Assistants and Dental Hygienists from the ADA Survey Center.
Return to Top Federal, Public Health, Academic and other Opportunities
When deciding where to practice, you may want to consider variations in dental career opportunities. Most new dentists intend to provide clinical services in private practice. Yet, others pursue dental careers in public health dentistry, universities, research, industry, the military, insurance companies and consulting. Information on these opportunities is available in the Alternative Dental Careers Packet prepared by the ADA Council on Access, Prevention and Interprofessional Relations (Ext. 2860).
Federal dental service opportunities. Employees of federal services need only be licensed in one state, which does not have to be the state of practice. To obtain more information on administrative or clinical positions with the federal government throughout the country, various agencies can be contacted. To obtain job opportunity information from branches of the U.S. military or from Veterans Affairs, contact the following:
For general information on dental careers in the U.S. Public Health Service, go to www.phs-dental.org/depac/newfile10.html. For information about dental careers in the U.S. Public Health Service Commissioned Corps, contact the Division of Commissioned Personnel at 1-800-279-1605 or 1-301-594-3360 or www.usphs.gov. For information on student programs, call 1-800-279-1605 or 1-301-594-3360 or e-mail phs@psc.gov.
For information on specific agencies, contact each agency directly:
- U.S. Public Health Service, Indian Health Service Recruiter 1-800-447-3368 or www.dentist.ihs.gov;
- U.S. Coast Guard, Chief Dental Officer, job opportunities 1-202-267-0801or e-mail dnoyes@comdt.uscg.mil;
- Federal Bureau of Prisons, job opportunities 1-800-800-2676 or www.bop.gov.
Dentists with advanced training who desire career options beyond entry-level positions with the U.S. Public Health Service also can seek employment with Centers for Disease Control and Prevention, Health Resources and Services Administration, U.S. Food and Drug Administration and National Institutes of Health.
For contact information, call the ADA Division of Government Affairs at the ADA’s Washington office (1-202-898-2400).
State and local public health opportunities. Unlike federal employment, state and local opportunities, even if federally funded, require licensure in the state of practice. These positions include those available through dental care programs at neighborhood health centers, school districts, and dental divisions and departments of state and metropolitan health departments. To inquire about openings, contact the state and territorial dental directors. A list of their names and phone numbers is available from the ADA’s Council on Access, Prevention and Interprofessional Relations at Ext. 2860 or the Association of State and Territorial Dental Directors at www.astdd.org. These dental directors may have information on practice opportunities as well as insight on the status of oral health in their states or territorries.
New dentists who are interested in state and local dental public health jobs also may wish to inquire with the dental consultants from the regional divisions of the U.S. Department of Health and Human Services.
| U.S. Department of Health and Human Services Federal Dental Consultants by Regional Division |
| HRSA* Regional Division |
States |
Consultant |
| Boston |
Conn., Maine, Mass., N.H., R.I., Vt. |
Vacant
1-617-565-1420 |
| New York |
N.J., N.Y., Puerto Rico, U.S. Virgin Islands |
Dr. Jan Richard Goldsmith
1-212-264-2768 |
| Philadelphia |
Del., District of Columbia, Md., Pa., Va., W.Va. |
Dr. Melvin Lerner
1-215-861-4393 |
| Atlanta |
Ala., Fla., Ga., Ky., Miss., N.C., S.C., Tenn. |
Dr. Galo Torres
1-404-562-4121
gtorres@HRSA.gov |
| Chicago |
Ill., Ind., Mich., Minn., Ohio, Wis. |
Dr. Steven Geiermann
1-312-353-4402
sgeiermann@HRSA.gov |
| Dallas |
Ark., La., N.M., Okla., Texas |
Dr. Robert Sappington
1-214-767-3719
rsappington@HRSA.gov |
| Kansas City, Mo. |
Iowa, Kan., Mo., Neb. |
Vacant
1-816-426-5226 |
| Denver |
Colo., Mont., N.D., S.D., Utah, Wyo. |
Dr. James Sutherland
1-303-844-7873
jsutherland@HRSA.gov |
| San Francisco |
American Samoa, Ariz., Calif., Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Hawaii, Nev., Republic of the Marshall Islands, Republic of Palau |
Bureau of Health Professions
1-301-443-6896 |
| Seattle |
Alaska, Idaho, Ore., Wash. |
Dr. Forrest Peebles
1-206-615-2493
fpeebles@hrsa.gov |
* Health Resources and Services Administration.
Academic opportunities. Although an advanced dental degree may be required, university dental school positions often don’t require a dental license in the state of employment. A list of the fully operational dental school programs can be obtained from the Commission on Dental Accreditation (Ext. 4653) or on the Web, in the Dental Education Programs content area.
Perhaps you are interested in continuing your education. If so, keep in mind that universities conduct graduate and postgraduate programs for continuing education, and many hospitals conduct postgraduate programs and award certificates for their successful completion.
For a comprehensive listing of the advanced dental education programs offered in both dental school and non–dental school settings, contact the Commission on Dental Accreditation (Ext. 4653) or visit ADA.org. The ADA Survey Center also offers the Survey of Advanced Dental Education. This report provides information on the recognized specialty and advanced general dentistry programs accredited by the Commission on Dental Accreditation. In addition to the names and addresses of specific programs, this report also provides information regarding general demographic data, enrollment and graduate levels, application deadlines, and tuition and stipends.
The topics and statistics in this report on practice location represent only a sample of the issues and concerns of the new dentist. When considering practice location and career opportunities, new dentists have a great deal of information to obtain and analyze. The ADA can provide you with this information and guide you. The ADA Survey Center’s publications offer a great deal of valuable demographic data on the status of, and trends in, U.S. dental practices—more than enough information to get you started. Call Ext. 2568 for a complete publication list.
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