Is it Immoral that Dental School Does Not Teach Business?
“Tell me and I forget, teach me and I may remember, involve me and I learn.” – Benjamin Franklin
A responsible rule of thumb is that one should not take on student loan debt in excess of their expected income resulting from obtaining the intended degree. If one expects to make $60,000 per year, it would not be financially responsible to incur greater than $60,000 in student loan debt. Within the dental field, the cost of attendance has greatly trounced upon the average expected income as a dentist. Most new graduate dentists will come out of school making a salary in the ballpark of $120,000 per year. Salary.com and money.usnews.com both report the average income of a dentist during their career to be around $150,000. Student loan debts when a student finally walks across the stage with their dental school diploma have soared to $300,000, $400,000 and even sometimes up to $600,000 of accrued debt if the student used debt to pay for their undergraduate degree as well.
With any other career pursuit it would be considered woefully irresponsible to rack up student loan debt that was double, or even sometimes triple, what you expect to make during your career. But for some reason in dentistry…we look past this fact. Dental School tells us to bury our heads and it will be okay. The government has ‘special loan programs’ to save us.
Or maybe the truth of the matter is that the facts are not looked past, but never even acknowledged to begin with. No one in dental school informs us, the so-called generation of “Debtists,” of the sobering realities that we face after graduation in the job market. Would it not be the responsibility of our educational facilities to educate us on the fact that if you owe $400,000 and only make $150,000 then you may in fact not be able to make ends meet after your multi-thousand dollar per month, high-interest, student loan payments? Should they not teach us to question that if we are going on an income-based government forgiveness program, because without it, some dentists would be living below the poverty line after making their gargantuan student loan payments – then maybe, just maybe, we are doing something wrong?
I will firmly tell you that tuition at dental schools is not going to go down at any near point in the future. The only solution is to guarantee that your income goes up.
Ex: Early Career Dentist at $120,000 per year salary –> after-tax: $80,000 –> after student loan payments of $5,000 per month –> $20,000 per year TRUE DENTIST SALARY
Ex: Average McDonald’s Manager Salary at $43,447 –> after-tax: $32,350 –> No student loan payments –> $32,350 TRUE McDONALD’S SALARY
A lifestyle built around student loan management is an albatross that is not manageable long-term on an associate dental salary. Most dentists will take DECADES to pay off their student loans. The exception to this is if you have a working spouse with significant income and little or no debt that can shift your debt-to-income ratio to a more favorable one. Articles such as this one by Dentistry Today, show us just how out of touch with the economic and career and debt landscape some dental schools are. They are encouraging more than ever, to take on dental associate jobs, and avoid early practice ownership. Early practice ownership is the only way you are likely going to stand to make the $250,000, $300,000, or more that is needed to service the loans in a responsible manner. If you have read my “Why I Made Practice Biopsy” page, you know that I started the process of building my practice from scratch immediately out of dental school. My first full-year of operations I will be tracking to take home somewhere between $250,000 and $350,000 if my current trajectory continues through to the end of 2018. There are many dentists who make a lot more than me. But there are not many associate dentists who make more than me.
So, if practice ownership is the clear road to a financially responsible career; why doesn’t everyone delve into that path? Why doesn’t everyone delve into ownership as soon as possible? Well; on my Private Facebook Group, I pooled some responses to that question:
-“Debt+ignorance+lifestyle. Fear also.”
-“Don’t want the hassle or responsibility of management of the 99/100 things we didn’t go to school for.”
-“How about zero actual education of practice management?”
-“For sure debt. After buying a practice many students have got to be pushing a million.”
-“Slow start with a new practice and you have your practice loan on top of school loans and you can’t afford to make all your payment.”
The tone of the answers is recurring. Debt. Fear. Complete and utter lack of knowledge on practice management or start-up. Lack of understanding that becoming an owner can quite literally 2x — 5x your take home income as a dentist. Lack of understanding that it doesn’t take a half a million or a million dollars to open a practice, and that it can be done for under $100,000.
But is this lack of knowledge and subsequent fear our fault? Is this lack of knowledge and subsequent fear our responsibility? Is it morally wrong to be charged $350,000 for an education that has not prepared you to fully utilize said degree? What is morality? Morality is defined as, “The principles concerning the distinction between right and wrong.” Is it wrong that after Dental School you have no idea how dental insurance works? No idea how to design or build a practice? Is it wrong that after Dental School you have no idea how to structure a practice acquisition deal or evaluate if a practice is worth buying? No idea how to implement efficient systems in a dental office? Or truly understanding overhead? I would argue that YES. It is wrong. And we could and should be doing better preparing our future generations of dentists to thrive in the modern economic landscape. I believe that it is immoral on behalf of dental schools to set so many students of for a life of indentured servitude after laying down their academic blood, sweat, and tears for a doctoral degree.
However, at this point, the source of fault is no longer relevant. Yes, we can say it is Dental School’s fault, but now it is YOUR responsibility if you desire to change your circumstances. Dental school has come and gone; and you are on your own now. Or maybe you are still in dental school; and are just now realizing that the faculty themselves, though well intentioned, are simply not capable of properly teaching dental business and practice management — because of the fact they are insulated from the true realities of the market. They are protected from these realities by the bubble of the school. The only hopes you have in learning the economically critical content you are after from a faculty is to approach a faculty who is part-time at the school, and full-time at a business which they own and manage; better yet if they started it themselves and can teach you the ground up inner workings of the business.
By and Large, if you are hoping that dental school will prepare you for having a successful business career as a dentist, you are doomed. Dental school doesn’t even teach the basics of this.
So How Did I Learn to Successfully Start and Manage a Practice Right out of School?
Like many of you reading, I knew from the moment that I started dental school that I wanted to be a practice owner as soon as possible. Rapidly it become vehemently apparent that dental school was not going to prepare me to do so, let alone to do so well.
So these are the THREE important things I did:
#1) I started skipping any class I could at the dental school and instead would go over to the business school (University of Michigan – Ross School of Business) and sit it on big lecture style classes. These classes were so big that nobody noticed or commented when I sat down. Note: I didn’t abdicate my dental school grades; I graduated with around a 3.8GPA and won the Operative Dental Award for clinical skills.
#2) I started to voraciously read books on business, leadership, and management. I was reading books at a rate of about a book per week.
#3) Most importantly — I created an “In-Field Business Curriculum” for myself. I called up dentists all over Southeast Michigan and asked to visit their practice for a tour and an interview on what they had learned on the business of dentistry. Most dentists told me ‘No.’ Some dentists told me ‘Yes.’ I visited many, many dental offices during what was my second year of dental school. I interviewed and recorded the interviews regarding what these dentists knew about practice management and leadership. From this massive project, I learned the ins and the outs of the dental business. I dug deep into the numbers that made the practice tick. I learned what worked, and what didn’t. I compiled hours upon hours of audio interviews with these dentists and had the audio transcribed. I turned what I learned from the interviews into an organized ‘curriculum’ which I formatted into a giant binder and later a booklet which I personally use as a resource for myself. Effectively created my very own tome of dental business knowledge compiled by this circle of mentors. This is the key resource which prepared me for practice ownership, and a resource I still turn to today.
So what is the point of these 3 things? If you want to learn how to start, acquire, build, grow, manage and lead a dental practice so that you can reclaim your financial future —- well, you aren’t going to learn it in Dental School!!!!
–DeAngelo S. Webster, DDS
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Dental Student, Employee Dentist, or Residents wanting to be a practice owner soon? Take Practice Launch CE for 22 CE Credits and let me work with you to help you become a successful practice owner. Email me at PracticeBiopsy@gmail.com with questions about the program.