In Episode 4 of “The Dental Marketing Mix,” DentalScapes co-founder Dan Brian sits down with Dr. Joseph Crowley, retired dentist and former president of the American Dental Association. In a wide-ranging conversation, Dr. Crowley shares his perspectives on the evolving oral healthcare landscape and whether there are still opportunities for dentists in private practice. From finding a mentor to ensuring work-life balance, building business skills to participating in organized dentistry, this episode is a must-listen for dentists grappling with decisions on how and where to practice.
NEXT STEPS
Connect with Dr. Crowley via email at jpcrowleydds (at) gmail.com
Transcript
Dan Brian:
All right, welcome back to “The Dental Marketing Mix.” This is episode four. My name is Dan Brian. I’m the co-founder of DentalScapes. We’re an online marketing agency for dental practices. And this podcast is all about conversations with leaders in the oral healthcare space about not only marketing, but topics tangentially related in any case. And today I am thrilled to welcome a very special guest, Dr. Joseph Crowley. He is the former president of the American Dental Association, the ADA. He completed his presidency in 2018, but he remains very much in the game, very active in organized dentistry and the oral healthcare profession in general. He’s actually working, I believe, as director of a program for oral health within his county’s public health department now. And I am so excited because today, Dr. Crowley is also a former private practice owner. He’s advised many associates on the next steps in their careers. And I’m really excited to dig into a topic that’s very much pertinent right now in the world of oral healthcare, and that’s changing ownership models in dentistry. You know, in particular, there’s a lot of question and debate right now over whether private practice is still a viable option. We’re gonna dig into that and a whole lot of other pertinent topics here today, and I’m just thrilled to have you on the show today, Dr. Crowley, thank you so much for being here, and what can you tell us if you don’t mind about yourself, and is there anything else you’d like to share before we dive into it?
Dr. Crowley
Okay. So Mr. Brian, if you and I can just for purposes of this call, refer to each other as Dan and Joe, that will make this much simpler for me.
Dan Brian:
Fair enough, fair enough.
Dr. Crowley
So, Dan, I appreciate you reaching out. I did a little research on your company, DentalScapes, and I’m not exactly sure how we connected on this, but ]you and I have spoken a bit about some of the things you’re doing and what’s going on in dentistry. And so this opportunity for me to talk with you has really been an awesome thing. I do, as Dan has said, I practiced in a general practice, private practice for 41 years. I had multiple associates, I’ve had partners, and I have helped them move on to other places. And I’ve also now been through the experience of selling a practice, because during my leadership roles at the American Dental Association, I would have found it very difficult to stay engaged at the practice at the level necessary. I could have had a work plan. I have friends who have gone through the same thing, who have done the work plan, but for me it became an opportunity to sell my practice and then move into this world and then figure out where I was going after that.
I must tell upfront, although I’ve held many leadership roles at the American Dental Association and throughout all of the tripartite through my whole career, which I found value added to me, I am speaking, Dan and I are speaking strictly as Dan and Joe. These are my opinions that I express. Sometimes I fall in line and sometimes I don’t. So I hope that there’s a learning experience, maybe some questions in your own mind as you listen to this, because we do need to take a big picture look at where dentistry is going. And yet I still see tremendous opportunities for anyone to pick the pathway that they want. And I think that’s significant on the front end as you move into your practice world and practicing as a dentist or a leader of a team or whatever, you get to pick your world and you’re gonna have a lot of options. So I think that that’s where we go. So Dan, we’ll start and at any point, if I go too far off the path, please bring me back and fish me back in and we’ll make this a valuable time.
Dan Brian:
I don’t think it’s going to happen. I think you’ll be right on point. Well, anyway, thank you so much, Joe. And, you know, I’ve been really looking forward to this conversation. We had, you know, an offline chat, you and I last week, and I just, you know, I know that you know your stuff, it’s very clear and you’re certainly passionate about what you do. So I can’t thank you enough for being here, but you know, to get started, I just wanted to ask, you do, as you said, have a long history of working in private practice, owning your own practice. You’ve had partners, associates, you name it. And many of those associates I know from our previous conversation, you’ve advised in terms of helping them sort of chart the next phase of their careers, whether or not it’s opening their own private practice or getting involved in some other aspect of dentistry. But I wanted to get back to this question of changing ownership models, because I think when we talked, you mentioned that in your graduating class in dental school, maybe 80% or more went into private practice themselves or started their own practices. And now of course, that number has gone down dramatically, you know, due to various factors. There’s a lot of different factors in play, but what would you advise younger dentists today who may believe that the private practice model is no longer viable? What would you say to that?
Dr. Crowley
Oh, boy, that’s a loaded question. We could talk for hours about this.
Dan Brian:
Well, you know, I have a secret agenda. I’d love to have you back on at some point. So if we don’t exhaust everything today, there will be other opportunities if I can have my way.
Dr. Crowley
Okay, I think it’s clear today the difference between 50 years ago versus now is there’s been a transition and we talk about private practice not being viable. That is a total misnomer because the private practice of dentistry, I believe, will stay alive and well. Interestingly enough, what we’re actually talking about is the solo practice of dentistry. The marketplace has changed dramatically and to have a solo practice, a dental practice, is a much more difficult pathway to take than it was in the past. Everybody did it, so you just fell in line. That’s the way the communities and our patients and the world looked at us. Today, actually still over 70%, you’ll have to… I’ll check my data. They used to say when I was president, if I didn’t know the data, I’d just make it up. So you might fact check me in some places.
Dan Brian:
I’m the same way, we’re comrades in arms.
Dr. Crowley
I’ll use, okay, I’ll use loose numbers, but we know today just from some recent studies that have been done through multiple places that still over 70% of the practices in dentistry today in America are privately held entities. And that’s converse to what we affectionately call the DSO world, which is just this broad umbrella term that is thrown over every practice there is now that has some type of multiple dentists practicing in it. The tradition of looking at DSOs in a more narrow sense of corporate owned, that might have venture capital money or who has outside money in it, that is different than the ownership’s involvement in the money part of the game, I think clarifies some of the discussion that we can have. And that leads to the idea that over 70% of the practices are still private practices with small groups and mid-sized groups being the new wave of where you go to practice dentistry. And that’s a business model. And it’s a business model where efficiencies and things can be gathered to keep the private practice alive and well.
Dan Brian:
Yeah, absolutely. Great points and you know, I was curious. So, you know, obviously, you say that this idea that private practice is no longer viable is a misnomer and I completely agree, but what was some of the, you know, more frequent advice that you shared with associate dentists in your private practice as they started to consider their own future career pathway? What were some of the common refrains that you passed on to them? And what would you advise to dentists today that may be, you know, fresh out of school or have maybe been practicing for a few years and now they’re kind of evaluating their options, looking at the landscape and wondering what to do next?
Dr. Crowley
You know, I still have the opportunity, I’m asked and I still go to talk with pre-dental students and young people, and I’m gonna make the generality that those in dental school are still young people, although when you look at the faces in the crowd, there are certainly a few more who have got a few more miles on them, but in general, I’d say people graduating from dental school today are in the group under age 30. So they’re fresh, they’re new in their career, they haven’t come from another place in life to move into the career of dentistry by choice, which are some pretty cool stories there too. But
when I get an opportunity to spend time with the new and future dentists, I try to make them understand that it is their choice to move how they want to move forward in life. And their first choice doesn’t have to be their last choice. So coming out of school today, the economics of graduating from a dental school, is much more difficult. We know that because of the debt that they come out with, because of the cost of dental education. I follow some of the social media groups. There’s some really good social media groups that I encourage the young people to get engaged in. Some allow dental students into the group early, but learn, because you’re gonna have opportunities and one of them is gonna fit your pathway that you want for yourself somewhere down the line. I just read today, there was an anonymous post on one of the more widely read social media groups about a young woman who has been practicing at a general practice, practicing a lot of pediatric. And economically, she’s doing very well as an associate. And she’s asking the question, would I be better off if I went out and opened my own practice? And the answers are all over the place. Obviously, some are saying, you’re making such a great living, just stay there. But there’s some want and need in her request that makes her wanna have a little more control over her own destiny for her lifestyle moving forward. So it’s very interesting. That’s what I asked the young people to do. When someone would come to me and they became my associates, they already had intention of being in the private practice world. But so many first jobs are as employed dentists. Now almost everybody starts out as an employed dentist, so they’ve got to really take it in. If they get the opportunity to work in a private practice setting, they’ll get to see the business side of that a little differently. If they take the opportunity to go into their first job in a large corporate setting, they’re gonna do more dentistry, get their skills, get honed up and become better and more confident as a dentist, but they may lack in some of the business types of responsibilities that might happen if they go into the private world. So those are all things I say, look, and nothing is wrong. There’s no wrong answer when you come out of school. If you decide to take a lifestyle that you’ll be employed where you can, and this young lady described, she gets to go home, she has three kids, she doesn’t have to worry about any of the book closings, doesn’t have to worry about the insurance, doesn’t have to worry about anything, but going home and going to our next place. And it’s attractive, but she’s still leading that idea of being her own boss. I like to frame it, control your own destiny. Pick the one you want and go for it. And guess what? If you work in a situation for 10 years, that doesn’t keep you from moving into a different place that might give you an opportunity to be an owner someday. I ask them just to be bold, broad, and then find mentors. Find people you can talk to that are in both settings and find out the best of both worlds and it’s still a great profession. Again, I won’t drag us here but I often look at these conversations around value-based care and pay for performance that are really embedded in some of the conversations today, especially in the third party payer world. And I ask people to understand what it is because they get lost in the fact that prevention is key, but dental disease is here. We are dealing with human beings that have to make choices for themselves and we can educate. That’s where we should go educate the young kids in schools. And that’s where I love school-based programs that can
really help educate a kid because we can prevent this disease. That’s the funny part about it. Dental disease is preventable, but let’s look at history. History says we’re not going to do that. Population expanded. So there’s still people that are always gonna need care. And I think that that’s a great opportunity.
Dan Brian:
100% well I can’t agree with you more and I love what you said about not letting your beginning necessarily be your end, you know we’re all works in progress and dentists are no exception and there’s opportunities to switch paths or try new things. And to that point, I wanted to kind of turn the tables here and ask you about your own personal experience. So how did your experience in private practice inform the development of your career and your own evolving professional interests? Because like I said at the beginning, you’ve served as president of the ADA, you’ve been involved in advocacy, you’re now doing work with school-based programs and mobile dentistry. How did your career evolve and what do you credit your experience in private practice to informing that journey?
Dr. Crowley:
So I have fond memories of my startup. I had a mentor in my own community who was a dentist. If you know any of my background story, I didn’t come from any healthcare providers in my life. My sister
and I, we were our first generation of going to school and college. But as a young man, very young man, my father, who owned a small grocery store, he always talked about the likes of owning your own business, controlling your own destiny, but he worked 16, 17 hours a day. And he picked out dentistry for me and then hooked me to a gentleman who was just a superstar. God bless him at 95, he’s still alive today and we talk all the time. But he helped me understand that I was making a good choice. And then when I wanted to come back to my community, they didn’t have space for me, but he and the gentleman practicing with him encouraged me to set up right in the community.
Dan Brian:
Wow.
Dr. Crowley:
And they would be there for me whenever I needed any help. And I remember my first setup, my wife and I, we just had a baby. That’s a whole ‘nother story. But we set up a practice and we lived in the house that we set up the practice in, which we could tell stories all day about that stuff. But I remember older people that they would refer to me, my first setup didn’t have a spit bowl in it. Well, everybody was used to spit bowl and I remember a little old lady telling me, I really like you Dr. Crowley, but I gotta go back because I need a spit bowl. And it really made me think through some things and
I made an adaptation because of that. And guess what? Future people who needed a spit bowl, they had a spit bowl. So those things I learned because I had mentors and that’s what I talk about, finding mentors. I encouraged the pre-dent students to go home, talk to the dentists in their community. That doesn’t mean they’ll go back to their community.
Dan Brian:
Yeah.
Dr. Crowley
Some of the HPI data might say that more than 50% of the young people that are educated in a dental school today leave the state of that dental school to go start their practices. So mobility is much bigger. So there are many things that are there. Now back to the organized dentistry, I’ll get a little plug in there. There was no choice. These people also said, you’re coming to a meeting with me and it just, it engaged me. I got to talk to so many different people that… that helped me make decisions. And if I ran into a problem, especially on business decisions, I would sit and talk to them about, look what’s happening here, and they’d suggest do this, and this. If I had treatment decisions, I’d go to another group of people more my age, we’d talk through things. So I think young people are doing that. So there are many things that are there. Now back to the organized dentistry, I’ll get a little plug in there. There was no choice. These people also said, you’re coming to a meeting with me and it just, it engaged me. I got to talk to so many different people that helped me make decisions. And if I ran into a problem, especially on business decisions, I would sit and talk to them about, look what’s happening here, and they’d suggest do this and this. If I had treatment decisions, I’d go to another group of people more my age, we’d talk through things. So I think young people aren’t doing that.
Dan Brian:
Yeah.
Dr. Crowley
They’re just, their avenue to get some of that is not necessarily always in organized dentistry anymore. You don’t see meetings filled up to the hilt like they used to be. But searching for the knowledge is the key, and then finding people who can help you do that is the key. I still feel strongly that organized dentistry has the ability to help in so many areas of those, what do I do next kind of decisions. But we’ve got to get good at it too. We’ve got to put it out there. That’s my plug for the ADA. We have to put it out there. And I think they’re trying to work on that because as they watch the membership numbers drop, they have to understand, why is that? And if we can adapt to that and come and fill the needs that some of the people are asking for, well then we have a chance to stay viable. I really think it is. And this is not about organized dentistry, but we could talk some other time maybe about all the things that the ADA does for dentists that they just don’t know. They get it, whether they’re a member or not, you get so many of the benefits. So, that’s there, but we’re in a much deeper conversation about how does a young person pull the plug to leave maybe an employed, comfortable situation with the potential to have opportunities. That might be much better for them, but guess what? It might not be either. So.
Dan Brian:
Well, one thing that’s interesting too, about, you know, pulling the plug and deciding to take the leap is that dental schools are wonderful incubators of the next generation of dentists, of course. And most of them, however, are more focused on clinical skills. You know, certainly there are a lot of innovative dental schools today that are doing great things with service-based learning and leadership development, as well. But they’re not necessarily focused, at least traditionally, on entrepreneurship and practice management necessarily. So what do you think or what do you advise younger dentists today do to prepare to perhaps own their own practice or embark on some kind of entrepreneurial venture?
Dr. Crowley:
Just a background on that. So, I mean, we’re talking, it’s 50 years ago that I started school. And we got one class in your fourth year to talk about the business of dentistry. So the idea of not teaching dentists how to be business people, that story has been around a long time.
Dan Brian:
Yeah.
Dr. Crowley:
And it’s still there. Talking about the current times, you talk to deans and people who are parts of school and talk to the education group. And they basically are saying inside the timeframe that they’re trying to teach dentists to have clinical skills, there is no time to do this other stuff.
Dan Brian:
Right.
Dr. Crowley:
So, and I just read another post today about a young person who’s in a named dental school right now who’s saying the pressures that they’re putting on these young students as students to get work done and be productive and do stuff is becoming a little bit overwhelming. So, my next suggestion, I can see where it’s tough to plug it in. And that’s each dental student should find a mentor that they can talk to. And write down the questions for yourself on what you want to know. And then let us help you find somebody who can sit and talk to you about those things and see if those are barriers that might get in your way of what you want to decide is your first job out. Or it might get in the way of your future long-term career. And it sounds like the young people today, it’s hard for me to understand. I was young once, but it sounds like they want this so-called work-life balance to be a much, much bigger umbrella than what it was when I was a young person. And a lot of young people today still, you put your head down and work and you come up for air and hope that there’s a work-life balance. Doesn’t always work that way, but it’s not gonna come to you. To the young people that listen to this, it’s not gonna come to you, you have to ask. But if you ask, I think you’ll find that there are people that really wanna help you through that.
Dan Brian:
Yeah.
Dr. Crowley:
But the cold hard fact, Dan, is learning the business of dentistry is not gonna happen while you’re in dental school. You can touch it, you can find it. We also know it’s almost unheard of for somebody to leave dental school and start up an independent practice on their own. It almost
does not exist anymore. So then hopefully as you start to look at your opportunities, moving into your first job, you have an opportunity where you can then take an interest in the business side of dentistry and learn that as you hone your clinical skills because it looks like getting good at clinical skills is still the number one thing you need to be a good dentist.
Dan Brian:
Yeah, yeah, absolutely. Well, so much comes back, it seems to me, based on what you’re saying, and I agree too from my own personal experience. Of course, I’m not a dentist, but so much comes back to mentorship and you were so fortunate to have such a strong mentor in your community. And I know you mentioned that one of the best ways to find a mentor is to simply, you know, look within your own community. And regardless of where you end up, like you said, many dental students now are leaving the state in which they learn, but beyond going back to your community and knocking on the door of a neighborhood dentist and asking for help and asking those questions that are so important, what are some of the other opportunities that you see for dental students and younger dentists, or at least newer dentists rather, what are some of the opportunities beyond that to find a mentor and really forge those relationships with experienced dentists that can help guide you in your career?
Dr. Crowley:
You know, and this is a place where I would hope organized dentistry can get better at, and that’s offering those opportunities. There’s dream days that some of the state organizations have where during their career they can go out and actually observe in practices where dentists have said, I’ll open my practice to let people come in. And so many of this, the dental school education pathways are, you know, almost all year round for most of their careers. So they’re gonna be in the community that their school is in for the most part. So touching base with the state, the dental society in the area and saying, hey, when I’ve got some time off in the summer because I’m only working emergency clinic, is there a practice that would let me come in and look over their shoulder and just go in? And unfortunately, the onus goes to the dental student because they’re gonna have to ask. But I think if they ask, there’s gonna be people willing to try to help them.
Dan Brian:
Yeah, you have to put yourself out there.
Dr. Crowley:
Exactly, exactly, Dan, I think that’s it. And I think you’d be surprised if you put yourself out there that the opportunities will come. Now, and that’s why I tell them, if you’re home for two weeks, ask to go observe an oral surgeon or something. Most of them, it might be the environment I hung in, but most of my friends open their doors constantly to let young people get in there. And I think in general for most dental schools now and during the application process, they’re asking the candidates to have observation hours.
Dan Brian:
Yeah.
Dr. Crowley:
Make that relationship, and that’s why I talk to the pre-dental students, make those relationships while you’re observing and question the doctor and sit down with them and talk a little bit more about, look at all this is going on, would you do it again? And ask a dentist that’s in private practice, would you do it again? I think you could learn an awful lot about what they think about it. And you might find some people who said, I’m not sure I’d do it again. Take that in, you know, and learn from it.
Dan Brian:
100%.
Dr. Crowley:
If you don’t ask, you’re not going to find out. You can read. There’s plenty of resources. Some of these good social media groups that are out there that will allow a dental student in. I would encourage them, when I talk to the younger people, to request to come into it and watch. But again, take it with a grain of salt because you’ll see people in these groups that complain, complain. You’ll see other people that tell stories that sometimes it’s too good to be true. And you gotta sort through it.
Dan Brian:
I’ve never heard of such a thing on social media.
Dr. Crowley:
As an old guy, the social media world, people laugh that I get in here and I don’t hit the keys very often, but boy, I sure read and try to take it all in to get an attitude of what’s going on. And so it’s an amazing world. And you, your company in the business of trying to help people make these decisions and market themselves, and I know you market for practices that are already existing, but teaching people how to market themselves too for that first job is really important.
Dan Brian:
Absolutely.
Dr. Crowley:
So learn to build your CV, learn to do these things and we can talk to them, but they have to do it.
Dan Brian:
Yeah, absolutely. Well, you know, it’s interesting. We’ve talked a lot about some of the various factors that go into the decision making behind, you know, a provider deciding where to ultimately practice and what to do, maybe from an entrepreneurial standpoint, but one of the biggest elephants in the room really, you know, that hovers over this conversation is obviously the debt burden that a lot of students face in dental school today. And like you said earlier, it’s gotten a lot more significant than maybe it was in the past. And so I wanted to ask you, for students who maybe feel a little bit confined in terms of what their options are because of that debt burden, what would you advise and what sorts of opportunities do you see for students coming out of school that have hundreds of thousands of dollars perhaps in debt? What kinds of options would you advise them to look into that will help them maybe explore the paths that are still available to them?
Dr. Crowley:
And I’ve been overwhelmed, Dan, when I’m reading that dental school tuitions just continue to go up. And I don’t know what the answer to that is. I threw some stuff, I threw spaghetti on the wall a lot with my ideas. I look at my own past history. I did three years of undergrad. I don’t have an undergraduate degree. I happened to be at that time, entered into the first three year dental program in the country. So that’s six years. You can take that, and were there shortcomings? Absolutely. Could we be working to create some wrap-arounds on some of those shortcomings and shorten the time it takes to be a dentist, still giving the education? I think it’s a conversation worth having. And I will tell you that the educators, they’re trying to have that. And let’s think of one more thing. The world of technology is changing so rapidly. So for these dental schools to have the technology to help the young people understand what kind of marketplace they’re walking into is extremely, extremely expensive. So I get it. So my first advice is just be a steward of your money. Learn that quickly. You’re gonna probably have to borrow and you’re gonna borrow to levels. But just understand what that borrowing means. And organized dentistry is trying rapidly to change some of the lending, especially through the federal government and stuff, some of the lending practices so that they’re not paying interest while the loan’s going on so that they can actually get out and get a job. That becomes important. That first job should be, and I’m gonna back up a second because any first job, I want these young people to make sure you understand what you’re signing when you sign. And it might seem like more money spent, but have an advisor, in this case, maybe an attorney, who understands the practices of dentistry so that you know if there are pitfalls, are there right to competes and things like that are in there that are so ominous. That first job on the surface might look good, but when you get into the details, it might not be what you need. But think about this coming out of school. The first thing you wanna do to make yourself marketable is find a job where you know you can work, where they’ll give you enough money, you stay inside yourself, that you can pay the debts as you’re moving forward, but you can learn more skills. So becoming a more, and I like to say, in my estimation, we’re graduating some of the smartest people in the world in dentistry today. But what’s their biggest downfall is repetition, learning how to get in and do things and walk away from that one patient for three hours to a schedule in three hours that almost looks insurmountable. Learn how to handle those things, learn skills, make sure your job is with an employer who understands that you’re walking in rather raw, but you’re willing to learn and hone those skills. And that’s why I sometimes say your first job’s not necessarily gonna be your career choice, because you gotta learn to get better at what you’re doing. And once you get that, then your vision of what you’re seeing might be a little different. So I advise them to look and understand what that job says. Know the fine print, and that means spending a little money to have somebody look at that contract and know. And I tease, if your uncle’s a divorce attorney, that’s his specialty. He might not know a thing about dental contracts.
Dan Brian:
Yeah.
Dr. Crowley:
So he might be a nice guy, but that’s not the attorney you need. You need somebody who understands what you’re getting into and hopefully they’ll treat you very fairly. And that’s where, my hope is that we can broadcast out attorneys that understand that or are willing to do it so that when somebody says, do you have somebody you could recommend, I’m very comfortable recommending some people to that. So, you’re welcome, Dan, to put my contact information out on your podcast.
Dan Brian:
That, yeah, if you’re willing that would be great.
Dr. Crowley:
And I might not be the person to answer them, but I certainly will help people find people who can answer this question. But understand what you’re walking into. Your first goal is to come out and hone your skills. And you might be coming from a dental school that you didn’t get as much repetition as other schools do, but understand your weaknesses, go try to fill those skills, get in a job that’s gonna let you learn and stretch a little bit.
Dan Brian:
Yeah.
Dr. Crowley:
And there are some great DSOs that offer those opportunities.
Dan Brian:
Yeah.
Dr. Crowley:
And so pick that right job, that first job right, but it is a first job, get out there, put yourself out there and know that your first job might be somewhere that you don’t want to live. So put your sights on that and gear everything up to it. So I think understanding the reality of where you are, you don’t walk out, you’re not an instant success, but you can get good paying jobs that will help you learn how to pay your bills and budget for it. And then your growth can happen. It can happen. And I’ve had the privilege of working with some young people that are transitioning into private practices and I know you’ve seen a lot of those transitions and they’re ready to go and their rise to success, how speedy it was, really is encouraging to me and I’m hoping that the future marketplace doesn’t walk into total control by third party payers and the misnomers around evidence-based. And I have a little personal dig with that because every piece of dentistry that I ever did, I felt had some evidence to show why it was the best choice to do what I was doing.
Dan Brian:
Of course.
Dr. Crowley:
Language can tear you up sometimes. I don’t know what evidence-based is.
Dan Brian:
Yeah, well that’s a whole ‘nother conversation that we could have.
Dr. Crowley:
Oh boy.
Dan Brian:
And like I said, I’m hopeful that we can dig into it in the future if you’ll have it. But it’s interesting what you said. I love this idea of looking at your first job out of dental school as really an opportunity to invest in, you know, continuing education, honing your skills as you said, and there are so many great opportunities for that. Like you said, some of these DSOs have opportunities to do that. There’s opportunities in public health dentistry. I know you’ve been involved in that throughout your career as well. There’s opportunities with Indian Health Service or the military. I mean, there’s so many great opportunities for young students to, you know, maybe not make the most money they’re going to make throughout their career initially, but it really is, I think, can be considered an investment in their future. And so many cool opportunities for that despite like we talked about, the debt burden. It’s really, it’s quite crazy to me, you know, at this point. And I understand what you said about, you know, dental education is expensive, but I really do hope that we can make some progress in terms of addressing maybe the interest rates or how those loans are structured in the future. But anyway, I digress. Before we close out here though, I wanted to ask, another one of those big topics that we sort of, you know, brushed on here over the last half hour or so is the DSO model. And so, as that model continues to grow within the industry, what kind of challenges and opportunities do you see associated with that? And what should younger dentists in particular be aware of as they sort of confront this new reality in terms of the competitive landscape out there?
Dr. Crowley:
Speaking directly of the DSOs, and again, we’re going to define DSOs as corporate owned that have ownership that’s outside of the dental owners, although there are DSO models that allow people to buy into that too. But in general, I think DSOs should be looked at as an opportunity. And think about this, and I don’t have the data, again, I’m not even gonna make it up, but there are a heck of a lot of people in America that don’t go to the dentist for whatever reason. Economics obviously has always been stated as the number one reason why somebody doesn’t get to the dentist. And we as a profession have to help solve that, but there are lots and lots of people who have means who still don’t go to the dentist. So what is that and how do we bring them in? And if some of the DSO models have, they have a pretty good front store, main street banner in their community so that people go by them and they think about dentistry. So if that’s a person’s step from not going to the dentist world into the dentist world, I think of that as a great opportunity. And I used to, when I was helping some young people in my own community back in the day, they’d say, why are you helping me? Aren’t we competitors? I don’t look at the dentist down the street as a competitor because I knew who I was. And if they’re being successful, that means my community is taking a good look at dentistry as a place that should be in their life. And I knew I could be fine in that world too. And I look at it the same way with the larger DSOs. If people are going there, what do they say? That rising water raises all the boats. I think that having the community engaged in knowing dentistry is important will help, number one.
Dan Brian:
Yeah.
Dr. Crowley:
Then number two, they’re offering good care. They’re offering opportunities and a young person can go in there and they might find that for their future lifestyle, it fits very well to be called an employed dentist. And today’s marketplace, the larger DSOs are probably one of the number one opportunities for that first job. So staying connected to that and looking at it as an opportunity, I think is what I try to tell young people today. There’s been this overriding thought that organized dentistry looks poorly on DSOs and I don’t really think that I ever saw that. There might be individuals who were afraid of the competition.
Dan Brian:
Of course. Yeah.
Dr. Crowley:
But the reality is, if you take in your own stuff and just work hard and treat people well, then the model you’re working in probably will do very well. The young people that are in there, I think they can learn a broad base of treatment planning. That’s the best way to do it. That’s why I say understand the job you’re taking because you wanna have the ability to see things and be able to provide it, not just be cookie cutter, doing stuff like that. And then the residencies and things that are available, you talked about military, you talked about Indian Health Service, you know, they have limited numbers of jobs, but I think everybody should look at that opportunity. The DSO world is here, let’s think about it. They can take and bring the overhead of a traditional solo practice that’s running a pretty good sized business is going to run in a 65% overhead world.
Dan Brian:
Yeah.
Dr. Crowley:
If by conglomerating a business model in that you can take that and keep the productivity up and you can bump that overhead down to 50%, I guess that’s the place where the investors in these dental models can feel happy that they can return cash to their investors.
Dan Brian:
Yeah.
Dr. Crowley:
But they better be doing the volume to do that because if it starts coming at the cost of quality of care and things, then that’s where I think people have that feeling of, uh-oh. But guess what? Quality of care is an issue whether you’re a solo practitioner or whether you have 10 practices.
Dan Brian:
Fair.
Dr. Crowley:
Or whether you have 100 practices. Quality of care still should be our main driver. And cutting corners to change that is not the model that anybody’s thinking about.
Dan Brian:
Yeah, absolutely. Well, you know, Joe, we’ve covered so many fascinating topics here today, and I can’t thank you enough for sharing your experience and expertise. I wanted to throw it back to you, though. Is there anything in particular that maybe we haven’t covered on the broad array of topics we’ve covered today that you want to leave folks with today? Is there one kind of key takeaway that you would want to impart to maybe younger dentists or new dentists rather, listening to this show that you’d like to leave them with before we close out here?
Dr. Crowley:
My personal opinion is I’m very happy that these young people are pursuing dentistry. I still think the opportunity to have a job that really can be rewarding at many different levels is just a great thing. I encourage people, that’s why I try to go and I encourage our dentists around the country to go talk to the pre-dentals programs. A lot of universities have pre-dentals. If you get the opportunity to go speak to them and tell them they’re in the right place, but it’s not haphazard. You know, you’ve gotta make a decision. You gotta know what the downsides are to some of this and then talk to people who will tell you, I think that they’re there. A shameless plug, I am chairman of a committee, it’s called the Coalition for the Modernization of Dental Licensure. And I’ve been working with this group for quite a while now and I’ve been chair for a while. And we’re a mix of educators, state dental associations, DSO organizations. And our goal, our sole goal there is to make sure that the pathway to initial licensure is fair and equitable, and that the portability of a license once it’s obtained can go anywhere in this country.
Dan Brian:
Love that.
Dr. Crowley:
And we’re making great inroads there. So to the young people I say, your dream to go somewhere is great. You know, we all wanted to live in the best weather environments and all that stuff, but make a practical decision when you look and see what’s the dental community about, is there really a job opportunity there for you? So do your research as you look and don’t start it when you’re in the last quarter or semester of your senior year of dental school. Start early and dream and don’t be afraid to ask. And if you start asking, you’ll eventually find the right person to help you answer some of those questions. Dan, the opportunity has been great. Man, we have thrown a lot of stuff all over the table. And again, I don’t know how you normally do this. You’re welcome to share my email address, if that would be the best way initially, if somebody wants to reach out to me.
Dan Brian:
That’d be fantastic if you don’t mind.
Dr. Crowley:
And I think you have that. And I’d be more than happy to help people, especially if they identify themselves that they came to me through DentalScapes, ‘ll get an idea as I answer why we’re making this contact. And that would be great. And in the future, maybe you can, if we have a conversation again, maybe you can narrow me down so I don’t throw stuff, like I said, like spaghetti on the wall, maybe.
Dan Brian:
I’m all over the place myself, but I think this has been just a phenomenal conversation and I think it raises so many interesting questions and topics for future conversation if you were ever up for it and I would certainly love to have you back on if that’s something that’s of interest to you. But in any case, Joe, Dr. Crowley, thank you so much for being with the show today. I really appreciate it. I think listeners will really benefit from this conversation. I hope so anyway. And to the listeners, thank you so much for joining today. If you enjoyed what you heard, I would love to connect you with Dr. Crowley. Like he said, I’ll be adding his contact information to the show notes, so stay tuned for that. And if you enjoyed what you heard today I would so appreciate a five-star review on Apple podcasts or wherever you get your podcasts. I can assure you the algorithm is brutal and a five-star review is the best way to help me get this show out to others within the dental community. So thank you so much and thank you so much, Joe, I can’t thank you enough.
Dr. Crowley:
Thanks, Dan. Thanks for the opportunity.
Dan Brian:
All right, take care.