PEORIA — Dentists are not being spared the increasing costs of education and the economic downturn.
While private practices are being shaken by changes in insurance trends, new graduates of dental school are being forced to go where the money is to pay off massive student loans.
"When I graduated in 1974, my dental education cost me $60,000," said Dr. Howard L. Waldrop, program coordinator for OSF Saint Francis Medical Center's General Practice Residency Program. "Today, it can cost $300,000."
According to a 2012 American Dental Student Association survey, the average educational debt from public dental schools was $192,299 for four years. For private schools, that debt reached an average of $263,382. But the cost at some schools can be up to $400,000.
An American Dental Association survey showed the annual cost of dental education rose 85 percent between 2001 and 2011.
Waldrop says he has seen the effects of higher education costs burden new dentists and residents in recent years with greater debt and less peace of mind.
"They feel like they have an anchor around them," Waldrop said. "They can't afford to buy into an established dental practice because it would add to that debt."
Waldrop also said living a normal life with getting married, purchasing a car and having children shifts the focus of new dentists to money rather than focusing on honing their craft.
Dr. Primal Sekhon, a recent graduate from dental school at Western University of Health Sciences in Pomona, Calif., moved to Illinois because her fiance works in Chicago. Now she works in the OSF residency program, which will prepare her for either private practice or a position with a corporate practice as she pays off up to $380,000 in student loans.
"It's not so much the loan, it's the interest rates," Sekhon said, adding that she considers the loan an investment in her future. "These interest rates are higher than for home loans. I'm not making as much money right now as a resident, so I'm just keeping up with the interest rates."
After she finishes her residency, Sekhon's first concern is finding a good paying job to help pay off her student debt.
But not many dental students take Sekhon's path, especially to rare residency "in-between" programs like at OSF.
Dr. Josh Hudson, a 2012 graduate from Southern Illinois University's dental program, is doing cosmetic workups, implants and oral surgery at two clinics but has about $260,000 in student debt.
"It's very prohibitive," Hudson said about his loans. "At least 70 percent is gone to paying off debt, the house and other things before it goes into my account."
While they've taken different paths after dental school, both Sekhon and Hudson feel the weight of student debt is a big factor in steering their colleagues away from becoming more specialized dentists toward making a profit.
Page 2 of 2 - "You get very stressed out," Sekhon said. "A lot of students don't want to go into a specialty. They feel they can't because loans are too high."
"It's a hard thing," Hudson said. "It's pushing a lot of people to become employees of corporate practice where they might not get the same experience."
Private to corporate
Waldrop said that new graduates are looking more for large group practices, or corporate-structure practices, which may pay more but don't focus on quality and learning as much as a traditional private practice.
"There's always going to be places for private, personal dentistry," said Dr. Michael Bentley, a dentist in Creve Coeur for 35 years. "But dentistry is going toward corporate roots."
Bentley built his private practice into a clinic in Creve Coeur, operating since 1981.
But it hasn't come without challenges. The introduction of Preferred Provider Organization dental insurance policies is paying private practices less as costs for procedures go up.
"A crown cost, lets say, $250 30 years ago. Now if you come into my office, it would cost $900 to $1,000," Bentley said. "But because of the PPOs, I'll only get $600. I really need $900 to drive this practice and keep everybody paid."
Bentley said because he is near the end of his career and has an established practice, he can take the financial hit.
He has also noticed that the downsizing of dental plans is leading to dental coverage for fewer patients.
"People come in and just do the minimum," Bentley said. "Instead of the full crown, they'll go for the filling."
While medical insurance beneficiaries will find more choices with the Affordable Care Act, dental benefits are largely untouched.
According to the American Dental Association's Health Policy Resource Center, dental benefits for patients will continue to erode, except for 8.7 million additional children who will benefit with coverage from the Affordable Care Act.
The ADA also found that patients will be looking for value and reduced costs, and that dentistry is trending toward large, consolidated practices that will be focused on efficiency.
Those are all hurdles for younger dentists wanting to start their own practices. But as a new dentist, Hudson is still thinking about doing just that.
While many dental students are discouraged from taking on more debt to do what they want, Hudson said it's still possible.
"For the most part if you search at different banks someone will give you a loan," Hudson said. "Banks want to know you can produce based on some experience."
But whether it's a corporate position, or owning a practice with your name on it, Bentley said meeting with and serving patients is always a satisfying part of the job.
"Giving people a better smile means they have more self confidence," Bentley said. "And they're happy in the end because they're not in pain."