Why dentists are so darn rich
WASHINGTON - At $50,000, the reported price of the trip that an American dentist took to Zimbabwe is nearly as shocking as the death of Cecil, the widely known and universally beloved lion he killed while he was there. The neighborhood dentist seems far removed from the upper echelons of medicine, someone who comes in for a few minutes at the end of a cleaning to check your teeth and ask about your kids, occasionally doing a filling or root canal. No doubt these services are critical to patients and our overall health, but some might be surprised to learn that a dentist could afford to spend $50,000 on a hunting expedition.
It turns out, however, that dentists are quite well paid. According to official government statistics, the median dentist in the U.S. in 2012 earned $149,310 per year. But that median figure obscures variation around the country, or among dentists with different specialties. In some high priced cities, dentists make a lot of money with nonmedical, cosmetic procedures such as teeth whitening. And according to the American Dental Association, the average dental specialist earned $283,900 in 2013.
Dentists in some places are so well compensated that they earn more than the average doctor. According to a 2012 report by the Journal of the American Medical Association, the average hourly wage of a dentist in America is $69.60 versus $67.30 for a physician. As recently as 1996, dentists were making less than doctors. Meanwhile, according to WebMD Medscape's annual compensation report, the average general dental practitioner took in $181,000 in 2013, compared to $175,000 for a family doctor, according to the dental association.
Behind the high salaries
Behind the high wages is a debate over whether Americans ought to be spending so much on dental care.
Critics of the U.S. dental industry have long complained that dentists are insulated from market forces, resulting in higher prices.
"They're afraid of the competition," said Jay Friedman, a dentist and researcher in Los Angeles who has long advocated for dental reform.
He contends that to make it easier for more Americans to receive dental care, dental nurses and hygienists - who have less training - should be allowed to perform basic services alongside dentists. In most states, hygienists are barred from cleaning teeth unless they are employed by a dentist.
One study concluded that allowing hygienists are free to offer services independently, like nurse practitioners in general medicine, reduced dentists' incomes by 16 percent.
The dentists had more competition from people whom they otherwise could have employed, forcing them to lower their prices. Not only that, but since hygienists' options for treatment were legally limited, they might have recommended less expensive treatments, and patients would have spent less overall. Hygienists who were not allowed to perform fillings, for example, might have recommended less costly sealants instead.
As it happens, Minnesota - where the trophy hunter practices - is one state that recently gave dental personnel besides dentists more freedom to serve patients.
Minnesota recently began licensing "dental therapists," and there were 32 people practicing with the designation in the state as of last year, according to a report from the state Department of Health.
Minnesota's law allows these therapists to clean, fill and pull teeth under the "general supervision" of a dentist, who does not have to be on site. The report found that therapists cost about half as much as dentists, which suggests that incomes for dentists in Minnesota could decline as more therapists are licensed.
In response to questions about expanding the dental workforce, the American Dental Association pointed to a study claiming that the main challenge facing patients acquiring care is not the limited number of dentists but the underlying cost of receiving dental services.