Of the 20 fastest growing occupations in the US economy, half are related to healthcare.

Healthcare is experiencing rapid growth, due in large part to the aging of the baby-boom generation, which will require more medical care. As healthcare costs continue to rise, work is increasingly being delegated to lower paid workers in order to cut costs.

For example, tasks that were previously performed by dentists are now beginning to be performed by dental hygienists and dental assistants.

As dentists‘ workloads continue to increase from treating the aging boomer population, it is expected that the demand to hire more hygienists to perform preventive dental care will grow as dentists will want to spend more time working on more complex dental procedures.

There is also the growing situation of not enough dentists to provide adequate care in rural areas where hygienists are needed to fill in the gap. According to the Center for Rural Affairs, in 2007, approximately 15 percent of rural residents were 65 years of age or older, 25 percent greater than in the nation as a whole.

The U.S. population of those 65 or older is predicted to double by 2030, reaching 20 percent of the U.S. total population, and the fastest group age living in rural America are residents 85 and older.

The average median wage for dental hygienists is $32.81 hourly, $68,250 annually with the best employment opportunities following the population size of states. New York, Texas, California, Michigan and Florida employ the most dental hygienists.

See: Occupational Outlook Handbook, 2010-11 Edition — Dental Hygienists

In a report by Sageworks, a leader in the financial analysis of privately-held companies, privately-held dentist offices have seen sales in 2011 decline about 3 percent after posting ongoing-though-shrinking gains in their top lines throughout the recent recession.

Sales growth rates for dentists in 2008 and 2009 were 5 percent and 15 percent, respectively, but dipped to 1 percent growth in 2010 before this year’s decrease.

Forbes.com reports that profit growth, too, has weakened.

Dentists have worked to keep costs and overhead down which has helped them maintain one of the highest net profit margins of private industries over the last 12 months, according to Sageworks data. Dentist offices had a 13.84 percent net profit margin in the 12 months ending Sept. 3, 2010, compared to the net profit margin of 14.15 percent in 2010.

The “2011 Survey of Dental Care Affordability and Accessibility” reported that 77% of the US are without dental care and put off visits to the dentist because of the cost of that care.

As the economy continues to crawl, more people may further opt to skip regular check-ups with their dentist because of increasing out-of-pocket expenses. Dentists will continue to struggle to maintain their profit margins, while trying to attract new dental patients.

It’s a vicious cycle that doesn’t look like it will be ending anytime soon.

For more on the Sageworks report see U.S. Recession Effects Gnaw at Dentists’ Business.

In this survey, 29% of dentists said their dental practice is completely paperless, another 17% are mostly paperless, while 27% are making some progress, and the remaining 32% haven’t even tried.

When it comes to fully automating a dental practice, some of the things that worry doctors include legal ramifications of electronic patient notes, concerns about security, training costs, and the time it takes to implement.

“I still worry about the legal ramifications of electronic patient notes if in a court of law where the judge is more than a little skeptical about the tamper-proof quality of computers,” said one dentist.

Here are some comments we got when we asked dentists, “Do you have a “paperless” dental office?”

• “Consents are the only thing lacking. We have purchased Dentforms, but have not implemented as of today.” (Georgia dentist)

• “I don’t know how an office can be totally paperless. I can see how they can be chartless.” (California dentist)

• “I opened my practice in 2003 paperless from the get-go. I can’t imagine doing it any other way. Digital everything is great! It certainly is more efficient and it’s wonderful not having to use up valuable office space with stacks and rows of paper patient files!” (Ohio prosthodontist)

• “We are not completely paperless we still do some scan and shred. Paperless plus digital saves at least one employee. Some offices use new “things” and maintain the old ways. Some use old “things” and old ways. A few create new ways to work and look for the easiest most cost effective way to make it happen. Is you office designed for paperless? What is the next frontier?” (Missouri dentist)

• “A better term would be chartless. We still have paper statements, invoices, etc.” (California dentist)

• “Paperless is the best thing that ever happened to us!” (Florida hygienist)

• “I have heard from other practitioners that it is very time consuming and she spends a lot of time correcting staff entries. I’m afraid that I’ll miss something and also don’t want to take all the extra time to do templates and correct entries.” (California dentist)

• “I see no immediate need and I have some concerns about security.” (Texas dentist)

• “We have digital x-ray and online clinical notes. The only things remaining in the chart are signed papers, referral slips and EOBs that aren’t available electronically. At this point going completely paperless seems like more trouble than it’s worth. We don’t see any point in spending money to go paperless with the rest of it right now. We have greatly limited the amount of times we are actually touching a paper chart.” (Minnesota dentist)

• “Try it you’ll like it. At first you might slow down. Later the benefits will be self-evident. It is a big cultural shift for the practice though.” (California prosthodontist)

• “We scan everything but still keep the paper copies. This adds work but saves us time later.” (California orthodontist)

• “5 years and no looking back. We are chartless — not actually paperless. This makes much more sense to us and to our patients. No huge wall of charts, no misplaced charts, easy to treatment plan, track, and follow up. Much much cleaner for staff. Lots of time savings. 1 front desk employee for 3 dentists and 2 hygienists at busy office … efficiency starts with chartless!” (Illinois dentist)

In many of The Wealthy Dentist surveys dentists have complained of career burnout.

Burnout is considered either emotional or physical exhaustion, usually caused by stress at work. It was initially described in the 1950s by Hans Selye as ‘the nonspecific response of the body to any demand made upon it and discouragement in the work setting’.

According to the U.C. Irvine report, burnout is viewed also as a complex of psychological responses (strain) to the particular stress of constant interaction with people who are in need. Differing from other interactional symptoms related to job stress is the effect on others seen as a depersonalization of clients.

Symptoms of Burnout -

1. Negative Feelings.
Feelings of disillusionment and being ‘stretched too thin’. Feeling that you aren’t making a ‘difference’ in your approach to lifelong goals. Other feelings of burnout are the feeling of being ‘run down’, easily frustrated and feeling that you are unable to concentrate.

2. Interpersonal Problems.
Your tolerance level drops as the burnout grows and you find yourself increasingly unable to handle social interactions. You begin to dehumanize your relationships by thinking of your dental patients not as people but as objects.

3. Physical Manifestations.
Burnout shows up physically as exhaustion, muscle pain, headaches, insomnia, respiratory illnesses, gastrointestinal disorders, depression, and hypertension.

4. Substance Abuse.
Often people suffering from burn-out will self-medicate their anxiety, depression and insomnia with drugs or alcohol.

5. Inefficiency at Work.
Burnout causes productivity to wane as you become less effective overall, either by hiding in your office or staying away from work more often.

Remedies for Burnout -

1. Take a Two Week Vacation.
Quite often by distancing yourself from your work you will be able to make some decisions on things you can do differently to alleviate stress when you return to your dental practice.

2. Cut Back Your Work Hours.
Sometimes burnout appears from an unwillingness to delegate job duties. Consider cutting back on your work load by delegating tasks you don’t enjoy and consider cutting back your dental practice hours if you can.

3. Schedule Time For You During the Day.
Make sure you always take a lunch break. Make it at least an hour and a half three days a week and schedule some light exercise for the last half hour like a brisk walk around the block or a yoga class.

4. Put Your Health First.
Go to bed at the same time every night and work on getting enough sleep. Look at your diet and see where you can cut out high sugar foods, and make time to relax with good friends on weekends.

5. Write Your Thoughts Down.
Some people find that keeping a journal at home and expressing your feelings of frustration on paper can go a long ways towards helping you deal with burnout. Commenting anonymously on this blog might even help too.

The most critical thing about burnout is to recognize it’s a shout out from your exhausted self. Try changing things up a bit in your life to break out of your routine. Come into the office thirty minutes later, drive a different route to work, learn a new hobby, or work on something you love. Take a break and list all the reasons you chose dentistry as your profession in the first place.

Have you ever suffered from burnout?  What advice would you give dentists for dealing with burnout?

But in August of this year, Chris Cook of Bakersfield, CA, pushed negative online reviews to a new level.

It was reported in dental news site DrBicuspid.com that Mr.  Cook took his 5-year-old son to see Bakersfield pediatric dentist Edward Dove, DDS, for a tooth extraction. Mr. Cook claims Dr. Dove mistreated his son during that visit by extracting a tooth before the child was adequately sedated.

According to DrBiCuspid.com, Cook stated that his son vomited up most of the sedative, screamed, and urinated on himself while allegedly being held down by three dental assistants during the procedure.  Allegations Dr. Dove vehemently denies.

Chris Cook decided to take matters into his own hands and created the “I Hate Dr. Dove of Bakersfield” page on Facebook, attracting more than 200 members in its first 48 hours.

Luckily for Dr. Dove, Facebook does have a policy for pages with the word “hate” and considers them in strict violation of their terms of service.  They swiftly moved to shut down the dental hate page.

Cook was undaunted by the Facebook boot, turned around and created a second Facebook group page, “Bakersfield dentist DOES NOT ROCK!!!!!!!!!” which is still up and active.

Dr. Dove has handled the situation by defending his treatment in the press and pointing to his 23 years in practice without a single disciplinary action. He has chosen not to engage with Chris Cook on his Facebook page, and was quoted in Dr Bicuspid as saying, “I think my reputation will be hurt a little bit, but right now I just want to calm down,” Dr. Dove said, “This guy is going ballistic, he’s trying to smear me, and I’m getting bullied.”

But should Dr. Dove be more concerned?

Just how significant are bad reviews for the future of your dental practice?

A new survey by market analysis firm Cone, Inc., found that four out of five consumers have reversed purchase decisions based on negative reviews found on the Internet. Another survey by Ratepoint found that 40 percent of consumers indicated they are more likely to consider a local business when they respond to a negative online review.

In the case of a Facebook page being dedicated to hating a dental practice, a dentist has little recourse since the unhappy page creator would have to allow the dentist to join the group page in order to issue a response.

Dentists have had little luck in defamation lawsuits when it comes to negative online reviews since the courts tend to look upon unhappy reviews as free speech. In a recent defamation case in California, a dentist has been ordered to pay $80,000 in attorney fees to the parents who posted a negative online review.

So how do you combat something like a negative Facebook page?

By making sure your dental practice has more than one website that appears on the top pages of Google when your business (and personal) name is searched online. Also have your own Facebook page, or pages for each type of treatment you offer. Have a Twitter page and make sure your practice is listed in as many dental directories as you can find. The idea is to control what appears on the first page of Google about your dental practice. Regular press releases help with this too.

For solutions to multiple name search and directory listing go to: www.InternetDentalAlliance.com.

For more on this story see: Facebook Pulls Plug on Angry Dad’s Antidentist Page

51% schedule a minimum of 40 minutes for comprehensive dental exams, this survey found.

Only 27% of dentists said they perform comprehensive exams in less than 30 minutes.

“Actually, I schedule an hour and sometimes it takes longer The compete exam is THE single greatest internal dental marketing technique,” offered one dentist, a subtle comment for comprehensive exams being a part of an overall dental marketing plan.

Here’s how dentists responded to this survey asking what length of time they schedule for an initial comprehensive exam:

• 4% 10 minutes.
• 10% 15 minutes.
• 10% 20 minutes.
• 3% 25 minutes.
• 22% 30 minutes
• 51% 40+ minutes.

Here are some further comments on scheduling comprehensive exams from dentists:

It should be one hour …

“One hour. It’s COMPREHENSIVE. That cannot be done in less than 45 minutes. It means you are looking at radiographs, perio probing, restorative, occlusion, TMJ, health history, and oral cancer exam. I defy anyone who says that a “comprehensive” exam can be done any faster.” (Georgia dentist)

“For new patients, an hour max, but if I only give them 20 minutes of my time, I don’t get the case as often.” (Illinois dentist)

“Really should schedule 50 or 60 minutes on adults.” (General dentist)

“We schedule one hour initial exam for perio charting, radiographs, photos, models, charting restoration, and for getting to know the patient.” (Michigan dentist)

“We schedule an hour, but sometimes it takes even longer.” (California dentist)

It should be more than an hour …

“We schedule 1 1/2 hours for initial medical history gathering, interview, complimentary Velscope cancer screening, necessary x-rays and comprehensive exam. NO cleaning at this appointment.” (Minnesota dentist)

“I actually spend and hour and a half for each new patient examination. Not one gets into hygiene without a NP exam.” (Washington dentist)

“My first appointment is 1.5 hours in length with a pre-paid reservation fee.” (California dentist)

“My patient is scheduled for 2 hours. In that time we take photos, x-rays, models and intra-oral images as well as the full exam, interview and charting with the doctor.” (New Jersey dentist)

“We schedule 90 minutes. 45 minutes for the exam and 45 minutes for records.” (Florida dentist)

Note: Survey sample included 100 respondents.

The New York State Association of Counties has endorsed the ProAct Dental Network Card program that provides cardholders with information they can use to locate dentists who have agreed to charge relatively low fees for dental services.

In Illinois, through a partnership with Careington International, a dental discount card can help patients save up to 50 percent on selected dental services, and 20 percent on orthodontic services.

The discount cards typically work through a network of dentists who have agreed to reduce the cost of their treatments to cardholders. This sets a rate of treatments that appear to reduce the cost to patients considerably.

Some dental cards offer a percentage off of the amount the dentist usually charges while other cards set the fees for a specific amount of money. The dental discount cards charge either a monthly or annual fee and will usually last for one year.

The main thing to understand is the difference between a “Discount Dental Plan” vs. a “Dental Insurance Plan.” Over the last three years the Insurance Plans… which have always been marginal as far as benefits are concerned, have lost enrollees as unemployment has topped 9%.

Many people have been forced to enroll in “Discount Plans,” again with marginal benefits.

For the doctor in either plan the issue is dental marketing for new patients. The discount is the dental marketing cost you, the doctor, pays to acquiring the new patient lead. From their it is up to you and your team to screen for financial capability and do an outrageously great job on case presentation on qualified patients.

Many dentists are hesitant to increase their fees over fears that they will see a reduction in patients.

The fact that the U.S. is currently reentering a second major economic slowdown in three years turns a fee increase into a serious dental practice management issue.

As one Illinois dentist put it, “I am concerned about raising fees and losing patients who already have money woes.”

The Wealthy Dentist decided to survey dentists and ask them when was the last time they raised their
fees. Here is how dentists responded:

• 27% raised their fees in the last 6 months.
• 29% raised their fees in the last year.
• 26% raised their fees in the last 2 years.
• 11% raised their fees in the last 3 years.
• 7% raised their fees in the last 5 years.

Suburban dentists were 3 times as likely to have raised their fees than their urban or rural counterparts.

What dentists had to say:

Economic woes …

“I am hesitant to raise fees due to present “slow” period.” (Kansas dentist)

“I raised them in the last 6 months, but I had not raised them for 3 years because of the economy.” (Texas dentist)

“We wait and see how the economy does.” (Tennessee dentist)

“It’s tough-as-hell to do in this economy.” (Illinois dentist)

“With this economy and my competition, I felt I should lower some of my fees.” (Missouri oral surgeon)

Keeping pace with inflation …

“We at least raise them annually to cover for inflation (approximately 3%). We raised our gold crown fees significantly more due to the increased price of gold and the lab fees.” (Ohio dentist)

“We raise them every year usually by about 2 – 3%.” (Minnesota dentist)

“Gold is up, so fees must follow. Our distributors adding gas surcharges, so they need to be addressed.” (New York dentist)

“Fees should be raised every year to keep up with inflation, increased supply fees and the loss of value of the dollar.” (Kansas dentist)

“We raise them every year on Jan. 1.” (Florida dentist)

“We raise our fees on a rolling schedule. We raise fees in certain areas (hygiene one quarter, crowns the next quarter etc.) every quarter. We base our fee increases on the prevailing fees in our zip code which we obtain through an annual fee survey which we purchase. While it may not be 100% accurate, it gives us a guide as to the fees in the area.” (Illinois dentist)

Insurance is a problem …

“How can we raise fees when insurance dictates everything anyway? One time a patient has Met-life that pays the fee for a service and the next time that we see them they still have Met-life, but the fee-schedule plan is at greatly reduced fee. Our fees don’t seem to make much of a difference. The insurance companies set fees at 1995 levels.” (Texas dentist)

“Are other dentists experiencing denied, or reduced fees that are submitted to the insurance companies lately (e.g., Delta)?” (California dentist)

“I haven’t raised fees for 3-4 years. I used to raise them every year. But raising fees is almost a moot point because the majority of my patients are on PPO insurances that are not raising fees at all, and in some cases, lowering reimbursements.” (Nevada dentist)

Have you raised your treatment fees? Tell us your thoughts in the comments!

As part of The Wealthy Dentist dialogue on dental practice management and marketing, we offer weekly surveys and invite your participation.

In order to understand different perspectives on the dental industry, we have developed surveys to canvas a diverse group of dental practices on their view of the dental industry, what constitutes current good practice in dental marketing and quality care.

The information collected will be used to prepare articles for The Wealthy Dentist readership.

The survey should take no more than 90 seconds to complete -

Pediatric dentistry isn’t as profitable as cosmetic dentistry, but it’s rarely about the money.

Pediatric dentistry is a good thing to do for your community, but only if you like doing it.

“If you treat children like gold, you’ll see their mothers, fathers, aunts, uncles, and grandparents as well!” said a Virginia dentist.

Pediatric dental patients can provide a whole new set of family patients. But not all doctors are cut out to be a children’s dentist.

“I break out in hives when I treat anyone under 18!” said an Indiana dentist.

Click on play to watch the survey video and hear the full survey results -