The biggest roadblock facing new dentists today

Dentists entering the workforce are facing more pressure to join DSOs under mounting student debt, one orthodontist says. 

William Kottemann, DDS, of Kottemann Orthodontics in Minnesota, has been practicing for 44 years. He recently spoke with Becker's about the challenges of dentistry today and the industry trends he is following.

Editor's note: Responses were lightly edited for clarity and length.

Question: How do you see DSO consolidation evolving in the next few years?

Dr. William Kottemann: Orthodontically speaking, I certainly do see consolidation coming in the next five years for larger practices, which is going to be an interesting dichotomy in the sense that the larger practices are obviously the ones that private investment is interested in as opposed to the small guy or gal, as the case may be, that might have a great small solo practice, but probably is not going to be able to sell to a large company and may shrivel up. Corporate dentistry overall is certainly going to be bigger. 

I'm probably going to practice one or two more years and then retire. And I'm still a very minority partner in Kottemann Orthodontics. Our company has been talking over the last couple years with different equity partners to consider being sold. We've looked at big groups, little groups, new groups and have decided if we're going to do this, we want to be on the ground floor rather than in something where your chance for equity appreciation is frankly very little. 

Q: What technology is improving patient care and efficiency?

WK: The digital ability to make crowns for us to scan patients and get a two-week turnaround on our Invisalign cases, the efficiency is just great. Also, in [orthodontics] specifically, the digital printing of customized brackets, which we're starting to use now to in theory make cases with fixed appliances more efficient. The jury is certainly still out on [whether] it truly will be more efficient, but I think the concept is really great. The way it works with the company we're using is we take a scan of the patient's mouth and then give them the parameters of how we want the teeth to look when we're done, very similar to an Invisalign setup. And then they manufacture the brackets including how they're positioned on the teeth to get the teeth as precisely positioned as possible. And then they make indirect bonding trays to be able to very accurately put the brackets on the teeth.

Q: What are the biggest challenges facing dentistry?

WK: There's pressure obviously, as always, from insurance companies for fees. We used to think there was a huge oversupply of young dentists coming out of dental school and I think that fear has somewhat subsided. The biggest concern is the amount of debt that students have coming out, which is really fueling [DSOs] because new graduates just simply can't afford to work just as an associate at a lower salary level while they're trying to pay off their debt.

A huge problem is staff shortages. As bad as it is in the service industry of restaurants, it's just about as bad in dentistry as well. So to keep and nurture a well-trained staff person is definitely a challenge. It's mainly just, for whatever reason, the schools just are not full, the dental assisting schools. We've always been really involved with the schools here in Minnesota as far as taking on interns and trying to find the bright ones in the class that would be interested in being an orthodontic assistant. Because [orthodontics], it's so different because we typically on our busy days will have five chairs simultaneously seeing patients, and the orthodontist moves from chair to chair and, frankly, the assistant does 90 percent of the work at each visit. The dental schools to become a dentist are as full as ever and, the last I heard, harder to get into than medical schools. But for dental assisting, I don't know where they're going, into what other field because it still is a very, for the amount of education they have to do, a well-paying job.

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