Again, sounds like pharmacy circa 2001. We used to get free BMW's for signing on and pharmacy owners could make several hundred thousand a year for doing nothing more than retailing brand name drugs. Rural pharmacy owners used to make bank too until reimbursement started tanking over the past decade as pharmacy chains started vertically integrating with PBMs. First, the corporations will spread like wildfire by cutting costs with massive economies of scale, predatory pricing, and buying out practices "to allow you to focus on the clinical aspect of dentistry." Working corporate actually won't be too bad (just like it used to be in pharmacy) in this stage and many dentists (especially newer ones) will work corporate or sell to corporate with the belief that it will always be this good. Once they've accumulated enough market share, they'll slowly cut costs. Wages will go down, benefits will disappear, operating hours will expand (night shifts, evenings, weekends) and you will be laughably understaffed and overworked (illegally too, they don't care). You won't be able to compete. There are plenty of independent pharmacies now that have plenty of customers that hate the chains, but the pharmacies don't get reimbursed enough to justify it. A pharmacy owner makes on average a bit less than a corporate pharmacy store manager now even after investing a few hundred thousand to buy/open a store and it's getting worse. You're almost paying just to have a career that leaves your sanity intact (except for the long hours and the constant threat of bankruptcy). I'm not going to write a ten-page essay on all the creative ways corporations will nickel and dime you and lie to you in order to extract as much of your mental health as possible to redistribute it to shareholders, but trust me when they can do it they will. I really hope it doesn't happen to your profession, but it is definitely trending that way the only question is when it will happen and how far it will go.
CVS isn't going to stop with Smile Direct. They're planning on opening "health hubs" in order to vertically integrate all of healthcare. PA's and NP's already work at CVS. It's happening now for ortho. The company has already said they're planning on getting into primary care (because we thought physicians were "immune") and there's no reason everything else won't follow. You won't even have to wait for Heartland Dental to buy out your practice. You know that Aetna health insurance you accept? CVS owns Aetna now.
Smile Direct Club will continue to hammer ortho into a pulp sadly. Do you have any idea how horrible the customer service is at CVS and yet the customers continue to return? I worked at a CVS pharmacy that had an entire week of prescriptions (about 2,000) in the que that were past due to be filled. Literally mothers had their physicians send in prescriptions and couldn't get their antibiotics for their kids a week later. There wasn't enough staffing to answer the phone to explain to everyone why their prescription wasn't ready or transfer prescriptions to other pharmacies. The entire day was spent filling prescriptions for angry customers that came to the pharmacy who urgently needed their prescriptions. And still the company won't bother to give adequate staffing and customers will keep coming back because it's convenient to pick up your prescriptions anywhere in the country, manage things with an app, have pharmacies open 24 hours a day, only CVS accepts their CVS owned insurance (Caremark), branding, etc. The company receives hundreds of complaints a day and then tries to blame frontline employees for all the issues. It boggles my mind that companies like this are allowed to exist.
Honestly, dentistry has been a pretty sheltered profession for the past 30 years (apparently the early 80's weren't great). Most dentists have never experienced the true corporate work culture consisting of being fired for making too much money or having too many benefits, being forced to work off the clock illegally, being yelled at by managers for not doing things that are literally objectively impossible, and being blamed by customers all day long for things that aren't your fault. These things are common in a lot of industries now. Corporate America has taken notice and is interested in taking their share of the dental pie. I wish you guys the best and hope the dental profession stays independent for as long as possible, but please don't ignore this. Fight and don't ever give your profession away. It's priceless. Hope this info helps.
I did the math when I considered switching careers. According to the ADA's Survey of Dental Education, dental school for residents cost on average $147,409 in 2008 and $251,233 in 2018. Break out a financial calculator and that's 5.47% increases per year. Maybe it's cooling down a bit lately, but it's still outpacing inflation. Plus interest and the fact that "average debt when graduating" means after parents contribute and after scholarships (every degree has scholarships). That $283k number is the most optimistic number you could possibly give. Show me an "average amount paid over the life of a dentist's student loans" statistic. Also, don't ever forget the time value of money when making your financial decisions. A dollar earned/saved in your twenties is worth 10-15x more than a dollar in your sixties (paying 283k in your twenties is equivalent to losing out on like $3.5 million in your retirement account not to mention all those lost wages from spending time in college). Pharmacists make almost as much as general practice physicians if you do the math and account for pharmacists spending less on school and earning more money in their twenties which can be invested over their lifetime. And we get to live our youth. There's a reason so many people have wanted to go to pharmacy school over the past 10 years. Hopefully all the schools start closing down now like they did for dentists in the 80's or lawyers 8ish years ago and we can get back to better times.
Again, hope all this info is useful to those in both our professions and students deciding what to do with their future. You know computer science majors make six figures easy a few years into their career with a bachelor's degree and they can also own incredibly profitable companies?
