Why Dentists Are Smiling
They Now Average Higher Incomes Than Some Physicians

By Mark Maremont
Staff Reporter of The Wall Street Journal

Randy Bryson and his brother-in-law Larry Fazioli are both medical professionals in their 40s who practice in Pennsylvania. The similarity ends there.

At Dr. Bryson's office near Philadelphia, a fountain burbles in the reception area, and patients are offered cappuccino or paraffin-wax hand treatments while they wait. Dr. Bryson works four days a week, drives a Mercedes, and lives in a 4,000-square-foot house. Together, he and his wife, who works part-time in the same practice, take home more than $500,000 a year.

At Dr. Fazioli's busy practice near Pittsburgh, patients crowd a utilitarian waiting room, and his cramped office is piled high with records awaiting dictation. Dr. Fazioli says he works between 55 and 80 hours a week, and his annual income of less than $180,000 has been stagnant or down the past few years. He drives a Chevrolet.

The key to their different lives: Dr. Bryson is a dentist, and Dr. Fazioli is a family-practice physician.

Sharp Turnaround

Once the poor relations in the medical field, dentists in the past few years have started making more money than many types of physicians, including internal-medicine doctors, pediatricians, psychiatrists, and those in family practice, according to survey data from the American Dental Association and American Medical Association.

On average, general dentists in 2000, the most recent year for which comparative data are available, earned $166,460-compared with $164,100 for general internal-medicine doctors, $145,700 for psychiatrists, $144,700 for family-practice physicians, and $137,800 for pediatricians. All indications are that dentists have at least kept pace with physicians since then.

Those figures are a sharp contrast to 1988, when the average general dentist made $78,000, two-thirds the level of the average internal-medicine doctor, and behind every other type of physician. From 1988 to 2000, dentists' incomes more than doubled, while the average physician's income grew 42% (slower than the rate of inflation). Factor in hours worked-dentists tend to put in 40-hour weeks, the ADA says, while the AMA says physicians generally work 50 to 55 hours-and the discrepancy is even greater.

"I feel so bad for Larry," says Dr. Bryson of his brother-in-law. "Especially when he's on call, he puts in some pretty long hours. Physically, it's really taking a toll on him."

Dr. Fazioli says he still gets a lot of satisfaction out of being a doctor and earns a comfortable living. But he admits he'd steer his children away from primary-care medicine as a career. Of his three sons, he adds, two might be interested in dentistry instead. "They see that Randy is doing OK," he says.

Many specialist physicians, such as cardiologists and radiologists, continue to rake in large incomes, generally exceeding those of specialist dentists such as oral surgeons and periodontists. But specialist dentists, too, have seen their paychecks increase at a much faster rate than their physician counterparts.

Why? In part, it's because dentists have avoided being flattened by the managed-care steamroller, and many have turned into upscale marketers. Dental care makes up less than 5% of the overall U.S. health bill, and hasn't been a major focus of cost-cutting.

Most private dental insurance is still paid on a fee-for-service basis. Many optional procedures aren't covered by insurance, leaving dentists free to charge whatever the market will bear. About 44% of all dental care is paid by patients out of their own pockets.

In competing for patients' dollars, dentists have become more entrepreneurial. Many dental offices display ads for everything from $400 whitening treatments to $1,200-per-tooth veneer jobs. There are even $30,000-plus full "smile make-overs" offered by dentists specializing in high-end cosmetic procedures.

Dentists also have taken advantage of new technology, some of it controversial even within the profession. One major advance was the invention of porcelain veneers, which are wafer-thin shells of material that are bonded to the fronts of teeth to repair chips or misalignment. Unlike older surfacing materials, porcelain resists staining and looks like a natural tooth surface. "Today, you can create a smile" from materials that people "can't tell are not real teeth," says Joe Barton, a Jacksonville, Fla., dentist who specializes in cosmetic procedures. He says he typically charges from $12,000 to $14,000 to put veneers on 10 front teeth, requiring about 3µ hours of his time.

Some dentists use sophisticated software-imaging programs to show patients virtual before-and-after photos of what their teeth could look like with cosmetic help. Others use intra-oral video cameras, tiny pen-shaped devices that can be used to display images of the inside of a patient's mouth. The cameras have little clinical use-but there's nothing like an up-close video of unsightly teeth to convince a patient that something needs to be done.

'Pennies on the Dollar'

The turnabout in fortunes has made some dentists pity their physician colleagues. Robert H. Gregg, a dentist in Cerritos, Calif., says he had an operation for a snapped Achilles tendon a few years ago, which required him to go under anesthesia for more than an hour. He was amazed that his insurer paid just $2,000 to his surgeon for the procedure. "I get about $3,000 for a three-unit bridge," Dr. Gregg says. "He's getting pennies on the dollar to what his skill level was."

Dr. Fazioli says if he had to do it all over again, he'd still consider being a primary-care doctor, but "I'd look hard at other areas, other states." As for his brother-in-law the dentist, Dr. Fazioli says, "Randy certainly did his homework. People who come to him want his service. He can charge as much as he can."

Dr. Fazioli recently went to a local dentist to get a bridge put in. The procedure, he says, took about 1µ hours over two visits. The bill: $1,200, all of which he had to pay out of pocket. "I was thinking, 'How many people do I have to see to get that?'" Dr. Fazioli says. "If I made $200 in that amount of time, I'd be lucky."