Health Policy Institute Dental Practice Settings and Job Satisfaction Thank you for joining! You will be on hold until the call begins at 12 p.m. Central time Today’s webinar will be recorded Please remember to mute your phone unless you are speaking If you are not currently connected by phone, dial If prompted, enter meeting number:

© 2015 American Dental Association. All Rights Reserved. 2 Today Key Findings Anthony T. LoSasso, Ph.D., Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago Marko Vujicic, Ph.D., Chief Economist & Vice President, Health Policy Institute, American Dental Association Commentary Quinn Dufurrena, D.D.S., J.D., Executive Director, Association of Dental Support Organizations Irene Marron-Tarrazzi, D.M.D., M.S., Dentist, Brickell Periodontics, Miami Q&A Please send your questions during the webinar via the chat box.

© 2015 American Dental Association. All Rights Reserved. 3 ADA Health Policy Institute

© 2015 American Dental Association. All Rights Reserved. 4 ADA Health Policy Institute

© 2015 American Dental Association. All Rights Reserved. 5 Defining Group Practice CategoryDefinition Completely Dentist Owned and Operated Group Practice An aggregation of a variable number and/or type of dentists in a single practice that may be located at a single or multiple sites completely owned and operated by dentists, usually organized as a partnership or professional corporation. Dental Management Organization Affiliated Group Practice A group practice that has contracted with a dental management organization to conduct all of the business activities of the practice that do not involve the statutory practice of dentistry, sometimes including the ownership of the physical assets of the practice. There are several types of dental management organizations and there can be significant variations in the nature of the agreements between the dentist and the dental management organization. Insurer-Provider Group Practice A group practice that is part of an organization that both insures the health care of an enrolled population and also provides their health care services. Not-For-Profit Group Practice A practice that is operated by a charitable, educational or quasi-governmental organization that often focuses on providing treatment for disadvantaged populations or training healthcare professionals. Government Agency Group Practice A practice that is part of a government agency. It is organized and managed completely by the agency. All dentists are government employees or contractors and operate according to agency policies. Hybrid Group Practice A practice that does not clearly fit into any of the above categories and can exhibit some characteristics of several of them.

© 2015 American Dental Association. All Rights Reserved. 6 Studies Covered Practice Settings and Dentists’ Job Satisfaction, The Journal of the American Dental Association, August 2015 Job Satisfaction among Dentists Varies by Type of Large Group Setting, HPI Research Brief, August 2015 Very Large Dental Practices Seeing Significant Growth in Market Share, HPI Research Brief, August 2015

© 2015 American Dental Association. All Rights Reserved. 7 Key Findings Dentists in small group settings reported the most satisfaction overall Dentists in large group settings reported more satisfaction with income and benefits, as well as having less stress, than those in solo practices DMOA dentists were less satisfied with income than DOO dentists but were more satisfied with reported fewer hours spent in nonclinical tasks From 2002 to 2012, market share increase for dental firms with 20 employees or more

© 2015 American Dental Association. All Rights Reserved. 8 Data and Methods Survey on income, benefits, hours worked, clinical autonomy, work-life balance, emotional exhaustion, and overall satisfaction in –Large groups (many dentists at multiple locations) –Small groups (multiple dentists in a single location) –Solo practices 2,171 dentists responded. Logistic regression to measure differences in reported levels of satisfaction across practice settings. DMOA and DOO dentists studied separately Evolution of dental practices based on U.S. Census Bureau’s Statistics of U.S. Businesses (SUSB)

© 2015 American Dental Association. All Rights Reserved. 9 Study #1 Practice Settings and Dentists’ Job Satisfaction, The Journal of the American Dental Association, August 2015

© 2015 American Dental Association. All Rights Reserved. 10 Descriptive Statistics - Satisfaction With…

© 2015 American Dental Association. All Rights Reserved. 11 Descriptive Statistics - Satisfaction With…

© 2015 American Dental Association. All Rights Reserved. 12 Descriptive Statistics - Satisfaction With…

© 2015 American Dental Association. All Rights Reserved. 13 Descriptive Statistics - Satisfaction With…

© 2015 American Dental Association. All Rights Reserved. 14 Category/Question Large group v. solo Large group v. small group Small group v. solo Salary Vacation Benefits Maternity/family leave time I am pleased with my income compared to other dentists = “more satisfied/agreement” = “less satisfied/disagreement” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 15 Category/Question Large group v. solo Large group v. small group Small group v. solo Hours that you work Flexibility in scheduling hours Opportunity for part-time work Weekends off per month Flexibility in scheduling weekends off = “more satisfied” = “less satisfied” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 16 Category/Question Large group v. solo Large group v. small group Small group v. solo Participation in organizational decision making Level of control in your work setting Ability to focus your energy on treating patients I am able to practice dentistry the way I want to = “more satisfied/agreement” = “less satisfied/disagreement” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 17 Category/Question Large group v. solo Large group v. small group Small group v. solo Opportunities for advancement Continuing education you have receive I have the opportunity to develop a special interest I have time to keep up with the latest research/lit in dentistry I feel driven to keep up with current advances in dentistry I feel driven to produce high quality clinical work Level of support you receive for participation in organized dentistry = “more satisfied/agreement” = “less satisfied/disagreement” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 18 Category/Question Large group v. solo Large group v. small group Small group v. solo I feel stressed in my job I feel emotionally drained from dentistry I feel used up at the end of each day at the office I feel burned out from dentistry I feel fatigued when I get up in the morning and have to face another day at the office = “unlike me/disagreement” = “like me/agreement” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 19 Category/Question Large group v. solo Large group v. small group Small group v. solo Delivery of care in your practice Knowing what I know now, I would make the same decision to go into dentistry Overall, I am satisfied with my career in dentistry My current practice situation is what I envisioned when I chose to become a dentist = “more satisfied/agreement” = “less satisfied/disagreement” = no difference Regression Results

© 2015 American Dental Association. All Rights Reserved. 20 Large group v. solo Large group v. small group Small group v. solo Annual Income$33,523-$1,063$34,586 Hours per week spent treating patients Hours per week spent on administrative tasks = more = less = no difference Additional Regression Results: Income and Hours

© 2015 American Dental Association. All Rights Reserved. 21 Study #2 Job Satisfaction among Dentists Varies by Type of Large Group Setting, HPI Research Brief, August 2015

© 2015 American Dental Association. All Rights Reserved. 22 Satisfaction among DMOA and DOO dentists We further examined two types of large group practices –DMOA: Those affiliated with a dental management organization (commonly known as DSOs) –DOO: Dentists owner and operated DMOA and DOO dentists were similar in likelihood to feel stressed at work, likelihood to be satisfied with the care delivered in the practice, working hours, schedules, work-life balance and clinical autonomy Some significant differences in satisfaction levels are of key interest in explaining how these categories of large group practice differ

© 2015 American Dental Association. All Rights Reserved. 23 DMOA Dentists Relative to DOO Dentists Income and HoursDMOA dentists relative to DOO dentists “Please estimate your 2012 income from your current primary practice before taxes” Make $14,809 less Hours per week spent on nonclinical tasks Spend 1.15 hours less Weekends off per month84% more likely to be satisfied

© 2015 American Dental Association. All Rights Reserved. 24 DMOA Dentists Relative to DOO Dentists Overall Feelings about DentistryDMOA dentists relative to DOO dentists “I feel emotionally drained from dentistry.” 62% more likely to say “like me” “Knowing what I know now, I would make the same decision to go into dentistry.” 35% less likely to agree “My current practice situation is what I envisioned when I chose to become a dentist.” 40% less likely to agree “Has the experience of working in your current practice changed how you feel about dentistry?” 229% more likely to say “yes, negatively”

© 2015 American Dental Association. All Rights Reserved. 25 Study #3 Very Large Dental Practices Seeing Significant Growth in Market Share, HPI Research Brief, August 2015

© 2015 American Dental Association. All Rights Reserved. 26 Market Share of Very Large Dental Practices

© 2015 American Dental Association. All Rights Reserved. 27 Dental Firms with 500+ Employees by State Percentage of Dental Establishments in the Largest Dental Firm Size Category by State, 2012 Source: U.S. Census Bureau, Statistics of U.S. Businesses. Note: Largest dental firms are those with 500 or more employees.

Quinn Dufurrena, D.D.S, J.D. Executive Director Association of Dental Support Organizations (ADSO)

Irene Marron-Tarrazzi, D.M.D., M.S. Dentist Brickell Periodontics, Miami

© 2015 American Dental Association. All Rights Reserved. 30 Q&A For more information on the ADA Health Policy Institute, please visit: ada.org/hpi To inquire about speaking engagements or custom data analytics please contact: