Name: Mitra Waite, DMD/PhD
Profession: General Dentist
Do many dentists work as contractors?
The short answer is no. What we’ve seen in the past is that dentists either own their own practice or they associate with a dentist in hopes of eventually buying that practice. For a dentist to be an independent contractor, we have to have a skill that is not offered by the owning dentist, and be able to provide our own staff and equipment. Most associates use the owning dentist’s staff and equipment, and generally provide the same treatments. Dentists who seek out additional schooling in the form of a residency to specialize in something more advanced (like challenging root canals or orthodontics) are typically the ones we see contracting work. They may contract with a few different offices to provide specialty care several times a month. The injectables industry has changed that. Many dentists see a therapeutic and esthetic value in offering injectables. If they don’t want to go through training or the hassle of keeping up with an inventory of products on their own, they may contract with a dentist who provides that treatment.
How long have you been a dentist?
I am going into my fifth year of practice. I started dabbling in injectables (like Botox) in my third year, which is something I knew nothing about until I started training. Some people are surprised to hear about a dentist offering injectables, but dentists are heavily trained in facial anatomy and esthetics, and give injections all day long. There are also a lot of therapeutic benefits to Botox dealing with the mouth (like addressing clenching and grinding), so offering this treatment made sense. I have found it to be the lighter side of practice… the part where my patients are excited to return for treatment, and actually enjoy getting stuck by needles!
Is your injectables business a separate entity from dentistry?
No. Each state has a dental board that will define the laws for how (if at all) dentists can practice injectables. In my state, our board recently further defined its opinion that dentists can only provide injectables in the dental office and as a part of regular dental practice. That may not be the case in every state.
What are the benefits of working as an independent contractor in dentistry?
Setting your own hours and expectations. Dentistry can be demanding. I know – that sounds crazy. When I initially decided to be a dentist, I thought I would be able to set my own hours and leave whenever I wanted. I thought I would just not see patients after 3pm if that’s what I wanted to do! And, you may be able to work that out with some employers, depending on their goals for their practice. Ultimately, dentistry is just a regular job. If you are employed, you are expected to produce for the practice. If you own your practice, you want to be present to produce as well. It’s just like any other business. Oftentimes that means working through lunch or staying late. Of course, we don’t just do that for the financial aspect. We have emergency patients walk in daily, or patients whose treatment changes or for whatever reason the procedure just takes longer, so you stay because it is the right thing for the patient. The benefit of contracting your work is that you really can set your own hours. You have flexibility in determining how many days or hours you want to work. If you are employed as an associate and the owning dentist suddenly wants to change the hours or be open 5 days a week instead of 4, you will be expected to shift with those changes as well.
Are there any drawbacks?
Typically, the biggest drawback for independent contractors is the lack of benefits. Since dental offices are very small businesses, most do not offer benefits, even if you are an employee. The drawback to being an independent contractor in dentistry is just like that of most other occupations. You have to hustle, and the work is not always steady. If you contract with 4 dental offices a week and you lose one, you’re probably out a good bit of anticipated income. So, you have to find a way to get that back. Paying the self-employment tax is not fun either.
Is working in an independent contractor position something you’d anticipated before graduating?
No. I put very little thought into the whole employment process, actually. In my head, I would get a job and that would be that. Honestly, I didn’t even know what an independent contractor was when I graduated. I don’t think I really grasped what it was until after I was already doing it. Sometimes life just takes you in these directions and you figure it out later.
What advice do you have for other contractors?
First, be fair to those you contract with and be fair to yourself. What we are doing here is making connections that will always end up somewhere. Good or bad, fast or slow, word of mouth will happen. If you are just starting out, anticipate that your rate will change as you gain experience and clientele, and keep that in mind when negotiating contracts. Look at the relationship from both sides. Remove yourself from the equation and put a friend in your spot. What would you want for your friend? If you were the person contracting with you, what would you want?
Secondly, remember that life ebbs and flows. Some months, you will be incredibly busy. Other months may be quieter. During busy months, be grateful, and save to cover the slower months. When it’s slower, don’t doubt yourself.
Third and last advice: get a good accountant and keep track of all your expenses. Learn what you can write off. Self-employment taxes can take an additional 15% out of your pocket. Don’t spend the money you already owe! Save along the way.
As you know, most independent contractors pay out of pocket for dental work. Do you have any advice for people navigating this system?
Yes! This is such a great question. My best advice is to call around and find a dental office that has an in-house plan. Lots of dental offices have started offering them. Basically, it works exactly like insurance does. If you anticipate needing extensive work and if you have a good relationship with your credit, consider Care Credit. It’s a credit card taken at various healthcare offices – even some veterinarian offices. If you end up needing treatment, this can come in really handy. Be sure to ask your dental home if they take it before starting the process.
I’ve also noticed people become afraid of what they might find out at the dentist if they haven’t been in a while, and that can deter people from making an appointment. I’m guilty of avoidance too (when was the last time I got on a scale??). Make the appointment. Get the exam. I promise it’s better to know sooner rather than later. The worse a tooth gets, the more expensive the treatment becomes. So don’t skip the 6-month exam and cleaning.
My last bit of advice is just to stay on top of your oral care at home. While I can never condone missing a dental check-up, it happens. Covid, finances, forgetfulness, depression, work… the list goes on as far as what keeps us away. Brush twice daily (two minutes each time), get a new toothbrush when the tips of your bristles turn white, floss daily and watch your diet. Without a solid home care routine, any work done at a dentist will just be undone anyway.