Monday, February 14, 2005

Dentists Take Earnings Crown

The DesMoines Register reports that dentist income surpasses that of some physicians - family practice, internal medicine, pediatric/adolescent medicine and psychiatry.

Dentist has plenty to smile about: Dr. Steffany Mohan, a dentist, and Dr. Michael Mohan, a general surgeon, work in different medical fields. Steffany enjoys more time at home with their children Halle, 18 months, Luke, 5, and Camaryn, 4, and also earns more.

Spending the day at home is standard for Mohan , a dentist, who has every Wednesday off. The mid-week break is a luxury that her husband, Dr. Michael Mohan , a general surgeon, doesn't share.

The disparity in work hours between the two parents and health care professionals is just one of several distinct differences that distinguish Steffany Mohan's life as a dentist and Michael Mohan's as a surgeon.

Steffany, 33, works about 3 1/2 days a week and is regularly home in time to make dinner for the kids: Halle, Luke , 5, and Camaryn , 4.

Spending the day at home is standard for Mohan , a dentist, who has every Wednesday off. The mid-week break is a luxury that her husband, Dr. Michael Mohan , a general surgeon, doesn't share.

The disparity in work hours between the two parents and health care professionals is just one of several distinct differences that distinguish Steffany Mohan's life as a dentist and Michael Mohan's as a surgeon.

Steffany, 33, works about 3 1/2 days a week and is regularly home in time to make dinner for the kids: Halle, Luke , 5, and Camaryn , 4.

Michael, 37, works at least 60 hours per week - twice the time his wife works. He is also on-call for a 24-hour period once a week, and he works a 72-hour weekend shift every six weeks.

Take into account that Steffany makes more money per hour than her husband, and the comparison of their practices becomes even more dramatic.

If Steffany worked as many hours as Michael, the couple agree that her annual pay would surpass his. She has been in practice for nine years and co-owns the Methodist Plaza Dental Group in Des Moines.

"If she worked as many hours as I do, it's virtually certain she would make more than I do," said Michael Mohan, who is with the Iowa Clinic.

According to the most available and comparable national data from 2001, dentists made more money than several types of physicians, including those in family practice, internal medicine, pediatric/adolescent medicine and psychiatry.

Independent general dentists reported an annual average income of $173,140. That surpassed the amount physicians in several different specialities were paid - $146,601 for those in family practice (without obstetrics); $149,720 for internal medicine; $150,222 for pediatric/adolescent medicine; and $157,509 for psychiatrists.

Although not consistent with the Mohans' situation, the national data showed that the pay for general surgeons continued to outpace that of independent, general dentists by a considerable amount - more than $84,000 in 2001.
Information on dentists from the American Dental Association looked at annual average income; information about physicians from the Medical Group Management Association used the median, or 50th percentile.

The data used different measurements, but researcher Roger Tracy at the University of Iowa College of Medicine said it's a fair comparison to look at average and median income figures. Most of the time, in a group of numbers, they are not far apart, he said.

Shorter workdays
Beyond the higher financial rewards that dentists may reap are the lifestyle luxuries that other types of physicians may not have - shorter workdays, flexible schedules, regular days off during the week, no mandatory call on weekends and less likelihood of urgent patient emergencies.

The difference in schedules is clear in the Mohan household. While both parents start their workdays early, it's more of a guess as to when Michael's work day will end. Depending on the day, he said, he'll get home between 5 and 7 p.m.

Michael's long days and unpredictable schedule give him less time with their children. While he has always wanted to be a doctor, he said he is envious of his wife's predictable work schedule.

"If I get home at 7, then I only have an hour with them," before they go to bed, Michael said.

Steffany, whose family encouraged her to go into dentistry because of its flexible and family-friendly work structure, said she has no regrets about choosing dentistry over medical school.

"No matter what you do, if you have kids and you're a woman, you're still a mom," said Steffany, who takes advantage of her Wednesdays off by catching up at home while taking care of Halle.

"Unless you have a dad who is super, super involved, moms tend to run the house and take care of the kids' needs. My husband is a phenomenal dad, but he really doesn't know what goes on around here. He doesn't know the kids' routines and what's coming up."

Consumer demand
One factor in the financial success of dentists is the increasing consumer demand for sparkling white teeth. The trend has been fueled by smile transformations performed on shows like "Extreme Makeover" and the willingness of patients to pay cash out-of-pocket for expensive cosmetic procedures such as teeth whitening and porcelain veneers.

The addition of these aesthetic services has changed general dentistry, said Roger Tracy, with the University of Iowa.

"That has added a whole line of products in dentistry that may have indeed increased the production of dentists," Tracy said.

Steffany Mohan recently attended a conference in Las Vegas and listened to "Extreme Makeover's" resident dentist, Dr. William Dorfman, speak.

"We do a lot more cosmetic stuff than we used to do," Mohan said. "I think people are more aware of their health and think a white smile is a healthy smile."

Pretty teeth come at a price. Zoom whitening, which costs between $400 to $500, is done in the dentist's office and uses a special light to whiten teeth in 11/2 to two hours, Mohan said.

Another popular request is porcelain veneers, costing $900 per tooth. The porcelain is bonded to the tooth, and patients usually have four, six or eight teeth done at a time, she said.

A smile makeover can change someone's life, said Mohan, who has had patients cry and hug her after the procedure.

In the field of cosmetic dentistry much of the work is fee-for-service, said Dr. Robert Margeas , a dentist with the Iowa Dental Group in Des Moines.

That's definitely helped his bottom line, he said. Over the last decade, his practice has found a niche in cosmetic dentistry. Currently, 70 percent of his procedures are cosmetic, said Margeas , who has been in practice since 1986.

He said demand for cosmetic dentistry is so great that last October he opened an educational center in Des Moines to teach other Iowa dentists the latest techniques.

While he won't talk specifics, Margeas, 44 , said his annual income over the last several years has "been on the increase every year."

Insurance issues
Dentists have been somewhat shielded from the insurance and reimbursement issues facing physicians in other areas of medicine. Margeas, who has friends in internal medicine and family practice, said those physicians are dealing with lower reimbursements for their services than what most dentists see from their patients.

"Most of them are complaining about the bureaucracy of the billing," not their income, Margeas said. "They're having to write off more of their fee than what they used to."

In medicine, prices are set by the government and insurance companies, Michael Mohan said.

"Effectively every year, I take a pay cut because the fee-schedule reimbursement doesn't change with the overhead costs," he said. Being part of a large medical group helps decrease the overhead costs.

Steffany Mohan is involved with the administrative, or business, aspect of her medical practice more than her husband.

"We take practice management courses in school," said Steffany, who graduated from the University of Iowa College of Dentistry. "I think the assumption is that almost every dentist is probably going to own their own practice at some point."

"If there is a (insurance) plan that doesn't pay you enough to meet your costs, you can't take it."

Margeas said the downside of dental insurance is the cost of dentistry outpacing coverage.

Longtime dentist Dr. Jerry Harvey agrees. Thirty-five years ago, it cost $75 to make a crown. A one-year dental insurance plan offered $750 in total patient coverage, he said.

Crowns now cost $800, Harvey said, but annual coverage has increased to just $1,000.
Another difference between Steffany Mohan's practice and her husband's is the cost of malpractice insurance.

"Our malpractice insurance isn't too bad," Steffany said. But "it's literally a fraction" of what her husband pays.

Dr. Eden Murad , a family practice physician with Mercy/Mayo Family Medicine Clinic in Des Moines, also pointed to geographic differences in pay among physicians.

Family physicians working in rural areas tend to make more money because of the higher volume of patients and fewer number of physicians servicing those areas, said Murad , who has worked in small towns. He also said that doctors on the West Coast make less than those in the Midwest.

Physicians who own their own practices have incomes comparable to dentists, he said.

"Often being part of a group is safer," he said. "There is safety in numbers among physicians."

Successful dentists, regardless of where they live, are those who understand their clientele and can give them what they want, said Amy Morgan, CEO and owner of Pride Institute, a national dental practice management company based in California. There's also been a broader awareness among dentists about customer service - from patient interaction to coffee and muffins in the waiting room.

"It has to do with how connected you are to your business," said Morgan, who has been a consultant in the dental industry for more than 20 years.

More women now gravitate to dentistry because they can set their own work hours, Morgan said.

"Women are attracted to dentistry because it's one of the few careers that can honestly be customized to their other roles, such as wife and mother," Morgan said.

While both Michael and Steffany Mohan say they love the medical fields they've chosen, Michael said there are particularly rough days at work when he wouldn't mind working on teeth for a living.

"We (he and his wife) joke around once in a while that if there were a dental school in Des Moines, I'd go back and do that," he said.

College of Dentistry

University of Iowa College of Dentistry. Number of applicants, enrollment.


1995 1,047 73

1996 1,037 75

1997 1,146 75

1998 1,102 75

1999 982 75

2000 816 75

2001 772 74

2002 688 76

2003 644 77

2004 760 77

2005 853 76*

College of Medicine

University of Iowa College of Medicine. Number of applicants, enrollment and graduates per year.

According to the college, the decreasing class size over the years was due to the college revising its curriculum in 1995 to focus on slightly smaller class sizes for a better educational experience for students.



1995 3,513 175 154

1996 2,727 175 166

1997 2,406 175 169

1998 2,556 175 175

1999 2,487 157 162

2000 2,388 157 160

2001 2,478 150 181

2002 2,345 142 165

2003 2,326 142 145

2004 2,294 142 131


And we have a better lifestyle too!

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