The career path of an orthodontist is changing. As millennial orthodontists enter the work force and the Gen Zers enter dental school, they are carving out a new career trajectory that speaks to their economic and social needs.

Every year, I have the pleasure of speaking with hundreds of orthodontic residents as they begin to plan their future careers in the orthodontic industry. And over the last 5 years, I have seen new trends and career paths emerge as these two cohorts make their way into the profession. Perfectly capturing these trends is our latest Orthodontic Resident Survey. Bentson Copple & Associates publishes this annual survey, which includes over 400 respondents from 63 programs, to provide data about resident training and career plans upon graduation. Of the residents surveyed in 2016, 12% completed their residency in 2016, 34% will complete their residency in 2017, 40% in 2018, and 13% in 2019.

When I began working with residents in years ago, many had the dream of owning a traditional private practice in a community. While many residents still desire private practice ownership, a variety of factors have influenced a shift away from ownership and toward employment. The most significant of these factors is student debt. According to the ADA, the average dental resident graduates with $250,000 in student loans. An orthodontic resident can easily accumulate an additional $150,000 to $200,000 in student debt putting them over $400,000 in total student debt (68% of surveyed orthodontic residents state they will accrue over $200,000 in student debt during their orthodontic residency alone).


Unfortunately, student debt has made an impact on residents’ ability and desire to purchase a practice. In our 2014 resident survey, 56% of residents indicated that their first choice was to purchase a practice after residency while 28% stated they desired to work as employees. However, in 2015 we saw a near complete reversal in these numbers with 54% of residents stating they were seeking employment while only 29% were seeking to purchase a practice. In 2016 the number of residents seeking ownership dropped again to 26% with those seeking employment rising again to 57%. Student debt is the primary factor deterring residents from obtaining the financing needed to purchase a practice and is part of the reason they are searching for associate or employee opportunities.

With the rise of Dental Service Organizations (DSOs), we will continue to see a shift in the thinking of residents away from ownership and toward employment. DSOs offer residents employment models with high salaries, good benefits, mentorship from senior/fellow orthodontists, and an attractive work-life balance.

The data from our resident survey showed that flexibility and predictability were the most important factors when choosing to specialize in orthodontics. Young doctors have a strong desire to strike a healthy balance between their work and their home life. DSOs often make this an attractive piece of their sales pitch for employees stating that they will handle the business of running the orthodontic practice while the orthodontist focuses exclusively on being a clinician. According to the ADA survey on large group practices, practitioners were most satisfied with weekends off and less hours spent on nonclinical aspects of being an orthodontist.

Another factor making an impact on the shift from ownership toward employment is the rise of female practitioners. According to the AAO, female orthodontic student members are rising at a rapid rate. While only 38% of practicing orthodontists are female, a whopping 49% of all AAO student members are female. Research indicates that females are more likely to pursue associate or partnership opportunities than practice ownership. These types of opportunities allow them more time to focus on family commitments rather than the administrative duties and stresses of practice ownership, which can often lead to burn-out.

As we see this shift among residents toward an associate or employee model and away from ownership, it is important to identify what is most important to them when seeking an associate or employee position. According to the Intelligence Group studies, 54% of millennials say it is a priority for them to make the world a better place, 79% want their boss to serve as a mentor/coach, 88% desire a collaborative work-culture rather than a competitive one, 74% want flexible work schedules, and 88% desire “work-life integration,” which is not the same as the term work-life balance since work and life now blend together intricately.

Just as in previous generations, money is the number one motivator for a young doctor saddled with student debt, but they also put a strong emphasis on a career that allows them work flexibility and skill acquisition. A survey recently published indicates that healthcare, family and vacation leave, tuition reimbursement, and retirement benefits are important factors when identifying career opportunities. Ultimately, millennial doctors want to know that their employer will take care of them. Millennials also have a strong desire for doctor-to-doctor mentorship and high-level engagement with their peers. Having a mentor and someone who understands that they will ask questions and seek guidance as they begin their career is extremely important to them. They also desire to practice in a culture that will invest in their development allowing them opportunities to advance, learn, and grow.

The new millennial orthodontists could redefine what a career in orthodontics looks like with their desire to practice in a team or group-based environment, how they measure success, and their desire to make an impact on a community. Their professional goals might mimic those of an employee physician model and we could see them aligning more with companies and employers versus building a private practice. According to the 2017 Healthcare Trends by Inventive Health Communications, only 14% of millennial doctors prefer to learn independently. The majority prefer learning about new treatment options (52%) with peers or partners.  Studies show that millennials want a high level of well-being. This term not only encompasses physical health but also a desire to lead a purposeful life, to be active in their communities, and to be financially secure.

The current generation of orthodontists coming out of residency face steeper competition than previous generations due to market saturation, including GPs and pediatric dentists practicing orthodontics, and many will worry about income potential as they are employed under a “pay for performance model.” However, they are more than ready to face the challenges in their careers due to their desire to make an impact on their communities and a difference in the world. They are looking for opportunities to invest in a place where they can make a difference! OP


ShannonPatterson_BWShannon Patterson, CPR, CMSR, is the director of practice opportunities and an orthodontic placement specialist at Bentson Copple & Associates. She is a recruitment leader in the orthodontic industry specializing in placement and retention. A Kolbe Certified Consultant and expert in the Kolbe suite of assessments for selection of the ideal candidate match specializing in strength-based relationships for both doctors, she believes great clients deserve great candidates and great candidates deserve great opportunities.