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A long-time dentist—the first woman to own a solo practice in the Roanoke Valley—looks back on the significant and ongoing changes to every facet of the profession, reaching back to the days when dentists didn’t wear gloves. And didn’t use computers. And were all male.
I did not wear gloves.
But then when I started my dental career in 1983, nobody did.
When I recently told that to a group of young dentists, they looked at me with absolute horror. I understood completely, and it made me feel ancient.
I graduated from Medical College of Virginia Dental School in 1981 and at that time we wore gloves only in the surgery clinic when performing extractions.
But then it’s all sort of relative: When I was a young dentist, the old guys (and they were all guys) talked about having mixed silver filling by hand. That meant handling the mercury and alloy in their bare hands.
And they treated patients while standing up and with no assistants. Xrays were developed by dipping them into a tank of chemicals and hanging them up to dry.
As part of my talk to the young group I asked them to imagine themselves at the end of their careers and what they might be telling a young group. What they think is modern now could seem so quaint in 30 years.
As with so many fields, technology has changed the way dentistry is performed every day. Computers came in to my practice in the early ‘90s. At first we used them for the business side. Appointment scheduling programs were soon added. Now all patient records can be digital.
Today’s offices have digital X-rays which are immediately available to read on the computer. Impressions of the teeth to make models are done digitally. You scan the teeth and then can order a model of the arch of teeth. You can even bypass the models and directly make the crown for a tooth from the scanned digital file with a milling machine. 3D printers are being developed to make dentures.
Mini CAT scans are available in the office to see the whole oral system for diagnosis. Implants are used to replace teeth or provide support for dentures. Dental materials have improved especially for bonding restorations directly to teeth. Teeth can be fixed with resins that mimic tooth color and provide strength for long-lasting results. Porcelain-like materials give crowns a natural appearance. Less metal is being used in the mouth due to these advances.
We now look at the total health of our patients. We now know periodontal disease affects diabetes and heart disease. In all, amazing changes and progress over the past 35 years.
I bought the practice of Dr. John Mingledorff when I returned to Roanoke in 1983. He had been in practice for 42 years. His office space was 200 square feet, located on Crystal Spring Avenue. There were two treatment rooms and a tiny waiting room. Patients sat with their knees practically touching each other. There was no private office or lunch room.
The equipment was from the 1950s but it worked and I used it. He was very kind and generous during our discussions about taking over the practice. I had completed a hospital-based General Dentistry Residency program in Baltimore.
We wondered if being a woman would be a problem for his patients. Dr. Lynn Robinson was a classmate in dental school and came back to Roanoke to join her father’s practice. She was the first woman to practice in Roanoke. I would be the first woman to be in practice by herself.
As I found out, being a woman was not a big issue. Being young was the problem. I didn’t just look like their daughter; I looked like their grand-daughter. Many of Dr. Mingledorff’s patients were of his generation. The bank wanted my father to co-sign the business loan. I left the banker’s office absolutely sure I was not going to do that. How dare he think I wasn’t going to be successful! I was naïve in the ways of business.
I ended up working with an accountant who developed a business plan that was acceptable and I got the loan on my own. Prime interest rate was a little over 20 percent at the time. I could only afford to pay back interest for the first 12 months.
I had wanted to be a dentist since about 10th grade, when I attended a career day with some seniors I looked up to. We went to the VWCC Dental program for assistants and hygienists. It occurred to me that I wanted to be in this field and I wanted to be the boss.
My parents put a great deal of value on education. I am one of six children. My father was middle management with N&W. We came from St. Louis in 1966 when the Wabash Railroad merged with Norfolk & Western Railway. My mother was a homemaker. How they managed to send us all to Roanoke Catholic School, I will never understand. I know my parents made tremendous sacrifices for our education. They instilled a strong work ethic. I knew I could do anything I wanted. I never doubted I could be successful.
I had no role model of a woman dentist who owned her own practice. Dr. Mingledorff and I sent out a letter to his patients introducing me. He encouraged them to call and make appointments. Patients did call! They called to make their regular six-month appointments.
In those first months, I saw maybe one to three patients a day. I usually had a patient at 8 a.m. and then not another until 3 p.m. In between I read journals and text books and drank coffee. I had only one employee. Slowly we built the practice.
No one advertised at that time. The growth was all word-of-mouth. I had many patients who worked at Roanoke Memorial Hospital (now Carilion). Dr. Bud Conklin, the founder of the Carilion Care Clinic, was a mentor. Since I had completed a hospital residency, he was comfortable sending me patients with special needs. These were patients who had complex medical conditions or who may have completed therapy for head and neck cancers.
I added another assistant in the second year and began to plan a move to a larger office. In 1989, I moved just two doors down to the corner of Crystal Spring Avenue and McClanahan. The new space gave me room to expand and update the equipment. I had a dental hygienist join the staff. As I continued to gain experience with the technical side of dentistry,
I soon realized that as dentists we are not trained to be business managers. I had not a clue about how to run a business. I had basic help with my accounting but again, not a clue on how to be a boss. Managing a growing staff was the challenge. As a practice owner we wear all of the hats. We are the chief provider of services, the HR department, equipment manager and quite often the maintenance staff. Every dentist I know who has built a practice has probably scrubbed a toilet at some time—with gloves on of course. Taking continuing education courses on management matters became as important as taking courses on new materials and techniques.
I attended the Roanoke Valley Dental Society monthly meetings. This organization has been around since the 1950s and provides a community for local dentists to get together to learn. Face-to-face meetings were valuable to develop relationships with colleagues. I believe that this is something that cannot be replaced with the online groups of today. I remember attending my first meeting and being the only woman present. When I introduced myself to a truly lovely wife of a veteran dentist, she greeted me and said “and your husband is…?”
After clearing that up, I found the group to be completely open and supportive. At our last meeting I noticed there were as many women as men in attendance.
Which brings me to a major demographic shift in dentistry. According to the ADA, in 1980 less than 1 percent of practicing dentists were female. In Virginia that number has grown to 32 percent. Dental schools are almost 50/50 in gender split.
In 1983, there were just Dr. Robinson and myself. Now there are over 30 women dentists in the Roanoke Valley area. Of all practicing female dentists, 56 percent are under the age of 45. Some of these women have their own practices and some have joined a group practice.
In the 1980s, the Valley had two group practices. One was located in Salem and one in Roanoke. Everyone else was in a solo practice. In Virginia at present, 67 percent of dentists are in solo practice. Twenty percent are in group practices. The rest work in education facilities, hospital-based clinics or government-supported clinics.
There has been an evolution towards multiple doctor practices. The primary advantage is shared overhead costs. The other and just as important advantage is having more contact with a colleague. Dentists who work alone can have a sense of isolation. Having someone you can discuss patient and staff issues with is helpful.
What drives many new dentists towards the group practice model is student debt. I came out of school with a debt that at the time seemed huge. But it is a fraction of what these students are now facing. According to the ADA, the average dentist graduates with debt between $250,000 and $400,000.
Add to that at least the same amount to start or purchase a practice, and the challenge is huge. Many starting dentists need to be in an employment situation to tackle the debt. Of dentists who have graduated in the past 10 years, 44 percent are employees. Those who have the desire to own their practice can find available practices to buy. The baby boomers are getting ready to retire. Today, 52 percent of male dentists are over 55 years old.
Besides size of practice, another choice a dentist can make is style of practice—how many patients a day to see and what procedures to offer. There is the choice of what insurance plans to accept or whether to accept any at all. Practice styles generally fall into high-volume, insurance-based practices or low-volume fee-for-service practices. There are pros and cons to each style and a dentist may decide based on business goals and the dentist’s own temperament.
What makes us different from the medical model is this practice choice. Almost gone are the independent physicians. Aren’t most working for the large medical corporations? Are they happy? I heard from several physicians of my generation who are not. They started out in medicine with the vision of being independent but that reality doesn’t exist anymore. There is a trend of physicians’ children going to dental school. I don’t have any facts to back that up but I see it happening. I enjoyed the independence of being the practice owner.
And I should mention that last year I sold my practice to Dr. Anne Newman, who is both a perfect example of the new wave of young dentists coming to the area, and an exception to the non-ownership trend. She was able to pursue the practice purchase after working at a large dental office for a few years.
I hope I was as much a help to her in the transition as John Mingledorff was to me back in ‘83.
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