By Dr. Tod Stillson, Guest WriterWhen I graduated from residency in 1995 and entered practice as an employed doctor in a rural community, I was surprised to discover that many of my local dentist colleagues were doing financially better than most of the physicians I knew. They drove nicer cars, had more time off, owned their own office buildings, and talked more comfortably about retirement planning than any of my medical peers. It wasn’t because they were necessarily smarter or because they had chosen a more lucrative field. It was because they had built something physicians rarely do: a micro-business that worked for them instead of the other way around.
How Dentists Are Trained to Think Like Owners
I started noticing how their practices were structured differently. While most of us physicians had signed employment contracts with hospitals, the dentists owned their practices. While we were stuck battling insurance companies for prior authorizations, they were running mostly cash-based practices. They didn’t just work in their practice—they owned it. And that subtle distinction made all the difference.
Dentists are trained—culturally and structurally—to be business owners. While it’s true that more dental graduates now start out working in DSOs or established group practices, the majority still aspire to and eventually transition into ownership within the first decade of practice.
Nearly 80% graduate and quickly move into private practice, often buying into or starting their own. With greater than 30% being solo practices, they typically form a PLLC or PC, establish S-Corp taxation, and start paying themselves a salary out of their own business income. Many also buy the real estate where their practice is located, allowing them to collect rent from their own business while building equity in an appreciating asset.
In contrast, the script is flipped for doctors. Nearly 80% of physicians now choose to work for healthcare organizations with W-2 employment arrangements, where they have no business ownership, no asset creation, and minimal control over how they practice. This shift has significant implications: physicians are increasingly subject to rigid schedules, corporate oversight, and productivity quotas that prioritize volume over value. They often lack the flexibility to adjust their workflow, hire their own support staff, or innovate within their practice.
These structural constraints not only cap their income to a fixed salary but also heighten the risk of burnout. A 2024 Mayo Clinic study reported that W-2 employed physicians are significantly more likely to experience symptoms of emotional exhaustion and reduced professional fulfillment than their self-employed counterparts. In contrast, many dentists, especially those who own their practices, enjoy greater autonomy over their time, systems, and staff—which translates into more control, less stress, and better lifestyle balance.
“Some doctors still own their careers. Most have quietly handed over the keys.”
More information here:
Why More and More Dentists Are Going ‘Out of Network’ — And Why That’s Actually Good News
A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way
Salary vs. Wealth: What the Numbers Miss
As a doctor, you might think this is fine—after all, on paper, physicians often earn more in salary. According to the 2025 Medscape Compensation Report, primary care physicians average $281,000 and specialists earn about $398,000 annually, compared to general dentists who make between $180,000-$220,000. But here’s the overlooked factor:
Many dentists stack multiple income streams.
In addition to their clinical pay, they often generate revenue through practice profits, rent from personally owned office buildings, depreciation tax benefits, elective cash-pay procedures, and retail product sales. According to the American Dental Association (ADA), nearly 70% of dental practice owners report income from at least two separate sources. Over a 30-year career, this diversified approach frequently leads to greater wealth accumulation. While exact net worth comparisons vary, multiple surveys—including a 2022 ADA Retirement Readiness report—indicate that dental professionals, particularly owners, often retire earlier and with higher net assets than their physician counterparts, especially those in W-2 employment. Therefore, it’s no surprise that although doctors earn more compensation, due to the benefits of a robust business model, dentists can come out with a few million dollars more in their net worth at the end of a 30-year career.
That’s not to say dentists don’t experience burnout—they do. But ownership often gives them more levers to pull: flexible schedules, practice model control, and multiple income channels. For physicians, especially those locked into employment-only pathways, those same levers are often missing.
Systems and Scalability: Building Beyond the Dental Chair
Dentists also build scalable systems. Their practices are built around team-based care. Hygienists and assistants handle a large portion of routine work, allowing the dentist to focus on high-value tasks. If a dentist needs to be away, the office can still function. Many physicians, on the other hand, are trapped in a model where they must personally perform nearly every patient interaction. We handcuff ourselves to productivity metrics, documentation requirements, and the inability to delegate meaningfully. That makes us more vulnerable to burnout, and it certainly caps our income at the limits of our own time.
Lifestyle and Longevity: Control Makes a Difference
The ownership model gives dentists flexibility, too. They can take a week off and reschedule patients without begging an administrator for coverage. They control their workflow, hours, and staffing. Most work predictable 9-5 schedules. Meanwhile, many physicians are still charting into the night, managing call, or giving up weekends.
Perhaps the biggest differentiator is that dentists build transferable business assets. Their practices can be sold at the end of a career, usually for 5-8x EBITDA. Their buildings appreciate. Their brand has value. Physicians in employment settings leave with what they came in with: their license and a few CME credits.
A Path Forward for Physicians
Over a decade ago, I transitioned from traditional employment to a micro-business structure working as a long-term contractor. I also purchased a medical office building that I lease to the hospital that hired me as a contractor. I took this page from the dental playbook, and the results have been remarkable. I’ve spent the last few years helping physicians realize that they, too, can structure their careers differently. You don’t have to be a dentist to build a micro-business. You can practice as an independent contractor, form a professional entity, lease your own space, and job-stack in a way that maximizes your flexibility, autonomy, and income.
Telehealth, concierge medicine, direct primary care, cash-only specialty services, expert witness work, medical consulting, and both long and short-term independent contracting are all viable paths.
Most importantly, physicians need to start seeing themselves as more than employees. We are valuable, not just for the work we do but for the businesses we can build around our expertise. Dentists figured this out long ago. Doctors used to understand this, and it’s time for doctors to pivot back toward this model again.
The answer isn’t quitting medicine or burning it all down. It’s about reframing your identity from worker to owner, from technician to entrepreneur, from salary-earner to wealth-builder. I believe the physician of the future won’t just wear a stethoscope. They’ll also wear the mindset of a founder.
I’ve come to admire the dentist business model, not because I want to be one but because I believe it provides a roadmap for reclaiming autonomy in healthcare. If more doctors embraced the micro-business mindset, we could transform our own financial lives and the culture of medicine itself.
More information here:
How Can I Make My Terrible Doctor Job Less Terrible?: Auntie Marge Explains It All
5 Practical Recommendations for Doctors
- Form a micro-corporation: Create a PLLC or PC with S-Corp election to separate your personal and professional finances and to unlock tax advantages.
- Pursue 1099 work as a core or side strategy: Whether it’s full-time locums; employment-lite; or a mix of moonlighting, telehealth, and consulting, 1099 work offers time control, income flexibility, and the ability to job-stack through your micro-corporation.
- Acquire or lease office space: Consider owning your practice location to build equity and take advantage of real estate depreciation.
- Diversify income streams: Explore medical directorships, call coverage, consulting, telehealth, content creation, expert witnessing, or niche cash-pay services.
- Think like an owner: Begin viewing every clinical encounter, system, and patient relationship through the lens of business ownership, scalability, and autonomy.
So, the next time you drive by your local dental office, don’t just see a clean smile business. See a blueprint for how to take control of your career.
What do you think? Do you think the dental model can make you more money than the current physician employment model? How else could you increase your income as an employed physician?
How much of a typical general dentist’s practice is cash pay?
Problem for doctors is that for most of us, even when we work for ourselves, our income is highly dependent on the whims of government or private insurance.
I agree. Dental health is considered a luxury. Primary and much of specialty care is not.
I am sure this article with have a response from regular WCI Dentist writers.
I will give my 2 cents here as a Dentist. We are forced to be better business people (in general) than our medical colleagues:
Yearly maximum benefits for dental insurance have not change since 1980s, $1000-1500 per calendar year that includes preventive visits on those benefits. It is not much if patient needs anything else short of preventive visits.
We all know eating habits and diet of population we both treat, almost everybody needs further treatment outside preventive care.
So, if we want to be paid for treatment rendered we are forced to know what insurance pays before hand and understand brakedowns very well as there are limited dollars to work with, financing options for patient (three different ones in our office), in office payment plans etc.
We do not have access to Hospital retirement plans, so we are forced to get educated on options and what it would cost us to go with different plans.
We are our own HR – we hire, fire and train.
We have to make sure our offices are in compliance with OSHA, HIPPA – yearly compliance training and walk through of the offices etc.
List can go on and on…
To not make it too long to read, it is out of necessity that we are better in business side. None of this is taught in Dental School.
Fantastic elaboration. This, plus this article, should be required reading for all with an eye towards a career in medicine or healthcare in general. When you are young, it doesn’t make any sense. As you grow older (esp. at my age), the lessons are obvious—in hindsight. By understanding multiple streams of income, doctors can learn what it will do for them and how it will help manage burn out.
Great post. Thank you for writing it. This part could not be more true:
“Many physicians, on the other hand, are trapped in a model where they must personally perform nearly every patient interaction. We handcuff ourselves to productivity metrics, documentation requirements, and the inability to delegate meaningfully. ”
Postoperative patients can show up in the ER anytime. Depending on your practice setup this makes going out of town difficult.
Great article.
I am an MD and hang out with a bunch of dentists. Honestly, they have taught me a whole lot more than the fellow “MD/DO” group.
Dentists always think in terms of ownership. billing, cash flow, investment, and, MOST IMPORTANTLY, RETIREMENT. Even though their field is now over 50% private equity owned, they still tend to think along these routes. Unfortunately, most “doctors” don’t and have much less financial literacy compared to an average dentist.
I am an employed dentist in Australia.
Dentistry is becoming more and more commoditised. There is so much over-servicing in dentistry. Owners place pressure on to employee/contracted dentists to bill more and more. Some owners still cry poor because profits are not as high as what it has been in the past (20%+ of gross billings).
Needing to do “high-value” treatment (higher $/hr) work to be “more successful” is nothing to aspire to. High-value treatments are inevitably more aggressive (remove more of the tooth or entire teeth followed by multiple implants in some cases) and will often lead to poorer outcomes long-term. While being cognisant of business factors, patients’ best interest must come before profits (and that isn’t always the case).
Agree passive income (and the WCI philosophy) is critical. I do dentistry because I enjoy the work and not because I have to.
Great article. I am a podiatrist that owns my own practice. Podiatrist are also subject to large equity groups, unfortunately, I felt like this article was describing me, except for the part of owning my own building. I wishlol. When you own your own shop, you’re forced to work smarter, not harder. I unintentionally became a business owner, but it is the best thing that could’ve happened to me financially. I was an employee for a long time, frustrated. I had to plan my vacation after everyone else. Then, when I became a business owner, I was jealous of people like my sister, who is an academic medicine, who gets paid to go on vacation. But I think I would choose the self-employed model, mostly because of the flexibility and autonomy you just cannot find as a W-2 employee.
The dental fee for service model is unfortunately a small niche. It may still work for very high end or very rural practices where competition is non existent
I support direct primary care by think it will similarly be niche as a majority of patients are locked into a mindset that they should have minimal out of pocket expenses and want to rely on insurance primarily. Being an out of network provider is tough competitively. You have to be truly great and able to communicate that well to get patients in.
While I generally agree with most of the article, as others have pointed out I think the picture of private dental practice is painted a bit too rosy.
Private equity is capitalizing on the fact that most new graduates are drowning in debt, and are thus much more likely to take a W-2 job that pays more in the short term but not the long term. I know former fellow classmates who are finding it very difficult to find someone to sell their practice to.
The statement that the practice keeps making money even when you’re out of the office is only true if you have another dentist there as your associate. No care can be legally provided by hygienists or assistants without a dentist in the office.
While as an employed anesthesiologist I was often envious of my dental classmates’ flexibility in scheduling time off, it is also true that many of them (especially in the first couple of decades of practice) took a lot less total time off both due to the loss of income from the doors being closed and also the fact that the bills (rent, utilities, lab bills, salaries) don’t stop just because you’re on vacation.
Dentistry is semi-elective, and thus very susceptible to market forces (as well as forced closure for months during pandemics). Imagine everything being at risk because of a factor totally beyond your control.
Many people also don’t value the care provided very much, and expect that “insurance will take care of all of it”, when that is the furthest thing from the truth. They will complain about paying $50 for a filling while driving up to the office in a Cadillac.
Buying a dental practice is expensive, as well as building your own practice. I worked to start to build a “practice within a practice” my first three years out of dental school. I did not have to put any money down and got some “overflow” patients from the dentist I was associated with. Even with this arrangement I made about the same as an intern the first year and about the same as a fourth year resident the third year. If I bought into the practice I would have continued to gradually grow into a “real” salary. The owner always gets paid last.
But while very exacting, tedious and stressful, dentistry can also be very rewarding, both professionally and personally. Private equity has come to dentistry later, so perhaps dentists can learn from the catastrophe that private equity has wrought on medicine as a whole to put up roadblocks to block PE from destroying it.
There are many advantages that having “the owner mentality” affords one as a physician, but it’s not all roses.
Start in medical school with who is teaching the med students. Essentially 100% of the teaching faculty and 90% of the adjunct faculty are employed physicians. Those individuals largely could never make it in the business of medicine and they teach their students “ it’s too hard to work for yourself— carry someone else’s golf bag”. Horrible role models for self employment.
Should we have businessmen and women teaching high school too?
There’s a reason those with an academic focus do the teaching, but I agree a little more business and finance training during school would be useful.
article conveniently ignores the fact that physician “owners” are becoming nonexistent not because physicians are not trained to be owners any less than dentists, but due to the disparity in insurance reimbursements that large hospital systems can secure versus small practices. It has become impossible for physician owners to be able to recruit new graduates and offer them the salary that large hospital systems can. Plus, the “meaningful use” EHR requirements from Medicare are so onerous that is impossible for an individual owner to afford and demonstrate that they are “meaningfully” using their EHR to Medicare. More than 50% of the US population relies on some form of government insurance (Medicare, Medicaid, The V.A., Tricare etc), so there are not enough wealthy people to provide a population to support more cash-based physicians practices like “concierge” services and cosmetic surgery that these white coat investors think will be a pancea