Ownership comes later, not never: the ADA HPI cohort data on when dentists buy in

What it says#

The Health Policy Institute's June 2025 research brief, written by Marko Vujicic and four colleagues, takes data HPI had already published by age group and re-sorts it by graduation cohort, so that each line follows one generation of dentists through its career. The headline numbers are the ones HPI leads with: as of 2023, 73 percent of dentists are practice owners, down from 85 percent in 2005. The November 2023 infographic that the brief cites puts the private-practice figures at 72.5 percent in 2023 against 84.7 percent in 2005, with male dentists moving from 88.5 to 79.9 percent and female dentists from 68.1 to 59.9 percent over the same years.

The cohort view is where the brief adds something. At 5 to 9 years out of dental school, 21 percent of the 2016-2020 graduating class were practice owners. At the same stage, 33 percent of the 2011-2015 class owned, and among the classes that graduated in 2010 or earlier the figure was 63 to 70 percent. At 10 to 14 years out the ordering holds: 58 percent for 2011-2015, 72 percent for 2006-2010, and 83 to 86 percent for the classes of 1991 through 2005.

Then the lines converge. At 15 to 19 years out, 81 percent of the 2006-2010 class were owners against 89 percent of the 1991-1995 class. At 20 to 24 years the three cohorts with data sit at 88 to 91 percent, and at 25 or more years the two oldest cohorts are both at 90 percent. HPI's reading is that the decline in ownership among young dentists is "primarily an early career phenomenon": ownership "appears to be significantly delayed for newer graduates, but eventually the vast majority of dentists become practice owners."

Gender runs through every stage. Female dentists are less likely to own than male dentists at each point, by 16 percentage points early in the career and 8 points late; in the 2016-2020 class at 5 to 9 years out the figures are 14 percent for women and 30 percent for men. HPI notes the curves have the same shape, shifted down, and that the decline in early ownership is happening among male dentists as well, so gender does not explain it.

For context the brief opens with the wider shift in practice modality from 2024 data: 27 percent of dentists less than 10 years out of school are affiliated with a DSO, up from 24 percent in 2023, against 9 percent of dentists who graduated more than 25 years ago; 15 percent of the under-10-year group are in solo practice against 48 percent of the 25-plus group. On causes, HPI is candid: 2011 is a turning point in the data and "We do not know why." It floats the opening of 15 new dental schools since 2011 as one hypothesis, says the evidence on educational debt is mixed (tuition and fees have been relatively stable after inflation), and calls work-life preferences understudied in dentistry.

Who it applies to#

The data describe dentists in private practice who told HPI they were an owner dentist, defined on the questionnaire as sole owner, partner or shareholder. That is a broad net: a dentist holding equity in a large group counts the same as a solo owner, and HPI says it cannot separate the two. The figures are population averages, weighted for nonresponse; they say nothing about any one dentist's odds.

For an associate, the relevant line is your own cohort. If you graduated after 2010, the brief says your class is buying in later than the classes before it, not that it is opting out. For an owner thinking about succession, the relevant lines are the older cohorts: nine in ten dentists from the 1990s classes still own, which is the population most sales come from.

Two limits matter when reading the newest lines. HPI has only one or two career-stage points for the classes of 2011 onward, and it explicitly cautions against extrapolating from them. And the youngest cohorts are measured earlier than the label says (3 to 7 years out for 2016-2020, 4 to 8 for 2011-2015), which HPI says makes those comparisons "not exactly apples to apples."

What changed#

HPI's earlier work, including the November 2023 infographic, cut ownership by age group and showed a steady decline: among dentists under 35, the share who are owners has nearly halved in the past decade. Read that way the trend looks like ownership going away. The cohort cut is the same survey data reorganized so each generation is followed over time, and it shows the decline concentrated in the first ten years of practice with later-career rates still in the high 80s and 90 percent range. The question the brief set out to answer, "Is practice ownership declining long term or just being delayed?", it answers as delayed, with the caveat that the newest classes have not yet reached mid-career.

The survey instrument also changed in 2023: the Survey of Dental Graduates was modified and renamed the Survey of New Dentist Practice Choices. HPI says it will keep updating the analysis as the newer cohorts age into later career stages.

Where the source is#

The research brief is a seven-page PDF on ADA.org, linked from the HPI page for the study; Table 1 on page 5 holds every number behind Figures 1 and 2, and the Data and Methods section on pages 5 and 6 defines ownership and the survey years. The November 2023 infographic is the earlier by-age analysis the brief cites as its reference 2. Both are free to download and copyrighted by the American Dental Association.