Insurance Primer for New Graduates: Keeping It Legal

  • by Richard C. Engar, DDS, FAGD
  • May 16, 2023
New graduates face several necessary decisions as far as practice protocols, licensing and more. Whether you are working for a large group practice or as an associate, decisions about insurance and licensing issues have to be made. Rarely does a new dentist open a private practice from scratch in this day and age, with school expenses such as loan payments due, but there are some things that the new dentist must face in the future that require decisions. 

This section provides the basics on necessary coverage with regard to insurance and licensing. It will also cover a few other matters that new graduates must understand as far as state or provincial practice act provisions. 

Personal Insurance Requirements 

1. Malpractice insurance. All dentists must carry professional liability (malpractice) insurance. With very few exceptions, these policies are written on individual bases, and everyone in a group practice must hold their own policy. There are two basic types of policy. One is called “occurrence form,” which means that coverage has to be in place at the time the claimed event took place, but coverage does not have to be in place at the time the claim is made by the patient if the dentist leaves the practice, for example. This coverage is more expensive, however. The other type of policy is called “claims made form,” which means that coverage must be in place at the time the claimed event took place and at the time the claim is made by the patient, even if the dentist has left the practice. Therefore, you have to purchase extended reporting, or “tail coverage,” to ensure that you will be covered if you cancel the policy. Policy limits are customarily $1 million per claim, but the limit may need to be more depending on the litigious climate in the state or province where you practice. 

2. Personal liability umbrella coverage. This coverage may be obtained through your homeowners insurance company, but it usually has policy limits of $1 million per claim. This coverage is good if you have teenage drivers or a swimming pool or other more risky aspects of your life that could create financial hardship without this coverage being in place. 

3. Life insurance. This may be required if you have student loans, and the loan issuer may require you to list it as a beneficiary in the policy. 

Business Insurance and License Requirements 

These may not be directly applicable initially, but, if you get to the point where you become a part owner of a practice, these are essential. If you are an associate, you should still ensure that the practice has these insurance coverages in place: 

1. Business owner’s coverage.
This covers the equipment, premises liability (in case a person falls down in the waiting room and gets injured) and the building (if owned by the dentist). 

2. Workers’ compensation insurance. This must be in place to cover employee injuries, the most common in dentistry being a needle stick. 

3. Employment practices liability insurance. This takes care of harassment claims and other disgruntled employee allegations. 

4. Business license. Some states, provinces, counties or cities require a business license. These are renewable on an annual basis, but requirements vary depending on the location. 

Practice License Requirements 

1. State or province licensure for dentistry. You must have your own personal license to practice in any U.S. state or Canadian province. You must follow the regional testing requirement for the particular state or province in which you wish to practice. Rarely, an individual state or province may conduct its own licensing examination, and the key to applicability in any other area is equivalency of the state or provincial test to the applicable regional examination requirements. 

2. State or province licensure for prescriptions. Requirements for the license to prescribe generally fall under the same rules as dental licensure.

3. Drug Enforcement Administration number to prescribe controlled substances in the United States. This is a separate license from the state license and must be renewed on a specified periodic basis. 

4. Sedation level requirements. How sedation modalities are licensed is dependent on state or provincial practice acts and rules. The American Dental Association classifies sedation by levels, but some jurisdictions classify licensure by modes, i.e., nitrous oxide, oral sedation and intravenous sedation. Some jurisdictions require a certificate or letter from the graduate’s dental school or residency program outlining the level of sedation training achieved. 

Protocols for Procedures Relatively New to Dentistry 

This section has to do with verifying the legalities of practice in your location and knowledge of the various protocols for unusual situations: 

1. Botox and dermal fillers for cosmetic treatment. You must review the practice act in your state or province to see if general dentists are allowed to perform cosmetic procedures involving injections or other methods. 

2. Expanded duties of hygienists and dental assistants vary among states and provinces. You need to know what specific procedures, such as injections or restorative material placement, that auxiliary personnel are allowed to perform in your practice location. 

3. Laws requiring interpreters for deaf patients and governing service animals in dental facilities, etc. You must be aware of these accessibility protocols as well as new situations that will occur in the future. 

In summary, these basic suggestions should help new dentists stay on the right track and avoid getting themselves into unpleasant situations, as ignorance is not always bliss! 

Richard C. Engar, DDS, FAGD, is retired CEO of Professional Insurance Exchange Mutual Inc., a Utah-based professional liability insurance carrier created by Utah dentists in 1978. He is also retired from the faculty of the University of Utah School of Dentistry and is the former AGD Impact Risk Management columnist.