Rising costs, staff recruitment and retention, and insurance reimbursements are among the top dental industry threats dentists are thinking about today.
Eight dentists share the biggest threats to the dental industry:
Note: Responses were lightly edited for length and clarity.
Oksana Boyechko, DMD. Boyechko Dental (Cameron Park, Calif.): I think it is the rising costs of dental supplies and equipment. Also, rising wages. At the same time, the insurance reimbursement for the crown has not changed in 20 years! Before COVID, I paid $4.99 for a box of 100 gloves. Now it is $15 at the least.
Caroline Zeller, DDS. SmileKeepers Dental (Salem, Ore.): [The first threat] is provider burnout. I sense an increasing dissatisfaction from newer dentists about the profession they have joined. However, I think the main contributor to this mindset is that it has not turned out to be the kind of job or profession that they thought it would be. Either they thought they would own a private practice without financial struggle, or they were motivated by wanting to help their patients and be part of the healthcare community. The current dental delivery system fails to support either one of these dreams. The dental industry is in the midst of an existential crisis. They don’t know who they are or what they want to be. Holding onto the past and being reluctant to accept necessary changes for survival has created a disappointing professional experience.
[There is also] the belief that the old way is the best and only way. We cannot hide from the rest of the American healthcare system forever. Our profession's capacity to care for our most vulnerable populations is limited. Our delivery systems are failing to provide care for a population of Americans that continues to grow in size. Accepting that change is necessary, and being a part of that charge is the best and only way to shape what our profession becomes.
Robert Boff, DMD. Ramsey (N.J.) Family Dental: I believe declining profit margins in combination with increasing debt loads and business management expenses will weigh heavily on the viability of delivering quality dental care. A good percentage of the declining margins can be attributed to over-regulation and legislation, third party involvement, taxation and employee retention.
Charles Schlesinger, DDS. Comfortable Dentistry 4U (Albuquerque, N.M.): The biggest long-term threat to dentistry is the reluctance of insurance companies to reimburse dentists at a commensurate rate for the work they do. Along with this, as the costs of dental procedures rise, the patient benefit cap has not risen in over 25 years. The combination of these two factors make it hard for patients to afford the dentistry they need, and it drives dentists to cut corners to stay profitable.
Dental offices are profitable only when they are part of a larger group that has buying power to decrease expenditures. The solo practitioner or small group does not benefit from dealer discounts and [that makes] it very tough to be competitive with larger DSO groups. In order for this profession to continue to grow in a healthy way and be encouraging for new doctors and those potentially looking at the profession, the insurance industry must change.
Rolinda Harsany, DDS (Napa, Calif.): The first [threat] is the HMO dental insurance industry. The second is large corporation-owned dental offices that accept these low-reimbursement plans.
Corporations push profit over patient care. This often results in over-diagnosis and excessive treatment planning. We often see patients who come in for a second opinion with large treatment plans that require no treatment at all other than routine cleanings and exams. If a patient is unaware of how insurance-driven corporate practices are managed, they end up paying thousands of dollars for unnecessary treatment.
Brian Harris, DDS. Harris Dental (Phoenix): The biggest threat is doctors not seeing the massive shift that is happening in the market and how people are buying today. We make it difficult for people to do business with us and get simple questions answered. People want convenience, trust, transparency and value, and that can all be given today by leveraging virtual dentistry platforms. If doctors continue to do the things the way they have always done them, they will be left behind.
Peter Grumbos, DDS. Gentle Dentistry of Las Colinas (Irving, Texas): Solo practice ownership is dwindling as new dentists graduating with such exorbitant school loans are buried in debt to the point that their only option is to work for a DSO. DSOs attempting to make quarterly projects are buying practices at higher multiples, and thus solo dentists are selling to DSOs versus their own associates if they have associates. DSOs also limit some of the procedures that general dentists are proficient in (such as orthodontics and surgical placement of implants) and only allowing specialists to do the treatment, as a specialist will on one hand receive higher fee reimbursements, but the DSO will have to compensate them more because they are specialists. DSOs don't understand that most specialists service DSOs as a side gig, but without the general dentist, the DSO doesn't have a company. So why favor specialists? Build the competency of the general dentist, have the general dentist make more money (if proficient in the service), and thus DSOs will reduce their high dentist turnover percentages.
The solo practice owner often does not have the patience to mentor a young dentist. In the DSO world, there is some education (usually not one-on-one mentorship and guidance), but the young dentist will either sink or swim.
Harold Biller, DDS. Jamaica Estates Dentist (New York City): The biggest challenge that dentistry faces today is a perfect storm of increase in the number of graduates of dental schools, poor distribution of dental practitioners and increased participation in dental insurance programs. Most dentists in the United States practice in major metropolitan areas. Most graduates tend to try and practice there too. But the graduates have an average $400,000 of student loan debt and feel forced to participate in any and all insurance programs no matter how poor the reimbursement. This allows the insurance companies to try and lower their level of contracted fees in the area. Meanwhile costs of running a practice continue to rise. Dentistry is becoming more efficient due to the ability to use digital workflows, but the costs of equipping an office with a [cone-beam computed tomography system], scanner and/or [computer-aided design/computer-aided manufacturing], plus the monthly support costs to maintain this digital workflow, are out of reach of most solo practitioners. This allows DSOs to attract more patients with their larger advertising budgets and deep pockets to equip their offices with digital workflow solutions. The only way dentistry will survive in the practitioner-proprietor model is as group practices, allowing for fixed assets to be used as many hours a week as possible.