Increased DSO presence, lower reimbursements and fewer solo practitioners are among the top predictions dentists have for the future of dentistry.
Here, six dentists share what they expect the dental industry to look like in five years:
Note: Responses were lightly edited for style and length.
Robert Trager, DDS. Dentist at JFK International and LaGuardia airports (New York City): In the next five years I believe there will be consolidation and contraction. The DSOs will absorb more of the private practices so there will only be about 30-35 percent of solo practitioners left. Many specialty practices will consolidate and or merge into one group practice. This just happened in the New York City area with five oral surgery practices. I predict that the next merges will be endodontic, periodontic and orthodontic practices as well as dental laboratories. I also envision in large states such as New York, Florida, Texas and California, as well as some others, that many dental components of the state dental societies will be forced to merge for better economic reasons. And the only thing that will remain the same is the dental insurance companies as well as the government agencies will always find a way to pay lower fees, and they make it difficult to do business with.
Clifford Marks, DDS. Hughes Dental Group (Campbell, Calif.): The number of independent solo practitioners will decline. It is harder and harder to keep up with government regulations and insurance restrictions. Solo practitioners will have higher costs than small groups and corporate offices. Solo offices will cater toward high-end patients. Certainly there will always be a niche for the solo practitioner, but the market for dentistry will evolve to allow a greater percentage of dentists to work corporate.
Women will continue to outnumber men in dentistry. Dentists will band into small groups, say two or three dentists, and form group practices. Small groups will be under pressure to remain profitable yet serve fee-for-service patients. The price of dentistry is ever increasing! It will drive the bulk of patients to corporate offices or insurance-owned offices. Basic dentistry in these settings will be affordable. Anything beyond a couple of cleanings a year and a couple of fillings will be prohibitively expensive. The average pay for dentists will go down, especially those that are employees. The percentage of dental specialists to general dentists will increase. The specialists will generally cater toward high-end patients as insurance benefits won't be much for specialty procedures. Dental schools will accept more money from sponsors and tailor their education to suit their sponsors' needs. The Golden Age of Dentistry will certainly be there for a select number of dentists, but for the rest, the status of being a dentist will diminish.
Rajdeep Randhawa, DDS. Innovative Dentistry (Rahway, N.J.): We are going to see some major changes in the next two to three years, and in five years there is going to be a complete transformation. The process of change and its implementation is going at a pace that we have not seen in the last 50-70 years. There is going to be more competition between DSOs if they venture into each other's territory, but if they coordinate their expansion plans and work together they will eventually reach a critical mass, maybe go beyond that to dislodge the insurance companies out of the equation of dentist-patient interaction by providing their own innovative platforms directly to the patient base and employers.
There will be complete digitization of dental offices, with heavy emphasis on single visit dentistry. All fixed prosthodontics, removable prosthodontics, implant supported teeth and prosthesis, and all invisible aligners will be made in dental offices. Better intraoral 3D scanning technology, CAD/CAM chairside milling machines and 3D printing will play a significant role in this transformational change. [I predict] more use of automation and AI to streamline the functioning of dental offices. The whole dental industry will face the issue of losing highly trained and competent staff to stress, burnout, premature retirement and change of profession, leading to staff shortages and disruption of dental care in dental offices.
The dental schools will still be graduating thousands of dentists every year with a crazy amount of debt load, without any moral or ethical concerns about if they are trained properly in the business aspect of dentistry, and how will the new graduates succeed in the challenging real world situation and pay off their debt? The insurance companies will enforce strict price controls on the fees they will reimburse to participating dentists, despite the substantial rise in the risk and cost of doing dentistry, ultimately leading to great resignation of independent dentists and DSOs from insurance networks and creating a whole new platform.
David Ramirez, DDS. (San Francisco): The industry will change from the way dentistry will be delivered. Recent graduates' dreams of seeking to buy or start their own offices as soon as possible will switch to [joining] larger group practices. The promise of a salary with little risk of increasing more debt allows DSOs to be the best opportunity for recent graduates. However, by being in-network with so many insurance plans, it is taking a bite out of established fee-for-service offices [because] patients are now having an opportunity to establish care in modern, clean DSO offices. Patients will tend to stay in-network now to save the ever increasing costs of healthcare, and due to insurance incentives they will tend to stay within their dental network. The DSO office can now reduce overhead by negotiating with large healthcare companies for lower prices on goods and negotiate higher reimbursement rates from insurance [companies]. Due to COVID, the increased costs of PPE and employees' wages are making it hard for single private practices to compete with larger group practices.
David Keller, DDS. Granite Dental (Vancouver, Wash.): In five years, dentistry will clinically look very similar to today. Change is slow in healthcare. Overregulation prevents nimbleness like in other market sectors. I do expect staff salaries to increase to lure employees back into the workforce. I expect staff sizes to increase to accommodate employees who have discovered they don't want to work as much as pre-COVID.
I expect the trend toward corporate dentistry will increase, but I don't expect it to accelerate. I expect the distribution of clinical procedures to shift toward disease control and rehabilitation of patients who have spent the past two to three years neglecting their oral health. I expect dental offices to remain less busy in general than pre-COVID. This will require offices to offer new procedures to patients to maintain historical profits. This will cause the variety of procedures done in most dental offices to increase, which I believe can be leveraged into added value to patients.
I expect dental benefits offered by employers to become more robust or comprehensive as they seek to retain employees. I also expect increased opportunity for employees to leave work for dental appointments, which might have the overall effect of less offices open extended hours.
Betty Jo Hirschfield Louik, DMD. Uptown Dental (Pittsburgh): DSO ownership of dental practices will continue to grow in the next five years, as will group practice. Solo privately owned offices will become a small fraction of existing offices. Fewer young practitioners will purchase practices for sale; many will be forced to just close their doors when doctors choose to retire. I do believe the market for hiring auxiliaries will improve as personnel leave hospital and medical practices to enjoy the better practice environment of dental offices. The world of digital dentistry will continue to expand, with software to change smiles virtually to give patients ideas of what is possible.