The current gap in the dental workforce, the large amount of student debt dental school graduates have and the reduced access to dental care are three of the biggest concerns that leaders in dentistry have about the industry.
The leaders featured in this article are all speaking at Becker's 2024 Fall Future of Dentistry Roundtable, Oct. 30 to Nov. 1 at the Hyatt Regency in Chicago.
If you work at a DSO or dental practice and would like to be considered as a speaker, please contact Randi Haseman at rhaseman@beckershealthcare.com.
Note: Responses were lightly edited for clarity and length.
Question: What aspect(s) of the current state of the dental industry makes you nervous or concerned?
Catrise Austin, DDS. Owner of VIP Smiles Cosmetic Dentistry (New York City): I'm increasingly concerned about the current state of the workforce and employment. Over the years, I've seen firsthand how a skilled and motivated team is essential to providing exceptional patient care. However, like many industries, we're facing significant challenges in retaining and attracting talent. The shortage of qualified dental assistants, hygienists and administrative staff has put pressure on practices, potentially impacting the quality of care patients receive. I'm deeply concerned that if we don't address these issues proactively, we may see a decline in the quality of care and patient satisfaction across the industry. It's crucial for us to invest in our workforce, provide better support, and create an environment where dental professionals feel valued and motivated. By doing so, we can ensure that we continue to deliver the excellent care our patients deserve and keep our practices thriving.
Sibera Brannon, DDS. Dentist and Owner of Affordable Dentures and Implants (Sun City, Ariz.): One of my primary concerns in the current dental industry is the overwhelming student debt that young dentists face upon graduation. This financial burden often pushes them to seek immediate employment, typically with DSOs, rather than pursuing practice ownership, a path that was much more common 30 years ago. As a result, many young dentists may never experience the rewards and challenges of business ownership, which can be a significant aspect of professional growth and fulfillment. Another concern is the lack of structured mentorship opportunities. With no organized apprenticeship models in place, young dentists often struggle to find the guidance they need to develop their clinical and business skills effectively.
Matt Carlston, DMD. Dentist at Comfort Dental (Lakewood, Colo.): Student loan debt. Dental students are being asked to pay a tremendous amount for their dental school education and are graduating with less and less clinical experience than ever before. With the influx of new dental schools the amount of dental school graduates continues to rise. The opportunities that they are finding upon graduation are becoming more and more diluted. They need a steady hand that seasoned doctors can provide. This will allow them to begin the process of learning the clinical skills necessary to tackle their enormous burden of student loan debt. Far too often I speak with doctors who have been working clinically for a number of years and still haven't begun the process of addressing their debt.
Alexander Einbinder, DDS. Dentist of Caterpillar Dental (West Babylon, N.Y.): No. 1: Access to dental care, despite significant advancements in dental technology and procedures, many people still lack access to affordable and quality dental care, particularly in underprivileged or rural areas. No. 2: The costs of dental education, equipment and supplies continue to rise, which may lead to higher prices for dental services and potentially make dental care less affordable for patients. No. 3: Many regions face shortages of qualified dental hygienists, assistants and even dentists, which can lead to increased workloads for existing staff and potentially compromise the quality of care. No. 4: Technological advancements can improve dental care, they also bring challenges like the need for ongoing training, investment in expensive equipment and concerns about data privacy and security.
Jason Genta, DDS. Vice President of Clinical Operations of Smile Brands (Costa Mesa, Calif.): My biggest concern is focused around the workforce within the dental industry. We know that during and after the pandemic many individuals left the field, and many have not come back. Dentistry is a wonderful field of medicine, and I think it is important to identify some of the shortcomings that caused these people to leave. Not only will it help us attract more people back to the profession, it will ensure that those in the field stay, and have happier and more fulfilled careers.
Andrew Goldsmith, DDS. Owner of Northshore Dental (Houston): The state of the dental industry that makes me the most concerned is a more pronounced recession than what we have already experienced after the COVID-19 pandemic. In the event of a recession, elective procedures will become more niche and less abundantly available therefore systems need to be in place for delivering exceptional dentistry. For private practice dentists this means there will be increased competition with larger DSOs that remain more competitive on multiple levels. For the dental industry in general this means that preparations must be made to run lean businesses, avoid leveraged debt and fight like hell to distinguish your brand.
Tara Good-Young. CEO of PDI Surgery Center (Windsor, Calif.): The lack of new dental providers entering the field and the impact this has on access to timely care concerns me deeply, particularly for the most vulnerable populations among us. If we are to make a significant impact in curbing rising costs of healthcare, including dental care, and increasing care accessibility we must address the cost of education reform. The significant rising cost of dental school creates a downward access spiral. It dissuades many candidates from pursuing their interest in the field and successfully completing their degrees. High loan debt further decreases the percentage of already limited new graduate providers willing to accept dentist roles in community clinic "safety net" organizations or to participate with Medicaid programs in their own private practices.
Haim Haviv. Founder and CEO of Hudson Dental (New York City): Two primary concerns as a CEO in the dental industry are talent acquisition and insurance reimbursements. Securing top talent is akin to building a successful sports team; the right players make all the difference. Finding skilled professionals is challenging, but we prioritize competitive compensation and benefits to ensure high retention. On the insurance front, the increasing use of AI by payers to minimize their costs has resulted in removing coverage altogether for some procedures while making reimbursement more complex and time-consuming for others. This necessitates robust in-house expertise and diverse payment options to ensure patients can afford the care they need.
Alicia Kieffer. Senior Vice President of Practice Services of Imagen Dental Partners (Phoenix): I'm particularly concerned about the shortage of qualified dental hygienists, which is putting significant pressure on our hygiene department, especially in certain geographies. This shortage, coupled with the increasing wages required to attract and retain skilled hygienists, adds another layer of complexity. The challenge is to ensure that our hygienists are not overburdened and compensated fairly while still maintaining high standards of patient care, all within a financially sustainable model. This continues to be a big focus area for my team at Imagen.
Jason Korkus, DDS. President of Sonrisa Family Dental (Chicago): These are the most concerning parts I have: The Insurance reimbursement has not caught up to the massive inflation in supplies and wages needed to properly run a dental office. The second component deals with the continued separation of oral health care from the coordination to overall healthcare with the patient's primary medical physicians. These two components limit the ability to provide comprehensive healthcare to patients.
Alan Law, DDS, PhD. President of the Dental Specialists (Woodbury, Minn.): I am concerned about the rising student debt burden on dental professionals, as well as the concurrent shortage of dental assistants, hygienists and educators, which may adversely affect the industry. Furthermore, the decline in dental insurance reimbursement rates is exerting financial pressure on practices, potentially compromising access to care and the long-term sustainability of dental practice.
Emily Letran, DDS. CEO of Sea Breeze Dental (Huntington Beach, Calif.): Our dental industry is changing rapidly. The implementation of technology and AI is a must, and I am concerned that there is still a lot of reluctance to leverage these concepts and tools. As a tech challenged CEO, I truly appreciate these new innovations. The solutions are here, but for some reason a lot of practices haven't grasped them. My concern is the ones that don't adopt and innovate will fall behind. Patients are so savvy now that they almost expect us, as healthcare providers, to use technology and serve them better. My challenge to practices out there is to jump on the bandwagon and utilize technology to grow faster. Now, if you are an oldie like me, then please hire the younger team members (associates, office coordinators, etc.) because they will take it and run. All you need to do is invest in the time to train and give them the tools so they can excel.
Tia Meyer. Clinical Director of NBD Partnerships (Sioux Falls, S.D.): The dental industry is currently facing several challenges that raise concerns. One of the primary issues is the shortage of dental professionals, particularly in rural and underserved communities. Hiring challenges are also a significant concern. Many dental practices are struggling to recruit and retain qualified staff, including hygienists, dental assistants and administrative personnel. This shortage can lead to increased workloads for existing staff, burnout and ultimately a decline in the quality of patient care. Another significant concern is the impact of changing insurance policies and reimbursement rates. Many dental practices need help with the financial uncertainty brought about by these changes, which can affect their ability to provide comprehensive care. Overall, while the dental industry is full of potential, these challenges require careful navigation to ensure that patient care remains at the forefront!
Carrington Morgan. Head of Human Resources of Great Lakes Dental Partners (Chicago): As a leader in the field of human capital, I share the concern that many of us have, the challenges presented by the current talent market. Since 2020, the dental industry has faced a significant shortage of professionals, particularly among dental hygienists and dentists. This shortage is compounded by the decreasing number of graduates entering the field and the increasing rate of retirements among seasoned professionals. As a result, the competition for top talent has intensified dramatically.While this trend is certainly concerning, it also presents a unique opportunity for organizations to innovate and establish themselves as market leaders in attracting and retaining exceptional talent. At Great Lakes Dental Partners, we are continually evolving our strategies to stay ahead in this competitive landscape. Our goal is to ensure that we provide not only an outstanding work environment and culture but also a comprehensive and compelling total rewards package. By doing so, we aim to attract and retain the best talent in the industry, ensuring our continued success and the highest quality of care for our patients.
Kenneth Nusbacher, DMD. Associate Dean of Clinical Affairs of the University of Kentucky College of Dentistry (Lexington): In my position I see two major challenges currently: The first is rising student debt. As is the case with higher education in general, student debt for dental students has risen at an alarming rate, creating a situation where graduates are often limited in options and clearly seek out opportunities that incorporate loan repayment and/or a higher guaranteed salary to offset debt service obligations. The second is the continual increase in Medicaid dental and patients with no coverage, but no ability to pay fee for service. With recent dramatic rises in the Medicaid dental patient numbers across the nation, and those with no coverage but no ability to pay out of pocket, many states are seeing a crisis situation arise regarding basic dental care. As many private practice and DSO groups opt out of exceedingly low reimbursement rates though Medicaid, the public health entities are overwhelmed with patients seeking out care. Additionally, access to care for patients in underserved areas continues to dwindle creating dental deserts in many states.
Nimesh Patel, DMD. COO of Brite Dental Partners (Briarcliff Manor, N.Y.): Supplies, labor and lab bills keep going up, but we are not seeing the same growth (or any growth with regards to state sponsored plans) in their reimbursements.
Ronald Perry, DMD. Professor at Tufts University School of Dental Medicine (Boston): There are a few concerns. No. 1: Access to Care: Despite significant advancements in dental technology and treatment, a troubling gap in access to dental care persists, particularly in underserved and low-income communities. No. 2: Workforce Shortages: The dental industry is increasingly facing a shortage of professionals, particularly in specialized fields such as pediatric dentistry, geriatrics, and public health. No. 3: Rising Student Debt: The escalating cost of dental education is leading to an overwhelming burden of student debt for new graduates. No. 4: Technological Disruption: The rapid advancement of dental technology, including AI and digital dentistry, offers tremendous potential for improving patient care. No. 5: Corporate Dentistry: The rise of corporate-owned dental practices is reshaping the landscape of dental care delivery. No. 6: Regulatory Challenges: The dental industry operates within a complex and evolving regulatory environment. Changes in laws, insurance policies, reimbursement rates or scope-of-practice regulations can create uncertainty and pose challenges for both practitioners and patients.
Raj Puri, DDS. Owner of Smiles Dental Center (Wood Dale, Ill.): I think the areas of concern I have for the current state of the dental industry are the ongoing qualified worker's shortages, stagnant or decreasing insurance reimbursements and the high costs of dental school tuition and student debt. For our industry to really grow, I believe we need to really address the need for hygienists and dental assistants. I believe there needs to be an easier and faster way for hygienists to be certified and increased certification for dental assistants to perform higher level duties to allow dental offices to be more efficient and expand. The insurance reimbursements haven't really changed since the mid-1980's and this issue will need government assistance to make any meaningful impact. The same can be said for dental school tuition and student debt, which really makes it difficult for a new graduate to open his/her first office or buy into an existing office where they may be an associate.
Peter Rivoli, DDS. Owner of Rivoli Dental (Spencerport, N.Y.): There are many things that I have concerns with over the current state of our industry. What concerns me the most is what I would term compression. What I mean by this is the resistance of the insurance providers in raising their reimbursement rates commensurate with the inflationary pressures we all are feeling. Couple that with the biggest pressure point being our staffing salary demands, which represent the biggest portion of our budget and the pressure to retain those employees from more desperate recruiting practices. In a nutshell our top line growth is being stunted and our bottom line is growing, and our margins are being squeezed. It is sad to say but, as the practice owner, in order to survive this institutional economic mismanagement, I am working harder, making less and visualizing the end point of this time is cloudy at best.
Daniel Romary. Chief Information and Analytics Officer of North American Dental Group (Pittsburgh): An ongoing challenge has been a shortage of dental professionals to provide patient care. Finding and retaining dentists has been a challenge due to various reasons including workload and burnout, high education costs and an aging workforce where many experienced dentists are retiring, but not being replaced. For dental assistants and hygienists, we see similar challenges also caused by heavy workload and burnout, career advancement limitations and compensation challenges.
David Sopp. Senior Vice President of Corporate Development of First Choice Dental (Madison, Wis.): I'm concerned about the staffing challenges that continue to impact the industry. Certain states have been progressive in enacting bills like authorizing dental therapists or empowering dentists to easily practice in other participating states through multistate compacts, but expanding training capacity to increase the number of hygienist and assistant graduates annually and creating new pathways to the professions such as hygiene assistants is needed. Progress is being made but more solutions are necessary.