Dentistry’s Metamorphosis: Four Trends Shaping the Future of Dental Practice

Each of these four trends, which involve staffing, patient volume, insurance reimbursements, and consolidation of practices coupled with the expansion of dental support organizations (DSOs), will have a direct and different impact on practice performance.

Prior to COVID-19 there was a perceivable staffing shortage. Since the onset of the pandemic in March 2020 the staffing shortage has become a full-blown crisis industry-wide. Many dental hygienists have left the profession. In addition, practices have lost other staff members and are working to recruit and hire replacements. The staffing crisis is affecting practice production in many offices because they do not have sufficient staff to maintain the levels of production that they had achieved in the past. In the author's estimation, this staffing crisis is expected to continue for approximately 5 years. In other words, there will be no overnight turnaround.

There are six critical stages of staffing that the author has identified: recruiting, interviewing, hiring and compensation, training, retraining of current staff, and anti-burnout. Each of these stages interrelate, and different practices may face them at different times. A simple example is that when a practice loses one or two team members it immediately focuses on the first stage, which is recruiting. A number of recommendations can be considered that will be beneficial to practices regarding staffing and building a high-quality team.

First, when recruiting, use multiple avenues. Steps a practice can take may include online advertising, offering referral bonuses to current team members for recommending a candidate who is hired, giving signing bonuses to new team members who join the practice, making all patients of the practice aware that the practice has open positions, social media communication, and even advertising the compensation levels.

Second, practices should be prepared to hire new team members in the first interview, which is contradictory to the typical multiple-interview method that has been frequently used in the past. Telephone screening of applicants to determine if an interview is warranted and asking for a résumé and references in advance allows a practice to make an offer at the first interview if the candidate is a right fit for the practice. Waiting could result in the loss of that individual who may accept another job in between interviews or communication with you.

Third, practice success is still ultimately about having documented, proven, step-by-step systems in place with appropriate scripting. It is easier to train new team members faster as well as raise the performance level of current team members with the right systems in place. "Documented" means team members can easily access the systems for review. "Proven" means that the systems already exist elsewhere, and the practice does not have to waste considerable trial-and-error time trying to figure things out. "Step-by-step" design means the systems are a true instruction manual, showing the team exactly what to do to reach its highest potential.

Fourth, take steps to avoid burnout from affecting you or your team. Check in with team members regularly to see how they are doing. Create a positive, energized internal environment. Bring surprises in monthly ranging from lunches to dinners to gift certificates to surprise bonuses and other opportunities. Hold a quarterly out-of-the-office fun activity to keep people engaged with each other beyond the walls of the office. If a team member is perceived to be highly fatigued or moving toward burnout, some time off for that individual may be beneficial. As difficult and challenging as that may be, it is better than losing the team member permanently.

While there are certainly other strategies and tactics that can be used to build a high-quality team, these represent a good starting point.

Patient volume has become a challenging issue in many practices and especially in general dentistry. Due to the pandemic and increased levels of infection control protocols, dental practices may feel remarkably busy, but they are probably seeing a lower volume of patients, which translates into less practice production. Practices may be working harder for lower production. Fortunately, whether they know it or not, most practices have a significant inherent growth potential and now need to exploit that potential to increase production without increasing the number of operational hours, chairs, or even active patients. There are opportunities that are both visible and invisible.

Visible opportunities are those that can be easily measured, and then specific system changes and modifications can be made to leverage them. This can include, for example, analyzing the schedule using procedural timed studies to identify time-saving opportunities. For instance, a 4-day-per-week practice that saves 10 minutes per hour by analyzing and redesigning its schedule based on actual time needed, will increase the number of doctor production days by 32 per year. This represents 2 months of extra doctor production per year or 2 extra years of doctor production for every 12 years in practice. That is a significant amount of revenue that can be taken as income and invested to work toward retirement funding as well.

Other examples of visible ways to increase production include reducing no-shows, increasing case acceptance, adding new services, increasing the number of new patients per month through a targeted internal marketing program, and increasing positive online reviews by properly asking patients for them after clinical care. There are many other visible opportunities as well.

Invisible opportunities refer to those opportunities that either cannot be or are not measured. One might be the number of new patients who contact the practice but never make appointments. The author generally finds this statistic to be much higher than the practice would estimate, and some simple steps involving positive scripting can be implemented that will help build value for callers and improve this important metric. Other examples of invisible opportunities include the number of patients with incomplete treatment and remaining insurance benefits, patients who refused further treatment until their benefits renewed but have not yet contacted the office to schedule that treatment, and follow-up on case presentations that are not accepted at the time they are presented in the office, just to name a few.

In an era where patient volume can be quite challenging, practices need to identify and avail themselves of every opportunity.

Many dental insurers have reduced reimbursements in recent years, a trend that the author believes will continue over time. Whenever reimbursement levels decline the practice will have lower revenue and collections for those specific services. Given that most practices participate in at least one insurance plan this has a direct effect on practice performance going forward.

Each insurer has specific contracts that are to be followed by participating dental practices. To a large degree participation with an insurer is a clear-cut issue, and most of the insurance codes are well-defined regarding how they are to be used and submitted for various services. However, there are areas where practices have other opportunities to improve performance with regard to insurance. Examples include the following:

Increase fees for non-insured patient treatment. Many practices have not analyzed or increased fees to the detriment of overall practice financial success. Non-insured patients are a different category of patient and raising fees will help to offset some of the declines in insurance reimbursement.

Communicate with your patient base every 30 days. As part of a positive marketing program, this communication should include a focus on older patients who no longer have dental insurance through their employer.

Target elective services as a growth area. Such services can include cosmetic dentistry, implant dentistry, and others such as sleep dentistry, etc.

Expand the scope of dental hygiene. This can be done by identifying all gingival or periodontal disease, staying completely current on all x-rays, providing fluoride treatments, etc. The hygienist should play a role in educating patients about elective services that may be appropriate or of interest for them.

Dentists today are well aware of the trend toward consolidation of practices under one group and the expansion of DSOs. Some groups are small with only a few practices, while others are much larger. Many dentists are being approached with opportunities to sell their practice or become employees of a DSO.

Each dentist will have to evaluate his or her individual situation. They will have to ask themselves: Am I financially independent even with the sale of the practice? Do I want to be an employee and am I comfortable in that position? Do the values of the group offering to purchase the practice and/or employ me match up with my own individual values? Is there an opportunity for growth and development? Will I be satisfied to work within the performance expectations of the organization?

Undoubtedly, for the near future at least, DSOs will continue to expand and coexist with private practices, and both forms of businesses can perform well and have financial success implementing appropriate key business principles.

The four trends discussed in this article should be studied and evaluated by every dental practice. Dentistry, like most industries, is presently going through a transition that is being shaped both internally and externally. Internally, practices are being affected by staffing performance, for example, which is being affected by the external factor of the staffing shortage. Evaluating each of these trends and implementing the right systems that will allow for practice growth will enable almost any practice to achieve higher-level goals.

Roger P. Levin, DDS
CEO and Founder, Levin Group, Inc. (levingroup.com), a dental management consulting firm that has worked with more than 30,000 dental practices