Here are 5 predictions for the future of dentistry in the States. I’ll be specific to this country that has become my adopted home. It’s what I know and have spent most of my professional life practicing in. I am grateful for the opportunities that have been provided to me here, in the form of mentors, connections, organized dentistry and even, the bureaucracy. There is no other country I’d rather be a dentist in.
You as the reader, are free to engage with me or debate any of the predictions below. Please use this as a platform for an insightful discussion. Remember, it is only a dialogue, not the beginning of WW3.
We are moving towards a hygienist-less practice
In the last 5 years of my career, I haven’t worked at a single practice without a hygienist. Every hygienist has been committed to their patients, and is an excellent communicator. It is truly challenging to manage a patient in the most comprehensive way possible without a hygienist. All that said, with the dropping number of hygiene schools across the country, lack of funding provided to existing hygiene schools, skyrocketing student loans creating an impossible barrier to enter the profession, I see our practice model changing in the next decade.
I am located in the Bay Area and as of yet, we still don’t have an ‘acute shortage’ of hygienists. However, I still have practice owner friends who have been unable to find hygienists for the last 2 years. This is despite offering higher salaries, benefits, and mileage reimbursements.
One prominent dentist in a nearby town is offering $70/hr to a hygienist with all the bells and whistles. They are even offering a bonus to anyone who may refer a hygienist to them!
They have had this position open for a year. No luck yet.
The situation is either more dire in other states or only a little better. In Washington state, that already has an extreme shortage of hygienists, there is yet a law to be passed to allow license mobility- which would allow hygienists to move across states without having to pay exorbitant fees for a new license. The law is moving slower than our profession’s needs.
So, similar to countries like India, UAE and others, it will become common practice for dental offices to not have hygienists. Instead, your preventive cleanings and more, would be done by your dentist or a highly trained dental assistant. I do see a future where dental assistants are able to do more than just polishing teeth. There is a bill on our governor’s table right now in CA that asks precisely for that. It received a landslide approval.
Will this affect a patient’s preventative care? Yes, it will. How? I don’t know that yet. I don’t think it will be fair to look at preventive care in India, UAE and match that to what might happen in the US. Our standard of care, levels of teaching etc, are different. Insurance also dictates a lot of this to our profession. Dental insurance doesn’t play as big a role in other countries yet.
Reliance on dental insurance begins to go down amongst privately owned ‘mom and pop’ dental practices. Reliance on dental insurance continues to go up in DSO’s.
This is based on economies of scale and also what I am seeing at SamsoSmile’s offices. Taking insurance demands efficiency, technology adoption and a superior managerial style, from an office. If you are not efficient with insurances, you are not going to generate as much revenue. If you are not generating revenue, you cannot pay your team and your bills.
For a small office to be very efficient with insurance requires them to invest in technology or other third party vendors for support. Moreover, in larger offices, the ‘insurance problem’ is more acute so they do not have an option besides getting more efficient and using automation to their highest advantage. They also tend to have centralized operations that manage the business aspects of all offices under them. This simplifies implementation of technology and training of teams.
This is why I see a trend towards private offices dropping or going OON with insurances. This is already happening on a small scale all around us. As practices become confident about the loyalty of their patient base, the more comfortable they will be in dropping insurance plans.
This will cause a related spin off and an uptick in in-house dental membership plans. There is evidence on the success of in-house membership plans. It will continue to become more common.
Rise of DSO’s
Yes, it is not really a prediction since you know it is happening anyway. Many of them are SamsoSmile’s treasured customers and I’ve come to enjoy the leadership, camaraderie and networking associated with their events over time.
What I do see change in is the interaction organized dentistry and dental schools will have towards DSO’s. Instead of painting them as the ‘bad guys’ or the ‘other guys’, they will just be ‘our guys’.
I became aware of the animosity towards DSO’s when I was in dental school. I remember when ASDA would bring in DSO’s for lunch and learns, every student would attend to have the yummy lunch and listen to the lecture, and after- proudly profess how they would never work for them. Well, working for a DSO can be a very good and important thing for many of us. I’ve worked at 2 DSO’s and had an excellent experience with both. They always paid me on time, took care of my medical, dental and vision benefits and exposed me to various forms of practice modalities. On the contrary, a private practice I worked at offered no benefits, never paid me on time (and when they did it would be incorrect) and left me so frustrated with the profession that I seriously considered quitting dentistry forever.
That said, not all practices are created equal. Humans are different everywhere and part of adulting is learning from all the good and bad things you see out in the world. All the while, we are just hoping we don’t turn into our own worst enemies.
When I say ‘the rise of DSO’s’, what I really mean is more large-scale, efficiently run practices with a single business center. It could be 3 clinical offices that have a common centralized business operations office. With the cost of dental education going up (and quality of education remaining the same?), more dentists will delay buying a practice or consider buying into a group practice to lower their investment risks. There are many such groups around the country (last I checked more than 500), some of which don’t even call themselves DSO’s. They call themselves DPO’s or DMO’s. While the name does not matter, it’s the efficiency that does.
Dentistry can and most likely will follow in the footsteps of physician offices and pharmacies in the States.
Rise of ‘middle managers’
Most dentists spend 90% of their time in dental school learning clinical skills and not business skills. Unless schools take an active interest in teaching students the business side of dentistry, our profession will always want to rely on the ‘suits’ to manage the business for us. There are good and bad things in this. Time for an analogy.
The most common financial advice you will ever receive in your life is: DO NOT GET A FINANCIAL PLANNER!
Yes, I know that was a controversial statement to make, but I am a boglehead. When it comes to your money, if you don’t know what’s happening to it EXACTLY, you may be tempted to get someone else’s expertise involved. Someone who knows a lot more about money than you do (and while at it, take a nice cut from your income).
I see this happening in dentistry currently. We have lots of people in our industry already, who have no background in dentistry or even healthcare. They have come to our profession through various other industries; technology, accounting, banking, finance and administration, and are hired to business development and management roles. While this may be a good thing, we need to remember that these new entries may not understand patient care the way we do. They see the numbers and make recommendations based on that. When we make patient care decisions based on numbers solely, nobody wins. Not our patients, us or the suits.
Based on my experience with SamsoSmile, I find that some of the best managed DSO/DPO/DMO’s/private practices and dental companies, have an owner-operator. It’s a dentist who dedicates 1-3 days towards the business side of his operations. This person always makes the most phenomenal leader.
While these owner-operators have a strong leadership team supporting them in making big decisions, they typically go into the nitty gritty and understands problems from the inside. They come up with creative, forward thinking solutions. The reason they understand problems well is because they are primarily dentists. Dentistry helps make them a better leader and business operator. I see people like that only get better with time, and build fantastic opportunities for their people.
More women and minorities being represented in the profession
If you see our current graduating classes’ demographic and compare that with the leadership of any national dental association, you will realize very quickly that our leadership does not represent the majority of us. In the next decade, I do see more women and minorities taking up leadership positions throughout organized dentistry and dental companies. I also see our dental conferences becoming more family friendly, having daycares for parents to leave their kids at while attending CE, practices offering maternity benefits to their teams (this becoming the norm rather than a surprising benefit), and others.
Our profession has gone on too long without offering these basic abilities. How did women before us do this? I don’t know. I just know that I won’t be able to survive in this profession for the rest of my life, if the last prediction does not come true. I personally want to make sure that the last prediction is just plain reality in all of my businesses.
What do you think about these predictions? Do you see any of them coming true? Feel free to leave a comment about your thoughts!