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    The future of dental practices

    Experts say the field of dentistry is shifting and new advancements will accompany the change. What will your dental practice look like five years from today?


    The practice

    The trend toward DSOs is slowing down, but it’s already made its mark. And because it can help lighten the burden of student loan debt, which averaged $260,000 for 2016 graduates, that’s an appealing promise. While more than seven percent of licensed dentists are involved with corporate dentistry, the number is twice as high for dentists under 30.

    When these students graduate, their debt load is so substantial that a lot of them go into corporate dentistry to pay the bills,” says John Flucke, DDS and technology editor for Dental Products Report. “What happens is they’re there for a while and they get used to a certain lifestyle and realize if they want to be in private practice they have to take a pay cut, but with increased personal responsibilities like families, it’s not going to happen. So, I think it will continue to grow and threaten private practice.” 

    Trending article: Are the DSOs really taking over?

    And corporate dentistry has its benefits. “We’ve all known that that’s been coming,” says Brian Gray, DDS, of Giannini Gray Dental Partners in Washington, D.C. “The corporate model has come in and created greater efficiencies in dentistry, not just on the supply chain side, but more importantly efficiencies in the management side, which has been pretty much a cottage-type industry.”  

    DSOs won’t take up 100 percent of the market—but the space they leave will be available only to a certain kind of practice. 

    “I do think you’re going to see more individual dentists owning more practices, but not necessarily more large group practices coming out,” says Parag Kachalia, DDS, of Innovative Dental Concepts in San Ramon, California. “I think it comes down to a financial standpoint: All these groups are getting together to get the sum valuation that they can sell the private equity. That’s kind of what we’ve seen along the way, that dentistry has a cash flow standpoint that seems good from a Wall Street component to invest in a private equity standpoint. But there are fewer and fewer groups to gobble up. There will be some degree of saturation of group practices, and then it’ll start to swing back.” 

    At that point, he says, the trend will head toward a private practice model. But what kind of private practice

    “Some offices won’t be able to compete,” Dr. Flucke says. “Corporate fees are often lower than private practices, so I can see an independent practice having trouble. 

    Trending article: Why the future is DSOs

    “I think relationship building will always have a market, although it will shrink while corporate grows,” Dr. Flucke continues. “I think you’re going to see people who want a personal relationship with their doctor, office and staff. I see it often. People come in and say they were going to a corporate office but they didn’t like it. They feel it’s impersonal because there’s a lot of turnover. They didn’t feel like anyone knew them.” 

    While there will still be a demand for private practices, they won’t be based off a traditional model. Dr. Kachalia believes that there will be an increase in solo-group practices—offices where multiple, single practices operate in a given physical space. 

    “I think how we define the private practice model is going to change,” Dr. Kachalia notes. “Dentistry is an incredibly inefficient model and there’s a vast majority of offices that are unused for a significant portion of the week. Dentists may work four to five days a week, but it’s a six- to eight-hour schedule on a given day. There are 12 hours-plus that an office is not being used.” 

    Dr. Kachalia believes that, by sharing space while running independent businesses, dentists will benefit from being able to invest in technology together and streamlining rent. This could be another solution to the problem of dental school debt. “A big reason group practices are thriving the way they are is because they’re offering an opportunity for dentists coming right out of school to get a job where they’re doing dentistry and there’s potentially some loan repayment,” he says. 

    But ultimately, working for oneself will be the feature that wins. “There’s definitely a movement toward working for someone else and not having to worry about anyone else but yourself, but I think dentists historically have been co-owners,” Dr. Kachalia says. “We like to do our own thing. We don’t necessarily like to work for someone else forever. I do think the pendulum will start swinging back.” 

    Trending article: Pushing back against DSO takeovers

    Dr. Gray sees three possibilities in the future of private practice. While the corporate model will comprise over half of all dentists in the future and be there to “treat the masses,” other practices will be smaller shops. “I think that those are going to be the ones that struggle the most because they’re going to fall between the Wal-Mart model and what people often call the Neiman Marcus model, which is high-end,” he says. “There’s not enough room right now to have that middle section survive.” 

    What’s left is what he calls the “dying mom-and-pop model,” which will be further divided into three categories: “The boutique dental practice, which is going to be a small, fee-for-service type practice; the cutting-edge specialty practice, which could be a practice that is focused in on one of the new things, from doing clear aligner treatment to sleep medicine to even just bleaching; and then the super practice, which will be a high-end, fee-for-service practice that will be team-based,” he says. 

    The team-based practice will have general dentists and specialists working together. 

    “To me, that’s going to be the ultimate model,” Dr. Gray says. “There is no way you can have any single dentist able to do all the different specialties, and I don’t think that personally at this point in my career I would want to be that kind of Jack-of-all-trades, master of none. Having those specialists who do these things on a regular basis work together under the same roof is going to provide an incredible patient experience. They’ll be able to offer cutting-edge technologies and stay abreast of what’s going on with the other specialties. When each specialist brings these things to the table through that workflow model, we can really change the way that we’re doing stuff.” 


    Next: How technology will make a difference...


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