The 10-year dental practice decline: Why it happened and how you can reverse it

February 28, 2015

Congratulations if your practice has increased in net profit since 2005. If it has, you are in the TOP 20% that regardless of the economy, insurance reimbursements, staffing issues, or world affairs, you are doing quite well. Your practice most likely continues to grow because you still attend CE courses, are involved in organized dentistry, take your team to courses, and stay current with technology, materials, and procedures. You are always looking for the next opportunity to help patients achieve the highest standard of care in dentistry. You might be fee-for-service or taking only one or two of the better plans in dentistry.

Is fee-for-service dentistry becoming extinct? We ask the experts.

If you are like many practices in the middle, those I call the "Bobbers," you have very few peaks or valleys and you are content with the status quo. You are not in dentistry to set the world on fire and as one dentist recently stated, "I'm leaving a lot on the bone as I never want to hard sell my patients. I feel that after 30 years if they want the best, they will tell me when to do it." This doctor has a solid practice that has produced about the same amount year after year. She's busy and prefers to take time off versus growing if it means "selling" or forsaking time off.

About 60% of the practices are in this "Bobbers" category. They once attended and took their team members to dental meetings or courses, but due to the fact they have seen their net profits in a non-growth or declining state, they have decided not to continue investing in the team or their own CE. This has been one of the major reasons for practice stagnation or decline in the past 10 years. These shifts of attitude in this important investment might be due to costs involved, or the changes in employee laws that have placed a barrier between CE courses and two- or three-day conferences. Or perhaps the team you currently employ isn't interested in contributing to practice improvements if it involves their personal time. Unfortunately for this 60% of the dental practice population, the declines will happen more often than before as this cycle continues.   

The group of dentists I feel most concerned about is the lower 20% of the practice population who are in dire straits. This group can be older practitioners, but are often the younger dentists who are on way too many insurance plans with lower reimbursement than their overhead percentages. This means they are not only doing the dentistry for free, they are taking 20-30% of their profit on that procedure to do so. As for marketing for more fee-for-service patients or the indemnity plan patients, there is nothing left in the budget to do so. And forget CE for the dentist or the team. It is out of the question due to the costs involved, yet this group needs the CE more than anyone in dentistry.

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What is the solution? Definitely the answer is going back to the 1980s and 1990s days of setting aside money for twice-per-year dental conferences and local seminars in both clinical and management. These costs are recouped within the same week of the meeting if the information is embraced and implemented. Until we see team members who have exciting CE opportunities to look forward to (and until they have strong and positive leadership from their dentist), this gloom-and-doom situation will not reverse. Apathy will be the name of the game with nothing except more of the same to look forward to. Those team members who vote on which meeting they get to attend and the courses are carefully assigned will truly have a career, not a job.

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The spark for success is gone ladies and gentlemen, and the only way to get it back is to have strong leadership, solid systems that are consistently worked, and competent/confident team members whose talent is fully appreciated. Until the staff is properly trained, how can they get praise and appreciation from the person who signs their paycheck? My advice: Change your next 10 years! Sign up for courses that will turn ordinary into extraordinary with a lot more fun and profitability ahead.