Competing with the Corporate Dental Chains

How corporate chains are getting into dentistry and what it means for individual practices.

Chain dentistry, the bane of the independent dentist’s existence. Just say the words “corporate dentistry” and you’re bound to get an eye roll or a scowl from many independent practitioners, who find themselves competing with these mega-chains. These low-fee, high-volume practices that attract patients with the promise of low costs have taken the dental world by storm and popped up on seemingly every corner, with new practices opening practically every day.

While that may seem like an exaggeration (and perhaps it is a bit melodramatic), there’s no denying the corporate-dentistry trend is growing. As of July 2018, dental chains with over 100 locations comprised between seven and 12 percent of dental practices in the United States, while practices with three to 100 locations made up an additional approximate 12 percent.1 And this trend is likely to continue as younger dentists join the field; one American Dental Association Health Policy Institute study found that while 7.4 percent of practicing dentists in the U.S. were affiliated with a dental service organization, the number jumped to 16.3 percent for newer dentists ages 21 to 34.2 And the pandemic did independent practices no favors: Many dentists, put under significant pressure, decided to sell their practices.

So, while corporate chains are often seen as the greedy overlords, devouring individual practices and posing a threat to the traditional standard of independent practices, they clearly hold an attraction—or at least offer valuable solutions—to some dentists. Part of this appeal stems from the benefits they can provide for clinicians, particularly those starting out.

“There seems to be an almost unlimited amount of money available to the corporate entities funded by private equity,” Michael Goldberg, DDS, chief strategist for Practice Perfect Systems, says. “This gives the corporates the upper hand, because they can offer sign-on bonuses or some loan repayment plans. So, employment through a corporate entity can be a lot more enticing financially for newer dentists than with a smaller fee-for-service or independent practice, which can’t afford to offer those bonuses.”

In addition to offering financial benefits to dentists looking to pay off student loans, corporate dentistry presents dentists with the opportunity to focus on what they do best: Dentistry. Many dentists, Dr Goldberg says, aren’t entrepreneurs, while corporate entities focus on the bottom line.

“The promise of the corporate world is ‘doctor, you want to do dentistry. You’re not a businessman. We’re going to allow you to do what you want to do’,” Dr Goldberg says. “And different corporations fulfill that promise in different ways. Some doctors are happy with the arrangements, some are not.”

While this provides a good solution for some doctors, it puts the ones interested in maintaining ownership of their own practice in a bit of a bind. In order to compete, these doctors need to focus on the business approach, including things like marketing, practice management, and patient retention. This poses challenges for many dentists who have, until now, primarily focused on dentistry rather than entrepreneurship. So, how can independent dentists survive?

Identify your market

It starts with identifying your target market.

“A big concern for private practice is the added competition to acquire and retain patients,” Greg Pellegrom, cofounder and chief executive officer of SmileSnap says. “The reality is though, there are plenty of people out there wanting and needing dental services but don’t pursue treatment for a variety of reasons. Private practices just need to evaluate who they want their target market to be within their geographic area and focus on that audience.

Dr Goldberg agrees.

“You need to know who your patient avatar is,” he says. “You need to define what your unique selling proposition or unique value proposition is so you can answer the question of why a patient should come to you rather than going to another dental practice. Those need to be really, really, well-defined, solidified, and communicated appropriately through your marketing.”

One way to convince patients to come to you over a competitor is to offer something the competitor cannot. This means finding a niche in your area that hasn’t already been filled, such as offering specialized services or care that the big chains don’t.

“One of the keys if you're looking to compete with somebody is go where they can't,” Dr Goldberg explains. He recommends looking into incorporating specialty care such as dental sleep medicine, TMJ, oral-systemic therapies, or even same-day treatments into a general practice.

“Things like TMJ or dental-sleep medicine are things that, in general, the big corporate practices don't do well—at least not across the entire spectrum of their offices or their practices,” Dr Goldberg says. “So, these become areas where private practices can compete with corporate.”

The bottom line is that small practices simply can’t compete with the marketing budgets of corporate chains, so competing for the same patients through traditional marketing may be a waste of money and energy.

“You can't hope to outspend an Aspen or Heartland Dental,” Dr Goldberg says. “But you can compete, if you look at these smaller niches and smaller problems, and focus on marketing around that.”

Retain the patients you have

Once you’ve acquired patients, the next step is to retain them.

Focus on keeping the patients that you have,” Dr Goldberg says. “One of the fears is that people are going to leave your practice to go to the big new shiny corporate office on the block. And I think it's imperative for doctors today to do better internal marketing so they retain the patients that they have.”

The first step in effective internal marketing is to identify what your patients are looking for, and how you can provide services that appeals to them. Private practices can offer a more familiar, personalized patient experience than corporate chains that often have high dentist turnover rates since many dentists don’t have ownership stakes in the office. Patients looking to have a relationship with their clinician will shy away from corporate chains, which opens the door for the private practice. This may mean personalized, trust-based communications, like an email newsletter exploring timely topics with a personal touch, or being easily accessible to patients and ensuring the patient experience is streamlined and simple.

“For me, it’s all about the patient experience,” Pellegrom says. “Provide effective communication through text messaging, utilize digital forms with e-signatures, offer virtual consultations and visits where applicable—in other words, respect [the patient’s] time and don’t over complicate their life. Remember, Amazon patented the 1-click button and not the 2-click button.”

Once you’ve solidified relationships with your current patients, use their loyalty to your advantage. While it may seem awkward to encourage referrals, a satisfied patient is a great tool for practice promotion. Ensure your patients know you are accepting new patients, and encourage them to let their friends and family know about your practice.

“Our practice thrives because we get new patients referred by existing patients,” Dr Goldberg says. “You should be asking your patients for referrals. It sounds basic, but I think it's something dentists sometimes just don't feel comfortable doing—and they need to.”

Use the tools available

When it comes to referrals, patients aren’t the only resources. Building solid relationships with colleagues in the dental and medical communities can increase referrals and bring new patients to your chair. Offering niche services or partnering with a medical professional for oral-systemic health issues can open the door for industry referrals.

“I would say a good portion of my non-internal referrals came from physician referrals,” Dr Goldberg says. “I became known as sort of the go-to person for anyone that had any kind of medical issues. These referrals were great for no-cost patient acquisition. It’s something I think is valuable enough that we (Practice Perfect Systems) actually teach dentists how to implement the physician-referral program.”

In addition to referrals, practices should also work on converting leads. While this sounds like a headache, technology is making it easier than ever. Online portals for scheduling, teledentistry options, and automated communications ensure that patients can easily and conveniently connect with your practice, making them more likely to actually end up in your chair.

“The easiest way to provide greater access for new patients is having a way for them to engage with you from anywhere at any time,” Pellegrom says. “Offering a virtual consultation component on your website is the perfect solution for any consumer to begin the discovery process to a new dentist or dental service they are interested in.”

Virtual consultation platforms such as SmileSnap allow practices to conduct virtual appointments, which can help translate online consumers to actual patients, increasing case-acceptance rates and successfully converting leads. Patients need a simple and quick way to engage, Pellegrom says, and online platforms can connect patients to your practice wherever they are and whenever they want.

“This can also save doctors time and frustration, by delivering patients that are qualified, informed, and ready to accept treatment,” he says. “It’s a win-win scenario.”

While connecting with patients is critical, it will all be for naught without a plan for capitalizing on that growth. This is where a consultant or business coach can come in handy. Clinicians should identify where their strengths and weaknesses lie, and then work with someone to make a plan for future practice growth and maintenance.

“I think it's invaluable today to work with someone more business-minded who can point dentists in the right direction,” Dr Goldberg says. “You want to wake up in the morning and enjoy going to work. So, you need to figure out what that enjoyment looks like. And then strategize as to what tactics you might need to employ to get you to where you want to go. And that's again where I think somebody who has a broader vision and experience like a coach or consultant has a place, because they can help with the strategizing.”

While face of the future dental market is still unclear, private practices shouldn’t give up just yet. The playing field is vast, and with good patient care, strategic marketing, and quality practice management, there’s no reason smaller practices offering high-level care can’t compete with low-fee giants. After all, Pellegrom says, there are plenty of fish in the sea, looking for different things.

“The real question is, how do we tap into the tens of millions of Americans that don’t regularly see a dentist,” Pellegrom says. “The top 3 reasons people don’t see a dentist are cost, time, and fear. As an industry we need to find ways to overcome these barriers by being more transparent on fees, providing greater convenience, and educating the public on the advancements in dental technology. Together, we can grow the size of the pie, as a whole rather than continuing to compete over the same size pie, and that is how everyone wins.

1. Dental Practice Transitions: Consolidation vs. Sole Proprietors.” Henry Schein, 17 July 2018,
2. Garvin J. HPI: 7.4 percent of U.S. dentists are affiliated with dental service organizations. ADA News. March 07, 2017.