The staffing crisis, expansion of DSOs, burnout-all challenges that could change the dental profession permanently. Roger Levin discusses short- and long-term strategies that can help ensure a successful future.
Roger P. Levin, DDS
Dentistry, like all industries, is going through a continual and rapid transformation. As this change occurs, there are emerging trends and challenges that will have a direct effect on dental practices. Understanding what the trends are will allow practices to establish short- and long-term strategies to ensure a successful future.
The staffing crisis and shortage
Trend and challenge
Staffing is more than a challenge; it is a literal crisis for dental practices. In the Dental Economics/Levin Group Annual Practice Survey of 2021, we found that approximately 65% of practices were seeking at least one additional team member. We also estimate that up to 10% of full-time dental hygienists have left the profession. This is beginning to have a direct negative impact on practice production, day-to-day operations, and levels of stress and anxiety. Practices will need to be more proactive and rethink how they hire and manage the team.
While there are no magic bullets, there are several potential solutions for hiring new team members:
- Regular online advertising. Make your ad stand out. Talk about the practice, purpose, fun, career opportunities, teamwork, and supportive environment. Be different and don’t look like every other ad.
- Signing bonuses. Offer a signing bonus that is significant enough to attract attention. If a signing bonus helps you quickly hire an employee, it will save you from spending enormous amounts of time in the hiring process.
- Cross-training your team. Turnover in dental practice staff is at an all-time high. If you don’t cross-train your team to perform all the responsibilities within the practice, you’ll be caught short if someone leaves and won’t be able to cover important practice tasks.
- Longevity bonuses. Bonuses for five-, 10-, 15-, and 20-year longevity go a long way toward keeping people in the practice, and set a goal in their minds. We are now hearing team members say “Next year, I get my tenure bonus.” That’s a good thing!
- Part-time employment. Reach out to former team members to see if anyone will come back, even on a part-time basis. Hiring part-time people or bringing back former staff members for part-time employment can help create the necessary coverage for a practice.
Dental insurance reimbursements
Trend and challenge
Dental insurance companies are typically lowering reimbursements as opposed to raising them. This happens differently in various regions of the country and for different dental insurers. In a time of inflation, when dental practices should be increasing fees simply to keep pace, dental insurance companies are not adding inflation adjustments to their reimbursements. If inflation rises and reimbursements remain stable, the only solution is to increase practice production to offset the effects of inflation.
The antidote to lower dental insurance reimbursements is to improve practice systems and efficiency.
- Accelerated scheduling. Implement a true accelerated scheduling model where a doctor can work two or three rooms, with each room having its own highly skilled full-time assistant. As doctors move back and forth between rooms in a true accelerated scheduling model, they have the potential to increase their production immediately by 30% if there is sufficient patient flow. Willingness to delegate significantly to the dental assistant is a key factor, so assistants must be highly trained with ongoing education.
- Longer appointments. Longer appointments that can handle multiple treatments often create high levels of practice efficiency. Overhead in certain long appointments can drop by as much as 20% after 90 minutes; as well, patients find longer appointments convenient, and longer appointments typically represent higher production.
- Same-day treatment. Same-day treatment is now becoming essential for many practices to reach the daily production goal. Between dentists and hygienists, there are many opportunities to identify treatment and have the patient complete treatment that day, which is convenient for the patient and the practice and increases practice production toward the daily goal.
- New patients. New patients, of course, are essential to production. But you may be surprised that the average new patient production in the first 12 months is 200%–300% higher than the average active patient. Also, scheduling new patients sooner increases practice production faster.
- Emergency patients. Get emergencies in that day. The case acceptance on emergencies is typically extremely high, often as high as 97%. Emergencies add to production.
- Procedural time studies. Consider performing procedural time studies to evaluate the scheduling system. Saving 10 minutes per hour in a dental practice amounts to the equivalent of two months a year of increase to doctor production based on a four-day week. In a 36-year career, this adds up to an extra six years of increased doctor production time.
Expansion of DSOs
Trend and challenge
Like it or not, DSOs are part of the dental profession. In recent years they have been growing and will continue to grow for many years to come. However, while it’s unknown at this time what percentage of practices will come under the DSO-style umbrella, private practice is still alive and well and will continue.
Admittedly, DSOs do offer advantages. They have strong marketing power that can benefit several affiliated practices in a geographic area. They have the purchasing power to procure supplies, materials, equipment, and technology at lower cost. Some DSOs even have in-house training and offer multiple specialty services.
For independent private practice dentists, DSOs represent a legitimate competitive factor that has emerged in dentistry in recent years. However, there are many opportunities for dental practices to address DSOs, including joining buying groups, participating in study clubs for continuing education, hiring expert trainers, and attending clinical institutes.
One question we are often asked is whether a practice should sell to a DSO. This decision is individual for each practice based on several different parameters. Questions that should be asked include:
- How will it affect a pathway to financial independence?
- Is the dentist ready and willing to be an employee?
- How much change will a DSO insist on for the practice?
- What percentage of the purchase price will be held back based on production over the next few years?
- What are the DSO’s culture, values, and vision?
The recommended solution is to build and maintain the best-run practice that you can. Keeping the practice systemized, efficient, and simplified is critical to success. Advancing technology will make daily dental practice easier and more efficient and allow for increased production. The concept of technology workflow in practices is continuing to emerge, and technologies are becoming excellent in advancing comprehensive clinical treatment. In addition, the practice should be designed as an extremely well-run business with documented, proven, and step-by-step systems that allow the team to become highly trained and manage day-to-day operations effectively.
Trend and challenge
Stress, anxiety, fatigue, and burnout in dentistry are at higher levels than ever before. It is similar in many fields due to the complexity of moving through the pandemic and managing a business.
Keep in mind that burnout is not a short-term effect; it is recognized as an occupational phenomenon by the World Health Organization (WHO), and it should be addressed preventively if possible. A team that suffers from burnout, fatigue, anxiety, or stress is a less effective team and could result in individuals leaving the practice permanently.
There are numerous ways to prevent burnout-related fallout. Here are some that you might consider:
- Take care of yourself. As always, sleep, nutrition, and exercise are part of the solution. It simply makes sense that if you get enough rest, eat well, and exercise, your stress level and pathway to burnout will be reduced.
- Take time off. Make sure you have adequate downtime. Taking vacations and days off, enjoying weekends, and spending time with people you love all contribute to less burnout.
- Take care of your team. If you take care of your team, they take care of you. Having monthly surprises such as lunches, stocking the refrigerator with food, and giving out gift cards all demonstrate caring. It is also essential for team members to have vacations so that they get downtime and rest. Finally, periodically meeting with team members for 10 or 15 minutes just to check in on them goes a long way toward avoiding burnout and showing them that you genuinely care.
At the time I am drafting this article, what will happen with the economy, gas prices, global conflicts, and interest rates is unknown. There will always be good economic cycles and not-so-good ones. The key to success in any business is to be proactive and resilient. Great leaders think ahead. Systemizing the practice, training the team, taking care of the team, building a culture of excellent customer service for patients, and having excellent financial management all go toward the heart of building and maintaining an extraordinarily successful practice.