At their core, the U.S. and Canadian dental markets share many more similarities than differences, according to this CEO.
The actual practice of dentistry doesn’t switch too much across the borders and that in both countries dentistry is a people business.
Jeremy Behar is CEO of Canadian Dental Services, one of Canada’s five major DSOs. He recently spoke with Becker’s about where the Canadian and US dental industries line up — and where they don’t.
1. The clinical playbook is identical. The biggest difference is the payer landscape.
Mr. Behar said that the fundamentals of dentistry don’t change at the border. “American teeth and Canadian teeth don’t carry passports; they’re teeth,” he told Becker’s. The clinical model, the technology and the staffing structure, with dentists at the top, supported by hygienists, dental assistants and administrative staff, are the same in both countries, he said.
The biggest gap, according to Mr. Behar, is the payer landscape. Canadian insurers are roughly a decade behind their U.S. counterparts in how aggressively they deny and manage claims, he said, which means Canadian DSOs can run with far leaner revenue cycle management teams. “If I was running exactly the business I’m running in Canada anywhere in the U.S., I’d have to 10x my accounts-receivable team to get money in the door,” Mr. Behar said. He said the ratio of accounts-receivable staff to patients in Canada is a data point worth watching for U.S. DSO leaders benchmarking their own overhead — and one that could shift if Canadian payers eventually manage claims more like their U.S. peers.
2. A new federal subsidy is already changing who walks into Canadian clinics.
Canada has long ranked among the highest in the Organisation for Economic Co-operation and Development for dental “IQ” — the share of the population that visits a dentist regularly, Mr. Behar said. He put that figure at 70% to 80% historically, compared with the roughly 50% of the U.S. population he said has seen a dentist in the past 12 to 18 months.
That utilization gap is widening further because of the Canadian Dental Care Plan, a federal subsidy that began rolling out roughly two years ago, according to Mr. Behar. The program covers basic care such as cleanings, cavity repair and root canals for lower-income Canadians who lack dental benefits through an employer. Mr. Behar described it as tens of billions of dollars in new spending directed at a population of 40 million, and said CDS clinics have already begun seeing new patients who previously couldn’t afford care. For U.S. DSO leaders and policymakers weighing what a public dental benefit could look like in practice, he said, Canada’s rollout is becoming a live case study.
3. There are five national DSOs operating in Canada — and CDS is the only one that isn’t private equity-backed.
Canada has five national DSOs operating at true multi-province scale, Mr. Behar said, and CDS is the only one of the five that is Canadian-owned and unsponsored by private equity. The ownership structure reflects a deliberate strategy rather than an accident. CDS prioritizes organic growth over acquisitions, makes tuck-in purchases only when there is cultural alignment, and employs no in-house mergers-and-acquisitions staff, he said. “We don’t spend a single dollar on M&A payroll in Canada in our business — the others have armies of the people,” Mr. Behar said.
The ownership distinction matters to sellers, and he encourages dentists weighing an offer from any enterprise DSO to treat it as choosing a long-term partner, not just a payout. “For every seller, whether it’s a week, a month or a year, at some point the honeymoon of the check wears off a little bit, and you still have to put your pants on one leg at a time every morning and go to work,” he said. “Get to know the people that are offering you a relationship. Don’t just get to know the money.”
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