The effects of COVID-19 are changing the industry in ways dental practices are having a hard time keeping up with, according to one dentist leader.
Brandon Prusa, DDS, is the owner of Compass Dental, which has four locations in the Chicagoland area.
He spoke with Becker's about the top challenges facing the dental industry, including inflation, workforce shortages, burnout and low reimbursement rates.
Editor's note: Responses were lightly edited for clarity and length.
Question: How are insurance reimbursement rates affecting your practice?
Dr. Brandon Prusa: What I've noticed in the last probably six months is Aetna and a couple of other insurance companies are starting to add a dental component as an additional supplement to people's Medicare. And it is a PPO policy so we accept that. It is decent insurance, but my fear is eventually that these insurance companies keep trying to reduce our reimbursement rates and our billable rate since we're in network. And what scares me is they're going to keep trying to do that. With inflation, the cost of living has gone up for everyone and our reimbursement rates have not gone up; if not, they're trying to lower them. These insurance companies have massive profits, and you see all these hospital systems that are having major financial issues. It's becoming such an industry where you have to be a business owner that does dentistry. It's getting to be a hard industry.
Insurance companies in the dental industry really need to come to a better solution because employees are wanting more money, [and] the bottom line is just getting smaller. Insurance companies, they're the ones that are really making money and they say that they want to help the patient and they're an advocate for their subscribers, but at the end of the day, if you're lowering the reimbursement fee, some dentists have to see more patients so they're tired. [The insurance companies] are shooting themselves in the foot.
Q: Are dental schools doing enough to educate students about the business of dentistry?
BP: They don't at all. They basically get you to pass the boards, get you on and [then] they get a new class for money. Unfortunately, it's all become a business. And then you've got banks that are handing out loans right and left, so they build these beautiful offices with all this technology because the suppliers, they all make it seem like you have to have every toy in the book for patients and these dentists don't realize you have to build relationships. You have to work 24/7 to get patients. It's a lot of work.
Q: How has patient retention been at your practice?
BP: For all of my practices, we have such a good word of mouth with my offices that we're really busy right now. We're very fortunate, but I'm hearing a lot of horror stories. All my offices are in neighborhoods or the suburbs of Chicago. And we have gained so many new patients from downtown dentists simply because people are not going downtown anymore and they don't want to. They aren't working in the office as much, crime is way up in Chicago. And so all my offices have received so many new patients that just don't go to their dentist downtown anymore. So we've been fortunate, but I've heard a lot of stories about dentists that are really struggling downtown.
Q: How is your practice dealing with staff burnout?
BP: Personally, I've had burnout from patients. People as a whole are just really agitated and I feel like patients are extremely rude to my staff [and] to myself since COVID. It's been very interesting to see how people's behavior is and I'm not practicing as much because I just couldn't take it anymore. Patients just really are difficult, and we see that in every industry, but in dentistry, patients already come in anxious … and everybody's so negative. It's when you just take on these negative things all day, it's just really hard as a practitioner to stay positive. So you've got that component plus the financial component, [and] it's not like it used to be. I think [it's] crime, inflation, politics, COVID, it's just all been a perfect storm that people are just agitated and they come in anxious and they're just easier to flip. I'm booked out for a few weeks and patients get really mad and say, "Well, why isn't he available now?" It's almost like an Amazon effect. People want it now [but] we can only accommodate so many patients at one time.
I tell [my staff], "Come talk to me, let's get through this together." You have to be such a leader these days too, because if you don't lead and you don't talk to them and make them feel valued, which I do value all of my employees, you can tell. There's people that are looking for better opportunities because it's not just about money. They want to feel valued.
Q: What supply chain issues are you experiencing?
BP: I ordered a new dental chair back in October. I just got it a couple weeks ago, and my other dental chair was dead, there was no saving it, so I was chairless in one of my offices for a long time. With dental supplies, not so much. I haven't had too many problems, but I buy in such bulk just because I learned with COVID. Before I was paying $2 for a box of 50 masks [and] during COVID that went up to $75 for that same box. We still have these waves coming, so I've learned to really stock up on PPE just because when I find reasonable prices, I buy a lot just to help combat that issue because we can't be operating without PPE.
Q: What other trends are you following in the dental industry?
BP: We're really busy because people haven't been brushing their teeth because they aren't going into the office, so people's mouths have been dirtier than they ever have been. My hygienists are always telling [me] and I see it when I work on patients. I've had lots of patients [aged 65 and up] that are breaking off front teeth. A lot of people are having decay. The body is producing less saliva because of the masks, so it's really created a challenge for a lot of patients. I've had patients that had great teeth and they're coming in with lots of cavities and broken teeth and they hadn't had these issues before. [We're offering more] education, fluoride supplements, fluoride toothpaste and just encouraging people that have really dirty mouths to come in for cleanings every three or four months now instead of the basic two times a year so we can monitor and make sure things aren't going downhill too quickly.