How inflation is affecting oral surgery: Dr. Jason Auerbach

Oral surgeons could be seeing a decrease in patient flow as inflation affects their willingness to spend on dental care, one oral surgery leader says. 

Jason Auerbach, DDS, is the founder of Riverside Oral Surgery, a New Jersey practice with 10 locations in the state. He recently spoke with Becker's about how inflation is affecting oral surgery practices and the importance of implementing a positive work culture for employee retention.

Editor's note: Responses were lightly edited for clarity and length.

Question: How is inflation affecting oral surgery practices?

Dr. Jason Auerbach: A good portion of dentist fees are controlled by the insurances with which they participate, and reimbursements have not kept up with inflation for the last 40 years, let alone the last year and a half where we've seen a significant jump in inflation, which is an unfortunate reality for dentists because dental materials cost more. There are a lot of increased costs in terms of employee costs and fringe benefits like healthcare, etc. So, the cost of doing business with dentists has risen, but you can't really pass those fees along to patients. Inflation in general has affected patients' willingness to spend on dentistry. A lot of people will sacrifice their own health just to take care of basic needs like gasoline and food, etc., which of course, turns into bigger problems for patients and ultimately the need for urgent or emergent dental care, which can be costly and more significant in nature akin to what we were seeing in early COVID when most of the general dentists were shut down, [when] we as oral surgeons were seeing more urgent and emergent patients. It can overburden an already burdened healthcare system, both in the urgent care world and in emergency rooms and hospitals.

As an oral surgeon, most of our procedures are referred to us by general dentists, so I don't know that we see as many no-shows and cancellations. I would say there has been a slowdown from the peak after there was a surplus of patients who were neglecting themselves in the early part of COVID that increased the total number of patient visits in the end of 2020 and through 2021. 2022 [went] back to more of a cyclical nature of patient visits, which is typical for oral and maxillofacial surgery, especially in private practice. We haven't seen cancellations as much as maybe a slight decrease in referred patients, which might indicate that general dentists are seeing more cancellations.

We've been very sensitive to [inflation]. We've, I don't want to say put a moratorium on fee increases, but we have, which I think is welcomed by patients. Nonetheless, it becomes burdensome when you're looking at, especially, a larger practice where you have a large payroll and significant cost of goods and supplies.

Q: What challenges do you predict for the oral surgery field in 2023?

JA: The biggest issue we have, and I think probably anyone I speak to in the industry is having, is finding good people to work. It's very challenging to find good people to bring onto your team at any level, from entry-level administrative staff to people who can speak about finances, to a higher-level manager or director and the surgeons. It's very difficult to find good people who want to work, who want to commit themselves to the process of learning and getting better and then ultimately achieving what makes our practices great, which is creating the optimal patient experience. Finding good people is really challenging.

It costs a lot more to employ our team than it did a short time ago. So again, with a limited capacity in terms of the ability to increase fees, it puts us in a position where our margins are squeezed a little bit. The profitability of practices becomes less because everything costs more, and our fees are not going up. [Also,] the availability of surgeons given the pressure from corporate dentistry and their ability to pay surgeons significantly more because of the overwhelming number of patients they have. So, it's much more difficult to recruit good, qualified surgeons, many of whom were in residency programs during COVID-19, and therefore, their training experience was limited relative to the training experience those who came before had because they were covering ICUs and ERs.

I think a major issue in terms of something we're looking at in oral surgery is shortages of drugs. We routinely throughout our careers have experienced different shortages of anesthetic drugs, IV fluids and things like that, but now we're seeing shortages of antibiotics and other types of medications that are necessary. Even emergency medications in some cases have been in short supply.

Q: How can practices implement a successful work culture to recruit and retain employees?

JA: I think culture is a huge piece of it, and for many years the culture piece was really what separated Riverside from everyone else. We had almost no turnover whatsoever until COVID-19, and then we lost some people. As we've gotten a little bit bigger, the culture piece has become a little bit of a challenge because it's difficult to scale culture. It's about relating to the people with whom you work on an everyday basis and having that one-on-one relationship so people know that, as the employer, you care. Everyone thinks having little pizza parties and all that matters. It doesn't really matter. What matters is really the moments within the office where people are talking to one another and getting to know one another as human beings. As a point of pride, NJBiz does the "Best Places to Work" in New Jersey, and we won that this year and that was directly reported by our team members. But again, despite that, it's still challenging to fill positions that are open. That's a huge part of it.

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