Rising labor costs and workforce shortages are squeezing DSOs’ growth plans — but three executives say the fix isn’t more hiring or acquisitions. It’s building a team that actually wants to stay.
Three DSO executives recently spoke with Becker’s to discuss innovative strategies for maintaining growth amid dentistry’s labor crisis.
Note: Responses were lightly edited for clarity and length.
Question: How will rising labor costs, workforce shortages and competition for dentists affect the ability of DSOs to continue growing?
Jessica Lo. Vice President of Operations of Urgent Dental Center (Indianapolis): I think it will assist with mergers and acquisitions because the individual and smaller groups will also feel those pains and there’s power in numbers. Aside from that, we do try to be very conscious of our spending, making sure we’re all doing our part. We flattened our organization recently just to make sure we’re utilizing all of our resources as best as we can, and everybody plays their role and does their part. That will allow us to invest more in growth in the future and into acquisitions.
The other callout is … we’re not very hygiene driven, so we don’t have that headwind. One of the things I’ve learned is that it can be very efficient for a doctor to perform the cleaning and to perform the [scaling and root planing.] Initially, they don’t all love it, but it can be very efficient. With our process, we have a new patient, we do their X-rays and exam, and then when we diagnose treatment, we talk a lot about same-day conversion and helping get the patient as healthy as we can before they leave. Typically, we’ll present the treatment plan, including the cleaning. Once a patient accepts and signs consents, the doctor will numb the patient and move straight into the cleaning. They’ll do all the scaling, the ultrasonic, and then they’ll move straight into prepping or whatever else it is that they’re doing. In Indiana, we have expanded assistants who can place fillings, so the assistants will come in, they’ll do all the fillings and scans or whatever else is needed, and then at the very end, they’ll do the polishing, flossing, fluoride and patient education on their oral health. It was surprising to me because we trimmed out a lot of that hygiene time [that is] spent in the chair. Versus a full hour of chair time, now we’ve trimmed it down very efficiently to 20 to 30 minutes at most, mixed in with a bunch of other procedures. You now have more chairs available. But again, the hump people have to get over is helping a doctor understand that it’s okay for them to perform a cleaning, that they are good at it, and that they now, instead of sitting and drinking a cup of coffee while they wait for the anesthetic to kick in, they can use that time to make just a little bit more, if that’s what motivates them, and to help that patient and save them a trip and chair time as well.
Hamza Asumah, MD. Director of Operations for Juniper Services (Sparks, Nev.): Labor has definitely been a big binding constraint to growth. First of all, as a DSO, you have to pay more for labor now, especially for providers in the hygiene market. We recently acquired our Boise locations, which are a different model, and we saw the effect of the labor constraints on our two markets because we had already built the structures in our other Nevada locations. We’d never had a turnover. We have the same core hygienists we’ve had for a long time. We are just adding to that, for the most part, for practices we are expanding. So, we have been very good at retaining, but on the other side, in our Boise locations, we saw a lot of turnover. We had to remodel whatever we had there to suit what we have here for retention.
That being said, it’s very important that even in the midst of this constraint, we get more innovative. As much as that will constrain growth, you need to spend that extra amount of money to be able to sustainably keep growing as a practice. If you’re going to be growing at 8% to 10%, or let’s say 15%, those constraints will probably drop your growth down by 2% to 3% more, but it’s important.
One of our very good factors, especially when it comes to the hygiene market, is our ability to implement what I think is a perfect assisted hygiene model. Now, instead of having two hygienists running two rooms, I have one hygienist. First of all, it cuts down your need to go out there and search for two hygienists for two rooms when you can efficiently use one hygienist to run two rooms. That’s where innovation comes in. How are you modeling the patient flow? Who is doing what at what time? How is the patient handoff done? Patients traditionally are used to hygienists spending the whole hour with them. Now, they have to probably spend half of that time with an assistant and half of that time with the hygienist. How is that workflow built such that the patient feels it’s a continuous care within that hour, even though they had two different people doing two different things? I think that’s where we need to start leaning toward.
When it comes to the front office, we have technology that can assist, whether it’s through phone answering systems, or AI has really taken up a lot of work from the front, where you don’t need the number of people that you usually would need sitting up front trying to work through everything. The only thing you cannot replace is your clinical staff, and I think that’s where the effort has to be. Put in a structure to retain them. If you are able to get a team that has more efficient ways to work, they’re not burning out, and they have very clear paths to growth. We had a hygienist who worked with us for a long time and transitioned into another DSO in a management role. If you have a group like that and you really want to solve your labor issue based on what has happened in the market now, create a clear growth plan for every role. Make sure the [staff] knows what their end could be with your support. There should be a clear pipeline for them.
If you want to limit how much [labor challenges] constrain your growth, you really have to be innovative because the only way you can actually grow at all is making sure you have ways to keep people in the organization and keep them happy so that the market trends are not affecting their judgment and affecting what they should be doing at any point.
Haim Haviv. Founder and CEO of Hudson Dental (New York City): I always see dental as a team sport, almost like a basketball team. You have the coaches, which you can say are the corporate people or the manager, and then the team players are actually doing the work on your team. It definitely cannot grow by buying more and more and more if you are not able to retain your team and recruit team members who stay with you. It’s recruiting and retention. Everybody knows recruiting. Everybody has jobs on job boards, but retention is the harder part and the trick here. For us, retention is identifying for each role, what are their goals? What can be offered to them? But you need to customize that. Some hygienists don’t really want to do assisted hygiene. It doesn’t matter what you say. We can say it’s efficient, we can give them more money, or whatever it is, they just do not want to do assisted hygiene. In fact, they will not even apply if the job is assisted hygiene. Some hygienists are happy to do assisted hygiene if they feel supported. Some are happy to try it and then see if they want to do assisted hygiene. So, you have to customize the way you work. There’s no other way around it. There needs to be a growth plan for groups of them, but then [you need to] be able to customize plans at the local level. That’s number one.
Number two is training internally. We have a program in which we take people from other backgrounds, non-dental, and we train them according to our way and the way we do things. We actually found that, a lot of times, that’s more successful. You can start with 10 candidates that you interview or even 100. You may hire 10, and out of the 10, one would survive. So, the percentages are not high, but once you have that one, that one knows your culture, knows how you do things, and it ends up being less expensive for you and [enables] growth.
One more thing is, there’s a difference between a single dentist office and a group. It doesn’t matter if the group has 15 locations, 150 or five … When you take people from a single dentist office, even if they are amazing people, they are still accustomed to the dentist sitting down at midnight and making sure supplies are on target. If you do it in a group, nobody’s going to sit down at midnight and make sure you can buy off label from foreign countries. You’re going to have to order from the big vendors because you have to do it in an applicable and consistent way. So, you need to know that when you hire these people, they come with that behavior. It’s not their fault. It’s just the way it is. So, training is something big that we do. We take people from coffee shops, we take people from hair salons, we take people from car dealerships, and if they feed the culture and they are hungry to learn, we teach them. We take dental assistants with zero experience. When they are at a level in which they can actually perform, then we can send them and pay for their education, for the extra lessons, etc. Up until then, they can do sterilization, they can cover the front and back — they can do a lot of things in their office to show us they are the right fit for the organization, and then we’re happy to pay for them. Suddenly, you took somebody who was making close to minimum wage, and you gave them that path. Sometimes they even leave after a few years or they get promoted, which is okay. But the ones you want to keep, you have to constantly see, okay, they’ve done so much this far — what are we offering them? What’s the plan for the next two years? That’s how you can solve the growth issue. You cannot grow a dental company without people that stay with you. The revolving door is not really a solution. You can always hire. Hiring is easy. You offer a job, you interview, people will show up, at least on the first day, but that’s not really the solution longer term.
At the Becker's 5th Annual Future of Dentistry Roundtable, taking place September 14-15 in Chicago, dental leaders and executives will gain insights into emerging technologies, practice growth strategies and the evolving landscape of dental care delivery, with a focus on innovation, patient experience and operational excellence. Apply for complimentary registration now.
