There is a major thread running through most of what ails dentistry right now: reimbursement hasn’t kept pace with the cost of care, and seemingly all woes flow from there.
Fee schedules are frozen, new dentists are graduating with record debt, and what dentists used to manage as isolated pressures — a bad payer contract, a slow quarter — are now converging into a structural problem.
These seven dentists recently connected with Becker’s to talk about the biggest risks in dentistry that are not getting enough attention.
Editor’s note: Responses were lightly edited for clarity and length.
Question: Given how much economic and policy uncertainty is out of dentists’ control right now, what is one risk, economic and/or policy, that you feel the industry isn’t paying enough attention to? How should dentists be navigating it?
Murat Ayik, DDS. Partner of Specialty1 Partners (Houston): One risk we’re not talking enough about is the growing gap between what it costs to provide high-quality dental care and what practices are being reimbursed. Labor, supplies and technology all cost more, while reimbursement isn’t necessarily keeping pace. As doctors, we can’t control the economy or policy decisions, but we can stay focused on what we can control — running efficient practices, understanding our numbers, strengthening patient and referral relationships and continuing to deliver great care.
Steven Haase, DDS. Dentist of Oak Canyon Dentistry (Austin, Texas): After 38 years associated with our profession, it is monumentally difficult to discuss one risk considering many risks exist in the management/financial side, the administrative side and importantly, the chairside aspect of a dentist’s daily routine.
To narrow it down to one risk, I’d have to suggest the onslaught of discount dental plans, which most DSOs and many dentists incorporate into their business plans. It’s become very apparent the overhead costs of dental offices have far exceeded the past average. Considering today’s overheads and having to adhere to discount fee schedules, it’s virtually impossible to break even on profit.
With that said, the quality of our profession’s dentistry is the worst I’ve seen in 38 years. It’s apparent the time spent with patients and associated treatment has unfortunately been reduced to a bare-bones timeclock in response to these new fee schedules, leaving the patient without the fine details and perfection we are trained to reproduce and take pride in. I’ve been in a number of industries and I have never known another business that can discount its product fees by 50%, 60% or even 70% and offer its full quality, time and warranty to customers. But strangely, our profession seems to believe this model can work.
Barry Lyon, DDS. Dental Director of Main Street Children’s Dentistry and Orthodontics and Dental Care Alliance (Sarasota, Fla.): One risk I believe dentistry may not be paying enough attention to is the growing complexity of regulatory and payer requirements. Dentists are understandably focused on reimbursement, staffing, rising costs, interest rates and the broader economic environment. But as dentistry becomes more sophisticated and increasingly consolidated, the regulatory landscape is becoming more complex as well.
Practices and DSOs need to stay ahead of that complexity through strong clinical governance, clear documentation standards, regular education and periodic compliance reviews. This is particularly important as technology, billing models and payer requirements continue to evolve.
The goal shouldn’t be to practice defensively. It should be to build systems that allow dentists to focus on patient care while giving organizations confidence that their clinical and business practices can withstand greater scrutiny. In an increasingly complex healthcare environment, proactive compliance is not simply risk management — it is good business.
Robert Ortega, DDS. Dentist of MCHC Health Centers (Ukiah, Calif.): I think that DSOs, while now part of the dental landscape, place more emphasis on the bottom line rather than patient care. I know that is painting with a broad stroke, but we will see a few years down the line how that will shake out. I’m a dentist with 49 years of experience, and I have been a public health dentist, a fee-for-service dentist and a dental HMO dentist, so I have seen the sides of dental healthcare delivery systems.
Chris Salierno, DDS. Chief Dental Officer of Tend (Nashville, Tenn.): I think the greatest risk is the supply of dentists. Research from the ADA’s Health Policy Institute in 2019 projected that the supply of dentists would likely increase through 2040. Dentists are retiring later and we’ve been opening new dental schools for the past 20+ years. In that same time period, demand for our services has gone from increasing roughly 4% per year to 2%. I don’t know what will happen with demand in the near future, but there will certainly be more dentists to compete over it. We do have a distribution problem, and we need to find ways to bring providers to areas that have access to care issues (incentivize rural and public insurance work, reduce artificial licensure barriers across states, etc.), but just increasing the supply of dentists alone won’t solve that.
Robert Trager, DDS. Dentist at John F. Kennedy International Airport (New York City): The biggest policy that is out of control for most dentists is to not be in control or to not be able to defend against data breaches of patients’ records and personal information. An uninformed employee or a simple mistake such as opening the wrong link or attachment that seems harmless can lead to a data breach. Congress has to find a way to avoid these mistakes from happening in healthcare and corporate relations. Too many scammers are getting away with these scenarios and people are having to pay a ransom. All dentists should have a policy in place with their computer operations so that these data breaches won’t occur. The ADA or state and local dental society should have courses informing their members about data breaches.
Willie Williams, DDS. Practice Owner of Affordable Dental and Implants (Morristown, Tenn.): The risk I feel is getting too little attention is how reimbursement pressure is driving consolidation in dentistry. Fee schedules have barely moved while supply costs, lab fees and wages keep climbing. That squeeze makes independent practices more vulnerable, and it makes offers from DSOs and private equity harder to turn down. The result is a market where fewer dentists own their practices, and more of the leverage sits with payers and large groups. None of this is in any one dentist’s control, but positioning is. Dentists should navigate it by:
1. Knowing their numbers. Track overhead and per-procedure profitability, and review payer contracts every year.
2. Dropping or renegotiating plans that no longer cover the cost of care.
3. Deciding on purpose whether to stay independent, partner or sell, rather than reacting to an unsolicited offer.
