I graduated from dental school in 1988. It seems like yesterday,
but denial of the passage of time isn’t working for me.
After dental school, I spent three years in the Navy. My first
job in the civilian world was in a corporate dental practice that
catered primarily to patients with managed care dental plans. I
spent about a year there. After that, I associated in a private care
practice for two years. Then I started my own private care practice
There's a Blue Light Special in Op #2
Nearly twenty-six years ago, rather than encouraging us
about the future of dentistry, the illustrious dental school professors
at my school painted a rather bleak picture. The “golden
days” of dentistry were in the past. The future was “Sears
Dental.” And, the future was breathing down our necks. Sure
enough, a few Sears Dental offices opened inside some of the
retail giant’s stores. A Google search reveals there are some Sears
Dental offices still around. But, they haven’t proliferated.
One could argue that the retail dental concept has proliferated…
under various names and companies. Today, there are
corporate dental offices that number in the hundreds (if not
more). They are aggressively marketed to the public via nearly all
marketing media. What does it mean to traditional solo private practice? That’s the $64,000 question. I don’t claim to be an
expert in macro or microeconomics. I can only give my opinion
based on 25 years of experience and observation. In a nutshell,
I’m not worried.
The End is Near!
I’ve been hearing the prognostications of doom for private
care dental practices my entire career. I am also reminded of the
“warnings” about a caries vaccine decimating the business of
dentistry. It’s a good thing I didn’t hold my breath. That “vaccine”
has been coming for decades, as well.
I don’t see corporate dentistry as a threat to my practice any
more than McDonalds being a threat to traditional sit-down
restaurants. They each serve the purpose of market stratification.
There are obviously many people who happily patronize
McDonalds. Likewise, there are many who scoff at the mere
notion of eating at McDonalds. “I would never (let my children)
eat that crap.” I submit that the two factions are not divided by
socio-economic status. It’s simply personal preference based on a
variety of factors including perceptions of health, quality, taste
The same is true for dental care. While many people see dentistry
as a commodity, others see it as a very personal service. For
some patients, a crown is a crown is a crown. And, it’s a tall order
to convince them otherwise. For them, low price, convenience
and fast service are the most important features of dentistry.
They likely can’t name the dentist that saw them last. And, that’s
OK! It works for them.
Let’s Get Personal... Personal...
It’s been long argued that dentistry will go the way of optometry
and pharmacy. I disagree. Those fields are not comparable to
dentistry. I contend (and many patients will surely agree) that
dentistry is arguably one of the most personalized services in the
human experience. We (dentists) are quite literally “in their faces.”
We’re actually inside their faces. And, they’re awake for it! The
mouth is one of the most intimate areas of our bodies. Consider
how a person will react if you touch them on the shoulder versus
the mouth. You can bet that merely touching someone on the
mouth without invitation, even with light force and an open
hand, will elicit a very different response than if you slap him or
her on the shoulder.
The mouth is personal... in many ways. The mouth is the
most emotively expressive part of our face. We also use it to talk,
eat, kiss and even breathe. The mouth is critical to human existence.
Poking at it with sharp instruments, loud drills and our
hands is not something most people enjoy. And, many will have
to place a lot of trust in the person who is doing the poking and
probing. For those patients, I submit that a “corporate” entity is
not going to cut it (pun intended).
“I Ain’t Got Time for That!”
A private care practice has the opportunity to cultivate relationships
with patients. I believe that such relationships are not
likely to occur in the corporate dentistry setting. Again, I’m
speaking from my own experience. The corporate dental practice
I worked in was a fast-paced setting. We didn’t have time to
chat up our patients. The rule of the day was, “Get in. Get out.”
Some patients were not bothered by it. Others were. I was. And,
that’s why I didn’t last long in that setting. It just wasn’t for me.
I enjoy getting to know my patients. It helps me help them.
They seem to enjoy it, too. I’ve
had patients leave my practice
because their plan changed
such that they felt they had to
see an “in-network” dentist. In
my area, it seems a preponderance
of “in-network” dentists
happen to work in corporate
dental practices. Oftentimes,
those patients come running
back. The experience is simply
very different, and they’re anxious
to tell me all about it.
What Ever Will We Do?
I see a lot of hand-wringing
by dentists about the bleak
future of private care dentistry.
I believe they are mistaken to assume that all or most
patients will jump ship and go to the cheaper corporate
dental practice. Some will. Some have! I say, “so what?”
Rather than being my competition, I see the resulting market
stratification as a way to make my practice stand out
even more. If more dentists bail out of private care practice,
I will have less competition. I see the potential scarcity
of private care practices as a boon to those of us who stay
the course. As the “sit-down restaurant” patients are disenchanted
with the corporate experience, they will seek out
practices like mine and be willing to pay for it. I’m not suggesting
that every patient will be disenchanted. No doubt,
there is a market for corporate dentistry. My point is that
I don’t believe private care dentists have to compete with
them. We can coexist just as fast food and sit-down restaurants
Stand Up! Stand Out!
I believe the key to survival and success in private care dentistry
is to provide a personalized service with attention to detail
and the total experience. Your entire staff needs to be onboard,
of course. Furthermore, I think today’s private care dentist has
to continually develop his or her clinical skills. Dentistry is
changing at an ever-increasing pace, and continuing education
is your ticket to keeping up and staying ahead of the curve.
Offering services beyond the “drill, fill and bill” menu is a great
way to distinguish your practice as something more than the
commoditized dentistry offered in the corporate realm.
Adding services such as: short-term cosmetic orthodontics,
implants, cosmetic smile makeovers, full-mouth rehabs, botox
and fillers, laser periodontal treatment, deep bleaching and
other elective services can go a long way toward success in the
private care world. But, I dare say you better have the “chops” to
do it well. Patients who seek these services do their homework.
They often conduct research online before choosing a dentist.
Show Me. Don’t Tell Me.
A great thing about these elective services is that they are
very marketable. One of the best ways to prove your “chops” is
with a great website. If you provide cosmetic services for example,
show them to prospective patients searching on the web. If
you have a well-optimized website, prospective patients searching
for these services will find you.
Another very powerful website marketing tool is patient testimonials.
They can be written (paired with before and after photos),
or they can be done by video embedded on your website. Real testimonials
with real stories are marketing gold. Online review sites,
such as Google Reviews, have become increasingly influential in
my experience. Just this week, I had two new patients attribute
their decision to come to my practice upon my online reviews.
But, it takes more than advanced clinical skills. It takes relationship-
building skills, too. That means running on time. It
means knowing and calling your patients by name when they
walk in the door. It means “we care” calls after treatment.
Be the (Wo)Man with the Plan.
Another way to stand out is to recognize that 60 percent of
Americans do not have a dental plan. They believe the only way
they can obtain dental treatment is by having an “insurance” plan
or going to a practice they perceive as less expensive. Corporate
dental practices often use lower cost as a marketing enticement.
An in-house dental savings plan is very much welcomed and
appreciated by that 60 percent. Furthermore, the in-house dental
savings plan is another way to market and differentiate your practice
as one that caters to the individual patient.
It’s Your Move.
In conclusion, my position is one that advocates “hitting
them where they ain’t.” Trying to compete with corporate dentistry
on their terms and their turf is a sure way to get frustrated
and dig yourself into a hole. Where will dentistry be in 20 years?
I dare not try to predict that, given the way the political winds
are blowing. I won’t even pretend to know where dentistry will
be next year.
Ultimately, each dentist must decide where he or she wants
to be next year, five years forward, or 20 years down the road.
Do you want to work for yourself? Do you enjoy being an
entrepreneur? Or, would you rather be a worker-bee for
a corporate entity and not have to deal with the business
side of it? There is nothing wrong with any of
the choices. However, I refuse to believe that
the future is pre-ordained, determined by
forces outside of dentistry, or that the
extinction of private care dentistry
is inevitable. The times… they
may be a-changin’. But, the
choice remains yours.
Dr. Michael Barr is a general dentist with a private care, fee-for-service practice
in Boynton Beach, Florida. He is a voracious consumer of dental continuing
education (more than 2,000 hours) and has a keen interest in cosmetic
dentistry. His other passion in dentistry is marketing, specifically
website marketing. To that end, he wrote a book, “The Complete
Website Owner’s Manual for Dentists,” which is soon to be
released as a second edition. Mike has been an active
member on Dentaltown.com since its inception and
is closing in on 30,000 posts.
In the next 20 years, it is my belief that half of all dentists
will be affiliated with a DSO-supported practice—the
companies often mislabeled as “corporate” dentistry. If
that belief does come true, I do not think the cause will be
dental support organizations (DSOs) “taking over” private
practices to gain control over the dental industry. My belief is
that DSOs simply recognize the current face(s) of dentistry
and are responding to the realities of the marketplace.
I think DSOs are a valuable model for modern times.
Modern dentists are encountering a multitude of challenges,
including keeping up with technology, increased
costs, slowing number of patient visits, government regulation,
legal issues, third-party payment changes, $300k+ in
student loan debt, implementing cutting-edge marketing
techniques and more. It seems most of these aspects have
been largely discounted or ignored by folks who are invested
in the hope that the future of dentistry will continue to
repeat the past. The free market ultimately decides what
comes to pass. It will not be organized dentistry deciding,
nor DSOs deciding. Dentists will decide what is best for
their personal situation. Many dentists will continue to
desire the independence of
solo practice. I predict an
equal number will recognize
the positive realities
of how various DSO models
meet or exceed their personal
and professional needs.
DSOs are responding to
a marketplace where dentists
want out of debt, want work/
life balance and freedom to
relocate. Most dentists don’t
really want to deal with business
responsibilities. The economic
problems we’ve seen
in the country have established
a new reality in our industry
– many dentists are unable to
sell or share their offices with
associate dentists, and young
dentists with a large amount of student loans can’t finance a new
office or startup on their own. This has led to a doubling of the
number of quality dentists searching for a means to succeed.
DSOs can offer them that.
Settling differences between organized dentistry and DSO-supported
dentists is still a challenge, but I think the majority of dentists
share common ground. Those supported with DSOs have
professional support, but still lead their offices and make decisions
regarding their patients and teams. In that regard, there’s really no
difference between a DSO-supported office and a non-supported
office, except for the extra support and training DSOs offer.
Simply put, DSOs have identified what dentists are looking
for in these modern times. In doing so, these organizations are
able to support dentists from all career levels in advancing themselves
and overcoming industry challenges. New dentists are
offered the chance to start their careers out on the right foot.
Experienced dentists can achieve a work-life balance and control
their career on their terms. That’s why I believe DSOs will continue
to see significant growth over the next 20 years.
Dr. Rick Workman, is founder and
chief executive officer of Heartland
Dental. While practicing full-time,
Dr. Rick Workman created Heartland
Dental, a world-class dental support
organization offering affiliated
dentists non-clinical, administrative
support. Heartland Dental has
more than 550 affiliated dental
offices in 26 states. Dr. Workman
has received many awards and honors.
Most notable is his receipt of
the Ernst & Young Entrepreneur of
the Year Award, Masters Category.
Dr. Workman may be reached at
First, I must say that there is no such thing as “corporate
dentistry.” Only dentists practice dentistry. That said,
dental support organizations (DSOs) are a growing segment
within dentistry because they bring tremendous value to
dentists and their patients. DSOs enable dentists to expand
access to care, improve efficiency of office administration,
reduce the procurement cost of dental care supplies, and
deploy advanced technologies that improve patient care and
safety while, in some DSO-supported offices, enabling sameday
It has been estimated that
more than 40 million
Americans have little or no
access to affordable dental
services. DSOs help address
this crisis by enabling dentists
to devote more time to treating
patients who need care
and less time to non-clinical
paperwork and other aspects
of running a business. Many
DSO-supported dentists also
serve communities where residents
often lack access to
convenient, affordable quality
The key advantages that
DSOs offer the dentists they support are enhanced capacity, access and consistent care.
Dentists who partner with DSO-supported group practices
focus almost exclusively on patient care, therefore enhancing
capacity. In helping to address the access to care issue, lower
overhead costs enable DSO-supported dentists to accept all
payer types and have helped open states to managed care plans.
Lastly, group practices support best practice sharing, peer-topeer
interactions, evidence-based treatment protocols, access to
new technology, training, mentorship and formal compliance
programs, resulting in consistent care for patients.
DSO-supported dental practices are often in convenient
locations, engaged in community marketing, improving the
number of patients activated to seek oral healthcare. The patient
may seek care at the DSOsupported
office or another
office, the important component
is the contribution to
increased number of people
deciding to visit the dentist.
offices, specifically, are community-
based with a focus on
the local neighborhood. The
owner dentist is highly integrated
in the community and
works at the dental office
each day to build long-term
relationships with patients.
Dentists also benefit from
using the business support
services of DSOs for tasks
including facility maintenance,
and other administrative support. In addition, DSO-supported
dentists enjoy the benefits of being part of a college of affiliated
dentists. Dentists are able to expand access to dental care by
devoting more time to the delivery of high-quality, cost-effective
care to patients and less time to administrative duties.
I believe that by 2050, large dental group practices
will be critical components of an integrated healthcare
system where people can get exceptional, comprehensive
oral care at affordable prices throughout the
Dentists should choose the best model that works
for them and their patients. It may be solo practice; it
may be choosing to affiliate with a DSO. And, of
course, amongst the DSOs, there are different models
for dentists to consider. There continues to be a lot of
opportunity to serve patients no matter what model a
|Stephen Thorne, founded Pacific Dental Services
in 1994 when he entered into his first dental
business support services contract in Costa
Mesa, California. Steve received his BA from
UCLA and his Master's in Health Administration
from Chapman University. For more information,
Although corporate dentistry will continue to grow over
the next few years, we do not believe that it will take
over dentistry in 20 years.
Current estimates are that corporate dentistry is the fastest
growing segment of the market, but still less than 10 percent
of the overall dental volume. The actual market share for
“corporate dentistry” is difficult to calculate because there are
several different definitions of corporate dentistry. According
to the new ADA report A Profession in Transition, released last
year, “approximately 6.4 percent of dentists across the nation
report that their practice is part of a larger entity that delivers
dental care at more than one location, up from 5.4 percent
in 2008.” Regardless of the definition, corporate
dentistry has grown substantially over the past few years, and
will continue to grow.
However, the forces that drove the corporate takeover of
pharmacists or optometrists just aren’t present in dentistry.
The financial results for both of those markets are driven largely
by buying power, because in both markets much of the profitability
lies in buying products better and then reselling them to
consumers, so consolidation makes sense. More units means
more product buying power, which means more profitability.
Add in the fact that it’s hard to differentiate between service
providers (can one pharmacist be “better” than another?), and
you’ll see how consolidation played a key part in the growth and
development of both markets.
Dentistry, though, is fundamentally
different. Most of the
value added to patients lies in
the work, craftsmanship and
skills of the dentist. As a result,
the individual dentist is well
compensated for his or her
work, relative to pharmacists or
optometrists. Certainly, there
are some benefits to consolidation
in dentistry. Some dentists
would rather be employees of
larger corporations than individual
business owners, and
larger organizations means better
branding/marketing (i.e., Aspen Dental), but those benefits
are small relative to those from consolidation in pharmacy or
optometry. And the benefits are offset by higher staff turnover in
a corporate dental environment.
There’s a reason why we’ve only had a handful of corporate
dental chains succeed in the eyes of Wall Street. Most have
failed as long-term publicly traded companies because they
haven’t shown consistent growth in sales or profitability.
We believe that the dental provider scene in 2025 will look
similar to today: The majority of dentistry will be delivered by
a lot of successful entrepreneurial dental offices, though we may
see more group practices as dentists see the benefits of banding
together in small groups outweigh the costs and stress.
Corporate dentistry will become a more significant, though
far-from-dominant, player. And one other segment will grow
quickly, maybe faster than corporate dentistry: Community
Health Centers (also known as Patient-Centered Medical
Homes, or PCMHs) – non-profit organizations designed to
provide dentistry to lower-income families and individuals.
Rick and Chuck Cohen are
Managing Directors and thirdgeneration
owners of Benco
Dental, the nation's largest independent
dental distributor which
serves dentists and dental laboratories
throughout the United
States. In addition to Benco,
Chuck and Rick oversee Clarion
Financial, a sister company offering
equipment financing to dentists,
and a family foundation.
Solo practices are shifting rapidly to a two-to-three
multi-doctor model, just as medicine did in its
earlier phases. The cost of technology, facility and
labor are driving this trend, along with inefficiency plus
low-fee PPO reimbursements, which cut profits.
Though we often try, we cannot avoid change. Dentistry
is not immune to change. The growth and expansion of
corporate dentistry is one of those changes. What will
“corporate dentistry” do for our patients, the health care of the
nation and access to care? And how will it ultimately shape the
traditional practice of dentistry? No one knows for sure, but if
you’ll allow me to share my thoughts, time will tell if my “crystal
ball” is correct or flawed.
Access to care continues to be an issue of concern today and
corporate dentistry is touted as a potential solution to part of
the access challenge. There has been widespread and sometimesheated
debate about what can be done to address the access to
care issue. One solution is to increase the number of practicing
dentists. It appears many states and dental schools agree that an
increase in the number of dentists or mid-level providers will
increase the access to care. This increase is being realized in
- Increasing class size: Several dental schools have increased
class sizes. Producing more dentists to replace those who
are leaving the practice of dentistry is believed to be the
answer to providing better access to dental care.
- Increasing the number of dental schools: Many recall
between 1986 and 2001 when seven private, not-for-profit
dental schools closed their doors. That reduction in the
number of graduates was short lived. Since that last closure
in 2001, 10 dental schools (eight private and two statesupported)
have opened. There are at least two new dental
schools that have begun the process of organization.
- providers purportedly solve access to care issues and a few
states have them (Alaska and Minnesota). Approximately
10 other states are considering them.
The recent increase in dental school graduates highlights how
things can change quite rapidly in dentistry. Choices are limited
with the associateship opportunities as traditional practices fight
busyness issues, particularly those out of network. So, what do
corporate dentistry and these new dental graduates have in common
and how can this help the access to care issue? Simple, one
meets the need of the other… employment and appointments.
These new graduates are walking out of dental school with a
great deal of pressure to repay the gargantuan debt they’ve
accrued during their eight years of higher education. With hundreds
of thousands of debt on board, these new graduates are
reluctant to increase risk and go deeper into debt to buy an existing
practice or to build a new practice from scratch. For many
of these new graduates, corporate practice offers a way for them to begin to pay back those student loans and do it with
little or no investment.
In addition, many corporations provide flexible scheduling
that is especially attractive to those dentists who need
more time with family or other interests. Corporate practice
association oftentimes takes the management responsibilities
off the shoulders of the doctor and is delegated to the corporation.
The dentist can focus on patient care and not be burdened
by the stresses of day-to-day practice management. There is also
a significant opportunity for the new dentist to be mentored and
trained by a more experienced practitioner in the corporate environment.
Most new graduates need help and support to become
proficient in all areas of general dentistry. The corporate environment
allows for more opportunities to learn and grow while
being aided by a more seasoned doctor. This “hand holding” is
seen as a positive to many of the new dental graduates who are
concerned about their ability to hit the ground running.
What is the ultimate effect of corporate “drawing” new graduates
away from traditional practice and into the bigger cities
and more desirable locations? In many areas where corporations
are plentiful, the value of the traditional practices that have
busyness issues has dropped. Before, a doctor looking to transition
out of practice by bringing on an associate with the intention
of that associate becoming a partner or buying the practice
outright was the norm. Trends show that these types of transitions
are occurring with less regularity, in part because traditional
practices don’t have adequate busyness. Some doctors who
are looking for associates are having greater difficulty identifying
a willing candidate to become a part of that solo or small group
practice. That solo or small group practice doesn’t offer the same
employment package and significant perks that corporate dental
practices can offer these graduating dentists (who must produce
or they are out). What does this mean for the doctor who needs
or wants to sell his or her practice? The process may take longer
than anticipated and the selling price may be lower than desired
(or in rural areas, no sale).
What’s in it for patients when a corporate chain opens in
their area? Because corporations tend to focus on productivity
and efficiency, the consumer may benefit by paying somewhat
lower prices and enjoying the benefits of receiving care from a
participating provider. Corporate dental practices are participating
in most PPO plans and offer in-house discount
plans as a part of their business model. Many corporations
offer discounts and specials that reduce the costs associated
with a new patient visit. This type of promotion can have
the effect of drawing new
and established patients
away from the traditional
practice. In addition, corporations
offer more flexible
and financing options for
their patients. Many corporate
practices are open six
days a week, offering early
morning and late evening
hours, making it easier for
their patients to arrange
more convenient appointments.
In short, these expanded hours increase access to care
and drive busyness. In addition, the corporate practices are able
to provide more flexible financial arrangements as well. More
convenient hours and more payment options address the two
most common objections to accepting care: time and money.
What effect does the corporate practice business model have
on the practicing dentist? The established practice must compete
with the corporate “machine” oftentimes without the necessary
training, infrastructure and systems that allow the practice to
compete on a level playing field. The solo mindset is to place the
dentist first (himself or herself ), not necessarily the practice. For
instance, the solo doctor is in a tug of war to either keep the dollar
personally, or spend it on the practice if he or she sees value.
Less than half of all dentists even have an up-to-date coding manual, while 100 percent of
dental corporations are savvy
when it comes to coding.
Corporations capitalize first, buying all necessary equipment,
installing best practices and then withdrawing profits.
In the past, dentists have been successful in spite of the fact
that they lack business skills and have no particular interest in
running the practice. With the increased competition and pressure
from the well-trained, well-run and well-maintained corporate
practice, the solo practice must become proficient in the
business of dentistry and focus on the practice. If the solo practice
wants to compete with the group or corporate practice, or
any other practice in the area for that matter, the choice is really
quite simple: determine what the patient wants and needs and
offer a solution better than anybody else and the practice will
thrive. But, often it means a merger of several dentists to thrive.
With more than one dentist under one roof, the odds of at least
one of them being an excellent businessman goes up – increasing
the odds for a well-run practice. Multi-doctor also offers some
multi-specialization of procedures.
What’s the ugly side of corporate dentistry? When the practice
ignores the best interests of the patient and begins to focus
on what’s in the best interest of the corporation and its shareholders.
When the bottom line becomes the motivating force
behind the treatment decisions made, that’s when there’s potential
Many traditional dentists say corporations have questionable
ethics, routinely over-treat, perform shoddy work and suck out
profits. But, don’t a percentage of traditional dentists have
these same qualities? What about the under-treatment
of periodontal disease? Who is guilty of that?
Corporations are superior to the traditional dentist
who commonly under-diagnoses and
under-treats periodontal disease.
Is there a greater chance that the
focus of that practice can shift from patient care to a focus on revenues generated and the bottom
line when owned by a business entity, rather than a dentist? I
think so, but time and the court system will ultimately decide
Are corporations here to stay? Yes.
Will corporations continue to grow? Absolutely, until the
market will no longer support their expansion and their profitable
operation or legislation prohibits them.
Are dental corporations bad for the public? Not necessarily.
What’s the bottom line? If the focus of any doctor
(employed by a corporation or self-employed) remains primarily
focused on the patient and what’s in the best interest of the
patient, there’s room out there for everybody. A little competition
never hurt anybody, and it just might encourage the profession
as a whole to improve. Mark my words: We are going from
solo to multi-doctor, and a significant percentage will be dental
corporations. Corporations have already taken over most businesses
from optical to hardware stores, from fast food to hospitals,
from drugstores to funeral homes, etc. So, who’s left
standing besides dentistry? Not many.
Time will tell if these things come to pass and we are able to
find dentistry’s “new normal,” with corporate dentistry a significant
part of the mix. Now my forecast: Corporations will
be 20 percent of the market in 10 years. Well-run, local,
two to three multi-dentist offices can compete, for
the most part, with corporate-owned practices.
If they don’t, my 20 percent estimate will be
low! As we move forward, remember
what’s important and the patient and
the profession will benefit.
Dr. Charles Blair is the publisher of
Insurance Solutions Newsletter and
the developer of Practice Booster, his
online resource for dental coding and
billing. For more information, visit