Navigating Dental Insurance Podcast (SayNoToPPOs.com)
Navigating Dental Insurance Podcast (SayNoToPPOs.com)
This podcast.blog teaches the best practices for cash flow, recurring revenue, Membership plans, PPO Fee negotiation, insurance best practices, marketing, reducing your dependence on dental insurance and building a fee for service practice.
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Jordon Comstock
Jordon Comstock

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Dentistry Is Stuck in a Stagflation-Like Squeeze — Here’s How Practices Can Fight Back

Dentistry Is Stuck in a Stagflation-Like Squeeze — Here’s How Practices Can Fight Back

8/18/2026 2:14:00 PM   |   Comments: 0   |   Views: 55

Dentistry Is Stuck in a Stagflation-Like Squeeze — Here’s How Practices Can Fight Back

There is something strange happening in dentistry.

Practices are busier than ever.

Teams are working hard.

Dentists are producing.

Patients still need treatment.

Technology is improving.

Fees on paper continue to rise.

And yet a lot of dentists feel like they are running faster just to stay in the same place.

That feeling is not imaginary.

The American Dental Association’s Health Policy Institute has documented what it calls an ongoing “fiscal squeeze.”Over a recent five-year period, practice revenues increased only 1.4%, while practice expenses increased 4.9%. The ADA says inflation-adjusted dentist earnings have been falling because practice expenses are growing faster than reimbursement.

Read that again.

Revenue: +1.4%

Expenses: +4.9%

That is roughly 3.5 times faster expense growth than revenue growth.

That is why I think dentistry is experiencing something that looks a lot like practice-level stagflation.

Technically, stagflation is an economy-wide condition involving stagnant growth, inflation and unemployment, so I would not use the term as an economics textbook definition of dentistry.

But as a description of what many dental practice owners are feeling?

It fits remarkably well.

Revenue growth is sluggish. Costs keep rising. Reimbursement isn't keeping up. Margins get squeezed.

Welcome to the dental stagflation problem.

And I believe one of the most powerful tools practices have to fight back is something surprisingly simple:

Build recurring revenue directly with your patients.

That means building a serious in-house patient membership program.

Not a dusty discount plan sitting on your website.

Not something your front desk remembers to mention twice a month.

I mean treating your membership program as a legitimate financial pillar of the practice.

Because if the economics of dentistry have changed, the financial model of the dental practice needs to change too.

The Problem Isn't Necessarily Production

When margins fall, the instinctive reaction is usually:

We need more production.

So the practice spends more money on marketing.

More leads.

More new patients.

More implants.

More Invisalign.

More hygiene.

More case acceptance.

And none of those strategies are inherently wrong.

But there's another question worth asking:

What if you're producing more dentistry inside a financial system that is becoming less profitable?

Imagine a restaurant whose ingredient costs, wages, rent and utilities keep increasing.

Now imagine that 60% of its customers hand the restaurant a contract saying:
“You can't raise our prices.”
Would your first recommendation be:

Serve more meals!

Probably not.

Eventually you'd examine the pricing model.

Yet dentistry often responds to deteriorating margins primarily by trying to increase volume.

That's the hamster wheel.

Work harder.

See more patients.

Add another operatory.

Add another hygienist.

Increase marketing.

Increase production.

Then wonder why the owner doesn't feel dramatically wealthier.

The underlying economics matter.

The Numbers Tell the Story

The ADA's numbers are difficult to ignore.

In 2025, average GP dentist income was about $215,320, and the ADA says inflation-adjusted earnings have been declining because of the widening gap between practice expenses and reimbursement.

The longer-term picture is even more striking.

According to ADA workforce data, inflation-adjusted average annual income for general practice dentists declined from approximately $267,168 in 2010 to $207,980 in 2024.

That's roughly a 22% decline in real income.

Think about what that means.

Technology improved.

Clinical capabilities improved.

Practice management software improved.

Marketing became more sophisticated.

Dentists became more productive.

And yet the inflation-adjusted economics for the average GP moved backward.

Something is broken.

The pressure isn't just coming from one direction.

Payroll is more expensive.

Supplies are more expensive.

Lab fees are higher.

Technology subscriptions multiply.

Rent goes up.

Marketing gets more competitive.

Benefits cost more.

Finding hygienists remains difficult.

And the ADA reported in 2026 that reimbursement rates had plateaued while hiring challenges persisted.

The ADA also reported that spending on dental services had increased only about 9%, compared with 22% for overall healthcare services and 24% for physician services.

Dentistry isn't participating equally in the healthcare spending boom.

That's a problem.

Then There's Insurance

This is where things become painful.

A dentist can raise the practice's UCR fees.

That doesn't necessarily mean the largest payers suddenly send larger checks.

Dental benefit contracts often determine reimbursement independently of what it actually costs you to deliver care.

In a 2022 ADA HPI poll, nearly 60% of dentists said insurance reimbursement rates had remained stagnant, while another 25% said reimbursement had decreased during the prior year. Only 7% reported increases.

And this hasn't disappeared.

In late 2025, more than half of dentists responding to an ADA HPI poll listed insurance-related issues—including low reimbursement and delayed or denied payments—among their major concerns looking into 2026.

So here's the fundamental problem:

Your expenses operate in today's economy.

Your labor costs operate in today's economy.

Your supply costs operate in today's economy.

Your rent operates in today's economy.

But a meaningful portion of your revenue may be tied to reimbursement schedules that don't respond to inflation the same way your expenses do.

That's margin compression.

And eventually you can't efficiency-hack your way out of it.

The Practice Can Fight Back

Fortunately, dentists are not powerless.

You have several levers.

You can renegotiate PPO contracts.

You can rank plans by profitability.

You can drop poor-performing plans.

You can improve case acceptance.

You can improve scheduling.

You can reduce waste.

You can increase fees.

You can improve hygiene productivity.

You can change your payer mix.

But there is another lever I believe far too many practices underestimate:

Build your own payer.

Your patient.

Instead of every uninsured patient becoming a cash transaction, build a recurring financial relationship directly with that patient.

That's what an in-house membership plan does.

What Is a Patient Membership Plan?

A membership plan is not dental insurance.

It's a direct agreement between the practice and patient.

The patient typically pays a monthly or annual membership fee in exchange for a package of preventive services and defined discounts or benefits on additional treatment.

A simple example might look something like:

$45/month

Includes:
  • Two preventive visits
  • Routine exams
  • Necessary X-rays
  • Emergency exam
  • 10–15% savings on additional treatment
The exact structure obviously varies by practice and state requirements.

But economically, something fascinating happens.

Instead of waiting for dentistry to occur before revenue appears, the practice begins collecting recurring revenue from its patient base.

That changes the financial architecture.

Imagine Starting Every Month With Money Already in the Bank

Traditional dental revenue is highly transactional.

Monday morning arrives.

The doors open.

You start largely at zero.

You have to produce dentistry to create that month's revenue.

Now imagine having 500 membership patients paying $45 per month.

That's:

$22,500 in monthly recurring revenue.

Before implants.

Before crowns.

Before fillings.

Before whitening.

Before Monday morning's schedule even begins.

At 1,000 members:

$45,000/month

or

$540,000 in annual recurring revenue.

At 2,000 members:

$90,000/month

or

$1.08 million annually.

Those figures are illustrative, not promises about any particular practice. But they demonstrate the mathematical power of converting part of the patient base into recurring revenue.

The question changes from:
“How much dentistry can we produce this month?”
to:
“How much revenue have we already built before we start producing?”
That's a very different business.

Membership Revenue Helps Fight Inflation

Suppose a PPO contract reimburses $900 for something you would normally charge $1,300 for.

Your payroll increases.

Your supply costs increase.

Your lab costs increase.

But the reimbursement remains $900.

Your margin shrinks.

Now compare that with your own membership program.

You control the economics.

You can evaluate membership pricing annually.

If costs increase meaningfully, you can adjust future membership pricing appropriately, subject to your agreements and applicable rules.

You're no longer waiting for a third-party payer to recognize that running a dental office got more expensive.

You are taking some control back.

That doesn't mean every practice should immediately drop every PPO.

That would be reckless.

Instead:

Build the safety net before jumping.

Grow your membership base.

Increase direct patient revenue.

Analyze individual PPO contracts.

Then make strategic decisions.

Membership plans can become the financial bridge between heavy PPO dependence and greater independence.

Your Best Membership Prospects May Already Be in the Practice

One of the biggest misconceptions about membership plans is that the practice needs to go find thousands of uninsured people.

Usually, there are opportunities hiding inside the existing database.

Look at:

Uninsured patients

Obvious.

They already trust the practice.

Give them a simple way to budget for preventive care.

Patients losing coverage

Retirement.

Job changes.

Self-employment.

Medicare transitions.

These patients may suddenly find themselves without traditional dental benefits.

Patients delaying treatment because of cost

The membership plan can create a clearer financial pathway.

Families paying high premiums

Some families may prefer dealing directly with a dental office instead of navigating another benefit arrangement, depending on their circumstances.

Patients who want predictable budgeting

Subscription economics aren't unusual anymore.

People subscribe to software.

Streaming.

Fitness.

Meal delivery.

Car washes.

Amazon.

Coffee.

Consumers understand recurring payments.

Dentistry shouldn't pretend the model is foreign.

The Hidden Benefit: Retention

A membership plan shouldn't only be viewed as a revenue strategy.

It's also a retention strategy.

Think psychologically.

A patient paying your practice every month has a fundamentally different relationship with the office than someone who hasn't visited in 19 months.

There's continuity.

The patient has already made a commitment.

They're connected.

They have a financial reason to use the benefits they've purchased.

And your team has another reason to maintain the relationship.

That's incredibly valuable.

The best new patient may sometimes be the patient you already have.

Membership Plans Can Improve Case Acceptance

There is another important economic effect.

Imagine telling an uninsured patient:
“Today's treatment is $3,800.”
That's a big psychological number.

Now imagine that same patient already belongs to the practice's membership program, understands their benefits and receives defined savings on treatment.

You have reduced one layer of financial uncertainty.

You haven't eliminated the cost of dentistry.

But you've changed the relationship.

The patient no longer feels like a stranger walking into a retail transaction.

They're a member.

Words matter.

Relationships matter.

Financial predictability matters.

And in my experience working with dental practices, membership patients often behave differently from pure transactional patients because they've already committed to the practice.

Don't Build a Membership Plan and Then Hide It

Here's where many practices fail.

They create a plan.

They put a page on the website.

Maybe they print a brochure.

Then six months later someone says:
“Membership plans don't work. We only have 27 members.”
No.

What you have is an execution problem.

I once spent hours inside a highly successful membership practice studying how the program was being presented.

The answer wasn't some magical Facebook campaign.

The membership program was everywhere.

The clinical team knew about it.

The front desk knew about it.

Checkout discussed it.

Printed materials were visible.

The plan was part of the patient experience.

That is the difference.

A membership plan cannot belong exclusively to the office manager.

It needs to become part of the culture.

A Simple Membership Growth System

If I were advising a practice starting today, I'd focus on five things.

1. Identify the right patients

Start with the existing database.

Find uninsured and inactive patients.

Identify patients whose benefits have changed.

Train the team to recognize membership-plan candidates.

Don't wait for people to ask.

2. Make the plan ridiculously easy to explain

Your team should be able to explain it in twenty seconds.

Something like:
“We have an in-house membership option for patients without traditional dental benefits. You pay a simple monthly fee that includes your preventive care and gives you savings on additional treatment.”
That's understandable.

No insurance dictionary required.

3. Involve the clinical team

This is huge.

The hygienist has trust.

The dentist has trust.

The assistant has trust.

If the only person discussing the plan is the person collecting money at checkout, you've unnecessarily limited the strategy.

4. Set a member goal

Don't say:
“Let's grow the membership.”
Say:

100 new members this quarter.

Or:

10 new members per week.

Then measure it.

What gets measured gets discussed.

What gets discussed gets improved.

5. Track recurring revenue

This is where it becomes fun.

Don't merely track total membership enrollment.

Track:

Members

MRR

ARR

New members

Cancellations

Revenue per member

Treatment generated by members

Once your team can see recurring revenue accumulating, they begin thinking differently about the program.

The Goal Is Not to Replace Insurance Overnight

I want to be very clear about this.

I'm not suggesting every dentist reading this should call every PPO tomorrow and terminate their contracts.

For many practices that would be financially irresponsible.

Instead, think strategically.

If 75% of your revenue comes from PPO patients, you're heavily exposed to reimbursement decisions you don't control.

What would happen if you gradually changed that mix?

Maybe:

75% PPO
becomes 60%.

Then 50%.

Then 40%.

Meanwhile:

membership revenue rises.

Cash revenue rises.

Out-of-network revenue rises.

Your negotiating position changes.

You gain choices.

And choice is power.

There Is an Enterprise Value Argument Too

This is something dentistry doesn't discuss enough.

Suppose you were buying two otherwise identical dental practices.

Practice A generates $2 million annually, primarily through transactional patient revenue.

Practice B generates the same $2 million, but $500,000 is represented by a highly retained base of recurring membership revenue.

Which business feels more predictable?

Which one gives you better visibility into next year?

Which one would make you sleep better before signing the acquisition documents?

Recurring revenue does not magically guarantee a higher valuation—the quality of the contracts, retention, margins, concentration and other factors matter tremendously.

But predictable recurring revenue is economically attractive for a reason.

Investors love visibility.

Owners should too.

Maybe Dentistry Doesn't Need More Patients as Much as It Needs a Better Economic Model

This is the bigger idea.

Dental practices have spent decades optimizing:

Production.

Collection.

Case acceptance.

New patients.

Hygiene.

Those remain important.

But the economics around the practice have changed.

The ADA's data should serve as a warning.

Over five years:

Revenue +1.4%.

Expenses +4.9%.

Over the longer term, inflation-adjusted GP income has declined materially.

Insurance reimbursement remains a major concern for dentists.

At some point, the answer cannot simply be:

Work harder.

The practice needs better economics.

And recurring membership revenue can be one part of that solution.

Build the Financial Safety Net First

If you're frustrated with PPO reimbursement, don't begin with anger.

Begin with math.

How much revenue does each PPO represent?

What are its effective write-offs?

What is the profitability of those patients?

How many membership patients would you need to generate $10,000, $25,000 or $50,000 per month in recurring revenue?

What percentage of your uninsured database could reasonably become members?

Then build.

100 members.

1,000 members.

Little by little, you're creating something unusual inside a dental practice:

revenue you actually control.

And that changes everything.

The Dental Practice of the Future

I believe the strongest independent practices of the future will have diversified revenue models.

They won't blindly accept every PPO.

They'll analyze reimbursement.

They'll negotiate aggressively.

They'll go out of network strategically when appropriate.

They'll improve the patient experience.

They'll embrace technology.

And they'll build large direct membership bases.

Instead of letting an insurance company sit between the dentist and the patient, they'll increasingly own that relationship.

That doesn't mean insurance disappears.

It means the practice stops allowing insurance to dictate its entire financial destiny.

That's the distinction.

Final Thought

Dentistry may be stuck in a stagflation-like squeeze.

But your practice doesn't have to remain stuck inside it.

You can't control the Federal Reserve.

You can't control wage inflation.

You can't control supply prices.

You can't control what every insurance company decides to reimburse.

But you can control more of your revenue model.

You can create a direct relationship with your patients.

You can build recurring revenue.

You can create a membership base.

And you can slowly build enough financial independence that a payer deciding not to increase reimbursement becomes an annoyance instead of an existential threat.

That's the real opportunity.

Don't just build a busier dental practice.

Build a financially stronger one.

Start a patient membership program!
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