Professional Courtesy: Is Your Practice About Altitude or Attitude? by Dr. Thomas Giacobbi

Dentaltown Magazine

by Thomas Giacobbi, DDS, FAGD, editorial director, Dentaltown magazine

The airline industry provides many interesting parallels to dental practice and I thought it’d be interesting to explore those in the context of what might be ahead for our profession. Let’s start with the key components:

  • Plane fleet = practice size.
  • Crew = office staff (a number that fluctuates with the size of the plane and fleet).
  • Passengers = patients.
  • Seats = appointments (empty seats are unfilled time in your schedule).
  • Flight = dental procedure (some procedures are more expensive than others).
  • Fuel = overhead (labor and fuel are the two costs that most affect the bottom line of an airline—it is the same for many dental practices).
  • Baggage fees = anything you charge for that used to be free.

Both airline flights and dental treatments operate with little margin for error, and delays due to unforeseen circumstances cost companies money and customers time.

Two areas that create great frustration for passengers are baggage fees and ticket-change fees, but they’re now profit centers for many airlines—in 2017, baggage fees and change fees accounted for more than $7 billion in revenue. While some dental practices charge patients for no-shows or late cancellations, this in no way represents a future profit center; the notion of charging patients to change their appointments would certainly lead to less rescheduling, but would be difficult to implement.

Dental practices, unlike airlines, can’t offer the equivalent of a frequent-flyer program. Some might argue that a patient who has insurance or buys an in-house plan receives a benefit of membership, but that’s not a system that rewards them based on the number of procedures completed or dollars spent. In dentistry, this would be unethical and likely illegal. In a practice where patient loyalty is valued, the benefits come instead through flexible scheduling or discounts for patients without insurance.

The airline industry changed forever when President Carter signed the Airline Deregulation Act of 1978, which opened the industry to increased competition and made it more attractive for new airlines to form. This made air travel more accessible to everyone thanks to lower fares.

The airline industry has gone through some significant consolidation and now the main players are so big that it’s much more difficult to start a new airline. This begs the question of whether we’ll see that same trend in dentistry over the next 5–10 years. As mega-DSOs continue to expand, will their presence in major population centers make it more difficult to open new solo practices? Will the low-cost battle ultimately lead to the addition of new fees for patients receiving care from large groups?

I know some will bristle at my attempt to draw parallels between the airline industry and the practice of dentistry—after all, we’re providing health care, not a ride from Point A to Point B. While that’s true, at the core, all businesses that deal with the general public have service at their center. In the case of the airline industry, the race to provide low fares increased flights, air traffic and the number of people who could afford to fly. However, it also made air travel a miserable experience. Every month there’s another video of a passenger or crew member screaming at someone, planes parked on the tarmac for insane amounts of time, and flight delays for sometimes unexplained reasons. Will this be the future of megacorporation dentistry?

A great experience should be available to any patient regardless of the fee. Some dentists mistakenly assume that their high fee means they already provide a great experience, but practices that make the effort to provide great service will win the day, no matter their size. For example, Southwest Airlines generally has some of the happiest employees and they have carved a niche of low-cost fares without baggage fees.

What kind of airline are you running? Share your thoughts in the comments under this article at Or contact me directly: (email) or @ddsTom (Twitter).


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