To Succeed in the Future, Dentists Must Navigate Rapid Economic Change
By: Mr. Greg Hill, JD, CAE
I was recently interviewed on a podcast about my thoughts on the future of dentistry. This topic fits very nicely with what organized dentistry is trying to understand as business models are rapidly changing in the profession.
When I think of the future of dentistry, I usually think of three different things: practice model changes, technology and payment models. My purpose in this article is not to make judgments, only to identify the trends as I see them.
Practice Model Changes
Hopefully, I am not the one breaking it to you, but there are some dramatic changes happening in the dental profession presenting significant pressure on the practice model that has existed for many years. Many of these changes were happening before COVID but were accelerated during the pandemic.
Recent reports from the Health Policy Institute (HPI) of the ADA showed practice ownership among dentists in private practice has been declining over the years, dropping from 84.7% in 2005 to 73.0% in 2021. For those between 30 and 35, this represents more than a 20% decrease during this ten-year span. Of female dentists, less than 60% are now practice owners.
Of course, one of the big drivers of this change is the growth of Dental Support Organizations (DSOs). In Colorado, 13.9% of all dentists were affiliated with a DSO in 2019. These two data sets, DSO affiliation and declining ownership indicate very strongly that we are at a tipping point from the traditional solo practitioner to some group ownership or DSO model. This is supported by another research report of the HPI that states, that significantly fewer dentists are working as solo practitioners. About 65% of private practice dentists were in solo practice in 1999. That proportion decreased to 46% in 2021.
So, one way that the future of dentistry will be different is that it will be a much younger, more diverse profession, with far fewer dentists operating solo practices.
Dental offices are becoming much more high-tech from 3D printing of crowns and implants to artificial intelligence that may prove to be more accurate at diagnosing tooth decay and providing treatment planning. We already know AI is being used to evaluate dental claims.
To me, the question is not what technology will not be able to do in the dental office, it is how willing dentists will be to adopt innovative technologies, and to what degree patients will expect them from their dentist. One thing I suspect is patient data will be a key driver to change.
One thing I suspect is patient data will be a key driver to change. First, patients will want and will have access to their data, 24/7. Patients are already pulling their health records into their mobile devices, synchronizing them with their smartwatches, and gathering key health data, data you as a dentist may want to access to better understand your patient’s health. The CDA recently began working on a pilot program to provide access to electronic health records from primary care doctors. This allows dentists to know with a much higher level of accuracy any prescriptions and underlying health conditions so they can provide better and safer care.
I’m not going to get into private dental insurance or fee-for-service here, but instead talk about government programs and value-based payment.
We saw this past year with the discussions ADA had with Congress, that some form of dental coverage for Medicare is on the horizon. Baby Boomers are turning 65 at the rate of seven per minute. They have gone through life knowing dental care is important. There is a strong appetite for the addition of dental care to the Medicare system and more than 60-million Americans are on Medicare. Adding dental coverage to this population could dramatically shift the delivery system, with millions of older Americans now seeking the care they may not have sought before.
Additionally, the ADA is seeking Congressional approval to expand Medicaid to adult populations in the states. Colorado already provides dental benefits to adults, and we have seen a positive impact on health outcomes. This could drive more patients to seek dental services; however, provider networks may not be sufficient to meet the economic demand.
Finally, a developing model of payment called value-based care is a critical component of the future of oral health. DentaQuest defines the system of value-based care in oral health as focused on proactively preventing dental disease rather than reacting to it. This means placing the value on quality care and health outcomes, not on the cost of services as in the fee-for-service model most common today. In other words, providers will be paid to keep a patient healthy proactively, rather than a reactive fee-for-service model.
How will these changes affect the dental profession? Only time will tell, but my opinion is those who successfully navigate these changes will be more successful in the future. Organized dentistry must recognize the future of dentistry will be different and we have a critical role to play in helping members navigate through these changes.
Greg Hill, JD, CAE has served as the Executive Director of the Colorado Dental Association since June of 2014. Prior to joining the CDA, Greg was employed by the Kansas Dental Association for 15 years and served as the Assistant Executive Director of the CDA and Executive Director of its Foundation. Mr. Hill is a 1999 graduate of the Washburn University School of Law in Topeka, KS and a 1994 graduate of Kansas State University with a Bachelor of Science in Economics. He became a Certified Association Executive (CAE) in 2016. In addition, he serves as Co-Chair and Treasurer of Oral Health Colorado; on the Board of Directors for the Colorado Dental Lifeline Network and the Colorado Mission of Mercy; and is a member of the Denver Tech Center Rotary Club. He and his wife, Gwen, are the parents of daughter, Haven, and son, Camden.