Saving the Dental Industry, One Practice At A Time
Updated: Apr 21, 2021
This text is from our consulting firm's latest 321 Biz Development episode found on fifteen podcast platforms. There is too much content to write for this article, so readers are referred to the podcast episode for complete story.
I knew it was coming...the impending disaster of the dental industry...both independent and corporately-own dentist business models. And, the 2020 lockdowns and business shutdowns have accelerated dental practice revenue woes faster than any organic dental industry mismanagement could ever have.
My consulting firm started tracking dental practice health about five years ago after three California dentists went out of business. Let's look at their stories. These are not the real names of the dentists.
The first was Dr. Cedrick, a 25-year dentist veteran, whose practice shutdown after trying to run his practice using employees hired from a temporary agency. My wife and I were his patients. During my last visit at Dr. Cedrick's practice, I noticed the employees were strangely giddy and not too disciplined as you would expect at a dental practice.
Dr. Cedrick, whom I met with for lunch, told me that his staff was temporary employees. Dr. Cedrick could not afford to hire permanent, full-time dental employees and pay for employee benefits.
Dr. Cedrick previously had a nice office in Sacramento's Elk Grove community and now had an office in a North Sacramento community with homelessness and high crime. And, to put a finger in old wound, while sitting in the dental chair, you could see cars in the parking lot and rays of sunlight because the wall paneling had small cracks.
Dr. Cedrick could not find enough dental patients who could afford intermediate to complex dental treatment, even with dental insurance.
Dr. Cedrick sent us a letter informing us he was closing his California practice and moving to Las Vegas to pursue an athletic director position at a high school. Dr. Cedrick played football while in college and majored in sports medicine.
I met Dr. Harold through his girlfriend while shopping at a local Sacramento Safeway grocery store. Dr. Harold attended a highly rated dental school in Washington state after graduating from Temple University in Philadelphia.
I was a patient of Dr. Harold before being treated by Dr. Cedrick.
Long story short, for about one year, Dr. Harold only had one employee at his practice...him. He answered phones. He did the billing. He cleaned the office. Dr. Harold did have a dental hygienist on-call when needed.
Dr. Harold could not find enough dental patients who could afford intermediate to complex dental treatment, even with dental insurance.
At the end, Dr. Harold shutdown his practice and became an employee, Medi-Cal dentist to provide dental services to California's staggering high impoverished communities.
Dr. Rina had a dental practice in an upscale community about 20 miles south of downtown Sacramento. I offered my consulting services to Dr. Rina about 8 months before she shutdown her practice.
I followed up with Dr. Rina after giving her some dental practice growth advice but she never returned my phone calls. Then, after six months, I got an interesting call from Dr. Rina to meet over coffee. I was excited that she finally called me and was thinking she was ready to move forward with the dental practice growth action plan.
To my dismay, Dr. Rina delivered some sad news. But the news was more sad for Dr. Rina. She told me that her practice was shutting down within 30 days. But the reason she gave surprised me initially, but at the same time, I was not too surprised.
Dr. Rina told me that she was paying $8,000 per month out of her personal savings to keep the practice afloat. She had paid over $200,000 over a 2.5 year period to stay in business. And now, she had about $100,000 in savings and was not going to lose that money.
Dr. Rina began to cry right in front of me at the coffee shop because her dream of having a successful dental practice just went up in flames.
Dr. Rina could not find enough dental patients who could afford intermediate to complex dental treatment, even with dental insurance.
Dr. Rina said that she was moving back to the Philippines Islands with her mother to buy a motel to recoup her losses as a dentist.
There are more dental stories I can tell people about how the dental industry is going through perilous times.
Just this week, a business colleague told me how a California dental practice tried to upsell a $5,000 dental procedure. Now, my colleague had just paid $9,000, in cash, for a long-awaited dental procedure. Figuring my colleague had more disposable income, the dental practice aggressively recommended another procedure my colleague felt was unnecessary.
And just today, April 14, I was reading some comments from a dental blog I have been following for the last two years. This one comment summarizes negative experiences dentist encounter. The words in italicized font are the actual words communicated by a dentist in 2018.
Here are the comments which I did not alter a single word:
"Yea, and feeling much the same. Half a mill of debt, a good portion of my free time dedicated to pain management like yoga or massage. My closest classmates who are now spread in different cities all say the same. Admittedly, I barely make ends meet by the end of the month with my loan debt, rent, and other debts like insurances and what not; I’m driving a 10 year old car because the thought of adding more debt is daunting right now. I’m glad I did a residency because I learned a lot but it was nerve wracking watching my interest accrue on my loans because residency barely paid enough for rent. I don’t even know how California graduates do it—they have to take personal loans during dental school for living expenses…I can’t even. Meanwhile, before my current job, I worked across different settings and was disillusioned at my older colleague. This is just a snapshot of what I witnessed across the various settings during my first year out:
a.) dentist doing shitty work for corporation in order to produce to the standard of their corporation—a company sent me for a day to shadow their top producer so I can observe how he produces and welp, I saw them deliver bridges with giant marginal deficiencies and caries excavate leading to nerve exposures with no mention to the such to the patient just went ahead and filled it sans pulp cap…another practitioner for the same company was so overwhelmed and overworked that they literally collapsed of exhaustion in the middle of a work day.
b.) Owner of practice doing shotty work, scams insurance at the benefit of working less—I caught multiple cases where he billed class IIs for class Is and left interprox caries because who has time to place a matrix band? same person did a bad root canal which 3 weeks later when the patient returned in pain, they extracted the tooth, cut off the apex, and retreated the rest of the root out of the mouth, then reimplanted it because it was better than refunding her money that she paid for rct + crown, and deducted from the advance payment she made on the crown towards the extraction of tooth (which was still in her mouth); did not return the rest of the money for the crown she never got; instead told her it would remain on the account for when they do the crown (patient was elderly and paying cash)—3 weeks later patient continued to seek pain relief, got Cdiff from being on so many antibiotics from him and her physician. I saw her once, 4 days after that ridiculous procedure had been done; she had a swelling on the gingiva and I offered her two options:
1.) I would remove the tooth and make her a temp partial (it was #9)
2.) have her f/u with him in a week as planned—she chose #2 because she honestly trusted him; I quit within a few days. I left disappointed that a seemingly successful practice was based on shady practices.
3.) I’ve also worked in public health where some think the patients they serve don’t deserve cell phones so why provide standard-of-care dentistry (Tell me if you’ve ever heard this one: “they have a nicer phone than me!”). One clinic does comprehensive exams but then only offers extractions and refers to private practice for routine fillings—why even do a comp exam? Also, some of these places think that someone receiving cheap treatment should expect to wait 3-hours, so their patient check-in process takes 30-45 minutes and the dentist don’t have any control over it.
I hope I can find a way to serve patients ethically and maintain science base practices while still having the time to take care of myself and pay off my loans before I’m 60. At this time that means being patient with the 45-minute check-in process and being ok with patients being upset because the wait is so long. As much as I want to have my own practice, the thought of adding more debt is daunting. It’s too bad that few opportunistic bad seeds have created bad practices and the culture has spread. I was once told that the dentist owner of well-known corporation said early in his career that his goal is to do with dentistry what McDonald’s did for the food industry."
So, what is the solution?
321 Biz Dev LLC has the solution and the solution is the same one we had in 2017. But now, the solution is more timely and relevant.
Here is the short version of the solution: dentists must finally see themselves as salespeople. Many dentists believe that they are not in the business of selling dental treatments. I say today as I said five years ago: dentists are salespeople.
Any person moving a product or service is in the sales industry. And, every person, be he or she a dentist, an attorney, a CPA, a plastic surgeon, an insurance broker, a real estate broker, a hair stylist, a tattoo artist, a plumber, a CEO of a medical group, a homebuilder or an esthetician...everyone must master sales fundamentals.
If this episode/article provoked some deep thought about improving your sales performance, please do not hesitate to contact me, Rick Nappier, at 726-999-0999. Or, if you are Spanish language business owner, please contact Yeilyn Rodriguez, VP, Business Development specialist at 786-697-3400. Ms. Rodriguez is fluent in both Spanish and English.
Interested parties can click here to visit our website. Then, click the Questionnaire tab to complete the 5-minute questionnaire so 321 Biz Dev can learn more about your current sales situation or learn about your current or past experiences with trying to improve sales performance. A 321 Biz Dev specialist will contact you within two business days to review your responses.
We hope your enjoyed today’s post and linked podcast episode. Please check out the podcast episode for a lot more content on this subject matter.