The current economic state of dentistry

Dentistry has always been immune to economic factors like recessions, but unfortunately, this is no longer the case. 

Several key industry trends and general economic challenges in the US are decreasing general practice incomes. According to the American Dental Association, there has been a 17% decline in general dentist income since 2019.¹ One immediate remedy for this downward trend is to implement strong practice growth strategies. Let’s take a look at the current economic state of dentistry and then review some of the best opportunities to reverse flat or declining practice income. 

What's happening in dentistry?

1. Inflation is affecting patient decisions. Inflation has reached the level where practices notice a higher level of no-shows, decreased case acceptance, and even lower numbers of new patients. This can be directly related to people who are facing economic choices based on the rise in cost of basic goods and services. When people see their grocery or utility bills escalating, they tend to delay dental hygiene and recommended treatment. 

No one knows how the economy will change in the near or distant future. However, on the assumption that it will continue to have some level of inflation, it makes sense to take steps to improve practice production and income now. 

2. The cost of practicing dentistry has skyrocketed. Much of this is due to the staff shortage and significant increase in staff compensation in the last few years. Whenever it is more difficult to attract labor, compensation increases and almost never reverses. Right now, there are many practices searching for new staff members, and the search reveals that higher compensation will have to be paid. The impact is on overhead, and every dollar spent on overhead is one less dollar of practice income. Although overhead can usually be decreased by a small degree, the reality is the limit on overhead reduction is 3% to 5%. Once those reductions take place, there is not much more that can be cut. The solution is to heighten the focus on increasing practice production, which has a greater upside than the amount of savings that can be accrued focusing exclusively on overhead reductions. 

3. Dental insurance companies are not increasing reimbursements to any large degree. In fact, many plans have reduced their reimbursements in the last 36 months, which means that they have not only failed to keep up relative to inflation, but they have also widened the gap. Dental insurers look for every opportunity to maximize their profitability, and reducing doctor reimbursements is one way to achieve that. This is happening in both medicine and dentistry, and there’s no reason to believe it will change. 

4. The increase in the use of technology and dentistry has been fantastic for patient care. But it also comes with a cost, and that cost is another contributory factor to higher overhead, longer learning curves, and more difficult staff training. The use of technology initially addscost in terms of time and capital expense. Savings may be experienced over time, but the primary benefit is typically related to improved outcomes and better patient experience. 

Recommended solutions to increase practice income 

1. Comprehensively train the office manager. The goal of a comprehensively trained office manager is to develop them into a chief operating officer who runs all aspects of the dental practice. This gives dentists the freedom to go back to focusing almost exclusively on patient care, which allows for clinical excellence and, importantly, for increased production and practice income. Office managers today need to oversee all nonclinical functions, including hiring/firing, team development, systems implementation, and understanding the key performance indicators of the practice, making course corrections with input from doctors as necessary. 

2. Dentistry, like any business, has a time management system. The more effectively your practice utilizes time, the more efficient it becomes. This raises production and practice income. Practices should perform procedural time studies in which frequently performed services are timed as many as 10 times to determine the real average amount of time needed for each procedure. We have found that doctors can save at least 10 minutes per hour, which increases the available production time by the equivalent of two months a year of doctorproduction. Run out over time and this means that the practice would increase doctor production by six full years over a 36-year career. Adding time within the practice without actually adding hours is one of the best ways to increase production and practice income. It is not about rushing or working faster, but about properly using time in the most efficient manner. 

3. Schedule all new patients as soon as possible. When a practice evaluates where revenue and income originate, new patients are one of the best sources. Most practices simply focus on adding as many new patients as possible, which is a solid strategy, but they do not always understand that new patients have a much higher financial value to the practice than current active patients, at least in the first 12 months. The sooner new patients are onboarded, the higher production will be at an earlier stage in the year, which also contributes to higher practice production and income. 

4. Improve case acceptance and treat as soon as possible. Dentists sell treatment. We may not want to think about it that way, but it really is the fundamental of having patients accept treatment. There are ethical ways to present cases with greater motivation and influence, withboth the patient and the practice benefiting. Improving case presentation skills is relatively easy once you understand how to use a systematic approach. This can include greeting the patient, knowing where and how to pitch the presentation, asking the patient meaningful questions, reading their body language, and offering the patient financing. In addition, it is important to schedule large cases as quickly as possible, which accomplishes two objectives: Firstly, the practice will recognize production and income sooner, and secondly, the patient will be less likely to change his or her mind. 

5. Ensure that every team member knows the exact job and results that are expected. The best businesses have excellent systems for every aspect of how they operate, and dentistry is no different. This allows team members to master the functions that they are expected to conduct. Their systems for scheduling, insurance, customer service, hygiene productivity, collections, all contribute to the highest levels of efficiency and allow the team to become highly proficient. Dentists who want to take their practice to the next level and overcome the challenges that are impacting practicing income today need to implement systems and checklists that allow the team to understand exactly what is to be done, how it is to be done, and when it is to be done. 

The truth is that most team members do not even know the expected results. A schedule coordinator might not suffer any consequence from open times in the schedule that have not been filled in. There might not be a system that tells the  coordinator to check the schedule every day for the next five days and what steps could be taken if there are open appointment times. These steps include quickly moving patients who have immediate needs that were just diagnosed into those times, reaching out to seniors who might have no problem coming in sooner, and alerting the dental assistants and dentist that there’s an availability for same-day treatment. All of these are parts of a system. Team members need to understand the entire “ecosystem” of the practice in order to make everything run smoothly. 

Summary 

Increasing production and practice income has a greater upside, and practices today need to be more efficient than ever before. A comprehensively trained office manager who can implement excellent systems that train the team and help them understand exactly how to do their jobs can have a massive positive effect on practice production. Any practice can improve and go to the next level if the right strategies are put in place. Although there are industry and economic challenges, the opportunities outweigh the challenges. Practices can experience much higher growth and practice income if they take advantage of them. 

Editor's note: This article appeared in the April 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Reference:

1.Burger D. Pandemic’s effect on dentists’ net income revealed in new HPI research brief. ADA News. September 3, 2021. https://adanews.ada.org/ada-news/2021/september/hpi-pandemic-effect-on-income/