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The no. 1 barrier to dental practice growth is not what you think

June 1, 2021
Insurance, location, competition—all might contribute to the growth of your practice, but not as much as you think...and not as much as this one factor.
Jay Geier, Founder, Scheduling Institute

Every dental practice owner knows lots of other owners. If you’re struggling to grow your business, you undoubtedly know others in the same boat. I’m sure you also know some who are in a different boat—people having more success growing their practices.

So what’s the difference—what barriers do you face that they don’t? Maybe they live in a bigger town, a smaller town, a more affluent community, a more close-knit community, a better neighborhood? Have less competition, a better location, a better building, a better labor pool? Can get away with charging more, undercut your pricing? Take insurance? Don’t take insurance?

The list goes on and on … and frankly, so do the excuses.

If you’re not growing your practice, there’s a reason—but none of these are it. Your mindset is the real barrier. You’re allowing these perceived barriers to justify your lack of growth. In particular, “takes insurance” and “doesn’t take insurance” are two of the most hotly debated barriers. Those who take insurance view that as their biggest problem; those who don’t take insurance think that’s the big problem.

So who’s right? Neither. You can grow your practice either way by focusing on the aspects of the practice that drive growth regardless of any of the above. See how our profitable practices don’t let insurance dictate the success of their practice.

Insurance-based practices

If you accept insurance (and/or Medicaid), you agree to accept a lower payment for services provided, per the plan’s contract. So you may think you can’t grow because you get less per patient.

If you think the answer to growing collections is to stop accepting insurance, you need to carefully evaluate the other consequences. Many patients find you because their insurance plan lists you as an in-network provider. That’s free marketing that drives patients to you without your having to spend marketing dollars to find and attract them. You may increase collections per patient, but simultaneously diminish your new patient numbers, and lose many of your existing patients. What will it cost you to recover the unintended losses? Those dynamics change the math considerably versus just comparing the change in negotiated price. The write-offs you face with insurance should be embraced just as a marketing investment would be.

There’s a good chance analysis will lead you to stick with insurance, so here’s an important tip that will keep it from working against you: You (and especially your team members who answer the phones) need to realize that few patients understand their own insurance. Unlike medical insurance, which everyone is required to have, many people don’t have dental insurance (in 2019, only 50.2% of adults had dental insurance in the US1). And if they do, they may not even realize who it’s with because they rarely use it and often aren’t even sent an insurance card any longer. That’s a key reason we advise clients to never ask a prospective new patient on a first phone call what insurance they have. The patient may well get flustered just being asked and might say they will have to dig it out of their files and call you back. You just lost that potential new patient; they’re going to call another practice in the hopes of making an appointment instead of being embarrassed and inconvenienced by the dreaded insurance question up front.

Private pay/fee-for-service practices

If you don’t accept insurance, you may think you can’t grow because you’re missing out on all the people who have insurance. Not true. (The one exception may be if you start your practice in an area with one major employer and everyone has the same insurance; then it may behoove you to accept at least their plan.)

Many more people don’t have dental insurance than you probably realize, and they’re perfectly willing to pay to maintain good oral health. Or they’re willing to pay up front and file themselves for insurance reimbursement. In other words, your pool of patients is more than ample to support a thriving, growing practice. You don’t need to become insurance-based.

You can, however, help mitigate cost barriers for your patients by providing payment and financing options, such as accepting major credit cards; offering third-party financing; and even offering your own in-house discount program through which, for example, patients can get two cleanings a year plus discounts on other products and services for a flat membership fee. These options make it easier for patients to accept recommended treatment plans, which is a win-win. This also applies to insurance-based practices, since there’s almost always a patient portion for all but the most basic services.

Most important, make sure you and your team are delivering a superior patient experience and level of care that builds your reputation, and keeps patients coming back and referring others because you consistently prove “you’re worth it.”

Don’t be your own biggest barrier

You are more in control of your ability to grow your business than you may think, so don’t allow yourself to be your own biggest barrier. Setting and staying focused on goals, executing action plans, tracking progress, and working as a team to achieve increases in all your key metrics (revenue, production, new patients, referrals, and net profit—not just collections), are the key principles that will lead to growth.

Assessing whether or not you should change from insurance based to private pay, or vice versa, may be a strategy worth exploring, but it needs to be a well-calculated move, literally. Identify what you’ll be losing and gaining short- and long-term, and do an opportunity cost analysis using actual data so you’re making a fact-based decision, not one based on assumptions or emotions. You might find the change would do your business more harm than good. Accepting insurance or not is simply a business strategy, and not all businesses have the same strategy. It’s how you execute that strategy and uncover opportunities that the strategy can provide.

It’s never necessary to change the type of practice you have; it’s only necessary to change your mindset about what’s holding you back. If your practice isn’t growing for some reason, challenge that reason. Are you letting perceived barriers become excuses? Look for more tips next month on how to push the excuses aside and build your business by focusing on what really drives growth and profitability.


1. Blackwell DL, Villarroel MA, Norris T. Regional variation in private dental coverage and care among dentate adults aged 18–64 in the United States, 2014–2017. NCHS data brief, No. 336, May 2019. https://www.cdc.gov/nchs/data/databriefs/db336-h.pdf

JAY GEIER is a world authority on growing independent practices to keep for a lifetime of revenue or sell for maximum value. He is the founder and CEO of Scheduling Institute, a firm that specializes in team training and doctor coaching to help people live up to their full potential and uncover the blind spots that are holding them back from that potential. To find out if your practice suffers from these blind spots that could be killing your practice culture, go to schedulinginstitute.com/de to request your complimentary analysis.

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