Why dental specialists can’t rely on referrals anymore

For decades, the specialist practice model in dentistry has relied heavily on a predictable stream of referrals from general practitioners. But the dental landscape is shifting, and fast. With the rise of dental service organizations (DSOs), a rise in GPs keeping specialty procedures in-house, and an increasingly competitive market, many specialists have seen their referral pipelines dwindle.

As an oral surgeon with more than two decades in private practice and a master’s degree in digital marketing, I found myself at a crossroads. To continue growing, I realized I had to adopt a more entrepreneurial mindset and embrace direct-to-patient marketing. Here I’ll share how the consolidating dental market pushed me to rethink my business model, and why I believe specialists must evolve to thrive in this new era.

Consolidation and consumer shifts reshape specialist practice models

Like all industries, the dental market is shaped by both predictable trends and unexpected economic forces. In recent years, these dynamics have placed a downward pressure on the traditional specialist practice model. Meanwhile, today’s health-care consumers are more informed, more selective, and increasingly influenced by online reputation. These forces have made it more difficult for specialists to rely solely on referrals to sustain or grow their practices.

Industry consolidation typically unfolds in four stages: fragmentation, aggregation, maturation, and stabilization.¹ The dental market is currently in the aggregation phase, marked by rapid acquisition and expansion, and it will eventually enter maturation, where the majority of market share is controlled by a few dominant consolidators.

According to the ADA Health Policy Institute, as of 2023, 13.8% of US dentists are affiliated with a DSO and several industry experts report that the dental market is currently 30% consolidated.² As consolidation advances toward stabilization, independent specialty practices will face mounting pressure to differentiate. Success will depend on delivering highly personalized care, cultivating a distinct brand identity, and developing a deeper understanding of niche target audiences. But this isn’t a strategy to defer; these efforts must begin now to build a practice that thrives, rather than one that merely survives.

Building in-house marketing teams strengthens patient engagement

So, what can specialists do now to strengthen their position in this rapidly consolidating landscape? No drumroll is necessary, and you don’t need a master’s degree in marketing to see the writing on the wall. Specialists committed to maintaining independence must adopt marketing strategies that engage a broader audience—not just referring doctors, but patients themselves.

While few specialists have the time or expertise to build and execute a comprehensive marketing plan alone, outsourcing this critical function to third-party vendors often leads to generic content and a lack of strategic alignment. In contrast, developing internal marketing capabilities within our own team has been a game changer for us.

By empowering staff who understand our practice’s mission, voice, and values, we’ve been able to create authentic, organic content that resonates with our audience and reflects who we are. Internal teams are more agile, more accountable, and better positioned to tell our story in a way that builds long-term trust and loyalty.

If you're thinking what I initially thought—how hard can it be to throw together a few ads and social media posts—you may find this business model transition more frustrating than expected. One of my earliest steps was to deepen my understanding of marketing as a discipline, not just a tactic.

I also hired a part-time team member with professional marketing experience. While she had no background in dentistry, she understood how to position service-based businesses effectively. I provided the vision, mission, brand direction, and clinical perspective, while she helped define our target audience and crafted messaging and organic content that would resonate with them.

Over the last 15 years, we’ve consistently tracked our efforts using key performance indicators (KPIs), allowing us to refine our strategy, adjust our messaging, and stay aligned with both patient needs and market trends. For example, we used post engagement data from our social media insights to determine which types of content resonated most with our audience. That led us to create more behind-the-scenes videos highlighting our team, office culture, and surgical process, which significantly increased interaction and contributed to the growth of our online presence and community.

Foundational business strategies help specialists remain independent

So, where should you start? Most health-care providers know very little about running a multi-million-dollar business because we never received the training. Between patient care, staff management, and clinical continuing education, there’s rarely time to learn the fundamentals of business strategy and marketing. But that doesn’t mean it’s out of reach.

Here are four foundational steps that helped me begin the transition:

• Define your vision. As the CEO of your specialty practice, clarify where you want to go and what kind of experience you want to create for patients and referring doctors alike.
• Evaluate and elevate your patient experience. Understand the level of service you currently provide, identify pain points, and make continuous improvements. Your patient experience is your marketing.
• Know your audience. Go beyond basic demographics. Identify the psychographic and behavioral traits of your ideal patient so you can tailor marketing messaging and choose the right channels to reach them.
• Build internal marketing capacity. Hire a team member with marketing expertise, not necessarily in dentistry, but in service-based industries, who can help you implement and track your strategy.

As an independent specialty practice in a consolidating market, now is the time to address the elephant in the room: the old referral-based model is no longer enough. If your vision is to remain independent and continue growing, you must take the next steps on your marketing journey with intention. Start small, stay consistent, and invest in telling your story—because no one else will do it for you.

Editor's note: This article appeared in the October 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Deans GK, Kroeger F, Zeisel S. The consolidation curve. Harvard Business Review. December 2002. https://hbr.org/2002/12/the-consolidation-curve

2. Vujicic M. The evolving dental practice model: data update for 2023 on practice size and DSO affiliation. American Dental Association Health Policy Institute. 2023. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpi_evolving_dental_practice_model_2023.pdf