“In 1926, the work of William Gies helped chart a new course for dentistry. I think we are approaching another “Gies” moment in which the dental community must face some hard facts and ask itself how effectively the current system is improving the oral health of the American public. In my view, the current dental care delivery and financing model will not drive significant, sustained improvements in oral health going forward as it did in the past, particularly for key segments of the population. We are stuck. And the changes needed to get unstuck are not tweaks, but major reforms.”
— Our Dental Care System is Stuck, Marko Vujicic, Ph.D., JADA
Clearly, this article is an indication of another nail in the coffin for solo practice. Decreasing access to dental care, growing costs of dental care, and the increasing knowledge of the relationships of systemic disease to oral disease will push harder and harder for dentistry to change.
Solo practices and their political organizations can’t kick the can down the road anymore on the issues of access and cost. They need to come to grips with the fact that they simply don’t have the political or financial will to stop these issues from snowballing. Based on my 40-plus years of experience in the industry, I think that solo practices and their political organizations don’t have the wherewithal to confront these issues.
Confronting Reality
Part of the conflict is realizing that solo practices cannot play a game of increasing access at a lesser cost. That’s not how solo practices are built: solo practices need to confront the reality that more dentistry — with greater access, decreased costs, and increased interrelationships with hospitals and physicians — is not achievable under the current solo practice model. Simply put, they are just not built to handle these issues as they intensify.
Furthermore, the solo practices’ cry about the quality of care will be washed away with cloud computing, AI, big data, and algorithms that crawl through the cloud looking at dental care optimization, best practices, value, and outcome.
The number of new dentists with no desire to own a solo practice is swelling. Soon, over 50 percent of clinicians will be women looking for flexible hours. New dentists prefer to work for DSOs, with signing bonuses, CE, mentorships, and stock options — how will solo practices stay viable in this ecology? They can’t. How can solo practices compete with DSOs, who invest significant money into recruiting, hiring and onboarding new dentists? They can’t.
The hardest part for solo practitioners will be the seismic shift in the economic engine. Dentistry has always worked under a for-profit, fee-for-service model. But this model is becoming both obsolete and unaffordable — for the patient and for the solo-practice owner. It’s becoming obsolete because it doesn’t serve the market.
Medicine Leading the Way
The shift will be led by medicine, from fee-for-service to some form of capitated model. Capitation is about managing the health of a population, not just individuals. Increasing digital strength makes this more probable. Medicine is already producing strong group and individual results.
Finally, on a personal note: Many solo practitioners disagree with our vision of the future. Our Facebook pages are scorched with ridicule and blame.
Ten years ago, I foretold the emergence and then dominance of managed-group practices (DSOs). I heard the same thing back then. But look around — what do you see? I am the messenger — don’t blame me. It’s not my fault that the future is not lining up with your wants. The future doesn’t care — and the dentist-entrepreneurs we work with see the future as opportunity, not extermination. Those groups who can increase access, decrease cost of delivery, and integrate with primary care, who can constantly increase their use of digital technologies and AI, will absolutely triumph.
As one of my teachers once told me, “it’s best to ride the horse in the direction it’s going.”
— Marc
