Practice Management

Predicting The Unpredictable


Ron Weintraub


May 23, 2018

May 23, 2018

What do we think dental practices might look like in the next decade? This is the time frame that most dental office leases occupy, so it is imperative that we plan ahead to ensure we are relevant down the road.

The dental profession is being subjected to unprecedented clinical and administrative pressures which are creating concerns about the ability to practice successfully without making significant changes to our mode of operation. In previous articles, we discussed current factors that affect our existing operations, but before we plan for the future, we should have a firm understanding of the etiology of potential motivating trauma. A review of the stresses should lead to the realization that significant clinical, sociologic, and administrative changes may be in order. 

Clinical Pressures

Clinical responsibilities are changing significantly.  The demand for the provision of more comprehensive dentistry in-house is growing. For example, patient requests often include the following:

  1. implant dentistry
  2. computerized crown fabrication
  3. sleep apnea treatments
  4. Invisalign orthodontic procedures

Many of these enhanced procedures require large commitments with respect to continuing education and, in some cases, require significant financial investment.  As an example, laser computer-guided implant placement as well as three-dimensional panoramic type radiography such as Orthophos XG 3D CBCT scanners are sometimes beyond the capabilities of single practitioners as the price tag may be in excess of $200,000. 

As focus shifts from preoccupation with the esthetic outreach of dentistry to the realization that oral health care provided by dentists is a vital component of the overall general systemic health and well-being of individuals, patients are increasingly viewing dental services as a crucial part of the medical health care system. We have to respond to this positive direction by providing more integrated support for patients' current assumptions.

Whether it is a conscious decision to present our profession in this manner or the inevitable result of more knowledge of medicine and dentistry, it is certainly the correct direction for professional growth for us to integrate more fully into the health care system.  

In the future, as clinical requirements for treating more complex oral health situations such as, sleep apnea among others arise, it is beneficial to collaborate and consult with other dental and medical practitioners.  A collaborative approach creates an environment where our patients' treatment may be enhanced and influenced by multidisciplinary providers including the following: 

  1. oral and maxillofacial surgeons
  2. dental anaesthesiologists      
  3. periodontists
  4. primary care and specialist physicians
  5. and sometimes psychologists


The nature of the changing job market is reflected in fewer employers offering dental benefits to their employees.  This phenomenon, which will inevitably continue, seriously affects our patient population.  Currently, most practices’ patient base are fortunate to have a large percentage with dental benefits, but the inevitable shrinkage of financial resources for patients to obtain dental services will affect the availability of patients to fill our schedules.   Combined with the foreseeable increasing costs of providing services which are reflected in a predictable increase of dental fees, we cannot ignore this challenge as we plan for the future.  Perhaps we should be stronger advocates for the government to play a role in assisting patients, starting with the youth population, to receive timely and routine oral health care that they require.  

The projected possible decline in patients may also interface with the on-going occurrence common in large urban centres of the abundance of single practitioner offices.  Consequently, diminishing demand for dental services may threaten the viability of a number of smaller, less robust dental offices in the future.  

Administrative Projections 

The previous discussion behoves us to consider expanding our footprint to provide capable, appropriate administrative staff rather than one individual with multiple roles such as re-care coordinator, dismisser, and phone in-take who may not be outstanding in any one role. Therefore, the timing to consider a group practice has come to the forefront.  Even if some predictions do not come to fruition, practitioners should honestly reopen the discussion of the viability of group practice versus solo practice.  It is one thing to predict very large changes in the next decade, but it is another to suggest smaller changes in the present that can lead to successful management of most of the inevitable alternatives. 

Group practice can help deal with many future predictable and unforeseen requirements that the profession may face.  It is not enough to predict without certainty.  For this reason, a follow-up article will deal with the thesis of how group practice may benefit practitioners in dealing with the potential significant upheaval of the next decade.