Why organized dentistry needs to change in order to survive

October 13, 2017

Big changes are happening in dentistry, and organized dentistry needs to accept the future.

According to a number of business experts and pundits, authors from numerous fields, scientists and social authorities, the context is decisive. The current context of organized dentistry is chiefly “preservation.” No matter how virtuous its mission statement, how altruistic its public speaking, the observable context from which it operates is the preservation of the past. The past being independent solo practices.

Given this context, organized dentistry generates a consistent effort to hold onto this past by attempting to retard the future. But, at some point, organized dentistry will need to realize that you can’t stop a contextual shift from happening. You can’t rewind the past. It has never worked that way. Context always wins.

The emerging context in dentistry is merger, acquisition and consolidation. This new context is validated by the explosive growth of managed group practices and DSOs. On the other hand, the context in which organized dentistry is trying to cement is the independent solo practice. As in Newtonian physics, two contexts cannot occupy the same space at the same time.

The majority of organized dentistry is made up of members who do not want the future to happen. Their current membership has done exceptionally well operating in the old context - the independent small business, fee-for-service, solo practice model. Members made good money; they worked the days and hours they wanted, they could be their own boss, they had no oversight so they could do what they wanted. The emerging context now threatens all of that.

When we talk about “organized dentistry,” we’re talking about its political organizations whose executives and trustees represent their membership. Their members do not want a future of acquisition and consolidation to occur. We’re also talking about state boards and boards of examiners who do not want this future to impact their view of how dentistry “should” be practiced and delivered.

But organized dentistry is in denial about the facts, statistics and data. Solo practices in number are shrinking, whereas managed group practices are growing at a high velocity. Managed group practices and DSOs of various sizes and shapes are beginning to dominate a number of sectors. This future will happen regardless of what organized dentistry feels, does or thinks. Uber doesn’t care about Yellow Cabs. Apple doesn’t care about payphones. Amazon doesn’t care about shopping malls. And, managed group practices don’t care about solo practices.

Forces shape the future. For example, the force of social media has changed dental marketing. The force of implants and digital radiography has changed clinical dentistry. The force of driverless vehicles will change commuting and trucking. A multitude of forces impacting dentistry are now intensifying. These forces will cause numerous changes to dental practice and the dental industry. These forces have already caused some deformation, allowing the explosive growth of managed group practices and DSOs at 20 percent and the shrinkage of solo practice shrinkage of solo practice at 7 percent per year, according to the ADA. Solo practices now are less than 60 percent of existing practices in the U.S.

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These forces are becoming more and more potent, growing in strength and exerting a greater impact on dentistry. Using the metaphor of a hurricane, the eye of the hurricane is the profound shift in context - from small business to big business. The surrounding eyewall of the hurricane is the tremendous influx of venture capital and consolidators, pushing forward the exponential growth of DSOs. The rainbands of the hurricane are horizontal integration, vertical integration, artificial intelligence, robotics, cloud computing, Big Data, electronic patient record, and genomics. And, this hurricane is moving from a Category 3 to a Category 4.

Other rainbands of the hurricane are lack of access to 47 percent of the population, direct connection to systemic diseases, dentistry becoming more and more seen as part of primary care, demand for midlevel providers, dental therapists, and a major shift in reimbursement from the fee-for-service model to the pay-for-performance model.

The very outer rainbands are the dental lobbyists from organizations such as the ADSO, talking to Congress about dentists in solo practice and their protectorate of organized dentistry. Implicit in the lobbyist's conversation is solo practice as a monopoly in dental practice. The lobbyists will argue that organized dentistry and their members are trying to control dentistry and are therefore preventing better costs and greater access by limiting competition. All this is occurring over the warmer waters of limited access and high costs of health care, creating this Category 4 hurricane.

What organized dentistry ought to consider is rather than trying to preserve the past of highly fragmented solo practices, trying to prepare its members for the new future. That future clearly will be managed group practice.

Complaining, faulting and blaming have no power. Condemning, criticizing and accusing have no power. Wake up organized dentistry - you can’t stop the future. The strategy in your states, trying to stop DSOs from entering your borders, is crumbling. Take a look at what happened in Washington state. Attempting to exert onerous state control over DSOs as a strategy to prevent managed group practices/DSOs from coming into your state will not simply hold up.

DSOs have the leadership, money and “smarts” to create the conditions that can fully adapt to the changes outside forces are producing, whereas solo practices cannot. The train has left the station. The future is going to happen regardless of how organized dentistry feels about it. The context has shifted.

My recommendation to organized dentistry is to get on board. Educate your members. Create pathways for them to succeed in this new future. The past is quickly eroding as the new future emerges. If you’re not helping make it right, then stop complaining about it being wrong. If you are refusing to light any candles, don’t complain about being in the dark. If organized dentistry cannot adapt to the changes caused by these continuously increasing forces and assist their members to succeed in this new future, then they will eventually lose power and go out of existence.

Organizations who stay relevant stay in existence. Organizations that don’t stay relevant go out of existence. What remains relevant is always context dependent. Look what happened to unions when they stopped being relevant for their members. The writing is on the wall for organized dentistry - change or perish.