Fall 2004 Table of Contents
Practicing for LifeSM
Mega-trends in Dentistry Today









By Roger P. Levin, DDS, MBA CEO and Founder, The Levin Group

This is the first of three articles that will appear in Global Health Nexus on dental practice management. The articles are designed to help dentists build long-term career success by using proven business models to optimize practice performance during changing times. In this article, I will discuss five mega-trends in dentistry today that have the potential to make or break a dental practice. These are:

1 Government Regulations,
2 Dental Insurance,
3 Comprehensive Diagnosis and Treatment,
4 Biomedical Advances in Dentistry, and
5 Practical Staffing.

First, a word about the difference between micro-trends and mega-trends. Micro-trends are minor developments that affect the way dentistry is practiced, but do not necessarily change the fundamentals of practice. For example, if dentists begin to use a new composite material or start performing all-ceramic restorations on a broad basis, these would be micro-trends, because a change in materials for one procedure represents an evolution in how the treatment is performed, not a transformation of the very nature of dental practice.

Conversely, a mega-trend has the potential to change dentistry forever. Mega-trends include major regulatory shifts such as OSHA compliance, HIPPA implementation, dental insurance, decreasing availability of trained staff, and reduced state funding for dental school education. While dentists need to be aware of micro-trends and to keep up with subtle changes in the profession, they have a life-or-death obligation to understand and be responsive to mega-trends, because if the dentist has not identified a mega-trend early on and adapted the practice to it, the results could be disastrous.

Mega-trend #1: Government Regulations
The role of government regulation in dentistry has gradually increased over the last 20 years. This increase is largely due to the Occupational Safety and Health Administration (OSHA) regulations regarding conditions of the practice environment. These regulations resulted from fears that developed in the mid-1980s, when AIDS was first identified as a major, national public-health problem. Levin Group research shows that two-to-three percent of all practice overhead is now associated with OSHA compliance.

Another set of government regulations that has become a mega-trend in dentistry is HIPPA. Many practices are lagging behind in understanding this mega-trend, whose ramifications cannot be overstated. Clearly, when two-to-three percent of overhead is tied to compliance with HIPPA regulations (in addition to two-to-three percent of overhead already associated with OSHA compliance), a practice’s bottom line is greatly affected.

Mega-trend #2: Dental Insurance
While dental insurance has been affecting practices for a number of years, a new mega-trend looms on the horizon. Levin Group projects that in the next five years, an additional 10 percent of Americans will be covered by dental insurance. This trend derives from the recent recessionary period, when employees began to request increased benefits from their employers in lieu of raises that were not forthcoming. Dental insurance is one of the most popular benefits sought by employees.

Most important for dental practices is the fact that these newly insured patients will seek out practices that participate in their plans. Patients will use insurance coverage as a key factor in selecting a practice, regardless of the dentist’s clinical skills or the ability of staff to provide a positive patient experience. Patients who are referred to specialists for particular types of treatment must also find those who participate in their plan, which could affect a general practice’s relationship with a specialty practice, and vice versa. It is important to note that as more patients become insured, the maximum allowable benefits for most insurance companies are not increasing. All of these factors will have a major impact on practice profitability, and dentists must be prepared to deal with them.

Mega-trend #3: Comprehensive Diagnosis and Treatment
The materials and technologies currently available to dentists to perform high quality clinical care are unprecedented in the history of dentistry. In theory, this should lead to more comprehensive care being performed within a practice, which would lead to greater productivity per patient. However, statistics show that 81 percent of appointments are still for single-tooth treatments, a decrease of only six percent from 20 years ago. The key to turning these numbers around is to adapt to the mega-trend of comprehensive diagnosis and treatment.

If only 19 percent of all appointments feature comprehensive diagnosis and treatment, practices are missing out on a tremendous opportunity to be more productive and more profitable. Levin Group data shows that approximately $750 worth of treatment can be identified for each new patient through comprehensive diagnosis and treatment. Even if a practice takes a year to respond to this trend by reducing its single-tooth appointment percentage to 65 percent, that additional 16 percent of comprehensive diagnosis and treatment can potentially yield hundreds of thousands of dollars in revenue for the practice. Most important, comprehensive diagnosis and treatment are in the best interests of the patient.

With options for aesthetic dentistry, implant dentistry, and occlusal dentistry, along with services such as whitening, there are comprehensive diagnosis and treatment plans that can easily be identified for each patient. A practice with a varied and significant service mix is better positioned to take advantage of this trend and to become more profitable in a shorter time.

Mega-Trend #4: Biomedical Advances and Dentistry
Dentistry has evolved far beyond simply “drilling and filling” and aspiring to achieve the desired restorative result. Dentistry will soon become a profession that is at least 30 percent dependent on diagnostic testing and pharmaceutical solutions to yield the best patient outcomes. These pharmaceutical solutions could include oral cancer testing, periodontal antibiotics, chemical treatment of periodontal disease, and even forms of aesthetic dentistry. The biomedical options for healthcare are growing rapidly, and dentistry must keep pace. If dentists do not embrace this mega-trend, they will miss out on a tremendous opportunity to increase productivity and profitability.

Dentists should welcome biomedical developments and be motivated by them to explore new services to add to their practices. Some of these new services will not be covered by insurance, but they will be services that will have a positive impact on the overall oral health of the patient base. Eventually, dental practices will have no choice but to adopt some percentage of these services if they are to remain optimally productive, while also offering the most advanced, state-of-the-art care for their patients.

Mega-Trend #5: Practice Staffing
Each year it becomes more difficult to recruit well-trained staff with extensive knowledge of dental practices and how they operate. As in medical practices, where finding trained nurses has become increasingly difficult, dentists are facing major challenges trying to find trained allied-health personnel. As an example, I recently spoke to a new Levin Group client who practices in a rural area and has been advertising a hygienist position for nine months. Obviously, this has resulted in lost productivity and increased stress. Other trends now developing include a potential shortage of dentists and lab technicians.

Hospitals use an array of programs to attract nurses, though with limited success. As a result, they are forced to delegate critical responsibilities to less-experienced personnel. Some in the medical field believe that this significantly lowers the quality of care that patients receive. This same mega-trend is also applicable to dentistry. For regardless of how well clinical dentistry is performed, it does not exist in a vacuum. The staff also contributes to the overall quality of patient care and customer service. Therefore, the practice must have a strong, well-trained staff in order to succeed.

Levin Group data show that this mega-trend can have a particularly distressing effect on a practice. Over the next five years, 70 percent of staff members will have a three-year turnover rate. Considering the loss in productivity from every staff member who leaves (productivity lost from the position being vacated, plus productivity lost while a new hire is being trained), it is entirely possible that dentists will lose $500,000 to $1 million worth of productivity during their careers simply because of accelerated staff turnover. This cost cannot be reduced to zero. However, the implementation of documented business systems covering every operating system of the practice and the cross-training of team members can reduce training time and lower these production losses by 50 percent.

While there are many other mega-trends in dentistry today, the five discussed above require the practicing dentist’s greatest attention. These five trends will continue to develop and reshape themselves in the years to come. A concentrated focus on them now will determine whether their effect on a practice is positive or negative.