A few years ago, I wrote an article for Dental Economics titled, “Who knew Dean Smith knew so much about dentistry?” I discussed how Coach Smith was often criticized for the widely held belief that he was the only person to hold Michael Jordan to fewer than 20 points per game. Jordan has countered this notion with the fact that he did average more than 20 points per game as a junior at the University of North Carolina. He went on to say that Coach Smith taught him that scoring 32 points per game can be broken down to scoring eight points per quarter.
My article applied this idea to the practice of dentistry. I discussed that consistent, daily production creates a simple manner of consistent, monthly production. To say it another way, if you want to average $80,000 per month, divide that by 20 working days and understand that you need to average just $4,000 per day to achieve this goal. Dentists should make a career out of hitting singles and doubles versus trying to hit home runs in order to achieve their production goals.
While Coach Dean Smith was a great coach and an innovator of the game, fast forward 21 years after Smith’s retirement and four years after my DE article. Roy Williams has been the head coach at UNC for 18 years. He’s won three national championships and enjoyed a Hall of Fame career. Outside of basketball, our world has experienced the most significant global pandemic since the 1918 Spanish flu. The way we interact with one another and how our society operates has changed immensely the last 18 months. Millions of Americans have lost their jobs, countless small businesses have permanently closed, and more than 600,000 Americans have lost their lives. Many businesses had to shut down at some point during 2020, including most dental practices that closed to nonemergency treatment for about six to ten weeks.
At UNC, the storied program experienced below average seasons in 2020 and 2021. The way college basketball operates has changed through the years, including the way players are recruited and the way the game is played and coached. This has resulted in the entire game becoming different. Legendary coaches who experienced Hall of Fame success have had to evaluate their place in the game. On April 1, 2021, Coach Williams announced his retirement. This was a profession that he loved. When announcing this decision, he said that he feels he’s no longer the right person for the job. Regardless of his past successes, the game has changed, and he feels UNC needs a change.
How does your practice fit in?
Dentistry is experiencing a new landscape the likes of which I’ve never seen in my nearly 20 years of practice. I entered practice after the 1998 recession, enjoyed the exponential growth of the early 2000s, experienced the 2008 recession and subsequent rebound, and am now facing practice during a pandemic and its subsequent recovery.
Much like college basketball, the landscape of dentistry is evolving. I’ve seen practitioners who have been successful in solo practices for 35 years deciding, like Coach Williams, that it’s time to step aside. I’ve also seen 35-year practitioners reinvent themselves. Single-location practices are expanding into multilocation groups or merging with and acquiring other practices to establish larger footprints with shared administrative resources to lower overhead and increase profitability. I have colleagues with multilocation groups who are entertaining private equity offers to sell their practices to form even larger groups so they can sell again for a retirement-level payday.
As a solo, noncontracted practitioner, I continue to achieve success in my own practice, but I’m not seeing the growth that I once experienced. I’ve written before that practicing in the new normal may mean acquiescing to flat or moderate growth from year to year. I look at practices and wonder if that new normal has actually changed. Maybe my model of practice has made me a relic, and much like Coach Williams, I’m no longer a leader of the profession.
Unlike any time in my career, there have been changes in how the business of dentistry occurs. While we still have single-doctor, single-location practices, the profession is also moving in many more and different directions. At first, we feared the impact of corporate dentistry, then DSOs, then DDSOs. Independent practices now fear those plus venture capital and private equity (PE). All these groups impact the business of dentistry, which affects the clinical practice of dentistry.
With these expanding business forces, the profitability of practices to parent organizations becomes even more important. How are we to manage independent practice in this environment? Are practices that have the primary goal of delivering excellent patient care dead or dying? With the many changes to the business of dentistry, I wonder what the profession will look like in 10, 15, and 20 years? Will it even resemble the profession I entered in 2002?
Add GPOs to the mix
As I observe dentistry, I have a unique perspective. Not only am I a practicing clinician, but I also founded a group purchasing organization (GPO) in 2010 with the goal of helping dentists stay competitive in the evolving landscape. Interestingly, I see changes in both these arenas. With the changes in the business of dentistry, we also see updates in how practices operate. We see greater use of different channels, such as GPOs, to allow independent practices to remain functional. We’re witnessing practice groups and even PE-controlled groups use GPOs to achieve greater profitability. As a result, even the GPO landscape is changing. There is an increase in the numbers, types, and models of GPOs for practices to choose from. The result of this competitive force is the need for GPOs to adapt so they can assist their members.
When we founded Synergy in 2010, our goal was to help independent dental practices. We did this with minimal staff and forward thinking. Today’s business of dentistry is creating an environment where we must change to better assist our members. Manufacturers are now more involved with buying groups and GPOs. Members have increased requests for assistance with administrative directions, human resources, payroll, insurance negotiation, membership plans, and continuing education. Members are looking for more to keep their practices competitive. While practices are changing, distributors, buying groups, and GPOs must also change in order to fulfill members’ needs.
Change has never been more apparent in dentistry. As practitioners, we need to examine the landscape and see which changes are appropriate for our practices. During these times, we must determine if our long-time “Hall of Fame” approaches to practice are the correct paths. Should we adapt to one of the many different paths that are now available? Do we need to decide if we’re the right person to lead our practices moving forward?
While I have no answers, my challenge to the profession is an introspective one. With all the shifts that our profession and world have experienced, what can we as practitioners do to influence the direction of clinical practice and the business of dentistry? Think about it.
Editor's note: This article appeared in the August 2021 print edition of Dental Economics.
MUSTAFA SHAH-KHAN, DDS, is a graduate of the University of North Carolina School of Dentistry, where he served on the board of directors for the dental alumni association. He is CEO and founder of Synergy Dental Partners and maintains a private practice emphasizing cosmetic reconstructive dentistry in Charlotte, North Carolina. He can be reached at [email protected].
