Virtues and Challenges of Solo Practice

Despite the growth of corporate dentistry, the large majority of U.S. dentists are solo practitioners or engaged in small group practice. As the industry recovers from the Great Recession, however, many offices would benefit from greater patient demand. According to a recent American Dental Association (ADA) survey, in fact, some owner-operators have expressed a lack of confidence about the future of their practices.

The challenges are myriad. Average net income for dentists in solo practice has dropped, partly because insurance companies have been reducing their reimbursements — a trend that’s likely to continue. In addition, many employers have eliminated dental plans, or the cost has gone up for eligible employees. In a presentation to the American Academy of Dental Group Practice, ADA Executive Director Kathleen O’Loughlin, DMD, MPH, noted that while dental care for children (ages 2 through 18) and adults 65 and older has increased since 2000, there has been a decline in visits by adults ages 19 to 64 during this same period. This last group represents a large portion of the average practice’s patients.

A tangential but equally important trend is the increase in dental school student debt, which, for many young dentists, makes it difficult to buy a solo practice, much less start one. Consequently, many choose to work for dental corporations or dental service organizations (DSO). But as these large group practices proliferate, it creates new competition for solo operators and small partnerships.

What can we predict about the future of dental practice?

ULTIMATELY, THE ABILITY TO BE MASTER OF ONE’S DESTINY REMAINS A KEY ATTRACTION OF SOLO PRACTICE OR SMALL PARTNERSHIPS

A study led by Marko Vujicic, PhD, chief economist and vice president of the ADA Health Policy Institute, investigated factors that will shape the future face of dentistry. The researchers concluded that the trends of consolidation among providers and growth in large, multisite practices are likely to continue, as is interest in the emerging midlevel practitioner model, in which dental hygienists with advanced training are allowed to perform some procedures previously the purview of dentists. In addition, the team suggests that dental insurance plans increasingly will use selective networks and demand better accountability.

How can solo practitioners rise to these challenges? As noted, consolidation is one answer, as some clinicians have chosen to go into small, independent group arrangements. The size of these groups can range from two to multiple partners, and from one to multiple locations. Another possibility — and I realize this may not be a popular sentiment among some dentists — is to embrace the midlevel practitioner model. This creates the potential to increase production as the dentist delivers more advanced treatment while the midlevel practitioner handles basic procedures, such as simple restorations.

It is often argued that economies of scale favor larger DSO groups by allowing them to optimize the use of facilities and clinical staff, order in bulk, and devote money to marketing. By the same token, some DSO dentists may wish they had more say in management, purchasing or scheduling decisions.

Ultimately, the ability to be master of one’s destiny remains a key attraction of solo practice or small partnerships. For this reason, and despite the challenges, I suggest there will always be a place in dentistry for independent operators.