Ep. 193: State of the Dental Industry 2025
What’s really happening in the dental industry—and what does it mean for your practice? In this special deep-dive episode of Dental Business RX, Jeff Blumberg breaks down the biggest trends shaping dentistry today, including an aging workforce, declining practice ownership, DSO expansion, and a looming dentist shortage. Whether you’re a new grad or a seasoned pro, this episode lays out the coming changes and what you can do right now to stay ahead of the curve.
Slideshow & DSO Summit - https://www.mgeonline.com/episode-193-downloads-form-page/
Free Fees & Plans Analysis - https://www.mgeonline.com/fees-and-plans
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Questions From This Episode
Why did the number of practicing dentists in the US actually decline from 2022 to 2023, despite dental schools producing more graduates than ever?
The US is in the middle of a genuine generational shift, a huge wave of baby boomer dentists trained heavily in the 1980s is reaching the average retirement age of 69, while dental schools scaled back sharply in the 1990s, leaving a thin pipeline of younger replacements. The actual count dropped from 202,536 to 202,304 dentists between 2022 and 2023, the first real decline in years, even as new schools have started opening again.
Based on Jeff's modeling, how severe is the projected dentist shortage expected to get, and when does the profession recover?
The model projects the supply of practicing dentists will fall to roughly 189,000 by 2028, even accounting for about 78,000 new graduates expected between 2024 and 2033, before partially recovering to around 197,000 by 2033, still short of 2023's count. The US isn't projected to fully recover to today's dentist supply until sometime after 2033.
Why are 20,000 to 30,000 dental practices projected to essentially disappear over the next five to ten years?
Roughly 43 percent of the country's 116,000 to 122,000 privately owned practices are owned by dentists 55 and over, a group approaching retirement age, while practice ownership among dentists under 30 has collapsed from about a quarter in 2005 to under 9 percent today. Since DSOs generally only target practices collecting at least $1.5 million a year, most of these smaller, aging-owner practices won't get acquired at all, they'll simply close or have their charts sold off if nobody buys them.
What financial problems are some of the largest DSOs currently facing, and why does that matter for someone considering the DSO path?
Several major DSOs are carrying billions in debt at credit ratings below investment grade, Heartland at a B minus and roughly $2 billion in first-lien debt, MB2 Dental with a $2.3 billion facility, and Pacific Dental Services projected to reach 5.3 times leverage, all of which raises their borrowing costs and limits their ability to expand or refinance as private equity has pulled back and grown more cautious about further investment. On top of that, a national survey found 48 percent of dentists in DSO-affiliated practices intend to leave their current setting, compared to just 8 percent in private practices, a real associate retention problem for anyone considering that path.
What does Jeff actually recommend a private practice owner do to take advantage of this shift?
Get out of network first, since staying heavily reliant on PPO reimbursement while costs keep climbing makes it financially unsustainable to compete on pay or reinvest in the practice, then use that freed-up margin to build a genuinely great place to work, since strong, stable staff make it far easier to absorb turnover and grow. Beyond their own practice, Jeff encourages doctors to get involved with state dental societies and legislators to push for more dental and hygiene school capacity, and to consider acquiring the practices of retiring doctors themselves rather than letting them close, essentially building a doctor-led alternative to the DSO model.
Episode Transcript
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What is actually happening in the dental industry right now? What are the most prominent trends, and how might they affect you and your practice over the next five to ten years? And most importantly, what can you actually do now to take advantage of these trends and create the most success for yourself, your family, your team, your patients, and the industry as a whole? That's what I want to talk about in this week's episode.
A quick heads up: regardless of where you are in your career, whether you're a fourth year dental student or you've been practicing for 35 years, this information has real bearing on you. I'd genuinely encourage you to listen through, since it gives you a real picture of what's actually going on. My name is Jeff Blumberg, and I'm your host.
If you've been an MGE client, or a longtime listener, you know that every year we hold our Owners Conference, a combined convention and alumni event, our largest event of the year. I usually open the four day conference with a presentation on the state of the industry, all the facts, figures, and numbers. A week or two after the conference, I typically follow up with a podcast covering the major points, and that's what this episode is.
What's different about this year's episode is that in prior years, I'd walk through all the numbers in detail, and I think that gets a little number-heavy for a podcast, especially if you're listening in the car and suddenly hearing a figure like 203,333, it's easy to lose the thread. I do plan to put together a video with all the specific numbers for our YouTube channel, but here I want to focus on the key points.
The other difference is that in prior years I was mostly tracking year-over-year changes. Now that I'm genuinely conversant with this data and track it regularly, I was able to build some of my own modeling and take a real deep dive into what's actually happening in the industry. What I found further confirmed something we've been saying for a while: we're in the middle of a genuine generational shift in dentistry, possibly one that only happens every few generations. It's hard to feel a shift like this while you're living inside it day to day, rather than looking back on it twenty years later, but it's happening now. This shift opens the door to real opportunity if you play it right, or genuinely difficult times if you don't.
So let's get into it. I'll cover the current supply of dentists in the US, ownership trends, DSOs, the general labor market in dentistry, insurance, and then wrap up with the big picture and some suggested action steps. I won't walk through every individual number here, I have full slides with all the exact figures and sourcing available as a free download on the episode webpage.
Let's start with supply. How many dentists are there in the United States right now? The number has stayed above 200,000 for the last five or six years. What's genuinely interesting is that from 2022 to 2023, the most recent numbers available, from the American Dental Association, the number of practicing dentists actually went down, after incrementally rising nearly every year before that. We went from 202,536 to 202,304, a drop of 232 dentists. That's notable, especially considering we're opening more dental schools, which I'll get to shortly.
Why is this happening? There's a broader demographic shift that's been building in the United States for decades. You've heard the term baby boomer, sometimes used somewhat derisively by younger generations, but I mean it purely descriptively here. The baby boom generation, born roughly from the mid-1940s through the late 1950s or early 1960s depending on how you define it, was enormous, the result of GIs returning from World War II and starting families at scale. Generation X, which I'm part of, born in the late 1960s and 1970s, was considerably smaller by comparison. Millennials followed, born in the mid-1980s through the 1990s, and now we're into Generation Z and beyond.
Think that through for a second. If you had a huge number of people born in the 1940s and 1950s, how old would they be today? Roughly their seventies and eighties, or late sixties. And people at that age typically retire, this isn't an ageism point, I'm over 50 myself and don't plan on working another 35 years, whereas someone in their mid-twenties reasonably does. The age composition of a profession genuinely matters.
Dentistry has an added wrinkle: a large number of doctors were trained in the 1980s, and comparatively few in the 1990s, since dental schools actually started closing their programs during that decade. That's reversing now, more schools are opening again, but it created a real gap, we produced a lot of dentists, then stopped producing enough, and are only now catching back up.
The standard demographic data from the ADA's Health Policy Institute, genuinely excellent data, without which none of my own modeling would have been possible, breaks dentists into age brackets: under 35, then 10 year increments through 65 and over. As of 2023, close to a third of the 202,000-plus practicing dentists in the US were 55 and over.
What that bracket alone doesn't tell you is how close any given doctor actually is to retirement. The average dentist retirement age is 69, and I know plenty of dentists still practicing into their seventies, but that's the average. Take the 55 to 64 bracket specifically, someone at the younger end of that range is roughly fourteen years from average retirement age, while someone at the older end is only five years out. That's a meaningful difference the standard bracket doesn't capture.
So I broke this down further myself, using general US demographic modeling, along with retirement trends from comparable professions like law and medicine, to estimate how that 65-and-over population actually splits by age, how many are 70, how many are 75, and so on. This matters because someone who's 70 or 75 is considerably more likely to have retired within five years than someone who's 65.
Based on that modeling, over 15 percent of the profession, nearly 32,000 doctors, are over the age of 65. And once I broke it down further, I found that over 50,000 doctors, more than a quarter of the entire profession, are 60 or older. Some of those doctors absolutely plan to keep practicing another 15 or 20 years, and more power to them. But realistically, many doctors in their sixties who are still practicing are likely doing so out of genuine enjoyment rather than economic necessity, often at a reduced schedule, one or two days a week rather than a full clinical week plus paperwork. It's a meaningfully different situation than a doctor five years out of school working a full 40-hour week.
So, keep that 25 percent figure in mind. Now, how many new doctors can we expect over the next decade? The good news is we're opening more dental schools, something the profession genuinely needed. From 2019 to 2024, seven additional schools or programs opened, going from 66 to 73, with two more planned to open in the next year or two.
Using a conservative estimate based on current program capacity, not assuming every seat gets filled, we're projecting roughly 78,000 new dental school graduates between 2024 and 2033, an average of about 7,800 a year, ramping up gradually as newer programs reach full capacity. For comparison, the US was producing roughly 6,000 new dentists a year as recently as five or six years ago.
That's genuinely good news. But is it fast enough to replace the doctors who'll be retiring? The short answer is no, not in the near term. Based on my modeling, I'm projecting that by 2028, we'll have roughly 14,000 fewer practicing dentists than we do today, and by 2033, still roughly 3,000 to 4,000 fewer than today. At the current projected rate of graduates and retirements, we won't get back to 2023's dentist count until sometime after 2033.
Here's the reasoning behind that projection. Start with that average retirement age of 69, and something called the projected outflow, or exit rate, over a five year period, meaning what percentage of doctors in a given age bracket leave the profession within five years. Up to age 54, only 3 to 4 percent of doctors exit over five years. From 55 to 64, that jumps to roughly 20 percent. For 65 and over, the average five-year exit rate is about 54.5 percent, meaning if you had 100 doctors 65 and older today, roughly 45 would still be practicing five years later.
Using the further age breakdown I mentioned, I modeled exit rates specifically for narrower bands within that 65-plus group. For someone 71 today, I estimate roughly a 75 percent chance they're no longer practicing by 76. For 75 and older, I modeled a 95 percent five-year exit rate, and for 80 and older, 99 percent.
Applying these exit rates to the current age-bracketed dentist population, and adding in the projected new graduates, advancing the whole model forward in five year increments, produces the projection I mentioned: roughly 189,000 practicing dentists by 2028, down from just over 202,000 today, then a partial recovery to around 197,000 by 2033, still about 5,000 short of where we stand right now.
Now let's turn to practice ownership, something I've cited on this podcast before. Ownership among dentists has been steadily declining for years, according to ADA data. In 2005, almost 85 percent of dentists owned a practice. By 2021, that had fallen to 73 percent, and by 2023, 72.5 percent. Extrapolating that same trend forward, and to be clear, these are projections, not certainties, we'd expect roughly 69 percent by 2028 and 65.7 percent by 2033.
The real problem is that the decline is concentrated almost entirely among younger doctors. Back in 2005, just over a quarter of dentists under 30 owned their own practice. Today that figure sits at 8.8 percent. Dentists aged 30 to 34 owned practices at a 55 percent rate in 2005, that's now down to 32 percent. Meanwhile, the 55 to 64 bracket has barely moved, dropping only from about 93 to 89 percent, and the 45 to 54 bracket has dropped just 3 to 5 percentage points. Older doctors, for the most part, still own their practices. It's younger doctors who've largely stopped buying.
This reflects a genuinely broken transition model. The traditional path used to be: graduate, associate for a few years, often carrying only moderate student debt, then either buy into that practice or open your own. That path has largely disappeared. Today, roughly a third of graduating dental students intend to go work for a DSO right out of school, drawn by guaranteed base pay and student loan assistance, which I understand, but it's changed the whole trajectory.
So think this through: the group most likely to own a practice is also the group closest to retirement. Over 50,000 doctors are over 60, and roughly a third of the profession is over 55, exactly the doctors who currently own practices, while younger doctors simply aren't buying them the way they used to. So what happens to all these practices as their owners retire?
First, how many actual dental practices exist in the US? This number is surprisingly hard to pin down accurately, since a mailing list of dental businesses might count three separately incorporated doctors sharing one physical office as three separate businesses, when there's really just one location. Based on ADA and government estimates, there are a little over 135,000 individual physical dental practice locations in the US.
Of those, an estimated 13,000 to 19,000 are owned by DSOs, a wide range since this is genuinely difficult to pin down precisely. That leaves roughly 116,000 to 122,000 privately owned locations. Complicating this further, ADA classification doesn't cleanly distinguish a solo owner from a partner in a multi-doctor ownership group, or a solo owner who simply employs an associate from a genuine multi-partner group practice, both get lumped into the same category, even though the ownership structure is entirely different. Given that roughly 145,000 dentists nationally report owning a practice, against only 116,000 to 122,000 actual locations, there's clearly a meaningful amount of shared, multi-owner practice happening.
Looking specifically at ownership by age across these roughly 120,000 private practices, about 43 percent, over 50,000 offices, are owned by dentists 55 and over. Sit with that for a second, nearly half of all privately owned dental practices in the country are owned by doctors approaching retirement age.
Given that ownership among dentists under 30 has fallen from roughly a quarter in 2005 to 8.8 percent today, if that trend continues, we'd expect it to fall further, to perhaps 7 percent by 2028 and 5.5 percent by 2033. I modeled two scenarios: a best case, where current ownership rates simply hold steady rather than continuing their historical decline, and a worse case, where the decline continues at its current trajectory, which is the more likely outcome.
Under the best case, the roughly 120,000 privately owned practices we have today drops to about 100,000 by 2028. Under the worse case, it drops to about 97,000. In other words, somewhere around 20,000 practices are projected to essentially vanish within five years. By 2033, that number grows to roughly 23,000 in the best case, and over 30,000 in the worse case, as aging owners retire faster than younger doctors are willing to buy in.
So, to summarize the core data points: the supply of dentists is projected to drop meaningfully over the next decade before slowly recovering. Nearly 70 percent of all private dental practices are currently owned by dentists 45 and over, with over 36,000 offices owned specifically by doctors 60 and older, virtually all of whom will reach average retirement age by 2033. Younger doctors aren't buying practices at anywhere near the rate needed to replace them, creating what I'd call orphan practices. Under current, conservative trend lines, 20,000 to 23,000 practices are projected to disappear within five years, and 23,000 to over 30,000 within ten.
You might assume DSOs will simply absorb these practices. They largely won't. DSOs typically target practices collecting at least $1.5 million a year, and most of these smaller, aging-owner practices simply don't fit that profile. So realistically, we're looking at doctors either selling if they can find a buyer, closing outright, or selling off charts, since younger doctors aren't stepping in to buy.
This creates a genuine opportunity, especially if you're a private doctor interested in opening additional high-quality, private practice locations. There's also a broader supply-and-demand dynamic at play, the US population keeps growing while the dentist supply is set to shrink, at least for a period. Personally, I'd lean into that opportunity aggressively, particularly given some real concerns I have about the DSO model specifically when it isn't doctor-driven, not because there's anything wrong with making real money in dentistry, but because decisions should ultimately be guided by what's genuinely best for the patient, not just the bottom line, and that perspective tends to come specifically from someone who's a doctor or who genuinely loves the profession.
A few things could shift this projection: a lower-than-expected number of dental school graduates, a sudden wave of new school openings, DSOs deciding to start targeting smaller practices despite the balance sheet challenges that presents, or a meaningful share of doctors 65 and older simply choosing to keep practicing longer than average.
Now let's talk DSOs specifically, starting with some baseline facts, then a few real problems currently emerging in that space, since this was the hot private equity investment five to ten years ago, and that's beginning to shift.
As of 2023, 13.8 percent of US dentists were affiliated with a DSO, up from just over 10 percent in 2019. Among dentists less than five years out of school, that figure was closer to 28 percent, and roughly 20 percent for those six to ten years out, meaning DSO affiliation skews heavily toward younger doctors. According to a survey from the American Dental Education Association, 34 percent of dental school seniors in 2023 planned to join a DSO after graduation, up from just 12 percent in 2015.
There are roughly 200 to 250 genuine DSOs in the US with five or more locations. You'll sometimes see wildly inflated figures like 4,300, largely because anyone who happens to own more than one location can get informally labeled a DSO, even without the actual corporate structure. Looking at real scale: fewer than 60 DSOs operate more than 50 locations, and only about 20 to 25 operate more than 100. The top 50 DSOs in the US collectively own over 10,000 practices.
As of 2024, nine of the top ten DSOs in the US were owned or backed by private equity. Private equity firms own 27 of the top 30 DSOs outright, and 84 percent of the individual practice locations connected to them. Their typical acquisition target, based on what we've observed across our own client base, is a practice collecting at least $1.5 million a year.
So what problems are these DSOs actually running into? I don't want to turn this into a blanket criticism of DSOs generally, that's not the point, but a few specific issues are worth flagging. Over the last four or five years, interest rates have climbed considerably. The typical private equity model involves acquiring a company, holding it roughly five years, and then selling it to another investor, a hedge fund, another private equity group, a pension fund. Private equity firms are increasingly stuck holding these assets longer than planned, since they haven't proven as profitable as originally projected.
The bigger issue, in my view, is debt and rising interest rates. Many of the largest DSOs are carrying enormous debt loads, in some cases billions of dollars, a meaningful share of it in high-risk, first-lien loans, meaning the lender has first claim on the company's assets if payments aren't made. Higher interest rates make it considerably harder for any organization, DSOs included, to refinance or expand without taking on costlier debt or facing real financial strain.
To illustrate, here are three real examples, all pulled from publicly available business information, primarily S&P Global Ratings. Heartland Dental, as of 2023, carries a $280 million revolving credit facility due in 2027 and a $2 billion first-lien term loan, with a credit rating of B minus from S&P. For context on what that means: credit ratings run from AAA, the highest, safest rating, down through categories like AA, A, and triple B, with anything below triple B generally considered below investment grade, meaning many institutional investors, pension funds and the like, aren't permitted to hold that debt at all, since it's considered meaningfully higher risk. A B minus rating doesn't mean anything's necessarily gone wrong, but it does mean Heartland is likely paying a higher interest rate on new debt than a more highly rated company would.
MB2 Dental has secured a $2.3 billion debt facility from KKR and is majority owned by a private capital partner group. Pacific Dental Services plans to issue an incremental $250 million first-lien term loan, which is projected to push its adjusted leverage to 5.3 times revenue by 2025, meaning its total debt would run over five times its yearly collections. In my experience, most banks get uncomfortable once leverage exceeds roughly four times revenue for a business, so 5.3 is genuinely elevated. Pacific Dental's S&P rating currently sits at B, also below investment grade.
None of this is a commentary on how these companies are run, I don't have access to their internal financials, this is simply publicly available data, and there isn't a ton of it available since these are largely privately held companies without the same disclosure requirements as publicly traded ones. But the practical effect of a below-investment-grade credit rating is straightforward: it's roughly the corporate equivalent of a personal credit score. A lower rating generally means higher borrowing costs, which increases financial pressure, particularly when a company needs to refinance.
There's also a real associate retention problem specifically within DSO-affiliated practices. According to a survey from the ADA Health Policy Institute, 48 percent of dentists working in DSO-affiliated practices intend to leave their current practice setting, compared to just 8 percent among dentists in non-DSO practices. I pulled an example directly from Heartland's own recruiting page showing genuinely eye-popping starting salaries with no experience required, and while I understand the appeal, especially for someone straight out of school, it doesn't strike me as a great long-term formula.
The other issue currently facing DSOs is a broader private equity pullback. Based on what we've seen anecdotally, including with our own clients who've had DSO deals fall through, private equity simply isn't deploying capital as aggressively as it was in 2021 or 2022. A supporting quote from the CEO of Freedom Dental Partners, a DSO, notes that securing private equity recapitalization has become an increasingly difficult undertaking for many DSOs, and valuation multiples have compressed too, from the seven to twelve times range that used to be common down closer to five times.
Recapitalization, for anyone unfamiliar with the term, is when a private equity firm either injects additional capital into a company or sells it to another investor to fund continued growth or cash out, essentially a financial refresh. These deals matter because they typically pay off existing debt, fund new acquisitions, and provide returns to investors. With higher interest rates and tighter lending conditions, some DSOs are struggling to find buyers or fresh capital, which can leave them stuck with expensive existing debt, fewer growth options, and potentially stalled expansion, staff reductions, or office closures.
So here's the data point worth taking away: most of the practices projected to disappear over the next decade aren't going to be DSO acquisition targets in the first place, since they typically fall well below that $1.5 million collection threshold. Meanwhile, a meaningful share of younger dentists are heading toward the DSO path anyway, even as several of the largest players carry significant debt, face real associate retention challenges, and are seeing private equity pull back. That's the opportunity: we're already seeing MGE clients start their own doctor-led DSOs, structured specifically to revitalize private, patient-centered dentistry and give younger doctors a genuine path to ownership. We have a full model we teach clients for exactly this, though it does require having your primary practice in strong shape first and knowing how to scale it properly.
Now, what about the broader labor market? Overall US unemployment has stayed relatively stable in the 4 percent range, aside from the brief COVID-era spike. One statistic worth revisiting: at one point, the US labor market had roughly two job openings for every unemployed person, a genuinely tight market. That ratio has since eased closer to one-to-one.
I covered the hygienist shortage specifically in a separate episode a couple weeks back, and it doesn't look any better than the broader dentist shortage, arguably worse. The general takeaway on labor right now: the market for non-technical, administrative staff has genuinely loosened, hiring for those roles should be noticeably easier than it's been the last few years. The hygienist labor market remains tight, and based on the data available, isn't projected to loosen meaningfully any time soon, since we simply aren't producing enough new hygienists to replace those going part-time or exiting the field. I covered practical steps for addressing that specifically in that earlier episode.
Now let's turn to costs, profitability, fees, and network participation. Overall inflation from April 2020 to April 2024 came in at 22.3 percent according to official government figures, though I understand the skepticism, plenty of people have pointed out that everyday goods often feel like they've risen considerably more than that in practice. Inflation over just the past year has slowed to 2.41 percent, still positive, but nowhere near as severe as the prior few years. That said, slower inflation doesn't mean costs are actually coming down, they remain meaningfully higher than they were four or five years ago.
Which brings us to fees, something I've raised repeatedly on this podcast without it always getting the traction I think it deserves. If you haven't adjusted your fees in the last four or five years, you're setting yourself up for real trouble, since every other cost in your practice has climbed considerably in that time. Your fees should realistically be at least 20 to 25 percent higher than they were five years ago.
The real complication is managed care participation. If you're heavily in network, say 70 to 80 percent, adjusting your private fee schedule only affects a small fraction of your actual patients, since the rest is governed entirely by whatever the insurance company has agreed to pay a network provider. Our position on this has become increasingly firm: remaining heavily in network going forward carries real financial danger, and getting out is something worth actively working toward now. I'll put a link to our Fees and Plans Analysis on the episode webpage, we walk through exactly what's happening in your specific practice and how to actually get out of network, since some plans take genuine time to exit, especially if you have a lot of managed care participation built up.
The core data points here: inflation has climbed meaningfully since 2020, and while the pace has slowed, overall prices aren't reversing. Staying heavily in network at reduced fees can genuinely undermine your ability to compete for staff and maintain profitability. To position your practice for real success, you need control over your own fees, which means reducing or eliminating in-network participation. And it's worth remembering that DSOs are facing this exact same squeeze, even with potentially stronger negotiating leverage on fees, they're still largely operating in network too.
So, the big picture, and I'll wrap up with the key data points. The supply of dentists is projected to fall to roughly 188,000 to 189,000 by 2028, with a slow recovery to just under 200,000 by 2033. Somewhere between 20,000 and 30,000 practices are projected to disappear over the next five to ten years, driven by aging owners exiting the profession without younger doctors buying in behind them. Over a third of current dental students plan to work for a DSO after graduation, driven largely by student debt and guaranteed income. Several major DSOs are carrying substantial debt, associate turnover within DSO-affiliated practices appears considerably higher than in private practice, which can genuinely destabilize day-to-day operations. The broader labor market has eased for non-licensed roles, but hygienists remain in critically short supply, and with fewer dentists overall, competition for strong associates may intensify. And despite inflation running nearly 25 percent since 2020, insurance reimbursement has largely stagnated or even declined in some cases.
There's a quote I included in the presentation from Dr. Greg Winteregg, who I first started digging into these trends with back in 2013, he came at it from the age-demographics angle, I came at it from ownership and broader economics, and we arrived at similar conclusions. He said dentistry is moving toward becoming a profession of haves and have-nots, and we're genuinely seeing that play out. Some doctors are thriving, fully out of network, running a patient-centered private practice. Others are struggling to make a living off a $700 crown, because that's all a given insurance company will actually pay.
Where does this all lead? As more dentists retire and fewer practices remain, patients will naturally consolidate into the practices that are still around, meaning your own practice could genuinely get busier simply as a function of fewer available options. Many of the practices closing won't fit the DSO acquisition profile, but they'd make genuinely excellent acquisition targets for a private, entrepreneurial-minded doctor interested in building their own patient-centered group of locations. That's exactly what we're advising clients to consider, acquiring a retiring doctor's practice, installing a new associate there with a real path toward eventual partnership, offering younger doctors a genuine route to ownership outside the DSO model.
The way I've framed this for our own clients: someone has to take responsibility for what this profession looks like going forward, so it doesn't simply default into a cold, corporate model with limited access five or ten years from now. That call goes out well beyond MGE clients, there's no reason more of the profession can't take that same responsibility. Given the supply constraints ahead, hiring associates and hygienists may become increasingly competitive, though that could shift depending on how much DSOs are actually able to expand given their current financial pressures. Winning long term means building a practice that's genuinely a great place to work, and with rising wages, ongoing inflation, and stagnant PPO reimbursement, staying in network has become financially unsustainable for real long-term growth, since it strips you of control over your own fees.
I wouldn't be entirely surprised, and I have a slide on this too, if some rural areas with disappearing private practices eventually end up with some kind of hybrid public-private dental office, government-run, in areas with no private practice left at all. I doubt that would be built around quality so much as sheer scarcity, but it illustrates the stakes here.
So, what are we actually recommending to MGE clients? First: get out of network now, and take real control of your revenue, your margins, and your ability to reinvest in the practice. If you're sitting at 80 percent PPO participation, that transition is genuinely more achievable than it might sound, that's exactly what our Fees and Plans Analysis is built to walk through, and we've helped a considerable number of clients make that exact transition. Use the additional margin that creates to offer genuinely competitive pay, fund practice expansion, keep your equipment and technology current, and invest in real training, mentorship, and team development, all of which increases profitability while reducing the stress of being financially dependent on insurance companies.
Second, and this might sound obvious, but it's worth really sitting with: build your staff specifically for growth. Whether you're expanding a single large practice or building toward multiple locations, since there will genuinely be more patients relative to fewer dentists, you need a genuinely strong team. I tell clients directly that the same professionalism they've built around sales or executive skill needs to extend fully into hiring, HR, and onboarding, building a culture that actually attracts and retains long-term team members. Great people reduce stress and support real growth, and they often become your future executives, I can't count how many office managers started as a lead dental assistant, a hygienist, or someone at the front desk, not hired directly into management.
Your practice has to become a place top talent genuinely wants to work, particularly once you're out of network, since that team is what maintains a consistently excellent patient experience. And there's a real practical benefit too, if you have five strong team members and lose one, it's considerably easier to bring a new hire up to standard with four experienced people supporting that transition than if you only had one person to begin with.
If you're inclined to expand further, add locations that are genuinely doctor-led and quality-focused, not fueled primarily by debt, mirroring your existing practice's culture and standards. Given that 20,000 to 30,000 practices are projected to disappear over the next decade, there's a real opportunity to acquire some of these and turn them into satellite locations. Ideally, a patient should feel like they're in the same practice whether they're at your primary location or a satellite, different physical space, different staff, but the same consistently high standard of care. This also creates a genuine path for younger doctors, instead of going to work for a DSO, they come work for you in a real mentorship arrangement with potential future partnership, and you're the one passing on what private dentistry should actually look like.
A properly run satellite location should be able to net roughly 20 percent without requiring your own personal production to hit that number. You can still go there occasionally if you enjoy the clinical work, but the location shouldn't depend on you working there to be profitable, you're there for oversight and quality assurance, not to personally carry its production.
If this is something you're genuinely interested in, we're holding a DSO Summit this November, running the 11th through the 15th here at our Florida office, myself and Sabri walking through the full process of acquiring additional locations and building the infrastructure for a doctor-led, patient-centered, out-of-network group practice. I'll put a link on the episode webpage if you'd like more information.
Last recommendation, and this connects to the broader challenge I mentioned earlier, taking real responsibility for changing where this profession is headed. If you're in private practice, get genuinely involved locally or at the state level, with your dental society or your state legislators. I know it's easy to stay focused on national politics, and I'll say clearly, we're apolitical here, this isn't about any particular party, but state legislators are specifically the people who approve funding and capacity for state colleges and university programs, and they're genuinely accessible. Make your state representative or senator aware if your area lacks a dental school, or if existing programs need more capacity, especially if you're in a state with real healthcare access gaps. This is about as non-partisan an issue as exists, more doctors benefits everyone regardless of political affiliation.
Specifically, I'd raise three things: expanded dental school capacity, expanded hygiene school capacity, since that pipeline is critically thin nationwide, and, if there's any way to meaningfully affect dental school tuition costs, since student debt is genuinely crippling for a lot of new graduates. I covered this in a past episode on stress and burnout among younger doctors, student debt is consistently one of the biggest sources of stress, and it's also very likely a major reason fewer young doctors are buying practices. Lower debt loads could meaningfully help address that ownership gap on their own.
You could also reach out to your own dental school alma mater, or a local dental school, and talk directly with graduating seniors about the genuine appeal of private practice ownership. It's worth doing, since DSOs are actively recruiting on dental school campuses making that exact pitch, and private practice owners largely aren't. If you're able to, supporting a residency program is another option, we have clients doing exactly this, bringing residents in for real hands-on experience.
One last point I've raised with clients, and I want to be clear this is anecdotal, since I'm not a clinician myself and can't speak to it directly, but I've heard from a number of clients that newer graduates sometimes come out with less clinical confidence, speed, or willingness to take on certain procedures compared to doctors who graduated decades ago. If that resonates with your own experience, it might be worth raising directly with your dental school or state society, whether curriculums need updating. Take implants as one example: placing an implant is now considered standard of care for replacing a missing tooth, the way a bridge might have been 20 or 30 years ago, yet most graduates come out of school without ever having placed one, requiring additional continuing education afterward to learn something that's arguably already expected of them as a baseline skill.
So the broader point is this: take responsibility not just for your own practice, team, and family, but for the profession as a whole. If enough of us genuinely do that, we can help keep private dentistry patient-centered and quality-focused over the next five to ten years, rather than letting outside financial forces determine what the profession ultimately becomes. And in the process, there's real opportunity to build something genuinely excellent for yourself too.
That's a longer episode than usual, but I think it's genuinely important to understand what's actually happening in your profession right now. I've got links on the episode webpage to the full slideshow with all the underlying statistics and sourcing, along with the Fees and Plans Analysis if you'd like help getting out of network, which I'd genuinely recommend looking into if you're currently participating in any plans. If you have any questions, you can always email me directly at jeffb@mgeonline.com, or find out more about us at mgeonline.com or by calling (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.