Ep. 4: The Economic Future of the Dental Industry
With the dust (hopefully) settling soon from the pandemic, we take a look at the future of private practice from an economic perspective. There are some key trends that every dentist should be aware of. We’ll look at the supply of dentists and population (1:43), economic effects from the pandemic (7:39), and some interesting opportunities for savvy private practice dentists (14:20).
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Studies mentioned in this episode:
Inside American dentistry’s identity crisis
COVID-19 Economic Impact - State Dashboard
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Questions From This Episode
What does the age breakdown of practicing dentists in the US suggest about the profession's future supply?
As of 2020, roughly 16.3 percent of US dentists were 65 or older, close to the average retirement age of 68.2, while total four-year dental school enrollment that same year was actually lower than the number of dentists already at or near retirement age. Combined with a projected US population increase of 5 to 7 million people over the following several years, the underlying trend pointed toward fewer dentists serving a growing population.
Was the dental industry's post-pandemic slowdown actually being driven by patients staying away?
The data doesn't support that as the primary explanation. A contemporaneous consumer survey found 94 percent of typical dental patients were ready to return, or had already returned, to the dentist by spring 2021, yet ADA economic surveys around the same time showed a large share of practices still collecting meaningfully less than their pre-pandemic baseline. The gap points more toward business model and mindset factors than an actual absence of willing patients.
Why did some practices thrive in 2020 while national industry projections predicted a major downturn?
Broad industry forecasts predicted a sharp overall decline for 2020 and continued softness into 2021, and many practices did see reduced volume, particularly during mandated closures. But a number of MGE clients had their strongest years ever in 2020, some surpassing the prior year's numbers by October despite one to three months of mandatory closure. The difference tracked more closely with outlook and whether a practice actively pursued the opportunities in front of it than with the pandemic itself.
What's the case for this being an unusually good time to grow a private practice?
The combination of a shrinking dentist pipeline relative to population growth, plus a meaningful share of existing practices still operating below their pre-pandemic baseline despite patients being willing to return, adds up to real, available opportunity for practices actively working to capture more volume rather than settling into reduced expectations.
Episode Transcript
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What does the future of the dental profession actually look like? Not the clinical future, not teeth grown from stem cells, the economic future. Whether you're a dental student or you've been in practice for 5, 10, or 20 years, what do your actual economic prospects look like going forward? That's what I want to cover this week. My name is Jeff Blumberg, and I'm your host.
This is a question I've gotten from a number of clients directly, enough that I built a full presentation on it for our Owners Conference this past May. One thing that presentation made clear is that several trends have been building in the profession for the last 20 to 25 years, and the pandemic genuinely accelerated a number of them. I'm recording this in August of 2021, roughly 16 months into the pandemic, and we now have a considerably clearer picture of where things are actually heading.
Here's how I want to walk through this: first, where things actually stand statistically, then what I think that means, and finally the real opportunities this has opened up. Let's start with the numbers, all sourced from the American Dental Association, and I'll have links to these available on the episode page if you want to look at them directly.
Start with practicing dentists in the US by age bracket for 2020, this includes every dentist and dental specialist across every practice setting, DSOs, public health, private practice, all of it. Total US dentists in 2020: 201,117.
Broken down by age: under 35, 34,190. Ages 35 to 44, 48,268. Ages 45 to 54, 43,441. Ages 55 to 64, 42,436. And 65 and over, 32,782.
As a percentage of the total profession, that's 16.3 percent aged 65 and over, nearly one in five. For context, the average dentist retirement age in the US peaked at 69.1 in 2018 and sat at 68.2 in 2020. Some of that 65-plus group is already well past that average. The remaining brackets: 55 to 64 makes up 21.1 percent, 45 to 54 makes up 21.5 percent, 35 to 44 makes up 24 percent, and under 35 makes up 17 percent.
Now project this forward five years. Not every dentist retires precisely at 68.2, of course, some retire earlier depending on circumstances, some practice well into their 70s, entirely their choice. But statistically, a meaningful share of that 65-and-over group will begin retiring or scaling back over the coming years, and dental school graduates are what replenish the workforce behind them.
How many students were actually in dental school? For the full 2019 to 2020 school year, across all four years combined, 25,807 students total. That's fewer students currently enrolled across all four years of dental school than there are dentists already aged 65 and over. Which points toward a genuinely shrinking dentist population over roughly the next five to six years.
Now compare that against population growth. Current US population sits around 330 million, projected to reach roughly 335 million by 2024 and about 337 million by 2025, an increase of 5 to 7 million people over the next four to five years. So while the population grows by several million, the underlying data points toward fewer practicing dentists over that same window.
Different organizations have modeled this differently, and nobody has a crystal ball here. One long-term projection I saw essentially covered every base, more dentists, the same number, or fewer, which isn't especially useful as a prediction. If you asked me directly to make a call, and this is genuinely just my own opinion, not something to base major decisions on alone, I'd bet on fewer dentists over the next five years given the current trajectory.
If you've been in the profession a while, you've seen part of this play out already. A wave of dental schools closed in the 1990s, and enrollment ran lower than it had been in the 1980s for a stretch running through the early 2000s before beginning to climb again more recently. That extended dip in graduating classes is a real part of why we're looking at this current supply picture. So: likely fewer dentists, meaningfully more people, that's point one.
Now let's look at where the profession currently stands economically. The ADA runs a monthly Economic Impact Survey, and I want to compare two snapshots, April 2021, which is what I used for my presentation in May, against the more recent August 2021 data, so you can see the actual direction of travel.
On practice status: in April 2021, 58.1 percent of dental offices reported being open and operating business as usual, 41.5 percent were open but seeing lower patient volume, and 0.4 percent were closed entirely or seeing only emergencies.
By August 2021: 64.8 percent open and business as usual, still under two thirds. 34.1 percent open with lower patient volume, meaning roughly one in three dental offices nationally were still operating below their pre-pandemic baseline. And 1.2 percent remained closed or emergency-only.
On collections specifically, comparing the same two periods: in April 2021, 35.9 percent of offices were collecting 95 percent or more of their typical pre-pandemic collections, essentially flat or only slightly down. The remaining 64.1 percent were collecting less than 95 percent of typical, with about 31 percent collecting 75 to 80 percent or less of typical.
By August 2021: only 47.1 percent of offices were collecting 95 percent or more of typical, meaning less than half the profession had returned to something close to their pre-pandemic collections baseline. The remaining 52.9 percent were still collecting less, 27.8 percent in the 86 to 95 percent range, and 15.6 percent collecting only 50 to 75 percent of what they collected before the pandemic. More than half the profession, by this data, was still collecting less than before.
Why would that be, if it's not simply patients avoiding the dentist? A poll conducted around the same period by the Engage Sports and Leisure Research Group and ROKK Solutions found consumer confidence in returning to the dentist had actually hit a new high that April, with 94 percent of typical dental patients reporting they were either already back or ready to return. Only 6 percent weren't ready yet. So the patients, largely, were willing. Something else was driving the gap, likely some combination of business model issues and a more pessimistic outlook among practice owners themselves, not an actual absence of willing patients.
So to summarize the data: reduced patient flow and reduced revenue across a meaningful share of the profession, despite patients broadly being ready to return.
Here's something worth sitting with though. In 2020, I personally saw more MGE clients, all private practice owners, post their best year ever than in any prior year I can recall, including practices that had been fully closed for one to three months depending on their location. Some had already surpassed the entire prior year's numbers by October 2020, despite two months of mandated closure earlier that year.
This matters because it would be easy to simply assume, of course everyone's down, there's a pandemic, which lines up with what was broadly projected at the time. The chief economist at the ADA projected a 38 percent reduction for the dental industry overall in 2020, with up to a 20 percent reduction continuing into 2021. And plenty of practices genuinely did see declines. But I also saw plenty of others doing standard, unremarkable dentistry who were meaningfully up. That gap isn't fully explained by the pandemic itself, it has a lot to do with outlook, and with whether a practice was actively working to capture the opportunity actually available to it.
So pulling this together: the data points toward fewer dentists entering the profession relative to a growing population, and a genuinely large share of existing practices still underperforming their own pre-pandemic baseline, despite patients broadly being ready and willing to come in. Less supply, more demand, and a meaningful chunk of the existing supply not fully capturing the opportunity in front of it.
Why might that be, especially if it describes your own situation right now? Generally, when people face real adversity, and the last 16 months qualified for nearly everyone outside a handful of internet-native businesses, the natural tendency is to quietly lower expectations and ambitions, to pull back a bit. That instinct, understandable as it is, means fewer patients actually get seen, even though it's clearly not the patients holding things back. Which, in turn, creates real opportunity for practices willing to lean forward instead.
So here's my honest take on all of this: in my own experience in this profession, there has rarely, if ever, been more economic opportunity than right now, particularly for a private practice. You can build real success right now, you simply need to genuinely know what you're doing. There's real room to grow an existing practice's patient volume, and real opportunity to expand into multiple locations if that fits your goals. The real question is how to actually capture that opportunity.
I didn't want this episode to turn into a pure sales pitch, but I'll say this directly: if you're genuinely looking to improve your position and take real advantage of the current landscape, we're happy to help. You can reach us at 800-640-1140 or visit us online at mgeonline.com for a practice consultation, we'll give you an honest read on whether we can genuinely help and go from there.
But my sincere view, stated plainly, and again, I'm not a fortune teller, just someone who's watched this profession closely for a long time, is that there has rarely been a better window than right now. I wish you the best, and I'll see you at the next episode.