Author Archives: Kevin Cooper

At this point, most dentists agree on the problem:

Hiring and retaining staff—especially hygienists—is one of the biggest challenges in dentistry today.

So naturally, the next question becomes:

Can better pay and benefits solve it?

The answer is:

Yes… but not entirely.

Compensation is a critical piece of the puzzle—but it’s only part of a much larger shift in how dental teams think about work.

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What the Data Shows About Benefits

Across dental practices, certain benefits are widely offered:

• Paid vacation and holidays

• Dental benefits

• Retirement savings options

In fact, a large majority of practices provide these core offerings 

However:

• Fewer than half offer health insurance

• Even fewer provide broader benefits like paid leave or professional development support

There’s also a clear pattern:

Practices with adequate staffing tend to offer more comprehensive benefits.

This suggests that benefits do play a role in attracting and retaining staff—but they’re not the only factor.

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Why Compensation Alone Isn’t Enough

If higher pay were the full solution, the problem would already be solved.

But despite rising wages:

• Hiring remains difficult

• Turnover continues

• Many positions remain unfilled

So what’s missing?

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1. Changing Workforce Expectations

Today’s workforce is prioritizing more than just pay.

Many dental professionals are looking for:

• Flexibility in scheduling

• Work-life balance

• Positive workplace culture

• Predictable hours

In some cases:

These factors matter as much as—or more than—compensation.

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2. The Economics Don’t Always Work

There’s also a structural challenge.

As we’ve discussed:

• Reimbursement rates are not keeping pace with rising costs

That means:

Practices can’t always raise wages indefinitely without impacting profitability.

This creates a tension between:

• What employees expect

• What practices can sustainably afford

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3. Competition Is Increasing

Practices are no longer just competing with:

• Other private offices

They’re also competing with:

• DSOs

• Temp agencies

• Alternative work arrangements

Some of these options offer:

• Higher pay

• More flexibility

• Different benefit structures

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What Successful Practices Are Doing Differently

The practices that are navigating this environment most effectively are taking a broader approach.

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1. Thinking Beyond Salary

Instead of focusing only on hourly pay, they’re considering:

• Flexible scheduling

• Part-time options

• Creative compensation structures

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2. Investing in Culture and Retention

Retention is becoming just as important as recruitment.

This includes:

• Building a positive work environment

• Supporting team development

• Creating clear expectations and communication

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3. Aligning Compensation with Strategy

Rather than reacting to the market, successful practices are:

• Evaluating what they can afford

• Aligning compensation with production goals

• Structuring roles in a way that supports profitability

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What This Means for Sellers

If you’re preparing to sell, your approach to staffing—and compensation—is part of your story.

Buyers will evaluate:

• How your team is structured

• What benefits you offer

• Whether your model is sustainable

A practice that demonstrates:

• Stability

• Thoughtful management

• A balanced approach to compensation

will be viewed more favorably.

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What This Means for Buyers

For buyers, this is an area that requires careful planning.

Post-acquisition, you’ll need to:

• Retain existing staff

• Potentially recruit new team members

• Balance compensation with profitability

Understanding:

• Local market expectations

• Competitive pressures

• Practice economics

is critical to making this work.

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The Bigger Insight

The staffing challenge isn’t just about compensation.

It’s about alignment:

• Between employer and employee expectations

• Between costs and revenue

• Between traditional models and modern realities

And solving it requires more than just:

“Paying more”

It requires:

Thinking differently about how a practice operates.

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Looking Ahead

Next week, we’ll bring everything together:

> How to position your practice for growth—or sale—in today’s evolving market.

If you’re evaluating how staffing, compensation, and practice performance all connect, that’s where a more strategic perspective can make a meaningful difference.

By now, it’s clear that staffing is one of the biggest challenges facing dental practices today.

But not all staffing challenges are created equal.

If you take a closer look, an important distinction emerges:

The hiring market looks very different depending on the role.

Understanding those differences is critical for:

• Practice owners trying to build a team

• Buyers evaluating opportunities

• Sellers positioning their practice for transition

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Not All Positions Are Equally Difficult to Fill

While hiring is challenging across the board, the level of difficulty varies significantly.

At a high level:

• Dental hygienists → Extremely difficult to recruit

• Dental assistants → Challenging, but improving slightly

• Administrative staff → Less difficult, but still competitive

This layered reality is important—and often overlooked.

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Dental Hygienists: Still the Biggest Challenge

As we discussed last week, hygienists remain the most difficult position to fill.

• The majority of dentists trying to hire hygienists report that it is very or extremely challenging 

• A significant percentage of practices report they do not have enough hygienists 

This is driven by:

• Limited supply

• High demand

• Changing work preferences

For most practices:

This is the primary constraint on growth.

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Dental Assistants: Still Challenging, But More Manageable

Dental assistants present a different picture.

• A similar percentage of practices are actively recruiting assistants

• However, the perceived difficulty of hiring assistants is lower than for hygienists and has been trending downward over time 

That said, challenges still exist:

• Candidate quality can vary

• Reliability and experience are concerns

• Wage expectations are increasing

The key difference is:

There are generally more applicants available—just not always the right fit.

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Administrative Staff: Easiest of the Three—But Not Easy

Administrative roles are typically the least difficult to fill—but still not without challenges.

More than half of dentists who have tried to recruit administrative staff report that it is very or extremely challenging 

Common issues include:

• Turnover

• Training requirements

• Fit with the practice culture

While the pool is larger, the role is critical—so finding the right person still matters.

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What This Means for Practice Operations

These differences create an interesting dynamic inside practices.

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1. Growth Is Limited by the Hardest Role to Fill

In most cases:

The entire practice is constrained by hygiene availability

Even if:

• The doctor has open time

• Assistants are available

• Front desk is staffed

Without hygienists:

• Fewer patients enter the system

• Production opportunities decrease

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2. Staffing Strategy Needs to Be Role-Specific

A one-size-fits-all approach to hiring no longer works.

Practices need to:

• Take a more aggressive approach for hygienists

• Focus on training and fit for assistants

• Emphasize retention for administrative roles

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3. Team Structure Is Evolving

Some practices are adapting by:

• Cross-training team members

• Adjusting scheduling models

• Rethinking how care is delivered

This reflects a broader shift:

Staffing is no longer static—it’s strategic.

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What This Means for Sellers

If you’re preparing to sell, buyers will evaluate your staffing through this lens.

They’ll want to understand:

• Which roles are fully staffed

• Where the gaps are

• How those gaps impact production

A practice that:

• Is fully staffed across all roles

• Has a stable, experienced team

will be viewed as:

More predictable and lower risk

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What This Means for Buyers

For buyers, this breakdown provides valuable insight.

A practice with:

• Strong hygiene coverage → Immediate production potential

• Assistant gaps → Operational improvement opportunity

• Administrative turnover → Management challenge

Understanding where the pressure points are allows buyers to:

• Assess risk more accurately

• Identify areas for improvement

• Plan for post-acquisition success

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The Bigger Insight

The staffing conversation in dentistry is becoming more nuanced.

It’s no longer just:

“Can we hire?”

It’s:

“Who can we hire—and how does that impact the business?”

And in today’s market:

• The answer varies significantly by role

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Looking Ahead

Next week, we’ll explore one of the most important levers practices are using to address these challenges:

> Are better benefits and compensation the key to solving staffing issues?

If you’re evaluating a practice—or preparing your own for sale—understanding how different staffing roles impact performance and value is essential.

That’s where a more detailed analysis can make a meaningful difference.

By now, most dentists agree on one thing:

“It’s hard to hire hygienists.”

But the more important question is:

Why is it so hard—and what does that mean going forward?

Understanding the why behind today’s hiring challenges is critical, because it shapes:

• How practices operate

• How buyers evaluate opportunities

• And how sellers position their practices

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The Reality: This Isn’t Just a Tight Labor Market

Nearly 2 out of 5 dentists report actively recruiting hygienists, and among them, over 90% say it is very or extremely challenging 

That level of difficulty isn’t typical—and it suggests something deeper than a temporary hiring cycle.

This is not just a shortage.

It’s a structural shift in the labor market.

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What’s Actually Driving the Hiring Challenge

Let’s break down the key forces behind it.

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1. There Simply Aren’t Enough Candidates

The most commonly cited issue is straightforward:

• There are not enough applicants

In many areas:

• Practices report receiving few—or even no—qualified applications

• Competing practices are all trying to hire from the same limited pool

This creates a situation where:

Demand far exceeds supply

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2. Wage Expectations Are Rising

Among available candidates, compensation expectations have increased significantly.

Practices are facing:

• Higher hourly wage demands

• Increased expectations for benefits

• Competition from other practices and corporate groups

At the same time:

• Insurance reimbursement has not kept pace

This creates a difficult balancing act:

Pay more to hire—or protect already tight margins

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3. Work Preferences Are Changing

Many hygienists are no longer looking for:

• Traditional full-time roles

• Fixed schedules

Instead, they may prefer:

• Part-time work

• Flexible hours

• Temporary or contract positions

This shift reduces:

• Full-time availability

• Long-term staffing stability

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4. Qualification and Fit Issues

Even when candidates apply, practices often report challenges with:

• Experience level

• Clinical skill

• Reliability

In some cases:

• The candidate pool is large—but not well-aligned with what practices need

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5. Mismatch Between Economics and Expectations

This is one of the more subtle—but important—factors.

There’s a growing mismatch between:

• What hygienists expect to be paid

• What practices can sustainably afford

Especially in practices heavily tied to insurance:

The math doesn’t always work.

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What This Means for Practice Owners

This environment requires a different approach to hiring.

It’s no longer just about:

• Posting a job

• Waiting for applicants

Owners need to think more strategically about:

• Compensation structures

• Work environment

• Scheduling flexibility

• Retention, not just recruitment

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What This Means for Sellers

If you’re preparing to sell, buyers will look closely at:

• Your current staffing situation

• Your ability to maintain the team

• Your approach to hiring and retention

Even if hiring is difficult:

A clear, realistic plan matters.

Sellers who can demonstrate:

• Stability

• Thoughtful management

• Awareness of the issue

tend to instill more confidence.

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What This Means for Buyers

For buyers, this is one of the most important risks to evaluate.

Key questions include:

• How difficult is hiring in this specific market?

• What is the current team situation?

• What would it take to recruit and retain staff?

At the same time, this challenge can create opportunity.

A buyer who can:

• Build a strong team

• Offer the right structure

• Adapt to changing expectations

may be able to:

Unlock production that the current owner couldn’t.

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The Bigger Insight

The hygienist shortage isn’t just about hiring—it’s about alignment.

• Between wages and reimbursement

• Between employer expectations and employee preferences

• Between traditional models and current realities

And until those align more closely:

This challenge is likely to persist.

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Looking Ahead

Next week, we’ll broaden the lens:

> How hiring challenges differ between hygienists, assistants, and administrative staff—and where the market may be easing.

If you’re navigating hiring challenges—or evaluating how staffing impacts your practice or a potential acquisition—understanding these dynamics is critical.

That’s where a thoughtful, strategic approach makes all the difference.

If you ask dentists across the country what their biggest operational challenge is today, one answer comes up again and again:

“We can’t find hygienists.”

This isn’t a localized issue. It’s not temporary. And it’s not just frustrating—it’s fundamentally changing how dental practices operate.

In many ways, the dental hygienist shortage has become:

The single biggest bottleneck in dentistry.

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The Data Confirms What Dentists Are Feeling

Across the industry:

• Only about 60% of dentists report having enough dental hygienists 

• Among those trying to hire, the vast majority say recruiting is very or extremely challenging 

In other words:

• Demand for hygienists is high

• Supply is limited

• And the gap isn’t closing quickly

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Why Hygienists Matter So Much

Hygienists are not just another team member—they are central to how a practice functions.

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1. They Drive Recurring Revenue

Hygiene is the foundation of most practices:

• Recall appointments

• Preventive care

• Periodontal maintenance

This creates:

• Consistent patient flow

• Predictable revenue streams

Without a fully staffed hygiene department:

That foundation weakens.

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2. They Feed the Doctor’s Schedule

Hygienists play a key role in:

• Identifying treatment needs

• Supporting case acceptance

• Keeping patients engaged in care

When hygiene is understaffed:

• Fewer patients are seen

• Fewer treatment opportunities are identified

• The doctor’s schedule can suffer as a result

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3. They Impact Patient Retention

Regular hygiene visits are often what keep patients connected to a practice.

If patients:

• Can’t get appointments

• Experience long delays

• Feel the schedule is inconsistent

They may:

Look elsewhere for care.

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What’s Causing the Shortage?

There’s no single cause—but several factors are contributing.

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1. Limited Supply of Hygienists

Many areas are simply experiencing:

• Fewer graduates

• Limited workforce growth

• High demand across practices

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2. Changing Work Preferences

Some hygienists are:

• Choosing part-time work

• Preferring flexible schedules

• Opting for temp or contract roles

This reduces:

• Full-time availability

• Long-term staffing stability

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3. Wage Pressure

To attract and retain hygienists, practices are:

• Increasing hourly rates

• Offering more benefits

• Competing more aggressively

But there’s a challenge:

Wages are rising faster than reimbursement in many cases.

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4. Burnout and Career Shifts

Like many healthcare roles, hygiene has seen:

• Increased burnout

• Career changes

• Reduced long-term retention

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How This Is Impacting Practices

The effects of the shortage are significant—and immediate.

Practices are:

• Leaving hygiene chairs unfilled

• Reducing available appointments

• Adjusting schedules around staffing limitations

In many cases:

The constraint is no longer demand—it’s capacity.

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What This Means for Sellers

If you’re preparing to sell, your hygiene department is one of the most important areas buyers will evaluate.

A practice with:

• Fully staffed hygiene

• Strong recall systems

• Consistent patient flow

is often viewed as:

Stable, predictable, and lower risk

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On the other hand:

• Open hygiene positions

• Limited availability

• Inconsistent scheduling

may raise questions—but also signal opportunity.

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What This Means for Buyers

For buyers, the hygienist shortage is both:

• A risk

• And an opportunity

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The Risk

• Difficulty hiring

• Delayed growth

• Increased costs

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The Opportunity

• Expanding hygiene capacity

• Increasing recurring revenue

• Improving overall production

If a buyer can successfully:

• Recruit

• Retain

• Optimize

they can unlock significant value.

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The Bigger Insight

In today’s market:

Growth is often limited not by patients—but by people.

That’s a major shift.

And it means that:

• Staffing strategy is now growth strategy

• Team building is now a core business function

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Looking Ahead

Next week, we’ll take this a step further:

> Why it’s so hard to hire hygienists right now—and what practices are doing about it.

If you’re evaluating a practice—or preparing your own for sale—understanding how the hygiene department impacts both performance and value is critical.

That’s an area where thoughtful planning can make a meaningful difference.

When most buyers start looking for a dental practice, they naturally gravitate toward listings that appear:

• Busy

• Profitable

• Fully optimized

• “Turnkey”

And while those practices certainly have their place, they’re not the only—or even the best—opportunities in today’s market.

In fact:

Some of the best opportunities are hiding in practices that appear underperforming at first glance.

The key is knowing how to identify the difference between:

• A struggling practice

  and

• An underutilized one

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Why “Underperforming” Doesn’t Always Mean “Bad”

In today’s environment, many practices are not operating at full potential due to factors we’ve discussed throughout this series:

• Staffing constraints

• Inefficient systems

• Limited hours

• Outdated workflows

Remember:

 > About one-third of dentists report they are not busy enough 

That doesn’t necessarily mean:

• Demand is weak

It often means:

The practice isn’t fully capturing the demand that exists.

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Where Hidden Opportunity Comes From

Let’s look at some of the most common areas where buyers can create value.

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1. Unused Capacity

This is one of the biggest opportunities.

Examples include:

• Open chair time

• Underutilized hygiene schedules

• Limited days or hours

In many cases, a practice may be producing:

• $700K–$900K

but could realistically support:

• Significantly higher production

with relatively modest changes.

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2. Staffing Gaps That Can Be Solved

Staffing is a challenge—but it’s not always permanent.

A practice that is currently:

• Short a hygienist

• Operating below full capacity

may offer upside if:

• The buyer has a plan to recruit

• The market supports hiring

• Compensation and structure are adjusted

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3. Inefficient Systems

Many practices have:

• Scheduling inefficiencies

• Low case acceptance

• Limited tracking of key metrics

These are often areas where:

A new owner can create immediate impact.

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4. Limited Marketing or New Patient Flow

Some practices rely heavily on:

• Existing patient bases

• Word-of-mouth referrals

While that can be stable, it may also limit growth.

Introducing:

• Basic marketing strategies

• Online presence improvements

• Patient acquisition systems

can significantly increase new patient flow.

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5. Outdated Practice Models

Some practices have simply not evolved with the market.

Examples include:

• Limited service offerings

• Older technology

• Traditional scheduling models

For the right buyer, these represent:

Opportunities to modernize and expand.

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The Key Question Buyers Need to Ask

When evaluating an “underperforming” practice, the most important question is:

Why is it underperforming?

Is it due to:

• Lack of demand?

  or

• Lack of execution?

That distinction is critical.

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Lack of Demand

• Fewer patients

• Weak referral base

• Challenging location

> Harder to fix

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Lack of Execution

• Inefficiencies

• Staffing gaps

• Limited hours

• Poor systems

> Often fixable—and where opportunity exists

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What Sellers Should Understand

For sellers, this perspective is important.

If your practice is:

• Not fully optimized

• Not operating at peak capacity

that doesn’t mean:

It lacks value.

In fact:

Opportunity is part of the value.

Buyers often recognize and are willing to pay for:

• Untapped potential

• Clear paths to growth

The key is:

• Framing that opportunity effectively

• Supporting it with data and insight

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The Risk (and How to Manage It)

Of course, not every underperforming practice is a hidden gem.

Buyers need to be careful not to:

• Overestimate their ability to fix issues

• Underestimate structural challenges

• Ignore market realities

This is where:

• Careful analysis

• Realistic assumptions

• Thoughtful planning

become essential.

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The Bigger Insight

In today’s market:

Value is increasingly created after the purchase—not just before it.

That’s a shift.

And it means that:

• Buyers who can execute have an advantage

• Sellers who understand their practice’s potential can position it more effectively

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Looking Ahead

Next week, we begin a deeper dive into one of the most important challenges in dentistry today:

>  The dental hygienist shortage—and why it’s become such a critical issue.

If you’re evaluating opportunities and want help distinguishing between risk and real upside, that’s where experienced guidance can make a meaningful difference.