Category Archives: Consulting

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.

When dentists think about practice value, they often focus on:

• Collections

• Location

• Equipment

• Patient base

But in today’s market, one factor is playing an increasingly important role:

Staffing.

More specifically:

• Whether a practice is fully staffed

• Whether that staffing is stable

• And whether the team can support future growth

In 2026, staffing is no longer just an operational issue—it’s a valuation issue.

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The Reality: Staffing Challenges Are Widespread

Across the country, dental practices are experiencing ongoing staffing shortages.

In particular:

• Dental hygienists remain the hardest position to fill

• A significant number of practices report not having enough staff to meet demand 

Even among practices actively recruiting:

• The vast majority report that hiring is very or extremely challenging 

This is not a temporary issue—it’s a persistent constraint on growth.

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Why Staffing Matters So Much for Value

Staffing directly impacts multiple aspects of a practice’s performance.

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1. Production Capacity

If you don’t have the staff, you can’t produce.

Common limitations include:

• Incomplete hygiene schedules

• Fewer available appointments

• Reduced clinical efficiency

Even with strong patient demand:

A short-staffed practice simply cannot operate at full capacity.

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2. Revenue Consistency

Staffing instability creates variability in production.

For example:

• Losing a hygienist can significantly reduce recurring revenue

• High turnover can disrupt patient relationships

• Temporary staffing can increase costs and reduce efficiency

Buyers are very aware of this risk.

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3. Patient Experience

A strong team contributes to:

• Smooth operations

• Positive patient interactions

• Higher case acceptance

Staffing gaps, on the other hand, can lead to:

• Delays

• Frustration

• Lower retention

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4. Cost Structure

Staffing challenges often lead to:

• Higher wages

• Increased benefits

• Use of recruiters or temporary staff

These factors impact profitability—sometimes significantly.

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How Buyers View Staffing Today

Buyers are placing more emphasis on staffing than ever before.

They’re asking questions like:

• Who are the key team members?

• How long have they been with the practice?

• Are they likely to stay after a transition?

• Is the practice currently understaffed?

A practice with:

• A stable, experienced team

• Fully staffed hygiene

• Strong retention

is often viewed as:

Lower risk and more immediately productive.

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How Staffing Can Affect Valuation

Staffing doesn’t just influence operations—it can directly affect price and deal structure.

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Well-Staffed Practices

• Higher perceived stability

• Stronger cash flow

• Smoother transition

 > Often supports stronger valuations

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Understaffed Practices

• Reduced current production

• Uncertainty around hiring

• Potential for delayed growth

 >  May lead to:

• More conservative offers

• Increased due diligence

• Greater focus on upside potential

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Unstable Teams (High Turnover)

• Increased perceived risk

• Concerns about post-sale continuity

>  May impact both:

• Valuation

• Deal terms

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What This Means for Sellers

If you’re preparing to sell, staffing is part of your story.

Strong positioning includes:

• Highlighting team stability

• Demonstrating full or near-full staffing

• Explaining any current gaps and how they can be addressed

Even if your practice is not fully staffed:

Clear communication of the opportunity can make a big difference.

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What This Means for Buyers

For buyers, staffing is both a risk factor and an opportunity.

A well-staffed practice offers:

• Immediate production

• Stability

• Lower operational risk

An understaffed practice may offer:

• Growth potential

• Ability to increase production quickly

• Opportunity to build your own team

The key is understanding:

Whether staffing challenges are temporary—or structural.

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The Bigger Insight

In today’s market:

A practice’s team is one of its most valuable assets.

And in many cases:

• The strength of the team matters just as much as the strength of the numbers

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Looking Ahead

Next week, we’ll explore how buyers can turn some of these challenges into opportunity:

>  The hidden potential in underperforming practices—and how to identify it.

If you’re evaluating a practice—or preparing your own for sale—understanding how staffing impacts value is critical.

That’s an area where careful analysis can significantly influence outcomes.

If you’re a dentist looking to purchase a practice in today’s market, you’ve probably realized something:

It’s not as simple as “find a good practice and buy it.”

The dental economy in 2026 presents a unique mix of:

• Stability

• Opportunity

• And complexity

The fundamentals are still strong—but the way you evaluate a practice needs to evolve.

Because today:

The best opportunities aren’t always the most obvious ones.

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The Old Way of Evaluating a Practice

Historically, many buyers focused on a few core metrics:

• Annual collections

• Patient count

• Location

• Basic overhead

And while those still matter, they no longer tell the full story.

In today’s environment, two practices with similar collections can have:

• Very different profitability

• Very different risk profiles

• Very different growth potential

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What Smart Buyers Are Looking At Now

Let’s break down the key areas that matter most in 2026.

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1. Profitability—Not Just Production

This is the biggest shift.

Buyers today are focused on:

• Net income

• Expense structure

• Margin trends

Why?

Because rising costs and flat reimbursement are putting pressure on profitability  .

A practice that looks strong on paper may:

• Have bloated overhead

• Be inefficiently staffed

• Struggle to maintain margins

Understanding this early is critical.

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2. Staffing Reality

Staffing is no longer a background issue—it’s a central factor.

Buyers need to evaluate:

• Is the practice fully staffed?

• Are key team members likely to stay?

• Is the hygiene department operating at capacity?

Given ongoing hiring challenges, especially for hygienists:

A well-staffed practice has real, tangible value.

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3. Capacity and Opportunity

One of the most overlooked areas is unused potential.

Remember:

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

That means many practices have:

• Open chair time

• Underutilized hygiene

• Limited hours

For the right buyer, that’s not a problem—it’s an opportunity.

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4. Insurance Mix and Fee Structure

This is an area that requires careful review.

Buyers should understand:

• PPO vs FFS breakdown

• Reimbursement levels

• Dependence on specific plans

A practice heavily tied to low-reimbursing plans may:

• Limit profitability

• Require strategic changes post-acquisition

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5. Systems and Operations

Not all inefficiencies are obvious—but they matter.

Look for:

• Scheduling gaps

• Poor case acceptance

• Lack of systems or reporting

These are often areas where:

A new owner can create value quickly.

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6. Growth Potential

The best opportunities are often not the “perfect” practices.

They’re the ones where:

• Demand exists but isn’t fully captured

• Capacity can be expanded

• Systems can be improved

This is where buyers can:

• Increase production

• Improve profitability

• Build long-term value

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The Most Important Question to Ask

When evaluating any practice, the key question is:

“Why does this practice perform the way it does?”

Is it:

• Fully optimized?

• Underperforming?

• Constrained by staffing or systems?

Understanding the why behind the numbers is what separates a good decision from a great one.

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Common Mistakes Buyers Are Making

In today’s market, a few patterns are emerging:

• Focusing too heavily on collections

• Underestimating expenses

• Ignoring staffing risk

• Overlooking growth potential

• Assuming current performance is fixed

Avoiding these mistakes can significantly improve your outcome.

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The Opportunity in Today’s Market

Despite the challenges, this is still a very attractive time to buy.

Why?

Because:

• Not all practices are fully optimized

• Many sellers are feeling operational pressure

• Strategic buyers can unlock significant value

In many cases:

The opportunity isn’t in finding the perfect practice—it’s in improving the right one.

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The Bigger Takeaway

Buying a practice today requires a more thoughtful, analytical approach.

But for those who do it well, the rewards are significant.

Because:

The gap between average and high-performing practices is growing—and that creates opportunity.

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Looking Ahead

Next week, we’ll explore one of the biggest factors influencing both value and performance:

  >  How staffing challenges are impacting practice value—and what it means for buyers and sellers.

If you’re considering purchasing a practice and want help evaluating opportunities through this lens, that’s where experienced guidance can make a meaningful difference.