Category Archives: Consulting

One of the most common things we hear from dentists today is:

“We’re busy—but it doesn’t feel like it used to.”

That statement captures one of the most important shifts happening in dentistry right now.

Because in 2026, being busy no longer guarantees strong profitability.

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The Old Model: Busy = Profitable

Historically, the formula was straightforward:

• More patients → more production

• More production → higher income

As long as a practice was busy and well-run, profitability tended to follow.

But that model is changing.

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What’s Different Today

Across the country, many practices are experiencing a new reality:

• Schedules are full (or close to it)

• Demand still exists

• But margins are tighter than expected

So what’s driving the disconnect?

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The Three Forces Pressuring Profitability

This shift is largely the result of three overlapping trends we’ve been discussing throughout this series.

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1. Rising Costs Are Eating Into Margins

Practice expenses continue to increase across the board:

• Supplies and materials

• Equipment and technology

• Staffing and wages

Even modest increases in these areas compound over time.

And importantly:

These costs are largely outside the dentist’s control.

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2. Reimbursement Isn’t Keeping Up

At the same time, revenue per procedure is not increasing at the same pace.

• Insurance fee schedules remain relatively flat

• Increases are limited and inconsistent

• Administrative friction adds hidden costs

The result is a growing gap between:

• What it costs to deliver care

• What the practice is paid for that care 

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3. Patient Behavior Is Shifting

Even when patients are coming in, they may:

• Delay larger cases

• Decline elective treatment

• Focus on immediate needs

This leads to:

• Smaller case sizes

• Lower production per visit

• More effort required to generate the same revenue

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Why “Busy” Can Be Misleading

A full schedule doesn’t always mean:

• High-value procedures

• Efficient production

• Strong profitability

In fact, some practices are:

• Working harder

• Seeing more patients

• Generating similar (or only slightly higher) revenue

but experiencing:

Lower net income at the end of the day.

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What This Means for Sellers

If you’re considering selling, this is one of the most important shifts to understand.

Buyers today are focused on:

• Net income and cash flow

• Expense structure

• Sustainability of earnings

Not just:

• Collections

• Production

• Patient count

A practice that is busy but inefficient may still sell—but:

• The valuation may reflect those inefficiencies

• Buyers will factor in the cost to improve performance

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What This Means for Buyers

For buyers, this creates both risk and opportunity.

The risk:

• Overestimating profitability based on collections

• Underestimating expenses

• Assuming current performance is sustainable

The opportunity:

• Identifying inefficiencies

• Improving systems and workflows

• Increasing profitability without necessarily increasing volume

In many cases:

The fastest way to grow income isn’t more patients—it’s better operations.

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The Bigger Insight

This is the key takeaway:

Productivity and profitability are no longer the same thing.

And in today’s market:

• Efficiency matters more

• Cost control matters more

• Strategic decision-making matters more

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Where This Is Heading

As these trends continue, we’re likely to see:

• Greater separation between high-performing and average practices

• Increased focus on business fundamentals

• More sophisticated buyers entering the market

This is part of a broader shift toward dentistry being viewed not just as a profession—but as a business that must be actively managed.

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Looking Ahead

Next week, we’ll look at how dentists are already responding to these pressures:

  >  What strategic changes dentists are making in 2026—and what it means for the future of the market.

If you’re evaluating your own practice—or considering a purchase—understanding the difference between being busy and being profitable is critical.

That’s where a deeper level of analysis makes all the difference.

If there’s one topic that consistently comes up in conversations with dentists today, it’s this:

“Insurance just isn’t what it used to be.”

That sentiment isn’t anecdotal—it’s backed by data.

While practice costs continue to rise, insurance reimbursement has not kept pace, creating increasing pressure on dental practices  .

And that pressure is doing more than just affecting margins.

It’s reshaping how practices operate, how they are valued, and how transactions are structured.

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The Core Problem: A Growing Gap

At a high level, the issue is simple:

• The cost of delivering care is increasing

• The amount paid for that care—especially through insurance—is not

Over time, this creates a widening gap between:

• What it costs to run a practice

• What the practice earns per procedure

That gap is one of the main drivers behind the “fiscal squeeze” we discussed last week.

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Why This Is Becoming a Bigger Issue

This dynamic isn’t new—but it’s becoming more pronounced.

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1. Fee Schedules Are Largely Static

Many insurance fee schedules:

• Have seen minimal increases over time

• Do not adjust meaningfully for inflation

• Vary widely between carriers

As a result:

The same procedure often generates less real income today than it did years ago.

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2. Administrative Burden Is Increasing

It’s not just about reimbursement levels.

Practices are also dealing with:

• Pre-authorizations

• Claim denials and resubmissions

• Longer payment cycles

These factors increase the cost of collecting revenue, not just delivering care.

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3. Patient Sensitivity to Cost Is Rising

Patients are becoming more aware of:

• Out-of-pocket expenses

• Coverage limitations

• Alternative treatment options

This can lead to:

• Lower case acceptance

• More treatment deferrals

• Pressure on treatment planning

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How Dentists Are Responding

Dentists are not standing still—they’re adapting.

Recent trends show that many are:

• Dropping out of certain insurance networks

• Becoming more selective with participation

• Focusing on higher-value procedures and services 

Others are:

• Investing in patient experience

• Enhancing marketing to attract better-fit patients

• Reevaluating fee structures

In short:

Practices are becoming more strategic about how they generate revenue.

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How This Is Changing the Market

These shifts are having a direct impact on practice transitions.

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1. Insurance Mix Matters More Than Ever

Buyers are taking a closer look at:

• PPO vs FFS composition

• Concentration within specific plans

• Fee schedule structures

A practice heavily dependent on low-reimbursing plans may face:

• Increased scrutiny

• Adjusted valuation expectations

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2. Profitability Is Driving Value

Historically, collections were a primary benchmark.

Today:

Profitability and sustainability carry more weight.

Two practices with identical collections can have very different values depending on:

• Insurance participation

• Fee structures

• Cost control

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3. Strategic Positioning Is Critical

Practices that have:

• Thoughtfully managed their insurance relationships

• Built a strong patient base

• Maintained pricing discipline

are often better positioned in today’s market.

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What This Means for Sellers

If you’re considering selling, your insurance profile is part of your story.

Buyers will want to understand:

• Which plans you participate in

• How those plans impact revenue

• Whether there is flexibility to make changes

This doesn’t mean you need to overhaul your model before selling—but it does mean:

You should be prepared to explain it clearly.

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What This Means for Buyers

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

A practice’s insurance mix can:

• Limit profitability

• Create opportunity for improvement

• Affect long-term sustainability

In some cases, a practice with a challenging insurance mix may still be a great opportunity—if:

• There is a clear path to optimization

• The patient base supports adjustments

• The buyer is comfortable making strategic changes

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The Bigger Insight

Insurance isn’t just a billing mechanism—it’s a strategic lever.

And in today’s market:

How a practice engages with insurance can be just as important as how many patients it sees.

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Looking Ahead

Next week, we’ll build on this and explore a question many dentists are starting to ask:

   > Are practices becoming less profitable—even when they’re busy?

If you’re evaluating a practice—or thinking about positioning your own for sale—understanding the role of insurance in your financial model is critical.

That’s an area where thoughtful analysis can make a significant difference.

If there’s one trend defining the dental economy in 2026, it’s this:

Costs are rising faster than revenue.

This dynamic—often referred to as the “fiscal squeeze”— is quietly reshaping how dental practices operate, how they are valued, and how buyers and sellers approach the market.

And unlike short-term fluctuations, this is a structural shift that isn’t going away anytime soon.

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What Is the “Fiscal Squeeze”?

At its core, the fiscal squeeze is simple:

• The cost of running a dental practice is increasing

• Reimbursement—particularly from insurance—is not keeping pace

Recent data shows that:

• Prices for dental equipment and supplies continue to rise

• Staff wages are increasing

• Reimbursement rates have grown only modestly and lag behind inflation 

Over time, that gap puts pressure on profitability—even in practices that appear healthy on the surface.

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Why This Is Happening

This isn’t a single-factor issue. It’s the result of several overlapping trends.

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1. Rising Overhead Costs

Practice expenses have increased across multiple areas:

• Supplies and materials

• Equipment and technology

• Lab fees

• General operating costs

Even small percentage increases in these categories add up quickly.

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2. Staffing Costs Are Increasing

Labor is one of the largest—and fastest-growing—expenses in a dental practice.

Contributing factors include:

• Competitive hiring environment

• Higher wage expectations

• Increased demand for benefits

Even practices that are fully staffed are feeling the impact.

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3. Insurance Reimbursement Is Lagging

This is the biggest pressure point.

For many practices:

• Fee schedules have remained relatively flat

• Increases are modest and inconsistent

• Administrative requirements continue to grow

As a result:

Revenue per procedure is not keeping pace with the cost of delivering that care.

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Why This Matters More Than Ever

Historically, dentistry has been a stable, predictable business.

But the fiscal squeeze is changing that dynamic.

Today:

• Two practices with similar collections can have very different profitability

• Efficiency and cost control matter more than ever

• Strategic decision-making has a direct impact on financial performance

In short:

Top-line revenue no longer tells the full story.

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How Practices Are Responding

Dentists are already adjusting to this new reality in a variety of ways.

Common strategies include:

• Reevaluating insurance participation

• Investing in efficiency (technology, systems)

• Adjusting staffing models

• Increasing focus on higher-value procedures

These decisions are shaping the market in real time.

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What This Means for Sellers

If you’re preparing to sell, the fiscal squeeze has a direct impact on how your practice will be evaluated.

Buyers are increasingly focused on:

• Net income, not just collections

• Expense structure

• Staffing efficiency

• Insurance mix

A practice with:

• Strong margins

• Controlled overhead

• Efficient operations

will stand out significantly in today’s market.

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What This Means for Buyers

For buyers, this environment requires a more sophisticated approach.

It’s no longer enough to ask:

“What are the collections?”

Instead, the focus should be on:

• How the practice generates profit

• Where expenses can be optimized

• Whether the current model is sustainable

At the same time, this creates opportunity.

Practices that are:

• Operationally inefficient

• Overstaffed or understaffed

• Poorly managed from a cost perspective

may offer significant upside for the right buyer.

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The Bigger Insight

The fiscal squeeze is not a temporary issue—it’s a new baseline.

And it’s driving a fundamental shift in the market:

Value is moving away from volume and toward efficiency.

That’s a big change.

And it’s one that will continue to shape:

• Practice valuations

• Buyer behavior

• Seller expectations

for years to come.

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Looking Ahead

Next week, we’ll take a closer look at one of the biggest drivers behind this shift:

  > How insurance reimbursement is reshaping the dental market—and what dentists are doing about it.

If you’re evaluating your practice—or considering a purchase—understanding how the fiscal squeeze impacts your specific situation is critical.

That’s where careful analysis and planning make all the difference.

If you’ve been in dentistry long enough, you’ve probably heard this as a benchmark of success:

“We’re booked out weeks in advance.”

For years, longer wait times were seen as a sign of a healthy, in-demand practice.

But in today’s market, that assumption deserves a closer look.

Recent data shows that appointment wait times for new patients have decreased, dropping to an average of about 12.4 days and trending downward over the past two years.

At first glance, that might seem like a positive.

But like many of the trends we’ve discussed so far, the reality is more nuanced.

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Why Wait Times Matter More Than You Think

Wait time is one of the clearest indicators of:

• Practice demand

• Scheduling efficiency

• Capacity utilization

It’s not just an operational metric—it’s a signal.

But the meaning of that signal depends entirely on context.

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When Shorter Wait Times Are a Positive

In some cases, reduced wait times can be a sign of improvement.

1. Increased Efficiency

Practices that have:

• Improved scheduling systems

• Optimized hygiene flow

• Reduced bottlenecks

may be able to see patients faster without sacrificing production.

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2. Expanded Capacity

Adding:

• Additional clinical days

• More hygiene hours

• Associate coverage

can open up availability and reduce backlog.

In these cases, shorter wait times reflect growth and scalability.

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3. Better Patient Experience

From a patient perspective:

• Faster access to care

• Less delay for treatment

can improve satisfaction and retention.

That’s a real competitive advantage in many markets.

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When Shorter Wait Times Are a Warning Sign

On the flip side, decreasing wait times can also signal underlying issues.

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1. Declining Demand

If a practice historically had:

• A 3–4 week wait for new patients

and now has:

• Open availability within days

that could indicate:

• Reduced new patient flow

• Lower referral volume

• Weakening marketing performance

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2. Lower Case Acceptance

Even with steady patient flow, practices may experience:

• More patients delaying treatment

• Smaller case sizes

• Fewer comprehensive treatment plans

This can create:

The appearance of availability—even when chairs are full.

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3. Underutilized Capacity

In some cases, the issue isn’t demand—it’s execution.

Examples include:

• Unfilled hygiene schedules

• Gaps in the doctor’s column

• Inefficient use of chair time

These are often fixable problems, but they still impact performance.

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How This Connects to the Bigger Trends

This ties directly into what we’ve discussed over the past few weeks:

• Spending is up—but not evenly distributed

• Demand exists—but isn’t always captured

• Practices are feeling pressure—even when busy

Shorter wait times are often a symptom of these broader dynamics.

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What This Means for Sellers

If you’re preparing to sell, your wait time data tells a story—whether you realize it or not.

Buyers may interpret shorter wait times as:

• A sign of opportunity (room to grow)

• Or a sign of concern (declining demand)

The difference comes down to context.

A strong seller position includes:

• Clear explanation of scheduling patterns

• Evidence of patient demand

• Identification of growth opportunities

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What This Means for Buyers

For buyers, this is where analysis becomes critical.

A practice with short wait times could represent:

• Immediate growth potential

• Untapped capacity

• A chance to increase production quickly

But it could also indicate:

• Weak new patient flow

• Poor case acceptance

• Structural inefficiencies

The key question is:

Why are the wait times short?

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The Bigger Insight

In today’s market, fewer days on the schedule doesn’t automatically mean:

“Less demand”

And longer wait times don’t automatically mean:

“Better practice”

Instead:

Wait time is a signal—but it needs to be interpreted correctly.

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Looking Ahead

Next week, we’ll dive into one of the most important forces shaping the dental market right now:

  > The “fiscal squeeze” on dental practices—and why it’s changing everything.

If you’re evaluating a practice—or preparing your own for sale—understanding operational signals like wait times can make a significant difference in how value is perceived.

That’s where careful analysis matters.

For years, the narrative in dentistry has been simple:

“There’s more demand than dentists.”

And in many ways, that’s still true.

But recent data reveals a surprising shift:

     > Approximately one-third of dentists report they are not busy enough and could be seeing more patients 

At the same time:

• Dental spending is increasing

• Patient demand still exists

• The long-term outlook for dentistry remains strong

So how can all of these things be true at once?

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The New Reality: Demand ≠ Utilization

This is one of the most important concepts to understand in today’s market:

Just because demand exists doesn’t mean it’s being captured.

In other words:

• Patients may need care

• But that doesn’t guarantee they’re walking into your office

This gap between demand and actual production is where many practices are struggling—and where opportunity exists.

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What’s Causing the Disconnect?

There isn’t a single answer. Instead, it’s a combination of factors that are reshaping how practices operate.

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1. Patient Behavior Has Changed

Today’s patients are more:

• Cost-conscious

• Selective about treatment

• Likely to delay non-urgent care

Even when they visit the office, they may:

• Decline treatment

• Postpone larger cases

• Focus only on immediate needs

The result:

Full schedules don’t always translate into full production.

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2. Marketing and New Patient Flow Matter More Than Ever

In the past, many practices relied heavily on:

• Word-of-mouth

• Long-standing patient bases

That still works—but not always at the same level.

Practices that are not actively:

• Attracting new patients

• Managing online presence

• Tracking referral sources

may find themselves slowly losing momentum—even in strong markets.

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3. Capacity Isn’t Fully Utilized

Some practices are simply not operating at full capacity.

Common constraints include:

• Limited hygiene availability

• Reduced hours or days

• Inefficient scheduling

In many cases, the demand is there—but the structure of the practice prevents it from being captured.

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4. Staffing Challenges Are Limiting Growth

This is a major factor.

Even when a practice wants to grow:

• They may not have enough hygienists

• They may be short on assistants

• They may be hesitant to expand due to staffing uncertainty

So instead of pushing for growth, they:

Maintain the status quo—even if it means leaving opportunity on the table.

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5. Insurance Participation and Case Mix

Practices heavily reliant on certain insurance plans may experience:

• Lower reimbursement

• Higher patient sensitivity to cost

• Reduced case acceptance

This can lead to:

• Lower production per patient

• More “maintenance-only” visits

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What This Means for Sellers

If you’re preparing to sell, this trend is important—but not necessarily negative.

In fact, it often becomes part of the story.

Buyers will look at a practice that is:

• Not fully utilized

• Not maximizing capacity

and see:

Opportunity for growth

The key is how that opportunity is presented.

A well-positioned practice will clearly show:

• Where additional production can come from

• What constraints exist today

• How a new owner could unlock that potential

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What This Means for Buyers

This is where the market becomes especially attractive for buyers.

A practice that is “not busy enough” may actually represent:

• Untapped demand

• Expansion potential

• A faster path to growth

Examples of opportunity:

• Adding hygiene days

• Extending hours

• Improving case acceptance

• Enhancing marketing efforts

The important distinction is this:

Is the practice lacking demand—or just not capturing it?

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The Bigger Takeaway

The idea that “dentistry is always busy” is no longer universally true.

Instead, we’re seeing a shift toward:

Practices that are busy because they are well-run—not just because they exist.

That’s a big change.

And it’s one that’s reshaping how practices are valued, how buyers evaluate opportunities, and how sellers prepare for transition.

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Looking Ahead

Next week, we’ll explore another important signal:

> Shorter wait times—what they really mean, and why they matter more than you might think.

If you’re evaluating a practice and trying to determine whether it has real growth potential—or if you’re preparing your own practice for sale—the key is understanding where opportunity exists and how to clearly communicate it.

That’s where the right guidance can make a significant difference.