Category Archives: Strategies

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.

If you’re a practice owner thinking about selling, you’re probably asking some version of this question:

“Is now a good time?”

The answer, as with most things in today’s market, is:

Yes—but with the right expectations.

The dental market in 2026 remains active, with strong buyer demand and continued interest in practice ownership. But at the same time, the factors that drive value—and how buyers evaluate opportunities—have evolved.

Understanding that shift is key to a successful transition.

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The Good News: The Market Is Still Strong

Let’s start with what hasn’t changed.

• Dentistry remains a stable, in-demand profession

• Buyers are still actively looking for opportunities

• Financing is available for qualified candidates

From a high-level perspective:

Well-run practices continue to sell—and sell well.

That’s important.

There’s no indication that the market has weakened in a fundamental way.

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What Has Changed: How Buyers Think

While demand is still strong, buyers today are more analytical than ever.

They’re not just asking:

• “How much does the practice collect?”

They’re asking:

• How profitable is it?

• How efficient is it?

• How sustainable is it?

• Where is the risk?

• Where is the opportunity?

This shift is being driven by the trends we’ve covered over the past several weeks:

• Rising costs

• Flat reimbursement

• Staffing challenges

• Changing patient behavior

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Timing: Should You Sell Now or Wait?

This is one of the most common questions—and one of the hardest to answer generically.

But here’s the key insight:

Waiting doesn’t automatically increase value.

In fact, in some cases:

• Rising costs may reduce profitability over time

• Staffing challenges may become more difficult

• Market conditions may shift in ways that are hard to predict

On the other hand:

• Improving operations

• Stabilizing staffing

• Strengthening systems

can absolutely increase value—regardless of timing.

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Value: What Drives It in Today’s Market

Practice value has always been tied to performance—but today, the definition of performance is broader.

Buyers are focusing on:

1. Profitability

Not just collections, but:

• Net income

• Expense structure

• Margin stability

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2. Staffing Stability

• Is the practice fully staffed?

• Are key team members likely to stay?

• Is the hygiene department functioning at full capacity?

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3. Operational Efficiency

• Scheduling systems

• Case acceptance

• Workflow

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4. Growth Potential

• Is the practice maxed out?

• Or is there room to expand?

Interestingly:

A practice that isn’t fully utilized can still be very attractive—if the opportunity is clear.

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5. Insurance and Patient Mix

• PPO vs FFS

• Fee structures

• Patient demographics

These factors play a larger role than they did in the past.

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Expectations: The Key to a Smooth Transition

One of the biggest challenges in today’s market isn’t finding a buyer—it’s aligning expectations.

Sellers who are best positioned for success tend to:

• Understand how buyers are evaluating practices

• Recognize both strengths and weaknesses in their practice

• Be open to how the story is presented

This doesn’t mean undervaluing your practice.

It means:

Positioning it accurately—and strategically.

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Common Mistakes Sellers Are Making

In this environment, a few patterns are emerging:

• Over-reliance on collections multiples

• Underestimating the impact of expenses

• Ignoring staffing issues until late in the process

• Assuming all buyers will view the practice the same way

Avoiding these pitfalls can make a significant difference in both value and deal structure.

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What You Can Do Now

If you’re considering selling in the next 1–3 years, there are a few things you can do today to improve your position:

• Organize and understand your financials

• Evaluate your expense structure

• Stabilize your team where possible

• Identify areas of growth or opportunity

These steps don’t require a complete overhaul—but they can have a meaningful impact.

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The Bigger Takeaway

The dental market in 2026 is still favorable for sellers.

But success is no longer just about:

Having a good practice

It’s about:

Understanding how that practice is perceived in today’s market—and positioning it accordingly.

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Looking Ahead

Next week, we’ll shift to the other side of the equation:

 >  What buyers should be looking for in today’s market—and how to identify the right opportunity.

If you’re thinking about selling and want to better understand how your practice would be viewed in today’s market, that’s a conversation worth having early.

The more prepared you are, the smoother the process tends to be.