As the Great Resignation reaches dentistry, it may exacerbate existing access-to-care problems — possibly leading to declining oral health, more dental emergencies, and even an increase in heart disease and other serious health problems.
In a January 2022 poll by the ADA’s Health Policy Institute, 69% of dentists cited staffing issues as the top challenge facing their dental practice. In fact, the problem continues to grow. In October 2020, 51.8% of owners said that it was “extremely challenging” to recruit hygienists. By March 2022, 73.1% of dentists made the same claim.
Meanwhile, many older dentists are accelerating their retirement plans.
However, even as the Great Resignation reshapes workplaces everywhere, young dentists are embracing the opportunity to step into established practices and retain hard-working staff. In many cases, these dentists can tap into programs, such as the National Health Service Corps, that forgive student loans for dentists providing care in underserved communities.
Hygienists are leaving the workforce
At the start of the COVID-19 pandemic in March of 2020, many practices were limited to urgent and emergency procedures, which reduced staff hours. Even as practices began reopening, many of the 98% of practicing dental hygienists who are female found themselves juggling child care and helping their children with Zoom schooling. Many didn’t want to return to work until a vaccine was available. And while teledentistry has grown, most dentistry still needs to be performed in person. This means that schedules lack the flexibility to pivot when a child has to stay home unexpectedly due to a COVID exposure.
As a result, many hygienists began to exit the profession. A year-long study of dental hygienist employment patterns during the pandemic found that as of August 2021, 74% of hygienists who left their jobs after March 2020 but had not yet returned did so voluntarily, deciding to retire early or pursue other career options. The study suggests that up to 3.75%, or about 7,500 dental hygienists nationwide, may have voluntarily left their jobs during the pandemic.
Dentists retiring earlier rather than trying to hire staff
The timing for this hygienist shortage couldn’t be worse. Right as dentists are losing staff, a third of dentists say that new COVID-19 infection control protocols require more staff to see the same number of patients as before the pandemic.
Meanwhile, 32.3% of owners say that trouble filling vacant staff positions limits their ability to run a full schedule.
For some late-career dentists, this challenge has proved to be the last straw.
Some older dentists had planned to work another three to five years. When they closed their practices to all but emergency procedures early in the pandemic, they had time to think — and some found they were truly ready to retire. Long-nagging aches and pains dissolved as they spent more time with family and rediscovered hobbies. Others had health issues that put them at higher risk of complications from COVID-19, making them reluctant to return to practice.
So as practices resumed typical schedules in the summer of 2020, some dentists began accelerating their retirement plans.
In some cases, they turned to practice transition services like ADA Practice Transitions (ADAPT) to find a buyer to continue caring for long-term patients. But in other cases, these owners simply closed their practices, especially if they were struggling with staffing or health-related issues.
Data confirms this trend: a January 2022 analysis of ADA masterfile data by the ADA’s Health Policy Institute found that the average retirement age for dentists has dropped to 67.9 years old, down from a peak of 69.1 in 2018.
Fewer practices, less access to care
When the only dentist in town closes their doors, the entire community loses out. Patients may now have to drive an hour or more to reach a dentist, making them more likely to forego routine — but essential — care. A patient who now must take a half day off work just to travel to and from an appointment is apt to skip preventive cleanings and exams. They’re even less likely to take their child out of school for a half-day.
Skipping this routine care has consequences. And without a nearby dentist, patients are more likely to ignore a problem when it could be fixed by a simple early intervention. Instead, they may wind up in the emergency room with more serious issues, such as a raging infection. Such infections can be expensive for both the patient and the health system. After all, emergency departments aren’t equipped to treat dental problems and can typically only provide antibiotics and painkillers. This can contribute to the opioid crisis and antibiotic resistance while increasing overall healthcare costs — without solving the underlying dental problem.
An opportunity for would-be practice owners
These challenges pose a great opportunity for ambitious young dentists. According to a February 2021 study conducted for the ADA by KJT Group, 83% of current dental students want to own or partner in a practice within ten years of graduation.
Now is the perfect time for them to do so. Banks are willing to lend to young dentists, even if they have student debt, because dental practices rarely fail. This is especially true in underserved markets where local banks are willing to write a loan that keeps a dentist in town.
Interest rates are still historically low while practice values are depressed. Many owners are willing to settle for a lower price if they can find the right person. I’ve seen practices valued at $800,000 list for just $500,000. I’ve even seen sellers practically give their practices away for the cost of the building, relieved that long-term patients will still have a trusted caregiver. This can give an incoming dentist some budgetary breathing room to upgrade the office.
Plus, I have spoken with dentists who have had hundreds of thousands of dollars of debt forgiven by the National Health Service Corps and similar state programs for committing to work in underserved markets.
These smaller-market practices can be very lucrative. I have talked to many owners who earn a very comfortable living working only three days a week. Many underserved areas lie within an easy drive of a larger city, enabling dentists to have the best of both worlds: the lower cost of living and lower crime rate, with ready access to urban entertainment and international airports.
At ADAPT, we’re matching these would-be buyers with owners ready to sell. Our goal is to help preserve access to care by helping sellers find someone with a similar philosophy of care who can care for their practice long after they retire. We also connect buyers with resources from the ADA and elsewhere to help them gain the skills they need to manage a successful practice — including hiring and retaining hygienists and other staff.
Solving the staffing shortage by retaining good staff
Practice owners seasoned and new can take proactive steps to retain their staff, including investing time and energy in understanding what staff want and need. Talk to each staff member to learn how satisfied they are — and what can increase that satisfaction. Evaluate:
• How much flexibility is possible. Consider adjusting the schedule a bit to meet staff needs.
• How compensation and benefits stack up. Look beyond other dental practices to understand where staff may find better options. (For example, a personable hygienist who’s great with patients may realize she can take her skills to a customer service career she can do from home, or on a more flexible schedule.)
• Career path satisfaction. Learn where staff want their careers to go. Do they want more responsibility, management, or autonomy? Do they want to learn new skills? Help them build a plan, then offer support along the way.
Above all, ensure staff are always treated fairly and with respect. Celebrate their successes, share compliments from patients or other team members and show gratitude through little things, such as unexpected PTO or celebrating birthdays or work anniversaries.
Inevitably, even the happiest staff will leave at some point. And when they do, pay close attention to finding the right fit for the practice: someone who will fit in with the office culture, treat patients to the same level and share similar expectations about their role within the team. While it may take longer to find the right person, it will be worth it when they prove to be a better fit who sticks around for the long run.
Finding opportunity in the Great Resignation
Early-career dentists are seizing this moment to take the next step in their careers, one that allows them to find satisfaction in practice ownership. And while many long-tenured hygienists have left, others are enrolling in dental hygiene school, eager to pursue a stable, rewarding career.
Together, this new wave of dentists and hygienists will continue to evolve the future of dentistry while building satisfying careers.
Meanwhile, the Great Resignation offers young dentists an unparalleled opportunity to purchase an established practice where they can continue to deliver care — as long as they take proactive steps to retain hardworking staff.
Dr. Ebert is the vice president of dental practice & relationship management at the ADA Business Innovation Group.