HR Issues in Dental Offices: How the Right Support Partner Can Help

Author: Alexa Mullins
Date: 03.24.23 Read Time: 9 min

Lightwave provides world-class business services so dental leaders and dental teams can realize their personal, professional, and financial goals

Dentists need help. Doing this alone has never been harder. Before the pandemic, running a dental practice was already a challenging endeavor due to increasing hourly rates, rising healthcare costs, and falling reimbursement rates. With new PPE protocols and staffing challenges, there is less profit in practice ownership. To top it off, practice owners must also make substantial investments to upgrade IT hardware, replace imaging equipment, and refurbish chairs/carpet/paint/furniture in order to stay competitive.

These challenges became back-breaking during the pandemic when government shutdowns left many practices without revenue, forcing dentists to terminate staff and take on even more responsibility, or in some cases, to retire earlier than anticipated. The current labor shortage is driving a shortage of hygienists and assistants, complicating the hiring process and compounding the pre-existing human resources issues such as employee turnover and toxic office culture.

The pandemic exposed just how hard it can be to keep a good practice up and running. While many dentists continue holding the pieces together on their own, many have failed. To ease the burden of ownership, it may be worth considering a dental support partner with the right approach to alleviate these difficult HR issues and help drive growth in the practice again.

COVID-induced talent shortage in the dental industry

During the pandemic, many dentists, hygienists, and assistants were terminated due to the government ban on elective dental procedures. Many dentists and hygienists chose to retire early due to the health risks posed by COVID-19 (especially considering 40% of US-based dentists are currently over the age of 55). A large number of dentists and hygienists were laid off while others left the profession for personal reasons. The American Dental Association (ADA) estimated a 38% reduction in overall dental industry for 2020 and up to a 19% reduction for 2021, suggesting the bleak prospect that the dental industry contracted in the post-pandemic economy. These reductions are not due to a lack of patient demand, but come from understaffed dental offices that are unable to meet patient needs.

According to a May 2021 ADA Health Policy Institute poll, 35.8% of owner dentists are recruiting dental assistants, 28.8% are seeking dental hygienists, 26.5% are looking to hire administrative staff and 13.1% are in search of associate dentists — all confirming increased competition for talent since October 2020. However, given the smaller pool of applicants and increased competition, 80% of dentists report that hiring dental hygienists and assistants is extremely challenging; more than 70% report that hiring administrative staff is very challenging and more than 50% reported the same struggles for recruiting associate dentists.

Hiring hygienists and assistants prior to the pandemic was already difficult, but health and safety concerns regarding the virus made it even worse. The American Dental Hygienists’ Association surveyed hygienists who voluntarily left their positions during the pandemic and found that 42.9% reported that “I do not want to work as a dental hygienist until after the COVID-19 pandemic is under control,” and 38.1% of respondents stated, “I have concerns about my employer’s adherence to workplace/safety standards.”

The pandemic and resulting labor shortage are creating a chain reaction that is exacerbating pre-existing HR challenges that leave owner dentists fighting an uphill battle to keep their practice afloat.

Ongoing HR issues in the dental industry

Implementing a PPE and infection control protocol that meets the shifting standards of the CDC and the ADA present a whole new challenge for practice owners. These protocols are driving substantial increases in dental supplies expenses for practice owners. Dentists are also grappling with employee demands for pay raises, prospective employees asking for higher hourly rates, while simultaneously keeping the office afloat with a very understaffed dental team.

According to the HPI data mentioned above, among dentists who are actively searching to fill open positions, 73.1% increased pay for dental assistants, 70.7% for hygienists and 67.1% for administrative staff. High turnover was always an issue in the dental industry, but in the face of the emerging labor shortage, practices cannot afford to lose their current employees. Practice owners are being pressured to offer raises to team members or face the prospect of turning away existing dental patients.

Many practices are still recovering from lower patient volumes and higher supply costs, as a result of the pandemic. Operating with an understaffed team creates more pressure and stress as the team takes on an unsustainable workload to keep patients happy and the business running. The compounding effect of these forces is squeezing practice owners financially and crushing morale for understaffed dental teams.

In an attempt to solve this problem, many practices will be tempted to fill open roles with inexperienced candidates. Professional job training for new hires is basically non-existent in most dental practices. Most candidates do a working interview and then jump right into the job after they are hired with little to no training and instruction. As practices hire more inexperienced candidates, the lack of training will drive even high employee turnover as new employees feel they are failing with no resources to fill the gap in their skills. These new hires will feel unsupported in their role and will likely leave in a matter of weeks.

This toxic cocktail leaves owner dentists struggling to meet the demands of providing quality clinical care, a great patient experience, properly filing insurance claims, collecting patient payments, managing the patient schedule, paying all the bills, and turning a profit. Dentists were never trained to deal with so many business issues simultaneously. The pandemic has created an uncertain future for practice owners, and many are facing the difficult prospect of selling their practice in this challenging environment.

Thoughtful DSOs are positioned to help practices succeed

Most dentists are reluctant to consider joining a DSO because of the preconceived notion that it means relinquishing all the control over your practice. While that may be true with some DSOs, there are more attractive alternatives that operate with the best interest of owner dentists in mind and are dedicated to preserving the heart and soul of private practice.

Partnering with the right DSO will relieve dentists of the management burden and allow them to maintain complete ownership and autonomy over the clinical side of the practice. This means dentists can delegate the recruiting, training, compensation, benefits, and employee relations to a management partner, allowing dentists to focus on providing high quality clinical outcomes and providing the best patient experience possible.

A thoughtful DSO lets dentists focus on what they do best, while providing robust business services that help fill the gaps for their dental teams. Partnering with the right DSO will dramatically improve a dentist’s work/life balance and remove the need to burn the midnight oil managing the business. Since 2018, there are now officially more women graduating from dental schools in the US than men. Many female dentists are joining DSOs at a higher rate than men because of the support and flexibility a DSO can provide to a practitioner.

A strong DSO partner will help with recruitment, training and retention. DSOs with strong financial backing will recruit top talent, provide comprehensive training and drive engagement with periodic employee surveys to measure sentiment regarding workload, compensation, benefits, and receive feedback to better meet their needs. DSOs drive retention for dental teams with regularly scheduled performance reviews, a structured process for employee raises, creating opportunities for professional growth, improving benefits, and adequate vacation time. With the increasing student loan debt for young dentists, joining a dental office supported by a strong DSO removes the financial risk and the management burden traditionally associated with practicing dentistry as a solo practitioner.

According to Fortune, 18% to 20% of dental practices are affiliated with DSOs today. DSO market share is projected to increase to 30% to 35% in the next five to ten years. However, given the business pressures created by the pandemic, DSO market share will likely increase at a faster pace. Most dentists are skeptical of DSOs, but there are DSOs dedicated to preserving the legacy of private practices that focus on helping dentists reach their personal, professional, and financial goals. Over time, when a high quality dentist partners with a high quality DSO, they can improve the patient experience, the employee experience, and ultimately the dentist’s professional experience.


Justin Jory is the Founder and CEO of Lightwave, the largest and fastest growing dental group in the Mid-Atlantic providing business services top tier dental offices. Lightwave is the first Dental Leadership Organization (DLO) that believes dentists are the natural leaders of the dental practice and the company’s purpose is to help dentists reach their personal, professional, and financial goals. After spending a decade investing in high-growth companies on behalf of investment firms (Mercato Partners, Leucadia, and Bank of America), Justin founded Lightwave to solve the problems surfacing in the dental industry in a way that will improve the industry for patients, dental teams, and dentists. Justin considers himself blessed to be working with some of the most successful dentists and dental offices in the Mid-Atlantic. Justin obtained a JD/MBA and BA in Philosophy from Brigham Young University where he also played tight end for the football team.