A recent report by The Health Policy Institute (HPI) of the ADA noted that 46 percent of dentists polled believed they would lose their practices if forced to keep postponing all nonemergency treatments through the end of August due to the COVID-19 pandemic.
The dentists polled also believe once restrictions were eased or lifted entirely, it would take months for patients to begin to feel safe enough to come back. Practices would be operating with much lower patient volumes and correspondingly lower revenues.
Marko Vujicic, Ph.D., Chief Economist and Vice President of the HPI, also reported in one model that dentists could expect a shortfall of 60 percent in revenues for the remainder of 2020 and a decrease of over 30 percent in 2021. There were other models with different outcomes, but we will soon know if this was the right one. The economic impact will certainly become evident by the end of June or July. As they say, "it all depends," the future is unpredictable.
In March, the ADA called on dental practices to postpone elective procedures until at least April 6th. A few days before the recommendation date, the ADA retracted that mandate and asked dentists to continue to defer nonemergency treatments through April 30th. Several dentists in a few states were requested to hold these restrictions until sometime in May.
The likelihood of these restrictive guidelines being extended again appears high if tremendous spikes begin or recur in COVID-19 infection rates and deaths.
Of those polled in the HPI sample, 4% said, "They would be unable to sustain their practices if restrictions remained through the end of April. That number jumped to 18% if restrictions extended through June. More than 52% polled said they would consider adjusting staffing or salaries if forced to continue postponing elective procedures through the end of June." But for most solo and small group practices, those actions would be too little too late.
"This is a serious threat," Vujicic said. Yes, losing half the practices in the country would be a severe threat.
The ADA and local affiliates, as well as local governments, will be pressed to reissue the previous orders if there is an increase in infections and mortality rates, even with the current mood in the country against social distancing or masks and the continued mismanagement of the pandemic by the Federal authorities.
LEADERSHIP BY THE DSOs IS PRIMARY
Given that the ADA and its local societies are political organizations, they operate by consensus and through necessary democratic and bureaucratic processes. Their cultures, structures and assets are simply incapable of handling a capital crisis of this nature for their membership.
The best political organizations can do is keep people informed, provide education and make recommendations. But they cannot do anything about keeping dentists in business when times get tough.
Nor do their lobbyists have the necessary clout to generate a government bailout of dental practices. If the government were more concerned about health, reducing inflammation and thwarting the enhancement of chronic diseases, there would be a better chance of getting government money. But when economics dominates health, it will be hard to find a welcoming ear in Washington DC. Dentists are not high on the totem pole of relief.
As in other areas of business, the pandemic exposes the dental industry and dental practice's fundamental flaws and weaknesses. The fact that we, as an industry, might lose 46% of operating practices, even though their aggregated value is in the billions, is tragic.
The only solution I see available to address this threat is led by the DSO industry. They certainly will be somewhat limited financially in their ability to acquire or merge all the at-risk practices. DSOs simply cannot acquire 874,000 dental practices.
I have little if any input into the members and board of the ADSO (Association of Dental Service Organizations), but tenured members of the DSO consist of professionals who began to aggregate practices back in the '80s and '90s. They not only have data, experience and knowledge but they also now have wisdom. They are the best hope to lead a collaborative effort to save 46% of the dental practices if the Coronavirus continues its contagion and mortality march.
The DSOs have the leadership and business acumen to help put together a crisis team along with at-risk practice owners and the ADA, focused on the survival of small practices that are coming under threat of extinction – and figuring out short and long-term solutions. These will not be past-based solutions but innovative future-based solutions that work for all parties.
The DSOs need these at-risk practices to continue to survive. Keeping the 46% viable is in their best interest for their future growth and the entire profession. It might be time for the DSOs to step-up, along with other stakeholders, and help figure out the answer to the question, what if the doomsday scenario transpires and we lose 46% of dental practices?
This pandemic clearly demonstrates the vulnerability of solo and small groups to catastrophic events. I believe something needs to be innovated and funded that enhances the strength and resilience of these kinds of practices.
THE REAL COSTS
Beyond the many financial costs to the industry, the most significant loss will be the health of the nation if we lose 46% of our dentist-workforce. The toll will be great. The inflammatory upsurge without dentistry, particularly to the cardiovascular system, is a well-documented co-morbidity factor of the virus infections. Without dental care, infection rates and deaths will continue to rise. Without dentistry, there will be many more lives at risk due to the systemic impact of this virus and its spread.
Fifty-two percent of the 330 million that make up the U.S. population see a dentist. If 46% of dentists go out of business, approximately 75 million people will have limited or no access to dental care.
Lastly, although no one has done any research to my knowledge, there is a possibility that having varying degrees of dental disease may be a co-factor or even an initiating factor in becoming infected by COVID-19. Some dental institutions might consider researching COVID-19 patients to see if there is a more direct etiologic link between dental health and COVID-19 infections.