The Top 10 Things That Keep Dentists Up at Night

by Sean Robertson, DDS; Lisa Philp

Unless you are very lucky, you’ve experienced a restless night of sleep with an overactive mind. Without rest, we burnout. Without rest, we lack the energy and clarity to set goals and grow as professionals. And in our profession, the constant state of change and adaptability we have experienced recently has undoubtedly contributed to keeping many of us up at night. This, in a time where you need more energy than ever to lead and show empathy to your team, care for your patients, ensure the highest standards of infection control, grow your practice, and make a respectable living despite the rising costs of delivering healthcare.

After decades of building thousands of dental practices and creating customized strategies to support growth for our clients, we’ve tracked the most common challenges that keep dentists up at night. What may be surprising is that our observation of the top 10 challenges that keep dentists up at night has remained consistent over the last decade. What does change is which of these challenges may be more prominent at a given time.

We’ve observed two categories in the most common challenges dentists identify as their greatest stressors. The first category includes the challenges that contribute to burnout. The second category includes the challenges that contribute to (or inhibit) practice and professional growth. Like a diagnosis, if we can identify and face a challenge at hand, we can then create a solution. Overcoming burnout, experiencing professional growth, and getting a good night’s rest are vital to feeling satisfaction in your career.

Burnout is defined as “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration”. The following are the most commonly observed challenges we see from dentists as contributors to burnout, and include 5 of the top 10 things that keep dentists up at night. These are, overhead and cash flow considerations, team synergy and recruiting obstacles, expansion/renovating/moving requirements, balancing personal time off with work demands, and debt/succession planning.

Overhead & Cash Flow
When it comes to your practice overhead, do you know your break even amount? When we engage with a new dentist client, it is common to learn that they are not aware of the revenue required to support their practice overhead. Knowing your numbers is an important part of running your practice. With the costs of supplies and personal protective equipment increasing, the aggressive rise in inflation and wage increases we are seeing to support the cost of living for team members, practice overhead is at an all-time high. Without a clear understanding of your cash flow requirements, your practice can feel like it owns you and not the other way around.

Team Synergy & Recruiting
It seems the pandemic has contributed to what many are referring to as “The Great Resignation” of dental office employees. The stress and burnout associated with working in healthcare, constant changes and increased demands have led to team shortages. With rising costs of living and consideration of future retirement, some dental office employees have looked outside of the profession for careers that offer entirely different roles but with consideration of benefits and pensions. Regardless of the reasons, there exists shortages in qualified personnel for dental office employment. This means creating an office culture with connection and community is important, especially in a time where community has been impacted well beyond our workplaces. Doing this means having effective leadership.

Expansion/ Renovating/ Moving
Many dentists (including one of the authors of this article) have faced the uncomfortable crossroads that requires considerations of practice capacity. Practice growth requires the ability to meet patient demands and treatment requirements. This can mean increasing hours worked or increasing clinical team members such as associate dentists and hygienists. But increasing care can also mean more square footage and equipment are required. This can mean considering remodelling existing spaces, expanding into adjacent units, or relocating the office to meet these demands. And like any renovation, time, money, and energy must be invested in the project before top line revenues can be realized.

The past two years have involved changes for every single dentist in the country to meet infection control requirements. Doing so has resulted in the pandemic proof ability of our profession to continue to operate safely. But the stress of office remodelling, combined with considerations of growth amidst all the uncertainty has undoubtedly contributed to sleepless nights for many dentists.

Time Off
What percentage of your time is free to balance your personal goals and family life with work? Does your current schedule align with what you want and need to have the energy you need to be at your best at home and work? As self-employed healthcare professionals dependent on ourselves for current earnings and retirement, the option to work more is always available. But working against burnout can be counterproductive.

Debt and Succession Planning
Being emotionally ready to transition out of ownership does not always align with having your practice optimally prepared for ownership transition. Communicating your goals with your advisory team and knowing your practice’s value can help guide your planning. Knowing how many more years you want to practice, what your ideal transition would look like, and what your goals are beyond practice ownership can help create clarity. Clarity and direction create confidence, which helps to avoid burnout.

It is next to impossible to have the energy and clarity required to set goals and achieve growth when you are burned out and exhausted. Identifying our profession’s greatest challenges is the first step in our ability to find solutions, reduce burnout, grow, and avoid counting sheep. We also know from coaching hundreds of dentists over decades that seeing your practice thrive and achieving clinical and professional growth can reignite your passion for your career and combat that feeling of burnout.

The five challenges that we have observed that keep dentists up at night under the theme of “growth” are, new patient flow and marketing, hygiene cancellations and schedule openings, technology, case acceptance, and dealing with insurance.

New Patient Flow & Marketing
How many new patients do you see every month? Do you track where these patients come from and what marketing efforts have the best acquisition cost for new patients? Annual revenue for patient spending in Canadian dentistry is approximately $750. But when we look at annual revenue for new patient spending in Canada, this is approximately $1,000. Put another way, the value a new patient brings to a practice in a given year can often be more than a recall patient. But it’s important to know how many NET new patients are seen at the practice in any specified timeframe. New patient value is important but patient retention builds your hygiene department and supports the heartbeat of your practice.

Hygiene Cancellations & Schedule Openings
You’ve bought the supplies, hired the people and invested in the equipment. But without a patient in the chair, you’re in the red not the black. What percentage of your schedule is attributable to no shows and cancellations? How is your team trained to book and confirm patients and minimize those vacancies in the schedule that result in your philanthropy? With increasing patient expectations and the availability of practice management software that can support your admin team with SMS and email confirmations and bookings, is your practice set up to optimize the schedule?

In the January 2022 issue of Oral Health, we wrote an article called “Investing in yourself can take you from surviving to thriving.” In that article we mentioned that the clients we have worked with that have experienced the strongest growth have often invested in clinical technology. The pandemic accelerated the movement that was already happening in the digitization of patient charts and imaging solutions. Like every new process or equipment, the learning curve can be uncomfortable but the other side of change can be extremely rewarding and productive. With increasing patient expectations and digital solutions becoming more mainstream, what type of technology do you think will add the most value to your practice, support your growth, and enhance care for your patients?

Case Acceptance
Are you a cabinet millionaire? The difference between planning treatment and delivering that treatment often lies in communication. To turn lemons into lemonade, the pandemic’s effect on commodities and travel has arguably resulted in the increased disposable income for some patients that reflects some of the increases we have seen in patient spending. Dentists are brilliant. But there can exist a gap between what the clinician knows and what the patient understands. In that gap lies the opportunity to communicate and deliver a treatment plan or have it stored in the software as a theoretical possibility. Furthermore, is the dentistry you are providing in line with your clinical passion?

Interestingly, we’ve seen more dentists now, more than ever, move towards non-assignment of insurance benefits. Increased costs of practicing and the expense associated with chasing a payment is becoming less tolerable for many dentists. A patient that doesn’t pay for their appointment is the only thing worse than a patient that doesn’t show up for their appointment. Understanding where insurance fits in your practice philosophy and how your team can manage that appropriately to support the practice operations can contribute to sleepless nights if it isn’t managed well.

You’ve got many hats to wear as a practice owner. It’s next to impossible to know it all. And that can be hard to accept for someone that knows as much as you do. But if you are having sleepless nights because of your practice, the first step in addressing this lies in understanding the problem(s). Name the challenges and collaborate with colleagues. And know there is practice management support available that is designed to eliminate burnout, promote your growth, and help you sleep at night.

Oral Health welcomes this original article.

About the Authors

Sean Robertson, DDS, is the Director of Marketing for Transitions Consulting Group. He is also a founding partner of The Dental Broker Team, a national dental practice appraisal firm and brokerage.



Lisa Philp is the Chief Visionary Officer and founder of Transitions Consulting Group; a full-service coaching company for dentistry. Lisa is an industry leader, author, consultant, coach and speaker.