Staffing shortages have made it hard for specialty dental practices to expand, according to Alex Mehler, DMD, Aspen Dental's vice president of endodontic support services.
Dr. Mehler recently spoke with Becker's to discuss how specialty dentistry has evolved this year and where it's headed in 2025.
Editor's note: This response was lightly edited for length and clarity.
Question: What have been some of the biggest shifts in specialty dentistry this year?
Dr. Alex Mehler: [With many] specialty practices and smaller DSOs, some of the big groups have been buying them up, and there's been a real shift in some of the practice models. Something that I really like having at Aspen is being able to work closely with those dentists ... As we have these new, younger practitioners who are on their own, they want to do a lot of the work themselves. There's a lot of training on doing implants or doing root canals, whatever it is. There's a lot of training from these dentists, so I think a lot of practitioners really want to do stuff themselves, and that's been a trend that continues to increase. One of the things I love about Aspen and [The Aspen Group] is having that specialty presence that's coming into the office side by side. You're really able to work as a team. Dentistry is really like a team sport. It's easier outside not to be able to have that team mentality when you're trying to grow yourself and be that super general dentist in all ways. I really feel that's been the shift here, and I'm curious to see what's going to happen in the next few years with the way practices are changing.
Q: What do you think has led to the increase in acquisitions of specialty practices and smaller DSOs?
AM: People see these big dollar amounts. I've talked to a lot of residents [and] existing specialists. We're at all of the trade shows, and everyone wants to talk about how much they can make, but at the core of all of that is really doing the right thing by the patient. I became an endodontist to diagnose, treat patients, get them out of pain [and] save teeth, and in the environment that Aspen has, I'm able to do that. What older, more tenured practitioners want to do is they want to sell their practice. They want to get out. They see all this private equity money coming in, and that's been a huge thing, like "How much can I sell my practice for? How much money can I make doing this?" You kind of lose sight of the core reason that you became a specialist sometimes. You're not thinking about that. It happens across medicine too. A lot of these smaller mom and pop medical practices have been acquired by larger companies and they've been rolled up. When you're trying to buy these offices, and then you try to flip it — and the whole goal becomes making more money and flipping these offices — you still have to have functional practices. You still need to have specialists who can work in the environment and work with the dentist and really support what you're trying to do. So, you basically have a lot of these medium to large DSOs ... and, fundamentally, they don't have that support function.
The whole part of DSOs, coming from the Aspen and TAG umbrella that I'm in, is you want to support your doctor [and] support your specialists. We want to make sure you're getting the best materials, the best products and you're running the best business. We're able to centralize so much of the administrative tasks. Now all these other groups have sold, and some of these older, more tenured specialists have made a lot of money, but it's still a referral-based practice. They still have to figure out, how do you get patients? How do you run your supply chain? How do you run your day-to-day operations in this large company? I'm interested to see when that comes to a head because a lot of the younger dentists I know want to do more themselves, or they want to bring the specialists into their office because they want to make more money too, and they want to try to keep everything in house … There will be an interesting shift as people start to age out and retire from some of this.
Q: How did you see patient demographics and expectations evolve this year?
AM: I think we have a much more informed and a much smarter consumer right now. There's been a huge shift in implants. That's been a growing trend for sure. People understand the importance of having their teeth or replacing their teeth, so we've seen an interesting shift because, as we've had a lot of the implants rise, there's also been a lot more endodontists seeing a lot more patients. Our endo business has grown substantially because if you have a more informed patient and they want to do the right thing for their health — if we can save a tooth and we can do a root canal, they're going to do that ... Now you're having people more inclined to replace their teeth or to put implants under dentures. Having implant-supported dentures is probably one of the biggest shifts in standard of care, and I think that's huge. There are more patients who want to have that highest level of care ... They want to know more about it. How can they take care of themselves? What's the best option for them? What are the other options? They have a better understanding. I think the dental IQ is probably rising a bit among patients.
Q: How else did you see competition among specialty dental practices shift during this past year?
AM: I think the competition is not necessarily among the specialty practices themselves. I think it's more of the workforce. There's a significant amount of pressure to recruit and add bodies to grow these practices. A few years ago, I could go to an endo conference or the oral surgery conferences, and all the big booths and vendors and sponsorships were all the dental supply companies. Sometimes you'd have some of the insurance companies [or practice management companies.] Today, all the big booths, the big parties, the big events, are really the specialty dental companies. The main goal for all of them from these events is to add heads and add their bodies. Going back to it, if you have a practice that's built and set up for a single practitioner or two practitioners, and now you're competing to recruit a resident or an existing specialist in a model that's really not built to add this many heads — you're trying to jam people in, and that's why I think we've been very successful.
The head count we've added for endo and [oral surgery] across Aspen [and] ClearChoice has been significant. We know we have that patient demand. We know our model, and we stand by it. A lot of people will ask me all the time, are we going to create specialty offices for Aspen? So far for us, I love the model we have. You can go into these offices [and get] that specialty care in office. We know that if we're going to recruit somebody and we say we have this demand, it's there because we have the exclusive offices for the specialists.
I have a lot of friends who are working for these other specialty practices who consistently want to add heads, [but] it's really built for one provider or two providers. Now, they come in and they're moving, they have families and they have bills, and they're not able to actualize and realize that income potential that they've been promised because whoever the legacy specialist is, whether it be the owner or the person that's been there for a while, they're keeping that work because that's how they make the bulk of their income, too. So, it's a really competitive market right now, and trying to figure out the best spot is sometimes difficult.
Q: Do you have any other predictions for what we can expect to see in specialty dentistry next year?
AM: I think we're going to continue to see the trend in trying to recruit more specialists. Aspen and ClearChoice have [some of] the largest specialty networks in the world trying to help people regain their smile, regain their confidence, and we're always going to prioritize delivering the best care possible. Endodontics is such a small pool of practitioners, and the industry is so competitive. We're constantly trying to build awareness and grow and tell patients the benefits of getting that specialty care.
I also think technology is going to play a huge role. I've been looking at [artificial intelligence] and have been doing the clinical evaluations for AI for a long time, and AI radiography is going to be the first part of that. I think it's just phenomenal. What that's going to do is it's going to help diagnose more comprehensively. So, when patients need work, making sure they know it sooner, [and] we can deliver that work more efficiently. I'm always amazed how different dentistry and medicine are perceived by patients sometimes, and I think that with having some of these advanced technologies like AI, my hope is patients will take it a little bit more seriously, understand more of that urgency to take care of it themselves, [and that] they're going to accept that treatment and take care of themselves better.
Q: If you could name one "game changer" that you expect to influence specialty dentistry in 2025, what would that be?
AM: One hundred percent AI. I think that flow of work, from the new patient exam to staging their dental procedures in the best way possible to deliver the best care possible, is going to do it ... It helps remove a lot of that subjectivity, and it makes it easier for [patients] to digest. So, I'm really excited for that.
Q: What will be the biggest challenges facing dentists next year?
AM: Industry workforce. Whether it's dentists, whether it's specialists — there's a staffing shortage at every level. It doesn't matter if you're in a small company, a private practice ... It's a very competitive work environment, and we're not able to deliver care to patients and work if we don't have all of these positions filled. That's why we're seeing more of these companies shoot up. That's why we're having more of this competitive grab at talent. I think there's a chance that the talent is going to keep getting better and better because it demands it, but I also know it's really tough to continue to offer all of these benefits and packages. I think somewhere like Aspen is uniquely positioned to offer a lot of these benefits, and the guarantee is because we're able to see exactly what the potential is — how much you can make, the path to growth and mentorship and education. If everybody is going to come in and you're going to clock in and you're going to make the same amount of money, it becomes "What else? How can I keep growing?" So, whether it's clinical growth, personal growth [or] business growth, more benefits or guarantees are going to be important because everybody wants to grow. Everyone wants to keep learning, and if everybody's pay is going to start to get to that level anyways, then you have everything else that kind of comes into play here.