Traditional Practice is Dead: Part 1

Hi, Rick Kushner here again, founder, Pres. CEO of Comfort Dental; practice management lecturer of the Lean & Mean series; the Anti-Dentist; Re-thinker of dental practice for 40 years.  My old friend Howard Farran of Dental Town asked me this question today:

In 20 years will corporate dentistry have taken over dentistry just like Walgreens and CVC did to pharmacists and Lee Optical and Eye Masters did to optometrists? What will the dental provider scene look like in 2025? Or 2050?

For Howard:

1)   You already know the answer or you wouldn’t have asked.

2)   Yes, but not quite as bad as you state.

3)   It is the natural order of things . . . our destiny

4)   There is some (very little) hope for traditionalists

For the rest of you:

Of course the answer is yes.  It’s been a one-way street for my 40 years in the profession and it’s moving along quite nicely, thank you.  I’m guilty of saying that my generation of dentists has left a legacy of employee dentists willing to work for $100K.  But that overstates it, even I’ll admit, and there are other powerful factors at play here.  I will discuss the big ones.  But let’s remember that $100K number as I’ll come back to it often.  For now, I will just say as I have for 30 years that our government, society, our culture, 3rd party payers, even our dental schools think doctors (in this case, dentists) should make $100K per year.  For goodness sakes, turn on the TV!!  I started saying it 30 years ago (it’s on the record) when even then I thought $100K was not near enough.  Again, remember that number.

By the time we get around to asking this question, it’s far too late.  Of course nearly all dentists in the future will be employees. First we should think about what you mean by “corporate dentistry”.  I think about this a lot because the ignorant think of us here at Comfort Dental as “corporate dentistry” and we are NOT corporate dentistry, but again, we look like it to the ignorant.  We think of corporate dentistry as dentists working for accountants, lawyers, investment bankers, venture capitalists, MBA’s, and business-suits in general for $100K per year.  (That number again)

To me, corporate dentistry is essentially traditional dentistry:  traditional hours, traditional fees (too high), traditional staffs, traditional marketing, very little branding, traditional locations, you know traditional.  I might mention my old friend Rick Workman and his immensely successful Heartland Dental.  They buy existing practices and the practitioner works back for a while at lower remuneration.  One day the traditional dentist owns his practice.  The next day he doesn’t but shows up for work and things look generally the same. (I know female dentists are approaching half of our ranks but I will use the masculine to save a letter – he instead of she)

(To me, this makes a comical point.  Here is how dentists of my generation have thought throughout their career while wondering how this all happened to their profession:  They practice traditionally, complaining to dental schools to turn out fewer dentists so they can have less competition.  Later, they learn there aren’t enough potential dentists to buy their practice, so they complain to dental schools to turn out more dentists, all the while complaining about corporate dentistry.  Now, young dentists are so debt ridden (among other things), they can’t afford to buy my colleague’s practice so he sells to corporate dentistry, forever leaving a $100K employee dentist in his practice and the hell with what happens to the profession. It’s happened a thousand times. Maybe you don’t think this is funny.  But I do.)

But when we’re talking corporate dentistry we’re probably referring mostly to the more visible dental chains such as Aspen Dental with good-looking recognizable street appearance and the young employee dentist inside making $100K per year for a year or 2 until he thinks he finds something better.  At Comfort Dental, we understand that we look like them to the ignorant, but more on this later.  What you don’t want to hear is that there are smart people behind these operations (not dentists). They will learn more and get smarter still. They recruit well, they understand markets and they won’t go away. We love corporate dentistry here at Comfort Dental because we think it clarifies the choices dentists face with their careers.  And we like our chances.

Oh, knuckle dragger traditionalists (kdt’s from now on, knuckle starts with a “k” you know, like knowledge) will continue to wage battle, making some of our professional lives miserable with their usual back-stabbing, cowardly acts, crimes, misdemeanors, and other stupid dentist tricks but it will all end the same.  Traditional practice is pretty much dead.  You know, toe tag . . . except for about 3 categories . . . as I discuss here.

Here’s a little good news for you — but for me it’s all good news as I believe the Golden Age of Comfort Dental is still ahead of us.  I need to adapt too, but I am and I will.  I think traditional practice has a chance to survive in rural America.  There is a size community of which, smaller than, corporate dentistry will not prosper enough to meet investor satisfaction yet will support traditional practice.  For us, Wal-Mart and Walgreens will go to communities smaller than Comfort Dental can go with our current model.  We have too much opportunity and too much work to do in larger communities and since we are so volume and so new patient driven, we would see all the patients in the rural community within a few months and then be reduced to recall practices.

Nevertheless, communities like, say Colby, Kansas will PAY US to come there but we struggle to recruit partners to places like Omaha and Kansas City (places I believe are wonderful both to live and practice –- I have a luxury home in Kansas City and love to spend time there.) because the dentist can’t convince his spouse to live there and after all, she still thinks she married a Doctor, don’t you know.  So we clearly can’t easily recruit to rural America and if kdt’s want to stay traditional, they should go to rural America.  Comfort Dental won’t be there and I’m guessing neither will corporate dentistry for the most part.

Having said that, I’ve traveled a gazillion miles in this country and seen it all.  I like rural America but it is shrinking.  I’ve always said that the dentist lives in the small town until his first child reaches the 8th grade.  He then realizes in 5 years, his daughter is going off to college and likely will never move back to the small town.  So he bolts.  I don’t blame him.  But small town shrinks, has no dentists remaining and blights.  Seen it happen for 30 years.  But there you go, practice traditionally in rural America.

*Watch for Traditional Practice is Dead: PART 2 in the coming weeks. Trust me…you don’t want to miss is it! rk

Categories: Corporate Dentistry and Traditional Practice.


  1. Matt

    Love this, Rick. As a 3rd year dental student, It is good to hear a bit of “good news” instead of the doom and gloom I get from faculty and other dentists. Please keep these coming! (by the way, Omaha is my FIRST CHOICE city I want to live!!)

    • Rick Kushner

      Paul, one of our biggest practices is in a mountain town of 12,000 drawing from 25,000. Also we are exploring the idea of “mini-market” Comfort DENTAL’s with solo Docs willing to work some evenings and some Saturdays.

      • Paul Bahlinger, DDS

        Thanks for the reply … your “mini-market” idea is sound. I’ve investigated Cortez, CO (about 10 – 12,000 folks) – plenty of dentists yet none open evenings and Saturdays.

  2. Michael Collins


    Great to see you online communicating. What are your thoughts on hygienists at this time? Do you utilize them in your comfort dental offices or are the dentists doing the 6 mth recalls?
    The 6 mth recall seems to be the real overhead killer in a lot of offices. How do you deal with it?

    Thanks- Mike

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