What characterizes the “sinking middle” dental practice model that most general practices drift into?
Commodity pricing under contractual write-offs, shrinking insurance pools, mandatory high-volume throughput, and technology costs that become increasingly difficult to justify on the margins available. The sinking middle is where most general dental practices have ended up by default. Providers battle each other for the same shrinking pool of insurance reimbursement dollars, services get capped by what contracts allow rather than by what the work is genuinely worth, and the practice survives only by pushing volume harder and harder. The arithmetic eventually breaks. Technology investments that used to pay back in three years now take seven. Team payroll keeps rising. Insurance write-offs grow as a percentage of gross production. The doctor works more hours for less per hour. The only widely-available lever for staying solvent in this model is to expand the dentist-as-employee labor pool and grow practice volume through additional doctors, which requires sophisticated management and convenience-marketing capability most owners do not have. Practices in the sinking middle that recognize the position can move upstream or accept the trajectory. Drifting produces predictable outcomes.
If the answers you are finding here resonate with you, my team and I work with a small group of clients each year. The next step is a complimentary Discovery Consultation and Practice Review with Dr. McAnally.
