How did dentists keep doing well for so long despite shrinking patient budgets? The counterweight was productivity, plain and simple. If you have practiced since 1980 you have lived it. We went from two-handed dentistry to four-handed, and the best operators pushed to six or even eight hands working a super-operatory, moving fast with high speed handpieces and tight protocols. At a minimum that bought a 20 percent gain, and that was for the slow learners. The gunners at the top probably doubled their output. That speed quietly absorbed the falling spending and falling free insurance money for years. The problem [...]