Independent doesn't have to mean alone

The case for scale in dentistry is a real one. We should say that first.

A group of twenty offices can do things a single practice can't. Pretending otherwise is how small-practice advocates lose the argument, and how owners end up surprised.

So this post starts by taking the case for scale seriously. Then it asks which parts of that case still require being big.

What scale actually buys

Strip away the brochure language and a large dental organization has four advantages over a single owner.

1. Specialists. A solo practice can't justify a full-time billing expert, an HR manager, a marketer, an analyst, and an IT person. It can't justify a quarter of each, either, because nobody hires a quarter of a person. A group spreads those salaries across many offices. This is the oldest reason companies get big.

2. Purchasing power. Twenty offices buying gloves, composite, and lab work get a better price than one office does.

3. Negotiating weight. A payer listens differently to an organization with a hundred providers than to a single practice asking for a better fee schedule.

4. Capital. A funded group can buy equipment, open locations, and absorb a bad year in ways an owner financing everything personally can't.

All four are real. None of them are tricks.

Which of the four still need size

Take them in reverse.

Capital: still needs size, or a bank. Software doesn't lend money. Dental practices remain among the more financeable small businesses, and that's a conversation with a lender, not a vendor.

Negotiating weight: still needs size. We'd love to tell you otherwise. A single practice negotiates with payers from a weak position, and no system changes that. Anyone who claims their software will get you a better PPO fee schedule is selling something.

Purchasing power: partly. Independent practices have had buying groups for years, and they recover some of the gap. That's a membership, not a software feature. We have nothing to add.

Specialists: this is the one that moved.

Last month we sorted the work around a practice into three kinds: doing, finding, and deciding. Look at what those shared specialists spend their days on. The billing expert builds claims and hunts for the stuck ones. The HR manager runs payroll and tracks time off. The analyst assembles the monthly numbers. The call center answers the routine calls.

That's doing and finding, nearly all of it. And doing and finding are what software has become good at.

A single practice still can't hire a quarter of a billing specialist. But it can now run a system that does a large share of what that specialist did, at a price that doesn't require nineteen other offices to split it with.

So the count is one out of four. We're not going to round that up.

Why one out of four is the one that matters

Here's the thing about that count.

Three of those four advantages show up as margin. A few points on supplies. A few points on reimbursement. Cheaper money. They matter, and over a career they add up.

The fourth shows up as your evenings.

In our experience, owners don't sell because they're paying a little more for composite. They sell because of the kitchen table at 9:40pm. Because they are the billing department's backup, the HR department, the analyst, and the person who notices on Thursday what went wrong on Monday.

We wrote in August about the offer every practice owner eventually gets, and about the question that sorts it out: if the business side ran quietly without you, would you still want to sell?

For the owners who answer no, the specialist gap was the whole reason. That's the gap that closed.

The dentists who never got the letter

There's a second group this matters to, and they're easy to overlook because they don't own anything yet.

The average dental graduate in the class of 2025 who borrowed left school owing $297,800, according to the American Dental Education Association. Ownership among dentists under 30 has fallen from 25.4 percent in 2005 to 8.8 percent in 2023, by the ADA Health Policy Institute's count.

A new dentist looking at those two numbers hears a clear message: ownership was for a previous generation. Take the salaried job.

Part of what makes the first years of a practice frightening is fixed cost. The rent is the rent whether the schedule is full or not. So is traditional software, which charges a startup doing $40,000 a month the same as an established office doing five times that. As we laid out in our pricing post, one percent of $40,000 is $400.

That doesn't erase a loan balance. It does mean one large line item starts small and grows only when you do. And it means the new owner isn't also the billing specialist on day one.

We'd like more dentists to believe ownership is still open to them. It's good for patients when the person deciding on the treatment is the person who answers for it.

What we believe

We've spent three posts walking up to this, so here it is plainly.

A dentist shouldn't have to give up the practice to get relief from running it. Those were bundled for a long time because the relief required scale. Much of it no longer does.

That belief turns into three commitments, and you can check each one against what we actually sell.

Keep the decisions. Our software does work. It has no opinion about how long your hygiene visits are, which lab you use, or how many crowns you place in a month. There is no production target in it, because there is no one on our side with a reason to set one.

Keep the data. You can export everything at any time, in open formats. If you want the whole system on your own hardware, you can self-host it. A vendor you can't leave isn't much of an improvement on a partner you can't leave.

Keep the margin. We charge one percent of what you collect. We take no equity. If we stop being worth it, you can fire us and take your records with you.

The short version of all that is the line we've started using internally:

Keep your practice. Lose the burden.

This is not an argument against groups

It would be easy to read the last three posts as a campaign against group dentistry. It isn't one.

We build for groups. A dentist who owns one office and a set of partners who own twelve have the same problem at different sizes, and the twelve-office version adds a few of its own: every location doing things slightly differently, and no single place to see how the whole thing is running. One dashboard across every location is part of the product for exactly that reason.

The line we care about has never been the number of locations. It's whether the people making clinical decisions are the people in the building with the patient.

Plenty of groups are run that way, including some large ones, and they're customers we want. For them, the pitch is the same one with a different noun: grow the group without growing the pile of work around it.

Where we fall short of this

The promise in this post is bigger than the product is today. We'd rather say that than have you discover it.

We're new. Our install base is small, and general availability is still ahead of us. The system does a substantial amount of the doing and the finding now, and it can be shown running. It doesn't do all of it, and some of what it does has less mileage than the same feature in a product that's been in the field for twenty years.

What we can say is that the direction is fixed. Every release is meant to move one more task out of the pile that follows an owner home, and to leave the deciding alone.

The short version

Independence used to mean doing all of it yourself. That was the price, and a lot of good dentists eventually decided it was too high.

We don't think that price is fixed anymore.

Independent doesn't have to mean alone.

If you want to see how much of the pile a system can carry, the product page shows it as it actually runs, and we do 20-minute demos on real data, with no slides.

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PracticeCore AI is a modern practice management platform built for dental practices. One price (1% of what you collect), no per-seat fees, self-host option available. We talk to dentists every day. We write here when there is something worth saying.