The organizational and economic patterns for the post-Covid-19 dental practice radically change.
For years we have held to be true, rightly I believe, that through the “saturation of the chair time” that is, by using the available production time as much as possible, we would have reached the maximum profitability, within the boundaries set by the business model of the dental practice.
So, if we had managed to get each dental unit to work up to about 85% of the time available (while still leaving space for the management of the peaks), we could have achieved the optimization of the management.
Eventually looking for further improvement in other areas (costs, prices, mix of services, etc.), but no longer in the already achieved ability to make the most out of the structure. Few succeeded, for some it was a kind of mirage. Never as now, the use of the past is more appropriate, a past that will soon be a distant past.
The change of the organizational model
A small, microscopic, biological parasite has changed our lives, all over the world, we will see for how long but in the meantime, to return with our feet on the ground, it has already changed the organizational model of dental offices, and many other environments where waiting times and gatherings were the habit.
In the specific case of the dental practice, the issues of waiting and crowding in the waiting room, the punctuality of operators and patients, the efficient organization of appointments, had long been on the agenda of things to improve, and for someone the improvement project was already well advanced.
Clearly, we are talking about dental practices in full activity, not those (about 30%) in the decline phase and with a demand that is progressively decreasing, often in parallel with the progressive increase in the age of the owner, who accompanies himself and his study towards a logical and biological quiescence.
But the central theme of this radical change is the organization of the working model. It is not only in the specific topic of the patient gatherings, easily resolved with an improvement in the management of the agenda, but the great problem also lies above all in the change of clinical and extra-clinical protocols, which will forcefully reduce the objective production capacity of the dental practice.
The Italian situation
All this already seems very clear in the mind of Italian dentists, who, interviewed in the last week of March (in collaboration with IDI Evolution for the activity of the collection of the questionnaires), as part of Key-Stone research, declare in 41% of the cases that the most likely possibility (the question was a single choice to indicate the most relevant aspect) is that they will have to transform clinical protocols and, in 35% of the cases, to improve the management of the appointments.
Only 15% focused on the increase in costs for the greater use of PPE (Personal Protective Equipment) and 9% of dentists (which doubles for those over 55) think that in the end it will not change much compared to their previous daily practice.
Although the data collection method (online only) could contain some possible systematic error, the sample size, made up of 1,028 dentists, encouraged us to publish the survey, which is believed to be reliable.
Clearly, these are points of view, moreover at a particular time, knowing perfectly well that mood and awareness change day by day during this interminable lockdown phase. Until official protection guidelines for operators and patients are published, objective conclusions cannot be drawn. Only then, it will be possible to make real and reliable calculations of times and costs of this sort of Copernican revolution of dentistry.
Personally, I believe that the real big problem of the coming months, or maybe years, will not be so much that of the demand for treatments, or rather the economic power of the families, instead, the objective capacity of the dental practices is the focus, because there is no doubt that, for the same working hours, fewer patients can be accommodated.
The concept of “dilution”
And here comes the concept of “dilution”.
It will not be so much from the ability to saturate the practice that efficiency and profit can be achieved: this would only produce chaos, conflict and health insecurity.
The key factor of success will be the possibility and ability to dilute in an optimized way the practice activity.
Everyone will find their own solutions:
- longer appointments to perform more treatments at once
- the extension of opening hours
- the use of digital technologies also to reduce delays and risks in the supply chain
- teledentistry for the development of some remote services
- serious and rigorous engineering of the workflows
- the elimination of some operatory units to increase the waiting spaces
- the reduction of the staff if the unsustainability of the fixed costs, compared to the demand that can be granted, is ascertained.
The competitive scenario
The competitive scenario may also change, with the possible closure of a significant part of dental practices (already stated in the same survey by 14% of the sample) and the likely unsustainability of some low-cost models.
But all this will, paradoxically, only exacerbate the problem of a possible excess of demand compared to the capacity and, incredibly, the real criticality could be the production capacity in a business model that must in any case generate a correct profitability.
The choice, on the other hand, to reduce the priority on prevention, hygiene, check-up visits, by someone ventilated since they would produce a reduced unit value, would be a misfortune for the entire system, for the organic expansion of the patient base and for the dental health of citizens.
We can only trust in the balance of the guidelines defined by the competent authorities, which take into account the health of operators and patients, but also the difference in risk of the different treatments and the indispensable economic sustainability of the dental practice.
Then, it will be the vision, intelligence, and entrepreneurial ability of those who will have to reorganize their profession to make the difference, and it is not said that the competitive advantages achieved in the past are a sure factor of success for the future.