The Dental Boardroom

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, and Chris Marshall break down some of the most important warning signs dentists should watch out for when evaluating a dental practice for purchase. Drawing from real client cases and common deal-flow patterns, they discuss the financial, operational, and clinical red flags that often hide beneath the surface of seemingly attractive listings.

Listeners will learn how to interpret declining numbers, inconsistent hygiene schedules, sudden production increases, PPO manipulations, risky seller behaviors, and gaps in patient flow. By the end of the episode, you’ll understand how to look past broker language and identify the true health or weakness of a prospective practice.

Key Takeaways

1. Declining Production or Collections Are a Major Red Flag

If collections or production drop year-over-year even slightly it signals deeper issues.

This could mean a declining patient base, ineffective ownership, poor systems, lack of demand, or mismanagement.

2. Hygiene Department Instability Signals Deeper Problems

• Large swings in hygiene revenue
• Inconsistent recall schedules
• Declining hygiene visits
• These typically indicate poor systems, weak re-care, or a lack of organization affecting long-term revenue.

3. Sudden, Unexplained Production Increases Are Often Artificial

A seller spiking numbers in the year before the sale is a common tactic.

Examples include:

• Over-treatment
• Running unnecessary procedures
• Pre-billing treatment
• A buyer should be cautious: inflated numbers ≠ sustainable revenue.

4. PPO / Insurance Manipulation Is a Growing Concern

Practices sometimes:

• Drop PPOs before selling
• Switch PPO participation
• Adjust fee schedules to appear more profitable
• Understanding the insurance environment is essential to projecting true cash flow.

5. Seller Behavior Tells You Almost Everything

Pay attention if the seller:

• Wants to leave immediately
• Avoids answering questions
• Has incomplete records
• Shows disorganized systems
• These behaviors often align with financial or operational decline.

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, and Dr. Howard Farran, Founder of Dentaltown, delve into the evolving landscape of dental ownership from the rise of private equity in dentistry to the challenges and opportunities facing today’s practitioners.

They explore how cheap financing and investor enthusiasm fueled massive consolidation in the dental space over the past decade, and why the focus is now shifting from quantity to quality. As interest rates rise and capital tightens, DSOs and private equity groups are becoming more selective, prioritizing well-run, profitable practices over sheer scale.

The discussion also contrasts private equity-led DSOs with those founded and guided by dentists, examining how leadership, culture, and long-term vision shape patient outcomes and professional integrity.

Dr. Farran passionately defends the importance of dentist-led organizations, transparency, and long-term patient relationships, emphasizing that dentistry is a “sacred profession,” not just a business. Wes complements this view with a grounded financial perspective, offering practical advice for dentists who aspire to grow sustainably, without losing their clinical focus or personal balance.

Key Takeaways

• The PE Boom and Shift: Low interest rates and abundant capital fueled a buying frenzy in dental practices, but the landscape is changing with higher borrowing costs.
• From Volume to Value: DSOs are now focused on high-quality operations and sustainable cash flow rather than mass acquisitions.
• Dentist-Led vs. Investor-Led DSOs: Dr. Farran stresses that DSOs led by clinicians, not “suits,” create better care models and stronger trust with patients.
• Operational Mastery First: Before expanding, dentists should perfect one successful “prototype” practice much like McDonald’s perfected its first store before scaling.
• Liquidity and Transparency Matter: Private equity’s lack of transparency and illiquidity pose risks; publicly traded or dentist-owned models offer more accountability.
• AI and Dentistry: Both see promise and potential pitfalls as AI expands into diagnostics and insurance, cautioning that technology can empower or restrict clinicians depending on who controls it.

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, sits down with Howard Farran, founder of Dentaltown and one of the most influential thought leaders in the dental industry. Together, they explore the evolution of dentistry from emerging AI technology to the rise of DSOs, the challenges new grads face, and the skills needed to thrive in today’s rapidly shifting landscape. This episode delivers raw insights, bold perspectives, and practical lessons for dentists at every stage of their careers.

Key Points

AI & the Future of Dentistry

• AI is transforming dentistry at historic speed—comparable to the rise of the internet.
• Dentaltown is building AI tools to unlock insights from 10+ million dental conversations.
• AI won’t replace dentists but dentists who adopt AI will replace those who don’t.
• Example: Robotics like Yomi are enhancing implant surgery, not eliminating the surgeon.

The Real DSO Landscape

• Not all DSOs are massive corporate chains.
• The real competition for private practices? Local 4–9 location DSOs scaling smartly across small regions.
• These local groups win by leveraging:
• Shared marketing
• Centralized operations
• Better purchasing power
• Structured systems

Advice for Young Dentists

• Student debt is real, but so are lifestyle choices that amplify it.
• Early career focus should be:
• Clinical reps and speed
• Learning practice systems
• Strong mentorship
• The best first job is one that teaches:
• Business operations
• Full-scope clinical care
• Patient flow and case acceptance

The Competitive Edge for Private Practice

• Patients choose loyalty, trust, and relationships.
• Private practices win when they deliver:
• Consistency in care
• Stable teams
• Real human connection
• High staff and doctor turnover in corporate settings creates opportunities for private offices to stand out.

Know Your Numbers With the Right Advisor

• A general accountant isn’t enough in dentistry.
• Dentists need advisors who understand:
• PPO strategy
• Overhead benchmarks
• Practice-specific financial planning
• Growth vs. profitability
• Specialized financial guidance is a competitive advantage.
• 
  

Insurance is Not the Whole Market

• Half of patients don’t have dental insurance.
• Present multiple treatment paths:
• Basic → Mid-tier → Ideal care
• Never assume what a patient can or can’t afford—let them choose.

Who Should Listen?

✔ New dentists navigating debt and career choices

✔ Private practice owners competing with DSOs

✔ Clinicians curious about AI adoption

✔ Anyone wanting unfiltered industry truth

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, kicks off a new multi-episode series focused on the most common financial mistakes dentists make in both their personal and practice finances. After returning from an October break, Wes zeroes in on cash flow discipline, spending habits, tax inefficiencies, depreciation strategy, excess distributions, and the development of automated systems for long-term wealth.

Wes explains how many dentists struggle with lifestyle inflation, unmanaged owner draws, and treating the business account like personal cash, often without understanding tax basis limitations. He highlights the “depreciation trap,” where large Section 179 write-offs paired with financed equipment purchases create short-term tax relief but long-term cash crunches. He encourages dentists to align depreciation schedules with loan terms to avoid future financial strain.

Key Points:

• Automate savings and retirement contributions
• Match depreciation timelines with equipment loan terms
• Avoid treating the practice account as personal spending
• Monitor tax basis before taking distributions
• Maintain disciplined budgeting and lifestyle control
• Reinvest profits to strengthen practice efficiency and growth

In this episode of the Dental Boardroom Podcast, host Wes Read, CPA and financial advisor at Practice CFO, and an AI co-host unpack the ADA Health Policy Institute’s Q3 2025 “State of the Dental Economy” report. The data paints a complex picture of a dental sector stuck in an uneasy holding pattern where rising costs, flat reimbursements, and persistent staffing shortages are squeezing practices nationwide.

Despite modest growth in consumer dental spending, many practices report being less busy than before, caught between financial pressure and patient affordability challenges. The discussion dives deep into the fiscal squeeze, workforce struggles (especially hygienists), and the strategic choices dental practices are making to adapt.

Key Points :

1. Confidence Levels: Stabilized but Still Cautious

• Dentists’ confidence in their own practices (67.5%) remains higher than confidence in the U.S. economy (33.4%).
• Optimism has eroded throughout 2025 despite a slight Q3 bounce.
• Top concerns: tariffs, political unrest, and global uncertainty.

2. The “Fiscal Squeeze” Explained

• Core problem: costs (supplies, labor, operations) are rising much faster than insurance reimbursements.
• Two-thirds (65.8%) of dentists raised fees in 2025 by an average of 6.7% just to maintain margins.
• This has worsened patient affordability and fueled a perception of dentistry as “discretionary,” reducing patient visits.

3. Spending vs. Busyness Paradox

• Consumer dental spending is up 10% (inflation-adjusted) since pre-pandemic levels.
• Yet, the number of dentists reporting they’re “not busy enough” jumped from 25% to 35% in Q3 2025.
• Average patient wait times hit a three-year low (12 days), showing ample capacity and lower demand intensity.

4. Staffing & Hiring Challenges

• Hiring in dental practices remains flat, but recruitment demand is high.
• Hygienists are the most difficult position to fill; 90% of dentists report it’s very hard.
• Only 43% of those recruiting for hygienists successfully filled the role.
• One-fifth of hygienist positions remained open 6+ months, hurting production and patient flow.

5. Strategic Responses by Practices

• Many dentists are investing in software (41%) to improve efficiency and adding staff (47%) where possible.
• Some are dropping low-paying PPO plans to regain control over pricing and profitability.
• Practices are focusing on what they can control: internal efficiency, cost management, and workforce adaptation.

6. The Big Picture: A Sector in a Holding Pattern

• The dental economy isn’t collapsing, but it’s not growing fast either.
• The balance between rising costs, stagnant reimbursement, and patient affordability remains fragile.
• The future may depend on technology adoption, workforce development, and new care delivery models to break the stagnation.

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