Almost all dental practices in states across the country can now open for elective treatment. And while the statistics were very promising to begin with, recent reports are suggesting that the initial surge of interest from patients is dwindling and is shortly expected to reach a plateau.
According to an ADA HPI survey, 68% of dental practices are open for about the same number of hours as they were before COVID-19. Only 16% of practices are open fewer hours than before and another 16% are open longer hours than before.
In the same survey completed at the end of June by 4,371 practice owners, the ADA discovered that current patient volume is around 70% of pre-COVID-19 levels. The states where practices can provide elective care are continuing to see an increase in patients, but the rates are much lower than in previous weeks, suggesting the rebound is slowing down.
Why are patient numbers down?
There are many reasons patient volume is not yet at 100% compared to the first few months of this year. From not having enough disposable income to cover dental bills to being too scared of contracting the coronavirus to visit the dentist, there are plenty of things preventing patients from stepping through your doors.
Another possibility is that the new safety protocols mean dentists simply don’t have enough time to see as many patients as they used to. With social distancing, additional disinfecting and increased sterilization, it now takes much longer to treat a patient and prepare the room for the next patient than it did before.
Since most dental practices are open for the same number of hours as they were previously, there literally isn’t enough time in the workday to see the same number of patients.
“It is unclear how much of an issue the reduced maximum patient capacity in dental offices is for dentists,” said Mark Vujicic, HPI chief economist and vice president. “Evidence suggests dentists were ‘not busy enough’ and could see more patients before COVID-19.”
How are dental staff being affected?
While patient percentages aren’t looking overly promising, the number of dental staff back in employment is a very healthy figure. Staffing levels in dental practices is around 90% of pre-COVID-19 levels.
In the second week of April, only 10.7% of dental practices were paying their staff in full, 45.4% were partially paying staff and 43.8% weren’t paying any staff at all. By the first week of June, things had improved drastically: 77% of practices were paying their staff in full, 17.5% were paying their staff partially and just 5.5% weren’t paying any staff.
However, when you compare the patient volume with the staff volume, you start to question how long this financial model is maintainable. If the average practice is receiving 70% of its pre-COVID-19 patients, but they’re paying 94.5% of their patients some or all of their wages, practice owners have got to be making a minimal income or possibly just breaking even.
Despite that, the ADA HPI survey revealed that the huge financial impact COVID-19 had in April doesn’t appear to be having a long-term effect on practice solvency. In June, dentists whose practice had been closed or restricted to emergency-only treatment were asked if they expected their office to be open for treatment by the end of the month. 69% said “Yes”, while 12% said “No” and 19% said “I’m not sure”.
Out of those who said no or were unsure, 68.8% still planned to reopen their dental practice in the future. Only 5.1% planned to file for bankruptcy.
Employing staff isn’t the only cost dental practice owners need to be concerned about. There’s a high price for complying with the CDC’s frequently updated guidelines for dental practices.
Sally Cram, a periodontist in Washington, D.C., spent more than $20,000 on PPE for her staff. When combined with the air purifiers, sneeze guards, digital thermometers and washer and dryer (so staff can safely wash their scrubs every day) dentists are really feeling the financial strain after reopening.
While PPE has always been necessary in the dental practice, it’s now costing dentists more than ever. Instead of a $0.50 surgical mask, dental professionals now have to wear a $10 N95 mask for each patient, as well as a fresh hair cap and protective gown over their scrubs.
It’s not just the current costs dental practices have to worry about, either. Their bills were piling up all the time their practices were closed or limited to urgent-only treatment. Even though owners were unable to practice to their full potential, these bills still need to be paid in full.
The surge in patients following the lifting of the restrictions greatly helped many owners cover the costs of the bills that had been growing while the practices were closed. Rent, utilities, phone line, internet, insurance...for many owners, the bills just kept coming and coming while they were struggling with zero to little income.
Periodontist Sally Cram was in that position and received a Paycheck Protection Program loan to help her stay float. But it wasn’t enough to cover all her expenses. If she’s forced to close or partially close her practice again, she’s considering calling it a day.
“At this point in my career where I am, it will be hard for me to actually say yes, I’m going to come back. As I’ve talked to some of my peers, some of them are saying, you know what, if we get shut down again, I’m really just gonna sell my practice and be done. It’s a lot.”
Keep on practicing
Without owning a crystal ball, it’s difficult to predict what the next few months will look like in dentistry. Until a vaccine is made publicly available throughout the US, it’s unlikely dental visits will return to what we’re used to. Until then, you need to keep moving forward, treating your patients as best you can, ensuring your employees are as safe as they can be and planning for the future when this is all a thing of the past.