Why the recruitment crisis in UK dentistry may force you to shrink your business

Recruitment of dentists (and its knock-on effects) is creating the highest level of disruption in the marketplace right now.

There is a growing shortage of clinical recruits (experienced or otherwise) as a result of:

  • the voluntary repatriation of overseas dentists;
  • the unwillingness of others from overseas to replace them and
  • the declining numbers of dental graduates who want to work in general practice

Back in the heady days of 2008-2010, when I had the job of developing IDH’s private practices, their European recruits were turning over at the rate of 30% a year.

Huge financial resources were then being allocated to attend recruitment conferences and on making sure each successful recruit was eligible to treat patients in the UK. 

Millions were spent by IDH and others, just to stand still.

Since then, the situation has deteriorated.

Blame Brexit, blame the DOH, blame who you like – it is what it is.

Politicians in this respect are like financial advisors, taking the credit for things they didn’t do and the blame for things they cannot influence.

The knock-on effects will be game changing:

  • associates who demand increases in their freelance income or salaries (in a world of declining profit margins)?
  • NHS practices (corporate or otherwise, general or ortho) who refuse to tender at the UDA/UOA rates on offer and look to go private?
  • (probably most significantly) the first audience member on Question Time who asks a bewildered MP why people in their post code don’t have access to NHS dentistry?

The proverbial is about to hit the fan.

I’ve been an advocate of realistic pay scales for dental associates ever since the first version of The Associate Profitability Calculator was jointly developed with a client 15 years ago.

Back in the day, we were able to demonstrate that, on benchmark production and overhead numbers (UK), the appropriate rate was around 35% for the average associate.

The development of sliding scale contracts was intended to reward the exceptional producer and, at the same time, protect the owner.

Many were the rotten vegetables thrown in my direction by associates who thought I was out to bash them.

That was never the case, I simply sought a win:win and still do.

It is interesting to note that the larger corporates have slowly moved towards that 35% remuneration figure over the years, no matter how well camouflaged in net UDA rates.

The paradox is that there has never been a time when the sliding scale contract was needed so badly and yet we are entering the first (in my 22-year experience) time period where the law of supply and demand on clinicians may over-ride economic good sense.

The light-bulb moment for some owners will be the realisation that, in those market conditions, it may make better sense to shrink a business rather than to grow it.

The economics may well prove that reducing clinician, support staff and patient numbers IS the better business model going forward.

That, of course, creates a spiral that makes any form of dentistry more difficult to get hold of – which then moves the price of dentistry upwards and/or increases non-attendance.

And so it goes.


Published by

Chris Barrow

Chris Barrow has been active as a consultant, trainer and coach to the UK dental profession for over 20 years. As a writer, his blog enjoys a strong following and he is a regular contributor to the dental press. Naturally direct, assertive and determined, he has the ability to reach conclusions quickly, as well as the sharp reflexes and lightness of touch to innovate, change tack and push boundaries. In 2014 he appeared as a “castaway” in the first season of the popular reality TV show “The Island with Bear Grylls”. His main professional focus is as Coach Barrow, providing coaching and mentorship to independent dentistry.