Prediction: By the End of 2026, “Knowing Your Numbers” Won’t Be a Skill That Sets Dentists Apart. It’ll Be the Price of Staying Open.

Hamza Asumah, MD, MBA, MPH

A specific, testable claim — and the reasoning, the counterarguments, and the checklist behind it. Save this one. I’ll revisit it in December and tell you honestly how it aged.

I want to make a prediction specific enough to be wrong, because vague predictions are worthless. Here it is: by the end of 2026, financial fluency will stop being the thing that distinguishes the best-run dental practices and start being the minimum required to keep the doors open.

I’ll put my credibility on it. Here’s the reasoning, including the case against.

Three forces are converging, and none of them are a phase

• Costs up, reimbursement flat or falling. Equipment and supply costs are up roughly 5%, while reimbursement stays flat or declines — and unlike almost every other industry, dentistry can’t simply pass those costs on to the customer. The margin gets absorbed inside the practice.
• A structural staffing shortage. Nearly 40% of practices can’t staff a full hygiene schedule, and around 90% report that hiring hygienists is very or extremely challenging. That drives labor costs up in exactly the roles that generate profit. This isn’t a hiring dip — the BLS projects the supply-demand gap continuing for years.
• Eroding confidence. Only about 1 in 3 dentists felt confident in the economy heading into this year. When confidence is low, the cost of flying blind goes up — you can’t afford guesses when the margin for error has already thinned.

Why the old approach stops working

For a decade, financial fluency was optional equipment. You could be an excellent clinician, run a visibly “busy” practice, and let the numbers stay fuzzy at the edges. The margin was forgiving enough to hide the gaps. A little waste here, some uncollected production there, a staffing line that drifted a few points high — the practice absorbed it and still cleared a comfortable profit.

That cushion is gone. When costs rise, reimbursement won’t budge, and your most profitable roles are the hardest to staff, there’s no longer enough slack to hide imprecision. The gaps that used to disappear now show up at the bottom of the statement. The practices that thrive aren’t working harder than they were five years ago — they’re working with more visibility.

The case against my own prediction

Intellectual honesty requires stating what could make me wrong. Consumer dental spending has actually risen about 8% since the pandemic and continues to grow modestly, so demand isn’t collapsing. A practice in a strong market with loyal patients could plausibly coast on top-line growth for a while longer without tightening its numbers. And technology — AI-assisted scheduling, billing, and analytics — may lower the fluency bar by doing some of the seeing for owners who never learned to. If those forces outrun the squeeze, financial fluency stays a differentiator rather than becoming table stakes. I don’t think they will, but I’d be wrong to pretend the outcome is certain.

What I think happens next

The practices that come through 2026 in good shape won’t necessarily be the ones with the best clinical outcomes or the newest technology. They’ll be the ones whose owners can tell you their overhead percentage, their collections rate, and their staffing cost — from memory, without opening a file. Not because it’s impressive. Because it became the price of admission.

The finance department isn’t a back office anymore. It’s the front line.

If the prediction is right, here’s your hedge

You don’t have to bet on who’s right. The move that protects you either way is the same — become fluent now. A minimum checklist:

Know your overhead %, collections %, A/R over 90 days, and staffing % — updated monthly.

Run a one-page dashboard you can read in 60 seconds.

Review it the same day each month and make one improvement per cycle.

Audit waste and renegotiate your top three vendors once a quarter.

Treat retention as a budget line, not an afterthought.

So save this essay. In December, I’ll revisit it honestly — including the parts I got wrong. If I’m right, financial fluency will have quietly become table stakes. If I’m wrong, I’ll tell you why. Either way, the safest move between now and then is the same one: learn your numbers cold. Agree or disagree?