Hamza Asumah, MD, MBA, MPH
The Dental Economics–Levin Group Annual Practice Survey puts average production per doctor at $1,001,807 — essentially unchanged from the prior year.
On the surface that reads as steadiness. A profession holding its ground in a difficult economy. Nothing broke.
It is not steadiness. It is a constraint, and understanding why changes how you should run the next twelve months.
The scissors
Production is flat. Overhead is not.
Sixty-four percent of practices saw overhead increase in 2024. Over the prior decade, expenses per dentist rose 13.2% against a 1.2% revenue decline. Rising costs remain the third most-cited challenge for 2026, named by 42% of dentists, unchanged from a year earlier.
Put those together and you get the actual situation: a flat top line against a rising cost base is a shrinking margin, expressed as stability.
The strategic consequence is what matters. When production is growing, volume growth absorbs cost inflation. You can be moderately sloppy about collections, scheduling, and staffing efficiency, and growth covers it. That is how most practices operated for a decade.
When production is flat, there is nothing to absorb anything. Every point of margin has to be found in execution — in how the day actually runs — because it cannot be found in volume. That is a completely different operating discipline, and most groups have not made the switch.
What “declining reimbursement” does to the unit economics
Reimbursement pressure changes the math per appointment, not just per year.
Each appointment now contributes less margin than the same appointment did three years ago. Which means volume matters more, not less — you need more appointments to produce the same profit. Which in turn means every empty chair, every broken appointment, and every uncollected balance costs more than it used to.
This is the part operators underestimate. Reimbursement compression does not just reduce revenue. It amplifies the cost of every operational inefficiency you were previously tolerating. A 10% no-show rate was expensive in 2019. At today’s margin per visit, it is worse, because the remaining appointments have less cushion in them.
Where flat production actually comes from
If production is flat at one of your locations, it is one of a small number of things, and they are distinguishable:
Fewer days worked. Monthly production is days worked multiplied by production per day worked. An enormous share of “flat production” conversations turn out to be calendar problems — CE, vacation, a holiday landing midweek, an office closure. Decompose before you diagnose.
A capacity ceiling. The doctor is full. Scheduled and actual production converge tightly at the same number month after month, utilization runs above 85%, and the treatment backlog is thin. This doctor is not underperforming; there is no more time to sell.
A conversion failure. Open chair time plus a large backlog of diagnosed but unscheduled treatment. Industry case acceptance runs around 34% to 40%, so there is nearly always room here.
A demand failure. Open chair time and a thin backlog. New patients, recall, reactivation, payer mix.
Four different conditions, one identical flat line. The cost of misdiagnosing is a year of effort aimed at the wrong thing.
The 32% you should read carefully
In the first quarter of 2026, 32% of dentists reported they were not busy enough to meet their full clinical capacity. Patient volume is a named 2026 concern for 32% of dentists.
Sit with what that means alongside the staffing data. Roughly a third of practices have clinical capacity they cannot fill, while nine in ten cannot hire the hygienists they want.
Those two facts coexist because they are different constraints at different locations — and in a multi-site group, they frequently coexist within the same organization.
Which is an argument for measuring by location rather than in aggregate. Group-level averages will show you a flat line and hide the fact that one office is at a ceiling while another has 30% open time.
Monday morning
- Decompose production for every provider: clinical days worked and production per day worked, monthly, trailing twelve months. Two columns. This single exercise resolves a surprising share of performance conversations before they start.
- Calculate chair utilization by location. Sort them. Your response to a flat line at 88% utilization and a flat line at 66% utilization should be opposite, and right now you are probably treating them the same.
- Pull total unscheduled treatment value by location. Cross it against utilization. High backlog plus open time is a conversion problem you can work this month. Thin backlog plus full chairs is a capacity ceiling that needs a hiring or hours decision.
- Calculate your production per visit and compare it to two years ago at the same location. If it has fallen while procedure mix stayed constant, you are watching reimbursement compression happen in real time, and that is a payer negotiation conversation, not an operations one.
- Pick one execution metric per location — not five — and work it for 90 days. Flat production years are won by depth on one lever, not by breadth across many.
The reframe
There is a version of this year where you interpret flat production as the market being hard and wait for conditions to improve.
There is another version where you accept that volume will not rescue the margin, and go looking for it in the gap between what you produce and what you collect, in the chair time you are not using, and in the treatment you have already diagnosed and never scheduled.
The industry data says the ceiling on margin recovery right now is operational, not external. Sixty percent of practices did grow same-store production in 2024, at a 5.5% rate. It is being done. Just not by waiting.
Sources: Dental Economics–Levin Group Annual Practice Survey (average production per doctor $1,001,807, essentially flat year over year; case acceptance averages); Patient Prism 2026 profit margin research, compiling ADA 2024 Survey of Dental Practice, PorterKinney 10,000-practice benchmark set, and Clerri 2026 DSO analysis (expenses per dentist +13.2% vs. 1.2% revenue decline; 64% of practices saw overhead increases in 2024; 60% grew same-store production at 5.5%); The Lead Magazine / ADA HPI Q4 2025 poll (42% cite rising costs, 32% cite patient volume as 2026 challenges); TurnUp 2026 analysis (32% of dentists not busy enough to meet full clinical capacity in Q1 2026).
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