"All of a sudden, they have to shut down, lay off staff. They have loans and business expenses," said Anjana D. Patel, a lawyer with Epstein Becker & Green in Newark, N.J., who advises health-care businesses. "Once they start opening up, they're not going to see patient flow like they used to, especially with all these protective measures they have to implement. It's not going to be the same for a long time, and some of them may not be able to survive that."
Unlike most medical offices, independent dental practices have not had a larger health system or management organization to help cover ongoing business expenses, such as rent and malpractice insurance, during the pandemic.
While emergency dental work was allowed to continue in most states, including Pennsylvania, emergencies account for just 10% of revenue for dental practices, on average. During the pandemic, general practice dentistry revenue plummeted 95% and oral surgery revenue fell 70% nationally, according to the Levin Group, a dental management consulting firm in Baltimore.
"Physicians who work within a health-care system are more likely to see more emergencies," said Roger Levin, a dentist and the CEO of Levin Group. "The independent practice is going to get hit harder because there are no guidelines, no resources, no administrator getting the PPE together."
Barnes and many other dentists are following the recommended safety protocols: They screen patients for virus symptoms before a visit; take their temperature upon arrival; require patients to wear masks and wait outside until it's time for their appointment; and permit only one adult to accompany a pediatric patient.
The state's order authorizing dental practices to resume nonemergency services said they "should" follow these infection-control guidelines but did not outline specific penalties for not complying. However, the State Board of Dentistry, which licenses dentists and hygienists, can discipline or issue violations to providers who flout infection-control protocols.
"It's very confusing because even in the dental world, none of us knows what's allowed," hygienist Tahita Ross said. "Nothing is mandated for us not to do. It's all recommended."
One hygienist who returned to work May 18 for the first time since mid-March said her dental practice forced her out two days later after she complained that the office wasn't following safety guidelines, including taking patients' temperature and limiting the number of people allowed in the office at one time.
The 36-year-old hygienist from Delaware County asked The Inquirer not to publish her name because she's looking for a new job. She shared text messages that, she said, were between her and one of the dentists.
"Honestly, I am shocked we aren't taking everyone's temperatures!" the hygienist texted on May 19.