For many dental practice owners, PPO participation feels less like a strategic choice and more like a trap they fell into years ago and never escaped. Reimbursement rates stagnate or decline, overhead continues to rise, and the pressure to do more dentistry in less time becomes relentless. Somewhere along the way, the practice you built to deliver thoughtful, high-quality care starts to feel like a volume business you no longer control.
Despite this frustration, most dentists stay in PPOs far longer than they want to. Not because they believe PPOs are ideal, but because leaving feels risky. The most common objections sound familiar: “My market won’t support fee-for-service” and “My patients only care about insurance.”
Dr. Gary Light, a Harvard-trained dentist with more than three decades in clinical practice, has heard these concerns hundreds of times. He once shared them himself. Today, after successfully transitioning his own practice away from PPO dependence and mentoring other dentists through the same process, he sees those objections not as facts, but as assumptions that deserve to be tested.
There are many successful PPO practices, and making the switch to fee-for-service (FFS) is doable for many practices, understanding why fee-for-service dentistry can work in more markets than dentists think, and how a thoughtful, structured approach changes the equation entirely.
Why PPO Frustration is So Widespread
At their core, PPOs promise simplicity. They offer dentists a steady stream of patients, administrative support, and predictable reimbursements. For clinicians with little formal business training, that promise is appealing, especially early in a career.
The long-term tradeoff becomes clear over time. PPO participation limits a dentist’s ability to raise fees, even as payroll, lab costs, supplies, technology investments, and compliance requirements increase. When margins tighten, practices compensate by increasing volume. Appointments shorten. Schedules fill weeks in advance. The day becomes more physically demanding and emotionally draining.
Burnout follows, not because dentists dislike dentistry, but because they feel trapped in a system that rewards speed over care and volume over relationships. Dr. Light often emphasizes that the real strain is not clinical. It is business pressure. Dentists want to practice their training, but PPO economics quietly push them in the opposite direction.
The Two Biggest Objections and Why They Persist
“My market won’t support fee-for-service.”
This belief is especially common among dentists in competitive or middle-income markets. The assumption is that fee-for-service only works in affluent zip codes, boutique practices, or niche cosmetic offices.
What this assumption overlooks is that patients do not choose dentists based solely on income level. They choose based on perceived value, trust, and relationships. Dr. Light has worked with dentists in a wide range of markets who believed their patient base was too insurance-driven to ever leave PPOs. What they often discovered was that a meaningful portion of their patients stayed because of the relationship, not the fee schedule.
Some patients will leave. Dr. Light is candid about that. Practices may lose around 20 percent of patients, typically those who are highly price-driven. But those patients often represent a smaller share of revenue while consuming a disproportionate amount of time, energy, and administrative effort. Losing them does not automatically mean losing profitability.
“My patients only care about insurance.”
Insurance often feels like the deciding factor because it dominates the conversation at the front desk. However, insurance is rarely the only factor patients care about consider. Most patients consider convenience, trust, comfort, communication, and confidence in the provider.
When practices shift in how they communicate, the conversation changes. Patients who understand what makes a practice different are far more open to staying, even when their insurance changes. Dr. Light points out that PPOs operate on the assumption that all dentists are interchangeable. Fee-for-service practices reject that premise entirely.
What Fee-For-Service Really Requires
Leaving PPOs is not about ripping off a bandage and hoping for the best. The dentists who struggle most are those who make the change without a plan. Dr. Light teaches a structured, three-phase approach that emphasizes preparation, execution, and sustainability.
First is analysis. Dentists must understand their practice at a granular level. This includes knowing average daily production, collections, insurance write-offs, procedure mix, and the percentage of patients tied to each PPO. The difference between plans which are truly profitable and which quietly drain resources often surprise dentists.
Third is sustainability. Fee-for-service dentistry is not a one-time decision. It requires ongoing reinforcement of value, continued patient education, and a commitment to staying the course when short-term anxiety appears.
Medical Coding Bill And Billing Codes Spreadsheets
The Role of the Team
One of the most overlooked factors in successful transitions is staff alignment. Dentists cannot carry the message alone. The front desk sets the tone when patients call. Hygienists reinforce value during longer appointments. Every interaction shapes how patients perceive the practice.
Staff training is not about scripts or sales tactics. It is about confidence and clarity. When staff understand why the practice operates the way it does, they communicate more naturally and effectively. Patients sense that confidence.
Why Many Practices Panic Too Soon
Dentists are trained to think clinically, not statistically. A few cancellations or schedule gaps can feel catastrophic, even when the overall trajectory is positive. Dr. Light encourages dentists to reframe how they view capacity. A practice does not need to fill its schedule weeks in advance to be healthy. It needs consistent, predictable demand.
Many failed transitions occur not because the model does not work, but because fear overrides strategy. Dentists abandon the plan before it has time to take hold, returning to PPOs out of short-term discomfort rather than long-term analysis.
A Different Way to Practice
Fee-for-service dentistry is not about elitism or exclusion. It is about autonomy. It allows dentists to control fees, spend appropriate time with patients, invest in better technology and materials, and practice with integrity.
Dr. Light does not argue that every dentist must leave PPOs. He argues that dentists deserve to understand their options clearly, without fear-driven assumptions limiting their decisions. For many practices, fee-for-service is not only viable. It is liberating.
For dentists frustrated with PPOs, the most important step is not dropping plans. It is questioning long-held beliefs, understanding the true economics of their practice, and recognizing the value they already provide. When those pieces come together, fee-for-service stops being a risk and starts becoming a strategy.
This article is based on a 2023 interview with Dr. Gary Light, DMD, who shared insights from over 35 years in practice and his experience guiding dentists toward fee-for-service dentistry. Click here to learn more about Dr. Light .
