Most dentists become practice owners because they want more: more control over how they practise, more influence over how their business runs, and more freedom to deliver the kind of care they believe in.
In the early years, that often holds true. But for many principals, the balance gradually shifts. Over time, they find themselves spending less time delivering care and more time running a business. This phenomenon – often described as clinical drift – is more common than the profession openly acknowledges.
A gradual process
Clinical drift rarely happens overnight. It accumulates in small increments.
A staffing issue needs attention. A compliance requirement demands review. A supplier contract needs renegotiating. Each task, in isolation, feels manageable. Collectively, they begin to dominate.
Many principals can point to a tipping point – a week, or even a single day – when they realise their clinical work has been deprioritised to accommodate everything else. Meetings with accountants, HR discussions, regulatory audits, rota planning. Dentistry remains part of the job, but no longer defines it.
This shift is not only personal. Practices heavily reliant on a principal’s clinical output can become vulnerable when that time is redirected. The downstream effects on patient care, team dynamics and performance can be subtle but meaningful.
The workload behind the chair
The forces driving clinical drift are rarely singular.
Regulatory compliance is a significant contributor. Requirements spanning CQC, NHS contracts, infection control and data protection demand ongoing attention. Evidence from healthcare more broadly shows that administrative burden is a primary driver of clinician dissatisfaction, often consuming a substantial portion of the working week.ⁱ
People management is another. Recruitment, retention and team development have become increasingly complex, particularly in a competitive labour market. When key team members leave, the burden often falls directly on the principal – covering clinical time while managing the hiring process.
Financial oversight adds further weight. Cash flow management, supplier negotiations, cost control and reinvestment planning all require time and expertise that clinical training does not necessarily provide. Many principals take this on themselves, increasing both workload and cognitive strain.
What gets lost
As principals move further from the chair, the impact extends beyond time allocation.
Clinical leadership plays an important role in shaping practice culture. A principal who is present and engaged clinically sets standards, supports colleagues and provides informal mentorship. When that presence diminishes, it can alter team dynamics in ways that are difficult to quantify but easy to feel.
There is also a skills dimension. Dentistry is a highly technical discipline. Reduced exposure to complex procedures can affect confidence, dexterity and engagement with new techniques or technologies.
Perhaps most importantly, many principals experience a gradual loss of professional fulfilment. When the role begins to feel more administrative than clinical, the original sense of purpose can become harder to access. This shift is often associated with increased stress, burnout, and wider mental health challenges within the profession.ⁱⁱ ⁱⁱⁱ
Finding better balance
Recognising clinical drift is the first step. Addressing it requires an honest assessment of what is consuming time, and whether each of those responsibilities is genuinely something the principal needs to own personally.
Some principals invest in practice management support – bringing in a strong manager or operations lead to absorb non-clinical functions. Others look at outsourcing specific administrative or compliance tasks. Both approaches can help, though they come with their own costs and coordination demands.
Alternative ownership models, including those offered by DeNovo Dental Partners, provide a different framework – surrounding principals with central support across areas such as HR, compliance, finance and operations, while leaving control and day-to-day decision-making with the practice.
Clinical drift is not inevitable, but addressing it does require a willingness to look honestly at how practice ownership has evolved – and whether the current model is still working in the way it was intended to.
Author: Caron Best, Chief Operating Officer DeNovo Dental Partners
Media Contact:
DeNovo Dental Partners
Kristen Pope
Chief Integration, Partnership & Communications Officer
Kristen.Pope@DeNovo.Partners
https://www.denovo.partners/
