Skip to content

The Endodontic Practice Future in a COVID-19 World

By Roger P. Levin, D.D.S.

The advent of COVID-19 and the ensuing crisis has influenced almost every type of business including dentistry. And while we all hope that COVID-19 will not last too long, we realize that endodontists can’t waste time waiting for it to go away. They must move forward and prepare their practices for a faster, better, and deeper recovery in a COVID-19 world.

Endodontics and COVID-19

Faring better than most other specialties and general practices, endodontic practices were able to maintain, on average, 65–70% of their pre-COVID revenue. Comparatively, oral surgery had an average of 30% of pre-COVID production and general practices had less than 5%. Endodontics was able to enjoy a measure of success because it is seen as a mainly emergency-based practice and could therefore maintain a continuity of patient care, and a higher level of productivity and revenue. This allowed endodontic practices to recover faster in the first phase of the recovery.

The Levin Group 24-month COVID-19 Recovery Timeline

Levin Group has developed a recovery model that is based on a 24-month recovery timeline. There are three phases in this timeline, which began on June 1, 2020. These are:

Phase 1 – Months 1 – 4: Pent-Up Demand

Phase 1 is characterized by pent-up demand. After the shutdown, general practice patients were eager to return to their dental offices to discuss problems, emergencies, and continuing care. This resulted in extensive referrals to endodontic practices and a level of pent-up demand. Many endo practices achieved record production in the months of June and/or July.

Pent-up demand has been beneficial to recover some of the revenue lost during the shutdown period, but by definition it will not last. Phase 2 will begin somewhere around late September or early October 2020, approximately 4-6 weeks after the first slow down experienced by general practices.

Phase 2 – Months 5 – 12: Declining Production

Based on data from the 2008–2009 recession, we believe that starting in September 2020 general practice production could drop in many practices by 12 to 15%. This will have both a direct and indirect effect on endodontic practices. The first challenge is that general practices will have fewer patients to refer. The second challenge is that once general practice production declines, general practices tend to provide more specialty treatment including root canals. We recommend that endodontic practices begin a strong referral marketing outreach effort and relationship building program as early as possible and before it is needed to maintain referrals in Phase 2.

Phase 3 – Months 11 – 24: Recovery

This is where practices of all types will begin the march back to a higher level of active patients and production. We estimate that at around month 24 of the recovery, practices of all types will achieve 70-80% of the average monthly 2019 production. At first this may look unimpressive, but it’s important to remember that 2017, 2018, and 2019 were three of the best economic years in United States history.  Practice production in 2019 was very strong.

The Faster, Better, Deeper Recovery

Endodontics is a specialty where, as a rule, case acceptance is high. In fact, studies show that pre-COVID, 97% patients who were diagnosed for a root canal agreed to undergo treatment. With this level of case acceptance, it looks as though endodontics is well poised for a strong recovery. However, endodontic practices will still have to face challenges that have not been seen since the 2008 – 2009 recession. These challenges will include referring doctors increasing their root canals, no-shows for consults or treatment appointments, patients who don’t accept recommended treatment, and patients who don’t return to complete treatment or handle final payments.

Practice owners are the CEO of their business.  The very first thing any CEO should do in a business turnaround is create a one-page strategic recovery plan. The purpose of the plan is to lay out high-value strategies within four practice areas—referrals, patients, staff, and financial—to create a faster, better, and deeper recovery. Once the plan is completed it should be understood by the team and reviewed daily with an intense focus. If you need help in developing a one-page strategic recovery plan you can visit the COVID-19 Resource Center at to download a complimentary template with instructions.

Referral Marketing

Previously, endodontic practices have not had to focus heavily on referral marketing. While referral marketing would certainly help increase referrals, it was not a concern for many endodontic practices. That was then, and this is now. Although the demand for endodontic services has traditionally been very high, we are uncertain as to what will happen in the next 6 to 24 months. Referral marketing should be implemented early to ensure a steady referral stream in Phases 2 and 3 of this recovery. When properly implemented, referral marketing will increases referrals, which is critical in the event of a referral slowdown.

One of the essential elements of referral marketing is to employ a part-time professional relations coordinator (PRC) at least 16 hours per week depending on the size of your practice. Trust me, it will be an investment that pays back many times over. The PRC will develop and carry out all the referral marketing strategies, build relationships with referring offices, and ensure that referrals don’t decline, in Phases 2 and 3. This will create a high level of consistency, but also reduce the endodontist’s time commitment and stress level. Without this individual, your referral marketing program will be extremely limited and primed for failure.

The Staffing Crisis

Levin Group has identified three critical staffing scenarios that could negatively impact endodontic practices in the COVID-19 era: Staff members who do not return following the shutdown, staff members who will need modified work hours due to personal matters created by COVID-19, and returning staff members that will change their mind and want to resign.

These three scenarios can lead to labor shortages that can lead to challenges in maintaining practice production, or higher stress levels, or staff burnout. One option is to hire and train new staff members quickly. If the practice is unable to hire new staff there are four additional options you can use to help you through this crucial time.

  1. Cross-train existing team members to provide flexibility in completing daily practices duties.
  2. Develop relationships with local temporary agencies so the practice isn’t left scrambling if a team member suddenly gets sick, has a conflict, or resigns.
  3. Batch certain types of treatment around the availability of certain staff members.
  4. Re-organize front desk duties such as filing insurance, follow-up scheduling, or collection calls to be performed every few days instead of daily. Rearranging tasks to fit around the availability of front desk staff will not have a negative effect on the practice if they are carried out consistently and effectively.

Resilient Leadership

For the most part, the endodontic specialty has never faced the adversity of a significant slowdown in referrals. However during this crisis, this may now be an issue. In order to help address this challenge, the endodontist must possess the resiliency needed to make rapid changes in practice dynamics, operations, and management of time, staff, and referrals.

Most business literature and research indicates that resilience may be the single most important leadership characteristic in a business turnaround. If you want to be resilient, simply make up your mind that you will take on each situation as it occurs, access the best resources and advisers, and move quickly.


A crisis creates unpredictability and leads to many questions. How long will the crisis last? How resistant will patients be to accepting treatment? How many referring doctors will increase the number of root canals they perform? The recommendations above combined with resilience will allow any practice to deal with uncertainty and recover with the highest potential. You must also keep in mind that all business turnarounds require a sense of urgency. The faster each situation is addressed, the faster the practice will move through the recovery.

Roger P. Levin, DDS is the CEO and Founder of Levin Group, a practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on dental practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world.

To contact Dr. Levin , visit or email