Sponsored Content
By Christine Sison, B.A., S.M., Founder & CEO, Swiss Monkey
Growth alone won’t solve front office coverage, which is why the strongest groups decide deliberately who does the work, where they sit, and how much they buy.
Most front offices weren’t designed. They were accumulated. Each location solved the problem in its own year, in its own labor market, with whoever happened to be deciding — and acquisitions tend to bring someone else’s answers in along with their patients. Some groups have centralized parts of this already. Many haven’t revisited the underlying decisions at all, because nothing forced the question.
Where it shows up is dispersion inside the portfolio: same brand, same software, same fee schedule, materially different case acceptance and time-to-fill between your own offices. When the spread inside a group is wider than the spread between that group and its competitors, the cause usually isn’t people and it usually isn’t markets.
What follows isn’t a prescription. Three design levers opened up over the last decade that weren’t available before. Knowing they exist is what lets you move in weeks instead of quarters when something breaks — a seat you can’t fill, a leave on the calendar, a location that opens ahead of hiring. There’s no wrong answer on how you blend them. There’s only whether you chose.
Part 1: The constraints your front offices were built around
Most of these constraints have lifted. The offices they produced mostly haven’t changed.
Everything lived in the building (through the 2010s). Charts, ledgers, and claims were on paper, in one building, so the work had to live there too. Each location’s hiring pool wasn’t people who could do the job — it was people who could do the job and be at the door by 7:30. One or two people did all of it, because there was no way to split it up.
The job was taught by apprenticeship. Hygienists and doctors are licensed and assistants are certified, but the person handling your PPO contracts and the $20,000 conversation learned it by sitting next to whoever did it before them. Which is why “just hire and train someone” stopped working once that generation stepped away — and why, across eight offices, you have eight undocumented versions of the same job with no way to compare them.
Then the records went digital. Practice software arrived with the PC in the 1980s and clinical charting took another decade or two, but the server was a box in a closet, reachable only from a computer on that network. Two things had to happen before remote work was possible at all: the workflow moving off paper, and secure access to those files from outside the building. Neither was any use without the other.
The first outsourcing wave (late 2010s). Medicine had already run this experiment — hospitals and physician groups were sending transcription offshore by the mid-1990s, and by around 2010 that had widened into coding, billing, and full revenue cycle work. Dentistry arrived roughly two decades late, and groups went first, sensibly, because you could run it at a few sites and absorb the result.
When it landed, it looked prudent: the savings were obvious and the risk seemed contained to the back office where no patient would feel it. But the early dental version came with no dental-specific training, so the mistakes landed in the two places practices feel most — the patient experience and the production numbers. Rather than fix that one part, much of the industry threw out the whole model.
COVID, and what actually changed (2020–2023). The shutdown forced the experiment. None of the technology was new — cloud software, remote access into server-based offices, VoIP phones, and electronic claims were all on the market by 2015 — but a model most owners had never seriously considered got tested across the whole industry in about six weeks.
It also changed what people want from a job. A younger workforce came out of those years with a different relationship to work — where it happens, on what terms, and how much of their life it gets — and that shift hit every industry, not just dentistry.
And the desk emptied. Those people didn’t leave dentistry, they left the desk, and many left W-2 employment with it. Most are still doing this work from home as 1099 contractors, often for a few practices at once. That’s the market every one of your locations is hiring into now.
Outsourcing 2.0 (which started earlier than people remember). The version that works was being built quietly over those same years. Six things make it different from the first wave:
Training built for dental. Not general administrative help — people trained on PPO mechanics, your practice software, and what to say when a patient goes quiet after hearing the number.
Software built for healthcare. HIPAA-aligned platforms made it safe to grant access from outside the building, and gave you a record of what actually got done instead of taking someone’s word for it.
Sorting the work by who talks to patients. Verification, claims, and posting can be handled anywhere. The conversations that decide whether a patient schedules go to someone equipped for them. That split is what keeps the risk contained.
Choosing where each piece sits. A US-based person on patient-facing work, an overseas team on structured back-office work. A decision made per task, not once for the whole organization.
Buying part of a job instead of a whole person. Verification only. Twenty hours a week of treatment follow- up. You define the piece of work and buy that.
Some of the work stopped needing a person at all. Confirmations, recall reminders, eligibility checks, first- pass claim scrubbing — software and AI handle a real share of it now, and the tools improve with each version. It works best paired with a person: the software does the repetitive pass, someone reviews what looks wrong and handles anything a patient will hear.
The lesson worth keeping: the problem was never that the work left the building. It’s that nobody decided what
should.
Part 2: What’s different now
| It used to be | It is now | |
| Who you hire | A W-2 employee | Employees, contractors, software — in any mix |
| Where they sit | In that building | The office, elsewhere in the country, overseas, or a hybrid |
| How much you buy | One full-time person per site | Full-time, fractional hours, a task, or a finished result |
The mix is the point. These aren’t either/or choices. A well-built front office runs several settings at once: employees on site for what needs presence, domestic professionals on patient-facing conversations, offshore support on structured back-office work, software absorbing what genuinely repeats. Most groups already have the beginnings of a blend — the question is whether it was designed or assembled.
One note on offshore: it’s generally the lower-cost option, but not always. Depending on the skill the work requires, the hours you need covered, and the oversight involved, it can land closer to domestic than you’d expect. Worth running the math per role rather than assuming it.
Three cost structures, not three prices. A W-2 seat is fixed cost. Payroll taxes, unemployment, workers comp, benefits and PTO typically add 25% to 40% on top of wage, carried through slow months, replicated at every seat in every office. A $50,000 role is really $62,000 to $70,000.
The premium buys availability, and that’s worth something. An employee is yours — you set the hours, nobody negotiates scope, surge capacity is already on site.
A contractor is variable cost. The rate is the cost, service fee included, with nothing carried when volume drops. An hourly rate comparison is the wrong instrument; loaded cost per productive hour is the right one.
The best person may not want to be your employee. Experienced billers, verification specialists, and treatment coordinators left the desk on purpose and run a business of one. They aren’t watching job postings.
Turnover isn’t a you problem. Dental front office turnover commonly runs 25% to 35% a year. National median job tenure is under four years, and under three for workers 25 to 34 — where most front office hires come from.
The arithmetic nobody totals. Eight offices, four front office people each, 25–35% turnover is roughly ten departures a year. At two to three months to fill each — the good case — that’s twenty-plus months of empty seat time annually, meaning about two seats are vacant somewhere in your group at any moment. Everyone has revenue attached: calls unanswered, treatment unscheduled, claims unworked. Most groups have never added this up across locations.
Part 3: What to do about it
- Sort work by whether a patient is on the other end. Before cost, sort by exposure. New patient calls, case presentation, and financial conversations get your strongest people. Verification, claims, posting, and eligibility are structured and checkable, and can sit wherever the math works. Most groups do this backwards — the experienced person ends up on claims, and the biggest conversation of the day goes to whoever’s free.
- Decide what centralizes and what doesn’t. The failure mode isn’t centralizing too little; it’s centralizing indiscriminately. Centralize verification, eligibility, claims follow-up, statements, and collections — defined inputs and outputs, no benefit to being local, and where most variance originates. Keep check-in, checkout, and rooming local but thin. Pool treatment coordination and case presentation by skill, so the patient at your smallest office gets the same conversation as the patient at your busiest. Leave alone what’s genuinely contextual: which referring specialists call back, which patients need a heads-up, what’s true about that market. Centralize what is procedural, keep what is contextual. Most efforts fail because offices experience it as authority being removed rather than burden being removed.
- Buy hours, not A role that needs ten hours at one site needs thirty across three — and thirty hours is a specialist. Twenty to thirty hours covers most specialized front office roles well, and the seat doesn’t sit half-idle in February. Henry Schein One’s 2026 Catalyst Index puts the best practices at 75% treatment acceptance against a 45% average, with smaller practices frequently beating bigger groups. Same diagnosis, same plans — it tracks who’s having the conversation, which makes it the one variable you can set identically everywhere. Unscheduled treatment is the cleanest place to start: a defined outcome, bought in hours, measurable in ninety days, and the return shows up in production rather than a cost line.
- Plan the leaves you already know about. Maternity leave, surgery, a sabbatical. Most groups absorb these at the location level — everybody covers, the schedule thins, follow-up stops, and a quarter later nobody can say what it cost. These are the most predictable gaps in your operation and the ones almost nobody staffs for.
- Build one bench instead of eight searches. Today a departure means that office starts from zero, on its own timeline, to its own standard. Eight offices means eight definitions of a good hire and eight gaps staggered across the year. The real cost isn’t the departure — it’s the restart, running continuously, in a recruiting function you never staffed for. Standing access means selecting from a pool that exists instead of building one.
And for the sites that don’t behave like the others. Every group has one or two: a market with no talent at any price, an office that’s cycled through four hires in two years. A fully virtual front office — everything offsite except the person who greets and rooms patients — is a real answer there, and it doesn’t have to be a group-wide decision.
One question before any of it
What experience are you trying to deliver? An organization where a person picks up every time and nobody rushes a patient through a $20,000 plan is one build. An organization indexed toward efficiency, where more technology and less touch make the economics work, is a different build. Both are legitimate. They need different front offices, and the answer to this question should drive every decision above it — not the other way around.
Your front office was never really designed. It was assembled out of whatever was available, in each office, and handed down. The honest test: if you were building it Monday, with everything available now, you would not build the one you have. That’s not an argument for tearing anything down. It’s an argument for choosing deliberately rather than inheriting — because scale doesn’t correct a design, it replicates one. The advantage you have over a single practice is that you can test before you commit: two sites, ninety days, one metric agreed in advance.
Seeing the same performance gaps across your locations?
Let’s talk about what’s driving them and what you can do next.
Scan the QR code below to schedule a conversation,
or email contact@swissmonkey.io
About the author
Christine Sison, B.A., S.M., is the CEO and founder of Swiss Monkey, a dental operating system that gives practices access to experienced front office talent in full-time or modular capacity, supported by structured workflows, KPIs, and accountability measures. She has spent more than a decade advising practices and groups on front office design and staffing, and speaks nationally on dental labor trends, front office optimization, and staffing strategy.
Prior to her work in dentistry, she conducted brain tumor research at the University of California, San Francisco, assisted in the integration of IT into clinics and hospitals, and later led the development of community-wide healthcare systems, including telemedicine efforts. She holds a B.A. in neurobiology from the University of California, Berkeley, and a Master of Science in Health Policy and Management from the Harvard School of Public Health.
