A long-tenured team member asks for a raise. You believe she has earned it. You open the numbers to find the money, and it is not obviously there. You say you will look at it, and you both walk away uneasy.
If that conversation happened in your practice this year, the arithmetic underneath it has now been published. The ADA Health Policy Institute’s State of the U.S. Dental Economy, 2nd Quarter 2026 Update charts the federal price data underneath it, and the distance between two of those lines explains a stalled raise better than a long night with your P&L.
Six months, two lines
From January through June of 2026, hourly earnings of dental office staff rose 2.2 percent. Over the same six months, the index that tracks what a dentist receives per visit rose 1.1 percent. Overall inflation ran 1.8 percent, and prices for dental equipment and supplies rose 0.2 percent. The wage and equipment figures sit on slide 17 of the report and the per-visit figure on slide 18. All of them are U.S. Bureau of Labor Statistics data, which the ADA compiles into its quarterly State of the U.S. Dental Economy series alongside its own panel survey of practicing dentists.
Put plainly, payroll moved at twice the speed of the money arriving per visit. Every raise you give is paid out of what arrives per visit, and in the first half of this year one of those lines grew twice as fast as the other.
What the per-visit number actually measures
This is the figure that gets misread most often, so precision matters. The report’s methods note on slide 44 identifies it as the BLS Producer Price Index for dental care, which measures the change in the reimbursement amount dentists receive per visit. The ADA is explicit that it includes payments from patients, private insurance, Medicaid, Medicare and other payers. Every dollar that comes through the door for a visit is inside it.
That means you should read it as collections across all payers and never as an insurance-only figure. It would be wrong to hold it up as proof that PPO fee schedules alone caused the gap. What it does tell you is narrower and more useful: across the whole market, the money that arrives for a visit has been rising more slowly than the cost of the people who deliver the care.
Five and a half years of the same shape
Widen the window and the picture holds. Since January 2021, the report shows the per-visit index up 19 percent while overall inflation ran 27 percent. Hourly earnings of dental office staff rose 23 percent over the same stretch, and prices for dental equipment and supplies rose 23 percent as well.
Read those numbers in order and the story tells itself. Your team’s pay has trailed the cost of living by about four points. What arrives per visit has trailed it by eight. The people who work in a practice have fallen behind, and the practice has fallen further behind than they have. The ADA’s own summary of the quarter, on slide 33, opens with a single line: “The ‘fiscal squeeze’ continues.”
Nobody in your building caused any of that. Three lines have moved at three different speeds since 2021, and one practice’s effort set none of them. If you have felt that you must be doing something wrong because the raise will not pencil out, the national data says otherwise. The squeeze is measured across the whole market, and well-run practices sit inside it too.
Why the labor side is not giving ground
It would be convenient if the wage line were about to flatten. The same report does not suggest it. In the ADA’s own panel survey for the quarter, based on 552 responses from dentists in private practice, nearly two in five were recruiting dental hygienists in Q2 2026, and among those dentists the vast majority described that recruiting as very or extremely challenging, a pattern the ADA says has held for two years. Total jobs in dental offices were up 1.5 percent over the twelve months to June, after two years of stagnation. The ADA reads that cautiously, as possibly early signs that staffing issues are easing but too soon for any definitive conclusion.
So the people you already have are worth more than they were, and replacing one of them is slow and expensive. Keeping a good hygienist or a seasoned office manager is the cheapest hiring a practice ever does. That is exactly why the raise conversation matters, and exactly why the squeeze hurts.
Why working harder only buys time
The natural response to a squeeze is effort. One more patient a day. Tighter scheduling. A longer Thursday. Those moves raise production, and plenty of practices have used them to get through a lean year. But they ask the same team to do more work for the raise they already asked for, and they leave the rate itself exactly where it was. A gap between two lines that you do not set will not close because you run more visits through the lower one.
The one line with your signature on it
Look at the four lines again and ask who set each one. Inflation is set by the whole economy. Equipment prices are set by manufacturers. Staff wages are set by a labor market in which a good hygienist has options. None of those answers to anything you do inside your building.
The per-visit line is different, at least in part. For a practice that participates with PPO plans, a real share of what arrives per visit was agreed in fee schedules the owner signed, often years ago. The range Fee for Service Academy works with is a write-off of roughly 25 to 35 percent of the full fee on those schedules. That is the only number in this whole picture that carries your signature, and so it is the only one you have standing to change.
Having standing to change it is a different thing from being ready to. For some practices, especially a young practice that depends heavily on one or two plans, the honest answer is to wait, prepare and build first. Which agreements still earn their place on your schedule is a question your own numbers answer, one plan at a time.
What to do with the raise conversation this year
Start by telling your team the truth about the arithmetic. A slow raise explained is received very differently from a slow raise left hanging. Your office manager is usually the person who already runs the reports, so ask her to bring two numbers to the next pay review: payroll as a share of collections, this year against last, and collections per visit, this year against last. Those two lines are your practice’s own version of the ADA’s chart.
Then put the conversation on a calendar. A practice that reviews pay in the same month every year, against its own numbers, has a discussion about arithmetic. A practice that waits until someone is frustrated enough to bring it up has a discussion about loyalty, and that one is much harder to win. If the answer this year is not yet, say what would have to be true for it to become yes, and when you will look again.
Finally, decide which line you are going to work on. The labor market will keep doing what labor markets do, and you will keep paying what good people cost. The per-visit line is where your own decisions live. Working through which agreements still make sense, and how to leave the ones that do not without losing the practice along the way, is slow and deliberate work with a real decision inside it.
That is the work Fee for Service Academy does with practice owners. If you want to see whether your practice is a fit, that is the place to start.