Short Staffed but Still Smiling: Navigating Workforce Shortages in Ambulatory Care and Dental Clinics
When people think of healthcare staffing shortages, they picture busy hospital floors, overwhelmed ERs, and exhausted nurses. But ambulatory care settings, especially dental clinics, urgent care centers, doctor’s offices, and outpatient specialty offices, are fighting the same battle, often without the same visibility or access to resources.
In these environments, the loss of even one clinician, dental hygienist, or front office team member can derail an entire day. Unlike hospitals with float pools or centralized staffing offices, many clinics run lean by design, often with just enough staff to cover that day’s appointments. This works beautifully until someone calls out sick and a patient needs emergency care.
How do they keep going?
Mostly through caffeine and the occasional miracle, speaking from personal experience. But there’s more strategy to it than meets the eye.
The Reality of Lean Staffing in Ambulatory Settings
Most dental and outpatient clinics operate on the edge of efficiency. A typical dental office might have two to three hygienists, one or two dentists, a few assistants, and a compact front office team. Lose one hygienist unexpectedly, and you’ve just cut your preventive care capacity by 30–50%.
Patients still show up. Procedures still need to be done. And rescheduling isn’t always an option, especially when patient access is already delayed due to high demand or there is a true emergency that requires intervention. Workforce volatility has become the norm, not the exception. Sick calls are now part of the daily schedule no one wants to publish.
Why the Workforce Shortage Persists in Ambulatory and Dental Care
The healthcare workforce shortage isn’t confined to acute care hospital systems. In fact, it may be hitting ambulatory and dental settings harder, and for reasons that are both structural and cultural.
Shrinking Pipelines
The American Dental Association reports that the U.S. has a shortage of more than 11,000 dental hygienists and nearly 6,000 dental assistants as of 2024.
Nursing programs and dental schools are still turning away highly qualified applicants due to limited faculty, clinical placements, and training capacity.
According to the American Association of Medical Colleges, the U.S. could face a shortfall of up to 86,000 physicians by 2036, many in primary care and ambulatory specialties.
When education programs operate at capacity, replacing retirees and career changers becomes a game of catch-up that no one is winning. We are losing skilled resources faster than we can replace them.
Post-Pandemic Attrition
Nearly one in five healthcare workers left the industry between 2020 and 2023, according to a Becker’s Healthcare analysis.
Dental and outpatient staff cited “emotional exhaustion” and “lack of flexibility” as key reasons for leaving. Many who exited never came back, opting for a remote position or non-clinical roles.
For every person who left, others were left doing more with less, accelerating burnout and turnover.
It’s a vicious cycle: fewer staff means more stress, which drives more staff out the door.
Compensation and Competition
Hospitals, backed by larger budgets, often lure ambulatory staff with sign-on bonuses or higher hourly pay. Facing their own staffing crisis for similar reasons, they have no choice but to do what they can to fill their own openings.
Meanwhile, dental hygienists and assistants are increasingly pursuing flexible part-time roles or mobile dentistry opportunities. The Bureau of Labor Statistics projects 19% job growth for dental hygienists by 2032, but only if clinics can attract and retain them.
When you can earn more cleaning teeth two days a week at multiple offices, traditional full-time roles lose appeal.
Lifestyle and Work-Life Balance Shifts
Healthcare professionals are increasingly seeking flexibility, which is a huge challenge for fixed-schedule environments. The 2024 AMA Workforce Trends Report found that 68% of clinicians value schedule flexibility overcompensation when considering new roles. Ambulatory settings, with rigid appointment structures, struggle to compete.
Aging Workforce and Delayed Succession Planning
In many practices, key clinical and administrative staff are nearing retirement. Without structured succession planning or cross-training, knowledge gaps widen overnight. But how can leaders spend time working on succession planning when so often they’re pulled out of their offices and into the fold caring for patients themselves?
Vicious cycle, remember?
Together, these factors have turned a temporary disruption into a long-term operational reality. The talent pool isn’t drying up; it’s being redistributed, redefined, and in many cases, rethinking healthcare altogether.
The Domino Effect of a Single Call-Out
I want to walk you through a day in the life to fully appreciate the impact of what just one call out can do to a busy office:
When a hygienist calls out: Exams, cleanings, and x-rays back up. Assistants are asked to do more, and dentists find themselves performing hygiene checks between procedures. The waiting room clock suddenly feels louder.
When a dentist calls out: Hygienists must pause procedures requiring supervision, and patients face reschedules, meaning lost revenue and a long day of apology calls.
When support staff calls out: Clinicians become front-desk multitaskers, juggling phones, check-ins, and treatment plans while still trying to deliver safe, timely care.
It’s not a mild inconvenience. It’s operational risk, and it compounds quickly.
Creative, On-the-Fly Staffing Solutions
Despite these pressures, ambulatory teams remain resourceful. The ingenuity displayed on a short-staffed Tuesday morning could rival a NASA control room.
Common survival tactics include:
Cross-training: Assistants trained to support both hygiene and provider procedures can shift as needed. Front-desk staff with clinical backgrounds may help with sterilization or room turnover. It’s not ideal, but it keeps the doors open
Schedule optimization: Many clinics reserve one or two “flex slots” daily for emergencies or last-minute changes. Those slots often save the day, or at least save lunch!
Partnering across locations: Multi-site organizations sometimes float staff between clinics, though geography and burnout often set limits.
Telehealth triage: Ambulatory medical clinics may divert non-urgent visits to quick telehealth appointments, freeing up in-person capacity.
Prioritization: When staffing thins, teams prioritize by acuity. Preventive care can wait; abscesses cannot.
Some leaders have also embraced shadow scheduling, creating backup appointment templates or “ghost blocks” that can flex up or down depending on the day’s staffing reality. It’s creative workforce elasticity in action.
The Toll on Staff and the Risk of Burnout
Every short-staff day takes a toll. Staff are repeatedly asked to step up, often without added support or compensation. Over time, that leads to increased stress and error risk. Where does that in turn lead? Lower morale and employee engagement plummeting. Now we’re dealing with higher turnover, perpetuating that vicious cycle I keep mentioning,
Leaders must recognize that managing through crisis is not the same as solving it. Constant heroics may get the job done, but they also drive your best people away. “Making it work” is not a long-term workforce strategy.
Moving From Surviving to Thriving: Strategic Recommendations
Build a float pool or on-call bench. Even small groups benefit from a few trained float staff who can rotate between clinics or stay on call for high-volume days. Consistency and familiarity with workflows matter as much as skill mix.
Invest in process optimization. Automate administrative tasks like patient reminders, intake, and billing to reduce the load on front-line staff. Automation should serve people, not the other way around.
Upgrade scheduling and workforce tools. Modern systems don’t just fill shifts; they forecast them. Analyzing patterns in no-shows, call-outs, and chair utilization allows leaders to staff to reality, not to wishful thinking
Promote cross-training and career pathways. A dental assistant today may become a hygienist tomorrow if given the opportunity. Invest in internal development. It strengthens loyalty and creates organic staffing resilience.
Develop micro-incentives for flexibility. Recognize and reward staff who pick up shifts, cross-cover locations, or help balance the chaos. Sometimes acknowledgment and a genuine thank-you are the strongest retention tools you have.
Address burnout directly. Encourage regular check-ins, access to wellness resources, and a culture where taking a day off for a “mental health day” (or even just actually using the PTO you receive as a job benefit) isn’t seen as betrayal.
Ambulatory and dental care teams are among the most adaptable professionals in healthcare. Their ability to pivot, improvise (see what I did there?!), and maintain patient care with limited staff is impressive but also unsustainable. Smiling through the chaos is admirable. But it’s also not a business model.
The real goal is to build systems so sound that the next sick call doesn’t send the day into orbit, because everyone deserves to end their shift with something left to smile about.
About Improv
Dr. Sarah Inman is the Senior Vice President of Healthcare at Improv, where she leads strategic initiatives that help healthcare organizations optimize workforce management, scheduling, and operational performance.
Improv partners with hospitals, dental groups, and ambulatory care organizations to design sustainable workforce systems that reduce administrative burden, improve staff engagement, and enhance patient care outcomes. Dr. Inman’s work combines practical experience, data-driven insights, and a deep understanding of the human side of healthcare operations. You can learn more about the team at www.improvizations.com.
