When Care Meets Capital
Why the future of care depends on who carries it.
Carriage is the system that decides how things move from the people who create them to the people who use them. In media, it was bookstores, radio stations, movie theatres. The moment a few companies controlled those routes, they controlled what got seen — and what didn’t.
For a long time, dentistry in Canada had open carriage.
Independently owned practices. Hygienists and dentists shaping their own patient experience. Care delivered by people who lived in the same community as the people they served.
Then consolidation began.
Large dental groups started buying clinics, one by one. At first it didn’t look like much. A smooth transition. A retiring dentist. A new sign out front. But quietly, carriage was shifting. A handful of corporations began to control a meaningful number of dental chairs.
And when a company controls the chairs, it eventually controls the culture.
We’ve seen this movie before — with Netflix’s growing influence, with Google turning search into pay-to-play, with Amazon prioritizing sponsored listings over relevance. When carriage centralizes, the priorities shift too.
In dentistry, those priorities aren’t mysterious.
They’re the priorities of shareholders.
Efficiency over connection.
Standardization over autonomy.
Production targets over personalized care.
And here’s the part people rarely talk about:
The cost to the patient doesn’t go down.
Your cleaning, your filling, your exam — the fees stay the same or creep higher. The only thing that really changes is where the profit goes.
Not toward more time with your hygienist.
Not toward better recall systems or preventative coaching.
Not toward community-level patient experience.
The difference goes to the corporate ledger.
In the U.S., this shift happened fast.
Independent practices didn’t disappear, but their influence shrank. Nearly half of all dental clinics now operate under corporate carriage. The culture became predictable, efficient, and less personal — not because clinicians stopped caring, but because the system stopped giving room for caring to shape the work.
Canada isn’t there yet.
But we can feel the slope.
Which is why independent hygiene clinics matter so much right now.
They are one of the last places where open carriage still exists — where care is shaped by humans, not headquarters. Where time can stretch instead of shrink. Where prevention is the point, not the pipeline. Where the experience benefits the patient, not the shareholders.
Carriage creates culture.
Once it closes, you don’t get to choose the experience anymore.
Right now in Canada, the door is still open.
But only if we notice who is carrying the care.
