How a community clinic in Gippsland navigated a corporate approach during Legends Dental's regional expansion
In 2023 a small community dental clinic in Gippsland, Victoria, serving a town of 18,000 people, found itself at a crossroads. The clinic - Oakvale Dental - had annual billings of about $1.2 million, a team of seven clinical staff and five administrative staff, and a long-standing reputation for affordable care and local outreach. Legends Dental, a corporate dental group expanding from urban centres into regional Australia, announced an acquisition plan that offered Oakvale an up-front payment of $850,000 plus continued employment offers for existing staff.
More than the dollars, Oakvale's principal dentist - Dr Sarah Martin, an AHPRA-registered general dentist with 18 years' clinical experience and a Graduate Diploma in Practice Management - was worried about what would change for patients, staff and clinical autonomy. The community valued late-afternoon clinics for working families, a sliding-fee model for low-income patients, and a school-based outreach program that ran each term. Legends Dental presented a model focused on standardised protocols, centralised scheduling, and target-driven KPIs tied to profitability.
This case study traces how Oakvale Click here for more compared community-based and corporate models, redefined the principal dentist role, negotiated leadership changes, and implemented a hybrid approach so the benefits of corporate scale were realised while preserving community care values. The outcome offers specific numbers, steps taken and lessons for other clinics facing similar choices.
The Principal's Role Under Pressure: Why local leadership clashed with corporate systems
At the heart of the challenge was a shift in what it meant to be the practice principal. In community clinics the principal often wears many hats: clinician, employer, patient advocate, trainer and community liaison. In corporate clinics the principal role can become more managerial and compliance-focused, with clinical decisions shaped by network protocols and performance metrics.
Key problems Oakvale faced as negotiations began:
- Unclear clinical autonomy - Would Dr Martin retain authority to set treatment plans and appointment lengths, or would protocols mandate shorter consults to meet utilisation targets? Leadership turnover risk - Corporate ownership often brings rotational regional managers. Staff feared losing the familiar local leadership that supported their community programs. Funding for outreach - Legends proposed ending the sliding-fee policy to standardise pricing, jeopardising access for low-income families. Operational disruption - Rapid IT and scheduling changes could harm patient flow and increase missed appointment rates in the short term.
These issues are common when independent principals consider selling or joining corporate groups. A clear, evidence-based comparison and an enforceable transition plan were needed to protect patient access and staff morale.
Negotiating a Hybrid Model: How Oakvale balanced community values and corporate systems
Oakvale's leadership team decided on a hybrid strategy: accept parts of Legends' offer that improved stability and investment while protecting community-facing elements through contractual provisions and a local governance layer.
Key elements they negotiated into the sale agreement:
- Clinical autonomy clause - Dr Martin retained final sign-off on clinical protocols for patients under the clinic's charity and outreach programs. Local advisory board - A three-person advisory board including the principal, a community representative and a Legends-appointed operations lead was created to oversee community programs and local hiring decisions. Protected funding for outreach - Legends agreed to maintain the sliding-fee model for two years with a scheduled financial review tied to patient volume growth targets. Guaranteed transition staffing - The agreement included a 12-month retention bonus for clinical and administrative staff who remained through the transition period, reducing turnover risk. Phased IT integration - The clinic committed to a staged roll-out of corporate scheduling software with dedicated training days and a local fallback system during the first six weeks.
Negotiating these items required clear numbers and evidence. Oakvale prepared a one-page packet showing:
- Patient demographics: 34 percent concession card holders, 28 percent children under 12, 18 percent aged over 65. Community program reach: 420 children screened annually through school programs; estimated 60 patients per month assisted by the sliding-fee policy. Staff retention costs: a recruitment estimate of $18,000 per replaced clinical staff member, based on recent hires in the region.
These figures helped persuade Legends that preserving local programs would protect patient volumes and reputation while the group introduced efficiency gains elsewhere.
Implementing the Leadership Transition: A 120-Day Timeline
Once the sale completed in October 2023, Oakvale and Legends followed a detailed 120-day implementation plan. Below are the steps, who led them and the benchmarks used to measure progress.
Days 1-14 - Stabilise staff and communicate the plan
Actions: Hold two town-hall meetings for staff, issue a written FAQ for patients, and sign retention agreements. Responsible: Dr Martin and Legends regional manager. Benchmarks: 95 percent staff attendance at meetings; signed retention agreements covering at least 90 percent of clinical staff.
Days 15-45 - Protect community programs and secure funding
Actions: Formalise the sliding-fee continuation, transfer the school outreach budget into Legends' community fund, and schedule the first advisory board meeting. Responsible: Local advisory board. Benchmarks: Written confirmation of two-year funding; first outreach event scheduled.
Days 46-75 - Implement phased IT and KPI introduction
Actions: Introduce the corporate scheduling system first for new patient bookings, run two full training days, and maintain the old system for rescheduling for six weeks. Responsible: Legends IT lead with a local superuser. Benchmarks: 80 percent of staff complete training; no increase in no-show rate during the transition.
Days 76-105 - Review clinical protocols and formalise autonomy
Actions: Map corporate protocols against local practice needs, document exceptions for outreach and complex cases, and draft clinical autonomy appendices. Responsible: Dr Martin and corporate clinical governance. Benchmarks: Autonomy appendices signed off and published to staff.
Days 106-120 - Evaluate and adjust
Actions: Conduct a staff and patient satisfaction survey, review financials for the first quarter under new ownership, and set KPIs for the next 12 months. Responsible: Advisory board. Benchmarks: Staff turnover below 10 percent; patient satisfaction score above 4.2 out of 5.
To keep the community informed, Oakvale published monthly newsletters summarising progress and community program schedules. Transparency eased anxiety and kept appointment retention rates steady.
From 18% turnover to 7%: measurable outcomes six months after the transition
Six months after the acquisition Oakvale's results showed concrete, measurable changes. Below are the primary outcomes compared to the six months prior to sale.
Metric Pre-sale (Apr-Sep 2023) Post-sale (Nov 2023-Apr 2024) Change Monthly average patient visits 1,040 1,120 +7.7% Staff turnover (annualised rate) 18% 7% -11 percentage points Patient no-show rate 11.5% 9.8% -1.7 percentage points Sliding-fee patients per month 60 58 -3.3% School screenings per year (projected) 420 430 +2.4% Clinic net revenue (annualised) $1.2M $1.35M +12.5% Patient satisfaction (scale 1-5) 4.3 4.4 +0.1Important context: the sliding-fee caseload dipped slightly in the first six months as administrative re-registration was required under Legends' billing system, but it stabilised after the second outreach event when the clinic re-established its referral pathways. The overall revenue increase came from longer opening hours funded by corporate investment in staffing and marketing drawing new patients from neighbouring towns.
Clinically, Dr Martin reported no change in quality metrics such as infection control audits and treatment outcomes. The advisory board successfully blocked a proposed reduction in appointment times, preserving appointment lengths for complex cases and outreach screenings.
Five leadership lessons for principals balancing community care and corporate systems
Oakvale's experience yields several practical lessons for practice principals considering sale or partnership with corporate groups.
Define the non-negotiables early. Know which services and policies are essential to your community - outreach, concession pricing, appointment length - and make them part of the sale contract. Turn numbers into leverage. Use real patient demographics and operational costs to show why local programs protect volume and reputation. Quantify the cost of staff turnover; these figures influence negotiation outcomes. Create a formal local governance mechanism. An advisory board with clear terms of reference gives the principal and community a voice once ownership changes. Phase technical changes and invest in training. Rapid IT change drives frustration and lost bookings. Plan staged roll-outs with local superusers and fallback processes. Protect clinical autonomy in writing. A clause that preserves clinician decision-making in specified contexts prevents later erosion under target-driven systems.How other practices can adapt Oakvale's hybrid approach
Below is a practical, step-by-step guide smaller clinics can use to replicate Oakvale's approach, plus two thought experiments to test decisions before signing any agreement.
Audit your practice with a community-first lens
Document patient mix, outreach programs, concession numbers and the cost of current services. Build a one-page data sheet you can present during negotiations that highlights community value and financial impacts of changes.
Decide your non-negotiables and rank them
Make a short list of the top five things you will not give up, and be prepared to explain why each one matters to patients and to the clinic's long-term viability.
Negotiate governance and autonomy clauses
Insist on a local advisory body, time-bound funding protections for community programs, and explicit clinical autonomy language for specified services such as outreach, paediatric complex care and aged-care visits.
Plan a phased operational integration
Require staged IT migration, training days, retention bonuses and a cooling-in period before performance KPIs apply to local teams.
Measure and publish outcomes
Agree on key metrics up front - patient visits, no-show rates, community program reach, staff retention - and publish quarterly reports to the community.
Thought experiment A: The pricing trade-off
Imagine your clinic's sliding-fee program serves 60 patients per month and costs the clinic a gross margin of $25 per patient, but delivers social value and keeps referrals flowing from local social services. Corporate offers to standardise fees and increase marketing, promising a 10 percent rise in overall patient volume but offering no concession program. Which scenario is better for long-term community health and sustainable revenue?
How to test it: model the numbers. If a 10 percent overall volume rise translates to an extra 104 visits per month at an average margin of $60, that's an additional $6,240 monthly gross, offsetting lost concessions. If the concession group drives unique referrals that corporate marketing cannot replace, the long-term reputational cost may outweigh short-term gains. Use your actual patient mix to run the math.
Thought experiment B: Leadership turnover vs operational efficiency
Corporate efficiency often reduces administrative load but may centralise decisions. Suppose centralised rostering saves 8 hours of admin time per week but increases staff dissatisfaction leading to one clinician leaving. The replacement cost is estimated at $20,000 and productivity loss of eight weeks while recruiting. Is the admin saving worth the risk?
How to test it: calculate break-even. Eight admin hours per week at an average admin wage of $32 per hour equals $256 weekly or $13,312 annually. If clinician turnover cost is $20,000 plus lost revenue, then the net is negative. This suggests negotiating staged changes and retention incentives is prudent.
These thought experiments show why numbers and community context must inform decisions, not just contract language or headline offers.
Final note for principals: selling or partnering with a corporate group does not mean surrendering community values. With careful preparation, transparent negotiation and enforceable governance mechanisms, it is possible to gain capital and operational support while still serving the people who depend on your clinic.