Retiring consultant Mastwijk: dental entrepreneurs need more regulatory freedom
Retiring advisor Mastwijk warns of regulatory excess and private equity overvaluation threatening dentist independence and practice acquisition.
Richard Mastwijk, who officially retired on 31 January 2026 as a consultant at van helder (an accounting firm he co-founded 17 years ago), has spent decades advising dental practices on business strategy and financial performance. In a wide-ranging interview, Mastwijk argues that Dutch dental entrepreneurs face excessive regulation that stifles growth and innovation, and that the regulatory framework fails to reward quality or market-driven pricing.
Financial benchmarking and practice performance
Van helder specializes in serving dental professionals, with 60 to 70% of its 95% healthcare-focused client base in dentistry. The firm uses normalized EBITDA expressed as a percentage of fee income to compare practices of similar size and lifecycle stage. Mastwijk explains that practices performing at 20 to 25% EBITDA-to-revenue ratio are performing adequately; above that range indicates exceptional performance, and below suggests room for improvement. By analyzing key performance indicators (KPIs) such as treatment room utilization and staff efficiency, practices can identify specific areas for operational improvement. However, Mastwijk notes with frustration that few practitioners invest time in this financial analysis, despite its importance for sound business management.
Regulation, private equity valuations, and the self-employed crisis
Mastwijk is critical of several regulatory and market trends. Private equity multiples for dental practice acquisitions have reached 7 or higher, compared to the 3.5 to 3.75 multiple typical for owner-financed purchases. This gap makes it virtually impossible for beginning dentists to acquire practices from colleagues at realistic valuations. On the self-employed (zzp) issue, Mastwijk warns that recent court rulings (including the Uber case) are being misinterpreted. Based on van helder's analysis of the nine Deliveroo criteria established by the Dutch Supreme Court, 53% of typical dentist-employer relationships would legally qualify as employment contracts, exposing practice owners to substantial back-payment liability for employee insurance premiums and interest if audited. The uncertainty created by the lifting of the enforcement moratorium on the Self-Employment Act (DBA) is paralyzing the sector.
Policy recommendations and entrepreneurial freedom
Mastwijk advocates for a two-tier system: secure employment contracts with full tax benefits for healthcare workers who prefer salaried work, and genuine entrepreneurial freedom for those who want it. He argues that the Dutch fee-setting system, controlled by the NZa (Dutch Healthcare Authority), is overly rigid and prevents market-driven pricing for superior quality or innovation. Orthodontists face an 11.2% fee reduction in 2026 without compensation for cost increases; general dentists a 1% reduction that effectively represents a 5.5% real loss. Mastwijk calls for a quality-based pricing framework with enforceable minimum standards but room for differentiation. He also criticizes the burden of financial reporting rules and suggests that regulatory effort should focus on detecting and prosecuting large-scale fraud rather than compliance paperwork for honest practitioners.
Frequently asked questions
What is normalized EBITDA and why do dental practices use it to benchmark performance?
Normalized EBITDA removes non-operational factors (interest, depreciation, tax, goodwill) to make practices at different lifecycle stages directly comparable. Expressed as a percentage of fee revenue, it shows operational efficiency: 20-25% is typical, above indicates exceptional performance, below suggests room for improvement.
Why do private equity dental practice acquisitions carry higher multiples than owner-financed purchases?
Private equity multiples reach 7 or higher, versus 3.5 to 3.75 for owner-financed deals. At such high multiples, annual earnings cannot cover debt service and depreciation, so profit relies on resale at an even higher multiple five years later, making ordinary dentist acquisition of colleague practices economically impossible.
What does the Dutch Supreme Court Deliveroo ruling mean for self-employed dentists in practices?
Analysis of the nine Deliveroo criteria suggests 53% of typical dentist-employer relationships would legally qualify as employment contracts, not self-employment. Practices face back-payment liability for employee insurance premiums plus interest if audited, creating substantial financial risk under the lifted DBA enforcement moratorium.
How much are Dutch dental fees changing in 2026 and does this cover cost inflation?
Orthodontists face an 11.2% fee reduction without compensation for cost increases. General dentists receive a 1% reduction that, when adjusted for actual cost inflation, represents a real loss of approximately 5.5%.
What policy changes would Mastwijk recommend to support dental entrepreneurship?
Offer secure employment contracts with full tax benefits for those who prefer salaried work, while freeing genuine entrepreneurs to set prices based on quality and market factors. Enforce a quality floor but allow differentiation above it, and redirect regulatory effort from compliance paperwork toward detecting large-scale fraud.
