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Becoming a Super GP
Tracking the trend of offering more specialty services in general practice
According to the American Dental Association’s Health Policy Institute, the average net income for a general practitioner (GP) in private practice was $180,950 in 2013, down significantly from its peak of $215,876 in 2005.1,2 Despite the slow recovery occurring in the general economy, the average net income for GPs has not seen a corresponding rebound since the end of the Great Recession in 2009.2 Today more than one third of GPs report being “not busy enough” (see Table 1).
Many dentists are kept up at night weighing strategies to recapture that lost income and encourage practice growth. There is not one answer that suits all practices, but there is a growing trend that deserves consideration—becoming a Super GP.
What is a Super GP? In essence, it is a general practitioner who makes the decision to expand his or her scope of practice to include a variety of specialty services. For the purposes of this article, Inside Dentistry is defining a Super GP as a practitioner who is placing implants, performing endodontic procedures, offering orthodontic services, and providing cosmetic dentistry.
“There’s no question that the trend of general dentists performing more specialty procedures is way up,” says Roger P. Levin, DDS, chairman and chief executive officer of the Levin Group, Inc. “In the last 5 years, 75% of general practices have declined in production. It makes perfect sense that GPs started to look for other services they can provide.”
The beginning of the changes that became the Super GP trend can be traced back to 2008, when the recession really hit. Levin Group Data Center™ research shows that the number of GPs offering specialty services has continued to rise ever since, with no signs of stopping. Today more than half of GPs offer some type of orthodontic service and perform endodontics regularly, and well over one third are surgically placing implants (see Table 2).
Although attaining Super GP status can have tremendous financial and personal benefits, it is not for everyone. Many of those interviewed stressed that offering new specialty services is not a proposition to be taken lightly. The investment needed to do it right can be great, and the stakes are sometimes high. At least for now, the Super GP as a practice model is an interesting opportunity, and with careful consideration and proper planning, it could be the answer some practitioners seek.
“Dentists are increasingly looking for new and better ways to serve their patients and grow their practice at the same time,” explains Louis Malcmacher, DDS, MAGD, president of the American Academy of Facial Esthetics (AAFE) and a private practitioner in Bay Village, Ohio, where he practices under the Super GP model. “There is no question that the most successful dentists I see when I lecture at dental meetings are those who love to learn new skills and are on their way to becoming Super GPs.”
Success has many definitions in dentistry, but some of the most common markers—high production, improved dentist satisfaction, and elevated patient care—are among the characteristics of the typical Super GP practice.
In an economy in which every appointment matters, adding specialty services is one way to boost production.
Michael R. Sesemann, DDS, a private practitioner in Omaha, Nebraska, who fits our Super GP definition, began his practice with a strong background in endodontics and periodontics from his training at the University of Nebraska Medical Center College of Dentistry. Over the years, he subsequently added implant prosthodontics, comprehensive esthetics, periodontal surgery, endodontic surgery, occlusal treatments, Invisalign, implant placement, and injectable esthetic treatments like Botox and fillers to his practice’s offerings.
“All of those additions were well received by our patients and they stabilized our production, much like how a diversified portfolio reduces risk in investing,” Sesemann explains. “Being able to offer a lot of different services allows us to ensure our own security.”
Levin has found that a general practice can expect on average a 12% to 15% increase in production by adding one or more specialty services. He stresses that it is not the whole answer, however. Offering additional services can be for naught if the practice is not also efficient and well run.
Malcmacher cites a recent AAFE member study that illustrates the stabilizing effect of adding specialty services. “AAFE members who are Super GPs and incorporated Botox, fillers, trigger point therapy, bruxism monitoring, and dental sleep medicine into their practices averaged a monthly production increase of $26,500,” he says.
Many dental manufacturers are well aware of this trend and what it means for production. Michael Augins, president of Sirona Dental, Inc. and executive vice president of Sirona Dental Systems, Inc., says his company is focusing on a model called ROI (Restorative, Orthodontics, and Implants). Although not yet complete, preliminary research around Sirona’s ROI model is promising.
“When our customers add orthodontics and implants, they get a 50% growth in revenue production, but generally close to double their profits,” Augins says. “This is because they have all their overhead already—they’re just really adding the education and technology. They don’t have to add a new room or a new office, and they already have the patients in their practice.”
Practicing at a Higher Level
The variety of services a Super GP performs facilitates a comprehensive approach to more cases, allowing clinicians to practice at a higher, and often more satisfying, level.
Taking an implant case from presentation and planning through surgery and restoration, for example, allows complete control over, and responsibility for, its final outcome. “Our office was getting patients who came from specialists with implants that were at difficult angles to restore,” Malcmacher explains. “That motivated us to learn to surgically place implants decades ago so we could control the whole case from start to finish.”
Although Amanda Seay, DDS, a private practitioner in Mount Pleasant, South Carolina, is not a Super GP, she sees how a GP could bring a unique perspective to specialty services that could have huge clinical benefits. Seay has contemplated offering limited orthodontics with aligners in her practice for the convenience of her patients and for the benefit of being able to monitor teeth movement before and during the restorative phases of treatment. And although she does not place implants, she says, “I think the major advantage of a restoring dentist knowing tooth length, shape, contours, contacts, embrasure spaces, and emergence profiles of the final design as well as restorative material options cannot be denied.”
Practicing at a higher level can boost a practice’s reputation as well. Malcmacher explains, “We have seen AAFE dentist members become the best Botox injectors in their geographic locations, with physicians referring patients to them for esthetic and TMJ/orofacial pain and headache treatment. One AAFE general dentist member gets referrals from the Mayo Clinic.”
A Super GP who is practicing at the top of his or her game has days that are challenging and full of variety, a characteristic that is appealing for many. Sesemann says, “In providing such diverse services, every day is fresh and exciting because it is not the same, day in and day out. Even though my team has been in practice for a number of years, we still find our work stimulating and satisfying, and part of that is due to the variety of things we do.”