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Inside Dentistry
September 2015
Volume 11, Issue 9

Patient Care and Satisfaction

The Super GP represents a truly patient-first model of practice, according to Filippo Impieri, vice president of marketing, North America for KaVo Kerr Group, Dental Technologies. “The primary motivation for GPs adding treatments such as endo, ortho, or implants is to offer better, more comprehensive care to their patients,” he says. “In fact, stories of improved patient experience and retention are what we hear most.”

Malcmacher has seen this positive effect on his patients. “For the last 40 years, we have always provided as many services as we possibly could to patients,” he explains. “We were able to provide better treatment because we knew exactly what the proper treatment sequence should be and what dental materials we used so they were compatible with other materials. Patients were thrilled to be able to receive all of their care in one place instead of getting bounced around from office to office.”

Patients’ lives are hectic today, Sesemann says, and they like the convenience of treatment by one office, as long as it is clinically appropriate. They also appreciate having everything done by the team of people they have come to know and trust.

Going to one location for fewer appointments to get a range of services completed leads to a more satisfactory patient experience, Augins says. “Dentists who provide a broader range of services to their patients create this kind of one-stop-shop effect that makes them attractive to new patients. We found in our ROI modeling that it increases overall patient satisfaction.”

The Disadvantages

Super GPs should have a passionate drive to learn everything they can about their craft, Sesemann says. “With that inspiration and motivation, it then becomes a commitment to put two important resources towards that objective—time and money. That is not easy to do, because it is initially in direct competition with personal time off and salary compensation.”

In addition to the expenditure of time and money, which alone are big enough disadvantages to deter some, there are other potential downsides to becoming a Super GP. These stem generally from proceeding with the practice model without proper planning and communication.

Stretching Yourself Too Thin

Providing a wider range of services can have a negative effect on practice production if clinicians attempt to add too many new procedures or services at once. Understanding your personal limits—and those of your team—will go a long way to avoiding this first disadvantage.

“It is important to be aware of possible distraction from what made the practice successful, or putting it another way, a lack of focus,” Impieri says. “We encourage clinicians to evaluate the ‘do-it-yourself’ approach versus creating partnerships where specialists come into the GP’s practice.”

Levin confirms that if a practitioner offers services before they can be performed competently and effectively, the workflow in the practice could really suffer. “Adding specialty services can create a more chaotic practice, because now you have GPs trying to master more and more procedures and complete them throughout the day,” he says. “The more variation in procedures you have, typically the less efficient you are in your process.”

Seay explains that she decided to focus chiefly on restorative care for a variety of reasons. She doesn’t offer certain services, such as endodontics and oral surgery, because she just doesn’t enjoy them that much. After spending years refining her restorative skills and learning to be a better business owner, Seay says that mastering another discipline was something she just wasn’t ready to take on.

“Specialists have spent many years going to school to learn how to perform their specialty at a high standard, and I respect that,” she says. “That is not to say that a general dentist could not perform the same quality, but I would want to do some serious training and schooling before I decide to do anything else.”

Case Complications

Despite the name, Super GPs are not infallible. Problems will likely occur at some point when incorporating new services, and it is wise for practitioners to plan accordingly.

Case selection is key—just because a GP can offer a procedure doesn’t mean he or she has to. Levin says that general dentists need to become experts at recognizing which cases they can take and which they need to refer immediately. Failure to do so can be disastrous.

“There are certain implant or endodontic cases that are easier than others, and as a general dentist, you don’t always know when you get involved if that case is going to turn into a more complex case,” he explains. “It may well end up in the specialty office anyway, but the patient has gone through a lot to get there.”

Along with mastering careful case selection, general dentists must not eschew interdisciplinary care, Levin says. It is important to maintain existing relationships with specialists, even after you have achieved a high level of comfort and skill with a new procedure or offering.

Although his office does a lot of specialty procedures, Sesemann says his practice highly values its relationships with specialists in the community, especially because patients are sometimes best treated by a specialist or interdisciplinary team.

“My obligation is making sure that I direct our patients where they can obtain optimal care,” he says. “If GP dentists are placing patients on their schedule, they need to be confident they can provide the same type of care for that procedure as the patient could obtain at a specialist’s office. If that assurance cannot be given, it is better to refer the patient for treatment to one of our talented specialist colleagues.”

The Turf Wars

This leads us to the elephant in the room—the friction that exists between GPs and specialists. One argument against the Super GP is that a general practitioner cannot provide the same standard of care as a specialist. Although that may have been true decades ago, John Kois, DMD, MSD, director of the Kois Center and a prosthodontist in Seattle, Washington, says that two trends are changing the game.

“First, technological innovation has simplified many of the restorative, surgical, and orthodontic skills required to provide successful treatment outcomes,” he says. “Second, many of these newer technologies have not been incorporated into graduate specialty programs so the ‘playing field’ has been equalized because many specialists learn about them after their specialty training anyway. In fact, many young specialists do not always have more experience or expertise than seasoned general practitioners regarding these newer procedures.”

Mirroring Sesemann’s sentiment, Kois notes that patient protection requires that the same standard of excellence be applied to all procedures, regardless of whether they are provided by a general dentist or a specialist. But technology is making it so that the label of “specialist” or “GP” is not as significant as the education and training behind the title.

“In the future, the most expert or qualified clinician may not always be the person with recognized specialty training, but the one dedicated to continuous learning,” Kois says.

In addition to the question of competency, there is little doubt that some specialists will see the Super GP trend as a threat to their livelihoods, a view that Malcmacher thinks is shortsighted.

“General dentists already perform over 90% of the endodontics in the US, and endodontists are busier than ever,” he explains. “Why? Because the more general dentists are trained, the more they recognize cases that need endo and refer. The exact same scenario is happening in orthodontics now. We will see the same thing in implants as well. Dental specialists need to get on board with the Super GP concept—they will thrive more than ever.”

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