Changing Business Models in Medicine and Dentistry
5 ways to remain proactive in growing your practice
I have been doing a lot of thinking lately about the similarities and differences between the medical and dental professions. We as dentists have been very fortunate to be able to practice with a great deal of independence, with little to no government interference, and the ability to pick and choose insurance participation.
Physicians, on the other hand, have undergone enormous changes in their practice models. My father graduated from medical school in 1954, and practiced in what became known as the “Golden Age” of medicine. He had a general family practice, took no insurances, and treated patients according to their needs, practicing everything from obstetrics to pediatrics to sports medicine. As we all know, those times are long gone.
The Ups and Downs of Modern Health Care
Physicians now live in the age of declining reimbursements from private and government payers, the rise of mid-level providers, and the near impossibility of sustaining a solo practice. Many have decided to sell their practices to corporate entities, such as hospitals or large medical groups. Many have dramatically limited the scope of their practices out of fear of malpractice litigation, or simply the cost of malpractice insurance. This is not to say that physicians cannot have a comfortable lifestyle, but the reality is that their lives have changed significantly and, generally speaking, not for the better.
Now let’s turn back to us, the dentists. From the early part of the last decade, until about 2009 to 2010, we were on an unprecedented roll. All of a sudden, we were the beneficiaries of technological advances, economic prosperity, and a new wave of cosmetic awareness. We became the go-to profession in the eyes of many who wanted to look and feel better, and who could suddenly afford it.
My practice, in a middle-class, somewhat rural area of New Jersey, was nearly overwhelmed by requests for esthetic care. People who wouldn’t even come in for regular hygiene visits were suddenly asking for porcelain veneers. I began to come in on days off to accommodate these patients. Dentists everywhere began building huge, palatial offices, where cost was not a factor. After all, there was an almost unending stream of new, motivated patients knocking down the doors.
Then, as quickly as it appeared, it seemed to fall off the cliff. Discretionary income, due to unlimited home equity, seemed to disappear. “Busyness” became a concern and the buzzword of the day. Holes opened up in schedules that had been packed. Some states began to use midlevel providers in “underutilized” areas. Dentists decided to join insurance plans that they would have never considered. Was this the end of our own Golden Age?
Fortunately, the answer was no, although adjustments were needed by many. Our practice had always had a large “bread and butter” component to it, and the nature of our community had convinced me to belong to a selective group of insurance plans. My practice stopped growing for a couple of years, but actually never dropped by less than 3% to 4%. By 2012, we were not only growing again, but we had our best year ever.
So, how did we pull this off, and what does this have to do with my comments about the differences between medicine and dentistry? I believe that there are 5 important lessons that can be learned by comparing medical and dental practice.
1. Always run your practice like a business. It is easy to forget this basic tenet when things are booming, but we need to keep expenses in check and always be planning for our financial future. Keep your salary at a reasonable level, and continue to save. Keep your office clean, comfortable, and up to date, but it is not necessary to spend extravagantly. Many physicians, practicing within large entities, can get away without business knowledge. We, as small business owners, cannot.
2. Remember that patients can choose their dentist. When my production began to fall off a little, I took the extra time to engage my patients in conversation, strengthen relationships, and plant the seeds for future dentistry. This is the opposite of what happened in medicine. There, appointments were often reduced to just a few minutes, and people’s opinions of their doctors began to suffer. Dentistry is often hard to understand, and creating value for what we do can be challenging. It is critical, however, that value creation becomes part of what we do with each and every patient.
3. Consider insurance. While economic realities have compelled many physicians to accept nearly all insurance plans, dentists have a choice. However, it is important to note that participating in an insurance plan is not a sign of failure. This is a controversial subject, but in my situation, it has worked out very well. We are careful about how we do this, but working with a mix of insurance and non-insurance patients allowed me to maintain profitability without sacrificing quality of care, even during the rough times.
4. Continue to expand the type of services you offer. Even as most physicians have continued to limit the scope of what they do, it is imperative that we take the opposite approach. As the demand for “smile makeover” dentistry has declined, the demand for implants has increased dramatically. As our population ages, advanced restorative care, endodontics, and periodontics become more important to our practices. As opposed to shuttling from one medical doctor to another, being able to keep our patients “in house” is a service to them, as well as a profit center for us.
5. Be aware of the part your team plays in patient satisfaction. How often do you have to repeat your story at the physician’s office? How often do you feel like a stranger when you enter the office? How long do you expect to wait in the reception area? We, as dentists, are much more focused on team building and its role in the ideal patient experience. This cannot be overstated in its value to practice maintenance and growth.
Medicine and dentistry are closely related in their goals of providing health care, yet they are very different in their implementation. We as dentists must continue to be proactive in our approach to delivering the highest quality of care while providing the ultimate in patient satisfaction. As we move forward in times of uncertainty in health care delivery, this is our best strategy in retaining the practice models that we have enjoyed for so long.
About the Author
Marc D. Schlenoff, DDS, FAGD, maintains a general practice in McAfee, New Jersey. He is also an attending dentist at Morristown Memorial Hospital in Morristown, New Jersey, a dental consultant for MDS Solutions, and an instructor at Weill Cornell Medical College and Aesthetic Advantage in New York, New York.