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Specialized Steps to Success
By Ellen Meyer, MBA
Years of education prepare a dentist for the clinical aspects of dentistry. Graduates emerge with expectations of a career that is rewarding both professionally and financially. Yet many struggle when faced with the realities of growing their practice in today’s competitive environment. Inside Dentistry examines some of the different ways dentists can achieve growth in this changing professional world.
Every practice is different and dentists vary greatly in terms of their scope of practice, use of technology, and relationship with colleagues and laboratories. It is now common for general practitioners to perform root canals, place implants, and render services previously restricted to specialists.
Leonard Hess, DDS, a Monroe, North Carolina, general practitioner who is also a senior faculty member of the Dawson Academy, explains. “There is always the question of how many specialty-type procedures—such as implants, orthodontics, extractions, and surgery—general dentists should perform in their practice.”
Hess, who himself performs soft-tissue procedures in his general restorative practice, observes that clinicians have the freedom to pursue advanced training in procedures they enjoy and that have a high need in their practices. “One of the benefits of being a general dentist is the ability to help patients with a wide variety of concerns, and many patients enjoy being able to keep their care under one office and doctor.” However, he points out, it is important that clinicians be able to provide any such advanced procedures at the level of a specialist, lest they compromise patient care, and should therefore first complete credentialed training in the procedure they wish to perform.
Nonetheless, he says, those delivering advanced procedures should “stay within their comfort zone” and situations in which “the outcome may become less than ideal.” Therefore, he says, “When clinical conditions exist which statistically lead to a higher risk of complication or a compromised outcome, a specialist referral should be considered.”
Denver general practitioner Gary Radz, DDS, “stumbled” into a growing area of his practice, sleep dentistry, nearly 10 years ago, based on his own need, not that of his patients. “I had severe sleep apnea and was CPAP intolerant,” he reveals. After searching for solutions to his own problem, he ended up creating his own oral sleep appliance with excellent success. Upon seeing the huge change this made in his life, he sought formal education in this area, which is more readily available through courses around the country today than it was nearly 10 years ago. But it wasn’t until he had completed 30 to 40 hours of coursework offered through Sleep Group Solutions (SGS), the Academy of Dental Sleep Medicine (ADSM), and the Academy of Clinical Sleep Disorders Disciplines (ACSDD) that he began offering treatment for people that suffer with sleep apnea and snoring.
Radz says the clinical techniques involved in creating appliances differ slightly from those required for restorations, but they can be easily mastered by restorative dentists. “What you need to do chairside to create the appliance that treats sleep apnea is just a slight expansion of our education; the formal educational needs involve learning anatomy, physiology, and science of sleep that goes into the issues of sleep apnea.”
Radz notes that sleep apnea—which remains undiagnosed in 90% of sufferers—must first be diagnosed by a physician based on a sleep study; a dentist cannot create the device without a prescription from a physician. “It is important to know that we need to be partnering with our physician colleagues to properly and ethically help our patients with sleep-related issues,” he explains.
Sleep dentistry now represents a significant part of his practice and has not required the purchase of any additional equipment. “There are some devices that people believe can assist in making a more accurate appliance; but as in other areas of dentistry, we each research to find the materials and tools that can help us improve.”
It was “by happenstance” that Dennis Fasbinder, DDS, fell into what has become an all-encompassing area of dentistry more than 25 years ago. He was just beginning his career at the University of Michigan, where he is now clinical professor of dentistry and director of digital dentistry in the Department of Cariology, Restorative Sciences and Endodontics at the University of Michigan School of Dentistry, when CAD/CAM digital dentistry first emerged in the US market. “It was a nice match for me. It was an interesting and unique kind of dentistry that offered new materials and new techniques, but it was totally unknown whether it would be successful. This blended well with both my clinical interests and academic focus.”
Looking back, he says, “It turned out to be a career-changing decision for me, like being in on the ground floor of Apple,” and became the focus of his career, including the core part of his research and a major component of the University of Michigan graduate program in restorative dentistry.
Fasbinder, who has always had a part-time private practice in addition to his academic position, stresses the value of digital dentistry to both patients and doctors. “Consider the value to a patient when getting a crown offering excellent longevity with esthetic and high-strength materials in one appointment, without the need to miss another day of work or arrange childcare. Being able to offer procedures that have grown out of a digital platform—be it a natural tooth, implant, immediate veneers, and same-day dentistry—can be a difference maker to a private practitioner.”
Fasbinder says perceived barriers to private practice implementation of digital dentistry, including digital impressions and CAD/CAM restorations, should be considered within the context of today’s environment. “There really isn’t anything inexpensive in a dental practice; just consider the cost of digital radiography in general. If we really wanted to save money, we’d go back to cheaper methods, like dip tanks, that are time- and labor-intensive. But the value of digital radiography to the practice makes it worth the investment.”
“Rather than consider the cost of digital dentistry as a barrier, it needs to be recognized as a way to invest in dentistry now. A better question now is how much does the doctor want to leverage it in practice.”
Multiple Practice Opportunities and Advantages
Both Franklin Shull, DMD, and Brian Wilk, DDS, who are owners of relatively small group practices, take somewhat different approaches to managing their practices, which are nonetheless thriving.
The owner of three practice locations, Wilk is likely part of the fraction of dentists who are capable of successfully implementing a growth plan alone, although he doesn’t have a business background or use a consultant. What he does seem to have is a firm grasp of patient-care concepts and the link between efficiency and profitability. “The key to having one or 100 practices is to be efficient and organized. I try to be efficient in everything I do, and focus on patient care starting at the front desk.”
Wilk, who has begun adding specialists to his practices in Chalfont, North Wales, and Jenkintown, Pennsylvania, believes that in 10 years, every successful group practice will have every specialty. “It is most efficient to offer multiple specialties in a single location. An office that keeps an endodontist and periodontist busy using the same CBCT is more efficient, and also patients appreciate quality one-stop care.”
At the Chalfont office of Highpoint Dental Medicine where he himself practices on a strictly fee-for-service basis, his staff includes a pediatric dentist and an endodontist; he plans to add an orthodontist to complement pediatric and adult dental services; he refers periodontal work to his colleague Barry Levin, DMD.
To offer patients high-quality dentistry who have PPO insurance, he opened the “sister office” in nearby North Wales, but mentions that the Jenkintown office he purchased also accepts insurance and has a periodontist once a week to handle the periodontal care for both the Jenkintown and North Wales offices; there are plans to add an endodontist for root canals in the near future.
Wilk says many solo specialists—especially endodontists— struggle in the current dental environment, and that it makes economic sense for them to rotate among several practices or be based in a large group practice rather than take on the debt of starting a specialty practice with high overhead, staff, and equipment purchase costs.
He says he is actively looking for specialists, but prefers to proceed slowly and methodically. “For a successful practice, you must have the right people and train them in the philosophy of comprehensive care.”
To maintain patient-care standards at all three locations, he says, he has all employees spend time in the offices that are not their “home turf” to help standardize procedures across all offices. “Things change, so standardized training is important.”
At Palmetto Dental Associates, Shull has taken various approaches to growing his practices in Lexington and Columbia, South Carolina, including improving efficiency through the use of digital technology and purchasing and expanding practices. Between the two offices, there is a total of four dentists—all general practitioners like himself—five full-time hygienists, and six dental assistants.
He says he has CBCT mainly as a diagnostic tool and uses intraoral scanning for indirect restorations, including full-mouth reconstruction cases. He works very closely with his ceramist, who also uses a digital workflow.
However, he says, because the greatest sources of referrals are patients and specialists, his practice remains squarely in the realm of restorative and elective dentistry, and he opts not to perform procedures unless they can be done at the level of a specialist. “For us, a referral-based practice has been a niche that has worked for us and the addition of digital technology makes it easier.”
Shull says he nurtures the relationships with the referring doctors to remind them how much they are appreciated. “Referrals should go both ways; if we each do what we do best, great things happen. We have after-work drop-ins for specialists and their staff to share a little wine and cheese and to make sure our staff knows theirs. We also make sure we share photographs of before-and-after shots of the patients we share.”
He says there are buying advantages to be had with multiple-dentist practices such as his compared to solo practices due to the increased volume they offer. “From staffing, to buying supplies in bulk, to making arrangements with laboratories—labs and suppliers can and do offer cost advantages to larger practices.”
It is apparent that achieving practice growth requires a combination of self-knowledge plus business and professional skills that may not come naturally to all dentists. Whether they use their “gut” or a proven system, their success is rooted in understanding their patients’ needs and desires and how they can best meet them, including by providing new services themselves or referring to their colleagues. Then, too, to maximize profitability, clinicians must maximize efficiency, and be ever mindful that dentistry is a business that, like all businesses, depends on customer satisfaction, and growth requires that its customers—ie, patients—be meaningfully educated about the benefits of the practice and the recommended treatments.
Get Good Advice
Practice management consultants can be an excellent resource
Many practitioners seeking to jump-start a young practice or press the reset button on a stalled or stagnant one turn to practice management experts such as dentist-turned-practice-management guru Roger Levin, dental marketing expert Naomi Cooper, or Jay Geier, founder of the Scheduling Institute.
Levin, CEO of Levin Group, Inc., in Owings Mills, Maryland, says that by following a recommended system that takes into consideration the uniqueness of the individual dentist’s practice, three things happen: (1) the staff is trained; (2) practice production and profitability increase; and (3) the patient experience improves.
“It’s much easier to train people if you give them a simple system—including scripts—to follow,” Levin advises. These systems, he says, are designed to minimize stress and enhance the patient experience. “The higher the stress, the lower the efficiency. With low stress, you receive the benefit of efficiency, production, and profitability; and placing patient customer service at the forefront to give them that WOW experience plays well as you move into your internal marketing program.”
Cooper, CEO of Doctor Distillery, a dental marketing agency in Santa Monica, California, believes that the focus should be on developing the right marketing tools. She says the starting point for a plan to succeed is creating a strategy and backing it up with a budget and a clear plan for implementation. This marketing strategy is different for every doctor, depending upon his or her unique circumstances and objectives.
“Is it a scratch practice, or is it a mature practice that is changing—perhaps with the addition of an associate or a new satellite office? Where is it—a big city or a small town? What’s the clientele? By how much does the dentist want to grow the practice—10% or 100%? How many more years does the dentist intend to continue practicing?” She says that 80% of dentists know that marketing isn’t their top priority, which is why they should hire an expert to help with marketing planning and implementation.
Geier, founder of the Scheduling Institute, says even dentists in the early stages of their career need to understand that how they build the value of their practice with new patients today can have everything to do with how profitably they can sell it tomorrow.
He suggests having the business appraised at least 5 years before you plan to sell it and then spending those 5 years raising its value. “The best investment in your practice is to raise its value prior to selling it. You need to know what it’s worth, and then sell it high.”
Geier stresses the importance of investing in the patient experience at every stage of practice and, therefore, keeping the office clean, fresh, and up-to-date on a regular basis, not just prior to selling it.
“You want to make your practice as attractive as possible to potential buyers, but it is not a good idea to spend a lot of money on something that doesn’t provide a solid return—including expensive equipment—especially in the short term.”