The Super-Solo Group Practice

Sept. 1, 1998
The author discusses a growing practice model that he feels gives dentists the opportunity for success, satisfaction ...and a life!

The author discusses a growing practice model that he feels gives dentists the opportunity for success, satisfaction ...and a life!

Dany Y. Tse, DMD

Depending upon whom you talk to, the kind of dental practice I`m going to describe to you - what I call the super-solo group practice - is either the future of dentistry or the end of the world as we know it!

My ideas for organizing, managing, and enjoying dental practice haven`t made me the most popular dentist in the world. But, they have made me one of the happiest. All I really can tell you is how I came to feel the way I do; a few of the simple, proven truths I`ve come across; and why I think a lot of dentists could be having a more fulfilling, less stressful career.

In dental school, I put enormous pressure on myself. I worked 16-hour days and weekends. I finished my clinical requirements for graduation halfway through my junior year. No one I know had ever done that before. It wasn`t because I`m all that bright - I just worked like crazy!

So, after that, I had a lot of time to spare ... and I didn`t waste it. I made it my goal to spend the time learning everything I could about dental practice. I researched every detail, every challenge, everything that might be coming in the future. I studied the business side, the productivity side, and the satisfaction side of dentistry. I compared specialists and general practitioners.

I met with dozens of people! I picked the brains of insurance-company people, capitation people, and the people who buy coverage for big companies.

And when it was all over, I put together all I had learned.

What did I know about my new profession and industry after all that homework? It was 1979, and it seemed to me that dentists in solo practice were very isolated and - I hope I don`t offend anyone - often slow to accept change. It appeared that most of them really hadn`t thought very deeply about their patients and the changes in market forces that were looming out there.

And it certainly seemed like big changes were coming. It looked like something of a meltdown was on the way for the whole health-care system and the way it was organized. The upheaval that medicine was facing was on the horizon for dentists as well. Nobody seemed interested. For a while, I felt like the only one out in the wilderness. Again, I`m no genius - I just did a lot of legwork!

I went into solo practice anyway, and, from the beginning, I was very successful. Chalk it up to good luck and hard work. My solo practice was in the top one percent in the country for both top-line and bottom-line earnings, according to ADA statistics.

Demand for longer hours The other thing that happened from the beginning was that my patients - my customers - began asking me for longer hours and weekend hours. Dentistry is difficult, stressful work, and I already was giving it my heart for five days a week. I didn`t see how I could work any more.

Then I heard, of all things, that McDonald`s had started serving breakfast. Up went the company stock and up perked my ears. It all made sense: here was my dental office, doing nothing because it was empty for so much of the time. I`m paying rent, I`m paying the bank loan, I`m paying off equipment - and more than half of the time none of it is being used! I could see the problem - and the opportunity.

I made the decision to put the patient - the customer - at the center of my universe. I decided to design some simple systems and find some good people - people who shared my dedication to helping and caring. This way, I could begin to answer all of the patients` needs - not just the need for good care, but also the need for convenience, confidence, and affordability.

So even though I had one of the most successful solo practices anywhere, I began a group practice. It really wasn`t about me - it was about patients and people and all the reasons I became a dentist in the first place.

It was 1981, and we were open from 7 a.m. to 9 p.m., and we also were open on Saturdays. No one else in our area was doing that. We always delivered great care at convenient times for our patients. We served our customers - and no business thrives without serving its customers. We put our customers at the center of everything. It was all simple stuff, but it put us ahead of the field.

We have stayed ahead for a long time now, simply by embracing change and understanding the forces of the marketplace. So while the glimpses I saw of the future have come true and as the pressures I saw for solo practitioners have come to pass, my colleagues and co-workers in our group practice have thrived. The people who joined me in the very beginning have prospered with the practice, and that is very satisfying.

At first, I worried that it would be very hard on us (the dentists in the group). Early hours, late hours, weekend hours. However, it soon became clear that not only was it not hard to work different hours, it was great! It`s great to be on the ski slopes when no one else is there, great to go shopping when no one else is shopping, and great to go away on vacation without even needing to leave your phone number. You can leave with full confidence that everything is under control, that good people - people you trust - are taking care of your patients.

Practice answers needs

Out of those revelations - that you can indeed design a practice that is just what the patient wants and just what the dentist and dental staff want - came the super-solo group practice. As the concept grew and developed, more and more of its tremendous benefits for the patients, doctors, and staff involved - as well as its great ability to answer needs on all sides - became clear. More than clear, they became inspiring.

What do your patients (and from now on, I`m just going to call them what they, of course, are: your customers) want?

How about quality, comfort, security, satisfaction, esthetics, value, respect, affordability, financing, location, state-of-the-art technology, and knowledge? Have I left anything out? If anything else comes to mind, add it to the list.

What does your staff want? Respect, appreciation, security, an opportunity for real ownership, opportunities for career growth, safety, benefits, profit-sharing, teamwork, harmony, interesting and challenging work - again, the list could go on and on.

Achieving quality and harmony Finally, what do you want as a dentist in the community? Let me propose that you want everything the customer wants and everything your staff wants. You want quality, harmony, and long-time retention of your staff. You want financial security. You want a strong sense of improving the oral health of the community and being valued for it. You want autonomy in your treatment choices. And you want a life and a lifestyle that gives you freedom and time with your family.

There are a lot of wants and needs from a lot of different people. Many times, those needs - and even the people themselves - conflict. What are the dangers of those conflicts and the resulting unmet needs? Patients have a choice: They don`t come back. Staff members have a more complex choice: They can look for other positions. You, on the other hand, don`t have much of a choice. It`s your business and your profession - your life and heartbeats are wrapped up in it. You can`t walk away.

For almost two decades, we have been developing and refining the super-solo, group-practice model to answer everyone`s needs and minimize or eliminate all the conflicts. This, to me, is the real definition of success. Success, in my mind - true success - is when everyone involved in the enterprise finds harmony and satisfaction. You know you have achieved this level of success when customers have the finest, most convenient care; when staff members have security and career potential; and when the dentists have freedom, reward, and happiness. The super-solo group practice can bring about this kind of complete, everyone-wins success.

So what exactly is the super-solo group practice and why does it answer so many needs? Well, let me begin by describing the particular bit of magic that is at its core.

Finding the right people

It all begins with finding the right people. Every dentist, and every staff person as well, must have the same philosophy. They must be dedicated to improving oral health and to providing the highest quality care. They should be dedicated to integrity and productivity and to serving the customer as a first priority. They also must be dedicated to the idea of working with colleagues, GPs, and specialists who support each other, but do not dictate to one another.

Finding and putting together the right mix of people isn`t always easy. It takes a combination of knowledge, intuition, and a little bit of luck. But it is like magic - once you find the secret, everything else just seems to follow, including success.

Our super-solo, group-practice model combines the best of the solo practitioner`s world with the best strengths of the group practice ... and it avoids the pitfalls that damaged a lot of the group practices that sprung up in the early 1980s. A lot of those practices had good doctors - doctors with good hearts and strong skills. But far too many times, I saw them bring in business-school people to manage things, and the clinical side began to take a back seat to business considerations. That isn`t what the customer of dental care wants. And, eventually, most of those group practices lost their presence in the market or failed altogether.

Dentists control care

Only one group of people should be in charge of dental-care delivery: dentists! Period. Our practice model makes that a prime directive. Each and every dentist in our group has control over his or her own patients, treatment decisions, and professional future.

So, super-solo group practice means that all of the rewarding and important aspects of solo practice are preserved - enhanced by the power of a large, or super, group of colleagues. The model is effective with 40 dentists in the group or with 4,000 dentists nationwide in the group.

Let`s look again at that list of wants and needs and how the super-solo group answers them:

1) The customer. Customers find a group of skilled providers dedicated to the best in dental care. They also find affordable prices and convenient hours. They can have the same, continuing one-on-one relationship with their "family dentist" that they always enjoyed, and yet when something unusual comes up, they can get an appointment on short notice. They can be referred to excellent specialists and find them across the hall instead of across town.

2) The staff. Staff members find terrific job security, with far more career opportunities, greater management opportunities - even ownership opportunities. These opportunities are seldom possible with a solo or small-group practice. The staff has access to the latest, proven technology; state-of-the-art equipment; and in-house continuing education that would be beyond the means of most solo or small-group practices. They find greater control over their work schedules and more flexibility for time off.

3) The dentist. What does the dentist find in this model? You still call the shots for your patients. You still work in an environment dedicated to quality care with a fee-for-service orientation. But, you also are part of an enterprise that carries a big stick with payers and corporate purchasers. You have far greater freedom to set your hours, take time off without worrying, and concentrate on dentistry rather than the questionable joys of running a small business.

No more isolation

You no longer are isolated. You don`t have to depend solely upon the Friday-night study club and the CDE course two weekends from now to keep up with the amazing changes in techniques and technology. You have the opportunity to share new ideas with colleagues - both GPs and specialists - every day. I call it the "continuous study club" atmosphere. And that rapport carries over into care - a free flow of consultation back and forth between colleagues who are just steps away.

Like your staff, you enjoy the kind of equipment and technology that would add a huge chunk of overhead as a solo practitioner. And speaking of staff, the good people you once might have lost because they wanted more career opportunities or ownership, now stay with you.

The super-solo group model also greatly expands your options for ownership and retirement. You can be involved in day-to-day management of the group, and, when retirement comes, you have many more exit strategies beyond simply selling your solo practice.

Finally, there is growth. The solo practitioner can treat as many patients as he or she can treat in the hours that are available - and that`s how much the practice and its value can grow. Obviously, there is an upper limit. In a super-solo group, the dentist owns a piece of something larger, something powered by the work and integrity of many people, not just one.

Clearly, there always will be a place for the solo practitioner. Even with all the market pressures of consolidation, competition, and cost-containment, certain dedicated, hard-working individuals will survive and thrive.

But there are other options. For the dentist with integrity, energy, a commitment to providing the finest care, and improving the oral health of the community - for a dentist with a desire for greater freedom and a varied, fulfilling lifestyle - the super-solo group practice is one of those options. For me, my more than 200 colleagues in our super-solo group, and the thousands of customers we serve, it has been a rewarding option - and a wonderful 18-year journey!

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