by John Weston, DDS
Accredited Fellow, AACD
For more on this topic, go to www.dentaleconomics.com and search using the following key words: multispecialty practice, diversification, specialists, staffing, Dr. John Weston.
Most dentists practice alone. In fact, the traditional model of dental practice is a single practitioner with a small staff in a stand-alone office. While there are advantages to this model, practitioners might be wise to consider other options. Group practices, for example, provide shared overhead, clinical coverage, and stability a solo practice does not offer. I like this model but would suggest an exciting and potentially more rewarding concept — the “multispecialty practice.”
This article will review the basic concepts that I believe have helped me build one of the most successful multispecialty, fee-for-service practices in the country. We have gathered certified specialists in every phase of adult dentistry at one location. This concept has helped keep our practice strong, financially healthy, and uniquely competitive.
Like investing in the stock market, diversification in a dental practice is one key to success. Most dentists refer to specialists for procedures they do not like or which prove too complicated.
We have taken this philosophy a step further by bringing skilled specialists directly into our practice. As a result, we increased the ability to treat patients, and allowed more time for me to do the cosmetic and elective procedures I enjoy most.
General dentists are referring less often. We may see this trend accelerate during an economic recession. As a result, some specialists may be significantly less busy. You might also be surprised to find they would be open to the idea of a satellite office — a sort of “second home” in which they are valued for their skills, and would appreciate the opportunity to serve patients in an environment where quality is the focus.
At our practice, in-house specialists see patients without worrying about scheduling, supplies, staff, collections, recall, or any of the other systems required to treat patients in their office.
The tangible is the paycheck, but a significant intangible is the professional stimulation between colleagues. Our doctors find it rewarding to be part of a team. There is a completeness of care by having the records, referring doctor, and treating specialists all in one location. I will often visit the specialty care area during my patients' surgeries to confirm placement of implants and other details.
Patients appreciate this, the specialists enjoy the interaction, and I learn something every time. Often, we will sedate a patient and complete all of the patient's specialty or restorative needs in one visit. I can supervise the entire effort, which is extremely rewarding.
How to begin
Finding providers who match your style and philosophy is important. Start by looking for quality-conscious doctors who are not in your immediate referral area. During the introduction call, I ask if they would consider working one day a week with us where quality is the No. 1 focus. Through the years, we have staffed our specialist positions with those who already own a practice and are excited about the opportunity to work one day a week with us. I emphasize our goal of providing a high-quality, low-stress environment.
My advice is for offices to start small. Look at areas in your practice in which you are referring out a lot of treatment, and start by hiring a specialist to support that need. This does not mean you have to bring every procedure in-house. It may be good to continue some referrals to local specialists, thus maintaining those relationships.
Periodontics and oral surgery are good specialties with which to start. In the beginning, I ask the doctor to bring any specialized instruments or equipment beyond the basics. As things progress, I do not hesitate to purchase the proper instruments and supplies for a specialist. The investment quickly pays off and the doctor is happier knowing he or she has the best.
Our oral surgeon and periodontist have been with us for more than 10 years and have no plans to leave. The endodontic and orthodontic positions tend to rotate every few years. We currently have an excellent prosthodontist one day per week who plans to stay indefinitely. When specialists do leave, they usually help us find replacements, and they have a good knowledge of other specialists in the area. In one case, we actually contract directly with a group practice and not the doctor. This ensures our specialty coverage will not be interrupted.
Staffing and scheduling
The goal is to fill chairs during operating hours. You are paying the overhead whether you have a patient in the chair or not. Adding a specialist one day per week is ideal but you may need to start with half days until the demand rises. When we hire a new specialist, we know in advance what days we are looking to fill, and this becomes part of the signed agreement. The team also understands the importance of having full chairs every day.
As an example, Friday was once a quiet day in my office. Now we have at least one or two periodontists, a prosthodontist, and a general dentist, as well as two to three hygienists. Friday has now become a very productive day — all without my being there. A key factor is balancing scheduling with demand. A day when the main producer is out of the office is a perfect day to add a provider. We also always open up extra days to our specialists when others are on vacation.
Most patients who see our specialists are referred from within the practice. It is amazing how complete treatment planning becomes when it stays in the practice. We still get referrals directly from other GPs, and encourage this. When this happens, we are essentially acting as a specialty practice. It is extremely important to make sure the patient gets back to the referring doctor so we don't lose the referral source.
Our specialists are all contract 1099 employees and the IRS requires they meet 21 criteria to be independent contractors. Most of these are self-fulfilling, if they have a primary practice location and satellite with you a day per week. Your tax attorney can make sure you are in compliance. We use standard “at will” employee contracts that allow either party to terminate with proper notice if things are not working out. All pay is based on a percent of collections, not production.
From my perspective, this is the best way to properly compensate providers. Production is easier to track but is not real money until it is collected. You want your providers engaged in the process and completing treatment that is agreed upon by patients who will pay their bills. Collections are real money — the stuff with which you pay your bills.
Compensation for restorative providers can run anywhere from 30% to 36% plus a 50% lab bill. Connecting a doctor to lab bills is important because they are conscious of remakes and quality issues. Compensation for endo, ortho, perio, and OS can run anywhere from 45% to 50%.
Just make sure implant and grafting procedures are priced properly to ensure accurate profit margins. Start on the lower end of the percentages so you have room to absorb initial costs and reward good providers.
A key factor for our success has been a focus on quality. From the first phone call and front-office experience to every point of contact throughout the practice, we focus on an amazing customer experience. We call these encounters “moments of truth.” Patients show up for appointments and pay bills when they feel a practice takes care of them. In addition, offering specialty care within your office goes along with a “patient-centered” focus and can add incredible value.
The office should never appear stressed, overworked, or understaffed. The expression “never let them see you sweat” goes a long way, and takes proper training. Attitude is not everything but almost. We hire team members based on attitude, and train them to our product. Never let a big resume fool you into hiring someone who does not seem right.
The goal in this competitive market is to stand out, find a niche, or distinguish your practice in some way. What causes a patient to drive past 25 other dental offices to visit yours? In our situation, we are the only fee-for-service, multispecialty practice in our city. We have a local, national, and international clientele which travels to our practice for high-quality care and a “one-stop” philosophy.
Simply stated, we provide top quality multidisciplinary care quickly and conveniently. The benefits and improvement in care for our patients far outweigh any challenges we faced in making this happen. Our ability to offer state-of-the-art care by certified specialists in one location is a successful model that, when properly implemented, could also help your practice stand out as unique.
Dr. John Weston, a Fellow in the American Academy of Cosmetic Dentistry, is director of Scripps Center for Dental Care, a unique multispecialty center located on the Scripps Memorial Hospital Campus, La Jolla, Calif. He writes and lectures nationally and internationally about cosmetic dental procedures. Reach Dr. Weston at [email protected].