What’s the Confusion?
Dental professionals need clarity on how we define the various types of dental practices that exist today. To understand and do business with a myriad of practices, we must recognize the specificity and management orientation of these entities.
The delivery of dental care varies according to geography, socioeconomics, government subsidy, insurance and focus. Likewise, collaborating or doing business with these entities will require customization and a broad range of products and services. The following is a list of practice types which are based upon my twenty three years’ of experience in distribution and a decade in practice management.
- Solo practice – One doctor, one location and one or two full time hygienists.
- Partnership – Two or more doctors who share costs, profits and exposure. These offices tend to have between two and four hygienists in one location.
- Multi-specialty practice – Generally, one dentist or a small partnership which employs associates and dental specialists. These facilities operate similarly to the solo and partnership business model but they offer a larger menu of services.
- Specialty Practice – Generally one to two specialists serving a referral base in a geographical area with one facility. The most common specialists today are: Endodontists, Oral Surgeons, Orthodontists, Pedodontists, and Periodontists.
- Specialty Group Practice – This business model is gaining traction. The costs associated with operations, management, human resources, human capital and technology are significantly reduced when multiple doctors share the facility and operational costs. Enhanced exposure, accessibility and expansion are some of the windfalls when these entities join forces in a geographical area. Today, most of these groups specialize in one dental discipline like endodontics. However, I believe multiple specialties; under one roof will be in vogue.
- Independent Group practice – Most dental professionals classify a group practice based on how many doctors are employed at that location (3 or more). When I hear Group Practice I think of a business with multiple locations. These independent groups are generally owned by entrepreneurial dentists and are on a trajectory towards an MSO structure.
- Large Group Practices (LGP): This is one of the fastest growing segments in dentistry, and changes the definition of Group Practice, as it is a Group of Practices (and can include Independent Group Practices). However, these regional group power houses can have self-imposed limits. The road to accelerated expansion requires venture capital or private equity money infusion. That in turn, requires a corporate organizational platform which affects owner autonomy. That’s when these overachievers and dental entrepreneurs think twice about relinquishing control. They can’t imagine working for someone else that holds the purse strings. While some may curb their growth, many LGPs are primed for expansion or acquisition and they have the infrastructure to manage it.
- Dental Support Organizations (DSO) – These organizations are enjoying significant growth and expansion all across America. They have created various platforms that are profitable, scalable and replicable. These organizations benefit from centralizing and outsourcing certain processes. They are accomplished marketers that focus on clinical and operational efficiency. Powered by venture capital money and an abundance of unemployed, in debt recent dental school graduates and older dentist looking to extend their work life after selling their practice. They offer fair compensation packages that resonate with young and close to retirement age doctors. I believe DSOs, (AKA as Corporate Dentistry) are here to stay but I believe the groups will dominate in the end.
- CHC – FQHC – Community Health Centers or Federally Qualified Health Centers – In recent years the growth of health centers has been enormous. The Affordable Care Act has had much to do with the growth and expansion of health centers around the U.S.A.
- Institutional facilities – Traditionally classified as Dental Schools, Municipalities, Hospital, Prisons and The Military.
According to the ADA, over 17% of all dentists in the USA work in Group practices!
My Latest Business Trip
Sixteen dental professionals came together for a business trip to Oregon that turned into an experience of a lifetime. The main characters of this traincation [Training/Vacation] were from Canada and the US. There were sixteen sales reps and several trainers and product managers. During this week of intensive training, all of the attendees experienced what it’s like to spend a day in the life and times of a dentist. The journey started at Adec’s world headquarters in Newburgh, Oregon and included a day of virtual dentistry at OHSU.
In addition to lecture and hands-on training, Adec sponsored a day of dentistry at OHSU. They wanted us to experience what our dental clients experience every day. We wore gloves, masks, goggles and gowns which clearly impacted comfort, vision and motion. We used the same instrumentation and dental materials our clients use in their facilities. We performed dentistry on simulators and were required to isolate our preps with a rubber dam. Our view into the oral cavity was limited to that which was reflected onto a #5, front surface mirror and our dental director insisted on proper seating and ergonomics.
Aside from the sweaty hands and face, the constant neck bending and body twisting took its toll on me. I have a new found appreciation for the complexity and difficulty of delivering modern dentistry. Because of this experience I have become a huge advocate of ergonomics. I now understand how the repetitive motion and discomfort can lead to poor posture and chronic back issues. It was truly a humbling experience and I did not have to deal with the gagging responses or tongue issues that dentists deal with every dayJ. In the end, my amalgam prep with under cuts, and my partner’s composite restoration did not warrant the usual and customary fee but we were proud of our accomplishment!
Special thanks to the dental team at OHSU for a memorable experience. The Oregon Health & Science School of Dentistry has 132 operatories of brand new Adec equipment and the campus is quite magnificent.
“I give Painless Injections”
Sturdy, Elegant, Comfortable & Lasts for 25 Years
I grew up when cars were made of mostly metal components and household appliances were built to last. Today, many of the devices we buy are manufactured to perform better, faster and more efficiently but they don’t seem to last as long. This is true for televisions, washing machines, steam sterilizers and even operatory equipment.
When I started in this business, the economics for private dentistry was quite different. There were more Fee for Service dental offices and cash was king. Twenty five years later, things have changed quite a bit. The economic tsunami of 2008, the infiltration of PPO insurance and the digital work flow have changed the landscape forever.
Since 2008 I have been writing about the need for speed, cost savings, competency and accountability. Yet the race for speed, efficiency and cost savings can have its limitations. You eventually get to a point where you have mastered the clinical, optimized the operational and controlled the spending. In the end, you have to pay attention to key performance/production indicators if you want a thriving and profitable business. All activities in the work place must be deliberate, purposeful and measurable. Everyone must execute and we must embrace new techniques and systems to keep up.
Likewise, depending upon your vision and business model, a long term approach to equipment/technology costs makes sense. Quality, durability and ergonomics matter. The remorse of purchasing cheap equipment that does not meet your expectations will linger for years but the right equipment will improve work flow and deliver benefits day in and day out. Of course, certain projects or time tables require you to manage costs so equipment selection can be a rather daunting task.
Recently, one of my clients bought equipment directly from a Chinese importer. The product looked good and was inexpensive (50% less) so she was intrigued. Last week I had one of his associates call me to arrange a service call to have one of my techs adjust the exposure times on the new X-ray units. It turns out that the new X-ray units must recharge after each exposure which increased the FMX time by over fifteen minutes per patient. In addition, the associate showed me how the new chairs were slower to position, did not have an articulating headrest and the evacuation tubing was kinking due to it being so thin.
Yesterday I received a call from my best tech while he was at the office. He said, “I can’t fix this equipment and we don’t have access to order replacement parts – why did you let the doctor order this stuff?”
If you want to buy equipment with the lowest cost, buy the best. Do not confuse price with cost. The price may be low (real low) but the cost of ownership may be too high. If the office stops taking FMX’s and doctors are having unnecessary fatigue and aggravation from subpar equipment, then the cost of saving was too high. Lost production and unreliable equipment can negatively impact your office and turn off a productive associate.
If you want beautifully engineered equipment that looks great and lasts for twenty five plus years, then go ADEC. The cost of ownership is the lowest of any other dental manufacturer on the market.