Practice Management

Dental Practice at a Cross-Roads


Ron Weintraub


October 21, 2020

October 21, 2020

Where do our dental practices stand in 2020? With the unexpected advent of Covid-19 in an already rapidly changing dental environment, conventional practice modes seem outdated as we realize that we are unprepared for inevitable changes. We need to take stock of our present operation and devise strategies for success moving forward. Although the impact of the pandemic on the provision of healthcare, in general, is uncertain at this early stage, it is clear that our profession must perform a self-examination using the same format of a classic exam: diagnosis and treatment plan. As one of the most effective components of our healthcare system, it would benefit dental professionals to re-evaluate our functionality.

Overview of Dental Clinics’ Position
Practitioners were already reacting to a loss of autonomy brought about by a surplus of providers vis-à-vis patients seeking care. The shock of the pandemic compounds the need for us to re-examine the viability of the functional dental facility and track the effects based on the following:
• Physical environment;
• Administrative functions;
• Clinical provision of safe services; and
• Management of patient concerns regarding Covid-19when presenting for treatment.

In an effort to maintain an adequate recall system to retain our gains in preventive dentistry, a thorough review of the administrative, clinical, and re-care departments is required.

Administrative Strategies
Organized dentistry has made a credible effort in implementing initiatives to keep patients and the team safe. Currently, providing minimum standards to ensure the practice environment is non-infectious is the general guideline. However, under the new “normal”, changes to the physical plant are mandated by the Ontario Dental Association (ODA) and Royal College of Dental Surgeons (RCDS), among others, as prerequisites for treating patients. Protocols including advice regarding appropriate personal protective equipment (PPE), masks, and social distancing have also been provided to our teams.

Clinical Department Strategies
While escorting patients into the treatment area, team members should point out the changes made to the physical plant they see as well as changes and upgrades to equipment which ensures that their environment is as safe as possible and beyond minimum standards. It may, therefore, take a little more time and focus to achieve the prescribed goals.
During the procedure, the clinical team should also take the opportunity to point out the adjustments made to previous techniques and the operatories to minimize aerosol infections. These strategies are included to fulfill our professional responsibilities to provide a safe environment as we perform necessary oral health procedures. Even though the pandemic effect is mostly unpredictable, we cannot ignore the possibility that dental practice that may never return to its previous state.

Recare Strategies
Most importantly, we need to communicate to our patients the steps we have taken to prevent the spread of Covid-19 and to create a safe and sterile environment. We need to share our plans with them to help maintain their safety. The guidelines we propose include strict adherence to appointment times as well as protocols which discourage group waiting for appointments. Patients are also encouraged to call the office to alert staff of their arrival before entering the clinic.
Another strategy to showcase our safe environments is to detail the physical additions we have added to our protocols. For example, this includes welcoming patients to the office and preparing them for the additional use of PPE they will notice when returning to the dental office. Administrative staff will also reassure them by screening for symptoms and taking a brief health and travel history before they enter the clinical environment.
Some of our clients who have been successful in retaining their patient base have summarized the changes and their relevance and then, communicated them by email or over the phone while confirming appointments. In certain situations, the re-care coordinator directly contacted patients to assure them that all steps had been taken to provide a safe environment. Communication with patients is key for their successful return to the office.

The New Reality
In light of the new norm, we need to collectively redefine “dental practice” by taking into account the following:
1) The new protocol takes longer to prepare and deliver to achieve the same amount of factual hands on billable capacity;
2) The capital investment must be retired via possible diminished gross production;
3) Additional staff cost and duties will add to the ongoing operating expenses of a similar size practice as previous;
4) Patients may fear contagion and elect to seek only urgent treatment.

Our profession must perform a selfexamination using the same format of a classic exam: diagnosis and treatment plan.

Not only are we dealing with the state of the delivery of our services, but also we are dealing with the accompanying possibility of recession from the pandemic that could further erode the insurance support covering dental procedures. This could seriously threaten the financial backbone of many practices. Not knowing what future regulatory changes may call for is a concern from a practice profitability perspective.
All of the above suggest that the profession is at crisis point. That the profession, as a whole, should collectively engage in a discussion of how to “reinvent private practice” to continue serving the needs of the public and team while earning a justified living, is realistic. Among the suggestions that resonate is to join forces to provide expanded facilities and share the necessary costly revisions to provide one expanded facility. Rethinking dental office operations could be the urgent task and we must be proactive rather than reactive.