Practice Management

Evolving Dental Practices: A 15-Year Retrospective


Ron Weintraub


June 20, 2016

June 20, 2016

Some routine dental practices have been evolving over the past that are apparent to even casual observers. Many of the changes have been beneficial and others potentially less so. A few of the obvious changes over the last 15 years of the existence of The Professional Advisory listed below deserve our attention.

Changes in the Physical EnvironmentThe future role of the former operator/owner dentist is usually prescribed in the legal Agreement of Purchase and Sale. Questions pertinent to establishing their involvement include the following:

Significant increase in the number and type of dental offices;Proliferation of the large multi-provider practices;On-going changes in the previous relationship between the general practitioner and the supporting certified specialists some of which fall under the beneficial while others fall under the detrimental categories;The shifting to a new team approach to the patient experience of those attending their dental offices; for example, engaging with a treatment coordinator and an administration including greeters, dismissers, and recare coordinators–all with more emphasis than formerly on customer/patient service issues;More welcoming reception areas containing beverage stations to make the patient experience a little friendlier and less stressful;Increased recognition of each team member as an important element in maintaining and servicing the patient base;Acknowledgment of the desirability of having practices located at ground level or store front as opposed to being hidden inside large office facilities;The obligatory website to inform potential patients of the team and the working philosophy of the particular office they are contemplating attending;Increased availability of dental services on evening and weekends when some patients can only present for treatment.

Positive Clinical Operational AdvancesIn addition to administrative changes, there have been a number of positive clinical advances over the last 15 years:

The growing realization by both the public and allied medical community of the importance oral health plays in the general systemic well being of the population. This has resulted in a growing segment of the public who regularly attend dental facilities. The increased focus of dental practices on prevention and biologic intervention as opposed to the preoccupation some of us previously had with the esthetic component of dental service despite its significant importance;Increased availability and use of extramural continuing education studies;Increased ability to replicate an intact dentition by using implant supported prosthesis, where applicable, without having to compromise healthy tooth tissue as much as it had previously with conventional crown and bridge therapy;Heightened use of digital radiography and CAT scanning allowing more benign access to the boney substrate of the areas that we must diagnose and restore;The efficiency of instantaneously transferring information and reports and actual radiographic evidence to other support sources has also been a benefit.

These innovations are only a few of many observable positive directions of which dental offices seem to be taking. In contrast, there are some negative directions I subjectively have observed.Commercialization Of Some Contemporary Dental PracticesChange is a constant in life and dental practice. The challenge is to adapt successfully to the new realities presented without compromising the integrity and positivity of what has been historically perceived as professional practice. Undoubtedly, the landscape has changed; however, the bedrock principles that have underpinned our profession are still viable and productive of success. Ironically, at a time when dental treatment is getting long overdue recognition for the vigorous biologic health discipline that it is, a competing narrative I subjectively call “commercialization” has been accelerating over the past 15 years, such as the following:

The growth of third party ownership putting the office under significant control of office and area managers who may attempt to implement standard operating protocols for managerial control purposes without necessarily focusing on the particular needs of that specific patient base;The inevitable danger of depersonalizing the patient experience by allocating appointments to different providers at successive appointments thereby making a trusting clinical relationship more difficult;The many practitioners who see themselves in a competitive mode rather than seeing other dentists as conferrers;The apparent trend towards advertising and promotion:• Promoting the dental office with large signs and pictures (often the same beautiful people) ostensibly patients of the office seem to place dental offices in the same general perception as spas;• Advertising free exams, free tooth whitening, sometimes prominently in the window, sending a dubious message;• Rewarding existing patient referrers with what seems like an excessively costly thank you token can appear to be seen as bribery; alternatively, donating to referrers’ favorite charity could be greatly appreciated and stimulate as many referrals;The seemingly increasing proclivity of having the hygienist be the principle professional in the new patient experience (NPE) to the detriment of the dentist’s ability to initiate a personal clinical relationship;The attempt to retain the majority of specialist treatments in-house by the generalist, thereby denying some of the benefits that highly trained specialists can offer.

While those of us in the dental profession have much to be proud of, the progress of the past 15 years behooves us to evaluate some of the compromises we may have felt necessary in order to accommodate the seismic changes in patient demographics and expectations.PA