Practice Management

Specialty and General Practices: A Changing Interface


Ron Weintraub


November 19, 2014

November 19, 2014

Years ago when I graduated from dental school, the distinction between the general dentist population, which was by far the larger grouping, and the certified specialists were very well defined. In contrast to those in smaller communities and rural settings, practices in larger urban centres had the luxury of having a number of specialists in various areas of treatment available for patient referrals. The changing interface between specialty and general practices requires examination.

Formerly, we enjoyed the skills of those in the following designations using current nomenclature:

  • Dental Anesthesia
  • Endodontics
  • Oral And Maxillary Facial Radiology
  • Oral And Maxillary Facial Surgeon
  • Oral Medicine
  • Oral Pathologist
  • Orthodontics and Dental Facial Orthopedics
  • Pediatric Dentistry
  • Periodontics
  • Prosthodontics

Today, all these areas of practice fall into the range of general practitioners provided they have acquired adequate training to deliver an acceptable result to the public. Those of us who chose to practice in close proximity to trained specialists had the luxury of deciding whether to refer patients to a colleague. We would assess the degree of difficulty, as well as our personal skill set, and, keeping the best interest of patients paramount, decide if we would transfer them to a colleague with specialized training who would be totally focused on remediating the diagnosed condition.

Colleagues who chose to practice away from urban centres were faced with the necessity of providing many different specialty-type procedures in-house. If they felt confident, they offered patients these services, sometimes on an emergency basis. This provided a benefit to the extensive community they served. They developed skills in many areas that superseded those of many of us who were urban general practitioners. In contrast, we depended heavily on solving problems by referring patients to a certified specialist of their choice. Specialists reported their findings to the referring dentists to keep them “in the loop.” This model has continued for many decades and, to a lesser extent, does so now. Recently, however, a significant shift in referral decisions of the general practitioner population has become evident.


Many factors predispose the changes to more sophisticated treatment afforded in-house by general practitioners and/or certified specialists who are part of the office provider team. Among them are the following:

Continuing Education

  • The availability of continuing education provided by specialists in designated areas who are willing to share their knowledge and expertise via lectures and hands-on courses;
  • The availability of study clubs for generalists and specialists to discuss the techniques falling into the skill set of general practitioners with an interest in carrying a phase of dentistry to a higher level;
  • The proliferation of treatment education sources available online for general practitioners that give them confidence to understand and deliver enhanced treatment.

Changing Practices

  • The growth of numbers of general practitioners who wish to confine their practices to areas previously thought to be the domain of the certified specialist and who are prepared to allocate scheduled time to provide these services in-house for other general practitioners; and
  • An upsurge for larger group practices that allow general practitioners to focus on specific areas of need within their own practices, therefore reducing the number of referrals to specialty offices.

Economic Realities

  • The negative effect of the dental economic system and the growing numbers of conventional general practitioner practices play a significant role in the change. Previously, general practitioner schedules were almost always full to the point that taking on an extensive periodontal case would not have been feasible; today, this is often not the reality.


Undeniably, practitioners require extensive training beyond the basic DDS or DMD designation. They provide the indispensable, wide-ranging expertise that only fully trained specialists can bring to the treatment options posed by a more sophisticated biological approach to health care issues in the head and neck region with which dentistry deals. Our patients appreciate a proper referral to “competent experts” in the areas previously delineated. A successful specialist intervention results in goodwill reflected to the general practitioner who initially referred the case.

Conversely, when the flawed philosophy I will try it myself and if the case is not successful, I will refer it to a specialist, is employed, an ethical disservice to patients causing undue discomfort and financial burden results. The consequence of this faulty thinking is often the loss to the practice of patient families. It also jeopardizes a good relationship between the GP and the specialist confrere. Certified specialists resent playing a role to remediate inadequately provided treatment. They understand that given the opportunity, they could have produced a far better, more stable result had they been allowed to intervene at the outset.

A follow up article will deal extensively with thoughts on how we can remediate this growing difficulty in a creative and professional manner for the benefit of the public and the profession as we safeguard our professional integrity and discharge our responsibility to our patients.

By: Dr. Ron Weintraub

Ron Weintraub is a founding partner with the Bayview Village & Downtown Dental Associates and brings over thirty-five years of knowledge and experience in the practice of general dentistry to the Professional Advisory. Large companies such as Patterson Dental, Ash Temple Ltd, Henry Schein Arcona, & the former Canadian Dental Co. have benefited from his insight. As owner of Innovative Practice Solutions, Ron advises dentists on practice enhancement, practice purchases, sales, location evaluations, associate buy-ins, and business mergers. Dr. Weintraub can be contacted at (905) 470-6222 Ext. 221 or