With everything laid out for the group practice development, some of even the most aggressively growth-minded doctors get stopped in their tracks by a fundamental concern: they don’t want to be that practice that upsets their own principles, and colleagues, by making business decisions that work contrary to the treatment of the patients.
The term “corporate practice of dentistry” has taken on a very negative connotation. For quite a number of years, I was one of those people in a corporate office charged with providing management services in a relatively sizable company. I heard about the potential evils of a group practice or MSO involvement in dental and orthodontic practices several times a week. We’ll address that issue a bit later, but for now, we know that few people want to be tagged as the owner of a “patient mill” or that guy who will put braces on a patient with 9 teeth. Heck, even a body as august as the U.S. Senate has broadly painted “corporate operations” as ones that place “profits above patients.” And if you can’t trust the government, who can you trust?
For a group practice, we should examine some more practical examples. And no, this is not some kind of ethics class. I’ll leave that to the experts in the field. Rather, this is an attempt to show you some of the common problems and decision making you will see as you go through this group practice process.
Let’s say that you have 5 offices in the same advertising market. Every office is covered under one marketing plan and things are going very well in terms of attracting consultations. In 4 of those offices, your numbers show that 10% of all patients that show up for a consultation do not need any kind of treatment. In that 5th office, you see that 40% of all such patients do not need treatment. As a result, the office is barely paying its bills. What gives? Perhaps that office is located in an area of the city where people simply do not need treatment, but that is not likely. The most probable case is that the doctor seeing these potential new patients has made the treatment decision that 40% of the individuals in front of him were not in need of care.
What do you do? Do you change up the marketing to attract a new subset of patients? No, because not only will you screw up the results for the other 4 offices, but you have not solved the most probable cause of the problem. Rather, examine the charts and X-rays of a representative subset of the patients that did not need treatment. My guess would be that the conclusion would be that while certain patients did not need treatment, a decent number could have benefitted from treatment (treatment that they are probably receiving at another practice by this point). What do you do? At this point, depending on your point of view, you’ll probably have one of 3 opinions:
“This is what the doctor determined and I need to go with his or her decision. I trust the opinion of a colleague.”
“This doctor is doing the patients an injustice and potentially more damage by not treating those who could benefit from care.”
“Every screwed up diagnosis is dollars out of my pocket.”
Your reaction (and I’m not going to comment on the sanctity or correctness of any of them) dictates the appropriate response. Maybe you decide to sit with the doctor on consultation days so that you talk through any debatable issues. You might consider that to be pushing the doctor to value the almighty dollar over professional judgment. If your attitude reflects one of the last two reactions, you may elect to terminate that associate and possibly risk the reaction of others scolding you for only seeking a doctor who is willing to be a slave to money. Whatever you decide, there is no better comfort than knowing that you did the right thing for your patients, practice and family.
Here’s another one that comes up a lot. You have a moderately successful office that is losing new patients because those people are being required to wait 6 weeks to 2 months for an appointment. They’re being required to wait this long because the office sees 25 patients per day and the schedule is simply fully. You know that an efficient operation can see around 100 patients in a normal production day. At OCA, we saw this issue at least monthly, if not more frequently. Here is where smart business collides with good treatment. You want to show the doctor how efficient operation allows him to see more patients AND spend more time with each patient, but you also don’t want to appear to push the doctor to increase his throughput simply for the benefit of your bottom line.
Issues like this represent the type of situation that require you to balance the business side with the perceived treatment side. The answer is to take baby steps to get to your goal. You want the doctor to go from 25 to 100 patients a day? Don’t try to do it all at once. Start with the most innocuous changes you can make first and then make them more involved. Start with having patients move around instead of the doctor and staff. Then, work your way up to adding an assistant or two to add extra columns of patients. Then, tighten up the schedule to eliminate holes and have the day be a steady stream of patients and high quality treatment.
When I’ve taken that path in the past, the vast majority of doctors look back and say that seeing more patients in a day is easy and that outcomes are improved. But it takes time. Just like everything else.
You can see how a lot different situations fall into this category. These are decisions that you make every day that will ultimately reflect the culture you create and attitude that you have.
From my experience, the decisions themselves are not complicated ones to make. In the end, you do what is ultimately best for the care of your patients. The issue is perception from the outside, but if you are comfortable with your choices, do you really care?
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