As we move along through the group practice roadmap, we occasionally hit topics that apply not only to the group practice, but also to practically any individual practice. This is one such topic. Here’s the situation in which you may find yourself: your practice may have reached its highest possible level of patient volume or you are one doctor spreading yourself among 2-3 different offices. In either scenario, you are experiencing a fair amount of nonpatient, or “dark” time in the practice. In the first case, your patient base may only merit running 8 days per month – leaving 12-14 work days per month of nonpatient days. In the second case, on the days you are working in Office A, Office B and C are not seeing patients.
On those dark days, doesn’t it make sense to try to make those days productive and profitable rather than simply incur rent, utility or employee costs with no revenue to offset those. Think about this: Let’s say that you are paying $400 per day in costs for your office on dark days including rent, staff costs, etc. If you can bring in just a little bit of money, say $700 net, before those costs, you now make $300 per day in profit instead of losing $400 per day. In a practice with 14 days of dark time per month, you now turn a $5,600 loss per month on dark days (that’s $67,200 per year to you and me) to a profit of $4,200 per month ($50,400 per year). That’s a turnaround of $117,200 per year all payable to you.
Interested? If you are, this means that you have considered, are considering or are working on setting up a multispecialty practice. Here, I’m not just talking about an orthodontic practice including a general dentist or a general dentist adding an orthodontist. I’m talking about more than 2 types of dental specialists including endodontists, periodontists, pediatric dentists, implantologists, etc.
At this point, we’ll talk about some of the considerations involved and then follow up with how to set up your multispecialty practice.
What about my current referral base?
This is probably the #1 question we receive from doctors considering a move to a multispecialty practice. For example, if an orthodontic practice adds a general dentist to his or her office, the assumption is that the orthodontist will refer all patients needing dental work to the in-office dentist and that dentist will refer all patients needing orthodontics to his or her office mate. Any outside dentist will no longer refer patients to that orthodontist because there is no longer the possibility of patients being referred back to that dentist.
This is certainly a very real concern and significant issue. You need to ensure that you know from where your patients come. If you are marketing directly to your patients via internal marketing campaigns (like promotions, sponsorships, etc) or electronic media (TV, radio, internet), chances are that you are not terribly dependent on dental referrals. Adding a dentist will not deprive you of any business. If you are currently getting a number of these referrals, you may want to consider associating with other types of specialists that won’t drive a stake into the heart of your referral base. Even without a general dentist, you can build a successful multispecialty practice.
What about the cost?
In a lot of cases, you will need some additional equipment and supplies in order to accommodate different specialists. Your chairs may need modifications to enable multiple delivery types, you may need new pieces of equipment to provide new services and you will almost certainly need new, specialized supplies.
We have converted quite a number of practices from a single specialty to a multi-specialty format (with 3-5 additional specialties per office) and the cost to accommodate those new specialists was about $20,000 - $40,000 per office to go from a sole orthodontic practice to a general dental practice. To go in the opposite direction, there’s substantially less cost because most general dental offices are more substantially equipped than their orthodontic counterparts. Now, you can certainly try to go cheaper and get deals from suppliers and cut out things that might not be must-haves, but always keep in mind what will be of best service to your patients.
How do I find a doctor to join my practice?
There are lots of ways to do this. You can place a classified ad in key specialty journals like the JCO, ADA Journal, Henry Schein website or even something as common as monster.com. You can utilize a service to do this as well. As we’ve discussed before, if you do utilize one, find one that doesn’t charge a fee up front for its services. Find one that will only charge upon successful completion. We’ve mentioned the folks over at American Business Consulting for this before and I’ll mention them again here.
In addition to these methods, your own networking or inner circle can provide other sources of names for you.
What other major things change with regard to a move to a multispecialty practice?
First, your marketing will change. Instead of one service or group of services within a defined range, the spectrum of services grows substantially. You need to let patients know that you can accommodate them for virtually all of their needs. We’ll expand more on this a bit later, but you cannot simply add doctors to your practice without having some method of driving patients to them.
Second, your consultation process will have to be adjusted. This ties in with the marketing process. If a patient comes in for an orthodontic consultation, that patient may not need orthodontic treatment at all, but that patient may have some gum issues. And what do you know? You happen to have a periodontist who works in the office. They can stay at the same location and get some fantastic service for their problem. Now, can and will the doctor originally seeing the patient make the proper call and proper referral? Please note that I am NOT talking about trying to upsell patients for the sake of making profit. If a certain procedure is necessary, you want to be able to notify the patient of such and offer them the convenience to have the issue taken care of within that same office.
Finally, scheduling becomes an issue that you need to resolve. If you have 5 specialties working on different patients, you want each of them to be able to service patients in a comfortable environment with adequate appointment availability. More importantly, you don’t want one of the specialists to be all the way in the way of the others.
Want to discuss further? Please contact us.
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