April 2016
Volume 37, Issue 4

Growing a Practice: What to Consider to Expand Range of Services

With the economy rebounding somewhat in the past year, one might assume that many general dental practices are too busy to consider adding more services to their offerings. And why bother? Providing services that dental specialists already capably offer would require an investment in time and money to learn the new skill and add the necessary equipment.

However, a December 2015 research brief released by the American Dental Association’s Health Policy Institute found that general practitioners (GPs) don’t have enough to do. Relying on data from the institute’s annual survey of dental practices, the researchers looked at how busy respondents said they were throughout 2014. Although the percentage of GPs who responded that they were “not busy enough” decreased from 36% (in 2013) to 34%, that change was not statistically significant. In addition, the researchers found that a substantial 40% of solo GPs (the solo-owner dentist in the practice) wanted to be treating more patients. “Significant unused capacity remains in the dental care system,” the report asserts.

As might be expected from the excess capacity, GP earnings also continued their multi-year slide, with average annual net income amounting to $174,780 in 2014, down from $180,950 in 2013 (a significant change). These two factors at least in part explain what has been described as a growing trend of GPs to expand into offering a variety of specialty services. Such services might include placing implants, treating sleep disorders, performing endodontic procedures, doing periodontal surgery, and providing a wide range of cosmetic services. General dentists who take steps to develop their practices in this way have been termed “Super GPs.”

Factors to Weigh

As appealing as that moniker might be, the question of whether to add any single specialty service—let alone a wide range of them—is fundamentally a business decision. The GP should consider the likely impact the decision will have on the following aspects of the practice.

The Practice’s Bottom Line

Instruction in new skills costs money. The hands-on and live patient training required to become competent at many specialty skills tends to be particularly expensive, especially if getting that training requires that the practice be closed temporarily.

It is also important to make sure key staff members become knowledgeable about the new service areas. Besides providing essential support for the clinician, well-trained auxiliary members can be effective at introducing patients to the new services and maximizing case acceptance rates.

Beyond the educational costs, adding services invariably entails acquiring new equipment and materials. The costs and types of acquisitions can range from minor to very large.

Against the added expenses must be balanced the likely impact on practice production. Practice-management consultants who have studied the economic impact of GPs adding one or more specialty services have estimated that the resulting growth in revenue production may range from 12% to 50%, depending on what the service is and how effectively the practice incorporates it. Growth in profits may be even more substantial; becoming a Super GP typically requires no increase in overhead nor increase in the existing patient base. Furthermore, diversifying services offered typically reduces risk and adds financial stability, much like diversifying an investment portfolio.

The GP’s Professional Satisfaction

The daily challenge of providing services that were once the exclusive province of specialists invigorates many GPs. For such individuals, more variety means more enjoyment and gratification. Others may relish the additional control over treatment outcomes that they gain from adding services such as implant placement.

However, such reactions can vary dramatically from one individual to the next. If an aspiring Super GP winds up feeling extremely stressed, the question then becomes whether the stress is transitory or rather an indication that the clinician simply prefers working within tighter professional confines. In any case, practice-management authorities warn against adding too much that’s new at once, lest the new services come at a high cost in efficiency and focus.

Patients’ Satisfaction

Many patients report a preference for obtaining their dental care from a single comprehensive source. They have come to know their GP team and trust the members of it. Their continuity of care also may be higher when delivered exclusively by that team.

While in Transition

Those who have observed GPs who have successfully expanded into new service areas advise starting with simpler procedures, or ones that build on existing skills, or ones that especially interest the particular clinician.

Maintaining good relationships with specialists is also recommended. Many cases will require the skills of the specialist, and even superficially simple cases can prove deceptive. If complications develop, help from interdisciplinary teammates will be needed.

By expanding their array of services, GPs can increase practice production, improve their own satisfaction, and elevate their patients' level of care.

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