Describe Your Ideal Practice

[avalanche]

Continuing from my reply to Ineedanassociate's message.

I'd like to hear from those who will be in the
workforce soon or have been out for a little while to describe their ideal practice . . .

more in the sense of scope of discipline you'd like to practice, type of set-up ( partnership, associateship, starting from the ground up),
locations . . .

and for those who have been out for just a little while, what things did you feel prepared for and not? . . .

we all want to work ( reasonable hours ), and be paid ( to get monstrous loans off our backs ;-) ) . . .

but beyond that?

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[Big_Poppa DDS]

I would like to associate and eventually become a partner with someone who is in their early to mid 40's. I like the idea of having someone to discuss cases with.

Basically, the only thing I don't really like doing is endo, and maybe thats because I didn't have enough experience with it in dental school.

I also wouldn't mind staggering hours between dentists, and maybe with a period of overlap. I am a morning person and would love to work 7 - 2 and have someone else work 2 - 8 or something like that.

 

[avalanche]

i'll go first:

i plan to live in Manhattan, NY
i'd like to start off as an associate, to learn the ropes of how to run a business, who needs what forms on file . . . how to be profitable, except in the eyes of the IRS ;-) . . .

4 operatories - - - 1 pretty much dedicated to Hygiene.

i'd like to work 4 and 1/2 days . . .
wouldn't mind if two of those were later hours
( till 8pm or so )
(as long as the hours added up correctly)
and an odd half weekend day would be accpetable as well.

i'm fairly comfortable with Oral Surgery and Endo and see those as things which could help out the bottom line. So as an associate if i could do those in-house, as opposed to referrals, i'd be appreciative. ( especially if as an associate i'm denied the big production patients ( bridges over bridges ))

i'm interested in Restoring implants and see that as becoming a standard of care . . .
have had some experience, but would expect CE to improve my abilities here.

Perio would probably be limited to crown lengthenings or borderline moderate / heavy Sc/Rp i don't want to refer ( i would expect this and recall to keep the hygienists busy < also good overhead help> )

Of course, the fixed and operative would be the bread and butter. As far as the latter goes i'd like to do more 'cosmetic' procedures such as veneers, bleaching and such.

Ortho is not a strong interest of mine, so things that can't be corrected with restorations would be referred.

i wouldn't mind the odd kid here and there, school exams, recall and whatnot, but if the question is making money off of pulpotomies, SSC's and Space Maintainers, i'll probably stick with the low overhead, high profit Endo thing . . . i'll do them but it will not be more than 25% of my patient load i think. But i do see the value of preventive care and to some degree expect the kids coming in to be there somewhat willingly.

Nitrous for the fearful.

Removable is not a favorite of mine, but i have no problems doing dentures and partials . . . but here again i'd try to express the benefits of implants to applicable patients .

i expect a mix of FFS and insurance. I think unless i'm on the verge of bankruptcy ( even with a second job ha ha ) i won't accept Capitation programs.

i guess that's about it.

I would like to find some free clinic where i could donate my skills for the under/served/privileged for a 1/2 day a week
or weekend day every 2 weeks . . .
hopefully not just limited to emergency procedures ( which are often endo or extractions) - - - i'd expect to do some Oral Cancer Screening - - - some Pedo . . .
So maybe having an connection with the local
public health agency would be expected.

i've also got a strong interest in music and literature and expect to do something with them on the side . . . so i need my spare time for that . . . as well as friends, family, significant others and getting to know NYC and travelling around the world.


Yeah i think that about sums it up . . .

 

[DrJeff]

I used to think that my "ideal" practice was going to be in an affluent suburb doing restorative and crown and bridge with some occasional removable and oral surgery. I'd have a very strong hygiene program, as I really don't enjoy perio. I'd do a couple of implant restorations a month and be in a partnership/group setting and not do alot of endo. I had that for 3 years, a situation with a group that looked great on paper and on interviewing. You know what, aside from the group practice setting I didn't enjoy my "ideal" practice. So I left suburbia, and moved to the country and joined up with another dentist in a small town. I'm now doing almost all my endo, a bit of oral surgery, crown and bridge, some perio (still I will say thank god for strong hygenists! ), an implant or two a month and roughly 5 arches of removable a month. My fees are less in the country than in suburbia, but I'm producing more while working less hours, not a bad change.

Something to think about that I never really realized until I saw it happening in my own practice. Granted almost every dentist wants the ideal fee for service, screw the insurance companies I don't need 'ya practice. Here's the reality, most patients will base their treatment on their insurance plans so for 95%+ of practices, it is a factor to some extent. Since most folks ins plans have yearly maximums between 1000 and 2000(1000 or 1500 are what most plans have), if someone needs endo, post + core and a crown it can eat through that yearly max in 3 a hurry. In my "ideal" suburbia practice endo (molar), post + core and a crown would run just under $2000, and I had roughly 25-30% of folks opting for the $100 extraction due to "my insurance plan won't cover it all". My new country setting practice the same procedures run roughly 1500, and I'm only picking up the forceps atmost 10% of the time. Reason being, the treatment is covered by ins.

If patients ask me why the fees are so much compared to the insurance plans, the first thing that I tell them is that the yearly maximums for most ins plans haven't changed since the 1970's. That generally answers all their questions, and often will lead to patients asking about what other types of services that I offer that aren't covered by the insurance companies (I've sold many arches of bleaching and units of veneers based on this)

Bottom line, living in an area that I never thought that I'd live in, in a practice that is quite different that my original "ideal practice" and I'm as happy as can be.