Perio doing all extractions in some DSOs

[deleted1035775]

I have being having jobs interviews where the DSO does not want the GP to do any extraction or implants; all go to perio including simple ones; it looks very suspicious to say the least. I am an international prosthodontist just got my US DDS, but I used to do all my extractions and implants (except the ones that can open the sinus or injure the IAN). Worked with perio and OS but never referred tough extractions to perio all to OS since they are trained on doing such extractions and more. Any thoughts on this?

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[yappy]

They want them to do it for the specialty code.

 

[Ivy.ch]

They also want maximum efficiency. OS and Perio, on average, are going to extract way faster than generalists.

 

[deleted1035775]

They also want maximum efficiency. OS and Perio, on average, are going to extract way faster than generalists.

extract #8 and 9 faster; I do full mouth ext in less than an hour.

 

[deleted1035775]

They want them to do it for the specialty code.

You know there was a big sign up bonus and actually that made me think again about the situation. None of that limitation in written in the contract. I think they just want to charge the patient more (insurance fraud). BTW, it was same DSO for both offers. I am moving on with another DSO that allows GP to do whatever they can do as there is no specialties and then you refer when you need

 

[ShortShortsDad]

You know there was a big sign up bonus and actually that made me think again about the situation. None of that limitation in written in the contract. I think they just want to charge the patient more (insurance fraud). BTW, it was same DSO for both offers. I am moving on with another DSO that allows GP to do whatever they can do as there is no specialties and then you refer when you need

It’s not fraud, specialists get better reimbursement from insurance. A sketchy DSO very may well be doing something fraudulent but that’s not.

The idea that perio will do anything “way faster” is laughable though. A respectable time for a full mouth extraction is about 20min

 

[deleted1035775]

It’s not fraud, specialists get better reimbursement from insurance. A sketchy DSO very may well be doing something fraudulent but that’s not.

The idea that perio will do anything “way faster” is laughable though. A respectable time for a full mouth extraction is about 20min

True I am OK with specialist charging more as long as the patient really needs to see specialist; I for example does not touch any ASAIII or more because of my concern about patient safety, but even in this case I would like the patient to be seen by an OMFS not by perio

 

[ShortShortsDad]

True I am OK with specialist charging more as long as the patient really needs to see specialist; I for example does not touch any ASAIII or more because of my concern about patient safety, but even in this case I would like the patient to be seen by an OMFS not by perio

Can’t fault you there. DSOs do so well not just because of economies of scale but because they can live in the grey area. If there is a loophole they’ll find it to make a profit.

 

[emma_m]

I have being having jobs interviews where the DSO does not want the GP to do any extraction or implants; all go to perio including simple ones; it looks very suspicious to say the least. I am an international prosthodontist just got my US DDS, but I used to do all my extractions and implants (except the ones that can open the sinus or injure the IAN). Worked with perio and OS but never referred tough extractions to perio all to OS since they are trained on doing such extractions and more. Any thoughts on this?

Do yourself a favor and don’t work for a DSO. There are plenty of International dentists who work in the USA in private practice and do all the procedures you mentioned above including cases with IAN proximity or where the extraction can have an oro-antral communication. It’s not hard to close the communication with a buccal flap if needed and there are many situations of proximity to the IAN one can manage with proper planning (sectioning or doing coronectomy). Have a prior CBCT, do proper informed consent and if something seems too difficult refer out.

 

[deleted1035775]

Do yourself a favor and don’t work for a DSO. There are plenty of International dentists who work in the USA in private practice and do all the procedures you mentioned above including cases with IAN proximity or where the extraction can have an oro-antral communication. It’s not hard to close the communication with a buccal flap if needed and there are many situations of proximity to the IAN one can manage with proper planning (sectioning or doing coronectomy). Have a prior CBCT, do proper informed consent and if something seems too difficult refer out.

Absolutely right! GP decides what to refer and what not to refer and BTW I know how to even do sinus lift and so I am not really worried about exposing the sinus as much . You know man I also see a lot of fake reviews about GP salaries as well; before I accept an offer I always look at what other doctors are making/made in the office I am interviewing for; so far it was never below 200K with some even do more the 350K especially those who can do extractions and implants. owners/partners can easily hit higher numbers as well especially those who owns more than one office. From what I have seen so far there is a big efforts from suck ass DSOs and owners to convince GPs that they cannot do anything other than filling and that there salaries are going to be 150k; in fact my guaranteed in 180K. I like the way you are thinking; way better without a so call specialist who is sniffing for simple ext to charge the patient more (and by more I mean $1500 with so many additions to an absolutely simple extraction. I hope that dentist start to treat each others as how MDs do. Way better respect and Way better determination on opposing anyone who is trying to make such as wonderful industry suck so they can make GPs cheap slaves for them

 

[Bereno]

A little side track, but OMS here. I have done a full mouth extractions in as little as 5 minutes (quick local, all perio with no need for alveo) to as long as 2 hours (granite for bone and teeth, bruxer, saving bone for implants, tori with alveo needed, and poor sedation tolerance). Those that have done enough of them know that it really depends on a lot of factors. When considering the bone density, root tips, proximity to sinus, extent of alveoloplasty, the patient's tolerance of sedation, airway, etc, the amount of time it takes is super variable in my experiences. Just a random thought I wanted to share haha.

 

[deleted1035775]

A little side track, but OMS here. I have done a full mouth extractions in as little as 5 minutes (quick local, all perio with no need for alveo) to as long as 2 hours (granite for bone and teeth, bruxer, saving bone for implants, tori with alveo needed, and poor sedation tolerance). Those that have done enough of them know that it really depends on a lot of factors. When considering the bone density, root tips, proximity to sinus, extent of alveoloplasty, the patient's tolerance of sedation, airway, etc, the amount of time it takes is super variable in my experiences. Just a random thought I wanted to share haha.

Absolutely right my friend! it depends on so many factors!

 

[customx]

Out of curiosity, what are some of the fee differences between a GP and a periodontist or oral surgeon?

 

[deleted1035775]

Out of curiosity, what are some of the fee differences between a GP and a periodontist or oral surgeon?

I think the extraction fee itself is not that big of a difference, but what is done in addition to extraction such as IV sedation, graft, membrane but not % sure

 

[yappy]

You know there was a big sign up bonus and actually that made me think again about the situation. None of that limitation in written in the contract. I think they just want to charge the patient more (insurance fraud). BTW, it was same DSO for both offers. I am moving on with another DSO that allows GP to do whatever they can do as there is no specialties and then you refer when you need

DSOs will do what is most profitable for them; in many cases that means limiting the scope of practice for GPs to operative dentistry and drumming up work for specialists. I think we're entering a time in healthcare, not just in dentistry, where it's not longer about what services an individual can provide; rather, what services can a health system or clinic provide? That may bruise the ego of individual providers, but it's one more reason not to work for a DSO if you can help it.

 

[deleted1035775]

I think we're entering a time in healthcare, not just in dentistry, where it's not longer about what services an individual can provide; rather, what services can a health system or clinic provide? That may bruise the ego of individual providers, but it's one more reason not to work for a DSO if you can help it.

Not sure if I understand you here can you please explain more

 

[deleted1035775]

DSOs will do what is most profitable for them; in many cases that means limiting the scope of practice for GPs to operative dentistry and drumming up work for specialists. I think we're entering a time in healthcare, not just in dentistry, where it's not longer about what services an individual can provide; rather, what services can a health system or clinic provide? That may bruise the ego of individual providers, but it's one more reason not to work for a DSO if you can help it.

man listen as a patient I don't want to see multiple doctors to have an implant placed in my mouth, and I don't want to pay more just to see a specialist as long as the GP can do the same exact job. an extraction of #8 for example followed by implant placement does not need me to see your majesty to charge me more for your majestic services. Reality is most GPs now a day do almost all procedures and only refer those that have high risks such as a patient on bisphosphonates by all means the risk is all yours. It sound to me as if you are the one who got his ego bruised here. problem is you limited yourself to certain things which is good as long as the patient really needs your expertise, but if the patient does not then you expertise is more of really not needed at that point.

 

[Ivy.ch]

man listen as a patient I don't want to see multiple doctors to have an implant placed in my mouth, and I don't want to pay more just to see a specialist as long as the GP can do the same exact job. an extraction of #8 for example followed by implant placement does not need me to see your majesty to charge me more for your majestic services. Reality is most GPs now a day do almost all procedures and only refer those that have high risks such as a patient on bisphosphonates by all means the risk is all yours. It sound to me as if you are the one who got his ego bruised here. problem is you limited yourself to certain things which is good as long as the patient really needs your expertise, but if the patient does not then you expertise is more of really not needed at that point.

Dude, you’re literally whining on the internet.

Some of us have attempted to explain things and you’ve completely ignored us or attacked us for just stating the facts on the ground.

It’s as if you’re personally offended by us explaining why DSOs function the way they do. Dude, none of us are managers for these places, why are you accosting us?

DSOs send extractions and implants to surgeons because, on average, we do those procedures way quicker than dentists (and as others have mentioned, specialists can bill more). The company makes more money by having dentists do the restorative work and surgeons doing the surgery work. DSOs care about money above all else. If you don’t like it, don’t work for a DSO.

 

[deleted1035775]

Well this escalated quickly…

my friend, I as a GP need specialist (e.g.OMFS) to for example handle my very sick patients. and so I am not trying to belittle any one here but give what is for Caesar to Caesar and what is for GOD to GOD. Thats all!

 

[Ryxndek]

Let’s try to steer this conversation back on topic and not escalate things please.

 

[gryffindor]

Out of curiosity, what are some of the fee differences between a GP and a periodontist or oral surgeon?

They are higher. How much higher depends on what the DSO negotiated with the insurance carrier. It could be $10 more than the GP fee or it could be triple the GP fee.

 

[yappy]

Not sure if I understand you here can you please explain more

The concept is that dental clinics are building a brand that patients are loyal to, not any one specific doctor. They’re not your patients, you just work there. Hence, you don’t get to only refer the hard stuff. This model works well for patients that are financially/insurance motivated, especially if other offices don’t accept their insurance.

For the record, im a gp. I don’t favor this model. Im just sharing how some operate. Some private offices are doing the same thing.

 

[deleted1035775]

The concept is that dental clinics are building a brand that patients are loyal to, not any one specific doctor. They’re not your patients, you just work there. Hence, you don’t get to only refer the hard stuff. This model works well for patients that are financially/insurance motivated, especially if other offices don’t accept their insurance.

For the record, im a gp. I don’t favor this model. Im just sharing how some operate. Some private offices are doing the same thing.

The concept is that I and the GPs I work with and many other DSOs I interviewed with do not refer anything except for the hard cases so that the patient does not have to scheduled with a different doctor or go to multiple places for each step of treatment for no reason. Way more convenient and actually profitable for the practice or DSO. If you do not want to do endo, extractions and implants and only do fillings and prophys because you do not trust that you are a well trained doctor then that is your problem but please do not generalize as I know for fact that almost all of my friends and colleagues do most procedures by themselves and those who refer just refer because for example they hate doing endo on a 2nd molar.

 

[deleted1035775]

They’re not your patients, you just work there

I work under my license and I just work there as a Doctor and so yes they are my patients and under my care whether you like it or not.

 

[deleted1035775]

Let’s try to steer this conversation back on topic and not escalate things please.

Totally agree; the point is that the offices that wanted to limit me to drill and fill where basically straggling with finding associates and offering high signup bonuses in exchange for 2 years commitment. I was not surprised after I started to look at numbers and schedule. I was so happy to see this because there is no point for any GP to undermine or accept to have anyone undermine his/her value. Previous associates where new grads which makes sense as well. I felt like these places rely on flipping associates from time to time but funny thing is that there patients are in fact complained about Doctor being changed frequently in their reviews. Very destructive behavior to say the least. Not to mention, if a new grad is not allowed to do anything surgical they will never learn how to do it and that is exactly what these places want. but again this forum is a nice place to share and learn from our experiences to make sure that no one greedy undermine our profession

 

[deleted1035775]

They are higher. How much higher depends on what the DSO negotiated with the insurance carrier. It could be $10 more than the GP fee or it could be triple the GP fee.

as a patient I am more than happy to pay the specialist fees as long as it is needed. for example an OMFS extracting #8 on an healthy patient is absolutely humiliating to the years of training OMFS spend in hospital learning how to remove a tooth with a cyst or tumor associated with.

 

[deleted1035775]

Dude, you’re literally whining on the internet.

Some of us have attempted to explain things and you’ve completely ignored us or attacked us for just stating the facts on the ground.

It’s as if you’re personally offended by us explaining why DSOs function the way they do. Dude, none of us are managers for these places, why are you accosting us?

DSOs send extractions and implants to surgeons because, on average, we do those procedures way quicker than dentists (and as others have mentioned, specialists can bill more). The company makes more money by having dentists do the restorative work and surgeons doing the surgery work. DSOs care about money above all else. If you don’t like it, don’t work for a DSO.

well since my response to your nonsense was deleted; I will have to say it again; you might be quicker than a D3 or D4 student but not quicker than an experienced dentist (2-3 years after school), last time I did implants it was for all on 4, used a surgical guide, full mouth extractions and 8 implants placement did not take more than 2 hours including delivering immediates. Not sure why do I have to refer to you my friend. BTW, my understanding is that most of your residency is hospital based; not sure if you really can even argue about the quality of your implant work as a surgeon who is trained to treat lesions and fractures and more fun stuff. I would really pity any OMFS who is sniffing for simple extractions and implant cases to make a buck. not to mention again that you cannot even place a treatment plan for a patient when it comes to what to extract and what to be replaced with implants. Basically you will be relying on referral that has a GP signature on it.

 

[FutureDent020]

I would really pity any OMFS who is sniffing for simple extractions and implant cases to make a buck. not to mention again that you cannot even place a treatment plan for a patient when it comes to what to extract and what to be replaced with implants. Basically you will be relying on referral that has a GP signature on it.

It sounds like you have a very specific view on what specialists “should” be doing and thought of them doing things you can do really bothers you. Every dentist has a comfort zone. Some also just don’t like doing certain procedures to avoid overhead, potential complications, or they are just so busy with their bread and butter they don’t bother. If I get sent 4 anteriors in a day as an endodontist it in no way is “humiliating to my years of training.” It’s an easy day at the office and a nod to my good referrers.

Someone answered your question up top already. They refer to the specialists to get the specialty codes. Some DSO don’t refer at all and the dentists screw a lot of things up. There’s one in our area that all we see are their “starts” that they screwed up or their retreats. Your office may be greedy, but it sounds like the patients are atleast getting quality care. Regardless, just leave and let it go. Go be the dentist you want to be and stop worrying about what specialist should and shouldn’t be doing.

 

[deleted1035775]

Ah an endodontist; you spend 2 years just doing endo; you only do endo; of course it is a good day for you! that is all what you can do.

 

[deleted1035775]

Ah an endodontist; you spend 2 years just doing endo; you only do endo; of course it is a good day for you! that is all what you can do.

It sounds like you have a very specific view on what specialists “should” be doing and thought of them doing things you can do really bothers you. Every dentist has a comfort zone. Some also just don’t like doing certain procedures to avoid overhead, potential complications, or they are just so busy with their bread and butter they don’t bother. If I get sent 4 anteriors in a day as an endodontist it in no way is “humiliating to my years of training.” It’s an easy day at the office and a nod to my good referrers.

Someone answered your question up top already. They refer to the specialists to get the specialty codes. Some DSO don’t refer at all and the dentists screw a lot of things up. There’s one in our area that all we see are their “starts” that they screwed up or their retreats. Your office may be greedy, but it sounds like the patients are atleast getting quality care. Regardless, just leave and let it go. Go be the dentist you want to be and stop worrying about what specialist should and shouldn’t be doing.

Don't worry you are not even counted in this dispute; this dispute is all about forcing the GP to refer what he can do; not sure what made you feel involved in here

 

[deleted1035775]

It sounds like you have a very specific view on what specialists “should” be doing and thought of them doing things you can do really bothers you. Every dentist has a comfort zone. Some also just don’t like doing certain procedures to avoid overhead, potential complications, or they are just so busy with their bread and butter they don’t bother. If I get sent 4 anteriors in a day as an endodontist it in no way is “humiliating to my years of training.” It’s an easy day at the office and a nod to my good referrers.

Someone answered your question up top already. They refer to the specialists to get the specialty codes. Some DSO don’t refer at all and the dentists screw a lot of things up. There’s one in our area that all we see are their “starts” that they screwed up or their retreats. Your office may be greedy, but it sounds like the patients are atleast getting quality care. Regardless, just leave and let it go. Go be the dentist you want to be and stop worrying about what specialist should and shouldn’t be doing.

oh btw same goes to you; I see lots of endo treated root tips; GP refers years ago and still endo do RCT even if the tooth is no longer restorable; when I see those I do ext, immediate implant placement. you also screw up. oh btw, remember the endodontst who used IV sedation and ended up killing her patient. well looks like you really can severely screw up

 

[princeafrica]

Beginning to think this is a troll post.

 

[FutureDent020]

Beginning to think this is a troll post.

Lol, yea. Thought I’d test the waters before the thread got closed. I made a mistake.

 

[artist2022]

This thread has run its course. Closing.