Specialist's boundaries

[Temple2007]

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I have a question about what a GP can or can not do. I have a friend in dental school who believes that GP's can step into the role of a specialists without even going to speciality school. He says that you can attend seminars and eventually gain the experience to do only lets say endo, get referalls, and charge the same as a specialist. Is this possible???? I guess a GP could charge whatever he wanted to. Im just curious what you think I dont think that it is possible. But what do you all think.

 

[ItsGavinC]

Yes, by definition (and according to the ADA Code of Ethics), general dentists can perform ANY procedure they wish, as long as they perform it with the same expertise that a specialist would.

Therefore, if a general dentist is comfortable doing Endo, and (most likely) has obtained a plethora of continuing education in Endo, they are more than able to complete those procedures.

If, however, the general dentist is confronted with a procedure which they believe is so difficult that they are NOT able to provide the patient with the same level of treatment that would be provided by a licensed Endodontist, that general dentist should then refer the patient to a specialist.

Also, a specialist (say an Endodontist), is NOT ethically able to perform procedures that would be handled by any other specialty OR by a general dentist.

This plays out in several ways: 1) General dentists, although able to perform a wide array of procedures, most commonly leave the extremely difficult cases (and often only mildly difficult cases) for their specialist counterparts. Time is money in the office, and a specialist might be able to do the procedure 2-3x quicker than a general dentist, while the GD could see 3-4 patients in that same timespan rather than the single patient. In 99% of the cases, referalls to specialists are best for BOTH dentists. 2) Part of specializing is the realization that a) you can not do general dental procedures and b) that when the really tough cases come along, you have nobody to refer them out to. 3) Because of #2, refering is an important part of our profession. Building a network of fellow dentists helps keep the profession alive and builds the income of all parties involved. GDs will send plenty of cases toward the specialists, and when the specialists are confronted with new patients who want general treatments, they will kindly point them in the direction of the GD.

I hope this rambling answered some questions.

 

[Midoc]

GPs can do any procedure they think they are competent to do. The kicker is that if something goes wrong the GP will be held to the same quality of care standards as a specialist would. ie. if something goes wrong because of your lack of training you cannot use that lack of training as a defense.

Referals are unlikely unless you had some close friends that really trusted your abilities. It is true that you can charge pretty much whatever you want but you won't get paid by patients or insurance companies if you try to charge what a real specialist charges.

 

[Temple2007]

Thanks for the input. It seems kinda grey to me but what i guess you are saying is that it is possible for a Gp to self declare themselves as a specialist. The catch is however that insurance would not pay your high rates and referalls would be a problem. In less you had alot of GP friends that trusted you. Are there any unwritten dental ethics that prevent Gps from over stepping into specialites realms. Just curious???

 

[UBTom]

Well, if you are a general dentist and has not had formal postgraduate training in a specialty, you are NOT allowed to say you are a specialist, because that would be misrepresentation.

What you can do however, is state clearly that you are a general dentist limiting your practice to a particular specialty.

For example, if you have not had formal training as an endodontist but you want to do only root canals, you will have to put this on your business card/shingle/ads/stationery:

Dr. John Smith, DDS
General Dentist
Practice limited to endodontics

And yes, issues such as this are covered in the ADA's Code of Ethics handbook.

HTH!

 

[MarkFitzsimmons]

Are there actually GPs out there that are strictly limiting their practices to a certain field of dentistry? Specialists like endos depend on referals and I can't see too many GPs sending out their more difficult endo cases to a non-endodontists.

Don't get me wrong here, I know there are many GPs out there that try to become as proficient as they can in procedures like posterior endo, fixed prostho, and implants so they can keep more of these procedures in house, I understand this is very common but wanted to clarify my question is about a GP limiting their practice to such a referal dependent field of dentistry like endo.

 

[UBTom]

Hi Mark,

Yes I just used that as an example of how a dentist who has no formal post-grad training should represent himself if he wants to do just a particular kind of procedure.

I don't know how prevalent this is though.

 

[no2thdk999]

It is not very prevalent. I know of two GP's who limit themselves to endo and one that limits himself to pedo.

It is harder for them to get referrals. The endo only GP's started by offering to come to an office once a week or every other week and do all the endo that needed to be done.

This lets the owner GP keep the patient in house and make money as the endo GP gets a % of the fee charged like an associate.

The downside is as a traveling endo-GP you have to lug all that equipment around everyday. Both I know of are trying to get their own office currently.


Rob

 

[gryffindor]

There is an ortho practice up here with three docs - a father and two sons. I think the father and one son actually did ortho residencies, but the other son did not. He just practices with them and does only ortho just like the other two. I think that is the deal with these guys, but no one seems to know... it's kinda shady.

 

[MarkFitzsimmons]

I know a practice that did that. After the son graduated from D school it took him a few years to get accepted to an ortho residency. So rather than practicing general dentistry he did ortho work for his dad in the office. They felt he was capable of doing everything but the planning, so his father handled all of that.

Nothing shady about it.

 

[gryffindor]

No, not shady if you are buying time trying to get into the residency. I highly doubt that the non-ortho son will be attending a specialty program anytime soon, the sons must have graduated dental school in the 80s. If anything, I've heard they are probably looking for a young associate to start to transition their practice to the younger graduates. However, this practice has other factors circulating around it that bring the "shady" connotation to mind, and this just adds to it.