Thanks,
@fancymylotus. I really appreciate the insight and the time you invested in providing it.
(I certainly don't want to take up any more of your time that you're willing to give, however, so please don't feel any pressure to entertain any of these other questions.)
Would you recommend looking to work in multi-specialty practices, if possible, based on your experiences? In addition, do you think the situation would change considerably depending on if the dentist is an employee vs. an owner?
It seems like the ease of keeping patients in-house for a variety of procedures would allow for greater patient convenience and a faster and more coordinated treatment course than if the patient had to schedule with out-of-office practices, which would likely have unfamiliar records and practice methods to further complicate the process.
Do you find that you're less likely to attempt advanced procedures on patients due to the availability of in-house specialists, and is your personal practice and CE much more focused on general dentistry as a result?
I recently shadowed a general dentist who does almost everything in house, across different specialties, although the other general dentist he shares office space with seems to refer everything but general dentistry either to the do-it-all-dentist, or other specialists in the area. The more general dentist is much younger, and so I wonder if there was a shift in how dental schools viewed the general dentist practice model, as it seems the newest generation of recently graduated general dentists is becoming more interested in expanding into specialty work, especially with the allure of increased income.
(The do-it-all dentist I shadowed, however, seems to charge less than specialists would for the same procedure, and his patients all seemed very appreciative of the added convenience and lower cost. His staff did not know of any cases where he has been sued for his procedures, in response to my hopefully-polite inquiry regarding the potential liability.)
As I mentioned, the general dentist who shares his office does not seem to be at all interested in expanding his practice into the specialty procedures, however, which was an interesting contrast.
I would think the specialists in a multi-specialty practice would also appreciate the very available referral base, and would have less need to solicit local primary care dentists for business. General dentists would likely benefit from similar patient referrals from the specialists, although at a much lower rate of referrals, I would think.
Differences in overhead, staffing, and equipment needs seem like they might be a hurdle, though, which could complicate issues for the practice owner, especially if they were a single-owner?
I would think our property insurance might also be higher if, as an owner, we're doing advanced procedures in-house, like oral surgery and anesthesia, which would likely result in a bigger bill and liability for the practice owner, as opposed to the employed specialists, unless the costs were appropriately passed through.
Doug Carlsen, a dentist who retired at 54, seems to have written extensively on the subject of creating a successful practice and achieving early retirement. Here's one example. (No mention of shoes, unfortunately
)
"
Characteristics of Early Dentist Retirees
Practice:
- Few had more than three employees.
- Half did not employ a hygienist.
- Very few had a “high tech” office.
- Specialist referrals were rare.
- All had practice overhead under 60%.
- Most owned a practice in only one location for their entire career.
- Less than half had significant practice debt for more than five years.
- Most worked in offices of less than 2,000 square feet.
There was a small group that had 2,500+ square feet offices, more than six employees, and high tech features. These doctors employed practice management consultants on an ongoing basis, had sophisticated tracking and communication systems, had incomes of over $500K per year, and saved 20%+ per year."
(
http://whitecoatinvestor.com/how-dentists-retire-by-50/)
His statements would suggest that keeping a lean, single-dentist office is one of the most effective ways to maximize success, especially as a dental practitioner, so your experiences in what I believe is a multi-specialty office would be very valuable, if you have any additional insight to share.
The cost-benefit analysis of employing a hygienist, for example, has been previously debated on these forums, if I recall, and it does not seem like there was a clear choice there, although it would appear that once a large enough number of non-hygiene patients could be generated, hygienists and associates would start to make more sense. However, I would think that more employees would create issues with needing to cut staff, or significantly reduce hours, if the patient pool ever dwindled, potentially through competition from other offices.
Based on your experiences with ownership, do you have any insight in how lower patient volumes and staffing reductions can be effectively handled?
In addition, have you always approached dentistry from an owner's perspective? It seems corporations tend to be appealing for many because they remove much of the business of dentistry. However, I would think dentist employees would be paying a significant cost premium for the convenience of focusing solely on practicing.
Does practice ownership seem to provide for more benefits than costs, in your experience? I would think unforeseen issues, such as Hurricane Sandy, would have made things challenging for dentist-owners in NY, and I certainly hope your family and any of your peers managed well despite the difficulties.
We appears to have seen a shift in medicine toward greater dominance by hospital-based and corporate groups, where physicians are employees rather than owners. Do you think something similar may happen in dentistry, based on your experiences, and private practices and owner dentists will become increasingly rare?
You mentioned observing a greater prevalence of group practices in dentistry. Do you find that these are typically multi-specialty group practices, or are they single-specialties coming together? I would think the pressures of having multiple owners or partners might make business decisions more complicated than with a single owner.
Based on your experiences with your family's practice, do you have any perspectives on a single-owner, multi-specialty practice, vs. more group-owned scenarios?
I would also be interested to know if you think employing staff to handle the business-aspects of the practice, like Carlsen mentions above, is worth the expense, or if it's preferable to have the owner more intimately involved with the business of the practice.
I'm very comforted that you don't seem to be too concerned with dental saturation, even with Touro opening up in NY. It seems like the incredible population density of the NY-metro area would allow for a large number of practices in the area, however, with so many available patients.
Did your family build your practice from scratch? Or had the practice already been established before they assumed ownership? I would think carving out a new practice in the NY-metro area would be difficult, even with the multitude of potential patients in the area, due to the ease in choosing from a variety of dentists.
Wow. That was surprising. NYC has a *much* lower number of physicians-per-capita than San Francisco, which I think would reflect on dentists-per-capita.
"NYC: 246; SF: 639; US Avg: 261"
(
http://www.bestplaces.net/compare-cities/new_york_ny/san_francisco_ca/health)
I certainly hope that situation allows your family's practice to continue to be successful. Those figures also seem to lend insight into how the practice may have developed for your family, since there seems to be a much larger healthcare need in the NYC area than I had expected.
Thanks, again, for the perspective. I hope you and everyone reading this are having a fantastic day.
)
