By Dr. Bill Simon
With research, development, and expansion of technology comes a broader scope of services, a deeper understanding of how to provide those services and improved outcomes. The standard of care elevates and, more than ever, dentists are faced with decisions on where to draw the line on what treatment they are comfortable providing and what should be referred out to a specialist. After all, we are all held to the same standard of care.
Twenty years ago, the complexity and scope of services was nowhere near what it is today. Many general dentists were doing a lot of specialty discipline services and, in most cases, providing equivalent care to that of the specialists.
In my opinion, that has changed. Do GPs have CBCTs in their offices? Yes, some do. Do GPs have microscopes in their offices for the purpose of endodontic treatment? Some perhaps, but probably not many. Do GPs have the knowledge gained from the advanced specialty training and the experience gained from being focused on the same treatment types? I would argue most do not. Again, we are all held to the same standard of care.
You will hear the consultants say, you must expand your procedure mix. You must keep things “in house.” Valuable information to a point … but at what cost? The best interests of the patient? Your risk? We all will decide where to draw the line on how far we are willing to go to provide care. I would argue that the “best interests” of the patient come first. To that end, partnering with specialists becomes a very important part of the care that you, the general practitioner, provides to your patients.
I think it is important to keep in mind that the specialist you refer your patient to is an extension of your care and impacts the perception your patient has on your quality of care.
So how do we go about finding the right specialist partners? This is what I consider.
Competence and quality of care: Rarely have I encountered a specialist who is not really good at what he or she does. So, while competence is often a given, it still must be considered and vetted. Quality of care, on the other hand, can be more difficult to measure. What materials do they use? What are their infection control protocols? Are they supported by a skilled and cohesive team? A visit to their practice may be the best way to find the answers.
Level of technology: Does that specialist utilized the most up-to-date technologies that will allow for the provision of the best care for your patient?
Communication: This, in my opinion is critical. Prior to the implementation of digital technology and the internet, the communication method of choice was typically referral cards. I recall having a plastic tower of stackable drawers. In each drawer were the referral cards for each specialty. We called it the “Tower of Terror.” We would fill out the card with the appropriate information, hand it to the patient, and hope that things worked out. Patients would often show up to the specialty appointment without the card … if they made the appointment at all.
If the patient did make and keep the appointment, the follow-up communication from our referral specialist would come in the form of everything from snail mail, to fax, to email (secured and unsecured), to nothing at all.
Today’s digital world now allows us to make referrals and share information, including digital images, through portals, provided ideally by the specialist’s office. For me, the portal options are the best but, at a minimum, an email or a snail mail should be provided. These communications serve not only to improve quality and continuity of care, but additionally for professional liability protection. Of course, there is nothing like a follow-up to the written communication in the form of a phone call from the specialist.
Chairside manner: Does the specialist treat your patients in a way that adequately meets your standard of interacting with a patient? Remember, the way that specialist treats your patient is a reflection and extension of your care.
Values: Does the specialist’s practice’s core values match well with those of yours? If you have a relationship-based practice, it might not be such a good idea to be referring your patients to a specialty practice that has more of a corporate mindset.
Culture: Does the culture of that specialty office adequately meet your expectations of what a dental office culture should look like?
Location: Is the specialty office located within a distance that is reasonable and convenient for your patients? This may not always be possible, particularly in rural setting, but certainly worth considering.
Honors your wishes: Beware of the specialist that, without your consent, will do more for the patient than you ask for, does not respect your treatment plan, does not honor your preferred implant system, or refers your patient off to another specialist or, even worse, to a GP, particularly if that other doctor resides in their group practice.
Added value: While certainly not high on the list, it is worth appreciating what your referral doctors do to add value to your relationship. This might include offering CE courses and/or study clubs, offers to shadow them at their office, CPR training, and social events, to name a few.
While it may not be possible to check off all the boxes for every specialist you refer to, it is important, in my opinion, to consider all the above. Make decisions on which will give you the most to serve your patients the best. I know that your patients will appreciate it. Remember, the specialists that you refer to are an extension of the care that you provide for your patients.
Dr. Bill Simon’s 35-year dental career has included its share of challenging situations. Starting as an associate in a run-down Medicaid practice, Dr. Simon grew to become the sole owner of two highly successful multi-doctor practices. His experience includes six build outs, nine locations, four space-sharing arrangements, one practice acquisition, and more than 25 associates. He experienced a lost lease, an embezzlement scheme, robbery at gun point, and a major fire after which the team worked out of three offices before settling into an abandoned dental office while he rebuilt. The fourth month after the fire, Dr. Simon’s practice had the best production month in practice history.
These experiences, coupled with Dr. Simon’s passion to help dentists succeed, have inspired him to speak to and mentor dentists. Sharing experiences and imparting lessons in leadership, communication and practice management principles, Dr. Simon encourages dentists, their dental teams and dental students with the knowledge and hope they need to allay their fears and facilitate their success.
Note: “Compass Study” by Calsidyrose is licensed with CC BY 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/2.0/