Long time lurker and practicing GP here.
Great thread and discussion. Have several questions for you, TanMan. Forgive me if some of these have been previously covered...its been a couple weeks since I read the thread.
1) About the construction process, how did you go about choosing contractors, assuming this was a new build out? Did you run into any zoning issues?
2) What duties are your assistants performing? Making temps, taking impressions, etc....expanded functions?? Do you practice assisted hygiene? I read one of Scott Leune's initial threads on Dentaltown and he was a big proponent of this 'idea'.
3) what CE have you taken thus far?
4) Are you doing RCT/BU/crown in one appointment? Thought I saw this earlier in the thread.
5) How did you perform demographic analysis before you opened doors? I know you mentioned determining what type of dentist/office you would like to be first and that you received some data from the television/media stations used for marketing. What led you to choose your specific area in Texas? What other resources did you use to gather data to make your decision?
6) So you mentioned you like to keep it simple and tend to stray away from certain procedures. What happens with patients that need dentures, have bombed out dentition, candidates for full-mouth rehab or difficult implant cases? Are there certain docs you refer these patients to?
That's all I have for now. I'm sure I'll have additional questions later. Thanks in advance!
1. Contractors... Choose a general contractor with a positive reputation. There are three general qualities, price, quality, and/or speed. When I first started, my first priorities were price/speed, but making it NOT look like a dental office. Landlords who care about the leasehold improvements usually know who's going to do good work on their property. In my case, my landlord was also a developer, so mine was developed nearly at cost. No zoning problems. As I mentioned before, it's better to have someone local who is well known within the building inspectors so you can get things approved quickly.
2. Texas is limited on what assistants can do. Anything and everything that can be delegated legally to assistants are delegated. My time is worth more than theirs. Assisted hygiene definitely makes sense, but it depends on how your workflow goes. Keeping rounded numbers (hypothetical), if you charge 100USD for a prophy and your hygienist can do 2 unassisted, and 3 assisted, you just increased your prophy production by 50% for the price of an assistant's hour (which is worth less than a prophy). However, I tend to balance the hygiene assistants in getting patients in and out, taking radiographs, walking patients out. Pretty much priority is all the auxiliary functions, secondary function is assist the hygienist.
3. The ones I can remember are Level 1/2 oral sedation, LANAP, pinhole, just did an implant course since I'm trying to develop an streamlined implant procedural system that can be implemented in my office (still in the works). The rest of the CE's I did were just to meet licensure requirements. I find it hard to do CE's that don't take away my weekends unless my return of investment is worth taking time off. I'm not going to be one of those dentists that brag about going to so and so institute, etc... I think earlier in my posts, I mentioned not doing implants, but now that I've cut out underperforming procedures, I'll start on implants and see how that goes.
4. Single appointment RCT/BU/Crown. Possible with the CEREC. How to justify to patients? You only have to go through this once unlike other places where you might have to go through it 2-3+ appts. Most ppl opt to one longer appt.
5. I worked in the area for a little bit and found that there's a deficiency in PPO/FFS offices since everyone and their mom was opening a medicaid mill. I prefer to look at it from a supply/demand side, but dentistry is not dentistry. There's medicaid dentistry, FFS/PPO dentistry, HMO dentistry; different models revolve around different demographics. One thing I learned is that in a medicaid heavy population, a large support staff population exists in the form of healthcare and teachers. Some of the research included what kind of PPO's the population had (were they any good - do they pay, and how much?), how hard is it to get an appointment in the area (if it takes too long, people want it NOW), is there an unmet market need in the region (convenient hours), etc... I'll try and go into more detail, my mind is usually fragmented and you'll probably get fragmented answers from me. I prefer specific questions, since I tend to just ramble on what comes to mind - that may not necessarily be a complete and thorough answer. Somewhere on these posts, I may have discussed what to look for in demographics.
6. If they need dentures, full mouth rehab, difficult patients, bombed out dentition. I refer them out. I don't even touch them, as it's not fair to the referred dentist (they should get the good and the bad), and I don't want to get involved. Only time I may get involved is if they are in pain. I'll take care of what gets them out of pain and refer them out. Production/hour drops significantly in these cases. Implants, I'm looking to implementing a nearly idiot-proof system to these, so I'll be placing implants pretty soon. I'm not planning to do all on 4/5/6's; If it requires more extensive procedures, I'll refer to an oral surgeon. You may have noticed I took sedation courses, but I don't do sedation as it does not work with the office workflow and attracts the wrong kind of patients.
I screen my specialists. They need to do high quality work and be nice to the patients. If the quality is bad, I stop referring. If my patients complain about how rude or unprofessional a specialist is/was, then I stop referring. I usually monitor patient feedback to the specialists. If it's a single problematic patient that I know loves to complain, then I don't really take note of it, but if its multiple problematic accounts, then I stop referring.
. Dealt with my wife's unpredictable major health issue that cost lots of $$$. The point is .... if my circumstances were different and I put all that money into proper investments ... maybe I could retire at 40. As is ... I'm working in my mid 50's and enjoying it ..... so far.
