I was asked the other day about bringing dentists, hygienists and other specialists into an Ortho office and going multi-specialty. The assumption was that this is the way to go now and that there is little danger in doing so. Furthermore, it seems to be vogue these days to strive for multiple locations to go along with multiple providers and multiple specialties. I talked about this extensively at the 2015 MKS Forum, I’m sure it will be a hot topic at MKS 2016 and I wanted to share our thoughts here as well.

While we do firmly believe that multi-specialty practice is the future, we would strongly caution all of you against jumping the gun. Control of your own patient base is the critical and underlying basis for any foray into expanded services or multi-specialty practice but we think this fact is overlooked by most if not all orthodontists. We understand it’s fashionable these days to pursue the ideal of multiple practices with multiple providers and multiple specialties while giving the finger to PCDs. However we think it’s unwise for anyone to bite the PCD hand that feeds them until one has control over one’s own destiny and control over one’s own patient base. Furthermore, we think it unwise to spend the money and resources and time in adding additional locations before utilizing the capacity that you already have available as much as possible. You would be far better off to double or triple your marketing budget if that helped you bring in more patients to your current location(s) than to build a new location and take on the Cap X, equipment expense, payroll, logistics and everything else that goes on with more locations.

You can make an incredible living in a “traditional” orthodontic practice with one provider who is also the owner seeing all the patients in one or a couple locations. One orthodontist can produce north of six million a year easily and we don’t recommend you complicate things by bringing on an associate until you are well past this mark. Associates are not you, do not sell like you do, they do not finish like you do, they do not run on time like you do, they don’t care like you do, moms don’t like them as much as they like you and referring dentists don’t refer to an associate the way that they refer to an owner. Some of the most profitable practices we see are owner operators who keep their overhead at or below 50% while collecting millions a year and flying under the radar. Of course there are long-term risks and issues associated with being referral dependent (and a few headaches) but one might as well swallow one’s pride and take all the PCD referrals one can get for as long as one can and get them while building alternative sources of new patients and making a great living in the meantime in our opinion! Looking and feeling like a “traditional” orthodontic practice is a great way to do this AND if you employ modern efficiency, modern techniques, modern scheduling and a modern mindset you can still have a massively successful and large practice within the traditional framework!

And, to be even more clear, when it comes to going “non-traditional”, there IS a great deal of immediate risk in going multi-location, multi-specialty and in bringing hygienists or PCDs (or other specialties) into an orthodontic practice because the resulting rancor among referring dentists can decimate your new patient flow. And the PCDs WILL be upset no matter what you say and no matter your intention. Different is bad in dentistry. Success is bad in dentistry. Both are feared and disliked by other dentists and this has a negative impact on your new patient flow if you are referral dependent.

In the light of all this, we would again advise you to continue to nurture PCD relationships as long as you can and get as many referrals as you can while working on alternative sources of new patients and gaining control over your very own patient base. Once you make the jump to multi-specialty the repercussions will be immediate and VERY dramatic – more than you anticipate. We would suggest you have significant cash on hand to weather the storm that can last for several years. We know this first hand because we’re in the middle of it still – years after declaring my intentions and hiring our first hygienists.

Probably the worst idea I’ve heard of late is from orthodontic residents saying they will go multi-specialty out of the gate when they graduate along with recent grads of other specialty programs – they basically plan to set up together and declare themselves multi-specialty to the public. Where will they get their patients? I always ask! They have no clue. Again you have to have a patient base to go multi-specialty.

Finally, we must mention (in reference to multi-specialty practice) if you go that way you will be an outcast in your local dental community and probably beyond. I am hated in the state of Arkansas by not only PCDs but also other Orthodontists and especially by Oral Surgeons! It comes down to them being upset about not getting the work we keep in house these days, of course, but the discourse is always about ethics and how terrible a person I am. You will have the same thing happen should you decide to go multi-specialty, I guarantee. You’ll have to choose whose admiration and respect you want to earn and keep – your peers or the public. That was an easy choice for me. Of course I want to grow a successful business – I’ve never denied that and I’m proud of what we have accomplished!!! There is nothing wrong with being successful and I’ve found the best way to become so is to increase access and affordability to dental care and act in the public good even when my actions fly in the face of dentists and dental associations who act as protectionist guilds.

As an aside, I will say that if we were orthodontists graduating these days we would strongly consider buying one or more established dental practices and starting Ortho first and then a full-blown multi-specialty practice out of the PCD practice. In this way you would have your own captive patient base and you would be referral independent from the beginning so you would never suffer in a changeover from being dependent on the referrals of others.

This is a large and interesting topic and the importance of this discussion will only grow as time passes. There is no right answer of course. We all have to figure out what works best for us! I look forward to your feedback!