The principal of a medium-sized dental practice in middle-England e-mailed me recently with a list of the difficulties he was experiencing whilst trying to grow his 4 surgery, mixed NHS/Private practice by hiring another associate dentist.
In particular, he observed that in his area:
- Dental nurses are as rare as hens’ teeth to recruit and agency fees are putting up costs dramatically. He needs to add £5.00 per appointment from next week to cover the additional cost of agency nurses compared with having a full complement of his own staff.
- His current staff want the equivalent of 10 – 15% pay rises
- The associate dentists he meets are happy to plod along and there are fewer available to recruit
- Compliance/HR requirements are ever growing
- His team don’t want to work the hours that patients want to be seen
- All of the responsibility of offering evening and Saturday appointments is falling on him
He summarised the way he felt as, “like a dog being swung around by its tail…”
I know that there are many other practice owners who are similarly frustrated and, for once, I believe the answer for these folk is to forget growth, forget always looking to increase the practice size and asset value and instead consider: downsizing the practice, simplify the practice, say goodbye to the associates and some of the staff and go small. If done carefully, this can create a much simpler-to-run practice, which is far more profitable, much less stressful and requires the owner to spend less time at work.
In a conventional private practice, a full time dentist requires around 800-1,100 adult patients (depending on the type of dentistry being done) to fill their diary. This equates to 8-11 check ups per day, in order to see these active patients twice a year. Any more active patients than this and the daily gross fees are held back by too many check ups in the diary and not enough room for treatment.
However, a lone dentist can look after 1,500 or more active patients if they utilise a delegated clinical model. There are various versions of this operating successfully in practices we have worked with and essentially the model uses these tactics:
- Check up appointments are hosted in the hygienist’s surgery during an extended Hygienist appointment. The dentist visits the hygienist surgery to examine the patient usually after the hygienist has completed any periodontal therapy. The hygienist might also take clinical photographs, radiographs, take impressions for study models or whitening trays etc.
- Basic intrinsic restorations are carried out for patients by a skilled dental therapist.
- The dentist carries out more complex restorative, prosthodontic and surgical dentistry (some dentists also have a clinical dental technician on their team) and of course, they examine, treatment plan and treat the new patients.
Here are some typical figures for this clinical model:
- Dentist/Principal: 4 clinical days/week, £1,800/day, 44 weeks/year = £317k/year
- Therapist: 3 clinical days/week, £750/day, 47 weeks/year = £106k/year
- Hygienist: 3 clinical days/week, £750/day, 47 weeks/year, £106k/year
- Total Gross = £528k/year
- Direct Costs = circa £140k/year
- Overhead (2 surgeries) = circa £240k/year
- Net Profit = circa £150k/year
- Practice open 5 days/week, dentist works 4 days/week
The advantages include:
- Relatively simple to run
- Patients receive an outstanding clinical service from a close team of 3 skilled clinicians working together
- The practice is not dependent on associate gross or good associate behaviours
- No NHS regulations to comply with
- Hygienist and therapist are employed avoiding any potential self-employed prima donnas
- Clinicians are having interesting days
- Both the clinicians and the patients enjoy the team approach
The disadvantages can be:
- Not enough in-house emergency-cover when the dentist not present
- Once full, no easy potential for growth (unless you set up another team of three clinicians)
- Will likely attract a lower sale price than a more conventional practice
I have seen this clinical model work extremely well. The dentist feels in control, the patients feel well looked after, it’s easy to set and maintain clinical standards and if the appointment books are properly managed and the expenses controlled, the net profits can be greater than in a more conventional practice.
Dentists who run practices in this way accept that they may not sell their practice so easily or for so much, but they enjoy the high income and the smart ones grow assets from their surplus income.
This model is certainly not for everyone and choosing to work like this is really all about taking back control of your practice and reducing the stress that can accompany owning and running a bigger, more complex practice.
It’s also about whether you want to risk being the dog being swung around by its tail…
If you would like to find the right clinical model for you, or get back control of your practice and your life, then please contact me for a chat.
m. 07770 430576