In a previous newsletter article, the issue of dentists not employing hygienists and the pros and cons of this decision were examined. Let’s take that topic a bit further. What is the impact on an existing practice when the dentist acquires a practice from a dentist who has never employed a hygienist? Thoughts of acquiring another practice probably conjure up thoughts of increased production which could in turn result in increased revenue. Though this would more than likely be the case, there are many other things to consider.
During the preparation phase of acquiring a practice, there is talk of how many active patients will be acquired, what the cost will be and fixing the acquisition date. There should be regard for how the acquired patients will be accommodated by the existing hygiene department. Typically, an increase in patients would mean an increase in production, but this cannot happen if the current hygiene team cannot accommodate the extra patients.
The number of patients being acquired is important, but it is even more important to learn how many patients are on the selling dentist’s active recall. If there are 1,000 patients on the recall system, the buyer needs to determine how many more days of hygiene the office will need to incorporate in order to keep these patients timely with their established recall interval, and then decide if or how the office can do this. If patients need two professional cleanings and periodic exams per year, you will need to add 2,000 more appointments annually. If the hygiene department works 48 weeks per year, the practice will need to see 41 more patients weekly. Seeing 10 patients a day would require four more days of hygiene per week.
The buyer needs to determine if the office has the staff and facilities available to handle this increased patient base and the flow of new patients who will expect to be seen within a week or two. Patients who need to change providers will appreciate being able to get in for an appointment in a reasonable amount of time; otherwise, they will call another office. They have no ties to the buyer’s office so making the decision to seek treatment elsewhere is not a difficult one. The buyer should take this into consideration if they are interested in increasing production/revenue by acquiring another practice.
In addition, the dentist should know if the seller employed a hygienist. If he/she has not, the recall appointment will be a new experience for the patient. It is possible they have not experienced scaling, periodontal charting or much else in the way of oral hygiene instruction from a dental hygienist. If there was a lack of professional cleanings by a hygienist, these patients more than likely will have large amounts of subgingival calculus and active periodontal disease. Scheduling these patients for recall visits must be reconsidered; you might schedule them for comprehensive examinations instead. Scheduling in this fashion will allow time for the hygienist or dentist to assess the needs of the patient thoroughly. If the need for periodontal therapy is determined this poses yet another hurdle. The patient has been seeing a dentist for many years and maybe has never been told anything other than, “Everything looks great!” Now, a new dentist is identifying problems. The patient has not developed trust in the new dentist and may be skeptical about what he/she is saying. If this situation is not thought about and handled properly, this can end up being another reason the patient may not continue to be a patient at the buyer’s office.
Prior to the acquisition, the doctor and team should determine how they will communicate these changes to the patients. Scripted answers to anticipated questions should be developed. Patients will inevitably ask why their other dentist didn’t tell them about this. The response should be along these lines: I cannot answer for your previous dentist, but as you can see from our examination there are pockets present now that are not normal in health. The advancement in periodontal diagnosis and treatment in the last few years enables us to treat this disease earlier and with less surgery. Fortunately, we discovered the gum disease and we may possibly be able to improve your condition.
Another common question is, “How could my gums be this bad? They don’t hurt.” Consider this response: Jane, gum disease is often painless until the final stages. Do you know anyone that has high blood pressure? That condition is often painless and until detected by your doctor may go unnoticed, yet it is certainly a very serious condition. Just as you would be concerned about your blood pressure and getting it under control, the same applies to the health of your gums and supporting bone. If undetected, the first sign of high blood pressure is often a heart attack. I would not want the first sign of gum disease to be the loss of teeth.
The team will need to be well-versed in the answers to questions that patients ask and allow the patient to co-diagnose dental conditions. If patients can see what the clinician is talking about, they will be more likely to understand what is being said. Having literature such as brochures available for patients to read will reinforce the answers given and will also help patients believe what they are being told.
Purchasing a practice requires thinking about more than an increase in production. If you are in this situation, be sure you do your homework to capture the existing patient base.
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