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Important Factors to Consider when Transitioning into Private Practice

The ACP Private Practice Committee is pleased to introduce a new series of articles for members in practice -- written by prosthodontists, for prosthodontists.

These articles are intended to share tips and wisdom that members have picked up from their experience in practice -- with useful ideas for prosthodontists new in practice and those who are further into their careers.

Contributed by: Dr. Sundeep Rawal

This is a very exciting time to be transitioning into private practice prosthodontics. We are in the midst of a renaissance in our profession, mainly due to the advent of technological innovations in dentistry, specifically restorative therapies, and our new guidelines that all residents be competent in the surgical placement of dental implants. 

With this in mind, I believe that these are the two main factors that a new graduate must consider when looking at career opportunities. We must surely look at individual practices in terms of the clinicians in the practice, the overall philosophy, and culture that pervade them; but these two “new” factors must be considered, as they will set the tone of your career. The first thing to consider is whether or not the new graduate plans on incorporating the placement of dental fixtures into daily practice. When I graduated, prosthodontists by and large did not place dental implants. Sure, there were clinicians who have for many years, but as a specialty this was not the case. I believe that the dialogue has changed today and this must be factored in when deciding on a career path. If a new prosthodontist is seeking to join an existing practice, you must ask if that model would support incorporating surgical placement of implants. The critical factor is how much of the existing practice is based on referrals from other specialists that place implants such as oral surgeons and periodontists. In my case, I joined an established practice of over 30 years with strong ties to such referrals. From my perspective, it did not then and continues to not make sound business sense for me to place dental implants. Financially, any economic incentive I would create by placing implants would be offset by the loss of restorative referrals from my oral surgeons and periodontists. This is something that is individual to the specific practice, the geographic area, and the culture of the dental community within that area. 

When evaluating practices to join, the nature and strength of the referral base must be considered. Expanding on this point, deciding whether or not to incorporate the placement of implants into your practice is critical if you are planning on starting a new practice from the ground up. With a new practice, there are no existing referral networks to factor into the decision. However, this one decision will set the tone for the practice. Those prosthodontists who choose to place implants in a new practice will probably gravitate to a more direct to consumer model rather than the “traditional” referral based model. This is not a dialogue to espouse one model over the other but rather to highlight that this must be considered when opening your own practice and evaluating the area and community you are choosing to be in. Both models can be highly successful, but both are very much affected by local factors specific to the local community.

The other decision the new prosthodontist must entertain is how much of an investment in technology they will make or how much technology is already incorporated into an existing practice. We are faced with an ever-evolving dynamic in prosthodontics today where technology is allowing us to innovate to treat patients better, faster, and with more predictability. All of this is predicated on technology, but that technology comes with significant capital expenditures. Whether joining an existing practice or opening up a new one, decisions need to be made as to which technologies to invest in. There is CBCT, intraoral scanners, CAD/CAM lab acquisition scanners, milling machines, and printing machines that can all contribute to the growth of a practice, depending on the workflow the prosthodontist chooses to use. The key point is that we must live in this technological world to be competitive and efficient which means investments must be made. There is already significant investment to be made to either update existing practices if necessary or build out a new one and these innovations are an added but necessary expense. So the new graduate needs to look at this when deciding the best fit for their career. Joining existing practices that have already incorporated these newer technologies may be very beneficial as it minimizes new expenditures, not to mention having incorporated those technologies into existing workflows. At the same time, building a new practice with these innovations in mind allows you to create a nimble, versatile practice that can easily adapt as these technologies change or are updated. No matter the model the new prosthodontist chooses, this issue must be thought through and factored in for future growth and development.

These two factors, whether to place dental implants and technological investments needed, are in my opinion the most important factors to consider when deciding the best fit as you transition into private practice.

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