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Should You Maintain a Referral-Based 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, Merritt Island, FL

One of the most important questions facing prosthodontists today is whether to be a referral-based practice or not. The landscape of prosthodontics has changed dramatically over the last few years in terms of clinical scope, and this has had a direct effect on our relationships with other specialists and the model we utilize in our practices.

Historically, by and large, prosthodontists have been focused on restorative aspects of clinical dentistry, and that has led to a “conventional” model of a referral-based practice with relationships among the other specialties.

Prosthodontists have developed interdisciplinary teams with our surgical colleagues in oral surgery and periodontics as well as endodontists, orthodontists, and pediatric clinicians as well. However, with recent changes – such as the advent of surgical placement of dental implants in prosthodontic practice – these practice models are evolving. Today, the prosthodontist must decide if he or she is going to build a referral-based model or be more “self-contained” with limited working relationships with other specialists.

The benefits of a referral-based model are numerous. First and foremost, working with other specialists allows the clinician to focus on specific aspects of therapy and share responsibilities which can be quite helpful, especially for complex treatments that are commonplace in prosthodontics. Furthermore, the very nature of working with others allows the prosthodontist to focus on those aspects of therapy that he or she enjoys and wants to do. This model can be highly successful from a business perspective in that the prosthodontist can cultivate strong networks wherein the vast majority of new patients are generated by other specialists referring cases. External marketing may be directed toward other clinical dentists, which can be cost-effective and efficient.

Traditionally, the strongest of these referrals have come from surgical specialists such as oral surgeons and periodontists, but other referral streams can be certainly cultivated within the clinician’s community, especially if the prosthodontist positions themselves as a resource to help other practitioners. This can lead to a referral network which also includes general dentists who view the prosthodontist not as a direct competitor, but as a colleague able to help in situations that are warranted or when the general dentist wants to be selective in the types of restorative therapies offered.

With these multiple types of referral mechanisms, the prosthodontist’s main focus with respect to cultivating relationships, marketing, office structure, and patient interactions are all centered around being of service to other dentists in the community.

However, as more prosthodontists embrace the surgical placement of dental implants in their own practices, referral relationships are changing. The prosthodontist must decide how much implant surgery he or she wants to perform, as well as when (or if) they are going to refer any aspects of the surgery to colleagues. As historically our biggest number of referrals have come from the surgical specialties, choosing to place implants and perform complex surgical procedures may have a negative effect on incoming referrals. This has a direct impact on how new patients can be generated within a practice and, in this case, it may be more effective for a prosthodontist to focus efforts in marketing directly to patients, not to referrals.

Direct-to-patient marketing is very different, with typically greater expenses and efforts needed. This is not to say that a strong referral-based practice should or would not also need to market directly to patients, only that a “self-contained” practice must do so for growth.

Two other interesting trends in the dental industry that are relevant when a prosthodontist is deciding on what type of referral system to utilize are the increase of surgical specialists who are undertaking restorative procedures within their own practices and the increase in general dentists who are bringing surgical specialists into their practices to perform surgery rather than referring directly to an established surgical specialty practice. These trends are of importance to the prosthodontist because they can help dictate what type of system would work best within the clinician’s dental community.

In the first situation, the prosthodontist who utilizes a conventional referral-based model can potentially become disadvantaged if the primary source of patient leads starts to diminish as more surgical specialists undertake restorative care. In this situation, having a more direct-to-patient focus while providing the surgical facet of therapy may prove to be advantageous. This is in contrast to the second trend of general dentists bringing in surgical specialists into their own practices. In this environment, the conventional referral-based model may be the more advantageous because stand-alone surgical specialists will have an affinity to refer and work with the prosthodontist versus the general dentist who employs an internal surgeon or periodontist within their practices.

The decision to refer or not therefore is critical for the prosthodontist to decide as this will dictate the nature of the practice. Not only will it affect marketing efforts and how new patients are generated, but if a prosthodontist wants to cultivate strong referring networks, he or she may need to limit the scope of their practice and decide not to do certain aspects of therapy such as placing dental implants. Coupled with the changing landscape where traditional boundaries of scope are being blurred, the structure of patient lead generation through various referral or direct-to-patient mechanisms must be weighed within the prosthodontist’s community to determine which model will be the most successful over time.

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