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Then and Now: Building 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. Paul Scruggs, Raleigh, North Carolina

It is often said, “the more things change, the more they stay the same.” As I look back on my 30 plus years in prosthodontics and how I built my practice, it certainly applies.

I graduated from UMKC dental school in 1981. At that time, our clinical requirements, particularly in restorative dentistry, were staggering compared to today. As an example, in my senior year, the clinical requirement for complete dentures was reduced from 10 sets to eight because they were having trouble finding enough patients. The prime interest rate was 18% and we had double digit inflation. It was reported that fluoride had solved the caries problem, and suddenly there were too many dentists and not enough patients.

After three years in the Army Dental Corps (to escape the economy) and a prosthodontic residency at UNC, I was ready to go to work. To make matters worse, Dental Economics reported that annual salaries for prosthodontists were actually lower than general dentists. With the extensive restorative training in dental school at the time, who would refer to a prosthodontist? But with excellent advice from some well-respected prosthodontists in the area, I decided to declare myself and my practice as specialist.

In a nutshell, it’s about building relationships! General dentists are concerned about their patients. That’s their nature and that’s why people go to them. They want their specialists to have that same respect and concern. If the patient goes back to them and says something like “they were not as nice as your office” or “they only care about the money”, you will never get another patient from that office.

The way you establish that trust is good old-fashioned networking. Go to the local dental society, take a leadership role, join study clubs, and get to know all the dentists around on a handshake and first-name basis. Do all of that before you ever ask them to send you a patient. When they realize you are a good person and you care for patients as they would, but have the additional expertise on that tough situation, they will form that partnership and refer.

This is hard work and at times it may not appear productive. But over time it will prove to be a solid foundation for your practice that simply can’t be bought with advertising and newsletters. I have also found it to be somewhat recession-proof because complicated problems and mayhem don’t go on vacation and don’t cease when the economy is soft.

It is imperative that your staff understand these tenets and live by them. In my case, it started out with doing the “no ridge” lower dentures before implants were around – and doing a good job at it. The doctors soon realized if I was willing to attempt that tough patient, who nobody else wanted to treat, I must be OK. Those relationships have been strong my entire career.

Part of any good relationship is communication. Letting the general practitioner know you have seen the patient – and particularly that you were able to complete the treatment to the patient’s satisfaction – is essential. They don’t want to know the details, but simply what the approach was and that the patient is happy. This is always best if written but if you actively socialize with these people at meetings or study clubs it can simply be a conversation letting them know what’s going on and their patient is being cared for.

Flash forward 30 years. My son is now a young prosthodontist. Social media has taken over human communication. Every dentist is an expert in everything and some would argue, there are still too many dentists. Then the ADA reports that dental spending trends are down. We endure the great recession. Sounds familiar, doesn’t it?

Well, young Dr. Bill Scruggs is president-elect of our local dental society. He participates in many of the local forums where today’s dentists interact. He is a member of several study clubs and is getting solid referrals from some of the dentists in the same way I did in the 80’s. It’s not fast and sexy but it works.

We have a newsletter that we send out several times a year. It features “before and after” photos of actual patients and has a small back story on why the patient was referred to a prosthodontist. We believe this is working and we are seeing an increase in the younger doctors referring.

Also, now that implants have greatly reduced the “no ridge dentures”, our practice has become the “go to” for problem implant situations such as broken and stripped screws, antiquated parts, and dissatisfied patients just as back in the 80’s but different. Again, treating the stuff that no one wants to treat. When a dentist can’t remove an implant screw and you can get them in that afternoon and solve it, you’ve earned an immeasurable amount of respect from that doctor, and you can look forward to referrals on future patients.

Combine these time proven networking concepts with good internal marketing, a pleasant staff, and a caring office environment, and in most markets you will be fine in a few years. It may not happen overnight, but if done correctly, it stands the test of time over other quick techniques.

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