More of the Same
Retail clinics offer similar benefits as practice management firms for dentists,
and will probably get the same response.
Got a sore throat? Sinus infection? Sunburn? You could make an appointment with your primary care doctor, spend some quality time in the waiting room, see the doc for a minute or two, then lay down your insurance card or credit card. Or, you could go down to the local Wal-Mart, Walgreens or CVS drugstore, see the physician assistant or nurse practitioner, get your prescription (and get some shopping done while you’re waiting for it to be filled), then go home or back to work … all for $59, or whatever the posted price is.
Such clinics have been getting lots of press, and with good reason. The Convenient Care Association says that approximately 500 of them are up and running today. That’s impressive, considering the first such clinic is said to have opened in 2000. In April 2007, Wal-Mart announced its intention to open as many as 400 in-store health clinics over the next two to three years.
Perhaps it’s no surprise that primary care doctors are wary of the clinics. They worry that patients may not get the best care; they worry they will lose control of their patients, who need to be monitored regularly; and, no doubt, they fear the competition.
Do independent dentists face a similar fate? To a certain extent, they already have. For example, Mayfield Heights, Ohio-based DentalCare Partners currently operates more than 70 Sears Dental and DentalWorks offices in Sears stores in nine Southeastern and Midwestern states, according to the company. Calling itself "one of the first dental services companies," DentalCare Partners was established in 1981 and currently generates more than $100 million in annual revenues. Nor is it the only dental practice management company operating today. Yet for a variety of reasons, the dental market may never offer as fertile a field for retail clinics as medicine, according to observers.
Let dentists be dentists
The premise behind dental practice management companies such as DentalCare Partners is simple: Let dentists be dentists. "Between filling out forms, ordering supplies, making payroll and balancing the books, when do you have time left to practice dentistry?" asks DentalCare Partners on its Web site. A handful of other dental practice management companies are offering dentists pretty much the same thing. Some examples:
Heartland Dental Care, Effingham, Ill. Twenty-five years in the dental-
practice-management business, Heartland says it works with 200 affiliated dental practices and employs 1,761 individuals, including 243 dentists. Dentists can either affiliate with the company or allow Heartland to become a minority partner in the practice. "Heartland Dental Care recognizes most dentists would rather practice dentistry than run a business," says the company in its Web site.
Birner Dental Management Services, Denver, Colo. Founded in 1995, the company is a publicly traded dental practice management company that serves a network of dental offices marketed under the name of Perfect Teeth®. The company has 60 offices in Colorado, New Mexico and Arizona. "Perfect Teeth was founded on the simple premise of ‘Letting Dentists Be Dentists,’" says the company on its Web site. "By managing the business aspects of the practices, the affiliated dentists are afforded the time to provide quality, comprehensive dental care." The company provides accounting, accounts administration, benefits administration, information systems, insurance administration, management information services, personnel and recruitment, payroll administration, purchasing management, practice management services, tax management and training and development services to each managed office. In addition, Birner offers patients the opportunity to participate in different dental plans. In return for monthly premiums, patients receive care at varying discount levels.
Bright Now! Dental Services, Santa Ana, Calif. The company was established in 1998 with the merger of three existing group dental practices on the West Coast. It expanded in 2003 with the acquisition of Texas-based Monarch Dental Corp., and again in 2004 with the acquisition of Texas-based Castle Dental Centers. Today, Bright Now has almost 300 affiliated offices in 18 states, as well as the ConfiDent® dental discount program for patients. "Bright Now’s mission is to manage the time-consuming business functions of running dental practices, in order to free dentists to devote virtually all of their time to caring for patients by delivering quality dental care, superior service, and exceptional value," says the company on its Web site. In affiliated offices, Bright Now assumes responsibility for business support services such as finance, sales and marketing, information technology, human resources, purchasing, and real estate development.
Dental One, Dallas, Texas. Founded in 1995, the company identifies itself as an "affiliated group of individual dental practices bound together by the common goal of delivering world-class patient care in a convenient, friendly, caring, group practice environment." Local practices are named after some landmark or theme familiar to each locality, according to the company. The company offers an orthodontic training program to help general dentists expand into full orthodontic procedures. And, as with the other dental practice management firms, Dental One presents itself to dentists as their way out of burdensome administrative tasks. From its Web site: ‘Experience has shown that traditional solo practice isn’t what most young dentists think. Where they expect to find independence, they find isolation. Where they expect control over their time, they find their practice obligations control them. Where they expect high incomes, they find themselves drowning in debt obligations and overhead. Where they expect to hire personable, motivated, and loyal employees, they encounter incompetence, entitlement mentality, and embezzlement."
Comfort Dental, Lakewood, Colo. The first Comfort Dental was opened in Denver in 1993. Today, the company has more than 40 offices, primarily in Denver and outlying areas. Each Comfort Dental office is independently owned and operated by dentists. The company offers two reduced-fee dental plans for patients.
Not for micromanagers
Data on today’s dental practice management firms is hard to come by. (In fact, First Impressions tried without success to interview executives from four of the companies mentioned above.) But it’s safe to say that only a fraction of the nation’s dental practices — about 120,500 in 2002, according to the American Dental Association — are involved. At one time, it appeared that more might get swept up in the dental practice management frenzy. "There were a number of prominent management companies that did provide [non-clinical] services to dental practices in the early to mid-90s," says Mary Govoni, clinical consultant and lecturer, Jameson Management, a dental practice management consulting firm in Oklahoma City, Okla. "But they crashed and burned in a very public way a number of years ago."
That occurred for a couple of reasons, she says. First, dentists tend to work alone. Indeed, according to the American Dental Association, 63 percent of private-practice dentists work in solo practices, 21 percent work with one other dentist, and just 16 percent work with two or more dentists. (Data from ADA’s 2005 Survey of Dental Practice.) Dentists who owned their own practices in 2005 as sole proprietors or partners made up 90 percent of all private practitioners.
"The behavior style of dentists is typically controlling, micromanaging," adds Govoni. "In a large type of setting [such as the dental practice management firms], they’re not likely to give up control of things." On the other hand, professionals who want to retire but are unable to sell their practices may be attracted to the large practice management firms, she says.
As for retail medical clinics, ala the MinuteClinics in CVS drugstores, they’re not likely to catch on in the dental world either, says Govoni. Reimbursement is part of the reason; insurance and managed care play a much larger role in the medical world than dental. Another factor – even larger — is the dentist-patient relationship. "Dentistry is much more relationship-oriented than medicine, because of continuing care," she says. "Patients see their dentist or hygienist every six months. It’s really about having a relationship with a dentist or hygienist. Medicine is more event-based. This week, I have pink eye, and I need antibiotics. But I won’t need to be treated again for some time." [FI]
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