Navigating Career Decisions in Dental Service Organizations: Practical Advice for Students, Residents, and Educators.

The dental practice market continues to experience unprecedented changes, including the increasing presence and influence of dental service organizations (DSOs)-corporate entities that provide support and practice management for group practices in such areas as financial operations, human resources, marketing, and legal services. At the same time, increasing percentages of new dental graduates are choosing to pursue an initial career path in corporate dental practices. As a result, new graduates and others making a transition into private practice are likely to encounter complicated, multifaceted variables related to associateship opportunities. Experts in dental education are articulating a need for more instruction in practice management, particularly related to DSOs. Accordingly, this Perspectives article discusses issues in five broad categories focused on vetting career decisions in DSOs: business systems; the dental team and patients; clinical dentistry; compensation and professional development; and ownership positions. In addition to explaining the importance of these areas, the authors provide specific questions prospective associates should ask in considering these career options. These considerations should be useful for students and specialists who are preparing for their dental careers and for the educators who help to guide them.

The Oregon Dental Market A Case Study.

This case study examines changes taking place in the Oregon dental care system. Data were obtained from interviews with senior executives from several delivery organizations. Conducted by the senior author (HB), the summarized interviews were reviewed by informants. Oregon Medicaid enrollees now receive medical! dental care in capitated managed care organizations. Several dental group practices that provide care to privately and publicly insured patients are growing rapidly.The largest local dental insurer has diversified into other health products, including management services for affiliated dental practices. The Oregon dental market is undergoing a major reorganization: (a) large dental group practices are expanding and solo practices are declining; (b) all Medicaid patients receive their care in state-regulated Coordinated Care Organizations and their contracted Dental Care Organizations; and (c) more dental graduates are seeking employment in group practices. Longer term, the dental group practice companies are expected to undergo some consolidation.Two key features of the Oregon dental market are the growth of large dental group practices and the reorganization of the dental Medicaid system.

A Comprehensive Health Group Practice Model.

Permanente Dental Associates includes 17 offices in the Pacific Northwest. Among the distinguishing characteristics of this model are a predominantly HMO structure and integration of care in a general medical program. Staff dentists are on salary and are largely relieved of the business details of practice. Ultimate control of the system is vested in a group of shareholders--the dentists who practice chairside. One of the shareholder-practitioners discusses his perspective on this system.

The Indian Health Service Model From the Treatment Perspective.

The nonprofit dental delivery model is appropriate for the needs of specific patient populations. The Indian Health Service is an example of how care can be provided where traditional fee-for-service and indemnity mechanisms may be insufficient. Separating care from management in this context gives dentists greater power over individual treatment decisions, increased choice of patient-relevant care options, and control over development of the practice model and its evolution. The needs of various populations groups and the funding or profit model inevitably influence the composition of the dental team and assignment of dental duties.

Group Practices and Partnerships: A traditional model that Fits Many Situations.

The traditional group practice model can take many forms, including general practitioners, specialists, and combinations, as well as solo practitioners sharing space and staff, partnerships, and other legal entities. These practices may share some or all staff functions, including contracting for some functions. The essential characteristic is that those treating patients also have full control over and often direct management of the business aspects of the practice. The most important requirements for success in this model may be a common philosophy of patient care and mutual trust regarding business matters.

Looking for the Right Balance between Dentist as Manager and Dentist as Care Provider.

In the quest to understand the implications of separating management and treatment, we must first examine the forces driving management decisions. By defining ownership and equity interest, we are able to isolate a critical factor in the decision-making process. Evaluating the spectrum of the different models of dentistry gives us insight into potential advantages as well as disadvantages that can arise. In private practice, an owner typically wants to see the business grow over a lifetime, while, on the other end of the spectrum, corporate dental companies may be prioritizing dividends, investment returns through speedy packaged sales, or other means of reporting progress to investors. Interestingly, each model of dentistry has shown strength and growth, but there is no clear path to what is deemed ideal.

Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network.

BACKGROUND: The growing availability of electronic data offers practitioners increased opportunities for reusing clinical data for research and quality improvement. However, relatively little is known about what clinical data practitioners keep on their computers regarding patients. METHODS: The authors conducted a web-based survey of 991 U.S. and Scandinavian practitioner-investigators (P-Is) in The Dental Practice-Based Research Network to determine the extent of their use of computers to manage clinical information; the type of patient information they kept on paper, a computer or both; and their willingness to reuse electronic dental record (EDR) data for research. RESULTS: A total of 729 (73.6 percent) of 991 P-Is responded.A total of 73.8 percent of U.S. solo practitioners and 78.7 percent of group practitioners used a computer to manage some patient information, and 14.3 percent and 15.9 percent, respectively, managed all patient information on a computer. U.S. practitioners stored appointments, treatment plans, completed treatment and images electronically most frequently, and the periodontal charting, diagnosis, medical history, progress notes and the chief complaint least frequently.More than 90 percent of Scandinavian practitioners stored all information electronically.A total of 50.8 percent of all P-Is were willing to reuse EDR data for research, and 63.1 percent preferred electronic forms for data collection. CONCLUSION: The results of this study show that the trend toward increased adoption of EDRs in the United States is continuing, potentially making more data in electronic form available for research. Participants appear to be willing to reuse EDR data for research and to collect data electronically. CLINICAL IMPLICATIONS: The rising rates of EDR adoption may offer increased opportunities for reusing electronic data for quality improvement and research.

Assessing production characteristics, influential factors and administrative policies in a multicenter dental organization.

BACKGROUND: In multicenter service organizations, managers often make centralized decisions without considering the effects of differing production characteristics and influential factors on each center. METHODS: In this study, the author examines differences in production characteristics and factors that influence production, as well as their likely effect on policy formulation, in a large, six-center dental group in the Chicago area. RESULTS: The results of the study show that the six centers (in two groups) exhibited two distinct production patterns, with three having logarithmic distributions and three having normal distributions. Production differences between the groups likely resulted from differences in managed care, staffing and dental procedures performed. CONCLUSIONS: Instead of being monolithic, the organization exhibited two types of centers, each with its own production characteristics and factors that influenced production. PRACTICE IMPLICATIONS: The study results suggest that large service corporations and }partnerships would benefit from conducting analyses of production characteristics and factors that influence production before making policy decisions that affect the entire organization.

Industry structures in private dental markets in Finland.

OBJECTIVE: To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. DESIGN: Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. RESULTS: Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. CONCLUSIONS: Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

A dear teacher.

We learn much of our professional expectations from colleagues, especially those we admire. This report describes one dentist's disappointment in extending the same professional relationship to an associate that he had experienced when he first associated. In the absence of a written employment agreement, the new associate set up practice a few minutes away, stealing staff and patients. The silver lining has been greater office efficiency and a richer relationship with patients and staff.