A patient who has been complaining of intermittent biting pain is scheduled in your operatory for a crown. This conclusion was decided after an image taken weeks ago revealed no abscess; however, you suspect a hairline fracture, and antibiotics were given just in case. As you start the prepping the tooth for a crown, the tooth fractures at the gumline -- now what?
Corinne Jameson-Kuehl, RDH.
Preparing to send a patient out to see a specialist can be a stressful task, especially if the visit put your schedule into the "running late" zone and you are kicking yourself that the production is not staying within the practice.
While the assistant and office personnel fumble through drawers attempting to locate referral pads, the patient asks how much it will cost and questions why you are not able to complete the procedure. In addition to the patient's concerns, you have your own anxieties: Did you educate the patient properly on this treatment procedure? Will the specialist communicate with your office? Will the specialist follow your treatment philosophy? After all, this is your patient and it is your responsibly to act within the patient's best interest.
Even if your practice is thriving, you need positive, comfortable relationships with specialists who you trust for those difficult cases. What are your criteria for choosing the best specialists, and where's the win-win?
The revenues for specialty practices have declined overall, according to a 2013 ADA Health Policy Institute research brief. Referrals have also declined, because of two main factors in my experience:
- The rise of corporate dental offices having a full specialty team within the facility
- More general private practices keeping periodontal therapies, prosthodontic, endodontic, and oral surgery services within the office
Private dental practices are still looking to recover after the 2008 recession, as Dr. Roger P. Levin and others have noted, so keeping higher production procedures in the office is appealing. Also appealing are the courses that are offered to general dentists to train on more specialty techniques, including everything from quick orthodontics to placing mini-implants.
“Filling your schedule with more efficient procedures ... could end up being more productive.”
Many specialty practices allow time in the day for same-day emergency appointments and are able to provide patient insurance answers quickly. This is a great option if you do not have the time in your schedule to pursue a challenging case. Although the patient who needs a difficult endodontic procedure may seem like high production, filling your schedule with more efficient procedures rather than a long, multiple-appointment case could end up being more productive in the end.
General practitioners often express a fear of the specialist taking more treatment liberties as another reason for not referring. One dentist told me about a patient who was referred to an endodontist: "It seemed every time I referred a patient to this certain endodontist, my patient would return with an implant, without my knowledge, from the periodontist who was in the same building [as the endodontist]."
I've heard this type of sentiment many times. Clear communication between the general practice and specialty practice is imperative. Are you looking for another opinion, or do you want the specialist to treat? Is the oral surgeon giving you a second opinion, or will that office be treating that suspicious oral lesion you discovered? Does the orthodontic office return the patients to your office for three-month orthodontic prophys, or do they preform them in their office? Do you want a periodontist or an oral surgeon working with your implant cases?
Both parties need to take the time to understand expectations and the preferred method of communication. What are the systems in place for information such as consultation fees and scheduling appointments? Will there be a same-day phone call or e-mail with current images and chart notes? These questions should be addressed and relationships formed with those sharing your practice philosophy long before attempting to locate a referral pad.
Corinne Jameson-Kuehl, RDH, has been involved in the dental field for more than 20 years as a private practice practitioner, business development manager, and dental staffing company founder and owner. She can be reached at email@example.com.
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