Now that you have all the elements to establish a great practice, what’s next? Many dentists look to bring in an associate to expand their practice or to have a little more time for themselves. Adding an associate brings a new dynamic to the practice. The associate may be the same type of practitioner or may have a different specialty. Over a short period of time a multispecialty practice may be formed with the right team that allows complete, all-phase dentistry to be completed in one office. It is extremely convenient if specialists are present in the same office as the general dentist and can treat the patient during one visit, especially if the patient has to travel a far distance for treatment. But let’s begin by seeing how to turn a general practice into a premier multispecialty practice where patients may come even from other countries for treatment, as they did for my former practice.

As the general practice grows, a wider range of treatment should be offered. Most times it begins with a periodontist and then you can add specialists as the practice is able to support each addition to the group. Along with the addition of each specialist, the staff has to become more proficient in the needs of the various specialties. This also brings new and unexpected problems that need to be addressed. With the addition of the associate–specialist, careful attention needs to given to independent contractor status as defined by the Internal Revenue Service (IRS) (see Chapter 19).

First and foremost, the general dentist is the team leader in that he or she must have excellent technical, diagnostic, and communication skills. Then the general dentist, usually the owner in such a situation, needs to have the office space to accommodate a multispecialty practice. Also needed are the patients to fill the schedule of all the dentists involved. So how does one bring life to such an endeavor? Find the right location.

The ideal location would be on a major roadway or other area that has easy access and visibility. Trying to start a multispecialty practice while hidden in the fourth floor in a large office complex is a large hurdle to overcome. Once the location is found, the next consideration is to have enough space for growth. Having 10 chairs/operatories may be excessive, while the minimum is six: two for hygienists, one or two for general practice, and the rest for specialists. However, if you plan on having orthodontics or a large pedodontic patient load, then a minimum of two to three chairs in an open bay is needed to accommodate the patients. One of the specialty rooms should be large enough to allow for sedation equipment and additional needed personnel for general anesthesia. The actual design to facilitate proper staff and patient flow throughout the office is beyond the scope of this section.

Now that the office is open in a great location, proper, professional, ethical marketing needs to be initiated. If you are the creative type, think of some ideas that could be marketable, write them, draw them, and take them to the venue in which you plan to promote your practice. Most magazines and newspapers have a talented staff who will be able to put the finishing touches on your ad. Advertising may not be the most favored vehicle to market your practice, but not to mention it wouldn’t be fair either. As the practice grows, the first specialist to incorporate is the periodontist, because most adult patients will have a need for periodontics and/or implants. The general dentist should then refer all periodontal patients, including those with simple or moderate periodontitis, to the periodontist, who will become an asset to the practice. There should be an increase in hygiene appointments due to the need for 3-month periodontal maintenance visits following scaling and root planing or periodontal surgery.

The next specialist to join the group should be an orthodontist or endodontist. Again, if an orthodontist is added, be sure you have the physical layout required for him or her to make that part of the practice efficient. The endodontist will need a room large enough to accommodate an intra-oral microscope. He or she will most likely need only one room to meet the patient load. Many general dentists are fairly proficient in endodontics. Howev/>