Growth Trends in Dental Service Organizations.

There are a number of factors fueling the growth of large group practices managed by corporations across the U.S., including California. These evolving trends are shaping the dental profession and practice models in a variety of ways.

Drivers Advancing Oral Health in a Large Group Dental Practice Organization.

UNLABELLED: Three change drivers are being implemented to high standards of patient centric and evidence-based oral health care within the context of a large multispecialty dental group practice organization based on the commitment of the dental hygienist chief operating officer and her team. BACKGROUND AND PURPOSE: A recent environmental scan elucidated 6 change drivers that can impact the provision of oral health care. Practitioners who can embrace and maximize aspects of these change drivers will move dentistry forward and create future opportunities. This article explains how 3 of these change drivers are being applied in a privately held, accountable risk-bearing entity that provides individualized treatment programs for more than 417,000 members. To facilitate integration of the conceptual changes related to the drivers, a multi-institutional, multidisciplinary, highly functioning collaborative work group was formed. METHODS AND APPROACH: The document Dental Hygiene at a Crossroads for Change(1) inspired the first author, a dental hygienist in a unique position as chief operating officer of a large group practice, to pursue evidence-based organizational change and to impact the quality of patient care. This was accomplished by implementing technological advances including dental diagnosis terminology in the electronic health record, clinical decision support, standardized treatment guidelines, quality metrics, and patient engagement to improve oral health outcomes at the patient and population levels. The systems and processes used to implement 3 change drivers into a large multi-practice dental setting is presented to inform and inspire others to implement change drivers with the potential for advancing oral health. CONCLUSIONS: Technology implementing best practices and improving patient engagement are excellent drivers to advance oral health and are an effective use of oral health care dollars. Improved oral health can be leveraged through technological advances to improve clinical practice.

Will Large DSO-Managed Group Practices Be the Predominant Setting for Oral Health Care by 2025? Two Viewpoints: Viewpoint 1: Large DSO-Managed Group Practices Will Be the Setting in Which the Majority of Oral Health Care Is Delivered by 2025 and Viewpoint 2: Increases in DSO-Managed Group Practices Will Be Offset by Models Allowing Dentists to Retain the Independence and Freedom of a Traditional Practice.

This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.

Decision dilemmas and opportunities for the new graduate dentist.

Career options for new graduate dentists are changing because of economic and management challenges in traditional practice, the growing trend toward group practice models, enormous educational debt load and lifestyle expectations of the millennial dentist. While new dentists learn to survive and adapt to an evolving profession with many pitfalls, they also have the opportunity to shape the future of our profession.

The evolution of dental group practices.

Dentists and the dental profession are changing. One significant change in the deliver of dental care is the evolution of group practices to include networks of dental practices with central management by various service organizations that are owned or financed by private equity firms. This article discusses their evolution and potential advantages and disadvantages for dentists who join them. The article concludes with a prediction about the future heterogeneity of the dental care system.

Evolving trends in size and structure of group dental practices in the United States.

In this study, the authors examined recent trends in the growth of dental establishments and dental firms, including geographic location. In this article, they also present information about the demographic characteristics of dentists who work in a dental practice that is part of a larger company that delivers dental care in multiple locations. The number of dental establishments (single locations) and the average size of these establishments grew from 1992 to 2007. Large multi-unit dental firms grew in terms of number of establishments and the percentage of total receipts. Large multi-unit dental firms represent a small but growing segment of the dental market. Dentists less than thirty-five years old were most likely to work in a practice that was part of a larger company, and females were more likely than males to work in such a setting. The percentage of dentists working in these settings was also found to vary by region and state. The authors present a typology of dental group practice and suggest that future research should take into account the differences so that appropriate conclusions can be drawn and generalizations across categories are not made.

El PADI a examen de sus profesionales. La opinión de los dentistas concertados del País Vasco y Navarra / The PADI analysed by dental professionals. The opinion of dentists approved by the Health System in the Basque Country and Navarra

Fundamento. El PADI (Programa de Asistencia Dental Infantil), más conocido como el programa de capitación, comenzó en los años 1990 (País Vasco) y 1991 (Navarra). Durante estos trece años se ha generado gran cantidad de información que permite evaluar su proceso y resultados. El objetivo es comentar la opinión de los profesionales, y las expectativas de futuro. Material y método. En los años 1990 a 1994 los colegios profesionales realizaron encuestas para conocer la opinión de los colegiados respecto del programa. En 2003, la empresa CIES, por encargo del Ilustre Consejo General de Colegios de Odontólogos y Estomatólogos de España, realizó un estudio de satisfacción de los dentistas concertados con el PADI. Resultados. Al inicio, más del 50 por ciento tenía una opinión negativa del PADI, un 36-38 por ciento era escéptico y sólo el 5 por ciento lo apoyaba. En 2003, el 65 por ciento se manifiesta satisfecho o muy satisfecho con el programa. En una escala de valores de 0 a 10, el programa en su conjunto recibe un 5,9, la capitación un 4,7 y la cuantía de la retribución un 4,0. Los dentistas de Navarra se muestran más satisfechos que los del País Vasco. Conclusión. Los dentistas concertados están mayoritariamente satisfechos con el PADI, aunque la cuantía de las retribuciones es el aspecto más criticado. La mejora en la aceptación del PADI por los profesionales facilita su implantación en otras comunidades, si bien será necesaria la adaptación de la práctica profesional a estos nuevos escenarios (AU)

Group practice vs. solo practice--a dentist's view.

The percentage of dentists joining group practices has increased sharply in the past fifteen years. Many advantages to practicing in a group setting including social, clinical, and financial aspects have contributed to this change. Solo practice has become increasingly difficult for new dentists. Market forces as well as insurance changes have accelerated the transition to group practice. Multispecialty groups have particular features that have allowed them to become much more popular. The advent of dental practice management companies has fueled the growth of multispecialty groups and has created new business opportunities for dental practice owners.