About 32% of Physician Offices are solo practice or two doctor practices. However, Physicians often belong to large Physician groups and Hospital networks. Within these larger organizations there exist more structured endeavors to measure and improve quality including the hiring of Chief Quality officers and the like. Additionally, research has demonstrated that higher volume hospitals have better outcomes. Recruitment into solo medical practice is falling as the larger hospitals thrive, however, the Dental profession is lagging behind this reform and failing to acquire the benefits of large group practices. Apart from the obvious benefits of economies of scale and greater leverage when negotiating with third party payers, there may be an unrecognized benefit – improved quality.
Even though evidence is mounting of growth in large group Dental practices and a subsequent decline in solo practice, an astonishing 58.0% of Dentists continue to work in a solo practice today. The problem with this is solo practicing dentists are not subject to quality improvement measures and have little cushioning against the threat of litigation. It has been known for decades that Dentists value autonomy and one Dental Practice may have enormous variability in processes, materials and methods compared to another. Yet, we cannot argue that one is, necessarily, superior to the other. This is both the strength and risk of the Dental Profession – the variety means every individual can find a practice environment and provider operating style that suites them, however, standardization and true quality gains remain elusive. Although provider consolidation is becoming more evident in Dentistry, the profession is significantly lagging in leveraging size of practice to reap a variety of other benefits including optimizing quality.
In terms of consolidation, a field that is ahead of Dentistry and Medicine is Law – the law courts are now considering other business models as liable for corporate negligence through vicarious liability. For example, Dental Service Organizations (DSO) have already been targeted for a lawsuit with the plaintiff alleging that the DSO is not only “managing” the practice but effectively “owning” the practice too. However, anecdotally, the Dental Profession considers DSO’s to be a non-clinical manager of your practice which is in conflict the above mentioned lawsuit.
To standardize, improve quality, improve efficiency and reduce cost the Dental Profession needs to embrace and move toward larger group practice models.