Combining Different Practice Types in the Same Office – Podcast
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Session 27: Combining Different Practices in a Single Location
By Scott McDonald
Hello: This is Scott McDonald and welcome to the Perfect Place to Put a Practice Podcast
I get this question with increasing frequency and it is time to offer some thoughts on the issue of combining different practice types in the same office. There are two big reasons we think that this is becoming a hot topic. But before getting into specifics, I think I am going to catch some flak for my opinion and reasoning. There are people out there who are not going to like it. But before you reject me out-of-hand, let’s talk about the issues:
We are hearing about this more because office space is becoming extremely expensive per square foot. That is the nature of commercial real estate in the U.S. right now. This is especially true for locations that tend to have very good accessibility and visibility. These are the two functions that when combined, make for the most cost-effective locations. Therefore, as prices of properties go up, creative solutions have to be considered.
The other reason we get this question is the nature of professionals themselves. More and more doctors are getting married to other doctors. If you want to see the reason for this, Dr. Charles Murray in his controversial book, The Bell Curve, explains this trend and its implications quite well. We will get a general dentist married to a pediatrician and they want to know if the combination of practices is practical. Other times, we will see medical and non-medical practices consider going together.
To answer the obvious (and easy) question, the answer is, “Yes, almost all healthcare practices can share office space within certain limitations:
- Because patients will be sharing a common reception area, mixing very young children with older adults can have some serious limits. Children are children and no one has to make excuses for them when they act their age. But that does not make it easy for people who may be anxious about a procedure, are in pain, or are otherwise stressed to have to cope with the additional challenge of small children. Incidentally, this is true for teens who are asked to share a reception area with very small children. It is not a natural fit.
- The nature of the front office staff may be challenged when having to consider the significant difference between people who are on-time, short-term patients versus those who are coming in for repeated treatments. As an example, oncologists, periodontists, and orthodontists maintain a very long-term relationship with patients. oral surgeons, ophthalmologists, and endodontists have very short-term relationships with patients. Staff members have to keep in mind that they are constantly changing gears based upon the clinical needs and relationship expectations with their patients.
- The clinical needs of each practice type vary significantly. While one can claim that sharing operatory space is “no big deal,” in fact they can be. An obvious example is when orthodontic patients and pediatric dental patients are asked to share the same treatment rooms. The size and configuration of the chairs are different. The same is true with oral surgeons and endodontists. It always starts off sounding plausible, but treatment areas reflect the difference in treatments. An operating microscope does not disappear as easily as one might hope although we have spoken with several equipment vendors who claim that the have innovative solutions. I am sure they do.
And while I am sure that you have considered all three of these issues, they are small when compared to the biggest issue: Can you share a common “brand”? And here the answer gets much more difficult. This is due to the undeniable fact that different practice types have very different patient bases and referral bases. Let’s deal with the key issues:
- Primary Care Provider paired with a Specialist
One could assume that the relationship is understood at the outset by both doctors. There is often an unspoken agreement that the GP will refer work to the resident specialist. But there are times the GP may want to send the work to someone else. Relationships that existed long before the partnering can be in place. There are many times that the paired specialist does not like to do certain procedures or is not particularly adept at them. Reasonable or not, this can create friction.
On the other hand, a single general practitioner can rarely provide all the “work” necessary to keep a full-time specialist busy. Other general practitioners may be reluctant to refer work into an office where a competitor is working. The husband-wife, sibling, or parent-child relationship is doubtless well-known in time. Therefore, based upon strong anecdotal evidence, the relationship can easily be strained when one of the two seems to be hurt by the presence of the other.
- Different specialists working in the same office
At first glance, if we accommodated for the inherent challenges discussed at the beginning, different specialists should be able to get along well. But a warning is in order when it comes to specialists working together: not all specialties are compatible. On the other hand, some can be natural allies. Periodontists and prosthodontists can be quite compatible when we consider they often work independently from other professionals although their back-office staff are usually quite specialized. That makes for an interesting challenge to sharing clinical staff. Pediatric practices of all types seem to get along well in sharing office space as well. Still there are some practice types that may look compatible but may have a harder time than one supposes. For example pediatric dentists and orthodontists working together seems to be a trend on the rise. But it is wise to consider that they rarely treat patients of the same age group (granted, there are exceptions). More importantly, keep in mind that pediatric dentists are primary care providers. Orthodontists are true specialists. Neither is as dependent upon referrals from general dentists as they once were. In fact, we note that each tends to have a unique referral base and this can make uniting the practices in a common “brand” to be more of a challenge than one might suspect.
As a general observation, working with a family member can be wonderful. I know this because I have three family members working for my business. On the other hand, if the personalities are not compatible and expectations for practice well understood, it can be a challenge of challenges. In the next installment of this podcast, I am going to discuss prosthodontics. I am pretty sure I am going to make someone angry.
This is Scott McDonald on the Perfect Place to Put a Practice Podcast. Visit us at www.DoctorDemographics.com and let us know how we can be of service.
Thanks for listening.