Looking at OMS – Podcast
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Session 22: Podcast: One more look at OMS locations
Hello. This is Scott McDonald and welcome to the Perfect Place to Practice Podcast. In this session I want to discuss some of the factors that are changing in one of the most challenging specialties in dentistry and medicine: Oral and Maxillofacial Surgery.
What I am going to say will apply to many healthcare practices that are dependent upon referrals from primary care providers. In the beginning of the modern era in which OMS practices were emerging as a true specialty, there were still a few general dentists who persisted in doing all extractions themselves but they were on the decline as they saw many problems with these procedures. Bone grafts were not a common practice and anesthesia was still an emerging study. While biopsies were being performed, most of the time they were being done by general surgeons and the outcomes were, well, not pretty. In these times, the primary factor in determining the viability of an OMS site was the number of potential referring doctors relative to the number of Oral Surgeons. The idea was that roughly 20 general dentists could support a single OMS. Granted, there was some serious wiggle room but this was not a ridiculous calculation.
Times have change and this calculous has evolved. One big reason is that dental consultants have been pushing general dentists to get all of the production money that they possibly can to mitigate their overhead. An empty chair was an asset losing money for the office. Therefore, for the vast majority of extractions, the GP felt inclined not to refer. Even in the case of full-boney impactions, there are still some GPs who think that the extra time and extra trouble are worth the effort the additional income. Granted, no one thinks that playing around, trying to find a root-tip in a sinus is not fun but, well, production is production, right?
Keep in mind that in these “old days,” the percentage of the population that would go for an asymptomatic third molar extraction was relatively small. Gradually, this percentage has increased. From a demographic point of view, the population acted more homogeneously toward oral surgery. Now, however, as society has become far more fragmented. This is a big deal. What is means is that the simple calculation of finding a site with a reasonable OMS-to-GP ratio is not as important as it once was. At this time, the change means that an ideal OMS practice must find a different type of patient profile to justify placing a practice. This may not seem like a straight forward phenomenon but it is. And, I want to make sure that I am being totally clear as to why. It has been just a few years ago, the calculation on the best site was quantitative. It is now more qualitative. The practice that is looking for a location in which to expand or to set-up must be directed by more than the ratio figure. At this time, there are three primary demographic factors that will define a good location:
- Age (you need a population of sufficient size that is 18 to 22 years old). Third molars erupting, right? But keep in mind that while college campus have a large number of these kids, they almost always go home to get treatment. Therefore, it is not just a matter of where they are living this second. It is also a point of where their PARENTS live.
- Education level of parents. Another way to think about this is that it takes a certain long-perspective that only education can give you in order to see why an otherwise healthy third molar should be removed. “Well, if it don’t hurt, why yank it?” Good question, Cleetus. Another way to think about this is to remember: preventive dentistry is almost exclusively becoming the domain of the well-educated.
- Household Income. Not everyone agrees with me but I think we have to consider the possibility that dental insurance plans are going to become more wary of providing funding for a service for asymptomatic teeth. In the good old days when doctors were on the insurance panels, they could justify insurance plans spending on wisdom teeth. In a complex environment of human resources fighting with providers, the bottom line is continually moving in favor of medicine at the expensive of dentistry and optometry. Therefore, finding a population that can afford its own treatments is desirable.
I assume you can understand now why we say that the biggest change in where to put an OMS practice is becoming more qualitative than quantitative. It is the quality of the potential patient base and their families rather than the mere quantity of GPs available as a referral base that is making the difference.
There is one last point I wish to make here: The size of the geographic area that an OMS can and should depend upon is changing. Because of the limitations on the referral patterns from primary care dentists, we are finding that a 10-minute drive-time may be insufficient. You may need to consider the next largest drive-time radius to determine whether the practice area holds sufficient population to support the practice. Stay tuned as we continue to examine these issues.
This is Scott McDonald and Thank you for Listening.