The uncommon Commons

A fashionable suite may be just what the architect ordered.

Susan Love

It`s no surprise that this is the best time to practice fee-for-service dentistry. Dental care, once relegated to pain relief and restoration, has become associated with a healthy lifestyle and is now considered routine. Public focus has shifted to wants-based dentistry, as evidenced by the growth in basic cosmetic surgery procedures - more than 750 percent in the last 10 years. This trend is expected to continue as the "Baby Boomer" generation ages and becomes more affluent.

Are you prepared to take advantage of this golden age of dentistry?

Dentistry`s upward trend

Unlike medicine - which has been impacted by managed care - the sanctity of the doctor-patient relationship is still alive and well in dentistry. This is one area of healthcare where patients have control over the providers they choose - and it is a power they exercise. Dentists who design offices that make them stand out from the norm are chosen more frequently than their peers who fail to create an ambiance that meets - or exceeds - their patients` high expectations.

That`s because patients have a new consumer consciousness. They expect superior service that meets the demands of their hectic lifestyles. The Starbucks, Lexus, and Nordstroms of the world have raised the bar in customer service and have shaped that consciousness. Now all service providers are expected to operate at levels of excellence never before imagined.

Patients today expect you to locate your office on a main thoroughfare with easy access. Touches of interior design and fresh plants must be apparent in your reception area. The most advanced equipment and treatment rooms that are attractive and well organized will be their basis for judging your abilities. Highly skilled and attentive staff members who are enthusiastic about the practice will be the rule, not the exception. In 10 years, patients will not remember the dental offices that did not meet these expectations.

Yes, there is an onus on you to create a practice environment that communicates quality in the mind of patients. A doctor who recognizes that his or her office is a tool to attract and retain patients - and not simply a cost of doing business - will profit from the positive trends in dentistry and renaissance in customer service

Challenges of developing a new office

Unfortunately, there has never been a more challenging time to develop an esthetically rich, fully equipped office with all the amenities that patients expect. If you have even considered building a new office in the last five years, you have faced daunting economic conditions.

Inflation and technology advances are the big factors. In 1982, a doctor who built a new four-operatory office could expect to invest $65,000 to $75,000 in equipment and leasehold improvements. By 1998, that investment had jumped to $250,000 for the same basic set-up, along with the essential computer system, practice-management software, and intraoral camera. Add air abrasion, digital X-ray, laser, and the litany of diagnostic and therapeutic tools deemed necessary to make a practice competitive today, and that total investment easily approaches $400,000.

Now, compound that with the inflated cost of real estate in most markets. Today, the budget of many doctors - especially those just starting in practice - can only buy space in a retail strip mall or the back of a professional building with limited parking. That budget does not allow for features - such as a kitchen, as well as a comfortable place for meetings and lunch breaks - which will attract and retain competent staff in today`s tight labor market.

The construction costs of a new office range from mind-boggling to terrifying. The architect, contractor, and equipment and furnishings vendors will drain all of your time for three to six months and, chances are, your money as well. A possible solution is finding a partner to help share the costs and development tasks, but you fear this will cause you to relinquish complete control over your financial destiny and the practice itself.

Indeed, doctors wishing to build a new office have had to make tradeoffs. Choosing a prime location meant purchasing lower-quality equipment or a less-appealing office design. Opting for high-tech equipment left little budgeted for attracting high-quality staff. Such tradeoffs brought doctors` offices that were less than they expected - and less than they deserved.

Offering a new solution - Dental Commons

One company is meeting the challenge head-on. The Dental Commons offers doctors esthetically pleasing, private dental suites which are equipped with the most advanced technology. They are located in prestigious neighborhoods with easy public access. By leasing one of the four suites in the Dental Commons, doctors gain the ambience and technical amenities expected by patients without having to raise the capital to build the facility themselves, or lose their practice or financial autonomy.

"It`s a way to get an upscale, high-tech environment without all the upfront costs," said David Lamothe, DDS, who has been leasing a suite in an Atlanta-based Dental Commons since November.

The facility allows him to attract the most desirable patients to his growing esthetic practice. The décor and technology enable him to dazzle his patients with the "wow effect" when they walk in the door.

"Patients say `My old dentist didn`t have anything compared to you. You must really know what you`re doing,`" commented James McKinney, DDS, FAGD, one of the dentists with an established practice who leases a suite in the Dental Commons in Knoxville, Tenn. "It`s amazing what impresses people. They really believe they`re getting a better quality of dentistry."

The lease is sweetened further through three on-site Dental Commons employees who serve all the practices. That common staff includes a sterilization technician who manages the common sterilization center, a support services director who manages the property, and a patient representative who welcomes patients to the facility in the common reception area.

"There is a dedicated greeting area," McKinney said. "None of the financial discussions or scheduling takes place in that area, and that gives patients a better experience. It`s so comfortable that patients actually come early so they can sit and enjoy a cup of coffee."

If patients have any complaints, he said, it is that they get called to the chair before they have time to finish watching a segment on the Smile Channel or reading a magazine article.

The shared staff reduces a doctor`s practice overhead by cutting the number of employees that he or she must hire for the practice. Individual doctors provide their own instruments, materials, and patients. The Dental Commons receives a fixed monthly lease payment and does not participate in practice revenue or profits.

Yet, with all this autonomy, Dental Commons` doctors can also have the camaraderie of a group environment. With five full-time doctors, one part-time doctor, and a periodontist using the facility two days a week, McKinney has the opportunity to share success stories with colleagues and commiserate when practice problems occur.

The Dental Commons also fosters relationship-building with patients who are attracted to the facility by the ambience, high-tech equipment, and its convenient location. Placing the facility in prime locations that support the busy lifestyles of patients is part of The Dental Commons business strategy.

"New patients tell us they were first attracted to the practice because they saw the building on their way home from work or shopping," McKinney commented. "We have the best location in town because we are in the center of all the prime residential areas, as well as close to the shopping centers and the main exits off the interstate."

The value of location is also evident in patients` reasons for switching from other dentists to McKinney. "Many tell me they`ve changed to our practice because their old dentist is no longer convenient to them. I can`t think of a better place to be."

These features also contribute to production. According to McKinney, even the four established anchor practices in the Knoxville Dental Commons have experienced about 15 percent growth in productivity in the last two years.

That growth opportunity is also captivating to Lamothe, who sees the facility as a stepping stone toward his long-term goals: building a profitable, stress-free esthetic practice that will also enable him to retire with financial independence at age 60.

On the surface it may not seem likely that leasing a dental suite is a good investment, especially for doctors who believe that owning the dental facility is the only way to build assets. But, according to McKinney, not owning a building enables doctors to invest in other areas.

"It gives you a chance to be more diversified in your assets," he said.

According to Brian Hufford, president of Hufford Financial Advisors, LLC, the least appreciating assets of a dental practice are the tangible assets. "The greatest value is the practice itself - the patients and their goodwill, and their desire to remain with the practice. The tangible facility and equipment is a small part, other than from a tax standpoint."

The Dental Commons offers doctors all the advantages of a sophisticated practice setting with the most advanced equipment and resources. That`s a benefit not only to doctors just starting in practice, but to those in their middle and late career phases as well.

"For doctors who have been in practice for 15 years, it`s a way to own your own state-of-the-art practice without the high costs of building your own facility in an inflated real estate market," McKinney said. "What you gain in a modern facility and equipment is a real plus in what you add to the practice."

It`s also advantageous for dentists who wish to share facilities with other doctors so that they can reduce their weekly practice schedule. This is especially attractive to doctors who wish to devote more time to their families. It also supports doctors with successful fee-for-service practices whose revenue structures enable them to work less. And it is a perfect venue for specialty doctors to establish part-time satellite operations.

Clearly, what practitioners gain is the office of their dreams without the sacrifices. Dentists can focus more fully on dental care and building long-term relationships with patients, while having quality time for life outside their practice. It`s a logical office model for reaping the rewards of dentistry`s golden age.

The Dental Commons: High esthetics, high tech, high visibility

Currently, three Dental Commons facilities are in the southeastern United States, with several sites under investigation in Texas (including Dallas, Houston, and Austin) and southern California.

The interior perimeter of each Dental Commons is divided into four private suites that are designed to meet all of a dentist`s facility and equipment needs. The core of the building hosts numerous central services such as a reception area, front desk, restrooms, sterilization, laboratory, darkroom, supply area, and panographic X-ray room. The second floor is designed for staff and doctor use and includes a conference room, locker rooms, a break room, and private offices for each doctor.

For more information about the Dental Commons, call Bruce Broussard, chief executive officer of HarborDental Properties, LLC, at (877) 942-7267 or e-mail [email protected].

"There is a dedicated greeting area," McKinney said. "None of the financial discussions or scheduling takes place in that area, and that gives patients a better experience. It`s so comfortable that patients actually come early so they can sit and enjoy a cup of coffee."