GAP Magazine Clear Idea Volume 5

26 www.acasociety.com | info@acasociety.com I n this day and age, many practitioners are learning orthodontics and starting cases in a general dental practice – and whilst they may not own the practice they are imposing a significant liability to the practice principal, who is usually unaware of these potential issues. I personally think it is excellent that dentists learn about orthodontics, from a diagnostic point of view and even how to perform treatment – but everyone must have their eyes fully open as to the possible consequences of commencing orthodontics in a general dental practice where the practice owner is not equipped for orthodontics, or doesn’t have the knowledge, expertise or possibly the passion to continue a patients ongoing treatment. Having an associate/assistant dentist in your practice can obviously be very rewarding – but what happens when an associate/assistant leaves your practice and he/she was looking after hundreds of active orthodontic patients who still require ongoing active treatment – and these patients will also need monitoring in their retention phase of therapy. Orthodontics has many nuances which are different to those in general dentistry. These “orthodontic nuances” include: a. Patients in treatment for an extended period, anywhere from six months to 3 or 4 years or possibly beyond. b. Once active orthodontic treatment is finished, these patients still require monitoring of their retention phase of therapy which should be for a minimum of a further two years after completion of active treatment. c. Patients who may have paid in full for their treatment or prior to finishing active orthodontic therapy – hence their payments do not relate to the actual treatment (work)performed. This is a unique situation in dentistry, as all other dental procedure’s payment usually equates to the work performed – but this is not generally true with orthodontics. d. There are significant extra expenses for a practice to incorporate and integrate conventional orthodontics – EG. brackets and possibly specific individual patient brackets, archwires, special orthodontic pliers, orthodontic bands etc and the question becomes who should pay for these items and does the usual % commission need to be adjusted ? e. If an assistant dentist uses a hygienist in the form of an orthodontic auxiliary (to help increase their own income), the hygienist is now no longer an income producer for the practice owner – and should be remunerated by the assistant. f. Who takes on the responsibility of the patients continuing orthodontic care? g. Orthodontics requires a thorough diagnosis and treatment plan – and who is responsible if the new treating practitioner feels uncomfortable with the initial treatment plan adopted by the departing dental practitioner, the mechanics utilised or the finishing that will be required? By understanding these potential issues, my aim here is to provide some reasonable solutions to save everyone a lot of heartache. 1. If the dentist is using a bracket system specific to an individual and cannot be used for other patients (e.g. A dedicated POS system or Insignia) in general, this should be allocated as a laboratory fee 2. If the dentist is using a hygienist in the practice, in the form of an orthodontic auxiliary, this should also be allocated as a laboratory fee— but take into account all “on costs” such as superannuation, workers compensation, entitlements including holiday pay, sick leave, long service leave and an appropriate management fee to the practice principal 3. Due to the extra costs of adding orthodontics into a practice, rather than the conventional commission rates of 35 to 40 %, this should be reduced for treatment of orthodontic patients by a minimum of 5%, and preferably 10% A very detailed agreement between the practice principal and the assistant dentist is required, outlining the terms of employment. With regards to orthodontic treatment remuneration, this should be based on work performed rather than payment on receipts. This would mean that when a patient finishes active treatment, there still is a further two years of retention that is required, and using the Australian Society of Orthodontists (ASO) guidelines, 20% of the total fee would be allocated to the retention phase of therapy. In addition, this would allow a fair adjustment for those patients who have paid in full at the beginning of treatment with the assistant dentist having been paid for the total treatment yet has not performed that amount of work! 4. In addition, this agreement should specify exactly who is responsible for the ongoing care of that patient, and from an ethical and moral point of view it should be the initial practitioner, and hence it should be their responsibility to maintain treatment for all orthodontic patients until their ultimate completion- and if not, some form of remedy / remuneration to the practice principal needs to be in place. These are all commonly asked questions, and I believe it is best to be proactive and have all contracts in place, and not “shut the gate, once the horse has bolted”! Please contact me by email if you would like to discuss your individual circumstances as I am here to help you succeed. Dr Geoffrey Hall Specialist orthodontist B.D.Sc(Melb) Cert.Orth( Uni Of Penn) MRACDS (ORTH) Director OrthoED Institute Ph: 03 9108 0475 geoff@orthoed.com.au How does a practice principal deal with an assistant dentist performing orthodontics in their general dental practice? By Dr Geoffrey Hall Dr Geoff Hall