By Ted Anibal, Assistant Editor
Photos by Maureen Meadows, Birmingham, Mich.
Dr. Tom Pullman had been in practice for 20 years when he joined the practice of father-and-son team Drs. Erwin Madorsky and David Madorsky in Bloomfield Hills, Mich. Their philosophies of dentistry meshed well, and they wanted the same good things for their patients.
"We have a patient-oriented practice. Our goal is to provide high-quality dentistry in a caring and comfortable environment," says Dr. Pullman. "We practice all phases of dentistry including crown and bridge, implant prosthodontics, endodontics, orthodontics, and complete family care."
As Dr. Pullman joined the Madorsky's, however, working space quickly became cramped. Since the office was due for an update, this was the perfect opportunity to expand and update both the look and functionality of the office.
Their timing was ideal. The upper deck of the same building became available as a tenant moved out. "Moving to an upstairs suite in the same building provided the additional space we needed, and the wall of windows provides beautiful views to enjoy," explains Dr. Pullman. The new suite offers much-improved flexibility and flow, with equipment accommodations for both right- and left-handed dentists. This was another good reason to renovate, because Dr. Pullman is left-handed and the Drs. Madorsky are right-handed.
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The high-tech equipment and cabinetry complement the light and airy feel of the new operatories without compromising privacy. "We have open operatories allowing easy access, while still providing patients with adequate privacy. We utilize our wall of windows which provide relaxing and comforting views for our patients," relates Dr. Pullman. "Our new cabinetry provide an effective barrier between rooms, as well as optimal efficiency in the use of X-ray heads and other equipment."
The design and layout was a joint effort. The doctors incorporated recommendations from their DentalEZ/Star Dental rep, Patterson Dental, the construction contractor, and Mrs. Erwin Madorsky, who is an accomplished interior decorator. The doctors also had established preferences from previous experiences in office renovation, as well as knowing what works well (or doesn't) in day-to-day practice.
Photos by Gene Meadows, www.gene-meadows.com.
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The new office plan came together by balancing functional and esthetic factors with the existing shape and features of 3,000-square-foot space. Dr. Pullman explains, "When designing an office, part of it is what the space lends itself to, part of it is knowing what is needed functionally, and then, in our particular case, it was adapting our operatories to the great windows that we have here. It's kind of a long, narrow office, and one whole wall is beautiful windows that look out onto trees and sky. So we wanted to make sure that all nine operatories could take advantage of that."
Since the space is leased, DE&M asked what percentage of the renovation was done or paid by the landlord. "We hired a contractor. All that the building people did was give us a small allowance, which probably took care of one operatory." With the cost of dental equipment, this is likely the typical extent of a landlord's contribution to a dental office renovation.
Shared resources
Dr. Pullman describes the main features of the office and the way they are using the operatories as quite adequate for their needs. "Out of nine operatories, three are used by hygiene. The other six operatories are usually used by two doctors, but do allow for all three doctors to work comfortably on the same day if needed."
The team must be doing something right, because the practice is still growing. In answer to the question of future growth, Dr. Pullman says, "The office could possibly support one additional doctor. We have no additional space for expansion at this time, but do not anticipate that we would need more." Working with the three doctors are four hygienists, five assistants, and six front-desk personnel.
Photos by Gene Meadows, www.gene-meadows.com.
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The office is both inviting and efficient, but what do the patients think? Dr. Pullman responds, "Comments from our patients have been very positive; only a very few were concerned with the more open operatories."
Dr. Pullman says that the overall feel of the operatories is "roomy, with a very roomy waiting area. I think the front desk area is pretty good, but we could use a little bit more in the way of storage. If we had it to do over again, I would like to see our lab area maybe a little bit bigger. But overall, it's a very efficient setup. We have two bathrooms, and a staff lounge area that has a kitchenette. Could we use maybe another hundred or couple of hundred square feet for some more storage space? Yes, however, I don't feel that we're squeezed at all. It works very well."
Advice on office design
DE&M: What advice would you give to a fellow dentist who is thinking about a new design for his or her practice?
Dr. Pullman: Visit numerous offices — especially those that have been recently redone or built new. Get help from equipment manufacturers and suppliers, and go to dental shows to learn about equipment. Especially if you have been in practice for several years, you need to find out what improvements have been made in equipment design and functionality.
Adopting new technologies
DE&M: How important is technology in your new office? Was it a consideration when designing and building the office?
Dr. Pullman: Yes, it was an important factor. We needed cabinetry and dental units that could easily accommodate left- and right-handed dentists. Our DentalEZ rep provided great help in that area. We also needed easy access to the operatories for the CEREC machine. The cabinetry and equipment layout comfortably meets those needs.
DE&M: What new pieces of technology have you recently incorporated into the practice?
Dr. Pullman: We have installed televisions for both education and entertainment, and the CEREC 3. We previously had CEREC 1 and 2.
Photos by Gene Meadows, www.gene-meadows.com.
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Implant technology has changed and improved in recent years. So it's great to have an oral surgeon right down stairs so we can check angulation and other considerations on our dental implant cases. And they refer a lot of implant work to us.
DE&M: Your practice is not currently using patient-education software for case presentation. Do you think there may be a need for that in the future?
Dr. Pullman: I would eventually like to get into that. We have a very, very busy practice here. My partners have been doing this for a very long time, and they've got a huge number of patients. They don't need to sell dentistry too much. They tell their patients what they need, and their patients do it.
Now granted, imaging software would be helpful for some of the cosmetic cases to help patients get a better understanding of what we're recommending, but we're all quite busy, so we haven't really needed it yet. I would like to use it eventually, because it might present some of the anterior cases better, and I could get even more of those cases that I enjoy doing so much. But we haven't incorporated it yet, because in a sense, we don't need it. We do a lot of dentistry in here, and we're very fortunate.
DE&M: Would you say that your cosmetic cases are increasing? What is the current percentage of cosmetic cases in your practice?
Photos by Gene Meadows, www.gene-meadows.com.
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Dr. Pullman: It's difficult to say, because you've got both the anterior cases, which is what I consider the biggest category of cosmetic cases, and you now have cosmetic posterior cases. I do a lot of porcelain in the posteriors with my CEREC machine. So I consider that to be esthetic work too, even though it's considered all "functional." So to answer your first question, yes, it is very definitely increasing. There's no doubt about that. But what percentage it is — it's hard to say because I haven't checked the numbers in a long time. If I had to guess, I'd say at least 20 percent.
DE&M: Would you like your percentage of cosmetic cases to increase?
Dr. Pullman: Well, yes and no. I like doing esthetic cases, but personally I enjoy all aspects of dentistry. I enjoy endo; I enjoy ortho. So I wouldn't want cosmetic cases to increase at the expense of not doing the other types of cases, but ultimately, yes, I would like the esthetic cases to increase.
Enhancements and profitability
There are many reasons for renovating an office or moving to a new space — accommodation of additional practitioners, replacing old, worn cabinetry or unreliable equipment, lease termination, zoning changes, the opportunity for a better location, and myriad other considerations. However, there are always the financial considerations that go along with it. You have to make it worth the effort and expense.
DE&M: How has building this new office resulted in additional revenue? How has it affected your profitability?
Photos by Gene Meadows, www.gene-meadows.com.
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Dr. Pullman: We went from seven to nine operatories in the new office. The additional operatories allow better efficiency for the doctors and staff, and provides the ability for all three doctors to be working at once. So it provides all of this, with much better flow, including a more efficient front desk space. The combination of all these factors has led to higher revenues and profitability.
DE&M: Overall, has the new office turned out to be everything you wanted?
Dr. Pullman: Yes. I don't think we can come up with any major omissions or regrets in what we were able to build and create with this new space. It's a pleasure to work here.
To contact Drs. Madorsky and Pullman: Phone: (248) 642-8130
