When specialists do general dentistry

Dr. Chris Salierno enjoys being a general dentist. He enjoys the team approach to patient care, so he's happy to refer procedures to a team of specialists. But his love of the profession doesn't keep him from feeling uncomfortable about a couple of situations, which he explains here.

Apr 10th, 2017
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I enjoy being a general dentist. Sometimes I call myself a “restorative dentist” to make myself feel fancy, but it’s an appropriate term. I enjoy the team approach to patient care so I’m happy to refer procedures to a team of specialists, including Perio-Implant Advisory editor and periodontist Dr. Scott Froum. Together we share liability for patient care but, more importantly, we work together to give patients the best care possible. Terrific. Occasionally I come across specialists who perform restorative procedures. I don’t necessarily have a problem with that, but I have come across two scenarios that really bother me.

Let’s say a periodontist has the appropriate training to fabricate immediate-load provisionals for implants. If the referring general dentist prefers not to do this procedure and requests that the periodontist do it, that’s fine. The patient is getting the care he or she needs by the dental professional who feels the most qualified to do it. But I believe it’s critical that the periodontist then charge for that service. I’ve encountered spoiled general dentists who have provisionals and even final restorations fabricated for them by their periodontist, and then the GP gets to bill for it. That’s ridiculous! The periodontist didn’t want to stop the crazy train for fear of losing the referral. I say that’s a referral not worth keeping for moral reasons.

The second situation that troubles me is when a specialist completes restorative procedures without consulting the GP. I recently referred a patient to a periodontist for an implant. The patient ended up seeing another periodontist who subsequently extracted the tooth, placed the implant, and placed an immediately-loaded provisional, all without consulting me. I’m not as upset about the lost revenue from the provisional as I am annoyed that I will be inheriting the restorative phase from someone else. What if I dislike the provisional? What if I need to add or subtract material to further sculpt the emergence profile? I may end up in a tough spot, having to do more work for no additional compensation or having to ask the patient to invest more.

As I said at the beginning of this article, I love specialists and I value our relationships. The dental profession is certainly undergoing some significant transitions, but we shouldn’t turn on one another. If you’re a GP who relies on a specialist to do some restorative work for you, please allow the specialist to bill for it. If you’re a specialist who does restorative work for GPs, please make sure the GP is kept in the loop. We’re all in this together.

Cheers,

Chris

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