Tag Archive: outsourcing

If you are a professional, you have experienced the scenario when someone is doing your job instead of you. Here we are not talking about others with equal credentials but about those that do not have them. Good model to explain the issue is relation between general dentists and orthodontists/dental surgeons in which first party plays a role of outsourcer and last one is outsourcee.

Yesterday I attended a meeting of General Assembly of European Federation of Orthodontic Specialists Associations – EFOSA. That body is top organization in Europe that represent orthodontic specialists. Among other topics, we have discussed about dealing with General Dentists that are practicing orthodontics. We have heard that in┬áCzech┬áRepublic orthodontic therapy is protected by the law, but this is not the case in other countries. There are countries where insurance companies do not want to pay orthodontic therapy to others but orthodontists and also those (like UK) where insurance will pay┬áwherever┬ápatient finds a therapist.

We are witnessing that in modern times we are deregulating many things. Perhaps we must not deregulate this issue, but to put it in the protected list you have to find a good reason. In USA, American Association of Orthodontists have done a survey where they wanted to show that the result of therapies done by general practitioners statistically differ from those done by orthodontists. The result showed difference, but without accepted significance. But that does not mean anything because in USA anyone that does orthodontic therapy is very careful because of the American legal system. Doctors that are not┬áofficially┬áeducated in residence programs are very careful: they choose only simple cases, they invest large sums to their education, they follow┬áscientific┬áliterature and they are counselling with orthodontists. All because of fear of mistake and in the end because of legal and financial consequences. We can see that effective legal system protects patients in this matter. In other parts of the world it is more complicated to determine doctor’s responsibility.

My opinion is that┬áthere is no legal instrument that can solve the problem. You can try to solve it by fighting it’s roots: to care about feasibility.

Why/where/when general practitioners are practicing orthodontics or dental surgery? After profound consideration you will see that in every case it is well linked to price levels. Everyday we can see more and more simplified approaches to medical and dental procedures. That is forcefully introduced by sellers of dental materials and equipment because they want to extend number of their customers to a larger group so they want to include general dentists to the business. New procedures help doctors to be quicker and to have better results in the end of any procedure. But, they also help general dentists to perform tasks previously reserved to specialists not because they are mean, but because they want to decrease their costs and to increase income, too.

In my experience, general practitioners basically do not want to do procedures reserved for specialists, otherwise they would finish a residence program. They only want to have excellent interdisciplinary team and not to lose money in vain. Specialists have to be aware that their services are required and that they have to be realistic and to adjust their fees. If your procedures simplify and/or your costs decrease, you have to consider changing of your prices, especially in the time of crisis. You have to be more reasonable and to offer good prices which will satisfy yourself, but which will not attract other dentists to start this unwanted behavior.

Be quick and well-informed. Be ready to make suitable deals for yourself, for patient but also for general practitioners. If you let them do easy procedures reserved to specialists, they will do more and more. That happened with dental implants and now everyone is inserting them. It is hard and very demanding to be a specialist. Specialists were educated to do complicated procedures and because of that they are recognized and well paid. But if they start to be overpaid, their dominion will decrease or in the extreme they will seize to exist.

The same story can occur in every other profession. What will happen if changing the wristwatch strap will cost you 100$ or if newspaper delivery 50$ daily? You know the answer: watch repairers and deliverers will be out of business!

I have been with my students in one dental laboratory today. Dental laboratories are some sort of outsourcing in dentistry which is: “the process of contracting an existing business function or process of an organization to an independent organization, and ceasing to perform that function or process internally, instead purchasing it as a service” (used from Wikipedia).

We have many students that are dental technicians, so they know procedures and how to “make something” in dental laboratories, too. Because of financial crisis it is very hard to start dental business in these days, so they asked me how to know where to draw the line between doing something by yourself in dental practice and sending it to a dental technician’s office. That is the same question in every outsourcing, in every business.

To facilitate thinking, you have some parameters regardless of business type.

First one are legal issues. There are some jobs that you can and others that you cannot do. For example: if you have need for biochemical laboratory you cannot do blood sample analyses because you’re not certified and that procedures are protected by the law. This is not the case in dentistry. Dentists can do nearly everything in dentistry in mostly all countries around the world.

After you have passed legal restraints you have to carefully choose procedures that are well candidates for outsourcing on economical basis. How? You have to calculate a ratio between costs and earning. Many entrepreneurs forget to calculate all costs and that tricks them to bring wrong decisions. It is easy to understand that you have to include costs like material, needed equipment and complicated education, but it is easy to forget to include production time. That last is important that distinct a dentist from dental technician. Dentists have much higher salaries on hour basis than dental technicians.

I have good contacts with my recent students that have finished dental medicine and are working for some time now. When they have problems, their problems are closely linked to the idea that “you have to use outsourcing as much as you can”. That is correct only if you have a lot of patients so in effort of saving time you can select “expensive” procedures for outsourcing. Under “expensive” I mean that if something is complicated, takes a lot of time, needs expensive equipment and cannot reach a high price it is a good candidate for outsourcing.

What do they choose for outsourcing? Great example are orthodontic retainers or plaster casts. In the beginning I teach them to do everything they can do because in first months they will have a small number of patients so it is not good to outsource something what is not needed. They can make plastic orthodontic retainers in dental office. The same thing are plaster casts made for analyses. The cost of plastic orthodontic retainers is around 100$ (for dentist) and they take 45 minutes of production per pair. The same procedure is for teeth whitening trays. If a young dentist has two patients in a day he cannot be feasible with doing of whitening with dental technician. Especially if he want to lower price to attract patients. Do not forget that one important factor is that young dentist has a lot of time to do anything so in the pause he can make simple not demanding procedures that technicians do.

Why this is all important? Because when you are a dentist or you are managing any other business you have to understand that you have the same goals: lowering the costs and production times in the same time with raising the quality. That will present you as a good and desirable service provider and in the end that will increase your earnings.