Simon Palmer, January 2005 - Specialist practice management is usually paid little more than lip service in the world of practice management in Australia. Specialists are often painted with the same brush as GPs by seminars and consulting companies alike but the difference in their business structures is considerable.

The specialist/patient relationship has important differences from the GP/patient. How many businesses do you know have clients coming in who don’t know why they are there or even what services are on offer? Regularly we hear of GPs referring patients to a Prosthodontist or Periodontist or Endodontist (for example) with very little explanation of what it is that that specialist does. As a result the patient turns up completely ignorant about why they are there, causing embarrassment and confusion for all parties.

The 2-client paradigm
In order to properly manage a successful practice, the specialist has to be aware that they have two client relationships that need to be maintained and satisfied. The patient is obviously one but perhaps just as important though, is the other client - the referring GP. If the specialist has a good relationship with the GP they will quickly streamline their referral process so that patients are passed between them effectively and efficiently in order that communication gaps like the one mentioned above don’t happen. Just as important, if the GP is happy with the Specialist’s work and their relationship:

• The GP will refer other patients.
• The GP may start to refer exclusively, rather than on occasions.
• The GP might even refer other GP referrers.

Losing a GP referrer can have an enormous impact on a specialist practice, much more so than a GP practice losing a patient. How much more? Lets look at the twenty-year value of a patient for a GP and then compare that to the twenty-year value of a GP referrer to a specialist.

Let’s say a patient comes to his GP for active maintenance scale and polish checkups diligently twice a year at $140 a time with x-rays taken every two years at $60. After twenty years this patient has spent $6400 at the practice ((140 x 2 x 20)+ (60x10)= $6400). When you consider a few basic fillings and other procedures that the average patient needs in a twenty year period, it’s not unreasonable to bring that figure up to around $10, 000.

Now lets look at the twenty-year value of a solid GP referrer to a specialist. Let’s say a good GP referrer refers 20 patients a year to the specialist and each patient is worth $5000 to the specialist. After twenty years the GP has brought $2 million in to the specialist practice ($5000 x 20 x 20 = $2,000,000).

This means that a solid GP referrer is potentially worth two hundred times more to a specialist than a patient is to a GP and losing a GP referrer therefore could make two hundred times the financial impact. Specialists need to be mindful of this and make sure that they have systems in place in order to maintain their relationships with referrers. This can be as simple as making sure that the GP is kept up-to-date on the referred cases at every step of the treatment and establishing systems so that contact, communication and rapport is maintained in other times.

Building and maintaining rapport
Many specialists we consult to have a lot of success engaging themselves in ongoing marketing to maintain this rapport with existing GP referrers. This is very different from GPs marketing to patients. While a GP has a large number of potential patients to market to and has to use a wide-net approach, the specialist is somewhat advantaged in that he is marketing to a small group (GPs) allowing for a focussed and sometimes more personal approach.

Some of Prime’s specialist practices have had success running study groups and/or clinical courses for their GP referrers. Sometimes they have an ongoing newsletter to referrers and dentists in the area to keep them in the loop about any new techniques, or new technology they are employing. Occasionally they may have social evenings where they invite referring or potential referring dentists in order to see them in a non-clinical environment.

Maintaining good relationships with a referring GP becomes trickier if the specialist feels that the referring GP is clinically not up to scratch. The specialist may respond by sub-consciously (or consciously) communicating his lack of faith in the GP’s abilities either to the patient or the GP somehow. Either situation will sabotage any rapport that the specialist had with the GP and potentially lose them as a referrer. The situation needs to be handled and communicated with extreme sensitivity and discretion.

While many practice management principles apply to the GP and specialist dentist alike, the specialist’s two-client paradigm obviously adds another layer to how a specialist needs to look at many aspects of his business. The different value of a referring GP to a specialist and different ways of building and maintaining rapport are just two places where this impact is felt. In part two of this article, we will be exploring how specialist practice transitions are to general dentist transitions.

[Published Australasian Dental Practice, January/February 2005]