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Professional Courtesy Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

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Specialty Relationships:
Collaboration is Critical
– by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

This month the 2010 Annual American Dental Association Meeting convenes in Orlando, Florida. As I write this, one of the first hurricanes of the season is battering the East Coast; let's hope this is a tame storm season. The last time I went to ADA in Orlando, it was after Hurricane Jean. Very few dentists realize it, but there is a storm brewing in our profession as well.

There will always be turf battles in dentistry since general dentists are trained to be a jack of all trades and specialists are master of one. This fact is precisely why I chose to become a general dentist. I enjoy the variety of providing many different services to my patients, serving as the main point of contact for a family's dental needs and delegating the things I do not enjoy or lack the specialized training for.

I take this opportunity to offer a sincere thank you to each and every specialist I have worked with over the last 15 years. Thank you for your service to my patients. Thank you for complimenting my temporaries and referring patients that need a general dentist. Let's continue to collaborate for our mutual success.

Unfortunately, this pleasant picture is not a reality for everyone. I hear stories of patients referred for specialty care who have been absorbed into the practice where they were referred! There are specialists who resent the volume of procedures performed by their general dentist colleagues – viewing this as taking food out of their mouths or making false assumptions that general dentists cannot perform at a specialty level. These behaviors and attitudes are old and stale. It is time to embrace the present and focus on collaboration as technology brings more options and more complex treatment plans.

To the specialists who read this article – be patient. Don't criticize general dentists because they do most of the root canals in their practice and only send out the tough ones. Implant placement is one of the fastest growing segments for general dentists. While periodontists and oral surgeons don't jump for joy at this fact, it means that more implants are getting done and increased involvement in a procedure leads to awareness and ultimately more referrals. Furthermore, some of us are fickle and our obsession with a particular procedure won't last forever. Be there for the tough cases and we will send more as our practice grows. Don't ever keep a patient in your practice. This is a disturbing fact but there are many general dentists that have adversarial relationships with specialists because they have had patients disappear after a referral. While no office can "own" a patient, it is simple professional courtesy to send the patient back to the referring office after their treatment.

A recent survey of 246 general dentists¹ revealed orthodontists to be the specialist category with the best personal relationship with GPs, at 84 percent. Oral surgeons, periodontists, endodontists and pedodontists were in the single digits. This could be because of the simple fact that general dentists and orthodontists are less threatening to each other's livelihoods than the other specialties.

The revolution of technology in dentistry is blurring the line between general dentist and specialist. Advanced laser technology and techniques to treat periodontal disease show promise, and the improvements to imaging via 3D CBCT make planning implant cases an exercise in simple geometry. New technology and treatment options have made many procedures more accessible to general dentists. Specialists benefit as well. Make no mistake; this evolution will not replace the need for specialists. In fact, there should be more collaboration as no treatment modality, new or old is foolproof. Implants fail, root canals fail and some periodontal cases do not respond well to the usual treatments.

If you have taken a particular interest in procedures you previously referred, tell the specialist. Talk to them about some of your tougher cases and ask for help. You should also continue to send them cases because when you get stuck or have a problem, you will be thankful for an existing working relationship. There was a time when I did more root canals in my practice, but as I became busier with other things, I started to refer more root canals to the endodontist.

Don't lull yourself into a false sense of security – things will fail, patients will have complications and everyone meets a case that they cannot treat alone. When that day comes, you too will be thankful for your specialist colleagues. Don't wait for that day to start a working relationship.

Have a comment to share? E-mail: tom@dentaltown.com
References
  1. Lanmark Group Online Research Study conducted 7/2010 – 246 GP Dentists.
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