Both of these scenarios are no doubt repeated daily across our country and our profession. Dealing with the problems of your particular practice arrangement can be very frustrating. More than twenty-five years of group practice involvement has convinced me: Group practice is the best mode of dental practice, for now and to meet the challenges that dentistry faces in the future. Succeeding in group practice is not automatic. It can be fraught with difficulty. In this article I will lay out what I have found to be some of the essentials for achieving success.

#1. Understand your group's particular style or arrangement. This relates to not only how the group is owned, but how it is managed as well. Add to these the financial structure, or how the income and expenses are shared, and the physical space design. All of a sudden, group structure can get fairly complex. Don Clay of Vantage Institute has identified as many as 19 different group practice arrangements, which represent various combinations of the above. ("Opportunity Unlimited," Don Clay, Vantage Institute.) Don is the foremost student, teacher and researcher of group practice in the country, and I owe much of what I've learned to him and his writings. For simplicity sake, we can break all these variations down into four basic practice arrangements:

A. Individual vendor-centered arrangements: A collection of solo dentists running their own practices within a common facility, generally for the purpose of sharing overhead expenses.

B. Collective ownership arrangements: Multiple dentists sharing ownership in a single business on a generally equal basis. Sometimes referred to as a "true" group.

C. Closed ownership arrangements: The dental practice is "tightly held" by one person or a small group of owners who limit the ownership to themselves. The practice may employ one or many associates.

D. Outside ownership: Ultimate ownership is controlled by persons outside the dental profession, such as an insurance company, or one of the new dental practice management organizations that are actively acquiring and consolidating dental practices.

No matter what the group's arrangement, the important thing is to recognize it for what it is and draw on the strengths of that particular arrangement and try to avoid its pitfalls. The individual vendor-centered group must draw on the individualistic efforts and the originality each person brings to the group. It must avoid letting the group drift into anarchy where anyone can do what they want, when they want and the way they want.

The collectively owned group must support the team concept and demonstrate strong organizational effort. This develops a strong sense of oneness and harmony. The danger is that everyone can start to just "go along with the flow" and become complacent and indifferent. By just coasting, the group will not be in a position to face the changes and challenges that can come its way.

The closed-ownership group needs strong, inspirational leadership to draw out the best in the office staff. Leadership must be sensitive and concerned and avoid the common problem of being domineering, bossy or tyrannical.

The outside owned group must constantly strive to create a win-win situation for all the players - the owners, the employees and the patients, and to avoid the oft-seen problem of taking financial gain at everyone else's expense.

Coming to the realization of just what type of group you are and recognizing the various strengths and weaknesses associated with the type of arrangement you are in is a major step in moving forward to success.

#2. Develop both your mission and your vision. Write down your reasons for existence, including professional, personal and financial aspects. Don't do it all yourself. Get your entire staff involved in the process. If you want to succeed, you have to be able to measure your success. This involves establishing your mission, writing down your goals and the values your practice has and using this as a filter for future decisions. You want to be certain every decision is in concert with who you are and what you hope to become.

Create a vision for what you see the practice looking like in the future, be it five years, ten years, or greater. If you or your management team are the architects of the vision, be willing to share it with your staff - they are the ones you'll need to get you to where you want to go. Nothing is more discouraging than for a dental staff to have something dropped on them "out of the blue." Provide a vision and they will develop the tools and find the pathway to fulfill it.

#3. Provide effective leadership. The greatest danger to any practice arrangement is going into "cruise-control" mode, and this happens all too often. For the group practice, this spells the beginning of the end. Effective leadership does not mean you have to do everything yourself in order to get things done. It does mean being able to trust and turn over responsibilities to the staff, give them decision making authority where appropriate, and not jumping all over them if they sometimes make a mistake. Develop effective communication channels in the office via staff or department meetings, a staff bulletin board or newsletter. Turn over the day to day operational responsibilities to the staff so leadership can focus on the future and accomplishing the vision.

#4. Realize a dental group practice is now a health care company. Like it or not, we are now in the business of providing a health care service. We are no longer "just doing dentistry." As a business, we can draw from the successful management styles and theories that apply to all companies today. We can focus on great customer service, appropriate use of new technology, employee empowerment. It demands that we become students again, to learn these techniques and theories. But again, we don't have to do it alone. Help is available for dentists and dental practice administrators through professional organizations dedicated to furthering group practice. Information can be obtained from the following organizations:

The American Academy of Dental Group Practice
5110 N. 40th St., Suite 250
Phoenix, AZ 85018
(602) 381-1185
fax: (602) 381-1093
e-mail: aadgp@hibcc.org
www.hibcc.org/aadgp/aadgp.htm

Dental Group Management Association
#320, P.O. Box 42036
Phoenix, AZ 85080
(602) 465-5691
fax: (602) 465-5691

Infonet Academy
Vantage Institute
American College of Dental Group Administration
(information for all three available through:)
112 S. Kimball, Suite 182
Caldwell, ID 83605
(208) 455-7484
fax: (208) 455-7486
e-mail: qco@cyberhighway.net