How to Set Your Practice Up For Success
By John Nale, DMD, MD, FACS
When I first arrived in Charlotte, North Carolina, I knew I wanted to perform major surgery—not just remove teeth and place implants. I had just finished years of training and certainly did not want to limit my scope of practice.
Quickly, I realized that there were no providers in the city that focused on surgery of the Temporomandibular Joint (TMJ). Fortunately, I had decent training in TMJ surgery in residency and was excited to incorporate this skill set into my practice.
Often, surgeons enter private practice with a similar desire to perform major surgery. What they soon realize is that it takes a team of administrators to help with scheduling, insurance approval, and reimbursement. Thankfully, my practice has an administrative team that has been in place for over 25 years. Not only that, but they have developed the appropriate relationships and know-how to negotiate high reimbursement rates for major surgeries. If I were on my own, my reimbursement rate would be a fraction of what it is currently. Not only that, but without multiple partners sharing the cost of the overhead, I would never have been able to afford the administrative team needed to facilitate major cases, especially early on in my career.
Another advantage of having a partnership with multiple surgeons was the mentorship that I received. It gave me great comfort to lean on the experience of my senior partners as I reviewed and discussed tough cases with them. From time to time, they would even assist me on some of my more challenging surgeries. Now, 12 years later, I continue to practice the same way, but now I’m the more senior surgeon reviewing cases with younger doctors.
Within a year I had a fully mature major surgery case log equating to about 10% of my total production. I was truly practicing full-scope Oral and Maxillofacial Surgery.
One day, I was talking with one of my partners about the amount of time we were wasting by not being productive, waiting for OR cases to turn over, and driving from the hospital to the office. We decided that with the combined knowledge of the partners and administrators, we could develop an in-office ambulatory operating room to help mitigate some of the financial and administrative burdens that hospitals create. We also discovered that this not only allowed the doctors to be more productive, but it created a huge amount of cost savings for our patients. A true win-win scenario! Now, a typical in-office OR day may consist of 3 or 4 general anesthesia cases with consultations or sedations in-between.
These opportunities have allowed me to really focus my energy on delivering top-notch patient care. In fact, I have been able to create and refine minimally invasive surgical techniques to the TMJ, which ultimately has resulted in improved outcomes and quicker recoveries. This has led to an ever-increasing, multi-state referral network and more patients than I could ever ask for!
Of course, I still enjoy traditional dento-alveolar surgery, but the opportunity to incorporate all aspects of my training into my daily practice gives me professional fulfillment.
I feel fortunate to have such a diverse clinical practice which would not have been possible without my partners and team.
John Nale
DMD, MD, FACS
Dr. Nale is a board-certified oral and maxillofacial surgeon and is recognized nationally for his publications on TMJ surgery. His surgical interests include the treatment of TMJ dysfunction and jaw misalignment, and he practices in Charlotte, North Carolina.