Working for a dental corporate - Is it for you?
Corporate dentistry has taken an increasing share of the NHS dental market since the inception of nGDS in 2006. The largest player, IDH, has slowly and quietly acquired more and more practices and contracts.
The merger of ADP, with IDH will form a group of 500 practices with perhaps 2000 dentists with a 12% share of the dental market and an acquisition budget to expand this over the coming years.
It is increasingly likely that associates looking for a job will find themselves in a practice operated by a Corporate.
The dental market is now divided into four distinct sectors:
- The large corporate chains, such as IDH ADP and Oasis.
- Smaller corporates operating usually in one region of the country.
- Independently owned practice groups perhaps with one owner or partners.
- "Traditional” single site practices with either an individual dentist or partners.
There are several urban myths about dental corporates and I will explore these further in this article. Some of these myths have developed because of the steep learning curve and transition which has occurred in dentistry since 2006. Perceptions of “sharp practice” from corporates have grown more from the fact that they understood the new world better than traditional practices and focused on delivery of the very rigid contracts. Whilst some independents hung onto every word of hope that the CDO uttered about “baskets of indicators" and "incredibly flexible contracts", the corporates just got on with making sure contracts were delivered, developing their structures to win tenders, purchasing contract value and delivering that contract at a profit.
What has developed is a position where independent dental practice owners and groups have learnt the hard way what the corporates already knew - we are in a brave new world where delivering the requisite number of UDAs is vital to a practice’s profitability. Distinctions between corporate practices and independent groups are becoming less - the better corporates have begun to recognise that dentists are people, not mere performers. The more savvy independent groups recognise that they are not charities and systems and processes need to be in place to deliver the contract for a profit.
If we then accept that the distinction between a corporate and an independent practice is becoming more blurred then we can perhaps focus on where there are differences. It goes without saying that all practice owners want an associate who is a competent clinician, has good interpersonal skills, is motivated both clinically and to earn a living and who is reliable and will show long term commitment to the dental practice and patients in return for a fair remuneration. Practice owners do not always get this from associates - and just as practice owners are sometimes criticised, associates are not immune from making life very difficult for their contract holders. There is no doubt that there are associates in post now who should take a long hard look at themselves.
- Are they clinically up to date?
- Are they often in receipt of complaints?
- Are they still motivated – or have they become complacent?
- Do they offer good value for money to the practice or do they take a good UDA value for granted and not deliver good dentistry in return?
- Are they dental mercenaries in post to deliver UDA and offer no other commitment?
I say this because as we move into a situation where the bulge years are graduating there will be more young motivated dentists seeking a place in practice - dental unemployment is a distinct possibility (but is so difficult to predict with workforce migration and factors like early retirement and maternity/paternity leave having an influence on recruitment.) I suspect all practice owners will welcome more competition for places - I know in some areas of the Country practices interview associates – but in other areas it is definitely associates interviewing practices and availability of good associates can be a real risk to the practice.
Perhaps this will affect the UDA rate paid to associates - as practice overheads increase it will become very unusual for associates to be paid 50% of the UDA value - Corporates recognised there was little validity in this arrangement very early on - practice owners have gradually followed suit. What associates need to ask is, ”what UDA rate will I be paid?” - the range can be vast from as low as £8 to perhaps as high as £13 - but this variation can happen in any practice - corporate or independent - and unlikely to be 50% of the UDA rate.
With CQC registration costs and time commitments to comply, a 50% payment to any associate would seem to be a historic arrangement not based on any sound business model.What corporates will openly admit is that they are not so good at the personal touch for performers. You are likely to have to pay for your Christmas dinner and not so likely to get asked to the “bosses” house for a party! If an associate joins a small single site practice or a smaller regional independent group it is very likely that the practice owner will work either in the practice or in the area. Decision making and information will be seen to come from them, mentoring and clinical support will be available especially from those with a training ethos. Whilst the practice will have a practice manager it is likely that the associate will see the practice owner as their line manager, mentor trainer and friend. New graduates will often find a supportive environment to continue their development.
The situation in corporate practices is more variable. Some are FD training practices with a lead dentist who is the trainer. Others however have no obvious clinical lead dentist with a sort of every man or woman for themselves situation. The practice manager is more likely to be the associate’s line manager and, of course, cannot offer the clinical support that might be needed.
IDH has a good clinical director network of dentists who do give support and mentoring – but clearly cannot be on site that frequently - if you are experienced and can practise independently then working in a practice with no obvious clinical lead should not be a concern – you could become that clinical lead. But if you are a FD who has struggled to practise independently you do need to consider the support you will get from the practice you enter - be that corporate or independently owned.
In summary nGDS has brought many changes to NHS dentistry:
- It will take several years for its effect to be truly evaluated.
- Associates are now performers.
- Practice owners are now providers.
- Perhaps the choice comes down to personal preference.
- Does the practice feel right, is it CQC compliant, is there an adequate patient list and good support staff and what do you need from the practice as support?
Balance that with what you can offer the practice and you should find the right fit. If you want to influence how the practice is run and have more choice of materials then perhaps you need to work in a small organisation. Corporates by necessity tend not to vary their protocols and material availability which can cause frustration.
If you want to buy into the practice you work in then clearly the corporates are not for you - and that at the end of the day could define your decision. All practice owners need and want ethical hard working competent associates. If you are not one of those beware. One thing is certain - the proposed 2014 contract will bring new challenges as to how to pay associates. Pay per session, or per patient or per KPI? This could be a minefield - perhaps once again we will look to the corporates for guidance on how to pay - I will not be saying "bring back the UDA" - but Item of Service - that’s another story altogether!
Ian established a group of 4 practices on Teesside before selling to IDH in 2007. He initially worked as an associate and Clinical Director for IDH and has since established Alpha Dental Group in North Yorkshire with four partners operating from nine sites. He also has a private practice in Stokesley.
Dental Protection is the leading indemnity provider.
Find out more
Leave a Comment: