DDS Referrals vs. Patient Referrals?
Just as a continuous supply of nourishment is a requirement for the survival of the organism, a continuous supply of referrals is a requirement for the survival of a referral-source orthodontic practice. It is the lifeblood of such a practice, and efforts to gain referrals may be the most fundamental practice management activity.
A number of authoritative voices in orthodontics have advised that at least 65% of referrals in the best practices are from patients. Although that may be true in some instances, in every JCO Orthodontic Practice Study dentist referrals have amounted to at least 50% in the average practice. In busier, higher-income practices surveyed, dentist referrals amounted to 60-65% .
When faced with such numbers, the advocates of patient referral over dentist referral say that is what patients think you expect them to say and they are merely accommodating you, but their actual referral came from someone else. No evidence is presented to support this idea. In fact, there is some evidence that people are more influenced by a dentist's referral. Some advocates of patient referral vs. dentist referral state that case acceptance is significantly higher for patient referrals--although no figures have been presented, and case acceptance rates vary without regard to the number of referrals.
It is likely that orthodontists take comfort in the broad base of patient referral, and that they dislike being dependent on a relatively few dentists for the majority of their referrals. One disaffected dentist referrer could put a noticeable crimp in total referrals. Also, dentist relationships require more kowtowing and more constant individual attention. Patient relationships should also include constant individual attention, but as a normal part of the practice day.
In addition, and not to be overlooked, is the animosity that has grown between specialists and generalists because of the amount of orthodontics being done by non-specialists. Many orthodontists believe that once a generalist starts doing orthodontics, he or she is lost as a referrer. Distanced maybe, but not lost.
In an article on "Orthodontic Treatment Provided by General Practitioners and Pedodontists in Massachusetts" (JCO, May 1989) there was an interesting table of orthodontic referral patterns of GPs and pedodontists. Among the GP respondents, 19.9% had an orthodontist in the practice and 4.4% performed orthodontic treatment and seldom referred. Among the pedodontist respondents, 37.5% had an orthodontist in the practice and 12.5% performed orthodontic treatment and seldom referred. It appears that 50% of the Massachusetts pedodontists and 75% of GPs were still referring cases to orthodontists in spite of the fact that almost all pedodontists and many of the GPs were rendering some orthodontic treatment. Actively seeking referrals even from GPs and pedodontists who are doing some orthodontics would probably produce some good referrers-- as has been the experience of many orthodontists.
Reprehensible though it may be for a dentist with no training in orthodontics to attempt to diagnose and treat orthodontic cases, the fact that it happens is understandable, considering the economics of general practice today. But this situation will not necessarily last.
Another interesting table in the Massachusetts survey indicated that GPs derived 1.1% of their incomes from 1.6% of their time spent on orthodontic procedures. It may not seem like much, but there is almost a 50% differential there. If GPs were aware of the unprofitability of the orthodontics they do, they might look for other ways to supplement their incomes. Implantology and cosmetic dentistry are potentially more profitable, and would appear to be more suited to a general dental practice.
There is no single individual capable of referring more patients to an orthodontic practice than a general dentist. It would seem foolhardy to consciously neglect general dentists for whatever reason--just as it would be foolhardy to seek only dentist referrals and neglect patient referrals.
At the very least, orthodontists ought to keep a referral log and know where and when their referrals are coming from. It is not a question of choosing one over the other. It is not "patient referrals vs. dentist referrals". An orthodontist's creed should be "I never met a referral I didn't like".