Your considered discussion is valuable. With a group practice as a business model, such opens up a great number of opportunities.  Patients are accustomed to the group model in medicine, and so are physicians.  Dentists have been slower to adopt the group model perhaps because the need was not there.  However, that may change for the precise reasons you state, that to provide technology and to deliver at a lower cost, we may be compelled into the group model.

In medicine, there is one standard of care.  No one gets a truss any more. Everyone, or nearly everyone, will have a surgical hernia repair.  In dentistry, we have never had one level of care.  In current practice, we have the implant, the fixed bridge, and the partial denture all being perceived as acceptable, with decreasing levels of acceptability both by professional standards and by the patients’ standards.  And by and large, and this is my opinion only, patients in the past chose dentists of varying levels of capability based upon their own needs and desires.
That may still be occurring. It has been an interesting exercise to see  how we, as periodontists, can open the market to allow patients to know that for their complex needs, they should be going to us first. I, as well as some other periodontists, have been able to do that.  It’s been fun. It’s required some effort and a learning curve to get there.  But it can be done.

Should periodontists develop group practices where we are in overall charge of both the diagnostic model and the business model?  That may very well be the future.

For today’s periodontist, who is seeing a decrease in referrals, the “primary care periodontist” may be the first way station on the way to the model that you propose.  It provides an answer for the periodontist who is practicing now in his or her own environment without creating a drastic change. As well, it provides an opportunity for the periodontist to expand business and marketing skill in a small environment before jumping to the group practice model.  This may be important, because the periodontist needs to develop the skills necessary to practice in a primary care setting.  For example, the skills that we often mistakenly feel are unimportant, such as how to answer the phone, take on an entirely magnified level of importance when one is a primary care practitioner.  A front desk person scheduling an unreferred patient needs much more skill than the front desk person who is scheduling a referred patient.  A periodontist marketing to the public directly has to develop the skills of the front desk to handle the patient phone calls that occur as a result of marketing.   And of course, the periodontist has to develop the skills to market, to do good PR, as well as to develop the diagnostic and clinical skills to bring about a superior result.  The periodontist also needs to develop the restorative and orthodontic team to create the best result for the patient. In many communities, these “best” practitioners are still in solo practice.

So what I propose is that it is possible for the periodontist to remain in solo practice now, and to develop all the skills that are necessary to get to the group practice level, if and when it is required.  The question that remains is when to do that. I would suggest that time is now.