Dr. Gregory L. Fauth answers questions about the career path he took after finishing his residency...
2005 Student Event: Scaling to New Heights in Periodontal Practice
STARTING AS AN INDEPENDENT CONTRACTOR
Below is an interview with Dr. Gregory L. Fauth.
Gregory L. Fauth, D.D.S., is in practice in Aurora, Illinois. He completed his periodontal residency at University of Chicago in 1982.
What is the most rewarding part of what you do everyday?
Working with people to move toward higher levels of health in an environment that is safe for them to be involved in their care.What was your ideal plan after graduation?
I wanted to join a group of periodontists in private practice and possibly spend a day or so teaching at the university.What realities did you encounter?
Things didn’t work out for me to join the group I had planned to join after finishing my program. An opportunity came up for me to start my own practice in a good location where I had previously practiced as a general dentist. Interest rates were very high (20+ %) and I needed to go to work.What appealed to you to become an independent contractor?
It was a way to walk in the door and immediately be productive and produce income. I could practice, make some money and not worry about developing a practice or setting up an office.What variables influenced your decision to become an independent contractor?
The decision was mostly financial, but the position I found also gave me the flexibility to have the time to set up my own practice and begin to develop that part of my professional career.How did you go about searching for an independent contractor’s position?
I just started talking to some people about being available. I found my position through my insurance agent who works with many dentist clients. In another situation that I had later in my career, I was approached by a dentist specializing in Cosmetic Dentistry about coming into his office to treat his patient’s periodontal needs. Most of the opportunities that I have encountered have come by word of mouth by talking around. I have also seen positions advertised in journals, but have never answered one of those ads.Did location factor into your decisions?
Yes. I have not taken positions where the patients I was treating would have been close enough to my office to detract from my own practice. The distance from my residence was reasonable enough to make going to that office feasible.Please explain your financial arrangement.
My compensation was based on a percentage of collections for my services. In the three arrangements I have been involved in, there has never been a formal written contract, just a handshake agreement. The percentage has ranged from 40-50%. Costs for special materials have also been handled on a percentage agreement. We split the costs of implants, components and regenerative materials 50:50. In talking with colleagues doing independent contracting exclusively, the arrangement has been based on production rather than collection and I see this as a better arrangement.Do you see this as a good form of practice?
I do see this as a good form of practice, given you are aware of the advantages and disadvantages of it. Having done it in three different arrangements, it is not my first choice. But with the right fit in personal circumstances it can be a good way to practice.What are the pros and cons of this situation?
Pros:- Patients are directly referred from the dentist. No referring source development is done. This is a pro from several aspects. Often dual consultations are done (dentist and periodontist in room at same time). It allows for a close case working relationship between dentist and specialist. It allows for better case acceptance and continuity of care for the patient. Often the dentist can see the periodontal aspects of the case up close and personal.
- No administrative duties. You come in and do the perio. You don’t set financial arrangements or get involved in collections, but you do set the fees for your services.
- No office to set up and maintain. No hiring and firing of staff. No equipment to buy. Only have to make sure the contracting office has the supplies you need when you need them.
- No overhead. The monies you collect are pretty much yours to keep since the overhead has already been deducted by the contacting office. Very few offices operate at 50% overhead by the way. Your only expenses are buying your own surgical instruments, your liability insurance and implant gear. You will also have expenses in getting to the offices where you work.
- Lots of freedom. You work only with dentists you like working with and pick the days you are available.
- No employees. Since you are the only person in your business, pension contributions do not need to be made for others.
- Don’t have to check hygiene patients.
- Get to learn more of the restorative considerations on your cases by working in the office of the dentist who is restoring the cases.
- All treatment records are kept in the chart of the patient in their dentist’s office. You just add a periodontal charting page to their record.
Cons:
- Working in different offices can be difficult because you are working with different assistants and different equipment. This may make operating very awkward at times.
- Have to be portable. You need to bring your own surgical instruments and implant drilling units, etc.
- You have no practice to sell when you quit practicing.
- You get no cut on the hygiene services >provided to the patients you treat unless you do those services yourself. You can’t supervise the ordering for each office you work in.
- Since you may not be in the office every week, you may lose some continuity in your treatment. Suture removals and postoperative visits may be done by the dentist on occasion.
- Since you are in that office only on occasion there may be times when you can not see all of the periodontal patients in that practice.
- You are at the mercy of the dentist and his practice for your business.
Did you benefit from this situation?
Yes. It gave me a chance to get my periodontal feet wet. It gave me a chance to make some money quickly without having to develop a referral source. And it also gave me a chance to learn to work out problems by having a close relationship with the referring dentist.Why are independent contractors often frowned upon by the profession?
The independent contractor is seen as competition for the periodontal patient by the periodontist with an office. The conventional practice has taken the risk of setting up an office and developing a team and the system to have his practice. The independent contractor is taking patients that might have been referred without his services being available, especially from a larger dental practice that has the periodontal volume to utilize an independent contractor. The quality of the independent contractor’s work may be seen to be compromised or not as good by traditional periodontal practitioners because the independent contractor is not on site or as available as the periodontist that has his/her own practice. There is also a concept that the independent contractor is not involved in organized dentistry.How did this experience affect you plan and decisions about your career and future?
It helped in a number of ways. It kept me busy and learning early in my career. It gave me a chance to work with a dentist more closely on the periodontal part of his practice and learn how to make perio work for the betterment of his patients. It provided some cash flow when my practice was not as busy as today. I also learned that I didn’t want to be an independent contractor full time and that I wanted to have my own office/practice to work in.What risks were involved?
Very few risks were involved. I selected locations for independent practice that would not affect my referrals to my own office. Having said that, however, to this day I still get referrals to my own practice from each place in which I have been an independent contractor.What is your situation now?
I am 100% private practice in my own office in Aurora, IL. I am in the office seeing patients between 30-33 hours per week. I have two full-time front desk employees, one assistant and one full-time and one part-time hygienist.What resources did you find most helpful?
I really didn’t use any resources other than talking to different people regarding my availability at the time. Today, if I were considering becoming a full-time independent contractor for a career, I would talk to the people in my area that I was aware of doing similar services to find out what they were doing and how they were doing it.What suggestions would you have for someone transitioning into an independent contractor arrangement?
I would suggest making sure that the dentist offering the position is honest and doing good dentistry so that my services are not going to be compromised and that I will be able to provide the quality of care that I am comfortable with at the fees I feel are reasonable.How did you work out your practice insurance?
I carry my own liability insurance and let my carrier know that I am providing services in other offices.What was my biggest mistake as a new practitioner?
I should have gotten help in running a business sooner. Systems implementation, marketing plans and staff management were areas that I was not trained for in my program or previous dental experience.How many different offices were you performing periodontal procedures at?
I have only been involved with one office at a time outside of my own office.What is the most important thing I have learned?
Life is much more enjoyable when I am doing things I really enjoy with people I enjoy being with.
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