Q&A on referring dentists with Dr. Russell Nishimura and Dr. Steven Rosenstein

In this Q&A, we spoke with Russell D. Nishimura, DDS; professor emeritus, UCLA School of Dentistry; fellow, Academy of Osseointegration; and Steven J. Rosenstein, DMD, FAGD, about how general practitioners can establish a referral network, its advantages and the future of the dental implant industry.

01. How did you first establish a referral network?

Russell D. Nishimura, DDS; professor emeritus, UCLA School of Dentistry; fellow, Academy of Osseointegration: As a prosthodontist, a referral network is an important aspect of my practice. This network was developed over time by building trust and confidence. Educating referring dentists and patients that I am a welcoming resource in the community was key. Personal interactions with potential referrals during local dental meetings and study clubs fostered great working relationships. I am also a strong advocate of membership and attendance at highly regarded meetings such as the Academy of Osseointegration’s annual meeting. These meetings provide great social opportunities where I have a chance to talk and network with colleagues who are general dentists or other specialists. It really exposes me to multiple perspectives and methods. 

Steven J. Rosenstein, DMD, FAGD: As a general dentist, I was approached by specialists when they learned I was a new dentist in the area. But I realized not every specialist was going to be right for my patients or me. My job has been to evaluate the skill and competency of the many specialists seeking my referrals to provide the best care for my patients. Once I found the first “right” specialist, I used him/her to help lead me to others. It was also beneficial to have discussions with other GP colleagues and learn about their experiences with each specialist. I agree with Dr. Nishimura that a wonderful way to do this is by getting involved with associations and attending medical meetings. The final overriding consideration, of course, is determined over time by working with them.

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02. What should a GP and specialist know about entering into a referral partnership? 

RN:Multidisciplinary care provides patients the best opportunity to be knowledgeable about their dental status and treatment options. It is a synergic partnership that enhances patient outcomes and increases the efficiency and productivity of the involved dentists. For me, it is about respecting the skills and talents of my referring dentists and allowing those most capable of meeting the patients’ individual needs to perform that aspect of care. It is not ownership but rather collaboration. Most patients are grateful to their general dentist for the referral to a specialist and are even more loyal after their treatment is completed. Both the GP and specialist must know it is a relationship that goes both ways and can build both practices.

SR: I think the most important aspect about building a long-term relationship with a specialist is that the focus is on creating the best outcome for the patient. As the GP, my patients are going to judge me to a great degree by the experience they have in the specialist’s office. A key factor is the processes and procedures for communicating between the offices. I expect the specialist to collaborate with me during the decision-making process and not let his or her “specialist status” dominate the process.

03. What have been the advantages for you?

RN: A referral partnership brings a refreshing professional opportunity that encourages those involved to perform at their best and appreciate the services each provides. Patients have greater satisfaction with their dentistry and return to their general dentists with more trust and confidence. People really appreciate that the GP and specialist are placing patient needs first. “Word-of-mouth” is the best advertisement, and the local community response is great. Working with young dentists is especially rewarding as we can all remember our early years and how some professional friendships can make meaningful differences in our practices and personal lives.

SR: Collaborating with an excellent team of specialists brings immense value to my practice. My patients get the very finest treatment that meets their needs and desires. I get to share the responsibility for decisions and outcomes with outstanding colleagues who continually add knowledge to my abilities. In addition, over time, the flow of patient referrals can go both ways almost equally, which adds more value to my practice.

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04. We often hear how dentists are trying to keep more things in house and keep the money there as well. What advice would you give to your fellow practitioners about that?

RN: Dental practice needs are very demanding in today’s economic environment. However, patients’ oral health and wellbeing are paramount, and, as health professionals, we are compelled to address our patients’ needs first. Though many patients are best treated in the general practice setting, there are those that would benefit from an initial visit with a specialist, such as a prosthodontist, for a baseline examination and consultation. Working together, the GP and specialist can often stage treatment over time and between offices to best accommodate the patient.

SR: The financial demands on dental practices today are compelling, but our charge as healthcare providers is to always put the needs and best interests of our patients first. As a GP, knowing my limitations is one of the most important aspects of being the best dentist I can be for my patients. If I cannot provide a given service at the level of a specialist then I choose to refer.

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05. Where do you see the dental implant industry heading in the next five years for both GPs and specialists?

RN: The growth of dental implants will continue strongly based upon the ever-increasing number of failing and missing teeth, greater patient awareness and the “graying of America.” The number of missing teeth that could be replaced with implants is tremendous and the benefits of implant restorations are well documented. This means all dentists-both GPs and specialists-will provide more implant dentistry than ever before. Implant dentistry has become a global topic. This will be reflected in the advances made by clinicians and researchers around the world.

I keep up in the field of implant dentistry by reading articles published in the International Journal of Oral and Maxillofacial Implants-the official journal of the AO-which comes free with membership. In my opinion, membership in the AO will continue to be the best way for me to stay current on the advances in implant dentistry and at the same time enjoy professional networking.

SR: Research in all areas that pertains to implant therapy will continue to proliferate, consequently placing even more demands on our time to stay current. This, in itself, is a great reason to get involved in an organization like the AO. I also believe the current trend of GPs placing more implants will continue to accelerate. I hope these practitioners will see the multitude of values inherent in becoming a part of the AO community. The camaraderie, networking and access to the latest scientific and clinical knowledge will become more and more valuable. 

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