What does a multi-clinician practice make possible?

Having several clinicians practising at one location changes what a practice can offer patients and what it can offer the people who work in it. This article sets out those effects.

A note on framing, since the original title was “why a bigger dental practice is better”: it is not. Size is a structural choice with genuine trade-offs, not a measure of quality. Excellent dentistry is done in single-chair practices, and a large practice can be run badly. What follows describes what scale enables — the things that are difficult or impossible to arrange otherwise.

This is part two. Part one covers the earlier material.

What it offers patients

Continuity when your own dentist is away

Patients can be seen all year round, including when their usual dentist is on leave, at the location they have learnt to trust, by a clinician who has direct access to all their clinical history and radiographs.

That last clause is the substance of it. Being seen elsewhere in an emergency means being seen by someone without your records, your radiographs, or any knowledge of the tooth that has been watched for two years. Continuity of records is worth more than continuity of person. How safe are dental x-rays is also relevant here: records that already exist do not have to be taken again.

It also removes the need for locum dentists during periods of extended leave, with the disruption that involves. Is it important to have a family dentist? makes the case for continuity from the patient’s side.

Extended hours and emergency care

Multiple clinicians make it practical to offer extended hours, out-of-hours emergency care, and a choice of dentists — see emergency dentistry, what is considered a dental emergency? and why choose Smile Solutions in a dental emergency?. Opening hours and location are the practical expression of it.

It also allows the practice to absorb emergency patients or a sudden influx without individual clinicians routinely working through breaks and after hours — which matters for the quality of what patients receive as much as for the clinicians.

Clinicians working to their strengths

Clinicians can focus on the areas of dentistry they most enjoy or are best skilled at. Delegating care to people specialising in a particular field, or with a keen interest in a specific area, promotes better comprehensive care. Dental hygienists are the obvious example — a practitioner whose entire focus is gum health and prevention. See what does a dental hygienist do?, dental hygienist vs dentist — what’s the difference?, what is the difference between a dental therapist and a dental hygienist? and what is the difference between having your teeth cleaned by a dentist and a dental hygienist?.

Where specialists work on site, the practical benefit for patients is that a referral does not mean starting again elsewhere: records, imaging and treatment sequencing stay in one place, and clinicians can discuss a case in person rather than by correspondence. See specialist care, why would I need to see a dental specialist? and everything under one roof — we do it all at Smile Solutions. The specialties themselves: orthodontists, endodontists, periodontists, prosthodontists, paediatric dentists and oral and maxillofacial surgeons.

That difference is most obvious where several specialties are needed at once: complex dental cases — what happens when multiple specialists need to collaborate and complex dentistry. It also shows in single procedures where training changes the outcome — endodontist vs dentist for root canal: why it makes a difference, why is the microscope so crucial in endodontic treatment by a specialist? and orthodontic treatment: general dentist vs specialist orthodontist?.

What “specialist” actually means, and how to check it

Worth being precise, because the word does a great deal of work in dental marketing and almost none of it is regulated by the person using it.

The Dental Board of Australia recognises 13 dental specialties in Australia, approved by the Australian Health Workforce Ministerial Council: dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial surgery, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry), and special needs dentistry. The six listed in the paragraph above are a subset of that list, not the whole of it — no practice, at any size, holds all thirteen.

Specialist registration is not simply a longer degree. The Board’s requirements include that an applicant has completed a minimum of two years general dental practice — which may be achieved by experience outside Australia, subject to assessment and approval by the Board — and has met all other requirements for general registration as a dentist, in addition to holding the specialty qualification. A specialist is a general dentist first, and was one for at least two years.

You can check any of this yourself, and it costs nothing. AHPRA publishes an online register of all dental practitioners which includes details of the specialty or specialties for dentists who hold specialist registration. The title is protected in law as well: under the National Law, only a practitioner who holds specialist registration in a recognised specialty may use the relevant specialist title in advertising — and that includes using it in the name of the business. See dentists and registered specialists.

There is also a regulatory version of the “clinicians working to their strengths” point above, and it binds every dentist in the building rather than only the specialists. The Board’s Scope of practice registration standard applies to all practitioners registered with the Board, and requires dental practitioners to practise within the scope of their education, training and competence at all times. Handing a case to a colleague who is better trained for it is not a professional courtesy; it is what the standard requires. Which is the honest version of the argument for scale — not that the work is better, but that the colleague is down the corridor rather than across town and six weeks away.

Sources for this section: Dental Board of Australia, Specialist Registration and FAQ: Specialist registration; AHPRA, Guidelines for advertising a regulated health service.

What it offers clinicians

Peer review and mentoring

Interactive peer review, constant mentoring by more experienced clinicians, in-house workshops, and the accessibility of multiple specialists for opinions, treatment planning advice and discussion.

This is the least visible benefit and arguably the most significant. Dentistry is unusual among health professions in how solitary it can be — a clinician can practise for decades without another practitioner ever looking at their work. A setting where a difficult case can be walked down the corridor and shown to a specialist changes the standard of what gets diagnosed and planned. It is also what makes a genuine second opinion easy to arrange rather than awkward.

For less experienced clinicians, being guided and mentored by other dentists, specialists and senior colleagues is a learning hothouse, with exposure to a readily available variety of philosophies, techniques and skills — the formal versions of that are the dental internship and the graduate program, with vacancies listed under careers. For senior dentists, mentoring is a genuinely fulfilling way to diversify their role in the profession and give something back. What makes a truly great dentist? and how important is communication in dentistry? are the articles closest to this question.

Sustainable careers

Three practical effects, all of which ultimately reach patients through retention:

• More frequent and longer holidays, and continuing education. With overheads spread across greater numbers, the financial cost of a clinician being away is reduced.
• Parental leave and return to work. A larger practice is better equipped to handle continuing patient care during leave, avoid layoffs of auxiliary staff, and absorb the effect on overheads — so clinicians can return when they are ready.
• Phased retirement. Retiring dentists can wind down at their own pace, in stages, eventually to one or two days a week — something that is very difficult to arrange in a small practice.

That last point deserves a word. A dentist who can taper over five years takes their patients with them through the transition, rather than a practice closing and a list of patients being dispersed. Continuity for the clinician produces continuity for the patient. The Great Resignation in the private health sector is the wider workforce context, and how do I manage to keep 60 demanding clinicians happy — all under the one roof? and running a large dental practice are the two first-hand accounts of running it.

The supporting infrastructure that scale also pays for: the technology in the surgeries and the on-site Smile Solutions laboratory.

The trade-offs

To be balanced about it, scale carries costs of its own:

• It can feel less personal. A small practice where the same person greets you every time has something a larger one has to work to replicate. The Smile Solutions experience is the attempt to describe how that is managed.
• You may not always see the same clinician, unless you ask — and you should ask, because continuity of clinician still has value. The full team lists who is available, with registered specialists identified as such.
• Coordination overhead grows with the number of people involved, and a plan spread across several clinicians needs someone holding it together. Understanding your treatment sets out how a plan is meant to be explained and sequenced.
• A referral inside the building is still a referral. The convenience of an on-site specialist is real, but it is not in itself a reason to choose that specialist over one elsewhere. The register is public; the comparison is yours to make.

None of these is inherent. They are what a larger practice has to manage deliberately, in the same way a small practice has to manage cover, emergencies and isolation deliberately.

Common questions

How do I check a practitioner myself — and what does the register not tell me?

It takes about a minute and it is free. AHPRA publishes an online register of every dental practitioner, and it includes details of the specialty or specialties for dentists who hold specialist registration. What you can establish from it: whether the person is registered at all, in which division, whether they hold specialist registration and in what, and whether there are conditions, undertakings or reprimands recorded against their registration.

The title itself is the other half of the check. Under the National Law, only a practitioner who holds specialist registration in a recognised specialty may use the relevant specialist title in advertising — and that restriction extends to using it in the name of the business. So a practice name containing a specialist title is itself a claim you can verify on the register.

What the register does not tell you is most of what you actually want to know. It does not say how many times a practitioner has done the procedure you need, how they would plan your case, what they charge, how long they take, whether they will explain things in a way that suits you, or whether their approach is conservative or interventionist. Those are consultation questions, and there is no database for them.

Nor does it rank anyone. Registration is a threshold, not a score. Two people can both be correctly registered and take quite different approaches to the same mouth, which is why a second opinion on a large plan is a normal thing to seek rather than an insult to anyone.

Is what a dental practice says in its advertising actually regulated?

Yes, quite tightly, and knowing the rules makes you a much better reader of any dental website — including this one. Section 133 of the National Law states that a person must not advertise a regulated health service, or a business that provides one, in a way that:

• is false, misleading or deceptive, or is likely to be misleading or deceptive
• offers a gift, discount or other inducement to attract a person to use the service or business, unless the advertisement also states the terms and conditions of the offer
• uses testimonials or purported testimonials about the service or business
• creates an unreasonable expectation of beneficial treatment, or
• directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.

These are not guidelines with a stern tone. A breach is a criminal offence. In 2022 the National Law was amended to raise the maximum financial penalty per advertising offence from $5,000 to $60,000 for an individual, and from $10,000 to $120,000 for a body corporate; as of July 2024 the increased penalties apply in every jurisdiction, including Western Australia.

What that means for you as a reader. If a practice advertises a free or discounted anything without the terms attached, if it publishes patient success stories, if it promises a result, or if it implies you need treatment you have not been assessed for, those are not stylistic choices. They are the five things the law names.

There must be hundreds of reviews out there. Why does this site not quote any of them?

Because the law does not permit it, not because there is nothing to quote. The National Law does not allow the use of testimonials or purported testimonials to advertise a regulated health service or a business that provides one. AHPRA's guidelines define a testimonial as recommendations or positive statements about the clinical aspects of a regulated health service used in advertising — and give patient stories, patient experiences and success stories as the examples.

The line falls at the word ‘clinical', and it is finer than most people assume. AHPRA is explicit that not all reviews or positive comments are testimonials: ‘comments about customer service or communication style that do not include a reference to clinical aspects are not considered testimonials for the purposes of the National Law.' Comments about the clinical aspects are, and cannot be used in advertising.

There is a second trap worth knowing about, because it catches well-meaning practices. AHPRA warns that selectively editing reviews or testimonials may break the law — so curating the good ones, or trimming a review down to its most flattering sentence, creates its own problem rather than solving one.

The practical consequence for you: the absence of glowing patient quotes on an Australian dental website tells you nothing about the practice, and the presence of them tells you something about its compliance. Judge a practice on what it will explain to you, what it writes down, and what it declines to promise.

If a practice says it is the largest, or has the most of something, should that count?

Only as a fact about the building, never as a claim about the dentistry — which is the point made at the very top of this page.

Under section 133, a claim must not be false, misleading or deceptive, and must not create an unreasonable expectation of beneficial treatment. A verifiable statement about size, the number of surgeries or the number of clinicians can be a plain fact. The moment it is offered as evidence that the clinical work is better, it starts doing work the evidence behind it cannot support.

Size genuinely predicts some things, all of them logistical: cover when your dentist is on leave, capacity to see an emergency today, access to a colleague with different training, longer opening hours. Those are the things listed throughout this article, and they are real.

Size predicts nothing about the individual clinician who will actually treat you. That person is registered to the same standard, and bound by the same Scope of practice registration standard, whether they work alone or alongside sixty colleagues. Ask about the person and the plan, not the floor space.

Does ‘everything under one roof' mean I will never be referred elsewhere?

No, and any practice suggesting otherwise is overstating it. As this page notes above, the Dental Board recognises thirteen dental specialties and no practice at any size holds all thirteen. A practice with six of them still has to refer out for the other seven, and there will also be cases within a specialty that are better handled by a particular practitioner somewhere else.

Referral out is a requirement, not a failure. The Board's Scope of practice registration standard applies to every registered dental practitioner and requires them to practise within the scope of their education, training and competence at all times. A clinician who sends you elsewhere is complying with it.

What scale changes is the friction, not the obligation. An in-house referral usually means your records, radiographs and treatment sequence stay in one file and the two clinicians can speak in person. That is a convenience worth having and it is not, on its own, a reason to prefer the in-house practitioner to one you could find on the public register yourself.

A reasonable question to ask at the first appointment: ‘Is any part of this something you would normally refer, and to whom?' The answer tells you more about a practice than the number of chairs.

Related reading

• Is a bigger dental practice better? Part 1
• What makes Smile Solutions an innovative business?
• Finding a dentist online in Australia
• Five questions you’ve always wanted to ask your dentist
• Why would I need to see a dental specialist?
• Why choose us and awards

Practical details

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Published fees are in the price guide.

Published 4 August 2014, by Dr Kia Pajouhesh. This article is commentary on dental practice structure and contains no clinical advice. Statements attributed to the Dental Board of Australia and AHPRA are those publishers' own.

Smile Solutions trades under ABN 28 193 514 103.