Why a bigger practice is better — and when it isn't

Media item: interview segment

This page records the media item. The recording is the property of its publisher and is not reproduced here, and no remarks are quoted.

The title states a proposition. This page examines it in both directions, because a page that only argued one side would be advertising rather than information — and because for a good many patients the answer genuinely runs the other way. The articles arguing the case are Is a bigger dental practice better? Part 1 and Part 2.

That is not only editorial taste. Ahpra's Guidelines for advertising a regulated health service list, among the things that make advertising false, misleading or deceptive, advertising that ‘misleads, either directly or by implication through the use of emphasis, comparison, contrast or omission’, that ‘compares health outcomes, regulated health professions or practitioners or prices without complete information’, and that ‘makes claims about providing a superior regulated health service’. The guidelines add that comparative advertising ‘can be misleading and/or deceptive because it can be difficult to include complete information when making comparisons’, and that where comparative claims are made they ‘must be clear, accurate and supported by acceptable evidence where relevant’. So a page with this title either carries the other side, or it is not entitled to make the claim.

What scale actually gives a patient

Not abstractions — the things you would notice.

Specialists on the same site. Complex dentistry is multidisciplinary: an implant case may involve a periodontist or oral surgeon placing, a prosthodontist restoring, and an orthodontist creating the space. When those practitioners work in one building they can look at the same scan together on the same afternoon. Coordinating that across three suburbs takes months. Australia recognises thirteen dental specialties — the Dental Board of Australia's own wording is that ‘there are 13 dental specialties in Australia which are approved by the Australian Health Workforce Ministerial Council’, and its specialist registration standard requires general registration as a dentist plus ‘a minimum of two years general dental practice’ before specialist registration (Specialist Care). A practice with several of them under one roof can keep a plan moving — see Complex dental cases: what happens when multiple specialists need to collaborate, Complex Dentistry and Everything under one roof.

Equipment that a single chair cannot justify. Cone-beam CT (how safe are dental x-rays), chairside CAD-CAM milling, digital scanners, an on-site laboratory. Utilisation is what makes these affordable — a scanner used twenty times a day pays for itself; used twice a week it does not. What owning a machine does not do is create a reason to use it: the same Ahpra guidelines treat advertising that ‘minimises, underplays or under-represents the risk or potential risk associated with a treatment or procedure’ as misleading, and a scan, like any radiograph, is taken only where it is clinically justified. Our Technology lists what is here.

Genuine cover. Someone is there when your practitioner is on leave, ill, or fully booked. Emergencies do not wait for a roster (Emergency Dentistry, Why choose Smile Solutions in a dental emergency?), and access to same-day care is one of the most practically valuable things a larger practice offers.

Longer opening hours, including early, late and Saturday appointments, which matter enormously if you cannot take time off work — Contact Us.

Clinical governance. Peer review, case discussion, audit, structured mentoring of newer graduates (Graduate Program, Dental Internship), and formal infection-control systems with records (Surgery Portfolio). A dentist who never has their work looked at by another dentist has no error-correction mechanism. See How do I manage to keep 60 demanding clinicians happy — all under the one roof?

A second opinion in-house, which is easier to obtain when there are colleagues to ask — Second Opinions & Corrective Dentistry.

What scale costs

Stated plainly, because it is real.

• Continuity is harder. In a one-dentist practice you always see the same person. In a large one you must ask for that, and it may not always be possible. For long-term dental care, continuity is worth a great deal — the practitioner who has watched a crack for six years is better placed to judge it than one seeing it fresh. See Is it important to have a family dentist? and Stopping staff separation.
• It can feel impersonal. Reception desks, systems, being one of many — The Smile Solutions Experience is the practice's own answer to that.
• Coordination overhead. More practitioners means more handovers, and handovers are where information is lost — How important is communication in dentistry?
• Overheads are higher, and overheads end up in fees — the price guide and The Great Resignation in the health sector, which sets out where a fee goes.
• In-house referral incentives. A group has a reason to keep work internal. That is fine when the internal specialist is the right person and worth naming when they are not. The check is a registration one, and it is free: Ahpra lists among misleading advertising anything that ‘suggests a practitioner is a registered health practitioner or holds specialist registration, qualifications or an endorsement when they do not, by using a title and/or other means’ — so if a referral is described to you as going to a specialist, that is a statement you can verify rather than accept. See Why would I need to see a dental specialist?
• Complexity of the plan. A large practice can assemble ambitious treatment. The best treatment is often the least treatment, and scale does not by itself protect against doing too much — Understanding Your Treatment.

When a small practice is the better choice

Honestly, in a fair number of cases:

• Routine care. Examinations, cleans (Dental Cleans and Hygienists), fillings, ordinary preventive work. A good solo dentist does these as well as anyone, often with more continuity and lower overheads. See What makes a truly great dentist?
• Anxious patients who need the same familiar person and room each time — Dental Anxiety.
• Local access. For children (Children's Dentistry), the elderly, and anyone who does not drive, the practice you can actually get to is better than the excellent one across town. A missed appointment helps no one. Directions here are on Location.
• When you already have a dentist who knows you. That relationship is an asset. Do not discard it for a facility.

When scale genuinely matters

• Complex or full-mouth rehabilitation — What is restorative dentistry?
• Implants, particularly where grafting (bone grafting), sinus work or multiple units are involved — All-on-4 Dental Implants.
• Cases needing several specialties in sequence, where coordination is the whole difficulty.
• Trauma and after-hours emergencies — What should I do when a tooth is knocked out?
• Medically complex patients, where a broader team and stronger governance help.
• Difficult retreatment, where the first attempt did not go well — Endodontists and Endodontist vs dentist for root canal.

The honest conclusion

‘Bigger is better’ is not true as a general proposition, and this page will not assert it. What is true is narrower and more useful: scale buys coordination, access, equipment utilisation and error-correction, and it costs continuity and intimacy. For complex, multidisciplinary or urgent work those are good trades. For routine care with a dentist you trust, they often are not.

The question to ask is not how large the practice is. It is: who will treat me, are they registered for what they are proposing, will I see them again, and what happens if something goes wrong at the weekend? Those answers matter in a practice of one and a practice of a hundred equally.

The second of those four is the only one with a free and definitive answer, and it is worth using. Under the National Law, certain titles are protected: Ahpra's guidance states that where an advertising breach involves unlawful use of a protected title, ‘this is also an offence under the National Law for which penalties can apply’ — for an individual, up to $60,000 per offence, imprisonment for up to three years per offence, or both, and for a body corporate up to $120,000 per offence. Whether the person in front of you actually holds specialist registration in the field they are proposing to treat you in is therefore a matter of public record, not of reputation, and the register at ahpra.gov.au answers it in under a minute.

Related pages: Why Choose Us, Specialist Care, Dentists & Registered Specialists, Our Team, Our Technology, In-House Laboratory, and the rest of the media record.

Common questions

Why will a practice's own page not simply say it is better?

Because it is not allowed to, and because the claim would not survive scrutiny anyway. Ahpra's advertising guidelines name ‘claims about providing a superior regulated health service’ as one of the things that make advertising of a regulated health service false, misleading or deceptive, alongside comparisons of ‘health outcomes, regulated health professions or practitioners or prices without complete information’. Where a comparative claim is made at all it ‘must be clear, accurate and supported by acceptable evidence where relevant’. That is why this page sets out what scale costs as well as what it buys.

How do I check that a ‘specialist’ really is one?

On the AHPRA public register at ahpra.gov.au, free, in a minute. There are thirteen recognised dental specialties in Australia, approved by the Australian Health Workforce Ministerial Council, and specialist registration requires general registration as a dentist plus a minimum of two years in general dental practice. Unlawful use of a protected title is an offence under the National Law carrying, for an individual, a financial penalty of up to $60,000 per offence, imprisonment for up to three years per offence, or both — so the word ‘specialist’ in front of a name is a checkable fact, not a description. What the register will not tell you is how good someone is, or whether you will get along with them.

If I am referred to a specialist inside the same group, should I be concerned?

Not automatically, but do ask the two questions you would ask about any referral: why this person, and what are the alternatives. A group has a structural reason to keep work in-house, which is perfectly compatible with the internal specialist being the right choice. Confirm on the register that they hold specialist registration in the relevant field, and ask whether an outside referral was considered. You are entitled to be referred elsewhere if you prefer.

Does having specialists on site make it more expensive?

Specialist fees are higher and far more variable, and the published data on them is thin. The Australian Dental Association's Dental Fees Survey 2022 drew 284 responses from members identifying themselves as specialists — around 10% of active private-practice member dentists — and the ADA cautions that because the response rate was low, ‘survey results for specialists should be interpreted with considerable caution’. Among those who did respond, a fifth charged an hourly rate; that mean hourly rate rose from $662 in 2020 to $921 in 2022, with a median of $800 and a range ‘between $450 and $1,500 per hour’. Which is the argument for asking the fee before the referral, not after.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a media item — an archive record, not current clinical advice. No remarks are quoted, and the material above is general information rather than a summary of the interview. Practice size is not a measure of clinical quality, and nothing here should be read as a claim about treatment outcomes.

Smile Solutions trades under ABN 28 193 514 103.