'The administrative burden has skyrocketed': Why 2 oral surgeons joined an MSO

Paul Boerman, DDS, would have never thought of joining a management services organization or DSO just a couple of years ago, but his views began to change as he planned for retirement. 

Dr. Boerman and William Purdy, DDS, recently became the first Vermont offices to join Hackensack, N.J.-based Max Surgical Specialty Management. 

Dr. Boerman, of Vermont Oral Surgery Associates in South Burlington, and Dr. Purdy of Northern Vermont Oral Surgery in Essex Junction, recently spoke with Becker's about their decision to join MSSM and the challenges facing oral surgeons today. 

Editor's note: Responses were lightly edited for clarity and length.

Question: What made you interested in joining Max Surgical Specialty Management?

Dr. William Purdy: We have different perspectives. Paul was approached first and Max had asked Paul if there was any other practice in the community that might also show interest, and knowing my career goals and where I was in my career, he approached me and asked if I was interested. I certainly was unsure about what I wanted to do but was open to listening to opportunities. I'll tell you that from the first interaction, I was very impressed with the management team. They've reinforced the importance of the fact that Max is really surgeon-led, which became attractive to me because the management goals and the strategy moving forward should have the surgeon's best interest in mind.

Also, one of the challenges Paul mentioned was I wasn't going to be practicing forever, and I had looked at various succession planning and because I was so interested in Max after talking to them, it made me interested because it allowed me to develop a plan to ensure my practice could continue to provide high-quality oral surgical care for our dental community. We were really struggling with the possibility of just practicing until we were happy with the end of our career and closing our doors. One of the things that was a struggle was that we felt we had an obligation to continue to provide care, or at least have some kind of a plan in mind to allow our practices to continue to provide care to the dental community. We're somewhat of an underserved oral surgery community, especially in Chittenden County, which is the most populous part of the state.

Paul Boerman: We were just getting to the point where we were starting to get pretty anxious about what the next chapter is, how we move forward with appropriate services for our communities and how we develop some kind of eventual exit plan. How do we keep our employees employed? That was a big burden for both of us, knowing that it's not just my career. There are another 20 people that have jobs they depend on us for. So we wanted to think of them in any kind of succession planning. So we were leery of this. If you asked me even two years ago if I would have any interest in talking to a DSO, I would've said no way ... I introduced them to Bill and then we had a lot of common meetings, and every time we would say we're impressed with this organization. We're impressed with their people, we're impressed with their professionalism, we're impressed with their vision. It made us more and more comfortable with the idea that our practices could actually not just survive but actually be something that builds into a much larger, better practice organization and something that would be helpful for our communities. 

WP: [It] became pretty clear, at least in my mind, that they had similar practice philosophies to mine. So it became an easy choice for me. It also became pretty clear that Max's goal was not to tell me how to practice, but it was to allow me to practice with greater efficiency by taking the burden of the administrative part of practice away from me. I'm starting to see how that is making my practice a lot more enjoyable. We've only been practicing under Max for a month, but I can already see the benefit of being able to concentrate on patient care and not worrying about the administrative part. I still feel like I have a very close relationship with my staff. I don't think that's changed at all, so that part of my practice is still just as rewarding. Ultimately, it allows me to concentrate on patient care.

Q: What are some other benefits of joining an MSO?

WP: One of the attractive things about being in a practice like Max is seeing it grow, having an opportunity to be a player at the start of a growing company and being able to mentor others who are joining the practice. That's one of the things I am looking forward to, is having other people join, being able to collaborate and learn from the network of accomplished surgeons Max offers. [Also,] being able to leverage some of the best practices in the delivery of care that the clinical advisory board can provide. So there are a lot of unforeseen benefits that opening a practice and starting from scratch just really can't offer.

Q: What are some of the challenges facing oral surgery practices today?

WP: When Paul and I came out of our residency programs, we really wanted to jump into a full scope of oral surgery. I think continuing to provide a full scope of care is going to be a challenge with oral surgery. Right now, a lot of the teaching centers are providing some of the more expanded scope and it's not being provided or offered by a lot of the private practices. I think that's going to be the biggest challenge moving forward, that people are going to want to try to limit their practice to office-based oral surgery and not expanded scope, hospital-based oral surgery. 

PB: I would echo that scope of practice might be a concern. I think that is partly driven by the challenges of compensation models, and the fact that one of the biggest problems with a lot of dental specialists is that they're small cottage industries. They're individual silos that don't have much negotiating power with anybody. So you're not a part of a larger network that has some potential negotiating power. That same thing goes for giving benefits and so on to all of your staff and being able to compete with larger healthcare organizations where you are trying to employ people and match benefits with the hospital that's two miles down the street. So you have a lot of challenges with the overhead of running an outpatient surgical center as an oral surgeon. 

The regulatory aspects of that, the legal aspects of it, are really ever-changing. Trying to stay on top of that, do all the care and manage the staff, do all of the HR, do all of the retirement, all of that kind of stuff — the administrative burden has skyrocketed. That's the biggest challenge. A lot of independent oral surgery practices, whether you're solo or you're a group of two to five surgeons, you just can't compete. That's why being part of a larger management organization allows you to be a part of a bigger family. You're under a bigger umbrella. You have the confidence to do patient care and focus on the things that are important, and some of these things that gnaw at you that you know you need to follow up on ... it just becomes all-consuming, and so you lose a balance to life when you do that. There are a lot of challenges and I think that's why the management organizations are attractive.

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