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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
The relationship is well established: When a dentist needs restorations crafted, the work is outsourced to a dental lab. In most instances, the case leaves the dentist’s office for work across town – or maybe even across the country – coming back a few days or weeks later for final placement with the patient.
However, there is a new trend gaining popularity – dentists are opting to hire their own dental technicians, in essence having their own in-house dental laboratories. The arrangement allows the dentist to work more closely with the lab and the restorations are ready for final placement faster.
Bringing it In-House
The number of doctor’s offices with their own lab services has been small, but the number is growing, albeit modestly.
“Historically, about one percent of dental laboratories have been in a dental office setting,” notes Bennett Napier, Executive Director of the National Association of Dental Laboratories (NADL). “We do see an increase, although it’s fairly modest. We see it at about 3 ½ percent of labs now are in a dental office setting. But it is increasing.”
Based on NADL market research and Dept. of Labor data, as of June 2014, there were about 8,700 dental labs in the United States.
Napier says that there are two primary reasons for doctors to use their own, in-house labs.
“In both cases, when you’ve got a dental office that’s using digital technology, like chairside CAD/CAM, they tend to find that they don’t have the skillset themselves, or their hygiene or assisting team, to get the maximization of the in-house CAD/CAM, so they end up hiring a dental technician to manage that process,” says Napier. “On the cosmetic side, or prosthodontics side, we’re seeing more and more technicians being hired to be in-house and brought into the setting as an employee, whereas in the past, there might have been a one-person lab in a subcontract relationship, and the practice has grown enough where they’ve said, ‘Let’s bring someone in, in-house, as a full-time employee.’”
The size of the practice is also a factor when a lab technician is hired. Napier says the sweet spot seems to be a practice with three to four doctors for an ideal return on investment.
One Such Practice
The act of bringing a technician into one’s practice is identical to any other employer/employee relationship – the doctor may already know the technician and his or her work, or conduct interviews with candidates that are new.
Dr. B. Todd Pickle, a prosthodontist in Colorado Springs, Colo., employed dental technician Dan Elfring without having first worked with him.
“He was actually looking for a technician’s job, and I was looking for a technician,” remembers Dr. Pickle. “So in his case, I didn’t use his services ahead of time. Some of the other technicians that we’ve had in the past, I did work with before I brought them in. Sometimes, you won’t really know how you work together until you’re in the same space, so the more you can do ahead of time to figure out how you might work together and how your personalities and philosophies will work together is pretty important.”
While the two men did not know each other beforehand, Elfring says the relationship has benefitted him, as he has been able to learn from Dr. Pickle.
“I had just retired from the Air Force and was looking for a job,” says Elfring. “I had heard Dr. Pickle was looking for a Removables Technician from a fellow Air Force technician. I told him I didn’t really know removables because in the Air Force, we did not make many dentures. My friend told me Dr. Pickle was willing to train. I did not know what type of lab it was; I was just looking for a job. As it turned out, Dr. Pickle has a beautiful clinic and the lab is in-house. In retrospect, it was fate.”
The reasons for bringing lab services in-house vary, depending on what individual doctors need.
“It really depends on the business model of that particular practice,” says Napier. “Control is one issue. More pressing is communication. In some cases, especially if they’ve got digital or chairside, they don’t have that skillset, and having that person in-house with that skillset is the driver, because they’ve got to make that technology pay for itself, and they’ve got to have the right person to help manage it and get the return on investment back.”
Dr. Pickle decided to bring a lab tech in-house after refocusing his practice on prosthodontics, and realizing a need for closer lab services with which he could communicate more effectively.
“I practiced for five years as a general dentist, then I went back to school and did three years residency in prosthodontics,” says Dr. Pickle. “Everything in prosthodontics, whether it’s fixed or removable, is associated with lab work and laboratory steps, and so when I got out as a prosthodontist, I knew I wanted to have an in-house technician or two so that I could have more first-hand input and control on all of those final lab products.”
For Dr. Pickle, having those services in his practice benefits both him and his patients, because there is better communication all the way around.
“It’s very interactive, both between myself and the lab, as well as the lab and the patients, because we’re all right here,” says Dr. Pickle. “The technicians can come in and meet the patient, and get to discuss the technical issues with the patient just like I do. So it’s beneficial for me, because I get to have interaction with the lab, but it’s also beneficial from a laboratory standpoint, because they get to have interactions not only with me, but also with the patients.”
With so few doctors having their own on-site lab services, it’s somewhat of a unique business model. But Dr. Pickle says that the decision to bring lab services in-house wasn’t a difficult one.
“The decision was easy, because there’s so much involved with the lab work I do on a day-to-day basis,” says Dr. Pickle. “It just makes sense to have the lab here, so the logistics of doing that; and finding the right people; and finding the right lab technicians – as well as the right equipment and products – is always kind of an on-going situation.”
The biggest obstacle is one of cost and expense, which is a reason the business model makes sense when there are more dentists to share the lab services.
“It’s probably more expensive for a single practitioner,” observes Dr. Pickle. “If there are two or more doctors, from a monetary standpoint, it starts to make more sense, especially if you need to buy some more expensive equipment, so you’re sharing the cost over more than just one doctor.
For a lab tech, there are a number of benefits. A major benefit for Elfring is the ability to perform lab work while interacting with patients.
“Working as an in-house dental technician offers immeasurable benefits,” says Elfring. “Maybe the most gratifying is being able to work directly with the patients to achieve the best results possible – some of which can only be achieved by actually seeing the patient.”
In addition to the personal satisfaction of seeing the end result of one’s work, in-house lab techs are also able to do more precise work, because they have access to the patient.
“Even photos sometimes do not provide a technician the key information needed when making dentures, as does visiting with a patient and looking at esthetics and phonetics when speaking,” observes Elfring. “A short conversation with the patient and asking them to do certain mouth movements becomes crucial in the fabrication procedures. It is much better than receiving a lab script with directions based on someone else’s questioning and determinations. When the technician is the one asking what they want, the technician is able to come closer to fabricating what the patient wants, because they are getting direct feedback.”
Not only can technicians get what they need to provide a better, quality restoration initially, but they are also able to make adjustments on-the-spot.
“If the patient comes from a distance or requires a quick turn-around, as an in-house technician, often times we can make the required changes right then and work with the patient until they are completely satisfied,” says Elfring. “Most often, many denture patients do not receive this kind of personal attention when having a prosthesis made, and sure appreciate the service because they feel their concerns are being directly and immediately addressed.”
Technicians aren’t without some downsides when working alone. While the pros far outweigh the cons for Elfring, he notes that the lack of other resident technicians makes it difficult to consult on cases.
“As the only technician in our dental office, I do not have other technicians to learn from by watching their techniques or to bounce discussion items off of on difficult cases,” he says. “However, with social media and the numerous forums I am in, any cases that I want to solicit advice on are available. In addition, I do have two prosthodontists readily available for any professional guidance, something a technician working in a laboratory often does not have.”
Tips To Try it Yourself
Dr. Pickle and Elfring have advice for both doctors and technicians who are considering entering into such an association.
“For me, nothing provides the job satisfaction as does working with patients to achieve the smile they envisioned, and seeing them leave with that smile of ‘job well done,’” says Elfring. “However, when providing advice, I like to ask questions about what the technician values and likes, and then advise them on what may be the best fit for them. There are many types of jobs available to laboratory technicians and finding the best fit for each one is the end goal. When someone finds that perfect fit, they will be internally motivated and come to work, eager to please more patients.”
From the doctor’s perspective, having a large enough practice with several doctors is an important consideration, and then knowing your technician and what you want from him or her.
“It helps if there are at least two of you sharing the technician in the lab,” says Dr. Pickle. “Probably the most important thing is to get to know the technician ahead of time, both in terms of what kind of work they do, and how the two of you communicate. Like any other employees, it’s important that the doctor and technician communicate well and get along well, because you’re going to be with each other a lot.”
It’s also necessary to know what you want your in-house lab to specialize in, because invariably there will be cases that need to be sent out to a dedicated lab.
“If anyone’s thinking about doing this in their office, it’s important to figure out what it is you want to do,” says Dr. Pickle. “Is it crown and bridge work? Is it ceramics? Is it dental implants? Is it removable work? Is it some of all the above? Because in an in-house situation, you still have to work within the budget and within the constraints of what you have to do in terms of equipment and time. So if someone’s trying to plan this out, they have to identify what they want and what they want to do in-house the most, because they may still need to outsource some of their other lab work.”
Being able to provide the service to a patient that the technician comes in contact with is something most lab technicians do not get to experience, but it is a definite bonus for Elfring.
“As the in-house technician, I get to see the smile on the patients face when they leave, ecstatic about their new teeth,” says Elfring . “That feeling of job satisfaction is much better than just completing another case on the shelf in a big laboratory.”