The disruptive therapist business model: a case study

by Business growth, Costs, Direct access, Leadership, Pricing, Recruitment

When the GDC gave direct access the green light in 2013 it created an incredible opportunity for significantly bigger margins in dental businesses. Anyone prepared to delegate their associates’ work to therapists could drastically cut costs, but for whatever reason few practice owners have taken advantage. Runeel Joye is one who has. His practice Oh My Smile in Cheshire is an example of what is possible.

Runeel, what’s your story?

When I saw Hive Business for a diagnostic day two years ago I was 80 per cent NHS. We looked at all my options: selling up, working as an associate, moving, but I thought there was a future in my business and decided to refurbish it and run a marketing programme to convert it into a private practice. I’ve had some struggles, including with recruitment and with my own health, but we now have a beautiful practice and a rebranded business.

What was the recruitment struggle about?

Part of it was continuing to meet NHS targets. We took the therapist model on because we were struggling to recruit dentists and we thought: how can we deliver NHS dentistry in the meantime? The plan was to take a therapist on for two days and see how it went, then we shortlisted two really strong candidates and decided to hire them both for five days. We weren’t sure how to build them up but they’ve gone wholeheartedly into everything: x-rays, impressions, hygiene, and all private work.

How has this gone down with your dentists?

Dentists are almost pricing themselves out of the market, so it’s about retraining them to work in a way they’re supposed to, not how the NHS has trained them to work. You use the team around you and delegate. Dentists have become used to working alone and doing everything themselves, but I’ve been trying to help everyone understand that it’s more beneficial and more motivating to work as a team. When I’m doing a filling I’m thinking, “Why am I doing this?”

Has there been any friction?

One of my associates was on maternity leave, and when she got back she was asking what she gets for referring a patient to a therapist. I thought: it’s the same as if you refer a tricky case to a specialist, you’re referring that work because that’s the work the specialist does. I think change always ruffles feathers, but people adapt. I decided that for this business model to work I’ve got to stand firm, and if some team members can’t come with me then it’s not for them.

What do your therapists do?

They do x-rays, perio treatments, hygiene, oral hygiene instruction, impressions, amalgam and composite fillings and whitening. NHS and private.

What was it about them that caused you to change your plan?

These two therapists are motivated, they have ideas and they want the practice to do well because they can see what it means for them. They came to me and said they were concerned that they were doing work for which the associates were still being paid, so we changed that.

Now when an associate refers to a therapist, they’re effectively giving that work to the practice, yet everyone understands that it wasn’t theirs to give away in the first place. It’s about making sure the right person is doing the right work to maximise their time and potential. For instance, I could do a surgical extraction, but it would take me two hours versus 20 minutes for an oral surgeon, so why not refer it?

How much do you pay your therapists?

They’re salaried at £25 an hour. It works out at about two thirds of what we were paying associates for the same work. They get 35 per cent for upselling private work and three per cent on orthodontic referrals — ideas suggested by one of the therapists. They do about 20 UDAs per day plus some private.

Meanwhile our associates are doing more high value treatments so they are yielding more than the 30 UDAs per day they were busy with before. Previously they yielded about £700 a day. Now it’s £900 and we’re aiming to get that up to £1,200. So there is significant extra revenue which is almost free profit.

How did you recruit the therapists?

They both had other offers. It was the presentation of our practice and our intention to use the full scope of their repertoire that attracted them. A lot of therapists get promised this but end up being used as hygienists. They could see we were serious. There are a lot of good therapists out there. We were struggling to recruit associates but we got loads of applications from therapists.

Have your associates changed in response?

They were underperforming before, as was the practice in general. Having the therapists in showed us that the associates needed to be doing more. If therapists can achieve an ADY of £700, then why pay dentists to do that? We invested in the practice refurb and in generating new patients, so the associates can see that they are being given an opportunity too.

It’s an opportunity to get away from the treadmill of low skill dentistry. Many people try to do this by doing courses but never use their new skills, largely because the traffic doesn’t come their way. It’s a vicious circle, the pattern gets engrained and you have to take a bold leap.

How has work changed for you?

I’m doing more complex treatments. We’ve recruited a lot of people in the past few months, with 75 per cent more staff. These people have only known the new brand and business model and it’s injected enthusiasm into the business, pulling older team members along. People are motivated to work hard, and our two therapists have created this change. I can see it’s the way forward in dentistry, not just in my practice. We’re looking at an extra 25 per cent of revenue with almost no extra costs.

Where do you want to take your practice in future?

I’d like to be NHS free, or at least have the choice. I wasn’t doing well out of it, it’s not the way I want to treat patients. We had a CQC inspection recently and they loved the way we were using the therapist model. They were looking at it from a culture point of view and saw that our whole team had bought into it.


“I can see it’s the way forward in dentistry, not just in my practice.”

Runeel Joye, Oh My Smile owner

Author: Zac Fine