What Went Wrong: The Quality of Care Wasn’t Up to My Standard

An illustration of dentists with a patient in a dental chair

When you’re considering buying or joining a practice, there’s a lot on your plate! You’re reviewing financials, insurance mix, schedules, local competition… the list goes on.

At ADAPT, we talk a lot about how important philosophy of care is for making successful matches. However, another element is just as crucial: quality of care.

Every dentist talks about delivering the highest standard of care. And while there are multiple ways to get a great result, that “great result” can look different to each dentist.

Let’s examine what went wrong when a buyer discovered she strove for a higher standard than the seller.

Dr. Celeste: too much retreatment after a purchase

After months of looking, Dr. Celeste finally found the perfect practice. It checked all her boxes: four operatories, well-located, solid financials. Health issues were forcing the seller, Dr. Jack, to retire earlier than he expected, so both sides worked quickly to close the deal.

Within a few weeks of taking over, Dr. Celeste noticed that several of her inherited patients had undiagnosed perio problems, failing restorative work, and poorly executed surgery. When she told patients they needed additional corrective work, many grew defensive and skeptical. “Dr. Jack was great! You’re just trying to charge me more.” Many of those angry patients switched to other practices and left negative reviews online.

Other patients took Dr. Celeste’s advice to heart, especially when she enlisted the practice’s long-standing hygienists to help explain why the work was necessary. She began preparing for these conversations with the entire team, stressing that the rework was in patients’ best interests. She was careful never to blame Dr. Jack, but rather frame the issue as wanting to ensure the best possible long-term outcomes.

Over the next six months of Dr. Celeste doing much of the necessary retreatment at a discount to the patients, the costs were getting out of control. When Dr. Celeste tried to get Dr. Jack to reimburse some of the expenses, they both engaged lawyers who sent them to a peer review. The neutral dentist reviewed the charts and confirmed that most of the cases Dr. Celeste flagged did indeed merit retreatment. With the lawyers’ help, they negotiated a figure they could both live with.

Once Dr. Celeste got through a rocky first year and established trust with the patient base, things got easier. The expensive retreatment and legal fees cut significantly into her first-year finances and forced her to delay some needed renovations, but today, she’s back on track. While she still occasionally has to have a difficult conversation, she’s moving ahead with confidence.

How to limit expensive retreatment: assess the quality yourself and plan for the unexpected

The reality is that retreatment can be a significant issue after a sale. This is especially true in crown and bridge practices and in practices that do a lot of orthodontics, TMJ, or sleep apnea treatments. Retreatment can easily become emotionally charged.

Typically, the seller does not want to pay or indemnify the buyer for retreatment, while the buyer wants the seller to either complete the retreatment themselves or pay for it.

That’s why your best defense is twofold:

  • Assess the quality of care yourself

  • Agree on retreatment terms before a sale

The right time to review an owner’s quality of care is before you sign on to buy or join a practice. During the assessment process, ask to review several charts together. Look at pre- and post-op photos and radiographs to see if the work meets your standards. Do you notice untreated perio or surgery that wasn’t handled in a way you’re comfortable with? Are there open margins on crowns? Ideally, you can also shadow the owner for a day to see treatment delivery first-hand. That shadow day can also give you a great feel for how the practice actually runs. (Would-be associates should also conduct this type of due diligence before signing on.)

Ask about the recare rate and what types of retreatment the practice typically sees.

Before you sign on, specify how retreatment cases will be handled.

Once you’re confident that the practice meets your standard of care, put retreatment details into your Letter of Intent. Specify how retreatment cases will be handled after the sale. Who will pay, and at what rate? You may want to establish a threshold or set up a “basket” for continued care. The key is to negotiate this right from the start and establish an agreement you can both accept.

You should also specify what happens when you have differences in opinion about whether or not a case requires retreatment. As with Dr. Celeste and Dr. Jack, you may want to use a third-party arbiter who can make this determination.

Ideally, your retreatment clause will be just another part of the contract you never look at after the transaction. However, spending some time to think it through now can avoid misunderstandings, expenses, and frustration down the road. And remember, there’s no shame in standing up for your high standards.