Reflections on a referral-based endodontic practice

Dr. Rich Mounce offers some tips for professional growth


The traditional model of endodontic private practice referral has changed since I graduated in 1991. Challenged by implants, corporate dentistry, and a glut of endodontists in major metropolitan areas, referral-based practices are more difficult than ever. In 1991, hanging out a shingle was almost a guarantee of success. At the present time, practices are often location dependent, and competition for referrals can be fierce. Given these headwinds, this article was written to give endodontists (and GPs) actionable ideas to help elevate their practices to a new level.

I believe the first and most essential ingredient for professional satisfaction in a referral-based practice (and any practice for that matter) lies in a positive outlook and a willingness to change some of our deepest-held biases and beliefs as we experience that which challenges our dogma.

There will always be setbacks (staff problems, clinical misadventures, difficult patients, etc.) but ultimately, our ascension into a higher level of practice depends on what we learn, and how we change from these setbacks. It certainly did mine. We can become bitter and negative, or we learn and ultimately fine-tune our actions, behavior, and policies to become stronger, wiser, and to perform better the next time the issue arises.

For example, one small course correction I made over time related to scheduling. We evolved from one-size-fits-all scheduling to one more tailored to the patient’s needs. Specifically, if the patient was a senior citizen, or his/her medical history complex, we moved to a method of consultation appointment first, then a treatment appointment. Over a career, literally thousands of such small adjustments and improvements can and should be made on a daily basis.

Coincident to such evolution, as endodontists, the strength of our personal relationships with our referring doctors cannot be overstated in value. The same is true in reverse. A solid referral relationship with one’s specialists always benefits all parties. Whether in a phone call, handwritten note, or short unannounced office visit, every personal touch is designed to develop a connection and lets your referring doctors (and specialists) know you care. People like to work with people they like. Growing personal relationships grows your practice. Similarly, a personal connection between your staff and that of your referring doctors (and vice versa) reinforces this connection.

Alternatively, referrals from “strangers” are almost always problematic. A real-world scenario is the iatrogenic event referred with no clinical information provided by the referring doctor prior the patient’s arrival and in the absence of a personal relationship between the doctors. This scenario is not predictive of a good outcome for any of the parties involved. Some form of relationship and communication prior to referral certainly minimizes the potential negative impact of the challenge.

Lower fees to attract business, flashy brochures, chair massagers, providing CE (at any level), sending newsletters, muffins, chocolates, flowers, etc., while nice, for me almost never were the “fire starter” of referral relationships. If anything, the reverse was true. It made me seem desperate for referrals, which was never the case. In fact, the time invested in personal contact and relationship with doctors is ultimately far more economical than using resources to provide the preceding premiums.

While much could be written about staff and their impact on the success of our practices, I have come to appreciate that recruiting, maintaining, and improving staff are every bit as important as any other foundational pillar of practice success. A capable staff reinforces the relationships we develop with our referring doctors by delivering on the promise that the patient will be well taken care of. The reverse is true.

And finally, there are exceptions to every rule. Counterintuitive and uncommon, I have had good referring relationships where little or no relationship exists with the referring doctor due to distance, and/or clearly the referring doctor did not want a personal relationship. As in all practice challenges, we cannot control the outer environment we work in, but in order to improve, we can and must adapt to what it brings. Such evolution is a harbinger of our personal and professional growth. I welcome your feedback.

richard-mounceRich Mounce, DDS, a practicing endodontist, has lectured and written globally in the specialty. He owns MounceEndo, an endodontic supply company also based in Rapid City, South Dakota. Dr. Mounce can be reached by calling 605-791-7000, emailing, or visiting

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