While representing a small percentage of the overall market, there are approximately 900* U.S. dental practices—ranging from solo practitioners to corporate dental chains—with in-house laboratories. Technicians who have been on both sides of the fence—working for an independent and an in-house laboratory—say they are vastly different experiences, and many prefer the in-house situation because working side-by-side with dentists provides the ultimate opportunity for teamwork, in-depth case planning and patient interaction.
"The biggest benefit of working in-house is getting to see completed work in the mouth on a daily basis. I enjoy a lot of patient contact and am asked to take shades, etc. so I really feel like part of a team. Since all my work is for the same doctor, I know exactly how he likes things and understand his philosophy," says Michael D'Agostino, CDT, TE, Lab Manager for Dr. Jeffrey Rodney and Dr. Cynthia Purtuc, Pennington, NJ.
Part of their satisfaction derives from the fact that in-house technicians feel they're providing faster, superior service to the patient, given the ease with which they can handle chairside shade taking, custom staining, adjustments and repairs. "There is a great deal of joy that comes from making patients happy," says Jeffrey Covington, Ballard Dental Group, Vicksburg, MS.
Also, remakes are lower because the doctor and technician can easily consult with one another throughout the day. In addition, in-house technicians appreciate the control they have over their work and feel they often experience greater financial stability because they earn a salary and don't have the stresses of owning the business.
Those who previously worked at a step-by-step production laboratory especially welcome the diversity of the in-house experience and opportunity to broaden their knowledge. "In the independent lab, I did only one thing: denture setups. Now, I do anything from alginates to fabricating implant overdentures. The dentist I work for values my opinion and wants to hear my ideas," says Barri Varga, Lab Director at Greenfield Dental Health Care, PC, Greenfield, IN. But being under the same roof is also a double-edged sword. While many of the technical issues are similar in both types of laboratories, in-house technicians say the number of distractions is far more daunting when the dentist is down the hall. "One of the biggest challenges is timing. Getting interruptions or emergencies that have to be taken care of as soon as possible can throw off your whole day's schedule," says a respondent from Iowa.
* Based on LMT's circulation data
LMT's recent poll of in-house technicians shows:
On average, our respondents have worked for 18 years as an in-house technician and their labs employ three people
75% work for general practitioners; 25% for prosthodontists
42% work for solo practitioners, 32% for a group practice, 15% for a corporate dental chain and 11% for a dental partnership.
The majority of in-house technicians are employees of the dental practice, working on a salary or piecework basis. Most often, they work exclusively for that dental practice, although some service additional dentist-accounts and, in some cases, other laboratories.
Another business model: the technician owns the laboratory but rents space from the dentist and again, either works entirely for that practice or also has outside customers. For example, Jerry Fountain, CDT, and his wife Charlotte, operate Charjer, Inc. and work exclusively for Dental Plus, a dental practice that employs a total of six dentists in two locations, DeRidder and Leesville, LA. The Fountains rent the space in the larger, DeRidder location and the dental practice provides the space in the Leesville location. The practice handles billing and collections and the lab receives a percentage of the restoration revenues. The lab owns all of its equipment and splits the cost of supplies with the practice.
"We've had this partnership for 30-plus years and it's been very successful," says Charlotte. "It's a busy practice so it keeps us busy, especially the same-day dentures, and we don't have to juggle multiple accounts."
The majority of our poll participants don't use any digital fabrication technologies. Among those who do, 28% use an impression or model scanner, 21% use a milling system and 17% use an intraoral scanner.
But as the use of digital technology in the operatory continues to grow, some respondents predict that the in-house laboratory will become an increasingly popular business model since it's an ideal niche for the in-house technician who has the expertise to operate the scanner, design, and stain and glaze. "It's often been said digital technology will declare the technician obsolete but my doctors love having me by their side as a sounding board," says Katja Krull, CDT, Bay Mills Dental Clinic, a tribally run Indian Health Service Clinic in Brimley, MI.
Others predict the growth of the in-house model because of the overall advantages to the dental team and ultimately the patient. "I believe the in-house lab as a business model will grow in popularity," says Joe Malzone, Lab Manager for Dr. John Hulbrock, New York, NY. "It's more practical and doable than most would expect. It allows dentists and technicians to come together and provides all-around benefits for both, including closer involvement and consistency. And as far as the end product, there is no comparison when it comes to communication and execution of the work."
For the dentist perspective, click here