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Managing Referral Relationships in Challenging Times

By Roger P. Levin, D.D.S.

Since the Great Recession disrupted the dental economy, many dentists have changed their referral patterns. Cases they typically used to refer to specialists – not only endodontists but also orthodontists, periodontists, oral surgeons and pediatric dentists – are now frequently retained. The reason is obvious; general practices that once could easily fill their daily schedules with customary types of treatment began experiencing production declines. Rather than giving away potential income to specialists, they decided to perform specialized procedures themselves.

While you can’t alter the underlying causes, you can serve your own purposes better – and earn the lasting respect and trust of referring offices – by rethinking how you work with them during these changing times. Here are some suggestions for making the most of the situation:

  1. Don’t express negative feelings to referring doctors if they’re retaining more endodontic cases. Rather than reacting to the slowdown, reinforce the benefits you offer, both to the referring office and to their patients. The idea is to preserve a valuable relationship.
  2. Find ways to help GPs decide when a referral (to you, of course) makes more sense than handling a case themselves. Earn the trust of your referrers by serving as an objective judge of which cases call for the services of someone who’s highly experienced in performing root canal therapy. As long as referring doctors are asking for your opinion, you’ll stay at the top of their endo referral list.
  3. Inform your referring dentists that you will endorse the next phase of restorative treatment to take place in their practice. General dentists will be more apt to refer endodontic cases when they are confident the patient will be back in their chairs for the restorative phase of treatment.
  4. Provide materials that help educate their patients about root canal treatment and that help make it easier to refer to your practice. As an endodontic expert, you can help referring offices inform their patients by offering patient education materials, such as the AAE’s brochures and videos. You can also provide referral forms for patients to present at your practice.
  5. Establish strong interoffice communications that enable referring offices to serve their patients better. When you do receive referrals, use them as opportunities to demonstrate that you and your staff function as excellent interdisciplinary partners. Be proactive in communicating with referring offices so they’ll be fully informed about the status of their patients. Your objective is to make it seamless.
  6. Become a trusted adviser on the subject of endodontic treatment. If a GP who has the potential to send you many referrals needs the advice of an endodontic expert, that should be you. Although you may believe you should be handling a particular patient in some cases, be generous with your expertise. It’s a wise investment in the relationship.
  7. Maintain strong branding that sets you apart from other endodontic practices. and may lead to patient self-referrals. Don’t neglect marketing, ever. Even though referrals from some offices may have slowed down, you still need to position your practice effectively and continue adding new sources. Continue to focus marketing efforts on referring offices, and establish an online presence – website and social media activities – to develop a good reputation in your community. When competitors cut back on marketing, that’s the time to double down.More information about developing a practice marketing plan is available in the AAE’s Marketing the Endodontic Practice e-books.
  8. Be patient. many general dentists will refer more patients again as they regain their footing in the new dental market. As more and more dentists master the new rules and get their practices up to speed, they will again find it more efficient to refer endo cases. Spend the time between now and then building strong relationships so that you’ll get a large number of those referrals.


    Macroeconomic factors have altered the referral landscape for endodontists and other specialists. By finding new and productive ways to work with general dentists, you can hold your own in the current situation and lay a foundation for greater future success.

    Dr. Roger P. Levin is a third-generation general dentist and the founder and CEO of Levin Group, Inc., the leading dental practice consulting firm in North America. He offers tools to help endodontists run more profitable, efficient and satisfying practices through the Levin Group Resource Center