Dentistry has found itself in flux and constant change. Even in office design and layout, we see newer trends driven by consumer demands, OSHA standards and state of the art equipment and services. Mitigating these changes is the over-riding increase in the cost of doing business and increased competition. Success in Dentistry includes taking into account the design of your office.
Office design and layout really have four key components: Location, budget, number of Ops, and design features. Under each of these key components are dozens of subcategories that will need to be considered. Each one has to be considered to end up with the facility you always thought you would have. You will need to partner with your real estate agent, attorney, CPA, architect and equipment supplier to be sure that every aspect and detail is taken into consideration.
One counterintuitive thought is that while our office is our workspace, it is also the most important marketing strategy we could consider. Patients can and will judge a book by its cover, and your facility is the first thing they see. Each patient has a phantom list that they use to compare you and your facility to their last doctor’s office. A great facility allows you to make a statement about the quality of dentistry and care they will receive. A well thought out facility and design gives us a head start at creating a positive first impression. Where you decide to locate is just the first step in any dental office consideration. With that in mind, I would first spend some time looking at locations and the demographics of that location. Since women make 92% of the purchasing decisions when it comes to dental care, we want our offices to be in high traffic areas, easily seen, located near where women would frequent, and have an overall design that appeals to a female’s eye. Equally important is the need to be sure that our visibility to passing traffic is reflected in the orientation of the building and the signage allowed by our landlord or the city sign ordinances.
Secondly, we want to consider your needs. The number of Operatories you anticipate needing will help you determine the overall square footage of the office. My suggestion is that you consider about 325 square feet per Operatory you want to have; not 325 square feet in each Op but 325 square feet per each Op. In other words just multiply the number of Ops times 325 to give you the approximate total square footage for the facility. If it was a 6 Op office, you would need about 1950 sq. ft. for the total facility. This will give you enough square footage to have a reception area, bathrooms, staff area, business office, everything. A major problem I see is that doctors will use a 500-1000 sq. ft. factor per Op only to find that they have created a huge overhead nut to crack each month without adding any productivity. For strategic planning you should consider that for each doctor you will need two Operatories and probably one swing room or 3 Ops. You would also need one room per hygienist but keep in mind that you should strive for two hygienists per doctor so that might add two more Ops for a total of about 5-6 ops. An additional room for every 2-4 hygienists would take care of overflow or scheduling issues. They don’t have to all be equipped initially, but you need to anticipate a growth of about 15% a year and that will give you an idea of what you will need for the future. If you include a doctor’s private office, I would even plumb it for a future Op. Leases for offices and the constraint of expansion in buildings you own are expensive and difficult to address so be careful to anticipate and plan for future growth.
Every office is challenged to keep up with designs to anticipate the rapid change in technology. I would plan for a location for a 3D Cone Beam. Scanned impressions and the technology that goes along with it will also be a consideration. Cad Cam generated crowns like E.Max have really taken over the crown and bridge in most offices and require space and access. Equipment and technology integration is one of those unknowns that we have to anticipate in creating an ideal space. Along with this is the increase of most general dentists doing what used to be considered specialist areas. Space for sedation, orthodontics, and endodontics require additional storage, space, and carts to do effectively.
Operatory design has actually settled on a modified Pride design with a Power Panel at the 12 o’clock position creating a partial wall with an entrance on each side of the panel. One of the changes we are seeing is fewer cabinets in our Operatories. There is a long overdue movement toward creating a little more space in our sterilization area and a well-designed storage closet to create a tub and tray setup that moves all of our instruments and setups in and out of an operatory to minimize the speed of turnover, while making it easier to clean and maintain without having undue supplies spread all over the office. The advantage of a central supply area with setups for every procedure is that we can minimize the foot print of our Operatories (lower cost and more profit) while making them feel much larger without the clutter that is impossible to maintain for a clinically clean setting. The x-ray unit is being mounted on the central 12 o’clock position to make it equally accessible from the left or right hand side of a chair. Many of the new offices that we build are moving to a portable x-ray machine allowing it to be moved and used in different Operatories. In addition to the x-ray, we are also placing the delivery unit (cart, arm, etc.) in the power panel at a 12 o’clock position making it possible to change from a left hand to right hand operating position in seconds while moving the cart or arm from one side to the other. Another advantage of having the hand pieces in this position allows us to remove all of our instruments out of the line of site of our patients. Nitrous oxide, scalers, carpule warmers, headphones, CPU, and monitors can all be placed in the power panel within easy reach and centrally located from either side. This design and arrangement eliminates the excessive cost of cabinetry while maximizing the ergonomic benefits of a 12 o’clock delivery system. Using plastic barriers allows us to easily turn a room in couple of minutes.
Supply and equipment purchases will be one of the steepest investments you will make and it is important that you take the time to shop for the best value and price. We have come to the age where we need supplies and equipment, but we don’t need a middle man to raise the price 30-40 percent above what these things should cost. With the advent of the internet and companies that limit their presence to its lower cost, ease to research purchasing model, you can save thousands. Going to a traditional national dental supply company nearly always ends in you the doctor paying thousands more than you should. I always thought it a little strange that dental suppliers and their representatives always decide that we needed what they had to sell. Their idea of what an operatory design should be is driven by an antiquated scheme that maximizes your need to purchase more cabinets from them while increasing their profit motive. Be wary of old designs with two or three huge cabinets that are built with drawer after drawer cluttering up the operating arena and creating holes where supplies and instruments seem to be swallowed up and lost.
As you can see, many things have to come together to create a functional, attractive, and affordable facility. Your budget should be to maintain an overhead percentage for your facility at about 7-9%. When I discuss new offices, the cost, budgets, and planning, I always suggest using the internet and equipment and supply companies that will undercut the top heavy, traditional national companies and find that we can open a new office with a savings of 30-60% less than we were able to do in the past. While there are other companies out there, I consistently use and refer my clients to Archer Dental for their equipment needs and planning, and Source One for their dental supplies. This initial purchase and its associated orchestration can be a very predictable project that can save you thousands, while creating an office that you can afford, grow into, and be proud of as your practice takes off.
Michael Abernathy, DDS