Working With Visiting Consultant Dentists

Every general practice refers cases out — implants, complex endodontics, surgical extractions, orthodontics. Each referral is a case, and often a patient, that leaves. A visiting consultant who comes to your clinic one or two days a month keeps both in-house.

The clinical case for it is obvious. The reason it goes wrong is almost always that nothing was agreed in writing.

How the arrangements usually work

• Per-case fee. The consultant is paid a fixed amount per procedure; you keep the balance. Simplest, and the most common.
• Percentage split. Typically weighted to the consultant, since they're doing the clinical work. Clarify gross or net of materials and lab — implant fixtures and lab work are substantial, and this single point causes most disputes.
• Chair rental. The consultant pays for the chair and bills the patient directly. Cleanest separation, and it means you're not in the clinical or billing chain at all.
• Sessional fee. A flat rate for a day, regardless of case count. Predictable for both sides; risky for you if the day underfills.

Agree these in writing before the first session

1. Who bears the cost of materials, implant components and lab work. The single biggest source of disagreement.
2. Who bills the patient, and who issues the receipt.
3. When the consultant is paid — on the day, or after the patient has paid in full. Matters enormously for staged treatment.
4. Who handles complications, and whether follow-up visits are included or charged. This is the clause people forget and the one that matters most at 9pm on a Sunday.
5. Whose indemnity covers the treatment. Both parties need appropriate professional indemnity cover. Confirm it rather than assuming.
6. Whose patient it is. Can the consultant contact them directly? Take them to another clinic? Set the expectation explicitly.
7. Notice period, both directions.

What actually makes it work operationally

• Batch the cases. A specialist coming for two cases isn't worth either party's time. Accumulate cases and schedule a session, which means telling patients "the specialist visits on the second Saturday" rather than booking ad hoc.
• Prepare properly. Radiographs taken, CBCT if needed, medical history current, consent discussed, materials in stock. A consultant whose session is spent waiting for an X-ray won't return.
• One shared record. The consultant needs the patient's history before they arrive, and their notes need to land in the same record afterwards — not on a sheet of paper in a drawer. Continuity of care fails at exactly this handover, and it's also where medico-legal problems begin.
• Brief the patient honestly. Who is treating them, what they're qualified in, and who to contact afterwards. Patients dislike surprises about who is holding the drill.

The economics, honestly

Work out your actual margin before committing. Take the fee, subtract the consultant's share, materials, lab work and the chair time you couldn't otherwise sell. If the answer is thin, the case for doing it is retention rather than revenue — keeping the patient in your practice for their routine care, which is worth real money over years. That's a legitimate reason. Just be clear which one you're pursuing.

Read how to work out your cost per chair-hour first — you can't assess a split without it.

The alternative worth weighing

For procedures you refer out often, a fellowship or certificate course may cost less over five years than the cumulative split, and it keeps the whole fee. It also takes time and volume to become good. Count how many such cases you actually refer annually before deciding — the answer usually makes it obvious.

EnamDoc lets clinics manage consultant dentists, shared schedules and a single patient record across everyone treating them — see what's included.