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Ownership of dental offices by non-dentists

Originally published in the November/December 2012 issue Dispatch

What are the permissible forms of business arrangements?

A non-dentist can own or lease the premises and physical assets of a dental office and can be a landlord to a dentist. Only a dentist can “own” (have custody and control of) dental records and only a dentist can “own” the goodwill portion of a dental practice. In addition, only a dentist can profit directly from the practice of dentistry. A dentist can rent or sublet (as permitted contractually) furnished, supplied, and even staffed, facilities from a non-dentist to operate an independent dental practice.

What are the legal restrictions?

A dentist cannot engage in any form of fee splitting or income sharing with a non-dentist except with dental hygienists providing services to patients in the dentist’s practice.

A dentist cannot practise dentistry in partnership, association, or as an employee of a non-dentist in a privately-owned business or professional practice.

However, a dentist can be a business partner of a non-dentist in the ownership/leasing of the premises and physical assets of a dental office.

If a non-dentist landlord is providing staff for a dental practice, the dentist must have supervisory control to ensure compliance with the regulations made under the Dentistry Act, 1991 and all the requirements of the Regulated Health Professions Act, 1991, the Personal Health Information Protection Act, 2004, and other legislation governing the practice of dentistry.

A non-dentist can install dental radiographic equipment with the approval of the Ministry of Health and Long-Term Care’s X-ray Inspection Service, but only a dentist can be a radiation protection officer. The Healing Arts Radiation Protection Act, 1990 requires that dental radiographs be prescribed by a dentist.

On what basis can a dentist pay rent?

A dentist can only pay a fixed rate of rent which cannot be rent calculated on the basis of a percentage of dental fees billed or collected. The rent the dentist pays to a non-dentist can include payment for the use of a furnished office, including equipment, materials, and the services of clinical and/or administrative staff. The rent should reflect current market conditions and not be determined in any way on the income or
profitability of the dentist.

Is it possible for dentists to share professional office space with non-dentists who provide services to the same patients?

A dentist can share office premises with non-dentists, e.g. other regulated health professionals. In such situations, each regulated health professional will operate an independent practice, will maintain separate patient records, and will collect fees from patients for professional services.

Each regulated health professional should provide insurance claims or receipts for submission to the patients’ dental or extended health insurance plan providers using appropriate forms and profession-specific codes.

If a dentist is sharing office premises with other businesses, these businesses should be understood by patients to be separate and distinct from the dentist’s professional practice.

On what basis can non-dentists pay rent to dentists?

A dentist can rent space to a non-dentist on whatever basis the non-dentist’s regulatory college permits.

Are dentists permitted to be in cost-sharing arrangements with non-dentists?

Cost-sharing arrangements whereby dentists and non-dentists pay expenses in common are permitted. Dentists are not able to practise dentistry in any arrangement with non-dentists nor can a dentist’s health professional corporation have such arrangements.

Are non-dentists able to be shareholders in a dentistry professional corporation or technical service corporation?

The directors, officers, and voting shareholders of a dentistry professional corporation must be dentists and members of the College holding a valid Certificate of Registration. Certain non-dentist family members of a dentist shareholder can be non-voting shareholders. Non-dentists can be both voting and non-voting shareholders in a technical service corporation, which can be used for the delivery of technical services, e.g. management or dental hygiene services.

Can a dentist share a practice name with another regulated health professional?

No. Dentists are not able to practise under the practice name of another non-dentist regulated health professional. Dentists who wish to practise under a practice name must submit their proposed practice name to the College. It is important to note that the College does not grant exclusivity for approved practice names of dental practices.

Who retains the dental records for patients treated by a dentist at the end of a dentist’s business relationship with a non-dentist?

Patient records are an integral part of the practice of dentistry and dentists have legal responsibilities to retain patient and practice records. The custody and control of patients’dental records must remain with the dentist on the termination of a dentist’s business arrangement with a non-dentist or the records must be transferred to another dentist.

In cases where office premises are shared with other regulated health professionals and patients are treated in common, the dental records must be separate from the records maintained by the other regulated health professionals and removed or deleted from the shared computer system’s hard drive or server at the end of the shared business
arrangements.

Where to get more information

Before executing any contractual agreement or entering into any business arrangement, the College suggests that dentists obtain legal advice from lawyers who understand the regulatory framework and practice environment for the dental profession in Ontario.

Questions?

Practice Advisory Service
practiceadvisory@rcdso.org
416-934-5614
Toll Free: 1-800-565-4591