From studies in France to German oral surgery
Dr Roman d'Olive, born in Marseille, studied in France and gained his doctorate in 2008. Because there was no proper further training in oral surgery in his home country, he first observed with the surgeon Jean-Pierre Gardella in Marseille and, by way of an EAO congress in Monaco, came upon Professor Fouad Khoury – with whom he eventually worked for six years in Olsberg in the Sauerland. For the German licence to practise he first had to learn German to B2 level; in the first year he was not allowed to do anything on patients and filmed the operations from a stool. After Olsberg he was drawn to Switzerland, his dream country with mountains – yet he found the treatment model there difficult for patients: everyone is a self-payer, and one sometimes has to say no because of the money. With the systems in Germany and France, by contrast, one is often very fortunate. After two years with another of Khoury's students in Gütersloh, homesickness led him to the border region: Freiburg became his adopted home.
Two locations because of one rule: twilight sedation
In 2018 d'Olive founded a new practice in Mulhouse in France. Then came the realisation: as a matter of principle, twilight sedation may not be offered in private clinics or private practices in France, but only in state institutions and hospitals. His answer to this rule was a second practice in Neuenburg am Rhein in Baden, only 15 minutes from Mulhouse. The business model he describes on the podcast Queens & Sons of Dentistry is simple: whoever wishes to be treated under twilight sedation comes to Neuenburg – and the treatment concept can be continued across both locations. At 150 square metres, the French practice is already a respectable size by local standards, even if German practices are often dimensioned differently.
A pure referral practice with a clear surgical focus
Both locations work almost exclusively in a referral structure; the remaining patients come through recommendations. Around 30 per cent of patients now reach the practice by word of mouth – a pleasing proportion for d'Olive, because a different relationship with patients arises from it. The spectrum is purely surgical; prophylaxis and further care are taken on by the referring colleagues. D'Olive makes an exception in extensive full-arch cases: because French colleagues are at times reticent about large restorations, his team occasionally also takes on the prosthetic part – perhaps ten times a year, as he estimates. This variety is said to be great fun and good for the brain, since one grows with new tasks.
Team structures: France and Germany compared
D'Olive's view of the team structures in the two countries is particularly revealing. In France the standard is one dentist with two assistants – no more. The assistants are allowed to take on almost nothing independently: no fabricating of temporaries, no taking of impressions, no producing of radiographs – 'they really are only allowed to suction', as he puts it pointedly. In Germany, by contrast, delegation to qualified staff is possible, which he describes as an enormous relief: he can go from operation to operation, time is better used, and more staff can be employed who take the load off the practitioner. The result is said to be more quality of life at work, concentration on one's own core competence – and an advantage for patients, who are looked after by the team in a quite different way.
Growth, new talent and the digital question
In Germany d'Olive is currently the only practitioner; in France he works with a junior partner, and two young colleagues come regularly to observe. An oral surgeon is joining the team, and in October two further French colleagues will arrive – a 'full house', as he announces. Finally there remains the question raised in the conversation of why the neighbouring countries appear more digitally inclined than Germany. D'Olive points to two aspects: on the one hand the beginning with digital tools is thankless, the practice practically has to pause for the transition, and not everyone wants to be a first mover. On the other hand, minimally invasive, digitally planned work is simply more pressing in France, because private practices there may not offer twilight sedation and there is consequently no other choice. In the end, his cross-border model combines the strengths of both systems.