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Designing Your Perfect Dental Practice

Designing Your Perfect Dental Practice

Table of Contents

Introduction: Achieving Your Dream
1. One Dentist's Story
2. Your Preferred Future in Dentistry
3. Designing Your Future: "Visioneering" Your Dental Practice
4. The Practice Philosophy
5. Communicating Your Philosophy
6. Establishing Communication Standards
7. Patient-Centered Communication
8. Creating Positive Public Perceptions
9. Systems and their Application
10. Schedule Busters: Communication with Your Oral and Maxillofacial Surgeon
11. The Black Triangle: Problems of Periodontal Communication
12. Banding Together: Solving Orthodontic Problems
13. The Patient in Pain: Endodontic Referrals and Follow-Up
14. Elmo Goes to the Dentist: Pediatric Practice and Referrals
15. It's Over My Head: Coping with the Complex Patient
16. Saying Goodbye: Not All Relationships are Forever
17. After the Ink Dries: Keeping the Dream Alive
Epilogue: A Day on the Bay

Introduction: Achieving Your Dream

Do you remember the goals you had in dental school? Have you achieved the life you used to dream about? How many of us ever get there?

Tough questions, I know. But if you believe there is a better world in your imagination than the one in which you actually live, and you want to make it a reality, then this book is for you. It will give you some answers to those important questions about how to achieve your dreams in your practice and your life.

On a recent poll of dentists, over 50 percent said they would not select the profession of dentistry, should they have the opportunity to live their lives over again. Less than 30 percent said they were highly satisfied with their profession. Isn't this a sad commentary? Yes, but not the end of the story!

Most of the anxiety dentists feel has a familiar source: stress. Ask any dentist if he or she can name two things that will solve most of his or her problems, and nearly every one will have the same answer. "Help me find more patients and reduce my stress!" Or, "get rid of managed care and reduce my stress!" Or, "get this staff working with me, not against me, and reduce my stress!" "Lower my overhead and reduce my stress!" Stress is always the common denominator. Why should that be? We work in environments of our own creation; we provide helpful services to our fellow humankind, earn an enviable living, and enjoy enormous social and professional respect.

The answer is simple. 1) There is no longer the stable, predictable environment that once existed in our profession. 2) Dentists have lost control of their professional and practice lives. 3) Picture the typical dentist, trying to maintain a professional demeanor in the face of the pressures we all feel today!

Practice management is a chore; it seems to yield far too little return on investment in many dentists' minds. Practice overhead expenses are going crazy, rising at more than double the rate of inflation, and fees are under huge downward pressures from consumers and third parties. Patients are now "clients" at best, or "consumers" at worst, demanding accommodation of days and times. They are ferocious too, in their expectations of perfect results.

Of course there is OSHA, the CDC, your State Board, CE requirements, even Environmental Safety regulations, and soon waterline sterility and standards for sewage effluent coming from your office. Insurance companies are positioning themselves to be the primary care providers of all health care as soon as market forces allow. The result is either a severe erosion of the dentist's income or a changing pattern of practice to increase the number of days and hours worked just to keep up.

Loss of control causes the dentist to focus on the next problem, on the daily crisis, reacting to the situation and the environment until burnout occurs. Yet this elusive idea of a controlled professional life in dental practice remains alive in the minds of most dentists as a viable dream.
The dream can be attained! It's simple in concept and can be accomplished with sustained effort and commitment. Decide what you wish for yourself, your family, your staff and your patients. Then make it happen according to your own design. This book tells you how.
Let's begin by introducing you to a friend of mine...

Chapter 1: 1 Dentist's Story

Dentists share a misconception. The misconception is that we somehow are gifted enough to create, manage and succeed at the very complicated and dynamic enterprise of dentistry without any training or expertise. Yet dentists come in all kinds of packages, and they bring their skills and weaknesses to the practice every day. Each dentist's practice is a reflection of that skill set he or she brings to work.

If the dentist is well organized, so will be the practice.
If the dentist is poorly organized, so will be the practice.
If the dentist has poor communication skills, the practice will not have a clear message that is conveyed to the public.
If the dentist is motivated solely by money, his or her staff will be greedy as well.
If the dentist is lazy and avoids unpleasant tasks, letting them build to crisis proportions, his or her staff will also procrastinate.
If the dentist is interested in the quality of care, the staff will be too.
If the dentist finds the enterprise of dentistry fascinating and challenging, and makes a study of small business management, the practice will be well managed.

I met Steve MacPearson, D.D.S., after he was in practice for nine years. Steve gets up each morning with high hopes for the day. After nine years in college and dental school, and another nine in practice, Steve feels like he should be in the peak years of his practice life. Yet at the end of each day he sits at his desk, defeated. He has a good practice, not what he would like it to be, but it has provided him with a living and many of the trappings of the successful health professional. He has not created a business. Nor has he created a professional life. He has created a personal job, and one that has begun to consume him.

"I went into dentistry because it offered me a chance to be my own boss and have a career in the sciences," Steve told me. "I was really a good student. I even thought about going into medicine for a while when I was in college. But I felt that the life of a physician was too demanding, and I really like to sail more than anything."

Steve was a high school record holder in four swimming events, was his high school valedictorian, and went to college on a swimming scholarship to one of the top universities in the country. While he was an undergraduate he took up sailing, joined the sailing club and became an exceptionally accomplished sailor.

"I really had very little time in college to plan my future," he said, gazing out the window to the bay over the stack of charts on his desk. "Yet I think this was a very good choice for me, knowing my aptitude for science and all. Do you realize how few jobs there were for science majors when I graduated in '83? Most of my friends and frat brothers went on to get a masters or something. Some of them are teaching; one is a college professor. A whole bunch of them are lawyers. The ones who were in the sciences and didn't pursue a professional career in medicine, dentistry, or teaching are not working in the sciences now. Some of my close friends wanted to work in an environmental science or resource job, or for Jacques Cousteau or someone like that. But there were more life sciences grads than dolphins left to study when I graduated. I only know of one who is actually working in the field. I think he's a forest manager.

"So when I went to see my advisor about careers, he suggested I consider dentistry. I had never even thought about dentistry before, other than being a dental patient as a kid. I had braces when I was a freshman in high school and hated every minute of it. I thought the girls wouldn't like a guy with braces, even though a lot of other kids had them. But I looked into it, even visited my family dentist when I was home on a break. Dr. Jennings was really enthusiastic about what he did. I was impressed with that, especially since he seemed to still really like what he was doing. He was even much older than my Dad, who was always complaining about his job. What I didn't realize was that old Doc Jennings was the last of an era. He worked virtually alone in a small office, probably with almost no overhead, and had earned and kept a small fortune many years before my visit with him.

"The next thing I knew, I was signing up for the DAT and applying to dental schools. Once I began that process, all my energy was focused on getting in to a good school. I never really questioned why, or if it was the correct choice after that.?

I looked at Steve's diploma hanging over his desk. "You went to a great dental school," I said.

"Yes it is great, and I did very well there. I was in the top of my class, and actually enjoyed my dental studies. I think it prepared me very well for the clinical side of things. But it was very expensive, and I still am paying off some of my loans."

Steve was quiet for a moment.

"But you know, Jay, I'm really not very happy with the way things have turned out for me," he said, glancing my way. "I expected so much more. I don't know if I feel betrayed, but it seemed like this would be a lot more rewarding than it has turned out to be! Nobody in college—not my counselors or professors—had any idea about the profession they were steering me toward.

Their knowledge was based mostly on their own personal experiences with their dentists. They really have no true knowledge of the profession and its challenges. It seems so trivial, but I guess I feel misled. Even the dental schools did nothing to help me understand what I was getting into."

He began to shuffle some of the mail on his desk. There was an enormous stack of journals and newsletters mixed with dozens of unopened envelopes. Even some patient charts were in the pile. The latest issue of Dental Economics was open to page 39.

You'll be hearing more about Steve as the book unfolds. Many dentists share similar difficulties putting it all together. The clinical side of things is often the easiest, because that is where our training is the most complete. The assumption among university professors and deans is that the quality of student who enters and completes dental school is a person who can "figure out" the rest of the problems and challenges of private practice. I have even heard the academic's excuse that dental students have no interest in learning practice management, so the deans and committees have not pushed it in the curriculum. Having been a dental student, I can attest to the fact that a great deal of the curriculum does not interest the students. But you sit there and learn it anyway. Nothing learned in dental school has as great an impact on a doctor's life, if he or she is in private practice, as the lessons learned from whatever resource about practice management.

Dentists are not clones of one another. There is no "typical" dentist, although we do share a lot in common. All happy dentists, however, are alike in several respects. They love their profession, and they have achieved economic success according to their own personal definition. Their lives are in balance. They are not consumed by their own practice. The practice is simply an important function in a balanced life, perhaps an element of great importance, but not the sole defining characteristic of the dentist's self image. Family, friends, spiritual life, recreation, intellectual pursuits, community activities, and much more are the elements and components of the lives of balanced dentists.

A prominent university dental school recently offered to its faculty the opportunity to enroll in graduate studies leading to an MBA, with instruction provided on site at the dental school. About 20 of the faculty enrolled. I wonder if this group includes any of the same faculty that have prevented a serious study of business management in the dental school. A dentist should not have to return for two years of graduate study and obtain an MBA in order to run a small business. Yet that may be the message in this faculty example. These "experts" in dental education themselves feel incapable of instructing the students in the business application of their clinical skills to make a profit, feed their families, send their kids to college and retire.

Dental practices are small businesses. The theories of small business management are very accessible, and dentists certainly have the aptitude and intellect to perform the duties of a small business owner/manager. That is not to say that small business is simple or effortless. Over 80 percent of all small business start-ups fail in five years. Dentists are far more successful at survival than that grim statistic. Yet dentists could be far more successful in the prosperity they derive from their efforts in small business if they would take it upon themselves to be as complete an expert about their business enterprise as they are about their clinical profession. This book is one component of a personal quest each dentist must begin in order to understand all the fundamental principles of the management of a private practice. It is not a comprehensive guide to practice management.

The following chapters will teach you the fundamentals of dental enterprise design. Steve will help illustrate the problems, and I'll help illuminate the solutions. It"s up to you to implement the knowledge in your own life and dental practice.More efficient operations, better patient outcomes, higher profits, reduction in malpractice risk, true quality control on referrals, clear communication between doctors and their staff, better staff relations, faster patient service, better patient compliance and retention, outstanding practice growth, peace of mind that the practice philosophy is understood and followed, no patients ?lost to recall? or ?lost to referral,? an environment with which managed care can?t compete, and increased referrals for specialists.

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