A blueprint for building a cosmetic practice
Jorge Pinero, DDS
People often ask me what steps need to be taken to change an existing practice into a cosmetic practice. It`s a decision that I made a decade ago, and my only regret is that I didn`t make the change sooner.
I view changing a practice as a paradigm shift. The change must first occur from within. You need to have a vision of what you want. If you can`t see what your target is, how are you going to know when you hit it?
This vision begins with you and what you stand for. If your belief system includes providing extraordinary esthetic and restorative dentistry, then your process is already easier.
Next, you must establish what you will accomplish when. I decided 10 years ago that I would take an average practice and radically transform it into a practice that fit my vision. Once you establish your timetable, you must set aside all fears and the feeling of "if it doesn`t work, I`ll return to my old system." There is no returning to the old system if you want to move forward! I burned all possible bridges that would take me back to my old ways. I cleared the old ways out of my mind and set my objective goals to achieve a cosmetic and restorative practice in one year. But, in actuality, I had a cosmetic and restorative practice the day I decided I would not turn back.
I realized that it would take some time for the practice to cleanse itself of the old ways, as many staff members resisted change. One of the largest obstacles in changing a practice is changing human habits - your own and your staff`s. If you change but your staff doesn`t follow and resists the change, you must be willing to let those members go and start anew. I had this problem. I had mentally changed my view of how I wanted to practice and placed those changes into the system. My staff wholeheartedly resisted them and tried to do things the old way. I coached them through these changes and was met by concerted opposition. I felt I was a lone soldier pushed against the beach by the onslaught of an organized army. I could either surrender or triumph.
I let my entire staff go at a time when my practice was grossing more than $350,000 with a good patient load. On Monday morning, I was the only remaining team member. It was horrifying, but I had no choice. I was the leader in command, and I was on a mission to carry out my vision of how I wanted to practice.
The next step was to reorganize my practice with people who wanted to make a difference in the lives of others, who wanted to provide (as well as have) the best life has to offer, who were energetic and positive, and who were "givers" and not "takers." We placed many new programs into place. I continuously researched other successful service professions and copied their models and tailored them to the dental practice. I viewed extraordinary service as the primary objective. I saw that I could no longer provide anything less than the ideal - period!
For me, one of the most definitive steps of creating a cosmetic and restorative practice was to do away with amalgam. More than a decade ago, I decided that I would not offer amalgam to my patients. It surprised me when no one wanted or requested it. Amalgam was only mentioned when we would receive an explanation of benefits from an insurance company, and the patient would challenge us on the choice of material. When this happened I took two approaches. First, I met the patient`s concerns. I advised them that I no longer believed in this inferior and toxic system of restoring dentition. If the patient insisted on adhering to insurance standards, I would refer him or her to someone who did amalgams. This way, the patient would realize that I truly meant what I said. I often heard, "No, I want you to be my dentist," or "If you believe that strongly about not using amalgam, then what do you think is necessary?"
The other side of the coin was dealing with third-party insurance. I decided I would not play their game. I rendered the treatment I felt was indicated and agreed upon by the patient. The requested narratives became a form letter stating that I was rendering optimal service that would improve my patient`s dental health by eliminating the myriad of problems associated with amalgams. I clearly stated that, regardless of the ADA`s stance on the issue, mercury is known to be a toxic substance. Insurance companies attempted to bad-mouth our system. But, rather than get into a mudslinging contest, we just ignored them. I rendered what the patient wanted - a beautiful, metal-free smile devoid of ugly, black fillings polluting it. You can`t state that you`re a cosmetic dentist if you still perform amalgam restorations. It`s an oxymoron.
You can`t get rid of insurance
We didn`t get rid of insurance; those who think they have are fooling themselves. What we did was utilize the insurance - on our terms - for the patient`s benefit. We stopped doing predeterminations. If patients requested a predetermination, we would give them the treatment plan and the ADA codes and they could do it themselves. Guess what? Most patients didn`t do the predetermination and would have the work we recommended performed anyway.
We wouldn`t accept assignment either. We made financial arrangements with patients regarding their fees. If fees were paid, that was a bonus. After all, this is what insurance is for. We ignored any limitations of yearly maximums or recare visits. We just used them for the patient`s benefit.
As the years have progressed, we are seeing that the brainwashing of our patients by insurance has slowly faded away. Those who did not want our services using our new method of delivery would be free to go elsewhere. "Getting rid of insurance" means not abiding by its rules.
Incorporating new technology into the practice
We eliminated amalgams and amalgamators and replaced them with high-speed curing lights and state-of-the-art adhesive systems that beautify and strengthen teeth. We installed intraoral cameras in every operatory for all of our examinations to show the patient what results we obtained. We installed CAESY patient-education systems in every operatory and had every patient watch the segments on ideal dentistry pertaining to his or her needs and wants.
I introduced lasers into the practice as a soft-tissue-management instrument and for use in "The Smile Lift Procedure™" that we render. We introduced power-bleaching systems to all of our patients to enhance their smiles, if they elected to do so. The main thing we introduced into the practice was the desire to deliver the best dentistry possible and to do it in a happy, energetic, and fun environment.
Marketing to patients
People are afraid of change because they only know what they know. They fear change because they have never been there before. I didn`t advertise change. I introduced the changes - as radical as they were - on a one-to-one basis by letting the patient know of the benefits he or she would receive due to the changes we introduced. This subtle process was integrated into the practice when everyone on the team began speaking the same language. A system of delivering the message was incorporated into every service we rendered, focusing on the features of the service, as well as the advantages and the benefits the patient would derive. The team was in harmony, which is crucial because the same message must be delivered by everyone.
Our external marketing was comprised of explaining the benefits of a beautiful smile and a healthier body to the patient. We told our patients our new methods while giving them a tour of our office. This allowed us to inform a captive audience of the services we offered and how those services would benefit from them.
Looking back
There are two things that I wish I would have done years ago. First, I wish I would have had this vision sooner ... but I was afraid to jump off the cliff. What I realize now is that if you see and believe in what you do, you will reach your objective in your desired time frame. Second, I wish I would have made a system out of the thousands of continuing-education hours I took, rather than using just a hodgepodge of techniques.
You must have a well-defined system to reach your objectives. I felt in the early years that if I took just one more course or bought just one more piece of equipment that that would change my practice. But I`ve learned that you can`t expect to get a different result if you keep doing the same thing. You need to have a paradigm shift - see your vision, set your goals, find a mentor who has done what you want to do, and emulate his or her system. Then work this system until you reach your goals.
