by Jack D. Griffin Jr., DDS
It's amazing how fast we come to a conclusion about someone we don't know. We see a person on television, and, in two minutes, we decide if we like or hate that person. We judge so quickly ... and with so little information!
Unfortunately, the same thing happens in dentistry. We slam those who we deem as being more successful or having more than we do. Maybe it's jealousy, envy, or just plain ignorance, but we go into the attack mode when someone has what we don't and try to find some "dirt" on that person. We come up with bogus reasons to justify our behavior, while trying to convince ourselves that we don't want the success that person has.
Why should we feel threatened by a dentist in another practice if we offer compassionate, current, and quality care? If we would just worry more about making ourselves better, everything else would take care of itself.
Unity is something that is definitely missing in dentistry. Rivalries exist between dentists in the same city, conflict goes on between some of the specialists and general dentists, and even more bitterness is displayed by many practitioners toward organized dentistry. Perhaps some of the most absurd hostilities are the barbs thrown at the "high production" or "high fee" practices. The fees of these practices only have to be a little higher than others for misinformation and lies to spew forth. If the energy spent ripping each other was spent learning to be better dentists, we would have a better profession in which to practice. Never, ever, is our status raised when we try to lower that of others. Our integrity is compromised when we attack others. We must quit giving credence to the following seven lies:
Lie No. 1 - They don't care about the patient; they only care about money ...
We often deem those with more money than us as being greedy. These high-netting dentists only care about the quest for the almighty buck, we say. They see dollar signs painted on each broken molar cusp. They hear the cha-ching in their heads when a patient needs a crown. When they get close to the pulp, money pulls that bur another millimeter into the $1,000 promised land of endo treatment, post and core, and a crown. They tell the patient: "That tooth probably would have been sensitive anyway, so we did endodontics before it had a chance to have a problem."
Some of these dentists will tell a patient that even teeth that need sealants ought to have porcelain onlays, since all bonding eventually will fail. The tooth then will need a composite, which also will fail from leakage and which eventually will cause sensitivity, leading to endo or even extraction. So, these practitioners will tell their patients, "We ought to do the onlay instead of the sealant to prevent all of this from happening. After all, this is the best treatment."
There is no question that there are some unscrupulous practitioners. There also is no doubt that some dentists are greedy and may even recommend treatment just because they want to pad their retirement plan. I believe the number of dentists who would do what I have just described is very small in number and that they will have to answer to their maker for taking advantage of their patients. However, to assume that all "high production" practices are like this is equally ridiculous.
The majority of these dentists know that the way to financial freedom is to do compassionate treatment with as much care and quality as possible. Financial reward is highest not from the one-time, mega-treatment plan of $4,000, but from providing continuing care to active patients over many years. In fact, happy patients are proud to send their friends in for the same great care.
Every few years, your existing patients may require a crown or a few fillings. These needs are discovered as a result of an organized recare program, and that is the way most of these practices thrive. If the patients feel gouged and ripped off, they will leave the practice and stop referring their friends and family to you. Busy practices are busy for a reason - patients return because they feel they receive high-quality care. If they don't receive quality care, patients will leave a practice.
Lie No. 2 - The reason high-netting dentists produce so much is high-pressure sales ...
The picture is of a patient being locked into a small, dark dungeon, forced to watch "The Jerry Springer Show" until he or she agrees to an $8,000 treatment plan. Does high-pressure sales happen in dentistry? Of course it does! But showing intraoral photos and videos and taking time for thorough explanations are not "high-pressure" activities. Perhaps the reason some dentists are more successful at gaining patient acceptance than others is because they are technically superior, more confident, more articulate, or they have a better trained staff that excels in presenting treatment.
High-producing practices either have a high percentage of patients accepting needed treatment or they have a smaller number of patients agreeing to treatment that is perceived as higher quality at a premium fee. This kind of success starts with a dentist who is totally convinced of the need for treatment. Such a dentist has a quiet confidence that patients and staff sense. Secondly, these dentists have staff members who are equally as confident that their dentist can deliver the needed treatment in a quality way. The staff reinforces the doctor's decisions; conversely, an untrained or unconfident staff can doom patient perception.
Staff members need to see and understand the successes, so that the failures are kept in their proper perspective. We all seem to remember 20 bad things for every one good thing. The staff is a critical element in influencing patients to commit to the dentistry they need. The reason for this is because staff members are often perceived by the patient as unbiased participants who don't benefit directly from the fee the patient pays.
Assistants and hygienists should do the majority of treatment-plan presentations, so the doctor can focus his time on doing dentistry. Assistants and hygienists also are more qualified to explain treatment to the patient than are front-office staff members. Intraoral cameras make presentations a slam-dunk if money is an obstacle. The organization of the practice, confidence of the doctor, and motivation of the staff are what gets treatment plans accepted, not strong-arming patients.
Lie No. 3 - If a dentist is fast, the work must be bad ...
I know a dentist who really believes that quality crown preps cannot be done in 10 minutes. He feels that time spent on a procedure is in direct proportion to the quality of the dentistry. Remember your first crown or two in dental school? Are you telling me that because the diamond touched the tooth for a total of two hours and 45 minutes that the prep was better than what you can do now? If you hired an associate right out of school, how much longer would it take Doctor Junior to do a quadrant of three-surface posterior composites than you? Again, do you think Dr. Junior's quality would necessarily be higher than yours just because it took him double or triple the appointment time to do the same procedure? Fast work is not necessarily bad work; only bad work is bad work.
The best way for you to take home more money is to work faster while performing work of the same high quality. Working this way will allow you to do more dentistry in shorter time periods, and that will lower your overhead. It's easy - the more you produce per hour, the more dollars you take home! Next to raising your fees, your speed is the most important factor in having a higher profit. This may sound simplistic, but slowness doesn't mean quality in and of itself. It just may mean that the practitioner lacks confidence, does not have enough experience in doing a procedure, the staff is inefficient, or the equipment is faulty.
Lack of speed kills. If you were having a root canal done on yourself, would you want the slower dentist doing it, or would you want a dentist who could do the same quality job in half the time?
You are not going to hear a patient say, "Please, Doc, can you file for 20 more minutes?" Patients want you to get the lead out and floor that accelerator - as long as the quality and care remain high! So, if the patients want it and you would make more money doing it, why don't you focus more on your speed?
Remember that sacrificing quality will rip into your profitability. Do great work the first time and in the shortest time possible and you will have a better practice. Often, the more-productive doctors have a higher personal confidence level and are more organized in their thoughts. This makes for more efficiency in the practice.
Lie No. 4 - It's their location that makes them so successful ...
Everyone thinks if he had that "kick-butt" location in Beverly Hills that he would be able to afford the two Ferraris. Why does every other location look better than ours? Just as the grass is greener, the molars are always more broken on the other side. You hear the complainers say:
"My town isn't growing as fast as yours."
"You don't have managed care like we do."
"If I were only next to Mc Donald's instead of Marty's Mufflers, I'd get more new patients."
"Your patients make more money than mine do."
Location, patient status, and benefits are important, but don't use them as the only reasons for a lack of new-patient flow or production. The real quality patients in a healthy practice come from patient referrals. No TV, radio, billboard, direct mailers, phone book, or banners behind airplanes can substitute for a happy patient who refers a few friends. Some dentists just think that the new-patient flow problem will be solved as soon as they can figure out in which direction to throw their advertising dollars. They just have to find the "right marketing consultant" to design the perfect ad for the best media. "The perfect infomercial is what I need to get that great practice," these dentists will say.
There is no question that an effective ad in the right medium can attract many new patients; however, a poorly run practice will never keep the patients. Then money will have to be spent forever to fill the chairs.
Focus on making your patients as happy with you as possible. Then they will be honored to refer friends. Sit your patients up in the chair and look them straight in the eye when talking to them. If a patient feels pain or doesn't like something you did, say, "I'm sorry." When the patient does speak, don't interrupt. Little courtesies like these will make for fewer charts being put in the dormant-file dungeon. Keep current patients ex tremely happy and they will be the active referrers a healthy practice needs.
Why do practices in the same town with the same basic patient pools have such differing success rates with recall and new-patient exams? The difference-makers in successful practices are: the practice's philosophy, well-trained and dedicated staff, and a perception of compassion and quality by the practice's patients. Location can help draw patients, but it won't necessarily keep them. Location is not the key to the more successful practice; caring treatment is the key.
Lie No. 5 -Their prices are too high; they are gouging the patients ...
A million-dollar practice is within our grasp. If we all charged $5,000 for each molar endo, I would only need to do 200. Or, maybe we could get $10,000 for the 100 crowns I'll do this year - after all, they are the best all-porcelain crowns in the state! You can't charge too much for quality! If I raised my fees this much, I could produce a million dollars by September; take the next four months off; write my Pearls of a Million Dollar Practice book, and then go on the lecture circuit teaching other slacker dentists how to be rich like me.
Of course, there are a few dentists who really think like this. Thank God, they are few in number! Most dentists I know have a good heart. They practice what they consider to be quality dentistry and don't try to price-gouge their patients. Think about how we set our prices - it is usually haphazard at best! There are a million formulas that some management people give you as a guide, but we dentists usually have our own methods that fall somewhere between "Clueless in Seattle" and "Dumb and Dumber."
The truth is that no matter our methods, we often hate the dentists who "rip off" the patients when they charge twice as much as we do for a crown that was made by the same lab we use. Conversely, we crab about dentists who keep the UCR fees down by charging discount prices. We always can find something to complain about if we look hard enough!
We all have seen crowns that sold for $300 that were a total failure and, at the same time, $800 crowns that were awesome. On the other hand, we've had $100 four-surface alloys hold up for 10 years when we've had the porcelain break on a $500 crown in six months. Cost and value are not e always equal.
Value is determined by the test of time, function, and patient satisfaction. So what if another dentist charges $2,000 per crown if the work is terrific? If patients perceive the value of the service to be outstanding, they will be happy to pay that fee. The dollars will chase fairness. When patients sense the quality does not match the price, they will not accept treatment and leave that practice. If I do a four-surface composite and it fails in two months, it has no real value. High fees in and of themselves don't rip patients off; poor work does.
Lie No. 6 - That dentist has a great personality, but he has the hands of a carp ...
This lie can be used two different ways. If the other dentist does great work, we attack his or her personality - i.e., "He's not very nice to his patients," or "She's awful with kids," or "I'd never let her touch the teeth of someone I like," or "His margins are fantastic, but I've heard he's a womanizer and always is trying to get his hygienist in the dental chair."
If, on the other hand, a dentist has a warm, funny, friendly personality and an outstanding practice, we concentrate on tearing his dentistry apart. "His fillings look like he carved anatomy with a Weed-eater," or "You can get a tongue depressor in his crown margins," or "He leaves two root tips in for every one extraction that he does."
Why do we feel better by finding fault in others? Let's find the good traits a successful colleague possesses and try to copy those instead. Patients don't know how good your margins are or how good at secondary anatomy your carvings are. They know how comfortable you make them feel, if it looks bad, how much it costs, and if it fails quickly or hurts.
High-production practices are usually good at all of these things. Pain control before and after a procedure is paramount to successful dentists. They take time to pick accurate shades and use labs that know what they are doing. They explain treatment plans well and are clear on payment options. Don't fool yourself - many dentists are able to blend a great personality with clinical excellence. We all can do this if we commit to improving ourselves. Quit being so negative!
Lie No. 7 - Sure that dentist has money, but it was all given to him ...
I've heard some say that well-off dentists only have "old money." Since we struggle to make what the guy building cars makes, a dentist with a resort home and a boat must have had a rich uncle. However, reports say that 90 percent of millionaires are first-generation millionaires. That means only a small minority of wealthy people had it handed to them. Everyone driving a Porsche 911 didn't have an Uncle Ebenezer to bequeath millions when he died. Money magazine recently said that there are more than seven million households with a net worth of at least $1 million! We have gone from roughly two million millionaires in this country in 1990 to over seven million in 2000.
Many dentists have had high-production practices, lived well within their means, and followed a savings and investment strategy. Others have collected a small mint, but spent above their means, had no coherent plan, constantly struggled to pay bills, and just couldn't save for retirement.
Successful dentists have a coherent, well-constructed financial plan. They have money because they saved and invested it well. Talking negatively about others doesn't fix your own poor planning. If the 1960s and 1970s were the "golden age of dentistry," then we now are in the "mega-platinum age of dentistry." There is infinitely more potential today.
If we honestly look at successful practices, we can learn a great deal from them. There is much we can teach each other if we would just stop putting up walls of jealousy, quit complaining, and not waste our time creating lies about our colleagues. The lies we tell about one another just get in the way of us reaching our own potential.
