by Richard J. Reinitz, DDS, MBA, FAGD
Disclaimer: I am not a leader in dentistry nor even one of the world’s greatest dentists. But after nearly 25 years in dentistry, I have learned a few things. Here are six “rules” that I would like to share with you.
Rule #1: There is no substitutefor education and experience
All dentists are created equal when we graduate. From there, the differentiating factor comes with advanced training, continuing education, and a willingness to continue to learn and experiment. The greatest lessons we learn come from our failures.
When I was in general practice residency at the Veterans Administration in Philadelphia, my mentor, Dr. Alan Samet, taught me a vital lesson. As I struggled to remove an impacted third molar - and ultimately had to be rescued by the senior resident - Dr. Samet watched in bemusement. After the patient was dismissed and I had been criticized by a senior resident for my mistakes, I sat slumped in front of Dr. Samet. He asked what I had learned. With absolute honesty, I told Dr. Samet that I now understood the valuable art of the referral! He laughed and told me that, while the episode had been difficult for me to endure (not to mention difficult for the patient), he assured me the mistakes I had made would likely not be repeated - or at least I would make them less often. Indeed, Dr. Samet was right. Ultimately, my failure taught me more than any success could have.
The memory of my failures has made me a better dentist, one who is more humble and more aware of his limitations. Success is great but it is also a tonic. Success can make you believe that you can do things that you should not do. A little reality can go a long way.
Rule #2: It’s always about the money
When I was still in my prosthodontic residency, I began moonlighting with only an assistant and no front desk person. The office had large floor-to-ceiling windows that overlooked the parking lot. A nicely dressed new patient came to see me, and following a full series of X-rays and a complete examination, I presented her with my treatment plan. I believe the total for the treatment plan came to approximately $2,000. She had insurance, so the total would have been reduced by the insurance benefit. But after telling me the cost was prohibitive, she left the office.
Being the dentist as well as the front desk attendant, I watched as she entered her car, a top-of-the-line new Mercedes with the temporary license plates still visible. In seeing this, the message I received was that she did not value dentistry as highly as she did her mode of transportation.
I think each of us has probably experienced similar situations or has been presented with patients demanding that we treat them according to their maximum insurance benefit. Some dentists might contend that we have to make patients understand the value of good oral health. But the volume of what a patient hears is directly proportional to the position dentistry ranks in the patient’s value system.
Pain may move dentistry into a high-ranking position. But absent pain, we must battle with a myriad of competing choices on which patients can spend their income. Often items such as Christmas gifts, cruises, and cars are not only far ahead of dentistry on the priority list, but they leave few dollars for anything else. Sometimes patient decisions are made because of your presentation, you, or your office. But most of the time, decisions are based merely on the amount of money involved, or the fact that patients want to spend their money elsewhere.
Rule #3: You have to care
A family friend, who had a son who was to attend medical school, had a question. Given the choice between two physicians - one who was clearly a recognized leader in his field but with little or no “bedside manner,” or one who was quite capable and possessed excellent bedside manner - this aspiring doctor wanted to know which physician my wife and I would prefer? Both of us said the second physician. My friend’s son was shocked at our answer and fully expected us to choose “the best.” He asked why.
We told him that treatment of a patient is not limited to mechanical diagnosis and treatment. A patient must believe that the person caring for him or her is not only knowledgeable but cares whether the patient gets better or not.
A belief in one’s caregiver is as important as the technical success of the treatment. We have all had what we consider successful cases but unhappy patients because we failed in our bedside manner. When a patient believes that his or her physician or dentist does not care or believes that money is the primary concern, the patient will get angry, and find fault - whether fault exists or not.
I still call my surgical and root canal patients the day after a procedure. While I believe I have provided excellent care, more importantly, the call demonstrates that I care more about that individual than his or her money. A patient who believes he or she has received excellent care will be a happier, more appreciative patient.
Rule #4: Let go
When I first went into private practice, I micromanaged everything, and became angry when a team member had to take time off for illness, a sick child, or any other reason. It was not that I was mean. I had large bills to pay, and when team members did not work, my job became more difficult. Ultimately, this situation affected daily production.
I wish I could tell you when I had my epiphany. But one day I realized that my team members had lives of their own! I have been fortunate to have had the privilege of hiring and being able to keep a team together for many years. The team members know their jobs and responsibilities. I had to learn to trust them to do what I paid them to do, then let them do it. I no longer hover around the front desk, or constantly question staff if this or that is done. If one of the team members needs time off, I grant it without question because they do their jobs well and deserve my trust.
There are times when team members have to bring their children or grandchildren to the office for one reason or another. At a younger age, I would have objected and complained about the interference. Today, these children are welcome in the office, and bring a smile to my face.
Team members only bring children to the office so they can keep working because of their loyalty to me. They don’t want to take off work, rather they want to keep working. Since the team is like my second family, why shouldn’t their children always be welcome?
Team member benefits like sick leave, vacation leave, health insurance, and retirement are more than just a cost center. These benefits demonstrate that you care. In addition, they make your team happier and healthier. This is a much greater payback than you can imagine.
Rule #5: Remember, it is a business
It would be nice to think of our practices in terms other than just money. But - quite simply - if our expenses outpace our revenues, we will not be calling ourselves anything except bankrupt. You should have an employee manual to address issues like job descriptions, expected work hours, and benefits. Keep a close eye on accounts receivable, and try not to overcommit to the latest must-have “toys.”
At the same time, you must recognize the need to invest in new equipment and training that will improve your practice. Also, the biggest factor in the production of revenues is operating efficiently. You only have a certain amount of time each day, so you must maximize the use of this time.
You should analyze how much time you need for treatment, then book accordingly. It is OK to time treatment procedures to find out how much time is being used. I think you will be surprised just how much time you waste. Don’t think this is a cold, calculated business. Patients will appreciate your being on time and getting them out of the chair faster. Running an efficient and on-time practice will make your patients understand that you value their time, too.
Rule #6: There aren’t any rules!
You must be guided by your principles and ethics. In other words, you need to do what you think is right. But there is no harm in learning from others. Also, there is no need to “reinvent the wheel.” If you have the chance to enter into an agreement with an associate that looks promising, then do so.
Don’t rush into a solo private practice. While a solo private practice has the advantage of your being the boss, it also means you have sole responsibility for everything from patient care to the water bill. When something goes wrong, everyone will expect you to solve the problem because “you are the boss.”
Even if you have no better idea of how to rectify a situation than anyone else, that is immaterial. You shoulder the burden alone. People often say to me how lucky I am since I am my own boss and can set my own hours. The reality is that, while all that is true, I also am responsible for my patients, team, the lab, my family, and myself. That responsibility can create much worry and anguish as well as much joy.
My final piece of advice is to find people with whom you share that worry and joy. If you build a warm and caring environment in your practice and at home, you will have a support system that allows you to succeed.
