Friday, May 27, 2016

Dentistry Has Changed Forever

If you own a dental practice, you own a business. In today’s new dental economy, there are too many dental businesses failing, even with gifted and excellent clinicians at the helm. Why? Insufficient training designed to deal with real business situations in a manner that predictably leads to good outcomes. If your business is struggling, it is probably not because of your clinical skillsets. It is more than likely your lack of business acumen, a critical component in today’s competitive dental environment. Let’s face it: The majority of dentists are clinicians with science backgrounds — not executives with business degrees. For example, in the 2010‒2011 academic year, 70 percent of first-year dental students had science degrees, according to the American Dental Education Association.

The majority of dental school programs are devoid of substantive courses in leadership, managerial accounting, strategic management, human resources management, marketing, organizational behavior, entrepreneurship, and more. As hard as it may be to acknowledge, we must admit we possess more intellect about bonding agents, soft tissue pathology, dental implantology, occlusion, endodontic therapy, and the muscles of mastication than how to run an efficient and profitable business operation. Truth be told, our business knowledge is limited. This needs to change. The days of the “cash cow” are gone. Dentistry has changed forever.

“There is nothing permanent except change.”
— Heraclitus

All of us face competing objectives both professionally and personally. As dental professionals, we are accustomed to working in finite spaces while continuously striving to maintain excellence. The demands on the dentist can be overwhelming both clinically and from a business perspective. Maintaining balance can be challenging and difficult. You are not alone.

As general dentists, we must adapt to the new dental economy if we want to maintain our autonomy, remain competitive, and continue to realize enviable profit margins ranging from 30‒60 percent. No wonder venture capitalist, corporate dentistry, and the insurance industry want a bigger slice of the pie. Can you blame them? Follow the money. As a comparison, in 2015, the hotel industry reported a 5 percent net profit margin, grocery chains 1‒2 percent, and the airline industry a hard-earned 5.1 percent. Even Starbucks reported a profit margin of only 11.52 percent in the first quarter of 2016. What do we have in common with these industries? We are in the customer service industry, and patients have a choice of where they want to spend their hard-earned money.

Patients expect more from their doctors and team members, and it is incumbent upon each of us to deliver. By incorporating award-winning business practices, based upon Ritz-Carlton-like service standards, we can discover how a service excellence culture results in a patient-centric environment through engaged employees. Patients purchase from people they trust, and trust is earned by building rapport that creates value in the consumer’s mind.

Employee empowerment that encompasses service excellence, while tapping into the emotional needs of each patient, makes for a better experience with superior outcomes.

Today, our success is not predicated upon our wonderful clinical skills alone. They are important; however, they are not as vital as delivering beautiful customer service based upon establishing rapport, value, and trust. Customer service ingrained in the DNA of each of our team members leads to enhanced treatment acceptance and patient referrals. When patients feel slighted, they will not hesitate to take to the “airwaves.” In 2016, the patient has a seat at the table in the form of access to Yelp, Google, and various social media channels. Remember, it is your name on the door and your team that is being evaluated by each and every patient. You own it — the good, the bad, and the ugly!

It is now time to realize that dentistry has changed forever and retool to meet the demands and expectations of today’s consumer. Our success depends upon it. We are up to the task at hand. Our “niche” should be designed around delivering dentistry with a hospitality flare. We don’t have to look like The Ritz-Carlton; however, we need to deliver like The Ritz does.

Duke Aldridge, DDS, MBA, MAGD

Wednesday, May 25, 2016

The Slightest Difference

Ontario Place, in Toronto, was Ontario’s gift to Canada on the occasion of Canada’s 100th birthday back in 1967. It took several years to build, but when it was finished in the early 1970s, it was a marvel of engineering and a new space for the public to enjoy on Toronto’s Lake Ontario waterfront.

Parked in the middle of Ontario Place was the “forum,” a theater in the round, surrounded by a covered-seating section and open-air grass hills beyond. The circular stage rotated so that there was not a bad seat in the “house,” as the performers faced all directions over the course of a concert.

The 1970s was a grand time to hear great music at Ontario Place’s Forum. They had free concerts every Friday and Saturday night, and I saw some of the greatest jazz and other concerts I have ever heard, including Count Basie, Maynard Ferguson, Buddy Rich, Chuck Mangione, Ella Fitzgerald, and Pat Metheny, as well as popular musicians such as Kenny Loggins, Seals and Crofts, Percy Faith, and so many more. Saturday night rituals with my friends were engrained with great music experiences.

For the first three or four years, this weekend music experience always started in late May with a performance by Grammy Award- and Juno Award-winning singer/songwriter Dan Hill. I loved his music then and still love it today. His music has grown and changed over the years, a rare feat for a musician still writing and performing over a 40-year time span.

A couple of weeks back, my wife, Tina, and I were major sponsors of a fundraising event for the Jewish Family Service Calgary organization that was honoring Rosslyn Steinberg for her 50-plus years of volunteer work there, at the children’s hospital, and more. Headlining the event for entertainment was Dan Hill. I was thrilled.

In recent years, Dan was diagnosed with prostate cancer. The treatment was invasive and difficult to endure. His life “flashed before his eyes,” and mortality was being faced head-on. What does a songwriter do? He wrote a song about it and titled it “The Slightest Difference.” It was featured on an album titled “Amazing,” which is about music from all genres coming together in the fight against prostate cancer. But on this evening honoring Rosslyn, he also was asking the same questions we all pose when we look back over our lives:

Did I make the slightest difference
Did I give more than I took back
Was the love I made equal to the love I gave
When they lay me down to rest,
All I ask is did I make a difference.”
(Lyrics used with permission.)


This chorus and the lyrics in between were significantly moving and made me think about my own mortality, as a husband, father, brother, dentist, and more. Have I made a difference? I am giving back more than I take? Have I gone into dentistry, and do I practice our profession, for the “right” reasons?

Enter Nancy. Nancy is in her late 80s, and it had been about two years since we saw her last. She had been having a difficult time. She lost her husband after more than 65 years of marriage. Her son, born with cerebral palsy, had become a successful lawyer, husband, and father and had moved to British Columbia. And now she is here in Calgary with fewer of her loved ones nearby.

But she came to our office, and when I sat down to say hello prior to her recall examination, she said, teary-eyed, “I feel like I have come home.” We have had the honor of caring for Nancy and her family for more than 23 years, and another 20-plus years by Dr. Rasmussen, whom I purchased my practice from in the early 1990s.

Nancy affirmed, in one small way, that I am making the slightest difference. It was a moving experience for me and my team — and still moves me today.

It makes our day less of a grind. May we always continue to make the slightest difference.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

Wednesday, May 18, 2016

What Do We Work For?

Let’s compare two men. They both make widgets. They both get up early in the morning to go to work. They both go to the same office building. They are put in side-by-side rooms to complete their job.

You tell one guy he will make $20,000 at the end of the year. You tell the other he will make $1 billion at the end of the year.

The guy earning $20,000 probably would come to work ticked off all day. He would bemoan the fact that he has to make these widgets every day. He would say things like, “I hate the drive to work” and “I hate the room I work in.”

The guy earning $1 billion would love widgets so much that he would talk about them to his friends. He would happily bounce to work every day. He would sing while he worked. He would be nice to his co-widget-makers. He would love his job.

Isn’t this how we all are? If you are saying “no,” then you are lying through your teeth (pun intended). Money is in the back of our minds.

If we have good production days, we are happy. If we get our 401(k) statement and the amount went up a lot, we take a deep breath and sigh in relief. Maybe we go home and treat our spouse, take him or her out to dinner, or maybe even pick up flowers on the way home.

Maybe the numbers in the story are a bit exaggerated. What would the number be for you? What would be your jump-out-of-bed, happily skip-to-work number?

How about this: Would the story mean as much if the first guy would get $75,000 for the year and the second guy would make $400,000? Would the guy earning $75,000 dread coming to work and the guy earning $400,000 skip to work?

I know sometimes it feels as if we make widgets. I use a reference from a popular Dunkin’ Donuts commercial from the 1980s when talking with my wife all the time. I leave the house saying, “Time to make the fillings.”

If I made $400,000 a year, would I bounce out of bed and skip to work because I was so happy? What is your number?

Do we jump out of bed and bounce to work because we have this awesome job as dentists? A job that gives us this awesome living? A job that allows us to help people? A job where the hours are such that we can be coaches and dance instructors and PTA presidents and board members? Do we jump out of bed because we get to do the job we love to do?

For me, and I have been a dentist for 20 years, the answer to all questions is mostly yes.

Does it get to be just something I have to do? Does it get to the point where I feel like I am just running on that hamster wheel? Of course it does.

But we have to make our “job” more than a job. It is our responsibility to ourselves and our staff and patients to make the place we work more than a place to make money. We have to make it a place where people want to come to ... including ourselves.

And guess what? When we make our place of employment a fun place to be, people will want to come to it. If your staff likes coming to work, and you like coming to work, it is only natural that your patients will enjoy coming to your office, too. Your patient will start to say things like, “You know, this place ain’t that bad” and tell his or her friends.

And then guess what? Because you like being in the office and because your patients like coming to see you, you will be the one making your happy number.

John Gammichia, DMD, FAGD

Monday, May 16, 2016

Looking for Answers

Have you ever had one of those patients describing a combination of symptoms who leaves you wishing you’d gone into accounting instead?

“Doc, the pain shoots from my nose to my left toe and back around to the tip of my tongue, but not every day, just on humid days, and only if there’s a waning moon. But it’s not a tooth pain.”

We (and by “we,” I mean “I”) like a little more certainty than that. We (I) like problems to be clearly defined and properly diagnosed so that we can provide effective treatment. Give me a shadow on a radiograph with a little cold sensitivity, and I’ll restore that puppy and move on. Large amalgam with biting sensitivity that can be isolated to a single cusp? Let’s get a crown on there!

I like the boring stuff. I like it when things fall within defined limits. But how often does that happen? How do we (I) react when things are a bit less certain? Frustrated? We don’t want to admit we don’t know the answer. We say those things are idiopathic. Theologically, I’m totally comfortable with uncertainty. Dentally, it makes me feel frustrated.

I mention this because in the past few years, I’ve had the tables turned, and I’m the one seeking answers, and I’m the one being told “I don’t know.” And I can’t tell you how bad that feels.

In the next few blog posts, I’ll tell you about my diagnosis and my journey to find an answer. I’ll tell you about how the inability to get a definite answer from a health care provider can perplex an otherwise intelligent, scientific-minded dentist. It’s pretty illuminating to see to what lengths people will go to seek an answer when conventional wisdom fails them.

One of my patients presented with what turned out to be lichen planus. We diagnosed it based on clinical observations and confirmed it via biopsy. Topical treatment was recommended with Lidex rinse. The appearance hasn’t changed, but the symptoms seemed to improve slightly.

Months later, I was listening to Mississippi Public Radio’s call-in medical show. The host doctor welcomed a woman caller, and when she started speaking, I instantly recognized her distinctive drawl. She described her condition and the treatment she received to the doctor — who agreed that that was exactly what he would’ve provided her. It sounded like she was disappointed that she hadn’t found a better answer when she hung up. But I felt great because our decision had been corroborated! Aren’t we great?

Well, I don’t think she felt so vindicated.

To be honest, it was nothing more than a patient seeking a second opinion. I encounter those patients all the time, so I understood.

That’s what we as humans do: We solve problems, and we seek answers to questions. And some of us look outside the box of common knowledge for those answers. And there’s a lot of uncommon knowledge out there.

So, stay tuned to this same bat channel on this same bat station, and I’ll fill you in on my search for answers.

Bruce M. Scarborough, DMD, FAGD

Thursday, May 12, 2016

A Liberal Arts Education Has Its Place

I did it. I’m an AGD blogger. I recall the days I would cradle my computer on my lap and eagerly read Dr. John Gammichia’s posts. They reflected on daily practice and all of the little things that either bother us as dentists or validate our choice of profession.

I always have loved to read and write. This may explain my particular nature of correcting staff members’ spelling errors in charts or my own grammar in documenting patient chart notes. Writing unlocks a different part of my brain, and reading complements my writing. The more one reads, the better one’s writing skills become. I take pride in constructing a well-written referral letter, for instance. Does it matter? I think so. Clear communication is central to how we conduct our dentistry.

Our days as dentists are filled with science and technology, but a background in liberal arts has its place. The relevance of a liberal arts education seems to be a widespread debate these days, and I began to think about my own education and its role in the profession I selected. Would chemistry or philosophy be more useful for a successful career in dentistry? Both are, in my opinion. I went to a liberal arts college, yet majored in biology. I got the best of both worlds, and that served me well. Patients are not interested in the biomechanics of their dental implants, but describing treatment and outwardly empathizing with their personal situations requires a different art and a language skill.

Deciphering moral and ethical conflicts, dental or otherwise, has its roots in the arts. As dentists, we encounter daily conflicts and ethical dilemmas knowingly or unknowingly with patients and even fellow colleagues. Having debates in sociology courses on controversial topics helped me to gain perspectives on opposing views and to learn the skill of “agreeing to disagree.”

For instance, when a patient rejects fluoride, rather than scoffing, I listen to the reasons for his or her choice. Or when referring a patient to a specialist, I am fundamentally telling a story by introducing my patient. Reading frequently brings out an ease with which I craft that letter, making the content more than a simple “treat tooth No. 3.”

So I’m still curled up with my computer on my lap, but I’m the one writing this time — with the hope of being able to stitch together events of daily practice and reflect on my experiences to share with readers. Dr. Gammichia, thank you for inspiring me to follow in your footsteps.

Zeynep Barakat, DMD, FAGD

Tuesday, May 10, 2016

Take a Seat in the Other Chair

During every patient’s appointment, I usually leave extra time to do some talking. Recently, I had a guy in, about my age, 46, and we started talking.

He said, “When was the last time you sat in this chair and looked around?”

I didn’t know where he was going with this, but I played along. I told him it had been about a month since I actually had sat in the chair and looked around the room to see what my patients see.

He said, “Are you serious?”

I said, “Yeah, why? Is something wrong?”

And this is where he ripped me a new one. I really don’t know what set him off, but he was in some mood. (Keep in mind that, throughout this dialogue, every statement he made was accentuated with a curse word, all of which were graciously omitted for your reading pleasure.)

”What is up with the fountain?” my patient said. “It looks terrible.” (I have a floor-to-ceiling water fountain in this room, and when it looks good, it is really nice). It has terrible water streaks on it.

He continued his rant. “And what is with the lava rocks? “What, did we time-warp back to the ’70s?”

“And you look over there and the cords are hanging out of the base of the aquarium. It looks terrible. The computer wires are all over the floor. I mean, a guy like me doesn’t want to come in here and look at that.”

(The computer is under the open counter.) True story. I can’t make this stuff up.

I told him, “Wow, I will be right back. I have to go and do a hygiene check.”

I came back, and he said, “I hope I didn’t offend you. You kind of got a little quiet.”

“Me?” I answered. “No. I am not upset.”

But I was upset. I was upset for so many reasons. But the main reason was that my patient was right.

I try so hard to make my office look nice. I have always prided myself on having a nice comfortable office. I put in the fountain and an aquarium all to make the experience second-to-none. But you know what? If you take your eye off it for one second, it just goes to pot. And patients see it every time. (I mean, I see it when I go places. I can’t tell you how many times I have gone to a place and said, “Man, they are really letting this place go.”)

I have a chair in the reception area that is worn pretty badly. For the past couple of months, we have been trying to get someone to come out and repair it. We tried a couple of patients … no can do. We tried local establishments. Nobody could do it. But in the meantime, you know that everyone who comes through that door sees that.

If you don’t clean the glass fountain in that room every month, it will start to get cloudy and have streaks. If it is not full, it will splash on the lava rocks and leave residue on the window it sits by — and that will look bad. The cords were out, and they did look bad. Do you know how easy it was to just tuck them behind the aquarium? Do you know how easy it was to tuck the cords behind the computer so it would look much cleaner?

This stuff is so easy to do. But we are too busy with a billion other things that are going on.

It was 90 degrees in Orlando today. My air conditioner is looking like it is on the fritz. My suction is not working quite right. But all these things have to be repaired while maintaining a certain cleanliness that says, “I care about the way the office looks, because I care about you.”

Today was my day off. I am usually running errands, taking the kids to school, taking the kids to orthodontic appointments, stuff like that.

But guess what I did today?

I dragged my blower, my pressure washer, and my fountain cleaner to the office. I pressure-washed the outside of the building and the walkway. I blew all the leaves away from the building. I put the chair that is need of repair in the back of my truck and brought it to a repair place. Then I went into that room and cleaned the fountain. Then I changed all the lava rocks to a more modern rock. Then I tucked all the cords out of sight.

Ugh. What a pain, and I thought about that patient the whole time — because he brought up what I knew in the back of my mind I wasn’t doing.

In the end, when I sent a text message to my patient to see how his tooth was doing, he apologized for his language and told me it was unprofessional. I told him that it was no problem, and I thanked him for being honest with me. I thanked him for pointing out the stuff that I knew to be true. I told him that I, and my staff, needed to hear that.

The last thing any of us wants is to have one of our patients “ripping us a new one” about the things that can easily be taken care of, if only we took the time to do so. So every so often, plop down into the patient chair and take a look at what they see. It just might surprise you.

John Gammichia, DMD, FAGD

Wednesday, May 4, 2016

Blue Light Special

Do you ever feel like you’re working the layaway line at Kmart?!

To those of you who have a patient clientele without financial issues, who always pay in cold, hard cash, who willingly put down large deposits to save appointments, and who agree to office fees without negotiation or discussion, I raise a glass of this red wine to you.

Cheers!

For everyone else — this one’s for you! We do some awesome dentistry for a lot of patients, yet sometimes, it is such a battle to get compensation and reimbursement. It’s mind-boggling, really. My dad always said something when patients gave front desk staff a hard time about paying: “Do you walk out of the store without paying for your groceries?!”

But really, what’s the difference? We provide a service with a high overhead and ever-so-thin profit margins. What gives patients the right, or the expectation, to think they don’t have to pay?

Sometimes, it has to do with us: the dentist/owner. Most of us have big hearts. We see some patients in dire situations with no means to afford dental care. We do free, donated, and deeply discounted dentistry all the time. Heck, often on a daily or weekly basis. We also have a tendency to “give away the house.”

Early on in my career, I wanted to wear all of the hats. Treatment planning and presenting were what I enjoyed, but I noticed myself all too often giving away serious discounts without much pressure from the patient. Bottom line, I used to think: If you’re in my chair, I might as well do some dentistry.

That’s certainly true, but it makes more sense to have standardized, clear, and accountable financial policies. And they can’t just be on paper. Staff must understand and follow the financial guidelines, and patients have to be held accountable as well. This is the only way to take “us” out as being part of the problem. Staff should be trained on treatment presentation and financial discussion skills. We’re here to do dentistry, and we need our teammates to feed us the assist on these other matters.

The flip side of the coin is the patient. I recently did a same-day crown on a patient I kindly worked into my schedule. Ninety minutes later, she walked up front to check out. I was happy; the crown looked great, the patient was excited she wouldn’t have to return for a second visit, and my schedule was still on track. And then it happened. The patient said: “Well, actually, I don’t have any money today.”

Wait, what?!

Why would you expect my 90 minutes of dental work to be done at no cost to you? (Again, do you pay for your groceries?) We worked out an automated recurring billing arrangement but still. It was unacceptable from my front desk staff down to the patient. Financial arrangements need to be outlined, cleared up, signed on, taken care of before I sit down and devote those precious minutes to prepping, designing, and spending my practice money on the patient.

I can’t place the blame on any single person, but I certainly need to work on my leadership when it comes to this side of my practice. I hope (assume) I’m not the only one who is working on this.

In the meantime, you better believe I’m going to try that trick with my groceries. I’ll pack my cart up and walk right out the front door. Look for me on the news. Maybe I’ll be in jail. #bluelightspecial

Donald Murry III, DMD

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