Friday, December 19, 2014

“It’s Christmas, Clark, and We’re All Miserable”

Most practices experience times when business is slow and, conversely, busy seasons—sometimes even hectic ones. I’ve heard dentists complain when it’s so slow they can’t keep up on the bills. I’ve heard the same individuals complain when it’s too busy because “there are not enough hours in the day.” At one point or another, I’ve been guilty of both laments.

Through the years, I’ve tried to discern a business pattern in the rollercoaster ride of sole proprietorship in order to financially plan a little better “than last time.” Early on, I noticed that the few weeks bracketing the Fourth of July seemed to be unusually slow, so my wife and I scheduled our vacation accordingly. One summer, as the family trip to the mountain lake approached, my office became incredibly busy; all of a sudden teeth were breaking in record numbers while numerous abscesses demanded immediate attention. I’d thought about closing up a day or two early, to get a jump on the summer break, but there was no way. The cabin would have to wait. So I worked my fingers to the bone until the day of our departure. Then I discovered that my retreat in the woods was crawling with more vacationers than crickets.

Although the time with my kids was fun-filled, it was not as relaxing as I would’ve liked, and too soon, I returned to my breakneck pace in the office. However, the workload quickly dropped off just when my vacation’s credit card bills came due.

On another family trip, just as we were pulling away from our home office, my wife, Kate—who also is the practice’s business manager—remembered that she hadn’t put the phones on the answering service. As she unlocked the office door, the phone rang—Murphy’s Law. A patient was calling in dire need. Kate told him to come right over. Not so patiently, our kids waited in, around, over, and under our Griswold-grey Volvo station wagon—complete with dangerously overloaded luggage rack—while I took a radiograph, wrote a couple of scripts, and referred the patient, who hadn’t been in for a regular checkup in three years, to my endodontist.

But Christmas time is different; business always seems to drop off with few exceptions, as when college kids come home. Actually, the parent’s desperation to get them in for a checkup isn’t as pressing as it once was; half of the kids are home through mid-to-late January these days. (I remember when we took first semester finals during the second and third weeks of the new year. We also had to walk through knee-deep snow to get to school, uphill—both ways). And those few folks who do make appointments don’t pay in a timely fashion. After all, they have their own holiday revelries to account for.

But through the years, I’ve learned that none of this matters. The holiday season gives me time to reflect on what is really important: family, friends, and neighbors. I now close the office without any destination in mind. I simply stay home and enjoy life. During this time, I greet each “emergency” not as a chore, but as a service to those in need. It’s no different than the time I donate to impoverished people here and overseas throughout the year. Or, if something comes up, like a snowstorm, I’m free to indulge myself on the ski slopes. Unplanned activities like that are gifts that I can graciously accept without any feeling of abandoning my patients.

So use any free time you’re given to get outside, take a walk, stop to smell the roses (even my book editor grudgingly admits that clich├ęs sometimes come in handy) and just enjoy life. Life is a precious gift that should be especially acknowledged at this time of year.

So, whatever your beliefs may be—and it’s impossible to list them all—I wish you a Merry Christmas, a Happy Hanukkah, and Seasons Greetings to all.

Jim Rhea, DMD

Wednesday, December 17, 2014

Things That I Wish Patients Knew

In speaking with patients, I’ve come to realize that there are some things that patients just don’t know. And, despite my brilliant explanations, there are some things that most people just won’t believe, especially when it comes to these dentistry topics:

  1. Dentistry Is Not an Exact Science
Ask three dentists to diagnose one tooth and you may end up with three different treatment plans. For example, you may have one dentist suggest a large composite, another may place an onlay, and another a porcelain crown. This is simply due to an honest difference of opinion. Other than price, the patient may never be able to tell the difference in his or her mouth. Who’s right and who’s wrong? Here’s a clue: Each provides quite a serviceable restoration.

  1. Dentistry Doesn’t Last Forever
Yes, that porcelain crown that I just placed may need to be replaced some day. I explain to patients that if the tooth that God made for them did not last forever, mine probably won’t either. He’s a much better dentist than I am and He uses better materials. Plus, God has been doing this much longer than I have.  
We’ve all been there: A patient comes in with a gold onlay that needs to be recemented. The patient complains about a “lousy dentist,” whose “work did not stay in.” You ask when it was placed. “Sometime around 1974,” the patient answers.
Even the latest and greatest implants don’t last forever—despite the advertising. If you are like me, you’ve even removed one or two loose implants with your fingers. Implants are good; it’s just that despite the claims, you can’t guarantee that they will last forever.

  1. Dentistry Is Stressful
This may come as a shock to you, but patients do NOT think your job is stressful. They think, “Are you kidding? He (or she) just sits there all day. How stressful can that be?”
This became clear to me at a party recently. A friend of mine, who is not a dentist but happens to know several dentists, said to me, “Phil is always complaining about how stressful dentistry is. Tell me, is it really that stressful?” She was shocked when I told her that I agreed with Phil—dentistry can be stressful. “But you just sit there all day!” she protested.

  1. Most Dentists Are Honest
Sure you have bad dentists. But you have bad people in every profession. You have bad physicians, bad priests, bad politicians … you get the idea; every profession has its proverbial bad apples. Based on my experience, most dentists are trying their best to do right by their patients.

  1. Your Dentist Is Not Filthy Rich
Sure, he or she makes a good living. Most dentists are not starving and are in the upper middle class. However, ask them about their yachts, or private planes, or mansions, or vacation homes, and you’re likely to get a blank stare. Maybe in the old days dentists were printing money, but, these days, dentists are working stiffs just like everyone else.

Is there anything else that you wish your patients knew?

Andy Alas, DDS

Tuesday, December 16, 2014

Kids Nowadays

I only get to blog once a month, so I have all of these ideas dancing around in my head. I used to write three times a week; whatever I thought about I would write. Now I get an idea and it festers for a week or two. Then, I get another idea and things start to get all mixed up. 

Today, I want to talk about the generation gap that exists between well, uh…generations. Maybe you haven’t thought about this, but I do because I am in that prime “I could hire an associate” age (been there, done that). 

I have to give you an example. My father is a baby boomer. My father and I have a very strange relationship. We were first father and son, then we were boss and employee, then we were partners, then we were employee and boss. Our relationship has been through it all, and I think we have had challenges at every stage. Why? You have to think of personality and how it is influenced. 

My dad was brought up right after the Great Depression, which had to be a huge influence on the way in which his parents raised him. He went into the military right out of school. Needless to say, all of these things influenced my father and his personality. 

I am 45 years old and a member of Generation X. What do you think are the things that influenced my generation? I have one word for you: MTV. 

Now, in my generation, the divorce rate tripled. We experienced the first Nintendo Game Boy, and were around when the personal computer was introduced. 

There is a quite a gap even between Gen Xers and the Millennials. Now what about the Millennials? The technology boom has had a huge influence on them. I mean, how could it not? They’ve also lived lives full of news about natural disasters, increased violence, gang activity, and more. 

I am kind of worried about my kids. I mean those f@#$ing smartphones are in front of my kids all of the time. It is a battle royale every day to get them to put those phones down (I have to say that I am guilty of this as well; I have to check my Twitter all the time.).

But a couple of things happened in the last month that got me thinking about this topic. I had a friend who hired an associate and things didn’t really work out for the two of them. See, it seemed that the associate didn’t really want to learn.

My friend, who is about my age, is really good at what she does, and she assumed that when this associate was slow on patients that she would come on over to the boss’ operatory and watch—to soak up all of my friend’s 20 years of knowledge. However, that didn’t happen. 

My friend would try to mentor her associate, but the associate didn’t really seem to want to be mentored.

My friend would go into the associate’s office and she would be on the computer. Sometimes she would try to better herself by looking at dental news, but other times she would just be on Facebook.

My friend would try to spark up conversations with her, but she felt like it was a one-way street. She was trying to help the associate to want to learn. My friend was frustrated. The associate was frustrated. The associate ended up leaving the practice and buying another practice.

Now that is a whole new set of blogs. How does a dentist who is fresh out of school buy her own practice and succeed—especially someone who didn’t really want to learn?

I know it can be done, but it is going to be much harder. I mean, in dental school they don’t teach you much about payroll or disability insurance. They don’t tell you how to buy equipment or how to repair things. School doesn’t teach you about when to refund money or when to fire patients. So, if you buy a practice right out of school, you better learn all of this pretty fast.

To me, the question is why?  Did the associate just want more money? Does she think she can do it better than the others in that town? Does she really think it’s going to be so easy that she can just walk in and do it? Is it that she just didn’t want to work for someone else? 

I know I am lumping together all Millennials, but it does seem to be a trend. 

My next story is this: I was browsing on the Internet and I found this website, GoFundMe. 

It turns out that this is a website with which people can ask for money for various things. I came across a young couple who was asking for money for their wedding. This is a textbook generational issue for sure. 

When I first saw this, I didn’t think anything of it. However, when I showed it to some of my friends it fired up a heated conversation. See, the person who I showed this to had it tough at this stage of life. This person got married and was poor. But this person had to just plow through it. This person and the spouse both got jobs and second jobs. The husband went back to school in order to better himself for their life ahead. 

There was no GoFundMe site then. Needless to say, the couple is very successful now and they are better because of their struggle.

I tried to explain that this is what is available now. Don’t fault the young couple because they are growing up in this new Web-based world. I continued to explain that we also have smartphones now and cars that talk to us. Maybe we should be taking advantage of this technology. 

The basic problem is that older people like saying stuff like, “Those damn kids,” while the younger generation is saying, “Uh, Grandpa, move out of the way, we are coming through.”


There is never going to be a right answer. Our profession is always going to have several generations working together. We have to know that the era that we grew up in will influence our personality, our work ethic, and how we deal with conflict. We have to try to understand each other and learn from each other.  

I know that I have a lot to offer a young dentist—or my children—but I also know that I can learn a heck of a lot from those who are younger than me. 

They just have to get off their cell phones long enough to teach me something (I’m joking!). 

Listen, if I don’t talk to you before then, have a great holiday season!

I know you are all working very hard and it is a trying time. Taking a bunch of days off and not producing can be stressful (especially if you just bought that practice…I kid), and you can lose the reason for the season.

Take a deep breath and try to reflect on all of the huge blessing we have. That is reason to celebrate.

Happy holidays!

John Gammichia, DMD, FAGD

Wednesday, December 10, 2014


A patient made a comment to one of my staff members a few weeks ago that has stuck with me. Never one to shy away from drama, I thought I would write about it, in hopes that I can verbalize my frustration in a positive expression of love, happiness, and butterflies.

[Releases colorful butterflies for dramatic flair.]

I appreciate every single patient who walks in our door. That’s the honest truth. Whether here for a child prophy or an implant surgery, I love them equally. It is, after all, their continued support year after year that keeps us afloat and able to treat our patients with the proper equipment, technology, and materials necessary; to hire and employ enough doctors and staff to keep patient appointments running on schedule; to open extra offices to better serve our metropolitan area; to market our practice and break down barriers to entry for new patients; to hand out toothbrushes—quality ones to boot—to every patient. You get the picture.

Are the butterflies still flying, or should I release more?

So, that comment…

“The crown is going to be HOW MUCH?! I might as well just hand it to him in cash to pay for his nice car.”

[Waits a second for typing filter to flip on.]

Ahem. Um, no. That insurance-mandated fee for said crown is actually half of my normal office fee. It covers the chair time for my assistant and me; the operatory equipment that we are working with; the chair with heat and massage that you’re sitting in; and the handpiece, burs, scrubs, gloves, masks, instruments, impression material, anesthetic, X-ray machine, computer, and TV that is showing “Oprah.” THAT is what your crown is paying for. 

Man, I could use some more butterflies. I’m totally out.

Again, I love all of my patients. I wouldn’t be here without them. But c’mon, really? Dental offices nationally operate, on average, at 71 percent overhead. In our case, with the addition of a new office a few years ago and a brand spankin’ new one this year, we battle to stay under that figure. We appropriate much of our positive income to outfitting these offices with the “latest and greatest.” We have chosen to maximize the patient/doctor experience, rather than pocket our extra earnings. We do this because we truly love what we do. We enjoy walking in every day to a clean office with happy, smiling staff members—three of whom had the opportunity to purchase their first homes this year. Talk about exciting!

So to my lovely patient with the beautiful new crown, know that your crown fee covered the full spectrum—equipment, staff, power bills, and new houses. You should be proud to know how far reaching it was. I know I am.

Butterflies for everyone!!!

Donald Murray III, DMD

Monday, December 8, 2014

Relationships and Remembering

Erik and Margaret (not their real names) met and fell in love quite young. They married in the early 1950s under controversial circumstances, as Margaret was a few years older than Erik, but their love endured.

Erik worked as a furniture upholsterer. It was hard work, but he enjoyed working with his hands, and the people he met and got to know over the years was very satisfying for him.

Margaret was a consummate homemaker and her specialty was baking pies. She would make a fresh pie every day for Erik, and he would happily enjoy these pies as they were made with love from the woman he fell in love with so many years ago. How Erik managed to stay trim and fit, I have no idea.

Erik also loved to fish—fly fishing on the Bow River in Calgary, apparently one of the best places in the world to catch fish. He would regularly bring me fresh fish, often smoked in his smokehouse at home, when they came to our office for their regular hygiene treatment and recall examinations.

Erik and Margaret have been a part of my dental practice for more than 50 years, first seeing Dr. Roy Rasmussen, whose practice I purchased more than 20 years ago. They have been regular patients all of these years. Whenever we see their names on the schedule, we look forward to seeing and welcoming them, as their love for each other and positive attitude make for a pleasant and enjoyable visit.

Margaret and Erik recently celebrated 60 years of marriage. Margaret is now in her early 80s and Erik is in his late 70s. Margaret has started to display signs of dementia. She is happy, she is physically well, but her memory is waning rapidly. Erik, now retired, spends more time at home and less time fishing so he can be with the woman he loves. She has shown him how she bakes—all from memory—and he now helps her bake the beloved pies daily, though he has had to do more and more of the work over time. But his love for her has never wavered, even in these difficult times, even with the knowledge that it will not get better, and very likely it will get much worse in the near future.

I have practiced dentistry for more than 27 years, and I have been so fortunate to have known and developed amazing relationships with our patients over time. We see them regularly, watch them grow up, have children, become grandparents, change jobs, deal with life challenges, lose loved ones, and more. And it never stops being difficult to watch someone with dementia decline to become a shell of the person we once knew so well.

I watched my mother succumb to senile dementia. I lost the mother I knew about 10 years before her physical body succumbed to pneumonia. I have watched many of her siblings and other family members also succumb to dementia. It is my hope that we will be able to find a way to slow this decline, to manage it, or even to cure it within our lifetime.

Nevertheless, it is such a privilege to get to know such wonderful people like my patients Erik and Margaret. It makes it easy to get up and go to work each day, knowing the joy I will have seeing these people I have cared for, for so many years. And it’s still hard to see them decline.

That is the gift of what we get to do every day, even when it is sometimes also called a daily grind.

Thanks for reading.

Warm regards,

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

Wednesday, December 3, 2014

Everything Comes Full Circle…

The weekend prior to Thanksgiving, I attended the 2014 AGD Leadership Symposium. It was a great opportunity and I was quite excited to attend. Ironically, as I was preparing to go to AGD Headquarters to get a peek at the new building, I was sitting with a friend and was sharing how much I was looking forward to the upcoming days. It was in that moment that I remembered that the AGD symposium was not my first experience participating in a leadership event. In fact, it was 19 years prior.

In November 1993, as a high school junior, I went to Washington, D.C., to attend the National Young Leaders Conference (NYLC). The NYLC is a weeklong leadership program for outstanding students. The program still lists as one of its benefits that students will learn essential leadership, communication, networking, decision making, conflict resolution, and critical thinking skills. At that moment, as I reminisced about my time in D.C., my friend asked me: What did you learn from that conference? I can say without a doubt that I left that conference learning more about my young self than I first even realized. I began setting goals and meeting them. I stepped up for leadership positions in my extracurricular high school activities and excelled in them. What the NYLC taught me has resonated throughout my life. I didn't realize it until that conversation, but I have always been a leader, volunteering within many organizations throughout my adult life.

As a young dental school graduate, I had a drive to lead and participate, but I struggled to find the right fit. It wasn’t until I attended the AGD Practiceology Conference in Atlanta in November 2012 that I recognized how comfortable I felt with the AGD. Although I had been a member since I was in dental school, the AGD Practiceology Conference enticed me to attend more AGD-sponsored symposiums and conferences. Following the AGD Practiceology Conference, there was a 24-month, fast-paced, accelerated drive within me to do more within the AGD. In 24 months, I completed my Fellowship, began blogging here, joined the Michigan Board as a MasterTrack committee member, and then served as a member of the Michigan AGD Board of Directors. I also made the commitment to attend every annual session possible.

Now that I have attended the 2014 AGD Leadership Symposium, I am wondering, what can I do next? Where am I best suited to serve? I am not certain where I will be in an official capacity, but I can tell you that I am very excited about the future of the AGD—and you should be, too! If you have always had a desire to do more, reach out to your AGD constituent board, or if you have a desire to collaborate with your colleagues at the national level, let AGD Headquarters know—the AGD is always looking for future leaders.

Here I am again—setting goals and aspiring to meet them.

Colleen B. DeLacy, DDS, FAGD

Tuesday, November 25, 2014


Those of you who know me or who have read my old blog posts know that I am a marathon runner. 

Well, two weeks ago, I finished the NYC Marathon. They say it is the best marathon IN THE WORLD. I have to say that it was a pretty surreal experience. This was my seventh marathon and, yes, I thought it was pretty special. 

It had its lows…51,000 people ran this race. And the runners ran through all five boroughs. The race started in Staten Island, so they had to ferry or charter bus over all 51,000 runners before 9:30 a.m. So you have to be on your bus or ferry around 5:30 a.m.

The race didn’t start until 10:30 (for me). So, yeah, after the 90-minute bus ride, that’s more than three hours of waiting in a park. It was 41 degrees with a 25 mph wind.

But the good thing is, once the race started, it was pretty awesome. There were so many spectators that you can’t hear yourself be in pain. My wife saw me and was yelling for me but I never heard her.

I figured it out: There were about seven runners finishing the race per second. Wow. It turned out to be a great day and the medal was pretty nice. (When you are a fat and slow runner, 45 years old, it is all about the medal.)

OK, about our topic…

The bane of our existence as dentists is the person who doesn’t show up. We spend endless amounts of time talking about how to get people who have scheduled appointments to show up. 

We all have our systems. (By the way, if you ever get an email or mail that advertises a CE course that promises that, if you attend, you will “never have a no-show again”—run.)

In our office we have a system. We think it is working for a while and then it doesn’t. So we tweak the system, then we tweak the system again...and so on and so on. 

This is what our system is now: No one leaves our office without another appointment scheduled. If they are here for a cleaning, they leave here with another cleaning appointment in six months. If they are a new patient, they leave with their first cleaning appointment or an appointment for restorative care. 

But it’s the showing up for the appointment that’s tough. 

Look, I know that if I made an appointment for six months from now, there is about a one in a billion chance that I will make that appointment. (I want to be honest with you guys.) The iPhone has made the chances better but, still, I am a busy man; I forget things. 

So knowing this…I know my patients are busy, too.

We have our system to try to get these folks back in the chair. We have a service that calls our scheduled patients two nights before their appointment. We send emails. We text. And I would say that our system works pretty well. (I mean our hygiene runs about 80 to 87 percent full. I know this sounds low, but it is what it is.) 

We are able to get a hold of people most of the time. 

Sometimes they have to change the appointment, but most of the time it’s a quick, “Hey, how are you? Yes, I will be there on Wednesday” kind of thing. 

Now there are a handful of these folks who have me wanting to jump off a bridge. We call them the DAY BEFORE and they say, “Yep, I will be there” and then they don’t show up.

What do we do with these people? They have confirmed with us that they know they have an appointment, and they don’t show up. 

I am hoping you are not letting them slide. 

At our office we have a NO SHOW fee and it is punitive. Our NO SHOW fee is $75 for a hygiene appointment. 

You are going to say, “John, wow, that is a lot of money. My patients won’t stand for that.” You might be concerned about ticking off your patients and that they will leave. 

I will be honest with you, we warn them first. They miss the appointment and we remind them of the no show fee. We tell them that we will waive it this first time.

Then, the second time, we hit them with it. I feel like it’s a “fool me once…” kind of thing. Yeah, my patients get ticked off. Yeah, they might go somewhere else. GOOD. 

They will sure know that we mean business. Who knows, they might even get ticked off enough to show up for their next confirmed appointment. Or, if they go somewhere else, they can start missing appointments over at that office. 

Take control of your office. Make folks take responsibility for themselves. 

We are all guilty of running our practices like a family-owned business. I think, in this case, it is time to run it like a corporation. 

Cold—this is how it is going to be. You don’t like it? TOUGH. In this case, it is my way or the highway. Your practice health depends on it. 

Have a great Thanksgiving.
We have so much to be thankful for. 

John Gammichia, DMD, FAGD


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