You Might Need a Vacation

Greetings,

Let’s face it: dentistry is a stressful job. I am finding out that taking time off is an essential part of the job. We owe it to ourselves – as well as our families – to make it to retirement. I can feel the stress in my chest, my joints, my breathing, my mood, in how I treat staff and patients. I have been carefully taking notes on what I believe are warning signs of stress. If you notice any of these signs in yourself, please take some time off.

1) If you are checking your hygiene patient and notice that you are humming the tune “It’s a small world.”

2) You accidentally show up to work in shorts.

3) You try to knock things off the counter with the air/water syringe.

4) You are putting all your jewelry in the ultrasonic cleaner while the assistants are trying to use it for patients.

5) You “accidently” turn off the water to the handpiece for those patients you have been wanting to dismiss.

6) You tell patients to “close” when the high volume suction is in their mouth.

7) You want to see what happens when you etch a tooth for 3 minutes instead of 15 seconds. Maybe there is smoke…)

8) Just before you give an injection, you say, “This is really going to hurt.”

9) You put a blindfold on just before you start drilling and say, “I’ve always wanted to do this.”

10) Using your highspeed as a microphone, you start singing as Steve Perry from Journey. (I actually sounded pretty good.)

Now, I am sure there are more signs, but I have noticed these are the major ones. For those of you who are already showing the signs (and even those of you who are not yet), I propose a 6-weeks-on, 2-weeks-off schedule. This will almost guarantee we can make it safely to 65, if we have to work that long. Some other suggestions have been to get rid of managed care and get higher fees for our hard work or get rid of people in your office that drag you down. Whatever it may be for you, I really think it’s important to “get away” from it. Our families and our friends need us. Excuse me while I start my second verse of “Oh Sherrie…”

Have a great week.

Scott

Your Staff Leave Something to be Desired

Hi all,

I got a call from a patient who works for (and was referred by) a local professional here. The professional’s entire family are patients here. This patient came in for a NPE. He has a hopeless 5-unit bridge on the upper right and missing lower posterior teeth. He said, "I am at a point where I want to look better and it is time I make my smile pretty.” And then he said, "Money is no object.”

Protocol is to run when someone says, "Money is no object." But, I didn't. I treatment planned this person for veneers and a couple of crowns, to remove the failing bridge, and to send him to my periodontist for implants in the lower posterior and the upper right (where he will be missing teeth when I take out the bridge).

When he went to the periodontist, his story changed. “I had an accident at my house that cost me a lot of money and now I really don't have that much money to spend. Can we do a partial on top and just a partial on the bottom?”

I agreed, but then things got a little crazy. I have to admit: this is where we could easily mess up. See, the treatment plan is in the computer and then the patient calls to talk to me. I am in the back and agree to change the treatment plan. But my assistant doesn't know anything has changed. I probably don't change anything in the computer. I change it in my head, but don't write it down. This is bad.

This patient called to talk about his treatment and schedule, but my assistant had no idea what he was talking about. Then we figured it out and he scheduled. He sat in the chair to work on a crown that was on the treatment plan. I asked him about an alternative treatment plan that I think would work that wouldn't show any clasps on a partial. He was all for it, but wanted to see if he could move some money around.

So we did the crown prep that day but didn’t take a final impression because he was thinking about changing the mode of treatment. We put a temp on the tooth and sent him off. The next week, the temp came off but he was too busy to come in. We told him to put the temp back on with Fixodent or toothpaste.

Then he called to talk about the treatment again. Apparently, there were tons of calls that I had not been privy to because he talked to my staff. He claimed that we kept changing the fees on him. He called and asked what the fee for a cleaning is ($89). Then at check out he was charged $124 (there is a $35 exam fee). Then he said something about me saying that I would charge him $850 for a crown. Our fee is $1,150-$1,250 for a crown. Why the heck would I say something like $850? So, there is a chance that he is hearing what he wants.

Needless to say, this is not a usual patient and we probably are not handling it well. I got the call saying that I am dynamite but my staff leave something to be desired. Then he went on to tell me the whole story. He told me he is still putting the temp on with toothpaste and how the charges keep changing. I told him that it is mostly my fault and I take full responsibility for my staff and that we need to have better systems to handle change.

I do not get carried away with this kind of situation. I don't get mad or feel insecure. I know there are some things we are not very good at. Changing treatment four times makes us crazy. The systems we have in place don't handle that well. When I get involved and talk to someone on the phone, all hell breaks loose.

It would have been easy to throw the staff under the bus to save face. But I am getting older and I don't really need to save face that much. I is what I is. (Listen, I know that sounds very admirable. But I have thrown my staff under the bus about a million times. They know that is part of their pay.) We do need to get better at some things. I need to get better at a lot of things. Communicating would be at the top of the list.

What don't you need to get better at? Do you throw your staff under the bus?

Have a great weekend,

john

P.S. Now go and get a Mother's Day gift. Hurry!

The $12/Hour Employee

Hey all,

Wow, have I been busy with life. Lacrosse if finished. (Let me tell you how popular lacrosse is here in Florida: they misspelled “lacrosse” on the trophy.) There is one more baseball on Monday. It would have been over last Monday, but we got our first rain in about 3 months here that afternoon, so they postponed the game. Everyone is over it anyway. Not because it isn’t fun, but because but we played about 22 games and these are eight-year-olds. My schedule is clearing little at a time.

My two-year-old is taking swimming lessons right now. He is learning survival techniques. My first two kids hated it and cried for through every lesson (which is 10 minutes, four times a week). Noah and David both love it. Noah is 8 and swims like a fish. David, the two-year-old, smiles and laughs through the whole thing. This is rare. Most of the time you can hear the kids screaming from the street as you are parking. But David can't wait to go.

I haven't told you this, but I am a freak about kids and water. I have an unhealthy fear about my kids (or me, for that matter) drowning. If we go to parties with the kids at a house that has a pool and no safety gate, I am like a hound dog. I don't let the baby out of my sight. If I come home and our safety gate has been left open, or if someone leaves a baby unattended in a bathtub... watch out, because it ain't gonna pretty.

I have nightmares all the time. It is weird. I think that when you grow up in Florida and you read in the paper all the time about kids drowning, you just get scared. But David being able to float makes me breath just a little easier.

I want to talk to you about my friend who works at Publix. Publix is an employee-owned grocery store in Central Florida. According to their website, there are a little over a 1,000 stores in five states in the Southeast.

Before I go on, I want to tell you that I work so I can retire. Everything I do now, as far as spending money, has consequences. I look to the end. Even though it is 20 years away, I think of the end. I love what I do, but I am definitely chasing after that carrot, and by gosh, I am going to get that thing one day. I think we are all doing that. We are all trying to build a nest egg so we don't have to die in our chairs doing a MOD filling on #13.

How much is enough? How do we do it? These are some of the questions we are all asking all the time. Are my kids smart enough to go to college? Should I save for that? (Okay, maybe we all don't ask ourselves that question. But I do. I look at my kids and say, "Yeah, you could be Duke material. But definitely community college for you." Is that mean?)

So, I have this friend who works at Publix. I think she is in her 34th year there. I don't know how much she makes, but I know it is around $12-13 an hour. She has slowly moved up and now works in the deli. Now, to the college-educated people, this job might sound trivial. What do you guys think of the person behind the counter at the deli?

I have a friend who owns his own business, This week, he found himself short-staffed. I am off on Mondays and I had told him that I would help him out if he needed. Well, he needed. So I put on a uniform and I was the $13-an-hour employee.

I have to tell you that this is good for any boss. It is good to have this feeling of helplessness, not knowing what you’re doing and hoping no one asks you a question. I had to ask people on a couple of occasions to bear with me because this was my first day on the job. One guy actually said to me, "Good luck with the new job," which I thought was nice.

It is also good because of how people treat you. I know for a fact that people treat my staff pretty badly and then come to the back and act so nice to me. Anyway, I am getting off subject. I was talking about the $12-an-hour friend.

If you work for Publix, they give you stock. After 30 years, it seems like she has been given quite a bit of stock. See, now she is working and making about $30k a year, and this year she received $12,000 just from dividend checks. She is basically getting a 30% bonus ever year. She gets paid for going to jury duty. They give all their employees a paid day off to get a physical every year. If they have to go for a colonoscopy, that day is also paid for. They get FIVE weeks of vacation.

Remember that nest egg we were talking about? Yeah, it seems that, depending on the price of the stock when she sells it, this $12-an-hour person has about $800,000 to $1,000,000. How do you like them apples?

At first, I was floored. A bit jealous, even. But you know what? Good for her. I hope like heck that that $12-an-hour person gets to buy her grandbabies everything they want. I hope that $12-an-hour person gets to fly first class to Rome and live it up. Or that she can have a mountain home or a beach condo.

Here the kicker: she is only 57. She has about 8 great years of working full-time. Which means more stock. Which means dividends. Which means more of a nest egg.

Her lifestyle is still $12 per hour. She and her husband never eat out. They drive beat-up cars. They live in a small house. They took out loans to put their kids through college. They don't know how to spend money. I was thinking I might be able to help them out in this area.

Have a great Thursday.

john

I still can't get over my patient with 1.8 million sky miles.

But, It's an Emergency!

How was your weekend? Did you hear about the Super Moon? It meant a busy emergency weekend for me. What do you do for after hour weekend emergencies? What is a dental emergency? I have my own thoughts on this; often, they seem different than patients’.

I am on a two-week rotation with Dr. Jackson, so we take turns. How do you handle emergencies? We have a phone system that allows a patient to leave a message that will be returned the next business day (usually prior to 9 a.m.) and get the patient scheduled. The patient has the option to have the phone system call the doctor’s cell phone, and they can leave a message. We usually get back to them within the hour. I rarely answer the phone so that I can hear the message, verify they are actually a patient, and go ahead and try to figure out what I want to do. Most of the calls sound something like this: “Hi. This is Mr. Jones. My filling just broke and is rough to my tongue. I would like to come in and get it fixed this weekend!” Sometimes they have an appointment scheduled for next week and want a call back to reschedule. My favorite always comes from the patient that I have been recommending treatment to for years: “My front tooth/veneer just came off, and I am going to die if I do not get it back on today!”

What do you constitute as a dental emergency? For a real emergency, I tell them to call 911 and get to the E.R. But to some patients, bleeding gums from gingivitis is a weekend emergency. We really try to offer complete patient care with exceptional service, but at times, it drives me nuts how demanding patients can be with truly minor issues that could wait until Monday morning.

I need a mental break from the office. At times, that is almost impossible. I know some doctors who cannot be found anywhere on the planet once Thursday afternoon hits. It is almost like they enter the witness protection program! We call every patient of record back and assess their situation, but rarely do we come in. To help curb abuse, we do have a standard after-hours fee. The time, gas and stress of having to come in and open the office, especially if I need an assistant, can be expensive. We do not always use the after-hours fee; it just at our discretion. If Mr. Smith is a great, long-term patient, I do not usually charge it. But if it is one of those patients that only shows up once in a while for limited care, they are getting the charge.

I have had patients demand that I extract a tooth on the weekend. They always go into elaborate, dramatic stories. I have even busted one lying to me, saying they had spoken to my partner and he told them to tell me to go in!

The main reason I do not want to go in is that I really need an assistant to help because I have the hardest time finding where everything is. I guess I really could treat a patient if I had to. But can you imagine trying to extract a tooth and having the root tip break, and trying to get that out without an assistant? That sounds like a great weekend to me! It is not easy trying to find an assistant to come in on the weekend, so it is typically pain medicine and an antibiotic, if needed.

Other dentists might subscribe to the philosophy that if the patient’s mandible is not in their hand with blood dripping down their face, there is no need to go in or even call them back. I think that is a bit drastic. Sometimes all the patient needs is a reassuring voice to tell them it will be okay and the problem is solved until Monday morning. Others are screaming and yelling, wanting treatment now for the chipped incisal edge of #9.

I think that I have had to come in three times in the last several years, which is not too bad. I guess if I want to make it on to Angie’s list with the plumbers and auto mechanics, I will need to start seeing emergencies in my kitchen like the commercial.

Have a good week.

J.J.

Hodge-podge

As I think of what to write today, I have so much going on in this brain of mine that I have a hard time thinking of one topic. So I am going to talk a little about a lot of things.

I had a patient who is retiring in a couple weeks come in yesterday. She had previously seen my dad and was happy with the care she received. She has seven teeth, three on the top and four on the bottom, canines and some premolars. Six years ago she had upper and lower partials made.

There are a couple of things you should know about this story. This patient hasn't been to a dentist since she had the partials made. She is a smoker and generally doesn't care about her teeth. She is in town for a couple weeks and then is moving to the Carolinas to retire. She wanted me to make her new partials so she could have a spare. She is not interested in any fixed, only removable.

I took a look inside and noticed that five of the seven teeth the partials rested on were decayed (all one surface, facials mainly). I told her she needed to have these taken care of and then we could take impressions for the new partials. She agreed.

When she got to the front office, she asked how much insurance would cover. My front desk person went into defensive insurance mode. Isn't it funny how we react to this question? We automatically start treating this patient with kid gloves. My people explained to her that there was a chance that the insurance was not going to cover new partials since she just had partials done six years ago. My staff began to think that this patient wouldn't want the partials if insurance wasn't going to get involved. However, the patient just shrugged and said, "Well, if they don't pay, then I will just pay with a check. Is that okay?” Yes, a check would be great.

But let’s not forget that this patient just doesn't seem to get it. She thinks she could just get new partials and everything will be okay. But she hasn’t see a dentist in five years and she only has SEVEN TEETH. There is a reason you only have seven teeth: you take them for granted. As much as I talked about regular visits and good home care, I don't know if it sunk in.

I had a patient this week pay with cash. We don't get a lot of people paying with cash here. But the weird thing about this patient was that her treatment was $3,810. Who carries four grand on them? I get nervous when I have to take the money bag to the bank. So, I don't know how I would feel carrying $4,000 to the dentist’s office.

On another note ... colleges are done for the semester here in Florida and there is a small break before summer semester begins. I am seeing a bunch of college kids this week. A couple of years ago, I sent a couple of my patients off to college and they wanted to be dentists. I have kept up with them over the years. I saw one of them today and asked how it’s going.

He said he is doing great and getting ready to take bio-chem next year. When I asked if he was still on the pre-dent track, he told me that he is thinking of going to medical school. Then I asked about his friend that I got going in the dental direction. He is also thinking about going to medical school. Then he dropped the bomb: "Actually, medical school is easier to get into than dental school," he said. WHAT?!

Are kids crazy now-a-days? I know this job looks easy from the outside, with good hours and decent pay. But, come on. I have been in this profession for 17 years and I am beaten down. Don't get me wrong. I totally love it—but beaten down nonetheless.

I know guys that are physicians that graduated at the same time I did. Although they work long hours, they drive Maseratis. Not Mercedes, Maseratis. They live in gated communities that won't even let me in. Sure, they might be beaten down too, but I would rather be beaten down in a Maserati.

Ok, the last thing. When I spoke in Tampa, the Kuraray rep was in from Atlanta to see me. When we left each other, he said, "Let’s talk next week." Well a week went by and nothing. Of course, I started to think that he must have hated me and wants to find a way out of this. I was freaking out.

Turns out, he sent an email to his superiors and told them that "This is the kind of guy that we are looking for." Being affirmed is like the greatest feeling. I was on top of the world yesterday. Ladies, listen up. All a man needs is to be affirmed every once in a while. My dad had a staff meeting once to tell everyone in the office that they needed to affirm us in front of the patients more. He said it was for internal marketing purposes, but I know that it was more for him.

But the Kuraray thing is going well. It looks like they are going to sponsor me to speak at the FNDC and maybe work with me on doing a Dental XP course. I’ll keep you posted.

Have a great weekend.

john

Dentaltown

Man, have I been crazy. My schedule has been packed. Let me run down my weekend for you. We stayed home on Friday and tried to recover from a stressful week. Let’s call this the calm before the storm.

Saturday morning started like any other day. My daughter had a piano lesson at 8 a.m.(don't ask me who makes the schedule). My 8-year-old’s baseball game was at 9 a.m. I am one of the coaches, so we have to get there at 8:30 a.m. or so. I dropped off my daughter, came home, and yelled and screamed until I had a baseball player and baseball stuff in the car.

My oldest son had a lacrosse game at 10:30 a.m. So straight from the baseball game (lost 15-1) to the other game on the other side of town. It took 40 minutes just to get to the lacrosse field. They ended up losing 9-7 (this was the playoffs, too). So far, 0-2 for the day.

We came home and we had lunch. My town puts on an Art and Foliage festival every year, and it was this was the weekend. I like going, but I just have to find time. After lunch, we got in the car and went to the festival. We were there from 2:30 until 5 p.m. Then at 6:30 p.m., there was a benefit dinner for the baseball league that we play in. We got home at about 11 p.m. How is that for a Saturday?

On Sunday, I was up at 5:30 a.m. to run 11 miles; I got home about 8 a.m. There was enough time to shower and help get ready for church at 9 a.m. We had breakfast after church, then baseball practice 1-3 p.m. A baseball party from 3-5 p.m. Then lacrosse practice 4-6 p.m. We had Church Community Group at 6 p.m. at our house (the last person left our house at 10:30 p.m.).

We usually don't like doing a lot on Sunday, like sports and stuff, but it just worked out that fields are tough to get and they were in a pinch. I am telling you, it is crazy at the Gammichia house. I won't bore you anymore with that; I just thought it was entertaining.

On to today’s topic. I know most of you are pretty computer savvy. That is why you are here on a blog. In the past, I have spoken about Dentaltown. I have not been to the site in over 3 years. I was talking to someone at Triodent; she suggested I give it another try.

Let me back up. I use to go on DT when it was first starting out. I felt like everyone with a computer was an expert. I would have a dentist fresh out of school trying to tell me I was doing it wrong, giving me his opinion like he was an expert. And not in a tone that was building up. I felt like people belittled others just to feel better about themselves. I got tired of the spirit of the whole thing.

I gave it another try last week. I didn't research to see if anything changed. I didn't read a couple of threads to see the lay of the land. I just went right to Case Presentation and uploaded an occlusal filling that I had done. It is an occlusal filling – what could they crucify me with?

Well, I wouldn't say they trashed me, but it got ugly in a couple spots. The first comment was about etching the enamel. Then they got on me about not using a rubber dam. Then they got on me about that little dark area on the occlusal surface, saying I should have taken it out in the prep. One guy said I had a white line on the distal facial part of the restoration in the final shot, saying I should have gone back and removed it and refilled.

There is still some attitude that if you are not doing it in one particular way, then you are doing it wrong. There are still guys that it seems just want to break you down. But this time around, I didn't take it so personally.

Taking this approach, I can look at DT in a different light. I have begun to see that most of the dentists on there are just trying to get guys like me to do it better. Now, it does seem like there are dentists on there who are untouchable (no one trashes them when they post). But now I find myself totally addicted.

Patients are waiting for me. Hygiene is waiting for me. And I am reading threads on DT. Kind of like you guys do with my blog. DT is fascinating. It is like a world unto itself. There are dentists on there that have 15,000 posts. That is like 10 years of 50 posts a day, EVERY DAY. This is not a well-rounded dentist.

I haven't gone to many of the threads yet. I have stuck mainly to the restorative dentistry threads so far, and have been quite impressed with the skill of the dentists. I think it is going to make me better. I mean, I think I am pretty good, but there are dentists on there that put me to shame (most of them are from Europe). I look at their stuff and wonder how they did that or I am convinced they guy must have photoshopped.

This could only make me better. And who knows? I might even try a rubber dam. Do any of you use DT? I would like to know what your thoughts are. Let me know.

Have a great Wednesday,

john

Ownership... Arghhh!

Good Friday to you. Hope you have had a great week.

My father and I are putting the final touches on the "hostile takeover." Some people will call it my buying him out. Things have been going pretty smoothly, but the minute details are maddening. My father and I have always done things a bit differently. A conversation between us might go something like this:

"Hey, you wanna buy the rest of the practice?"
"Uh, okay."
"Okay, done."
"Uh, okay."
"Okay, done."

Then a week later:
"How much do you want for the practice?"
"How about X?"
"Uh, okay."
"Okay, done."

This is really how two dudes do things. I don't recommend it, because now we have to start talking about things like medical insurance for "an employee." What if this? What if that? How about if you? I think you need a professional to handle all this.

One thing that I have started thinking about is trading. I am not saying I do this, but what if one of his friends comes into the office? Can he work on his friend for free? Can he trade services?

What if (and I am not saying this is a real situation) he had an optometrist friend from the military? Say they met at McCoy Air Force Base in 1971, and since then my dad and our family have received eye care and got a professional discount of 100%. His family has received dental care for the same professional discount here. He is on a 3 month recall here and I think my father and his wife get eye care. I went to him once in 15 years. I would consider him my eye doctor but I don't have any issues so I don't go. (I know, I know I should go more often.)

I found out about their agreement when his office didn't charge me as I left. I wrote him a really nice note and told my dad about the service I got at his office. My dad then told me their relationship."OOOOOHHHHHHHHH!!!" I said.

I took one of my kids there last week and was charged, as I expected. So now the question becomes: what happens when my dad no longer owns the business? Do I have to tell this guy who hasn't paid for a dental cleaning in 40 years that it is time to buck up? What about all the other "arrangements" my father has?

And that is just one thing. Now that I will own everything, I have to change the credit cards to my name. The office card that we have now has 350,000 sky miles that are mine. And do I give him a credit card? (Totally off the subject, but I had a patient that came in today that has 1.8 MILLION sky miles. Wow! He could go on a first class overseas flight with his wife over 150 times.)

What about his lab? I am partial to my lab (no pun intended). Mainly, my fixed lab. I don't think his lab is nearly as good as mine. My guy is local and is around the office all the time. And his work is really nice.

What about vacations? I guess he gets none because he is basically an independent contractor. See what I mean about the details? And that is only what I could think of off the top of my head. Disability? No. Is he is the bonus pool like the other staff members? What about if he starts to have a crappy attitude? What if he starts talking down to patients? Well, it is my practice now and I have to police everything. Do I send him to the schools? Uh, no. Do I send him to Rotary?

I think my head is going to blow off. Thanks for listening.

Have a great weekend,

john