Wednesday, May 14, 2008

Tier Specialists

Here is the thing.
I have been so busy that I just couldn't do the blog.
I was going from 5:30am to 10pm every day and sat down on the couch at 10pm and just stared at my computer.
And the blog is not only thing in my life that I have let go.
I have half done projects all over the house. This weekend it all came to a head. I am going in a thousand different directions and going nowhere. Not that all these things don't bring me a lot of joy but when I can't do them to the level of excellence that I want I explode.
Just ask my wife.
For instance I sat at my computer for 2 and a half hours last night (yes on Sunday) and wrote up my charts from Wednesday through Friday.
But I have definitely missed you and I am sorry about last week.
I am back on track (for now).

Last week we were talking about Tiers. But once we have established ourselves in a particular level we can't forget one thing.
We are who we hang out with.

Specialists and Labs and other institutions that you deal with become a huge part of your identity.

Lets talk about specialists for a minute.
When I first got out of school the periodontist I used was my dad's periodontist.
It was just assumed that I was going to use this guy. So I did.
Well this lasted for awhile until I realized his style was not my style.
I mean I am working my badonkadonk off trying to create an environment that people like. I was trying to establish myself as a Tier III++ guy. I was going out of my way to raise the level of expectations of my patients. And I felt he wasn't.
I had to make a change.
So I was thinking what do I do now. I have people that need a periodontist and I don't think this guy is taking care of them well enough.

So my quest for a Tier III or Tier IV periodontist began.
Well I know a couple of guys but I don't know anything about how they roll. I have heard their names but don't know anything about them.
I found myself being my own private investigator.
I would stalk some of these guys (they were all men, there are not any woman periodontists in my area, so guys mean guys) at meetings.
I would listen to the way they spoke.

I have a big thing with EGO.
I have a big problem with people who think their poop doesn't stink. I have a big problem with people that think they know it all. I graduated 13 years ago (damn I am getting old) and I still learn every day. I might know stuff but I am learning new stuff.
I don't want to hear a guy speak that doesn't listen. I want a guy that is confident and compassionate.
I want a guy that is good but doesn't know it. Or knows he is good but is trying to get better.

I narrowed my search down to three.
Now I started to call their office (from my cell phone so they didn't know who was calling). I wanted to hear how they answered the phone. I wanted to feel like my patient feels when they call. I might ask a gum question to see how they handled it.
Then I would walk into their office unannounced. They don't know me from Adam and I wanted to see how they treated a stranger.

Now I have narrowed it down to 2.
So I sent them both a patient.
I found out when they were going and marked it down.
The day after their appointments I called the patient and we played a game of 20 questions.
How did he treat you?
Do you feel like you got ample time with him?
Did he and his staff explain everything to you?
Do you feel like you have a decent grasp of your perio situation?

Then I called the periodontist. You got to see Mr. Smith yesterday, how did it go?

Now I say these kind of things like it is an easy process. It is not. It is a pain in the tookas.
But in the end it all worked out.
I chose one about 10 years again and have not used another periodontist since.
He treats my patients like I do. (He is not nearly as good looking as I am but this is also what I am looking for).

I can call him anytime of the day (I can but I don't because I know he is busy) . I can ask any question I want. We go to CE together.
I consider him my friend. I would trust him with any patient, even my family.
But what I like best is he is real. His poop stinks.
I can constructively criticise him. Actually I think he would want me to do this, because if no one ever tells him he never knows.

Now once you think you have spent all your energy finding a new periodontist then what are you going to do about your lab.

I had a real problem with my father's ceramist.
Every time I would send him a case I would get a call. Now the call was not, "This is some awesome work" or "great prep" or "what an impression." It was always a lecture of some sort.
I don't mind some constructive criticism but enough is enough.
I had to change.
Now the PI thing starts all over. I have 5 ceramists come to my office. Then I show up at their lab unannounced (to see what the place looks like. Have you ever been to your lab? You must.)
I saw how they rolled.
I browse around the lab and see what there "everyday" crown looks like (not their show pieces they want you to see). I will look at the impressions of the other dentists they are using.
If the impressions suck then they are not asking the dentist to get better.
If they are not calling you and me and asking for another impression then they are not helping you and me get better at what we do.
I chose my ceramist about 10 years ago. I have not sent a crown anywhere else since then. (talk about loyalty....I guess I would be a terrible NBA player. Oh and I am 5'10 with heels on)
My ceramist and I go to CE together. I also consider him my friend.

Now I know all you older dentist are set in your ways. You may be saying I don't need to worry about this anymore. I have got my periodontist and everything is cool. IS IT?
I told you I am sending my perio people and all my crowns to the same person for a long time. This doesn't mean I am resting on my laurels.
I still call the office on my cell to see how they answer. I still occassionally call the patient to see how their first appointment went. I still show up there unannounced. I still go to my lab and look at all the impressions. I am still investigating.

I guess this PI's case is never closed.

Food for thought.
I am glad to be back. I hope you are.
See you Wednesday

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