Monday, February 6, 2012


I hope all is well with you. We have had a change in dynamics at our office. About 8 months ago, we had a senior dentist approach us about working in our office. It sounded like he was in a real pickle. He had sold his practice and was forced out but then realized he wanted to continue working. He needed a place to temporarily “grow roots” for a few years. He is a very nice man and we wanted to help him. We have an extra chair and would benefit from having him at the office. We came up with a contract and off we went.

Well, he practices very differently than Dr. Jackson and I do. He advertises himself a “biologic” dentist. He does not believe in fluoride. Many of his patients are on the holistic side with a different view of the dental world, or, world in general. His approach to hygiene is different than ours. Many of his previous patients followed him and brought their ideas of how a dental office should run. At our office, we have developed guidelines and somewhat strict procedures on how we bill and collect payment for treatment. Many of his patients are used to a very “liberal” way of how the billing and financial side of the practice works, so several of his patients are less than nice to the front desk staff. Needless to say, the front desk personnel are many times up in arms frustrated mad with him and his overly demanding patients. They can get very rude and demanding, always throwing out, “This is not how it used to be done!” Our staff just politely and professionally explain our policies, hold their ground, and move one.

The hygienists are going batty trying to figure out how to manage his patients from a perio perspective. They are used to a very conventional, standard approach. We are not overly aggressive with scale and root planning, but we do them if clinically supported. We all know that many times patients don’t want to do it! Our staff explains to them it is the proper treatment and, in some cases, we will have to dismiss the patient if they do not decide to accept treatment (this is very rare). His view is that it is okay if the patient does not want the correct treatment. He wants the hygienists to just continue on with a regular adult prophy. Some view this approach as supervised neglect. The staff are so confused on how to deal with him on this issue.

We have invested in special supplies and equipment that I will never use but is in the “biological” dentistry realm, I guess. He has patients drive hundreds of miles for amalgam removal using a special ion beam that binds the mercury vapor and reduces exposure during removal. I do not know about all this, but I will only remove amalgams after a long conversation. I explain that I have not found any peer-reviewed, properly designed study that indicates amalgam removal will cure disease or produce other health benefits. It will likely not cure M.S., Lupus, or any other ailment. I know this could be a blog in itself and no nasty dissenting emails, please. I know there are different opinions on that subject. I will remove amalgams that are not failing after a long discussion if the patient understands it is for cosmetic purposes only and is aware of the benefits or risks involved. However, amalgam removal is a large portion of his practice.

He is driving the office mangers crazy at times. Besides dealing with the staff running around frustrated, he often wants to do things differently than the contract we signed. We agreed on a certain things in the contract and he frequently wants to change them. He always wants a check. It went from once a month to every two weeks, and now he wants one every week. We could say no and stick to the contract, but he always seems so desperate that we feel bad and try to bend to help him out. At times, we feel that if we give an inch, he tries to take a mile.

Having him work here has made me realize even more how differently dentists will practice and do things. It makes me realize how difficult it will be to find a future partner or associate when Dr. Jackson packs it up and rides off into the sunset. When it comes to how I think certain things should be done, some things in my mind that are black and white but some things have several shades of gray. I worked closely with many dentists while in the Navy, but rules and regulations kept everyone on the same page. I am trying to be understanding and accepting of alternative treatment styles, but still feel I need to protect the reputation of the practice. I also want to keep the staff headed in the right direction and have some sort of consistency and organization.

I have observed one very interesting thing. It turns out that the staff really seem to like to know the rules and expectations, and when someone tries to change them or get out of step they really get angry. I feel good knowing that they have all come to understand and believe in how we do things and want to maintain it. This accomplishment is much easier said than done.

Well, the journey continues.

Have a great week,



Anonymous said...

Really enjoy these blogs. I am currently a Senior applying to dental schools this summer.

I was wondering if you, and the other contributors if they were willing, would write an entry concerning your perspective on the current application process and whether or not it has changed since you went through it.

Do you allow students to shadow? What do you appreciate from the students if you do?

Dr Joyce said...

Anonymous student,

The application process and acceptance has gotten much more difficult. I probably would not have gotten in dental school with my grades and DAT score would have worked much harder. Many more applicants and many more females are applying. I think I heard UF's last class was about 60% female and when I went it was about 25%.

We have students in the office regulary to shadow. Today in fact we have a foriegn trained dentist observing.

Pre-dental students will come and observe and want a letter of refence. I look for someone that already acts professional and mature, that pays attention and asks questions. Just dose not sit in the corner picking thier nose asking when lunch is!

good luck.

Anonymous said...

Sounds like he has grown some roots and is time for him to stand on his own.

Anonymous said...

Show him the door.........its not worth the confusion and harm that may be done to what you have built.

Anonymous said...

I sense this nice gentleman has another "Forced Out" in his future. Surprised you guys didn't see the red flags waving. Good luck

Anonymous said...

Some years ago my staff fronted me to say they were upset by the standard of dentistry being produced by our new after hours dentist. They declared they were "not going to have our patients treated like that" and also said they wouldn't work with him so I had better get rid of him or teach him how to "do dentistry properly". I immediately acted, the young dentist was relieved to have some feed back and some mentoring and 20 years later, the dentist and the staff involved are still great friends.


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