Friday, March 31, 2017

Systems for Success

Beautifully designed systems enable a well-trained team to deliver excellent dental care and superb customer service. Everything a team member does needs to be documented, rehearsed and mastered to ensure excellent results. Systems or standard operating procedures (SOPs) should be maintained in the practice’s operations manual and used for training new employees, continuing education, measuring employee performance and providing direction for the entire staff. Employees appreciate systems that are clear and concise and provide direction so they can perform to their utmost potential. Detailed systems that are adhered to help alleviate vague and ambiguous scenarios. They also help provide clarity and guidance that leads to increased efficiency, accountability, quality output and uniformity of performance.

Systems incorporate every operational protocol in a dental business. The level of success for the business is directly correlated to the quality of the systems and team’s overall effectiveness. Well thought-out systems include step-by-step instructions on how every aspect of a dental office should run. Excellent systems are analogous to a great recipe that yields predictable outcomes through step-by-step instructions. There should be systems for how to answer the phone, process payments and ask for referrals; systems for well-designed hand-offs that motivate patients to seek treatment; systems for how to turn over a treatment room; and systems for how every clinical procedure should be performed. There also should be systems on how to evaluate business metrics and data that incorporates the practice management software, marketing, insurance, phone call conversion rates and personnel. In fact, there are about 300 systems that should be part of every dental office. Can you imagine a pilot jumping into the cockpit of a beautiful Boeing 787 bound for the other side of the world without checking to make sure all systems are operating properly? Without systems, a business is flying blind.

Developing systems that work is not an overnight task, nor is it easy. Companies such as Starbucks, Alaska Airlines and The Ritz-Carlton have accomplished earning world recognition through the delivery of fantastic customer service and satisfaction. At the core of their excellence are integrated systems that promote teamwork and empower employees to reach their ultimate potential.

While it takes time to develop and implement systems, the rewards are well worth the effort. Having a sound financial system that maintains high cash flow is one simple example that can eliminate devastating financial results. Cash flow is critical to any business, and in dentistry, the outstanding accounts receivable (A/R) ratio should never be greater than the average monthly production. In other words, the total outstanding A/R ratio should be < 1:1.

Have you ever had a patient in the chair for multiple extractions, alveoloplasty and delivery of immediate dentures, only to learn that the prosthesis is still at the dental lab? How does this happen? Is this an employee or a system deficiency? Usually, this a result of poor systems and not the employee — at least, if the business has hired and onboarded personnel with the use of systematic hiring procedures that includes background checks, verification of references, team interviews and much more. In fact, insufficient training for new personnel is one of the most overlooked and undervalued aspects of most employers.

As an industry, we can do better. High employee turnover in the dental office can be demoralizing and expensive. Patients do not like to see new employee faces each and every time they come in the office.

If you do not have a comprehensive operations manual with standard operating procedures in place, then I highly recommended that you begin to develop one as soon as possible. This can be a team effort, or you can get help from a dental analyst or consultant who has experience in operating manuals and systems.


Tuesday, March 28, 2017

Extending our ‘Best Before’ Dates

Among the many things I have enjoyed in my lifetime, I have had the opportunity to appear on stage as a stand-up comedian. Personally, I find a lot of comedy routines today to be filled with objectionable language or focused on insulting certain groups or too topical and, thus, not enduringly funny. Me? I just wonder about things, such as:

  • If you leave sheep out in the rain, will they shrink?
  • How does one plant seedless grapes? 
  • Why do we park in the driveway and drive on the parkway?
  • Does mystery writer Stephen King ever have nightmares?
  • If you make a cow laugh hard enough, will milk come out of its nose?
  • If sour cream is milk that has gone bad, why does it have an expiration date?

Oh, I’ve pondered these things and more. A lot more. I’ve been collecting this kind of stuff for years. It’s fun and really different to do so. But it was that expiration date joke that especially resonated during a recent patient visit.

“Sandy” is a retired school teacher, now well into her 70s. Her recent health has not been ideal. First, she had a cancer scare with a diagnosed tumor. It was removed surgically and found to be benign. Then, shortly after recovering from that surgery, she had her right hip replaced. And last week, she walked into our office, with a normal gait, looking and feeling well, but her oral region had taken a beating due to long hospital stays and intermittent home oral health care. Thankfully, we were able to restore her oral health simply and inexpensively, due to her lifelong habit of seeing us regularly. 

But it was her comment at the end of the appointment that had us all laughing. She commented that she has now entered the period of her life known as her “best before” date. She was bright and cheery stating this, and we thought it was a delightful way to look at aging.

Many of you may also know I am an avid “Star Trek” fan (my favorite TV series is “Deep Space Nine”), and I have been subscribing and listening to the free podcast, “Engage: The Official Star Trek Podcast.” In a recent episode, the host, Jordan Hoffman, was on the first-ever “Star Trek: The Cruise,” and interviewed Ethan Phillips, the actor who portrayed the character Neelix on “Star Trek: Voyager.” I had no idea before listening to this, but Phillips is a funny man. And on this cruise (which I was unable to attend), he held a session to teach people about the art of comedy. Oh, to have been able to attend that session. In the podcast episode, Phillips told a joke (which I cannot repeat here) that illustrated the importance of how words are used in a certain way for dramatic and/or comedic impact. It is the basis for some of the comedy I use in my keynote talk, “Success Is All about Relationships.”

In the January 2017 issue of AGD Impact, AGD Editor Roger D. Winland, DDS, MAGD, wrote about keeping frustrations in perspective. Having a lighter heart, seeing life through the eyes of others with an attitude of abundance, and connecting and enhancing the relationships with our patients will bring us more success — and extend our “best before” dates to a much later time in our lives.

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

Monday, March 20, 2017

Part 2: What Defines a Successful Practice?

This is my second blog post in which I strive to define success through my eyes. In my previous blog post, I talked about how I feel like success is always measured in dollars. (If you haven’t yet read it, I recommend you do. It is a must-read. I mean: Pulitzer Prize-type stuff.) I also discussed that while making money is important, regardless of how much money you make, it will never be enough. With this in mind, I have changed my definition of success, and I now measure success in the intensity of my happiness.

I love coming to work every day. I actually like and enjoy all of my staff members (most of the time). I love doing dentistry, and I like most of my patients. Now, I don’t know about you, but I feel pretty successful in light of these things.

Today, I want to tell you about my practice. Now, it is probably going to seem different from yours and even different from some of the other bloggers’ practices. (I know Dr. Murry has multiple offices, but the funny thing is that when I read his blog posts, I feel like I could have written them because we think the so much alike.) I have a relatively small practice. This is how it started: I joined my father’s practice about 22 years ago, two days a week. I began working full-time in a little more than 2½ years later. (Joining your father’s practice has its good and its bad components. This is a story for a different blog post series.)

My father allowed me to buy 25 percent of the practice after eight years of being an associate. Four years after this, he allowed me to buy another 25 percent. At this time, my father was about 60 years old. It took a couple more years, but he started to allow me to start making decisions.

And it took a couple of more years before he was coming into the office less. Then, a natural evolution of the office was starting ... and it was starting to look a lot like my practice, the product of my vision — after 15 years of working there.

I bought 100 percent of the office six years later. That’s right: I was 42 years old before I owned the practice. (See, I told you that there were both good and bad components that go along with working with your dad.) My father was my associate for a year and a half before he fully retired.

As an aside: When my father retired, I brought in an associate, and after about a year, he bought his own practice and left. (Again: This could be the topic of another blog post series.) This is when I decided that I was just going to work by myself for some time. (I probably will never hire another associate until one of my kids becomes a dentist or before I am about to retire.)

I have eight rooms in my office. In my practice, I work with three hygienists, but I only have nine hygiene days. I have a four-day, a three-day and a two-day hygienist. Every day, I work with two hygienists, and one day, I work with three. I work four days a week, so that means on the days I am in the office, there are at least three empty rooms, and three days a week, there are four empty rooms. And I have no desire to fill them with patients or staff. (I did work something out with an orthodontist, and he is now working one day a month and is trying to build a practice out here.)

I take only traditional dental insurance. These are the insurances that involve you picking your own dentist, and you go, and they pay a certain percentage. I am not on any PPO or HMO networks.

I am not on any lists, and if the patients have one of the above and they want to come here, we will take the out-of-network benefit, and they will be responsible for the rest. We know that this means that a lot of people are going to be paying out-of-pocket to come to our office. So we have to make a practice that is worth visiting.

For this reason, there has to be a perceived difference between us and the dentist down the street who is within their insurance network. This is how I try to make my office stand out from the others. Our office has to be warmer. We have to have perceived technology, whether this means monitors mounted on the ceiling, an intraoral camera or digital X-rays. The people who work here have to be nicer and friendlier, and they have to be “service above self” people. We are a service profession, after all! How many offices don’t serve patients well? In how many offices is it about the dentist and not about the patient? I think when you go above and beyond, people are going to notice. And it is not that expensive to do so.

Pictured is my reception area. I bought at least four of the chairs on clearance. The massage chair was $300, and I recently reupholstered it. A patient made me the armoire. I bought the little fridge on clearance. And so on.

And the only other thing I think is important is me and remembering to always put the patient and the practice first. It’s important for me to be all of the above: warm, nice, friendly and all about service. Look, to me, this profession is about building and maintaining relationships. I have always said, “Patients don’t care how much you know until they know how much you care.”

You have to get be able to talk with the kids. You have to be able to relate to Grandma. You have to be able to have a conversation with Mom — not your assistant, but you. Yes, it’s important for you, not your assistant, to go out into the reception area, sit next to Mom and have a discussion. You have to remember that your patient’s 50th birthday is next year and that your 65-year-old patient is retiring in April (so that you can send him or her a birthday card and a congratulatory gift card, respectively). You have to notice someone driving into the practice parking lot in a new car — go out to the parking lot and tell the patient how awesome it is. Talk their language; ask them, “How many miles do you have on that baby?” Are you starting to see a theme? It is about them, my patients — not me. I have learned that people just want to feel known and special.

Yes, this is a lot to do. And if you are thinking that you have a schedule that is so packed that you have no room to talk with patients, well, then I would think about changing that. I know some of you are not good at this. Chit-chatting with patients may not come naturally for you. I get that. Some dentists are introverts. My advice is to “fake it until you make it,” as they say. Give talking with patients a try. Or enlist the help of your staff members. Remember: People just want to feel special.

John Gammichia, DMD, FAGD

Friday, March 17, 2017

Striving to Be Like the $350,000 Man

I read an article a few weeks back — when my beloved Pittsburgh Steelers were still in the playoff picture — about how linebacker James Harrison, at the ripe ol’ age of 38, spends $350,000 a year on maintenance, conditioning and recovery of his body. He’s still making body-shivering collisions with players who are half his age and remains at the top of his game, so it clearly works. He’s even got the NFL baffled at how he’s able to do it — and is drug-tested more than any player in the league because of it. But $350,000?! That’s on top of the stellar treatment provided to him as part of his contract with the Steelers. Wow!

I bet that I won’t spend $350,000 on care, training and recovery of my body in my lifetime. Hence, the reason I’m a dentist and not a professional athlete, I guess. But there’s a message within that amazing statement, or at least I took it as such. It’s time to make yourself a better dentist and person. I don’t recommend making it a $350,000-a-year venture, but invest some time, energy and money into yourself. I put together a hefty list of things I want to change for the better this year, both personally and professionally, and I intend to crush it, much like Harrison crushes his 5:30 a.m. workouts daily — even getting one in in the morning after arriving back from Kansas City at 2:30 a.m. That’s dedication, people.

I intend to be a better clinician. I’ve put together a significant continuing education schedule for the coming year. I’ve increased our marketing efforts fivefold. I intend to set a new bar for communication with my team members. I also intend to reset my attitude dial at morning huddles, before coffee enters my bloodstream — all in an effort to make myself a better boss and provider to my staff and patients.

On the flip side, I’ve set equally high marks for my personal life. My time at work needs to be kept within a well-defined window of time, and my time at home with my young kids needs to be quality, connected, invested time. I too often hear dentists get up and speak at lectures about how they wish they could have their first 10 years of practice back, mostly because of the experiences they missed with their families. It’s understandable and something that’s a constant battle.

Add a 6 a.m. workout a few times a week, regular chiropractic visits and a massage once in a while, and it becomes more difficult to achieve these goals due to time constraints. But I’m focused on overcoming obstacles to achieve my mission. (And, man, I could have a masseuse on staff for back massages between every patient for less than $350,000! Wouldn’t that be the life?)

Push your boundaries for the better, people. Work hard, love hard, recover hard. Make it your mission.

Donald Murry III, DMD

Monday, March 13, 2017

Turn a ‘Triple Play’ for Your Patients

There are so many reasons I love being the team dentist for the Chicago Bandits. 

Are you familiar with the Bandits? The four-time league champion women’s professional fast-pitch softball team plays every summer out of their beautiful stadium in west-suburban Rosemont, Illinois. My role as the Bandits’ team dentist is so fulfilling. On a personal level, and as the father of two daughters, I’m extremely proud to support women’s professional sports. On a professional level, my role allows me to further the advancement and knowledge of sports dentistry in the public eye. Most importantly, it’s just flat-out fun to watch the team play.

Each game, the best softball players in the world meet on the field, and the action doesn’t disappoint. The team (and league, for that matter) is chock-full of National Collegiate Athletic Association all-Americans and former Olympians.

Over the past five years as the Bandits’ team dentist, I’ve been fortunate enough to watch some amazing softball on the field and associate with the stellar players, coaches and organizational staff. The past two seasons have been especially fantastic, as the Bandits are repeat defending league champions (in 2015 and 2016). Many amazing plays took place in order for the team to earn back-to-back championships, but one play in particular will always stand out in my mind.

It happened during the 2014 season before the recent championship run — a triple play! Yes, one of the rarest plays in the sport was started by none other than the Bandits’ redheaded ball of fire herself, shortstop Tammy Williams. Her triple play made ESPN’s “Top 10 Plays of the Week,” and she gained national recognition for not only herself, but for the team, league and sport as well. The video clip of the play rocketed through the internet and was shared again and again by women’s softball teams, players and fans of all ages. In all, that single play resonated throughout the softball world exponentially for longer than the several seconds it took to physically complete it.

Wouldn’t it be amazing to be able to be in Tammy’s cleats for just a moment? To have a skillset that allows us as dentists to have such a vast and far-reaching impact? I firmly believe that we as dentists are in a fantastic position to make a difference. There are chances to turn a “triple play” around us all of the time, to make an impact on our patients’ lives.

To do this, like Tammy, we need to be in the right place, at the right time, and we need to identify the opportunity and then execute! The opportunities to perform procedures that resonate with patients likely present themselves routinely in your dental practice. You just have to identify them.

There are numerous procedures that fall into the “triple play” category, but several of the best examples are pit/fissure sealants, athletic mouthguards, bruxism night guards and routine prophylaxis. Each of these typifies a “triple play” procedure, as they are noninvasive and low-cost and yield long-term benefits for the patient. Even knowledgeable parents of pediatric patients rarely are aware that noninvasive, low-cost dental sealants can reduce their child’s probability of occlusal caries by up to 80 percent.

Broadly, in my office, a “triple play” procedure should satisfy all three of the following requirements, in order for me to pitch it to my patients:
  1. It must be minimally invasive. 
  2. It must be inexpensive, relative to other dental procedures.
  3. It must offer long-term benefits for the patient’s oral health. 

If I can answer “yes” to each of those requirements, then the procedure certainly counts as a “triple play” and likely will resonate throughout that patient’s world in the same way that Tammy’s play did the softball world.

After I discuss with them the procedure, the science and the “triple play” way of thinking, my patients always leave with not only a better understanding of dentistry, but an effective approach to dental treatment planning as well. In my opinion, patients truly appreciate this way of thinking, and it’s been a real practice-builder, as patients are more willing to accept recommended treatment to improve their oral health.

So whether you’re sitting in your dental practice or in the stands watching the Bandits, be sure to watch closely for that “triple play” opportunity that could have a long-lasting impact.


Tuesday, March 7, 2017

Dentist and Dental Assistant: A Necessary Duo

I’m sure we’ve all been there: Our dental assistant tells us that he or she is resigning. You know, the one who has the whole office put together and knows it like the back of his or her hand. The one whom you know, deep in your heart, you’d rather not function without.

I’ve worked with numerous assistants throughout my career, and over the years, I’ve understood their job to be a difficult one — not that ours as dentists is a walk in the park, but I can’t imagine a day without them. In fact, as I look back, my most beloved assistants were at the center of those smoothly run days integral to the running of the practice and, more importantly, patient treatment. (Of course, I’ve had assistants who totally ruined a day, too, but I’m choosing to focus on the good ones here.) This isn’t news to anyone, I’m sure, but I’m reflecting on this now because lately, we lost a superb assistant to dental school and another to an injury. In the meantime, I’ve had to work with short-term assistants, striving to fill the void and, boy, has that opened my eyes.

They don’t know our systems, our codes and our vices; they are like first-time guests in my house being asked to cook a four-course meal. They don’t know where our materials are kept, are not familiar with our software and, of course, don’t know the staff or our patients. Sure, everyone starts from scratch, but when you get so used to your routine, and the way your favorite assistant kept all of your cabinets well-organized, the “outsider” assistant is difficult to integrate for such a short amount of time. Ultimately, I’ve become both a dentist and an assistant lately, and this has given me a perspective of what assistants’ work entails and how important their job is to our job.

It’s no secret that it all comes down to team effort. I can’t treat a patient efficiently (and effectively) without my assistant. A short while ago, it took me close to 10 minutes to break down a room and just as long to set it up. I was grumbling internally the whole time, thinking that it would have taken My Favorite Assistant Who Wasn’t There half the time. And to think I used to do that in a flash in dental school some 10 years ago. Another time, I battled furiously with the suctions and resigned that I’m not good at operating both sides of the chair at the same time.

As much as we all know assistants do not share our exact perspective or the responsibility that lies on our shoulders as dentists, patients still typically confide in them more than they do in us. Assistants are uncanny when it comes to organizing and structuring drawers and cabinets, ordering, etc. Most take beautiful alginate impressions and can take a full-mouth series in less time than I can say “full-mouth series.” Most of all, they echo our treatment philosophy and reinforce our practice protocols when we’re not in the room.

Needless to say, I’ve felt my dental assistant’s absence and the misery of not having a consistent, reliable comrade by my side. Much the same way physicians may feel as if they can’t treat patients without nurses, dentists need assistants to streamline patient care. I’m sure that few dentists would disagree, unless they are the kind who likes to work alone. Here’s to all of the dental assistants out there.

Zeynep Barakat, DMD, FAGD

Wednesday, March 1, 2017

The Profitability Factor in Selling a Practice

At the ripe old age of 52, I am starting to consider selling my practice and pursuing other opportunities that have been presented to me. As may be the case with most of you, I am a planner. No final decisions have been made, and we’ll see what the future brings. However, I want to share some things that I have learned because, eventually, each one of us will be selling our practices.

Let me begin by explaining that last year, my office had the best production numbers ever. We also had the best collections ever. By far, our numbers exceeded anything we had done before.

When I contacted a well-respected practice broker in my area, I was expecting to hear how wonderful my practice was, how lucky any potential buyer would be, etc. Do you know what she told me instead? “We will have a difficult time selling your practice.”


This is the reason: profitability. While your practice may be generating enough income to meet your needs, it needs to generate enough income for the new dentist to collect a salary and pay off the new practice note. Additionally, these days, it must also cover student-debt payments. In other words, your practice needs to be very profitable. Unless you are willing to sell your practice at a steep discount, you need to be extremely profitable. As an aside: This profitability needs to be apparent on at least three years of tax returns. It does not matter what your practice-management software says; the only thing that is considered are your tax returns.

Without this high profitability, a buyer will not be able to convince a bank to lend him or her the money to purchase your practice. Older practitioners may have thought that today’s high dental school debt did not affect them. It does, unless you are willing to significantly reduce the sale price of your practice so the buyer qualifies for a loan. By significantly, I mean at least $100,000 off your asking price but probably much, much more.

As I discussed my surprise (no, better said: shock) with my broker, I came to realize something important. You need to work at getting your practice so successful that you don’t want to sell it because it is generating so much income for you. When you get to that point, you know that is the time to sell. Yes, ironically, the day you don’t want to sell your practice is the best time to sell it.

During these conversations, I remembered when I was trying to buy my office all those years ago. I, as the buyer, had a difficult time qualifying for a practice loan. In fact, the practice I was finally able to purchase was the third office on which I had placed an offer. The first two deals ended up falling through. For a long time, I believed the problem was with my qualifications. After a few years in practice, I came to realize that the practices I was looking at were not profitable enough. That is the reason why banks refused to finance those purchases. The banks were protecting their investment. They wanted to make sure that I, as the new practice owner, could draw a salary and pay back the loan. Several years later, the tables are turned. Now, it’s your turn to make sure whomever takes over your practice can draw a salary, make the office note and pay off those expensive school loans.

So, for now, I’m off to the daily grind. I’m going make my practice so profitable that I don’t want to sell it — so that I’ll know the time has come to sell it.

Andy Alas, DDS


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.