Friday, September 4, 2009

Selling Dentistry

Hey all,

Well it has officially started. FOOTBALL SEASON. And it started with a punch/bang. All is well.

I am about 100 pages into The Power of One and it is very good.
The author writes like he talks and he talks with a drawl and it is hard to figure out. So it is taking me a while to get going.
I am just finishing up King Arthur and the Knights of the Round Table with the kids. 400 pages and I read every one of them out loud. That is hard because they use words like smote (which is the past tense of smite) and thither.

My wife and I watched a movie called Doubt. It was average. It is about a nun.

I started watching a movie called Mr. Destiny. This is an old film (1990) about a guy that is down on himself. See if he just would of hit a home run in the state finals in high school, instead of being the goat and striking out, things would have been different. So classic, ghost of Christmas past, movie. So the movie is about what his wife would of been like if he was the hero.

That is it for the other stuff so let's get right to it.

I wanted to talk about selling dentistry. Now I know this is going to be a HOT topic for some of you. Let me say that this is my opinion and if we disagree it is not because I am a jerk or I am hateful. It just means I have a different way of doing things than you. I don't want you to be mad at me. If you disagree with me I would want you to comment but I don't want you to say nasty things about my mother.

Selling dentistry. Hmmm? Where do I begin?

Let's start by talking about a car salesman.

I mean they take selling and make it an art. But you know most of us don't have great experiences at the car dealer.

"I have to tell you ma'am if you leave today you are going to miss out on this deal."

"I mean, who knows, that car might not be here. We have had a rush on that color lately."

"I know your car is only three years old but you never know what is going to happen out there on the road. Do you really want to be driving your precious kids in a three-year-old car on that crazy highway?"

"I am going to have to talk to my manager."

"Let's just take if for a test drive and see, you are going to love it."

I know a couple of things.

The salesman is thinking, "They are here and the iron is never going to get as hot as it is right now. If they leave there is a very low chance they will be back."

I also know that I don't know too many people that like pressure sales. I don't know too many people that like the run around that they get at a car dealership.

Now consumers who understand what they are going to get when they go there, are better prepared. That is if they know the game and they think they have the upper hand.

(Now, all things are different at the luxury car dealerships. I have heard things are very different there. I have friends that have very expensive cars and they invite their car "consultants" over for BBQs.)

I don't think many people feel great leaving a dealership. I have heard so many stories from patients. The newspaper has written articles about it.

Now that is all that surrounds an industry that SELLS its products.

Let's bring it back home.

Let me tell you how I do it and I will tell you about what I have heard about other offices.

There are two things going on here. The stuff that will make them healthier and things that will make them prettier.

Let's start with getting them healthier. They have a mouth problem. I know what is best for the patient. I have been through the Pankey Continuums. I have taken all the Spear courses, anterior esthetics courses ... blah, blah, blah (what I am trying to say is that I have try to educate myself to know what is best). Let me rephrase that, I think I know what is best for my patient.

You do a new patient exam. And you find some problems.

There are two kinds of patients with problems. One that knows they have problems and they come to you for solutions. The worse of the two is the one that has problems but doesn't know it.

Now the million dollar question (more like ten million). How do you get these people to see what you see?

Some dentists say, "This is your problem, this is what it is going to cost to fix it. Now I am going to introduce you to Mary who is going to discuss with you how you are going to pay for it."

I get this approach. I get that someone has spent 25 years trying to explain to their patients their problem but they don't want to know it. They get mad at the dentist and the patient kills the messenger. So they figure on this technique because it is the least stressful.

Some dentists might be shy about telling someone that doesn't know they have a problem that they have a problem. They don't want to ruffle any one's feathers so they just fill some cavities.

Now I am kind of a mixture of both. I spend a lot of time in the new patient exam on building a relationship. I find that if my patients like me and trust me that they can hear me when I tell them there is a problem.

I spend a lot of time on education.

"This is what periodontal disease looks like. Here is a picture of periodontal disease looks like. This is what the exam looks like so when we get into the clinical room and we start probing your gums you are going to know what I am doing and you are going to know 1-3 mm's are good and anything above 5 mm is something to worry about." They have to own their problem.

That is why I do a lot of intraoral photos. See this big black thing in your tooth? This is bad. Black is bad.

This is not selling. This is educating. And I think you have more than a patient. You have a relationship with someone and they trust you.

And I always, always, always hear, "No one has ever taken this much time with me" (granted some people get pissed when they are used to a 10-minute exam and cleaning and we give them the full monty ... you can't win).

My issue with telling people their problems is when it is a BBBBIIIIIIIGGGGGGG problem.

They are 45 years old. They have a terrible bite. Maybe some crossbite, maybe some crowding. Maybe some group function. Patient is a bruxer.

Chipping of the maxillary anteriors and wearing down of the lower anterior. Flat occlusal plain the back. Scalloped tongue. This person needs an overhaul.

This is too much education for someone to grasp in a 90-minute appointment. If I tell them all their problems and try to educate them on all I know ... I will lose them. They will leave my office with their head spinning and never come back.

I can justify this by saying to myself, "They needed to know" or "I planted the seed."

Or I guess I could tell them the treatment plan and introduce them to Mary.

You know what I mean.

This is a tough one.

So how do I handle it? It depends. If they know their problem, I give them what I think is the solution.

For instance, this week, new patient exam. The patient was 34 and had an impacted upper canine. He has tooth #C (baby tooth). He was a class II and a grinder. He knew his problem. He has been told by the last three dentists.

He did not want to do anything. What was I going to do change his mind?

I said, "You know you have a problem. You know what it would take to fix your problem ... ortho, oral surgery, possibly an implant. I am here for you when you perceive the problem needs to be fixed."

I recommended a occlusal splint and some fillings.

So this guy is in my practice, likes me, trusts me, but doesn't want to do it.

Now could I have told him if he doesn't do it he is going to have to find another dentist?

Or could I have made the problem seem like a 99% clogged cardiac artery?

To make him feel that if he doesn't do it he is making a dire mistake, I guess I could.

And would I fault a dentist who did? No (because if he was my brother I would want him to fix it).

Then I look at my patient pool as a whole. I think I have seen a great number of 85-year-olds that have all their teeth and have crappy bites.

Now do I see more older people with great occlusion with all their teeth? Yes.

Now this is what I tell my 40-year-old patients. I can only tell you what I know. More elderly people have healthier teeth at 85 when they have this (fill in the blank).

Do I get mad at the 40-year-old that has never heard this before, has three kids in private school, is in over his head with his new car payment, work is very stressful, who understands what you are saying and just can't do it? NO.

Am I babbling? Probably, because I have battled this to myself for a long time.

I am not done with this but I think I might come back to it.

But before this gets too long I wanted to talk about selling stuff.

As a young dentist, I knew this dentist that would put veneers on 90-year-olds. Not spry, I want to look more beautiful 90-year-olds. People who needed to be helped into the chair 90-year-olds. This jaded me so bad as a young dentist. I thought this dentist was putting his gain above the patients. And I think this is really the key here. If the dentist is selling for his/her gain instead of what is best for the patient, they have stepped over the line. Now granted this is a slippery slope to be trodding. Some dentist may think that veneers on a 90-year-old is what is best for them.

I started writing this blog, today, with the intention of talking about hygienists who are on a production bonus. Meaning they get a cut of everything they sell. We don't do this. Do I want my hygienist to talk about what the patient desires? Yes. Do I want my patient to leave the practice because they were getting the hard sell everytime they came in? NO!

We have this questionnaire before the new patient exam. One of the questions is, "Is there something that you would like to do to improve your smile?" They inevitable say that they would like to whiten their teeth.

During our exam I at least address this by saying, "I am not a seller, but I want to at least address this question. We can do so many things to make your smile brighter. I just want you to know that we will never push anything on you. BUT I want you to know it is all available. Take-home whitening, in-office whitening, bonding, veneers. So if that is something you would be interested in please ask someone about it."

I think the hygienists are most valuable when they listen to the patient. Have a discussion about procedures, not selling. Then I come in and my hygienist might say, "Mr. Stud was asking me about the spaces between his front teeth."

Very casual.

Maybe I will come back to this but this is now definitely getting too long.

Just remember I had no intention of putting anyone down. If you give someone a treatment plan and then hand this patient off to Mary then I would like you to comment. Not about my mother but tell our readers why you do this.

If your hygienist is on a production bonus tell us how this works. Your mindset behind it.

Have a great Labor Day weekend.


P.S. Don't forget ... New blogger Dr. Ric Crowder on Monday.


Unknown said...

Hi Dr. Gammichia,

I'm a soon to be dentist (Dec 2009) and I have been visiting the Daily Grind on a regular basis since last year.

Since then I have started my own site, where I combine regular dental articles, an "Ask the Dentist" section as well as tips on dental insurance. It can be found here :

My question to you is : I would LOVE to have an interview with you on my site - as I am starting an interview section there. Would you be willing to do that ? It would be 5-6 written questions over email and I'll link back to you in the interview of course.

Look forward to hearing from you.

Kindest regards,
Torunn Birkeland

Contact : private email : torunnbirkelands (at) gmail (dot) com

Emergency Dental said...

Selling dentistry can be hard, especially if you have a new patient where you have not gained their trust. If the patient has alot of problems, I try to focus on the main problems first, then briefly mention the other problems. I do not want to overwhelm the patient and lose their trust. Later on, I will go back to the other issues when the patient has gotten to know me better. I know what you me, selling dentistry is an art form.

Unknown said...

Very Good post. I googled "How to sell to dentists" and this came up. I thought of my dentist and I had similar experience. After 22 years in the military and retirement I decided to make our family dentist my dentist and switched from military care. The best decision I ever made. I must admit it was based first on the fact they accepted our insurance but the great care my wife and daughter received played a bigger part. On my first examination as a new patient I had one of the most comprehensive exams that was informative and actually asked questions. Of course at age 43 I knew I would not have the teeth of a 20 year old but did not know I had a cracked tooth. He aslo noticed some grinding and erosion on the back teeth possible caused by acid reflux. Wow! After 20 years in practice my dentist still attends conferences, meetings and keeps up on TMJ issues. I always had respect for this profession but did not fully understand the life long impact it has on our health. Keep up the good work!

Debra said...

Thanks for sharing this post to us. This is really informative about selling dental practice. Keep posting.

Angela said...

Such a great and informative post. Thanks for sharing this to us and keep posting.


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