Ethics during tough times

It's Friday, and I have had a tough week. Not tough like I am crazy busy but more emotionally draining. I think if I'm not that busy at work, it is really emotionally draining. So I got a lot of that stuff going on. And the Magic lost.

I am not that busy at work, and people have come in that have challenged my ethics. I want to talk about a couple of scenarios that have I had to deal with this week.

Here in Orlando, I deal with a lot of snow birds: retired people who have two homes. They have one home in the South for the winter and another home in the North for the summer. Great people for the most part. A little tough because you are not their only dentist, but for the most part, they are people with means and that makes it a little easier to say, "Hey, you have a cavity. We should fix this." Most of the time they say, "No problem. When?"

But I saw a woman yesterday and we were replacing an amalgam filling that had a hole in it. Then she had some decay on the incisal of #26 and a small cavity on the facial of #11. I told her that when people "mature," their teeth nerves get smaller and sometimes they don't even need anesthetic. I told her, "Why don't I start and if you have any issues please let me know." She was game.

The facial on #11 took about 2 minutes, the incisal took about 4 minutes, and the MO took about 12 minutes. After all the talking, after the fillings, all the saying goodbyes for the winter the max amount of time she was in my chair was 30 minutes - tops.

Now, in the talking time of this appointment, we got to talking about the cruise she was going to go on next week. I talked about how I am looking forward to the days where tuition for the kids, school loans, practice loans, and mortgages don't consume my thoughts. I am looking forward to being able to take my grown kids on cruises.

She then goes on to tell me that her and her husband love cruises and one time she paid for all her kids and her grandkids to go on a cruise - THIRTEEN PEOPLE in all. So, although you would never know it, this was a woman of significant means. Back to the 30 minutes in my chair. You are thinking, "What is the dilemma so far?"

Well, my one surface anterior restoration fee is $160; she got two of those. I then did a three surface posterior restoration which, in my office, is $280. If I charged her full fee this is a grand total of $600. For 30 minutes of my time? To me, this is too much. Some people might say, "This is what she got, this is what she is going to pay for."

Not me. I can't stomach charging someone $160 for something that really only took me 2 minutes to do. I know. I used products to clean the room, I used the same amount of bonding materials, but I don't want people to feel ripped off here. So she was going to pay for her and her husband's cleanings, her and her husband's x-rays and exams. So really if I charged her full feel, she wasn't going to notice because it was going to be expensive.

I just couldn't do it. I think I charged her the full fee for the posterior restoratio,n but only $100 each for the two facials. I took off $120 of the bill. Her total bill was $980. AND I am just finding out now that my front desk person told her how much it was going to be (full fee) before we started. So, she was even prepared to pay the whole thing. Arghh!!!

I still think I am ripping people off if I charge someone $160 if it literally takes me two minutes. But $120 more for the day would really be nice, especially if I do it 4 times during the day.

What do you do? Is it full fee regardless? Do you feel the same way as me? Let me know. I don't think I am devaluing myself; I just think I am being fair. Kind of the way I want to be treated. Like if you go to a mechanic

(definitely the sphitzer valve)

and you know that it doesn't take very long to do X but the book allows them to charge 2.5 hours of labor for that X. Just because you can charge something doesn't mean you always have to.

Okay, next one. I am a tooth saver. My Pankey training has brainwashed me to always thinking of ways to save a tooth (that can be saved). Now a guy comes with a tooth that is broken off at the gum line. The tooth could have been saved. But you know as well as I do this is some major dentistry.

He just got a new job and is going to be getting insurance soon. I start telling him how much it is going to be to save this tooth: $850 for the root canal, $375 for the post and core, $1150 for the crown. I am thought this was a ton of money for this guy, so I told him that I could put him on antibiotics until he gets his insurance stuff squared away with his new job. I just wanted to help this guy, but wouldn't just taking his tooth out be helping him too?

In last 10 years or so, I have softened my "not taking teeth out" stance. I have died on that hill before and I feel great about it. I have told people that they are at the wrong office if they want that tooth taken out. Some have actually gotten up and left and others have tried to save the tooth.

But $2400 could have been a month's worth of pay for this guy. He had missing teeth in two other quadrants. I think it can be done case by case. I don't think that prognosis on this tooth would have been excellent. It would have been good, but not excellent. Is it okay to just take 15 minutes and take this tooth out? He thought about it for a sec and decided to have it out, and I was okay with this.

I feel like I educated him on what his issue was, on what we could do, and on what would happen if he took it out. I let him make the decision. I took the tooth out.
I don't think I am selling out or doing him a disservice. I think I met a guy where he was at.

What do you think? Any Pankey guys out there who are shaking their heads at me?

Okay, that is it for this week.
Have a great weekend.
john

Rich people

Hey all,

I was talking to a friend the other day who owns a retail store. He was telling me that an unassuming customer came in, saying she was referred to his store by a friend. She started walking around pointing at things saying, "I want that. I will take that. I want three of these."

My friend didn't know how to take this person. Like I said, she was unassuming. She wasn't wearing the $15,000 Rolex, she didn't have the latest Coach purse. She didn't have any bling of any kind.

This woman was getting ready to drop $10,000, at his store he started think, "What is going on here?" (Do you ever get that? Someone comes in and says, "Money is no object." When I was a young dentist, I would just salivate when someone said this. Now when someone says this, I think it is bulls@#$%^t. Money is always an issue. I had a professional boxer that made over 5 million dollars a fight complain about the cost of my crowns. When someone just comes in and says, "I want 8 veneers on the top and 10 veneers on the bottom," usually I tread very cautiously.)

Turns out, she was totally legit. She is the wife of a famous athlete. But this got us talking about rich people's tendencies.

I set my office up so that lots of people will be comfortable here. I think the blue collar guy would really feel special here and the mega-rich will also feel like we are what they are looking for. The rich do come in, and almost 99% of the time, I love them. I don't love them more than the blue collar guy because most of the time I don't know who is who. But for the sake of this blog, let's talk about the 1%.

I think there are usually two types of rich people (with some sub-categories). The one that I described: the rich person that wants everyone to know. Bling everywhere. Rolex, Coach, David Yurman, fancy cars, nice clothes, never going out of the house without looking like a million bucks. It seems that these kind of people want everyone to know they have money. In fact, they will spend most of their money to show off. They have most of their money in stuff and not in the bank.

Then there are the millionaire-next-door rich people. Rich people that you would never know are rich. Drive Ford trucks, have one wedding band (no diamonds, just a band), no bling, nothing on their person that would give it away. They mow their own grass. They eat at home all the time and bring their lunch to work. And the main thing is they save, save, save. These people don't want anyone to know that they have any money. All of their money is in their bank accounts not in stuff.

Maybe there is a third category, people like me. People that make a lot of money but have not much to show for it and don't have anything in their bank. I am saving (but it doesn't seem like a lot). We do eat at home a lot, and I bring my lunch to work everyday. But it seems like most of my money goes into tuition for the kids, my student loans, my home or my practice loan, gas or food.

Now listen, I am not knocking any of these. I am just telling it like it is. Look, my wife and I both have Rolex watches (though we don't wear them) and I have bought her some serious bling. I am kind of the Ford Truck kind of guy too. I think I am more of the save, save and save.

But, back to my discussion with my friend. Rich people have tendencies (as do many groups. They all have the same tendencies; I am just picking on the rich today). Some day, I want to be the rich guy everyone likes. I want to roll up in my modest car to the Ritz and tip the valet a $20 because I can (and to make up for all the $1 tips I gave all his colleagues in the past). I know it would make his/her day. I want to ask nicely for things. I want to be able to bless people. I want to be able to bail my church out of financial trouble. I want to be able to afford the nicer patio furniture (I got my set at Wal-Mart for $350, but the one I really really like was $5800). I want to be able help my kids with their kids' tuition. I want to be able to take my kids and grandkids on a cruise.

I don't want to be a pain in the a$$. Speaking of PIAs... Sometimes, people can be real PIAs. You know, they just come in wanting to be served. Sometimes people that are rich have unbelievably high expectations. They want to be called an hour before their appointment so they won't forget. They don't want to wait for any reason. They want the nitrous mask to be on and waiting for them. Their home care stinks and they can't believe they have decay, but then they get bent out of shape when an impression doesn't come out. They think those crowns will last forever. And every time you do a procedure, there should be no post-op sensitivity or issues of that matter. Treatment plan can't be $1 over than what is on that piece of paper, either.

Oh, and we need to work around their schedule. Now I have always said we want to be the Ritz around here but... And we are a service industry but... Some people are a little more demanding than others. Do you find that people with money are a bit more entitled and have very little patience for less than ideal results?

When someone comes in that is unassuming and has heard great things about our office and wants what we have to offer, this person is solid gold. And you know what? I tell them so.

They get educated; they ask intelligent questions. They follow through with appointments. They give grace. They are thankful. And they are happy to pay for the service. No comments under their breath (even though the tires on their Lexus cost about 50 times the cost of a cleaning).

SOLID GOLD, I tell you. So I would say to Mrs. Gold, "You know Mrs. Gold, I absolutely love having you as a patient. When you come in you light up the room. We have fun with you. I truly appreciate you as a patient. So, if you think about it, please send your friends here because a practice full of people like you would be so awesome."

The PIAs don't get that. I smile when they are here. I do the best I can. I try my best to make them less sour.



I think I have rambled enough. I was all over the place today, but I know you guys will give me grace. How is it with you? Got any gems for us? Let me know.

Have a great Administrative Professional's Day (Oh, you forgot? Well, 7-11 is open 24 hours.)

Talk to you on Friday,
john

Moving!

Well, this is my fourth official blog and I have not gotten yanked by the boss or anything, which is good. Let’s see if I can make it a few more.

As many of you might remember, I was in the Navy as a dentist for seven years. I remember when people would hear I was a dentist and would day “Oh you must be rich!” In many ways I was but, as a military dentist, not financially. During that time in the Navy, I was relocated five times. We never lived under the same roof for more than two years. Always moving became the norm. Gainesville, Fla to Ponte Vedra Beach, Fla, to San Diego, then to Washington D.C. Next stop, Camp Lejeunce, N.C. and finally home to Ocala.

When my wife and I decided it was time to take my skills to the civilian world, we decided to build our next home. We knew it was not going to be our final resting place; we tried to build a nice but modest home. Getting out of the military as a dentis,t my salary dwarfed in comparison to most of my friends in private practice. I still had no clue or concept of my true earning potential in the civilian world. Frankly, I was nervous, anxious, maybe even scared about if I could make it in my view of the dog-eat-dog world of dentistry outside the military.

It was the same feeling I had going from high school to the University of Florida. All my teachers told me the first two years at UF were weed-out years when they would do everything they could to flunk you out. My response was the same to both situations: I worked my tail off and never gave up. I have been out of the Navy for five years, and feel I have been successful in many ways. I share a great practice with a great partner. I have many great PAYING patients and many more wanting to join them. The financial side of dentistry has been better than I thought. I do work five times as hard as I had to in the military, but the rewards are there.

Back to the house situation. My wife and I have been saving money to try to save up for a larger home closer to the office. We had a third boy about sixteen months ago. The home we were previously living in is nice but it just seems like it has gotten smaller over the years, especially with three boys running around now. We started our hunt several months ago and finally found a great deal (short sale = their loss, our gain), less than a mile from the house. It is a beautiful larger home, really almost our dream home. We took the plunge, and with the help of my Veterans Administration Certificate and some luck, we got the house. I built our previous house during the real estate boom; I am upside down in that house now and cannot sell without a big loss. We decided to rent (finding a renter is a blog in itself) and we found a nice young family.

Wow. I had forgotten what a pain in the @#$ moving is, especially now with three kids. It is amazing how much more stuff you accumulate with kids. In the military, I would get a few paid days off work to move, but not anymore! I hired some movers and did the rest myself. Having to do dentistry during the day and moving in between can make for a very long day. We finally got all moved in and we had to do some work on the house. I like to ask patients to help. I like to give back some business to them but this does make me a little uneasy in some situations.

For example, we had a patient come to the house for a job. Towards the end he gave me a joking comment. However, I think there was some serious undertone to it. “I guess the cost of my next crown is going to go up to pay for this house.” I laughed it off, but it really bothers me to think people would feel that way. Like many of you, I took out student loans, busted my butt for 10 years in post high school education, served in the military, and still work my tail off to do the best dentistry and take care of patients the best way possible.

I do not know why I feel guilty or bad when someone makes that sort of comment. Oh well. I guess it is another burden I must deal with and continue to struggle against. When I think of this beautiful home, I also think how blessed I am to have these great patients that trust me to take care of them the best that I can. This is also due to the fact that I have had great mentors - professors, colleagues, parents, family and friends - that have given me the knowledge and skills to meet my goals.

Dentistry has allowed to go far beyond what I thought I could do with some hard work, and along the way, to help others as well.

And I do not plan on moving ever again, if I can help it.

Have a great week!

Joseph C Joyce, DMD, MS

Home Depot (con't)

Today is Good Friday. Are you supposed to say "Happy Good Friday?" Because I don't think you are supposed to be happy on the day you are remembering Jesus being crucified. But, I digress.

By the way, I did write a blog last Friday, but the AGD folks thought "not everyone would think it is humorous." So today, I hope I won't offend.

I watched a couple of movies this week. "Happy Tears" was a waste of two hours of my life. I don't know where I got this movie. And I watched "127 Hours." Now this was a good movie. This was about the hiker kid that got stuck trapped out in the canyons and had to cut his arm off to free himself. The cutting of the arm off was a bit gory, but I thought it was really good. I think I get "The King's Speech" next, and I am really excited about that.

Okay, back to Home Depot. I got a comment from a person that works at the Ritz. The Ritz is something that our staff talks about all the time. Not about its opulence, but about it's service. The Ritz is willing to go to that next level to serve people AND the customers are willing to pay for it.

Here are a couple of things that I have been thinking of for the last couple of days. What is it that Home Depot offers that has us running to them?

For me, it is their return policy. I buy something and I don't need it, no problem. If I open a package and realize it was the wrong thing, no problem. If something breaks or doesn't work like I want it to, no problem. If I break a pot taking it out of my truck, no problem. How about this? If I buy a plant, and after 6 months I kill the plant, no problem. Bring that sucker back for a full refund.

You know why Home Depot can get away with this? They have all the power. They take all those things that you bring back and they push it off to their vendors. They don't even lose money on the deal. The give it to the vendors and they get a full refund. If they vendor doesn't like it, well, tough. I mean we are talking Home Depot here. Why do you think Costco can get away with it? As a vendor, you do NOT want to lose the Home Depot account.

Now, what happens to the mom-and-pop garden center when the plant dies? They know they are competing with Home Depot for this person's business. What really happened? The customer took it home and didn't take care of it, so it died. That would be like someone getting a filling done here. They don't brush it, they eat candy and then, after 5 years, the filling fails. "Uh, Dr. John, are you going to stand behind your work or not?" Uh, no. I am not.

But anyway, the mom-and-pop garden center takes it back and give the customer another plant ,and then eats that plant. They don't have power over the vendor. "Shoot, the mom-and-pop store buys 100 plants from us a month. Home Depot buys 100,000." The vendor laughs at the mom-and-pop store when they try to muscle them.

What about the broken pot? Eaten by the mom-and-pop garden center store. The opened package? Eaten. What if the product breaks? Eaten. At every turn, the mom-and-pop garden center takes a hit.

The thing that mom-and-pop garden center rest their head on is integrity, knowledge and service. And what Home Depot rests their big fat rich head on is price. And each will try the other thing; Home Depot tries real hard to fake service and knowledge. The mom-and-pop garden center will try their hand at lowering their prices but...

I don't think it works out very well either way. Yy friend (the owner of the mom-and-pop garden center) told me he was in Home Depot getting something and he started to help a customer because the Home Depot employee didn't know enough to help them.

I am that mom-and-pop dental office. I don't normally drop my prices, so I would say I have to hang my hat on service. We have to do it well. But what is service?

Having an office that looks good, inside and out. Doing great dentistry that doesn't hurt (because that is what the customer knows). Treating someone that way that you would like to be treated. Calling to confirm. A courtesy call after the appointment to let them know you care. A hand-written note on their anniversary. Things like this. It all, hopefully, keeps people from going to the Home Depot of dentistry. Think about that.

Okay, I would be remiss if I didn't talk about Easter. Today, especially, is a very somber day. I, growing up, didn't fully accept what Jesus had to go through today.
He knew it was going to be bad. He knew he was going to get spit at and punched and kicked and whipped. And He did it willingly.

I am studying Isaiah right now, and it is kind of cool that Isaiah talks about Jesus 400 years before he is born. Isaiah also talks about Good Friday. In Isaiah 52, it talks about how he was beaten "beyond human likeness." But Isaiah 53:5-11 talks about what all this means.

"But he was pierced for our transgressions, he was crushed for our iniquities; the punishment that brought us peace was on him, and by his wounds we are healed... He was oppressed and afflicted, yet he did not open his mouth; he was led like a lamb to the slaughter [if you know anything about lambs, they will get sheared and never make a sound and then killed and still never make a sound] and as a sheep before its shearers is silent, so he did not open his mouth [he did it willingly]... Yet the Lord's will to crush him and cause him to suffer, and through the Lord makes his life an offering for sin, he will see his offspring and prolong his days, and the will of the Lord will prosper in his hand. After he has suffered, he will see the light of life and be satisfied; by his knowledge my righteous servant will justify many and he will bear their iniquities." [All written 400 years before Jesus was born... pretty cool.}

After today, we look for the empty tomb, because HE is risen. Conquering death and opening up the gates of heaven (really being our intercessor so we can hang with God).

He is risen. He is risen indeed.

Have a great weekend. Happy Easter.
john

Home Depot

The idea of this blog came about because of my wife. She now is going full-on organic. She feels like there are too many hormones in milk and thinks eggs... Uh, don't get me started.

Now we are buying milk and eggs straight from the farmer. There is a guy who pulls up in a parking lot and pulls jugs of milk out of a cooler and she is buying them. She says the farmer controls what the cow and the chickens are eating. So yes, now we are buying ground beef from Mr. Farmer; the label says "grass-fed only."

I don't know how you feel about all this stuff, but my wife and her friends feel very strongly about it. I am pretty ambivalent. But one thing she also talks about is helping the local growers. This I can relate to. Now, I don't want a ton of comments about how the government is a conspiracy and stuff like that.

There are huge grocery chains basically running the small mom-and-pop store out of business. How can a mom-and-pop grocery store compete with Publix (or Kroger or Ingles)? I don't think they can if they are just selling goods.

Let's look at the mom-and-pop garden center (this is very close to home because one of my best buds owns a mom-and-pop garden center). Before I go, on I want to tell you that I LOVE Home Depot. I just love walking through there. I like doing stuff myself. I love planting my own plants. I love hammering things. I love drilling big holes in things and really love power tools. I just get a warm feeling all over when I walk into Home Depot.



But Home Depot is making the old small garden center obsolete. If my friend is just selling plants, he is dead in the water. Home Depot will go to a grower and tell them that they will pay $.05 per plant because they are buying tons and tons of plants (and the grower might not like it, but they are selling tons and tons of plants. The grower makes less and Home Depot makes more.)

This same grower will go to the small garden center and tell them that the cost is $.50 a plant. Home Depot sells the plant for $2.25 and makes a pretty good profit. My buddy either sells it at $2.25 per plant and makes a lot less per plant or sells it for $2.75 and runs the risk of losing some clients because they "can get it at Home Depot for less."

I remember my friend telling me a story about poinsettias at Christmas time. Home Depot was selling them for less than he could buy them at his growers. He told me a couple of times he would go to Home Depot and buy product! (He doesn't do this a lot because he says the quality of the plant just doesn't live up to his standards.)

But you know what? I have stopped getting my plant stuff at Home Depot and I will tell you why. First, I want to help a brother out (kind of like my wife wants to do). But getting past tha, my friend is so knowledgeable about plants and everything that grows. He knows how the temperature at night effects the way plants grow.

He knows that there is a difference between plant fertilizer and flower fertilizer. He will sell me grass fertilizer (so I can do it myself) but he will let me borrow a fertilizer spreader (this is a service to all his customers). He will sell me weed killer for my lawn and let me borrow the spray thingy to put it on my lawn. All part of the service.

If a customer would like him to sit down with them and plan out a garden design, he will do it for them. They sell fountains and, after they sell them, they provide the installation. See now he is not just selling plants; he is providing a service. He is separating himself from Home Depot.



Do you see where I am going with this? This is what we, as dentists, need to be careful of. Medicine is definitely going through this. Hospitals are becoming the Home Depot of medicine. The hospitals want to be a one-stop shop for patients. They hire urologists, radiologists, pathologists, OB/GYNs, internists, and give them a good job. They pay them well and then what happens to the mom-and-pop internist? Gone.

Dentistry has always had the mom-and-pop mentality. But we can't lose what customers/patients really want. They don't want to just buy a plant. They want the plant AND the service. They want us to know what their garden looks like. They want us to know the different types of fertilizers.

But most of all they want us. The smiling faces behind the fillings and crowns. They want our hygienists to know them. They want to talk to a person on the phone.
They want to walk in and hear, "Hi, Mr. Greene." They want to know that we care. They want to know that money is not the reason we are here.

It is complicated. All I know how to do is good dentistry. But you know what? I don't think a patient knows a good dentist from a bad one, just like I don't know a good plant from a bad one. They all look like plants to me. I am pretty smart - if my friend sat me down and showed me the difference, I could surely appreciate the difference. And so can our patients. So show them.

Take a before intra oral photo and then an after. And say, "This is what a good fillings looks like." Then they see good service WITH good dentistry.

Do I still love Home Depot? Yes I do! But I can tell you that, to me, they are just a store I can buy something in. I am not looking for knowledge and/or service. I never see the same guy/gal working there. I am in and out of there in about 20 minutes. [Unless I am in a bad mood and I need some therapy. Then I just hang out in the power tool section for about 15 minutes and then I feel better. If I am really in a bad mood, I will buy something from that power tool section and be on cloud nine for about a month).



But when I don't know what I need and I need an expert, I go to the mom-and-pop store. Like my local garden shop and my local dentist.

I think I will follow up with more comments about Home Depot on Friday. "What do people want?" Do they just NEED a cheaper price? I had a patient today whose child had two cavities in two permanent teeth and she said she simply couldn't afford to get them done. She didn't need service, she needed a cheaper price.

Let's talk more on Friday.

Have a great day,
john

Hobbies

Greetings,

Thanks to all who emailed me about the full moon effect. I am glad I am not alone. If you haven't read it yet, go back to the March 21st entry.

I was going to talk about dentistry today, but got caught up on this topic this weekend. I think everybody needs one!

Whether it's golf, tap dancing, stamp collecting, motorcycles, music, or hunting, I think everyone should have an outlet or a special interest they enjoy doing for themselves. Escaping from the day-to-day grind of dentistry, or whatever your job is, devoting time to a special hobby or interest is therapeutic. I looked up the word hobby in the dictionary, and it says that a hobby is "an activity or interest pursued outside one's regular occupation and engaged in primarily for pleasure." I don’t know about the rest of you, but if I were to bury myself in dentistry every day, week to week, month to month, I would go insane. Don’t get me wrong, I love dentistry, but we all know how stressful it can be at times. Add that to the role of being a father, husband, mother, wife, girlfriend, or boyfriend, and stress or monotony may not make you the friendliest or happiest person to be around.

My hobby happens to be music (even though I have a motorcycle that keeps me living on the edge). My father taught me how to play a banjo and a guitar when I was about 5 years old. He instilled in me the importance of having a hobby at a young age. I believe it’s a stress relieving as much as it is pleasurable. ( this is a photo of our group playing at the historic Marion Theater)

The thing with hobbies, though, is that they can get expensive. Just recently, I went up to Canada to a one-week guitar workshop that was located in the home of the instructor, Don Ross. Wow, what an experience that was. First, you have the price of guitars. You can spend a hundred dollars or thousands of dollars on one. Then you have all the accessories that go along with it: strings, straps, tuners, cleaners, cases, speakers, cords, mics, recording devices, music stands, and instrument stands, just to name a few. And of course, you do have to dedicate some time to hobbies, and fortunately I have a supportive and understanding family that lets me pretend I am John Mayer every once in a while.

One great thing about having a hobby is that you don’t have to be good at it! You don’t even have to make money at it! I don’t have to compete with James Taylor or Eric Clapton; shoot, they don’t even know who I am. I'm in the middle of making a CD right now. You wouldn’t believe what a process that is. It has been a year so far, and I think we have 5 songs recorded.

I can’t wait to talk about dentistry on another day, but I wanted everyone to get a sense of who I am and what I enjoy. I would love to hear about other hobbies people have. If you don’t have one, find something that you are passionate about that makes you uniquely ‘you’. Sure, playing guitar takes time and money, but I am convinced that having a hobby makes me a better husband, father and dentist. And that is what matters most to me. Talk to you soon.

Scott

Scott A. Jackson, DMD, MAGD

How is it with you?

I don't know about you, but I have been really stoked seeing a blog on Mondays, especially because I don't have to write it. I can sit back, read and enjoy.

I've got a funny story. David, my 18-month-old, and I were eating lunch together. I was eating BBQ ribs with a bunch of BBQ sauce and he was eating strawberries and whatnot. Every once and a while, I would give him some pork from the ribs. About 20 minutes later, he was walking around and I saw him with what looked to be BBQ sauce on his hand. We were far from a bathroom or any wipes, so I licked it off his hand (I didn't want him to get it all over everything). It wasn't much, but I noticed it didn't taste like BBQ sauce and wondered what it could have been.

Anyway, it was Monday, so we all (my wife, me and David) got in the van to go pick up the others from school. I was driving and Hilda wass in the back and I heard, "David, you didn't get poop on yourself again did you?"

WHAT????!!!!!!

I am not saying it was poop, but there is this very small chance it was. Just so you know, there isn't any Listerine or Pro-Health left in our house anymore. Oh, the joy of having kids.

Okay, let's get right to it. As I look for ideas for blogs, sometimes I will do a literature review. I usually read AGD Impact and the Journal of Esthetic Restorative Dentistry (half of them are still under my desk in a bag). But this month, because I am low on ideas, I read my state dental association's magazine and skimmed the DentalTown magazine (hey, I get it because it is free).

The magazines have an overwhelming amount have practice management stuff in them. "How to Keep Patients From Going Out the Back Door." "Are You Treating Your Patients Right?" "Where Have All the Patients Gone?" ...stuff like that. It is no surprise that people want to know what the hell is going on with patient flow. They turn to their magazines to find the silver bullet.

Look, we are all going through a rough patch. And, for sure, this is a time to fine-tune your systems. But I don't think this is a time to change who we are. [For the record, I wrote an article for AGD Impact on this very subject. They said they loved it and that was the last thing I heard about it.]

All these articles say the same thing - work on your systems, do great dentistry, give them exceptional service. This is not rocket science, people. Now, if you are like me, practicing dentistry has been a grind lately. I walk around asking each and every staff member what they have done to increase patient flow today. I am becoming kind of a son of a b!@#ch. I know that I am, but I feel like I am the only one that cares if we go bottoms up here. They are all sitting around talking and laughing and I am in the back with a serious case of the butt-sweats, thinking about how I am going to pay the bills this week. I do try to keep a pretty good attitude about the whole thing most of the time.

Anyway, after twelve articles about patient flow, I get to one article about suicide called "What's Your Risk of Suicide?" It talks about numbers and how many people are affected by this. It dispels the myth about dentists being the profession most prone to suicide. Then it talks about how it is with you. Let me tell you about the risk factors for suicide (that I found rather amusing):

-alcohol and/or substance abuse or addiction
-adverse changes in personality or behavior
-signs of depression
-recent adverse life change
(I don't know about, you but I am 4 for 4)
-loss of confidence and working longer hours with decreased productivity
-decreased interest in anything outside the office
-postponing vacations
-excessive interest in prestige and power
-atypical aggressiveness and hostility
(So far, I am still 100%)
-vigorous denial and rationalization
-new lack of organization
-giving away possessions
-use of expressions such as "ending it all"

I haven't taken a test in a long time, but I am pretty sure I aced this one. NO!! I am not suicidal.



But you can see how it would make you chuckle. I think the timing of this article didn't take into account the times that we are in. It didn't see that almost everyone has a bunch of these. I certainly don't mean to make light of suicide (and if you are having a rough time right now and need to talk email me at Jgammichia@aol.com).

Some of you might be going through some tough times right now but... it ain't that bad. We all have good days and bad days. We are all slower than 3 years ago. You are not alone. And if someone tells you that things are going great, they are probably lying. We are in this together. We can laugh together and we can cry together.

How is it with you? Have a great Wednesday.
john

That was a close one!

We have seen a slowdown in our production, as I am sure a lot of offices have recently. Ours is not catastrophic, but it has slowed down. We are trying to figure out trends or issues internally that can possibly lead to increased production. We try all the stuff from internal marketing, recapturing lost production, advertising, anything and everything that could benefit the office. My friend told me about a little "misadventure" that he had trying similar ideas.

He had heard from another office about their wonderful referral program. Here is how it works. You give the referral cards to patients, staff, any old stranger. The cards state that with the referral card and completion and payment for specific treatment (in our case comprehensive exam and full mouth series of radiographs) the referring person and the patient will each receive a gift (in this case, a gift card to a local store). Supposedly it works great for new patients at the other office.

I called my friend up to get more info and this is what I heard. Let's call him "Dentsit Close Call." He told me they were so excited to try it. After a few weeks, it was going well. He said he soon realized one of his patients sells dental insurance and he was getting a boatload of patients from her. So, in reality, she should have been getting lots of gift cards. He started thinking that maybe there could be a problem here.

He knew he had a great office that every patient would love because they would receive high quality care and his intentions were pure and good. He started to think that possibly an outsider could see this as a “kick-back” to the insurance agent for selling policies and referring patients to his office. There could be a real conflict of interest. He has always tried to stay above board and keep things as ethical as possible. He obsesses over this sort of stuff with me and even told me he was awarded the Student Award for Ethics his senior year in dental school.

Dr. Close Call told me he started getting very concerned and talked to another coleague. He said his friend agreed with him, understood his point, and would be equally as concerned. He decided to look at the American Dental Association Code of Ethics. There is a section dealing with referrals and it is a little unclear but this definitely can be viewed as not “kosher.”

Dr. Close Call called a lawyer with his state’s ADA affiliate. He explained to the attorney the situation and what his concerns were, and the attorney dropped the bomb. He told him not only is it against the ADA Code of Ethics, but it is against the law! SAY WHAT?! The attorney explained that even though most dental offices have good intentions, a law was established making it illegal to give anyone a monetary benefit for referring patients. Part of it stems from when all the MRI centers were popping up all over the country. The MRI centers would pay MDs money for sending them patients. Well of course some dumb @$$ took advantage and starting sending people that really did not need an MRI. Poof, a new law.

Dr. Close Call totally understand the intent of the law and what the problem is. The lawyer tokd him that the District Attorney is not running around trying to bust dental offices, but it could still be viewed as possibly illegal in his home state. The attorney also said he knows lots of offices that are doing similar programs. What makes his situation unique is that there is a state certified insurance agent getting what could be viewed as kick-backs, and it would just take one person to complain to the state insurance commission and an entire can of worms (or what I would think could be a can of “whoop @$$”) could be opened up. Dr. Close Call became concerned about possibly paying attorneys to defend him, and this would not fall under malpractice, so it would all be on him. Just trying to do a nice thing, and look what happens. Needless to say, my buddy, Dr. Close Call, told me his referal program has been stopped.

He said the attorney did state that you could reward patients for “loyalty” with gifts as long as it was not specified as a gift for specific patient referrals.
There cannot be any “quid pro quo” system. It is all about the wording.

With issues like these, there is a big advantage to being in organized dentistry and having access to an attorney to answer these sorts of questions. Also, having open lines of communication that allow you to call a colleague or friend to run ideas by and get feedback is beneficial. This time it really helped us. I think this is also what this blog does as well. We continue to learn more and more about issues running an office that do not involve teeth directly.

The next time we decide to borrow a great idea from a buddy, I will call and discuss it with them - and I might run it by an attorney to save myself some future anxiety.

Hope this helps someone else out.

Have a great day!

The Shoulds

One comment. I thought Wednesday's blog was the best blog in a long time. It was thought-provoking, I put in some good photos, I thought it was well-written and funny. I thought the comment lines would be lit up. The comment section is a barometer to me if you are engaging. I have been told by two of my friends that it was great but, just one. Huh.

I will see if I can get you to write about this one. I read an article in DentalTown magazine a month or so ago. (I had to get it out of the trash; I don't normally read it, but I had a friend tell me to.) "A Prominent Dental Disorder: The Shoulds," is written by Doug Carlsen, DDS.

I found it very thought-provoking, and it kind of goes along with Wednesday's blog (that apparently no one liked). He talked about how dentists are cut out of the same mold. We all grow up with "trauma of expectations." And then this morphs into problems associated with issues that involve guilt and stresses to succeed. I know most of you can relate to this. I certainly can (I love you, Mom and Dad). The shoulds begin at an early age. I should get all As on my report card. I should love and do well at sports. I should keep my room clean. I should...

Carlsen talks about how, as we mature, the list becomes bigger and more expensive. I should have a big house. I should live in an affluent community. I should always wear named brand clothes. My wife and kids should represent me well in the way that they behave and appear. My kids should be getting good grades in their private school.

Oh my gosh, this is hitting home to some of us. It is hitting right in the center of the bullseye to me. And, of course, we are giving the shoulds to our children.

How about as a young professional? I should have a successful practice. I should work in an upscale part of town. I should own my own practice within 6 years. I should go to all the hot guru speakers.

Just writing this, my blood pressure is building. I am thinking I am still there. I am still (even after I know that I shouldn't have the shoulds so far along in my career) saying, "I should be keeping up with my journals. I should have already established myself. I should have a staff that loves me. I should have the latest equipment. I should be doing implants or Invisalign."

How about the older dentists? Do you think they are immune? "I should have saved more for retirement. I should find a perfect replacement dentist for this practice before I retire. I should be cutting back my hours. I should have a hobby outside of dentistry. I should be traveling more."

He talks about how the shoulds always lead to blaming others for our perceived shortcomings. Maybe we blame the government, the economy, a spouse, our staff or our parents. And some of us begin to hate our life and job and spouse. Then to deal, we get counseling or maybe go to drugs or alcohol. I like the latter. (this is where I have to tell you, again, that the AGD doesn't condone the use of drugs and alcohol to deal with problems).

Carlsen quotes some experts and then says he believes a balanced family life is very important. He pointed to the Pankey Cross of Life. The cross has four points in it all pointing to the things we should try to balance: work, family, worship and play.

The problem is the our perception of reality. What is important to older folks? As young people, we would think it would be travel, nest egg, I can finally buy a bigger house or other stuff we never could afford. But an overwhelming answer from the older folks is, "I want to spend more time with my grandchildren and family."

(my kids)

WOW!!! Isn't that a huge slap in the face with reality? That is turning my life upside down. I hope it is turning yours upside down too.

Okay, now what? Well, let's take this a day at a time. We are going to try to build our practices or our associateships and enjoy them more. I am going to try to enjoy people more. My patients, my family, my friends. I am going to listen to my older patients more and see what they are like. I am going to talk more to the ones that seem happy.

Had a patient in his mid 80s this week. He is a multi-millionaire. He has NO family. He said, "I have a son and I don't even know where he lives." You don't want to be like that do you?

One day at a time. This weekend and next week, I want you to think about the shoulds. They are not reality. Reality is boring and it doesn't sell stuff. That is where I want to be - boring.

But hey, it's FRIDAY!!!! Now let's go and have a glass of wine or a nice cold beer (this is where I am supposed to tell you that the AGD... well, you know). It is supposed to be 90 degrees in Orlando this weekend. I think I go swimming.

Have a great weekend.
john

How was your day?

Hey all,

I was listening to Dave Ramsey on the radio yesterday and someone was calling about spending money on her daughter. It reminded me of Dr. Scott's Monday blog. This single mother has an only child, a 10 year old girl. And she LOVES to ice skate. Oh, did I tell you she is TEN? This woman spends... wait for it... TWENTY-FIVE THOUSAND DOLLARS on ice skating lessons.

Dave starts to probe this woman, and she ends up telling him that she makes $85,000 a year. Not bad, but she is spending a good chunk of her income to teach a 10 year old to ice skate. Come on, lady.

About 20 people every four years make it to the Olympics in ice skating (and that is guessing high). Take that $25,000 a year and put it in a savings account. You can buy her an awesome house after she graduates from college. Oh, yeah college. You know, the place where people in the real world go to get jobs. Put her in a great school and give her aspirations of becoming a doctor, a dentist (I had to say that), or a veterinarian. $25,000 a year for a 10 year old. Come on, lady.

Anyway, about a month ago, I heard about all the movies up for Best Picture. I put them all on my queue. This week I watched The Kids Are All Right. It had a great cast and I have to be honest - they were very good. I thought the acting was fantastic. Man, is this one for the critics. It had everything they like. Alternative lifestyles, sex, unfaithfulness, conflict. For me, all this was okay but I just didn't think the movie was that good.

I had a great day at work yesterday. I had something else to talk about but this trumps my original topic. I went home just happy as can be because of the day that I had. Let me preface by saying that I pride myself on being happy all the time. Regardless of the circumstances, I try to be at least pleasant. But I don't think I am doing a very good job lately.

My kids are calling me on the phone on my way home and asking me how my day was. I think they are trying to gauge how the evening is going to go. If they don't get me on the phone, they will ask when I come home. "How was your day?"

So I ask you guys, "How was your day?" That is such a loaded question to people like us. What are we really asking? Did you have a good production day? Were you able to pay all the bills today? Do you have a cushion for the bad week coming next week? Did any of your equipment break today? Did you staff get along today? Did your staff give you any grief today? How were your patients? Did they show up? Were you able to get everyone numb without a huge struggle? Is the schedule looking good this week and next week?

For me, there is one thing that makes my day great - my patients. Yesterday, I had great patients. I had a man that broke a tooth and we did a crown. He was a very pleasant man that seemed to like us a lot. My assistant and I banter usually through most appointments. He was totally getting into it. He was laughing, and at every break he would interject with more funny stuff.

The next patient was a woman that had some aesthetic issues and some decay. She kind of got the run-around from her last dentist, and she "just wanted to be able to smile again." I love it when people say that. We did some facials on the upper anteriors and some restorative in the back. But again, she was thrilled to be at my office and she told me so a number of times. And she was so thrilled with the work. Like I like to say, "She was picking up what we were laying down." She liked the way we did things.

I worked on a woman who was dental phobic. I love dental phobics. It is such an opportunity to really change someone's attitude toward dentistry. Sometimes it works and sometimes it doesn't. But when it does work - you know, turning on the charm, trying to be as painless as possible and doing great work - it is really rewarding. And it worked yesterday. She did great and I think she is on her way to liking it here.





Don't forget to double click on the image to get a full-size image.



I heard a lot of laughing yesterday. In my room, in the hygiene rooms, in the staff lounge. It kind of reminds me what I am trying to do here.

And last but not least, I think I did some pretty nice work yesterday. Lately, it seems that the people that come do so because they HAVE to, not because they want to.
Tooth is broken, tooth is hurting; I have to go to the dentist. Not, "I care about my teeth and I like my dentist, so I should get over there."

So what makes my day good? Nice patients that like me. Laughing. Good work and a little money to pay the bills with. That's it. Sometimes I have nice patients that don't have any money. Is it a nice day? If I made tons of money on really mean people, I think this is an empty day. It is not that satisfying. You are not building. You are making money once. You know that patient is kind of lukewarm about you. They may or may not come back in and they sure are not going to talk to their neighbors about you. It is kind of empty. That is the only word I can think of.

But let's not dwell on the negative, because yesterday, I got it all. All my dental moons were aligned. It was really nice. I might not even have to have a great day today because I am riding this high for a couple of more days. I hope this continues, because I finally got to tell my kids that no one was getting a whoopin' today. It was so good I was even ready to give my wife some lovin' last night (too bad she wasn't more receptive to the idea. I know, TMI).


Have a great Wednesday. See you Friday.
john

Volleyball Dad

Well, that was fun. I just got finished doing a MODBL composite on tooth number 14. I went through half of a syringe of caries indicator, about 3 mm of liner for the "near exposure", and 3 compules of composite. Thank heavens for a dead soft band, because I don't think I could have ever established my mesial and distal contacts without it. Why did I do that? Because the patient asked me to try it. I am affectionately known as "the can opener" at work. I can open up a can of worms faster that you can say the word. I will spend a whole blog on my most famous "can opener" moments at a later date.

We just returned from yet another volleyball tournament. This time it was in Tampa, Florida. Let me back up a few months. Sometime in October of last year, my youngest daughter, who is now 16, asked us if she could try out for the travel volleyball team for the county. Not knowing at all what that entailed, we agreed. Later that next month, she tried out for the team and made it. Now, here is the deal. The fee for being on the team is about $1,500, which doesn't include shoes and knee pads (that is about another $130).

When they say travel, they mean travel. Basically, every Friday-Sunday (and sometimes half a day Thursday), from January to May, we have to travel to a different city and sometimes a different state to play in a volleyball tournament. That means, hotel, food, and travel for 3 or 4 days every weekend for almost 6 months! Oh, and we have to pay to watch the games which is about $12-18 a weekend, each. On top of that, there is practice 3-4 days a week for 2 hours at a time. These people are serious about volleyball. After watching them practice and play these last few months, I am really starting to appreciate the value in something like this. The girls are doing better in school, they are learning about teamwork and cooperation, and they are becoming skilled in a very demanding physical sport.

This weekend was Tampa, which is about a 2 hour drive from where we live. The venues change from city to city. This time it was in the convention center. I have never seen so many people playing volleyball. There were 25 courts set up, and the games were going on all at the same time. Supposedly when we go to Atlanta later this month, there will be 180 courts! I can't even imagine that. We even have the packing routine down to a science, which includes ibuprofen for the 25 ref whistles (all blowing at the same time) and an antacid for some of the fast food we have to eat.

This has been my developing thought on this. Your kids grow up fast. It seems like yesterday when my daughter was born, and now she is driving! I always treasure the time I get to spend with any of my kids, because I know one day they will be few and far between. I must admit, when I realized the cost involved in this whole thing, it sort of made me wonder if it is worth it. After these last few months, here is what I came up with.

Volleyball fees: ~$1650
Hotel rooms, food, and gas: ~$3000
Lost revenue being away from work: ~$12,000
Watching your daughter score the winning point in a championship match: Priceless



Have a great week.
Scott

Scott A Jackson, DMD, MAGD

Do you have a friend like this?

Not much going on on the home front, so I will get right to it.

I have this guy in my study club. I like this guy; he seems to be a good guy and I think he loves dentistry. [As an aside, this is the dentist I migrate toward - the guy that likes our profession.] There are still guys in the group that could give a s@#$%t about teeth but come for the social aspect of the study club. I get not wanting to talk about work all the time, but we are there to talk teeth.

This guy is pretty with it. He is my age and is a family guy as well. He was the first guy that I knew that had computers installed in all his operatories, and he installed them himself. I was like, "WHAT?!!!"

He said, "Yeah, I just installed some CAT V wire all through the office. I also put a wireless router in and hooked it all up to my server. But I had to by a 4533 giga watt ram something or other blah blah blah."

I was like "Huh, how the hell does this guy know all this stuff?" I have to pay someone to tell me about the computers, buy the computers, and install the computers and this guy is doing it all himself. And when the computers break down, he fixes it.

But that is just the beginning. He was the first one with a phone that he could pull up his office x-rays on. Not a big deal now, but this was 5 years ago. Okay, so he is computer geek. But see, he really isn't a geek kind of guy. He races his car (that he does all the mechanics on)on the weekends. He is a father of 3 and he has tickets to the Gator Football games. He is always two steps ahead of me (okay, maybe four) on everything with dental stuff. I look forward to seeing him because I get to learn what is hot in his office.

But the thing with this guy is that it never stops. He told me that he was using the Paraject (if you don't remember, this is the interligament injection system). For lower molars, you put the needle in the sulcus and shoot and almost all the time you get ONE tooth numb. It is perfect for lower molars that you are just doing a 20 minute procedure on.

Anyway, it took me awhile to do my research on this thing. Then I bought it. I slowly started to implement it in my practice, and now I love it. I use it all the time. This took a couple of months.

I finally went back to a study club that this guy was at and I told him how much I was loving this Paraject system. He said, "Oh, I don't use that anymore. I am using the X system now." I was squished like a grape.

I talk to my other friends in the group, and they all feel the same way, like they can't keep up with this guy. He is like a walking encyclopedia. He knows everything about everything. About teeth and about cars, about computers, and everything else. We all finish talking to him and just shake our heads.

Like I said, he is a father of 3. When does he have time to hard wire his office up for computers? When does he have time to learn everything about everything? What is he doing reading computer periodicals? Is he a part of a computer geek forum in his spare time? Does he read PCMag? Or surf the PCMag.com website for new things?

So you are thinking, "Sure, he is good at computers. So what? He probably isn't that good of a dentist." I've got bad news for you. We use the same lab and when I go to my lab to talk to my ceramist, I always pick up some models and check out my competition. I see his work and it always really good. Damn this guy.

How nice would it be to to have a computer, have computer problems, and not get to upset? You just stay a couple minutes after work and do a quick diagnostic. Then you realize you are having a problem with the motherboard. You run up to CompUSA, buy the part, and then come back and open up the server and install the new motherboard. Problem solved. Then, on your way home you notice a shimmy in the car. Well, get the thing you lay on backwards and roll up under the car. Of course, you have all the right tools and you fix the shimmy right then and there. "I'm going to need some pliers and some 30 weight ball bearings. It's all ball bearings nowadays."

He probably has huge muscles.


Goes home and mows the grass without a shirt and smokes Marlboro reds and wears a cowboy hat. And he probably has a gorgeous wife and a huge house. And, of course, all the kids get straight As.


Next you're going to tell me he went to Butler for his undergrad studies. Son of a... Butler...

I hate Butler.

Now to me, this would be so boring. I mean, who wants all that? He probably isn't happy. Right? That is what I am going with.

Do you have this guy in your study club? Did you have him as a classmate? Tell me he isn't one of a kind.

Have a great weekend. I am not watching the Final Four. I don't care. I really don't. Just please don't let Kentucky win. Please God, I beg you.

Have great weekend.
john