Wednesday, January 27, 2016

Dental Journal Guilt

I suffer from dental journal guilt. My suspicion is that most of you do, too. Symptoms include that sad look on your face when you see the pile of unread journals sitting on your desk. Each month, the pile seems to grow. A second symptom is reassuring yourself that you’ll get to them “someday.”

On that rare occasion when you actually open a journal, you tell yourself, “This would be a good article to read.” However, this thought quickly disappears as you struggle to read the abstract at the beginning or the conclusion at the end of the article. Either you start to nod off or your mind wanders. Adding to dental journal guilt is the fact that we all have “that” colleague. You know, the one who can always reference the latest research off the top of his or her head. Your colleague always can tell you the name of the journal and the authors of the article.

My conversation with my colleague usually goes like this:
Colleague: “Andy, how was your vacation?”
Andy: “It was great. I was in Vegas with a cocktail in one hand and a pair of aces in the other.”
Colleague: “Mine was great, too. I spent it catching up on my journal reading.”

Yup, you can just feel the guilt building up — just like that pile of unread journals, you might say. In my years of practice, I’ve only come across three known cures for this type of guilt. I will offer them to you in the hopes that your guilt will be reduced:

Read them: I, of course, have no firsthand knowledge about whether this treatment is effective. I’ve heard that dental journal guilt is cured by actually reading dental journals. But, I wouldn’t know.

Toss them: Think of it as a yearly cleansing ritual. Believe me, there is a great sense of accomplishment that comes with finally clearing your desk of unread journals. You’ll congratulate yourself and be amazed by how much bigger your desk looks.

Publish an article: I’ve been fortunate to have been published in the AGD’s newsmagazine, AGD Impact. Want to guess which publication I actually have read? I have found this treatment works so well that you will find yourself forcing your friends and family to read the publication that features your work, too. You’ll willingly carry a copy of the publication with you in your briefcase. As an added bonus, the next time you meet with “that” colleague, you will finally be able to reference at least one author and publication name.

Andy Alas, DDS

Monday, January 25, 2016

New Year’s Resolutions

As I write this, it’s one week after the first day of 2016, and I’m still thinking about my resolutions for the year — or, I should say, I’m still making my resolutions. My first one, obviously, should be to stop procrastinating. If there was a rating for procrastination, mine definitely would be five stars. In fact, nearing the end of 2015, I decided I wouldn’t make resolutions for 2016, because I usually have made them in the past and haven’t followed through with them.

But now, I realize that I have actually completed (mostly) one of my annual resolutions. It is one many people make each year — to lose weight. I have lost more than 60 pounds since September!

I thought this was worth sharing, because I took an approach that some people would consider extreme and that many may be considering. I decided to have gastric bypass surgery, which was performed Sept. 26, 2015. Like most of the people who decide to go through this procedure, I had yo-yoed up and down for years trying various diets and types of exercise to lose weight. Usually, gastric bypass patients have other comorbidities, such as diabetes, high blood pressure, high cholesterol, and sleep apnea, among others.

In my situation, I was concerned about my sleep apnea for which I used a continuous positive airway pressure (CPAP) device, and I started taking blood pressure and cholesterol medications about two years ago. In the group-orientation meetings that the clinic holds for patients, I heard convincing evidence that this procedure could be great for me both short-term and long-term.

My weight loss is above the target for this time after my surgery, as the goal is to lose the computed excess weight in 12 months. So I am making above-average progress. I also am off both my high blood pressure and cholesterol medications and can get a good night’s sleep without the CPAP device. I have adapted to the changes in eating habits, and now have no restrictions on what I eat. I am physically restricted from overeating. My energy level is great, and I’m looking forward to buying a new wardrobe in about three months.

What I see as the greatest benefit from this procedure is what is does for patients with diabetes. Within a short period of time, and in most cases in just a couple days, they are taken off their diabetes medications, including insulin. The surgeon told us of one patient who was diabetic, but only slightly overweight, who asked for the surgery to cure her diabetes. Because she was not clinically obese, her insurance company would not cover the procedure, but she was willing to pay the $18,000 fee (if only many of our dental patients had this same attitude), knowing that she was the only non-obese patient he had ever treated with the sole aim of ending her diabetes. The operation was a success, and the patient is now a non-diabetic.

My advice to anyone who might be considering this procedure is to first find a surgeon who specializes in gastric bypass surgery and does the procedure endoscopically, as my surgeon does. Open gastric bypass has a history of problems. Secondly, listen to everything they tell you to expect following the surgery regarding normal healing sequela, required diet regimen, and necessary vitamin and mineral supplementation. Third, exercise daily. A minimum of 30 minutes of vigorous walking is all that is required, but you will find that you will be increasing this because you probably will like it. Finally, don’t be afraid to talk about your experience with your friends. At some point after the surgery, your friends probably will notice that you “suddenly” have lost a lot of weight and may be concerned that you have a health problem. My answer has been: “Thank you for noticing! I had gastric bypass surgery to help with my weight loss, and I feel great!” You likely will have more questions to answer, but the conversation usually ends with my friend saying: “Wow, that’s great, and I’m proud of you!”

If you have questions about this procedure or locating a surgeon in your area, I’ll be happy to answer what I can and check with my surgeon for referrals in your location. Maybe the key to completing those difficult resolutions every year is to consider a different approach.

Have a prosperous and happy new year.

Terry G. Box, DDS, MAGD

Friday, January 22, 2016

Give Peace (err…veneers Nos. 7 to 10) a Chance

In my years as a dentist, I’ve learned many things (and there’s a lot to learn in this profession). Learning is a daily reoccurring theme, and I love it. Besides making standard clinical improvements and grasping new techniques, where I’ve matured most in my more than six years as a practitioner is in the realm of treatment planning and presentation. It’s an art form, and I’ve only begun to paint my canvas, but I have a pretty good base established so far.

I have an associate in my practice, and I appreciate everything she does for us, but when I look over her X-rays after comprehensive exams or peek at her treatment plans, I sigh because I can see myself — my younger self. I see that time when I would have tunnel vision of a single surface on a single tooth in one quadrant. Not to mention, the time when I would have forgotten the mantra that there’s a head attached to the tooth. It’s easy to do, and we’ve all been there. It’s a natural growth spectrum we as doctors go through, so I let it slide and have faith the growth will come.

Some of my worst regrets were doing an endo/core/crown on a patient, only to realize afterward that the patient was overwhelmed with the cost of that single tooth and wasn’t able to afford to treat any of the other 10 teeth that needed immediate attention. I no longer do limited exams. If you’re in my chair, you’re going to get the whole shebang. If money is an issue, I make sure to prioritize my patients’ most urgent needs, but I want them to be able to weigh the options to treat a chief concern they have, knowing what’s ahead on their dental radar.

Along those same lines, I’ve expanded my mind when it comes to cosmetic consultations as well — hence, the title of this blog. Again, I use my associate (and thus, me, five years ago) as an example. If a patient presents with a chief concern to fix the esthetics of tooth No. 8, it’s worth it to have a conversation with the patient about teeth Nos. 6, 7, 9, 10, and 11 as well. Give it a chance. Wax it up, and let your patients feast their eyes on what kind of magic you can do. Or they present wanting a lower denture — and I make sure they’re aware that my standard of care is a two-implant overdenture. Steak tastes much better when a patient’s denture isn’t flopping in the breeze (or in the nightstand drawer).

Already too often in my career, I’ve opted to present my patients with the affordable treatment option without giving any second thought to approaching them with the comprehensive, ideal, or advanced plan. And too often, we’ve gotten to the end of implementing an affordable plan, only to have an unhappy patient or a regretful doctor. Your patient will feel special if you give his or her case extra attention to detail — and take the time to explain all options, regardless of cost. You might be surprised at the positive response you get. Hey, give it a chance!

Donald Murry III, DMD

Wednesday, January 20, 2016

Closing One Year and Starting Another (a Three-Part Series)

I am not sure about you, but the months of December and January can be a stressful time for a business owner. It’s a time when we must truly analyze our business, determine if we are providing bonuses, and start planning for the next year — and with a positive holiday disposition. In this and the following two blog posts, I am going to share some of my secrets and strategies to make this process efficient, accurate, and predictable to help guide you toward a successful new year.

Part 1: The Year End

Looking at your numbers.
Every month, I create at least a profit and loss report using my QuickBooks accounting software. At the end of the year, it is imperative to not just look at the month of December, but also to stop and evaluate the entire year. Pull a snapshot report, and look at trends. These are some that I follow: an income and expense trend, a previous year income comparison, a previous year expense comparison, and an expense breakdown. These reports are simple to read and will provide you with a greater understanding of how your business is doing. Did you make your goals? Did people stay within their budgets? Go back, look at your strategy for the previous year, and see how things truly played out. Make sure your team is pulling reports for you, and hold each team member accountable for doing so. I encourage my clients to do this routinely throughout the year, but if that isn’t possible, this is the time to follow up.

Looking at your team.
We complete annual reviews for our employees on the anniversaries of their employment start dates. At the end of the year, I assess if we made our bonus goal and decide who gets how much of a bonus. This is all based on the figures I calculated at the beginning of the year, and their portion is determined by how their performance throughout the year helped us reach our goal. If we didn’t make it, I decide whether staff get a “holiday bonus,” or not, and if so, how much. We have had some amazingly productive years and some where we just made the mark. Regardless, I feel that my team always has done its part to help the practice grow, so I give holiday bonuses. No matter how bad the year is and how much pressure you feel like you are under, December is not the time to cheap out. Make the month special in some way — if not with money, then with a special event to celebrate everyone’s hard work! If you are having a hard time awarding a member on your team, maybe that’s a sign that he or she shouldn’t be with you any longer.

Committing time to review.
Each December, I go on a date with my QuickBooks accounting software to a coffee shop to complete the tasks that I discuss above. While finding the time to do this around the holidays may not be easy, the peace of mind of achieving clarity when it comes to understanding your business’ finances is priceless and an absolute necessity for success.

Be on the watch for my follow-up blog posts to complete this series! Happy 2016, and best wishes to you, my colleagues!

Pamela Marzban, DDS, FAGD

Wednesday, January 13, 2016

Am I My Brother’s Keeper?

I had an interesting conversation with my assistant last week that I want to talk to you about.

Let me first tell you that I have almost no turnover in my office. I have an assistant who started working for my dad when I was 9 years old (that is a 37-year tenure). My other assistant has been with me for more than 19 years. My front desk superstar has been with me for 16 years. My hygiene team has been with me for nine, seven, and five years.

I would say we mostly are a pretty tight group. I have one assistant who feels like she can talk with me. She can tell me what the vibe is in the office, and she can tell me when I am being difficult to work with.

Here is a little more information before I tell the story: I worked with my dad for 18 years before I bought him out about 2½ years ago. We use to make fun of him because he was always wound up so tight. He always would talk about production and stress out every week when it came to paying the bills. This stress would be his personality. He would not be very fun to hang around, and it would show in the way he would do dentistry.

The other day, the assistant who is comfortable talking with me sat me down and told me how I was becoming in the office. She told me that I am starting to become my dad. She was not saying that she didn’t like my dad, just that I am taking on that personality—the one that drives someone to work hard, not be appreciative, and be no fun.

In my office, we have production goals. If we meet certain, very attainable goals, my staff can make a $200 bonus per person, per month (and I pay the taxes for the bonus). There is no crazy formula; it is not based on collection (we collect 98 to 100 percent anyway), and there is no performance grade. I think last year, we made our goal 10 times.

Our office is doing very well. But my staff members see this: that our office did “X” in production for the year. They know that an average office will run about 75 to 90 percent in overhead after everyone is paid. So they know the ballpark figure of what I make.

They also know that two of my four kids go to this school that costs more than their salaries (they know because I complain about it all the time). They know that I am trying to pay down debt as fast as I can. (Because I say that too and tell them we will have an awesome party when the office debt is paid off.)

I am pushing everyone to work hard, complaining about openings in the schedule, and complaining about no-shows, but to them, it probably seems to be a bit of the “rich getting richer.” And when the rich get richer, is a small bonus at the end of the month enough?

I have always been this fun-loving person. I have always been fun to work with and for. The office is doing so great. It is like a well-oiled machine. We have been so blessed to do what we do. People really like what we are doing here.

But I have to admit that this year has been hard.

My home bills are at an all-time high (and I mean high). We do not have consumer debt, but my household has a lot of output, which puts major pressure on me.

So the question I have for you: Am I my brother’s keeper? What do we owe the people who help us?

Are you a person who believes, look, I take all the risk; I took out the million(s)-dollar loan to make this happen. The profit is mine. Do you believe their job has no risk and that they get their salaries and bonuses, and what else do they want? Or maybe do you feel like whatever you give them will never be enough? Do you believe they are half of what makes this thing successful, and I will give them more of my take because they deserve it?

Regardless of how you feel, I think this is worth discussing. I will try to be less of an ogre at work. I want to be easier to hang around and more fun. I will try to get my house in order so I don’t have to be THAT GUY at work. I am going to work hard at making my staff feel appreciated.

Tell me your thoughts. Have a great day.

John Gammichia, DMD, FAGD

Monday, January 11, 2016

I’m an AGD Blogger

So now I’m an Academy of General Dentistry (AGD) blogger! John Gammichia is probably screaming in anguish over the thought that I’m now a coblogger with him! Actually, I bet his anguish relates more to the pathetic performance of Florida in the Citrus Bowl while Ole Miss dominated in the Sugar Bowl. But I feel for the poor guy.

How about a little insider’s history?

A long time ago, in a galaxy far, far away, I was actively involved in organized dentistry and had accepted an appointment to serve on the Communications Council of our illustrious AGD. The council was later reorganized, and I found myself one of three dentist members of the Technology Council.

My knowledge of technology at the time was slightly more advanced than my parents’. I could turn my computer on. I could reboot it for any and all problems. And I could use “the Google.”

Our committee chairman was a brilliant dentist from New York who was so full of ideas that his ideas had ideas. His Friday afternoon phone calls to the AGD IT director in Chicago were legendary. Lemme tell ya, IT guys love it when dentists call in with 27 things the organization can do just before they leave work. But Stephen Akseizer, DDS, MAGD, was passionate, detail-oriented, and blunt. I came to love the guy.

The third member was this young-ish, energetic Gators fan from some place in Florida I can’t pronounce. He was much more technologically advanced than I because he knew what blogging was. He knew what the term meant, at least. I’m not so sure he knew what blogging actually involved from the time and idea standpoint, though.

Anyway, John Gammichia had this idea of a blog as a way to make the AGD more relevant to younger dentists. He figured that since he was young (at the time) and could write about the challenges particular to the young dentist, it would be a way to promote the AGD to an oft-overlooked segment of the dental world.

I mainly remember him causing lots of hand-wringing among the professional AGD staff. I remember eagerly looking for his posts and getting a kick out of his personal honesty about his practice or staff or kids or movies or whatever. In those early days, I would post a comment just to see if we could get some traffic. I think now we call what I did trolling. He would write about his staff, and the posts sometimes would draw mixed responses. The AGD staff would worry about whether something was appropriate or not. I was always of the opinion that “hey, it’s a BLOG! What do ya expect? We wanted an honest perspective, and we got it!”

Somehow, I got off the blog mailing list and haven’t seen any posts for a long time. Accepting this gig has prompted me to go back and check out what others have written. I’ve got to say, I’m very impressed! And humbled! This Andy Alas guy writes like I think. Terry Box is talking about burnout in a way that I can relate to. Larry Stanleigh had a good one about hiring staff. Plus, he’s got all those letters after his name!

And John Gammichia is still active! And he still writes! And he still has that funny, beautiful wife and that litter of kids!

I’m not so sure what I’ll bring to this besides the perspective of an old-ish, near-burnt-out, seen-it-and-heard-it dentist who just wants to see his patients (98 percent of whom he loves) and aggravate his grown kids and play his guitars and try to fish, etc…. I’m also looking forward to trolls trying to bait me into battle!

If you’ve made it to this point of the post, let me go ahead and say “thank you.” Thank you for offering me your time and attention. Time is becoming more and more precious, and if you’ve spent some of yours reading what I’ve written, then I owe you a huge debt of gratitude. I won’t take that lightly.

See ya next time!

Bruce M. Scarborough, DMD, FAGD

Wednesday, January 6, 2016


My father was born in 1920. The oldest of three children, his father was a shoe salesman in Toronto. In 1936, in the middle of the Depression, with the family shoe store failing, my grandparents told their 16-year-old son upon finishing Grade 10 that they could not continue to afford for him to stay in school. Angry and rebellious, my father and a buddy of his bought a car and travelled to California.

With nary a dollar in their pockets, they shot pool and hustled their way across America. My dad was a smart guy, skilled with a pool cue. They had an amazing adventure. My father left as a teenager filled with dreams and returned as a man with a greater sense of the world. He ended up working for his father in the shoe business, eventually falling in love, marrying my mom, and starting a family before the beginning of the Second World War.

Growing up in Toronto, I learned that my father had wanted to be a lawyer but never finished high school—because he never had the opportunity to do so and realize his dream. Starting in 1940, the first of his 13 children over the next 19 years would be born, and he had a family to support. Higher education was not part of that equation. But when he had time off, he loved to read books: biographies, business books, fiction books, political thrillers, and science fiction books, he loved them all. The rise of paperback books in the 1940s only exposed him to more opportunities for inexpensive entertainment. And as the years went by, many of those paperback books had been kept in our basement “library.” I shared my dad’s love of reading, particularly of science fiction books, when I was a boy and early teenager, and I loved that connection with my father.

My father died suddenly, at age 57, when I was only 18 years of age. Due to a series of unfortunate events, we lost everything, including the home I grew up in, and we moved into a rental apartment. We packed up all the old books and stored them in a neighbour’s garage until we could have a bigger place. I managed to grab a small handful of some of the books, particularly the science fiction ones. When our neighbour’s garage suffered a terrible flood that destroyed all of those books, the few that I salvaged were all that remained of my father’s old “library.”

I too had a dream of a higher education, but my family could not support my pursuit of higher education. Fortunately, it was no longer the Depression, and we had lots of resources to allow me to get that education. Between student loans, grants, and bursaries, I managed to get two degrees before finally reaching the path toward my dream career by gaining acceptance into dental school at the University of Toronto. Clearly out of money, I joined the Canadian Forces, which paid for my education, and upon graduation, I was sent to Calgary, Alberta.

When my contract ended, I worked as an associate in a shopping mall dental clinic. I worked open mall hours, all year-round, and when the Christmas holidays rolled around, as a member of the Jewish faith, I told my Christian colleagues to take Christmas off to be with their families. I told them that I would work and requested a week off of my choosing some other time. Everyone was happy with this offer, and for four years, I worked between Christmas and New Year’s, manning the “fort.” And in those weeks, I went for walks, I read books, and I twiddled my thumbs; people tend to not want routine, preventive dentistry done during the Christmas holiday period. I saw a few emergencies, the odd student home for the holidays needing to get work done, but largely, it was unproductive time.

When I purchased my own general practice from a dentist who had retired, I decided that between Christmas and New Year’s, the best place for my team to be was with their families. For 22 years, I have taken the week off between Christmas and New Year’s and have referred any emergencies to the shopping mall dental clinic where I used to work. Everyone has been happy with this arrangement.

And for me, taking time off means taking the time completely off. It’s my time to kick back and pick up some books. And I like them all: business books, biographies, sports books, political thrillers, and, my first love, science fiction and fantasy books. We’re doing some renovations to our basement, and before we packed up the contents to put into storage, I chose a couple of those old paperbacks for me to read during this holiday period. And now, at age 57, I am reading some of the books that my father read so many years ago.

These books may not be the height of literature, but they are an entertaining way to pass some time, relax, and stay connected to my dad.

May your days off never be a grind.

Warm regards,

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


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.