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

This month’s blog post concludes a three-part series I began two months ago about business leadership and analytics. Part 1 focused on making time to evaluate your business performance for the year end and comparing it with the previous years’. Part 2 shifted to direction: What is the direction of your business? Is it in line with your business goals? Do you need to change course? This final post will focus on business projections.

I have found that most dentists dislike taking an introspective look at themselves and/or their businesses. For example, a simple question such as “What do you want?” can be a struggle to answer. On the flip side, it seems easy for dentists to work with numbers and create the financial goals they would like to reach in the upcoming year. I hope you find these three steps painless and easy to follow as you create your business projections for this year and the ones to follow.

1. Look at your 2015 collections and determine what percentage your business ideally needs to grow in 2016. Many factors must be evaluated in this first step: Are you a new practice? Did you meet or surpass your goal for the year? Are you adding more producers, or are you cutting back your time?

2. Create daily goals for each producer. Once you have established your collection goal, you must determine how much of that collection comes from the doctor schedule and how much comes from the hygiene schedule. Count the number of days each producer works, and divide that by the percent of collection from each department.

For example:
Total collection = 1,000,000
25 percent hygiene = 250,000 / 192 (days working in 2016) = 1,302 daily collection goal
75 percent doctor = 750,000 / 192 (days working in 2016) = 3,906 daily collection goal

Make sure you know which days you will be out of the office for holidays and continuing education courses. The number of working days typically is fluid and changes due to inclement weather or any other unexpected leave occurrences.

3. Create a bonus system. A bonus for your team should be based off collections. If you know how much business growth you want, create a larger goal for a bonus, and share part of that profit with your team. Let’s say your collection goal is 7 percent of last year’s; create a tier bonus system by calculating what your goal would be if the practice grew by 10 percent, 12 percent, or 15 percent. Make sure you compensate your team members for each tier. While most of our team members may not be driven by money, it is always exciting to get a bonus at the end of the year for surpassing your goal. It can create a challenging and fun atmosphere if it is presented and accepted by your team.

With the growth of dental-management organizations, lack of growth in our economy, and increased level of sophistication we see in our dental patients, we must act like chief executive officers as well as doctors. I have seen too many great clinicians leave our profession due to failing businesses. This is not a trend I wish to see grow. I hope this series of blog posts has helped simplify and organize the business analytics that can help keep your practice thriving.

Pamela Marzban, DDS, FAGD

Does Dental School Owe You a Job?

Several years ago, I was asked to serve on an advisory committee for a local dental assisting school. I happily agreed to offer whatever advice I could give.

My only responsibility was to attend a meeting twice a year. The purpose was for me, along with a handful of other dentists, to advise the school on what real-world job skills graduating dental assistants need in order to succeed. This helped the school tailor its curriculum in order to prepare their students with real-world life skills.

During our meetings, the officials from the school informed us that they had a job-placement rate of more than 80 percent within the first six months after graduation. I was impressed, to say the least.

The name of the school? Everest College, a subsidiary of Corinthian Colleges Inc. You may have heard about Corinthian Colleges Inc.’s bankruptcy in the news last year. There were many reasons for the bankruptcy, but to put it simply, it was partly due to overreporting placement rates among its graduates.

As the events unfolded in the news, I could not help but wonder: “Could the same thing happen with dental schools?” In my area, I’ve seen several dental hygiene schools open over the past few years. The result? I get resumes from new hygienists on a weekly basis. I ask them, and they tell me the job market is brutal for new hygienists.

With more dental schools opening, I begin to wonder if dental students could face the same fate.

As I see it, the main purpose of dental schools is to produce dentists — not necessarily employed dentists. Once a new dentist graduates, the school chalks that up as a success. You’ve heard the spiels: “Ninety percent of our graduates pass the boards,” “Many of our graduates go on to advanced studies,” etc. That is great, but does any of that translate to a financially rewarding career as a dentist?

With dental education costing as much as a several hundred thousands of dollars, I believe the majority of dental students aren’t doing this as a hobby. They attend dental school as in investment in their future. Most of us do, for that matter.

So does a dental assisting school owe their students a job? Hygiene school? How about dental school?

Considering most students have to take out loans in order to pay for their education, my answer is yes.

The dental hygiene schools in my area charge a lot of money for tuition. When pre-hygiene students ask me if it’s worth it, I stumble to find an answer. The same with pre-dental students.

Would you go to dental school if after completing your studies you could not find decent employment? Does dental school owe you a job?

Andy Alas, DDS

5 Implant Dentistry Insights from Dr. Todd B. Engel

Todd B. Engel, DDS, founder and director of the Engel Institute — which educates dentists about implant dentistry through the live patient experience — believes that general practitioners should understand the basics of implant placement in order to make informed decisions when it comes to their patients. Here are some insights he offers on how to get started.

1. Prioritize the Patient: Always begin and end with the patient’s best interest in mind, regardless of how it may or may not benefit the provider. This will set the stage for an honest, healthy, and long-lasting relationship.

2. Visualize Ideal Treatment Outcomes: Oftentimes, ambiguity exists when we’re not sure when to refer out a patient for more experienced care. It’s quite simple: We must clearly visualize the goals and have the end in mind for our patients, and then decide if we feel capable of achieving that desired result. Should either concept be unclear, a referral is definitely in order.

3. Research Technology for Proper Usage: When entering the surgical arena as a provider, consider technology as an available source and apparatus to enhance the predictability of our outcomes but not replace the necessary knowledge of the required skill set. Technology in dentistry is often presented as “plug and play” for our convenience and added profitability. We should all be cautious about this and do our due diligence in researching before we commit to its implementation.

To continue reading Dr. Engel’s advice, access the March issue of AGD Impact.

Curing

I recently had the honor of attending a friend’s son’s ordination to the priesthood. Alex was one of six candidates who graduated from seminary last summer and reached the culmination of years of discernment and study.

Now they’re priests, with all the vestments and collars and ontological changes that occur through ordination. And they’re all young. They all looked like kids. Heck, they are! Alex is in his late 20s, and now he’s Father Alex?

Where did the time go?

As I watched the young men and women become ordained, I was reminded of my own dental school graduation.

My classmates and I were (for the most part) the same age and suddenly, we were to be called “doctor.” And while we were well educated and prepared for basic clinical dentistry, we were as green as saplings — at least I was.

Was I ready to run a private practice? To hire and train and maintain a staff? To deal with all the personalities involved among my own staff and the other partners in my group? Finances? Technology?

No, I wasn’t. I still wonder if I’m able to now.

Looking at the young priests, I know if I had some doctrinal question or theological conundrum, I could go to one of the whippersnappers and get a seminary-fresh answer that would be delivered with conviction and sincerity. But, would I go to Father Biff with a relationship crisis involving a recovering alcoholic? Sorry, but what does that “kid” know about that kind of thing?

Similarly, why should anyone listen to my treatment options with any confidence that I not only am competent to do the work, but also ultimately have their best interests at heart? Especially after I’m only one month out of dental school?

All those priests will go through a “curacy” period. They’ve been created; now they have to “cure.” They’re put in an assistant role, usually, which allows them to learn from a mentor and gain some life experience so that they can one day handle the responsibilities of their own parish.

I spent my senior year trying to finish my requirements and wasn’t able to set up a practice or find one to purchase or associate with. I realized a general practice residency (GPR) was what I needed to provide me with more clinical experience and allow me the time to figure out what I was going to do next. I know friends who went into private practice immediately after graduation and have done extremely well, but I knew that wasn’t going to be me. The GPR helped me “cure.”

Someone told me early on that once I got some gray hair, people would respect my “authority” more. Well, I’ve got plenty of gray now in an ever-decreasing field of hair. I’m not so sure it’s the gray hair, but maybe the 25 years of practice, that gives my suggestions a little weight now. When something is presented along with the phrase “in all my years of practice,” I think people pay attention.

So hang in there, all you young rascals, you. The gray is coming.

Bruce M. Scarborough, DMD, FAGD

Dating

Our first child was 11 days overdue, and, in the third day of labor, my wife, Tina, finally was dilated enough that delivery could happen. But something stalled in the process, and we learned that our child was in distress and an emergency C-section was required. It all happened so fast, and we were so tired that it still is all a blur of memory.

Isabel was born a mere 5 pounds, 5 ounces. Apparently, the placenta had not fully formed. But our little “peanut” was a healthy girl, and we named her after my father’s mother, Isabel, a lady who charmed all who came to know her. Our girl has since grown into a charming woman so reminiscent of her namesake.

The first three months of my daughter’s life is an even greater blur. Trying to run a busy general practice and caring for our newborn child, we got caught up in the routines of each day, and it consumed us.

Tina fell into the all-too-common baby blues. Days and nights filled with caring for a newborn who cannot communicate to you, having a husband who is busy caring for all of his patients who are demanding of his time, and having little adult conversation in her daily existence made it a difficult time. She went to her doctor for help.

Tina came home that night with an envelope for me. Inside was a note from her physician. It contained five words: “Take Tina on a date!” It was a light bulb moment. Eureka. A brisk slap in the face. Of course, we had gotten so involved in the day-to-day that we had lost the path that led to our reality — a child had been created in our union.

So then, with Isabel at 6 months of age, we spent time preparing bottles and finding a babysitter we could trust, and we nervously left our daughter in someone else’s hands while we went out for dinner. And it was wonderful. Nothing bad happened to our girl, and we had a delightful meal with a waiter who was so great that we are still friends with him 20 years later (and now his children and grandchildren are my patients, too).

Ever since, we have made sure to arrange babysitters for a “standard” Saturday night out. We subscribed (in different years) to the symphony, ballet, theater, and more, so we would be forced to “go out” due to a schedule. Our second daughter, Samara, arrived almost five years later, and my wife and I continued dating.

Our girls grew up getting to know the other people who helped look after them, and the experience helped them learn independence from us. And my wife and I kept our romance going. Sometimes our dates were just a long meal out so we could have an adult conversation. Other times, it was dinner and a movie, theater, dancing … it has been great. Now our girls (ages 15 and 19) encourage us to go out on a date, and my treatment of their mother has become a model of what our daughters look for in a future companion.

And now with Facebook, I have been regularly posting on my practice’s page what my wife and I have been doing on our dates, including which restaurants we have gone to, which movies we have seen, and the music we have listened to. Our Facebook friends are part of our practice family community. Some of my male patients have thanked me for giving them ideas for things they could do with their wives. Some wives have used my posts to goad their husbands into doing more with them (kind of like a “Why don’t you take me out on a date the way Dr. Stanleigh does with his wife?” thing). Our patients are our friends, and this all occurs with the affection, kindness, and good intentions it was meant to have. (Incidentally, these “dating” posts regularly get three times the number of views, likes, and comments than any dentistry posts. That is why they call it social media. It’s the social stuff that people want to know about, interact with, and be a part of.)

We never travel far without our children. Travel is such a great education. We don’t need to spend the holidays without our kids, because we have the weekly dates that have kept us together, engaged with each other, and still in love, almost 22 years later.

My wise brother (whose nickname is Yoda) told me in the years B.T. (before Tina) that love is not having two half-empty buckets and trying to fill one bucket. The result will always be one empty bucket. Instead, he said love is having two half-empty buckets and trying to help to fill each other’s buckets.

So my advice is to plan a date with your partner this weekend. Massage the romance. Set an example for your children. You can only become richer as a result.

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

Zika Virus Recommendations for Health Care Providers

With the recent outbreak of the Zika virus primarily in Central and South America, the Centers for Disease Control and Prevention (CDC) estimates that the number of cases among travelers visiting or returning to the United States will likely increase. In fact, a number of travel-associated cases have already been reported.

The virus is primarily transmitted through mosquito bites. Spread of the virus through blood transfusion and sexual contact have also been reported. Health care providers should be aware of the following:

• The Zika virus should be considered in patients who traveled to areas with ongoing transmission in the two weeks prior to the onset of illness.
• The most common symptoms of the Zika virus are fever, rash, joint pain, and conjunctivitis (red eyes). Symptoms typically begin two to seven days after being bitten by an infected mosquito and last several days to a week. 
• Health care providers are encouraged to report suspected cases to their state or local health department to facilitate diagnosis and to mitigate the risk of local transmission.
• No specific antiviral treatment is available for the Zika virus. Treatment can include rest, fluids, and use of analgesics and antipyretics. Acetaminophen can help reduce fever and pain, and aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided. Pregnant women who have a fever should be treated with acetaminophen.
• No vaccine or preventive drug is available. The best way to prevent Zika virus infection is to avoid mosquito bites.
• Pregnant women are most at risk for complications from the Zika virus. The CDC recommends special precautions for pregnant women and women trying to become pregnant. It’s possible for the Zika virus to be transmitted from a pregnant mother to her baby during pregnancy or around the time of birth.

AGD is staying abreast of the latest developments regarding Zika virus and how it may affect dental patients. For more information, visit cdc.gov/zika/.

Sources: Association for Professionals in Infection Control and Epidemiology, Centers for Disease Control and Prevention, and New York State Department of Health

AGD Headquarters 

Attitude. Attendance. Awareness.

I think we’ve boiled it down to the basics: Attendance. Attitude. Awareness.

I have tell you, the hiring and firing of dental assistants is definitely not something they taught us in school. I know we may have more turnover than the norm, being a large, multi-location group practice, but still. We run a fair operation where we pay well, are nice (most days), and have a relatively healthy work environment.

And still, we have trouble getting our three basic requirements we look for in assistants — and our other support staff — out of many hires. Is it just us? Are these requirements too much to ask for?

There’s certainly a science to this whole thing. I find it rather amusing living in a small city where most assistants on a job search have worked for, been fired by, and/or got tired of one of our peers. A phone call to Dr. Jones reveals that, “Sarah, while a reliable worker, just didn’t have the necessary skills,” “She’s just too green,” or the ever-telling “Good luck, mate”! And still, we take the plunge. We see enough promise and a nice-enough attitude on the eight-hour working interview to sign the job candidate up.

And begins the merry-go-round. It’s one that we’re currently riding at my practice, so it’s fresh in my brain, and you all are my best outlet!

We clearly haven’t figured it out. Are 18-year vets better than fresh-out-of-high school/assisting program newbies? There’s something to be said for both sides of the coin, but man, have we been disappointed lately. We’ve tried using headhunter-type groups, temp agencies, and good ol’ Craigslist — boy, do we get some interesting responses from that! Nothing seems to pan out.

My dad always told me: “There’s always going to be a ninth hitter.” If you don’t understand the baseball analogy, normally the last hitter in the lineup — the ninth position in the batting order — is the worst hitter on the team. The idea is that the first couple of batters will get more plate appearances and, thus, a greater chance of getting hits and scoring runs than those at the end of the order. It’s why the pitcher is often the ninth hitter. They stink at hitting!

I understand the idea completely, but I’m not OK with it in my own practice. Why can’t we have nine all-stars? There’s got to be offices out there like that … or are there? What’s everyone’s experience with this? I think what makes it tough is when you have a pretty darn good team of ballplayers surrounding the ninth hitter. He or she sticks out more and often has a negative attitude and poor attendance and is completely unaware. The majority of our stress related to staff issues is pointed in his or her direction.

Cheers to those dealing with a poorly hitting, needs to change teams, stressing you out at night and as soon as you get to work ninth hitter. For now, I guess we live with the lineup we have. Or do we? The grass is greener on the other side, right?

Attendance. Attitude. Awareness. This can’t be too much to ask. And if it is, so be it. Because it’s what I’ll continue to ask for of all my batters, leadoff man to the ninth hitter. This is a team sport.

Donald Murry III, DMD