Friday, June 30, 2017

We’ve Moved!

To the Loyal Readers of The Daily Grind,

The Academy of General Dentistry (AGD) unveils a bright new look at As part of this new look, we’ve moved The Daily Grind onto, where you can now access all of your AGD news sources in one place.

You also will find the tools and resources you’ve come to rely on, as well as new features and a fresh, modern look fit for our thriving organization. The mobile-friendly website includes improved organization and search capabilities, a Find-an-AGD-Dentist tool for patients and content that is segmented for general dentists based on their career stage.

If you are currently a subscriber to The Daily Grind, you will see a lapse in the notifications of the new posts. We encourage you to follow AGD’s social media sites for notifications on the latest posts from our bloggers.

We encourage you to take some time to explore the new website and check out some of your colleagues — including some familiar faces from The Daily Grind — who have shared their stories.

The AGD Communications Team

Friday, June 23, 2017

Online Dental Information: Marvel or Myth?

No doubt we’ve all used or heard the phrase, “I read it on the internet.” But what this exactly means is unknown, not to mention risky. I’m certain that countless health care providers hear it all the time from their patients and clients. I gather information from the internet, too. Is an internet search a good thing or bad thing? It may be both. 

Naturally, being able to sort through the infinite amount of available information is no easy task and, just like the products at the eye level of grocery shelves that draw our attention, we focus on the first few search results. Those results are not there by accident. Their placement is the result of a highly sophisticated algorithm that is computed with utmost binary accuracy. That’s wonderful and “informative,” but it still may not give me the answer I’m looking for. And that’s just the point; it’s not supposed to. Rather, it gives you information. For those who can remember, that information used to come from a collection of thick, heavy books called “encyclopedias.” Just substitute “encyclo” for “Wiki,” and you have your 2017 version.

Where am I going with this? In comes my patient who tells me she read about a procedure online and then decided against it. How did she come to that conclusion? If we search via Google for “root canals,” for example, thankfully the American Association of Endodontists (AAE) has the upper hand on the information. But scroll a little more, and it’s stunning to see myths about root canals that are available by clicking just one search result below that of AAE’s.

When I was considering Lasik surgery on my eyes, I had a hard time not reaching for my computer and simply typing “Lasik surgery” into a Google search bar. Instead, I consulted with my optometrist, who gave me advice not only based on evidence-based research, but that also tied in to the particulars of my case. Decision made.

If the internet was to provide us with the answers to our medical and dental questions, I think health care providers would have easy careers. I’m not against being informed; on the contrary, that is the basis for our “informed consent” forms. If we’re not informed, we’re not making an educated decision about dental procedures.

However, that information must be credible, scientifically valid and accurately apply to a particular situation. I think dentists should give patients sources that are sound and ethical from which they can draw reliable information on their own time. Then they can tie it all together in an open discussion to reach a solution best suited for the patient.

Now, that advice should be available on the internet.

Zeynep Barakat, DMD, FAGD

Thursday, June 15, 2017

Relationships Matter above Everything Else

As we know, dentistry has entered a new economic reality — a reality that is reshaping the way in which we do business, as part of an industry whose foundation is built upon the appreciation and realization that relationships matter, above everything else. Yes, everything! Stated another way, no longer are our clinical skills the differentiator between success and failure. Rather, it is the manner in which all team members commit to building relationships that has meaningful and lasting importance.

In 2017, dentists are no longer insulated from market forces. In many communities, the competition is fierce, employee engagement is abysmal, and the price shopper is alive and well. For the new dentist or seasoned practitioner, the ability to carve out a “niche” is seldom based upon clinical skills. Rather, building long-term relationships that lead to a following of lifetime customers is key to personal and professional satisfaction. Considering less than 1 percent of dentists file for bankruptcy, I don’t think we need to worry about going out of business. However, as an industry, we can do better. How much better? A lot! We are fortunate to have chosen a profession that by its mere existence is financially successful. Consider us wise from this perspective. Or maybe lucky? Who knows.

For most general dentists, their profit margins are shrinking and will continue to do so. Why? The competing forces are fierce; dental insurance reimbursements are continuing to decline as more dentists enroll (this is simple economics: supply and demand); corporate dentistry will grow (they want a piece of the profits); fewer dentists will retire (many because they didn’t prepare for retirement); and there will be more graduating dentists, not to mention poor business acumen and an employee-engagement profile that is frighteningly low. What does this mean?

According to Gallup, a worldwide strategic consulting firm whose focus is on “analytics and advice to help leaders and organizations solve their most pressing problems,” only 32.6 percent of employees are engaged in their place of business. Gallup defines engaged employees as those who are involved in, enthusiastic about and committed to their work and workplace. The remaining 67.4 percent were found to be not engaged or actively disengaged at their place of employment. In other words, they are underperforming and costing the business owner a substantial amount of money in wages and lost production. Suffice it to say, there is a production crisis and relationship disconnect in today’s workplace. Gallup’s employee engagement work is based upon more than 30 years of in-depth behavioral economic research involving more than 17 million employees.

A recent study by Deloitte, one of the four largest consulting firms in the world, reported a direct correlation between the patient experience and perceived quality of clinical care, noting that higher patient experience ratings are associated with higher profitability. Relationships were key. Not only was there an increase in profits, but there was also an increase in customer loyalty, reputation and brand while boosting utilization through increased referrals to family and friends. The Deloitte Center for Health Solutions’ outcomes mirrored the Gallup poll findings, stating, “A highly engaged staff likely boosts patient experience, translating into better performance.”

Are these new findings? No. According to the article, “Top 10 Online Patient Complaints – How Does Your Customer Service Stack Up?” published in September 2012 in the McGill & Hill Group LLC newsletter, McGill Advisory, nine out of every 10 dental patient complaints are relationship-based and continuing to rise. Our employees and teams can do better, and when they fail to do so, they are hurting our business. How are your relationships with your team and patients? Are they built upon a culture of “do no harm” or “do unto others as you would have done to you”?

While we may be facing big-box dentistry, miserable insurance reimbursements, and a marketing maze of well-intending individuals and companies, there is no substitute for a culture whose core is built upon developing rapport that leads to value, and value that leads to trust. When patients trust you, they will buy from you.

While we can’t be all things to all people, we can be all things to some. This includes our patients and team members who appreciate our services, education, and commitment to each of them and each other — a type of credo that nourishes relationships built upon rapport, value and trust, or what I refer to as “RVT,” an association between the services we provide and a relationship-driven culture that leads to brand loyalty for life.

Are your employees engaged, enthusiastic and committed to their work and workplace? Remember, a highly engaged workforce means the difference between a company that outperforms its competitors and one that fails to grow. Relationships matter, above everything else.


Tuesday, June 6, 2017

Extinguishing Fires — Literally

“Doctor, the radio keeps turning off!”

So began my morning. Little did I know that within the hour, an electrician, my dental equipment repair team and an electrician would be in my office. My staff also would be cancelling all of my appointments for the day.

“Why does the radio keep turning off?” I asked. No one knew.

“By the way,” I said, “who is smoking a cigarette in my office at 7:50 a.m.?”

Being a dentist and inhaling all of those chemicals over the years, my sense of smell is not the greatest. So I asked my assistant, “Do you smell anything?” She responded, “Oh yes!”

I quickly realized that we had an electrical fire. Somewhere in my office, an electrical wire was starting to burn. Where? It did not matter. My staff and I rushed to the circuit breaker box and turned off all of the switches for the operatories. We were finished for the day.

You’ve probably heard the saying, “Don’t sweat the small stuff.” Fair enough. The trick is to know when it is no longer the small stuff you are dealing with. A light bulb burns out in your private office? Small stuff. Smelling smoke each time you turn on a light switch? Not small stuff.

I learned this lesson a few years ago from a colleague. He got a call early in the morning informing him that there was a fire near his office. Within minutes, he drove up to realize that it was his entire office that was on fire. The cause? A water leak mixing with a power junction box inside his office. The total loss? His entire office.

This is not sweating the small stuff. This is knowing that things can go wrong — really, really wrong.

After my electrician checked things out, he gave me his report. The radio kept turning off because the circuit kept breaking. The circuit kept breaking because a fire was about to start. We were a few minutes away from ending up on the local news.

The electrician informed me that he would need to tear up the floor in our operatories in order to get to the wiring.

He tore up my flooring, dug a hole and located an outlet. This outlet had been buried for at least 15 years. It had given out. My electrician replaced it, and we were back in business.

Our patients were understanding about having to reschedule their appointments. As you well know, our patients are already nervous about having a filling placed. Now, having a filling placed inside a burning building? They’ll happily hold off until another day.

If you show up to your office and something keeps switching off, you may want to take it seriously.

Andy Alas, DDS

Tuesday, May 30, 2017

Sleep Apnea: Our Journey to Be Recognized as Physicians of the Oral Region

We dentists started as barber surgeons, with teeth as disposable as hair. The oral region was glossed over as unimportant by the medical community for thousands of years. A good friend of mine, a physiatrist (physical medicine and rehabilitation specialist), admitted to me that his education stopped at the temporomandibular (TM) joints and anything beyond that was a total mystery to him. In my orofacial pain and TM joint dysfunction practice, we naturally are working closer together than ever before.

With increasing evidence that diabetes affects the progression of oral infections — particularly, periodontal disease and how periodontal infections can affect the stability of diabetic management; and the growing links between oral infections and premature, low birthweight babies; as well as the links between premature atherosclerosis and periodontal infections and higher levels of c-reactive proteins in the presence of chronic inflammation from infections — the medical community is starting to pay attention to the orofacial region and dentistry as an integral part of the assessment and treatment of the entire human body.

When I was in dental school, many of our courses were identical in the first two years as the medical students’ courses. Basic information about the human body must and should be understood by all members of the health care community. Only in later years do we emphasize the subject areas of our particular field of study.

About 20 years ago, I became aware of the work of James F. Garry, DDS, a pediatric dentist who understood the critical link between breastfeeding and the development of the oral region, including the development of the airway. He was instrumental in the development of the NUK® and Sauger nipple and pacifier, along with Dr. Wilhelm Balters, a leading health expert from Germany.

Now, orofacial development, airway development and airway issues are affecting such a large part of our population that it is a serious general medical issue, and our role as physicians of the oral region continues to grow in importance. Steven Y. Park, MD, an otolaryngologist (ear, nose and throat specialist) in New York has a great website, blog, podcast, book and more, which are focused on airway and sleep issues, and he regularly interviews dentists, as he has recognized our role in this issue.

It is gratifying to see that our medical colleagues slowly recognize that our role in early childhood development and possible prevention of future airway and sleep apnea issues is critically important to the long-term well-being of the general population. Indeed, obstructive sleep apnea and sleep disorders are part of the Fellowship Exam of the Academy of General Dentistry.

It is time for all of us to study this field more, and to continue to collaborate, positively and collegially, with our medical colleagues, for the betterment of the members of the public whom we humbly serve.

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

Monday, May 22, 2017

What Do You Sell?

Today’s dental economy is rapidly changing, and the dentist owner is challenged to remain current in every facet of his or her business, both clinically and operationally. There is a continuous wave of new materials, techniques and technology inundating us, begging for our attention 24 hours a day, seven days a week.

With the arrival of discount dentistry, social media, poor dental insurance reimbursement and the “price shopper,” many dentists have had to postpone their retirement five to 10 years or more. The seeking of excellent dental service is slowly being replaced by questions such as, “How much is your crown?”; or, “How much is an implant?” In the eyes of too many consumers, the dental industry has become a commodity-driven industry where “tangible products are replacing intangible services.” Aren’t all crowns equal? Look at your insurance reimbursement fee schedule. Do you charge the same for an anterior crown as a posterior crown? Maybe the anterior crown should be more expensive? I think so.

Photo caption: A 28-year-old female patient whose chief complaint was, “This is what my insurance covered, and the doctor said it was the best he could do.” 

A tangible product is an object that satisfies a need or want and can be perceived by touch or feel (clothing, groceries, automobile, etc.). A service is intangible and cannot be touched or felt and is derived through the application of skills and expertise that fulfills an identified need. Dentists sell services, not products. Services are more about selling a relationship and the value of the relationship. As a result, they can be more difficult to sell. The key component to selling dental services and establishing long-term relationships is trust.

With the advent of and big-box superstores (Costco, Sam’s Club and 24-hour grocery stores), the consumer is demanding more. “One-stop” shopping and many dentists’ decisions to “compete on price” have shifted the dental industry toward a commodity-based market where emphasis is placed on product instead of service. This is a dangerous proposition for the small business owner. Much of this has been introduced through dental service organizations (DSOs) and the dental insurance industry, which is growing exponentially through acquisitions and marketing, while appealing to patients on numerous levels. Examples include: brand, national name recognition, being more cost-effective, etc. Considering the average student debt in 2015 was $247,000, many new graduates have decided to join a DSO to hone their clinical skills, be paid well, and not have to worry about managing or operating a business.

Dental insurance is another facet of business that dentists have had a difficult time keeping up with. For example, in 1972, the cap on dental insurance reimbursement was $1,000, and for many carriers, it hasn’t changed since then. Today, $1,000 would only pay for 177 dollars’ worth of dentistry in 1972. Conversely, it would require $5,660 dollars in 2015 to cover the purchasing power of $1,000 in 1972.

In 2016, it is worth noting that the No. 1 reason that dentists contract to become “in-network” providers is to grow their patient base. In other words, adding potential new insurance-dependent patients who, in most instances, don’t determine their own dental plans. Their employers do.

Unfortunately, many business owners do not realize that both the dentist and the insurance company are competing for the patient’s business. As a result, the dentist’s profit margins have dramatically shrunk, with more than 90 percent of dentists participating in one or more dental insurance discount programs. Prior to signing a contract to become an “in-network” provider, the business owner should evaluate the potential return on investment, with a clear knowledge of their breakeven point (BEP).

In my evaluation of hundreds of dental offices, I have found that more than 78 percent of all business managers and dental owners have contracted with insurance companies as “participating providers,” only to realize later that the insurance reimbursement is less than their cost of doing business. In other words, they are losing money while at the same time decreasing their cash flow. As an aside, it is important to note that insurance contracts are prepared and written by attorneys, not dentists.

In summary, an increase in patient flow that results in reimbursement for your services that are less than your cost of doing business is a recipe for disaster. Have you read your dental contracts, and do you know what your BEP is?

As dentists, we are considered physicians of the oral cavity, and we should focus on selling our services and expertise, not products and insurance affiliations. For the price shoppers and insurance-driven consumer, in most instances, they can go elsewhere.


Monday, May 15, 2017

Lend an Ear to a Fellow Dentist

It’s midweek, and you have a schedule that somehow just went way south. A staff member just informed you of a situation that will affect your schedule. An insurance claim denial waits on your desk to be appealed. Oh, and you just remembered you’re up for CPR renewal, and darn it, that model trimmer is still leaking. You know, it’s a typical day in our field. Needless to say, the drive home can sometimes be pretty serene despite the Google traffic GPS map showing dense red lines everywhere. 

But what happens when you get through the door at home? It must be nice to have a spouse or partner or parent who is a dentist and “gets it” when we narrate the ups and downs of our day. (Though, I’ll admit it’s refreshing to delve into the day of someone far removed from my tooth world.) What if we don’t have dentists waiting at home to hear us out? Do they find our stories boring? Repetitive? My favorite response to my own animated description of dental practice was, “Well, you wanted to be a dentist,” when I used to have my mother as my audience. And that was if my day was bad; when I was ecstatic about a case outcome or felt good that day, my joy might have only been my own. She always smiled and, with good intention, replied with nice comments, but did she get it?

As dentists, we carry a plethora of burdens. We must be mini-specialists (my coined phrase) in business administration, law and ethics, staff management, insurance policies, human resources, risk management, and on and on. Almost all of these things, I might add, we had to learn on our own. We are not only responsible for our own work and income, but that of our staff as well. That is a hefty burden on our shoulders. Who would empathize with us better than other dentists?

This is why camaraderie is so important in this profession. It provides us with constructive support that our loved ones or staff members may not be able to provide. I find that study clubs, dental meetings, board meetings and courses are venues where we can vent about our highs and lows and seek genuine empathy alongside sincere praise. Call me naive; perhaps dentists are more competitive with one another. But the most beloved listeners to my good and bad have been those who have walked in my shoes — because they get it.

Zeynep Barakat, DMD, FAGD

Monday, May 8, 2017

Cross-Train for Dental Success

Cross-training is a way of life for the modern athlete, and no one in Chicago’s professional sports scene more illustrates that than Jake Arrieta, pitcher for the World Champion Chicago Cubs. His training regimen received quite a bit of press over the past baseball season for being so multidimensional. Yoga, Pilates, Olympics-style weight training, visualization and sports psychology were all incorporated by Arrieta to help him reach his highest potential.

Are you unfamiliar with the term “cross-training”? defines the term nicely: “In reference to running, cross-training is when a runner trains by doing another kind of fitness workout such as cycling, swimming, a fitness class or strength training, to supplement their running. It builds strength and flexibility in muscles that running doesn’t utilize.”

How does cross-training in sports apply to the field of dentistry? In my opinion, the best all-around dental offices are the ones that consistently provide excellent patient care and do so daily with ease.

While there are numerous aspects that must come together to create an office of this caliber, in my opinion, one of these aspects is invariably cross-training of the dental team. Cross-trained offices thrive in the same way Jake Arrieta does: They build strength and flexibility in individual dental departments by doing another kind of work. These offices exhibit increased fluidity and typically operate at a lower level of daily stress regardless of what obstacles present on a day-to-day basis. Additionally, employees of cross-trained offices always seem to work better together. Being knowledgeable about a coworker’s job fosters increased understanding, empathy and appreciation for the daily tasks among the dental team (comprised of dentists and dental assistants), the hygiene team and the administrative team. Cross-training your dental practice will inevitably help yield stellar patient care and patient office experiences.

The beauty of cross-training a dental office is that there’s no wrong way to do it. While certainly impossible to completely achieve, the cross-training goal should be that everyone knows how to do everyone’s job. In actuality, simply having all staff members possess a basic understanding of all of the jobs is a monumental undertaking (and achievement). It might be challenging, but it’s worth it. Think of how much more effective your administrative team would be if they possessed firsthand knowledge of common dental procedures. Similarly, think about how much more effective the dental team would be if team members could execute common administrative tasks such as making appointments and answering incoming phone calls. Add the dental hygiene team into the equation, and the positive benefits are even greater.

The following are just a few ideas to get you started down the cross-training path:

1. Cross-train within a specific position (i.e., ensure that all dental assistants are fluent in all procedures for day-to-day operations, and that your team is not just comprised of a highly trained and experienced lead assistant with lesser trained and experienced coworkers).

2. Rotate in members of both the dental hygiene team and the administrative team to witness a variety of dental procedures firsthand.
a. Educate staff members (and the patient) during the procedure about as much as possible to create standardized informational scripts, and so that they will be able to more completely and effectively discuss the procedure on their own.
3. Rotate in members of both the dental hygiene team, as well as the dental team (yes … dentists, too!) to learn and review basic administrative skills and tasks.
a. Review predetermined scripts to ensure phone calls are answered within two rings even when the office is overwhelmed.
b. Schedule a patient’s next appointment.
c. Take payment.
d. Find charts and properly print/email X-rays and photos.
4. All staff members from all teams should be knowledgeable about how rooms are stocked and where extra supplies are kept.
a. Staff members should be knowledgeable about the names of dental equipment and their locations (i.e., a hygienist is asked to get a highspeed handpiece, burs and articulating paper for a chairside occlusal adjustment of a filling on a patient in a hygiene room).
5. Do you have an overflow dental chair? What about an “overflow dental assistant” from the hygiene or administrative teams who can help when all dental assistants are busy? Cross-train the overflow dental assistant to not only be able to help out, but also to thrive when called upon. Keep their skills sharp by periodically asking them to assist.

Learn from Arrieta’s success and cross-train your dental practice. It will certainly take time, determination and a lot of effort, but in the end, the office and your patients will undoubtedly benefit from it!


Friday, May 5, 2017

Put on Your Thinking Caps!

One of the biggest struggles most dentists have is hiring the right people to be on their teams. For me, the ability to think through, understand and resolve tasks is a must-have trait for an applicant to be considered. I have found that the struggle is that people are not used to thinking anymore. The thinking-process concept is becoming obsolete. 

In today’s younger generations, I feel that they are taught to listen, memorize and do rather than to slow down, understand and think through a process. This type of learning seems to be further continued and reinforced in most business settings. In fact, I have attended continuing education seminars where this same approach was being used to teach doctors and their team members.

It is faster and easier to just tell people what to do, and for the learner, it is quicker to only memorize; it takes a lot less energy. People robotically proceed through the day, and then they’re confused when things go wrong. There is little understanding and no connection to what it is they are doing. This teaching model is detrimental to our youth and to our workforce because it does not inspire people to be more and creates no sense of loyalty.

For example, when I used to conduct hiring-process interviews with dental assistant applicants, I found that the majority of them thought their responsibilities finished with suctioning and successfully passing instruments. They were quiet and timid, and most of them had no understanding of how to use the materials they potentially would be handling. When I asked them why they were searching for a new job, the answer given rarely was about money. The most common response was: “I want a job where I can learn and continue to grow.” They had little connection with their patients, and most came from offices with a lot of internal conflicts amongst the staff members.

If we teach people to interpret and process tasks, it will better equip them to handle the next task they are presented with. In my office, I train my assistants to function as clinicians. I am clear about my practice vision and my expectations of them. Each task is broken down, reviewed and reassessed until the trainee feels he or she has mastered the concept and is ready to move on to the next. You see, it’s when people understand why they are doing something that they really get how to do it and it sticks with them. Aside from that, they value the time spent in developing their skillset. Team members who are continuously well-trained feel confident and are present in their encounters throughout the day.

If we have a team of “doers” rather than “thinkers,” we set up a work environment where the mind-set becomes, “well, that’s not my job” or, “no ever told me.” However, if we cultivate “thinkers,” the entire team has a unified vision of the practice philosophy and a clear understanding of what the collaborative goals are. What type of team would you rather work with? 

Pamela Marzban, DDS, FAGD

Monday, May 1, 2017

Love What You Do

His name was Percy Faith. The eldest of eight children, born to Abraham and Minnie Faith in Toronto, he was a gifted violinist. Greatness was within him, and a vibrant future was his to command until one day he used his hands to put out a fire that was engulfing his youngest sister. She was badly burned and scarred, but he saved her life. Unfortunately, his hands were also badly burned and scarred, and his career as a violinist ended before it began.

But Faith loved music. He turned from performing it to composing and arranging it. After reaching a pinnacle of success with CBC in Canada in the 1940s, he moved to New York and continued his career there. Eventually, the industry encouraged him to settle in Los Angeles, and there, he raised his family while becoming a prolific recording artist, with more than 60 albums, not to mention film scores and more. In 2012, he was inducted into the Canadian Songwriters Hall of Fame for his song “My Heart Cries for You.”

He loved to take popular songs and arrange them for an orchestra, allowing him to introduce Caribbean and Central and South American sounds to North America in the 1950s. It was his life’s passion (other than his family, whom he dearly adored). It is what stood out for me, that he loved what he did for his career.

I grew up listening to classical music and Faith (because he was my mother’s eldest brother), and now, as an adult, attending performances by the Calgary Philharmonic Orchestra is a regular part of my life.

It was a Friday night, and my wife and I went to the Oak Room in the Palliser Hotel after enjoying a performance by the orchestra. We sat to enjoy a drink and quiet conversation when a beautiful young woman walked to the center of the room, lifted a microphone and started to sing. Her name was Ellen Doty, and she had this sultry, breathy, beautiful voice as she sang some jazz standards. She had the room totally captivated. As she sang, a keyboardist suddenly appeared to accompany her, and it was magic.

After a few songs, another musician joined her. He played some saxophone and drummed on a box. And he had joy written all over his face. Creating and playing music that others can enjoy was what they were passionate about. I don’t remember the keyboardist’s name from that evening, but the other musician was Oliver Miguel. These are artists who love what they do, like my uncle did.

I have to admit, I love being a dentist. I love what we get to do every day. I love that what I do changes people’s lives. And I laugh when patients tell me that they could never be a dentist and do what I do. I tell them that is a good thing because if everyone was a dentist, I would not have any work to do.

With springtime now firmly staring us in our faces, as we strive to emerge from our winter homes and enjoy the outdoors again, remember to engage that passion and love what you do.

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

Monday, April 24, 2017

Part 3: What Defines a Successful Practice?

This is the third blog post in this series. (If you missed the first two, go back and read them; I will see you in a couple of minutes.) 

OK, we have been talking about success. In the first blog post in this series, I talked about my opinion of what success means: being happy in your job. I don’t equate success with money. Although, I think if you love your job and are happy, you are going to work in a way that attracts people and probably make a great living.

In the second blog post, I talked about how I thought I wanted a big practice (much like everyone), but I found I am much happier being in a small office. I love the people with whom I work, and I truly like most of my patients. I talked about how my office is fee-for-service. And to survive as a fee-for-service practice, you have to separate yourself from the rest of the dentists. We try to be a warm and friendly staff who focuses on the patient.

Today, I want to talk with you about my management style. First, I want to say that I want to be the dentist who I know I should be. But after 22 years, I realize being a leader doesn’t come easy for me. I am the guy whose leadership style is to not micromanage. I am a guy whose employees have been with my office for years. (I have employees who have been with me for 39, 21, 18, 11, 10, nine and five years.) I believe that at this point, everyone should know how to do their jobs, and they should know how to do them well. When someone does something that should be pointed out, I do this — but only then. Theoretically.

What usually happens is that I think about how I should talk to this employee after the patient leaves. (I don’t want to talk to him or her in front of the patient because that looks bad.) But sometimes, I get busy, and then it never seems like the right time to talk, or I just don’t want to get into it. Or I don’t want to create drama during the day, so I tell myself I will initiate the talk before the employee leaves for the day. But then I get busy and never actually say anything. Then, by the next day, it has been more than 24 hours since what seemed like an insignificant detail actually happened, and I have forgotten about it. Problem solved.

Not having a “sit down” with someone has some benefits. There are no tears. There is no attitude from that employee for the whole day. There is no argument about how it “wasn’t my fault.”

Let’s say you don’t talk about that fairly insignificant thing. The next thing you know, it has been a week, and the issue has long been forgotten. Everyone wins. How about that leadership?

I know some of you are probably thinking, “This guy is a total wuss.” I know, I know. But I also know I am talking to dentists who probably do the same thing as me. It is far easier to ignore than to deal with every little thing that comes up. I mean, we don’t have personality conflicts in our office, thank goodness. Everyone really gets along, and drama is almost nonexistent.

If the assistant doesn’t have the bonding agent ready before the etch is taken off the tooth, is that really a big deal? From a big-picture perspective, no. I feel like I am fairly critical, and I find if I just marinate on a particular issue, something that seemed like kind of a big deal yesterday becomes not that big of a deal the next day.

There is some leadership, by me, when it comes to doing dentistry and how people should be treated. I know what I like to do. I know how to treat people, and there is no compromising this.

I just finishing reading another blog post about the way The Ritz-Carlton approaches leadership. I know that taking the easy way out or not “rocking the boat” is not the leadership philosophy of most CEOs, but micromanaging is not my style. I guess my philosophy is to hire the right people and let them do their jobs. Then, every month, we get together and have lunch and talk about ways we can improve or make each other’s jobs easier.

Look, this philosophy works for me. I love my job and my team. We have production goals that get met almost every month. We do a lot of laughing around here, and I think most of my employees/team members like to come to work. Maybe because I don’t nitpick everything they do. I don’t nitpick about supply costs or lab costs. I don’t complain about how the manufacturer raised the cost of its composite. (One hundred and fifty dollars’ worth of composite could possibly make me $3,000; what do I care if they raise their cost $10?) I don’t even look at my lab bill. I like my ceramist, and he does great work. Am I going to complain if he charges me for a reduction coping or a custom shade? So his fee goes from $225 to $239 for one case; I charge $1,300. We have a great relationship. I am not going to change this because I want to complain about $14.

I do my best to keep costs down. I shut the air conditioner off at night. I turn the lights off when I leave. I ask the staff member who handles ordering to do his or her due diligence. If the hygienists need new scaler tips, I say, just buy them, no question. If they can’t do their job well because they need X, then just buy X, I say.

This is my management style. I know I am not alone when it comes to disliking confrontation. I know I am not the only one who dislikes micromanaging people or working with numbers. Think about how much time I save because I don’t read spreadsheets to find out how I can bring the hygiene-per-patient average up from $124 to $128. Think about how much better my life is because I don’t care that my expenses are 2 percent higher this month than they were last month. Pennies, I tell you.

Compared with having a patient who loves coming to your office and feels so comfortable at your office that he or she keeps coming back. Compared with patients who trust you when they want to make their smile prettier. Compared with a grandmother who loves you as her dentist so much that she wants to send their grandkids to see you and doesn’t care how much it costs. That is really what I care about it. All of those other things? I will worry about them tomorrow.

Tell me about your management style. Am I alone in offering this type of “leadership”?

John Gammichia, DMD, FAGD

Wednesday, April 19, 2017

The Dental Admission Test: Not Just an Entry Test

Does anyone remember the Dental Admission Test, aka, the DATs? For the nondentists, it is exactly as it reads: an admission test that must be passed successfully to enter dental school. Yes, I know I should have blocked it out of my memory once I saw that I had passed, but I thought about it recently. 

The other day, I found myself — mouse in hand — staring at a two-dimensional screen but manipulating a three-dimensional tooth model. For those of you familiar with CAD/CAM, you know what I am talking about. Rotating, smoothing and shaping these “models” of virtual teeth and their future restorations is not exactly easy. I wanted to reach in through the screen and simply handle the models with my own hands. And that’s when I remembered the last time I had those thoughts: when I was sitting in front of a computer screen taking those dreaded DATs.

The test included a section that examined a student’s understanding of spatial objects, and the skill required the test taker to think in three-dimensional ways. That section is called “perceptual ability.” At the time, I’ll admit to sharing stories with friends about that section, and if anyone is familiar with triathlons, it’s much like the swimming portion of a triathlon — you just get through it and move on to the next sections. Some of us weren’t thrilled about that part. In fact, some of my friends didn’t see the connection with dentistry at all.

Seventeen years after taking the test, I think it was smart to include that section in the test. The entire field of dentistry is based on acquiring and developing perceptual ability. It sometimes seems as if we deal with much more than three dimensions and don’t necessarily see them most of the time. Negotiating a root canal or extracting teeth are examples of “imagining” multidimensional anatomy, if such a thing is possible. In fact, even giving a routine injection demands imagining where tiny cylindrical nerves are located within a mass of bone layered with tissues.

Entry requirements to dental school might have changed since my time. During dental school, I was actively involved in the predental arm of the American Student Dental Association (ASDA) and had been a resource for predental students at my alma mater. It was so gratifying to mentor students who are grumpy about the tests and subjects they are taking to enter dental school. I was basically telling them that they weren’t a waste of time. That they actually do relate to the profession in one way or another and more so, with the evolving technology within the profession. If there’s a student out there who barely passed the perceptual ability part of the DAT, you bet you’ll be tested on that endlessly on the first day of clinical dentistry. From mentally folding cubes on one screen to mentally milling a crown on another almost two decades later, my perceptual ability is still being tested.

Zeynep Barakat, DMD, FAGD

Wednesday, April 12, 2017

Asking for Referrals: The Most Powerful Marketing Tool in the World

In last month’s blog post, “Systems for Success,” I noted that there are more than 300 systems or procedures (excluding clinical) in any dental office that when properly designed, implemented and rehearsed serve as the blueprint to success. In fact, after reviewing hundreds of dental offices, including my own, I have found that well thought-out systems and protocols are at the core of highly trained teams who deliver excellent dental care, supported by superb customer service. 

Intuitively, this makes sense. As dentists, we were taught clinical procedures in a step-by-step fashion. For most of us, it goes something like this: seat the patient; ask if there is any change in the patient’s health history; take the patient’s blood pressure and heart rate; place topical anesthetic; deliver local anesthetic; use the No. 557 bur; remove decay; place matrix, wedge, etch, primer and adhesive; use a light cure, etc. You get the point. When delivering dental treatment, we progress in a logical and systematic way that yields excellent outcomes most of the time. What about the nonclinical side of dentistry, though?

Analogous to the systematic manner in which we provide clinical dentistry, every dental business should possess step-by-step protocols how to answer phones, provide financial options, present recommended treatment, collect monies, schedule patients, address medical emergencies, transfer patients from one employee to another (handoffs), ask for referrals and many, many more. In other words, dental professionals follow each business’s individual recipes, committed to writing, that when combined lead to predictable and meaningful outcomes — the seamless and impeccable kind of outcomes that patients rave about.

New patients are the lifeblood of the dental practice
In this blog post, we will look at one of the most powerful marketing systems in the world, a form of internal marketing that begins by learning to ask for referrals. Asking for referrals is a recruitment method for acquiring new patients that invites your existing patients to refer colleagues, family and friends to your business. Sound simple? It should be. However, it is one of the most overlooked marketing strategies in the dental business, with less than 10 percent of dental offices employing this technique regularly. Why? Various surveys and my own experience reveal that most dentists and dental teams assume their patients will automatically share good words about them, and they simply don’t think to ask. Others report they don’t believe it is important enough or they are embarrassed to ask. Some believe they don’t need new patients. This simply does not make sense.

As many of us know, new patients are the lifeblood of any dental practice. Why? Because of attrition, or the normal loss of patients associated with moving, relocating, loss or change in insurance, unemployment, divorce, death and numerous other causes. In fact, the median attrition rate for solo practitioners in the United States is 3 to 5 percent annually. For example, if a dental business has 2,000 active patients, defined as anyone who has been in for treatment within the past 18 months, then they can anticipate losing 60 to 100 patients per year due to normal attrition. As a result, it is important to offset this loss of patients by adding new patients to replace them and help the practice grow. In the ideal situation, the astute businessperson realizes that by adding quality patients, or what I refer to as “A/B” patients (who arrive on time, pay their bills, appreciate you and your team, are not insurance-driven, etc.), they can predictably grow a patient base that appreciates and values excellent clinical dentistry and five-star customer service — a means to a recession-proof dental business, not a company dependent upon external marketing campaigns whose precursor is to attract price shoppers looking for the free prophy, $300 dentures or $400 crowns. Value-added patients create tremendous goodwill and substantial profits so when it comes time to sell your practice, you reap the rewards of hard work. In a March 1, 2017, The Daily Grind blog post, “The Profitability Factor in Selling a Practice,” blogger Andy Alas, DDS, was kind enough to share his own experience regarding potentially selling his practice. Thank you, Dr. Alas.

In his national best-seller, “Influence: The Psychology of Persuasion,” Robert B. Cialdini, Ph.D., outlines the six laws of persuasion and explains the psychology of why people say “yes.” Dr. Cialdini is the originating expert in the rapidly expanding field of influence and persuasion, whose teachings are circulated worldwide. Two of the laws, the law of reciprocation and the law of liking support, address “asking for referrals,” noting that people buy from people who are similar to them and from people they like. We have all heard the adage “birds of a feather flock together.” This proverb dates back to the 16th century and can be interpreted as people who have similar interests and characteristics or who like to socialize together.

Recently, the Levin Group reported its results of a survey of dentists. It revealed that 88.3 percent of respondents stated that “referrals from current patients are the most successful marketing method.”

Our findings and data are very similar. This form of internal marketing ranks at the top of marketing strategies and delivers the most predictable results.

“Birds of a feather flock together”

In 2015, a worldwide study (in more than 100 countries spanning five continents) by The Nielsen Company. looked at consumers’ trust levels and how they relate to purchasing services and products. The results were unanimous. Family, friends and colleagues are the most trusted source of referrals in the world. It doesn’t matter what the product or service is. It is a universal finding.

In summary, asking for referrals is the most powerful and unequivocal manner in which to grow a successful and prosperous dental business. The chances of your most esteemed patients having friends like them are very high. These are the patients for whom you and your team should target your request. Begin today by asking your team to develop a script, or what I prefer to think of as learned verbal skills on how, when and whom to ask for referrals. Some key points to include:

  • Only asking patients who are ideal and represent the value you and your team deserve.
  • Asking your team to take action and develop a few key phrases that can be used when asking for referrals. 
  • Looking for opportunities keying on patient compliments. 
  • Soliciting comments. Upon checkout, have your front desk personnel ask patients about their visit. If the response is excellent, ask for a referral. If the response is poor, address the patient’s concern and attempt to resolve the issue before the he or she leaves the office and reviews your business on social media. 

Why do less than 10 percent of dental offices routinely ask for patient referrals? I am not sure. However, for those that do, congratulations. The best part about asking for referrals is that it is free — and it delivers the most predictable results.


Friday, April 7, 2017

Be Careful What You Wish For

You’ve heard dentists say, “I want to be busier.”

But have you noticed how much busier you are these days? Yes, dental practice owners are busier than ever. Perhaps they’re not always treating patients, but they’re definitely busier.

Each of us probably has an extra, unpaid part-time job. Like most things in life, being busier came about slowly. This dawned on me when I began to spend a lot of time in front of a computer screen long after my family had gone to sleep.

Here is the premise: Why would a corporation pay someone to accomplish several tasks when it could, instead, have a highly educated doctor do it for free? We, as dentists, are now doing jobs once held by others.

I first noticed this trend several years ago with concert tickets. Some of you may be old enough to remember standing in line to purchase tickets to see your favorite artist. Then the internet came along. Now, you don’t have to physically stand in line. However, you do print the ticket using your own computer and ink. Now, you pay a “service charge” for the privilege of doing this. You are now doing a job once held by someone else. Of course, the ticket companies said this would lead to cost savings that would be passed on to you, the fan. I don’t think it has quite worked out this way.

As far as being a dentist, it used to be that my office business insurance policies were audited once every few years. My turn would come around after several years because it was too expensive for the insurance companies to audit everyone each year. They would have to hire someone to contact me, receive whatever information I had to supply, analyze it, etc. This, of course, cost them money. Not anymore. They can now have a person holding a doctorate degree do this for free each and every year. They require me to log in each year and input all of the numbers for them. It requires no effort on their part, no real expense. We, as dentists, have become their unpaid data-entry professionals.

Remember the days when you would call payroll? Someone would take your data and process your payroll. Now, either you do it on your computer, or your staff does it on the web. You either have become the payroll specialist, or you pay for one on your staff. Again, you are doing the job once held by someone else.

Even companies that you pay to help you keep up with government regulations have joined the game. They used to send you the printed updates for you to include in your office handbooks. Now they just send you a letter with the links for you to locate and print them. Yes, you do the work of printing and collating all of this documentation. You perform a job once held by someone else.

Recently, I had the State Department of Radiological Safety contact me for an audit. The state wanted to make sure our X-ray machines were up to par. No problem. I asked, “When do you want to come in to inspect our X-ray machines?” No, instead, I was sent all the materials so that I can expose the special film myself and mail it back. Again, the state either has a highly educated doctor do the job for free or has this same doctor cover the salary of the person doing the job that was once held by someone else.

Lastly, we’ve all had the same experience while traveling by airplane. It used to be that a travel agent would acquire your flight ticket. Once at the airport, someone would check in your luggage by placing that destination sticker around your luggage handle, then print your boarding pass.

These days, why pay all of those people when the airport can have you do it for free? Now, you purchase your tickets online, you print them, you print your own boarding pass and, once you’re at the airport, you tag your own luggage. As I’ve often said to my wife, “Pretty soon, they’ll have me flying the 747 myself.” Here I am preparing for that day:

(The gentleman on the right is a 20-year airline pilot. I’m the guy on the left. Sure, it’s a flight simulator, but I’m getting ready nonetheless.)

You’ve often heard dentists complain about not being busy enough. As the old saying goes, “Be careful what you wish for; you just might get it!”

Andy Alas, DDS

Friday, March 31, 2017

Systems for Success

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

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

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

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

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

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

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



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