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

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

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.




Duke Aldridge, DDS, MBA, MAGD, DICOI, MICOI, FMISCH

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