Tim Twigg
Case presentations do not have to indulge in such tricks as pressure, hype, fear or guilt.
Most dental experts agree: Your rate of acceptance for the different types of treatment you do determines the level of success you experience. The better your case-presentation skills, the better your rate of acceptance. Yet, developing more effective case-presentation skills often is the most neglected component of the dental-practice model.
Learning to be more effective at case presentations implies learning sales skills. Dentists, though, have a tendency to resist sales, thinking that:
1. Treatment should sell itself. If it doesn`t, it must be due to influences beyond the dentist`s control, like cost, insurance companies or other factors.
2. In order to sell treatment, the dentist would have to compromise his or her ethics; in other words, the dentist would have to be slick and manipulative, employ unethical sales tactics or even wear a white belt with white shoes and purple pants.
Because of the negative stigma associated with sales, most practices spend a disproportionate amount of their resources (time, energy and money) on marketing and considerably fewer resources on case-presentation skills.
Without sales, the fruits of your vision and marketing labors go nowhere. Without sales, there is no money to collect, appointments to make or services to deliver.
The truth is that effective case presentation is really about communication and building value, not about mastering tricky closing techniques.
From a sales perspective, dentistry has traditionally used a need/fear-based approach to selling dentistry. The typical case-presentation scenario goes something like this: patient comes in, is seated in the chair, is examined by the dentist and then is told what he or she needs. The telling involves communication like this:
"You need to have this done or else..."
"If you don`t get this done now, you are going to..."
And then the fight begins: "Do I really?" "Can it wait?" "Is there a cheaper alternative?" "I think I`ll get a second opinion." "What will my insurance pay? I`ll do only what they will pay for."
Also, because traditional treatment plans are determined principally by the dentist, the dentist`s sense of self-worth invariably becomes tied to the outcome. Rather than present full comprehensive cases and face possible rejection, quality treatment is compromised by presenting pieces to gain some acceptance and avoid fights. This, coupled with falling prey to assumptions like "my patients will only do what insurance pays" or "my patients can`t afford comprehensive dentistry" is the principal reason for one-tooth-at-a-time dentistry.
Where is the building of value or desire in this traditional approach when the dentist essentially determines and dictates the treatment-plan agenda and tells the patient what he or she needs?
Even with its pitfalls, the traditional method has worked pretty well due to a lot of patients with a lot of need. Besides, need, fear and pain make for easy sales. But those times have changed:
* The amount of needs-based dentistry is shrinking, largely due to the shrinking incidence of tooth decay due to the use of sealants, fluoride and generally improving societal health. The results of a study by Proctor and Gamble shows the average number of cavities in children aged 5-12 is now three, compared to 12-15 in the 1960s.
* Dentistry stopped extracting teeth as routine treatment 20 years ago. As a result, the average adult has nine more teeth in his or her mouth compared to 20 years ago (meaning no extracted teeth, no bridge work or implants). An ADA/Colgate Oral Health Trend Survey indicated that nearly 90 percent of all 18-year-olds have all of their natural teeth and that nearly 85 percent of individuals 24-44 have 20 or more of their natural teeth.
* According to ADA studies and published surveys in Dental Economics, the average practice overhead is approaching nearly 70 percent, due to the effects of limitations of fee increases, higher costs of doing business and the overhead required to run a practice.
* Insurance companies looking for their own profits will work to keep fees low and not increase annual maximums.
Patients know that they don`t always need the treatment dentists tell them they need. Why is that? Because when they don`t have the treatment, nothing tragic happens. They don`t die, go to jail or get a serious illness.
Can dentistry really blame the public for distrusting the industry, especially with all of the horror stories about doctors, HMOs and dentists reported in the media?
Because a needs-based approach limits the possibilities for treatment to just the findings, you miss out on the wider range of incredible treatment opportunities that are available now in dentistry.
Fortunately, some wonderful trends exist in our society that can work in your favor to help improve this situation. Many people want and appreciate quality and are willing to spend money for it; people want to look good and are willing to spend money to do so; and people want to be healthy and live long, productive lives, and are willing to spend money to do so.
These trends point to a predisposition to long-term, aesthetic dentistry, almost all of which is elective and discretionary and, by definition, not needs-based. Evidence of this also comes from an American Academy of Cosmetic Dentistry study which showed that:
* Over 90 percent of Americans agree that an attractive smile is an important social asset;
* Over 70 percent of Americans agree that an unattractive smile can hurt a person`s chances for career success; and
* Only about 50 percent of Americans are satisfied with their own smiles.
To truly communicate and build value, and more effectively present dental services, calls for a different approach. This approach requires dentists to re-examine the purpose of dentistry. It requires dentists to come out of the dental closet and boldly proclaim, "Yes, this is a business, and my purpose and my job are to satisfy patient wants."
That`s right-the shift in orientation is that your job as a dentist is to satisfy wants, not just fix needs. How does satisfying these wants benefit you? Because satisfying wants is:
* More fun, personally rewarding and professionally satisfying;
* More profitable, allowing you to realize the financial rewards commensurate with the investment of money, education, hard work, dedication and commitment; and
* Better protection from the economic changes of the dental-business landscape and, therefore, provides greater long-term security.
Elective and discretionary dentistry are like a new frontier-the growth areas. The technology, materials, techniques and capabilities are truly amazing. Since managed care`s orientation is not toward elective and discretionary dentistry, the door is wide open to a great opportunity for those dentists committed to growing that area of their practices.
Put another way, this is indeed a new universe of possibilities in dentistry. It does not negate the dentist`s responsibility to provide treatment that will ensure pain-free health - the new paradigm encompasses the old - but a proper dialogue between the dentist and patient now will include the new wants-based possibilities and not just the needs-based ones.
By learning case-presentation skills geared for elective and discretionary dentistry and with higher treatment acceptance per patient:
- The return on invested marketing dollars will be higher;
- Accepted treatment will be more comprehensive, meaning less patch-up, fix-up and one-tooth-at-a-time dentistry;
- Appointment times will be longer, with less room set-up, breakdown and infection-control costs;
- You`ll see fewer patients per day, meaning lower stress and better quality service;
- You`ll have less paperwork and administrative costs, thus reducing your overhead expenses; and
- You`ll have more money to show for your hard work.
Tim Twigg has more than 20 years of experience in the dental field and is the president of the Coaching Resource Center, a division of CRC. Inc., a Eugene, Oregon-based, practice-management consulting corporation. More information can be obtained by calling (800) 345-3169.
Offering comprehensive care to patients
Scenario #1: Typical Practice
20 new patients each month,
80 percent are presented with a treatment plan,
With 80 percent accepting, and
An average case fee of $1,500
Put another way, this would mean that 12 to 13 of the 20 new patients are proceeding with treatment. This brings in $19,200 in production per month (20 x 80% x 80% x $1,500).
Note: The rest of the typical month`s production would come from hygiene, emergencies and other restorative procedures.
Scenario #2: Same practice, now presenting more comprehensive cases with a lower acceptance rate.
20 new patients each month,
80 percent presented with a treatment plan,
With only a 40 percent acceptance rate,
With the average case fee being $4,000.
This would mean only six - seven of the 20 new patients are going ahead right away. The resulting production, though, is now $25,600 (20 x 80% x 40% x $4,000) or an extra $6,400 per month ($25,600 - $19,200).
On the profit side, assuming that all fixed overhead costs already are paid and the only appreciable expense associated with this increase is the lab costs and supplies - which amounts to maybe 15 percent at most - the net profit increase is approximately $5,440 per month ($6,400 less 15% = $5,440) or an additional net profit of $65,280 per year. Not bad!
Worksheet #1: Your current situation. (Round your numbers up or down as appropriate)
Variables:
1. Net collections for the last year or for a recent 12-year period: $__________
2. Lab expense as a percentage of last year or for a recent 12-month period: ___________%
3. Total lab expense for the last year, or for a recent 12-month period: $ _______ (multiply your lab percentage by the collections to determine total lab expense)
4. Average lab cost per unit (for simplicity, use average crown unit cost): $ __________
5. Average unit fee to the patient (for simplicity, use average crown fee): $ __________
6. Number of days worked on average each month: __________ (If you typically work four-day weeks, your monthly average is 17)
Calculation:
Step 1: Divide the total lab expense (Variable #3) by the average lab cost per unit (Variable #4) to determine the number of units you averaged during that 12-month period: ___________
Step 2: Divide the number of units from Step 1 by 12 to determine the number of units you average each month: ___________
Step 3: Divide the number of units from Step 2 by the number of days you work on average each month (Variable #6) to determine the number of units you average per day: ___________
Worksheet #2: If your lab-related production increased by 50 percent
Variables:
1. Use the same variables from Worksheet #1.
Calculation:
Step 1: Multiply the number of units you average per day (from Step 3 on Worksheet #1) by .5 to get the number of additional units per day with a 50 percent increase in unit production: ______________
Step 2: Multiply the number of units you average per day (from Step 3 on Worksheet #1) by 1.5 to get the total number of units you would average per day with a 50 percent increase in unit production: ______________
Step 3: Multiply the number of units you average per year (from Step 1 on Worksheet #1) by .5 to get the number of additional units per year with a 50 percent increase in unit production: ______________
Step 4: Multiply the answer from Step 3 by the average unit fee charged to the patient (average crown fee) to get the increased production realized per year on the additional units: ______________
Step 5: Multiply the answer from Step 3 by the lab cost per unit (Variable #2) to get the lab cost on the increased production: ______________
Step 6: Subtract the answer from Step 5 from the answer from Step 4, to get the approximate increased net income realized per year: ______________
Worksheet Summary: Fill in the blanks and then read this to yourself.
"If I increased my units per day by only ____________(answer from Step 1) over what I am doing right now, I would realize additional production of $ ___________(answer from Step 4) per year, which would lead to an increase in net income of around $ ___________(answer from Step 6); all by averaging only _______(answer from Step 2) units per day." Not bad!
