by Dwight Jones, DDS
Once upon a time, there was a shoe store that only sold black shoes...
All of the shoes were the same style and made of the same material. Large shoes cost more than small shoes, but that was the only choice the store offered to its customers. The black-shoe store had a fairly good business until a new store opened in town.
The new store only sold white shoes. They came in several styles and materials, but all of them were white. The owner of the white-shoe store told customers that black shoes were of poor quality. The black-shoe storeowner said the same thing about white shoes. (Both of them were right more often than they would like to admit.) The white-shoe store made more money than the store that sold black shoes, but both of the owners thought something was missing, and they wanted to do better.
Eventually, both shoe stores started offering a wider variety of quality shoes in any color the customer wanted. They sold dress shoes, work shoes, running shoes, and loafers. The owners went to shoe conventions where they could learn about all the new styles of shoes. They started taking special orders from customers and showing them all the choices available. The people in that town learned to appreciate fine shoes, and both stores prospered.
Four factors contribute to a busy dental practice: location, dental insurance, the ability to attract patients and present dentistry to them, and the actual ability to do the dentistry.
Dentists who have an excessive dependence on location or bad insurance plans probably have not given enough thought to the other ingredients of a busy practice. Those dentists who wish not to deal with patient insurance plans must have a total mastery of the other three ingredients.
Here are seven steps intended to im prove your practice enough so that you can stay in your current lo ca tion and still have free dom to decide which in surance plans you would like to accept.
Step 1 - Free up some money
Reduce your living expenses to the point where you can afford to take some financial risk. The seven steps should cause your income to start going up in a year or so, but you will need to give yourself some breathing room if you wish to make it a reality. You can never be free as long as you are dependent on a monthly capitation check.
Step 2 - Free up some time
Cut your workload by 20 percent. Do this by dropping your worst managed-care plans or by dropping those patients who do not show up for their appointments. (Note: You can skip this step if you are already working less than 25 hours a week.)
Step 3 - Put the time to good use
If you cut 20 percent off a 35-hour week, you will have seven hours of free time. If the time doesn't immediately fill up with cash patients, you should spend the entire seven hours on continuing education. This may seem like a lot of CE, but that's what I needed in order to get where I wanted to be. (I'm not quite there yet, but the road is enjoyable!)
Your self-improvement can take many forms. You can take classes, watch videos, read journals, go to seminars, and visit your friends. Do whatever it takes to be at the top of your profession. Every new technique that you master will give you another source of income that doesn't depend on managed care. A blue-collar practice may not give you a chance to do a lot of porcelain inlays, but you will get to do enough to make it worth learning how to do them well. The same thing is true of a hundred other procedures. Do you see how you might eventually get to be too busy to need any low-end insurance plans? Do you see how this kind of practice would be more fun than spending your life looking for holes to fill with amalgam?
Step 4 - Remember that you get to choose
I can't think of any other profession - not medicine, not law, and not education - that offers as many choices as general dentists have. As dentists, we really do get to choose what we will do at work and how we will do it! We get to choose how big our practices will be. We get to choose how much work we will do in a day. We choose what insurance plans to accept. We choose whether to work full-time or part-time. We choose who we will work with. We can choose solo practice, group practice, or government practice. We can find a little niche that we like or one in which we can serve a wider variety of patients. We set our own fees. If we don't like what we are doing, we can pick up the phone, sign up for some CE, and start doing something we like. Anyone who doesn't enjoy dentistry has not taken time to choose what he or she really wants.
When you go to management courses, try to expose yourself to a variety of extreme viewpoints. If you listen to only one expert, you could be led in a direction that is not right for you or your practice. If you don't listen to any extreme viewpoints, you may not be aware of the choices available to you. By hearing and understanding the real benefits of numerous practice alternatives, you become better equipped to decide what is best for you. You may like one of the extreme styles of practice being promoted today, or you may choose to stay somewhere in the middle. It is possible that you may end up charting a totally different course - one you wouldn't have thought of if you hadn't observed the way others are running their practices.
Step 5 - Set realistic goals
If you're like me, your office is located next to a feed store in a small town where the average annual income is very low. I like my town and I plan to stay, but I think it is unrealistic to think that every dentist should dump all of his insurance patients and do veneers all day long. I think it is realistic to expect every dentist to do good work, make an honest living, and have enough freedom to drop any insurance plan that is unfair to him or her or to his or her patients.
If our main goal in life is to have seven operatories, we may have to do some unsavory things to fill up those operatories. If we are happy with what we can produce in a smaller office, we can be more selective about what kind of patients we want to treat and what kind of insurance we will accept. It's better to run out of room for new patients than it is to run out of patients to fill up new rooms.
Step 6 - Consider welfare as an alternative to "temporary" capitation
When you take capitation patients into your practice, they won't fill up the slow part of the day. Capitation patients will need to be seen at the same time as your cash patients, and they will crowd out the patients you really want to treat. Also, taking capitation plans could encourage your existing patients to sign up for capitation insurance. It's truly a no-win situation.
Welfare patients actually can be scheduled for times when you would not be seeing any other patients. Welfare is a good way to get temporary patients to fill in during a slow month. In any given year, a number of your welfare patients will move away or get jobs. It is easy to expand or shrink this portion of your practice simply by deciding how many new patients you will accept each month. With managed care, it's not so easy to turn the faucet on and off as your practice grows. Also, welfare pays better in some states than capitation does!
If you treat welfare patients, spend time with them and treat them with the same respect you give to everyone else. It's good business, and it's the right thing to do.
In a small town, rich and poor people are not as segregated as they are in larger cities. Therefore, welfare patients are a better source of referrals in a small town than they would be in a big city. More importantly, some of your welfare patients will become cash patients when they find a job.
Some segments of the welfare population are notorious for missing appointments, while others are very reliable. I think foster parents are the most reliable people in the world. If you enjoy pediatrics, you may want to spend some of your mornings seeing foster children. It's a good service to your community, and it's a lot more fun than getting ripped off by an HMO.
Step 7 - Take a long-term view
At any given time, you could generate a sudden increase in take-home pay by cutting the amount of time and money spent on self-improvement. This is shortsighted, because it will limit your ability to do better next year and the next.
A real "general dentist" is not "someone who didn't take a specialty."
A general dentist is someone who increases his or her skills in every area of dentistry so that he or she can better serve his or her patients. Specialization is fine if that's what you like and if your town can support a narrowly focused practice. Many small towns don't need specialists as much as they need real general dentists who can offer a wide range of services. Following the seven steps is the best way I know to succeed in a blue-collar town.