THE BU$INE$$ of the BU$INE$$ of DENTI$TRY

Sept. 1, 2004
In Part 1 of a five-part series, a retired dentist explains why the 'practice' of dentistry and the 'business' of dentistry must mesh.

A new series created by Alan Stuart Markoff, DDS, MBA

There is a fine line between the "practice" of dentistry and the "business" of dentistry. I spent some 40 years practicing dentistry. Now, with a master's degree in business, I realize I never reached my "business" potential and therefore, my "practice" potential.

I rejected marketing, other than internal. I rejected outright advertising as unprofessional and expensive. I realize now that I deceived myself, and probably never realized the number of clients I aspired to treat.

Now that I have been away from active practice for some five years, and am able to step back and assess the experience from afar, I realize that the "practice" of—and the "business" of—dentistry need to mesh.

Numbers

Is it crazy behavior to be preoccupied with production/collection/new patient numbers? I don't think so. I sense we all want, and need, a barometer of our journey. My questions to each of you are: Are you reading the numbers correctly? Do you know which numbers are the most significant? And, most importantly, do you grasp what the numbers are telling you?

Production/collection vs. profit

Some dentists have naturally attractive personalities and attract large numbers of patients without even trying. They are not always the most profitable, and are not always the best technical dentists. I also sense they do not realize just how fortunate they actually are.

So many practitioners are scratching, clawing and, would you believe, praying that new patients will call and schedule. Since these doctors see fewer people, frequently they are more thorough relative to examinations (this is good). They have to do this to be more productive. Dentistry is more of a struggle for them. For both groups, the business of the business of dentistry is frequently an enigma.

Hopefully, this series of articles can shed some light on this aspect of your practice, and clue you into the poignant aspects of business that can change your "practice life."

The problems remain universal: How does one keep production up, expenses down, and find some money to take home each month? Some of you even have the audacity to entertain fantasies of saving money!

Overhead

We always received, each month, a computerized print-out of our expenses. This consisted of the actual cost of a given aspect of overhead, plus that percentage of the whole that it represented. Along with my preoccupation about keeping production, collection, and new patient numbers, this print-out was my favorite reading material monthly.

The biggest numbers, both actual and percentages, were: salaries, laboratory, rent, and dental supplies. So, the question is: How can we best control, minimize, or even eliminate, some or all of these major cost factors?

Each of these categories merits an article unto itself. Therefore, articles on these categories will be forthcoming.

Rent

Rent is always a significant number whether it represents actually leasing another's property, or owning the building in which you practice and paying yourself rent. I would opt for the latter because, when your journey is complete and you figure the amount of money that was spent on rent, the total will be a near-mortal wound.

If you own the facility like you do your home, then you are building equity and enjoying the positive tax consequences. When you sell the practice, you can either retain the building and have a passive source of income, or sell the building and recover most—if not all—of what you spent through the years for use and maintenance.

Laboratory

If you have a managed care (cost) practice, and you are doing prosthetic dentistry for compromised fees, you have few options. You must attempt to find a decent laboratory that charges very low fees. As in almost every avenue of life, "we get what we pay for." So, can we pay very little, and get consistently good work? Can one win the lottery once a month?

Laboratories can make or break you. Frequent "remakes" steal every ounce of profit. Some laboratories, on the other hand, do such extraordinary work, they can "pick and choose" the dentists with whom they work. Isn't that a fantasy most of us coddle relative to our clientele?

If you are striving to be the best cosmetic/restorative dentist in your community, find the best laboratory to be your support system and your partner. If you want to place veneers, and/or porcelain crowns, and feel a sense of immense pride because you know the work is extraordinary and you want these patients to be your missionaries, then expect to pay high fees for the laboratory aspect of cosmetic/restorative dentistry.

How can you do this and show a profit? Here's my suggestion to allow you to feel great about what you are doing and eliminate a significant overhead factor: Invite the patient to pay the laboratory fee. That's correct. Invite them.

Explain to each of your clients how important the laboratory aspect of the cosmetic/restorative dentistry is, and that you do not want to compromise the result. You want to use the very best laboratory for each client's case.

I utilized this approach for the last 20 years of my practice with few, if any, objections. Was it self-limiting? Of course. Did I lower my fee, and then share the laboratory cost? No. The fee remained the same, and the exact laboratory fee was shared with them at the completion of the case.

I would urge that you estimate the laboratory cost in the beginning, and put it in writing. We estimated on the high side, usually coming in with a lower fee, and the patients felt good about it. The final fee was lower than anticipated.

The only decision you have to make then is what laboratory you are going to utilize for your patients, based on each patient's needs and desires, and not dictated by your overhead objectives.

When people make a decision to purchase cosmetic dentistry, they want your best effort and the most beautiful result they can get. If approached positively, they will pay the additional monies with appreciation and gratitude. Patients do not want dentists to compromise their treatment.

There is a bit of salesmanship involved here but, when you become comfortable with the concept, you will be astounded relative to the level of acceptance. Just remember that excellent labs can make you look like an artist. Poor and mediocre labs cause you to look like all of your colleagues, at best, and a bad choice for the patient, at worst.

One last thought on this issue. Name another aspect of medicine that pays for a patient's laboratory fees. I know of none!

Dental supplies

There are a number of ways to keep a handle on supplies. You can, as many offices do, comparative shop for items. You can form a co-op with your study group or neighbors. Both of these approaches can be time consuming, and a drain on the practice.

Many dental supply houses will put your office on their computer, and send you supplies only when they are needed.

One dental supply company, which does this routinely, will respond to your numbers and budget, and guarantee not to surpass them during the year. If they do, they refund the difference at the end of the year.

If I were still practicing, this type of company would be my supplier. I like the concept. It frees up my staff members to do what they were originally hired to do: make the experience "unforgettable" for the patient.

Salaries

This is frequently the biggest overhead factor. It is easy to choose to diminish salaries by diminishing the quality of your team. Each of us has to decide what image we want to present, and what skills are most important to the success of our practice.

In my adult restorative practice, I wanted "super stars" at the front desk, at the chair with me, and in hygiene. Other team members were chosen from high school work programs, and paid at or near minimum wage.

Previously, I thought that the dental business was all about people. I have subsequently realized that is not exactly how it is. It's not about people. It's about the right people. You must have the right people on your metaphorical bus, and in the correct seats.

Only then can you thrive.

Conclusion

As I offered in the opening lines of this article, there is a fine line between the "practice" of dentistry, and the "business" of dentistry. Define, for you, what the parameters of each are, and then blend them into a winning combination. They definitely do fit together. In actuality, they need each other for ultimate success and happiness.

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