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Why is the business side of dentistry so much less fun?

Sept. 20, 2019
Why is running a dental practice so much harder than doing dentistry? Why is it more fun to prep three crowns than to do one job interview?

Why is running a dental practice so much harder than doing dentistry? Why is it more fun to prep three crowns than to do one job interview? Why is it many of us have said at some point in our careers, “I wish I could find someone to run the front office so I could just be the dentist?”

It all comes down to two words: knowledge and experience.

We have knowledge about the clinical aspects of dentistry. We spent four years acquiring that knowledge—just on the oral cavity and its related structures. It calls to mind a brief discussion I had about this with a friend who is also an MD. He looked mystified when he asked, “How in the world can you spend four years on just the mouth? I think we had two lectures on it in medical school.”

Looking at it in that light, it’s actually pretty amazing that we spend so much time learning about dentistry. And that doesn’t include all of the clinical experience and continuing education after graduation.

Let’s break this down further. If you work 35 hours a week and take two weeks of vacation, you have treated patients for 1,750 hours a year. That means that in 10 years, you have 17,500 hours of knowledge and experience. And after 20 years . . . you get the idea.

I found in a recent online search that airline pilots are only allowed to fly 1,000 hours in a year. To captain a flight, it only requires 1,500 hours—although this would be on shorter flights. That’s less experience than most dentists have in a single year. And they take the lives of thousands of passengers into their hands.

When we sit at the chair, seeing patients and doing what we love, we have the same amount of confidence as the captain of an airplane. What gives us that confidence is having certain rules we’ve developed that help us make decisions: When preparing the site for a restoration, don’t leave any decay. When placing a restoration, don’t leave an overhang. Don’t leave the occlusion too high. 

Our training and experience helped us to develop rules that guide us in our clinical decisions, making it possible to operate quickly and confidently. We don’t have to “think” about them. 

I understand that your clinical rules will probably vary from those of your colleagues, but as long as we all practice within the standard of care established by each state, then everyone is right. When we follow our rules, we practice with confidence and pride, and the clinical part of dentistry is a cinch. 

Why then is the business of dentistry so difficult? It’s because we spend thousands of hours learning and practicing dentistry and next to zero hours learning how to run a dental office. And besides that, there is no “standard of care” for running a business.

I began reading business books within six months of graduation. I became overwhelmed with the many different opinions and ideas about how to hire, manage, pay bonuses, set fees, etc. It honestly made me feel confused, inadequate, and sometimes stupid. 

Finally, in 1992, I got some basic business training and developed my own “rules of engagement” that all of a sudden made most business decisions as easy as my clinical decisions. 

I’m going to share a few of my business rules, and hopefully these will help make your days as an owner a bit simpler.

Diagnose and treat every patient as if they were a close friend or relative—or you

The first one is a bit of a clinical rule, but it involves diagnosing and treatment planning—not the delivery of dentistry. I can’t tell you how much easier diagnosis and treatment planning became when I just looked at each clinical situation and said, “What if this was my mom, my wife, my brother, or me?” The decision was all of a sudden clear, obvious, and simple.

Forget about what the insurance covers

I get some doctors who will argue with me on this one. They claim that they can’t get patients to do what they need—that everyone only wants to do what the insurance allows. Try this. Ask every patient a couple of questions: Do you want to keep your teeth? How do you feel about dentures? If they say that they want to keep their teeth and avoid dentures, then getting them to do what they need instead of what is allowed by the insurance is as easy as a buccal pit restoration.

I would say: “Great. That’s exactly how I feel. Is it OK with you if I do your exam and make my recommendations just as if it were my mouth and we forget about the insurance for a minute? I want to help you keep your teeth as long as I want to keep mine.” I never got any resistance after that. 

It was, obviously, different if they didn’t care about their teeth and didn’t mind having a denture. But the point is, don’t just cave in and do only what insurance will allow. Get to know your patients and hold your ground as their doctor.

My fees are my fees

Everyone loves getting a good deal. And patients will oftentimes ask if you can do better on the fees. I can write about 20,000 words on this, but the short answer is that once you make a deal and lower your fees, you are just announcing that you are ripping everyone else off who pays the full price. It has a used-car salesman feeling to it.

Each year, I purchased a dental fee survey for my area. It lists the fees for the routine procedures done in my three-digit zip code region. I placed my restorative fees in the 80th to 90th percentile. I placed my hygiene and pedodontic fees in about the 60th to 70th percentile. I felt good about that. I was completely prepared for patients to leave to find a cheaper doctor. That didn’t bother me in the slightest (read my article in August’s issue and you’ll see why).

Have fun

Dentistry is a stressful profession. We are putting needles and drills in people’s mouths, and they don’t like it. It goes with the territory. 

But I got to choose who I worked with and who I treated. And I chose to hire and work with staff who could have fun in a stressful environment. Not everyone is wired like that. 

I chose to work on patients who respected me and my staff as professionals. I am not required by law to treat patients who are disrespectful, rude, and antagonistic. It didn’t happen often, but I did not hesitate to dismiss a patient from the practice. Every employee I hired had to be on board with our practice philosophy and culture. 

Obviously, this list could be longer. But these are a few guiding rules that made practicing dentistry a lot more fun. I suggest you make your own. You are the only one who can make your list. Then apply your rules with confidence, certainty, and pride. You’ll be amazed at how your staff and patients respond, and how much better you will feel.

GREGORY A. WINTEREGG, DDS, is an internationally recognized practice management speaker and author. After transforming his small-town office into one of the top practices in the nation, Dr. Winteregg joined MGE Management Experts as a partner in 1994. Since then, he has personally consulted and lectured to tens of thousands of dentists. Visit mgeonline.com or call (800) 640-1140 to learn more about MGE and the upcoming calendar of CE events across the United States and Canada.

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