Dentists of distinction

Sept. 1, 1997
For a time during the post-World War era, all dentists earned the same amount of money. Dentistry was a quiet profession, always there for the patient. As dental plans emerged in the 1970s, dentistry changed, and this change dramatically and permanently affected our earnings.

By displaying a little evangelical gusto, dental practices do not have to buy into managed care.

James Pride, DDS

For a time during the post-World War era, all dentists earned the same amount of money. Dentistry was a quiet profession, always there for the patient. As dental plans emerged in the 1970s, dentistry changed, and this change dramatically and permanently affected our earnings.

Today, it`s not uncommon for dentists practicing next door to each other to have a $50,000 to $200,000 disparity between their respective incomes. The reason? Four words: practice management and managed care.

Whether you feel compelled to participate in any dental plan is based entirely upon your attitude about your practice. No matter how many plans come knocking on your door, it`s entirely up to you to manage your practice as your business style dictates. Benefit companies pay for approximately half of all dental services. The other $21 billion - that`s right, I said $21 billion - is up for grabs.

Contrary to the rumors, dental plans are not going to take over our profession like they did with medicine. They won`t because dentistry is not viewed as an essential life-and-death benefit. A recent survey by Arthur Anderson ranked dental benefits in fifth place with consumers behind medical, disability, liability and life insurance. And while big business firms (companies with more than 100 employees) want to offer a dental plan to employees, they want to pay less than they did in the past.

Small companies (those with fewer than 20 employees) account for two out of three new jobs these days. Only 19 percent of these businesses offer what they perceive as dental perks to their folks. That leaves at least 100 million employees without coverage.

Over the past two decades, I`ve talked with more than 10,000 dentists. In all that time, I`ve never seen our profession more challenged than it is right now. Employers, big and small, are cutting back on dental coverage en masse. Just 20 years ago, 9 percent of all employers provided their employees with some form of dental coverage. Today, less than 48 percent offer a dental plan in any form.

Combine this fact with the entrepreneurial, small-business trend sweeping our country, and you`ll see how an independent practice can increase its wing span substantially.

Others cashing in

Roll-up companies are a new force to be reckoned with. These folks are cashing in on our practices at an ever-increasing rate. In return for a lot of paper, investors who know little about how a dental business operates are snapping up solo practices and groups. In 1996, asset-hungry investors purchased at least 77 American dental practices with a combined value of over $22,000,000.

Unfortunately, in my opinion, we can look for more of this kind of activity. Wall Street looks at dentistry as one of the top service investments, surpassing surgery centers, labs and pharmacies in potential earnings.

Only dentists of distinction will thrive during these precarious times. By dentists of distinction, I`m referring to men and women who possess that rare combination of technical know-how, communication and marketing skills necessary to survive - and, indeed, thrive - in this tumultuous climate.

Dentists of distinction practice the art of dentistry with evangelical gusto. You don`t have to buy into PPOs and capitation programs to survive. You value your patients, staff and self enough to command full value for your superior skills and training. You sense your patients` needs, responding with a level of service and genuine commitment that is immensely satisfying to them as well as to yourself.

Recently, at our annual conference in the Colorado high country, a gentleman approached me saying the same thing I`ve heard from hundreds of dentists across the country: "You can`t survive in my town without leaving a paper trail, Jim. It just isn`t possible. If I didn`t take nine or 10 plans, I`d die."

I listened politely while he expounded upon all that was particularly challenging to his practice in his part of the world. What I told him later was that standing no more than six feet from us was a dentist from the same town who had not participated in any plan for at least five years.

Naturally, attitude plays a role in everything we do. These two dentists had decidedly different attitudes about running their practices and the fees they charge. However, attitude alone does not distinguish between those who feel they must live off the plans and those who don`t.

If I had to limit myself to the most important quality that makes a dentist of distinction, I`d start with where it all begins and ends - with the patient relationship. You might think you`ve got a positive relationship with a patient, but how do you know for sure? The answer is perception, perception, perception!

Patients` relationships are all about their perception of you and your ability to communicate treatment options effectively while, at the same time, sensing their needs and responding to them compassionately and skillfully. Unfortunately, this can`t be accomplished with shotgun marketing or a business-as-usual attitude. There are no silver-bullet, quick fixes. Matching your perception with your patient`s reality takes time and a heads-up approach to everything you do.

Virtually every dentist I know with a thriving private-care practice embraces these principals of free enterprise, creativity and attention to detail. In fact, every successful business I can think of consistently addresses the issues outlined here. This is the beginning of an exhilarating process for creating and maintaining a thriving practice. Surviving as a dentist of distinction - not extinction - must become our mantra. We are, as a tribe, some of the most educated and talented people created. It`s up to us to recreate ourselves continually!

Establishing a presence

While steps such as those outlined in the checklist on the preceding page ensure sound patient relationships and ongoing patient referrals, sometimes we need more. Perception`s trusted partner is visibility.

Increase your visibility by establishing awareness with the patients you have now, as well as within your community at large. It is through these relationships that you will continue to build a name for yourself. I repeat, visibility is the name of the game here - innovative marketing and publicity help stake your claim. Implement the following recommendations and you`re on your way to the "Dentist of Distinction Hall of Fame:"

- Letters of testimonial, combined with before-and-after photographs of your patients (with their permission, of course), attractively displayed as a collage or in an inviting portfolio in your waiting room, will instill tremendous confidence while giving your office a distinctive personality. This is not a commercially purchased book of oral pictures, but a personalized album of the people who trusted you to make their lives more comfortable and productive.

- Hands-on involvement with your favorite local charity on a year-round basis. Whatever you`re passionate about - literacy, education, the arts, sports, mentoring youth or the environment - stand up and be counted as a leader. You`ll consistently make connections while supporting something bigger than your everyday world. This also is an excellent forum for media exposure.

- If you consider yourself a proficient writer, create a general or specialty article for your local newspaper and/or business publication a couple of times a year. If you`re not the writer type, hire a local journalism major to write the articles for you.

- Enjoy speaking in public? Hook up with your local speaker`s bureau. If you`re introverted, save your energy for behind-the-scenes activities, such as chairing an association committee or serving on a community board.

- Consider doing something extraordinary to get media coverage. Hire a local group of artisans to paint your wall with creative murals. Start a jazzy band made up entirely of dentists and hygienists. I know this might sound uncomfortable, but this is what some highly professional dentists are doing these days to keep their practices visible and robust. Use your imagination. The possibilities are limitless.

- Create an annual event or open house at your office, assuming it will hold a good 30 to 40 guests. Ideas to get you going include holding a reception for a local artist, sculpturer, storyteller or poet. Have a birthday party for the "tooth fairy" - you do remember her, don`t you? Host a limerick contest titled "My Teeth," inviting all participants to write and read their limericks at "Dr Richard`s Mouthing Off" bash. At a bare-bones minimum, every dentist should hold an annual picnic for patients and their families. Invite them to bring a friend as well. Be as traditional or outrageous as you like with theme, location, games, entertainment, food and prizes - but whatever you do - do it! The goodwill this simple event can foster is amazing.

- Don`t want to host an event at your place? No problem! Piggyback onto something you`d like to be associated with. Set up a book-drive booth for your local library as part of a literacy event. Make your office one of the drop-off points for Toys for Tots at Christmas; sponsor a needy family for Thanksgiving dinner; team up with local media (radio and television stations, newspapers and magazines). They`re always looking for more businesses to play a role in these visible activities. You`ll get some press coverage along with helping your community.

- Sponsor a scholarship for a young person pursuing a dental career. Meet with the principal of your local high school or the dean of your community college to discuss developing such a program. This is a good networking opportunity for you. You will become a mentor for young people. Make a contest out of your scholarship program and you`ll create another press opportunity in the process.

- While it sounds obvious, you`d be surprised to see how few people follow this basic principle: Invest in attractive business and appointment cards, letterhead, thank-you cards and brochures. Have a professional graphic designer create "your look" expertly printed on quality paper. Spring for a clever logo and slogan.

- Possibly the most effective marketing tool around also is the easiest. Join at least one local networking club or business association such as the Chamber of Commerce or an early morning breakfast exchange with other business people and professionals. Most communities have several active associations from which to choose. I know a number of dentists who pick up one or two new patients every month in return for enjoying the company of others.

- Sponsor your Chamber of Commerce`s annual business directory or a similar, much-referenced business directory. This can be achieved with the purchase of an ad creatively touting your services.

This checklist reminds you to:

x- hire `happy` people

x- express yourself on paper

x- survey, survey, survey

x- listen, listen, listen

Periodically review this reality checklist to ensure that you`re accurately perceived by your patients and your staff as the dentist of distinction you truly are. By all means, add to this list as you see fit.

- Hire emotionally stable, happy, healthy people. Despite what we hear, there is no shortage of them (except for hygienists, a subject we`ll tackle in a later article). Take the time to train your people. If they require education and/or training outside the scope of their experience, see that they get it. Practice precise verbal-skill systems with them. This is the single, most effective means of ensuring your patient feels good about what you want them to hear.

- Use a mission statement. Yes, I know. You`ve read this piece of advice over and over - but are you doing it? This is, in essence, your reason for being. Artistically display your mission statement by having copies professionally matted and framed. Place them in your reception area and in each operatory. Kick off every staff meeting by reiterating your mission. This keeps everyone focused on it and committed to a united philosophy and practice goals.

- Communicate effectively and emotionally with patients and staff. Have a game plan, starting each day with a morning huddle, updating staff and being updated by them regarding the current agenda. How do your staff members know when you can see an emergency patient if you don`t tell them? How do you know about scheduling changes, a distressed patient or supply and maintenance issues if it isn`t communicated to you?

- Fear occurs when you don`t know what to expect. Talk to your patients. Talk to them before, during and after treatment, keeping them relaxed and informed at all times. This is the ultimate form of service. There is, quite simply, nothing as important as active listening and empathetic communication. When taking an impression, ask the patient if she`s comfortable. When drilling, tell her what to expect, as well as when you`re finished with that part of the procedure. At the conclusion of the appointment, your assistant should debrief the patient again - one of the single, most important duties of an assistant. Debriefing is misunderstood by many and not done by most.

- Ask your patients how you`re doing through an annual survey. Keep it simple and to the point with short, direct questions and a numerical ranking system from one to five to rate their answers. Ask your receptionist or office manager to present the survey on attractive clipboards, inviting all patients to participate as they arrive for appointments. To encourage input, reward patients with an attractive, quality pen featuring your name, address and phone number; a charming boutonniere; or a thoughtful, dental-care product.

- Greet all patients by name upon arrival. After 26 years of saying, "Smile, smile, smile," I`ve concluded a smile is not always appreciated or even warranted. As outrageous as this might sound, there are times not to smile. Effective communication includes knowing when it`s appropriate to light up the room with your dazzling grin and when it`s not. Your patients want to feel that you understand their feelings and have empathy toward them.

- Treat all patients with genuine warmth and courtesy throughout their visit, engaging them in a candid discussion concerning their lives. Nobody wants to feel like a mouth full of teeth and gums. These are human beings in your chair, with human challenges, fears and victories. Find out about them! To do this, practice the fine art of listening over and over.

Dr. James Pride is founder and chairman of Pride Institute, a practice-management consulting group dedicated to substantially improving the professional, financial and personal lives of dentists and staff through education, training and opportunity. Corporate offices and workshop facilities are headquartered in Marin, Calif., 12 miles north of San Francisco. Pride`s 50-member consulting team travels over 1,000,000 air miles annually conducting seminars and conferences in every major city in North America. Call (800) 925-2600 for information on conferences, seminars, workshops, videos, audiotapes, manuals and books.