Surviving 2001: How to weather a national crisis

May 1, 2002
The events of Sept. 11, 2001, impacted all of us in a profound way. Immediately after the tragedy, Dr. Pride sent a note of comfort to the doctors who study with Pride Institute.

by James R. Pride, DDS; Amy Morgan; and Michael Gradeless, DDS

The events of Sept. 11, 2001, impacted all of us in a profound way. Immediately after the tragedy, Dr. Pride sent a note of comfort to the doctors who study with Pride Institute. He charged each with the responsibility of being a haven of warmth and security in troubled times:

"Our staff and patients need us to be the leaders now more than ever. It's very important that we be aware of our own behavior and how it supports those around us. ... We need to be that solid rock in the stormy sea. Our staff needs to know that we have confidence and are not worried. ... Our patients may question the advisability of spending large sums of money on comprehensive care right now. If we get this question, we must show them our confidence in the current process of treatment."

We expect patients and staff to experience low-level anxiety for some time. They may not be able to spot the direct source of their frustration and stress; nevertheless, they need outlets to express their concerns, and they need to be consoled. Dentists have a great opportunity to become community leaders, spreading a message of care and support. Whether a patient is worried about the potential loss of a job and dental benefits, or a staff member is concerned about future terrorist attacks, it is the strength of the dentist's human relationship skills and willingness to communicate that will help others be more optimistic about the future.

Examples of dentists acting as role models are everywhere. A group of dentists whom we counsel in Sweden each sent a letter to their patients immediately after September 11, offering them comfort and support. They have received a tremendous response. Patients welcome dentists in the role of community leader.

Were dentists economically affected?

Some dentists - like Drs. Anthony Chillura and Scott Firestone of New York - were profoundly affected by the events of September 11. Dr. Chillura, who has a clinical practice two blocks from the site of the World Trade Center, is a forensic odontologist who volunteered his time to identify victims. His office closed for a week following the terrorist attack. When he and his staff literally cleared the dust and reopened, they sadly discovered that 12 of their patients had perished in the atrocity. Many others were lost due to the relocation of more than 100,000 people working in and around the collapsed Towers.

Dr. Firestone, also a forensic odontologist and a member of the federally sponsored DMORT (Disaster Mortuary Operational Response Team), closed his Melville, Long Island, clinical practice for three weeks to perform the grim task of identifying victims at Ground Zero. When his office reopened, he, too, was affected. "The downturn in the stock market has had a definite effect on my retirement investments and will probably result in changes to the date of my 'financial freedom' and thus retirement," he observes. "The downturn has also affected my patients, especially those employed in the stock market. My practice caters to that clientele, and firsthand feedback confirms the fact that many of my patients' discretionary income has decreased considerably, resulting in less elective dentistry performed."

Other dentists report being unaffected or only slightly affected by the tragedy. According to Callie Haynes, a Pride Institute consultant, "Practically all of the dentists I work with experienced a slowdown and certainly more patients delaying treatment. Things seem to have picked up this January, in part due to the new benefits year for dental insurance, according to some dentists."

If you have not been affected, that is great. However, we caution you to look carefully at your production, collections, case-acceptance rates, and other statistics to determine the effects of the crisis. Be sure you know the reasons why patients decline treatment. Gathering this information is a good exercise to prepare you for handling other unsettling situations you may face.

How to find out if you were affected

Consider, for example, the practice of co-author Dr. Mike Gradeless of Indianapolis, far from the scene of the terrorist attacks. On the surface, he was not affected very much by the atrocities of September 11. He continues to have a busy practice, and he met his preset production goals for 2001. He did not have to postpone any vacations or cut back on his spending. Dentists who are unaccustomed to carefully monitoring practice statistics may be tempted to conclude that Dr. Gradeless was virtually unaffected by the crisis. But let's look more closely.

Dr. Gradeless lost one patient immediately. The office remained open on September 11 to accommodate a cosmetic patient who had driven more than two hours for her appointment. In the meantime, another patient left a message canceling her appointment. When the staff called to reschedule, the distraught patient thought it was insensitive for the practice to remain open during a national crisis and so decided to find another dentist!

Another patient suffered a job layoff as a result of the economic slowdown. This patient had accepted treatment involving multiple units of bridge work and implants. The implants had already been placed, but her layoff delayed the restoration of those implants.

Therefore, $18,000 of treatment that Dr. Gradeless would have performed over two months was left incomplete. The implant case caused the practice to be $3,000 under goal for each of the two months, instead of $5,000 over. There were other similar instances involving smaller cases as well.

Because Dr. Gradeless runs a comprehensive-care practice that is not based on urgent cases, there are many opportunities for patients to delay treatment. If patients are financially strapped - due to a sudden plummet of the stock they planned to redeem to pay for treatment, a layoff, or hesitation about spending when a recession threatens - sometimes treatment must be delayed.

Although Dr. Gradeless met his production and collection goals for 2001, this is only part of the picture. For the first six months, his production ran at 105 percent of goal, or 13 percent higher than the previous year. This prompted him to give staff raises and make additional expenditures. In the last six months of 2001, production ran below the goal. At year end, he reached his goals; however, he had incurred additional overhead under the assumption that production would be higher. While gross production was higher than in 2000, net earnings remained the same because of the extra expenses incurred. Closer analysis showed that the practice was not growing, but stagnated as a result of the tragedy.

How to get back on track

Because of compound growth, relatively small changes in production can make a profound difference between personal finances growing exponentially or growing only linearly. (See "Dentist's compensation: taking your finances to the tipping point," by Dr. James Pride and Brain Hufford, in the February 2002 issue of Dental Economics.)

Realizing the potentially significant effect of subtle changes in production, especially over the long-run, Dr. Gradeless has taken steps to improve his practice's performance. What if we are in for five to 10 years of lower investment growth in a more sluggish economy? Who can know for sure? If airline travel suffers a sustained slowdown, for example, it could affect hotels, restaurants, and many other businesses, which, in turn, could affect Dr. Gradeless' patient flow. Consequently, he has cut back on expenses and also has refined his practice-management techniques.

Following the terrorist attack, Dr. Gradeless devoted his next staff meeting to discussing patient uncertainties and potential changes in their priorities. He and his staff instituted policies to increase the level of comfort for patients. His team revisited some of the basics, including how to transfer patients between staff members, how to greet and seat patients, and how to send patients home prepared for their next appointments.

Quality practices rely on solid practice-management techniques. Dr. Chillura reverted to a three-day workweek to cut expenses during this period of reduced production. Some of his staff members took this opportunity to return to school part-time. Dr. Chillura used the free time to search for a new office. He plans to stay in the area and recover with others. He reacted to the dip in production by temporarily cutting expenses and gearing up for long-term growth by modernizing his practice.

Dr. Firestone from Long Island also has made changes in his practice. "I recognize that good leadership is the key to emerging from troubled times. 'Inspect what you expect' is foremost on my mind. If I am to energize the practice, I must energize myself first, so the first change I'm making is in my leadership. The second change is to streamline the practice, both financially and psychologically. I have dismissed a team member who was adversarial and caused stress among the other staff. This move has cut my expenses and decreased office tension. Third, I want to recognize that what makes my practice different is not the dentistry per se, but the way we treat our patients. Attention to patients is even more important during difficult times."

Performance-proven business, management, and leadership tools will be needed more than ever to help dentists reinforce patient loyalty and strengthen the value of their practices in times of crisis. Practice management can make the critical difference between just getting by and excelling.

There are three major guidelines for weathering crises:

  • Improve customer service. Make the dental office a safe haven for patients - an oasis where they are given a welcome relief from external stresses. Your dental practice can be a solid rock in a stormy sea.
  • Understand the patient. Through "active listening" and other communication techniques, discover the patient's motivators and concerns. Probe to uncover the reasons for any hesitation in treatment acceptance. You will be able to influence a worried patient positively with your own confidence in the future.
  • Monitor practice statistics. Know how to interpret the numbers that tell your practice's story, and react promptly to the first sign of problems. Don't just "feel" you are doing OK; confirm it with the numbers.

What lies ahead for dentistry?

While we need to remain prepared for challenging times, the long-range outlook for dentistry is still very positive. There will be more dentists retiring and selling practices than new dental graduates buying these practices. This should result in a solid patient base, and may produce a buyer's market for dental practices.

Some areas are experiencing this now. Dentists need to look ahead to retirement. We must develop the kind of steady increases in production that will compound wealth over time and create a highly marketable practice when it's time for a transition.

The decisions you make now about your practice can profoundly affect its future course and your financial picture. Now is the time to question everything. Do you need to move to a new building? Do you need to aggressively grow your practice? Do you need to hire an associate? Do you need to improve the quality of the practice to distinguish it in a buyer's market?

The dentists who have the proper plans in place will be the ones best able to ride the crest of the wave in stormy economic times. Those who excel in business skills will be well-poised to enjoy a "golden age of dentistry" for the rest of their careers. Dentists who excel in human relationships will become pillars of their communities. As Dr. Pride said to his clients shortly after September 11: "We health professionals have an important role as leaders to play in the months to come… So I join with you in revisiting our leadership commitment to be positive, responsible, and motivational communicators who will do our part to support the greatest nation on earth. ... We are all in this together."

For more information and course offerings on how to position your practice for success in an uncertain future, call Pride Institute at (800) 925-2600.