HOW TO PROFIT FROM... laboratories

Feb. 1, 2000
A survey of dental practitioners revealed that the average dentist uses 3.5 laboratories. One would expect the response to be one or two, thanks to the ease, efficiency, and convenience that using a lesser number would produce. Why is the number so high? The common response is that different labs are selected for a variety of reasons - quality, price, service, technical expertise, habit, etc. The surprising phenomenon is that the average dentist continuously changes those labs.

Communication is the key

Thomas McAndrews

A survey of dental practitioners revealed that the average dentist uses 3.5 laboratories. One would expect the response to be one or two, thanks to the ease, efficiency, and convenience that using a lesser number would produce. Why is the number so high? The common response is that different labs are selected for a variety of reasons - quality, price, service, technical expertise, habit, etc. The surprising phenomenon is that the average dentist continuously changes those labs.

Even more intriguing is that a laboratory that Doctor A finds fault with for one characteristic is praised by Doctor B for the very same thing. Conversations with people in the laboratory business will reveal an equal state of confusion. How do you deal with clients who send in a perfect impression on Monday, and then submit one "from hell" on Tuesday? What do you do with a client who gives the lab two weeks to produce a single crown, but only three days to do a semi-precision cast partial? What is the basis for this apparent hiatus in perspective? How does this search for the Utopian laboratory impact a dentist`s productivity, performance, and personal satisfaction? How do dentists establish a meaningful, profitable, and enduring relationship with their laboratories?

Let`s go back for a moment to dental school. So much of the dentist`s practice demeanor is established in such a structured environment that deviation from that indoctrination is very difficult. Yet, as we all know, many limitations are placed on the dentist by time constraints and practical necessities. These issues result in significant opportunities not being addressed.

One issue that has a lasting impact is the dental schools` lack of direction on communicating with commercial laboratories. Most schools have a limited in-house laboratory, and the remaining restorative appliances are outsourced to a commercial dental laboratory. This allows the student limited exposure to what eventually will be a critical component of his or her successful professional development. Again, we all know that many of the in-school restrictions are offset by CE mandates and the drive and desire of dentists to enhance their professional performance. But few, if any, opportunities are available which feature the essence of establishing a working and rewarding relationship with a laboratory.

One of the most frequently heard complaints is "When I switch to a new lab, the first case always come back perfect. After that, I`m treated just like everyone else." What is the dentist`s expectation when he or she first goes to a new lab? Is it realistic to think that that dentist is special and the lab`s other clients will be held in a lesser light? Some labs may make that promise to get the dentist as a customer, and then do their best to carry out that commitment. But when reality sinks in and the "new" client is no longer "new," the relationship is altered. This seems to be more prevalent with smaller labs that have limited resources and therefore can reach out to only a limited number of clients. Successful larger labs have learned that their success is a direct result of their ability to consistently reproduce a product at the same level of high quality. The keys are equality and consistency.

There is an approach that is simple, effective, and proven, and will help create what dentists and laboratories are seeking - a rewarding and profitable relationship. Be proactive. Set yourself up for success, not failure. Understand the principles that are the catalysts for success.

Paramount is information- give more, not less, about yourself and the patient. A laboratory can`t possibly fabricate appliances that meet the dentist`s expectations if it does not have a profile on hand that specifically defines the nuances and idiosyncrasies for each product, whether that product is an all-ceramic crown or a cast partial frame. I would be very cautious if I were going to use a new lab and I was not given a form that provides for my specific profile. Only after such a form is completed does the laboratory have the necessary supporting information to enter into a database for each case.

Next, I suggest a personal call to your lab`s customer-service representative. Discuss your profile in detail so that each party is clear and comfortable with its meaning. Discuss the lab`s work schedule, and make sure that there is a clear understanding of the standard time for the fabrication of your requested products. It may make more sense for the person in your office responsible for patient scheduling to work this out with the lab. All too often a staff person schedules the patient for either the convenience of the patient or the office, but ignores the laboratory`s work schedule. This is a constant area for discord and aggravation. The office hates to get a call from the lab asking for additional time. Unfortunately on occasions, production problems occur that the lab can`t control. These problems will require the patient to be rescheduled. When the lab has to call the office to reschedule a case, it is always awkward, time-consuming, and unproductive at best.

As noted above, dentists feel they always get what they want when they start with a new lab - then things change. The labs have a different "spin." Often, the first preparations and impressions from a new client are textbook perfect. But, on the second or third submission, a margin is missing or there is insufficient occlusal clearance. When the dentist is called about the problem, the common response is, "You have to go ahead with this one because..."

Simply put, we all are trying to do our best in sometimes very trying conditions. It is my firm belief that dentistry is one of the noblest of all professions. All of the participants - from the dentist, to the hygienist, to the assistant, to the laboratory, to the manufacturer, to the distributor - are conscientious and have the best interests of the patient as the first and most important consideration. Is this the basis of why we struggle and why we create the stress for ourselves that we do? Are we trying too hard to achieve perfection? Are the expectations beyond reality?

I am not suggesting that inadequacies are acceptable. If a contact is shy, it has to be adjusted. If a shade is off, it has to be corrected. However, what I am suggesting is, at times, there are certain contributing factors that have a direct impact on the results of the case. To have an understanding of these factors is important before the case is started.

Case-planning with the laboratory and patient is essential for predictable results. Pictures, pictures, and more pictures, along with mounted casts, sharing the dentist-patient dialogue, type of preparation, and diagnostic wax-up are some of the dynamics required to produce a result that is known rather than hoped for.

I think the greatest cause of dissatisfaction is created when the expectations of the patient differ from that of the dentist. The dentist expects the technician to produce an acceptable restoration, but has failed to communicate that expectation and the parameters of acceptability. In conjunction with and tied directly to this issue is the comment, "Just follow my instructions."

Having spent 45 years trying to figure out why dental technicians have the innate ability to read a prescription and then produce something other than what was asked for, I have come to this conclusion: They simply have not been formally trained to learn and understand the process. Few have had the opportunity to see first-hand what actually goes on in the dental operatory; thus, they do not have an appreciation for the ramifications of an incorrectly produced restoration. "If it looks like a tooth, it must be a tooth," just won`t work. Some large labs have recognized this generic characteristic and have initiated training programs that instill the importance of accurately fulfilling a prescription. Additionally, dentist-clients have been invited to explain to lab employees what the impact is to the patient, the dental office, and the laboratory when a case has to be redone because of errors of omission or commission.

A clear and concise prescription goes a long way to getting you what you want. Ambiguity begets confusion. If there is a need to get into descriptive dialogue, call your rep to discuss the case. Direct verbal communication is far more suitable than a written document that requires translation and interpretation. If you feel more comfortable writing, still make that call. It will provide your rep with the ability to synopsize in an appropriate format.

If a problem arises, be calm and reasonable. An intelligent discussion with your rep probably will bring about your desired results, whereas a shouting tirade only will cause more stress. Yelling and screaming will most likely cause lab personnel to react as human nature dictates ? they will detest you. As unlikely as it may seem at times, labs really do try to satisfy their clients? requests. When work has to be redone, it has a significant impact on a lab?s profitability and reputation.

Finally, the world of e-commerce has arrived to enhance dentist-laboratory communications. There is a service that now allows the dentist to fill a prescription on the Internet. Your first response might very well be OSo what?O In a very short time, you will be saying OHow did I get along without it?O One of the main features is the accuracy mandated by the rules-driven format. The fields guide you through the process quickly and precisely with no opportunity to omit critical information, schedule a return date that does not meet the time requirement for that restoration, or select a material that is incompatible with that type of restoration. Other features that will help your productivity include automatic scheduling of the pick-up, an off-site secure database of all patient activities, before-and-after imaging with no software requirements, and instant access to case status within the lab.

Our profession can be stressful and frustrating. However it can be extremely rewarding to cure an oral disease or cosmetically alter a person?s smile that will bring about a change in his or her ability to function in business and society. The trick is doing this in an environment that produces the maximum results professionally, economically, and personally. Working with your laboratory in a corroborative mode will go a long way toward making that happen.

For more information about this article, contact the author at (800) 222-8980. A biography of the author appears on page 8.