Managing a business requires its own body of specialized knowledge.
James R. Pride, DDS
A science is a systematized body of knowledge, derived from observation and study, to determine the nature and principles of the subject being studied. Certainly, dentistry is a science - one that involves the systematic study of teeth and their care. Dentists well know the discipline through which they acquire their specialized knowledge of teeth and gums and learn how to prevent, diagnose, and treat oral disease.
To succeed, however, a dentist also must also be able to manage a business. He or she must be able to lead the staff, communicate with the patient, market for new patients, present treatment plans, schedule time, collect money, establish other systems and procedures, and show a profit. What is the typical dentist`s view of management? Does managing a business require its own body of specialized knowledge? Is that knowledge exact? Does it form a systematic whole? In other words: Is management a science?
What do dentists think?
The average dentist`s view of management became obvious during a recent event sponsored by Pride Institute. At our request, a marketing company randomly selected general dentists to participate in focus groups that explored the administrative concerns of their practices and how they deal with them. As is customary in this type of market research, the dentists did not initially know which company was seeking their input, so their remarks were completely candid.
Virtually every dentist surveyed said that staff issues were of great concern. One dentist said hygiene cancellations bothered him. He also was bothered by staff members reading People magazine and eating their lunch at the front desk. What does he do about these problems? Nothing, he admitted, shrugging his shoulders. Another dentist was irked by emergency patients being scheduled just minutes before lunch time. What was his solution? To forego his lunch break and to snack between patients. Another dentist complained about having too many new-patient exams on one day, while having too many back-to-back surgeries the next. Still another wished his staff would make more effective confirmation calls and better prepare patients for treatment in advance. Collections, case presentation, and other issues also were problem areas for those surveyed.
The dentists were asked how they would tackle the management issues of their practice. "Call a friend," "Let the staff work things out for themselves," and "Pop a management tape in the car stereo," were some of the answers. One dentist was interested in a management service that she could call when she had questions, one for which she was willing to pay about $59.95! Would the dentists do anything more to study management? "I`d look for management help only if my business were failing," said one. "I don`t want to change my life dramatically," said another dentist who had been practicing only a few years. "All I want is a little fix," concurred another. "If I have an issue like collections, I just want to deal with that. I`d like à la carte management training, not a program that deals with everything."
Observe the plethora of management issues bothering the dentists and the limited scope of the solutions they would entertain.
A different approach
Consider the vast difference between the doctors` approach to dentistry and to management. To develop their clinical skills, they devote years to systematic, exacting, methodical study, followed by continuing education throughout their lives. For management, many favor a random, seat-of-the-pants, nonsystematic approach. When it comes to procedures for taking X-rays, would they "let the staff work things out for themselves"? When it comes to learning how to perform endodontic therapy, would they pop a tape in the car? And to master the latest restorative techniques, would they call a service for $59.95? Would they say to a patient, "Come in for a hygiene visit only if your gums are failing"? Would they say to a clinical professor, "I just have one à la carte issue, an amalgam. I don`t want to learn about asepsis, tooth structure, decay, or anesthesia."?
Of course, they would do none of these things because they view dentistry as a science. They know that placing amalgams is interconnected with giving anesthesia, maintaining asepsis, understanding tooth structure, and eradicating decay. But collections in their minds is an isolated subject that has nothing to do with marketing for quality patients, educating those patients, debriefing the patient on the treatment performed, offering comfortable financial arrangements, hiring and training the staff, and all of the other interrelated management skills that make patients appreciate quality dentistry and willingly pay for it. Dentists would think it absurd to learn the healing art of dentistry through a quick-fix, correspondence course. Yet, a quick-fix is all that many dentists are willing to try to manage a business that will play a major role in their lives for decades.
Why do dentists distrust practice management?
In our focus groups, we found that companies of questionable value have fed the flames of the dentists` distrust of practice management. Some of these companies have lacked the depth to differentiate their approach for a variety of dentists in diverse circumstances with different goals. Others have been unfamiliar with the nuances of the dental office and proposed solutions that were impractical. All business consultants have a responsibility to be effective, to be consistent with the highest clinical standards, and to give real value to their dentist-clients. In this way, we can foster among dentists an appreciation for, yes, the science of management.
We also found that dentists in practice for 10 to 20 years had more experience with and appreciation for business training through courses and consulting. Those dentists in practice from one to 13 years were noticeably less appreciative and more skeptical of management training. However, it is the new dentists who need business skills most. It is they who can benefit for a longer time from such training and avoid many mistakes. Dentistry in this respect is like horse racing: the earlier one begins training a prized thoroughbred, the better the outcome.
The skepticism of the young dentists in our focus groups presents a powerful case for teaching practice management properly in dental school. Instead of students graduating with business skills and an appreciation for management, we are seeing dentists who go into practice with no understanding of business management. These new graduates then take a decade or more to acquire such appreciation (some never acquire it), which intensifies their stress, compounds their mistakes, injures their self-confidence, and undercuts their goals.
In contrast, recent graduates of the University of the Pacific School of Dentistry in San Francisco feel differently about practice management. A survey conducted by the American Association of Dental Schools shows that UOP graduates give their practice-management education a 90 percent approval rating, as opposed to a 60 percent average approval rating given by dental graduates for practice-management education in other schools around the country (where offered). UOP realized that its faculty, although excellent in clinical issues, lacked the total expertise in management necessary for the comprehensive training of students in the future operation of their businesses. So, the school took a different approach, outsourcing practice- management education to an independent firm.
Now, UOP`s students are applying their business skills to the management of the school`s dental clinic, preparing them for success in their own future practices. As a result, they are graduating with business plans that financial institutions recognize as viable for loans to start practices. If all dental schools taught practice management effectively, students would be graduating with respect and appreciation for a subject so vital to their success, rather than with the skepticism we are seeing.
Attitude holds dentists back
Besides bad experiences or youth, a number of the dentists we surveyed revealed a certain attitude that prevented them from learning business skills. When asked if they would consider serious training in management, a common refrain was: "I don`t want to be carved out of the same mold as everybody else. I don`t want to have a cookie-cutter practice." This could be a reaction to unsophisticated management trainers who have a one-size-fits-all approach to every practice. Often, however, this attitude seems to be a resistance to systematization.
Remember, a science is the systematization of knowledge in a given field. Certainly, dentistry is rooted in systematization. All dentists use basically the same approach to endodontic therapy, crown preparation, and virtually every other procedure. The variations in materials, tools, or techniques are slight compared to the fundamental similarities in performing clinical dentistry. However, this fact does not strike dentists as being "cookie-cutter." No dentist says, "I`m not going to take the decay out of the tooth, because I don`t want to have a cookie-cutter practice that`s the same as everybody else`s." As clinicians, dentists recognize that there are basic principles that apply universally to their profession. As managers, however, many dentists do not recognize that there are basic principles that govern their business as well.
Management really is a science
Just as the science of dentistry does not insist on any one handpiece or material for temporaries, sound management does not require that all dentists be exactly alike in terms of the hours and days they work, their procedure mix, the kind of patients they have, the payment options they offer, the production levels they attain, or other optional issues. However, there are basic business principles that apply universally to all practices, which provide the framework in which all choices are made. Here are a few:
> All dentists need to define a philosophy and vision for their practice. The specifics may vary from one office to another; however, all dentists and their employees need to know the purpose for which the business exists and the goals it wants to achieve. Obviously, the goal is quality care, but delivered in what context? Is the practice to be: 1) state-of-the art, specializing in implants and the latest cosmetic techniques not generally covered by insurance; 2) an HMO clinic; or 3) a combination of both?
The answer will affect the kind of office and equipment a dentist will need, the location of the practice, the patient profile, the marketing efforts, the number and type of employees hired, the clinical options, the financial policies, the scheduling guidelines, and the kind of customer service given. The staff needs to know the practice philosophy and goals before it can do a proper job. If the dentist thinks the goal is developing an implant practice, and the staff reads People magazine and eats lunch at the front desk, there will be problems.
Dentists need to put their philosophy in writing. Many dentists feel that if they know in their heads what they want from their businesses, that will be sufficient. But too often, when the philosophy is only in a dentist`s head, it`s half-stated and easily lost. For example, one dentist told me he was thinking of joining a new PPO program that was somehow different from the others. I asked him, "Do you do comprehensive exams?" He replied, "I`ve been to Pankey." I then asked, "Does this insurance plan allow you to do Pankey dentistry?" Silence. In this dentist`s head, he was committed to Pankey dentistry, yet he was about to join an insurance plan that limited him to 10-minute exams. Without a written philosophy, we are vulnerable to accepting the first new idea that comes along, which can sway us from our chosen direction.
> A business needs to have a plan. If we start driving a car without a destination in mind, we drift. If a person has no goals, his or her life drifts. Without a plan to drive the business, it drifts. When the practice drifts, critical decisions are not in the dentist`s control, but left to chance. Humans have the capacity to project their actions into the future. Without a plan, the dentist is not pro-actively molding the future to meet his or her goals, but merely reacting to the present.
We know dentists who would have liked to have retired at age 55, but because they did not plan to make that happen, they must continue working, sometimes for the rest of their lives. A plan allows you to make consistent strides toward your goals each day. One value of an annual plan is to break down a yearly production goal into a daily one. This allows the staff to balance the schedule to ensure the finest care and the highest production. In an office that does not have a daily production goal, the appointment coordinator may schedule eight new-patient exams on one day, for very low production, and five surgeries on the next day, for excessively high production and physical strain on the dentist.
> Systems and organization are essential. The staff may know that you want to accomplish certain goals, but without systems and procedures, they will not know how to achieve these objectives. For example, the staff may know that you have a daily production goal, but without an effective, correctly used system to preblock and fill the appointment schedule to meet the goal, your pleas for them to boost daily production will fall on deaf ears. Or, the dentist may tell the staff to reduce hygiene cancellations. But how? Without an effective recall system in place, the staff does not know the steps to take to make the doctor`s request a reality. Systems and organization are the means by which the goals are attained. This is the training that is all-too-often lacking in most dental schools and for which dentists and their teams need to acquire outside help.
> Employees are essential, and their behavior is profoundly influenced by leadership. Without guidance, your team will take the practice in its own direction. If there is no procedure for collections, the staff may wait until an account is three months past due before making the first attempt to collect or never make an attempt to collect your fee. Without guidance, the staff will schedule emergency patients, make confirmation calls, and do other tasks as they see fit.
Leadership is the skill that places the right people in the right jobs; takes quick corrective action when mishires occur, finely hones the staff`s skills; corrects poor performance; gains the staff`s commitment to improve; and praises and motivates people. Without leadership, staff conflicts continue for years, stress builds, systems break down, and quality care and service suffer. With leadership, competent, productive employees work together to achieve clearly defined goals to benefit the practice. A baseball team needs a manager and leader to take it to the top of its league. So does a dental team.
Management is a science. It has foundational principles. Businesses that follow these principles succeed; businesses that do not are left to chance.
"I`m not a salesperson." One dentist in the focus group said that he couldn`t present treatment plans the way the management courses teach. "I just want to do dentistry. I don`t want to be a salesman," he explained. Others echoed his sentiments. What would have happened to Henry Ford if he had said, "I just want to manufacture cars. I don`t want to sell them." Chances are, we never would have heard of Mr. Ford. Forgive me for saying so, but it seems unsophisticated for an entrepreneur who runs a business to be unconcerned with sales.
Without sales - which in our profession means case acceptance - the doctor who "just wants to do dentistry" has no procedures to perform. Shying away from "sales" is not a service to the patient. If someone needs scaling and root-planing, the dentist who cannot communicate the value of the treatment and influence the person to accept it places the patient at risk of tooth loss.
A variant of this attitude is, "I`m not a leader. I just want to do dentistry." All business techniques are learned. Effective salespersons and leaders are made, not born. With study, any dentist can acquire these skills.
Are dentists willing to recognize that management is a science? Are they willing to learn another body of knowledge, that of business and leadership? Will they raise their level of sophistication about management to match their clinical expertise, and with it raise their practice, their personal satisfaction, their income, and their goals to new heights? Today`s dentists face a dichotomy. They have never before been so well-equipped clinically to do wonders for the patient. But in the area of running a business, today`s typical dentist is, unfortunately, in the anteroom of science.
Like the dentist of yesteryear, with limited knowledge of teeth and reduced to pulling them out when they stopped functioning, many of today`s dentists are suffering from lack of management knowledge, enduring the chronic toothache of irksome administrative issues, extracting the staff when they don`t perform, and, eventually, when the prolonged stress of many years reaches burnout, too often pulling themselves out of the profession.
Management is a science that virtually every other segment of American business takes seriously. A small percentage of dentists has applied it to successfully operating their practices. It`s time for the others to discover its power and glory.
For more information about this article, contact the author at (800) 925-2600.
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