Christian B. Sager
Wow, is a million-dollar practice success or what? Using the average net income figures provided by organized dentistry, this amount of practice revenue would equal a personal annual income of $350,000. This certainly would go a long way toward retiring student loans, educating children, providing for retirement, and covering a full complement of desirable creature comforts.
Let's see how you can get there. If you identify 1,000 patients with $1,000 of annual insurance benefits, and diagnose and treat those patients up to their annual coverage limit, you could be one of the million-dollar practices! Throw in the occasional "cosmetic makeover," and your revenue would be even more. How would that make you feel — successful, prominent, accomplished?
But would you have fun spending 1,800 to 1,900 hours making this happen? How many of the 1,000 patients you identified would not benefit from a comprehensive oral-health evaluation and the optimal treatments you could provide because of the limitations of their insurance coverage? Do you believe the above scenario reflects the public's and profession's ethical expectations of professional health-care providers?
Perhaps this is a good time to visit the differences between goals and values. Goals are set; values are lived. Goals change; values remain. Goals are directive; values are our measurement of self. Happiness in our life's work isn't just about the financial reward. It also is about the spiritual (or psychic) income you receive from investing your care, skill, and judgment on behalf of others.
After observing dentists for many years, I have concluded that there is one great obstacle to investing their time in elevating the public's understanding of the value of excellent oral health and in performing comprehensive oral health evaluations. This obstacle is payment mechanisms and treatment codes that do not place value on the time required of dentists to evaluate and plan comprehensively, to communicate treatment options and their benefits, and to follow through with informed consent. This leads to a perpetuating cycle of "fixing what's broken" and watching until the next thing breaks.
Staying in this mode doesn't provide you with all the enjoyment you could have in practice. Many of you probably have not taken time to clearly articulate to yourself and your staff what constitutes "fun" in dentistry. Following that assumption, I'll proffer what may be a worthwhile starting point. How does it feel when you get to do your best work on people who appreciate it? Does it feel energizing, fulfilling, and fun? Is this what you envisioned when you began practice? Would you like to work toward experiencing more of those times?
Before you can move from "fixative" dentistry to comprehensive dentistry, you need to understand the value of your time. How much are you investing on an hourly basis on behalf of the people you serve? Divide your annual or quarterly total revenues by the total number of hours your practice was open for patient visits during that period. This is the amount you are currently investing to render services to your patients. You now know how many dollars you need to generate per hour to continue doing what you've been doing, from a financial perspective.
Evolving toward a new practice model can be a natural course of events if you increase the time you spend with patients to build value for comprehensive care. In every practice, there are significant numbers of patients who will choose more than "fixative" dentistry. Beginning with these patients and new patients entering the practice, do at least one truly comprehensive evaluation and treatment plan per week, and follow through to discuss options in the patient's best interest.
At The Pankey Institute, we are intent on helping dentists understand their leadership role in educating the public and preparing to succeed in a more rewarding mode of practice. We believe patients have the right to choose dentistry beyond their insurance coverage. Understanding each patient's circumstances and leading the patient to informed consent requires time. If you aren't afraid to step outside the "insurance perimeter," comprehensive treatment will lead to compensation for your time. This becomes the bedrock upon which a valued relationship can develop.
Since 1982, Christian B. Sager has been the CEO of The L.D. Pankey Dental Foundation and Executive Director of The Pankey Institute, where he leads discussions on leadership principles and behavioral aspects of patient care. He has been awarded honorary membership in the American College of Dentists, International College of Dentists, ADA, and Florida Academy of Dental Practice Administration. As a lead voice for comprehensive dentistry, he frequently publishes articles and speaks at dental meetings worldwide.