What Dentists Think

Last summer, 3M Dental Products Division ran a series of full-page advertisements in a variety of dental publications asking, "What`s on Your Mind?" This unique communications program was designed to find out what burning issues are facing today`s practicing dentist. The advertising campaign encouraged dentists to identify key issues affecting their practice.

The answers to 3M Dental`s survey offered some insight into the concerns of today`s practice owners.

Joseph A. Blaes, DDS Editor, Dental Economics

Last summer, 3M Dental Products Division ran a series of full-page advertisements in a variety of dental publications asking, "What`s on Your Mind?" This unique communications program was designed to find out what burning issues are facing today`s practicing dentist. The advertising campaign encouraged dentists to identify key issues affecting their practice.

The response was terrific. Dentists shared their common concerns regarding the obstacles facing their individual practices and the profession as a whole. There is not much data available in dentistry about what "dentists are thinking," so I was anxious to see the results of the survey.

More fee-for-service

3M has reported on the top five issues that you identified as critical. By far, the number one concern was increasing fee-for-service dentistry. Dentists indicated a need to generate more fee-for-service patients and procedures to augment their overall business. One dentist commented, "Patients think that if it`s not covered by insurance, it must not be necessary."

What is "fee-for-service" dentistry? To me, that phrase has come to mean dentistry without regard to any kind of third-party payment. It means complete diagnosis, complete treatment planning, and complete presentation of findings. It does not mean, "No third-party payment." Patients ask, "How much will my insurance cover?" My reply is, "We will maximize your insurance plan."

How do we get more fee-for-service patients into our practices? The key is to build relationships with our patients. In my practice, the most important thing everyone does is to communicate with people - not with patients, clients or customers but with people. Isn`t that what we all want? We all have a phrase tattooed on our foreheads: "Make me feel important!" When we come away feeling that service was poor, isn`t it because someone failed to recognize our importance? I have a pet theory. I believe that most of the people who come to us for care do not have a relationship with the dentist. Instead, the relationships are with Barb, the clinical assistant; with Sally at the front desk: or with Pam, the hygienist. After all, don`t most patients spend more time with them than with the doctor? If my theory is true, then perhaps the dentist can delegate relationships to a point.

Service begins with communication. That means that the most important skill in the dental office is not how to cut on teeth, but how to communicate. Why are there so few courses in communication? When my team discovered this secret, we went outside of dentistry to find courses to build our skills in communication. More courses are available today, but you still have to seek them out. You will not find these classes at most major dental meetings. People like Sandy Roth, Dr. Paul Homoly, Nate Booth, Terry Goss, and Mary Osborne have great courses on communication in the dental office.

If you want more fee-for-service patients, take a hard look at the "service" you offer. Today, people are "service starved." Make your practice stand out by offering services that your patient can`t get at the office down the street. Make them feel at home in your office. Build relationships and your practice will grow beyond your dreams.

Stop playing the waiting game! The paradigm has already shifted, and you must change with the times. I personally believe that the Platinum Age of dentistry has already begun, and it will make the Golden Age look like the Great Depression. This is a great time to be a dentist, and it is only going to get better as time goes by. This is driven by many factors.

Since 1980, seven dental schools have closed. Downsizing within the remaining dental schools has resulted in a 37 percent decline in undergraduate dental enrollments. More dentists are retiring and leaving the profession than are coming in. The number of women dentists is increasing dramatically. Simply put, the supply is not going to keep up with the demand.

The demand is coming because people are living longer, and those same people are keeping their teeth longer. When I graduated from dental school, a 65-year-old could expect to have an average of six teeth. Today, that same 65-year-old will have an average of 20 teeth. What a difference! The dental profession should be proud of the patient education that we have accomplished. In addition, a large segment of the population known as the Baby Boomers grew up in the pre-fluoride era. They are now turning 50 and many of them will need restorative work. Many of our patients are interested in how they look. They are fueling the demand for bleaching, smile changes, and the whole esthetic revolution.

This is nothing new. You are all aware of what is happening around you. How will dentistry meet the demand with fewer dentists? How will dental manufacturers and distributors grow their companies if there are fewer providers in dentistry? Will some of our duties be delegated to others? My crystal ball just clouded over; I don`t have the answers. This is one of the reasons that 3M ran the survey. It is important for them to know what you are thinking.

Products all look alike!

The second concern that you told 3M about was product differentiation. Dentists told 3M that it`s hard to keep track of all the various products on the market. They want to better understand what the differences are in similar products and how varying prices relate to product quality. I have a problem here as well. A manufacturer will launch a new product, and, if it is successful, five or six look-alike products suddenly claim better characteristics than the original at a price that may be more or less. How do you choose? I have heard some dentists say that they choose on price alone. Others say they read the research. Who is right?

In my visits to dental manufacturing facilities, I have been very impressed by the controls that are in place to assure product quality and consistency. When I use a product, I look for consistency. I want that product to do the same thing each time I use it no matter if I bought it in the summer or the winter. I want the last tube to work the same way as the first. My observation is that, for the most part, the major manufacturers deliver product consistency. The money that these companies put into new product development and product research is amazing. Many very talented people work hard to bring you the next generation of products.

My advice is to find products that work for you in your practice - products that will meet and exceed your needs. Be careful to keep things simple; don`t have too many choices. That`s when it becomes confusing for everyone. I have found that it is important to involve the clinical team in these decisions. They are an important resource that often is overlooked. When trying a new product, ask about return privileges. Most companies will take back a product that you are not satisfied with. Use resources such as Clinical Research Associates (CRA), Dental Advisor, Reality, and "Pearls For Your Practice" (Dental Economics) to help with your decisions.

What do the numbers say?

The third concern was cost containment and practice management. Dentists said they are finding it difficult to maintain the most current products and equipment. They are also having a hard time practicing their profession while marketing their practice. The first part of this concern dovetails with the previous concern. Do I need all these new products and at what price? This is an area we all need to be concerned about, particularly when you begin purchasing the high-dollar equipment items.

You cannot contain costs in your practice if you do not know how to manage your practice. The first principle of management is to know the numbers. Some dentists obtain all types of computer printouts about their practices. Most never look at the reports. They give the reports to a bookkeeper or an accountant, who are both historians. The numbers usually come back in a form that the dentist does not understand, and so the practice continues without direction. The very first thing to do is to give Dr. Charles Blair a call at (704) 424-9780 and find out when he is giving his next "Profits Plus Practice Analysis" course. Charles is my numbers guru. He has the best information on which numbers to watch and why. He will actually guarantee to raise your production without seeing an additional patient.

Be careful which overhead items you are trying to control. Dentists often focus on lowering supply costs and end up saving less than 1 percent on their overhead. Dr. Roger Levin has a favorite saying: "Don`t step over the dollars to pick up the pennies." Your largest overhead item is staffing; maybe you should focus here first.

Show-and-tell! Is anyone listening?

The fourth concern is patient education. Dentists mentioned a need to educate and persuade patients to change their behavior. I am sure that you know that the only person`s behavior you can change is your own. I believe that the basis of all patient education should be a complete examination. The best way to educate patients is to show them conditions that exist in their own mouths and the treatment for those conditions. One of the best ways to show-and-tell is the intraoral camera. I use a camera in all new patient exams, and my hygienist uses one with her patients. The person doing the education must develop a trusting relationship with the patient. If a relationship does not exist, the education begins to sound like a sales pitch.

Another great educational tool when the patient wants more information, or when introducing new concepts, is the video educator. Many systems are on the market. One of the best is the CAESY system. It is important to know how to use this system because you need the right words to make it effective. You must be constantly planting seeds with your patients. Keep reinforcing (watering the seeds) the need. Eventually, the need will change to a want and the dentistry will be done.

Staff for the long haul

The final concern is recruitment, training, and retention of staff. There is a great deal of concern about the availability of trained staff. Every service industry is facing the same problem. Because of our national birth rate and the sad state of public education, the pool of qualified people keeps getting smaller and smaller. It will not get better any time soon. Look at all the help-wanted signs around your own community. In the past, we advised keeping staff because of the great cost of turnover. Today, long-term staff members are important because they are so hard to replace. I have always looked for behavioral traits in people whenever I come in contact with employees of service companies. When you find one that is a gem, you might ask if they would consider a career in dentistry. I have found that it is much easier to teach dental skills than behavioral skills.

Training in my office used to consist of having the "new" staff member watch over the shoulder of a well-trained staff member and when they got bored of doing that, letting them jump right in. It was on-the-job training of the worst kind. Mistakes resulted in stress, thrown instruments, repeated procedures, and sometimes a new employee quitting. All dental offices need to take a critical look at their training programs for new employees. First and foremost, they must understand and be committed to the office philosophy. Consider training on a mannequin before moving to a live patient. Does your office have an in-service training system, so that all team members can keep up with the new skills needed for new materials? Or do you just order new materials at dental meetings and when they arrive at the office, have the team read the instructions. Then, when things don`t go right, you have them reread the instructions because they must be doing something wrong.

Your team needs to be involved in the everyday management of the practice. This means that the dentist needs to disclose the practice numbers. Staff members cannot help if they don`t know what is happening. This can be a stumbling block for many dentists. Several good books describe how disclosing this information has helped many businesses retain long-term employees and, in the process, become more profitable. You can find them in the business section of your favorite bookstore or visit amazon.com.

I was excited to see this information from the 3M survey. It always helps when we know what you are thinking out there. At Dental Economics, we are dedicated to bringing you information that will assist you in the business of your practice. I could write enough articles on these five concerns to fill an issue of the magazine. My purpose here is to acquaint you with the survey results and give a few ideas on some systems that have worked in my practice. The keys are communication, a strong team, and good systems!

3M Dental also wants to help. The manufacturer has produced a booklet by Dr. Jim Pride with some of his solutions to your concerns. You can receive a copy by sending your name and address to 3M Dental, c/o Richie Resource Group, 4530 West 77th Street, Suite 192, Edina, MN 55435

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