Daniel Steele, DDS (our fictive young dentist), has been practicing dentistry for seven years. He is bored, frustrated, and discouraged. He knows there must be a better way to practice. The way he practices now doesn’t fit him, but he doesn’t know of any other way. He attends dental society meetings and hears older dentists complain about being frustrated, bored, and discouraged. He has thought about quitting dentistry, but hasn’t found anything else that has its potential. And his parents would disown him after helping him through all the years it took to become a dentist. Discussions at dental meetings he attends all circulate around one way of practicing dentistry. Insurance companies, the government, and the American Dental Association seem to view dentistry as a homogeneous profession.
Dr. Steele is correct. The ADA, insurance companies, and governing bodies are prime examples of this one-size-fits-all mentality. Decisions are made, papers are written, seminars are given, advice is rendered, legislation is passed, insurance plans are written, and actuaries compute on the assumption that all dental practices are the same. These people and institutions think dentists and their practices operate on a common set of assumptions, beliefs, and values.
The dental marketplace shows this is not true
It is a mistake to view all dental practices as the same. Four basic practice styles are described, and within these four categories are innumerable variations due to each dentist’s personal choices and style. Finding your own groove is a process of matching your circumstances, temperament, values, and objectives - and making decisions that best support your needs and values. When there is a good match, dentistry is enjoyable and fulfilling.
Dr. Steele and his colleagues can practice at least four ways. When they find their matches, they will enjoy dentistry more. They can choose how to practice dentistry from the following:
- Health-centered or relationship-centered (also called relationship-based)
- Technically centered
Each type has its own strengths and weaknesses. These types are non-hierarchical. No one way is best, although each dentist within the first three will swear his or her way is best. (Personally, I enjoy and practice in the health-centered or relationship-centered mode.) But, when dentists such as Dr. Steele find a way of practicing that fits their values and needs, they will be happier and fulfilled.
It is stressful to try to be everything to everyone. Just as there is no one way or best way to practice for a dentist, there is no one type of practice that all patients want. The four basic types fit different wants and needs of the marketplace. For some patients, the relationship is most important. For others, it is cost, convenience, or technical reputation. For a large number of patients, it is who is listed on their insurance plans. Some people just don’t care and only seek emergency or urgent treatment.
In health-centered or relationship-centered practices, the relationship is most important to health. There are several well-known role models for these practices, including Drs. L.D. Pankey, Henry Tanner, Bob Barkley, Bob Frazer, Mike Schuster, Peter Dawson, and The Pankey Institute. These practices are characterized by the following:
- Primary driving forces: optimal health and service, trust
- Psychological/philosophical orientation: holistic, helper, people-oriented
- Small percent of dentists (by my estimate, probably 10 percent or fewer)
- Niche market: patients concerned with values more than cost
- Low-volume, distinctive service with moderate to high fees
- Fee-for-service or moving toward a fee-for-service practice
- Good to excellent income
- Small to moderate teams with participative management
- Fair to excellent systems
- High motivation
- Innovative, embracing change
Business-centered practices are guided by, “When you get to my pocketbook, you get to my heart.” Typical of this type are franchise practices/DPM, Drs. Howard Farran, Omer Reed, and Woody Oakes, and most cosmetic practices.
- Primary driving force: profit
- Psychological/philosophical orientation: business person/entrepreneur, results and money oriented
- Medium percentage of dentists (by my estimate, around 20 percent and increasing)
- Broad market appeal
- High-volume practice with moderate fees
- Best price and least inconvenience to patients
- Mix of fee-for-service and managed care
- Good to excellent income
- Large staff with expanded duties
- Good to excellent systems
- Authoritarian management approach
- Moderate to high motivation
- Innovative, embracing change that produces profit
Technically centered practices are characterized by, “You can check my margins under an electron microscope.” Typical of this type are Drs. William McHorris, Peter K. Thomas, Charles Stewart, John Kois, plus Orognathic Bioesthetics International and some cosmetic practices.
- Primary driving force: technical
- Psychological/philosophical orientation: reductionistic, engineer/scientist
- Small percentage of dentists (by my estimate, 10 percent or less)
- Specialized quality market niche
- Low-volume practice with high-value fees
- Fee-for-service, no managed care
- Low to high income
- Small to medium staff
- Authoritarian management approach
- Fair to good systems
- Varying motivation
- Conservative, resisting change
Standard-centered practices combine a little bit of this and a little bit of that. Dentists tend to pick this style up from each other and the organized profession. This is the “homogeneous profession” our fictive Dr. Steele observes as the norm. These practices are influenced most by the practices of dental friends.
- Primary focus: unknown
- Psychological/philosophical orientation: reductionistic, technique-oriented
- Large percentage of dentists (by my estimate, approximately 60 percent)
- Middle- to low-cost market niche: patients most concerned with cost
- Low- to moderate-volume practice with low to moderate fees
- Largely managed care with some fee-for-service
- Average to good income
- Small to medium staff
- Authoritarian or no management
- Fair to good systems
- Low to moderate motivation
- Conservative, embracing the status quo
Many dentists have refined their practices into one of these practice orientations. These dentists have blended practices that eventually become refined. If they stay blended for a long period, they easily can revert to a standard-centered practice. Balance is needed to maintain excellence. If the strengths of each practice type are overextended, they can become weaknesses.
For example, a health/relationship-centered dentist cannot afford to focus solely on relationships at the expense of technical excellence, good systems, and business sense. Health/relationship-centered dentists need challenges. If not, they can think dentistry is boring. Continuous growth is needed in all the clinical, managerial, and behavioral areas of dental practice. One must re-center one’s self. For development and re-centering in all aspects of health-centered practice, institutes and centers such as The Pankey Institute (www.pankey.org) and the In A Spirit Of Caring (www.spiritofcaring.com) advisory board members are excellent resources.
When a business-centered dentist does dentistry for only his or her profit and not patients’ benefits, ethics are shaken. Relationships must not be manipulated to the point that a responsible, caring practice is secondary to money. In these practices, dental treatment tends to be episodic and focused on remedial or maintenance dentistry. Business-centered practices need to strengthen their commitment to long-term relationships, their technical abilities, their focus on patients’ health, and service.
In the technically centered model, a dentist may treat the person as a delivery system for the mouth. Because focus tends to be on technical things, frustration may appear as, “I’m the expert. Are you questioning my judgment?” Focus on details may cloud views. Because of their perceived technical excellence, these dentists may exclude preventive, remedial, or maintenance dentistry because they are not challenging. This reduces incomes and abilities to establish relationships. A technically oriented dentist must develop strength in the helping relationships and business systems. Finding the motivation to change what needs to be changed is worth the effort.
In the standard-centered model, dentists may do well when things stay the same but when new challenges appear, it is difficult for them to change and adapt. With a sigh they think, “I just want to make it through the day and make enough money so I can retire early.” Dr. Bob Frazer of Austin, Texas, thinks the standard-centered dentist is a remnant of the traditional 1970s and ‘80s practice. Often these dentists’ practices are secondary to other life interests. Their dental practices provide adequate income streams and vocations so their true passions can be channeled into their avocations. Standard-centered dentists need the power that comes from being motivated to change, grow, and enjoy dental practice. They need to pursue advanced training in all areas of dentistry. If they keep doing what they have always done, they will continue to experience a low level of enjoyment in their practices.
Most dentists start out standard-centered. Some stay standard-centered and enjoy dentistry. In my experience, however, dentists who enjoy their practices have moved to one of the other modes. All dentists can burn out, have low motivation, and not enjoy their work. Enjoyment and motivation come from seeking, growing, and changing.
What does this mean for Dr. Steele? He needs to decide what style of practice will be best for him. He needs to find mentors, institutes, Web sites, articles, seminars, and workshops to help him develop in his chosen style of practice. Only then will he be excited to go to his office. He will be challenged instead of bored. He will experience new joy in learning. He will be rewarded in many ways for developing a balanced practice that is centered on what best fits his personality, situation, and values. At his best, he will provide optimal dental care - a product of optimal knowledge, planning, caring, trust, management, and technical skills.
In the end, it is the integrity, thoughtful caring, and competence of the dentist that are most important in delivering optimal dental care. Happiness comes from these disciplines.
Lynn D. Carlisle, DDS, FAGD, practices dentistry in Fort Collins, Colo. He has served on the board of directors of The Pankey Institute and has been president of The Bob Barkley Foundation. He is the publisher and editor of the Web site www.spiritofcaring.com. The Web site is dedicated to helping dentists and teams with the people part of dentistry. Reach him at [email protected].