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The challenge of dental leadership

Aug. 1, 2011
When it comes to running their practices, dentists are at a distinct disadvantage compared to CEOs of major companies. Doctors have to not only be the practice's chief executive, but also its main producer. This situation is almost unthinkable in a large corporation.

Roger P. Levin, DDS

For more on this topic, go to and search using the following key words: leadership, staff training, office systems, scheduling, delegae, Dr. Roger Levin.

When it comes to running their practices, dentists are at a distinct disadvantage compared to CEOs of major companies. Doctors have to not only be the practice’s chief executive, but also its main producer. This situation is almost unthinkable in a large corporation.

For example, does the CEO of Ford Motor Company design, market, and assemble vehicles in addition to running the company? Of course not! Dentists, on the other hand, spend most of their days focused on one thing — providing optimal care to patients.

Due to the demands of dentistry, dentists have very little time to lead their practices. Most dental leadership occurs in the few minutes between patients. Despite those limitations, dentists are often adept at handling leadership basics such as:

  • Recognizing team members for a job well done
  • Saying “thank you” and displaying appreciation
  • Motivating staff members with incentive programs
  • Providing regular feedback and performance reviews to improve staff skills
  • Holding staff meetings to focus on training, customer service, and practice enhancement

Unfortunately, without adequate guidance from the dentist, the staff often reaches a performance plateau that translates into a financial plateau for the practice. Dentists need a well-trained team to take their practices to the next level, but doctors have little time to train staff. This is one of the main reasons practices fail to reach their full potential.

The leadership conundrum

Early in my practice management career, I recognized that many of the classic management techniques do not apply to dentistry. As CEOs of their practices, dentists are most productive not when managing people, but when they are treating patients. This is how practices grow and dentists achieve their goals.

Many dentists are frustrated by their inability to provide sufficient training to their team members. Recognizing the inherent difficulties of dental leadership, I would like to postulate a new theory of dental management which is ... stop trying to train the team! Instead, let your systems train your team.

The solution to building an outstanding team is not to spend time in training, but rather focusing efforts on implementing step-by-step management systems. Once documented systems have been put in place, team members are then taught the systems and required to follow them.

It is amazing how quickly team members become trained simply by following excellent systems. This can turn a practice from a chaotic and stressful office to a highly productive and efficient business in less than a year. The return on investment is nothing short of exponential. Let’s look at an example that illustrates the power of systems on training and doctor leadership.

Case study

John ran a fairly successful Michigan practice for 17 years. When the recession hit in 2008, his practice declined by 11% in the first year and an additional 6% in the second year. He reduced expenses, froze all staff salaries, and laid off one assistant. This approach limited profit declines by about 3% in the first year and an additional 2% in the second year.

By the third year of the recession, several team members had resigned their positions and taken jobs in other practices or industries due to their salary freezes, general dissatisfaction, and less than positive feelings toward the practice.

As new team members were hired, John found himself spending more and more time educating, training, coaching, and “putting out fires.” His days were becoming increasingly stressful and he was more tired than ever.

John finally reached a point where he decided that the best thing he could do was to step back and start over in terms of staff-building and systems implementation. He spent six months implementing all of the key systems in the practice, which included all front-desk activities, administration, efficiency, clinical systems, and operational flow.

He replaced his scheduling system, learned entirely new systems for case presentation and patient financial management, and restructured the collection processes and several other major systems in a six-month period.

At the end of six months, John was amazed by the performance of his team. They had:

  • Reactivated all overdue patients
  • Reduced no-shows to less than 1%
  • Scheduled more than 98% of all active patients
  • Closed 90% of all cases presented to patients

At this point, his production was up 16% and he was happier than he had been in all of his years in practice. Clearly, the difference was related to the staff becoming trained by implementing step-by-step systems in the practice.

Renting staff

At the Yankee Dental Congress this year, I presented a new concept in my seminar on increasing practice productivity. I called it “renting the staff.” I do not literally mean that doctors actually hire temporary staff members each day. What I do mean is that staff should provide a return on investment.

Think about hiring a company to wire every room in the office for computers. Does this mean that you pay the company the full price if the workers only complete 70% of the job and you must finish the rest? Obviously, in this case, you would be calling the company’s owner and insisting that the firm complete the job.

However, we unknowingly encourage our staff (not due to their fault) to perform like this on a regular basis. Imagine what would be expected if you rented each team member day by day.

As one client mentioned, “I would expect more of a temp than I do of my team now. I simply have gotten into habits over the years, and we all just sort of do things without really thinking about who should be doing them and if there is a better way to get it done.” The problem is dentists hold on to too many activities that should be delegated.

Extreme delegation

An excellent staff multiplies the ability of the doctor to provide patient care. In a long-term analysis of new clients, it became obvious that the top-producing doctors were simply better at delegation. They typically worked over- time to build excellent management systems and internal marketing programs. Staff were then asked to follow the systems, give input, and perform at the highest level based on their delegated tasks. These doctors engaged in what we call “extreme delegation.”

Extreme delegation is a concept that focuses on doctors removing all unnecessary activities from their plates so they can concentrate on what they do best — providing quality patient care and producing for the practice. This technique is how our top-producing dental clients run their practices.

They delegate all nonclinical activities and spend 98% of their day in direct patient care. These doctors report that they are happier and enjoy dentistry because they spend their days doing what they love and not on administrative (i.e., superfluous) activities.

Good systems and delegation of nonclinical tasks

The lack of time makes dental leadership an incredible challenge. The best leaders implement step-by-step systems that help maximize the skills of each team member. The most effective dentists also use extreme delegation to give away nonclinical activities and tasks to their well-trained teams. This type of leadership leads to higher productivity, less stress, and greater success. In fact, it’s the only way to practice!

Visit Levin Group’s Resource Center at for a wide range of educational materials, including “The Tip of the Day” newsletters and whitepapers. You can also connect with Levin Group on Facebook and Twitter (@Levin_Group) for tips, news, and sharing ideas.

Roger P. Levin, DDS, is chairman and CEO of Levin Group, a leading dental management consulting firm that is dedicated to improving the lives of dentists through a diverse portfolio of lifetime services and solutions. Since the company’s inception in 1985, Dr. Levin has worked to bring the business world to dentistry. Levin Group can be reached at (888) 973-0000, or

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