You cant be everybodys dentist ... but try!

April 1, 2000
You often hear many bad connotations associated with a high-volume practice. It`s called a "roller skating practice" or a "room-hopping practice." Some lead you to believe that is a highly stressful practice where patients are perceived merely as numbers. And, of course, the assumption is that inferior dentistry is produced in these revolving door offices. I suppose this might be the case with some practices, but it certainly is not the rule.

Joe Steven Jr., DDS

You often hear many bad connotations associated with a high-volume practice. It`s called a "roller skating practice" or a "room-hopping practice." Some lead you to believe that is a highly stressful practice where patients are perceived merely as numbers. And, of course, the assumption is that inferior dentistry is produced in these revolving door offices. I suppose this might be the case with some practices, but it certainly is not the rule.

I firmly believe that the majority of dentists are not satisfied with our careers, and survey results back this up. I used to be in that majority until I became highly profitable. Sure, we all know that money isn`t everything, and as Dr. Earl Estep says, "There more to life than money - there`s also poverty and hunger and debt, etc."

As much as my critics may condemn my deliberate focus on money, please understand that I believe you first have to be committed to providing excellent, compassionate, friendly patient care and then money is the byproduct of such efforts. That has to be the primary goal or your practice will not reach or sustain a high level of success. When we are justly rewarded, we are happier and more satisfied with our profession. I believe this results in us becoming better employers, better dentists, and even better parents and spouses. Sure, it`s not going to solve all of our problems, but it certainly gives us an edge.

I`ve experienced my own frustrating "down-on-our-profession" episodes in my earlier years, so I can relate with many of those doctors. It wasn`t until I really started making a good living at dentistry that I truly appreciated our great profession. I haven`t met a dentist yet who makes a good living in dentistry and is down on our profession.

I`m a little reluctant in getting so specific and seemingly so obsessed with money, but I think it`s extremely pertinent to this discussion. I still believe that the large majority of dentists who take continuing-education courses do so to learn ways to increase their bottom line. If this is the case, then it`s imperative to know what is more likely to work for you so that you can move in the proper direction. So, with that in mind, let`s get real specific here.

The average income of a dentist is around $125,000 a year. That can make for a somewhat comfortable living, but it usually is not what most of us envisioned while attending dental school. Actually, for what we have to deal with on a daily basis, it is not nearly enough! I`m not about to define exactly what is enough, since that will vary for each dentist. I can tell you what is possible in dentistry if you`re willing to work at it!

Two types of practices

I`ve always acknowledged that there are basically two ways of having a highly successful solo practice. One is a high-volume practice that I call a "Type A" practice. It involves working out of five or six treatment rooms with a large staff doing a full range of services. The "Type B" practice can best be described as cosmetic "boutique" practice that we hear so much about now. This type of practice usually involves a smaller number of rooms and smaller staffs, while working on fewer patients that involve more profitable procedures. Either one of these practice styles can generate a net income to a solo practitioner of $400,000-plus per year. It`s hard to find a dentist who nets that amount of money and talks bad about our profession.

Don`t kid yourself, though. It takes a lot of work and dedication in either of these two types of practices if you are to net that high of an income. I also believe that, for the majority of dentists, it is easier to develop a successful Type A practice than a Type B practice. That`s because the average sector of our population is where the numbers are. Sam Walton found that out a long time ago. We all can`t be a Nieman Marcus dentist - there aren`t enough of these patients to go around!

Regardless of which type of practice you`re striving for, a good number of people who present seminars and courses are out there to help dentists achieve these goals. But, unfortunately, most of these courses don`t talk too favorably about a high-volume practice. We are inundated with course after course advocating a low-volume practice providing excellent cosmetic dentistry. These courses are very popular because they are so enticing when you start thinking about working on fewer patients for higher fees and not playing the insurance game because you collect your fees upfront. Do I really believe that this type of practice is possible? Yes, absolutely! I just don`t believe it is as easy as some think, especially when 85 percent of the patient population is composed of average wage earners.

Know yourself

Probably the most important factor in deciding which direction to take your practice lies in first understanding what type of individual you are. Some individuals are more suited for the high-volume practice, whereas others are better off with a smaller Type B practice. I don`t have the temperament or discipline and, as a result, the desire to operate a low-volume cosmetic practice. I`ve always said, in some ways, it`s easier to build a "bread and butter" practice providing general dentistry for average people than it is to build a cosmetic practice. With a boutique practice, you`re catering to a smaller segment of society which can afford these elective services. Frequently, you also are dealing with more demanding patients. Years ago, I decided that wasn`t the direction I wanted my practice to go.

I know many of you out there are just like me. You keep questioning your decision, because someone leads you to believe that you can`t do quality dentistry unless you throw away your amalgam, slow down, and spend more time with each patient doing strictly cosmetic dentistry. Quality dentistry involves much more than getting rid of your trituator. Quality pertains to root canals, dentures, surgery, patient education, patient management, and much more. I still think it`s unfortunate that quality dentistry now seems to be only associated with cosmetic dentistry. I still would put my money on gold restorations as being of higher quality than any type of posterior cosmetic restoration. I have a mouth full of them that were placed almost 25 years ago!

High volume and quality

I also think an argument could be made that a high-volume dentist possibly could provide higher quality dental procedures simply from the standpoint that he or she has more experience. Generally speaking, if a dentist does two, three, or four times as many root canals as another dentist, I think you can assume that this doctor may be better at endodontics. If a dentist has many more encounters with patients than the average, I would think that he or she would be a better communicator and, as a result, possibly a better dentist in dealing with patients. There`s always two ways to look at something.

I`m not about to deny the fact that there are high-volume practices that simply are playing the numbers game with big marketing budgets and inferior dentistry. Usually, these practices can`t last the distance and burn out after a few good years when the word gets out. On the flip side of the coin, I think we can agree that simply having a low-volume practice doesn`t by any means guarantee excellent dentistry.

So, don`t be too influenced by the popular trend that we see promoted and advertised everywhere. Cosmetic dentistry is high right now. Just keep things in perspective and know the limitations involved.

Keep trying!

I learned a long time ago that you can`t be everybody`s dentist, but that didn`t keep me from trying. For most of my career, I did my fair share of treating Medicaid patients. Guess what? I couldn`t please all of them either and lost many of them along the way for one reason or another. You can never please everybody, but we all try to and should continue to do so.

My recommendation to any dentist who wants to earn a high net income from dentistry would be to first develop a high-volume practice, while incorporating cosmetics a little at a time. A high flow of patients into your office will result in you finding more and more patients who are interested in cosmetics. And, if you are fortunate enough to find that you are really good at selling and producing these excellent procedures, then you can gradually phase more into this type of a practice. You may even wish to bring in an associate to help with basic procedures that you choose not to do. I`ve seen the concept work many times at other offices with great success.

I`ve seen too many doctors try the "all or none" approach in developing a Type B practice, only to find it results in decreased revenues and a lot of frustration. It is very disheartening to see a doctor go through so much effort only to realize that this practice concept is not working for him or her.

My intention is not to steer anyone either way. I simply want to point out both sides of the story, which hopefully will help you select your path to a successful practice. In my situation, a Type A practice is ideal. If high volume is good enough for Sam Walton, it`s good enough for me!

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