Rewriting the Book on Teaching Practice Management in Universities

An Interview with Pride Institute and Dental School Leaders

By Dr. Joe Blaes, DDS, Editor

Editor's Note: After almost three decades of coaching dentists on leadership, management, and other business skills, Pride Institute has in recent years expanded its teachings to the universities. In collaboration with school faculties, this leading practice management firm has been revamping curricula and teaching business courses as they've never been taught before. As a result, a quiet revolution in education is taking place at the dental schools of the University of the Pacific (for seven years), Indiana University (two years), and Marquette University (one year). I recently asked the CEO of Pride Institute and the leaders of these dental schools to reflect on their innovative approach and the lessons they've learned that can help other schools in preparing the next generation of dentists for business success.

Dr. Blaes: Why did Pride decide to teach practice management in dental schools?

Amy Morgan, CEO, Pride Institute: Pride Institute was created out of the university environment. The whole idea of the Institute came from Dr. Pride's tenure on the University of the Pacific faculty and his observation that dental students needed not only clinical skills, but entrepreneurial know-how. He and I feel that it's our ultimate goal and duty to take the profession of dentistry up a notch. We're doing this by reaching out to the students with knowledge and skills that we know are critical to their careers. We believe that all of us working in the industry—consultants, suppliers, bankers, etc.—should do all we can to make dentists more successful. That will help the next generation of dentists, as well as all of us who are associated with them.

Dr. Blaes: What prompted you to seek outside collaboration with your practice management curriculum?

Dr. Art Dugoni, Dean, University of the Pacific School of Dentistry: It has been my philosophy that we should not only train individuals to be outstanding scientists and clinicians, but also provide them with the tools that would help them be successful. There is no value to having an unsuccessful but very competent clinician and scientist. Approximately seven or eight years ago, I decided that we needed to do more, so I met with Dr. James Pride of the Pride Institute. Dr. Pride's company has a long history of providing the profession with outstanding programs in continuing education, management and leadership. I felt that we needed to enhance our teaching in this extremely important area. This was complimented by instituting an MBA program here at the School of Dentistry. Now over 25 individuals have MBA degrees who are functioning in leadership roles at Pacific.

Dr. Lawrence Goldblatt, Dean, Indiana University School of Dentistry: Dr. Ray Maddox of our part-time faculty, who for many years played a leadership role in our practice management course, brought a new possibility to our attention. Through his friendship with Jim Pride, he knew that Jim was interested in expanding the model he had established at the University of the Pacific (a private school) to include at least one public school and perhaps a school that had characteristics of both private and public. He also let Jim know of our interest, and Jim gave me a call. I then brought those discussions to our key faculty, who had been teaching practice management, and we considered a collaboration.

Dr. Blaes: Why did you choose to partner with Pride Institute?

Dr. Dugoni: In consulting with many graduates of the Pride Institute, all were uniformly enthusiastic about the programs that Pride provided. In addition, I reviewed many documents from individuals that demonstrated the outstanding success of the practitioners who had participated in the continuum of courses in practice management and leadership at Pride.

Dr. Goldblatt: Pride Institute is widely considered (certainly by the people I most respect) as one of the finest sources of professional education in practice management in the world. In addition, my personal discussions with Jim Pride and subsequent attendance at a number of classes given at our school have convinced me that the professional and ethical principles that guide the Pride philosophy are a great value added to the education of our dental students. This impression has certainly been borne out by our experience of the past two years.

Dr. William Lobb, Dean, Marquette University School of Dentistry: Our selection of Pride Institute came from an awareness of its work with the curriculum at the University of the Pacific School of Dentistry and its valuable contributions to the practices of some of our Marquette University School of Dentistry alumni.

Dr. Blaes: Are you pleased with the results?

Dr. Dugoni: Here at Pacific, we are extremely pleased with the results. When I review the presentations by our students and the business plans they create with respect to anticipated associateships or negotiations to buy practices, I am amazed at the depth of their knowledge. The attendance at the Pride Institute courses, although voluntary, is usually near 100 percent due to the quality of the presentations and the importance of the material. I believe that we at Pacific were the first—and for years the only—dental school to outsource practice management to a company specializing in that field. We are proud to have led the nation in a new and dynamic direction with respect to practice management and leadership courses integrated into the curriculum.

Dr. Goldblatt: There is no doubt that the students enjoy the program and could probably use even more exposure to it. One of the principal challenges, as with all new additions to a dental curriculum, continues to be finding just the right timing and sequence to keep the students focused on both the material and its importance. We very much have enjoyed working with the Pride faculty to continuously enhance the presentation, relevance and flow of the program. Because of the program's newness, we do not have a large number of measurable outcomes. But anecdotal evidence suggests that our graduates have a huge head start in developing and running a practice compared to their predecessors.

Dr. Blaes: Who teaches your practice management program and what are the goals of the curriculum?

Dr. Lobb: Our program is delivered by a combination of Pride speakers and faculty with two curriculum goals. One goal is to convert the fundamentals of good practice management into applicable skills for each student's current clinic practice. There are universal skills that all practice management experts agree on. Pride Institute does an excellent job of formatting these skills. We dovetail them into our behavioral science and ethics curriculum, enhancing them with a practice management course fitted into our clinical structure. We encourage our students to learn the principles and apply them immediately to their clinical practice. We monitor the program with exit surveys of lecture content and assigned homework that gauges the effectiveness of the lectures. Some lectures that were redundant were removed. The homework indicates a growing number of students experiencing success with applications. Good examples here are the lectures on appointment making, confirming and debriefing appointments, and handling compliments and complaints. All of this data is preliminary, but it's in the right direction. Our second goal is to provide a basic business foundation for practice. Fourth-year students get a full description of the information they will need to transition to the practice environment—the business terms and forms, personal and office finances, staff relationships and manuals, etc. We want them to begin converting the skills that they have learned and applied in the clinic to the practice they will be in after graduation. They also receive information on where to find practices, what to look for, and what to ask when interviewing.

Dr. Blaes: What have been some specific outcomes of your practice management program and how do you measure your success?

Dr. David Nielsen, Associate Dean, Chair of Department of Dental Practice, University of the Pacific: In 1996, we brought in Pride Institute to help structure a program that would encompass our entire curriculum and develop a major management course for seniors. We look at many different data sets to try to evaluate the impact of such a change in our curriculum. Outcomes are a major part of our evaluation process. Perhaps one of the best measures is the Annual Survey of Dental School Seniors conducted by the American Dental Education Association's Center for Education Policy and Research. Each year since 1979, all graduating seniors have been surveyed and the response rate is around 80 percent. Each school receives its own students' results, which it can then compare to national averages. Two areas we follow closely are the sections on "Future Practice Plans" and "Rating of Time Devoted to Areas of Instruction." Students are asked to give a subjective rating of the instructional time devoted to each subject. The result is a percentage of students who rate the course as Inadequate, Appropriate or Excessive relating to time in the curriculum. It is interesting to note that the percentages since the Pride program started are significantly ahead of the national average in the Appropriate category.

Other measures we follow are how many University of Pacific graduates go into private practice both right after graduation and 10 years later. Pacific graduates are ahead of the national averages in all categories. One factor contributing to this could be the superior preparation provided by the Pride management course. Another measure we look at is the student loan default rate for dentists. Our student loan default rate—under 2 percent—is one of the lowest of any dental school in the country. This could certainly indicate that Pacific graduates are successful in practice and responsible in paying off their student debt. We also do an annual in-house student survey at the end of each course. The practice management course is rated right at the top in every category.

Dr. George Willis, Associate Dean for Clinical Affairs, Indiana University: Graduating seniors have an opportunity to answer questions concerning the overall curriculum in the form of an exit survey. The data derived from this survey indicates that our graduates are more comfortable with the business aspects of running a dental practice now than has been the case in the past. In addition, Dr. Steve Dixon [introduced below] conducts course evaluations at the conclusion of the course. We do not yet have a mechanism to track graduates after graduation concerning curriculum issues.

Dr. Steve Dixon, Director of Comprehensive Care, Indiana University: I compiled a list of written comments from this year's class. As we would expect, the comments range widely in both their specificity and their positive/negative nature; however, in general, it is clear that the course and faculty have fully engaged the students and that the students are interested enough to express strong (usually positive) comments and suggestions. The enthusiastic and creative nature of the comments and suggestions lend further credence to the positive impact of the course. Feedback from alumni indicates that our recent graduates are well-prepared for interviews and know what questions to ask. The alumni have been impressed with the quality of questions, information and overall demeanor of our graduates.

Dr. Blaes: How do you think Pride has done, so far?

Ms. Morgan: At the University of the Pacific—the school we've been working with the longest—we're now seeing our original students taking Pride courses as seasoned professionals, realizing the value of the initial information they received while looking for more. We're also seeing, in all three schools, an immediate benefit regarding transition planning. The dental students are asking penetrating, well-informed questions that are impressing the dentists whom they're interviewing for a possible associateship or purchase. We also are seeing the students enlist appropriate brokers, bankers and other specialists in practice transitions, so they're negotiating better deals. And the clinics in all three schools are reporting increased efficiency and productivity as the students begin to apply new management skills there. The management course, I think, is an important factor in the efficiencies we're seeing in the students' completing their requirements faster, improving appointment scheduling, reducing no-shows and cancellations, etc. One of the things I'm most proud of is that we've now implemented business plans in all three schools. This year, for the first time, I had 300 business plans in my hands. Some were really well done, and some not as good, but 300 students are now thinking like businesspeople—and that's a milestone.

Dr. Blaes: What does the faculty think of the program?

Dr. Nicholas Shane, Adjunct Professor, Marquette University: We are currently several months from our first real in-service presentation to the faculty. We've been asked to present an overview of the curriculum, a synopsis of the information students are being asked to apply in the clinic, and an outline of how clinical faculty can be trained to get all of us "on the same page." Obviously, there's still a lot of work ahead, because this is not a turnkey operation, but rather one that gets carefully customized to the school's curriculum. That's what makes it so effective. I'm glad to say that the support structure for our efforts at Marquette and at Pride has been terrific. Don't look now, but we actually may be nearing the elimination of practice management as the No. 1 subject on a graduate's list of "didn't learn what I needed" exit surveys. And THAT'S our goal!

Dr. Blaes: What would you like to accomplish at the dental schools in the future?

Ms. Morgan: When we first embarked on this project, we were pretty excited and a little naïve. We had the crazy idea that we would arrive at the dental schools armed with all of this business information, and the students would immediately embrace it all. But the truth is that it was sometimes like pulling teeth (if you'll pardon the pun). After having spent years now collaborating with the dental schools, I realize that the student mindset and the dentist mindset are opposites. The focus in dental school is on gaining clinical competence, so it can feel like an intrusion to the students to drop that focus and learn business skills for which they don't see an immediate need. My goal is to refine our teaching of practice management in a way that sticks as much as possible. And, even if students can't assimilate all the information, I want them to know that there is a huge body of knowledge and expertise out there to get them through any barriers they encounter later when they practice. I want them to realize that they don't have to live with problems; they have the control to steer their future practices in the direction they choose.

Editor's Note: After DE conducted the interviews for use in this article, Dr. James Pride passed away on Aug. 11.

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