This month: Profit centers with Dr. Joseph Rubino and Dr. Thomas Ventullo
Dr. John Jameson
This month continues another exciting innovation in the pages of Dental Economics. Many people have neither the time nor the inclination to write for publication. I have been searching for someone who could interview these people and then create an article. The search is over. Dr. John Jameson has agreed to fill that role for Dental Economics. John has a general practice in Davis, Okla., and is well-known for his seminars on high-tech in dentistry. He will be interviewing other dentists, staff, manufacturing people, distributor people, and laboratory people to bring you the best and the latest trends in dentistry. I am very excited about the personalities that John will bring to Dental Economics. John and his wife, Cathy, own and manage the Jameson Management Company.
This month, Dr. Jameson speaks with Dr. Joseph Rubino and Dr. Thomas Ventullo about the use of external profit centers in the dental environment. - Dr. Joe Blaes, editor
Dr. Jameson: Why are profit centers an essential part of what we begin to look at in the general cashflow of a 21st-century practice?
Dr. Rubino: First and foremost, profit centers revitalize practices. They do so in four areas: the patients, the practice, financial elements, and the staff.
As far as patients are concerned, profit centers are really wellness centers. The products that form the basis of the profit center are products that support the patient`s health and well-being, the patient`s esthetics, and the patient`s quality of life. So, when a practice introduces products that support patient wellness, it creates a value-added benefit. Patients see that your practice is more concerned than the typical practice they might have been exposed to in the past.
Dentists see that the compliance increases because they are recommending products that are preventive in nature. These products actually support health rather than just treat disease. They increase the efficacy of the procedures that are done, and help to take the practice up a couple of notches so that it is perceived as a practice that patients want to refer people to.
Dr. Jameson: So what you`re saying is that when we are able to do this, we are able to change the entire way that our patient base sees our practice? Patients see us as a state-of-the-art practice that meets their needs in a cutting-edge way and not just the way that we were trained in dental school 20 years ago. We are viewed as dentists who are treating patients in the most modern way possible.
Dr. Rubino: Absolutely. We are shifting from a disease-treatment approach to a total patient-wellness approach. We now focus on what not only will help the patient maintain his or her health, but also what will be preventive in nature so that he or she can maintain health, esthetics, and lifestyle. It`s a quality-of-life issue that contributes to patients in a lot of ways. As a result, your practice image is enhanced, as is your practice`s bottom line and staff relationships.
Dr. Jameson: When we start looking at this total wellness effort that we have in dentistry, and we know how little is being accomplished in medicine preventively, we`re beginning to see a big paradigm shift as we look at oral medicine, aren`t we?
Dr. Ventullo: That`s right. One of the things that we`re starting to notice is that the health of the oral environment plays such a big role in the total health of the body. For instance, restorations that have been in the mouth for years that may have gone bad will be removed or replaced. We soon notice that it`s not only the patient`s tissue that improves, but it`s also the patient`s overall well-being - his or her mood and ability to function - is improved. A patient`s overall health is related to the oral environment.
Dr. Jameson: As we see the clinical value of these profit centers, what are some of the most significant profit centers that doctors can implement to accomplish these goals?
Dr. Rubino: In my opinion, first and foremost is the periodontal-management program. Instead of treating periodontal disease, we begin to show patients that periodontal wellness is on the front-burner of our agenda. We start showing patients that they actually have the ability to not only keep their teeth for a lifetime and maintain healthy gums, but they also can be healthy systemically. We start to educate patients about the fact that they are in charge and control of their systemic wellness and their total esthetic condition.
We`re shifting from a disease approach - which is, unfortunately, the way that the Western world has looked upon dentistry and medicine for too many years now - to a preventive approach. We are teaching patients that they are in charge of their own well-being. As a result, we`re seeing all of these benefits - not only to the patient, but also to the practice, the staff, and the image of the dentist as a total health practitioner - that go way beyond dentistry.
Dr. Jameson: What are the feelings of our patients when they come in and see retailing in a dental office? What should our response to the patients be?
Dr. Ventullo: I think that we, as health-care professionals, have a fear that our patients will have a certain perception about things that we do in our office that might make a profit. What we`ve found by creating these profit centers and having them available to our patients is that our worst fears are totally unfounded. What we are seeing is the patients see this as a sign that we are totally enrolled in their care. We are looking to provide them with products and services that are for their benefit and their convenience. We know there are certain products that they need to maintain their oral health. Instead of sending them out to the drugstore or the variety store to get products, we have them available in our office as a service. As practitioners, we know that the items they take from our office will be used. We can give personal instructions on how to use them. This lets us know that there will be patient compliance and gives us a different kind of patient relationship. They see us as more than just people who are fixing their teeth; they see us as someone who is enrolled in their total, oral health care. They now have a responsibility as they go home to use the products. They realize that they are partly responsible for their health.
Dr. Jameson: We now have control of the equipment and the materials and can physically place them in our patient`s hands. What can you add to this, Dr. Rubino?
Dr. Rubino: There have been interviews where patients have been asked if they want their dentist recommending products to them. The overwhelming response - in the 90-percent range - is, "Of course." They want dentists to make recommendations on the products that they feel most comfortable about.
The second question asked was if patients would rather pick them up at the pharmacy or have the option of picking up products in the dentist`s office. Again, the overwhelming majority said that, because of convenience and because of a level of trust established with their dentist, it`s much more advantageous to have the products available in the practice.
The level of compliance increases substantially because, when a doctor makes a recommendation and the patient has to go to the drugstore to pick up the product, the patient will see that as an inconvenience. If it`s in the dentist`s office, the patient will pick up the product and use it.
Dr. Jameson: In this type of involvement, which is untraditional in many ways, how do you think that, by putting these ancillary profit centers in the office, staff morale is affected? How can we use these centers to improve staff morale?
Dr. Rubino: All of these programs - whether they are periodontal management, treatment of breath disorders, or nutrition-wellness programs - can be auxiliary-driven. That means that we have programs that support patient health and we have profit centers that are over and above the dentist`s and/or the hygienist`s time, so we`re actually leveraging time by creating a profit center within the practice.
As far as staff is concerned, profit centers increase the ability of the staff to have a significant role in impacting a patient`s health. It increases communication between the staff and the patient. The staff members will feel that they are contributing on a whole new level than they would be otherwise. It also gives the staff in offices that are aggressively implementing these wellness centers a substantial raise that can be in excess of 50 percent more than their salaries per week. This is done without the dentist reaching into his or her pocket and actually having to give the staff a raise. This creates tremendous staff loyalty to the practice. It gives staff members a new focus on total patient wellness, while improving their communication and giving them the opportunity to contribute on an entirely new level.
Dr. Jameson: If we look at bringing profit centers into the private practice, what can a practice anticipate in terms of the bottom line?
Dr. Rubino: The revenue that a practice can generate can range from a few hundred dollars per month to more than $10,000 per month. The sky is really the limit. It`s the function of the number of dentists and hygienists in the practice. It`s a function of the number of programs that are implemented, such as soft-tissue or periodontal-management therapy, treatment of breath disorders, nutritional-wellness programs, whitening programs, and several others. In our practice, we typically will generate an additional $6,000 to $7,000 per month through the implementation of periodontal-management, treatment of breath disorders, and nutritional-wellness programs. So not only are we treating our patient`s health but, at the same time, we actually add 25 percent or more to our net income with virtually no overhead associated with it and staff morale elevated through bonus situations.
Dr. Ventullo: The thing to realize about this is that, to have it totally auxiliary-driven, is a way to increase the income stream to your office. Look at the possibilities of having an income that is almost residual in nature and which comes in as a bonus, not only to your staff, but to you as well. What could you do with an extra $2,000 to $3,000 added to your bottom line that you really didn`t have to put out any extra effort to earn? You could use it for something personal or something charitable. It`s a very powerful type of income and an income that is a total win-win situation for your entire office.
Dr. Rubino: The other possibility on these staff-bonus programs is that many offices actually are taking the extra profit and not only giving the staff monetary bonuses but also doing things such as providing complimentary continuing-education trips, vacations, shopping sprees at the local mall, and/or dinners for the staff members and their families. They actually are increasing the quality of life and the lifestyle for their staff members, so that they are not only giving the staff more money for participating, but also are making the office a fun place that the staff wants to be a part of. As a result, the staff-retention rate is proportionally higher than that of a typical dentist`s office because extra money, extra fun, and extra self-motivation is being created.
Dr. Jameson: Knowing what we have today, and having a vision for where this could be tomorrow, what will dentists and their teams have to consider as parts of their new treatment mix?
Dr. Rubino: For one thing, patients will come to expect preventative services that give them more control over their own health-care futures. The highest demand by patients will be for offices that are preventive in nature and offer auxiliary services. It will be unacceptable to do 1950s dentistry. It will be unacceptable to not offer these cutting-edge services that patients demand.
Dr. Ventullo: I see a paradigm shift in the way that the patients relate to the dentist and vice versa. Now we have a place to come from where we are totally focused on patient care instead of just fixing teeth. We are involved in the patient`s total wellness, quality of life, and in the quality of the lives of those people that our patients touch.
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