Seven steps to building a successful practice

Oct. 1, 1999
Dentistry may not be the world`s oldest profession, but it could very well compete for the distinction of being the least-liked profession. As dentists, we kick off our daily agenda by greeting our patients with great enthusiasm and a smile, hoping to understand and treat what`s ailing them.

Priya D. Kothari, DMD

Dentistry may not be the world`s oldest profession, but it could very well compete for the distinction of being the least-liked profession. As dentists, we kick off our daily agenda by greeting our patients with great enthusiasm and a smile, hoping to understand and treat what`s ailing them.

Dentist: "Hi, my name is Dr. Kothari. How can I help you today?"

Patient: "My tooth hurts. Oh, and nothing personal, but I hate dentists and I`d rather be somewhere else!"

What a wonderful start this is going to be! For those of us from the dental community who begin our mornings with similar ominous greetings, it can be challenging to steer patient perceptions and office morale toward a satisfying and rewarding experience.

Two years ago, equipped with a DMD degree and a lot of enthusiasm, I joined an Advanced Education in General Dentistry (AEGD) residency program at the University of Pennsylvania. The program was unique in that the residents practiced in individual satellite clinics owned by the university and operated exactly like private dental practices. The clinics cater to the many university faculty, employees, and their families across the city. Since 95 percent of the residency is based on clinical general dentistry, the residents are expected to practice in the satellites to gain general-practice experience.

On day one, I was thrown, headfirst, into an ocean of dental problems. My relaxed schedule of two to four patients a day at school had suddenly become 8-10 patients a day in my residency! It is from this initial chaos, however, that I learned to hone my clinical, patient-management, and office-management skills. I had the opportunity to treat a wide variety of cases, while participating in the set-up of one of the new satellite clinics. I was fortunate to find out what works and what doesn`t when you open a new office, without having to worry about my own overhead costs. I want to share with you my experience as a resident with insider and outsider perceptions of facility operations.

The greatest lesson that stands out in my mind is that it takes a conscious and continuous effort to convert a skeptical patient into someone who trusts you and becomes a happy patient. To achieve this, there are some principles that have helped me to succeed and will continue to guide me in the future. As a practitioner, I value these Key Success Factors (KSFs), and I feel they are essential to building a satisfying and rewarding practice. The KSFs include seven principles:

(1) Professionalism

(2) Patient care

(3) People management

(4) Product integrity

(5) Perceived value

(6) Priorities

(7) Perceptions

Let`s examine these seven areas in detail to determine how they can help a dentist succeed in practice-building.


To me, this term typifies the special conventions, mannerisms, and forms of politeness that a business should practice and project to its customers. For contrast purposes, in a dental setting, unprofessionalism may encompass a lack of discretion among staff members when resolving disputes, poor front-desk etiquette, and a failure to send follow-up and thank-you letters for patient referrals. Patients should never be placed in a situation where they see weaknesses in office management. It will be the one aspect they always remember. Professionalism is reflected in the values that we respect and practice when we do what is right for the patient - our customers - every time.

(2) Patient care

I still believe that "customer comes first" is the right attitude to follow, even in dentistry. Since the university`s dental benefits covered 60-100 percent of procedures, I was afforded the luxury of offering my patients the best treatments available. However, in many instances, patients without insurance would seek low-cost treatment. In both scenarios, I asked my patients what their short- and long-term goals were. Most of the time, patients said, "You tell us what the best thing to do would be." With that, I offered a primary treatment plan and also suggested alternative choices. I allowed them a degree of control to choose their plan, and I provided all the background information and technical skills to put the plan into action. I tried to focus on the best option for my patients. I made it clear to them that I would be happy to try to accommodate their desires within a realistic time frame.

Patient care also draws on chairside manners. Listening to their stories of traumatic dental experiences, what they do for a living, what some of their interests are, and what some of their present concerns are has helped me to ease and alleviate current dental fears. Quite often, it has broken the ice and shown my patients that I am genuinely interested in their welfare. I believe that an extra few minutes talking with patients goes a long way in generating trust.

People management

Building a successful practice involves teamwork. A typical practice involves dentists, hygienists, dental assistants, office managers, and receptionists. Everyone must be motivated to perform to the best of his or her abilities and to play as effective team members. I have noticed that monthly staff meetings work well to bring everyone up to date on office issues, as well as providing an open forum for discussing concerns. I also have noticed that, in large organizations, it is easy for names of staff and their valuable services to be "lost." Recognition and celebration of staff work must be addressed. Recognition is important because people derive self-worth from their jobs. The contribution and importance of their roles must be appreciated and respected.

One office I worked in permitted staff members to take the day off on their birthdays. Another office held potluck lunches on a staff member`s birthday. These are fun ways to recognize and celebrate a person`s role and contributions. Such gestures create a family atmosphere, promote open discussions, and provide creative ideas for attracting more patients. Inevitably, if the staff is unhappy, the patients sense it immediately - which is a no-no - and this brings us back to the issue of unprofessionalism once again.

Product integrity

As dentists, we sell a service to our patients. This service is delivered using tools, technology, processes, and people. It is this service that the patient experiences and remembers. If any of the four components are less than satisfactory, then it affects the entire service.

The best example I can think of was the time I tried to repair fractured porcelain on the facial side of a crown. I didn`t think I would need help with this procedure. I decided I could simply bond any resin to repair the surface. I did so very neatly with a perfect, matching resin. Then I cured, finished, and polished the surface and sent my patient - who was very happy with the restoration - home. Well, sure enough, the following day the same patient returned complaining to me that my "repair job" failed. I examined the surface and noticed the resin had fallen off. After discussing the situation with my advisor, I followed his suggestions by microetching the fractured area first, then using a hydrofluoric acid etch, and finishing with an unfilled resin. If I had asked first, I probably could have saved my patient the extra visit.

It was through such experiences that I learned how important it was for me to acknowledge that I needed help and that it was OK to ask for a second opinion, regardless of how young, experienced, or specialized a dentist is. In the final analysis, it is the well-being of our patients and the quality of service we provide to them that count most.

Perceived value

Value is the worth your patient associates with your service. It is an indication of overall satisfaction with the level of trust, quality of service, and fairness of cost to the patient. Value is experienced every moment as the service is being provided. It starts right from the moment a patient walks into the office and ends with a follow-up call from the dentist to make certain that everything is OK. Value is perceived in the manner in which the service is provided, how treatment is followed up, and how genuinely the dentist expresses interest in or concern for the patient.

As part of the residency program, our production levels were monitored. We were encouraged to keep it above a certain minimum to simulate private practice. As we all struggled to work quickly, efficiently, and effectively in our first few months, we also learned when to place justifiable values on our services. Usually, a patient-of-record who needed an adjustment was not charged. This included denture adjustments, temporary crown recementations, occlusal adjustments, etc. If it was work performed by our office relatively recently that needed minor adjustments, then we did not charge our patients. Nothing ticks off patients more than receiving a bill for $120 for a visit that lasted not more than five minutes. (This is assuming it really was under five minutes and no major procedures were performed. Some of the residents had to be clear on this.)


What should the priorities of any dental practice be? Certainly, dentists need to profit from their work. This is the source of your livelihood, especially if you are opening a new office.

Too many times, however, I have seen dentists make profits their number-one priority. As much as dental practice is a business, it also is a trusted medical treatment and service. What complicates the delivery of the service is a patient`s low threshold for pain and working in an intimate and congested area, like the oral cavity. That`s why it is even more important to provide this service with a human touch, so the patient does not feel that he or she is part of an assembly line in factory-production work!

When profits do become the chief goal, I have seen results such as patient dissatisfaction, low staff morale, increased staff turnover, and, finally, bad business. I like to believe that "profits follow patients." The next time you are about to undertake any major decisions in your office, try asking yourself, "How will this benefit my patients? How will it benefit the staff and the office?" Once you have the patients and staff working together with you, then profits can only follow.

The survival and growth of a dental practice depends upon building successful relationships. I have developed a trusted one-on-one relationship with all my patients. With respect to staff, I believe that building relationships begins by fostering teamwork. To develop relationships within the community, you need to build on professionalism. Many patients still perceive going to the dental office as part of health care. They don`t see that it really is a business dependent on their presence. In one office I worked in, I thought it was professional of the dentist to be so considerate of his "customers." He always thanked them for "coming in today" and for being "with us" at the end of their appointments. I liked his attitude and incorporated what he said to his patients into my own routine.

These seven principles have been a part of my continuous learning. Every day I learn about new and interesting facets of dental-practice management as I treat new patients, manage office interactions, and seek advice from role models. I know the "Seven P`s" are working for me, because the nicest thing one of my patients said to me was, "For 10 years, I stopped going to the dentist because I had a bad experience. You`ve changed that for me. Since I`ve been coming to see you regularly, I feel like I`m doing something good for myself, thanks to you."

Who knows? Maybe next time I`ll even be able to get a patient to say he or she actually enjoys coming to the dentist! That may not be such a long shot after all!

Dr. Priya Kothari graduated from Boston University`s School of Dental Medicine in 1997. She completed an AEGD residency program at the University of Pennsylvania and practiced for an additional year in the school`s satellite clinics. She currently practices general dentistry in Toronto, Canada. She can be reached by e-mail at [email protected].