What's on the horizon?

Is a tidal wave coming or is it smooth sailing ahead for dentistry? Consultant Sally McKenzie identifies some of the trends and how they will affect you.

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by Sally McKenzie, CMC

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Change is inevitable, so it's a fair assumption that your practice has been - and will continue to be - affected by changes in patient care, practice management, and administration. The more you're able to "go with the flow" and stay abreast of change, the easier time you'll have riding the crest of the coming waves.

On the flip side, if you have trouble keeping your head above water in the face of change, there's always the danger of being pulled under. The key to staying afloat is to follow the old sailors' mantra: Know the ropes and watch the tide. Up periscope.

No torrents, just trends

First of all, just because something's showing up on your radar screen doesn't mean you need to follow it. Nor does it mean you shouldn't. Keep watching that screen; in time, you'll know what to pursue, what to disregard, and what to continue tracking. By conducting in-office analysis as well as online practice management, I'm in a pretty good position to tell you that the coast is clear. No torrents are in sight at the moment, but several trends are worth keeping an eye on. Here, then, are some of the more notable ones showing up on my radar screen.

The dearth of dentists trend

Although many doctors I meet scoff at the idea that there is a shortage of dentists, they concede that there may be a scant supply in some mountain and rural states. Seeing dentistry from the inside out in practices across the country, I can tell you that the harsh realities of the trend are visible not just in the backwoods and wilderness, but most everywhere. It's simple math. Since the mid-'90s, the rate of dentists dying and retiring has been greater than the rate of dentists emerging from dental school. The resulting supply-and-demand problem is reflected in several areas, namely scheduling, customer service, expanded duties for auxiliaries, and marketing. At first glance, these areas seem to be separate and distinct, but, on closer examination, it's clear that they are interdependent, especially in times like these. Remember the old "knee-bone's-connected-to-the-thigh-bone" routine?

Due to the decreasing supply of dentists and the increasing demand from patients (thanks to patient education), doctors' schedules are booked out so far that what ensues is a customer-service nightmare. How can a practice attract new patients (or retain existing ones) when the wait time for hygiene is two months and three months for a three-unit bridge? Thinking this might be the gold rush of the new millennium, some dentists build larger facilities with more operatories and hire more employees, but then struggle to find an associate dentist to take up the slack. There's a rude surprise in store when that same associate dentist hangs out his or her own shingle right next door. We can't deny that the history of dental practice in the '70s has surely begun to repeat itself.

Will dentists get some relief from auxiliaries? While there is no groundswell of legislative proposals, leaders in most state dental societies aren't sitting around biting their nails either. The ADA reports that it is now permissible - in more than 30 states - for hygienists to administer anesthetic and nitrous oxide. Furthermore, several state societies are considering giving assistants expanded-duties status for such procedures as coronal polishing, placing restorative material, and making temporary crowns. It's too bad so many doctors - seasoned veterans as well as rookies - don't have a really good grasp of how to utilize a dental assistant to increase efficiency, just when they've gotten the green light to do so and could sorely use the help.

Finally, we come to how practice marketing is being affected by this supply/demand phenomenon. Overall, fewer dollars are being spent on practice marketing today than over the last 10 years. When there are more patients around than can be handled by the existing number of doctors, nobody needs promotional campaigns like in the '80s when everybody was scrapping for the same new patient. Upon closer examination, though, that rationale falls short. Although fewer doctors actively market their practices, those who do are typically marketing special services such as cosmetic dentistry. The resulting marketing materials are designed to appeal to members of an upscale niche market who might consider treating themselves to a nicer smile. These people want to know about their doctor's credentials, and they like reading about the various cosmetic options. If they're going to spend that kind of money on a vehicle like this, they want to kick the tires.

The technology trend

If anything in dentistry appears like a tidal wave these days, it's technology. But as we know, appearances can be tricky. This "virtual tidal wave" is actually the combined impact of a myriad of tiny ripples being made by technology on most every aspect of the dental practice.

Now clearly in an article like this, there simply isn't adequate space to address the many technologies - perio probes, voice charting, caries-detection, patient education, and computers in the operatory - designed to make dentistry better, faster, and/or more effective. So let's just examine imaging and the Internet.

Imaging: From a clinical standpoint, dentists now have high-tech solutions for diagnosis, treatment planning, and presentation provided by digital X-rays, intraoral video cameras, and digital still cameras. Patients are enthusiastic about seeing "before" and computer-simulated "after" shots of how their new smiles will look. Such imaging technology - once prohibitive in cost - is now not only within budget, but - thanks to easy-to-use software programs - it's also revenue-enhancing as patients buy into both treatment needs and cosmetic options.

There are further positive implications of imaging technology, such as sending preop and postop shots to the lab. Sent as .jpg files, they are relatively small, quick to download, and surprisingly clear. For the lab, such files are heaven-sent, allowing the technician to see the model in relation to the patient's face. This helps the technician with prepping and creating fabrication, all within the context of the "golden proportions" so critical to the highest level of cosmetic dentistry. Finally, with practice-management software, images are automatically stored within the patient's record.

World Wide Web: Now we come to the most colossal trend within the realm of technology - the Internet, which is all about convenience. We can use e-mail to conveniently communicate with patients for otherwise labor-intensive tasks such as scheduling, appointment confirmation, cancellations, rescheduling, sending out recall reminders, and patient newsletters. The Web also makes consulting with specialists very convenient.

Speaking of convenience, being able to shop, compare prices, and order supplies over the Internet has helped to bring dental supplies down from an all-time high of 7 percent back to the 5 percent they were before 1987.

For many dentists, one of the most exciting uses of the Internet is for continuing education. Whether the course is for the doctor or staff, travel time and cost savings add up fast. In addition, there's also the bonus of lower course costs on the Internet. The most remarkable bonus is ending up with a better-managed practice, thanks to the consistency of employee training that can now be accomplished online. And finally, there are the enormous benefits of online practice management.

Other trends

The insurance trend: There is a definite swing away from managed care today. Many doctors have had enough; in fact, they would be very happy to call an immediate halt to their participation in HMOs, PPOs, and other capitation plans. But before such hasty action, the number of patients in the practice who are on these plans should be determined, as well as how much practice revenue is derived from these plans. Professional assistance here is both beneficial and essential; in fact, much of the work done by my consultants and me over the last 12 months has been in this area.

Accounts receivable trend: We're seeing practices whose accounts receivable have dropped from 2x monthly production to 1x or just below over the past few years. Filing insurance electronically has sped up the payment process in most cases, as opposed to the six weeks it previously took to receive payments from insurance companies via mail. Another factor in this success story is the extensive use of Visa and MasterCard, plus the influx of patient-financing companies, like Care Credit, that weren't as prominent back in the '80s and '90s.

Despite the good news trend in accounts receivable, there's a bad news trend as well: Receivables over 90 days now stand beyond the target number of 10 percent of total accounts receivable.

Hygiene trend: Although hygienists are becoming a little more aware of the previous lack of periodontal assessment and delivery of interceptive periodontal therapy, perio still hovers around 20 percent of hygiene productivity, rather than the industry standard of 33 percent.

Preappointing trend: Recalling patients via preappointment of patients six months in advance is responsible for the highest-ever rate of cancellations and appointment failure, yet practices still continue to use the system without question.

Enduring trends: In my 20-plus years of practice system analysis, I have seen some trends that seem to endure, even though nobody's too happy about them. Payroll percentage is still too high, with gross salaries hovering beyond the industry standard of 20 percent and payroll taxes and benefits beyond the recommended 3 to 5 percent.

The enduring trend, though, that takes the greatest toll on a dental practice is no job descriptions, no training protocol, no accountability or performance measurement, and employees who are unproductive and uncooperative, yet who still keep their jobs.

Sally Says: Be it a tidal wave, torrent, or trend, remember that the winds and waves are always on the side of the ablest navigators. Bon Voyage!

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