It was great to see the articles by Dr. Jack Griffin Jr. ("I Can't Believe What I Hear!" in the February 2001 issue and "Seven Most Common Lies About Success" in the March 2001 issue.) I would expect that you will receive letters of criticism from those who will never get it, but I throw my praise and support in with Dr. Griffin. As a high-producing practice, we have been subjected to the prejudices he describes and the critical remarks of other dentists. His portrayal of myths and their faulty perceptions do a lot to tell it like it really is. We at Total Dental Care Ltd. have always thought it ironic how the perception of this practice by colleagues is just the opposite of what it actually is ...
- Caring about patients enough to present and provide the best care, rather than prejudging them with an opinion that they cannot afford the best long-term restoration
- Caring enough to stick with them and show them the benefits of a more durble restoration, even though they think a lower cost, less durable repair is the right choice
- Charging what we are worth, but also being worth what we charge
- Providing services quickly while maintaining quality
- Giving service, service, service, and SERVICE!
And, if I may elaborate a bit on Dr. Griffin's article, it would be on the myth that fast is bad or low quality. Back in the 1860s, at the time of the Civil War, medical technology had advanced to the point where the benefits and use of ether in anesthesia were discovered and just coming into use. Unfortunately, it was not widely available in the treatment of battlefield wounds. If you were a soldier who needed the amputation of a leg, treatment without anesthetic was a horror. There was a very famous surgeon who had a reputation for being the best. Why? Because he was the fastest! He was able to remove a leg at the knee in 14 seconds. If we take the patient-based point of view of our practice as touted by Dr. Howard Farran, we would see that none of our patients wants to be in the chair any longer than necessary.
To get patients in the chair and provide a quality service in the shortest possible time is what should be done and it is what they want. The real myth that fearful dentists believe is that patients equate a longer time in the chair with better quality or the perception that they are getting better value for the fee. I can assure you that if practitioners would put themselves in the patients' shoes, it would become self-evident. They want in ... and they want out!
I recall vividly a fearful patient who was in severe pain with an abscess that necessitated extraction. We got him in the same day he called where other offices could/would not. After all preop and postop instructions, financial arrangements, and anesthesia were handled, I sat down and removed the tooth in about 20 seconds. When the patient asked, "That's it? It's out?" and I replied, "Yes," he began to complain about the fee in relationship to the short time the actual procedure took. I told him, "Well, I can take longer to remove a tooth if you want ... if it makes you feel like you're getting your money's worth." He sheepishly shook his head "no" and shut right up. Quality service delivered quickly is a good and responsible thing to do.
Gary A. Kauffman, DDS
The "more fun than fishing" practice
I got a lot of e-mail after my "More Fun Than Fishing" Viewpoint was published in the January 2001 issue of Dental Economics. Many dentists wanted to know if it actually is possible to earn a living while treating low-income children in a small office. I think it is. This kind of practice will produce less than other practices, but profit margins are good because overhead expenses are quite low. My practice was earning an average daily net when the first article was written. We have had considerable growth since that time.
My practice does more than treat low-income children, but these kids are a significant portion of the practice. Treating this kind of patient is the most enjoyable part of my day. I would not consider working in a practice that didn't treat foster children at least part of the time. I have given this a lot of thought and would like to share some ideas that will help you earn a better living while you help these kids:
1. Do more work at each appointment. Most foster children have multiple problems that can be treated during the same visit. Most of them have already missed a lot of school. You will be doing them a service if you can do good work in fewer appointments so they don't have to miss more school than necessary. Alternatives to the mandibular block will reduce the discomfort of being numb in multiple quadrants. Foster parents will be grateful if you can minimize the number of times they may have to take off work to bring a child to your office.
If you are organized, you can do upper quadrants while waiting for the lowers to get numb. This has a dramatic effect on profit. Let's assume that you now have 75 percent overhead. Doubling your production will cause your profits to increase fivefold. (You will pay a trivial amount for the extra supplies that are consumed.)
The DIAGNOdent laser has had a significant impact on my production. Kids benefit from early diagnosis and treatment. Dentists benefit from doing a couple of extra occlusals when the patient is already numb for other work.
2. Use time-saving technologies. If your time is worth $4 a minute, why would you want to waste it? Digital X-rays are essential in my small office, because I don't have extra operatories to work in while films develop. Before you buy a system, go to your state dental convention and play with different models. Choose one that is easy to use. Some of them are quite cumbersome. I am happy with my Dexis system.
Depending on your situation, the Ultradent supply rack could save several minutes per patient. If time is worth $4 a minute, you'll make an extra $100 each day. Work 180 days a year and you'll have an extra $18,000, just because you put your supplies where you can reach them!
I just bought a Comfort Control Syringe for each room in my office. I used to preinject with Citanest before giving anything stronger. That worked well, but it takes time and kids complained about getting so many shots. If Comfort Control saves me five minutes per patient and I use it 25 times a week, it will help me earn an extra $500 each week. I expect to use it more than 25 times a week, so the $500 estimate is probably on the conservative side. More important than money, I seem to have a better success rate at giving painless injections now that I have invested in Comfort Control Syringes.
3. Be as good as you can be. It is amazing how much CE a person can take without reaching a point of diminishing returns. Pedo lecturers tend to cover a lot of the same material, but each speaker will give an extra idea or two that helps your work go more smoothly. Working smoothly is essential if you are going to do multiple procedures in a 30-minute appointment.
In addition to attending classes, you can buy tapes and videos to study while you are at home. The following programs have been useful to me: Dr Marvin Berman's pediatric dentistry videos are available from Clinical Topics in Dentistry, (402) 472-2007. Greg Stanley has an audio program titled, "Lower Your Practice Overhead 15% in 90 Days," (623)934-2108.
4. Keep a small office. Two or three operatories is all you need if you make good use of them. The object of the game is to do a little bit more in a small office rather than building a big office and working like crazy to pay the overhead. I would rather have a small office because it gives me time to be with the kids.
5. Reward staff for their contribution to the practice. We use Greg Stanley's bonus system. This makes it possible for my staff to earn more than I would be able to pay if we were not using this system.
6. Be flexible. As soon as I start thinking that I'm a children's dentist, a month's worth of denture cases will walk into the office. Take what comes your way and be grateful. The kids will return next month.
My daily profit from the first quarter of this year was 41 percent more than it was last year. I have been following these principles for about three years and have seen my income increase each year. I started out with an income that was far below the national average, and now it is a bit higher than average. I don't plan to grow any more in the coming year, because I fear that excessive growth will jeopardize the "more fun than fishing" atmosphere.
I think these results speak for themselves. There is a real shortage of dentists who do this kind of work. The low overhead enjoyed by small-office dentists gives us enough time to be compassionate and still earn a good living.
Dwight Jones, DDS
Lake Los Angeles, Calif.