Back to school
Dentists who begin serious practice-management study typically are over 40, and have endured years of needless office stress and less-than-optimal rewards from their profession.
by James R. Pride, DDS, and Amy Morgan
Dentists who begin serious practice-management study typically are over 40, and have endured years of needless office stress and less-than-optimal rewards from their profession. We often hear them lament, "My dental school prepared me to be a dentist — not a practice owner." Because of the intense study required to gain technical proficiency and because of the science-oriented personality that dentistry attracts, many dental school graduates feel comfortable delivering a mandibular block, but uncomfortable giving a performance evaluation or developing a strategic business plan. Although clinical expertise is essential for a successful dentist, entrepreneurial management is too. Having one without the other is like trying to walk with only one leg.
Besides accomplishing the enormous task of producing good clinicians, can dental schools also teach students the in-depth business skills they need to run a practice? Besides mastering the clinical science of dentistry, can students also learn entrepreneurship? The jury is out, but we are proud to be involved with experiments to learn the answer.
Our goal at Pride Institute is to give dentists the vital business skills they need to become successful practice owners as they begin their careers. Dr. Pride, a former assistant dean who has taught in dental schools throughout his career, considers this his primary goal and legacy to dentistry. We now are reaching the students.
We have teamed up with three dental schools — the University of the Pacific (UOP), Indiana University, and Marquette University — to create a curriculum that prepares students to be successful business professionals. We have been teaching at these schools for five years, one year, and since inception, respectively. To test the curriculum in different settings, these schools range from private to public to a combination of both.
The new curriculum is significantly different from the typical method of teaching practice management in dental school.
• The new curriculum is comprehensive. It covers fundamental topics, with one class building on another to form a cohesive body of knowledge, rather than isolated fragments of information combined in a loose arrangement of subjects. The teachers are like pieces of a puzzle; they each contribute a specific, defined part of the whole picture. The curriculum is established first, and then appropriate instructors are chosen to fulfill it. When there is no comprehensive program, courses tend to be designed to fit existing instructors' special areas of knowledge.
• The new curriculum focuses on skill-building, not just knowledge acquisition. In the traditional academic setting, the emphasis is on knowledge acquisition. Practice-management courses often impart knowledge to be applied later in private practice. The new curriculum goes a step further. Its focus is to implement knowledge for building skills that are immediately useful in the university clinic and to design a detailed plan for starting a career upon graduation. Students are graded on their performance while using these skills — not just their knowledge.
The curriculum is introductory for the lower grades and in-depth for seniors.
Retreats for lower grades
At the UOP, we hold one-day retreats for students below the senior grade to introduce them to management concepts as early as possible, thereby increasing the acceptance of new ideas. This early exposure allows students to enter the university clinic armed with the skills they need to obtain the requisite patients and treatments to complete their graduation requirements, and to practice from the outset the skills necessary for success in private practice.
We embellish the clinical mindset learned in other courses with these "softer" skills:
• Building strong relationships with patients
• Using the "influencing cycle" to discover a patient's dental motivators and concerns and to gain treatment acceptance for needed dentistry
• Introducing the fundamentals of management and leadership, which are important to all dentists, whether they become business owners, associates, or military dentists
The curriculum for seniors
The senior curriculum delivers comprehensive, weekly instruction to the senior class, designed to accomplish two goals:
• To make the seniors as successful as possible in the dental school clinic. The skills needed for success in the clinic are the same as those needed in private practice. When these skills are not learned in school, dentists may spend the first decade of practice at a disadvantage. For example, if students form a habit of communicating little with clinic patients, they may begin their practice reinforcing this behavior. Years later, many realize that their communication skills are lacking, which hurts their practice. Learning the proper skills in school saves the time and effort of having to break bad habits and instill new ones down the road.
Being successful at practice management in the clinic involves giving students the communication skills and other tools required to obtain enough patients necessary to fulfill graduation requirements. Meeting this goal is a challenge for many students, especially where HMOs and other reduced-fee services compete with dental school clinics. The management program equips students to be proactive — to market for their own patients, instead of waiting passively for the school to provide them. This teaches students a valuable lesson about taking control of their careers.
Success in the clinic is an essential goal of the curriculum for another reason. If the learning is to "stick," it must be experiential. Students should not be presented merely with abstract lectures for use sometime in the future, but with viable skills they need now. Our curriculum applies the same experiential learning to business skills that dental schools use to teach technical skills. In addition, a successful, profitable clinic, which instills loyalty in patients and fosters excitement for dental treatment, is a great financial benefit to the school itself.
• To arm students with the business information and tools necessary to practice their noble profession and reap its rewards. Besides success in the school clinic, which, in itself, is a precursor to success in private practice, we prepare students in-depth to make a considered decision on which road to travel after graduation. Choices vary among individuals, depending on their values and goals, so we give guidelines they can apply. We discuss in detail each practice option (advanced study, associateship, practice buy-in, start-up), eliminating the guesswork from this critical decision.
Classes for seniors follow a pattern of presentation, practice, and results. We teach a skill, give a homework assignment to practice in the clinic, then ask the students to report in a subsequent class on their experiences using the skill. Thus begins the hands-on application and eventual mastery of the skill, just as the students learn their clinical techniques.
The fall semester focuses on implementing interpersonal and business skills in the clinic, so students can ensure patient satisfaction and obtain a sufficient patient flow to meet their clinical requirements. Here they gain appreciation of those "softer" skills needed after graduation.
We strive for these outcomes:
• Nurture patients' loyalty to the clinic and their commitment to long-term care
• Achieve greater competence in clinical and practice-management skills
• Complete clinical requirements on time
• Join other students, faculty, and clinical staff in working together to gain patient satisfaction
• Gain an understanding of the opportunities available after graduation
• Begin pursuing an after-graduation opportunity during the holiday break [For this, we prepare students to: a) interview prospective practicing dentists for an associateship; b) develop criteria for finding a practice compatible with their career goals; c) create a viable business plan for starting a practice, which then can be submitted to a bank for a loan; and d) project cash flow for beginning a practice.]
In the spring, we continue developing key skills to make students successful beyond graduation, as well as in the clinic.
We strive for these outcomes:
• Understanding the psychology of patients. This includes applying the "influencing cycle" of active listening, relationship-building, asking questions to determine a patient's motivators and concerns regarding dental treatment, presenting benefit statements to patients, and learning other interpersonal skills.
• Managing on-going visits. This includes identifying and overcoming common clinical pitfalls. We teach students how to handle patient objections to treatment, reduce cancellations and tardiness, and address financial concerns.
• Developing sound businesss systems. We address the issues of scheduling, financial arrangements, staff hiring, leadership, charting, etc., which make the difference between organization and chaos.
• Creating a compelling vision and philosophy of care. This will serve as the standard by which to make every decision in the student's future practice.
• Learning the key elements of a successful business plan. Students learn how to compose a business plan to take to the bank when they apply for a loan.
• Understanding tax law and business structure.
• Analyzing after-graduation options. Students learn how to choose the right direction for launching their careers.
Pride Institute consultants and its "alumni" dentists — those who have completed extensive entrepreneurial training and successfully applied it to their practices — teach the practice-management curriculum. Faculty members also are involved. Key specialty lecturers include Jim Pride, Amy Morgan, Brian Hufford, and Hy Smith, who are all Dental Economics contributors and seasoned professionals. These are lecturers who teach management to practicing dentists with measurable results; operate successful companies that help dentists achieve business success and financial freedom; and specialize in practice transitions, tax planning, and other areas students vitally need.
The alumni doctors are excited about sharing their knowledge and expertise with future dentists.
"We're teaching them valuable tools that will make or break their success," says instructor Dr. Judy Culver of Kokomo, Ind. "The teaching is fun because, at that age, the students are so enthusiastic. They love dentistry and their patients, and they make a great audience."
Indianapolis dentist and Dental Economics contributor Dr. Mike Gradeless, another Pride Institute instructor, adds, "Teaching dental students keeps the important skills fresh in my mind, which inspires me to continue reinforcing them in my own practice."
At the UOP, where the program has been in effect long enough to collect more supporting data, income has increased in the clinics. In the school where obtaining patients is a concern, we are seeing a record high percentage of students fulfilling their clinical requirements on time after the introduction of the program, and we believe there is a correlation. Students rate the program as a valuable part of their dental school experience.
Dr. David Nielsen, associate dean for Postgraduate Studies and Community Programs at the UOP and co-director of its Practice-Management Program, offers these observations on the curriculum and its results:
"The impact of Dr. James Pride and Pride Institute on the students and graduates of the University of the Pacific School of Dentistry has been huge by any measure. Years ago, leaders throughout dentistry were asked to consider two essential traits of dentists, technical skills and communications/interpersonal skills, and to assign a percentage to each as related to success in dental school and in dental practice. The results were unanimous: The percentage required for success in dental school was 80 percent technical and 20 percent communication/interpersonal, while in dental practice it was reversed — 20 percent technical and 80 percent communication/interpersonal. UOP needed a process to facilitate a transition from the technical to the business aspect of delivering highly technical skills in a dental practice. Dean Arthur Dugoni contacted Dr. James Pride to develop such a process.
"The current program starts with communication and interpersonal skills in the first year and continues with a full-day retreat introducing the business aspects of dental practice. In the senior year it includes a two-quarter, 40-hour course in practice management. Faculty are fully integrated in the program with follow-up and reinforcement in the students' clinical program. A unique feature of the program is the development of practices the students can implement in the clinic with their patients.
"Probably one of the biggest signs of a change in philosophy was the implementation of a clinic patient-management competency required for graduation. In fact, this competency carries equal weight with any of the clinical or basic science competencies. We have actually delayed graduation for students because of a failure to meet the patient-management competency, even though they did meet competencies in all of the technical areas.
"The practice-management course in the senior year is a concentrated introduction to all of the business skills required to run and manage a solo dental practice. Within the past three years, we have had an increasing number of graduates start their own practices from scratch, a feat almost unheard of in recent times. Overall, Pride's program has filled a void in dental education and helped better prepare dentists for a successful career. It also has added to their success in dental school.
"As soon as funding is secured, a nonprofit, outside group will study the long-range effects of Pride's dental school curriculum on the subsequent careers of the students. Will the management curriculum increase a student's material and spiritual rewards from dentistry, including higher income, financial freedom for early retirement, reduced office stress, and deeper satisfaction from practicing one's dream? We hope to know the answers in the future."
We are proud to be involved with this noble undertaking. We have always wanted to enrich the professional lives of our future dentists by offering them critically needed skills as early as possible in their careers. Just as Pride Institute encourages dentists to "practice their dream" — to be true to the highest standards and vision they have defined for themselves — our dental school programs allow us to "practice our dream"!