by William G. Dickerson, DDS, FAACD
I would like to introduce you to Dr. Nelson Clements of Valdosta, Ga. Nelson is a fabulous individual who is committed to providing only the best for his patients. In this interview, we take a snapshot of his practice to see what he has done to achieve excellence. I hope you enjoy his view from the Deep South!
Dr. Dickerson: Nelson, you have developed what most would consider a successful aesthetic practice. As you look back on your career, what do you think were the most difficult hurdles you encountered to get where you are today? What successes and pitfalls did you meet when you transitioned your practice?
Dr. Clements: I'm certain I did not define what my goals were before I started my practice transition. I knew two things:
- I did not want to be insurance-dependent, and
- I wanted to do dentistry that was fun and satisfying for me.
Dr. Dickerson: Are patients in Valdosta different from those in other areas of the country?
Dr. Clements: I've never practiced anywhere else, but I think people are the same everywhere. Our patients want the best dentistry available today. Adhesive, aesthetic dentistry is the means I have identified to give patients what they want. This is a rural area, but our patients have access to information from a variety of sources such as television, national publications, and the Internet.
Because I don't practice in a major metropolitan area, I don't get to do as many anterior cosmetic cases as dentists in Atlanta or Orlando probably do. We average about three veneer cases a month (each case is usually eight to 10 units). To me, aesthetic dentistry includes back teeth and occlusal rehabilitations. We do more posterior inlays than anterior veneers nearly every month. In my office, the fee is the same for front and back teeth, but the visual results I enjoy are pretty much the same.
Dr. Dickerson: How do you continue to evolve in your practice?
Dr. Clements: I see my evolution in both clinical and nonclinical terms.
Nonclinical evolution is difficult to explain. When I began the transition to an aesthetic practice, I continued to staff and manage my office like a traditional general practice.
That was a mistake. When a dentist begins the transition process, there must be a realization that the fundamental interaction with patients will change. Typical general practices "tell" patients what dental procedures they need and what their insurance will cover. Aesthetic practices have to discover what people want and help patients understand how that relates to the aesthetic services the practice offers. Since staff members handle most of the pretreatment interactions with patients, they need to be coached differently. We spend quite a bit of time evaluating what we say to people. Everyone on the team needs to be receptive to constructive feedback from other team members, including the dentist. This is how we improve communication with patients and, ultimately, provide a better service.
Clinical evolution is easier to describe. I am constantly evaluating my techniques and the new materials that become available. As you know, we have cements today like Nexus 2™ and RelyX™ that are color-stable and very easy to clean up. This year, I decided to switch to Cristobal+® for inlays & onlays. I used Empress® for six years, but Ron Jackson's long-term success with Concept® convinced me that resins are more desirable than porcelain for these restorations.
Three years ago, my left arm and hand went totally numb from two herniated discs in my neck. I was scheduled for disc fusion surgery that would include a cervical plate. At 47 years of age, I was advised to make alternative career plans. That was frightening.
Some of your West Coast buddies told me my neck problems came from a bad bite. I laughed and called them holistic quacks. Well, they were right. My mouth has been restored to the correct neuromuscular position. The herniated discs still hang over the sides of my vertebrae, but now I can prep a full arch and go home without pain. I didn't think that would be possible two years ago.
Based on this life-changing, personal experience, I have been pursuing all of the knowledge about neuromuscular occlusion that I can obtain. I was trained in CR for four years in dental school. Immediately after graduating, I began taking continuing-education courses about CR from the country's foremost experts. They called neuromuscular dentistry "quackery" and "charlatanism." I believed them just as I believed my dental school instructors. I tried for 19 years to make CR work in my practice.
Based on my experiences, knowledge, and research, currently I am doing one full-mouth case each month to the patient's neuromuscular position. This probably is the ultimate application of aesthetic dentistry. I am aware of the debate and skepticism this will create among some readers. I also am aware of what happened in my own body.
So far, I have applied this approach to more than 200 patients in my practice with either full-mouth aesthetic or orthotic appliances. All but one person has total symptom resolution. I think that is extremely significant.
Dr. Dickerson: How do you keep your team motivated?
Dr. Clements: I am lucky to work with a self-motivated group of people. That is a fundamental requirement I would look for if I hired a new person today. My team enjoys the results we obtain for our patients, and that motivates them to encourage other patients to enter treatment.
We have a coach, Cindy Powell of Tallahassee, Fla., who spends two days with us every two or three months. That really sharpens their focus.
Dr. Dickerson: What have you found to be the most successful case-presentation ideas?
Dr. Clements: I believe successful case presentation begins with incredible customer service. Everyone on the team has to know that our practice can deliver what the patient is looking for. That confidence comes through to the patients. Successful case presentation simply means defining what the patient wants.
Patients accept aesthetic treatment plans when they believe the dentist and team understand them and what they want. Patients must believe the dentist and team can deliver satisfactory results. This happens through relationship development, which is what dental offices should focus on.
Imaging, photography, and wax-ups are all wonderful props, but they don't close cases. Relationships close cases. Our best prop is before-and-after Polaroids® of similar cases. How low-tech is that!
Dr. Dickerson: Do you do any external marketing; i.e., direct mail, television, radio, etc.?
Dr. Clements: I ran Yellow Pages ads in the 1980s and early 1990s, but my practice was very different then.
I have not done any external marketing in about 10 years except for press releases. Ivoclar has made two television ads about Empress® that I plan to run because they are of such high quality. I finally completed a 60-page book for our patients patterned on Paddi Lund's work. I anticipate it will become our primary referral source. Also, I am actively attempting to establish a network of referring MDs, physical therapists, chiropractors, and massage therapists for patients who will benefit from neuromuscular therapy.
Dr. Dickerson: What is your practice policy on insurance, and how do you educate your patients about it?
Dr. Clements: We stopped accepting insurance assignment almost three years ago, and, since then, the practice's gross collections have gone up more than $250,000 on an annual basis. So it can be done successfully. We began by asking patients to take care of any visit costing less than $100 at the time of service. This got patients accustomed to paying for prophies instead of expecting us to get the money from their insurance company. We asked existing patients to come prepared to take care of the next visit. Those who objected to this policy elected to leave us for a dentist who would bill their insurance company. They probably never would have attached value to $1,000 inlays anyway.
Recently, we produced a mailing list to send our patients a newsletter about neuromuscular dentistry, which led us to discover that about a third of our patients have left the practice in the last three years. As I read the list, I realized that I don't miss any of them!
Dentists need to realize that the loss of exisiting patients is pretty much a certainty in their practice if they complete this transition to an aesthetic practice. But also they need to realize that their net income, satisfaction, and happiness will go way up.
Today, we explain to all new patients that our relationship is with them. We work for them, not their insurance companies.
We will submit all of their forms. We will do everything we can to get them all of the insurance money that they are entitled to, but we expect to be paid at an agreed-upon time, which is usually before treatment begins.
Dr. Dickerson: Can you do this anywhere?
Dr. Clements: If I can do this in Valdosta, Ga., without truly knowing what I was trying to do when I started, then any dentist can do this anywhere!
Dr. Dickerson: What are your keys to success?
Dr. Clements: I never gave up. I am confident I have made every possible mistake to this point, but I have tried to learn from those mistakes. Sometimes I made the same mistake over and over again because I did not recognize the message in the mistake.
I've been blessed with wonderful mentors. Dr. Mike Couch, of Ocala, Fla., helped me for many years when I was asking myself the basic questions about how I wanted to practice. Mike owns an incredibly successful technology-integration firm for dentists, Navigator Interactive, and he is helping me overcome my technological challenges. And, you, Bill, have inspired me to master many things in dentistry I would never have attempted otherwise. I remember coming to your Baylor course to learn cosmetic dentistry, wondering what you could teach me because I just knew I was pretty good. I was so embarrassed by how much better your cosmetic cases looked than anything I had ever done. Yes, I have had some incredible teachers who took me under their wings.
Dr. Dickerson: How do you balance your life between family and practice?
Dr. Clements: My wife, Angela, is the key to everything I have accomplished. She encourages me to do whatever it takes to attain career satisfaction.
Not only does she encourage me to strive, she also pushes me to keep going when I slow down. We have a 6-year-old daughter, Kaki, and Angela is completely involved in parental activities at her school. She's the unofficial "head of the mommies." Angela and Kaki travel with me in the summer during vacation, and they cheer me on when they have to stay at home. I have a grown son, Jason, who just got married and is becoming famous for his rock-and-roll concert posters. You can look him up on the Internet. I'm convinced that my practice never would have been as successful without the support of my family.
Dr. Dickerson: How long does it take to develop an aesthetic practice?
Dr. Clements: The decision can be instantaneous. A dentist can read this article and decide right then to change his or her practice. While I applaud that decision, I encourage dentists to plan better than I did.
Once the transition starts, some results will show up right away. The dentist will get much better clinical results. The entire team will have more fun and make more money. It will probably take between 18 months and two years to complete the transition; the process of refining and improving will continue until retirement. I could have completed the transition in my practice in that length of time if I had planned properly.
Dr. Dickerson: What advice would you give to those who desire an aesthetic practice? Where should they start? What should they expect?
Dr. Clements: The first thing to acquire is clinical knowledge and skills. You have to have it on the shelf before you can sell it. Two courses that I believe are fundamental are the Las Vegas Institute's "Advanced Functional Aesthetics" course and Ron Jackson's posterior aesthetics course. These courses will give dentists the knowledge, skills, and confidence to tackle most of what presents in the office. The classes also will help dentists begin to realize what they don't know, which can keep them out of trouble.
Next, the dentist and team must fundamentally change the way they interact with patients. There is an unending need for behavioral skill enhancement. Some good sources are Cindy Powell (our coach), Dr. Bill Blatchford (he teaches the thinking man's version), and Bob Maccario and Dr. Nate Booth (they have teamed up and are doing a wonderful job).
What I can't stress enough is planning. If the practice is involved with Delta Dental, for example, or any managed care, then the dentist must put in place the steps necessary to maintain cash flow while ceasing participation. Likewise, when and how to stop accepting indemnity insurance needs to be mapped out. Everyone on the team needs to know what to say to existing and new patients, and when to say it.
I think every dentist in private practice everywhere should choose this type of practice. What we can do for our patients today is so rewarding. For the dentists who do decide to make this transition, I applaud and congratulate you. And I look forward to meeting you along the journey.
Dr. William Dickerson will present "Unleashing the Power of Dentistry" on February 14 during the Cosmetic Dentistry 2002 conference in Las Vegas.
