If you build it, they will come

"I have found that location is virtually irrelevant in the development of an esthetic practice ... If people want quality cosmetic dentistry, they will find a way to finance it. So, small towns, blue-collar neighborhoods, and metropolitan areas with lots of competition are just not an excuse."

By William G. Dickerson, DDS, FAACD

"I have found that location is virtually irrelevant in the development of an esthetic practice ... If people want quality cosmetic dentistry, they will find a way to finance it. So, small towns, blue-collar neighborhoods, and metropolitan areas with lots of competition are just not an excuse."

In an effort to inspire dentists to achieve the success they have always wanted, I have been asked to do a series of interviews with successful individuals. The goal is to give some insight into the thinking of those who have persevered and find out how and why they are successful. This month's interview is with Dr. Larry Winans, a general dentist practicing in Lewisburg, Pa.

Dr. Dickerson: Larry, you have developed a very successful practice in a short period of time. How old are you and did you expect this type of success this fast?

Dr. Winans: I am 35 years old and have been practicing dentistry for six years. I can honestly say I did not expect this type of success this fast; however, I am exceedingly pleased with the direction my career has taken.

My wife and I chose to leave our hometown of Pittsburgh just a few months after graduation. I had several opportunities, including one in Pittsburgh, but I chose an associateship in the small town of Lewisburg, Pa., for several different reasons.

First, we liked the idea of raising our family in a rural area with strong family values and a close-knit community. Secondly, the associateship gave me an opportunity to practice nearly independently, with little interference from the owner-dentist. With this unique situation, I was able to learn the mechanics of office management quickly. Unfortunately, soon my goals and philosophies clashed with that of the owner-dentist, and the associateship ended abruptly after 11/2 years.

With my newfound freedom, I knew that I wanted my own office. I would be able to implement my own ideas and techniques without input from someone else. I purchased an office building, renovated it, hired employees, and opened our doors in less than three months. My practice is now 41/2 years old, and our growth is beyond my wildest expectations. For example, I achieved my third-year projected numbers at the completion of my first year. So, no, Bill, I only dreamed about this success, but I did not expect it.

Dr. Dickerson: Why did you want an esthetic-based practice?

Dr. Winans: From the beginning, I've always liked helping someone look better. I guess I've always had an appreciation for esthetics and tried to incorporate what little I knew into each case. When I started getting compliments on my work and requests and referrals specifically for esthetics, I gradually decided to focus the direction of my practice in this area.

I've always enjoyed making a transformation in the life of a patient. I've seen a quiet, shy patient with no self-confidence absolutely blossom as a direct result of cosmetic dentistry. The difference is immediate. It's not unusual to place temporaries on patients, hand them a mirror, and find them with tears in their eyes. Patients are amazed that they can look and feel so different so quickly.

Dr. Dickerson: Did you ever think you could have an esthetic practice in Lewisburg, Pa.?

Dr. Winans: Early on I had an interest, but I had doubts as to whether an esthetic practice could flourish in a small community. That was before I became educated and received the training that I now have. I have found that location is virtually irrelevant in the development of an esthetic practice.

Patients deserve the opportunity to make their own value decision about this type of dentistry. Our society is clearly influenced by youth and beauty, and people want to look and feel better, no matter what their economic status in life. Lewisburg is in a rural farm county - not Los Angeles - and I have just as many Amish and Mennonite farmers getting cosmetic work completed as university professors and corporate CEOs.

One of my favorite movies is "Field of Dreams." The concept of "If you build it, they will come" applies directly to the development of an esthetic-based practice. If you have the right philosophy and tools, and believe in yourself, location is not an issue.

Dr. Dickerson: But how would you define success?

Dr. Winans: I used to equate success with earnings. Now I view success from a broader perspective. Yes, the financial rewards are an important marker. Ultimately, I am responsible to provide for my family. However, fulfillment and job satisfaction are equally as important.

Dr. Dickerson: What was the reaction of your patients when you made all these changes necessary to create this success?

Dr. Winans: Our patients reacted enthusiastically, as we expected. Actually, the changes have followed an evolutionary path. We always had differentiated ourselves by providing good service; however, when the practice took an esthetic focus, we began looking for ways to enhance that reputation. For example, we had always provided coffee, but now we have added a variety of wines, gourmet hot chocolates and cappuccinos, and a refrigerator filled with juices, iced teas, and iced coffees.

Our treatment rooms have always been considered large and comfortable, but, ultimately, patients spend most of their time in the dental chair. To make that time more comfortable, we added massage pads to the treatment room chairs. Patients were thrilled! Gradually, we've added heated neck pillows, hot towels, cable TV, Gameboys, DVD movies, and over 400 CDs with personal headsets. For our larger cases, we surprise patients by having their cars detailed while they are in treatment, and give them gift certificates to dinner when the case is completed. As a result of these ongoing changes, patients are constantly asking what the next improvement will be. It keeps them wanting to come back for more.

And, after all, who doesn't appreciate an increased level of service and attention to detail with a greater quality of dentistry? Yes, we increased our fees to compensate for the higher cost of providing these services, but there was very little objection from our patients. If they did question our fees, we discussed what they were getting from our office that justified those fees.

Occasionally patients leave. When they realize what they are missing, and if we have made them feel welcome, many come back.

Most importantly, our reputation has spread like wildfire. Over 70 percent of all new patients come to us from a referral by an existing patient or doctor. We've even had patients referred to us by people we have never seen. These patients are asking specifically for esthetic dentistry. It has helped us to establish our identity in the community.

Dr. Dickerson: What changes in your personal life, confidence, pride, and self-esteem occurred because of your metamorphosis?

Dr. Winans: My metamorphosis is continually taking place, but it did get a boost after I advanced my training and focused my direction. My confidence level has risen beyond my greatest expectations. Patients sense this subtle air of confidence, and it becomes an upward spiral. Patients can detect my sincerity and my belief that I am doing everything I can to help them.

Dr. Dickerson: Knowing what you know now, what has been the most surprising thing about the last few years?

Dr. Winans: Most surprising is that our patients truly perceive value in the work we do. We are no longer a commodity player in this market. We have worked hard to educate patients about the reasons behind our treatment plans, so they believe I am competent to provide the treatment.

I also was surprised by how quickly I have been able to establish a reputation for excellence in esthetic dentistry - not just with patients, but also with other doctors and dentists. For a while, I was hesitant, as many are, about focusing so intently on cosmetics. I didn't want to alienate our long-term patients who simply need occasional hygiene and restorative work. But I finally realized that it takes too much energy to be everything to everybody.

Once I made the move to focus on esthetics in my continuing education, marketing, and treatment plans, our patients made it easy for us. They spread the word, and our reputation grew.

Dr. Dickerson: If you could attribute one thing to your success, what would it be?

Dr. Winans: I have to say it's my positive attitude. I work hard to enjoy my office and have fun, projecting my enthusiasm throughout every aspect of the day. One of my patients says I have a "Rum Punch Attitude," and I think that's a perfect way to describe it. Cosmetic dentistry doesn't have to be solemn and uptight - we like to make it fun.

Patients also love my team. I am not so egocentric as to think that my office is just about me. I am fortunate to work with a terrific group of individuals. Each one of them is highly skilled, talented, and dedicated. They support my philosophy of practice management whole-heartedly. The entire team contributes to the power of the positive attitude in the office.

Dr. Dickerson: If you could offer some advice to those dentists who think that a practice like yours is not possible in the location where they live, what would it be?

Dr. Winans: Again, location is not the issue. If people want quality cosmetic dentistry, they will find a way to finance it. So small towns, blue-collar neighborhoods, and metropolitan areas with lots of competition are just not an excuse.

I would like to offer two pieces of advice. First, advance your education. I've always said they only teach you just enough in dental school not to be dangerous. If you want to focus on cosmetic dentistry, you simply must learn more. I knew esthetics was what I wanted to do, but I lacked the confidence in my clinical skills to promote myself to patients as a dentist with a special interest in cosmetic dentistry. With considerable advanced education, I now feel extremely confident in my ability to produce superior cosmetic dentistry for my patients.

The second piece of advice is related to positioning. Too many dentists try to be everything to everybody, and they lose out in the end. Cosmetic dentistry obviously is a hot topic, not to mention profitable. In the past two years, nearly every area dentist has come to refer to himself or herself as a "Family and Cosmetic Dentist" on signage, in Yellow Pages ads, and in the newspaper. Well, which is it? Are you a family dentist or a cosmetic dentist? You can't do it all and still do it the best. Choose your position, and then pound that message into everything you use to communicate with your patients.

Dr. Dickerson: What is the best way to educate your patients on cosmetic dentistry?

Dr. Winans: There's no single best way - it's a package of repeated messages that are part of the patients' visit from the moment they walk in the door. We display a book of before-and-after photos in the reception room and have framed photos in every treatment room. I've also placed veneers on my two assistants, who love to talk to patients about their experience. It's a great way to give patients a "real person" perspective about the possibilities.

Next, we use the CAESY patient-education system. We'll run the cosmetic portion during a hygiene visit or a restorative procedure. This usually prompts patients to ask questions.

I also use a comprehensive new-patient exam to ask patients how they feel about their smile. When they express dissatisfaction, I explain what can be done to change things. Most people aren't even aware that options are available. As part of the new-patient exam, I take digital photos and ask patients if they would mind my presenting them with a digitally enhanced image. When I present the image, patients are always full of questions.

Dr. Dickerson: How do you educate your patients on insurance coverage?

Dr. Winans: Most patients are used to health insurance and expect full participating doctor coverage. My front-office team carefully explains that we see insurance as a rebate, sort of like a bonus. We expect full payment at the time of service, but we still act as their advocates. We will contact the insurance company to get as much information as possible about benefit plans, complete the paperwork to maximize their rebate, and then give the forms back to patients for them to submit. That way, any deviation from expected coverage makes the insurance company look bad, not our office. While insurance companies typically pay dental offices in 60 days, they pay the policyholder within 14 days. So it's better all the way around.

Dr. Dickerson: How many patients do you need to develop a high-end esthetic practice?

Dr. Winans: More is definitely not better. When I began this transformation, I worked primarily with our existing patient base, around 2,000 charts. However, if you want to build a primarily esthetic practice, it's best to have patients come to you specifically for cosmetic dentistry, via referrals or marketing. That way, you don't get bogged down with procedures that make it hard to schedule cases.

Prior to establishing our cosmetic focus, I saw 35-40 new patients per month. Once we refined our direction and focused on cosmetics, we've dropped to around 24 new patients a month. However, our collections are up 43 percent, and these 24 are more enjoyable patients. Ideally, I want to get down to around 15-18 new patients per month.

Dr. Dickerson: As far as you are concerned, what has been the most important dental advance for your practice?

Dr. Winans: Definitely the Las Vegas Institute for Advanced Dental Studies (LVI). I've learned the clinical skills necessary to boost my confidence in my abilities and gained invaluable management training about how to operate this type of practice. I have been absolutely soaring since my first LVI course. I can pinpoint that event as a turning point in developing the practice that I now have.

To be happy, human beings must feel that they are continuing to grow. To succeed in today's business world, dentists must be constantly improving. We must adopt the concept of continuous improvement as a daily principle, rather than as a goal to be pursued occasionally.

Dr. Dickerson: What do you think about the future and the direction of dentistry?

Dr. Winans: I see a trend toward a growing dependence on insurance-based dentistry. This is a huge problem, especially when viewed through the perspective of the medical industry. A third party should never be allowed to dictate the standards of care. The influence of the insurance industry has driven talented individuals away from the medical field and contributed to the decline in the total number of new applicants into medical school. This may jeopardize the quality of care that we should be able to expect. I don't want to see the same thing happen to dentistry.

I see a growing appreciation of posterior esthetics in addition to anterior esthetics. We should not neglect the importance of attractive back teeth. With millions of failing amalgams, patients may justify posterior esthetics for functional reasons, but they come to appreciate the enhanced esthetics. I love being able to improve posterior esthetics while, at the same time, enhancing strength and function.

Dr. Dickerson: Since you are so young, what are your goals for the future?

Dr. Winans: I love the idea of changing someone's perception of dentistry, and I want to help other dentists communicate a positive message to their patients.

With esthetics, I can make dentistry an overwhelmingly positive experience for my patients. We begin by treating our guests like royalty from the moment they walk in the door. Even our terminology is carefully chosen to sound positive - for instance, it's not a waiting room, but a reception room. We don't have operatories; we have treatment rooms. There's a way to put a positive twist on everything. Guests walk out of our office eager to tell someone about their experience, showing off a brilliant new smile to prove the point.

I also have had the incredible good fortune to work with some wonderful dentists who were very willing to lend a hand in my development. I would like to be able to do the same for other enterprising young dentists.

Most importantly, I want to keep enjoying dentistry. For me, that means staying in my present location, retaining my valuable team, and having a lot of fun each day at the office.

More in Cosmetic Dentistry and Whitening