Monday, March 20, 2017

Part 2: What Defines a Successful Practice?

This is my second blog post in which I strive to define success through my eyes. In my previous blog post, I talked about how I feel like success is always measured in dollars. (If you haven’t yet read it, I recommend you do. It is a must-read. I mean: Pulitzer Prize-type stuff.) I also discussed that while making money is important, regardless of how much money you make, it will never be enough. With this in mind, I have changed my definition of success, and I now measure success in the intensity of my happiness.

I love coming to work every day. I actually like and enjoy all of my staff members (most of the time). I love doing dentistry, and I like most of my patients. Now, I don’t know about you, but I feel pretty successful in light of these things.

Today, I want to tell you about my practice. Now, it is probably going to seem different from yours and even different from some of the other bloggers’ practices. (I know Dr. Murry has multiple offices, but the funny thing is that when I read his blog posts, I feel like I could have written them because we think the so much alike.) I have a relatively small practice. This is how it started: I joined my father’s practice about 22 years ago, two days a week. I began working full-time in a little more than 2½ years later. (Joining your father’s practice has its good and its bad components. This is a story for a different blog post series.)

My father allowed me to buy 25 percent of the practice after eight years of being an associate. Four years after this, he allowed me to buy another 25 percent. At this time, my father was about 60 years old. It took a couple more years, but he started to allow me to start making decisions.

And it took a couple of more years before he was coming into the office less. Then, a natural evolution of the office was starting ... and it was starting to look a lot like my practice, the product of my vision — after 15 years of working there.

I bought 100 percent of the office six years later. That’s right: I was 42 years old before I owned the practice. (See, I told you that there were both good and bad components that go along with working with your dad.) My father was my associate for a year and a half before he fully retired.

As an aside: When my father retired, I brought in an associate, and after about a year, he bought his own practice and left. (Again: This could be the topic of another blog post series.) This is when I decided that I was just going to work by myself for some time. (I probably will never hire another associate until one of my kids becomes a dentist or before I am about to retire.)

I have eight rooms in my office. In my practice, I work with three hygienists, but I only have nine hygiene days. I have a four-day, a three-day and a two-day hygienist. Every day, I work with two hygienists, and one day, I work with three. I work four days a week, so that means on the days I am in the office, there are at least three empty rooms, and three days a week, there are four empty rooms. And I have no desire to fill them with patients or staff. (I did work something out with an orthodontist, and he is now working one day a month and is trying to build a practice out here.)

I take only traditional dental insurance. These are the insurances that involve you picking your own dentist, and you go, and they pay a certain percentage. I am not on any PPO or HMO networks.

I am not on any lists, and if the patients have one of the above and they want to come here, we will take the out-of-network benefit, and they will be responsible for the rest. We know that this means that a lot of people are going to be paying out-of-pocket to come to our office. So we have to make a practice that is worth visiting.

For this reason, there has to be a perceived difference between us and the dentist down the street who is within their insurance network. This is how I try to make my office stand out from the others. Our office has to be warmer. We have to have perceived technology, whether this means monitors mounted on the ceiling, an intraoral camera or digital X-rays. The people who work here have to be nicer and friendlier, and they have to be “service above self” people. We are a service profession, after all! How many offices don’t serve patients well? In how many offices is it about the dentist and not about the patient? I think when you go above and beyond, people are going to notice. And it is not that expensive to do so.

Pictured is my reception area. I bought at least four of the chairs on clearance. The massage chair was $300, and I recently reupholstered it. A patient made me the armoire. I bought the little fridge on clearance. And so on.

And the only other thing I think is important is me and remembering to always put the patient and the practice first. It’s important for me to be all of the above: warm, nice, friendly and all about service. Look, to me, this profession is about building and maintaining relationships. I have always said, “Patients don’t care how much you know until they know how much you care.”

You have to get be able to talk with the kids. You have to be able to relate to Grandma. You have to be able to have a conversation with Mom — not your assistant, but you. Yes, it’s important for you, not your assistant, to go out into the reception area, sit next to Mom and have a discussion. You have to remember that your patient’s 50th birthday is next year and that your 65-year-old patient is retiring in April (so that you can send him or her a birthday card and a congratulatory gift card, respectively). You have to notice someone driving into the practice parking lot in a new car — go out to the parking lot and tell the patient how awesome it is. Talk their language; ask them, “How many miles do you have on that baby?” Are you starting to see a theme? It is about them, my patients — not me. I have learned that people just want to feel known and special.

Yes, this is a lot to do. And if you are thinking that you have a schedule that is so packed that you have no room to talk with patients, well, then I would think about changing that. I know some of you are not good at this. Chit-chatting with patients may not come naturally for you. I get that. Some dentists are introverts. My advice is to “fake it until you make it,” as they say. Give talking with patients a try. Or enlist the help of your staff members. Remember: People just want to feel special.

John Gammichia, DMD, FAGD

Friday, March 17, 2017

Striving to Be Like the $350,000 Man

I read an article a few weeks back — when my beloved Pittsburgh Steelers were still in the playoff picture — about how linebacker James Harrison, at the ripe ol’ age of 38, spends $350,000 a year on maintenance, conditioning and recovery of his body. He’s still making body-shivering collisions with players who are half his age and remains at the top of his game, so it clearly works. He’s even got the NFL baffled at how he’s able to do it — and is drug-tested more than any player in the league because of it. But $350,000?! That’s on top of the stellar treatment provided to him as part of his contract with the Steelers. Wow!

I bet that I won’t spend $350,000 on care, training and recovery of my body in my lifetime. Hence, the reason I’m a dentist and not a professional athlete, I guess. But there’s a message within that amazing statement, or at least I took it as such. It’s time to make yourself a better dentist and person. I don’t recommend making it a $350,000-a-year venture, but invest some time, energy and money into yourself. I put together a hefty list of things I want to change for the better this year, both personally and professionally, and I intend to crush it, much like Harrison crushes his 5:30 a.m. workouts daily — even getting one in in the morning after arriving back from Kansas City at 2:30 a.m. That’s dedication, people.

I intend to be a better clinician. I’ve put together a significant continuing education schedule for the coming year. I’ve increased our marketing efforts fivefold. I intend to set a new bar for communication with my team members. I also intend to reset my attitude dial at morning huddles, before coffee enters my bloodstream — all in an effort to make myself a better boss and provider to my staff and patients.

On the flip side, I’ve set equally high marks for my personal life. My time at work needs to be kept within a well-defined window of time, and my time at home with my young kids needs to be quality, connected, invested time. I too often hear dentists get up and speak at lectures about how they wish they could have their first 10 years of practice back, mostly because of the experiences they missed with their families. It’s understandable and something that’s a constant battle.

Add a 6 a.m. workout a few times a week, regular chiropractic visits and a massage once in a while, and it becomes more difficult to achieve these goals due to time constraints. But I’m focused on overcoming obstacles to achieve my mission. (And, man, I could have a masseuse on staff for back massages between every patient for less than $350,000! Wouldn’t that be the life?)

Push your boundaries for the better, people. Work hard, love hard, recover hard. Make it your mission.

Donald Murry III, DMD

Monday, March 13, 2017

Turn a ‘Triple Play’ for Your Patients

There are so many reasons I love being the team dentist for the Chicago Bandits. 

Are you familiar with the Bandits? The four-time league champion women’s professional fast-pitch softball team plays every summer out of their beautiful stadium in west-suburban Rosemont, Illinois. My role as the Bandits’ team dentist is so fulfilling. On a personal level, and as the father of two daughters, I’m extremely proud to support women’s professional sports. On a professional level, my role allows me to further the advancement and knowledge of sports dentistry in the public eye. Most importantly, it’s just flat-out fun to watch the team play.

Each game, the best softball players in the world meet on the field, and the action doesn’t disappoint. The team (and league, for that matter) is chock-full of National Collegiate Athletic Association all-Americans and former Olympians.

Over the past five years as the Bandits’ team dentist, I’ve been fortunate enough to watch some amazing softball on the field and associate with the stellar players, coaches and organizational staff. The past two seasons have been especially fantastic, as the Bandits are repeat defending league champions (in 2015 and 2016). Many amazing plays took place in order for the team to earn back-to-back championships, but one play in particular will always stand out in my mind.

It happened during the 2014 season before the recent championship run — a triple play! Yes, one of the rarest plays in the sport was started by none other than the Bandits’ redheaded ball of fire herself, shortstop Tammy Williams. Her triple play made ESPN’s “Top 10 Plays of the Week,” and she gained national recognition for not only herself, but for the team, league and sport as well. The video clip of the play rocketed through the internet and was shared again and again by women’s softball teams, players and fans of all ages. In all, that single play resonated throughout the softball world exponentially for longer than the several seconds it took to physically complete it.

Wouldn’t it be amazing to be able to be in Tammy’s cleats for just a moment? To have a skillset that allows us as dentists to have such a vast and far-reaching impact? I firmly believe that we as dentists are in a fantastic position to make a difference. There are chances to turn a “triple play” around us all of the time, to make an impact on our patients’ lives.

To do this, like Tammy, we need to be in the right place, at the right time, and we need to identify the opportunity and then execute! The opportunities to perform procedures that resonate with patients likely present themselves routinely in your dental practice. You just have to identify them.

There are numerous procedures that fall into the “triple play” category, but several of the best examples are pit/fissure sealants, athletic mouthguards, bruxism night guards and routine prophylaxis. Each of these typifies a “triple play” procedure, as they are noninvasive and low-cost and yield long-term benefits for the patient. Even knowledgeable parents of pediatric patients rarely are aware that noninvasive, low-cost dental sealants can reduce their child’s probability of occlusal caries by up to 80 percent.

Broadly, in my office, a “triple play” procedure should satisfy all three of the following requirements, in order for me to pitch it to my patients:
  1. It must be minimally invasive. 
  2. It must be inexpensive, relative to other dental procedures.
  3. It must offer long-term benefits for the patient’s oral health. 

If I can answer “yes” to each of those requirements, then the procedure certainly counts as a “triple play” and likely will resonate throughout that patient’s world in the same way that Tammy’s play did the softball world.

After I discuss with them the procedure, the science and the “triple play” way of thinking, my patients always leave with not only a better understanding of dentistry, but an effective approach to dental treatment planning as well. In my opinion, patients truly appreciate this way of thinking, and it’s been a real practice-builder, as patients are more willing to accept recommended treatment to improve their oral health.

So whether you’re sitting in your dental practice or in the stands watching the Bandits, be sure to watch closely for that “triple play” opportunity that could have a long-lasting impact.


Tuesday, March 7, 2017

Dentist and Dental Assistant: A Necessary Duo

I’m sure we’ve all been there: Our dental assistant tells us that he or she is resigning. You know, the one who has the whole office put together and knows it like the back of his or her hand. The one whom you know, deep in your heart, you’d rather not function without.

I’ve worked with numerous assistants throughout my career, and over the years, I’ve understood their job to be a difficult one — not that ours as dentists is a walk in the park, but I can’t imagine a day without them. In fact, as I look back, my most beloved assistants were at the center of those smoothly run days integral to the running of the practice and, more importantly, patient treatment. (Of course, I’ve had assistants who totally ruined a day, too, but I’m choosing to focus on the good ones here.) This isn’t news to anyone, I’m sure, but I’m reflecting on this now because lately, we lost a superb assistant to dental school and another to an injury. In the meantime, I’ve had to work with short-term assistants, striving to fill the void and, boy, has that opened my eyes.

They don’t know our systems, our codes and our vices; they are like first-time guests in my house being asked to cook a four-course meal. They don’t know where our materials are kept, are not familiar with our software and, of course, don’t know the staff or our patients. Sure, everyone starts from scratch, but when you get so used to your routine, and the way your favorite assistant kept all of your cabinets well-organized, the “outsider” assistant is difficult to integrate for such a short amount of time. Ultimately, I’ve become both a dentist and an assistant lately, and this has given me a perspective of what assistants’ work entails and how important their job is to our job.

It’s no secret that it all comes down to team effort. I can’t treat a patient efficiently (and effectively) without my assistant. A short while ago, it took me close to 10 minutes to break down a room and just as long to set it up. I was grumbling internally the whole time, thinking that it would have taken My Favorite Assistant Who Wasn’t There half the time. And to think I used to do that in a flash in dental school some 10 years ago. Another time, I battled furiously with the suctions and resigned that I’m not good at operating both sides of the chair at the same time.

As much as we all know assistants do not share our exact perspective or the responsibility that lies on our shoulders as dentists, patients still typically confide in them more than they do in us. Assistants are uncanny when it comes to organizing and structuring drawers and cabinets, ordering, etc. Most take beautiful alginate impressions and can take a full-mouth series in less time than I can say “full-mouth series.” Most of all, they echo our treatment philosophy and reinforce our practice protocols when we’re not in the room.

Needless to say, I’ve felt my dental assistant’s absence and the misery of not having a consistent, reliable comrade by my side. Much the same way physicians may feel as if they can’t treat patients without nurses, dentists need assistants to streamline patient care. I’m sure that few dentists would disagree, unless they are the kind who likes to work alone. Here’s to all of the dental assistants out there.

Zeynep Barakat, DMD, FAGD

Wednesday, March 1, 2017

The Profitability Factor in Selling a Practice

At the ripe old age of 52, I am starting to consider selling my practice and pursuing other opportunities that have been presented to me. As may be the case with most of you, I am a planner. No final decisions have been made, and we’ll see what the future brings. However, I want to share some things that I have learned because, eventually, each one of us will be selling our practices.

Let me begin by explaining that last year, my office had the best production numbers ever. We also had the best collections ever. By far, our numbers exceeded anything we had done before.

When I contacted a well-respected practice broker in my area, I was expecting to hear how wonderful my practice was, how lucky any potential buyer would be, etc. Do you know what she told me instead? “We will have a difficult time selling your practice.”


This is the reason: profitability. While your practice may be generating enough income to meet your needs, it needs to generate enough income for the new dentist to collect a salary and pay off the new practice note. Additionally, these days, it must also cover student-debt payments. In other words, your practice needs to be very profitable. Unless you are willing to sell your practice at a steep discount, you need to be extremely profitable. As an aside: This profitability needs to be apparent on at least three years of tax returns. It does not matter what your practice-management software says; the only thing that is considered are your tax returns.

Without this high profitability, a buyer will not be able to convince a bank to lend him or her the money to purchase your practice. Older practitioners may have thought that today’s high dental school debt did not affect them. It does, unless you are willing to significantly reduce the sale price of your practice so the buyer qualifies for a loan. By significantly, I mean at least $100,000 off your asking price but probably much, much more.

As I discussed my surprise (no, better said: shock) with my broker, I came to realize something important. You need to work at getting your practice so successful that you don’t want to sell it because it is generating so much income for you. When you get to that point, you know that is the time to sell. Yes, ironically, the day you don’t want to sell your practice is the best time to sell it.

During these conversations, I remembered when I was trying to buy my office all those years ago. I, as the buyer, had a difficult time qualifying for a practice loan. In fact, the practice I was finally able to purchase was the third office on which I had placed an offer. The first two deals ended up falling through. For a long time, I believed the problem was with my qualifications. After a few years in practice, I came to realize that the practices I was looking at were not profitable enough. That is the reason why banks refused to finance those purchases. The banks were protecting their investment. They wanted to make sure that I, as the new practice owner, could draw a salary and pay back the loan. Several years later, the tables are turned. Now, it’s your turn to make sure whomever takes over your practice can draw a salary, make the office note and pay off those expensive school loans.

So, for now, I’m off to the daily grind. I’m going make my practice so profitable that I don’t want to sell it — so that I’ll know the time has come to sell it.

Andy Alas, DDS

Thursday, February 23, 2017

Four Ways to Boost Your Internal Marketing Efforts

No matter where we run our business, we have to remain relevant in our communities. I believe in branding — creating some type of image or logo that represents you and your office. Once you have established your brand, you can really start to create an image to share with the public, which will communicate what your mission is and what it is that your office has to offer. If your brand expression is clear, then your marketing will be powerful and effective. Then, you simply need to decide how much money will be allocated toward your marketing strategy and the vehicle: internal (within your office) marketing, external marketing (using outside resources, such as print ads or radio), or both.

Throughout my years of gaining business experience and education, it has been proven that you get the most return on investment through internal marketing. So, here are four ways to boost your internal marketing efforts:
  1. Send informative emails. Most of us are using some form of computerized patient relationship-management system to aid with scheduling. All of these services offer a library of fact sheet templates with information in areas such as Invisalign®, VELscope®, the importance of hygiene and so on. You can send informative emails to your patients to promote specific procedures you want to do more of or products you are trying to sell. If you are creative, you can customize your own emails. Regardless, these emails can establish you as an expert among your patients, who may forward them to a friend. Be careful not to inundate your patients with too many emails, though.
  2. Ask for team support. Ask your team to approach patients for referrals. If you have a supportive and cohesive team, this will be easy because your team members know which patients are the best ones to approach. There are so many opportunities during each appointment to do this. For example, let’s say patient “John” just got married, and he is in for a routine hygiene visit. In this scenario, anyone in your practice can ask, “So, John, when are we going to meet your wife?” However, when these moments arise, they need to feel natural. 
  3. Provide rewards or gifts for referring. Anytime a person refers a patient to your practice, the referring patient must be thanked. We have done this in many ways throughout the years, and each time, patients are so often surprised and grateful to be recognized. It also indirectly incentivizes them to refer more patients to us.
  4. Smartly display print advertisements in the office. I am not a fan of placing posters and display ads promoting random dental products throughout the office. What I have found to be effective is having a dedicated space to let patients know what is new in our office or whatever it is that we want to be promoting. This creates a focus toward what we want to highlight, rather than a “store” full of generic advertisements that people are likely desensitized to.

We all know that the best referral source is our own patients. We know that if a potential patient calls us who has been sent to us from an existing patient, it’s almost guaranteed that he or she will make an appointment. This same patient will come to us with a built-in trust that will make treatment acceptance much easier to attain. So considering external marketing can be unpredictable and extremely costly, why not invest most of your marketing strategy into internal marketing?

Pamela Marzban, DDS, FAGD

Tuesday, February 14, 2017

Career Choices

My parents grew up during the Great Depression. My father, an exceptionally bright man, never went past grade 10 due to the financial pressures and costs associated with trying to keep him in school. He dreamt about being a lawyer but never became one; instead, he became a salesman in the men’s and boys’ fashion industry.

My parents grew up in a time with many others who were immigrants who had left behind professions and careers in other countries, only to do more manual labor and hold lower paying jobs in Canada due to their lack of English language capabilities. They instilled in their children the need to study hard and become a professional (a doctor, dentist, accountant, lawyer or engineer), and I grew up amongst peers who were driven to do just that.

Today, I continue to find the children of immigrants to be hardworking and driven to excel at school, in an effort to become a professional.

My children, however, are the progeny of the generation of people driven to excel in school. Our parenting style is more relaxed (I am generalizing here; of course, there are exceptions), as we live in a society that allows people to dream and offers them the opportunity to realize their dreams. Neither of my daughters have any interest in science, math and engineering (the so-called STEM subject: science, technology, engineering and math). One daughter would like to study art history and possibly curate a museum or art exhibit. The other would like to be an actress. Many of my younger patients now dream about becoming a chef. One cousin loves working with glass art. A nephew is an illustrator working on TV and movie productions.

We are incredibly fortunate to live in a society that has matured to the point where we now value art in all of its forms — visual, auditory, gustatory and tactile — and are willing to pay a reasonable fee to access it. Now, people can dream, work toward making that dream a career and anticipate they will be able to make a living wage pursuing those goals.

When I talk with my patients and learn about their careers, I am amazed at the variety of opportunities that are out there. We don’t learn in school how to do what most people do in their careers, and I think that is very cool.

One thing I am fairly certain, though, is that the pace of change is so rapid that I am starting to see people start in one career and, 15-plus years later, they need to go back to school and retrain to do something else completely different. I see the near future of people having two careers in their lifetime, without company pensions. The idea of retiring at 65, or another artificial number, will fall away as irrelevant. The focus seems to be turning toward staying healthy and productive, regardless of age.

And our success will be all based on the relationships we grow and cultivate. It is a fascinating time to be alive.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA


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