17 Jun The Search for the Holy Grail of Dentistry
This year another set of fresh faces will obtain diplomas certifying them qualified and competent to practice dentistry. To this new phase of their journey they bring energy and enthusiasm, hopes and dreams. Most have high expectations of earning substantial incomes, working four day weeks, being their own boss, and finding joy and satisfaction from their service to others; something we like to call the Holy Grail of Dentistry. All of them arrive in the wet finger world of private practice with certain expectations about what it will take to achieve their goals and obtain the Holy Grail. But sadly, as with the fabled knights of King Arthur’s court, many of them are soon disillusioned, and only a few will actually obtain the prize.
Look around you at the day-to-day real world of dentistry. Notice the number of other dentists; each of them vying for his or her piece of the dental pie; each of them a small little island in the vast ocean of commerce, striving to attract new patients, keep existing patients, ward off PPO’s, HMO’s and capitation plans, keep their staffs motivated and satisfied, and make enough money along the way to support their family and put something aside for the future. As independent (and often isolated) businessmen and women, dentists don’t always know how or why a few of their colleagues succeed at this real-world challenge better than others. They marvel that some of the lesser students from their graduating class now have incredible practices, while they, despite all their best efforts, continue to struggle.
If we survey graduates in the same class from any dental school in the country we find this same phenomenon. Seventy-five or eighty dentists with the same degree, from the same school, doing much the same clinical work, working about the same amount of hours, yet some are earning over $250,000 per year while others are barely making
$75,000. As early as three or four years out, some of these young dentists will already own substantial practices with plenty of fee-for-service patients. Their incomes will be well into six figures, and they will have time to travel, to golf and to spend with their children. They will already be setting aside significant amounts of money for their future, and by the time their incomes and interest in dentistry peak out in their mid to late 40’s, they will be financially free to pursue a wide variety of options. But they will be the minority.
The ADA reports that only about five percent (5%) of dentists are able to retire comfortably by age 65. Years after graduation, most dentists from your class will still be wondering how the others do it. Four or five years out, many will be still be gutting it out in startup practices, hoping patients will show up before their bank line runs out. Most will still be associates, hanging on and waiting until their host decides to let them own a piece of the pie; waiting for their turn to get back as much as they have put into their career.
Why does this happen? Why are some dentists so much more successful than others? After almost twenty-five years of first hand experience, we can summarize it in just two words: willingness and knowledge. And in that order.
Willingness is an attitude. It is what we call an enabling or empowering attitude. It is that quality which allows for everything else to happen. Willingness is being willing to accept the possibility that you don’t really know what to do. It is being willing to accept guidance from others. It is being willing to accept and take risks. It is being willing to make and keep commitments. Yes, willingness is an attitude. It is the attitude of success.
Contrast that with the young doctors that come out of school thinking that somehow their dental diploma has someway imbued them with the answers to life’s great questions; who inwardly believe that they are different than their predecessors; that the business part is easy or just plain common sense; that their particular abilities will allow them to beat the odds. They really believe that their associateship will actually work, because they alone know the secret to structuring the world’s greatest associateship; they know how to build the perfect practice from scratch in less than three years; they know just where to go for financing; and finally, they know the secret to attracting and keeping vast numbers of quality fee-for-service patients. They, of course, know so much that they don’t need anyone else to show them.
This latter description is also attitudinal, and to one degree or another, it plagues way too many in the dental profession. If we really want to know why so many dentists wallow around in mediocrity, it is because so many of them suffer from this mental malaise. However, those who are willing to be open minded; who are willing to be instructed in the art of business as well as the art of dentistry; who are willing to reach and stretch beyond themselves; they are the ones who will make it through to the other side with their lives, and their families, and their finances intact. They are the ones who obtain the Holy Grail. Willingness is the key.
Let’s suppose for a moment you are willing to do whatever it takes to make your career in dentistry the very best it can be. The question now becomes, “What does it take?” We know from experience that there is virtually no correlation between clinical perfection and practice success. Some of the best clinical dentists we know experience
high stress, continual staff turnover, and low productivity. When they get together at the dental society meetings they stand around bemoaning the difficulties and pressures of private practice, and the fact that they can’t make any real money in dentistry. Listen closely to what they are saying: “there are just too many dentists, too many cut-rate dental plans, too much advertising, too few patients who appreciate their work, too few patients willing to accept treatment, too many whining staff members, too many government regulations, too few hygienists, blah, blah, blah.” Poor fellows.
Down the street, their colleague (who graduated in the bottom half of his class) is experiencing something much different. His same staff has been with him for years; ever since he bought the practice from Dr. Smith (or Dr. Jones or Dr. Whatever). They are friendly, motivated, and extremely good at what they do. They really enjoy working together and share a common vision of why they are there and what they need to do to meet the needs of their customers. Last year each staff member received just under
$5,000 in bonus income, placing each one’s individual compensation well above the industry norms. Nevertheless, the doctor took home over 45% of his practice collections. That came out to just under $250,000 working the same 32 hour week as his neighbors up the street. This doctor earns enough to set aside a significant amount toward savings and investments. By the time his practice earnings peak out in his mid to late 40’s he will be financially free.
Let’s see, here we have a clinically average dentist who somehow has plenty of fee-for- service patients, a motivated and happy staff, works a four day week, earns a net income in the top 4% of all dentists, and will be set for retirement before he turns 50. If there really is a Holy Grail in dentistry, this guy has found it. Sounds like a very successful dental practice, wouldn’t you say? Does it sound like yours? Does it sound like something you would like to have? You can have it, if you are willing, and if you know what to do to get it!
What kind of knowledge is required? First, how to acquire and retain large numbers of fee-for-service patients. Second, how to acquire and train a motivated, topnotch staff. Third, how to treat and serve your patients so well that they will never leave; not for a PPO, not for another dentist, not for anything. That’s it.
That’s it? Yes, that’s it. Are you surprised? It sounds awfully simple, doesn’t it. And in a lot of ways it is simple. Simple stuff that anybody ought to be able to do – right? So why then don’t more dentists have practices overflowing with happy staff members serving loads of fee-for-service patients? Maybe it’s not so easy after all. Maybe things get confused in the vast gulf of reality between talking about it and actually doing it.
No doubt some dentists just don’t know how to actually implement those simple things in the day to day workplace. Others just aren’t willing. Either way, their failure to create the best possible environment for their patients and staff can literally cost them millions over their careers. It can also mean the difference between working at something you hate because you have to, and working at something you love because you want to.
So what is the first key to any successful practice? It all starts with patients. Without patients you have nothing but equipment and a lease on some real estate. (Read O-V- E-R-H-E-A-D) I am always amazed at how many young dentists think that because they have a location and some equipment they have a practice. Wrong. Those things can be had just about anywhere. They are commodities which can be acquired anywhere, at any time, from any vendor or leasing agent. In a way, patients are also commodities, only they are not so plentiful, and are much more precious, as any practicing dentist will tell you. Nevertheless, fairly large groups of quality patients can be acquired. Sometimes they come with equipment, a location, and a staff. Sometimes they even come with a doctor willing to do some of the production. Sometimes they come with only their charts and a letter of endorsement from the one guy they have trusted for thirty years or more. Amazingly, over 95% of them will typically show up to let the new doctor treat them. (If the proper steps are taken, of course.)
So if you are not making the kind of money you deserve to make in dentistry, perhaps you need to acquire more fee-for-service patients. How many patients do you need to have the kind of practice I described earlier? About 2,000 would be a good start. If you average just $300 in collections per active patient per year (the national average is just under $300), then you would have a practice grossing in the $600,000 range. Most of our clients collect $500 or more per patient per year as we take them closer and closer to the Holy Grail.
Some dentists already have the patients in their practices. They just don’t know how to properly diagnose and prescribe treatment in a manner in which patients will readily accept it. This takes some special skills on the part of the doctor and the staff. If all the pieces are not in place and working in sync, it won’t happen. How efficient are you and your staff at this? It is relatively easy to ascertain. Simply divide your annual collections by the total number of active patients (those who have been in for treatment during the past 24 months). If that number is anywhere below $300, you seriously need help. If the number is below $400 you still have a lot of room for internal growth. Just like the doctor below, you may well be sitting on a gold mine and not even know it.
Not long ago, I sat down with a 50 year old dentist who had experienced a surprising
$100,000 increase in gross collections during the past year. When I inquired as to what had happened, he said his front desk person had quit and he had replaced her with someone new who had been trained in certain management techniques. That’s it. Just one new staff member who knew a little about what to do. The patients were the same. The doctor didn’t do anything differently. The rest of the staff remained intact. His experience is not at all uncommon. I estimated that his former staff member had cost him well over $700,000 in lost production during her five-year stay. The doctor didn’t have a clue anything was ever wrong. Even this past year, his collections per active patient were just $236. He has a long way to go, but it is his staff that will get him there once we show them the way. After quality patients, a well-trained and motivated staff is the next essential ingredient in the successful practice.
Building the right staff takes time and patience. It requires many things, but most of all it requires leadership from the doctor. At some point you may have to let someone go who you happen to like personally, but who just can’t seem to work as part of the team. There will also be times when you will have to confront a member of your team who is not carrying her share of the load, or who is causing strife among other team members. What do you say? How do you say it? How will you know what the right thing is to do? How can you provide direction without coming off like a dictator and demoralizing the troops? How can you hold people accountable without causing mistrust and resentment? These leadership skills are without a doubt the most difficult thing we have to teach in our consulting firm, and yet they are the very things which dentists need most.
Let’s assume we can help you find enough patients (our consultants have been successfully doing this since 1988), and through our practice management affiliations with nationally recognized practice management consultants that we can also help you pull together and train a wonderful staff. Let’s further assume that you are willing to provide the necessary leadership. The only ingredient missing is the knowledge of what to do, and a proven system for holding people accountable for doing their part of the process.
The essential knowledge of what to do, what to say, how to build a team and how to lead that team is all part of the comprehensive practice management programs that we offer our clients through affiliations with these nationally recognized practice management consultants. These practice management consultants have spent years focusing on the development of essential tools and techniques to help dentists get the most from their practices and their careers. Whether you are in need of more patients, more production per patient, or a complete overhaul of systems, staff, and patients so that you can begin to enjoy yourself again, we know how to get you where you want to be. We know how to find the Holy Grail of Dentistry.
All you have to do is be willing to make the journey with someone who knows the way. Just remember that most of your colleagues will seek dentistry’s sacred Holy Grail, yet few will ever find it. Now you know why.
Remember, for the noble Knights of the Round Table, the requirements of success were virtue, humility and the sinless life. For dentists, they are willingness and knowledge.