Management Systems Endodontics Root Camp
January 9 - 10, 1998
Irvine, CA
614-889-0246

Diagnosing & Correcting Malfunctioning Systems
January 21, 1998
Southern Maryland Dental
College Park, MD
301-490-2882

Management Rx
Dallas Mid-Winter
January 22 - 24, 1998
Dallas, TX
214-386-5741

Diagnosing & Correcting Malfunctioning Systems
February 5, 1998
Utah Dental Association Convention
Salt Lake City, UT
801-261-5315

Diagnosing & Correcting Malfunctioning Systems
February 13, 1998
California Central Coast Dental Society
San Luis Obispo, CA
614-889-0246

Management Rx
March 4, 1998
University of PA/Lehigh Hospital
Allentown, PA
610-865-6999

Diagnosing & Correcting Malfunctioning Systems
March 12, 1998
Greater Houston Dental Meeting
Houston, TX
614-889-0246

Diagnosing & Correcting Malfunctioning Systems
April 3, 1998
Kentucky Dental Meeting
Louisville, KY
502-459-5373

I was the first person to publish an article on why financial bonus plans don't work and offered dentists a solution that doesn't yield high salaries in the face of level production. When the percentage of salaries to practice income shot up from 18 percent to 22 percent in the latter part of the 80s and then the shortage was over but salaries remained high, I was the first person to write about, "Salaries Beyond The Limit." My allegiance is to the truth about a situation -- even if the truth is against the flow or current trends. I'm energized by uncovering what makes dental practices become and remain healthy and telling the world about it. I guess I'm just a natural born investigative reporter.

There's been a lot of hype lately about managed care. Whether you're for or against it, it has arrived and must be reckoned with. My job as a consultant is to analyze its impact on a dental practice and make recommendations from that point of view. The degree to which a practice has to deal with managed care depends on the socioeconomic situation of its patient base and the region of the U.S. where the practice is located. Having your practice's business and clinical "ducks in order" will allow you to at least consider the possibility of managed care.

Managed care is why states should be pushing for passage of expanded function of dental auxiliaries. I can legally place restorative material in the state of Ohio and have been able to since 1977. That was 20 years ago, yet still less than seven states in the U.S. have legalized this function for dental assistants.

Everybody talks about the fact that if you reduce your fees you have to work "x" times harder and longer for the same net profit. Sure you do, if you practice the same old way you've always practiced. A dentist taking 90 minutes to prepare a crown who charges $500 produces $333 per hour (500/1.5). If the fee is reduced to $350 and now we have an assistant taking preliminary impressions, packing cord, preparing the final impression and making and seating the provisional, the doctor's time is reduced to 30 minutes and production increases to $700 per hour (350/.5).

Dentists are notorious for taking the same amount of time today to do a crown that they did ten years ago. A carefully designed time and motion study in the clinical areas will show the dentist and the assistant how to be more efficient at their procedures. Delegation of duties is one of the ways to make managed care a better option. I consulted with a practice which had five cap contracts for the past three years and wanted to get out of them. He had 3,500 patients on the computer system and only 450 fee-for-service patients. He leased a 3,500 square foot facility for $3,850 per month and had a 75 percent utilization rate of the cap plans.

This practice had ignored the retention of the fee-for-service patients by using a faulty recall system plus had high overhead. This doctor can't get out of the cap plans now because he's dependent on the $15,000 per month income from the plans to support his high overhead. But we've got him on some medicine that will retain those fee-for- service patients and decrease his overhead. As soon as we secure a healthy recall and overhead situation for this doctor, we'll reevaluate "dumping" the cap plans. I'm betting the numbers will show the plans can be retained to the advantage of the practice. Managed care is not for everybody but I guarantee you there are dentists out there getting quietly wealthy from them. Make sure that your fee-for-service practice is functioning to the best of its ability before you jump. Make an informed decision, don't just go with the flow.

The other management trend that has been pretty sleepy over the past ten years is marketing. From the time that Dr. Burt Press' troops gave birth to it in the early 1980s and the ADA created their first marketing division, practice marketing has cycled into a lull. It's now making a big comeback triggered by keen competition among dental practices. Doctors who are in a panic to remain fee-for-service are suddenly realizing they need a logo, a customized practice brochure, letters to send to new households, etc. I'm also seeing a trend of doctors who did no previous marketing in the 80s but tried to have an "A" practice (high quality and high fees) that are now struggling to get new patients. They don't seem to realize that the consumer of the 80s is not the consumer of the 90s. Yet they have kept the same management systems and attitudes in their practice for the past 10 to 20 years. We get calls weekly from practices like this seeking our marketing services to help them capture new patients. Sending letters to people who purchased real estate in your area is very popular. Although not a new idea, it just takes a while for dentists to catch on, and catch on they have! Ask a new neighbor how many letters they got from dentists in the area.

I consulted with Doctor Smith (not his real name) located in a small urban town, three years out of dental school, who is booked eight weeks out and seeing 15 patients a day himself, not including hygiene, and getting 30 new patients a month. About two hours from that practice is Doctor Jones (again, not his real name) getting five new patients a month with 325 patients on the recall system after 24 years in practice. Doctor Jones has not retained patients (even though he has had a person working on the recall system for eight years) because of high fees -- shocking patients in a predominantly blue collar community with $1,500 to $3,000 treatment plans when they think they have good dental health. This is why doctors who go to management seminars and hear they should spend quality time with each patient plus get 35 new patients a month go home scratching their heads.

And then there are those doctors who were told by misguided management gurus, "Build it and they will come." Doctors have built Taj Mahal buildings and aren't doing anything different than what they were doing in the smaller space and the patients aren't coming. So now they have higher overhead.

The thing that flips me out the most is doctors whose long term employees have cost them business and money primarily because of their defiant resistance to change. And the doctors continue to allow these employees to work in their practices. And to top it off, the doctors want to know why their payroll expenditures are more than 22 percent of their income when this deadwood has been getting salary increases every year! Get a grip on your shorts! Stop taking the path of least resistance. Recognize the truth of a situation and take action! I have a client who has such an employee and his exact words to me were, "I'm afraid to fire her because she is the only person who knows how to work the computer system." This is sick! Don't allow yourself to be put in that vulnerable of a position. Learn the computer system. Most computer software companies have trainers that will come into your office and show you how to use this tool.

I had another client who called me saying that he wanted to get out of dentistry because he was under so much stress. So I went to his office and found out he was coming in at 6 a.m. every morning (he started seeing patients at 8 a.m.) to do patient billing and insurance filing. While he had shown his receptionist how to do these tasks, she wasn't doing them satisfactorily so it was easier for him to do it himself than to fire her. Remember that person (or persons) at your front desk can make or break you. It is extremely important for these people to be professionally trained. With regular frequency, we prove to dentists how our in-office training programs save them thousands of dollars each year for every person we train -- including employees with many years of dental experience. Doctors want to hire people with previous dental experience so they can take the path of least resistance which is, "They won't have to be trained because they know how to work and manage a dental practice."

The assumption can cost you dearly. Case in point: Dr. Johnson had Barbara working for him for eight years, collection ration 99.9 percent. She moves away and he hires Vicki -- qualifications: seven years experience in another dental office. After six months, his collection ration drops to 85 percent. What Vicki had done was to bring into Dr. Johnson's practice the bad habits and practices she learned from her previous job. Doctors are also lacking in voicing their performance expectations to a new employee. This is why I wrote "Performance Measurements for the Dental Team." I believe strongly in professional training, accountability and self motivation for employees.