Debt and Dentistry

Posted on October 30, 2009 by Gary DeWood

Did you attend the ADA meeting? It was an excellent meeting in a beautiful venue. I had never been to Hawaii, and one could argue that I still haven’t been since I spent the entirety of my trip in Honolulu attending the meeting. I had the privilege of sharing some information through four presentations over three days and spent my “free” time in the exhibit hall, seeing what’s new and saying hello to old friends from around the country. With the current state of the economy I was heartened by the attendance and the hopeful attitudes of the dentists I met.

One of my programs discussed the issues of debt and the new dentist, a growing problem in dentistry, as more and more states lessen or abandon their support for dental schools. There are many new graduates carrying more than $400,000 of debt from undergraduate and graduate education into a business that requires very large capitalization costs to get started. Dentistry has historically been a profession in which a very good living could be made without paying much attention to business. This is not an option when debt of $1,000,000 plus is commonplace.

So what does paying attention to business look like? There is a huge clinical component to dentistry. If you treat the “tooth,” as most of us were trained to do in dental school, life becomes a dizzying chase to make the numbers. It’s not only about speed; speed lets you treat the “tooth” faster and more efficiently than ever, but dentistry becomes a race from tooth to tooth and room to room. If that’s a race you’d rather see from the outside, you need to learn to see “teeth.” I need to think, to see, to act comprehensively. The ability to do that is what makes the numbers component of paying attention to business easier to plan for, and that’s a subject for another blog.

How My Tailor Earned My Business – for Life

Posted on October 30, 2009 by Imtiaz Manji

One of the advantages of living in Scottsdale is that there is no shortage of opportunities for shopping. And yet, despite all the reputable and enticing menswear boutiques in this city, I save my clothes-buying for when I’m in Vancouver. Why? The answer has to do with the loyalty I feel to my tailor there-a loyalty that was earned not just because of how long I’ve been going there, or because they know me, and know my sizes and style preferences. It’s because they provided an experience that goes above and beyond what you would expect from any retailer.

I have a mild form of color-blindness that can make it difficult for me to select the right clothes combinations-I’ve always had to rely on the advice of people close to me when it came to buying and matching the right suits, shirts and ties. One day I happened to mention this to a sales associate at Harry Rosen Menswear in Vancouver and he took it as an opportunity to earn a client for a life. He offered to come to my home and inventory my wardrobe. He advised me on which items where outdated and should be removed. He put coded labels on the remaining items so I would know what goes with what. Then he photographed everything and went back to the store to find selections to update and complement the clothes in my closet. When he called me in to see his suggestions, I was so blown away by the thoroughness of his research and the thought that went into his selections that, even though I had only planned to get a couple of new suits, I ended up with four suits and a number of new shirts and ties-all carefully labeled to ensure I didn’t make any color-matching mix-ups.

What goes with what: photos from my inventoried wardrobe

I have now put my sartorial life in this man’s hands. He keeps an updated album of my wardrobe, and when I’m traveling to Vancouver and it’s time to make new additions, I call ahead and he puts together a selection for me to look over when I arrive. He never tries to oversell me (or undersell me), he just makes sure I have everything I need in front of me to make the right choices. He has earned my trust, and now I can’t imagine getting my clothes from anyone else.

I’m not saying that as dentists you need to go to quite these lengths to earn your patients’ loyalty. A home visit to ensure proper brushing and flossing would be taking things too far in anyone’s book. But a thorough, fully-narrated exam and a well-prepared case presentation with plenty of visual aids and lots of references to the patient’s unique needs-that shows a real commitment to personalized care that goes beyond mission statement slogans.

And don’t forget that great relationships are built on the little things. Things like having a staff member give an elderly patient a ride home after treatment. A simple follow-up phone call in the evening after a particularly complex procedure only takes a few moments of your time-but it can go a long way to cementing a personal bond with a patient. These are the kind of gestures people remember and talk about, the kind of “above and beyond” thoughtfulness that creates real lasting loyalty.

Expanding Cups: Part III – Engagement

Posted on October 28, 2009 by Steve Ratcliff

We talked last time about the obvious rings in the cup model. The Primary Request and then Action. Diagnose and treat!

When I think about the patient who comes to my practice because they want a cleaning and we discover a mouthful of trouble, I have to help my patient engage. I distinctly remember how often I would hear, “Ah, Doc, it doesn’t bother me; why do I need to do anything?” I would say to myself, “They just don’t value what I have to offer!” then dismiss them as a lost cause. Then five years later they would come in and say they wanted the work done.

How can I shorten that process?

I think the key is engagement. I missed engagement all the time. That’s the patient who says, “It bothered me once but not since then,” or as the appointment ends and walking towards the door voices the comment, “I doubt this is important, but…”

There are unanswered questions there and these patients are asking for US to engage THEM! Don’t let those questions go unexplored; simply say, “Tell me more about that,” and then listen carefully.

You can create engagement by putting a mirror into your patient’s hand and asking them to look with you as you do the exam. This simple act spurs people to do something they may have never done before…participate in their dental exam.

Engagement begins with the first phone call and can be expanded at every interaction. If your patients are asking a question about their mouth or oral health, that is engagement. Now take them deeper by asking questions and helping them uncover what they value about their teeth and health.

Our job, really, is to help our patients make healthy choices.

Creating a Presentation – Part 2 of 8

Posted on October 27, 2009 by Frank Spear

Frank expands on the early creative process in developing a meaningful message honoring the late Dr. Lloyd Miller, a great influence to esthetic dentistry, and personal hero and friend to Frank.

The Loyalty Myth

Posted on October 26, 2009 by Imtiaz Manji

If you’re like most people today, you have a wallet full of “loyalty” cards for various services and retailers—airline miles, gold or platinum membership with a hotel chain, grocery store points, “buy-10-get-one-free” at the local coffee shop. They all want your repeat business, and they’re prepared to buy it, with enticing special privileges and reward offers. In the process, the meaning of loyalty in the marketplace is changing.

Loyalty Cards and Keychain Tags

Dentists, thankfully, don’t need loyalty programs. People don’t buy dental hygiene care the way they buy gas, looking around for the best price that day, so most dentists are comfortable with the fact that their patients are loyal to them. But that’s only true if you just count showing up for recare and check-ups as being loyal. A more meaningful definition of loyalty—one that is shaped by our current hyper-competitive retail landscape—is where they choose to spend their time and money. And in that sense your patients may not be as loyal as you think.

If a cut-rate dentist across the border who they find online will do the implant you’re suggesting at a fraction of the cost, would they still commit to you? And it’s not just discount dentistry you’re competing against. The patient in your chair who gives you a “thanks, but no thanks” to discretionary treatment that you know could make a huge difference in his quality of life and then walks down the street to buy a new Xbox is making a statement about what he values more—and about who has won his loyalty.

This is why creating the right value experience is so important. It’s not just about getting them to feel good about where they are—although that is important, too. It’s also a matter of making them see the value of what you’re offering, of giving them the right context so that they want to make enlightened decisions for their ongoing dental care. And it’s a matter of making them see the urgency of timely dental care so that they understand the implications of putting off treatment, and are motivated to make a commitment today. Because when they leave the office, their loyalty goes with them.

Just seeing the same faces year after year isn’t enough. You’ll know you’ve really gained your patients’ loyalty when they are as interested in their dental care as you are, and they can’t imagine anyone but you delivering it.

I’ll give you an example of what I mean by this in another post later this week, when I talk about how a smart small retailer earned my enduring loyalty.

The Right Time

Posted on October 26, 2009 by Lee Ann Brady

Probably the most frequently asked question at dental meetings is, “Do you do a comprehensive exam for every patient?” My answer is always “That’s my goal,” and then I wait…if they don’t ask the next question, then I do. “When?”

My hope is that every patient in my practice gets a comprehensive evaluation and the opportunity for us to discuss together all the possibilities dentistry has to offer. The answer to when is very different from office to office and team to team. In my practice in Jacksonville, we worked at moving toward the model of every new patient having a comprehensive exam at the first appointment. We had become pretty adept at asking the right questions in a phone interview and helping people choose this as a first visit. We still had patients who requested a hygiene visit and exam, and that’s what we would schedule. For these patients my hope was that once we met them, began to get to know one another, and were face to face, we would know when to extend the invitation to return for a comprehensive exam.

Whatever your exam process looks like now, and however you see it changing and growing in the future, I believe the first step is to sit down as a team. A great starting point is to invite every team member to have a comprehensive exam, and then sit with you as you work through the EFSB treatment planning process on their case. Once the team believes in the process and understands the value to the patients’ health, then together look at how your practice could best invite patients to experience this as well.

We began by setting aside a half day for our comprehensive patients, and then we identified at least one patient at our morning huddle to invite. Then it just spread from there; my team loved inviting patients to experience this and soon we were inviting everyone and having to block out more time in the book. Once you get this ball rolling, and existing patients refer based on this experience, more and more of your new patients will call hoping to experience a comprehensive evaluation.

Defining Success: Growth (Part 8 of 14)

Posted on October 22, 2009 by Imtiaz Manji

This video is part of an ongoing series on Defining Success. To view the series from the beginning, click here. To receive notifications when new blogs are posted, subscribe to the Spear Education RSS feed.

Expanding Cups: Part II – Processing

Posted on October 21, 2009 by Steve Ratcliff

Think about that camping cup: it closed up into itself so that all you could see were the first ring and the base. That is like my old model of patient care. Patients came in with a primary request, like “I need my teeth cleaned.”

In my old patient care model, that meant I had to “sell” them an exam and convince them they needed lots of cool dentistry they didn’t know they needed or wanted. In other words, fix what is broken. They tell me what is wrong and I fix it.

I think we need to understand that our patients are no different than we are when it comes to learning. Go back to when you were first in dental school and you were blasted by mountains of new data to learn and integrate. Did you get it right away? Did you believe everything you were taught without question? Did you sometimes have to hear things over and over again before it really started to sink in?

Our patients are the same way; they need to go through a process, and that process has many layers or “rings in the cup.” Sometimes they go through them quickly and sometimes it takes years.

Coming up in Part III: engagement

Get a Grip!

Posted on October 17, 2009 by Gary DeWood

Do you struggle with trying to hold those little teeny-weeny-eeny inlays and onlays? I sure do. Coating them with porcelain etch and silane and bonding resin is a difficult proposition that usually results in equal amounts of material on and off the restoration. The good news is there is product specifically designed for this purpose:

The Pic-n-Stic from Pulpdent has a waxy material on the end that can be pressed into the restoration to hold it. I have found them to be useful, but I’ve also wished they would “GRAB” more. At the last Posterior Partial Coverage Bonded Restorations course, one of our live patient treatment experiences, a participant with a very small inlay and onlay used a different technique. He bonded a mini-brush to the restoration using resin. It REALLY held on!

It can be easily popped off the porcelain once the restoration is seated and a Brownie Point removes resin without damaging the restoration.

Expanding Cups: Part I – Patient Learning

Posted on October 14, 2009 by Steve Ratcliff

Collapsing Cups Levels

Remember these cups from your childhood or perhaps from camping trips? They fold up and the lid snaps in place to hold a compact drinking cup.

My friend Mary Osborne and I think these cups are a metaphor for how our patients learn. We are taught in dental school and perhaps by other dentists that all we have to do is an exam and then a treatment presentation and move straight to treatment.

It wasn’t too long after I opened my practice some 22 years ago that I experienced different patient behaviors. My patients said “NO!” far more often than I thought they should. I was dismayed; I had followed the model I learned to the letter!

What I didn’t understand was that my dental operatory is more of a learning center than it is a treatment center.

Over the next several blogs, I’d like to share our model with you in hopes that you might see your role in developing your patients differently than just getting to yes.

Monthly Archives: October 2009