My apologies to the Bard for co-opting or paraphrasing, but in Dentistry we are frequently bombarded with solicitations from various national speakers urging us to follow their paths to success. Each day that we slog through the minefield of treating patients, we look for answers, and lo and behold, those answers appear to await us amongst the millions of unsolicited credit card offers and spam that fill our email boxes. What do we do? Whom do we follow?
If I appear dismissive of the various coaches, mentors, and schools, I don’t mean to be. I do believe that these groups, schools, and speakers lend value to our practice—or at least they can. Yet I am troubled by the assertion that there is some predictable formula or mechanism for the success we all seek. Gurus define success as a happy, motivated team, satisfied patients, minimal stress, and an overflowing bank account. I am not much for clichés, but one I do subscribe to is that if something looks too good to be true, it probably is. Perhaps it is my skeptical nature, but I do not believe there is any one formula for success.
I am reminded of the fable of three blind men who come upon an elephant. Since they cannot see, each feels a different part of the elephant and comes to a radically different conclusion as to what the elephant looks like. I believe there is a correlation between that story and dentistry. Dentists live in the world we call our office, and from that world, we form our opinions. In our world, our destinies are controlled by our personalities, abilities, local economic conditions, and frankly, luck. If you practice in rural America, you may not be doing a great deal of cosmetic dentistry. If you practice in an area where all of the local industries provide excellent dental benefits, your view may not be governed by the economics of dentistry. Your world can be shaped by the relative dental “IQ” of your patients, and/or your ability to market your services. The point is that each office, and each dentist, is different, and the success or failures you experience may or may not translate to my office and my practice.
I am not arguing against what I consider basic necessities. Certainly, success is dependent upon the abilities of the dentist clinically, and the ability of the dentist to relate and retain patients and team members. You absolutely need to have trained, motivated team members who are amply rewarded for your success. It does not serve the interests of the dentist or the practice to have constant turnover. All too often, with an eye solely on cost, dentists pay poorly and offer no benefits. Is it any wonder that the practice does not run smoothly? The doctor doesn’t have a team that he or she can count on, and patients can see and experience the tension—which is not conducive to receiving or accepting treatment.
You need to have systems and policies for everything, including: financial, team benefits, accountability, safeguards against embezzlement, overall efficient handling of patients, laboratory matters, sterilization, training, and most importantly, team management. These are the aspects that good consultants can help every office with, which will ultimately translate to the bottom line and diminished stress. These are also issues and skills we do not have coming out of dental school and must seek out independently. For instance, we dentists are poorly prepared to treat our practices as the businesses they really are. I know that using the words business and dentistry in the same sentence has a negative connotation, but the fact is we are in a business, and no matter what our motives, failure to address our practices as businesses will serve neither doctor nor patient. We must pay attention to costs and treatment of our employees, and plan for our future. In other words, do what every other business does everyday, or we risk not being in business for very long.
What I don’t think consultants can do is help you sell something that a patient does not want. I have tried a number of treatment plan presentations as espoused by the Gurus, including special consultation appointments, written proposals, etc. For me, in most cases, patients do not seem to want secondary appointments for consultation. They do not want, can’t or won’t take, additional time, in most cases, to come back for lengthy case presentations—they want answers and they want them yesterday. We are all busy and under pressure, and the usual response I have received for these lengthy, detailed case presentations is largely negative, in that patients either did not schedule appointments or didn’t keep the appointments; when they did make and keep their appointments, the acceptance rate was low. Today, when I have a new patient, unless the diagnosis and plan is very complicated, I present to the patient at the initial appointment, keeping it simple and short. I use a patient educational system called CAESY, and if necessary, burn a disc for the patient to take home. I try to ask questions and listen, and provide answers to the best of my ability. I rely on my team members to deal with issues such as insurance and financial matters, soothing the patient, and answering treatment questions. I feel that for the most part I am successful, and yet, despite the best efforts of my team and myself, my patients don’t always do what I suggest; and while the gurus may explain my failures in terms of what I am or am not doing, my world suggests a simpler answer—money.
Money can mean that patients don’t have it, or choose not to use their money for their teeth, or at least not to the extent I would like (or that I think they need to). The Gurus would be quick to point out that my team and I should be able to overcome the obstacles of how patients prioritize their lives and income. I have seldom gone to a guru seminar where they have not put up the case of Shirley, a $20,000/year secretary who, because of her value of dentistry aided by the guru, spends in excess of two years of her total income on her mouth. Well, the skepticism in me suggests that there aren’t too many Shirleys out there. In my experience, Shirley lives paycheck to paycheck and does well to keep her recare appointments as long they are paid for by insurance.
Another assertion by some Gurus is to be prepared to “see the backs of patients’ heads.” In other words, “this is my practice, this is the way I practice (if you don’t like it, you can leave).” Usually, this approach is associated with “comprehensive care” and either the patient accepts the entire, expensive package, or they don’t belong in your practice. Now, if that is what you want, great, but for a vast majority of practices, the end result would be a lot of empty chair time—and empty chair time means no revenue. Also, as an aside, patients may interpret your desire for comprehensive care as a negative experience fueled by your desire for their money. Negative experiences result in patients talking to their friends, family, and colleagues, and impugning your reputation. Unfortunately, unhappy patients speak to more people than happy patients. So when you see the back of someone’s head, you may be looking at a far greater impact to your practice than you anticipate.
Basically, I am saying that the practice of dentistry, in my opinion, is not formulaic, and you have to do what works for you, your team, and your patients. Having good systems and policies, treating your team members well, and good, honest, ethical treatment, are the keys to success, and certainly consultants can help. It also doesn’t hurt to remember that our local, state, and federal governments treat us as a business when it comes to regulations and taxes, a fact that reminds us that we should run our practices with good business principles. What I don’t believe we should do is to try to clone our gurus and their offices. We must each find our own way and extract what we need and can use from various sources and experiences, and thus obtain our own definition of success.