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Finding Your Drive

July 17, 2015 by howardfarran Leave a Comment

I knew I wanted to be a dentist long before I knew I had to be a dentist. There’s a big difference there, and want versus need can determine the long-term success of a decision. I still get up every morning excited to go to work even though I’ve been in the same professions (dentistry and media) for a long time now.

It’s not enough to just want to own your own business. If you don’t feel like it is what you were meant to do, get out now.

Take away all the business education, experience and expertise you’ll pick up throughout your life as a business owner or even as an employee, and you better have one thing underneath it all: purpose.

Let that purpose drive the decisions you make. If you’re a business owner, identify that purpose clearly for your employees. The most successful business leaders in the world have one thing in common; each one has a simple, clear purpose, one that fulfills the desires of their customers, and one that the employees can get behind day in and day out.

The following excerpt deals with purpose and is from my new book, “Uncomplicate Business: All It Takes Is People, Time, and Money.” The book comes out in October 2015 and is available for pre-order at HowardFarran.com.

Excerpt: My dental career has always been filled with purpose. Within six months of opening up my dental practice in 1987 in Phoenix, Arizona, I was utterly demoralized. I had come from Kansas City, where the tooth decay rate in children was so much lower than the rate in children in Phoenix. I could not understand what was going on. Every mouth of every child I saw was riddled with rotting cavities. I was so baffled I called the local office of dental health and spoke with a man who turned out to be the smartest dentist I’ve ever met in my life, Dr. Jack Dillenberg. Jack simply said, “It’s because Phoenix’s water supply isn’t fluoridated.” I told him I felt like I’d be wasting forty years on an assembly line, drilling, filling, and billing for no purpose at all. I wasn’t going to make a dent in this pile. Jack agreed with me and suggested we start a group called the Arizona Citizens for Better Dental Health and get the Phoenix water supply fluoridated. I couldn’t say no. We met every Friday for two years until we convinced the city of Phoenix to add fluoride to its drinking water. I lived all week for that Friday meeting with Jack; it gave me such amazing professional purpose.

During that time, I’d speak at local schools and teach the children the importance of good home dental care with lots of brushing and flossing. My goal was to noticeably improve the overall dental health of my community. It still is. It is my purpose!

No matter what your business, you need a purpose!…

You need to give your entire company a purpose. I don’t just mean your staff, or you, or the chairs, or the bricks, or the mortar, but the driving philosophy of your entire company…

Your company’s purpose gives you clear-cut direction. If you take a team of people who place a high value on profitability, every decision they make will go toward maximizing profits. On the other hand, you might have a group of people who highly value customer care and will do and spend almost anything to make sure their customers are well taken care of. Put those two groups together and you’re going to see some battles. One team might want to hold back on spending money in order to lower overhead, while the other team really wants to implement something new to offer customers at the expense of the bottom line.

A mission statement explains to your customers and your team what your goal is and why your business exists. A mission statement serves to make your core values and their purpose crystal clear…

The mission statement for my dental practice, Today’s Dental, reads, “Build a long-term relationship between our staff and patients, and provide quality consumer-friendly dental services the whole family can value and afford in a happy environment.” Now tell me you aren’t sure what we do after you read that. When my team and I started Today’s Dental, we worked on this mission statement for a long time. When we set out, we never wanted to be a cosmetic-only practice with a spa-like setting. Yes, we do some cosmetic work, but we focus on bread-and-butter dentistry, and we aim to please. No frills, happy staff, solid relationships, and good dentistry. This mission statement is not just what we do day in and day out at the practice; it’s what we stand for! We live by this mission statement every single day, and if we feel as though we aren’t, we retool to make sure we’re getting back to our core mission…

The difference between leadership and management is purpose. The happiest people on earth are those who have meaning and relevance to their lives.

You have to develop a team that wants to play for you, work hard for your vision, and work with meaning and purpose. As the old saying goes, the fish rots from the head down. You are the head. Your corporate culture is only a reflection of you. If you make a horrible product or service, if you lie and cheat on your taxes, if you don’t refund customers’ money, all that reflects on you. The easiest way to be successful is to live with integrity and purpose.”

What Makes a Leader a Leader?

July 10, 2015 by howardfarran 1 Comment

When I first started my business I made a list of the qualities I wanted to see in my employees, and just as importantly, the qualities I wanted to have. Now I’m not talking about the stereotypical qualities of a CEO—I’m talking about the characteristics that make a person a leader.

When I went into business I did a lot of research and reflection on leadership traits because I wanted to be the best leader I could be for my employees, my business, my family and myself. I’m going to share a few of those qualities here today, along with why each of them is important.

The following excerpt is from my new book, “Uncomplicate Business: All It Takes Is People, Time, and Money.” The book comes out in October 2015 and is available for pre-order at HowardFarran.com.

Excerpt: Your business is your business. You are the one who is going to benefit the most from running it. Whether you make it successful will depend on much more than the education and training you got in school…

As an avid reader, I’ve read hundreds of books on business—books that suggest to me that, as a CEO, I must be a magician, motivator, leader, charismatic, tall, dark, handsome, and capable of riding a unicycle while juggling bowling pins, just to get everyone to follow me.

I disagree. Leadership is much simpler. To be a leader, you’ve simply got to be a winner.

George Steinbrenner once said: “Winning is the most important thing in my life, after breathing. Breathing first, winning next.” Steinbrenner was always the first to admit he didn’t make all the right decisions (after all, he did hire and fire manager Billy Martin five times), but he was the most successful owner of the winningest professional sports club in North America. He is an excellent example of what leadership is all about.

Steinbrenner knew that he needed to lead five categories of people to build a winning team: fans, players, managers, other team owners, and himself. From studying hundreds of CEOs, I discovered the winning characteristics necessary for me to be a good leader in my business.

A leader is humble. A lot of people have trouble with this one and I get that. A dentist comes out of eight years of dental school ready to champion the oral health of an entire town, and such an achievement comes with a little bluster. But the credentials that go with any highly trained professional don’t give that person the right to be a highfalutin jerk. You can’t look down your nose at anyone—certainly not your employees or your customers. You have to be a leader.

I’ve had mothers of young patients come in and say, “If I don’t give my baby Mountain Dew, she’ll cry.”

A leader embraces and drives innovation. You have to adopt all technology that helps you do your job faster, easier, at higher quality and lower cost. Macroeconomics is made up of three things: people, technology, and capital. Embrace all new technology. If you study Wall Street from 1792 to 2000, technology is what has driven the market, from steam engines to ship building, railroads to canal building, the telegraph, telephone, automobile, assembly line, radio, television, and the biggest technology boom in my lifetime—the Internet. I always tell young people in high school and college that, by the time they’re my age, there’s a good chance they’ll be working in an industry that hasn’t even been invented yet. The biggest millionaires and billionaires of all time are the ones who jumped on a brand new technology. Today it’s apps on the Internet, natural gas fracking . . . There’s always something new. Learn everything about the new technology in your industry, because likely that will give you a huge competitive advantage.

A leader follows the golden rule: “Treat others just as you would want to be treated.” The Golden Rule is first found in Hinduism and then in every major religion thereafter. I love its simplicity. As a business owner and professional in the dental field, I want the trust of my employees. And if I want them to trust me, I had better be willing to trust them, or my business will suffer. The same holds true for any business. If you can’t learn how to delegate duties to the right people, you will never be successful. When someone calls up your business and your employees don’t have your permission and trust to answer the person’s questions, there’s something wrong. Ray Kroc, founder of McDonald’s, knew he couldn’t make McDonald’s a massive franchise if he insisted on doing everything himself. Consequently, today more than 33,000 McDonald’s franchises serve up burgers and fries every single day all over the world.

I’ve never met a millionaire who hasn’t mastered delegation. You have to learn to let go. You can’t be a control freak.”

Changing Yourself

July 2, 2015 by howardfarran Leave a Comment

Over the next few months I’m going to share stories and excerpts from my new book, “Uncomplicate Business: All It Takes Is People, Time, and Money.” The book comes out in October 2015 and is available for pre-order at HowardFarran.com.

With Father’s Day being so recent, I find myself thinking of my dad and how he taught me about business. Let’s start there.

I grew up in Wichita, Kansas with six siblings. Mom stayed at home and dad drove a truck for the Rainbow Bread Company. My dad, who put in 80 hours a week just to keep the bills paid and his family fed, wasn’t able to be around much, and when I did see him, I was usually sitting in the passenger seat of his delivery truck while he drove his route to local grocery stores.

There came a day when a friend of my dad’s, who had saved up a lot of money and got a loan, quit his job and purchased a fast-food franchise. It didn’t take long before this guy was bringing in more money per month than he’d brought in the whole previous year.

My dad started asking his friend a million questions about this new business. Dad educated himself the best he could and then took the biggest risk of his life: he scraped up savings and got a loan so he could open up a franchise too.

I went from bouncing along in that Rainbow Bread truck, to watching my dad run his own business! This was an amazing opportunity to learn the risks, failures and triumphs of business early on. I learned the ins and outs of customer service and employee management, along with the importance of the numbers that make or break a business.

I also watched my dad acknowledge which areas of the business he excelled in, and which areas were a challenge. When he didn’t know something, he’d ask, and when he knew he needed help, he went out and got someone who would excel in that role. Putting the right people in the right roles at the right time was something he made look easy. To learn more about understanding what you bring to the table, read the below excerpt from Chapter 1.

Excerpt: When it comes to business, the most important question to ask yourself is: Am I really cut out to run a business? Sure, it may feel good to brag to the gang at the gym that you own and run your own business. It feels even better if you are able to say you own and run a successful business. Yet not everyone has what it takes to run a successful business. As you work with other people, you need to be aware of your personal strengths and weaknesses. Some of who you are depends on your genes, but a lot of your personality depends on where you grew up. If you are going to be a successful businessperson, you have to understand the roots of your personality.

As I said, I have the personality of a successful businessperson. I was hardwired for success from childhood. I witnessed my father’s successes firsthand. From his and my mother’s examples—for better or for worse—I learned three valuable lessons. From the strength and depth of their religious beliefs, I learned that there is a purpose and power to life that not only extends well beyond me, but also resides within me.

From the exclusionary nature of their beliefs, I learned about the separation created when love and acceptance are conditional upon sharing those beliefs. So I chose the path of acceptance and unconditional love instead. From seeing my father exploited by business partners and landlords, I learned the value of self-reliance. To borrow from the old American proverb, I learned to love many, trust few, and paddle my own canoe…

…If you want to change the biggest things about your business, you must work on the smallest things. You need to understand who you are and be willing to develop the good, positive ways of thinking that will enable you to run a successful business. You’re the business owner—you’re the spine and central nervous system of this company, so what traits do you bring to the table in order to direct your company to success?

It helps if you have a decent balance of left-brain (analytical) and right-brain (creative) thinking, but we all lean more toward one or the other. I’m very much a left-brain, critical thinker; I thrive on analytical information that can give me specific measurements on which I can base success. Whichever way you lean, it helps to bolster the “weaker” side of your brain among your employee base. As I wrote in my dedication, and will expand on later, Lorie, the president of my media company, is the perfect balance for my strengths and weaknesses.

Know the weaknesses as well as the strengths you bring to your business. I assert it is more important to know your weaknesses than your strengths—to honestly examine what skills you lack that other people can provide to help you succeed.

In any line of work, there are things we know we love to do and do well. Dentists love doing dentistry—that’s what we went to school from eight to twelve years for—but for the most part, we aren’t all that good at running our own businesses. That’s why I, and many others, have office managers to assist in the day-to-day operations of our practices.

Finally, don’t let anyone make you doubt yourself or your passion. When faced with critics, remember the words of Theodore Roosevelt: “Far better it is to dare mighty things, to win glorious triumphs even though checkered by failure, than to rank with those timid spirits who neither enjoy nor suffer much because they live in the gray twilight that knows neither victory nor defeat.”

Overhead and Efficiency

December 2, 2014 by howardfarran Leave a Comment

by Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine

If you were to ask practice-owning dentists around the country what their biggest business concern is, many of them will simply say overhead. I can’t stand it when people in the dental profession generalize overhead percentages for the entirety of the United States, because every state and every market is different. A dentist in North Dakota will always face different overhead costs than a dentist practicing in Manhattan. The economic and market variables that practices face in big cities differ greatly from those faced in rural areas, so to generalize and say a dental practice’s overhead should only be X percent isn’t fair.

t’s also frustrating to me when certain entities completely negate the cost of the dentist in overhead equations. When I practice dentistry I pay myself 25 percent, which makes up a lot of my practice’s labor costs. The rest of which is — of course — split up amongst my staff. This includes receptionists, office managers, hygienists and assistants. In large markets, that remaining labor cost makes up 25 to 28 percent of total overhead. In rural areas it’s about 20 percent. Regardless, it doesn’t matter who you speak to about their overhead, because no matter if your practice is in rural Kansas or a big city, we’re alltrying to bring our overhead percentage down.

When you’re looking at between 50 to 60 percent in labor costs (including what the dentist makes), the best way to bring your overhead cost down is you need to find every single advantage you can to ensure your practice is working as efficiently as possible. One of those ways is through magnification.

I know a lot of younger dentists who look at magnification as something used by old, fat, bald guys whose best days of practicing dentistry were 20 years ago. But even though you might say, “Dr. Farran certainly falls into that category,” that generalization simply isn’t true. Anybody who can see something four times larger than you is going to see things you can’t, see more than you can, and do a much better, quicker, more thorough job than you.

I really don’t understand the professors in dental school who tell their students not to invest in loupes because “they’ll rely on them too much” and “they’ll always have to work with that level of magnification.” Are you kidding me? Um, hey professor, that’s not a bad thing. Loupes are not a crutch — they’re an advantage. Loupes should be the first tool a dental school should hand their students. Practicing without them is like the difference between doing a filling with the lights on and doing a filling blindfolded in the dark. In my practice, loupes are mandatory for every person who works clinically. My entire staff tells me they would not and could not perform the high level of dental care they provide without them — they just can’t!

I’m on the message boards of Dentaltown.com every day since 1999, and I recall a dentist who once said he is so tired of going in to check the patient after a cleaning and he ends up clearing away a big chunk of calculus. The thing is, he’s wearing loupes so he can see this piece of calculus, but his hygienist isn’t wearing loupes and cannot see what he sees. This difference really puts the hygienist at a disadvantage. And of course, the doctor gets upset with her because she missed this obvious piece of calculus… well, obvious to him because he can see it. This clinician has the same kind of professional blinders on as the dentist who goes to a dental convention or seminar and doesn’t take his team with him. Sure it’s great the doctor is learning a lot and getting energized and excited about dentistry, but his staff isn’t. Then he wonders why his team isn’t as pumped as he is. I know this is getting a little off track, but doctor, you have to invest in your staff! You need to get them loupes so they can see what you’re seeing. You have to get them to CE courses so they can get as excited about practicing dentistry as you are. I digress…

Not only do loupes help your vision, but think of the ergonomic benefits! You can sit straight up while you work on your patients, and you don’t have to crane your neck around in someone’s mouth to see what’s going on. Over time, loupes will help you practice dentistry longer than the dentist who has a constant kink in her neck from trying to get a better look at her patients’ chompers.

Loupes are great, but let’s take this a little further. You can even improve upon what you’re seeing in your patients’ mouth with proper lighting. Overhead lamps and LED lights that attach to your loupes are a true godsend in this profession, but when I really want every single thing illuminated in my patient’s mouth, I’m going to turn to my trusty Isolite every time. I mean, take a look at this photo, I’m using an Isolite in this patient’s mouth, and his mouth is so illuminated, I can see everything — especially when I’ve paired the lighting with my loupes. I almost need sunglasses his mouth is so bright!

Not only am I thrilled about having such bright light in my patients’ mouths, but it frees up my assistant’s hands from continually adjusting the overhead light. Jan, my assistant, swears using the Isolite is like giving her another set of arms. Since we’re talking about making sure your practice is working as efficiently as possible, when I’m using an Isolite, I almost don’t need Jan in the room while I’m working on a patient. Instead of babysitting an overhead light for me, Jan can be setting up other things for the procedure or setting up another operatory for my next patient. In fact, it is so handy, I’ve heard from other colleagues that their assistants feel a little threatened by it. While it certainly doesn’t replace the entire functionality of an assistant working in your practice, having the Isolite is really like having a free dental assistant work in your office all while you’re getting the best light possible in your patient’s mouth

That’s the beauty here! It has to be the most boring job in the world for your assistant to sit there and suck spit all day while you’re working on a patient, when you could just get an Isolite to do that task for you, freeing up your assistant to take care of other more important tasks.

I recently met with a bunch of office managers in Nashville, Tennessee, and I had a conversation with some of them about how frustrating it is now that the practice has purchased a CAD/CAM milling unit because the doctor is spending three hours of his time making a crown. That’s crazy! Before he purchased the CAD/CAM milling unit did he do his own lab work to make the crown? No, he sent it to the lab. So, now he went from being a doctor to a lab-tech. Congratulations, you just spent $100,000 to spend your time doing lab work.

Doctors, you need to start investing in your team and delegating things like making a same-day crown to them. It’s time to free up on the reins a little bit, doc! Let your staff soar! You need to invest in your team. Allow them to see what you’re seeing with your loupes. Start using other helpful instruments so you can free up your assistant from sucking spit, allowing her to take on other more important tasks. And for heaven’s sake, start bringing your team with you to dental conventions and seminars and get them on the same excitement level you’re on. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=375&aid=5125#sthash.7K8kKc1Y.dpuf

Debt and Cash Flow

October 28, 2014 by howardfarran Leave a Comment

by Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine

There is not a billionaire on earth who doesn’t use debt to benefit business. Even if you started saving money the day you were born and never spent a penny, you’d die before you’d ever see your bank account reach a billion dollars. Billionaires borrow other people’s money (OPM), whether through stock or bond offerings or a bank. They buy or build something and then they pay back the loan.

You could have worked a minimum wage job for 40 years, saved money and paid for dental school in cash. But instead most of us took out student loans. You may not be a billionaire, but you used OPM to build your career. This was smart debt.

The same goes for purchasing equipment in the practice. The adage “you have to spend money to make money” is true, and it often entails other people’s money to get to that point. This isn’t to say you should blindly go into massive debt. Analyze the ROI on a piece of equipment. What will the benefit be to your practice and how long will it take to pay back the loan?

It’s a privilege to borrow

It’s a privilege to be able to borrow money. Third world countries don’t have this option. Debt is leverage, but it’s treated as an emotional decision.

I graduated from dental school in 1987 with $87,000 in student loans. That’s in the $220,000 range today. I paid it back after graduation while working as a dentist because the lowest-paid dentists made $50 an hour. That’s 10 times what I would have made working and saving money at that minimum wage job. If I hear one more dental school graduate whine about his $300,000 in student loans, I’m going to slap him! Those loans took him from earning $5 an hour to $50+ an hour

I often hear dentists say they don’t want to purchase a CAD/ CAM or CBCT unit because they don’t want to go into that kind of debt. You have to look at a number of other factors besides the sticker price of a piece of equipment like that. What will having your own CAD/CAM unit do to your lab bill? If you’re doing more crown and bridge work and slashing your lab bill in half, how long will it actually take you to pay the loan off? Does the technology attract more new patients because of same-day appointments? Does adding a CBCT unit mean you can start performing more complex implant procedures in your practice?

Work with a dental CPA

Work with a dental CPA to see if a big purchase is a good move. When I say dental CPA, I mean a CPA who works exclusively with those in the dental profession, not a CPA who has one or two dental clients. To find one, check out: The Academy of Dental CPAs (ADCPA.org) and The Institute of Dental CPAs (INDCPA.org). These professionals specialize in dentistry and can help you to best determine if a purchase will be beneficial to your individual practice.

Look at the reports that matter

There are three main reports when you’re looking at your practice finances: the statement of cash flow (Fig. 1), the balance sheet (Fig. 2) and the statement of income (Fig. 3). They’ll all reflect debt differently.

Your statement of income (P&L) shows numbers like depreciation, deferred taxes, etc. It’s mostly used for tax purposes.

Your balance sheet is only used when you’re trying to get a loan. It’s not used to make business decisions. Debt will always make your balance sheet look ugly. The statement of cash flow is what actually matters. This statement is what really shows what’s happening in a business. As humans, we tend to be emotionally connected to the debt on a balance sheet.

But your statement of cash flow can be solvent. It’s what makes leverage out of debt, and debt is what separates the billionaires.

The data provided in the Financial Statements is based on an average from the clients of Naden/Lean, LLC. These reports were provided by Tim Lott who is a partner with Naden/Lean, LLC, a professional services and CPA firm with a specific concentration in the dental industry. He has been working with dental professional for thirty years and w e appreciate his contribution. Timothy D. Lott, CPA, CV A; Naden/ Lean, LLC; tlott@dentalcpas.com; (410) 453-5500 Local; ( 800) 772-1065 National; www.dentalcpas.com

In memory of Dr. Rou’aa Diab

Dr. Rou’aa Diab, a female dentist, was arrested by the Islamic State on August 22, 2014. She was arrested with four others in Al-Mayadeen, a city on the border of Iraq. Without proper trial, Diab was charged with the crime of “treating male patients,” and was executed.
As fellow dentists, Dr. Diab was a colleague to each of us. She was beheaded for helping prevent and treat dental disease. She should be recognized for her bravery and dedication. And her name should never be forgotten.

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=372&aid=5079#sthash.OfKFTcgi.dpuf

How to Successfully Integrate CAD/CAM

September 25, 2014 by howardfarran Leave a Comment

I had active Townie Dr. Sameer Puri come to my practice to train my staff on a new CAD/CAM software last month. Why? Because I wanted my assistants to know how to use the system just as well, if not better, than I do. I know that 90 percent of the questions asked by patients are fielded by the front desk and the assistants, not me or the other doctors. And because of this, I want all my staff to know what they’re doing!

So many doctors go to CE courses or conferences alone. They’ll do in-office training alone. They’ll never teach their staff the software or systems or procedures. This doesn’t make any sense. You don’t work alone. You don’t run your practice alone. Why would you attend a conference to learn how to better your practice and then not bring your staff along? That just doesn’t make sense.

I sat down with Sam to ask him about CAD/CAM implementation. Our office has it already, but not all offices do. I wanted to see what he had to say about the technology and how he helps doctors successfully implement the machine into their offices. Here are some of his tips:

Train Your Team

The key with any office utilizing CAD/CAM is getting your team on board. At one point, there was a lot of debate about whether the technology worked or was worth it. I think that’s over. There have been offices—single doctor, one assistant, one front desk—that have been successful and there have been multi-doctor, multi-staff offices that have integrated it efficiently.

Once you get your team trained with how to use CAD/CAM properly, the dentist really just needs to do what he or she has been doing with a lab. The dentist should numb the patient, prep the tooth and then leave. With CAD/CAM, the team can take over (depending on the laws of the state) and nearly the entire process can be done without the supervision of the dentist. The dentist can be in the other room being productive. And when the restoration is done, come back in to check the work and cement it. If the team member takes the impression, designs the restoration, mills it and either polishes or glazes it, it saves the doctor a lot of time he or she can spend in another operatory. The key is that you have to have your team trained. You have to help them learn how to utilize the machine.

Don’t Let it Be Disruptive

Introducing a new piece of equipment into the office can be huge. Change doesn’t have to be overwhelming. I hear from dentists all the time, “We’re really busy. I don’t know if we have the time for it.” Well, it’s no different whether you have a well-functioning office using CAD/CAM or if you’re sending your restorations to a lab. The doctor does not have to be heavily involved in the design of the restoration…if you train your team.

Integrating CAD/CAM doesn’t have to be disruptive. You should adapt the system to your practice, not adapt your practice to the system. No matter how big or small your practice, you have a certain flow in your office that obviously works for you. Make the machine accommodate the flow of your office. Things don’t have to change drastically.

Yes, you’ll have to learn how to take a good digital impression. But that’s easy with the current generation of CAD/CAM systems. The impression gives you a lot of feedback. You instantly know whether you have a good prep or not, whether you’ve reduced enough, whether you need to do a reduction coping or spot the opposing. You know instantly whether you’ve captured the margins and whether you’ve prepared the tooth properly.

If the team member is doing all that work for you and they say, “I can’t quite see the margins.” He or she simply calls the dentist back, the dentist makes the appropriate modifications and you proceed.

Recognize the Need for Same-day Dentistry

When it comes to implementing the technology, the biggest mistake that offices make is they forget that there is a person attached to those teeth. They’ll say, “My lab is great. My temporaries fit well. My patients don’t mind coming back for a second visit.” This is utter nonsense. I have never met a patient who would prefer to have a restoration done in two visits instead of one. It’s crazy to believe that your patients have all this free time and can come back for multiple appointments.

Discover CAD/CAM’s Potential

When CAD/CAM first entered the mainstream market, many offices bought a CAD/CAM but they didn’t know how to use it to its full potential. This was common because the learning curve was significant. Twenty years ago you had to spend time doing 50 to 100 restorations just to learn how to do a simple inlay. You had 2D software. You had to manipulate a bunch of lines on the screen and imagine that would be a restoration. Today, with proper training, a dentist can do 30 restorations his first month. The learning curve is significantly reduced. The return rate (those who buy the machine and say it doesn’t work out) has dropped exponentially too, because the machine, the software and the results are so good.

In the past, dentists were limited by the materials they could use. We only had one material: feldspathic porcelain, which is a relatively weak porcelain. We had to use that everywhere. Today, a dentist has anywhere from six to ten different types of blocks they can mill—from composite to zirconia to lithium disilicate to feldspathic porcelain. We can do inlays, onlays, implant abutments, bridges…we’re not talking about just a simple little machine anymore. We’re talking about a robust piece of equipment that can serve as a center of the practice doing many different types of restorations.

What’s your experience with CAD/CAM? Have you integrated it? Are you ready to do so? Let’s continue to talk about this massive evolution of technology at Dentaltown.com. – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2680&t=233712#sthash.teltjuS7.dpuf

Howard Speaks: And the Band Played On…Again

August 25, 2014 by howardfarran 1 Comment

Howard Speaks: And the Band Played On…Again
Dentaltown Magazine
August 2014
by Howard Farran, DDS, MBA

When you’re young, everything is black and white. When you’re half a century old, everything is 50 shades of gray. And as you get older, you see patterns.

I remember my senior year of high school when two men were dying of something called Kaposi’s Sarcoma in a hospital in California. This was strange because the two men were young and the cancer was something typically only found in the older population.

Then researchers found out both men were gay. When they crunched the odds of this, it caught the attention of the Center for Disease Control and Prevention (CDC). Soon the numbers grew to prompt a medical investigation.

A New York Times article dated July 1981, reported: In the United States, [Kaposi’s Sarcoma] has primarily affected men older than 50 years. But in the recent cases, doctors at nine medical centers in New York and seven hospitals in California have been diagnosing the condition among younger men, all of whom said in the course of standard diagnostic interviews that they were homosexual. Although the ages of the patients have ranged from 26 to 51 years, many have been under 40, with the mean at 39.
This was, of course, the start of the AIDS epidemic of the 1980s. The CDC just hadn’t quite realized yet how widespread and destructive it would be.

In 1987 Randy Shilts published a book titled And the Band Played On: Politics, People and the AIDS Epidemic. A movie stemmed from the book, which premiered in 1993.

The synopsis: Don Francis, epidemiologist and main character, questions the escalating number of unexplained deaths among gay males, particularly in large cities like New York and San Francisco. He starts to investigate the possible causes and keeps tally of those affected by the disease. This list is nicknamed “The Butcher’s Bill.” He talks with politicians, professionals within the medical community and activists and eventually theorizes that AIDS might be sexually transmitted.

Now, we’re more than 30 years beyond this public health nightmare. And hindsight is 20/20. We might have high awareness now but at the time, it flew under the radar for years. And part of the problem was that people refused to talk about it.

In the past, oral and oropharyngeal cancer—or “mouth cancer,” as they call it in the U.K.—have most often been linked to drinking and smoking. And even more specifically, the cancer has been linear—someone who had smoked two packs a day for four decades was more likely to get cancer than someone who had smoked one pack a day for one decade. Chewing tobacco didn’t follow this model. It was less predictable and didn’t get a lot of attention, though still a cancer risk.

Now, the tides have turned. Today we’re seeing an explosion of oral cancer in young girls! Girls who have never had a cigarette in their lives and don’t have a drinking problem. They’re showing up at the doctor with lesions and screening positive for cancer. It’s HPV and it’s hitting us all by surprise. But nobody is talking about it.

You can’t talk about HPV without talking about oral sex… so let’s just get that out of the way. It’s awkward, but you’re an adult, so buck up. Last year the U.K.-based newspaper The Guardian published an article about Michael Douglas, who opened up the conversation about HPV’s ties to oral sex, attributing his own cancer to it.

I get it; you’re not a sex ed teacher, but if we’re going to call ourselves doctors, we need to be asking some tough questions. When I lecture I ask dentists if they talk to their patients about HPV. It’s not even on dentists’ radar.

You should be asking every patient who comes in if they’ve been vaccinated for HPV. Many dentists give excuses. “That’s not my area. Their family physician should do that.” No! We are all on the frontlines of health. If we’re not talking about this, let’s just say we’re not doctors. We’re just molar mechanics.

We have a serious biological problem here: a virus. We’re knowledgeable about AIDS—possibly one of the only positive outcomes of the epidemic—but we’re missing the new problem right in front of us.

I talked to a mother of a patient in my office who refused to talk to her daughter about HPV. And the mother thought that vaccinating her daughter against the virus would be the same as sending her off to college with a box of condoms. She didn’t want her daughter to feel protected. These are huge moral, ethical, religious questions. We need to talk about this stuff, even if it is uncomfortable or controversial.

In 2007, Texas Governor Rick Perry worked to mandate the HPV vaccine among middle-school girls. Though it was controversial and was overridden in the months after, it was one of the only big-time public actions taken against the virus. All 50 states in the U.S. have a Department of Health and Human Services, and nearly every state has a dental division. Have you ever called yours to talk about HPV? Ask for resources. See what the division is doing in your state.

HPV is a topic that makes people squirm in their seats. We don’t want to talk about it. No one wanted to talk about AIDS either. It made people uncomfortable. But the epidemic happened right in front of us anyway. And in a way, we were blindsided! This is what’s going on right now with HPV. The fact is, we don’t know how serious it is or isn’t. And it’s our job— as dentists—to talk to patients and parents about the risks of the disease.

Not only are we not talking to patients, but we’re not talking to each other about it either. I’m on Dentaltown all the time and there is hardly any discussion at all about HPV. Let’s talk about how to educate patients and parents! Let’s converse about the public health risk and our part in the big picture. Americans see a dentist twice as often as they see a physician. We have 125,000 dental offices in America. That’s manpower! We have a massive ability to get out in front of this.

We don’t want to look back at an HPV Butcher’s Bill and ask ourselves what we could have done about it. I’d love for dentists to stand up and become physicians of the mouth. We’ve got a problem on our hands right now.

References

Rare cancer seen in 41 Homosexuals: by Lawrence K Altman; July 3, 1981; The New York Times http://www.nytimes.com/1981/07/03/us/rare-cancer-seen-in-41-homosexuals.html
National Conference of State Legislatures http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
Michael Douglas: oral sex caused my cancer”; June 2, 2013; The Guardian http://www.theguardian.com/film/2013/jun/02/michael-douglas-oral-sex-cancer?CMP=twtgu

– See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=365&aid=4974#sthash.utdmJeBH.dpuf

Why Two Out of Three Cavities Go Untreated

August 7, 2014 by howardfarran Leave a Comment

Every year, since 1991, there have been more cavities diagnosed than the year before. That’s a terrible statistic.

What would happen if the fire chief of a city reported that in the 23 years he had been in the position, more houses had burned down each year than the year before?

Legendary, successful mayors are the ones who substantially lower the crime rate while they’re in office. “I’m so proud of the fact that there were more murders than last year! We’re hoping and expecting even more next year!” said no one ever.

On average, for every three cavities a dentist diagnoses, he only removes the decay on one. One! He doesn’t remove the decay two out of three times! That’s below average dentistry! We all claim to be good dentists, but on average, we can’t all be.

I always hear clinicians say they’re 20/20/20 dentists—“My fillings are bonded with greater than 20 megapascals.” “All my indirects fit within 20 microns.” “All the materials I use wear less than 20 microns a year.” They use their fancy adhesive bonding agents and their fancy CAD/CAM machines on one-third and do squat on the other two-thirds.

You are a dentist because you got A’s in science and math, and because you (hopefully) genuinely care about removing decay and disease. But part of the problem is that dentists typically aren’t good at sales. And to fix patients’ cavities, and in turn, prevent the spread of disease and decay, you’ve got to convince them they have a problem that needs fixing.

Say you have a patient in the dental chair and you are presenting treatment after an exam. You might say something really technical and clinical. “You have an interproximal legion on the distal of three. It’s causing irreversible pulpitis. You’ll need endodontic therapy, a post-build up and a full-cast restoration.” The patient just stares at you like a deer in headlights. She doesn’t understand what you just told her, doesn’t realize the importance of fixing the issue and because she, like most people, doesn’t buy based on information, she walks out to the front desk, says she’ll call later to schedule her treatment and then leaves. Two out of three cavities are walking right out your front door!

Let’s look at this same situation by putting ourselves in different shoes. Say a dentist was selling real estate. He’d walk in the house with the client and say something like: “The altitude of this house is 368 meters above sea level. This side of the street gets direct sunlight in the morning. The climate of the area is mostly rainy…” Boring! It would be all technical information.

A good real estate agent, on the other hand, would present a house much differently. She would walk you into the living room and help you imagine the big parties with family and friends that you could have. She’d sit with you around the fire pit and talk about how fun it would be to BBQ on the patio during the summer. She’d make it relatable. She’d make it an emotional decision rather than an informational one.

There is a biological science to selling. There are only two things humans can love. It’s not ice cream or cookies or dogs or cats or family. It’s dopamine and serotonin.

Your dog sees you walk in the front door from work. His tail wags and he jumps up, excited to see you. You think you love each other but you actually love the two chemicals. The real estate agent is secreting dopamine and serotonin too.

What on your résumé makes you think you’ll be good at sales? Sometimes dentists are their own worst enemies. Patients are already on edge when they visit the dentist, so it doesn’t take much to (even unintentionally) put them in fight or flight mode. Looking back to the patient in the dental office, it’s no wonder she wasn’t compelled to schedule her treatment. You weren’t giving off any dopamine or serotonin. In fact, you were secreting norepinephrine and adrenaline, which have the opposite effect.

We’re putting patients in fight or flight mode because of the clinical information we’re spouting off and because many dentists feel compelled to comment on previous dental work. If you’re not impressed, keep it to yourself. In 1997, William Ecenbarger published an article in Reader’s Digest called “How Dentists Rip Us Off.” The investigative journalist went to 50 different dentists for consultations. He received 50 different treatment plans. Dentistry is as much an art as it is a science. It’s inexact. So unless you see shoddy dentistry worthy of malpractice accusations, don’t badmouth! What if the patient was a family friend with her previous dentist? What if their kids played sports together? If you’re badmouthing her previous dentistry, you’re telling the patient that her decision to have treatment years ago was a bad one, but now you’re asking her to make the decision for treatment again with you.

The point is we need help selling treatment. Most of us are just not biologically good at it. I’ve had the same dental assistant for 25 years. She is great at presenting treatment because she gives off serotonin and dopamine. She’ll present treatment like this: “You have two cavities, but I wouldn’t fix them just yet because if the doctor puts those fillings in there, he’s going to match them to the existing teeth. So, what I would do is bleach them first. But before you do that you need to have them cleaned. So let’s get you in the hygiene department and we’ll get all the plaque and tartar off your teeth, then we’ll bleach them in the office and send you home with bleaching trays. Then we’ll remove those cavities and match the fillings to the pretty white teeth. It’s going to look great.” The patient gets excited about what her new smile will look like!

I lucked out having an assistant who is so good at selling dentistry. But the fact is, I still have a treatment coordinator. This is something that orthodontists figure out two years into practicing and nine out of ten dentists never figure out. Treatment coordinators have been known to triple treatment production! By hiring a TC we can lower the rates of decay and disease, and maybe clean out two of three or three of three cavities that come into our offices! – See more at: http://www.dentaltown.com/MessageBoard/thread.aspx?s=2&f=2669&t=230414#sthash.47OLzMj8.dpuf

What Dentists Can Learn From the Downfall of Sears

June 24, 2014 by howardfarran Leave a Comment

In February 2014, Forbes published an article titled “Sears Still Missing the Boat: 6 Ways the Brand Can Be Saved.” Sears has been on a painful decline for the last decade. When I was a kid, Sears was the be-all end-all. It was all things great. I can still remember sitting around with my five sisters looking at the Sears Catalog. We’d circle things. We’d make Christmas lists. It was fantastic.

Sears was one of the first department stores to carry exclusive product lines including DieHard Batteries, Kenmore appliances and Craftsman tools. But now, it’s had its lunch handed to it by Lowes and Home Depot. But why?

The smartest economic gurus in the U.S. and Canadian market insist the market is split in two—half shop on price and half shop on service. But companies, department stores and even dental offices have to have one of the two. They can’t cater to both markets successfully.

For Sears, it used to be all about the service. You knew when you walked into Sears that its product lines were good quality and that you would receive great service if you had any questions or needed help. Now, you walk into Sears and nobody can explain anything about a battery or a tool or an appliance. Its service has taken a plunge but it hasn’t made up for it in price. Other stores, like Wal-Mart for example, have the same products but offer them at a better price.

On the other side of the coin, every time I go into Home Depot and have a question, I get it answered immediately (and of course, realize I need more equipment and tools). I end up being led by the sales associate to four other aisles to find things. It’s good business. That store is staffed with a bunch of people who know what they’re talking about.

This is interesting to me on the dental side of things because I go into dental offices all the time. Nine out of 10 dentists don’t let their staff talk intelligently to patients. Hygienists are afraid to show patients a cavity on an X-ray because they’re “not the doctor.” This is absurd.

The patient is sitting in the chair and the dental assistant is taking a PA and a bitewing for an emergency. The tooth is completely bombed out. It’s obvious that the tooth has to be extracted. The patient asks the dental assistant, who has been working for the practice for years, what the verdict is. She doesn’t answer because she’s afraid of her own doctor. She’s afraid of being knowledgeable staff member. So basically, the doctor wants to be Sears.

I often hear dentists use the excuse: “It’s illegal for a dental hygienist or an assistant to read an X-ray.” Can you name one hygienist, dental assistant or receptionist in America who is serving time in prison for reading an X-ray? It’s not like you, the doctor, are going to go in there and take the hygienist’s reading on the X-ray and just start doing a root canal blindly. No! You are going to evaluate it for yourself. You’re going to ask her to clarify if her handwriting is messy. You’re going to discuss what she saw versus what you’re seeing. This is why the “it’s illegal” excuse is just crazy. It’s crazy for the patient’s questions to be put off and it’s not fair for the staff. They’re knowledgeable, so let them show it in the work they do. The same way the knowledgeable employees at Home Depot take pride in their work, your assistant’s knowledge in the work she does is one of qualities that make her proud to work in your office. And it’s what keeps staff turnover low.

The best thing about having knowledgeable staff is that they’re empowered to do well, which means they’re often the longest-retained employees. Mary at the front desk might not be able to say for sure whether a tooth needs a root canal, but between a little knowledge about what might be causing the patients pain and the fact that she’s been sitting by the doctor’s side for 20 years… patients trust that. It’s selling the invisible.

I continue to hear dentists talk about how they want to operate on service not price. They want to develop a high-end practice. They want to do implants and veneers. It’s interesting to note that these are the same doctors who often come to meetings alone rather than bringing their staff. All I can say is “Where is your team!?” Where is the person answering the phone at your practice? The person who answers the phone should be sitting in a class on ortho or perio or root canals or gum disease. That person is going to be fielding 90 percent of the questions. That incoming call is one of the most powerful things in dentistry.

The greatest stores (those that are continuing to be successful in this economy) are all adding new services. Nordstrom added Topshop. Macy’s expanded their shoe department and partnered with Finish Line. They’re also continuing to train long-term staff to be knowledgeable. The workers know the brands inside and out. They offer specialty services like tailoring and personal shopping. Or in Home Depot’s case, tool rental and installation offerings. They’re differentiating themselves through staff as well as product and service offerings.

You need knowledgeable workers. Our team has busted our butts for 15 years to develop our online CE program. All you need to do is spring for a pizza or sandwiches and you can sit around a table for an hour at lunchtime with your team and watch a CE on Dentaltown. Right now we have about 215 courses online. You could watch one a week for four years and still not finish them! These courses are particularly great because they’re only an hour long (which is about how long our attention spans work effectively). You need knowledgeable workers. You shouldn’t be watching these courses alone. You shouldn’t be learning alone!

There is a lot to be learned from Sears. The failing department store and the stores that are thriving have one big difference—knowledgeable staff. So, which model are you going to follow?

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=360&aid=4903#sthash.i3uf3H4E.dpuf

Google Reviews are the Only Ones that Matter

May 27, 2014 by howardfarran 1 Comment

Everyone’s buzzing about online reviews as if they’re something new and different. The fact is, we’ve always had reviews. They just haven’t always been posted online for everyone to see. Online reviews are a digital version of an analog voice, and everyone reacts to them differently.

Here are some facts about online reviews:

92 percent of people have confidence in online reviews (Wall Street Journal, January 2009).
70 percent of people consult reviews or ratings before purchasing (Businessweek, October 2008).
61 percent of reviewers are motivated to write reviews to give recognition to a company, versus only 25 percent who write them to punish a business (Nielsen 2011).
Women are more likely than men to write online reviews (Nielsen 2011).

Humans don’t like transparency, but when humans aren’t transparent, bad things happen. I raised four boys. Whenever they all went into one of the bedrooms and shut the door, I knew something bad was going to happen. It was a red flag that definitely made me go check out what was going on.

Online reviews facilitate transparency. They’re a digital platform for checks and balances, and reviews can be your best ally if you handle them right.

Sometimes patients will make a comment about how great their experience in our office has been. Ask patients who you know are happy to write an online review for your practice! Most of the time, they love to be asked. Don’t show them how to do it from your office computer. Google is watching and if they see your reviews coming from your IP address, it might affect your SEO optimization. The patients can, however, post a review from their cell phones.

There are hundreds of review sites out there—Yelp, HealthGrades, Yahoo—but don’t waste your time on these; Google drives the whole industry. Google and YouTube (which is owned by Google) are the two most-used search engines. If you Google a dentist and they have a website of any kind, he or she will come up on Google’s search results. This means the doc’s reviews also come up (Fig. 2).

In my practice, we give out “Review us on Google” cards (Fig. 1). These cards are included with new patient gifts, in recall goodie bags and are also available in all the operatories. The card not only reminds patients to write a review after they leave the office but it also guides them through the process of writing one.

Occasionally patients might have a bad experience and surprise you with a nasty online review. Say this happens. You’ve made a woman so mad that she’s gone home and registered on Google+ (which she might have had to read instructions or watch a YouTube video to learn to set up) and she’s gone through the process of writing several paragraphs about her practice experience. This probably took her the better part of an hour start to finish.

For many dentists, their first response is to hire a lawyer or try to get Google to take down the review. But you should be going the opposite way! This is an awesome opportunity. First of all, how many patients who don’t come back take the time to write a letter telling you what you can do better? Not too many!

Second of all, can you imagine if this woman, with the amount of energy and determination she has, was rallying for your practice instead of working against it? If you can rectify her bad experience, she’s a walking marketing campaign for your practice.

The best way to deal with a bad online review, whether it’s a minor complaint or an absolute disaster, is to call the patient. There are often posters on Dentaltown who will ask what to do about bad reviews. The initial answer seems to always be to show it to your malpractice carrier. Really?

This patient is already in confrontation mode. Why isn’t your first response to call the patient? Say: “Hey Sally. You are mad. Can you come down to the office and we can go to lunch and talk about it?” Most the time, the bad reviewer just wants to be heard. And by doing whatever you can to fix the situation, you’re not only addressing that patient’s complaint but also creating good rapport for your practice overall.

In addition to online reviews, I’ve found exit interviews to be very effective for getting feedback. Call all the people who haven’t been in to the office in 24 months. See why. It’s important to keep track of why patients leave. Do you really think they all died or moved? Who are you kidding? You’ll find some of them have moved, some of them changed because of insurance policies or better scheduling. But what if you find out that a substantial number of patients decided not to return because they hate one of your hygienists? What if you find out a front office person is unwelcoming?

Most of your new patients are just old patients from the dentist across the street, which means you need to ask them why they left their old dentist. When a new patient comes in to the office, the person fills out a health history. Why don’t you include a question about why they left their last dental office?

Sometimes you’ll get answers like: They didn’t take my insurance or they didn’t provide nitrous oxide as an option or they weren’t open on evenings or Saturdays. You might learn their previous dentist was unapproachable or talked down to patients or created a culture of “don’t ask questions.”

How do you get feedback in your office? Sign on to Dentaltown.com and visit the Howard Speaks article for this issue. I’d love to hear about what you do to receive and track feedback. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=357&aid=4863#sthash.pqxdvVBG.dpuf