Dentaltown – Howard Speaks

Not Getting It Done? Hire a Consultant!

November 25, 2013 by howardfarran Leave a Comment

There is a very interesting thread on Dentaltown.com called “43 and Burned Out” that, as of this writing, is pushing 6,000 views and almost 250 replies.

Every year since we launched Dentaltown in 1999 a thread like this pops up, where a dentist admits to being burned out. You read upsetting declarations like, “I just don’t feel it anymore,” or, “I’m trapped because my lifestyle is based on the earnings of a dentist, but I hate dentistry and there’s no way I can get another job to make this kind of income.” They’re desperate for help or even a point in the right direction.

I’ve written about burnout before. Sadly, it is still the biggest problem facing the dental profession, leading to awful, harmful vices like alcohol and drug addiction, and even suicide. You can focus on improving your environment and your gear, and you can retool your practice so you can work on what gets you excited, but another thing you need to focus on is your own health.

I’ve written often about my Four Bs – the four things I always focus on to remain successful: my Body, my Babe, my Babies and my Business. Take notice of the first B: my Body; it’s the most important one. Once you lose your body, it’s game over, and the other three Bs don’t matter anymore.

The most powerful and productive dentists I’ve known over the last 25 years all have one thing in common. No, they weren’t all valedictorians. No, they’re not all second- or third-generation dentists. No, they didn’t have specific undergrad degrees in business, marketing or finance. All of the successful dentists I know have their bodies together! They’re healthy. They eat right. They exercise.

I know far too many dentists who are couch potatoes. They work a high-stress job and come home at the end of a long day and just veg out, eating and drinking awful things, and generally do not take very good care of themselves. Then they wonder why they’re depressed and sick all the time. We still have a society that is based on the ancient model of medicine that goes all the way back to when people saw witch doctors: You have a problem, you go to the witch doctor, they make you a lotion or a potion with herbs, or they pull out their knives and cut something off of you. No pill a doctor gives you will counteract years and years of destructive living! It’s time you realize your health is in your own hands and you need to do something about it!

That’s easier said than done, though. I should know! On the day I turned 50, I asked myself, “What’s my goal?” I mean, every New Years Day when I was in my 40s, my goal was to lose 10 lbs. Then it became, “I want to lose 20 lbs.” Then it became 30 lbs. On my 50th birthday I realized I was 50 lbs. overweight and I wasn’t getting it done. So, what did I do? I hired a diet coach who came to my house, threw away about six grocery bags of food I had laying around in my pantry, sat me down and went over nutrition. That coach came to my house every Tuesday for three months before I finally figured out the proper way to eat.

Once I figured out my nutrition, I signed up for maybe what is the craziest goal I ever could sign up for: I decided I was going to participate in an Ironman triathlon where I would have to swim 2.4 miles, bike 112 miles, and then run a full marathon. Everyone I told about my new goal literally laughed in my face. They’d say, “Dude, you’re 50 lbs. overweight, you don’t swim or bike or run, you’re a workaholic and you basically sit at a desk all day.” Because I wanted to achieve this goal, I knew I had to train properly. I couldn’t do this myself, and I had such success with my diet coach that I hired coaches to help me train for my triathlon. I started taking swimming lessons and found after swimming for two minutes straight, I’d either have to stop to catch my breath, or I’d turn my head to breathe in and I’d breathe in water. I also had to relearn how to ride a bicycle. You think all you need to do is mash your foot down on the pedal, but when you’re training for a triathlon, you clip your shoes onto your pedals and learn to push and pull. I even needed a running coach who taught me the proper way to run. People who run marathons have a high cadence, they lean forward, and they try not to swing their arms left to right. Basically, the point I’m trying to make is I raised my hand. I realized, “I ain’t gettin’ it done,” so I brought in consultants for my body.

If you’re stressed and burned out, it’s time to start getting your body in better shape. I’ve met thousands of dentists over the last 25 years and any dentist I’ve ever met who had his or her body in shape was never burned out. Ever. Since I’ve been training for an Ironman triathlon, I’ve been really tuned into a message board on Dentaltown.com called “Ironman Training“. The other Townies who post on this thread will get up early in the morning, ride their bikes 50 miles in two hours, come home, shower and get ready for work. The cool thing is, because they’ve worked out, they come to work totally fired up and engaged! Why? Intelligent people know that even though they weigh 150 lbs., they live inside a 3.5 lb. brain. The brain has a trillion circuits, was built by 3.6 billion DNA base pairs, and it’s probably the least-taken-care-of organ in the body. People take better care of their teeth by brushing and flossing and getting their teeth cleaned every six months than they take care of their brain. If your diet is horrible and you don’t exercise, don’t sit there and wonder why your 3.5 lb. brain isn’t working right. It’s all connected.

Once you start taking care of your body, then you can really focus on the remaining three Bs. Along the same lines as what I’ve explained previously, when you start focusing on your business and you realize that your practice is just not getting it done, guess what? Raise your hand and hire a consultant! I’m serious! When I started my practice, right out of the gate I hired Sally McKenzie. I thought I was doing well, but Sally McKenzie came in and took us to another level pretty much overnight. Since then, I’ve had Sandy Pardue and other consultants come to my office to help me figure out the best way to run my practice.

When I talk about consultants, I’m usually asked, “Well, is it worth it?” Dentistry is a cottage industry – if you sneeze in dentistry at one end of the ADA convention hall, everyone knows about it at the other end of the hall. Consultants cannot make a living in dentistry by taking money from dentists and providing no value. Every consultant I know has reams of happy customers. Consultants wouldn’t exist if they didn’t work. Believe me, consultants work!

My friend and colleague Dr. Jerome Smith in Louisiana might have one of the best – if not the best – operating practices in the profession. I mean, his practice runs better than a Rolex watch, and he still has Sandy Pardue come in and consult on a regular basis. When you ask him why, he just laughs and says, “You can always do better! It’s always a value. I’ve always seen Sandy as an investment. She’s never come here once when she didn’t bump us up to the next level.”

If you’re burned out, there’s a good reason you’re burned out, and nine times out of 10, it’s because of something you’re doing (or not doing). If you’re not taking care of yourself, it’s time to hire a coach, and if you’re not taking care of your business, it’s time to hire a consultant.

– See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=340&aid=4641#sthash.gXy4fc6M.dpuf

Treatment Plans, Social Media Marketing and the Meaning of Life

October 24, 2013 by howardfarran Leave a Comment

People don’t buy on facts or information. You see it every day in dental practices everywhere. The dentist will explain a treatment plan to a patient, telling her what percentage of a certain type of restoration typically fails or the chances she’ll get paresthesia or what her insurance will cover, producing nothing more than a blank stare or a remark like, “Well, I’ll think about it and I’ll call you.” But when someone presents the treatment plan with enthusiasm, excitement and emotion, people buy into it.

I learned this the hard way 25 years ago when I would present a treatment plan to patients and maybe half of them would schedule treatment. I asked my assistant, Jan – who is high energy, on top of her game and radiates enthusiasm – to review and answer questions about diagnosed treatments with our patients to be sure they understood everything. When she started talking to our patients about treatment, people just got excited!

Then when it came time to schedule treatment, our Treatment Coordinator, Dawn, would continue the positive, uplifting discussion. Instead of merely getting a necessary filling done, Dawn would even talk them into getting their teeth cleaned first, then she would sell them into whitening their teeth because then we could do a tooth-colored filling so everything would match properly. Then she would say, “Another way you could make those teeth brighter is to contrast your teeth with darker lipstick. Oh my goodness, you’re going to have a million-dollar smile and it’s only going to cost you a few hundred dollars!” Any questions patients had about financing, Dawn would answer and provide great payment options such as CareCredit. The way Jan and Dawn reviewed and presented these treatment plans really spoke to our patients’ needs and desires. Patients got excited about it because Jan and Dawn were excited about it and because of this patients would agree to come in for treatment.

There’s a funny cartoon that depicts evolution and the meaning of life (see page 18), where all of the animals leading up to the evolved human have three things on their mind: eat, survive, reproduce. Then when you get to the human, he’s wondering what it’s all about. Well, if you talk to any evolutionary biologist, it’s still all about eating, surviving and reproducing! When Jan and Dawn review treatment plans, they enthusiastically appeal to our patients’ base needs: eating, surviving and reproducing. You can’t eat very well without teeth; you need to eat to survive, of course; and if you want to reproduce, you want to look as attractive as possible. Functional, aesthetically pleasing teeth hits on all three of those needs. I can present all of the facts about a case to a patient, but the difference in case acceptance is because Jan and Dawn elicit a deeper response from the patient, which boosts their dopamine and serotonin levels because Jan and Dawn excitedly appeal to the patient’s base needs.

The way you present an effective message applies to social media, too. I really got into Facebook about three years ago. In fact the main reason I got into it was because I read an article about Facebook reaching 400 million users. It was exploding and I wanted to see what it was all about. Since then I’ve branched out onto Twitter, Google+ and Pinterest. I’ve really enjoyed learning about and measuring this marketing medium, and it’s interesting to see the correlation between an effectively presented treatment plan and an effectively marketed message.

I see so many Facebook pages with posts that read, “Did you know that one in three people have this disease or that disease?” It’s all facts, figures and information. There’s never any excitement. Nobody clicks “Like” or shares those posts because they’re just white noise. There’s no reason to interact with a message like that.

Mothers make a major percent of all health-care appointments. Of all of the users on Facebook, more than 60 percent are women (according to a July 2012 article from the Huffington Post); but Pinterest is truly the social media site for women; in fact I’ve read that of the 70 million users on Pinterest, 80 percent of them are female. I have a Pinterest account and I find it amazing that almost all of the 1,500+ people who follow me on Pinterest are women. When women post on Pinterest and Facebook I see a lot of meal plans, diets, healthy snacks, etc. But it’s the base need of reproduction that is the most meaningful part of life, and that’s why a lot of women who have children post pictures of them on social media. People draw the most purpose and passion from reproduction – that’s why three out of four married couples have babies. Women are hard wired with maternal instincts, and when you start posting anything about babies and children on social media – like when you should bring your baby in for his or her first check up, or the germs that live on your baby’s toothbrush – it gets viewed, commented on and shared. I mean it just comes alive.

One of the biggest posts we had on my practice’s Facebook page (www.facebook.com/todaysdental) was when one of our staff members had a new baby. It’s one thing to post about the new laser or CAD/CAM system that you just got in your practice, but if you want more excitement or shares of what you’re posting on Facebook, post a photo of your newborn granddaughter. Post about the people who work at your practice. Post about the community outreach function everyone participated in over the weekend. That is the kind of stuff people will click the “Like” button for, comment on or even share. The average dental practice Facebook page has about 300 followers, and when you post something to Facebook, those followers have 300 followers of their own. If they all share what you’re posting, you have the potential of reaching up to 90,000 people – it’s huge!

The only way your social media efforts are going to get you new business is when your existing patients see what you are posting, make an emotional connection and share it with all of the people who follow them. There are three things you can do on Facebook: you can like something, you can comment about it, and you can share it. Sharing something is the big deal. You want people to share your Facebook posts, because all of their friends and followers will see it on their timeline. Facebook users almost never share high-quality dental information or facts about disease, and they certainly don’t interact with it. What they share are the things that make them secrete dopamine and serotonin. And for the majority of people who make dental appointments – women – the number-one thing they share is anything that has to do with babies and children. My practice always increases its Facebook “Likes” when we make our posts more personal.

Here’s something else you should consider in regard to social media: When you share information and it ends with a period or an exclamation mark, the person viewing it sits there, takes it in and moves onto the next post. They don’t do anything with it. But when you end your post with a question mark, you are engaging with them. So if you post something and end it with a question, they’re more inclined to answer, and that’s how you engage people on social media. That’s how you get people on Twitter to answer you back. That’s how you get people on Google+ to actually post back. Instead of making a statement or a fact about you or your dental office or your dental technology, engage with them. Ask them a question. If you ask your fans a question, they will answer you. When they answer you, all of their followers will see it. This is how you can judge how successful your social media campaign is going. There are a lot of companies that do social media for dental practices, and dentists will often show me how great they think their Facebook page is. What I usually see is a page with a plethora of information, with zero likes, zero comments and not a single share. The dentist thinks her Facebook page is good because her page is filled with a bunch of great scientific dental information that could really educate all of her patients. But there’s no interaction whatsoever. The dentist might as well be putting all of her practice’s marketing efforts into direct mail – a one-way conduit of information.

Real social media is about interacting with your fans and followers – so do it the right way! Remember the cartoon on the meaning of life: eat, survive and especially reproduce. Women have maternal instincts and are a lot more likely to communicate about their children than men. They are far more likely to show up to a parentteacher conference, or a PTA meeting, or schedule their kids for a recall than dad. So engage with them. Post fewer facts. Get personal! Show them your babies. Tell them what you’re doing for their babies. Ask them what they are doing for their babies. Get focused on children. Aim your marketing around babies and children, share the personal side of your practice, and you will absolutely crush the meaning of life and get more new patients.

Quit Rambling On

September 24, 2013 by howardfarran Leave a Comment

In 1980, when I was a freshman at Creighton University, one of our professors told us we’d earn 10 extra credit points if we went to see Warren Buffett speak when he visited our campus. One of the clearest things I remember Buffett say to the crowd was when someone pitches him an idea for something in which they wanted him to invest, he would hand that person a 4×6 recipe card and a No. 2 pencil and ask them to explain their entire idea on the card. He said 90 percent of those people couldn’t do it.

This doesn’t just apply to investing, gang – this applies to dentistry! Dental manufacturers will call my practice and try to sell their products to us. We’ll tell them, “For a product to be successful, it has to meet four criteria; it has to be faster, easier, higher in quality and lower in cost.” Many of them can’t explain their products to me with those four simple criteria in mind. In fact a few weeks ago, just out of morbid curiosity, I listened to someone pitch an idea for one hour and 45 minutes. Even after all the time my team and I spent with the salesman we still had no idea what the value proposition was. It blew my mind! It doesn’t just stop at dental manufacturers, though – this also applies to treatment plans. If you can’t explain to your patients what they need on a 4×6 index card, you fail at presenting treatments. Period.

Effectively presenting a treatment plan to your patients is one of the most serious aspects of dentistry. It can be the difference between a dentist who treats one-third of the caries in his or her practice to a dentist who treats twothirds or better. In the best dental practices, treatment plan presentations are typically done by a staff member; someone who can speak your patients’ language and sell the necessary dentistry. In other practices, what you often see are dentists rambling on, trying to explain what’s going on in their patients’ mouths. The patient has a toothache and the dentist says, “You have irreversible pulpitis. You’ll need endodontic therapy, post build-up and a fullcoverage restoration.” And then the dentist opens up a computer program and jumps into a giant, in-depth, scientific lecture about what a root canal is, what it does, what can go wrong, etc. Forty-five minutes later, the dentist asks, “Any questions?” and the patient looks like she got run over by a truck with no real comprehension of what just occurred.

The best treatment plans are simple and explained in ways patients can understand them. The reason Christianity thrived was because the religion was recited in short, simple, understandable parables – and there was a point to each one of them! Stop complicating things and get someone on your team to explain treatment plans to your patients in the simplest terms.

Your treatment plan also needs to be interactive. You need to follow your patients’ cues. When you talk to someone and they break eye contact with you, it means their mind is processing. When they do this, you need to stop what you’re saying and let them process. More often than not, they’ll respond with one of the following: “How much is it?” “Will my insurance pay for it?” “When would you do it?” “How long will it take?” “Will it hurt?” or “Will I need antibiotics?” What matters is you listen to their concerns, explain it in plain English and cut to the chase. I have had several patients come to my practice after they visited other offices to address their loose-fitting denture. In literally two minutes, I present the choices by saying, “Well you’ve got just a few options here. One, we can do nothing. Two, we can re-line it. With a reline, you drop it off at eight in the morning and you come back and pick it up at the end of the day. Three, we can make you a new denture. The fourth option, which would be a lot better, involves implants. We can put two of these little titanium screws into your jaw where the denture snaps on and stays in place. Better yet, we can put four implants in there and then the denture would really snap-on nicely. Or we can put six implants in there and that denture wouldn’t even come out of your mouth. Which one of those options sounds best for you? Let’s have Dawn, our treatment coordinator, go over the fees for these different options and assist you with reserving a time to get started.” What I just wrote would literally take you two minutes to recite. It was simple, explanatory and to the point. Why can’t we all do this?!

We continually see data that suggests dentists treat only 38 cavities for every 100 cavities diagnosed. That’s a terrible statistic. You might be earning your FAGD or your MAGD and think you’re on your way to total dental enlightenment, but I’ll let you in on a little secret – you’re not. Why? Because two of every three kids come into your office with caries and you don’t remove them. I don’t care if you’re using composite or amalgam – you need to treat as many cavities as you can. It’s your sacred and sovereign duty! Easiest way to do this is to get your staff involved in the treatment plans. It’s one thing for a patient to try to trust the guy who’s presenting a treatment plan in Latin (that’s rare), but it’s another thing for the patient to implicitly trust the entire staff standing behind the dentist nodding their heads in agreement and better explaining the treatment plan.

When you and/or your staff can explain a treatment plan in plain English and combine it with some great visuals from your digital X-ray system, every single one of your patients is going to fully understand what’s going on in their mouths and will want you to do something about it. It’s impossible for your patients to grasp what you’re trying to explain to them on a one-inch by one-inch X-ray film. I still can’t believe there are dental practices that do not employ digital X-rays in 2013. You want to explain something to your patient? Blow up the image on screen and do some teaching. Better yet, print off their X-ray on a piece of paper and circle the trouble spots, then give them the printout to take home as a reminder of what they need to have fixed.

Every single dental practice consultant I’ve ever met has told me when they walk into an office and pull up the report generator on the practice management software, 80 percent of all of the reports have never been run once. So, maybe you are only treating a third of the diagnosed dentistry, or maybe you’re doing a better job than that… or maybe you aren’t. You’d never know because you don’t know what the score is. You don’t know what your close rate is. You don’t track it. When you start tracking the dentistry you’re doing against the dentistry you’re diagnosing, you start to become a much better dentist. You start to realize you might not be the best person in the practice to sell dentistry to your patients. Your close rate will improve and your patients will be much happier with healthy mouths. You owe it to yourself, your practice and your patients to start running your treatment plan reports and actively reviewing them to help identify your monthly close rate. It’s time you start taking the selling process more seriously. Taking 500 hours of CE and earning your MAGD is completely useless if you’re not going to treat two-thirds of the people who come through your doors.

Getting Poised for Growth

September 24, 2013 by howardfarran Leave a Comment

Humans are social animals. Social animals exist in tribes, and for the survival of every tribe you need order. For there to be order, there needs to be control. Social animals are hard wired for control, and because of this a lot of businesses become unsuccessful because the owner or CEO abhors delegation and feels the strong need to control everything. How does the CEO of a Fortune 500 company run her operation of 100,000 employees if she doesn’t delegate anything? It would be impossible! The leaders who rise to the top don’t fear risk or delegation – they retain and attract quality key people, give them responsibilities and then get out of their way. Success is counterintuitive to how humans operate.

Another great example is how most dentists imagine the way they are going to retire and sell their practices at age 65. At age 55 they start thinking, “Well, I’m going to retire in 10 years, so the last thing I’m going to do with this practice is invest in any new equipment or new technologies or implement any new techniques into my repertoire.” They’re content with milking the cow dry and refuse to feed it anymore oats, grass, grain or water. But here’s the amusing part: when it comes time for that dentist to sell her practice, she thinks it is going to sell for some huge amount, but it’s not going to happen. Nothing in the practice has been updated, new patients have dwindled to zero and it has become a business that nobody in their right mind would purchase at the price in the dentist’s head.

You have to realize the final 10 years that you are in practice are the most important years to double down on your business bet! In this time you can’t be milking your practice of what it’s currently worth only to sell it for pennies on the dollar. You need to modernize your practice. You need to move it from a lousy 1,000 square foot rental space on the third floor of a medical building to a premium 4,000 square foot building right out on Main Street with a huge sign. This is the time for you to upgrade from 2D X-rays to 3D cone beam computed tomography! This is the time to invest in CAD/CAM! In dentistry the only dogs that can’t learn new tricks are dead dogs!

If your practice is neglected because you milked it for the last 10 years, you will end up with an illiquid asset. You have to get your business poised for growth. You can’t sell a sinking ship. Just like with the sale of a home, when a window breaks, you don’t say, “Let’s just wait until two other windows break and then we’ll fix it.” No way.

Here’s another housing example tied to liquidity: a three bedroom, two bath house in Phoenix, Arizona, can easily sell within 30 days, but a 10 room house with an eight-car garage and a tennis court and Olympic-sized pool can sit there for three years because it is just not a liquid asset. Nobody wants it or can afford it. Along these same lines: the corner commercial lot on the corner of 1st and Main, you can sell in a heartbeat for premium price. But if you go just 300 yards down the street either way, you might be looking at half the price and, worse, you might never be able to sell it. I mean there are intersections in Phoenix that are still vacant from when I moved here 25 years ago because they just weren’t perfect. This is why location is key! So if you’re renting in a medical building or you aren’t set up on a great location, you need to be poised to sell, so get moving!

Here’s something else you need to think about if you’re considering retiring and selling your practice in the next 10 years: interest rates on CDs right now are at two percent, so that means for every million dollars in cash you have in the bank, in government bonds or CDs, you are going to make $20,000. Let’s say the average dentist makes $140,000 dollars a year. That means they would have to have $7 million in cash in a two percent government bond or CD at Bank of America or Chase to maintain their income. That is just not going to happen. I don’t know of too many dentists that can walk away at 65, sell their practice and have $7 million in cash earning two percent.

If you’re a renter and you sell your practice for $400,000, that’s it. That’s all you get. But if you owned your practice and you owned the building, you could sell your practice for $400,000, but keep the building, so you would charge rent to the new dentist who purchased your practice. Every year you can adjust the price of the rent based on the Consumer Price Index, and over the next 10 years, you could earn an additional $400,000. Then, maybe, at the end of the 10- year lease, the new dentist wants to buy the building. Then you finance that to the new dentist and you end up with yet another 10-year income stream. Think about it: the renter made $400,000 and gave half of it to Uncle Sam, so she’s sitting there with $200,000, which at two percent is making $4,000 a year. At that point the renter dentist is going to have to go be an associate somewhere else (at age 65) in order to live the way she did when she was practicing! So instead of continuing to rent the space for your practice, you need to get poised for growth. Buy that premium property on 1st and Main or a 4,000 square foot building right next to a WalMart, then sell your practice and rent out your building to earn revenue the smart way.

But this only applies to dentists who want to retire. Me, personally, I never want to retire. Sure, the first year of retirement is fun – you get to golf all the time and go fishing. It’s like a really long vacation. But by the second or third year of retirement, you start to see some dysfunctional behavior. There’s no passion for life. They let themselves go. They don’t have a reason to shower in the morning, let alone get out of bed. Here’s something you should consider if you’re actually considering retirement: don’t retire! I’m serious! There are 5,000 new dental school graduates entering the dental profession every year and they’re looking for a job. These kids are so desperate for a job, when the government asks them to join the military and sit on an aircraft carrier in the middle of the Pacific Ocean or Afghanistan, it sounds really enticing to them. And I hear the excuse all the time from dentists in rural areas that they can’t find an associate because they practice in Middle of Nowhere, Montana. Really? You can’t convince someone to stay in America where nobody’s shooting at them but the government can convince them to practice in Iraq? Stay in practice and be a mentor for crying out loud! Do you know what your unique selling proposition is to these new grads? Do you know what you have to sell more than anything? You! You get out there, you get poised for growth, you go to the finest finishing schools in America like The Pankey Institute or Spear, you get your practice to the very top of your game, and then you get your pickings from 5,000 graduates, some of which are seriously considering going into the military and practicing dentistry in some third world country. Instead you could just reach out and say, “Hey you, new grad, come work for me. You’ll probably look back on this decision when you are 65 years old and realize it was best decision you’ve ever made, because I’m going to teach you how dentistry gets done. It’s all going to be cool, we are going to have a good time working together and you are going to become a very successful dentist.”

Best Tips for Better Practice in 2013

Dentaltown Magazine wants to know what you’ve done this year to make your practice the best it can be! Visit www.dentaltown.com/BestTips2013 to tell us what you’ve done to improve your practice. Keep your eyes peeled for the December issue of Dentaltown Magazine and your tips could be featured in that issue. One lucky contributor will be drawn to win a copy of Dr. Howard Farran’s One-day Dental MBA DVD.

See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=334&aid=4538#sthash.iedaYMzG.dpuf

Dentists are Still Doing Way Too Many Three-Unit Bridges

September 24, 2013 by howardfarran Leave a Comment

Dr. Carl Misch, who is regarded by many as the number-one implantologist in the world today, (and who just filmed a series of four awesome online CE courses for Dentaltown.com), wrote in his book Dental Implant Prosthetics that the 15 year survival rate of implant restorations is 95 percent and for a three-unit bridge the survival rate is 74 percent. In this day and age, dentists really have to ask themselves, “If an implant and crown has a 21 percent higher success rate over a three-unit bridge, why are we doing so many three-unit bridges?”

Insurance Coverage?

Is it because insurance still doesn’t cover implants? We all know that’s not true! Twenty-five years ago, when I opened my Phoenix, Arizona, dental practice – Today’s Dental – almost zero insurance companies offered any coverage of dental implants. Today, based on the insurance plans that we have verified and have in our system at my practice, we have come up with the following percent of insurance plans that have implant coverage:

Delta of California 86%
Metlife 76%
Delta of Arizona 74%
Aetna 53%
Cigna 35%
Humana 18%

When I started my practice in 1987, implants were not a covered benefit under most insurance plans, but today, we are seeing an upward trend in insurance companies realizing the benefits of implants; such as, preserving tooth structure and making it virtually impossible for decay to form. With more and more insurance plans covering dental implants, it can’t possibly be a good enough reason to not be placing implants.

Pricing and Presentation?

Here’s another reason why we might be placing way too many three-unit bridges: price breakdown and case presentation. When I graduated from dental school in 1987, I argued with a lot of local Medicaid plans because coverage of an extraction was $2 cheaper than a filling. Moms in lower socioeconomic brackets had the economic incentive to pull their babies’ teeth instead of fixing them, just because it was cheaper. I always thought the extraction should cost $2 more than an amalgam filling, because when it comes to certain procedures for certain patients, affordability was always the key decision maker.

The same thing is happening with bridges vs. implants. Most dentists will offer their patients an exact flat fee for a bridge, and they’ll say they can prep it today and cement it in two weeks. Then when the patient asks about an implant, most dentists break it down to something like, “Well, um, it’s $1,500 for the implant and it’s $1,000 for the crown, but then we might have to do a bone graft, and we might have to do a gum procedure, and I won’t really know what we’re looking at until I pull the tooth to know how long this will take…” It’s a total confusing quagmire! The implant is the better option, but you make it so difficult for the patient to understand. I mean, I’m a dentist with an MBA and an MAGD and because of the way you present a bridge vs. an implant even I would opt for the bridge!

You need to figure out a way to explain that the cost of an implant is the same as the cost of a bridge. If you charge $3,000 for a bridge, then an implant should be $3,000 as well. Now, whether or not you have to do a bone graft or something more, that’s just the cost of doing business. Obviously some cases will be easier than others, but that’s life. It’s also the way everybody else does business. When you take your car in to fix your radiator, they’re going to do it at a flat fee. I guarantee some radiators are easier to fix than others – you’re not going to get nickel and dimed because your radiator was harder to fix than the last one they worked on.

You know what would help you place more implants in your practice? If your implants cost less than a bridge! They have a 21 percent better success rate, after all! You need to take the economic incentive to do the cheaper but less effective option out of the equation. If you tell your patients it’s cheaper to do an implant and a crown than it is to do a bridge, you’re going to be placing a ton more implants, doc!

Specialists?

I recently spoke about this issue with Dr. August de Oliveira, the author of Implants Made Easy, and he brought up a survey conducted by Straumann, which indicated the United States of America currently ranks fifth in total implants placed. More than 85 percent of general dentists in South Korea place implants, more than 50 percent of all general dentists in Europe place implants, and the most implants placed in the world is Israel. When I asked August why he thinks so many dentists still do bridges over implants he said, “It’s a loss in production if general dentists send out the implant case. Rather than learning how to do implants themselves, they do bridges and send out an occasional implant. That is changing as patients are getting educated on the benefits of an implant crown vs. a three-unit bridge.”

In America, culturally, we got into this groove where oral surgeons and periodontists place implants. GPs don’t want to do implants because it’s inconvenient, it’s a loss of revenue to send out, and you have to work with a specialist. If you’re not going to place implants yourself, you need to work with a specialist who will agree with your vision of a flat fee for all implants placed. If you charge $3,000 for a bridge, you’re going to charge $3,000 for an implant whether you place it or the specialist does. You want the safety of being able to tell your patients that they’re going to go to another doctor who will place the implant, it will be the same fee, and there will be no nickel and diming. If your specialist cannot work with the laws of averages like every other service industry does, then find another specialist! Either that or learn how to place implants. Too hard, you say?

Implants Are Hard? Really? In 2013?

I learned how to place implants early on in my dental career. I earned my Diplomat in the International Congress of Oral Implantologists (DICOI) and my fellowship at the Misch Institute. In 1987 placing an implant was hard. You had 2D Xrays, panos and PAs, and you never truly knew what was going on until you laid a flap. Today, with 3D cone beam computed tomography (CBCT), diagnosis is twice as easy – heck, even the software that’s been developed for these systems will tell you how long and wide the implant can be to place in your particular patient. You almost don’t need to think about it. Oh, and anatomical features that scared us to death back in the day, like the inferior alveolar nerve and the sinus, are all spelled out for you in a 3D image. You know exactly what you’re looking at before you even pick up an intrument. This harkens back to my May 2013 column “Is Dentistry Getting Too Easy?” It’s twice as easy to do a root canal today (with high-speed handpiece-driven NiTi files), and it’s just as easy to place an implant with the help of 3D CBCT.

It’s time we all sit back and rethink placing implants. Placing an implant today is so much easier than pulling a wisdom tooth – yet I know more dentists who pull 10 to 30 percent of their wisdom teeth but don’t place a single implant. I think that’s completely backward (and bizarre)! That’s like saying you can repair your car but can’t fix the chain on your bicycle. You need more skill to pull a wisdom tooth than to place an implant. With the technological advancements we have at our fingertips today, it just doesn’t make any sense why dentists don’t place more implants.

Remember the 4,000lb Gorilla in the Room

When it comes to the dentistry we do, nobody likes to talk about the 4,000lb gorilla in the room – mortality. The average man dies at age 74, and the average woman dies at almost 80. When grandma and grandpa go into the nursing home to live out their remaining days, all the dentistry we’ve performed over their lifetime crumbles and rots after 18 months. I’ve been a huge proponent of there being less inert and more bacteriostatic restorative materials in the dental market – and dental implants fit that bill. When I visit nursing homes, it’s sad to say that the lucky ones are the people who have dentures and implant-supported prosthetics. The people who have their mouths full of $20,000 worth of root canals and crowns are the most unlucky, because their teeth turn to mush from root surface decay. These people are too old and brittle to do any extractions or full-mouth restorative, and their home care is essentially nonexistent. You really need to start asking yourselves, especially by the time a patient turns 60 years old, are we really going to do a root canal buildup, a crown and a three-unit bridge instead of titanium implants, which the Streptococcus mutans won’t eat? Think about it.

In Summary

While I was wrapping my head around this issue, I talked to longtime Townie, Dr. Jay B. Reznick, oral surgeon at the Southern California Center for Oral & Facial Surgery, in Tarzana, California, and founder of OnlineOralSurgery.com. He sent me an e-mail that summed up the issue of why dentists don’t place implants more than bridges quite nicely. Jay says:

“A dental implant is designed to be ‘permanent,’ however there are a lot of factors, such as hygiene, patient general health and nutrition, systemic disease, local factors, age, implant positioning, prosthetic stresses and individual variation that will reduce the longevity. I always tell my patients, ‘Dental implants are as permanent as their “permanent” teeth,’ so they understand that even what nature gave them is not always perfect and can fail under the right set of conditions. A three-unit bridge is also meant to last a long time, but dental insurance companies will pay to replace a bridge after five to 10 years (depending on the policy), so that should tell you a lot.

“There are a number of reasons why dentists may choose to do a bridge over an implant. I think the biggest is still the misconception, especially in the older practitioners, that implant dentistry is too complicated. They also feel the bridge will be delivered sooner than in the case of an implant, where the extraction site needs to heal and the implant needs time to integrate. Right behind that is the economic desire to keep all the revenue within their practice, rather than sharing the case with a surgical specialist. Of course, that model is changing rapidly, as more and more general dentists are becoming trained and placing their own implant fixtures and then restoring them.

“We are seeing an increase in the number of dental insurance carriers that are covering implant treatment. They are usually the more expensive plans for the patient or employer, and reimburse at a substantially reduced rate from usual, customary and reasonable (UCR) charges.

“The only advantage a bridge has over an implant is that it is faster. The implant helps preserve bone and soft tissue architecture, is easier for the patient to maintain, and leaves a one-tooth problem as a one-tooth problem, rather than creating a three-tooth problem (which will become a four-tooth problem, and eventually a denture).”

It’s time to change the way we think about implants and the way we present this incredible option to our patients – the future of the dentistry we provide depends on it!

Focus on Your Strengths & Delegate Your Weaknesses!

July 8, 2013 by howardfarran Leave a Comment

Focus on Your Strengths & Delegate Your Weaknesses!

The 5 D’s: Design your plan. Drop everything else. Delay everything you can’t drop. Delegate. Do.

Let’s focus on the 4^th D; Delegate. Let’s look at this issue together as if we were standing on the moon starring back at your dental office on earth. Can we at least agree on one thing, someday you will be passing on.

Ray Kroc started McDonald’s in 1954, died in 1984, yet today McDonald’s has over 33,000 restaurants in 118 countries. Sam Walton started Wal-Mart in 1962, the year I was born, died in 1992, yet today Wal-Mart has 8,500 stores in 15 countries. Today Ray Kroc and Sam Walton are gone but through their management teams and systems both men are still managing successful innovating profitable empires from their graves, yet you are alive, have only one dental office location, and still can’t delegate to anyone on your team to take over the responsibly and authority to run anything?

Why? Because you are a social animal. Like a dog, cat or an ape, you are hard wired at birth to organize your social group of monkeys without tails into strict hierarchies of organized control through fear, intimidation and violence. Every organization evolves this way. The military has a 400 pound gorilla on top named The General, then delegates down the chain of command to the Captain, Officer, Private grunt. Religion does the same with Pope, Cardinal, Bishop, Priest, Altar Boy, Parishioner.
Much of our behavior is hard wired at birth and if we do not understand it we cannot be successful because a lot of success runs counter intuitive to how we were hard wired at birth from our 3.6 billion genes. Take “Lazy” for example. People are “lazy” at birth because the only reason we are here after billions of years of evolution is because we mastered how to burn less calories than we consume. When you see a lion eat an antelope in Africa what does he do next, jumping jacks and sit-ups, or does he roll over and sleep for 3 days? Your brain says sit on the couch and chill, while success says work harder and read more than anyone else for a decade and you will rise to the top of your game. Logic says avoid risk, success is counter intuitive because it demands risk for reward.

When I see a stressed out dentist, almost every time it is because they are not getting the support they could be getting if they delegated more to their team, and I mean, a lot more. So your staff runs out the door at 5:00pm while you stay behind in your office overwhelmed about your overhead, your cash flow, and trying to make payroll, let alone the bills. Should you focus on the bills or focus more on marketing? You know new patient flow equals cash flow. What about all of this new technology? Would CAD-CAM lower my lab bill even after I paid the monthly lease? Will insurance companies pay for the new 3-D CBCT or kick it down to a 2-D pano fee? What should I do? Should I just log onto www.dentaltown.com and surf 3 million posts all night, again?

How would Ray Kroc solve all of your problems, today? He’s dead! How would Sam Walton solve all of your problems, today? He’s dead too! They would delegate. Most dentists have an amazing team and don’t even know it. You never have given your team a chance to rise and shine. The more purpose you give your team members, the more you delete to your team members, the more they all have a mission, and the more the more they will work every day with blood, sweat and tears. You already have a happy to be a filling fixer, patient preparer, saliva sucking Dental Assistant, so why can’t you add Marketing Director to the title?

Every dentist is book smart or they never would have earned a Doctorate Degree in Dentistry. But the dentists who are also street smart usually make all of their dreams come true. Street smart farmers in Kansas where I grew up can fix any tractor with duct tape and WD-40. Street smart dentists can do everything faster, easier, higher in quality with lower cost. Why do so many dentists have to spend $5000 to fly to a course in an airplane, stay in a hotel, eat out at restaurants, miss their family for the weekend just to learn how to prep a veneer or occlusion? Street smart dentists fly to the course via photons through the internet and do online continuing education on http://www.dentaltown.com/Dentaltown/onlinece.aspx. Our amazing, brilliant, genius Online Continuing Education Director Dr. Howard Goldstein DMD has put up a full curriculum of over 183 courses and they have been viewed over a half million times. The courses range from free, to $18 a credit hour, with a few a little more. The largest university on earth is the University of Phoenix Online www.Phoenix.edu because it provides the most value, education, for the lowest cost.

We have a full curriculum on everything you and your team need. Tell your new dental assistant marketing director to watch all 10 online CE marketing courses on dentaltown first so they can learn from the very best in dentistry. No need to reinvent the wheel. You can also see what the other 163,456 Townies think of them and their marketing ideas. You might want to have your whole team watch them together. Spring for a pizza and sub sandwiches and have a lunch in. I watch most of them on my iPad so I can lounge anywhere I want around the house.

Anesthesia (4)
CAD-CAM (7)
Cariology (3)
Cosmetic Dentistry (11)
Dental Ergonomics (1)
Dental Hygiene (1)
Digital Radiography (2)
Endodontics (10)
Ethics, Jurisprudence, and Malpractice (2)
Fixed Prosthodontics (4)
Health and Medical Topics (7)
Implant Dentistry (16)
Infection Control (3)
Laser Dentistry (2)
Marketing (10)
Minimally Invasive Dentistry (1)
Oral Medicine and Pathology (5)
Oral Surgery (4)
Orthodontics (9)
Pediatric Dentistry (1)
Periodontics (8)
Personal Finance (1)
Photography (2)
Practice Management (20)
Public Health (1)
Removable Prosthodontics (5)
Restorative Dentistry (33)
Sleep Medicine (3)
Substance Abuse (1)
TMD and Occlusion (7)

I always say you only mange 3 things: People, Time & Money. People are over 80% of the equation whether you are talking about your dental office or the Miami Heat who just won the big championship game in part because of the HR move to attract and retain LeBron James from Cleveland and other very important HR moves and decisions.
You may encounter the Peter Principle after you give a team member more responsibility and duties. The Peter Principle is the reality that team members will eventually be promoted beyond their level of ability. Employees tend to rise to their level of incompetence, meaning that they should never have been promoted in the first place. Now they have been promoted and are in over there head, so if their ego permits they need to be demoted back down to where they were before, but due to emotions and complex human feelings, when you do this they usually jump to another tree branch, scream, quit and then eat a banana.

But this is what you have to go through to realize that when you take endodontics and performing dentistry more serious than HR (Human Relations) then you will live in a constantly overwhelmed state of mind. Do you enjoy business stress? Why do YOU bear most of this stress. Why can’t you raise your hand and ask your team for help?

Everyone knows you never skimp on payroll when you own a NFL football franchise or a NBA team, yet so many dentists I know thinks they are over paying on payroll. You are only overpaying on payroll if you are not getting value for what you are paying for. The Miami Heat made money paying LeBron James $17.54 million, especially considering the Los Angeles Lakers pay Kobe Bryant $27.8 million.

Maybe delegating more to your staff will make you have an honest discussion about your team members. Maybe you don’t have any LeBron James or Kobe Bryant’s on your team like I have HoGo’s, Jan’s and Lorie’s. Maybe you think and say you want to win the big game and be successful but your actions don’t match your words because you are not attracting and retaining star players. Is it because you skimp on payroll? Is it because you are a control freak and won’t trust them enough to turn them loose and set them free? Maybe you need more Dr Phil and less Dr Farran. Relationships are built on trust, respect and love. Are you treating your team members the same way in which you would want to be treated if the roles were reversed?

Hire people who are disciplined in their own right. The second you need to manage someone, you have made a hiring mistake. Manage systems, not people. When you have disciplined people, you do not need hierarchy. When you have disciplined thought, you do not need bureaucracy. When you have disciplined action, you do not need excessive controls. Delegate. I know you can just do it.

You Need an Associate Now

July 8, 2013 by howardfarran Leave a Comment

Every year around this time, 5,000 lesson-weary yet fresh-faced dental students emerge from dental school ready to take on the challenge of maintaining and improving the oral health of millions of Americans. When I look across the American landscape at the 125,000 general dentists currently in practice it blows my mind that those 5,000 grads haven’t been snatched up by their junior year of dental school because of how valuable they are.

Don’t think the same way? Indulge me a little while I prove that no matter what you currently think, there is, without a doubt, room for you to hire an associate immediately.

Phones

Your current phone system is just awful. You’re probably using the same copper cable technology invented by Thomas Edison, you have someone manning the phones only during business hours and when you’re closed all calls go to your little answering machine that still uses the little cassette tape. Hey, doc, wake up! The turn of the century happened 13 years ago already! You need to move to a digital phone system – a voice over Internet protocol (VoIP) – run it through the Internet and your network. My practice, Today’s Dental, in Phoenix, Arizona, uses Avaya (formerly Nortel) and it is awesome! When my practice is closed and we get 12 phone calls from people who didn’t leave a message, we can track the missed phone calls and someone on my team can call those numbers back first thing when they get in.

Humans are extremely complex. They’ve got a three-and-a-half pound brain powered by a trillion circuits. The brain is influenced by a person’s nutrition, genetics, whether or not they’re hopped up on caffeine, chocolate or sugar, etc. Humans are very imperfect decision-making machines. When a human brushes her teeth at 6 a.m. and feels something missing in the back of her mouth, she will pick up her iPhone and call her dental office. When an answering machine picks up instead of a live person, she shrugs her shoulders, says, “Eh, whatever,” and just hangs up to either A. just live with it or B. call another dental practice later on that will pick up the phone so they can fix her up. If you can track when your calls are coming in, not only can you call those numbers back right away, but you can adjust your staff ‘s schedule to best cover when the majority of your phone calls are coming in. That way when patients call, you can assure they’re being answered by an actual person.

What I find most ridiculous about your phone system isn’t the technology itself – it’s that you only have someone living and breathing answering the phone 8 a.m. – 5 p.m., Monday through Thursday, with an hour break for lunch each day. There are 168 hours in a week and the average dental practice is open for 32 of them. A practice’s primary concern is, “How the heck can we get more new patients?” Easy answer, make sure a living, breathing person is answering your phones during high-call-volume hours.

Almost every dental practice I visit has two dental assistants and a dentist doing all of the dentistry, and there’s only one person out front filling the schedule. I always say, “Here’s what we’re going to do. We’re going to change your phone system to a digital VoIP, and instead of having two assistants helping do the dentistry, we’re going to move one of those assistants up front. Also, instead of having one person answer the phone from 8 a.m. to 5 p.m., one receptionist is going to come in at 6 a.m. with the owner doctor and she’s going to take a lunch from 11 a.m. to Noon, and then she will leave at 3 p.m. The other receptionist is going to come in at 9 a.m. with the associate dentist and she’s going to work from 9 a.m. until 6 p.m. That way the phones are going to be 100 percent answered when the majority of people are calling. We’re going to stagger the staffing of your front desk because 50 percent of the incoming calls to your practice are made when you are closed early in the morning and later in the evening. Also, of the calls that do come in while you’re open, 50 percent of those go to voicemail while your one-person front desk is taking care of other business. And if both front-desk staffers have their hands full, you need to make sure that any staff member in your practice is comfortable picking up the phone. This way you have much better coverage at the front desk and you’ll be able to fill more holes in your schedule so you can do more dentistry!” If you answer twice the number of calls coming into your office with a live, highly trained receptionist, you will increase the number of appointments. When you increase the number of appointments, most dental offices today can actually absorb almost all of that capacity. Dentists don’t have a problem if you double book them, triple book them, have to work them through lunch, or make them work past 5 p.m.

Don’t want to be open more, or keep someone in the office longer to cover the phones and make appointments after hours? Fine, but I challenge you to track the phone calls you’re missing and then tell me you’re OK with the status quo.

If you have an antiquated phone system, your little answering machine isn’t going to tell you about the missed call at 6 a.m., and unless your patient is fiercely loyal to your practice, you might not hear back from her at all. But if you use the digital VoIP system, your front desk comes in at 8 a.m., notices the list of missed calls and starts calling the numbers back immediately. When you call your 6 a.m. patient back, it clicks with her and she says, “Oh, yeah, I did call you this morning. Thank you so much for calling me back so soon. I have a problem. I think I’m missing part of my tooth.”

Expand Your Hours

Your front-desk staffer is still on the phone with your 6 a.m. caller, and your staffer should know her job so well that no matter the patient’s protests, she goes right for the close and says, “Let’s get you in. Can you come in today? What’s the best time for you to come in?” That’s at least what she should say, but is your practice able to accommodate emergency patients? When it comes time to schedule a patient, almost 140 million Americans will tell you from 8 a.m. to 5 p.m. they can’t leave their business because they’re working! Oh and you’re open Monday through Thursday from 8 a.m. to 4 p.m. – the same block of time your patient can’t come in. So what should you do? How about you hire an associate and expand your practice hours! You have the land, the building, and the equipment. Would you rather it just sit there costing you money, or would you rather use it and make money?! Bring in an associate and cover 50 hours a week instead of only 32.

Don’t think you can land an associate in your neck of the woods? The largest employer of dentists on planet Earth is the United States military. It employs around 5,000 dentists, and it can get these kids to sit on an aircraft carrier in the middle of the Pacific Ocean for half a year at a time, leaving their spouses and children on shore. You think you can’t land a quality associate because you live in Hays, Kansas? Are you kidding me? In Hays, Kansas, at least your associate can have breakfast and dinner with his family! Think about that!

Beef up your front desk so your practice can sell more dentistry, and stay open longer so you can accommodate your patients’ schedules and you can perform more dentistry. Pretty soon you’re going to have more dentistry to do than you have dentists to accommodate it. When that happens – hire an associate!

What are your thoughts? Once you’ve finished reading this, please log onto Dentaltown.com and post your comments under my column. See you online! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=325&aid=4435#sthash.umefwXW1.dpuf

Is Dentistry Getting Too Easy?

July 8, 2013 by howardfarran Leave a Comment

This year I celebrated my 25th year of practicing dentistry and looking back over the last quarter century, sometimes I wonder if dentistry is just getting too darn easy.

The first five years I practiced, I had a 24-hour-a-day, 7-day a week, callous on my thumb and index finger from carefully moving stainless steel endofiles up and down all the time. When I graduated from dental school, it literally took me two hour-and-a-half appointments to manually clean out a tooth. Dentists today are so lucky! Now we have 300RPM nickel-titanium files that takes care of business in less than half the time – and in a single appointment, no less.

Radiology is also undergoing a complete revolution right now, and endodontics has become so much easier because of it. There is a high percentage of American dentists who use two-dimensional X-rays and it’s so surprising to me how few have moved over to the new 3D technologies. I have still not met a single dentist who’s gone from 2D to 3D and will ever go back. So many skeptics who still use 2D ask: “Well does insurance cover it? Will I have to charge extra?”Yet every single dentist I know who uses 3D says they don’t even care. It’s just amazing what you can see with the new technology. I mean, look at endo again. For years, every time a root canal failed we just assumed we did something wrong. Like, maybe we were just short of the apex and we didn’t get it all cleaned out. When you use 3D imaging, you can plainly see the root is fractured. If you can see that, just imagine how much more dentistry you can diagnose and treatment plan!

I predict, within a few years, general dentists will not refer to endodontists who don’t have 3D X-rays – how would the endodontist even know if the tooth had a vertical fracture if she can’t even see it? Root canal failure is why so many endodontists warranty their work. If it fails in the first year, the patient will get 3/4 of their money back; if it fails in two years, the patient will get half of their money back and so on. If the root canal lasts four years, it’s good enough. The best endodontists, on the other hand, outright refuse to warranty their work. They’re good at what they do, and if they’re using 3D imaging, they can see everything! You’re telling me you’re OK with taking $1,500 of someone’s hard-earned money to perform a root canal that’s not going to last a year and you don’t feel any shame or guilt about it? That ruins endo and root canals for everyone! What sort of connotation does it carry when someone tells you: “I don’t want a root canal. Just pull the tooth. My cousin got a root canal and they had to pull the tooth a year later anyhow. What a waste of money.”

The American Dental Association was way ahead of the curve when they granted specialty status to oral radiologists. In the future, the dentist isn’t going to be the person reading X-rays. Oral radiology is going to explode – not just in the United States but internationally. That’s all thanks to the Internet! I see practices taking 3D X-rays and e-mailing them to an oral radiologist somewhere else on the planet, and within a few minutes, the oral radiologist reads the X-ray and tells you what you’ve got.

The best endodontists in the profession use 3D cone beam computed tomography (CBCT), and they have the ability to place implants. I want my retreats to go to an endodontist who can take an accurate 3D X-ray and if she decides that the tooth isn’t salvageable, the money isn’t an issue because she can either make $1,500 doing the retreat or she can make $1,500 pulling the tooth and placing the implant right then and there. That is outstanding customer service to the patient!

You’d have to agree with me; dentistry is getting so much easier! Look at CAD/CAM. Since I’ve been a dentist all the best labs that I know will tell you that all the best dentists have about a six percent remake rate (couple that with the dentists who say they have never had a remake in 25 years, you know the truth is somewhere in the middle). Now with impressions going digital with optical scanning, those same labs say remakes drop from six to one percent. One percent! When you digitally scan the teeth, if you’ve got a huge monitor that’s two feet by a foot, you just can’t see a prep better than that. You can’t even see a prep that well with loupes on. Taking it further, if you have a milling machine right there in your office you don’t even have to send the impression out to the lab, and you can take care of your patient in the same day. I mean, CAD/CAM technology is something we only dreamed about and wished for 25 years ago. Now it’s a reality, and there are still some of you who won’t give it a shot. You can’t afford to sit on the sidelines with CAD/CAM. If you’ve been thinking about it, take the next step!

Look at implants! I got my fellowship from the Misch Insitute, I got my diplomat from the International Congress of Oral Implantology and I’m telling you, just thinking about placing implants in the 1980s makes my stomach turn. Placing implants has come such a long way since then. When you placed an implant back then, you were talking about long incisions, and when you thought you had an inch of bone to work with, you really didn’t know until you got in there, and you’d receive such a shock that you really only had half as much bone. You had to stay so far away from the mental foramen for fear that an anterior loop could ruin your day. It was such a difficult procedure! Today, you don’t even need to extract the teeth before you get started on placing an implant. You take a 3D X-ray, send it to a lab, the lab makes a snap on retainer with a pilot hole, you get it back, numb the patient up, snap on the retainer, drill right through the pilot hole and the tissue and place the implant. There are dentists who come up to me at seminars to tell me they don’t pull wisdom teeth and that they can’t stand the sight of blood, but they purchased a 3D CBCT machine and are placing seven to 10 implants a month. They’ve gone from zero to 60 in about three seconds in the implant world. I mean, tell me dentistry hasn’t gotten too easy!

And then there’s orthodontics! I remember doing ortho in my practice from 1987 to about 1992, bending stainless steel with these three prongs, trying to figure out the best way to improve someone’s smile. You could literally get a migraine headache trying to figure out what you had to do with the wire. Some things are extremely difficult to wrap your head around and orthodontics in the 80s and early 90s was one of them. There’s a reason orthodontists take so much more school! Then nickel-titanium wires came out, where they could pre-cast the archwire so everything was at the right angle, and all you have to do is bend it into the bracket. The wire straightens all by itself and drags the teeth with it! It’s just gotten so much easier!

What’s even more amazing is thinking how much easier dentistry is going to be in another 25 years! Think about it!

What ways has dentistry become easier for you? When you’ve finished reading my column, I wish you would jump onto Dentaltown.com and post your thoughts under my column this month. See you online! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=322&aid=4386#sthash.kFjkk5GV.dpuf

What Winners Do and Losers Don’t

July 8, 2013 by howardfarran Leave a Comment

For the last 25 years, I have been interested in what winners do and losers don’t. There are varying definitions of “what winners do,” so to make sure you understand what this column is about, I’m not defining winners as dentists who fit crowns within a few microns. I’m talking about the big picture here.

One of the strongest predictors of being a winner is having a massive intellectual curiosity, which is easily measured by the number of hours of continuing education one takes. You will be a success if you pursue a Master of the Academy of General Dentistry (MAGD) designation. I’ve never met a dentist with an MAGD who has gone bankrupt. I just haven’t. If all you can do is take an X-ray, and do cleanings, fillings and crowns, you’re just not going to be successful. By the time you have forced yourself to cross-train in the very structured 16 different categories of continuing education requirements to get your Fellowship of the Academy of General Dentistry (FAGD) and then take another 600 hours to get your MAGD, you know how to recognize, diagnose and treat so many different oral health issues that you’re just always busy. A dentist with an MAGD can do twice as much dentistry on the same number of patients a regular dentist sees because an MAGD dentist can see it, understand it and diagnose it better.

Another element in determining success is presenting treatment. It seems like everybody I know who takes home $300,000 a year always has a separate person presenting the treatment. These dentists do not present the treatment plans themselves. Dentists by and large are introverts and have a difficult time explaining things like gingivitis and irreversible pulpitis in layman’s terms to their patients. I still contend that 99 percent of all physicians, dentists and lawyers could never make the income they make if they were salespeople. Just because you’re the dentist and you own the business, it doesn’t mean you’re the best person to explain treatment. When you find an energetic person who can understand the treatment plan and can explain (aka, “sell”) it to your patients, your treatment acceptance skyrockets. It is very important to know what you’re good at, but I think it’s more important to know what you’re not good at. Data has shown that the average dentist fills 38 out of 100 cavities diagnosed. You should go to your report generator and look up your own numbers, but why is it some offices have an 80 percent close rate and other dentists have less than half that? How can you call yourself a winner when two-out-of-three people who come into your office with a cavity leave with a cavity and still have a cavity at the end of the year?

I tire of the so-called 20-20-20 dentists (dentists who are so proud that they bond with a greater than 20 megapascal strength, their wear rates are less than 20 microns a year and their indirect crowns, inlays and onlays fit within 20 microns), who are so into the science and themselves that they completely ignore the big picture enough to realize they suck at getting actual dentistry done! Tell me again how well your inlays fit when you only do one out of every three you diagnose.

The true litmus test for me is in answering, “Would I send my own children to your office?” I don’t want to send my four babies to a dentist who only has a one-in-three chance of even removing the cavity. I’d rather send my kids to a dentist whose fillings were 30 microns of wear a year and whose crowns fit at greater than 30 microns a year as long as the dentist at least numbed up the tooth and removed the decay.

Another variable that determines success is whether or not you have an emergency operatory. We always talk about new patients, new patients, new patients. We all want more new patients. If I could sum up your receptionist’s job description in one sentence, it’s, “Your receptionist sells appointments.” If someone were to call your practice and say, “My tooth really hurts. Can I come in?” and all your operatories are scheduled, the answer is, “No.” So the patient calls another practice that will see her. My practice keeps an operatory open for emergencies all the time. Nobody schedules it. If you’re saying you can’t do this because of your schedule, you’re the same dentist who continually complains about no-shows and cancellations. Free up one of your operatories! These practices probably make $50,000 a year more than the ones that don’t.

Another success factor is whether your practice is hidden in some office building that you don’t own or if you have a standalone practice that you do own. For years I’ve told every dentist I know to stop renting and move their practices to a visible commercial space. If you only have one or two operatories, get some courage and look for a bigger space. Almost every dentist I’ve talked to who built out their own space tells me if they could do it over again they would have made their practice bigger. Ever notice the companies that design 10’x12′ operatories never have to work in them? The happiest dentists I know are in operatories that are 15’x15′ or larger! Why would you want to work the rest of your life in a tuna can? Double your space! It’s so cheap right now! Make the move!

These are just a few variables of what I think differentiate the winners from the losers. Initially I thought about telling you what the winners do and the losers don’t from only my own perspective, but I thought, “That’s kind of a big responsibility to put on myself.” I want to always make sure I give good advice, so I contacted some of my friends – heavy hitters in the dental profession – and asked them what they think winners do and losers don’t. Here are some outstanding responses from Dr. Rhonda Savage, Sally McKenzie, Dr. Dan Fischer, Dr. Rick Workman, Linda Miles, Dr. Gary Kadi, Dr. Gordon Christensen, Cindy Kushner, Dr. Rick Kushner and Sandy Pardue. I know you’re going to appreciate this.

Dr. Rhonda Savage
Winners close their office doors and focus on patients, patient care (including correspondence with specialists and insurance company rebuttals) and staff training. Winners are warm. They connect. They listen well. Winners are focused. Winners ask for staff input and are fierce about communication systems like team meetings, morning huddles and performance reviews. Winners hire carefully. Winners train well and are clear about their expectations. Winners follow up, coaching and appreciating. Winners are positive. Winners show up early or at least before the start time. Winners start on time respecting the team and their patients’ time. Winners are passionate and inspire others. They share their short-term and longterm goals. Winners discuss the “why.”

Sally McKenzie
Winners seek and learn and execute and measure and share in celebrating. Unsuccessful practices just do the same old thing the same old way.

Dr. Dan Fischer
Winners have integrity. They listen well. They put their patients first and treat them with respect. They communicate and educate. They inform before they perform. They are not egocentric. Winners keep current on new technology. They do not push their own agendas. They are generally happy, enthusiastic people.

Dr. Rick Workman
Winners are open, positive and mentally flexible. They have an optimistic mindset and seek to build relationships with their team and patients. They seek to solve problems versus place blame. They visit other dental practices and study the world around them. They strive for mastery of their craft. They understand entrepreneurialism to a degree and realize success is up to them.

Linda Miles
Winners realize their business is only as focused, ethical, and accountable to customers/clients/patients as their leader. They have outstanding clinical skills and instruments, and expect the same of their staff. They communicate effectively with their team, patients and colleagues.

Dr. Gary Kadi
Winners ask, “How do we find a way?” instead of letting themselves off the hook. Winners focus on outcomes versus activity. They operate on a foundation of honoring their word – the builder of trust, empowerment and workability. Winners are not whiners. Winners face their fears. They are authentic and vulnerable. Winners have a clear vision and engage and enroll others to support them. They focus on value creation in every interaction; losers are value consumers. Winners do not sabotage opportunities when offered.

Cindy Kushner
The difference between winners and losers is simply the willingness to work hard – do whatever it takes to make a practice successful (within the realm of ethics). Winners try things outside their comfort zone. They have good work ethic and never believe they deserve success, but rather believe they can create it.

Dr. Rick Kushner
Winners accept responsibility for everything. They know their success, or lack thereof, is about them and nothing else. Losers always have something or someone else to blame.

Sandy Pardue
Winners realize the business aspect of the practice is different than technical skills. They are great at building relationships. They are willing to spend time focusing on the business of their practice because they understand that accountability, research, development and practice evolution all contribute to practice success. They are effective communicators. They have a skilled person answering the phone. Winners have set production targets for all providers in the practice. They keep as many services as they can inhouse versus referring them out. They have incorporated additional services such as implants, ortho etc. There is a solid recall system in place. Winners know if they continue to learn and make improvements, they will continue to improve and be more profitable. Winners insist on high ethical standards. They are strong leaders and they don’t let staff dictate the direction of the practice. They know that systematized training for staff and written procedures on how to do their jobs will increase efficiency, production and profitability. The practice has production goals set for each provider. The practice has a vision and goals that they created together. They understand that successful practices are built on good relationships. They delegate effectively.

Dr. Gordon Christensen
Winners are patient-centered. They offer a great value for patients, including moderate fees. They are not ego-oriented. They don’t over-treat. They are honest, authentic and live by the Golden Rule. They treat employees as equals and they keep up-to-date on technology and products.

When you’ve finished reading this, I want you to jump onto Dentaltown.com, and post a comment under my column this month to join in this conversation and let everyone know what you think winners do and losers don’t. See you on the message boards! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=319&aid=4334#sthash.LFmVfaZt.dpuf

Dentistry Could Come Back with a Vengeance

July 8, 2013 by howardfarran Leave a Comment

This recession has been hard on all of us, but there is a little economic secret that you all should know that will turn your frowns upside down. It’s called pent-up demand, and you’re going to be seeing the results of it very soon.

During an economic contraction, if you decide at lunchtime you are not going to go to Arby’s and get a sandwich, fries and a Coke, but instead bring a sack lunch to work, Arby’s loses that sale. It’s finite, they’re never going to get it back. Knowing money is tight, you go home and instead of taking the family out to the local Mexican restaurant, you might stay home and eat Ramen noodles. That’s a sale the Mexican restaurant will never ever see. This always happens in down economies.

The thing we all need to keep in mind is with the nine recessions we’ve seen since World War II – the current one being the 10th – the economy always comes flying back. Why? You might not be spending discretionary income on things you don’t need, like going out to lunch or getting a facial, but you are still driving your car, your tires are getting bald, you’re still using the refrigerator you’ve meant to replace for years, lightbulbs need to be replaced, etc. Important things are breaking down; they are things you use every day that you need to replace soon before you end up in the dark, with a flat on the side of the road or with a refrigerator full of spoiled food.

That also pertains to dentistry and orthodontics. I’m 50 years old and when I was kid growing up in Kansas, there were a lot of families that had around five children. Usually then the child with the most crooked teeth was the only one in the family who got braces. Now, with birth control and as America progressed, we average around two children per family, and every child gets ortho. Since the beginning of the recession in 2007, a lot of orthodontic practices have experienced a huge drop in the number of cases they’ve started. Several ortho practices have had to shut their doors because of this. For the ones who have stuck this recession out, I want to remind you that all those families who put off braces for their children over the last five years are going to come back and get braces soon. It’s pent-up demand! Maybe Molly didn’t get braces at 12, but she’s sure as heck going to straighten her teeth when she’s 16! Maybe she’ll even pay for Invisalign herself when she gets her first job out of college. You might not have seen her in the last five years, but I guarantee you’re going to see a lot of her soon when she finally comes around to get treatment.

The economy is coming back in America. They say it’s always darkest right before sunrise, and I’m here to tell you I’m already seeing the sunrise in Phoenix, Arizona. We were hit massively hard here during the recession. Construction companies were building 60,000 homes a year here up to 2006, and after the great economic contraction, that number shrank to 10,000. All the people it took to build those other 50,000 homes each year lost their jobs. Home prices contracted big time. Also during this time, around 150 dental offices here in the Valley of the Sun closed their doors forever.

The other issue we had in Arizona was until recently the state didn’t have a dental school. Now we have two: Arizona School of Dentistry & Oral Health – A.T. Still University, and The College of Dental Medicine-Arizona (CDMA) at Midwestern University. See Fig. 1 for the number of new dentists each school has graduated since 2007:

We saw hundreds of new dentists graduate from our brand-new, local dental schools during the recession who tried to open their own practices and failed because they thought all it took to own a practice was to open up in a great visible location, in a strip mall anchored by a grocery store or a Walmart, next to a four-lane intersection, do some direct mail, and put up a website. The supply of dentists in our area was way oversaturated and massively changed the business of dentistry in the Phoenix area. The problem isn’t local to Phoenix, it’s everywhere. Look at Fig. 2, which shows unemployment figures from the Department of Labor since 1984, then take a look at Fig. 3, which shows the total number of practicing dentists each year since 1984. You’ll also notice in Fig. 4, that during this latest recession, the dental school graduate numbers have risen. Everyone talks about a demand problem in dentistry with this current recession, but what dentistry really faced in the latest high-unemployment years was a supply issue.

Things are changing, however. According to InternationalForestIndustries.com, due to rapidly increasing housing starts in the United States, “lumber and panel prices will move to new highs in 2013 and record highs for lumber in 2014.” The average median real estate price in Arizona has risen from $248,229 in Aug-Oct 2006 to $320,164 as of January 30, 2013 – that’s a 22 percent increase. Housing is the biggest sector of the economy. Everything I’m reading indicates housing prices are increasing, which means the inventory is being bought up, and wherever real estate goes, so goes the economy.

As the economy improves, we’re going to start seeing the results of a five-year pent-up demand for dentistry. It’s already happening! I’ve owned my dental office since 1987, and today we are doing more root canals as a percentage of income than we’ve ever done before.

I’m sorry to sound this upbeat and positive, because this truly is the dark side of economics. When the media talks about how bad Hurricane Sandy and Katrina were, it’s true, those storms were devastating. People lost their homes, their jobs and their way of life. On the other hand you don’t hear any construction companies complaining about it because they get a ton of work in the rebuilding process. Whenever you see a house burn down, it’s really sad for the family, but that devastating fire does provide jobs for firemen and people who build and remodel houses.

In dentistry, we diagnosed a lot of cavities in 2007, 2008, 2009, 2010, 2011 and 2012, when patients just said, “I lost my dental insurance because of this recession. I really can’t afford to take care of these cavities right now,” and walked away. Now those little $250 cavities have grown into the nerve, they’re painful and they require a $2,000 root canal build up and crown. You don’t feel good about it, but on the balance sheet, man, it’s just endo heaven. I’m also hearing stories all over the dental profession like little Molly has been whining to her mother for five years about her crooked teeth. When is she going to get them straight and when is she going to get braces? Housing is coming back, people are now getting root canals and crowns, and I see ortho starting to come back with a vengeance.

Better times are ahead, gang. Remember, dentistry is a need, and we’ve seen a lot of pent-up demand accrue over the last five years. The economy is improving and dentistry is just going to explode! What didn’t get fixed in the last five years is going to get fixed. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=316&aid=4291#sthash.6CuPBQZA.dpuf