HowardFarran.com

Start building your ideal dream dental office!

facebook twitter linkedin pinterest googleplus googleplus email

Debt and Cash Flow

by 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

by 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

by 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

  1. 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
  2. National Conference of State Legislatures http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
  3. 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

by 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

by 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

Best Practices, 2013

by Leave a Comment

At the end of my September 2013 column, I asked readers to visit www.dentaltown.com/besttips2013 and post what they did this year to make their dental practice the best it can be. I really love the responses this thread generated. For the sake of this column, and for the health of your business, I’m going to share with you my favorite posts from this thread and my thoughts about them.  First of all, for this thread to be kicked off by a first-time poster on Dentaltown.com – and that the advice drkinnarshah provided was spot on – thrilled me to no end. When we look at patterns of a successful dental office, practices that have morning huddles do infinitely better in any way you want to measure, whether it’s stress reduction, or increases in productivity and net income. The only thing I want to add to drkinnarshah’s post is to remember, after the morning huddle, it’s imperative to keep in constant contact with the team via walkie-talkies throughout the day.

Dr M’s post is spot on. Everyday since the economy tanked on September 15, 2008, (aka, “Lehman Day”), when asked “If you could have just one magic bullet to improve your practice, what would it be?” four out of every five dentists would say, “I need new patients.” I’m personally proud to say that October 2013 was the best month my practice, Today’s Dental, has ever had in terms of production, collection and new patient intake; I attribute this to two things. The first thing we did was begin nurturing online reviews; this is very powerful. In my neck of the woods, Internet marketing is very strong. We know nine out of 10 appointments are made by women, and more women post online reviews than men do. At my practice, our staff outright asks our patients to post reviews about their positive experiences online. We know that we might receive a negative review from time to time (you can’t please everyone all the time), but if you can drown out any negative review with a ton of positive reviews, you’re doing something right. Our staff hands our patients a card prompting them to say something nice about us, and it’s been a great success.

The second thing we did in order to obtain more new patients was handing our current patients a referral card. I know pretty much every practice management consultant on the lecture circuit and just about all of them have told me when they do in-office consulting, the first day is always observation. They want to go in there and see what the team is doing and not doing. In almost every instance, on the day of observation consultants never hear a single employee – whether it be the dentist, assistant, receptionist or hygienist – ask for a referral of a friend or a loved one. This is the number-one most powerful form of marketing, and it’s never done. When we hand out our referral cards, our patients refer a friend to our practice and when their friend becomes a patient of ours, our patients and their friends will receive a $20 Visa gift card. These cards aren’t validated unless a member of our staff signs it. Also, we incentivize our staff to hand these cards out; whomever on the team has the most referral cards with their initials turned in at the end of the month receives $100.

Also in this thread, Jen Butler wrote…  For years, I’ve said all leaders are readers, and I’m glad Jen made this recommendation. In my practice, we all read a book a quarter (we’d love to do a book a month, but it is hard to try to find the time to fit a book in each month). I highly recommend getting your team to all read the same business book once a quarter, and discuss it – but, for non-readers, instead of reading the book, you might consider the audio version of it. All non-readers can knock an audiobook out in the same amount of time it takes to do three loads of laundry and mow the lawn. It’s team building and total enrichment for the entire practice.

 I applaud dave27 for implementing new procedures into his practice (it already seems to be paying off for him), and for streamlining his processes to do dentistry faster, cheaper, higher in quality and lower in cost. If you’re burning out in dentistry, start learning new procedures like short-term ortho, or implants, or CAD/CAM.

 Dr. Duke talks about how she set up a private Facebook group for her team and in the thread, Sandy Pardue quotes that as saying that this is the top pick of this entire thread. I have to agree with Sandy, but I am going to have to one-up it a bit. You have to have a communication platform for your team, at Today’s Dental we’ve had our own e-mail platform that has been very effective. The Facebook group Dr. Duke refers to is very interesting; I like that a lot. It’s also why we set up the same kind of platform on Dentaltown.com. Dentaltown’s private groups are far more robust than the Facebook private groups, however, because you can organize them by subjects. I mean you can set something up for hygienists, something for the entire office, something just for insurance or marketing, etc. It’s more organized. But here’s what I like even more: If the dental office staff members are on Facebook in the private Facebook group, they are extremely tempted to hop off that page and go see what all their nieces and nephews and girlfriends are doing. When they are on the Dentaltown.com private group, now when your hygienist, receptionist, assistant or office manager leaves that group she sees three-million other posts by thousands of other dental assistants. And if she gets caught up and lost and distracted in that, she’s still learning about dentistry.

I want to thank everyone who participated in this thread, and I invite everyone to read what’s been posted already, and continue to contribute their best practices from 2013 as we move into the new year. Best of luck to you in 2014, and I’ll see you on Dentaltown.com! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=343&aid=4683#sthash.tTzSBN8t.dpuf

Not Getting It Done? Hire a Consultant!

by 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

by 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

by 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.