Almost 70 years since the first American city – Grand Rapids, Michigan – introduced fluoride to its water supply, the fluoride debate continues. The media in Albuquerque, New Mexico, has been abuzz about fluoride because the city recently voted to stop adding supplemental fluoride to its water supply (citing budget constraints and that an acceptable amount of fluoride already appears in the water), and the cities of Portland, Oregon, and Phoenix, Arizona (my backyard, and the city I helped fluoridate in 1989), recently took another gander at regulating fluoride in their own water supplies.

As a dental professional you are well aware of the oral health benefits we all receive from fluoride. You give fluoride to your patients during their cleanings and you insist your patients use a fluoridated toothpaste at home because it promotes stronger teeth and less decay. What you might not be fully aware of is the benefit fluoridating a city’s water supply provides to its citizens, and I am writing this column for the community water fluoridation dentists (CWFDs) out there who, over the course of their career, might be questioned by either their patients or concerned citizens about water fluoridation.

When I opened up my dental practice – Today’s Dental in Phoenix, Arizona – in 1987, tooth decay was rampant. I couldn’t understand why all of my patients were presenting with such horrible oral health problems. I went to dental school in Kansas City, Missouri, and I didn’t see even a tenth of the amount of decay in the patients I worked on there. I looked into it and found out the difference in the areas was that the water of Kansas City was fluoridated and the water of Phoenix was not. For a year, myself and some close professional friends of mine like Jack Dillenberg, who is currently the Dean of the Arizona School of Dentistry & Oral Health – A.T. Still University in Mesa, Arizona, championed the movement for Phoenix to fluoridate its water, and it passed.

Once the city of Phoenix fluoridated the water supply in 1989, my practice witnessed a noticeable drop in cavities in all of my patients. Economists have crunched the numbers and found that for every 40 cents spent on fluoridating a community’s water supply, it saves each patient nearly $40 in dental care. That’s why, in America, fluoridating the water has been classified as one of the top 10 greatest public health measures in the last 100 years.

As I mentioned, the common council of the city of Phoenix recently voted on whether or not it should continue fluoridating its water supply, and on September 5, 2012, I took part in a public debate over this issue. This debate drew a large audience and consisted of interested observers, several local dental and health-care professionals, as well as some members of the community who oppose fluoridating city water supplies. I entered the debate with a side to present, but I decided to keep an open mind, anticipating that the opposition might provide some key evidence to the contrary, but nothing the opposition presented changed my opinion about fluoride.

The evidence against regulating acceptable fluoride levels in the water doesn’t add up. All legitimate studies on water fluoridation find that it does not cause any adverse health affects at the levels U.S. citizens are exposed to, but what all of the studies find is that it significantly decreases tooth decay when compared to people who drink water containing no fluoride in it. The fringe studies that anti-fluoridationists often locate to bolster their arguments tend to be based in foreign countries with water supplies that have fluoride levels of up to 11 parts per million (acceptable levels of fluoride in the United States are 0.7 parts per million).

Anti-fluoridationists also like to point out that European countries don’t fluoridate their water supplies. The infrastructure of European countries is quite a bit older than that of the United States – by several hundred years, in fact. In the States, it’s easy and cost effective to set up a single fluoride installation facility to treat all of the city’s water, whereas in Europe, you might have to set up 25 or 30 of them. Not very cost effective. Europeans do get fluoride, however, because they fluoridate their salt just like we iodize our salt to prevent goiter!

The big flap opponents of fluoride have is about the city adding fluoride to the water supply, but what they tend to leave out is fluoride actually appears naturally in water; this is actually one of the reasons Albuquerque gave for not adding supplemental fluoride to its water supply – it naturally appears in the water already. The ocean, for another example, contains fluoride! In fact it contains an even higher level of fluoride than the water we drink. While some cities have to add fluoride to the water supply to get it up to an acceptable level, there are some communities that actually have to filter the fluoride out of their water because it naturally shows up in their supply and the levels are higher than the acceptable amount of .7 parts per million. When cities regulate the amount of fluoride in the water, they’re regulating an element – not a man-made medication like Keflex or Viagra.

Another argument I hear is that there’s already quite a bit of fluoride in toothpaste. That’s true. And that does help fight tooth decay. But what we also need to understand is that poor children may not have access to toothpaste. Given a choice between spending what little money a family might have on food, or toothpaste and a toothbrush, a family in dire straits will choose food all day long. Fluoride in the water helps build stronger teeth so these families can actually eat their food. We also need to understand that, while it is important to brush our teeth with toothpaste that contains fluoride, it is equally important that we ingest fluoride to get it into our blood supply and help build teeth and strong bones.

I applaud the passion of anti-fluoridationists, but a lot of their ammunition stems from misinformed hysteria, a supreme distrust of the American government and baseless conspiracy theories. When you pull fluoride out of the water supply of an American city, you see a rise of almost 25 percent in tooth decay immediately.

You can digest this column and take my word, but for a deeper analysis of the fluoride debate, you really should read The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest Running Political Melodrama by authors R. Allan Freeze and Jay H. Lehr. This book should be sitting on the desk or nightstand of every dentist and dental hygienist in the world. I’m not kidding. It is thoroughly researched and well written, and I highly suggest every single one of you read this, because if the fluoride debate hasn’t happened in your neck of the woods, you can bank on it probably happening some time during your life, and it will continue happening throughout the country 100 years from now.

The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest Running Political Melodrama by authors R. Allan Freeze and Jay H. Lehr.

What are your thoughts about fluoridated water? When you’re done reading this, sign on to Dentaltown.com, click on the link under my online column this month which will take you to a message board already in progress on this topic, and post your response! I will see you online!

We’ve all witnessed the extreme sides of management either first hand, through stories of others or even on TV. We’ve watched Donald Trump put eager contestants through grueling hell on The Apprentice for years. Even if you never watched the show, you’re likely aware of his scathing catch phrase, “You’re fired.” If you didn’t step up to the plate and knock one out of the park, you heard the catch phrase. If you didn’t work well with the rest of your group, you heard the catch phrase. Trump has a reputation for being a pretty brutal guy on TV and off. Another pretty brutal guy, who I was pretty fond of, was New York Yankees owner George Steinbrenner. After Steinbrenner passed away in 2010, I wrote a column about him and the way he managed his team. If his people weren’t the best, he shipped them off to the farm league and got the best. If you weren’t cutting the mustard, you were gone. You’re the big bat and you haven’t hit one into the stands in weeks? Adios. Can’t pitch? Sayonara, tiger.

The reason why I wrote a column about Steinbrenner and encouraged you to “win like George” is because I see the other management extreme in dental practices far too often. I’m talking about the soft-spoken, sweet doctor who keeps to himself, is afraid of confrontation and whose employees either rule the roost or are all looking to work at another practice. I’m talking about the doc who hears complaints about Amy from his entire staff all day. Amy never shows up to staff meetings, she’s rude to her co-workers in front of patients, she never sticks around for lunch-and-learns, she leaves early and she never helps prep for the next day’s patients… and the doc never does anything about her. Sure there’s probably a good reason why. Maybe she’s a really good assistant when she’s around the doc. Maybe she’s worked at the practice since before the drywall was put up. Maybe she’s the best friend of the doctor’s wife. The other employees absolutely love the practice, they dive for the ball every time and they’d love the place a thousand times more if the doctor would just get rid of Amy the bad apple. But the doctor can’t pull the trigger. What more damage does Amy have to do for the doctor to see she needs to go?

Being the owner and/or manager of a dental practice requires a skill set that you never learned in dental school. Dentistry is hard, but managing people can be much harder. People are infinitely more complex than a crown placement or even a trifurcated root canal. Nobody comes with a manual. Every person responds to positive and negative reinforcement differently and in different ways. You need to build up the courage to be a leader and make some tough decisions. You need to find ways to evaluate your teams properly. You need to find ways to reward your superstars and to weed out your non-performers.

When you employ a C, D or F player, they’re trading their time for money. They don’t care one iota about your business, your services or your customers. They’re working for you because it allows them to earn a living to do what they truly want to do, or perhaps, in many cases, in lieu of what they want to do. It’s likely they sit around all day just dreaming of what it is they’re going to do the second they get out of work. You need to fire these people, not just because they’re bringing your business and your team down(which they are), but because these people need to learn what their true calling is.

I once hired a dental assistant who was decent on paper, but she only lasted on my team for about three months. I was fresh out of dental school and she was about 10 years older than me and had been a dental assistant for about 15 years. She had all the credentials needed to do the job. She was fairly proficient, and I had very little concern with her ability to do the job. The main problem was she wasn’t a people person.

You’ve likely been in the presence of an assistant who pokes around in the patient’s mouth asking them questions to which they can’t possibly answer because their mouth is open and jammed with 80lbs of gauze, but she keeps talking, telling the patient what she sees in his mouth, what problem areas he needs to focus on, etc. That’s the kind of assistant you want. Someone who’s so concerned about the current state of your patients’ teeth she won’t shut up about it.

Well, this particular assistant of mine didn’t talk. She didn’t talk to the patient, or the rest of the staff. I’d watch her, puzzled. I couldn’t believe, when she actually did talk to people, how she talked to them. I couldn’t believe how she reacted to people. She had very little empathy for others. We got along pretty well and I genuinely liked her as a person, but I knew I had to let her go. When the big day came, I first said, “You’re being fired right now.” (And by the way, if you have to fire someone, “You’re being fired right now” really needs to be the first thing out of your mouth. No story. No hemming and hawing. None of this, “You’ve been a valued employee here for X amount of months and I’m really sorry to blah blah blah.”You need to lay it all out from the get-go, be like the Donald and say, “You’re fired.”). When she asked why, I told her I needed to give her some advice. I said, “You don’t like people. You don’t work well with people. In fact, I think you might actually hate working with people. You’ve been a dental assistant for 15 years and I bet you’re miserable doing it. You know what you need to do? You need to get out of dentistry! It’s not for you! I really think you need to find a job where you’re not working with people at all.”

(Yes, I was pretty blunt, and sure, this sounds cruel, but stay with me here.)

As I said this to her, I recalled the numerous conversations she and I had about her garden and her plants. She was really into it, man! She could list off what was in her garden and what it took to care for certain things and which plants needed more sunlight than others. Whenever she spoke to me about plants, it’s like the light turned on in her eyes.

I told her, point blank, “You seriously need to get a job at a plant nursery. It’s the only thing you ever talk about with any passion whatsoever, and I really think plants are the only thing on the planet that would actually get along with you!”

We settled everything pretty soon after that. She collected her belongings and I walked her to her car. Yes, she was shocked that she was getting fired, but I reinforced the plant thing.

Six months later, guess who shows up at my practice for her bi-annual cleaning? You got it. I was very surprised to see my old assistant. In fact she came in with her husband and her kids. She sought me out right away. I didn’t know if I was going to get punched or what. She shook my hand vigorously as she told me getting fired from my dental practice was the best thing that ever happened to her.

Seriously!

She told me she was completely trapped in thinking that she had to keep doing what she was doing because dental assistants made pretty decent money and that she had gone to school and spent all this time becoming a dental assistant that she never stopped to ask herself if she actually enjoyed it or not. She went to go work for a nursery and she loved it! She thanked me up and down for breaking her unfortunate momentum.

When staff in your office are not involved, when staff are detached, give them the freedom they need and fire them! Most people, when they’re being fired, think the person doing the firing is a total jerk. No! Not true! If this person loved their job, if this job gave them purpose, if it was the first thing they thought about when they woke up and the last thing they thought about when they went to bed, you wouldn’t have to fire them. They’d be doing a good job! Humans are too complex to offer up any blanket statement on anything, but from my experience, if you have to fire a C player, it’s because they really don’t like what they’re doing – which means they’re probably in the wrong career! It’s almost like a divorce. There can be fighting going on and total dysfunction, but it finally takes one person to take the high road and decide, “It can’t go on like this for 20 years. It’s time to end this for both our sakes.”

When you fire a C, D or F player, it’s not because you don’t like the person, it’s because they’re just not right for the job they’re currently doing. As crazy as it sounds, you might be doing many of these people a favor.

Employers too often settle for marginal employees. You have to aim high with your standards. You are allowed to be picky! The number-one mental error in practice management today is that managers think they are responsible for their team’s performance. This is completely backward. Management is responsible for finding teammates who perform exceptionally well. It’s not your job to motivate your team. They need to come to the office already motivated. I have never regretted letting someone go who wasn’t meeting expectations; and usually when we find a replacement, we find that the person works out so much better than the last person. The only regret I have is for not making the change sooner.

You don’t always have to fire someone, though. Sometimes there are other options. Let’s say your dental assistant is a really nice person. She’s great with people, she’s outgoing, she enjoys her interactions with you and your patients, but she just doesn’t like assisting. Then perhaps instead of keeping a miserable assistant around, and instead of letting her go, why don’t you move her up front where she can be around people and schedule appointments and thrive and not have to worry about prepping operatories or taking digital X-rays? I can’t tell you how many times I have been pleasantly surprised by how an employee who struggled in one position really excelled and thrived in a different position.

You constantly need to evaluate your team. Letting an employee know how he or she is performing in their job is still important to do on an annual basis, but if someone is really struggling and their performance is a major issue, you can’t wait until their annual review – that’s too damn long. If Amy is shirking her responsibilities or being a jerk, you need to nip that behavior in the bud and let her know what happens if she keeps it up right then and there. You can’t wait a year to tell someone they’re not doing what they’re supposed to be doing. Yes, letting someone go can be a traumatic experience for the person getting fired and the person doing the firing, but even more traumatic than not making this kind of tough decision is allowing someone with no passion for what he or she does to continue draining the life, spirit and (eventually) profits out of your practice.

In the July 2012 issue of Dentaltown Magazine, I wrote about the importance of a purpose-driven life and the difference between people who have a passion for what they do vs. the poor souls who trade time for money. I wrote a little about giving your team a purpose as well, but I saved the bigger idea for this column, which is giving your entire practice purpose. Not just your staff, not just you, not just the chairs and the bricks and the mortar, but the driving philosophy of your entire practice.

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

That’s why it is so important for companies – large and small – to make their values and their purpose crystal clear. That’s where a mission statement comes in. Yes, even though you might consider yourself “just a dental practice,” you need a mission statement. A mission statement explains to your customers and your team what your goal is and why your business exists.

Southwest Airlines’ mission statement says, “Southwest Airlines is a company that is for anyone and everyone that wants to get from point A to point B by flying. Our service and philosophy is to fly safe, with high frequency, low-cost flights that can get passengers to their destinations on time and often closer to their destination. We fly in 58 cities and 30 states and are the world’s largest short-haul carrier and we make sure that it is run efficiently and in a economical way.” In a rather succinct 80 words Southwest Airlines lays out exactly what it does, and if you’ve ever flown Southwest, it’s apparent that its employees take this mission statement to heart.

Other mission statements use broad strokes. Take Sears’ for instance: “To grow our business by providing quality products and services at great value when and where our customers want them, and by building positive, lasting relationships with our customers.” Pretty broad (actually, a little too broad… and maybe a bit vague), but that’s OK, because when you delve into your company’s list of core values, you can further define your mission.

And in case you were wondering, Dentaltown’s mission statement is: “To better dentistry by connecting dental professionals through traditional and innovative media.”

Now that you’ve explained who you are and what you do, it’s time to explain the “how” through developing your core values. Core values are extremely important. Without them, your team members will make all of their decisions based on what they think is best – which may not actually jibe with the practice’s philosophy. You can’t afford contradiction and infighting; everyone needs to be on the same page and adhering to the same values, otherwise you’re not going to move forward. Your company needs to make clear to the entire team what it values and how it will conduct business.

Some companies have five core values, some have 25. We spent months developing the core values for Dentaltown and my dental practice, Today’s Dental, and whittled our list to what we thought are the 12 most important values we, as a company and a dental practice, needed to adhere to. If someone doesn’t “get” my corporate culture, I can get them right out the door permanently.

First off, we all decided it was important to create a fun, positive and professional environment. People don’t want to come to work and deal with all the catty, tacky garbage people tend to bring into an office, which eventually makes people feel bad. These are your teammates and they’re your allies.

We require our teams to be passionate, enthusiastic and determined to make a difference.Try as hard as you can but you can’t train people to be these three things. You must make sure you’re hiring people who carry these traits and be prepared to jettison those who do not.

You have to embrace and drive innovation. You have to adopt all technology that makes you do dentistry faster, easier, of a higher quality and at a lower cost. Macroeconomics is made up of three things – people, technology and capital. You have to embrace all new technology.

You’ve got to follow the golden rule (“Treat others like you would want to be treated”); the common thread found at the heart of every major religion. Simple enough, right? Not really… Let’s say your child was injured or sick and you needed to take her to the emergency room. Your child might be scared and might start asking the nurse questions. Would you really want to hear the nurse say, “I’m sorry, I can’t talk about this with you. The controlfreak doctor says I can’t talk to you like a human.” Nobody wants to hear that, and certainly nobody wants to say that, but when someone calls up your practice and your front desk can’t explain what they think because you’ve got them gagged, there’s something wrong.

Mistakes will be made. Be accepting and accountable, and move forward. You’re not perfect, doc. Nobody is. There’s a reason why we call it a “dental practice” – nobody’s perfected it, and nobody ever will. We are our own worst critics; if someone screws up, help them realize their mistake, redirect if it’s needed and then move forward. You don’t laugh at them or chastise them or belittle them. Mistakes are an opportunity to learn. Speaking of which…

Never stop learning. This is a favorite of mine because if your practice chooses to adopt this particular core value, I can help you and your team along by shamelessly promoting Dentaltown.com’s awesome line-up of online continuing education courses. You don’t have to take notes. You don’t have to get a hotel. You don’t have to buy an airline ticket. And all of our courses will not just benefit you but your whole team. Why don’t you do something educational and morale boosting for your team like Terrific Tuesdays, when every Tuesday you spring for pizza and the whole staff stays in and watches a one hour-long online CE course given by the best instructors around the world? It’s important to continue improving your knowledge base and your skills. Keep learning new techniques that will start making your practice money, like sleep dentistry or implants.

If you’re on my team, you need to be honest and respectful. Integrity is everything. You have to report your cash because if you don’t your staff thinks it’s OK to steal from the IRS, therefore it’s OK to steal from you. You have to warranty all your work. You have to be honest. If you screw up, you tell a patient, hey I’m a human and I just broke the bur off into your nerve and this is what I did. Don’t cover it up. Don’t lie. It just makes things worse. Be honest, get it all out front.

You have to balance life and work and be fully present in both. To take this a little further, I’ve got my four Bs: my body, my babies, my business and my babe. If you don’t take care of your body, then babies, business and babe don’t matter because you’ll be dead. You stay healthy in order to be there for your family and your business. So many of us are workaholics. We ignore our families until they want nothing to do with us and we get upset when they eventually only love us because we give them money (because that’s the only part of you you really ever gave them). It disappoints me when dentists take personal calls from their spouses all day long but won’t let their staff take personal calls from their spouse or their children. When your kid is having a crisis, you reschedule all of your appointments, but when your hygienist’s child is facing a crisis, you raise hell and start making threats. It’s an awful double standard. Remember, treat other people how you want to be treated.

Strive to make everyone feel safe, valued and important. I’ve witnessed dysfunctional staff meetings where the doctor barks orders or makes a decision before talking to the staff, and the whole team just looks at him, their eyes as wide as saucers, and before anyone can ask a question the team is dismissed and everyone runs away. That is so dysfunctional. I remember the last time I ever held a staff meeting like this. I told my staff we were buying a CEREC milling unit and my assistant Jan spoke up and said, “That’s the stupidest thing I’ve ever heard in my life.” It wasn’t because she thought buying a CEREC was a bad idea, it was because our office needed to be updated. After that meeting, we argued about this for about a month. Eventually, and with some long-term financial planning, we all got what we wanted. The point of this story is, in that month while Jan and I butted heads, not once was she afraid that she was going to lose her job because she stood up to me. My team knows I’m not going to fire them or abuse them for standing up to me. We can disagree and have heated debates, but they must be done in a respectful way so nobody fears losing their job just because they disagree with me. You need this in a practice because it allows your team ownership of all of the decisions that are made.

Be remarkably helpful. Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. Empower your staff. Be helpful. Coach them. Invest in training your team and when they are finished training, get them some more! I can’t say enough about online CE. Your hygienists and assistants should know exactly what is going on with a root canal. If you want your receptionist telling people how much a root canal costs, she should at least know what a root canal is. Have her take a CE course on Dentaltown.com. In one hour, she can learn what a root canal is, know how to make one better and faster and then when she’s done with the root canal course, she can explain what she learned to patients (and tell them how good you are at it). Empower everyone with knowledge – it’s the best help you can give.

Our final core value prompts our team to create opportunities to make our customers feel special. In these turbulent economic times, why are you taking off your gloves and mask and slinking back to your office while the local anesthetic sets in? You need to take these golden opportunities to bond with your patients, share things with them and listen to them. At the very least, review their social network. Why not?! They’re just going to be sitting there soaking up the Novocain anyhow. Say to them, “By the way, how’s the rest of the family? I haven’t seen your husband in a while. When’s the next time he’s going to come see me?” Review the treatment plan – not just of your patient in the chair, but of their family as well. Say, “OK, your kids are nine and 10. We talked about sending them for an orthodontic consult when your daughter is 12 and your little boy is 13…” Engage them. Bring up their pano, their digital X-rays. Stay in that operatory to teach. Ensure everyone in your office is a teacher. Give everybody a purpose to teach, you want a measurable impact on the improvement on everyone’s oral health from when you graduated from school to when you retire.

Being clear about your purpose is one thing, but actually following your own core values is another. You might spend a year coming up with your company’s mission and core values, but without consistent follow through, they won’t mean a damn thing. When you review your employees, you must hold them accountable to all of your practice’s values. The staff should also have the freedom to police each other. If someone’s behavior isn’t in line with any of your core values, that person needs to be called out and be held accountable for their actions. Everyone should have the opportunity to change their ways, but if someone on the team is consistently not adhering to any of your company’s values, perhaps it’s time that person find another practice whose values are more in line with his or her own.

It’s big-picture time, boys and girls. As a new doctor preparing to graduate from dental school or who has recently graduated, you’re preparing yourself to champion the oral health of the world head on. This is a very exciting time for you! But there are things you didn’t learn in dental school that you need to know now. I’m writing this column to let you know you are going to have to face some harsh realities about the dental profession soon and you are going to have to make some big decisions before you get going.

I’ll start off with some good news and some bad news. The bad news is most of you are coming out of dental school around 25-years-old and swimming in more than $300,000 of student-loan debt. Economically speaking, it’s not necessarily the ideal time to get started as a dentist. The good news is all of the immediate stress you’re facing like major debt and where to start will merely be a bump in the road if you’re smart, driven, passionate, skillful, humble and dedicated to continuing education. You are starting on a career path that can keep you going until you’re 75 (or older), and that’s awesome!.

As of now, you’ve spent your entire post-grad career focusing so hard on doing dentistry just to earn your degree to become a DMD or DDS, that you haven’t had the time or even the opportunity to glance at the big picture of dentistry. Why they don’t teach you about macroeconomics in dental school is beyond me, because it’s extremely important and it affects your level of success as a dentist. It’s so important that I want to talk to you about macroeconomics right here; consider this your first continuing education course (sorry, there’s no test to earn credit at the end).

My message isn’t meant to scare you, it’s meant to prepare you. One of the reasons I love macroeconomics is it’s very simple, and once you start comprehending it, the results you get will pay off in a big way. There are only three variables in macroeconomics: people, technology and capital. That’s it. Easy enough, right, Doc? Let’s take a look how each applies to you.

People
Everyone needs to have a mentor at every stage in his or her life. When you were five years old, you might have been a mentor to your three-year-old little brother or sister. You were the one warning them not to do certain things or they would get in trouble. Now is the time in your life when you need a mentor. Did you think now that you’ve graduated you know everything you need to know about dentistry? I hope not, because it’s not true. I’ve been practicing for 25 years and I still don’t know all there is to know about dentistry. It’s why we call it a dental practice – nobody’s perfected it and nobody ever will. Right now you know just enough dentistry to be dangerous. It’s your job to keep improving your skills and acquiring new ones, as well as learning the business and practice-management aspects of dentistry. Your best bet to becoming the greatest dentist in your town is to latch onto mentors who have practiced dentistry for decades.

I personally know around 100 dentists who emerged from dental school in the last decade and almost instantly rocketed to success. Want to know how they did it? They simply asked for help. They were smart enough to realize that they didn’t know it all and they were humble enough to seek advice from veteran dentists who have been there and done that. I started Dentaltown in 1999 just to make it easier for dentists to network with new peers and form strong relationships. These few young doctors leveraged the collective wisdom of Dentaltown.com by starting and contributing to message board threads, picking the brains of seasoned dentists. And all these seasoned dentists really got into lending a hand and giving these young doctors the advice they wish they had gotten when they were just starting out!

The goal of Dentaltown has always been that through the use of this unique online community, no dentist would ever have to practice solo again. Dentaltown’s members (who call themselves “Townies”) want to help you, and they thrive off of your enthusiasm – it’s a win-win. Nobody on Dentaltown.com gets paid to tell you their advice – every Townie is a volunteer. The reason people actively participate on the Dentaltown.com message boards is because they are passionate about making the field of dentistry the best that it can be, and a big part of that is helping you become the best you can be.

You have to create meaningful professional relationships with your peers and mentors to become successful, period. On Dentaltown.com, you don’t just get one mentor who might be good in one area and bad in another; you get multiple mentors offering multiple points of view. Are you stressing out because you don’t know if you should join the Navy or take a job with a corporate dental chain? Get on Dentaltown.com and say, “Hey, I’m 24-years-old, I’m $300,000 in the hole, I’m stressing out, what should I do?” You will be shocked by the generous, heart-felt responses you will receive from our Townies and the lasting relationships that will form.

Technology
It’s likely you learned next to nothing about CAD/CAM, dental implants, sleep dentistry or orthodontics in dental school. This is why jumping right into continued education is crucial. And it will continue to be crucial throughout your entire career as a dentist, because technology just isn’t going to stop improving. And as technology keeps improving – allowing all of us to practice dentistry easier, faster, higher in quality and lower in cost – if you want to be successful, you need to expand your knowledge of it.

When you learn about new technologies and apply them to your practice, you have more services to sell. Distribution models of the last 200 years in the United States show that it’s extremely hard to open up a store and sell one thing. It’s why Walmart is so successful; you can buy bread in one aisle, chlorine for your pool in the next aisle, and a pair of jeans in the next. You can’t succeed if you’re a store that only sells bread, which forces your customer to go to a butcher to buy meat, and then to a linen store to buy fabric. If you pack all those things into one store – like Walmart has – you’re going to get just about all the customers. If one dentist can only offer cleaning exams, X-rays, fillings and crowns, but the guy down the street can do all that and root canals, extractions, implants, ortho and sleep dentistry, who do you think is going to see more patients? If you can do more procedures on fewer patients, you’re going to pay off your student loans in half the time it takes the other guy. It’s basic economics! So go learn endo! Go learn how to place implants! Learn clear aligner treatment!

Where should you start? Well forgive me for being a little biased, but Dentaltown.com has 130 online CE courses, each one an hour long. I implore you to get online and start taking them; not because you need the credits to maintain your dental license, but because they will all improve how you practice dentistry. I personally have taken all of them, and they’re outstanding!

And when you’re done taking all of Dentaltown.com’s CE courses, you need to venture out of your town and go to dental seminars and dental conventions like the Townie Meeting (www.towniemeeting.com) to learn even more. One of the best things about getting out of your routine, getting out of town for a few days and learning new techniques and ideas, is actually a by-product of what you initially intend to do: networking! In dental school, you ran with the same 50 to 125 people for four years. Now you’ve flown the nest and you’re practicing on your own in your own corner of the world. You’ve got to go meet with your peers. You can’t do this alone. Aside from the knowledge you will absorb at these educational opportunities, the greatest benefit of CE is expanding your social and professional circle – it’s feeling the passion and energy that radiates from a community of like-minded individuals. I’ve made some of the closest friends at dental meetings – all people who are as passionate about dentistry as I am and who are facing the same issues I faced in my practice all day, every day. I highly suggest you register on Dentaltown.com, get on the message boards, ask questions, take our online CE courses and then get yourself to the Townie Meeting in Las Vegas every year so you can meet with your online peers in person!

Capital
You have near $300,000 in student loans and you live in one of the 20 richest countries in the world – if you’re the majority, you probably don’t have access to capital. Banks are currently eating huge losses around the world, and the Federal Reserve is telling these banks they need to have more capital. Their debt-to-loan loss ratios are too high. They can’t offer what they’d consider high-risk loans anymore. So you need to research. There are hundreds of towns in America that have fewer than 100,000 people – some only have 5,000 people, and that’s where the cost of buying a practice is about half of what you’d have to spend in an over-saturated big city. You need to look at areas around the country that are completely underserved and you need to consider setting up shop in those areas. A bank in a town with no dentist is going to give you the loan you need and they’ll do it with a big old grin on their faces.

You might be sitting there weighing your options, wondering whether or not you should join the Navy so you can sit on an aircraft carrier six months out of the year to do dentistry in the middle of the ocean. But if that’s not really your cup of tea, why wouldn’t you look into moving to a county in Kansas that doesn’t have a dentist? Do you realize that if you were to visit these towns and met with the mayor, he’d walk you downtown to Main St. and show you three or four buildings that haven’t had anyone in them for the last 10 years and say, “Pick a building and it’s yours.” Then he’d walk you over to the bank and say to the banker, “We need a dentist in town,” and then they’d give you a signature loan. That could seriously happen! Forget about opening up a practice in Manhattan that overlooks Central Park – you and about 5,000 other dentists your age have the same idea. When I got out of dental school, I did my research. I looked at the last 20 years of history, and I looked at the economic and social projections. I chose an area that was flourishing economically, that had virtually no competition nearby and a ton of potential customers. I pinpointed where new developments were happening and I set up shop in an area that had 25,000 people living in it. And in 20 years it boomed to 75,000 people. This is all information you can obtain from local, state and federal government agencies. You need to be smart about this.

You live in the richest country in the world, and it’s near impossible to not earn a really decent living as a dentist. Right now you have nothing but options. You can be a success in dentistry, but you have to get out of your routine, muster up a little courage and go for it. I know you can do it, and so do you. I can’t wait to talk to all of you on Dentaltown.com.

Late in the French Revolution, as Napoleon took over his battered nation’s army, he came to the realization that his opponents were merely unorganized bands of angry mercenaries – thugs who were simply paid money to fight. Napoleon felt his opponents didn’t fight with valor, honor or purpose, so he developed an elaborate system to motivate his own army and give them a strong purpose for fighting. He handed out badges, medals and other awards for acts of heroism and valor because his men were taking risks for their country. Napoleon changed his army from a bunch of pay-for-play brutes into an honorable fighting force. He spoke at length about fighting with a purpose and his army dominated. His army consisted of men who were willing and wanting to fight, and if necessary, die for their country, which was unlike any other fighting force in Europe.

All people want to live their lives with purpose. A purpose-driven life has meaning. It has relevance. Nobody wants to take up space, eat, drink and die. Everybody wants to leave something behind and make their mark.

Professionally, I’ve been pretty lucky, because my dental career has always been filled with purpose. Within six months of opening up my dental practice in 1987 in Phoenix, Arizona, I was utterly demoralized. I had come from Kansas City, where the tooth decay rate in children was so much lower than the population of Phoenix. I could not understand what was going on. Every mouth of every child I saw was ridden with rotting cavities. I was so baffled I called the local office of dental health and talked to what turned out to be the smartest dentist I’ve ever met in my life, Dr. Jack Dillenberg. Jack simply said, “It’s because Phoenix’s water supply isn’t fluoridated.” I told him I felt like I’d be wasting 40 years on an assembly line, drilling, filling and billing for no purpose at all. I wasn’t even going to make a dent in this pile. Jack agreed with me and suggested we start the Arizona Citizens for Better Dental Health and get Phoenix fluoridated. I couldn’t say no. We met every Friday for two years until we convinced the city of Phoenix to add fluoride to its drinking water. I lived all week for that meeting every Friday with Jack because it gave me such amazing professional purpose.

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

Doctor, you are a member of Dentaltown. You read Dentaltown Magazine every month. You are a member of our online community. You join in discussions and passionately argue your case. You lurk around the message boards looking for amazing tips you would never have gotten by attending a seminar. You share cases with your colleagues to find a better way to do a root canal or a sinus lift. You take Dentaltown’s online CE courses not only to get the credits you need but to learn about a new material or technique. Why? Because you have a purpose, too! Maybe you want to be the best cosmetic dentist in your city. Maybe when you were young, your life was changed by a friendly dentist, which made you decide to become part of the profession and pay it back. Maybe you don’t outright know what it is, but since you’re a member of Dentaltown, you’re contributing to your purpose of becoming a better dentist to serve your community better than you would have the day before!

You Are A Public Health Dentist
What’s your purpose, doctor? Think about it! Is it just to improve the smiles of everyone who comes in your door? Are you a self-esteem booster? Is it that you want to improve the functionality of someone’s teeth? Is it that you want to ease the pain of patients whose caries have bored down to the nerve? I read the message boards on Dentaltown.com all day long. I know know there are a lot of people who believe everything needs to be done by free enterprise and that the government is “untrustworthy” and doesn’t trust free enterprise. Here’s the thing… right now in your career, you are a public health dentist. It’s your duty to ensure the dentistry you’re doing is being done faster, easier, of higher quality and at a lower price. And it is your duty to ensure dentistry is available and accessible to everyone. If you don’t do this, then you are proving that the government needs to step in; that’s what happens when free enterprise fails.

If you don’t think you have a professional purpose – make this your purpose!

Go do a Google search on emergency room visits caused by dental problems.What you find might astound you. There is a sickeningly high percentage of ER visits by people who really should be taken care of by a dentist. Why the hell aren’t these people coming to see you?! Do you take insurance? Are you unlisted? When you close your practice at 5 p.m., do you flip on the answering machine? Do you call back?

Make Cost a Purpose
Are you too expensive? You know how when one of your staff members approaches you with the following dilemma, “Um, Dr. Soandso, my friend really needs a root canal and she doesn’t have insurance and she really doesn’t have a lot of money to take care of this, so could you maybe do it for half off?” and you say, “Oh sure, since she’s your friend and you’ve been here 20 years, I’ll do it for half off.”

Really, doc?

Shouldn’t your goal be to treat everyone in your community like they’re your best friend? Shouldn’t all of your root canals be half off? Why should your assistant’s friend get the privilege of paying half off when half of America doesn’t have dental insurance and you’re charging all of them full price?! And why do you raise your prices three, four or five percent every time the Earth revolves around the sun? Why don’t you keep a closer eye on cost and keep your overhead down so you can offer your services to your patients at a lower price?

Once you take your eyes off cost your patients don’t have the freedom to afford the faster, easier, higher in quality, lower in cost dentistry that they deserve. They’ll go somewhere else… like the ER. Furthermore, why would you consider doing an occlusal composite on a six-year-old kid’s #3 when you know amalgam is going to last four times as long and costs you (and the patient) half as much? I understand cosmetic needs, but does anyone really care what the occlusal surface of someone’s molar looks like? Remember, price elasticity tells us that price has a lasting effect on demand. If you sell a Mercedes Benz, very few people can afford it and will pay for it, but if you sell a Chevy, at a much lower price point, everyone will want one and everyone will buy one. Lower your price, increase demand.

Say you’re one of the dentists out there who really loves placing implants – I know a lot of dentists who really do! If you love placing implants, but you keep raising the price every year, you’re going to do fewer and fewer cases. If you really love implants, lower your fee 10 percent and you’ll see more people. Cut your fee in half, and your practice will be swarming with patients.

Give Your Staff A Purpose
I’d say in about half of the offices in America, the dysfunction is palpable enough to cut through with a handpiece. It all stems from the top, doc. The word “doctor” comes from the Latin word “docere” which means “to teach.” Doc, you might be the only one in your practice who went to dental school, but you can’t be the only “teacher” in your practice – you maybe have three operatories but there’s only one of you. You can’t teach to everyone all the time! So delegate your teaching responsibilities. Your hygienists, assistants and front desk staff should be teaching your patients as well. Empower your staff! Great teachers take the incredibly complex and make it so simple to understand that they empower all who listen. Your hygienist knows what’s going on in a patient’s mouth. Your hygienist knows what she sees on the X-ray. She can point out some of the trouble spots to the patient. Give your team members purpose in their jobs. Your receptionist is the front line to your practice, and she should be able to share as much information as she knows with patients and potential patients over the phone.

My assistant, Jan, often tells me about how her job has given her so much meaning and purpose. She fights the good fight to take complex dental knowledge that she has mastered and getting patients to listen to her, because they know if they do they’re going to save their teeth. Then with this knowledge, they’ll go home and start brushing like they were powered by rocket sauce! If they do what Jan says, they’re not going to learn things the hard way by waking up in the middle of the night with a toothache or losing all their teeth. Stop hindering your assistants. Let them teach your patients.

When It’s All Said and Done
When you retire – or, when you die – how will you be remembered by your community? Will you have made an impact? Are you going to be the dentist they say “came to this community 40 years ago when the average six-year-old had three cavities, and now the average six-year-old has four”? How are you going to defend that one when you’re dead, huh?

Wouldn’t you rather people in your community say, “When Dr. Soandso came to this town, he started a denture every day, and when he left he was only starting a denture a month. When Dr. Soandso arrived, kids didn’t floss, now everyone flosses.”

People who trade money for time go home at night and escape with science fiction movies or alcohol or drugs or overeating or something else they need to escape from their dull lives. These are the people who constantly grouse and say they can’t wait until retirement. People who work with purpose die at their desks. Sam Walton, founder of Wal-Mart, was so driven to be the lowest-cost distributor in the world, he worked until he was found dead at his desk. Doctor, it’s time to remember why you got into dentistry in the first place! It’s time to realize or revive your purpose! The people who live and work with a purpose don’t need a 401(k). Know why? Because they’re not the type of people who want to retire.

I’m turning 50 this year, and one of the many things that still amuses me after living a half century on this planet is how a person’s thoughts and ideas evolve – sometimes progressing as we learn new information, other times reverting to old ways of thinking. And it is just as interesting to see how certain points of view change over time. In my first business class at Creighton University in 1980, I learned the return on stocks was about 12.5 percent on average, bonds were about a seven percent return and the ultra-conservative, risk-free government bonds gave you about a five percent return. And if you told me back then that 30 years later bonds would have outperformed stocks, I wouldn’t have believed you. Yet here we are!

While I was in dental school in the ’80s, up to that point in my life I’d never had a cavity. One day, one of my classmates, Dr. Paul O’Malley – who is now, in my opinion, one of the best dentists in Texas – did an exam on me and found eight sticky occlusals on my molars. He did eight amalgam fillings on me the very next day. Then in 1987, when I graduated from dental school, I got caught up in the cosmetic revolution. All of these “gurus” were running around telling anyone who’d listen, “Amalgam expands much more than composite, and that’s why they break all the teeth away. Patients don’t want black metal in their mouths anymore. This new composite material is going to bond the walls together and the tooth will be much stronger than if you used amalgam. Besides, amalgam has mercury and other poison in it.” I was young, got caught up in all the excitement and bought into everything they told me. God knows the patients wanted white fillings. I wanted to believe this beautiful, white filling was so much better than this black, metallic, ugly filling. Everyone wanted to believe it – especially me. A decade ago, I even went so far as to get all eight of my amalgam fillings replaced with pretty composite ones.

I don’t have too many regrets in the last 50 years, but replacing those amalgam fillings with composite fillings is one of them. Every single one of those composites is now a gold inlay or onlay. When those composite fillings failed one by one, I got tired of screwing around with it. I went all gold. If I want something to last the longest, I’ll go gold. But your patients can’t afford gold every time (or ever, in some cases). They’re also tired of coming back to your practice every 10 years or so to get the same tooth fixed and refilled with composite, since you don’t offer amalgam anymore.

It’s time we stopped fooling ourselves. Yes, everyone will continue to ask for composite because it looks good, but it’s time to start informing your patients about the risks and rewards of using a particular filling material. Because aesthetics is valued as much if not more than functionality, if you give a woman the choice between a white composite filling or a dark metallic filling that will last much longer than the white one, she will still choose the white filling 80 to 90 percent of the time. But if it’s a young man who’s starting a family, is extremely busy, barely comes in for scheduled appointments as is, and doesn’t want to keep coming back to get a new filling every 10 years, he might choose the amalgam. And me? Well, I’m a short, fat, bald guy, who, at 50 years old isn’t interested in doing anything cosmetically. This is as good as I’m going to look, gang! I’ll take amalgam any day (in fact I just did… Take a look at the the before-and-after photos on page 18. That’s me last month, baby)!

I’ve had enough of this all-or-nothing, extremist view on dentistry. Are you telling me you can’t place one amalgam in your office? You really think you’re a doctor of dental surgery placing only composite? There are seven billion people on the planet and you don’t see an indication for amalgam in your office? Let’s look at your own six-year-old boy who has an occlusal cavity. Why would you put a tooth-colored filling in there? Is it in the cosmetic zone? Who the hell is going to see it?

The fastest growing segment of the U.S. population is women 100 and older; the second fastest is women 90 to 100. Women are living longer, and coming with it is arthritis, dementia and medications that all but shut down their saliva production. They start getting plagued with root surface decay. So you are going to put in a completely inert composite restoration instead of an amalgam or a glass ionomer? Really? News flash: you can’t call yourself a doctor anymore – you’re an extremist! If you don’t have amalgam in your office – an option that is cheaper, easier, faster and typically lasts longer than composite – then, my friend, you’re an extremist. You can’t call yourself a doctor. You can’t call yourself a scientist. And you think you can call yourself a cosmetic dentist? What, on an 80-year-old lady with Alzheimer’s? Really?

It’s time we take a closer look at amalgam and start offering our patients a choice instead of forcing the cosmetic option down their throats. It’s time the debate took a fact-based turn for the better – for all sides!

This is a very special issue of Dentaltown Magazine. My editorial team and I are proud to present the close-to-definitive Point-Counterpoint debate on amalgam, composite and glass ionomer (see page 82). This process started when I met Dr. Michael Wahl – probably the dental profession’s foremost expert on amalgam. He said he wanted to put a little article together for our readers, which piqued my interest because I had been looking into more information on amalgam at the time. It was kismet, I tell you! There are very few dentists alive today who have done as much research on amalgam as Dr. Wahl, and we are very pleased that he wrote an amazing article for this issue. Dr. Wahl’s first draft was so large, it took him months to pare it down to its most essential points – and it’s still a beast! We also invited two of dentistry’s most outspoken professionals, Drs. David Clark and Lee Ann Brady to present the composite side of this important debate, because there are still some of you out there who have never joined the 21st century and placed composite. And we asked Dr. Umar Haque to discuss the oft overlooked glass ionomer angle. There are indications for all of these materials! It’s time to forego this all-or-nothing crap! It was our team’s goal to be fair, present all sides of the debate and then allow you to make up your own mind and join in on the discussion on the message boards of Dentaltown.com.

It’s amazing what you can find in old closets. I was cleaning out one of mine the other day when I ran across an old, dusty, beaten up Yellow Pages. The fact that it made its way into my closet where it lived for years and not immediately into the nearest trashcan is astounding! I even thought back to 1987 for a couple seconds as I shoved that sallow beast into the Hefty bag. How many of you recall placing expensive ads in the Yellow Pages?

When I graduated from University of Missouri- Kansas City dental school in 1987 the Yellow Pages was a total cash cow. Back then all the “older guys” wouldn’t place an ad in it because they thought it would harm their reputation. So, of course, in Howard Farran fashion, I did it in a huge way and it worked like a winning slot machine for more than a decade! But then every dentist caught on and it eventually started to break even and then lose money. Ten years ago my practice, Today’s Dental, had three full-page ads in three different phone directories. Today we have one small ad in our small local phonebook that covers my neighborhood of Ahwatukee in Phoenix, Arizona.

The slow and steady decline of the Yellow Pages was simply caused by the slow and steady rise of the Internet. And because Mom switched from the stale, static scarcity of limited paper ads in the Yellow Pages to endless Internet search engine results which link to an endless number of Web sites containing information ranging from meet the dentists to blogs on every subject, I now spend $500 a month just on pay-per-click Google ads!

We get so much bang for our buck with online marketing! On the other hand, there are a lot of moving parts with online marketing; things start to add up and it requires a lot of upkeep. You’re not just tweaking the content or the usability of your own Web site anymore – you also have to be mindful of social media, search engine optimization (SEO) and ads on Google; and then throw in all of the tracking that needs to happen to ensure you’re getting a decent return on investment (aka, inquisitive phone calls and new-patient appointments), you’re talking about a full-time job! Unless there’s a member of your staff completely devoted to your online marketing efforts, you’re probably not going to achieve the results you’re hoping for (read: “paying for”). I don’t know about you, gang, but I can’t afford to have one of my assistants or hygienists or even my practice manager spending time updating the practice’s Facebook status – times are tough, we’re a lean crew and we’ve got patients to tend to!

There are a lot of components to juggle and they all channel into the one most important part of online marketing – SEO. Becoming the top practice in a search on Google and Yahoo is the gold medal for every practice’s marketing plan. When someone types in “Ahwatukee dentist” we want our practice to be the first thing potential patients see. It’s what earns you the most new patients – the lifeblood of any dental practice.

The recent recession hit Arizona pretty hard; it was second in state home foreclosures after Nevada, and thousands of Arizonans lost their jobs. The dental industry in Phoenix was hit hard and more than 150 dental practices closed their doors. Some were my very good friends who opened their doors more than 25 years ago like me! But like I’ve written time and time again, when the going gets tough you cut your costs; lower your prices; join a few dental PPOs; add more services to your now smaller patient base like placing implants, using CAD/CAM, treating sleep apnea, incorporating Invisalign; and last but not least, you double or triple your marketing efforts.

The Yellow Pages died in my area, maybe your area is different but I doubt it. You will only know if you track it all meticulously! I went from creating my own dental office Web site in 1999 with my own full-time programmers to now outsourcing it to Sesame Communications because its team did it better than our team could do it internally. Building our B2B (Business to Business) Dentaltown.com Web site was an entirely different set of skills than building a B2C (Business To Consumer) TodaysDental.com Web site. The biggest reason was search engine optimization (SEO). Dentaltown.com does not show up on a Google search because it is a private dental Web site community (which, by the way, recently passed its 150,000th member). We do not want patients doing a search for dental-related questions and answers by trying to become a member of Dentaltown.com. That is not our focus and it’s not why Dentaltown.com exists.

I want patients who live in Phoenix, Arizona, “Googling” dental-related searches to land on my TodaysDental.com Web site, and that is what Sesame did for me in spades! I usually show up first, third and fifth on Google and Yahoo searches. Now my Web site and Google ads are cash cows!

It simply doesn’t make any sense to hire someone to handle our dental office marketing internally. The skill set to understand SEO is far beyond the scope of handing it as a part-time job to any one of my current staff members! People who understand SEO have to do it full time, just to stay on top of it, and all of the good ones earn six figures. I knew this was an outsource play and I needed to find an SEO expert. We needed someone who could be a master of this new, lucrative online marketing tsunami.

You are all likely familiar with my 5 D’s: 1. Design Your Plan; 2. Drop Everything You Don’t Need to Do; 3. Delay Everything You Can’t Drop; 4. Delegate; and 5. Do. This decision, obviously, falls heavily on number four – Delegate.

Since 2008 we’ve been working with Sesame Communications, which has overseen and worked on many of our marketing efforts from Web site development to tracking phone calls. I seriously thought I knew of what we needed to do to increase our SEO and be front and center in Google searches in my area. I was so wrong.

From the get-go my eyes were opened to the myriad components that work together to increase SEO. Did you know you have to have a presence on YouTube? Did you know you need to focus on creating a special mobile Web site for iPhone and Android users? Did you know the fresher your content, the better your SEO? Did you know you really needed your Web site to go live years ago instead of last week (yes, even that impacts SEO)? Did you know posting on Facebook and linking directly back to your Web site impacts SEO as well?

(Speaking of Facebook, I want you to “Like” my three Facebook pages so you can always see what we are posting on…
Today’s Dental: www.facebook.com/todaysdental
Dentaltown: www.facebook.com/dentaltown
And please follow me at www.facebook.com/drhoward to see my daily tips and where I will be lecturing again near you or some place fun in the sun!)

Because of our decision to outsource to a marketing company, we have coherence between our Web site and mobile site, search engine optimization, pay-per-click advertising and a social media strategy, as well as our patient portals and patient engagement tools. On average, we get 148 calls each month from our online presence alone – 41 of those calls can be specifically identified as new patients.

Because 30.43 percent of our prospective patients visit our Today’s Dental Web site before they make their first appointment (as shown by our Sesame analytics dashboard), we decided it was in need of a redesign. Our original Web site had become outdated – and it was merely three years old. With the goal of our site being to get patients to pick up the phone and call our practice, we worked with Sesame, who came to the table with solid research and helped us understand what content needed to be present, and what design elements would keep prospective patients on the site longer. Since we launched the new site in 2011, our bounce rate (the percentage of visitors who enter our site and immediately leave) has decreased from 47.79 percent to 40.52 percent.

And while mobile sites might currently make up a smaller percentage of online activity, it has been suggested that they will exceed desktop browsing in the next three to five years. Think about it, guys! How many of your friends own an iPhone or an Android? Probably everyone! It’s pretty rare to find anyone using a candy bar phone that only makes calls anymore. It’s for this reason we had to develop a mobile site. The mobile site gives patients an optimal view of our site. It reduces image sizes and contains only the information prospective patients need to make a decision, including links to appointment requests and click-to-call functionality. On average, our practice gets 17 calls per month from our mobile site with three of those calls specifically identified as new patients.

One of the key agreements we have with Sesame is improving SEO on popular search engines like Google and Bing. You can’t get to the top of a Google search and just forget about it. It’s a continuous method and it needs to be constantly updated – and every couple of years, the pesky powers that be at Google change up how their engine pulls up information. I’ve learned a good SEO strategy doesn’t just focus on the term “Phoenix dentist,” but also what are called “long tail terms” and terms that aren’t as popular. In September 2011, we decided to focus our efforts on improving our SEO for sleep apnea in Phoenix – and in three months we moved up 66 places.

We’re fairly new at integrating Google AdWords into our marketing plan, but basically when someone types in key words, like “Ahwatukee dentist,” our ad should come up first next to his or her search. Then you set a limit as to what your monthly budget is. The more you spend, the higher up your ad will appear. We spend about $500 a month, but a lot of the effectiveness has to do with how those ads are written. My practice would have a hard time doing it alone, because it is extremely time consuming to come up with new ad ideas and also to track the performance of each ad. You have to keep coming up with fresh content and you have to make sure your staff gets involved.

I was shocked to find out social media has a major impact on SEO as well. Facebook, YouTube and practice blogs all contribute to higher rankings on search engines. We designed our Facebook, YouTube and blog pages to match the look and feel of our Web site. Basically we feed Sesame bits of information about our practice from time to time, which they turn into Facebook posts. We also take 30- to 90-second videos and post them on YouTube, which Sesame optimizes within YouTube.com. Everything connects as well – so when we put a new video up on YouTube, we use Facebook to link to it, and also back to our Web site. Or maybe my associate, Dr. Michael Glass, will post a new blog about sleep apnea, and we will link to it via Facebook and our Web site. In the last five months, we’ve increased our likes on Facebook by 39 percent and we now have 233 percent more patients using Facebook to “check in” at our practice (aka, let all their friends know they’re at Today’s Dental).

(Before you write your next blog you should read our blogs for ideas! I actually think the best dental blogger in America is Alan Mead, DDS, and you should check out his site: MeadFamilyDental.com.) If that’s not enough mind-blowing integration for one practice to worry about – all of our SEO strategies work well into our patient reminder system. Through our practice dashboard, we know 13.3 percent of our patients prefer phone reminders, 4.35 percent prefer SMS text and 86.86 percent prefer e-mail (in which we’ve recently integrated a “refer a friend” button – which, so far, has been used by 13 of our patients). We give all of our patients the option to choose which reminder method they prefer. And all of this automation puts downward pressures on your number-one largest cost, labor!

And when all those calls start coming in, you need to make sure your staff is trained how to close each and every call by getting each one to schedule an appointment. One of the best guys out there to help you with this is Jay Geier and his Scheduling Institute. Jay and his crew just about doubled our close rate of newpatient phone calls. I know this because we can track everything with Sesame’s help.

You know why this sounds like a lot of work? Because it is! If you can manage all of these things yourself, do it! If not, I strongly suggest you work with a company like Sesame that can help you out. These are merely my suggestions to you, and I hope you consider them, that is unless you’d prefer your practice to end up old, dusty and unused in years like the Yellow Pages.

Back before the Renaissance and before Gutenberg’s press, just about everyone farmed. They did everything; raising cattle, chickens, sheep, wheat, corn and potatoes. They made butter and milk and every single farm was the most inefficient operation on the planet. Then people started getting educated, and when people started getting smarter, they started specializing. So rather than focusing on raising cattle and pigs and corn and all the rest of that stuff, they’d modify their entire farm to produce only wheat or whatever would best be produced on their patch of land – and productivity would go through the roof!

Think about health care, now. Even as soon as 1900 you had one doctor doing everything. He delivered your baby. He treated your cysts. He amputated your arm or your leg if you got an infection. He treated your gout. He did everything, and he sucked at all of it. Now look at where we are. In 2000, health care was 14 percent of the GDP, and about half of all practicing physicians are specialized. There is somewhere around 40,000 health journals published monthly around the planet, each one dealing with some specific part of the body or dreadful malady. If you have prostate cancer, you’re not going to see a doctor who treats all different kinds of cancer like breast, liver or pancreatic, you’re going to see a doctor who specifically treats prostate cancer and who has seen thousands of cases of prostate cancer. You’re a dentist. You’re a physician of the mouth. You know that doc who works next door to you who studied ears, noses and throats doesn’t know a single thing about the mouth.

With professions specializing as much as they have – even in the last decade – why are most of you working with a run-of-the-mill Certified Public Accountant (CPA) who literally only has one dentist as a client: you! OK, I’ll try to be fair here; it is likely that your CPA works with one or two other dentists, but you know what that means? Your CPA still doesn’t know a single thing about dental practices. When you’re looking for advice on equipment, purchasing, remodeling or expansion, you’re going to get a crappy, uninformed answer.

In the last 10 years, we’ve seen an evolution in accounting and there are now hundreds of CPAs who are highly specialized and focused solely on the dental profession. Those of you who are on the message boards of Dentaltown.com are likely aware of the most famous one – Tim Lott (tlott@dentalcpas.com). I’m really pleased that Tim is going to be speaking at the 10th Annual Townie Meeting, April 25-28, at The Cosmopolitan of Las Vegas, Nevada. Tim is part of the Institute of Dental CPAs (www.indcpa.org). This group has CPAs across the country who only work for dental practices. You also have another specialized group of dental CPAs called the Academy of Dental CPAs (www.adcpa.org) – founded October 17, 2001, in Scottsdale, Arizona – and they cover just about every geographical area of the United States. One of the larger CPA firms I’m aware of that works solely in dentistry is Cain Watters & Associates, PLLC, out of Dallas, Texas (www.cainwatters.com). For the best interest of yourself and your practice, I suggest you ditch your current know-nothing CPA and hook up with one of these cats.

(As an aside: Maybe your first step should be to ask your CPA how many dentists he/she works with. There’s a small percentage of you already working with a dental CPA, and for that you should be commended! But maybe some of you are working with a CPA who has 50 other dental practices as clients – and at least that guy might get you in the ballpark. I’ll write this again: if you’re the CPA’s only dentist, get out. Then again, if you’re the CPA’s only dentist and only cousin, that’s a bigger problem and I wish you the best of luck over the holidays.)

There are far too many variances between dental practices for a non-dental CPA to be able to give you any reasonable advice. When we look at overhead for dentists there is a huge variance from practice to practice. A solid comparison depends on whether you are in a small, rural farming village of less than 5,000 people in the Midwest or if you’re in a highly saturated urban area like San Francisco or Manhattan. You really can’t compare overhead in a rural area to an urban area. Same thing goes for rent or mortgage. It is so common in rural America for the rent or mortgage on your practice to be one to two percent of sales. It is very common for rent in Manhattan and San Francisco to be seven to 12 percent of sales. Dental CPAs know this. They track the variances and can give you a solid apples-to-apples comparison of your practice to others. And here you are using a CPA who only works with one dentist. You are crazy (maybe not as crazy as someone who isn’t working with a CPA at all, but still… crazy, man).

When you ask dental CPAs, “Should I expand? Should I remodel? Should I add an operatory?” they have spreadsheets and oodles of information at their fingertips that they can use to show you the return on investment, the difference between the return on assets and the return on equity, and how all of it would affect your tax schedules.

Let’s have another look at CAD/CAM. Every single dentist has considered this technology, but what exactly does it do. It lowers your lab bill at the outset, sure, but when you first get it, you might be taking two hours to mill a crown, eating into the time you could be spending with another patient. But then you have to take into consideration, if you keep working with CAD/CAM in your practice, you’re going to get better at it, and what took you two hours to accomplish might only take you one hour in a couple years. By then you’ll be making bank, drastically lowering your overhead and increasing your net income. Your dental CPA can help you make decisions that will positively impact your practice like that. They have the data from all of their dental clients that can aid you in making an informed decision. This is called benchmarking.

Toyota, Honda, Ford, Nissan, Kia and General Motors are all obsessed with what each other are doing. They benchmark each other to death! Benchmarking is done in pro sports and every other industry – even in dentistry. You compete with the guy down the street for your patients’ business. Don’t you want to know how you rate? Don’t you want to know where you excel and where you need to improve? Stop using a general CPA and get with one who is specifically involved with dental practices.

Guys, I see the traffic on Dentaltown.com. I know what you’re into. You really want to learn how to do fillings and crowns and root canals and you’re completely obsessed with the “make something” part of business. You all know you have problems with the “sell something” part and as for the “watch your numbers” part, you’re horrible at it. Usually if I ask a dentist, “Who watches your numbers?” I hear, “Oh, it’s my brother-in-law,” or, “It’s my cousin. He gives me a good deal.” You get what you pay for, gang. Since you’re bad at watching your numbers, you need someone who’s going to hold your hand and help you through it. You need to go to a dental CPA who can sit you down and tell you how your practice rates based on information he’s gleaned from working with hundreds or thousands of other practices.

When you’re working with a dental CPA, they can tell you exactly what you need to do to become more profitable because they can compare your practice to all of the practices with whom they work – successful and non-successful alike. Your dental CPA can tell you if you’re spending way too much on hygiene labor (or not enough), if you’re too high on supplies, if you’re low on assistant labor, if you should purchase CAD/CAM to lower your burgeoning lab bill and how much cash you should be socking away for your future in case you ever feel like it’s time to retire.

It’s time to wake up, gang. We know how much we like making dentistry; it’s what we spent eight years in school for, it’s why we take CE courses to maintain our licenses and improve how we practice, and it’s what gets us out of bed every day. But we all know how much we collectively suck at selling to our patients what we do (that’s another column completely), and we’re fully aware how much we abhor watching our numbers to ensure that what we’re doing is keeping our practices thriving. So if you’re not going to watch your numbers, get someone on your team who will, and make damn sure he or she is as in tune with dentistry as you hope.

I find it extremely amusing how every dentist knows what the politicians on Capitol Hill should do to balance the budget and improve things for the USA. You say they need to cut overhead, scale back entitlements, raise taxes and deregulate. But, here’s what you need to understand: our government is paralyzed. They’ve seen what happens to smart guys who made difficult and calculated decisions that focused more on our long-term sustainability – instead of shortterm, ill-thought-out band-aids – and then lost the next election because of them. The government is not going to do what you know it needs to do to right the ship; the funny thing about all this is while the government isn’t making the tough decisions you know it needs to make, you’re not making any yourself. You all know how difficult it is to do effective dentistry, run a practice, keep paying your mortgage and keep food on the table these days. Do you really even need a reminder about this crappy economy? Here are a few things I see going on in dental practices around the country that make me think some of you need a wake-up call.

Get Your Staff in Gear
When I attend an Arizona Cardinals or Phoenix Suns game with certain dental colleagues who rant and rave about how stupid the team is for keeping certain players on the roster and that they should trade this guy for that guy, I get angry. While they’re going on and on about pro sports, I’m sitting there thinking to myself, “Are you kidding me?! Your receptionist is quite possibly the most slothful human being on the planet and you are fully aware of this, but even after 10 years she still does the same awful job for you, and you let it continue. You really think you can run the Arizona Cardinals? You can’t even run your own practice!”

Why is it some of you have the laziest, most unmotivated, dysfunctional staff in the world, but you hang onto them because of some emotional connection or because they’ve been with you for five years? Guys, listen up, it’s time to make some tough decisions! You need to evaluate your teams. What have they done for you lately?!

It’s tough out there, so it’s time to get tough! Some of you give your staff a dollar raise every time the earth travels around the sun. Your entire pay structure is based on the zodiac. Doctor, if you work hard, you see more money because you’re the dentist and you own the joint. Your bottom line directly correlates with your performance. Your staff doesn’t care if it works hard or not because it keeps getting paid no matter what. They are trading time for cash! It’s time to knock that off. Staff incentives need to be based on production. You need to make the decision and say, “I used to provide a 401(k). I used to provide health insurance. I used to give you a dollar raise every year but I am not doing any of that anymore until our collections reach this dollar amount.” Get your team focused. Give them the same incentives you chase. If the practice does well, then everybody does well. Let your staff know you are only collecting $50,000 a month and until it gets up to $60,000 not a single raise or bonus will be given. That’ll separate the wheat from the chaff pretty damn quick.

Get Personal
I tire of the complaints from doctors who say their practices are failing, but they drive a wicked sports car and live in a high-falootin’ mansion in the ritzy part of town. If this is you, take a good look at yourself in the mirror, doc. Think you made some good decisions? Are you not making tough decisions because you’re afraid how your wife is going to take it when you tell her it’s time to rein in your household spending? Are you afraid of disappointing your oversized ego by downsizing your house and trading in your BMW for a practical car? We hear over and over how important it is to market our practices to get more new patients, and I know a handful of dentists who say they can’t afford to undertake a marketing campaign, yet they lease a Mercedes Benz at $1,000 a month! Are you kidding me?!

Maybe putting your Rolex up for auction on eBay is a good idea. Not just because you’ll pick up a couple thousand dollars but because maybe you’ll start to understand you’re personally spending way too much. I’ll borrow a line from the movie Fight Club: “the things you own end up owning you.” You don’t need the boat. You don’t need the vacation condo. You don’t need the fancy cars. You don’t need a membership to the country club. You can’t afford a stay-athome spouse. You can’t afford to go out to eat four nights a week. You need to sit down and figure out how to cut your personal expenses because they’re also eating into your practice’s bottom line. Seriously, how good does it feel that you bought your wife that Gucci purse? That’s $5,000 that you could have reinvested in your dental practice. You could have bought two or three AMD Lasers for what you dropped on a handbag.

You need to deploy some capital and do some serious investing in your office. I have written about investing in CAD/CAM until my fingers bled. We’ve got continuing education courses about cone beam computed tomography (CBCT) and how nobody wants to go back to using 2D X-rays like a pano or a PA after using 3D CBCT. Why can’t you pull the trigger on these new technologies? Because you – just like your neutered congressmen – feel more comfortable kicking the can down the road another mile hoping things will change. Nothing is going to change until you start making some tough decisions.

Get Marketing
Every time you eat out for $100 that could have been $100 worth of Internet ads on Google or Facebook. My dental practice runs advertising on Google and Facebook and they cost us about a dollar a click. I would rather have 100 clicks to my dental office’s Web site than a fancy dinner. You need higher patient flow, which equals more cash. Every time you are supposed to go out to dinner, go to the grocery store and buy a box of Kraft Mac & Cheese for a dollar instead. Then go home and buy $100 worth of advertising on Facebook. The smaller your market the more effective your ads will be. I live in an area of Phoenix, Arizona, called “Ahwatukee,” and there are 3,600 people on Facebook that have Ahwatukee in their profile. Every time those 3,600 people log onto Facebook they see my ad. Most of the activity on Facebook is from women, and women make about 89 percent of all dental appointments. You can put two and two together…

Get Learning
We have 4,000 periodontists in the United States and every single one of them does a crown lengthening procedure every single day and you don’t even know how to do it? Why don’t you sell your Rolex watch, get on an airplane and fly to some pig jaw course that teaches you how to do crown lengthening especially because insurance pays 80 percent of it. Spend a little of your money wisely on new technologies or CE courses that make you better at dentistry in order to make more profit for yourself and your practice!

Get a Move On
I recently had some long, over-the-phone conversations with two despondent dentists. They are both from a town of 5,000, and the only factory in town – which employed all of the townsfolk – closed down a year ago. The town is drying up and 80 percent of their insured patients were people who worked at that factory. Now those people are not only unemployed but they are leaving the city because there are no job opportunities in town, they have no money and they need to downsize. I listened to these two doctors tell me they were born in that town, married in that town and their kids were born in that town. I told them it was time to make a tough decision. I told them they needed to move, plain and simple. I said, “Look at your ancestors. Damn near every American immigrant made a tough decision 50, 100, 200 years ago when they were sick of living in the country they were in. Maybe they hated the king or the noble landlords. Maybe they were squatter peasants and despised their lives. They knew about the opportunity in America and left everything they had behind. With just the shirts on their backs they took a boat ride for six weeks and landed on the shores of America with nothing (if they survived the journey) just for the mere opportunity for a better life. And you are afraid to leave a ghost town that used to have 5,000 people and move an hour away or to a different state for better economic stability?”

Get ’em Out of Your Pocketbook
Another thing I hear all the time that continues to bother me is dentists telling me they are about to literally go broke by putting their kids through college. Here’s what I say, “Doctor, did your dad pay for college? He didn’t? OK, does your son in college even have a job? No? Does he have an iPad and an iPhone? Does he have a credit card? Are you paying his car insurance? Why don’t you do your son a favor and tell him after this semester he is on his own. I was on my own, I made it, and I was a better person for it!” I would put all of my eggs in the basket of a self-made man any day over some daddy-did-it who was born with a silver spoon in his mouth.

Some of you have heard of the Five Ds. Design your plan. What do you have to do? What is your tough decision? Number two, drop everything that doesn’t matter. This isn’t the time to be in the Kiwanis Club, guys. This isn’t the time to be coaching your kids’ little league team. Get focused back on your business! Let’s delay everything we can’t drop. Let’s delegate everything that can be delegated so you can do your plan. Guys, the feather in your cap is this – unlike your government, you don’t have an election to worry about every four years. You can make the tough decisions to ensure your personal and professional success. Stop trying to make nice with everyone and start acting like a boss. If you and your practice fail because you didn’t make the tough decisions, do you think they’re going to help you out? No, because your staff is now out of a job and hates you for letting the practice tank; you were your family’s bringer of bacon, and they know nothing but “spend.” It’s time to end this craziness. The buck starts and stops with you.

I’d love to hear from those of you who were recently faced with making a tough decision – whether in your practice or on the home front – and I want to know what the outcome was. Send me an e-mail at howard@dentaltown.com, or post your tough decision on the message boards of Dentaltown.com or in the comments section under this article on Dentaltown.com.