Wednesday, April 19, 2017

The Dental Admission Test: Not Just an Entry Test

Does anyone remember the Dental Admission Test, aka, the DATs? For the nondentists, it is exactly as it reads: an admission test that must be passed successfully to enter dental school. Yes, I know I should have blocked it out of my memory once I saw that I had passed, but I thought about it recently. 

The other day, I found myself — mouse in hand — staring at a two-dimensional screen but manipulating a three-dimensional tooth model. For those of you familiar with CAD/CAM, you know what I am talking about. Rotating, smoothing and shaping these “models” of virtual teeth and their future restorations is not exactly easy. I wanted to reach in through the screen and simply handle the models with my own hands. And that’s when I remembered the last time I had those thoughts: when I was sitting in front of a computer screen taking those dreaded DATs.

The test included a section that examined a student’s understanding of spatial objects, and the skill required the test taker to think in three-dimensional ways. That section is called “perceptual ability.” At the time, I’ll admit to sharing stories with friends about that section, and if anyone is familiar with triathlons, it’s much like the swimming portion of a triathlon — you just get through it and move on to the next sections. Some of us weren’t thrilled about that part. In fact, some of my friends didn’t see the connection with dentistry at all.

Seventeen years after taking the test, I think it was smart to include that section in the test. The entire field of dentistry is based on acquiring and developing perceptual ability. It sometimes seems as if we deal with much more than three dimensions and don’t necessarily see them most of the time. Negotiating a root canal or extracting teeth are examples of “imagining” multidimensional anatomy, if such a thing is possible. In fact, even giving a routine injection demands imagining where tiny cylindrical nerves are located within a mass of bone layered with tissues.

Entry requirements to dental school might have changed since my time. During dental school, I was actively involved in the predental arm of the American Student Dental Association (ASDA) and had been a resource for predental students at my alma mater. It was so gratifying to mentor students who are grumpy about the tests and subjects they are taking to enter dental school. I was basically telling them that they weren’t a waste of time. That they actually do relate to the profession in one way or another and more so, with the evolving technology within the profession. If there’s a student out there who barely passed the perceptual ability part of the DAT, you bet you’ll be tested on that endlessly on the first day of clinical dentistry. From mentally folding cubes on one screen to mentally milling a crown on another almost two decades later, my perceptual ability is still being tested.

Zeynep Barakat, DMD, FAGD

Wednesday, April 12, 2017

Asking for Referrals: The Most Powerful Marketing Tool in the World

In last month’s blog post, “Systems for Success,” I noted that there are more than 300 systems or procedures (excluding clinical) in any dental office that when properly designed, implemented and rehearsed serve as the blueprint to success. In fact, after reviewing hundreds of dental offices, including my own, I have found that well thought-out systems and protocols are at the core of highly trained teams who deliver excellent dental care, supported by superb customer service. 

Intuitively, this makes sense. As dentists, we were taught clinical procedures in a step-by-step fashion. For most of us, it goes something like this: seat the patient; ask if there is any change in the patient’s health history; take the patient’s blood pressure and heart rate; place topical anesthetic; deliver local anesthetic; use the No. 557 bur; remove decay; place matrix, wedge, etch, primer and adhesive; use a light cure, etc. You get the point. When delivering dental treatment, we progress in a logical and systematic way that yields excellent outcomes most of the time. What about the nonclinical side of dentistry, though?

Analogous to the systematic manner in which we provide clinical dentistry, every dental business should possess step-by-step protocols how to answer phones, provide financial options, present recommended treatment, collect monies, schedule patients, address medical emergencies, transfer patients from one employee to another (handoffs), ask for referrals and many, many more. In other words, dental professionals follow each business’s individual recipes, committed to writing, that when combined lead to predictable and meaningful outcomes — the seamless and impeccable kind of outcomes that patients rave about.

New patients are the lifeblood of the dental practice
In this blog post, we will look at one of the most powerful marketing systems in the world, a form of internal marketing that begins by learning to ask for referrals. Asking for referrals is a recruitment method for acquiring new patients that invites your existing patients to refer colleagues, family and friends to your business. Sound simple? It should be. However, it is one of the most overlooked marketing strategies in the dental business, with less than 10 percent of dental offices employing this technique regularly. Why? Various surveys and my own experience reveal that most dentists and dental teams assume their patients will automatically share good words about them, and they simply don’t think to ask. Others report they don’t believe it is important enough or they are embarrassed to ask. Some believe they don’t need new patients. This simply does not make sense.

As many of us know, new patients are the lifeblood of any dental practice. Why? Because of attrition, or the normal loss of patients associated with moving, relocating, loss or change in insurance, unemployment, divorce, death and numerous other causes. In fact, the median attrition rate for solo practitioners in the United States is 3 to 5 percent annually. For example, if a dental business has 2,000 active patients, defined as anyone who has been in for treatment within the past 18 months, then they can anticipate losing 60 to 100 patients per year due to normal attrition. As a result, it is important to offset this loss of patients by adding new patients to replace them and help the practice grow. In the ideal situation, the astute businessperson realizes that by adding quality patients, or what I refer to as “A/B” patients (who arrive on time, pay their bills, appreciate you and your team, are not insurance-driven, etc.), they can predictably grow a patient base that appreciates and values excellent clinical dentistry and five-star customer service — a means to a recession-proof dental business, not a company dependent upon external marketing campaigns whose precursor is to attract price shoppers looking for the free prophy, $300 dentures or $400 crowns. Value-added patients create tremendous goodwill and substantial profits so when it comes time to sell your practice, you reap the rewards of hard work. In a March 1, 2017, The Daily Grind blog post, “The Profitability Factor in Selling a Practice,” blogger Andy Alas, DDS, was kind enough to share his own experience regarding potentially selling his practice. Thank you, Dr. Alas.

In his national best-seller, “Influence: The Psychology of Persuasion,” Robert B. Cialdini, Ph.D., outlines the six laws of persuasion and explains the psychology of why people say “yes.” Dr. Cialdini is the originating expert in the rapidly expanding field of influence and persuasion, whose teachings are circulated worldwide. Two of the laws, the law of reciprocation and the law of liking support, address “asking for referrals,” noting that people buy from people who are similar to them and from people they like. We have all heard the adage “birds of a feather flock together.” This proverb dates back to the 16th century and can be interpreted as people who have similar interests and characteristics or who like to socialize together.

Recently, the Levin Group reported its results of a survey of dentists. It revealed that 88.3 percent of respondents stated that “referrals from current patients are the most successful marketing method.”

Our findings and data are very similar. This form of internal marketing ranks at the top of marketing strategies and delivers the most predictable results.

“Birds of a feather flock together”

In 2015, a worldwide study (in more than 100 countries spanning five continents) by The Nielsen Company. looked at consumers’ trust levels and how they relate to purchasing services and products. The results were unanimous. Family, friends and colleagues are the most trusted source of referrals in the world. It doesn’t matter what the product or service is. It is a universal finding.

In summary, asking for referrals is the most powerful and unequivocal manner in which to grow a successful and prosperous dental business. The chances of your most esteemed patients having friends like them are very high. These are the patients for whom you and your team should target your request. Begin today by asking your team to develop a script, or what I prefer to think of as learned verbal skills on how, when and whom to ask for referrals. Some key points to include:

  • Only asking patients who are ideal and represent the value you and your team deserve.
  • Asking your team to take action and develop a few key phrases that can be used when asking for referrals. 
  • Looking for opportunities keying on patient compliments. 
  • Soliciting comments. Upon checkout, have your front desk personnel ask patients about their visit. If the response is excellent, ask for a referral. If the response is poor, address the patient’s concern and attempt to resolve the issue before the he or she leaves the office and reviews your business on social media. 

Why do less than 10 percent of dental offices routinely ask for patient referrals? I am not sure. However, for those that do, congratulations. The best part about asking for referrals is that it is free — and it delivers the most predictable results.


Friday, April 7, 2017

Be Careful What You Wish For

You’ve heard dentists say, “I want to be busier.”

But have you noticed how much busier you are these days? Yes, dental practice owners are busier than ever. Perhaps they’re not always treating patients, but they’re definitely busier.

Each of us probably has an extra, unpaid part-time job. Like most things in life, being busier came about slowly. This dawned on me when I began to spend a lot of time in front of a computer screen long after my family had gone to sleep.

Here is the premise: Why would a corporation pay someone to accomplish several tasks when it could, instead, have a highly educated doctor do it for free? We, as dentists, are now doing jobs once held by others.

I first noticed this trend several years ago with concert tickets. Some of you may be old enough to remember standing in line to purchase tickets to see your favorite artist. Then the internet came along. Now, you don’t have to physically stand in line. However, you do print the ticket using your own computer and ink. Now, you pay a “service charge” for the privilege of doing this. You are now doing a job once held by someone else. Of course, the ticket companies said this would lead to cost savings that would be passed on to you, the fan. I don’t think it has quite worked out this way.

As far as being a dentist, it used to be that my office business insurance policies were audited once every few years. My turn would come around after several years because it was too expensive for the insurance companies to audit everyone each year. They would have to hire someone to contact me, receive whatever information I had to supply, analyze it, etc. This, of course, cost them money. Not anymore. They can now have a person holding a doctorate degree do this for free each and every year. They require me to log in each year and input all of the numbers for them. It requires no effort on their part, no real expense. We, as dentists, have become their unpaid data-entry professionals.

Remember the days when you would call payroll? Someone would take your data and process your payroll. Now, either you do it on your computer, or your staff does it on the web. You either have become the payroll specialist, or you pay for one on your staff. Again, you are doing the job once held by someone else.

Even companies that you pay to help you keep up with government regulations have joined the game. They used to send you the printed updates for you to include in your office handbooks. Now they just send you a letter with the links for you to locate and print them. Yes, you do the work of printing and collating all of this documentation. You perform a job once held by someone else.

Recently, I had the State Department of Radiological Safety contact me for an audit. The state wanted to make sure our X-ray machines were up to par. No problem. I asked, “When do you want to come in to inspect our X-ray machines?” No, instead, I was sent all the materials so that I can expose the special film myself and mail it back. Again, the state either has a highly educated doctor do the job for free or has this same doctor cover the salary of the person doing the job that was once held by someone else.

Lastly, we’ve all had the same experience while traveling by airplane. It used to be that a travel agent would acquire your flight ticket. Once at the airport, someone would check in your luggage by placing that destination sticker around your luggage handle, then print your boarding pass.

These days, why pay all of those people when the airport can have you do it for free? Now, you purchase your tickets online, you print them, you print your own boarding pass and, once you’re at the airport, you tag your own luggage. As I’ve often said to my wife, “Pretty soon, they’ll have me flying the 747 myself.” Here I am preparing for that day:

(The gentleman on the right is a 20-year airline pilot. I’m the guy on the left. Sure, it’s a flight simulator, but I’m getting ready nonetheless.)

You’ve often heard dentists complain about not being busy enough. As the old saying goes, “Be careful what you wish for; you just might get it!”

Andy Alas, DDS

Friday, March 31, 2017

Systems for Success

Beautifully designed systems enable a well-trained team to deliver excellent dental care and superb customer service. Everything a team member does needs to be documented, rehearsed and mastered to ensure excellent results. Systems or standard operating procedures (SOPs) should be maintained in the practice’s operations manual and used for training new employees, continuing education, measuring employee performance and providing direction for the entire staff. Employees appreciate systems that are clear and concise and provide direction so they can perform to their utmost potential. Detailed systems that are adhered to help alleviate vague and ambiguous scenarios. They also help provide clarity and guidance that leads to increased efficiency, accountability, quality output and uniformity of performance.

Systems incorporate every operational protocol in a dental business. The level of success for the business is directly correlated to the quality of the systems and team’s overall effectiveness. Well thought-out systems include step-by-step instructions on how every aspect of a dental office should run. Excellent systems are analogous to a great recipe that yields predictable outcomes through step-by-step instructions. There should be systems for how to answer the phone, process payments and ask for referrals; systems for well-designed hand-offs that motivate patients to seek treatment; systems for how to turn over a treatment room; and systems for how every clinical procedure should be performed. There also should be systems on how to evaluate business metrics and data that incorporates the practice management software, marketing, insurance, phone call conversion rates and personnel. In fact, there are about 300 systems that should be part of every dental office. Can you imagine a pilot jumping into the cockpit of a beautiful Boeing 787 bound for the other side of the world without checking to make sure all systems are operating properly? Without systems, a business is flying blind.

Developing systems that work is not an overnight task, nor is it easy. Companies such as Starbucks, Alaska Airlines and The Ritz-Carlton have accomplished earning world recognition through the delivery of fantastic customer service and satisfaction. At the core of their excellence are integrated systems that promote teamwork and empower employees to reach their ultimate potential.

While it takes time to develop and implement systems, the rewards are well worth the effort. Having a sound financial system that maintains high cash flow is one simple example that can eliminate devastating financial results. Cash flow is critical to any business, and in dentistry, the outstanding accounts receivable (A/R) ratio should never be greater than the average monthly production. In other words, the total outstanding A/R ratio should be < 1:1.

Have you ever had a patient in the chair for multiple extractions, alveoloplasty and delivery of immediate dentures, only to learn that the prosthesis is still at the dental lab? How does this happen? Is this an employee or a system deficiency? Usually, this a result of poor systems and not the employee — at least, if the business has hired and onboarded personnel with the use of systematic hiring procedures that includes background checks, verification of references, team interviews and much more. In fact, insufficient training for new personnel is one of the most overlooked and undervalued aspects of most employers.

As an industry, we can do better. High employee turnover in the dental office can be demoralizing and expensive. Patients do not like to see new employee faces each and every time they come in the office.

If you do not have a comprehensive operations manual with standard operating procedures in place, then I highly recommended that you begin to develop one as soon as possible. This can be a team effort, or you can get help from a dental analyst or consultant who has experience in operating manuals and systems.


Tuesday, March 28, 2017

Extending our ‘Best Before’ Dates

Among the many things I have enjoyed in my lifetime, I have had the opportunity to appear on stage as a stand-up comedian. Personally, I find a lot of comedy routines today to be filled with objectionable language or focused on insulting certain groups or too topical and, thus, not enduringly funny. Me? I just wonder about things, such as:

  • If you leave sheep out in the rain, will they shrink?
  • How does one plant seedless grapes? 
  • Why do we park in the driveway and drive on the parkway?
  • Does mystery writer Stephen King ever have nightmares?
  • If you make a cow laugh hard enough, will milk come out of its nose?
  • If sour cream is milk that has gone bad, why does it have an expiration date?

Oh, I’ve pondered these things and more. A lot more. I’ve been collecting this kind of stuff for years. It’s fun and really different to do so. But it was that expiration date joke that especially resonated during a recent patient visit.

“Sandy” is a retired school teacher, now well into her 70s. Her recent health has not been ideal. First, she had a cancer scare with a diagnosed tumor. It was removed surgically and found to be benign. Then, shortly after recovering from that surgery, she had her right hip replaced. And last week, she walked into our office, with a normal gait, looking and feeling well, but her oral region had taken a beating due to long hospital stays and intermittent home oral health care. Thankfully, we were able to restore her oral health simply and inexpensively, due to her lifelong habit of seeing us regularly. 

But it was her comment at the end of the appointment that had us all laughing. She commented that she has now entered the period of her life known as her “best before” date. She was bright and cheery stating this, and we thought it was a delightful way to look at aging.

Many of you may also know I am an avid “Star Trek” fan (my favorite TV series is “Deep Space Nine”), and I have been subscribing and listening to the free podcast, “Engage: The Official Star Trek Podcast.” In a recent episode, the host, Jordan Hoffman, was on the first-ever “Star Trek: The Cruise,” and interviewed Ethan Phillips, the actor who portrayed the character Neelix on “Star Trek: Voyager.” I had no idea before listening to this, but Phillips is a funny man. And on this cruise (which I was unable to attend), he held a session to teach people about the art of comedy. Oh, to have been able to attend that session. In the podcast episode, Phillips told a joke (which I cannot repeat here) that illustrated the importance of how words are used in a certain way for dramatic and/or comedic impact. It is the basis for some of the comedy I use in my keynote talk, “Success Is All about Relationships.”

In the January 2017 issue of AGD Impact, AGD Editor Roger D. Winland, DDS, MAGD, wrote about keeping frustrations in perspective. Having a lighter heart, seeing life through the eyes of others with an attitude of abundance, and connecting and enhancing the relationships with our patients will bring us more success — and extend our “best before” dates to a much later time in our lives.

Larry Stanleigh, BSc, MSc, DDS, FADI, FICD, FACD, FPFA

Monday, March 20, 2017

Part 2: What Defines a Successful Practice?

This is my second blog post in which I strive to define success through my eyes. In my previous blog post, I talked about how I feel like success is always measured in dollars. (If you haven’t yet read it, I recommend you do. It is a must-read. I mean: Pulitzer Prize-type stuff.) I also discussed that while making money is important, regardless of how much money you make, it will never be enough. With this in mind, I have changed my definition of success, and I now measure success in the intensity of my happiness.

I love coming to work every day. I actually like and enjoy all of my staff members (most of the time). I love doing dentistry, and I like most of my patients. Now, I don’t know about you, but I feel pretty successful in light of these things.

Today, I want to tell you about my practice. Now, it is probably going to seem different from yours and even different from some of the other bloggers’ practices. (I know Dr. Murry has multiple offices, but the funny thing is that when I read his blog posts, I feel like I could have written them because we think the so much alike.) I have a relatively small practice. This is how it started: I joined my father’s practice about 22 years ago, two days a week. I began working full-time in a little more than 2½ years later. (Joining your father’s practice has its good and its bad components. This is a story for a different blog post series.)

My father allowed me to buy 25 percent of the practice after eight years of being an associate. Four years after this, he allowed me to buy another 25 percent. At this time, my father was about 60 years old. It took a couple more years, but he started to allow me to start making decisions.

And it took a couple of more years before he was coming into the office less. Then, a natural evolution of the office was starting ... and it was starting to look a lot like my practice, the product of my vision — after 15 years of working there.

I bought 100 percent of the office six years later. That’s right: I was 42 years old before I owned the practice. (See, I told you that there were both good and bad components that go along with working with your dad.) My father was my associate for a year and a half before he fully retired.

As an aside: When my father retired, I brought in an associate, and after about a year, he bought his own practice and left. (Again: This could be the topic of another blog post series.) This is when I decided that I was just going to work by myself for some time. (I probably will never hire another associate until one of my kids becomes a dentist or before I am about to retire.)

I have eight rooms in my office. In my practice, I work with three hygienists, but I only have nine hygiene days. I have a four-day, a three-day and a two-day hygienist. Every day, I work with two hygienists, and one day, I work with three. I work four days a week, so that means on the days I am in the office, there are at least three empty rooms, and three days a week, there are four empty rooms. And I have no desire to fill them with patients or staff. (I did work something out with an orthodontist, and he is now working one day a month and is trying to build a practice out here.)

I take only traditional dental insurance. These are the insurances that involve you picking your own dentist, and you go, and they pay a certain percentage. I am not on any PPO or HMO networks.

I am not on any lists, and if the patients have one of the above and they want to come here, we will take the out-of-network benefit, and they will be responsible for the rest. We know that this means that a lot of people are going to be paying out-of-pocket to come to our office. So we have to make a practice that is worth visiting.

For this reason, there has to be a perceived difference between us and the dentist down the street who is within their insurance network. This is how I try to make my office stand out from the others. Our office has to be warmer. We have to have perceived technology, whether this means monitors mounted on the ceiling, an intraoral camera or digital X-rays. The people who work here have to be nicer and friendlier, and they have to be “service above self” people. We are a service profession, after all! How many offices don’t serve patients well? In how many offices is it about the dentist and not about the patient? I think when you go above and beyond, people are going to notice. And it is not that expensive to do so.

Pictured is my reception area. I bought at least four of the chairs on clearance. The massage chair was $300, and I recently reupholstered it. A patient made me the armoire. I bought the little fridge on clearance. And so on.

And the only other thing I think is important is me and remembering to always put the patient and the practice first. It’s important for me to be all of the above: warm, nice, friendly and all about service. Look, to me, this profession is about building and maintaining relationships. I have always said, “Patients don’t care how much you know until they know how much you care.”

You have to get be able to talk with the kids. You have to be able to relate to Grandma. You have to be able to have a conversation with Mom — not your assistant, but you. Yes, it’s important for you, not your assistant, to go out into the reception area, sit next to Mom and have a discussion. You have to remember that your patient’s 50th birthday is next year and that your 65-year-old patient is retiring in April (so that you can send him or her a birthday card and a congratulatory gift card, respectively). You have to notice someone driving into the practice parking lot in a new car — go out to the parking lot and tell the patient how awesome it is. Talk their language; ask them, “How many miles do you have on that baby?” Are you starting to see a theme? It is about them, my patients — not me. I have learned that people just want to feel known and special.

Yes, this is a lot to do. And if you are thinking that you have a schedule that is so packed that you have no room to talk with patients, well, then I would think about changing that. I know some of you are not good at this. Chit-chatting with patients may not come naturally for you. I get that. Some dentists are introverts. My advice is to “fake it until you make it,” as they say. Give talking with patients a try. Or enlist the help of your staff members. Remember: People just want to feel special.

John Gammichia, DMD, FAGD

Friday, March 17, 2017

Striving to Be Like the $350,000 Man

I read an article a few weeks back — when my beloved Pittsburgh Steelers were still in the playoff picture — about how linebacker James Harrison, at the ripe ol’ age of 38, spends $350,000 a year on maintenance, conditioning and recovery of his body. He’s still making body-shivering collisions with players who are half his age and remains at the top of his game, so it clearly works. He’s even got the NFL baffled at how he’s able to do it — and is drug-tested more than any player in the league because of it. But $350,000?! That’s on top of the stellar treatment provided to him as part of his contract with the Steelers. Wow!

I bet that I won’t spend $350,000 on care, training and recovery of my body in my lifetime. Hence, the reason I’m a dentist and not a professional athlete, I guess. But there’s a message within that amazing statement, or at least I took it as such. It’s time to make yourself a better dentist and person. I don’t recommend making it a $350,000-a-year venture, but invest some time, energy and money into yourself. I put together a hefty list of things I want to change for the better this year, both personally and professionally, and I intend to crush it, much like Harrison crushes his 5:30 a.m. workouts daily — even getting one in in the morning after arriving back from Kansas City at 2:30 a.m. That’s dedication, people.

I intend to be a better clinician. I’ve put together a significant continuing education schedule for the coming year. I’ve increased our marketing efforts fivefold. I intend to set a new bar for communication with my team members. I also intend to reset my attitude dial at morning huddles, before coffee enters my bloodstream — all in an effort to make myself a better boss and provider to my staff and patients.

On the flip side, I’ve set equally high marks for my personal life. My time at work needs to be kept within a well-defined window of time, and my time at home with my young kids needs to be quality, connected, invested time. I too often hear dentists get up and speak at lectures about how they wish they could have their first 10 years of practice back, mostly because of the experiences they missed with their families. It’s understandable and something that’s a constant battle.

Add a 6 a.m. workout a few times a week, regular chiropractic visits and a massage once in a while, and it becomes more difficult to achieve these goals due to time constraints. But I’m focused on overcoming obstacles to achieve my mission. (And, man, I could have a masseuse on staff for back massages between every patient for less than $350,000! Wouldn’t that be the life?)

Push your boundaries for the better, people. Work hard, love hard, recover hard. Make it your mission.

Donald Murry III, DMD


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