Setting your Dental business up for success or setting it up for stress are two very real alternatives in today’s uncertain economy.
On the one hand there exists the opportunity of dealing only with patients who seek out and value your services and your skills.
In this environment there is no intermediary.
You perform a procedure. For that procedure you charge a fee. And your client pays you that fee for performing that procedure.
There is no middle man.
There is no intermediary.
There is no third party person telling you what your patient can and cannot be “entitled” to.
There will always be a percentage of the population who will seek out this sort of relationship with which to do business.
This section of the population are so happy with the service that you provide that they consider your fee to be such exceptional value that they have absolutely no desire or care to find out what your competitors are charging.
The other type of Dental business involves the intermediary.
You treat patients based upon what the intermediary says they are entitled to.
Often the intermediary is not a clinician let alone a physician.
The intermediary is a bean counter at best who decides what parameters they [the intermediary] wants to stretch to produce maximum profitability for the intermediary.
With total disregard whatsoever for health.
“F#@%ing HMO Bastard pieces of s#@*”
was I think how Helen Hunt’s character Carol described an insurer so eloquently in the movie “As Good As It Gets”
DR. BETTES: “No. Actually, I think that’s their technical name.”
This week I had the pleasure of visiting a very nice Dental Office that dealt mainly with insurance patients.
One lady patient was telling the receptionist that her insurance allowed her to have a “deep cleaning” every three years.
Who the heck decides the time frame of three years?
Where on earth does that number come from?
My feeling is that if the lady’s teeth and gums need a “deep cleaning” at all then they’re going to need another one more frequently than every 1095 days.
Otherwise she may as well just sign the paperwork for the full clearance now, because every three years for her would have to be not better than doing as little as nothing.
Sure, it’s a way of doing business….
I get it.
Having an intermediary paying you for treating their members, and constantly sending you a stream of patients who have to be treated by a set of parameters that have little regard for the individual health needs of each patient is a model that some dentists choose.
But, and it’s a big BUT, the intermediary determines the financial remuneration you as the dentist will receive, without any consideration at all of the rent you pay, the salaries you pay or the laboratory costs you incur in providing those treatments.
And now more than ever we’re seeing contracted dental offices being squeezed by the insurers who are not increasing the remunerations but are rather cutting their payments to dentists.
Is that a tough way to do business, being a dentist?
The issue is, that with the oversupply of Dentists now, there will always be dentists willing to work under these relationships.
And the remuneration is so poor that sometimes the dentists are actually treating those insurance patients at a loss.
These dentists are confusing activity with accomplishment.
They’re thinking that it’s better to be doing something for some money, when doing that something is actually at a negative financial reward.
Along with the negative physical reward and the negative emotional reward as well.
I heard last month of a Dentist who cut out insurance from his office, with a resultant forty percent drop in collections.
However, his Office experienced a twenty percent increase in profits.
We’ve always got to consider the net of everything.
Both physical net, emotional net as well as financial net.
Believing that as long as there are gross collections there has got to be some net around somewhere is purely and simply fool’s gold.
However, holding out for the ideology that your product is exceptional and everybody should be willing to pay for it what YOU think they should is also foolhardy if practiced in the wrong environment.
Like walking slowly through a lion enclosure at the zoo.
Sometimes it’s not the place to be walking at all.
Whatever you decide, you need to be comfortable that the results you are achieving a worthwhile return on your investment of time, education, effort and expenses.
Working for working’s sake is not a great legacy to leave.
When I first met the best Dental Coach I ever had he said to me:
“We can go into a Dental office and find one employee there costing that practice over $200,000.00 per year…”
And those words sent shivers down my spine.
Because I knew then at that moment that he was talking about my very own practice.
And he hadn’t even been there, yet.
To my Dental Office.
But I knew he had to….
I knew I needed his help.
You see Dentists are a self-righteous bunch, really.
It takes brains and lots of study to acquire a Dental Degree.
We know that.
And in knowing that, we as dentists start to think that we know it all.
And we may know a lot, but it’s the little things we do not know that are costing us big time.
They cost us time.
They cost us patients.
They cost us money.
All of which are limited valuable resources.
What was it that was costing me those hundreds of thousands of dollars, each year, back in the 1990s?
That’s a very good question.
I hear you say:
“After all David, you’re a smart guy. You’ve done well. How could you have missed this?”
And I thought I knew it all.
I thought things were going along well for me.
But in the back of my mind, back then, I had a feeling, a gut feeling, that something just wasn’t right in my office.
Here’s what I had….
Patients were loving me.
In the treatment room, we could do no wrong.
Patients were leaving the treatment room with overwhelming expressions of gratitude towards me and my clinical team members for the care and the work that we were doing for them.
We had a wonderful new facility.
Fully renovated rooms.
It couldn’t have been better…
But indeed, it could have.
And it needed to be.
In the back of my mind, I knew there was a problem.
You see, despite the fact that I was receiving platitudes in the treatment room, there just seemed to be a never-ending number of vacancies in my appointment schedule.
And there seemed to be no diminution in the number of those blank appointments.
Why were we not getting busier?
If patients were loving us, why were they not returning?
If we were doing such a great job in the treatment room, why were we not seeing that reflected in more and more bookings?
As good a dentist as I was, and as good a clinician as I was, the problem was still there, and it wasn’t going away…..
But we had to find the problem….
My coach had said to me:
“When we find that staff member who is costing you big time, we’ll need to change her, or we’ll need to change her….”
And that’s what happened.
My coach identified with me that the behaviours of the person working on my reception desk were not in sync with the philosophies and goals of the dental practice.
And so we set about changing her behaviours.
“What were those behaviours?”
You may be wondering what were her behaviours?
To put the answer simply, this woman operated her station with a very abrasive manner that did not endear her to those that she dealt with in her role as “the face of the practice”.
And patients were reacting to her nature by not making appointments, or by making appointments and then cancelling them later.
It appeared that as much as she behaved pleasantly when other team members were around, sadly, when she was on her own up front her persona became “difficult” in manner.
I’ve described the effects of her manner as if she were stroking a cat backwards while holding it up by the tail.
So here’s what we did.
We tried firstly to encourage a more pleasant demeanour from her, when dealing with patients.
We asked her to follow better ways of saying things to patients that would endear her to those patients when she was scheduling their appointments and processing their payments following their visits.
We asked her to show more interest in the patients when dealing with them, when they called, when they arrived, while they were preparing for their treatment, and following their treatment.
And you’ll be pleased to know, we had a very happy ending to this story….
You may ask:
“So what happened in the end, David? How did it all end up?”
We identified that we needed to change the way this employee spoke with and dealt with patients.
Sadly, we were not able to change the way she behaved.
So we changed her.
We were able to broaden her employment opportunities, and the new lady we then hired to be our new front office manager filled the roles that we required of her in so much of a better way that things at my Dental Office improved dramatically in such a short space of time that well, the rest is history…
Things got better.
I hear so many stories about Dentists who hang on to the wrong staff member for way longer than they should.
To the detriment of their Dental Practice.
It costs them hundreds of thousands of dollars, year after year after year, because they fail to see, or they fail to act on the disruptive behaviours that this team member is displaying.
And that money lost, by failing to act quickly, is never recovered.
In one case, I knew of a Dentist whose wife along with his marketing guru had encouraged him for what seemed like more than five years to divest the Dental practice of a very “limiting” employee!
Five years is a lot of water under the bridge.
The point of the process is that we need to identify the problem, excise the offending problem, and move on.
An independent second set of eyes is a great asset in this situation.
Having a coach that helped me to correct this deteriorating long-term problem was a blessing for me.
In the past twelve months I have worked with two specialist dental offices that have excised employees who they thought were appropriate but were wrong for their businesses.
And the resultant improvements have been dramatic.
Do you have any questions about the people on your bus?
Is everyone on your team pulling in the same direction?
I often wonder at the stupidity of things that some people do and say.
Could you imagine trying to row across the Pacific from Sydney to Los Angeles?
Or walk from San Francisco to Boston?
Yeah, sure, you could do both, and sure you’d get there eventually, but wouldn’t it be simpler to just take a plane?
I was talking with a dentist this week about improving his practice and he said to me that he preferred to do it on his own because as long as he was making progress then that was OK…
But at what pace?
Because in reality, with help and accountability to someone thrown in, for a small fee the results and rewards would be a lot lot larger and he’d arrive a lot lot sooner at where he wanted to go.
And isn’t that more desirable?
Who wants to create unnecessary missed opportunities?
Don’t some people see that??
What the heck is wrong with them?
I guess while ever there are dentists who think like this then they’re the kind of dentist who invites a progressive thinking dental practice to set up right beside them.
Just think about it…
If you found a slot machine at the casino that gave you back two dollars every time you put one dollar into it, without fail, how many dollars would you put into that little puppy?
As many dollars as you could darn well find!!
And when would you stop doing this?
But when I tell dentists that I can, and have given dental practices advice that has resulted in their collections improving by not twice my fee but *TWENTY FIVE TIMES* my monthly fee, I get the brain dead response that they’d rather keep doing what they’re doing on their own.
Even if I got your practice improving by three times my fee, wouldn’t that be a great result?
We know that it takes years of doing the wrong things for your practice to get into the state its in now.
And so it can take a little time to turn the draught horse around and back into a racehorse….
I know there are so many simple little things that dental practices can do that will increase collections and drive up profitability….
It’s just a matter of knowing which ones to do and in which order and at which frequency.
And this is where a coach provides invaluable advice.
I’ve seen people at the gym who train without advice and who never receive the best results.
Yet those who are committed to the advice of a personal trainer with a system will arrive at the body they desire and the level of fitness they desire.
A lot quicker than those who try to do it on their own.
In fact the majority of those who try to get fit on their own usually arrive at the same destination…
*And that’s on THE COUCH!!*
And not the body they desire.
And why wouldn’t a dental practice be any different?
This week I met a dentist who said that his practice each month for twenty-five years had only made him enough money for a very modest lifestyle, and that he had ZERO money for retirement or even for re-investment back into his practice.
He told me that the practice income had been inadequate to sustain a wife and children and had been a direct cause of his divorce.
And I so so hate sad stories like this because after seven or eight years of dental school and on top of investing in building or buying a dental practice as well, I believe that all dentists deserve a decent ROI or return on their time and money investment rather than to simply end up as society’s doormat.
“Physician, heal thyself!”
Only when we are in a state of financial health with our practice and ourselves are we truly in a position to be able to truly help others in a better way.
We need to think *Abundance*.
We need to think that there is plenty there for everyone and that there is not scarcity.
We need to think that when we trust the theory of Abundance, then not only will riches and benefits flow to us, but they will flow to our profession.
Omer Reed said that ninety five percent of dentists are not able to afford to retire at the age of sixty-five because they have not reached financial independence.
It’s my belief that those dentists in that situation have not had a plan and a coach and a mentor to be accountable to.
They’ve done it on their own.
And that’s why they end up where they end up…
Walking or running across the country is OK if you’re Forest Gump.
But for a lot of us, that act seemed pointless..
We could all do with some help with our golf, with our piano playing, with our learning to cook, with our fitness…
It makes sense to seek help doing these things, rather than trying to stumble on blindly, just “hoping” things will work out with our score, with our music, with our food and with our bodies…
Sometimes the act of making a mistake with our product and service can present our business with an incredible opportunity of *making things better*.
So much so, that the act of rectification immediately overshadows our original defect in such a way, that the customer is in awe of our business because of the way that we seamlessly switch into recovery mode.
It’s a process called *Service Recovery*.
While ever I teach and lecture about Service Recovery in the Dental Office I am consistently horrified that as Business Owners most dentists do not have Service Recovery protocols for all of the defects that can go wrong in their office and for those defects that can create poor and negative customer experiences for their valued patients.
Traditionally what happens in most Dental practices out there is that the complaint or defect is treated as if it is a hot potato.
By this I mean that the defect, or potato, is rarely held or embraced by a team member for any reasonable period of time.
In fact, to the contrary, the defect is simply passed quickly to another team member and in so doing the first team member immediately washes her hands of the responsibility.
“Oh yes, I told her that I’d get Dr. Jones to call her about it…”
And of course now the problem belongs to Dr Jones, despite the fact that he may have an agenda full of other items, and despite the fact that his receptionist could easily have been empowered to resolve the original service defect without it ever needing to involve Dr Jones…
But we see it time and time again.
Poor systems involving processes lead to even poorer systems involving defects and even poorer protocols for Service Recovery.
What if you were able to empower your dental team members to know the various places in your Customer Experience Cycles where defects could possibly occur?
And what if as business owners we were able to train our valued team members to make calculated decisions that alleviated the patient’s situation with such certainty that the patient left our dental office relieved and appreciated, rather than angry and frustrated?
You see, Service Recovery is by definition the ability of your Office to rectify any Service Defects that occur throughout your day.
Service Defects therefore are defined as any Obstacles and Challenges that can occur at any stage of the Customer Experience Cycle that have the potential of ruining the Customer’s experience.
Our Dental Office’s Service Recovery systems and processes and the way we seamlessly swing them into action are what defines us as a business that cares unconditionally about our customers.
While these customers that experience a service defect may complain about that defect that has just happened, they will be in awe at the way our business handles their defect through its service recovery processes….
So here’s what we need to strive to achieve in our practices…
We need to create a culture of *Zero Risk* throughout our business.
A Zero Risk philosophy is essential in order to create even more WOW Experiences for your customers and patients.
As a patient of our World Class Dental Practice our clients and customers have a sense of security when they deal with us so that should ever any little thing not go to plan, then we as their Dental Office will make it right regardless.
Zero Risk for your Dental Office is having all your team members fully aware of the potential common service defects that can arise at any stage in the Patient Cycles and visits to your Office, and having the team trained and empowered to provide World Class Service Recovery if and when any defects do arise.
So that they never have to play hot potato….
And your Dental Office becomes known as Zero Risk to do business with…and that’s a really nice way to be known in your community.
Remember that Zero Risk addresses an intimidating array of issues in your practice that can potentially produce unhappy customers, yet those issues may not always be the fault of our Office.
Having a seamless contingency plan and empowering your team to take action is what makes your Dental Office an absolute pleasure to do business with.
And that will make you World Class within your community….
I’m surprised that there are dentists out there that are making no money.
Dentists owning dental offices but living off the incomes of their spouses.
Their dental offices are a hobby.
A break-even prospect at best.
All that work. All that management. All that ordering. All that HR. All that marketing.
What the heck for?
Really, what is the point?
What’s the point of studying all that time, for year upon year upon year and accumulating all that student debt, and then not trying to get back into the black?
And then some?
For dentists it’s really crazy.
In the USA, dentists graduate after all that study with up to a quarter of a million dollars of student debt.
In the USA the country’s student debt surpasses the country’s credit card debt.
It’s seventy-one percent more!!
It’s an industry in its own right!
And here’s what happens:
After graduating with a student debt, the young dentist then borrows even more money to either purchase or start up his dental office.
Add another four or five hundred thousand dollars of debt for that purchase on top of the student debt and then you’ve got a five thousand pound albatross…
That means a graduating dentist can owe around three quarters of a million dollars before they even begin drilling teeth.
And with that sort of debt, there are dentists who only want to be dentists as a hobby?
There can’t be dentists who don’t want to pay down that debt as quickly as possible, and then start to make a profit?
I mean, start to show a Return On Investment?
Why shouldn’t they?
Why would you not want to receive a dividend for investing three quarters of a million dollars, plus all those years of blood, sweat and tears?
And then there’ll be people, and then there’ll be companies who tell you that you have no right to charge the prices that you do.
They’ll tell you to keep your prices low, so that the people who choose to eat the rubbish and not practice good oral hygiene can receive their treatment at the lowest cost so that they can then go out and spend the money they save on more things that can ruin their teeth?
There will always be people who want to guilt you into a compromise.
As long as it doesn’t affect them…
But if that were the case everybody out there would be riding bicycles rather than driving cars.
Let alone European luxury cars.
While ever we cater to the lowest common denominator we’ll never attain our true potential.
Who’d watch the Kentucky Derby if the horses all sauntered around the track?
That’s right…. they go their hardest.
To be their best.
And there’s really no reason why we as professionals, with the investment of time and money we’ve put in to this point should NOT be going our hardest.
To gain that Return On Our Investment.
What gives anyone who’s not us the right to tell us what we should be doing, and earning?
What gives anyone the right to guilt us into a fee schedule that doesn’t reward us for the education and the money that we’ve invested in ourselves.
I read last night that in the USA there are insurance companies who need to scrutinise every claim before treatment of the patients is approved because there’s apparently a very small percentage of dentists [in their words] who may be over-servicing their patients.
Well this is a rule that punishes the ninety eight percent for what the two percent may be doing.
And it insults the integrity of the ninety eight percent, who have their treatment plans subjected to scrutiny by pimple-faced bean counters.
You have to be kidding me.
I’ve seen some of the things that these bean counters want to do or not do..
The sooner that all businesses toss out the third party middlemen and go back to a simple relationship between the purchaser of the service and the provider of the service, then and only then will sanity be returned to the arena of free trade health.
But while ever there are dentists who falsely believe that there’s a need to work in this manner at prices fixed by the bean counters that have little or no relevance to market forces, then we’ll always have a society of doubt and indecision.