An Associate’s Guide to Measuring a Practice by Jennifer de St. Georges

I'm not a dentist, but I feel like I went to dental school. I married my former husband, Edmond, two weeks after he graduated from dental school, and I've been connected to the profession for more than four decades since.

The dental school faculty encouraged graduates to first select a location where they wanted to live, and then to determine where in that location they wanted to practice. During Edmond's last year of school we spent every weekend driving around Northern California to find our "ideal location." We decided not to follow the faculty's advice and instead selected a city that was off the beaten track—not one we'd live in, but one with a fast-growing population and few dentists in the area. We never looked back; within a year, we bought the perfect home that was a 20-minute drive from the practice.

Other graduates opened practices in downtown areas or beautiful coastal cities, but these popular areas were already packed with hundreds of dentists who also wanted to live there! The going was hard for many practices and while many survived, a few didn't.

Historically, after graduation, a vast majority of dentists chose to open their own practice with a minority choosing post-graduate, military or associateship. For the past few years, there has been a total reversal of how graduates are handling their entry into the dental world. With the high cost of equipping a new practice, plus the desire to hone their clinical and management skills, most graduates have moved towards first working as an associate in a wide variety of delivery options.

How to get a good sense of the practice even before your first interview begins
I believe that doing homework before your interview will increase the potential of you finding a practice that meets your expectations.

• Call the practice during the day to give you an idea of how patients are handled. Likewise, call when you know the practice is closed and analyze the outgoing message. Listening for key things gives you a great deal of information about the quality of practice you're applying to. Is the message professional? Does it contain all the information patients need to know when they call? Are emergencies given clear directions for help? A practice's outgoing message tells one so much about the attitude of the owner and the quality of the practice/patient relationship and customer service.

• Arrive at least an hour before your scheduled interview appointment. (Tell the staff you left extra driving time.) Investing an hour to sit in the reception room will show you more about the practice than you would learn in multiple interviews. Pay attention to how the telephones are answered, and how patients are released at the end of their appointments. Is the administrative staff casual about communicating financially with patients? ("That's OK, just mail us a check when you have time.") Or is there no discussion with the patients about their financial obligation and responsibilities? When administrative team members aren't committed to—or are uncomfortable with—discussing and collecting money at the front desk, it doesn't bode well for an associate's future income!

While the first impression you make on the practice is important, be sure that the practice delivers a good first impression on you, as well, or you could be applying for a position unsuitable for your long-term goals.

When the interview moves into the second phase, I recommend that potential associates join the practice for a half-day "working interview."

In our practice, Edmond would ask the applicant to work as his assistant. This allowed interviewer and interviewee to learn about each other clinically, philosophically and personally. He would also invite the applying dentist to give him a lower block. His philosophy: If we were going to refer present and schedule future patients with a new dentist, we needed to have clinical confidence in him or her.

When new associates joined us, we asked them to perform a dental exam on each of our administrative team members as well. The quickest way to grow a new associate's practice is for staff to walk in the patients' shoes. I recommend all staff, especially administrative staff, receive an injection from new and current doctors. Patients of record happily schedule with a new associate when the staff can say, "Oh Dr. Smith just joined our practice, she is wonderful!"

How to understand—and negotiate— the role spouses play in the practice
When I came into dentistry, ADA statistics showed that 62 percent of practices had at least some level of a spouse's involvement. I find that percentage has gone down over the years, but still today it's common to see husbands managing their wives' practices and dentists inviting their partners or fiancées to help with (or take over) the management side of the practice.

I spent 28 years working and living with a dentist husband—I've had two!—and give programs about how to work together in your business.

Most of the time, I've found that the involvement of a spouse or partner can be beneficial when running a successful practice. When it's not a good fit, though, nothing kills a practice's future success than a family member on-site who shouldn't be there! It's hard to fire relatives; if you ever hire a family member—or even a friend—you should always have an exit strategy to orchestrate a professional parting of the ways if needed.

As an associate, cover these six points and questions with the hiring dentist:

• Is your spouse involved in the practice, and to what degree?

• May I have a written job responsibility or description for the position your spouse holds?

• May we agree that when decisions are to be made, you and your spouse will speak as one?

• I promise to always be 100 percent supportive of you both when communicating with the team.

• If I am seen doing something wrong, please correct me away from staff and patients.

• I have (or don't have) a spouse/partner, and I would (or wouldn't) like him/her to be involved at some level with me as my career grows.

Know your role: How to properly integrate with the rest of the team
While the doctor may have been the one who hired you, it is the staff who can either support or sabotage your future in the practice. Over the years, I've seen many young associates not succeed in a practice because of the way they handled themselves with the team.

Common sense and logic dictates that one always is supportive of the senior dentist and management. Taking the side of the team against the senior dentist or management may make you feel accepted by staff at the time, but long term, I guarantee you'll lose the respect of the team.

At all times, you are a doctor. That doesn't change, regardless of which point you're at in your career—even if you're an employee of the practice who works just one day a week. You always walk a fine line with the team. To earn respect, offer it—but don't feel obligated to become "one of them," because you're not.

How to instill (and reap the benefits of) valuable meetings and communications
I'm a great believer in the benefits of a five-

minute meeting every morning. A quick analysis of the day's schedule ensures everyone is on the same page and allows any potential problems to be identified. If a doctor works a different schedule and isn't able to attend this meeting, a key management tool is compromised, so doctors who arrive after the morning meeting should check in with the scheduling coordinator to be brought up to speed with last-minute changes or issues.

Successful practices also schedule monthly meetings, where participants are encouraged to identify aspects of management and policies that are working well. This type of meeting is great for morale and promotes team participation. More importantly, the meeting gives people the opportunity to identify an issue early and offers the team the ability to solve problems before they grow to become a major issues. Participation in these meetings is essential, although they're are not a venue for doctor-to-doctor disagreements; such discussions should be conducted privately.

If you're working as an associate in a practice that holds staff meetings only when there's a problem, you have two options: address the shortcomings of the current system and propose meetings and morning huddles, or accept the reactive management approach and live with the consequences.

In larger practices, there should be separate meetings for clinical and administrative departments, scheduled to increase efficiency within each department.

I urge every practice with multiple dentists to conduct weekly and monthly doctor-only meetings, with an agenda created and minutes recorded. It's imperative that the team perceives the doctors as working in unison. Again, if you're working in a practice where there's no cohesiveness between the dentists, you have the choice of either putting your head down and soldiering on, or trying to help management change its approach to doctor/staff communication.

Avoid having these interactions with the team in the front office

Doctors do not belong at the front desk. This rule applies to all doctors, but especially to new associates; there's not one good reason for them to interrupt the flow of business. Feel comfortable to walk your patient down to the front desk area, but release the patient by saying, "Mary, I'm going to give you over to Jenny now, who will take care of all your clinical and management needs. If you have any questions, do please let us know."

Nothing will upset administrative team members—

and, in time, turn them against you—more than a dentist who hangs around the front desk asking questions.

Here's a list of more no-nos when it comes to talking to the business staff:

• Don't check the schedule to see if the next patient has arrived.

• Don't ask whether the last patient paid in full.

• Don't ask if a new patient from yesterday agreed to treatment.

• Don't ask when a certain patient is coming back for the next visit.

• Don't ask any insurance-related question about a patient.

Finally, let me conclude the article with some advice about the best way to communicate with other doctors and the staff. If there's something you want to follow up about later, write down those thoughts, frustrations, ideas or questions. Maybe you keep a notebook in your pocket, or create a voice memo in your phone. Then present those thoughts later, in private: There are no benefits to interrupting people during their busy day, and if patients are present such action also would be unprofessional.

An added benefit to this method is that it allows you to capture a potential problem in its infancy, rather than let it fester until it becomes unnecessary baggage.

Hear the author share more practice insights
Practice management educator Jennifer de St. Georges discusses why automatic appointment reminders often backfire, how successful dental practices marry marketing and management, and much more in her recent podcast with Dr. Howard Farran. To listen, go to dentaltown.com/jennifer-pm.