Office Visit: 4 Patients a Day Keeps the Doctor at Play by Kyle Patton, Associate Editor

As a dentist, you spend most of your waking hours at your practice, so it's understandable that you might not get many opportunities to see what it's like in another doctor's office. Dentaltown's Office Visit profile offers a chance to meet peers, see their practices and hear their stories. This month features Dr. Tuan Pham of Austin, Texas, one of Dentaltown's most-followed Townies. Since 2007, Pham, known as "fliegenfischen" online, has posted more than 12,000 times on the message boards and has nearly 300 followers. Read on to learn more about the dentist behind the name.

Tell us the story of how you became a dentist.
I was a junior at University of Texas at Austin with more than 80 hours of credit when my adviser asked me what I planned to do with my life. I said that I did not know but that I'd return in two weeks with a definitive answer. I cannot lie—the main goal that I wanted in my career was to not work Fridays. I thought about who didn't work Fridays: dentists. I went back to my adviser and said definitively that I would become a dentist.

You have a pretty varied background. When you started practicing, you were overbooked and facing burnout. Now you're relaxed, happy and seeing—on average— only four patients a day. How did you do it?
I worked three types of offices before I discovered myself and what style of work I preferred. I tried FFS, high-volume PPO and ultrahigh-volume Medicaid (triple-booked) offices. Although I was the top producer at the Medicaid office, I hated the pace and knew that I would burn out. I feel like we often limit ourselves to what we can accomplish. Many think that working longer, harder and faster is the only answer to success. If we are true to ourselves and know what and how we want to practice, we can accomplish it by analyzing and learning the needed skills. I find that four doctor-patients a day is my optimum. I spend time talking to patients to effectively create the value of why treatment is needed. Then I spend time, without pressure, to do good and accurate work.

How do you plan your day at the office?
Our morning meeting at 7:45 a.m. is "patient-centric"— we discuss fun facts or info about them to remind ourselves. I see my first patient at 8 a.m., the second at usually 11. Hour lunch somewhere; the next patient typically at 1?p.m. and the last one around 3:30. Hygiene checks in between, and then I hit the gym by 5:15.

You remain incredibly passionate and excited about dentistry, while many of your peers are bored or facing burnout. What's your secret?
Work should be enjoyed as much as possible. If we are going to spend 30 years (or more) of our lives doing something day-in and day-out, then we owe it to ourselves to create the work environment we want. I see four doctor-patients for a reason. It allows me to spend time with each patient and help him understand what and why dental work is recommended. In our career, many stresses come from misunderstandings and misperceptions. I focus on effective communication with patients so they thoroughly understand and accept their reality. Once they do, it becomes a win-win scenario. Patients get high-quality dental work with plenty of time and attention, and they have a thorough knowledge and understanding of why the work was needed and the issues it solved.

It's safe to say that you're running your practice exactly the way you want. Let's talk practice management. How did you get to where you are today? What's your practice management style?
I'm a man of my word. If I say that I will do something, I will always do it. Effective management and leadership are based on trust and consistency. When someone is a new boss, he's a boss simply by title. Over time, with consistency and direction, the notion of you being a leader should shift toward respect, because your team will understand and realize that the things you do, expect and enforce are for the benefit of the entire office. If you are consistent and fair, and create an office environment where duties have valid reasons, your staff will grow to respect you and work with you.

What aspects of your work are you most proud of?
The time that I spend on my work. The best advice I received as a new dentist was: Do the work that allows you to sleep soundly at night. I don't like to rush dental work. I want patients to feel comfortable as possible. As such, my appointment times are longer so that I can obsess over margins and have time for patient breaks as needed.

What aspect of dentistry never ceases to amaze you?
Technology and the implementation to make procedures more predictable. It blows my mind when I see cases from Townies like Dr.?Cory Glenn doing guided implants with 3-D model printing and treatment-planning a case from start to finish before even touching a tooth.

What do you find is the best way to market your practice? Were you always successful, or was it trial and error?
To market your practice effectively, you need to understand, first, your desired style of practice, and second, the types of patients and their values. There are patients who value service and quality above all. There are those who value lowest cost above all. And there are those who are in the middle and can be swayed either way, kind of like politics. Once you know all this, you can congruently market your practice to acquire the desired patients. I market via Facebook and by gaining online reviews, which cost pennies compared to direct mail. Facebook videos can be like constant billboards, and combined with social proof from high reviews (I have 100-plus such reviews on Google), potential patients will choose you.

What do you think is the biggest problem dentists face today?
High tuition and corporations leading to diminishing private practice. Tuition costs are sky-high, with some in the $400,000–$500,000 range. If you're a young dentist saddled with debt and need to start repayment, what do you turn to? A corporation. Corporate-run dentistry focuses too exclusively on speed, volume and numbers. I am a fan of well-run practices, but not a fan of sloppy work for a buck. The problem is, this cycle feeds itself, because the costs and risks to start up or purchase a practice out of school become harder as debt load increases. These factors will cause the erosion and loss of private practice, and eventually an overall decline in dentistry.

What is the greatest advancement of change you have seen during your tenure?
Control that technology offers. Cerec, CBCT, etc., give us the ability to have active and physical control over work that simply wasn't available in the past. I love the ability to have exact control over the crown process: If for any reason I mill a crown and it isn't proper, I have the ability to recognize, address and solve the issue immediately, instead of waiting three weeks to realize that my crown doesn't fit properly. I love that aspect of technology.

Looking ahead, what would you like to see dentistry do in the next five to 10 years, in terms of the way it operates as a profession?
I'd like to see organized dentistry put more effort into supporting, protecting and promoting dentistry instead of diluting it. I do not foresee this happening.

It's easy to talk about we're good at. But what is something that remains a challenge for you?
Dentures! Clinically, I have given up many procedures—including dentures—that I don't enjoy or want to increase my skills in. Now I have in-house specialists or refer out.

Describe the most successful or rewarding experience in your professional life.
My biggest accomplishment is the creation of my Dental Maverick training program, and its live CE event, Maverick Summit, last August in Austin. There are core skills that every dentist needs to master outside of clinical skills for success in private practice. Learning to effectively communicate with patients and to lead and manage staff is crucial not only for success and satisfaction with patients, but also for creating your ideal office environment for the next 30 years of your career. To be excellent doctors, we must not be lopsided in our CE, and master both clinical and nonclinical skills. If you have the "best" hand skills and can create the most technically masterful crown, are you still a great dentist if you can't get patients to accept the need for that crown?

What has Dentaltown done for your professional life? What's your favorite feature?
My favorite part of Dentaltown is the message boards. I love message boards because the information is organic and constantly changing. There is so much information on the boards! You can learn from experts about practically any aspect of dentistry. Through the boards and Townie Meetings, I've met and created great friendships with some doctors that I would have never met in real life!

Give us a snapshot of your life outside of dentistry.
I recently got married to my beautiful and amazing wife, Kristin. We have a French bulldog and a Rhodesian mix that both like to get their teeth brushed. We love to travel, and Kristin always offers me amazing support and lets me go fly-fishing whenever I want.

If you could send one note back to yourself before you began practicing, what would it say?
Open your browser, go to dentaltown.com and click on the message boards. Who knows where I would be now if I'd opened my mind to all the possibilities earlier?

What would advice would you love to give to dentists?
That anything and everything is possible. Often it's our preconceived notions and thoughts that hold us back. I meet so many unhappy dentists who say they want a change, but when I ask them why they don't change they offer reasons or excuses like "It's too hard," "I don't know how" or "I'm scared to do so." Thirty years at work is a long time! Start with small changes today. Tell your assistant to lay out that instrument that you've been wanting her to. Every issue or problem that you recognize is the opportunity to steer your office toward your ideal. Solve enough issues and soon you won't have any; before you know it, your office is what you want. If you're scared or think it's too hard, reach out to someone who's done it. If someone else can do it, so can you!