Dentists spend most of their waking hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown magazine’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we visit Dr. Peter Drews and his practice in Lewiston, Maine. This Townie served as an officer in the U.S. Navy before he converted an old Friendly’s restaurant into the practice of his dreams.
With a background in mechanical engineering, time spent as president of Maine’s Dental Association, and a synergistic blend of cutting-edge tech and down-home hospitality in his practice, Drews’ practice and his take on dentistry are worth a spotlight.
Before dentistry, you studied mechanical engineering and worked in the automotive industry. Tell us about that.
It’s purely the result of a strong Type A personality and my mother. She is a practical-minded, now-retired high school math teacher who would remind me to always have a backup plan in case I changed my mind. (She knows me well.)
I’d originally wanted to go into the medical field, but when I explored the different programs at Michigan State University, I realized that engineering was the liberal arts degree of the 20th?century. Engineering got bonus points because it provided me with all the prerequisites for medical and dental schools if I did change my mind, and regardless of any future indecisiveness, I knew a degree in engineering would have good job currency. Thanks, Mom, for the “have a backup plan” advice!
You were an officer in the U.S. Navy and the “dental doc” aboard the USS Rushmore.
How did you spend your time while in the Navy?
The decision to join the Navy right out of dental school was the best thing for my professional development, not to mention the student loans. My “real world education” started with my first assignment to Great Lakes Naval Hospital in its one-year AEGD program. I was immersed in exodontia, periodontal surgery and endodontics. From there, I was stationed to a dental clinic in Bahrain. This assignment is where I really learned the meaning of “home is where you make it.” I had an amazing mentor who pushed me to the next level.
From the Middle East, I went to the West Coast, to Naval Base San Diego, and then boomeranged back to the Persian Gulf aboard the USS Rushmore. I like to think of these as my “M*A*S*H years.” I have so many great stories—imagine trying to do a root canal with 20-foot waves crashing into the side of your ship.
After your time in the Navy you went on to purchase a practice in 2008. As a do-it-yourself guy, you had quite the remodeling and renovating adventure, converting a former restaurant into a dental office.
I bought the original practice from a local dentist who was operating out of a converted house along a main thoroughfare in town. It had a small waiting room, which originally had been the front parlor, a reception desk, four operatories and a back office. Oh, and everyone—patients, employees and I—had to share one tiny bathroom. The basement that housed our lab had 6-foot-5-inch ceilings ... but I also am 6-foot-5, so it felt like I was back on the ship.
Because the practice was on a primary roadway, parking was always an issue—even more so during the months of snowbank accumulation known as “winter in Maine.” I was constantly scouting buildings that would allow for more growth. (And more parking.)
There was a Friendly’s restaurant, mostly known up and down the East Coast for its ice cream, that had been something of a local institution and gathering spot until the corporate office closed it. It was a big space, with more parking spaces than there are teeth in your mouth, and I liked the idea of taking an old commercial space and transforming it into a new local business, the way I’ve seen many banks, gas stations and churches do recently.
The building was rough and needed a lot of work to convert it into my dream practice, but there is truth in the saying “In the midst of chaos, there is also opportunity.” Or in this case, ketchup-stained booths, grease-covered grills, ice cream cone-patterned carpeting, and a giant walk-in refrigerator. There was still ice cream in the fridge but the power had been cut to the building when it closed, so it was a great test of my gag reflex.
Initially, I got quotes from the big two dental design companies, who also saw an opportunity. Once I recovered from sticker shock, I opted to be my own contractor. I like to keep busy! I recruited some muscle from the local labor-ready employment agency, and we gutted the building down to its wood studs within three weeks. I hired an AutoCAD technician from an ad on Craigslist to produce blueprints, which were sent to Extreme DDS Dental Design Service. This incredible company produced construction plans for permitting, as well as material recommendations for paint colors, carpet, electrical/networking locations and operatory layout—all at a fraction of the cost of a typical architectural firm.
Obviously, the other big expenses are cabinetry and chairs, but like a car, a dental chair doesn’t maintain its value once it’s off the showroom floor. Luckily for me, several companies specialize in bank repossession and refurbishing of equipment. Sunrise Dental Equipment and Planet Dental provided five matching A-dec operatory packages that complemented my existing stuff. After another ministroke when I checked prices from some major dental suppliers, I found another company, Woodway Dental Cabinets, which has a competitively priced quality product and some of the most attentive customer service I’ve ever experienced.
What’s the average day like at your practice?
How does it compare to when you first started practicing?
They are literally two different practices! We’ve increased the number of providers, patients, parking spaces and procedures. (We even have a picnic table for lunch during the summer.) We also moved through the growing pains of changing mindsets and workflows without casualties. Scheduling has evolved from the vertical “squeeze in anything that fits” approach to dovetailing and block booking for production. This means I have a good variety of procedures to keep the day interesting, rather than the 30-minute, back-to-back onesy-twosy stuff … and my assistants still like me by 5 o’clock.
One of the most important and measurable changes as far as treatment acceptance is that all new patients are initially scheduled in the doctor’s chair. Assembly-line dentistry has never been my goal, and I find there is far more value in spending an hour getting to know patients, increasing their dental IQ and reviewing treatment options. And if there’s any time left over, we can talk conspiracy theories and ’80s wrestling. When new patients understand the benefits of completing their treatment, and that I’m a nice guy who just occasionally pokes at them with a needle, my schedule stays full.
You’re a self-proclaimed CE junkie who loves reading
books on business and practice management. What are some of your favorite titles, and what has investing time in CE and reading done for your practice?
The biggest ROI has been a combination of working with the coaches at Jameson Management and sending my business team to the American Association of Dental Office Managers (AADOM) national conference. The first contact a patient has with us is online, when they call the office or walk in the front door. Invest in your administrative team because they don’t just answer phones and collect money; they are a special breed of multitasking human who must be kind yet firm and able to de-escalate grumpy patients, explain the difference between a crown and a filling, deliver the bad news when insurance doesn’t cover a procedure, and keep up with everyone’s vacations, grandchildren or new puppies. While there is no mandatory CE to maintain a license to run the front desk, you don’t want someone up there who has no clue how to drive. The business team may not be “producers,” but they are the ones who make it happen so the rest of us can be.
The two books that first come to mind have a similar style and approach. Fred Joyal’s Everything Is Marketing: The Ultimate Strategy for Dental Practice Growth is pure common sense with a boatload of creativity. Several members of my business team have attended his lectures at AADOM, and they all returned with original strategies we’ve applied with great results. The other go-to is Uncomplicate Business: All It Takes Is People, Time and Money, by Mr. Dentaltown himself, Dr. Howard Farran.
If I’m not in the mood to read, it’s very easy to disappear down the YouTube or podcast rabbit hole with either of these guys; both make very watchable, content-rich videos.
Let’s talk practice management. I know you’re a believer in the Frank Spear approach, but you’ve also customized a lot of systems to work for you. What are some things you do in your practice that you’d recommend to other docs?
Communication and patient flow are probably the two areas that create the most stress between front and back office, and between front office and patients. The Weave phone system has helped the business team confirm schedules ahead of time; so many people text nowadays that it’s a great way to confirm appointments or get a hold of patients during their workdays about getting them in sooner. We also have electronic forms to email to new patients and an iPad for all of our consent forms in the office. Automate as much as you can to streamline things for both the patient and team—without compromising the person-to-person interaction, obviously. You can’t put a value on that.
As past president of the Maine Dental Association,
you’ve had a unique vantage of the profession and industry. What would you say the state of dentistry is?
Everyone is always worried about the next big change, whether it’s corporate models, insurance companies, or other kinds of providers coming in to “steal” your patients, money, job. I’m excited for the changes that are happening; they force everyone to get more creative and innovative, and that’s the stuff that will make your practice stand out.
The big thing I see coming is how 3D printing is going to revolutionize this profession. In Europe, printer companies like EnvisionTEC already have approval for long-term indirect crown-and-bridge material. Printer technology is going to change full denture fabrication, and this could be a huge practice builder. Studies have shown that the number of edentulous patients who will need complete dentures will increase in the next 20 years. Unfortunately, many young dentists are not comfortable with creating full dentures because of changes in dental school curriculums. Digital dentures will provide a faster, predictable way to fill this void. By lowering cost, we will broaden the marketplace by delivering an aesthetic denture to a greater percentage of the population.
What aspect of your work
are you most proud of?
Most of my dental school contemporaries stayed in Michigan because that’s where they grew up, had family there, or they really liked Ann Arbor. (It is a cool town.) A few others headed off to New York and San Diego to follow their dreams. These are all great places, but I also recognized from a business perspective—which directly impacts lifestyle, right?—that saturation is a dentist’s biggest enemy. Don’t get me wrong; I also had preferred criteria (proximity to ski resorts and an airport), so I did some research and that’s how I found a former factory town 45 minutes north of the uberhip and, therefore dentist-saturated, city of Portland, Maine. The classic diamond-in-the-rough Lewiston had plenty of opportunity for growing the kind of dental practice I had envisioned. I understood there would be challenges coming in as an “out-of-stater,” particularly after the beloved local guy retired. I just blocked out the messages of fear and low expectations.
Not to get all Field of Dreams, but honestly, “If you build it, they will come.” They have. We have a great brand and have fun with our marketing and social media. We do have some cool technology that allows our patients to have a more comfortable experience, and I am fortunate to be able to say that I really do have a dental dream team. All of which makes the marketing part even easier.
In your practice you have something called the “tote system.” What is it, and how did it come into existence?
In a general dental office, we do so many different kinds of procedures each day. Trying to keep everything you need in one room means clutter, and I’m all about streamlining and efficiency. It was actually when we moved to the new location that I tasked my assistants with implementing Zirc’s “ZOBE” system. ZOBE stands for Zirc’s Organizational Box of Efficiency—I need a few of these in my everyday life. It’s basically like kindergarten has come to the dental office: Every box is color-coded by procedure—endo, restorative, ortho, hygiene, etc.—and specific instruments are further designated with the relevant color band. This means I have only what I need in the room at one time, so if I’m doing a root canal and then prepping it for a crown, the assistant can grab the next tote. It’s also an easy way for them to stay accountable and track what we have, which helps to control our inventory costs. The other advantage is if things get separated during sterilization, literally anyone can sort and match them all back together—and we’ve had the business team jump in a couple of times to help out.
What do you think is the biggest problem dentists face today?
It’s not actually insurance companies, embezzling employees or litigious patients—it’s the dentists themselves. Not enough people are getting involved in organizational and legislative issues that affect the way we practice. I recently attended a local CE course and was asked by one of my peers, who’s been practicing for 10?years, what was going on with our state dental association. He’d told me he wasn’t a member because he didn’t feel like there was “value in it.” The Maine Dental Association has been primarily focused on developing ethical standards for the midlevel provider because now that the bill itself passed, we cannot allow a professional dilution of a patient’s standard of care. He looked at me with disbelief that Maine even has a midlevel provider. It was voted in ... in 2014.
I explained that for the past seven years, the association has been in a legislative battle trying to educate our elected representatives. Three other dentists at this CE were also oblivious to advocacy efforts at the state level. Unfortunately, human nature often assumes that someone else is taking care of things, so there is a diffusion of responsibility. This kind of bystander effect is going to kill our profession, and all dentists have a responsibility to step up in fighting these legislative battles.
What would you like to see dentistry do differently or better over the next five to 10 years?
Stop giving so much weight to a patient’s dental insurance when treatment planning. Dental insurance first started in the early 1970s. Dental insurance plans offered insurance a $1,000 cap in 1972, and $1,000 bought a lot of dental care in those days. Today, the average cap on dental plans is still $1,000, which in 2018 does not buy a lot of anything. If insurance companies used inflation like the rest of us do for cost, the equivalent 2018 cap should be $6,587. So why does dentistry feel the need to follow insurance blindly?
What is something that remains a challenge for you?
My team teases me that I’m unable to function unless I have a low level of stress operating as my baseline. There’s no doubt that dentists tend to be control freaks, which definitely makes for great dentistry. So, in the past two years I’ve been attempting to back off and allow my employees to solve problems within the practice. Howard Farran’s message couldn’t be more relevant: Find the best people, and just get out of their way. I get it; if I can’t delegate duties, I will slow the growth of the practice. And nothing slows the growth of a practice like a heart attack.
Give us a snapshot of your life outside of dentistry.
Rumor has it you spend a considerable amount of time with all kinds of DIY projects. What are you working on at the moment?
I am a firm believer of N-E-T (no extra time). So whether I’m at the gym, skiing or getting dragged out for a hike with the dogs by my wife, I usually have my headphones in, listening to podcasts. Despite what my team thinks, they’re not always dental- or business-related! I also enjoy getting my blood pressure up with a combination of history, politics and conspiracy theories; these also serve to add to my “random and useless information” file, which I can use to bore my assistant during endo appointments, or as filler during the inevitable patient small talk.
The next DIY project is to make my own teardrop camper. Maine is a very outdoorsy state and my wife loves camping—unfortunately she’s also a bit of a purist/sadist, which means tent camping. The prospect of buying a 30-foot RV went nowhere in my house but in life you don’t get what you deserve, you get what you negotiate. So if I complete my 1950s-style teardrop camper, I might not have a sore back on the next camping trip.