Office Visit By Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

Dr. Melkers and Dr. McDonald are married, working together and making the most of their chosen profession Welcome to the fourth installment of Office Visit, where we visit a Townie’s office and profile their equipment, design or unique practice philosophy. If you would like to participate or nominate a colleague please send me an e-mail at tom@dentaltown.com. This month we are pleased to take you inside the office of married couple Jeanine M. McDonald and Michael J. Melkers in Spokane, Washington. They discuss how their business is run, what equipment they enjoy using and how they keep from strangling each other when they go home each day.

Office Highlights Advertising New Patients, Inc. Dental 101.com Bonding Interface, Surpass, Anchor-Apex Gradia Direct (GC), Amelogen Plus/ Vitalesence (Ultradent), Premise (Kerr) Optibond Solo (Kerr) Viscostat Clear (Ultradent) V-Ring Flexithin mini #1, IPC (Hu Friedy) Burs & Polishing Finishing diamonds & carbides (Axis) Disposable diamonds (Neo) Groovy brushes (Clinician’s Choice) Jiffy points & brushes (Ultradent) Polishing disks (Cosmedent) Cameras Canon Rebel XT (Photomed)

CE Dentaltown.com The Pankey Institute Dr. Newton Fahl Matt Roberts Dr. Paul Homoly National Dental Network Diagnostic CariScreen (CariFree) Diagnodent (Kavo) JVA (Bioresearch) Impression Materials Alginator (Cadco) Affinity (Clinician’s Choice) Flextime (Heraus) SENN (GC America) Triphasix alginate (Parkell) Occlusion NTI (NTI-tss) Protar (Kavo), Anamark (Denar), Panadent articulators Vacuspat (Whipmix)

What is the biggest advantage of working with your spouse?

Michael J. Melkers (MM): Some people look at us like we are crazy for working together, but the truth is that there are days that we may not see each other all day. When we do though, it can be just like a mini-study club. Having grown up with a “Mom & Pop” dental parents (RDH & DDS), there is a sense of comfort “in good times and in bad” that we are both in the same boat and picking our course together.

Name two challenges of working with your spouse?

MM: I think that the obvious challenge is that we need to keep the ‘personal’ out of the office – no making out in the hallways and such (laughs). Honestly though – it isn’t comfortable for anyone in the office when personal problems or issues are brought into the office. This rule goes triple and then some for Jeanine and myself. The patients and team can pick up on it in a second. It happens from time to time, but we really try to keep it to a minimum.

The second challenge can be time off… and time “on” for that matter. When we both want to be out of the office, we do not have an associate or partner to keep the burs turning.

How do you avoid/prevent other challenges?

Jeanine M. McDonald (JM): We have interests that we participate in separately. I enjoy running alone or reading a (non-dental) book. Mike often goes out and plays disc golf with his friends. We have “couple friends” in town, but we also have friends who we spend time with alone.

What is the extent of your involvement in dental education (as a provider of education)? How did you become interested in this?

MM: I first got involved in education because I wanted to learn – and that hasn’t changed. My involvement in dental education as a provider started when I was “tricked” by Matt Roberts into coming up onto stage to discuss a case together. I was shaking like a leaf! I learn so much when I teach but also have the opportunity to share with others what so many of my mentors have shared with me over the years.

I have had the privilege of presenting at the AGD (Academy of General Dentistry) and ADA (American Dental Association) annual sessions as well as several of the DT (Dentaltown) Vegas meetings. From PAC-Live! Occlusion, things have progressed to our own Nuts & Bolts courses in our office as well traveling around the country and the world to present to various study clubs and societies. This last year I was also asked to be a visiting faculty member at The Nash Institute. I have also accepted the position of director of occlusion & aesthetic dentistry at the new AEGD (Advanced Education in General Dentistry) Northwest Dental Residency. Who knows what the future brings!

JM: I never really planned to teach. I started teaching at Eastern Washington University Dental Hygiene School when we first moved to Spokane, Washington. In Washington, hygienists can place restorative materials. With a new scratch start practice, I had some free time and I wanted to make sure the students were being taught up-to-date information. I ended up liking teaching.

Describe your teaching duties at the Washington University School of Dental Hygiene. What have you learned from your students?

JM: I prepare the teeth and work with the students as they restore them. I also provide clinical examinations and observe the administration of local anesthesia. Any time you teach you are learning. It is rewarding to have students who are eager to learn and take the time to ask questions and watch so the next time they can try it themselves.

What is your least favorite procedure / specialty to perform?

MM: That would have to be pedodontics, hands down! Now don’t get me wrong – I love kids. Jeanine and I have a standing rule in the office – I do blood, she does kids. We try not to get the two confused.

What is your favorite procedure / specialty to perform?

MM: Anything that really pushes me to have to work to put the puzzle pieces together. It seems that the longer I am in practice, the more I enjoy the diagnostics over the actual procedure. I think that is why I am drawn to the more complex, “occlusion” TMD cases… even the aesthetic restorative rehabilitations. Success-or failure-of the case is decided long before the first spin of the bur.
JM: I could do quadrant direct composites all day.

How has Dentaltown impacted your practice? Give examples of something that you now do differently because of Dentaltown.

MM: What haven’t I done differently is more like it! I honestly cannot imagine practicing without Dentaltown. The amount that all of the Townies share is beyond belief-the successes as well as the challenges. The message board is my go to resource for techniques, as a buyer’s guide, a management forum.

JM: I think the biggest impact has been the people I have met. There was a period of time last year when I saw Mark Fleming four times in a three month period and we live on opposites sides of the country. It was great.

•If you would like to see Jeanine and Michael’s Top Five Click Here

You recently made some changes in your office team. What happened? How did you select your current team? How do they impact your practice?

JM: Honestly I think both Mike and I got too involved in other aspects of dentistry than the day-to-day running of a practice. I think my biggest challenge as a boss is balancing the “allow your team to make mistakes” ball and the “micro-managing” ball. I think we gave our previous staff too much autonomy. Unfortunately it took us longer than it should have to realize they were not self-starters and if they weren’t checked up on, they tended not do what we asked. Once we started holding them accountable (thank you Dan Marut!), they resisted.

MM: I think that so much of it has to do not just with aptitude but with attitude. There is the saying of making sure that you have the right people on the bus and in the right seats. A true team concept isn’t for clock watchers and punchers but for those who are looking to be part of the solution and journey-those looking for a career.

The team that we have in place right now is amazing. I absolutely could not work without them, and I truly enjoy coming to the office.

Describe your office philosophy.

MM: Our philosophy is to offer appropriate solutions for our patients… one patient at a time. While we certainly strive to offer the most complete and comprehensive care, solutions need to not only fit into a patient’s concern, but also their budget, life realities, timeline. Sometimes people are not interested in the ‘right’ dentistry, but the ‘right now!’ dentistry.

JM: Just like I enjoy the one-on-one relationship in teaching, that is how we practice. We see one patient at a time. I want my patients to know they have my undivided attention when they are in the chair. We want to provide optimum comprehensive care so our patients can experience health, comfort and a beautiful smile.

Do you participate in any PPOs? Explain.

MM: We do participate in a couple of PPO’s, After opening an insurance-free… and cash-free… and patient-free practice, we reassessed our whole attitude towards insurance. It is a coupon that helps patients be able to afford their dental treatment. As long as a PPO can get patients into your office, fits your business model and does not affect your treatment philosophy adversely I say go for it. That may shock some people but get over it, we did.

JM: Initially when we started we did not accept even assignment of benefits. After a very slow start and with the advice of mentors, we made some adjustments. We have signed contracts with a few companies if the negotiated fees allow us to provide the quality of care we think our patients deserve in the one on one environment we provide.

Why do you see one patient at a time? Are you working out of a single room / single column? Explain.

MM: That influence started with my first and best mentor: my father. I practically grew up in his practice, seeing him treat his patients with care and compassion – one patient at a time. It makes me sound older than I am, but I feel like I grew up in a slower time, living in the farm country outside of Milwaukee.

Seeing one patient at a time is a philosophy shift. When they are in our office, they are 100% the focus of my attention. We may not make as much money as some, but we enjoy the pace that we practice and I know that our patients appreciate it.

JM: As a patient I hate it when the doctor pops in and out between patients and most of my dialogue is with support staff. I deserve more and so do my patients. We try to do more quadrant dentistry so our efficiency is maximized. Yes, we generally work out of one room.

Tell me something that nobody knows about you/ something people would be surprised to know.

MM: This may come as a real shock to some but about two years out of school, I walked away from dentistry. That lasted about six months. I was so burned out and just hated practicing. A good dose of Jeanine and The Pankey Institute pulled me out of that funk and got me turned around.

JM: If anyone would have bet me when I was in dental school that I’d be happily married to a dentist, I would have lost that bet.

What was the genesis of the Townie Fiesta? What are your future plans for this event?

MM: Townie Fiesta started the same year as the Vegas Townie Meeting five years ago. The Vegas meeting is THE Townie meeting pioneered on demand by Drs. Tarun Agarwal and Sameer Puri. Townie Fiesta was started as a thank you to Dr. Howard Farran, Sameer Puri and Tarun Agarwal for all of their hard work. While DT Vegas is the Mardi Gras of Dentaltown, Townie Fiesta is the backyard BBQ meeting. It is a fun, laid back time for family, friends and team members to reward themselves. This year, Mark Murphy of The Pankey Institute will be keynoting, followed by DT’s own Young Guns – Drs. Bailey, Bridges, Clayton and Young who will share the secrets of their four successful practices.

Describe the experience of making your Nuts & Bolts of NTI Therapy DVD. What was the biggest surprise? Would you do it again?

MM: The Nuts & Bolts NTI DVD project was FAR more work than I ever could have imagined! It was an eye opener to watch dozens of hours of shooting and dozens more of editing get chopped down into a two dvd set. I am actually working on a second dvd set that I hope to have out in time for DT Vegas… but that is a surprise for now!