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2009: A Record Year for Some, Intangible Rewards for Others Dr. Douglas Carlsen, DDS

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2009 was an interesting year to say the least. Dental suppliers report that production was down an average of 10-20 percent nationally. Dentists with overhead percentages above 70 percent were especially hard hit with up to a 50 percent decline in net income.

Yet, if you are reading this issue, you obviously survived 2009 with continued interest in the pulse of the profession. Remember, you are part of one of the greatest professions in the world (if not the greatest). What other small business shares so much management and financial information with direct competitors? What other small business improves people’s appearances without using trashy advertising hype? Celebrate this holiday season that you are part of an honorable and intellectually challenging profession.

2009 was a record year for some dentists. Those whom I encountered had common practice management traits:

Practice Vision: It is the key to practice success. This was the universal trait of the 2009 record setters – 100 percent had a vision. You might think this is silly “touchy-feely” stuff. Well, Dr. Dentosaursus Rex, dentistry just happens to be “touchy-feely” and if you don’t project the proper caring image along with all your left-brain technical savvy, you’re doomed. A solid practice conception is the main difference between those practices prospering and those not. In First Things First, author Stephen Covey wrote, “Vision is the fundamental force that drives everything else in our lives... Creating and integrating an empowering personal mission statement is one of the most important investments we can make.”¹

Here are two examples of vision statements, both from clients I’ve advised.
  • I want to provide the best patient experience possible, from the moment they walk in the door the first time, until I retire. Family is most important to me: patients and staff that share my compassion and integrity will always be welcome in my dental home.
  • Above all else, I want to be honest in all my dealings with people, even if it involves confrontation, for in being honest, I can exhibit the joy and passion I have for giving others a more physically comfortable life.
Evaluate your team according to your vision. Most offices are overstaffed. Eliminate those who don’t fully share your vision and don’t be quick to hire replacements. Often in offices with six or more employees, a current committed team member will fill the vacant shoes quickly with no need for a replacement. And all the deleted salary becomes net income, doc.

After making any changes, let all committed team members know that their jobs are stable. With all the fear in job stability these days, your team will function at a higher level knowing that they are secure. In other words, weed out the bicker-rubble, make sure your goals are clear and move on praising those who are on your side. This is essential.

Cross Training: Make sure team members can perform all duties legally permissible. The front-desk person should be able to fill in with assisting, sterilization, and take radiographs, wherever possible. The assistants and hygienists should be able to schedule, post payments, and post insurance forms. With touch screen computers in operatories, this is not only possible, but advisable. In many cases, it is possible for one person to handle the front desk for practices grossing over $1 million. In fact, well-trained teams of four, including the doctor, are producing at the million-dollar mark.

Block Scheduling: 70-80 percent of the doctor’s production will come in blocks, usually scheduled in the morning. This can be as simple as scheduling one two-hour and two one-our blocks for the doctor each morning with new patient exams, emergencies, crown and bridge seats and small fillings in the afternoon. The one-hour blocks can be for endodontic treatment, multiple fillings, crown preps. The two-hour block can be for bridge preps, implant placements, sedation cases, perio surgeries, quadrant preps and any more complicated procedures. Of course, the two one-our appointments may always be combined to make a two-hour block.

Using this simple format, offices are able to easily produce $5,000 per day with one assistant and one hygienist.

Block scheduling requires discipline. Rule: Do not fill blocks with unproductive procedures until 3 p.m. or later in the day before an open block. Often, right before the open block, a call will come in or a procedure will appear in hygiene.

Doctor, if you fill your blocks each day you won’t need to worry about hygiene. Eighty percent of your production is normally from the doctor and 20 percent from hygiene. A no-show for one of your small blocks equals the whole hygiene day! Have your front desk focus 90% attention on the blocked schedule and NP appointments and 10 percent on the hygiene schedule.

Block scheduling is this simple. You don’t need a full-day course or lots of colors and hieroglyphics to learn it.

Expanded Procedures: Find more than 90 courses on Dentaltown.com. Endo and oral surgery update courses are free. All the doctors learned new procedures in 2008 and 2009. This is the quickest way to increase your net income.

Additional avenues that I feel will provide immediate help for 2010 include:

Staff Training: Wow your new patients with proper training and scripting. You never get a second chance to make a first impression. Fabulous reviews for The Scheduling Institute at www.schedulinginstitute.com have been posted on Dentaltown.com and from Dr. Howard Farran.


The Mini-Dental Bible can be found here. Howard Farran provided a detailed primer on practice operations in a February 2008 thread on Dentaltown that we all need to read. Print it out and read it thoroughly. In my opinion, it just might change your career.

Intangible Rewards
For many dentists, 2009 provided intangible rewards. My clients’ little rewards:
  • The multiple generation families of awkward iEquiped teens, bumbling bald boomers and the walker-wielding oldies who still come in, even with a plan in which you don’t participate.
  • The doctor who was certain he’d elicit an attorney letter from the irritating jeweled-out Mercedes queen who needed a root canal on an abutment of a recently seated bridge that subsequently loosened and needed a complete redo. Yet, she showed up a month later and thanked, then kissed him. No, it wasn’t his wife!
  • The patient who fashioned a smile for the first time after an anterior reconstruction.
  • The Grinch who stole an office’s heart with mayhem at every appearance until someone pointed out that he’d lost his wife recently. The doctor offered a condolence and now the kind Grinch appears weekly with cookies.
And the big rewards:
  • Finding a lab that provides correct occlusion and contacts every time.
  • The front-office diva who was finally let go.
  • The subsequent new front desk hire that matches the doctor’s style perfectly.
  • The Dow that climbed back up and you didn’t sell at 6547 or 8146.
Reflect back on your 2009. What jewels happened in your practice and how might you use the information to improve your practice in 2010?

On a personal note, I found renewed joy in wet-fingered dentistry in 2009. Most of my time is spent at home writing and consulting with scant face-to-face personal contact. Sanity requires me to get out at least one day a week. I’ve worked at a local Medicaid clinic treating children ages 0-18 and pregnant women on Mondays over the last year. I hadn’t placed anything more than simple small fillings on children since my Indian Health sortie in 1979. Pulpotomies, stainless steel crowns and space maintainers might as well have been brain surgery. In fact, a couple maxillary pulpotomies came close.

My most fond memory of 2009? Lap exams on the under-three crowd. It consisted of the following: Mom sat on the dental chair at a right angle, facing me, with knees touching knees. Mom took little Spiderman and straddled his legs around her belly, then laid Spiderman onto my lap, facing up. Easy, right? Now the battle of the arms and head began. While Mom struggled with Spiderman’s arms and head, I asked little Spidey kindly to open. That request was granted as often as insurance pays a claim in 30 days. Need I mention the siren call prompting a medical clinic one block away to request noise abatement? Using a fat Dora toothbrush, said oral cavity was cranked open to do a full exam, a toothbrush prophy, flossing, and the coup de grace, fluoride varnish. The trick with the varnish was to get Spiderman back up before the green slime, otherwise known as breakfast, erupted.

A quick high-five and our little human was off to another adventure! I was really intimidated by this visit at first, yet it soon became the best part of the day.

Where will your joy come in 2010? People are incredible! And you will find the most committed ones at Dentaltown. Keep reading, keep posting, keep committed to health.
1. Covey, Stephen, Merrill, A. Roger, Merrill, Rebecca, First Things First, Simon and Schuster, New York, NY, 1994.
Author's Bio
Douglas Carlsen, DDS, owner of Golich Carlsen, retired at age 53 from private practice and clinical lecturing at UCLA School of Dentistry. He writes and lectures nationally on financial topics from the point of view of one that was able to retire early on his own terms. Dr. Carlsen consults with dentists, CPAs, and planners on business systems, personal finance and retirement scenarios. Visit his Web site: www.golichcarlsen.com; call 760-535-1621 or e-mail at drcarlsen@gmail.com.
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