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Howard Speaks Howard Farran, DDS MBA, MAGD, Publisher, Dentaltown Magazine

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Non-confrontational Treatment Planning

Howard Farran, DDS
MBA, MAGD
Publisher,
Dentaltown Magazine
 Some animals are instinctively social, some are not. Polar bears, for instance, aren’t social animals. When you look at a polar bear, it doesn’t smile or frown or cry. Polar bears don’t need anyone. The polar bear can go off on his own and only comes back during mating season to hook up with other polar bears. Monkeys and apes are very different – they’re social animals. They live in big groups and are genetically programmed to conform to the group. If the group of monkeys or apes kick you out, your life expectancy plummets. When you are down on the ground foraging for food, you need other monkeys and apes up in the trees looking for predators. Monkeys and apes have to conform. That is why it is very unnatural for apes and monkeys to confront other apes and monkeys – they are very non-confrontational.

Humans, like monkeys, are social animals and, by nature, non-confrontational. In dentistry, this is evidenced by the treatment plans you present – there’s fear you’re going to get rejected! In dental school I lived in a house with five dental students – all of us class acts (don’t laugh) – and Friday nights we would go to the bars. We were all-American boys learning how to be dentists, yet we were afraid to ask a girl to dance because we were afraid she was going to say no. When we treatment plan we do the same thing. We fear rejection. I see this phenomenon when I visit a medical dental building and there might be five general dentists in the same building and four of them don’t even average one implant per month but one of them is averaging 10 implants a month. So what is the big difference? The difference is that dentist doing 10 implants uses a market segmentation approach to presenting dentistry in a very non-confrontational sort of way.

Let me give an example of a dentist doing the wrong thing: Grandma Mary calls up and says she has a sore spot under her denture. Immediately the receptionist diagnoses and treatment plans a denture adjustment. She looks at the schedule and finds 15 minutes open during the next day and schedules a sore spot adjustment on a denture. The minute that she makes that decision it is a domino effect. The assistant sees that written on the schedule so she goes out and sets up for a denture adjustment. They get out the PIP, they get the Dr. Thompson’s color transfer applicators out, they set up a slowspeed with an acrylic bur and then they’re ready to see Grandma Mary.

Basically the assistant dries out the denture, finds the sore spot and tells the dentist about it. Then the dentist comes in, goes through the motions and says, “OK, you have a sore spot, let me adjust that for you.” He adjusts the denture. Grandma Mary says it feels much better. Then the assistant says, “Should we charge anything? She was only in here for 10 minutes and all we did was adjust a denture.” The dentist thinks, “Should I charge anything? Oh, probably not. What the hell, all my supplies are donated for free and my staff works for free anyway, right?” So the dentist just lets Grandma Mary walk out the door and doesn’t charge her a single penny.

Here’s what would be done in my office. When Grandma Mary calls the office and says she has a sore spot from her denture, our front desk would say, “You need to see the dentist. You need an exam,” and then our receptionist would tell her how much the exam costs. Then all it would say on the schedule is “Grandma Mary examination with Dr. Farran.” Then I would go in there, put on my loupes, lean her back and I would examine the entire denture. I would look at the soft tissue and find the sore spot; look at the bite; ask relevant questions such as, “How old is your denture?” I’d check her joints and perform a thorough exam. Then I would sit her up and look eye to eye with Grandma Mary and say, “OK Mary, you can do one of about seven things.” With market segmentation, the lowest cost is what is done the most and the highest cost is what is done the least in your practice, given this particular situation. So I am going to present her about seven different treatment plans and as they get more expensive you sell less of them but you end up selling more overall because you are presenting options.
…Just like when you buy a car (see Fig.1) Car-wise, a Chevy would be the least expensive – they sell many of those. But if you can afford more than a Chevy, you might buy a Ford Taurus – but they’ll sell less Tauruses. And on and upwards you go – the more “premium” the vehicle, the more you charge, but the fewer you sell.

With market segmentation, as the price goes up, the quantity you sell goes down, but overall, if you present all of the options rather than just the premium option, you’re going to sell more dentistry.

You need to present all of the options. I’ll ask, “Grandma Mary, first of all, how old is this denture?” and she says, “10 years.” Then I say, “The denture hasn’t changed at all – you have changed. You have gotten older. Your jaw bones dissolve over the years. You might have gained or lost 10 pounds. Something has changed. Here are your options.
  1. You can just do nothing, you’ve got a sore spot and it might go away in time.
  2. For $50, what I can do is try to retrofit your denture into your new changed jaw by adjusting it.
  3. For $275, what we can do is we can reline this denture, put some impression material underneath that denture and get a new impression of how your jaw is today and get that denture a new base.
  4. Or if you have $1,250 we could just make a brand new lower denture, but I really don’t recommend building a new lower denture without building a new upper denture too and a new set would be $2,500.
  5. For $5,000 what we could do on that lower denture is place two implants where that sore spot is. They have little balls and snaps. We could put those in there so your lower denture snaps into place. It is really nice and I really think you would love it.
  6. If you have $10,000, what we can do is place four implants. When we place four implants, we connect them all with a bar and that denture snaps onto that bar and it is really slick. It has good stability and when you have four implants, it is twice as stable as when you have two implants.
  7. But if you want the Cadillac and if you are willing to put up $20,000 we could place six implants and build a lower bridge to those implants where this denture won’t even touch your jaw. It is so sturdy I could hang you from the ceiling by these teeth.”
The reason we sell so many implants at Today’s Dental is because we present all treatment plan options. Basically I just told Grandma Mary that she could have anything from, “Do nothing for zero dollars,” all the way to “Get six implants and a lower bridge for $20,000.” You are never going to sell dentistry if you don’t present it. I’ve seen time and time again what other dentists usually do – they bring the patient intake study models, mount them on an articulator, do a diagnostic wax-up, bring Grandma Mary back a week later for an hour consultation and just present her the $20,000 treatment plan. Then when she rejects it your morale is totally blown! Response like that makes you feel like your patients don’t appreciate quality dentistry, or that you live in the wrong area and that you wish you practiced in Manhattan or Key Biscayne and that you are tired of wasting your time. So you go back to the drawing board, you don’t present any implant options and all you do is a denture adjustment. This is wrong.

You’ve probably seen Meineke muffler commercials on television. They offer three different muffler solutions when you are having a muffler problem. Number one is called the “basic” and costs the least. Number two is called the “preferred” and it costs a little more money. Then they have the third option, the “premium,” which costs the most money. What do most people gravitate towards? Somewhere in the middle.

When you offer someone anywhere from two implants to six implants they are very likely to at least get two – maybe four. They might say, “I don’t have $20,000 but I think two implants for $5,000 or four implants for $10,000 might be a good deal.” So they buy somewhere in the middle. The middle is where you make your money – you just have to present it.
Howard Live

Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, email colleen@farranmedia.com.

Dr. Farran’s next speaking engagement is February 5, 2010, at Northeast Arkansas District Dental Society in Jonesboro, AR. For more information, please call Colleen at 480-718-9914.

Seminars 2010
February 5, 2010 • Jonesboro, AR
Northeast Arkansas District Dental Society
Renee Aspinwall
870-932-0015		 February 12, 2010 • Carterville, IL
Southern Illinois Dental Society
Wayne Hawkins
618-357-9333
March 12, 2010 • Sarasota, FL
Sarasota County Dental Society
Kim Feathers: 941-953-6235
sarasotacountydentalassociation.com		 March 19, 2010 • Aspen, CO
The Dentist’s Wife
Liz Pryor: 727-667-6945
liz@thedentistswife.com
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