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30 Years of Dentistry: Lessons Learned
Lesson #4: Diversify Your Services Joe Steven Jr., DDS

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Quite often I visit with dentists who complain that they just aren’t making enough money in their practice. I proceed to ask them very similar questions like, “Do you do molar endo?” They usually say, “No, I refer those out.”

Next question, “Do you extract wisdom teeth?” They say, “No, I don’t do any extractions.”

“Do you do dentures?” I ask. “No, I hate dentures!” they say.

“Do you do implants? mini-implants? Invisalign? Zest anchors?” Their answers are almost always, “No,” “No,” “No” and “No.”

Way too often dentists are referring procedures out their front door that they should be doing. Ortho, gone! Endo, adios! Perio, bye-bye! The list goes on and on. We are trained to do most of these procedures. If you haven’t been trained on any of them, what are you waiting for? There are plenty of courses out there, so take one! We need to force ourselves out of our comfort zone and start providing these services. Another positive to that is, if you’ve been in practice 20 years or longer, any new services you incorporate into your practice will give you a good shot in the arm as far as reinvigorating yourself and staying motivated.

Let me describe the best week I’ve ever had in my career in regard to production: Not too long ago in one week I did a six unit veneer case, started an Invisalign case, did a single root form implant, did a mini-implant case, did a Zest anchor case, started two immediate dentures in addition to our normal endo, surgery, crown and bridge, etc. Please don’t get me wrong; this was the only week I’ve ever done something like this. The point is if we offer more services to our patients instead of referring them out, they slowly start to accumulate and snowball into more productive days.

In today’s economy, now is not the time to be referring out procedures. I received an e-mail recently from a doctor who asked me about proper protocol in doing amalgam restorations. He explained that he had not done them in years and felt that because of the poor economy he needed to offer that service since his patients were looking for less expensive alternatives to his cosmetic procedures. His thinking is right on!

A comment that I hear from patients quite often is, “It’s nice that you do everything here because I don’t want to go to a specialist.” Patients hate going to specialists because they know that it’s going to cost them more money, plus they have to get acquainted with a new doctor, which they prefer not to do. They want you to do it all. Just yesterday (at the time of this writing) I was ready to bail out on an endo procedure because I could not access the canal on a bicuspid. This patient has been with us for 30 years and he did not want to be referred. When I mentioned the difficulties I was having, I told him that I better have a specialist do this. He said, “Come on Joe, try one more time would you please?” I agreed and was extremely satisfied when finally I got into the canal and was able to complete the procedure. I called him that night to check on him, and he was so appreciative that I was able to finish it for him. That kind of marketing goes a long way!

At one of my recent seminars a doctor told me he thought it was OK that he referred endo out because the patient would be coming back to him for the crown later anyway. I told him, “You threw $1,500 out the window that day. I can’t do that.” My emphasis has always been about “today,” not tomorrow. I am always concerned with today’s production! When a patient comes in with a “hot tooth” – which happens almost every day, if not twice a day – and we need to do endo, a post buildup, and a crown prep, we try to do it all that day which adds up to about $1,500. When I shared that information with the endo-referring dentist, he said, “Wow, I didn’t look at it that way because I was thinking in terms of not wanting to do the endo, but I am still going to do the crown later.” When he thought about today, he came away with a new perspective.

Surgery is the most profitable procedure there is, yet a lot of doctors refer it out. With the innovation of Luxators and Physics Forceps, it should be rare to refer out extractions. Granted, even I don’t do all surgeries – I still refer out severely impacted third molars. I also understand that many doctors who do immediate dentures send the patient and the denture to an oral surgeon for the procedure. The majority of the profit is the surgery part not the denture itself; that’s why we need to become proficient at surgery!

Let’s address the comfort level that usually prevents doctors from doing various procedures. I have said this many times before: If you are doing a procedure that you don’t feel comfortable doing, then do it on your time, not the office time. What I mean by that is if your office is normally closed on a Wednesday afternoon, have that patient come in at 11:45 on Wednesday. Get the patient numb, finish up your regular patients, send everyone home except the assistant who will be helping you, and then take your time and do the procedure. How many times would you have to do that before you felt proficient and comfortable doing that on a daily basis? Three times, maybe 10? So what! Just do it, and then once you become comfortable and proficient at the procedure, you will gradually work them into your schedule.

The other thing that I have done any time I add a new service to our practice is to look for a “guinea pig” for my first patient and do it at no charge. That’s what I did when I learned to do mini-implants, Zest anchors and regular implants. You won’t have any trouble finding volunteers when it’s free! With each succeeding case, as my confidence and proficiency improved, my fees went up. Look at it as cheap tuition for expanding your practice.

More dentists need to incorporate new procedures into their practices and once they do, they’ll say, “Wow, I have really been busy lately and quite often!” If you keep referring a lot of procedures out of your office, then you may find that you have a lot of empty chair time on your hands especially in this economy. So, take time to evaluate your practice and see how you are doing as far as diversification of the dental procedures that you offer your patients. Hopefully you will see that you may be far better off by expanding your treatment services. I guarantee that your patients will appreciate it, and you will definitely enjoy greater profits!
Author’s Bio
Dr. Joe Steven graduated from Creighton Dental School in 1978 and has been in solo practice in Wichita, Kansas up until June 2007 at which time his daughter, Dr. Jasmin Rupp, joined him. He is president of KISCO, a dental products marketing company, providing “new ideas for dentistry,” and is the editor of the KISCO Perspective Newsletter. Dr. Steven along with Dr. Mark Troilo present “The $1,000,000 Staff" & the “Team Dynamics” seminars. Dr. Steven also presents three other seminars: “Efficient-dentistry,” “Efficient-prosthetics” and “Efficient-endo.” Dr. Steven also provides the KISCO Select Consulting Program to dentists in the form of a monthly audio cd recording. (Contact info: jsteven@kiscodental.com, 800-325-8649, www.kiscodental.com)

This story, originally published in the KISCO Perspective Newsletter, is reprinted with permission.
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