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30 Years of Dentistry: Lessons Learned Dr. Joe Steven, Jr.

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Oh, we dentists love our toys! I'm one of those also, but I try not to get carried away. Too many doctors think that they have to have the latest laser, digital X-rays, a CEREC machine, the iTero system, computerized anesthetic delivery systems… the list goes on and on and on. I have to tell you, some of the most successful practices that I have come across don't have hardly any of the things listed. They don't have intraoral cameras; they don't have lasers; they don't have electric handpieces; they don't have automated endo… Yet, they sit back and just smile because they are big producers with low overhead and great profits!

Please don't misunderstand me because I do believe in many of the great high-tech innovations that we have seen in our profession, and I really enjoy them. But, more doctors need to understand that high-tech equipment is not the most important thing for success. On the other hand, I have written and spoken about many benefits behind new technology to make our practices more efficient and profitable.

Unfortunately though, I see too many doctors who are saddled with so much debt because the sales rep says, "You can have this piece of equipment, and it's only going to cost you this much a month, but its going to make you so much more efficient. Then, you can have this laser and that is only going to cost you this much, but oh, the increased production is just going to come in…" Many doctors become slaves to equipment bank notes. Yes, it is nice to have some of these things, but trust me on this, that's not the answer for generating a highly profitable dental practice.

Too many of our leaders steer us in that direction because firstly, they look very impressive to their audiences when discussing this new technology. And secondly, many times doctors (myself included) who spend a lot of money on high-tech equipment, are so psychologically and emotionally committed to it, they don't see any of the negative aspects of the purchase. I recall when I got my electric handpieces about 10 years ago, I was so excited about them I just had to share this with everyone. I spent around $10,000 to get three rooms equipped with all the attachments, etc. and I started using them and I thought they were great! I know many doctors will disagree with me on this, but I'm not convinced that they are as great as many claim them to be. Sometimes I think our emotional excitement is part of justifying the cost. I have heard this from other doctors who attend my meetings who share the same thoughts about this.

So, equipment is not the answer to a highly productive and profitable practice. Yes, it will help, but you have to balance things out. You can't just sit back and say, "I need, this, this and that because when my patients see me use all this high-tech stuff, it's going to generate a lot of referrals and they will accept more of my treatment proposals." Yes, there is some truth to that, but not as much as some doctors would like to believe. I wish I could give you a formula as far as how much to spend on all of the high technology that is available for dentistry, but there is no such thing because every practice and every dentist is different.

Of course, our sales reps are more than willing to share with us specific "return on investment" information concerning pieces of technology. And they do sound very convincing. CEREC comes to mind! What a great concept: make the crown and seat it the same day without having to deal with temporaries or a second appointment. I've been tempted several times to take the plunge, then I met a doctor who said he tried one but didn't like it and sent it back. One concern that sales reps don't understand is that all dentists are different when it comes to the discipline of incorporating new technology into their offices. Some doctors dive into it and perfect the incorporation of their new purchase. Many others don't and the equipment may still be in the box.

I know, I know – many of you out there think I'm way behind the curve on this one, but we still don't have digital X-rays in our office. I have three estimates sitting on my desk right now so I will be pulling the trigger on this one soon. Once again, there are many highly successful dentists who still don't have this technology, yet they do extremely well. I never have believed the "return on investment" calculations from sales reps in regards to reducing staff salaries because of the time savings involved with digital X-rays. I haven't met a doctor yet who said their salaries have gone down once they went digital. Anyway, it's only a matter of a few years before it will be mandated that we all have digital X-ray systems in our office.

Regarding X-rays, I have always recommended what I consider the number-one best "return on investment" purchase to be a panoramic X-ray unit. I feel that should be at the top of the list before anything else. And yet, I see offices purchase many other high-tech items and they still take full series X-rays. Every new patient in our office receives bite wing X-rays and a pano film. Extremely diagnostic, educational, with less time and cost involved.

I'm still a big fan of intraoral cameras and believe they are extremely beneficial in presenting and selling dentistry. I like my three chairside air abrasion units and my Ellman electrosurge units. Automated endo has been a life saver and extremely profitable. Once again, you have to balance out what "toys" you want to bring in to your office. These are not easy decisions.

On another note, one thing that I have observed over my career in regards to technology is that few sales reps discuss the upkeep on equipment. There are days where I seem to be constantly repairing things around the office or calling the computer or service rep because something is not working properly. I long for the days when my main concern was not getting the dental chair to move. I recently had a conversation with a high profile dentist who complained about the same thing while telling me about his $300,000 investment ordeal of redoing his large office with a computer/X-ray system!

Several dentists have encouraged me to buy a perio laser unit because they said it was great for treating their perio patients and that their hygiene department is extremely profitable because of it. I think the price tag was somewhere around $50,000 or so, and I thought to myself, why do we need this? With four hygiene rooms, do I need four units? Of course, you can move it from room to room, but we all know that's no fun and many times you won't use it because of that. We have a very profitable and effective soft tissue management program with traditional instrumentation, so I think I would rather spend the money on something else or simply keep it!

So, look at your equipment needs and try not to make an emotional decision because the sales rep or lecturing doctor got you excited. One of the biggest mistakes that a struggling office makes is to buy a piece of equipment thinking it is going to save their practice. It will not! I prefer and recommend that a doctor first develop a highly successful practice so that it allows you to afford the new high-tech "toys" that will make you more efficient and even more profitable!
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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