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30 Years of Dentistry: Lessons Learned – Lesson #10: We Can't All Be Cosmetic Dentists Dr. Joe Steven Jr., DDS

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The debate continues! Which is better – a small office with two or three treatment rooms and a small staff, or a larger office with five, six, or more treatment rooms and a larger staff? From visiting with many doctors over the years at our seminars, this is probably the number-one decision that a dentist needs to make in order to progress to their desired career goals. Unfortunately, most dentists never really commit to either one; they simply wander through their career without defining their practice's main objective.

There are two major career pathways to choose from for a solo practitioner in managing their practice. I will simply refer to them as Type A or Type B. There is no right or wrong way; they both will get you there if managed properly. One is just easier. The decision really depends on your own personal preference of how you would like to practice dentistry, and just how much success you would like to attain. Yes, you can attain success with both types of practices, but the evidence is overwhelmingly obvious that success in a Type B practice is extremely difficult to attain, and is limited to approximately less than five percent of all dentists.

The Type A practice deals with what many dentists call "bread and butter" dentistry. This involves doing a wide range of dental procedures on many patients in an efficient manner while working with a larger staff in a larger office. This is the type of practice I have developed over the past 30 years. It is dependent on a higher-than-average new patient referral base, which is generated internally through a very personable staff. Teamwork, efficiency and maximum utilization of the staff are essential for this to work, or else your overhead will skyrocket. Cosmetic dentistry is part of this practice, but not focused on as much as in a Type B practice.

A Type B style practice is based on a smaller staff, a smaller office, fewer patients, larger treatment plans and longer appointments. This type of practice is described more as a cosmetic practice involving veneers, instant ortho, direct and indirect posterior composites, etc. This type of practice is committed to excellence in cosmetic and/or reconstruction dentistry. Three or four treatment rooms would be sufficient, employing one or two dental assistants and one or two hygienists. It is not uncommon for some of these dentists to just work on one or two patients in the morning and one or two in the afternoon.

An obvious advantage of a Type B practice is that it should be less stressful working on a fewer number of patients per day. A smaller staff usually decreases a lot of management stress as well. And, one of the best benefits of this type of practice is the great personal and patient satisfaction that will be experienced when rendering this type of treatment.

It's easy to see why cosmetic lecturers have proliferated in the last 10 to 15 years. This is a very attractive type of practice to strive for, and I have been tempted to do so many times. Then reality hits me and I realize that, for me, success is easier to attain with a Type A practice. There are four very enticing features about a Type B practice that captivate and draw dentists toward that type of practice goal: 1. Work on fewer patients per hour. 2. Charge a higher fee per procedure. 3. Don't deal with insurance companies. 4. Collect cash up front.

As attractive as these four points sound, it is probably one of the most difficult goals to attain and be successful. Sure, we can all do those four things starting tomorrow if we choose, but unfortunately the large majority of dentists who accomplish those points will not be financially successful. I could bore you to death with countless stories of dentists that I have encountered throughout the past 20 years of lecturing who will confirm this to be true.

The biggest challenge facing dentists who attempt to develop a Type B practice is actually selling those big cases that are typical in that type of practice. Certainly, taking courses and actually perfecting your skills is a very challenging task also. But, I think a much bigger challenge is selling the dentistry. There are plenty of good courses out there that will help you do this and should be a prerequisite before committing to this type of practice.

Another negative with this type of practice is that a Type B practice is more sensitive to the changes in the economy. We're in a recession now and many patients are delaying elective dentistry until things improve. I'm hearing that from dentists all over the country.

Back to the "selling dentistry" part. Many authors and lecturers say that most dentists don't develop a Type B practice because of fear of rejection. Dentists just can't accept it if a patient doesn't accept their $20,000 treatment proposal. Heck, I have patients not accepting a simple stainless steel crown, so am I going to stop presenting it because I can't handle the rejection? I think this concept is highly exaggerated. Sure, there are some cases of this happening, but I don't think it is as common as some people believe.

Instead of fear of rejection, I think there are three other predominant reasons why many dentists don't fully commit to a Type B practice. One reason is that some dentists just don't feel technically comfortable doing extensive cosmetic and reconstructive dentistry. Another reason is that many dentists simply don't want to cater to the more demanding segment of our society that is usually found in a Type B practice. And, the third reason is because most dentists are not afraid of, but are tired of rejection! They soon realize that the large majority of their patients simply refuse these large treatment plans.

It took me many years to realize just why I never accomplished a Type B practice. Most dentists just go with the flow and attempt to develop a Type B practice while their mindset and manner of practicing dentistry is that of a Type A practice. That's what I did my first 10 years, not really committing to one style or another. Finally, I made a personal and professional decision about 20 years ago to have a Type A practice. Even now though, after hearing many of the popular cosmetic lecturers on the circuit, I do get tempted to go the Type B route. Then, reality hits me; I just don't have the patience, personality or temperament to deal with the challenges of a Type B practice on a full-time basis.

One of the reasons I chose not to strive for a Type B practice is because I really didn't want to work in developing it. My hat is off to those doctors who do all the advertising, promoting, training, etc. necessary to have a Type B practice. I just find it much easier to find success in doing basic dentistry on many patients each day. Without a doubt, you will find that the majority of highly successful dentists practice in a Type A practice. Very few do it off a Type B practice, and I congratulate those that do.

And the simple, obvious explanation for this is because there are not enough of these "big case" patients around for all of us. This type of dentistry is very expensive, and 95 to 99 percent of the population can't afford it. It is for the same reason that you don't see everyone driving a Mercedes. This stuff is expensive! Most dentists will not spend the money to restore their own mouths with some of these "high-dollar" treatment plans. Yet, we are advised to present these cases to everyone, and if we don't have great case acceptance, then it is because of our verbal skills!

Dentistry is stressful enough. I prefer to work on a wide variety of patients ranging from the assembly line workers at Boeing to their CEOs. And if I were forced to make a choice of having only one class of clientele in my practice, I would always choose the middle class. I realize that a Type B practice will also include many middle-class patients, but most patients in a Type B practice are probably in the upper economic brackets.

Yes, the Type B boutique cosmetic practice is very appealing and that is why you hear so much about it. But once again you will find that the majority of wealthy dentists have a Type A practice and comprise the silent majority. I say silent because very few of our leaders advocate this type of practice because it doesn't sound as attractive as a cosmetic practice. Unfortunately, many dentists don't learn this lesson until after several frustrating years, and then they come to the realization that we can't all be cosmetic dentists!
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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