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Howard Speaks: Teach Your Team to Teach Howard Farran, DDS, MAGD, MBA, DICOI; Publisher, Dentaltown Magazine

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It's December 2011, and I'd really love to write about recent and upcoming economic improvements and about the sacred and sovereign profession of dentistry getting back to business as usual – but things aren't getting any better, gang. The economic state we've been in since 2007 really cannot be called a recession – we're in a great contraction, and I bet we probably have about 10 years before we'll see actual recovery. Since the economy took a tumble in 2007, one of the top complaints I hear from dentists is their new patient flow has plummeted.

This is nothing new, of course. Countless articles have been written on this problem over the last four years. People are still holding off on taking care of necessary dentistry; they're waiting until it hurts (which means you've probably seen an uptick in emergency patients). Traditional means of marketing, like direct mail, aren't as effective anymore. The return on investment just isn't there. It's very hard to get a new patient in your door. This means we all need to try to do more with the patients we have. This doesn't mean you're going to do extra or unnecessary dental work on your patients (and if that was your first thought, please ask your assistant to slap you really hard).

No, what I'm saying is we all need to learn how to sell dentistry better. The general rule of thumb for dentistry is for every $100 you treatment plan, you're probably only getting $38 of it done, on average. To put it another way, for every 100 fillings you diagnose, only 38 of them get done. How can you be profitable if you're leaving so much on the table?

For the last two decades, my dental practice has averaged between $62 and $65 for every $100 we treatment plan. On average, dental practices in the U.S. have 850 active charts (charts of patients who have come in at least once in the last 24-36 months). My dental practice has about the same amount of active charts as the average dentist, but I'm getting so much more diagnosed dentistry done than the average dentist. Why? Because I'm teaching my patients about their mouths. My practice sells dentistry.

I've said and written this a thousand times before, but it's important you remember this: The word "doctor" comes from the Latin word "docere," which means "to teach." The reason I know this, and the reason you probably know this, is because we were required to learn 5,000 words in Latin and Greek. I could carry on a conversation with a fellow dentist in Latin or Greek for hours, but when I talk to my patients about dentistry, I use language they understand which, unless they are also in the medical profession, probably isn't Latin or Greek. I teach them. You need to ask your hygienists and your assistants how often your patients ask them for clarification after you examine them, barf out a bunch of foreign terms, and move on to the next patient. If it happens even once, you probably need to re-examine how you're teaching your patients. But even more, you might not be the best person in your practice to teach or sell dentistry to your patients!

Do you know what the difference is between the dentist who brings home $100,000 a year and the dentists who bring home $300,000 a year? Every single person at the $300,000 dentist's practice is a "doctor." From the front desk to the assistants to the hygienists – they all teach!

It all starts when someone calls your practice. Let's say they've got a hot tooth and they're in some pain and they're asking the front desk what they think. Your front desk person should know enough to say, "If you're in pain, you really need to come in. Chances are, if it's an infection, it will get worse. Let me see if we can squeeze you in today." If your front desk says, "I'm not the doctor," you need to give him or her the license to teach this person about what it could be. You and your front desk aren't going to get arrested for teaching someone about dentistry.

Let's take it to the hygiene room. Where's the passion for saving teeth? Instead of chitchatting about newborns or what they did last weekend or plans for the holidays, they should be talking to your patients about dentistry and what's going on in their mouths. I could ask your hygienists, "In the U.S., three in 10 people have no teeth in their mouths by age 65, and another three in 10 have lost half of their teeth by 65. If you lost all of your teeth, would that be OK with you, tragic or unthinkably tragic?" One-hundred percent of them would answer "unthinkably tragic" without hesitation. I could even ask them if they'd pull all of their teeth out if I gave them $1 million. Not a single person in your practice would ever take that deal. So if you wouldn't want to lose all your teeth for $1 million, where's the passion for saving the teeth of your patients?

It's time to put the passion for teaching back into your practice! Think about this: when you go to a great aerobics class, it's not because your instructor is some 400-pound dude who smokes Cuban cigars, drinks dry martinis and tells fart jokes while you're sweatin' to the oldies. No way! It's always a motivated (and motivational), physically fit instructor who gets you to do 100 leg lifts in one minute. You want to look like that instructor; that's why you're in the class. And your instructor is passionate about getting you as fit as she is! Your team needs to teach dentistry like an aerobics instructor (sans loud music and screaming, of course). When you walk into your operatory you need to be able to tell your patient, "You know why I want to schedule you for a three-month recall? Because if you do what I tell you, you will never go through the pain, agony and suffering of losing your teeth when you're 65." You've heard the gut-wrenching cries from your female patients after you tell them you have to extract their teeth. It's horrible to hear, but unless you've had all of your teeth yanked, you really have no idea how terrible this is for them! Selling a plan to women to keep all of their teeth should be a no-brainer. The reason you're not selling it is because the dentist won't let the hygienist or the staff teach his patients dentistry.

Think about this, after your assistant takes the X-ray, because you're not letting her talk to your patients about dentistry, she just sits there like a bump on a log, or maybe talks about her weekend. Why can't your assistant say, "I'm not the dentist, but I'm 99 percent sure that is a cavity. It's a flossing cavity. You have 15 fillings in your mouth and 10 of them are flossing fillings. Five of them are from not having sealants. You're probably going to need another filling." Have your dental assistant really utilize your digital X-ray system (and if you don't do digital X-rays in your practice, you're not allowed to read the rest of this column until you do! You can't teach dentistry on a one inch Kodak film on a view box). Have your assistant blow up the X-ray to the size of a sheet of paper and print it out so she can circle, in red ink, exactly where the problem is. Have her circle the nerve and explain, "Right now you have a flossing filling. If you wait another year or two, the cavity will grow into the nerve and you'll be in a bunch of pain, and it will become a root canal." Then you're buzzed into the operatory where you confirm and diagnose the situation. Once you're done, you hand the patient off to your treatment coordinator who can put a dollar amount on the treatment, explaining the cost of the filling and the financial benefit of doing the filling today instead of waiting until the tooth will need a root canal, build-up and crown or an extraction. The more informed your patients are, the better the decisions they can make.

I saw a number from Delta Dental recently, indicating that average new patients in America will claim $398 on their dental insurance. Meanwhile, my practice does more than $1,000 per patient. How can my practice surpass $1,000 and the average dentist barely hits $400? Because my receptionist is selling dentistry instead of sitting behind a wall and talking through a window. When you walk into my practice, everyone greets you by your first name and exudes passion for dentistry; everyone on my team is on a mission to do better dentistry. They love giving patients the knowledge to keep all of their teeth and that they don't have to be one of the millions of edentulous men and women in the United States walking around with plastic upper and lower dentures.

Here's another angle to think about: When you're in the back doing a root canal, you can't stop midway through the procedure to talk to your other patients about dentistry. So leave it up to your team! If you want to be a million-dollar practice these days, you're not going to do it with a bunch of new patients, because they're not going to show up. You need to delegate teaching dentistry to your staff so they can sell it to your patients and so you can do all the dentistry you need to do. When you do a hygiene check, you need to be able to ask your hygienist what she sees and then confirm the obvious. While your hygienist is waiting with your patient for you to come into the operatory, she should be pulling out the intra-oral camera and showing the patient (on a big screen) where she sees some issues. If that patient has no idea she has three cavities or no idea this tooth needs to be extracted by the time you're in the operatory, you need to let your hygienist know that she needs to start teaching your patients about what they need – and if your patient still doesn't know what the deal is, then you need to find someone who will talk to your patients. In all my years in dentistry, after I've given my assistants and hygienists the opportunity to teach their patients about what's going on in their mouths, not a single one of them has been arrested. They're not diagnosing – they're educating! It's time for your team to start teaching.
Seminars
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, e-mail colleen@farranmedia.com.

January 13, 2012 • Phoenix, Arizona
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