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Howard Speaks: Overhead and Efficiency by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

Dentaltown Magazine

by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

(Editor’s note: This column first appeared in the November 2014 issue of Dentaltown magazine.)

If you were to ask practice-owning dentists around the country what their biggest business concern is, many of them would simply say “overhead.” I can’t stand it when people in the dental profession generalize overhead percentages for the entirety of the United States, because every state and every market is different. A dentist in North Dakota faces different overhead costs than a dentist practicing in Manhattan. The economic and market variables that practices face in big cities differ greatly from those faced in rural areas, so to generalize and say a dental practice’s overhead should only be “X percent” isn’t fair.

It’s also frustrating to me when certain entities completely negate the cost of the dentist in overhead equations. When I practice dentistry I pay myself 25 percent, which makes up a lot of my practice’s labor costs. The rest of which is—of course—split up among my staff, which includes receptionists, office managers, hygienists and assistants. In large markets, that remaining labor cost makes up 25 to 28 percent of total overhead. In rural areas it’s about 20 percent. Regardless, it doesn’t matter whom you speak to about their overhead, because no matter if your practice is in rural Kansas or a big city, we’re all trying to bring our overhead percentage down.

Office Highlights

When you’re looking at between 50 to 60 percent in labor costs (including what the dentist makes), the best way to bring your overhead cost down is you need to find every single advantage you can to ensure your practice is working as efficiently as possible. One of those ways is through magnification.

I know a lot of younger dentists who look at magnification as something used by old, fat, bald guys whose best days of practicing dentistry were 20 years ago. But even though you might say, “Dr Farran certainly falls into that category,” that generalization simply isn’t true. Anybody who can see something four times larger than you is going to see things you can’t, see more than you can, and do a much better, quicker, more thorough job than you.

I really don’t understand the professors in dental school who tell their students not to invest in loupes because “they’ll rely on them too much” and “they’ll always have to work with that level of magnification.” Are you kidding me? Hey, professor, that’s not a bad thing. Loupes are not a crutch—they’re an advantage. Loupes should be the first tool a dental school should hand their students. Practicing without them is like the difference between doing a filling with the lights on and doing a filling blindfolded in the dark. In my practice, loupes are mandatory for every person who works clinically. My entire staff tells me they would not and could not perform the high level of dental care they provide without them—they just can’t!

I’ve been on the message boards of every day since 1999, and I recall a dentist who once said he was tired of going in to check patients after cleanings and ending up having to clear away a big chunk of calculus. The thing is, he’s wearing loupes, so he can see this piece of calculus, but his hygienist isn’t wearing loupes and can’t see what he sees. This difference really puts the hygienist at a disadvantage. And of course, the doctor gets upset with her because she missed this obvious piece of calculus ... well, obvious to him, because he can see it. This clinician has the same kind of professional blinders on as the dentist who goes to a dental convention or seminar and doesn’t take his team with him. Sure, it’s great the doctor is learning a lot and getting energized and excited about dentistry ... but his staff isn’t. Then he wonders why his team isn’t as pumped as he is. I know this is getting a little off track, but doctor, you have to invest in your staff! You need to get them loupes so they can see what you’re seeing. You have to get them to CE courses so they can get as excited about practicing dentistry as you are.

Not only do loupes help your vision, but think of the ergonomic benefits! You can sit straight up while you work on your patients, and you don’t have to crane your neck around in someone’s mouth to see what’s going on. Over time, loupes will help you practice dentistry longer than the dentist who has a constant kink in her neck from trying to get a better look at her patients’ chompers.

Loupes are great, but let’s take this a little further. You can even improve upon what you’re seeing in your patients’ mouth with proper lighting. Overhead lamps and LED lights that attach to your loupes are a true godsend in this profession, but when I really want every single thing illuminated in my patient’s mouth, I’m going to turn to my trusty Isolite every time.

Not only am I thrilled about having such bright light in my patients’ mouths, but it frees up my assistant’s hands from continually adjusting the overhead light. My assistant swears that using the Isolite is like giving her another set of arms. Since we’re talking about making sure your practice is working as efficiently as possible, when I’m using an Isolite, I almost don’t need an assistant in the room while I’m working on a patient. Instead of babysitting an overhead light for me, she can be setting up other things for the procedure or setting up another operatory for my next patient. In fact, it’s so handy, I’ve heard from other colleagues that their assistants feel a little threatened by it. While it certainly doesn’t replace the entire functionality of an assistant working in your practice, having the Isolite is really like having a free dental assistant work in your office all while you’re getting the best light possible in your patient’s mouth.

That’s the beauty here! It has to be the most boring job in the world for your assistants to sit there and suck spit all day while you’re working on a patient, when you could just get an Isolite to do that task for you, freeing up your assistants to take care of more important tasks.

I recently met with a bunch of office managers in Nashville, Tennessee, and I had a conversation with some of them about how frustrating it is now that the practice has purchased a CAD/CAM milling unit, because the doctor is spending three hours of his time making a crown. That’s crazy! Before he purchased the CAD/CAM milling unit, did he do his own lab work to make the crown? No, he sent it to the lab. So, now he went from being a doctor to a lab–tech. Congratulations, you just spent $100,000 to spend your time doing lab work.

Doctors, you need to start investing in your team and delegating things like making a same-day crown to them. It’s time to free up on the reins a little bit, doc! Let your staff soar! You need to invest in your team. Allow them to see what you’re seeing with your loupes. Start using other helpful instruments so you can free up your assistant from sucking spit, allowing her to take on other, more important tasks. And for heaven’s sake, start bringing your team with you to dental conventions and seminars and get them on the same excitement level you’re on.


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