Dentists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we introduce longtime Townie Dr. William “Tom” Peck, who’s been a member of Dentaltown since 2004 and is one of the most-followed members on our online message boards.
Peck’s practice, Plainfield Dental, is a throwback to keeping dentistry simple without sacrificing success. Peck is a proud antithesis to the docs out there who want all the newest gizmos, do every
procedure under the sun ... and exhaust themselves in the process.
His family practice just outside of Chicago is the oldest in the community and sits along the historic Lincoln Highway, and north of the historic U.S. Route 66. Go with us on a virtual tour of Peck’s
practice to see how he stays stress-free, how every day is “bring your guitar to work” day, and how his advice might just keep you from pulling your hair out.
Dr. William “Tom” Peck
Townie name: WTP
University of Tennessee, 2006
Plainfield Dental, Plainfield, Illinois
7 operatories, 10 staff
We have it on good authority that you’re actually a bass guitarist
posing as a dentist. If you had a fantasy set list to play with any musicians in the world, what would your top three songs be?
My musical tastes reside for the most part in 1990s alternative rock, but I’m a fan of all decades of classic, alternative and punk rock. I’m definitely a rock guy—I believe most songs should have a distortion guitar. As far as bass playing, again, my interests are varied but it’s mostly alt-rock or punk rock. If I feel like playing with my fingers, I turn on a Red Hot Chili Peppers song to jam to. If I want to play with a pick, then
I’m going to crank up some Rancid and jam to that. To pick three songs to play on stage with the original bands, off the top of my head I’d go with:
1. “Soul to Squeeze” by Red Hot Chili Peppers.
2. “Fall Back Down” by Rancid.
3. “Hysteria” by Muse.
Tell us about your guitar collection, garage band and how your love for music plays into your practice.
Before I get started, I want to make one thing clear: I am by no means a professional musician! Legit professional musicians on Dentaltown such as “Bassslapper” actually get paid gigs and cut albums, so I don’t want to get confused with people who really know how to play!
I started playing guitar and bass in high school. At first it was just my friend and me jamming on our guitars, but we eventually found a drummer. Then it got a lot more fun. The point of the band was to jam to songs we like and to drink beer. (We did play a few parties that had actual girls in attendance, though, so that was cool!)
We continued this through college and then I moved away for dental school. After getting into dental practice, I again found a band to play with. We played some open mics and played a few bars—we may have gotten paid a few times? I can’t remember.
But getting back to music and the dental office, playing music is a great stress reliever. Over the years, my partner and I (mostly my partner) have collected guitars and amps to play. We rotate into the office what guitars and amps we feel like playing. One day it could be an ’80s Gibson Silverburst played through an old Fender Bassman amp. Another day it could be a Fender Jazzmaster played though a Bogner Uberschall. As far as basses, I play a Fender Precision Bass or a Musicman Stingray.
Normally, we have one or two amps in the office and three or four guitars. I play between seeing patients. Do patients hear it? Yes, they definitely hear it. They don’t mind. And I wouldn’t stop if they did anyway!
What were your first years of practice like for you?
I think most new grads are surprised that there are patients who don’t want to pay you. Or who blow off appointments, or don’t care how involved and demanding providing dental care is. My hardest part of being a new dentist was figuring out which patients were being reasonable with their requests and which patients were not. As a new grad, you think they’re either all being unreasonable or all being reasonable, and you blame yourself for things you shouldn’t be. The more experience I gained, the more I realized there’s a certain segment of the population that is straight-up crazy. There is no fixing them and they have to go. Luckily for us dentists, the percentage is pretty small.
As far as my progression, I first started in corporate dentistry. I went in knowing this was going to be a stepping-stone, but I gave the corporation the full benefit of the doubt. If it was as great as promised—all corps promise the best experience possible!—I had an open mind to stay. But after about six months, I knew I had to move on.
I started searching the dental practice classifieds and found an office that was looking for a partner in an area I wanted to be in. That practice actually had my letter on file from when I was a D4 dental student. Back then, I sent out letters looking for employment in areas I wanted to practice. This practice kept that letter, and now was the time they were looking for someone. It was funny how that worked out! That’s the practice I am in today.
You’re long removed from those dark days, and now you’re part of a practice where you’re never bored (or too stressed) at work. Tell us about Plainfield Dental—the people, the patients, etc.
You’ll probably never come across an office like ours. It looks like we don’t do
anything. But somehow we make money. We even take a bunch of insurance plans. basically work out of one chair. I chalk up this freedom and ability to work this way because we own the office and the land and have no debt.
We have a team of 10 members. We’re a hygiene-driven practice. We do no advertising outside of sponsoring some local high school activities and a church bulletin. Most of our dental work is diagnosed out of the hygiene chair. Depending on the day, we have between two and four hygiene chairs going.
We cater to normal everyday people who want to maximize their insurance benefits. We have a dedicated staff member who reviews everyone’s coverage, because most patients have no idea how their insurance works. If we get to the end of the year and a patient is out of benefits but still has non-emergency work that needs to be done, we’ll tell them it may be best to wait and get started again in January. We tend to send out a pre-estimate for almost everything. This flies in the face of what most people say on Dentaltown’s message boards, but patients don’t like surprises. And this prevents us from being blamed for anything. I like that; part of the stress of this job is being blamed for stuff you didn’t do or cause. This is just one thing of many that helps alleviate that stress.
The office is the oldest practice in the community. What’s its history?
Dr. Richard Schmitz started the practice in 1968 right out of the U.S. Air Force. Back then, Plainfield was basically a little farm town and it was Dr. Schmitz and perhaps one other dentist nearby who served the community.
When Dr. Peter Muraglia joined in 1996, Plainfield was transforming from a farm community—he recalls watching tractors drive down the main street—into a suburb of Chicago.
And when I showed up in 2007, it was a full-blown suburb, nearly indistinguishable from any other suburb around Chicago. But it was still growing, because we were on the outskirts of the sprawl and the town expanded to the south and to the west. Which it did, and our practice grew.
1. 3M Filtek Supreme Ultra. Good universal composite that works
well anywhere in the mouth.
2. 3M Astringent Retraction Paste. Works fantastic at drying out the sulcus for great impressions.
3. 3M Imprint 4. Combined with the retraction paste, again allows for great impressions.
4. Kuraray Dental Clearfil SE bond. Still the gold standard in bonding, in my opinion.
5. Triodent V3 Rings. Makes Class II composites simple and consistent.
Many dentists try to pack more into their practices as a means
to reach more patients, but your office is a successful throwback to keeping things simple. What are you content not doing—and why?
We do pretty much all the procedures you learned in dental school back when schools actually taught you how to do dentistry: amalgams, composites, endo, surgical and simple extractions, partials, dentures. We see kids, teenagers, adults, the olds.
We do all the bread-and-butter stuff that one would assume any neighborhood practice would offer (yet has gone out of vogue for some reason). We don’t search out the glamorous, sexy procedures: veneers and smile rehabs? No, thanks—you don’t make any money doing that stuff, anyway. Same with placing implants or even doing molar endo. We do endo, but it had better be pretty straightforward. That means most molars don’t qualify. Most dentists will tell you as they get busier and busier doing crowns and fillings, hard endo gets sent out first. I’m no different.
All the advice I learned as a new grad about having to take out third molars, place implants, do all your own endo and ortho ... well, that was all garbage. I placed 50 implants and then quit, and I do zero ortho. As soon as I focused in on what I felt comfortable doing and sent out the rest, income went up.
I would like to mention Brad Smith as someone on Dentaltown who taught me that sexy procedures don’t make you any money. Predictable procedures make you money. And to be predictable, you have to cut down on what you can offer. Sure, my office offers a healthy variety of procedures, but nothing too demanding. In other words, “jack and master of a limited set of trades” would be a good way to put it.
Similar to your clinical offerings, you keep practice management
simple. What’s your approach and why does it work?
When I came into the practice, it was a very laid-back style of management. But then again, with advice I got from some, I tried running the office like a Fortune 500 company: employee handbooks and daily huddles and production reports and employee reviews that felt like they occurred several
times a month. What a disaster! We might as well have installed cubicles and asked team members for their TPS reports. It was basically the antithesis of the atmosphere that we wanted to keep with the patients.
Phil Zelmanow mentioned the term “country club management” on the message boards. What a great term! That is exactly what we are now, and what we were at the beginning when I joined. We have an open-door policy and encourage all employees to come in and talk to us, one-on-one. Staff schedule their own reviews if they want one.
Now, you can’t be totally laid back, because we do run a business and certain legal requirements and bookkeeping duties can’t be ignored. We have an employee handbook and monthly office meetings to hash out any issues that need to be addressed. But the days of trying to treat it like your own little corporation and having a written policy for every single mundane thing are over.
Walk us through a typical day in your office.
I show up, pour a cup of coffee and surf Dentaltown or YouTube until I’m buzzed—from the old-school omega light system, not from drinking! I then go numb someone up, then go back to web surfing or play a little guitar. Once the patient is numb, I do whatever procedure I’m supposed to do. Repeat that about 10 times, and that’s my day, along with taking calls from specialists and the lab, and various questions from staff and patients.
One thing I want to mention is how I check hygiene patients. Once the medical history, probings and any films scheduled are taken, I’m notified via computer. I can then go in at any time to do my exam. This keeps the hygienists from waiting on me and keeps me from being interrupted during a procedure. After I started doing things this way, my stress level went down considerably.
What’s the biggest problem facing dentistry today?
Student loans! Once the government gets out of the lending business, a lot of the problems we see in dentistry will go away.
Many graduates believe it’s necessary to become an associate/employee for the long term because they don’t think they can financially afford to buy a dental office. There are a lot of forces in dentistry that are pushing for this, and want to see private practice go away. Outside interests want that profit for themselves.
However, you’ll never make as much as a dentist being an employee as you will if you’re your own boss—and you certainly won’t be able to have a laid-back style of practice, like I do. If I were forced to be an employee in this profession for the entirety of my career, I never would have entered into it. That’s not to take away anything from career associates; I just want the ownership option to always be available to me.
The ironic thing is that with today’s debt levels, you really need to be an owner
to produce the income to pay back those massive student loans. It’s a Catch-22. This issue is complex and I’m giving it just a cursory view. However, I thought it was necessary to address, because I do believe it’s the biggest issue the profession is facing.
What products make your professional life easier?
- A bite block: I hate having to constantly tell patients to stay open.
- 3M retraction paste: That stuff works great and I hate packing cord.
- Electric handpieces: They make your work look so much better.
- Dexis imaging with the spotlight feature: Finding caries is way easier and the software never lies.
- Spade proximator: It makes surgical extractions much easier.
RelyX Luting Plus
NSK Ti-Max (electric)
• DFV 4.5 loupes
• SurgiTel 2.5 loupes
What are some of your favorite hacks when it comes to practicing? Any tips, tricks or shortcuts that you’ve learned over the years that a new doc might love?
The hygiene check trick I mentioned before really helps.
I cut all my restorative preps like an amalgam. I cut them big enough so you can see. They’re much easier to fill than if you’re trying to be some super-conservative guru. You’re not doing the patient any favors if you can’t see what you’re doing.
All my crown preps are feather-edged. If you look at the chamfer on your lab work, it probably looks like crap unless you’re really good, and that takes up too much time. Most dentists can’t screw up a feather edge or do it in a reasonable amount of time. As long as there are no undercuts, porcelain feathered margins perform fi ne.
When treating lower molars, every patient gets two carpules of lidocaine 1:100k epi (unless it’s a pediatric patient, then just one). I used to just do one carpule but that was inconsistent. Now that I do two carps on everyone, most people get numb. The few who don’t numb get a PDL injection, and that usually does the trick.
All of my anterior composites are one color. People see shape before they see color. As long as the shape of the tooth is correct, most patients are happy. Of course, there are exceptions who would require a lab restoration to get an acceptable result. When that is the case, the patient gets a custom shade done at the lab.
Let’s talk treatments. What kind of case gets you the most excited to be chairside?
I don’t want to get excited doing dentistry. I like boring and predictable—the
more boring, the better. I get my excitement outside of the office.
Give us a snapshot of your life outside of dentistry.
I’m married and have two daughters. I live a typical suburban lifestyle with a house and a yard I have to mow. I did rebuild an old Jeep. I like hiking. I love Colorado. I like exercising. I like walking through the woods with my dogs.