Blended for Success By David Palmer, DDS

You Can’t Be Everyone’s Dentist… Or Can You?

Many dentists strive to be everyone’s dentist, but they become overwhelmed and ultimately miss the mark on this ambitious goal. Most dentists practice under two distinct practice types: 1) Boutique, and 2) Bread and Butter (B&B). I would like to add a third practice type, the “blended practice,” which encompasses aspects of both the boutique and B&B practice styles.

I define the “boutique” practice as one where the dentist sees one patient at a time, concentrates on a specialty or esthetics, is completely fee for service, and slows the practice way down.

On the other hand, a B&B practice is a very fast paced, “room hopping” practice that may or may not accept managed care, does large amounts of basic restorative dentistry, and many single-unit crowns when needed.

I recently listened to an audiotape of the classic esthetic dentist pushing the boutique practice. This dentist lives in a “prime” location, markets heavily to the “right” people, self promotes in many ways, including his/her own weekly radio show on dentistry. So, with this type of “perfect” practice, where every attempt is made to fill the practice with high-end cosmetic cases, this practice should gross collect what…$2 million, $3 million, more?

Try around $800,000. I know what you’re thinking, that’s under $70,000 gross per month with an overhead percentage of probably at least the national average. Do those numbers really add up? In fact, if the dentist was filling his/her practice with high-end cosmetic cases, wouldn’t you assume at least two “average” $10,000 cases a week? Even with those numbers we should be close to $1 million.

A quick comparison to the B&B practice reveals that many of these practices have far higher gross collections and net the doctor much more. These practices are scattered all throughout the country, many in rural areas.

Joe Stevens, DDS of KISCO, is a classic example of a solo B&B practice that grosses over $1.3 million. Dr. Roy Smith from Tyler, Texas, grosses over $2 million in a solo B&B practice. In fact, for every strictly boutique practice which grosses $1million or more, there may be 100 or more B&B practices doing equal numbers or better.

So, how about a more novel approach? Let’s see if we can be everyone’s dentist and create a blended practice. In my opinion, a blended practice is the best of both worlds and has allowed many dentists to enjoy all aspects of dentistry while making a great living at the same time. Following are seven common denominators that make a blended practice possible.

1) Desire, determination, and a willingness to change

The most important characteristics for anyone thinking about a blended practice are personal desire, determination, and a willingness to change. First off, do you really want to be everyone’s dentist or are there certain fields of dentistry you truly despise?

Second, have you really given these “despised” areas a fair opportunity, or have you been talked out of trying them due to: a lack of training in dental school, fear, a colleague’s negative comments, or the stubborn unwillingness to change? I have found that it is usually a combination of several of these factors that keep general practitioners out of fields such as implants, wisdom tooth extractions, orthodontics and even molar endodontics.

2) The right staff doing the little extra things

To make a blended practice successful, all team members must like to work hard, like people, like dentistry and possess an eagerness to do minor “pampering” things for your patients.

In my blended practice, “pampering” means something quite different than in a boutique practice. For instance, we don’t offer paraffin wax hand dips, massages or pedicures. We do; however, offer five types of hand lotions in the patients’ restroom, hot coffee and two different papers every morning in the reception area, fresh cookies baked both morning and afternoon, soft fleece throws to cover our patients when they get cold, lemon scented disposable towelettes (warmed in the microwave) given to our patients after a long operative procedure; satellite televisions in all operatories, and most importantly, personal phone calls from the doctor the evening after treatment for longer or more difficult appointments.

3) Expanding your clinical skills and services

If you take a gazillion hours of continuing education to improve and expand your clinical skills but apply almost nothing, what’s the point? Let’s say a new patient, a 19-year-old gentleman, walks into the typical practice with almost perfect teeth. No caries, slight anterior crowding, Class I occlusion, and impacted third molars. “Doc I’d like to get my teeth straightened and my wisdom teeth are killing me! What can you do for me?” In many GP offices, this patient gets no treatment as he is referred right away to the specialist. This is terrible for several reasons: a) the patient is asking for your help which you refuse, b) he has no connection to your office because you immediately sent him to the specialist, and c) he has no incentive to refer anyone to your office, after all, how did you help him?

4) Continuing Education

What CE should you consider as a GP? If you have a practice like most I have seen, orthodontics, oral surgery, and endodontics for starters. Get good at the most common and needed procedures in dentistry. Don’t waste thousands of dollars and many hours of your time on CE for procedures that are rarely done. In my opinion, orthodontics is an absolute must as nearly every child in the U.S. gets a mouth full of braces now, with an ever increasing number of adults. The demand is absolutely huge.

Remember, the patient chose you. Failure to learn and apply very common procedures such as basic orthodontics and wisdom tooth removal will cost your practice dearly. The good news is that CE for orthodontics, endodontics, implants, you name it, ALL have been simplified and streamlined to encourage GP involvement. Does this mean you have to tackle every dental procedure, no matter the difficulty level? Absolutely not, specialists have extensive and focused training; make appropriate referrals.

5) Correct scheduling and efficiency

Correct scheduling is probably the one little “trick” that must be applied in your practice in order to have a successful blended practice. The relatively small numbers of patients willing to spend a lot of time and money with you require your full attention. If your practice is nothing more than a hurried “rat killing” from day to day, you will push the full-mouth cases right out your door. In our office the boutique patients are always scheduled after the last patient in the morning, or after the last scheduled afternoon patient unless it is impossible for the patient.

Now you have an opportunity to “change gears.” Everyone is gone, or nearly gone, and Mrs. Jones (who was anticipated to show by the team) is greeted warmly in a quiet, subdued, attractive office. No waiting for Mrs. Jones. You then sit down and listen to what Mrs. Jones has in mind. We have an ever growing book of “before and after” pictures from our office that Mrs. Jones can thumb through on her own or be shown by the doctor or team member. Allow your female team members to talk to the patient and show them the benefits of needed treatments. Patients are often more trusting of the staff, as they see the staff as more on their level. Explain the pros and cons but by all means, stay away from the details and dental jargon we think everyone should know by now.

Scheduling treatment for the boutique patient is another problem if not handled correctly. Large cases naturally require larger blocks of time and cannot be “squeezed in” or around your regular B&B patients. To do so shows disrespect for your patient’s time and commitment. No one wants to feel like “one of many,” especially if they are spending thousands of dollars in your office at one time.

In my opinion, the best way to see patients who want and desire major treatment now is to block one half-day every week, one week in advance. For example, in our office, my partner and I share seven operatories, but stagger our schedules to stay out of each other’s way (Fig. 1). My schedule is generally Monday, Tuesday, Wednesday and half a day on Thursday. This half day on Thursday is always kept open until the Thursday or Friday directly preceding it. Then it is booked starting at 8 a.m. forward, not for example, 11 a.m. leaving 8-11 a.m. open.

This allows anyone desiring major treatment to be seen within one week for the treatment. Only on occasion will the Thursday already be so heavily booked with major treatment that the patient must wait two weeks. It is imperative that a patient wanting 10 veneers, not be required to wait three, four, or even six weeks. Putting people off for that amount of time, or worse yet not even seeing the new patient for weeks on end is a financial disaster for a practice.

The dentist who brags, “I’m so busy I can’t see anyone for two months,” is very inefficient with his/her schedule. People are people and will change their minds in far less time.

Clinical speed and efficiency is an absolute must for a blended practice. The sheer number of people needing minor dental work is staggering. If your staff is well trained, you will do the dentistry and dentistry only while everything else is taken care of through delegating as much as the laws of your state legally allow. Plus, Dr. Scott Perkins teaches an excellent course on efficiency with crown and bridge and endodontics. Dr. Joe Stevens also has numerous tips to increase efficiency and therefore your bottom line.

Need tips on how to be more efficient? Give cash money for any idea brought to you by a staff member which improves efficiency and is implemented. Scan Dr. Howard Farran’s message boards at Dentaltown.com daily, which has transformed many practices (including mine) because of the sheer volume of knowledge brought together in one place.

Or, just visit with your colleagues from around your state or beyond and glean what you can. Dr. Woody Oakes did this early in his career and attained invaluable knowledge of what to do as well as what not to do. Every dentist does things a little bit different and multitudes of minor improvements make a huge difference in your overall clinical speed.

6) A nice facility

Of all seven factors necessary for a blended practice, the facility cannot be ignored. B&B practices can thrive in very Spartan facilities, and a few cosmetic practices may do well in “plain Jane” buildings, but by and large, the patient desiring the best in cosmetics, needs to know they are in the right place from the minute he/she pulls in the parking lot. From personal experience, our cosmetic cases have quintupled or more after building a new office in the same small town. Same staff, same doctor, just different location in a professionally designed office.

As you know, most marketing in dentistry is aimed at women, small things like a nice flower bed outside subtly states, your teeth will be beautiful inside this office. An immaculate, well-decorated patient bathroom is far more important than the rpm of your electric handpiece. And, in order to have the best of both worlds, you must have enough operatories. To have a highly successful blended practice I would recommend six to eight operatories for adequate treatment area for the doctor(s) and one or two hygienists.

Contrary to what many dentists think about the multiple operatory practices, they are actually less stressful than the typical two- to three-operatory practice. With more operatories, there is now room to seat “work-in” emergencies and do minor dental adjustments without killing your schedule.

7) Time

There are a lot of 20- to 30- year success stories out there. And although a large blended practice can be accomplished in a relatively short amount of time, it is not a realistic two- to three-year goal for a student fresh out of school. There is just simply too much to learn about different specialty fields, developing the right team, leadership skills, and perhaps most important, understanding those hard to read, unpredictable, illogical and often frustrating things we call patients.

Of course, a surefire shortcut for the young practitioner to establishing a blended practice is to associate with a large blended practice while you take a ferocious amount of CE. While the established practitioner’s clinical speed increases with time, the same dentist tends to slow down and listen to the patient’s needs, “connect” with more patients, and therefore has an easier time filling his/her schedule.

Conclusion

A blended practice is not for everyone nor should it be. Thank goodness we have such a wonderful profession that we can customize our work almost any way we want and still make a decent living for ourselves and our families. You can be everyone’s dentist within reason. It can be done and is being done by a growing number of practitioners every day. Wanna’ have fun Monday morning? Start saying “Yes!” to proposed patient treatment that takes you out of your comfort zone. Take good CE and get started. Your patients will thank you, your staff will thank you and when you look in the mirror, you may find a much happier, wealthier and more contented dentist, smiling back at you.

Doctors David T. Palmer and Amy L. Ross practice in Lufkin, Texas. Dr. Palmer has been in Lufkin since graduating from the University of Texas Dental Branch in 1987. Dr. Ross is a 2002 graduate of UTDB and after two years of associating, became a partner in Dr. Palmer’s practice.

Their practice incorporates all fields of dentistry including: cosmetics, oral surgery, implant placement and restoration, as well as orthodontics. Both Drs. Palmer and Ross can be reached at 936-637-3788 or at palmerdental@consolidated.net.