Howard Speaks: Reassessing Dentistry’s ‘Villains’ by Dr. Howard Farran, DDS, MBA

Howard Speaks: Reassessing Dentistry’s ‘Villains’ 

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


There’s always a “bad guy” in dentistry. When I got out of dental school, the bad guy was capitation dentistry, where we were told, “You’re incentivized to do a lot more dentistry, so we’re going to give you a dollar amount, every month, per head, and whatever you don’t spend, you’ll make extra profit. You won’t overdiagnose things.” I thought that was a brilliant idea, but they gave us like $10 a month per person when they should have given us twice that.

After those plans fell out of favor, dentists moved on to demonizing PPOs instead. Today, it’s DSOs. These companies aren’t perfect, but neither is your practice! We all have different perspectives, but we can learn a lot comparing DSOs to restaurant franchises.

Who’s got skin in the game?
In the early days of McDonald’s, Ray Kroc would allow franchisees to have only one location because he believed if that one location was the sole way franchisees earned their income, they’d get in there and focus. Chick-fil-A has a similar one-location dictate today; it wants to ensure people have skin in the game. I think that helps explain why Chick-fil-A makes more per location than any other food franchise today, even though their locations are closed Sundays.

Meanwhile, it’s not uncommon for someone to own 10 Subway or Burger King franchises … and you know what the experience there is like! You know what I like most about Burger King French fries? Somewhere at the bottom of the bag, there’ll be half an onion ring or a quarter of a tater tot. There’s no quality control.

Similarly, in DSOs—and multilocation private practices—if the dentists aren’t owner-operators or associates who are properly incentivized, they’re not going to have a reason to work through lunch or stay late. They’ll be likely trying to reschedule their last patient of the day so they can go hit the town.

Do you have the right support?
Meanwhile, if you’re a newer dentist who’s ready to work, you might be scared out of your mind about doing a root canal tomorrow morning— so the last thing you need is for your dental assistant to not show up for work and be replaced by a temp you’re meeting for the first time. That happens a lot at some DSOs and multilocation private practices.

I, meanwhile, had the same dental assistant for 30 years and I never had to ask for an instrument after 10; I’d just put out my hand and she’d give me whatever was needed. That can’t happen with a temp you met an hour ago!

Same for office managers: Your office manager should be absolutely committed to that office, living and breathing one location. If she’s working three or more locations, she’s working at the dental equivalent of a Burger King. And by extension, so are you!

Not all DSOs or multilocation private practices should be painted with a villain brush, but look closely at the details before you decide if any position is right for you.

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