Anatomy of the Dental ‘Business’

Dentistry can be a ‘calling’.  It may be a noble profession that enables one to both earn a significant income as well as help the public in both obtaining decent oral health and maintaining it.  Dentists are trained in university dental schools with a curriculum that is chocker block full of clinical training, and precious little (if any) business training. 

 

As practice consultants, we have literally walked in one thousand dental doors doing various surveys and evaluations.  Invariably the primary reason we may have been called in is not the biggest issue affecting the practice. Frequently the dentist tells us they simply need help in lead generation, or closing cases.  Not until we arrive on site and have a chance to interview all players individually off-site do we begin to see accurately the scope of the problem or problems within any one practice.

 

Most dentists begin their career as an associate.  This is another word for employee.  All team members are also employees, which is an important distinction because many view themselves as something much different than that.  If you worked as a bus driver for your city transit division – you would expect (and grudgingly adhere to) all the rules of employment concerning dress, work hours, lunch breaks, etc. You would fill out your route reports, be on time for the perhaps 37 revolutions of your route throughout the day, and scramble for bathroom breaks while avoiding speeding tickets.  If you don’t like any of that – forget being a bus driver. There are ‘terms and conditions’ of your employment and you live with it – whether or not it involves a collective agreement.

 

I arrived an hour early for a restaurant reservation at a seaside hideaway recently. They hadn’t opened yet, but kindly allowed us to sit in the corner with a glass of wine while they got set up.  The wait staff were all called into the kitchen, and every word the cook spoke was clearly audible. He explained that they had a load of crab that was going to have to be tossed out if it didn’t get sold that day. His clear cut instructions were ‘push the damn crab!’.  As the restaurant slowly filled up, I was interested to hear how every employee did their level best to steer each patron towards the ‘delicious crab’. They explained that the cook had a special way of doing this or that – and in many cases the patrons obliged by ordering the same.  Problem solved.  They all had to pull together for the collective good to move soon to be dormant inventory – or else.  The survival of the restaurant (a classic small business) depended upon it. Their employees did what they were instructed, including the verbiage with patrons to encourage them to eat the crab. 

 

Fast forward to the local dental office. This is also a classic small business with 3 – 20 employees. It has plenty of overhead (75% – 80% in many cases), and is subject to the ups and downs of each local economy. Big strike in a union town?  Forget high end elective dentistry until that is settled. This is a vulnerable business, just like all others.

 

So – after this long introduction – where does the average dental practice cease being like your typical small business?  I call it dental ‘mania’.  Dental team members (employees) frequently refuse to work in a manner instructed, requested, or begged.  They are in many cases absolute time clock punchers, who would no more dream of staying behind an extra few minutes than fly to the moon. They often refuse to use scripting supplied because that ‘just isn’t me talking’. Hygienists are in the greatest position to ‘sell’ dentistry which is just simply looking, noting, and communicating about the dental problems they see while they are in the patient’s mouth – yet frequently do nothing to help the practice ‘sell’ these services. They want to use every single last minute to scrape teeth instead of selling the patient on restorative work – because that is ‘not their job’. Guess what? If someone doesn’t sell something their $45-$60 per hour wages can’t me met! Honestly – quite a few of them believe they breathe rarified air, and are in partnership with the practice instead of employed by the practice. Talk about complete irresponsibility. We see hygienists earning $100,000 per year – and demand $55 per hour to attend a practice team meeting (your College backs them up)! We’ve heard dentists tell us the same individual has been operating like this for perhaps 10 years, and he actually hopes she is going to wake up and realize the economic survival of the practice depends on her cooperation.  It ain’t going to happen!

 

Associates are also in their own world in some cases. They work on their 40% and assume that all lead generation, case presentation, and management of the practice ‘business’ has nothing whatsoever to do with them. We have consulted with many practices where the associate refuses to attend a practice management meeting because it doesn’t concern them. There are even cases where they refuse to perform scheduled dental work, or refer it out because they don’t ‘prefer’ to do endos, or teeth straightening. In some cases there is a colleague in the same office who could easily do the work, but they send it away anyway. Who cares if the practice owner loses revenue? This person needs to be happier elsewhere. I’ve seen prescriptions written because that was the fastest way to get out of the practice that day instead of doing the root canal – and a ball game was going to be on the television at 4:30.  Wake up.

 

So – what is happening while an entire team is doing things ‘their’ way?  The dentist is fighting with the bank, paying the rent and lease payments, subsidizing CE in the sunniest locales the team can find (Why aren’t we all going to that conference in Hawaii this year?) – and wondering why he or she is the only one concerned with falling revenues?

 

We all know someone who has spoiled their dog. We all have friends and neighbours who have spoiled their children (some of whom are in their 20’s and still mooching off Mom and Dad). I can point to dozens of practices who have absolutely and totally spoiled their employees. They are paid well – have great time off – frequently have good benefit plans – and don’t have a care in the world after 4:30.  Yet they treat their employer like they are doing him/her a favour just by showing up. .

 

In the real world these employees would be bounced out the door for refusal to cooperate with practice rules. Remember the bus driver? I know one who had to complete 37 rotations with no bathroom break, split shifts (sometimes 3 in one day), and is forced to speed to meet the schedule but will be fired if she gets more than 3 speeding tickets. She has only been there 12 years so she won’t get summertime vacations for another 8 years, and has been spat upon and assaulted on the job. She makes less money than a CDA, and less than half what a hygienist earns. The waitress in the sea food restaurant would be fired if she didn’t ‘push the crab’ because that is what the business dictated.

Dental employees need a rude awakening when it comes to helping their employer out with doing what is best for the practice – which is nothing but a small business.   Times are tough, and not going to get any better. If you can’t straighten out your business plan – get a consultant who can assist you because your livelihood absolutely depends upon it.