In a world driven by media hype and often false narratives, how can we convey, and deliver, that we are a trusted resource and provider of care? The answer is worth contemplating.

Slick websites and media ads may drive patients to contact your office but they are only a tiny fraction of what is needed for someone to schedule an office visit or commit to allowing you to physically intervene with care on their behalf. A far better resource is the recommendation of an existing client. But even that is only a crack in the door to the development of trust.

Dr. L. D. Pankey often used the phrase “Know yourself. Know your patient. Know your work.” In other words, are you trustworthy? Is your patient able to express the outcome they are looking for so you can help facilitate their health? Are you the right provider, and is this the right time? Are you capable and competent to deliver the desired outcome?

Our client’s sense of trust will be built from a series of experiences. Some items we can control; others we cannot. We can’t control their prior life and dental experience. We have an impact on, but cannot really control what others say about our office or our skills. We can control our behavioral skills and level of accountability. We can create a client experience that allows for the development of a relationship based on trust and mutual respect. This will require a philosophy shared with our team that is implemented at every point of client contact. If we want our clients to trust us, we must be worthy of trust. We must have mutual trust in our team and among team members. When this situation exists there is an unspoken aura that exists within your business. We don’t have to talk about it because our clients can feel it.

Creation of a climate of trust in our office takes time and effort. The return on the investment is lower stress for everyone involved, and the elimination of having to sell dentistry or worry about third parry concerns controlling patient decisions. Cost will always be an issue for some patients. However, in a trust based relationship we can find ways to overcome that barrier. Some people will not choose to trust and should be guided to another office. For those who choose to participate in a trust-driven relationship, we will be able to provide care, skill, and judgment that will be satisfying to all involved.

Discover more of the Pankey Philosophy and learn how to build a thriving dental practice with The Essentials Series. This comprehensive 4-part course starts with Essentials 1, diving deep into the core principles that will transform your approach to patient care and practice management. Trust is a cornerstone in building strong patient relationships, and The Essentials Series will equip you with the knowledge and skills to establish trust from the very first interaction.

🌟 Trust. Transform. Thrive. The Essentials Series awaits you! 🌟
Click here for more information and to get started.

In his recent book Subtract–The Untapped Science of Less, University of Virginia professor of design Dr. Leidy Klotz points out many instances where we allow ourselves to be overwhelmed with information and complexity. He argues and demonstrates that subtracting the extraneous often leads to greater clarity and efficiency.

Reading Klotz’s book, brought to my mind the Pankey Institute’s Essentials continuum that begins with Essentials 1 (E1). Dentists arrive at E1 overloaded with information taught in their dental schools and other CE programs. All that information may have some value but the role of the Essentials courses is to subtract the extraneous and focus on what is essential.

We arrive at E1 thinking everything is important, and we discover that there are essential elements of dentistry that are key to effectively working with patients, performing a complete exam, diagnosis, and technically excellent, predictable care. From these key elements, we can build practice systems that are clear and efficient.

What Is Essential?

We aren’t born with complete wisdom like Athena born from the forehead of Zeus. We learn wisdom (what is essential) faster by being in the company of others who have traveled the same road, asking, “What is essential? What do I NEED to know?”

The Pankey Essentials continuum exposes dentists to the clinical, behavioral, and financial aspects of practice. And goes beyond exposure to exercises and exploration. The courses invite dentists to understand themselves, their patients, and their work exceptionally well. The courses invite dentists to focus on and develop essential skills.

Our profession has undergone a technological explosion over the past few years. Some of this is wonderful. But how much of what we invest in are we fully utilizing? What is the best technology to invest in? What is the best way to implement it? The Institute’s faculty help us cut through the clutter and determine what works best…what we can implement with our teams and patients that will improve our dentistry and the patient experience. But first, the Essentials courses peel away the layers of hype and technology to help us grasp the core skills we must attain.

The core skills are behavioral as well as technical. And because the behavioral aspects of dentistry are not discussed to great extent in dental school curriculums, one of the roles of the Essentials continuum is to fill in this gap. In the Essentials courses, we learn the importance and skills of behavioral science. We learn how to most effectively lead and affectively influence. We dig deeper into understanding ourselves and our patients…our emotions, our motives. We discuss the behavioral concepts that were taught by Dr. L. D. Pankey because they remain valid today. These concepts are straightforward and help us develop lifelong patient relationships and personal skills.

The business aspects of dental practice are overwhelming. Dental schools do not have time to teach business essentials. In the Essentials, dentists learn essential financial skills such as how to understand their financial statements. If we are not making a profit in our practice we can’t stay in business.

Self-Examination

When I first attended an Essentials course (then called C-1), I worried that I might not know enough. I discovered that I knew a great deal but I had not clearly defined what was essential. I learned I needed to be more assertive about asking myself why questions. For example, I found myself asking:

• Why am I doing this? Does this step add value to the final result?
• Why is my final result not stress free and predictable? What step did I miss?
• Why am I “telling” my patients rather than “asking” for their input and values?

An Intentional, Essential Community of Support

The Essentials faculty and my fellow students helped me understand that getting rid of what is not needed is not simple. Determining what is essential and building my practice systems around the essentials takes time, thought, and effort but was made easier for me because I had the help and constant encouragement of the Pankey faculty and community in shaping my approach to dentistry and my career.

My friend and colleague Dr. Richard A. Green has always said, “Intentionally becoming both more affective and more effective is essential to excellent patient care.” So often we intend to do something but don’t have the encouragement we need to remain intentional. As my friend and colleague Dr. Barry Polansky says, “We humans tend to slip, slide away. It is by developing habits intentionally and self-checking our assumptions that we stay alert to the possibilities of how we can become more.”

A great doctor-patient relationship is the key to delivering quality care. The ideal model to help people move toward optimal oral health is based on a behavioral approach that we can use every day. This approach is allowing the patient to drive outcomes.

An illustrative example:

There is a stark difference in a patient’s emotional response between being told, “You need a filling,” and saying, “You have decay in your tooth. How would you like us to address that?”

The principles of this approach are not difficult.

1. You need to honestly commit to always placing the best interest of the patient first. You cannot fake this. All of us know when others are not sincere.
2. Letting the patient drive the outcomes is a habit developed from committing to this approach and intentionally choosing your words to put the ball in your patient’s hands, then waiting for their response and listening well to clearly understand the outcome desired by the patient.
3. Is the outcome congruent with your philosophy and standard of care? Does the patient need more information and time to come to an understanding of what is in their best health interest? How might you lead them there? Most folks really do want the best for themselves and their family. They will make good decisions if we provide the proper environment and education.
4. You, the patient, and your team must be comfortable with the means necessary to get to the outcome desired. Both you and the patient must be comfortable with the time, energy and dollars involved in reaching a mutually agreed upon goal. A key element in eliminating stress and dependence on insurance, is painting the picture for your patient that they are in control of the outcome–not their insurance company. You and the patient have the patient’s best interest at heart, not a third party. I say this again. You are working on behalf of your patient, and with this approach, they are in control, not an insurance company.

Does this approach take more time and effort up front? Yes. However, once you adopt this approach you will be forever glad you did. Patients who enter your practice through this system will value you, your staff, and your care. They will commit to more and better dentistry and pay with gratitude. You and your staff will have lower stress and more fun because you are dealing with people you understand at a deeper level. Long-term, these people will refer new clients just like them.

I didn’t invent this model. I learned it from great mentors like L. D. Pankey and half a century of folks participating in The Pankey Institute and passing forward the priceless and timeless value of this approach.

Mentorship from the Institute will help you on your way to long-term success as a thriving dentist. As my colleague Dr. Barry F. Polansky often writes, “Mastery in dentistry is a continuous journey.” It’s a lifetime of learning, practicing, and reflection that enables us to more easily and fully transform the health of others who present themselves for our care. The journey, itself, propels us forward into greater and greater connection with our patients and our true selves.

Pankey Institute mentoring and encouragement made all the difference in my life and the lives of countless others. When I try to sum up the dental professionals and patients this “approach” has positively impacted, I get lost in counting the millions we have touched as a community dedicated to putting the dental patient’s best interest first.

As a small business owner emerging from the Covid crisis, one of the issues we face is how to manage employee compensation in a fair and open manner. Are we paying our employees a fair wage for what they do in the demographic area that we live in? Often it is not possible to know what the competition is paying.

In our current job market, skilled labor knows that they can be tough negotiators. Under current National Labor Relations Act rules employees have the right to discuss wages, hours and working conditions with others. Pay discrepancies can result in potential claims of discrimination and resentment. A mix of new hires and old hands, in particular, may lead to conflict about wages.

Your Wage Budget & Scenario Analysis

One way to address this as an owner is to create a spreadsheet that establishes the range of wages you are able to pay for various positions based on your requirements and your budget. It might look something like this:

In my case, I need to know not only what I am paying and whether I am competitive to get the best talent. I also need to know how any changes will impact my overall budget. As I am considering changes in my current employee wages and what I can pay a new hire, I need to know my overall business finances.

I also need to not manage my practice revenue to cover the luxury items I want in my personal life but instead to grow and sustain my business. I need a business growth mindset plus the attitude that Dr. L.D. Pankey promoted when he admonished dentists to learn to live on less than they make. Our teams make it possible to be in business. People come first. We’re in a people business.

Professional Guidance & Standards

My state professional association conducts a survey of offices every few years that provides a reasonably accurate picture of wages and benefits based on a number of demographic variables. That information, along with discussion of this issue with my peers, provides me with an idea of what the range of wages should be in my area.

My industry ideal is to keep total overhead for staff as close to 25% as possible, but in today’s economy this is becoming more difficult. I have found it helpful to define the market value of the various positions in the business and to understand the difference between the team members who produce income and those who do not.

Ask & Answer for Yourself a Few Questions

Where are your wages relative to your peer group? Are you underpaying, or overpaying, some of your people, and if so, what will you do about it? Where are your wages with respect to your budget and to what business analysis considers Ideal?

Something Most Dentists Don’t Do

You can take the information from your spreadsheet and share what you have learned with your team on an individual basis.

Each person needs to know that there is a range of pay for what they bring to your business. When they reach the top of the range, often due to longevity, that is all you can offer in wages. You might consider offering additional employee benefits, for example, additional vacation time. But know that what you offer will very likely be shared with everyone else.

Your wage budget worksheet allows you to develop an open and fair discussion of compensation. It helps remove much of the emotion that often gets in the way when employer and employee seek to justify levels of compensation. Your team members need to know you respect and value them, and to grasp that to remain in business there must be a profit and a budget for the business that makes sense for all concerned.

Relationship-Based Dental Practices Have an Advantage

Although recent news and chat forums indicate wages are rising for dental workers and this is putting pressure on dentists to increase their fees, we have much goodwill we can use to counterbalance this. Employees are not apt to jump ship when they like the environment in which they work…where their work is respected, their work is meaningful, they enjoy their co-workers, and solutions are found to reduce stress.

Dentists, who are truly relationship-based in their philosophy of dental practice, offer a totally different working environment than the many dental practices, in which employees describe their workplace as toxic. You can leverage the goodwill of your team members to help recruit the right new employees and stay in budget.

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In the comments below, I’d love to hear how other private, fee-for-service dental practices are currently mindfully managing hiring and wages.

In a world where the profession of dentistry is facing commoditization with the development of Dental Service Organizations (DSO’s) and large group practices, those of us committed to private, fee-for-service, comprehensive care are facing increased competition. Over many years in practice, I have observed why people choose us and what we can do to foster this even more.

Our Competitors

1. DSOs and multi-location groups are on the top of all our minds, as their centralized business services and approach to higher volume scheduling allow them to be profitable while offering extremely low-cost new patient exams and reduced fees for restorative services.
2. “One-tooth dentistry” dentists in private practice are also a form of competition as they seem to be lower cost to consumers since they only treat “the problem” rather than looking at the whole person.
3. Smartphones compete for attention. With the entire world’s knowledge lodged in our smartphone, we now find the average attention span in America has shrunk to a meager 9 seconds! Now we are in a world of TMI (Too Much Information) where a less than a 5-star review might eliminate your office from consideration even though it has no bearing on your professional skills.
4. Nonstop digital advertising for all kinds of desirable goods and services constantly competes for patient dollars.

The Reputation of Private, Fee-for-Service, Comprehensive Care Dentists

It is interesting to note that, throughout the current Covid-19 pandemic people, have continued to visit their dentist. What have we been doing right?

We have a reputation for:

1. Being sanitary.
2. Following proper safety protocols.
3. Being trustworthy.
4. Treating people with genuine interest, respect, kindness, and thoroughness — one person at a time.

Your Approach to Patient Engagement Is Special

To continue growing our restorative practices with new patients who need and desire our type of comprehensive care, we need to create an environment of mutual engagement between our office and our clients. This is not a “paint by numbers” exercise. Each dentist and care team must create and commit to a philosophy that fits their core values and style. The way you engage with your patients is “special” to you.

Your philosophy of care distinguishes you and allows you to stand out in the marketplace. When your actions are consistently guided by your ideals, patients know it. They value it. They refer other like-minded patients to you. Your special behavioral foundation is why they come to you.

4 Tips for Building an Environment of Optimal Patient Engagement

To execute on this philosophy, we need to build a behavioral foundation that promotes alignment with our team, commitment to excellence, ample time with patients, and mutual respect. Here are some tips that have guided many private practices focused on individualized, fee-for-service, comprehensive dental care.

1. Doctor, start by engaging and educating your team to be the best that they can be by modeling the behavior you want to see in them. Commit to high quality Continuing Education for you and your staff. Join a study club and associate with like-minded members of your profession.
2. Engage your new patients with a patient-centered experience from first contact onward. Make a special effort to create a first visit that includes time for becoming acquainted with one another on the behavioral level and more time for a true comprehensive exam.
3. Make sure that your patient understands that you respect them as “the expert” in choosing what outcome is right for them at this moment in time.
4. Make sure your patient understands that your office is “the clinical expert” at determining the various outcomes that are available based on the:

• Situation they are bringing to you,
• Findings of your exam,
• Technology available, and
• Time and dollars they choose to spend.

More tips will follow next in Part 2.

In times of disruption, small changes can have a large impact. Follow the 5 P’s and see where Proper Planning to Prevent Poor Performance leads you.

Those of you who experienced the joys of boot camp may remember the 5P’s: Proper Planning Prevents Poor Performance. Since we are all stuck waiting to get back to the office, now is a great time to work on plans for a preferred future.

Although we will be opening in a disrupted world and the market we left has been transformed by forces outside our control, good business principles and practices remain valid. Here are some key performance indicators adapted from Roger Levin’s 2019 article about the KPI’s every dentist should know.

Production, Collections and Profit

Review your production, collections and profit for the last 12 months. Levin points out that the trend on each of these items should be up. Sounds simple but it is not. Dig in and analyze deeper. Start with monthly figures and look for trends, then weekly and daily. What are your most productive procedures, days, time of days? When was your last fee increase? Analyze your outstanding accounts. You should be collecting 98% with only a small percentage over 60 days outstanding. How much are you writing off due to insurance mandates? How profitable are you? Have you set any goals? Understand that any item in your practice that is not true overhead is profit. Now you are ready to start working “on” your business.

What percentage of your active patients is currently scheduled? Nobody should every leave your office without another appointment. Your goal should be 98% of active patients are scheduled for some form of care. What is your case acceptance rate? Are you tracking patients with planned treatment that is not scheduled? What is your average production per patient? What is your average production per new patient? It should be at least two times greater than existing patients. What is your hygiene cancellation rate? If you are not happy with what you are learning, now is the time to be planning for better outcomes.

Overhead

Now is the time to carefully assess every item included in your overhead. If you have a practice generating a million dollars, a 2% decrease in overhead is $20,000 directly to profit. Levin Group tells us that general dental practices should have overhead at 59%. Very few practices meet that goal. It is very likely that new mandates from the government will be coming for PPE and testing. Now is the time to get lean and mean in this area.

Patients

Are you tracking your monthly new patient growth and your patient attrition? With all the media attention to aerosol spreading of Covid-19, it is likely there will be resistance to treatment and dentistry in general. Knowing your current situation is important. It is imperative that you use every means available to help your current and new clients understand that you are concerned for their health and safety as well as to emphasize that deferring treatment will only lead to future more difficult and expensive problems.

Staff Costs

The elephant in the room…staff costs in a general dental practice should be 25% of collected production. Your team members are the most expensive and most important part of your business. You may want to share your homework with your team – or even involve your team in the exercises above.

Over the years I have visited many offices and found every office has a special “hideaway” reserved for the new technology that the doctor is going to implement that never happens. I just looked over an article by Dr. Lou Shulman in Dental Products Report that reviews a multitude of technology options available to us. I was surprised to note the number of doctors who stated that they do not plan to purchase three specific tech areas that we have found to be significant in increasing our production, quality of care, and positive patient reaction. Based on our practice experience, these three items will very quickly provide a return on your investment when you integrate them into your practice.

Voice Activated Software

We have been using Dentrix VoicePro, a voice-activated perio charting and clinical note dictation, for over 15 years. Our hygiene staff would quit if we took it away. We do a full perio charting on every re-care appointment. This software makes it quick and easy, AND the patient hears the numbers and pays attention. There are numerous other features, but the perio charting is worth the price and learning curve. In today’s environment, the system eliminates the need for added staff as a recorder or the constant picking up and putting down of pens or probes.

Intraoral Scanner

We are using iTero and love it. We have had a CAD/CAM system for years and use it routinely. However, if you are doing any aligners or sleep appliances you will love the scanner. Your patients are so appreciative that you no longer have to have them sitting with “goo” in their mouths. There is a learning curve, but it is not too steep. The accuracy of the images is excellent. The unit will not let you send a poor impression to the lab. The cost of a scanner is far less than CAD/CAM. Your lab loves getting your impressions electronically. Your patients are fascinated by your ability to image their teeth with ease and accuracy. Our staff has quickly adapted to the use of the scanner and loves it.

Soft Tissue Laser

The price of soft tissue lasers has dropped dramatically. We were relatively early adopters of the soft tissue laser. We use ours for soft tissue shaping in crown and bridge, desensitization, and soft tissue periodontal procedures. We have had near-zero post-operative complaints in any of these procedures. The desensitization of teeth is amazingly quick and easy. All of our hygiene staff has been trained in laser use and feels that was worth the effort. Patient acceptance of soft tissue laser in hygiene/periodontal procedures is very high.

We try to be at or near the leading edge of the technology curve, not the “bleeding edge,” and we expect technology to have long term value as well as a rapid payback. These items have proven to be time savers, improve our quality of care, and are recognized by our patients as adding value to the experience in our office.

We are “all in” on getting ready for our office to re-open. We have been in dialogue with our team members, reviewed our cleaning, asepsis, OSHA protocols, and worked out client and staff management protocols that follow the ADA guidelines. We are ready to go! However, our governor may prevent us from starting for another month. If that happens, we will have lost a full three months of production – one quarter of the year. 

We can never regain that lost revenue. Like the car salesman who does not close the sale, the money that was going to pay our fees is now gone forever as it has been spent somewhere else. If you want to understand a bit more about the mathematics of loss, take a moment to read this letter from Steve Blumenthal. The letter is old, but the math still makes sense and it is not pretty.  

“The New Normal” 

Like many of you, we have been “Zooming” into a variety of web-based CE on how to manage the new normal. The new normal to us looks like less productivity and higher overhead. The new normal also looks to us like a time when our clients and staff will feel a sense of increased vulnerability, so it is imperative that everything we do at every touchpoint is focused on active listening, positive messaging, and mutual respect.  

The Question of Fees 

This leads to the question of fees. Some presenters are suggesting adding charges for PPE or raising fees in general. Our opinion is that, as a nation, we are about to enter a period of deflation. If our clients are worried about maintaining their jobs, they are not going to spend discretionary dollars. We are very unlikely to see a V-shaped recovery. Our government has poured a great deal of money into the economic system, but fearful people will not spend if they are not sure of a paycheck.  

Most of us will have to eat the added overhead in our practices. In fact, many practices will look at staff costs and decide to run with less people. You can count on insurance carriers to use the pandemic to push on dentistry to accept lower reimbursement.  

Our Plan 

We know we will lose production until we refine our new systems. We are asking our team members to consider flex time until we can ramp up and have everyone working effectively. We are asking team members to multi-task so we can avoid adding extra people for the increase in sanitation needs. We are revamping scheduling and hours to get maximum productivity with patient flow that will be less than the old normal.  

We have mapped out projected production and can meet reasonable goals under the new model with no fee increase for now. We plan to hold the line for four months and then we will have a fee increase. How much? We do not know yet, but we project at least 3 – 5%. We believe that amount will be accepted by clients and will cover most of the cost of increased overhead. We do not foresee the fee increase dropping the bottom line. If you want to share what you are doing, feel free to do so in the comments section of this blog. 

Covid-19 is a true Black Swan event for everyone around the world. Suddenly all dentists are banned from practice, except for emergency care, for at least several weeks. We are all feeling the impact of this strange new virus. How we choose to respond will make a significant difference in the long term impact of this crisis on our lives and our practices. Here are some ideas and information that may be of some help. 

Stay Positive 

Yes, your office is closed, and your team members are not working. There is legislation in the works that will allow you to pay your team with funds from the government. Sit down with your team and reinforce that this situation will not go on forever. Life will return to a more normal scheme. You are not going out of business, and they will have a job.  

Tell the Truth

Most of your team are hourly workers and this is really scary for them. Be honest about what you can and cannot do for your staff. Communicate openly with your staff and patient base. Make sure patients have access to you or a designated team member 24/7 if they need urgent care. Prepare your office totally for the event of having to care for someone with proper protocols and all the needed PPE. Take time to discuss what is happening with your family. Since church will not be an option for the near future, this might be a good time for some family prayer time. This is an opportunity to grow together and support one another and to demonstrate and ask for accountability.  

Take Advantage of the Time Off

Are there projects that you have been putting off at home or the office? Could some of your team be doing a deep cleaning or re-organization at the office? Could you be setting up some additional team training that can be done within the parameters of safe spaces or by video? Doctor, how about taking advantage of some of the video and other CE at The Pankey Institute that is online? 

Collaborate with Your Peers

Pick up the phone and call your friends. Share the information from the IRS. It is a big deal for your bottom line. Discuss putting together some group events when you can gather again. If you know of someone who needs a helping hand or some cheering up, just do it. 

Look at the current situation as a learning experience in coping. Keep the big picture in mind. There may be lines in stores and some folks with a “me first” attitude about toilet paper. However, we have power, water and food. Let’s do what we need to do to get past this and move on. Stay safe, wash your hands and pay it forward. 

We are bombarded weekly with ads for this or that course in “airway management” or “how to make money treating sleep apnea.” And, we are dealing with airway management every day whether we like it or not.  

Who has not had a patient come in with a worn dentition who claims, “Doc, I can’t ever remember grinding my teeth.” How about the patient who keeps fracturing restorations and says the same thing? You might want to question these folks or their partners about sleep habits. It is very likely you will find they are members of the population with some form of sleep-disordered breathing.  

Do you remember why we learned to fabricate and adjust bite splints?  

Have you had parents ask you about what it means when they can hear their young child grinding his or her teeth at night? Childhood bruxing is almost always a symptom of some sort of airway issue. What is happening in a child who presents with proclined incisors and an anterior tongue position? Do you think putting the child in headgear is going to solve the underlying reason the tongue has to be forward so they can breathe? 

We don’t have to treat all these issues, but we certainly should be able to communicate with our specialists and medical community for appropriate diagnosis and treatment of underlying issues that have a direct impact on the success or failure of our restorative care. 

The American Sleep Apnea Association estimates that 22 million Americans suffer from sleep apnea. Since we see our patient base, on average, two times a year, it makes sense that we should be doing at least a basic screening for sleep-disordered breathing. This can be anything from mild snoring to serious sleep apnea.  

Basic diagnostics would include paying attention to a person’s body mass index, neck size, asking whether they snore, and providing the Epworth sleepiness scale as part of your standard health history. Be aware that some folks with the worst sleep apnea or narcolepsy are not overweight. These are often the very fit appearing folks who are serious bruxers. 

If you really want to get involved in treating these people, you need to get more education.

Either at The Pankey Institute or somewhere that has a multi–day course. You need to commit to going into the process deeply, as there is much to learn and treatment is not simple. You will quickly learn that unless you develop great systems and team members, it is not an easy way to make money. However, you will be truly saving lives. 

If that does not sound right for you, commit to being a good diagnostician and develop an excellent referral network with some ENT doctors in your area. Most of these doctors are looking desperately for a dental colleague with whom they can discuss cases and develop treatments beyond just the use of CPAP. If you can refer just one child for early treatment each year and help prevent a heart attack or stroke for a person with undiagnosed sleep apnea, you will have done great service whether you get involved in active treatment or not. 

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