Every year around this time, 5,000 lesson-weary yet fresh-faced dental students emerge from dental school ready to take on the challenge of maintaining and improving the oral health of millions of Americans. When I look across the American landscape at the 125,000 general dentists currently in practice it blows my mind that those 5,000 grads haven’t been snatched up by their junior year of dental school because of how valuable they are.

Don’t think the same way? Indulge me a little while I prove that no matter what you currently think, there is, without a doubt, room for you to hire an associate immediately.

Phones

Your current phone system is just awful. You’re probably using the same copper cable technology invented by Thomas Edison, you have someone manning the phones only during business hours and when you’re closed all calls go to your little answering machine that still uses the little cassette tape. Hey, doc, wake up! The turn of the century happened 13 years ago already! You need to move to a digital phone system – a voice over Internet protocol (VoIP) – run it through the Internet and your network. My practice, Today’s Dental, in Phoenix, Arizona, uses Avaya (formerly Nortel) and it is awesome! When my practice is closed and we get 12 phone calls from people who didn’t leave a message, we can track the missed phone calls and someone on my team can call those numbers back first thing when they get in.

Humans are extremely complex. They’ve got a three-and-a-half pound brain powered by a trillion circuits. The brain is influenced by a person’s nutrition, genetics, whether or not they’re hopped up on caffeine, chocolate or sugar, etc. Humans are very imperfect decision-making machines. When a human brushes her teeth at 6 a.m. and feels something missing in the back of her mouth, she will pick up her iPhone and call her dental office. When an answering machine picks up instead of a live person, she shrugs her shoulders, says, “Eh, whatever,” and just hangs up to either A. just live with it or B. call another dental practice later on that will pick up the phone so they can fix her up. If you can track when your calls are coming in, not only can you call those numbers back right away, but you can adjust your staff ‘s schedule to best cover when the majority of your phone calls are coming in. That way when patients call, you can assure they’re being answered by an actual person.

What I find most ridiculous about your phone system isn’t the technology itself – it’s that you only have someone living and breathing answering the phone 8 a.m. – 5 p.m., Monday through Thursday, with an hour break for lunch each day. There are 168 hours in a week and the average dental practice is open for 32 of them. A practice’s primary concern is, “How the heck can we get more new patients?” Easy answer, make sure a living, breathing person is answering your phones during high-call-volume hours.

Almost every dental practice I visit has two dental assistants and a dentist doing all of the dentistry, and there’s only one person out front filling the schedule. I always say, “Here’s what we’re going to do. We’re going to change your phone system to a digital VoIP, and instead of having two assistants helping do the dentistry, we’re going to move one of those assistants up front. Also, instead of having one person answer the phone from 8 a.m. to 5 p.m., one receptionist is going to come in at 6 a.m. with the owner doctor and she’s going to take a lunch from 11 a.m. to Noon, and then she will leave at 3 p.m. The other receptionist is going to come in at 9 a.m. with the associate dentist and she’s going to work from 9 a.m. until 6 p.m. That way the phones are going to be 100 percent answered when the majority of people are calling. We’re going to stagger the staffing of your front desk because 50 percent of the incoming calls to your practice are made when you are closed early in the morning and later in the evening. Also, of the calls that do come in while you’re open, 50 percent of those go to voicemail while your one-person front desk is taking care of other business. And if both front-desk staffers have their hands full, you need to make sure that any staff member in your practice is comfortable picking up the phone. This way you have much better coverage at the front desk and you’ll be able to fill more holes in your schedule so you can do more dentistry!” If you answer twice the number of calls coming into your office with a live, highly trained receptionist, you will increase the number of appointments. When you increase the number of appointments, most dental offices today can actually absorb almost all of that capacity. Dentists don’t have a problem if you double book them, triple book them, have to work them through lunch, or make them work past 5 p.m.

Don’t want to be open more, or keep someone in the office longer to cover the phones and make appointments after hours? Fine, but I challenge you to track the phone calls you’re missing and then tell me you’re OK with the status quo.

If you have an antiquated phone system, your little answering machine isn’t going to tell you about the missed call at 6 a.m., and unless your patient is fiercely loyal to your practice, you might not hear back from her at all. But if you use the digital VoIP system, your front desk comes in at 8 a.m., notices the list of missed calls and starts calling the numbers back immediately. When you call your 6 a.m. patient back, it clicks with her and she says, “Oh, yeah, I did call you this morning. Thank you so much for calling me back so soon. I have a problem. I think I’m missing part of my tooth.”

Expand Your Hours

Your front-desk staffer is still on the phone with your 6 a.m. caller, and your staffer should know her job so well that no matter the patient’s protests, she goes right for the close and says, “Let’s get you in. Can you come in today? What’s the best time for you to come in?” That’s at least what she should say, but is your practice able to accommodate emergency patients? When it comes time to schedule a patient, almost 140 million Americans will tell you from 8 a.m. to 5 p.m. they can’t leave their business because they’re working! Oh and you’re open Monday through Thursday from 8 a.m. to 4 p.m. – the same block of time your patient can’t come in. So what should you do? How about you hire an associate and expand your practice hours! You have the land, the building, and the equipment. Would you rather it just sit there costing you money, or would you rather use it and make money?! Bring in an associate and cover 50 hours a week instead of only 32.

Don’t think you can land an associate in your neck of the woods? The largest employer of dentists on planet Earth is the United States military. It employs around 5,000 dentists, and it can get these kids to sit on an aircraft carrier in the middle of the Pacific Ocean for half a year at a time, leaving their spouses and children on shore. You think you can’t land a quality associate because you live in Hays, Kansas? Are you kidding me? In Hays, Kansas, at least your associate can have breakfast and dinner with his family! Think about that!

Beef up your front desk so your practice can sell more dentistry, and stay open longer so you can accommodate your patients’ schedules and you can perform more dentistry. Pretty soon you’re going to have more dentistry to do than you have dentists to accommodate it. When that happens – hire an associate!

What are your thoughts? Once you’ve finished reading this, please log onto Dentaltown.com and post your comments under my column. See you online! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=325&aid=4435#sthash.umefwXW1.dpuf

This year I celebrated my 25th year of practicing dentistry and looking back over the last quarter century, sometimes I wonder if dentistry is just getting too darn easy.

The first five years I practiced, I had a 24-hour-a-day, 7-day a week, callous on my thumb and index finger from carefully moving stainless steel endofiles up and down all the time. When I graduated from dental school, it literally took me two hour-and-a-half appointments to manually clean out a tooth. Dentists today are so lucky! Now we have 300RPM nickel-titanium files that takes care of business in less than half the time – and in a single appointment, no less.

Radiology is also undergoing a complete revolution right now, and endodontics has become so much easier because of it. There is a high percentage of American dentists who use two-dimensional X-rays and it’s so surprising to me how few have moved over to the new 3D technologies. I have still not met a single dentist who’s gone from 2D to 3D and will ever go back. So many skeptics who still use 2D ask: “Well does insurance cover it? Will I have to charge extra?”Yet every single dentist I know who uses 3D says they don’t even care. It’s just amazing what you can see with the new technology. I mean, look at endo again. For years, every time a root canal failed we just assumed we did something wrong. Like, maybe we were just short of the apex and we didn’t get it all cleaned out. When you use 3D imaging, you can plainly see the root is fractured. If you can see that, just imagine how much more dentistry you can diagnose and treatment plan!

I predict, within a few years, general dentists will not refer to endodontists who don’t have 3D X-rays – how would the endodontist even know if the tooth had a vertical fracture if she can’t even see it? Root canal failure is why so many endodontists warranty their work. If it fails in the first year, the patient will get 3/4 of their money back; if it fails in two years, the patient will get half of their money back and so on. If the root canal lasts four years, it’s good enough. The best endodontists, on the other hand, outright refuse to warranty their work. They’re good at what they do, and if they’re using 3D imaging, they can see everything! You’re telling me you’re OK with taking $1,500 of someone’s hard-earned money to perform a root canal that’s not going to last a year and you don’t feel any shame or guilt about it? That ruins endo and root canals for everyone! What sort of connotation does it carry when someone tells you: “I don’t want a root canal. Just pull the tooth. My cousin got a root canal and they had to pull the tooth a year later anyhow. What a waste of money.”

The American Dental Association was way ahead of the curve when they granted specialty status to oral radiologists. In the future, the dentist isn’t going to be the person reading X-rays. Oral radiology is going to explode – not just in the United States but internationally. That’s all thanks to the Internet! I see practices taking 3D X-rays and e-mailing them to an oral radiologist somewhere else on the planet, and within a few minutes, the oral radiologist reads the X-ray and tells you what you’ve got.

The best endodontists in the profession use 3D cone beam computed tomography (CBCT), and they have the ability to place implants. I want my retreats to go to an endodontist who can take an accurate 3D X-ray and if she decides that the tooth isn’t salvageable, the money isn’t an issue because she can either make $1,500 doing the retreat or she can make $1,500 pulling the tooth and placing the implant right then and there. That is outstanding customer service to the patient!

You’d have to agree with me; dentistry is getting so much easier! Look at CAD/CAM. Since I’ve been a dentist all the best labs that I know will tell you that all the best dentists have about a six percent remake rate (couple that with the dentists who say they have never had a remake in 25 years, you know the truth is somewhere in the middle). Now with impressions going digital with optical scanning, those same labs say remakes drop from six to one percent. One percent! When you digitally scan the teeth, if you’ve got a huge monitor that’s two feet by a foot, you just can’t see a prep better than that. You can’t even see a prep that well with loupes on. Taking it further, if you have a milling machine right there in your office you don’t even have to send the impression out to the lab, and you can take care of your patient in the same day. I mean, CAD/CAM technology is something we only dreamed about and wished for 25 years ago. Now it’s a reality, and there are still some of you who won’t give it a shot. You can’t afford to sit on the sidelines with CAD/CAM. If you’ve been thinking about it, take the next step!

Look at implants! I got my fellowship from the Misch Insitute, I got my diplomat from the International Congress of Oral Implantology and I’m telling you, just thinking about placing implants in the 1980s makes my stomach turn. Placing implants has come such a long way since then. When you placed an implant back then, you were talking about long incisions, and when you thought you had an inch of bone to work with, you really didn’t know until you got in there, and you’d receive such a shock that you really only had half as much bone. You had to stay so far away from the mental foramen for fear that an anterior loop could ruin your day. It was such a difficult procedure! Today, you don’t even need to extract the teeth before you get started on placing an implant. You take a 3D X-ray, send it to a lab, the lab makes a snap on retainer with a pilot hole, you get it back, numb the patient up, snap on the retainer, drill right through the pilot hole and the tissue and place the implant. There are dentists who come up to me at seminars to tell me they don’t pull wisdom teeth and that they can’t stand the sight of blood, but they purchased a 3D CBCT machine and are placing seven to 10 implants a month. They’ve gone from zero to 60 in about three seconds in the implant world. I mean, tell me dentistry hasn’t gotten too easy!

And then there’s orthodontics! I remember doing ortho in my practice from 1987 to about 1992, bending stainless steel with these three prongs, trying to figure out the best way to improve someone’s smile. You could literally get a migraine headache trying to figure out what you had to do with the wire. Some things are extremely difficult to wrap your head around and orthodontics in the 80s and early 90s was one of them. There’s a reason orthodontists take so much more school! Then nickel-titanium wires came out, where they could pre-cast the archwire so everything was at the right angle, and all you have to do is bend it into the bracket. The wire straightens all by itself and drags the teeth with it! It’s just gotten so much easier!

What’s even more amazing is thinking how much easier dentistry is going to be in another 25 years! Think about it!

What ways has dentistry become easier for you? When you’ve finished reading my column, I wish you would jump onto Dentaltown.com and post your thoughts under my column this month. See you online! – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=322&aid=4386#sthash.kFjkk5GV.dpuf

Former Chairman and CEO of General Electric Jack Welch always used to say a company should either be number-one or number-two in a particular industry, or else leave it completely. How does your dental practice stack up in your area? How do you know if you’re in the top two dental practices in your zip code? How do you compare your practice to the competition?

When I earned my MBA at Arizona State University, one of the first things I learned when it comes to evaluating your competitors and your own business was the SWOT analysis. SWOT stands for Strengths, Weaknesses, Opportunities and Threats. It is a way of looking at businesses and determining its most impactful factors. I’ve always recommended that dental practices do a SWOT analysis on the top competitors in their area.

Just like in cross-country running or competitive swimming, there will always be someone faster and slower than you in your business competition. What are their strengths? Do they have more knowledgeable workers? Do they offer their services at a lower price? Do they advertise more efficiently? Are there any affiliations that are helping them? And what are their weaknesses? What opportunities does their business present you? What threats do they pose?

Doing a SWOT analysis with your management team to answer these questions is a perfect team exercise. We start off with a box (see page 18) and write down what we see are our competitors strengths, weaknesses, opportunities and threats. It’s a fantastic mental exercise and it really gives clarity to my team.

I learned years ago that there was another dental practice in my area that was entirely focused on Medicare/Medicaid business. That practice had a much lower cost structure because it used very low-cost, entry-level employees. So, in doing a SWOT analysis on that practice with my team, I gave up that demographic. I could not compete in the Medicare/Medicaid business because I employ several long-term staff members who are extremely knowledgeable, extremely developed, and we were making more of the middle-of-the-road, Ford-Taurus-type of dentistry.

There is another dentist in my area who is entirely focused on the cosmetic end of dentistry, doing fancy veneers, bleaching, etc. He is focused on this type of high-end dentistry 40 hours a week. Because cosmetic dentistry is a very small part of our business, we decided not to be a “cosmetic spa practice that just focuses on smile makeovers.” We knew how to make the expensive Mercedes-Benz-type of dentistry but we decided not to focus on that area of dentistry because I practice in Phoenix, not Beverly Hills. Just like I didn’t feel like I lived in the area to sell the Mercedes- Benz-type of dentistry, I didn’t feel like I lived in the area to have a Medicare practice. I zeroed in on my demographics – solid, middle-class Americans – and consequently we focus on the Ford Taurus, mid-range, quality, no-frills, family dentistry.

As far as your core competency, like Jack Welch says, you have to be first or second in your market or you’re eventually going to get run over and die. So if you’re third, fourth, fifth or sixth place, you have to ask yourself if you can fix it. Maybe your competitors have a cost advantage. Maybe they employ minimum-wage employees, no frills, no thrills, and they have the lowest prices in town because they have the lowest cost. Maybe you realize you have a higher cost structure because you employ more expensive, more knowledgeable workers.

There are a lot of plumbing businesses in Phoenix – it’s rare to go for a drive and not pull up next to a plumbing truck at a stoplight. They’re everywhere. Even though there are dozens of plumbing businesses in our zip code, they’re different from one another, and not just by name. Some of them focus on residential plumbing, some are commercial plumbers, some focus on new construction and others focus entirely on 24-hour, same-day service. Even though they’re all plumbers, they all work in entirely different markets. By using a SWOT analysis, you can figure out who is doing what and who is going after what in your dental market. Is anyone doing cosmetic dentistry? Is anybody focusing on 24-hour emergencies? Does anyone focus on early morning appointments at 6 a.m. or 7 a.m., or after-work appointments at 5 p.m. or 6 p.m.? Is anyone open on Saturdays? Is anybody focusing on Medicare/Medicaid patients? Is anybody focusing on sleep apnea and snoring? Is anyone focusing on Invisalign? These are all areas in which you can differentiate your practice from competitors.

If you do a SWOT analysis of dental practices in your area, you’ll be able to better understand each practices’ unique selling proposition (USP), and you can see if there’s an opening in the market for you to offer your customers something more unique. Take emergency dental for example. You might find that of all your competitors, no one ever takes emergency patients on the same day. Emergency patients aren’t price sensitive. They’re in pain right now and want to get out of it right now; everyone else makes them wait three days to three weeks to get in, so you should adjust your business in order to get them in that very day.

After you do a SWOT analysis on your competitors and you figure out a way to differentiate your practice from the rest of the pack, the next time you go to the ADA Annual Session you might start thinking, “I practice in a small town of 5,000 people, there are eight dentists in this town and not one dentist mentions sleep medicine, snore guards, TMD or migraine headaches.” So instead of going to the ADA and taking your 300,000th course on fillings, root canals and crowns, you might instead take your entire team with the mission of: We’re going to be at this convention in New Orleans for three days, we’re going to learn something new and we are going to come back to the office and attack sleep medicine or Invisalign.

When you do a SWOT analysis of your competition, you should start at the same place all potential customers start: their websites! Get your team together and start looking at your competitors websites, asking them, “OK, knowing what we already know about our competitors, does their website spell out what they do? Is it clear?” Maybe after you do your SWOT analysis on your competitors, you’ll take a look at your own website and think, “Y’know, our unique selling proposition really doesn’t stand out on our website. Maybe we need to spend more time, money and effort on our web presence. Maybe our core competency should be in bigger letters on the home page. Maybe the things we don’t really excel at shouldn’t even be on the first page.” Like I said, it’s a great exercise for you and your team to discuss.

I’ve worked with Jay Geier and the Scheduling Institute quite a bit. The other day, Jay and I placed calls to some of my competitors. We called some of the elite dental practices in the area, and when the receptionist picked up the phone, you’d think you were calling Joe’s Tire Shop. That exercise alone made me double down on my front-office training, to make sure that we’ve got the best people on our front desk selling the dentistry we love to do. You just learn so much with a SWOT analysis!

Do your SWOT analysis on every one of your competitors and you will learn a lot of what to do, what not to do, what to focus on and what to give up. At the end of the day, remember, if you try to be everything to everyone, you’ll go out of business and end up being nothing to no one. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=314&aid=4259#sthash.4F5ExCq0.dpuf

After one of my recent lectures, I was shooting the breeze with a few doctors and we got on the topic of retiring in this putrid economy. One of the docs said, “Y’know guys, I went to a funeral the other day and I thought about that phrase, ‘Nobody on their death bed ever says they wish they would have spent more time in the office.’” This elicited some hearty chuckles, but I thought, “Are you freaking kidding me? That’s exactly the opposite of what every meaningful person ever said on their deathbed.”

I mean, do you think Mother Teresa would have said, “Man, I wish I didn’t spend so much time working in the orphanage. I wish I didn’t take so much time caring for the sick and the dying, and raising money for my mission of hope,” on her deathbed? Most spiritual leaders say the way to serve God is to serve your fellow man, and the more you serve your fellow man, the more you serve God. Guys, you’re health-care providers! You’re not out there selling something someone doesn’t need. When you’re doing dentistry faster, easier, higher in quality, lower in price, you’re serving your fellow man. You need to stop thinking about when you retire, and think more about how you can better serve your patients!

OK, spirituality aside, you’re all aware by now that we’re in the middle of an economic contraction. Things aren’t looking too good. In fact, things aren’t going to look any better until we have at least one balanced budget. It bothers me when economic Neanderthals constantly claim the U.S. economy is growing one-and-a-half to three percent a year when the national debt is more than $15 billion. Things need to get worse before they get better. When I was a freshman in 1980, interest rates were around 21 percent. If we endure another round of inflation, a 21 percent interest rate will probably be the absolute minimum (which if you have an adjustable rate loan with floating interest, you’d better tie that sucker down ASAP). And you’re thinking about retirement? Guys, here’s the bottom line: It’s time for an attitude adjustment.

One of the ideas you have to get rid of is you’re not going to retire at 55. You’re probably not going to retire at 60, or even at 65. But even more – why would you want to?! The most fun and exciting people I meet when I go out and lecture are dentists who are 70 years old and they’re still going strong; they still love what they’re doing. Sure they might have cut back from five days to three or four days a week – but they’re still really into dentistry. The days they do work, they make a hell of a lot more money than they would on the interest of their retirement savings account. When you’ve been a dentist that long, you know just about all there is about your patients’ mouths. You’re pumping money into your 401(k) in hopes to retire by 60, but that’s working against you. Seriously. Yes, it’s pre-tax savings, but right now we’re seeing the lowest tax rates in 100 years, and it’s a certainty that when you pull the money out in 10 or 20 years, the tax rates will be twice as high. A 401(k) doesn’t make sense.

You need to find a way to keep working and the way to do that is to keep enjoying what you do. Look at Sam Walton, the founder of Wal-Mart and Sam’s Club. He found a way to sell all of the big brand names like Sony and Hitachi and Coca-Cola with a low-cost distribution model. He had multiple myeloma at the end of his life. Instead of lying around feeling sick, he’d fly from his office in Bentonville, Arkansas, to Houston, Texas, to get his chemotherapy treatments, and then fly back to Bentonville to continue working. The man died a billionaire – and he died at his desk doing what he enjoyed doing. He saw his work as a mission.

Another attitude you’re going to have to beat is running your practice the way you’ve always run it. In this great contraction you need to have lower prices. You’re going to have to increase your marketing and add new products and services.

Every time the Earth goes around the sun, you give your staff another dollar-an-hour raise, and you end up raising your prices five percent. You have to knock that off. In this contraction, you need to freeze wages, and maybe the next time our planet goes around the sun, you’re going to have to lower your prices five percent. This means you might even have to go back and join dental insurance plans. People are going to buy only what they really need or really want to buy. If they can’t get their dental work taken care of with some supplemental insurance help, they might not do it (they’ll even shop their treatment plan around to other dental practices and go with the cheapest office).

Marketing-wise, if you don’t have an awesome Web site by now, you’re not even trying – hell, you’re not even paying attention. You should be search-engine optimized so you show up on the first page of Google results, you should be buying Google ads, you should have a Facebook page, and you should be buying Facebook ads.

You should be adding new products and services. Get a 3D CBCT machine and start placing single root form implants. Go to an orthodontics course and learn how to do simple ortho. Learn Invisalign. There’s a bunch of sleep dentistry groups that treat sleep apnea and snoring. Go sign up to make all the mouthguards for your high school football team. Do something!

It’s also important you start lowering your costs. So, quit doing gold. If an insurance company is only going to give you $1,000 for a crown, you can’t afford a $250 gold bill for a full gold crown. This is challenging to people because they believe in phrases like, “Treat other people like you want to be treated.” I have seven restorations in my mouth and they’re all gold. But I can’t do that for all of my patients. I’m not getting a raise from the insurance company and the price of gold has doubled. I can’t do full gold. Neither can you. So instead of a lab bill, invest in CAD/CAM technology.

Right now, I feel really bad for people who work in the luxury business. The sales of Fairline yachts, Cadillacs, Porsches, high-end steak dinners, Louis Vuitton purses and Barker Black shoes are going to plummet. You’re even going to see the profits of midlevel restaurants like Chili’s and Olive Garden shrink while the profits of Taco Bell and McDonalds grow (a $5 lunch looks better than a $15 lunch to just about anyone these days).

That being said, I live in Phoenix, Arizona – one of the most saturated markets in dentistry – and I could give you the names of almost 100 dental offices in my backyard that have gone under. They were part of two groups. One group was the high-end, cosmetic, metalfree practice that would replace all your fillings with tooth-colored restorations. They dealt in bleaching and veneers – and now they’re gone. They quit doing bread-and-butter dentistry like root canals and crowns; they didn’t know how to make a denture, they didn’t pull teeth, they couldn’t dig out a wisdom tooth, they couldn’t do minor orthodontics. Everything was elective, and patients elected to do something about their yellow, crooked teeth some other time.

The other group of practices that went under was start-ups. Start-ups went under because new-patient flow is down coast-to-coast. Even practices that are flat or growing five or seven percent every year are still facing low new-patient flow. It used to be you’d open a practice, do some marketing, buy an ad in the Yellow Pages, do some targeted direct mail and you’d fill your office up with patients. That’s not working anymore. Practices that have been around for 15-20 years and have good word-of-mouth referrals, solid reputations and high marketing budgets are going to take most of the patients in the area.

This contraction isn’t letting up any time soon, gang. It’s time we all realized we’re in this for the long haul and we need to remember to return to our core competencies, stop thinking about retiring at 55 or 65 and make it a point in this new year to lower your costs, increase your marketing, add something new to your dental armamentarium and lower your fees. – See more at: http://www.dentaltown.com/Dentaltown/Article.aspx?i=270&aid=3617#sthash.dXWqZKSm.dpuf