Measures of SuccessEach dentist defines success in his or her own manner. Almost all can do so in hindsight. Too few do so with foresight.
It is well known that those who can clearly define their measures of success and envision the process of reaching their goals have the highest probability of achievement. I have worked with hundreds of dentists and have heard a great variety of individual aspirations. Most, however, want to be altruistic, achieve professional fulfillment, and gain a reasonable level of profitability. When these 3 parameters are out of balance, a sense of failure can ensue.
Altruism is the act of helping others. Those who work in clinical dentistry are often naturally altruistic. Indeed many who work in the profession state that helping others was one of their primary motivations in seeking a dental career.
Fulfillment is a feeling of satisfaction. It can occur in a specific case when a dentist is pleased with a clinical result. It can also occur more generally when a dentist has positive feelings about helping those in need, his/her patients, or the community at large.
Profit is measured via objective criteria. Stated simply, it is practice income minus overhead. From practice profit, most dentists have 4 general areas of expenditure: lifestyle, taxes, childrens’ education, and retirement. These categories overlap—meaning that strategic planning in one category often affects planning in another.
Out of necessity, dentists who are early in their careers tend to focus more on profitability. This tendency has increased in recent years due to the high costs of dental school education and the debts that often exist at graduation.
Traditionally, dentists in the middle of their carriers have often focused on practice growth. It is common for all 3 success parameters to have equal priority.
Dentists in the later part of their careers often focus on fulfillment. Their reputation and brand are often healthy and their cash flow adequate. A desire for professional enjoyment and personal satisfaction become paramount.
As markets change, new challenges can occur. Until recently, the dental marketplace has been remarkably stable. Dentists, however, have never been immune to market forces and the effects of competition. For some, recent changes have thrown the 3 success parameters out of balance. Many are seeking ways to re-synchronize the parameters. CDA Practice Advising was created to help members achieve balanced success.
Presentation of Ideal Treatment... Do patients need or just want what we are selling?Years ago, when I was active on my local dental society board, our members were very concerned about the managed care juggernaut that was moving up the freeway from the south—threatening to engulf our local dental community. One of the resistance strategies I adopted was to do a literature review that would hopefully uncover some obscure bits of evidence-based dentistry that would connect managed care delivery systems to poor quality treatment outcomes.
To my dismay, I not only failed to find articles with the right philosophical bent, I found long-term studies performed within the confines of Britain’s socialized dental care system that concluded there was no correlation between a patient’s life span and the age when his/her teeth were replaced with complete dentures. In short, people who lost their teeth at an early age lived just as long as those who went through life without ever losing theirs.
The scientific credibility of these studies aside, the revelation that dental treatment was rarely increasing patients’ lifespan, but often increasing their quality of life was profound for me. This meant that dentists are providing services that, for the most part, are discretionary for patients and therefore must be sold rather than mandated as necessities for health.
Few business people outside of dentistry would disagree with the idea that dental case presentation is a form of sales and that successful sales requires an effective technique. I have developed a technique for my practice which incorporates thorough diagnostic protocol with effective sales strategies. The steps are:
Most dentists are analytical in nature and feel most comfortable presenting to patients by explaining proposed treatment in great detail. One of my early mentors once stated that “dentists often spend 3 minutes selling a case and the next 10 buying it back.” We erroneously assume patients share our passion for details and end up creating uncertainty and confusion in the process. I found it much more effective to communicate with each patient what I think would be ideal for them based upon their goals—without them feeling pressured to accept treatment. Most often, my technique is successful with patients deciding to accept some, if not all of the treatment I present. In addition, my thoroughness creates feelings of confidence and trust within the patient, my team, and myself that, in turn, increases my personal fulfillment, profitability, and practice growth. Isn’t that what fee for service practice is all about?
The Challenge of LeadershipThere are fundamental characteristics most dentists share. Dentists tend to be: analytical, compassionate, introverted, and linear thinking. These are attributes which often create an aptitude for being an effective doctor and microsurgeon, but not necessarily the leader of a dental practice in today’s marketplace. Indeed, in those practices in which I have consulted, leadership was the most common issue challenging the owner/dentist.
My father practiced pedodontics for 44 years. My clinical career overlapped his for about 15 years. Observing my dad, his colleagues, my clients, and in my own practice experience, I have seen 3 basic styles of private practice leadership: 1) the authoritarian (military) model, 2) the family model, 3) leadership by facilitation.
I’ve met very few dentists who declare or are even aware they are utilizing one of these specific styles. For better or worse, the vast majority adopt one style by default.
During the 70’s and 80’s, most dentists were men and were typically the unquestioned authority in their practices. They gave orders concerning every detail of practice operation, and employees complied. A diminishing percentage of dentists still use this model.
In recent years, a greater variety of private practice types have evolved including those with tiered management—which often separates the dentist from a significant portion of business decisions. This evolution, dentists’ fundamental characteristics, and their lack of management and leadership training have created, in my view, the family model that commonly exists today. In the family model, leadership is often performed via consensus and relationship dynamics within the practice are a significant force in decision making. Some dentists have made the family model work to create their version of success. In general, however, I do not see this model as effective in today’s marketplace.
Max DePree in his seminal book, Leadership is an Art, states: “Everyone has the right and the duty to influence decision making and to understand the results. Participative management guarantees that decisions will not be arbitrary, secret, or closed to questioning. Participative management is not democratic. Having a say differs from having a vote.” This statement catches the essence of leadership by facilitation—the optimum style, in my opinion, for today’s private practice.
Leadership by facilitation is the art of moving an organization toward a declared purpose. In a dental practice, it is the owner/dentist’s responsibility to define and declare his/her purposes for being in practice. A purpose could be the overall mission of the practice or a more specific one such as the level of service and profitability in the hygiene department. Employees are respected and receive a say in defining a purpose, but they do not receive a vote.
Once a purpose is defined, the dentist engages in a participative process with employees that leads the practice toward that purpose. This “facilitation” revolves around the question: “how can we move as effectively, efficiently, and enjoyably as possible from where we are now toward the purpose I’ve defined?” The answer to this question always creates an action plan. Employees continually participate in answering this question and are then responsible for playing their respective roles in implementing the action plan.
I have talked with many dentists who would like to change the way they lead their practices, but feel trapped in their current circumstances with their employees. Changing a practice which utilizes a family style of leadership to a one utilizing leadership by facilitation can be a challenge, but is well worth the resources and effort to achieve it. In my own experience, making that transition and running my practice via facilitation has been one of the most freeing and effective experiences of my professional life.
The Links Between Quality, Profitability, and the Dental MarketplaceI often speak of the “golden age of dentistry” which seems to have occurred sometime between the late 1950’s and the early 1970’s. Even though I am uncertain about the dates, I know the age ended before I graduated from dental school. As the son of a dentist, it—s interesting for me to talk with my father about those years—a time when he was in the prime of his professional career.
There was a shortage of dentists rather than patients, and overt marketing was only for the unethical. Lending institutions would provide all the funds a dentist needed on his signature alone. It took months rather than years in private practice to establish a consistent flow of patients. No one even acknowledged that a dental marketplace existed.
With dentists’ financial success all but assured, the sole emphasis during the golden age was quality of care. The moral structure of the profession did not make room for a focus on practice profitability. The unspoken litany was: focus on quality and the financial rewards will follow in their natural course.
In spite of the dramatic changes that have occurred in the dental marketplace since the golden age, I still often find vestiges of the litany in our profession. Even with the significant risks abundant in today’s marketplace, I still see dentists who don’t wish to acknowledge the link between their profitability and their ability to deliver their best for their patients.
I maintain that delivery of quality in private practice today requires significant initial capitalization, a healthy cash flow, and continual reinvestment in the practice. How do dentists compete for the best employees when they are in short supply? How do they maintain physical offices that create value in the minds of patients? How do they obtain the finest continuing education and equipment? How do they design and implement effective marketing programs? Quality is not possible without these, and none of these are possible if a practice is not profitable.
Just as strategies can be developed and skills obtained for creating quality care, so can they be for creating profitability. We have rightfully always taken quality seriously. It’s time we do the same with profitability.
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