9.14.07 - Issue # 288 Forward This Newsletter To A Colleague
Patient Retention
Dr. Performance Appraisal
Demographic Update

Feeling the Mid-Career Slump?
by Sally McKenzie CEO
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The “middle” can be a challenging place. It is often the point at which you’re too far from where you’ve come to turn back yet seemingly still a long way from your destination. The middle of anything doesn’t seem to denote much that is positive, “the middle of nowhere,” “middle of the road,” and the dreaded “mid-life crisis.” 

Similarly, the mid-point in a dental career can bring great uncertainty, many questions, and frustrations. As the financial struggles, personnel problems, patient issues persist, is it any wonder that mid-career dentists find themselves asking, “Is this all there is?” Where’s the excitement, the enthusiasm, the career satisfaction?

Consider your position on this mid-career path. Are you enjoying the view from the pinnacle of success? Or are you frozen in place, stuck somewhere between merely average and truly excellent? And, if you’re not where you want and feel you should be, are you willing to take the necessary steps to change it? If so, the question then becomes, how? Look at those areas most likely to be sending your practice, and consequently you, into a mid-term slump, starting with patient retention.

We see this scenario routinely in mid-career practices: Everyone is busy. The schedule appears to be bursting at the seams. Hygiene is typically booked out six months. A couple thousand patient records are on file. Therefore, the doctor is convinced that patient retention is perfectly fine. “Busy” is one of those great illusions of the mid-career dental practice, a perception that is not only deceiving but also very expensive. In fact, most dental teams are stunned to learn that 80% of dental practices are losing more patients than they are bringing in new. But upon hearing such statistics the crew will simply turn and tell each other that they must be in that select 20% group because, well, you know, they are crazy with work. Just how crazy? Find out.

How many inactive patient records are taking up space in your files or stored away? Have you increased the number of hygiene days per week in the last year? Is your hygienist’s salary more than 33% of what she/he produces? Finally, have you converted 85% of your emergency patients to comprehensive exams?

If the number of inactive records is enough to open a second practice, you have patient retention problems. If you have not increased hygiene days, you have patient retention concerns. If your hygienist’s salary is more than a third of what she produces and if you haven’t converted 85% of your emergency patients to loyal patients, you have more patients leaving your practice than you have new patients coming in.  

While misery loves company, it doesn’t require you hang around this pity party indefinitely. Patient retention is an area in which you can take prompt steps to improve and see immediate results. In most cases, patients have simply drifted away because the recall system, if it exists, is weak.  Put recall to work and patients in the chair.

Here’s how:
Generate a report from your computer of all patients past due for recall appointments in the last twelve months. Your objective is to reconnect with these patients using a defined strategy that will enable you to set goals and track the results of your efforts.

First, assign a member of the business team, typically the patient coordinator, to take the following steps:

  1. Contact a certain number of past due patients each day. The coordinator should use a specific script that she/he uses as a guide in making the calls. In addition, she/he should check the patient records to identify a treatment concern noted in the patient’s chart that she/he could reference in the phone call.
  2. Everyone needs goals, and beyond just making calls, the coordinator should be expected to schedule a definite number of appointments, and follow-up with patients to ensure that a specific number of patients complete treatment.
  3. The coordinator also assists the hygienist in meeting production objectives by scheduling the hygienist to achieve daily or monthly goals as well as managing a precise number of unscheduled time units in the hygiene schedule per day.
  4. Finally, the patient coordinator monitors and reports on recall monthly at the team meeting. 

You will find many patients who are more than willing to schedule an appointment. They do so because you’ve demonstrated to them that you value this patient relationship and want them to return.

Next week, out of the mid-career slump and into your stride.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

Interested in having Sally speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Who Does Your Performance Appraisal?

If you do routine performance reviews in your practice, congratulations. Giving feedback to your employees lets them know how well they are meeting your expectations, particularly as applied to their duties and responsibilities. The only way for your staff to get better at what they do is for you to give them honest, timely performance evaluations.

So who does your performance review?

You may have made a habit of critiquing your own performance – perhaps you take a few minutes at the end of day to reflect on a particular situation, what you intended, what happened and how you might do things better next time. That’s great.  What you think of your own performance is important; however, your own view is both limited and biased.

Success at work and in life depends on what other people think of you more than what you think of yourself. Unfortunately most of us live in a world of ‘no-news-is-good-news’. We operate under the assumption that if no one complains we must be doing everything right. WRONG!

There are several reasons why people don’t give you honest feedback:

  1. They don’t want to damage their relationship with you.
  2. They want to avoid confrontation as much as you do.
  3. They want to be supportive.
  4. They don’t want to hurt your feelings.
  5. They’re afraid of your reaction. 
  6. You haven’t asked.

As marketing professionals know, formal focus groups are necessary to find out what people really think.  Furthermore, it doesn’t matter what people have to say when they are in a logical, analytical mode. What really matters is how they feel about you. Scary stuff, but absolutely essential to know this if you’re going to become more effective, in business and in life. 

Should you seek out feedback from your employees? Absolutely. Asking your staff for their observations will engender loyalty, and will likely make you a better boss. But since people will very rarely tell you the truth about yourself, you need to figure out a way to get honest feedback on how you’re doing. That’s the one thing that limits leaders from achieving their full potential. They want to hear the good things about their behavior and performance, but not the bad.

Few of us enjoy hearing about our shortcomings, and few of our employees will lavish the thought of critiquing their boss. So how do you solicit good feedback?

Marshall Goldsmith, a leadership coach to top executives in many of the world’s leading companies, has a process that he calls feed forward. He believes that there is a fundamental problem with all types of feedback: it focuses on a past, on what has already occurred—not on the infinite variety of opportunities that can happen in the future.  As such, feedback can be limited and static, as opposed to expansive and dynamic.

Over the past several years, he has developed a new way for his clients to solicit information about how they can improve. Although it is deceptively simple at first blush, it is an amazingly powerful and safe way to get information for the future.

As an introduction, it is important to tell your employees that you are working on becoming a better leader. Otherwise your search for feedforward will be confusing. Then say:Give me two things I can do to be a better boss.”

Listen to their suggestions, even write them down. Learn as much as you can. Refrain from any commentary or rebuttals. Simply say, ‘Thank you’.

Use the feedforward statement with the other people you value most in your life. Modify the wording to reflect your relationship with them. For example, “give me two things I can do to be a better husband – wife – father – mother – friend - etc.”

Pay attention to the themes in your feedforward. Identify one behavior that you would like to change that would make a significant positive difference in your practice. In my next article, I’ll tell you how to follow-up on this so you can be the best boss you can be. Becoming a great leader is worth the effort…and it will show up in your bottom line! The most successful leaders are aware of the impact they have on others. You only need to ask.

Interested in becoming a better leader? Contact Nancy at coach@mckenziemgmt.com.

Interested in having Dr. Haller speak to your dental society or study club? Click Here

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Scott McDonald
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Dental Demographic Update: The NEW Migration

McKenzie Management likes to keep its Clients up-to-date on the changing world of demographics. As part of their services, they offer practices a detailed demographic analysis of their location including competition and lifestyles. 

New patterns of migration in the U.S. may have a profound effect upon existing practices. Traditionally, when people moved out of the big city to the suburbs, they merely expand the size of their metropolitan area. They moved from Manhattan to Long Island or from Los Angeles to Pasadena and The Valley. Now, something new is happening.

According to Brookings Institute’s Robert Puentes, the shift is “more significant than the migrations of the 1950s or 1970s.” Almost every demographic scholar agrees that something big is happening with the redistribution of populations within the U.S. The question they have is, “Why is it happening and What will it mean to Dentistry?”

The What: There is significant growth of cities and communities that are outside of these traditional “Big City” centers. Small communities are springing up in “fly-over” country that represent opportunities for young doctors and established practice expansion.

The Why: In our opinion, the catalyst is affordability of housing that is sparking this trend. It is demonstrated by taking the median home price divided by the median household income that determines the “median multiple.”  In short, it calculates how much house can one afford. The lower the number, the more affordable the market is. Atlanta, Dallas-Fort Worth, and Houston (all with growth-friendly public policies and few restrictions) grew fastest. These markets were at a “3.” Ten years ago, most cities were below 4.5. Now, Los Angeles is over 11 and San Diego is over 10.  Why would it surprise anyone that people are leaving?

Many of our older friends in Northern California discovered that they could sell their homes and move to Nevada or Utah where they could buy a home outright. Younger families found that they were almost forced to move to these lower ranked markets because their debt and expectations for a high quality-of-life demanded it.

What makes things more complicated is public policy to “fight sprawl.” Massachusetts, for example, has local regulations that encourage low-density housing (few people per square mile) to “fight sprawl.” This has the tendency to make whatever housing is available extremely expensive because more cannot be built. The result has been that young families have to move further and further away from the city centers (or out of state) to find a place that they can afford to live.

Raleigh, Atlanta, and Houston still have growth friendly practices in place. The question of employment cannot be ignored. But we see this as a “chicken and the egg” issue. Do people move to an area because jobs attracted them or are jobs available because that is where people are going? Increasingly, we find the latter to be the case. Factory situations (where factories are placed), are more often determined by available workers (the cost per worker is partly a function of how much housing will cost). Thus, the “Field of Dreams” saying should be changed, “If you come, they will build it.” Self-employment, telecommuting, and mega-commuting are also making this trend increasingly possible and desirable.

The implications for dental practice are significant. A practice that was once situated on the leading-edge of growth may now find itself in what is considered the “City Center.” Once the area has been “built out” and new housing is no longer possible, the demographic character of the local population may change. One practice in Glendale, California went from a predominantly Whites with young children area to White retirees, to Young Hispanics with few children, to Russian/Armenian with many children. All of this occurred within 25 years. Without ever moving his practice, the doctor found that he had gone through four significant changes in the demographic character of his patient-base. And all through this process, there was no significant increase in the number of households near the office. But the price of purchasing homes in the area has soared. San Jose is an example where even a very modest home will sell for more than $1 million dollars BUT homes may have twice the number of people living in them than was ever intended.

Because of these changes, we strongly urge dentists in established practices to get a demographic review of their area to know what they are facing in the near future.

Ultimately there are two results of this new trend in migrations: The first is that many established practices are considering satellite-offices and second-offices to take advantage of the new migrations. This trend is likely to continue for the foreseeable future.

The other primary result is an entirely new set of factors in determining where the best place to practice will be for younger professionals.

Scott McDonald is the largest provider of dental marketing research to dental practices.  For more information demographics@mckenziemgmt.com.

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