08.21.09 Issue #389 Forward This Newsletter To A Colleague
Making the Call For Help
Creating Your Dream Practice
Communicating With Your Team

Dental Career or Daily Drudgery? You Decide.
by Sally McKenzie CEO
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Recently, I was sitting with a small group of dentists during the lunch break at a dental meeting and they were commiserating, divulging their war stories if you will. Obviously, in my line of work it is not uncommon to have dentists willingly share their often painful experiences. This was no exception. 

The doctors were talking about some major problems they were having in their offices. One of the dentists, I’d say he was probably 45 – mid-career guy – I’ll call him Doc #1, was asking the other dentist, Doc #2 – I’d put him around 55 – should be nearing retirement – about how his office schedules patients. Doc #1 explains that his days are a string of frustrations, stops and starts, frantically running until everything comes to a screeching halt. There’s no rhyme or reason to how his scheduling coordinator is organizing the day. And his practice’s production is nowhere near where he thinks it should be regardless of the current economy – one day it’s $5,000 the next it’s $1,000. Of course, Doc #2 asks him if he’s talked to his scheduling coordinator and Doc #1 replies with an emphatic, “Definitely! She knows that I want to be busy, I have made that completely clear.” He notes that when he brings it up, things will improve a little for a while but then it’s back to the same erratic production.

Well, misery does love company because Doc #2 proceeds to open up about the staff conflict and collections nightmare he’s been experiencing for the past three years - this has been going on far longer than the current economic downturn. Suffice it to say that Doc #1 was certainly feeling much better about his scheduling woes after hearing Doc #2’s blow-by-blow account of the turf wars and serious financial worries he’s facing.

All the while, I’m thinking to myself “Why are these dentists living their careers in such misery?” Suffering truly is optional. They desperately need the help of an outside management consultant; they need someone to help them identify a plan of action. Otherwise, they are going to be on the misery march to retirement for many, many years.

In nearly 30 years of working with dentists, I know how incredibly difficult it is for them to acknowledge that they don’t have all the answers. They don’t have the training or the expertise to deal with the multitude of issues and problems that come up when running a business. But I also know that once they reach a point when they have had enough, when the thought of walking through the doors of their practice generates so much anxiety and unhappiness, it is often at that point when they will finally seek out a company that can help them realize the dream they had given up hope of ever achieving.

They finally come to terms with the fact that sometimes it takes someone else besides the dentist or his/her spouse to look at the practice and objectively assess what is working and what isn’t, to identify why production is down one month and up the next, to figure out why a group of people can’t ever seem to gel into a team, to discover why collections, patient numbers, and overhead aren’t where they should be in spite of a team’s best efforts.

Yes, it takes a lot of soul searching, but at some point the doctor decides that he/she is finally sick and tired of struggling. She isn’t going to compromise any more. He has studied, read, and attended all the practice management continuing education courses he can and to no avail. She has tried to fix it herself year-after-year, but no matter what they do it seems that the same problems, with the same systems or the same people, continue and continue. When the dentists accept that they don’t need to have all the answers, and they pick up the phone and make the call for help, it is the point at which they begin to build an entirely new practice, and most importantly, an entirely new and satisfying career in dentistry.

Next week, has the time finally come in your practice to make the tough decisions?

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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Belle DuCharme CDPMA
Instructor/Consultant
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The Challenges of a Start-Up Dentist

Case File #214 - Dr. Lin Wu

After many years as an associate dentist in a general practice, Dr. Lin Wu decided that he wanted to start up his own practice. The decision to leave was fueled by an increasingly hostile environment created by the deteriorating relationship with the owner dentist, Dr. Smith. Dr. Wu had confidence in his abilities to be an excellent dentist and, over the years, had built a loyal following of about a thousand patients that were supposed to be his, according to the loosely drawn agreement with the owner dentist. One last dispute ended the relationship and sent Dr. Wu in a tailspin as to what to do now: accept an offer to join another established practice as an associate, or take the big leap and open his own practice. He chose to open his own practice.  The first step was to enroll in McKenzie Management’s Practice Start Up program for 2 days.  There was a lot to be done but he knew that he needed the guidance of an expert to make it all come together.

The hunt for a location using a real estate specialist yielded a smaller but doable space within a few miles of his previous practice. Dr. Wu knew the demographics and psychographics of the neighborhood and was pleased with the practice location and availability of parking. Luckily he was within the ruling of the “non-compete” clause in his associate contract and would be able to take his established patient records without too much resistance. He would still be held to the agreement of giving Dr. Smith a percentage of the collections on work pending with insurance companies.

Working out the new lease with the current tenant, broker and landlord was challenging to do quickly and with the same goal in mind. The previous tenant had invested in beautiful flooring, painting and artwork which would be part of the lease agreement. The dental chairs were in very good condition, the plumbing and electrical were installed correctly and with a few alterations, they would be ready soon. Getting the new computers, software, digital x-ray and televisions installed took a team of about ten people from several sources working in tandem or in sequence. 

Dr. Wu was able to avoid one of the biggest hurdles facing new start-up dentists. His staff was willing to come with him, understanding that they would not have as many hours or benefits in the beginning.  Deciding to go chartless with the new set-up and getting a new software program met with some resistance, but when it was explained to Dr. Wu and his staff how much time would be saved and how much more efficient they would be, everyone was open to learning the new program. So as hammers banged putting up shelves and running cables, the team learned the new software program and prepared to see patients the next day.

Unlike many start-up scratch practices, Dr. Wu had many scheduled patients that wanted to be seen as soon as possible. Would it be possible to work on patients while the office was being built up around them? It was deemed possible but only with the cooperation of an incredible team of people. Much like the television show Extreme Makeover, where a brand new home is built within a week, the process of putting a working practice together required many people to do their jobs quickly and correctly.

Dental supplies started coming in with a parade of boxes and the staff scrambled to organize the work area and put the supplies in containers and labeled shelves so that they could be found without much time lost. Dr. Wu needed a sterilizer, new handpieces, instruments, burs, endo supplies, trash bags, paper towels, drawer organizers, alginate, impression materials, composite materials, etc. The list seemed endless and just when the staff thought they had everything, they were adding more to the list. In the business area, getting the phones set up and the merchant services for credit cards along with getting the sign pad for the health history forms and the credit card receipts took time on the phone doing installations. Signing up for electronic claims and electronic statements involved uninterrupted time on the phone and on the computer.

Within a week Dr Wu and his team were seeing patients. Sure it was rocky and had its challenges, but they made it work. It has now been three weeks and although they are still working through the daily bumps in the road, every day is exciting and fulfilling with the knowledge that teamwork has paid off in creating the start of a dream practice.  Want to start-up your own practice?  Learn what to do to get started and what not to do to avoid pitfalls by taking McKenzie Management’s Dentist Start-Up Program.

If you would like more information on Treatment Acceptance Training to improve the performance of your team, email training@mckenziemgmt.com.

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Nancy Caudill
Senior Consultant
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Do You and Your Team Communicate on the Same Planet?

Dr. Barry Bronson – Case Study #216

Dr. Bronson, a general family practictioner was constantly annoyed every day by his team. Not surprising, his team struggled with the same challenges – how to communicate with one another!

Hygiene

What annoys Dr. Bronson:

  • His team members would catch him in the hall to ask if they could have next Thursday off because of their child’s kindergarten graduation, lunch at school, etc.
  • Instead of calling him to tell him that they were sick, they would call one of their team members. He would arrive at work short-handed.
  • Where was his assistant when he needed her? He has 3 and no one is around!
  • The morning meeting starts at 7:45 but he is the only one ready to start.

What annoys the team about Dr. Bronson:

  • They would ask him a question and his response was, “I will think about it” and they never get an answer.
  • When a team member would be sick, the last thing she wanted to do was call and tell the doctor. He thought that no one should ever be sick.
  • Dr. Bronson would be running 4 operatories at one time and the assistants are frantically trying to keep up with him, develop x-rays for the hygienists, check to see where there next patient is… and he wonders where everyone is!
  • 3 out of 4 mornings Dr. Bronson is late for the morning meeting.  As a result, they stopped arriving on time as well.

These lists could go on indefinitely from both parties. It was organized chaos in Dr. Bronson’s office. Temperament types indicated that his employees liked organization, following the same protocols daily without unnecessary changes, and a little recognition from him. He was spontaneous, ambitious and always planning ahead for the next move. Different planet, different universe! These annoyances were not “earth-shattering” issues. However, sometimes it is the little things that cause doctors to call and say “Help! My office is out of control.”

Recommendations
Morning meetings – Dr. Bronson and his clinical team would gather in the hall while the hygiene patients were being walked between them to briefly “chat” about the day. The meeting was non-productive and did not completely cover the areas that needed to be covered in order to have an efficient and productive day.

Morning meetings should include but not be limited to the following:

  • Review of all the procedures that are scheduled to confirm the accuracy of the information.
  • Inform the clinical team of any financial concerns of patients coming in.
  • Review medical alerts.
  • Determine any patients’ birthdays for the week that are coming in for celebration.
  • Share production goals for the previous day, as well as scheduled production for this day.
  • Look for good times for emergencies that may need to be seen for the day.
  • Make sure that all lab cases that are scheduled for the day are in the office and ready for delivery.
  • Review tomorrow’s schedule if time allows.

In conjunction with the morning meeting, the hygienists and assistants should have access to their patients’ records for the next day by lunch time in order to have time to review the information prior to the morning meeting the next day.

Walkie Talkies” could be used by all team members and doctors to improve inter-office communication. Team members were running around the office trying to find other team members to ask questions or share information with. Team members were constantly playing hide and seek with the doctor or each other.

Questions for the Doctor – Many times the team doesn’t realize that the doctor has a lot of clinical concerns rolling around in his mind when he is moving from one patient to another. Catching him in the hall between hygiene patients is NOT a good time to approach him about any management issues, let alone a personal issue.  Unless the building is on fire, wait until the end of the day or before lunch to approach him. Doctor, in order to avoid answering yes or no to a question without giving it any thought, I give you permission to respond with, “Susie, I need to think about that. Come to me in the morning and I will have an answer for you.”

Sick!  You can’t be sick! – A system was implemented for the team to use when they were ill. The doctor was notified by phone as soon as the team member recognized that they were not going to be able to work. Dr. Bronson’s response was to be, “Susie, I am sorry to hear that. Take care of yourself and unless I hear from you, I will see you tomorrow.” The team member that is sick also contacts her working “partner” to inform them of her condition and fills her in on anything that she might need to know regarding the day.

Conclusions
Dr. Bronson must keep the doors of communication open so the team members don’t feel intimidated by his responses to certain situations. It is also necessary to have a mechanism in place to be able to express concerns without fear of being reprimanded: a suggestion box, whiteboard, etc. Remain open-minded about your team’s concerns and comments.  Remember – Men are from Mars and Women are from Venus!  Success is when you can all come together on Earth. 

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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