05.08.09 Issue #374 Forward This Newsletter To A Colleague
Family in Dentistry
Periodontal Charting
Leadership In A Recession

Are you Thriving or Merely Surviving in the
'Family Business'?

by Sally McKenzie CEO
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Family businesses can be very complex – to say the least. And navigating through the potential minefields is no small challenge for many. After all, when it comes to working with family there is a lot to gain …and a lot to lose. In dentistry, family-run practices are common with fathers and sons, husbands and wives, mothers and daughters, siblings, in-laws, aunts, uncles, etc working under the same roof.

Some function very effectively together and, typically, those that are the most successful are able to deal with business issues as partners, not as husband-wife, father-son, mother-daughter, etc. Family communication and trust are essential. But well-established management systems and accountability are absolutely critical. Without clearly defined roles and detailed practice systems, emotion and family “issues” can quickly take over.

Maybe the doctor’s spouse has been doing things “her/his way” since she/he arrived in the office five years ago. Such as, asking prospective patients whether they have insurance immediately after the caller indicates that they would like to schedule an appointment. But the approach simply isn’t good for the office – no matter how long she or he has been doing it “her/his way.” Perhaps, brother Joe, the financial coordinator, is allowing his friends and neighbors to carry balances indefinitely, sending accounts receivables over the top. And Aunt Carol is habitually late. Joe, Carol, and yes, even the doctor’s spouse, must be educated and held accountable for their systems, their actions, and their results.

In other cases, family members are in the wrong jobs and would be much more effective in another position. For example, Ellen, the wife, is working as the office manager but would make a much better financial coordinator. Doctor must have the courage to make the change and Ellen must have the courage to accept it – a tall order for both. And oftentimes, it’s necessary to bring in outside help to navigate the players through the process of developing job descriptions and identifying who will work best in which positions. The fact is family members are often too close to the issue … literally.

While conflict may seem to be an obvious area for family strain, trying to avoid it can be far worse. Too often family members won’t question one another’s decisions or actions. They won’t address problems. They refuse to buck the status quo and push for necessary change because they are afraid to start an argument within the family. And if family members won’t confront family members, where does that leave the rest of the staff? Most likely searching for employment elsewhere.

Then there’s the issue of control. Countless dentists or their spouses are running dental offices. They are “in charge” but don’t understand what it takes to manage the business side of a practice. They don’t comprehend practice reports and business statements. They don’t understand the impact of overhead. Yet because they “own the practice” they make decisions that affect their own long-term financial health as well as the fiscal health of the practice based on what they think is right. They are flying blind. Dental practices, whether family are running them or not, are businesses first, and they need to operate like a businesses, yet many of the family members in these family-run practices have never had a day of business training.

For some, joining the “family practice” is something that is simply assumed. But before you decide to work in your spouse’s, your father’s, your mother’s, your brother’s practice, realistically consider if you can work with your family. Being honest with yourself from the beginning will potentially save you years of frustration and discontent. Remember, a “good son,” “good daughter,” or “supportive spouse” is far different from being an effective business partner. It will take courage to raise issues that may put you at odds with your family. Yet serious problems will arise if communication is weak or if the relationships in general tend to be strained.

Certainly, there are those families that sincerely enjoy working together and are successful in doing so. But it’s not for everyone. Before you decide to partner with your spouse, sister, brother, mother, father, uncle, cousin, or whomever, evaluate the decision carefully. We all have family members whose company we enjoy, but we wouldn’t necessarily want to spend 40+ hours a week with them.

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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Angie Stone
Angie Stone RDH, BS
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Is There Life without a Chart

Recently I heard a shocking statistic. On average, seventy percent of adult dental records do not contain a full periodontal charting. With all the knowledge the world of dentistry has, how can this be the case?  Are offices still, “spot” charting?  Are they probing but not recording findings? Is the hygienist replacing the periodontal chart with “perio- WNL” in the treatment notes?  I have been told “WNL” means, “We never looked”. 

Without proper periodontal documentation, the health of patients and the livelihood of the office are potentially threatened. Current periodontal standard of care indicates all adult patients should have full periodontal probing and charting accomplished once a year. There are many reasons for this.  The two biggest reasons for this recommendation is to ensure patients are either disease free or receiving the treatment necessary to bring them to a healthy state and to prevent litigation against the dental office for not diagnosing periodontal disease.  Having a complete, up to date periodontal charting on file is the only way to protect the office against a claim that the office is not screening for and treating periodontal disease.  Why then is there not a complete periodontal chart in every adult dental record?

 Many reasons for this come to mind.  1. Periodontal probing and charting takes time.  If the appointment length is not appropriate, probing and charting may get delayed to the next appointment. While intentions are good, probing/charting never really get accomplished. 2. The hygienist needs to bother another staff member to help chart the findings.  If there is no one available, again, it gets pushed off to the next appointment and quite possibly there is no one available the next time either.  Again, the charting never gets accomplished. Measures need to be taken to remedy these situations.

Florida Probe Corporation recently launched the, “GoProbe System” to remove barriers to periodontal charting. GoProbe utilizes Florida Probe’s FP32 Software and new Wireless Keypad Input Device.   The GoProbe wireless key pad allows the clinician to input periodontal probing data without the assistance of a second team member.  Keypad entry is so effortless the patient can enter the data for the clinician if needed.  Pushing the button that corresponds to pocket readings is faster than writing numbers manually thus precious time is saved.  In addition the GoProbe is economically priced for general practice offices, is easy to use and can be used with ANY periodontal probe.  It is a more reliable alternative to voice activation, installation and training is easy, and it bridges with over 40+ practice management systems.

Can a hygiene department survive financially without periodontal probing and charting?  No, it cannot.  When periodontal data is not gathered and recorded, the hygiene department is inevitably prophy-based.  The billing of prophy procedures cannot sustain the department at a healthy level.  Fees for cleanings, x-rays and fluoride are not high enough for hygiene to produce 1/3 of practice production, or to reach the industry standard of 1/3 of hygiene production coming from periodontal procedures. 

Production in prophy based hygiene departments is usually not enough to ensure hygiene salaries are within recommended ranges either.  In this situation, production/revenue from the dentist is used to subsidize the hygiene department.  This does not need to be the case if periodontal probing and charting is accomplished. Research reveals the need for some sort of periodontal therapy in at least 30% of adults.  Based upon this knowledge, if a hygienist is seeing ten patients per day, at least three of them should be periodontal patients.   Periodontal maintenance appointments bring in more production than prophies and are typically charged out 4 times a year instead of 2 prophies. 

If an office has 500 patients, the production for prophies annually would be $75,000 (500 patients x 2 prophies /year = 1, 000 prophies x $75= $75,000). If 30% of the patients were receiving periodontal maintenance 4 times a year at a cost of $150 the production from these procedures would be $90,000 (4 visits at $150= $600/yr per perio patient x 150 patients =$90,000). When production of $52,500 is added for the other 350 patients receiving 2 prophies /year at $75 (2 visits at $75 each= $150/yr per patient x 350 patients= $52,500) the production for prophies and periodontal maintenance is $142,500. Doing the math makes it obvious having patients in periodontal maintenance after active therapy is a must, not only for the patient, but for the practice as well.

Once the need for periodontal therapy has been discovered, GoProbe assists the office in gaining acceptance of active periodontal treatment.  This is accomplished through the use of Florida Probe’s FP32 software that is part of the GoProbe system.  Software contains:

  • Pre-exam educational videos and risk assessment screening
  • Superior charting and printouts
  • Talking software involves patient in memorable, co-diagnosis experience
  • Picture-oriented charts for greater patient understanding

If periodontal therapy is accepted and one quadrant of scaling and root planing is done each day, hygiene production increases a great deal.  If a quadrant is charged out at $250 every day based upon a four day work week, for 50 weeks a year, production from scale and root planing would be $50,000.

There can be no life without a chart, as periodontal probing and charting is the lifeline to patient health, hygiene department productivity and safeguarding the office against potential litigation. 

Need help with implementing new systems and products in you hygiene department? Email hygiene@mckenziemgmt.com.

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Free Overhead Assessment

Nancy Haller
Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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When the Going Gets Tough, the Tough Get Going

When times are tough, business leaders need to tighten their economic belts. Unfortunately, what you ‘slash’ is critical to your on-going success. And leveraging your ‘human capital’ is more important now if you want to position your practice for future profitability.

Although training and development budgets are among the first to get ‘axed’, there is a trend in many companies these days. Wise leaders are looking beyond today's economic strains and are continuing to invest in their employees. More than ever before, team effectiveness means business efficiency, especially now. To survive through the recession means making good leadership decisions. Good decisions don't just happen. They come from leaders who take the time to align their actions with their practice vision. Here are some important factors to keep in mind.

Avoid knee-jerk reactions. Of course you’re worried about when the economy will improve but don’t give way to decisions based on fear. The best way you are going to weather these turbulent times is to keep your team focused and fired up. Be objective and deliberate.

The worst decisions are usually the ones that are made quickly. Good decision-making takes time and so be sure the decision you make is the right one. Evaluate the need for lay-offs carefully not emotionally. The same is true for pay cuts. It’s far better that you make sacrifices in your own pay than to risk actions that diminish your employees’ morale. Every minute your employee spends wondering or worrying is a minute your patients are being ignored.

Help your employees deal with their fear. Be an open communicator about your decisions to reduce expenses. If you announce that you’ll no longer be providing beverages in the staff refrigerator some of your staff may wonder if they’re next in line to get the ax. You may see soda pop, coffee and donuts as unnecessary or a place to save a few dollars. However, to your staff these could symbolize an unwillingness to “feed” them emotionally. The intangible costs could easily outweigh the monies you expected to save. If it’s crucial for you to take this kind of action, explain the decision with objective facts. More importantly, tell them that by reducing smaller expenses you are maximizing your plan to keep everyone on board and at the same pay level.

Continue to invest in training your team. “Dumbing down” the practice is a short-term solution. Be judicious about where to spend training dollars but don’t defer essential skill-building. Remember that your practice has a great opportunity to position itself for the future. If the schedule is lighter now, use the time to advance your employees’ knowledge. Engage in team building activities that lighten spirits and keep morale high.

Focus on ways to improve customer service. And pay extra attention to the patients you’ve got. This is an excellent time to show you care by spending a bit more quality time with everyone in your office. Crank up your ‘personal touch’. Just like you, your patients are concerned about their pocketbook. And research shows that people will continue to spend money when the perceived value is high. Find small but powerful ways to give T.L.C. treatment. In doing so you’ll build stronger loyalty with better patients, and maybe even more business.

Continue to recruit. Although it sounds strange and seems scary, this is a perfect time to hire. Capable dental employees are out there looking for work. The recession means the talent pool is large and strong.

Work on yourself. Effective leadership overrides a tough economy. You need to be disciplined. Develop a plan and stay the course. Your employees will model your behavior so be calm and optimistic. If you’re having trouble staying positive, get a coach who can assist you in keeping a hopeful perspective. Fear leads to sloppy decision making which almost always backfires.

Times are tough right now. However you have a choice about how you will respond. You can impact your practice in a powerful way. Plant your feet. Talk more with your employees and your patients. Include others in your decisions. Reach out for support and help. Be hopeful in your thinking and your actions. And remember to be appreciative.

Dr. Haller is the Leadership Coach at McKenzie Management. She can be reached at coach@mckenziemgmt.com.

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

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