Being the Boss / Owner is NOT EASY

By far the greatest amount of negative feedback I receive in writing this blog is from staff members who do not like me talking about the dental office in terms of an employer – employee relationship. They get mad at my depiction on the staff working for the owner. They prefer to think about the office as being a perfect team / partnership relationship with each person just playing a different role on the team. In their depiction, the dentist is just an even employee with a different job.

While I am strong believer that there should be a friendly and congenial relationship amongst all those people working in a dental office, it is naive to think that a dental office is not the same as any other regular business with an owner and employees.

The dentist / owner goes to school for many years, borrows the money to start and grow the practice, and is financially responsible for all the action of the business. Ultimately the dentist hires the staff, determines the salary levels and benefits and if necessary fires the employees.

The dentist is also solely responsible for the ramifications of legal suits against the practice, regardless of which staff member may have committed the problem. The dentist /owner is financially liable for all events that occur in the office.

Staff should not be angry at the depiction of the dentist being the boss and that they work for the boss. It is not a demeaning statement to say the staff works for the dentist. It does not negate any skills the employee has or the value they contribute to the success of the office. It is not fair to the dental owner to try to tell them that they are not in fact the boss and the buck stops with them – it does.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Patient Who Harassed Staff Member

If you practice long enough, you will experience a situation where a patient touches or sexually harasses a staff member. Most staff members are young and often attractive women and every blue moon you will have a patient that thinks your office is the local gentleman’s club. I don’t understand the logic but I have seen this behavior happen a number of times over my career.

Normally, the dentist can stop this behavior by nicely asking the patient to cool it. It takes a little finesse and humor but the offender typically backs down once it has been pointed out that he is out of line.

On one occasion the offender would not stop being inappropriate. We changed staff members working on the patient and finished the procedure at hand and then we dismissed the patient.

Next, we sent an official letter from the office informing the patient that he should seek further treatment elsewhere. We said that we would be happy to send his records and X-rays to his next dental office and wished him well.

We did NOT mention the reason for asking the patient to change dental offices. We figured that the patient knew and there was no reason to inflame the situation further. We just wanted the patient never to return to our offices while leaving the least amount of collateral damage. The patient never inquired as to why we asked him to leave.

If you are wondering why we finished the dental treatment and just did not kick the patient out of the office at the time of the offense – there are several reasons. (1) We did not want to escalate the situation by accusing the patient of sexual harassment. He might have started to argue or become a larger problem in the office. (2) We did not want to be left with a patient abandonment problem – a legal problem.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Should I Buy It?

I love new gadgets! I want to have all the newest and coolest dental equipment. I am guessing that you do as well.

The real question we need to ask ourselves is what are the costs and the benefits of upgrading equipment. A new x-ray unit or imaging system might have new features but does it justify an expenditure of $30,000 when the older unit you are currently using works fine and is paid for? The answer is usually NO!

You should have great equipment that allows you to make a quality diagnosis and treatment plan for your patients. You should have equipment that allows you to deliver quality dental care. After that level a lot of what we buy is just for our ego and for fun.

If your profitability is 20% and the new piece of equipment costs $30,000 then you will eat the profit on the next $150,000 in production you just generated - and the cost is more if you are financing the equipment.

I just has a friend upgrade his sterilization systems for a cost of over $10,000. He said he will no loner need to buy test strips. The test strips cost les than $40 a month. The old system worked fine and was reliable. He will now have equally clean instruments for more money.

I may sound a lot like Suzy Orman but most times upgrading equipment is not the smart business move.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Inappropriate Staff Dressing?

I received an email from a male dentist who was unsure of how to handle the situation of a young, attractive dental assistant who was dressing inappropriately.

The first thing I asked him was to be more specific as to what he meant by inappropriate dress. He said she was well endowed and would wear revealing clothe that showed too much top and shorts that did not cover enough bottom. He said that her attire would work in a night club or on the beach but was not what he wanted for his office. He was worried that by talking to her that he might offend her or get a harassment law suit. Additionally – the rest of his staff was not happy with her appearance either!

I told him that he could choose to create a dress code that demanded that the entire staff (or just clinical staff) wear scrubs while they work. If he did this he would have to either provide the scrubs or uniforms for the staff or give them a uniform cash allowance.

Another option was to create an office dress code that allowed more freedom of choice but set limits as to sleeve length, cleavage exposed, stomach exposed, pant or skirt length, etc… This method would require more staff buy in but would also work. The dentist might have to give the staff a clothing allowance because staff would be ruining their own clothe during work. I personally opted for having scrubs and providing them for my staff. I let the staff pick out the outfits and we all loved them. They often picked really funny colors or patterns.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

When Business and Personal Goals Conflict

Did you just go through a period of personal reflection that included setting new goals for your practice? It is very common for people at this time of year to try to determine what would make them happy and also accomplish their financial goals as well.

It is very common that people find themselves at odds when their personal goals and business goals are conflicting. Most people set goals to be better husbands/wives, to be more involved parents, to become healthier, to get in shape, to be more involved in the church and community – these worthwhile goals require additional time – LOTS of additional time. To accomplish the new business goals also take the allocation of additional time – this is where the conflict arises.

It most cases it is not possible for us to simply fix all our problems with allocating more hours – because we don’t have endless hours to allocate. We have to make carful, thought out decisions of where to spend our hours.

While I love building big and productive offices, I also believe in building healthy families and healthy people. I cannot imagine too many scenarios where a more profitable practice is a better goal than being a more involved parent. Be careful what you choose as your metrics for success – don’t let money be your only or most important measuring stick.

Dr. Corey Gold
President – Advanced Continuing Education Systems
www.aces4ce.com

Who Makes Financial Arrangements with the Patient and Who DOES NOT!

In a typical, well-run dental office treatment planning is the responsibility of the dentist and the financial arrangements are made by the front office staff members. It is vital that these two areas stay separate and neither side encroaches on the others area of authority.

As a dentist, I would not be happy if my front office staff changed my treatment plan for the patient – in fact – I would be mad. If a patient had financial challenges and could not arrange for the treatment we had agreed upon, then I needed to be brought back in to re-explain the treatment plan or plan an alternative approach that solved the patient’s issues. The treatment plan is not to be set by the front office staff – that was not their area of expertise or responsibility.

Likewise, the dentist should never be involved in setting fees, insurance, payment plans or other financial issues that are the front office staff’s area of responsibility. The dentist should be the passionate dental professional and not involved in the money matters (from the patient’s perspective). The staff are the people who know the insurance and understand the office’s financial policies. It is their job to set the plan and then execute it. They talk money and payments – you the dentist do not.

It the patients believe that they can go around the front office staff to change the financial arrangements with the dentist then you have taken all the power and authority away from the people tasked to collect the money. The staff cannot set plans or collect moneys effectively if the patients know they can ignore them and go straight to you – the dentist.

Your staff will resent you usurping their responsibility and complicating their job. Your daily life will be harder as the dentist/CEO if the patients are asking you to make financial arrangements and are asking you for special considerations.

Do yourself a favor and just say “NO”. Tell the patients that you are awful at all the financial stuff and would most likely just screw it all up. Tell them you are the wizard of the oral cavity but that your staff is people who know the insurance and other financial stuff. Tell them the staff can help you the right way and that you don’t even know how to turn the computer on. Kid around and point them back to the front office staff.

Dr. Corey Gold

President – Advanced Continuing Education Systems
www.aces4ce.com

Who is in Charge of YOUR Practice?

The dentist as a CEO is a strange arrangement. As dentist you are often the boss and co-worker at the same time. This places many dentists in the role of wanting to be a liked co-worker more than wanting to be an effective CEO.

If the dentist CEO worries too much about being liked by the staff then they cannot effectively run the office as they truly wish. They are always afraid of making changes that the staff won’t like and are worried about losing their popularity with the team. They are also worried about the staff making their day more difficult or giving them the cold-shoulder treatment.

I am NOT suggesting that the dentist CEO act as an authoritarian and not take into account the effects of change on the staff members but I am saying that ultimately the dentist CEO must make business decisions that let them reach their business goals. As the dentist CEO, you are responsible for setting the business strategy for your business.

Most dentist CEOs are sole practitioners, they have spent considerable time and money to go to school, purchase and build a practice. The success of this practice directly influences the financial future of their family. Being a wise CEO and looking at the long term success of the dental business is absolutely necessary.

Although it may be difficult, as dentist CEO you must be willing to make strategic business decisions that you know are good for the long term health of your business, even if they are not popular. Your dental staff depends upon your business to be successful for their employment, they will either get on board your decisions or in unusual cases – they will have to leave your practice.

Being CEO is a big responsibility. A lot of people depend upon your decisions – your family, staff, and others. You cannot delegate the success of your practice to staff. You should ask for input, access the pros and cons of change and then decide how best to proceed for the long term success of your business. Don’t be afraid to build the practice you desire – be bold – chase your vision – make your dental office one you are truly proud of. Charge!

Dr. Corey Gold
President – Advance Continuing Education Systems
www.aces4ce.com

Get Excited!

As the leader of your office, you set the tone. If you are not excited about your mission and goals, why should anyone else be. If you are fired up and excited abut making each day and case great then your staff will follow your lead.

Come in with energy and passion each day. Ask your staff to be their best. Try to do your best work each patient.

I see so many offices that appear to be zombie land. Everyone is just going through the motions. Ground Hog Day offices that aren't passionate about their work.

I would want to be treated by a doctor and staff that are highly motivated to do their best work. I would refer patients to an office that I thought was devoted to their craft.

Patients are more likely to accept your treatment plan when they believe you are really giving it your best.

You owe it to yourself, staff and patients to lead with your enthusiasm, energy and passion.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Make More $ with Cash Up Front Discounts

One of the best income and cash-flow generators for your practice is offering a discount for patients who pay for their entire treatment plan before the first session. The discount needs to be strong enough for patients to want to pay for the full treatment in advance. In my practice this was a 10% discount for complete prepayment.

There are several great reasons why accepting less upfront actually earns you more money and a smoother practice operation.

1                 Having the patient pay upfront ensures that you will be paid on all your treatment and greatly reduces your aging receivables. Your discount ensures that the patient waits for the insurance company to pay their share not you. It also means that you are always collecting your co-payments.

2                 Dentistry can appear expensive and everyone likes a discount. A reasonable discount percentage encourages people to seek the proper care and opt for the more complete treatment plan.

3                 Scheduling is a synch when most of your patients are fully paid in advance of their appointments. The patient simply calls and sets their times on your calendar. There are no more sticky phone calls between the staff and the patient before the appointment can be set up due to money issues. 

4                 You save considerable staff time and mental aggravation chasing past due accounts. Some dentist’s do not realize how much staff time it takes to collect money from people on payment plans. Not only does this staff time cost you money but it also means your staff is not working on other projects such as customer service, retention and other vital aspects of your practice.

I strongly suggest you consider giving cash up front discount for patients who pay in full for their entire treatment plan before the first visit. It is good business for you and represents a value to your patients.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

What Hours to be Open?

Every dentist has to make many decisions in how best to operate their business. One of the first and most important decisions is what days and hours to be open.

The hard question to answer is should I be open at the hours that my patients have most availability (early mornings, evenings, weekends) or should I be open during hours that best fit my preferred hours.

A lot of patients will go to your website and see your available hours. They often won't even call your office if the hours listed don't match their schedule. Offices with limited schedules are missing out on a lot of business they don't even realize.

With everyone online today, many patients will surf the net for dental offices in their areas that's best fit their needs - days open, hours open, insurances accepted, servos offered. Your office is not their only option. You are in competition for patient business with a lot of other quality dentist who may be making their offices more accessible to potential patients.

Consider your patient's needs when setting your days and hours of operation. What seem to be small decisions are really huge decisions!

Dr. Corey Gold President
Advanced Continuing Education Systems
www.aces4ce.com

What do vacations really cost?

Everyone loves vacations but what is the true cost of your vacation?

Well, first their is the cost of your actual vacation - the travel, hotel, food, etc. but then there is the hidden cost that is actually a LOT more expensive. You have to factor in the cost of your office for your week(s) off. You have a ton of overhead during your time off and no revenue coming in to offset your costs.

This means that every day you are closed has to be supported with revenue generated during your time on. The more weeks off, the more money you must generate during e weeks in to cover your down time.

Staff members rarely understand the true cost of your closing the office and giving them a paid vacation. They take it for granted that paid vacations are just part of the perks of working.

I find it helps to let your staff understand the true cost of their weeks off. Having a staff meeting to help them understand that the rent needs to be paid, insurances, salaries, utilities, phones, loan payments, borrowing costs, etc. They should understand that their free time is not free.

Bringing the staff into the overhead discussion often makes them appreciate the vacation time you give them. It often gives them incentive to find ways to increase revenue so that they can justify more vacation time.

A profitable business can afford to do MORE for their staff members - higher pay, more vacations, better benefits, new equipment, etc. Bring your staff into the conversation.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Teach an Old Dog a New Trick or Two

Are you still treatment planning like your first year in practice? I hope not if you have been in the profession for a while. Learning does not end with our graduation from dental school. Great dentists continue to expand their skills.

Keeping excited about your office and work can be a lot easier if you are still a student of the art of dentistry.

The profession is expanding at an amazing pace. Keeping up with the new alternatives and treatments takes time but is worth the extra effort.

Learning for the sake of expanding your skills is exciting!

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Keep Politics OUT of your Office!

Keep Politics OUT of your Office!

The best advice I can give you on talking about politics in your office is DON’T!

This rule applies to all the members of the dental office including the dentist (owner).

You will often offend individuals who have different political leanings and make them feel uncomfortable in your office. Uncomfortable people = ex-customers.

You will often offend other staff members who disagree with your opinions. Many times, the offended staff member will not mention to you they are uncomfortable with your voicing your political beliefs and will just quietly be agitated at you. This agitation will lead to disharmony in the office and often acts of passive aggressive behaviors.

Even when you think the patient or the staff member you are speaking to agree with your political beliefs, your conversation may be overheard by others who are near you.

The bottom line is that making customers and staff feel uncomfortable is a bad idea. Have strong political opinions but keep them OUT of the office!

Dr. Corey Gold
President – Advanced Continuing Education Systems
www.aces4ce.com

Private Practice vs Group Practice

There was a time when all physicians were private practitioners, today most doctors work in groups to be cost effective. Is this same phenomenon headed towards dentistry?

Today you see more and more dental groups. Often these groups contain a few general practitioners working as a collective. More recently you start to see dental groups that include a few specialists with many general dentists.

The trend is that there are and will be fewer single dental offices and there will be more groups and mega-groups in the future. The economics of dentistry is driving this model at warp speed.

Why would a single dentist want to rent 2,000 square feet and put in 5 dental chairs when a team of five dentist can use 3,000 square feet and 10 chairs. By grouping the dentist in the group is only paying for 600 square feet and 2 chairs - but has access to everything.

Why would a single dentist want to hire 4 staff members when a group can function with 10 staff members - thus paying for only 2 staff members?

Why would the Brits want to have live phone hours 40 hours a week when the group phone will be manned 70 hours a week?

With the complexities of insurance continually increasing, the group can afford to hire a t quality person to handle this area.

Dental groups is the direction that delivery of dentistry is heading. It is not a better direction or a worse direction - it is just the more economically feasible system.

Sad but the day of the sole practitioner is going the way of dial up Internet and fax machines - they will still be around and work but you will see less of them each year.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

The Walls Have Ears

Every staff member needs to be aware that patients can most often hear what staff members are saying in other parts of the office.

Private conversations between staff or staff and patients can be overheard by people throughout the office.

Now that everyone has cell phones, private conversations are also heard by patients as well.

Your patients need to see the office as being professional and trustworthy. Make sure your staff fully understands that what they see is heard by others. That their behavior is being judged all the time.

I had my staff members sit in the operatories when I made a phone call from the break room and they all heard the call. My staff now goes out back if the have to make a call that they would not want being overheard by others.

Just be aware, the walls have ears.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Should I Buy It?

I love new gadgets! I want to have all the newest and coolest dental equipment. I am guessing that you do as well.

The real question we need to ask ourselves is what are the costs and the benefits of upgrading equipment. A new x-ray unit or imaging system might have new features but does it justify an expenditure of $30,000 when the older unit you are currently using works fine and is paid for? The answer is usually NO!

You should have great equipment that allows you to make a quality diagnosis and treatment plan for your patients. You should have equipment that allows you to deliver quality dental care. After that level a lot of what we buy is just for our ego and for fun.

If your profitability is 20% and the new piece of equipment costs $30,000 then you will eat the profit on the next $150,000 in production you just generated - and the cost is more if you are financing the equipment.

I just has a friend upgrade his sterilization systems for a cost of over $10,000. He said he will no loner need to buy test strips. The test strips cost les than $40 a month. The old system worked fine and was reliable. He will now have equally clean instruments for more money.

I may sound a lot like Suzy Orman but most times upgrading equipment is not the smart business move.

Dr. Corey Gold
President - Advanced Continuing Education Systems
www.aces4ce.com

Drug Addicted Dentists

Dentists are just like other people and they can sometimes wander down paths that lead them into dangerous addictions. No dentist ever went out and intentionally became addicted – it is always a series of unfortunate events and decisions that spiraled into an addiction. For dentists it can often start from legal use of prescription pain killers.

If you know an addicted dentist, urge them to seek help. Most dentists don’t seek help because they are afraid of losing their license, their practice and their income source. Most states have special anonymous treatment program for dentists just for this reason –the dentist can seek treatment without the loss of their license or public embarrassment.

Knowing an addicted dentist puts us in a difficult position – what do you do when a colleague you know is addicted. Your friend says they will take care of the problem but they don’t. What do you do? I was confronted with this situation and had to threaten to turn the doctor in to authorities unless they voluntarily sought treatment. Luckily for me – that dentist sought treatment and was successful in their therapy.

It is an awful position for you if you know an addicted dentist but it is very important for patient safety and for the long-term health and safety of your addicted dentist friend for you to make sure they get proper treatment. You must act! Go to your state’s dental board website and look up their addiction or diversion program. Most states have set up mechanisms for addicted professionals to safely seek the treatment they need.

Dr. Corey Gold
President - ACES
www.aces4ce.com

The Reward is Doing Quality Work

I remember being a newly minted dentist and getting excited when my work looked great or a procedure worked out just as planned. I also got satisfaction out of overcoming a challenge in the work that I had not anticipated. Heck, in the early days, I got satisfaction out of sending a cosmetic case back to the lab because it was good but not great – I wanted it to be awesome. My patients thought I was too picky – and for me that was a huge compliment.

A lot of dentists lose their “new dentist smell” and the excitement of doing quality work becomes old news. We used to get satisfaction out of the regular, routine work and now it is just Groundhog’s Day. We become stale – the honeymoon is over – the thrill is gone.

The trick to having long-term happiness and satisfaction in your practice is to try to remember why your patients come to you – they come to you because they trust you to use good judgment and deliver quality care. If we are meeting and exceeding our patient’s expectations then we should take great pride in that.

I know a lot of dentist who go build incredible new offices when things get stale and then wind up feeling stale again a few months later. The new office was like a middle age man buying a convertible – we are looking to feel young again (and yes I have a shiny convertible – lol). At the end – the only thing that can make you feel excited again about your work is going back to the mental place you were when you were young in your practice – that is to love doing dentistry and enjoy doing quality work. The joy is in the work being good.

By the way – I am not saying not to build a new office – build your new office and enjoy it, just don’t expect it to make you happy if you weren’t before you built the new office. As for convertibles – I love them J

Dr. Corey Gold

President – advanced Continuing Education Systems
www.aces4ce.com

Quit Doing Procedures You Hate

I know lots of dentist who don’t like doing endo or oral surgery but continue to do these procedures for decades. My advice to you, for your happiness and your patient’s quality of dentistry, is for you to STOP doing procedures you do not like to do.

If you dislike a procedure I doubt you are taking a lot of continuing education in that area of dentistry. I doubt you recommend that procedure as much as you should when doing treatment planning. In general we do not do our best work when we are not happy or we are resentful.

I know a dentist who still does endo and they openly tell me they are not good at it. As a patient, I would prefer that you send me to another dentist who is good at it – I deserve that referral.

My advice, you have two choices when it comes to dental procedures you do not like to do; (1) get lots of continuing education in that area and get super good at it (you tend to like what you are good at) or (2) refer all procedures you don’t like doing or feel you are not good at to a specialist.

At the end of the day you will be happier and less stressed when you refer out the procedures you truly don’t want to do.

Dr. Corey Gold

President – advanced Continuing Education Systems
www.aces4ce.com

Staff Taking Advantage of Your Friendship

Being a dentist can be tough when it comes to staff relationships and I will admit that I have been exceptionally lucky over my career. On one hand you are the owner of the practice (or the boss) and on the other hand, you are a co-worker and an active part of the daily work flow.

Most dentist become very close friends with their staff. Luckily, most staff members treat the dentist as both a friend and still respect them as the boss at the same time. This fine line between the dentist being a friend and the boss can sometimes get strained.

The dentist is put into an awkward position of having to enforce his authority as the boss if the staff member tries to abuse the friendship relationship. I know a number of cases where experienced, long-term staff members have turned from respectful staff to taking advantage of their friendship with the dentist. The staff member starts to come in late, leaves early, takes longer breaks, doesn’t pull their fair share of the work load – in essence, the staff member starts leveraging their friendship with the dentist to take advantage of the long standing rules. The dentist typically responds by very low key requests for the staff member to go back to the correct behaviors. In some cases this is enough to redirect the pattern but in many cases it is not enough.

When friendly requests for the staff member to get back in line with their job requirements fail it is a tough moment in the friendship for the dentist and the staff. The dentist must now put on their ‘boss’ hat and have a serious talk with the offending staff member. This is a challenging conversation because the two have not needed this type of chat for a long time. The dentist must say how much he likes and values the staff member but that the individual must get back into the required office norms. You must say that this is a tough conversation for you to have but that you feel it is a talk that had to be had and that you expect a change in behavior.

Often this talk ends with an apology and a change in behavior – the staff member might even feel bad about taking advantage of the relationship once it has been pointed out. Other times the staff member is not at open to the coaching session and we learn during this conversation that the individual has many other issues they want to address with you and that these behaviors have been a sort of passive aggressive conduct. If the staff member’s complaints are legitimate – then it is an opportunity for you both to take corrective actions.

At the end of the day, you need to have your staff members follow the established rules of the office. In most cases the staff member will go back to their regular and positive working format. In the odd chance that the staff member continues to act against the rules of the practice it might be time for you to let that staff member go. Their acting up even after a conversation about the poor behavior might be their way of forcing your hand in ending the employment.

Sorry – no one ever said being the dentist / boss was going to be easy.

Dr. Corey Gold

President – advanced Continuing Education Systems
www.aces4ce.com