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HOW SHOULD WE BE PAID IN A MULTI-DOCTOR OFFICE?

    (YOU ARE GOING TO WANT TO READ THIS EVEN IF YOU ARE SOLO. WHAT FOLLOWS HOLDS THE SECRET TO SUCCESS FOR ANY DOCTOR IN ANY SIZE OFFICE.)

Got an email today from a doctor in a three-doctor office.

“I’m in a group practice (3 docs – 2 partners and 1 associate).  We have an “eat what you kill” arrangement that has generally worked well over the years but we have been discussing modifying that recently and I was wondering if you might have input or access to compensation models other than our current one that practices use successfully that you could share?”

This is a common problem that seems to pop up after a few years of partnership with any type of pay strategy. It’s not this strategy that causes problems, it is any strategy utilized to the point where one doctor feels that the grass looks greener on the other side of the fence. I have not spoken with the doctor that emailed me, but I am willing to bet that this situation is no different from a two-doctor office where one doctor out produces the other. While I hear various reasons for wanting to change a pay strategy, they all seem to begin with an inequity in production resulting in un-equal division of profits. While human nature, I only see this problem arise when one doctor is either more productive or wants to work more and the other isn’t or doesn’t. Bottom line is that one doctor takes home more than the other and the lesser of the two feels like something is not fair.

Before I get into the causes of this common predicament, I will say that in one form or another, it is never fair to divide the profits equally regardless of how much each doctor produces. That is called socialism, and there are many fatal flaws using that as a business strategy. I am more in favor of the “you eat what you kill and clean” approach. Regardless of how you color this strategy, it is still the fairest distribution of profits. It rewards the worker who is efficient, who takes care of their patients, and provides a service or product the public wants. Certainly, there are a variety of ways to structure this, but overall it is the best way to insure a productive office and outstanding service from doctor and staff.

Generally, the pay inequity feelings begin when one doctor seems to get more new patients than the others and this subsequently results in more referrals and repeat business for that doctor. Bottom line here is that any patient that calls or comes in should be afforded the privilege of choosing any doctor in the office. NOTE: Trying to equally split the new patients regardless of their wishes is a fundamental break in logic and consumerism. Patients get to decide where and with whom they purchase products and services from. It will never work to just take and give one new patient to each doctor so that they are distributed equally among the office. Doctors that fail to embrace their responsibility to inspire patients to refer and come back don’t deserve to be given patients. It will ultimately reflect on the reviews that the practice receives and the high level of patient satisfaction that you seek to provide and be known for.

We will assume that there are differences in the doctors and staff that service patients and that most of the patients come to the office requesting a particular doctor, service, or scheduled appointment time. Here are the reasons one doctor will always outperform another in a partnership, and the “trait” that you need to develop to do each one well.

  1. One doctor will have better reviews: Certainly, this will be the result of satisfaction by previous patients. Nothing says you are great better than a lot of 5-star reviews. If you get them, then you deserve the patients who flock to see you. Trait: Consumerism (giving the patients what they want, when they want it, at a price they can afford).
  2. Patients like a particular doctor more than another: In a way, that is why they left their previous dentist and came to your office. Isn’t it logical that they would also have a preference of one doctor over another in a multi-doctor office? Trait: People skills.
  3. The staff like one doctor more than the other(s): Respect, clinical excellence, bedside manner; you name it. Staff members are just like patients. They will gravitate to the best doctor in the office. Like it or not, they will also steer uncommitted new patients to their choice of the better doctor. If you are a doctor in a multi-doctor office, you have to understand the inner workings of the social order in your office culture. How staff view you is as important, if not more so, than what patients think of you. Trait: Leadership and social skills.
  4. Doctors with great communications skills will always win out: Regardless of where you are, life will reward those who communicate best with those around them. Once again, this applies to your staff as well as with your patients. Trait: Making sure that staff and patients hear what you thought you said. Don’t overwhelm them. Speak to them using non-clinical terms that are easily understood.
  5. Those doctors who listen well tend to be the favorite of staff and patients: The longer we work in this small consumer driven business, the more I see doctors turn their back on actively listening to patients and staff. Everyone can tell if you care, and caring comes with actively listening and responding appropriately to the needs of your patients and staff. It is not enough to just have good clinical skills. People skills encompass communication and listening. Trait: Co-diagnosing while involving the patient in case acceptance.
  6. Doctors who get more new patients might be working more hours: More hours mean more chances at interfacing with more patients. Trait: Horsepower. You have the energy and drive to do whatever it takes.
  7. Doctors getting more new patients might be working better hours: If you are the doctor that works 7AM-9AM, 3PM-6PM, and Saturdays, you will end up with the most new patients because these are “peak demand times” (the hours when patients want to come in and be seen). Trait: Consumerism.
  8. Staff match-up: You will always find that if you could check the 1-7 boxes from the above, you will be the doctor that great staff will want to work with. When great staff members gravitate towards one doctor, so will the patients. Staff will steer them toward the doctor that they know will provide the best result and most satisfaction for the patient. Trait: While not really a single trait, this staff match-up is the result of many traits. Communication, leadership, people skills, listening, etc.
  9. Clinical skills: Yes, I did intend to list this one last. It is the last in importance to becoming the doctor you always thought you would be. While not surprising, if you could check 1-8 above, you also tend to be a very competent clinician. It tends to go hand in hand. On the other side of the coin, I see great clinicians (they place this trait as number one or the only number) that struggle to attract any patients or secure good long-term staff because they lack all of the traits that actually represent are how you are judged by your staff and clients. Anti-Trait: You have a great self-image for no apparent reason. You are a legend in your own mind but a failure in every other sense of the word. Generally, these doctors are in denial and fail to see the simplest truth: You are judged and rewarded for your leadership, communications skills, culture you create, ability to listen, horsepower, work ethic, people skills and understanding of consumerism. Great dentistry is relegated to the most basic entry-level trait of having a practice that others would want to go to.

 
The saving grace is that all of these traits except people skills can be learned. If you are like me, and struggle with people skills, all you have to do is hire people that compensate for where you fall short while complementing what you do well. This is the formula for success in a Super General Dental Practice. Being the one that can check all the boxes means that your practice will be the one everyone will flock to. This is how you Summit.
 
Michael Abernathy, DDS
[email protected]
972.523.4660 cell
 
PS. The revised second edition of The Super General Dental Practice is available for download here at no charge (PDF format). Twice the information to actually build the practice you always thought you would have. You don’t want to miss out on your best year ever by not picking up this book. If you prefer a “real” book, click here to order.