Often times we fail to see our own shortcomings. You can’t see the forest for the trees. When you’re up to your neck in alligators, it’s hard to remember that your initial objective was to drain the swamp. We’ve all been there. Many go through life never finding a way out of the swamp of challenges and mediocre performance.
If you’re like most of us, we began with a naïve vision of what our careers and practices would look like. Time passes, shift happens, and boom, you wake up one day and realize where you are is not where you want to be. You live in the world of unintended results. You’ve tried everything, but the decisions you made early on are haunting the results you are currently getting. For ideas and solace, you turn to social media dental posts, only to find everybody else but you is kicking it (Not). You now feel worse, but wait, there is an article by some consultant that has all the answers to your problem, if you just had the money to buy your way out of this cloud of “average”. Another “Not”.
I have to admit, for the average dentist the “new dental economy” isn’t looking that bright. Many see this as a perfect storm or black swan event. The problem is that where you are right now is dental climate change. It’s never going back to the good old days. This change is fueled by more and more dental graduates (6,857 plus in 2024) all wanting to live and practice in the “it” location. Generally new graduates are attracted to awesome places to live, with terrible demographics, overpopulations of dentists to potential clients, that only seems to get worse every year. We see dental distributors who have hefty markups on equipment and supplies rob us of our profits. DSOs and large corporate practices are the bullies on the street that seem to aways have the best location, slick marketing, and unlimited number of new patents while the average dentist subsists on the leftovers. Not.
It seems that over the last 50 years, change has become a given in dentistry yet, new doctors are in demographic denial and fail to adapt or persevere. Overall, it is looking like those that deny change or decide they are done with change, are done (finished). The world is winning, and many doctors are thinking they chose the wrong career, as if something else would be easier. It won’t be.
With change comes opportunities for those who see the change and act quickly. With change comes choice. If you really think about it, you are exactly where you want to be or you would change. You would change everything to win. If you are following my train of thought, if you want more, you have to be more. The next level of practice requires another level of commitment and engagement.
In this next level of commitment, entitlement and instant gratification take a back seat to perseverance and consistent learning. You have learned that people fail to get what they want most, so they can have what they want now. The good ones understand that what gets measured gets done, so you can’t manage what you don’t measure. Seems like a pretty obvious diagnosis that needs treatment.
In my own timeline, I realized at about age 40 I could have anything I wanted. I just couldn’t have everything I wanted. I learned to choose wisely.
Let me give you an interesting analogy. Back in the day, miners learned that too many of their numbers had died because of gas and lack of oxygen in the mines. It became common place for the miners to carry a small canary in a tiny cage with them. This bird reacted much more quickly to these dangers giving the miners time to escape the toxic trap in the mines they worked. In a way, there are canaries in dentistry that would help you avoid an unintended result and poor performance. We have already talked about the “yellow card” a few articles back, but too few of us really embrace the idea of setting up benchmarks and goals that would push us up to the next level of success.
Decades ago, I wrote an article entitled Donor and Recipient Practices. The thrust of the article was that there are great practices (Recipient practices) and poor or underperforming practices (Donor practices). The Recipient practices have unlimited new patients, over 50% direct referrals, no staff turnover, 50%-60% overheads, little stress, and happy clients. They do what they do so well that people can’t help but tell everyone they know about this practice. The Donor practices struggle with no sign of improvement. They run off more patients than they can attract. Poor systems, high staff turnover, a struggle to pay their bills are all canaries in a Donor practice. The Donor practices market to get a patient in, but they don’t stay and end up going to the Recipient practice. Here are some canaries that would indicate you are a Donor practice:
- Increased cancellations and no-shows. Donor practices have a lot of no-shows and last-minute cancellations. Patients that see them will make an appointment that they know they will never keep just to get out of your practice. Good practices (Recipients) have a great rapport and culture that automatically decreases no-shows and cancellations from ever happening. Patients respect the Recipient practices enough that they would not take the chance on cancelling the appointment. They respect them so much they would not want to disappoint a Recipient practice.
- Few direct referrals. The number and especially the percentage of new patients coming from direct referrals from an existing patient is the number one KPI that indicates a healthy culture. The lack of new patient direct referrals (30% or less) is the direct result of a Donor practice. The scary part of this is that 90% of dental practices don’t track this number. They have no canary.
- Patients frequently want a second opinion or can’t afford your treatment plans. I had a patient that came in with muscle pain, TMJ soreness, limited opening, but no headaches. I asked her if she had a lot of headaches. She said no. Later, in speaking with her, I mentioned I was surprised she didn’t have a lot of headaches. Her response was no, she only had headaches once or twice a day as if that were normal. Headaches were not frequent in her mind even though normal people rarely have headaches. This is the challenge in #3. Too many dentists would say no, they don’t have frequent requests from patients for a second opinion or can’t afford their treatment plans. They do, but they actually think a couple of patients a day doing this is not “frequent”. Yikes. Their canary died two years ago, and the doctor is just now wondering why things are doing better.
- High staff turnover. Good practices tend to retain employees indefinitely. The teams are built on a strong culture, good pay, and great esprit de corps. Donor practices just don’t understand that leadership means commitment from their team that is vision built and a real partnership with every employee. In Recipient practices there is “staff ownership” where each member of the team looks at the practice as “our” practice, not just the owner doctor’s. This pride and dedication will always separate the great from the mediocre. In Donor practices there is always a different employee when patients walk in. No continuity or consistency in staffing or systems.
- Marketing Driven. You can sometimes find a high producing practice that is a Donor practice. Their direct referrals are terrible, but the new patients are very high. The trouble is they spent a very high percentage of their income on external marketing: Marketing Driven. They have to, because very few patients come back after being there one time. Eventually the word gets around and the office crashes. There is no amount of money that can maintain a Donor practice over the long haul. Their destiny is failure and mediocrity. You can’t get better at giving patients what they don’t want.
So powerful is this concept of Donor and Recipient Practices that my best referral sources in my practice after having over 50% from direct referrals are my competition. Good doctors clinically, that just don’t embrace the concept of consumerism where you try to give your customers more of what they want and less of what they don’t want. My win has seldom caused my competition to change the way they do business. As obvious as it is from an outsider or even one of their patients, the Donor practice remains in denial and destined to be just “average”.
Michael Abernathy DDS
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