Dentistry has accepted two huge lies: The past will return, and the justification for entitlement that says: As Dentists we deserve to be successful. I was re-reading a book by David Platt called Radical: Taking Back Your Faith from the American Dream published in 2010, and couldn’t help but think about the challenges he poses for us in our current culture and demographic. It is a sobering read and one of the better books I have read in a long time.
When we think of Healthcare, and Dentistry in particular, we would be hard pressed to ever consider calling our best leaders or successful doctors anything close to “radical”. I don’t know about you, but most of the speakers, coaches, and stellar practicing doctors that I know have spent their entire careers borrowing their success from the ones that have gone before them. For the smart ones, they borrowed their strategies and business models from other consumer driven businesses that have excelled in inspiring their customers, because Dentistry stays a good ten years behind other businesses in embracing the change we all should recognize as necessary to sustain our profession. The current state of the culture in Dentistry could be summed up in a simple story about a bridge, a storm, and what the people of Honduras are doing today.
It was 1998, when Hurricane Mitch hit the city of Choluteca, Honduras. Situated on the Pan-American Highway, Choluteca was the recipient of a beautiful silver bridge from the nation of Japan to Honduras and was constructed using the most modern technology available. (The company that built it was so proud of it that its picture adorns their business brochures.) However, Mitch devastated the country of Honduras by dumping 75 inches of rain in less than four days. The results were that the river that the Choluteca Bridge was built over actually moved so that both sides of the bridge, which sustained no damage, now spanned hundreds of yards of dry ground. It soon became known as the “bridge to nowhere”.
After this devastation had taken place, some designers and engineers suggested that their next challenge was to figure out how to redirect the massive river so that it flowed back under the bridge! How stupid is that?
Many are just waiting to see if the next storm will correct the problem and put the river back where it flowed for centuries. How stupid is that?
The only strategy that has not been proffered is to extend the bridge and span the rivers new location. How smart is that?
This story has been repeated for Dentistry when we look at how dental students debt has crippled the future of young dentists, while creating an ever larger and never ending group of doctors for the rising tide of corporate practices. These corporate dental entities see solo dentistry as a dinosaur that can no longer compete. Then consider these tendencies common to most solo practices: failure to offer consumer-friendly hours, failure to offer convenient locations, failure to embrace insurance, failure to offer services patients would want at a time they would like to come in and at a price that they could afford. If you throw in insurance companies with ever decreasing reimbursements, arbitrary contract stipulations, and the unilateral ability to fire a participating doctor while changing any contractual points they choose, you have a catastrophic storm of Biblical proportions facing Dentistry and Healthcare. Too many of us consider this to be the perfect storm, and think that while bad, this too will pass. Their strategy is to wait for Dentistry or in our example, the river to go back the way it always was. This will not happen and we can see this in what is happening to physicians and what happened to the mom and pop pharmacist. This is not the perfect storm, this is climate change and we as a profession are repeating the sins of the past by not proactively making the changes we need to make in order to prosper. Fail in this endeavor and we will see the end of Dentistry as we know it in the next five to ten years.
It’s time to be Radical and relook at where we have been and where we want to go. Consider the rhetoric that sounds perfectly logical and almost honorable but is totally erroneous. I hear this every day from failing practices that continue their slide into mediocrity and financial ruin.
1. “I don’t want to be everything to every patient.” Sounds great and noble but consider that all of your potential patients want this. None of my patients ever wanted to come to me and be referred to the Pediatric, Endodontic, Prosthodontic, Orthodontic, Oral Surgery specialist. They all wanted me to do it, and we did. Is it any surprise that Orthodontists are down 47% in the last 5 years and 92% of root canals are done by the general dentist. With the advent of technology, continuing education and a challenging economy, any of us can do implants, ortho and oral surgery, and we are seeing this in overwhelming statistics that will not reverse. We are not seeing specialty services becoming more difficult to do, they are getting down right simple, consistent, and predictable for the general practitioner. Before you decide to make a stand on only doing adult Crown and Bridge, you might want to take a look outside your window and consider what the patients want. Also consider that corporate practices are giving your patients this.
2. “I refuse to do dentistry on my patients that I wouldn’t do on myself.” Are you kidding me? There seems to be a double standard in dentistry that most of us are obviously not aware of. You and your staff don’t have the kind of dentistry you want for your patients. You can’t afford the dentistry you would like to do on your patients (you are up to your belly button in debt with your credit cards maxed out and no clue as to what it will take to retire). You get upset when patients are late, but you’re never on time. Cosmetic dentistry is the product of an affluent society with a lot of discretionary income to spend, and is only needed by a particular older demographic that is either fixed or dying off. The generations following are characterized by a low decay rate and no missing or filled teeth. Knowing that 43% of all Internet searches are done for “general dentist”, 15% are done for “braces”, and the next highest is insurance at 9% should give you pause as to the viability of a “boutique style practice”. It isn’t until we look at the three areas at the very bottom of the percentage search that you will ever see anyone looking for implants, cosmetic dentistry, or sedation representing 4% of the searches but only 1% of the searchers. We are seeing the end of the stand-alone sedation, implant, and cosmetic practice because everyone advertises that they do this (Yes, every dentist should be placing implants, using sedation, and doing cosmetics, but not just that). If you are thinking you only want to do “comprehensive” dentistry, and I use this in a derisive tone, you had better come up with another strategy before it is too late. Your ability to find, attract, and keep this type of patient is diminishing every day you practice.
Sorry, I got off the track a little. It just frustrates me when I see dentists struggling in a profession where everybody should be doing incredibly well. My point is that we all need to take a Radical approach to dentistry. I will say, for the few of you that already embrace our strategy for the Super General Dental Practice, you will see this “radical” mindset to be everyday stock and trade. But for the majority of doctors who revel in their hobbies rather than being passionate about their professions, it will seem unnecessary or too difficult to even consider.
We have been focusing goal setting the past few weeks, so before you begin this “radical” transformation, you need to ask yourself three questions:
1. Where do I want to be?
2. What does that look like?
3. What do I need to do to get there?
Within these three questions are the secrets to creating radical goals.
Quick and easy and down and dirty. Here is a list of “radical” personality traits that you need in order to make your goals reality:
• Proactive: Beginning with the end in mind (that’s what you do with goals) means crafting a vision. Being the leader you need to be is sharing that vision with your staff. You need to have this written down, reviewed and revisited daily.
• Engaged: No more showing up late and leaving early, or in some cases just being there in body but not in mind or spirit. We need commitment, not just a token showing up and putting out fires. You have the right to determine how each day will turn out.
• Commitment: Similar but different from engaged. Engaged is physically being present so that you can emotionally rise to the occasion to make this important enough to make that commitment. It is being so emotionally tied to your goal that nothing is more important during those eight hours you are at work.
• Seek out guidance: Find a mentor, coach, or friend that will insure that you have a partner in your goal or vision. Someone that can help you attain a higher level of results. That’s what we do. We supply the expertise, history, and consistency to get you where you want to go without having to reinvent the wheel. We add the effectiveness to efficiency. I see too many doctors floundering in simple business problems or going 90 mph and going nowhere: The fast track to failure.
• Application: We all have closets of practice management material, volumes of DVD’s on clinical excellence, and have attended over twenty hours of continuing education a year only to squander the opportunity for advancement by not applying what we heard or read. There are magazines, web sites, and online videos that could expose us to every possible system in dentistry but we still fail to apply it. Bottom line: There is no learning without application.
Be honest. Are you really where you want to be? Is this your best effort and the best result you can produce? Is this the practice you always wanted it to be? If not, go radical and become the Super General Dental Practice.
Michael Abernathy, DDS
PS – This was first published in early March 2014. At that time, most dentists were just SURE that the economy was getting stronger and everything would soon be back “like the good old days”. Here we are today mid-way through 2017. To repeat the question above: Are you really where you want to be? (MG)