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Dental Practice Management Blueprint

Dr. Dave Robertson • May 08, 2021

Practice Management Blueprint


What is dental practice management?


I write, consult and speak on practice management. So what the heck is it anyway?


Practice management is the art and science of creating success in your dental practice.


So what then is success?


Now please do not confuse practice success with clinical success.


Most of our training and continuing ed courses are designed to improve our clinical excellence and by extension our clinical success. In other words can you do excellent dentistry that works well for the patient?


Dental practice management success begs the question that only Dr. Phil could ask: your dentistry may be working well for the patient, but how well is it working for YOU?


You might do excellent dentistry but it takes so long, that it is not profitable. Or you might do nice work but no one says yes to treatment. Or you are the best in town, but the stress of dealing with patients is killing you. Or you might do great work, are profitable, not under stress, but just aren’t enjoying dentistry. Or maybe everything works well, but you just don’t have enough patients; it doesn’t help you to do a crown in 15 minutes if you have a 2 hour opening right after it.


Even though practice management is thought of as kind of a small subset of dentistry, there are just as many issues and factors to consider as there are in achieving proficiency clinically. Just look at the program for any dental convention. Practice management instruction is generally far less than 5% of the topics to choose from. And they are just as important, and in some ways more important.


In fact some people would not even go to a practice management seminar. They look down on this type of thing. They think is less than professional, or for greedy dentists who want more money or will destroy the integrity of the profession by promoting misleading ads that steal patients from good dentists like them. And some practice management courses probably are guilty of that.


And certainly there are dentists who resort to low class ways to promote themselves and are greedy. But that is not what practice management or in particular practice management excellence is all about.


Practice management is the means by which you operate you practice. Picture a practice the opposite of the one I just described; it is of the highest integrity, well respected, high performance, great, motivated staff, high acceptance of treatment, everything working just right.


None of that happens by accident. To be the best, you need to be a good practice manager. And this involves the entire office staff. I can do excellent dentistry without a good receptionist, office manager, without a good assistant, and if I really had to without any assistant at all (although it would take a lot longer). But I cannot have an excellent successful practice on my own; everyone needs to be in on it and doing a great job.


So what are some of the issues to consider if you want to consider your practice a success?


What you like: type of dentistry; hours; people you work with; challenge;


Relationship development; this is at the core of staff retention and patient retention; if people know you care about them they are far more likely to care about you. And therefore more likely to stay. Oh, by the way, and a lot more interesting, fun and satisfying for you.


Money: the ultimate paradox of dentistry; the harder you try to make money the less you make; the more you try to do your best even if it costs you money, the more you will make. People are strongly repelled by someone out for your money. Money is more like a scorecard. It is proof whether you’re doing a good job or a bad job because money goes where it is well treated.


Stress: why does money matter at all if you are stressed, depressed, unhappy, moody, suicidal?


Ability to sell: so you are the best in town, but no one gets the treatment you can do so well because you don’t offer it, you offer it so poorly that they don’t accept it or worst of all, present it in a way that the patient feels pressured and leaves your office and has the work done by your competitor down the street at half the level of quality you are capable of.


Dental Marketing: you can’t sell to them until they are sitting in your chair


Organizational skills: more patients are lost from practices because of administrative and clerical screwups than bad dentistry or dislike of the dentist. Can we say ‘fee misunderstandings’ here??


Efficiency: Your patients love you, you can market, you can sell, you can do beautiful work. There are no financial surprises and the happy patient pays the bill in full and refers 2 others. Your staff adores you and will do anything for you. What could be wrong here? Only one thing; what if you are so slow and/or inefficient that you don’t generate any profit?


Vision: This is your typical business buzz word, but it really is important. How can you have practice success if you don’t know what your practice should look like when it is just the way you want it? How big? What type of work? How many dentists? Any partners? Associates? How much time off? How much are you netting? The analogy I like is the 2 guys trying to hack their way out of the jungle with a machete. One guy is a hard worker and hacks away 12 hours a day. The other stops every hour, climbs a tree and makes sure he is getting closer to the place he wants to get to so that all the work with the machete is not wasted. The other guy is working harder, but will not get out the jungle as soon and maybe not at all.


Team: A great team will make or break your practice. So how do you get and keep a great team? There are lots of things involved here. You need to be able to identify great talent and great people. But you also need to keep them. Some dentists are excellent judges of character and all the factors that make great staff; make great hiring decisions, but then they are not nice to them! So guess what, they leave.


Too many dentists take their clinical perfectionism and translate that into the expectations they have for their staff. And the truth is, most of us have or have had staff members that are so good that they do seem perfect so all others are judged against that standard. Well, if you have some people like that, show your appreciation! And because people are not perfect, take it easy on the ones who make mistakes. If their attitude is good, help them improve. If their attitude is bad, give them a chance to change it, and if they won’t, move on to someone else.


Most dentists have no idea how many good staff they have lost because they kept someone that had a bad attitude or weak work ethic. Good staff will cover for someone who is not pulling their weight for a while, but if nothing is done the unfairness of the situation usually causes them to leave. “Why should I bust my butt while she sits in the back making personal calls all day?”


Backbone: The last point ties directly into this one. We dentists feel that we have to be nice to succeed. Nice to patients. Nice to staff. After all who wants a dentist or a boss who is not nice? And there is nothing wrong with nice. Nice is good. But nice is not enough. It is totally inappropriate to be nice in certain situations. Is someone is damaging your practice, you need to deal with that. You need to be polite, but you also need to be firm in some situations. After all, we are paying people to do a job. They are going to expect to be paid at the end of the month, so why shouldn’t we expect them to do what we paid them to do during the month?


I’m not saying this is easy or fun. But the fun comes when you have a great team. So you sometimes need to go through the pain of discipline or termination in order to get a team that is committed and hard working and is just as focused on looking after your patients as you are. Your team needs to know that although you are nice, you also have standards that you expect them to meet. Because the whole team is watching how you deal with the weak link, slacker or ‘cancer’ in the office. What you put up with for them will be expected by everyone.


Whenever he had a difficult staff issue to deal with, a friend of mine used to say “I’m going to have to take a backbone stiffening pill to deal with this”. And he would. And his business continued to grow and prosper. He didn’t like doing it. But it comes with the territory of being in business. If you want to be nice all the time, be a dentist and work for a businessperson or get a government or teaching position.


Business mindset: This ties right in here. You might say, I am a professional and I am concerned with my patients and with quality dentistry, not dirty things like profit and money. Well that’s fine, and ties right into point number one: what do you like? If you are caring and compassionate and just want to help people, then you probably should be in a salaried position, a community clinic, or an associate. Because by owning a practice, by definition you are in business. And the purpose of any business to maximize profit. So if profit is not important to you, being in business is not going to be fun, because your competitors are interested in profit, your bank, suppliers, leasing company, landlord, lab and staff all want to be paid. And it is not good enough for them that you really helped someone this month. So either be in business and do it right, or be a dentist and focus on helping people and quality dentistry and don’t put all the pressures and liabilities onto yourself.


Do you see what I am saying here? Dentistry is not a business. Owning a dental practice is a business. Decide if you want to be a dentist or a businessperson. They are not the same and the skills required are not the same, and the definition of success is not the same. I have 10 associates. They are all dentists. They do not own a practice, did not sign a 5 year lease that obligates them to pay rent every month for 5 years whether you have the money or not, did not borrow hundreds of thousands of dollars, do not worry about marketing, payroll, systems, labor laws, cash-flow, advertising, staff evaluations, hiring, firing, etc etc. They just worry about patients, teeth and good dentistry. And there is nothing wrong with that. Most professions learn their trade and then go work for someone else. I have had associates for over 20 years.


There is nothing wrong with being a dentist. Dental practice management skills are for people who want to be a businessperson as well.


We do Dental Consulting worldwide; on the phone and in person.


If we can help, call any time; (587)-391-5883 in Canada Mountain Standard Time or email info@dentalmanagementsecrets.com


All for now.


Dr. Dave

Someone Getting Fired Should Never be Surprised

By Dr. Dave Robertson • 12 May, 2021
Have you ever terminated an employee and they were shocked? If so, the situation was not handled correctly. If someone is not up to scratch, it should have been pointed out to them earlier. You need to decide if it is an issue of a poor fit for the position, inability to do the job, a lack of training or a refusal to do it. This last one also includes the general area of bad attitude overall. Most people who are genuinely trying to do their best should be given more chances and more training or a reassignment to a new role, and this usually can solve the problem. The ones that should get fired are generally those who understand what they are doing wrong or what they are not doing that they are supposed to be doing and just don’t care. At some point before they are fired, they should have heard something along these lines: Do you want to work here? If so, you do realize that you are (not) doing this and that is unacceptable. In fact, you are so out of line that I really am justified in terminating you right now. (You probably aren’t, but they should at least get the message that this was a close call.) And finish with saying that if this happens again, that you will have no choice but to let them go. A month later when they do the same thing and you bring them in and say good-bye, they may not be happy but they should not be surprised. If they are not willing to comply, they need to go, for the sake of the entire office. As one of my mentors once said, “they make their own bed so they have to sleep in it”. Don’t feel bad terminating people like this who misbehave, disrupt the office or don’t do their job. The other staff will see what has happened and be thankful that you got rid of the problem. All for now, Dr Dave 

Are you a Mailman or a Highly Trained Up to Date Professional?

By Dr. Dave Robertson • 12 May, 2021
A Mailman, or Mailwoman for that matter, is shown how to do their work, and basically goes about their work for the next 25 years doing exactly the same thing every day. It reminds me of a dentist I know who have been practicing 30 years, but he does not have 30 years experience. He has one year of experience repeated 30 times. Kind of like a mailman. If you had cancer, who would you like to treat you? Someone 90 years old who still believes in leeches and bloodletting? Or someone who learned one way to treat cancer 30 years ago and still works that way because ‘I have had some good results with this”. Or would you want someone state of the art? Maybe they check your genes and see where the weakness is and correct that. Or create a specific protein that activates your own immune system to fight the cancer. Or use the newest methods that optimize the doses of chemo and radiation for maximum results with minimal side effects. Well, what do you think our patients are looking for? They want the best, up to date clinical methods. And most dentists are doing pretty well in this area. And guess what, there are also state of the art ways to manage your practice. And in this case, the only one you hurt by not being up to date is yourself. If you are not highly automated, with systems to save time and minimize unnecessary staff procedures you are leaving a lot of money on the table. Do yourself a favor and get as up to date on your management skills as you are with your clinical skills. All for now. Dr Dave 

​Can you guess the problem?

By Dr. Dave Robertson • 10 May, 2021
Last week I received a frantic email from a dentist asking for help. It was from a dentist who said he needed help finding a decent treatment coordinator who can do dental case presentations and also advice on what to do about high staff turnover. So I set aside time to speak to him later that week. Well, he never called. No email to cancel or re-schedule and no apology.  But that’s okay. I know what the problem is. Can you guess? This is all the information I have but I am sure that I know his problem. This is a person who either does not care about his patients and staff, or at least creates the impression that he does not care about them. It could be a great person with poor communication skills but more likely it is someone who thinks his agenda is more important than anyone else’s. (Did not call when scheduled) This is probably the reason that people don’t like to work for him. (High turnover) And patients are not accepting his treatment plans. (Needs someone else to ‘sell’ his services.) Let’s face it, the dentist’s role and work is arguably the most important in the office. But that does not mean the world revolves around the dentist. Because every job in the office is important. As dentists we need to make sure that everyone feels a part of a team, and that their role is valuable. And patients need to feel like we heard THEIR ideas of what should be done. If they don’t feel listened to, no treatment coordinator can come in later and sell them something. And no one respects someone that does not do what they say they are going to do. As the dental office leader, dentists need to be careful what they agree to or promise and to come through 100% of the time when they do make a commitment. Start to listen to your staff and patients. Be receptive to them and they will respond well to you. Did you guess correctly? It is a good sign if you did. Because lots of courses and having great technical skills will not overcome the damage to your practice that a bad attitude will do. All for now, Dr Dave

In case you missed it…….

By Dr. Dave Robertson • 10 May, 2021
Yes, Craig is making his expertise available to everyone in a convenient (view from home), affordable (only $199) and interactive (live on Zoom with questions from the audience) format. Make no mistake, dentistry is competitive. As one of my friends told me, his wife switched dentists because something happened in the office that she did not like and why stay with him when there is a dentist on every corner? One of the key mistakes dentists make that hurt their practice is focusing on doing great dentistry and not knowing how your staff is treating your patients when you are not looking. Often, they drive patients away thinking that they are doing their job and following the office “policy” instead of helping the patient get what they want. Learn how to keep every patient you get because each one is like gold.

That Sounds Ridiculous!

By Dr. Dave Robertson • 10 May, 2021
The last time I spoke at a live seminar, I was discussing how I could squeeze in a molar endo for a patient in acute distress with minimal disruption to my schedule. Of course, one of the staff members in the crowd said they would never try that as they would get too far behind, blah, blah, blah. She thought the entire concept was ridiculous. What I was explaining was how I actually did it, without getting too far behind. Yet she had already decided that this was impossible. As the old saying goes, “if someone else has done it, it might be possible”. She lost sight of the fact that her team was there to learn some new things and how to get better. They were not there to tell me how they do it. They were supposedly there to hear how I did things. Is squeezing in an endo easy? No. Is it possible? Yes. Can you do it without changes to how you currently operate? Probably not. So, is it worth it? What are some of the advantages of trying this? Perhaps $1000 or more added to your daily billings. An extremely grateful patient who becomes an ambassador for how well you looked after them and bonds to you and your practice for life. They bring their whole family and refer their friends when they are impressed. More money is available for office improvements and staff pay increases. You kept the emergency patient in your practice because if you could not help them today, they usually keep looking for someone who will and you lose the patient. All for now, Dr Dave PS For all the reasons above, if it was humanly impossible to solve their problem, I would freeze them up and then stay late and treat them. That is the next best thing. 

Wear a Button

By Dr. Dave Robertson • 10 May, 2021
Dentists have hidden behind masks for years, so that is nothing new to our profession. What is new, however, is that between procedures, or for discussing treatment options, the mask used to come off. Now, the masks stay on for most practitioners from the time they enter the office until they leave. The problem this creates is a lack of personal connection with our patients. It is much harder to connect with someone behind a face shield, mask, eye protection, surgical cap and full body gown. To patients it must look like we are cleaning up a nuclear spill. One easy way to help this situation is to wear a button on the front of your gown with your photo on it. This seems a little trivial, but it reminds your patients that there is a real person behind all that PPE. This is a low-cost tip that can help your patients relate to you. Since patient trust and bonding is the key to our success as dentists, anything that can improve that is definitely worth doing. All for now, Dr Dave 

I Was Too Busy Talking To Hear

By Dr. Dave Robertson • 10 May, 2021
Song writers Joseph Davis Kirkland, Mathew Tyer Musto & Jurek Reunamaki wrote a song titled “One Sided Love” . The first line in the song speaks to poor patient service that so many of us are guilty of “you’re too busy talking over me to hear what I’m saying”. The chorus has another applicable line “And you don’t even notice, do you?” Here is my word of advice; wait till the person speaking completely finishes their sentence, then respond to what was actually said; not what you anticipated. True but not funny I heard an example of this just now, which is why I am creating this module. We’ve just had a record-breaking snowstorm here in Chestermere where I live and work. Here is the conversation between the patient and our Treatment Coordinator (TC). TC: Wow that was some kind of snowfall last night Patient: Sure was, it has really kept me busy TC: Oh (pause) how so Patient: I have been busy digging (TC speaks over patient) TC: Yes, it’s impossible to get out of the driveways Patient: No what we do is dig out (TC speaks over patient) TC: Cars they are stuck everywhere Patient: No, we are digging out Fire hydrants TC: Oh Patient: They are hard to find too, we have to (TC speaks over patient) TC: Look on every corner or do you have a map? Patient: I was going to say use a metal detector TC: (sounding uninterested) Oh, I guess we should be booking your next appointment You can only guess how long it took to book the appointment. What should have been a few minutes was dragged out (forever). TC: When would you like to book the appointment? Patient: I prefer after (TC speaks over patient) TC: Afternoons Patient: I was thinking after 2:00 on Thurs (TC speaks over patient) TC: How would next Tuesday be? Patient: Anything on Thursday TC: You bet how about 10:00 AM Patient: Nothing around (TC speaks over patient) TC: Oh yeah you like afternoons Patient: Yes after 2 (TC speaks over patient) TC: How does 1:00 sound Patient: Sound like before 2:00 is that all you have TC: How about 2:30 Patient: Thanks Every statement the patient said after this was reduced to one word. I am guessing he felt like I did: no point. It did get interesting when they were saying goodbye. During the (long) conversation the TC mentioned that she would not be here at the booked appointment. When the conversation was coming going to an end, the TC said. Thanks, I will see you on the 22nd. The patient replied I thought you were not going to be here. Oh, I will not, the TC laughed. This patient was booking a Three-Thousand-dollar Implant. Unfortunately, this is not a made-up story, but the sad truth. This exchange caused me to listen actively listen. TC and patient exchange at the end of each appointment was more than doubled, simply by us being too busy talking to hear. I could not help but think of all the productive things we could be doing rather than doubling our exiting times. Time to train the team on listening skills!! And by the way that patient, I will call him this afternoon to confirm his appointment. In our conversation I will let him know I am listening and that we will listen. This and so much more is addressed in our Customer Excellence seminars. Join us online on February XXXX. 

You Should Plan to Live Past 100

By Dr. Dave Robertson • 10 May, 2021
We can’t predict the future, but life spans are increasing. Since the 1940’s, life expectancy has increased by almost 7 years to 84. And that’s the average. If you are healthy, you’ll blow by that. And biotechnology and medicine are exploding with new ways to keep us healthy even longer. That’s the good news. The bad news is, if you retire at 60, you are going to need money for a long time. Governments are broke and all the promises they have made about supporting everyone are going to have to collapse at some point, leaving you on your own. And dentists don’t have cushy indexed pension plans like government workers do. We are on our own. So, if you are the altruistic dentist who says I don’t care about money, I just want to help my patients, hopefully someone else is thinking that way about you if you run out. Because if you are 90 and you’re broke, you’re kind of stuck. No one is hiring you. Not even MacDonald’s. This sounds harsh, I know. But life is harsh if you can’t afford to support yourself. If your practice is not generating enough to enable you to retire comfortably for 40 years, it’s something to think about. Sorry to present a downer today, but I believe to hope for the best, but plan for the worst. All for now, Dr Dave 

Dentist or CEO Part 2

By Dr. Dave Robertson • 08 May, 2021
My last post seemed to create a bit of confusion. If you didn’t get to read “Dentist or CEO?”, you can see it here: Some people thought that I was implying that just being a great dentist is not important. Not so at all. In fact I still practice 2 days a week and during my time in the office it is extremely important to me to be the best dentist in the city. In fact, in spite of the recession, I just had my best month ever in terms of dental productivity. I only work 2 days a week now, and this month I hit $100,000 in production not including any hygiene. This bests anything I ever produced while working even full time (although that is quite a while ago). But my point is being a great, productive dentist is VERY important. My first two home study programs are devoted entirely to all the things I try to do to make patients happy, do great dentistry and be very productive. The reason I had such a great month is because I did a lot of major cases; full arch crown and bridge, etc. But the reason I did a lot of major cases this month is: A) I can do them B) I present the options available to patients very well. If you want to learn how to do these things very well to boost YOUR dental productivity, you need my Home Study Program, Dental Productivity Secrets. You can get it here; In this program you will learn all the secrets I use daily to help me become a better dentist. I also use them to help my 11 associates also become better dentists. If you can’t pay off what I charge for it in one week I’ll give you your money back. But the point I was trying to make in my CEO or Dentist blog is that dentists are ALSO CEO’s if they own a practice. Those skills are just as important, and probably more important to your take home pay. That’s why I have a totally separate program on Dental Management. I call it A Dream Practice for Dentists; The Practice of the Future, because I believe my type of practice is the practice of the future. The lessons in this one are totally different from being a great dentist; they are all about being a great owner/leader/manager/businessperson. But the dentist who is profitable, loves his/her work, has lots of time off and loves their life, invariably is good at both. How convenient that I have a discounted package deal where you can get both: Let’s face it, if you have a practice you are in the game, so why not try to win? Is someone offered you a program to improve in whatever game you like to play with a 100% refund if it didn’t work, you’d probably give it a try. That is what I am offering; 100% refund if you are not happy with the programs no questions asked. I have only had two people ever ask for a refund, and one of the two phoned me a month later looking for free advice! So take a risk, even if it is no risk and give it a try. All the best, Dr. Dave PS Today is the cutoff for the Dental Cruise at the rates I quoted. I still have one spot left. Info on the cruise is here:

Dentist or CEO?

By Dr. Dave Robertson • 08 May, 2021
Every now and then I run across an article on my computer that I have written and forgotten about. Today I stumbled across this one and I thought I would post it: Dentist or CEO? It’s time to decide. So what are you? Dentist or CEO? A dentist is someone who fixes teeth. An associate is a dentist. They come to work every day, fix teeth and go home. If you own a practice, it means that at some point you decided to stop being a dentist and become a CEO. A CEO runs a business. A CEO’s primary role is to maximize shareholder value. In other words to maximize profit, cash flow and the value of the business. A CEO’s primary activity is creating and communicating a strong vision for the business. A CEO is keenly interested in the effective marketing of the business. A CEO is always looking to leverage the strengths of the business into new markets or to do more business in the existing market. A CEO manages the culture of the business by promoting the most deeply held values and beliefs of the organization. A CEO looks at the big picture. A CEO does not micro manage. A CEO delegates to a carefully chosen team. If a court of law accused you of being a CEO would they have enough evidence to convict you? If you think your role is to be nice to patients and staff and give painless injections then you are a dentist not a CEO. That may be okay as long as a real CEO doesn’t move in next door and begin to compete. Dental practice management is not a game; it is real life with real consequences; good or bad. Improve YOUR Dental management skills here: www.dentalmanagementsecrets.com I have a couple of rooms for the dental cruise event reserved for a few more days. After that it is on an availablility only basis. You can get info here: https://dentalmanagementsecrets.com/index.php/dental-cruise All the best. Dr. Dave
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