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Weekly TidbitsSign Up for FREE Weekly Tidbits Weekly (or almost weekly), for more than twelve years, L. Hurston Anderson, PhD, has been sending practice management morsels (tidbits) to dentists and other dental professionals via internet. Starting with just a handful of readers, current readership is in excess of 41,000 dentists from 18 countries on 6 continents. This makes the Weekly Tidbits the most widely read dental practice management essays in the world. In this section is found many of the hundreds of essays written during this time. Below are individual titles. Click on your choice and read that essay. Use your back button to return. My father was a school teacher, and my mother was a homemaker. When I was still a rather young lad I realized that there were other children whose parents had more money than mine…and, there were those with less. It hardly mattered in our small town, but those on “Snob” Hill did find some things a bit easier, I guess. Still, until I became a bit older and realized that everything I needed/wanted seemed to have a price tag, I didn’t really pay much attention. Then, at age 12 I got my first job working for a neighbor, Farmer Bassett, mowing fields, chopping corn, and other assorted farm duties. I remember he told me that he would pay me six bits an hour, and I had no idea how much that was. Well, that was about 30 dollars extra a month for only working 10 hours or so each week, and I liked him and his farm. I probably would have worked for less…maybe free. So, it was a great situation, and I had a little extra money to buy soft drinks and save for a car and college (not my idea, as I recall). They flooded Mr. Bassett’s farm when they created Lake Ray Hubbard outside Dallas while I was in High School, but I had moved on by then to pumping gas (about 23.9 cents a gallon then) and checking oil at the County Line Service Station where the pay was a bit better and I could get a 10% discount on gas for the 292 V8 gas-guzzler in my 1955 Ford Victoria. I had come to realize that while my family had given me wonderful gifts, money would have to come from my own earnings, and I began to like having the things money could buy. A brief venture into college football proved that my future was not in professional athletics, so I concentrated on my education. I worked throughout college where I met some incredible entrepreneurs like Ross Perot, spent time in the service, and later moved up rather swiftly into upper management including a time on Wall Street. Sadly, I got overawed by the hypnotic attraction of money, and I earned a great deal and lost a great deal…in relationships as well as money. There is a point to this little stroll down memory lane, I promise. First, I learned that there are many, many things more important than money. That, however, is a subject for another time. And, no matter how much we want to do things simply for altruistic reasons, the mortgages must be paid, food must be purchased, colleges expect their tuition, and almost everything else has some sort of price tag. We must deal with money effectively regardless of our not wanting to be controlled by it. Tragically, in my almost 20 years in the dental industry, I have observed that this is one of the biggest problems for many dentists. Dentists make a lot of money, relatively, but they also waste a lot of money.
Dentists and Money
Some dentists have a knack for such things, so this is not meant for them. Honestly though, that is not really a large number. Others pay someone else to manage their money, and I would quarrel only that it is not that difficult to do adequate bookkeeping, and some of the prices I have seen for such things are almost criminal. Though, even with these atrocious charges, I guess it is better than not understanding…and not properly handling money. For the vast majority of dentists, money is managed poorly by themselves, a spouse, or an employee. So much is improperly spent and wasted, that dentists as a group could provide free basic dentistry throughout Latin America (or some other worthy pursuit), if they more effectively handled the money they earn. (That is my estimate by doing some quick arithmetic, so it is subject to discussion; though the point is still valid.) Dentists, even those not in the top tier, earn in the upper 2% of people in the world, and many are in the top ½ %. Yet, their financial management skills are rudimentary, at best. There are reasons for this, some rather valid. First, dentistry is not about money for most dentists. Most dentists are caregivers first and foremost. Pre-dental courses are almost always science-oriented rather than business-oriented. Few dentists enter dental school with a degree in business, and dental schools have a full four years of clinical education to cover. Credit is extremely easy to get for a young dentist, so he/she can get too deep really quickly. They can borrow much more than they should. Then, those who own their own practices discover that practice ownership carries with it another enormous financial management burden. It costs a great deal to begin and operate a dental practice providing the type of dental care that dentists have learned in school. Unless there is some financial management skill introduced early in life, it must be learned along the way by dentists. Yet, along the way there is a great need for continued clinical education. And, even the training of childhood cannot really prepare anyone for being a business owner. Is there any wonder that so many dentists are not good money managers? Dentists have problems in two areas with money. They have trouble with their personal income and they have problems with their practice income. Solutions from accounting and bookkeeping firms are oriented toward one or the other, and the companies which work with both as a unit are exceedingly expensive. Yet, this stuff is not rocket science, if a few simple steps are taken. I am going to try to clear up some of the mystery with this short message, but I will run long, so I will have to ask the reader to click into our website for the final portion. Click this paragraph to be taken there automatically. Don’t worry, I am not trying to sell something, I just want to finish the entire subject. Thanks. Financial Status Evaluation. Actually, you cannot decide how to get where you want to go unless you really know where you really are. Suppose I want to drive my car from our office in Tampa to our office in Minneapolis (bad idea, but bear with me). I wouldn’t have a chance of picking the right roads, planning the trip, calculating the cost, or estimating an arrival time if I simply said I am leaving from Florida. But, by starting with my address from here in Tampa, I can precisely choose the right roads, etc. Now, I don’t actually have to have the final destination until I get a bit closer, but I do have to know where I am beginning. Admittedly, it is a bit harder to collect all the information to know where you are financially, but for proper planning it must be done, and there are easy ways to do that. I know it is a bit scary, like looking in a teenage son’s closet, but ignoring where you really are financially is a recipe for disaster. It is particularly important to prepare for downturns in the economy. Realistic Budgeting. This idea is so odious to so many people that the word budget itself is almost a curse word. Well, if anyone is still with me, let me explain why the idea of budgeting should not send shivers down your spine. Too often a budget is used as a weapon to restrict spending with violations leading to arguments, stress, and massive guilt. After 20 years working directly on a day-to-day basis with dentists I can attest that dentists and their spouses almost universally dislike (and delay or avoid completely) the process. Most of us do not want to face how much money we spend on a monthly basis because it exposes our waste, errors in judgment, and weaknesses. Forget all that. It is your money, and you struggled through eight years of school, accumulated student loan debt (usually), acquired even more debt to begin the practice, and have overhead that is a constant monthly pressure. Budgeting is not about controlling realistic spending. Dentists earn a great deal normally, so they are not supposed to live like a college student or someone who has less education and reduced expectations. A budget should be crafted with reality and an understanding of human nature, so that it does not lead to marital conflicts, or a suppression of the good things in life. It is true that a dentist is not likely to own a personal jet or a villa on the Riviera. However, with earnings in the top 2%, at least, a nice home, regular vacations, club memberships, etc. are definitely allowable while still saving for the future. A budget is not a restrictive covenant, if it is realistically prepared and regularly updated for changing conditions. It should be a document of comfort…not stress. Continuous Tracking. Okay, let’s go back to my trip from Tampa to Minneapolis. I have planned the trip, but I still have to watch where I am at all times to make sure I have not gotten on the wrong road. Likewise, we have to keep our bookkeeping properly and professionally recorded to be sure we are on track. In addition, the IRS (or other governmental taxing agency) will shut you down, if you do not have good records. The best way to do this is to have a close relative (like a spouse or yourself) keep the books on a software program like Quickbooks. I am a little leery of using an employee because that can lead to problems more often than not. 90% of embezzling is done by an employee who is trusted with too much knowledge of the financial situation. An attitude of entitlement seems to creep into their heads especially if they are struggling financially. It is hard to see the doctor earn hundreds of thousand a year while you earn $15 an hour. The cost of schooling, establishing the practice, monthly obligations, legal liability, etc. get conveniently forgotten when someone gets too close to the doctor’s finances. Beware of who you allow to do your bookkeeping. The bookkeeping can be sent out to a bookkeeping service. Many local ones are reasonably priced and can provide usable reports (if properly directed). This process inevitably escalates costs and often they present themselves as accountants charging accounting fees when all they really provide is simply bookkeeping services. You need an accountant to file your taxes and provide tax advice, but you do not need an accountant to enter data into Quickbooks. Still, it is a way to keep the books current. I have seldom known a dentist who is comfortable with the reports he/she receives from these services, but that can be improved, if they are properly instructed. Timely Updates. As the Scotsman Robert Burns said in “To a Mouse”, “The best laid schemes o’ mice an’ men / Gang aft a-gley”. So, no matter how well a financial plan is devised it must be altered appropriately along the way as unforeseen events occur. This means understanding the original plan, diligently and regularly watching its progress, and adjusting when circumstances dictate. Had I not done that in my lifetime with my career, I would be a very unhappy NFL wannabe, failed politician, bankrupt high tech entrepreneur, etc. We cannot always predict conditions for the future, and we cannot be sure we will have the same goals. We will change, circumstances will change, and our financial plans must change. Information For Appropriate Decisions Along The Way. This is more of a catchall to include things that happen about which we must gain in-depth knowledge so that we can make decisions about them. For instance, we may need to increase insurance coverage, purchase a beach house in order to improve our quality of life and keep the family together, increase the size of our college funds for a child who wants a PhD in 18th century Scottish poetry (never going to be able to make much money), or accelerate retirement plans due to ill health or changed priorities. We must be able to find resources for the right information and counsel for decision-making on major issues. Knowledge is power, so we need to have access to as much as possible in areas with which we may deal only once in a lifetime. We cannot be experts in all subjects, but we can know where to find the experts. That is the key.
Summary. If you inherited $10,000,000 from a great-aunt in Buffalo, or whatever, this is not a very important discussion for you. But, if you are like the rest of us, who will have to earn every penny ourselves and preserve as much as possible, you need to be realistic here. Do not ignore good financial management and planning because it is scary. There are some “experts” out there who are predatory, I admit…and I hear about them every day it seems. But, there are good, honest, helpful resources, too. Call or email, if you have questions. I have provided some links for a few items to help, but I am happy to discuss your personal situation with you. Kicking the Devil out of the American League. Okay, I am going to do it. I am going to brag on the Tampa Bay Rays. The Tampa Bay professional baseball team has been in existence for about ten years. Truthfully, I can’t remember exactly how long because they have been simply awful and forgettable…since the beginning. New teams have started and won World Series, but one thing was always consistent…the embarrassingly bad Tampa Bay Devil Rays would occupy the cellar in the AL East. This past season they decided to change from the Devil Rays to the Rays. Now, that is a small step, if ever I saw one. Oh yeah, they finally solidified a pitching staff of great promise. It is now mid-May and the best record in the American League belongs to Tampa Bay. They are leading in a division with such storied franchises as the Yankees, Red Sox, and Orioles. I know it is highly unlikely that this will last all season. Their payroll is about as much as A Rod and Jeter combined, but last night Yankees owner Steinbrenner said his team needs to be more like the Rays. There was a local cartoonist who drew a picture of hell freezing over, and I think that about sums it up. We’ll enjoy baseball until reality sets in, I guess. And, who knows…maybe? Have a great week, L. Hurston Anderson, PhD Can Good Practices Become Great? For about
fifteen years now I have been analyzing dental practices with the ultimate goal
of helping dentists to improve their businesses.
In simplistic financial terms all these hundreds of dental practices
could have been categorized as shaky (i.e., struggling to make ends meet,
doctor inadequately compensated), good (i.e., solidly performing, doctor
and staff compensated adequately), and great (outperforming 90% of
comparable practices in the area, doctor has tax and investment issues).
Sometimes, I am reprimanded for discussing success in these essays in
terms of financial performance to the apparent exclusion of other factors such
as quality of care, staff morale, contribution to the community, and personal
fulfillment. I would again state
that these things are not mutually exclusive.
All who succeed financially will only do so over a sustained period with
the acceptance of the community, a reputation for excellence in care, and a
willing and eager team. Many of our
clients had been in the shaky financial category with the need to reduce
the financial strain as quickly as possible.
Many had even used credit cards to pay our monthly fees the first few
months while the transition was taking place.
Since reducing expenses is seldom an option, an all out effort to
increase income while not increasing stress or expenses was necessary.
The intent was to move these practices to a good financial
situation. Some of our
clients are great performers already, but they are interested in making
some sort of change such as adding an associate or partner, preparing for
retirement, moving to a new location, or purchasing another practice.
The trick here is to undergo the transition without destroying the magic
that provided the greatness. Most of the
dental practices we evaluate and/or assist are already good practices
that strive to be great. For
years we have been working to assist them in this journey.
It has often been challenging, always exciting, and extremely gratifying.
Going from good to great is a rarity because it requires
changing daily protocols and approaches, and it means taking risks.
The reason there are so few great dental practices is that being good
gets in the way, and there is a rare combination of attributes that is always in
place when good practices advance to become great practices. Empirical
knowledge tells me that there are dental practices performing twice or three
times as well as others under the exact same conditions.
A perfect example (without violating confidentially) is a dental practice
in Texas that had been producing a very good $63,000 per month with a staff
consisting of one dentist, one hygienist, one assistant, one front desk
specialist, and one rover from front to back.
Within two months this practice moved to the great category
producing close to $100,000 per month consistently while increasing staff by one
hygienist and one full-time assistant. A
one-dentist practice in the mid-south that was overstaffed for its production of
about $70,000 per month grew to average close to $110,000 per month while
actually reducing staff. Why can
these dental practices make that leap to greatness while others do not?
Only recently have I found an explanation that discusses this phenomenon
in a way that I am convinced is correct. The research
and resulting book written by Jim Collins titled Good to Great is right
on. While his book is about public
corporations and my interest is dental practices, this book explains better than
anything I have ever read (or wrote, unfortunately) what factors create
greatness. I strongly advise anyone
who is interested in the subject of excellence to get a copy and read it,
probably more than once. I am
sorry, we do not sell this on our website but it is available from just about
any bookseller including Amazon, Barnes
& Noble, etc. For a few weeks
including this week, I intend to take Collins’ analysis and apply it to dental
offices. I cannot do proper
justice to his book, but I think the knowledge gained about excellence in dental
offices combined with his own structure of presentation should be worth the few
minutes it takes to read it. Each
week, I will then post that week’s essay on our website WiseDentist.com
should reference to previous week’s installment be helpful.
Comments are greatly appreciated. I think it will
take 6 to 10 weeks to complete the series, and I may skip a week or two to cover
another subject should that seem appropriate.
Very generally, Collins found that there are six characteristics that are
always present in great corporations. The
first three are present during the initial time he calls the buildup and the
other three are present during the breakthrough phase.
The six with very brief explanation are listed below. 1.) Level 5 Leadership. The leader is “a paradoxical blend of personal humility and professional will.” This does not require, and probably specifically excludes, management superstars. The leader must be a member of the team not the tsar. 2.) First Who …Then What. Despite the old adage that “People are your most important asset.” the fact is that the right people are essential. One person can spoil a team. Teams win together. 3.) Confront the Brutal Facts. You must have unwavering faith in your success while being realistic about the difficulty no matter how bad it is. Lack of conviction results in lackluster efforts. 4.) The Hedgehog Concept. To be great you must be able to be the best in the world at your core business. (This requires special discussion to adapt to dental offices, but it still applies.) 5.) A Culture of Discipline. When you have disciplined action, you do not need excessive controls. This involves well-defined internal procedures and protocols as often discussed by me. 6.)
Technology Accelerators. Great
companies think of technology differently.
They are experts in the application of carefully selected technologies.
Buying every new gadget is counter to this. I am convinced that every shaky dental practice can become a good dental practice and that every good dental practice can become a great dental practice, if the dentist is willing to think outside the box and make some changes that will require some risk. School is
starting and it is a perfect time to contact all patients for “back to
school” dental needs. Contact me
by email, if you want some ideas for
a patient newsletter. (Minimal
charge.) As I have
written often, I am a baseball fan. For
those of you outside the Americas I cannot explain our fascination with this
rather slow sport and our (at least US) lack of devotion to soccer (football).
Right now, though, players who average more than $3,000,000 each per
eight-month season are threatening to strike just before the playoffs.
Already Major League Baseball in North America has deteriorated to the
point that only about one-fourth of the teams have any legitimate chance of
winning the championship given the salaries and disparity of income per team. Professional baseball is ailing, and I fear it may receive a
fatal blow. While fans in my native
Dallas and my adopted Tampa Bay might consider a strike to be a merciful end to
an abysmal season, it would be a shame for those fans in Minnesota, Seattle, St.
Louis, Cincinnati, Houston, and Anaheim. Besides,
this could be the year that the Red Sox curse ends.
I pray that cooler heads will prevail. Have a great week, Hurston Anderson 813-963-7228 PS: Strongly consider our Practice Management Cookbook and Protocol Series of workbooks for internal organization in dental practices. There are specials for purchasing more than one book at a time. Positive
Motivation for Employees I realize this is
a subject that I discuss rather frequently, but it is also the area of dental
office ownership that causes the most stress (and distress) for the dentist.
Simply stated, most dental practices operate at less than 50% of their
potential primarily because the staff and the doctor are not a cohesive team.
They are just showing up and going through the motions.
Their hearts, their souls, their minds, their joy, and their creativity
never make it to the office. Woody
Allen is quoted as saying that 90% of success is showing up.
That does not apply in dentistry or any other profession with which I am
acquainted. Part of the problem is that we business
owners are almost schizophrenic at times in dealing with our employees. We are in an age and a society that promotes egalitarian
values, so we often try to be one of the “guys” on an even level.
That is understandable from a societal perspective, I suppose, but it is
too often overdone, and it is naïve to the extreme. There are some realities that we must face
as business owners and employers, if we want our businesses, our families, AND
our employees to prosper. He (she) who writes the check is the boss, and that
cannot be disguised or ignored no matter how uncomfortable we may be with the
idea of bosses and employees. Human
nature will complicate a relationship that is too close between bosses and
employees no matter how much both parties seek to avoid these complications.
The inescapable fact that someone is the boss and someone is the employee
does not make the person who is boss superior, or better, or more worthy.
It just gives them a different role to play on the stage of life as
described by Shakespeare. An
important key to being a good boss is being comfortable with the role. Some bosses are too overbearing and
arbitrary. Attila the Hun may have
been an effective leader of barbarian warriors, but his style will not work in a
dental office. There are
organizations that operate best when individuals need only show up and go
through the motions assigned in an acceptable way.
(In fact, a lot of dentists I know would settle for that in their
offices.) An army in combat, a
manufacturing line, and even some parts of sports teams require absolute
discipline and limited individual creativity for success.
(I realize this does not apply throughout any of the organizations cited,
but it does at the more basic levels.)
Although I believe a lot can be done with very detailed Job Descriptions,
internal protocols, and training in dental offices, there is at all positions in
dentistry also a need for creativity. Steelworkers,
the guys who walk girders and erect the skeletons for large buildings, call
their low-level managers “Pushers” (or they did 20 years ago).
That descriptive management style will not work in today’s small
business. While the relationship in
a dental office must recognize that all are not on exactly the same level, the
days of kings and subjects is passed. Just as the
relationship between boss and employee must adjust to our modern concepts of
egalitarianism, the relationship cannot be too collegial either.
If you are the dentist and your best friends are your employees, there is
the potential for concern. What
kind of real friend can say no to someone who wants more money or more time off
for good, or bad, reasons? How can
the other employees be anything other than concerned when the boss has a
particularly close friendship with a particular employee?
And then there are the too frequent extramarital relationships that exist
in dentistry. Although I would rather not, I must discuss this a bit. A dental office
contains all the elements necessary to foment romantic liaisons. Young, attractive, females who are often financially
struggling are working in uniquely close proximity to more financially
established males who sometimes become bored with their jobs and lives. Typically, women seek security while men seek proof of their
manhood. Even if neither is
particularly evil or predatory, our culture encourages promiscuity and no longer
condemns those who stray. Unfortunately,
anyone who has fallen prey to this temptation knows the downside or will soon.
The pain is usually so great as to completely negate the original
attraction. In as kind a way as I can, I want to suggest to those who may be
tempted or have already succumbed to temptation, “Rectify this immediately.
This is a practice corrupter that will cause even greater problems than you
already have.” If there is a boss
taking advantage of his position with a vulnerable employee, you have the
potential for blackmail and even legal action brought against you.
If there is a boss who is beguiled by an inveigling employee, I would ask
the employee how secure a future relationship might be with this dentist?
If you were able to take him from his family, could he be tempted by
another version of you in a few years? It
goes back to the best advice I ever received from my father.
“Don’t do things you know are stupid.
We have too many things we can’t control to deal with already.” Sorry about that sermon, but so many
innocent lives are involved, and it is an issue of some significance in
dentistry. Actually, my real
interest is discussing positive motivating factors in dental offices.
The first is where money fits as a motivator because that is the area
that gets the most attention from both management and employees. First, it is important to understand the psychology of why people act and react as they do especially as that relates to salaries and bonuses. People perform at
their absolute maximum when they are working cheerfully with their heart, not
just their body. You cannot capture
the heart and soul of an employee with an increased salary.
Salary and wages feed the body, not the heart. Most employers, especially in small businesses, think the
relationship between boss and employee is improved as salaries increase.
Salary and wages are for work already completed, and they are NEVER
responsible for improved employee productivity.
Salaries can be a de-motivator, but they are NEVER a motivator.
You cannot pay enough to gain loyalty and hard work from employees. How else can we explain professional athletes who make
millions a year and still under-perform and are disgruntled? Leadership captures the heart.
Salary only captures the physical presence. Money motivation has a place, but it can only be used for
short-term objectives. While
salaries must be competitive, to get the best from employees requires more than
money. Part of the confusion some have is confusing compensation with incentives. Compensation is paid for work
that has already been done. Incentives
are offered for future excellence. If effort has been consistently excellent
in the recent past, a bonus as compensation for that effort is appropriate so
long as it still fits in the basic overhead limits.
Certainly, if this compensation is a result of a properly outlined
bonus/incentive plan, it can encourage future excellent effort, also.
However, unless there is a clear, fair and easily understood
bonus/incentive plan already established future excellence will not be
encouraged by past compensation. While
I heartily endorse one-time rewards for extraordinary performance as fair and
farsighted, this should not be the only type of incentive plan in the office.
A good bonus/incentive plan can be effective as a motivator, but most are
so poorly conceived and explained that they actually have the opposite effect. No matter what the approach the practice
must be kept healthy financially, or everyone loses.
Part of the problem we often face with new clients is that salaries
already exceed acceptable standards while greater effort is required.
When salaries are already out of line (20% of gross production) there are
only two options available. Either
salaries must be reduced or production must be increased. Although I am going to discuss forced
personnel changes, because there are times when that is necessary, this is
almost never an option for bringing salary overhead within acceptable standards.
For reasons beyond our control there are people on this planet who are
simply just too negative, too damaged, too immature, or too lazy to be a member
of an effective team, and dentistry is a team effort.
If you have an individual who is holding the entire office back, you need
to solve that problem immediately and humanely.
While not all people were blessed with a positive upbringing and outlook
on life, they must learn to leave that at home.
There is no acceptable excuse for souring the entire office or fomenting
discontent. A negative person can
be employed so long as she/he is not in a position of leadership.
Negative leaders will spoil the entire team’s efforts.
(If the negative element is the dentist, that is a particularly difficult
situation. Often we find that the
dentist’s negativity can be resolved if the surrounding team and/or financial
circumstances are improved. Sometimes,
though the doctor needs to undertake deep personal or professional analysis.
This is very important and should not be ignored.) In most cases the best way to bring salary
overhead into an acceptable range is to raise the production to the level that
the salaries are no more than one-fifth of the gross.
In more than 9 out of 10 cases when we go into an office that is the
issue we face. Then, the great
challenge is how to effectively motivate this team to the degree that they can
raise production while salaries remain the same. A combination of techniques is used, and the approach varies
from dental office to dental office, but there is always an answer. I have reread this several times in order
to shorten it so that I can get into more specifics, but I think it is going to
have to spill over into the next essay, which I promise to complete by week’s
end. I have overstayed my welcome
this time, I fear. These few weeks since Memorial Day have
been challenging on a personal level. Thursday
after Memorial Day our eighteen-year-old graduated from High School with all
that attendant excitement and angst. There
were visitors from out of town to be picked up and delivered, graduation
parties, college issues to settle, etc. all that week. When our
twenty-one-year-old came home from college for her graduation, he reported that
he wants to transfer to a school nearer home rather than complete his fourth
year at in Texas. Although he has
valid reasons for the move, there are a lot of things that have to be done in
order to get that move completed by second summer session here.
One was getting a Florida driver’s license.
As he was driving my Lincoln to the drivers’ license office he was
rear-ended by one of our elderly citizens giving him a sore neck and me a
smashed car to be repaired. Both
will recover, but both required special attention.
When I got back from the clinic where he was checked that evening, I
discovered that we now have a new grandson (Nicholas Richard Gebhart) some two
weeks early. Everyone has gone home, the car is in the
shop for repairs, our son is back in Texas temporarily, my wife is in
Minneapolis being a helpful grandmother for the newborn (as well as his
eighteen-month-old sister and her beleaguered mother, of course), and things are
beginning to settle down a little so that I have a bit of time to think and to
jot down these few notes. As I sit
here catching my breath with dozens of unanswered emails, faxes out my ears, and
a stack of paperwork that overflows the in basket, I think, “ When will life
ever settle down?” Then, I think
how lucky I am and have always been. We
can choose how we deal with life. This
like all life’s challenges will pass and contribute to the continuing tapestry
that is a full and happy lifetime. To
quote the incomparable Jackie Gleason, “How sweet it is!” Have a great week, Hurston Anderson 813-963-7228 Memorial Day is a time to remember our war casualties,
and it coincides with high school graduation in many places as well. I grew up 20 miles east of Dallas in a small town (then
anyway) called Sunnyvale. The town
was so small that there was no high school, so we were bussed everyday to the
larger town of Forney across the Trinity River in the next county where there
was a high school. My graduating
class contained only 37 students, so obviously neither town was very large those
thirty plus years ago. Now, the
area is just part of the Dallas suburbs. Of the 37 students in our class,
17 were male. Of those 17 males, 2
died in Vietnam. Others from our
school were lost in that war in the class before and after ours. Did Billy and Fred give their lives in vain?
It seems like a lot of people believe that they did.
I do not think so. I think
they were heroes whose sacrifice has finally been proved despite the thoughtless
rhetoric of the past thirty years by individuals with questionable objectives.
There was much discussion about that war, and I will be swamped with
disagreements to my previous statement, but I want to point out one salient
fact. Ultimately, the west defeated
communism, which has been responsible for more deaths, repression, destruction,
and inhumanity than any other movement in the history of mankind.
Estimates are that Nazism killed upwards of 10,000,000 individuals.
Yet, estimates are that Stalin alone murdered 60,000,000 of his own
citizens in his maniacal paranoia.
Had America backed down some forty years ago in the face of overt
invasion by a communist country supported by both the USSR and Communist China
of a neighbor, it is possible that communism might not have ultimately failed. It was important for the totalitarians who called themselves
Communists to realize that the west was not soft, nor softheaded.
The shine is definitely off the great intellectual (sic) concept of
Socialism and the repression wrought by socialism’s political brother,
Communism. No, I believe my
classmates, my cousin from CA, and the thousands of others who died in Vietnam
are heroes who died for the ultimate freedom of hundreds of millions of people
around the world, and after some thirty years historians are begrudgingly
admitting the same thing. Forget the historians, though, ask those walking the streets
of Vilnius or Tbilisi or Kiev or Moscow, if you want to know what the collapse
of Communism has done for mankind. Of course, soldiers are dying
right now for their country and for the ideals we hold that are so odious to
those who despise freedom. Personally,
I did not have to raise my flag for this holiday weekend.
I have displayed it night and day since September 11 and will continue
until no American soldiers are under fire by the enemy.
That may be longer than my allotted time here on Earth.
I hope not. For some strange
reason patriotism has somehow been translated by some as dangerous, unfettered,
exclusionary jingoism. What a
hurtful misrepresentation that is. Luckily,
that was not the case in 1776 or 1945, or those critics would not now have the
freedom to criticize so smugly. I suggest that the Memorial Day
weekend is a special time not only for remembering but for living our lives as
fully and wholly as those who sacrificed theirs for us would have wanted us to.
We owe a great deal to those who paid the ultimate price for freedom, and
one way we can make their sacrifice more worthwhile is to try every day to make
this a better society for all. That
is why they gave their lives. This may mean pausing a few seconds before
snapping back at our children or spouse, waving another car ahead that is trying
to enter the highway (even if they are pushy), smiling at the staff in the
dental office the first thing in the morning and the last thing at night.
Give others the benefit of the doubt even if we are sometimes
disappointed. Francis Hutchinson,
the Scottish philosopher, maintained that God gave mankind the basic precepts of
knowing the right thing to do, and that we knowingly violate those when we act
selfishly, meanly, etc. Well
obviously, I am seriously condensing his life’s work, but the basic concept is
that we know how to do the right thing, if we choose to do it. Memorial Day is not only the day
we pause to remember those who died for their country, but it is the traditional
start of summer in the US. Just as
their lives gave us life celebrating their sacrifices is followed by the
liveliest time of the year. I like
that, and I think they would, too. Tuesday morning let’s all
decide to smile just a few seconds more and soften our tongues with our staffs
and coworkers. Let’s not violate
that inner voice that is telling us to do the right thing, and our businesses
will benefit enormously, not to mention our lives. I realize there is not much here
about dentistry, and I usually try to segue in some way into dentistry even on
the holidays. Unfortunately, not a
single one of my classmates became a dentist.
That would have been a great transition. However, of the 37 who graduated in my high school class four
earned PhD’s, two became MD’s, and two are CPA’s. So far as I know not a single criminal or reprehensible
individual has come from the group, although I did hear that Mike Swindell
became a trial lawyer, so we did have our blemishes. (For those with lawyers in the family, sorry about the cheap
shot, but all that advertising to create lawsuits that goes on here in Florida
leaves a bad taste in one’s mouth for the profession in general.
Their professional association really should clamp down on that stuff,
but I suspect it is much too successful). Have a great holiday weekend, Hurston Anderson Forney High School Class of 1965 (813) 963-7228 PS: Our website www.WiseDentist.com
contains many of the Weekly Tidbit essays that have been sent over the
past five plus years. In addition,
there is info about our practice management workbooks and lots of other free
stuff. There is a rather large audience for these Weekly
Tidbits. At present the count
is about 30,000 dentists and other dental professionals in eighteen countries
spread across six of our seven continents.
If anyone is forwarding his or her copy on to Antarctica, please let me
know. That would give us a clean
sweep of the continents. I have
never quite been able to reconcile my thoughts on Greenland, but we do not seem
to have a dentist there either, although there are a few in Iceland.
(Incidentally, why are there only five rings in the Olympic emblem?)
Since the vast majority of readers are the result of direct referrals, I thank
you. Amazingly, of these 30,000 at least 75% are not happy with their practices at present, or at least that is my estimate from my correspondence. To some extent that is a healthy statistic because complacency can result in lethargy and ultimately indifference. To stay current and vibrant as individuals and in our businesses we need a healthy amount of uneasiness. Standing still while the world is moving, if possible, would result in falling behind. The key is not to worry but to act, though.
One of our themes of our website is “Wise is he who thinks before
acting, then acts decisively.” The corollary to that would have to be, “Dumber than a rock
is he who needs to act and sits around worrying instead.” A dentist should receive as compensation for his/her
education, knowledge, experience, and practice-ownership risk 40%-50% of the
practice income. The % is generally
lower when the production is lower and higher when production is higher.
For instance, it would be about normal to see a practice producing
$40,000 per month return to the dentist/owner $16,000 per month ($192,000 per
year) while a practice producing $100,000 per month should return closer to
$50,000 per month to the dentist/owner per month ($600,000 per year).
Do not believe that I am exaggerating.
I see hundreds of dental office results each year. If your return is falling below 40% of practice income, it
is time to be concerned, and if your return is falling below 30% of practice
income, it is time to consider panicking. In
either case, it is definitely time to act. In the business world every successful business has a plan
of action for what it expects to do for the short-term, mid-term, and long-term
to reach its objectives. First,
though, it has to have some objectives. Some
dentists go from year to year not happy with the progress of their practices but
never putting on paper what their goals and objectives are for the practice.
Instead of “ready, aim, fire” the approach is “ready, fire,
complain”. Every dental practice should have a statement of why the
practice exists. It should next
have a list of goals and objectives termed not just financially but also
clinically and in humanitarian terms. How
does one know if one is succeeding, if the terms are not defined? After setting goals it is next important to create a plan
of action for how to get from here to there.
It is like looking at a map when you are going to take a trip and
plotting the course. Well, it is a
little harder, but it is also worth a little more time considering what is at
stake. In general, list steps to be
taken to reach the goal in measurable time periods. For instance, write down realistic expectations for the first
year, the second year, and the third year.
Longer periods of time should be included for more long-term goals like
retirement, etc., but for practice improvement and growth, for building a new
office, for hiring an associate or taking on a partner, for reducing work hours,
etc. action plans should be for no more than three years.
For a real world example, look on our website at a sample Action Plan we
actually produced for a client. (The
name was changed and numbers slightly modified to protect anonymity, but this is
a real situation.). Click
here for ACTION PLAN SAMPLE. If you don’t like it, change it, but don’t go off on
tangents. Investigate, cogitate,
and “act decisively”. I think this NBA Championship Series and the Stanley Cup
Series have some of their leagues’ best “floppers”. I am reminded of the
incredible blow that Cassius Clay (maybe already Ali) delivered to floor the
mighty Sonny Liston some forty years ago. It
was so hard a swing that just the wind from his fist carried enough power to
knock Liston out cold. You have to
give these athletes some credit for their power too, but then, I see why so many
are moving into films and television, too. Have a great day, Hurston 813-963-7228 PS: It might
be useful for those who are not happy with their practices to have us do one of
our free evaluations to see where you are.
Click her for FREE
EVALUATION. From that you can set some realistic goals and create a solid
Action Plan, or we can help, if you like. Eliminate Cancellations in the Doctor’s Schedule, Too! As
I wrote a few days ago, this time around I want to talk about techniques for
eliminating cancellations and no-shows for the dentists’ schedules.
Generally, the theme is similar. That
is, it all begins with knowing your patients.
This is critical for so many reasons that it should speak for itself,
but, in particular you want to know their habits when it comes to honoring
appointments with your office. Also, the best internal marketing practice builder is for
everyone in the office to treat patients like friends and family.
You must know them first, of course. Here
are a few rules about scheduling patients for the doctors’ schedules, which
will effectively solve the problem. They
also can in many cases be applied to the hygiene schedule. 1.
Never schedule patients with a past history of CA/NS. (Three strikes, you’re out) 2.
Always schedule AAA (most trustworthy) type patients for Monday mornings. 3.
Always record the CA/NS in computer for future reference. 4.
Always ask for the “#1 phone number”!.
The number you can use to reach the patient between 8am and 5pm.
(Then, other numbers - cell, car, beeper, home, work, relatives, etc.) 5.
Always ask permission to call patient at work!
(Record in computer comments) 6.
Always confirm (1) week prior for 1 or more hours of scheduled time 7.
Always confirm (2) days in advance for hygiene appointments and less than 1 hour
of scheduled time 8.
Always confirm (1) week after hygiene cards are mailed 9.
Always explain when appointing the importance of 48 hours notice if they need to
cancel 10.
Always place CA / NS patients on a "Very Special Call List" for "
Our Very Busy Patients" (Ask for the best time, day, and # of days needed before
calling to appoint) 11.
Always schedule " chronically late “ patients "15 minutes"
earlier than their appointed time 12.
Always ask "New" patients to come in "15 minutes"
early to fill out their paper work
(Never schedule “New”
patients at 8am or first hour after lunch, unless paperwork is done.)
Note: Confirming
by leaving a message and general rules: 1.
Include our work
number for them to call us back to confirm the appointed time 2.
Be sure to follow
up with any left messages on schedule 3.
RULE:
No one is confirmed unless we speak to them personally 4.
Know
your patient and their past history in your practice (see #3) 5. Always have your call list nearby to call " Our Very Busy Patients" 6. Pre-plan your schedule with the entire team present each week to make certain all members are able to contribute intelligence about the patients on the schedule and to be able to treat them like friends. 7. When a patient cancels we need to know the reason!!! Always record in computer! If a cancellation letter is appropriate mail it the same day. If not make sure we have everything recorded in the computer as to why the patient canceled. Truthfully, I just pasted most of the above from our Practice Management Cookbook, Hygiene Protocol, and Scheduling Protocol. If you have one of these you can go directly there. One of the first things we do in a practice when we are asked to assist is to instill, train, and monitor this cancellation/no show protocol along with several others. One of our clients wrote me after last week’s Weekly Tidbit and offered the following. He is a rather well-known clinician and management expert from the ArkLaTex area. Besides building and managing one of the largest single dentist practices in the country, he has written and spoken extensively on these and other subjects to dental groups. Hurston There is
another major element of this continuing subject, which should be discussed at
length, but I’ll save it for next time. Most
dentists do not like to even think about pre-planning for many reasons, but I
know the results, which come from these weekly Pre-Plan Meetings, and I’ll go
into that later. Have a
great day, Hurston 813
963-7228 PS:
Many of you have the Practice Management Cookbook by now.
There is a discussion of this week’s subject in Section V, as well as
the Hygiene and Scheduling Protocols. The
methodology for establishing an efficient hygiene protocol is in the Protocol
Series workbook, Increasing Productivity in Hygiene. Cookbook is $249.95
plus 19.95 shipping/handling and each Protocol Series member is $199.95 plus
s/h. Fax 813 963-5974 with
Visa/MC#, exp. date, and address…or call above #.
For a FREE
Production Potential Analysis and Evaluation, contact me. Order
on line at our store.
Living
With Cancellations And No-Shows Is Not Necessary I am
noticing as I read the analyses we are doing free for dentists that there are
indications of high cancellations and no-shows. What a waste this is. We
work very hard with our clients to eliminate these, and we know exactly how to
be effective. Candidly, it is not
that difficult, if a protocol is followed precisely, no exceptions.
I am going to rewrite some general comments I made about this subject
several years ago. Today, I will
discuss hygiene, and in a few days I will discuss doctor’s appointments, too. This first quarter was excellent for all of the dental practices with which we are associated nationwide. Hopefully, it was for your practice as well. The first quarter is an excellent time to stop to assess your progress this New Year. Multiply your production and collections by four. That is about what you will have at the end of 2002, if you stay on the same course. That will be one thing to consider, but there are other critical areas. For instance, how bad were cancellations and no shows for hygiene, as well as the doctor, this first quarter. If they were about like last year, you are following the same procedures as last year. In many average-sized dental practices there may be 20 to 30 cancellations and/or no shows per month. The problem is that the more we take it for granted as a practice, the worse it gets. A sort of “resigned acceptance” attitude spreads throughout the entire office. Cancellations and no shows are a chronic problem in dentistry that CAN be solved. However, it does mean that we have to pay attention, and we have to be proactive. We have to be proactive in time to make the difference. First, hygiene no shows and cancellations result from inconsistent following of the hygiene protocol…or, an ineffective hygiene protocol. Pre-booking is important and effective, but it must be done properly. It starts with a good Hygiene Card (samples in our Cookbook and Hygiene Protocol) clearly stating that the patient should call the office upon receiving the card. The patient while in the chair should address the card. The Hygienist should remind the patient that they are to call upon receiving the card by pointing to that portion of the card upon handing it to the patient. The Front Desk person should highlight that sentence on the card in front of the patient, so that when the patient receives it in the mail, he/she will be reminded. Why should patients write the address on their own Hygiene Card? Because when patients see their own handwriting it is like an implied contract they make. Most people are honorable and do not break contracts. Why do we want them to call us? Two reasons. First, action by the patient will again substantiate the implied contract and make them less likely to forget. Also, it saves a lot of phone calls. Assume 1500 recare patients per year. That means about 5,000 calls, recalls, etc. to reach the patients. At even two minutes per call we can save as much as 167 hours per year. At ten dollars per hour that is $1,670. The cards are to be sent the first of the month for appointments in the last half of the month and at mid-month for patients in the first half of next month. When the patient calls we mark that call on our recare schedule. If they have not called within a week of the card’s being sent, then we must call. This is critical because this is the step that is most often missed and most often leads to cancellations and no shows in the hygiene schedule. At this juncture we have enough time to become proactive in filling the schedule from our lists of patients who are due. (Always call those with the most outstanding treatment first. Then the next, etc. Every Hygienist’s schedule should have at least three patients with treatment outstanding per day.) We still confirm patients the day before their appointment too, but we have fewer surprises. Leaving a message is not confirming. Only speaking with the patient of patient’s guardian is a confirmation. No confirmation, no appointment. Still,
there will be patients who cannot make their appointment at the last minute.
For this we have the “Special Consideration Patient List”, or “VIP
List”, or whatever you like, so long as it makes those patients feel they are
getting extra service, should they ever see it.
Never put someone you want on a list that would insult him or her, if
they heard about it. Actually, this is the list of patients who are good
patients but who are chronic cancel-ers or no show-ers.
Of course, it is essential to KNOW YOUR PATIENTS.
Just because a patient has problems making appointments does not make them a bad patient. Some times the office forgets that they are not the most important thing in the world. I personally am always on the list by choice. For years I was in a highly demanding position as the CEO of a company with worldwide offices. No matter |
