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Mastering Complete Care: The Other Skills You Need to Stay Ahead of the Curve

In the early days of your dental practice, you probably equated success with satisfying a steady stream of patients whose problems you could readily fix. Back then, you worked mainly as a tooth carpenter—repairing broken teeth, bleeding gums, and caries—and you needed only a simple business model and modest leadership skills. Your greatest challenges involved attracting patients, retaining staff, and understanding business finance.

Once you reached that initial level of success, you looked for a new challenge and found it when you attended your first class in occlusion. Suddenly, you recognized the signs of dental problems in patients you had seen for years. To fulfill your new vision of mastering complete care, you piled on the heavy-duty clinical courses. You surveyed the entire masticatory system and learned how to restore mouths in centric relation. 

Now, however, after spending thousands on tuition, travel, and high-tech equipment, you realize you are seeing more rehabilitative cases in darkened classrooms than in your dental chair. You find that you are still bogged down in fix-it mode instead of enjoying the rewards that come from providing advanced clinical care. You have acquired all the technical skills you need to move forward, so why are you unable to make the leap from tooth carpentry to skilled restoration?

What you may not have learned in hundreds of hours of continuing education is a fundamental truth regarding advanced restorative dentistry: the greater the complexity of care, the greater the demand on leadership skills. It is leadership, in combination with clinical knowledge, which elevates you to the peak of complete dentistry.

What exactly do we mean by leadership? Leadership authority Stephen Covey states that “leadership is the organization of people, while management is the organization of things (i.e., systems).” But profit in a dental practice revolves around the dentist doing dentistry, not managing systems. Therefore, a dentist’s ability to organize and motivate others to accomplish objectives is fundamental to profitability. So let us specifically define leadership in dentistry as organizing and motivating people to effectively merge clinical, organizational, and relationship expertise.

The Leadership Curve offers a unique way for the restorative dentist to look at leadership. The curve illustrates how leadership requirements increase exponentially as the clinical complexity of care increases. It demonstrates how leadership is a prerequisite to practicing profitable, low-stress, advanced clinical care (see graph).
The graph shows clinical skills in gray, organizational skills in blue, and relationship skills in red. The vertical axis of The Leadership Curve shows the leadership level required, and the horizontal axis shows the clinical range—the level of care you want to provide.

Along The Leadership Curve, we have labeled the key organizational and relationship skills you need for leadership in complete clinical care. We are not implying that you should implement these skills in a rigid sequence; rather, we have arranged these in a way that makes sense for most dentists. As we move up The Leadership Curve and discuss the key skills, answer the questions at the end of each section to measure your progress in achieving leadership.


The appearance of your office should reflect the level of expertise you offer. To attract patients who seek advanced restorative care, your facility must be appealing and meticulously clean. High-tech equipment can help, but it is not mandatory—many complete-care dentists do well without the latest and greatest technology, but their surroundings still make it clear that they offer excellence at every level.

Ask yourself, “Does my facility make it immediately and overwhelmingly obvious to complex-care patients that they are in the right place?”

Fee Structure
Practicing advanced restorative dentistry with the same fee structure as “tooth” dentistry will undercut your profitability. The time and skill required increase for rehabilitative cases, as do the laboratory support needed for planning, final restoration, and the occasional remake. To be profitable, you must develop a new fee structure to reflect these realities.

Ask yourself, “Have I invested the time and energy necessary to balance fees so that they reflect the additional cost of complex care and provide the desired level of profitability?”

Patient Financing
Money is the most emotional topic in a dental office, and dealing with it well demonstrates a high level of empathy, common sense, and patient advocacy. Financing eases the emotional impact of high costs for the patient and your team.

The fees charged for restorative dentistry surprise most patients, but you can ease their “sticker shock” and their financial burden—while boosting the number of case acceptances—by offering flexible, user-friendly payment options. Providing patient financing also increases the confidence of your team when quoting high fees. Most of us find it far easier to tell a patient their rehabilitation will cost $600 a month rather than $20,000 total. Unless you thoroughly understand the personal loan business, however, we suggest you work with finance partners such as DentalFeePlan or Care Credit. 

Ask yourself, “Do I offer flexible financial options to every patient when I present their treatment options? If not, how many more patients would accept care if they had a convenient way to finance it?”

Customer Service
Advanced restorative patients generally purchase high-quality products and services in their everyday lives. They are accustomed to the warm and personal customer service that accompanies high-ticket items. Patients going through the discomfort, inconvenience, and expense of complex-care dentistry deserve gracious hospitality, custom-tailored service, and a high degree of competence from everyone on your team.

Ask yourself, “Does the personalized service my patients experience surpass their expectations and delight them?”

Many dentists find that a successful, mature practice in complete dentistry requires a colleague to share the load. Think of the additional dentist as a co-therapist—someone who can support you in the everyday clinical and management challenges. For example, the co-therapist can lead your recare program, provide simple restorative and operative care, and handle procedures you currently refer.

Of course, bringing in another dentist may also mean adding additional complexity to an already overwhelming practice, but if you carefully select your co-therapist and business structure, the benefits to patients, the dental team, and you can be significant. In particular, a colleague can help you enjoy the rewards of your efforts to build a practice—including precious time away from the office.

Ask yourself, “Do I have abundant quality time and energy to spend with complex-care patients?”


First and foremost, surround yourself with the right people. Then invest in their future with you by providing personal and professional development and expressing appreciation for their work. Bear in mind that if leadership relies on people to put systems in place, implementing complete care depends on your ability to establish a team that grasps your vision and shares your excitement. Of all the elements on the The Leadership Curve, the most continual investment will be in team development.

Ask yourself, “Does my team contribute to or undermine my energy and intentions to provide complete care?”

Case Acceptance
The hardest lesson to learn about case acceptance for complex dentistry is that the methods that work for tooth carpentry do not necessarily work for complex care. Patients at the fix-it level are buying a commodity—filling or cleaning—with modest fees and minimal risks. When patients need rehabilitative care, however, their buying decision is influenced heavily by the relationship they have with you and your team. They also base their decision on how your proposed treatment fits into their life in terms of their time, budget, work, family, and other obligations.

You need to acknowledge the concerns of your patients and learn to shape your recommendations to respond to their issues. Let them know you will be glad to provide care when they are ready. With rehabilitative dentistry, the goings-on in the life of a patient often impact the decision to receive care more than what is going on in their mouth. 

Ask yourself, “Do I act as a patient advocate or adversary when presenting recommendations for complex care?”

Insurance Freedom
If your insurance contracts prohibit you from collecting the fees necessary for profitability, you may want to gain the freedom to do so. Before disengaging from any insurance contracts, your team needs to communicate personally with each affected patient. We have found that a short one-on-one conversation a few months before the change works best to maintain the loyalty of the patient to the practice. Reassure them that you still honor their insurance, but will be handling business differently with their insurance company.

Ask yourself, “Have my team and I allowed enough lead time and communicated sufficiently with our patients to transition harmoniously to a practice free from insurance contracts?”

Laboratory Collaboration
Like every other part of your complex restorative practice, you must up the ante when it comes to laboratory support. As a provider of complete care, you must partner with expert laboratory technicians who understand and support your skill level and can deliver the quality you envision when you present care. Doing so comes with a price tag—and not just a financial one. The laboratories that truly deliver excellence in precision, occlusion, and beauty require more detailed information from you and more time to produce the superior product you need to complete a case.

Ask yourself, “Do I feel confident that my patients are receiving the quality they expect when they arrive for the final delivery appointment?”

Specialists Network
As the clinical complexity of your care increases, so does your reliance on dental specialists to help you deliver optimal care. Working with specialists can, however, complicate communication and unintentionally sabotage treatment. The key to keeping patients happy is for the general dental team to prepare them well for the referral appointment.

First, you should provide solid consultative and diagnostic information to the specialist, who can often give reasonable treatment estimates before you present care to the patient. Then, you present the entire treatment (both general and specialty procedures) to the patient, including an estimate of appropriate fees, financial arrangements, and time commitments. Only after the patient understands the treatment plan and is comfortable with the financial and time aspects of care should you refer him or her to a specialist. You will find that taking the responsibility for preparing a patient well for a referral makes communication and treatment easier for all concerned.

Ask yourself, “When I refer patients to a specialist, do they feel prepared and supported before and after the referral?”

Your best advanced restorative patients provide the most useful insights for your marketing plan. They can tell you what they read, who they listen to, and what makes them happy (and uneasy) about your dentistry. Combine their input with the support of an experienced marketing company to create messages for internal marketing efforts, print and broadcast advertising, and publicity. Keep in mind that your messages reflect on all dentists, not just on you. Be sure your messages honor the profession, offer important solutions for the patient, and work for your practice.

Ask yourself, “Is my marketing attracting my target market—the patients I can treat most enjoyably and profitably?”

We believe the highest level of success occurs when you realize that your own achievements are not enough. The successful advanced restorative dentist has accumulated an enormous amount of information and experience that cannot be transferred through dental schools, books, or multimedia. The pinnacle of advanced clinical care comes from sharing the important lessons you have learned with other dentists and team members.

When you act as a steward of dentistry and share your knowledge, you ultimately become the benefactor. The greatest rewards in life go to the givers, not the takers; to the creators, not the consumers. Be grateful for your success, and give some of it back to those who are still climbing up the slope. When you do, you will soon experience the sweetest rewards dentistry has to offer—knowing that the profession is better because you are a part of it.

Dr. Homoly is a world-class leader in dental education. As a comprehensive restorative dentist and acclaimed educator for more than 20 years, he speaks with the voice of experience. His innovative and energetic approach to coaching enriches dentists worldwide. He is author of the best-selling books Dentists: An Endangered Species and Isn’t It Wonderful When Patients Say “Yes.” He is a frequent contributor to dental journals and is a top-rated speaker, consultant, and coach. Dr. Homoly is president of Homoly Communications Institute. Its focus is to coach high-performance dental teams and advance communication in dentistry worldwide. His unique process helps dentists master their practice, giving them more freedom in work and life. He can be contacted at (800) 294-9370 or visit his Web site at paulhomoly.com.

Disclosure: The Leadership Curve is a trademark of Homoly Communications Institute, all rights reserved.

Dr. Maples has led a full-time comprehensive dental practice in Holt, Mich, for 17 years. In addition, she teaches leadership, business principles, marketing, and communication skills to dentists throughout the country. Dr. Maples earned her dental degree from the University of Michigan and her master’s degree in business from Madonna University.

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