How To Build Your Dream Practice, Part 3 Some Remaining Steps

Dentistry Today


Figure 1. Orient the new employee to start producing.

Figure 2. Monitor duties and responsibilities.
Figure 3. Don’t turn your ear far from interoffice quarreling.
Figure 4. Forms and checklists are highly effective.
Figure 5. Know what your staff is doing.
Figure 6. Know who’s carrying the load.
Figures 7a and 7b. Gain the space you need.

In this final article in my 3-part series on building your dream practice, I will discuss some remaining steps that will help you achieve your goals.

As positions in the office open up, we not only need to hire and orient new employees properly, but it is also of the utmost importance that we have a functional system to introduce them to. They need to be oriented to the entire office and their job and have an organized learning transition to get them fully productive in that job in the shortest amount of time. Someone needs to be assigned and responsible for helping the new person learn the systems (Figure 1). Not many dentists have anyone trained to do this. I cannot understate the importance of establishing this system, if for no other reason than to take away the stress of dealing with the change and to gain confidence and control. Therefore, we must have a system of staff procurement and job orientation.

Mark Twain said, “Inherently, each one of us has the substance within to achieve whatever our goals and dreams define. What is missing from each of us is the training, education, knowledge, and insight to utilize what we already have.” Without training and having the proper ingredients in place, production will be stymied. For instance, you have a new scheduler on the job and the phone rings. She answers and the patient says, “I hate to call you and tell you this, but I can’t come in for my 2-hour bridge prep appointment this afternoon. I’ll have to call you back and reschedule.” The untrained scheduler says, “Okay, when should I call you back?” or some other inappropriate response, and the production is shot for the day. So, how do you feel on days like this when your production is low and your spouse needs new furniture, a car, or money to pay those big college tuition costs? I suspect your morale would be low, and if this low production is chronic, it can get pretty depressing.

Without training and/or an internship, there is inadequate control of our systems, causing certain failure. Along with this, expenses go up and a lot of attention becomes focused on being able to pay the bills. The next step is to try to stop the spending, which often includes downsizing. I’ve seen this happen often, where the doctor will lay off or fire the extra part-time hygienist or some other staff member, go to a cash-only practice to cut down on the number of staff members needed, find a cheaper laboratory, etc.
The reason most dental offices try to control costs first is that they cannot predict income and expenses week by week, month by month, or year to year to determine what their net income will be. If the income is on a roller coaster ride, it makes it almost impossible to have any prediction of a profit margin on a regular or routine basis.
Each time a manager tries to solve a problem by a “shotgun” approach or by some other unpredictable method, it usually just causes more problems, which further causes more chaos and contributes more to the downward spiral. Then the dentist gets apathetic about his or her practice and doubts his or her ability as a dentist and manager. Some people call this burnout.
The solution is not to live a life of guilt, desperation, or apathy, and not to reduce the practice down to a “practicette,” especially if you have kids to send to college or live in an expensive area. (Practicette is my term for a small or miniature practice.) I’m talking about making things go in the direction we want them to go. An example: we decide to do something about the backlog of recalls for all those patients we promised to call. This is assigned to a staff member to get started. Weeks later, nothing is done or only a few or small number of patients are called. The problem was that the staff member did not start the project because of some confusion, fixed attitude, lack of direction, no training, or lack of supervision. At this point, most people get apathetic about even trying and say, “That didn’t work.” They give up on trying to get the staff member to do the project, and the result is costly and disastrous.
The point here is, if you don’t know what to do and how to do it, you can’t control it. This applies to any function in the office, such as controlling the appointment book, accounts receivable, accounts payable, or ordering supplies.


Physically routing things through the office is a constant necessity. So many things are going in and out of the office that it really eases the work load and decision-making when systems are set up to make this routing automatic. As an example, take the case of new patients. It is very important that they be taken care of by everyone in the office that deals with them and all aspects of their treatment and business. There are certain steps the receptionist takes when this patient walks into the office. Where do they go from there? What forms do they fill out? What office policies are they given? Who sees them next? How and where are finances addressed with them? How is the treatment plan presented to them? What do we do with them when the treatment is finished for that day?

By having a checklist for all of these things, the decision is already made in advance, so everyone inherently knows and does not have to decide what to do next. This makes everything flow smoothly and completely. This principle holds true for patients, payments, dental supplies, administrative supplies, mail, laboratory cases, etc.
Other good businesses do this and we should as well (Figure 2).


Discord among staff members is a major distraction when we are trying to keep our attention on doing dentistry. Oddly enough, all of these problems can be enumerated as c words: conflict, contention, clashing, combat, controversy, competitiveness, corivalry, and cut-throating.

We are not our staff members’ religious leader, psychologist, judge, or jury. We are not trying to change people’s inherent beliefs or psyche. We only want to get back to the work of doing good dentistry, without distractions and interoffice fighting. Championship teams work together not by fighting with each other, criticizing others behind their backs, or trying to sweep the strife under the carpet. When staff members team up in groups of 2 or more to speak badly of another or whisper secrets, you have trouble in the camp. In successful practices, the staff members have an admiration for each other because they get to the bottom of quarreling so that they all understand each other and work hand in hand. To get all staff members working together and not in conflict requires only a small amount of basic knowledge and skills. It’s not as complicated as it usually seems to be, but there are simple ways to bring about harmony (Figure 3).


Do not underestimate the value of using forms and checklists. Their value in office use is evidenced by the great number of requests for them when we have had visitors and workshops in our office. They make life easier and safer. You would never see an airplane pilot skip his checklist before taking off. That’s because his life and the lives of his passengers depend on it. Checklists have been used by good businesses since the 1800s. If you want things done right in your office, you’ll use them too. The problem I see in most offices is that they have too few forms and checklists because it takes some creativity to make good ones. Any form or checklist is better than none at all. They do not have to be perfect and rarely are at the start.

Some examples of checklists and forms are the following: daily, weekly, and monthly duties; routing forms; time-off requests; and operative setups. They can be added to and fine-tuned as you use them. Just start writing them or acquiring them (Figure 4).


Most dental offices keep track of their collections and production as a way of knowing if all the bills can be paid at the end of the month and how much they have left over to spend. These are important statistics, but it is the work not usually measured that makes production happen and gets the dollars collected. Patients have to be scheduled, and without someone making the calls to patients and skillfully scheduling their recalls and needed treatments, they wouldn’t be in the dental chair to get the dentistry delivered and paid for. This is why measuring the behind-the-scenes activities such as outgoing calls is so important. Keeping statistics is nothing new to successful businesses; it is new only to dentists. Measuring performance has been used throughout industry and businesses worldwide for decades.

The dentist working at the chair cannot supervise employees, see what they are doing, monitor their progress, or coach and teach them. This is why we need a system to measure the progress and effectiveness of the things they do that eventually result in the patient being scheduled, receiving needed treatment, and paying for it. The same is true for staff members in other positions (Figures 5 and 6). Keeping statistics is nothing more than keeping score, and it is looked upon as a game. This actually keeps things interesting and fun. Like any other game (Monopoly, checkers, etc) or athletic activity, it would not be interesting or fun if no one kept score.
When you get your head out of a patient’s mouth and review the posted statistics, you or your office manager can quickly monitor the progress of staff members’ functions and make management decisions based on what you see, thereby avoiding the roller coaster ride of production and collections.


Knowing how to deal with the teeth and surrounding structures is challenging, but usually not as much as the people they are attached to. Recently I asked a new veterinarian how she was enjoying her practice. She said, “Not too well. The animals are fine. The problem is they are brought in by people.” We, like anybody else in the people business, had better get a grip on dealing with all kinds of people effectively because—to a large degree—our success or failure depends on it.

I have read that Ann Landers said that patients change dentists every 5 years due to poor communication with the doctor and/or his staff. I do not know if that is true, but I do know that patients leave us because we fail to handle or adequately address their concerns and disappointments. Furthermore, their concerns are very often not communicated to us, which presents a greater challenge, since we would like to retain them as a long-term patient. This is a huge area to address, and I could not begin to cover the subject here. Suffice it to say that nothing is more valuable than good interpersonal relations and dealing with a huge variety of personality types and emotions. Establishing a habit of reading good materials on this subject for only 10 minutes a day can greatly increase your ability to deal with a variety of patients and staff effectively and bring more enjoyment to your practice. Your success depends on it.


Whether we purchase, build, rent, or lease an office space, do not let your building limit your practice. If you are in a practice and still would like to grow but are worried about the time, trouble, and exposure of moving or knocking out the walls, don’t give it a second thought. Just do it. I can tell you that bricks, pipe, and drywall should never limit what your heart desires. Initiate plans for office space to create your future practice the way you want it to be. If you have physical plant needs, don’t be afraid to address them. (Figures 7a and 7b).

There is no substitute for technical competence. If there are things in dentistry that you are not interested in doing, that is okay. There are others out there who do like those things. For those things that you most enjoy or are interested in doing, pursue excellence in those areas and do them to your heart’s desire. No one can be happy doing things they don’t want to do, but on the contrary, it can be exhilarating when we are challenged and pushed to our limits, even on difficult things that we enjoy doing. The better or more technically competent we become, the better it is.

Take a look at your practice and be honest with yourself based on what I recommend here. You don’t have to share or discuss this with anybody. Just be honest with yourself. If you have these things covered, that is great. If it seems like an elephant you’re trying to eat, then start with one bite at a time.

If I helped you spot or identify something or some area of your practice that may be holding your practice back, I will have accomplished what I have set out to do here. After all, it may not be some earth-shattering data. Confucius said, “Man does not stumble over mountains but over molehills.” So, step a little higher. Here’s to wishing you the best.


Dr. Westerman has served extensively in his local and state dental associations and is a frequent contributor to dental journals and textbooks. He has taught at many dental association conventions, study groups, and management seminars in a variety of healthcare settings. He holds 5 patents in the dental field and is the author of the highly acclaimed Classic Practice Series literature on dental management. He is the founder of Classic Practice Resources, a dental practice management company that presents training and management seminars and workshops to thousands in the dental field. He can be reached at (225) 927-3442 or via e-mail to To contact Classic Practice Resources, call (800) 928-9289.