How to Build Your Dream Practice, Part 1 The First Steps

Dentistry Today


We go to great lengths to try and build our practices. We invest a tremendous amount of time and money to become dentists and set up a practice by getting through college, dental school, and continuing education courses. We invest heavily in office space, dental equipment, office equipment, supplies, computers, and other expenses. Despite all this, we still have problems achieving the practice we would really like. This could be for a multitude of reasons, but the majority of these reasons is because of the blind spots we have in administration. Finding your blind spots is key to developing a plan of action and achieving your goals.

What dentists consider their dream practice is certainly different for each, but regardless of what that is, some basic principles apply. Effectively managing a practice is paramount and is often a major problem that is not addressed advantageously. How effective can we be juggling the duties of doing the clinical dentistry while being what others call the chief operating officer? How much of your time is taken away from doing dentistry to try to manage the office effectively? Why is it that some offices get so much more production than other offices while working approximately the same amount of time? This is because they are very adept at both the technical and administrative responsibilities of dentistry. 
Doing clinical dentistry and managing the office are 2 entirely different things. Most dentists are really absorbed in the technical aspects of dentistry. They aspire to do great dentistry and want to do just that—be dentists. A very small percentage want only to manage a practice and have someone else do the technical part. These diametrically opposed responsibilities can lead to a big dilemma when one is trying to do a good job with both. The vast majority of us, however, are strapped with doing both, like it or not. The question is, “How do we do a good job with both at the same time?”
My goals for you in this article and succeeding ones are to address that question and help you (1) change some self-limiting beliefs, (2) achieve what you want to achieve, and (3) reach your potential so you will become a better, more productive, and more fulfilled professional. Also, I want to help you rekindle some of your dreams to have the kind of practice you have always wanted. For you, that may be in a small, part-time, or boutique practice. You may want to practice only a few days a week or from 8 am to 5 pm for 4 to 5 days a week, or you may want a mega-practice with a large staff and big production statistics. What­ever is right for you, due to your family, financial obligations, and other needs, is only known by you and is not for someone to advise you otherwise. So, stick to your goals and be true to yourself rather than complying with what someone else says you should do. 
The typical scenario in dental practices is this: the doctor gets overloaded and overburdened because the employees are not organized or trained to handle the duties and functions needed to make an office run productively and smoothly. This is because the dentist is dealing with front-office personnel (eg, receptionists, schedulers, account personnel, insurance secretaries, file clerks, accounts payable staff, and other administrative personnel) as well as back-office personnel (eg, dental assistants, hygienists, and inside or outside laboratory technicians). All of these people must be dealt with, supervised, and trained. All of the front- and back-office personnel are there solely to aid and expedite the doctor(s) and the hygienist(s) efforts to deliver higher quality dentistry without getting burnt out while actually enjoying the art and science of doing good dentistry. Being overwhelmed by the superabundance of duties and functions only adds to the problem.
What I am going to discuss with you is not a panacea for your life’s or practice’s problems, nor is it a magic bullet for instant practice success and amassing a fortune. No one can give you that. Rather, it is a prescription for eliminating blind spots, confusion, and misdirection in our work and living a productive life while creating and maintaining a practice that will be a great source of pride and satisfaction.

You certainly have had the dream to have a beautiful and productive practice at some point in your life. This may have been when you got out of school, started your practice, or had children (and realized the expensive need to educate them). Some pursue this dream for the love of dentistry, some for the love of the money, but most dentists simply want to do great dentistry and be rewarded for it. I have seen so many dentists who really had a rough time trying to provide their families with the amenities that any good professional should deserve. In order to do so, many have resorted to unusual solutions to try to generate the income they felt they needed. Many have based their practices on HMOs, PPOs, and other low-paying insurance plans that did the opposite of what they were trying to do. Some dentists have tried marketing plans like expensive Yellow Page ads or targeting neighborhoods by sending out reduced-fee coupons and coupons for free examinations, radiographs, and/or cleanings. Whereas state boards forbid offering a free service, these dentists get around it by offering the same service for the give-away cost of one dollar. These unusual or poor solutions rarely pave the road for one to reach their dream but rather increase one’s stress and apathy toward the great profession they used to love.

Many dentists just give up too easily and therefore don’t achieve their dreams. It’s not their dreams that fail them—we all can dream—but it is the lack of follow-through to gain the know-how that prevents their dreams from becoming reality. Then, your dreams can become a nightmare.

Some of the best technical dentists have never seen a good management model implemented by another dentist and therefore do not have a concept or vision of what effective dental management is. Take a concert pianist as an example. No great concert pianist has ever achieved greatness without studying and listening to other proven pianists. No great concert pianists are self-taught, but they learn, practice, and invest the time to become exceptional. Our profession’s literature is filled with a plethora of technical instructions on clinical dentistry but not much on training dentists as managers or chief executive officers. When a dentist cannot create a well-managed office or is not trained in how to take charge and manage the office, the income and profit can suffer or at best never come close to its potential. There is no question that the highest paid people in society are good administrators. This is also true for dentists who are good administrators. They not only have a better bottom line, they are happier and enjoy their practice because they are running it. It is not running them.

One of the most important things I’ve ever learned is that most people are filled with wasted time and motion. I learned that by not wasting time and investing it with the same care wealthy people exercise in investing their money, I could in effect have much more productive time in my life and in essence lengthen my life. Time is the most important of our resources. We can’t change it, we can’t alter it, and we can’t manage time. That is a misnomer. We can only manage ourselves in relation to time. We have our practices, our family, and our dreams. We want to provide for our loved ones and still have a great practice. So, how do we achieve doing both and still get sleep? You do it by incorporating the following principles.

If you are going to be successful, it is necessary to have goals. If you don’t know where you are going, any road will get you there. However, to reach your goals, you may have to reengineer your whole office, or you may simply just have to tune it up here and there. Only you know what you want. Is it more production, working less hours, having a better bottom line, having a more organized and less stressful life, or all the above? In order to have these things, there must be a plan and you must know how to make it happen.

How is it possible to reach our goals? We do it by networking and delegating.

Networking is the most powerful success tool to get you where you want to go. Historically, dentists are not good at networking. It is a system or pattern made up of interconnecting parts. Net­working is one of the most valuable things I have ever done.

What do I mean by networking? It is about putting together the interconnecting parts in a chain of command with trained staff that function properly together. In other words, you set up your organization and staff so they function like the ports on your computer. All the major positions in the entire office must be listed, posted, and known by the entire office staff.

Like the positions on any athletic team, there are different functions that are necessary to make a complete team. No football team could ever be complete without a left tackle or someone to call the plays. Every duty and function in the office must be accounted for and assigned to someone, or they become everybody’s job, which insures that they never get done. This is no quick task in itself but not difficult for those who know how. 
There comes a time for us to demand that we get the changes implemented, get the job done, and see it through. Even though some staff members will not agree with this or understand it, they will greatly benefit from it themselves. If staff members are on your team, they will follow your leadership. It is also important to remember that if they are not on your team, they’ll do everything they can to sabotage your efforts, even if they have to do it in a hidden way. If you run into this problem, you’ll have to send in another player.

George Bernard Shaw once said, “Money is the most important thing in the world. Money represents health, strength, honor, generosity, and beauty as conspicuously as the want of it represents illness, weakness, disgrace, meanness, and ugliness.”

To some extent, we all are motivated by money because of what it can buy us and what it can do for us. However, this quest for money can get out of hand. When money becomes dentists’ motivating factor, and they get dollar signs in their eyes, they will be blinded, unable to see what is in the best interest of their patients. The patients will be able feel or perceive that the motivation is for money, and you’ll see the backs of a lot of people’s heads as they march out of your office and never come back. So, it is necessary to abandon the pursuit of money and put our attention on becoming better at dentistry and managing our practice on a higher, healthier, and more enjoyable level. Then the rewards will come.
What you are going to read about in this series of articles will make you more money, but it will come as a by-product of doing what is the right thing for your patients in a manner whereby they perceive that you really care about them and take their best interest to heart.

It is impossible to achieve your goals and dreams without also having high ethical standards in all operations of the office. Any staff member that exercises low ethical standards is like a team member who keeps fumbling the ball. The other team members have to fight like crazy to get the ball back and will still lose it to the other side. These people are obvious and easy to recognize. Others with low ethical standards are not so easy to identify or in reality are hidden, concealed, and very difficult to uncover. They booby-trap your operations and create extra work by forcing others to frantically handle things that have been done incorrectly or not at all. These things create discord with patients and harm our practices.

What kind of things am I talking about? You name it— everything from incompetence, laziness, and a “don’t care” attitude to stealing prescription pads. I always thought I heard it all until someone tells me the latest story. For brevity, I’ll just say that if you know someone’s behavior is wrong or you have a bad feeling about it, it is likely creeping into the office in other areas as well. I’m not only talking about just our staff members; I am talking about us as well. We also must have high ethical and moral standards. An example is how we speak to our patients about dentistry and other dentists. 
As chairman of our local peer review committee for over 25 years, I can honestly say that putting down other dentists and saying critical, derogatory things has caused the vast majority of complaints by patients to our dental society. Staff members do similar things to each other, and this causes strife. No one can make themselves look better by putting down somebody else, but apparently some think they can. It is important that we have standardized ways of dealing with ethical and personnel matters that cause problems and interrupt the smooth flow of production in our offices.

Formulate some concepts in your mind of what you want your practice to be like and write them down. What kinds of dentistry do you enjoy doing or do you aspire to do? How much time can you devote to your work? What are your family and financial obligations? What are you willing to do to change your conditions?

In future articles, I will address some things that might have been a blind spot for you and some things you already know but need to be addressed in your practice to get and have what you want. We will also discuss how to unburden the dentist by organizing staff to handle major organizational problems that dentists face in their practices.

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.