How to Build Your Dream Practice, Part 2 The Next Steps

Dentistry Today


Achieving your dream practice is dependent upon understanding and exercising basic organizational applications. One of the first things to do is remove the bottleneck around you. Good administrative and technical help are needed to take the load off the dentist and unclog the bottleneck. Sometimes, there are those who do not recognize how much the doctor is overloaded. They think this is normal or business as usual. The staff must be aware of the problems and know that conditions can change. Then basic systems and procedures must be adopted for everyone to follow. When staffers realize the efficiency of new organizational applications, they all will be more willing to continue. You will soon see how magical the results are in terms of relieving the workload (Figure 1).


Figure 1. Unburden yourself by removing the bottleneck around you. Delegate and trust your staff.

As long as agreements exist between individuals, groups, countries, etc, there are no problems. Where there is disagreement, problems exist. This also applies to doctors and staff in dental offices. A complete and easily understood manual that spells out employment arrangements, policies, and philosophy is mandatory. This manual informs incoming new employees of what they can expect and obtains their agreement prior to them becoming a team member. It is also used for review from time to time for tenured employees. Employees may ask you, “Can I clean my husband’s teeth for free? Is Memorial Day a paid holiday? Do I get funeral leave for my cousin who passed away up in Canada? Can I get a loan from you for a couple of months?” Having a general policy manual already answers these questions, makes employment fair for everyone, and greatly unburdens those in managerial positions.

Organize all the duties that you and your staff perform. Start by listing every duty that you and each member of your staff can think of and develop a job description for everyone as a permanent record in your office (Figure 2). Staffers will need help and encouragement with this, so show some leadership. This list of job descriptions can easily be added to and handed down to new personnel as your staff changes. Beginning this process with the basic duties performed in the office starts to unburden the dentist, and this unburdening brings about happiness, higher morale, and more production where more quality can be delivered.

Can you imagine how great this becomes when your staff is trained to handle all the administrative tasks that you as the dentist prefer not to do? The staff is usually very willing to do this because they would like to have more order and less stress in their jobs as well. Everyone wants a better job, and when they realize how much this will help them and their job, they will nearly always back you up on organizing your office. However, if they are objecting quietly or loudly, then you need to find someone else who really wants to cooperate on your team. No matter how important you think a particular staff member is, the whole organization is more important than any one staff member. You need staff that will be with you and back you up on this.
When you have all the duties assigned to staff and everyone is doing their jobs as they should, it relieves stress and builds confidence for the entire team.

Figure 2. Have detailed job descriptions for every position and have specific instructions ready for staff. Figure 3. Training staff on standard operating procedures.

Figure 4a. You lose.

Figure 4b. You win!

I have had hundreds of participants in my office for training and workshops for office administration, scheduling, accounts receivable, and office manager training. When we ask these dentists and their staff members what they think their number one problem is, they nearly always say it is acquiring a good staff. This is a vast misconception. I have been teaching this in my training manuals, workshops, and seminars for over 20 years, and it is finally being proposed by many others. This misconception can be deadly, and often is.

The problem is threefold, but the number one problem is the lack of training of staff members. Another major problem is a lack of systems that are staff and patient user-friendly. We must have and implement systems that mechanize practically everything in the office, adopt these systems as standard operating procedures, and expect everyone to follow them. Third is finding the right staff members. We often get these 3 major problems mixed up and fail to see where our problems really lie. We need the correct number of staff, workable systems, and the training of those staff on the systems. If we think of these 3 things in terms of circles, we also need to be aware that all the circles need to be in focus. If any one circle is out of focus with another, we will never be in enough control to accomplish any goal. Knowing this one principle greatly simplifies how we manage a practice (Figure 3).
Imagine the lost work and money we caused in the past by “solving the wrong problem.” Example: you hire an employee to work in the front office in the reception, scheduling, finance, or management area. If there is no exact workable system of scheduling and appointment book control or recall and reactivation, that employee will fail at doing the vital functions of the post. This employee had no chance of succeeding from the beginning, and this is a losing type of situation for everyone involved, including our patients. 
On the other hand, assume we have an appointment book control system in place. It may not be the best system, but it works to some degree. What will happen if we take that new employee and put her to work without first training her completely on the existing system? Basically, she would not know what to do. There would be many things done incorrectly and many left undone. Therefore, she would not be successful. This opens the door for many other problems to ensue. Likewise, if we only partially trained the new employee on the existing system, it would hurt production, ruin our bottom line, and be disastrous. This is the scenario that we usually see happen in many dental offices.
How many basically good employees have left our employment through quitting or dismissal due to a misunderstanding that was actually an organizational problem? On the other hand, how many times have we spent time and money to train employees and they just couldn’t cut the mustard?

Let’s look at what would happen if we implemented a proven system of scheduling in our office and spent the time and money to train an employee on that system. If, despite all the training, we could not achieve the desired results, then should we replace that employee because she (for any number of reasons) will not accomplish what needs to be done with our scheduling? It would be unfair to the operation of the office, other staff members, and our patients not to correct the problem by taking whatever action is necessary, regardless of how bitter the pill is.

To summarize the point: when a problem shows up, it can be tricky trying to determine which of the 3 the main problem is. It’s like the street magician with the pea and the shell game (Figures 4a and 4b). Unless you have a mighty keen eye, it is almost impossible to tell which of the 3 shells the pea is under. This is because the hand is quicker than the eye. This same maxim holds true in management, but like the magician, if you know the systems and have them in place, you’ll be able to tell where the problem is every time.

Dentists often ask me what it takes to make a successful practice. They also ask what is the quick fix or bag of tricks. There are none. So, to amuse myself one day, I sat down to address this question and make a list of some of the ingredients it takes.

The practice of dentistry is an interesting profession from the standpoint of everything it takes to create the practice of your dreams (Figure 5). As a general dentist, you have to have knowledge of anesthesia, operative dentistry, endodontics, oral surgery, pharmacology, periodontics, pedodontics, crown and bridge, removable prosthodontics, implants, etc. You also have to have some knowledge as an engineer, business manager, financial expert, personnel and hiring manager, ethics officer, counselor, public relations person, customer service expert, organizational genius, administrator, management expert, loan officer, personnel trainer, marketing expert, and so on. Also, each of these areas has many subtitles. This is why dentistry can be an extremely difficult profession. 
Dr. Ingle has described the practice of dentistry as trying to run a 4-minute mile and trying to keep up the pace all the way from Chicago to Denver. This is especially true if you have blind spots that prevent you from fully addressing all the responsibilities listed above.


Figure 5. Ingredients for practice success.
Figure 6. Standardize your scheduling and appointment book control.
Figure 7. Which ones would you not give credit to?

To get the practice under better control, all we have to do is look and see which ingredient is missing and put it in, or recognize which ingredient is weak and bolster it up. We should continually be trying to improve each facet of the office. For example, a recall system exists, but it is not getting the job done. There is a lot of unfilled production time on the appointment book and there are too many broken appointments. This is a weak ingredient that needs strengthening. (The first thing to remember is that almost any system is better than no system.)

Regardless of the size of the practice, it is easy to lose managerial control. As dentists’ offices grow, the management problem is either not addressed or is not adequately planned. Then there is confusion of duties, functions, and authorities. Consequently, chaos ensues. When this chaos gets too unpleasant, the typical response is to try to reorganize by tweaking a few things here and there. This nearly always proves to be inadequate.
It’s a piece of cake to manage 2 or 3 employees. Four or 5 is somewhat tougher, but where there are 6 or 7 employees in a dental practice, it’s too much for the dentist to manage. At this point, the dentist usually appoints an office manager, but does not supply any plan, training, written job description, or internship to see that the office staff is operating at the efficiency level expected by other industry standards.

Consider a list of (1) every duty we perform, all the decisions that have to be made, and all the armamentaria necessary to perform every dental procedure we do; (2) all the supplies used for our dental and office procedures, and ordering, stocking, and distributing them; (3) handling all the business forms and paying the bills and taxes; (4) doing all the scheduling and recalls; and (5) working with patients on their accounts, finances, and insurance. Then there is administering payroll, handling benefits, and coordinating all the laboratory crown and bridge and removable prosthodontic cases as well as other intraoral appliances. Then we have to do staff enhancement and training, take care of the building maintenance, evaluate new products and procedures, and on and on.

You will see that so very many of these things are never done. This is because of the great magnitude and complexity of doing all of these things. Not having them simplified would drive a conscientious person crazy. Therefore, it is paramount that all complexities and confusions be simplified, whether you do it personally or hire this task out to someone or some group that has experience doing this. Or perhaps you can purchase a system that already accomplishes these things, and more importantly, has been proven to work.
Duties that are not recognized and assigned never get done until a conflict or a problem arises, which is too late. Handling the conflict or problem then requires considerably more of your and other staff’s time to straighten it out. So, assigning these hidden or omitted duties in the beginning saves a great deal of time in the long run, and you have orderly activity.

One of the things many staff members don’t want to do is make decisions. The demand for us to make so many decisions so often is where a great deal of our stress comes from. This is especially true in dental offices where there are so many things to be addressed. Establishing office policy for how things are to be done in most instances makes their decisions automatic, so staff members do not have to decide on administrative actions in the office. Staff members love having decisions already made for them. It makes their life so much easier, regardless of how much you have heard to the contrary. Don’t worry, if staffers like making decisions, there will be plenty of opportunities.

When the various positions in the office have complete, up-to-date job descriptions, the vast majority of decisions are already made. This enormously simplifies things because the duties are divided among staff, allowing persons on the team to take care of their area, know it well, and complete every task with minimal supervision. Furthermore, this “unjams” the activities of the doctor and those in supervisory positions, and greatly reduces stress. This is because each staff member is not responsible for making decisions about everything in the office. An example would be if patients asked a dental assistant or hygienist if they could pay for needed treatment using a payment plan over a period of time. They are simply informed who the accounts receivable secretary is and that she will work with them on their financial arrangements.

In general, is your production lower than you would like it to be? Would you like to be producing in a higher range and realize the rewards of working smarter, not harder? Are broken appointments costing you production? Is your staff scheduling patients who may not pay you? Would you like to get your staff really trained so they are effective and feeling better and more confident in their ability to create an ideal schedule every day? Do your staff members know the right scripts for getting patients to schedule their needed treatments? Do they know the 7 objections to scheduling? Do they know how to salvage broken appointments and no-shows? If a staff member is not good at calling recall patients and is not successful, is she going to be happy trying to do so? Of course not! People don’t like to do things they are not good at.
So, when there is poor scheduling, no one is having any fun or making enough profit. It is essential to address the above questions and develop standardized scheduling and appointment book control (Figure 6).

Do not treat everyone’s account the same
All patients are not the same and should not be treated the same, especially when it comes to how they pay for their services. I have talked to thousands of dentists and dental office personnel, and I can tell you that the decision to go into a cash practice is based on several things. They, like you and I, have been victims of patients who were deceiving and dishonest or were actually credit criminals that we were not aware of and trusted they would pay their accounts. We have given deadbeat and untruthful patients appointments on our schedules and had the appointment times wasted by them not showing up, or if they did, never paying us. Others, however, are totally honest, sincere, and trustworthy, and should be treated as such.

By establishing accounts for our patients, we can stimulate production by increased acceptance of our treatment plans. Establishing credit has been a way of life for businesses selling goods and services in America. There are more than 27 million credit applications made every day in the United States. Prudent businesses know to do this. Without credit, our economy would never have made it to the best in the world. This idea of credit is so valuable that it remains the only way anyone can discriminate against anyone else in this country. Dental offices in general have turned their heads away and have not dealt well with credit (Figure 7). This is why we hear such things as “I forgot my checkbook” and other ploys more often than other businesses.
In 2000, there were 1,253,444 bankruptcies filed and over 1.2 million bounced checks in the United States for nonsufficient funds, closed accounts, and stop-payment requests. Unfortunately, you cannot look into patients’ faces and tell if they have a past history of stiffing people when taking their products or services. We must be like other prudent businesses and have other ways to do that. The problem again is that accounts receivable is really a staff responsibility, and we have not been able to completely train our staff to handle accounts or we have never given them a system or tried to delegate these responsibilities to them. A knowledgeable, well-trained staff member knows the difference between patients we can trust, the ones who will pay, and the ones who will not. They can quickly learn which ones need financing, which ones are worthy of the convenience of establishing an account, and how setting up an account for them is a great way to sell more extensive dentistry, including cosmetic and restorative dentistry. Consequently, this helps us do more and better dentistry of the quality and amount that we would like to do. If patients can’t afford the cost of their scheduled appointment, you can bet they won’t show up. Making dentistry affordable is important for practice success.

In a future issue of Dentistry Today, the third and final article in this series will discuss more valuable systems for achieving your dream practice.

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.