Ten Ways to Improve Your Practice: Time-Tested Principles-Based on an Interview With Dick Barnes, DDS

Dentistry Today


The “Barnes Principles for Creating a Successful Cosmetic Dental Practice,” as they are known, reach areas of personal and professional practice much deeper and more significantly than mere case acceptance. Dick Barnes, DDS, has cultivated a fundamental system for practice success grounded in empathy for others that ultimately leads to pure satisfaction by delivering truly high-quality work. Let’s take a look at his principles, which present a blueprint for improving the way you can practice dentistry.

Look at the World Differently

Illustration by Cheryl Gloss

This first principle suggests that dentists need to open their eyes to new possibilities and new ways of seeing themselves, their practice, and their patients, as well as the way they perform the dentistry they have been trained to provide. The other principles that follow are natural continuations of this first step toward change.
“The first things we learn are usually the most difficult to unlearn,” Dr. Barnes observes. “What dentists need to do, therefore, is ask themselves why they are doing things the way they are doing them.
“When we change the way we see our world, all of a sudden we’ll have different materials. For example, we have implants today. It used to be that when we’d look at a space where a tooth was extracted, we’d think ‘bridge,’ but that’s old-fashioned. Implants are the new thing in dentistry. So, we have to change the way we see our world, and if you see a space, now you see an implant.”

Always Present Comprehensive Dentistry

Obviously, looking at the world differently requires an introspective and honest view of one’s professional self in the context of his or her patients and skill set. By doing so, it becomes easier to segue into this next principle, which urges professionals always to offer patients comprehensive dentistry that is representative of quality care. This is what all patients want, need, and deserve.
“Comprehensive care is what it takes to bring the patient to ultimate oral health, and it is not just about mechanics and aesthetics,” Dr. Barnes explains. “Respective to the given individual, of course, comprehensive dentistry should be presented to all patients—even if they can’t afford it—so that they know you have diagnosed everything.”
Dr. Barnes believes this principled philosophy was cultivated by his own mentor, Dr. L.D. Pankey, who performed a great deal of comprehensive dentistry for his patients. He understood the value of dentistry and charged fees accordingly, Dr. Barnes says.

Only Perform Necessary Work: That Will Lead to Quality

When clinicians focus only on what is needed, they’re performing quality dentistry. In reality, that is what every patient needs. However, dentists all-too-often become complacent. Dr. Barnes therefore urges clinicians to ensure that they are the best they can be, and if they are not, to recognize that they have a responsibility to keep enhancing their skills.
“Also, I think we have to internally and retrospectively figure out who we are and stop feeling guilty,” Dr. Barnes says. “If we don’t feel as though we’re the best, then we have to keep working at it.”
Dr. Barnes has found that doctors who enjoy dentistry the most do so because they are doing the kind of dentistry that gives them a sense of satisfaction and accomplishment. Of course, financial success usually goes hand in hand with that, but performing good, quality dentistry is gratifying in and of itself. This is especially the case when dentists know they’re doing their finest work and trying to do what is right.

Stop Selling Hardware: Educate Patients About the “Why and Value” of Treatments

When dentistry is comprehensive, necessary, and quality based, it inherently holds value for the dentist performing the treatment and the patient who undergoes it. That being said, this principle focuses on what is being “sold” to patients, and it shouldn’t be a crown, or a filling, or any other piecemeal remedy consistent with the more traditional “it’s-broken-so-I’ll-fix-it” mentality. Rather, dentists themselves must first begin to see the value of the treatments they provide. Then, using interpersonal skills that are based on human engineering and motivation, they should educate patients on why the comprehensive care is in their best interest, not merely something they “need.”
“What they do not realize is that the patient’s teeth might not hurt, so they might not understand why they ‘need’ to have something done. That’s when value becomes important—and value equals benefits minus the cost.”
When people see the value in a particular service for themselves, they will make the necessary financial sacrifices for whatever it is that they want. Quality dentistry that can change their lives is no different.

Do Not Be Afraid to Make a Profit

The fee for comprehensive dentistry—perhaps a case that involves 10 or 12 units—is no longer based on an individual unit price as if selling pieces of hardware, but rather, on the difficulty of the case as a whole and its ultimate value. This isn’t something to be afraid of, as it is only a number.
“There isn’t much difference between a $13,000 case and a $10,000 case,” Dr. Barnes says. “When it’s time to discuss the fee, do not be afraid, because you can always help the patient find the money.”Like any business, Dr. Barnes says, a dental practice ultimately needs to make a profit.

Deal With Objections to Treatment Empathetically

Dr. Barnes believes that it is possible to change other people’s behavior—in this case, the inclination for patients to say no to needed treatment—by changing how you react to them. Therefore, when patients express that they “want to think it over,” it is important for clinicians to have empathy and use inference to handle some critical questions they may ask. Additionally, dentists need to speak with authority and conviction.
Understanding the patient is also paramount to case acceptance and educating the patient on the value of the dentistry that is being recommended. Asking questions in response to a patient’s questions will enable the doctor to demonstrate empathy and learn more about that patient’s motivations, fears, and apprehensions.

You Cannot Make Up for a Day of Lost Production, So Schedule for It

Just because you are busy does not mean that you are productive. Therefore, it is important to specifically make time in the schedule for production. That requires working with the dental team and delegating responsibility for scheduling to the treatment coordinator. It then becomes that particular individual’s job to monitor practice production and ensure that each team member is reaching his or her goal.
Dr. Barnes says, “When I first started out in practice, I used to look at my schedule on Friday and see what next week looked like. If I saw any holes in the schedule, I would wonder how I’d make my mortgage payments!” He goes on to explain, “When the week was finished, those holes tended to get filled in. However, it was not planned that way. The holes were just filled.”
While he admits he was busy, Dr. Barnes says he was not as productive as he could have been if he would have planned for a certain amount of production. Therein lies a basic business principle: plan daily to produce a certain amount, keeping in mind that you are not going to put people in the schedule who do not need treatment.

Transfer Authority to Team Members

As implied by the previous principle, it is important for clinicians to learn to delegate and not try to do everything themselves. Throughout his tenure teaching and meeting dentists from all over the world, Dr. Barnes has seen practices in which the doctors feel as though they must be involved in everything that is going on in order to feel in control.
“You’re not going to control what happens in life. I think we like to think we can, but it’s impossible,” Dr. Barnes said. “We’ve got to let go and relax a little bit.” For example, he says, if a crown doesn’t fit, some dentists might go nuts. But they just need to fix it, make sure it’s right, and then get over it.
“It’s the same with staff members. They have to learn from their mistakes,” he says. “None of us are perfect, and the sooner dentists realize that, the sooner they’ll learn to let go and give responsibility to their team members.”
Furthermore, Dr. Barnes emphasizes that the dental team members are the ones who will make the dentist successful. Staff members, he says, do a better job of dealing with people—the patients—than do the dentists. For this reason it is important to train staff members in financial arrangements, how to greet patients, and how to address a patient’s questions and/or objections to treatment.

To Be Successful, Do What Works: Copy Success

The problems dentists face are the same everywhere, reflecting a common theme: getting patients to say yes to the treatment they need. Dr. Barnes teaches clinicians to become effective in their interactions with patients. “Being successful can ultimately be very easy,” he says. “Dentists who are successful don’t try to reinvent principles or processes,” he says. “Rather, they just copy success. They do what works.” He goes on to say, “Success in life generally follows from other people. We just learn from them. My role, I guess, is to pass along what I have learned and to be an example to other dentists.”

Be Firm in Principle and Flexible in Procedure

While it is important to implement structures within the practice regarding how to do things and who will do them, some dentists may go too far and not deviate from their plan even when it is in their own and their patients’ best interest. For this reason, having taken all other principles into consideration, Dr. Barnes strongly advises dentists to be firm in principle and yet flexible in procedure. In other words, remain steadfast in what you know and believe, but be willing to try new things. Be open to deviate momentarily from the norm in terms of how those principles are executed. “All successful businesses and practices must have a certain amount of flexibility, whether it’s in financial arrangements, scheduling, or considering new techniques,” Dr. Barnes says.


A constant theme woven throughout the “Barnes Principles for Creating a Successful Cosmetic Dental Practice” is the need for understanding the human condition as well as the acquisition of skills required to interact effectively with patients in better ways than before.
“The bottom line is that if patients do not get the treatment that they need, then their condition gets worse, not better, and we’re not doing them a favor by allowing them to walk out of our offices with less dentistry than they need,” Dr. Barnes emphasizes.
At a time when dentistry’s future is likely to keep getting better, Dr. Barnes advises dentists to remember that the principles of business and dealing with people will remain timeless and unchanging.
“The way we do dentistry will change, and we have to be prepared to move with it, whether it’s digital impressions or CAD/CAM,” Dr. Barnes says. “But as far as dealing with patients goes, it will continue to be about doing your best, and doing what is right and fair.”

Ms. DiMatteo is president of Crème della Crème Copywriting & Communication, a consulting firm in upstate New York. She specializes in copywriting, editing, and publication management for businesses and individuals in healthcare, publishing, and consumer industries. A regular independent contributor to Inside Dentistry magazine, she has also contributed medical and healthcare related articles to The Citizen newspaper in Auburn, NY, as well as volunteered her services to organizations that benefit individuals with developmental disabilities or that promote cancer prevention and screening. In addition, her corporate/manufacturer clients rely on her skills for print advertisements, brochures, video scripts, and sales presentations, as well as Web site and downloadable news and education content. She can be reached at allison@cremedellacreme.org.

Disclosure: Ms. DiMatteo has received payment from Arrowhead for writing this article.