The Best Practices Show with Kirk Behrendt

Real Value vs. Perceived Value

Episode #580 with Dr. Christian Coachman

For patients, it doesn't matter why you're a great clinician. What matters is that they perceive you as skilled, competent, and great. Today, Kirk Behrendt brings back Dr. Christian Coachman, founder of Digital Smile Design, to guide you through the process of creating perceived value. Your patients aren't buying your treatment — they're buying the emotional experience that you provide! To learn how to translate your real value to perceived value, listen to Episode 580 of The Best Practices Show! 

Episode Resources:

• Dr. Coachman’s Facebook: https://www.facebook.com/christiancoachman
• Dr. Coachman’s social media: @chriscoachman
• Digital Smile Design: https://digitalsmiledesign.com
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Main Takeaways:

People buy an emotional experience.

What matters is patients’ perception of value.

Every great practice needs a great storyteller.

Master the process of creating perceived value.

Being a good clinician is not a guarantee of success.

Learn how to translate your real value into perceived value.

Quotes:

“From my dental technician perspective, what I realized was that many clients that I have, dentist clients, of course, could be great clinicians but not necessarily have great practices, and vice versa. I saw clinicians that were not that great but were really succeeding with their practice. So, I noticed that being a good clinician, unfortunately — and I say unfortunately — is not a guarantee of success. And as a technician, 25 years ago, I started to ask myself, how can I help my good clinicians to be more successful beyond just managing the clinical procedures? That's when I started what I call the emotional dentistry concept, everything that can help a dentist generate perceived value.” (3:23—4:15)

“What I realized was that we all have our real value. Our real value is the value that we know we deserve because of our effort on learning, practicing, becoming more experienced, trying over and over again, using the right instruments and materials, etc. Every year, we get better, and that grows our real value. But what I also noticed is that in a capitalist world, real value doesn't make the magic alone. It doesn't really matter how much real value you know you deserve. What really matters for a business, including a dental practice business, is the value that people believe you deserve, or people feel you deserve. Basically, when patients accept a treatment plan, this treatment plan actually has very little to do with your clinical skills and a lot to do with the perception of value that this person had until that moment. So, I understood that it’s all about mastering the process of creating perceived value. That's when we started to explore the psychology, the human behavior, communication skills, body language, emotional experience, and everything that you need to do, everything that you can improve, to translate your real value into perceived value.” (4:16—5:49)

“People don't buy your treatment. They buy the emotional experience before your treatment. Meaning, they make the yes or no decision based on everything that they experienced so far, until the moment you presented the estimate to them. Now, rationally, people think that they are saying yes or no because of your clinical skills. Doctors think that the patient is saying yes or no because of their clinical skills. But, in fact, what we see is that the yes or no depends on this emotional experience. Why? Because major decisions in life are emotionally driven, and also because it’s very hard for the patient to understand clinical skills, even after the treatment. Imagine before the treatment.” (6:15—7:09)

“Even if you're a great clinician, a happy patient will have a hard time explaining the clinical technicalities of why you did something well. And the explanation, the word of mouth, will end up being much more on the emotional side, on the experience, on the perceived value generation. So, at the end of the day, before or after doing — it doesn't matter. What matters is the perception of value. And the perception of value is not necessarily 100% connected to your real value. So, it’s an art. Translating your real value into perceived value is an art that needs to bring — your team needs to master this process. The whole nonclinical experience needs to represent this process — your ambiance, your hospitality, your communication skills, your body language, the quality of your team in terms of behavior as well. And these things, unfortunately — and I repeat the word unfortunately here — are usually even more important than the quality of the treatment for at least the short-term success.” (7:17—8:32)

“Steve Jobs had a quote that is more or less like this. He says that the most powerful people in the world are the storytellers because they generate change. So, when I listened to that quote, he’s saying that it’s not the doers that are changing the world, the people that are actually doing something. Before them, you need a storyteller creating the inspiration. They are the ones, at the end, that are making people embrace the change. So, every great project, every great practice, needs a very good storyteller.” (8:54—9:35)

“We know that idealistically, philosophically, what really matters is our internal value. But the shortcut to succeed is to learn how to transmit this value. If we can, every day, invest a few minutes to try to imagine our day tomorrow, try to forecast, try to predict the key moments of tomorrow — just a day, tomorrow. It can be a normal day. But maybe you have an important discussion with your assistant. Maybe you're going to have to cover an important topic with your son. Maybe you're going to have to talk about a complex topic with your wife. Maybe you're going to have to interview somebody. Maybe you have a patient that is a little tougher than the average patient. You know that's going to happen tomorrow, so you have the chance to prepare for these moments. And you invest a few minutes, and I mentioned the shower because I like to do this exercise in the shower. So, as you're having a shower, you're thinking about tomorrow, and you're identifying those one, two, three moments that can be a key moment of your day that you can easily not think about. But if you think about it, it allows you this chance to mentalize the moment, to predict the moment, to build the moment in your head, to try to anticipate, what are the challenges that that moment will bring? What are the barriers that the other person will have when listening to you, or the topics that will create friction, that will create stress?” (10:56—12:45)

“If you put a little bit of energy, you can almost identify, anticipate, most of the issues that you're going to have in the key moment of your day tomorrow. And by anticipating this, you can build a strategy in advance. Building a strategy in advance is basically building the communication process to create value in your words, to create the perception of value. So, it’s not about you knowing that you're right, you knowing that you have the answer, but it’s you putting yourself in the other person’s shoes and trying to understand how to make that person at least respect a little bit more of what you're going to say.” (12:46—13:26)

“My goal is never to convince everybody. It’s not about convincing everybody. I think it’s about increasing the chances of people respecting a little bit more of what you're saying, even if they don't agree with it. They say, ‘Christian, I actually don't agree with you. But the way you're putting this and the way you're explaining yourself makes me think, and I'm at least respecting what you're saying.’ That makes a huge difference. And for me, this is the shortcut to achieving your goals. This is the shortcut to building projects. This is the shortcut to grow. This is the shortcut to empower partnerships and collaboration. This is the shortcut to empower staff members. This is the shortcut to avoid problems, [mis]communication, and stress.” (13:27—14:12)

“We’ve been talking about AI — not in dentistry, in life, in general — for many, many years. And why, suddenly, a few months ago, boom, ChatGPT and things like this? I was thinking about it. And in my non-AI specialist humble opinion, I had an aha moment why a tool like ChatGPT is so disruptive. It’s because it’s not only about information — Chat GPT tells stories. It’s actually a very well-written answer. If you asked AI in the past, you could search on Google, ‘I want to find this,’ and Google will give you the links, and the topics, and the explanations there in a very direct way but not transforming that information into a beautiful paragraph. ChatGPT creates an answer that looks like a human. Why? Because it looks like there's somebody thinking and putting a story together. That's why I think this is so disruptive. That's why everybody is feeling so threatened that suddenly AI is going to substitute us, because suddenly AI is telling stories about the information.” (14:44—16:06)

“The more you understand about emotions, human behavior, communication skills, persuasion, body language — [there's] so much content out there about that, showing that if you master all of these tools, you become more powerful. You can influence more people. You can make people change their minds. You can make people change their priorities. You can make people give up on certain things and adopt other new things. You have an impact on people. The better communicator you are, the bigger the impact you have on people, period. That comes with responsibility. And, of course, we can use examples of people that are great communicators without responsibility or good intentions. Many, unfortunately, politicians do that. They master communication. They become very good with persuasion, and they don't have your best interest. So, I believe that to make myself comfortable with investing in communication skills, to make myself ethically supported, I need to always remind myself that every little thing that I learn about how to communicate better makes my job harder in terms of being more responsible for everything I say and everything I do.” (19:47—21:16)

“There's a saying in the book, The Little Prince, that says something like, the more you captivate people, the more you fascinate people, the more responsible for them you are. That's so beautiful. When you make somebody like you a little bit more, when you make somebody admire you a little bit more, you are a little bit more responsible for that person, and you need to take that very seriously. And if you have that in mind, that really makes you think more and more about your behavior, your attitude, and everything you do towards that person because you already brought that person to your side. You made that person like you a little bit more. And this is something that I like to always remind myself of. When people say, ‘Christian, you are a good communicator,’ I immediately try to think about that. If I'm a better communicator, I need to be even more careful about people, about what I say to people, and about the influence that I have on people.” (21:19—22:25)

“Your treatment plan needs to be the most ethical treatment plan possible in the world. I usually use the example, the daughter test. You know you are a very good communicator. You know you can convince the patient. You build that beautiful treatment plan. You're full of confidence. Of course, we have the financial side in our head saying, ‘You're going to sell this $80,000 treatment plan,’ and you're super excited. You need to hold that for a minute and do the daughter test. What is the daughter test? It’s to pretend the patient that is walking in is your daughter. You look at your daughter with the exact same problems and clinical situation, and you look at your treatment plan, and you ask yourself, ‘Would I do this on my daughter?’ And if you're not 100% sure, don't use your communication skills to convince the patient.” (22:50—23:48)

“Let's say we could define what makes patients say yes. If we could dissect the “yes” and divide the yes into pieces and say, ‘Seventy percent of the yes comes from here. Thirty percent comes from there,’ I believe that at least two-thirds of the “yes” of patients comes from nonclinical aspects. So, the perceived value creation, the experience, the emotional connection, the fascination, the link, the relationship building, the trust building, in minutes, in one appointment, because everything needs to be happening before you present the plan. So, all this magic needs to happen, and two-thirds of that, in my humble opinion, comes from nondental things. But one-third of it still comes from dental. That's when you can really top this amazing experience with a very different way of explaining the actual clinical vision, the clinical plan that you have for the patient. And that's through what we call visual storytelling.” (24:37—25:55)

[Visual storytelling] is translating a boring treatment plan — and I say boring because everybody that is not a dentist thinks that dentistry is boring, and they don't want to talk about dentistry. So, if you talk about dentistry as a dentist and you present treatment plans like everybody does, you're working against yourself. You're diminishing the chances of people actually engaging with it. So, if we know that nobody likes to go to the dentist, it means that everything that we do that makes people feel like they are at the dentist’s works against us. That's basically the rule. Everything that you can do that makes the experience not look like a dental experience is a smart thing to do — absolutely everything, anything. If your practice smells like a dental practice, that's working against you. If you're even looking like a dentist, if your team looks like a dental team, if the front desk — everything. Whatever you can change works in your favor, including the process of presenting the plan.” (25:56—27:01)

“You need to translate your [treatment] plan. You need to change your treatment plan presentation from two perspectives. First, you need to change your dental language into a language that people actually connect with. Second, you need to translate your vision into a visual presentation. So, we know that every smart person that wants to convince somebody else of a project, they build a slide presentation. Treatment plans should be presented like any business project is presented, with a few cool visual slides that can make the nonexpert understand your vision and make that person embrace your vision. This is what we call visual 3D storytelling. And this is when 3D technology comes in. This is when working with your lab, transforming your lab into a content generator is key. So, your lab needs to support you with storytelling. Your lab needs to support you with images to allow you to tell a cool story. You need to learn how to ask for the right images from your lab because they have the software. They have the technology, not you.” (27:07—28:28)

“Let's say you want to tell the patient that their chin is too far back because the bone behind is not supporting it. You show the face in 3D, and you have the CBCT behind, and you put transparency on the facial image, and you show the position of the bone and the thickness of the bone, and you trace some lines. You draw over the picture, then you overlap the intraoral picture with the X-ray, the CBCT, the ideal design, and the 3D simulation of the ortho simulation. So, everything needs to be visual. That's completely, directly related to the first question, perceived value. I would say that this is one-third of the magic. Two-thirds of the magic is the nonclinical connection value, perceived value generation. One-third is the visual, clinical, 3D, perceived value generation.” (28:54—29:47)

“The shortcut to success is understanding how to translate your real value into perceived value. But the definition of success is very tricky. The success that we are [talking about] here is the exterior success, the business success, the professional success. And we talk about professional success because it’s very important. You cannot deny that succeeding in the world is important. But, at the end of the day, without being successful internally, meaning everything that nobody knows, everything that nobody cares [about], everything that has nothing to do with anybody else — that is the real success, when you're successful inside yourself, with yourself.” (34:11—35:01)

“Commercially speaking, we talk about the exterior success. But we cannot forget the balance, and we cannot forget that, at the end of the day, happiness comes from first having your inner success.” (35:08—35:24)

Snippets:

0:00 Introduction.

1:55 Dr. Coachman’s background.

2:54 Real value and perceived value, explained.

5:50 People buy emotional experiences.

8:32 The power of story in perceived value.

10:29 The shortcut to overall success.

14:14 Why people feel threatened by AI.

16:07 The optimism and silver lining around AI.

19:16 Communicate responsibly.

22:26 Do the “daughter test”.

23:50 Make the invisible visible.

27:07 Use visual 3D storytelling.

30:19 The story of Digital Smile Design and its future.

32:58 More about DSD and how to get in touch with Dr. Coachman.

33:57 Last thoughts about real value and perceived value.

Dr. Christian Coachman Bio:

Combining his advanced skills, experience, and technology solutions, Dr. Christian Coachman pioneered the Digital Smile Design methodology and founded Digital Smile Design company (DSD). Since its inception, thousands of dentists worldwide have attended DSD courses and workshops, such as the renowned DSD Residency program.

Dr. Coachman is the developer of worldwide, well-known concepts such as the Digital Smile Design, the Pink Hybrid Implant Restoration, the Digital Planning Center, Emotional Dentistry, Interdisciplinary Treatment Simulation, and Digital Smile Donator.

He regularly consults for dental industry companies, developing products, implementing concepts, and marketing strategies, such as the Facially Driven Digital Orthodontic Workflow developed in collaboration with Invisalign Align Technology.

He has lectured and published internationally in the fields of esthetic and digital dentistry, dental photography, oral rehabilitation, dental ceramics, implants, and...

Membership Plans: Automation & Intelligence

Episode #579 with Kirk Behrendt & Dave Monahan

Patients want dental care, but they feel that it’s too expensive. Employers want to offer dental care, but they feel that it’s too complicated. Dentists want to provide dental care, but PPOs are getting in the way. How can we solve these problems? It’s called a membership plan, and it’s the solution to providing easier, affordable, more transparent care. To explain how it works and the intelligence behind it, Kirk Behrendt brings back Dave Monahan, founder and CEO of Kleer, a platform to liberate dental care for patients and dentists. With a membership plan, everyone wins! To learn more about Kleer and the benefits of offering a membership plan, listen to Episode 579 of The Best Practices Show! 

Episode Resources:

• Dave’s email: [email protected] 
• Mention ACT for a special offer! https://www.kleer.com/partner/act-dental
• Kleer’s Facebook: https://www.facebook.com/KleerLLC
• Kleer’s social media: @kleerllc
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Kleer Intelligence: https://www.kleer.com/kleer-intelligence

Best Practices Show Episode 578 with Shelley DeGroff: https://www.youtube.com/watch?v=VIXlupM40DA

Main Takeaways:

Incorporate a membership plan to increase revenue.

Membership plans will increase uninsured patient visits.

You will have recurring revenue with a membership plan.

A membership plan will help you move away from PPOs.

Investors will pay much, much more for subscription practices.

Quotes:

“A membership plan will improve patient engagement, the retention, and the revenue you generate from your uninsured patients. That's typically the number-one reason to do a membership plan. Most practices assume their uninsured patients come in, accept treatment, and everything is great. If you actually pull the data out of practice management systems, uninsured patients, on average, come in once every two years. Let me say that again — once every two years. And they accept half the amount of treatment of your insured patients. And so, it looks great when your insured patients come in and accept treatment, and you use your UCR maybe with a discount, and things like that. But you can make that so much better if you focus on those patients and gave them what they want.” (4:08—4:53)

“So, what do [patients] want? Well, we've done a lot of research. We actually did interviews of uninsured patients. We did focus groups. We did a national survey. They want care. So, they value oral care. They actually relate it to their overall health, their quality of life, and their longevity. So, they get it. They get that oral care is very important to them. They don't come in because they're afraid of the cost and they don't have a plan. They feel exposed when they walk into your dental practice. They're unsure. And pricing in the dental market is anything but transparent, so they don't know what they should pay. So, what do they do? What's the reaction to that? They don't come in. So, that comes back to the coming in once every two years and accepting half the treatment.” (4:53—5:38)

“The first value proposition is, get those [uninsured] patients to come in more often. If you give them a membership plan, it’s a simple subscription. It includes preventative care. They come in a lot more often — like two to three times more often. They accept two to three times more treatment. You create a loyal patient that comes in more often and accepts more treatment. It works over and over again. It’s amazingly consistent how well it works.” (5:39—6:05)

“[Value proposition] number two is, you can create a nice recurring subscription revenue source in your practice. On average, on our platform, our practices charge $372 a year for their subscriptions. So, if you do some simple math and you add 300 patients to your membership plan, it’s over $100,000 of recurring revenue. A lot of our practices build up that recurring revenue and they use it to pay their recurring bills like their office lease or their equipment lease, things that are recurring in their practices. Their subscription offsets that, and they can rely on that revenue. You know it’s coming in, year after year, because of the high renewal rate on membership plans. So, that's really nice to have.” (6:08—6:52)

“The third [value proposition] is reducing your PPO dependence. Most practices, about 75% of their patients use PPOs. We’ve done a bunch of measuring of these, and about 50% of those PPOs are unprofitable for a dental practice. And I know everybody is feeling this pain. It’s getting worse and worse as costs go up in a practice, and reimbursement rates go down. At some point, you're crossing into unprofitability for these PPOs. And some of them are very unprofitable. You can start moving away from those PPOs. We never say just run away from the PPOs. You've got to manage it . . . If you can start that journey and maybe drop the low production, low profit plans, and move a membership plan in, you can start that journey of moving away from your PPOs.” (6:58—7:51)

“When you have a new patient come into your practice who is uninsured, the reappointment rate, on average, for those patients is about 45%. If you put them on a membership plan, it’s 100%. So, you can move from a reappointment rate of 45% to 100%. If they buy a membership plan, I guarantee you they are coming back. It’s a great way to get insurance on those new uninsured patients. And by insurance, insurance that they are going to come back. And I think, on average, a practice spends about $400 per new uninsured patient that walks into their practice. So, you're basically making sure that patient comes back.” (7:55—8:29)

“On average, a practice has about 2,000 dormant patients in their practice management system. These are patients that came in at some point and haven't come back in 18 months. Those patients typically don't come back because they don't have coverage. They're much like the uninsured patients I described earlier. And so, if you get them on a membership plan, those dormant patients will reactivate and start to become loyal patients to your practice. So, I know it’s a lot, but there's a lot of value that you can create in your practice through a membership plan.” (8:36—9:04)

“For our practices on our platform, one thing that distinguishes Kleer from some of the other systems out there is, we actually measure results for a practice. So, we integrate with practice management systems and then pull the data back. And I'll give you the average on our platform of what a membership plan looks like compared to an average uninsured patient. They’ll come in twice as often. It’s almost right on that number. It might be a little lower than that, or a little above it, but on average, it’s two times more often. So, a membership plan patient, on average, comes in three times a year, whereas an uninsured patient comes in one-and-a-half times a year. So, it has a major impact on their visits.” (9:45—10:23)

“An uninsured patient will accept about 2.2 procedures a year and get 2.2 procedures completed in a year. A membership plan patient will accept 5.4 procedures a year. So, it’s well over two times more procedures that are accepted. What that all translates to is actually, from a revenue perspective, a membership plan patient will generate almost three times more revenue per practice. So, a membership plan patient will drive about $1,000 a year in revenue for a practice, whereas an uninsured patient will be about $370, $380 a year. So, it has a major impact.” (10:28—11:08)

“A membership plan patient, the preventative care is embedded in the plan. So, let's say you're paying $30 a month. You have your two cleanings, your exams, your X-rays embedded in that. The patient doesn't need to pay more for that. That's part of the subscription. So, what happens? They come in for their preventative care. So, they get their cleanings. They get their exams. They get their X-rays. And then, where does treatment come from? It comes from the hygiene appointment. About 75% of all treatment comes from hygiene appointments. And so, they’ll get their crowns or fillings, their whitening, things like that. So, it builds on itself. You build a subscription revenue, a recurring revenue model, patients come in more often, they accept more treatment, and it builds on itself.” (11:12—11:59)

“Our platform has a bunch of automation features in it from the get-go. So, from the very beginning, we have things like auto-renewal. So, a patient joins. They're put into auto-renewal, which means when they come up for renewal their membership plan automatically renews. They can opt out of it if they want. The practice can opt out a patient if they want as well. But what ends up happening is that automatic process and the patients agreeing to it drives about 75%, 80% renewals on your membership plan. It’s automated. Nobody needs to do anything. You don't need to call the patient. You don't need to email the patient. You don't need to recollect their credit card information. It just happens.” (13:40—14:14)

“We see about nine percent [of credit card] expirations. And basically, what you end up having there are some exceptions. In our example, when a credit card expires, the notification is sent to the patient and to the practice that this is expired and there's action to be taken. And so, you're handling the exceptions, and then 92% is going through automatically, which makes the job much easier. So, you have things like that. You have things like subscription payment processing happening in the background. You have these notifications happening, like I've described. There are lots of legal notifications that are required. You have things like receipts going out automatically, and all that stuff.” (14:26—15:09)

“[Automation] saves you time and money because it’s not cheap to have somebody enter information manually. That is an expensive — it’s hidden, but it’s expensive. We asked the office teams, ‘Do you like doing this?’ The obvious answer is, ‘No, I hate it.’ Who likes entering data into a system? It’s not fun. And so, they're happy that they can go do other things. It’s both saving money and time, and then, also, it’s a team satisfaction thing. It makes them feel better that they don't have to do that type of work.” (18:05—18:40)

“The data I referenced before, it doesn't matter if you're a PPO practice or a fee-for-service practice. Your uninsured [patients] are coming in about once every two years, and they're accepting about half the amount of treatment as a membership plan patient. So, it is what it is. And I don't care if you're fee-for-service or you're not. When you look at the data, that's what it says.” (19:07—19:27)

“This is the really interesting part about the discount. We actually measured fee-for-service practices and looked at the discounts that they're providing. It’s 10% to 15%, on average, because they give day-of-care discounts, and it adds up. It adds up fast. And the thing that is not smart about that is you give that away for free. You say, ‘If you get this treatment today, I'll give you a 10% discount.’ The patient is like, they're probably going to need treatment anyway, ‘Okay. Why not?’ I mean, they got the treatment. But you didn't ask them to commit any longer than that treatment. So, what's going to happen next time? What is that patient going to wait for? . . . So, now, there's a game in hand, and they know the price is not the price. They know they're now negotiating. But you haven't answered anything back except for, ‘I'm giving you a discount if you accept treatment,’ and therefore, I've trained you to ask for a discount every time you need treatment. Wouldn't it be better to give them a membership plan where you're giving a 15% discount — so they're getting that discount — but they're now committing to care? They're committing to coming in. They're committing to paying a subscription. And we also know they are going to come in and they are going to accept twice the amount of treatment. So, it’s a give-get. And that makes sense versus just throwing discounts at them.” (19:29—20:58)

“I don't think you want to [discount 15%] unless you get something in return. That's my feeling about it. For me, yeah, I'll give that 10% to 15% if the patients are committing to something longer term. The membership plan, I'm committing to at least 12 months. And then, if you do it right, you'll get at least 80% renewals on that. Plus, you'll get two times the amount of treatment accepted. So, it’s not like the patient is sitting there going, ‘I'm going to accept twice the amount of treatment. I'm going to come in twice as often.’ But you know it's going to happen. You know it. And so, you're getting them to commit to something of value to you, and you're giving them a discount, which is of value to them.” (21:46—22:25)

“From the patient’s mindset, it’s two things when they look at a membership plan. Yeah, they like the discount. Who doesn't? Nobody doesn't like discounts. But the other side of it is, they want care. They want access to care. They want it to be transparent. They want to know what they're going to pay. They'd much rather pay $30, $40 than come in and be surprised by a $400 bill. The psychology of that has been proven. So, you're now making it transparent. You're making it affordable. I understand what I'm going to be paying. I understand what I'm going to be getting. It’s a good deal for the patient, and they accept that, and then they commit to it. So, there are a lot of dynamics there from the patient’s perspective. It’s not just about the discounts. It’s access to care and transparency as well.” (22:26—23:11)

“I don't have proof of an investor coming in and paying this, but what the average is on subscription businesses versus non-subscription businesses is investors pay three to five times more for a subscription business than a non-subscription business. So, let's say you have a fee-for-service practice and it’s doing $1 million a year and it’s all fee-for-service. It’s one-off. There are no subscriptions. Or you have a $1 million practice and let's say $500,000 of that is a subscription revenue business and it’s something that's proven. It’s been in place for a few years. They’ll pay three to five times more for the $500,000 piece of that business than they will the other $500,000 part of that business. Why? It’s really simple. They know they're going to get that revenue in the future. They know those patients are coming back. They can put a value on that. They can see renewal rates going into the past and what they can expect. So, you put a much higher value on the practice by having that recurring subscription business.” (23:52—24:45)

“If you get the implementation wrong, it’s trouble. We measure the performance of our dental practices all the time, every day. We know how well they perform, what makes them perform well, and what doesn't. The number-one factor on success or failure in a membership plan is the first 60 days, roughly. And what does the first 60 days actually get driven by? Well, first, the design of the membership plan and the pricing of the membership plan. You've got to get that right.” (25:29—25:59)

“The [practices] that were really successful weren't the highest priced ones. But they weren't the lowest priced ones. What they were was somewhere in between where there was basically a place where it was profitable for the dental practice, but also, the patient looked at it and said, ‘Hey, that's a pretty good deal.’ The ones that were priced really low, the patient looked at it and said, ‘That's cheap. There's something wrong, and I don't buy into it. It’s a trap.’ The ones that were priced really high, obviously, you exclude a certain amount of patients. So, you've got to get that price just right. We have something called Smart Pricing that will take your fee schedule and all the data we have on our platform for all the practices, and it'll come up with a range of the right pricing for your membership plan. It'll give you a range, let's say, from $28 to $32, something like that, and you need to pick what you want to do on that range. Do you want to be more aggressive and have higher volume, or go a little higher and have less volume? So, you've got to get that right.” (26:06—27:04)

“You also have to get the plan design right. So, we can have an infinite number of care plans, but we don't suggest that. We suggest three to five care plans. One for a child, one for an adult, one for perio. If you have older patients, maybe one for senior care. And then, if you have children, maybe multiple plans for children. And you customize treatment inside those plans for those patients sets. You've got to get that right. And our team, the success team, will actually, to get the pricing right and also to get the care plan design right, we’ll talk to you. We’ll understand your practice, the treatment philosophy of your practice. Some like fluoride. Other practices don't like fluoride. Fine. We’ll build that in, your preference from a treatment perspective. We’ll look at your patient demographics. We’ll figure out what type of care plans you need based on our experience. We’ll help you price them. So, you've got to get that all right.” (27:04—27:53)

“You also have patients coming in who own small businesses. You can start there and talk to your patients. Ask them what do they do for a living, and they're like, ‘I own a small business down the street. It’s a construction business.’ ‘Oh, great. Do you have dental benefits that you offer?’ Most of them will say no. Sixty percent of small businesses do not offer dental benefits. ‘Would you like to offer dental benefits?’ Almost all of them are going to say yes. Eighty-four percent will say, ‘Yes, I would like to do that. But it’s too expensive. Too complicated.’ Say, ‘I got your answer. I have this subscription plan you can offer to your employees. You can decide, as an employer, how much to contribute to the subscription.’ It can be $5. It can be $10. Whatever an employer can afford, they can put into the plan. And then, our system will, basically, once you set that up and the employer agrees to how much...

Difficulties in Credentialing

Episode #578 with Shelley DeGroff

Episode Resources:

• PPO Advisors: https://ppoadvisors.com
• PPO Advisors Facebook: https://www.facebook.com/PPOAdvisorsLLC
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

PPO Advisors blog, “Case Study Shows 21% Fee Schedule increase after renegotiating PPO Contract”: https://ppoadvisors.com/case-study-shows-21-fee-schedule-increase-after-renegotiating-ppo-contract

Main Takeaways:

Credentialing is no longer a simple process.

Understand why it’s important to get credentialed.

Consider going fee-for-service and PPO in a hybrid model.

Don't go in-network with every insurance or the wrong insurance.

Understand the stacking order and the Most-Favored Nations clause.

Steer clear of NPI fraud! You will be caught, with heavy consequences.

Quotes:

“Why do we credential? Well, we credential because most of our patients that we see anymore have insurance and they want to go to an in-network provider. The statistics are changing though. It used to be where there was only seven percent fee-for-service the last couple two years. That statistic has changed and we’re growing to see more and more fee-for-service, which is great. I like seeing that. The latest statistic is around like 18, 19% fee-for-service practices back into the U.S. But still, we have a ton of providers graduating out every year, and there are more and more providers building their own practices, joining as associates, and they need to be busy. And so, the “why” there is getting in-network with insurances and credentialing and becoming an in-network provider.” (2:20—3:08)

“Becoming a credentialed provider, it’s a process. It’s a process that has gotten increasingly difficult over the years. They don't make it easy. They don't want it to be easy. But they do want you to be in-network, and they really push for providers to be in-network and for patients to go to in-network providers. Now, the insurance companies send their EOBs out to the patients with, ‘If you would've gone to an in-network provider, your savings would have been X. Here’s a list of five providers in your zip code.’ They're promoting in-network. So, it is really hard to stay fee-for-service or to not go in-network. But we certainly don't want people to go in-network with the wrong insurances just out of fear either.” (3:11—3:49)

“My personal hypothesis [for why fee-for-service increased from seven to 18%] is COVID-19. Right before COVID-19, we were seeing seven percent. Now, it’s 18%. So, that gave providers time to look at how insurance was impacting their practice when they were shut down. They were looking at contracts. They were looking at their dollar values and saying, ‘This isn't working.’ And a lot of providers started to drop.” (4:19—4:43)

“I really see more of a hybrid. I think we’re not going to see that full-on fee-for-service structure just blow up, but a hybrid of dropping lots of PPO plans that are not working for practices and keeping just a very few in-network policies. I think that's the new way that everybody is going to start to trend.” (4:52—5:12)

“[The credentialing process] takes a long time, much longer than what you're going to anticipate as a provider. So, associates that are graduating this month, most providers that are getting ready to graduate, they're not going to actually get their license until June or July. They can't even start the credentialing process until they have a license. And that means, from there, it’s going to take an additional, with the insurance companies, 30 to up to 120 days — 30 days at best, which we rarely see a contract go through in 30 days. That's not normal, especially for a brand-new provider.” (5:21—6:00)

“When you go through the credentialing process, they are verifying that you don't have malpractice, that you truly do exist, that you have a dental license, and there's nothing risky about you as a provider being in their network. So, the vetting process that first time definitely takes a lot longer than your second go around with either a recredential or going back into network after deciding to have termed maybe several years ago. So, new providers, they really need to expect, especially if they're going with umbrella companies or third-party contracts, that process always takes about six months. That's the number I'm going to give you.” (6:00—6:42)

“[Submitting claims under someone else is] very dangerous — NPI fraud. So, right there, you're committing NPI fraud. NPI fraud is identity fraud. It’s a fraud where you are saying, ‘I'm a provider of service, and this is my claim that I am submitting as the provider of service who did all the work,’ when you weren't that provider. So, now, the insurance companies who you know data mine every single thing you submit — they know how many claims, on average, a provider is submitting in, the types of procedures that they typically do on a daily basis — they have an idea of exactly how this practice functions. And then, all of a sudden, all of that doubles because the provider is now submitting claims in as the associate as well. They find that out immediately. And that is when they start digging in, red flagging the practice, and start to look at things.” (7:09—8:02)

“Most practices get caught on NPI fraud through a Medicare of a Medicaid audit first. And then, it explodes from there. So, those RAC audits that the Medicare and Medicaid sent out, that's where those get caught. And so, when you are doing NPI fraud, identity fraud, and you're defrauding the government, they like to make a case out of you and scare everybody else. So, it’s definitely something you want to stay away from. It’s very easy to catch NPI fraud.” (8:03—8:36)

“I see [NPI fraud] a lot. I hate to uncover that, but I see it a lot. There are small cases where we’ve had instances where an associate has been submitting under an owning doctor for a little bit, and an insurance company catches it — because you know what the insurance companies are doing. They're trying to recruit providers. So, they're looking at directories on websites and saying, ‘Well, I don't have that doctor on our register. Why is it listed on their website?’ And so, then they're calling, and they're saying, ‘Hey, do you have more providers than just doctor so-and-so?’ And in those cases, when a recruiter is trying to find doctors to get their quotas, and they use that to their advantage, let it slide, get them credentialed, and will just forget that that ever happened. Unfortunately, that's how the system works. There are other cases where the [NPI] fraud is so big, it was caught by a RAC audit first, that these providers are basing prison time, fines that they can't recover from, loss of license, forever. There are some big red flags that go with this. So, we certainly don't want to encourage providers to even play with the idea of it.” (8:46—9:59)

“For those new providers coming out of school, no, [there's not a lot you can do until the credentialing process is complete] because they don't have a license. So, there's nothing that can be submitted until the license is in. But for providers that are switching associateships and they’ve been credentialed in the past — no. I mean, it’s still going to take time to get them credentialed. It may not take as long, but they can at least start the process significantly sooner. So as soon as a letter of intent is signed with an associate that has all of their credentials, their license, their DEA, all of the things that are needed, then the credentialing process can start. So, even if that contract for the associate doesn't start for 90 days down the road, still start credentialing them so that that timeframe is narrowed down.” (10:12—10:58)

“The other thing is, providers can see patients as out-of-network. There's that thought of, ‘Well, for out-of-network, we just can't see anybody. They can only see the fee-for-service patients,’ and that's not true. They can see patients that are in-network as an out-of-network provider. Out-of-network benefits will be utilized, and you can give insurance patients a discount so long as the discount is shared with the insurance company. So, you can put on the claim form that we’re providing a 10%, 20% discount to the insurance patient to offset that out-of-network benefit that they're utilizing. So, there are ways to work with patients so that they understand that, ‘Hey, this is what's going on,’ and the practice is taking care of the additional out-of-pocket expense that they're taking on to be seen as an out-of-network patient.” (10:59—11:53)

“There are so many plans out there, and it’s overwhelming. This fear of, ‘We need to be in-network with everybody so that we can gain as many patients,’ is really not what I want our clients to be doing. I want our clients to credential with what is necessary for their demographic to be successful long-term. Meaning, looking at insurance companies that negotiate, insurance companies that have a record of increases annually, or at least every two years, that are substantial enough to keep you at a sustainable rate. This going in-network with everything because one patient asked for you to be in-network sometimes doesn't make sense.” (12:03—12:44)

“There's a connection between all of the insurance companies. They're all connected one way or another. So, when a provider says, ‘Well, yeah, I'll go in-network with your insurance companies,’ you may also be going in-network with six, seven, 20, 30 other insurance companies from that one agreement. And that's where then you start to really fall into the cycle of, ‘Now, we’re in-network with everything. We don't know where it’s coming from. The fees are getting out of control, and you start to feel overwhelmed. So, we don't want providers to just blindly decide, ‘This is who we’re going in-network with.’ There needs to be a “why”. Why am I going in-network with this insurance company? There are X amount of employers that have this insurance company in my area.’ Typically, you want the city’s insurance. You want school’s insurance. You want the hospital’s. Typically, the fire department’s and the police department’s fall under the city. So, those big employer groups, look into those in your demographic. Know who their insurance is with and start there. And then, figure out those contracts, ‘What else am I getting from those?’ before we start this spiral of accepting everything.” (12:45—13:58)

“The insurance companies should give you a payer list when you sign up to be in-network with them. So, when you sign up with Guardian, they send you a fee schedule and their payer list, all of the other insurances you get, but being in-network with them. So, on a yearly basis, you should be asking for the payer list from the insurance company so you have an idea of what new networks have come into play, which ones may have fallen off. And that's with every insurance company. So, all insurance companies have a payer list. Most of them don't give them out unless you're asking for it. So, it’s super important to have a copy of those.” (14:16—14:56)

“[Look] at your EOB to verify how the claim was paid. And that goes back into when I talked about the Most-Favored Nations clause. I don't know if you remember that last quarter, but the Most-Favored Nations clause is what gets every office without them even knowing. It’s where these insurance networks that are all connected — they're all connected one way or another. Aetna shares to Guardian. Guardian shares to Principal. Principal shares to Ameritas. It’s all one big web. So, once you sign an agreement with one and it’s shared to another, they have the ability to default to the lowest fee schedule in your practice. So, if you're not stacking your contracts and making sure they're paying off of the fee schedule you want, it’s an uphill battle. You're never going to get ahead.” (14:57—15:46)

“The Most-Favored Nations clause, it’s huge. It really covers everything. It is an agreement that allows other shared agreements within one agreement to share their information, and fee schedules, in dental. So, that’s how it all comes into play for us. But a lot of people don't think Most-Favored Nations clause even applies to dental. ‘That's a government thing. That has something to do with something bigger than us.’ And no, that's not the case.” (16:07—16:35)

“There are so many ways to contract. We have direct contracts, which are going to be directly going with that company. So, that's me as a provider directly going to Aetna and saying, ‘I want to be in-network with you, with you directly,’ and Aetna says, ‘Here’s my contract. Here’s the agreement. You'll be credentialed with us in 10 weeks.’ Or as a provider, I can go to Connection Dental. And it’s one of the largest umbrella companies or third-party administrators, so you'll hear TPAs used a lot. You can go to Connection and say, ‘I want to be in-network with Connection.’ And through Connection, I'm going to grab Aetna, Ameritas, Principal, UnitedHealthcare, Guardian, and on down the line. So, now, I'm in-network with multiple insurances through one contract, one fee schedule. And there are so many ways you can use that to your advantage, but there are so many ways that it hurts a practice because they don't understand the stacking order and that Most-Favored Nations clause coming into effect.” (17:04—18:07)

“When a provider goes in-network with Aetna and Guardian and Connection, now there are three ways Aetna can be picked up. It’s picked up directly, it’s picked up through Guardian, it’s picked up through Connection. So, now, Aetna is going to look at all of those agreements and see which one is going to pay less. So, even though they’ve got a really good fee schedule negotiated with Aetna when they originally signed up, Guardian may be less, and so they're going to pay those claims that way. So, it’s figuring out, ‘Wait, I'm over-credentialing. I'm already in-network with so many plans. Maybe I shouldn't be picking up this contract because it’s going to override a different contract.” (18:07—18:49)

“Unfortunately, that's a double-edged sword. We can go direct for a lot of good reasons. Some of the direct contracts have incentive plans. Some of the direct contracts — they're always going to credential faster than a third party. So, a lot of providers that are going through acquisitions or are in a huge hurry to get credentialed, they feel going direct is a better route because it’s significantly less credentialing time. But on the flip side of that, their fees, directly, are typically not as competitive as third-party fees. Now, that's not always the case. Every demographic is different. So, a provider who’s going to do their own credentialing really needs to know how they can pick up each insurance company so that they're looking at all of their options and deciding from there, ‘This is how I'm going to credential. I'm going to credential with these six companies through this one third-party contract, and then I'm going to go direct with MetLife, and I'm going to go direct with Humana,’ because they don't pick up through the third party or their direct contracts are better contracts.” (19:11—20:21)

“A direct contract sometimes traps a provider. So, it used to be you can get out of a contract whenever you wanted. You still can. You can still term a contract. It takes 90 days to term a direct contract. But these direct contracts are now putting stipulations in where if you term them directly, it’s at their discretion to put a block from you getting picked up through a third party if they want to put that block in place. And so, now, it’s not as black-and-white as it used to be. It used to be a no-brainer. I can term whenever I want. I can readjust this contract over here. Now, we have to really look at the big picture to make sure — that door may not open down the road. So, I wouldn't risk contracting direct because of the way their clause is written. I would go indirect for that purpose. So, those are the things that we look at when we’re credentialing a client.” (20:38—21:33)

“I think the idea was, five years ago, as a young provider, ‘I've got to be in-network with everything in order to build my practice up as quick as possible to catch up to the guys or gals that have been doing this for a lot of years and be competitive.’ Now, we’ve really got to look at what that write-off looks like first. The national average write-off is 45%. That's a big write-off. And overhead costs have jumped. It used to be 67%. Now, it’s 74%. That's a big jump. So, as a new dentist, a young dentist, with overhead as high as it is and write-offs as high as they are, honestly, needing to be that hybrid doctor where we’re fee-for-service for some of these big players because it just doesn't pay to take that 50% write-off is actually going to help you become a better sustaining practice than just accepting every insurance company.” (22:21—23:18)

“We see the trend changing. It went from seven percent fee-for-service and it’s jumped all the way to 18% in the last couple of years. So, I do feel like that number is going to continue to grow. But I'm going to see it grow, hopefully, more in a hybrid model where providers that have been heavy PPO starting to come in and drop a lot of their insurances that just don't make financial sense for the practice anymore. And then, we can strategically make the plan of, ‘These are the insurances that need to go. These are the ones we keep,’ looking at the ones that will continue to negotiate over the next couple years that will allow them to get out of contracts. All of those will go into play here. And then, as they continue to drop a few, you'll continue to do that over the course of several years, and then maybe hit that fee-for-service model. But it’s not something you want to jump into, in my opinion.” (23:19—24:11)

“[Forty-five percent in write-offs] means that you have a full-fee service. So, your full fee, your master fee for your practice, is $100 for a prophy. Obviously, I'm just throwing out easy math here. One-hundred dollars for a prophy. But if the write-off level is 45%, that means you're only paid nearly half of that. You are writing off half of what you do at 45%.” (24:46—25:13)

“Everything is going up. Employee costs are going up. Have you been on Facebook threads, all these threads of, ‘Front office came

Disease Prevention & Wine Tasting

Episode #577 with Kirk Behrendt & Katrina Sanders

Your practice can save lives. With routine care and education, you can help patients prevent many of the diseases they present with. So, how can you make the most of this opportunity? Today, Kirk Behrendt is back with Katrina Sanders, The Dental WINEgenist, to share advice for building value to the preventive care and treatment you provide. Help your hygienists do what they were trained for! To hear more about Katrina’s course and how it can help you optimize disease prevention, listen to Episode 577 of The Best Practices Show!

Episode Resources:

• Katrina’s website: https://katrinasanders.com
• Katrina’s email: [email protected] 
• Katrina’s Facebook: https://www.facebook.com/katrina.sanders.948
• Katrina’s social media: @thedentalwinegenist
• Tooth or Dare social media: @toothordare.podcast
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Register for Katrina’s next Disease Prevention & Wine Tasting course (October 5-6, 2023): https://www.eventbrite.com/e/act-dental-hygienists-live-course-october-5-6-2023-tickets-368595568267

The Trust Edge by David Horsager: https://www.simonandschuster.com/books/The-Trust-Edge/David-Horsager/9781476711379

Main Takeaways:

Trust is the currency of business, and core values are the pillars of trust.

Don't limit the opportunities for disease prevention in your practice.

Support your hygienists by being engaged in their education.

Help patients value their preventive care appointment.

Hygienists are not “just teeth cleaners”.

Quotes:

“A recommendation would be, ‘You should go to the gym every day.’ A recommendation would be, ‘Have five servings of fruits and vegetables.’ Those are recommendations. We use that “recommendation” word when we’re talking about treatment modalities that need to be done in order to address an active infection for the patient. And when we use the word recommendation, somehow, inside of the lizard brain of our patients, they think, ‘So, I have the option to not do it.’ Now, we know inside of autonomy, the patient always has an option not to do it. They could easily walk out. If you're in a hospital, and you've got a gunshot wound, and you choose not to have that treatment done, if you can walk out, you can walk out. They have autonomy inside of that. But the idea is, we need to be coloring this picture to help our patients understand that the treatment that we are talking about is a prescription from a licensed practitioner — because that's what it is.” (6:51—7:48)

“You have to have leadership. You have to have a culture inside of the practice, and you have to be very crystal clear about your core values.” (8:13—8:21)

“It’s called The Trust Edge, and this book is absolutely unbelievable. Inside of the book, it talks about the fact that trust is the true currency of business. It is. Because people will buy if they trust. They will actively seek out a Starbucks because they trust that logo. They trust that there's going to be consistency in what they order, that I can go to a Starbucks here in Milwaukee, I can go to a Starbucks in Honolulu, and I can order the same drink and get it prepared exactly the same way. There's consistency. I see a lot of trust inside of businesses that have worked and focused to maintain that trust. And then, you see things — I'll use an example. Southwest Airlines had a big issue with trust because they were not consistent. They lacked some competency in what was happening over the holiday season with flights and things like that. And because of that, because of that decline in trust, they see a decline in their overall revenue. Trust is the currency of business.” (8:33—9:37)

“This is what's crazy about [The Trust Edge]. He talks about the eight pillars of trust. There are eight specific pillars of trust. And inside of that, you have to be able to build those pillars of trust. He says that a critical aspect to that trust is knowing your core values. That's a huge piece. In the book, the author says that if you, as a business owner, practice owner, whatever, if you are not communicating your core values and your mission statement to your team every 30 days — every 30 days — your team members cannot recite that back to you. Now, that's important. Because in a dental practice, if you think about AZPerio, I mentioned I walk through the entire process of care. The doctor comes in at the end. So, who’s conveying those core values to the patient? Myself, the assistant in the operatory with me, the front office team member, even the website. These are all touchpoints before the doctor even has the opportunity to communicate with the patient.” (9:42—10:42)

“If we don't know the core values of the practice, then I don't have a scaffolding — I don't have a framework — for how to behave inside of this.” (11:03—11:10)

“This is the important piece of what AZPerio does. We look at numbers. We look at production. Every day, we've got our big, hairy, audacious goal. We look at, what do we want to see? What percentage are we on our way to our goal? What opportunities do we have? What openings does the doctor have? The masculine energy around a lot of that, those processes are built out. That is the framework. That framework is intended to protect so that when something like this happens — the bone material falls out, the sutures don't go in, the patient’s anesthesia isn't working as readily as possible — that the framework protects us inside of that. But it also means that we have to be okay when we’re not productive because, at the end of the day, we’re not taking care of people’s insurance plans and billing, we’re taking care of humans — humans with beautiful, robust lives. And our job is to be a part of that and to make it better for them.” (17:15—18:13)

“Disease prevention is something that dental hygienists focus on in our training. And yet, we get out into the real world after we graduate from hygiene school, and I think we’re so limited on what our opportunities are inside of disease prevention. We’re looking at a myriad of diseases that we can see in the oral cavity or that patients are going to present with in the operatory and talk about what our role is inside of that. We’re going to do this from a team perspective because we need our doctors, we need our front office team members, we need our practice managers to understand that when a patient comes in and they have periodontitis, that we have to be treating this disease fully and thoroughly. We need the time to effectively treat these cases. We need the products. We need the medicaments. We need the entire scaffolding of what that process of care looks like for a periodontally diseased patient to occur. We need the same thing with caries. We need the same thing with oral pathological lesions, oral cancers, tethered oral tissues, airway complications, infection control that, inside of all of this, these are all of the ways that we contribute to preventing disease, and we have to be able to break apart what these modalities look like so that we can understand what are some of the modern trends or techniques inside of delivering care for our patients.” (18:45—20:05)

“This is what's so crazy. The average statistic right now is that one in three individuals who have dental insurance use it routinely. So, we already know that there is a small portion of our population that will come in and receive routine dental care. And by “routine”, I think we’re all in alignment that this is a patient who comes in for their every-six-monther. I tell this story all the time, but where did that six months come from? This drives me crazy. In the 1950s, there was a toothpaste called Ipana Toothpaste. That spokesbeaver, Bucky Beaver, says, ‘Brush-a, brush-a, brush-a. Here’s the new Ipana.’ And then, at the end of the commercial, he says, ‘Brush your teeth with Ipana Toothpaste and see your dentist twice a year.’ Now, that was done by Ipana Toothpaste as a means of encouraging these individuals, the general public, to go in, see a dental hygienist, and have that dental hygienist say, ‘Oh my gosh, the Ipana Toothpaste commercial brought you in? Absolutely, you need to be brushing with Ipana.’ It was an interesting marketing strategy, was it not? Well, that was in the 1950s. And here we are 70 years later, and most individuals across the United States think it’s completely normal to see your dentist twice a year.” (20:22—21:35)

“If you see my very first slide in this program, it’s going to say, “That's how we've always done it.” That is the toxic statement that we have said inside of dentistry. In fact, I think that is the most disease-ridden statement. Dirty mouth? You've got to clean up that.” (21:40—21:55)

“We have seen an evolution inside of dentistry. And we’ll talk about that this afternoon, how we’ve evolved in dentistry in a myriad of ways: disease prevention, infection control, technology. There are so many ways that we’ve seen a change. And yet, it doesn't matter because, at the end of the day, we are still doing the same procedures. If you're using a rubber cup polisher, and you're using hand instruments, and you're treating your patients every six months, no matter what the complexity of the disease looks like, we are not delivering the correct layer of care for that patient.” (22:04—22:32)

“[When] we look at the prevalence of oral disease, currently, the statistic is about one in two adults between the ages of 30 and 79 have some form of periodontitis. Dental caries is the number-one chronic childhood disease. It is five times more prevalent than asthma. And every hour, one individual will lose their life to the ramifications of oral cancer. So, when you take a look at that, the reality is the disease is not stopping. Porphyromonas gingivalis isn't like, ‘Oh, I'm sorry. I didn't realize that you guys were all banding together and trying to help.’ The disease is still occurring. The disease is showing up in our chairs and across our communities. And so, when we take a look at what it is we understand about prevention, the first step in that is, what are we doing to actually prevent this? Because there's such an activity of the disease right now.” (22:33—23:22)

“It has to start at the top . . . And [by the doctor not being involved], what you're doing is you're bringing in a team member and now expecting that team member to transform the entirety of the scaffolding of your hygiene department, including how you're diagnosing periodontitis, diagnosing incipient decay versus active decay, identifying modalities in how to detect oral cancer, looking at pathological lesions, transforming the way we look at oral and subsequent systemic disease. You are expecting one individual — or maybe you send your two hygienists — you're expecting two individuals to go to a workshop, come back after three hours, and implement this when these individuals are not going to have the support from the top.” (24:10—24:54)

“I've worked with doctors who are very fixated in high-end cosmetics. ‘I want to be over here. I want to cut and prep veneers all day long. That's what I want to do. I want my hygienist to really be the wheelhouse of the practice, and I'm going to give him or her everything they need. So, I'm going to send them to this workshop. And then, afterwards, I'm going to sit down with them. I'm going to say, walk me through the pieces that you learned that you find to be impactful inside of our practice. What pieces of equipment do you need? How much more time do you need in the patient hour in order to be able to implement these strategies? What support do you need from our front office team members? What ways do we need to change some of the protocols? What needs to be done in the clinical notes? What types of conversations do we need to be transforming? What needs to be added to the website?’ When you implement a change in the practice, it has to go through every step. That change is like hot potato. It has to touch every hand.” (24:58—25:55)

“As a hygienist, if I go to a disease prevention workshop and I learn about how great probiotics are for oral disease, and I come back and I want to implement that, and the doctor says, ‘Yeah, go ahead. That’s great,’ now, I need the doctor to understand what these probiotics are, why these probiotics are important, why patients who not only have gingivitis but periodontitis, periimplantitis decay, risk for candida, are all going to be terrific candidates for that. I need the doctor to be on board so that when I prescribe this, the doctor comes in behind me and says, ‘Absolutely, Katrina is correct. Here’s why we need to integrate this into the practice.’ I need whoever the lead is who is ordering products to be able to order these products, stock them in the practice. I need my front office team to understand how we bill for that. I need to know, how do we integrate this into an explosion code so that any time that I'm diagnosing a patient with gingivitis, periodontitis, periimplantitis, decay, candida risk, that these are automatically exploding into the patient’s care plan. I also need support from the front office team in the event that the patient calls in and says, ‘Hey, I don't exactly remember. How often am I supposed to be taking that probiotic? Once a day? Twice a day? I'm not quite sure,’ because it’s going to be different depending on the patient. I might need an administrative team member to help me print out even postoperative instructions so I can send the patient out with it. I need every single team member to be involved in that tiny protocol.” (25:55—27:16)

“I travel all the time. I'm speaking, I'm presenting, I'm delivering. I can't tell you how many times a hygienist will come up to me and say, ‘All of this was amazing. I wish my doctor were here.’ I think doctors have this thought, number one, that hygienists want to be empowered to do this. And we do. But we want to be supported by our doctors. We want to be backed up by our doctors.” (27:20—27:42)

“People talk about The French Laundry all the time. It’s the amazing three-Michelin star experience . . . But when you go to a restaurant like that, it is choreographed. There is no room for issues. It’s just ships passing in the night. The drink comes down, the empty glass gets taken away. It’s not cumbersome. It’s not clunky. But you will go to a restaurant sometimes and experience this where it’s like, ‘Where is the waitress? What's going on?’ Well, how many times do you leave a patient sitting in the operatory, everybody is running behind, and the patient is just sitting there staring at the wall, going, ‘Where is everybody? Did they just leave me in here?’” (30:05—30:48)

“It's those little nuances that an intellectual human being is going to observe. And they won't be able to put their finger on it but, ‘I walked in, and nobody greeted me. Everybody at the front desk, they were all on the phone. So, I just sat down. Then, when somebody got off the phone, nobody said hello, so I had to be the one to get up and say, hi, I'm here for my 9:00. Then, I'm sitting here. It’s 9:05. Nobody is coming back to get me. Nobody has said anything. It’s 9:10. By the way, none of these magazines are up to date. They're all from the 1990s. So, what am I supposed to do? So, I'm just sitting with my phone. My phone has a clock on it, so I'm watching as I'm playing a game on my phone, or on Instagram, aimlessly scrolling. And nobody’s brought me back.’ All of these little inconsistencies — and that's before anybody has actually said anything. That's before I'm interacting with the clinical competence that I expect to see, tiny, tiny little things that we are casting judgment on right away.” (30:49—31:45)

“It drives me crazy when I would work in clinical practice, I'd be working on a patient, front desk would come back — I'm literally working with a patient, and the front desk would say, ‘Oh, Doctor is buying Panera today. What do you want?’ That's so weird. You're going to have me list off my lunch order while delivering clinical care to a patient? It’s those little micro nuances that completely erode and break it down. So, when we come together, when we bring the entirety of the team, when they hear a speaker say, ‘Here’s why we need to integrate this into clinical practice,’ I'm going to give you and the team time to now say, ‘How do we take this? How do we integrate this?’ so that anybody who has a touch point with a patient experiencing this disease modality understands why we’re approaching care this way.” (32:23—33:10)

“People make decisions based on emotion.” (35:51—35:55)

“It’s the invisible things that people will comment on.” (36:11—36:13)

“When you think about the brilliance of what happens inside of a practice — think about it. You have patients that come in and see your dental or hygiene departments every three, four, or six months. These patients, for one reason or another, do trust you. And the biggest issue that I see is that dentistry doesn't necessarily fully understand that with these individuals, these patients who come in three, four, or six months, that these individuals, at a minimum, are experiencing risk factors associated with oral disease.” (38:07—38:38)

“It is unbelievable what we’re unpacking inside of that oral and subsequent systemic disease profile. And this is where, I think, we have to change that conversation. Because our patients are so used to seeing us as, ‘I've been going in every six months. I get my teeth cleaned.’ Okay. Well, language issue number one, we don't clean teeth. I'm not a tooth cleaner. That's not what I do. I'm not a cleaning lady.” (40:20—40:43)

“The vast majority of the issue that I see inside of patients’ declining treatment plans across the United States is a lack of value and trust in what we do . . . These individuals see our value as, ‘I have dental insurance. The dentist I go to takes my dental insurance, so I'm going to use my free coupon.’” (41:00—41:21)

“These patients come in, and this is what they see. It’s transactional. ‘I'm going to...

The Recall Renewal Exam

Episode #576 with Debra Engelhardt-Nash

For the same reasons people renew their wedding vows, you should renew your commitment to your existing patients. Their recall renewal exam is the perfect opportunity to review your progress, reaffirm your philosophy, and strengthen your relationship. So, how do you get more patients to show up? To share advice for communicating the value of recall exams, Kirk Behrendt brings back Debra Engelhardt-Nash, practice management expert and co-founder of The Nash Institute. Remember — it’s not “just” a recall exam! To learn how to reengage, reignite, and reinspire patients with a recall exam, listen to Episode 576 of The Best Practices Show! 

Episode Resources:

• Debra’s email: [email protected] 
• Debra’s website: https://debraengelhardtnash.com
• Debra’s phone number: (704) 904-3459
• Debra’s social media: @debralnash
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Debra’s courses at The Nash Institute: https://www.thenashinstitute.com/about-the-nash-institute/meet-debra-engelhardt-nash

Debra’s other programs: https://debraengelhardtnash.com/programs

Pearl: https://www.hellopearl.com

Dental Intel: https://www.dentalintel.com

BlueIQ: https://getblueiq.com

Main Takeaways:

Recare treatment acceptance is between 25% and 35%.

Run a report to know your unscheduled treatment rate.

Understand why your patients don't accept treatment.

Be engaged and intentional in your conversations.

Exhibit proper body language in conversations.

Use artificial intelligence to educate patients. 

Quotes:

“It’s one thing to know how to do the dentistry. It’s another thing to know how to talk about it and get your patients to say yes to it. Those are different skillsets. And sometimes, you have a great clinician who’s not a great communicator. And sometimes, you have a great communicator who’s not a great clinician. If you can marry the two and have a hybrid, that's the best of all worlds.” (3:52—4:13)

“The average treatment acceptance rate for new patients is between 70% and 78%. When dentists say they get 100% treatment acceptance, they're fooling themselves. That's not true. If you want to dummy down — if you want to talk about your phase treatment plan or modified treatment plan, and if you want to inflate your statistics to make yourself feel good — but if you're presenting comprehensive treatment plans, you're not going to get 100%. So, there's that statistic. But here was the statistic that really caught my ear, and it was that the treatment acceptance rate for recare patients is between 25% and 35%. That's when you go, ‘Uh-huh. Why is that?’” (6:01—6:53)

“We’re not spending enough time talking to our patients of record about treatment. We’re just not doing it . . . Familiarity sometimes breeds apathy. Familiarity breeds apathy. So, Kirk, if you were my patient, I say, ‘Oh, I know Kirk. He’s not interested. His insurance won't cover it. We’ve talked about those two crowns before. He doesn't want it. I don't want to offend him.’ So, that's one reason that we say, ‘Oh, Kirk’s not interested. Kirk doesn't want it. I've already spoken to Kirk.’ Seventeen years ago, I told Kirk, ‘You need those two crowns.’ And every time he comes in, I say, ‘You know, Kirk, you need those crowns.’ And you go, ‘I know.’ And I go, ‘Okay. I need to clean your teeth.’” (7:02—7:46)

“The other piece of that is, we don't give hygienists enough time to have conversations with their patients. So, timing is everything. Sometimes, doctors — and I say this lovingly and half in jest — brag about how little time their hygienists need to be effective. And I go, ‘Wait a minute. How are you determining effectiveness? Is it their production per day, or is it not only what is their production per day, but what additional treatment was diagnosed and accepted out of their treatment room, out of their operatory?’ So, we have to take a look at both of those things. I could have a great perio hygienist, and maybe he or she is not getting a whole lot of treatment acceptance out of their operatory because that's not what they were designed to do. But if I have a hygienist who’s seeing general care patients, then I want to take a look at, what additional treatment is being accepted out of that room?” (7:46—8:41)

“I go into some offices, and doctors will say, ‘My hygienist can see 12 patients in a nine-hour day! And they're not children.’ And I say, ‘Great. But what's your treatment acceptance from those nine people?’ And there was a hygienist who said to me, she sort of crossed her hands and she said, ‘I am not hired to sell dentistry. I am hired to clean teeth.’ We have a problem. We have a problem.” (8:42—9:08)

“Any strength taken to excess becomes a weakness.” (10:10—10:13)

“We don't intend to be apathetic. But, once again, I may look at your record — hopefully, in the morning huddle. I'm looking at Kirk’s information. And if I'm using Pearl, I'm seeing what radiographs are due for my patients coming in. So, I'm ready for you to come in. But I also can say, ‘I know Kirk. He’s not interested. He doesn’t want it. He’s not going to do it. So, we’re not going to talk about those crowns.’ And sometimes, we even coach the new hygienists coming in, we say, ‘Don't talk to Kirk about flossing. He doesn't want to talk about flossing. Don't ever talk to him about flossing. He hates talking about flossing. Don't talk to him about home care. He doesn't like to have that conversation about home care.’ So, now we train our successor, possibly, some of our bad habits.” (12:37—13:18)

“I think it’s timing as well. You talked about some of the other factors. Sometimes, we ask the patient [about treatment] at the end of the visit. So, first of all, if you already had to wait for the doctor for the exam for 20 minutes, and then you're going to sit and listen to the doctor and the hygienist talking about unscheduled treatment, or treatment that has just been diagnosed, or treatment that has been previously diagnosed — I need to get my kid to the soccer game. I need to get out of here. So, timing is also really important.” (13:22—13:49)

“We talk about new patients being VIPs, and we talk about how we’re going to razzle and dazzle them. What about our patients of record? What about those patients who've been true, blue, loyal to your practice for 15 years? So, that is when I came up with what I call the recall renewal exam. A lot of my friends heard me say it years ago. I remember Cathy Jameson hearing me say it at an ADA meeting in Seattle in 1995, and said, ‘Oh my gosh, I'm using that,’ which is great. And I think, once again, if we sit down — the most important question that a hygienist will ask a patient, and when she or he asks it, that's critical. And also, if we start doing some math on what this could look like, even if we had 10% of our patients of record move forward with some level of treatment, what that would do to our practice productivity.” (13:52—14:53)

“We need to be renewing our relationship with our patients of record. So, if you were my patient, Kirk, for 10 years, I am assuming that the relationship or the new patient experience you had 10 years ago is probably different than the new patient experience that I'm providing today. There are probably things we talked about 10 years ago that we don't talk about now. And I don't want to see you as just Kirk. I don't want to see you as just another recall, just another cleaning. I want to reinvigorate my relationship with you. I want to reengage. I want to reignite. I want to reinspire you to be a part of my practice.” (16:50—17:27)

“We really need to go back with you, my patient, and I might say, ‘You know, Kirk, you have been a patient in my practice for 12 years.’ ‘Wow. Has it been that long?’ ‘It has. Here’s where we were when you were a new patient, and here’s what we’ve done so far. Here’s where we are now. Let's talk about where we are now. Let's talk about your dental future. Let's talk about where we’re going, where we want to be.’ I also want to remind you of our treatment philosophy. I want to remind you of our culture. I want to remind you of the quality of care that you have received in the past. So, it’s not “just” a recall. In fact, sometimes we use that term. ‘Hi, Kirk. This is Debra from Dr. Smedley’s office. I'm just calling because it’s time for your recall. It’s just a recall.’ And sometimes, patients will call and say, ‘I'm calling to cancel my appointment. It’s okay. It’s just a recall. It’s just my recall.’” (18:00—18:57)

“One of the things that I might say to my elderly patients, my older patients — I'm one of those. I'm an older patient — I might say, ‘Your dental care is even more important than it was when you were younger. There are so many systemic causes that we’re discovering with dental health that it’s going to be even more critical for you to be on a more frequent appointment with us. We want to make sure that your oral health is part of your systemic health, and that's critical as we age.” (20:04—20:37)

“Don't wait until the end of the appointment, number one. So, if I looked at your record and I see that we have treatment that we planned that you have yet to complete, that's what I need to bring up first. And my body language has to be — I'm not looking at a computer. My head isn't turned. I'm not putting down my instruments. I'm not giving you the ugly — I'm not glaring at you, but I'm looking you in the eye and saying, ‘Kirk, I see that we have treatment that we have planned for you that is yet to be completed. Tell me what's prevented you from having it done.’ Because now, you're going to say a couple things: it doesn't hurt. Expensive. I don't have time. I really don't see the value. People used to say there are three things. There are four things. I think there are four things.” (21:35—22:32)

“Let's say you said [the reason you haven't accepted treatment is] cost. It’s expensive. I say, ‘You know, Kirk. Exceptional dentistry is expensive, you're right, because it needs to last. But think about this. Think about what it would have cost you five years ago when doctor originally treatment planned that for you. Think about what it might cost you five years from now. It will never cost you less than now. So, we could find a way to make that work for you, to factor that into your budget. What other concerns do you have?’” (23:02—23:35)

“I have my two questions. And my two questions work for almost everything. Number one, if we enhance our communication skills and commit our patients of record to treatment, is it good for them that we’re doing that, or is this a bad thing? Is it a good thing or a bad thing? . . . It’s a good thing. Okay. Then, the next question is, is this a good thing for our practice? . . . Then, why aren't we doing it? So, if you have to answer no, ‘Is this good for our patient?’ ‘No. It’s terrible.’ Then, don't do it. Sometimes, when we talk about allowing patients to make small payments over a long period of time in-house, is that good for the patient? No, because it’s going to prevent them from wanting to come back. It’s going to make them reluctant to return for care. There are all kinds of reasons why it’s not good for them. So, don't do it. If it’s not going to be good for the patient, don't do it.” (24:33—25:24)

“Let's say we have two hygienists working, and they see eight patients a day, and they work 200 days a year. That means we’re going to have 3,200 visits per year, and we divide that. We can say that would be about 1,600 active patients, possibly. But let's say we have the capacity for 3,200. See, that's the other thing we have to know, what's our capacity? But we have the capacity for 3,200 visits. Let's say that 10% of those patients are going to move forward with some level of treatment, and let's say it’s the equivalent of $800. That's another $128,000 per year. So, we want to know where my additional compensation is going to come from. It’s going to come from that. And it’s less expensive to market to patients I already have!” (26:45—27:42)

“We sometimes make assumptions based on age, based on what we’ve talked about, based on what I know about this person, based on insurance restrictions.” (27:58—28:07)

“Pearl is what is called second opinion. It is artificial intelligence that's actually reading the radiographs, not with your naked, subjective eye, but with an analytical, technological eye. So, it becomes a second opinion for the patient. It’s also a great visual for the patient. And knowing that patients, 50% of the population are visual learners, for them to be able to see — because sometimes we put those radiographs up, and for all they know, they're looking at an ink blot. They don't know what we’re looking at. They don't see what we’re looking at. But when you bring Pearl up and Pearl says, ‘We see decay here,’ and it colors it, and it circles it, and it says, ‘This is 35% into the dentin,’ it actually gives percentages, ‘This is 25%. You've got calculus, and calculus is into the tissue by X percent,’ man, it is hard to dispute that. A patient could dispute, ‘It doesn't hurt.’ A patient could dispute, ‘My gums don't bleed.’ But when you're looking at that visual chart that artificial intelligence has picked up, it’s pretty hard to dispute.” (31:48—32:58)

“One of the things we say to the patient during the recall renewal exam is, ‘It is time for us to gather new baseline data.’ If you've ever had a colonoscopy, or a mammogram, or an MRI measuring things, they want your baseline, and then they want to measure your current against the baseline radiograph, the baseline images that they have. So, we say to the patient, ‘It’s time for us to gather new baseline data.’” (35:09—35:33)

“The doctors, when you take a look at how to increase their revenue, one of the ways of doing that is you look at what I call your HPA, your highly productive activities. What are your highly productive activities that yield the most productivity in your office? I'm white-labeled for another consulting company, and I go in and I lecture. And they always ask the young doctors, ‘What do you think your highest paid activities are in your office?’ And they say new patient exams. And it’s not. The patient exams aren't your highly productive activities. What's it going to be? Now, if we want to talk about lab, it’d be crown and bridge. The other thing we talk about, if you're doing CEREC and if you're doing in-office crowns, it could be a highly productive activity. Quadrant dentistry, highly productive activity. Single-unit restorations, not a highly productive activity. Ross just did four direct restorations on a patient. It’s a highly productive activity at $1,200 a tooth. That's a highly productive activity. So, what are my highly productive activities, and are we doing them? What's your service mix?” (36:09—37:25)

“So many doctors are concerned about, ‘Do I raise my hygiene fees? Will my patients turn away?’ Not if you're doing a great service. Once again, if you're charging $125, or $135, $150 for a recare examination, you can't be doing a dine-and-dash exam. In fact, here’s another point. So many times, patients will say, ‘I only want my teeth cleaned. I don't want an exam.’ I would say you need to figure out, if you've got patients saying, ‘I don't want an exam,’ why is that? And I ask audiences, ‘Why do you think that patients say they don't want to have a recall examination?’ Some people say, ‘They don't want you to find anything wrong.’ And some people say, ‘Because they don't want to pay for it.’ Why don't they want to pay for it? They don't want to pay for it because they don't see value.” (38:17—39:10)

“I probably don't want to come in and have an examination because I'm getting the one that John described. We’re going to talk about cats, and TikTok, and we’re talking about construction. We’re not talking teeth, so why am I paying $150 to talk about my cat? Why am I doing that? I don't want to do that. Clean my teeth. If you're not going to have a conversation with me about my teeth, then I want to get out of there. I'll go have a drink with you at the bar and we can talk about our cats.” (39:19—39:48)

“[Start with] one patient a day and ask the magic question. ‘I see that you have treatment that was treatment planned that we have yet to complete. Tell me what has prevented you from having that done.’ And then, your hygienist needs to be comfortable having the answer. ‘Well, that's a lot of money.’ ‘It is a lot of money, isn't it? Think about what it would have cost you five years ago, and what it'll cost you five years from now, and what it would cost you today. It'll never cost you less than right now.’ Let's say it’s fear. ‘Help me understand what you’re fearful of. Are you fearful of the discomfort of the treatment? Are you fearful of the procedure? If you're fearful of the discomfort of the procedure, imagine what it will feel like if you do nothing, and it gets worse, and it starts causing you pain.’ So, we can talk about that fear. ‘It’s not bothering me right now.’ Yeah. So, we could actually solve a number of things. If you're afraid of discomfort, and you're afraid of cost, then the most important thing when we talk about now — that it’s not bothering you — this is when it'll cost you the least, and it'll be the least uncomfortable.” (40:01—41:09)

“You have to be careful that it doesn't sound like you're supersizing. ‘Hey, you want a crown with that cleaning today? Hey, you want whitening?’ You've got to be careful. But here’s the other piece. You've seen that cycle, the belief cycle. You've heard of the belief cycle. So, if I believe the patient doesn't want it, if I believe the patient isn't interested, if I believe the patient can't afford it, I'm going to behave in a way that I believe. So, I'm not going to say anything. My actions are going to perpetuate my belief. My belief is the patient doesn't want it, doesn't care about it. So, my actions are going to perpetuate what I...

How to Calculate Your Overhead in 60 Seconds

Episode #575 with Kirk Behrendt & Dr. Barrett Straub

If you're going to own a business, you've got to do some math! Overhead is one of the most important numbers that dentists should know, yet it’s the most neglected. To prove how uncomplicated it truly is, Kirk Behrendt brings back Dr. Barrett Straub, ACT’s CEO, to help you calculate your overhead in under 60 seconds. With ACT’s Roadmap to Practice Profitability, you can start thinking better and making the changes you need to improve your overhead. To learn where to access this free resource and start using it today, listen to Episode 575 of The Best Practices Show!

Episode Resources:

• Dr. Straub’s email: [email protected] 
• Dr. Straub’s Facebook: https://www.facebook.com/barrett.d.straub
• Dr. Straub’s social media: @bstraub10
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

ACT’s Roadmap to Practice Profitability: https://www.actdental.com/free-resources/money-tool

Main Takeaways:

Overhead isn't as complicated as you think.

Understand why you need to know your overhead.

Learn how to track, control, and lower your overhead.

Give yourself grace. Make small changes and improvements.

Quotes:

“Overhead is going up. Costs are going up. And so, the problem or the challenge with overhead is multifactorial. One is, it’s going higher, and it’s harder and harder to keep that profit margin. Number two, we, in dentistry, have made overhead overly complex — way more complex than it has to be. And the outcome of that complexity, I believe, is many dentists, maybe most dentists, don't even track it.” (2:28—2:58) -Dr. Straub

“The complexity is coming from what we call buckets. What bucket does each expenditure go in, whether it’s team compensation, facility, supplies, lab, or operating costs? And us detail-oriented dentists, we get too into the details, and we worry so much about, ‘Am I putting this expense in the right bucket?’ that we eventually throw up our hands, wait for our accountant to tell us whether we’re doing okay or not, and move on. And that, ultimately, is not the right way to run a business.” (3:11—3:45) -Dr. Straub

“Overhead is a percentage of collections, not production, number one. Overhead has zero to do with production. Now, you could say that, ‘Well, your collection is a factor of your production.’ Absolutely. But it is a percentage of your collections. And you're right, we’ve been talking a lot about this, this push to produce, produce, produce. We like it when dentists produce more. But we want them to produce more when they have the gap set up, and the foundation and their profit margin set up, to where they're going to benefit from that.” (4:16—4:48) -Dr. Straub

“There are two reasons to know your overhead. One is so you know what day of the month you start making money. When you know your overhead, you know when you cross that dollar line in terms of collections, ‘Now, I get to make some money.’ And the earlier in the month that is, the happier we are.” (4:50—5:09) -Dr. Straub

“If you don't know your overhead, you're just outrunning the wolf every single month. It’s like me being your cardiologist going, ‘Don't worry what your cholesterol is. We’re just going to get you jogging. And salads.’ No — bad advice. Come on. And if you're going to transition someday or sell, profitability is huge. I don't care if you sell to a DSO or another private dentist. At the end of the day, the best practices to buy are the profitable ones.” (5:15—5:42) -Kirk

“At the end of the day, most dentists are realizing cash flow matters. Every one of us wants to have profit left over to put in our bank account. And there are many factors — we call them our gaps — but there are many gaps where cash leaves the practice. One is overhead. And we need overhead. We need expenses to run our business. But we want to manage it. We want to limit it. We want to make sure that we’re spending our money wisely and not on things we don't need.” (5:43—6:13) -Dr. Straub

“The other “why” [for caring about overhead], one is so that you know what it is and when you start to get paid. You can't decrease it until you know what it is and set up a budget and plan to decrease it. Otherwise, to your point, you're just guessing like, ‘Oh, what was my overhead last month? Oh, that's high. I don't have a plan for it next month.’” (6:14—6:34) -Dr. Straub

“The reason [overhead is] so complex is we dentists worry so much about how to organize it. And once we learn what the true definition is and how to calculate it in 60 seconds, we’ll realize it doesn't really matter in the end. So, all overhead is, is all your expenses minus your doctor salary and benefits. Your overhead is a one, dollar figure. It’s X amount of money. And then, divided by revenue, it’s a percentage. Now, we can break that overhead expense up into team comp, facility, supplies, lab, operating costs — our buckets, as we call them. And that is part of our process in our Money Roadmap in terms of setting a budget and setting up a strategy for decreasing it. But if you don't even know what it is, then who cares what bucket it is. You want to know, ‘How much money did I spend to run my business?’ You take all doctors, associates, doctor providers, out, salary and benefits. That's your overhead.” (7:30—8:34) -Dr. Straub

“If you're going to own a business, you've got to do a little bit of math.” (9:11—9:14) -Kirk

“You need to know [overhead] because you're a business owner. You want to know, ‘When I cross this line, I make money.’ We advise our doctors to have a monthly salary that they want to take, and then they know, ‘If I cross overhead, I get paid. When I cross that next line of my salary, now I'm in the bonus. Now, I have extra cash flow to invest, to bonus my team, to make all of our lives a little bit better, put money away for a rainy day. So, knowing these numbers, knowing these gaps, knowing when we’ve crossed into break-even just to stay afloat, then break-even so I get paid, now, what we all hope for is that there's money going in the bank even after all that.” (10:05—10:53) -Dr. Straub

“Your business will eat every dollar — every dollar — if you don't prevent that. If you leave money in the checking account and say, ‘Oh, we've got plenty in there,’ if you don't know your overhead, the business will eat it.” (10:56—11:11) -Kirk

“You can't cut to grow. A lot of dentists think, ‘Lower the overhead. Well, I've got to lower wages. I've got to buy cheap paper. I've got to go and get the cheapest supplies and C-Fold towels that are at the bottom.’ You can't think like that. It’s a function of your overall profitability. And so, knowing what influences those — because if you're in the game of caring about people, you're going to need to be able to pay benefits and good wages, long term. So, you have to understand how they go up and down.” (11:53—12:24) -Kirk

“Overhead is only one function of profitability. So, we can lower overhead. And what we mean about lowering overhead is, get rid of the waste. Get rid of the stuff you're paying for that you don't even know. Supply budget is one of the easiest ones in that we can set a budget, and when we hit that number, we stop ordering. Not all overhead — there's fixed, there are variables. Our Money Roadmap gets into that. You can cut so much on overhead. Once you're lean and mean, now we've got to increase our profit margin. We've got to increase the collections, our revenue, the top end, the top line. So, both of them go into that true profitability margin.” (12:25—13:12) -Dr. Straub  

“For every $1 million you collect — think about this — you take your overhead from 71% to 61%, that's a net profit gain of $100,000. I would even argue you're going to work fewer days.” (14:11—14:25) -Kirk

“The way to keep your team well-compensated is to watch your overhead. Because if you're spending too much money in the other categories, then you can't pay your team as much as you want to, as much as you could, as much as they deserve. So, a lot of times, when we reluctantly don't want to go down the overhead management route because dentists feel like it means we've got to cut staff, or we have to limit — actually, it’s quite the opposite. The way to pay them more, incentivize them, is to control all your other costs so that when that added profitability does hit the bottom line, you can use some of it to incentivize your team.” (14:49—15:27) -Dr. Straub

“If your team compensation is 33%, it’s not that you're overpaying people. You could — it could be. But what that screams to me is your practice doesn't collect enough to be able to service that payroll level. So, a private practice, or less PPO-driven, that has great systems in place, watches their costs — you might have the same payroll as another practice. But your percentage is 33, and the other doctor who is paying the same amount out is at 25% or 24%.” (15:35—16:11) -Kirk

“Your overhead percentages can indicate that your collections aren't where they need to be. So, they can be diagnostic as well. The moral of the story is, track it, and then figure out how to improve it.” (16:13—16:28) -Dr. Straub

“[Finding your overhead is] super easy, 60 seconds. You're going to pull your P&L. Now, again, back to the “man up, woman up”. You're a business owner. You all have QuickBooks. You’ve got to be able to print a P&L . . . You can [call your accountant], and they’ll get you it. But as business owners, we should be able to print a P&L any day, any hour, any time we want. So, if you can't do that, talk to your accountant and say, ‘Hey, I want your services, but I want to be able to pull financials whenever I want. Let's figure out how to do that.’ QuickBooks is super easy to use. So, you print your P&L. That's number one. You have it in front of you. You go to the bottom of the P&L. It’s going to say something called Expense Total. It’s a big dollar figure. Write that down. Now, you go above that, and you find out one of your categories or buckets is going to be called Doctor Salary and Benefits. There's going to be a total. You're going to write down that number. You're going to subtract that from your total expenses. That's your overhead. That's it.” (16:30—17:37) -Dr. Straub

“That's part of the complexity, is that there's no standard way for a P&L. So, all a P&L is, is in QuickBooks, you get to organize all these line items of expenditures. And you get to organize them and dictate which category they go in. We have a seven-bucket model where there are seven buckets where all of your expenditures should fit in. The reason we like that is because it’s designed after how a dentist thinks. ‘Okay. I bring in money, and it goes out in one of these seven ways. And then, what's left over is my salary and benefits.’ We’ve seen a lot of P&Ls from lots of our clients, and there's no standardized way in the accounting world to do it. So, some will have three buckets, and some will have 342. And ultimately, we’ve got to talk to our accountant and say, ‘Hey, we’ve got to organize this a little different so I can understand it. Because all of these different categories make no sense to me.’” (17:46—18:41) -Dr. Straub

“In life, you go through these cycles. You go through ups and downs. You might be having the greatest quarter ever. Things are amazing. And then, the snow hits. Or you get hurt. You have to have a lower overhead so that you can deal with the weather, or life circumstances, or you have to go to two funerals in a month, or whatever. You've got to be able to have that breathing room. And knowing your overhead in 60 seconds, or following this, will make you sleep better.” (20:22—20:53) -Kirk

“One cautionary tale for overhead. I think another reason we dentists don't like to track it is, unfortunately, we like to compare ourselves to others. We dentists do that a lot. I mean, human nature. And what I'm going to say, track your overhead, and then take a deep breath. It’s okay. You can improve it. You can work on it. You're not a bad businessperson. You're not a bad dentist. Give yourself a little grace and get a little bit better every day. That's all we’re going to advise on how to improve your overhead.” (20:55—21:25) -Dr. Straub

“When we control our overhead, when we get that percentage as low as we can, reasonably, without stifling growth — we don't want you using a bad lab. We don't want you using bad materials. Never — then, any additional production/collections, we reap the increased profit margin based on that. So, let's say we have 72% overhead. We have a 28% margin before we even start to get paid. That's before taxes and before loan payments and all that. Well, if we go and just produce more, produce more, produce more, that goes with us. So, now, we’re producing more. We’re paying even more tax on a pass-through entity, and we’re getting less of that 28%. So, we’re saying, ‘Hey, why don't we control the overhead a little bit, even if it’s a few percentage points?’ Now, when you go produce more, which is always good, you're going to take more of that profit margin.” (23:00—23:55) -Dr. Straub

“We have a seven-bucket model. Number one is team comp. Historically, it’s always been 25%. We understand that's getting harder and harder to meet, and we’ve got to get creative. We have facility and equipment. That's going to be your rent, your utilities, your facility, your property, janitorial services, all of that, eight percent. Supplies, five percent. That includes drugs. Your lab, eight percent. That’s lab, that's implant, that's ortho, that's CAD/CAM. And then, operating costs, nine percent. This is the one that can get out of hand. This is the one where you kind of throw everything that doesn't fit a different category.” (23:59—24:40) -Dr. Straub

“[Operating costs can be] like office supplies, business office equipment, legal fees, accounting fees, collection costs — I'm reading right off the Roadmap — bank charges, all of these things. Computer expenses. They're typically expenses that are necessary but not related to the dental piece all the time.” (24:40—24:58) -Kirk

“The low-hanging fruit on improving your overhead is, one, set a supply budget. When you hit that number, stop spending — except for emergencies. And then, operating expenses, I can guarantee there's some money going out on a monthly auto-charge to your credit card that you don't even know about.” (25:00—25:18) -Dr. Straub

“If you're not collecting 100% of your net production, your overhead percentages will be worse than they should be. So, if we’re only collecting 95% of our net production, then that's five percent that doesn't get factored into these overheads.” (25:52—26:08) -Dr. Straub

“People look at team compensation as an expense, and they get angry. Back in the day when they would write checks, we would joke that the dentist’s pen would bend when they were signing checks. Think better. Our job here at ACT Dental is to help your thinking. That shouldn't be an expense — that's an investment. You're investing in human beings. You've got to invest in the business.” (26:50—27:10) -Kirk

“If you've listened this far into the podcast, which we’re hoping you have, you're probably a little angry, a little frustrated right now. We’re here to tell you, there is a way out. It’s actually wildly predictable. If you sat down and actually did the math once a month — I'm going to recommend that you get a coach. But even if you didn't have a coach, you could say, ‘Okay. This is not good. I need to fix this.’ Nothing stands in your way. You can literally fix this one bucket at a time.” (28:21—28:47) -Kirk

“Once you start tracking numbers, the decisions that you need to make become very clear and a lot easier to make. Knowledge is power.” (28:49—28:58) -Dr. Straub

“Don't overthink it. Don't beat yourself up. Just start tracking numbers and make small, incremental improvements every month and every year. And the long-range benefits or outcomes from doing that little bit of behavioral change will pay off dividends for decades.” (31:10—31:25) -Dr. Straub

Snippets:

0:00 Introduction.

1:30 The challenge with overhead.

3:57 Why you should care about overhead.

6:58 Why overhead can be so confusing.

9:50 Why you need to know your overhead and how to lower it.

16:28 How to calculate your overhead in 60 seconds.

20:55 The best advice for thinking about overhead.

22:47 The seven-bucket model.

29:02 About ACT’s Roadmap to Practice Profitability.

30:59 Last thoughts.

Dr. Barrett Straub Bio:

Dr. Barrett Straub practices general and sedation dentistry in Port Washington, Wisconsin. He has worked hard to develop his practice into a top-performing, fee-for-service practice that focuses on improving the lives of patients through dentistry.

A graduate of Marquette Dental School, Dr. Straub’s advanced training and CE includes work at the Spear Institute, LVI, DOCS, and as a member of the Milwaukee Study Club. He is a past member of the Wisconsin Dental Association Board of Trustees and was awarded the Marquette Dental School 2017 Young Alumnus of the Year. As a former ACT coaching client that experienced first-hand the transformation that coaching can provide, he is passionate about helping other dentists create the practice they’ve always wanted.

Dr. Straub loves to hunt, golf, and spend winter on the ice, curling. He is married to Katie, with two daughters, Abby and Elizabeth. 

5 Strategies to Encourage Dental Hygienists to Diagnose Periodontal Disease

Episode #574 with Miranda Beeson

Hygienists are more than mouth janitors. They have the power to improve and potentially save your patients’ lives. So, why is your perio percentage still at zero? To help you improve that number, Kirk Behrendt brings back Miranda Beeson, one of ACT’s amazing coaches, to share five strategies that will empower and elevate your hygienists to diagnose more perio in your practice. Half the population has this disease! Let's give patients the optimal care they deserve. To learn how, listen to Episode 574 of The Best Practices Show! 

Episode Resources:

• Miranda’s email: [email protected] 
• Miranda’s social media: @actdental
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Best Practices Show Episode 573 with Jaime Taets: https://www.youtube.com/watch?v=3W-sAG9LtXg

Other Best Practices Show episodes with Miranda: https://www.youtube.com/@actdental/search?query=miranda%20beeson%20

Best Practices Show episodes with Robyn Theisen: https://www.youtube.com/@actdental/search?query=robyn%20theisen

Pearl: https://www.hellopearl.com

5 Strategies to Encourage Dental Hygienists to Diagnose Periodontal Disease: https://www.dropbox.com/s/0jm5gywzaquobuu/5%20Strategies%20to%20Encourage%20Dental%20Hygienists%20to%20Diagnose%20Periodontal%20Disease.pdf?dl=0

Beat the Heart Attack Gene by Dr. Bradley Bale and Amy Doneen: https://bookshop.org/p/books/beat-the-heart-attack-gene-the-revolutionary-plan-to-prevent-heart-disease-stroke-and-diabetes-bradley-bale/16685772

Books by Patrick Lencioni: https://www.tablegroup.com/books

Main Takeaways:

Establish what periodontal health looks like in your practice.

Provide hygienists opportunities for education and training.

Foster a culture of collaboration and communication.

Implement a periodontal disease screening program.

Use all the technology you can to your advantage. 

Quotes:

“We all know how prevalent periodontal disease is and how impactful periodontal disease is on overall health and systemic health. And if we’re not navigating our patients through that process and helping them to understand what the risks are, if they have the disease how can we manage it, are we truly helping them to the fullest potential?” (2:42—3:01)

“When we look at the prevalence of periodontal disease in our culture, we know that over half of the population, depending on the data around people’s age, has some form of periodontal disease. And as patients get older, 65 and up, we know that goes up into the 60s, and based on some research, even to the 70th percentile of people who have periodontal disease. And with the correlation we know now to so many systemic health risks — heart disease, diabetes, Alzheimer’s, and I think prostate cancer is in the mix now. There are so many things — patients are starting to become aware of that too. And so, it’s our responsibility to make sure that we’re doing everything that we can to support our hygienists to make sure that they're comfortable and confident in helping patients navigate that disease process.” (3:02—3:46)

“If you're not diagnosing and treating periodontal disease in your practice consistently, hundreds of thousands of dollars a year are walking out the door. And periodontal treatment itself, as well as building value, when people start to get more inquisitive about their health and their oral health and they start to look for more answers and, ‘How can I be healthier and better?’ that feeds into restorative as well. So, we’re leaving money on the table, for sure. So, from a business and profitability standpoint, if we’re not doing this, the profitability isn't where it could be, significantly. But then, on the other side of that is, we’re decreasing more and more risk for patients. And so, that's where we have to balance. Because as business owners, if you tell me I'm going to be hundreds of thousands of dollars more profitable — hygienists, you'd better get out there and start diagnosing perio. But the hygienists, they're not receiving that same impact that you are as a practice owner. Where it’s really going to impact the hygienist is knowing the impact that you're having on your patients, who a lot of these hygienists consider friends after years and years of taking care of them.” (5:05—6:10)

“When I first graduated, I graduated top of my hygiene class. I was so excited to go out into the world, and be this hygienist, and share all the knowledge that I had. And on day one, I remember having a patient, and I remember thinking, ‘Wow, this is more than I can do in one visit.’ Like, ‘This is perio. I'm pretty sure this is perio, but I don't know what to do here.’ And I remember the dentist who was so sweet. He took me in the hallway, and he was like, ‘So, are you finished with this patient?’ after the exam. And I'm like, ‘I don't think I am.’ He’s like, ‘I don't think you are either. There's a lot more going on here.’ And so, some of [the hesitancy] is a lack of knowledge, a lack of awareness of, how do we navigate treatment planning, diagnosing, talking about this with our patients? And then, there's also a lack of confidence. So, it stems from confidence and knowledge.” (6:33—7:21) 

“For those hygienists that are a bit more seasoned, it can sometimes be a level of complacency. Like, we as a practice have never really made this a priority. We have never really talked about our philosophy around perio in this practice. I'm doing a good job. And a lot of times, they're doing perio and not actually treatment planning perio. They're just working really, really hard . . . They're breaking their bodies, honestly, over delivering care that is more than what they're coding or presenting to their patients. A lot of hygienists are doing perio in a prophy visit when the impact should be focused and deliberate so that also the patient is aware of the disease state and the risks that it has to them in their overall health.” (7:21—8:17) 

“When [my client and I] talked today about creating a hygiene priority and working through some of these ways to encourage them to align, I said, ‘Do you feel like this is going to be valuable to you?’ And [one of the hygienists] said, ‘Yes. Even just having time for all of us to sit and talk about hygiene. Like, we do hygiene all day, but we don't ever talk to each other about what you do, or what I do, or what works well for you.’ So, the time dedicated to having that alignment time, she was like, ‘That in itself is so valuable.’” (9:24—9:57) 

“You said something last week when we were at our To The Top study club about alignment, ‘Alignment and agreement are not always the same thing,’ which I thought was so cool to say out loud. You can align with someone even if you don't fully agree. It’s a compromise that you're making so that you're all on the same page. You don't have to be in full agreement to be aligned. I thought that was really cool.” (10:31—10:54) 

“The first [strategy] is providing opportunity for education and training. So, like we just talked about, a lot of times, the hesitancy isn't because they don't want to do a good job, or they don't believe in perio, or maybe they [don't] recognize they're seeing perio. They just aren't exactly confident or have the knowledge to really move forward with diagnosing and treatment planning. So, creating that awareness and knowledge through providing opportunities. So, bringing in continuing education into the office, doing things as a team, internally, or seeking out and encouraging your team members to look externally for opportunities to learn about periodontal disease and where it’s going currently in our research.” (12:04—12:47) 

“Having the opportunities there for the team to grow and learn together, it’s team building, and it’s alignment driven, and it’s going to help for them to have the knowledge and the confidence that they need to feel comfortable bringing that up with patients, and being able to answer the patients’ questions when they ask them.” (12:57—13:15)

“There are experts that are out there like Katrina Sanders who are going internationally to learn this information. You can't do that as a practicing hygienist working four or five days a week, chairside. You can't go to all of the best symposiums throughout the country, internationally, to learn all of these new processes. But you can find an expert or a couple of experts or mentors who are doing that and learn from them. They are teaching you through their learning. The whole community needs to come together to start to see that we can impact, starting very small, and go as big as we want to go. But it’s how much time do you have. And sometimes, the teams don't have that time. That's why it can be helpful to carve time out, where you're bringing someone into the office, or playing some webinars in the office together as a team.” (14:14—15:04) 

“There are so many books in the world that we can learn from. There are so many people with a plethora of information. They're out there. We have to seek them out and then carve that time intentionally to make sure that every year, we’re not just going online and getting our 15 free CEs, clicking through the videos as fast as possible and just answering the quiz because we already know this information. Seek out new information that might take you into a more mindful growth place in...

The Stages of Change

Episode #573 with Jaime Taets

If you own a business, you need a coach! Even coaches need their own coaches for support and guidance. Today, Kirk Behrendt brings in ACT Dental’s very own coach, Jaime Taets, CEO and founder of Keystone Group International. She shares key insights from her years in corporate culture that will help energize and unify your practice. With her model, the stages of change, you will finally understand why your team isn't on board with your plans, and what you can do to change that. To learn more, listen to Episode 573 of The Best Practices Show!

Episode Resources:

• Jaime’s website: https://jaimetaets.com
• Jaime’s social media: @jaime_taets
• Keystone Group International: https://www.keystonegroupintl.com
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

The Stages of Change: [link needed]

You Are Here by Jaime Taets: https://jaimetaets.com/product/you-are-here

Pre-order The Culture Climb by Jaime Taets (launches June 20, 2023): https://jaimetaets.com/the-culture-climb

Jaime’s podcast, SuperPower Success: https://open.spotify.com/show/0W4ht8Sb4jxV9lMLI0XsBq

Culture Cohort - Creating a Culture of Contribution and Not Fit (event on May 17, 2023): https://www.eventbrite.com/e/culture-cohort-creating-a-culture-of-contribution-and-not-fit-tickets-567064203297?aff=ebdsoporgprofile

The Five Dysfunctions of a Team by Patrick Lencioni: https://www.tablegroup.com/product/dysfunctions

Main Takeaways:

Everyone needs a coach.

Understand the five stages of change.

When you know better, you can do better.

Don't hire a coach that doesn't have a coach.

Communicate seven times in seven different ways.

Quotes:

“You don't hire a personal trainer to give you a bowl of ice cream and the remote. Right? Think about that. You would never hire a personal trainer to do that. Why would you hire a coach to come in and pacify you, or just come in every now and then and tell you you're doing a good job? I don't believe that's the job of a coach.” (5:23—5:40)

“I think we’re advisors. We’re there to help you see what you can't see, because you're too close to it . . . You already know your business, so I'm not coming in and telling you, ‘This is what you need to do.’ I'm coming in and asking you questions so that you can take a step back and say, ‘Wow. I didn't realize it because I was so close to it, but we do have that problem,’ or, ‘I can see that now.’ And that's worth its price in gold.” (5:40—6:04)

“I have a coach. Any advisor, coach, anybody you're going to have come into your business, if they do not have a coach, run in the opposite direction. Because we all need to level up and have somebody that's helping us.” (6:05—6:18)

“As humans, when something is changing — and this can be the smallest change, it can be a big change. So, it really doesn't matter, the magnitude — you go through these five stages. And when we talk about it with leaders and coaches, let's say we’re a business owner of a dental practice. They're going like, ‘Why won't my people get on board with what we’re doing?’ We usually help them step back and say, ‘Because we haven't done the work needed to help them see the change and what's involved in the change.’” (7:55—8:28)

“The different stages of change, our job as leaders is to help people get through the stages as fast as possible, not expect them to just be on board because we sent an email, or we said something once. And that's the part as leaders I think we get hung up on, is we get frustrated. And so, when we share the stages of change, it’s to help leaders understand, don't be frustrated. Just realize they're somewhere on the stage. They're in one of those stages and we have to figure out how to move them.” (8:29—8:56)

“The first stage of change is awareness. So, if you think about a curve and there are five stages on that curve, the first stage is awareness. And what awareness means is — wait for it — I'm aware of the change. But that's it. I've seen an email. Okay. That doesn't mean I'm changing. It just means you've sent me an email. I've heard you mention it. Okay. But that’s all that is to me. I'm just aware that there is a change we’re talking about.” (9:58—10:26)

“After awareness, we move people to understanding. Understanding is interesting. I know a little bit more about the change. Not quite sure how this is going to work or how it’s going to impact me, but I understand it maybe a little bit below the surface, a little more than just, you've sent me an email.” (10:28—10:45)

“Whenever somebody says, ‘But we communicated it to them, and we wrote a process for them,’ I'm like, ‘That's two out of seven. What else are we going to do?’ And they're like, ‘What?’ It’s scientifically proven, [you need to tell people something] seven times in seven ways. And that might mean verbally. That might mean in a meeting where they're connecting dots, because it’s all about dot-connecting. They aren't on the journey. They haven't been thinking about it for three months or three years like you have. They don't see the same problem you see from their seat. And so, you have to paint the picture for them in pieces and put it together for them. Most leaders give up too early. They get frustrated, and then the employee is frustrated. And it's because we don't have this common language to point and say, ‘I'm only at awareness. You haven't gotten me further than that. I need more,’ whatever that looks like. That's what we want to create, is that common language.” (11:54—12:47)  

“Awareness is discomfort. Like, ‘Uh-oh. What's changing?’ Understanding is, ‘Okay. Open to hearing more, but I have no idea what this means for me.’ The third stage is acceptance. This is a really important one. We call this stage fragile hope. This is three stages in to the five, and they're still not fully on board. What it really means is, they're now open to being involved in the change, but they don't fully understand the change yet. And what happens with most leaders is we get people to use the language, even trigger words that you'll hear from people on how they know where they're at on the change. You'll think you got them there because they're saying all the right things. But all it’s going to take is for someone to be like, ‘Oh, yeah. We tried this three years ago. You weren't here, but Kirk did this before. Yeah, we tried. It doesn't work, and he’ll probably go back.’ All it takes is someone to put any amount of “uh-oh” in there, and they slide right back down the change curve.” (12:57—14:03)

“Most organizations that we come into, even if they think they're good at communication, only get people to acceptance. And then, they wonder why people are still wavering. Because at acceptance, I have a foot in the past, pre-change, and I have a foot in the future, knowing something is happening, and I haven’t yet decided which one I want to be in.” (14:04—14:22)

“So, going from acceptance to the fourth stage of change, which is commitment, that's the biggest chasm, as leaders, that we have to cross. That is where the work is. So, I tell leadership teams, ‘When you feel like you have someone to acceptance, double down. Don't take your foot off the gas at that point and think you're done and move on to the next thing.’ That is the point where you actually have to increase your communication. You have to talk more about what's going on. You have to create a different space and places for people to have the conversations and drive the change.” (14:27—15:01)

“Commitment means I am taking proactive steps in relation to the change. So, words that you would hear from somebody when your team is fully committed, you're going to hear things like, ‘Hey, Kirk. That thing you were talking about, I know we’re doing that. But I was also thinking, what if it could also help us over here?’ You know you have them, because they're not focused on the change and the pain of it. They're actually proactively thinking about other things that could happen and that you could also leverage that change for.” (15:02—15:32)

“Advocacy is where I am going to be an evangelist for the change and I'm going to help other people get through the change. I'm going to advocate for what we’re doing, and why it’s the right thing for the company, how it’s going to help us. And so, you have to get through commitment and get somebody to that evangelist stage for them to be in advocacy.” (16:13—16:33)

“We get this question all the time, ‘That sounds like a lot of time.’ Here’s what I will tell you. You can spend it upfront on the change, or you can spend it on the backend when it’s not working and when people aren't following the process. You're going to spend the time regardless. So, why not spend it proactively? Focus on that so that you can move on to the next change. Because how many organizations are still reliving change they made a year ago, processes that aren't being followed, things that aren't being done in a consistent way? It’s because they didn't actually manage the change the first time out, and so now we manage the fires that are created because of it afterward. So, I think you're losing time no matter what.” (16:36—17:19)

“Most don't know about models like this. This is from my big corporate days, but I've simplified it down. I'm reminded of the Maya Angelou quote, ‘When you know better, then do better.’ If I don't know it, I can't do it. But now that you know it, now we need to actually use it and be more aware of how we come across. Self-awareness is the first step. But how you do it is you focus on the people on your team who are actually good at this. So, when I come into a leadership team, I'll know the people that have a little higher emotional intelligence. And that's not a disrespect to — some people have higher natural emotional intelligence than others. Emotional intelligence typically, and empathy, is the key to being really good at change management and getting people through. Because you have to be able to sit in their seat, and look at what you're saying, and go, ‘Ouf, that email could really come across wrong if we say it that way, from their seat.’ And so, sometimes as a leadership team, for you, it’s surrounding yourself with people that can see different perspectives and aren't afraid to tell you, ‘I don't know if that message is going to be received in the way you intend it to be received.” (18:00—19:10)

“When you feel like you are micromanaging, it’s because you're not managing change. You're not having the real dialogue, human to human, to say, ‘Does this make sense? What else should we be thinking about?’ It’s oftentimes asking different questions to get people through that change curve, is you've got to turn their brains on in a different way. Because here’s the thing. Your employees are not sitting around like, ‘I'm just going to stay at the awareness phase. Screw them.’ That's not happening. They don't realize they're not at advocacy.” (19:54—20:28)

“A $300 million general contractor, I've been working with them for four or five years. In January, at their annual planning — they’ve had Lean. So, a lot of people heard about Lean in the manufacturing and construction space, Lean Six Sigma. They hired a full-time person who’s been there for two years driving a Lean agenda in their organization. But it’s been faltering, and stopping, and starting. We were planning it, and I finally turned to the executive team. I drew the stages of change, and I said, ‘Where are you at as it relates to Lean on the stages of change?’ This is the executive team leading the entire organization. We’re two years in. And all but one of them, the person who owns the Lean team, said, ‘I'm back at understanding.’ I'm like, ‘Hundreds and hundreds of thousands of dollars have been spent that is really going nowhere because none of you are actually committed or advocates for Lean.’ And it was this moment of — they weren't operating every day trying to undermine what was going on in the organization. But until they have the language to say, ‘I'm not there yet,’ that opened up a whole dialogue, and now actually has had other ripple effects in the organization where they're like, ‘We’re not having these kinds of conversations, and this is the kind of stuff that's holding us back.’” (20:32—21:55)

“The entire organization follows right where the leaders go. And if the leaders are all going in different directions, what direction does the organization go? It’s spattered. It doesn't have clear focus. And that's actually the biggest fracture we see in most organizations today, and why you're having retention issues, and all these things, is because they look at the leaders and go, ‘Every single one of them is misaligned.’ And what we tell leadership teams is, ‘If you think you're hiding your misalignment, your dysfunction, your distrust between yourselves, you're not.’ Think about parents who think they're hiding what's going on. You're not. The organization is seeing it, and they're seeing that you're not aligned.” (22:32—23:14)

“Two things happen when a leadership team is not aligned. People take advantage of it. It’s the whole mom, dad — I'm going to go to which one’s going to give me the answer about what I want to do this weekend or give me the answer I want. That's what they do to the leadership team. So, when they see fractures, if they know they can get it from Kirk, they're going to say, ‘I'm going to go ask Kirk and get what I want,’ even if somebody else isn't aligned to that. So, they see right through it. Or it causes them anxiety. It causes them like, ‘I don't know what to do because I don't see my leaders being cohesive and being aligned.’ And so, if we don't start there, none of the rest of it matters.” (23:15—23:54)

“Pick a change. And this could just be, ‘We’re going to make a small change to a process,’ or, ‘We’re going to start measuring something different.’ Don't pick your biggest, like, ‘We’re implementing a whole new system.’ Don't start there. You’ve got to build the muscle. But start with a change that's happening.” (24:22—24:38)

“Here’s what advocacy is. Advocacy is when someone else pushes back, I step forward versus stepping back. And what a lot of leadership teams don't realize is they go through the stages of change, and they don't get as far as they think they do. And the moment somebody on their team down in the organization has a problem with it, what do they do? ‘Oh, yeah. Yeah, you're right. Yeah, that's not the best thing to do. You're right.’ We need all leaders to be full-on committed and advocates of this. And to do that, we have to make sure they have the talking points, and they have what they need.” (25:15—25:52)

“Start using this language, whether it’s in a one-on-one and you're having a performance conversation. Where are they at? ‘Do you understand? Do you fully accept where we’re at? How can you be committed and show your commitment to this?’ Start using the language because I think it’s going to change the dialogue that you have.” (25:53—26:10)

“Unless there's a high degree of trust, we’re having good, healthy debate and discussion, we’re not fully committed. We’re nod-our-heads committed. And that's what I think happens in a lot of organizations. Especially as a business owner, and this is something that owners need to realize, is people are going to nod their heads when you say something just because they feel like they're supposed to do that. That does not mean they're committed. So, create the opening to say, ‘I see you're nodding your head. Walk me through where you're really at. Do you fully understand why we’re doing this?’ And give them the opportunity to say no. At least then, you know, and you can do more work, versus we go, ‘Okay. Yup, they nodded their heads. Everyone was looking at me in the room like we’re all good,’ and then I move on to the next thing. That's where the pain comes from, because people are just nodding their heads because they know they're supposed to, because you're the business owner.” (26:54—27:45)

“When we know better, we do better. So, now, you know. Everybody who is listening, you know that this is a real thing. It’s scientifically proven. It’s how humans’ brains are wired. You can use this at home. You can use this in your community groups. You can use it, when you get good at it, at the office. It works in life to say, ‘How are we going to get people on board with what we’re trying to do where they feel comfortable, and we can be successful as a team?’ So, just practice it. Try a conversation. Try it out with somebody that you trust. Start using it in your leadership team. And maybe you just start there.” (28:19—28:53)

Snippets:

0:00 Introduction.

1:39 Jaime’s background.

4:47 We all need a coach.

6:18 The stages of change, explained.

8:56 Stage 1) Awareness.

10:27 Stage 2) Understanding.

11:39 The 7/7 rule.

12:48 Stage 3) Acceptance.

14:27 Stage 4) Commitment.

15:33 Stage 5) Advocacy.

16:34 Choose how you spend your time.

17:20 Know better, do better.

19:10 What's holding your team back?

21:57 As goes the leadership, so goes the team.

24:01 Where to start.

26:12 Give your team the opportunity to say no.

28:10 Last thoughts on the stages of change.

29:26 Get in rhythm.

31:24 More about Jaime’s podcast, books, and future events.

Jaime Taets Bio:

CEO, public speaker, author, podcast host, and thought leader, Jaime Taets, is uniquely qualified to address this internal culture crisis. With over 20 years in corporate culture, 13 of which were spent leading large-scale global transformations at Cargill, one of the largest privately held corporations in the world, Jaime has honed the craft of bringing leaders and their people together for a unified goal. It is with that leadership mindset

4 Steps to Follow When You Lose a Rockstar Team Member

Episode #572 with Heather Crockett

If you own a practice long enough, you will lose some great team members. How do you not freak out when that happens? To help you keep calm and carry on, Kirk Behrendt brings back Heather Crockett, one of ACT’s amazing coaches, with a four-step process to guide you through what to do, how to do it, and a better way to think when it happens to you. It’s not always horrible when a team member leaves! To learn why, listen to Episode 572 of The Best Practices Show!

Episode Resources:

• Heather’s email: [email protected] 
• Heather’s Facebook: https://www.facebook.com/heather.r.crockett
• Heather’s social media: @actdental
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Traction by Gino Wickman: https://benbellabooks.com/shop/traction

Main Takeaways:

It will be okay.

Take a deep breath.

Do a current assessment.

If possible, do an exit interview.

Assess all the people you still have.

Have a contingency plan (not a plan B).

Quotes:

“Yes, it’s true. It’s going to happen. There are team members [that] come to the practice that are the right people. They fit your core values. They get results. They do all of the things that mean a lot to you and to the other team members in the practice. Sometimes, those people leave. They move on. The reasons can range. Oftentimes, it’s because you did something to encourage them to become a better person or to pursue something amazing. And that's okay too. We talk about how amazing leaders grow other amazing leaders. And sometimes, they hit a point where they need to move on and go somewhere else.” (2:23—3:08) -Heather

“Off of the heels of the pandemic, ACT Dental lost three of its top people — in a row! I was floored. And they were amazing people — still are — great contributors to our environment. Two of them said, ‘It’s just time to chart a new course. I'm going to start my own business.’ And they did. I'd love to sit here and say, ‘Yeah! I love giving people wings! I love it when they quit and start their own business, and I high-five them!’ In my soul, I say, ‘I'm so happy for you!’ But in my gut, I'm like, ‘No! Why? Not today!’ The third one said, ‘This has been unbelievably stressful. I can appreciate where you're going. I just want a regular, predictable job.’ And I was so happy for them to do that. In the middle of it, I almost had another panic attack. So, I had a panic attack during the pandemic. I probably almost had a heart attack during this one. It’s going to happen, and you think the world is going to come to an end. And it doesn't.” (3:23—4:37) -Kirk

“Kirk, with what you just said with what you experienced, you needed step number one right away: deep breaths. It’s going to be okay. It doesn't always feel like it. But what I'm reminded of are your circles that you refer to with what I can control and what I cannot control. If you focus on what you cannot control, you're going to drive yourself absolutely crazy mad. If you focus on the things that you can control, you're going to be okay. We cannot control if a team member chooses to leave. Like, let's not hold them hostage in the practice. No. It’s going to be okay. People are going to come and go. This is a reality of running a business, running a practice.” (4:55—5:39) -Heather

“During the COVID-19 days in the conference, we brought many people in that were experts on mental health. I am not one of them. One of the models that the World Health Organization showed us — it was powerful. Still use it today — was two circles. In the middle circle, you write what I can control. Outside of that circle is another circle. That's what I can't control. And what they taught us and everybody that was listening was, where is your focus? When your focus is on the middle circle, it’s a healthier day mentally, emotionally, and physically. When it’s all over the circle, it’s not so much.” (5:45—6:27) -Kirk

“You have to not do anything stupid. Don't make any rash decisions in the moment. Take those deep breaths, know that you're going to be okay, and realize that these things are going to happen. So, you just have to accept it and say, ‘Okay. Yes, it’s not ideal. And we had this happen before. So, it’s okay.’ And with these steps, you're going to have a good plan of what to do next.” (7:16—7:45) -Heather

“Give space to your emotions. It’s valid to feel all the things. It’s okay to be upset. It’s okay to be relieved if it’s not a great team member. It’s okay to be disappointed that they left your practice as well. So, I would say, it’s okay. It’s okay to feel all of the emotions.” (8:48—9:07) -Heather

“When you have a foundation of core values, systems, good things — the more the foundation, the less the tree waves at the top. You're like, ‘Okay, we’ve got a pretty good business here. We’ve got good values. We’ve got a good rest of the team.’ The less that exists, the more the tree is waving all over the place and you're thinking, ‘I should just sell and get out of here. I don't know if I should do this anymore.’” (9:11—9:37) -Kirk

“Step number two is to take a step back and do a current assessment. If there's the potential for an exit interview, do an exit interview with the team member. See what worked and what didn't work for them. Really get down to what their main issues were. Was there anything that they held back and they didn't share with you? And then, look at the things that you could have changed about the relationship, if anything.” (9:42—10:14) -Heather

“I do love the exit interview when you can get it. You're not always going to be able to get it. And then, if you do get it, the second question is, ‘Did I really get some authentic feedback?’ And so, I did that with those team members. I'm like, ‘You've got to help me. This really hurts. Can you give me some coaching?’ And I always preface things good, bad, or indifferent with, ‘You can't hurt my feelings.’ I've been saying that for a long time because it doesn't always lend itself to everybody telling you the truth all the time. But what it does do is it opens it up for more of that. And so, when you do an exit interview, you can start to assess, ‘Wow. I probably should learn from this experience.’” (10:18—11:01) -Kirk

“People don't leave practices. They leave people. And so, there are some things you can control, and you can't control. But when I can diagnose like, ‘Wow, they left me,’ my next question is, ‘How do I not do this again?’ And this is the part that probably hurts the most, the current assessment.” (11:05—11:28) -Kirk

“What can I now learn from this, moving forward? From this experience, what can I take from this in order to improve myself and become a better leader?” (11:33—11:43) -Heather

“Remember, you're the business owner, if you're the dentist listening. And no one could make as many mistakes as you and stay employed as long as you have. If you've turned over your team three or four times in the last couple of years, what's the constant here? It’s you. So, we’re not here to beat you up. What we are here to do is, every change process starts with telling the truth, getting some feedback. That's why it’s essential to have a coach.” (11:45—12:15) -Kirk

“[If] you don't have a coach and you lose one or two good team members, you start making up your own story if you don't have that feedback. And oftentimes, the story that you make up is not a good one. But if you have somebody from the outside looking in saying, ‘Okay, let me tell you what happened there,’ you can be receptive. You're not always taking the information and liking it. Some of my favorite people in the industry always start with telling me something like this, ‘You don't have to like what I'm going to tell you.’ And I'm like, ‘Okay, here it comes.’” (12:18—12:50) -Kirk

“This is your humility check. This is your, ‘Okay, what can I do?’ Look inward for a minute so that you can have a better outward mindset.” (13:00—13:10) -Heather

“Step number three. Let's talk about the people that you still have. Let's assess those people. Are they fitting our core values? Do they get results? What can we do now that we’ve gone through step one and two without making those rash decisions? Is there someone within the practice that can now help to fill this current void?” (13:18—13:43) -Heather

“My favorite thing that happened — even when this happened to me — I had someone raise their hand and say, ‘I want that job.’ I thought to myself, ‘But you're in another department.’ They said, ‘I think I can do this job.’ And they shined in it. There are hidden opportunities that you don't see yet. And people, when they want to be a part of it — remember, you're now recruiting internally. Somebody knows that role. They think they can take the role. They want the role. That's a good move for you.” (14:07—14:38) -Kirk

“There's also the purging of over-functioning type of things. So, this is another instance. You might have somebody that's an office manager. They do a lot. You've told yourself they do so much here. And now, one day, they're not there. You're like, ‘Okay, who’s going to do all this work?’ And you think to yourself, ‘Okay. Well, we got it all done in a day or two.’ So, you don't have to run out and hire a very — it’s always good to have somebody in that role if your practice is big enough. But you don't have to make the rash decision to hire somebody and fill that void of that salary right away. There are times you can say, ‘Okay, listen. There are some things we can outsource.’ In any change or any system, I think this is a good process to go through, like what can we systematize, what can we automate, what can we outsource? Are there any of these things that we can outsource that might fill this void for now?” (14:39—15:34) -Kirk

“This is a great opportunity to go back to the drawing board with your Function Accountability Chart. So, let's look and see, in the organization, who does what, what are their roles, what are their titles? Perhaps we do have, or we did have, too many people. And there may be an individual that is ready to rise to the occasion and fill that void.” (15:45—16:05) -Heather

“[Heather’s] thing was, you’ve got to have a plan B. And I told her, ‘Heather, no! Plan B is for wimps.’ So, I tell my kids — please hear me. I'm not trying to be right. I never think plan B. Maybe that's one of my problems. I think there's only plan A. You don't come up with a plan B. But what we’re really talking about is when plan A doesn't work. What's the new plan A? That works better for me. Or a contingency plan. ‘We’re working with this. What I'm working on isn't working anymore. Now, it’s time to go to a new plan A.’” (17:33—18:07) -Kirk

“I'm on board with a contingency plan. I think that this step has to include — you have to be honest and address this with the team. So, the big elephant in the room, you have to address it. And the sooner you address it with the team, the better. After your 24 hours or 48 hours of having all the emotions and being able to think about it and process what's happening, then you're going to address it head-on with the team and say, ‘Okay. What's our contingency plan?’ This is when the team is probably going to come out of the woodwork, the right people, if you have the right people in your practice. They're going to start stepping up. ‘Well, I can do this. I can scan documents. I can make confirmation calls. I can do . . .’ And you're going to be pleasantly surprised with those people in your practice that are going to step up to the plate and help out.” (18:11—18:55) -Heather

“Plan B might be more than a people plan. It might be a business plan. There were some offices that we coached that when COVID-19 happened, they said, ‘Listen. I'm going to go the no-insurance route.’ And so, they pulled the trigger on the last few insurances and never looked back when or if they lost some key people.” (18:57—19:22) -Kirk

“Another one might be like, ‘I'm trying to build this bigger practice. I've lost two amazing associates. I'm not going down that route anymore because what I've taught myself is I'm not good at keeping associates.’ So, they rethought their business plan, kept it simple, and became more profitable that way. That's not for everybody. But what you can do in a new plan, or a contingency plan, is rethink your future here.” (19:22—19:47) -Kirk

“Dentistry is an amazing business. You're not stuck to somebody else’s rules. So, when bad things happen, it’s good to, number one, take a breath. Number two, take a current assessment of the situation. That's why I think it’s critical to have a coach or an advisor, somebody that can help you think through the numbers, the emotions, and maybe what happened. Number three, take a look at the people that you have and say, ‘Okay. What do I do here, and how do I better strengthen this group?’ Then, number four, does this all make sense with how we’re going to move forward in the next couple months? I think, at the end of the day, it’s good to know that you're always going to be okay.” (19:49—20:28) -Kirk

“I ran into a dentist that I worked for for almost ten years. Long ago. Great, amazing man. Like a second dad to me. I learned so much from him. I ran into him at the Utah Dental Association Convention here in Salt Lake a couple of months ago. He was speaking with a young woman I'd never met before, so I went up and said hello. He introduced me. She’s his former assistant. She’s in dental school. So, as his dental assistant, did she leave the practice? Was she an amazing assistant? She’s now in dental school and wants to buy his practice. So, it’s not always horrible when a team member leaves. It’s an opportunity.” (20:56—21:45) -Heather

“When you start putting your brain in the right place, on the other side of the fence, good things happen.” (22:14—22:19) -Kirk

“Prepare yourself mentally because this is going to happen. And follow the steps. Take a deep breath, come back and revisit this podcast, follow the steps, and you will be just fine. And if you really feel like you're anxious about it, give us a call. We would love to help you through it.” (23:00—23:18) -Heather

Snippets:

0:00 Introduction.

2:11 Why great team members leave.

3:09 Step 1) Take a deep breath.

5:39 The two circles, explained.

7:12 Think before you act.

8:43 Give space to your emotions.

9:40 Step 2) Do a current assessment.

10:15 Learn from the exit interview.

13:16 Step 3) Assess the people you still have.

17:20 Step 4) Have a contingency plan.

20:55 Look for the silver lining.

22:56 Last thoughts.

Heather Crockett Bio:

Heather Crockett is a Lead Practice Coach who finds joy in not only improving practices but improving the lives of those she coaches as well. With over 20 years of combined experience in assisting, office management, and clinical dental hygiene, her awareness supports many aspects of the practice setting.

Heather received her dental hygiene degree from the Utah College of Dental Hygiene in 2008. Networking in the dental community comes easy to her, and she loves to connect with like-minded colleagues on social media. Heather enjoys both attending and presenting continuing education to expand her knowledge and learn from her friends and colleagues.

She enjoys hanging out with her husband, three sons, and their dog, Moki, scrolling through social media, watching football, and traveling.

3 Keys to Identifying the Early High-Risk TMJ Patient

Episode #571 with Dr. Tiffany Lamberton  

About 10 million people in the world have TMD. So, why do dentists ignore this problem? We need to think better, and today’s guest helps do exactly that. Kirk Behrendt brings in Dr. Tiffany Lamberton from TMD Collective to help you understand everything joint-related, how to be fearless about treating these patients, and finding ways to connect with the right specialists. Identifying it early is the key! To learn more about this overlooked condition and what you can do to help, listen to Episode 571 of The Best Practices Show!

Episode Resources:

• Dr. Lamberton’s website: www.tmdcollective.com
• Dr. Lamberton’s LinkedIn: https://www.linkedin.com/in/tiffany-lamberton-4354aa228
• Dr. Lamberton’s Facebook: https://m.facebook.com/tmdcollective
• Dr. Lamberton’s Pinterest: https://br.pinterest.com/tlamberton2
• Dr. Lamberton’s social media: @tmd.collective
• Dr. Lamberton’s TikTok: @tmdcollective 
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Dr. Lamberton’s educational platform or coaching/mentorship: www.tmdcollective.online

Specialty Imaging Temporomandibular Joint and Sleep-Disordered Breathing by Dania Tamimi: https://www.elsevier.com/books/specialty-imaging-temporomandibular-joint-and-sleep-disordered-breathing/tamimi/978-0-323-87748-0

Chicago Study Club: https://chicagostudyclub.com

Main Takeaways:

Look beyond the teeth.

Slow down your diagnosis. 

Know the signs of airway issues.

Pain isn’t the only symptom of TM issues. 

Start collaborating with different specialists. 

“There needs to be a way to bring the joints into the picture more because we always are just very focused on the teeth, and how they fit together, and the bite, and the occlusion. But I always think of like, if you're building a house and you do these beautiful front doors, you're building this entryway, you’ve spent $40,000 on these doors and the hinges are like $3.99 from the hardware store, you may run into problems. And so, I think that as dentists, we need to have a little bit bigger lens of looking at the jaw joints, looking at the muscles of the head and neck — myofunctional therapy is really big right now. (3:20—4:04)

“I think that there are a lot of myths as far as telling people, ‘Oh, you have clicking and popping. You're fine,’ or like, ‘Oh, your joints look like they're really degenerated, but you're going to be fine with that.’ I give the analogy — I have an 11-year-old and he’s an incredible skier. We were just up at Whistler. He’s doing hits, and he’s in and off the runs. If he had a bad ski injury and injured his knee, let's say his medial meniscus, ACL, some of the soft tissue of the knee, you wouldn’t even think twice about ordering an MRI to evaluate, ‘Are we going to do PT and a brace, or are we going to do arthroscopic surgery?’ And so, I get a little bit frustrated when I start hearing so much pushback about like, ‘Well, why do you need an MRI of the TM joints? Why would you do that on someone that doesn't have any pain?’” (7:40—8:35)

“I think especially our young female patients where they may be a little bit hypermobile, or they may have more ligament laxity, or basically where you have a series of things, maybe they had a gymnastics injury, or they fell on their chin, or they fell off the rope swing, as a dentist, or especially as a mom, you're like, ‘Are your teeth okay? Are you bleeding? Do you need stitches?’ But no one thinks about the jaw joints. And the issue is that even if you have a little bit of displacement of the disc, that's going to affect the growth of the condyle early in life.” (10:18—11:00)

“When you're thinking about craniofacial defects, and as we’re starting to see different bite presentations — we used to call it cheerleader syndrome. They used to say, ‘Well, there are all these young females with anterior open bites. Maybe they're yelling too much.’ It turns out, from talking to Jim and Drew and those guys, as we’re starting to get better tools with our modern imaging and correlating that with our clinical exam, we’re realizing that not all TM joints are normal, or not all of them are healthy, and not all of them are reaching their full growth potential.” (11:01—11:39)

“What we’re seeing is rotations of atlas in these kiddos. Even though they may not have a lot of pain, they may be starting to have other sympathetic system symptoms that are manifesting as maybe headaches or postural changes. And so, I think that what I want to manifest is this crystal ball of — so, rather than having that 45-year-old patient in my chair that's crying because she can only open two finger widths because her jaw is locked closed after she had her restorative work, what if we could go back in time, or now, as we’re moving forward, as we’re starting to look at interceptive ortho and these kids that are younger and younger, and we’re starting to see things like crossbites, or anterior open bites, or bite changes, and postural changes, muscle changes, that's where I think the myofunctional therapists are really our advocates because they're looking at them in different ways. (11:59—13:03)

“I think dentistry, with how we’re trained, we’re just very focused on the teeth. I think we need to have that bigger lens of looking at things as we’re learning more and more about how all these systems work together and function in our patients.” (13:47—14:03)

“We need to start training ourselves to utilize the tools that we have available to us. I'm friends with a lot of endodontists, and I say to them, ‘Would you ever want to do molar endo without your microscope, without your GentleWave, without your CBCT?’ And they're like, ‘No! I could never go back!’ And so, I think that when you start seeing things like in the airway world, if you start seeing that kiddo that has the tonsils that are kissing on the midline, or you see the kiddo that can't even lift their tongue from the floor of the mouth, or you see that mismatch between the maxilla and the mandible of the growth and development, once you start seeing those things and start to look through that bigger lens, I think you just can't unsee it.” (14:21—15:11)

“Airway dentistry is really amazing. I think the paradigm is shifting where there are a lot of dentists that are getting excited about airway and realizing that the oropharyngeal airway space is really our jam, and we can impact that, especially in these young kiddos. But I want us to think more than just putting in a mandibular advancement device, because I do think that back when I was starting to delve into the sleep and TMD world, if you start to change the position of the jaw, you realize that you need to know what the condition of those joints are before you start doing that. Because if the patient ends up having maybe some subpar outcomes, maybe they have some bite changes. Maybe they start to have clicking and popping of their joints. Maybe they start to have pain. You want to know what your starting point is. And I think that that's what I really want to emphasize . . . is really, in the beginning, let's slow down to get the diagnosis.” (15:28—16:40)

“I think with dentistry, we’re so quick to jump to like, ‘Okay, this is a great case! I can really fix these things. I can change your bite.’ But you've got to know that those joints are stable. So, no matter what your treatment proposal is, whether it’s ortho, whether it’s a referral to an oral surgeon, whether it’s restorative dentistry or equilibration, my message would be, let's slow down and let's look at all those three points of the triangle.” (16:41—17:12)

“I don't want us to forget about the joints. Because, like I said, those are the hinges. And if those break or aren't functioning properly, you're going to really start to see show it affects other parts of the system. You're going to start to see how it affects the neck and the cervical spine. You're going to start to see how, if you start looking at your patients, their sternocleidomastoid, or maybe they have a torticollis in their neck, or you start to look at how they're holding their body or how they're moving. And so, I think that we can't leave those things out. As a general dentist, I think we’re perfectly positioned to be the leader of the team and to really be bringing all these different collaborators into our orbit. And so, I want to encourage — don't be afraid of that.” (17:33—18:23)

“Our friends in the oral and maxillofacial radiology world, we've got to be talking to them. They're taking those big, full-field of view CBCTs that look at airway and upper cervical and the TM joints. I always do an overread with my OMR. They're an important part of my team. Even though I know a lot, I want to make sure that I'm not missing anything.” (18:53—19:18)

“Back in the day, we used to think that splint therapy was the only thing. I don't know if you had a patient like this where you made an appliance, and they're like, ‘Oh, it’s great! It’s wonderful!’ Then, they come back like six months later and like, ‘Augh, I'm having all this jaw pain again.’ And so, you adjust. Or maybe you have your assistant come in and adjust. And then, you're like, ‘Oh, no! She’s back!’ She comes back six months later and, ‘It’s broken.’ And so, again, I think that whatever type of appliance you're doing, just knowing what your starting point is really gives us that prognosis discussion, and it really lets us tell our patients like, ‘This is your anatomy.’ I tell my patients, ‘You want to own your anatomy.’ Because no matter what you do, if you didn't tell them about it ahead of time, it’s your fault. Because you did that crown, or you did that splint, and all of a sudden, it changed everything.’ (19:47—20:49)

“I think myofunctional therapists have really jumped on that virtual model as well [during COVID-19]. And so, even if you don't have someone right down the street from you, or you haven't hired one, I would say, as a dentist, first of all, talk to your team. Who’s excited about this? Who wants to be certified? Or sponsor someone to get certified. One of my colleagues in the Chicago Study — actually, a couple of the female dentists there have paid for a person on their team member to become a myofunctional therapist. I'm like, ‘Yes!’ Or look into big networks. Social media has some incredible myofunctional therapy communities. The Breathe Institute is incredible. There are a lot of different ways to connect virtually as well. Find out, is there a myofunctional therapist that is an outstanding rockstar in their right that would take virtual appointments?” (22:34—23:40)

“The crushing debt of dental school, we’ve got to figure out a way to not let that be an anchor and limit how we think and how we practice.” (25:54—26:04)

“If you're interested in doing this, do a fee-for-service model style of practice. And even if you have a restorative practice, Dr. McKee always says, ‘Just pick out three patients that you're going to work up this way this month.’ Or maybe two. Do that slow process of gathering all your records, your photos, your digital scans, deciding after you've taken the clinical history, are there enough check marks that you're thinking like, ‘I think that this person may have some issues’? whether it’s pain, or jaw deviation, maybe limited range of motion, maybe headaches. Or maybe in this young kiddo, you're seeing these bite changes and you're seeing growth patterns that, there's that mismatch between the maxilla and the mandible, or you're seeing some concerning things about how it’s not just about getting the teeth to fit together, it’s also how are they growing.” (27:08—28:13)

“The NIH tells us 10 million people, worldwide, have TMD. Females are twice as likely as men to have it. And my question is, why are we ignoring this? Or why are we waiting until they have pain or problems?” (29:05—29:21)

“As a dentist, we can't be fantastic at everything. But we can bring people into our orbit that have that different lens. And then, that pushes us forward in our learning.” (29:45—29:56)

“When you start to understand modern imaging and how that correlates with our clinical exam, all of a sudden, it’s not scary anymore because you know exactly what's going on, and you can tell the patient, ‘Hey, instead of this beautiful ice cream cone, your condyle looks like a high-heeled shoe because you have this really degenerative condition.’ And so, I think that really, with our young patients especially, if we’re starting to see changes with their growth that are concerning as far as that mismatch between the jaws and with the cervical spine, that's when we can really make the most difference to these young kiddos.” (33:55—34:41)

“Do Pilates. I'm a huge proponent of Pilates. I think as dentists, you're in these terrible postures all day. You've got to find a way to preserve your spinal mobility. I was listening to a couple other podcasts where they're like, ‘You've got to be able to practice and take care of your body for the next 20, 30 years.’” (34:54—35:18)

“Stay humble, stay curious, find your people, and do Pilates.” (36:04—36:08)

Snippets:

0:00 Introduction.

1:31 Dr. Lamberton’s background.

6:49 What dentists get wrong.

14:05 Look through a bigger lens.

15:13 Don't forget about the joints!

19:18 Know your starting point.

21:19 Connect virtually.

24:13 Slow down.

28:40 Why are we ignoring TMD?

30:01 Build a practice with what you enjoy.

31:42 More about TMD Collective.

34:49 Last thoughts. 

Dr. Tiffany Lamberton Bio:

Dr. Tiffany Lamberton is a Washington native who has dual degrees in both Physical Therapy and Dentistry, both from Loma Linda University. When she graduated with her DDS degree, she was also inducted into the Omicron Kappa Upsilon National Honor Society and received awards in Oral Pathology and Leadership. She currently has focused her practice on evaluation and treatment of Temporomandibular Joint (TMJ) Disorders and is available for New Client appointments via her website www.tmdcollective.com. She will be a speaker for the Pacific Northwest Dental Convention and is delving into the educational world speaking about TMJ, Airway and Myofunctional Therapy. She is a member of the ADA, WSDA, and is a Pierce County Dental Society Board Member. She is also a member of AOMT and the Chicago Study Club. Dr. Tiffany considers herself a life-long learner! She lives in the North End of Tacoma with her husband and two children, and enjoys snowboarding, wake surfing, and Pilates.