The Best Practices Show with Kirk Behrendt

Real Talk About the Dentist-Assistant Relationship

Episode #550 with Kevin Henry

If you’ve ever wondered what your dental assistant is thinking, don't miss this crossover episode! Kirk Behrendt brings back Kevin Henry, co-founder of IgniteDA and host of the Dental Assistant Nation podcast, to demystify and help improve dentist-assistant relationships. He highlights common roadblocks that each side faces, and solutions you can start applying today. Your dental assistants deserve more than they're getting! To hear what they're really thinking and to learn how to help them, listen to Episode 550 of The Best Practices Show!

Episode Resources:

• Kevin’s website: https://www.kevinspeaksdental.com
• Kevin’s social media: @kghenry23
• IgniteDA: https://ignitedds.com
• IgniteDA social media: @ignitedentalassistants
• 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:

Dental Assistant Nation podcast: https://open.spotify.com/show/26p2Sp3hw53va0EkeKun33

Rocky Mountain Dental Convention: https://rmdconline.com

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

Main Takeaways:

Learn how to communicate.

Stop playing the blame game.

Prevent favoritism and learn how to fix it.

Value and appreciate your assistants so they stay.

Help train your dental assistants so that they become great.

Money won't fix everything. If assistants are unhappy, they will leave.

Quotes:

“It’s absolutely true [that great dental assistants are hard to find]. And let's define what great is. Because I think a lot of times, we have assistants who are coming into this industry right now, some of them are actually coming from outside of dentistry, being taught from the ground level all the way up. So, I've heard the same thing from dentists. And assistants who are listening to this podcast, yeah, I have heard there aren't a lot of great ones out there. But I always say, ‘What's the definition of great? And how are you, as a dentist, actually helping to train them to become great? And how much leeway do you give in that time?’ But absolutely, there's a huge shortage out there of dental assistants.” (4:13—4:45) -Kevin

“We have to make sure that the assistants who are here feel valued, feel appreciated, and they stay.” (4:53—4:58) -Kevin

“I always tell my assistants, ‘You can't sit back and expect somebody to come to you and say, we need you to do this. You have to tell them, what are your passions, what do you look forward to doing this year, and then work on a plan with the dentist on how you become a better assistant and work together on that.’” (5:41—5:55) -Kevin

“Over communicate. There should be incredible clarity around job descriptions. And you should treat everybody with the same respect. When somebody excels, then that opens the door for them to be a leader. You can talk to them, and they could potentially be the lead. But I think you also have to be vulnerable with your team. If you're doing favoritism, you should give people license to call you out and go, ‘Listen, I need to talk to you about something. It’s what I'm experiencing. You have a favorite here.’” (8:01—8:32) -Kirk

“I was speaking to the assistant, and I said, ‘Whenever we know that somebody is a favorite and we’re not that person, sometimes, we pull back.’ Right? And so, I said, ‘Are you the one pulling back instead of pushing forward?’ And like you said, having that open conversation about, ‘This is how I feel,’ and really bringing it forward, or you’re just taking it home and grumbling. I think that we’ve got to get past the point where we’re talking to others about it instead of talking to the person that we have the issue with.” (8:44—9:12) -Kevin

“If you're truly going to create a team, you have to have high levels of trust where they can give you feedback. And you have to be emotionally intelligent as a leader and go, ‘This is going to hurt, but it’s the truth.’” (9:26—9:35) -Kirk

“The dentist has to be open to hearing [feedback], and the assistant has to have enough guts, shall we say, to actually have that conversation too.” (10:03—10:09) -Kevin

“Data removes all emotion. There's nothing that fixes [the doctor blaming the assistant] faster than a time study. Here’s what a time study is. It’s recorded time in and out on a patient when the patient arrives and the patient leaves for a procedure. So, if you're an assistant, pick the top ten procedures this is happening in. Create a time study sheet. Patient came in, patient left for this procedure. Doctors are going to hate it because “everything is an hour” — and it’s not true! They're going to look at it and go, ‘Wow . . .’ There are a couple things to this. It’s a time stamp. All it is is time in, time out. Doctors only notice when the patient is there. They don't know when the patient arrived. They don't know when the patient left. And so, now, the blame goes away. We’re just looking at data. If you and I don't have any data, we’re talking about how we feel. And that's going to be emotionally charged.” (10:35—11:30) -Kirk

“Remember, the doc was blaming the assistant because the room wasn't set up properly according to his standards. That's why I said, ‘Is there some truth in there?’ We don't often like to be told that we didn't do the right thing. So, I asked, ‘Was there some truth to it that the room maybe wasn't set up properly? Or is there a communication problem between expectations?’ And if that's the blame game that's going on there, then eliminate that part of it. Make sure that you understand exactly how it should be, and eliminate that part of the blame game, and then see how the timing does.” (12:32—13:06) -Kevin

“If you're saying that the assistant can't read your mind, don't you already know the problem here? Don't you already know that you're not communicating?” (16:49—16:55) -Kevin

“Dentists and assistants spend so much time together. You've got to ask, ‘How do I communicate with you? What do I need to know from you, even if it’s just short, sweet stuff?’ This dentist may not want to talk a bunch. Get in, get out. Fine. Just give me the little bit of information I need to know.” (17:13—17:29) -Kevin

“Communication is always the responsibility of one person: the sender of the information. It’s never the [receiver’s responsibility] to understand all the details.” (17:33—17:41) -Kirk

“Pay scales are going up and up and up for hygienists, for assistants, for front office because docs don't want to lose them. They're willing to pay over the top to keep them. And team members know that now. So, it’s a different game, I think, than it even was for COVID-19.” (18:42—18:56) -Kevin

“As a dentist, as an entrepreneur, you have to run a profitable business. When your pay compensation across the board is in its 33% range, I can already tell you a couple of things. I don't even need to know your name. You already have a people-dependent practice. Your practice is pretty chaotic. You throw person after person. Everybody is tired and everybody feels underpaid. And that is true. And it’s not because you overpay people. The truth is you don't have a business that collects enough money to support the payroll that you have. Because if you're really good at running a business, you should know where your pay compensation number should be. And when you keep them in the 20%, 25% range and you're collecting enough, now you can pay people top level. You should pay people top level. It’s on you as the business owner to make sure you've got great systems. If you don't have any systems in place, you're doomed. Now, it’s just a free-for-all, and you're probably giving what's called a hush raise.” (19:10—20:10) -Kirk

“You're not just running a practice. You're running a small business. Just like the local florist, the funeral home, the hamburger stand, whatever you want to pick in your hometown, it’s a business, just like yours should be. And every one of those employees are part of your business.” (21:19—21:32) -Kevin

“People often think that money will fix everything. And I will tell you, from the assistant side of things, it’s a very temporary Band-Aid. Because I guarantee you, if they're not happy, they’ll look for somewhere else. Even if it’s a dollar more an hour, they’ll take it.” (21:38—21:52) -Kevin

“People won't leave unless they're unhappy . . . The best [dental team members] never say, ‘Money is the reason I'm here.’ It’s on there — don't get me wrong. It’s two, three, or four, but it’s never number one.” (21:54—22:09) -Kirk

“[Dental team members] want to feel appreciated. They want to feel like they belong. They want the culture thing that people sometimes roll their eyes about. I guarantee you, it’s so important, and so often overlooked.” (22:10—22:19) -Kevin

Snippets:

0:00 Introduction.

1:42 Kevin’s background.

2:14 Roadblocks in the dentist-assistant relationship.

3:09 Why Kevin started Dental Assistant Nation.

4:01 The shortage of great dental assistants.

5:57 Roadblocks created by dentists to assistants: favoritism.

10:12 Roadblocks created by dentists to assistants: blaming assistants.

14:15 Roadblocks created by assistants to dentists: lack of communication.

18:12 Roadblocks created by dentists to assistants: expecting more work for no extra pay.

21:07 You're running a business, not just a practice.

22:20 Dentists and assistants need to collaborate.

24:11 More about Dental Assistant Nation, Ignite DA, and how to get in touch with Kevin.

Kevin Henry Bio: 

With 16 years in the dental publishing industry, Kevin is the former group editorial director for UBM Medica’s dental division, consisting of: Dental Products Report, Modern Dental Assistant, Dental Practice Management, Digital Esthetics, Modern Hygienist, Modern Dental Business, and more. He was named as one of the top five influential voices in the industry on Twitter (@kgh23). 

In Kevin’s former life, he was a public relations director for NAIA, a national small college sports organization. He is currently a beat writer for the Colorado Rockies and the Denver Nuggets. Living in Colorado, Kevin loves to be outdoors, whether it be hiking, skiing, or white-water rafting.

Why Investing in Your Team Is So Important

Episode #549 with Jenni Poulos

Your team is your most important asset. If you want a better practice, investing in your team members is one of the best things you can ever do. To share how you can commit to their growth, Kirk Behrendt brings back Jenni Poulos, one of ACT’s amazing lead coaches, with advice for training, educating, and growing the people around you. When you take care of your team, they will take care of you! To learn how to build a better team for a better practice and a better life, listen to Episode 549 of The Best Practices Show!

Episode Resources:

• Jenni’s email: [email protected] 
• Jenni’s Facebook: https://www.facebook.com/jenni.poulos
• Jenni’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:

Rocky Mountain Dental Convention: https://rmdconline.com

Atomic Habits by James Clear: https://jamesclear.com/atomic-habits

Main Takeaways:

Let go. Learn to delegate and elevate. 

Commit to growing the people on your team. 

Invest in your team’s education the same way as your own. 

A two-hour team meeting, done right, is a worthwhile investment. 

Your team members are the people who will bring your vision to life. 

Quotes:

“We oftentimes think team members should come trained, they should come educated, and the time that they spend in the practice should be enough. Dentists are quick to invest in themselves on tons of education. Clinical education, they will fly all over, spend top dollar for top education. They see it as an investment. But they don't, for some reason, take that leap to, ‘I need to invest in my team in the same way,’ because they need to stay in their circle, and they need to delegate and elevate their team members so they can be ballers everywhere else in the practice. And the way to do that is to invest in education.” (2:49—3:34) -Jenni

“As leaders, what we need to get really good at is letting go of the things that a) are not our highest and best, the things that we shouldn’t and don't have to be spending our time doing. We want to delegate those items to other team members that are going to be better at them so we can stay doing the things that are best for us. We can put them executing and killing it at the things that they want to do that they're best at. And by doing that, we continually elevate the people around us. We trust them. We have to let go of the vine, let them take the reins, delegate where we can, and we continually grow the people around us. You have to invest in them, invest in some education, invest in bringing them into a room where they can hear you speak, laugh, have a good time, learn something new, and be in this amazing community and this amazing environment, and go back and say, ‘I want to take the reins. I want to take this over. I want to kill it for you, and I want you to stay in that op doing what you do best. You delegate the money to me. You delegate these things to me, and I'm going to grow for you.” (3:52—5:07) -Jenni

“You're going to build a team. It is your most important asset. Facebook ads, your CBCT, your building — those are not your most important assets. Your most important assets, your secret sauce, is when you have the right people in the right seats. That's the whole jam. When you make that happen, your life gets better by the minute.” (5:14—5:32) -Kirk

“The real issue here is that dentists take on extra stuff because they think, ‘Nobody is smart enough,’ and they just take it on. Well, you have to take on less in order to grow.” (5:38—5:48) -Kirk

“As a dentist, there are people that can talk money. There are people that can do scheduling. There are people that can do photography. There are people that can do anesthesia. You shouldn't have to do all of those things. It all depends on your vision, now. And every time you do that, the “elevate” comes with the time. You free up more time. So, you now can invest your time into the things that you want. But you have to have the fundamental thought process like, ‘We’re going to delegate and elevate together.’ So, it’s not just taking people to education. You've got to invest in them in team meetings, other things like that.” (5:54—6:25) -Kirk

“You've got to commit. You have to commit to growing your people. You have to commit to your values and what you want, and you have to stop, sit down, work on the practice, and you have to allow your people time to work on the practice as well.” (6:48—7:08) -Jenni

“Some doctors who are listening don't think a two-hour team meeting is a worthwhile investment. I'm just going to say this. If you work 32 clinical hours, you give me two hours. You don't need to work all 32. You can work 30 clinical hours, pay your team for 32, and I promise you, if it’s done right, they will kill it for you.” (7:10—7:34) -Kirk

“One of the things that [a two-hour team meeting] allows us to do is getting back to that delegate and elevate. It gets us in the same room talking about things, and we can create alignment. We can say, ‘Who’s going to be best here? Who’s going to be best here?’ We create systems and we create predictability in our days. So, when we sit down, when we get aligned as a team every week, we stop and we pause and we say, ‘Okay, what are we doing? Where are we struggling? What's the issue? What do we need to work on? What do we need to improve? Who can own this?’ Suddenly, things start to fall into place. Our days become more predictable. It gets easier. And really, the profits follow that.” (8:41—9:31) -Jenni

“If you're a dentist and you think your team meetings suck, and it’s a two-hour waste of time, you're telling yourself the truth. You should look at those two hours like, ‘They might suck right now, but they're not going to suck forever.’ And that's why working with a great coach, having a structure, when you get it down, the meeting gets better and better and better, and you start to look forward to it.” (9:41—10:01) -Kirk

“[If] you start being late [ to your team meetings], you don't show up, then you scream to the team, ‘I don't care. It’s not important for me and for us to sit down to work on things.’ And I tell everyone, you've got to trust. Give it time. You have to actually learn how to run a great meeting. And we had to learn at ACT how to do this as well.” (11:22—11:43)

“A lot of you are looking at your profit and loss statements and, ‘Oh my gosh, dentistry is becoming an expensive profession.’ True. But when you're looking at the line item that says “team cost”, stop it. Change your name. It’s not a cost. It’s an investment. I'm going to invest in these people, and my job as a business owner is to make sure the rest of the numbers work. So, you can look at that number and you can write checks — if you still write checks — and those checks will be bending. Or you can say, ‘No, I'm investing in human beings. And I'm happy to pay people that because when I think right, it lends itself to the right output.’” (12:39—13:14) -Kirk

“When you invest in [your team], they get better. They invest in you. They care about you. They are engaged and invested in the practice. And when team members are invested, they're happier, you're happier, and the patients see it. Again, the profits will follow, and they will stay.” (13:15—13:32) -Jenni

“We have to be even more so invested in creating amazing experiences for our teams in which they feel like they can grow, like they are a part of a team, like they are a part of something, that they come to the practice, and they leave more days with their cup full than empty.” (14:14—14:34) -Jenni

“We’re going to have hard days, and not every day is going to be perfect. And in the dental practice, we have exhausting days. Our motto here is a better practice for a better life. If we leave every day with our cup completely empty, we have no time left for our life outside. So, by creating predictability, by investing in people — yes, we have struggles. Yes, there are days that are really hard. But we band together as a team. We function in our unique abilities, and we work really hard for each other. And when it’s a hard day, we might leave exhausted. But we leave saying, ‘Man, we nailed it today. We accomplished something today.’ And then, we have room left for those big moments that happen outside of [our work] life.” (14:37—15:33) -Jenni

“If you want to build the life that you want in your practice, you want your vision to come to fruition, you want to have this amazing life and this amazing practice where you take care of your patients and you feel like you're making the world better, like, why you became a dentist, that starts with taking care of the people that are around you. Because when you take care of them, they're going to take care of you. And they're the people that are going to bring that vision to life for you.” (15:47—16:21) -Jenni

Snippets:

0:00 Introduction.

2:20 Invest in your team’s education.

3:35 Delegate and elevate, explained.

5:48 Commit to growing your team.

7:08 How a two-hour meeting can change your practice.

12:08 It’s an investment, not a cost.

13:34 Fill your cup.

15:36 Last thoughts.

16:33 About ACT’s future courses and seminars.

Jenni Poulos Bio: 

Jenni brings to dental teams a literal lifetime of experience in dentistry. As the daughter and sister of periodontists and a dental hygienist, she has been working in many facets of the dental world since she first held a summer job turning rooms and pouring models at the age of 12. Now, with over 10 years of experience in managing and leading a large periodontal practice, she has a firm grasp on what it takes to run a thriving business. Her passion for organizational health and culture has been a driving force behind her coaching career. She has witnessed firsthand how creating an aligned and engaged team will take a practice to levels of success that they never believed possible! 

Street Drugs and Dentistry

Episode #548 with Thomas A. Viola, R.Ph, C.C.P.

Patients don't always tell you about the drugs they take. This is potentially dangerous — even fatal. Drug education is the best way to protect them, and Kirk Behrendt brings back Tom Viola, “Mr. Pharmacology” and founder of Pharmacology Declassified, to share critical information about popular drugs that can affect patients while they're in your chair. Learn more about the drugs that people take, and you can start to save more lives! To learn what dental school never taught you about drugs, listen to Episode 548 of The Best Practices Show!

Episode Resources:

• Tom’s website: https://www.tomviola.com  
• Tom’s podcasts: https://www.tomviola.com/category/podcasts
• Tom’s email: [email protected] 
• Tom’s Facebook: https://www.facebook.com/tomviolarph
• Tom’s social media: @pharmacologydeclassified
• 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:

NIH: https://www.nih.gov

Chicago Midwinter Meeting schedule: https://www.cds.org

Hinman Dental Meeting schedule: https://hinman.org/Education-Events/Courses

Greater New York Dental Meeting schedule: https://www.gnydm.com

Star of the North Meeting schedule: https://star.mndental.org

Main Takeaways:

People today have greater access to drugs.

Educate yourself on common and popular substances.

Patients don't always tell you every drug and medication they take.

Use verbal skills when asking patients about substance use or abuse.

Know how to detect substance abuse in your patients and get them help.

Quotes:

“Pharmacology is like the Rosetta Stone. If you know a patient’s medications, you know everything about them. All you need to have is a list of medications and a working knowledge of pharmacology, and you've got everything you need to fill in that medical history with everything that's important for today and for the future, as far as treating that patient. So, it’s building treatment plans and it’s building the rapport, but it’s treating the patient as safely as possible.” (2:42—3:07)

“Twenty-five years ago, when I first got started in dental pharmacology, when I first designed that form that people would fill out for their medical history, I left spaces for people to write in the names of their medications. I left five spaces, and most people filled in three. So, can you imagine — 25 years ago, people took three medications. Now, if they have cardiovascular disease, that's three drugs just by itself. Then you add on GI, respiratory, diabetes, the list goes on and on. It’s not uncommon now for patients, on average, from what I'm seeing working with my students, eight to ten meds. Eight to ten medications! Plus, the over-the-counter drugs, the dietary supplements. It’s an incredible, long list of things. And with every new drug comes new complexity for dentistry, which is why we do what we do.” (4:57—5:43)

“Patients either give you the wrong information or don't want to tell you everything about them. And there are numerous reasons why. Sometimes, it’s also, ‘I'll tell you, but I won't tell you the extent to which.’ So, for example, alcohol is a good one. Tobacco, another good one. Marijuana, another good one. ‘Do you use marijuana?’ ‘Occasionally.’ But what is your definition of occasional? And lately, it’s this topic of street drugs. What really is not a street drug anymore — I would say there are substances of abuse that are in the fringes. They're not mainstream drugs, but they're becoming more mainstream, and more and more people are being exposed to them. So, do you, as a dental professional, know everything you need to know about that substance to be able to treatment plan around it? Were you taught about it in school? Where would you get an education on a “street drug” or a substance of abuse if you've never even heard of it before?”  (6:43—7:36)

“If I had to say to an average dental professional, ‘Give me an example of a street drug,’ I think some people would say heroin. Some people might say cocaine or methamphetamine. But when you think about it, those drugs have been around for 20 to 30 years. And at the same time, the heroin that I saw people doing on the streets of New York City when I lived there so many years ago, that heroin is nothing like the heroin that's available today. That potency back then may have been somewhere around 8% to 10%. Now, the potency of heroin that's available on the street is upwards of 80% to 90%.” (7:59—8:33)

“Beyond what we call mainstream street drugs or substance abuse are the more exotic ones. The one that's affecting a lot of communities right now is a drug called xylazine, which is known on the street as “tranq” because it’s a tranquilizer. But it’s mixed with so many other drugs, heroin and fentanyl, especially. And the problem is, it’s so popular, it’s so attractive, that it gets mixed into the “drug supply”. Even though you didn't ask for it, you get it anyway.” (8:43—9:17)

“People ask me this all the time, ‘Why is fentanyl so popular?’ Every time I hear anybody talking about drugs, it’s fentanyl, fentanyl, fentanyl. The answer is micrograms. That's the best way I can describe it. Fentanyl is so super potent that you only need micrograms of the drug. Now, that's less than a milligram — a microgram of this drug — to get some feeling. So, number one, that means, what? It’s easy to conceal because you only need a very little bit. It’s easy to transport because, again, you only need a little bit. So, it’s not like you’ve got this big package of hashish or this big package of cannabis you're trying to carry around. You can carry this in a tiny, tiny, little bag in your pocket without anybody really noticing. So, a small amount of drug yields a big return. Fentanyl will always reign supreme because it has this super potency. A little goes a very long way.” (9:54—10:57)

“I get this all the time, and it’s a very good question, ‘Hey, Tom. I work in a pretty nice neighborhood. I don't have people that are strung out on drugs lying on the street or in shelters around me. Most of my clientele are middle class or upper middle class. They're not going to be the type to use fentanyl and xylazine.’ And that's the problem. The problem is, people who are not in the mode of staying under the influence of a drug all the time will use smaller doses and will use enough so that they can still function, but still use at the same time. So, you don't get to the point where you're under the influence of this combination of two drugs for days at a time, but maybe for several hours.” (14:02—15:52)

“At some point, I need to see a dentist. Right? At some point, I need to see my hygienist. And you may not suspect that this person is using fentanyl with this drug, xylazine, in it. You might think this person doesn't do any drugs at all because they don't mention it on their medical history. They don't “look” like someone that uses fentanyl with xylazine mixed in it. But what if they need anesthesia? What if they need sedation or conscious sedation? Now, even though they haven't mentioned it on their medical history, and never mentioned it to you — it doesn't even come up in conversation — that becomes life-threatening because the drugs that we use for sedation — some of the drugs that we use, anxiolytics, even nitrous oxide — can increase the potency of these drugs, fentanyl and xylazine, dramatically.” (15:59—16:45)

“You might say, ‘Who would be nuts enough to use fentanyl and xylazine before they go to see the dentist?’ And that's when I always say, what's one of the most stressful places a patient can find themselves? In your dental chair. So, in that case, why wouldn't they use the fentanyl and xylazine in advance of the dental appointment to escape what they consider to be the pain that they're going to experience in the chair?” (16:46—17:10)

“I decided the easiest way to do it was to be flat-out honest and ask point-blank. In the nicest voice and with the biggest smile on my face, I say, ‘Have you had, or do you currently have, an issue with substance abuse disorder? Do you have an issue with substances? Can you say that you rely on a substance on a somewhat regular basis to get through your busy, trying days?’ And let it hang in the air. It’s awkward and uncomfortable for the first five seconds. But then, when the patient realizes you mean them no harm, and that you're not going to be calling the police, and that you just honestly need to know that information, that's when it comes out.” (18:30—19:13)

“You and I might talk about a glass of wine, ‘How many glasses did you have?’ I might admit to three, but I probably had six. It might be that with using fentanyl and xylazine. Again, there's no cookie-cutter approach to this. Every patient is going to be different. Some patients might take offense. But always try to keep it as light as possible, and keep it coming from the perspective of, ‘Look, we deal with thousands of patients. We’re not here to judge. We’re just here to get all the information we can to keep this appointment safe for you. So, we’re not judging. We just need to know.’ And that's what I say over and over again. When you say it like that, and when you let it hang there, and you don't say anything else, after you ask that question, ‘Do you currently have, or have you had an issue with substances or a substance abuse disorder?’ stop talking. Let them talk. And they might say no. So, maybe you qualify a little bit and say, ‘What I mean is, do you use substances like a lot of people use, like cannabis? Have you tried fentanyl?’ ‘Maybe two or three times.’ If you get a no each time, then fine. Then, I think you could say you've probably exhausted every effort. But I think when you ask a few times, and you keep it light, and you keep the smile on your face and come from that perspective of, ‘Look, I'm just trying to get the information here. Not just you, it’s thousands of patients,’ those people who really do use it were more than likely to admit to some part of using it.” (19:17—20:43)

“A lot of people won't tell their medical doctor, their physician’s assistant, their nurse practitioner, about these strange sores on their arm that have developed as a result of this drug, xylazine. That's the thing about xylazine. If you inject fentanyl that's mixed with xylazine, you will get these sores on your arm that don't heal very well. As a matter of fact, it sometimes becomes gangrenous and sometimes leads to amputation. So, ‘I don't know what's going on, but I've got these sores on my arm. They don't look really good.’ I may not tell that to anybody, but I might tell you, the dentist or the hygienist, because you're approachable. You're easy to talk to. ‘Hey, you bothered enough to ask me, so here it is.’ Are you ready for that answer? What do you do then? So, that's why you listen to podcasts like this. You come to courses like mine so you can say, ‘Okay, here’s what you've got to do.’” (20:47—21:38)

“The first thing you've got to do [if you have a patient with xylazine sores] is get them to see a medical doctor. And again, it’s no stigma. Get them to see a medical doctor. Get that wound addressed because it could get bad quickly. We don't want anybody getting amputations for a reason of, ‘Well, we only took a look at it.’ Get them medical help and let them know that they're not the only ones. That way, you've taken a situation that could be potentially deadly for that patient and literally save their life. And you've heard me say that before. Dentists, hygienists, and assistants save people’s lives every day because you save them from themselves. They don't make very well-informed or well-thought-out decisions because they're not experts. That's where we come in.” (21:38—22:22)

“Stimulants [are important to know about]. I can't say it enough. I know a lot of people really hang their hat on energy drinks and stuff like that. But I will tell you that ADHD medication and ADD medication still ranks up there as a stimulant that a lot of people use because, quite frankly, their insurance company pays for it. So, I don't have to go out and buy methamphetamine — although it’s cheap enough now. I don't have to go out there and buy cocaine. I can buy Adderall or Vyvanse. By prescription, my doc writes me the script. I go to the pharmacy, and I get them filled. It costs me virtually nothing, whatever my copay is. I come back to my room, if I'm a student in school, I come back to my house, and maybe four out of the seven days that week, I take my Concerta, my Vyvanse, or whatever, the way I'm supposed to, every day. But for the other three days, I crush the tablets up and I snort them. Now, nobody’s going to know this, number one, because it came out of the same bottle. And if anybody were to do a drug test on me, what would they find? I've already admitted I take Concerta, so why would you look for anything else? But I'm not using it the way I'm supposed to. I'm using it in a way that I wasn't supposed to. And yet, it flies under the radar, and nobody knows about it. So, stimulants scare me because of the access. And it’s the same thing with cannabis.” (22:35—24:01)

“Children have never had greater access to cannabis and stimulants than they have today. In my day, it was alcohol. My mom and dad would lock up the cabinet with the alcohol in it. But now, most homes have, perhaps somebody uses cannabis, even if it’s for medical reasons. Or maybe they have a child that uses medications like ADHD medications. The access is there. So, if you don't know to think about it or ask about it, it won't even show up on your radar. That's why you ask the question as generically as possible, ‘Do you have any issue with substances? Do you have a substance abuse disorder?’” (24:06—24:45)

“What if, [when you ask about substance use, a patient says], ‘I don't know. Oh, once in a while, I take . . .’ Go on the NIH.gov website. It’s right on the front page. Download the questionnaire. Hand it to the patient and say, ‘Fill this out.’ Just from their scores alone on that page, you could pretty much tell if they may have an issue with substance use. And that will help you make some more informed decisions about what to do with sedation, with the analgesics. If I'm using fentanyl and xylazine, and then I've had enough done that I need an opioid for my pain control, wow, that's a lethal combination, adding an opioid to the fentanyl and xylazine I'm already using. Unwittingly, the dentist may have created that cocktail because he or she prescribed it without knowing the patient was on these other two drugs.” (24:45—25:31)

“The other thing that scares me a little bit, besides stimulants, is the drugs that you don't know the patient is using. So, there are drugs out there, for example, Suboxone. Suboxone is prescribed for patients who have an opioid addiction to prevent relapse. But Suboxone, in high doses, actually causes an opioid-like effect. So, there are people out there that are addicted to Suboxone. The drug that they were using to treat the addiction has become the drug of the addiction. ‘Well, then somebody will find out.’ Really? How will they find out? They're going to do a urine test and, ‘Whoa, it says Suboxone.’ ‘Well, I'm supposed to be on Suboxone.’ It’s that kind of hidden substance abuse that really makes it valuable for a dental professional who’s listening right now to say, ‘Hmm. Let me ask that question. How bad could it be? If I've got to know, I've got to know. But at least let me ask so that I cover myself and I protect my patient from themselves.’” (25:33—26:30)

“A lot of people who attend my lectures say, ‘I love everything you said, Viola. But the problem is, if I did everything your way, I'd need 15 minutes just for the medical history. I basically have three to four minutes to get all the information down. I can't do everything you said.’ And I agree with them and say, ‘Okay, here’s what you do. You ask a few questions, but ask good ones, a minute each. And don't rely on asking questions to get all your information. Get the names of the medications. Anyone in your office can do that for you. They can make sure the patient has listed all their medications. So, when you look at that list of medications, you know, when you attend enough of my lectures, to figure out, ‘Okay. This drug does this. This drug does that.’ Even if you have to look it up, you're going to get a better sense for that patient than you would have if you didn't pay attention.” (27:40—28:24)

“I've gone to dentists myself who never took my blood pressure, never took my pulse, never looked at my medical history. Didn't know anything about me and just got right to work — even some hygienists. So, the point is, now is our chance to change things to become more patient-centric and realize that we’re not just in the business of treating the mouth. We’re in the business of treating the person to which that mouth is attached, and all that comes with it, including becoming more knowledgeable about everything they're putting in their bodies.” (28:29—28:59)

Snippets:

0:00 Introduction.

1:58 Tom’s background.

3:57 Why pharmacology is important in dentistry.

5:44 Patients often give you the wrong information.

7:37 Street drugs, defined.

9:18 The dangers of fentanyl and xylazine.

13:46 Why understanding drugs is important in your practice.

17:20 How to begin the conversation with patients.

22:22 Things to know about other street drugs.

26:31 Ask patients short but meaningful questions.

29:13 Last thoughts on street drugs.

31:21 More about Tom’s courses, webinars, and future courses.

Tom A. Viola, R.Ph., C.C.P. Bio:

With over 30 years of experience as a pharmacist, educator, speaker, and author, Tom Viola, R.Ph., C.C.P., has earned his reputation as the go-to specialist for delivering quality continuing education content...

The Cost of Open Chair Time

Episode #547 with Christina Byrne

An empty chair is more than just an empty chair. It will tell you the strength of your systems, where you can improve, and the true cost of each vacant seat. By tracking and understanding your open chair time, you can start making better business decisions! To help you simplify the process, Kirk Behrendt brings back Christina Byrne, ACT’s director of operations, to talk about ACT’s Capacity Tracker, where to get it, and how to get your team to use it. To start running a better, healthier practice, listen to Episode 547 of The Best Practices Show!

Episode Resources:

• Christina’s email: [email protected] 
• Christina’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:

ACT’s Capacity Tracker: https://drive.google.com/file/d/1MdN96fVhau8tcP10kW2_cU-Tv91K8r7l/view?_hsmi=241651107&_hsenc=p2ANqtz-98AjmJ7LkC2HvkK9uuY8l577tbOQ_8dHgEv1V_RVjByeE1xTLRFEYlHJVqxNmOsEBjwFPH-Cjr7iCbb4p-dJiLdKWb7A 

Main Takeaways:

Help your team understand the cost of having an open chair.

Tracking numbers and a healthy culture go hand in hand.

Before anything, start tracking your open chair time.

Hiring a hygienist is not always the solution.

Filling chair time is a team effort.

Quotes:

“[Open chair time is] one of those things that people don't understand, really. Oftentimes, we’ll talk to a team, and they’ll say, ‘I can't get a patient in for six months. We’re totally booked. We need to hire a new hygienist. We need to do this.’ And what they fail to do is look backwards and see how much open time they had. And so, the why of tracking this is so important to the practice because if you don't look back and if you don't track the capacity in that way, you are going to make really bad business decisions. You're going to hire that other hygienist, and you're going to find out it’s going to be so costly to have another person in there who can't see patients because you're not filling the schedule, or patients are falling off the schedule.” (3:12—3:59)

“If you're taking PPOs, one opening and you're ruined for the day because you're really only getting about 60% of those dollars anyway. And one of the things we do know about practices is when they're calculating how much PPO is in their practice, the majority of those patients are coming into hygiene. They might not be doing all their dental work, but they're for sure coming in for that “free cleaning” twice a year. And so, that's a huge loss to the hygiene department and to the practice, in general.” (5:40—6:14)

“We have to start with tracking [open chair time]. Most offices are not tracking it. They're just thinking from their perspective, ‘We can't get another patient in for seven months, eight months. I don't have an opening until October.’ So, what I like to do is have practices first be proactive and set it up every day, how many hours was I available to see patients, and how many hours did I actually see patients? And not from the time I punched in. It’s, when are you available? So, if you start at 8:00 a.m. and that's when you start seeing patients, and you take an hour lunch and you're done at 5:00, you have eight hours available to see patients. So, if you don't have all eight of those hours filled, you need to do that math and do that calculation on a daily basis and figure out, where am I right now, moving forward?” (7:03—7:53)

“When I was doing hygiene clinically, if I had an opening or a patient didn't show, I was like, ‘That's awesome. I can write my notes. I can sharpen instruments. I can stock my room.’ I loved it. I thought it was great. Now that I understand the business side of it, I'm like, ‘Oh my gosh, I'm terrible.’ I have to apologize to Dr. Tingzon if she’s listening because I didn't realize. Now, I know. And I understand the cost of that opening in that room.” (8:09—8:38)

“If I'm going to have a conversation with your hygienist and he or she says to me, ‘I feel like I'm working really hard. I have to talk to doctor about getting a raise,’ I'm going to tell them, ‘You can't just go into that meeting with a feeling. You have to go into that meeting with data.’ And if that hygienist is incentivized to increase his or her compensation, then they should start tracking their numbers and making sure that their chair is filled so that they can go to the doctor and say, ‘Look, doctor. For the last three months, I have been at 95% capacity, and I've been doing great with these patients. I have a great mix of services. I'm diagnosing more perio.’ Then, that hygienist is in a position to actually earn what he or she is asking for. So, it actually is a win-win, doctor. If you are going to plan to have those conversations with your hygienist, give them the tools so that they can come to you. I think you'll be happy to give them an increase in their compensation if they are showing you that they're increasing revenue to the practice.” (10:08—11:15)

“If there is a cancellation, it’s not always [the hygienist’s] fault. However, all cancellations start at the chair today. So, if I have you in my chair today, I'm going to do everything I can to increase your predictability of coming in at your next three, four, or six-month interval based on my conversation with you, based on what we discover, how we talk about what's necessary, any treatment that you need, any areas of bleeding or recession, anything that we want to check the next time you come in. So, I'm building value for that next visit — and every visit beyond — with what I do today. So, in that sense, it is [the hygienist’s] responsibility to [fill chair time].” (11:35—12:18)

“A healthy range is somewhere between 92% and 95% capacity. So, over the course of a week, a month, however you want to track it, there are times when you need to do things in the operatory. We’re not saying it has to be 100%. But I would say 92% to 95% is industry standard for what's a healthy capacity. And that's for doctor too. You're not off the hook either, Doctor. This isn't just about hygiene capacity.” (13:25—13:54)

“There is nothing wrong with sharing numbers. One of the things we often do is we internalize those numbers and we think that it’s because we’re bad. But the number is just reflecting how strong your systems are. So, if your capacity is low, let's take a look at some of our systems. Let's look at our handoff system. Let's look at our preclinical conversation system. What do we do when we’re handing off a patient? Do we just say, ‘Oh, yeah. The patient had bitewings and a prophy today’? Or are we going in and saying, ‘Mrs. Jones was talking to me about this tooth that she has on the upper right, Doctor. So, I took a PA, and I took an intraoral photo, and I showed her this fracture. I told her that sometimes when you see something like that, you might recommend a crown.’ Now, I'm building trust with the patient, and I'm actually building a lot of respect with my doctor because I am partnering in that patient’s care. And the patient is like, ‘Wow, this is really different.’ They're going to be incentivized to come back.” (15:43—16:42)

“People think you can either have one or the other. You could have a healthy culture, or you could track numbers. But you can't do that. You [need to] have both. When we don't track anything, when everything is unknown, that's not healthy. People are worried. They don't know the health of the practice. Are we going to have a job next week? When you're tracking numbers and you're showing that — you're not condemning somebody or picking on somebody because they don't have the number. You're saying, ‘Hey, let's talk about this. Let's talk about how I can help you to improve. What could we do differently? How can I support you? Is there any training that I can help you with that can help you to improve this number?’ So, instead of looking at it as a negative, it’s such an opportunity for growth.” (17:45—18:30)

“If I look six months out and my schedule is full, but my capacity is only at 75%, what's happening? Am I not building that value for that next visit? It doesn't even have to be something from our perspective as a clinician. What does our confirmation or our reminder system look like? Are we reaching out to patients? Are we providing them with the value of coming in and making sure that what they're doing is valuable to them too? We have to look at it from their perspective. Most people have that, ‘What's in it for me?’ So, we have to find out what that is for our patients so that they feel incentivized to come in for that next visit.” (19:40—20:22)

“I'm not saying it’s just the hygienists’ responsibility. It’s everybody’s responsibility. If I spend time chairside and I'm talking to the patient about bleeding, or perio, or whatever the case may be, and the doctor comes in and he or she is like, ‘Oh, no. This is fine. She’s good. We don't have this,’ that's not helpful. So, everybody has to be on the same page as far as where we’re going and what our philosophy is.” (20:29—20:57)

“You have to know: do you even have enough hygienists? Do you not have enough hygienists? Do you have too many? This might be a good opportunity. If you need 13 days of hygiene but you're only using nine, then that means you have so many patients who cannot get into the schedule. And if you still have a capacity issue, then it’s chaos. So, then you need systems to make sure that the patients are actually showing up for the appointments. And once you do that, then you can either add hygiene days or you could start to consider, if you are a PPO practice, this might be a good time for you to start thinking about dropping some of those PPO plans. Because rather than hire a new hygienist and go through all of that, maybe you can still satisfy everything that you need in the practice by eliminating some of those PPO plans and getting your full fee for some of those patients.” (24:39—25:35)

“The knee-jerk reaction is always like, ‘I've got to hire a hygienist. I've got to add a new room.’ But we have to look at the data and we have to do some homework before we make those decisions.” (29:28—29:37)

“The first thing to do is download the tracker and start using it. Now, I'll say, start using it after you talk to your team about why it’s important and why it’s valuable to track this stuff. And it’s not as a punishment to anybody. It’s a way to understand where we are today so we know what we need to do to improve.” (31:32—31:51)

“Get your data aligned first and see where you are. Because if you don't know where you are, you don't know where to go from there. And also, make sure that it’s a team effort, and it’s collaborative, and nobody is out to get anybody, that we’re all here to help each other and we’re trying to make everybody’s job easier.” (35:27—35:48)

Snippets:

0:00 Introduction.

1:57 Christina’s background.

2:34 Why understanding open chair time is important.

6:54 Things to know about the cost of open chair time.

9:38 Getting hygienists to track chair time is a win-win.

11:17 Is it the hygienist’s responsibility to fill chair time?

13:13 Healthy and unhealthy capacity ranges.

13:55 ACT’s tracking sheet.

15:02 Numbers reflect the strength of your systems.

16:55 Track numbers to have a healthy culture.

19:15 Capacity will help diagnose root problems.

21:16 Determine how many days of hygiene you need.

24:31 Why you need to do the math for hygiene.

25:36 Be smart about how you expand.

27:53 Part two of the formula.

30:01 Building emotional intelligence into the formula.

31:07 Recap of the tracking process.

33:23 How dentists can track their capacity.

35:14 Last thoughts on open chair time.

Christina Byrne Bio:

Christina Byrne has been involved in dentistry since 1985. Over the years, she has held many positions on the dental team, including dental assistant, business office, and dental hygienist. Christina’s extensive knowledge of the front office and clinical procedures is a great asset, and she loves to impart her knowledge to guide dental teams do the best they can to achieve a Better Practice, Better Life! 

Insurance Free: Is It for Me?

Episode #546 with Shelley DeGroff

Insurance is a game, and insurance companies have the upper hand. So, what can you do to win? To help answer that question, Kirk Behrendt brings in Shelley DeGroff, founder and CEO of PPO Advisors, a company that turns PPOs into profit. She shares insight into how PPO contracts work and advice for strategically dropping your PPOs. Insurance-free is the way to be! To keep more of the money you deserve, listen to Episode 546 of The Best Practices Show!

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

Main Takeaways:

Add and drop PPOs strategically.

Do an EOB audit on a regular basis.

Start credentialing as early as possible.

Negotiating isn't easy, but everyone should do it.

Understand how to stack and navigate your contracts.

Quotes:

“Credentialing and insurance contracts are not what they used to be. It used to be that you could sign up with an insurance company, and you were going to get a great rate, and you were going to get patients from that contract. It doesn't work that way anymore. You're signing up for a contract, or with a contract, and you're getting 50 other shared networks with that. And if you don't set yourself up into the right contracts, you're really backing yourself into a corner for successful PPO negotiations and contracting down the road. So, we really need to understand what we’re doing so the success of our practice can continue to grow.” (3:02—3:42)  

“[Credentialing is] not fast. Nothing about credentialing is fast, so prepare yourself. If you're a new doctor doing an acquisition or doing a startup, you need about 120 days to get yourself a network. So, don't wait until you take ownership. Start that process as soon as you have the letter of intent signed and you know this practice will become yours, or your startup six months in advance, if you can.” (4:08—4:35)

“As you're still building out, get your PPOs set up. You need a tax ID number, a physical address, a phone number — which, you can get a Google number and then we can transfer that somewhere else if we need to. Those are really the key things we need to get you set up with an insurance contract. So, get that process going as soon as possible. Don't wait around and think, ‘Oh, I've got 30 days till closing. I know this is in the bag. Now, I'm going to start the process.’ You're going to overwhelm your staff and you're going to overwhelm yourself. It’s hard. It’s a long process. They don't make it easy.” (4:35—5:11)

“Delta Premier is everybody’s worst nightmare. We’re to the point where now we’re seeing most states do not honor Premier status through an acquisition or any sort of change. So, even if you're bringing on a business partner and you change your TIN, most states are removing the Delta Premier access at that point. So, grandfathered in is truly grandfathered in, in these states. Meaning, you can't change a thing. So, when you buy a practice, you've really got to be looking at the numbers and saying, ‘Okay. When I came into this, the practice was Premier, and they were doing $300,000 in production with Delta. My reimbursements are going to be significantly less on that.’” (5:42—6:29)

“If the majority of your practice is Delta — which, almost every practice we work with, the majority of production comes in from Delta. It’s the top producer in almost every state — you're going to see a difference of anywhere from 15% to 25% in reimbursements on Delta Premier and Delta PPO. So, those numbers need to be crunched. We definitely need to have a better game plan in place. And maybe we’re going to have to pick up a different PPO in addition to Delta PPO. Maybe we’re going to pick up Aetna now that we’ve never had. And if the rate is negotiated to 80% of the UCR of the practice, well, then that helps offset that major deficit we took by becoming a Delta PPO for the associate coming on board. And then, we can start to schedule out and not receive as many Delta patients, and we start filling our chair space with better PPOs. So, strategically looking at how we can make a better game plan, long term, with the right PPO contracts in play.” (8:09—9:09)

“Everyone should negotiate because you can still negotiate. It’s just not as easy as it used to be. It used to be a letter. It used to be, send in your UCRs, and we’ll take a look, and we’ll bump them up a little bit. It’s not like that anymore. Really, the narrative is, they try to get rid of you when you call in and ask for an increase — transfer you many times, drop your call. They hope you get busy with other things, and it doesn't pan out. So, negotiations mean you really need to look at the big picture. Don't waste your time in your negotiations. Understand that they're shared contracting with every PPO you deal with.” (10:58—11:35)

“If you're not getting the value out of the current contract you hold, look at your shared contracts and see how you can stack and navigate that whole web of agreements to your advantage.” (11:58—12:10)

“You have shared agreements, and you have umbrella companies. A shared agreement is typically, for instance, Aetna. Aetna is a direct contract. You can go to Aetna, directly get insurance from them, or an insurance contract from them, for you to be a provider. In signing that, Aetna has an agreement with Guardian, Ameritas, Principle, and so forth. It’s a shared agreement. So, now, you're in-network with all of their shared options. An umbrella company, or a third-party administrator — TPAs are often called umbrella companies as well — that's not typically insurance. So, when you go to Zelis, Zelis is the third-party administrator and the direct contracts shared to the umbrellas in a way to expand their network. So, when you sign up with Zelis, you're also now getting Aetna, Ameritas, Guardian, and all those big national players, as well as a lot of small demographic players. But it’s always to expand that PPO network.” (12:21—13:23)

“You're seeing campaigns of Cigna, Aetna, DenteMax, all these companies reducing their fees, saying, ‘Hey, you know what? We’ve paid out too much. We’ve done too much. We need to lower the pay scale for your demographic. Here’s a new fee schedule. Take it or leave it.’ That started happening in 2020 as COVID-19 came out and everybody was struggling with their businesses. Then, they dropped, ‘Hey, we’re going to reduce your fees too.’ And as one company starts doing that, they all start doing that. So, we’ve seen significant increases, a rise in these write-offs. But they’ve also still left that door open to play the game. And I keep telling my clients, ‘You've got to look at insurance as a game. Because that's really what it’s turned into. Now, they're reducing your fees here. How can we raise them somewhere else? What do we need to do to get that back to a manageable level? We really need to be seeing write-offs with the amount of overhead we’re dealing with. Our write-offs need to be in that 20% range, not 40%, not 45%.” (15:04—16:11)

“The best way to find out how you're participating and how your claims are actually getting paid is on that EOB, because your EOB is always going to say, ‘This claim was processed utilizing the connection fee schedule, utilizing the Aetna direct fee schedule.’ The reason why that's important is the most-favored nations clause. And every doctor should know what that is. Yet, I speak all over and nobody really knows what that is. So, the most-favored nations clause is the clause that allows the shared agreements to utilize the lowest fee schedule they can attach to within a practice. So, when Aetna shares to Ameritas, and Ameritas is shared to Principle, and Principle is shared to Guardian, they're all connected through this web. They have the ability to say, ‘Oh, this practice, the doctor has a direct contract with Aetna. They also have one with Guardian, and they have one with connection.’ Now, they're looking for the lowest fee schedule to process that claim on if you haven't stacked your contracts accordingly.” (16:39—17:44)

“When you're researching and trying to find out what's the next step for us to do better with our insurance and you're trying to vet that right company, negotiations is a part of it, but understanding how to stack and navigate those contracts is just as important because you can negotiate a great rate. But if it’s not placed in the right order within your contracts, it will not be utilized.” (17:47—18:10)

“Really, it’s coming down to looking at your fees, your UCR for your zip code, and then looking at all of the fee schedules available in your demographic. Fees are negotiated by zip code. So, you can't share a fee schedule and call an insurance company and say, ‘Hey, my buddy opened up a practice. They're in a different zip code, but I really want that fee schedule.’ You're going to get yourself in trouble, so we can't do that. So, it comes down to looking at the fees, looking at your master fees. And I want to put some importance on master fees. All too often, master fees are too low for your demographic. And if we continue to keep our master fees too low, then the insurance companies have no reason to increase their reimbursements. So, we have to be diligent about increasing master fees yearly. Far too often, when we evaluate practices, they're in the 40th percentile. And they should be in the 80th.” (18:35—19:29)

“Your master fees are your UCR for the practice. It’s the UCR of the practice, and then the insurance company gives you their UCR. And then, the difference between the two, if you're in-network, is your write-off . . . There's a difference. And we never want to see a practice submit full fee as the PPO fee, because you are telling the insurance company, ‘Oh, we’re paying you 100%.’ ‘We’ll lower your fees next year.’” (19:43—20:15)

“I don't want [practices] to look at the amount of contracts they hold because, ‘Oh, I only have two contracts.’ No, you don't. Your contracts are shared out to a million other contracts. So, that is not the gauge you want to look at. It is definitely the amount of write-offs that you are providing to your patient base. So, your ratio between fee-for-service and PPO. A client that's working with us, they can be 30% PPO and the remainder fee-for-service. We can still help. The reality is, there's less than six percent fee-for-service practices left in the United States. Now, I think that number is going to start to increase where we are going to see, we can't keep going. Our next step is to become insurance-free because the overhead is too high, the write-offs are too high, and the math doesn't work.” (20:53—21:41)

“It’s so liberating to have these conversations with our clients who are like, ‘We dropped MetLife. We dropped Delta. Can you help us now with the rest of this? Can we look at the game plan long term?’ because they can't sustain. But we don't want our clients to feel like that's our only option. We want to look at the numbers strategically. And our goal is to help you increase what you can, get out of what is not making sense, and then, two, three years down the road, maybe you will be completely fee-for-service. But you don't want to jump ship all at once because that can cause a lot of stress on the whole practice.” (22:32—23:06)

“[Scheduling out is] a real gray area. It’s really touchy, and each contract is a little different. Your paid contracts, they're a little bit more lenient on saying, ‘Hey, if you don't want to accept new patients, that's completely fine. If you're not accepting new patients this month but you are next month, perfect.’ There are ways around the lingo to be able to schedule out so that you fill up chair space with the right PPO patients, and then backfill with the ones that are not paying as much. So, look at the lingo within your contract that will allow you to say the right things so that you don't get into any legal situations. Because we are supposed to treat all patients as though they are the exact same, whether they're fee-for-service, insurance-based — no discrimination.” (23:59—24:51)

“Communication is key here, and the understanding. Because it’s scary to go out-of-network with some of these insurances. And when you spring that on staff, they're like, ‘Wait a minute. We’ve had families that have been coming to us for 15 years, and we’ve been accepting their insurance. You're just going to tell them no more? They're going to leave.’ There is a way to do this. There is a way to talk them through to where they want to stay with your practice. And if you prepare your team and they understand your end goal, the results really do work.” (25:48—26:16)

“You hear all the time that DSOs are able to negotiate better rates across the board. What's happening is, they can leverage a fee schedule from a certain demographic and share that fee schedule across their entire group, sometimes. But it’s not that the individual provider can't do the same thing. It’s just, demographically, they only have one region to work in. And what defines a large DSO? That changes too, with each insurance company. So, I don't want that to get into the minds of these solo practitioners because they still have a lot of leverage that they can fight against those DSOs that are moving in.” (28:16—28:58)

“Absolutely, you can [go insurance-free]. And I would be worried if you feel like you can't, honestly, because there are so many ways that you can grow your practice. There are in-office membership plans. There are all these other avenues that you can bring in outside revenue that's not tied to PPOs. Now, when you acquire a practice, it’s a little bit harder because you're acquiring a patient base that is used to those PPOs coming in. That's where we really want to start to thin out the ones that are unnecessary and get them to a manageable level of PPOs and contracts that are sustainable. But those startups where they're looking, if they can keep their overhead costs low and do things the right way, you absolutely can still be fee-for-service.” (30:21—31:10)

“Don't just sit on your contracts and understanding your PPOs because it’s too overwhelming. You're losing money if you don't know how you're set up. So, take charge. Start that process of figuring out our network, and don't get so overwhelmed with the process because it can really be something that is able to make huge strides and changes within your practice by making a few easy tweaks.” (36:03—36:28)

Snippets:

0:00 Introduction.

1:33 Shelley’s background.

2:47 Why this is an important topic.

3:42 What you need to know about credentialing.

5:12 The “Premier” nightmare.

7:16 Associates need to crunch the numbers.

9:09 Add PPOs strategically.

10:42 The current landscape of negotiations.

12:10 Shared coverages and umbrella companies, defined.

13:30 Why average write-offs are climbing.

16:12 Perform regular EOB audits.

18:20 The game of insurance and looking at your fees.

19:32 Master fees, defined.

20:20 Diagnosing your involvement with PPOs.

21:41 Is fee-for-service increasing?

23:36 Is scheduling out a good idea?

25:00 Communication is key.

26:17 Will dental insurance become more like medical insurance?

27:49 Do solo practitioners get different rates than DSOs?

29:58 Can you go insurance-free in the future?

31:13 About PPO Advisors and how to get in touch with Shelley.

35:56 Last thoughts on going insurance-free.

Shelley DeGroff Bio:

Shelley DeGroff, founder and CEO of PPO Advisors, knows dentistry. After graduating from the University of Nebraska, she began working as a dental receptionist in a nearby dental office. After completing her certification as a dental assistant, Shelley transitioned to become a successful Office Manager. It was in that role that Shelley began noticing the need for PPO negotiations for her employing doctor. This experience began the business model for PPO Advisors, which has now become a nationwide industry leader. 

Objections Are a Gift!

Episode #545 with Miranda Beeson

Objections are a normal part of your practice. They are also opportunities if you change your mindset! To help you reframe objections and see them as gifts, Kirk Behrendt brings back Miranda Beeson, one of ACT’s amazing coaches, with advice and strategies so you can overcome the most common objections you hear in your office. Help more of your patients stay in your chair! To learn how, and to hear more about Miranda’s dental administrator’s course, listen to Episode 545 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:

DiSC: https://www.thediscpersonalitytest.com

Miranda’s course March 16-17, 2023: https://www.eventbrite.com/e/act-dental-administrators-live-course-march-16-17-2023-tickets-347257716177

Main Takeaways:

Reframe how you think about objections.

Train your team to build trust with patients.

Identify what a patient is actually objecting to.

Create a welcoming space for patients’ objections.

Use “Feel, Felt, Found” to affirm your patients’ feelings.

Quotes:

“We want to shift our mindset around objections and consider them a gift. So, instead of being afraid of an objection, how can we create an environment where our team welcomes objections? When we have a patient who is interested and they're still engaged and providing us an objection, we have to look at that as an opportunity to present them with the information they need to help them make a decision.” (3:38—4:02)

“When we look at objections as gifts, it’s really a request for more information. And so, that means they still want more. They're still in it with us. They haven't written off the idea of moving forward with that recommendation just yet. So, if we can shift our mindset — and part of that is building the skills and having some verbiage to feel confident so that we can approach it in a way that is welcoming. We’re actually going to be inviting objections in instead of running away from them as fast as possible.” (4:03—4:34)

“A lot of times, a patient is just really nervous about telling you what their objection is. Maybe they're embarrassed because they're afraid it’s going to hurt. Or maybe they're self-conscious about other people knowing that they're doing this treatment. Maybe they know someone that works with them in practice. Maybe it’s about their finances. And then, again, that makes them feel a little shameful or embarrassed, and they don't want to bring that up. And so, we have to create a space that's very welcoming of an objection.” (5:50—6:19)

“Imagine that you're putting a pillow out on your desk, a nice, soft pillow. A nice place for that objection to land. You're going to welcome that objection. You're going to invite it in. You might even encourage what that objection might be if they're not saying it out loud. Use the words, “it sounds like”. I love saying, ‘It sounds like you might have some more questions around the finances. Tell me more about how you're feeling about that,’ or, ‘It sounds like you're curious how your insurance benefits are going to play into this. Let's talk about what limitations there may or may not be.’ So, you can put the objection right on that little pillow for them, welcome it, invite it, and create a safe space where they're like, ‘Okay, this person is on my side. They're going to help me through this.’ Because until they can build trust with you, they might feel that shame or that guilt and they don't want to put the objection out there. So, sometimes, we have to pull it out of them a little bit and welcome that objection.” (6:45—7:46)

“If you're taught how to make the transaction when you're brought on board, like, ‘Here’s how you open the treatment plan. Here’s how you print it. And here’s how you post the payment,’ it’s very transactional but there isn't focus on that relational aspect of that role, then you're not going to be able to openly build that trust. They're not going to feel as comfortable inviting that in.” (9:17—9:38)

“If you're talking about your patient needed fluoride, you know why they need it, you've talked to them about why they need it, and they're still not sure, they're still creating some objection, don't immediately take it personal or get upset or defensive. Now, you're visually sitting across the table from that patient looking at this problem. Slide up next to them, figuratively, sitting at the table. Be shoulder to shoulder looking together at the same problem on, how can we solve this? How can we push through this objection? How can I help you to understand the value in what we’re talking about? So, a big part of it is getting your mind wrapped around, we’re on the same team. You're not objecting to me. You're objecting to what I'm offering in this moment. Let's figure out why. How can I help you?” (10:16—11:05)

“A big piece of motivational interviewing and changed behavior is affirming the patient or your client. So, their feelings are valid. Their feelings are their feelings. We need to acknowledge and affirm the validity of that.” (12:37—12:52)

“Any one of us has been in a situation where we are in a consideration phase of a product, a service, a trip, a car, anything, and we have to really contemplate, ‘Can I do this? Do I need this? Should I do this? What are all the other factors going on in my life that this could impact?’ And so, that's real. It’s real when [patients] are having those thoughts and feelings. And so, yeah, we have to tell them, ‘I completely understand where you're coming from. If I was in your situation, I may be having the same questions. Would it be okay if we take a few minutes to talk that out?’ Again, it’s going to build little pieces of trust every time you open up and have those conversations. So, acknowledging and affirming that their thoughts and feelings are valid, even when you don't know what they are yet. They don't always tell you what the objection is. But even acknowledging, ‘I can sense some hesitation. I feel like you have some thoughts around this. I feel like you have some feelings around what I'm recommending. Would you share those with me so we can work through that together?’” (12:55—13:58)

“I love the [Feel, Felt, Found concept] for two reasons. One, it builds in that affirmation. It builds in that concept of, we’re on the same side. But it also provides the person who has to approach that objection with a little moment to create clarity in their mind . . . Feel, Felt, Found is basically saying to someone, ‘I understand how you feel.’ Maybe you're going to say, ‘I have felt the same way before,’ or that social proofing, that herd mentality, ‘Many of our patients have felt just like you. What we have found is,’ and then you can go into your “so that,” your why. And so, when you have the “feel” and the “felt” always the same, ‘I understand how you feel. Many of our patients have felt the same way,’ those three to four seconds of verbalizing that, in the background in your mind, you can be decompressing, taking that breath, and formulating the “found” and what's going to come after that. It gives you a pause. Even though you're speaking, it’s a pause in the background to, ‘Okay. Now, I can approach this “found” and I can handle this objection with this patient.’” (14:23—15:34)

“A significant amount of our population is S [personality] style, 69%, I believe. And then, we have our I-style, which are also very people-oriented. That's about 11%. So, we’re at well over the majority of the population who have an attachment to being a part of something and that people connection. And so, if you can help people to understand, ‘You're not alone in this. There have been plenty of other people,’ many other people, most of our patients — you can phrase that however you want — then they feel like, ‘Okay. I'm not standing over here alone on this island with this objection. They’ve encountered this before, so they can probably help me. I don't need to be ashamed. I'm not the only one.’” (16:09—16:54)

“There's also the factor of how many more people could we help. So, how much money walks out the door every single day if we have team members who aren't confident with handling objections? And in the same breath, how many people are losing the opportunity to be healthier and to be built into this trust environment with us if we’re not approaching those objections in a healthy way? And I promise you, I didn’t. For years, ‘Please don't ask me any questions. Please don't ask me any questions. Just do what I'm asking you to do,’ because I didn't feel confident as a clinician, early on, to really handle those things. It takes practice and it takes time.” (21:45—22:28)

“I always say, any time a patient is in my vicinity in a practice, ‘I am working towards your agenda, not mine. Now, I may have things that I'm looking for, and checklists that I'm following, and all of those things. But ultimately, you chose me to serve you, and this is your body, and it’s ultimately your decision. Now, I feel like it’s also — because you chose me to serve you — my responsibility to be equipped with the communication strategies, the knowledge, the experience and skill, to then provide you with the best benefits when you're here.’” (24:26—25:00)

“There are going to be people that still need to go home and process. They can't make a decision on the fly. Fine. But if you take that opportunity, if we had that conversation and you still said, ‘I think I'm still going to pass,’ they're going to be more likely to at least look a little deeper into that subject or consider it a little bit more the next time when their teeth are sensitive. When they're eating ice cream at home, they're like, ‘Hmm, I wonder if that fluoride would've helped.’ It doesn't mean they're ever going to change their mind. But they may. And they definitely trust you more and respect you more for validating their feelings and having that open conversation. So, next time they have a concern or a question, they will be so much more likely to bring it to you than they would have if you had just shut it down or shut down yourself.” (25:35—26:21)

“A lot of times, patients will say, ‘I mean, that's a car payment,’ when you really break down financing or something around a large case. And I love it when they say that because I agree with them. I tell them, ‘You are exactly right.’ It may be $400 or $500 a month. These large All-on-X cases, this could be $800, $1,000 a month, if they're financing the whole thing. So, I tell them, ‘You're exactly right. It is. However, you would get that car and drive it for about five years, two hours a day. You could make the same investment in yourself and in your health, and you're going to use it 24 hours a day, possibly for the rest of your life, at least for the next 20 years. You could decide which you'd rather invest in. But you're exactly right. It is.’” (28:40—29:28)

“If a team member is listening to this, a front office team member, a clinician, and they say, ‘I tried that Feel, Felt, Found. I did it one time. It failed terribly. It felt horrible. I'm never going to do it again,’ no! You have to keep trying. You have to try again because the more you do it, the better you're going to get. And you will start to see the change in the relationship and in the conversations you have with your patients. You just have to stick with it, and you have to keep trying.” (30:18—30:45)

“Often, the first objection that someone puts in front of you may not even be their true objection. So, work with open-ended questions as much as you can . . . ‘Do you have any questions?’ That's a closed question. You're not going anywhere with that. But if you ask your patients, your clients, open-ended questions, what I mentioned earlier, I said, ‘Tell me more about your feelings on that,’ or you can ask someone, ‘I sense a little hesitation. What would be helpful in you making this decision?’ So, again, you're creating an open paragraph form for them to fill in the blanks with something other than a yes or a no. And a lot of times, people will lean into, ‘That's a lot of money,’ as their first objection because it’s top of mind. But there's something deeper. So, even if you figure out the finances, if they're still wanting to think about it, the value is not there, or they're afraid of the pain, or they know someone who has done this before. So, you do have to keep asking those open-ended questions to really uncover the true objection.” (32:50—33:57)

“How often do we acknowledge the things that our team is not doing well? And I say this both ways. The team has to acknowledge and celebrate their leaders too, when they see them making change or making progress. As a team, we have to celebrate each other. If you overheard someone use Feel, Felt, Found and make some change with someone, shout them out at huddle the next day, or in the moment. You have to celebrate each other as you're working through these challenging concepts. If it’s just the negative all the time, we’re going to give up. If we can be positive and celebrate each other, that's when everybody really rallies and gets motivated.” (35:29—36:05)

Snippets:

0:00 Introduction.

2:08 Miranda’s background.

3:10 Why it’s important to reframe objections.

5:15 Identify the true objection and use the “pillow”.

7:47 Train team members to build trust.

11:06 Acknowledge your patients’ thoughts and feelings.

14:04 Use the Feel, Felt, Found method.

18:04 Patient objection example: “I don't want to do X-rays.”

19:38 Create anchors and talking points.

23:06 Patient objection example: “I don't think I really need fluoride.”

26:54 Patient objection example: “I want to go home and think about this.”

28:15 Patient objection example: “It’s too expensive.”

29:35 Keep trying Feel, Felt, Found.

30:47 About Miranda’s course for front office administrators.

32:39 Last thoughts on why objections are a gift.

34:30 Celebrate when you or your team does well.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson, MS, BSDH, has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach. 

12 Systems to Prevent Burnout

Episode #544 with Kirk Behrendt & Ariel Juday

At some point, you and your team members will experience burnout. Without great systems in place, you may end up where you don't want to be! To help you prevent burnout in your practice, Kirk Behrendt brings back Ariel Juday, one of ACT’s amazing coaches, to share 12 simple systems you can start implementing today. Planning is the key to preventing burnout! To learn how to get started, listen to Episode 544 of The Best Practices Show!

Episode Resources:

• Ariel’s email: [email protected] 
• Ariel’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

Main Takeaways:

Planning is the key to prevent burnout for you and your team.

Create checklists and task lists to streamline the workday.

A spreadsheet of important contacts will save you time.

Review the schedule in advance with team members.

Reassess your goals and values periodically.

Plan your ideal schedule and then protect it.

Use technology to save your energy.

Remove negative communication.

Ask for help when you need it.

Have a plan B in place.

Leave work at work.

Quotes:

“[Burnout starts] when they don't prepare for the growth . . . We see a lot of practices, and they’ve made it so far just based off of their own knowledge, or their people that they have are great team members. But what they don't realize is when you multiply team members or you multiply patients, things get stressful because we’re not doing things necessarily the same way every time, or we don't have a system, or we don't have a checklist. So, then things start getting missed, and then we get overwhelmed.” (4:37—5:12) -Ariel

“A system means that we all know what we’re responsible for, when we’re responsible for it, and how to get it done. So, if we have every team member on board and they know what they're supposed to do, they have their daily tasks, they have their daily systems, then we know exactly where we’re at in the system and we don't go home thinking, ‘Did that get done? Did I miss that lab case? Did I forget to submit that insurance claim?’ Because as soon as we start taking work home with us is when we know we’ve already hit that burnout threshold.” (6:30—7:04) -Ariel

“Create basic checklists and task lists for every position. So, what is your admin team members’ daily checklist? What is your office manager’s daily checklist? What is your assistant and hygiene? Have one for everyone. That way, we know, one, are all of the tasks getting done? And two, are multiple team members doing the same task? Because we can easily divide it in a better, more efficient manner if we know who’s doing what and if it’s going toward that department’s strengths.” (7:19—7:51) -Ariel

“Something everyone can do is make a daily task list for every position so that you know what to do. And then, order it in the importance of the day. So, ‘First thing, I need to do this. By lunch, this needs to be done.’ And then, by the end of the day, I know everything is done so when I go home, I can enjoy time with my friends and family.” (7:55—8:18) -Ariel

“We always joke that team members are waterboarded. They're not really onboarded. They get thrown into these positions. Now, as a dentist, you think everybody gets it. You think you've told them all these times. You have to remember, you're working with human beings, wonderful people, and they're trying to manage these situations. And they don't think like entrepreneurs. They're just trying to do the best they can every single day, so you have to give them the benefit of the doubt.” (8:21—8:47) -Kirk

“You'd be surprised how many people are like, ‘Oh, we just do it.’ I was like, ‘But what do you do? What do they do?’ Or you ask, ‘Well, what does your office manager do on a daily basis?’ You'd be surprised how many dentists can't answer that. ‘Well, she answers the phone. She submits insurance.’ I'm like, ‘For eight hours?’ So, it helps you to know. But I always like it too, to be able to help my team members. So, if someone is really busy, if you're really busy, I don't even have to interrupt you. I can say, ‘Okay. Let me see your checklist.’ I can see where you're at and say, ‘Well, I can help with that,’ and then go do it. So, it also helps with that teamwork of, I know what everyone is doing. I can go and help them when they need it.” (9:16—9:59) -Ariel

“You'd be surprised how many people don't have a checklist because they think it’s common sense. They think we just know it. And even if it is common sense, what about when it gets hectic? You've answered phone call, after phone call, after phone call, and now you have a patient walking in. Now, you have an emergency. We’re human. We forget things. And sometimes, we need that checklist to bring us back into, ‘Okay. Where was I at? What do I need to do?’” (10:00—10:24) -Ariel

“Once you have that checklist in your system, I always tell everyone to have a plan B. So, these are the 100 things we need to do in a day as plan A. But what do you do when you're short-staffed? Have that plan ahead of time so that the team knows, ‘Okay, we’re down a hygienist. These are the 90 tasks that absolutely need to be done. The other 10 are great. But if we don't get to it, we don't get to it. It’s okay.’ If you're down an admin team member, what are the essential tasks that need to be done, and what are the ones that we say, ‘Hey, if these don't get done for the week that she’s on vacation or out sick, we will still survive’? That way, you don't leave it up to the team members to pick and choose what are the important tasks. Because remember, in the moment, we’re not thinking straight. We’re just going with the flow. And sometimes, we fill our days with the easier tasks or the tasks that seem important, but maybe we then forgot a whole week of insurance claims to submit.” (11:47—12:44) -Ariel

“Anything that you're doing manually, use your technology. I had one doctor, we were talking the other day, and he’s like, ‘I spend a half-hour at the end of the day typing my notes.’ I was like, ‘Wait. There are templates. You just push buttons and answer questions. It’s very quick.’ He never thought of, ‘Let the technology work for me.’ If we’re spending a lot of time on inserting patient forms that patients fill out, use the technology. Let them fill out the form digitally, and then we can import it directly into the software. So, anything that can save energy — and I know it’s not hard to enter a medical history, but I don't want to use my mind power on that.” (13:09—13:56) -Ariel

“Have a spreadsheet, internally and externally, of who to go to for what. Because I feel like dentists, all day, are putting out fires and answering questions and, ‘Oh, we need to change a lightbulb. We need to call the plumber.’ But as a team member, I can call the plumber if I know who the plumber is and what his phone number is. But a lot of times, I have to interrupt you to go and ask who that is. So, if we can create a Google spreadsheet or anything in the office that any team member says, ‘Hey, I need to call,’ they can call right then, and it’s not bogging someone else down to have to go find that information.” (15:37—16:12) -Ariel

“Create an ideal schedule and stick to it. And have your team protect it . . . If you don't like to do crowns in the afternoon, you don't have to. You can set up your schedule. I have one client, he said, ‘I don't want to do any exams on Wednesdays.’ I'm like, ‘Well, then why are you doing exams on Wednesdays?’ We have to design the schedule. And you can't make it overnight. You can't all of a sudden say, ‘I don't ever want to do this.’ It takes some planning. But protect it. Find out what makes you happy, what procedures you enjoy, when do you have the most energy, and protect that.” (16:29—17:08) -Ariel

“Pay attention to time zones in which you're best at what you do. When you're younger, you can do a lot. But when you get older, you're like, ‘I can't think in the afternoon.’ And so, you've got to protect your time and get everybody invested in that. Because if I'm working for a dentist and I haven't had this communication about how to organize the schedule, I'm going to put whatever I can find in there. And you're just going to do it because the schedule is the thing we follow service to. Whatever is in the schedule, we’re just going to do. We’ve been trained to do that.” (17:36—18:15) -Kirk

“We’ve been trained to see those seven emergencies that just got put in. And it’s like, hold on. What if we only limit it to three emergencies today, and we did three tomorrow? But it’s going back to, ‘I need to take care of everyone.’ Well, I want to take care of them. But we all know that true emergencies are different than what patients tell us an emergency is. So, have those questions. Are they in pain? Can they eat and sleep? Because some of it, they're fine if they come in tomorrow instead of squeezing them in today. It’s just we put that mindset of, ‘We’ve got to get everyone in. We’ve got to get them in today.’ And it’s like, no. Let's protect our schedule. Because we know when we have a nice flowing day, we all have more energy.” (18:17—19:06) -Ariel

“Do not take any work home with you. I know people have after-hour cellphones. And I only think those are necessary if you're really wanting to interrupt your evening and you're wanting to go in the office. Especially if you're going back in the next morning at 7:00 a.m., is there really anything that's going to happen that the patient can't live? We have to remember, there are emergency rooms and urgent cares for a reason, that they can go and get out of pain, and then see us first thing in the morning. Don't take it home with you.” (19:13—19:48) -Ariel

“Have a plan. Plan out, when are you going to be taking vacations? When are the holidays? A lot of offices are closed on Fridays, or they work every other Friday. If you can plan which Fridays you're off that go right into the long weekends that have Monday holidays, that’s going to give you and your team more time to recuperate. And I always say when you have that plan, I know we always try and squeeze a little bit more in towards the end of the year. But if we know how many days off, or we know what time we’re working extra, we don't get that resentment because we know, ‘I'm working five days this week, but I only have three days next week.’ Mentally, that helps you and your team members prepare.” (20:40—21:28) -Ariel

“Ask for help when someone is too busy. If you normally write up the lab slips but you're really busy, or you have a long procedure to go into, ask your assistant to help. Ask your front desk to help fax in or call in that prescription. Sometimes, we think, ‘Oh, this is my task, so I have to do it 100% of the time.’ But our team members are happy to help. They just need to know what to help with. So, don't be ashamed to have to ask, or delegate tasks and say, ‘Hey, for today, can you make sure this gets done?’ And I guarantee you, they’ll be happy to do it.” (23:07—23:48) -Ariel

“Go back to your values. Really look at, what do I enjoy? What are my values? What is success? Because I think we start getting in, and we start out practicing, and ten years later, we don't necessarily have the same idea of what kind of practice we want to have. So, you have to reassess and make sure, am I following the vision I have? How do I want to feel? What do I need to accomplish that feeling? What's my vision? That's going to help you assess your goals and make sure that you're on the right track. Because sometimes, we don't even know what our goals are or what our vision is, and we let the day-to-day take it over.” (24:29—25:14) -Ariel

“Sometimes, producing more is not going to give you what you want.” (26:45—26:49) -Kirk

“Be prepared. A lot of team members are not reviewing the schedule, and they're being very reactive instead of proactive. Because in the day, the schedule is, and we’re just taking care of the schedule. But if I review it ahead of time, I know where there are times that it’s going to get a little hairy.” (27:39—27:59) -Ariel

“If you're not having a huddle, definitely start having a huddle. This helps you plan out that day and review the schedule. And not too far in advance, because we know the schedule changes. But at least one to two days in advance so that you can make that plan.” (28:41—28:55) -Ariel

“Remove the negative communication, either with yourself or with your team. I always put it back to stay in the bubble. So, if we only talk about things that we can control, that's in the bubble. I can control my attitude. I can control the schedule, for the most part. But I can't control the weather. I can't control politics. I can't control the traffic outside. I don't even allow that communication to come in from team members, from patients. I never ask, ‘How was your drive here?’ because I'm opening up a can of worms if it was terrible. So, only talk about the positive things, and don't let our team members go in that negative circle.” (30:58—31:41) -Ariel

“You work hard every day. None of you ever signed up for how physically and emotionally demanding dentistry was going to be. And it’s an amazing profession. But without countermeasures, without systems, this great profession can take you in a direction you don't want to go.” (33:06—33:21) -Kirk

“Do it early. If you're saying, ‘I don't need it,’ everyone hits burnout at some point. So, get prepared and think about it now before you get to the moment, because we don't make good decisions when we’re tired.” (33:32—33:45) -Ariel

Snippets:

0:00 Introduction.

1:46 Ariel’s background.

2:46 Why preventing burnout is important.

4:12 How burnout begins.

5:53 Systems can help prevent burnout.

7:06 Create basic checklists and task lists for every position.

11:39 Have a plan B.

13:03 Use available technology.

15:19 Have a spreadsheet for important contacts.

16:24 Create an ideal schedule and stick to it.

19:08 Don't take work home with you.

20:37 Have a plan for vacations and days off.

23:02 Ask for help when you're too busy.

24:23 Reassess your vision, goals, and values.

27:34 Be prepared by reviewing your schedule in advance.

30:50 Remove the negative communication.

32:57 Last thoughts on burnout.

Ariel Juday Bio:

Ariel has a master’s in healthcare administration and several years of dental experience in all aspects of the administrative roles within the dental office. Her passion is to work with dental teams to empower team members to realize their full potential in order to better serve patients, improve office systems to ensure a well-functioning team/office, and to help everyone have fun in the process!

Outside of work, she can be found by the beach or the pool reading a good book, enjoying sporting events with her husband, Alex, or exploring the outdoors with her Bluetick Coonhound, Maddux. 

The Truth About Being a Dental Entrepreneur

Episode #543 with Dr. Barrett Straub, Dr. Timothy Baggott, & Dr. Ashley Berghuis

If you do great dentistry, the rest will take care of itself. That’s what dental school tells you, but there's one problem: “the rest” doesn't just take care of itself. There is much more to being a successful practice owner. To fill in those gaps and provide guidance, Kirk Behrendt and Dr. Barrett Straub brings in Dr. Timothy Baggott and Dr. Ashley Berghuis to talk about ACT’s Dental Entrepreneur Program and how it helped them become better leaders, better entrepreneurs, and have a better life. To learn more about DEP and the things dental school didn't teach you, listen to Episode 543 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
• Dr. Baggott’s email: [email protected] 
• Dr. Berghuis’s email: [email protected] 
• 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:

Margin by Dr. Richard A. Swenson: https://bookshop.org/p/books/margin-restoring-emotional-physical-financial-and-time-reserves-to-overloaded-lives-richard-swenson/6893728?ean=9781576836828

The Energy Bus by Jon Gordon: https://jongordon.com/books/theenergybus

ACT’s Dental Entrepreneur Program: https://www.actdental.com/dental-entrepreneur-program

Main Takeaways:

Most dentists graduate with high clinical skills, but low business skills.

Doing amazing clinical dentistry is the easy part of your practice. 

Owning your own practice will put you in control of your life.

Cultivate an environment that you and your team will love.

Start by making one small improvement every day.

Learning doesn't stop if you want to succeed.

Quotes:

“The important piece of being a dentist is you have a life too. A lot of times when you get into dental conversations, it’s all about, ‘Oh, yeah. The practice, and the production, and another day.’ A big reason you became a dentist is to have a life. And we also understand that they compete. They compete for resources, energy, and time.” (4:28—4:49) -Kirk

“The first seven, eight, ten years of my career — you're so fixated on developing your dental skills. As you forge the clinician you want to be, and as the business becomes a more consuming part of the equation, you realize all those skills, that's kind of the easy part, and this other stuff that you didn't go to school for and that you're figuring out on a daily basis is a whole new bag of challenges.” (6:11—6:40) -Dr. Baggott

“As I've gotten more secure or more confident, I've honed in more on the little things and realized there is no magic bullet to suddenly take your practice to these million-dollar projections that you hear people talk about. It’s really just . . . tweaking things on a daily basis. Turn this knob a little bit here, turn this knob a little bit here. And it’s not as overwhelming for me and for the staff if we can, every day, leave the office a little bit better than we left it.” (7:12—7:45) -Dr. Baggott

“In dental school, they teach you how to be a good clinician. You get out of school, and your first couple of years out, the wheels are turning, you're doing great with your skills, and you're honing those in, trying to get faster and more efficient. But you don't know how to manage your staff. All the numbers, and being an entrepreneur, being a business owner, you don't learn that stuff in school. They dabble in it a little bit, but you really don't get a whole lot of that in school.” (8:13—8:41) -Dr. Berghuis

“I think after that five-year hump is when you start to realize, okay, you have the skills. Now, it’s making sure that your staff is on the same page with those core values and making sure your practice has the value that you want it to and it’s what you want it to be.” (8:47—9:05) -Dr. Berghuis

“I think we’re people pleasers as dentists, to a fault. And so, we want our staff to be happy. We want our patients to be happy. And if we feel like somebody isn't, I think that's what keeps us up at night too, other than the business part.” (9:32—9:45) -Dr. Berghuis

“Dentistry is lonely. I always say dentistry is lonely. Leadership is lonely. And dentistry, especially, can be lonely because we didn't learn a lot of this in dental school. And every dental school, probably in the world but certainly in America, we get this advice: just do great dentistry, and the rest will take care of itself. I think it’s some of the worst advice I've ever gotten.” (10:15—10:38) -Dr. Straub

“It’s true, you always want to do the best clinical dentistry. But there are world-quality, amazing clinical dentists out there that are running horribly failing practices because they are living by that, doing amazing clinical dentistry. Their patients don't know it, their team doesn't know it, their books are a mess, and they have the bedside manner of a table and can't talk to someone — and they're still doing great clinical dentistry. But that's only part of it. We have to do that. That's a minimal requirement. But there's so much more. We've got to be good businesspeople, we’ve got to be likable, we have to learn how to communicate with people, and we’ve got to be good leaders.” (10:38—11:16) -Dr. Straub

“It’s hard sometimes because the world is sharing stories with us and there's competing information coming at us. We’re reading different dental magazines and listening to different podcasts, and when we’re there alone, we’re thinking, ‘Gosh, I've got to produce $3 million. Everyone’s got 15 hygienists or eight practice locations. I should do that too.’ And for some people, that is the right path. But for some, it’s not. And that's the beauty of dentistry. But it’s hard sometimes to wade through the noise and find your true one path that's right for all of us and go down that road.” (11:17—11:54) -Dr. Straub

“I think that's the biggest challenge that I face, and all of us, is getting to that hump where it’s like, okay, I have this self-confidence. I've been around long enough. I see where I want to go, and I'm going to put on earmuffs for some of this noise, and I'm going to listen only to the advice and the people and the things that share my core values and are going to get [me] closer to that final goal.” (11:54—12:19) -Dr. Straub

“What I find the most rewarding is not when I have a good day, it’s when my entire staff — especially watching my associates — have a good day. They're newer grads. They’ve been out of school a couple of years. So, watching them grow, watching them have success, honestly, is more rewarding for me, at this point.” (16:05—16:23) -Dr. Baggott

“Most dentists do want to live that American dream of leading their own practice. It’s difficult in the beginning, obviously, and I think that scares a lot of young dentists away because, financially, they didn't get a lot of information in school on how to do those things. But I think going through the trenches in the beginning, you're going to reap the rewards later.” (19:52—20:11) -Dr. Berghuis

“I worked the corporate life for a while a couple of years out of school. And there are pros when you're just out of school because you can just focus on the dentistry. But if you don't have the personality to be an employee, which I do not, it’s tough to stay in that position for a long period of time.” (20:16—20:33) -Dr. Berghuis

“As an entrepreneur, I think of, ‘Hey, if I solve one problem, and then I solve another, I get to make a buck. And if I solve a few more problems, I get to make another buck.’ And eventually, you solve enough problems, you can make a living. And that's kind of how I feel. And I don't say that to scare people away from ownership. I've come to embrace it. When you take that mentality, it makes it easier to fight through the suction pump that keeps struggling. If something breaks, can you fix it? There's going to be an endless amount of problems that you can solve, and you’ve got to look them in the face, and smile, and take them one at a time, write them on a Post-it note, and then start throwing them away.” (22:24—23:07) -Dr. Baggott

Snippets:

0:00 Introduction.

0:54 Dr. Berghuis’s background.

2:33 Dr. Baggott’s background.

4:51 Dr. Straub’s background.

5:56 The reality of being an entrepreneur and a dentist.

6:42 Things that keep dentists up at night.

10:13 Dentistry and leadership is lonely.

12:20 One-year goals for a better life.

18:22 Associateship or ownership?

20:33 The path to ownership.

24:36 About ACT’s Dental Entrepreneur Program.

28:25 Leave the campsite better than you found it.

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.

Dr. Timothy Baggott Bio:

Dr. Timothy Baggott has lived in the Greater Milwaukee area his entire life. After completing his undergraduate studies at Marquette University as a Pre-Dental Scholar, Dr. Baggott graduated Cum Laude from Marquette University School of Dentistry in 2010. Upon graduation, he began a private practice in Greenfield, sharing a location with his father, Dr. William Baggott. In 2013, Dr. Baggott returned to MUSOD as an Adjunct Professor. In 2018, Dr. Baggott took over the downtown dental practice of Dr. Paul Smaglick. He has served on the Board of Directors for the Greater Milwaukee Dental Association, as well as a delegate for the Milwaukee Region for the Wisconsin Dental Association House of Delegates.

Outside the office, Dr. Baggott enjoys spending time with his wife, Laura, and three kids, Ken, Andrew, and Evelyn.

Dr. Ashley Berghuis Bio:

Dr. Ashley Berghuis grew up in southwest Michigan, more specifically Gull Lake, and completed her undergraduate studies at Western Michigan University. She moved to southeast Wisconsin after undergrad to complete her dental education at Marquette University, where she graduated Cum Laude and fell in love with the cheese-head state.

Dr. Berghuis finds it important to give back to her community and the dental field through volunteering. She has been involved with Give Kids a Smile Day, Mission of Mercy, and many school oral health programs in the area.

Outside of dentistry, she is an avid football fan who enjoys hiking, traveling, yoga, spending time with family, friends, and her rescue Black Lab mix, Riley

Without Value There is Only Price

Episode #542 with Miranda Beeson

Dentistry is sales that's done with your ears. You need to listen more, talk less, and still build value. It sounds challenging, but anyone can do it with a few simple steps. To help you get started, Kirk Behrendt brings back Miranda Beeson, one of ACT’s amazing coaches, with advice for creating value with your words and actions. Price isn't always the problem! To learn the system for communicating value, listen to Episode 542 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:

Healthy Heart, Healthy Brain by Dr. Bradley Bale and Amy Doneen: https://bookshop.org/p/books/healthy-heart-healthy-brain-the-personalized-path-to-protect-your-memory-prevent-heart-attacks-and-strokes-and-avoid-chronic-illness-bradley-bale/18640747?ean=9780316705554

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

Main Takeaways:

Help your team understand the value of what you do.

Standardize your messaging among your team.

Objections are a gift and an opportunity.

Always apply the “so that” concept.

Utilize the power of the pause.

Listen more and talk less.

Quotes:

“When you take the price off the table and you look at, ‘Did we build the value we needed to build from the phone call, in the back, throughout the whole process?’ then price isn't really the problem anymore. So, then we can look at, ‘Is there still an objection? And if so, how can we take care of that?’ because it’s not price if we've built value.” (3:34—3:51) -Miranda

“Dentistry is sales. Whether we want to call it sales or not, it is sales in its own way. And so, there's a buying cycle. It starts with that awareness that the patient has at home. And then, that first transition into consideration is when they call us. So, the first opportunity we have to start building value with a patient is when we say hello on the phone. And then, where do we take it from there? So, it’s probably the most important piece of where we start building value. Are we affirming the patient calling us, and are we validating that we’re the right fit, and having a really relational conversation with that patient on the phone versus just your transactional, ‘What's your insurance? Give me your phone number. When can you come in?’” (4:44—5:26) -Miranda

“It’s all about the way that [value is] shared through the words. You have to be really intentional with that in building that value. We talk all the time about right person, right seat. You have to make sure that the person that's answering the phone can deliver this level of value to your team. I want someone to walk in the door, and when they walk in, if I'm that person who answered the phone, I want them to feel like they're greeting a friend. They were looking forward to coming in to seeing me. And if they share with me something on the phone that's important to them or valuable to them, I need to hear that. I need to bank it. And then, I need to turn that back around and let them know, ‘You have chosen the right place. This is how other patients with similar experiences have benefited here.’ Give them a testimonial. Do that social proofing. Let them know, ‘You're not the only one, and we’re here for you.’ It is all about the words.” (7:20—8:11) -Miranda

“Money spent on dentistry is one of the best investments a human being can make. I think you've got to start there. So, when you're working the front desk, or you're working chairside, or you're working hygiene, or you're a dentist, you've got to believe that what you do is crazy valuable. That's the first place to start. If you think you're overcharging people, nobody wants dentistry, then nothing we’re going to say in this podcast is going to help you.” (9:27—9:47) -Kirk

“Another great thing that I think works really well to help team members, especially if they're new to your team, maybe they worked at another office, or maybe they came from veterinary world or something of that nature, help them to understand the value of what you do. Share patient experiences. Maybe present a case to your team at a team meeting, all the way from how that patient felt, what their confidence level was before they came in, what were they looking to achieve, and then what did they get to through the dentistry. Because the dentistry and the quality of that is incredibly important, but how did you impact that person’s life with that dentistry, their health, their family, their appearance, their confidence, whatever it may have been, because that's where the value really comes from.” (10:25—11:09) -Miranda

“It’s hard for team members who look at a large treatment case and they say, ‘Gosh, it would be hard for me to approach that treatment case and take care of that investment,’ and they start to relate to the patient, and they start to pass some of that bias on when they're delivering or talking about the care. But if they can truly see and understand, they're not in that hopeless place that the patient is in. If they can see that case study, if you can share with them, ‘This is how we’re able to help people here,’ the value is going to build within your team members, and it will exude from them naturally once they fully understand what you're capable of doing in the office.” (11:10—11:45) -Miranda

“So many patients walk through the door obviously nervous. That's probably one of the biggest things. People have a fear or nervousness, or they may have a conditioned bias, ‘I know they're just going to try to sell me X-rays. I know they're just going to try to sell me that fluoride.’ So, if you can lead with why, and that's really what “so that” provides you. If your mind is conditioned to lead with “so that” every single time, ‘So that we can see the areas of your mouth that we can't see just by looking with our eyes to make sure they're healthy, we'd like to update your radiographs today so that we can protect those exposed root surfaces. And I know you shared with me you have some sensitivity. We'd love to help you with that. We'd like to apply fluoride varnish for you.’ That can apply in any aspect. It can apply with a crown. It can apply with their treatment plan itself, ‘So that we can make sure we don't have any unexpected surprises throughout this process, I'd like to really look at this plan with you and make sure you understand where your investment is going.’ So, it takes that, and it flips everything around to where the patient’s brain is moving forward with you. And then, you can put out the information versus them objecting as soon as they hear you say, ‘You're due for X-rays today.’” (12:33—13:40) -Miranda

“You would be in the hygiene chair and working with a patient, and you feel like they're on board. And then, they leave, and you'd see they didn't schedule. And then, you'd go talk to your business team coordinator, your treatment coordinator, and they'd say, ‘Oh, they were a little overwhelmed with how much it was. They weren't ready to invest.’ And you're like, ‘What? They were so ready in the back.’ So, part of it is developing the value in the back using — co-discovery is a word that gets used a lot in dentistry now, but it’s very helpful.” (14:35—15:00) -Miranda

“The biggest thing is creating the space when you're in the clinical world for the patient to share with you what they're thinking and feeling about what you're seeing, for them to drive that conversation and let you know, are they motivated, do they have questions. I love, as a hygienist, to have a photo up, ‘Oh, I need to get myself ready over here. I'm going to grab some things,’ and you leave it in front of the patient. It’s that large molar with the cracked, old amalgam and all the things going on that you know is really best served with a crown. But they're going to hear crown, and they're going to think dollar signs. So, if you could have that image up, allow the space for them to say, ‘Is that my tooth?’ and if you can say, ‘Actually, it is. What are your thoughts on that?’ and then open the door for them to start telling you what they see and how they feel, you'll be surprised how you can extend that conversation.” (15:03—16:00) -Miranda

“You have to not just share what we need to do next when you get up front, but why. ‘Why does it matter? What's in it for me?’ is all the patient wants to know. So, it’s just as important to say what we did today, what we’re doing next time, why are we doing that next time, and how is it going to benefit Mrs. Jones.” (16:23—16:42) -Miranda

“I heard one of my mentors say you're going to sell more dentistry with your ears than your mouth.” (16:48—16:52) -Kirk

“Talk less and listen more. If you're doing most of the talking during your OHI, during your co-discovery, you're doing it wrong. It really should be, ask a question, open the space for the patient, and then have them talk as much as possible because they're going to give you their motivators. They're going to give you their values. And then, they’ll let you know if they have a desire for this, if they feel like they have a need for this.” (17:26—17:51) -Miranda

“It’s not about us just dumping our agenda and information on our patients. And some of that is time. We get a little crunched in and we kind of revert to that. But it’s more about opening that communication and letting the patient out there know, ‘Yes, I'm with you.’ For us to say you should, you need, you would, some patients will resist even more because, ‘You're not going to tell me what to do.’ So, you have to be really careful and work with the person. It’s a person in the chair. It’s not just a set of teeth.” (18:26—18:57) -Miranda

“There are extremes on both sides, if you look at the worst of it. The worst of it could be that they are too agenda-driven, too price-driven. They're just trying to build profit and not really looking at the bigger picture. And I think you can have the worst-case scenario be on the exact opposite end of that too where they're too empathetic and biased and they're not putting enough value on their work. They're doing a lot of “gimmes” or, ‘We’re just going to patch that up for now because I know it’s going to be expensive.’ And they're trying to be nice. But nice isn't always being nice because it may not be what’s most appropriate, or at least even giving the patient the option to decide.” (19:20—20:01) -Miranda

“The best-case scenario is when a dentist really values and has confidence in what they're doing. They’ve invested in their education and their skills and their equipment and their team, and they also care very deeply, not only about that person but about the outcome that they're delivering.” (20:08—20:26) -Miranda

“In a dental office, it’s always a team thing. There are no individual players. Every single person and every single department works together like a cog in a wheel. It’s the inner workings of a watch. There's that center spoke, but every piece that revolves around it is important. So, if you're a dentist who’s 32 and trying to figure all this out, and the main objection that keeps coming up of why people aren't accepting is it’s just too expensive, I think the whole team needs to work together on, ‘How do we orchestrate and collaborate our conversations so that we’re speaking the same message, so that we’re standardized in how we care about people? What is our philosophy? What are our core values? Are we implementing those and living them every single day?’ working together departmentally and as a whole to make sure that if Jane, our hygienist, is going to build value in a certain way, then when Joey up front helps take care of that, they're good to go.” (20:56—22:00) -Miranda

“One thing I hear dentists say often when we work in coaching, you'll hear every now and then, ‘I have someone that when I overhear what they're saying, I'm kind of like, oh, I probably wouldn't have said it like that.’ It’s like, ‘Have you shared that with your team? Have you shared how you would like information to be communicated with patients in the office?’ It’s something that you have to create a system around.” (24:37—25:01) -Miranda

“If you're in the front office and you're getting stuck on price with a patient, more than likely, the value wasn't there. So, a quick, easy question is, ‘I can hear where you're coming from. Most of our patients who still want to think about it share with us that maybe there's more clinical information you'd like to know about this procedure before moving forward. Would you like to have an opportunity to speak with your hygienist about this a little bit further, or speak with the doctor about this a little bit further?’ because they may be afraid to open up to you that they really just didn't understand what or why they need it. So, give them that. Give them that opening to share that true objection. And a lot of times, it’s not actually the cost. There's something else around it. So, open that up. Is it something clinical, or is it truly financial? Because I can help you with both while you're here. You don't have to go home to think about it.” (27:02—27:53) -Miranda

“Lean into photography, whether it be extraoral or intraoral. And then, create that space [for patients to share their thoughts], the power of the pause. Actually, count in your head. Give it five seconds after you pull it up and ask them, ‘Tell me what you think about this picture,’ and then stop. Don't close that silence. It’s going to feel a little awkward, but just live in it for a minute. Count in your mind, and they will fill that silence with some very valuable information that's going to help you help them.” (27:59—28:28) -Miranda

“Objections are a gift. They're a gift and an opportunity for you to build that value and figure out, where is that little missing piece of value, and how can we help this patient to get there?” (30:46—30:56) -Miranda

Snippets:

0:00 Introduction.

1:49 Miranda’s background.

2:47 Where this idea originated.

3:55 It starts at “Hello.”

5:25 Show patients value through your words.

9:16 Believe that what you do is valuable.

10:22 Help your team value what you do.

11:54 Apply the “so that” concept when you communicate.

14:15 Create space for patients to think and share their thoughts.

16:42 Sell dentistry with your ears.

18:57 Without value, there is only price.

20:27 Collaborate on conversations with patients.

22:41 Standardize your messaging.

26:34 Give patients an opening to share their objections.

28:42 Objections are a gift.

31:08 Last thoughts.

Miranda Beeson, MS, BSDH Bio:

Miranda Beeson, MS, BSDH, has over 25 years of clinical dental hygiene, front office, practice administration, and speaking experience. She is enthusiastic about communication and loves helping others find the power that words can bring to their patient interactions and practice dynamics. As a Lead Practice Coach, she is driven to create opportunities to find value in experiences and cultivate new approaches.

Miranda graduated from Old Dominion University, and enjoys spending time with her husband, Chuck, and her children, Trent, Mallory, and Cassidy. Family time is the best time, and is often spent on a golf course, a volleyball court, or spending the day boating at the beach. 

Clicking & Popping in Your Practice

Episode #541 with Dr. Jim McKee

There's a quick way to build your practice — and no one wants to do it! Millions of patients have occlusal disease, and you can help them by adding joint and occlusion diagnosis to your practice. To help you become more confident in this space, Kirk Behrendt brings back Dr. Jim McKee from Spear Education with advice for rethinking occlusion and understanding its value. Don't shy away from occlusion — embrace it! To learn how, and to learn more about Dr. McKee’s Advanced Occlusion workshop at Spear, listen to Episode 541 of The Best Practices Show!

Episode Resources:

• Dr. McKee’s Facebook: https://www.facebook.com/jim.mckee.104
• Dr. McKee’s social media: @jim.mckee.104
• 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:

Spear Education: https://www.speareducation.com

Dr. Gary DeWood and Dr. Jim McKee’s upcoming Advanced Occlusion workshop: https://campus.speareducation.com/workshops/advanced-occlusion/details/schedule

Chicago Study Club: https://chicagostudyclub.com

American Equilibration Society: https://aes.clubexpress.com

Main Takeaways:

It is more important now than ever to understand joints and occlusion.

Occlusion and joint diagnosis is the fastest way to build your practice.

Embrace joints and occlusion rather than being intimidated by it.

Recommend treatment to patients who are ready to hear it.

Not all clicking and popping is the same.

Learn to redefine occlusion.

Quotes:

“[I] got out of school after four or five years and didn't really understand occlusion. I saw a lot of cases that intimidated me. I started to pull away from recommending treatment planning on more complex cases because I really didn't understand how the teeth should fit together. But what I really didn't understand is when someone came in with a clicking joint or a popping joint, what that meant to me. So, I did what most of us are taught to do. I ignored it.” (2:30—2:57)

“My journey in this whole area of occlusion started out as most people do, from a pain-based perspective, because if a clicking joint didn't hurt, I basically ignored it. And sometimes, that's the right thing to do. But what I've learned over the years is every clicking joint is not the same.” (3:12—3:33)

“A clicking joint is basically a structurally altered joint. And part of the problem is, as dentists, we’re taught about occlusion in terms of how the teeth fit together. And while that's an important part of it, the reality is, occlusion today should be defined, I think, as how the lower jaw fits to the upper jaw. So, it’s not only how the teeth fit together, but it’s also how the right joint fits against the right joint socket with the disc in between, and the left joint fitting in the left joint socket with the disc in between. So, where I used to think of occlusion as primarily how the teeth fit, now, I'm thinking of it basically as a tripod and how do the three legs fit together. What I've learned over the years is that, many times, we have problems at the back end of the system because we have some type of structural alteration of the joint. And I didn't understand that in the early years. I was focused just on the teeth.” (3:40—4:43)

“When dentists really understand occlusion, what happens is we see how many patients occlusion touches in our practice. So, if a patient is going to come to you, let's say for an out-of-network service, it could be implants, it could be airway, it could be holistic dentistry, it could be esthetics — it could be any of those — I will tell you that most of the time, occlusion or joint diagnosis is the easiest way to build a practice because, quite frankly, no one wants to do it.” (6:47—7:23)

“I would really encourage dentists, especially young dentists, if you're looking to build a practice where patients are going to come to you for a specific reason and not necessarily because of the insurance company that you're affiliated with, if you can learn how to diagnose joints and understand occlusion, I know it’s the fastest way to do it because no one else wants to do it. That's the reality.” (7:59—8:25)

“Today, with especially the popularity that airway has, you have to know joints if you're going to do airway. Really, so many of the problems that we see with airway are at the maxillary level, and there's some constriction of the nasal complex so we don't have adequate breathing. We have a lot of collapsed pharyngeal airway space as well. And a lot of times, that's related to the joint. So, in order to treat airway today, I think you have to be an expert in occlusion as well because, so many times, those patients have both of those problems going on. So, I really think today, occlusion is the foundation for so many things that we do on a day-to-day practice. Regardless of the complexity of the case, occlusion touches everything.” (9:12—10:07)

“When I look back at my career, if I was a 30-year-old dentist and I had a 30-year-old new patient come in, a lot of those patients had large amalgams or were going to need crowns over the course of the next 25 years. So, a lot of my early production revenue was generated through doing crown work on old fillings. If I'm a 30-year-old new dentist today and a 30-year-old new patient comes in, they don't have that type of future restorative work that's going to be necessary to replace those composites or whatever would be filling the tooth today. I think, today, what you're going to see is a lot of those patients have had orthodontics that maybe now has relapsed and hasn’t been stable because there has been an occlusal component that wasn't recognized. So, today, I think as a practicing dentist, it becomes more important than ever to understand occlusion, especially to understand the joints.” (10:18—11:18)

“When we talk about occlusion and joints, it’s a ball-and-socket joint. The top of the lower jaw fits into the base of the skull, and muscles contract to open and close the jaw. So, if it’s a ball-and-socket joint, we don't want the ball or the condyle to grind against the base of the skull with a joint socket. So, we’ve got a disc in there that attaches like a bucket handle, and the disc has attachments on the outside lateral pole, inside medial pole. And if those attachments tear, that's how we start to click or pop.” (11:21—11:55)

“We've made joints way too complicated. Part of it is because we never saw them. Everything that we saw and our knowledge about jaw joints was basically an artist’s drawing based upon what a dentist told them they thought it looked like. When we started to image, back when imaging came out 30 years ago, we realized, ‘Mm, that's not really an accurate representation of what we’re seeing anatomically.’ Many times, the structural breakdown was far greater than the drawings in the textbooks. And that's why occlusion became an unpredictable discipline in dentistry.” (11:58—12:35)

“If we can understand the structural changes at the joint level, the discussion becomes so much easier. So, basically, structural alterations generally start at the soft tissue level. If you've got hard tissue bone and soft tissue disc, we generally don't see bone issues if the disc is protecting the bone. So, the tipping point or the first domino that has to fall is a ligament tear. And that can be a ligament tear at the outside, the lateral pole, which would be a partially displaced disc. If we were looking at the literature, it'd be called the displaced disc with reduction, which means we get back under the disc when we open. But I'm going to add a qualifier. I'm going to say at the lateral pole.” (12:37—13:22)

“The other type of disc displacement we have is if the ligament tears at the medial pole. Easy enough to think about. Partial disc displacement of the lateral, complete disc displacement at the lateral and the medial pole. So, that's the first part to think about, is it a partial disc displacement or a complete disc displacement? Now, the reason why that's important is because if we look at the joint socket, we talked about bite forces. And when we bite down, we have a lot of muscle force that we can generate when we bite down. The muscles are positioned between the teeth and the joints. Forces are going to be distributed between the teeth and the joints. At the tooth level, what we try and do is to make sure that every tooth touches with the same amount of force. We don't want to overload one, two teeth. They break, they wear, they loosen. So, basically, we’re trying to get an even bite to distribute to all the bite forces through the roots of the teeth and into the bone.” (13:23—14:24)

“Generally, what we’re seeing is we’re seeing injuries at the joint level earlier than we ever thought. When you really think about the jaw joint, it’s an orthopedic joint. The problem is, orthopedic physicians don't look at this. There's not an orthopedic physician that I know that thinks that this jaw joint is an orthopedic joint. So, now, it falls to the dental world where normally it would fall to the oral surgery profession, their specialty. Oral surgeons are plenty busy taking wisdom teeth out, doing orthognathic surgery, placing implants. So, from a patient’s perspective, it’s an area that's kind of fallen through the cracks in terms of trying to get diagnosis and treatment.” (16:39—17:23)

“If you can be the dentist in your community who can recognize these problems and give people answers, they will beat a path to your door. And that's exactly what happens in clinical practice. It really is.” (17:25—17:38)

“When we talk about managing occlusion, I think people are living longer. People are also getting injured earlier. If I look back, when my mom was younger, she didn't drive until she was 30. She wasn't playing travel soccer, travel basketball, getting elbowed in the jaw. She wasn't having the amount of facial injuries, trauma, whatever you want to call it, to growing patients, especially females, who are in a subset of patients who are least able to adapt to an injury to the joint. Females tend to have a more lax ligament system to account for childbirth. And what happens is, especially today in growing patients, we see more joint injuries than we used to.” (17:39—18:23)

“The easiest thing to think about clicking and popping, number one, is it a partially herniated disc or a completely herniated disc? Because if it’s clicking and popping, it’s herniated. Now, I'll give you a tiny exception that's an outlier just so we have a little bit of context here. You can also get a click or pop if you open really wide and maybe open past the eminence. You might get an opening click at 40, at 42, at 45 millimeters. But that's exceedingly rare. That's probably one to two percent of the cases. Most of the cases, if a patient comes in with a click or a pop, the question is, is the ligament torn at the lateral pole, or is it torn at the lateral pole and the medial pole? If it’s the 60-year-old patient who has been clicking for 30 years and never had a problem, I'm thinking it’s probably a partially herniated disc. Because discs that are completely herniated, generally, if they have problems — because they all don't. Some will adapt. But the problems generally are in that population. If they do have problems, they generally present in one of two ways. Something hurts, which is a low distribution issue, because the soft tissue isn't present and now the bone is grinding against the joint socket, or something doesn't fit, which is namely the teeth because we've lost the gasket and now we have a bite that doesn't fit together because we don't have stability at the back end of the system. And as that changes, now the front teeth don't fit together either.” (21:41—23:29)

“In terms of clicks or pops, number one, is it a partially herniated disc or a completely herniated disc? Number two, does it present as something is hurting or something is not fitting? Now, one of the things you have to do as a dentist when you're checking whether it fits or not, we can have the patient close down and see how the teeth come together and look at it that way. What we also should do, though, is not only check from a dental position but also check from a skeletal position. So, if we can seat the joints in the socket, whether you use bimanual like Pete Dawson talked about, whether you use a leaf gauge like Frank Spear talks about, whether you use an anterior deprogrammer like John Kois talks about, what we want to do is to position the condyle skeletally, and then look at the bite. And here’s the take-home: if the bite is uncoupled greater than the thickness of the disc, let's call it two millimeters, then the likelihood increases that we’ve lost the gasket at the back end of the system. That's the easiest way to think about it.” (23:30—24:40)

“[There is] an old tool that Mark Piper called reading the bite. Basically, what you're doing is you're looking at the anterior tooth relationship in a skeletal position. And really, what you're doing is you're now comparing that space to the thickness of the disc. It’s an easy clinical skill to look at. I think, honestly, it’s probably the easiest clinical screening tool that we have, along with understanding the history.” (24:41—25:06)

“I used to present treatment plans or discussions like this before the patient had enough information to make a good decision. What I have changed is I have frontloaded my educational discussion with the patient earlier in the appointment than I ever did in the past. So, generally, this discussion starts by taking a history. If they say they click, if they said they had ortho because they had a large overbite, if they say they had ortho with headgear, I know right off the bat that, likely, there was a joint-based problem. So, if they're coming in specifically for a joint-based issue, I'm going to educate them early so that by the time we get to the end of the clinical exam, all that's doing is verifying what we talked about initially before we even looked in their mouth, based upon what I learned from their history.” (27:31—28:26)

“I learned this at the Pankey Institute, that if I could build a patient base of patients who valued the type of dentistry I was offering, it was more likely that they would say yes to treatment, or that we would do treatment, but we may have to phase it. My mistake early on is that I was presenting treatment plans to patients who weren't ready to hear it. They didn't value it, so the first question that came out of their mouth is, ‘How much does insurance cover?’ And a lot of the stuff I was doing wasn't covered by insurance, so I had a lot of noes.” (30:03—30:39)

“In terms of implementing, my best advice to a young dentist is take a morning a week and make that your comprehensive dentistry day, whatever you want to call it. And I'm talking about joints and occlusion. But really, what I think the practice of the future is going to be is the diagnostic practice. You're not going to have, as I said before, as much restorative dentistry to do as we've had in the past simply because people are taking better care of their teeth and we have better materials. So, I think what you are going to have is a diagnostic practice that might be joint-based, that might be occlusion-based, that might be airway-based, that might be orthodontically based. It could be anything like that. But what we have to do, I think, is become diagnosticians. Because so many times, the patients who I have seen who have problems have not had treatment plans that have been developed with a comprehensive thought process.” (30:48—31:53)

“I still see patients today that come for insurance reasons, so I'm not saying you have to get rid of that or you shouldn't do that. But I'm saying if you can develop another side of the practice, a diagnostic practice, I always think of it almost as a diagnostic subspecialty in my neighborhood practice. And the beauty of that, from a practice management perspective, is I have a column for my production, and I have a column for the assistants’ production. And if we can create a diagnostic practice, whether it’s airway, whether it’s joints, whether it’s restorative, whether it’s implants, our assistant now can produce revenue through diagnostics. And all of a sudden, now, you start to build a practice that has some sustaining numbers, and you have enough money now to go to some CE that will allow you to implement more.” (32:44—33:30)

“When I look back at my practice, there's nothing that I have done that has had a greater return on investment than continuing education. That's what allowed me to treat patients that I never would have treated otherwise.” (33:33—33:47)

“There's an old saying, if you're a baseball player, you can hit for average and hit for power. That's kind of what I did for my practice. I had a regular practice. I would do single-unit crowns. I would do direct restorations. And as my skillset started to increase, first in recognizing problems and then being able to provide treatment, what I started to do was to do bigger cases. I still had the bread-and-butter stuff going, but I started to add to that. That was my pathway.” (35:21—35:54)

“A lot of times, if I look back at my mistakes, it’s because I was recommending treatment to patients that simply weren't ready to hear it yet. Technically, the treatment was correct. But I hadn't prepped them well enough so that they can make a good decision and accept the treatment.” (37:40—37:59)

“Realistically, you're not going to get everyone. There are going to be people that no matter how well you explain it, they're not going to be able to do it, for whatever reason it may be. But I think that your case acceptance rate can increase dramatically based upon how we explain things to patients and how we give them choices to move through a case, either all at once or on a phase basis, based upon if they need to do that.” (38:01—38:28)

“I'm hoping that the people listening to this podcast will redefine occlusion. And if we can redefine occlusion to include not only the teeth but also the back end of the system of the joints as well, all of a sudden, now, occlusion becomes very predictable. And with occlusion, so