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Inside Dentistry

February 2013, Volume 9, Issue 2
Published by AEGIS Communications


Winning Strategies

Dental practitioners share their rules for professional and personal achievement

By Ellen Meyer

a generation ago, professional success among practicing dentists—mainly male solo practitioners—followed a well-marked path and was to some degree defined monetarily. While these dentists certainly enjoyed their work rendering dental care independently in their own private practices, the comfortable lifestyle it afforded them and their families was virtually guaranteed, as was the respect of their patients and communities.

However, much has changed in the dental profession. Dental school graduates, emerging from basic training with an unprecedented amount of debt, can’t just hang out a shingle and expect to become quickly established and profitable. It’s complicated. With the explosion of new materials, techniques, and technology, there is more to learn than ever before. Adding to the mix is the need to understand the intricacies of insurance, government regulations, and attracting patients through newfangled marketing tools such as Facebook and Twitter.

The playing field is continually shifting, and dentists are adjusting their strategies accordingly. Some take pleasure in facing challenges their professional ancestors could not have imagined. Others choose to delegate some tasks to staff members, colleagues, or consultants, shaping their practices to their philosophy and interests—eg, research, continuing education, community outreach—and balancing them accordingly. For real-life examples of how today’s dentists are managing their careers, Inside Dentistry asked representative practitioners to share their experiences, action plans, and philosophies for professional and personal success.

In the Beginning

Most respondents started out as associates in an established practice, with or without the intention of eventually buying in, but found themselves adjusting their approaches as their views of professional and personal success became more defined.

For Cherilyn Sheets, DDS, this position was in the Inglewood, California, practice of her father, James Sheets, DDS, a much-beloved and innovative general practitioner, who mentored more than 60 graduate students during his 48-year dental career. While Sheets always knew she’d be a dentist—she entered USC Dental School at 19, after passing a qualifying exam at 17—she eventually diverged from the predictable path. After 9 years with her father (6 as an owner), she embraced the opportunity to branch out into a prosthodontics-focused practice.

Dental school chums Michael (Mick) McDill, DDS, and Todd Rosenzweig, DDS, MDS, took different paths to their eventual partnership, which was built on trust and shared goals (as well as a harrowing experience mountain climbing together after their freshman year at the University of Colorado Dental School). Rosenzweig, a periodontist, recalls his 5-year stint as an associate with a plan to buy into a specialty practice, which taught him a lot clinically but eventually proved frustrating. “I didn’t have a clear sense of purpose or control, and I was eager to round out my services in a general practice.”

Amanda Seay, DDS, too, was dissatisfied with the associateship position she assumed, realizing that to practice the kind of dentistry she wanted to provide, she needed to go it alone.

On the other hand, for Michelle VanDyke-Topp, DDS, the associate-to-owner model went as hoped. She purchased the practice in which she began as an associate, keeping most of its patients but changing its name to Dental Impressions and making it her own.

Partners and Mentors

Most respondents credited their success to important relationships that helped to support or stretch their goals. For example, while Robert Margeas, DDS, and McDill had successfully begun in their own solo practices, both found their respective careers really took off through subsequent partnerships that enhanced their professional development and career satisfaction.

Margeas, Adjunct Professor in the Department of Operative Dentistry at the University of Iowa and founder of the Center for Advanced Dental Education, maintains a private practice devoted to comprehensive dentistry in Des Moines, Iowa. The practice he had maintained for 12 years was thriving when he decided to merge it with that of Paul Polydoran, DDS, a mentor who had a successful practice for 40 years. This took his dental practice and teaching activities to a whole new level. Polydoran convinced him to build a $1.5 million building, saying, “I believe in what you’re doing. You should have your own building and teaching center.” Margeas says, “I went from 1,000 square feet and four operatories and paying $1,100 a month rent to a 5,000 square foot freestanding building with a $12,000 a month payment. It was a big leap for me, but I never looked back. In 26 years, I’ve never had a year worse than my previous year—each year has built on itself.”

Sheets’ mentors, of course, include her father. However, the practice she runs today is an outgrowth of her relationship with Carl E. Rieder, DDS, her USC dental school professor, who “understood prosthodontics inside and out,” giving her “a prosthodontics mentor-type education that changed my professional career forever.” What’s more, she says, “Rieder was a genius at organizing things—flow charts and check lists.” Her Newport Beach practice focuses on solving very complex problems and attracts patients from all over the country. Her all-female practice includes partners Jacinthe M. Paquette, DDS, and Jean C. Wu, DDS, and associate Devin L. Stewart, DDS —all of whom are prosthodontists.

Rosenzweig and McDill bought an established practice, Alpine Dental Health, from a practitioner who chose them as carefully as they chose his patient-centric practice. According to McDill, life improved dramatically after that decision. “We have complementary strengths and expertise, and we work really well together. We were able to expand the services we could offer our patients. We are each other’s sounding board, and we keep each other grounded.”

Noting that business partnerships fail at a higher rate than marriages, Rosenzweig emphasizes the importance of shared goals—including a focus on their vision and mission—and, most of all, trust. “We each need to trust that the other will make the right decisions, do the right thing, because both our names are on everything we do. We’re in this together.” To keep themselves on track, they devote a significant amount of time to continuing education and practice management support for both themselves and their staff.

Defining a Mission/Philosophy

The much-ballyhooed marketing term for it is “branding”—the idea that every practice needs its own identity and focus around which to build its patient base. To a dentist, all agreed that their identity—along with their greatest success and satisfaction—came from meeting or surpassing the expectations of their patients and treating them with respect, as well as high professional standards.

The daughter of two nurses, dentist Michelle VanDyke-Topp makes sure the mission/vision she has for her Muskegon, Michigan, practice permeates all aspects. “We believe in making the experience for the patient the most comfortable and enjoyable caring experience they’ve ever had. My philosophy is that I treat people—including patients and staff—the way I want to be treated.”

She is especially committed to “building better patients” by making the experience fun, not fearful, for children. “I’ve seen too many adults who were traumatized as children and it really interferes with their access to care because they cannot bring themselves to come into the office.”

Alpine Dental Health, says McDill, was also committed to its vision and didn’t proceed with its new marketing plan until “we felt confident we could ‘walk the talk’ of what we wanted our brand to be.” Their tagline We Make it Easy for You to Smile is more than just words. “It’s an experience our entire team commits to delivering each day for our patients. In our vision statement—yes, we have one!—we talk about how our constant concern for our patients earns us their trust and loyalty. We mean that!”

Getting up to Speed

All interviewed agreed that their success demanded a firm hand on the business reins and ongoing continuing education—far more than the number of hours required—to remain current clinically and successful financially.

Continuing Education

While Margeas says he never sought outside practice management support and still doesn’t have a treatment coordinator or completed website, he has invested heavily throughout his career in continuing education. “New dental school graduates learn just enough to touch the surface, because there’s not enough time to teach everything.” However, he points out, even if it were possible to “teach everything,” so much of it changes. Despite a mountain of debt and desire for the long-deferred “good life,” he believes a $5,000 investment in first-rate training, such as that offered at the Kois Center, is money well spent. He highly recommends all new dentists join a study club like the Seattle Study Club if one is available in their area. “This is the most economical thing in dentistry. It offers the opportunity to be taught four or five courses a year by world-class dentists.”

Rosenzweig says he and McDill place enormous emphasis on continuing education and estimates that they each devote 100 to 125 hours per year to honing their professional skills, although Colorado, where they practice, does not require dentists to do any annual professional education. “If there’s a better way to do something, we want to do it that way—not reinvent the wheel.” This, McDill adds, they did right from the start. “Even though our first year in practice together was a whirlwind, and despite the cost, energy, and time required, we decided to invest in ongoing training at the Pankey Institute to elevate our dentistry. It’s been crucial to our success.”

Sheets and Seay, too, came out of the gate intent on learning all there was to know. “At first I was a ‘safe driver’—graduated from dental school with my state license and determined to take every CE course I could. I joined study clubs, went to every dental meeting possible, and became a sponge for knowledge,” says Sheets, who found “the more you learn, the more you find out what you don’t know.” However, after being in practice for 44 years, she has focused her learning. “At this point in my life, I belong to academies that are meaningful to me, where there is a peer exchange of knowledge that stimulates more thought. An added passion is our independent research with our non-profit research team into some ground-breaking areas of diagnostic tools.”

After graduation, Seay continued to expand her base of dental knowledge and skill by completing hundreds of hours of continuing education and advanced training at the most prestigious dental institutions across the country, including the Kois Center (the model for her own practice), where she now teaches as a mentor. Even now, she averages 128 hours of continuing education per year, although the state of South Carolina requires only 14. Looking back, though, she realizes that she was very well prepared academically and clinically, but she was not prepared for the business side of practicing dentistry.

Down to Business

Seay admits that she may have been naïve in thinking that all that clinical experience amassed while reaching those milestones would automatically lead to financial success. “There came a point where all the academic training did not translate into a successful business model,” she says. Therefore, she turned to someone she knew well who had done it well—Columbia, South Carolina, dentist Thomas Trinkner, DDS.

Although she was confident about her clinical skills, Seay admits she opened her own practice reluctantly. She knew she wanted a family and flexibility, but she also had a vision of the kind of environment she wanted and the type of dentistry she wanted to practice—modeled after the Kois Center’s principles, but similar enough to that of Trinkner, who steered her to consultant Belinda Bryant for the help she needed to get on the track to the success she enjoys now. “She offered me complete dental practice management consulting, coaching, and assessment to improve my and my entire team’s professional, personal, and financial life, and offered all the services to make that goal a reality.”

VanDyke-Topp, too, stumbled in the process of hitting her stride. She dabbled in simple marketing methods, which were largely unsuccessful, because as she later learned, internal referrals were their biggest source of growth. After hearing about the Levin Group’s approach to power scheduling in Inside Dentistry, she ordered Roger Levin’s book, then arranged to take her front office staff to one of his seminars in Baltimore.

The consulting advice didn’t so much change the practice’s focus—caring, individualized patient care—as make patients aware of it. For example, patients who called to cancel—a significant problem in the practice—needed to know how much the team cared, not that they would be hit with a cancellation fee, she explains. “Now instead of that being the number 1 thing, we want these patients to understand how important keeping their appointment is, how important their health is to us, that we value and are concerned about them. Now when they try to cancel, we put value in the actual appointment,” she says. This, she explains, they do by pulling and reviewing these patients’ charts, then discussing with them how canceling may cause a delay in their treatment or that there may be a pending situation that needs to be handled. This approach has improved the cancellation problem considerably—perhaps by as much as 50%.

She felt the Levin Group “got who I am” and supported her patient-oriented approach, sometimes even at the expense of profits. “I know I need to make money, but there are times I feel I need to bend and treat patients as I would want to be treated.” Their advice, she said, was to work it into the budget. “They said, ‘That’s who you are and that’s what we want to market.’ From them, I found the confidence to stand on my own two feet. This is what I believe in and what I stand for.”

For their part, Rosenzweig and McDill never hesitated to invest financially in the future of their partnership, boosting their careers. Just as they invested in their training, they went whole hog into implementing Levin’s practice management principles, as well as developing and launching a strategic marketing plan.

Like VanDyke-Topp, Rosenzweig and McDill learned to improve their communication with patients. “The Levin group teaches you the importance of having thoughtful and consistent answers to common questions, taking care that the whole team is on the same page,” says Rosenzweig. “Mick and I sit down together and work out what we’ll say, for example, when someone asks about a crown. This way, we’re prepared with clear, helpful responses.”

Being efficient, he says, does not amount to working quickly or having the dentist pop in before or after the patient’s teeth are cleaned—quite the contrary. “At Alpine Dental Health, we spend 90 minutes with a patient doing a comprehensive examination. We look at the whole mouth, then we sit down with them, listen to what they have to say, and discuss any concerns they have. During that first visit, there’s 1 hour of strictly doctor-patient time. We’ve built our entire practice around that one visit.”

Success—a Matter of Balance

For many who choose this profession, success is measured in terms of achieving a balance between personal and professional life. Sheets, who now maintains a full-time private practice in Newport Beach, California, is where she wants to be. As an educator, clinician, author and lecturer, she is professionally stimulated “working with a team of individuals who are inspiring, allowing us all to perform at a level higher than any could perform separately.”

In short, she feels fulfilled, in keeping with her definition of success: “doing something you feel passionate about at a quality level you can feel proud of, while achieving a balance between family life, professionalism, and philanthropic responsibility to your community.”

Seay says her attitude has changed greatly since the days when she measured professional success in the number of courses she’d taken, the programs she’d completed, and the awards that validated various career milestones. “Professional success is more well-rounded than just financial success. We all want to be profitable—it’s a business—but we want to love what we do.” The crucial components for her “would be happiness and balance—feeling fulfilled in being able to provide a service for your patients and know that you’re really helping them, clinically being able to do the kind of cases in dentistry that you want to do, and making a good living at it.”

Rosenzweig and McDill both thrive taking the work-hard/play-hard approach to their personal and professional lives. Now in their 11th year out of school, both emphasize the importance of having a balanced life, which their 4-days-per-week practice is designed to promote. While many of those weekend days are devoted to continuing education, both relish spending their leisure time with their families and sports activities—for McDill, it’s mountain bike racing; for Rosenzweig, it’s golf and tennis. While McDill says he feels “a rush of accomplishment” at the end of the grueling 100-mile mountain biking race he competes in each year, “For me, success really lies in recalibrating my training to be faster and stronger next year.” This same philosophy, he says, applies in his professional life, where “success involves a series of goals that Todd and I continue to set and then push ourselves to achieve.” Similarly, Rosenzweig says he relishes “being able to do the things I enjoy doing and having the team around me that enables me to achieve my goals.” 

Not that financial success isn’t part of what these dentists aim to achieve. “A lot of dentists get caught up in the money machine aspect of a practice, and we all need to make money to keep our doors open. But when it’s just about money, it just doesn’t work,” says VanDyke-Topp. For their part, Margeas and Rosenzweig see financial success as a byproduct of practicing high-level, patient-friendly dental care. Rosenzweig boils it down to this single principle: “Give people the time they deserve, and truly listen, and your chairs will always be full. And with full chairs, you’ll be comfortable financially.”

Words to Practice By

Advice given or passed on from others

Rosenzweig
If you are true to yourself and you practice with integrity and compassion, the patients will fill your schedule.


Sheets
Be a lifelong learner. Find the area of dentistry that really stimulates you, then try to be the best you can in that area.

Seay
No matter what level of dentistry you practice, you can still be better. (from John Kois)

VanDyke-Topp
Work hard and treat others as you wish to be treated—especially your team.

Margeas
Find a mentor, join a study club, and always keep learning.

McDill
Just because you can do something—even if you are good at it—doesn’t mean you should do it.

Definitions of Professional Success

In a word, respect. I would rather have an average income as a dentist than be more successful financially but
not respected.

— Margeas

Enjoying what I do for a living, which is providing top-quality dental care in an environment that is comfortable and enjoyable.

— VanDyke-Topp

Being able to do the things I enjoy doing and having the team around me that enables me to achieve my goals.

— Rosenzweig

Being honest about your strengths and weaknesses to improve, and having the integrity and respect to grow solid relationships.

— McDill

Doing something you feel passionate about at a quality level you can feel proud of.

— Sheets

Feeling fulfilled in knowing that you’re really helping your patients, clinically being able to do the kind of cases in dentistry that you want to do, and making a good living at it.

— Seay

The Role of Dental School

ow can dental school better prepare students for careers that meet their personal and professional goals? As Rosenzweig sees it, dental school may not be the best way to learn about practice management. “Most of my classmates and I had no management experience, so it was hard to relate to that role and its responsibilities. Instead, it made sense to focus on our clinical skills until they were second nature and we felt like they were mastered.” Instead of teaching management skills, he says, schools should teach students a framework for setting goals for their practice and developing action plans to achieve them.

VanDyke-Topp felt well prepared clinically after residency, but was not at all ready for the business side of private practice. She believes all dental students—even those who don’t plan to open private practices—would benefit from courses from consultants. “It’s always beneficial to understand how businesses work and to understand aspects that affect patients, such as co-pays, so that when you’re talking to patients you can be sympathetic/empathetic to their situation.”

While most interviewed said they thought it was not the job of dental school to teach practice management, Seay has a different perspective. Given that dental school can provide only the basics clinically, she maintains, a pointer or two on the dental business might have saved her from being blindsided by learning that first-rate clinical skills were not enough. “I think I’m a little more philosophical about it than many of my colleagues. There’s no question that that dental school should focus on the clinical, but even if they could teach everything—which they can’t—they should make some effort to make you aware of what lies ahead. I knew I’d need continuing education to build on what I learned in dental school clinically, but I had no idea what it meant to have my own practice—not what it looked like, how much money I could earn, what my expenses would be.”


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