thoughts on dental practice

My Associate Is Leaving - Now What?

6/27/2017

We recently had the following discussion with a forty year old doctor with an excellent practice in a small mid-western community. He is losing his associate doctor after four years. He is working very hard, generating excellent cash-flow and wondering what he really wants for a preferred future.
“Our associate doctor recently advised us that she will be taking an extended leave of absence after delivering her baby. She has decided that she only wants to work a day or two a week in the future. For now she has decided that she does not wish to work at all for the first year after her baby is born. While we respect her decision to be a full time mother her work schedule does not fit the needs of the business. Since she does not wish to meet the obligations in her contract we have agreed to a parting of the ways.”
“We are now in a position where we have grown the practice over the past four years to the point where we are fully booked for two dentists and three dental hygienists. Once our associate leaves we will have one doctor trying to serve the needs of a two doctor practice.” We suggested it is time for a SWOT[1] analysis to help figure out what options exist.
Strengths: Long-term practice in the area, Good reputation, Stable patient base, No insurance participation, Delivering comprehensive outcomes based care. Great long-term staff.
Weakness: Not enough doctor time for volume of patients, Difficult to find another associate doctor. Some staff reduction will be needed. Some clients exhibiting insurance/price sensitivity. Office currently too big - We own our facility – it is designed to handle up to three doctors.
Opportunities: Purify practice (help patients who are a bad fit find another office), Reduce overhead, Focus on what we do best and refer the rest, Less management issues with smaller staff, Could rent part of facility to other doctors. More delegation.
Threats: New clients will not tolerate long wait time to join practice, Old clients will not tolerate long wait time for treatment, Too much doctor time used doing hygiene checks.
What are the key drivers that we can address that will allow him to maintain his good clients, allow the doctor and staff to work hard but not be overburdened? Is it worth the time and effort to hire another doctor at some point?
The core philosophy of care will drive much of the decision process. Here is his philosophy statement; “ We will deliver care in a caring and pain free environment to those who choose to take ownership of their own health, with whom we can agree on desired outcomes at fees that are fair to all concerned.”
We pointed out two initial action items: Time management and Client service
How do we prevent a backlog of appointments developing when we already have a busy schedule? Issues that must be addressed – doctor and staff efficiency, delegation/training, hygiene time management.
The doctor and staff need to meet, openly discuss the associate departure and discuss procedural efficiency, appointment scheduling, increased delegation (will more training for staff be needed?) If the office can create just twenty minutes per day of additional productive time in the doctors schedule the effect will be significant over time. Staff needs to be diligent about maintain a schedule based on booking for production and not letting high production time get filled with unproductive short appointments. It is more effective to take a day or morning and fill it with all the low production items. We call it a “roller skate day” or a “lump the junk day”.
The doctor needs to do hygiene checks when it fits his schedule not at the end of a hygiene appointment. As soon as the hygienist has completed needed data gathering the doctor should be notified so he can fit the exam into his work flow.
The hygiene department will need to work on helping patients grasp the concept of owning their own personal/dental health. Those who grasp this concept will place a higher value on pre-scheduling preventive recare visits. If a doctor check is involved the doctor has a responsibility to emphasize the value of regular preventive visits. We have found that the hygiene schedule is a good predictor of how busy the doctor will be four to six months into the future.
The whole office must be careful not to let new patient flow become hindered by the busy schedule. When the office is very busy and the schedule is over filled it is very easy to let new client visits slide. When new client flow drops normal attrition will soon take effect. Also, at times like this there is a tendency for rumors to develop that “doctor is not taking new patients”.
Should he continue the search for another associate? Where are all the new graduates going? He has had a hard time attracting associate doctors to a practice in a small town in the mid-west. His pay and benefits package is competitive. His practice model allows a young doctor room to grow. The community is an excellent place to live. They are advertising and talking to dental schools. Yet, his response rate is very small. He questions the return on the investment of time and effort involved in getting an associate fully trained only to lose the person after four years. By the way, his associate was not interested in becoming a partner in the practice.
We suggested that our doctor review Steven Covey’s book The Seven Habits of Highly People[2] and focus on the concepts of – Be proactive and begin with the end in mind. Age 40 is too early to be thinking of selling or retiring. And, with two children to educate he will need to work at least another 25 – 30 years. Decisions need to be made about the total lifestyle that our doctor wants to achieve. What sort of balance between work, play, love and worship does he want to create? When he reaches some conclusions he can then begin to design a revised life plan. He will need to discuss this with his family and his office team.
His initial actions have been suitable for managing the crisis of going from two doctors to one. However, the longer term success or failure of his practice will be driven by his philosophy of care and ability to define and develop a suitable work – life balance.

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[1] Strengths, Weaknesses, Opportunities, Threats
[2] Covey, Steven, Seven Habits of Highly Effective People, Mango Media Inc (June 20, 2015)

When yes means n0 - conflict avoidance

6/27/2017

When Yes Means No – Conflict Avoidance
You are having a staff meeting and discussing how your dental hygiene team could improve patient education by increased use of intra-oral photos for patient education. Rather than just dictate that a certain number of photos are expected every day you have chosen to ask your entire team for ideas on how to achieve this goal. You begin by explaining that we learn better and comprehend more when we use visual means of communication. You ask the team for their experiences of how a photo helped someone take ownership of an issue we had been explaining verbally in the past. You then go around the room asking each team member whether making more photos makes sense. Everyone says yes. At next month’s staff meeting the photos in hygiene have increased by only one per cent.
What is the problem?
Did we really get total staff buy in? Everyone said yes when polled. Why no follow through? Is everyone avoiding conflict? The doctor wants this so why should we point out the problems associated with implementation? If the assistants and business staff are not truly a team with the hygiene staff they see this as a non-issue. The photos don’t involve any effort for them. So, who cares? If they have not taken a true ownership interest in the practice they don’t grasp that the photos are a part of the reason they have a job and a paycheck. The hygiene team may grasp the value for education but not like the extra time involved due to the photo system used in the office. The staff has to feel that they can push back without fear of repercussion when they do not see things the same way that the doctor does. However, as the business owner/professional it is not unfair to ask those who disagree to also offer a solution from their point of view.
How do we know conflict avoidance is in play? If someone – especially the doctor - proposes a change and there is no discussion, just quiet nodding of heads with no eye contact, you should smell a skunk. Change is difficult. Most of us don’t like it, especially if it is not our idea. Rather than stating that more photos in hygiene were needed. Perhaps the doctor could have just pointed out the issue of how more intraoral photos would help the patients and the practice and asked for ideas. After discussion the group might have come to a consensus on how to create a better educational experience. (There is a near 100% probability that more photos in hygiene would be part of the solution.) The ideas could then be written down and the team – and doctor - held accountable for implementation. Would this take longer? Absolutely. Would it be more likely that something good will happen? Yes.
This approach requires more patience and trust on the part of the doctor. It also builds trust among all the team members and the doctor. This sort of exercise is also good barometer for the doctor to determine whether the staff has true buy in to the practice. You will quickly see whether everyone is engaged or not. If there is someone who is clearly unwilling to have any input it is time to have a quiet chat with that person to understand why they feel unable to contribute as a part of the team.
A great resource for implementing this strategy can be found at Mike Scott’s website - www.totallyaccountable.com/
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