"How you can put Your Practice in the Top Ten Percent..." (Part 2)

Exploring: Practice Philosophy

Establishing a Practice Philosophy of Patient Care Part 1:

How You Can Put Your Practice In The Top Ten Percent…

By Peter E. Dawson, DDS I’ve met very few dentists who couldn’t put their practice in the top ten percent…if they just knew how. I believe that any dentist, who is willing to make a few absolute commitments, can learn the skills and concepts necessary to become a top ten percent dentist.

There is an almost magical triad of skills that, when learned and practiced, virtually guarantees the success of any dental practice.

Excellent continuing education resources are readily available to any dentist who desires to become proficient in all three elements of this triad for success. The first two skills that are typically thought of as the keys to practice success are management skills and people skills.

While it is true that management skills and people skills are crucial factors to success, they can be lost without the third part of the triad, leading to frustration and overwork with minimum reward for efforts. The missing link in many offices, and the part of the triad that is most important for fulfillment and practice success, is the combination of skills that must be learned to produce clinical excellence.

Most dentists really want to do what is best for their patients, but too much emphasis has been put on hype, promotion, and motivational techniques as a means of attracting large numbers of patients and “selling” them dentistry. When the patients’ welfare is our principal concern, we don’t need the hype. Our sincerity will shine through. But this process requires a different type of management approach. Management must be focused on the control of quality and the continuous upgrading of diagnostic and clinical expertise.

There’s nothing wrong with motivation as long as it is directed toward better patient care. But for better patient care, clinical proficiency must be the absolute first goal of practice building.

Sadly, there are many dentists who are dedicated to their patients’ welfare who do not have thriving practices. In fact, some of them are earning less than average incomes. Many times this is the result of poor management. Many dentists who go through our seminars on complete dentistry have worked hard to develop clinical competency, but have failed to develop the kind of practice I know

they can have. Some tell me, “I’m trying to do everything right.

I’m trying to provide the highest quality for my patients, but why am I struggling when some of the less dedicated dentists are doing financially better than I am? Do I have to lower my standards to improve my income?”

When we look analytically at dentists who are trying hard but falling short on practice success, we almost always see that they are making the same mistakes over and over again. These repeated mistakes prevent them from ever leading their practices into a truly successful mode of operation. We can show irrefutable evidence that productivity increases dramatically as clinical competence improves, if it is combined with a correctly structured management approach. But one without the other is not enough.

If you show me an office that is performing below expectations, I can guarantee that some of the following mistakes are being made: 1. Inadequate scheduling 2. Inadequate initial exam 3. Failure to make complete treatment plans 4. Selling commodities instead of education 5. Lack of managed quality control 6. Failure to pre-plan 7. Lack of structure in office administration 8. Lack of controls and monitors.

9. Ineffective communication and people skills DEVELOP A PRACTICE PLAN It is important to develop a total plan for practice improvement.

As an example, there are diagnostic skills that must be developed before anyone can move a practice into the top ten percent because these skills are absolutely essential for effective treatment planning.

And complete treatment plans are a prerequisite for managing a productive schedule. The problem is that diagnostic competence and certain management skills must be developed concurrently. It is obvious that if your schedule is not managed to provide adequate time for complete examinations, the whole process suffers.

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Exploring: Practice Philosophy A further problem is that management of the doctor’s time can’t be done effectively until some firm commitments are made regarding the level of care the doctor intends to provide. It’s my experience that most dentists need help in understanding what their options are. Many dentists have self-limiting visions of what they can do because they have never been shown how a real quality practice operates. When they understand what skills must be mastered, they can make a more realistic decision regarding what commitments they are willing to make.

of their soft tissues, joints, and periodontal structures, not just the condition of their teeth. Patients also need to understand any problems that may be preventing them from having a completely healthy mouth and specific diagnostic tests can be tailored to the individual’s real needs. Patients routinely want what they need if they understand the need. There are almost no exceptions. When dentists become convinced of the importance of a complete, new patient examination, they are amazed to find how much it changes their entire practice.

Development of a practice is a process, and it is best done with slow, methodical, but consistent improvement.

VISION AND COMMITMENT Development of a practice is a process, and it is best done with slow, methodical, but consistent improvement. Quick fix approaches don’t work. In fact, no approach will work without a master plan. Development of the plan is the first step dentists must take to put their practices in the top ten percent. While we begin with clinical skills, at the same time we must also develop an orderly plan to get some structure into the office management process. Specific tasks that must be done by each team member must be defined and documented. A schedule that makes sense and provides time for complete exams and quality controls has to be developed. Each team member must be taught how to do the aspects of the exam and treatment plan work up for which they are responsible.

One of the weakest links in dental education is the diagnostic process. This, combined with a tendency to isolate the different parts of the masticatory system as if there were no relationship to the other parts, leads to incomplete dentistry. Evidence of this kind of thinking is obvious in the confusion that has resulted from the absurd pronouncements that occlusion has nothing to do with temporomandibular joint disorders. When a dentist finally learns that all the parts of the masticatory system are inter-related, he or she can make a major breakthrough in improving diagnostic accuracy and can stop treating patients so empirically. I don’t know a dentist in the top ten percent that hasn’t worked very hard learning to diagnose problems from the perspective of the total masticatory system. Until a dentist understands the logic of complete examinations, he or she will be limited to selling commodities called, “crowns”, “bridges”, “implants”, and “x-rays”.

From a clinical standpoint the first priority is to learn how to do an absolutely, thorough and comprehensive initial examination.

Failure to examine new patients properly is the biggest shortcoming I see in dental practices. A dentist today must be the physician of the masticatory system. That is our role, and there is no other specialty in medicine that can fill it. We must be able to evaluate every segment of that system and diagnose any problem that is present.

I’m convinced that most dentist do an inadequate exam because they think patients will resent the cost of a more complete examination. I don’t know where this mind set came from but it is one of the hardest patterns to change. A complete examination is the single best practice builder there is. Patients are routinely appreciative that someone finally took the time to examine them thoroughly. If it is done correctly, it is a “no lose” process.

There is no need to “sell” patients an examination. The average intelligent patient wants to have a healthy masticatory system.

They just don’t know to ask for it in those words. The dentist should educate patients to help them understand the condition

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Dental Explorer | Third Quarter 2009

I’ve organized all those basic requirements for successful practice so dentists can develop an inventory of needs. I want each dentist who attends our seminars at The Dawson Academy to leave with a prioritized checklist of all the things that must be learned or actions that must be initiated to put his or her practice in the top ten percent.

For each skill that must be learned or each concept that must be better understood, we recommend specific sources where the dentist can learn what is needed. The only thing I can’t do is to make their decision to commit to completion of the plan. But, I can help dentists develop a vision that they can get very excited about.

And I can promise them that if they make the decision to put their practice in the top ten percent, they will start at that moment to find new enthusiasm and excitement in dentistry. The only difference between highly successful people and those that are not is that successful people do what others won’t do. Dentists are a lot more motivated to set up an action plan if they can have a clear picture of where it is taking them. I can give them that picture and show them how to make it happen.

CLINICAL SKILLS There are certain diagnostic skills that must be learned and there are certain clinical skills that must be perfected to create a highly successful and fulfilling practice. I have monitored enough practices to know what happens to a practice as these skills are improved, and we help dentists develop an action plan for learning what they need to know. We can even help them prioritize those needs so there can be a logical order regarding the learning process.

There are four clinical skills that are essential however to predictable analysis and treatment of a wide variety of masticatory system problems. The first and most important skill is the ability to determine and verify centric relation. Failure to develop an acceptable skill level in this procedure leads to many missed diagnoses and compromised results. Accurate analysis of the TMJs is dependent on this skill as is the predictability of any treatment involving the occlusal surfaces. Those dental professionals who have not perfected a method for determining centric relation often turn to gimmickry and trial and error methods for solving problems that proficient dentists can solve routinely and predictably. Learning to find and verify centric relation should be a top priority. Dentists cannot be in the top ten percent without perfecting this skill.

The second necessary skill is the ability to determine the correct incisal edge position for all anterior teeth. This skill is necessary for predictable restoration or analysis of anterior teeth and is essential to determining correct anterior guidance. The methods for determination are logical and learnable.

they simply must be learned and learned well or the dentist will pay dearly in wasted time, missed diagnosis, and frustrated patients.

Oddly enough, many dentists go on practicing without ever learning these skills and are not aware that they could improve the quality of care dramatically. When they do learn the methods and the rationales involved, they are routinely amazed at how much simpler their lives become.

There is at least one more clinical skill that can’t be ignored. That is the ability to develop adequate treatment plans. And any plan that does not include preliminary procedures for making the supporting structures healthy won’t qualify as top ten percent dentistry regardless of how much money a dentist may be making.

A third skill that must be perfected is the ability to equilibrate with predictable results. If this skill is not developed, there will be many patients that will not be helped and it will be impossible to predict the final outcome of any treatment involving the occlusal surfaces.

Failure to develop equilibration skills is often the result of inadequate understanding of occlusal factors and their relationship to the temporomandibular joints. The principles and procedures are absolutely logical and learnable.

Many dentists learn the skills but can’t find a laboratory to produce the quality they want. I can’t count the number of times dentists have told me “I can’t find a technician who will give me what I want.” My response is always to ask a question, “Have you told your technician what you want?” Part of quality dentistry is to determine specifically what you want so you can communicate precise guidelines to your technician. Generalities won’t do... We can give dentists very clear methods for making tremendous improvements in their lab work as well as ways to evaluate their present technician. Very often the problem is very correctable. If not, it will be obvious and a change will be in order. But that, too, can be a very logical process.

There are other skills that are important, but the three just mentioned are essential to so many facets of diagnosis and treatment,

Please look for Part 2 of Dr. Dawson’s article in Atlanta Dental’s October 2009 issue of Dental Explorer Magazine.

Biographical Outline: Peter E. Dawson, D.D.S. For more than 35 years, dentists from around the world have been traveling to St. Petersburg, Florida to attend Dr. Pete Dawson’s seminars on “The Concept of Complete Dentistry”. In addition, Dr. Dawson has lectured throughout the United States at almost every major dental meeting, at many universities and study clubs, and in many foreign countries. He is known all over the world for his contributions in the field of occlusion and restorative dentistry and for his concepts on diagnosis and treatment of temporomandibular disorders. He is the author of the best selling dental textbook, Evaluation Diagnosis and Treatment of Occlusal Problems, published in 11 languages, and the recently published textbook, Functional Occlusion: From TMJ to Smile Design. He has received many national and international honors in his field, including the Thomas Hinman Medallion Award for Leadership in Dental Progress and the Distinguished Alumni Award from Emory University.

Having grown up in his dad’s dental laboratory, Dr. Dawson has been actively involved in dentistry since age 13 when he went to work as an apprentice technician. One of his principle objectives is to develop and teach better dentist/technician communication, which he sees as essential to master quality dentistry.

He is a Fellow in the American College of Dentistry and the International College of Dentistry. He serves as consultant to the “International Journal of Periodontics and Restorative Dentistry”, and is: - Past president of the American Academy of Restorative Dentistry - Past president of the American Equilibration Society - Past president of the American Academy of Esthetic Dentistry - Past president of the Pinellas County (FL) Dental Society - Past president of the Pinellas County Dental Research Clinic - Past president of the Florida Academy of Dental Practice Administration - A graduate of Emory University School of Dentistry

Dr. Dawson firmly believes that dentists must accept the role of physician of the masticatory system. For those who do, the next 20 years should be the best years in history to be a dentist.

Dental Explorer | Third Quarter 2009

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