Dental Entrepreneur - Summer 2023

How to Win Friends and Influence People...

Dr. Rebekkah Merrell Anderson

Finding Fulfillment and Success in Dentistry

Dr. Robert M. Maguire

The Biggest Mistakes New Dentists Make

Dr. Earl Douglas

BUILD EVERY PRACTICE ON TESTED, TRUSTED PRODUCTS.

When quality and consistency are paramount, Patterson brand is the obvious choice. With an established line of products and thousands of choices at your disposal, there’s a bright array of solutions to prep your practice for every procedure.

Summer 2023

Editor & Publisher

Anne M. Duffy, CEO, RDH

Assistant Editor Clare Yeo

Project Manager

Tari Sixpence

Website

Bhakti Kulmala

Sales & PR Officer

Nyasha Maripakwenda

Editorial Board

Mary Fisher-Day

Travis Rodgers

Barb Stackhouse

Dr. Lucas Shapiro

Dr. Dirk Fleischman

Dr. Earl Douglas

Dr. Tom Snyder

Derek Champange

Dr. David Rice

Cover Photo

Mario Morin

Layout and Design

Brian Rummel

Summer 2023 Contributors

Dr. Rebekkah Merrell Anderson

Dr. Zina Berry

Dr. Earl Douglas

Gary Giegerich

Dr. Yvonne Simmons Howze

Jackie Joachim

Dr. Robert M. Maguire

Dr. David Rice

Travis Rodgers

Dr. Lucas Shapiro Ryan Vet

Editorial Office

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Every entrepreneur, no matter the field, has a common direction in mind – forward. The dental entrepreneurs I know share this common goal of moving the industry into the future, finding bigger and better ways in which we can show up for our industry, and the people we serve.

This is reflected wholeheartedly in this issue. Sometimes, our journey forward requires a look back into the past. Our cover entrepreneur, Rebekkah Merrell Anderson, shares how a classic by Dale Carnegie remains a pillar in her life and business. She takes us on a journey of the four biggest contributors to her success today, and why sincerely caring about others is at the core of it all.

Ryan Vet and Travis Rodgers speak of influence through two different lenses. Ryan takes the modern approach, looking at dentistry’s very own social media influencers as the new KOLs. Travis highlights the impact of two of the dental industry’s original “influencers,” Jim and Naomi Rhode, and how their impact still resonates vibrantly today.

Gary Giegerich discusses the role that technology plays in scaling the dental field, and how his co-founded company, Alta Smiles is leading the innovative charge in the world of orthodontic care.

Looking back at past mistakes is a key element in paving a brighter future. It’s made even better if we can share these mistakes with new generations of entrepreneurs so they can steer clear of them. That’s exactly what Yvonne Simmons Howze and Zina Berry do, writing about ways in which we can reduce errors in dental operations. And Earl Douglas shares his wisdom on big mistakes that new dentists should avoid for a fruitful and successful future.

Finally, the forward movement every entrepreneur charges towards can be summarized in one general goal – success. That is what David Rice and Dr. Robert Maguire speak of in their respective articles. Where David Rice empowers you to choose your own success, Dr. Robert Maguire builds off of that by encouraging you to do so with fulfillment in mind.

The road forward is rarely easy. It’s why Jackie Joachim writes about the importance of listening to your gut instincts, especially when leadership is the role you want to play.

This issue is an inspirational look at your path forward. I hope you find the support, guidance, and reflection you need to carry you through the rest of 2023 and beyond. Let’s wrap up this summer, looking forward to a fruitful future.

SUMMER 2023

SPOTLIGHT

6 How to Win Friends and Influence People... The Foundation for How to Own and Operate a Successful Dental Practice

Dr. Rebekkah Merrell Anderson

CULTURE

10 Meet the Influencer: Dentistry’s New KOL Ryan Vet

14 Legendary Entrepreneurs of The Dental Industry, Jim and Naomi Rhode

Travis Rodgers

BUSINESS

18 Finding Fulfillment and Success in Dentistry

Dr. Robert M. Maguire

20 The Biggest Mistakes New Dentists Make Dr. Earl Douglas

INNOVATION

22 How to Develop and Scale Transformational TechnologyMy Story

Gary Giegerich

LAUNCHPAD

26 From Clear Aligners to Content Creation - How Dr. Avi Patel is Shaking Up the Dental Industry

Dr. Luke Shapiro

IMPACT

30 Reducing Errors in Dental Operations

Dr. Yvonne Simmons Howze and Dr. Zina Berry

34 Great Leaders Trust Their Instincts

Jackie Joachim

32 Choosing to Create Your Success

Dr. David Rice

How to Win Friends and Influence People...

The Foundation for How to Own and Operate a Successful Dental Practice

Rebekkah Merrell Anderson, DMD, MS

When I was initially asked to be on the cover of DE Magazine, I felt very humbled and honored to be selected. Although it has been four years ago now, it feels like it was just yesterday that I purchased a small dental practice in Asheville, North Carolina. I never could have anticipated all of the trials and tribulations that I would endure in this short time. Not even nine months after purchasing my practice, the entire world shut down. I was terrified that I had made a huge mistake in taking on so much debt to follow my dream. I kept the faith. Every day, my staff and I showed up to work with one goal in mind: to utilize the latest and greatest dental technologies to provide world-class dental care with the comforts of home. With a lot of hard work, my gamble eventually paid off. DE Magazine asked me to tell my story of how I grew a practice from producing $600,000 a year to over $2 Million a year working only four days a week. The answer may surprise you. After much consideration, the secret to a successful practice is not how many hours you work. It is not that you can do every dental procedure. I do not work crazy long hours over multiple days. We see patients for only 32 hours each week. I do not do every dental procedure. I refer to specialists often. As for the procedures I perform in my practice, I strive to provide the best quality of care I can. I send my patient

to another provider when I know a specialist can provide a higher quality of care than me. This trust will enhance my patient’s dental experience. So what is my secret?

In dental school, my group leader preached about a book by Dale Carnegie titled, “How to Win Friends and Influence People.” He told us that every year he got out his worn copy and re-read the book from cover to cover. He was one of the most skilled dentists I have ever met. He taught me so much about the practice of dentistry and provided me with a solid foundation. Most importantly, he taught me that no matter how talented you are, you cannot do great dentistry if you do not understand how to win friends and how to influence people. Building relationships is the building blocks for success. I know I am not your typical business owner. Every dental consultant would probably agree that I do one million things wrong. They would also agree that I could improve my management style, have a standard speech to patients to increase sales, and have my staff better trained to close sales. They would frown upon how I never have my team focus on daily production goals. Most days, I don’t even know what the estimated production will be for the day. Instead, we focus on our patients. We customize every individual’s care to meet their individual needs. We strive to get to know our patients and

remember the little details. We focus on things we know about each patient and how to make their experience better. I operate with the belief that if I take good care of my patients and do what I feel is best for each individual, production numbers will reflect this level and quality of care. There is no higher compliment than the referral to someone’s friend or family member. So far, I have been abundantly blessed by my patients’ trust in me.

The next biggest reason for my success is my staff. Without them, I would not be able to provide the quality of care I strive to provide my patients. Like everyone, I, too, have struggled with staffing post-Covid. It is difficult to find a team that shares your beliefs and can work well together. I have had to let go of fabulous, skilled individuals because “they could not play nice in the sandbox.” The day goes by much smoother if your staff can all work together and get along. One bad apple can cause the entire team to rot. Honestly, I know that I may not be the best manager of people. My management style is somewhat goofy. I try every morning in a huddle to praise the team for their hard work the day before. I try to privately provide constructive and educational criticism when they make mistakes versus tearing them down. Most importantly, I try to make a stressful day fun for them. Dentistry is hard work and high stress. It can be easy to get frustrated with patients, procedures, and even staff. Trying to keep the day lighthearted and fun makes the team and patients more at ease. By taking great care of my team, I know they will, in turn, take great care of my patients.

The third biggest reason for running a successful practice is investing in the relationships within your community. I am actively involved in multiple social organizations, philanthropic organizations, and professional organizations. These clubs allow me to get to know members of different communities and give back to different areas within our town. Taking the time to get people in the community to know you personally is the simplest and best form of marketing. There is no better marketing than

being true to yourself and doing what you love.

Lastly, self-care is one of the most important relationships that needs to be nourished to own a successful dental practice. This relationship is often the most overlooked, but it is imperative that it does not get neglected. When your blood, sweat, and tears go into your practice it is hard to find any time for yourself. Being a practice owner requires you to wear many hats. You must show up with a positive attitude every day. You must be on your “A-game” for your patients. You must lead your team. You must be fiscally responsible. You must, you must, you must…. The list of musts is daunting. Taking a few minutes out of your day for your mental and physical health is imperative to keep you sane. Having a good support system to lean on, get advice from, and have your back makes all the difference in the world. I could not do my job without the support of my family, my friends, my faith, my massage therapist, and my gym.

Any way you look at it, dentistry is about building relations. Sometimes actual dentistry is not the hardest part of the job. The hardest part is managing staff, patients, and your own expectations. Unfortunately, I do not have a copycat method that will make you turn your practice into a multi-million-dollar practice overnight. My best advice is to follow the advice of a wise dental school professor - learn how to win friends and influence people. Dale Carnegie said it best, “Sincerely care about others. Smile! Always remember that a person’s name is the sweetest, dearest, and most important sound to them. Listen and encourage others to talk about their problems. Talk about what other people care about. Honestly, let other people see they are important.” Invest in taking the time to build relationships, focus on the big picture, and practice with purpose. People will recognize your sincerity, and the money will come.

Dr. Merrell completed a Bachelor of Science and Master of Science program in Bioengineering at Clemson University. She then went on to earn her Doctor of Medicine in Dentistry degree from The University of Pennsylvania School of Dental Medicine. In addition to completing her residency in general dentistry at Carolinas Medical Center, Dr. Merrell has completed more than 1,000 hours of advanced training in cosmetic, laser, and implant dentistry. She is the owner of Asheville Smiles Cosmetic & Family Dentistry.

Meet the Influencer: Dentistry’s New KOL

Ryan Vet

The human race has always been inclined to follow luminaries—those thought leaders who innovate, who make a difference, who want to change the world. From philosophical minds like Plato dating back nearly 2,400 years to the centuries of athletes, royalty, politicians, actors, writers, and beyond. For millennia, the tendency of many is to gravitate towards perceived power and influence. They want to follow those who are movers and shakers. Often, when we think of celebrities, we imagine the macro-celebrities, movie stars, athletes, and pop icons. We envision those superstars cruising up to their Gulfstream being driven in their Rolls Royce. These macro-celebrities were trendsetters. The general populous wanted to wear the clothes that these celebs had in their most recent Vogue photoshoot and wanted to be drinking the same Champagne. Times are changing. While it is too soon to say, “long gone are the days of the macro-celebrity,” the power of cultural influence may be shifting. Since the invention of social media, we have seen the rise of the micro-celebrity or more commonly referred to in marketing as the micro-influencer. These are individuals that have a much smaller reach, but their audience is more engaged. In fact, a micro-influencer can have as few as 500 to 1,000 engaged and active followers. But, these followers are far more connected and responsive to the influencer. Countless social media studies published by Hubspot, SproutSocial, et

al. show that micro-influencers can garner at least double the engagement of an A-list celebrity like one of the Kardashians or Taylor Swift. This massive influence in a small pond is likely due to several reasons. First of all, micro-influencers are often focused on a very specific niche. Their followers are generally like-minded and all rally around a specific topic, idea, or industry. Similarly, in these smaller circles, followers are often more empowered and feel more heard within their community, creating a deeper sense of trust and loyalty.

DENTISTRY AND MICRO-INFLUENCERS

For some time, the dental industry has been built around the notion of micro-influencers—even long before social media. The industry has affectionately referred to them as KOLs or Key Opinion Leaders. The KOLs were primarily comprised of speakers, writers, and consultants that were and are prolific throughout the industry. While there was no set formula or public requirement for donning the title of KOL, many would argue that if you were a speaker that graced the stages of Chicago Midwinter, the American Dental Association Meeting, Yankee Dental Congress, Hinman Dental Meeting, or the Greater New York Meeting, you were in the club. Similarly, if you had been

published in leading publications like Dentistry Today, Dental Product Report, Inside Dentistry, and Dental Economics, you were a thought leader. The speaking circuit and publishing tracks launched the careers of many speakers and consultants alike in the dental community. These traditional avenues are showing signs of aging, and a new wave is emerging. As major national meetings, state associations, and local study clubs struggle to regain attendance at their in-person events, meeting planners are desperately trying to figure out ways to fill seats. Many aspiring and even seasoned dental thought leaders are turning to new modalities to spread their message.

THE RISE OF THE NEW DENTAL INFLUENCER

The term influencer triggers thoughts of macro-celebrities flashing their favorite brand logos in images plastered across their social media profiles. Being an influencer spans far beyond posting a picturesque life on social media. I have done my fair share of so-called social media influencer work for over 20 brands, and it’s not all it’s chalked up to be. Plus, it is surprisingly more work than you would think. I digress. Being an influencer in dental is the new KOL. The terms are generally interchangeable, but the channels for influence are greater than

ever before. Arguably, the most commonly thought of definition of a dental KOL is one who writes and one who speaks. The quantity and breadth of each often determined how “popular” or “famous” a given KOL was within the dental industry. As the tides turn, we are now forced to look beyond the stage and the pen and look into the virtually endless facets of influence available to the next general of dental thought leaders.

TRENDS OF DENTAL INFLUENCERS

Some of the earliest trends we saw in dentistry of the changing of the guard included Facebook Groups, podcasts, and niche organizations and/or seminars. Let’s dive into Facebook Groups. There are countless groups, such as Dental Nachos or Mommy Dentists in Business, that solidified their spot as thought leaders in a completely new forum. Dr. Paul Goodman and Dr. Grace Yum each respectively launched these channels as a way to allow like-minded dentists to connect, grow, collaborate, and be a part of a community. It actually is not all that different than the local dental study club, it is just using a new methodology to deploy a community. As those communities grew they launched custom events and built whole companies around their model of influence. There are countless podcasts that have grown and evolved,

taking on sponsors and have ultimately been acquired. The Tale of Two Hygienists started as a passion project and ended up being acquired and integrated into one of the big dental publishing houses. Why? Because it had influence. Many aspiring speakers or those that feel they have unique content found it hard to get onto the national dental speaking circuit. These new speakers found it hard to crack the code of how to get on the stage of prominent meetings. We know that Millennials don’t like to wait for things—so some people took matters into their own hands. Sonya Dunbar and Melissa Turner co-founded the National Mobile and Teledentistry Conference. This conference is one that is niche and focused on an underserved group of dental professionals. With a great deal of experience in the space, these two dental woman entrepreneurs launched their own event and filled the stage with a whole new line-up of speakers that also were not getting booked on the more legacy stages in the industry.And for fear of running out of words, we have not even covered the way in which social media influencers in dental are exploding as thought leaders and influencers.

SO WHAT IS THE FUTURE?

The future of dental speaking, consulting, and writing, is changing. There is little argument there. Traditional dental meetings are not going anywhere any time soon, though they have shown signs of being on the decline. Meetings are working

hard to reinvent themselves to be relevant to the younger and rising generation. While the more traditional channels, such as large tradeshows, study clubs, and state associations rework their angle, new and emerging speakers will likely continue to gain their voice by launching their own courses, their own seminars, and speaking to niche groups.Similarly, as publications continue to push for digital and reinvent their platform, the next generation of content producers and thought leaders will likely continue turning to membership communities, social media avenues, online courses, digital mediums, podcasts, and beyond, to reach their connected group. The idea of KOLs in dentistry is here to stay. However, what we call them and how they make a positive dent in dentistry will continue to evolve as more and more innovative creators work to get their voices heard and content noticed.

Ryan Vet is an acclaimed entrepreneur that has redirected his success towards inspiring others. He helps catalyze extraordinary experiences for leaders and the teams they inspire, for brands and the customers they serve.

INFLUENTIAL WOMEN IN DENTISTRY

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Some of the most influential women in dentistry are coming together to present this two-day symposium dedicated to elevating technology in your practice.

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■ Exclusive after-hours cocktail party and dinner hosted by Jim and Parvina Glidewell

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Top left to bottom right: Stephenie Goddard, M.S.; Rella Christensen, RDH, Ph.D.; Diana Batoon, DMD, Stephanie Botts, RDH; Taylor Manalili, DDS; Joy Poskozim, DDS; Kelly McCracken, DDS; Rebekah Browder, DDS; Amanda Sheehan, DDS; Trudy Reese, DMD; Jarrett Manning, DDS; Lan Chi Le, DDS; Mary K. Shields, DMD, MPH; Susan McMahon, DMD; Kaveeta Channamsetty, DDS; Christina Do, DDS; and Jinny Bender, DMD.

The Glidewell Symposium is an event for dentists and their team members. *Offer expires 08/31/23

Legendary Entrepreneurs of the Dental Industry, Jim and Naomi Rhode

Travis Rodgers

When most of us think back on our life and those we have met, there are few people we would call “legendary.” The list for me is short. I was blessed with parents who attained that status with their marriage and career achievements. I have also been blessed to have Jim and Naomi Rhode as friends and mentors in dentistry. I refer to them as my “dental parents.” This article details the key takeaways of how they became “Legends in the Dental Industry.”

Like my parents, Jim and Naomi met and got married right out of college, and 66 years later, their achievements define the word “legendary.” Their journey in dentistry started in 1967. When they retired, they had grown their company, Smart Practice, to $100 million in annual revenue and positively impacted thousands of dentists, consultants, speakers, and vendors while maintaining a fantastic marriage.

They are referred to as “legendary” by all that know their story. They will say their 3 children, 12 grandkids, and 8 great-grandchildren are their greatest achievements. (Including spouses, 5 of them are Dentists. Their achievements in dentistry and speaking can fill an entire page. What sets them apart from other legends is their fantastic marriage and partnership that spans over 6 decades together.

Naomi has been awarded the CPAE, National Speakers Association Hall of Fame.

Both Jim and Naomi have been honored with the Cavett Award for their contributions to the Speaking Profession.

Both were presidents of NSA, and Naomi was President of the Global Speakers Federation.

Naomi’s theme as President was ‘The Privilege of the Platform.’

Jim’s theme as President was ‘Voicing Vision and Values.’

Both themes have been long remembered and valued.

Jim was Arizona Entrepreneur of the Year in 1990, co-authored 3 books, spoke in Hawaii 88 times, spent 30 weeks a year speaking.

Naomi was an alumnus of the Year for the University of Minnesota Dental Hygiene School, authored five books, and Co-Authored many others.

It's clear that Jim and Naomi Rhode, the founders of Smart Practice, have significantly impacted the dental industry and earned their legendary status through their dedication, innovation, and commitment to building solid relationships. Their story is inspiring, and their approach to business and life holds valuable lessons for aspiring entrepreneurs. Here are the key takeaways from their story:

Building Genuine Relationships: One of the core principles that Jim and Naomi Rhode built their business and life upon is the importance of genuine relationships. They understood that fostering strong connections with patients, clients, and colleagues is crucial for success. This principle likely contributed to their long-lasting impact and the success of Smart Practice.

Collaboration: The fact that Jim and Naomi Rhode worked together as a couple speaks to their ability to collaborate effectively. Their shared goals and efforts likely contributed to their achievements, and their partnership is a testament to teamwork’s power.

Overcoming Challenges: Jim's background, born during the Depression and having started as a long-range corporate planner, after graduating in Engineering from the University Of Minnesota, shows that success can come from unlikely beginnings. Despite challenges, he found his way into dentistry and identified opportunities within the field.

Value of Small Improvements: They believe in finding 1% improvements in dental practices and building upon them to achieve success. This approach demonstrates how even incremental changes can lead to significant advancements. (Jim reports that a 1% improvement seldom remains 1%, rather: it grows to 3-10% improvement).

Vision and Innovation: Jim's involvement in disruptive innovations like preventive dentistry and patient education revolutionized the industry. Their emphasis on teaching patients proper oral care techniques highlights the value of patient education and behavioral change to prevent dental issues. Jim and Naomi Rhode's visionary approach to dentistry, including preventive care and patient education, set them apart as industry pioneers. Their ability to recognize trends and adapt strategies to meet evolving needs contributed to their long-term success.

Continuous Learning and Improvement: The Rhodes' commitment to personal and professional growth is evident through their engagement with influential figures and dedication to continuous learning. They embraced opportunities to improve their skills and knowledge, likely contributing to their long-term success. Jim and Naomi Rhode's involvement in education, both for themselves and others, reflects their dedication to continuous improvement. Their contributions to dental education have inspired countless professionals to strive for excellence.

Impactful Speaking: Jim and Naomi Rhode's extensive speaking

engagements were crucial in disseminating their knowledge and ideas. Sharing insights through speaking engagements allowed them to reach a wider audience and inspire positive change in the dental industry. Their “Three Pillars of Success” approach started with speaking, then extensive multi-day seminars to build trust that drove the third pillar of product sales.

Adaptability: The dental industry is subject to changes and advancements like any other. Their ability to adapt to these changes and stay relevant over decades demonstrates their flexibility and resilience.

Strong Values and Ethics: Jim and Naomi’s emphasis on honesty, trust, and doing the right thing highlight the importance of integrity in business and life. Their deep faith in God is as strong as it comes. Their strong commitment to family is second to none. These values likely contributed to their reputation and enduring success.

Entrepreneurial Spirit: The Rhodes’ entrepreneurial spirit is evident in their willingness to take risks and explore new avenues. Their journey from starting Smart Practice to achieving a leadership position in the industry showcases their ability to identify and execute opportunities effectively.

Thought Leadership: Through their speaking engagements, books, and publications, the Rhodes established themselves as thought leaders in the dental field. Sharing their expertise and insight helped elevate their reputation and influence within the industry.

Longevity: The fact that Jim and Naomi remained active and influential in the dental industry for decades highlights their enduring impact. Their ability to stay relevant and maintain their status as legends over time is a testament to their lasting contributions.

Impact: Their motivation to be change agents and positively impact people and practices exemplifies that success should be driven by a desire to create meaningful change rather than just financial gain. Their contributions to organizations and causes within the dental community demonstrate their desire to give back and uplift others. Even today, in their mid-80s, they continue to mentor and coach dental speakers and dentists.

Role Models: Their recognition of influential dental industry figures as idols and legends showcases their humility and willingness to learn from others. This openness likely contributed to their continuous growth and development. They are role models for generations to come. They are proof that good people can finish first and that a marriage that includes being work partners can be achieved.

Legacy: Perhaps one of the most significant aspects of Jim and Naomi’s journey is the legacy they have built. Their impact on the dental industry and the lives they've touched through their work and teachings will continue to inspire and shape the industry for generations to come.

Overall, Jim and Naomi Rhode's journey in the dental industry showcases the transformative power of deep faith, genuine relationships, innovation, continuous learning, and values-driven decision-making. Their story inspires entrepreneurs in any industry looking to leave a lasting legacy through their work and contributions.

Travis Rodgers specializes in technology, strategy, fundraising, go-to-market strategies, and tools for dental software companies. He is VP of Business Development for Revere Partners Venture Capital. His company, DrDDS Innovations, is best known for building many practice management integrations, custom software solutions, white-labeled software, dental databases, and marketing systems used by dental vendors and dental practices. He has developed 27 different dental software programs and helped launch hundreds of dental products since 2003. Travis grew up in Silicon Valley and is a lifetime entrepreneur. Travis is considered “The Technology Guy” in the dental industry. He was the first to develop the electronic referral, online scheduling, and a patient file-sharing app in the dental industry. Travis is a speaker and consultant on technology and implementing change in dental practices. You can find Travis on LinkedIn or subscribe to his Dental Venture Capital newsletter.

7 years old. Rampant decay on 13 teeth. Julia had never been to the dentist until she was brought to one of our member nonprofit clinics. Even at a reduced rate, the cost of the extensive care she needed put relief just out of reach. Together with MGE: Management Experts, we saved Julia’s smile, increased access to dental care in marginalized communities, and provided oral health education resources for thousands of kids to prevent tooth decay in the future.

To read Julia’s story and help more kids get the dental care they need, scan the QR code or visit AmericasToothfairy.org.

Finding Fulfillment and Success in Dentistry

Dr. Robert Maguire

Alike-minded dentist colleague of mine, call him Dr. Smith, sold his dental practice in 2018, the same year as me. He now spends his post-practice years teaching first- and second-year dental students. Frequently we will get together for lunch or dinner; he’ll often comment, “I love teaching the dental students! They are so smart and are already thinking about the ‘big picture.’”Dr. Smith always beams when he talks about “his students.” A few months ago, he shared a story with me about two second-year students who approached him and asked, “Can we ask you a question about private practice?” “Of course,” he said.

Dr. Smith expected their question to be a clinical one. Instead, they asked him, “What’s the secret to a fulfilling and successful career? You seem like someone who really loved your work and your private practice.”

Dr. Smith was taken aback. Here, two second-year dental students, who were entrenched in their technical learning, were seeking a deeper meaning with their dentistry, looking for pearls of wisdom about fulfillment and success in dentistry and in private practice.

At first, Dr. Smith didn’t tell me what he told his students. Instead, he asked me, “Rob, in one sentence, how would you answer their question?” I paused for a moment, and then I replied…

“I’d tell them, ‘Do your best dentistry every day, take care of yourself, your patients, and your team, and the money will follow.’”

Dr. Smith’s answer was similar in that he told them to not only learn how to be a good dentist but to also learn how to become a good leader and a great communicator.

Dr. Smith and I both agreed that dental school taught us how to be technically competent but did not teach us how to be good leaders and communicators. We had to learn those skills on our own.

Over the course of our careers, we both read a lot of the same leadership and communication books, took many management courses, and after a few years in private practice, sought help from practice management consultants.

After graduating from Georgetown University School of Dentistry, I practiced for three years as a Navy dentist and was stationed at Parris Island, SC. I had a blast. It was a great place to develop my technical skills, but I never got to see my work months or years later.

People in the military frequently move from one location to another, and they take their teeth and their dental work with them. We described this as “a geographic success.” Whether your work succeeded or failed, you never knew, because “it moved.”

After my years in the Navy, I worked as an associate for three years and then purchased my own private practice, which I had for 28 years before selling it in 2018.

I was the happiest and the most fulfilled during those years in private practice. I was a lifelong student of communication, reading books like “The 7 Habits of Highly Effective People” by

Stephen Covey, “How to Win Friends and Influence People” by Dale Carnegie, “The One Minute Manager” by Ken Blanchard, and “Leadership Effectiveness Training” by Dr. Thomas Gordon. Over the years, I also took communication courses and learned things like the DiSC Personality Assessment to help me build a great team and better connect with others. Eventually, I hired a dental consultant who helped me better manage the “business side” of private practice. My years in private practice were both spiritually and financially rewarding.

If I was able to change one thing, I wish I had purchased my private practice sooner. It was my lack of confidence and selflimiting beliefs that kept me from purchasing my own practice.

• I had naively assumed that my associateship would eventually lead me to a co-ownership situation. I did not know that statistically, 98% of associateships fail.

• I had falsely assumed that because of my school debt, I wouldn’t be able to buy a practice.

• I stupidly assumed that I needed to have everything figured out before plunging into private practice.

Here are a few tips to consider for those of you who are dental students or for those of you who are unhappy with your current practice arrangements.

First, strive for excellence in all that you do and know that at the beginning, you may stink at it. I recommend that you consider starting your career in a residency, the military, or in a place where you’re given the time you need to do your best work.

Be gentle with yourself, and know that as you practice, you will experience moments of failure, both with your dentistry and with your relationships. But also know that with time, you will get wiser, better, and faster. Remember that the definition of a professional is “someone who practices today with the hope of being better tomorrow.”

Next, don’t assume that you cannot afford to purchase a private practice. Choose a geographical area where you (and your family members) want to live.

Look for a dental practice transition consultant, one who can help you find an opportunity, and then explain specifics like earnings ratio, cash flow, projected production, and net earnings.

Realize that you don’t have to purchase a “Taj Mahal” practice. What matters most is to maintain the relationships with the patients that have been coming to that practice for years. It’s best to keep things the same for 6 months to a year and then make your physical changes gradually.

Get your pride out of the way and get a mentor. Contrary to popular belief, asking for help doesn’t make you a “less than” dentist. In my opinion, seeking help makes you a wiser dentist.

One of the best places to find a trusted, more experienced

colleague to help you, is at your component dental meetings. During my practicing years, I had several dentists from the NH Dental Society who willingly came alongside me and helped me for free. The first step was for me to simply ask them for help. And every time I asked, they always said, “yes.”

Know that as leaders of our practices, we all are self-blind and, therefore, need to develop our emotional intelligence. Dr. L.D. Pankey calls this “Knowing Yourself.” Remember that dentistry is a people business. Learn how to communicate clearly and learn how to connect well with others.

Strive for excellence with your dentistry and your relationships. Do your best to keep the bar high and resist the temptation to cut corners. Hire the right people and treat them and your patients like gold. There is a market for this type of quality. Just look at Nordstrom’s.

Develop clarity about who you are, what you are about, and why you are doing what you are doing. Set the direction, define your values, and set goals. It’s like a GPS that will help you and your team “steer your ship and redirect it when the seas get rough.”

Lastly, physically take care of yourself and be gentle with yourself. Dentistry is a demanding profession. It’s important to take time to relax and exercise. For your mental health’s sake, be sure to extend forgiveness and grace not only to yourself but to others as well.

Know that you will have challenging days, but that’s where the learning takes place. Know that you are a human who is working with other humans and that you will make technical and communication mistakes. The key is to be honest with yourself, learn from them, make things right, adjust, and keep going.

Fulfillment and success in dentistry is “doing the dentistry you love, with a team you love, and with the patients you love.” My prayer for each of you is that you will open your mind and your heart to the possibilities, find the courage to pursue your dreams, and have a career that is abundant with joy, fulfillment, and financial success.

Dr. Robert Maguire, DDS, MASCL is a retired dentist, speaker, author, coach, and consultant. An expert in both dentistry and communication, he loves helping dentists find more fulfillment in their lives and in their practices. To learn more about Dr. Maguire and his “hands, head, and heart approach,” visit www.thefulfillment.coach or contact him at contact@thefulfillment.coach.

The Biggest Mistakes New Dentists Make

Earl Douglas, DDS, MBA, BVAL

Iam going to start this article by explaining that it is not intended to teach you mistakes that you should make, but rather make you aware of things other dentists have done and wished they hadn’t. If you learn from these mistakes, then you can go out and make new and original mistakes of your own and learn from them.

I’ll admit it took me many years to decide to take expert advice rather than ignore it when I didn’t agree with it. I was pretty headstrong and, as a result, had to suffer through many experiences that I was warned about.

I think that listening and accepting opposing views is now a strength that has benefited me a lot. In my fourth quarter, I now know that I don’t have enough time to make all the mistakes myself and am quite open to wise counsel. I was once wise enough to tell an associate who joined me, “Doug, I’ll never take away your opportunity to learn from your mistakes. Or to learn from mine either.” Enough about me; let’s talk about dentistry as a career and how one might make the most successes and the fewest mistakes. Here are some of my personal observations that might just benefit you.

First, remember that you are entering a profession, and it is not immune to failure. Dentistry is quite vulnerable, and it is under attack by forces that would seek to own and control it for their personal profit. “What’s wrong with that? It provided a job, right?” Well, in order to generate the greatest profits for the shareholders, management must increase fees and lower its overhead. And dentists are part of the overhead. The average net, as a percentage of personal production, for sellers that I deal with, is 52%, and it is not unusual to see it higher. DSO commissions that I have seen are about half that. I believe that most new graduates have about a million-dollar investment in

their eight years of college and dental school and lost earnings opportunities. I have heard that the average debt upon getting a dental license is in the range of $400,000. So, the takeaway here is that with that kind of debt and investment in time, money, hard work, and stress, I shouldn’t settle for a position that pays half of what I could make. I also believe that investment should prepare me to enter a profession, not just a workforce.

Another mistake that I see new dentists make is to seek the advice of a friend who has already entered practice and believes that they are the source of the best advice and information about dental careers. It’s my opinion that when someone chooses one option out of many, they have very little perception of what is good or bad – they have very limited experience. It’s like going to a Japanese restaurant and ordering off of a menu written in Japanese when one doesn’t speak Japanese. One doesn’t know what they could have ordered or what Japanese dishes they even like. They might like or dislike their choice and have no idea what another option would be. So my sense tells me to look for an interpreter of Japanese who knows the cuisine and seek expert advice rather than ask a friend who unknowingly made one choice and has no basis for comparison. Or, to put it differently, when faced with career choices, seek the advice of expert counsel who has seen all the choices and can help the uninitiated make their best-informed choice.

Another area involves risk assessment. New dentists may feel that it’s too risky to own their own practice. One statistic that I look to is the default rate for practice acquisition loans, and according to several dental practice lenders that I work with, their default rate is less than one-half of one percent. That means that over 99.5% of practice buyers are making their payments and would surmise that they are also successful in their practice.

I’ve told dental students in my lectures that dentistry is such a good profession that even dentists can succeed in it. And today, we have the benefit of so much professional management advice and counseling that would prevent mistakes in the business of the practice. But if someone did run into trouble, it’s possible to cure any issues and easily and quickly be right back on track.

Many new dentists are not aware of the actual financial workings of a practice. Looking at a practice tax return will mislead more new dentists that enlighten them. We need to keep in mind that the purpose of a tax return is to compute how much tax one needs to pay, not to clearly disclose what a practice net income is. I’ve discovered a few fascinating facts over the years. One of the best is the value of a hygienist. In over 90% of the practices I examine, I find that the profit from the hygienist – after paying her salary – will more than pay for the payments for buying the practice. And in a number of cases, will also pay the mortgage payments for the building too. So when a new dentist says he can’t afford to buy a practice, I’ll suggest that he let the hygienist pay for it for him.

It’s disappointing to see a new dentist forgo an excellent opportunity to buy a practice because they feel it is too expensive, thinking that a cheaper, smaller practice is a safer option. This is exactly the opposite of the fact of the matter. The biggest mistake a new dentist can make is buying a small practice with very little cash flow to live on. This is the riskiest proposition one could take because a lack of adequate cash flow will result in financial failure. Alternately, larger practices, in a great majority of the time, provide a very strong cash flow for a purchaser and, unlike the small practice, are much farther away from the dangerous break-even point and even of losing money. If the hygienist is going to pay for your practice, let her buy you a strong profitable practice, not a low-earning one on the edge of bankruptcy.

Thinking that dentistry is a tooth business rather than a people business will cost a dentist dearly. You’ve heard it said that you can go anywhere and just do excellent dentistry, and you will succeed. But if a dentist doesn’t care about people and shows his patients through his and his whole staff’s attitudes and actions, his excellent clinical work won’t impress anyone. I noticed from my practice days, as well as my own dental care, that patients cannot judge the quality of care. How many times have you heard a patient compliment a dentist by saying, “Gosh Doc, that’s an amazing margin!” If you can match the shade of a single upper anterior crown, which was my biggest challenge, then patients will be able to judge your work, at least the shade selection and custom staining. They can’t judge the prep and the margins, though. But patients are acutely aware of the respect they were shown and the friendliness and helpfulness of everyone they encounter in your office. And that is why they will or won’t refer others to you.

One more piece of advice to chew on. I’m a numbers person, and I prefer excellent odds over long shots that don’t pay off. This applies to where one decides to put down roots and practice. My

excellent odds suggestion would then say, pick an area that needs a dentist, rather than an area that is overserved with dentists. I’ve noticed that affluent rural dentists are able to enjoy the bright lights much more than dentists living in the metro area and struggling to afford the lifestyle. My perspective has consistently shown me that getting outside the highly competitive bright lights will provide a number of important benefits.

For one, patient share is much higher in rural areas because dentists are not crowding to be there. Think about how much marketing expense one could put back into their pocket. There’s even room to do a start-up if there’s not a practice for sale. If you do find one to buy, expect the price to be much less than a practice in the high-demand bright light areas. Staff salaries will be lower, another savings. One is much more likely to be able to very reasonably build a building to their own specs, since there is usually land available and costs are lower. Alternatively, even renting is much less expensive than in the bright lights. Patients will be much less stressful to deal with; take it from me. I’ve practiced in the bright lights, and those patients can be demanding and unappreciative. The cost of living will be lower as well, and people tend to be friendlier. And it won’t take an hour each way to drive five miles to your office and back each day.

These are the issues that I see on the top of the lists that new dentists could benefit from understanding. I also realize that the solutions to these issues are not always comfortable or attractive, but I sincerely believe as uncomfortable as they may be, they are more comfortable compared to the unintended consequences of alternative choices. But whatever choices you end up making, I wish you the best outcome and the best success possible.

Earl Douglas, DDS, MBA, principle of ADS South, LLC, began his dental career in 1971, practicing in the U. S. Army Dental Corps for six years and another five years in private practice. He began his dental transition career in 1982 and completed his MBA training in 1984. His company, ADS South, LLC, performs appraisals, equity associateships, and sales of dental practices throughout the Southeast. In addition to his Doctor of Dental Surgery degree and Masters in Business Administration, Dr. Douglas earned the BVAL designation (Business Valuator Accredited in Litigation) from the Institute of Business Appraisers. He is the author of numerous published articles on practice transitions and has presented to numerous dental organizations. In 1996 Dr. Douglas organizedADS, the largest independent dental appraisal and brokerage organization in the country

www.adssouth.com

How to Develop and Scale Transformational Technology - My Story

Gary Giegerich

Not everyone is cut out to be an entrepreneur. Lots of people have grand ideas about owning their own company - of being their own boss and reaping the benefits that can come from that. But, for every person that has an idea and dream, many more will never actually pursue that dream. That said, the dental field is exceptionally entrepreneurial. With hundreds of thousands of dental entrepreneurs worldwide, I doubt there is another industry that is quite as concentrated with owner-operators and the multitude of companies and entrepreneurs who support them.

While it takes tremendous fortitude and hard work to open a practice and follow a well-traveled path of attracting patients and profitably providing excellent care, the vision that I had when I founded Alta Smiles would require a much different, and, dare I say, more complex approach. My goal was and remains to transform the orthodontic industry in a way to make highquality orthodontic care accessible, affordable, and convenient for everyone. While I am not a clinician, I am a lifelong entrepreneur and the son of an orthodontist. I have been in and around the industry my whole life. What I saw was an industry that was innovating slowly. Some new technologies were being adopted, but overall, the industry still needed to meet the real needs and desires of patients and their providers. Our research showed that patients wanted greater convenience and discretion in their

treatment options, whether those options were fixed appliances (traditional or ceramic braces or clear orthodontic aligners). Both general dentists and orthodontists want to provide highly consistent, reliable results with a high degree of patient satisfaction, all delivered profitably with as few hassles as possible. I was convinced that through proprietary technology, we could meet the needs of both patients and doctors in never-before-imagined ways. So, while we saw a massive opportunity, we also saw the many challenges we would face. Below I will shed some light on how Alta Smiles is building a company that is poised and committed to transforming the industry with our C5 Hidden Orthodontics solution.

As CEO of Alta Smiles, the job description I created for myself and posted next to my desk reads:

• Establish a strategic vision

• Assemble a team with the right people in the right seats

• Focus on the corporate culture

• Align (no pun intended) priorities

• Ensure adequate resources (financial and otherwise)

• Create a corporate rhythm (meetings and tasks/processes functions)

• Assure execution

• Manage risks

While each element of my job description is critically important, this article will delve into what I believe are the three key elements of our success - both in the short and long term. They are: 1) advancing technology that provides the company with a truly differentiated product/service, 2) creating a highly scalable business model, and, 3) ensuring that we create an intellectual property moat that can be protected.

From a technological perspective, we are embracing the inexorable trends in orthodontics - digital treatment planning, remotely monitoring patients to cut down on chair time, and making custom appliances for every patient. But we are not just bundling a myriad of off-the-shelf solutions and calling that innovation. Our solutions utilize digital planning and appliance innovations, but what makes C5 Hidden Orthodontics truly amazing is that we can straighten teeth without brackets or aligners. During treatment, nobody can see that a patient is having their teeth straightened, and it’s totally comfortable. Patients love our treatments, and many clinicians have described what we are doing as the “holy grail of orthodontics.” That’s some pretty amazing praise! With so many technologies out there and being a start-up with limited resources, how does one choose what technologies to buy and which to “build”? We have certainly used both approaches. For instance, there are many digital treatment planning software packages out there, so we were not about to recreate the wheel. Instead, we looked at and evaluated existing solutions, adapted and customized them to our needs, and then created our own protocols. We took a similar approach to provider software so that we could seamlessly communicate with our providers. Others had spent years fine-tuning their software solutions to make them scalable and well-supported, so we started by using 3rd party software rather than building

new ones. Of course, we had to make plenty of customizations to meet our needs, and we will continue to invest in our customized solutions. Still, my advice to any would-be entrepreneur is to focus your resources (both time and money) on your critical needs and outsource to other technology partners where it makes sense.

Our technology solution is much more than just what software we buy, build, or customize. Since we have fundamentally reimagined how to move teeth, there is a lot of technology that goes into making that successful. Our system of placing orthodontic wires directly on the lingual surface of the patient’s teeth requires us to understand how the specific forces applied to specific teeth in specific locations will affect the movements. So, we had to learn to analyze and optimize those forces without putting unhealthy pressure on the teeth. This necessitated engaging a cadre of external material scientists, engineers, and technologists to help us create our solutions. I am a big believer in supplementing internal resources with outside consultants and experts and engaging them to work in a collaborative environment to achieve the desired outcomes. In addition to leveraging internal resources much faster, this approach also has the added benefit of taking the politics out of research and development efforts wherein internal development folks feel threatened by “outsiders.”

So, now that we have created a better solution, how do we make sure our solution is scalable? We are big believers in training and documentation. That applies to what we do internally, but it also applies to the clinicians and their staff who are providing the services. To that end, we have invested heavily in envisioning and executing training materials that are straightforward, inter-

From a technological perspective, we are embracing the inexorable trends in orthodontics - digital treatment planning, remotely monitoring patients to cut down on chair time, and making custom appliances for every patient.

esting, and easy to learn. We have created training materials covering everything you can imagine. The materials utilize the full spectrum of mediums, including animations, videos, and printed materials. We have invested heavily in animation materials, in particular, as we believe they make it easier to understand and visualize what’s going on in the patient’s mouth. We also have created learning systems that are fully available online and tailored them to the specific audience(s). We believe that making this investment upfront will pay longterm dividends in ensuring that we can teach our systems in a highly scalable manner to anyone, anywhere.

The final element that I want to touch on is our obsession with protecting our intellectual property. As I have founded and operated 7 companies throughout my career, I have learned a lot about competition. One lesson that I have learned is that well-established companies don’t like to see upstarts succeed, particularly when they take market share from them. And these well capitalize competitors are all too willing to “emulate” solutions from others. So, it’s great to be nimble and innovative and to have amazing customer service, but it’s even better to have truly defensible intellectual property (patents) that create long-term competitive advantages. From day one, we have been protecting our innovations. To date, we have filed for and/or acquired over 25 patents. That includes key patents in countries all over the globe, as we intend to be a global company. We have also extensively researched other companies’ patents to ensure that we are not infringing the IP of other companies. I have been through and ultimately prevailed in patent litigation in my prior companies, but it is a distraction (and expense) that is best avoided.

Every day I hop out of bed excited by the possibilities of this company and the market-changing solutions we are pioneering. By understanding my role as CEO and engaging experienced, talented, and passionate individuals who share our vision, we are more optimistic than ever that we will continue on our path to success. Focusing on innovation, protecting it, and ensuring that our company can scale is a critical part of our strategy.

As the President, CEO, and Co-founder of Alta Smiles, Gary Giegerich has had a successful 30+ year career as a serial entrepreneur. His belief that a higher level of world-class orthodontic care was achievable through an improved care delivery model and innovative technology is what drove him to found the company. Prior to founding Alta Smiles, Gary also founded and grew five other multi-million-dollar companies covering the fields of technology development and consulting, consumer products design and manufacturing, promotional products, and retail. Gary is a graduate of the Wharton School of the University of Pennsylvania, where he received a Bachelor of Science in Economics. He also has served as President of the Entrepreneur’s Organization Philadelphia Chapter.

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From Clear Aligners to Content Creation - How Dr. Avi Patel is Shaking Up the Dental Industry

Luke Shapiro, DDS

Dr. Avi Patel grew up in Jacksonville, Florida, completed dental school at NYU, graduated in 2018, and worked at a handful of associateships in the Northeast and then moved down to Austin, Texas, during the pandemic in 2020. Last year he created an aligner course for general dentists, and you can find him on Instagram as @Doctor.Avi - the Clear Aligner Advisor - or on his website www.clearaligneradvisor.co

LET’S JUST TAKE IT BACK A LITTLE BIT. WHEN DID YOU START POSTING ONLINE, AND WHY?

So I started posting last year in 2022, and I was posting because, at the time, I was doing one-on-one consulting with other general dentists, and I was just teaching them how to do aligners. This was pre-course, literally just working with docs, trying to teach them everything from A to Z.

WERE YOU PAID FOR THAT? OR WAS IT JUST A PART OF YOUR GROUP?

The docs were paying for the consulting. Even before that, I was just helping doctors in the practice I worked at. Then I wanted an official position, but the DSO that I was at didn’t want to create that position. They just wanted me to focus on producing. So then, on the side, my wife gave me the idea to start consulting, and I was just like, what’s consulting? How do you do that? She helped me because she has a finance background. And then I was just doing cold outreach to doctors in Austin for the consulting business. Then I used social media as a free way to just market for the consulting business. So that’s why I started posting.

FREE IN THE SENSE THAT YOU DON’T HAVE TO PAY FOR IT, BUT YOU HAD TO SPEND ALL OF YOUR TIME DOING IT?

Exactly. And I had time at that point, but I didn’t have money. So I was like, let’s give this social media thing a try.

SO BEFORE THAT, DID YOU EVER THINK OF DOING COURSES OR POSTING ON SOCIAL MEDIA?

Honestly, no. I wasn’t even following a lot of dental accounts because I was at such a low point in dentistry early in my career where it was kind of triggering for me, because I was suffering from the whole comparison thing where I’d see people doing amazing dentistry, and I just felt like the work that I was doing wasn’t up to this high standard.

But now that I look back on it, and realize, the people who are putting out these gorgeous veneer cases and stuff like that are because they took years of training and hours of practice to make it happen.

It’s funny because my mom had actually told me to post when I first came out of school. But I just didn’t feel passionate about making content like teaching patients how to brush and floss. Cause that’s all I had seen. And so I was like, that’s not true to me, so I didn’t post anything dental.

SO, WHAT DO YOU THINK HAS ALLOWED YOUR COACHING BUSINESS TO BE SUCCESSFUL?

I think the fact that one, there’s a need. I think there’s a big gap in just foundational training for general dentists from a general dentist perspective. And then I think about the fact that I’m willing to share a lot of free education. I’m not holding the secrets back. I think it’s a procedure that a lot of GPs don’t know how to do, but are interested in learning how to do it.

But then also I think the general public wants it. Patients want this treatment. I think we’re living in an era where a lot of people in their thirties had braces when they were kids. They didn’t wear retainers - so there is a lot of treatment out there.

HOW OFTEN ARE YOU IN THE OFFICE WORKING, HOW OFTEN ARE YOU WORKING ON THE COURSE?

So ever since January, 2023, I went down to two days in the office. So Mondays, Tuesdays, and then I spend the rest of the week working on the business. I’m learning a lot about marketing because that is kind of the biggest thing for me to grow the business right now. Over the last year and a half, I’ve made several

modifications and improvements to the course itself, just based on feedback from the doctors in it.

IS IT JUST YOU DOING THIS WHOLE THING, OR DO YOU HAVE AN ASSISTANT?

So it was me for the longest time. I just now got an assistant, but I’m working on training her to take some of this stuff off of my plate. A lot of the content was taking up most of my time. So I’m working on creating systems to have her run some of my social media. I mean, it’s still me on my page, but I’m starting to see the power and the value of delegating some things so that I can work on other projects.

DO PEOPLE EVER SAY YOU’RE TOO YOUNG FOR THIS? OR LIKE ANYTHING LIKE THAT?

I had one guy that I talked to recently, I was actually trying to sponsor his group. He was like, “What makes you qualified to do this? Why would anyone want to learn from you?” And it kind of threw me off, because that was the first time someone has directly asked me that. But it was a fair question. I answered, “I’m qualified to teach people how to start doing this because I just went through this. It’s fresh. I know the challenges. I know the struggles.”

WOULD YOU SAY YOUR COURSE IS INTENDED FOR PEOPLE THAT HAVE NEVER DONE ALIGNERS?

Yeah, like zero clue on how to do it. It teaches people how to start.

AND WHAT ARE YOUR PLANS FOR THE FUTURE? DO YOU PLAN TO OFFER MORE ADVANCED COURSES, OR DO YOU REALLY WANNA HONE IN ON THIS NICHE?

I think, me personally, it’s going to be honing in on this niche. I’ve had some doctors ask if there’s more, like a part two. But I think what I would want to do is collaborate with orthodontists or other doctors who have more advanced training. Or create an even more basic version for someone who may not be ready to dive into all this.

IS YOUR GOAL TO BE ZERO DAYS IN THE CLINIC?

It’s funny you’re bringing it up because I was actually thinking the growth with the program has put me in a place where even when I have the three days a week to work on it, I still feel like a

time crunch. So, I’m trying to optimize my time, but I could see myself going down to zero clinical because, for me, I’m seeing other gaps in dentistry that I would love to kind of help fix.

DO YOU LOOK AT THESE OTHER ALIGNER COURSES AS COMPETITION?

No. So when I first started, I was kind of measuring myself against them. Like, dang, these people already have solid courses. How am I going to be able to compete? But the more that I’ve exposed myself to non-dental entrepreneurs, and some super successful people, I’ve learned about and leaned into an abundance mindset. And at the end of the day, if you are adding value to an area of need, then there is no real competition at that point.

WHAT ARE YOUR THOUGHTS ON THESE COMPANIES WHERE THE GENERAL DENTIST ISN’T REALLY DOING IT?

Yeah, I think it’s interesting. So I think I get why those companies exist. I understand what they’re trying to solve, but I still think that the general dentist, if you’re offering aligners in your practice, you need some type of foundational education, because as much as it might be easy to just get a treatment plan and execute it, I’ve been in an office where that was the case and I just saw train wrecks of cases because the doc didn’t know how to do the basic things like IPR or to remove flash around attachments.

It sounds great, but if they don’t know how to do it, it’s going to cause a lot of refinements and wasted time. And it’s because I don’t think the GP actually had that foundational training. So I think you’ve got to have both. But as a GP, you got to know the basics.

Dr. Lucas Shapiro is a graduate of Washington University in St. Louis and Stony Brook University School of Dental Medicine, where he received his Doctor of Dental Surgery. He completed his post-doctoral orthodontic training at Tufts University School of Dental Medicine. He currently practices orthodontics at Lemchen Salzer Ortho in NYC. He started the Instagram page @futuredentists, works with the educational organization @ignitedds, and has an orthodontic tiktok page @drshap

Reducing Errors in Dental Operations

Yvonne Simmons Howze,

PhD

& Zina Berry, DDS

Dentistry is a highly respected healthcare field, and dentists are highly-skilled, competent professionals. Dentists seem to have it all together, and to the average eye, their offices run smoothly. However, unbeknownst to most patients, a dental office has a significant number of daily processes that must be followed to minimize the time a patient spends scheduling an appointment, preparing for their visit, receiving treatment, and paying for the service. Thus, this article describes three common clinical and operational errors found in many dental practices, and it makes recommendations for reducing them.

Dental offices can be increasingly more efficient and effective in reducing errors by analyzing the impact of three critical measures of success: accuracy, timeliness, and costs. Figure 1.0 gives a brief definition of each measure.

These three measures, when used consistently, ensure sustainability, reduce staff burnout rate, and keep patients committed to following through on their treatment plans. These measures can be used to both prove and improve the work that dentists do.

REDUCING ERROR RATE #1: PATIENT DENTAL RE-WORK

Typically, when we think of errors in Dentistry, we first think of errors that require re-work. Re-work is waste, and waste within any business can be a costly endeavor. If a dentist must re-do a procedure, the Practice and the patient are affected. For example, in Figure 2.0, a dentist might consider the following when a patient must return for re-work of a root canal: (see Fig. 2.0)

For two hours of re-work, the following estimated costs might be applicable:

Patient Time off work per hour

$60.00

Patient travel to/from for 25 miles at $.62 per mile $62.00

Average Daycare costs $36.00

Dentist and dental assistant re-work

$240.00

Front desk rescheduling $42.00

$440.00

IMPACT OF RE-WORK

Practice?

Who pays for the re-work?

• Patient?

• Insurance?

• Practice

What impact does the re-work have on staff?

Dentist

1. Acknowledge the mistake was made

2. Must re-schedule the work

3. Spend time away from another patient

Dental Assistant

1. Must re-do preparation

2. Must setup again

3. Must assist dentist

Front Desk

1. Must shuffle other patients to accommodate dentist’s and patient’s schedules

2. Must spend time finding a new time slot

3. Re-greet, listen to complaint, and appease patient

Figure 2.0 Example of Waste-Focus on Errors

Hypothetically, if a dental practice has to re-do work for three (3) patients a week at the minimal rate of $460.00, then in a year’s time (52 weeks), the re-work will have caused a potential loss of nearly $70,000. Of course, the biggest cost due to the re-work might be the loss of the patient’s confidence in the dentist.

Additionally, if the patient has to pay out of pocket for the rework, the practice may lose the patient to another dental office. By tracking the number and type of errors, and the potential costs for re-work, it can easily be determined how errors are affecting a practice’s profitability. With that information, the practice gets clarity about the best ways to reduce the error rate (e.g., additional training, scheduling additional time for certain procedures, etc.). It all begins with a simple acknowledgment that an error has been made, followed by a commitment to creating a great patient experience.

REDUCING ERROR RATE#2: THE MORNING HUDDLE

The Morning Huddle is a common activity used by many dental practices to organize staff around the daily clinical and operational goals and to remedy any potential scheduling issues. It is the greatest opportunity for the dental team’s maximum efficiency and success at the onset of the day to ensure each patient has a delightful patient experience.

Patient

• Travel to and from dental office for return-gas

• Travel to and from dental office for return-time

• Possible need for childcare

• Time off from work

• Time waiting at new appointment

• Fear factor, lack of confidence, lack of trust

• Who will they tell about the error, and what will they say about the need for the re-work?

• Will the patient be happy with the return and the end result?

• Will the patient return for future treatment?

There are specific activities that can reduce the error rate in Morning Huddles.

First, the huddle needs to start on time. If there is no specified time, then it is likely that staff will be late for the huddle. Once the time is determined and the dental team is informed, the huddle should start on time, every time! A practice can use a sign-in sheet (Appendix A) that specifies date, name of staff, and arrival time to the huddle.

Secondly, the dentist or practice manager should lead the huddle. A process involving a report out for each patient should be developed and used daily. For example, will each hygienist talk about all of their patients or only the ones that are potentially problematic? Does the front desk need to report on patient payment status, such as insurance pre-authorizations returned or not returned? Howze (2013) contends that creating clear process steps so that everyone knows the time, timeframe, and activities to be completed and by whom will ensure that time is spent on goals and outcomes, not on apologizing for being late (timeliness), not having the necessary information so that the dentist can make an informed decision (accuracy), and not on figuring out whether a patient should be re-scheduled because their pre-authorization has not yet returned (costs).

REDUCING ERROR RATE #3: LABORATORY ERRORS

Dental labs contribute to the successful operation of a dental office. Dental labs are suppliers who create products on behalf of dental offices. As such, it is important that a dental lab has a customer-centric focus whereby the dental office’s patients are valued, patient expectations are met, and products for patients are of high quality.

Dental labs customize a variety of products, such as dentures, crowns, and bridges. The dental lab is used to create a solution suited to the needs of each patient based on the prescription from a dentist. Some dental offices have their own in-house lab, but there may still be times when an outside dental lab is used. Either way, timeliness is a critical measure for a dental office using an in-house or outside dental lab because the patient must wait until their product has been received and accepted.

Delays in the delivery of dental lab products may create a potential problem for a dental office. A delayed product may extend the cycle time that a patient may get fitted for the new product, causing a potential patient distrust issue for the dentist. If the product is received and tried but must be returned to the dental lab because it is not the best-fitting product, then there must be a re-examination of whether the prescription was accurate, whether the prescription was followed, or whether the patient is simply dissatisfied with the product based on their assessment of attractiveness or functionality. If the product does not fit and must be re-made, then more time is needed in the dental office as described above for re-work. If the product is a matter of attractiveness or functionality, then the dentist and dental

staff must take more time to appease the patient. The matter of appeasement is important, particularly if the patient has paid out of pocket for the product.

The dental lab is a corporate partner with the dental office. Consistent errors in dental products will need to be addressed through an evaluative process. A dentist can develop quality domains to determine whether to continue or discontinue with a lab supplier. Below are measures a dentist can use to determine a supplier’s performance:

1. % of problems fixed the first time

2. Timeliness of completion of the product/appliance

3. Timeliness of arrival of the product/appliance

Mark Graham Brown (1996) recommends the use of a scorecard as a way to assess a supplier’s performance. Figure 3.0 shows an example (Howze, 2009) of a vendor scorecard for a lab supplier. A dentist can identify the vital few key measures to score the lab’s performance by assigning a weight according to its importance to the practice.

Once a satisfaction score is determined, the dentist can decide whether to keep the same dental lab or seek the services of another one. If the target satisfaction score is 80%, then the dentist may want to re-assess whether they want to continue working with this vendor or at least have a discussion with them. This same process can also be applied to evaluate the performance of other suppliers the practice uses.

PRODUCT OR APPLIANCE QUALITY DIMENSION

(What

Figure 3.0 Example of Lab Supplier Scorecard

For every error, there are costs, whether it is in time or money to the patient or to the practice. When a dental office gets it right the first time, gets it done within the allotted time, and gets it done with the least cost in time or money, the patient will be delighted, and they will return and tell others. That means great patient engagement, satisfaction, and loyalty!

THINGS TO DO, PLACES TO GO

References

Brown, M. (1996). Keeping Score. Productivity Press. Howze, Y. (2004). Tips for Success. Unpublished paper.

Howze, Y. (2009). Measuring vendor performance. Presentation to the Texas Comptroller, Procurement and Management Division. Howze, Y. Toolz You Can Use. HowzeNow Press, Jacksonville, Florida.

Howze, Y. (2023). A Systems Thinking Approach for the Education and Training of Performance Excellence: A Pedagogical Approach. Submitted for Publication.

Dr. Yvonne Howze is co-owner of Dental Leadership, LLC, which sponsors the Dental Leadership Academy (DLA) to train dentists and others in the dental profession nationwide. She has gleaned critical insights into dentistry to help Dentists (and their staffs) run their operations with systematic efficiency by teaching them tried-and-true techniques and by training them on continuous improvement principles and tools to reduce waste, work closely with vendors, and improve staff-patient interactions.

Dr. Berry is co-owner of Dental Leadership, LLC, which sponsors the Dental Leadership Academy (DLA) to train dentists and others in the dental profession nationwide. Dr. Berry is a seasoned and savvy dentist with nearly three decades of expertise. She has received many certifications and awards demonstrating her highly successful career as a dentist and business owner. Because of her wealth of knowledge and expertise about business operations and day-to-day management in healthcare environments, she is frequently invited to be a guest speaker.

Academy of Dental Management Consultants

August 21-23, 2023

Atlanta, GA

AAOSH Collaboration Cures

September 7-9, 2023

Orlando, FL

Georgia DHA

September 8, 2023

Atlanta, GA

DS World

September 21-23, 2023

Las Vegas, NV

MGM Resort

2023 New Heights in Interdisciplinary Care

September 8-10, 2023

Phoenix, AZ

Glidewell Influential Women in Dentistry

September 22-23

Irvene, CA

ADA Smile Con

Oct. 5-7, 2023

Orlando, FL

Annual DeW Life Retreat

Oct. 25-72, 2023

Charlotte, NC

If you want to arrange a meetup, please email anneduffy@dentalentrpreneurmedia.com

We’d love to see you!

Great Leaders Trust Their Instincts

Jackie Joachim

Many practice owners underestimate their abilities as entrepreneurs. Practice stats, financials, HR issues, marketing, and all this comes before the raison d’être; patient care and management. A practice owner would be forgiven for feeling overwhelmed. Some owners tell me they are terrible at business and choose to let someone else handle it.

I believe practice owners are much better at business than they believe. The reality is that practice owners are business leaders. And therefore, business leaders are faced with important decisions daily. You determine strategic direction, guide hiring, set practice priorities, the list goes on. People generally make decisions using two different processes; the first is based on logic and facts, and the second is based on intuition. This is where I feel practice owners do not give themselves enough credit. Intuition is our intuitive sense of the best course of action. Obviously, we must look at the facts. But have you thought to yourself when you do see the facts, “I’m not surprised, I felt that was not right at the time…”

Perhaps we do not want to trust our instincts as much as we should because it means we must pay attention to our emotions. We try and most often need to remove the emotion from difficult situations. Controlling emotions is more important when it

comes to reacting to a situation. But what about when making decisions? What if you have the facts and information, but there might also be competing or incomplete information? In these cases, trusting intuition becomes a valuable leadership competency. As Bill Gates says, “Often you have to rely on intuition.”

Sometimes, people do not want to trust their intuition. It is important to discern between intuition and fear. We have all faced a situation where we were simply afraid to take action. Fear tends to be accompanied by bodily sensations of constricting or minimizing. You may feel tense, panicky, or desperate. Fear has a pushing energy, as if you’re trying to force something, or selecting an option because you want to avoid a threat, rejection, or punishment. Fear also tends to be dominated by self-critical thoughts that urge us to hide, conform, or compromise ourselves. Intuition, on the other hand, has pulling energy, as if your choice is moving you toward your best interest, even if that means pursuing a risk or moving more slowly than others. This is usually accompanied by feelings of excitement and anticipation or ease and contentment. Physically, gut feelings tend to cause your body to relax. With intuition, your inner voice is more grounded and wise, like a good mentor. And remember, using intuition does not mean you have a make a quick or snap decision. An intuitive decision can still take a few days.

Whenever I have important decisions to make, I do trust my instinct or my gut. Try asking yourself:

• Do I pay attention to my first reactions about a given issue?

• When I am faced with a decision, do I consider my feelings in addition to the facts?

• Do I check in with my gut feeling after summarizing the pros and cons?

• Do I pay attention when my gut sense is at odds with the available information?

To help use your intuition more, simply slow down. We answer our texts and emails far too quickly. We may feel compelled to make a quick decision despite being extremely tired. It is hard to slow down, given the pace we are all running at. But taking a step back is important and necessary in order to access intuition. I highly recommend sleeping on a big decision and taking the night to process a position. It is never as daunting in the morning. The next time you are faced with an important decision, take some time to get out of your head and away from your office. Go for a walk. Do not feel the need to respond quickly. Just sit with the decision, ponder alternatives, and try brainstorming new solutions. As you do so, tune in to your emotions and evaluate your reactions to understand how intuition might be leading you in this situation.

What about the time your intuition failed? Did it really fail? Or did you let biases get in the way? There will be times when intuition leads you astray because mistakes can possibly be attributed to unconscious biases. Biases are cognitive distortions that manifest in personal preference or misleading assumptions. Have you noticed when you decided too quickly or were overconfident, that is when things went wrong? Whenever you let your biases interfere with your decisions, they skew your objectivity leading to the wrong decision. Your gut did not let you down, but rather, you chose to listen to your own personal opinions that influenced your judgment.

The next time you have a decision to make, try and engage your intuition. It is always important to remind yourself about your core values and what is most important to you. Examples include service, stability, family, or calmness. Perhaps you are feeling agitated after a long day at work when nothing went your way. Your core values can help you pinpoint the source of your frustration and understand it more clearly. Using your values, you can check in to figure out what feels off internally and gain perspective on the situation. Remember, your core values represent what is most important to you, so I highly recommend you use them as a fallback or reset position.

I am confident that you have people who pride themselves on

having a strong intuition, honed through years of experience, that guides their decisions. Others will be ambivalent about relying on their intuition to make important choices because they are concerned that their gut reaction is inherently biased or emotional. This latter group is no doubt responding to the oft-given advice that we should use formal data and analysis to “check” our intuitions. So, who is right? Should leaders make decisions based on their gut feeling, or should they not? Please do both. Facts speak loudly and clearly, but facts cannot measure every business decision. They cannot be dismissed. But remember to listen to your inner voice. Go to a quiet place, clear your mind, remove fear and biases, and truly listen to your instincts. They will not lead you astray.

A challenge for you after reading this article is to take a moment today or tomorrow to reflect on what your top one to three values may be. The next time you find yourself struggling to make a decision, ask yourself, “Which action or decision brings you closer to those core values?” Going within can help dissolve the internal tension that leads to mental loops. A tidy spreadsheet is not always available for every business decision.

Finally, keep in mind that intuition cannot flourish in busy, stressful environments. Give your mind space to wander and make connections. Remember, while intuition is not perfect, it is also a decision-making tool you are likely underutilizing at the moment. Trust yourself a little more, and you will probably be surprised to find that your gut is a more powerful decisionmaking tool than you may have realized.

You are a practice owner and entrepreneur for a reason. Embrace this role. Sometimes a big challenge is a distaste one may have for leadership. The more you fight it, the harder it can be. Implement systems that help you manage effectively. Always remember, you are not in this alone. There are resources available, provided you choose to deploy them.

Jackie Joachim is the Chief Operating Officer and one of the main appraisers at ROI Corporation since 2013. Jackie’s 30-year experience includes leading a successful team in the banking industry. Jackie has taken great pride in helping practitioners understand the business side of their practice along with the factors that affect their value. Jackie has been a keynote speaker, contributed to industry publications, and delivered many webinars with the intention of educating and empowering owners.

Choosing to Create Your Success

David Rice, DDS

Do you want to know the difference between new grads who cross the stage and succeed beyond their wildest dreams - and those who struggle…

It’s simpler than you think. Those who struggle leave their success to chance. Those who massively succeed create it by choice. Let’s walk through some of those choices here, leaving no time to waste on chance and struggling.

PEOPLE

People’s choices are, very frankly - the most important of all your choices as a new dentist. Some will tell you process comes first. Here’s why I challenge that concept. People break processes unless you have the right people. When you’ve chosen the right people, and you add the right process, that’s when you accelerate and have control over your future.

Here’s the challenge. In life - there are known, knowns. There are known, unknowns. And there are unknowns. Hence the phrase - you don’t know what you don’t know. Hence the life truism - that you and I often choose the wrong people when we believe we are choosing well. Think about that person you dated who you thought was amazing - even when some of your family and friends knew better. They were amazing - until they weren’t. And then, somehow, you saw what those who warned you saw. AKA - choose very carefully.

Here’s a short list of the people I’d want to know right now if I’m a D3 or a D4. D1s and D2s - if you want to get ahead of the game - you can get started on this list too!

Mentors - if you’ve followed along here at DE in the past - you know I highly recommend three types:

• A cheerleader to help keep you motivated

• A contrarian to help you see your blind spots

• A top 2%er to help you achieve faster and more predictably

P.S. This is an area too many young dentists miss out on. All I can share is where you are after your first five years will define how successful you are. I’ve coached hundreds of dentists. Your first five years are critical. When you’re ready - email me at david. rice@ignitedds.com. We have mentors of all ages - crushing it in all practice models.

Insurance - it’s one of those things you pay for and hope you never need. The right broker will shop for the best companies and policies for you. Every other broker will shop what puts the most money in their pocket, whether it helps you or not.

Disability - get it before you graduate - absolutely within 6 months of graduation! You get a significant discount now. It’ll cost you if you wait. It’ll cost you more if you wait, and you’re one of the 80%+ who need it.

Term life - if you have kids - it’s cheap to get now. It’s costly to get it later

Malpractice - if you’re graduating. I highly recommend negotiating your ability to buy your own policy and get reimbursed.

P.S. If you want the best people in dentistry - reach out to me at david.rice@ignitedds.com. Twenty-nine years of speaking and traveling has helped me filter in the best of the best. I’m happy to connect you.

Financial planner - yes - I know you don’t have any money. Great financial planners won’t care. They’ll invest in helping you build your plan now even though you’re not paying them yet. Crazy stat - most 65-year-old dentists cannot afford to retire. I know - that won’t be you. That’s what they all said as dental students, and here they are. Get a plan in place now. You’ve worked too hard not to.

Attorney - if you’re graduating and going right into practice. Associate contracts are easy on the front end and really difficult when you’ve signed one without a lawyer and want to terminate your contract early. This happens every day! You’ve spent a ton on dental school. Don’t let a few hundred dollars keep you from a great attorney protecting you.

CPA - if you’re making money now and/or graduating this year. Here’s the deal. Uncle Sam is greedy. He’s going to try and take a major percentage of every dollar you make. The best CPAs will keep him in check.

PROCESS

Now that you have a head-start on some of the most valuable people - it’s time to know what processes help you dentists today. Process takes you from doing what most do… winging it - to what the most successful do…make all their choices of data and best practices. Emotion is our enemy. Data drives our best decisions.

As a young dentist - here are some best practices for your best practices. Understand and choose the practice model that best suits you. There are many.

• You can associate with a traditional practice

• You can associate in a DSO

• Some DSOs are nationwide

• Some DSOs are regional

• You can start up from scratch

• You can acquire a practice

• You can go academic

• You can go to public health or the military

• You can do more than one part-time

Each offers strengths. Each brings risk. Go to your lunch and learns. Listen. More importantly - question. You’re often only getting half-truths. The danger in that is you’re often getting the wrong half - and the only one who loses here is you.

P.S. If you want to get the whole truth - shadow each model for a few days. Ask the young dentists how great it is. Ask the team how great it is.

GO ALL IN

Every highly successful person I have ever known goes all in. When you do this - one of two lessons arises. You either learn

you’re exactly where you’re supposed to be, or…

You learn this isn’t the practice and/or model for you. Both are outstanding lessons you want to learn as quickly as you can. Waking up 3, 4, or 5 years later and realizing it then really slows you down.

TAKE MORE CE

This is likely the last thing you want to hear as a student. And I know there are at least Facebook groups that tell you school should prepare you better so you don’t need more education. They are dead wrong - and wouldn’t be a part of my people, FYI. When we graduate dental school, our greatest asset is our ability to think critically. Materials and technology progress quickly. In fact - there’s not one material or technology I use today that I used in school - not one.

PRODUCTION

There are a few ways to look at production.

• Goal setting - this is healthy - until it isn’t

• A measure of success - also healthy - until it isn’t

• Inspiration to be your best - my favorite

Let me elaborate. I like a mindset shift in production from one tooth at a time, to complete care. When you and I see our patients in totality when we learn to diagnose and treat their total oral health, we will give them great care, and by association - yes - we will be very productive.

The key is that CE is in the process bucket - given by the top 2%er in the people bucket. That is how this all ties together. Friends, I truly hope this helps you. Please reach out. We have one goal @igniteDDS. Get you to be a top 2%er in 3 areas - clinically -systematically - and financially. You can live a self-determined future. We can help!

David Rice, DDS, is on a mission to improve our profession by leading the next generation of dentists to grow successful lives and practices. The founder of igniteDDS, Dr. Rice speaks to over 35 dental schools and residency programs a year on practice building, team building and wealth building. Dr. Rice is a private practitioner, educator, author, and mentor who connects students, young dentists, and professionals from diverse dental-related businesses, “fueling passion beyond the classroom.” ignitedds.com

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