Everything Dental Blog September 2017

The Perfect Storm

In the aftermath of Harvey, Irma and Maria I suspect everyone will expect this blog to be weather-related. I promise that this essay is not about climate change or the death and destruction of raging storms. Instead, my aim is to talk about the convergence of many forces certain to leave their impression on our dental landscape.

About seventy percent of the transactions that govern commerce to and from the dental office can be traced back to a handful of companies. These companies provide us with a looking glass into the future. By watching and researching these dental giants (3M, Danaher, DentsplySirona, Adec, Midmark, Patterson Dental and Henry Schein Dental) we can make certain assertions about the future. Their investment in time, people and resources provide us with valuable data that can help us make better decisions for our businesses.

I remember promoting cosmetic and adhesive dentistry during the nineties. I knew I was part of a revolution and I was contributing to an industry-wide transformation. At that time, we went from a need-based business model to a need/want business model. In those days, it was common to have a heated discussion with conscientious doctors who questioned the esthetics, reliability, shade stability and the longevity of composite restorations. Many of them doubted the wear and bond strengths of these new materials but I knew the public wanted white fillings and were willing to pay a little more for them. I also knew the insurance companies would soften their position on composites over time because of the controversy over amalgam and the increase in composite restoration insurance reimbursement submissions.

Pioneering products, concepts, and technology have been a burden for me over the years, but it has also resulted in some of my greatest career accomplishments. One of my greatest accomplishments was getting over 85% of my clients to integrate digital radiography when the national adoption rate was in the 30% range. I recall countless discussions about computerizing the offices and putting computers in the operatories. Again, I was met with resistance but I knew it was an inevitability and I persevered. Looking back, I recall the outright fear associated with Y2K. The media and experts warned us about this millennium computer bug that was going to create havoc in computers and destroy networks around the world. Well, we survived Y2K and 99% + of all dental facilities are computerized, have a network and use digital radiography today. In addition, over 90% of all dental fillings done today are with composite materials and adhesive (minimally invasive) dentistry is the gold standard.

Today we are distracted by divisive politics. We struggle with a sluggish economy and a myriad of regulations and mandates. We are distracted by marketers with “Me Too” products (proliferation of bonding agents, cements and composites) who are trying to gain market share by selling you similar chemistry in a different box. We also have the burden of managing people (patients and staff members) through change while trying to operate an efficient business with shrinking margins. We are distracted by the pressure to modernize and digitize the workplace. For some of us it’s a financial challenge, for others it’s a change issue and for many, it’s an internal struggle to keep up or not. I know many fifty-plus year young dentists that expected life and work to resemble something out of a Norman Rockwell picture. They expected to be on “Easy Street”, playing golf and fishing every day. Instead, many middle-aged and older dentists find themselves practicing during a technological revolution. They never expected to be changing and modernizing or reinvesting in their business at this stage of their life. The good news is that we are living longer. The bad news is we will work longer too.

In my work, I am distracted by corporate initiatives, a changing marketplace and a client base that runs the gamut from the technologically savvy to the reluctant participant. Personally, I have been all over the place with regards to technology and keeping up. It is a serious discussion that I have with myself often. For those who know me well I have been a pretty good performer in my work. I have been a top 5% performer for most of my career but the work, commitment, and obstacles are many. I think about my performance and the effort needed to maintain my rank and there are moments when I submit to the temptation to be old. However, on most days, I forge ahead and know that slowing down will not enhance my health, my wealth or mental state. There is something to be said for being amongst the best and leading that still resonates with me. While managing all this change and keeping up with the physical and emotional aspects of work are difficult, the alternative is less appealing to me. I have come to this conclusion that I am still vital and have a great deal to offer to clients, co-workers and the industry at large.

Just like the dentist who must learn how to attract millennials, I too have had to get out of my comfort zone. I’ve moved away from a comfortable existence (working from a monthly call schedule) to an anchor schedule. I anchor my day with an ongoing project or business meeting and call on my clients that are nearby. This allows me to be more responsive and more hands which resonates with entrepreneurial dentists and millennials. These customers are driven to succeed and they are laser focused on production, revenue, and opportunity.

In addition to these distractors, we have disruptive elements complicating an already challenging market place. The competition for dentists and distributors alike is fiercer and less forgiving than ever before. The internet, social media, patient reviews and mobile technology have changed how we market, attract customers and communicate with them. Online giants like Alibaba and Amazon are disrupting retail and business to business commerce. Companies like Google and Facebook are providing data and reviews about you and your organization which requires your attention, engagement and due diligence. And the government is playing a disruptive and, to some degree, a destabilizing role regarding enhancing, improving, replacing or repealing the affordable care act.

The distractors and disruptors mentioned above are why we need to embrace ‘Same Day Dentistry’. SDD is here and many are resisting it just like they did composites and computers and digital radiography. Patients are people and as consumers they want good quality, fast service and fair pricing! SDD means different things to different people so I will try to clarify it. The Boomers are dying, X’ers are aging and Millennials are quickly becoming our best prospects. They want Same Day Dentistry!

What is Same Day dentistry?

Same Day dentistry is efficient dentistry. The goal is to get the most number of people in the chairs and provide them with optimal oral healthcare. We want to produce as much dentistry as we can in those time slots and create the greatest amount of production from those appointments. If you provide a patient with restorative dentistry and bill them or their insurance provider for $900.00, and complete the work in one appointment, you  have maximized output. If you required two appointments to complete this procedure, the billing would take place after the second appointment and your hourly profitability would take a hit.

If you examine a patient during a hygiene appointment and identify a small cavity and treat it immediately, you will have made X. But if you had the patient return for a second appointment, you would have made less. In addition to dental materials and set up costs, you would also lose an appointment slot from your schedule. There are other costs associated with the return visit but for now let’s focus on indirect restorations (lab work).

Here is another scenario: during the hygiene exam, it is confirmed that the patient needs a crown. You ask the patient if they can stay a while so you can prep the site and take an impression. Fortunately, the patient has time so you don’t have to reappoint them for the crown prep and impression. After the appointment, you schedule the patient to return a week or two later so you can insert and cement the final restoration. It is important to calculate the resources and time you have given for this transaction. In the end, this crown procedure has taken two chairside appointments, required costly impression materials and a lab fee.

If you had a digital scanner, you would have eliminated the materials associated with this procedure. You would have gained valuable time to see another patient because the dental assistant would have scanned the impression for you. It’s always welcome when a business identifies a process that can be done by an employee with a lower hourly cost. In this case, the assistants hourly rate is only a fraction of that of a dentist. To summarize: In one visit, you produced the same revenue (billable that day) and created a better restoration than you get from your lab. In addition, you added an appointment in your busy schedule and save money on your clinical supplies and lab fees. You were more profitable and created a very happy patient!

So why is this a perfect storm?

It’s simple. Many factors are creating mass distraction, disruption and uncertainty for small business people. These events are also providing the environment for a new and transformative business model. The technology in digital impressioning and CadCam will transform the way you do dentistry. The popular scanners are so fast that you can scan the upper and lower arches in under three minutes. Some scanners are cordless and others have shade matching capability.

Dentists who embrace digital impression scanning are happier and so are their team members and patients. A scanner will stream line many processes and will help market your practice. It will reduce supply costs and you’ll add valuable patient appointments to the schedule. Competent and well trained clinicians will learn to produce implant guides and other indirect restorations (veneers) with lucrative profit margins. You’ll be able to profit from these cosmetic restorations and bill them at a fraction of the cost of your competition.