The Times They Are A-Changin’

In Business by Dental Entrepreneur

You can breathe a sigh of relief as your final clinic patients are complete and national and state boards are behind you. Perhaps you can finally get lost in a book, purely for pleasure. You’re young, brave and filled with new ideas as you carve out the prospects of creating this next chapter in your life as Dr. ______. Congratulations! As you make your way to the path of success as a fresh new dentist, you follow in the footsteps of many who have come before you.

Those before you faced many challenges that can now serve as a rich source of experience for you. You’ll find, many of those challenges are not much different from the ones ahead of you. However, it is clear that the landscape in the delivery of care is shifting and providing some new challenges along with opportunity like never before.

I invited a colleague and friend, Dr. Dennis Pezzolesi to join me as we explore a few critical challenges and opportunities in an effort to support you in making your next big move.

Student Loans and Expenses

According to the American Dental Education Association (ADEA), the cost of dental school education has doubled since 2000, leaving a heavy financial burden on you and your colleagues.

The result is student loan debt in the neighborhood of $200,000 to $300,000 — translating into a $2,000 to $3,000 monthly bill for 15 years. Sadly, this is not uncommon. Add to it the estimated budget for the start of a dental practice at roughly $500,000 and you’re likely to doubt your chances of success in opening a solo practice. It is not completely out of reach if it is truly an option you want. However, what is crucial is creating a game plan to make it happen.

Managing debt and making powerful financial decisions now will support you in building the foundation for your long-term success in dentistry. You can do that by surrounding yourself with key people who will mentor and support you through the process of setting goals and designing a course of action to achieving your desired outcome. Keep in mind, you don’t know what you don’t know and getting connected to the right people can unlock a lot of mystery and possibility for you.

Clinical Competency – Getting Fast … Fast!

Practicing dentistry in an office is an entirely different ballgame from the safety net of the clinic floor in school. Getting into the swing of a practice — keeping pace, working with a team, managing new systems and flow – all while maintaining a high-level of quality care can seem overwhelming. However, getting good and fast at what you do will accelerate your growth and bring you closer to achieving your goals. Dr. Pezzolesi adds, “…bottom line in this business is, you need to get good at what you do and quickly.”

He believes the three key areas to develop, following clinical skills, are:

  • time efficiency
  • communication
  • treatment planning

“All of this comes with experience and the more you can do that early on the better you will become,” he says. “Anyone coming out of school that will not be doing a residency, I absolutely recommend she/he consider taking a couple of years to practice in a large group setting, if for nothing else, for the experience of the number of patients s/he will see.”

Owner Versus Associateship Dilemma

Your dreams may see you in your own private practice and yet, the reality may be taking an initial step as an associate. This doesn’t have to be a conflict. However, it is a component in making those powerful financial decisions and how that can directly impact your long-term success.

Here are some things to consider as an associate:

  • offers a built-in mentor
  • often need to settle for lower-paying hygiene positions if the prospects to hire on as an associate are not available
  • common expectation is the new associate will build a patient base with the existing new patient flow and/or bring in his/her own new patients; resulting in the added responsibility of marketing and generating new patients
  • smaller private practices may not have the systems and protocol to support high-efficiency and volume
  • due to the expense of high technology, the smaller private practice owner is often limited in keeping up with the demand to utilize the finest products and materials and deliver state-of-the-art procedures
  • as a new associate, you are often expected to work with a team in which you did not choose and may find yourself in an environment of unmanaged and untrained team members, frequent turnover and HR issuesAs an owner:
  • for many, the idea of buying or starting a new practice is financially inconceivable and
  • overwhelming without the right mentoring and support
  • cost of hiring and developing a quality team
  • managing HR, overhead, marketing and generating new patients
  • invest in coaching and consulting for establishing operating systems and clinical protocols

I believe the opportunity to own is always a viable option available to you. However, as a new grad, it’s critical to take the time to plan, network and use the support and counsel of a successful dentist and then invest in a financial and business team to support your long-term goals.

Influence of Corporate Dental Group Practices

One influence shifting the landscape of dentistry is the rise of large group practices. One concern is how some private practice owners are viewing this change. I’ve often heard many refer to these groups as, ‘the Walmart of dentistry’ and express their fear of how this rise will be a threat to their practice and overall patient care. While I have nothing against Walmart, I think we can agree at which the tone implies. Based on my research, reputable dental group practices are not lacking in any area of patient care. In fact, Dr. Pezzolesi shares his personal experience, noting, “These practices are scrutinized more closely than any private practice. Currently, I work with the most well-rounded and progressive soft tissue management program that I have ever experienced in private practice. If anything, large group practices are setting the bar for a high-level, proactive approach to diagnosis and treatment.”

Perhaps their lead could alert our industry to up our game. Examining and making adjustments to diagnose and treat disease with a more progressive approach ultimately serves the best interest of the patient.

In viewing the large group practice as an opportunity, here are some key benefits to consider:

  • build clinical skills and speed
  • offers a built-in mentor
  • solid income and strong benefits package
  • pay off student loans without the stressors of owning a private practice
  • opportunity for future ownership (percentage of profits or equity) – without having to deal with the management aspect of the practice
  • future option to purchase a practice or become a partner with affordable in-house financing and support
  • deliver enhanced patient care with the most state-of-the-art technology and products – more affordable for group practices to invest
  • become proficient with charting, software and computer use, proven protocols and systems, presenting treatment and communicating benefits to patients
  • organizational consistency and increased quality assurance
  • experience working with a high-level trained team
  • less interaction with insurance, HR concerns, OSHA and HIPAA compliance, collections, managing equipment, ordering and supplies, marketing, referrals, and generating new patients

Dr. Pezzolesi’s vast experience and insight is built on 28 years as a practicing dentist. Therefore, I asked him to share his perspective of large group practice and what led him to where his is today.

Here is what he has to say: “After years of practicing dentistry in every conceivable way — solo practitioner, boutique practice, partnership and HMO clinic setting — what I found was that large group practice was my best fit. Aspen’s Practice Ownership Program (POP) was the best way to get that group practice with ownership. I get to do all phases of dentistry, see numerous new patients per day, have autonomy in my choice of supplies and labs all with the advertising and purchasing power with Aspen as my partner. Most, if not all, the management part of dentistry is performed by highly trained team members that become part of my team. I get to do my dentistry and go home, all while owning a busy practice that is growing every year.”

Ultimately, the experience of working with a large group practice out of school can be a springboard into developing your own practice. With the gained knowledge in the operations and what it takes to develop a successful practice – enhanced clinical skills, know what you want and how you want it from the layout of the office, to software and technology, to hiring and developing a winning team – you can be ahead of the game once you’re ready to operate your own practice.

The Difference for New Grads

An area that could make a tremendous impact would be a rise in the mentoring and leadership of mature private practice owners. Today, many private practices are not financially prepared to bring in an associate to expand the practice. The idea of bringing in an associate, under the wings of the practice owner, to mentor and support is lacking. This simple practice would support new grads in growing quickly as successful dentists and have a positive and direct impact on patient care as well as the growth and strength of the dental industry.

I strongly recommend that new grads actively participate in their professional organizations, commit to leadership and mentorship development, engage in networking opportunities, continue their education and inspire involvement from practice owners with students and new grads.

Lastly, the rise in the cost of education is hindering new dentists from expanding their options and growing quickly. Lobbying for revised tuition and addressing scholarship challenges that students face can have a direct impact in paving the way for a smoother transition.

Despite the challenges, there is always opportunity. These are exciting times for you. Get mentored, plan and get crazy! “Because the people who are crazy enough to think they can change the world are the ones who do.” -Steve Jobs
Dennis Pezzolesi, DMD Tufts University of Dental Medicine, 1987; Practice owner at Aspen, Natlick, MA; Member of ADA, MASS Dental Society, Fellow Academy of Comprehensive Esthetics

Christine Brooke, RDH is a Southern California-based dental hygiene coach and founder of Hygiene by Design, committed to empowering dental teams to develop an extraordinary and profitable dental practice. Christine is all about the discovery process of what’s possible and laying the groundwork for you to blend practice and life rich in purpose and passion. To begin your path to long-term practice growth, productivity and designing the life and practice you love, go to www.hygienebydesign.comto download FREE your Roadmap to a Wildly Successful Hygiene Department.