By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

During a break at a recent Leadershippresentation, some dentists were talkingabout how hard they work. The discussionwasn’t particularly new—most practitioners,at one time or another, feel they are overworkedand underpaid. However, one dentist(a littlemore vocal than the others—caught myattention: “I just wish someone would showme how to work less and earn more.” Hisremark got us all thinking. Can dentists workless and earn more?

I’m convinced they can and �rmly believethe 10-step program outlined in this articlecan set the process in motion. Note that wepurposely left out any reference to 10 “easy”steps. Although achievable, like most worthythings in life, the “Work Less-Earn More”goal requires motivation, planning, disciplineand dedication.

THE “WAR ZONE”Many dentists attending clinical seminarsand practice management programs are inwhat we call a mode of busyness or a “warzone.” I suspect that’s the case with thedentist who asked how he could work lessand earn more. These dentists have alreadycrossed the barrier of starting a practice, arenot particularly worried about day-to-day�nances and don’t have pressing concernsthat the rent won’t get paid. But they areexperiencing discontent because they seemto be running all day and getting nowhere.They dream of seeing fewer patientsand

doing comprehensive care but are so busythey haven’t time to get organized and initiatechange. Besides, all too often they are lookingfor a quick �x(and there never is.

Interestingly, in many of these situations apersistent voice nags, “Can’t I do better?Shouldn’t I be able to get more out of thispractice?” These are honest questions thatbeg answers. How badly do I want it? Howmuch distress am I willing to put up with toachieve my goal? At this point, it’s wise forthe dentist to step “outside” of the practiceand view it as if he or she were looking intoa mirror. It’s decision time. It’s time to honestlyanalyze what the mirror re�ects back. Hereare just a few considerations for your ownpersonal mirror. They vary according toparticular practice circumstances:

• Am I really that busy? How did this happen?• Are clients being denied ideal dentistry

because I’m too busy?• Is the team working but lacking the momentum

for real growth?• Am I taking time for true collaboration with

specialists and laboratories?• How con�dent am I in my clinical techniques

in all this busyness?• Am I just going from day to day without a plan?

Once this personal appraisal is completeand you’ve said to yourself, “With all thisrunning around, I’m at this level, but I know Ihave the potential to be up at that level,”

then you’ve made your �st big move. It’s amove that will set you on the road to seethose just-right patients and help you treat theright cases for the right value. But the transitionfrom busyness to productivity must be creativebecause you don’t want to alienate eithersta� or patients.

Now that the decision is made to move out ofthe war zone, you’re ready to deal with the10 steps of working less and earning more.The �st �ve steps are extremely important.They are all about laying the foundation fordoing more with what you have and whatyou already know.

1. Recare and Hygiene—Windows of Practice Success

2. Case Presentation and Acceptance—Creating Value

3. Are You Diagnosing Needs or Wants?4. Clinical Skills

—Deliver Dentistry More E�ectively5. Team Skills

—You Can’t Do It Alone6. The Invitational Practice

—“You Have to See My Dentist!”7. Referring Out

—Everybody Wins8. Puri�cation

—It’s About Ability and Utilization9. Associateship and Transition

—Extra Hands Equal Extra Value10. Dental Fees

—A Balance With Quality Service

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If you feel like you’re constantly on a treadmill and cannever get ahead, read on. These steps will get you on trackto reach your practice dreams.

By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

1. Recare and Hygiene—Windows of Practice Success

It’s no chance happening that recare andhygiene rank No. 1. Recare is an indispensa blepart of the patient’s treatment plan. It reinforcesthe thoroughness and need for a lifetime ofoptimal oral care. Recare and hygiene arethe windows—they provide the numbers(toanswer the questions, “How well am I doing?Am I really that busy? Can I do better?”

Recare and hygiene can indicate whetheryour grasp of busyness is fact or �ction.Often a “busy” practice proudly claims, “Wehave 3,000 charts and see 25 new patients amonth.” But when asked if they have addedany new hygiene days in the past few years,the frequent response is, “No!” In reality,this “busy” practice probably has only about1,500 charts, with 25 patients walking out thedoor as 25 new patients walk in.

My advice: Hygiene is more than a cleaning.Before anything else—particularly with thenew patient, make a speci�c point to discussthe importance of dental hygiene so thepatient understands clearly that seeing thehygienist is not “just another cleaning.” Inreality it is a clinical appointment leading toa lifetime of optimal oral care.

Know your numbers. In consulting with dentalpractices, we always start with a thoroughchart audit. (For a detailed discussion onchart audits, see my article “How to achievea 96% patient retention rate.”)

A good example of the “numbers game” andthe role of the chart audit is this: Say yourhygienist works four days a week and sees apatient every hour—32 patients a week.Presuming every patient shows up for twovisits a year, then the hygienist can handleonly 800 charts a year. If that is the capacity,how is the new-patient �ow looked after?And how does this match up with what youthink your patient numbers are?

Look at hygiene downtime. Downtime shouldnever be more than 5% to 8%. If you are havingongoing problems with hygiene downtime—and your chart audit reveals excess patients—then either your recare system is notbeing e�ectively administered, or both yourteam and your patients need training on thevalue of dental hygiene.

2. Case Presentation and Acceptance— Creating Value

Case presentation and acceptance are allabout creating value in your patient’s mindabout his or her dental needs. Patientacceptance requires a total team e�ort andis created when a “we care” attitude lies atthe foundation of every treatment phase.

Doctors must make certain that they activelyeducate patients about their mouths andmotivate them to achieve optimal oral healthbefore asking them to accept a treatmentplan. To achieve treatment acceptance youhave to help patients understand their dentalneeds and instill in them the desire to dosomething about them. It’s about creatingvalue and establishing strong relationshipsbuilt on trust and respect. And everyone bene�ts.When patients accept comprehensive dentistryrather than basic insurance-plan treatment,the quality of their oral health is signi�cantlyenhanced, and at the same time the dentist’schairside per hour returns substantially improve.

Presentation and acceptance—like recareand hygiene—are numbers that can becalled up, checked and analyzed. If you feelyou aren’t as e�ective in this area as youwould like to be, you may be:• Only presenting treatment you are certain

the patient will accept• Only presenting treatment covered by the

patient’s insurance plan• Only presenting emergency treatment that

is easy to justify

• Assuming patients will only ask about cosmetictreatment when concerned about their smiles

• Assuming patients cannot a�ord certaintreatments or materials, or

• Failing to retain patients in hygiene so thatunaccepted treatment can be re-communicatedand accepted at a later date

My advice: If you feel rushed to present thecase properly at the end of the appointment,particularly new-patient appointments, examineyour scheduling. Give yourself enough timeto focus on the case presentation and not bedistracted because a patient is waiting in thenext room.

For a period of 30 days, spend an hour at theend of each day going through all yourcharts and asking yourself, “Could I havedealt with this patient di�erently? Did Ipresent the dental treatment I would wantfor my own family—the people I love? Wasthere a need for esthetics, implants, ortho(orany other particular treatment— and did Icommunicate these options e�ectively to thepatient? Was it accepted? If not, why not?”

Sit down with your team and review yourpractice’s protocol of giving patients theideal dental experience. Is the team’s visionfor dental care the same as yours? Is it possiblethat you could be telling the patient thatesthetic treatment is a wonderful optionwhen the hour before the hygienist didn’tthink it was really worth it?

You don’t have to be modest. Don’t be afraidto create value for yourself. You don’t have tojustify your fees if you have faith that “I’m goodat this!” If you have trouble communicatingthis message, think about having a treatmentcoordinator present the case. We have seencases in which a team member gets a higheracceptance rate than the dentist simply bytelling the patient, “Our doctor is one of thebest in town for this kind of treatment.”

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3. Are You Diagnosing Needs or Wants?It is not the purpose of this article to teachthe �ne art of diagnosis. What we do want todo— while addressing time expended andbene�ts accrued—is to determine your levelof participation using the most advanceddentistry at hand.

Are you only diagnosing basic dentistry, whichall too often is related either to what thepatient wants or what the dental insuranceplan will cover? Or, are you looking at thecomprehensive value-added dental needsthat contribute immeasurably to the patient’slifetime of oral health and quality of life—plus your pro�t margin? The dentist who isbusy-busy and not doing anything about itmay not be recommending value-addedtreatment because all his or her time is �lled justtreating to the limits of the patient’s insurance plan or serving the “wants” of the patient.

My advice: This may be the time to re-examineyour practice philosophy. Review and renewyour commitment to ideal patient care. Isthere a di�erence between what you saw,what you communicated to the patient andwhat the patient accepted? How are yourcommunication skills these days? Perhapsthis is a good time to candidly analyze them.

Are you diagnosing needs or wants? As adiagnostician, your ultimate responsibility isto tell the patient what you see and thenrecommend proper treatment. Are youtaking the time to explain crowns, implants,veneers, perio, ortho—whatever is best forthe patient’s oral health and quality of life?Are you answering their questions in termsthey understand?

How con�dent are you in your diagnosisskills? A tip we often suggest is to think ofsome of the best clinicians in North Americaand say to yourself, “Am I seeing the sameneeds they would see in this mouth?” If thequestion makes you feel uneasy, then dosomething about it.

4. Clinical Skills—Deliver Dentistry More E�ectively

When you’re looking for a way to break outof your busy zone and it seems all your timeis �lled, one of the most productive things youcan do is to increase your ability to deliverdentistry more e�ectively. The quality andquantity of your dental skills directly in�uencethe value of chair-side time. Without question,one of the best ways to keep those clinicalskills e�cient and e�ective is continuingeducation.

My advice: Take at least two major clinicalprograms a year if you want to remain enthu-siastic in a particular area. It’s not alwayseasy to �nd the CE course that best suitsyour needs, and you will have to do someresearch. Who are the leaders? How longhave they been around? Do they practicewhat they preach? What do you hear backfrom others? Have they published theirresearch and techniques? Do they have apresence on the Internet? Do they have auniversity a�liation? Have they presented atlarge, reputable meetings?

Look at the type of dentistry you did in a90-dayperiod after taking a major CE programand ask yourself: “Did going to that coursemake a di�erence?” Don’t be surprised thatyou are not only diagnosing di�erently butalso are treating di�erently because nowyou have more knowledge, are morefocused and committed, and are less likely toallow busyness to intervene. Chances areyou will never look at patients’ mouths thesame way again.

Join a study club. There probably is no betterway to ensure that clinical skills are maintainedthan by joining people of like spirit in anenvironment where the focus is on learningand excellence.

Start looking at specialists as professionalswith whom you can collaborate, rather than

as people at an o�ce to which you sendpatients and wait for their return. We havenever seen the specialist who isn’t willing towork with the GP to jointly determine what isbest for the patient. It’s amazing how muchthe GP and the specialist can learn from oneanother.

5. Team Skills—You Can’t Do It Alone

Whether you have a three-person o�ce or a25-person o�ce, you have no chance ofdecreasing time or increasing income withouta skillful team. In the process of breaking outof your busy zone, you’ve accepted challengesand made certain personal commitments. It’snow your responsibility, as a leader in thepractice, to bring your team out of their busyzone to accompany you on this journey ofgreater prosperity. You can’t do it alone.

Team participation is a large, encompassingtopic, and we do not have space within thesepages to discuss this topic fully. For details onhow to hire and develop a loyal, participatingand contributing team, see my article, “Put astop to the revolving door” in the May/June1999 issue of Dental Practice & Finance oronline at www.dentalproducts.net.

Share with the team your vision of patientcare and practice goals. Work hard to com-municate that it’s this vision, built on trustand respect, that creates value and estab-lishes strong relationships. This is the visionthat educates patients about their mouthsand motivates them to achieve optimal oralcare. And it’s the vision that returns rightfulrewards to all involved.

Share your philosophy of continuing education.The teams we see working together best arethose who share continuing education. Theyare the practices where the dentists say:“This is the kind of dentistry I love to do.

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By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

I’m going to make a commitment to be moreknowledgeable in this area. And I’m making thesame commitment to give you the educationyou need so we can be the best we cantogether. It’s going to be a challenge butwe’re all up to it, and I know it’s going to befun.”

The �ve preceding steps will help you on theroad to working less and earning more. Byrealizing you are no longer satis�ed with “justcoasting along,” you can expand on whatyou already know. You know you have to getyour patients to keep coming back, you haveto get them to accept treatment and youhave to diagnose to the best of your ability.You also know you need to have excellentclinical skills to produce the �nest quality ofdentistry. And, of course, you know that yourteam has to be right there along with you.The �nal �ve steps will help you build on thatfoundation.

6. The Invitational Practice—“You Have to See My Dentist!”

Each of the �ve steps I discussed in the �rstpart of this series was designed to create anenvironment that encourages trust, respectand universal values between practice andpatient. In this scenario, a patient wants tocare for his or her own health and make it aprime part of his or her life. These are thekinds of patients you want to see in yourpractice.

When you work at creating this environmentand fostering relationships with this sort ofpatient, a remarkable course of eventsoccurs. You turn an ordinary patient makingordinary referrals—“Oh, you should see mydentist”—into an extraordinarily committedpatient who enthusiastically says to relativesand friends, “You have no choice; you havegot to see my dentist because he/she is thebest.” Quality patients who value your servicewill refer other quality patients with similar

mindsets. The goal is to �ll your practice withsuch patients.

We call this the invitational practice and it willhave a powerful e�ect on your relationshipwith newly referred patients. Patients whohave been referred this way come into yourpractice with a predetermined knowledgebase—they expect value and they know thatyou can deliver. Of course, this makes casepresentation and acceptance much easier.The patient who invited the client to youro�ce did half your case presentation for you!

My advice: Together with your team, committo doing everything possible to create aninvitational mindset from the moment thepatient �rst contacts the o�ce. Look at thetotal client experience. Ask yourselvesregularly, “How can we keep building andreinforcing the invitational spirit from thetime of the very �rst appointment and everyone thereafter?”

It starts with, “Mr. Smith, welcome to ourpractice. We are going to provide you withthe best possible care so we can earn theright to your invitation. Just as your friendJohn invited you to our practice, somedayyou also will invite someone special. That’sthe greatest compliment you can pay us, Mr.Smith, and every invited referral is very special.”

More likely than not, these patients willcome to your practice with an appreciationfor valueadded dentistry, which of course,makes them even more special and valuable.Show them how much you value their trust.While your new patient, Mr. Smith, is in theo�ce, write a few personal notes on thebottom of a standard letter thanking John, theperson who sent him to you, for his referral.Mr. Smith will not only be impressed withhow much you value him, but also withhow you value your relationship with hisfriend John.

How valuable is the invited referral? If yourpractice has 2,000 patients and you aregetting 20 referrals a month, it will take 100months— or over eight years—for eachpatient to make even one referral.

7. Referring Out—Everybody Wins

The general practitioner’s greatest role is thatof a quarterback. The GP controls the patient’saccess to optimum care and coordinates theteam’s activities to reach that goal. Thegreatest quarterbacks use the team to thebest of their ability; they do not hold on to theball too long to reach their own glory. If theGP chooses to perform comprehensive care,then he or she must accept the fact thatcomprehensive referrals will be part of thepicture. This is where the �ne art of referringcomes into play.

My advice: Referring should never be a matterof: “Now that I’m busy, let’s send the case tothe specialist.” Nor should you only referprocedures you don’t like to do or proceduresyou tried before that didn’t work. Rather, lookat each case comprehensively. Determinewhen the help of a specialist could help thepatient achieve optimal dentistry.

This may mean you’ll have to sharpen yourabilities as a diagnostician. Every quarter-backing GP should ask these basic questionsof himself or herself: “Do I have the ability tocompetently diagnose all the treatment optionsavailable to the patient? When I examine thepatient, am I doing so comprehensively, keepingin mind what everyone on the dental team iscapable of doing? Or, am I intent on just�lling my own appointment book?” If there issome doubt, you should seriously considersigning up for relevant continuing educationcourses and developing a more collaborativerelationship with your specialists. There isno shame in going to a specialist and saying,

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By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

“Tell me what I should know!” Developinterdisciplinarystrategies. Join study clubsthat allow you to communicate better and createconsistency of treatment for your patients.

Again, it’s a matter of creating value. Whathappens when you say the following to yourpatient? “Mr. ________, you need to see aspecialist.I want you to see Dr. _____.He/she is the very best I know. In fact, ouro�ce will phone right now and make theappointment for you.” You create value. It’s awin-win. The better you make your specialistlook, the better you look in the eyes of yourpatient, not to mention in the eyes of yourspecialist.

8. Puri�cation—It’s About Ability and Utilization

Puri�cation is a re�nement and simpli�cationprocess. It involves cutting away the clutter,so you can deliver optimal dentistry in themost e�cient, rewarding manner. It meansvaluing your time and making the most ofhow you use it.

Say you’ve determined the number of daysyou want to work per year. It may be 190, 175or 160 days per year... it is the number ofdays you have decided you want to work.What happens when that schedule becomesfull? Do you continue to do things the sameway where you just keep getting busierand busier? Or do you choose to enhanceperformance and value? If you choose tochange your habits in order to maximize thevalue of time, then you’ve reached the stateof puri�cation.

My advice: Puri�cation is all about ability;speci�cally your ability to diagnose morecomprehensive dentistry. Ask yourself: Areyou diagnosing comprehensive dentistryrather than diagnosing according to thepatient’s insurance policy? You may need tosharpen your ability to coordinate the entire

oral care team, including specialists, towarda more comprehensive approach.

This means you schedule procedures thatincrease the value of your time. Evaluateyour own ability and the ability of your team,and determine whether you should attendcontinuing education courses to reinforceand enhance your capability and e�ciency.

Once you’ve honed your ability to diagnosecomprehensive dentistry, you need to utilize it.That’s the key to patient acceptance. Ifpatients aren’t accepting your treatmentplans, then you and your team need to bettercommunicate the value of your dentistry.Again, by attending a carefully selectedcontinuingeducation course with your team,you will go a long way toward improvingthe utilization that delivers dentistry at itshighest level.

In the puri�cation or re�nement process, youalso may have to make some decisions aboutwhich patients you want to keep in your practice.Often these choices are di�cult. Considerthis dilemma. What is more important: themodest-means families seeking only basicdentistry but who rave about you all the timeand regularly invite others to your practice?Or, the wellheeled client who regularly keepsappointments and accepts every suggestionof comprehensive dentistry but has neverreferred a patient to your o�ce in his life?Which is the most important to your success?

As suggested, these choices are not alwayseasy. But a bit of arithmetic on the value ofreferrals may help. An average patient’s valueover 20 years for just basic care that includes14 hygiene appointments, 20 completeexaminations and whatever essential care isrequired totals about $10,000. If you have apatient who refers only four or �ve clients toyou over a 20-year period, then that trustingreferring patient is worth more than $50,000to your practice.

9. Associateship and Transition—Extra Hands Equal Extra Value

Hopefully, each of the preceding steps,carefully executed, will bring you to a pointwhere you don’t have su�cient time to dothe dentistry you like best. You can’t workany faster, and you don’t want to put in longerhours. And, if you’re like most dentists, youaren’t comfortable telling a patient that he orshe has to �nd another dentist.

It appears that you have reached what we callthe “sweet spot” in the life of your practice.You have developed your practice to thepoint where it can support more than justyou as the sole provider. Not only are younow a successful clinician but you are also asuccessful business owner.

It’s decision time. Do you take the necessarysteps to recapture the excess value you’vebuilt into the practice over the years or doyou allow it to slide away? Unfortunately, I’veseen too many dentists just “top out” and letthe excess go. The wise dentist accepts thatthere’s excess practice value that isn’t goingto be retained through manipulation of theclinical schedule. They welcome the realitythat it’s time to take on an associate.

My advice: Understand you are not makingdecisions about either client care or quality ofcare. You are making decisions about the valueof your business. It is important at the outsetto seek out the best possible professionaladvice. You need to learn everything there isto know about bringing on an associate.

The ideal transition starts �ve years beforethe associate comes on board. Within everyassociateship there is an education process,a planning process, an implementationprocess and a mentoring process. Throughoutthese processes, you want to do everythingyou can to retain the value of the practice.

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By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

You’ll gain nothing by rushing one of the mostimportant aspects of your career. Plan allagreements so the new dentist can e�ectivelyand in a timely manner be brought to thepoint where he or she can a�ord to pay youfor the share of the business at its full value.

Take the time to recruit the right person whohas the ability to communicate, has a properattitude toward learning and who possessescompatible goals for the future. Realize thatat the outset, this person won’t be able todeliver at your level, but he or she should havethe potential to quickly grow to your level.

10. Dental Fees—A Balance With Quality Service

It’s no accident that dental fees comprise thelast step in our strategy to work less andearn more. You may think, “Why didn’t youjust raise your fees at the beginning?Wouldn’t that increase your income?” It’s notthat simple. Fees are essentially restrainedby the marketplace. In this age of theknowledgeable and discerning consumer,value must be attached to the price. A quoteby Sam Geist in his book, Why ShouldSomeone Do Business With You... Rather ThanSomeone Else? (Addington &Wentworth Inc)puts this consumerism in perspective: “Thereal issue is value, not price.”

My advice: The �rst nine steps in theprocess laid the groundwork necessary tomaster a higher level of value for everythingyou do and a higher level of value for the

time in which to do it. You have worked longand hard with diligence and professionalismto reach the point where patients view avisit to your o�ce as a privilege. They arecommitted to the value of their oral healthand the role you play in maintaining it. Nowyou have �exibility with your fees. Butalways, the fees must be fair and balancedwith the quality of service delivered.

Someone or some organization may tell youwhat your fee should be, but if it’s not the feeyou’re comfortable with, it’s not the fee foryou. When you honestly feel in your heartthat you are worth more than the “usual andcustomary fee,” then go for it! But don’t raisefees across the board. Review your statisticscarefully and then establish fees procedureby procedure. It is also a good idea to sitdown with your team and let them help youcreate a fee structure. This way they will feela part of the value.

BUT WAIT! THERE’S MORE!There is one step left and it is probably themost important one you will ever take. Itshould be an integral part of your �rst stepand parallel subsequent steps throughoutyour entire practice life. It is the initiation ofa �nancial plan that creates economic freedom—the day when you have accumulatedenough assets that will reproduce yourstandard of living for the rest of your life. It ismore than a retirement plan. It is the point intime when, if you wanted, you could quitworking altogether and maintain your

desired lifestyle. Or, if you choose to contin-ue working, you do so because you want to,not because you have to. The key is that youare able to make that choice. And that’swhen real freedom occurs.

My advice: To be e�ective, �nancial planningmust start early, be consistent and be guidedby an expert in the �eld. Unfortunately, toomany leave this important aspect of workingless and earning more until it’s too late. Onlyabout 5% of the dentists reaching age 65 canmaintain the lifestyle to which they havebecome accustomed.

If �nancial planning isn’t emblazoned oneach and every tread of the 10 steps that ledyou successfully to a goal of working lessand earning more, then you must start today.Economic Freedom® won’t occur without a plan.

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By Mercer Advisors

10 WAYS TO EARN MORE AND WORK LESS

First printed in Dental Practice Report

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