It's one of the most difficult decisions a senior dental student faces:
"What to do next?"

Should I associate with the dentist in my home town who encouraged me to go to dental school? What if we don’t get along and this covenant not to compete will prevent me from working in my hometown. Should I start my own practice from scratch? What if no one comes to see me and my student loans are so high… I could have to file for bankruptcy. Maybe I should join the military and learn a little bit more and pay off some of my loans. But then, I’ll be over thirty before I can really get started in private practice and I want the big money now. Come to think of it, most of my dental school instructors were in the military. No… I definitely don’t want to do that. I know that it is the least respected option, but maybe working for Sears as a dentist wouldn’t be so bad after all. No responsibility, OK salary, working weekends, no equity interest in the practice, Naaa. Ah ha, I’ll do a general practice residency and then make up my mind. That way I can put it off for another year.

Meanwhile I’ll learn to do all of the specialty procedures so I won’t have to refer any of them out when I do get into private practice. Yea, that’s what I’ll do. Then I’ll decide next year. And that’s exactly what I did. The following article will contain bits and pieces of what I have done over the last decade since I graduated from dental school at Ohio State in 1987. I have built from scratch one of the more successful practices in the country. Lets first go back to the beginning.

Following my general practice residency graduation from The Richland Memorial Hospital in Columbia, South Carolina I arrived in Cincinnati to begin what was to be a busy associateship. I already had a bridge and two crowns scheduled on a patient before I even arrived. What I later found out was that this patient could only come after seven pm and the senior doctor had no interest in treating this case. In fact most of the patients I saw were in the evening after the regular staff had gone home. Most of the time I worked by myself with no front desk person, hygienist or assistant. This is not what I had in mind. After a few months I was told by the senior doctor that this situation was not going to work out in the long term. You see, I was supposed to buy his practice in the next couple of years. Incidentally, it took him seven more years before he finally did retire.

I continued to work for him for a few more years while I started my own practice on the other side of town. In fact, I also worked for a government subsidized program in rural Ohio on Wednesdays extracting teeth. I made $ 10,000 per year working one day per week in 1988. This income coupled with a similar cash flow from my associate job kept me comfortable. I must let you know that thanks to my wonderful parents, I had no student debt and was not married. With out these other jobs, I could not have started my own practice. I did not take home a paycheck for ten months. I’m now going to tell you just what I did right and what I did wrong from this point on to build the practice I have today.

The most important decision I made at an early stage was location. I was living in an old established wealthy part of town and wanted to practice there. My emotions were leading me toward a big mistake. Most people in this part of town already had a dentist that they had been seeing for years. New families were not moving to this part of town from out of town. Future growth was not promising. Yet my emotions told that I could succeed here despite the obstacles. Fortunately, the local dental supply manager convinced me that West Chester was it. Growth would continue for decades. He was right. Our new patient flow has been tremendous. Our school system is the fastest growing in the state with new homes and light industry springing out of the corn fields.

I knew that there were many new families moving to west Chester from out of state that did not know anyone in the area. They would all eventually need a dentist. The easiest way was to send them a piece of mail introducing myself and my practice. The only problem was that everyone else was doing the same thing. I received a few pieces of mail from staff members that other dentists in my area were sending out. I was greatly encouraged because the other mail pieces were so bad. Spelling errors, poor quality Xerox copies, metered mail, computer generated address labels and poor content were what I was faced with for competition. I came up with a nice one page letter with numerous benefit statements for the potential patients, like expanded hours and services, intraoral camera’s, caring environment, and on time appointments. The stationary and envelope were heavy grade linen paper. A first class stamp was affixed to the front and the address was hand written very beautifully. Later we added a magnet to the package. Even if the letter was thrown out, no one can pitch a magnet. It is usually put on the refrigerator to hold that one extra piece of art from little Johnny’s pre-school. We still do this direct mail campaign every month. A list of new families is purchased from a real estate company. We send out about 180 pieces per month and generate about ten referrals per month. This is extremely cost effective at about $1.10 per letter sent.

Consumer friendly hours are another very important factor in the rapid and successful expansion of a dental practice. Consumer expectations of hours of operation for places of business have changed drastically over the last thirty years. I remember when I was a child that nothing was open on Sunday. Over the years almost every business has evolved their hours of operation to include every day of the week. We expect this. If a business is not open when we expect them to be, we become angry. Just last week I completed installing a satellite system for my house on Sunday afternoon. An 800 number booted up on my screen to activate my system. I assumed that there was no way it could be activated on Sunday, but I called anyway. I was promptly greeted by a cheery voice welcoming me to the Dish Network and I was receiving their signal in ten minutes. I was extremely happy with them and will not forget it. Banks being the archaic industry that they are, are just beginning to offer expanded hours. The banks that survive and thrive in the future will be accessible 24 hours a day, seven days a week. A successful dentist must be available beyond the hours of nine and five. It need not be every day, but some expanded hours are necessary for growth. Our office is open Monday through Friday with hours as late as eight o’clock two days a week. Our phone is answered by a person every hour of every business day. Our front desk staff staggers their lunch hours so the phone can be answered. People do not like to recordings or voice mail.

The office environment in a successful dental practice needs to be comfortable and friendly. Let me start off by telling you what a dental office should not be like and contrast that with what it should be like. It should not have chairs with fiberglass seats and chrome legs, but have comfortable living room furniture. It should not have a sign in sheet and a sliding glass window , but have a smiling receptionist that greets the patient by name and offers them a refreshment. It should not smell like a "dental office", but have scented candles burning or fresh bread baking. It should not have last years issues of magazines brought from the Doctors home, but have a large selection of current magazines, many coffee table books, a before and after photo album, and a reception room television playing a patient education program. The office must not be dirty, but be spotlessly clean. The ambient sound should not be of screaming children, whining drills, groaning patients, and ringing phones, but be of soft relaxing music in every room. The decor should not be dated, but be cheerful and up to date. You get the idea. It should be everything the stereotypical dental office is not.

Every dental practice needs help. Efficient systems are necessary to handle every aspect of the dental office. During my senior year in dental school, I was fortunate enough to attend a series of lectures by Rick Pereira. Rick is a practice management consultant and volunteered to impart some of his wisdom on our senior class. I thoroughly enjoyed his lectures. This was the kind of stuff that none of got enough of in dental school. I contacted Rick when I was trying to arrange a buy in and contract with the doctor I was associating with. I soon came to realize that I knew very little about the business of dentistry and that I would need some help. After my first full of private practice in my own practice I hired Rick to spend two days with us to work on systems. This was a tremendous expense for me at the time, but turned out to be worth every penny. You see, I thought that we were doing alright. I thought that our systems were pretty good. They just needed a little fine tuning. The first thing we decided to concentrate on was recall. Rick asked me what I thought our recall percentage was. I told him that I thought it was about 100%. So Rick pulled 100 charts to see how many patients had been in in the last six months. I was astounded to find out that only thirty had been in. We decided to change our recall system and to preappoint all of our patients for their six month recall visit. Since that visit, I have had Rick return to our office about every two years. We get our blinders on and after awhile, we can only see straight ahead. Rick could come in and point out things that we never would have seen.

Our patients have also been a source of help. You see, we give our patients a survey and ask them to grade us on our performance and to ask for suggestions. You would be surprised to see how much you can learn from your patients if you just ask

.Use your hygienists to full advantage. Hygienists are one of the greatest assets that a dental practice can have. When we first start in practice the doctor usually performs all of the prophy’s and usually the X Rays. But this is not the best use of your time or your hygienist's skills.

Seek out continuing education. Continuing education is perhaps the most important of anything you can do to further your career. In dental school we learn just enough to get our dental license. There is far too much to learn in dentistry than can be taught in four years. Most of the techniques we learn in dental school are tried and true. They have worked for years and you will not get into any trouble practicing them. The problem is that they aren’t any fun. I have a blast performing dentistry. I constantly try new procedures. I push the envelope of applications and materials. I have patients come into my office and say, "Wow, This place is really different!". I am able to do this because I have learned a great deal after dental school. I have taken over 200 hours of continuing education every year over the last decade. I have focused these hours on procedures and applications that I enjoy doing. I don’t perform endodontics so I don’t take courses in endodontics. I love restorative dentistry. I have taken so many courses on this subject that I feel that I should be giving the lecture. If I spend all day in a lecture and learn only one pearl, it is worth it. I also have reaffirmed in my own mind that we are still doing it right… on the cutting edge.

Read every professional journal you can. You will recieve a flood of journals once you are in practice. Many of these journals are practically useless. However, some are tremendously educational. Ironically, the journals published by the political institutions of dentistry such as the ADA are the least interesting and are usually far removed from the everyday problems associated with the practice of dentistry. This, however, does not stop me from reading them. I feel that it is extremely important that you take the time to read every thing that comes across your desk that has to do with your profession. Reading to improve and advance your career also includes books, journals and periodicals not normally associated with dentistry. You must learn about how to manage people, how to manage money, how to provide excellent customer service, and many other skills that are not taught to you in dental school.

Keep your life in perspective. No, this doesn't have anything to do with growing your practice. But I believe it is a key to a successful practice.With all of the things you have to do to get your practice off the ground, it becomes critically important to learn to balance work, family, play and inner peace. If all of these elements of life are in a happy equilibrium, you will be successful. Success and it’s definition is a personal matter and if different for everyone.

These are but a few of the hundreds of things that we do every day to make and keep our practice a tremendous success. It has been a long road to travel, but being well on the way in our journey, the trip itself has become a great source of joy. In fact arrival at my destination can only be a let down because the trip is so much fun. Take your time and enjoy the journey you are about to embark on. Learn as much as you can on the way. Someday you will turn around and look back and smile, only to realize that you have traveled a long way.

Lessons I Learned From Starting My Practice

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