The seven most dreaded words a dentist hears during a workday are: “May I speak with you after work?” Does this mean the employee is quitting, needs maternity leave, or wants a raise? Whatever the situation, the doctor hopes they will handle it well.

For the employee who feels the need to ask for a raise, it often takes days or weeks to muster up the courage to ASK! With the slower economy of the past few years, raises have been few and far between. Some dental employees have not had a raise in two or three years yet they feel they are working harder than ever to maintain practice goals. They report going above and beyond the call of duty to keep the schedule full and to work in emergencies.

The best way to ask for a raise is to keep a record of the date of the last increase in pay along with the history of all you have personally done for the patients, practice, and coworkers since your last raise. What CE or online courses have you taken? What above-the-call-of-duty projects have you done recently? Examples might including: volunteering for community activity/service which promoted the practice; working on the marketing committee which met during lunch six times in the past six months; developing on one’s own time the in-school program for elementary schools; and/or participating in the reactivation process of inactive patients. You might say, “I personally called forty-five patients and rescheduled seventeen of them as well as getting four new family members by asking about family members who might not be seeing a dentist.“ Dentists are busy taking care of patients and running a business, so they are often NOT thinking about someone’s last pay raise nor what each employee has done for the practice since that pay raise. Don’t go to your doctor with the “I-need-a-raise-because-I-DESERVE-it” attitude. Go with an attitude of gratitude and show your personal value to the practice. Does this guarantee a raise? No, but it greatly increases your chance of its being considered. It also lets your employer know you are not only assertive but you value yourself.

Every practice has a tremendous ability to succeed far beyond the owner’s expectations. In consulting for over thirty years, I’ve learned the true secret to success is to build a structure, or a foundation, known as the cornerstones. The same is true in every practice, large or small.

The first and most important part of the foundation is COMMUNICATION.

From the doctor to the employee, from employee to co-worker, and from all to the patient. Knowing very little about one’s services and less about the benefits to the patient is the downfall of many professional practices. In his book, Everyone Lives By Selling Something, the author Alan Lord clearly defines this weakness in most businesses as one’s inability to connect customers with the product or services on the shelf. The same is true for dental practices and includes the inability of the doctor to clearly define the mission or goals of the practice to the workers. When the communication within a practice improves, the likelihood of workers enjoying their environment is greatly enhanced.

The second important cornerstone of success is ORGANIZATION.

Some people are totally disorganized which causes stress for others as well as low productivity for all. Looking for things that could be found in seconds versus minutes or hours is one of the key reasons why some practices are not only less productive but also less profitable. I truly believe it is the top 20 percent of efficiency and organization that creates another 40 percent of productivity. Going home “happy tired” versus “stressed-out tired” will be the workplace of the future and one that is highly organized. Some workers are born organized and others struggle with it. I find that some employees need simple organizational plans to accomplish more each day. Outlining these plans step by step, prioritizing the lists by due dates, then color-coding or computer tracking memos will help.

The third cornerstone is MOTIVATION.

Often employers and employees lack motivation to move their practices to the next level. At meetings, they continue to discuss what needs to be done but the motivation necessary to turn great ideas into finished projects through teamwork and delegation is not there. Motivation is a gift we give ourselves. We can’t look to others to motivate us. How a person thinks, who they spend time with, and what they listen to often shape their level of natural motivation. It isn’t the daily challenges that come to a person during the day that causes their stress. It is how one chooses to deal with the issues that come their way. If they process responses through a negative filter, they will have negative results. The opposite holds true for the optimistic people of the world. They process everything, even obstacles and challenges, through a positive filter, which brings positive results. We all enjoy being around positive, motivated individuals as they give us energy. Negative people are referred to as “joy robbers” who drain our energy!

The last, but certainly not least, is the fourth cornerstone for success in business, which is APPRECIATION.

Appreciation for one’s work, co-workers, patients, and the opportunities for being able to contribute is having “an attitude of gratitude.” So many employers are not appreciated by the people they hire, even when the employers go out of their way to create a good work environment for the employees. Some employers do not appreciate their employees. These employees usually end up leaving when there is little, if any, praise and respect for the workers. If a practice has good employees, they should be treated like gold. In today’s world, attracting and retaining good employees is not an easy task.

Most important to success is an appreciation for patients. Let them know you appreciate their business, so when they need your service, they think of you first and only. This type of patient loyalty is found in practices that have strong leadership, effective communication, praise, and appreciation for employees and employers. The trickle-down effect is obvious in a happy practice where the levels of appreciation and respect are strong.

New Associates

The success of any associateship or partnership depends greatly on the acceptance of a new member to the practice by the entire dental team. Well-organized, happy, solo practices can go through tumultuous changes that can play havoc on anticipated growth when another person is added to the team. Unknowingly and most often unintentionally, sabotage of these relationships can become apparent before the ink is dry on the agreement.

The Dentist’s View

“My associate has been here for a year. I would have thought by now he would be more productive. My overhead is up, my stress has increased, and I’m not sure this is working.”

The Staff’s View

“We liked our practice the way it was before. We had to give up our Fridays off, our patients are loyal to our senior doctor, and, frankly, we wish we could be a happy work family without this added stress.”

The Consultant’s View

An associate dentist needs the full support of the senior dentist and the entire staff in order to become a passive income center. He or she must be properly introduced to the patients and staff. Sitting down to discuss WHY the practice is bringing in a second dentist is key to the success of the arrangement long-term. What benefit will the associate provide for the patients? What benefit will the associate provide for a healthier business, and finally, what benefit will the associate provide for the senior dentist and staff? Until the “whys” are identified, the relationship is doomed.

The senior dentist should sit down with the team. The script should go as follows: “Thanks to your dedication and hard work over the years, we have built a patient base that requires another dentist. The benefit to the patients will be more available appointments and additional services. The benefit to the practice will be higher revenues if we support this new dentist in developing a highly successful two-doctor practice. The benefit to me is someone to cover on days I am not here, a colleague to consult with on patient or management issues, and increased net profit for the practice by increased revenues. The benefit for you is additional room for growth in your compensation packages as the practice develops.”

The associate dentist’s ability to produce more revenue depends on scheduling, staffing, and support issues. If the team and senior dentist have feelings of wishing they could go back to “the way things were,” no wonder the associate looks for opportunities elsewhere.

The Dentist’s View

“My associate tends to be one of the staff. She goes to lunch with them and never consults with me in regard to practice issues. I wonder whose side she’s on. I feel like I’m the odd man out. I thought bringing an associate into my practice would be a plus. Now I’m feeling even more left out of my own office. “

The Staff’s View

“Our senior dentist is acting very jealous of the relationship we have with our new associate, Dr. Karen. He gets really mad if he sees one of his patients on her schedule. We are caught in the middle. Why did we bring this second dentist into the practice if our senior dentist can’t share the patients and be happy we like her?”

The Consultant’s View

One of the major problems with interpersonal relationships within a two-doctor practice is that the second dentist is typically closer in age to the staff. Staff members often want to confide in the younger dentist about the practice or their senior doctor. This can be the kiss of death to the doctors’ relationship. While it is fine for the associate to go to lunch occasionally with the team, a hard, fast rule must prevail: If the conversation turns into a gripe session, the associate must let the staff know it is totally unfair of the associate to discuss with the team the practice or senior dentist’s faults. The associate needs to offer to arrange a meeting with both doctors and staff to discuss the issues fairly. Likewise, the senior doctor cannot ever discuss faults of the associate with any member of the team. Practice problems should be aired in a group situation. Personal intervention should take place privately.

In some practices, there’s enough money in Accounts Receivables (A/R) to go around the world three times…while in others, the A/R is a non-issue. There are many important ways to keep the A/R low, such as instituting:

• A firm financial guideline/policy that all staff and doctors clearly understand, execute daily, and adhere to.
• Immediate proper filing of insurance and a follow-up tracking system that is checked weekly. Mistakes on submitted forms create a huge delay in the processing of forms and result in more work for the insurance/financial coordinator. The key to insurance efficiency is “do it right, not over!”
• A systematic way of following up on past due accounts, not waiting until the account is over 90 days late to be proactive.

In addition to the above, one of the most important factors in having low Accounts Receivables is using the right financial verbal skills … so you have the money in the bank rather than on the books. These financial conversations take place over the telephone, chairside, and at the desk. These verbal skills are every team member’s responsibility, even the dentist’s. While walking the halls of many dental practices on observation day, my consultants and I are astounded at how poor some of the financial verbal skills are, and even more astounded and excited at how fast the A/R improves with just a few weeks of communicating differently.

ON THE TELEPHONE

A new patient calls to make an appointment, is scheduled for a specific time in the near future, and then asks, “How much will the first appointment be?” Some of the incorrect ways to handle this question include: 1) “Uh, we don’t quote fees over the phone,” 2) “That’ll be $160 and we expect to be paid that day,” and 3) “I’m not sure. I’m new here. Let me ask someone.” In scheduling a new patient, one of the best ways to introduce the fact that there will a fee which you expect to be paid at the time of service, and to sound more interested in the patient than their money, is to say “Mr. Walker, whom may we thank for referring you to our practice?” After hearing the name of their referral source, continue with, “I’m not sure how much your sister Barbara told you about our office. If you have a moment, I’d like to tell you what to expect on your first visit.” The conversation continues: “Your first visit will consist of a thorough dental examination by the doctor and your necessary radiographs. At the end of the first visit, Dr. Randall likes to spend quality time discussing your dental concerns. During his complete oral health exam, he will then refer you to our hygiene department for your professional dental cleaning within ten days of your first visit, as soon as he determines the amount of time our hygienist will need. Your fee for the new patient visit is $130. And, for your convenience, in addition to our normal cash and check services, we also accept Visa, MasterCard, and Discover.” If the patient asks if the fee will be covered by insurance and your office accepts assignment of their benefit plan, your conversation should be: “As a courtesy to our patients, we submit benefit claims and are happy to place any charges not covered on your credit card the day of the service.” If the practice does not accept assignment, the conversation should be: “As a courtesy to our patients, we are happy to submit benefit claims for personal reimbursement. The majority of our patients enjoy the fact that by placing their office fees on a credit card, they receive their benefit plan reimbursement by the time they receive their credit card statement.” In order to have patients pay at time of service (insurance or not), the doctor and staff must have competency and confidence in talking financially to patients. More than 70% of treatment acceptance falls apart in the financial discussions. One weak or incorrect word or phrase, or a loss of words when questions are asked, becomes the moment of truth. Just as clinical dentistry is an art to be developed, so is the reduction of A/R through effective financial verbal skills. In short, it’s important in the first phone conversation to establish that: 1) We’re glad you called our office, 2) we’re going to take good care of you, and 3) we expect to be paid for services rendered. Let’s now focus on the patient’s visit to the office, including two other financial communication stages, chairside and at the desk.

CHAIRSIDE

Oftentimes, patients will inquire about certain fees in the hygiene or doctor’s treatment areas. This communication usually takes place between the patient and hygienist or the patient and assistant. One of the worst responses to financial inquiries are: “I’m sorry, I can’t tell you the fee for the crown, but Mary will be glad to.” Passing the buck is an indication to the patient that a) “Fees here are so unimportant, I don’t know what they are,” or b) “Our fees are so high I would rather have someone else tell you what they are.” While I agree that there should only be one person making financial arrangements, EVERYONE on the team should know the fees, be proud of those fees, and be able to answer occasional fee questions. The proper response would be, “Mr. Walker, the fee for the crown the doctor discussed with you is $875. This includes all of your crown-related visits including final cementation, the best materials dentistry has to offer, and all of the doctor’s consultations with the laboratory that will be custom designing your crown.” Some of the doctor-related A/R management problems arise from the dentist’s lack of confidence in talking financially with the patients. Some of these negative words and phrases are: “Mrs. Richardson, the restoration in this tooth is very badly broken down and ONE DAY you need to think about a crown,” or “Mr. Hunter, EVENTUALLY this tooth is going to break and you will need to have a crown.” Another scenario occurs when the patient has been presented with a treatment plan and the fees involved; the patient looks at the dentist and says, “Doctor, I know I need this bridge but I just don’t know HOW I’ll be able to pay for it.” Dr. Nice Dentist then says, “Don’t worry, Janice. We can work this out.” Saying “We can work this out” is dangerous. To the patient it means: “I do dentistry for the joy of it and money is not important to me.” Many well-intended phrases from the dentist to the patient have caused tens of thousands of dollars in additional A/R. It is these same dentists who write off thousands of dollars of dentistry per year and wonder why their A/R is so high. Remember also that the number one solution for reducing broken appointments and no-shows is to clear up the A/R. People who owe the practice money break appointments! To be effective chairside, it is also important to be assertive and learn to confidently do fee rebuttals when patients complain about the fees. Feelings of anger, embarrassment, or frustration normally follow fee complaints. And most dentists or staff find themselves at a loss for words when this happens. Please know it is normal for some patients to complain about the fees (no matter how low or high). Having a good rebuttal on hand helps. Try one or more of the following: “Mrs. Weber, we would rather apologize for our fees once than the quality of your family’s dentistry for a lifetime.” “We are very proud of our fees. They reflect the quality of dentistry our practice provides.” “I’m not sure how your sister-in-law’s dentist can have fees that low. Only he or she knows the quality of their dentistry. We base our fees on the quality of ours.” “Mrs. Freeman, I know you can have your dentistry done CHEAPER somewhere else in town, but having worked with Dr. Randall for the past three years, I also know you can’t have it done BETTER.” “Mr. Walker, in dentistry, just like anything else, you get what you pay for. Dr. Randall is a fine dentist. I should know as he is my personal dentist and my entire family comes here.” Remember, patients accept your fees when you and your staff do. We hear more fee complaints in a low-fee practice than a high-fee practice! The reason? Someone in the low-fee practice thinks the fees are high. This usually filters on to the patients.

AT THE DESK

Occasionally, on my seminar questionnaires, clinical staff write, “I enjoyed your entire lecture except the part on collections as it is not my job.” This is not true. It is everyone’s job to be involved in the collections process. One of the best phrases the clinical staff can use when escorting patients to the desk: “Mr. Walker, it was nice meeting you today and I look forward to your next visit. I’ve given your chart to Mary. She’ll be giving you your receipt for today’s visit.” Over-the-counter collections improve immediately as everyone in the practice expects payment and therefore patients pay at time of service. In some practices, there is no ease of transfer from one staff member to another so collections are the responsibility of the financial coordinator only. Reducing the A/R is truly a team effort. In presenting the fees, remember the person in the tallest position is in control. My advice for Financial Coordinators is to stand when patients are checking out at the desk. (If you’re short, step on a stool). Present the fees in positive terms and you’ll have positive results. “Never-say phrases” include: “Would you like to take care of this today?” or “How would you like to take care of this?” Being proactive can make a huge difference in getting paid. The best presentation is: “Mr. Walker, your fee for today was $130. Will that be cash, check, or bankcard?” If Mr. Walker has insurance and your office accepts assignment, you may say, “Mr. Walker, even though your benefit plan states your initial preventive care appointments are covered 100%, please know that is based on UNC. This means ‘usual, normal, and customary.’ Broken down into lay terms, that means average. If we had average fees, we could only provide average care. Therefore your appointment may only be covered 70-80% in our practice. Today, your estimated portion is only $39.” After-insurance balances are a huge A/R problem. Many practices would be shocked if they totaled all outstanding accounts with less than a$100 balance. Pre-estimating and collecting ahead is of utmost importance in controlling the A/R. Make 2007 the year your entire team gets on the same page and becomes accountable for lowering your A/R. Financially, a practice is only as successful as the dollars it collects. Staff members often wonder why there’s no money to get the increases in pay and benefits they want or feel they deserve. In a practice with $30,000 too much in A/R, at 22% for staff salaries, this dentist would have had an additional $6,600 to share with the staff. In a large group with $300,000 on the books, the practice could have spent another $66,000 in staff salaries. When staff realize “the better the collections, the better everyone’s rewards,” the new verbal skill for collections become a comfortable second language.

There are two main points to never forget when it comes to fee discussions with patients:

• The mindset of the dentist and team regarding money must be positive.
• The quality of the verbal skills relating to the fees makes or breaks the acceptance rate.

“Patients can’t value what we don’t”. You must be as proud of your fees as you are your dentistry.

“We are very proud of our fees. They reflect the quality of our dentistry”

“Nothing good is cheap. Nothing cheap is good”. Remember, patients complain about the fees regardless of the amount.

Why do a large percentage of big cases NOT appoint? Lack of proper verbal skills at fee discussion and zero follow up two days later.

Example: Patient hasn’t been to the dentist for a while…..realizes they are in need of restorative but are thinking a few hundred dollars. Chances are the treatment plan is several thousands of dollars. Fee is presented by treatment coordinator or financial coordinator. “Your total charge will be $6425”. After the patient catches their breath, they say, “oh, it’s been awhile, and I knew I needed some work done but I had no idea it would be THAT much! I need to talk it over with my spouse”. Typical response might be: “Just give us a call when you are ready”. Sadly, you never see that patient again until they decide to come back for an emergency or never. 

Let’s go over the above verbal transaction….

Never use retail words in a professional setting. Charge, cost etc. only make patients think money. Always use the words fee or investment.

Next the patient refers to her needed treatment as “work”. That’s because dental practices refer to treatment as work! it’s always dentistry or treatment…never work!

The proper verbiage regarding the fee should be: “Mrs. Baker, “your total investment as far as time will be, a longer appointment then two or three shorter visits. Your total investment as far as the fee will be $6425”. 

After the patient states they had NO idea it would be that much, and she must go over this with her husband, the best response would be: 

“Mrs. Baker, if I were making this type of investment in my total health, I’d certainly need to discuss it with my husband as well. Do I have your permission to call you in two days after you have talked to him? Also, remind your husband that our practice has a fee plan that allows patients to make smaller monthly payments over time with zero interest. We want all of our patients to know that ideal dentistry is affordable to everyone in our community”. THEN FOLLOW UP IN TWO DAYS!