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Conference The 5th Annual Dentists Conference was held on the weekend of 6th to 8th of September at the Sanctuary Cove Intercontinental Resort. In attendance were 150 dentists and 30 hygienists. Sponsors, guests and staff brought the total number of registrants to 270. We thank all the attendees and hope you enjoyed it as much as did the staff from Head Office.

The Perfect Storm – Suggestions on how to “ride it out”   

Employment for dentists has dropped from 110% to 82% The Global Financial Crisis has now well and truly hit Australia The Chronic Disease Scheme has ended

All in all, a difficult time for many practices. The good news – it will improve, the bad news, not any time soon. Accordingly, the Clinical Advisory Committee has surveyed Dental Partners practices which appear to be coping with the prevailing conditions as to their “take” on what is contributing to their success. The CAC now present contributions from their practices for your consideration, evaluation and possible adoption should you deem that appropriate.

Recall Approach        

Dentists themselves arrange recall appointments Dentists thereby endorse the importance of the next recall by relating it to a specific dental problem already identified with the patient. Where appropriate, resend a copy of an outstanding treatment plan with the recall notice to select patients. These should be selected by the dentist Implement systems to catch any patients who “fall through the cracks” in the recall process Utilise written, SMS and phone messages to contact patients. Some practices prefer direct phone contact. Determine a cut-off point at which patients are contacted to ascertain whether they wish to remain ‘inactive’. Employ KPI’s to track recall success and associated relevant data Pre-book recalls at hygiene level. In this environment, hygienists are a wonderful strategy. Patients regard the services of their hygienist as necessary and routine maintenance, even while they postpone a discretionary spend on dentistry. Hygienists provide a nonthreatening flow through of patients and provide the opportunity to identify incipient pathology. Make use of an offer to reactivate an inactive or ‘dead’ recall list

Treatment Plans Each of the practices, canvassed by the CAC, presented treatment plans to patients. Here are some of their recommendations:      

  

 

Acquire a complete set of records including radiographs, photographs and, where applicable, study models. Consider using diagnostic wax-ups The immediate phase of your treatment plan should address any concerns and preferences articulated by the patient Some practices engage in patient profiling and then treatment plan accordingly. Treatment plans should be staged, where appropriate, and treatment phased. For example, definitive treatment delayed until hygiene sign-off As professionals, dentists present the treatment options and respect the right of the patient to choose affordability. We should never presume to make financial decisions for the patient Risk analysis should be addressed. For example caries-prone patients require strategy to control the disease process. This should be documented in the treatment plan Don’t over complicate the choice process. Where possible, limit treatment options to two Don’t try to be too technical with the presentation process. Patients care about pain, cost outcome and aesthetics. They are not overly concerned with aspects of their treatment which impact on the dentist eg: technical difficulty Treatment should always be discussed face- to- face. Patients should not be reclined at this time and the dentist should also be seated Informed consent is mandatory. The signature of the patient has to be obtained prior to commencing treatment

These are a summary of the suggestions forwarded to the CAC on the topic of treatment plans. Perhaps some may be of relevance in your practice.

The Patient Experience Each of the practices surveyed, relied heavily on optimising the patient experience. As one principal dentist said “I try to imagine my patients asking themselves the question ‘why would I want to go somewhere else?’ and answering ‘this is perfect’. Another dentist suggested that he strives to make each patient feel that they are the only patient whom he is seeing that day. So, remaining objective about the ‘patient experience’ is very much a tool for success.

Reassessing your Personal Needs Dentists are reporting a drop in their personal incomes. We have included a simple formula to aid in determining your required income. This formula allows you to factor in your lab spend, your commission etc, and so acquire an hourly rate which will satisfy your personal needs. The CAC hopes that the calculations will help to allay unwarranted fears regarding reduced income.

Example 1 Your desired income Your commission rate Your required gross Your required gross plus lab if lab 9% Working 48 weeks/year Working 4 days/week Working 8 hours/day

$260,000/0.4 $625,000 x 1.09 $681,250/48 $14,193/4 $3,548/8

$250,000 40% $625,000 $681,250 $14,193/week $3,548/day $443.50/hour

NB: To reduce hourly rate, you can work 4.5 plus days

Example 2 Your desired income Your commission rate Your required gross Your required gross plus lab if lab 9% Working 48 weeks/year Working 4 days/week Working 8 hours/day

$200,000/0.4 $500,000 x 1.09 $545,000/48 $11,354/4 $2,839/8

$200,000 40% $500,000 $545,000 $11,354/week $2,839.00/day $354.80/hour

We have included the following article from Dr Mark Hassed for your consideration. If, after perusal, you find any aspects at all helpful, you may opt to incorporate those into your practice.


Dentists feel under pressure when the economy is flat and people are not spending money on dentistry. The moment that gaps appear in our appointment books there is a tendency to start desperately reaching out to attract new patients.

Some dentists respond to this challenge by cutting their fees and luring patients with Special offers such as free consultations, free check-ups, free cleanings and free x-rays. Unfortunately, there are three drawbacks with "freebie" offers:

• Firstly, "freebies" tend to attract bargain hunters who often use up a lot of our time but Generate very little ongoing treatment. In the motor trade such people are called "tyre

kickers". Such patients know that there is no such thing as a "free lunch" and so they are wary of our treatment recommendations because they suspect that we are trying to recoup the loss leader.

• Secondly, free offers can scare off good patients. As a friend said to me recently: "Dentists who give free offers must be dodgy. I'd rather pay and get it done right."

• Thirdly, doing work for free devalues and demotivates us. Every dentist knows that diagnosis is a valuable service and is the basis for sound treatment. When we give our diagnosis away for free the tendency is to rush through it and be neither as careful nor as comprehensive as we should be. We don't feel good about our treatment and we don't feel good about ourselves. I'd like to suggest to you a different and better way to ride through recessions that eliminates your need for vast numbers of new patients. That way is to get more value out of each of the new patients that you see. You achieve this by doing comprehensive examinations, full-mouth diagnosis, thorough treatment planning and having clear, concise treatment discussions. In short, you put each new patient through a compelling and powerful new patient experience. Practices that rush patients through with a cursory new patient experience generate on average about $500 of treatment for each adult new patient. In contrast, practices that provide a comprehensive, powerful new patient experience generate an average of $2,500 or more per new patient. That's a remarkable five for one difference.

It means that, if your goal is to generate $50,000 per month from new patients then with cursory examinations you must see one hundred new patients but with a powerful new patient examinations you only need twenty new patients. What does a powerful new patient examination look like?

Prior to the patient seeing the dentist there are some things to accomplish:

• The telephone must be answered in a warm, professional manner and the patient appointed within a week of calling. • The patient must be greeted warmly by name when they arrive at the practice. • The patient fills out a comprehensive new patient form.

• The patient is seen on time. A full description of the clinical examination would run to many pages but I will give you some bullet points to think about. Details for each bullet point will depend upon your professional opinion but the following things I personally regard as essential: • Oral cancer screening. • Baseline charting of all existing restorations. • Charting of decay, cracks, fractures, abfraction lesions, tooth wear, abrasion and erosion. • Recording the orthodontic classification. • Periodontal screening examination. • TMJ examination if indicated by the history. • Set of clinical photos both intra-oral and extra-oral. • Set of radiographs that comprises an OPG, bitewings and periapicals of any suspect teeth. • Further tests as required such as vitality testing, frac finder and tapping. • Study models for complex cases. • Diagnostic wax up if required. • Developing an overall plan for the patient's mouth, not just tooth by tooth. • Discussion of treatment options including fees. • Issuing a written quote and treatment plan.

That's how you raise yourself from a practice where an average new patient is worth $500 of revenue to a practice where a new patient is worth $2,500 or more. If you want to push your practice to the next level then look long and hard at how you examine new patients. Are you getting rapport at the outset? Are you gathering a full set of diagnostic records? Are you thinking through the treatment options? Are you laying those options out in a way that the patient finds compelling? Or, is your examination of new patients cursory?

You need to practice the choreography for new patient examinations and figure out how long you need to do it really well. I started with 60 minutes but was able to reduce it to 40 minutes by adding a second nurse and with lots of practice. I couldn't do it well in less time than that and if you take 30 minutes or less then I'm sure that you are missing things. The fee I charged five years ago was $260 and I got zero resistance. The thoroughness of the examination wowed new patients and was a real point of difference for my practice.

Patients would often say: "That's the most thorough examination I've ever had. Why don't all dentists do that?"

I tried never to do an examination and cleaning at the same appointment. It all became too rushed. It forced me to hurry through the examination which resulted in me missing things. When patients saw the thoroughness of the examination they seldom insisted on a cleaning. I used to say to people that I take time at the start planning thing perfectly so that I can get their treatment done in as few visits as possible.

One other thing. Some patients require two visits because their treatment needs are so complex. You know the type of patient. They have perio issues, endo issues, missing teeth, a collapsing bite, cosmetic issues and possibly even TMJ issues. If you can't get it all done in the time allowed get them back for a second appointment. I used to say: "You have a lot of complex problems going on in your mouth. I need to think about it and work everything out. Can I get you back in a couple of days when I've had a chance to think?" I never had even one patient object. They were delighted that I was being so careful in working out their problems.

Improving how you look after new patient will bear big and immediate dividends. Stop discounting and get better at what you do. It is the road to a prosperous practice and greater professional satisfaction.

Memo 1. A reminder to all of our practices regarding the protocol for disposing of sharps. We are experiencing an increase in needle stick injuries across the group. Responsibility for correct disposal of used needles rests with dentists. 2. The Clinical Advisory Committee has established an Accreditation Sub Committee with Dr Heather Apthorpe as Chairperson. Heather has distributed a survey to enable her group to start the process of our practices becoming accredited. If you have not, at this stage, filled out that survey, your attention would be appreciated. Pip Clements can be contacted for a copy of the survey form if you have not received it (

3. An audio tutorial on the topic of case presentation and acceptance is now available from the CAC. Again, a copy of this tutorial is available from Pip Clements. The tutorial runs for approximately 90 minutes.

4. Dr Neil Peppitt will be holding two limited number tutorials in Brisbane on Wednesday October 2nd on general problems in restorative Dentistry. Dental Partners has secured five places in these sessions at no cost to our dentists. Neil intends to discuss his failures, his successes and invite a “warts and all” discussion among the participants. We urge you to consider this offer to engage face-to-face with one of Australia’s best known prosthodontists. Neil practices in Macquarie Street Sydney and is an Adjunct Associate Professor at Sydney University. 5. With the holiday season fast approaching, now is an opportune time to advise your Practice Support Manager of intended holidays. We have a limited number of locums who are available to help. 6. We have copies of Professor Ian Meyers’ powerpoint presentation on “Diagnosis & Treatment Planning” from our recent Dentists Conference. If you would like a copy of this presentation, please contact Pip Clements on

Clinical newsletter Issue 4 September 2013  

Dental Partners Clinical Newsletter Issue 4 2013

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