A graduating dentist came into my office last month to discuss life after graduation. He had been presented with a contract from a corporate dental provider, commonly known as a dental service organization (DSO) and wanted to discuss the opportunity with me. As a side note, this recent dental school graduate was encouraged to pursue a Master’s degree before applying to dental school. Now, six years later, he’s married with 2 children and financially burdened with over $350k in educational loans. During his interview process with several private practices, he was not viewed as a strong candidate due to his heavy debt load and his limited clinical experience. His clinical experience consisted of 4 crown preps, 3 anterior endodontic procedures and very limited exposure to pediatrics, a skill set often desired by practices when seeking recent graduates.
Private Practice Challenges
Before I tell you the rest of this story, let me share with you the other side of this equation. After working with a number of private practitioners firsthand, I’ve gained insights into the very real and common challenges private practice dentists face when looking to bring on an associate. First and foremost, the financial status of many dental practices today are now experiencing 25%-35% in insurance write-offs from their gross production leaving less revenue on the table to pay for an associate salary. The increasing number of negotiations between insurance companies and employers is taking place and the dentist is not at the negotiation table - yet he’s the “featured item” on the menu.
Dentistry has become one the last arms of healthcare to avoid the tremendous power of leverage. Traditionally, we’ve operated as solo doctors or group practices. Medicine and pharmacy have long experienced the demise of mom and pop operations. Today, the solo doc and pharmacist are becoming part of our history.
The Mentality Shift
The mindset as “clinician owners” is evolving to the mindset of “providers”. This mentality shift is probably the most notable in recent graduates. For example, many young graduates are not only signing up for higher salaries made available by the DSOs, but they’re also signing up for multiple insurance programs not realizing the poor reimbursement fees many are providing. Many practices I consult with are finding that their insurance write-offs are as high as 42%. This leaves 58% on the dollar to pay for staff, fixed costs and doctor salaries. Further complicated by many students who carry $200-$300k of educational debt, of which is paid for by after tax dollars. The financial status of practices today is literally being shaped by insurance companies who are bidding on employer contracts.
As these external forces occur, it’s imperative that we understand the implications they have on each stage of the dental practice. Remember, venture capitalists are evaluating our industry from a business standpoint and they see amazing opportunities for increasing the bottom line.
DSOs recognize that they can provide the following:
So where does that leave the future of solo practitioners or group practices?
There is little doubt that the traditionally structured dental practices will continue to see increasing competition with DSO-"owned" practices for the foreseeable future. However, there are lessons to be learned from DSOs and opportunities to excel where DSOs are weak. Developing strong leadership skills, relationship building skills and word-of-mouth marketing enhanced by social media will be more critical than ever for the private practice. Likewise, hiring and retaining quality associates, hygienists, assistants, and support staff can help differentiate the private practice from DSOs. This is the Achilles heel of many corporate practices as they cost cut staff salaries to increase profit. Spend time assessing the quality of the workplace culture you provide employees, and set aside your ego in inviting constructive criticism and ideas to grow. Ideas often come from the employees and may help owners more quickly figure out what works for the practice, patients, and specific location. It’s important to recognize that in addition to the dentist’s acumen, some may have an affinity toward leadership and staff development, while others may have an affinity towards marketing and business management. Very few dentists will have the unique ability to have or seek to excel in all three areas. As a result, I find many who are isolated within their four walls and wake up one day with a disturbing realization that they don’t know what they don’t know. The landscape surrounding suddenly looks foreign and is a far cry from the day he hung his dental license on the wall.
How did the story end for the young dentist considering the corporate position?
The young dentist ended up accepting the corporate dental position with a salary of $120k and benefits. The $10k/month is before taxes and his note payment for school loans is $3500/month. Along with the $120k annual salary comes an expectation for this young dentist to see between 40-45 patients a day. My recent follow-up with this gentleman revealed that his greatest challenge that he personally faces is his ability to deliver the quality of care he deeply desires to embrace.
Where do we go as an industry from here?
There are several areas for examination and strategic development using a collaborative approach.
There are many lessons we can learn from corporate dentistry in today’s world. In Virginia, in the last five years, two new corporate structures have been developed. There unique model has the dentist as the owner and decision maker within the corporate structure. Please take the time to visit their website to learn about the exciting changes taking place in the delivery of private practice dentistry. Atlantic Dental Care, VA Beach, VA and Central Virginia Dental Care, Midlothian, VA. These new models provide economies of scale often enjoyed by larger corporate structures. As professionals, we must stand strong and avoid passively watching our profession be shaped by outside forces. This is a unique opportunity for individuals and organized dentistry to be proactive in shaping our future.
What’s important to understand today is that no matter where you are within your career journey as a dentist, there are and will continue to be, external forces actively changing the dental landscape. Yet, if you are an owner-dentist, you still have the greatest advantage of all: to proactively influence the change taking place in your environment.
Take time to examine the many new developments taking place and to be part of the solution as we move forward.
Dr. James R. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. If you have any questions or would like help implementing a change in your office, contact Dr. Jim Schroeder at 804-897-5900. firstname.lastname@example.org. The American Dental Association has a wealth of information that can be helpful to understand the changes taking place. American Dental Association www.ada.org
Are you a business owner or manager running into difficulty with your younger employees? As I have helped numerous organizations face issues in their communities, one of the most important obstacles we have learned to overcome is cooperation with Millennials. The number of companies who haven’t yet had issues with this rising generation are dwindling. More and more managers and company owners are recognizing a lack of direct communication, finding their young employees evading of phone conversations only to send a response via text two hours later. Others realize that their younger employees see merely doing their job correctly as a laudable performance, or that their college GPAs should land them above the bottom of the totem pole in the workplace. Others find huge issues in being able to rely on this generation to focus for long periods of time, whether it be zoning out during important meetings, texting or checking social media during independent work, or overall not accomplishing their tasks in a timely manner.
So, what is a new business to do when the future workforce embodies the overall air of, “I’m great; reward me for what I am, despite the outcome”?
One of the new shifts in any business, from a large corporation down to a staff of two or three people, will have to be creating a culture within the workplace that replaces the culture the employees provide themselves. This process requires intention and leadership. When you can, confront the issues with your employees when you can talk to them face-to-face. Let them know what they’re doing right, but build on that with what is expected for success in the workplace. Finally, go ahead and take the risk to empower your employees. Give them tasks to oversee on their own, for which they are responsible. Follow up with them through the process and outcomes, offering insight and guidance. It is amazing to see the shift in performance when the results become someone’s own.
Keep in mind that intergenerational cooperation is difficult for every generation, but you can learn some amazing things from your younger staff. Stay open, and teach what you can to create an empowered, driven team, while expanding your own horizons. If you would like help in this process of development and growth, please contact me at (804) 897-5900.
© 2017 Leadership by Design, LLC | Would you like to use this article on your blog or website? You can, as long as you include the following complete verbiage: “Dr. Jim Schroeder is the President and Founder of Leadership by Design, Inc., a consulting firm that works with and teaches organizations and individuals how to bring personal and business strategies to life by focusing on people and relationships.
As I travel throughout the state I experience a wide range of dentists and practice models that vary in size, scope, age and experience. Our profession is morphing right before our very eyes. If you haven’t taken the time to look outside your window, the landscape is changing quite rapidly. Graduates leaving dental school today enter a far more complex world than those of the prior year. Although very talented and academically prepared their limited clinical skills and experience leaves them in a difficult situation. Today’s graduate leaves school with an average debt ranging in the area of $200,000 and some as high as $400,000. Many are choosing to opt for additional training in a residency program which provides them the opportunity to build their confidence and speed.
A rapidly growing option is corporate dentistry....and it’s here to stay. In this year’s senior class, I reviewed 12 different offers from corporate entities that offered seniors salaries ranging from $100,000 to $130,000. These are complex choices for the young graduate. They are unsure of the clinical environment that exists in the corporate model, but the urgency to secure gainful employment remains first and foremost in their mind. With student debt looming over their heads they have to make these difficult decisions. The legal language requires them to seek counsel on contracts often with anxiety of the unknown. The advantage of signing an agreement provides immediate income for the young dentist, but does not address factors unseen or unknown.
Managing staff, the operation, and the financial health of a practice should all be considered when making these important decisions. There are a variety of different models not seen 30 years ago. These provide diversified experiences for the growth of the young graduate and an opportunity to learn about the business and leadership necessary to develop their professional career.
Other significant changes in today’s work force:
These significant changes are important as you develop your strategies for your future and that of your practice. The fingerprints of change are stamped all over our profession.
In 1992 there were 10 significant dental service organizations frequently referred to as “corporate dentistry” in operation. Today there are over 100 of these models and they are growing rapidly.
They leverage the economics and the scale that lowers expenses, which increases revenue through negotiating fee schedules with insurance companies and suppliers. Expanded hours, large budgets and expert marketing make it difficult for the once dominant solo practitioner to compete in the marketplace. Much like medicine years ago, dental practices are forced to make the effort to operate multiple offices and/or consolidate to gain leverage in their business.
Many of the practices I work with are writing off 25% to 35% of their gross production due to participation in insurance programs. This is not a gloom and doom article, but an alert or eye opener that we be astute about all phases of our practice to remain healthy.
I opened this article to highlight the dynamic changes our profession is experiencing and how that impacts the future. Each of our careers and practices has a series of mini chapters leading to the next chapter. In the past we might often pull the trigger without planning or seeking consult outside our four walls. If you are approaching the twilight of your career, I encourage you to take the time to seek consult. You will need to develop a succession plan in multiple areas for your exit strategy. It has become too complex to do on your own without a careful objective. In the end, the assessment and a well thought out plan will be your strongest tools to assure strong choices and results.
If you are in the prime of your career and ou’re not taking time on a regular basis to assess your position from a business perspective, leadership, technical skills viewpoint, then grab your calendar and set aside the time to start the conversation and seek outside consultation.
Select individuals with expertise in each of the three areas that can expand your understanding before making a decision. The time you invest today, will have tremendous returns for tomorrow. Helping people grow is far more enjoyable than digging out from choices made without adequate knowledge or planning. Decisions made without a complete understanding can have dire consequences such as:
Notice none of the above areas are related to your technical skills in dentistry yet they severely impact the outcome of your business. I not only encourage recent graduates, but all colleagues to take the time to evaluate your career. Developing your tool box is mandatory and will equip you for our changing profession. We must be comfortable to reach for additional expertise and the stamina to persist in difficult times. Your expanded tool box will equip you to enjoy a wonderful career in dentistry.
Editor’s Note: Dr. James R. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. If you have any questions or would like help implementing a change in your office, contact Dr. Jim Schroeder at 804-897-5900. email@example.com.
The workplace, family and marriage are often greatly impacted by our ability to provide consistent feedback to people we interact with on a daily basis. It can impact the work performance of our employees and the quality of our relationships at home. As a consultant, I interview many employees across the state where I consistently hear a desire for meaningful feedback from their employer and a desire for stronger relationships. Considering the average dental office spends 25% to 35% of their revenue on employees we would do well to become students in the art and skill of effective feedback. It affects every area of our lives. As father of six children I can vividly remember times where I missed the target in an effort to provide meaningful "feedback" to one of my children or even worse my wife of 44 years. Feedback can come in many different forms which can be either subjective/objective or destructive/constructive and be heard quite differently than we intended! At the School of Dentistry we all remember reviews that brought either exhilaration or disappointment. The learning process must be woven with encouragement and constructive correction. A great resource for assessment of employee engagement is Gallup’s Qr2 Survey. “Twelve important questions to engage employees.” These principles apply as we develop employees or teach students. This will help you understand where your employees line up with engagement in your office. It will also give you a hint of your return on investment in staff salaries. A fully engaged and energized staff member will make a great contribution to office growth.
Will you improve the art and skill of how you provide feedback to your team? Major studies indicate the lack of employee engagement exists across the workforce (Gallup). Investment in this area could provide immense financial and job satisfaction for all involved. Let’s start with a simple self-assessment of ourselves! Have you developed a process for conversational feedback when engaging your team members or is it shot from the hip? Would you start a complex treatment plan without a plan? As doctors we often overlook our role of developing others on our team, this requires reflective time to make a plan of communication coupled with metrics the employee understands are their responsibility. Think back over the past few months and evaluate your ability to provide feedback in the development of your team. Has it been effective in bringing about the desired change or rewarding exceptional performance? I am including two references for your development. Warning! Feedback and employee development is often avoided, or procrastinated because it is uncomfortable, or the skills were never developed because you are just too busy in the dental chair and your office manager has not acquired the effective feedback skills.
Following are some tips to strengthen your feedback system to enhance a thriving culture and growing employees.
As employees grow your organization grows, take the time to invest in these critical skills, no less important than our endodontic or restorative skills “I believe that everyone is a leader at some point in time, we have a choice how well we lead.”
Building a relationship the first step
1) Telling someone something is not the first step in feedback. The Gallup survey reveals employees want to know the boss or management cares about them and takes time to listen to them. When this takes place it opens the door to receive feedback.
Making regular deposits in the brain bank is critical
2) I like the model of depositing “positive feedback-appreciation and affirmation” regarding an employee performance, like a bank account. When critical feedback is needed, which I call a withdrawal, you have built up deposits in the account for the withdrawal to take place. If you find it impossible to make positive deposits it may be time for the employee to be on probation or dismissed.
A multi-lingual mind set is required
3) Become multi-lingual, by this I mean understand that we all have different communication styles. We often have to speak the language of the employee we are engaging. I often have a dominant boss come to me saying, "Jim, I don't understand I provide feedback and my employee starts to cry or get angry, I just tell it like it is." The employer often does not realize they are perceived as being rude, cold and ineffective in empowering their team member. Two great tools to improve our multi-lingual skills are the DiSC instrument and the Strength Finders. I use one or both of these with all of my clients. Understanding our own language and that of the people we are evaluating or developing can be a major factor in our effectiveness. Acquiring and applying these skills can take your practice to the next level!
Develop a feedback toolbox for diversified situations
4) Feedback can range from simple affirmation such as a Great Schedule, or you were really organized for the complex procedure. Affirmation of individuals is tremendously underutilized, yet it is a powerful transformer of attitudes. A recent comment from a doctor, “Why should I have to affirm them, that's what I pay them to do?” The absence of affirmation impacts an organization and the quality of service and employee retention. The most effective feedback is conversational directed with the individual not at the person. Having the skill to create an interactive conversation is most valuable. Often we fail to define clear metrics that indicate the objective quality of the employee performance. These should be written, clearly defined and objective. Feedback can be simply verbal or include a written report and scheduled meeting. One size does not fit all. The leader must have the knowledge and discernment to differentiate poor performance or have you failed to train and equip the individual to do the job or acquire the skill?
What gets measured and reviewed gets attention
5) Feedback with metrics requires further planning, conversation and understanding. The School of Dentistry has many metrics in place and is in continuous pursuit of calibration of multiple faculties providing consistent feedback to students. Calibration without a mentoring relationship will short circuit the learning process at schools and offices. The most effective learning and growth takes place when clear metrics, healthy communication and dialogue are in place. Both parts of your brain (ANALYTIC +RELATIONSHIPS) need to be engaged for maximum learning to take place.
Establish a time and place for important feedback
6) Selection of time and place are important components of creating an atmosphere to provide meaningful feedback. A common statement I hear from many employees, "It's been 3 years since I have had feedback or a review, I really feel devalued. It's always going to be in a few weeks.” It makes a statement to the employee or family member. “I am important because time is being given to me and someone is listening to me in a conversation.” Time and listening are two great tools for meaningful dialogue.
Dentistry in the 21st century requires more than dental skills
7) We are often expecting change when giving feedback for growth and improvement, but without planning and developing our own skills we fall short of our expected out come.
A skilled leader and communicator will develop a personal feedback style that recognizes both excellence in performance and addresses standards that do not meet the core values and expectations of your organization. We cannot relinquish the important development of this Art and Skill of Feedback in our home or office. It requires multiple factors to be in alignment: time, planning, dialogue, understanding of the multi lingual nature of relationships and clarity of the topic being addressed. This will lead to mastery of a powerful feedback system. It shuts down the commonly used system of accuse and defend often leading to frustration and confusion between doctor and employee.
Where Do I start?
I have provided several references for your reading in addition to a complimentary telephone conversation on this topic. Acquiring a coach, taking courses and reading on the development of people are all ways to grow. Take the time to develop this skill set to enhance your leadership and growth in your practice and life. It will lead to growth of everyone around you. “Leaders become great not because of their power, but because of their ability to empower others”
Is Your Feedback Effective?
Dr. James R. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. If you have any questions or would like help implementing a change in your office, contact Dr. Jim Schroeder at 804-897-5900. firstname.lastname@example.org.
 GALLUP, October 8, 2013 “Worldwide, 13% of Employees are Engaged to Work” by Steve Crabtree  IF YOU WILL LEAD-Enduring Wisdom for 21st Century Leaders, by Doug Moran ISBN: 978-1-932841-58-9  THE FIVE LEVELS OF LEADERSHIP, Proven Steps to Maximize by John Maxwell, page 9 ISBN: 978-1-59995-365-6
Dr. Jim Schroeder is the Founder of Leadership by Design. He has been writing about leadership and organizational growth for over 30 years.
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