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The second ‘D.D.S.’ degree A formula for practice success JACINTHE M. PAQUETTE, D.D.S.; CHERILYN G. SHEETS, D.D.S.
raduation from dental school signifies the completion of years of study and allows us to put into practice our knowledge of general dentistry. As we work hard, we soon realize that there is a second level of education that must be mastered to be successful in the business of dentistry. This additional education can be thought of as a “second D.D.S.,” an acronym that stands for Develop a vision, Deliver quality and Surpass expectations. We will review these concepts below as they relate to a clinical dental practice. By following Dentists need these fundamental guidelines, one can to apply basic excel in any of the disciplines or specialties of dentistry. business principles to DEVELOP A VISION planning their At completion of an undergraduate dental careers. dental education, the new dentist faces many choices. He or she can enter the domain of a general dentistry practice, train for a full-time life in academia, develop a private practice as an associate or owner, join the military dental corps, be involved in a managed care clinic, join the public health service, go back for specialty training or consider numerous other options. Regardless of the direction chosen for the practice of dentistry, new dentists need to establish a philosophical course as early as possible. For example, decisions and commitments need to be made regarding continuing professional education (ideally, a commitment to lifelong learning), support of professional organizations (local, national, international), membership in study groups, involvement with other interdisciplinary specialists to provide more complex treatments, and the development of professional mentoring relationships. It is through involvements such as these that professional
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ABSTRACT Background. Planning for success is critical in clinical dentistry and in the management of a dental practice. Dentists need to apply basic business principles to planning their dental careers as they develop a vision, deliver quality products and services, and surpass patients,’ staff members’ and their own expectations. Conclusions. By applying general business management principles, dental practices can develop a logical, systematic approach to the management of a professional services business. For many dental professionals, these concepts were not learned in an undergraduate dental educational program and need to be mastered after professional school. Practice Implications. Ideally, each dentist will establish a philosophical course that provides direction to the practice of dentistry. For a private dental practitioner, part of his or her goal is to create a tangible, transferable asset and a solid business plan that can benefit the practitioner in the present, as well as in the future practice transition.
growth is enhanced and professional vitality is renewed. Establish a governing philosophy. For example, if a dentist wanted to establish an esthetic and reconstructive dental practice, it would be important to have a clear vision of the governing philosophy for that practice. A written philosophy might be summarized as follows: “XYZ dental practice philosophy: provide the highest quality interdisciplinary care to meet the patient’s esthetic, functional, biological and psychological needs in a supportive and educational environment that promotes long-term oral health.” Once this philosophical direction has been established for the practice, other decisions become easier. For instance, if the XYZ practice is located in a large medicodental center, it could develop beneficial working relationships with interdisciplinary specialists, ultimately forming an interdisciplinary orofacial team. Further, if the surrounding com-
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munity is considered to be affluent, it is likely advanced education, move locations, have children that patients will be able to seek the highest and make numerous other decisions? At times, levels of oral health care, thereby providing a sufthese important decisions are delayed or not made ficient pool of patients for the specialized practice. at all owing to a “paralysis from overanalysis.” The practice can achieve additional value when Sometimes, the best advice is not to overthink the owner/dentist lives and works in the same things. Make the best decision based on the facts geographical area. Our hypothetical owners, by and your passion for the project, and proceed with living in the community in which their office is the plan. Reassess as you go along, and make any located, have convenient access to the office, as necessary modifications if they are indicated. The well as natural social contacts that will help them important concept is not to stagnate, but to blend build their business. The practice issues menone’s intellect and emotions regarding major decitioned create synergy, and continue to strengthen sions or directions in life. the overall business foundation. Part of the vision for a private practice should The owners can expand their model further to be to create a tangible transferable asset. Because meet the practice philosophy by aiming at a niche the private dental practice typically is the most market—the dental patient who seeks esthetic and important business asset of a family, or at the reconstructive treatment in a fee-for-service pracvery least represents a significant portion of a tice delivering a high-quality product with superior dentist’s collective net worth, the dentist should service. To further develop their skills in providing develop an achievable business development plan. esthetic rehabilitative care, the pracA solid business plan requires montitioners in this hypothetical pracitoring on a daily, monthly and Part of the vision for tice have received advanced educaannual basis for dentists to reach a private practice tion and have become teacher/ goals and for the practice to deliver clinicians. The owners also decided a reasonable profit. should be to create a to combine their international Asset-building will center in part tangible transferable teaching experience with the experion the physical facility that the asset. ence gained from clinical practice, by dentist occupies. Investing in one’s customizing their practice to incorsurroundings will pay off in the porate a commitment to teaching short-term with increased patient through a nonprofit teaching and research instisatisfaction and patient referrals. Welltute. The owners of XYZ practice have established maintained facilities also will bring a long-term a unique professional balance, which combines prireturn to the dentist’s investment when others vate practice, teaching and research in their daylook to join the dental team or buy the practice to-day responsibilities as dental professionals. (Figure 1). An office philosophy that is understood Need for customized balance. The ability to by the team creating an effective office culture, direct one’s own practice to meet individual with systems to turn the office philosophy into desires is one of the exciting benefits of being an reality, also is of value when the dentist transfers independent dental practitioner. Some dentists the practice to another owner (Figure 2). may look at this XYZ practice mix of professional Another important aspect of practice vision is to choices and feel that they also would enjoy the design a plan to attract an ideal mix of patients— variety and stimulation created by this type of children, adults and/or seniors—for a specific practice. Others may feel that this would not be practice profile. In addition, it is important to their ideal environment and would design an make other choices, including the following: entirely different pattern for their private pracdwhere one wants to live and practice; tice. The objective is to create a lifestyle that is dthe ideal practice economics (for example, balanced in three important areas of life: profeshighest quality, slower patient flow); sional time, family time and personal time. dthe desired area of expertise (for example, Regardless of one’s sex, it is critically important esthetic dentistry, geriatric dentistry, general to have supportive relationships when making practice, family practice). quality-of-life decisions that affect one’s business Once these decisions are made, it is easy to lay and home life. out the physical characteristics of the dental Timing. One consistent issue in life is timing. facility: square footage, design, number of operaWhen should I open my own practice, go for tories, technologies appropriate to the practice, 1322
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Figure 1. Part of the vision of the private practice is reflected in the physical facility’s style and layout.
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Figure 2. An effective office culture is created when dental team members understand the office philosophy.
amount of space dedicated to patient education product instills pride in the dentist as well as in and treatment coordination, and room for staff members. Some important characteristics of growth.1-3 staff members include maturity (regardless of For the more comprehensive esthetic and age), a caring personality, orderly work habits, a prosthodontic dental practice, the foundation of professional appearance, a positive attitude, a patient care consists of three pillars: a thorough career orientation, an ability to accept responsiand comprehensive clinical examination process bility and a good work ethic. on the patient’s entry into the pracImportance of continuing tice (Figure 3), a systematic patient professional education. In addieducation and treatment coordination to developing staff members’ To provide the tion program, and a delivery system abilities through in-office training highest quality care, that is able to create a high-quality and continuing education courses, the dental product combined with a pleasant dentists must continue to refine professional must experience for the patient. their own professional skills. To provide the highest quality care, the constantly improve DELIVER QUALITY dental professional must constantly and expand his or Appropriate staffing. To deliver improve and expand his or her skill her skill level. quality care to patients, dentists level. When staff members and need to address several areas. Of patients observe a commitment critical importance is appropriate from the dentist to continuing professional education, this builds confidence in and staffing. In today’s environment, in which there can be a shortage of qualified dental support perloyalty to the practice. sonnel, this goal can be a challenge. Dentistry, Some guidelines for building technical skills however, shares the same business principles are the following: with other successful companies as they relate to dlearn from the best in the field; employee retention; therefore, dentists can learn dtake hands-on courses (Figure 4); these principles from other business fields. For ddo not take shortcuts to quality; example, the Walt Disney Company has a reputadinvest in oneself; tion for customer and employee loyalty that, dinvest in dental and business equipment; according to Connellan,4 the company believes is dbe a committed and passionate lifelong learner. based in part on its commitment to watching the Interpersonal skills also are of vital impordetails, which translates into a quality experience tance. Dentists should develop these skills as they for guests and staff. develop their clinical skills, and expand them as The more that the dental team member feels they mature professionally. They should seek out he or she is a part of an organization that conand hire staff members who possess qualities that siders the patient’s needs to be of highest priority may be less well-developed in their own manageand provides quality care, the higher the staff ment skill set. This focus on team-building will retention level will be. Providing a quality strengthen the practice’s overall capabilities. JADA, Vol. 135, September 2004 Copyright ©2004 American Dental Association. All rights reserved.
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Figure 3. A thorough and systematic examination and charting are key to effectiveness in a comprehensive esthetic and reconstructive practice.
Figure 5. A close working relationship with skilled dental technicians ensures consistently high-quality care.
Develop management skills. Dentists also can develop and refine management skills.5 One should begin by knowing one’s own personal management style, then establish systems within the office that are logical, organized and consistent. Dentists should monitor the results and make sure they understand the financial profile of the practice. Be fair, ethical and consistent in treatment of patients and staff members. Do not “major in the minors” in management. If something is minimally important (such as telephone bills), leave it at that level. Alliance with dental technicians. Closely related to the delivery of a quality dental product is a close working relationship with a dental technician or technologist. Whether this alliance is within one’s own office or located remotely within a dental laboratory is not critical. What is critical is the quality of the technical work provided. It is only by associating oneself with a highly skilled dental technician or technologist who under1324
Figure 4. At the Newport Coast Oral Facial Institute, Newport Beach, Calif., hands-on courses can assist the dentist and staff members in heightening skills and continuing their professional growth.
stands the esthetic, biological, functional and bioengineering aspects of constructing prostheses that dentists can deliver high-quality care consistently to patients (Figure 5). Just as dentists provide opportunities for the professional development of clinical staff members, they also must put time and energy into developing the laboratory team. In developing an effective alliance with the dental laboratory, dentists must remain focused on the orientation to provide quality care, the need for a high level of communication between clinical and laboratory teams and the need to nurture the shared commitment to success. In addition, dentists must be willing to compensate dental technicians and technologists in accordance with the exceptional service they provide. Alliance with interdisciplinary specialists. Creating a high-quality practice also requires strong alliances with colleagues in different specialties. Finding the talent needed for an interdisciplinary team approach to patient care brings excellence to comprehensive care. The various specialties—such as periodontics, orthodontics, oral and maxillofacial surgery, and endodontics— provide an opportunity to enhance treatment results through collective treatment planning. Dentists need to choose specialists for their specific talents in specific areas. The specialty of periodontics serves as a good example to illustrate this point. Some periodontists are most interested in periodontal plastic surgery and have developed expertise in this area beyond that of some of their colleagues. Other periodontists may choose to focus on controlling periodontal disease. Dentists should be familiar
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with the specific talents or areas of expertise of the specialists with whom they work and choose the best interdisciplinary team member or members to achieve the best results for the patient. Optimal interdisciplinary teamwork can be achieved by focusing on a shared philosophy of quality patient care, as well as on frequent and thorough communication to keep treatment goals consistent. SURPASS EXPECTATIONS
Practice success comes from a focus on surpassing expectations at all levels. Dentists should adopt a goal to surpass the expectations of patients, staff members and even themselves. Patients’ expectations of a dental experience can be surpassed if dentists treat everyone with utmost respect, provide service with a smile, meet special requests and needs, give patients enough time so they do not feel rushed, and always do their best. If these services are delivered consistently, patients will develop a sense of loyalty to the practice and dentist, and they willingly will pay the fees that are justified by this high level of service. A similar set of goals also applies to one’s staff. Dentists can surpass staff members’ expectations by treating them with respect, rewarding them for excellence, creating a caring environment at the workplace, and listening to their ideas and concerns. Dentists may surpass even their own expectations if they develop high but reachable goals, allocate time for family and friends, and set aside time for themselves to stay healthy and become emotionally rejuvenated. CONCLUSION
We encourage every colleague to dare to dream and create his or her ideal practice profile by fol-
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lowing the formula discussed in this article. By removing personal glass ceilings, denDr. Sheets maintains a tists remove the Dr. Paquette is a prosthodontist in priprivate practice in false limitavate practice in NewNewport Beach, Calif., is co-executive director tions that keep port Beach, Calif., and is co-executive director of the Newport Coast them from of the Newport Coast Oral Facial Institute, Oral Facial Institute, Newport Beach, and is reaching their Newport Beach. Address founder of The Children’s potential as reprint requests to Dr. Dental Center in InglePaquette, Newport Coast wood, Calif. dental profesOral Facial Institute, sionals. It is 360 San Miguel Drive, Suite 204, Newport helpful to find Beach, Calif. 92660, someone who e-mail “jmpaquette@ ncofi.org”. has accomplished what one wishes to achieve and turn to him or her as a role model or mentor. Ultimately, it is important to take intelligent risks. An often-expressed regret of people in their 80s and 90s when asked what they would do differently if they had their lives to live over is this: they wished that they had taken more risks in life. If one starts with a clear vision, works hard to deliver quality dental care and establishes a goal of surpassing expectations, the results will be astounding. ■ 1. Malkin J. Medical and dental space planning: A comprehensive guide to design, equipment and clinical procedures. 3rd ed. New York: Wiley; 2002:401-515. 2. Unthank M. Dental office design: A guide to building, remodeling and relocating. Chicago: American Dental Association; 2002. 3. Pollack-Simon R. All the right moves: The definitive guide for integrating dental team ergonomics, treatment room technology— Auxiliary utilization and office design. Tulsa, Okla.: PennWell; 2002:24-6, 69-78. 4. Connellan TK. Inside the magic kingdom: Seven keys to Disney’s success. Austin, Texas: Bard Press; 1997:135-48. 5. Lundin SC, Paul H, Christensen J. Fish!: Catch the energy and release the potential. New York: Hyperion; 2000.
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