Monday, April 21, 2014

What a Dentist Should Do When a Patient is Fearful

Here is a guest blog post from our friend Jen Butler, M.Ed., CPC, BCC from Jen Butler Coaching.
Fear and dentistry seem to go hand in hand.  Whether the fear comes from childhood experiences or is solely psychological, fear is a real thing that patients often bring with them to their appointments.
Here’s what most dentists and their teams fail to remember: people have two biological, automatic reactions when dealing with fear, FLIGHT or FIGHT.
Those patients that are in flight mode often look and sound like this:
  • Sound, they don’t make sounds, not even when asked questions. They are struggling internally to keep it together.  They also know the more conversation had during their experience, the longer they will be there.  Their goal is to get out!
  • Often show a nervous twitch by moving their feet, bouncing their leg, moving their hands, etc.
  • Ask, “How much longer?” or “What’s next?” or even “Are you almost done?”  They can’t wait to get to the door and RUN.
  • Avoid talking about same day treatment, say they want to schedule another appointment and then don’t schedule.
Flight patients are harder to notice because they are stealthy.  Meaning, they don’t let on that they are afraid.  These patients leave you wondering ‘what’s wrong with them’ or ‘with you’ because their appointment was like pulling teeth, and not the literal kind.  You can’t help but reflect on how awkward their appointment was for you and the team.
To effectively work with people in flight mode:
  1. Know the signs.  You and your team need to be able to recognize patients in flight mode.
  2. Offer calming methods to reduce fear and stress (music, laughter, warm blankets, dim lighting, stress balls, show comedies, etc) if you think they are a flight patient.
  3. Be assertive and ask, “I’m curious Mr. X.  How nervous are you about being here today?” The problem addressed is the problem solved.  Until the fear is addressed, the patient can’t truly listen and take in what you are saying about their oral care.
  4. Demonstrate confidence in your clinical skills. So often when a patient isn’t giving off the right vibe dental teams back away, feeling awkward and it throws them off their game.  They start second guessing their movements and begin to put further psychological stress on themselves which makes everything even more uncomfortable.  Know that your training and experience has uniquely prepared you for this moment with this patient.  You know how to connect, offer painless procedures, and provide a comfortable, caring environment.  Trust in that and move on.
  5. Don’t reinforce stress by talking badly about the patient, ever.  It’s normal to want to vent or release the stress of working with a fearful patient to your team.  DON’T!  The more you talk about how awkward it is to work with that patient, or how much they squirm and jump while you blow air on their teeth, or even when they don’t say two words to you the more you reinforce to you and others that it was a negative experience.  Find another way to release your stress like breathing, positive self-talk, or take a 5 minute break.  What you tell yourself you believe so be careful of what you think.
Flight patients are experiencing something very real.  As a dental professional, you want to learn how to navigate through working with this type of patient because it will make  your job and that of your team much easier.  Plus you will have less stress!
Contact Jen Butler, M.Ed., CPC, BCC at (623) 776-6715 and visit her website at Jen Butler Coaching

Wednesday, April 16, 2014

Is a Traditional Practice or a Group Practice Right for a Dentist?

Here is another guest post from our friend Carl Guthrie at ETS Dental.

Twenty years ago, the vast majority of dentists were solo practitioners who called their own shots and ran their own businesses. Today, group practices represent a significant percentage of the market and now provide an alternative to traditional solo practice. At this point in your career, which setting is right for you?

We have placed hundreds of dentists in both group and traditional settings. While walking a job seeker through the decision process, we consistently hear the same set of "pros and cons" offered for both settings. Here is an overview that we hope will prove helpful to any dentist considering a new position.

There are many types of group practices. For the purposes of this blog I will define traditional practices as those that have a sole practitioner or two partner doctors. Group practices include corporate groups, offices run by practice management companies, and private practices with three or more doctors.

Traditional Practice:

    Pros:

  • More income potential as a practice owner or partner
  • Freedom to run the office as you see fit
  • Freedom to pursue your own clinical interests
  • Equity position is more likely

  • Cons:

  • Complete responsibility for the practice
  • Many hours of administrative work outside of clinical hours
  • Balancing clinical CE with business development training
  • Practice growth is your responsibility

Group Practice:

    Pros:

  • Limited or no administrative responsibilities
  • Limited or no time required outside of office hours
  • Reduced overhead could improve compensation
  • Collegial setting
  • Larger marketing budget
  • Ability to specialize within practice
  • Mentors available – clinical and business
  • CE program in place
  • Ability to negotiate higher fees from insurance companies
  • More funds for equipment and technological upgrades
  • More common to find benefits packages include group health insurance, 401K, and more

  • Cons:

  • Less clinical autonomy
  • Less or no control on business of the practice
  • More colleagues to disagree with
  • Quality of colleagues work reflects on you
  • Less freedom to pursue niche
  • Equity position less likely
  • Higher staff turnover
This is certainly not a complete list of all the varying aspects of these two settings.

Contact Carl Guthrie with any questions you may have.

Tuesday, April 8, 2014

The Value of a Second Opinion to a Dentist

Here is another thoughtful blog from our esteemed client Dr. Don Lurie.

It seems to me that every health care professional sometimes needs to take the same advice that he gives to his patients.  "I suggest that we get a second opinion on this…"

I have written many articles regarding the beginning of our practices and continuing to retirement.  As I have said, (The Profession of Retirement, May, 2013) the new career of retirement requires planning and thought including the obvious financial requirements  and also the emotional preparation (Emotional Preparation for Retirement, March 21, 2014).  I strongly believe that preparing for retirement should start with the onset of our practices and that careful management by the proper team of advisors is essential to accomplish this.  Like with most things, we get into a routine and things just continue to function and run - timely donations to retirement funds, investments, insurance, etc... 

However, I made the mistake and took it all for granted.  Things and circumstances do change.  Health can be a factor in your planning (or lack of same), personal goals, motivations, insurance needs and many other components that combine to make our new career of retirement frightening and foreboding.  It is my hope that you can learn from my mistakes and make this transition so more calming and smooth.  I think the key word here is "transition". 

About 10 years before I retired (after 50 years), my "CEO" who really was my accountant (and the head of the Team of Retirement, August, 2013), suggested that we examine several areas of my life and practice.  He also suggested that we get a second opinion on various subjects that incorporate the business of dentistry and oral surgery.  Did we have an accurate appraisal of the worth of the practice or were we hiding our head in the sand? Do we still need to continue large amounts of life insurance or can we scale back as the age increases and other investments take over? Do we have a team in place to advise us on how to Transition the practice, think about buyers, target the buyers, bring in an associate/buyer etc? Are the investments good for the short term (while in practice) or do we need to start looking for a different quality of investment or moderate style of investment for those retirement years so that there can be some inner peace without the volatility of "the gamble"? I thought that my accountant was really so wise to suggest second opinions and it proved to me that he was the correct person for the job of CEO by being unafraid to show and share our information to an unbiased group of advisors.  It is with this vision that I was able to make even better decisions, long before retirement, to make this retirement career seamless as the time approached.  Of course, the first 6 months were an adjustment but I was ready for them.  And after that period, my life has taken on a new purpose and joy that I could only hope would be the case for everyone.   Another big area that needed a second opinion was the role of the corporate attorney.  Were our documents in order? So a review of the articles of incorporation was carried out at that time.  This also helped me in finding the attorney that I thought would be the right person at the time of transition.  This was invaluable and helped to keep that stomach-ache at a minimum.  It was just one worry that was eliminated knowing that there was the right person to turn to at the given time. Another area in transition to be considered is insurance.  Do you have the right kind of life insurance, enough or too much, malpractice insurance (enough or too much), real estate insurance if it applies and are there other insurances that your situation requires? What about HIPPA? Do you have the right IT person to help you to transition? Does he need to install systems at home to help in the transition? The list of questions goes on. 

I always made it a rule when I was in active practice, that I would not be the treating surgeon after I gave a second opinion.  I made this clear to the patient initially and reinforced it.  This gave me clearance to be more objective and to sincerely want to help both the treating doctor and the patient in solving the problem or conflict.  I followed this rule when I receive my second opinion from the outside group of advisors.  They were helpful and, more importantly, reinforced my admiration for my lead accountant.  Both groups agreed that I needed a specialist in practice transition to get to where I needed to go. 

The detail of this team was amazing including instructions to staff on what to say to the patients, how to explain what was going on, where charts would be available, etc.  Actually scripts were written so that there would be consistency among the staff when answering questions.  I cannot emphasize enough the value of scripts.  They should be used throughout your entire career

So I would urge you to reevaluate your situation, get that second opinion and move on, either with your original team or perhaps with the new advisors.  It may be an amazing discovery.  The goal is to make this as smooth a process as possible but you too must have an open mind and be clear about your goals.  They should be written down. Keeping a journal is a valuable tool.  Remember, "You cannot live a positive life with a negative mind."

The Team of Retirement for me was key.  Outside advisors and specialists were brought in at various stages of my career and for their efforts, I am eternally grateful.

These are just some thoughts that were on my mind regarding practice transitions and the possibility of a need for second opinion.  We are all here to help one another.  Please do not hesitate to send me you thoughts and questions.  It would be an honor to help.

More Mistakes Made and Lessons Learned next time.


Dr. Donald B. Lurie
email:  donald.lurie@att.net
Phone:     717-235-0764

Cell:         410-218-2228

Friday, March 21, 2014

Emotional Preparation for Retirement from Dentistry

This is another guest post from our dear friend and client, Dr. Don Lurie.

It seems to me that many of the doctors that I talk to as they prepare for retirement, are terrified.  Their anxiety is obvious after just a few minutes of conversation.  I am asked (being recently retired for 2 years): what do you do with yourself, are you happy, does your wife like having you around, and many similar questions.  I have talked before in my articles about the obvious financial preparation for retirement and associated subjects in my blog titled "The Profession of Retirement."   I think that attention needs to be placed on the emotional aspect of retirement.  This was difficult for me and, while I thought I was prepared and "longed" for retirement, it took the better part of 2 years to be emotionally comfortable with this new life. 

Now I would like to share with you some of my fears, visions, and thoughts that have occurred and I am, excited to say, how wonderful this new life - this new career - has become.  In the early stages, the financial aspect was certainly a fear.  After all, I never had to live on a budget where there was a "fixed income."  Thanks to my "Team of Retirement." which I outlined in another earlier article, this was easily overcome and after about 6 months, it was obvious that our preparation was accurate and that life could be sustained.  I don't want to minimize this but I would like to concentrate on the emotional aspects of retirement for this article.  For some folks, no amount of money is enough.  But just as important, is the fear of being unprepared for retirement.  After all, there is no clock that says you must be at the office at 8:30 and leave at 5.  Or that you must be at this meeting or seminar at the given time and so on.  It is a challenge to be able to make your schedule properly; but that is exactly what must be done.  I knew that I wanted to be in a situation that allowed me to be a mentor and a helper.  I wanted to give of myself and this was a major factor in planning my time and for concentration on this new career.  I would urge everyone to look at retirement as the beginning of a new and wonderful career.  You have the tools and the experience.  You have been the CEO of your practice, and with help, the CFO also.  You have learned to communicate, delegate, and to take part in community service.  You have learned to keep informed and to take continuing education, and more importantly, you have learned to bring healing, happiness, and joy to others.  So, soul searching need to be done as to where this new career is headed and what ends do you desire.  There is no limit. 

I prepared for retirement with my team, with my wife, with my pastor, and with my heart.  I knew that I wanted to be an instrument to give back to people and community.  Thus, I was able to list the areas that I could do a little good with the tools that I possessed.  I was then able to see that the areas I was interested in were both professional, secular, and religious.  And then, the list got larger and the openings became clearer.  This introspection takes time and effort.  The schedule is now so filled, that I wonder how I had time to practice Oral Surgery. 
I give council to students, I work at a new profession (photography) which was a hobby of long term, and I still teach at local area study clubs.  I try to write articles that come from the "school of hard knocks" and to share the experience that comes with 50 years of practice.  But this was not enough.  I am proud to be part of a large out-reach program that takes a great deal of time plus volunteering.  And now a new idea has come to me!

Since I wrote an article on "The Specialist and theStudy Club", it occurs to me to start a Study Club for Retiring Dentists.  This would be a group who can share their story with those who are near, not so near, or just beginning to think about the "new career after dentistry."  As I have said before, Planning for Retirement should start when you first begin practice.  Now you see why my group of articles start out with mistakes made! My thoughts on this club would be simply a chance to exchange ideas, to help rid ourselves of the fears, to hear a colleagues' story, or just knowing that you are not alone.  As the time goes on and the group continues, many other avenues can be addressed.  Psychologists, out-reach experts. hobby enthusiasts, financial planners, wives and spouses and their interaction and so on.  I think it can work and it is something that we will start in our area.  There is no age limit and should encourage the 30 year-old on up to the senior group.  Each age has a different prospective and could be a big help to both senior and junior including the transition of a practice. 

These are just some thoughts that have been on my mind and I think you understand where I am coming from.  We are all here to help one another.  Please do not hesitate to send me your thoughts and questions.  It would be an honor to help.

More Mistakes Made and Lessons Learned next time.

If you are interested in participating in a study club for dentists thinking about transitioning out of dentistry, contact Dr. Lurie or Ellen Dorner.

Dr. Donald B. Lurie, DDS
email:  donald.lurie@att.net
Phone:     717-235-0764

Cell:         410-218-2228

Tuesday, March 18, 2014

Dental Case Study: Selling the Real Estate with the Charts

Here is a guest blog from Ellen Dorner, Managing Director of Dental Practice Sales

Dr. A is a 62 year-old GP that is in the process of transitioning out of his practice.  Dr. A owns his own building in a small office park with good parking, good visibility and in a very stable area.

When Dr. A decided he was ready to transition out of practice, he also decided that he would sell the building at the same time.  With all the good things about his building location, the sale has not gone as easily as he thought it would.  He has had several interested buyers for his practice, all of which are young dentists just starting out.  And while they would love to eventually own their own building, the decision to do so now has been a difficult one.  With @ $200,000 in school loans still outstanding, the additional cost of a building purchase along with the practice has become too daunting.

This seems to be the situation with many dentists who own their real estate.  The buildings were purchased with the notion that real estate always goes up and is a great investment.  And while commercial real estate has taken a hit over the last few years, the decision to own was not necessarily a bad one at the time.  The glitch is that in transitioning a practice with the real estate to a young dentist just starting out is proving to be too much for them to handle at this point in their career.

A better idea may be to lease the building with an option to buy the real estate at a later date.  The critical piece to this situation is to be sure that all terms are in the lease – who will value the real estate, the terms of the eventual purchase and the timing of the purchase.


As in any part of the transition, it is critical to have trusted advisors to walk you through this process.  You are the dental expert, don’t hesitate to rely on other experts for this important transition in your life.

To discuss your situation, email Ellen or call her at (800) 772-1065.