I preached overheads in the low 40’s and taught how to achieve it so we could make informed decisions on managed care and other discounted fee plans. Elitists taught how to “beat” managed care. How’d that work out for ‘em? Here at Comfort Dental, we can accept any dental plan we choose to and profit from it because all of our overheads are under 50% . . . . Quite a few under 40%. Very few believed. They got used to 75+% overheads and now dental students are taught to expect it.
Speaking of dental schools, I preached that they actually do a decent job if they don’t try to do too much. I was worried that students don’t get enough procedure “reps” and that instructors need to be cautious of their tendency to impart an elitist mentality to students . . . . dental students for goodness sakes! I said that dental school was not to be taken too seriously. That it should be considered a right of passage, a place to get your ticket punched and that the focus should be on getting maximum reps in Bread-and-Butter procedures. Nobody listened and a few schools graduate dentists who can’t do endos or extractions and therefore aren’t even real dentists. (They can do posterior composites, though.) Others graduate dentists with an elite bent that retards them financially for years until they finally figure out they were sold a “bill of goods”. Some never do.
The result is a continuing plethora of bankruptcies. If you are not aware of a dental bankruptcy, you need to get out more. At any given time, I’m aware of at least 10. See: Utah. We have a young superstar partner who was awarded “dental office” of the year by a large supply house 2 years before he went bankrupt in Utah. They sold him everything under the sun because he couldn’t practice without all of it. Thankfully he found us and now sees the light. He’s an immensely talented guy who simply got sucked into the elitist bottomless pit. He is one of a precious few elitist rats to have successfully accomplished jumping the elite ship.
I preached and preached collection policy as the number 1 factor in low overhead. We taught thousands of dentists how to collect 100+% of their production without sending statements. We taught the painful steps necessary to achieve overheads in the low 40’s. Very few listened and most simply didn’t believe us.
We talked about the Recall Myth: That is, the false security that nearly all dentists think results from a big recall system. I told what you get from a big recall system: big overhead. Show me multiple hygienists and I’ll show you 80% overhead. Security doesn’t come from big recall. It comes from big NEW PATIENT flow.
I showed how to handle the new patient. I taught how to open the telephone and front office gates to allow hundreds of new patients per month into the practice. We demonstrated how new patients should and could be invited into the practice same day or next day from the initial phone call. We taught why and how to NOT schedule new patients in hygiene, how NOT to do first visit prophies and how it results in complete-case dentistry . . . . better for our patients and better for our success. Very few listened because it was hard. That’s the catch. What we do is hard. So most dentists do things the way they always have and think the way to increase income is to raise fees. The best way to increase income is to find a way to help more people and the best way to meet more people is to hold the line on fees.
Maybe my best preaching of all was concerning our Lean and Mean Group practice concept. It allows the senior doc to recapture the equity in the practice in multiples through growth and the sale of partnerships. It also resulted in reduced overhead via the expanded hours that are mandatory in today’s market along with the other economies of scale that maximum usage of the facility provides. I conveyed my heartfelt belief that solo practice is an antiquated concept and only suitable for a tiny few percentage points of elite-leaning dentists. I warned dentists against taking their solo practice downhill into retirement. Very few listened and what we have are multitudes of retiring dentists closing their doors because no one will buy their practices. Retirement is not what they hoped it would be.
I spent eons teaching how important location is to dentists and that proximity (or not) to other dentists is NOT a factor. I ranked the types of locations from best to worst so no dentist who listened could possibly locate in anything but a good location. Very few dentists paid any attention and I still see dentists who look like they are hiding from their patients.
For all these many years, I preached that traditional one-patient-per-hour hygiene practice was a failed ideology that drove overheads ridiculously high and didn’t meet the needs of our patients or the practice. Most hygienists reacted with all too typical knee-jerk venom, refusing to own up to their role in the fiasco and refusing to learn how they could serve more and better for our patients while earning better for themselves as well. We taught accelerated hygiene practice in our Lean and Mean hygiene series and our hygienists prospered and served our patients well. We talked about such things as no hygienist “nesting” meaning no specified hygiene rooms creating all-same treatment rooms, no first visit hygiene scheduling, no new patients scheduled with the hygienist, and doctor diagnosis of perio disease. Very few listened and enough dentists are fooled by the ancient ideology and have now accepted 75+% overhead. In my geography, we suffered through a horrific hygienist shortage in the late 90’s so by necessity we learned to do without hygienists and we learned well. Nobody believes me but I love hygienists and they are NOT overpaid but they could do so much more and in our system they must do it our way or they’re not with us. Mostly, they’re not with us.
Surprisingly, on the rare moment when I look at a professional periodical most often filled with nothing but mindless drivel, elite CE hustles, and gadget/product huckstering, I occasionally see messages similar to mine espoused by a respected colleague. I appreciate it. It gives me hope. Make no mistake though: I said it first, I said it best and I still do. It would be nice if they mentioned my name now and then. I’m no longer the irreverent smart-ass punk you used to know disrespecting my elders and the institutions of the profession. I’m a smart-ass elder-statesman disrespecting everyone who doesn’t see it my way because we got it right.
To be sure, Cindy and I have been humbled by the tragedies of life in general, but our passion for how we know dental care should be delivered to the dental patients of this land has never wavered and we are more confident of our righteousness than ever. We have taken our lumps from the profession in every way imaginable as you would expect to happen to someone who elects to swim upstream for an entire career. Dental politicos, dental school instructors, elitist traditional soloists, et. al. consider us fair game for pot-shotting and perpetually in season. This is to be expected . . . however painful . . . . as we are dealing with, after all, well . . . . dentists. (And I don’t mean that in a good way.) We have found too many dentists to be jealous and hypercritical of their own kind all the while being non-confrontational poster children for passive-aggressive behavior. Translation: Embittered, Backbiting Cowards. Such is the price we pay for our success. We carry on anyway. Every arrow in the back that I suffer determines and emboldens me even further to grow our wonderful organization throughout this country.
So, Cindy and I spend our time with our sons, caring for our Comfort Dental Partners, (You see, they DO listen.), investing in real estate, and entertaining our partners in Colorado and around the country (often in our own jet and in our own resorts). I wanted to be able to bring you new practice management techniques and tools for this new millennium on my first effort after these past few years. But there aren’t any. I wanted to bring you a new message. But there isn’t one. Maybe this time, you’ll listen to the old message. It just doesn’t get any better.
My best to all of you.
Rick Kushner, DDS