Two Colorado dental hygiene practices embrace independent business models.
by Lynne Slim, RDH, BSDH, MSDH
Once upon a time, there lived several unfulfilled RDHs in Colorado. With crammed schedules, old equipment, and poor job satisfaction, these hygienists wished for a small miracle. Along came a burst of light (unsupervised dental hygiene by law after a great deal of effort by CODHA) and a good fairy appeared. Some Colorado RDHs, such as Edie Gibson, whom I wrote about in 2006, went from riding in a pumpkin to riding in a sparkling coach, and they now run successful and rewarding dental hygiene practices.
Last spring, Edie invited me to stay in her Crested Butte condo for a few days so I could spend time with her and visit her dental hygiene practice. Her condo is located near Mt. Crested Butte, an incredible ski mountain that’s within walking distance of her condominium. The town of Crested Butte where Edie’s spa practice is located is a true ski town. It is located in pristine surroundings that captivate, and has an uncluttered, small-town feel, with no fast food franchises. I fell madly in love with the unspoiled setting, and my eyes couldn’t get enough of the majestic peaks, wide valleys, and natural beauty of the region.
I decided to ride the Silver Queen lift, which is located a short walk from Edie’s condo to the Crested Butte Mountain Resort base area. All I can say about the ride is that it’s a bird’s eye view of magnificence.
I began my visit by spending the day at About Face, Edie’s dental hygiene spa that she’s successfully operated for about six years. When Edie opened the practice, she placed ads in local newspapers about a month before she opened. She is now booked full, three days a week for five weeks, and she said it takes time to develop relationships in the community. Now she doesn’t even have to advertise and continues to get new patients by word of mouth.
Edie Gibson treats a patient in a relaxed environment.
Since my first visit to About Face in 2006, Edie can now take radiographs on patients unsupervised, which resulted from the passage of a 2009 Senate Bill (SB 09-129). She administers local anesthesia under general supervision by a supervising DDS. The dentist is not on the premises but has knowledge that she is delivering it. She has a signed supervisor agreement with a local DDS. Edie still cannot make study casts for teeth whitening, something she finds puzzling. She and I find it ironic that by law she can take study casts for other reasons, but not for the purposes of teeth whitening. SB 09-129 adds diagnosis and radiographs to unsupervised practice, moves local anesthesia to general supervision, and defines the dental hygiene diagnosis. SRP can be done unsupervised in Edie’s practice.
Edie displays several referral business cards for local dentists and specialists and fosters good relationships with many of them.
Before she opened her practice, Edie gave a lot of thought to the overall patient experience. She’s a dental-phobic and definitely didn’t want to run what she calls an “inhumane dental mill.” She wanted a calm and peaceful atmosphere in which her patients would be treated like family.
In taking the time necessary to listen to her patients’ fears and dental history, she can relate to them on a personal level. She often asks patients if she can “talk while I pick at you,” which makes light of the appointment and puts them at ease. While I was observing one day, I asked a few patients to compare/contrast the service at About Face to previous hygiene/dental experiences. Here’s a bit of what I heard:
“The overall experience is much different. I’m way more relaxed.”
“It’s spa-like here. Edie cares about us as individuals and pampers us according to our individual needs.”
“She doesn’t try to sell me stuff.”
We can all learn something from Edie. Whether it’s a tip for a clinician about communication or relationship building or some business advice, Edie is a good advertisement for unsupervised dental hygiene practice. I asked her about “selling” services in dental practices today, and she said she’s a fan of selling good treatment, but not of overselling.
She admits she’s extremely aggressive when it comes to periodontal diagnosis, treatment, and referrals, and she doesn’t understand how so many clinicians dismiss it. She thinks it’s a shame some dentists and RDHs don’t dedicate sufficient time to self-care measures and overall oral and general health promotion. She enrolls her patients in the decision-making process through good communication and open-ended questions.
About Face business model
Edie is a unique business owner because of her many years of experience in the dental corporate world. She is close to graduating with a BSDH degree from the University of Bridgeport and hopes to receive an MBA in the future. She said that if her many years of business acumen were taken into account, she’d already have a PhD! Edie runs a cash-only practice and finds that patients willingly pay her fees. She operates at 40% to 45% overhead and works nine to 10 months a year, three to four days a week. Her income is near the six figure mark and she’s her own boss!
Gibson schedules an appointment in her reception area.
Edie’s ability to deliver a high standard of dental hygiene care has opened many doors for her. Most of the dentists she refers to share her philosophy, and she gets huge thank you baskets from them every Christmas. Her biggest referral service besides word of mouth comes from three dentists in town.
Last year, Edie was supporting a family of three, plus five horses, three dogs, and three cats. She admits her family wouldn’t have made it through the economic downturn if it hadn’t been for her business. She produces an average of $125 an hour, which is about $70 an hour when you subtract overhead. Working seven to eight hour days adds up to about $560 a day, and Edie insists there are a lot of myths about profitability and hygiene.
I sat in Edie’s dental chair to get a feel for the total experience. A beautiful oriental screen separates the operatory from the rest of the practice, and a delightful waterfall trickles away. A good sound system and mood music complete the atmosphere, and Edie won’t admit it but she’s a very talented interior designer. Taking into consideration the whole person, Edie is realistic when assessing patients. Instead of nagging someone to floss when she knows darn well a patient’s self-care measures won’t change, she recommends more frequent cleanings instead. Patients don’t want to be scolded, and they often come into the operatory with excuses prepared. As a testament to the individual attention Edie provides her patients, those with 100% preventive coverage pay cash at the time of service.
The next gloriously sunny morning, I left the Crested Butte condo and headed for Gunnison. It’s a straight shot heading south from Crested Butte and takes about 30 minutes. I was scheduled to meet with Leslie LeFevre, RDH, who owns Healthy Smiles Dental Hygiene Care, Inc., a wellness dental hygiene practice that is about a year old. Leslie and her teenage daughter, Ashley, greeted me, and we walked to a local sandwich shop. Ashley delighted in telling me that she was going to work as a congressional page and she was very excited for the opportunity to work in our nation’s capital. Leslie, Ashley, and I sat outside and chatted about the reality and Leslie’s visions for Healthy Smiles.
Like Edie, Leslie understands the business side of dental hygiene because she was co-owner of a printing business for about 20 years. She describes her business in just two words, “happily thriving,” and she said it’s just plain fun. I asked her what a typical day in her practice was like, and she had a lot to share.
Healthy Smiles is a small business with no employees, and Leslie plans to keep it that way. She schedules patients every hour and 15 minutes, and in between patients she answers messages and makes necessary phone calls. Her goal is 24 patients a week, and right now she’s seeing about 18, or about five a day. In her business model she does not want to see more than 24 patients a week.
For many years, Leslie was happily employed at a nearby dental practice, and she speaks highly of her previous employer. What’s different now is the flexibility of being able to plan her day and adjust her schedule to meet her family’s needs. In addition, she can pace herself, but admits that the services she provides patients are exactly the same services she provided as an employee.
Leslie talks about nearby dental practices, and she likes the idea of matching her patients to general dentists and specialists. She said she’s had great support from local dentists, and she’s thrilled that some send patients to her from time to time.
During Leslie’s first year in business, some of her patients expressed concern that their personal DDS would be upset that they were seeking hygiene services elsewhere. They were also worried about what to do in case of a dental emergency, but this turned out to be a non-issue due to her continuing relationship with dentists in the Gunnison area.
Healthy Smiles business model
Payment is expected at the time of services at Healthy Smiles, and Leslie does not have to worry about accounts receivable. She does submit insurance claims for her patients as a courtesy even though some of her colleagues in Colorado don’t offer this service. Since Leslie doesn’t plan on hiring employees, her maximum overhead goal is 35%. Right now her income is less than it was when she was an employee, but she’s satisfied with it and says that it’s not about getting rich.
Leslie LeFevre and her daughter, Ashley.
Leslie loves the business side of her dental hygiene practice. This year she purchased a new dental chair, and she’s proud that she even has new countertops in her operatory. In addition to treating patients at Healthy Smiles, Leslie supplements her income with state grant money, as she is a Medicaid and CHP+ provider. She is paid hourly to provide care to young children through the Caring for Colorado Foundation, and she also uses portable equipment to care for senior citizens as part of another state grant.
Let’s celebrate the success of business owners such as Edie Gibson and Leslie LeFevre. These two hygienists, rather than avoiding unconventional practices, have chosen to embrace them, and in doing so are slowly but surely chipping away at that pesky glass ceiling.
The author thanks Philips Oral Healthcare for generous grant support in making this trip to Colorado possible.
Lynne Slim, RDH, BSDH, MSDH, is an award-winning writer who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of dental practices. Lynne is also the owner and moderator of the periotherapist yahoo group: www.yahoogroups.com/group/periotherapist. Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. She can be reached at firstname.lastname@example.org or www.periocdent.com.