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Up Up and Away!

July 1, 2005
Taking a General Practice to the Advanced Clinical Level

Taking a General Practice to the Advanced Clinical Level

Amy Morgan

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Transforming a general family practice into one focused primarily on crowns, bridges, and implants can be extremely rewarding for your patients, staff, and you. But before you see rewards, you have to weather the storm of making major changes in your practice. You will need to learn new techniques, buy equipment, refine office systems, prepare your staff, budget, develop new marketing strategies, create viable financial options for patients to accept comprehensive care, and more. You will need to do all these things while running your practice! How can you handle this? Due to the initial difficulties of making major practice changes, it’s understandable why many dentists turn back. It’s also very sad to see dentists leaving their dreams behind because their loads are too heavy. They may walk lighter, but not happier. What would you do in a case like this?

Far from being burdensome, a major practice change can be invigorating. It can lead to a higher level of patient care and satisfaction, increased staff enthusiasm, and professional fulfillment. If you dream of expanding your horizons clinically, but dread the office upheaval, fear no more! I’ve had the pleasure of helping many dentists reinvent their practices to achieve their clinical dreams. This article explains how to prepare your practice for a new direction. I’ll describe how one woman dentist did this. I’ll call her “Dr. Whitehall” to protect her privacy. This dentist carefully implemented effective management and business systems before undergoing extensive technical training to ensure the proper office infrastructure for new clinical techniques. She, like many dentists, needed to gain control of the business to be free to do what she really loves - dentistry!

Creating a supportive infrastructure

After completing dental school, residency, and a brief associateship, Dr. Whitehall bought her own practice about 10 years ago. Although most young dentists wait at least a decade to obtain formal practice-management training, Dr. Whitehall began immediately. She did not know how to run her new business, which made her feel anxious every time she spent money, hired staff, or made other operational decisions. This out-of-control feeling encouraged her to get her business in order before focusing on establishing a specific clinical philosophy.

Dr. Whitehall had purchased a good family practice, but she wanted to make it excellent - in quality of care, staff commitment and performance, office systems, production, customer service, clinical procedures, and more. In contrast to many dentists who fight business training, find excuses why new ideas won’t work, or procrastinate making changes, Dr. Whitehall and her team implemented everything they learned about practice management. As a result, they developed sound financial goals, business plans, budgets, procedures, and tracking programs that made the practice more profitable. After three years of intense focus on practice management, Dr. Whitehall had developed a sophisticated infrastructure to support quadrant dentistry and a soft-tissue-management program. She and her hygienists were using their five operatories effectively. They were ready to advance further with comprehensive care and esthetics.

Dr. Whitehall was an unusual dentist. She had a full-time staff of 12 plus one part-time person, more than double the number of employees in the average dental office. She worked with three clinical chairside assistants and one lab assistant. Three hygienists, aided by a hygiene assistant, delivered a strong soft-tissue-management program filling 11 hygiene days per week. The front desk staff consisted of three appointment coordinators, one treatment/financial administrator, and one part-time insurance coordinator. Most importantly, everyone was busy and happy!

Employing such a large staff meant that the money spent on payroll was much higher than in an average practice. However, due to the high production made possible by the large and well-trained staff, the actual percentage of Dr. Whitehall’s payroll and employee benefits was at a very fiscally responsible 23 percent.

Dr. Whitehall made an important decision early on that shaped her future. She decided to involve the staff completely in her quest to improve the practice. Realizing that she couldn’t implement things by herself, she sought the staff’s understanding, participation, and commitment at every step. They accompanied her in both her practice management and clinical training courses. If a course did not allow staff attendance, she would call the sponsor to ask if she could bring team members. After every course, she and her team developed an action plan to implement the training. Dr. Whitehall made a considerable investment in staff training, including an average of six out-of-town courses each year. As a result, she instilled in her employees a true pride in their work as a career, not just a job. Dr. Whitehall avoided a common problem - returning from a course anxious to implement new things, only to have that enthusiasm quenched by an indifferent staff.

Getting advanced clinical training

A few years ago, with her infrastructure, staff, and comprehensive care philosophy in place, Dr. Whitehall began a series of courses to advance her clinical training. Within 18 months, she and her team had completed a considerable number of clinical courses, including advanced esthetics, masters’ esthetics, full-mouth reconstruction, posterior esthetics, occlusion classes, and some programs to support the clinical training. All the while, Dr. Whitehall’s regular clinical practice continued to thrive, surpassing the goals set in her annual plan.

Because her team members had participated in the training and fully understood the goals of the practice, they were excited about offering new, comprehensive clinical treatment, and very proud to offer patients high-quality care. Now, the doctor and staff needed to implement the new level of dentistry they had learned. This meant refining operational systems to encourage patients to accept comprehensive care, offering financing to support it, ensuring completion, and doing it all while running a busy practice.

Implementing the training

The doctor and her team took the same approach when they implemented their existing practice-management systems. They developed a master plan and set specific goals, responsibilities, and completion dates for each step. Their training did not give them just specific static systems; it gave them ways to adopt or change any systems in the future. They knew how to formulate a plan, break it into steps, assign pieces to different team members, and measure progress. In short, their practice-management training taught them how to tackle any challenge at any time. They applied their skills to implement advanced clinical techniques and transform the practice into one with a strong emphasis on comprehensive care and esthetics.

Here are some highlights of their successful effort:

Goal-setting An initial goal was to perform five comprehensive care cases per month, which were defined as cases involving more than one quadrant of dentistry.

Identifying the ideal patient In one of their regular meetings, the doctor and team defined patients most likely to accept and benefit from the new treatment. They sketched their ideal patient in terms of age, deterioration of existing restorations, periodontal soundness for reconstructive treatment, and motivation toward oral health and esthetics. Through their prior practice-management training, the dentist and team had a system for discovering and recording patients’ dental motivators and concerns. This information helped identify the patients they would introduce to advanced clinical treatment. They didn’t diagnose the patient’s pocketbook, but focused instead on the person’s clinical condition and his or her need and interest in quality care.

Selecting patients to ask for referrals The practice had an effective morning huddle, which was vital to achieving their clinical goals. At the huddle the doctor and team determined which patients would be approached that day, which clinical person would help the doctor educate the patients, and how the case would be presented based on each patient’s motivators and concerns. The “patient educator” was the chairside assistant or hygienist in whose room the patient was placed. This person explained the diagnosis. Having honed their management skills first, the doctor and team had developed systems and verbal skills to help patients make treatment choices.

Debriefing on the results At the following day’s huddle and each departmental meeting, the team discussed which techniques worked well and which did not so they could continuously improve.

Developing and fine-tuning the strategies Dr. Whitehall and her clinical staff developed a procedure for introducing patients to esthetic dentistry, and for doing a clinical work-up (X-rays, study models, etc.) and consultation for interested patients. The doctor and staff used computer monitors in the treatment rooms to present a digital slide show of before-and-after shots and intraoral pictures. They used their practice-management systems, verbal skills, and experience with case presentation and patient education to promote comprehensive care. Dr. Whitehall and her team choreographed every person’s role in patient education, case presentation, answering clinical questions, closing the patient clinically, and passing the patient to the financial coordinator.

The practice chose to handle financial arrangements through outside credit sources. The doctor reveals the price range early to avoid surprising patients. The financial coordinator assists the patient in completing and processing the necessary credit application on the spot. Because these systems were already in place, they were hugely helpful in implementing the new clinical goals.

Scheduling the new treatment The schedule needed to be preblocked to accommodate the advanced clinical cases. To simplify the implementation, Dr. Whitehall and a skeleton team worked an extra day to do the comprehensive cases without disrupting the normal schedule. This allowed them to concentrate on other aspects of the implementation first and avoid taking on too many changes at once.

Monitoring results Another way in which prior practice-management training prepared the infrastructure for supporting advanced clinical goals was in the area of tracking results. Dr. Whitehall already had monitors to track treatment presentation, case acceptance, and completion. These systems were applied to the new cases to measure how successfully the practice was introducing advanced treatment options.


The practice averaged 4.2 comprehensive care cases per month in almost two years of the program, close to the doctor’s goal of five such cases each month. Dr. Whitehall is now experimenting with outside marketing to attract more targeted patients to the practice and increase the number of comprehensive cases. Her comprehensive case acceptance rate rose from 50 percent the first year to 65 percent the second year. It is very significant that her completion rate is almost 100 percent.

This is testimony to the excellent job the team and dentist are doing in educating and encouraging patients to embrace comprehensive care. The mix in the practice is approximately 20 percent comprehensive care and 60 to 70 percent quadrant care. Because most patients present with restorations that are breaking down, their treatment is as much functional as it is esthetic.

Do you see how extremely helpful it was for Dr. Whitehall and her team to have all of their practice-management tools at their fingertips? They had mastered the skills of action planning, goal-setting, appointment preblocking, financial arrangements, treatment presentation, morning huddles, and patient education. They needed all of these skills to implement new clinical goals.

You can see how operational management and leadership play a key role in achieving technical goals. If you have clinical goals, don’t let them go by the wayside. Prepare yourself and your team by getting the business end of your practice ready. Then all of your clinical aspirations will be yours for the taking.

Develop the staff and systems you need to build the practice of your dreams. For dates and locations of Pride Institute AGD-accredited seminars, call (800) 925-2600.

Amy Morgan

Ms. Morgan is chief executive officer and lead trainer of Pride Institute, a practice-management consulting firm serving dentists for 30 years. She conducts seminars and workshops for dentists and their teams on how to turn average practices into successful, satisfying ones. Contact Ms. Morgan at (800) 925-2600 or visit