VOD, Trust And Crispy Fries

Episode 080

This week I make my pitch for the Voices of Dentistry Live Summit, talk about trust and crispy fries…all on this episode of Business of Dentistry.

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There are a few things we’re going to talk about today, one of the first is the Voices of Dentistry live summit. It will be held at the DoubleTree Hotel in Scottsdale, Arizona on January 26 – 27, 2018. I was invited to speak last year and I’m excited to be there again this year as a speaker!

There are a number of great reasons to attend: you get 16 hours of CE credit, great information and, what I think is the most valuable, the networking. Last year I learned as much in the hallways talking to people as I did in the sessions.

I’ve also heard the podcast lounge is going to be bigger and better. I look forward to sitting down with you and to hear your ideas, your thoughts and maybe even interview you when you’re there.

If you’re a student (like Jackie from episode 79!) there’s special pricing for you. You can find more of the details at the Voices of Dentistry web site.

Switching gears now, we’re going to revisit my recommendation to trust but always verify. If you’ve listened before you’ve heard me say this and today I’ll reiterate why. Personally, I failed to follow my own guideline this past week. As a result, I’m disappointed in myself and the vendor. We’d been working together for 16 years and I thought we had a history I could rely on.

But i found out this week I was wrong; I had paid this vendor for things that hadn’t been completed, so I’m disappointed in myself and in this company. Now I’m going to find a replacement before I tell the rep that we’re not going to work with them any longer.

But the lesson I want you to learn is you have to verify you are getting what you paid for. We’re often targets as dentists because we’re all learning the business ropes. So I’m sharing this lesson to remind you to trust but verify. And I’ll revisit this particular instance as I make the transition in my office.

Our final topic this week is crispy waffle fries at Chick-fil-A. My kids love this place so we went there this weekend. When we have gone in the past I’ve always had them make my fries extra crispy, they’re basically burned because that’s the way I like them.

So this weekend when we went, I placed my order and was shocked when the woman said they no longer make crispy fries. It was so surprising because their customer service has always been amazing. They have always been exceptional at asking what they can do for you and then doing it, whatever it is that you ask for.

I’m sure there is a valid business reason for this change, but in my mind this was a huge shift in their policies. And it got me thinking about how and where I might be doing this in my own practice.

I tried to put myself in the shoes of my patients and think through our process to see if there is anything we do that could be perceived as bad customer service. Is there anything we do in our practice that we could alter to make the customer happier? Are things like early morning visits, block scheduling, filling out forms, after hours forms, etc., not helpful to your patients? It’s a question worth asking and worth investigating.

So to recap today’s show, make sure you are revisiting your vendors and make sure you are getting the products and services you pay for. Be sure you are consistently reviewing your customer service and what you are saying no to them about.

If you have any questions feel free to email me or leave a message below, after you listen to episode 80 of Business of Dentistry. And be sure to join me at the Voices of Dentistry summit in January of 2018!

 

Tweetable: “You have to verify you are getting what you paid for.”

Episode Resources

Voices of Dentistry Summit 2018
Jocko Podcast

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Speaking To Jackie

Episode 079

This week we discuss an email I received from Jackie. She took time out of her studies at the Texas A&M College of Dentistry to ask a couple of questions. Listen in to find out what she asked on episode 79 of Business of Dentistry…

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First Jackie, thank you for your email, your kind words and your questions. I’m going to go through your email line by line so I speak to each of your points.

In your email you first share that you listen to the show on your way to and from dental school. And you are encouraging your friends to listen so you can all talk about these topics together. That fact alone tells me a lot about all of you – trying to learn more about the business of dentistry on your own outside of school says you are motivated and you have initiative.

You go on to say you get close to zero hours of training on the business of dentistry and I can tell you not much has changed: that was true when I graduated in 1994.

I remember we had one private practice management course during my dental school years, and I think it was taught by a guy who hadn’t even had a private practice. I’m pretty sure he taught from a book, and I don’t remember if the people who wrote the book had even been in private practice! Unfortunately the business education side of dental school hasn’t changed much. But I am hoping dental podcasts can change that fact.

Your next comment was about the rise in corporate dentistry. I’ve never been in corporate dentistry so I can’t speak to whether the lack of business education is leading to its rise. However, there are people out there who see the beauty in dentistry and see the monetary upside of it, and they are capitalizing on that because they understand business systems and business overall.

The second part of the rise in corporate dentistry might be happening because of dental school debt. I heard a statistic the other day that over 60% of new dental school graduates are hired by corporate dental entities. Maybe that’s because of the debt load you’re having to carry right out of dental school. Going into even further debt to open your own private practice puts an even bigger strain on new graduates.

There also may be people out there who just want to be clinicians and don’t want to deal with the business side so they sell their practice and work for dental corporations. I think there are a few factors that are contributing to the rise of corporate dentistry.

Your next question asks if I will do an episode about how best to secure an associate position and what I look for in someone fresh out of dental school. I’m going to be totally transparent: I don’t have an associate in my practice and I’ve never hired an associate.

But I will tell you the questions I ask when I talk to recent dental school grads: I ask questions about what they are interested in professionally. I don’t buy into the “I like it all” answer; I think deep down if you are honest there is some aspect of dentistry you like above the others. For me, I liked oral surgery best, which is why I went into it!

I also ask questions to see if you are opening to learning: you don’t stop learning the day you graduate. I want to see if new dental graduates are open to continue learning. I still learn every day. We have to keep learning not only in our practice, but in our lives, too.

You are learning techniques and other things today that I would have no idea about – I can learn from you, and of course, you can learn from me.

Next you ask about resumes: resumes are really a list of your accomplishments and achievements. Personally, I will glance at a resume to see if there is anything unique to talk to you about.

Things that have impressed me in the past: a woman who was an air traffic controller in the Air Force. This woman was looking for a position in my office. She was only in her 20s but I knew she could handle stress and I knew she could handle my front desk if she could handle air traffic control!

I’m more about life experience, education is important but it’s not everything. I’d rather have the person who has 3.2 average who was involved in activities outside the classroom like community volunteering, mission trips, military experience, etc. I’d prefer that person over the person who does nothing but study and has a 4.0 GPA and gets a 98 on their boards because that person with the outside activities and lower GPA can relate to others.

If you aren’t there right now, that’s okay. I’m encouraging you to get out and experience life. Good grades are important, but I feel like the folks who excel are the ones who have experienced life in a variety of fashions.

Continuing in that vein, I tell a story of a guy I was on a mission trip with. He wanted to go to dental school and asked for my advice. Listen in to hear the question I asked him, and why it’s a question you should be asking yourself.

And I wrap up with a discussion on failures, how to look at them and why having them and accepting responsibility for them is a characteristic I look for when talking to new dental graduates.

I hope this helps you, email me if you have more questions and I’m happy to talk more. Thank you for being here, I appreciate you for listening and being part of the discussion on episode 79 of Business of Dentistry.

Tweetable: “We can learn from each other.”

Episode Resources

Gary Takacs’ Thriving Dentist podcast
Dentalpreneur podcast with Dr. Mark Costes
Start Your Dental Practice podcast with Jason VanHorn
The Dental Hacks podcast
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We’re Doing OK

Episode 078

This week was a bit bumpy and I started to make this an episode with me venting. But instead, I put a positive spin on things and had some fun based on the income of an average private practitioner. Check it out…and, we’re really doing OK.

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As I mentioned, my week was a bit bumpy. All of our surgeries went fine and our patients are doing well, but there were some difficult interactions I didn’t see coming. I had some after-hour communications and overall things weren’t as smooth as I would’ve liked them to be.

So rather than getting down on our profession like I may have in the past, I looked for the positive. I went to the American Dental Association web site and looked at their 2015 financial income on dentists, from general practitioners to specialists.

According to their site, the average net income for a private practitioner was $179,960 – just shy of $180k. Specialists make about $320,460. Now that’s net income – billings were just shy of $650k for general practitioners and specialists generated a tad over $1 million. What’s interesting about that is those incomes are solid, even considering this is the average.

And I took it a step further – I found a site that allows you to plug in your income or your net worth, and it tells you where you stand compared to the rest of the world.

Now I don’t know how accurate this site is but it’s still interesting to explore. It’s called the Global Rich List. So you go to the site, put in your location, and your annual income or your net worth/your wealth. They’ll find your net worth for you by asking for the equity in your home, the value of your possessions and assets. Then they compute your results and show where you stand compared to the rest of the world.

So if we take the average net income for a private practice general dentist in 2015 – $179,960. If you add that to the site, next choose the United States as the location (if that’s your location, it is mine) and hit calculate. What comes up next is a graph of people that shows you where you are versus the rest of the world.

Based on the number we gave it – $179,960 – this web site says that income puts a person in the top 1/2% of the world’s richest people by income.

Think about that – the average dentist is in the top percentage of the wealthiest people in the world. We’re in a damn good profession! I lose sight of that sometimes, and when I do, I revisit this site and it puts things in perspective.

That site also gives more data, it says we make $93.73 on average per hour. It then compares that number to other parts of the world. For example, the site says the average laborer in Zimbabwe makes 50 cents an hour.

It also compares your annual income and tells you how long it will take people in other parts of the world to make that same amount. For instance the site says the average laborer in Indonesia would need 242 years to earn the $179,960 you earn in a year. It also says your monthly income could pay the salaries of 1100 doctors in Malawi.

Can you see the good in that? By telling you about this site I’m trying to help you see the positive. We’re fortunate to have the opportunities we have thanks to our profession. I know sometimes it doesn’t feel that way! We get disgruntled and discouraged, and it is a stressful line of work, but there is good in it too. When I get down on what we do I go to this site and it reminds me of that fact – I hope it will do the same for you.

Let me know what you think about this site and any other things going on in your world, positive or negative. I look forward to hearing from you and getting your feedback, after you listen to episode 78 of the Business of Dentistry.

Tweetable: “For the time we work we do pretty well.”

Episode Resources

Global Rich List web site
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Collect and Spend Trends

Episode 077

Do you have slow months in your practice? How about busy ones? Are your spending trends in line with the busier ones? These are the topics we discuss this week…thanks for joining me on this episode of the Business of Dentistry.

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It’s Labor Day weekend here in the U.S., so I’m keeping this episode short. But I’m also talking about the holiday because it relates to our topic today: comparing your practice collection trends or patterns with your purchasing trends or patterns.

To compare these two trends review the historical data you have collected from the time you’ve been in practice. So if you’ve been in business for three years, you can look at the collections per month for three years. Open up your practice management software and see what have you historically been collecting in January, February, March and so on.

Then find out what your average collections are per month across the board for the past three years. I take a look at the past three Januarys, make an average of that data and then I know what we will probably generate in January of next year. I do the same for all of the other months.

When I have that information and I have an idea of what we’re going to collect, then I know the months that will be busiest in my practice. For me those months are March, July, October and December.

I know those months are solid for me, so when I get the average collections for those months I can start looking at my purchasing trends. I want to know when am I buying the most, when am I making my largest purchases per month. I compare that data with the previous data of the months with the largest collections, then I’ll know if these are matching up or not.

We were not, now we’re trying to make those adjustments so we are making our biggest purchases in the months when we have the most collections.

I do so because there is more cash on hand. If I’m making a big purchase I can slide it into the time frame when I have the most cash flow, which reduces my monthly overhead. But I can only do that by looking at the data and knowing my spending trends, collections trends, etc.

Doing so also helps me to set aside cash for bigger purchases that will need to be made in the future. Typically I like to pay cash for things whenever possible, unless it’s a very big ticket item like a $150k CT machine. I would opt for financing versus paying cash on something that costly because I don’t want to deplete my reserves to that extent. But you might, and that’s okay.

The main thing is to evaluate, analyze and plan the way you are making purchases so it works for you and the way you run your business and your practice. This is just how I do it and I’m telling you so you put some thought into how you’re doing this rather than just flying by the seat of your pants.

Another thing I want to talk about is planning ahead for the slower months. I know that September is typically slow for me and every year I tell myself I’m going to do some kind of marketing or advertising to change that and stimulate my practice’s number. Although I say this every year I have yet to do it!

I hope you are better about this then I am, if you have certain months that are slower than others make a plan on how you will handle them.

Maybe you plan your vacation time for those slow months, or you attend conferences like The American Association of Oral Maxillofacial Surgeons has their annual meeting every September because they know we are all slow so we can all attend. You can also condense your schedule in the slow months, or plan a marketing campaign to boost your numbers.

Do whatever you can to balance your collections out across the months to make them as close as possible. This will make your overhead better month per month, which ultimately results in lower overhead and better profitability for your business and practice at the end of the year.

If any of these episodes have helped you in any way, go over to iTunes and leave a review. For those of you who have left reviews, thank you! You’ve helped me on this show and in my practice. I appreciate you and again I thank you for listening and being here on previous episodes, and on today’s edition of Business of Dentistry.

Tweetable: “Know the trends and patterns in your practice.”

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Procrastinate On Purpose

Episode 075

In episode 075 we discuss a decision funnel to determine how we should spend our time performing tasks in the practice. Our discussion is based on the book Procrastinate on Purpose by Rory Vaden. Check it out to see if procrastination may be right for you on this edition of Business of Dentistry!

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While this isn’t our usual type of show, I thought it was a good topic to share because so many of us procrastinate or have dealt with some type of procrastination in our lives (both business and personal). I’ve always been a proponent of procrastination so when I saw the title of Rory’s book I was intrigued. The more I listened to the audio version, the more relevance I could see in applying his principles to our businesses.

The easiest way to break this down for you is to explain the funnel imagery Rory uses in Procrastinate on Purpose: first the tasks that need to be done come into the top of the funnel, this is also where the time you need to spend on those same tasks will come in, too.

Next these tasks and time for these tasks go through a series of filters. The first filter through that funnel is whether or not you can completely eliminate that task. In other words, do you actually need to do the task?  If you took a task like surfing the web, Facebook, or other forms of social media then the answer would be no.

It’s something to think about as you go through your day: ask yourself if the task you’re working on is really necessary. Will it change anything today, or tomorrow if you don’t do it? Will it help you save time or be significant down the road? Social media is a great example of something that can be completely eliminated from your funnel.

The second level of the filter is for things you cannot eliminate. Ask yourself if you can automate it – can you put it on autopilot and set it up so you don’t have to manually do it every single time? An example of this is our office cell phone bill. I used to have to manually pay it, and it was frustrating and time-consuming to remember when to pay the bill and then to actually pay it.

So I decided to set up an automatic payment of the bill on the corporate credit card. Now it gets paid every month automatically, and I get a notification of when it is done. It’s completely hands off for me, unless I need to update the credit card information for some reason.

Now if you find you can’t eliminate or automate a task, then the next step in Rory’s funnel is delegation. This is something we have talked about on the show a lot. Some of us are good at delegation and some of us are not. But ultimately delegation will make you a strong leader and a better business person.

To find out if a task can be delegated, ask yourself if you are the only person in your practice who can do this particular task. If not, who else can do it?

For me, I am the only one in my practice who can do surgeries so I cannot delegate that task. But when it comes to things like payroll, bookkeeping or accounting, can I do those? I have in the past, and I can struggle through it. I’m not efficient or effective at it, but I can get it done when necessary. Today I delegate it to the professionals in an accounting firm.

In this book, Rory promotes delegation as another hallmark of a great leader because you are helping the person you delegate to by training them, pushing them outside of their comfort zone and helping them grow. Delegating to others improves you as a leader and improves the person you delegate to.

The final step in this funnel is tasks that only you can do. When you reach this point, you have to ask yourself if the task must be done right away, or if it can wait. In other words, is it something you can procrastinate on? Timing is key to this.

In my practice an example of this would be surgeries. If there was someone waiting in our office for their scheduled surgery, can it wait? Since I’m the only one who can perform this task, do I need to do it now or can it wait? Obviously I would perform the surgery right then at the scheduled time.

What about if you are a solo practice owner and you are thinking of expanding and bringing on another associate? The actual task of making this decision is something you would need to do. You cannot eliminate it, automate it nor delegate it – making this important decision is a task only you can do.

But do you have to do it when you have two patients waiting in your lobby? No, it can and should wait. It’s important to delay the task til you can schedule time to focus solely on that decision.

Those are some ideas Rory covers in Procrastinate on Purpose, and I like the way he brings them together in an easy-to-understand manner. I also like this book because I think it’s a good way to look at your upcoming day and prioritize items on your schedule.

On this episode, I also talk about when Rory encourages us to procrastinate, and when to take action, and why we all have to work every day to achieve our goals. I’d encourage you to read or listen to this book and Rory’s first book, after you listen to episode 75 of Business of Dentistry.

Tweetable: “Every day the rent is due.”

Episode Resources

Procrastinate on Purpose, by Rory Vaden
Take The Stairs, by Rory Vaden
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Team Transitions

Episode 074

Welcome to the Business of Dentistry podcast! Check out this week’s episode as we discuss our options on reacting to team transitions and how I’ve navigated these changes recently in my practice. Listen in to hear that and more on the 74th edition of Business of Dentistry.

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Recently there have been several transitions in my practice and they’ve impacted some business decisions I’ve made. A few of our front office team members have left on their own accord because they found other opportunities.

One of the people who left had been working in an administrative role and found clinical work elsewhere, so she gave her notice and moved on. The other person was a mother with young children in school and sometimes our work schedule conflicted with caring for her kids. To solve that she found an administrative role within the school district.

We also have a team member who went on medical leave, but we don’t know how long that leave will be so we had to figure out everything they do and build a system for it. We had to transition some of these tasks to other people without overloading anyone, all the while still getting the work done.

Even though we’ve had a pretty big shake up on the administrative side lately, we are weathering the storm well.

One of the team members who left, Catherine, did so right about the time I was set to leave for my Navy reserve duty. Of course it wasn’t great timing but we made the necessary adjustments. My office manager Paul and Becca, my front office team leader, asked me what to do. I told them to start the search for finding a replacement while I was gone.

During my 2 weeks service Paul messaged me to say he and Becca thought they found someone. They both interviewed her and thought she would make a great addition to the office. He then asked if I wanted to talk with her when I returned or if they should go ahead and hire her.

Initially I was reluctant to hire this person without meeting her first. But I took a step back, took a few deep breaths and realized I have known Paul and Becca for years. I trust their judgment so this was my chance to show them. I took a big leap of faith and told them to hire this person if they really believed she was a good fit.

My initial hesitation was not because I don’t think they can hire good people on their own, it was about my ego getting in the way. When I realized that I knew I could delegate this to them and they would hire the right person.

When I returned from my two weeks in the reserves, I was walking down the hallway to our team meeting when I met Whitney. This is the first time I had a new person in the office whom I had not personally interviewed and hired. It was refreshing! I will say that it’s early in the game, but I think she has great potential.

And I’m bringing this up because this is the first time I’ve ever delegated the hiring process to my staff. You may already be doing this, but in my 16 years of practicing I’ve never done it before.

This is also timely for me because I was on social media recently and read a Facebook post from a man who had fired his entire staff, in one fell swoop. At first I thought he was kidding, but as I read more I realized he was serious!

I don’t know the entire story but it was interesting to me that someone would do something this extreme. And I’d love to have this person on the show and interview them, if you know this individual or are this person then email me. I’d love to know what prompted this person to wipe the slate clean and shut down their business while they retooled their entire staff.

On this episode, I also share how I had a similar experience in my practice, plus some office hiccups we’ve experienced with various technology. And I wrap up with a few takeaways I want to share including why a good leader often requires you to delegate, and why change is inevitable but how we react to it is so critical.

And before I go, I have to give a quick shout out to Ms. Betty Williams, who has jumped on the dental podcast listening bandwagon. Her husband is Dr. Chad Williams, and I appreciate her feedback and sharing better business practices with me. If you have any questions or anything I can help you with please email me, after you listen to episode 74 of Business of Dentistry.

Tweetable: “Transition in your team is always going to happen. ”

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A Patient’s Viewpoint With Mr. Nathan Harris

Episode 073

The Business of Dentistry is back this week with a special interview. In this episode I interview a former patient, Mr. Nathan Harris. In our discussion he gives us an unbiased opinion on what potential patients are looking for in a new dentist. Episode 73 of Business of Dentistry is definitely worth a listen.

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You may have noticed I’ve been away for awhile, I’ve had a few weeks with the military and the office has been busy because it’s summer. Now I’m back and bringing on a friend and former patient of mine to talk about dentistry from the patient’s perspective.

Nathan Harris and I met in a leadership group about 10 years ago and we’ve been friends ever since. Because he’s moving to a new area I asked him to share how he’s gone about finding a new dentist.

When looking for a new dentist, Nathan said he would go to Google and search for a phrase like “best dentist in X: (X being his new town or county). He would do a lot of research first, and including things like insurance, but also he’d research finding a place that he feels comfortable. He doesn’t like the going to the dentist but he knows it is necessary, so finding a place he feels good about it is important to him.

To get a feel for the new dentist he’d look at their online reviews, their social media and anything else he can find via Google. From there he would potentially schedule a visit or just drop by their office to see what it looks like.

He’d do so because he wants to know if it’s in a good part of town, if it is a nice-looking professional building and office space. Once he’d narrow it down to a few potential dentists he would ask around about those specific practices. He would ask for other people’s experiences and input on those potential dentists he had found.

Nathan explains word of mouth plays a bigger role than social media, so if a friend or someone else he knows, likes and trusts tells him not to go to one dentist, he’s going to listen to that over online reviews.
The opposite is true, too: a positive referral will reinforce any positive research he has found online.

As far as scheduling and the actual office visit, he wants to call to make an appointment. The first thing he’d want to hear is a smile on the other end. He believes if someone is enjoying their job and has a pleasant attitude about their work it comes across when they answer the phone. Also he wants someone who identifies the office by name, and someone who can answer basic questions or will put him in touch with someone who knows the answers.

In terms of the physical office, he is looking for a space that conveys what the office is about: cleanliness of course, but also the waiting room experience. Do they offer things like wi-fi or music or other distractions if he has to wait? He also looks for a place that doesn’t smell like a doctor’s office!

Initially, he said a tour would be nice and he would like to see the equipment and highlights of the technology available. During his first meeting with the potential new dentist he wants to spend a few minutes talking with that dentist. He also wants to hear credentials, how long they’ve been in business, and what they specialize in.

We wrap up our discussion by talking about the big three: time, money and fear, and why I try to find out what each of my patients are most concerned about from those three. Nathan shares which of those three is his biggest concern, but also why all three are critical for him.

This is a great topic from a unique perspective we don’t often get to hear from directly so let me know what you think after you listen to episode 73 of Business of Dentistry.

Tweetable: “You can hear someone smiling through the phone.”

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Struggling With My Thinking

Episode 072

Over the last few weeks I have been struggling with my thoughts. So much, they have been waking me up in the middle of the night. I’m not sure if my subconscious mind is trying to tell me something or not. Listen in to episode 72 of the Business of Dentistry to find out about my struggle and see if it may sound familiar…

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I don’t know if you have this same thought so I wanted to talk through it and get your feedback. What I’ve been working through about how we think is tactical vs. strategic. I’m comfortable thinking at the tactical level, like how to fix things.

That’s part of our training: we work in microns and millimeters and procedures on everything from dentures to crowns, etc. All of our training leads us to how to do something, how to work out the step by step of a procedure. But do we get into this profession because we think like that, or does our profession train us to think like that?

The counterpoint to this way of thinking, the tactical approach, is strategic thinking: why are we doing what we are doing? And that’s the piece I struggle with the most.

For example if you go into any of the online dental forums we’re all a part of and look at the questions being asked, most of the questions are related to the tactical thought process. There are far more questions related to the tactical side of things then to the strategy. And I’m comfortable with that thought process and that way of thinking, as most of us probably are.

However I get uncomfortable when I start to think of the why, what is our purpose. I’ve noticed that is something you don’t see much of online: the strategy. Which I understand, at least for me it’s hard to make the transition from tactical to strategic.

I don’t know if you do the same thing but I struggle with what am I going to do long-term? Like what is my real long-term game plan for my practice? I’m opening up and telling you this: I have some ideas but I’m not sure I’m comfortable with the long-term view. This is something we all have to think about, we all have to think about our exit strategy and have one in place.

I haven’t played with my exit strategy enough: do I want to work part-time eventually? Do I want to go into academics part-time? Do I want to get a job with a government agency? Do I want to get out of this entirely and do some other line of work? Do I want to sell my practice? Do I want to get an associate and sell it to them? When do I want to do this? I’m 50, but do I want to do this when I’m 55 or 60?

I struggle with those answers, but I need to know them and you need to have a game plan for yourself. It’s never too early to start looking at your exit strategies. Ask yourself why you are doing what you are doing. Where are you going with it?

I challenge you to think strategically, consider your exit plan and think about your long-term plan.

After you listen to episode 72 of the Business of Dentistry chew on that concept and those questions for awhile, no pun intended! And then let me know your thoughts.

Tweetable: “It’s hard to go from thinking in millimeters to thinking in years!”

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Introduction To Medical Coding

Episode 071

Hey folks, this episode we jump into the topic of medical coding. Now, don’t go worrying… I know medical coding is a complex topic but we are only covering the basics here. We will use a specific pathology case and go over the way I would approach the International Classification of Diseases Revision 10 (ICD-10) and Current Procedural Terminology (CPT) codes. Thanks for listening to episode 71 of Business of Dentistry!

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The reason for the topic today is because I am in a few closed Facebook groups with other dental professionals and many of them have questions and a lot of interest in how medical coding is done. Personally my office uses medical coding because we do oral surgery. In fact, we use it every day.

When I was an oral surgery resident they made us code, and I hated it (at the time)! Of course now I can see the benefit in my private practice, knowing the coding and understanding how medical coding works has helped me since going into private practice.

Let’s talk about the basics of medical coding: there are two simple components, the diagnosis code and the procedural code. The diagnosis code comes from the International Classification of Diseases, better known as ICD. The latest revision is the 10th and it’s known as ICD-10. ICD’s coding will be a combination of alpha numeric numbers.

The procedural code is based on the Comprehensive Guide for Current Procedural Terminology, better known as CPT. This code is 5 numbers.

You list your diagnosis codes to support your procedural codes; a lot of medical insurances look at ICD 10 to tell the story of what is going on with the patient, that determines whether it is a covered benefit or not for that case.

Now let’s talk about a specific case I saw online.

The case was posted with a picture of a soft tissue neoplasm. I call it that because the photo showed an anterior maxilla which had attached gingiva between the anterior teeth, pinkish red and non-ulcerated). The picture was posted asking what we thought it was and what should be done.

Personally if I were submitting this I would submit my pathology as general categories: soft tissue neoplasm vs hard tissue neoplasm.

In this instance it would be soft tissue neoplasm. In the medical diagnosis code they want to break it down even further, they want to know if it is malignant, benign. I use the code of unspecified behavior because that is really what I am looking at. I’m looking at a bump on the gums of a patient, it’s soft tissue and it’s soft tissue neoplasm but I do not have a definitive diagnosis.

I know in my mind what I think may be based on clinical and historical data, but I don’t know for sure. So when I submit this case for coverage of a biopsy I submit it as a diagnosis code of neoplasm of uncertain behavior.

Then there are several categories in the ICD-10 coding book. They break it out into lip, tongue, salivary glands, even into submandibular, sublingual, etc. They have one that is a catch-all and it’s called other specified sites in the oral cavity which means gingiva, palate, gum, mucosa, cheek, alveolar, process, etc. That particular catch-all code is more in line with this specific case.

I’m highlighting my use of medical coding here because I want you to see how I use it, and how I do it in such a way that the patient can get benefits from their medical coverage if their dental won’t pick it up (or if they don’t have dental but they have medical).

So in this particular case I would use the ICD-10 and would use the code for a soft tissue neoplasm (and I use neoplasm instead of cyst or granuloma). And I would use the code for uncertain behavior in other specified sites in the oral cavity (there’s no specific code for anterior maxilla). In our example this would be D37.09, which gives information about the actual diagnosis.

To hear what CPT code I’d use and why it’s important in terms of your reimbursement listen in to episode 71. You’ll get a clearer picture of the basics when you do along with an explanation of a common form my staff created to help with coding in our office (the same one you can get by clicking on the photo above).

Feel free to email me with any questions, comments or insights you have about medical coding. Thanks for being here, I appreciate you listening to this episode of the business of dentistry!

Tweetable: “Understanding medical coding has helped in my private practice.”

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Sitting Down With Dr. Chad Williams

Episode 070

In this episode I have the privilege and honor of speaking with my friend and colleague Dr. Chad Williams.  In our discussion he gives his story on how he went from an associate to practice owner and then we delve into some of his experiences over the past 16 years.  I think you will find what he shares informative, educational and entertaining.  Give a listen to episode 70 of Business of Dentistry!

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I asked Dr. Chad Williams to join us for a number of reasons. He’s my top referral, and one of my closest friends. Because he’s has been in practice for 16 years, he has plenty to share about what he’s done right, what he’s done wrong and what advice he has for someone in the first few years of their practice – and he’s talking about it all on today’s show.

We are both located in Lebanon, TN. He arrived in town after graduating from dental school in Louisville, Kentucky. But before settling down here, he tried to join the Army Reserves in Clarksville, TN. The Army wouldn’t take him because of multiple knee surgeries, so when he heard about a dentist in Lebanon who was leaving his practice to become a firefighter, Chad jumped at the opportunity. He’s been here ever since.

Those first few months and years had their rocky moments though. Originally he was given five months to work in the practice before deciding if he wanted to continue, walk away or buy the dental practice outright.

A few months in Chad decided he wanted to buy it. He liked the people in town, and the proximity to Nashville. So on January 1 of 2002 he bought the practice.

It didn’t take long for his new practice’s office to need an overhaul though. The original dentist hated being a dentist, and hated having a practice so he did the bare minimum in terms of services, and spent as little as possible to keep the practice running. Chad gave it a complete makeover from the carpeted floors to the outdated wallpaper.

Plus the office was in a residential area; the original dentist had remodeled a family home into a dental office so by 2005 the practice was at maximum capacity. Chad had only 1.5 rooms to work in so he and his wife Betty looked into all their possible alternatives.

They found a piece of property on the main drag of the town and thought it would be a perfect place to build a new office. It was about 1.5 acres, so he built 5,000 sq. ft. of space to lease to others, plus 4,400 sq. ft. for his dental office. They loved it and got to work on the design in 2006 and started building in 2007.

He says the entire process was as smooth as broken glass! The economy took a downturn so they struggled to fill the additional office space. They had been looking for service professionals to complement a dental practice: dental specialists, medical specialists, CPAs, lawyers, etc.

They turned down 200 liquor stores, tobacco stores, and other non-professional service businesses. Because of that they were the only tenant in the building for a few years, but recently they signed a lease with a hospice that will occupy for the front 3,000 sq. ft. and are hopeful the rest will soon be occupied as well.

We also talk about his two pieces of advice if you are in the first 3-5 years of your private practice. His first bit of advice is to lose your ego, put down your pride. He admits his practice has always done much better when he’s put aside his pride.

For example, whenever he sits down with a patient and looks at them as a peer, it changes the dynamic in a positive way. He talks to them about how he can help them, and what they need done, rather than telling them what he could do for them. Then he listens to their questions. All of this helps his patients to be less nervous and more agreeable to his treatment plan recommendations – that and his use of humor, something he is known for!

Hear the other piece when you listen in to today’s show. You’ll also hear how he works 3.5 days a week, how presents his treatment plans for greater patient buy-in, and the three hurdles that patients have. Dig in to that and more on episode 70 of the Business of Dentistry podcast!

Tweetable: “Learn from your ears, not from your mouth.”

Episode Resources

Dr. Chad Williams’ website
Dr. Chad’s practice on Facebook
Eaglesoft Dental Software
The Alan Mead Experience
Patient Activator from 1-800-Dentist
Solutionreach Total Patient Relationship Management
Platelet Rich Fibrin Basics course

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