The Dentist's Network #102

Thomas L. Snyder, DMD, MBA
Managing Partner
The Snyder Group, LLC
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Steps to Successfully Welcoming Your First Associate

We still hear stories about unsuccessful experiences with an associate. The fact of the matter is without careful preparation and planning, your first experience with an associate could spell disaster. There are many variables to consider in the successful equation for a successful associate relationship.

First, you must determine your objectives for hiring an associate. Not every dentist who is recruiting an associate wants this individual to be part of their long term transition plan. So how many years have you been in practice and, more importantly, how many years do you envision continuing to practice? The answer to these questions will have a direct bearing on the type of individual you are considering: an employee or a transition solution?

If it’s an employee, the level of effort you may be willing to commit may not be as critical in the short run. Whether it is hiring an associate to extend office hours, use the facility more effectively or handle patient overload, your primary concerns should be clinical competency and ability to produce. If this individual is there to fill the gaps with no promise for a partnership or eventual sale, these factors are paramount. If, on the other hand, you are grooming this individual to be your short-term or long-term successor, here are some points you should consider.

1. Staffing Requirements
We recommend that you assign your best dental assistant to your new associate so that he/she “learns the ropes” of your practice. This individual is best qualified to judge the new doctor’s patient communication and clinical management skills. Chances are they know most of the patients, so that will be helpful in making patients feel comfortable with the “new doctor.” We suggest that this assignment be maintained for the first one to three months, based on the skill and experience of your candidate.

2. Reactivation Hygiene
Saturated practices, as we’ve discussed in prior columns, often experience patient retention problems. We recommend that your new associate provide the hygiene reactivation appointment when overdue recall patients are brought back to the practice. This will be an excellent way for the new doctor to meet his/her “new” patient. It also provides a better opportunity for casual conversation between the doctor and the patient. If any treatment is needed, the associate can complete it. The next hygiene appointment, then, will be scheduled with a hygienist.

3. Scheduling Templates
Time management for new doctors, especially, can be a real issue. Never use the host doctor’s time units as the associate’s time units! Rather, create new time units for associates. Of course, if the candidate has good clinical experience, this is not as big an issue. Remember to address this at the outset. Also, set realistic production goals based on the anticipated service mix of your new doctor. We typically set production goals of $800 up to $1,750 per day, based again on the associate’s skill and experience. The template would include a certain number of daily reactivation appointments until that task is completed.

4. Develop a Marketing Plan
This is especially critical if you are continuing to grow and anticipate that your candidate will become a partner. Developing new patients should be a key goal for your associate. At the outset, we recommend:

Print business cards
Change the signage on your building (if feasible and cost effective)
Modify your brochure to include the associate’s name, picture, and bio
Edit your web page
Write a feature in your next newsletter about your new associate to include professional qualifications and experience as well as personal information
Run an ad in the local newspaper if you employ external marketing strategies

We recommend that full scale marketing efforts be made after the new associate’s probationary period, which usually runs 90 days. In the interim, staff can promote the new associate when scheduling a patient for reactivation hygiene or new patient or emergency visits

5. Communication
We recommend weekly meetings to discuss clinical and patient management matters. Do this routinely for the first three to six months (based on need). Additionally, a monthly meeting should be scheduled to review production and collection reports and discuss other staff or business management issues.

6. Mentoring and Over-the-Shoulder Training
Based on your practice’s clinical philosophy, it’s appropriate for young doctors to participate in some “over-the-shoulder” observations. This is especially true when you’re performing more involved clinical procedures, and also when it’s obvious that your associate has never performed these procedures.

Finally, retaining the services of a consulting firm that has experience in integrating associates would be a very wise investment. Chances are you will get a good return on investment and increase your chances for success.

If you would like additional help, email Dr. Snyder at drsnyder@thedentistsnetwork.net.

Interested in having Dr. Snyder speak to your dental society or study club? Click here.

Hear Dr. Snyder’s FREE podcasts at The Dentist’s Network - HERE

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Sally McKenzie, CEO
McKenzie Management
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Personality: Plus or Problem?

What exactly is this unwieldy thing called personality? Well, there are a variety of traits and every person's “individuality,” if you will, is comprised of a combination of 16 categories. Four of these characteristics can have a powerful impact on the practice: Introverted vs. Extroverted and Thinking vs. Feeling. Let me explain.

Introverted personality types, for example, enjoy spending time by themselves. Introverted dentists tend to be exhausted when they go home at night. Depending on the degree of introversion, these doctors have to force themselves to be extroverted all day long, which drains their energy. They also are not comfortable giving verbal feedback to employees, which is essential in running a practice.

Moreover, introverted dentists can have low case acceptance rates because they are unable to clearly articulate patient needs. They don’t naturally engage in conversation, so they are less likely to ask patients about dental wants. This trouble communicating takes its toll on the practice, as introverted dentists commonly struggle to reach practice goals and can unwittingly come across as uncaring or aloof to patients.

Opposite of introverted personalities are the extroverted. Extroverts love talking to people and being with people. Extroverts like variety and action in their jobs and are sometimes impatient with long slow jobs. It is not uncommon for extroverted dentists to run behind schedule.

The typical misunderstandings between extroverts and introverts can be a source of ongoing conflict in dental practices. Introverts seem to understand that extroverts are boisterous. But extroverts cannot seem to comprehend why their introverted colleagues don’t enjoy talking and being around people like extroverts do.

Introverts can come across to extroverts as being snobbish. Similarly, introverted doctors often unwittingly come across as moody. In some cases, the difficulties of the doctor are further compounded by the fact that introverted dentists are more comfortable with introverted staff, who like themselves, don’t care to talk all the time. Unfortunately, this general aversion to communication can spell trouble for the practice. The overall lack of communication not only affects treatment acceptance, it also has a powerful impact on team dynamics and the ability of the office to maximize staff talents. To achieve the level of success that these dentists want and are capable of requires that they learn some extroverted behaviors.

Another dimension of personality is Thinking and Feeling types. Other than the extroverts and introverts, this is the second greatest source of conflict among dental teams.

Thinking types are "bottom-line" people and call things as they see it. As a result, they can hurt a person's feelings, but are totally unaware they have done so. Fairness is extremely important to thinking types. They are able to step back from a situation, analyze it for what it is, and apply an impersonal solution. Thinking types can come across as insensitive and uncaring and are seemingly very critical.

Feeling types like harmony and will work very hard to make this happen. They will tend to be sympathetic toward other co-workers, even if those co-workers are not performing to practice expectations, and they need plenty of feedback and praise from employers. They dislike telling people unpleasant things and have an inner desire to please everybody. They can come across to others as weak and emotional.

“Thinkers” tend to only voice their discontent, because giving praise does not typically come naturally for them. However, all employees need feedback, direction and guidance, regardless of their personality type - even thinking types. But for feeling employees - and this temperament type tends to be most attracted to dentistry - they can be crushed by a thinking dentist’s tendency to only find fault and never give praise. Feeling type employees need praise regularly to help them achieve maximum performance.

Thinking type dentists can turn this firm and tough-minded attitude toward patients as well. Conversely, the feeling type dentists will be apologizing and agonizing over the fact that their treatment plan is going to cost upwards of $3,000, so they will present it then hurry up and tell the patient that they can pay $50 a month for the next 5 years.

Dentistry requires certain parameters to be successful, and every dentist and dental team needs to know and understand themselves, as well as the others in the practice. Explore personality assessments such as the Keirsey Temperament Sorter. In doing so, you’ll understand much more clearly why you work the way you do and how to maximize your personality strengths and address the weaknesses.

For further information, click on the following link: Personality Types and How They Affect Practices

Sally McKenzie is CEO of McKenzie Management, a nationwide dental management, practice development and educational consulting firm. Working on-site with dentists since 1980, McKenzie Management provides knowledge, guidance and personalized solutions that have propelled thousands of general and specialty practices to realize their potential.

Interested in speaking to Sally about your practice concerns? Email her at sally@thedentistsnetwork.net or call 1.877.777.6151.

Interested in having Sally speak to your dental society or study club? Click here.

Hear Sally’s FREE podcasts at The Dentist’s Network - HERE

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Dr. Emry Karst
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Endodontic Breakthrough and No More Separated Files

There are at least three things that should interest and encourage a general dentist into doing more root canal fillings. The first is to reduce the time it takes by 50% or more, second is no more separated files, and the third is a successful outcome with no symptoms or perapical radiolucency over a 5-year period.

Reducing the time by as much as 50% or more is entirely possible, but one must understand how to use hand and rotary files efficiently and safely. Hand files are used to negotiate to the apex, then rotary files are used to do the rest of the reaming. Rotary files that are #25 .06 taper are used to do most of the reaming. Sybron Dental makes a Twisted File and it is the safest and most efficient file on the market. The apical 5mm is done with larger rotary .02 taper files. K-3 files are the most flexible and Sybron makes these too, as well as a cordless reversible endo hand-piece, which is essential to preclude file separation as it can be set at the correct RPM and set to provide only so much torque.

There are a number of prominent endodontic clinicians who have stated that the cleaning and sterilization of the apical third of the root canal is the most critical step for a successful endodontic outcome. Success depends on a number of factors. The first is the removal of all organic and other debris, all the way to the apex. The use of rotary files can accomplish this 100% of the time if done in the right fashion. The rotation draws everything away from the apex. Next, most canals are oval and making a completely round canal in the apical 5mm is imperative.

To create a round canal, the canal needs to be filed at least to a #45 (.02 taper) or larger. There should be at least one file used that is larger than the one that engages the walls of the canal, at least 2.5mm from the apex. Secondly, since obturators all come in a round configuration, voids could occur if the canal is not round and if the sealer does not fill in the void.

Because there may be remnants of organic materials and bacteria left in the canal, sodium hypochlorite is necessary to dissolve these and to sterilize the canal. This takes no more than one minute and then a plastic broach is rotated to the apex to remove the dissolved organic tissue. EDTA is then used in a similar fashion to remove the smear layer.

Finally, a successful root canal requires a complete root canal seal. A modified lateral condensation technique will provide this. Sealer is always used in this process. The apical 5mm of a cleaned and shaped canal will have an .02 taper. Discus Dental makes a 5mm long .02 taper gutta percha point that is attached to a removable metal shaft, and is called a “SimpiFil” plug. When this plug (a size larger than the last file used) is pushed to the apex, it produces lateral pressure and the best seal possible. This process entombs any possible bacteria that may be stuck in the dentinal tubules.

The success rate of this procedure is about 95% over a 5 year period. This means the tooth is asymptomatic and the radiograph shows no lesion at the apex. In a classic study of 55 single-rooted teeth done by Sjogren et al using a similar protocol, complete periapical healing occurred in 94% of cases that yielded a negative culture.

For complete information on this procedure and to obtain 3 hours of CE credit, visit www.EndodonticBreakthrough.com

Dr. Karst is a graduate of Loma Linda University's School of Dentistry and has practiced cosmetic dentistry for over 25 years. A pioneer in such cosmetic techniques as porcelain laminate veneers, he has been administering aesthetic dentistry to his patients since the early 1980's.

If you would like additional information, Dr. Karst can be reached at: ittakesanartist@gmail.com

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