Future Trends, Staying Competitive and Skill Development
I recently had the honor of interviewing three of the dental industry’s greatest and most influential leaders to find out their thoughts on dental office productivity, trends, and the next big “thing” in dentistry.
Howard Farran, DDS, has been a practicing dentist in Phoenix, Arizona USA since 1987. He earned his DDS degree from the University of Missouri, Kansas City and Masters in Business Administration, MBA, from Arizona State University. He has lectured over 1000 times in 6 continents and is the owner, founder & CEO of Dentaltown. He wants to connect every dentist on earth so no dentist will ever have to practice solo again. Dentaltown has over 250,000 dentist members from every country on earth. It boasts of over 400 online continuing education courses have been viewed over 600,000 times.
Dick Barnes, DDS, is a founding member of the American Academy of Cosmetic Dentistry and the Dr. Dick Barnes Group. Before the concept of "cosmetic dentistry" was fully formed, Dr. Barnes became one of the highest producing dentists in the world, which came about from his understanding how to effectively create desire in the patient's mind for needed treatment. Many of his peers requested his coaching and this eventually led him to invitations all over the world and he became a keynote speaker at all of the national dental meetings. Dr. Barnes has been teaching for over 30 years, but his message continues to be relevant for the most modern and productive practices in the world. His mission: Teach dentists how to become better dentists and more productive.
Arun K. Garg, DMD, is a nationally recognized dental educator and surgeon who for over 20 years, served as a full-time Professor of Surgery in the Division of Oral and Maxillofacial Surgery and as Director of Residency Training at the University of Miami, Leonard M. Miller School of Medicine. Frequently awarded faculty member of the year by his residents, Dr. Garg is considered the world's preeminent authority on bone biology, bone harvesting and bone grafting for dental implant surgery and has written and published nine books and a dental implant marketing kit which have been translated in multiple languages and distributed worldwide. He has been a featured speaker at dozens of state, national and international dental association conventions and meetings including the American Academy of Periodontology, the American College of Oral and Maxillofacial Surgeons and the International Congress of Oral Implantologists. Dr. Garg is the recipient of numerous awards including outstanding educator by the ICOI and an award for best article published by the Implant Dentistry Journal. Dr. Garg earned his engineering and dental degrees from the University of Florida and completed his residency training at the University of Miami, Jackson Memorial Hospital. He is also the founder of Implant Seminars, a leading dental continuing education company that offers a variety of class-based, hands-on, and live patient programs in the United States and abroad.
KG: Since about 2006 we have seen a steep decline in adult patient visits, combined with continued declines in insurance reimbursement which has resulted in a decline in dental office profits and dentists take home income. What do you think dental offices can to do reverse these trends in their offices?
DB: As far as I can remember, dentists have always had some trouble making a profit out of dentistry. But it doesn’t have to be that way. To reverse that decline, dentists have to develop a philosophy of comprehensive dentistry. My philosophy has always been that the most important person in the practice is the patient, and that the patient buys the dentist and the dental staff before they buy the dentistry. In other words, most patients don't come into the office saying, "Cap me," they come in for their “annual 10-year checkup.” Therefore, it's up to the dentist and the staff to create an atmosphere in which patients are really glad they came to the office. And once patients are comfortable, they will buy the dentistry and see the value in taking care of their teeth for their lifetime, regardless of their insurance situation.
HF: There are approximately 325 million Americans. About 211 million Americans (65%) have dental benefits. If you prefer high volume / low margin you could attract more new patients by signing up for more dental insurance plans. About 114 million Americans (35%) have no dental benefits. If you prefer low volume / high margin you could attract more new patients by signing up for more dental marketing plans.
AG: While I agree that the early 2000s experienced a decline in adult dental patients, often attributed to the recession and its aftermath, there’s plenty of data to suggest that those numbers have again improved. Could they be better? Yes. I do agree, however, that there’s been a long-term decline in insurance reimbursements. Reversing or improving the first trend comes down to effective marketing and community outreach. It’s imperative that adults are made to understand the critical importance of dental care. It always surprises me that Americans tend to care more about their cars – spending the money and taking the time for preventative maintenance – but they apply none of that logic to their teeth. Using analogies like this might help.
Working with them to achieve flexible payment might also be a secondary approach. Fear can sometimes be a major impediment to treatment too. Fortunately as you and I know, dentistry today is far less painful than patients believe it to be. We can educate them here too through effective brochures, flyers and additional outreach. Combined, I think all of these approaches will help reverse the trends of which you speak.
KG: One of the things I’ve noticed over the years is that, it seems to me, many dentists who take continuing education either don’t follow through with what they’ve learned or they try and fail to implement the information in their practice. I find that all of you have created your clinical courses in a remarkable way because they combine great information in an easy to understand and implement format, with excellent practice management information that helps the dentist with the “soft” skills needed when they get back to the office.
Tell me about how and why you evolved this “hard skill – soft skill format” and what steps you recommend dentists take to maximize their chances of being able to follow through and implement new procedures into their offices.
DB: Dentists who come to and start working with the Dr. Dick Barnes Group develop a mentor relationship with industry experts. These experts not only teach dentists new clinical and managerial tools during the seminars, they make themselves available after the courses to help the new dentists as they implement what they’ve learned. With the Dr. Dick Barnes Group, dentists get a mentor to help them through the critical period of time when they are trying to learn a new skill and make it part of their everyday practice. It makes all the difference. Plus, the dentists establish a network of colleagues (other dentists who attend the course) who are trying to implement the same skill and they help each other with support throughout the process.
It’s not enough just to learn a new skill at a CE course and then expect everything to go perfectly in the practice. It takes hard work and dentists must implement the new skills one step at a time, because sometimes it’s better to slow down in order to speed up. Mentorship and support from others in the industry are key components to developing new skills and making them part of a dentist’s practice.
AG: Thank you for the praise of my courses in the question. I think what you’re driving at is what is it that sets my courses apart? Following through on new procedures takes a commitment to the goal at hand – increased case loads and the ability to perform new treatments. That’s why I stress the confidence building aspects of my courses as much as I do. If you’re not inspired by the material you’re not going to implement it as effectively as you otherwise could. That’s the first step: personal empowerment. Once dentists have accepted the “novel” idea that they too can perform a host of advanced treatments, once solely the province of specialists, their passion is ignited.
Then the skills they learn – lecture by lecture, where each step builds on the next – become incorporated the more they practice it. Again, to use a car analogy, it’s easier to learn one component of assembly line work, than it is to build an entire car. The difference with what I teach is that eventually they will know how to build the entire car. They’re just learning and implementing the process step by step in the interval between my main lectures.
KG: Dr Farran, your “Dental MBA” courses broke down barriers between business and the practice of dentistry and have helped many dentists. They provide excellent practice management information that helps the dentist with the business skills desperately needed in the office.
Tell me about how and why you evolved this “MBA” format and what steps you recommend dentists take to maximize their chances of being able to follow through and improve the office after taking CE.
HF: A leader is someone who creates more leaders. When you go to dental continuing education lectures about two-thirds of the dentists come alone to save money, while one-third brings their entire team. The dentists that are bringing their entire teams on average net twice the income as the dentists who come alone. You should get your entire team on board to get implementation. Second point, most dentists try to solve all their financial problems buy going deeper into debt with new high-tech equipment purchases. You need to get your house in order before you buy expensive toys and the single best #1 ROI in dentistry has always been to hire and bring in a dental office consultant.
KG: In the last few years, sleep apnea care has emerged as an important, potentially life-saving treatment that can benefit both the patient and the dental office. It can be complicated and time-consuming to learn and implement. This puts offices that started treating apnea early on at an advantage.
What other new areas of growth do you see emerging in dentistry in the near future, and how should dentists position themselves to best be able to prepare for it?
DB: All dentists should develop an armamentarium of skills and abilities so they are capable of doing multidisciplinary dentistry. If they can keep their skills up to date, they don’t have to refer out patients and can keep revenue in-house. Most dentists don't know how to prep a full arch, and all dentists should attend programs to get up to speed on the latest developments in the industry. Dentists should embrace technology and modern procedures like any successful and competitive business. When I was a young dentist, I took classes all the time. I lived in southern California and I had an hour’s drive to get to USC and UCLA, but I did it and I took more and more classes. Afterwards, I tried some of those new skills on my patients. I was so nervous for my first full arch case, that I did that case for a welfare patient, who didn’t have money for dentistry. I reasoned that I hated to charge somebody $50,000, and then have him or her have trouble with his or her teeth later on. So I did it for free and I even paid the lab bill for the work so that I could get the experience. That’s why it’s great to have a mentor who is already trained in doing full arch cases because they can help dentists get through the early days of inexperience and the mentor will know how to handle any issues that may arise.
HF: The most emerging sectors in dentistry are all the areas that dental insurance companies have not set the price (fee) mandating that everyone must be high volume with a low margin. In Tokyo, London, and Paris the government reimbursement for a molar rootcanal is about US $100, but the fee to place a dental implant is open to the free market. Do you think those dentists would prefer to spend an hour and do the molar endodontics for $100 when their overhead for the hour would be over $300, thus losing $200? Or do you think they would prefer to extract the tooth and place a $1500 implant and crown. Many dentists in high volume, low margin dental offices accepting Medicare in the USA, or the NHS in England breakeven or lose money on their basic services where the fee is set by the government, but if they can pull a US $5000 Invisalign orthodontic case each week, 50 times per year, that is a whopping $250,000 and the dentist will actually earn a nice living and possibly pay off their inordinate amount of student loans someday. Treating obstructive sleep apnea is economically interesting to many dentists because it is often paid for by medical insurance and more people have medical insurance than dental insurance.
What areas do these industry leaders expect to see significant growth?
AG: I think what we’re seeing today is a coalescence around the dental office. It’s a trend that’s ongoing and is likely to gather even greater momentum in the years ahead. What I mean by coalescence is this: today more and more procedures are done In-house in a general practitioner’s office. Routine extraction, third molar extraction, simple implants, complicated implants, All-on-Four, and digital guided surgery to name a few.
In the not too distant future I could see the lab component of dentistry significantly diminished as these capabilities shift into the dental office umbrella.
I’m certain dentistry will see inroads of “virtual care,” just as other branches of medicine have already begun to witness. Artificial intelligence and remote sensing equipment will allow for at least some routine dental patient information to be sent to dentists off-site and to assist in preliminary treatment planning. Granted, for most practices, these advances are still years away. But the future has a way of catching up to us faster than we think.
KG: Thank you all so very much for allowing me to interview you today. Also for the contributions you each continue to make on a daily basis to improve our patients lives through improving the profession of dentistry.
Dr. Ghaboussi is a paid consultant of KaVo Kerr who received an honorarium to write this article. The opinions expressed are the personal opinions of Dr. Kaveh Ghaboussi, Dr. Howard Farran, Dr. Arun K. Garg and Dr. Dick Barnes. KaVo Kerr is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own judgment in treating their patients.