Dr Michael Sernik, December 2007 - When faced with a problem, what is a dentist’s natural instinct?

Dentists have been trained to work on problems that require attention to fine detail. Problems that require x-rays and microscopic glasses to look at and work on. As a result of this training, a dentist’s natural instinct when presented with a problem that needs solving in the practice is
to automatically ‘zoom in’ to attack it at a micro level. The only problem with a dentist approaching a problem in this way is that we could easily find ourselves working on a symptom of the problem at hand instead of the real cause.

All problem-solving involves two fundamental choices.

1. You can jump straight in and get busy working on the fine detail of the problem or
2. You can step back from the problem (“panning”) and try to get a big picture view first.

Dentists who aren’t natural ‘panners’ will need to approach clinical and practice management problems from a bigger-picture point of view. Otherwise there is every chance that they may just be mis-diagnosing the cause of the problem at hand.

I have put together four examples of this behaviour that we see in dental practice management:

Problem 1: Not enough patients
The Zoomer’s Solution: Do more marketing
The Panner’s Solution: The first thing a Panner would do with this problem is question the premise: “Is it that we don’t have enough patients or are we not busy enough? And does ‘not busy enough’ = not enough New Patient’s?” Things to analyse when answering this question:

• Are all calls being answered in an appropriate amount of time?
• Are enquirers finding it easy to make appointments when they call?
• Are appointments turning up?
• Are patients being comprehensively diagnosed?
• What rate of patients are reappointing?
• Are they coming back for active maintenance/hygiene visits?
• Are patients referring?
• Where are the new patients coming from?
• What is our patient retention like? Are we losing a lot of patients?

By panning you may find that the practice is losing a lot of potential business that it could retain by tightening its patient management.
By simply marketing to get business you may find that any results of that marketing are lost to the “patient leaks” that exist in your practice. You may have the same problem of ‘not enough patients’ in a short period of time.

Problem 2: The practice overheads are too high
The Zoomer’s Solution: reduce costs/expenses. practice with reasonably high overheads costs may have them at 70% of production. The beakdown of this would be something like 52% in fixed costs and 18% variable costs (6% supplies, 12% lab). Lets say that a practice with the above overhead costs is able to achieve a 10% reduction in supplies by spending a lot of time shopping around. This 10% reduction in supplies equates to 0.6% of production. By cutting costs this way you could be achieving very little and reducing the quality of service
provided.

The Panner’s Solution: Panners will take a more holistic view of their expenses and understand that the overhead percentage is made up of both expenses and production. They will be able to realise that if they can increase production the results are more dramatic.

Problem 3: Too many emergencies: The appointment book is too full.
The Zoomer’s Solution: Extend hours, Find ways of squeezing more patients in. Reduce length of appointments, etc. This can compound the problem, causing you to be overworked, late and it could upset loyal customers.

The Panner’s Solution: The full solution to this problem can take some time to fully explain if  this is a new concept. Briefly it involves:

• creating an ideal day model and then pre-blocking your appointment book to match your ideal day
• diagnosing more comprehensively and doing less patchwork. Again there are a lot of skills needed here to make it work but you can imagine that the less patchwork dentistry you do, the less these people will return with emergencies.
• raising you patients dental IQ so that they regularly come in for checkups and take better care of their teeth. The better care that is taken of your teeth the less emergencies will happen.

Problem 4: Dentist is stressed due to financial pressure

The Zoomer’s Solution: A Zoomer will work harder, take less vacations and work longer hours. They won’t employ someone to help share the load, as this would also be sharing the financial gain.

The Panner’s Solution: The Panner will look at many variables and realise that in this case it may be due to lack of accurate financial perspective and clarity. The uncertainty surrounding their financial future is causing stress. By creating an accurate financial plan with monthly
cash flows which include all the vacations built in and daily production goals, this will provide more financial clarity and reduce stress.

In summary, as dentists we need to retrain ourselves from the “reactive fine – detail, zooming” approach to our practice management problem-solving. Most Zoomers will attack a practice management problem by treating the symptoms and it’s a lot smarter to be a Panner and treat
the causes.
{Published in Australasian Dental Practice Magazine 2008}