Dr Phillip Palmer, September 2003 - I've often thought on my trips around Australia and New Zealand, how should a dentist choose a practice management (PM) company? After all, many dentists believe all PM companies do the same thing. Well, no more than all dentists are identical; all PM companies are not the same. There are some fundamentals to consider when hiring and working with PM companies.

What do you want?
Firstly you have to consider what it is you want:

• Do you want more money?
• Do you want to work fewer hours?
• Do you just want some control over your practice? You're sick and tired of it controlling you.
• Do want to be the best you can be at the business of dentistry?
• Are you looking for a quick fix?
• Do you want all of the above?

Methodology of the PM company.
Do you want someone to come in and tell you who to hire and fire and order your team to do various tasks to solve what they consider are your problems? Or, Do you want to learn how to solve problems yourself, or better still learn how to prevent them from occurring in the first
place. Some Dentists want to be better leaders while others want to hand over leadership to a company. (Handing over leadership can create a long-term dependency. There are also the risks of the management company upsetting your staff. There are several stories of practices
losing all their staff due to conflicts with the PM company). Do you want to be a better leader, take the pressure off yourself by learning to empower your staff to run your practice according to your goals and what you want.

Contracts
Some PM companies insist the dentist signs a contract for a period of time that is enforced no matter how poor the service or how meagre the results. Other companies allow the dentist to decide on a month-by-month basis. This forces the PM company to continue to deliver
measurable benefits every single month. If there were no benefits, the client would quit.

No dentist should sign any agreement with a PM company that they can't withdraw from, or cancel, with a month's notice.
The cost of PM companies varies considerably---a full service programme can cost from $25,000 p.a. to $40,000 p.a. Depending on the PM company, the price, length and enforceability of a contract can vary widely.

How and when is success measured?
There are many things that should be constantly assessed after taking on a PM company -some of them are numerical, and thus easily tracked, and others are less quantifiable -like staff happiness and degree of commitment. The metrics that should be tracked at all stages
include (but shouldn't be limited to) such things as: net take home pay, production, profitability, collections, number of active patients, production per hour, expenses in all major categories, case presentation success, number and percentage of patients participating in active maintenance, lost patients, source of and number of new patients, etc.

Staff happiness and empowerment should be evident from a reasonably early stage and continue to grow over the length of time spent with the PM company. Surveys can be conducted before, and at various stages in any contract or agreement to ensure the staff are actively involved, and happy with the PM company. A large degree of the success of any PM company depends on the staff's willingness to be part of the programme.

Transitions service
A transition is a way of growing your practice by having other dentists come in to your practice and buy a part of the practice in stages. It is the most profound way of adding leverage into your business life - but done wrongly will be the most stressful decision you have ever taken. Any PM company worth its salt can grow a practice. Its what you do with the excess value created that sorts out the different companies. If there's no Transition service (methodology, agreements, financial scenarios, opinions as to value, etc) being offered, what are you going to do with the extra load created and all that excess value? There are obvious pitfalls to be avoided with respect to associate dentists, but done properly, a Transition
can be the most rewarding (in a financial and emotional sense) path you can embark on.

Diversity of skills and experience.
Ideally a PM company would have a mix of people with backgrounds in dentistry, human resources, change management, organizational psychology, marketing and corporate training.

Experienced Dentists on staff
In an ideal world, no dentists would need a PM company-all dentists would have learnt business, staff management, leadership in dental school. Realistically though, only a few dentists have truly studied these matters in a serious manner. However, it would be a considerable advantage in any PM company to have dentists on board who understand first-hand the issues facing dentists and their staff.

Coach rotation.
No one can expect to 'get on' with everyone else. Make sure your PM company has several different people who can coach your practice. A system of coach rotation can be very helpful. There should be a minimum of three coaches.

Culturally appropriate
While there are many North American management systems that are beneficial, we know that one cannot simply use American scripts, terminology, mailings, and communications in Australasia. We have all experienced experts from overseas advising approaches that fall flat in this part of the world.

What will they get me to do?
Some PM companies virtually start every practice the same way-tell their clients to put their fees up and re-activate their patients who haven't been in for a while. Some companies tell their clients to do more crowns as their way of increasing the fees generated by the practice. Look for a PM company that has done work for specialists such as endodontists and periodontists as well as prosthodontists in order to make sure they have wide skill-sets and not just one size fits all.

If you are contemplating joining a programme, make sure you first talk to others who have taken that course.

PM companies should be forthcoming with references of comparable (in location, size and type of practice) dentists for you to talk to.

[Published Australasian Dental Practice, September/October 2003]