Do you ever wish you could do things differently in the past to help your career? While you can’t get in a time machine, you can learn from the experiences of others. To help you with this, Kirk Behrendt brings back Dr. Jim McKee to offer you his advice about the three most useful things he didn’t learn in dental school. You can’t change the past, but you can learn from it by listening to Episode 613 of The Best Practices Show!
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Links Mentioned in This Episode:
Sign up for Dr. McKee’s Advanced Occlusion course
Check out the Chicago Study Club
Listen to your patients
Work with your team members
Set your fees differently
Structure your meetings to make them more effective
Your patients have to understand the value you provide
A restorative diagnostic practice can be incredibly productive
“And when I look back at dental school, while there’s a lot of things that I really wish I would have learned, I think there’s three that kind of stick out. The first one is I really wish I learned how to listen to my patients. Because, you know, as a young dentist, you don’t quite know how to set your practice up. And you hear a lot about ‘What you want to do is to create a personal relationship with the patient.’ So I remember this guy came in, and he grew up in an area relatively close to where I did. He needed quite a bit of work, actually, probably five or six crowns, needed some root canals. What I was busy doing was creating a personal relationship with him. We talked about similar places on the South Side of Chicago where we grew up together, people we might have known. When he came back for the consultation, basically he looked at me, went up to the front and said, ‘Could I get my X-Rays,’ and I never saw him again. And I realized something didn’t connect. And it really brought home the fact that it’s taken me a while to learn this. But ultimately, patients want two things. Patients want answers and patients want options. I was busy trying to create a personal relationship with him so we could get along well. The reality was he wasn’t coming to me as a friend. He was coming for someone to solve his problems.” (01:46—03:16)
“So it became really clear that in order to treat these types of patients, it seemed like I needed to be able to up my clinical game a little bit. So I always said I lived in the golden age of dentistry. I heard Pete Dawson, I heard a lot of guys who weren’t around anymore. But like any dentist today, whenever you learn new material, our tendency is to go back and to tell everything we know to the patient. You know, I did that when I came back from Dawson. I hear dentists doing it today with airway stuff, and all of a sudden now the patient becomes overwhelmed. So ultimately, I realized, ‘Yeah, you have to have a personal connect with the patient, but at some point, we have to be there to understand what they’re looking for.’ I wasn’t able to do that as a young dentist.” (03:20—04:14)
“The philosophy in dental school is one of learning. So what you’re trying to do, you’re literally drinking from a firehose. There’s so much to learn in four years. You look at the medical side, you look at the dental side, you look at the nuances of having a drill in your hand for the first time and putting a diamond that’s spinning at 250,000 times a minute in someone’s mouth, and all of a sudden, you’re terrified. You’re trying to think, ‘What degree do I prep the tooth?’ So there’s all these things running through your head. So, quite frankly, we’re trying to manage our own issues. So it’s hard to get in someone else’s—hadn’t had the time to listen to theirs. And that kind of magnifies when you get out in dental school, because when you get into private practice, a lot of times the way the fees are set up is you’re not being paid unless the burr is spinning. So it’s difficult to take the time to listen to patients. What developed over time is I started to realize something . . . that whoever asks the questions controls the conversation. And ultimately, I think our job as really good diagnosticians, is to hear what the patient is saying and then lead them to the questions that they should ask. And what that means is we have to listen to what their issues are.” (04:51—06:18)
“So as a new patient coming into your practice, how are my issues being listened to from a patient perspective? Am I coming in and getting my teeth cleaned and having a two second look and saying, ‘This is okay,’ or is it a different experience where I’m meeting with the doctor first and trying to get an understanding of what my problems are and quite frankly, what do I need as a patient? Sometimes all I need is the cleaning. So Frank Spear talks about filtering your patients, and he’ll give patients the options. ‘Would you just like the cleaning? Would you like the complete exam along with that cleaning?’ So it kind of gives the patients a little bit of leeway to make that choice.” (06:20—07:05)
“That’s where it gets down to, I think, really starting to figure out how those patients are coming into our practice, which leads to a discussion probably at some point then about how do we answer the phone and how does all that stuff work together. But that’s all the things that we need consultants to teach, because so many times, quite frankly, if we’re busy at the chair, there’s not really time for that. So it needs to get done somehow, so whoever does it, whether you in-source it or outsource it, it needs to be handled.” (08:15—08:50)
“Every patient is going to communicate differently. I remember I had a patient who really needed a lot of comprehensive dental care, and I did a consultation with them, and I was done in 15 minutes with the consultation. Patient walked out, my front desk person came up and said, ‘They didn’t accept the treatment, did they?’ I said, ‘Yeah, they did.’ But he was a type-A driver type personality. And he was ready to hear it. So he didn’t need a lot of time, but what I have found is the greater the complexity of the case that you’re treating, generally, the more time we have to spend upfront in diagnostics and exams before diagnostics, quite frankly. But if it’s just two or three fillings, then yeah, then maybe you can move through the process a little bit more quickly. If it’s a more comprehensive problem, and I’ll tell patients this, dentistry is like a funnel. If you spend a lot of time at the beginning, the end comes out pretty easy. If you don’t spend as much time at the beginning, then you tend to have a lot of problems later on in the process.” (10:09—11:19)
“Number two, without a doubt is I wish I learned the importance of how to work with my staff members. You know, it’s funny, we typically call it staff management, and I used to think that I needed to manage people all the same because that way I could be fair to everyone. What I realized is that everyone brings different strengths to the table, and everyone brings different weaknesses to the table, myself included. And it’s taken a while to get comfortable, to realize that what I need to do is I need to try and accentuate the strengths that my staff members have, and I need to try and compensate for the weaknesses that they have as well.” (13:01—13:45)
“My advice would be to find the strengths that people have and build on them. But ultimately, I think the term staff management is kind of a troublesome term because I don’t think people like to be managed, I think they like to be led.” (14:02—14:18)
“I think what I found is my ability to lead the staff became infinitely greater once I started having regularly scheduled staff meetings, because I had time with them, and it gave me a chance to understand from a leadership perspective what I had to change in the practice technically. But not only technically, but non-technically as well.” (14:59—15:26)
“I used to always get stressed out the night before a staff meeting because I never knew what I was going to do. And then sooner or later, after I kept talking about the same thing over and over again, even I got tired of listening to myself. So I sat down and I don’t know how this came, but I put together a staff meeting format that I will tell you has been bulletproof, and the dentists who use it will uniformly tell you to a person that it decreases the stress in their office and it increases the ability of their staff to understand the big picture view of the practice, which is ultimately practice leadership.” (16:01—16:39)
“So we do a review preview. We look at last week’s schedule, what worked and what didn’t work. From a scheduling perspective, from a patient management perspective, from a financial perspective. So we said, ‘Okay, this situation comes up again. Here’s how we’re going to handle it.’ And here’s the thing, I’m going to recommend you really develop this skill. There are things that our staff does well every day, and we never tell them because we’re too busy. During that time at the staff meeting, ‘You know, these are great diagnostic photos. This is exactly how we’re trying to capture this look, great job,’ and start to build the process that way.” (16:54—17:41)
“Then the other thing we did is we looked at our new patients and our consults. This is a new patient coming in. They were referred by Mrs. Jones. Their chief concern is they have clicking in the left joint. They need some implant work on the lower right. So basically what it did, it became a treatment planning discussion. If this patient’s going to need implants on the lower right, then we’re probably going to want to get a CT scan so we can look at the bone. We’re probably going to want an intraoral scan so we can do our digital diagnostic wax up so we can start planning our implants. So the whole philosophy, the culture in the practice was what was developed during the staff meeting time. You couldn’t pay enough to develop that culture. So when people say they can’t afford it, I’m going to look back and say, ‘I don’t think you can afford not to do it, because all of a sudden, then what happens is the next week the new patient comes in—they have a consultation. So now you looked at the new patient last week. Now you’ve got the scans in front of you. You’re looking at the case that your oral surgeon or your periodontist or if you’re putting the implants in. You look and see where you’ve got this all developed digitally. You’ve got your guides on how you’re going to place the implants. Your clinical verbiage and training skills with your staff becomes off the charts because they understand the cases and all of a sudden now it’s not difficult for them to talk to patients while you go to get a hygiene check because they understand the process completely. So all of a sudden, all that time the dentist had used cleaning up the bits and pieces of the questions from the consult, that all gets handled because staff can handle it, because they know exactly what they’re doing. (17:45—19:38)
“What most dentists don’t do with staff is they don’t define their roles. I’m going to go back to an old tool that Pete Dawson taught me, and you probably remember the script. He talked about looping, and I use looping for lectures I put together for staff, I taught my kids how to write their papers in high school with it. Basically, for any position in your office, you write down everything related to front desk as fast as you can, go back and prioritize it, combine like topics, eliminate anything that’s extraneous, and then go back and prioritize the top one of those and do the same thing about the top one. Loop everything and what you end up with is as many times as you want to loop that, basically standard operating procedure manual for your office.” (20:08—20:56)
“So it gives you a chance to validate them, which honestly is what we should be doing more than we do, quite frankly. We have enough time to nitpick the things we need to change. We need to make sure that they’re validated and that they understand that we know that they can do a good job.” (21:15—21:28)
“I wish I had learned how to set my fees differently. You know, let’s think back, are our dental school fees set? They’re typically based upon government fees. And then when you get out of dental school, you go in to practice and you’re either going to be in-network or out-of-network. If you’re in-network, that’s real clear. Your fees are set by a network, by whatever plan that you’re with. And a lot of times when you get out of school, that’s what you have to do. When I got out, I did welfare dentistry, so I was working in a fixed fee practice that the government set the fee for. But usually, even when I started the fee for service practice, if you really think about it, I wasn’t involved with insurance plans, but my fees were still set by insurance companies. Because how do most dentists, when they get out of school, set their fees for a crown? They call their buddy down the street and say, ‘Hey, what are you charging for a crown?’ And usually their buddy’s charging and usually customary or maybe just a little bit above usual and customary because we don’t want to have a talk about why insurance isn’t covering. And that’s usually how the fees are set.” (24:43—25:55)
“Most of the time, if you look at people that own small businesses that are basically into construction, or reconstruction is what we are basically in the mouth, if you think about it. It’s basically a time and materials fee structure. That’s what we need to be. I have someone who’s coming over to do something at my house, it’s going to be a time and materials. Someone comes to the practice; it really should be time and materials. We’re not good at that because again, we’ve been taught that we really don’t have value unless the burr is spinning. And that’s because insurance companies generally don’t pay for things unless they’re decayed, or they’re broken. So the ability to diagnose is gone because we’re not being paid for it. so unless you’re able to create value for your patients on something that you’re going to be able to give them answers and options for which they need and they want, you’re going to have a hard time.” (26:10—27:05)
“The thing that no one talks about, though, is the foundation of the entire system, which are the jaw joints. So send us your huddled masses, we’ll be happy to take care of them. And really, what’s happened actually, honestly, in my practice, it’s what allowed me to have a fee structure that was not tied to usual and customary. Now, when I started, it was. But the more I realized these cases take time to work up and diagnose, and once I started to realize that I was doing something different than the patient was getting when they went somewhere down the street, I became more comfortable raising my fees.” (28:05—28:45)
“I would suggest—because most of the people listening to this, I’m going to guess, are going to be a restorative dentist—create a restorative diagnostic practice. So basically diagnostics in our practice is a subspecialty now. I have one column with restorative booked, and I have one column with diagnostics booked. And quite frankly, my assistants out produce hygienists every day of the week because of the fees for diagnostic records. What it allows you to do is to have a practice model that doesn’t have to be 8 to 10 chairs and have a huge overhead. And yet you can be extremely profitable because you’re going to have a referral-based system with well-trained staff with fees that are significantly higher than usual and customary. It is a practice model that, in my opinion, is not discussed enough, and I think today is a practice model that is really underserved. You can do airway in this model. You could do implants in this model; you could do whatever.” (31:02—32:03)
01:26 #1: Learn to listen to your patients.
04:15 Understand why the patient is there.
08:52 The level of communication required depends on the treatment.
12:47 #2: Learn how to work with your team members.
15:26 Structuring a better team meeting.
21:46 Build a more attractive practice to attract team members.
24:34 #3: Learn to set your fees differently.
27:05 Create the practice you want that builds value for patients.
33:30 Why has occlusion gone away?
38:22 Learning advanced occlusion from Spear Education.
41: 44 The Chicago Study Club.
Dr. Jim McKee Bio:
Dr. Jim McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.