**This post has been added by a new contributor – Mary Fusco – With the joint purpose of finding out more about the shortage and access to dental care. Thank you in advance for your input. We appreciate your time and efforts to contribute to this study.**

I was a dental assistant for 12 years right out of high school and I have maintained an interest in dental workforce issues ever since. After completing my bachelors and masters degrees, I worked in non-profits where I devoted my time to dental workforce issues. I am now working at a dental school and I’m a PhD candidate in the dissertation phase with a topic focused on dental workforce shortages affecting access to care.

I’m interested in finding out if experience with dentistry prior to and during dental school affects how a person feels about their dental skills and abilities, and then finding out if these experiences (such as community outreach) influence practice preference. I believe the results of my study will help with dental admissions processes and with dental clinic recruitment and hiring. I’m focusing on dentists who have graduated between 2006 and 2011 to complete a short (10 minute) survey. I’ll share the results of my research with those who are interested.

Anyone interested in learning more about the research study and taking the survey please go to: https://catalyst.uw.edu/webq/survey/mpfusco/142155

Thank you, in advance, for your participation!
Mary Fusco, MA, PhD ABD

Certainly, the last year brought more change than most care to think about, as much of it was not easy.  If you don’t ever again want to face a year like you just did, I strongly suggest you commit to making economic change of your own in the coming months and ensure that regardless of the financial sector’s projections of  boom or bust, you practice is well positioned.

Start with the messages that you and your team regularly communicate to patients. Does your staff convey ordinary or outstanding, state of the art or status quo? Is the excellence of the team and the dentistry routinely conveyed to the patient? And, most importantly, have you even considered the messages you’re sending to your patients in every interaction, from the first phone call, to the emergency appointment, to the routine visit? If not, it’s time to listen up and script your success.

Use a well-crafted script to discourage patients from canceling appointments. When a patient calls to cancel, your business staff should ask for permission to put them on hold, access their file, and use the information to motivate them to keep the appointment. For example: “Mrs. Jones, I’m looking at the doctor’s notes and she emphasized that there is significant decay in that tooth. I know it is very important that you keep the appointment, would you reconsider?” The patient may still cancel, but in some cases, they will be convinced to keep it. Moreover, calling specific attention to the patient’s need for the appointment further underscores the value and importance of pursuing the recommended treatment, and emphasizing the need for care has never been more critical. Particularly since even in the best of economic times, many patients will put off certain procedures for as long as possible. Additionally, ensure that there is an established protocol to follow-up with patients who cancel. In many offices, it is months before anyone follows up on a cancellation.

“Dr. Tom” called me in frustration to discuss the fact that his office manager of 15 years leaves every day at 2 p.m. He is understandably concerned because the office is essentially left unattended for the better part of the afternoon. Moreover, a multitude of essential duties are routinely left undone because when the clock strikes mid-afternoon, “Kim” is out the door.

While the role and specific duties of the office manager may vary from practice to practice, the cornerstone of the job is efficiency. This person should be able to oversee key practice systems to ensure that the office is running efficiently. They may have multiple duties including answering phones, helping with the schedule, running reports, sitting down with the doctors to alert them to issues, and concerns with patients and staff. Whatever shape the role takes, it must be clearly defined to best meet the overall management needs of the practice. And the duties must be spelled out, point by point, in black and white. Additionally, specific goals for the position that compliment overall practice goals must be identified. Performance measurements must be in place to measure the individual’s success as well as necessary tools to help the individual achieve success, such as office manager training.

In the case of Kim, Dr. Tom values her contribution to the practice and emphasizes that she has been a good employee. However, it appears that given her years with the practice she now believes that she is entitled to a “flexible” schedule. Again, Kim needs specific direction from the doctor as to what is expected of her. Once Kim understands clearly what the role of office manager means in this practice, she can choose to accept the job or find other opportunities.

Whether you just graduated from dental school, finished a residency program or specialty training, the majority of young dentists begin their careers as associates. The road to becoming an associate is full of variables, and knowing the ‘lay of the land’ can help you make wise decisions. The journey begins with choosing the practice that is right for you.

If you want to join a practice as a full-time associate and have adequate patient volume for yourself, you need to join a practice that is “saturated.” Saturation means that the owner is working at optimum speed, practicing optimum hours, is scheduled fully, six to eight weeks in advance, and has more new patients in the practice than can be cared for.

By joining a “saturated” practice, you have an immediate opportunity to gain clinical experience and enhance your income. Additionally, saturated practices afford greater opportunities to build a patient base. A saturated practice may also offer long-term opportunity in the form of an equity interest or potential buy-out.

Usually, general practices with more than 1,700 active patients are at the saturation point. An active patient is one who visits the practice at least once during the past 18 months for a recare visit. The degree of saturation, or the number of excess patients in a practice, will determine the actual opportunity for you to work as a full-time or part-time associate. For example, an efficient and skilled owner who is servicing 1,700 patients with a full-time workload may want to reduce hours and transfer patients to a part–time associate. Generally, practices with 2,500 or more patients present excellent full-time opportunities for new associates.

Therefore, if you are considering a full-time associateship, be sure to inquire about the size of the active patient base.   

Snyder, DMD, MBA, Tom  (2009, Summer). Becoming an Associate…What You Need to Know. the NEW DENTIST™ Magazine, 20-21.

I started my practice from scratch about five years ago. Right now, I have two days of hygiene per week and I want to build this to four days. I also want to increase my new patients. I used to get about 18-20 new patients a month, that’s dropped to about 14. Thankfully, I don’t think I’m losing my existing patients. But how do I know? I’m starting to worry.  Midwest DMD

Hey Sally,

I was very impressed with your New Dentist publication, especially the aspect of establishing a “green” office. One thing that even the green movement does not realize yet is the aspect of mercury vapor hygiene in the dental office. I am the vice president of the International Academy of Oral Medicine and Toxicology (www.iaomt.org). We have been advocating proper office ventilation with filtration and personal protection for patients and employees for 25 years. OSHA has a maximum PEL limitation exposure of 50 micrograms of mercury per cubic meter of air in an eight hour day and 100 micrograms in a single exposure. When my assistant opens up the back of the dental chair to clean out the trap we have measured mercury vapor levels as high as 600 micrograms in the air. I use a Jerome mercury analyzer which can detect levels as low as 3 micrograms in the air, much like a Geiger counter. We also use an air filter with carbon filtering masks to reduce employee exposure. We are hopeful that the allopathic dentists will begin to realize this danger and then all offices can become more green. In addition we advocate the use of mercury separators in order to reduce dumping it into the environment. If you have any questions feel free to ask.

Thanks…Dr. Matt Young

I am looking into entering an associateship that could possibly lead into a buy-in. I would be interested in hearing suggestions about how to structure my compensation.

Dr. S.C.

TN

Help! Recently, one of our dentists sold the practice to a younger dentist and she kept us all on as staff.  This may sound just great, however, there no rules, no accountability, no structure, and no punishment. I’m the office manager and I don’t know what to do. This is a great practice that she’s purchased and it’s going downhill fast.

Florida Office Manager for New Dentist Owner

I live in North Carolina, and am considering going out on my own in private practice. Ms. McKenzie had said it was possible to roll over the fee from the Start Up Program into the loan for the practice. Another thing I’m considering doing, before actually opening the doors, is going to a Spanish language school in Latin America for about four months or so. There are a lot of Hispanic people in my area and I think this would be a great practice builder. Could I roll the expenses for this into the loan as well?

Hi Sally,
My name is Dr. Orjiekwe and I am a general dentist.  I just read a response you posted in December (@ the new dentist website) for a new dentist that was looking for a job without success in California.  I think that new dentists make a terrible mistake by jumping right out of dental school and think about associating or much worse starting a practice right away.  We should stop advising them to do so.  I strongly believe that every general practitioner should complete at least one year of general practice residency in a hospital or an advanced education in general dentistry (AEGD) in a dental school.  New dentists need to gain valuable experience treating patients.  Dental school does not prepare anyone for the type of care and speed needed in private practice.  Medical students do not graduate from medical school and start associate positions or even yet open their own practices.  This is insane.  After dental school, I did a general practice residency and associated for 5 years before setting up a very successful practice.  I am only 34 years old and I would not do it any other way.  New dentists need experiences beyond what dental schools offer.  My recommendation is that the dental community and the new dentist magazine/website should stop encouraging new dentists to go from dental school and get associate positions.  Worse yet, new dentists should not open up practices right after dental schools in order to avoid making a potentially huge terrible mistake.  THERE IS NOTHING LIKE GAINING A VALUABLE EXPERIENCE.  WHAT IS THE RUSH?
Dr. Ogonna Orjiekwe