Dad, its a leech, er, practice consultant, grab your fishing rod and run real fast!

July 1, 1997
My father is a dentist. He has instilled in me immense professional pride and has given me a dentist`s perspective on many issues. Dad is a very unpretentious guy. He doesn`t own a luxury car. His vehicle is plastered with square-dancing bumper stickers, and the paint is faded. The car suits his purposes well, since he needs something that will get him to the fishing spots.

Heidi Emmerling, RDH, MA

My father is a dentist. He has instilled in me immense professional pride and has given me a dentist`s perspective on many issues. Dad is a very unpretentious guy. He doesn`t own a luxury car. His vehicle is plastered with square-dancing bumper stickers, and the paint is faded. The car suits his purposes well, since he needs something that will get him to the fishing spots.

He`s definitely not high production. He practices in a two-operatory office in the small town of Grass Valley, California. The office walls are crammed with his trophy fish. Although he graduated from USC dental school some 35 years ago (and was within one year of the graduating class of the Gordon Christensen), he is very different from that high-profile image. But I maintain, every bit as successful. His extravagance, you might guess, is fishing. The other day he boasted of owning 43 fly rods, most of which he created and wrapped himself.

Happiness is a boot camp in Texas?

The leisurely pace at which Dad practices drives efficiency experts absolutely nuts. He gets bombarded with phone calls from these folks. They all tell him how much he "deserves" a more "successful" lifestyle via a more productive practice.

Whose definition of success are we using here, anyway? They all promise they can make his life so much happier. Some have boot camps in Texas, homes in Virginia Beach, facilitate in the Arizona desert, insist on "10`s," and call themselves practice managers, consultants, facilitators, whatever. They live in different areas and give themselves different labels.

They are all the same, however. That`s why, no matter where they are from or what they call themselves, to Dad and me, they are all blood-sucking leeches.

As hygienists, we all know why we cringe when one of these folks makes a call to our office. The first thing they do is charge the doctor through the nose, $200 per hour, while cutting the staff`s salary. They persuade the doctor to make you feel more like a "team" member by tying your salary into the office`s profitability. Usually, this takes a form of a huge pay cut with promises of financial independence in just a few years.

Did Gina ever make her millions?

Funny, I haven`t met a single hygienist who was able to retire early because of the wonderful advice of a practice management guru. Usually, when we start making a little bit of money playing their production game, the rules suddenly change.

"Oh, did I say your salary is based on production? No, it`s now based on collection."

"Oh, did I say I`d pay you 50 percent of your production? No, I can`t afford that. It`s now 25 percent."

They pound this "team" concept into our heads to make us feel compelled to show up early for the morning huddle, where the practice manager recites the doctor`s "vision" of the practice.

"My vision is for profitability. I want patients to feel loved here, so loved that they feel they face a harsher and crueler world outside, so loved that they hesitate to walk out the door when they touch the doorknob, so loved that they turn around and insist that they schedule that four-unit bridge prep, paid in advance."

Then they want us to attend lunch staff meetings, without pay of course, on our own time, because we are team players committed to, you guessed it, office profitability. We wouldn`t dare think that our lunch hour is valuable. What we had planned for our lunch hour couldn`t be nearly as important as listening to this consultant spew forth euphemisms and convince us that we are spending way too much time during our appointments.

They try to convince the doctor to increase production. To increase production, the doctor needs to do more work. This means either doing more work on the patients already in the practice or getting more new patients.

Better go down to the courthouse and get copies of all the birth certificates. One can never start too early in luring patients. And the work doesn?t get done by itself. More operatories are needed. Have a grand opening to celebrate this remodel. Hire an advertising exec to get the word out. More assistants and front office staff are needed to handle all this extra work. The doctor better not get sick or plan any vacations ? there is a staff to support after all. Oh, and the doctor will need all the latest gadgets and gizmos, including a self-promoting video library in the reception room. Oh, we need to have T-shirts printed. Hey, why stop with T-shirts? Let?s get coffee cups, water bottles, and let?s not forget the fanny packs and pens. Newsletters will be sent out. Better hire an editor.

And Dad thought he knew what he was doing after 35 years of practice.

He thought he knew what made him happy. He thought he was going to be able to use those fly rods looking for that elusive 18-pound steelhead in the Feather River.

Ha! No, instead, we should be spending our time becoming statisticians, collecting all sorts of numbers like cash patients vs. insurance patients, no-shows, cancellations, how many crowns we sold, our production per minute vs. cost per minute, and translating all this into full color, 3-D bar graphs and pie charts.

Should we do these chores during cancellations? Of course not! We don?t have cancellations. We have Oschedule adjustments.O Even so, we are not even supposed to be sharpening instruments during Oschedule adjustments.O

Something too trivial about Ointangible activity

I attended one management course where the speaker chastised hygienists who sharpened. OThat is an intangible activity. Your time is much better spent making yourself visible in a fun way. Go tell the other patients some jokes or ask them questions from Trivial Pursuit.O Yeah, right.

Because our salaries often are tied to overall office production, we are strongly encouraged to sell, sell, sell. We are taught to verbally bully our patients into accepting treatment plans. So your patient is a single Mom working at Wal-Mart one shift and Burger King on another to put food on the table for her four kids? It is your job to convince her she needs a $10,000 treatment plan. No problem. Simply say, OIf money were no object, would you like to have this needed dentistry? Of course you would. How much per month could you afford for this needed dentistry? $100? No problem. Just send us $100 per month until you have a $10,000 credit. Then we can begin immediately. See how easy this is?O

You don?t need me to tell you how repugnant this is. And I can?t speak for all dentists, but I know of at least one who finds this equally repugnant. One thing he abhors about management consultants is their insistence that dentists not participate in governmental assistance programs. OYou are better than this. You should have enough clients who can pay you so that you do not have to deal with this.O

Excuse me. Dad always has treated patients on Medical, the California version of Medicare. He does not make money when he treats these people. Does he hate the red tape, and does he see people who abuse the privilege? Absolutely! Does he quit? No way. There are many people who need the work and cannot afford it.

OHeidi,O he says, Othat?s the definition of being a professional ? to contribute to society. It means treating people right and maintaining your obligations. This is my way. No money-grubbing facilitator is going to convince me otherwise.O

I am thankful for my personal and professional role model, Dad.

Heidi Emmerling, RDH, MA, is a consulting editor for RDH, a writer, speaker, and clinician from Sparks, Nevada. Her e-mail address is [email protected].