Selling products and emphasizing production

Dec. 1, 2011
I work in an office where the doctor puts pressure on all employees to sell products and meet production goals.

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,

I work in an office where the doctor puts pressure on all employees to sell products and meet production goals. This has really become old over time. Every staff meeting is occupied with discussion about how much we "sold" and how we can sell more. I feel like we've crossed the line from providing good care to becoming salespeople. I'm not convinced some of the things we are supposed to sell are any better than products patients can buy over the counter at a much lower cost.

I guess I need to reconcile this in my own mind somehow. But I do not feel good about promoting products in the office. I did not go to school to become a salesperson. Can you help me put this in the proper perspective?

California Hygienist

Dear California,

One of the big mistakes doctors make is when they go to meetings without taking staff members and learn some new information about products that they feel would benefit their practices. Sometimes the emphasis is on something becoming a "profit center" for the practice. Oh, and by the way, this will also help your patients achieve better oral health through some mechanism. Often projections of significant increases in income are touted if the practice sells certain quantities of a given product. Doctors come back with a gung ho attitude about the value of XYZ product and expect staff members to magically embrace the product without the benefit of hearing an informed product presentation. It is a prescription for failure.

If a person does not believe in a particular product (or service), it is impossible for that person to effectively promote the product. It is ludicrous to expect staff members to believe in something they know very little about. A doctor may have a belief about the benefits of XYZ, but staff members may or may not share those beliefs. Asking staff members to promote products when they are not convinced of certain benefits smacks of hucksterism and makes staff members feel deceitful.

That being said, I am not totally against dispensing certain products from the dental office, especially when those products have great efficacy and cannot be bought elsewhere. There are antisensitivity agents and antimicrobial medicaments that can be dispensed through dental offices that patients cannot purchase over the counter. Most often, these are prescription items that require a trip to a pharmacy. Dispensing these items directly from the office helps the patient by eliminating an extra trip to a pharmacy and ensuring the patient actually has the item he or she needs.

Additionally, I am not against production goals when said goals are used for the right purpose. Production goals give the clinician a benchmark by which to gauge individual output. It answers the questions, "How did we do today? Were we above or below our goal? What did we do well, or what do we need to improve?" Production goals are relevant only if there is some tangible reward for attaining the goal over a set period of time. Many practices build a bonus system for staff members around the attainment of a production/collection goal monthly or quarterly. Done right, these systems create a shared team purpose, in that the clinical staff has to produce the dentistry and the business staff has to collect payment for the services.

Production goals become a negative force in the practice when attainment of those goals places inordinate pressure on staff members by requiring them to promote and/or sell products or services. The focus shifts from simply providing excellent care to selling in order to meet a goal. When I have to sell X number of bottles per day of XYZ product to meet my goal, the selling takes precedence over the patient.

Patients are not stupid! My friend, Steve, is a good example. Recently my husband and I were having dinner with Steve and his wife, Linda. The conver-sation drifted to dental care, and Steve related he had recently changed dentists. When I asked the reason, he said, "Every time I go in, they always want to sell me something. I didn't like the pressure tactics they used, so I took my business elsewhere."

Steve is a savvy businessman, and although he personally liked the dentist and his staff members, he lost trust in them. When I asked him if he told the dentist why he left the practice, he said, "No, I don't think they would have cared anyway." Not only did the practice lose Steve, they also lost his good wife and any future referrals they might have made.

Would you be comfortable knowing your medical doctor had a goal to prescribe X number of tests or X-rays to meet a production goal? Would you trust a mechanic who had a goal to produce a certain dollar amount every day? Could you trust someone if you felt there was the slightest propensity for overdiagnosing?

Many doctors do not realize the negative impact on them personally and professionally when staff members feel pressured to sell. They often lose respect for the doctor and do not refer their friends and family members. Although they may lose respect for the doctor, they will continue their employment because they have bills to pay. Most doctors are unaware of the negative feelings staff members may feel as a result of being too production-oriented.

Dental practices are businesses that must adhere to certain standards to maintain viability. Long-term viability is dependent on building a loyal and trusting patient base, because without patients, we have no practice. Patients are the motor in the car. When selling becomes the most important concern, that all-important patient trust is abused and damaged. Patients often register their disapproval by leaving the practice. Patient retention becomes problematic, and the practice suffers decreased profitability.

If you believe this is a problem in your practice, you should approach the doctor privately with your concerns. Of course, the top concern should be the health of the practice.

"Doctor, I'm concerned that we may be losing patients because it seems we're always trying to sell them something. I feel sad when our staff meetings are all about production numbers. My goal is and has always been taking the best care of our patients, but the pressure to sell is making me feel like good patient care has become secondary. Is it possible to focus on excellent patient care without making it a numbers game?"

At the same time, please keep in perspective that your production is important. Your contribution to the practice in the form of production you generate is something you should be interested in knowing and tracking. All hygienists should be aware of their production/salary ratio.

One of my core beliefs is this: if we treat our customers as we would treat beloved family members, the reward will be multiplied many times over as they refer their family and friends. Products have their place in the practice, but the test should be if I would feel comfortable promoting it to my best friend or family member.

There's a ripple effect in all that we do: what you do touches me, and what I do touches you.

Best wishes,

Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at

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