Hey Doc – why the heck would you ever want to do this? In this episode of The Dental Practice Fixers Podcast for dentists, Dr. Rich answers one of the most frequently asked questions, and that’s the response….sort of. Then of course we do some mystery shopper calls, and miraculously someone almost gets it right!!

Richard H. Madow, DDS:   Hey there, I’m Dr. Richard Madow and welcome once again to The Dental Practice Fixers Podcast. We have a great question from a listener today. And of course, a mystery shopper calls and all kinds of other fun stuff. I think this question will lead to some very valuable advice for any dentist at any stage in their practice. So we’re going to get right down to it in a second, but of course, first I want to remind you that at The Madow Center we love lowering our overhead and we love teaching other dentists how to lower their overheads too. And of course, one of the simplest things to do is switch your credit card processing to Stax, S-T-A-X because they don’t charge that annoying percentage for processing. Just a low, flat monthly fee. Really low. We’ve saved thousands and thousands of dollars and you should too. Find out more, just go to madow.com/save. M-A-D-O-W dot com, slash S-A-V-E.

Okay, over to our question. I feel like I get questions like this all the time. I probably handled a similar question on the podcast maybe a year ago or so, but I wanted to do it again because I think it’s so important, and even if this doesn’t apply directly to you, there’s certainly plenty of lessons we can learn. Simple lessons.

Okay, so here it is, it says:

“Dear Rich, Love the podcast especially the Secret Shopper calls.”

Well, thank you. Everyone seems to love the Secret Shopper calls. They don’t want to hear me, just the secret shopper calls. Alright.

“Thanks so much for doing this. Question for you. I’m a dentist, early 40s. Purchased what I would call a fledgling practice around six years ago. I’m definitely making a go of it, but things aren’t great. In other words, it’s doing better than it was when I purchased it, but I’m still not super busy and my income is not what I had hoped. There’s a similar practice around 12 miles from mine that is for sale and I think I can grab it for a steal.

I feel like I should purchase and try to build it up also, what do you think?

That combined incomes could be exactly what I need. Thanks for your time.

Midwest, DDS.”

Wow, I like how you chose your own- because I would usually not read the names I kind of, you know, protect your anonymity or whatever. But I like how you just called yourself Midwest, DDS. Covers a lot of ground though.

Okay, Midwest, DDS. Here’s what I’m going to have to say to you. You’ve got one practice that’s not doing as well as you want. Why would you ever, ever, ever want to double your overhead? More than double your overhead because you’re going to-

you can’t be in two places at once. You’re going to have to hire associates or just run each practice part time, which really kills your overhead. You will triple your frustration and you’ll probably have two mediocre practices when you haven’t even proven you can run one practice successfully. Do not buy this practice that’s 12 miles away.

Now let me back that up by saying this is totally different than an older dentist or for some reason someone very close to you has to retire and they’re either selling the charts, so to speak, or they’re selling the practice at a fire sale price. And your intention is to blend the practices into one physical location. That’s totally different. But 12 miles apart, you’re talking about having two physical locations, you’re going to try to run both of them. So again, you’re doubling your overhead or more tripling your frustration.

And here’s the thing. You have not even mastered the art of running one practice yet.

By your own admission, you’re not doing as well as you would like. You’re not as busy as you would like. Your income isn’t as high as you would like. Well, what’s the reason? It’s not because you don’t own another practice. Figure out. Let’s try to figure out what’s going on in your practice. You know, I think we get so distracted by the shiny objects and again, sure, has this worked for some people owning multiple practices in different parts of their state, whatever? Yes, it has.

But you’re talking about a practice and a dentist who presumably you haven’t really mastered the basics yet, you know, if you are a musician, I would say to you, you haven’t even learnt your scales and arpeggios yet.

Or if you’re a football coach, you got to learn to block and tackle. Whatever the bad metaphors that you want to use. Let’s make this one practice fantastic before you even think about another one. And why even think about another one? I got to tell you, unless your current practice is busting at the seams, more money is coming in than you know what to do with, and there’s no chance for physical expansion because of severe limitations. I will not even think about another practice.

You know, some of the most successful practices I’ve seen are four-person practices.

A dentist, a hygienist, an assistant, and a business team member.

I’ve seen dentists net seven figures, net a million dollars with that kind of line up.

Now I’m not saying everybody can, but my point is let’s do what we do best and the old phrase I always use is, dance with who brung ya. You know, who brung ya into a successful dental practice? Well, it’s usually one practice and it’s usually doing the procedures that patients actually want. Again, another mistake is I’ve seen dentist and believe me, I have nothing against great clinical training and expanding your treatment menu so to speak, those can be great things. But I’ve seen dentist with mediocre practices, they want to do better and they wind up taking some esoteric courses, providing treatment that very few people want or need and purchasing expensive tech equipment that just raises their overhead like crazy and doesn’t really do anything to help their bottom line.

So again, until you can prove that you can succeed in this one location, don’t even think about a second location. And that means a practice whose overhead is under control, doing the procedures that most patients need. What do most patients needs?

Sure, exam and prophy, of course, but, scaling and root planning, endo core and crown, implant abutment and crown, just these basic services, simple cosmetics, nothing that’s going to drive you crazy. Again, I’ve nothing against, you know, super complex, comprehensive care, TMJ therapy, sleep apnea treatment. These are all great services to provide. But I think until you prove that you can have what I would just call a typical, successful practice where you’re enjoying yourself, providing great patient treatment, making it a great income don’t even think about doing these esoteric things.

You know, dance with who brung ya, it brings up another thing. I’ve had dentists contact me, saying, hey, my practice is doing okay, but I’ve got this other business opportunity. It’s going to be a passive income stream. I could just sit back and money is going to be thrown in my mailbox every month. Those things very rarely work when you haven’t even realized the full potential of your dental practice. So let’s concentrate on that first. No matter what situation you are in personally, there are so many great lessons that could be inferred from this when it comes to dancing with who bring ya. Don’t go investing your nephew’s brew pub. Or, you know, some crazy real-estate scheme. Typically, if you are a dentist, the dental practice, doing what you do best is who brung ya. So let’s concentrate on that.

Now if you’re having incredibly massive success and you want to back off and have some other projects so you think it’ll be fun, whatever, that’s different.

But Midwest, DDS, in your situation I would say let’s make your practice great first.

And again, I think no matter what stage you’re in, if you’re listening to this, you can infer some really, really great practice lessons from that.

By the way, if you want to chat with me, I’d love to talk to you. If you are a practice owning dentist, it seems like a bunch of people have taken advantage of this lately.

You can set up a time on my calendar, just go to madow.com/chat. That’s M-A-D-O-W dot com, slash C-H-A-T this is for practice owning dentists only. I’d love to hear what’s going on in your practice. No matter what happens after this call. I guarantee you’ll get some great advice and something you can think about. Some people that I have chatted with have actually gone on to become coaching clients of The Madow Center they’re doing really, really, really well. But there’s no cost, no obligation. If you own your practice and you have a question or a struggle, or whatever, let’s chat. I love doing it and I think you’ll really enjoy it too, and certainly get some great tips to help your practice.

So again, just go to meadow.com/CHAT, schedule right on my personal calendar and as you can see I leave tons of space open. So why don’t you do it? Okay, let’s move on. Let’s move onto our mystery shopper calls. Again, I kept it. I’m a simple and basic because that’s the kind of call that typical new patients make. So will go over to command central and take it away.

Caller 1: How can I help you?

Richard H. Madow, DDS: Yeah, how much would it be to get my teeth cleaned and have a check up?

Caller 1: Are you going to be using any type of insurance for your visit?

Richard H. Madow, DDS: I have. I do have some kind of dental insurance, yes.

Caller 1: What insurance is that?

Richard H. Madow, DDS: It’s called Delta.

Caller 1: Okay, so we’re out of network with Delta. So we will just go ahead and bill Delta first and whatever they payout of network with your plan we’ll go ahead and bill you that after. So normally the visit with exam X-ray cleaning is about 550, I want to say.

We do, do an X-ray that goes around your head. It is a 3D X-ray, so it’s more of a special X-ray just so we can see if there’s anything wrong from your sinus’s all the way to your airway. Our doctor is usually pretty good at seeing everything like that.

So we’ll send that to insurance as well. Once they pay their portion we’ll send you the difference. It might be, I don’t know, maybe they will pay $100, 150, 70.

So just all depends on your insurance, how much they pay for being out of network.

Richard H. Madow, DDS: I see. So you’re saying essentially the charge for the checkup and cleaning and X-rays and all the stuff is 550 and my insurance will reimburse around 100 and then I pay the rest?

Caller 1: Yes.

Richard H. Madow, DDS: Okay. So aren’t don’t you in network with Delta?

Caller 1: So they do have a lawsuit going on right now with American Dental Association. So we just didn’t want to be in the middle of it or deal with anything like that. They’re just not giving the proper care for our patients. So Delta right now doesn’t really care. As you know, everything has been going up and Delta has been paying the same thing to any to everything since they started, since they founded Delta Dental, since Delta Dental has existed their maximums has been the same, their coverages have been the same, and I mean, that’s not fair so the American Dental Association is putting a lawsuit on them.

Richard H. Madow, DDS:  Wow. I didn’t hear anything about that. I have to Google that one. That’s interesting. And that fancy-schmancy 3D X-ray thing, do I have to get that or is that optional?

Caller 1:  Yes. So you do. Our dentist is a comprehensive dentist, so we have to evaluate everything. We did have a patient that did have a little ball on her cheek but never was aware of it. And because of our flat, if you usually just take a flat X-ray, you can’t see it. So once we went ahead and do that type of X-ray when we got it in the office like three years ago, I want to say, we did that X-ray and it was able to see that little weird area on her cheek and we sent her to a physician and it came out to being a tumor.

So we like to let our patients know everything that’s going around on their mouth.

Richard H. Madow, DDS:  Wow, crazy man. Alright…

Caller 1:  I know.

Richard H. Madow, DDS: Yeah, well that all makes sense. Okay, thank you so much for explaining all that.  I really appreciate it.

Caller 1:  Of course. You’re welcome.

Richard H. Madow, DDS:  Okay. Bye now

Caller 1: Thank you.

Richard H. Madow, DDS:  Bye. Okay. Bingo. 2 minutes and 55 seconds. Three minutes of our time. I mean, she was nice. She did a lot of crazy things. I don’t know why she had to go into the Delta Dental lawsuit BS, that just doesn’t make anybody look good. One phrase she said that I loved, she said, “Our doctor’s usually pretty good at looking at those X-rays”

Not always. Usually. He’s pretty good. Pretty. Pretty.  He’s not great, he’s usually pretty good. I know that she was just making conversation and not measuring everywhere, but I thought that was hilarious.

Well, yeah, you need to get these X-rays. You know, going to run your bill up to 500 bucks and actually pretty good at looking at it. That just cracked me up.

Middle of the lawsuit. You know, it’s tough to explain why you’re not in network from Delta or to PPO, but I don’t think you should make it sound like you’re not in network with them because they don’t pay enough. It just makes the doctors, you know, look, we all know why you’re not in network. And it’s true they don’t pay enough in many circumstances but you never want to appear that you’re doing something for the money. I mean, you know, we’re not a network because we find that they’re too restrictive in their treatment coverage and we like to provide the best treatment possible. This way we’re just out of the relationship between with us and the insurance company, we do what’s best for you.

You know, something like that where you don’t start talking about money and poor reimbursements. And when you calibrate your practice you can take care of that. If you’re not sure what calibrating is look for the podcast we did on practice calibration. So it’s a great chance to really perfect your answer to why aren’t we in network.

But again, don’t make it about the money. Don’t make it sound like the dentist is doing because they’re not compensated enough, because this patient thinks all dentists are rich anyway. But my main point here is, if I can ever stop rambling is that three minutes later, decent conversation, they made no attempt to get the patient on the schedule, zero, zero, zero. So, bad, bad, bad call. Okay, let’s go to the next one. Bingo.

Caller 2:   Thank you for calling. [censored] How may I help you?

Richard H. Madow, DDS:  Hi, how much does it cost to get a check up and a cleaning for someone that’s never been there before?

Caller 2:  And no insurance?

Richard H. Madow, DDS:  I do have insurance, actually.

Caller 2:  Okay, what kind of insurance do you have?

Richard H. Madow, DDS:  I think it’s called Humana.

Caller 2:  Okay, so it does depend on the Humana plan. There’s different types of plans. We have to verify you. So the way that we go about that is if it’s a full coverage plan,

normally Humana covers exam X-rays and regular cleanings for the first visit, okay? And then we go from there, whatever you may need. If it’s major treatment or if it’s just like simple treatment. So it just depends.

Richard H. Madow, DDS: I see, what’s major treatment? Is that like a crown?

Caller 2:  Yes, those are crowns, bridge’s, partial root canal, or surgical extractions.

If it’s simple treatment is like simple extractions, fillings, deep cleaning.

Richard H. Madow, DDS:  Then what happens?

Caller 2:  So just depends on your, honesty, on your plan, on your benefit.

Richard H. Madow, DDS:  Okay, so it’s like a deep cleaning that’s covered differently than a crown?

Caller 2: Correct.

Richard H. Madow, DDS: Alright, alright, okay, I had a cleaning like a year ago, so I doubt I would need a deep cleaning, but I guess you never know, huh?

Caller 2: Yeah, we will just have to diagnose you. Probably it would just be another regular cleaning, but it just depends.

Richard H. Madow, DDS: Okay, great. Well, thank you so much.

Caller 2: Of course. Thank you. Do you want to schedule an appointment or do you want to wait on that?

Richard H. Madow, DDS: You know, I’m not quite ready to schedule, but I do appreciate that you asked that question.

Caller 2: Okay. All righty. Thank you so much. Give us a call back.

Richard H. Madow, DDS: Okay. Bye.

Okay. The information you gave wasn’t great. I think she went way too into detail about how much insurance covers for each procedure without even really knowing exactly what my insurance is, that’s besides the point because she did something in the end that so few of our people do. And she said, would you like to make an appointment? She said, would you like to schedule something? But then as we all do in dentistry, you know, we just like they keep talking and say too much, she said, or would you like to wait? Would you like to schedule appointment, or would do you like to wait?

Just think that one tiny difference if she would have said let’s get you on the schedule. We have tomorrow at 3:00 PM. If that’s not convenient for you we’ve got Thursday at 11:00 AM, which works best? Would have been so much better, we’ll give her a little credit because at least she did say would you like to schedule an appointment then she kind of screwed up by saying or would you like to wait.

But, sadly, as far as our Secret Shopper calls go we’ll have to say even ending it like that was better than many.

Richard H. Madow, DDS: Hi, I have a question for you. Do you do root canals in your office?

Caller 3:  Depends which tooth. Did you know which tooth you need a root canal?

Richard H. Madow, DDS: It’s, I don’t know. It’s a tooth. It’s on the top. It’s about halfway back.

Caller 3: Yeah, I need to know the number of the tooth. You know, if it’s another last three molars, we may do it. But we have to see the X-ray. See the root is not complicated because we are not a root canal specialist.

Richard H. Madow, DDS: I see, I see. Okay. So should I go to a root canal now specialist?

Caller 3: Yeah, but the best, of course, they’re charging more than double than regular dentist, you know? But if you know your tooth number, you can tell me, then I can let you know if we do or not.

Richard H. Madow, DDS: I see. Okay.

Caller 3: Okay, all right.

Richard H. Madow, DDS: Okay. Bye now, okay.  Oh, man, she couldn’t wait to get me off the phone. I mean, acting like I’m an annoyance. I’m calling to see if they do a root canal. Tooth number, patients never know the tooth number. But you know what? I’m calling because I think I need – I’ve been told I need a root canal. She’s not sure if they do it or not. They refer some, they do some. Specialists are more than twice the cost. Well, it’s pretty darn expensive. Why not say come in, you know, we’ll take a look. You can have a free consultation to look, see whatever. You could very easily, whether you send the endo out or not, could very easily have a great new patient here.

Obviously, they were not happy with their previous dentist for some reason because they’re calling around seeing who can do the root canal. Have them come in. It’s not that difficult folks.

Okay, that should do it for today. Thanks so much for listening to The Dental Practice Fixtures. Again, if you want to have a little chat with me and you’re a practice running dentist, madow.com/chat. Or if you just want to e-mail me, anybody, e-mail me any questions: rich@madow.com. Chyme is like what comes out when you vomit, right?

It’s called chyme. We don’t want to e-mail that. It’s rich@matter.com.

Anyway, thanks so much for listening or watching and I’ll see you again soon in the next episode of The Dental Practice Fixtures Podcast.