Team Selling In The Dental Practice

At a recent Whitehall Team Training held here in Arizona, a survey of the group revealed that in 80% of Whitehall offices the staff make the treatment plan presentations.  I might add that these are among the most successful practices in the country and most of them are heavily manned with associate doctors. 

So why are staff so successful at closing cases that even owner doctors struggle with?  Actually, there are several reasons:

1. The personality of the owner doctor can be an impediment to his or her own success with treatment plan presentations.  The owner doctor may be so non assertive that patients are quickly confused by his natural gift for draining all sense of urgency from the presentation.  On the other hand he may be too dominant, leaving patients feel like they’ve been bullied into unwanted treatment.

2. The staff’s natural patient perspective.  So often, a dentist has so much clinical training that she’s unable to get down to the patients simple level of clinical understanding.  The staff however, know exactly how a patient thinks and feels when expensive dental treatment has been recommended. 

3. The patient’s perception of ulterior motives.  Most of you reading this article already know that patients trust staff when it comes to presenting expensive or unexpected treatment.  As soon as the doctor walks out of the treatment plan presentation the typical patient will turn to the assistant and ask them if they really need all that treatment.  That’s right, you already had your suspicions that staff have the edge where this is concerned.

4. Assistants have far more time to spend helping a patient get up to speed.  To often, the doctor’s body language communicates to the patient that he needs to be elsewhere ASAP.  This leaves the patient feeling like they can’t air their doubts.  This can only lead to one outcome:  “I want to go home and think this over”, or “yes, I want the treatment but I need to check my schedule and call you back”.  None of these responses end well.

5. Patients feel more comfortable asking. what they fear will be perceived as dumb questions, to a staff person as opposed to the doctor.  Unfortunately, we’ve found that it’s the unasked “dumb question” that leaves a patient with overwhelming doubt about the treatment. 

We’ve found that a “team selling” approach is the end-all answer to improving case acceptance.  This means that every staff person who comes in contact with the patient will do their part to infuse credibility and urgency into every presentation.  Usually it’s what’s said before the doctor enters the room that imparts urgency, and remember, without urgency you’re not presenting a treatment plan, you’re just having a nice discussion about dentistry.

Cube Farm Dentistry

If you ever get the chance to visit the offices of a large corporation you will probably be quick to notice the size of the cube farms occupied by an army of bored looking employees.  And why shouldn't they be bored, there are hundreds of them in tiny cubicles entering data or answering help lines.  If you're from the dental world and you are exposed to this scene from a dreary forced labor camp, the first thing that comes to mind is how do they get all of these people to be fully productive.  The answer to this question is usually that they don't get them to maximize their performance, they just pay them accordingly.

I mention this phenomenon because too many dental offices have outgrown their ability to supervise their ever growing contingent of employees.  No, there are no cube farms in dentistry but you can experience the same frustration corporate supervisors face when they're charged with getting under supervised employees to perform at or near their potential.  In dentistry, staff's performance falls along a continuum ranging from lackluster, near stupor-like zombies, all the way to highly motivated, compassionate employees with a laser focus on customer service.  Unfortunately, they all want top pay.    If you're normal, you're probably so busy triaging patients that you don't really know where you're staff fall along this continuum.  You may not, but I'll bet your patients know where they fall.

What are the symptoms of an under supervised dental office?

1st:  Inability to implement new systems.  You return from a practice building meeting with a three ring binder filled with great ideas, only to find that staff humor your enthusiasm, but put off implementation until you've lost your zeal for the new programs.

2nd:  Barely disguised hostility toward other team members.  The office runs more like a sand lot football game with no referees.  New staff are especially vulnerable to the natural abuse veteran staff are likely to dish out to the uninitiated.  It's not unusual for a sorority like environment to set in with an unendurable hazing in store for the new arrivals.

3rd:  Staff pick and choose which patients they will connect with.  In the under supervised office, staff will go out of their way for people they would normally like if they met them outside of the office.  Those who remind them of someone who has previously mistreated them, are treated with barely disguised contempt.  This isn't an indication of how corrupt a staff person is, it's simply the natural outcome of the unprofessional environment that arrises when no one's in charge.

4th:  Staff defaulting to a reduced work load.  This is actually worse than it sounds.  A reduced work load in this case refers to staff consciously or unconsciously failing to do their part to push for daily production.  This can be as simple as front desk staff failing to check with the clinical staff to determine if an emergency or same-day opportunity can be accommodated.

5th:  Staff mistakenly believing that they're super stars:  In the under managed offices I've visited I'm always impressed at how many people who I would quickly identify as needing to be fired, are instead, at the head of the line of those demanding higher pay.  In their supervisory vacuum, they've reinvented themselves as irreplaceable workhorses, when in fact, they're anything but.

No, dentists are not cube farmers, but their inability to maximize team productivity can easily match that of a sprawling nest of under worked corporate employees.  So, what's the answer to this problem?  Simply this, appoint a member of your staff as the leader of the practice or of a department.  Yes, I know, you don't have a single person on staff with a management background.  Not to worry, the best leaders in Whitehall have little or no management background.  In the majority of offices I've encountered, they're better off with poor leaders than having no one in charge.  In the leadership vacuum of dentistry, a nasty feral community grows up to eventually block all hopes of practice growth.

The Terrible Cost of An Under Trained Team

From the few times that I have actually gone fishing I learned one valuable trick for hooking extremely large fish.  It was this simple, just wrap your line around the trolling motor several times after casting your bait into a likely big-fish hiding place.  That's right, just make sure that if a large fish does grab your bait that you're not ready to reel him in.  I know that sounds strange but I've found that this technique works when nothing else will.

Of course you realize that I'm sort of making a joke here, but the technique I'm describing actually works.  The downside is that even though you finally did lure one of the big ones to your bait, there's no way you'll ever get the line unwrapped from the motor quick enough to set the hook and land the fish.  In other words, the lack of preparation seems to attract opportunity that will ultimately mock you.

Every week that passes I'm more aware of practices that aren't ready to deal with the occasional large case that shows up in the practice. The title of this article is "The Terrible Cost of An Under Trained Team", well here's one of the most common points where the practice is punished for lack of preparation.

Most doctors don't even know this is going on in the office.  While they're in the back, head down, drilling, filling and crowning for all they're worth, the staff assigned to make financial arrangements are consistently finding that treatment plans greater then one or two thousand dollars always result in patients deciding to return for treatment when their finances improve.  In the fully trained office, the financial arranger is able to consistently collect on five figure treatment plans.  Most doctors don't really know how to respond to a staff person that routinely finds that none of the big-case patients has the money for treatment.

My point in this article is to emphasis the cost of this lack of preparation. Think of how many doctors set off in search of sedation riches only find that all the phobics are broke.  On the other hand, there are offices where every phobic that can overcome their fear of treatment is able to somehow come up with the money for needed treatment, the staff's training and commitment making the difference.

As we struggle to cope with the ever mounting discounts demanded by insurance companies, many doctors are fearful that there will literally be no profit whatsoever to take home if this unrelenting trend continues.  The office that can fully maximize its larger case opportunities will have a greater profit cushion to throw against the 30 - 40% in-plan discounts that currently stalk the industry.

I've found that each staff person has their own individual financial arrangement qualifications.  Some are good up to $1,500 (quite common) and a few can go all the way past $25,000 (very rare).  As you read this you may be thinking that your practice gets access to larger cases so seldom that there's really no point in pushing a staff person to learn these skills.  I disagree.  For years Whitehall's emphasis has been on consumerism and seeing that no one is oversold.  While that's true, were finding that the handful of large cases that actually could change your life are usually mismanaged at the front desk by the financial arranger.  All they have to tell you is that yes, the patient wants the care agreed to with the doctor, but no, they don't have the money to pay for it.

While there are a few offices that actually do have someone trained and motivated to collect on larger treatment plans, this skill usually resides in just one person.  As soon as the office gets busy enough to occupy this one great collector, the big case will float up out of the back, only to land with the new person who believes that in this economy, no one can afford five figure treatment plans.

If a patient really does want the care, there is a way for them to pay for it.  Maybe you don't really believe that, but you'd better hope your financial arranger does, because there lies the profit that could save your practice from the ravages of deeply discounted insurance plans.  I'm not talking about pushing large cases on reluctant patients, I'm talking about knowing the techniques for making F.A.s that could add $2,000 - $5,000 per week to your bottom line.  If you're a bit non assertive and you hesitate to show willing patients what they really need, and if that same lack of assertiveness causes you to accept your staff's claim that patients can't afford the care they agreed to in the operatory, then you're headed for a very thin paycheck.

In that sense, practice is a lot like fishing.  Quit wrapping the treatment plan around the weak F.A. skills of your front desk.  Yes, it causes the big cases to show up in the office, but you never get to treat them.  A very costly mistake.

File Cabinet Millionaires

You've told patients what they need, some of them even agreed to schedule treatment when they were in the chair, but at the end of the day only a fraction of what you've recommended actually gets scheduled.  I think the term that's often used is "File Cabinet Millionaire".  In other words, if everyone did what you recommended you'd have a awesome dental practice filled with perfect smiles.

The impact of under developed cases on dental practice is staggering.  Everything from poor profitability to low doctor self esteem are on the table.  So what's at the heart of this problem?  Actually there are several underlying issues to look at.

First:  Overwhelmed Patients.

Although we often to think of our patients as having low dental IQs, I doubt we would do any better if we were in the same position.  What if you weren't a dentist and found yourself in the chair seeking treatment for a specific tooth, only to be told that you needed thousands of dollars of unanticipated treatment?  I suspect you'd need to go home and think it over (another way of saying you're going to go home of try to forget this ever happened).

I fear that too few doctors or their assistants know where treatment is really sold.  Most believe that it's all about the case presentation or the "close".  Nothing could be farther from the truth.  A common practice is for a doctor to repress a patient's questions during their examination.  This is understandable because the doctor often has another partially treated patient in the next op, and at least one patient waiting to be checked in the hygiene department.  While this is understandable, in the end the overwhelmed patient always has the same response to a perfectly worded treatment plan presentation:  "I want to think it over".  That's another way of saying "Game Over".

So, where IS the treatment really sold, if not during the treatment plan presentation?  Forget where the treatment is sold and focus on where it's bought, that is, where the patient buys it.  The answer to this question is that it's bought during the examination.  When you're examining a patient and you find something, the patient will want to ask questions about what you've found.  A doctor's intuitive response is tell the patient to be patient and wait for the whole picture.  When the patient asks about what you've found and you put off your answer until a time when you can bundle the entire package into an overwhelming, unexpected list of needed dentistry, the outcome can't be anything but "I want to go home and think it over".

Second: Lack of Urgency

While this is often a factor of a doctor's personality, it also comes about as patients are expected to come into our offices already knowing a great deal about their teeth.  Without a smooth and well scripted interaction between staff and patients, most of what a doctor tells patients in the case presentation is not fully understood.

Telling a patient that they have an unexpected problem with a single tooth and that treatment is needed, is usually well received, especially if they are a patient of record.  If the patient is new to the practice and you announce that there are number of teeth in need of expensive treatment, an unprepared patient will naturally flee the office.

Once you've told the patient that unexpected treatment is needed for several teeth, questions about severity and consequences arise in the patients mind.  Add to this a doctor that softens the presentation with waffle words like "you may want to eventually" or "this is a tooth that could cause you problems down the road".  Add these together, waffle words with multiple, unexpected treatments and you've got the perfect formula for patient overwhelm.

Third:  Lack of Team Support

If your assistants fail to portray urgency or value, and your front office staff handle financial arrangements like they're collecting money for a traffic ticket (meaning they don't have to do any more selling), the odds of the patient agreeing to treatment or showing up for their next appointment are weak at best.

While these three points are conceptual, they should help you zero in on aspects of the practice that are contributing to your under developed cases.