Dental Practice Owners Understanding Ownership

Episode #363 with Andre Shirdan

You would never advertise, “Please come run my million-dollar business. No experience necessary!” But not understanding ownership in your business is like doing exactly that. And to help you become a better owner of your practice, Kirk Behrendt brings in Andre Shirdan from The CREW Process to share the four pillars you need to know to understand how to run your practice. If you’re ready to be the business owner you need to be, listen to Episode 363 of The Best Practices Show!

Main Takeaways:

Dentists are never trained on understanding practice ownership.

Four important Ps in your practice are: people, process, profit, and philosophy.

Philosophy is the strongest pillar of the four Ps.

Every single dental procedure needs to be a process.

51% of dentistry is technical. 49% is people and customer service.

Understanding KPIs and norms will help in understanding the business of dentistry.

Quotes:

“My brother-in-law was the worst businessman in the whole world. Phenomenal clinician, but really the worst businessman in the whole world. And coming in and looking at it, I realized dentists are never trained on [understanding ownership]. And we go in and train these guys how to run their businesses, but they never really get it. I mean, in general terms, they're not accountants; they're dentists. And that's what they should do, and that's what they do best.” (5:23—5:50)

“What I found is that a lot of [dentists] abdicate that responsibility [of running their business] to somebody else — like me. I worked the front desk, but I did everything. But we, front desk people, and I always consider myself a recovering front desk person, I came in — and think about this. If there was a Monster ad, it would say, ‘Please come run my million-dollar business. No experience necessary, and the girls will train you.’ And that's really what I came into, as running this business having no idea how to run a dental practice. And I realized that almost everybody that I ran into had that same story.” (5:52—6:29)

“What was really interesting about when COVID hit, I got these phone calls from doctors who said, ‘All my staff is gone. I've never had to put anything into my software. I've never had to do this, and I need to become the owner of my business again. I need to be able to run my business that I've never had to before.’” (6:30—6:56)

“And that started this chain of events, which was, now I have to train a doctor to run a software, to understand what the reports mean, to understand the discrepancies that we typically see or get explained away from a front office person who says, ‘Oh, yeah. That's just an adjustment we make for this,’ but now understanding how that impacts different things, understanding why the deposit slip, when I deposit $1,000, I only get $960 out of my bank account — well, there are credit card fees and care credit fees, etc., etc. — and understanding that where they never really got it before, they just sort of handed it off to the accountant.” (6:57—7:34)

“I think the biggest benefit [of understanding this] is the ability to understand it if you need to understand it. We don't have to. I always say it’s a light switch. Just flick it. You don't need to know how electricity works. But there's some value in walking into Home Depot to buy a new light switch and understanding how the electricity actually gets to that switch. So, you have to understand it even if you don't ever do it on a regular basis. You've got to understand the process, or — to use that analogy — you get shocked.” (7:55—8:22)

“What happens a lot of times is, in the course of my consulting time, I recovered $750,000 worth of theft where the doctors had no idea it was happening to them. And this last year, I saw a lot of doctors who stepped up and said, ‘I've got to run my business differently, not just the guy who writes the checks and the guy who says yay or nay for vacation time. I've got to really run this business.’ And that was an unbelievable thing to watch.” (8:26—8:57)

“[What dentists consistently get wrong is] typically insurance, especially the PPO market where there's this, ‘I'm losing X dollars to X, Y, Z insurance. Look at how much I'm writing off,’ those kinds of things, and not looking at net numbers. I think it’s Tarun Aggarwal who says your gross number is for your ego, and your net number is for your groceries. It’s understanding the difference between the two. And we are caught up in this cycle of, ‘Dentistry is supposed to work this way. Dentistry is supposed to work that way. We’re supposed to always do new patients. We’re always supposed to get 25 new patients a month per providers,’ all these norms that I find aren't really normal.” (9:23—10:19)

“Everybody in a dental office who doesn't understand insurance comes to the table playing checkers and expects that the same board is something that when they put chess pieces on it, they're going to be able to still play. It’s a completely different game, and the people who created that game control that game. And it doesn't work the way they expect it, and they seek knowledge amongst a pool of people who have the same base of knowledge that they have. And then, when an expert brings up what's right and wrong, they’ll question it because the masses don't say the same thing.” (10:47—11:21)

“I would tell any new dentist you need to reach out to experts [for insurance information], the Tom Limoli, the Roy Shelburne, the Teresa Duncan, the Rick Garofolo, those guys. Go to the experts. Don't go to Facebook. Going to Facebook for insurance information is the same as going for medical information.” (13:03—13:28)

“I realized this when I finally had to find a dentist for myself. The first thing I thought was, ‘Which of my clients who I would love sitting in their chairs takes my insurance?’ And as a consumer, when I became a consumer, I realized I needed to look for a coupon. And that's a shame. I mean, I've got enough money that I can spend on dentistry. But I realized that my leading indicator was towards insurance. So, our patients go that way. And if you're in the middle of the “big mitten” of Michigan and you've got a lot of GM retirees, those guys, they think insurance first. So, where you are makes a big difference, where the practice is going. A young dentist who bought a practice who might be engorged with PPOs, that's a transition that you've got to really think through and understand the process.” (14:15—15:08)

“Understanding KPIs, key performance indicators, understanding the norms in dentistry, if we do that, then we also can help ourselves with understanding the business of dentistry, understanding that payroll is going to be your biggest chunk of the money, understanding that for every dollar you make, you're going to be paying 60% to 65% to 75% of that dollar to do that.” (16:23—16:44)

“Every part of a practice needs to be broken into four parts. And if you've ever seen The Profit on CNBC, he talks about people, process, and profit. Those are the three buckets that are the most important leaders in a practice. So, we’ve got to have the right people, we’ve got to have the right processes, and we’ve got to have the right profitability. It has to be, or we shut the lights off. The fourth part of that, which is the most important thing that I do, is work on the philosophy of the practice. Those are the four Ps: people, process, profitability, and philosophy.” (17:30—18:10)

“I love seeing the rest of the office get involved in CE. I love seeing them take ownership in the practice. Almost every company that is employee-owned takes pride in that business. And the doctors have to see that.” (21:29—21:53)

“I think every single dental procedure needs to be a process. And I know it is. That curing light has to be on for 15 seconds, all those things. But I don't think we write down those recipes, and I don't think we use them as recipes. I think we just walk in and say, ‘Eh, flour here.’ Even our hiring processes need to be processes. Our meetings need to be processes. I'm truly of the mindset that everything has to be a process.” (27:42—28:11)

“One of the things that bugs me the most about dentistry is this idea when we schedule that the doctor can come in at any point and do a hygiene check. But don't you have a process in place that says the doctor needs to come in at the 50-minute mark so that they can see and have this conversation about hygiene where the hygienist can repeat that? And they go, ‘Nah, they just come in whenever.’ And I go, ‘Well, okay. Then, we have the burger on the outside of the bun, and it doesn't work for me.’ So, I look at processes like that. And I know there are going to be margins of error. But let's come up with a process so that we can work on that margin.” (28:17—28:52)

“I like checklists that are like Ikea instructions, really general. Because I see checklists in dental offices, and I go, ‘Nobody will ever, ever read this. Just give me a one, two, three, four, five.’ Pictograms are perfect for that. Patient sits down, patient gets in the chair, we clean their teeth, and the doctor comes in for an exam. Give me those five steps, but don't go into the minutia like, ‘Patient opens mouth, instrument goes in the mouth.’ That's too much. Just give me five steps on every procedure, and we’re good.” (29:12—29:43)

“Every process should be something that I can show to a patient, and they get. So, I can even pull out my exam process, my checkup process, for a patient and go, ‘This is the part, number three, that's where you open your mouth. Number four is where the doctor is going to come in and do the exam.’ And they would go, ‘Oh, that makes perfect sense.’ And guess what? You'd probably be better off on time because the patient would go, ‘That's right, I can't talk through step one if I want to get done by the 60-minute mark.’ I wouldn't do that, but in theory, you could.” (29:56—30:25)

“The new breed of dentists coming into the practice come in without the baggage of never using computers. They come in with an idea of using technology for impressions, for building crowns, that kind of stuff. They come in with a different mindset than they were when I started 30 years ago, so a lot of that baggage is gone. So, we’re over the technology hump and that kind of stuff. But the staff hasn't changed. The staffing and the interaction with people, that’s the part that the younger dentists are going to have to get used to. They're going to have to make that transition into understanding that interpersonal skill thing happening. And that's hard. And that's any relationship, is getting into the room with a bunch of people and dealing with them. Knowing how to prep a crown, that's easy.” (32:03—32:52)

“I teach this course on customer service, and it’s called Omotenashi, which is a Japanese term which is about customer service that goes above and beyond. And I've always thought I would hire somebody, I want 51% of the time, them to be customer service-focused, 49% on the technology. You could be technical, anything you want, but that's not going to get the person to say yes. That's not going to get the person to move forward with care. That stuff is all touchy-feely stuff.” (33:20—33:52)

“As you build your practice, look at those four things that we talked about, those four pillars that we have to work on. And remember, the strongest pillar is that philosophy pillar. That's the one that's really holding things up. Then, step back. And everything that you do in your practice, as you go forward, does it apply back to your philosophy? Use this as the way to judge anything.” (34:40—35:00)

Snippets:

0:00 Introduction.

1:00 Andre’s background.

5:09 Why this is an important topic.

7:34 The benefit of understanding how to own your business.

9:08 What dentists get wrong consistently.

10:20 PPOs and insurance are getting more complex.

11:21 What young dentists need to do for the future.

13:53 You don't have to stay 100% PPO.

15:26 The importance of understanding KPIs.

17:02 The four Ps that are important for your practice.

20:53 Allowing the team to take ownership in the practice.

23:30 The people part of the P formula is the most important.

27:28 Everything needs to be a process.

28:52 What the process looks like in a great practice.

30:26 The future of dentistry.

31:32 Self-awareness as an owner.

32:54 51% of dentistry is technical. 49% of it is the business and people.

34:19 Last thoughts.

35:53 What Andre’s company does and his contact information.

Reach Out to Andre:

Andre’s Facebook: https://www.facebook.com/shirdan

The CREW Process: https://www.thecrewprocess.com/

#andreshirdan

Andre Shirdan Bio:

Andre is an inspirational and motivational speaker, executive coach, and certified trainer.

Since 1989, Andre has worked with thousands of practices, helping to create systems for treatment planning, staff training, goal attainment, internal and external marketing, and computer systems integration.

Andre founded Systems Practice Management, Inc., a dental practice management, training, and consulting firm. He created Building Blocks Scheduling, Countdown Confirmation, SELL Training, and PracticePar Analysis. He co-created the nonsurgical periodontal protocol Stat-Ck.

Andre is best known for creating The CREW Process - a better way to define practice philosophy, bring consistency to treatment, and getting the entire office in alignment. Practices working with Andre have found great personal success while getting to know his genuine, frank, and devilishly funny personality.