The Successful Endodontist
Success hinges on a strong team, good technology and relationship-building, says one endodontist/coach
The successful endodontist isn’t that much different from the successful sales rep. For example, he or she has excellent clinical skills, just as the outstanding rep has excellent selling skills. The endodontist has empowered staff members to keep the office running smoothly and efficiently, just as the outstanding rep relies on the inside sales team to help him or her in the field. The successful endodontist tends to use the latest technology, just as the rep does. But perhaps most important, the successful endodontist understands that strong personal relationships - with referring general practitioners, patients and others - are the key to success. And what rep wouldn’t agree?
Endodontists are in the business of rescuing dying teeth, that is, teeth whose pulp has been injured. ("Endo" is the Greek word for "inside," and "odont" is Greek for "tooth," according to the American Association of Endodontics.) Their procedure of choice is the root canal, and their tools tend to be burs, files and irrigants. They may also use technologies such as operating microscopes, electronic apex locators, ultrasonics and digital imaging, to perform their services.
Like many professionals, endodontists are feeling the effects of a weak economy, says Albert Goerig, DDS, MS, who recently gave a presentation on "Practice Success for Hard Times" at the recent annual conference of the American Association of Endodontics in San Diego, Calif.
Goerig has a unique perspective on the state of his profession. Not only does he practice endodontics at Northwest Endodontic Specialists, a two-doctor practice in Olympia, Wash., but since 1996, he has been coaching endodontists around the country on how to improve their operations. He figures he has coached a couple of hundred of the roughly 4,800 endodontists who practice in the United States today. He is also the co-author of Time and Money: Your Guide to Financial Freedom.
Challenges
When the economy slows down, general dentists tend to do treatments that they normally would refer such as root canals, says Goerig. In fact, according to the American Dental Association, close to 70 percent of the 15,000 root canals performed annually are performed by general dentists.
Although general dentists receive training in endodontic treatment in dental school, and are capable of doing routine root canal treatment, there are many procedures that are more complicated and are best left in the hands of specialists, says Goerig. "The greatest enemy of the general practitioner is unpredictability." For example, a general dentist may find himself, after a couple of hours working on a patient, unable to get down a root canal that has become calcified. He or she then has to refer the patient to the endodontist. "[General dentists] can be much more profitable if they refer these cases out," he says.
Another challenge facing endodontists is the popularity of dental implants. Instead of saving a tooth through root canal treatment, some dentists elect to pull it and insert an implant and crown. Often, such decisions are made hastily or on the basis of faulty information, says Goerig. First of all, a root canal is cheaper and quicker than an implant, which requires multiple visits over several months. More important, dental literature shows that root canals enjoy the same high rate of success as implants - around 97 percent, he says. "If you asked the patient, they would rather have their own tooth instead of an implant, but many times they are not given the option." For these reasons, many endodontists are now doing implants to help their patients in an unbiased decision-making process, as they contemplate an implant, he says. "We want to make sure the diagnosis is correct, and that the tooth absolutely cannot be saved through a root canal."
Their own worst enemies
While it’s true that endodontists face many real challenges from the external environment, the fact is, many if not most of the challenges facing them are internal, that is, they lie within their own practices and even their own work habits, says Goerig. As a coach, he tries to help his clients recognize that success comes from having great business, marketing and scheduling systems in their practice, along with a highly competent team that knows how to implement those systems.
Most endodontists perform between three and five root canals a day, when actually, they could do one or two more cases a day- with better quality and lower stress. This small change in production could mean an additional 30 percent to 50 percent increase in net profitability, Goerig points out. Many of the endodontists he has coached are doing just that, he says.
Clinical knowledge and skill are important in providing high quality patient care, but they have little effect in increasing productivity and profitability in the practice, says Goerig. One of the biggest roadblocks to increased productivity is the doctor’s mindset. Many hard-working doctors cannot see themselves working less and producing more. But seeing is believing, says Goerig. That’s why he has other endodontists and their teams visit his office to see the potential of effective systems and highly trained team members. Once they see how easy it is, they go back and change their practices, he says.
One of these systems is efficient scheduling. An efficient schedule calls for the endodontist to treat one patient at a time, with a slight overlap. As one case is close to finish, the endodontist diagnoses and anesthetizes the patient in the next operatory. At Northwest Endodontic Specialists, if one patient cancels, the staff is on the phone telling the next patient that the doctor will see him or her earlier than previously scheduled.
Indeed, efficient schedules call for efficient schedulers. "I’m 65, and I don’t even see myself as working," says Goerig. "It’s so easy, because I surround myself with a great team. My job is to be told what room I need to be in, and then to get there.
"I never pay people to make me miserable," he adds. "I hire people who are givers and who are team players."
The result is greater productivity with less stress. "Some people feel they have to work hard for a living, and they make it difficult and a struggle," he says. Such "imprints" may have been planted years and years earlier, when the person was a child. "Some people will keep making mistake after mistake, and keep sabotaging themselves."
Successful endodontists, however, empower a strong, effective team member to essentially run the office, leaving the doctor free to practice his or her craft, he says. This team leader has responsibility for hiring and firing, marketing the practice, and monitoring its financial performance, in conjunction with the practice owner.
The ‘go-to’ endodontic practice
With good systems and people in place, the successful endodontist continues to build his or her practice. Northwest Endodontic Specialists has positioned itself to be the go-to endodontic practice, so that there’s little reason for patients to go elsewhere, or for general dentists to refer their patients elsewhere, says Goerig. It does so in a number of ways:
- First, the practice is open five days a week. It can do so because it has two doctors on staff (Drs. Goerig and Michael Behnen).
- Second, it has the latest technology. "I was the first to have digital radiography in the early 90s," he says. He has cone beam imaging technology as well.
- Third, Northwest offers a wide variety of clinical services, including apical surgery (root-end resection), nitrous oxide and conscious sedation. (In five years, predicts Goerig, the majority of endodontists will have the capability to perform implant procedures.)
- Fourth, the 1,200-square-foot office itself is clean and attractive. Every three or four years, walls are repainted, rugs and upholstery changed.
- Fifth, and most important, the team must reflect the spirit of the practice - efficient, friendly, service-oriented. "Because we deal with patients in pain, we see our referring doctors’ patients that day, and usually complete the treatment the same day."
"You have to look at your office," says Goerig. Do you have the right person upfront? Does she have a loving, caring spirit that makes all patients feel at home especially when discussing finances? Does she connect on a personal level with those in the front office of referring dentists?
Nurturing relationships
Indeed, the successful endodontist nurtures relationships with two important sets of clients - patients and referring dentists.
"We cultivate our relationships with our patients by calling them the night of treatment to check up on them," says Goerig. "At the end of treatment, we provide them with small gifts such as pens, pocket calendars, mouse pads or other promotional items. It is like a toy box for adults, as recognition for their courage for showing up and as a reminder of us if they need another treatment in the future."
Failure to cultivate relationships with referring dentists will hurt the specialist’s practice, he says. "It’s all about personal relationships." In fact, 70 percent of general dentists change specialists because they have a poor or no relationship with the specialist, he says. Only 30 percent do so because of price or quality.
The successful endodontist has a tracking monitor to determine the number of referrals he or she gets from each referring doctor. "If you get an average of 100 patients referred [per dentist/per year] among your top 10 [referring general dentists], your marketing efforts are highly successful," says Goerig. "If your top 10 referrals average around 50 patients per year, it would indicate the endodontist and team have some work to do."
Much of that work involves "constant, positive, and repetitive" contacts with referring dentists and their team members, he says. Some specialists, including endodontists, provide service, but then fail to follow up with the referring dentist, except perhaps to provide a gift during the holidays, he says. Instead, they or their marketing coordinator should be making regular contact. Once a month isn’t too often to drop off donuts, chocolates, or even a lunch. "If a lunch brings one extra treatment, why not do it?" he asks. Sponsor a wine-tasting, or bring in a top practice-management speaker for a full-day lecture.
It’s important for endodontists to do their own "prospecting" for new referring dentists. Young dentists are particularly important, because they tend to bond or connect with the first specialist who reaches out to them. The endodontist should also get involved in dental society leadership and other high-profile community projects. Goerig also provides scholarships for the local dental assisting program and provides a two-hour presentation to the dental assistants on endodontic office procedures. This gives him the opportunity to meet and connect with every new dental assistant in the community.
Relationships expand when your intention is to help other dentists and team members become more successful in their practices and lives, says Goerig. One of his most successful marketing ideas is to provide seminars for doctors and their teams on how each one of them can be completely debt-free in five to seven years. Based on a book (Turn Your Debt Into Wealth) and tapes by John Cummuta, Goerig teaches that anyone can be completely debt free by using 10 percent of what they make each month to focus on one debt at a time and pay it off.
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