It's time we talked about pie.
What I've noticed pervading this and many other threads is scarcity-thinking. Assumptions about the zero-sum game. A sense that we must choose between being a staunch capitalist or a dentist who does much for their community which also means taking a vow of poverty. That we have to choose between running a profitable dental practice or caring about social issues, as was the original poster's concern. We see on many threads this pervasive notion of "I gotta grab a slice of the pie before someone else eats it all!"
But what if the pie could get bigger? And, more to the point, what if you were the one who made that happen?
Here's why I want to ask this here: I know from my pre-dental shadows, dental students, residents and newly graduated dentists that you young people (not that I'm that old yet!) are amazing and have off-the-charts potential. And yet there's too much in the way here of giving in and giving up in the face of external forces like government action, the economy, the vagaries of self-involved patients... You are all so amazing that you should be proudly shouting "I picked myself!" rather than murmuring "Pick me, Pick me."
In the capitalism of the industrialist, major corporations and commodities, More is the goal. One example will suffice: Coca Cola, Pepsi and Gatorade care about selling the maximum amount of their products, and that means more all the time. They don't give a fig about caries, obesity, Type II diabetes or any other societal effects of what they sell. The next quarterly report is all that counts. Yet even they have discovered the PR benefits of social networks and social action. So what do you think they do about that? They fake it. They slap a veneer of false social conscience on what they do, just so they can look good. That may be part of where we get this idea of the either/or decisions about profit versus community action in our dental practice.
But now let's take the individually crafted, personal, bespoke business that is a dental practice and set it down in this brave new world of the connection economy. (Maybe the world of the bespoke business was always based on connection, but we can agree that it's highly augmented now.) Should we be thinking like an industrialist? Many business thinkers say no.
Connection and Attention are, in many respects, as valuable as cold hard cash. Not in all respects, but don't ever underestimate them. And so what many authors have suggested, and many small business owners have found to be true, is this: If you connect people, your own success increases dramatically. My friend Anne McCrossan said, "When organizations cannot be trusted, we're inclined to give them less attention." The converse is also true: trusted organizations gain attention. And business.
So what I'm suggesting about the pie is that you remarkable young people entering our profession need to cast off your limiting beliefs and pick yourselves; you need to leave behind the factory owner's mindset and instead focus on making a difference, for that is how a modern bespoke business grows. You need to look at the pie that is the neighborhood your practice is in and say, "I'm going to connect people and effect change and make this pie grow bigger."
We need specific examples. Some of these have direct, tangible effects on dental practice. Others have no direct tangible effects on an individual practice, but before you scorn them, consider their importance in raising the stature of dentistry as a profession generally. We've come a long way since the Civil War when dentists paid boys to roam the battlefields, removing teeth from soldiers' corpses to use in dentures for wealthy patients. But there are still selfish practitioners out there who bring us down in the public's eyes, and there remains much work to be done.
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My first example is that if we are pissed off about insurance companies and government Medicaid programs, a valid response is to say "I pick myself" and create our own insurance. We did this a few years ago and it's been spectacular. Basically the idea is to have plans for individuals, couples and a family plan. You tally up the cost of 2 exams and prophys and a number of X-rays and you heavily discount it, and that's the yearly premium. To be paid in advance. Your patients who have no insurance can maintain their health at a more affordable cost than if they paid piecemeal, and you get money way in advance with no staff costs to collect it later. Then when it comes to treatment, the plan discounts that as well. We chose 20%. And again, patients must pay up front, although I suppose one could make other arrangements, but they can lead to collection trouble. Anyway at first I was freaked out by the idea of losing 20%, since we already write off a percentage in the five PPOs we participate in. But here's the thing: patients come in. They maintain, and they do treatments. I found I'd rather write off 20% from the patient I had a chance to talk to than 100% of the patient I didn't get to see at all. And of course one point of this program is to attract new patients on the basis of something of real, sustainable value, and so--my pie has grown bigger.
Another strategy that I have not tried is a day of free dentistry. OMG there's that word that the industrialist thinkers so despise: "Free." But the free can lead to the paid. So, when the economy tanked in 2008, many dentists, especially in rural areas, decided to do a day of free basic dental treatment for those who could not afford it. I suspect that this works better in rural areas where the local economy is more self-contained than in big urban centers, but I may be wrong in that. Anyway everyone volunteered: The dentists volunteered their time, expertise and materials. The staff worked a weekend day without being paid. Local restaurants donated food for the line that would inevitably form, and local musicians even provided entertainment. Most offices I heard of required folks to register and gave them approximate times, so it wasn't just a chaotic line. Their treatments were mainly relief of pain via extraction and pulpotomy, or esthetic fixes in the Front Six area.
I haven't done this, but from what I hear from those who had, two things tended to happen. One, the standing of the practice in the wider community of paying patients skyrocketed. It was tremendous and sustained marketing, and it really cost just a fraction of signing on to a print or TV ad or some such thing. Two, who the heck do you think all those patients, many of whom were in tears, they were so grateful, sought care from once their luck turned around and they got a new job? As long as they didn't move away, there was only one dental practice they'd go to ever again.
These are both excellent strategies for our Dr. Tand, from earlier in the thread. Her name means "tooth" in Dutch and Danish, by the way.
In a more diffuse realm of "I picked myself," I've been volunteering prophys and other basic services at a school for the blind for something like 18 years now. One day I got pissed off that the state didn't really care about the population of institutionalized patients who have profound disabilities, and so I picked myself and did what I could pro bono. For restorative and perio treatments we occasionally bring a patient into my office or the residency I teach in etc. My own patients think this is cool, and it increases my street cred. Indirect, but valuable.
We also occasionally take dramatic pro bono action. About four years ago I got really angry about the plight of Mandaeans. This is an ancient religion and culture that has been severely disrupted by the war in Iraq. There are only about 60,000 of them in the world and they've undergone a terrible diaspora. I befriended a Mandaean physician and ended up treating, and becoming friends with, a refugee family. I kinda lost it on this one--I did about $12,000 of free dentistry, and never made any real use of it in terms of marketing, since it's a Mandaean thing to keep quiet about acts of charity and I wanted to respect that. But it's a heck of a story, and four years on it still feels damn good to have done more than the government for these fine people. Our government's handling of refugees is, it turns out, even more inept than its tax code. I really, really enjoy outsmarting the government once in awhile.
Many years ago, we did a similar thing with a family of five kids who were suddenly orphaned, and written up in the paper. Back in the old days, when newspapers had influence haha. Again, we didn't brag about it or use it gratuitously for marketing, but we did talk about it all with our paying patients and there were all kinds of positive effects from our actions.
I hope these specific examples inspire some of you to re-think your view of the pie. The realm of commodities is a realm of scarcity. The market forces of supply and demand reign supreme in the commerce of equivalent products and services like oil, high fructose corn syrup and mortgages. But you are dentists. You are not "equivalent," you are unique and remarkable.
And it is my considered view that it's not a zero-sum game, it's not either/or, and you should pick yourselves and grow the pie bigger in your own neighborhood.
Because you can.
