Cliff's Notes

Looking Back on 50 Years in Dentistry

This February my family celebrates 115 years in dentistry, in the United States.  Family members were dentists, hygienists, assistants, suppliers & manufacturers. Unfortunately, it looks like I am the last one. On January 6, 1974, my story began. I thought that over the next few weeks I would look back on some of the people, places and fads.

Although I grew up running around my dad’s dental supply store my first day as a paid part time employee was 1/6/1974. On that day an Impregum (now known as Impregum F) Giant Pack was delivered for the first time. It was a case of 10 tubes each of Base and catalyst. Yup, hand mix. But it was revolutionary as an impression material, it was almost idiot proof.

The product Impregum was owned by the ESPE Corporation and marketed in the U.S. by Premier Dental Products (ESPE/Premier). Premier Dental Products leaped onto the scene with ESPE and brought to market products like Hemodent, Cavit & retraction cords that are still used, in volume, today. Those products were the foundation of today’s Premier Dental.

However, the 3M Company had a struggling dental division that was losing money, and they couldn’t sell it because nobody wanted the product line. So, they boosted it by buying the ESPE Company, ending Premier’s involvement. Today all those revolutionary products are sold by 3M/ESPE.

Morton Charlestein started Premier Dental Products. He has been inducted in “The Dental Distribution Hall of Fame”. It was my pleasure to have known him. His son Gary took it over and Gary’s daughter Julie, now successfully controls the company.

Then for those of us in the New York metro area, there was Andy Defatta, “Mr. Premier”, enough said.

As a side note: The Impregum formula was invented by DMG Europe. Ever heard of Luxatemp? Hey, you don’t know what you don’t know. Next week we will talk about ADAPTIC by Johonson & Johnson.

January 8, 2024 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

John Henry Holliday was a Dentist

“Even if you’re on the right track, you’ll get run over if you just sit there”

Will Rogers

John Henry Holliday (August 14, 1851 – November 8, 1887). At age 20, Holliday earned a degree in dentistry from the Pennsylvania College of Dental Surgery. Soon after he moved to Atlanta and opened a dental practice. After contracting tuberculosis he moved out west for the dryer climate. He became a gambler, gun fighter and Wyat Erp’s closest friend. He was affectionately known as Doc Holliday.

Back in the 1800’s dentists were rare in in many of the areas of our growing country. Often dentistry was performed by barbers, bar tenders, and even medical docs (imagine that). Treatment was often nothing more than extraction and anesthetic was either liquid ether, whisky or the recently discovered Nitrous Oxide.

I hate the title “Dentist”. How many times does someone ask you what type of doctor you are? When you say “dentist” the reply is usually, Oh! Well, we are now in the 21st Century and the medical community is beginning to understand the dentist’s role in systemic healthcare. Just to make a point, you are a physician! You specialize in oral medicine just like a cardiologist specializes in the heart mussel and a pulmonologist specializes in the respiratory system. The difference is that you can be proactive in finding systemic concerns, where as the medical community is reactive. Often that reaction is too late to prevent a patient’s suffering or death.

The diagnostic tools available to dentistry are increasing every day and insurers are looking for ways to reward preventive medicine. Insurers are also looking to “punish” healthcare providers for reactive medicine. Medicare just reduced reimbursement rates to a number of area hospital because patients needed to be re-admitted after discharge. They want diagnosis and treatment handled more efficiently. That point will be driven home over the next several years.

So, what diagnostic tools should the dental practice focus on? The first is a no-brainer, Oral Cancer! The only excuse for not utilizing OC detection equipment is that you don’t want to spend the money. The liability is still there. Now let’s be real, 2 single crowns more than covers the cost of equipment like the Identifi System. Your hygienist (I hope you have one) should be doing a preliminary exam (2 minutes) prior to you entering the room. This is also an excellent internal marketing program. On a personal note, don’t charge for the exam! Raise your exam fee if you have to, but don’t ask your patient to pay for what could be a life saving exam when you are doing what you are supposed to do.

Does your practice take and record blood pressure? Is your team asking diabetic patients to check their levels before beginning any procedure? Are you screening for systemic conditions such as sleep disorders, diabetes, and digestive issues? Why not? Insurance companies will be looking at these preventive screening and their results as the medical and dental disciplines move closer together. The train is leaving the station, it’s time to get on board. It’s time to be a physician, It’s time for a Total Health Program!

John Henry (Doc) Holliday Earned his fame in the old American west as a gambler and gun fighter. He died of tuberculosis in 1887. Doc Holliday was a dentist.

Please feel free to contact me at any time with any questions or concerns.

June 27, 2023 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

What Is MBWA? Maybe a New Year’s Resolution …

A close friend recently sent me a book called “The Four Freedoms of Dentistry” and it reminded me that a dental practice is a business and has all the common business issues to deal with. It’s an easy read and the book is free. Log onto FreeFourFreedomsBook.com. Your team is the #1 most important priority. Your team’s job is to take care of you #2 most important priority, your patients. Your team is your most important investment. Their success is yours. MBWA!

What is MBWA? … Back in the 1980’s the acronym was coined by IBM, it stood for “Management by Walking Around”. The concept was to get management to interact with their team by getting up from their desk and walking around and asking if anyone needed any help with anything or if they had any ideas or suggestions. Several years later Disney picked it up and renamed it “Management by Wondering Around”, I like that one better.

Management by Wandering Around … Disney’s reasoning for changing the word was simple and effective. Team members (especially lower level) will be reluctant to voice any problems to superiors, it’s human nature. But when you “Wander” you are walking slow with your hands in your pockets, you are now “Approachable”. I did it, it works!! How do you approach your team?

Approach Your Team … The key to beginning any negotiation is to understand what the other side of the table wants. You may not agree with it, but you have to understand their reasons. Most practicing dentists do not understand the day-by-day issues and frustrations that team members deal with. They see it and hear about it, but they don’t live it. Sit in the chair and see what the job is all about. It’s the boss’s job to understand their team, but it’s not the team’s job to understand the boss’s.

The Front Desk … Dealing with patients wouldn’t be that hard if it wasn’t piled on top of scheduling, collections, re-care, insurance companies, email requests, and the clinical team. In smaller offices that person may also be involved with treatment planning. With a daily plate full of problem-solving issues, it is reasonable to assume that some things will slip between the cracks. And then you want to know why they couldn’t fill the schedule. Try asking your front desk what is the one thing that would make their job easier and explore the suggestion, you may be surprised at the end results. You just wondered into their world and the moral will instantly rise and productivity will improve as long as you follow through. Now what about your assistant?

The Dental Assistant … Did you know that your patients ask your assistant for their opinion when you walk out of the room? Patients even ask if you are good at what you do. You are a dentist and that means you are creative and artistic; you enjoy reconstructing the oral cavity. Your assistant gets to listen to the patients complain, the doc complains, the Hygienist complains, and then clean up the mess. Look at what they have to do between patients while following all regulations. Anything that would help speed up the room turnaround time is worth looking at. What is your turn-around workflow? What would make the job faster and easier? Wonder into their world and grow your practice by wondering outside your comfort zone.

The Comfort Zone … If it works don’t fix it. That is so true when it comes to your equipment, but your practice flow and team harmony are what the patient sees and feels when they are in the office. Team harmony and moral must be an everyday concern. Team discovery meetings are always available free of charge so please feel free to contact me at any time with any questions or concerns. And, read the book!! FreeFourFreedomsBook.com

January 6, 2023 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Time Change Making You Grumpy?

Fall back, spring forward is something most of us grew up with. Daylight savings time was just converted back to standard, maybe for the last time, I hope! First established in the late 1800’s it was designed to get more hours of daylight for work. The concept took one hour of daylight and moved it from morning to night. It also has a big effect on people that work on a time slot schedule like in a dental office. Unfortunately, the psychological adjustment also effects the boss.

The Boss … This is when a team leader needs to step-up and show why you are an All Star! That hour will affect you as much as anyone else but unlike your team you have no choice but control your emotions while dealing with theirs’s.  Lead by example and do something special to lighten the environment.

Lighten the Environment … For the next few weeks or so your team will be grumpy. Your patients will be grumpy. Your family will be grumpy. Everything in your life will be “out of it” however, it will get better. But you can’t let your team’s “blahs” add to your patient’s grumpy day. So, carve out an hour and buy them lunch. Smile, be overly upbeat to compensate for the time change blues.

Time Change Blues … Daylight Saving Time (DST) messes with our body clock. Changing the clocks does not create extra daylight, but it shifts the time the Sun rises and sets. This can cause disruptions to our body clock, otherwise known as the circadian rhythm. Generally, adjusting to the time change in the spring is more difficult than when the clocks go back one hour in the fall. But losing an hour of sleep may do more than just make you feel groggy — it could have a serious impact on your mood, motor skills, appetite, and even your heart. Understanding the effects of time change is part of employee management and the Total Health Concept.

The Total Health Concept … The key to success if finding the positive that is in every negative and use it for the overall good. Question: What is the positive in a biannual time change? Answer: Asking your patients how they feel…  How many people ask you how you feel with the time change? Nobody… so it is something different that a patient will not expect but remember. Have a conversation about the concept. Ask your team to bring up the subject with the patient and you will see how it helps them to understand that time change effects everyone. You are also creating a small WOW factor because nobody ever spoke to your patients about total health and sleep deprivation.

Sleep Deprivation … Don’t you just love how everything comes full circle? The real positive of the time change conversation is that it opens the discussion of OSA (Obstructive Sleep Apnea). Now you may have a clinical treatment plan that fits and advances you overall marketing plan.

Your Overall Marketing Plan … Everything feeds everything else. Please feel free to contact me at any time with any questions or concerns.

Cliff.Marsh@dcdental.com

November 9, 2022 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Risk Management, did we forget?

It’s been a long 2 1/2 years and a lot of things in the outside world around us may have us forgetting about some basics. The chances are that your risk management program is outdated and should be reviewed. Over the last several weeks, a number of my clients/customers have requested the conversation.

Your exposure to litigation depends on your ability to defend yourself or your team against a legal assault on your practice. The stories I have heard and seen are countless. Patients, team members, pedestrians, tenants, all ages, all demographics, the potential for a legal disaster is only around the corner. The key is to be ready to defend yourself by creating an updated risk management program. You may want to start with a “Patient’s Bill of Rights”.

Patient / Practice Bill of Rights … What is it exactly? A printed statement informing the patient of what they can expect form your office with regard to privacy, professionalism, diagnostic opinion, clinical options, referrals, liabilities and payment options. It also states what the practice expects of the patient such as scheduling, cancellations, payment terms, etc. The “Bill of Rights” should be prepared by a professional familiar with healthcare law. A signed & dated document is gold to any defense team representing a well organized facility. Signed and dated documents are your first line of defense.

Defense Wins Games … When I coached baseball I believed in defense. Offense (your marketing & treatment planning) sells tickets, but your defense will save a close game. You’re your business and clinical teams are the on the front line everyday so training and consistency are critical. Every patient must be processed according to practice protocol. Train your team on people skills so they know what to say and when to ask a supervisor. Prevention is the best form of risk management.

Risk Management … Every business has an offence & defense. In the real world your defense won’t stop litigation, it will only minimize your out of pocket expense. Litigation can come at you from any direction so a professional consultant is strongly recommended. Yes, it will cost you some money but it’s part of your business investment and figured into your quarterly budget. Unfortunately, most people that read this rant won’t want to spend $350.00/hour on legal advise. I can’t tell you how big of a mistake that can be. A couple of thousand dollars now may save a couple hundred thousand down the road if you have to go to court.

Court of Law … A person is innocent until proven guilty but when the plaintive is a general consumer and the defendant (you) is a professional business the rules tend to change. It’s not that the law changes, it opens more doors for the plaintiff’s legal counsel as far a business ethics and the Consumer Protection Act. Most litigation is settled out of court but “settlement” costs money regardless of right or wrong. I know it is hard to believe, but quality documentation can be the difference between a $10,000.00 settlement and $100k. A Risk management program must also include disaster recovery.

Disaster Recovery … What is considered a disaster and I don’t mean a day full of cancelations. A disaster can be a flood, fire or death. The one thing we never really plan for is what happens after we die? Sure, there is money for the family, but what about everything else. Anticipate disasters, they will happen.

Please feel free to contact me at any time with any questions or concerns.

November 1, 2022 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Embezzlement? Not Me!

Embezzlement is alive and well and the dental office is no exception. As a matter of fact, most dental offices (80%) have been embezzled. Some catch it some don’t. I have heard about it and seen it countless number of times over my 40-year career (I started when I was 8). New team members, long time staff, young or old, it doesn’t matter, and whose fault is it? The boss!

The Boss … The identification of faults in any business relies on information supplied by reports from different departments. Management’s job (The Boss) is to review these reports and make sure they match. Checks and balances are necessary to ensure that all procedures and protocols are operating efficiently and “that the “check book” balances! Production reports, daily collections, day sheets & deposit slips must all balance with each other. Trusted long time team members as well as new ones must all be subject to checks and balances. A team member should never feel insulted by verification. As Tom Hayden said to Sonny Corleone “it’s only business”.

The Control Freak … We all have or have had the team member that wants to be in control. They develop ownership of their tasks and get agitated when someone else gets involved or asks question. This situation is not healthy for the practice or the employee. Assuming the person is extremely honest, any inconsistency may cast doubt and damage a good relationship with management or other team member and disrupt team harmony. That will affect the patient experience and office production. Then there is the other side of the equation, they don’t want you to look.

Receivables & Deposits … Who opens the mail? Who enters payments into your management software? Who fills out the day sheet? Who fills out the deposit slips? Who goes to the bank to make the deposits? If it is the same person and not an immediate family member, a change is needed. Checks and balances, ask your business financial advisor to help set up the system. Let the accountant be the “bad guy” changing the system. My dad once told me that when it comes to business trust two people, God and yourself, and watch God.

Payables … Payables involves so much more than just paying bills. Why do you have the bill? Who authorized the services? Where the services requested in the best interest of the organization? Embezzlement isn’t just diverting receivables; it could be theft of goods and services. I could think of a hundred examples like the front desk that has the snow plow company do their home and add it to the office bill. Or, the assistant that places a $2000.00 supply order to get the “Free Kindle” that is shipped with the order and the assistant is checking in the shipment. Did you need the supplies? Were they priced correctly? Nothing is free. Then there is the accounting manager that has been with you for 10 years submitting bills from non-existent companies and depositing them into a personal account..

Embezzlement … is alive and well in the dentistry. It is all about prevention. Talk to a professional and please feel free to contact me at any time, with any questions or concerns.

August 14, 2022 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Starting to think about selling your dental practice? What’s the 1st step

There comes a time in every great athlete’s career when it’s time to walk off the field. Decades of commitment and sacrifice to achieve the success and financial security for your family. Now it’s getting time to plan on turning the page and moving on, but where do you start & what can you expect?

When planning on selling real-estate there are some universal basics that we all know. A real-estate broker can help you find a qualified buyer among the hundreds of people that are searching hundreds of listings. However, a private dental practice is different. It’s an on-going healthcare business and a discontinued item! Yes, that’s right, “a discontinued item”, but that’s another discussion. Today, it is a seller’s market for most situations and that may continue for some time. So how do you take advantage of a bullish market? Talk to a dental practice broker?

What about dental practice brokers? What do they do? Do you need one? Maybe, or maybe not. Unlike the real-estate market there is a much smaller field of active, qualified buyers. Identifying the serious buyers from the ones just looking for a deal is the hard part but can easily be controlled. However, if you want someone to do all the work for you, it will cost 3%-15% of the selling price depending on how much work you need the broker to do. Also, there are dozens of dental practice brokers available, who do you use? Did you know that you don’t need a license to be a dental practice broker? Can you do this work yourself? Yes, with the right planning and a little more involvement you could save a lot of money.

You don’t know what you don’t know. A one-hour non-committal conversation is
all you would need to understand the best direction to go. It all starts with what
you want, when you want it and how much you want to be involved in the transition.

Prior to any conversation, a signed non-disclosure agreement will always be
supplied.

For more information and a 5-minute chat to schedule a time to speak, please call, text, fax or email:
Cliff Marsh
(Mobile) 201-321-7494
(Fax) 201-262-2210
(Email) cliffmarshsmile@gmail.com

June 14, 2022 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

 Don’t Practice in Your Blind-Spots

I have always told my clients that my #1 job is to tell you what you don’t want to hear. This week’s topic on Cliff’s Notes is about knowing what you don’t know, and articulated by Mike Massotto, CEO of Staff Driven Dental after decades of observing 100’s of dental practices.

As you’re reading this, ask yourself this question: How do my patients and staff really view me and my practice? Before you ponder too long on this, I’ll save you a lot of undue effort because most of what you will come up with is probably inaccurate. There is an age-old quote that goes something like this: “The true gift in life is to be able to see oneself as others see you”.  The follow up line to this quote should read something like, “sounds great, but the trouble is that isn’t so easy to do…” And here in lies one of the biggest practice dilemmas that may be unknowingly costing you more money, patients, and staff relationships than anything else in practice each day. It also happens to be the main area of practice development that my coaches and I initially spend most of our time doing our observation, enlightenment, and resolution with our clients when we first engage with them as a foundational must for future success.

I call them your professional and personal “blind-spots”. I have observed time and time again that there hasn’t been a person that I have consulted and coached over my last 17 years in dentistry that doesn’t have them. Unfortunately you and everyone else in your practice are not immune to the detriments of this malady of self-obliviousness if you will.  They are not unlike the blind-spots that you were first warned about in driver’s education. You were told that your car has them and so do the other cars on the road, and not to drive in them because even though you’re there, the other driver can’t see you.  You’re essentially invisible to him, and that makes you dangerous, so position yourself there on the road at your own peril. Yet despite these warnings and our best intentions, how often do we unwittingly find ourselves swerving to avoid calamity on a semi-regular basis while on the roads (especially in this state!)?  Now wouldn’t it be great if we could all just drive cars that would allow us have full spectrum vision and awareness of the road and all the other drivers, potential hazards, and obstacles that surrounded us at all times? Think of the money, stress, and lives alone that this would save.

Unfortunately, the technology and know-how to create such a vehicle may or may not become a reality someday, but realistically, the ability to achieve this same level of total transparency of self as human beings will probably elude us for an eternity.  Holding up the mirror of self-analysis to yourself can be quite helpful and enlightening, but it is only through the outside, trusted and well-intentioned observations of others that you will truly begin to discover, improve on or correct what you cannot see, and what may be holding you back or dragging you down in practice and in life.  This first takes an honest willingness and intention to want to look at yourself and your practice, and acknowledge that you don’t know what you don’t know, or in this case, you can’t see, and be open to changing it. This is the toughest challenge that my coaches and I face every day in our work, but there is no greater reward and practice gain when we are able to achieve this with a doctor and his or her team.

There are many facets on which a successful and prosperous practice are built, and perhaps the most important of all that I have found is uncovering each individual’s costly and potentially dangerous blind-spots that are impeding his or her personal and business growth, and getting these resolved first and foremost prior to any major practice consulting or operational reform. Most practice management programs fail not due to faulty information or poor ideas, but from the lack of implementation or self-sabotage brought about by the individual being coached because of what they do not or refuse to see within themselves.  These personal barriers have been stopping them long before me or anyone else has tried to help them, and will continue to do so until they first come to the realization that what they need to confront and resolve first comes from within themselves, and not with their practice, patients, or staff.  Assigning blame and making other outside factors or people wrong (for example, your staff) for the less than optimum place you may feel you or your practice is in each day,  is a symptom of practicing in your blind-spots. Look to first discover the source of these and identify them clearly as they are within you.  You will then be able to get on a path to practice success that is effective, sustainable, and supported by your staff, your patients, and others who you may now as a result truly understand and better accept in life to help you continue to be better as a doctor and as a person.

Please feel free to contact me at any time with any questions or concerns.

October 4, 2021 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment

Gelato Prophy Paste

Product Review

Keystone Industries dental.keystoneindustries.com/

Consultants’ Comments

• “Does not splatter.”
• “Easy to rinse.”
• “Cups are color-coded and easy to open.”

Description

Gelato Prophy Paste with fluoride (1.23% fluoride ion) contains a unique blend of cleaning and polishing agents. Gelato Prophy Paste was reformulated prior to this evaluation and is designed to apply smoothly without splatter and rinse easily. It is indicated for application during standard cleaning and polishing dental hygiene procedures. Gelato Prophy Paste with fluoride delivers a wide variety of flavors including pina colada, orange sherbet, mint, cherry, bubble gum, and raspberry in three grits (fine, medium and coarse). Gelato Prophy Paste is packaged in 200-count boxes of individually sealed, single-use cups. The manufacturer recommends the use of fine grit for gentle cleansing and polishing and for use with children; medium grit for normal plaque removal, cleaning and polishing; and coarse grit for medium to heavy plaque and stain removal. Dye-free and x-coarse varieties are also available. Gelato Prophy Paste was evaluated by 35 consultants in over 2500 uses. This prophy paste received a 91% clinical rating.

Product Features

Gelato Prophy Paste offers a variety of flavor options that are enjoyed by patients. The paste has a creamy consistency that is easy to pick up with the prophy cup and spreads smoothly on the teeth without splatter. Unit-dose cups are color coded with flavor labels that are easy to read. Sixty-three percent of consultants would switch to Gelato Prophy Paste, and 80% would recommend it

Cliff’s Notes September 21 special pricing available.

September 2, 2021 Posted by Cliff's Notes Blog | Uncategorized | Leave a comment