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Howard:
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This is a fun Friday for me. I can't believe I get to spend an hour with the legend herself, Cathy Jameson. How are you doing, Cathy?
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Cathy:
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I am doing just great, and how about you?
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Howard:
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I'm doing great. My son that helps me, he was a senior in college, and they told him he could finish his senior online, so he moved back home to help his old man out with this podcasting stuff, and it's just a blast doing these with my son.
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Cathy:
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Isn't that great?
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Howard:
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I should be calling you Dr. Cathy Jameson. Congratulations on your PhD you got back in 2010. That was amazing. What made you set out to do that?
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Cathy:
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I think I am just a committed forever student. I really love the learning process. I'm a teacher. My bachelor's degree is actually education, so I love teaching, I love learning, and I really feel like I owe to my clients and to the audiences, and to the industry to be on the cutting edge. If I'm going to profess to be a management expert, then I wanted to do as much as I could, to learn as much as I could, about the background of management, the theories, the principles, as well as the most recent research in management, what works, what doesn't work, what's proven, what's not proven. Then to fold that in to a management strategy for dentistry that works and works well. While we always believe we've done that, I just wanted the continued education personally and professionally as well. It was great.
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Howard:
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Well, I couldn't even count all of my personal friends who have used your consulting service over the years, and I'm from Kansas, you're from Oklahoma. I always thought those Midwestern people, they're always more about keeping it real as opposed to some fancy, high-faluting theory that they learn in some of these coastal big cities, and America's the heartland, and you've been keeping it real in the heartland forever. I want to ask you this. You come out of dental school, you open up a practice, is a leader just born, or can you learn to be a leader? Is this something you can educate a kid to be a leader, because I think it's the hardest skill you ever learn. It's not doing a root canal. It's not placing an implant. It's how to be a leader. How much of that is just natural born leader, and how much of that can they train themselves and educate themselves so that they can lead their team?
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Cathy:
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That's a very good question. Leaders are not born. We all have a different personality style. Some of the greatest leaders in the world have had vastly different personalities, and vastly different backgrounds, so leaders are not born. These are skills and therefore, because they're skills, they can be learned. Are there some attitudes that are beneficial to becoming a great leader? Absolutely. You have to want to, you have to see the value of it, and understand that while it's not necessarily a didactic skill, like as you say, doing a root canal. These are skills that can be learned.
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The truth of the matter is, Howard, if you ask all of the consultants that have ever worked with us at Jameson Management, and certainly that would include myself and John, my husband John, that if were to say what was the ultimate difference in whether or not a doctor has a successful experience in his or her practice or in a consultation experience, it's their ability to lead, to lead themselves, to lead their team. Then in my opinion, be our leaders of our patients. You can't, nor do you want, to push a patient into making a decision about their treatment, but we can lead them into making decisions that are good for them, and then hopefully that decision to go ahead. These are skills to be learned. Certainly a lot of people learn their leadership skills from modeling. Modeling is perhaps the best way.
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If you ask most people, and I love to ask this question, thinking back over your lifetime, think of someone in your life that you considered a great leader in your own life. What did they do? How did they impact you? How did you interact with them? What were their characteristics like? What was their integrity like? Then if you ask them the flip side of that question, think about somebody in your life who maybe wasn't a good leader, who had a negative impact on you or on your work, what did they do? How did that impact you? What were their behaviors? Most people can pull those out very quickly. Oftentimes it's a teacher, a parent, a grandparent, an instructor, a coach, someone that really impacted them.
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It was somebody who believed in them, someone who cared about them, someone who probably pushed them, because that person saw a strength or talent, or ability, and they pushed them a little bit, or maybe a lot. It was interesting, the Australian Open's going on right now, and so I was listening to an interview with Sharapova, and she had lost to Serena, and her immediate reaction or conversation in the interview, immediately following the match, was, "I learned so much. I can't wait to get with my coach and find ways I can do better." Here's the second best female tennis player in the world and her immediate reaction after her loss was, "It's time to go back to the table and learn how to do what I'm doing even better." That kind of an attitude makes all the difference in the world.
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Howard:
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Cathy, everyone I know that talks about you and has used you, I mean they've used you for management, you're known for marketing, you're known as a legend in building up the hygiene department, but I want to start with management, because when I'm reading the boards on Dentaltown or I'm talking to any dentist and I say, "What keeps you up at night? What's your biggest problem? If you could solve one thing what would it be?" It's always the staff. It's always the staff.
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They never say, "What sealer are you using?" They never say, "Hey, do you use direct mail," or "Are you on Facebook?" If something makes them nauseous and they just want to throw up or quit, it's always staff. What advice would you give my homies listening to this to where they can lead their staff, or deal more functionally with their staff, and not get so worked up and sick and nauseous? Some of these dentists don't have to fire staff. They almost want to quit. They don't even want to go in there to fire them. It's horrible for so many people. What advice would you give them?
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Cathy:
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Well, first of all, number one of course, you're right on the money with that. In fact, I did a survey of 3,000 dental professionals, all aspects of dentistry, all states, and the number 1 source of stress, just exactly what you just said, the number 1 source of stress ... I was doing a survey and a research project on stress in dentistry, and the number 1 source of stress was team issues: Conflict among team members, not having team members who are performing well, losing a good team member. Yeah, you're right. It wasn't the dentistry. It wasn't the patients. Sometimes their business systems are not functioning well and that can cause them a lot of stress, but it's team.
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The first thing is that, in my opinion, the first thing doctors have to decide is, "What do I want in my practice?" Get that vision in their own mind's eye, and then they need to look at mentors like you or me, or many others to even develop an idea of what they want in their practice. Hopefully, if they want a team of professionals that are going to work cohesively together, and be on the same wavelength as the dentist and be on that same path ... My definition in fact, of a great dental team, is it's a group of leaders working cohesively toward a common set of goals. I break that one sentence down. I think everybody on the team is a leader, not just the dentist, so I want people on my team that are leaders, that buy into the vision of our practice, that live, and walk and talk our mission, our purpose.
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What are we doing here and why, and that are entrepreneurial enough themselves that they want to get better. I don't want any 8 to 5'ers. I don't want somebody who constantly blames another person for something that doesn't go wrong. Blame in the workplace is toxic. The first thing I think a dentist needs to do is just figure out what he or she wants to do. Figure it out, and maybe again, as I said, get some mentoring about what can a dental team look like. They need to learn how to hire, and here's another huge missing element in almost every practice. The operative word there is almost, but most doctors will hire someone because they happen to have been in dentistry a long time. That doesn't necessarily mean this is a good person who brings to the table what they want.
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I want a dentist to identify what's the job position. What does this person need to do? If I were looking at the ideal, how this person would perform, what does that look like? What are the end results I want? What kind of personality? What kind of characteristics? Then I would look for that. I'd rather somebody hire slow and hire right. Then, what I started to allude to, is one of the weakest areas in most practices is the training protocol. People just throw somebody into the fire and say, "Hey, good luck. Figure it out." The systems may not necessarily be working well anyway, and they throw somebody in and either the person doesn't have the wherewithal to clean up the systems, or they don't know how the systems are working and so they just do what they know to do, and chaos leads to more chaos.
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I'd say the training and what I call the orientation period for a team member, and their integration into the practice, is usually very weak. If doctors would spend the time, money, energy, and effort to really hire right and integrate a person correctly, and do an ongoing, forever evaluation of that person's progress and their development, then they're going to probably have a pretty good team. The study of communication skills is also a huge ongoing part of anybody's life. There's never a day any of us, and I include myself, will ever know enough about communication. If relationships break down, it's often from misunderstandings, so keeping those lines of communication open and having regular evaluations.
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A lot of doctors will say to me, "Oh, Cathy. I don't give feedback. My team members don't need feedback. If I don't tell her she's not doing a good job, then she should just know she is doing a good job." Well, nothing could be further from the truth. The truth of the matter is no reinforcement is connoted by a human being as negative reinforcement, so people do need to know if they're on the path. They do need to know if they're doing a good job, and they want to know. Most people want to know if they're not performing as well as they could, and then be given a chance to do even better. Not everybody, but most people do. I would say those are some of the criteria: The hiring, the integration and orientation, and then the ongoing feedback.
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One of the things that the knowledge worker ... Peter Drucker calls people in the workplace today knowledge workers, and he says the knowledge worker of today wants continuous education, so a big question I would ask in an interview, "Does it interest you to continue your education, to have an opportunity to learn more, to go to courses, to have in-office courses, to study together to get better?" A lot of people know how to interview, and the answer to that's probably going to be yes, but I want to ask that. I want to know if someone has an interest in being better tomorrow than they are today.
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Howard:
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I'm going to ask you the longest, weirdest question, and since you're a PhD at this, hopefully you can [answer 00:11:55] my question, but I see all these posts on Dentaltown, and it starts out with some of the younger girls will say, "Well, staff reacts differently to me because I'm a woman," versus, "I bought my practice from Charlie, and if Charlie said do this, they would. I bought the practice, I say this and they don't." I don't see it as a male/female thing because I have 53-year old classmates from UMKC, like Stephanie [Caramata 00:12:23], who's an excellent operator. She has none of these issues, and I almost think it's not a boy/girl. I think it's the difference between ...
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I mean, we have dentists right now practicing that are from the greatest generation, the baby boomers, the generation X and the millennials. I sometimes think that our generation had more defined lines between boss/employee. I see them kind of blurring the lines. They go to Happy Hour and they get drunk. They post pictures on Facebook that you just wouldn't have done with your team.
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My question is this. I can't answer it because I'm a man. You're a woman. Do women have different leadership issues when they're leading an all-female staff versus a man leading an all-female staff? The follow-up question is do you see different leadership styles between the greatest generation, the baby boomers, the generation X, the millennials? Do you think the younger kids are creating some of their problems by their leadership style that their dad wouldn't have done? Is that enough questions for one question? How many question marks did I get in there? 28?
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Cathy:
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You know what? It's great, because you hit so many of the current, and I would say relevant issues. Let me address the male/female. Howard, I do believe there are some differences between the female dentist, whether it's an all-female staff or not. I do think there are some differences between the male and the female dentist in how they are functioning as a leader, owner/doctor/leader, not better or worse. Let me make that point. Not better or worse, just some differences. Now, that's kind of going into it. Oftentimes we'll see, at the outset, the early period, someone either buying a practice and coming in to a practice, where perhaps a male doctor has owned the practice and now a female owns it, or someone coming out and starting a practice, which doesn't happen very often.
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But if they handle this correctly or handle it well, there ends up being no difference. Here's what has to happen. I want these open lines of communication, or we can call it open channels of communication. I want those established between any dentist and his or her team, but I think it's imperative that the female dentist, not necessarily ... This would be true of the male dentist, too, not necessarily, I'm going to use the word wallow, wallow in a lot of the issues that are non-practice related. Now, I'm not saying don't be friends with your team. My husband John was very good friends with his team. He loved these people, took care of them, nurtured them. He isn't practicing anymore, but they're still in his life.
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These people were friends, but there was still a line of ... I'm going to call it a line of demarcation. He was the owner. He was the owner, he was the dentist. He wanted to include them in decisions, there was open discussions, we cared about what people thought, but ultimately he was the bottom line, and that was very clear. This sounds like a silly thing, but I want my female dentists to dress differently than their clinical team. I don't want the female dentist coming to work in the same scrubs as the rest of the team. She's the dentist. I want her to be dressed like a dentist. I want her to look like a dentist. I want her to behave like a doctor, and I think there needs to be a line of separation.
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When there is discussions, the female dentist needs to be very clear on the parameters within which behaviors exist in her practice, what is acceptable, what isn't. Very clear as a leader about these are the systems we're going to be using and this is why, and let that team see her stand behind those systems, even if somebody comes in and says, "Oh, I think we could do it a different way," or, "This doesn't seem to be working," or, "I used to do it this way. It seems to be better." If this is what she wants to do, and believes this is what she needs to do, she needs to stand firm on that and not be overridden necessarily. I'm not saying not inclusive, but I'm saying don't be overridden.
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I think there are some differences. Now, everything that I just said would be applicable to a male also, so there's very little differences. Some of the very best practices we work with, where they have some of the very best leaders, are female. We don't see a lot of differences anymore, not so much as what perhaps we used to. Now, in terms of the generations. I did quite a bit of study on the generational differences when I was doing my research, because it's here, and I do think there is a difference in the generations. I would not say better or worse. I'm just going to say a difference. I'm a baby boomer, and my father was a traditionalist. He's the greatest generation, World War II veteran, a Marine, so I grew up with that.
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There were very stringent, but I would also say healthy lines of demarcation for behaviors, what was acceptable, what wasn't, and integrity ruled all things. As the generations have altered, we've seen differences. There was, and in some cases still tends to be, a desire on the part of the younger dentists to be more friendly. As you said, go out and drunk with people, party with people, just not come across as a leader, but as a pal. Again, it's a fine line to walk, but it's hard for the pal who's gone out the night before and been drunk with them to come in today and say, "That is an unacceptable impression. Let's do this again. You didn't give me the right materials," whatever. It's hard to walk those 2 paths.
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Then, we all hear about the difference in work ethic of the current generations versus historical. The research says ... I'm not sure I agree with this necessarily, but the research says ... I'd be interested in your take on this. The research says pretty dogmatically that it's not a difference in work ethic. It's a different in work style, that the younger generations don't want to work as much. They saw their parents working really, really hard, earning money, paying for the kids' college, doing all the things they needed to do to get to the point that they could retire, and then by then they were worn out and all that stuff. They want to make a lot of money now.
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I was just visiting with one of our established doctors who's just hired an associate, and that associate's going to make more money in his first year out of school than I will ever make in my lifetime, and it doesn't seem to be enough. Are you kidding me? Do some research. Look at what the average dentist in America is making [inaudible 00:19:33]. But they want to make a lot of money, and want to make it quickly, and without putting in necessarily any extra hours to do that. I'm not being critical about that. That's just an observation.
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What the data shows, and again, I'm not sure I have a sense of this quite yet, is that a difference of work ethic, or is it a difference of work style? I have a tendency to believe it's a work style. I see ethics, good ethics, in the young doctors. I don't see a lack of ethics there. Would I like to see a little bit more commitment to high quality versus rapid dentistry, high quality dentistry instead of rapid dentistry? I would. Anyway, I don't know if I answered that question, Howard, as fully as you'd like me to, or I left out part of it.
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Howard:
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Well, I think it's true. I don't think I've ever met a young dentist working for his dad, that hasn't told me, "I never want to work as hard as my old man." Look at the birth rates. If you take United States, Japan, and all of Europe, and back out immigration, their populations are shrinking. You need 2.3 kids just to keep the herd stable, and you back out immigration, they're all under 2.3. Japan's under 1. It's at 0.9. If Europe didn't have immigrants, and if the United States didn't have immigrants, we'd have a contracting population.
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They want to have less kids, they don't want to work as hard as their mom. Look at my mom. She had 7 kids in 3 days. How many women do you know that want to get married to a Catholic guy and have 7 kids in 3 days? A quarter of them don't want any kids. They want less kids. They're having them a decade later, and they look at their dad, [inaudible 00:21:10] all day, every day until he dropped dead of a heart attack. I would just say they're just far more well-rounded and balanced, and don't want to work.
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Cathy:
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I don't think there's anything wrong with that. I don't think there's anything wrong with people wanting balance earlier in their lives, and enjoying their youth, perhaps, and taking advantage of ... Making a good living, and being able to spend time with their families, or their significant other, or travel more, whatever it may be. I don't think there's a problem with that either. In fact, I think it's a healthy evolution, that everybody talks about balance in life, but I think the younger generations are saying, "We're not just going to talk about it. We're going to do it." There's some kinds of demands, I'm going to use the word demands, that they're asking of either doctors they're going in with, or expectations of themselves when they go into a practice or buy a practice, whatever it may be, that are different than say the baby boomer generation. But I'm not sure that's a bad thing. Again, I don't really see a difference in the ethics as much as the style.
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Howard:
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I want to switch gears completely now from management to hygiene, because ... I'm going to start with this. I know, you told me 25 years ago, when I was listening to you lecture in Destin, Florida, and I don't know if it's ... I've heard you several times, but a lot of dentists just look at their hygiene department and say, "I don't care if it makes money or loses money, because I don't want to do the cleaning. I'm over here doing crowns and root canals and fillings, and pulling teeth and all that kind of stuff." Is hygiene just a loss leader so that you can be free to do expensive dentistry? Is hygiene just a loss leader, or do you think the hygiene department can and always should make a profit on its own?
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Cathy:
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That's a great question. I truly believe that the hygiene department is the lifeblood of a dental practice. Therefore, I want it to be a profit center. Now, there is no question what you just described is critical, meaning that I don't want the dentists doing the hygienic appointments. Maybe when a doctor's first out and building a practice, sure. There's a point where that may be appropriate. But I want the dentist having a free schedule so that when dentist, restorative or aesthetics, whatever it may be, is available to him or her, I want that person to be able to put that in the schedule. I don't want the doctor's schedule locked up with hygiene.
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Here's a rule of thumb. We want the productivity that's coming out of the hygiene department to be approximately 33% of the total production of the practice. If it's a million dollar practice, I want $333,000 approximately coming out of hygiene. That's all procedures that are produced in the hygiene area. We'd like for about 50 to 60% of the hygienic procedures to be periodontal in nature. It is true, the American Academy of Periodontology and The American Dental Association tells us that approximately 80% of American adults are in some stage of periodontitis. Okay. Then what are we doing maintaining people in a state of disease? We need to have an active, healthy, proven, stable periodontal program.
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Then the other thing that happens is that doctors really think that most of their patients are actively involved in hygiene, and the fact of the matter is that's not true. We analyze every practice before we even ask a doctor to consider having us consult with them. We have data from almost 3,000 practices now. Well, a doctor will say, "Oh, 70% of my patients are actively involved in hygiene." Well, when we analyze that, and we're going to follow the ADA mandates, and I just, in fact, reread this last night, that the ADA does say, and we agree with this, that it's acceptable to allow 2 years of patients in the active files, to remain in the active files, if those people have been in for treatment in the last 2 years.
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Anything past 2 years, if you've made a conscientious effort to contact them, let's not kid ourselves, that's an inactive patient. It doesn't mean they might not come back some day, but they're not active. We want a practice to set a goal of 85 to 90% of the active patient family actively involved in hygiene. Well, the truth of the matter is across the board in the country, it's about 40%. Some practices will do 50, 60, but it's about 40%. If practices could realize that by nurturing that which they already have, and that's their existing patient family, they could build a hygiene department that is exponentially bigger and better than what they have now. That's both through activation of patients, reactivation of patients, and/or non-surgical perio.
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Now, here's another factor, that to me, and it's true in our own practice, it's true in all practices, about 40 to 60% of a doctor's restorative or aesthetic dentistry should come right out of hygiene. We tracked this every day. We tracked how much dentistry we scheduled into John's schedule from our hygienists, and it was thousands, 3 to $5,000 a day, a day, from hygiene. Now, of course, he had done the diagnosis, and hear me well here. This is a question I think every dentist should ask him or herself, and I want them to ask their hygienists this question and then listen. Ask a hygienist, "Okay, how many patients do you see on the average in a day?" Most general practices they're going to say 8. Sometimes you're going to see more if it's assisted hygiene, or whatever.
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But most of them see let's say on the average, 8. Now, here's the 5 questions to ask a hygienist. "How many of those 8 patients either have dentistry diagnosed, but it's not finished yet? That doesn't mean that we don't think that they might finish it some day, but when they walk out of your treatment room on Monday, it's not finished." Hopefully, we all agree that if the doctor diagnosed it, and treatment planned it, then that patient either needs it or wants it, or it wouldn't be in that chart, the patient's record, so are there patients that have dentistry diagnosed but incomplete? The 2nd question is, "Do they have new issues, new areas of concern, since their last appointment? Has something happened? Did they crack a tooth? Did they lose a filling? Is there open margin that they didn't have before?" Whatever it may be.
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Are there new concerns since the last appointment that need to be addressed? The 3rd question is, "Does this person have periodontal concerns that either need to be continued or need to be addressed?" The vast majority of those people, the answer's going to be yes. The 4th question is, "Could some of those 8 people coming through your practice, through your room on Monday, could they benefit from some kind of advanced aesthetic dentistry? Implants, crowns, bridges, inlays, onlays, a new Cerec, whatever it may be? That's a pretty good question.
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The 5th question is, "How many of these 8 people could benefit from some kind of an aesthetic alteration?" Well, if you ask most hygienists, the answer will be anywhere from about half of them, but most of them will say, if you ask those 5 questions, all of them. Okay, great, so that's 8 patients a day, how many days a week are you working? Okay, and how many weeks in the month? How many months in the year? Look at how much dentistry could be coming right out of hygiene. Your question's a very good question. It's a very relevant question. If a doctor really sees the depth and the potential of hygiene, I think he or she will agree, it's the lifeblood of a dental practice.
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Howard:
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True story, I was lifting weights this morning at Life Time with my hygienist, Chris [Hicks 00:28:58], and I asked her if she thought I should whiten my teeth. She said I should lose 50 pounds, get a tan, and wear a wig. That was her answer to aesthetic [dentistry 00:29:08]. Let's stay on hygiene. Do you like paying them hourly? Do you like a bonus system? Does pay influence the hygiene department in your professional opinion?
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Cathy:
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That's been a controversial question throughout time. Yes, I think a hygienist should be paid an hourly wage. Hourly's the fairest of all ways to pay actually, according to our HR people and most HR people. I love bonus. I love for people to feel like they have the lid taken off their salary, that if they do better, if the practice does better, the patients do better, that there's not a lid on their salary, and that if the practice does better, so can they. However, I am not a fan of bonus programs that incentivize one person and not the rest. What I mean, I really like a team bonus program, a team bonus program whereby if the hygiene department does better ...
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That means the whole productivity and therefore collections of the practice is better, that not only does the hygienist make more, but so does the business staff, so does the clinical team, so does the doctor. Because if it weren't for me making the financial arrangement or scheduling the appointment, or confirming the appointment, or filling the void, or answering questions that the patient might not have asked the hygienist, that patient might not have scheduled.
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I really think that everyone has a role in helping people move ahead with treatment. I think everyone has a role in keeping those people on the schedule, so I'm really a big fan of bonus programs. It has to be very carefully aligned. It has to be very carefully set up. Everybody has to be clear about how it works. No funny business, and it has to be a formula that works. It has to be based on collections, because if the money isn't in the bank, the doctor can't pay. But again, I'm in favor of a bonus program that benefits everyone.
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Howard:
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Cathy, you've seen so many dental offices for a quarter of a century, what does an average dental office look like, as far as number of operatories, dentists, collection, number of hygienists, versus what is the 10%? What is attainable? If someone was to contact you, and you can contact Cathy at jamesonmanagement.com. That is Jameson, J-A-M-E-S-O-N management.com. Can they email you, Cathy?
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Cathy:
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Yes, absolutely.
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Howard:
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What's your email? What would be the email?
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Cathy:
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The best would probably be info, I-N-F-O, @jamesonmanagement.com.
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Howard:
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Is it realistic if someone said, "Well, this is what the average dental office does, and I want to be in the top 10%?" Everybody can't be in the top 10%. Someone's got to be the 50%, but what is a reasonable expectation of where the average client is when they call you, and what is achievable down the road five, ten years, if they committed to success?
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Cathy:
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Are you talking about in terms of productivity?
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Howard:
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Well, productivity, number of operatories. When you talk about a hygiene department, should every dentist have 2? Should they all be shooting for 3? Is a 5-operatory office all you need? Do you need 6 chairs, 7 chairs? Because what is the top 10%?
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Cathy:
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I love a practice, and this is going to sound very conservative, and I'm going to give you a caveat around that, I love a practice that has 4 treatment rooms, 2 hygienists and a doctor, with 2 assistants. Now, that's a solo practice.
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Howard:
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That's 6 ... 2 hygienists ...
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Cathy:
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No, 4 - 2 hygienists, 2 ops for the dentist, working with 2 assistants in those 2 ops.
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Howard:
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Okay, so just 4 ops?
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Cathy:
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Yeah. We can have a multi-million dollar practice in a practice like that. Now, if you're moving into more dentists, every dentist needs at least 2 treatment rooms. Then if you're going to have 2 dentists in the practice, I want to maximize how much hygienists that that state will allow. In the state of Oklahoma, let's say, if we had 2 dentists in our practice, I would want 4 treatment rooms for those dentists, 2 per doctor, each doctor with 2 assistants, so we can do expanded functions to the degree that the state will allow, and then I want each dentist to have 2 hygienists. Then as it grows bigger and bigger, it would expand in that way.
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With the vast entrance, and the vast influx of managed care, a lot of doctors are doing more treatment rooms and seeing more patients because of the lower fees, obviously increase in volume is ... The reduced fees is indicating a need to increase the volume, and so we're seeing doctors doing more treatment rooms and seeing more patients. In certain states, where there truly is expanded functions ...
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EFDA is great, in my opinion, because then you can certainly follow this rule of thumb. You want to delegate everything you possibly can to anyone who is qualified or certified according to the laws of the state. We want the dentist to do the things that only a dentist can do. I feel like as the managed care continues to evolve, the states will be, hopefully, it is my hope, that more states will become actively involved in providing good, quality, certified expanded functions capabilities and certifications.
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Howard:
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I want to ask you a very politically incorrect question. These kids are coming out of school, 3, $400,000 in debt. Most of the people giving them a job is in a dental office that's 80 to 85% PPOs. Then the society is telling them, "Well, you can't be a good dentist unless you buy $150,000 CEREC machine, a $100,000 3D CBCT x-ray machine, and a $75,000 laser machine." You can't have everything. Can you have an 85% PPO practice, have $350,000 student loans, and still think it's a good idea to buy a CEREC, a CBCT, and a laser? What do you tell these young kids when their debt sheet is huge and they want to double their student loan debt? If you walk out 350 in debt, and you turn around and buy a laser, a CBCT and a CAD/CAM, you just doubled your dental school debt in a day.
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Cathy:
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Absolutely. There's 2 directions that can go. If a doctor coming out of school is going into a practice that already has that equipment, they're capable of using it, they don't have to buy it, so that's good. If they're going into a practice where they're going in as a partner, or going in and buying a practice, which again is not the norm. About 60% of dentists are going in to a corporate environment as they graduate from school, but they have to look at their debt, and look at their capability of servicing that debt, and manage the debt.
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Hopefully they get great advice from their accountants or advisers, so that any time they buy a piece of equipment or refine their practice, or build on or whatever, if they're adding to their debt, they need to know how much is that going to cost additionally per month, and they need to have a plan of action about how they're going to increase their revenues by that much plus. Otherwise, it's going to dip into their own salary, and/or the capability of servicing debts. The managing of debt in the beginning is going to number 1, give them a better credit rating as time evolves and they're ready to buy a practice or whatever it may be. They don't want to mess up their credit rating right off the bat.
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Actually, John just sent me an article, but I haven't read the whole thing. I just got it this morning, from the ADA, that rates dentists as one of the 3 top lending persons because of the high salary that they make and their integrity, and their willingness and ability to service the debt. It was physicians and dentists and ... I can't remember the other one, but dentists are right up there in terms of a desirable person to lend to from the financial entities.
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But the ADA also tells us that financial stress is the largest detriment to a dental family, marriages, of any of the other stresses. While there's a desire to get all the big, new, beautiful equipment, and that does help people do great dentistry. I'd love all of it. It has to come at a time when the increased productivity can service the debt without that taking away from the doctor's ability to either service debts and/or take money home. Now, the debts the kids are coming out of school with are just huge, and it's frightening. It's frightening to them.
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Howard:
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Cathy, you've had huge books in dentistry over the years. Your book, Success Strategies for the Aesthetic Dental Practice was an international bestseller forever. You've got a new book, Creating a Healthy Work Environment, based on your doctoral work in leadership, there it is right there. Where do they order these books? On your website? On Amazon? Where do you recommend?
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Cathy:
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Get it right from us.
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Howard:
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At jamesonmanagement.com?
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Cathy:
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Jamesonmanagement.com. You can go our website and we have a catalog right there online. If you go to jamesonmanagement.com, they can order the book there, and Howard, I'm very proud of this book, and I appreciate you reading it already. I appreciate that. This is an accumulation of my experience over 25 years, and it's the doctoral work. It's called Creating a Healthy Work Environment because it's all about the leadership principles that I truly believe are instrumental in helping people enjoy their work, to find fulfillment in the profession, to not burn out, to really nurture their team members to be happy with the people that they work with, and to make a lot of money.
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All that makes sense. That's not necessarily the norm out there. One thing I'd like to go back to Howard, and this relates to the book as well, I have a section on hiring. I have a section on orientation and integration of new people, and then how to nurture those relationships. I also have a section in there on if there are problems between team members or between the doctor and team members or whatever, how do you handle those conflicts in a constructive way? I believe most situations can be resolved. We've just never been taught how to do that.
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Again, if I've got somebody on my team that I really like, I really care about, I really believe has talent and capability, I want to nurture that relationship. Does that mean we're never going to have problems? Absolutely not. We're human beings. If we have problems, I want to learn how to address that and solve it, and be stronger on the other side. But sometimes if that isn't resolvable, then one of the best things that dentists will do, one of the hardest things any business owner will ever do is let someone go. We take a long time to do that. Sometimes we take too long to do that, but it can be one of the best things that can ever happen for the growth and the health of a business. All of this is included in the book. It's all oriented towards ... [crosstalk 00:40:44].
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Howard:
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What makes me so frustrated is I think of the thousands of hours I spent studying calculus and physics, and the periodic table, and never have used it for 1 minute my entire life, and everything I needed to know, like what you're talking about ... I want you to address this. We're coming up on the Super Bowl, and I look at those industries where they have 3 or 4 full-time employee scouts, and when they're trying to fill a quarterback, they have a complete list of every single player that ever played in college.
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They take HR hiring just seriouser than they do the election. Then the dentist needs an assistant, he runs an ad on Craig's List, 2 people drop a resume off, and he hires one of them. I've always thought that they just don't take HR serious. If the assistant quit or gave 2 weeks notice, they're like, "Well, I got to fill this right now, and I ran an ad on Craig's List, and I got 2 people, and I need someone to start next Tuesday, and so you're it." How would you grade HR in dentistry?
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Cathy:
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Is pathetic an appropriate word?
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Howard:
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Yeah.
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Cathy:
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It's just pathetic. Now, are there people out there that can help? Are there entities that do practice good HR? Absolutely. While I say that, is it 100% universal? No. There are great companies in dentistry that do provide HR guidance. Howard, most people, when we first start working with them, don't even have a personnel policy manual, or I'll say, "Do you have a personnel policy manual?" They'll say, "You know what? I think we did that once. Let me go see if I can dig this out from some box in the attic." It's unbelievable to me. Do they have personnel files? No. Are their people aware of the personnel policy manual? No. Do they even know what the [inaudible 00:42:51]? No.
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Then the issue about how do you handle different situations, there's no rhyme or reason why or how things are handled, so people get into a mess. Then this whole thing, as I've mentioned several times, is a whole critical factor of hiring. I know that you've read Jim Collins' work in Good to Great. Well, his research of 20 PhD researchers over a long period of time, they were studying Fortune 500 companies, and they wanted to know what makes these companies tick. They found that about 11 of those Fortune 500 companies went from what they called measurably good to measurably great. Well, a lot did, but only 11 held that there, and some of that's changed over time.
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But at that time of the study that was the way it was. They said, "Oh, well, we thought they had to have a new strategic plan, a new vision," and they said that was not what happened at all. Here's a quote from Mr. Collins' book. He said, "What they did, these companies, was they got the right people on the bus," that's his quote. "They got the wrong people off the bus, and they got the right people in the right seats."
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I would add, as a management person, they have the right people in the right seats, doing things in the right way. I want people to hire slow and hire right. The cost, emotionally and financially, of not having the right people in place, is horrific, and that's what causes people to throw up. You're exactly right. The time, money, energy, effort, to get the HR correct, and to stay on top of that, and to have a resource to go to any time there's questions or issues, can not only help people in a legal way, it also can save a lot of problems down the road.
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Howard:
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Cathy, I want to ask you this, because you're perfect for it, because you're not from Beverly Hills or Manhattan. You're from Davis, Oklahoma. Half the dentists in America are rural, and they always say, "Well, you don't get it. I'm in a town of 5,000. There was only 1 dental assistant in my town who currently lived in my town that was available for a job. It's not like, Howard, you're in Phoenix. You got 3 million people." What do you tell people in rural areas that say, "Well, the reason my assistant and receptionist are not quite right in the head is because I only had a small town of 5,000 to pick from." What do you say to that?
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Cathy:
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Well, John practiced in a town of 2,000 people. We had brick streets and 1 stop light that really didn't even work. What we did, Howard, was we didn't have anybody who had dental experience at all in our community. There was 12 dentists in a 12-mile radius of about 12,000 people, so we didn't have a pool of dental [inaudible 00:45:36]. Hygienists obviously had to be licensed, and we were fortunate to have great hygienists that came and worked with us. But, for assistants and business administrators, we identified what kind of a person do we want on this team? What characteristics, what kind of attitude, what kind of skills do we want them to have?
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We would hire that person and then took it upon ourselves to train them and give them the education they needed, get them certified in everything we could certify those clinical assistants in in the state of Oklahoma. We paid for it, we did whatever it took to get them certified, nurtured them, built them, taught them. We were continuously educating, and those people were stars, stars, and stayed with John for years and years and years. Over his entire career, practicing 30 years, he only had 5 assistants total.
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Howard:
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I always noticed this, also, to those rural dentists. I've seen so many people that you hired, because she's got 10 years experience at a dental office, and she's been on Dentrix the whole time, and I walk up there and say, "How many reports does Dentrix have? Does it have 5, 10, 50, 100?" She has no idea.
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Cathy:
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No clue.
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Howard:
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Then I go hire someone off the street who was a bookkeeper, or who I stole from the desk at a Chase Bank, and I put them in your office, and at the end of the week they know all those answers.
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Cathy:
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One of the best administrators we ever had was a legal secretary, and her attorney, who was a good friend of John's in another town, he was not going to practice anymore for various reasons, and so John went to him and said, "Pat is great, but she's wasting away here. She's got so much talent, so much ability, so much energy. Can I hire her for my practice if she wants to?" He said yes, and we worked it out, and she worked with us, and you're right.
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She learned whatever she needed to learn, and she put out time, energy, effort. You're right. There are so many people, and your Dentrix example is classic, they don't even have the initiative to pick up the book and learn, or pick up the phone and call the trainers. If you're on Dentrix and you can't even tell me how to run an [inaudible 00:47:49] accounts receivable report, stop it people. How do you run a business without the people in your business office knowing how to use your computer software? It's nuts. It's nuts.
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Howard:
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You're also known ... I know a lot of people that use you for marketing.
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Cathy:
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Yes.
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Howard:
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When you think of marketing, the first question I always wonder is when you say to dentists, "What do you think the best marketing is?" They're always going to say something like Facebook, Twitter, but I'm old-school. I always think the best marketing is on your existing patients. There's 7 billion people on Earth. I'd rather focus on the thousand who I've met over the last 28 years, who aren't in my office, than some guy in Cambodia. When you think of marketing, do you think of internal marketing to existing patients, or do you think of external marketing: Billboards, radio, TV, Facebook?
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Cathy:
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I'm going to classify that as external. We want a 70/30 split, Howard, and we really ... Again, I bought and integrated a marketing company into Jameson Management about 12 years ago.
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Howard:
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What's the 70, external or internal?
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Cathy:
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The 70 is internal, the 30 is external, and [inaudible 00:49:06], these marketing experts are awesome. They understand the connection between marketing and management, that these are not 2 separate entities, that these two have to fold in. What I mean by that is, so somebody goes down and spends a bazillion dollars on marketing, and they generate a bazillion new patients. If those new patients are coming into the practice, imagine this as a funnel, coming in the practice as new patients, they're falling out the bottom as fast as they're coming in the top. So what? It's like a vicious cycle, and it wears people out, and it's a waste of time and energy.
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I want people to come into the practice as a new patient, receive a good new patient experience, and then say yes to treatment and stay there. In fact, here's the cycle we want. We want to market well enough that we have the appropriate number of new patients for that practice. We want them to say yes to treatment in healthy numbers, 80% or more, 75, 80% or more is even better. We want them to schedule the appointment and keep it, because they believe in what they're getting ready to receive. They're going to pay for the dentistry willingly. I'm not going to say happily, but willingly. They're going to stay actively involved with us in hygiene, and they're going to refer.
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That 6-step cycle, if a doctor has the vision that every single person that we attract to our practice, we're going to fit in to that 6-step cycle, can ... Call that the raving fan. The person who comes to you, says yes to treatment, schedules and keeps it, pays for it willingly, stays actively involved in hygiene, and refers. We want about 70% of all marketing efforts to be internal, and again, it's nurturing that which you already have, and that's your existing patient family, and then getting referrals from those people that have had a great experience with you. I think that will always be the number 1 source of new patients, about 30%, other.
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Social media is huge. We want a very strong, excellent social media presence, and also the website. The website is where a lot of people are going to seek either a new dentist, or seek information about a dentist they know about or their own dentist. Not only having a great, interactive, beautiful website where that someone that knows what they're doing has developed, but also have strong SEO, search engine optimization, where they are constantly evolving that and making sure that when people are going in and looking, that doctor's name is going to come up on that first page. They have to have the right hit words and et cetera, et cetera.
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But also that website needs to be evolving, so if you have a reason to go back and revisit it, and they need to be encouraging their patient family to go back and revisit, so through your social media, you can encourage people to go to the website, but they're not going to go to the website unless there's ever-changing, ever-evolving new and exciting information there. There are companies that can do that for a doctor. A doctor may say, "Oh, I don't have time to do that." Well, that may be true. Then they need to seek experts to help them with that. Again, yes, social media is here. You need a strong presence, but there's nothing that will ever take the place of personal referral.
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However, and so going back to that, they're going to make sure ... I challenge doctors to do this. Sit down as a team, go through your entire new patient experience or any patient visit. I don't care what kind of patient visit, and ask yourselves what happens from the minute somebody picks up the phone to the time they come in, to the time they ... Listen to and look at, and experience everything that that patient experiences. Ask yourself what is really going well and keep doing more of that. Then ask themselves the more productive question, and that is, "How can we do everything that we're doing a little bit better and stay on that cutting edge?"
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Howard:
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My problem ... When I look at the consulting industry, I think the number 1 problem is all the really successful dentists like myself, we've always used consultants for 25 years, and we're trying to get from a million to 2 million to 3 million. Then I look at all the people that are just drowning, and where you could just be a life changer, and they never raise their hand and get help. I look at the consultants as they always help the people who need the least amount of help, because that's why they're successful.
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They've always their hand up, because they know if they give Cathy a dollar, they're going to make the dollar back and at least 50 cents, and then the person drown- ... I want you to do this. You're talking to several thousand dentists right now. I want you to tell them what you like to fix, how much is it? What are you good at? I want you to paint pictures of these thousands of listeners, they're all commuting to work, where you sit there and say, "If this is your problem, give me this much money, I'll do this." What do you like to fix? What's your ideal dentist/client problem? What's Cathy the best at fixing?
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Cathy:
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That's a good question, and let me go back and say to a question you asked me earlier that I didn't quite answer, and that was how much can a doctor expect as a return on investment from consulting. Our average increase in productivity is 35% within the first year to a year and a half after a doctor works with us. For the practices doing a million ...[crosstalk 00:54:23]
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Howard:
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Yeah, but the problem with that is, the guy who's calling you, they're already doing a million, and they're going to a million, 3 hundred. But the idiot doing 3 hundred thinks he can't afford you.
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Cathy:
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Exactly. I just talked to a young doctor, he's like 40, and he's producing ... He's in a nice area. He's been practicing for 10 years. He's producing $40,000 a month. I'm like, "$40,000 a month doesn't even pay your bills." But yet he doesn't feel like he can afford to consult, so Howard, the first thing we do is we work with the doctor. One of the first things we do right out of the shoot is work with the doctor on leadership, because we know, again, I said at the outset, if the doctor doesn't understand his or her role in leadership, the consultation isn't going to work as well as it can.
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Then we're going to start digging in to, and we're going to evaluate the practice. We're going to start with the area that needs the most attention. Let's say ... A practice that I had a little bit of input with not too long ago in Manhattan, their schedule was ... They didn't have a scheduling system. We started right there with scheduling. They don't have an insurance system in place and they're 90% PPO. She was losing more money per month than she was producing. We had to dig in immediately and get that insurance system set up, and her people trained on how to administer that insurance.
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I think in answer to your question, we try to individualize what we work on based on the immediate needs of the practice, and whatever is going to make the most profound difference for the practice more quickly. That is going to be a combination of systems. Usually the systems that need the biggest issue are scheduling, financing - big issue, always a big issue. Insurance management - huge issue, growing as an issue. Once we get some of those business systems in place, we want to move into hygiene rapidly, and get the hygiene, the management of the hygiene system going well, as well as building a non-surgical perio.
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Throughout every single consult, we want to work with every single person on the team on helping more people say yes to the treatment that the doctor is recommending, and get some of that dentistry out of the charts, into the mouths of the patients. Again, no consultation that we do is exactly like any other consultation, because we have to know who you are, what you want, what your goals are, what your areas of need are, and based on our evaluation also, we're going to come to an agreement on a plan of action that's going to generate substantial money for you rapidly. Most doctors, in fact, another doctor I talked to this week, is producing, every 2 months, he is producing more additional money than he invested with his entire consult with us.
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Howard:
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How much does this cost a month, or how much do you charge?
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Cathy:
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His monthly fee was $3300 a month, and he's producing $15,000 more per month than when we started.
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Howard:
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Does everybody pay the same fee, or is it different? Does it depend on the size of the practice?
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Cathy:
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What he received was the 2-day leader conference, which I teach, monthly support, monthly coaching calls with he and his team, via GoToMeeting or Skype, then for him we did 6 days of in-office coaching, where we actually fly to his practice, work with him, his team, his patients, his facility. Some doctors do 2 days a quarter. He did 6 days plus the leadership. The number of days we work in a practice determines the total investment. Some will be more, some will be less. Then he was a solo practice, so that fee was what he paid for a solo doctor doing 6 days in-office consulting.
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Howard:
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What I want to tell you homies is that in a small dental cottage industry ... Dentaltown, the website has 210,000 members. You can't survive in this industry for 25 years unless you're doing something productive and helping people. If every client Cathy had lost money, she would have gone bankrupt 24 years ago, and I just can't stress enough ... Take one of my buddies, Jerome Smith. I don't know of an office better than that. He's had 10 different consultants in the last 20 years, and that's how they get to a perfect office.
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They always are humble, they always have their hand up, and they always know a consultant is a return on investment. I don't think I've ever had a consultant where I didn't learn a major pearl that paid for itself threefold, and my 28-year journey has just ... All kinds of consultants. Cathy, I just want to say I think you're the luckiest woman in the world, because the coolest dentist I've ever met on life was your husband, John. He has got to be the coolest good ol' boy dentist from Oklahoma, and that's where Brad Pitt's from too, isn't he? Brad Pitt's from Shawnee, Oklahoma, isn't he?
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Cathy:
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You know, I'm embarrassed I can't tell you that. I don't know.
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Howard:
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Yeah, yeah, Brad Pitt, and it's funny because I met his dental office that used to work with him. They said he was also the best good ol' boy, just the best good ol' Oklahoma boy they had ever met. But your husband, he's just got to be the greatest guy in the world.
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Cathy:
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I have to agree, Howard. He's the nicest human being I've ever known. He's nice to all people all the time, no matter what.
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Howard:
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I'd like to get him on a podcast. Do you think he'd ever do this?
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Cathy:
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Oh, yes. He would do that, and you'd have so much fun.
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Howard:
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Tell him it'd be the first time we ever talked for an hour where we weren't sitting at a bar having a beer. Maybe we'll just each drink a beer on Skype together. We'll just ...
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Cathy:
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Nobody would care. You might as well.
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Howard:
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What I like ... I don't know if it's because I'm from Kansas or whatever, but I just always feel like the consultants like you guys in the Midwest, you just keep it real. It's real advice that works, and it doesn't matter where you are, whereas some business models only work in Beverly Hills and Manhattan and Key Biscayne. I think 90% of America is more like how you do it. You know what I mean?
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Cathy:
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I think, Howard, the fact that we did it, we built a practice together, we figured out those systems together ... We have had the high roads and the low roads, and we've learned how to work through those, so the practicality of the management reflects the fact that it's not theory, although I've done a lot of research and a lot of study. It's based on being in the trenches and doing it every day for 30 years.
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Howard:
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How much does your book cost on jamesonmanagement.com, and should they get the new one, Creating a Healthy Work Environment, or should they also get the last one, Success Strategies for the Aesthetic Dental Practice?
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Cathy:
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Okay, well the Success Strategies, if somebody buys that book, which is published by Quintessence. I'm very proud of that. It is a textbook on how to manage a practice, and it's got the major systems of dental practice lined out so that if somebody reads that and studies that as a team, it's even got how-tos at the end of every chapter. If they read that book and put it into action, it's worth millions, I promise you. There's the practicality of that. The Creating a Healthy Work Environment is leadership, teamwork, how to function more effectively as people, really striving to build a great practice. Buy them both.
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Howard:
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Buy them both, and I'm just curious, did you renew John's lease for 2016? Are you going to keep him another year?
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Cathy:
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You know what? I am going to keep him for another year.
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Howard:
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All right. Tell him he's a lucky man. Cathy, thank you so much for spending an hour with me today.
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Cathy:
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I loved it.
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Howard:
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All right. Thanks, buddy.
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