Podcast: Jennifer de St. George on business options for dentists

Hello and welcome to Ascent Dental Radio. A program dedicated to the balance between the clinical aspect of health care and the business of health care. And now here is your host, Dr. Kevin Coughlin.

Kevin: Welcome. You’re listening to Ascent Dental Radio. My name is Dr. Kevin Coughlin and I’d like to just give a notice of thanks to Mr. Doug Foresta. His company, Stand Out and Be Heard, has been producing and managing this podcast now for several months. I’m proud today to introduce to you Mrs. Jennifer de St. George. I’ve had the pleasure of chatting with Jennifer over the last several months, and in particular, a variety of subjects.

But mostly, the independence and the options that dentists now have. Perhaps one of the most significant changes is the advent of corporate dentistry, or what more properly would be referred to as managed service organizations and dental service organizations.

Anyone who has followed practice management, anyone who has been involved in the field of dentistry will be familiar with Jennifer de St. George’s background and accolades. She is one of the leading practice management speakers. And she is an authority in building teams and providing perhaps most importantly, education, team work and the development of a dental practice to suit the current goals and necessities that are available to today’s dental force.

Without any further ado, I’d like to introduce Jenny de St. George. And as always, these podcast are brought to provide the dental profession with the best in these areas and other areas. And I can’t thank you enough, Jenny, for taking the time to speak to me today about what’s new and what’s going on in the dental profession and how perhaps, between the both of us, we can shade some information to a variety of different topics. Jenny, thank you so much for joining me today.

Jenny: Kevin, it is absolutely my pleasure. I am going to, I’m afraid, date myself a little bit. When I first into dentistry almost four decades ago with my then current husband after he graduated from dental school, we opened our independent practice. And along with about 97 percent of graduating dentists at that time, which would be in the late 60s, about 97 percent of dentists graduating went into solo practice.

They took some money from the bank, in our case it was a whole whooping $25,000, to start four treatment rooms in 770 square feet. About three percent went to the military, postgraduate and once in a while, went into an associateship. So really the decisions that Edmond was making and the dentists at that time was not even a decision they had to make. It was a given.

When we went to crack a bank to get our loan to equip and open and finish the practice because the building was not completely finished, we had to do the last construction, the bank manager as he gave us $25,000 — and by the way, the only collateral we had, two wedding rings, a used VW that Edmond bought going through dental school and a DDS degree. And the bank manager looked at us and said, “We’ve never had a bankrupt dentist yet in the state of California, you will do nothing but succeed.”

Fast forward to today, 2017, and historically I think that has changed to maybe — and I’m going to exaggerate a little bit — perhaps 97 percent of graduating dentists are now looking for some sort of relationship where they don’t have to go out and start what we would call in England a scratch practice. And maybe three percent take that huge leap of faith, put their name on the door, open the door as we did, and just pray that somebody walks through the door.

I know it’s beginning to turn. I was at a meeting recently in San Francisco and I ran into a vendor from Wells Fargo who’s worked in dentistry for actually as long as I’ve been. He remembered me, I didn’t remember him. And we sat and chatted and he said that the market — and I can obviously only talk for California — he said is changing and he’s beginning to see more and more doctors graduating beginning to consider the potential of setting up an independent practice.

Either way, I think that Kevin your goal and my goal is to help in any way we can, the professional make an educated decision. So if they decide to join an organization or they make that commitment to go solo, they do it with, to the best of their ability, all the facts that they can get and not just make a blind emotional decision which I fear that many of them do.

Kevin: I can’t agree with you more, Jenny. I do teach at Tufts School of Dental Medicine in Boston, Massachusetts and the focus of my course is part of a practice management curriculum. Which now is mandated basically through almost all 60 dental schools in the United States to provide a business background and try to improve the business acumen of these young graduates so that they’ve been given the tools to make informed decisions about what works for their particular wants and needs.

So one of the reasons I was interested in bringing Jenny on to our podcast is dentists look for experts. They are looking for information and knowledge. Because unfortunately, most of us have a very strong science background, but we have a very weak background in business. And today, we’re surrounded by significant debt, significant challenges and it’s up to us to provide tools and information to guide these graduates or any particular part of your career whether you’re in mid career or in the twilight of your career, to make informed decisions.

Jenny, in your professional background, what would you consider would be the greatest opportunities, potentially the greatest threats to the profession as you see it? And you’ve traveled all over the world speaking and I believe you’ve been to five continents. What is your feedback from the people who are participating in your programs, reading your books, listening to your CDs? What do you see as their biggest opportunities and threats?

Jenny: I think it’s very important for your listeners to know I do not come from a clinical background. I came into dentistry through marrying Edmond, so I feel like I went through dental school. I feel I graduated as a dentist, but I did not.

When Edmond graduated out of the last year of what was known as P&S in San Francisco, College of Physicians and Surgeons, that was the last year before they moved the school and it became the University of the Pacific. Edmond and his class and the classes before him used to tell me that there was virtually nothing that would walk into their practice on the first day that they did not have the confidence to know how to handle.

Edmond told me he chose to be a GP because he liked the stimulation and the challenge of never knowing what kind of patient was walking through the door. He just didn’t want to go into a specialty practice where he was limited to a specific amount of procedures. So his confidence was so high that he could barely wait for the next patient to come through as an emergency.

Today, and this is just third party feedback, I am wondering if today’s graduating dentists have the same confidence and they have the same skills. I’m going into my memory bank, I think Edmond, I want to say, he made 35 dentures off the top of my head. I do know that when he delivered a new set of dentures, that the patient could not get it out. The fit was so good. He had so much confidence.

And so the most important it would seem to me to say as a non-clinician is to do whatever you need to do to get your clinical expertise to the level that you are confident and comfortable with yourself.

And I think as a number one, therefore, if you have that confidence, the second decision is where to take that confidence and expertise becomes a little easier. I sometimes wonder if the youngest dentists graduating lean towards going into a management service organization because they perceive that perhaps they still need to get more experience or more expertise.

Which in a way, he’s almost made the decisions for him or her. I don’t know how you feel about that comment because you and I have not discussed it and I appreciate I am a non-dentist making it, but it would seem to me that expertise is what the profession is all about.

Kevin: I can tell you that from my perspective, a number of factors are taking place today. One, many of the young graduates are limited in their exposure and in their clinical skills today, much different than it was 30 and 40 years ago and that’s because of the rise of specialization.

Today, that graduating student, that third or fourth year student is many times taking patients and these patients that require specific clinical care are referred to the post-grad departments, whether that’s endodontics, periodontics, pediatrics, oral and maxillofacial surgery, public health. The list goes on and on and the nine specific areas of specialization.

So unfortunately, and this is a generalization in my part based on 34 years of clinical experience, not only my own business but teaching, that many times these young men and women — and I shouldn’t use the term young, but recent graduates — may be lacking the experience that your husband had three and four decades ago.

I don’t see that changing and my feedback from my students are, “Dr. Coughlin, I just need a couple more years of working anywhere I can to get my skills and confidence levels up,” where your husband’s confidence levels are because of perhaps additional clinical training.

I always tell the students, and perhaps you can comment on this, I always say you would never marry someone just to be married. And I don’t think you should take a job just to take a job. I think you should take a job that you’re passionate about and a location with a support team that you’re enthusiastic about. And it’s up to you to get that additional training.

Because from a purely financial standpoint, since the bulk of our profession is still general dentist, I cannot emphasize what you mentioned earlier in this podcast, you have to get training in the nine areas of specialization.

And although you may not be a complete expert in all areas, with adequate training and mentoring, you should be able to do 80 or 90 percent of the treatment that walk through your doors to improve your bottom line, keep yourself technically and didactically stimulated, and also offer more services for your patients than just simply a radiograph and a referral path. What would be your comments on that, Jen?

Jenny: Number one, I could not agree more because if the graduating dentist does not follow your advice, they will end up by rather being like a traffic cop at an intersection. A patient comes into the GP practice and like the interns doing medical, they pass them on to somebody else. They’re just like the gatekeeper and I wouldn’t have thought most dentists would go to school to become a gatekeeper.

Kevin: I couldn’t agree more. One of the things, Jen, that I’ve actually seen and are part of my presentation, is it’s almost like a dating game. I have them fill out a series of 20 questions and those questions are basically personality questions that determine do you have the entrepreneurialship, do you have the drive and the desire to be a solo practitioner, to be in a group practice or to be guided towards corporate dentistry.

And it’s interesting over the last ten years, typically the groups that I’m speaking to are between 50 and 100 students. And more and more, each year, I see them gravitating towards corporate entities, sometimes because what we touched on is lack of clinical and business skills, but more and more, I see two incomes.

Many times one professional is marrying another professional and they say, “Dr. Coughlin, I’m looking for a different life balance. I’m interested in pursuing other aspirations and goals and I don’t know if I want the trials, the tribulations and the potential stresses of being a small business owner.”

And as I’ve said to you in private, I think our job as educators is not to necessarily put our views on people, but to explain to them the risks, the strengths, the opportunities, the threats and the decision-making process so that they don’t make a mistake.

Because personally, being independent, being in control of your clinical and business, to me is hugely important. But sometimes for other people, they’d rather have other people make those decisions and just focus on the clinical aspect. What would be your thoughts on that?

Jenny: Many years ago, I was interviewed and in fact, interviewed him, a psychologist on entrepreneurship and small businesses. He had worked in the dental field for quite some time and he told me that dentists’ group was the most individualistic of any of the professions. And in his opinion, there were dentists who were brilliant, they could have been heart surgeons or flown to the moon, whatever, but they choose to go into their own practice because they wanted to be in charge. But it takes a personality.

I think that what dentists today who have been practicing for many years, is they realize that 50 or 60 percent of the stress in their practice, maybe more, was not caused by their clinical area, it’s caused by staff and patients.

I joke when I speak from the stage, the ideal dentist if they could wave their magic wand, would let the patient drop off their teeth in the morning, pick up their teeth at the end of the day. The dentist at the dentistry never has to see the patient because it’s the patients and the money and the insurance and the staff that cause the stress, not the dentistry.

So I think that some of the dentists think that by going into a corporation that this stress, as I described it, will disappear, but that is absolutely not true.

And if there’s one practical suggestion I could share with you, Kevin, that I have said from the stage for years, when you are going to interview, whether it’s a DSO, an MSO, to be an associate in a private practice, whatever it is, call up and be a mystery shopper.

Call up and pretend to be a patient and make an appointment for an emergency. Get to the reception room two hours before the interview with the senior doctor or the manager of the group. Watch the staff, watch how they behave to each other, watch how they handle patients.

And if this is a mismanaged rude office where you will do nothing but learn how not to do it, I suggest you make your appointment five minutes and leave. You only want to go where you will be surrounded by the quality in management and communication.

Kevin: Jennifer, how do you feel, what’s the best way for the listeners of this podcast to improve that situation? What are some of the areas if a dentist listening to this podcast says, “You know what, I think I’m doing a good job, but really if I was to be critical of my team, myself, my office, I need improvement,” what would be the best way for them? How do they reach out to get better?

Jenny: The sad thing is we shouldn’t have to ask this question. The sad thing, Kevin, is that in dental schools, patient management, patient-doctor communication and human resources, how to hire and fire and manage, should be part of every program.

In England, a few years ago, they actually took the four-year dental program and made into five years so they could add all this stuff that was not being included in the four-year program.

When I talk to deans of dental schools as I have over the years and I got on my little soapbox about the kind of thing you and I are talking about, the deans tell me that the students are not ready for this kind of information. Yet when you go and talk to the students, they are more than ready and they want it. The deans will say there’s no time in the schedule, the students say you come in at 5:00 in the morning, we will come in.

At the moment, to answer your question, I don’t think there is a structured approach. It’s going to people like me going on to webinars, going to the conventions, but it’s not a systematical approach. I am hoping to get it finished this year, 2017, I would like to start a JdSG Learning Center online where I put up a very basic but the whole program. Because in my opinion, when you learn staff management or you learn how to communicate with patients or how to ask for money, you must always do it in the context of the whole program.

But dentists graduate from dental school and they maybe go to a convention and in theory they could have three speakers who actually say three opposing views on the very same subject. So it can be confusing. It should be part of the school curriculum and it’s not.

Kevin: I couldn’t have said it better myself. Hopefully, with experts in communication, in teaching, in education like yourself, we’ll see an improvement. And if I could give you a little prod, a little push, I will tell you get that program out running because our profession needs it. The better our business is, the better our communication skills are, the higher level of care and service we’ll perform. And I think understanding the independence and the luxury of being independent — I tell the students be careful what you wish for.

Nothing in this world is for nothing. And when someone tells you they’re going to take away all your stress and all your problems, sometimes you’re left with more stress and more problems.

Our goal out there in the practice management field, in the educational field is to provide data and information so that students, the seasoned practitioner, that practitioner getting ready to transition perhaps into a new area of their life, they need these tools and they need this information to make the most informed decision.

I  want to thank Jennifer de St. George so much for her expertise, her knowledge and her time. She’s been doing this for over two decades, actually over three decades, and it has been an actual honor and a privilege to have you on this podcast.

You’ve been listening to Dr. Kevin Coughlin, Ascent Radio, that’s Ascent Dental Radio. And again, my thanks to Mr. Doug Foresta for producing this podcast and it’s Stand Out and Be Heard. Doug, thank you so much for your expertise and I look forward to our next podcast. Thank you listeners very much.