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Paul A. Homoly, DDS

Dr. Paul Homoly practiced restorative dentistry in Charlotte, N.C. for twenty years. He is one of the rare practitioners who excels at the clinical and managerial aspects of dentistry. Dr. Homoly presents his work internationally and is active on the national teaching level and designs business and marketing plans for general dentists and specialists. He is author of Dentists: An Endangered Species and is a frequent contributor to dental trade journals. He can be reached by telephone 704-527-6600 and e-mail

An Endangered Species

Practical survival strategies for fee-for-service care

There are two emerging and competing trends in dentistry. First, reconstructive and cosmetic technical advances have brought ever-escalating dental fees. Second, the health care business environment is collapsing under the weight of managed care, increasing overhead and stress.

The technical advances in dentistry have out-paced the willingness of the dental insurance industry to pay for them and the dentist's ability to sell them. Thus, contemporary fee-for- service dentistry is fighting to survive in a hostile business environment.

Dentists: An Endangered Species is a program that offers what every fee-for-service dentist wants - a practice model that will endure in the changing business climate, to be able to provide care outside the limitations of dental insurance, to enjoy a predictable collections policy, to take the stress out of selling, and to have a practice philosophy that makes a career in dentistry survivable.

For information on how to schedule Dr. Homoly's program in your area call 800-294- 9370, or e-mail

Free by fax.
Want the baker's dozen (the dentist's dozen!) of great ways to build early value before your recommend care? Just fax your letterhead with your name with the words "DENTIST'S DOZEN" to 704-843-0753. Parts of this article were excerpted from Dr. Homoly's new book, Dentists: An Endangered Species.

Learn Practice Development at
Your Bakery

Why does the baker add one extra donut to your dozen to total thirteen -- the bakers dozen? Because he knows it's easier to give away one donut than to find another customer.

When you really understand the baker's dozen, you'll understand how to build your practice of dentistry and to better manage relationships.

What does the extra donut represent? It represents an unexpected positive experience. It represents going the extra mile -- getting more than your money's worth. In a word, the donut is value. The baker adds value (one donut) to your purchase -- a value added experience.

Last year I gave a program in White Plains, New York. My flight landed late and it was about midnight when I walked into baggage claim. Standing there to meet me was a man dressed in a chauffeur's uniform holding a sign with my name. He grabbed my bats and ushered me outside into a stretch Lincoln Town Car limousine. Soft music played. Snow flurries piled snow on the split railed fences. Soon, we arrived at the Rye Town Hilton. By now it was 12:45 and I was just about asleep in the back seat.

The driver carried my bags. I was slow to get to the lobby. It was empty -- the only one there was the receptionist who I can only describe as an angel. She smiled as I approached and said, "Hello Paul, we've been waiting for you." She handed me my room key. "You're all checked in. All you have to do is walk a few steps down that hall and your room is ready."

As I walked to my room I thought, "How did she know my name? How did she do that?" Of course -- the limo driver. And how about that greeting: "We've been waiting for you." That was nice.

I've traveled often in my career, and I can't tell you how many times I've slid the key into the slot and opened the door into a pitch black hotel room, worrying maybe this is the time the guy with the hook is standing behind the door. When I opened the door this time, a small colonial brass lamp beside the bed was on. I walked in and heard soft classical music playing on the clock radio. The bed was turned down with a gold-foiled chocolate placed on the pillow. I thought -- "Mom, are you here Mom?"

What does it cost the baker to add one more donut? Very little, but it adds a lot.

What did it cost the hotel for the angel receptionist at the front desk to say "We've been waiting for you"? Very little but it made my day.

What did it cost the hotel to have the light on? Next to nothing, but it made me feel welcome and safe.

Let me ask you something. For the patients in your practice, is the light on? Do they get the extra donut? Where is the added value in your practice? What do you do on a consistent basis to create an unexpected positive experience?.

The Timing of Value:
Give before you get

Is there an optimum time to provide value? It's been my experience value offered before treatment recommendations are made enhance their acceptance. Doesn't it make perfect sense to build value early in the relationship to foreshadow the quality of the experience during the treatment phase?

Here's a graph of traditional clinical thinking related to value. I was taught, as were many of you, patient had the greatest sense of appreciation and value after treatment was completed. (Figure #1) Practice management experts told us at the completion of care to have a post treatment consultation with patients and ask for referrals. Do you think patients get burned out on dental care? Do you think the last thing they or any of their friends want to hear about is more dentistry? Waiting to provide value and ask for referrals at the end of care is too late.

A better way to approach value is the entrepreneurial perspective on value -- maximize it as soon as possible. (Figure #2) Early value does three things:

-- enhances the acceptance of
treatment recommendations
-- inspires patient referrals before and
during the treatment process
-- makes for easier long-term
patient management

Treatment plan acceptance is enhanced when patients have actually experienced value in your practice. Dentists who are totally clinically oriented (not value oriented) will argue the greatest value a patient can receive is superior clinical quality. They believe the promise of that quality should be enough for patients to postpone their appetite for value now and wait for it to hit them all at once at the completion of care. Does this sound familiar? Does this work?

The major flaw in this thinking is clinical quality does not represent value. Value is a positive unexpected experience -- getting more than their money's worth. Isn't the patient already paying for clinical quality and isn't it the assumption the work will be good? Saying the quality of your care is value is like the restaurant boasting it's food is digestible. Isn't that universally assumed?

The greatest values in dentistry are found within relationships, not restorations. Quality relationships are easily recognized by the patients and create immediate and overwhelming responses. Plus, thanks to the long history of the doctors and dentists being stereotypically dull, a dentist (and staff) with great people skills is definitely a positive unexpected experience. Creating positive unexpected experiences prior to care being offered will do more for treatment plan acceptance than all your promises of clinical excellence and accolades to quality.

Providing value early gives you more opportunities for patient referrals. Patients are typically more excited and involved with the care before it starts than when it's finished. If you have been reconstructing your patient's mouth for nine months, do you think she and everyone she talks to is tired of hearing about her experiences? If you wait to ask for referrals at the end of treatment, it's already old news. No one cares and the last thing many of her friends want is what your patient just went through. Instead, provide value early and ask for referrals early. My experience has been word-of-mouth is strongest during the treatment process.

Early value makes long-term patient management easier. From the baker who gives the extra donut, we're apt to forgive a smashed eclair. The dental experience is laden with hassles, inconveniences and expense. Early value helps take the sharp edges off some of the normal but unacceptable behaviors and events associated with dentistry. People will forgive us if they know our hearts are in the right place. Early value lets people know we want to serve well and keeps them coming back -- for the extra donut.


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