Pearly white profits


Tips from doctors who offer dentistry as demand for other services declines.

Ten years ago many veterinarians reveled in an expanding economy with affluent clients. It was a climate in which practicing veterinary medicine—and building a dental program—may have been easier. Now you're facing a recession, along with increased Internet pharmacy competition, new vaccine protocols, and pressure from better-educated and more demanding clients.

But before you get stuck reminiscing about the good old days, consider the opportunity in front of you. If you can launch a strong dental program now, you may be able to keep your profits from sinking—and position yourself for greatness when the market rebounds. Dr. Jeff Rothstein, MBA, a Veterinary Economics Editorial Advisory Board member and president of Progressive Pet Animal Hospitals and Management Group in Michigan, knows firsthand the effects of the current economy. Michigan has been hurting since the stock market crash in 2000, and many of Dr. Rothstein's clients are directly affected by the ailing American auto market. "I feel like I work for the car companies because they impact us so much," Dr. Rothstein says.

Here's the rub: If he's making dental care work in a tough market, so can you. Use these ideas to improve patients' dental health and push your dental revenue from 2 percent of your profits to 10 percent or more. Here's how.

Check your measuring stick

In the 1990s some practices in the Detroit area experienced growth of 10 percent to 20 percent a year. But that ended for many practices in 2001. "It's not been unusual in the past few years for practices to be down 5 percent or more," Dr. Rothstein says.

So get real about your losses. To start with, Dr. Rothstein says, emphasize the seriousness of this decline to your team. "We shouldn't say, 'We're only down 2 percent and that's not bad,'" he says. If you've been forced to increase your prices when the cost of products and services has increased, your 2 percent decline may be more significant than you think. "Being flat doesn't mean you haven't taken a loss," he says.

The good news is that you can take control by managing your profit centers. "Whatever you're doing, you can do more of," Dr. Rothstein says. "And dental care has a good profit margin."

Make new friends, keep the old

Take a look at the potential market for your dental services. Before you rush out and try to attract 100 more clients for dental procedures, make sure you've evaluated your current client base. "Many of us could be doing a lot more with our current clients," Dr. Rothstein says. "It's about being an advocate for the pet. You and your staff can increase your passion for services you may have previously been ho-hum about—like dental care—and clients will notice."

And it's easier to promote your services to existing clients than to find new ones, says Dr. Scott Linick, FAVD, owner of Plainfield Animal Hospital in South Plainfield, N.J. "Your clients are already familiar with you and appreciate your recommendations," he says. He asks his associates to devote two to five minutes of every 15- to 20-minute office visit to talking about dental care. Many clients schedule a dental procedure immediately.

To be successful in dental work, it's important to let go of any fears. Don't be afraid to make a small investment in better equipment. Don't be afraid to suggest dental care to clients who are already tightening their belts. And don't be afraid of longer procedures that may take more of your time and require a bigger financial investment from clients. All these fears can be overcome.

Educate yourself

Our experts agree that if you're not ready to offer high-quality dental care, it's better to pass on this profit center. High-quality care requires that you and your team learn and create protocols that offer consistent recommendations and care. Dr.?Rothstein outlines three levels of care practices offer.

Level one: Basic dentistry. This is not ideal. At this level you're working without specialized dental equipment and mainly performing dental cleanings and easier extractions. Without dental radiography equipment, some dental disease will go undetected. Much of the work here is performed by technicians, with doctors handling extractions.

Level two: Comprehensive dental care. At this level you're more proactive, and your level of care is closer to that of a typical human dentist. In addition to cleaning teeth, you're also looking for periodontal disease by performing radiography. You're extracting diseased teeth and doing minor repair work. You'll rely on the proper equipment, which includes a high-speed drill and a dental radiography machine. "You can purchase all that for under $10,000, so it's not a huge investment," Dr. Rothstein says. "When you buy the right equipment, inevitably your associates and technicians will enjoy doing dental procedures a lot more." The key, he says, is emphasizing how the equipment will make team members' jobs easier and faster, which will eliminate most of their resistance to offering the care. (See "Power up your dental services" in the related links to learn how these tools can increase your practice's revenue.)

Level three: Advanced dental care. This type of service involves crowns, fillings, and reconstructive surgery. "Unless you have a strong interest, you don't need to be involved at this level," Dr. Rothstein says. You can refer more complicated cases to a specialist in your region.

Our experts agree that many practices offering level one care can expand to level two and offer comprehensive dental care. Most of your work here will involve cleaning the teeth, charting the teeth, and performing dental radiography. After all, they say, anything less isn't good medicine, so it's not good business either.

Dr. Kate Knutson, owner of Pet Crossing Animal Hospital and Dental Clinic in Bloomington, Minn., notes that teeth are a renewable resource for a veterinary practice. "You don't do a neuter more than once, but every year teeth need to be cleaned, charted, and radiographed," she says. In fact, Dr. Knutson has seen many clients migrate to her clinic because they were frustrated by inadequate dental care at other practices. Those hospitals not only failed to offer complete care, they didn't refer clients elsewhere for it either. "If I had an 'A' client who was spending thousands of dollars with me, I wouldn't want to lose them," she says. "I'd refer them to someone who did something better than I do it. I know they'd come back."

Not convinced? Consider this. Dr. Knutson recently removed 20 teeth from a new client's dog. The client was "very angry" with her previous veterinarian, Dr. Knutson says, because it was clear her dog's oral health had suffered. And here's the kicker: This client had never declined a product or service that her last veterinarian had recommended.

Once you're committed to comprehensive dental care, take your team to a seminar where everyone learns to chart, clean, and radiograph teeth. Then, Dr. Knutson says, you can start offering routine dental services and refer more complicated cases. As you receive more training, you can treat according to your current expertise and comfort level. "When you become proficient at these procedures, you keep more and more in house," she says.

Create a protocol

This can be a difficult step, Dr. Knutson says. Depending on your practice's culture, you might have one strong leader who dictates all medical decisions or more of a group leadership dynamic. "If you're in a dictatorship, it's easy," she says. "You as a leader decide the protocols and teach them to the staff." If you operate as a collective, however, it's a good idea to give everyone homework. Different team members can learn about different topics—radiographs, cleanings, educating clients—and then you'll all meet to set your protocols.

Jazz up your team

Everyone at the practice must be convinced of the need for dental care and be enthusiastic about it, from the receptionist to the technician to kennel personnel, Dr. Linick says. "This is how I built my dental program in normal times, and it holds true twice as much in tough economic times," he says.

Once you have your leaders on board and your team educated, you can relax and do what you do best—which is practice medicine, Dr. Knutson says. A well-trained team will take the lead in the chain of client communication. For example: Let's say a receptionist takes a call from a distressed client who notices a retained deciduous tooth. The technician has already taught the client to recognize this condition. The receptionist, drawing on her training, tells the client that the pet's condition requires an immediate visit, and the client schedules the appointment. During the visit, the team communicates at every step about the importance of the extraction, so that by the time the doctor examines the tooth and schedules the procedure, the client understands the problem thoroughly. The doctor needs to focus only on the technical aspects of the case.

Helping the team maintain enthusiasm for dental care can be a challenge in the everyday grind of practice, Dr. Linick admits. So he's committed to regular CE to keep team members focused on the goal of improving pets' oral health. Why is this so important? "Say I go into an exam room and tell clients their pet really needs dental care," Dr. Linick says. "And when they go out to schedule an appointment the receptionist says, 'Oh God, Dr. Linick's at it again. Your pet doesn't really need dental care.' The client's getting a mixed message." The key is to educate the whole team to keep them enthused and on board with your message.

Brainstorm ideas together

Dr. Rothstein suggests planning an hourlong team meeting to make a list of the top 10 things you can do to increase the number of dental procedures your practice performs. When his team members brainstormed, they came up with ideas such as using before-and-after photos of patients' teeth, posting color diagrams of periodontal disease stages in the exam room, and creating displays for the waiting area. "Each clinic needs to figure out what works for them," Dr. Rothstein says. "But team members are more likely to buy in if they come up with the ideas."

Network with colleagues

Visit other practices to learn from what they do right—and wrong. Many veterinarians and practice managers love to share their biggest screwups—and these can be your best learning tools as you plan your own program.

As more clinics offer dentistry, the whole profession benefits. "We need to increase the awareness of dentistry until every client knows they need to have this done," Dr. Knutson says. "If every client is compliant, we're all going to be very busy practitioners."

Market your services

If you believe in the importance of pet dental health, it's easier to convince clients. Consider these marketing tips:

> Show before-and-after photos of pets that undergo dental cleaning.

> Place photo albums or displays in your waiting room or exam rooms with dental success photos.

> Give away toothbrush kits with all dental cleanings.

> Throw an open house. Consider offering free dental exams, free dental report cards, or discounts to kick-start your program. Invite attendees to tour your practice, and ask pharmaceutical and food companies to exhibit and distribute samples of dental products.

> Offer to contribute an article in the local newspaper.

> Give lectures at breed clubs, schools, or churches in your area.

Help clients pay

Many clients have less money right now, so they're going to spend less on their pets, right? Wrong. Dr. Rothstein says he's seeing an increased focus on the simpler things in life. And one of the things people value most is their relationship with their pets. For example, Dr. Rothstein saw a regular client before Christmas who brought her cat in for a dental cleaning. When Dr. Rothstein examined her second cat, he recognized that this cat needed a cleaning more than the first. So he recommended a cleaning for the second pet as well. Although it was close to Christmas and the client worried that she'd have to buy fewer presents, she still opted for the care, saying her family loved the cats and she felt obligated to pay for the care her pets needed. "It was heart-wrenching, but it's interesting to see how our clients have been educated about the importance of dental care," Dr. Rothstein says.

You can make paying for dental cleanings and other care easy for clients with a variety of options. For example, Dr. Linick recommends pet insurance for new pets and third-party payment plans for clients who can't pay for the care their pets need immediately. (See "Offer your clients extra credit" for tips on using third-party payment plans.) Dr. Rothstein extends credit, allowing clients to pay for needed care over a few months with an initial deposit and regular scheduled payments.

If you're still thinking your patients won't pay for dental services, think again. "Last year my practice merged with a neighboring practice," Dr. Linick says. "One of the doctors told me, 'My clients won't pay for high-level dental care.' It's absolutely amazing how many of his clients are happy they're being offered this service—and they do in fact pay for it."

It may sound a little strange, but many veterinarians say this is the perfect economic climate to launch a dental program. "We have to dig deep and discover the opportunities out there," Dr. Rothstein says. "Dental care is not a panacea, but it's a good time to do a good job with it."

A few additional tips

Soothe clients' fears

Many clients have heard horror stories about a pet that went in for dental care at another hospital and died. So Dr. Scott Linick, FAVD, says you must overcome clients' fears by practicing the highest-quality medicine possible. "This means performing preanesthetic blood testing and preanesthetic ECGs, as well as monitoring and giving IV fluids during the procedure," he says. "It also means providing pain control with the appropriate multimodal pain reduction."

Remember receptionists

The veterinary receptionist is the most important person clients interact with when they come to a practice, says Dr. Scott Linick, FAVD. "Receptionists are the first people clients see and the last people they see," he says. "A good reception team will review the pet's record before the visit and be prepared to recommend the necessary services, such as dentistry."

Educate clients

Need a little extra help educating your clients and your team about dental health? See the related links section below for tools you can use.

Portia Stewart is the former editor of Firstline and a freelance writer in Lenexa, Kan. Send comments to

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