Business Growth - Endo Mastery

It’s the most endoful time of the year!

The AAE 2023 meeting season is upon us, running from May 3^rd to May 6^th in Chicago. It’s the ultimate endo event of the year with endodontists across the nation gathering for CE and professional development. At this year’s meeting, we are sponsoring the entire Practice Management educational track, plus:

Look for our booth #239! At this year’s meeting, Endo Mastery will have a prominent presence on the exhibit floor. We invite every newsletter subscriber to stop by and say hi. Meet our key team members including Dr. Ace Goerig, Debra Miller (Director of Coaching) and myself. We love to connect (and reconnect) with doctors.
Meet some of our clients! If you’re curious about coaching and how Endo Mastery can help your practice, hang out in our booth lounge and meet some endodontists who are clients. They will be happy to share their experiences and success stories with you.
Hear Dr. Ace Goerig speak! Goerig is presenting twice during this year’s meeting. The first presentation on May 4^th at 11:45 am is “Creating the Lifestyle Practice”. This program is a 1-hour primer for every endodontist who wants better economics and lifestyle. The second presentation on May 5^th at 3:45 pm is “A Step-by-Step Guide to Starting Up and/or Buying a Practice”. This 30-minute program covers essential decision points for doctors and residents planning their entry into private practice ownership.
Get some great deals! To celebrate the AAE meeting, we always offer our lowest tuition rates of the year for registrations in upcoming seminars. This year, we have two eligible events: a 1-day livestream event in June and a 2-day in-person event in September in Orlando. Online registrations for these events at promotional rates will be available later this month (stay tuned for the official announcement) and you can register onsite at our booth as well.
Discover your practice possibilities! Drop by our booth and set up a complimentary one-on-one practice analysis conversation. This is the easiest “first step” towards growing your practice and improving your lifestyle. Find out what is possible for you, whether you are at the beginning, middle or nearing the end of your career.
Learn about our free Endo Career Start program! Last year, we launched our complimentary Career Start program for residents and endodontists transitioning into private practice. This year, we’ve added even more resources and better guidance for doctors choosing their path in private practice endodontics. Come to our booth to learn more or sign up for free. You can also find us at the AAE Career Fair.

Marketing Tip: Bunny Tails

Ever notice how powdered donuts look like bunny tails? Easter is just a few weeks away, wrap powdered donuts or powdered donut holes in individual bags and treat your referring offices. You can deliver bags of donuts in Easter baskets! The free printable shown above is available from Frog Prince Paperie (along with other great marketing and gift bag ideas to browse on their website).

Free bunny tails printable by Paula Biggs at Frog Prince Paperie

Celebrating women in endodontics

Women in dentistry are simply amazing!

According to the ADA Health Policy Institute, just over half of dental school graduates are now women, making dentistry one of the few science-based fields that has parity with the general population. Women represented in the endodontics specialty lag slightly by comparison, comprising about 41% of endodontic residents in the recent 2020-2021 academic year. However, the resident ratio keeps growing year to year, and female endodontists now account for nearly a third of practicing endodontists.

One of the most admirable qualities about women in endodontics is strongly rooted empathy and caring. Lying in a dental chair for a root canal can be very intimidating, and it makes some patients feel very vulnerable. Patients are often more willing to open up about their fears or concerns to a female doctor and feel calmed more quickly.

In addition to female endodontists, there are also many female team members who work in endodontic practices. These women play an essential role in ensuring that patients are warmly welcomed, receive excellent care, and that the practice runs smoothly. From dental assistants to receptionists, female team members are the backbone of many endodontic practices.

Challenges and opportunities

Like many professional women, female endodontists are often juggling multiple responsibilities. Despite some progress being made on the division of household duties in families in recent decades, this is one area that is still far from parity. Women often remain the primary caregiver in the family, the primary organizer of family activities, and the primary doer of household chores even when both partners are working.

These factors don’t change the goal to be successful professionally, but often amplify the need for work/life balance in their vision. It can be particularly challenging for women with young children, who may need to adjust work hours to care for them.

We believe that endodontics is a wonderful profession for women. Women can design and structure their practice life to perfectly meet the needs of their personal and family life. On top of that, endodontic practice owners can be highly productive and profitable on a limited schedule. We’ve helped female clients working full-time grow and reorganize their practices to be able to take more time off while protecting (or even growing) their income.

Of course, some female doctors don’t want to own a practice and prefer to work as an associate. Since associates in Endo Mastery-coached practices are often paid more than the average endodontic practice owner, associate opportunities can be a desirable option for women practitioners, especially in the early years of their family when they want the most flexibility.

Our appreciation

At Endo Mastery, we love working with female endodontists and helping them achieve their vision through practice coaching. This month, we are offering a special promotion for practices with female endodontists. Register using code W33 before the end of March for any Endo Mastery seminar offered this year and receive 33% off tuition.

Maximizing practice value before equity transactions

At some point, every practice owner faces the question of how much their practice is worth? A quick search on Google for dental practice valuation will produce links to articles and websites that talk about methods of valuation such as discounted cash flow, capitalization of earnings, revenue multiples, earnings multiples, summation of assets, market comparisons, etc.

For a lay person in valuation such as the typical practice owner, not much is gained in reviewing the methods and formulas on those websites. Formulas don’t actually determine the value of your practice; a buyer does. A practice is only worth what someone will pay for it, and there are a lot of factors at play. This includes everything from the financial qualifications of the buyer to your reasons for selling in the first place.

A formal practice valuation, even one performed by a valuation expert, only results in a starting point for negotiating a price and a deal. A great price for the seller always means having a great story that the buyer wants. You see this in real estate all the time: two very comparable listings in the same neighborhood, and one gets multiple offers and sells quickly while the other sits on the market for months. Someone (realtor? homeowner?) is telling a better story.

Here are 3 things you can do to tell a better story about the value of your practice:

Boost the financial story

Every practice purchaser is looking at your practice as a business and means to generate profit, and so every valuation method places high importance on the financial health of the practice. Often the revenues or earnings of the past 3 years are considered, usually in a weighted average where the most recent year counts the most.

Typical Endo Mastery-coached practices often get on track to increase revenues by 50% or more within 1 year, which can result in significantly higher profitability and reduced practice debt. That can have a major impact on valuation results. More importantly, it gives you a much stronger story about the potential future revenues of the practice for the negotiation of a deal. Everyone loves a strong growth trend.

Supercharge the marketing story

Most of the value in your practice is in the form of goodwill, which means your relationships with your referrers. When a purchaser buys your practice, they count on (a large majority of) those referral relationships to continue. Typical purchase agreements require you to stay on as an associate for some time to protect and facilitate the transfer of goodwill in those relationships. For a doctor purchase, you might stay for 6 months to a year. For a corporate purchase, you may need to stay up to 5 years to meet various additional requirements (vesting, etc.) of their structured deals in addition to goodwill value.

In either case, strong referral relationships tell a great story and remove the uncertainty from goodwill assessments. As a seller, you want to ensure you have an effective and robust marketing system in place, with careful management of each referrer by your marketing coordinator. This is also part of the process to stimulate economic growth for your financial story.

A powerful marketing system is also the antidote to the kind of buyer who is looking for a practice that doesn’t market effectively, and then uses that fact to highlight uncertainty and negotiate a reduction in the goodwill value. Their logic is that an underperforming and undervalued practice can quickly be stimulated to grow by establishing a better marketing strategy. It’s not a bad strategy because most endodontic practices underperform when it comes to marketing. Don’t be one of them when you sell your practice.

Amplify the expansion story

This final point particularly applies to corporate purchases, which are so commonplace these days. The corporate model allows you to stay on as an associate in your practice and continue to earn an income. But they also value that your practice has the potential for easy expansion with an associate.

Unless you plan to significantly reduce your days (and cases) in the practice, your practice needs to be at a certain size in terms of referral base and economics to support the addition of an associate. At Endo Mastery, we think that practices are ideally ready for expansion when revenues hit around $1.4 to $1.5 million (depending on your fee levels). The closer you get your practice to that number, the more expansion-ready you are and the more valuable your practice will be in a corporate portfolio focused on future growth.

Good business sense

The pattern that is all too common is when doctors reach a comfort zone in their practices, and then slowly allow the practice to coast downhill for years until they are ready to exit the profession. Sometimes fear of that potential decline to a lower future value is what prompts doctors to sell their practices prematurely.

Ironically, doctors who take the steps to optimize and improve practice value in advance of an equity event are frequently delighted that their practice is better than ever—often choosing to remain as an owner in their renewed practice.

Regardless of when or why you are considering a practice sale, it’s good business sense to start prepping your practice to achieve peak performance before you sell. Even just one year of focused improvement through teamwork, coaching and value-based goals completely changes your story and the final deal you end up with.

The personality of practice success

Even though all endodontic practices are essentially engaged in the same business and deliver the same services, there can be vast differences in the level of practice success. While some of the differences can be chalked up to demographic variations between communities, even two practices in the same community can show dramatic differences.

It is the practice owner’s personality that is often the key variable which determines how successful a practice is likely to be. Some doctors have a personality and natural leadership ability that stimulates growth and success. For other doctors, it takes more effort to get to the same level (more about this at the end of the article).

In a world where unlimited knowledge about practically anything is just a Google search away, attitude is the differentiator. Here are some key personality factors of an owner doctor that contribute to making a practice more successful:

Passion and push
When you love what you do, there are follow-on effects: a desire to be good at what you do, having fun and enjoying every day, and a work ethic to be focused and productive with your time spent meaningfully. That passion and the innate drive to keep pushing yourself to improve keeps a practice owner moving forward.
Curiosity and enjoying the game
Business has an economic result, but the experience of business ownership is an intangible benefit to be enjoyed. When you are curious about how to keep growing and optimizing the business, then roadblocks and limits are seen as opportunities. It’s a fun game of possibilities to play where learning and growth inspires persistence to succeed.
Future-Focused Priorities and Decisiveness
You see the limited results of GP-performed endo all the time: missed MB2 canals that blow up, retreatments, separated instruments, and cases where the doctor simply realizes they are in over their head. Every time they refer a case where they get in trouble, it’s an opportunity to help them realize endodontists provide a faster and more predictable clinical outcome with a significantly reduced risk of a failed case or need for retreatment. It’s generally not possible for them to rise to your level: They lack the clinical techniques plus all the specialized technology and tools we have in our practices, such as CBCT, microscopes, etc.
People-based investment mindset
You need others to help you reach your goals, which means surrounding yourself with people who have the skills to support you. That means investing in people to align themselves with you. Whether it’s your team, your referrers, a mentor or coach, or other professional advisors, building relationships where you can amplify and access the expertise and resources of others is vital.

It’s easy to see how these leadership factors work together to create a positive, happy, engaged, forward-looking practice. When the doctor embodies these qualities fully, it creates a culture for the entire team. The full force of growth potential becomes unlocked. 90% of practice growth is driven by the team, and the team’s attitude and mindset reflect the doctor.

Upping your game

It is estimated that only 10% of people have natural superlative leadership qualities. Another 20% are within reach of being very effective leaders. What does that mean for the 70% that agree in principle but haven’t found the knack of putting leadership into action?

Everyone can take stock of their strengths and weaknesses. You might be great at vision but limited when it comes to motivating your team. Or you might be great at creating an enjoyable work environment, but weak at building referrer relationships to drive growth. Or you might provide excellent clinical care but have trouble staying on-time with your schedule.

Many doctors focus on their leadership strengths but gloss over the impact of their weaknesses. That inattention to certain aspects of business ownership dilutes your success far more than you would think and compels you to work so much harder to achieve the success you want.

The secret is put the right delegation, systems and accountability around your own limitations as a business owner. Having a coach support you with a 360-degree approach to your team and practice systems could be all it takes to achieve your next level of success.

Beating your endo competition

For every endodontic case that you complete in your practice right now, there are at least two other potential cases in your patient community that could be referred to your practice. That’s a significant opportunity for growth if you can tap into it.

However, even though that opportunity is available to you, it is also available to every other endodontist in your area too. Why? Because over two-thirds of endodontic cases are completed in GP practices without being referred. Truly, the competition in endo is not with other endodontists.

Factors that drive referral relationships

The question we are really facing is what moves a GP to prefer to refer endodontic cases rather than completing those cases themselves? If you think about your best referrers and analyze why they are great referrers, then you generally find they have one or more of the following mindsets:

They like you and see you as a trusted interdisciplinary partner.
Everything begins with the doctor-to-doctor relationship, which is established both socially and clinically. If you look at the top GPs in your community who have busy and successful practices focused on high-value comprehensive care, none of them reach that level without embracing an interdisciplinary philosophy. That means they have optimized comprehensive treatment around a team of trusted specialists with whom they feel aligned clinically and that they enjoy working with.
Treatment in your practice is more convenient for patients and less stressful for the GP practice.
While most endodontic practices typically have a schedule that plans for a certain number of emergency same-day treatments, that is not the case in the GP practice. The typical productive GP is usually scheduled 2 to 6 weeks in advance. They often have two hygienists seeing patients every day, which require hygiene checks in addition to the patients scheduled in the doctor’s chairs. It’s very difficult to carve an hour or more out of those tightly scheduled days for an emergency endo, and it’s easier to refer.
Treatment in your practice results in better clinical outcomes.
You see the limited results of GP-performed endo all the time: missed MB2 canals that blow up, retreatments, separated instruments, and cases where the doctor simply realizes they are in over their head. Every time they refer a case where they get in trouble, it’s an opportunity to help them realize endodontists provide a faster and more predictable clinical outcome with a significantly reduced risk of a failed case or need for retreatment. It’s generally not possible for them to rise to your level: They lack the clinical techniques plus all the specialized technology and tools we have in our practices, such as CBCT, microscopes, etc.
Endodontic procedures dilute the GP’s productivity.
GP practices grow differently than endodontic practices. In endo, we grow by focusing on efficiency because most of the core procedures that we perform have relatively the same economic value. In a GP practice, at a certain point adding more patients does not result in any more growth. There is an upper limit to how many patients can be retained in hygiene, after which GPs need to focus on case acceptance for less frequent but larger cases, such as quadrant dentistry, esthetics and discretionary care, and full mouth cases. These cases feed into the interdisciplinary mindset mentioned above, but it also results in the understanding that any GP time spent on endodontic treatment would be more productively utilized on comprehensive restorative care. So, for economic reasons, it is better to refer out endo.

It is all about the relationship

While we think about GP referrers every day, GPs rarely think about us in the same way. We’re part of a treatment plan generally, but they don’t usually view the success of their practice as dependent on referring to us.

The most important things you can do is provide excellent, responsive and timely patient care (especially for emergencies), build up your doctor-to-doctor relationships through personal interaction, and back that up with a great marketing system to stay top-of-mind with referrers.

When we can nudge GPs over time by understanding what leads them to prefer to refer endodontic care, we become the specialist for all their endodontic treatment needs, which potentially triples the number of referred cases they send now.

Marketing focus: plan now for holiday gifts to referrers

It’s less than 60 days until the busy holiday season begins. Many doctors will send referrers a gift for the holidays as part of their annual marketing strategy, but they fail to make the most of the marketing opportunity. Here are some key questions and recommendations.

Are gifts necessary or recommended?

It depends on your current marketing strategies. If you have a great marketing coordinator with a systematic approach to visiting all your referring practices throughout the year, your referrers are probably fairly well informed all year long that your practice appreciates them. It’s really a personal choice for you as part of your doctor-to-doctor relationship with the GP.

If you don’t have a marketing coordinator following a systematic approach, then your marketing activities throughout the year are probably quite minimal or sporadic. In that case, a year-end gift could be very important and probably advisable.

How much should you spend?

There are two camps of opinion on how much to spend. The first camp says that if you have a good marketing system where you are investing in marketing activities, including doctor-to-doctor activities (such as taking a referrer to a sports game or other activities), then a flashy gift at the end of the year is probably overkill. A personalized message along with a thoughtful gift like a nice bottle of wine or gift basket is completely suitable.

The other camp says that the gift should be obviously meaningful in the context of how much an individual GP referred during the year. A GP who refers 50 cases to you deserves some special recognition (and extra spending) versus a GP who refers 6 cases to you. It is a slippery slope though because once you set a precedent with a high value gift, it’s hard to back down from that in the future.

Overall, we lean toward having a great year-round marketing systems and then, if you do send a year-end gift, that it be modest without being extravagant.

When is the best time?

The whole point of a gift is to communicate a message to the referring doctor that you appreciate and value your relationship with them. If you wait until the second or third week of December (or later), your gift is going to get lost in the mix. It’s the busiest time of the year with their family. Everyone else (from their accountant to other specialists they refer to) are also sending gifts at the same time. Yours will be one more on the pile.

The best time to send this kind of gift is right around Thanksgiving or just before, which is well ahead of the masses of cards and presents from others. It gives you a head start, and your gift could very well be the first one they receive of the season. So, it will get noticed, which is what you want. Also, a gift of appreciation and gratitude ties in very nicely with the theme of Thanksgiving. That means the best time to start budgeting and planning your gifts is now, especially if you are going to try to give personalized gifts for your key referrers. It takes time for those ideas to percolate.

How should it be delivered?

If you don’t have a marketing coordinator, then you will probably need to mail gifts to your more distant referrers or have them delivered from where you ordered the gift (such as for a basket). If you have a marketing coordinator, it’s best that they hand-deliver gifts for those referrers that are a distance away.

For referrers that are closer to you, it is recommended that you personally visit those doctors, which is something you should do at a minimum at least once a year. It gives you a chance to connect with the GP’s front desk team, have a few minutes of face time with the doctor to generate goodwill. This is especially important if you are not face-to-face with them any other time during the year. In one day, you can probably drop in on 15 or so practices without too much effort.

Remember that 90% of marketing is teamwork

Year-end gifts can be a nice touch in a marketing system, but no gift is as influential as your practice team. What they do throughout the year by communicating with referrers and taking care of patients effortlessly guides the entire referral relationship. And a great marketing coordinator makes sure that practice-wide effort by you and your team is noticed throughout the year.

Marketing focus: 3 mistakes that lead to unhappy patients (and referrers)

An unhappy patient spreads their unhappiness. They report a poor experience back to their referring doctor or clutter up your Yelp and Google reviews with 1-star ratings. If you scan those reviews, most of them are the result of factors within the control of the endodontic practice. Here is what you and your team need to avoid:

Failing to address their fear

The word “specialist” generates a certain level of anxiety in every patient. Anything that requires the care of a specialist sounds complicated and serious. The phrase “root canal” generates an even higher level of concern. Root canals have a historical connotation of discomfort that no longer matches our clinical processes but endures in the public mindset as dental mythology.

Certainly, an endodontist’s chairside manner is vital to calm fearful patients and bring them down from their anxiety orbit. But the mistake that most practices make is assuming that it is only when the patient is in front of the doctor that their fear can be dispelled.

Addressing the patient’s fear needs to begin from the moment that patient calls the practice to book their appointment. It is absolutely essential the administrator receiving that call has a warm and caring demeanor. They have to project calm confidence, superb knowledge and totally informed certainty about every concern or hesitation the patient has. Reassure the patient that the doctor is the best endodontist, and they will receive treatment easily and quickly.

In this way, starting with the phone call, the team can telegraph calmness to the patient, so the patient feels “these people know what they are doing.” Done at the highest level, even before the patient walks in the door they will feel gratitude and privilege to be taken care of by the best.

Lack of same-day appointments

Americans are not people who like to wait in line, whether that is for a coffee, to check in at the airport or hotel, or to get a root canal. Furthermore, when they are in pain, their tolerance for any delays virtually evaporates. And with endodontic pain in particular, even one day of delay (and a sleepless night of discomfort) seems like an eternity.

A patient in pain wants the pain addressed immediately, and a referrer with a patient in pain wants the pain addressed immediately too. That should be the #1 awareness that your scheduler should always have. Your team needs to be adept at assessing and triaging the patient’s level of pain in the first phone call. They need to show empathy for the patient’s pain, so the patient knows their pain is your priority and you’ll take care of them as quickly as possible.

Then, your scheduling strategy and template needs to have the appointment openings built into every day to accommodate necessary same-day treatment emergencies. No doctor likes to see openings in their schedule, but strategically leaving time reserved for urgent care means that emergency patients will be thankful, not annoyed by waiting. Plus (importantly), when referring doctors know they can count on you for same-day treatment of pain, it is the greatest practice- and relationship-building strategy ever.

Financial surprises

Just like the word “specialist” invokes the feeling in patients that care will be complicated, it also invokes the feeling that it will be expensive. Patients need total financial clarity in advance so they can be prepared.

Financial clarity particularly requires your team to be experts at determining the patient’s insurance benefits for treatment, so you can give a very close estimate of their co-pay prior to the patient’s arrival. Even if the patient is just coming in for a consult, they need to be prepared for treatment on the same day, so the estimate needs to be prepared in advance.

Remember, if the patient is undergoing treatment at the GP concurrently, insurance limits can shift benefit payouts overnight. An expert practice administrator stays abreast of every detail for the patient. Patients truly don’t understand the ins and outs of their insurance.

The two biggest mistakes when it comes to finances are 1) not giving patients a co-pay estimate until they are in the practice, and 2) giving them an estimate based on inaccurate insurance information and then surprising them with a higher required co-pay when treatment is performed.

90% of marketing is teamwork

Great practice marketing is far more than just doctor-to-doctor outreach. It means involving the whole team in marketing goals and getting every individual on your team to be aware of how they influence patient and referrer satisfaction.

Perspective for endodontic leaders

For the last two weeks, I’ve been on my honeymoon in the Caribbean. It was magical to have that time with David after the busy time leading up to our wedding a month ago.

But we did have an unexpected surprise on our trip: the resort that we booked was a bit more party-focused than romance-focused at this time of the year, despite the beautiful photos on the website of couples lounging alone on a pristine white sand beach. We made the best of it though. We moved our room away from the pool sound system and, in the end, created our own one-on-one experience that was memorable.

The situation made me realize that in today’s world we see a lot of “Hollywood reality” and hear a lot of stories that tell us what our lives should be like. We are always tempted to compare our daily experience with glossy polished brochure images. In the day-to-day busyness of our family and practice lives, sometimes we can feel very distant from those dreams.

In fact, if we give in to those comparisons, we can end up talking ourselves into an equally deceptive story. If David and I obsessed on what the resort wasn’t, rather than what we could make from it, we would have come home with a different story. But we focused on all the pluses: we were in the Caribbean on a beautiful island, there were so many interesting things to see and do everywhere, and we were with each other. That was more than enough to have a wonderful honeymoon!

The need for leadership perspective

When you look at your practice, it’s tempting to focus on the problem areas. You might have a team gap, marketing gap, financial gap or some other concern. You might feel a lack of excitement or that you are going through the motions without making any progress. The truth is that doctors are, by necessity, problem solvers. You solve problems every day for patients, for referrers, for your team, and for yourself.

But that perspective is not the whole story. Your whole story can only be seen from outside your daily experience, which is a very different perspective and different story: You’re a credentialed accomplished professional with a successful operating practice. You have a team to support your goals, and you have the foundation of all the essential practice systems. Perspective shifts your mindset from seeing liabilities to seeing assets that can be empowered to create even higher success.

Finding your perspective

Getting outside your bubble is a leadership technique for everyone. I found, returning to work this week, that I was more charged up and inspired than ever, and more laser-focused on the assets we have at Endo Mastery to advance our vision for endodontists.

Overall, endodontists are the least likely among dental specialities to give themselves the away time and vision time that they need for perspective. You worry about your referral sources suddenly being seduced over to another endodontist if you’re out of office and not available for emergency care.

I encourage you to think about your leadership perspective and plan to give yourself the benefit of that viewpoint … whether that’s taking a vacation or organized around professional events where you can get inspired by a new vision for your practice assets.

One option that Endo Mastery offers is our 2-day seminar, which is coming up in September in Philadelphia. Many doctors have used this seminar to re-energize and put their practice on a new path to incredible success. You can hear some of their stories here:

I promise you; these are not slick marketing videos filled with unrealistic brochure images. It’s real doctors, talking about how they changed their perspective, found their true focus, and transformed their practices and lives.

Poppin’ by to say hi!

“Poppin’ by to say hi!” … that’s an easy one, and one that everyone loves. Popcorn snacks are a great favorite, and you can provide them in different ways:

• Microwavable bags
• Pre-popped snacks from the snack aisle
• Individual cellophane sleeves
• Barrels and tubs
• Different flavors
• With a movie or online rental gift card

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Tag: Business Growth