The Case for Practice Management

I left my Fleet Street, London newspaper job in my 20s and moved to New York City to work for the J. Walter Thomp-son Advertising Agency. Moving to San Francisco, I held 3 widely different and challenging jobs. I worked as an executive assistant for an entrepreneur who purchased, renovated, and managed old San Francisco commercial buildings. I then became a collection manager for the country’s oldest mortgage company. Then, I moved on to the challenge of handling return orders for California’s largest privately owned clothing manufacturing company. These positions provided me with a wealth of management experience, and I saw my future climbing the corporate ladder. That is, until I was drafted into dentistry!
Marriage to my former husband, 2 weeks after his graduation from a California dental school, changed my destiny. During his final year, each weekend we drove hundreds of miles through the San Francisco Bay area. Our mission was to find the “ideal” location to start our practice.

Just Practice Where You Want to Live?
The dental school faculty advised final-year students to “open your practice where you want to live.” We wanted to live in Tiburon, a community just north of the Golden Gate Bridge. A town of then 2,000 people, we would sit on the deck of the local restaurant, sipping our gin fizzes and gazing at San Francisco’s gorgeous profile across the blue sparkling bay. What was wrong with this picture? Well, along with the 2,000 residents, evidently 8 established dentists! Therefore, we shifted our focus to Monterey. Here, we found more than 100 dentists looking after a population of 45,000! We needed to rethink the school’s concept of “work where you want to live.” We opened our practice in California’s then fastest-growing city. It had a population of 50,000 and just 6 dentists. At the end of the first year, we closed the office for a 2-week vacation and went to Europe. We had made the right choice...for us.
In preparing to open our practice, we went through an extremely difficult building process. Whatever timelines an architect, contractor, or dental supply house may give you, multiply that figure by 4. Building supervisors became our full-time job. We were onsite every day, blueprints in one hand and tape measure in the other. We quickly learned to never assume anything and to double-check everything. The most overused phrase in the construction industry is, “In your absence, I had to make an executive decision”!
As we finalized our suite, I started to search for a new job. However, I soon discovered that my presence was required onsite. I needed to answer the phone for the first 2 to 3 weeks, until we found someone who actually knew what to do! Calling on my corporate experience, common sense, and logic, I jumped in with both feet. Blessed with a husband who did not interfere, our practice became my management lab. We worked well as a team, and I never interfered in the clinical area. He kept his questions about patient and systems management until we got home. I made every mistake in the book, from sitting the telephone installation man down in our chair for a new patient exam to asking a new denture patient (in front of everyone, of course), “How do you like your new dentures?”

My Management Lab
For 6 years, I managed our practice 24/7. During social gatherings, I noticed local dentists complaining about this management issue and that patient problem. I would offer a suggestion, and feedback showed my input was correct. I became curious about management courses offered in dentistry, so I registered for my first continuing education (CE) course. At its conclusion, I asked for my money back. The seminar company’s president happened to be onsite and asked for the reason. I said I felt the speaker was poor—the information incorrect, impractical, and illogical. He asked, “Can you do any better?” I answered, “For sure I couldn’t do any worse.” He asked for my card and promised to call me. He never did. Four months later, I booked a hotel, bought a mailing list, designed and mailed a flyer, and waited and prayed. More than 75 dentists and staff registered. Five years later, I had given more than 100 full-day public programs throughout the country. Dentists knew who I was, but the dental profession did not.
Then I met Dr. Jim Pride. At the time, Jim was associate dean at the University of Pacific School of Dentistry in San Francisco. A chance meeting with Jim gave me an opportunity to comment on the advice his final year students received about “work where you want to live.” (It seems that every graduating dentist from the 2 San Francisco dental schools wanted to live in San Francisco because the population/dentist ratio was 700 to one! Then 450 Sutter Street became famous for its 25 floors of 1,100 physicians and dentists.)
I then moved our discussion onto what I perceived as a lack of management programs offered in the dental school, thinking of the mistakes we had personally made because of ignorance. In addition, I discussed how lucky my husband was to have not only a spouse to help but also one from the corporate world. Without this kind of support, how were other new dentists handling their new professional lives? Jim did not take umbrage, defend his school’s curriculum, or duck the issues. “Come to the school and let’s talk,” he said as he handed me his card. We met and we talked. He gave me the amazing honor of changing his schedule to include me in the final- year students’ last 3-month’s schedule. I called my program “What You Need to Know About Running a Practice in the Real World.” He gave me the 8 a.m. Monday slot. He told me the committed would get out of bed, and the uncommitted would not. We had more than 85% attendance every week.
The following year, Drs. Jim Pride and Phil Whitener, along with Nancy Carr and I, started Pacific Institute of Management and Design (PIMD), now known as PI. The original consultant training manuals, forms, concepts, and protocols all came from our practice, where I continued to work part-time when not speaking for PIMD.

Changes in Attitudes, Changes in Latitudes
Over the years, I have shared my Dr. Jim Pride conversation and the University of the Pacific student experience with several dental school deans. Without exception, the feedback is always the same: my comments are graciously listened to and heads nod in agreement. Then, I hear the 2 main objections: schedule limitations and the students are not interested in management until after graduation. I can accept the clinical scheduling issue. However, many years’ research shows me final-year students do want business courses included in the final year. Dentistry is a business with a health aspect. To build a stable practice, today’s graduating dentists benefit from having mastery of both clinical excellence and solid management tools. What are the top 3 management skills that students need? First, interpersonal skills to elevate the doctor-patient relationship, and the ability to both (2) communicate with and (3) manage the team; tools and techniques to hire, fire, and handle human resource issues while remaining legally compliant and safe from expensive legal repercussions.
Graduating dentists considering an associateship need to protect themselves from making unwise choices. Final-year management training provides the tools to help them select a well-managed practice for their apprenticeship. Such a practice delivers effective scheduling and financial remuneration paid in a timely and correct fashion. This additional learned and practical knowledge becomes a huge advantage if and when they open their own business. The young dentist selecting a poorly managed practice unfortunately learns the lesson in reverse.

What is the Future of Practice Management in Dentistry?
Regarding management training in general, I am both sad and concerned to find conventions and meetings have either reduced or totally eliminated practice management courses. I am informed the reduction has been done to increase the ability of dentists to satisfy their total 2-year CE credit needs at one meeting. When we applied for our dental loan to open our practice, the bank approved our loan on the strength of the 4-worded degree: Doctor of Dental Surgery. We had 2 wedding rings and a used Volkswagen valued at $300. The banker added 6 months of living expenses to the practice loan. He smiled and said, “We have never had a bankrupt dentist in California yet; I don’t think we are about to change that, so take the money and go!” Today, with $250,000 being the starting point for a new practice, credit hard to come by, one out of 4 dentists embezzled, the role of dental insurance, the Internet making many dentists feel as if it is a buyer’s market, I do not think dentists can receive enough business training to protect them for today’s challenges in running a small business. I recently heard from a dentist friend of mine who just found out that he had been embezzled ($450,000) by his most loyal and longest-employed business team member.
Currently, I am especially concerned about 2 dental groups: dentists in practice for less than 5 years and dentists in practice for more than 20 years. The first group has not been prepared for the harsh realities of running a business; the second group may not be updating their thinking about what impact the Internet, Web sites, and social media can have on their practice stability and growth.

Closing Comments
I believe all health professionals benefit from being supported by their associations, not only in expanding their clinical expertise but also to provide avenues of learning for running a healthy business. Management inclusion in dental school curriculum and convention and meeting events, in my opinion, is to offer the profession the total package. I believe that it is important to have CE credits restored to dental practice management programs on the local, regional, and national levels. Today, I notice that almost without exception, practices that are stable and growing with a strong patient referral base have made practice, business, and communication skills learning an integral part of their ongoing training program.


Mrs. de St. Georges has been a professional consultant and adviser to dentist and staffs in efficiency systems for the last 30 years. A Fellow of the International Academy of Dental Facial Esthetics, she presently serves as the senior executive efficiency consultant to The Massad Center for Higher Learning. She was the first nondentist to be appointed to the Dentistry Today Contributing Editors Board, and she has written more than 300 articles for international published journals as well as Web sites. She wrote the chapter "Communicating Financially with Your Patients" in PennWell's Essential Dental Handbook: Clinical and Practice Management Advice from the Experts (2003). An international lecturer, she has given more than 1,000 programs on 5 continents at major dental meetings as well as speaking 8 times for Fédération Dentaire Internationale. She may be reached at (800) 393-2207 or at jdsg.com.

Disclosure: Ms. de St. Georges reports no disclosures.

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