I've thought about writing a post on this for awhile. I'm going to go much more in depth on these topics in liftoff academy. But, I thought I'd start to open up the dialogue on topics that you should be putting on your radar... The best way to highlight how you need to prepare yourselves for private practice is to do a walk through of your first day, because I think it would be a great way to highlight what you don't know you don't know.
I remember my first private practice job after my 1 year residency at the V.A. hospital in Minneapolis. I walked into a very successful private practice in suburban Minnesota. The doc had grown the practice from zero patients to over 4000 in just 8 years! The place was a finely tuned machine, and it was going to be an exceptional private practice learning opportunity for me over the next 5 years. But, at this moment, day 1...I was starting from zero.
At the V.A. (or dental school) we didn't deal with dental insurance plans, marketing, collections, hygiene flow, case acceptance or the patient expectations that exist in private practice setting. I remember the owner asking me before I started, "So, I want to have patients scheduled for you on your first day....How much time do you need for a crown appointment? How about if I add in and extra 2 fillings? ". Honestly, I really wasn't sure? I knew that I needed to figure that out fast. I knew that the 2 hrs it took me to do a couple fillings in dental school would not fly at this fast moving, high quality practice. What should I say?...Be conservative and ramp up over time? Push myself and risk getting very behind, angering patients and getting myself very stressed out?
I looked at my hygiene schedule...usually I'd have 2 or three columns to cover an hour. What was the best way for me to plan the "flow" of my day? How could I not get behind schedule on my 1.5 hr molar endo case when I have 6 hygiene exams to do as well?
So, you know what happened?...I did get behind. I did get stuck in hygiene exams...trying desperately to treatment plan - and answer questions- all the while falling farther and farther behind on the endo case that I was supposed to finish. Patients started asking me about insurance questions (of which I knew zero about). Things were stressful...For a long time.
Luckily, my boss was able to give me a pretty good description of the time formula that she used to schedule appointments and procedure times. After several months I was able to start to block my schedule correctly and struggle through the chaos. Eventually I learned to manage hygiene, choose the right cases ( and schedule them at the right times). I learned what procedures NOT to do, and when to refer. I learned how to best utilize my assistant, and how to present cases and treatment plan effectively.
Today this is something I do automatically ( I do have a formula), because I've actually done hundreds or thousands of procedures and know what to expect in different situations and with different patients. But, on your first day - you DO NOT have this dialed in yet. Looking back, I wish someone would have given me at least a little heads up, a little training in order to make this transition smoother (and less stressful).
Here are some things that you'll encounter on your FIRST DAY OUT...you'll find that there are many things that you probably "don't know you don't know"
1) Schedule management
2 Hygiene Flow
3)Time Management in private practice setting: getting behind, predicting tough procedures, when to refer and when not to refer
4) Working with an assistant
5) Insurance (downgrades, patients complaining, your pay vs write offs, understanding dental benefits plans)
6) Treatment planning (communication, knowing what patients want, how present treatment plans...and actually have patients accept treatment
7) What procedures kill time and lose money, what you enjoy that makes $
8) Managing patient expectations, communicating potential problems and dealing with failures and mistakes.
I'd be interested in your reactions to the list above. Please post your comments and questions below...I'll continue to hit on the topics with the most interest. Be on the look out for future posts and training material!
Also, please invite your classmates to subscribe to this site. The more students I get involved...the more likely I'll be able dig deeper into bringing you the training you NEED!
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~ Cole Brenny DDS