Associate Dentist Deep in Debt With Poor Treatment Planning Skills

person pushing a money symbol up a curved incline, representing the burden of debt

Welcome back to The Dental Practice Fixers podcast, dentistry’s most unique show! Today we have a question from a listener asking what he should do with his associate. The associate is a decent clinician but has very poor treatment planning skills. Add to that, he is $300,000 in debt, which is causing him to be extremely aggressive when it comes to recommending treatment. Listen to the advice that Rich and Dave give to this great question. Then of course we do the call of the week. Today we are going to a wedding and need our teeth super white. Is it better to have a cleaning or a whitening procedure? Find out how the woman at the front desk handles this one! If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!

Associate Dentist Deep in Debt With Poor Treatment Planning Skills

The Dental Practice Fixers Podcast is brought to you by the Madow Center for Dental Practice Success. To find out how we can help increase the success of your practice, checkout madow.com or call us at 1-800-258-0060
 Dr. Rich Madow: Hello everyone and welcome to season two, episode four of the Dental Practice Fixers Podcast. First of all, thanks so much for everybody for your great support of season 2. We've gotten so many nice comments so far and we really, really love it. If you want to take it a step further and help out the Dental Practice Fixers, please go on iTunes and rate the podcast. Give us a five star, give us a nice review, an honest review. If your honest review is a five star, you'll really, really be doing us a favor and helping us out. So again, thanks for all your great listenership today. It's a little unusual because, uh, Dave and I are in different locations. This is the first time in the history of the podcast that we've been doing it remotely. So, this is Rich speaking to you right now. I'm in my home office in Baltimore, Maryland and Dave is out in some undisclosed location. I'll just tell he's in the mountain time zone and I think maybe through all those mountains and the fog and the snow and the rain and the sunshine. Let's see if we can hear him. Dave, are you there?
 Dr. David Madow: I am here. Can you see my green screen? I greenscreen the mountains in the background here, right? Oh, it's only you, oh darn. 
 Dr. Rich Madow: It looks good though. I can see it. It looks really nice.
 Dr. David Madow: I have to admit Rich, I was trying to be quiet during the intro and let you do the intro, but when you give us, give us a five-star, honest review, I was just, it just hit me as funny. 
 Dr. Rich Madow: Is there any other kind of review? 
 Dr. David Madow: Well, we deserve it. This is the best podcast in dentistry. There's, there's no questions about it. 
 Dr. Rich Madow: Or so, or so, we've been told. 
 Dr. David Madow: Exactly, exactly. 
 Dr. Rich Madow: There are a lot of podcasts in dentistry. Some are really good. I mean we, we listened to other people's podcasts. Some of them, you just wonder why people think they should be doing about this. 
 Dr. David Madow: Yeah exactly right. 
 Dr. Rich Madow: Lot of great ways to get information out there. We've really enjoyed the podcast, Again, your fantastic comments. So, Hey, what do you say man? What's going on today? 
 Dr. David Madow: I'll tell you something, Rich. Uh, I'm feeling great. Ready for a fantastic episode. How are you doing there? Are you good? 
 Dr. Rich Madow: Doing good. Love it. Loving life in downtown Baltimore. I'm overlooking the beautiful harbor. They're not, they're not dragging any bodies out today, so it's a good day. 
 Dr. David Madow: Oh my God. Okay. Hopefully they won't be any time today or anytime in the near future. 
 Dr. Rich Madow: You know, it's funny, one of the things we really enjoy, we've been, you know, writing, publishing, teaching for so many years and we get, when we do our emails, we get nice replies. It seems like we just started getting comments to the podcast, so I'm keeping it up. We really love hearing your opinions. If there's something you like, something you don't like, if you want to ask a question, make a comment, please feel free to write in. But I can never remember if the email addressed as podcast or podcasts @madow.com, but I think it's singular podcast.
 Dr. David Madow: Yes. 
 Dr. Rich Madow: Is that correct? 
 Dr. David Madow: It is. And I'll tell you something, Rich, every episode we talk about having Sylvia fixed the thing, so any either of them will work, but we, I think we haven't done it yet. 
 Dr. Rich Madow: Okay, well we've got too many other things to do here in podcast land. If you're listening, Sylvia, make it, so podcast@madow.com or podcasts@madow.com, come to our direct inbox. Not some bogus inbox, but our direct inbox.
 Dr. David Madow: Can't be bogus, can never be bogus. And before we start with, we got, Rich, we’ve got a great question here. I'm going to, I'm going to share it in a second, but I've got to tell you, I don't know if you've ever done this. I'm just, I'm working on like a blend. I made this, I made this dark coffee this morning, very dark roast coffee, but I added a tiny bit of French vanilla to the mix as well. It is just awesome. I'm just, I'm just feeling great. 
 Dr. Rich Madow: Well, I am not a flavored coffee guy. I like my coffee hot and black. I'm straight up. No cream, no sugar, no flavor. But I got it too since you brought up coffee. I got to tell you, our coffee maker, we've had the same um, Cuisinart coffee maker for about 10 years. Candy and I got it when we moved downtown. So, we've had it for 10 years and finally, finally gave up the ghost as they say. Um, and-\
 Dr. David Madow: It went up. 
 Dr. Rich Madow: It went up as they say in Baltimore, our coffee maker went up. So, we got this Ninja coffee maker. Ninja is known for making like juicers and juice extractors, I don't know if you're familiar with the brand. So, we've got this Ninja coffee maker and it is fantastic and the coffee is strong and most of all it's really hot. Like it hot like so it almost burns your mouth.
 Dr. David Madow: It's the only way to, yeah. And I like, and like you said, I like it black too but, but hot of course. I'm going to. Rich, I'm going to write this down because I might end up getting one of those and maybe, maybe we can set up an affiliate links. So, and our listeners could get this Ninja coffee maker, we can make a few pennies per coffee maker. 
 Dr. Rich Madow: Now that's a great idea. The coffee maker that pays for itself. 
 Dr. David Madow: So, let's get into the question because we have a good one. Richard, we're going to want to talk about this one for a few minutes. 
 Dr. Rich Madow: I know you've got it all primed and ready to go. So, let's do it. 
 Dr. David Madow: So here is the question from a doctor and I will tell you we're going to keep this doctor’s name anonymous as he requested it for obvious reasons. You'll see as we as, as we ask this question, but here's what he says. He says, I have a young dentist just out of residency working with us. His skills are good, but he has no treatment planning skills. He's also- 
 Dr. Rich Madow: I'm cracked up already, he's a good dentist and he has no treatment planning skills, none. 
 Dr. David Madow: His skills are but he has no treatment plan. 
 Dr. Rich Madow: Okay. So, so in other words, his clinical skills are good. 
 Dr. David Madow: Yeah, I think that's what he meant by that. And he's also $300,000 in debt and he needs money. In parentheses, he has three young kids. I liked the fact that it's in parentheses. I feel he is doing treatment just to generate income such as crowns instead of fillings, etc. He wanted to do an extraction last Friday afternoon at 2:00 PM on a 92-year old woman. She was not in pain. He just wanted to produce. I stopped him. I found out today she is taking Prolia, which could cause, which could have caused a real problem at her age. What do you think? Name withheld. Keeping it confidential.
 Dr. Rich Madow: Wow.
 Dr. David Madow: I mean. What can we say about that? There's so many routes we could take on answering this question is just, it's unbelievable.
 Dr. Rich Madow: Yeah. Well I'll say it's kind of a modern take on the age-old question in dentistry, you know, we're here to make a living. We deserve to make a living. There's nothing wrong with making a lot of money if you do it ethically and if you treat your patients correctly and do the right treatment. So, this guy's got kind of a double dilemma because he's under a lot of financial pressure, but is a poor treatment planner, maybe a poor diagnostician, and it sounds like maybe a little bit lacking in ethics, don't you think?
 Dr. David Madow: Oh, absolutely. From what it sounds yes. And you know that this problem has always been around even before this tremendous, I'm going to say tremendous student debt crisis. Back, you know, back in our day when people didn't have this kind of student debt, there's debt for, you know, for paying for dental school and practices and whatever, um, there were other reasons people were over-producing. And Rich, you and I saw it all the time, you know, I'd like to think we didn't do it, but, um, I guess there are always going to be people that just want to produce, produce and be unethical and make more and more and more money. And that's, in my mind is it's just not cool. I think you have to look at the patient as the kind of, suppose this was you or somebody in your family, how would you want to be treated? I think you always have to look at it like that.
 Dr. Rich Madow: I don't understand the little dichotomy in this question because it sounds like this associate has poor treatment planning skills, yet they're always trying to get patients to do unnecessary treatment. It seems like the kind of person that does that will be like a real slickster. They can talk anybody into anything. So, the whole thing is just bizarre.
 Dr. David Madow: It's a mess. But what do you do if you've got, again, like I said, this can go in so many directions because as I've talked about in previous episodes, this student debt crisis thing for, especially for dentists, which just really, really worries me. I mean Rich, we spoke to somebody, we were speaking in a city, which we'll, we'll, um, we won't even, we don't have to name the city just a week ago, and we spoke to a dental student there. So, he's in his fourth year of dental school and he already has $600,000 of student debt, where, where does he go from here?
 Dr. Rich Madow: Well that's another story all together. I remember that guy, super nice guy, the D-force, they call them. And he also, he also didn't like doing crowns and was under pressure from his father who thinks his rich dentist son is going to support him when he graduates. What a disaster.
 Dr. David Madow: It's a, it's a huge problem. But I think, so my point is a lot of these docs who are accumulating massive debt, they're in trouble because what can they do? That's why I think that's why there is going to be, there already is, and there's going to be a lot more overtreating to see, to get out of this debt, sooner rather than later. But it's, it's horrible.
 Dr. Rich Madow: Okay, so what can they do? Well, first of all, what can't they do? They cannot get unethical. You cannot intentionally overtreat a patient just because you're under financial pressure. So, let's start with that. But, but secondly, I think it was interesting that the writer of this question, um, remarked on this associate dentist poor treatment planning skills because you know, it, it seems like if the practice is fairly busy and they must be fairly busy, if they hired an associate, there's enough ethical dental treatment to be done that this dentist should be able to make a good living. Don't you think?
 Dr. David Madow: Yeah. But maybe in this doc's mind, maybe not fast enough. Like he's got three kids, $300,000 in debt. Maybe he just feels I need money. And you know, it just seems like a lot of people these days especially, want things sooner, rather than later, they're not willing to do the right thing and take a little bit of time. They just, they want it to happen like now or yesterday. That's a problem. 
 Dr. Rich Madow: Okay. Well for, okay, let's, so let's go back to this, this exact situation. The letter was written by an experienced dentist, I'm assuming, who's been around, actually you withheld the name, but I know this dentist and so do you, at least enough to say that this person is an experienced dentist with great skills that he's honed over many years. Agree?
 Dr. David Madow: And ethical.
 Dr. Rich Madow: Right, ethical. So why doesn't the dentist become a mentor of sorts and work with this young dentist on their treatment planning skills and work with them on their diagnostic skills, so they can diagnose optimum treatment, which let's face it, many times the right treatment for the patient is the most expensive treatment. And if it's the right treatment, then that's great. And work on them to diagnose proper treatment and present it properly and carefully to the patient. It's a long-term plan. It won't put money in your pocket tomorrow, which is why this dentist must be so anxious, but long-term it will be good for the dentist, good for the practice, good for everyone.
 Dr. David Madow: Yeah. I, I would agree with that 100%. I don't know of another answer. Well, again, we can get back to the root of the problem and then let's take care of these student loans, which I think are just crazy, but it's too late for this guy. If I were him, I would not get into any more debt. I wouldn't go out and buy a house now. I wouldn't like buy into a practice. I wouldn't incur more debt. I would work on his treatment planning skills, be the best dentist he can and start chipping away at this $300,000 a day. And I think maybe they'll start to feel better about themselves.
 Dr. Rich Madow: You kind of starting to peel open a can of worms there because you know, one of the things you'd have to ask is, okay, this dentist has three kids. Do the husband and wife think that they deserve the dentist's lifestyle or are they sending the kids to private school and buying them shirts with little horses on them and you know, living in an expensive house, are they doing all those things? Well, Jeez, that that's going to multiply the financial pressure.
 Dr. David Madow: Yup. I would agree. I think you need to live on, live a life way, way, way, I don't care how many kids you have, live a life way below your means to chip away at this debt and then maybe never live the doctor lifestyle. Just live a regular life.
 Dr. Rich Madow: And I think it's also really important, you know, when we're talking about treatment planning skills, the patients, whether consciously or subconsciously can see the financial pressure that this doctor's under and it just kind of comes out of your pores, you know? And they're trying to talk somebody into something, it just as a horrible short- and long-term plan. So, I think this young dentist needs to work on ethically building up the trust of the patient, becoming their trusted advisor, discussing their treatment needs, maybe giving them options and just being totally honest. And yeah, and I like your approach too, do the treatment that you would recommend on your family member and tell the patient that's what you are doing to your family member. Be honest about it. And that's the way that you can hone your skills, but it's not going to happen overnight. And none of us knew what we were doing when we first got out of school. It's just natural law.
 Dr. David Madow: I think you hit the nail right on the head, Rich. Sometimes the answers are really just the simplest answers, and the simplest answer here is do the right thing, to do it right. Treat people like they're you or like they’re somebody in your family and it's really not that much more complex than that. But yeah, hone your skills of course and do it right. Don't rip people off. 
 Dr. Rich Madow: Yeah. Listen to Spike Lee. Do the right thing. You know, it's funny, Dave, when we had our practices, as many of you listeners know, Dave and I both, um, had really nice practices but we never practiced together. But at one time we were using the same consultant or consultancy as they might say in the UK and this company, part of their teaching was anytime a patient has a somewhat large restoration, two or three surface amalgam or composite, treatment plan them for a crown and that's just not right. In the short term, yeah, you might get a few more bucks in your pocket, but that stuff just comes back to haunt you.
 Dr. David Madow: Well, I think the most ironic thing from that whole, from that philosophy, Rich, is that these people that were teaching us this or sharing this great knowledge with us, were not dentists. They were, they were business people who were, who were like pretty much telling dentists when to do crowns. That that was the most ironic thing. That was weird.
 Dr. Rich Madow: That's, that's another can of worms. The dental consultants who never, never owned or worked in a dental practice, who never, you know, how do they know? How do they tell him, you, you're on, how do they teach you how to diagnose and treatment plan? 
 Dr. David Madow: Yeah. I mean a consultant that does not have a dental degree is telling a dentist when to do a crown. I mean it just does not make any sense at all. It's actually unbelievable. We never really talked about in that level, but think about that. It's true. 
 Dr. Rich Madow: That's pretty funny. 
 Dr. David Madow: Oh my God. Okay. Well I think we, I think, um, I hope doctor that wrote in, I hope, I hope this really helps you. Yeah, take this, take this guy aside and help him out because maybe, maybe he's got potential, but I don't know. I've got kind of bad feelings about it.
 Dr. Rich Madow: I do too. I have bad feelings too and I don't think it's going to be fine right away. I think it's a long-term project. And again, if you were his doctor, Dave, would you consider, if things don't shape up quickly, getting rid of this person because this person can bring your whole practice down. Getting horrible reviews on Yelp and just, you don't want that.
 Dr. David Madow: 100%. I'm going to go back to a word that you used earlier to answer the question. He sounds like he might be a slickster and that's the last thing I would want in my practice. Some slick guy who's, you know, who's known in the community for overtreating. It's gonna, you know, with Facebook and all these groups these days, the word's going to get out so quickly. I'd be very, very careful. 
 Dr. Rich Madow: patients think, a lot of patients think you're over treating even when you're not overtreating. 
 Dr. David Madow: Exactly. That's it. It's exactly right. 
 Dr. Rich Madow: Too much. Oh, Hey, let's, let's move on and get to our call for the day. But before we do that, just a couple quick really cool announcements for all our listeners. Dave, do you want to go first here?
 Dr. David Madow: Sure. I'd be happy to. So, one thing I wanted to share with you is that Rich and I have been doing these Masterclasses, and they have been some of the most, I'm just gonna say one of the coolest things we've done in our 30 years of helping dentists reach success. We get about somewhere but we keep it very small, 8 to 10 docs in a room. We'd been doing them mainly in Baltimore, sometimes we may choose another city. But we invite you to come attend the Masterclass and the main reason we're doing these Masterclasses, we want to share with you along and we have our coaching staff there and our Madow Center staff, we want to share with you how we can help you become more successful, happier, and just have a greater life in dentistry than you are right now through our coaching.
 And it's, it's, the reason we do a Masterclass is just simply because in an email or in a phone call, we just can't really maybe share all the details or how great this relationship can be. So, we bring you in, spend a full day with you and maybe about 8 to 10 of like-minded docs and in one day we just share with you how we can work with you and how we can help your practice. So, the best way to check it out, and by the way these are free, we don't charge, we don't charge, but you have to at least have an interest in becoming more successful through coaching. The best way to find out where our next Masterclass or Masterclasses will be is go to masterclass.madow.com; we would love to share the day with you, so come see us.
 Dr. Rich Madow: Fantastic. We've also been getting great comments from people who are using Fattmerchant for their credit card processing. Fattmerchant is the disruptor in credit card processing and they do not charge you an overage percentage. It's just a low flat monthly fee and they've got great technology and dashboards so you can see exactly what's going on with your credit card charges and patients and all those things. But the main thing you need to know is it's a seamless switch. Use Fattmerchant, you'll save money every month and then hey, something else will pay for itself, maybe even this podcast. So, check them out. Um, of course we, we established a special deal for our podcast listeners and for Madow members. They'll give you your terminal for free so there's no expense in doing the switch. They'll do the whole thing for you, your patients just hand charge cards to you, like usual and you save money.
 So, we've set up a special website so you can learn more about it. It's bit.ly/fattmadow, but fat is with two t's, and it's a bit.ly, if you're familiar with that. So, there's no www or http or anything like that. So, I'll just spell it out for you. It's bit.ly/fattmadow, checkout Fattmerchant. You will definitely be glad you did and you'll save some money. 
 Dr. Rich Madow: Fantastic. Dave, ready to do the call of the day? Let's do the call of the day. I am excited. Okay, here it is.
 Dr. David Madow: Yes. Hi. How much would it cost for a good, for good teeth cleaning?
 Caller: So, you will need an exam and x-rays too, in order to get a cleaning, that'll be $161.
 Dr. David Madow: $161?
 Caller: Yes. That includes the exam, x-rays and a cleaning.
 Dr. David Madow: Okay, great. And one more question. If I want to have my teeth really nice and clean for a wedding I've got coming up, is it more important to have a cleaning or, or like a whitening or whitening procedure?
 Caller: We do have, we do whitening in the office. We have a special going for $175, which you get a tray and 2 syringes and they're reusable. But the hygienist recommends whitening after cleaning.
 Dr. David Madow: Oh, I see. Okay. That makes sense. So, doing both, maybe doing both of them is best, right?
 Caller: Correct. Yes.
 Dr. David Madow: Okay, great. Thank you so much for the information. I really appreciate it. Bye, Bye. Oh my God. I mean, could there have been a better set up for this one? I mean, okay, so the caller said I, I was the caller obviously, but okay. I want my teeth really white. I need a cleaning. I'm going to a wedding, I want, so in other words, I'm going to a wedding. I want nice teeth. And I mean, she didn't do anything. She, she gets, yeah, she gave a couple of fees, but she certainly didn't go, didn't go beyond that whatsoever. Could there had been a better setup?
 Dr. Rich Madow: It was a great setup. I mean, I think somebody really good would have had the entire wedding party in there for whitening.
 Dr. David Madow: Exactly. I mean, that's a really good point. But at least the caller, I mean, how do you know, okay, she could've said something like, well, you're going to a wedding. Let's get you in and make sure your teeth look really good. You're going to be in pictures. You want to look great. It was like a such a great opportunity. She did not take the bait at all.
 Dr. Rich Madow: Well, let's, let's go back. Let's back up a little bit because this is something that we teach in our courses a lot, that we get asked a lot, and that is when you asked how much is a cleaning, she just gave a number. Just said $161 or something like that. 
 Dr. David Madow: Right. Something like that. 
 Dr. Rich Madow: Yeah. That's kind of a loser right there. Sometimes with people push, push, push, push, push, you have to give a fee. But as we teach in our courses too, this is time for the person on the phone to take control of the call by saying something like, "Oh, you're interested in a cleaning, it sounds like you're looking for a new dentist, is that true?" And then take that opportunity to tell them how great your practice is, and tell them that, you know, there are different types of cleanings and the best thing to do is to come in for a full checkup and you know, meet the doctor, they'll even do a free consultation, whatever it is. Instead of just saying $161 and again, and we hate answering insurance questions, but let's face it, if you have good insurance, the cleaning is free. So, it's such a loaded question. She could've gotten around by saying, "Oh, it sounds like you're looking for a new dentist. Come on in and you’ll meet everybody." Just anything but just saying $161 and then nothing. And then she left it to you to ask the next question, which she got even worse, right?
 Dr. David Madow: Yeah. And see now if I would, if I would have been her, I would've used the wedding a little bit more. I would've said something like, oh, that's great. When's the wedding? And the wedding is in two weeks, that's a little bit more of an issue, but it's the wedding is like a month or two. We've got some time. Let's get an appointment, get you in and let's check everything over and let's make sure your teeth are beautiful for this wedding and you're going to look great in the pictures. I would've, I would've really gone with that one. But she really did nothing. And the scariest thing, Rich, as we see almost every time, some poor doctor that owns that practice thinks that his front desk person is doing a great job. 
 Dr. Rich Madow: And let's take it a step further. Let's, she knows nothing about you. You could be the groom, you can be the best man, you can be whatever. But take it even further, you could have, really, you know, you could have ugly composites hanging out of your anterior teeth and you know, bad shades, all kinds of crazy stuff. You could be a candidate for eight veneers. I mean, and you know, if the wedding's in a month, they can complete a multi thousand-dollar case that you've been looking for and this is the thing that pushes you over the edge because you have a wedding coming up. Who knows what could have happened with this great patient? 
 Dr. David Madow: Bingo. That's it. 
 Dr. Rich Madow: She just did not, she never, ever, ever asked for the appointment. She never made you feel welcome. As you said, you know, it's always good to have a little chit chat, good conversation. You gave her such great bait saying that there's a wedding coming up and she just wouldn't take it. 
 Dr. David Madow: Would you say She muffed it? 
 Dr. Rich Madow: She muffed it. A total muffed job. 
 Dr. David Madow: I'm giving her an F man. 
 Dr. Rich Madow: I'll give her an F plus. 
 Dr. David Madow: Hey everybody, thanks so much for being here. This was episode four of the Dental Practice Fixers and we will see you next time. Thanks so much for being a listener and a friend. 
 Dr. Rich Madow: Bye. 



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