Chapter 12

Management Principles

Lots of people confuse bad management with destiny.

Kin Hubbard

Most people that choose dentistry as a career have weighed their perceptions of various careers. The length of time in preparation, cost of training, qualifications for entrance, expected income, and expected lifestyle all contribute to their career choice. Most applicants to dental school understand that dentistry involves caring for people, technical and artistic expertise, and scientific and technical knowledge. Most profess loyalty to the notions of being independent (their own boss) and a member of a learned profession. However, few applicants pause to consider that they will be operating a small business. If they do consider it, they probably do not understand all that it entails. Most have the belief on entering dental school that they will have friendly patients, work on some teeth, make good money, and play golf or go fishing on Wednesdays. That vision is only partly accurate. They have loans to secure, taxes to pay, payrolls to meet, meet with suppliers, staff disagre­ements, and patients who have unreasonable expec­tations. If a person properly handles these business problems, then dentistry becomes a richly rewarding career and satisfying daily experience.

Success in dental practice comes from a combination of clinical, behavioral, and managerial skills. Each of those domains has a rich history and large body of knowledge. Each can be taught and learned. Learning business principles is no different than learning the principles of operative dentistry. Once a dentist understands the fundamental concepts, he or she can apply them to each particular circumstance. Lacking the concepts, that dentist can search for a new solution to each problem. If he or she understands the principles of business management and uses them to develop a modern business model, then the dentist can run a practice and it fulfills all of his or her personal expectations. If he or she does not understand and practice sound business management, then the practice runs the dentist, leaving him or her a victim of the needs of the practice.

Characteristics of Dental Practice

Dental Practice as a Business and a Profession

Dental practice has many characteristics of both a ­profession and a business, although dentistry and management come form entirely different mind-sets (Box 12.1). Dentistry (and therefore dental education) is scientific, procedural, and dogmatic. Most procedures have a right and wrong way to do them. Management is much less dogmatic. In fact, management teachers praise students and practitioners who do things differently than everyone else as innovators. They are encouraged to try something different, even if it does not work. (Imagine the opinion of dentists to another practitioner who tries a new way of cutting an alloy cavity ­preparation?) Dentistry teaches conformity; business management teaches to be different. Dentistry teaches the safe, proven, tried, and true methods; management teaches innovation and experimentation.

Dental practice is a business. A business is an individual or group effort to distribute goods or services for a profit. This is done by providing an economic good or service that the public wants and needs. A business tries to make a profit. In fact, this profit motive separates businesses from public organizations that are often only held to the standards of accountability and not ­losing money. Society expects business owners to treat customers fairly and honestly but not necessarily to look out for the best interest of the customer. In fact, there is always some tension between the business and customer as each tries to gain in a transaction. Dental practices are businesses in that society expects them to generate income, pay bills, and follow regulations the same as any other business.

Dental practitioners are also professionals. Society has created the professions and granted them certain privileges. To be considered a profession, members must possess ­special knowledge that the public does not have. Gaining this knowledge often involves long training requirements that are not necessary in other vocations. Because the ­professions hold this advanced knowledge, society allows them to regulate themselves through licensure, education standards, and disciplinary actions. They are then relatively free form lay control. The knowledge that professionals hold and apply is necessary for the ongoing functioning of society as a whole, not something from which only few benefit. Because society grants so much authority in the professions, they also expect members to place the good of society above personal interest. That is not to say that society expects a vow of poverty from the members of ­professions, but they expect professionals to do what is best for patients, not just their own pocketbooks. If professionals abuse this power, then society can unilaterally change the rules through legislative actions.

A dental practitioner can satisfy both views in his or her practices when these differences are understood. In interactions with patients, concern for the patient must drive suggestions for treatment, and the treatment itself must be given as a professional. Business interest must not dictate or even influence patient interactions and the delivery of the care. The structure in which a professional delivers is the business of dentistry. Here, systems and methods are established that allow a dental practitioner to profit from the dental care that provided. The hazy line that separates the two often leads to tension for the practitioner. Which side “wins” if a given insurance plan’s reimbursement for a procedure is too low to allow for adequate profit, but it is in the patient’s best interest? Such problems lead professional to continually rebalance business and professional interactions.

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