Yours Truly — future TMJ Specialist

When I received the phone call from a USC dental school classmate inviting me to a 40 year reunion, I was something way short of excited. I hadn’t stayed in touch with more than a couple of the guys—and I use that term generically to refer to both male and female-type dentists—and I wasn’t sure I wanted to see the results of 40 years of leaning over a dental chair and listening to the high-pitched whine of a handpiece.

My lack of enthusiasm may have also been because only a few short months before I had attended my 45th high school reunion. I did manage to reconnect with a couple of old friends from back in those distant days of the 1960s, but on the whole it was a pretty boring evening. I dragged my wife, Andrea, to the gathering and she was less than pleased with the whole affair.

But after a little consideration, we made relatively short trip to Anaheim for an evening with many of the old gang (note to self: Never drive from San Diego to LA on a Friday afternoon. You might be able to make it faster on a bicycle). And the result? Fabulous.

So it’s 40 years on. Some of us are retired, though most are not. Some have sold their ownership in the practice, but are still working in the practice as associates—employees of the new owner. A few of the guys have passed on. But on the whole there was a good turnout with more than half the old class there for the reunion.

Now, it was apparent that a lot organization and planning went into the event. Certainly much more than went into my high school reunion. There were shared emails for several months. There was a nice banquet room at the Hilton Hotel next to the Convention Center. There was a bar and a good spread of snacks to eat. All of us had name tags with—what else?—our photo from the senior year book. I didn’t realize I looked like I was 14 years old when I graduated. It’s no wonder that patients back in 1972 asked, “Are you old enough to be doing this?”

And now, 40 years later, we’ve all found our way somehow. Most of us have put on a few pounds and lost a little—or a lot—of hair since 1972. I think we’ve all suffered some hearing loss. It sure was hard to hear each other talk in that banquet room! I wonder how many stories could be told. Has it been a “long, strange trip,” like the Grateful Dead song says? I got the feeling, hanging out with all these guys again that for some it has been exactly that and for some neither particularly long nor strange. Just a steady path to a great career. Furthermore, for most there is still a passion for dentistry.

Looking around the room I couldn’t help but wonder what a vast storehouse of knowledge and experience is locked up in all our heads and hands. I know what it’s like to be a new graduate: bursting with confidence, the idea that you can do almost anything in dentistry. And then the gradual realization that there is still much to learn. And then continued learning not just for a few years, but for decades.

I was left with a feeling of some regret, a feeling that I should never have let all those old connections go. I was left with the knowledge that USC class of 1972 is simply a great bunch of guys.

Here’s what I know about USC dental school’s class of 1972: we worked darned hard to get through it; we worked hard to achieve what we accomplished in the years since; we’re a mostly down-to-earth and fun group; as a group we carry ourselves with a certain quiet and sure dignity; we’re successful, we know it, and we don’t really have to prove it. I sure wish I could bottle that up and pass it along to a younger generation of dentists only now trying to figure out things we all did a long time ago.

What could we tell the young dentists? For those younger guys and ladies still trying to figure out how in the world you’ll ever pay off those student loans it’s a mixed message. Time is fleeting. The 40th reunion came around much faster than I would have imagined. You need to get with it and grow the practice.

But at the same time, be patient. Don’t run out and buy the car of your dreams (or house of your dreams, etc. etc.) too soon. Your abilities will grow. Your experience will accumulate. You can be an overnight success in about seven years. You won’t have a mature practice until you’ve paid dues way beyond graduating from dental school.

For me, I know a lot of time has gone by since I connected with the class of 1972. But it’s not too late, even now. There’s a good deal of camaraderie left to share, old memories and new ones. Today’s technology makes it almost easy. This week we’ll all share addresses, phone numbers, email addresses. Here’s to staying in touch a little better before the 50th (whew!) comes along.

The dog looked up at his owner. “Woof.”

Thirty seconds, then a minute went by. My wife and I walked past. The man’s gaze never left the cell phone.

“Woof.”

We walked on another block and I looked back. The dog still lay at the man’s feet. The man still held the phone in both hands, his thumbs working the keypad.

“Woof.”

Even a dog knows we’re too plugged in and disconnected.

And on local hiking trails, I often see a couple walking together. But when one of them has the little white ear buds of an iPod in his ears, what kind of walk together is that? One of our family friends confided in us that she hates going for walks with her husband because he listens to music on his MP3 player while they hike or stroll. She feels alone and isolated even though they’re together.

When my own nieces and nephews come over to the house for dinner, or we meet at their grandfather’s place for a holiday meal you can imagine the scene, right? The twenty-somethings aren’t talking with us. Their heads are down reading text messages, their thumbs flying over the key pads at an impressive 80 words a minute. Sometimes they chuckle at a private joke that has showed up on screen. But otherwise, it’s hard to get anything out of them.

Almost 50 years ago, Paul Simon wrote a song called The Dangling Conversation. The song paints a picture of a couple together but not talking with each other; they are reading. And they “mark their place with bookmarkers, to measure what they’ve lost.”

What they lost was an opportunity to actually relate with each other. Was it the book’s fault, or did they really prefer not to relate personally anyway? Holding a book is an easy barrier. And so is a tablet, a cell phone or a lap top.

What they’ve lost is obvious to everybody except those who are so plugged into electronic toys that they ignore people around them. They don’t seem to notice how much they’re losing. Any chance of real connection is gone in favor of an electronic one.

Now, you personally aren’t guilty of any of that bad behavior. But you see it and are affected by it. So, what to do?

I Google searched “Cell Phone Etiquette,” and the information is easily available. Listed no-no’s are: Ignoring people who should have your attention, yakking endlessly in the line at the grocery store, talking too loudly in the doctor’s waiting room. All those things are supposedly off-limits. I guess nobody reads etiquette rules anymore.

One of my patients, a bright and sweet lady, has a solution, at least in her own home. She placed a good sized basket just inside her front door. Anyone coming for a visit has to check all electronic gizmos at the door—kind of like cowboys in the old West checking their guns at the swinging doors of the saloon.

“But, why Grandma?” her 14 year old grandson whined.

“Because when we’re at dinner, I want to see your shining face, not the top of your head while you sit there texting. Cell phones, music players, lap tops, everything goes in the basket.” I’m sure she says it sweetly but firmly enough that all visitors, even adults, obey the rule.

I like it. A no cell phone zone. By the way, this is the one and only sign in our reception room:

Click for larger view

Now, I’m sure none of you talk about your personal business while you’re in line at Vons, but you know there are folks who do. And loudly at that. Up to now, I’ve just pretended not to notice. But I think it’s time for some gentle correction. So, here’s my idea.

You’ve probably seen those clever notes you can leave on a car that is parked so close to yours that you have to open the passenger side door and crawl over the seats. Something about leaving you a can opener next time, right?

Well, I’ve found that the folks at Post-it Notes will make and print custom sticky notes for you. Any size. Would you like extra sticky with that?

Okay, so here are a few I have printed:

• “I talk about my daughter-in-law’s affair on my cell phone in the grocery store.”
• “I broke up with my boyfriend on my cell phone in an elevator.”
• “I talk about my husband’s anatomy on my cell while waiting in line at the cleaners.”
• “I have 230 Facebook friends but no real ones.”
• “I gossip about my neighbors sex lives on my cell in the doctor’s waiting room.”

Now you have to be a little subtle, but I’ve found that with practice you can get really good at this. You overhear things nobody should hear in a public place. You get the appropriate custom sticky out of your pocket or purse and pretend to accidentally bump the person. And of course you plant the sticky on your victim’s back for everyone to read. And you imagine what it’s like when he or she gets home and finds the sticky. Oh, so that’s why everybody laughed when I checked out at Ralphs.

So, that’s it. A gizmo basket at your own front door, and a bunch of custom sticky notes. Change the rudeness of your world one obnoxious yakker at a time. Even dogs will be grateful.

A few months ago, my wife, Andrea and I met Michael Gerber’s wife Luz Delia. She understands The E-Myth very well, so well in fact that it took her about 90 seconds to explain the nittty-gritty of it and how it definitely related to my practice. She gave us a gift: a new book entitled, The E-Myth Chiropractor. That book also sat around, but not for very long.

Want to hang out with a book and actually get through it? Try getting out of town. That’s what it took for us.

About every 6 to 8 weeks, we manage to get away for a few days. And one of our favorite get away spots is Picacho State Park on the Colorado River. It’s a desert park about 20 miles north of Yuma, Arizona and from October to March it’s a delight. No phones, no cell service, no TV, no internet. No distractions. Bathroom with flush toilet? Sorry. But don’t worry; the chef does bring her kitchen. We spent three days there in late February.

Andrea Halligan is all set for dinner in Picacho State Park.

As an aside, Zane Grey fans may recognize the name Picacho as it was the setting for at least part of the action in his novel The Wanderer of the Wastelands.

Picacho State Park boat launch and campground.

There was once a town on this very spot. There was a bustling mining camp nearby; the goldmine employed 700 miners and the town had 3 elementary schools and an equal number of saloons. The mine gave up most of its gold by the early 1900s and the town was abandoned by about 1909. Now a state campground with a boat launch it is a favorite for bass fishermen and canoeists.

Looking West: Picacho is named for the high mountain peak on the horizon.

As you can see, this is desert with not a growing thing in sight.

But a river flows here, and for half a mile on either side, you can see the green of willows, Palo Verde and ironwood trees and all manner of desert shrubs.

Andrea and I started each day with a leisurely walk along the river and then settled into shady spots for hours of reading—me technical and clinical journals, and Andrea The E-Myth Chiropractor. Every few minutes she interrupted my reading to share a paragraph or two from her book. When finished, she said something quite amazing: “This is the book I was born to read.”

Of course, I had to dig into that book as well.

The desert night sky at Picacho.

The weather was fine in the desert, and if you’ve ever experienced the amazing sea of stars in a desert night sky, you can understand why we eschewed the tent and slept each night in the open with sleeping bags right on the ground. We lay side by side on our backs watching the heavens: the sliver of a moon followed by bright Venus and Jupiter dipping to the horizon. Then Mars and the Pleiades and the Hunter Orion with his dog close behind. And while we watched we talked about Gerber’s book.

His premise is that we aren’t business people. We may say we own a business—a practice. But in fact we act as employees, “doing it, doing it, doing it, until we can’t do it any more,” in the words of the book.

Of course in dental practice we need to do dentistry, but we have to put on another hat, that of the business owner who manages and manages really well. We need to develop systems that work and are tested and then recorded in detail. We need to think strategically, and not just do lip-service to that term. Our product, Gerber says, is not our dentistry, or at least not just that. Our product is the practice itself. The product is a practice that is alive and growing and functioning smoothly in all areas and should go on living and thriving for someone else long after we are gone or retired.

The practice itself as product: that is a thought I had never considered. And it’s actually quite a lofty goal, and one that is worth pursuing.

I believe there is a book in Gerber’s series just for dentists. But Luz Delia chose to give us The E-Myth Chiropractor. She may have done that because of my particular kind of practice—it’s more like chiropractic than general dentistry.  But on the other hand, maybe she knew that the message and specific strategies in this book would fit dentistry just fine.

Over the years I’ve read a lot of practice management books. My wife and I have both been deeply influenced by Omer Reed. We’ve both heard Sally Mckenzie and the Du Molins. But not many have had the impact of this book. You may think it can’t be for you, because of the title. But it is about you, your practice, your family, and your life. Just get a copy. And if you need to get away from the TV and the computer and the phones to really digest it, get to your favorite place, settle into the shade and do it.

“I love dentistry. I’d even do it for free. In fact, sometimes I do. And so do you. The difference is I know when I’m doing it for free.”
~ Omer Reed

To The Dentist: Thinking about your practice long-term

In a recent column in his Dental Town publication, Howard Farran wrote that in our current economy a dentist should reduce fees and join the discount dental insurance plans in order to stay busy and survive the downturn. He also recommended using low cost—read “cheap”—dental labs for work that requires a laboratory. This week, I just want to throw in my 2 cents. My opinion? Howard’s wrong on this one. Since Dr. Farran has an MBA and is one very bright dentist, I even wonder if he was kidding. But it wasn’t the April 1st issue, so I guess he was serious.

I had my annual tax meeting with my accountant last week and at the end of our review of my practice I asked a question: “How many of your dentist clients are signed up with the discount insurance plans, and how are they doing?”

For a few seconds he just shook his head. It looked like I’d struck a nerve, if you’ll pardon the expression. “I have 500 dentist clients in my practice. About 325 of them are on the plans. Most of them wish they weren’t. But once you’re in, it’s very hard to get out. I had a young man in here just a few days ago, sitting in the chair you’re sitting in now. We reviewed his practice in detail. How many patients did he see during the year, what work was done? At one point I said to him, ‘You did 270 crown restorations last year for no pay. Zero.’ By the look on his face, I thought he was going to cry.”

“Suppose you were an idiot, and suppose you were a member of Congress. But I repeat myself”
~ Mark Twain

Here’s the situation as I see it. Thanks to a number of factors, including our own government’s actions, we’re in an economic down turn. There are a couple of possibilities that could unfold over the next few years. The American economy could collapse and we’ll be like Greece, begging for bailouts from other countries. If that happens, all bets are off anyway.

But I am optimistic. We’re Americans. We know how to get things done, including righting this ship. In a few years we should be enjoying a robust economy again. What if, those few years down the road, you’re a “Preferred Provider” (preferred by the insco, not necessarily by your patients) and you’re doing the same work for a 30% to 50% reduced fee. How much more work do you have to do, how many more hours will you spend in your office for the same take home pay? You had better be running a real well-oiled machine, or you’ll have less take home pay. This economy will improve. Will you still be stuck with a decision made in a bad economy?

“The dentist is often the lowest paid staff member. Maybe it’s a good thing he doesn’t know that.”
~ Omer Reed

The decision to join a discount insurance plan is a long term one. You won’t be able to simply stop when the economy improves. Getting out of the plans takes some real planning, some real number crunching with the help of your accountant. Be prepared for a tough time in your practice for at least a few months when you drop even the worst of the plans. Even in a strong economy, you may still be the dentist who has to use a less than top quality lab because you can’t afford to do otherwise.

Am I telling you to avoid those plans in no uncertain terms? I can’t say that unequivocally. I know a few dentists who are top-notch practitioners, and they still participate in some discount insurance plans. In general I’ll say this: If you’re not a Preferred Provider in one of those plans, please think twice before becoming one, and even then, sit down with your accountant and take a very serious look at what a 30% discount means. If you’re already in the plans and wishing you weren’t, a serious strategy for getting out is required. Again, request the help of your accountant. My point is, don’t make a short-term decision that will run your life and your practice for years or even decades to come. Times will change. Take the long view. Just look at a couple of pictures that make the point:

Duration: The Inca Trail is 26 miles of paving stones laid down 500 years ago and hiked by an estimated 75 thousand of tourists every year.

Andrea and a 500 year old Inca wall.

These Inca walls were built so precisely that not even a sheet of paper or a knife blade will fit between the rocks. There was no mortar used, yet these walls have survived numerous storms and earthquakes for centuries. How was it done? No one knows for sure. It is thought that each stone was shaped and smoothed painstakingly to fit the adjacent stones with great care and accuracy. Think of these walls as a symbol of Care, Skill and Judgment—and that is what you really have to offer your patients.

Back to the title: Your short-term decisions will have long-term ramifications. If your practice is going to have to have long-term growth and thrive not just survive, then your relationships with patients will need to have longevity too. And your dental restorations will require longevity. Look to improve those three. Think in terms of care, skill and judgment.  You can’t have all of those things at a 30% discount. Just my opinion.

Cusco City. The famous Plaza de Armas is on the bottom right of the photo.

A single titanium implant can be placed for under $500 and the implant restoration placed for about the same fee. So, single implant and restoration for less than $1,000. It appears that the “all on four” approach to the full arch implant restoration has not caught on in this part of the world just yet. I saw ads for 12 implants and crowns per arch.

Euro Implant Center in the “Dentel” clinic, Cusco, Pero.

Are they providing the precision of excellent 3D conebeam guided implant placement? At those discounted fees, I doubt it. This past weekend, I attended a course on the latest in 3D imaging and how that technology relates to implant placement.  I asked one of the presenters, Dr. Jay Reznick, a Los Angeles oral surgeon, if he had seen any of the implant cases done at low cost South American clinics. He said he had.  While not all such cases are poor quality, those done at bargain basement fees would hardly qualify as a temporary in the States:  Final implant restorations done with thin aluminum shell crowns, chairside fabricated acrylic, etc.  And the implants themselves were of low quality and none were from reputable manufacturers.  The lesson as always is, read the fine print and beware of unbelievable bargains.

After two days in Cusco, we left the city for the mountain trails.

Salkantay, a mountain sacred to the Incas. Our first day of hiking.

The intrepid hikers. Andrea and me at 15,253 feet at the Salkantay Pass. It's mid-summer in Peru, but cold at this elevation. Yes, that’s snow in the background.

A rainy day in Machu Picchu.

High in the Andes and above the clouds.

Here is a wonderful testimonial from Angela G:

Hello Dr. Halligan, Andrea and Debbie,

I just wanted to thank you for the wonderful medical treatment I received from you. You made me feel very comfortable and paid attention to my situation as if I was your only patient. I feel grateful to have known you personally as well as professionally. I think we have met before somewhere in time.

Your approach to treatment is very scientific in nature and you explain it to me in a way I understood without having any knowledge in TMJ. Actually, I had no idea what it was before I came to you. All I know is that my dentist wanted me to check and see if I had a problem.

I am grateful for the treatment I received from you and I love your “bed side manner” and the way you greeted me every time I came to your office, with a big smile.

Hope we meet again soon.

Namaste

Angela G

Click here to read more testimonials.