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Running a dental practice in a time of crisis

It is said that crises are always the times in history when the greatest business opportunities arise. However, in the midst of crises, it can often be difficult to remain optimistic and see the big opportunities. Nevertheless, they are there.

I've always been fascinated by the way other dentists run their practices, just as I've always been inspired by other industries' ways of doing things. In this post, we take a closer look at what general dentists can learn from ordinary clinics in different European countries, why this is interesting in a time of crisis and how you can be inspired by other dentists.

Dark woman frames her beautiful smile with her fingers

Do dentists run their practices differently?

The last year has been interesting for me in several ways. Firstly, I have had the opportunity to pass on some of my knowledge about practice management, patient communication and clear aligner treatments to colleagues in several countries in Europe. It has provided an interesting insight into the way dentists run their practices relatively differently.

Below you will get an overview of the differences between different countries in Europe and finally you will be able to read more about what you can do to increase profitability, improve job satisfaction and at the same time reduce stress levels in your dental practice.

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Don't get me wrong, there's basically not much difference in running a dental practice, no matter where you are in the world. But there is a huge difference in the framework in which the practices operate. Take the Netherlands, for example. Here, all prices are dictated by the state. Price differences are due solely to differences in the cost of laboratory fees, which must be added to the patient's bill and, moreover, documented on the patient's bill by a copy of the laboratory bill! As a consequence of the State's zealous control of dentists' finances, many practices have become enormously adept at delegating tasks to their staff, without this leading to any reduction in quality.

State intervention distortion

Sweden has a complex system of extensive state subsidies on some services and none on others. This creates a bias in the way patients are treated, as it is much easier to convince patients to have treatment where the state pays most. Whereas services with 100% fee for service are significantly more difficult to market. Perhaps in reality because dentists in Sweden are not used to having to assist patients to desire a given treatment, making them want to invest in the treatment. However, the way complex treatments are subsidised means that Swedes generally receive more comprehensive restorative treatments.

A bureaucratic nightmare

In Germany, the practices struggle with enormous amounts of bureaucracy. In several places, sterilisation processes have become so time-consuming that in larger cities the task can be outsourced to separate companies that take care of cleaning, packing and sterilising the clinic's instruments. These companies simply pick up and bring the equipment to the practice because it is easier and less risky than having the practice's own staff perform the task, as they can easily make procedural errors and be held accountable to governmental oversight authorities. Even receiving goods and disposing of used packaging has become a time-consuming challenge.

However, it has also led to several clinicians developing innovative electronic documentation systems that make it easy to track the movement of all goods through the practice - patient-specifically.

Freedom through mutual respect

Looking out the window and watching the swiss alps

Switzerland has a very liberal system by and large, although it is influenced to some extent by health insurance. The public trusts that dentists generally have an interest in meeting the highest professional and hygienic standards. Public scrutiny is a rarity that virtually no colleagues will experience in their lifetime. Despite the influence of private insurance, the system is relatively agile and allows a great deal of freedom for individual practices. A reasonable economy, good framework conditions and a requirement for relatively extensive annual continuing education allow dentists to focus strongly on their professionalism. This is only possible because there is a general understanding that people, across all industries, generally want to do their job as well as possible. Which means that dentists, by definition, are the ones who know the most about treating teeth and therefore what steps to take to run the best possible practice. Partly for the patients but also for the owner and staff.

The phoenix

Belgium only started training dental hygienists a few years ago. Many dental practices are one-man practices in the literal sense of the word. They do not even employ a dental assistant or receptionist. In general, it seems that dental practices in Belgium are run in a very old-fashioned way. Needless to say, running a dental practice in such an environment is quite challenging. The majority of dentists are opposed to dental hygienists and employee delegation possibilities. However, it is a relatively free market, so dentists often have the freedom to set their prices as they wish and practice in a way they find most appropriate. There is, however, a bias towards health insurances, which have some influence on pricing. With a massive shortage of dentists, entrepreneurial practice owners have a real opportunity to create a successful dental practice with a focus on high professional standards and good economics.

When chains (DSO's) take over the market

Finland is characterised by around 80% of all dental practices being part of some form of DSO. This creates inappropriate internal workflows that make it difficult for individual dentists to be effective. The ownership structure is somewhat different from what I have seen in chain clinics around the world, as they allow each dentist a large degree of influence over his or her own schedule. Many dentists therefore have the opportunity to achieve a better balance in life as they become skilled at managing their appointment books.

The effect of strong competition

The Norwegian dental market seems to me to be the least restrictive. However, there is extremely strong competition for patients in the big cities, while there is a great shortage of dentists in rural areas. As in Sweden, in Norway it is possible to build up a really good business in areas that are far from the big cities.

The successful dental clinics in the major cities have generally become adept at branding, as they need to differentiate themselves in order to keep their patients and attract new ones.

A free market, with no interference in pricing structures from government or insurance, creates some of the best conditions for running a dental practice. Especially in the more remote parts of the country, dentists have a real opportunity to create the life they dream of.

Opportunities in constraints

The reason I write about all these regional differences is partly that we can learn a relatively much amount about running an efficient and profitable dental practice by looking at "best practice" across countries' opportunities and constraints. But perhaps even more interestingly, crises and challenging framework conditions have been the driving force behind innovative ways of running practices. Just as crises in general have created major new breakthroughs in society at large.

During my 18 years as a practicing dentist, I experienced several crises. None of them were particularly pleasant to be in when they were going on. But by actively acting to come through the crises stronger, I always managed to come through them and stand stronger on the other side.

I have no doubt that the countries which, as a result of mutual trust between dentistry and society, have the least control and the best framework conditions are those where dentists are able to treat their patients best, achieve a reasonable financial situation, combined with a balanced working life. But even though you might not be in such a market. It is possible to find ways to improve your workflow and achieve more financial freedom while living a more balanced life.

Proactive rather than reactive

When we don't have an ideal environment to run a clinic in Denmark, it's worth looking at the possibilities that exist in our environment to create the type of dental practice we dream of. It is so easy to blind ourselves with all the limitations. It just doesn't help to complain about everything you could wish for differently, because it doesn't change the situation. Instead, it helps to look for opportunities, focus on what we can change, develop an action plan and ally with a sparring partner who can help keep the focus and then make the best of the framework in which we have to operate.

Woman looking at financial papers

In times of crisis there are always companies that go bankrupt and disappear from the market. A few years ago, it was estimated that around 25% of all Danish dental practices would go bankrupt if the owner took out a salary equivalent to that of an employed dentist....

A month ago I got the latest figures from one of the big accounting firms. Today the number has increased to 50%.....

This means that about half of all Danish dental practices have some serious challenges that require action.

I don't necessarily know your area's financial challenges for dentists. However, I have seen a general trend in Europe that it has become increasingly difficult for dentists to run a profitable dental practice.

As you've probably heard before: If you keep doing what you always do, don't expect to get any different results from what you always get.

In other words. If you want change, you have to do something different from what you used to do.

Winners of the future

It is always in times of crisis that the successful companies of the future are being shaped. This is because these companies rethink their business structure, implement new knowledge and technology. It is also clear that the best thing to do to become part of the winners of the future is to invest in knowledge and technology. Especially when the crisis hits. When the level of activity goes down, we have the time to get smarter, reflect and implement new ways of working and work with new technology.

A word of warning: it is rarely a good idea to start by implementing new technology. All too often I have seen new technology introduced into dental practices that is never going to provide a return that justifies the investment. On the other hand, I have never seen practices lose money by getting smarter, creating a clear vision followed by clear goals with plans that lead to the goal via clearly defined responsibilities for execution, resources, deadlines and follow-up.

Practice optimisation

Right now, I'm being contacted by a lot of practice owners who want to get better at getting patients to accept the treatments they need. Often, however, it turns out to be much more effective to start somewhere else.

In most dental practices, it is possible to double or triple profits within 2-3 months. This in a way that reduces stress levels among all team members and makes it more fun for everyone to come to work, without having to learn a lot about patient communication. In fact, it is more about how we can become better at structuring our workflows in the practice.

Once the stress level has decreased and the profits have gone up. It becomes much less demanding to implement new skills like communication tools. In addition it often becomes a much more profitable way to do it like this.

You can of course spend time and money hiring a consultant to come into the practice and help with the changes. But maybe... maybe theis is not the most appropriate way to start for you...

Honestly. I actually think that a lot of dental practice owners, would benefit from starting somewhere completely different. That's why I, along with dentist and stress coach Lars Nielsen, developed a one week course where 4 instructors, take a small group of dentists to Italy.

Here we seek the peace for reflection and spend time calibrating and developing each colleague's inner compass and personal leadership first. Indeed, this is essential if participants are to return to their everyday lives with skills that lead to greater job satisfaction, a better work-life balance and much higher earnings.

You are of course always welcome to call or write me if you want a free conversation about your opportunities.

Exciting news

One final note of encouragement: most economists agree that the current crisis will be relatively short-lived, probably leaving only a small dip in the boom that was slowed when Europe was drawn into a war on the Eastern Front. So 2023 is likely to be relatively dull, whereas 2024 seems to have a bright promise. So keep your spirits high and make sure you inform your patients about the best possible treatment. They probably say they need to "think about it", but that doesn't mean "no thanks" to treatment forever. Once the crisis is over, you will be able to reap the rewards of your current efforts in the years to come.

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Jesper Hatt DDS smiling to the camera

Many kind regards

Dentist & Consultant

Jesper Hatt DDS

Phone: +41 78 268 0078


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