Dental Practice Heroes

How to Get Your Team to Diagnose, Treat, and Communicate Consistently

• Paul Etchison, Henry Ernst, Stephen Markowitz • Episode 588

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Case acceptance is down. Patients are confused. Your team is frustrated. Sound familiar? These are all signs your practice is out of alignment. Whether you own one practice or multiple locations, this episode will help you get everyone on the same page clinically — from the front office to hygienists, assistants, and doctors.

You’ll learn how to run effective calibration meetings that set clear clinical standards, get your team on board, and guide them without conflict. These tips will improve communication and cut out the chaos in your practice!

Topics discussed in this episode:

  • The key to getting your team on the same page
  • How to get your team engaged
  • The first step to clinical calibration
  • Why you should coach and not teach
  • The role of SOPs and team buy-in


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Paul Etchison:

Is your team on the same page? If you have to think about your answer, then chances are they're not, but no worries. Today the DPH coaches and I are talking about how to get your team aligned, consistent and working together. Learn how to run effective calibration meetings, how to coach rather than teach, and that one special thing that you need to do before you can get everybody on the same page. You are listening to the Dental Practice Heroes podcast, where we teach dentists how to step back from the chair, empower their team and build a practice that gives them their life back. I'm your host, dr Paul Etcheson, dental coach, author of two books on dental practice management and owner of a large four-doctor practice that runs with ease, while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started.

Paul Etchison:

Welcome back to the Dental Practice Heroes podcast. I am your host, dr Paul Edgerson, and today I'm joined by my DPH coaches, dr Henry Ernst, owner of an 18-op practice in the Carolinas, and Dr Steve Markowitz, who has a six-practice group on the East Coast and has a vacation home in Nantucket that he is getting ready to. I do not. He is going, I do not. He is going to have a vacation home in Nantucket that he is getting ready to. I do not. Here's Garo, I do not. He's going to have a fancy weekend in Nantucket, so welcome, let's go there for a weekend. Welcome, steve. Steve, thank you, pips. Yeah, so Steve does not have a home in Nantucket. He has an estate, two homes.

Steve Markowitz:

That's why he's being humble, he we just spent the past five to seven minutes. I was telling them how much I enjoy hanging out with these guys, and the first thing they do, as soon as Paul Press record, is find a way to crap on me. So I am pushing back. Oh shit, dude, we're like bullies.

Paul Etchison:

Henry.

Steve Markowitz:

Yeah, I really, I'm really feeling.

Henry Ernst:

It's a sign of love, steve. We only mess with people that we love, and it's both ways bro I appreciate that.

Paul Etchison:

So today we are talking about you know getting. We always talk about when we see an office in chaos. Typically it'll be like a coaching client presenting. They'll say, hey, like you know what, I got a department that's not working out very well. A lot of times I feel like it's the front desk. It's like they don't know what to do. They don't know what's up there. But we rarely ever talk about how to get everybody on the same page clinically. How do we get consistency in our clinical department on the backend? Because what we're looking for and what our patients are looking for as consumers as our patients are consumers is they're looking for a consistent experience. I always say they want what I got last time, I'm getting it this time. If I send anybody to you, they will also get that same treatment. So how do we get our clinical teams on the same page? So I'll go to you first, henry. Like I mean when your experience, like when people don't nail this.

Henry Ernst:

What does this look like? It's really challenging as an owner of a multiple doctor practice or even multiple hygiene practice. You know, is the fact that it's a Chick-fil-A sandwich, right? If I have Chick-fil-A in Chicago, nantucket, if they have Chick-fil-A there I don't know if they allow them Never or Charlotte, or, you know, south Carolina, it should be the same, it should be the same quality, should be the same consistency everywhere, and that's the hard secret sauce that you have as an owner. And what I've found that's really, really valuable is what I call calibration meetings. So a calibration meeting is you know, you got a new doctor. That's starting Like in our practice.

Henry Ernst:

We typically have four to five doctors. We typically have doctor meetings once a month. New doctor comes on board. A good time to just reinstitute those calibrations. Like, hey, we'll show pictures of a tooth with a broken mesiobuccal cusp, right? What's the standard for this, right? If we have a broken cusp, we're not doing a big humongous restoration fill. You know the standard for this, right? If we have a broken cusp, we're not doing a big humongous restoration fill. You know a filling or something like that. We're doing a crown, if you like, an onlay. You know something like that If we see this decay this deep, we're always going to add a root canal preemptively, just to say, you know, as worst case. So if we're removing all the teeth in the office and we're doing a denture case, we're always going to give them the backup of implant over denture, right? So all of us should be the same and those calibration meetings are very valuable to make sure we're the same.

Henry Ernst:

And that goes for hygiene too. Like I know Paul we were talking about the other night like we have about eight, nine hygienists each, something like that. Does one hygienist recommend gum infection therapy and does another one not. It should be some calibrated, like a scale gets calibrated, so it's always the same. That's the most important thing. And your team should feel comfortable. A hygiene team, for example.

Henry Ernst:

I love it when I'll see the hygienist in the hallway and they're looking at a panoramic or they're looking at some bite wings and looking at, they're like what do you think about this case? And they're discussing it with each other, right? So they don't feel like, oh my God, I'm going to be wrong. You know, it's okay to be like to be in the middle, right, because this is dentistry, we're practicing dentistry, but I love the calibration meetings. Those are really important. You also have to set calibrations for your team that's going to bring the information to you. So let's talk about dental assistants. Are we always taking in-roll photos of that broken cusp Right? Are we just taking an x-ray, a PAA, and that doesn't mean anything to a patient? You show a patient an amalgam that's broken and cracked and you'll get more treatment acceptance. So we always have to calibrate them to make sure that we're always having the same information presented.

Paul Etchison:

Yeah, Like when they give you the picture of the fractured marginal ridge and there's a ton of spit bubbles on it and it's like blurry and coming from the side and you're like what can I do with this?

Henry Ernst:

Yeah, so that should be a calibration right there. This is not acceptable. We need clarity, right? If I'm a patient, I'm making a big decision. I want a clear picture, so take another one.

Paul Etchison:

So you know, just a hypothetical situation, Henry, you're an associate, there's an associate in your practice and rather than tell that assistant right there, this is an unacceptable photo, could you take a better photo? That associate goes and tells the lead assistant, so the lead assistant could tell that assistant that took the photo. Do you have a asking for a friend? Do you have a suggestion for that associate? That might be a better approach.

Henry Ernst:

Typically I preemptively treatment, plan the case for a walk in the room. So I'll take the x-rays, I'll take the photos. A lot of times the assistant will be like next to me and I'll just look at the pic maybe in that spit bubble picture, and I'll say you know what, I don't think this picture looks so great. You know, just if I was showing you this tooth, you know, would this make sense to you? Let's just take a better one. Do you need help with me getting the saliva out of the way for you? I think that comes at it as good as possible.

Paul Etchison:

It's almost too simple. Thank you, henry. That's amazing. You know that's an issue that the reason I'm asking is because that has come up in my practice and this is something we've actually been working on.

Henry Ernst:

We've had that happen before and we've just said you know what, let's have our next dental assistant meeting, let's spend half that time just practicing taking inter-roll photos and maybe the people who take the best ones can lead that and let's just consistently take great photos. I mean, photographs are the biggest part when you're not doing it. I mean, you're true, in plan acceptance it's down for a reason.

Paul Etchison:

Well, you know it's funny, we just had this all day meeting on Friday. So we're having this meeting. I'm speaking, I'm like, hey, let's do this exercise, this exercise together, and what I'm trying to do is to get more direct confrontation or not confrontation, just like discussion. And we came up with a lot of issues. That was one of the ones that came up and we would say, okay, if you were an assistant and any assistant, feel free to chime in. You know I've got nine assistants. Feel free to chime in, you know I've got nine assistants. Feel free to chime in If you wanted to. If someone was to tell you how they needed that picture to be different and they need you to retake it, how would you like to be told. And it was like, so simple.

Paul Etchison:

But then we had this other one that was like the front desk has a patient go up there and the doctor has said you need an extraction, and didn't mention crap about the bone graft or the membrane, but let the front desk then be the first person to tell the patient about it. So we're saying this is hypothetical, I'm not singling out anybody and like Dr Steve's, like, is this about me? I'm like this has nothing to do with you, dr Steve. And then I'm like, even though you were the only one in this practice that uses a membrane, I don't want to single you out and that uses a membrane, I don't want to single you out.

Paul Etchison:

And then, like the girls in the back, it's you, steve, it's you, you do it, yeah. And he's like, oh, I would just tell me, hey, it really screws me over when that happens, no big deal. And I'm like, yes, yes, we can communicate. So it's little things like that, getting everybody on the same page clinically. I mean, we mentioned the calibration meetings, but that's something too. It's like, can we please mention the membrane in the bone graft, so that the front desk is sitting there? Like, hey, what is this? Oh, I don't know. The doctor didn't mention it.

Henry Ernst:

That's calibrating the treatment plants too. I'll give you one example. We do something called socket gel Sock. You ever heard of that stuff that you give for extractions? Yeah, so years ago I found that material and I'm like, oh man, it prevents dry sockets, that's great. So years ago we just said we're going to add this to every single extraction and if there's more than four extractions you get two, you know, and stuff like that. But the point is now it's a system and it's automatic and it's nice because we charge like 20 bucks for it. So we probably make a spread of like 10, 12 bucks on it.

Paul Etchison:

But that's the reason we have so much less post-op visits or dry sockets potentially, but Tell people what it is if they're listening and they don't know.

Henry Ernst:

So it's called socket gel. They're not a sponsor of the program. It's just like a tube. It comes in a big red tube and I think it costs about seven or eight bucks and you give it to the patient and it has like a little instruction thing. A little instruction thing and basically what they do is they can put it on their gauze for the first day or two or they could just squirt it directly in there and it's just a gel and the studies have shown that it prevents dry sockets. And I can't tell you it really hit me when we started using it a lot and patients would come in and they were they had an extraction done like four or five days ago Like, oh, I'm on that socket gel, can I buy another one? Because there was just something about it. And so I mean we have a huge box of it and we always I think there's like an open dental where you can click extraction. It's dummy proof. It automatically clicks the socket gel.

Paul Etchison:

I like that. That's really cool. Well, hey, Steve, you've been sitting here so patiently.

Steve Markowitz:

Dude, I'm just timing myself. I was quiet for nine minutes. I know that is the longest I've ever not spoke in history in history in history.

Paul Etchison:

Yeah, it's like when you're like when you can tell your wife just touched the thermostat, like you know something's wrong and you don't know what it is, you're just after a while you're like something changed. That's what I felt right there. I felt like Steve.

Steve Markowitz:

If anyone's watching the video, I'm like tweaking out, I'm.

Henry Ernst:

You touched the thermostat. I haven't touched the thermostat in 25 years of marriage. Bro, are you serious? No, how do you live?

Steve Markowitz:

Very cold. I just live. She keeps it cold. Oh, we're rocking.

Henry Ernst:

She keeps it cold.

Steve Markowitz:

I'm good Live cold and happy.

Paul Etchison:

Oh God, we are warm and I can't get any more naked I am literally like 71 degrees in here. This is exciting at 40 years old, damn, okay. Hey, we're kind of getting in the weeds. I love it. Hey, stephen. Stephen from Nantucket.

Steve Markowitz:

What's happening. So let's turn back to getting everyone on the same page.

Paul Etchison:

Clinically, yes, that's what we're bringing in.

Steve Markowitz:

I have a couple things. I wrote them down so you know they're true. Even before the calibration meetings, which I think are amazing, you need to set your own standards, so you need to go through every procedure and write it down. This is what we're going to do when we need a crown. This is when we're going to recommend scaling. This is when we're going to recommend I don't know debridement. This is where we're going to recommend the 4346 gingivitis code. This is where we're going to recommend and define it for yourself. Understand how you want to communicate that with the team, and then you can create those calibration meetings, because you will have everyone be able to see what your standard of excellence is. That's step one. Step two is, especially when you're a multi-doctor, multi-provider practices, those calibration meetings are awesome. Henry beat that up and did a great job.

Steve Markowitz:

The third point that I wrote down that, I think, is something that I talk about with my doctors, associate doctors, all the time is coaching moments versus teaching moments, and there's a distinct difference. To me, a teaching moment is not anything particular, paul, kind of what you were talking about in a group setting. We're going to talk about this thing. We're not going to single anyone out and now everyone's sitting there and they're saying I can't believe someone would do that and they don't even know that I'm talking about them. Who did that? Coaching moments. And what I encourage all of our doctors or any of our leaders to do is create these coaching moments.

Steve Markowitz:

Someone does something. They take an x-ray that isn't it's missing the apex. So they take a picture that let's look at that together and say we've set up our standards in the moment. Can you do me a favor and take that? Take that picture again. Or let me show you how I would take that picture, because this person's tongue is the size of their face. I know this is really hard. Let me show you how I would do it. Create as many coaching opportunities throughout the day and then you'll see that improvement or that calibration happen a lot quicker. It's not that teaching doesn't work. Teaching works. It just takes a hell of a longer because there's less accountability through it. So I would encourage everyone to find as many coaching opportunities and they happen every day in a dental office Take advantage of them. Lead your team to understand why you're doing it, and then you'll see them grow.

Paul Etchison:

Yeah, you know the why is important too, because you mentioned the apex thing. You may be like, oh my God, my assistant never gets the apex and your assistant might go wait, you got a problem with my PAs. I miss the top of the root every now and then, but damn, I always get at least 95% of it. You know they don't know they're like I got most of the root. What do you need? You need that last little piece, that little nugget, doc. Are we?

Steve Markowitz:

that particular Because they don't understand when we acquire a new practice and their clinical standards may be very different than what we are used to. The first thing I'll say to a hygienist or a doctor I was like that's your tooth, what would you want to do with that if that was yours? And just kind of see where they're at? Today I had a hygienist tell me they had a tooth that was savable. It would need a root canal and a crown. And I asked her she's newer to us. I asked her I was like what would you do with that tooth? And she's like, honestly, I would wait till it bothered me, I would take it out and then I'd put an implant in. And I was shocked by that, because it's a savable tooth, it would need a root canal. And it led to a conversation of like Tell me more, why would you, in your experiences, led you to think that that's the appropriate situation.

Henry Ernst:

Is that an experienced hygienist? That's an experienced hygienist? Yeah, because they've seen stuff fail and they're like I wouldn't put that money into that thorn tooth.

Steve Markowitz:

Yeah, but even in this situation, there's just so much good that can come out of that, just by having understanding where they're at. And their first thing is like well, I'm not, I don't have DDS after my name, I'm, you know, I'm just the assistant. I'm like no, no, no, no, no. You've seen more teeth than actually some of these doctors have Come over here. Let's talk this out. And those are the moments where we can actually learn where they're at and then coach them to calibrate to where, how we see things.

Paul Etchison:

Yeah, that's a great point. I love that you brought that up. You know, one thing that popped in my head was just having some sort of SOP, standard procedure, you know, or what standard of protocol? What is SOP, standard Operating Procedure? Ah, standard Operating Procedure. See, you know, I've been abbreviating so long I forgot who invented it.

Paul Etchison:

But you know, having something for, like, what x-rays do we take? When do we take panos? That's like the thing that comes up. I see it in a lot of coaching clients' offices. I want my team to take more panos. We're missing the opportunity for that revenue and we're not getting the information and blah, blah blah. And there is no protocol of when do we take this. Ideal time for us to take a pano at my office is, you know, when the eight and nine have erupted and seven and ten are coming. That's when we want it. We want it then, and then typically we'll time it every five years after that, which will give us canine eruption, will give us wisdom teeth eruption. Those are the three things we're looking at for.

Steve Markowitz:

Yeah, that's a great point, paul. I think, starting with x-rays, x-ray protocols, perio protocols when do I crown a tooth? Are probably the three areas I would start.

Henry Ernst:

yeah, when introducing calibrations one of the things that I found very valuable, that I did years ago when we started having, you know, hiring front desk people who had no experience in dentistry. I created a video. It's about an hour long. It's called dentist, we call it dentistry for dummies and basically it just starts from, like, a point of view like you have no idea from dentistry, you have no idea from anything about dentistry. It talks about what is a crown, when do we do a crown? When do we do a filling? What is gum infection therapy? Why do we do it? You know what is sedation, what are our expectations? And it's very dummy proof, no-transcript.

Henry Ernst:

Do we think it would be a good idea if we have something that we can ask them if they'd like us to put on their teeth? That'll make it better? Oh, yeah, that's great. So we use Brush Bond or Gluma and other offices use it. Why don't we just offer it to them? And what do we think we should charge? Hey, 35, 40 bucks, that sounds fair. Okay, great, let's do it. Let's make a pact that we're always going to ask every single patient sensitive teeth, that we're going to offer this service to them. So it makes a pact. It doesn't just stand from a top like a bully pulpit and say, okay, this is scaling and root planning, this is what we're going to do here. You're basically saying is there value? And they say yes, and then we all agree that we'll be a better clinical team if we offer this and do this.

Paul Etchison:

I think what I hear you saying, henry, a good point, is that these procedures and these protocols that we're creating as practice owners are much more likely to stick if we involve the team and the owner doctor doesn't need to sit there alone in the office and write all these things by themselves. Involve your team, like what do you guys think? I mean, I can't tell you how many situations with my team that, from their perspective, just seem like there's an easy solution, and when I discuss it with them and they see all perspectives, they go shit, yeah, I don't know what to do now. Well, that's in my position. There's no good answers.

Henry Ernst:

Yeah, do know. Well, that's in my position. There's no good answers. Yeah, I'll give you one or two good examples here is like maybe after COVID, like the world was just a shit show everywhere. And I remember there was a period of time where we didn't do these meetings like we normally do, and I remember there was a patient that I saw it wasn't my patient, I don't really see new patients so this patient, 99 dentists out of 100 were triumphant. Two crowns on these two teeth, two was eight and nine and I put it on a platter, a silver platter for the associate. I talked to the patient, I said, yeah, one of them already had a root canal, the other one was really, really broken. And so I said, oh, you need two crowns. This is why blah, blah, blah but you know I need one of my other doctors to do this, he's really good at this and she said, yes, and then, about an hour later, I looked at the chart and I saw that it had one crown and one filling.

Steve Markowitz:

And I was just like what, why?

Henry Ernst:

And I tried to explain to this young associate doctor. I said listen, you think you're a hero, donna, sometimes like you're going to be this patient's best friend, you're going to come in there and be ball this tooth is going to break very soon and why. You made your life harder too. It would have been so much easier to just put two crowns. You made your life harder. So this was this instance where, if we continually had those meetings, that wouldn't have happened.

Steve Markowitz:

Yeah absolutely Even before that, henry. Like when you have multiple doctors like that and you guys are saying different things, people you're in the dental office they're already adverse to trusting what's going to be happening and when they hear they don't hear consistency. That's right. They don't get that Chick-fil-A sandwich the same way every single time. They're going to be less apt to trust anything that they hear. Yeah, so even like part of these calibration meetings is like why is it so important that we're all on the same page? Because we need our patients to trust us and if I'm saying something different in this room than you are in the next, we are fighting each other and taking worse care of our patients.

Henry Ernst:

And it's hard at dentistry because there's no magic button you can touch a tooth with that says boop, boop, boop, boop, boop. Crown. Boop, boop, boop, boop, boop. Filling right, Not yet. It's coming. It's probably probably coming.

Henry Ernst:

We all three of us could see three different things and it could be real quick here on the um, calibration of the team and x-rays and stuff like that. Sometimes I feel like our team would get our dentist too, would get so bogged down. And this is an emergency patient. They come in with broken tooth number four. We can only look at tooth number four right now. Remember I started seeing emergencies, you know new patients for a short period of time when we were short of doc and all of a sudden I showed the doctor. So I was like, look, I got this patient that comes in with number four, but I've got a panorex of all the other teeth. Now I'm telling them you know what? Yeah, this tooth needs treatment, but you know what these other four teeth do. And now, next thing, you know I've got four crowns and two root canals and been so stuck on that one tooth. There's no rule that you can't tell them and offer them what they actually need, and they're afraid to do that sometimes.

Paul Etchison:

Well, I think you actually screw the patient over sometimes doing that too. Doing where you don't is because there's been a number of times and maybe somebody listening can relate to this is where you did that single tooth. You fixed number four, you had a root canal and crown on and then they had rampant decay all over the hell place. And then they come back and they're like, well, shit, I'm out of money and I'm like you know what we should have done with that number four? We should have yanked that sucker out. We could have fixed like seven or eight, nine teeth for that same amount of money Exactly.

Paul Etchison:

And it's like you're kind of really not giving them the whole picture. So, yeah, great discussion guys. So I honestly, hey, if you're listening to this and you want a better running practice and you're I mean, just listen to Steve and Henry here what would it be like if you had somebody looking at your practice every month, talking to you, giving you complete focus on how to make your practice better? Do you think working with either of these guys could help you? And I think that's an obvious yes. I mean so much knowledge here and we went in a lot of different directions, but I think it was really great.

Paul Etchison:

And you know what? Henry actually posted his Dentistry 101 video on our Hero Collective community, to which I watched and realized my Dentistry 101 video is not very good because there's a lot of things I watched in Henry's and I go damn it. I forgot I should have put that in there. And now I'm like, well, I'll make an addendum to my video. I'll make an addendum to my video. It's, I can't addend it, I have to redo the whole damn thing.

Henry Ernst:

Sharing is caring. You can just give it mine if you want to, man.

Paul Etchison:

Well, no, I don't want to do that. Then you're the authority. I like being dude. Come on, I want my team to see me as, like the guy, I'm the guy. So if you're thinking about working with a coach, check it out at dentalpract.

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