The first blog of this series was about Stages of Dental Practice and in this post we will discuss some commonly faced problems at respective stages of practice and their solutions.

Stage 1 Introduction:

Some young doctors are worried because of low pattient footfall in initial days of practice. Actually they can take this as an opportunity & utilize the empty hours of practice to grow their network. The idea of network building is not to get direct patients but to tell the world that "You Exist!" Because Network is the Net Worth! Every practice will take its own course to establish, however some tiny steps can act as catalyst to curb this phase.

1. Interact with as many people as possible around your practice and create rapport by talking about their interests.

2. Keep your conversation generalized, however if you get a chance, push about your profession in a softer way.

3. Look to grow your online network by simply creating (free) business pages for your practice on Google and social media sites such as Facebook, Twitter etc.

4. Post content in regular intervals once the pages are ready.

Stage 2 Growth:

You can enjoy growth stage till the time you are competitive, ignoring this fact can sometimes damage the practice. Bellow are few things that you can implement in your practice for being competent.

1. Attend CDE programs/Courses regularly.

2. Invest in new equipment.

3. Start using practice management software for appointments.

4. Learn about financial management.

5. Doctors practicing in metros should also think in a direction to get Website for practice.

Stage 3 Maturity:

The most valuable thing in maturity stage is "Time". You will have to literally spend money for buying your own time. If you act smart then probably you won't have to  much efforts to save a lot of your time. Bellow are few things that you can incorporate in your practice.

1. Staff training right from doctors to front office staff.

2. Work delegation to respective person.

3. Investing in new equipments that can save you on your time.

Also this is the most appropriate stage to think about hiring an agency which can help you to boost your dental practice.

Stage 4 Saturation:

The most common complaint in this stage is "stagnated income". In order to overcome this situation you should first try to identify the problems. Some basic reasons that results in stagnated income can be, Decreased patient footfall, Low treatment charges, Absence of high end treatments or Combination of above problems. Solutions can be very simple to this problem..

1. Identify the problem factors.

2. Once you identify the problems; try to understand why the problems are occurring.

3. Evaluate all the possibilities to overcome them.

4. Make a strategy to get resolution and have deadlines for every task.

5. Spend more time in your practice as it can definitely improve your chances to find the solutions.

Stage 5 Decline:

You can't practice dentistry with stethoscope and green cloth. It is really difficult to run a successful practice without good clinical skills. Aging results in health issues such as backache, hampered vision or trembling hands etc. which sometimes makes the operator skills questionable. When one can't work because of such unavoidable factors, it's time involve fresh blood in practice. Nobody has a magic stick that can get a potential doctor like you for your practice in an overnight.

You will have to take efforts to groom young doctors by sharing your knowledge and experience which will keep the practice going, whereas you can take the charge of patient consultation and clinic management.

These are some of the important points which can bring a phenomenal change in you practice, however there are further deep aspects to every stage, which I'll share with you in my upcoming posts.

In India, we are taught dentistry but no one taught us business cycle of Dental Practice. This business illiteracy has put many dentists in dilemma; leaving them unsure about their future. I believe this is one of the primary reasons why many dentists are unhappy with their practices.

Let’s get into the details of "Lifecycle" of your practice... 

An average life of your practice is 25-30 years. It undergoes five different stages which are Introduction, Growth, Maturity, Saturation and Decline & all these stages have their own set of pros & cons. The beauty of your practice lifecycle is; unlike human lifecycle these stages can be reversed, delayed or avoided to a certain extent.

Understanding practice lifecycle gives you the orientation of Do's & Don'ts of the respective stage. It acts as a guide in strategic planning & building a successful practice. Let's try to identify which stage your practice is in.. 

Stage: 1 Introduction (Practice age: 0-3 Years)

Introduction stage is the beginning of your dental practice which lasts up to 3 years. The avg. age of the doctors in this class is between 24 to 30 years and most are bachelors. This is your first opportunity to earn (after stipend) after studying for 5-8 long years. You try your best to establish the practice; no matter however hard it takes, you are always ready! You entertain each and every patient even when you understand he/she won't go for the treatment. Sometimes if the spot selection is not proper, you end up with stiff competition.

Stage: 2 Growth (Practice age: 2-12 Years)

Growth stage lasts for 5 to 10 years and avg. age group is 26 to 40 years. It is the best stage of your practice as patient flow is good and you leap towards financial stability. You will observe the rise in your income by 15%-25% every year. Most doctors get married in the beginning of this stage and plan baby in mid-stage which sometimes adds to your financial burden and so you are ready to work as per patient’s convenience. 

Stage: 3 Maturity (Practice age: 10-20 Years)

Maturity is the stage where you enjoy the premium. This stage lasts for 5-10 years & avg. age group is 35 to 50 years. You are financially stable by this stage and you will appreciate 10%-20% rise every year but it doesn't increase like it was there in the growth stage. You will also observe change in the approach towards practice; of course you work to earn but money isn't your priority. Your priority becomes "Time" for your family which stops you from entertaining every patient; you get relatively rigid about the treatment charges and are least bothered about the competitors.

Stage: 4 Saturation (Practice age: 20-25 Years)

This stage can last for 5-10 years & it is commonly experienced after the age of 50+ years. In this stage you appreciate stagnation in your income whereas increase in your expenses. The financial requirements are increased as your kids will need money for education, marriage or business. You will also experience the increase in competition; as the young dentists to whom you considered "Bachchaa" has now entered into their growth or maturity stage... 

Stage: 5 Decline (Practice age: 25+ Years)

This is the last stage of your practice which is experienced after 60 years of age. Dentistry is a skill driven branch unlike other medical fields where green cloth, stethoscope and a prescription pad is enough for practice.

It is the stage where either you have to close down the practice or hand it over to younger generation. But there are always exceptions; I personally know some dentists who are into their 60's and still enjoying the maturity stage.

Strategic Planning!!

The above blog is based on my interactions with doctors, market research & understanding of business. You need not agree with all the points but I am sure that somewhere it co-relates to your practice. Now you know which stage your practice is in; you can always extend, delay or avoid particular stage. 

One of my good friends, a well known speaker & author of New Age Dentalpreneur  (soon to be launched) Dr.Sujit Pardeshi says "Pranav, attitude is everything! Age is just a number in our mind.. almost always!" 

Believe me,"It is possible to be always in the growth stage.."

Check out what strategies you should follow in my next blog, Life of Your Dental Practice: [Part 2] Strategic Planning!

1. Deteriorating Education Standard

In India, oral health care awareness amongst population is low resulting in fewer patients. On the other hand the number of dental schools & their intake capacity is ever increasing. Earlier the PG seats were limited so interns were getting the opportunity to perform most of the procedures but since PG seats has increased now; a lot of procedures are allowed only to PG students in many private dental colleges. In some private dental schools the situation is such that students have to pay patients to visit college and get treated.

The lack of clinical exposure obviously reflects; these young dentists hold the degree yet very few are confident about dental practice.  

2. Lack of Opportunities

Job opportunities are relatively low for dental graduates. Practically speaking there are (no) very few government jobs and even in private jobs dentists doesn’t get paid well.  

Stipend LOL!!!!!!!

Stipend ke naam pe to chavvanni atthanni milti hai...

Hope you pay some respectable salary to the dental professional at your clinic.

3. Quackery

Its 2015 still some patients are getting roadside dental treatment and no strict action is taken against quacks.

The situation is getting even worse due to some educated quacks. Some dentists are misleading patients by writing MIDA & MADA after their BDS degree (MIDA stands for “Member of Indian Dental Association”) It is not any degree but is used to brag about qualification. Whereas some post graduate dentists are working as visiting consultant under quacks.

4. The Attitude Problem

Unlike medical practitioners, many dentists are reluctant to share knowledge as they believe this will increase their own competition but in reality they are actually restricting themselves from self improvement.

Everyone is willing to practice in urban areas resulting in overcrowding & artificial saturation. This cut throat competition is resulting in price war and hampering our own future.

5. Lack of Unity

It is my personal observation that dentists don't have unity amongst them. Dentists practicing in same locality consider each other as rivals & the one who takes advantage of this situation is patient.  You can read my blog "Be the change you want to see" on www.DentistFriend.com

6. Lack of Insurance Coverage

In our country most of the medical treatments are covered under insurance but no dental treatments are covered under insurance which is somewhere restricting the industry growth.

7. Under-Performing Authorities

The authorities are getting commercial. Someone please make them realize that they are here to create new opportunities & raise the standard of dentistry. They are not just to collect sponsorships from Tooth Paste Companies.

How can we uplift the status of Dental Profession?

I believe that it's not just the fault of authorities but somewhere you & I are directly or indirectly responsible for whatever dentistry is facing today.

All of us want a better future but in reality nobody wants to take the responsibility. Let's stop this blame game because circumstances won't change until and unless we consider ourselves responsible.

On one end of the ladder is leaving the crown high and telling the patient “Settle ho jaega” and on the end is over reducing the prosthetic crown thinking “yeh supraerupt hoke contact mein aa jaega”

Unfortunately both these can have long term deleterious effects on the patients dentition and thus we clinicians should refrain from such erroneous practice.

As ethical clinicians, it is imperative that we do not introduce any interference in the patient’s mouth when crowning a tooth and this makes adjusting the occlusion at the bisque trial phase one of the most critical steps in fixed prosthodontics.

Occlusion at bisque trial should be adjusted in two separate steps:

1. Static Occlusion: where the bite is adjusted in Maximum Intercuspation with POINT contacts on functional cusp tips, mesial/distal marginal ridge and/or central fossa only. 

This should ideally be done with 40 micron Blue colour articulating paper.

2. Dynamic occlusion: where excursive contacts are checked (in working side excursion as well as non-working side excursion) and any LINE markings are eliminated completely. It is important to remember that posterior teeth should contact only during Maximum Intercuspation and should be completely disoccluded in every excursive movement.

This should ideally be done with 40 micron Red colour articulating paper

Let’s see how to go about doing a Bisque trial for tooth number 17 diagrammatically.

 First static occlusion is adjusted to achieve 4 points of contact in MIP using blue paper.

Next with red paper working excursion is checked. As depicted a line is seen on the buccal cusp. This line is a working side interference and thus should be completely eliminated.

 Following this the non working excursion is checked and any red line marking is eliminated.

This concludes the bisque trial and the crown is now ready for glazing.