ELEMENTS

OF
GROWING
A DENTAL
PRACTICE

Follow along my journey from

scratch start to scalable business

BY DR. SHANE FRANCIS

 Introduction

Section One: Making Your First Moves

Pages 2 - 14

Section Two: Diving Into the Details

Pages 15 - 27

Section Three: Differentiate Your Business

Pages 28 - 34

Page 1
 Introduction

Welcome everyone! I first off want to say this is most

definitely not just a book for dental professionals as the title
may suggest. My name is Shane Francis, I live in beautiful
Victoria British Columbia, Canada and I am an entrepreneur
at heart that happens to be a dental professional. Although
essentially all examples given in this book are from my
experience building a dental practice from scratch I strongly
believe the principles of building a business can be scaled
from what I discuss. Fair warning, I am not a professional
writer I simply wrote this book to speak to my reader and
share the knowledge that I have gained along my
entrepreneurial journey that I feel can help people all around
the world get through the things that I struggled with along
the way. I hope you enjoy the book and take away the
knowledge that has helped me realize the success as a
young entrepreneur. Lets go!

So you want to start a dental practice! Or you are looking to

take your current dental practice to the next level. Or maybe
you just want to start a totally unrelated business. This is the
most exciting business in the world to be part of. I believe it
and if you dont believe it after reading this book you need to
reconsider what career path you are following. Life is too
short. On a daily basis you have the ability to change
peoples lives. You can take an individual with absolutely no
self confidence who refuses to smile due to dark, discoloured
teeth and, in a very short period of time, transform this
invdividual into a new person who embodies confidence and

Page 1
 Introduction

smiles wide at every opportunity. You have this magic ability

to take an individual in the worst pain of their life and in an
hour or so with the movement of a couple metal instruments
completely relieve their pain. You get to be a magician
everyday you go to work. Dont ever forget that. Dont ever
forget how lucky we are to have the unique opportunity to
provide the life changing services we can. So lets look at
what it took for me to grow a dental practice from the ground
up to a efficient business that can operate even while I am
half way across the world.
A number of topics will be discussed throughout this book,
but I want you to keep in mind that a fundamental reason for
a dental office to exist is to provide the highest level of care
to the patients it serves. In no way will I ever suggest a
practice building method that compromises patient care.
Initially I thought I would tailor this book to only to dental
practice startups since I learned a great deal of this
information from my first startup practice, but the information
contained within this book is just as applicable to a well
established or struggling dental practice.

Section One: Making Your First Moves

Mission Statement and Core Values

Before contractors start to build a house they ensure a

detailed set of house plans has been written with sufficient

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 Section One: Making Your First Moves

detail to answer all future questions about construction of

the house. These plans will be the basis for all future
decisions during the construction of the home. A business, or
in this case a dental practice is no different. You will need to
sit down and do some very deep searching for the purpose
for your organization to exist within the market, the
community you are choosing to practice in. In your mission
statement you want to include a concise overview of the
scope of services or products you will offer and what impact
you are trying to have on the market. Make it unique. Make it
your own. Your next objective is to list out the core values of
your business. What is important to you? What will you hold
yourself to in your day to day operations? There are
countless resources online about these two topics so I wont
say anything further. Go YouTube both of these topics and
this will jump start the process for you.

Your Number One Asset - Its Reputation

A highly regarded dental clinic with its reputation kept in the

highest regard will self maintain. In his book Good to Great
Jim Collins describes the flywheel example where through
consistent and deliberate small efforts everyday what was
once a heavy, difficult flywheel to move begins to
gain momentum with time and consistency and eventually
has enough momentum that only small consistent effort is
required to maintain the same speed of the flywheel.

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 Section One: Making Your First Moves

There are so many milestones along your practices growth

curve that you can lose sight of maintaining the practices
culture, its stellar reputation and in this the very future of
your practice. I get it, as you start to have a busier schedule
you start spending 7 to 8 hours of your day in the office in the
operatory preparing teeth. Michael Gerber in The E-Myth
refers to this as the work of the technician You no longer are
keeping a finger on the pulse of the practice. You didnt catch
that your one dental assistant is not acting with empathy
towards all of your patients and is even coming off rude at
times. You dont have the quality control in place to assure
that new patient you recommended 10 anterior crowns
receive a detailed, accurate estimation of treatment costs.
The patient follows up with your front desk asking about the
cost of treatment two weeks later and your front desk
member is scrambling to find the words to avoid making your
business look entirely incompetent. You will be lucky if this
patient does not go onto public social media (Google Review,
Facebook etc.) and share their poor experience. This will be
visible forever by the way. You lost track of the details while
you were too busy acting as only a technician in your
business (read The E-Myth and this will hold more value). A
bad review is not the end of the world, I suggest you just bury
the thing with 100 positive reviews and make the poor
reviewer look like they dont know what theyre talking about.

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 Section One: Making Your First Moves

My point here is that no matter what direction your practice,

your business takes that you maintain the core principles that
you wrote in your mission statement and core values. You
need to nurture your business reputation like a baby fern,
consistently providing all the care and attention it requires.
Jim Colllins in Good to Great drills home the point to perform
autopsies, engage in dialogue (with your team), debate and
repeat over and over again. A constant engagement in
quality control and auditing was pivotal for me to maintain
order and consistency within the practice. Remember the
core values you have written down in your operations manual
(we will cover operations manuals later in the book) and
shared with all team members over and over again and keep
these values in mind each and every day through each and
every decision. In a business where the direction is always
looking forward it is so simple to lose track of previously seen
patients along the way. This is where specific and detailed
reports within your practice management software can make
your life a lot simpler. If you are truly a paper chart practice I
dont know what to say. Its probably time to pull that band
aid off and join us in the twenty first century. I think Ive been
watching too many Gary Vaynerchuk YouTube videos
because that last statement sounded harsh even to me.

Designing Your Office

Design your office to look non intimidating and non-

traditional. Why would you want to look like every other
dental office? A good rule of thumb is to go into 5 dental

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 Section One: Making Your First Moves

offices that are over 10 years old and generally do the exact
opposite. If you already have an established dental office you
can make some small subtle changes that can have a huge
impact. Change some of the photographs within the office.
Introduce an essential oil diffuser into the reception area and
make sure a smiling face is always sitting or standing behind
your reception desk. Christian Coachman (if youre a dentist
and dont know the name you need to follow this guy on
social media) speaks frequently about emotional dentistry.
An approach to dentistry where we appeal to our patients
emotions to give them the life changing care they so badly
deserve. One of the first examples he used in his last lecture
I attended was to spend some time in high end hotel lobbies
in large cities. The Ritz-Carleton, Fairmont go into these
hotels and look at how they use indirect lighting and warm,
luxurious finishings to create a relaxing, welcoming
environment. This doesn't mean you need to spend a fortune
on decorating your office. There are countless affordable
decor options that can give your office a distinguished, high
end appearance. The use of non-aggressive and light scents
as you enter the doors lets your clients know this is a place
that cares about how its patrons feel. Creating a safe,
welcoming environment and culture within your practice is
going to put your patients in a relaxed state of mind where
they can finally put their guard down that has prevented them
from recieinvg the care they so badly need and want. All of
these details from start to finish are so critical to the end goal
you cant miss a single one. The end goal being you
changing more lives through your business operations.

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 Section One: Making Your First Moves

Building Your Team

This topic is so important and deserves a significant amount

of your attention when you approach building your own team.
The dentist that has the most difficult team building ahead of
them is the one that has just bought a dinosaur of a practice
that has had the same dysfunctional team for the last 20
years who have each consistently been given pay raises way
above what their job title and have become so complacent
because they know how things are done around here. Good
luck implementing any change with this team. Sorry that is
my doom and gloom on this topic but I feel for the dentist that
has inherited this situation.

A good simple rule to start out with is that a team should be

selected first for a culture and team fit and only once this
criteria is met should you consider technical training and
skills of the applicant. Likely you as the dentist will be
performing the interview alone, but I will encourage you to
have someone else like a hygienist or receptionist join you
for the interview. I am definitely guilty of missing some red
flags in applicants during a short initial interview that others
caught right away. Trust your teams judgement and dont
take on this responsibility alone. Here is the formula we have
found to work well in our practice. After we have received a
number of applicants for a position we start with a short
meeting in the office that starts with one of our girls taking
the applicant on a tour of the office letting them know a little

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 Section One: Making Your First Moves

of what we are about and introducing them to each team

member along the way. The applicant then meets with the
dentist for a fairly informal interview where we are primarily
looking to make sure the applicants values align well with
our own. After the interview I consult with the team members
and get a brief idea of their thoughts on the applicant. Why
do I involve the team so much in the interview process? I
have learned that it is not the practice owner that hires the
applicant it is the team that hires the applicant. I have
interviewed many applicants that I felt would be a good fit
with the team and a number of the existing team members
caught several red flags that proved to be true and would
have resulted in division of the team. For my first 3 years in a
number of different associateships I got to experience that
one problem that persisted through most all dental offices
was a team that lacked unity and common direction and
frequently this manifested as a cliquey team with either
avoiding each other at all costs or clashing throughout the
day. Thanks to my mentors I was able to experience teams
that were all on the same page moving towards a common
goal. It was amazing the first time I was able to practice with
such a team! Isnt it true that things dont seem to become
possible until we have seen them occurring in real life?
Okay so the applicant has met all the criteria for a culture fit
and the team had a positive first impression. At this time I
invite the applicant in for a shadowing day. The applicant will
shadow a team member in a similar position for the day and
we encourage interaction with as much of the team as

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possible. This is where we really try out the applicants fit with
other team members. Generally throughout the day I am able
to see how the applicant is interacting with the team in
situations that I am not directly involved in, almost like a fly
on the wall. Provided this day of shadowing shows promise
for the applicant we will move to a second working interview
where the applicant will get hands on experience. For a
dental assistant, they will get to spend the day with a dentist
to prove technical skills and ability. For a hygienist, we would
schedule them a half day of patients to get a clear idea of
how the patients respond to the applying hygienist.
I want to spend some time on when to add the next team
members. My approach here is to add the team member
before their job title or position is 100% required. Ive read a
lot of dental books written by dental consultant gurus who
themselves I should note are not dentists. Almost all of these
books have advocated keeping a very lean team
encouraging and advocating the minimum number of staff. I
get it. The single largest overhead expense for a dental
practice is staffing costs. I think I should differentiate that a
lot of the examples these dental consultants have given is
the well established dental practice that the owner dentist
has hired more job positions than really is necessary My
argument of when to add team members will apply more to
the startup of a dental practice or the practice that is
experiencing practice size growth and requires more team
members. My biggest mentor in dentistry always advocated
filling the position well before it is absolutely required. Think

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 Section One: Making Your First Moves

about it, this decision of when a new position is available is

actually quite subjective. Lets use an example I experienced
early on in practice growth and I know a lot of other practice
owners can relate to. Likely a scratch start practice wilI start
with a single hygienist a couple days a week. I dont think this
is a bad approach but it does require some strategy to
balance overhead cost of paying the hygienist with offering
enough variety in appointment times and days to offer
convenience to your patients. The simple rule I feel applies
here is that the second hygeinist needs to be added even
before you feel they are absolutely required. Lets say you
offer three days of hygiene throughout the week and you are
approximately 75% scheduled over the next three weeks.
Over the next three weeks only 25% of your hygeine
appointments are availalbe. I will argue that this is right on
the cusp of being where you need to add two more hygiene
days. In this example the second hygienist or more hygienist
days are added before the schedule is 100% full. At this point
you should also have a general idea of what rate of growth
you are currently experiencing and this will apply to when you
add team members.

New Patient Experience

I strongly believe this is the most important appointment your

patient will ever have with your office. Note how I have title
this section the New Patient Experience? Not the New
Patient Exam or New Patient Appointment. You need to look
at this appointment as the greatest opportunity to set your

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 Section One: Making Your First Moves

business apart from anything the patient has ever

experienced in this market. With careful attention to a
number of key details this is easily achieved. Lets be honest
the bar has not been set very high in the dental industry in
regards to customer experience. Consistently follow through
with the details I am about to describe for this new patient
experience and I promise you will have set a new tone for
your new patients and built a stronger level of rapport and
trust that leads to high case acceptance and long term,
happy patients. Remove yourself from the dentist role, the
technician as Michael Gerber would refer to it, and imagine
you are a new patient to your dental office.
You are somewhat anxious about visiting the dentist and it
has been more years than youd like to admit since youve
been to the dentist. You called into this dental office that
seemed to have a great reputation and were pleasantly
surprised with how non-judgement, non-assuming and
empathetic the receptionist was on the first call and
immediately put you at ease assuring you were in great
hands with their team. You then arrive to the office for your
first physical experience and open the door to a front seating
and reception area that resembles more of a high end hotel
lobby or spa than a dental office. There is a hint of floral
essential oil diffusing through the air and a professionally
dressed receptionist (not wearing scrubs!) at the front desk
greeting you with a big smile. You almost question if you are
in the wrong office until you see the business name on a
beautiful sign behind the reception counter. The smiling

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receptionist walks from around the counter and introduces

herself insisting you must be our new patient and guides you
to an area to fill out the new patient forms. New patient forms
are a huge missed opportunity with nearly every single office
I have ever worked at. I wont cover this topic in this book but
feel free to email me and I will gladly answer any questions
you might have. After the new patient forms have been filled
out fully a dental assistant enters the waiting area and
introduces herself with a big smile asking how you are doing
today and inviting you on a tour of the office introducing you
to any of the team members you pass so that things start to
become less intimidating and you feel more a part of this
office already! The dental assistant seats you in a private
operatory and starts a very light conversation asking about
some of the information you had just filled out on your new
patient form. I see youve recently moved from Calgary, how
are you enjoying our city so far? Or I noticed you work at the
engineering firm just down the road, how long have you been
in the profession? Only after a short discussion of non-dental
topics and rapport building does the conversation shift to the
patients chief concern and dental history. I will stop the
example here and touch on a few critical points in the new
patient experience that follow, but I hope the previous
dialogue gives you an idea of how we need to put ourselves
in the patients shoes and analyze how each of these touch
points appear and feel to the patient. I will go into some of
the technical details of the new patient experience now. As a
part of our thorough data collection to later discuss the

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patient's conditions with them I have implemented a specific

digital workflow for the new patient that includes a very
important set of standard photos. After all appropriate
radiographs have been captured the dental assistant takes
the point and shoot camera that is wifi enabled along with the
retractors and occlusal mirror to capture the standard
photoset for all new patients. With the appropriate software
and wifi capability the photographs are immediately
displayed on a monitor to the patients side. The doctor can
now take the discussion of the patients condition to a visual
level that the patient cannot deny as it is so evident on the
large monitor. These photographs are now stored on your
server for future reference. Photos can be zoomed in on the
touch screen monitor to highlight occlusal decay starting in
the grooves or to illustrate incisal wear on the canine and
incisor teeth as a result of a poorly aligned bite. This is a
game changer. Showing the patient their condition through a
mirror is showing them what they see everyday through their
eyes and it may not be obvious what you are trying to
illustrate. Displaying a clear image on a monitor that can be
zoomed in is an entirely different experience and realization
for the patient. Create a culture of photographs within your
practice. Note that I mentioned a point and shoot camera and
not the giant DSLR (digital single-lens relflex camera) that
you bought and your team refuses to use. The large DSLR
for your big cases has its place but the point and shoot is
unmeasurably more valuable I can assure you. The point and
shoot is small and quick, something that your team can grab

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and start shooting with in the fast paced day of your dental
office. With all of these photographs you will be able to have
a portfolio that I call "Quick Case Reference Examples" for
each of the common types of patients that might come to
your office for optional treatment. For example, I have a
couple of veneer patients that have different conditions to
show my possible veneer consults. I have a case with simple
gum contouring and bonding on the edges of teeth as I
commonly see patients for consults about this condition. The
list goes on but would include Invisalign patients, implants,
etc. Having this "Quick Case Reference Examples" on the
desktop of each of the computers in each of the operatories
allows either your assistant or a hygeinist to show patients
what you are capable of without you even being there. This
should be a general goal to master delegation to your team
and allow them an appropriate amount of autonomy and
independence. I think there is a time and place the dentist
needs to be present and build rapport with the patient but I
personally have my assistant do a large part of my
consultation both before and after I have come in and met
and examined the patient.

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 Section Two: Diving Into the Details

Section 2: Diving Into the Details

Marketing

Marketing falls under two main areas. Direct and indirect

marketing. Indirect marketing is everything you do and
everything that you are in the eyes of your current and
prospective clients. Everything down to the name of your
practice, they way your team dresses, the way the phone is
answered. The experience, the culture, the touch points of
your business all fall under indirect marketing. There is no
outright attempt at selling your client on your products or
services in indirect marketing. In a startup practice situation,
direct marketing can be a make or break differentiator to get
the ball rolling. Think about it, you open your doors and have
absolutely no patients. You are relying solely on people
walking by your door (I hope youre not 5 floors up in a
hidden office building!) and being curious enough to come in
the door and inquire further about the services and products
you offer. Dont worry if you are in an office building with no
outside exposure you can still build a massively successful
dental practice! Allowing enough capital to afford a strong
marketing budget for the first year or two (depending on your
market) of the startup is critical. Cash flow is going to be very
limited for a period and you will need capital available to
maintain a consistent marketing strategy guiding patients
toward your practice. The good news is that with the advent
of social media there are more avenues of affordable, even

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free marketing and advertising available. When I first started

in dentistry I learned very quickly that the word marketing
was quite taboo in the profession, at least among the older
generations of dental professionals. In our particular
jurisdiction the governing body is providing guidelines on
how we are allowed to market our practices and services. I
think this is a great thing, provided we are not unreasonably
limited in marketing our businesses. Certain marketing
practices can lower the value and reputation of our
profession and should be regulated. I will give some
examples of direct marketing that I have direct experience
with. Remember that no matter what the form of direct
marketing it needs to meet the criteria of being trackable. If
we cannot track the results of our marketing how can we
know if it is working for us or not? How can we track our
return on investment? Ill tell you what I mean. In the below
example with Google Adwords I employ a marketing
management company (I currently use SearchKingz, I have
used Reach Local in the past, if you have any specific
questions feel free to email me.) to set up my marketing
campaigns. Within their service I receive full tracking of my
campaign including call recording. On their dashboard I am
able to link certain phone call leads to what services the
patient received at the office and therefore can calculate the
return on my initial marketing investment.

Google Adwords - google is king when it comes to a

prospective client looking for a good or service. When a

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patient is ready to commit significant financial investment into

10 veneers or when they have a painful toothache that needs
immediate attention its very likely that they are going to turn
to Google to give them the information on who to choose for
their dental services. What is Google Adwords also know as
PayPerClick? You know when you search for something on
Google and the top three links are labelled as ad? Those
are where you ad will show up among a few other places.
This form of marketing is not cheap and you will need to
allocate a decent marketing budget each month to your
campaign. What do I mean by decent amount? There are no
rules and you can play around with the amounts but to give
you a rough idea I started out with a monthly management
fee of around $300 and I allocated around $1800 to $2200
that goes directly to Google for adwords. I have tracked my
campaigns very closely and can say the return on investment
here is generally a 2 to 1 or 3 to 1 depending on the month.

Facebook Ads - I really cant comment on this particular

marketing vehicle but I want you to keep an eye on it so it am
mentioning it here. We have invested recently in Facebook
Advertising but need to track metrics for a longer period
before I will comment more. So far what Ive learned is that it
is a low cost low return marketing. If you have $300 a month
to add to your marketing budget I think it is better spent on
Facebook Ads than a newspaper ad or bus stop. Why?
Because it is infinitely more specific. You can target your
audience down to the most specific detail instead of just

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spewing an ad out at every single car that drives by a street

in a day. YouTube ads fall right in with this category and Im
curious to explore these mediums in the future.

Growth Too Fast

Wouldnt it seem that this would be a great problem to have!

I agree if you are experiencing rapid growth you are officially
in the realm of good problems, new problems, big problems.
Trust me this is where you to be. Just like Newtons law of
gravity it is law that you will always have problems. So why
not have big, new, exciting problems instead of old, recurring
boring problems. Just remember that there is not a final
problem-free destination so dont kid yourself, especially in
the world of dental practice ownership. Okay give me a
moment to explain big problems. Big and new problems arise
from things like growth, more new patients, better treatment
acceptance and all of a sudden the schedule is over three
weeks booked out. This is a problem because where are the
new patients that have urgent problems going to be fit into
the schedule? Telling the patient who has a chipped or
broken front tooth that you can fit them in at the end of the
month is not a great practice builder, this patient is going to
seek treatment elsewhere. So back to a warning on how
rapid growth can be detrimental. Think of the core of your
business and why it exists, what you wrote down as your
mission statement that embodies your philosophy. The
easiest time to lose track of the proper direction of your
organization is when you are busy with other things. I am

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certainly not suggesting that you start turning away new

patients if you are experiencing rapid growth but dont start to
compromise on all the small things that have your philosophy
and culture written all over them. Remain true to these
philosophy and culture values even while experiencing rapid
growth by all means possible.

Growth Indicators and Auditing Maturation

How do you know if you are doing a good job? There needs
to be constant and real time auditing of where your business
is at and how it is performing. How do we measure this? Is it
how many new patients are walking in the door? This is
important but far from the whole picture. There is no single
performance indicator that will tell you if you are operating
well. There are a number of metrics to keep an eye on
throughout your practice growth. I wont be covering each
and every practice metric in this book as it is not the purpose
of writing this, but I will cover some examples of how to
monitor some of these metrics. Yes you will want to know
your new patients but the problem here is that if you ask one
dentist how their practice is doing they tend to blurt out how
many new patients they are getting each month as if this is a
measure of how their practice is doing. If you havent heard
of the back door let me explain how this can be even more
important than the number of new patients coming in the
front door. If you are getting 50 new patients per month
through the front door but 25 patients are sneaking out the

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back door because they were not followed up with to

schedule their treatment or they didnt receive an estimate of
treatment costs or any other reason, how many new patients
did you really get that month? Imagine the new patient
experience (the first visit a patient has with your business) as
being the first (more accurately second or third because
patients generally call over the phone first) checkpoint along
a long list that each and every must pass through. All the
way from new patient experience to providing treatment cost
estimates and answering patients financial questions to
scheduling the appointment to confirming the appointment to
providing treatment to keeping the patient in the recall
system there is a detailed checklist of criteria that must be
met. This sentence is incredibly oversimplified. With each of
these steps there is such a delicate amount of details that if
not respected the entire process will breakdown and you will
have more patients running out your back door than there
are coming in the front door. I hope this illustrates why the
new patient per month metric isnt the gold standard for
practice growth but it is still an important metric.
I wont go into detail on hygiene numbers but the general
goal is that a hygeinist should be producing three times their
hourly wage or salary. So if a hygeinist is compensated $42
an hour they should be producing around $126 a hour or
ideally more. Also keeping your hygiene schedule full can
become a responsibility of your hygienist as well. Teach
them how to run an outstanding hygeine report. The golden
rule to follow is that all hygiene patients must leave with a

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scheduled recall appointment even if they are resistant

because they dont know their future schedule. Appointments
can always be rescheduled later on but assure the patient
that it is best to save their appointment time now as
appointments become limited as the time comes closer. I
want to share where I found a tonne of value in ensuring
growth was consistent. The best part is that this can be
100% delegated to an assistant. I chose to learn this from
the ground up myself because I wanted to know the ins and
outs of nearly every aspect of my business. I had to write the
operations manual, the training manual etc so I needed to
know all of these things. What I would do is after two weeks
had passed I would go back in the schedule to day one and
starting with the first patient we saw that day go through a
thorough chart audit to ensure not a single detail was
missed. Was the treatment plan entered properly into the
chart? Was the patient given an accurate estimate? Were
pre-authorizations sent to the insurance carrier for any major
work? Did the patient schedule treatment? If the patient did
not schedule treatment, why not? Follow up with the patient
at appropriate intervals. You are not bothering a patient
when you are recommending treatment that you fully 100%
stand behind and feel will make the patient healthier and
happier. Every two weeks I would take a Sunday morning
and go through every single patient we saw and make a list
for my team to correct and follow up with. No patient was
forgotten about. We werent waiting on the insurance
company. We were fully accountable for every detail in

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ensuring the patient received the care we recommended.

Once this becomes a system within your practice and is
happening like a well oiled machine even when you are
vacationing in Spain for two weeks is when you have a
serious metric representing growth and success.

Keep More Procedures Within Your Practice

One of the first things I mentioned at the start of this book is

that no matter how much we talk about the bottom line or
what might be a profitable business decision, if it
compromises the quality of patient care it shouldnt even be
considered. We are healthcare providers holding the highest
standards, but this does not need to be mutually exclusive
from operating an efficient and profitable business. Every
market will be different so what I was experiencing when I
opened my practice doors will be different than you might
experience. Thankfully in my dental school training I was
exposed to most all aspects of dentistry and most every
procedure general dentists provide. Early on in clinic in
dental school I sought out the right mentors and clung to
them like glue to ensure I received the training I needed to
prepare me for the real world. Dont worry if you didn't get
training in all areas while in dental school it just means you
will have a larger time and financial investment in training
after graduation. Okay back to why this section is relevant,
we want to be treating more of the patients that come in your
door. My dental school experience afforded me the ability to

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treat more of the patients that walked in my doors with the

wide range of dental conditions that can exist. A patient has
a toothache on a back molar and, lets be honest, it is
frequently a molar tooth that needs a root canal. Do you want
to be able to confidently treat this patient or be the practice
that doesnt do molar root canals. Not being able to treat
your patients is not a great practice builder. Just take a look
in your patients eyes when you tell them you are going to
have to refer them to a specialist and they will have to wait
an unknown period of time for this appointment. Oh and also
they will have to have another exam before anything actually
gets done about their problem. Im not done yet, this
specialist also doesnt bill to their insurance plan so they will
have to pay in full upfront. So in this example, if you do not
feel competent enough to treat molar endodontics you have
two choices. Your first choice is to go out and find some
training in your area or even across the country (it will be
worth the travel and course costs if it is going to get you to a
point of treating more cases) and learn the skills necessary
to treat these cases. Or the second choice is to refer the
case to a nearby specialist. Im going to revisit it again so it is
very clear. If it is a case that you feel you cannot treat to or
above the standard of care you should consider referring the
procedure or even better have someone else in your practice
treat the case. For example, an upper molar that has been
crowned and has no visible pulp chamber or canals in a 70
year old patient. This might be one to refer to the
endodontist. The general dentist to specialist relationship
needs to be symbiotic, mutually beneficially to both parites.
Feel free to email me more about this relationship.
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Lets break down the referral process for a minute with an

example. A new patient comes to your office with a chief
complaint of throbbing in a lower right tooth. Your front area
staff have had the patient fill out all the new patient forms
and have collected the patients insurance information and
called the insurance carrier to verify the coverage. This has
taken approximately 15 to 20 minutes of the receptionists
time. The certified dental assistant then walks the patient
back to the operator and discusses the dental history with
the area and proceeds to take a radiograph of the area and
comes to the doctor to brief them on the patient. This takes
another 10 minutes. The doctor then enters the operatory
and discusses the patients symptoms before proceeding
with a thorough evaluation and testing of the teeth in the
area to form a diagnosis and treatment plan for the patient.
This takes another 10 minutes. In this example, the lower
second molar was diagnosed with partial necrosis with acute
periapical periodontitis and requires root canal treatment. Up
to this point from the time the patient has walked in the door
the office team has spent a minimum of 40 minutes with the
patient. Now if you are going to consistently end up referring
out situations like the one outlined above, I can tell you the
numbers are not in your favor. You would have collected
payment for a specific exam and periapical radiograph which
lets say is $55 total. It is important that you know an
approximate value for one hour of chair time in your practice
(this isnt a detailed book on practice metrics but take your
monthly total expenses and divide it by the number of hours

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practiced in this month to get this value). In fact we dont

even need to know the exact value of your chair time to know
that if you consistently are not able to provide patients with
treatment shown in the example above that your expenses
per hour are going to far outweigh the revenue generated.
Further, think about what It cost to get that patient in the
door. Your practice may exist in a retail location or even a
mall where you pay a premium in rent to have increased
visibility. You may market your practice online through
Google to let prospective patients know who you are and
what you do. Both of these are significant overhead
expenses and if you are not willing to treat a large majority of
the patients that come through your doors you can see how
the numbers are going to work against you. I havent even
touched on the relationship that is built when you are able to
get somebody out of pain in the same day or you are able to
repair a cosmetic issue before their social function in the
evening. Arm yourself with an ability to treat more of the
patients that come through your door and I assure you will
realize great and more rapid practice growth.

Technology

You likely perked up when you read the heading

Technology as you expect some breakthrough secret to be
revealed here that will sky rocket your business ahead of all
the competition. Im sorry to disappoint but this section will
be short, just long enough for me to share my few thoughts

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on technology and its impact on your business. Technology

and the significant investment that tends to accompany it
needs to be a thoroughly thought out and impeccably timed
decision. All too often we are excited by the latest and
greatest technology that we expect will be life changing to
our personal lives or our business but I dont believe this to
be true. Technology will only ever be an adjunct to the
principles I have discussed in this book or the sound
business principles described by the great authors listed in
the reading list section at the back of this book. Let me give
you an example. First you have a $150,000 crown imaging
and milling centre that will allow you to perform a crown
procedure in a single visit (dont get me started on how with
this purchase you have just taken on a new job position as
lab technician as well as dentist). Next you have a $500 point
and shoot camera that is wifi enabled implemented into a
digital workflow that allow you to take intraoral photographs
on every new patient in a matter of seconds and have the
images displayed immediately on a large monitor in front of
the patient so the doctor can discuss any findings in the
patients mouth in great visual detail. The $150,000 purchase
is going to ensure you are not making money on the
purchase for a very long time and the $500 purchase is
going to producing revenue every hour of every day in your
practice. Dont spend money on expensive unnecessary
equipment when you are just getting started with your
business. As a note, I think the imaging and milling units
have great potential in the correct practice size and only if
the workflow is controlled appropriately.

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Systems and Operations Manual

A huge influence in my entrepreneurial journey has been a

dentist by the name of Mark Costes owner of the Dental
Success Institute and the Dentalpreneur Podcast. Mark has
always advocated that a systems dependent dental practice
over the long term will outperform a fly by the day style of
practice any day. Systems outline how operations are carried
out in the business and the collection of these systems are
compiled within an operations manual for ease of reference.
There can never be a cookie cutter, generic operations
manual, it must be written specific to your business. When I
first started the practice I was very frustrated because I knew
it was important to have an operations manual I just didnt
know where to start. Here is a simple way to approach this.
Each time a question or problem arises, open up a word
document and start writing out detailed steps of how you will
find the solution to this problem or an answer to the question.
This can be anything from how to handle a patient that is
upset about an invoice they received for a balance their
insurance plan didnt pay to sample scripting for anyone who
answers the telephone. Add this page to the operations
manual. Here is a good time to talk about perfection can be
be paralyzing. Just get started writing things, dont worry
about nailing the operations manual on your first go. Just
start writing things down and you can modify as you go. My
operations manual is still a work in progress always getting
revised with the latest information of our organization. In
general, dont worry about being perfect right away just get
started and keep progressing.
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Section 3: Differentiate Your Business

Care more!

This is a governing principle of how you should approach

each day within your business. Show your clients and
patients that you care more than all the healthcare providers
in their past. This should be motivation to go above what
might be the standard in your market to separate yourself.
This can be as simple as post op calling your patients after
all surgical and root canal procedures. Another example
might include handwriting a certain group of patients a card
welcoming them to your practice or thanking them for the
referral of their sister Sally. This takes minutes and returns
countless amounts of value.
When you are in the writing stages of your mission statement
you need to consider what will be your unique proposition to
the world. Why should the market buy from you instead of
your competitors? If you cant answer this simple question it
is time to sit down and really work out what sets your
business apart. When you are making the decisions on how
you will operate, what services you will offer etc. always keep
in mind how you will differentiate yourself from your market.
Unless you have a serious monopoly in your market your
customers will generally have a wide variety of other
business in your field to buy from. In Victoria, BC the market
is very saturated with other dentists and if I am not willing to
deliver on all the key points a patient is looking for they can
very easily decide to take their business down the street.

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As you make the key planning decisions within your business

always keep in mind how you can set yourself apart from the
competition. With all the touch points within your practice
where can you do that one extra thing that leaves the patient
thinking hey Ive never had a dental office do that for me,
this group must a) really care about my well being and b)
really be thorough in their approach to care. I can promise
you the patients that have this thought or even better the
patients that actively voice this to you will be the same
patient to go around town telling everyone and anyone about
this experience they had with their new dental office. Yes,
they will even feel compelled to tell that complete stranger in
the Starbucks lineup about you. Walking, talking marketing is
a very powerful thing! So the end goal here is to put yourself
in the shoes of your target market and ask yourself where
can you (the entrepreneur, the business owner) set the
standard above the competitors? Where can things be done
more conveniently, more efficiently, more comfortably?
Always pay attention to these details and I assure you will
start to see your business separate from the competition. In
this section I called my business a dental office and those
two words actually make me cringe because it is so far from
being an all encompassing term that describes our business
and our services. My business Smile Esthetics exists to
change our clients lives through services in facial and dental
esthetics. My team and I view our physical business as a
comfortable, safe and welcoming location for our clients to
receive the life changing esthetic services they desire and
the dental health services they need.

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Time Investment

I can only comment on how I have personally approached

building my first practice and certainly wont argue this is the
only way it can be done. This was a game changer for me,
but I dont feel it is 100% necessary for you and your journey
in business growth. I happened to be building my patient
base at a time in my life where my fianc and I did not have
children yet and we were both very independent and
understanding of each others career goals. This allowed me
to dedicate a large period of time over each week to offer
available appointment times. Physically being in the practice
was very necessary for me to realize the practice growth I
saw in such a short period of time. I am not suggesting that
you need to be in your practice 7 days a week, I just
happened to be willing to sacrifice an amount of my time with
the intention of growing a practice faster than any other in my
market, and it worked.
Being able to see a patient for emergency dental treatment
same day is absolutely critical whether your practice is brand
new or well established. I never understood the office that tell
their long term patients we dont have any time in our
schedule to see you for another two weeks. You mean to tell
me you cant see the patient for 5 minutes somewhere in
your day to write them a prescription for pain medication or
antibiotics? I cant even begin to place a value on that 5
minutes you take out of your busy schedule to see the
patient in pain, but it is huge. The patient will never forget it

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and I promise they will tell a minimum of 5 people about how

amazing their dentist is. Now lets talk about the patient that
you go into the office to meet after hours for a dental
emergency. This is something I learned a lot about in my first
year of practice building. We actively marketed the keyword
dental emergency online and would have any after hours
voicemails emailed to the doctors cell phone as an audio file
with a return phone number. This worked incredibly well as
the doctor could screen if the call was in fact a dental
emergency or simply a dental issue that could wait until
regular business hours. For these callers if I wasnt busy with
family time I would almost always make the 10 minutes drive
to the office to meet the patient. Most of the time the
emergency is easily managed with a prescription for pain
medication or antibiotics until the patient can be seen during
regular office hours and takes only minutes. Out of the last 7
or so patients I met at the office after regular office hours for
a quick examination 4 left amazing reviews on google raving
about how the doctor came in on his day off to get them out
of pain and how much they recommended our dental
practice. I would conservatively say this brought no less than
100 new patients to my practice in the first year. And heres
the best part, the review keeps on working for you giving that
return on investment that took only minutes out of your day
off. Now in all fairness I need to mention the amount of times
I was taken advantage of coming in to meet patients who
later just ended up seeing their regular dentist or who just
wanted a prescription and we never heard from again. The
way to nearly eliminate this from happening is make it clear

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that there is an exam fee due prior to being seen by the

doctor. You can make this whatever you want $100 or $300
but it will discourage the previous mentioned patients. Even
though not all these patients become great patients of the
practice I wouldnt change a thing this was such a valuable
part of my practice growth.

Setting Aside Time to Work ON The Practice

Dont make this something you do by yourself. Involve one or

more of your team members to sit down for what I called
strategy meetings. You are likely going to be spending a
large majority of your time working IN the practice and
therefore need to consciously set aside time to work ON the
practice. Also because you will likely be in your operatory
with your handpiece spinning for a good part of the day you
will not be aware of all the happenings in the office
throughout the day. This is where it is good to keep in touch
with all members of the team working in different areas of the
practice. Keeping a finger on the pulse at all times. I
encourage you in between patients to spend some time
upfront with your team, interacting with patients in the waiting
room. So many dentists in between patients go straight to
their back office and shut the door to get away from their
team and their patients. Throughout the day spending even
small amounts of time in different areas of the practice will
give you an accurate feel for the teams culture, how the
team is interacting with the patients and most importantly
how happy the patients appear. It takes constant effort to

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remove yourself from the dentist role and step aside as the
business owner and entrepreneur to view the practice
through different eyes. What is the day to day feel of the
business? Are team members laughing frequently or are
heads down as team members pass by each other in the
hallway? It can be difficult to know how each and every team
member interacts with each other and if they are getting
along, but it is your responsibility to actively monitor for the
signs that team members may not be happy or may not be
getting along. If the interview and hiring process is done
thoroughly and correctly this becomes less of an issue but it
is always a possible problem that needs attention. You may
think a team member is an A player but your team all agree
they are a B or C player and you can end up losing the team
members you cant afford to lose because of it. You need to
hope the right team members bring these situations to your
attention if you havent caught it yourself. It is difficult to give
advice on how to be aware of how the team is getting along,
the best advice I can give is to spend time in the business
outside the role of just the dentist or the technician as
Michael Gerber describes it in his book The E-Myth.

Value of a Long Term Patient

This isn't that we want to look at patients as numbers but I

can assure you that the more successful your practice is the
higher the quality of care will be. You will be able to learn
more through continuing education, to get your team more
training and motivation, and offer better treatment for your

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patients conditions. I bring up the value of a long term

patient because I want you to adopt a culture of retaining
patients for the long game not just as a one time transaction.
Ive heard from many practice management consultants
place the value of a patient over the course of 15 to 20 years
being in the ballpark of $40,000. Where do they get this
number? Well on the average amount spent by themselves
each year on cleanings and routine dental work. Add to that
they bring their husband and children as patients. Next they
refer their friend from the soccer league they play in. This
friend then has a great experience with your office and refers
another two patients. $40,000 can add up very quickly in this
above scenario its not hard to justify. Therefore in all the
interactions you office has with this patient remember that
you have a culture of retaining this patient for the long game.

Closing Statements

You made it! This is the first book I have ever written and I
really hope you have taken away some massive value that
you can apply to your life, your business and your future.
Take a few points each week from this book and go
implement and execute. Remember reading is of zero value
if you are not willing to implement and execute. Dont be
afraid to go out and try these things. Dont worry about what
people will think of you. Go and do. Remain confident in the
process and I promise you will reach the place you are
striving for. If you want to contact me with any questions
about topics in this book or dental and business questions
you can email me at drshanefrancis@icloud.com.
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Shout Outs

Invariably, any individual that has found success in any

arena of their life has done so on the shoulders of others in
their life. Mentors, role models, friends, family, authors. I
have included some of my mentors below that you might find
valuable in your own pursuits.

Grant Cardone - I was introduced to Grant first through his

book The 10X Rule which I highly recommend. He is the kind
of guy you either love or hate. I love him.

Gary Vaynerchuk - This Russian immigrant to the United

States is one of the biggest names in Social Media right now.
His energy is fricking contagious.

Mark Costes - I first heard of Mark on his Dentalpreneur

Podcast which is full of pure gold. He covers so many topics
under the practice ownership umbrella with different guests
each episode.

Gary Takacs - Gary is a highly successful dental practice

consultant and host of The Thriving Dentist podcast. He has
his area of business down to a science and with good reason
because he owns a dental practice (as a non dentist himself)
where he has tested all of the strategy he preaches.

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Christian Guzman - This young man has founded incredible

success through his fitness YouTube channel. Christian is an
amazing young individual spreading huge positivity and
impact to people around the world looking to change their
lives through fitness.

Reading list

Good to Great by Jim Collins - Jim and his team have so

thoroughly researched a group of companies that are simply
good and those that have risen to greatness and what the
differentiating factors were between them.

The 10X Rule by Grant Cardone - Grant has changed the

way I wake up and approach my day. He argues how
everything you attempt in life will require 10 times the effort,
time etc. to achieve than you expected.

The E-Myth by Michael Gerber - Michael brilliantly separates

the business owner into three critical roles, the entrepreneur,
the technician and the manager that must all exist within a
very delicate balance to achieve long lasting business
success.

Uncomplicate Business by Howard Farran

Everything is Marketing by Fred Joyal
Marketing the Million Dollar Practice by Dr. Bill Williams
Delivering Happiness by Tony Hsieh

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