What do dentists know that we don’t?
The incidence of cavities in American mouths plummeted when fluoride was added to the U.S. water supply. Rather than surrender, the dental industry adapted and thrived.
What can we learn from other medical professions, particularly those that have experienced significant disruption? Which medical practice most resembles that of veterinary medicine? Pharmacists and optometrists are largely commodities-based and greatly corporatized. Physicians are similar to veterinarians in training but are highly regulated and driven by third-party payments.
But what about dentists? Dental practices are a healthy mix of independent and corporate, are generally small — one to five doctors — are largely unregulated and are situated in very similar facilities.
This prompts these questions: What do dentists know that we don’t know? How has their profession adapted and innovated over the years? How have dentists responded to disruption?
My take on what we can learn from our friends in dentistry goes like this. Imagine you’re a dentist in the 1960s and ’70s. You’ve got a nice little mom-and-pop — literally wife and husband — practice. Your business is doing well largely because of the staggering number of cavities in the U.S. You’re in the drill-and-fill business and there’s lots of work to be had. Cavities are your primary trip driver — the driving force behind consumer trips to your business.
Then, fluoride comes to your community. Almost overnight, it seems, your business is devastated. Fluoridated water cuts cavities by 50 to 60 percent. Your business is cut in half. Your primary trip driver is gone.
The dental profession struggled for years as it reinvented its business practices. Having largely lost the cavity business, what could the profession do to replace it?
How does the dental industry’s experience with fluoride inform us as veterinary professionals? Have we lost any trip drivers? What about annual vaccinations, pharmacy income, spays and neuters, and the shrinking scope of primary care practice? Whatever the drivers, it’s become tougher to drive consumer trips through our doors. Veterinary visits have been flat for years, and Idexx data suggests recent growth of just 0.7 percent in the face of growing pet numbers.
What can we learn from the fluoride experience in the tooth biz? I see three creative innovations that dentists brought to their business as they adapted to the disruption of fluoride.
- The entire dental profession wholeheartedly embraced preventive care by recommending twice-yearly visits. Nowadays, you’d be hard-pressed to think of someone who doesn’t go to a dentist twice a year, or at least once?
Could the same be applied to the pet health industry? Twice-yearly pet examinations — or perhaps one, more realistically — is still better than current trends. According to American Veterinary Medical Association data, 44.9 percent of cat owners and 21.5 percent of dog don’t visit the vet. (Insert future segue into forward-booking tactics.) However, if you’re not forward-booking, you are losing, your clients are losing and most importantly, the pets in your care are missing critical preventive care. (Take a look at the Partners for Healthy Pets website for a nice description of forward-booking.)
- Dentists empowered and leveraged their paraprofessional staff. The result: Dental hygienists, dental assistants and dental business managers have become an honored and critical part of every dental team. Dentists now care for about 30 patients a day. This is possible only through the use of a fairly compensated, well-trained and empowered team.
In contrast, the average veterinarian helps 12 pets a day while the dentist (dental team) next door helps 30.
Do you remind your doctors and yourself every day that veterinarians have only four jobs? They are diagnose, prescribe, surgery and relationship building. Everything else is to be delegated to the team, just like your dentist does.
This unscientific and anecdotal data comes from quizzing my family’s health care team. I leave it to someone else to fact-check.
What conclusions can we draw from the above? It seems clear to me that team-based health care delivery is a win-win. We help more pets, our teams are empowered and we reap the financial rewards.
- Dentists looked in the mirror and determined that they were great health care providers but lousy business people. Sound familiar? They hired professionals, engaged consultants, incorporated business training into dental schools and became more financially savvy. They learned that good business and good medicine go hand in hand. The result: better business practices and smoother running practices.
As veterinary professionals, how good are we as business managers? Do you find yourself frequently reaching back for your notes from the finance, HR and leadership courses you took in school? Wait, you didn’t take any finance, HR or leadership courses in school?
Does your practice fully buy into preventive care or are you stuck in the reactive paradigm of treating disease that should have been prevented in the first place? Do you employ and empower veterinary nurses, certify your veterinary assistants and offer continuous professional development opportunities for the team? Or do you rely on a workforce primarily composed of high school kids working for minimum wage and employees just placeholding until another job comes along? Do you employ a certified veterinary practice manager and consultants who have the freedom to marry their business knowledge with your doctor’s medical knowledge? Good medicine is good business.
Adapt to Change
What can we learn from dentists? Here is the Cliffs Notes version:
- Fully embrace preventive care. Twice-yearly exams should be the norm, and forward-booking should be standard practice.
- Empower your team; delegate. As veterinarians, we have only four jobs: diagnose, prescribe, surgery and relationship building with our team and clients.
- Buy or build basic business acumen. Financial literacy — get some! Engage a consultant, hire a CVPM or do both.
Anybody remember undergraduate biology? It’s a stretch for me. Recall The Finch Effect. Darwin famously observed that the beaks of each generation of Galapagos Islands finches changed to accommodate shifting food resources, allowing the birds to survive by adapting their capabilities to a new environment. How’s your beak adapting? Your resources are certainly shifting.
If Darwin and The Finch Effect aren’t compelling enough, how about Stephen Hawking? Dr. Hawking is quoted as saying, “Intelligence is the ability to adapt to change.” We in the veterinary profession are intelligent. We can adapt.
The veterinary industry’s equivalent of the fluoride disruption has come and gone and will come again. Loss of annual vaccine revenue, online pet meds, fewer spays and neuters, the list could go on.
In short, trip drivers change over time. Are you ready to continuously adapt, learn and thrive? Look to the dentists for some hard-won lessons and benefit from their experience. Let’s adapt as dentists have.
Creative Disruption columnist Dr. Bob Lester is chief medical officer of WellHaven PetHealth, a former practice owner and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves on the North American Veterinary Community board of directors.