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Can a dental practice function on a NO-hygienist model? In this Monday Morning Episode, I sit down with Dr. Ron Schefdore, a trailblazing dentist who dared to challenge the conventional hygienist-dependent model and hasn't looked back since. He bravely shares his transformative journey, detailing the hurdles and victories of running a practice without hygienists. By prioritizing time with patients and refining diagnostic capabilities, Dr. Schefdore not only enhanced patient care but unveiled significant financial benefits. He offers a candid look into the operational dynamics of his practice, demonstrating how a focus on customer relationships can complement financial growth in the dental industry.
Further into the conversation, Dr. Schefdore delves into practical strategies for managing the shift, particularly in scenarios involving the exit of hygienists. His methodical approach includes a gradual dropping of insurances to attract and maintain loyal and high-quality patients, while emphasizing the pivotal role of training and teamwork. Ron passionately challenges the traditional mindsets that dominate dental practices and invites you to do the same!
Tune in now to explore the no-hygienist model with Dr. Ron Schefdore!
You can reach out to Dr. Ron Schefdore here:
Website: https://www.pharmaden.net/
Facebook Page: https://www.facebook.com/dentalcoachingsystems/
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Michael: Hey Ron. So talk to us. What's one piece of advice you can give us this Monday morning?
Ron: Don't worry about not finding a hygienist or having hygienist issues because I did a no hygienist model very successfully for decades. And I teach that to dentists now and how to do the same thing.
Michael: Interesting. Okay. So if you can a little bit expand on, how did you first transition to the no hygienist model and what were the biggest operational challenges you faced?
Ron: The first 17 years in practice, we built three practices. I owned the three buildings. Staff of 36 associates out of network financially.
It was fantastic. It was like every dentist's dream, right? And what I realized after that long of managing people that that is not my forte drove me nuts somebody offered me some stupid money and I took it And thank God because it gave me an opportunity to grow up now being a dentist and say, you know, what do I really want to do?
Why am I here? What excites me? And for me, it was spending more patient time, which a lot of doctors want to do. So I says, if I want to spend more doctor time, and I really want to help people with their perio, get them cure basically of perio, get them to look better, the things that excited me and the work I wanted to do, that means that I can't be chair hopping.
Forget the chair hopping. I don't know a dentist that likes it. I mean, There is some weirdos that like it, but who the hell wants to keep jumping from chair to chair? This never excited me, never interested me. And not getting paid, they're all joining these cut rate insurances.
Why you went to all the schools, spent all this money and you're an expert. Why are you doing that? I never bought into that and I had, a bunch of money. So I didn't really need to worry about the money when I opened up the second practice of a new hygienist model. we figured it out and very quickly in today's dollars, we got up to doing a million dollars and bringing home ham and I did that for a couple of.
and I had six weeks vacation, sometimes a little bit more, took a month off. A lot of times, it was the best of all worlds. And so once I retired the second time, five years ago from clinical dentistry, I started getting on Facebook and just telling dentists, Hey, you guys could still have it all.
It works out really good. You're having so many hygienist issues. You don't need those anymore. Hygienists are valuable. However, they're getting theirselves. Out of the market, they're pricing themselves out of the market. They have quite an attitude. So many of them think they're doctors and it's like, no, you're an employee.
You might be a colleague, but you're still an employee. So let's not cross that line, it's just a weird dynamic. Now, I've met hygienists that are awesome. I'd hire them in a second. That's 5 or 10 percent of them that I've met. And this is a real problem with most dentists that I've talked to.
Don't do a hygienist model. Get out of network or minimize the PPOs. Keep just the best ones. You only need 400 active patients. For this. That's it. If we all only had 400 active patients, there's plenty of patients to go around. All these dentists are fighting over. I need 1, 000. I need 2, 000. I need 3, 000 patients.
That's crazy. No, you don't. You know, just, Just stop the nonsense already. So that's my advice.
Michael: Okay. Okay. So then when you apply this or what systems or workflows did you have to adjust to maintain or improve your patient care without a hygienist?
Ron: One column, see one patient at a time, minimize the amount of re cares that you do, and it's assisted hygiene.
No, it would be stupid for a doctor to do hygiene all day long. Get that out of your brain. Oh, I'd rather do something else where I make more money. I could prove to you, any dentist can make six to seven hundred dollars an hour doing a re care visit. I've done this on dozens of practices.
How many doctors are making 700 an hour without even breaking a sweat? I mean, That is about the easiest appointment you could do. Why not have some appointments during the day that are easy on us both emotionally and physically? There's nothing wrong with that. So, you know, 800 an hour and you get a 50 percent overhead, that's a million a year and bringing home 450, 000 pace.
Why do we need a hygienist? Most dentists, if they made a half a million dollars a year take home, they would be very, very happy with that. I did that for decades, took six weeks off, and it was, dentistry's still hard, but you know, I only had three cross trained staff. So when you're doing hygiene, you minimize the amount of re care that you do, and you use a great cross trained assistant with you.
That's all you need to do, and you fit those half hour appointments, it's half hour doctor time, half hour assistant time on the recare, that time that you spend with them is so much more fun, and it's relaxing in between all the hard work that we have to do, look, I don't have any physical problems, it didn't burn me out, it was so much easier than what dentists are doing.
Please do this, please look at this.
Michael: Gotcha. Yeah. if we are already, we have a hygienist our new patients are coming in, we're pretty bustling office, right? And then right now our hygienist left. We're listening to this episode and we're thinking, man I, I want to do this, but we just have too many patients at this time.
would you recommend in that situation?
Ron: That's when you strategically over 18 months get out of network and half the patients will fall off, which is fantastic because the ones that stay will stay pay and refer because they like your service, but you got to change the mentality of a PPO doctor to an out of network doctor.
It's a big change and you need some coaching on it. If it's not me, get a successful other network doctor to talk to you on how to treat, how to present treatment to patients, how to make the appointments in your schedule. It's. It's way different than a PPO. You can't expect a network patients to get the care that they receive in a PPO setting.
It's much different. So you gotta learn that.
Michael: Okay, interesting. So then, how have the dentists you've taught responded to the model? Like What are the most common difficulties or misconceptions they have when transitioning?
Ron: Number one, oh, it's going to cost me money to do a recare visit because I could make so much more money by going and doing blah, blah, blah, blah, blah.
And that's their belief. And I say, well, why are you making half the income that I am? And I'm seeing half the patients. I had to change their belief system. And it's the common belief with dentistry that they miss. The biggest reason they missed that is because. Where do we make our money in dentistry?
Every dentist misses this. It's the diagnosing. The PPO doctor spends two minutes diagnosing. Why would you do that when I could spend 30 with the patient? If I spent 30 minutes with the patient and you spend two, who's going to diagnose more work? Who's going to get more acceptance? Who's going to do bigger cases?
Me, all day long. the thing that makes dentists the most income and the most fun is the diagnosing and helping the patient get through that process. They're not doing that. So when you get the hygienist out of that, and the doctor does more of that, it's great. Keep your hygienist. Keep her doing the scalings.
Most of the office I see, 16 percent to 10 percent of their patients are going through scaling and replanting, or less. Where 50 percent of the public has periodontal disease. If you don't have at least 30 percent of your practice going through scaling and replanting, there's a lot of bloody profits being done.
It's just a fact. And your two minute exams, I'll fly anywhere in the country. I'll follow you around, doctor, after you do the exam, and I'll find five to fifty thousand dollars worth of treatment every week that you didn't even diagnose or talk to the patient about. So don't give me that bullshit.
Thirty seven years, I can't be bullshitted. There isn't nothing you're going to tell me that I haven't seen in dentistry in thirty seven years.
I challenge any doctor at that one. I've done this already.
Michael: Yeah. Okay. So then how has the dynamic when this happened your team changed the removal of a hygienist?
Like, did you need to train your dental assistants differently? And how does this affect the efficiency?
Ron: Yeah. I mean, You have to spend time with the hygienist, which was a lot of fun teaching them dentistry. My assistants knew almost as much as I did, and technically with their hands, geez, I had two assistants.
They were better with their hands than mine. You should see their temporaries. Their were awesome. They were very good with their hands. So you might be surprised that one of your team members might be just as good, if not better than you. And they're quick. they come up with ways to make things more efficient.
So you just spend time with them, nurture them. And there are a lot of smart people that really appreciate that can really help you, but yeah, you have to train them and be patient. It's like a child. You know, If you're at home, what are you going to do? Scream at them all day? You got to be very patient.
Michael: Yeah, no, that makes a lot of sense. So then, did you communicate the change to your patients? Or, like, did you face any resistance? if so, how did you overcome that?
Ron: At first I did, there's always remarks and dentists, this is one of the things the challenges they have is the patients will mentioned something about the hygienist and most dentists look like, oh, you're doing so bad that you can't even get the hygienist.
I flipped that around. I said, look, I spent eight years in school. Would you rather have somebody clean your teeth that's been in school for eight years or somebody that's been in school for two years for the same money? And I had to shut up. Every patient then laughed and says of course, eight years.
I go, good. Then you win me today. All right, let's go. And that was the end of it. You built more of a concierge service and a better service. It's like, holy cow, no doctor in this community spends this kind of time with their patients. That's what made us unique. And those are the kind of patients that you're willing to attract, that are willing to pay your fees.
Most of my patients were not rich. They were middle class America, but they were looking for better service and they found the money or payment plans in doing a treatment in stages.
Michael: I like that. So then is there any fear, Ron, where it's Oh man, I don't ever have time off almost a thing, right?
Like I'm going to be called for emergencies for any little thing, for cleanings, all these stuff. It's too much on me. I want to start delegating these things that I kind of don't like like pro fees and stuff like that Where does that mentality go?
Ron: Okay. The mentality is Doctor do you like to make money?
Well, Of course Well, then you better find a way on how to do a recare and do part of the pro fee You're not doing the full pro fee you're doing part of it. So my sonic cleaner I thought of it as a perioprobe, it just wiggles up and down, because I go through every pocket and look at every tooth and take pictures along the way.
To me it was a diagnostic tool. So doctors, it's how you look at things, I looked at it as this has given me an opportunity to find the work that I want to do. All of a sudden I'm doing cases I want to do. So it's the bad attitude that they have, the belief that they have. you got a lemon, make lemonade out of it.
It was great. I'm lemonade all day long like this. I was in such a saturated market in Chicago that there was like 15 doctors within walking distance. I was always busy. I made more income. I took more time off and they all were doing the opposite of what I was. And when I told him about it, I go, no, that'll never work.
Okay. You keep doing what you're doing, because others clean up here.
Michael: Yeah,
Ron: works. It works every time. You just have to change your belief system and I'll prove it to him. I've been doing this for so long.
Michael: Yeah, no, that's wonderful. Now, real quick. One of the last questions is this model.
Cause you mentioned where you were at in the location. Is it scalable for practices in different settings, like urban, rural, large or small, what adjustments would need to be made?
Ron: It's easier to do in the rural area because you're the only one there. And if you give better service than any dentist, within 30 miles, 40 miles around, holy cow, they immediately drop all the insurance.
They can't believe it. I can give you a bunch of names of a bunch of doctors that haven't to in urban areas where there's a lot of competition. New York City, Chicago, big cities that are wealthier. This is perfect because you don't need a lot of patients. There's patients that want good service in urban areas, period.
you don't need a lot of them because it's so condensed. It's not that difficult to find 400 patients. you gotta get a really good marketer, but you gotta learn how to answer the phone. the doctor has to present treatment and treat people well.
You have to learn those leadership skills and those presentation skills too.
Michael: Awesome, Ron. Thank you so much for this. I appreciate your time. And if anyone has further questions, you can definitely find them on the Dental Marketer Society Facebook group, or where can they reach out to you directly?
Ron: Okay.
DRS Coaching Systems, Facebook page. Just go there. You'll hear what a bunch of doctors are saying about the coaching. And go to make an appointment with me at pharmaden. net. That's P H A R M A D E N dot net. Yep, at my calendar. that's my nutraceutical company. we figured out at Loma Linda, we did a double blind test and figured out the periodontal disease.
If you give them a certain nutraceutical during treatment the outcomes are much better. The bleeding pocket depth was much better. We created that 20 years ago, used that on so many patients. go to there, go to the website, go to the calendar, make an appointment. I'll talk to anybody for free.
I'm not an expert, I'm just going to tell you what worked in our office. what worked really well and what we achieved, most dentists are trying to achieve. So I'm not saying I'm some guru, I'm just going to tell you what worked for me. and I'd be happy to show you exactly the same way.
I got no special skills. If I could do it, you guys could do it.
Michael: Nice. Awesome. So that information is going to be in the show notes below and Ron, thank you so much for being with me on this Monday morning episode.
Ron: Thank you very much for inviting me.