Here Come the Millennials

Given the current scenario, these millennial dentists tend to have different needs, expectations, and working styles than their more experienced counterparts. There is little tolerance for the glitches that were par for the course in the past. They need to work efficiently with all dental team members to be profitable in the face of new practice realities and patient expectations. This means finding ways to deliver consistent quality in a shorter timeframe, and expanding communication capabilities to avert negative outcomes, extra chairtime, and disgruntled patients. For laboratory owners wanting to cultivate and retain customers from this crop of dentists, the ability to understand the forces impacting their businesses and how best to service this new generation will be critical.

Dentists who have entered practice since 2000 have come of age professionally during a period of unprecedented change. There is much information to absorb regarding the explosion of new materials, techniques, and technology—little of which was taught in dental school to even the most recent graduates. Compounding the issue and knowledge gap are the increasing numbers of questions on procedures and materials from dental-savvy patients who have sought out dental-focused information on the Internet.

Those who wish to pursue private practice must also master the intricacies of insurance, government regulation, and electronic health records. Then, too, there is the brave new world of practice management and marketing using new methods such as social media, often based on the advice of consultants such as Roger Levin, DDS, who, in a recent publication, identified a number of events he calls “permanent game-changers.”¹ These events, he said, have profoundly colored the perceptions and influenced the decisions of younger dentists who have emerged from dental school with more debt and fewer opportunities, thanks to increased competition, including from dental service organizations, a higher number of dental school graduates, and older dentists’ postponing retirement because of the recent recession and lower insurance reimbursements.¹

To deal with these challenges solo practitioners Amanda Seay, DDS, and Michelle VanDyke-Topp, DDS, and practice partners Michael McDill, DDS, and Todd Rosenzweig, DDS, MDS, each took different, sometimes circuitous routes, to establishing successful practices, but not without further investment. All sought additional training to raise their skill level to meet clinical challenges, and enlisted experts like Levin to meet practice management challenges and mold their respective practices to fit their vision. What is most important to each of these practitioners in their work-related lives parallels the attitudes of a majority of the millennial generation now in the workplace.

Although work and life for millennials blend inextricably together, the need for flexible work schedules to enhance the work-life balance is important. This was the vision for Seay, a Mount Pleasant, SC private practitioner who originally sought the work-life balance she desired through a partnership. “I knew I wanted a large family and thought the flexibility and camaraderie of a partnership would help me reach this goal.” However, she says, she ultimately chose to build a practice based on the kind of dentistry she wanted to offer her patients, which—contrary to her initial expectation—has enabled her to assume greater control of her professional and personal life. “By focusing my energy on what I enjoy and honing my skills toward accomplishing that, I’ve developed a practice geared towards esthetic restorative dentistry.”

However, the life-work balance focus is not restricted to female dental professionals. Rosenzweig and McDill, who were classmates in dental school and are now partners at Alpine Dental Health in Fort Collins, CO, also seek such balance, which their 4-days-per-week practice is designed to promote. While many of those weekend days are devoted to continuing education, both enjoy spending down time with families and engaged in sports activities—for McDill, it’s mountain bike racing; for Rosenzweig, it’s golf and tennis.

Because of the economic realities faced by this new generation of dentists, the need to acquire the business acumen necessary to run a profitable practice is critical. Seay says she learned the hard way that clinical excellence alone would not build a profitable business. “Dental school does not do a good job of teaching you the business of running your practice. You need go out and learn the basics to make sure you are in line with a successful business model.” With practice management guidance and a sense of her own business goals, however, she has learned to become more comfortable with the business side of practice. “When I am more proactive about understanding and managing my practice numbers, I see a natural increase in my production. One thing for sure is that there has to be a clear goal and plan of how to achieve that goal. Like anything you want to achieve in life.”

VanDyke-Topp, too, took the practice management principles she invested in for herself and her staff to heart—using proven marketing methods to increase internal referrals, decrease cancellations, and effectively project her caring approach to her patients. She also notes the challenge of communicating with patients with such variable information processing and learning styles. “Dentists are treating such a diverse age group of patients. Each can be like different species.” However, she says, it’s important to find the most effective ways to educate them all about their dental condition and needs. “The younger generation is very techie. They love to see their digital x-rays as educational films, but the older generation still wants chat.” These different communication styles, she says, also come into play when scheduling appointments and discussing fees, so it is crucial that the necessary information be conveyed appropriately, whether it be by phone, mail, email, or text. And, in her experience, the latter is becoming the preferred method of handling appointment reminders for patients under 60.

These younger generation practitioners are also facing strong competition from corporate dental practice groups, which makes running a tight, competitive business a must. Like VanDyke-Topp, Rosenzweig and McDill consider excellent communication a competitive advantage—especially when the competition comes from the large corporate practices that have proliferated in the past 12 years. McDill says it is no coincidence that this segment has grown as the structure of dental payment has changed in recent years. “When we started 12 years ago, most people had indemnity insurance —PPO represented only about 10% of patients—but now it’s nearly reversed.” He says the best way to stay competitive is with efficiency and excellence, and staying on message—ensuring that dental team members provide consistent answers to common questions and concerns, such as the different recommended treatments and restorations.

All those interviewed recognized the importance of continuing education—both through formal courses and exposure from study clubs, laboratories, and manufacturers—to keep up with methods and technology that can help them improve their dental practices.

As Rosenzweig put it, “If there’s a better way to do something, we want to do it that way—not reinvent the wheel.” This includes use of technology. The partners are now milling some 85% of their crowns and bridges in-house. Beyond that, McDill explains, they make an effort “to keep up with new things,” he says, adding, “We don’t want to be the first ones to adopt a new technology, but we sure don’t want to be the last ones either.” Rosenzweig, in particular, finds the use of technology essential for working on large implant cases, sending scans back and forth among team members digitally.

Matilda Dhima, DMD, MS, Assistant Professor and Maxillofacial Prosthodontics, University of Pittsburgh School of Dental Medicine, finds the ability to share and send clinical photographs especially important for complex esthetic cases and full mouth rehabilitations. “Being able to provide the laboratory with crucial information such as stump shade, incisal edge position, views of tooth preparations, and the facial form of the patient helps minimize the barrier to actually seeing the case chairside together with the laboratory technician.”

Although Seay says she does not consider herself to be especially tech-savvy by her generation’s standards, she is, after an initial struggle, comfortable with her ability to use technology for everyday tasks. “I have been doing my laboratory prescriptions directly on digital photos for years and have begun using video as well. I am able to share that information with all specialists involved and I can easily edit only the photos that I want to share with the patients as well. I can do digital smile designs as a part of my laboratory prescription and they can in turn send me back their remarks on the file.”

VanDyke-Topp, takes pride in her patient-friendly approach to dentistry, considers her intraoral camera essential to communication with patients, laboratories, and specialists. “Using the intraoral camera, we can send pictures to show them visually so they can fully understand what we’re talking about,” she says.

So what are the implications for laboratories working with this newest generation of dental professionals?

Foremost, they need partners who will help them meet the demands of their patients. Just as patients—many of whom are developing a taste for same-day dentistry—are beginning to flock to providers who offer restorations that meet their busy work-life timetables as well as their esthetic and functional expectations, younger dentists demand that their laboratories step up to meet those patient demands and expectations.

Good communication skills, supportive customer service, and a collaborative relationship are recurring needs and expectations expressed for forging lasting laboratory partnerships. Nearly all appreciated a quick call or text giving the go-ahead, but were especially adamant about the need for a prompt heads-up on delays or issues such as problems with digital impressions, preferably while the patient is still in the chair.

Dhima says she expects her laboratory to be technologically adept both at both communication and fabrication—including CAD/CAM capability—to help improve esthetic outcomes and turnaround time. She is currently working with a laboratory that can track a case as it progresses through the fabrication process and considers this to be “an excellent opportunity to evaluate the case through the different production steps with photography and communicate effectively with the laboratory.”

McDill and Rosenzweig, who now use a laboratory for only about 15% of their crowns and bridges, use it as much as ever for removables such as dentures, partials, and nightguards. McDill says that, although the more complex laboratory-fabricated crowns and bridges involve traditional impression approaches, the process can be expedited by straightforward, prompt, decidedly modern communication. “We need a laboratory that’s not afraid to tell us that we didn’t give them a good impression, or the information they need or if the prep isn’t the right shape to make a well-fitting crown.”

Open, honest communication is vital to a good working relationship for VanDyke-Topp. She realizes that problems are often unavoidable, but just wants to know when they occur. “If they are having issues with a restoration and don’t prepare me for any potential pitfalls or don’t deliver the specific engineering and esthetic goals that I desire without any communication, that is a problem.”

Alexandra Smith, DMD, needs a laboratory partner that is accessible and willing to educate as well as communicate. “Because I’m new, I want to make sure I give the laboratory a good impression—so I want them to feel free to reach out and let me know right away if there’s something I need to change or there’s something I can do better in the future.”

In addition to suggestions and feedback on her cases, VanDyke-Topp appreciates insights about new equipment and materials and believes it is important that her laboratory partner find value in continuing education to stay abreast of new industry developments. “We dentists can become stuck in what we know. Dentistry is changing, and it’s important to not just stay in my comfort zone. I try to stay current, but also depend on my laboratory to help me by letting me know if there is a better way to do what I am asking for.”

More than previous generations, this younger group of dentists value a collaborative work culture and, despite their embrace of electronic communication media, also want in-person collaboration with colleagues and other members of the dental team. “It’s important for me to meet the technicians I work with so I can put a face with the name,” says VanDyke-Trapp. “I can call them up and discuss an important case with them and collaborate on what I’m thinking and what they might suggest to make sure the patient has the best experience and is restored with the best product.” All agree—even the CAD/CAM dentists—that it is imperative that their laboratories offer the best available options for their patients. Communication, says Seay, is the key to meeting the demands of challenging cases. If the dental team members understand one another’s processes and provide each other with all the necessary information to carry out a case, then meeting a challenge can be as simple as a quick phone call. To her it makes the difference between a good laboratory and a great one.

“I could never achieve the smile I envision, plan, and engineer for without having a skilled technician who can deliver an exceptional-quality restoration,” asserts Seay. She believes that laboratories adept at CAD/CAM technology, digital smile designs, and high-quality videos and photography are driving dentists to stay more current with technology. She admits she felt the need to raise her own game to work effectively with a first-rate laboratory, likening it to getting on the basketball court with Michael Jordan. “You don’t want to play with someone that good until you know you have developed your own skills and abilities to a certain level.”

References

1. Levin RP. Building and sustaining a referral network. Compend Contin Educ Dent. 2013;34(7):486-487.

2. Fox K. Number of women dentists is on the rise, ADA News, April 23, 2012. https://www.ada.org/news/7000.aspx. Accessed April 9, 2014.

3. Future trends forum: Women in Dentistry https://www.dentaltradealliance.org/Future-Trends-Forum/future-trends-forum-women-in-dentistry.html. Accessed April 9, 2014.

Just one year out of dental school, Alexandra Smith, DMD, is among the growing number of women in dentistry. She is also among those who selected one of the newer practice options, a position in a dental support organization (DSO), which serves her personal as well as professional goals. As an affiliated dentist with Heartland Dental, the DSO that supports the Champaign, IL, office where she works as a solo practitioner, Smith has been able to begin earning a living rather than add to the debt amassed during her education.

This choice, too, has provided her with a “village” that supports her professional growth—including the formal professional education offered by Heartland Dental to all first-year dentists.

However, she says, her decisions there are geared toward serving the best interests of her patients and her growth as a practitioner. Smith tries to maximize her use of resources, including her dental laboratory. For example, although she has a list of preferred laboratories, she chooses to work with one that is willing to answer all her questions and otherwise support her learning curve and desire to offer her patients the best possible products despite her inexperience. “While price is a major factor for me, as a new grad, having someone who can talk me through on the phone is so much more helpful than having a really low price.” She says she was grateful when her laboratory called her when a restoration she prescribed was contraindicated for a patient with a thin ridge and recommended an alternative. “I’m glad I can depend on them for advice on materials and contraindications or what they would recommend as to what would work best in a particular situation.”