Dr. Jason Howell, A Business savvy dentist who has learned some tips and tricks to help you drastically increase your dental knowledge, production and leadership. Dr. John, Dr. Howell and Wendy discuss treatment planning for REAL life patients that are currently sitting in your chair and tweak your processes to increase acceptance of treatment you know your patients need, while improving yourself as a provider and leader. Listen in to this transformational episode and go back to your office and rock the work week!
"EP58: Become a Better Dentist, Become a Better Leader with Dr. Jason Howell" Transcript:
Hey, everybody. Welcome to this episode of the Double Your Production Podcast. I'm Dr. John Meis and I'm here with the amazing Wendy Briggs. Hey, Wendy.
Hi. How's everybody?
Yeah, we're doing good. I'm also delighted to have on with us Dr. Jason Howell. Hey, Jason.
Hey, John. Hey, Wendy. Good to see you.
Good to see you too. So Dr. Howell and I have been friends now for a few years, and I really have thought of him as an amazing guy. So just to kind of talk a little bit about some of his experiences and some of his successes, I know of a startup that he started and brought it up to the very top of his group. I know of two underperforming practices that he took over and doubled both of those in a very, very short amount of time. I know that he has studied the world's master and has then gone on to teach some of those principles, both as a mentor doctor in the largest DSO in the United States, and as a founder and instructor at Martinson Dental Partners Top Docs program. So I really think of you as one of the best of the best, and so happy to have you on our podcast.
Well, thank you so much, John. I really appreciate the kind words, and it's an honor to be on here with you and Wendy, so thank you for having me.
One of the things that I thought was really interesting as we met and got to know each other was that you had followed in a lot of ways a similar path as I had, in that you really went on a quest to find the best way to do things, and you traveled around, you visited offices, you learned from all kinds of people, and I wonder if you might just walk us through some of the key pieces of discovery that you have come up with, and I know now you've refined them and have made them even better.
Yeah, absolutely, and when we first met, it was very interesting as we talked about our journeys and how similar the paths were, so I think for you and I or at least for myself, I think that's what helped gravitate us together because we share the same experiences. When I think back on the journey that I've had, I always go back to probably about four years out of dental school when I was having struggles throughout daily work days and felt like I was banging my head against the wall sometimes, and I got very, very lucky and fortunate that I had met some people that had some mastermind groups and I got involved with those, and what I found out quickly was the struggles I was having were not just my own struggles but struggles that almost all of us dentists tend to go through at some point in our career, and so that was very reassuring to me to know that I was not alone out there. And so as I got involved with those and got to meet other dentists that had those same struggles, and as I met those dentists, found mentors that I could spend time with and get coaching as far as what they had done to help them become better dentists and better leaders in the practice and really, that was where the journey started, for me. I don't know if you had a similar experience with that?
Oh, exactly the same. Yeah, not similar. The same.
Yeah. So what are some of the things that really were turning points for you?
Probably one of the biggest turning points for me was when I got out of my own dental practice and the walls that I was in every day and decided that the best way to become a better dentist, become a better leader, be able to connect with my patients was to spend time visiting other doctors and getting out of my practice. And one of my first mentors always told me that you can't work on your practice while you're working in the practice. And so I really started dedicating time to travel and spend time with other dentists and learn from them. And so I would start visiting practices. Usually, once a quarter, I would go somewhere and spend two or three days at someone's practice, to really just observe, watch, listen and hear how they were doing things. One of my mentors had encouraged me to get involved with dental boot camp and this was probably back in 2006. And so I started doing a lot of dental boot camp and learning that maybe the way that I was communicating with patients was not the best way to communicate with patients. And so I think my journey really started from that point on as learning how to communicate with patients, really share what my passion was, as far as dentistry is helping the patients. And how could I communicate best to be able to help them receive the treatment and care that they wanted and deserved? And so that was the first big stepping stone for me, was to really be able to understand the patient and to help my team. And I took my team to a lot of those events as well. So it was not just me going. And we all started learning how to talk and communicate to patients in a different way than maybe what we had learned in dental school so to speak.
So was Walter Haley still there when you were going to these or was this a--?
Walter was not there at that point. But one of my mentors did as he had given me a package of cassette tapes. And it was Walter and Steve Anderson in the early 2000s, and they had recorded a series of these boot camps. And it was probably 12 cassette tapes, A side and B side. And I'd put those cassette tapes. This was when you still had a cassette tape player in the car. Anytime I was traveling to a dental meeting or doing anything like that, I would just play these cassette tapes over and over. And it was the early version of the podcast. I was just listening to these lectures and role-playing . And so I never got to meet Walter. But I have got to know Steve over the years through Crown Council. And I've told him that story several times and we always get a chuckle out of that.
Yeah, he's a good guy. And that program produced an awful lot of superstars, didn't it?
It absolutely did. And it's interesting, I'll still-- they had some different guests on there throughout those cassette tapes and I'd go to some different Crown Council meetings and meet people like Geoff Gray and people like that, that were part of that, and I'll tell them the stories as well. It's good to reminisce, absolutely. Yeah.
Yeah. All right. So one of the big turning points had nothing to do with clinical dentistry. It had nothing to do with technology and nothing to do with instrumentation. It had to do with communication?
You're absolutely right. I mean, we come out of dental school, and at least for me, you've learned how to do some of these different procedures and you've got this miniature toolbox , so to speak. And you're raring to go and what I found very quickly, was I wanted to do a lot of different dentistry and I was excited about what I had learned. I just didn't know how to communicate to the patient and didn't have the confidence to communicate in a way that I was getting patients to say yes and accept treatment. And I think, that for me, was the most frustrating part in the beginning.
We see this so frequently. That when we're looking at the data, the dashboard from Dental Intel, we often have dentists with this fear that they don't want to have to change their treatment plan for the rest of the year. They don't want to have to start talking about unnecessary dentistry to increase their productivity. In reality, it's not about that, right? There's so much dentistry sitting in the practice that's already been diagnosed that patients haven't made that decision to move forward on. That if we just tweaked the processes and the systems and the conversations a little bit, they'd be doing so much more. So we hear this a lot. A lot of people know what to do, they just don't know quite how to do it. And that's the most amazing thing when you figure that out, what changes.
Absolutely. It's transformational. Not just for us as a dentist and for the confidence that we can have but transformational for the patients. I always talk with my team and we share that the patients come in our practice for a reason and they have a want and a desire and it's our job to understand what that want and desire is, and how can we provide that for our patients. And without that tool, that communication tool, we're all ready to do dentistry, we want to do dentistry but sometimes we just can't connect on that personal level to move the dentistry forward so to speak.
I've heard you teach your communication process, how you talk with patients. I've heard you teach it now probably three or four times and it's just it's absolute liquid gold. It just rolls out of that with your Tennessee accent and I call you silver lips because it's awesome the way you do that. Okay, so communicating with patients, that was turning point kind of number one. What's the next turning point?
The next turning point was when I really, through several of my mentors, started discovering the Yes philosophy and we really started looking at our practice from the inside down and started looking at what limitations we were putting on oursleves really, more than anything. That's probably the easiest way to say it. And we found that more often than not, we were the barrier to treatment. And for a dentist, that's sometimes very difficult to admit or for a team to really be able to look at. So we started looking at everything that we were saying no or that we were putting the barrier up to patients receiving the care that they wanted and deserved. And so we developed or didn't develop, but started implementing the yes philosophy that some of our mentors had taught us. And we just started looking at anything that we were saying no to, anything that we were being a barrier to. And we all decided we were going to say yes to anything and everything we possibly could. If a patient called, how quickly can you get here? We're not going to wait for two, three days or two weeks to get a patient in. If a patient said they were ready to do treatment and would like to stick around today, we were going to say yes and figure out a way to make it happen. This was very critical in the fact that myself and the team had to be on the same page and had to be on board. And in fact, the team really drove this more than anything. And this was probably the first time I really stepped back and tried to empower my team to really lead the practice, which for a dentist sometimes, can be a little difficult to let go of the reins. But I really got to the point where there was no more schedule watching and there was no more me controlling the day. It was I gave the team permission that whatever the patients wanted and they were ready to do, they didn't have to come to me and ask when we could or when we could fit something in or if we could not. It was entirely up to them. And for me, that was very radical in our practice because what I found is although I was concerned the days could get chaotic and how would we make this happen, what I found was it actually made things go so much smoother when I got out of the way and let my team kind of run the show.
And most doctors listening to this podcast or most of the team that's listening to this podcast, they're going to say, "Oh, we don't get in their way. Oh, we don't do that. We don't do that." And it's because you don't recognize it. And we don't know what we don't know and we don't see what we can't see. And we generally have really good clarity when we look and watch other people, but we don't really have that same clarity for ourselves. So we just go round [rubbing?] here between the three of us of ways that we see the practice is saying no without realizing they're saying no. So I'll start out, give you a minute to think about it, Wendy. So what I've observed in a lot of practices is if there's something that the team thinks they should put in or something that might be a same-day, somebody wants to stay and have the treatment started day, they go and ask the doctor. Instead of just doing it just making it happen, they go and ask the doctor. And then depending on how the doctor's feeling at that second, whatever reaction they give, the team looks at that and make some meaning from it. So any kind of sigh, any rolling of the eyes, any okay, or any complaint about it will shut that down in the future really, really easily. So it's a way that even if the doctor didn't say no, even if they did it, the way they did it, the way they communicate [inaudible], they really communicated no, but I'm going to do it anyway. So that's one example. Wendy?
Yeah, probably the most common I see and I still see questions asked about this is this outdated philosophy that we have to pre-authorize large treatment. Yeah, we can't do same day because we have to send some ridiculous pre-authorization through the insurance to get the exact payment amount with patient [inaudible]. And it's just such outdated thinking when you should be able to have all that information readily available on the internet, fax or services that will actually do this for you. But we have it so many times. We can't do same-day crowns because we don't have a pre-authorization from the insurance. It's such a huge, huge opportunity loss for the practice.
I just spoke today with a practice that the practitioner and her spouse are so frustrated that they're not making any money and everything is so slow and so delayed. And they were doing pre-auth on everything, which this--
It's so funny. It's so funny. And there's so much fear in stepping away from that and doing it differently. And that's a very common way we say no.
All right. Well, how--?
Yeah, what's another one?
Another example for us is when patients call before they're ever even in the practice. And maybe they call specifically saying, "I've got a tooth that I know I need a crown on. Can I come in today and get that done?" And we would typically say, "Well, we'd love to get you in and we need to do a comprehensive exam. And we have to make sure that you've had your-- when was your last cleaning? What type of insurance do you have?" All these questions that we asked upfront on the phone prior to getting the patient in when really, our answer is, "Absolutely, we'd love to have you. Come on in." And allowing us in the back to be able to help the patient, once they're in the chair, understand, would we need x rays? Would we need an exam? Those types of things. We'll have patients call on a daily basis. And they only know what to ask for based on their previous experience. So sometimes we'll throw roadblocks up before the patient ever has even entered the practice, if that makes sense.
Yeah. It's just--
I was just going to say we see the same thing happened. We get questions like this all the time from audiences, right? Well, where do you schedule the new patients first? Do they see hygiene first or doctor first? And they've been taught you have this really complicated, elaborate script that helps you sound like you're saying yes when really you're saying no. You can't have a cleaning first day. We don't know what kind of cleaning you need. Therefore, this is how we do it. And it's such a waste of time.
Yep. Going into all that detail, talk about a waste of time. And just getting things on the book. And in one of my own practices, we which some team members around and new team member was of the philosophy, "Let's get them in today." And new patients almost doubled just because she was answering the phone, and she was asking them how soon could they get there. It was such a profound impact. And the team members that were there before, they didn't realize what they were doing to the practice by trying to schedule people out into the future. And so it's such a critical thing.
Yeah. I will definitely agree with you. The phrase "How soon can you get here" is something that we use on a daily basis. And that truly did change our practice almost overnight in the fact that we would make a spot for a patient regardless. If they said they can get here today, we're going to get them in. And what we found from the patients themselves was the response of, "That was amazing that you got me in today. And I didn't have to wait two weeks." From the very beginning, the patient-- it changes the mindset in the patient that they are important just as much as anybody else and that we're going to try to take care of them immediately. I think us doctors and practices have been trained over the years to-- as Wendy said, there has to be a specific spot in a specific time that the patient can come in. And that just doesn't work for, especially today with people's schedules. And people are busy. So that changed our practice tremendously.
That mentality of the two-hour exam, come-back-for-a-case-presentation-type thing for most general bread-and-butter practices is really-- that mindset is really destructive. Get him in and take care of them. All right, so what was the next turning point?
One of the biggest turning points that came after that for us was what we call in our practice focused treatment planning. We had been trained over the years to see a patient, diagnose everything, the entire mouth, and sit down and go tooth by tooth or quadrant by quadrant on every single thing that's going on and put together this elaborate treatment plan and then present the entire treatment plan. And what we started discovering is we would ask the patient what's most important to them or what their chief complaint may be. And by the time we got around to presenting a treatment plan, the chief complaint and what was most important to them was somewhere in this three or four-page treatment plan mixed in with everything else. And the patient and the team was deer-in-headlights. "Where do we begin? What's going on?" And the patient is-- they're feeling, at least, what we understood was that we had lost focus on what was important to them. And so we really changed dramatically on how we presented our plans. And so what we do is called a Focus Treatment Plan. So we will still diagnose to a full comprehensive exam and diagnose everything going on. And we still have that conversation with the patient as far as what everything's going on. At that point, we will back up and then refocus on what their chief complaint or their main concern was. And when we present the treatment plan, we present the treatment plan only for that area. And so everything is treatment planned, and it's ready to go. But we go over-- so an example would be, patient has a broken tooth on the upper right quadrant. We will go ahead and diagnose them her mouth but we present the treatment plan for only that upper right area. And we call it a focus treatment plan or a next step plan. And the goal is that, "This is what we're going to focus on today. And if you'd like to get started on that today, we will make sure that we can get that done for you. If we're not going to get it done today, if your schedule doesn't allow it, this is the next step for us." And what we found is that all of us as patients have anxiety about everything that's going on in their mouth. And so the anxiety level would immediately decrease. You could almost see the patient just relax their shoulders. And it was as if they were understanding that we were finally listening to them and what was important to them.
We will also have to-- we'll remind them of everything going on and say, "Hey, we can take of everything else as quickly or slowly as you would like. But today, we'll go ahead and focus on this area." And we found that patient's treatment acceptance more than doubled-- or same-day dentistry more than doubled. And the really interesting part of it is we found that patients ended up moving on to the next steps and completing more dentistry over a shorter period of time than they ever had in the past. The other thing that really, really changed which we all have concerns with is the patient that comes in the door and leaves out the back door and you never see them again. This simple philosophy of focus treatment plan decreased that amount by more than 50%. We had patients going ahead and taking that first step, and we found that as they took that first step, and then we could show them the results and use photographs, internal photographs, show them what they had accomplished. And we'd have a celebration that they had accomplished their first step. They were more apt to take that second and third and fourth step if that makes sense.
No, it makes total sense. And I've seen you do this now on multiple times. And so you walk through what the issues are in their mouth. So they know everything that's going on. When you talk specifically about treatment and even more so when you talk about financial arrangements, you're just picking that one area to focus on. And then more often than not, giving them the option to do it right then.
Absolutely, absolutely. And so every patient has different wants and desires. And this is where we go back to the conversations we were talking about earlier is when we meet a patient and try to understand what their wants and desires are, this focus treatment plan may change. For instance, you may have a patient that is truly bread and butter dentistry, and we're going to focus on a quadrant or side at a time. We may have a patient that has multiple things going on, but they specifically have come in for maybe a smile design, maybe they're wanting to improve their smile or they have something going on in their life that that's really where they want to focus. So the conversations and really understanding what the patient's wants and desires are are very important in this focus treatment plan because we as dentists tend to want to focus on what we see as the most important when, in fact, sometimes that may not be the same thing that the patient sees as the most important if that makes sense.
The patients, they're going to find and seek out the treatment that they want and deserve, and it's our job to help provide that means. When I think about it in a term of if this was my mom, dad, sister it's her brother, and they lived in a different state, and I was not able to be their dentist, and they had a specific desire-- or had hoped that their desires were able to be met. And so I tried to keep that same focus in our practice, as well, that every person that we're talking with is a mom, dad, sister or brother, and how would we take care of our own? And so that plays a large part in how we do this-- if that makes sense as well?
Yeah, we love it. And I can tell you this too, Dr. John, I'm sure you're going to get to this, but when we had Dr. Howell present, we did a two -day case acceptance program with our members just last summer, and Dr. Howell was able to spend some really significant time walking through that next step plan and focus student planning. And I can think of-- gosh, more than just a handful of practices, but one practice specifically where the doctor had only been practicing three years, he came back and his personal production jumped by $50,000 a month on average, it was that powerful, right? And so that's just one case that I can think about at the top of my head. I know we can probably tell you case study, after case study, after case study where the impact can be that powerful. And so I mean that wasn't the only thing that they learned in that two-day process, but it can have an immediate impact. Dr. John, there are tremendous strands of strategies that can have an immediate and powerful return on investment, and this is one of those things. It really can have a powerful impact when you change your way of thinking, and you communicate at a higher level, and you hyper focus on giving people what they want.
That's impressive. That's so exciting to hear. That is what inspires me to continue doing what I'm doing when I hear stories like that because to have people that are ready to do dentistry and excited about dentistry and then can take just this extra little pearl and put it to use and see the results, and what's exciting about that is those numbers are impressive, but when you break it down all those patients that were probably not getting the care that they wanted and deserved, and now they're getting it-- we're getting patients and having results.
Yes, and most practices have a tremendous number of "one and dones" where the patient comes in-- has an exam-- gets bombed with this huge treatment plan usually printed off on the computer, and usually, it's got all the codes and all the clinical jargon on it, and usually, it has the percentage that the insurance company is going to pay on this and that, and they just look at that and it's so overwhelming and so confusing and so intimidating that they're just too frustrated, too anxious and so they do nothing. And what you've done is really show doctors how to break that down-- how to break through that so that we can have a conversation. One of my kind of stumped speeches that I give is the emotionally connect to the exam, and what you just talked about, that focus on what's important to them is such a critical component to that because if you don't they don't trust you, they don't think you care about them, and they feel not understood and not heard. And I know that's not dentist's-- it's not their intention-- it's not how they want to come across and that's not how they want to make people feel and it's not how they feel, but that's how it's perceived by the patient, so it's really an important tip.
Well, you made a great point that the patients see the treatment plan, and there's overwhelming anxiety that they till they leave the practice. They may schedule an appointment. They may not come back for that appointment because as they leave, they're overwhelmed with everything going on. And a word that we use in our practice all the time is that we never want a patient to leave feeling hopeless. And what we found over time was when patients were overwhelmed with the entire treatment plan-- and a lot of these patients know they have a lot of work going on, right? They understand. They'll sit in your chair, and they'll say, "Hey, Doc. I haven't been to the dentist for five, six years and I got a lot going on in there. And I'm embarrassed. It's been so long." And then we as doctors think that we're doing a great service by filling them in on all this stuff that is going wrong, which they understand and they know. And then we say, "Okay, now it's going to be $7,000. Where would you like to start it or when would you like to start it?"
Or $27,000? I mean, yeah, it's just going to be all over the map.
Yeah. And so we found that hopeless feeling that a patient could feel walking out the door is something that we wanted to avoid at all costs. And this really, really changed how our patients felt as well as being able to see them take those steps and get healthy was so, so critical. I will let you know one other thing we tied in with the focus treatment plan, that we talked about on a daily basis, when we are communicating with patients, we use them a lot of [inaudible] photos, which help the patients really see and understand what's going on. But we talk about things in terms of problems, consequences, and solutions. And so when we get into this focused treatment plan, we'll really zero in on whatever specifically we're going to take our next step on it. And when I mention problem consequence solution, what I found over time was that we as dentists were really really good at telling patients what treatment they needed. For instance, they needed three crowns, two fillings. But what we, as dentists were not so well at is backing up and letting them know what the problem was and why they needed those three crowns and two fillings. And so in our practice, we'll focus more on the photos, what's going on with the patient and what the problem is, and then what the consequence is to not taking care of the problem. And through this process, what we found is that more often than not, the patients will almost ask or seek out. So Doc, what's the solution? What do we need to do about this area? I like to say that patients don't want a solution to a problem they don't perceive they have if that makes sense. So if a patient doesn't understand they have an issue going on, they don't understand why they need a crown or they need a filling or they may need a root canal. So in our practice, we really try to back up and let the consequence be the key to the patient seeking the treatment, if that makes sense.
So when we focus on our treatment plans, and then tie in a problem, consequence, and a solution, it tends to increase that sense of urgency. And that's where our same-day dentistry really, really becomes key because the patients, at that point, are ready to do dentistry that day. And we're ready to take care of whatever problem that is before this consequence occurs. And that's been a huge game-changer in our practice, as well as many others that I've talked with and that we've done these training sessions with. So I encourage doctors and teams to really rely on using that problem consequence solution equation to help get the patient's sense of urgency on how we're going to take care of this. In our practice, and this is where the yes philosophy comes into play - if we really focused on a problem and a consequence and develop that sense of urgency, yet we're not using the yes philosophy and tell the patients we can't see them for another two weeks to take care of this, well, where did this problem and this consequence-- how big a consequence are we really dealing with if you can't get this done in the next three weeks? So we had to get all get on the same page on this process to really help continue to keep that sense of urgency up.
Oh, that is awesome. I really appreciate you coming on and sharing some of the key lessons that you've learned, these turning points that have made your career so successful. One of our team members was in your office earlier in the week and was impressed that you had, I think it was $11,000 day on the books, which is pretty decent day. But where did you end up? Do you know?
It was a fun day. It was a fun day.
That's a pretty good day of dentistry. And that's the kind of things that you can do. And patients feel better cared for and the team is more energized because team members who sit around and don't have anything to do aren't very happy. They tend to pick at each other and we all do. We all tend to pick at each other. And doctor's not busy. All of a sudden, he's getting into other people's business and looking over people's shoulders and starts to micromanage. So I really appreciate you sharing all this with us. Wendy, any words of wisdom to finish us off here?
No, I think, like I said, we just are super appreciative of you willing to share what you're doing because we've long said when someone's is doing it, we know it can be done. And so that just gives our own members and our listeners the confidence to know, "Hey, when we can help patients today and we get that done, people accept it and they move forward." And we're certainly not talking about unnecessary dentistry. So you and your team is just doing an exceptional job of helping your patients get what they need. And so it's rewarding to see that. So we appreciate you sharing all that insight.
Appreciate being on and thank you very much. And thanks for having me. I enjoyed this.
Yeah. Again. Thanks, Dr. Howard. I appreciate all that you do for us.
Yeah. Thank you so much.