Marketing with bite
Dentists take different approaches

by Christopher Key


There was a time not so long ago when it was considered beneath the dignity of professionals to advertise themselves. Attorneys were the first to break down the barriers, quickly followed by doctors and dentists. Now, you can find dozens of full page ads in the phone book, commercials on radio and TV, and well designed direct mail pieces.
The first wave of advertising by dentists took place some time ago and led to a realization that niche marketing was in order. Dental patients are no more alike than dentists are and the latest wave of marketing has changed to reflect that fact.
Dr. Jeff Prager grew up in San Diego and received his degrees from UCLA. He worked at the Veterans Administration in Seattle before opening his Bellingham practice in 1985. His office employs five people.
“It’s not easy to hire skilled labor,” Prager said. “There is a critical shortage of dental assistants and hygienists. Bellingham has seen a huge influx of dentists in the last few years and that means more competition for available workers. The quality of the applicant pool has dropped dramatically in the last ten years. Schools are not turning out enough people both from a quantitative and a qualitative standpoint.”
Prager feels that the best and brightest are not seeking dental careers.
“Dental assistant is a great career,” Prager said. “You can get a job anywhere. Generational trends are being reflected in the workforce. People don’t stay in one city or one job that long anymore. There’s not as much loyalty. There’s also a generational difference in the work ethic. Because of the water, the mountains and the border, Bellingham can’t draw talent from 360 degrees. It’s a lot like an island that way.”
If you can find good help, it’s important to keep them.
“I try to provide a lot of opportunities for employee growth,” Prager said. “We have a bonus system and incentive programs. If the office has a good day, we have a drawing for nice prizes. Everybody gets regular time off. Our benefits are good and we have a retirement plan. I believe in working hard and playing hard. It’s great to have long term people.”
Like many professionals, Prager learned his business skills by trial and error.
“I’m an honors graduate of the business school of hard knocks,” Prager said. “You work in other offices and learn what not to do, but not what to do. Now, they have post-graduate courses in dental business practices.”
Most dental schools charge no fee for the services of students, so there is little resistance from patients over the cost of a procedure. Real life doesn’t work that way.
“We can do things that will change your life,” Prager said. “However, just because somebody has needs doesn’t mean that I can help. I can’t work for free.”
There’s some good news and bad news for patients.
“Pain management is much better than it used to be,” Prager said. “Dental insurance, however, is practically irrelevant. Most of it will only pay for about $1,000 a year. Often, it only hinders treatment. Dental insurance has become a loss leader to sell medical insurance. People won’t let me help if the cost is too high, but they have no idea what the cost of neglect is. Thirty years ago, $1,000 paid for a lot more than it does now. If they had adjusted it for inflation, it would be $5,000 – $6,000 today. They should adjust it or give people a lifetime maximum.”
People often take better care of their cars than their mouths, according to Prager.
“There are lots of ways to prevent problems,” he said. “Many problems can be treated quickly and easily if they’re caught early enough. Don’t wait for insurance to pay for it.”
People are making risky choices about dental care.
“Dentistry today is a choice for many people,” Prager said. “Do I get treatment or do I take a vacation? What are your priorities? Insurance isn’t going to save you. Learn preventive care. Buy a night guard to protect against grinding. It’s a lot cheaper than a cracked tooth.”
There has been an explosion in dental technology and knowledge.
“It’s good to have great dental specialists here in Bellingham that I can refer to,” Prager said.
Prager thinks changes in the profession have forced dentists to advertise.
“The good old boy network of the previous generation has retired,” he said. “When the next generation moved in, they needed to advertise. That’s good in the sense that it helps educate the consumer. People are learning more about what is possible. TV makeover shows indicate that the smile is one of the top two choices and it’s a lot easier that plastic surgery or liposuction. Those shows have provided natural marketing for us all.”
He admits that not all marketing has been good.
“Good marketing helps people make informed choices,” Prager said. “People tend to assume all dentists are the same. Insurance companies would have you believe all dentists are the same. Nothing could be further from the truth.”
Prager takes the educational approach.
“I have to set myself apart,” he said. “This is not just a garden variety dental office. No other office has the complete mix of services that we do. I don’t allow insurance companies to tell me what to do. Different people have different circles of influence in town. If you grew up here, you’re better known. Dentists depend a lot on word of mouth and referrals, but you have to let new people in town know you’re here. You have to replace patients who move away.”
He’s not signed up with any insurance company, but hopes his patients see him as their preferred provider.
“Dentistry is the last bastion of health care where you don’t have to give up control of your practice,” Prager said. “You can practice independently, but it takes guts. More and more dentists are doing just that, refusing to let insurance companies come between them and their patients.”
Dentists work just as hard for insured patients, but reimbursement rates are lower.
“I charge everybody the same, regardless of insurance,” Prager said. “I’m committed to being on the leading edge of dental science and educating people through marketing. The more information people have, the better choices they will make.”
Dental phobias are the focus of Dr. Eric Yaremko’s practice. So much so that he has published a pamphlet called The Seven Ways to Deal with Dental Fears.
“My initial experiences at the dentist were terrible,” Yaremko said. “I had severe pain, no control over the situation and the dentist seemed to be at a loss to come up with a solution. He also communicated to me (with a look) that this was my problem and that I was expected to sit there and behave until the work was done.”
Yaremko grew up in the Midwest but went to high school and college in New England. He received his dental degree from the University of Connecticut and served a one year post doctoral residency at the University of Washington Hospital.
“Because of my experiences, I was interested in keeping people more comfortable,” Yaremko said. “During my residency, I was free to follow whatever I wanted to tackle, so I worked a lot with sedation. The residency exposed me to a lot of different situations. I worked with patients at Harborview and Children’s Hospital where pain was a critical issue.”
“From 1986 to 1989, he worked in Anchorage. Later, he served at the Yakima Valley Farm Workers Clinic. Yaremko came to Bellingham in 1990 and took over the practice of a dentist who was retiring.
“I did a lot of research into sedating patients with valium or nitrous oxide,” he said. “I was approached about using IV sedation, but the monitoring equipment is expensive; IV sedation is mostly for oral surgery. It’s tough to do reconstructive dentistry and monitor an IV solution at the same time. Oral solutions are safer. It’s harder to make serious mistakes. It’s also harder to keep people in a comfort zone with IV sedation. I need to concentrate on dentistry, not the anesthetic. I’ll call an anesthesiologist if necessary.”
Yaremko checks in with his patients constantly.
“Before we get started, I ask patients how nervous they are on a one to ten scale,” he said. “I ask them again at the end of the procedure and it’s usually much lower. Dental phobias are learned behaviors. Often, we were hurt as kids or in the military. In those situations, you can’t just get up and leave. That inability to leave is part of the fear.”
Like many of his colleagues, Yaremko is not a business person by nature.
“Over the years, I found out what doesn’t work and tried to learn from my failures,” he said. “In my postdoc studies, I learned that how you communicate with people is vital. It’s been a 14 year learning curve figuring out how to do that successfully.”
He has a different approach to the beginning of treatment than most.
“The first hour is devoted to an examination,” Yaremko said. “Then, there is a separate appointment to discuss problems and options. Patients need to know what their dentist is doing and why. They need to understand the consequences of not doing the work. The unknown is always worse than the known. People need motivation to continue care. I spend hours consulting with them as needed. If you try to shortcut communication, you have a business disaster. People will leave if they’re scared or don’t understand what is going on. Of course those hours of examination and consultation don’t generate much revenue. I have to make it up elsewhere.”
Yaremko claims a retention rate of 90 percent, which he says is higher than most.
“You have to pick where you want to be in dentistry,” he said. “I don’t want a high volume operation. I want to insure the quality of restorative care. I want to maintain my standards and focus on a relational practice.”
He believes he is something of an anomaly in that many dentists don’t like to do heavy reconstructions.
“One of the hard lessons I learned is that you can’t be everything to everybody,” Yaremko said. “My marketing efforts are designed to attract specific clients. Fearful people don’t fall into a specific demographic. Low fees is one kind of marketing. My fees are upper end on purpose. I’m selling service and time and will do work that lasts. Once you get people expecting that level of service, you’d better deliver or you’re in trouble.”
Forty percent of dentists are in preferred provider plans that, according to Yaremko, encourage dentists to work faster and cheaper.
“My mother always taught me that faster and cheaper was not as good,” he said. “If you don’t have the patience to do it right, don’t do it.”
Dr. Jim Sweeney is originally from Vancouver, BC, and has lots of relatives in this area. After receiving his degree from Northwestern University, he practiced on the east side of Lake Washington before coming to Bellingham for the lifestyle.
“This place has such a great community feel,” Sweeney said.
He’s come up with a solution for the lack of business training in dental schools. Sweeney is taking the accelerated one year MBA program at Western Washington University.
“Dentists have to run a business and do marketing,” he said. “I need more business sophistication. I’m used to working with small organizations. The MBA program offers training in working with larger organizations.”
Sweeney wants offer all the services he can, but will specialize in complicated reconstruction.
“In my MBA program, I worked with the Economic Development Council on finding ways to attract Canadian business,” he said.
His new office has two employees.
“Computer skills are important and many applicants didn’t have those,” Sweeney said. “The Bellingham Technical College dental assistant program is a great resource. I believe in incentive programs. You have to share with employees if the practice is doing well.”
Marketing, according to Sweeney, is part of his personality.
“Some professionals find marketing distasteful,” he said. “I’m really middle ground. I believe in getting information out there so the patient can decide. Marketing should be an educational tool. A lot of people don’t know what I can offer.”
He believes that the dental IQ is much higher than it used to be.
“I’m going primarily with Yellow Pages ads and a street front location,” Sweeney said. “The location is part of the marketing plan, but street fronts are hard to find. It’s all about visibility. Like any other business, I have to emphasize my uniqueness; the services that can be done, the options that are available.”
Marketing, he believes should be informational, rather than just selling.
“Reconstructive dentistry can be a life changing decision,” Sweeney said. “Give people the information and let them decide.”
Dr. Laurie Brion grew up in Yakima and had orthodontics as a child. The experience was good enough that she knew what her profession would be from age 15. She did undergraduate work at the University of Washington and was admitted to the dental program after just three years because of good grades.
“My Dad was a doctor and always gone at night on emergency calls,” Brion said. “I knew I didn’t want to be in that situation.”
After graduation, she went to Europe and worked in Switzerland for four years. She came back to the US and worked in a clinic for a while before purchasing her Fairhaven practice in 1994.
“We had a program in school called Dental Practice that provided us with some business lessons,” Brion said. “We weren’t entering the business world completely blind out of school. There are also lots of practice management programs and articles in journals. Dentists often serve a sort of apprenticeship in business with an established practice.”
Brion claims some dentists abdicate business matters to office managers.
“I like the business side,” she said. “It’s a control issue, I suppose. I like to know where I am. I like to run our numbers.”
The changing marketplace poses a challenge.
“You have to keep track of what’s going on with insurance,” Brion said. “You have to ask ethical questions. How does this jibe with who I am? This is very important. It seems like people are trying to move dentistry away from a profession into a service industry. We can’t meet all the needs out there because we can’t afford to help. It’s a real dilemma. I don’t want to get out there and promise a beautiful smile and a healthy mouth unless I’m sure I can deliver. It’s not always possible.”
She relies on a strong relationship with her patients.
“If you treat patients right, they will do your marketing for you,” Brion said. “I don’t want to make promises I can’t keep. I’d rather work with patients to get them to good dental health.”
She believes business people tend to be cautious.
“Dentistry is a funny profession that is often maligned,” Brion said. “If I do a painless root canal, I tell the patient to tell others.”
Overhead in a dental office tends to run about 70 percent.
“Most dentists are not making a lot of money and it tends to make us sensitive about jokes,” Brion said.
Some patients seek out women dentists in the belief that they are more empathetic.
“Some come to a woman dentist by accident and find out they prefer our approach,” Brion said. “There is a chemistry between the doctor and the patient. Maybe they think we’re more sensitive and gentle. I wouldn’t say that it gives us a huge advantage.”
Brion’s practice has six employees.
“Getting good people depends on your business reputation,” she said. “Hygienists are particularly had to find. I’m fortunate to have two great ones. They like working for a dentist who focuses on honesty and quality work. When you interview someone for a job, you’re being interviewed, as well.”
She thinks the dental assistant program at BTC is one of the best anywhere.
“There are not enough openings in the schools to accommodate all the applicants,” Brion said. “Dental assistants can do more here than they can in most other states, which makes it harder to get licensed. Demand is such, however, that salaries are high.”
Dentistry is beginning to struggle indirectly with the high costs of health care.
“Employers are cutting dental and vision coverage as health insurance costs rise,” Brion said. “The insurance companies cut costs by not providing good benefits. Affluent employers can still afford good benefits, but small businesses can’t compete. Preferred provider plans don’t account for inflation. I got grandfathered in on an insurance plan, but I’m taking a big hit because reimbursement rates are not keeping up.”
All those factors may be driving the push for cosmetic dentistry.
“Cosmetic is a big moneymaker,” Brion said. “It’s a luxury item that is paid for by the patient rather than an insurance company. I’m not sure that’s our role as dentists. It’s fun and a great rush to create a wonderful smile, but it has to be part of an overall treatment plan. We must try to do what’s in the best interest of the patient. There is an almost unspoken controversy within the profession as to whether or not we’re becoming plastic surgeons. The bottom line is, do you really want to spend $15,000 for a Hollywood smile?”
The way patients answer that question may well affect the future of dentistry and how professionals market themselves.