Episode #232: Debra Engelhardt-Nash – Fundamentals Of A Great Dental Practice

Dr. Eric Block: Welcome to the Stress-Free Dentist Podcast. I’m your host, Dr. Eric Block. As always, I want to inspire, entertain, and educate you on the best tools and technologies out there. My goal is to help make your practice and career more profitable, efficient, and most importantly, more enjoyable. And check out all of my nonfiction and children’s books on Amazon, and check out thestressfreedentist.com  for any upcoming events. And if you’re feeling you’re a dental professional that’s burnt out, or you just feel stuck or want to get to that next level, visit the International Academy of Dental Life Coaches or www.iadlc.com,  and we’ll get you matched up with a life coach that understands dentistry.

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Hey everyone, welcome back to another episode. And today I’m joined by Debra Engelhardt-Nash. And Debra, thanks so much for joining us.

Debra Engelhardt-Nash: A pleasure. Good to see you again. Last time I saw you, it was Yankee Dental Meeting.

Dr. Eric Block: It was Yankee Dental. But then I feel like I stood you up where we were supposed to have our previous, uh, first recording of this podcast, but somehow the calendar got messed up. But we’re here today, so here we are. No harm, no foul.

Um, and Debra, um, uh, like we were chatting about, uh, you know, you and, um, and Ross, uh, nothing but great experiences in your institute. I learned so much, and it was really, uh, a great experience. I was there before COVID, uh, for the, um, full reconstruction course, and I just learned so much. And I have nothing but good, good things to say about it. Thanks.

Um, but first, let’s hear about how you even got involved with helping dentists.

Debra Engelhardt-Nash: Interesting. You know, my, um, education, my degree is in secondary education, and I lived in Seattle, Washington at the time. All the bond issues failed. And when bond issues fail—you know, school bonds—that’s what happens. Liberal arts school teachers get axed. So I was substitute teaching wherever I could find a gig. And my dentist said—and I think I must have been at my hygiene appointment—and I said something about, "Oh my gosh, this is so frustrating." And he said, "You know, you’d be great in a dental office." And I said, "Isn’t dentistry a science? I mean, I took geology in college ’cause I didn’t wanna cut a frog."

And he said—and he was smart, he was an instructor at the University of Washington—and he said, "You know, it is a science."

Debra Engelhardt-Nash: The clinical, the clinical portion of dentistry is a science. But then there’s this whole people portion, and I think you’d be great at that. So he taught me. He gave me a book on dental assisting. He said, "Read these five chapters," or "You’re gonna do a Myers-Briggs test, a tactile skills assessment." And he put me at the chair to learn clinic assisting. And I got my certification, my CDA. And then, whatever you think about it, I was either promoted or demoted to the front office, where I really found my passion. I really absolutely loved it.

From there, I was recruited by a four-man group. There was—there back in the day—there was, and I don’t think people do it anymore, but do you remember the day of solo group, where there were four solo practitioners?

Debra Engelhardt-Nash: But they shared the facility. They shared supplies, they shared sterilization, but they were individual practices. They shared the reception room. And I managed the four-man group until one of them decided to branch out and went on his own and said, "Would you come with me?" And he said this to me: "I promise you, if you come with me, I’ll make you the highest-paid office manager/ administrator in Seattle. And I also know, Debra, that someday you’re gonna outgrow my practice and you’re gonna do something more."

And from him, I was recruited by the Pride Institute to consult, to be one of their consultants. So I managed Washington, Oregon, Idaho, and Northern California. And then in 1985, I decided that I wanted to do it my way—my own way. I wanted to be Frank Sinatra and do it my way, and started my own company in 1985. And that’s, there you go, in a nutshell.

Dr. Eric Block: And now, would you call yourself a consultant to dentists or dental offices?

Debra Engelhardt-Nash: I would. I would call myself a consultant to dental teams and to doctors. You know, it’s interesting. I would call myself a consultant/coach, ’cause sometimes what I do is coach. And sometimes, you know, I do anything from coaching the doctor on how to be a better, stronger leader, to treatment presentation skills and how to, you know, be a better communicator at the chair. And I coach and consult teams on systems, but also on personal and professional development—once again, with communication skills in the dental office and culture, you know, creating the right culture.

I just had this conversation. I spoke in Longboat Key last weekend, and I was talking about team culture and the importance of that. So, and KPIs—you know, analytics I know are critical—but I always say that, you know, culture eats analytics for breakfast. So for me, it’s culture first, numbers second.

Dr. Eric Block: Let’s, let’s jump back to the word "communication." Uh, you had a great quote here that we typically spend about 80% of our time with patients communicating and 15% on the clinical treatment. Yeah. Um, it just shows you how important those communication skills are.

Debra Engelhardt-Nash: I mean, and if you think about it—and I picked the diagram I typically show in my programs—if you think about it like a funnel, I come in through some sort of awareness: social media, referral, whatever. Google, obviously number one—typically people like to challenge that—but still, I think number one. Then I receive, I have a phone call. There’s a phone call, and then I receive some literature, whether it be via downloaded forms and/or welcome letter, whether it be snail mail.

Then I enter the reception room, I meet the people at the front desk, I meet the treatment coordinator, hygienist, dental assistant. I have an introduction, I have diagnostics. Typically, the last person I meet on the team is the dentist. And the last conversation we have is typically diagnosis, exam, consultation, treatment acceptance, financial arrangements. And then, down at the end of the funnel—down at the end of the funnel, if I had a little visual aid—here is clinical application. It’s way down, it’s way down here. So all this stuff has to go well for me to get this patient down to the end of the funnel. Um, so that is huge for me.

Dr. Eric Block: It is so huge. And, you know, if I could go back in time, I used to take so many courses in bone graft and extractions and implants. I would go back and take courses on leadership and communication and public speaking. Um, I feel like those would’ve just helped me just as much as any clinical course that I could’ve taken.

Debra Engelhardt-Nash: I think you’re right. I also think there’s so many subtle things you could do. You know, I white-label for another practice management company, and I’m not—I don’t consult for them—but I do speak for them. And I do their program on treatment presentation, which includes body language and tone of voice and pace. And sometimes people say, "It feels or sounds contrived." But once you start understanding the impact that it has, it becomes very natural.

And I catch myself—I did this this past weekend—I caught myself and I said, "Wait, I need to stop myself and ask you, what did you just hear me do?" when I was doing a kind of a how-you-would-present-treatment-to-a-patient, or how you would have a conversation with a patient.

Debra Engelhardt-Nash: I said, "You heard me—when I become intentional in what I have to say—I lower my voice and I slow my pace." So, you know, one of the things you and I had spoken about was when I’m gonna have a conversation with a patient about what insurance will and will not do, that is a very intentional conversation. So I choose my words very carefully, and I change my tone of voice, and I change my pace of play, if you will—for, you know, golf referral—so that it becomes, um, it becomes important.

And I think that—so you’re right—I think that most dentists… and I have offered dental schools to come in and teach the third- and fourth-year students communication skills and how to talk to patients and how to present a treatment plan. And they say, "I’m so sorry, we don’t have time."

But, you know, I always say, it’s one thing to know how to do the dentistry—and that’s critical, you have to have that—but it’s another thing to know how to present it in such a way that the patients want to do it, want to have it, and that we’re comfortable talking financial arrangements. And, um, we have, you know, we’ve got team training so that the team’s talking about big cases.

And I was doing a team meeting on Zoom with a group out of Victoria, Canada, on Thursday. I didn’t spend much beach time when I was in Longboat Key ’cause I was doing meetings and webinars. But one of the things they talked about—when I mentioned a big-number case, a full-mouth reconstruction case that could be $60,000—they said, "We don’t have any cases that are greater than $7,000."

And I’m thinking, is that doctor’s philosophy of diagnosis? Is that doctor not… is that his discomfort in treatment presentation and treatment planning? Is that a clinical deficiency, or is that a communication deficiency? And it could be both. It could be both.

Dr. Eric Block: Yeah. When I first got out and for, you know, several years after I got out into the real world—um, you know, first of all, in dental school, you talk over the patient, you don’t talk, you know, to the patient or with the patient. There’s absolutely no communication skills there. And, you know, when I first got out, I was such a nervous wreck and I lacked confidence. Um, it took me a while to build that, you know, that self-confidence.

What would you tell, you know, the young dentist out there that suffers from kind of a similar thing that I did?

Debra Engelhardt-Nash: You know, that’s interesting because oftentimes, if there’s a young dentist at the Institute taking one of our courses, or if there’s a young dentist in my audiences, I will go to them—and not in a challenging way, but sort of in a challenging way. I say, "I’m your patient, and I’m old enough to be your mother or your grandmother. How are you gonna convince me that I should trust you? What are you gonna say to me that helps me feel comfortable and confident that you can take good care of me?"

And so oftentimes I will coach young—especially young—doctors. And I said this this past weekend, and there was actually a sponsor, a company sponsor, who said, "That was brilliant." And I would say, "Gee, doctor, I’m not buying what you do. I’m not buying your clinical abilities. What I’m buying is why you do it. I’m buying your purpose. So when your purpose is strong, your ‘how’ becomes easy. Your ‘what’ becomes easy."

So for me, my advice to the young doctor is, I would sit with you if you were my patient and I would say, "Thank you for allowing me, giving me the privilege of treating you, and I promise to serve you well. Here’s what I want to offer you." And here’s the magic question—whether you be a brand-new dentist or an experienced dentist. In one of my workshops I did with Peter Boulden out of Atlanta Dental Spa, he said, "Debra, I wish you would’ve taught me that question years ago."

This would be a question for a young dentist to introduce treatment to a patient, and it works. Ross uses it all the time. And the question is this to the patient: instead of saying, "I’m gonna tell you what you need," or "Here’s what you need"—I don’t buy what I need, I don’t care, I don’t choose what I need. The question is, "Eric, would you allow me to tell you what I’d like to do for you? If you gave me carte blanche, if you were my brother, would you allow me to tell you what I’d like to do for you?"

I have never heard a patient say, "No, don’t tell me." But I’ve heard a lot of patients—when I say, "I want to tell you what you need"—say, "I only want to hear what insurance is going to cover." So that is an open question.

So I think that, you know, a young dentist is not going to prove themselves by their clinical aptitude. They’re going to prove themselves by saying, "This is who I am and this is why I’m a dentist, and this is how I want to serve you. And would you allow me to tell you what I’d like to do for you?"

Dr. Eric Block: Uh, I’m gonna use that. I love that. Uh, you know, "If I had carte blanche, can I tell you what I can do for you?" And that, in combination with—we started taking diagnostic wellness scans on new patients—and to show them their scans, right? And show ’em their teeth in 3D, um, is such a great way to increase, uh, case acceptance. I love that.

Debra Engelhardt-Nash: Absolutely. It’s huge. It’s huge. The other thing that happens is—and I say this a lot in my programs—once again, I was just in an office in Scottsdale a couple of weeks ago, and we have a tendency—and I’m not saying you, but you are a dentist—so, we have a tendency to assume that it’s okay to jump into a patient’s mouth. We don’t ask permission. We don’t ask them how they’re feeling about their experience with us so far. We don’t have a segue.

You know, we walk in—either sometimes it’s a treatment coordinator or a dental assistant, sometimes you walk in and it’s a dental hygienist—we walk in and we jump into their face. And I love it when we could take a moment, when we stop a little bit and we say to the patient, "Tell me how you’re feeling about your experience with us so far."

And they say, "Oh my gosh, you guys are awesome." You know, I love to hear that. I mean—and even if you said it at the end—that’s obviously the invitation to ask for a Google review. But I think that there’s something, especially—and it could be because of my age—and now, I don’t know, maybe I’m… some of my friends accuse me sometimes of being too informal or too formal, which I totally disagree.

I mean, I do have—I mean, I have minions and chickens and everything around me right now—but I always say, "Would you allow me to examine you?" When was the last time you asked permission? So for a young dentist to say to me, "How would you prefer to be addressed?" And someone should have already told you, if you were the young dentist, "This is Debra, this is how she likes to be referred to—by the Queen of the Nile or, you know, Princess Leia," or whatever that may be.

And they say, "You know, Debra, thank you so much for trusting me with your care. Would you allow me to—how are you feeling about your experience with us so far? Would you allow me to proceed with the exam?" I mean, that’s kind of a Ritz-Carlton next level that is easy to learn.

Dr. Eric Block: It’s super easy to learn and, you know, anyone can do it. And it’s such a great segue to, um, yeah—you know, transition—

Debra Engelhardt-Nash: Bit of open wide. Here’s another thing that we have to be careful about. Um, I know you think you’re in control of this podcast, and you and I have never done this together, but, you know, I got things to say.

Debra Engelhardt-Nash: So thinking—speaking of that—I wanna, I’m gonna kind of jump into recare, ’cause I think it’s really important. And you have to tell me when we have to quit. I’ve got a flight at six, so we’re good—I’m good until, you know, four.

So actually, um, any strength taken to excess becomes a weakness. So sometimes familiarity with our patients can sometimes be perceived as apathy. So oftentimes when we’re talking in hygiene—if you were, let’s say, my patient for a long period of time—I might say during the morning huddle, "Oh, I know Eric. He’s not interested. He’s insurance-driven. He knows he needs two crowns on the top left side, but he’s not interested. He’s not gonna do them. We’ve told him for years. This is gonna be a really easy cleaning. You know, he doesn’t want to hear about flossing."

And we go into our bias—our relationship bias—what we think. Or we almost become… and everybody says, "Okay, engage in relationship and talk about their children and talk about golf and talk about their kids and talk about food." But we could take that to an excess, and it really becomes a weakness.

And the epitome of this, an example—my former husband—I don’t like to call him "ex" ’cause it sounds like he’s icky and he’s not. He’s a great guy. And we had a beautiful child together. And he’s living happily in Ocean Shores, Washington State. He called me one day—and I know his dentist. His dentist is an exceptional dentist—and I know his dentist in Seattle. And he said, "Debra, I’m gonna dispute my recall exam fee, and I’d like you to walk me through some language skills."

Debra Engelhardt-Nash: I was like, "Okay, wow. Tell me more about that." And he said, "Well…" I said, "When you were there, did Don come in the room?" He said, "Yes." And I said, "Did he have some little instruments in his hands? And was he in your mouth with them?" He said, "Yes." He said, "But Debra, the time that I was there, he asked me about you and Ross and our daughter Sophie. He asked me about the film I’m working on. He asked me about what it was like living at the beach. He asked me about, you know, my life."

And he said, "He spent very little time talking to me about my dentistry."

Debra Engelhardt-Nash: And he said, "Why am I paying $125 for a social visit?" He said, "It was a social call, not a dental exam." I went, "Lights!" You know, wow. Wow, wow. That happens so many times in dental offices, where we take that friendliness and that socialization to another level—to a level where it shouldn’t be. And we forget that the patient is there for your clinical expertise.

And oftentimes when I ask the question in audiences, "Why do you think patients say, ‘I only want to have my teeth cleaned. I don’t want an exam’?" the audience usually will answer, "They don’t want you to find anything wrong," or, "They don’t want us to take the time." And I totally disagree. It’s because they don’t see the value in the examination process—because you devalue it by being too informal with your clinical findings.

Dr. Eric Block: What would you say is the best transition to go from that initial chitchat, you know, building that relationship, to that clinical exam?

Debra Engelhardt-Nash: Uh, great question. And I think, you know, sometimes that’s experience and knowing when. But here is an important question that I think the hygienist needs to ask—especially a patient of record—before the hygienist begins with the muscular motions per minute, and before the radiographs and before the diagnostics and the oral cancer screening and perio charting and bringing up Pearl or overjet or, you know, artificial intelligence diagnostics.

They need to look at that patient’s record and they need to see if there had been treatment that had been discussed—that had been planned—but has yet to be scheduled. And before they start—once again, their body language is they’re leaning slightly forward, they’re not getting things ready, they’re not doing, getting their instruments laid out—and they turn to the patient.

And I would say something like this: "Eric, I see the doctor has recommended treatment for you in the past that has yet to be completed. Tell me what has prevented you from having that done."

And I’m not gonna say, "You know, you need those two crowns on the upper left. You know he’s gonna probably talk to you about that, you know, that bridge that he’s been talking to you about for years." I don’t want to—we have a tendency to throw that away, to throw that conversation away.

Debra Engelhardt-Nash: So I think it should be top of the conversation. And, you know, the little, the side stuff—it can be while we’re getting ready and, you know, I’m saying, "Hey, let me get this taken care of…" I mean, the room should be ready when I walk in.

I have a client—and it’s really great—they have a little sign on the chair, you know, much like a maid service or housekeeping services in a hotel. And you walk into the room, and there’s a little sign, a little tent that says, "This room has been prepared for you by Maria."

So they have a sign on the chair and it says, "This room has been prepared for you by Kelly." You know, and so it’s like, wow, this is pretty cool. And they put that up there. And the other reason they put that up on the counter is that that patient—even though they may or may not have a name tag—that patient can see that name tag and see that this is Kelly.

So I think that’s the time when they come down and say, "Wow, last time you were here, you talked about you were taking a three-week trip to Europe. How did that go? I’d love to spend a little bit of time talking to you about that. How was that? What was your favorite thing?"

I’d say, "Man, I wish I could have more time that we could—I could really learn all about your trip and see all of your pictures. So we might have to schedule some extra time next time you come in."

Dr. Eric Block: That’s great. And the answer—or the question that you had—that says, you know, "Why didn’t you get to this treatment?" If the answer from the patient is insurance-driven—um, you know, "’Cause my annual maximum," or, "My insurance didn’t cover it," or, "I only do one crown a year"—what do you recommend there, when the patient’s trying to steer that conversation towards insurance and insurance benefits?

Debra Engelhardt-Nash: Um, well, first of all, I coach my offices not to use the word benefits. It’s a dental allowance. It’s a supplement. It was never—well, it was designed in 1957 to be a dental benefit. And in 1957, when dental insurance was first introduced to the consumer, it was a $1,000 maximum allowance per year—in 1957. So then it was a benefit. It was a supplement to a medical plan.

Now, it’s a dental allowance. So, one of the things that I would say to the patient is, “We’ll do our very best to help you receive whatever dental allowance your employer has provided for you. However, if we wait—it’s never going to cover everything. It’s not designed to do that. It’s no longer designed to do that for you.”

Debra Engelhardt-Nash: So, one of the things we really need to talk about is: waiting for what your insurance will and will not do on an annual basis may compromise the quality of your care, may compromise the results of your treatment, and may clinically put you in harm’s way. That’s not something that we would ever want to do for our patients.

So let’s talk about how we could possibly bridge that gap for you. Utilize the allowance—your annual allowance—but at the level of your treatment. I mean, if we’re talking a big case, at the level of your treatment, we will probably not be able to phase it throughout several years to accomplish it all for you utilizing your allowance. It won’t be right. And typically, no matter how we phase it, your allowance will never be designed to cover 100% of your care—ever. No matter how long we wait. It’ll never be designed to cover 100%, and it’s diminishing almost daily, as we all know.

Dr. Eric Block: Are you seeing more and more dentists reduce their insurance dependence and go out?

Debra Engelhardt-Nash: Absolutely. Absolutely. And it’s becoming… One of the things I say to the patients—you know me, I’m very sensitive to what the patient sees. The patient’s perception is: “I have Delta. Everybody has Delta. You only have to work with Delta Plan 2000 because that’s the only one I have to work with.”

So I always say to the patient, “Dental insurance is very confusing, isn’t it? There are exceptions and limitations and restrictions on almost every plan. And the employer makes the decision on what those restrictions will be.

So in our office, we have chosen to offer our patients one standard of care that would not be dictated by the limitations, restrictions, or exclusions of any particular plan. And that is why we don’t participate on a network level with insurance companies.”

Debra Engelhardt-Nash: So once again, if a new patient—I get this question all the time: What do you say to the new patient who calls and says, “Are you in my network?”

And I just—I don’t want to lie or manipulate them to say, “Yes, we take your insurance,” if we are not in network. But I always like to say, “You know what? I’d be happy to tell you how we handle insurance. Before I do, may I ask you a few questions? Help me understand how you chose our office for your care.”

Then I’m going to get into the: “Here’s how we handle insurance. We will do our very best to help you receive whatever allowance your employer has provided for you. But the doctors made a decision long ago: they would offer their patients one standard of care—regardless of the exceptions, restrictions, and exclusions of any particular plan. They would not bias themselves based on insurance coverage.”

Dr. Eric Block: And is it a similar response if it’s an existing patient and you’ve decided—you know, the dentist has decided—to go out of network, kind of control the narrative of the conversation?

Debra Engelhardt-Nash: Yeah. And I think one of the things we have to… once again, it has to be intentional. So many times—I still go in offices. I know a lot of coaches don’t anymore, and it’s all done like this [virtually]. But I still like to go in and observe, ’cause I catch things—and not in a negative way. I don’t catch people doing things wrong, but I’ll say—I hear a lot: “I’m sorry, we no longer take your insurance.”

But what you’re basically saying when you’re apologizing is that we’re doing something wrong.

So I say: “Yes, we have taken that insurance in the past. But we have found that there are so many restrictions that compromise our quality of care that we can no longer participate in an in-network relationship with that plan.”

“So we will absolutely, as a courtesy, bill your carrier for you to be reimbursed. We’ll absolutely take care of that for you. We will adjudicate anything we can. We have no control over what they will and will not deny.”

Dr. Eric Block: Yep, that’s great. Now, earlier in the conversation you mentioned KPIs and helping dentists with KPIs. What are some critical KPIs, or key performance indicators, to track?

Debra Engelhardt-Nash: Um, great question. Key performance indicators for me would certainly be not how many new patients you acquire per month, but what are you doing with them? So what is your treatment acceptance rate on patients?

I mean, I had a doctor say, "I attract 35 new patients a month. I think I need 50." And I said, "Well, why 50? What is your treatment acceptance rate?" And he said, "I get 100% case acceptance rate." There is no such thing.

And typically, if you are an average practice, you’re performing about 60% to 65% case acceptance rate. If you are a high-performing office, you’re going to have about an 80% case acceptance rate. So I like to take a look at: what is my diagnosis amount? Because is that where I need to focus?

Debra Engelhardt-Nash: Am I diagnosing dentistry? If I’m not diagnosing dentistry, there’s nothing to do. If I’m diagnosing it and they’re not saying yes, then even if I feel clinically comfortable and confident that I’m diagnosing appropriately, I now need to work on my language skills to get patients to say yes.

So: diagnosis rate. What is my diagnosis versus my treatment acceptance rate?

The other piece is not only do I want to take a look at how many people am I attracting, but how many people are leaving? So I look at my attrition rate.

So sometimes at the end of the year, we say, "Okay, you acquired 145 or 200 new patients." How many did you lose? So what was your actual growth? Was it really 10%? Or was it 5% because of attrition?

I also like to look at capacity. What capacity do you have?

I did a Zoom meeting with a practice in Victoria and I asked them, "How many active patients do you have?" And they said, "We have 2,500 to 3,500 patients." That’s huge—that’s a 1,000-patient difference. We need to be specific.

They had two hygienists working five days a week, seeing about seven patients a day. They don’t have the capacity to see 85% of 3,500 patients. They can’t get ’em in.

Debra Engelhardt-Nash: Why is that important? Because even though our hygiene schedule is full, it could be full of the same people over and over and over. We keep recirculating the same people. And the people we can’t get in—well, we’re full, so we stop trying. And now we can’t get those people in, and they have restorative needs and we’re not treating them.

We’re not seeing them. We’re seeing the same people again and again. And oftentimes we’re not reintroducing them to their unscheduled treatment.

So I like to take a look at capacity: what is my recall return rate? What am I capable of? How many patients of record am I capable of treating in a year? And if it’s too low—if it’s below 80%—I’ve got to fix it. I’ve got to figure something out.

Dr. Eric Block: Now do you recommend sharing these numbers with the team? And if so, absolutely, what numbers do you recommend sharing?

Debra Engelhardt-Nash: Great. Uh, yeah. In fact, I was just… one of the speakers at this meeting I attended at Longboat Key Resort in Sarasota was a CPA, and he talked about sharing the numbers as well.

And he said, "I think it’s really critical for your team to have something to strive for." So, once again, I think treatment acceptance rate, collections rate—that’s huge.

I’m a big fan of… I love bonus plans. But bonus plans should be based on collections, not production.

So everybody should know: if you’re going to ask me to play the game, I need to know what the rules are. And I also need to know how we’re going to score.

So if you’re going to take me bowling and say, "Debra, we’re going bowling. I’m going to put a sheet over the pins. There’s this wooden alley, and I’m going to hand you a ball. You’re going to roll it down the alley. You’re going to hear some noise in the back behind the sheet. Then the ball’s going to come back to you, and I want you to roll it again and hit the pins that didn’t get knocked down."

I have no idea where to take my ball.

Debra Engelhardt-Nash: So the analogy is: if you’re going to ask the team to have direction—if you’re going to ask the team to be on the same playing field with the same focus that you have—I need to know where to put my focus. And I won’t know where to focus my attention if I don’t have some of the numbers.

Am I going to know the overhead? No. But let’s face it—most team members can figure out production and collection. What they may not figure out—unless I’m working at the front desk—is gross production versus net.

That goes back to that whole insurance thing. When you take a look at: here was our gross production, but after insurance write-offs and adjustments, this was our net production.

And I think that’s… sometimes when team members get uncomfortable needing to talk to the patients about restricting their insurance dependence, I will say: "Let me ask you this—if the doctor came to you and said, ‘I know I’m paying you $40 an hour. However, because we’re taking a 40% cut in our fees from insurance, I’m going to ask you to take a 40% cut in your payroll’—would you do it?"

What would a team member say?

So I think it’s important for the team to understand: we want to increase our net productivity. Because when my net productivity increases, I can reimburse my team more. I can offer more benefits. I can offer more bonuses. I can offer more perks.

So I like them to know: you are in direct control of what is available to you in this dental practice, based on your commitment, your passion, your ability, and your desire to take risks to help this practice grow.

Dr. Eric Block: Now you mentioned sharing the numbers and bonus plans. What else do you recommend for dental offices? I know they’re struggling out there to attract, retain, and motivate team members.

Debra Engelhardt-Nash: Isn’t that the case? I think you have to indicate—and a doctor just asked me about this on Saturday—and I said, it’s tough out there. I mean, I wish I could say, "Oh my gosh, I know 27 people in all the states that happen." Not so many.

First of all, I am saying that sometimes we get mired in wanting to find somebody with dental experience. And I understand—in terms of, certainly I need certification as a dental assistant and as a hygienist. I need licensing and certification. If I’m looking for somebody who is a certified dental assistant or a registered dental hygienist, I’ve got to create an environment that is better than most. So I have to promise that we have a culture that’s going to make you want to come to work every day.

Debra Engelhardt-Nash: You know, I’m not burned out. You know, it’s an interesting statistic—71 out of 100 people who go to work every day don’t enjoy it. That’s a lot.

So we are going to create an environment—you know, we don’t have a merry-go-round in the reception room, and we’re not serving margaritas at the end of the day—well, maybe we are—but we create an environment where you matter. Every day you come to work, you matter.

So we create an environment that… you know, I always ask doctors, "When was the last time you helped a team member out? When was the last time you sensed something was going on in their lives? When was the last time you asked them, ‘What more could I do to help you today?’"

I mean, do you really function as a team? And have you created a culture that attracts the right people to you and keeps them there? That’s a critical piece.

So I have an office right now—they’ve got a revolving door. He’s a great doctor, but his culture is toxic. And we’ve got to fix that.

Debra Engelhardt-Nash: The other piece—for front office—I say find people who are in a retail industry, people who have been in customer service. They understand.

I have an office in Vancouver, Washington, and they had a person with a lot of dental experience who—I can’t even tell you the story about how that person drove patients away from that practice.

And now they have Steve. And Steve has no dental experience, but he has a lot of customer service experience. And Steve is absolutely amazing. He doesn’t know dental language, but he knows people. He knows how to take care of people.

And I asked, I said, "Steve, if I could clone you, I’d clone you." No dental background whatsoever. But he has a sense of serving. And I think that’s the other thing you look for—do you want to work in an environment where you truly are serving people?

And I understand that we have to pay attention to our productivity per hour, and we have an overhead that we have to meet. But once again, if I’m one of your team members and you help me find my purpose, then your practice will become my passion.

Dr. Eric Block: That’s great. Love it. All right, let’s wrap up with two final questions. Number one—

Debra Engelhardt-Nash: Are we done?

Dr. Eric Block: We’re wrapping up. Yeah, that went by fast. Let’s—

Debra Engelhardt-Nash: Was this helpful? Was this information helpful?

Dr. Eric Block: Oh, this is—you’re crushing it. This is great. Great stuff.

Debra Engelhardt-Nash: Cool.

Dr. Eric Block: Two final questions. How do we find out more about what you’re up to? And then final question—what advice would you give to the young dentists out there?

Debra Engelhardt-Nash: Okay, well we kind of covered that, but—I do have a website: DebraEngelhardtNash.com.  I know it’s long—I tried to use every letter in the alphabet. I couldn’t figure out where to put the Z!

So DebraEngelhardtNash.com.  You can also call me on my cell phone. I take the call and I don’t have a stripe on my phone to charge you for it.

You can reach me at (704) 904-3459. I always think I should say “zero” because it really is a zero, not an “O.” So it’s (704) 904-3459. That’s my cell. You can text me and say, “Hey, do you have a couple minutes to chat?” “I have a situation I’d love to run by you.” Happy to do that. I don’t have a meter. Happy to do that.

Also, the Nash Institute—www.thenashinstitute.com   I do courses with Ross there. I also—I’m doing a team communication workshop in June. It’s a day of, "How do you talk to people?" Of course, that’ll be long gone after this is aired. But I do team communication workshops and dental business school training at the Nash Institute.

Debra Engelhardt-Nash: The advice for young dentists—and you kind of alluded to this in the beginning when you said, "If I had taken more courses on communication when I was young"—I would find a Dale Carnegie course, or a…

Oh, what is that—the weekly course you can go to and learn how to speak?

Dr. Eric Block: Toastmasters?

Debra Engelhardt-Nash: Toastmasters. Yes, thank you! I had a little brain lapse there. Yeah.

I would tell a young dentist—not only would I take a Dale Carnegie course or a Toastmasters course…

Debra Engelhardt-Nash: Toastmasters course. Guess what? You go in and you’re a young dentist—guess what? You’re gonna meet potential new patients in your community. Yep. So—and I think, when you asked me that—I said, learn how to communicate with your patients. Sit down, learn.

There are some great courses, whether or not you are a reader or a listener. My favorite book that I recommend to all young dentists is Simon Sinek’s Start With Why. I think it’s a great, great book.

I also like a book called If Disney Ran Your Hospital. It’s also a wonderful book. And I really like a book that I give to a lot of my clients, written by a restaurateur by the name of Danny Meyer. Fame—he started Shake Shack, Gramercy Tavern, Eleven Madison—famous New York restaurateur. And he wrote a book called Setting the Table.

And it’s really about customer service. It’s really not—it’s about his restaurant—but if you take some of the principles of establishing these fine dining experiences, you’ll learn a lot. You’ll learn a lot.

So… learn how to speak.

Dr. Eric Block: Yeah, that’s great. Love it, Debra. Thank you so much. It was such a great episode. I really appreciate you joining me.

Debra Engelhardt-Nash: Great to see you again.

Dr. Eric Block: Thank you.

Debra Engelhardt-Nash: Uh-huh. Take care, everyone.