Home Dental 649: The Restorative Diagnostic Practice – Dr. Jim McKee

649: The Restorative Diagnostic Practice – Dr. Jim McKee

by adminjay

You’re always busy — yet you make no money! Being a referral-based, fee-for-service, and diagnostic practice is the way to fix it, and Kirk Behrendt brings back Dr. Jim McKee, founder of Chicago Study Club, to share how to successfully build this type of practice. Enjoy dentistry while still making money! To learn how, listen to Episode 649 of The Best Practices Show!

Episode Resources:

Links Mentioned in This Episode:

Register for Dr. McKee’s Advanced Occlusion course (February 29 – March 2, 2024)

Join Chicago Study Club

Main Takeaways:

Find something you enjoy doing and become an expert in it.

With dentistry becoming more complex, diagnostics is crucial.

Commit to training your staff. You can’t build your practice alone.

In a referral-based practice, the caliber of patients you get is higher.


“When you have professional colleagues sending you patients, your patients are coming in at a different level. Having done traditional neighborhood dentistry for the first five, six, seven years of my career, I certainly know the difference. Patients come in more ready to say yes, and finances aren’t as much of an issue. Not that there’s still not an issue, but they’re a little more open to the discussion, and the first thing out of their mouth isn’t, ‘Does insurance cover this?’” (5:55—6:21)

“The advantage of the in-network practice is you’ve got an unending number of new patients. I mean, it’s awesome. You’ve got one new patient after the next. But the problem is you don’t necessarily have enough time to work them up. You don’t necessarily have enough time to develop a treatment plan and talk to them about it. And a lot of times, there’s a mentality that, ‘I’m only going to do what insurance is going to cover,’ and that’s okay because that’s what they’ve been told. So, for that reason, I think it’s the most challenging practice style out there today. The difficulty is, that’s where a lot of young dentists end up out of school because they’re paid well and it allows them to pay down some significant debt that they have. The problem is, you’ve got to get through those tough years until you go out and do something else, and you hope that you can make it through that.” (9:52—10:50)

“You’ve got to bring new patients in. And in order to bring them in, you need a specific skill set. If this is more of a generalized practice that just drills and fills teeth, these are the practices that are getting squeezed today because there’s nothing to bring new patients into the office. Therefore, if a patient doesn’t perceive a problem, they’re going to go in-network because why would they pay more if they didn’t have to?” (12:17—12:43)

“We always talk about profitability in dentistry. And it’s interesting, most of the time when we talk about becoming more profitable, we’re always talking about how to cut down on expenses to increase the profit level. The reality is, a lot of the times we have to look at the other end of the equation. Many times, we need to raise the revenue to be paid a little bit more appropriately for our services, which are then going to increase the profitability that we’re able to do with those types of services. So, with this, there’s going to be a higher cost to the patient. But here’s the real key to the discussion. This practice absolutely demands a specific skill set, whether it’s diagnosing joints, whether it’s doing restorative dentistry, whether it’s being an aesthetically trained dentist. No matter what it is, you have to have a specific skill set that brings people to you.” (13:16—14:21)

“Everyone talks about, ‘I want to get new patients referred to my practice.’ And that discussion is always talked about that, ‘I want patients to refer other patients to the practice.’ My advice is, if you can develop a practice where other dentists refer you patients, that is the most sustaining practice you will have, because it is not uncommon for a dentist to refer two to three patients a day to me, sometimes, depending upon who they see. That’s not going to happen from a patient. And those dental-referred patients are already prescreened, so we basically know what they’re coming in for. Those are patients that are more in my wheelhouse. It’s more specifically designed for the skill set that we’ve been able to develop. And for that reason, I honestly think that’s the most secure type of practice that’s out there today. It insulates us from third-party issues. It provides a constant stream of new patients. It allows you to be profitable. It allows you to have time off to take continuing education to continue to build your skill set. It allows you to pay your staff more than they can get paid anywhere else in the community, which is going to promote long-term retention and decrease stress in the office. So, for me, that’s the practice style. The problem is figuring out what you want your skill set to be.” (15:08—16:39)

“I remember back when the economy went south over the past 20 years. The few times it did, a lot of the aesthetic dentists sometimes took a little bit of a pounding because that was a discretionary-income-based need that the patient was filling. I was lucky, because if patients had growth problems, a patient had joint problems, if patients needed treatment planning issues worked out, those tended to not be as dependent upon the economy as some of the more discretionary items might be.” (17:59—18:38)

“I think the practice of the future is going to be a practice with multiple practitioners who can share specific skill sets. If you can develop a practice where you have three or four really good dentists that practice together and each emphasized a certain area, maybe one did joints and occlusion, one did airway, one did aesthetics, however you wanted to structure it, you can make that a specialty practice as well. The problem is, again, you have to keep a lot of people happy in that marriage.” (18:54—19:34)

“I’ve been talking to a dentist in the Chicagoland area about this concept of developing a multi-specialty practice for high-end dentistry. I think patients need it. You could imagine if you had one orthodontist, one periodontist, one oral surgeon, one restorative dentist, one joint dentist, and an airway dentist all under one roof who could collaborate, that would be a rocking practice.” (19:39—20:07)

“The practice that we’re talking about, I think, gives you the best chance for a low overhead, because a lot of the dentists that we’re talking to today, I’m sure you’re hearing the same thing, they’re saying they’re too busy, they’re too busy, they’re too busy, they’re too busy, and they’re not profitable. But because they’re having to write off fees because they’re in-network — so, are you too busy, really? You’re busy, but it’s a case of working really hard for not maybe getting the financial reimbursement that you should be getting for working at that level. If you can develop this diagnostic practice, basically, you could do this having one front desk, two assistants, and a hygienist. You could probably have a four-person office if you were really clean about it. Five, maybe, if you wanted to have a lab tech and another help at the front desk. So, you don’t have to have a big practice to do this. And that practice model can be modular where you could add on to that with another doctor, if you want. But I’ve got to be really clear. You don’t have to do it. You could very easily make that a single-doctor practice and, I think, have a very sustaining practice if you were able to build that skill set and become more of a concierge type practice or a boutique type practice.” (21:16—22:53)

“There’s definitely a practice within a practice. That’s really how you build this practice. Your new patients could be the restorative practice. The diagnostic ones could be either new patients or patients who pull out of your own hygiene department. That’s the beauty of this practice model. You’ve already got the patients there. You just need to bring them through in a different way so they’re able to understand, a) the problem so, b) your solution makes sense. The biggest mistake I made is I provided solutions to patients who didn’t understand they had a problem.” (25:28—26:03)

“There was an old saying, ‘Examination before diagnosis. Diagnosis before treatment planning.’ What we tend to do is jump right to treatment planning because we’re looking to help people. And honestly, the exam gets cheated, and the diagnostics get cheated. Now, if all you’re doing is filling teeth, you can probably get away with that. The problem is we’re doing more today than just filling teeth. So, therefore, the exam really has to be at a different level than it’s been before. We’re not just looking to see if there are buccal caries on the lower first molar. We’re looking at wear patterns, we’re looking at joints, we’re looking at gum tissue, we’re looking at aesthetics, we’re looking at airway, we’re looking at facial development, all that stuff. And then, from there, what we have come to realize is that many of the patients that are coming to our practice have poorly developed mandibles and poorly developed maxillas. So, a lot of times, as restorative dentists, we have a foundation that hasn’t developed very well. And then, all of a sudden, we’re supposed to take not-great parts and create this masterpiece out of it where the teeth are exactly in the right place, and they look beautiful.” (26:42—28:06)

“The complexity of dentistry has changed. That’s why I think, today, you can’t get away from diagnosing, because most of the time we’re not just putting fillings in teeth anymore. That’s why the diagnosis part becomes critical. Because without that, your treatment plan — you don’t know where to go with it.” (28:23—28:46)

“[Dentistry is] a whole different discussion today than it used to be even 10, 15 years ago. The ability to see MRIs, to see soft tissue and CT scans, to see heart tissue — it takes all the guesswork out of it. Which, honestly, you know what it does? It makes it fun. All of a sudden, the cases that used to make me nervous treatment planning, they’re not there anymore because generally we understand what’s happening at the back end of the system as well as the front end of the system, and we pretty much can give people answers. But not only can we give them answers, we can frame their expectations from a more realistic perspective. I used to promise the moon sometimes because I thought the only problem was muscle, and if I made a really good splint, they were going to get better. That’s true if it’s just a muscle problem. The reality is, there are more patients with structurally altered joints than we think. So, that’s why if you’re going to build a restorative diagnostic practice, my advice is to do it through the occlusion-joint or the occlusion-TMJ world because the need is so great, and there’s no one out there answering the need.” (30:40—32:59)

“You have to be at a point in your career where you’re ready to make a choice. For every dentist, that comes at different points in their career. I was fortunate to go into a small practice early, but I probably made my choice four, five, six years into it. When I talk to most young dentists, that’s about the age where dentists start to realize, ‘I want to figure out where I want to spend my time in this profession.’ My advice is, find something you like and go after it. It doesn’t matter what it is. Find something you like and become an expert at it. You’re going to enjoy dentistry more. You’ll attract people who have that need.” (33:16—34:05)

“If you really want to build this type of practice, you’ve got to commit to training your staff . . . Otherwise, it’s too hard just for the dentist to pull the rope all by him or herself.” (34:07—34:24)

“Dentistry today, I think fee-for-service is alive and well. You have to be smart about it, and you have to choose something where there’s a need, and where patients understand the need and are willing to pay for the need — but it’s out there.” (34:31—34:45)


0:00 Introduction.

2:32 Dr. McKee’s background.

7:21 The three models of practice, explained.

17:03 Benefits of being a specialty practice.

20:58 You don’t need a large practice for this to work.

23:10 You have a practice within your practice.

26:04 The diagnostic practice, explained.

28:48 About Dr. McKee’s course.

30:08 Occlusion, explained.

33:02 Last thoughts.

34:50 About Dr. McKee’s study club.

Dr. Jim McKee Bio:

Dr. Jim McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984. 

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