Are You Running A Covered Market?

One of the most common questions Breathe gets from many of the practice owners we work with is, “Can you help me sort out my ‘under-performing’ associates or hygienists.” Simon explains what they really mean and what you can do about it.

In our experience, what Principals actually mean is:

  • The Practice owner is earning the biggest gross and wonders why the associates and hygienists are grossing much less.
  • The Practice owner doesn’t know what sort of diagnosis and treatment planning the associates are carrying out.
  • The Practice owner suspects the associates might be discounting or even giving away items of dental treatment.
  • The Practice owner suspects that his hygienists maybe carrying out less treatment than is clinically necessary, so as to save the patients money.
  • The Practice owner knows that the associates are happy to do an, ‘Exam, Scale and Polish’ rather than refer their patients to the Hygienists
  • The Practice owner discovers that the associates are doing ‘patch-up’ dentistry instead of treatment planning long-lasting restorative solutions.
  • * The Practice owner worries that his associates are planning to move down the road and take as many patients as they can persuade to come with them.

So, most of this remains unsaid by the Practice owner and an uneasy truce breaks out between the principal and his fellow associates and hygienists. The Practice owner continues to run a Covered Market, his surgeries being manned by market stall sellers under his one roof who build or dismantle his reputation, whilst selling different opinions and services at many different qualities.

This may have worked in dental practice for the last 50 years. Historically, practice owners could achieve a net profit getting towards 50%, whatever everyone was up to on their market stalls! However, with costs rising and competition growing (and net profit often below 30%), it will become much more important to create a practice, with one way of doing things, regardless of which dentist you see, to one set of standards. I don’t believe that the Covered Market will work in the future, particularly when practices such as these find themselves competing with well run, branded Corporate and Retail dental practices.

Recently, I helped a Practice owner review the value of work completed by herself and her three associates for new patients during the first year the patients attended her practice. The principal is an ethical restorative dentist and the practice attracts upwards of 40 new private patients/month (mainly those who are 50+). Her average yield per new patient in year one was a little under £4,000. The yields generated by her three associates came in at: £1,650, £930 and £460 on the new patients they cared for during their patients first year in her practice. Four different standards of care under one roof. A Covered Market.

Of course each clinician will apply, to a greater or lesser extent, different standards and different distinctions when treating patients. I remember when I was in practice going on a very enjoyable and well run course on occlusion. When I returned to work, I quickly discovered that a lot of my patients clearly had some problems which were being caused by their occlusion that previously I hadn’t understood… However, despite your clinicians having different eyes, different distinctions, different confidence levels, your patients expect one set of standards from your practice, one set of promises, the same set of outcomes delivered to the same standard.

So, how are you going to achieve this?!

The key is to develop two sets of standards that your whole team (clinical and support) will sign up to:

  1. A set of standards for performance and
  2. A set of standards for behaviour.

And these standards will be represented by your Brand. This makes for a powerful marketing message and your clients, old and new will understand exactly what they can expect from your practice.

Picture this:

  • One patient journey run by everyone.
  • One set of diagnostic criteria run by all clinicians who work in your practice.
  • The same fee regardless of which clinician your patients see and the same outcomes.
  • One business not a Covered Market!

If you are interested in achieving a set of ‘Brand Standards’ for your practice’s patient journey and clinical performance (no more Covered Market), here’s the to-do list:

  1. Build a reproduce’ able patient journey from first contact to end of first course of treatment. And then, for subsequent courses of treatment, include critical non-essentials (such as hot towels) to help distinguish your practice from 10,000 other UK practices, (some of whom will also have heard of Paddi Lund!)
  2. Agree with your clinicians what the standards of performance will be for New Patient Consultations, Re-Examinations, Hygiene visits, Common restorative procedures etc. Refer to accepted best practice.
  3. And then create a system for each of these clinical circumstances that is implemented and sustained.
  4. Agree with all your team (clinical and support) what the practice standards will be for behaviours (such as running on time, painless dentistry, courtesy etc).
  5. And then create a system for each of these behaviours so that they are implemented and sustained.

And consider using our help! We are providing a new service at Breathe to help Practice owners equilibrate the behaviour and the performance of their practice’s clinicians. This will enable the practice to create an agreed set of standards and provide outcomes that are measurably similar! For more information on this valuable service, contact Ernie on 0845 299 7209 or

We’d like to hear your views and comments – we will publish them in one of our ezines, so please email the Editor

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