June 1, 2005
by Damon C. Adams, DDS
One of the most important and challenging decisions we make as practitioners and small business owners is choosing our dental laboratory partner. It has far reaching consequences for the success of our practice, since nearly 38 percent of the average general practice’s revenues are from fixed crown and bridgework alone. According to a recent Dental Products Report survey, dentists rank quality and consistency as the most important factors when it comes to choosing or evaluating a lab. Good communication, the laboratory’s reputation and turnaround time rank high among the factors that they look for when selecting a laboratory. According to the same survey, 64.5 percent use two to three fixed indirect laboratories and approximately 33 percent of dentists say they have changed laboratories in the past two years, with the majority stating inconsistency as the reason for their need to change laboratories.1
We have enough evidence to know that there is room for improvement within the dental laboratory industry. We need to continually assess and improve the communication skills needed to achieve the desired outcomes with our laboratory partners. As doctors, we also need to examine our knowledge and skills involved in the selection process of a quality dental laboratory.
Is my practice compatible with a quality dental lab?
Before we begin the search for the optimal dental laboratory for our practice, we need to look within our own practice walls. Have we articulated our business vision and treatment philosophy? Are we willing to pay for the quality that we are seeking just as we expect our patients to do? Once we have determined our own vision and practice goals, it is a lot easier to determine if we are compatible with the dental technicians that we are considering for our team.
Stress, distrust, and inconsistency enter into any relationship that involves incongruent visions. Look for a lab that delivers value for the prices they charge. In addition to a good quality, consistent product, do they offer technical support? On-time service? Open communication? Technical feedback?
Quality and consistency or high production with low fees?
A practice that is heavily insurance-based and operates on a fee-for-commodity philosophy basis, is not compatible with a high-end, quality fee-for-service based dental lab. The converse is true as well. Laboratory owners, like their doctors, are faced with the same quality vs. quantity dilemma. Dental technicians know the law of diminishing returns just like us. The more they are pushed in high production laboratories, the higher the stress and the more numerous technical problems can become. The temptation to just “let it go” quickly takes over their business. The internal (in-lab) and external (doctor) re-makes dramatically increase. Training and continuing education is often overlooked and employee morale decreases. Not only is quality reduced, consistency becomes a problem. The doctor buying their product may be making a decision to buy based on fees and not quality, consistency, service, and support. (Ironically, some of these same dental professionals state their resentment when their patients reflect the same dollar conscious buying habits and often lack a sense of loyalty.)
What do you look for to identify a quality dental laboratory?
We need to take the time to get to know one another better before making the final decision to commit to a long-term relationship. The best way to evaluate any dental laboratory is to visit it during a workday to meet and observe the dental technicians in action. Some of the things you should be looking for include:
* Appearance and cleanliness (inside and outside) of the laboratory. Does the overall appearance and dcor compliment your type and style of dental practice?
* Does the laboratory have a reception area with a staff member dedicated to greeting visitors? Is there adequate and convenient parking for visitors?
* Would you feel comfortable sending your patients there for a custom shade or tour of their facility?
* When in the working area, what is the overall “feel” of the laboratory? Stressful? Friendly? Hectic? Relaxed? Professional?
* Are the technicians professional and courteous as you introduce yourself to them? Are they dressed in professional attire appropriate for their job?
* Observe the way in which the individual technicians are working. Are the benches neat and well organized? Are they using magnification (when appropriate)?
* Are the case pans clean, organized, and fitted to the size of the cases?
* Take a tour of their technical production capabilities. Do they have all, most, or none of the different types of restoration production capability that you require?
* Are there any future plans to add to their restoration selection?
* How do they choose new materials for their doctors? Do they get thorough training in the material before it is introduced? Do they involve any of their doctors in the decision process?
Ask permission to randomly choose at least a dozen cases to look at, in various stages of completion. Take your time with this step in the laboratory evaluation process. Observe not only the quality of the lab work, but the quality of the impressions and preparations coming in from their doctors. How are larger cases being handled? Bite registrations? Articulators? Occlusion? Are they completing work on cases that should have been returned for a re-prep or another impression? This will tell you a lot about the level of the laboratory’s sophistication and abilities. It will let you know how effectively it is communicating with its doctors and supporting them with technical assistance.
A two-way interview with the laboratory owner
You will need to spend time talking with the laboratory owner during or after the laboratory visit. To get off on the right foot, both of you must give priority and energy to making the meeting a success, regardless of the decisions that will come out of this time. To set the stage for meaningful dialogue it is always best to schedule this time outside of the laboratory facility or your practice facility. This will allow for an uninterrupted time and give both a chance to speak candidly about any issues of concern in private. Allow at least 60-90 minutes for this important meeting.
Why are we meeting? Usually, we just call for boxes and scripts and I send in the case!
Many times as dentists we fail to see the importance of taking the time to establish a good interpersonal relationship. We often leap headlong into putting some of that new-fangled equipment or recently acquired knowledge into executing a patient’s treatment plan. (Lawsuits are often born out of this rush to treatment!) It must be understood that it is not necessary to come to an agreement or to draw any final conclusions from this first meeting. You may have to meet more than once before both of you feel like you have established the right foundation on which to build a superior business relationship.
All right, let’s get together. What should we talk about? Empress or Procera?
Another important ground rule is that the meeting must not gravitate towards a discussion of techniques and materials. This can be difficult, but realize that there will be plenty of time later for technical discussions. This is the time for gathering information regarding compatibility between the two businesses and for beginning to explore the possibility of a professional relationship. The following are some of the topics that can be put on the table.
Start with sharing some personal information. Introduction of who we are and where we have been in life. Education? Employment? Family life? Hobbies or interests?
the laboratory owner what their vision is for his/her dental laboratory business. (If they have not developed this aspect of their life and business, they might feel a bit uncomfortable and unprepared. Be careful not to push or embarrass them with this topic.) Share your vision and business philosophy.
What are the lab’s continuing education goals and priorities? Share your education goals and how they fit into your overall vision. Ask if there is openness to the option of a coordinated continuing education schedule that would involve the entire doctor-staff and laboratory owner-staff team in the development of relationship, communication, business, and technical skills.
Ask the laboratory owner what his/her ideal client would be like. (Pay close attention to references to personality traits, emotions, type of work, practice style, etc.) If he could wave a magic wand and make changes to improve the quality of laboratory work, decrease stress, reduce re-makes, and increase profits, what would they be?
Re-cap and discuss what you have in common in all of the above. Briefly note any significant differences. This is the “meat” of the meeting that will be crucial to your joint decision whether or not to work together.
Finally, ask if he/she has any other questions or concerns about you that have not been covered.
At this point, if you have managed to do all the above things to gather information about your potential laboratory partner, you have done far more than 95 percent of your peers in dentistry! (A minority has ever visited their laboratory with their staff.) You are now armed with lots of great facts and feelings. You have the confidence in knowing whether your partner shares your vision, aspirations, and philosophy. This will help you make a good decision. If you do not come to a mutual agreement at this point, then you are back to the drawing board. The time spent on this process is not time lost. You will become more adept at the two-way interview process and your next laboratory interview will be even easier. If the decision is positive for the relationship, and your laboratory colleague comes to the same conclusion, then you are off and running!
Whether you end up working with a small, medium, or large dental laboratory, leadership skills to help you choose and properly nourish your relationship will be needed. There are many doctors who want the very best and have the technical skills to achieve their goals. Yet many of those same professionals may never fully realize their complete potential without the ability to find and forge a long-term relationship with a like-minded laboratory. Through further study, excellent mentoring, and learning from side-by-side experiences with your laboratory partners, each and every one of you can live your dreams and create the practice of a lifetime.
Dr. Damon Adams is from Traverse City, MI. He is an Assistant Professor, Department of Otolaryngology, at Medical College of Ohio. Dr. Adams is an internationally recognized speaker who has lectured and consulted for many dental organizations and laboratories including the Shaw Group of Dental Laboratories headquartered in Toronto. Dr. Adams is listed in Dentistry Today’s Leaders in Continuing Education. .firstname.lastname@example.org