Running a dental office is very different than any other business.  Yes, there are many similarities, but very few other businesses or professions have to deal with the challenges that we face every day as dentists, especially if you are an owner of a dental practice.  A lot of us have, at least at some point in our practice, fallen victim to one or more of these challenges.  The only question remains; were you able to get out and move beyond these challenges or are you one of the many still enduring the claws bringing you down and limiting your success?

If You Feel Like Giving Up, Keep Reading. 

I see these challenges as enemies to our success, draining us of our passion, energy, and the true reason we became dentists.  So many dentists I speak with are frustrated, overwhelmed, and have given up on trying to reach their potential.  Many of you have fallen victim, either out of this frustration, being overwhelmed or you are simply tired of fighting. So you settle into doing the kind of dentistry you wish you weren’t doing, you run your business the way the insurance companies tell you or you simply do what I almost did—you get out. 

I Chose to Fight Back

For those of you who know me or my story, you remember when I almost got out, ironically right before the market crashed in 2008. But this blog is not about that. It is, however, about the 5 enemies that threatened my business—threaten all our businesses—and what I did to get past them, fight them, or ignore them. This blog is the first in a series, each one addressing one enemy and the solution, my suggestions, and maybe a little bit of connection so that you don’t feel you are all alone.  

Enemy #1: The Insurance Companies

Dental insurance is not necessarily the enemy.  It’s great when our patients can get some money back for the dental services they receive after paying giant premiums and co-pays each and every year. The problem is the way insurance is set up, the way it’s limited, and the way it’s “policed” to make us, the dentists, look as bad as possible.  How many of you have submitted a crown to an insurance company and had it denied due to “not enough tooth structure damaged”.   It happens ALL the time!  Some desk a$%, who has never seen your patient, never looked at their mouth, doesn’t know their habits or parafunction and has never set foot in your office during the case presentation, knows that this patient doesn’t need a crown!  Why do we, as the doctors who went to school for this, passed the boards, got our licence, did a bunch of continuing education, why are we the ones who have to then write letters asking permission and justify why patients need anything?  What’s the point of this permission?  If we need permission, or we need someone else to review what we are recommending then what’s the point of the license in the first place?

Then there is my favourite aspect of insurance—the annual maximum.  The annual cap.  The total amount the insurance company ‘allows’ the patient to ‘spend’.  And the problem is that the insurance company takes it literally.  ‘Allowed’ as in ‘you can’t go over’.  And if you do, that means your dentist did something bad! But there is something about the annual maximum that you probably don’t know. It is really important to know so that you can understand what the annual maximum really means. 

Insurance Companies are Behind the Times

Around 1970 is when insurance companies started implementing annual maximums. Insurance companies set a maximum spend, annually, to control what they paid out to their insured so they could make money and still sell insurance premiums.  Kind of a ‘win-win’ I guess. At the time, they said, look, you get somewhere between $1,000 and $2,000 depending on how much you pay in your premiums and you can spend up to that amount each year with your dentist, after that you pay the rest out of pocket. Sounds like a fair deal, right?  Sure. In 1970. If we kept up with inflation, it would actually still be a good deal today. Not sure how many dentists are aware of this, but I researched it. If we take that $1,000-$2,000 maximum that was set in 1970 and adjust it for inflation, this is what it would be equal to today:

$1000 maximum in 1970 = $12,655 today
$1,500 maximum in 1970 = $18,982 today
$2,000 maximum in 1970 = $25,310 today

Think about it, had the insurance companies kept up with inflation, wouldn’t you be able to provide your patients with the comprehensive, full, beautiful, and long-lasting dentistry that you were meant to provide?  And couldn’t you do it properly, all at once, or at least over 2 years or so for just about anyone?  The answer is an unequivocal yes!  

Insurance companies are enemy #1 for the simple reason that they make us look bad, look like we are recommending treatments that are not right for the patient, when in fact, the insurance companies are the ones who are screwing them, screwing them out of what should be theirs, to begin with!  

I graduated dentistry in 1996 and by the time 2008 rolled around, I had enough.  Enough of the bullshit, enough of the insurance companies telling me to submit “permission” a.k.a. “predetermination” for simple procedures, enough of the patients’ distrust of my recommendations when their insurance turned them down. Insurance wasn’t the first enemy I attacked when I decided to stay in dentistry but this was the enemy I had to take down eventually. So if you do have all the other elements, systems, and solutions in place, this is the one you must fight, attack and overcome; at least to a point.  Otherwise, you will always be a slave to “permission” slips.  

Slaying This Enemy

How do you take down enemy #1?  It’s not easy. I started this blog series with the toughest enemy but that’s not actually how I did it in my office. Before I could defeat enemy #1, I made sure I first had all the right systems in place (more on those in subsequent blogs) to support my business without the insurance companies. This enemy is too important to ignore any longer.  The numbers, the research, the constant battles with insurance companies telling my patients that what I was recommending was “not necessary” has gone on too long.  The reality is that insurance companies have not kept up with the times since 1970.  So move forward to get the right systems in place; systems for your customer service (link); systems for continuing care (link); properly set up team meetings (link) that give you results; systems for case presentation (link) so that your patients understand that you are trying—so very hard—to HELP them! 

Know Where You Want to Go

Once all of the systems were in place, there were two things that really worked well, and continue to work well, for me.  First is to have a properly defined strategic plan (link) so I knew where I wanted to be at the end of the year, and exactly how I was going to get there with my team.  And that’s key.  Having your team on board, aligned with your vision, is so critical to getting where you want to go. 

Present Your Case

The second undeniable system that made all the difference when it came to bringing down enemy #1 in my office was having a kick-ass system for case presentation (link). Now don’t get me wrong.  It wasn’t easy and it didn’t happen overnight. It took time, effort, trials, training, role-playing, and finding out what worked and what didn’t.  Some things didn’t work at all. So we got rid of them.  Others worked some times but didn’t other times so we looked at when and why they worked. I started mapping out, recording data, learning from different experts in sales and influence, and psychology, and natural language processing (NPL) techniques, and refined refined refined, until it really started to come together and change.  Then I started to record and summarize all the aspects of what worked and worked beautifully into an organized systematic step by step pattern of actions, words, behaviours, and explanations so that I could communicate this to others.  Over time, this became what we now call the Ultimate Case Presentation (link) program, a 7-step transformation to achieving incredible case acceptance, and ultimately, the destruction of enemy #1.  

Stay tuned for more blogs in this series on the Five Enemies that are challenging your dental business. To combat them, learn more about UPB Dental Academy courses, created by a dentist to help dentists reach their goals and grow their business. Contact UPB Dental Academy at and follow us on LinkedIn.