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Dentistry and the Corporate Thought Process
Money talks, BS walks.
Money talks, BS walks.
Money talks, BS walks.
Anyone among us who doesn’t understand this doesn’t understand the 90’s. And, hasn’t life always been like this, at least in the business world?
No. No it hasn’t. Over the last several decades, health care in the United States became separated from this most basic of premises. The growth of third party coverage and the sense of entitlement of the public accomplished a surreal era in health care which peaked in the late 80’s. It is not coincidental that the ebb of this peak coincided with the rise of leveraged buy-outs, hostile take-overs, and Barbarians at the Gate.
The public was led to believe that they were entitled to the highest technical levels of health care and that they should have no personal financial risk in the purchase thereof.
Corporate visions have changed significantly over the past decade, both in external (product and market based) and in internal (managerial) thought processes. The profession of dentistry missed this change, perhaps because of those little reception windows that too many of us still have in our offices. Perhaps because we are/were a cottage industry of small, suspicious, scarcity-mentality competitors who still don’t quite see the big picture. Perhaps because we expected someone else to act on what we saw as an individual. Perhaps because we expected our organizations to see and respond for us.
If you have not read Barbarians at the Gate, or have not seen the movie, then you must do so tomorrow, and before your next "better bonding" course. This entertaining and true story relives the drama of the leveraged buy-out of RJR Nabisco. It was a classic tale of the good ol’ boys, living big off the fruits of the endeavor, versus the evil empire of cut and chop efficiency experts who could find the fat in a business, cut it out, keep the prime pork, and sell off the remainder to the sausage makers. It documents the change of the corporate mindset in America from "good is good enough, only overt failure is bad", to "kill or be killed". This does not describe a "kinder, gentler" corporate culture. This attitude breeds scarcity mentality, downsizing, right-sizing, RIF’s, and outsourcing. This marks a fundamental change in Corporate ethos that lingers to today.
How does this revolution in Corporate thinking effect the health care industry, and dentistry specifically? First of all, from an internal, or managerial perspective, human resources costs of all types have come under scrutiny. After a few years of looking at big ticket items like total payroll, 90’s executives have next targeted benefits as the next layer of fat. They have had to deal with the societal expectation of health care as an entitlement, so to eliminate health insurance in total would be corporate suicide. So a quest for reduced cost health care has ensued, as true cost containment for some corporations and as a wave-effect for others. Insurance with higher levels of third party intervention and stricter contractual provisions were accepted easily by the workers because the health care providers had already accepted financial responsibility for their patient’s care. The financial doctor-patient relationship had already died in the previous decade. The corporate world never came to the health care professions and asked them to do a good job for less money. They asked the third party industry to provide them with something that they could sell to their employees as insurance that would be less costly. They went to the source, to the purse strings. They looked at medicine first, as the larger health care expense, and next they looked at dentistry. Executives need to cut expenses to keep their jobs, so they will do so. We live in a bottom-line era.
Corporate visions have also changed in their external affectations, namely marketing and product development. Marketing is the science of how people make decisions, and how to influence those decisions. Marketing is not advertising. Marketing is high science, advertising is low art. Marketing is awesome, and possibly dangerous, because of the effect that a marketing premise can have on the public.
A history of twentieth century marketing may be derived from the very entertaining works of Al Ries and Jack Trout, but suffice it to say that the accepted key to marketing success in today’s over-communicated society is positioning. Positioning is the concept that, to be successful, you must be first in the hearts and minds of the public in your domain. Positioning is the challenge to find a void in the marketplace and to fill it. Being first in an industry is usually analogous with success, leaving late comers to struggle for a sub-niche (such as disposable razors versus women’s disposable razors). The first must generally only not shoot itself in the foot to remain first in the hearts and minds of the public.
Traditional, fee-for-service dentistry has failed to take advantage of its being the historical first in its industry. By clinging tenaciously to its admonitions against advertising, Organized Dentistry has failed to serve its profession in the most basic of ways. For, once again, marketing is not advertising. Advertising is the servant of marketing, and marketing is the science of how to influence purchasing decisions. Many of us may have individually become first in the hearts and minds of the few patients we treat, but which of us has had the impact of say, a David Acer, or of the HBO movie, The Dentist, on the masses?
Dentistry is a basic health care need, yet we only touch less than 50% of our potential market. We are still equated with discretionary spending, and thus compete with Gucci purses and even confections for discretionary dollars. The basic and fundamental omission of Organized Dentistry is that it has failed to make a position for dental health in the hearts and minds of the public. Thus, despite our "firstness", we have left a void that outsiders, mostly non-dentists have filled. We have allowed third parties to waltz in and define dentistry to the public. And, it was easy for them, as the combined marketing budgets of dental managed care last year were $150 million, three times the entire budget of the ADA!
Money talks, BS walks.
We have lost the benefit of being first in our marketplace, and run the risk of playing perpetual catch-up. Organized Dentistry has repeatedly voted against proposals for significant external marketing. The few organizations that have had the courage to externally market have been ineffective, mostly because of very poor vision or poor guidance. Most nauseating are the commercials, "When choosing a dentist, make sure to choose a member of the South Podunk Dental Association.". Most external marketing, such as this example, communicate nothing, show fear of taking a stand on health, and are totally emasculate. They do not serve any purpose, are negative in their value to the profession, and must not be used as examples of the failure of external marketing. They are examples of failure of advertising.
Real world, corporate, marketing, as is now being used against the concept of free choice/fee-for-service dentistry, must be answered with real world, corporate, responses. We do have some advantages in the competition, which we must take advantage of. Three of the strongest are the time that we can afford to spend with our patients, our ability as dental leaders to define and create brand recognition/demand for Optimal Dentistry™, and once again, our "firstness" while that perception may still be regained. Organized Dentistry should be obligated to create a marketing position for Optimal Dental Health. This is the best way to serve its constituents and the public, and the message is undeniably righteous. This should be Organized Dentistry’s number one calling.
The American Independent Dentist’s Association, in its parallel service to Organized Dentistry, hopes to advance its concept of External Patient Education™, as the ADA and many other dental associations re-address the issue of marketing. External Patient Education means to market dental health to the world, and to do so in a manner similar to how we traditionally handle internal marketing in our individual practices. We need the marketing equivalent of a fireside chat, heavy with trustworthy and usable information that will create benchmarks for Optimal Dentistry that the public may use and place first in their minds when they evaluate their own dental care, needs, and desires. This will require ingenuity, money, and courage- courage to allocate money (and lots of it) for such an enterprise and the courage to benchmark dental care.
Dentistry has been traditionally reactive and dilute in its courage. As courage breeds commitment and commitment facilitates money , we must first concentrate on demanding courage of our leadership. Courage is often a virtue that lies hidden within a person, and surfaces only on necessity. Today is a time of necessity. We are a guild without solidarity in Corporate times. Our leaders must have the courage to commit. Excellent dentistry for us is excellent health care for our patients. Remind your dental representatives. Become a dental representative. Join Organized Dentistry if you don’t already belong, and then challenge it with your courage to pursue your ideals. Give it two years, and see if you don’t make a difference. However you do it, make sure that the dental profession is able to mount a Corporate response to its Corporate challenge. All we really need to do is to respond the way the public wants us to. But we won’t know that without the help of marketing, not advertising, professionals. Armed with this knowledge, the ethic of External Patient Education™ will create our position and wear well with dentists. It’s what we do in our practices, but on a Corporate scale.
And remember, money talks, BS walks. It's a bottom line world, outside of our offices. And that’s where our patients live.
K. Randall Groh, DDS
Acting Chair
The American Independent Dentist’s Association
336 Alhambra Circle
Coral Gables, FL 33134
E-Mail feeforserv@aol.com
July 20, 1997© K. Randall Groh, 1997
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