"Selling Dentistry" - How to Triple Case Acceptance with the "Treatment Triad" (feat. Janet Hagerman)

Janet Hagerman, case acceptance coach, fractional Chief Hygiene Officer and author, joins "The Dental Domination Podcast" to discuss the importance of selling dentistry ethically and effectively. Despite many dentists cringing at the idea of "sales" in dentistry, Janet shares how soft communication skills can bridge patient education with effective sales strategies to triple case acceptance and improve practice profitability. She also discusses the role of the dental team in case acceptance and the importance of creating a patient-centered practice in this must-listen conversation with Dan Brian, co-founder at DentalScapes.

Be sure to check out the show notes for the podcast video and additional resources.

Transcript

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All right, welcome back to the Dental Domination podcast. This is Dan Brian or I am Dan Brian rather, that was weird. But this is episode 16 of the podcast. I'm so excited to be here today with a very special guest, Janet Hagerman. And Janet is a case acceptance coach. She is an author of the book Selling Dentistry Ethically, Elegantly, Effectively. And she's also a fractional chief hygiene officer for DSOs. And we are here today to talk about something that I think is not talked about enough within the dental field and that's really, you know, the essence of Janet's book, which is selling dentistry. And I know that for a lot of dentists out there, a lot of the dentists that we work with at dentalscapes, that's sort of an uncomfortable touchy subject. So the idea of straddling that line between patient education, treatment planning, and then actually selling the service or selling the treatment. And there's been some some resistance to to that idea in the past and and I understand I think we can all relate to You know that sort of you know that that bit of discomfort for in that in terms of you know wanting to do things like like Janet says in her book Ethically and effectively at the same time, but there's definitely a way to do it right and do it ethically and do it do it well And so I'm so glad to have you here today, Janet. Thank you so much for joining the show. Before we really dig into the nuts and bolts of this, I wanted to give you an opportunity to share with our listeners who you are, where you're coming from, how the heck did you get involved in this element of dentistry in the first place? Thanks, Dan, for having me. Yeah, this is a subject dear to my heart. My degree is in dental hygiene, so I practiced dental hygiene for years. And I always thought I was a great communicator till I had a patient one time reach up and just pat me on the arm and say, little lady, little lady, please dispense with a lecture. I have an important meeting to go to. Just hurry up and finish me up and get me out of here. So once I got over my A, embarrassment, B, anger, and then C, curiosity, you know, I thought I was so great at patient education, where did I go wrong? How did I miss out on such a big opportunity to have a relationship with this patient? And that... I don't feel like there's any way to gracefully recover after little lady. I don't think that's probably, yeah. I was in the deep south when that happened. So, yeah. So that sort of began, that definitely began my quest for, you know, what is communication? How do we get through to our patients quickly? Because we don't have a lot of time. So fast forward, I was in private practice. I did consulting, not just for hygiene, but for full practice consulting. And then I was invited to become the director of hygiene for a DSO, a large DSO. We had over a hundred offices and I basically created the hygiene department. So, you know, it's like having your laboratory because you get to practice and test ideas and see them happen over a broad variety of different offices and practices. And that's where I really honed this idea of case acceptance and selling dentistry. Yeah. I ended up writing the book about it. My friend Paul Homily told me if you want to be successful write a book write a book write a book and Yeah, yeah, and I named it selling dentistry because I had a lot of dentists that said Don't call it selling dentistry. We want one you're like, just watch me. Sort of, yeah. But with the caveat of ethically, elegantly, and effectively. So ethically means we're not selling somebody a bill of goods that they don't need, right? This needs to be clinically diagnosed treatment that we have discovered. Ethically effectively means did they say yes? So you can. patient educate all day long, but if the patient doesn't say yes, you haven't been effective. And finally, Dan, I added elegantly because I want this to be a process that's comfortable for the clinicians where they don't feel pushy and salesy. We're not pushing, we're not selling, we're basically helping our patients and guiding them to make good healthcare decisions. Yeah. I want it to feel comfortable for them and comfortable for the patient as well. So that's sort of my show where that came from. love that and you know, I love your focus on ethics as well You know, it's something I'm a marketer obviously, you know, that's that's that's what I do my in my nine to five and you know, it's funny when I first well, you actually know my husband Zach who's a dentist and you know when I Yeah, that's right. So it's funny when I first told him that I was in marketing when we met he was like, oh you mean trickery and I don't And and I get it I get that perspective but I've always thought and I've always taken the approach that I think you do which is that there is nothing inherently wrong with selling so long as you're selling something that is right for the client and that is evidence -based and in dentistry but but also in marketing, you know to a certain extent and then and then also something that you deeply passionately truly believe in And and I think that's true not just in dentistry but also in marketing and also pretty much universally So I love that you focus on that. But anyway, I'm digressing they say, we all love to buy. We just hate to sell. Yeah, that's right. So anyway, I'm so glad that you know you mentioned all of those really important points and I want to dig into it. So one of the things though that you said is that you know we're not necessary. I'm saying we're I'm not a dentist. Believe me, you don't want sharp things in my hands, but you know I always say like. You don't go to dental school to learn how to run a business and you sure as hell don't go to dental school to learn how to sell. And yet that is a very important part of running your own practice. It's an important part of working in any practice regardless of whether or not you own it or not. So tell me about that. Like, what do you think the issue is that most clinicians are facing when they graduate from dental school? Suddenly they're thrown to the wolves. They're in this real life environment now where there is an expectation that, you know, you... you need to produce and you need to to sell. But most people, I think it's fair to say, probably are not super comfortable with that. Of course, there's some natural salespeople among dentists and that that works just fine. But like, what is the real issue? What's the pain point facing folks that you talk with on the ground? Yeah, I would change that from being uncomfortable to hate. I'm a clinician, I'm not a salesperson. So, I mean, you can change the word to case acceptance or enrolling patients in their treatment, use whatever you want. But I think if you break down the resistance to the concept of selling and use the selling concepts that the best, really best salespeople use, you'll find that they're not pushy or salesy. Okay, so we come out of dental school, learn or hygiene school with our clinical skills, but no, we're not taught any communication skills. And particularly in our era now, I mean, where do we communicate the most? It's on these silly devices with emojis, and then we expect people to be able to sit down and have a face -to -face, eyeball -to -eyeball conversation with a real live patient. about the second most important and intimate thing in their lives, and that's their pocketbook, their wallet. So we're totally unprepared for that. So how do we learn that? And the other thing, Dan, is this is not just Dennis and Hygenist. This is a total team effort. Some of the things I've heard in dental offices, I just shake my head, so I can't believe somebody actually said that. So one person on the team can sabotage the efforts of everybody else. That's why it's so important that the whole team be on board and with the same mindset. Everything we say and do in dentistry either pushes patients away or pulls them toward us. So having a mindset first and foremost is really important that the whole team's on board. And then secondly, The main pain point is that the average in this country is only 30 to 50 % case acceptance. So, you know, you have that syndrome, the in the front door, out the back door. You know, we've spent, dentists spend all this money marketing, as you know, marketing, how do we get our patients to call the office? We get a nice fancy website. We do our social media and we get patients calling. So how many of those patients never make an appointment? and then they finally do make an appointment and then they walk out the back door without scheduling treatment. So there's that 30 to 50%. That's a huge pain point for a number of reasons. You're losing revenue. You're losing revenue. Your patients are not getting the treatment that they need. Oral systems, systemic health, they're walking around with diseased oral cavities, diseased... systemic health and it's already been diagnosed. So for a lot of reasons it's really important that we really focus on how do we have a healthy case acceptance which should be around 85 percent. Right, right. And I mean, you have even said that within your work in this coaching program, you know, you've been able in many, many cases to take dentists from where they're at and actually triple their treatment acceptance, which is phenomenal. So, and that's obviously, I mean, who doesn't want to do that? But where do you even start? So what's sort of step one when someone comes to you and says, hey, Janet, like, I think we need to talk. I've got an issue here. Maybe they're at that 30 % acceptance rate. Yeah. the starting point and where do you even begin? getting the whole team on board with the mindset first. So this is what I like for people to understand. You know, science pretty much has concluded now that our brain operates with two halves. We have a very logical side of our left brain, and that's where we make logical decisions, mathematical computations, things like that. And the right side of our brain is the more creative side and the more emotional side. So in dentistry, where do you think we live? We live in a world of millimeters. We live in a very exact, precise scientific world. So when it comes to patient education, we have a tendency to speak logic. We know from many marketing surveys over and over repeatedly that have been done that buying decisions, including healthcare decisions, are made. with emotion. We rationalize them with logic, but they're made with emotion. And so we need to understand how do we reach our patients emotionally and find out where they are emotionally. We know that they're anxious when they come to the dental practice, but how do we really plug into their values so we can relate their treatment to their individual values? You know, it's funny you say that because this, this whole idea of the left brain versus right brain and, and appealing to emotion and selling it's funny because I think you're absolutely right in that most dentists probably live in that left brain area most of the time. But you know, one thing that's always struck me and that I kind of fell in love with in terms of learning more about the dental world. Uh, you know, when I got married and now that I work in dental marketing, people always talk about it as this. really cool mix of science and art. And it's really kind of the same when you think about it, when you talk about selling dentistry itself, it is both an art and a science. So I think you're onto something. I love that you said that because a lot of the presentations that I give, I call particularly for people who are so resistant to the concept of selling dentistry, the art and science of case acceptance. It is absolutely. I'm not saying that there's not a place for patient education, which is the scientific explanation of. why you need a crown or why you need periotherapy instead of a prophy. I'm not saying there's not a place for that scientific explanation, which you layer on with, you know, layman's terms. What I'm saying is the relationship has, the rapport has to come first. And we do that by having to quickly, because we don't have a lot of time. getting in rapport with our patients. So these are soft skills, Jan. These are not hard skills. These are soft skills and communication skills. And you know, the more technological we get, the more technology gets involved in dentistry, the more we need these soft skills. And a lot has been written about that as well. But the soft skills become more important as we get more technological. So where do you start with that? I mean, how do you, you know, like I said earlier, some people are salespeople naturally. Some people are natural people, people, people. But where do you start with that? You know, it is a soft skill thing. And like you said, patient education is about science at the end of the day, but there's also, I have a master of science degree. There's an art to communication as well. So where do you start with that? And how do you advise your clients? to approach conversations in patient education, to lay the groundwork for actually ensuring that follow through and that case acceptance. The first thing I do, we talk about mindset in terms of what you and I have just talked about. So people begin to understand that process. And then we talk about the values questions. So open -ended values questions like what is the most important thing to you about your teeth and your dentistry? And just... Janet now you're getting into motivational interviewing. I knew you were after my heart. know, for a hygienist, instead of jumping in and telling them all about periodontal disease, to be able to say, so tell me, what do you know about periodontal disease? What do you know about implants? And you get the patient's perspective and you get to hear where they're coming from and then have conversations based on what they've told you. That's really interesting, Dan. Did you know that 50 % of the population or more has periodontal disease? Or did you know that implants feel exactly like your real tooth? Or I'm glad you mentioned the fact that your mom had dentures and you don't want them too. It just gives you something to have a personal conversation that you then can connect to your clinical findings. I know you told me, Dan, But the most important thing to you about your teeth were that you don't have any more pain. You've had so many painful experiences. And I want you to know I'm here to support your goal. And as a result of that, let's look at your treatment, at your situation and how we can handle that. So those values questions are the first things that I teach. The whole team can learn that. The whole team should be aware of that and have the ability to ask that question. Yeah. the ability to say, you know, I know Janet asked you about what the most important thing was to you about your teeth. And I can see that what you said, you want to keep them for a lifetime. And we're all in the whole office dedicated to that. So everybody starts talking in those terms. All the skills that I teach are skills, because you mentioned this earlier about perhaps not feeling like you're the kind of, they're all can be taught for any. personality style. You're an A type personality or you might be a very shy, quiet type of person. These are the types of things you can still ask no matter what your personality style is. everyone for sure. You know, I brought up motivational interviewing because, well, I know we've had Matt Allen, Dr. Matt Allen on the podcast in the past, and I know you're familiar with him in different kind. Oh yeah, absolutely. And yeah, you've been a guest on his podcast, I know, and sat on panels with him. But yeah, this concept of motivational interviewing and shared decision -making in particular, it's interesting. I... I am so behind that concept in dentistry and it is, there's so many parallels because in marketing and sales, we call that consultative selling essentially. So it's, it's having the conversation as opposed to, you know, just talking at someone and really evoking their own values and their own emotions and that sort of thing. So I love that you said that once you sort of established those foundational values though, with a patient in discussing. their treatment plan. What's next? Where do you go from there? Well, I'm going to jump to, because you sort of touched on it when you mentioned that we sometimes, you know, offices can triple their case acceptance by utilizing these processes. One is what I call the treatment triad. And one of the reasons I call it the treatment triad is because it does have a tendency to triple case acceptance when you use it. But, you know, often... I'm a marketer. Oftentimes in dentistry, we are reluctant to present a comprehensive treatment. Patient comes in, they haven't been in eight years and they have a lot of work that needs to be done and we're going, oh my gosh, if I tell them they need all this work, are they gonna be overwhelmed and think I'm just after their money or... being overwhelmed. So we break it down, we prioritize it in three types of treatment. Dan, do you mind? I'm gonna be looking at three types of treatment as I evaluate your mouth. You mind if I share that with you? One is urgent, the 911, we've got to do, this is why you came in, that we've got to get you out of pain. And the other tooth on the other side that's broken, we need to fix those right away. There are other things that are going to need to be done. I can't tell you when they're going to break down, but we want to keep you out of pain. So we want to do those as quickly as we can, but they don't need to be done right now, but they need to be done preventively to keep you healthy. And finally, we're going to look at cosmetic options. Totally unnecessary, but fun to look at and just amazing technology that we have now to share with you. yeah. than nice to have exactly. And so by utilizing that three step prioritizing, it makes a huge difference because now the patient's going, well, that is like a really thorough, I've never had it explained to me that way. And it also gives patients a feeling of control over their own dental destiny, if you will. It gives them an opportunity to feel like they are, and they are indeed participating. and how that plan rolls out. So, you know, gone are the days where you went to the doctor and the doctor just said, well, whatever they said, I don't know what it is, but they're the doctor. So they know those days are gone. Our patients are well informed. They're educated. They regularly consult Dr. Google, as we all know. So patients want to have a relationship with their provider. We know this from surveys. and they want to feel like they have part, that they are active participants in the plan of their health. So by using the treatment triad, it helps provide that for patients. now you mentioned at the outset, the most important part, step one is getting the team on board. But you know, once you've, once you've taught these, these approaches, the treatment triad, once you've, uh, you know, introduced dentists and their teams to these concepts, how do you, how do you instill that or how do you, um, how do you integrate that into the culture of the practice and make sure that it remains embedded? Like what's, what's, Because it's one thing to teach something. It's another thing to ensure follow through and consistency. How do you ensure the practices compliance with this method to improve compliance? Like, how do you do that? Yeah, that's a great question because we all know that it's one thing to learn at one time and then to implement it successfully and then to keep it going. So. it's one thing to learn it, but like to actually keep it going. so for private practices and for DSOs, it becomes especially important because now you're multiplying it by many more practices. So when I teach the course, I also utilize some follow -up calls to do some follow-up coaching to reinforce what we learned. And then, you know, practices need to have regularly scheduled meetings. I've written a manual called Meetings Make Money. to teach practices how to have productive meetings where you actually end on time and you actually do accomplish things. So those are opportunities to reinforce that mindset, see how we're doing and measure, you need to measure where is your case acceptance now and where is it? I just finished with a practice, they went, a huge practice, they've got lots of doctors, about six doctors and about eight hygienists. And they went from an average of about 34% to an average of about 70%. So now the trick is going to be how do we keep that? The great news too is that of all of them, every single one of them improved. So the average wasn't like, well, some did really, really great. Some didn't really improve. No, all of them improved in their case. So it's just ongoing reinforcement of that. And then being able to, you know, perhaps have a refresher course once a year or so if you've had any kind of turnover. Yeah. Now, you know, you talked about, we've talked about culture. We've talked about instilling this idea as really being team -based and that's what it is. But at the end of the day, we also know it's the dentist that diagnoses. It's the dentist that puts together the treatment plan and makes the recommendation, you know, and communicates that to the patient ultimately. But what is the supporting role? in all of this for say a hygienist who also interfaces with the patient and you know other members of the dental team what is what is their role in in cultivating this type of system as well? Well, first of all, the dentist isn't always the one that presents the treatment. Oftentimes there's a treatment coordinator that's very good at that. So they help to support the dentist. And the assistants should obviously be of a mindset where they want to be in rapport with the patient. So look, a lot of times, patients will, the doctor will go out of the room and the patients will say to the assistant, do I really, do you think I really need that crown? Or do you think I really need that implant? So there's a great opportunity for that supporting role, that assistant or whomever is in there to be able to answer that question positively and gracefully and compassionately. Doing the treatment triad, the way I explain it, It's like a blueprint for further treatment. So every time that patient comes in, that hygienist has the opportunity to have a supporting role in saying, I see Dr. Brian diagnosed a crown in this area. The last time you were here, we've been watching that. And it looks to me like it might have broken down more since the last. Here's the caveat. The next thing should be, What questions do you have for me about that? Instead of that crowns, that tooth is breaking down, you're probably gonna need a crown and this is why, blah, blah, blah. Instead of patient educating, once again, asking good open -ended question. Not do you have any questions for me, but that tooth that Dr. Brian recommended crown, it looks like it's broken down a little more since the last time. What questions do you have for me about that? open it back up and get some patient feedback. Yeah, yeah, absolutely. Now, ultimately, this whole process is designed obviously to improve case acceptance, in turn improve production profitability, but it's also about creating a more patient -centered practice. And so ultimately, none of these ideas are mutually exclusive. Of course, no, absolutely. Yeah. so when you when you work with practices on implementing this system and that what sort of the the end game, what do you see beyond just a more profitable practice beyond just you know the impact on the bottom line? What sort of the transformation ultimately that you see in the clients that you work with at the end of the day? I don't think I've ever gotten that question before, but I will tell you what my clients have told me. I had one doctor that said, you know what, it's just pulled, well, several that have said, it's just pulled our whole team together. We work together more as a team. I had one doctor say, I learned a lot more about myself and I learned that little changes can make a big difference. Yeah. Yeah. And then I had one doctor that just said, well, our case acceptance soared and that's higher production and our patients are happier and that makes me happy as the dentist. So those are some of the added benefits. The techniques that I took, one of the people that reviewed my book said, these are techniques that could be used for any business. or in life in general. And so the things that I teach can be helpful just in your personal life as well. Things like prioritizing decision, prioritizing big things to make in more bite -sized pieces, asking good open-ended questions is always a great way to, and then listen with the intent to understand, not to respond, but with the intent to understand. That's how. That's how we create relationships and get them rapport quickly because we don't have a lot of time in dentistry to do that. much of it is simply about listening, I think, and elevating the patient and their concerns and their values and their perspectives as well. And truly making this a, again, it's all about shared decision -making. So I love that. Well, Janet, this has been such a wonderful conversation and I can't tell you how much I appreciate you dropping by the podcast and sharing your knowledge with our audience. What is the one thing you want to leave folks with today? to maybe a practitioner who is struggling with case acceptance or thinks that maybe it's time to think about a change in terms of how they're approaching patient education and treatment planning and that sort of thing. Like what would you want to leave folks with today above all else? want to leave them with the idea of be open to new perspectives. Open to new perspectives and reach out to me and have a conversation about how I can help you and your team. It starts with the doctor or the practice owner, whether it's who owns the DSO or a solo practice, but it starts with the leadership. I mean, they have to buy in and say, you know what? Case acceptance is important and we're not... we're no longer willing to accept 30%. We want 35 % and we wanna do it ethically and elegantly and effectively. Yeah. Yeah. Yeah. so I'm gonna put in the show notes the link to your book, to your website, but what's the best way folks can get into contact with you if they want to take things to the next level? they're welcome to call me and leave a message and I'll call back. And or the best way is just to simply shoot me an email and we'll schedule a complimentary discovery call and find out where they are and where they want to go. So that's Janet at JanetHagerman .com. Awesome, and I'll put all those links in the show notes. Well, Jana, I can't thank you enough for stopping by today. Thank you so much. And if I have my way about it, this will not be the last time that we have a conversation on here. I would love to have you back at some time in the future, because like I said, you are also doing fractional chief hygiene officer work for DSOs. And that's a whole nother topic that we didn't even get into today. I couldn't have been happier, Dan. This has been great. Thank you. This has been really enjoyable for me as well. Thank you so much. I'm so glad to hear that. Thank you, Janet. And thanks to everyone who listened today. If you enjoyed what you heard, please take a moment, just a minute or less to leave us a five star review on Google podcast or Apple podcast or Spotify or wherever you're listening to this show. Really appreciate it. It's the best way that you can help us reach other dentists and folks within the dental field. Really appreciate it. Like I said, my name is Dan Brian. You've been listening to the dental domination podcast. Thank you so much for joining us. Thank you, Janet, and we will all talk soon. Thanks so much. Take care.