Thursday, March 17, 2011

Dental Mill Dentists: The Art of War Applied


Learning dental mill recruiters are very well trained should be no surprise.  How far they will go and sources of their tactics may be very surprising to some, not so much to others.

While the dental students were studying Cariology, dental mill executives were studying the dental students by way of Strauss and Howe’s, Millennials Rising: The next generation and Hershatter and Epstein at Emory University.

They have your number letter

Millennials, also known as Generation Y, are those born between 1982 and 2002.

The first group of Millennials are out of college.  They started entering the workforce approximately 6 years ago and were studied extensively prior to their grand entrance. 

They are getting their chance to make their mark on the world.   In their mind, they plan to do it right.  GenYers feel prior generations half-assed everything they touched and it must be fixed to save all of mankind.

Andrea Hershatter and Molly Epstein of Emory University’s Goizueta Business School have studied Generation Y and published their findings, “Is Your Firm Ready for the Millennials?”

Hershatter warned “integrating Millennials into today’s workplace may not be straightforward” and “[a]mong the college-educated who have been polled," Hershatter says they seem "not to be particularly comfortable around populations less educated and less well off than they are."[1]

Epstein pointed out:

  • Nearly 70% of Millennials agreed that “Authority figures should set and enforce rules”. – compared to appromimately 40% of Generation Xers.” 
  • 60% of Millennials agreed with the statement, "I trust authority figures to act in my best interest." Only 40% of GenXers agreed.
  • Nearly 60% of Millennials said they "felt comfortable asking for special treatment," while only 40% of GenXers felt that way.

    "They need to understand what the organization stands for and what their role in it is; they are much less likely to be focused on their next step in terms of career progression, and more likely to care about making a meaningful contribution in their workplace."

    “This interest in doing good appears to be very deep-seated, according to Hershatter.”

    “There is a strong millennial dislike of ambiguity and risk, which leads them to seek a lot more direction and clarity from their employers, in terms of what the task is, what the expectations are, and the job progression.”

    “They are like quarterbacks: the whole team has been blocking and tackling for them so they can run the ball, and they come to expect that level of blocking and tackling so they can get the job done. They feel entitled because they feel special, they feel entitled to have others support them in their efforts to accomplish and achieve.”

“The promise of the brand has to match the reality or they quickly shift preferences. The ones who are unhappy in their first jobs in general are not complaining about the amount of work or day to day tasks. It’s that the culture doesn’t feel as meaningful to them, or isn’t as conducive to belonging as they expected.”

Teamwork will be stronger - "Millennials are unbelievably gifted at building, maintaining, and tapping into networks. I think that is a very interesting resource that more companies will figure out how to use," notes Hershatter.
Racial and ethnic tensions will be lower - "One of the things you would find is a very high comfort level among these students in working with others who represent different ethnic and racial backgrounds," Hershatter concludes.
Class tensions will be higher – “Among the college-educated who have been polled, Hershatter says they seem "not to be particularly comfortable around populations less educated and less well off than they are."
Sense of personal responsibility will be lower - "I think they're very reliant on people to tell them what they need to do," notes Hershatter. "The least positive thing I can say about this group is that they're not very good at accepting end-line responsibility."
Risk-aversion will be greater -  Hershatter mentions that in William Strauss and Neil Howe’s Millennials Rising: The next generation, "they'll either be on the platform on time with their ticket punched or they'll miss the train and never be on the platform again."   Millennials may have difficulties if they run into situations that are less structured and ambiguous than their life experiences have been thus far.

"They don't do very well in situations of ambiguity," Hershatter says. "They have been protected and directed since early childhood.  The helmets they have worn during every potentially dangerous physical activity are a great symbol of their early years.  From nanny-cams to after school programming to teaching-to-the test curriculums to early and binding college admissions, they have been shielded from unstructured time and unknown outcomes their whole lives. They have not had to be big risk takers thus far."[2]

As pointed out, Generation Y is looking for certainty in their lives – no guessing, no what if’s and as little risk of failure as possible.

”Everybody needs me” – They feel they call the shots now.  They can make the deal that suits their needs and the life they have envisioned for themselves. They are certain of their future. 

“Get ‘er done” - as Larry the Cable Guy put it, they want to complete the job at hand with as little resistance as possible - ideally with as much support as can be mustered and safety harnesses in place – staff raised and the Red Sea parts on demand comes to mind.  Rebels are a thing of the past.  They have never heard about ‘failure’.  They feel entitled to the protection and support to ensure perfection and no accidents.  They have been shielded from all scrapes and bruises. They were given a trophy just for showing up.

”Keep it real” – another phrase we hear these days.  This too is assigned to the Millennial group.  They want things to “be real” - authentic - and will settle for nothing else. 

”Yes we can” – here’s one we have heard a lot since 2008.  It’s another important part of the Millennial mindset and, I might add, easily exploited.  They have been told from infancy it is up to them.  They know they will make a difference in this world.  They will  give and volunteer. They are a ‘cause’ - without a rebel.


Know thy self, know thy enemy. A thousand battles, a thousand victories. - Sun Tzu, The Art of War

All warfare is based on deception.
– Sun Tzu, The Art of War


The Art of War Applied: The Battle and Conversion

The war for the soul begins.

Hearing the word ‘conversion’ in respect to Medicaid dental mills usually isn’t associated with the dentist, it’s associated with converting the patient, from a simple cleaning to 14 root canals – surprise!  Converted!

The staff doesn’t realize, especially the dentists, they were the first ones exploited, duped and converted.  

How?  By declaring war.

Who is the enemy?  It’s not a who, it’s a mindset.  It’s an expectation.  It’s the dream.

About a dental student’s third year, they can clearly envision their life after graduation.  The finish line is close and they know it, they feel it, they see it, they can taste ever morsel of success laying in front them.  Soon they will be medical professionals!  Thoughts of owning their own business, being their own CEO, making truck loads of money, custom designing their own hours - rescheduling their entire day’s appointments when the golf course is calling – freedom – is set in their minds.  After all, that’s why they chose dentistry, right?  They wanted to work in the field of medicine yet wanted no part of the grueling schedule of a family practitioner.   They certainly didn’t like the idea of paying student loans for the next 50 years.  Maybe the female dental student feels she will be the second wage earner and dentistry fits her life that includes children perfectly.

By the beginning of their fourth year they begin to feel the power they have worked and studied so hard to attain – slightly drunk with power and even a little ego if they were honest.   The ‘everybody wants me’ attitude feeds the perception they are in control of their own destiny with unwavering certainty. 

By midyear everything they thought they were certain of is beginning to crack.  Reality is fast approaching, what they knew for sure, isn’t so certain anymore. – Student loan payments soon – Start-up costs – Equipment costs – Employment taxes – Insurance – Rent or Lease – Find a building – No credit.

Unlike many college graduates, the dental students are being courted by various entities.  Soon-to-be dentists have been hearing the sermons at job and recruiting events. They are told generalities about the overly-generous offers that include sign-up bonuses and relocation bonuses along with other benefits such as medical insurance for them and their family. 

The recruiter, or guerilla as I see it,  explains the company will pay all the application and credentialing fees, the coming year’s CE’s will be provided or paid for in full, professional association fees paid, help with loan repayment and more. Just look at the ads online.   

The ‘soon-to-be graduates’ never saw the need to study the Art of War or The Art of the Deal for that matter. 

Uh oh. 

Problem - the graduate doesn’t know there is a war and has not prepared.  They enter the lions den unarmed and make for easy prey, and the lion is hungry.  In some cases the dental college served the students to the lions on the proverbial silver platter.

The dental mills know they have an uphill battle selling to the dentist why they should give up the original idea of being an independent business owner,  but as stated above, they have been preparing for the new recruits.

What is their tactical strategy?  Neutralize the enemy.  It’s time to use GenYers characteristics against them.  But first up, must be to dispel the misconception of dental mill business model.

Challenge 1 - Upon hearing the term ‘Medicaid patients’ they know that a negative mental picture is visualized - mountain children featured in documentaries - crude working conditions where the dentist will be a one-person operation.  They know when the word ‘children’ is mentioned the heart starts racing and apprehension takes over.

Neutralize – Show the sparkling clean state of the art facility.  Keep the images at the forefront of all presentation materials.  Notice that just about every ad for employees mentions ‘state of the art facility’.   As for the ‘children’ part of the equation goes, use the following keywords and terms:

– gratifying
– rewarding
– changing lives
– enormous impact on a child’s life
– appreciated.

Positive visual images must be used extensively to counter the previous vision the recruit had envisioned their life to be after graduation. 

Challenge 2 – Some new graduate dentists may be concerned about the training they have received in school on treating children, or lack thereof.  Most feel the need to finish honing their skills on adult patients.  Just because they have the diploma in their hands, does not mean they feel 100% confident in their skills.  Then to think about being thrown into a hectic environment with kicking and screaming children is really frightening.  For many, the most contact they have had with children is their siblings at home. 

Neutralize – Again, talk about highly trained support staff.  Other trained professionals will be right there to assist.  Show more visuals of support staff using equipment and assisting other dentists.  Use pictures of more mature dentists in their offices to reassure the recruit of continued guidance by elder dentists.

Next will come the appeal to Millennial’s characteristics.  Let’s take them one by one:

Entitlement ‘Everybody needs me’ – This will be tackled with feeding the ego with keywords like:

  • Success is not measured by what you own; it’s measured by what you do.
  • You have studied to be a dentist. It’s time to put those skills to work and not worry about day to day problems of owning your own business. 
  • We carry the stress load.  You use your skills to change the community who needs you.
  • Challenging – again appealing to the ego in a backhanded way.
  • Be a dentist, not a business man.
  • What could be more rewarding than helping a child in need?
  • What could make your family more proud than to know you are dedicated to underserved children?
  • No possible way to fail if you work for us.

Authenticity “Keeping it Real” – The recruiter will emphasize the purpose of the company with snappy catch phrases and keywords such as:

Making a difference ‘Yes We Can’- key phrases will include:

  • More rewarding than the alternative of owning your own business
  • Most important? Number of days or hours you work or the number of children you help?
  • Service to the community
  • Start creating smiles today

Certainty “Get ‘er done” – Here is where the scare tactics are implemented and the recruiter goes straight for the jugular - GenYers “risk aversion” by:

  • Stressing the failure rate of a small business – show the stats with visual aid.
  • All the government agencies and their local, federal and state regulations – list the scary ones like the IRS. Show IRS agent knocking at the door.
  • Recount the number of unknowns like steady income, expenses, employee issues, week to week expenses.  Show pictures of stressed out medical professionals, employees calling in sick, general accounting sheets, stacks of bills.
  • Emphasize the uncertainty of when they will ever get a paycheck – let them visualize scared family members, their children needing food, clothing, spouse with checkbook throwing up hands, etc.
  • We are here to save you from all of the uncertainty.
  • We can give you peace of mind.  You can enjoy the fruits of your labor.
  • Show chart of income if owning own practice compared to income with the company.
  • We offer protection from unknowns.
  • We deal with all those insurance forms and problems.

Conversion completed.

After that, sign me up.

D. B. Cooper, SOL

[1],[2] Is Your Firm Ready for the Millennials? - Knowledge@Emory, (accessed March 13, 2011).