The Dental Leader no longer exists other than in cached format. But I located this discussion and going to repost it. I’m not sure when it was written, but here is the cached copy. By looking at the Wayback Machine, it was archived the first time in February 2001, and this News Letter was there at that time. So this goes back a while. I guess, sadly, no one listened to Dr. Maroon. Look where we are in 2012! Maybe too much nitrous in the operatories and folks were sleeping!
The Dental Leader Inc - Michael Maroon, DMD, FACE, FAGD - Editor & Publisher
39 Webster Square Road, Berlin, CT 06037
Email: contact@TheDentalLeader.com (no longer works)
Great Article...Great Newsletter
Mike,
I thoroughly enjoyed the June issue of your newsletter, especially "There’s Always Tomorrow." I read quite a few parallels to my own life in that article.
The rest of the newsletter also contained quite a bit of meat along with some thought-provoking, insightful articles. Keep up the good work!
Dr. Kit Weathers, Griffin, GA
The Devil Revisited
Well, I don’t quite know how to respond to all this DPMC (Dental Practice Management Company) stuff that is starting to manifest in our profession. However, I do know when I see a biased and self-serving article when I read one. Case in point, the reply of a one Mr. R. Kirk Huntsman (sounds like an attorney to me Vern) to the article written by a fellow dentist Mike Maroon.
I believe Mr. Huntsman referred to Dr. Mike’s article as a condescending diatribe (a long, violent, or blustering speech, according to Webster). This description would more appropriately fit the pen that wrote the reply. Dear R. Kirk, should I call you "R" or "Kirk", the R. Kirk just didn’t sit well with my simple Midwestern mind. Makes me feel like I gotta have sum one ta represent me. So I’ll jist call ya Kirk then. I’m sorry, I’m jist a Dennust. Ya know...sore on the hind end from rollin’ over so many times to ya’all. So Kirk, please enlighten me on your credentials that enable you to speak so intelligently about the dental profession. Are you one of us? Do you have a DDS or DMD degree? Or, are you yet another wonderful, charismatic and caring purveyor of management expertise who beckons to save us by convincing us that big brother (DPMC) is here for the good of all?
You can make fun of Dr. Maroon. He is a funny guy. You can demean his mathematics. You can impugn his integrity with statements that are of no relevance to the issues he brings forth (a typical tactic of abbreviated names and titles...if you catch my drift). However, you cannot expect to derive any respect from those of us who know that you are operating from a self-serving position, poising to take advantage of those in our profession by tossing out the big carrot to gain your control and then to prostitute our profession for you own _ _ _ _ _ _ _ gain. No pun intended.
Further, your repudiation and categorization of Dr. Maroon’s statement— "DPMC's are in the business to make money for the principals of the company and maybe the shareholders,"—as hypocrisy, is just clearly and simply a statement of pompous bias. To convince me that your intention is not ultimately to put us in a subservient position would require much more than I think you have in your vocabulary.
G. Edward Kirtley, DDS, Indianapolis, IN
(George to all those in the DENTAL PROFESSION)
P.S. Wake up you dentists out there! Or, you all are going to live up to your reputation as being "knuckleheads" when it comes to good business decisions...DO NOT RELINQUISH CONTROL TO SOMEONE WHO DOES NOT GIVE A RAT’S ASS ABOUT YOU OR YOUR FAMILY...OUR POWER IS IN OUR NUMBERS...STAND STRONG TOGETHER. LOOK WHAT HAS HAPPENED TO THE PRIMARY CARE PHYSICIANS IN MEDICINE...OR HAVE YOU HEARD????
From "The Cutting Edge"
Mike,
I read with interest the series of articles relating to your stand against dental practice management companies in your recent newsletter. Let me speak to the issue from some personal experience. About 15 years ago a dental consultant that I was working with asked me to come and work for him. He would run the business and I would do the dentistry. After explaining to him that it was not legal for either of us to enter such an arrangement, we explored the possibilities. Another dentist friend joined the discussion. My dentist friend and I ended up hiring this consultant as a business manager. He also owned the building and office space that we leased. He was paid based on our profitability. It sounded like a great idea. no more staff headaches. No more paying bills and figuring payroll taxes, just dentistry in its purest form. What we ended up with was not what we had intended. We had more staff problems than before. The business manager would promise something to the staff and then not be able to deliver, or change his mind. Guess who they complained to and who had to go to bat for them? Worse yet, the staff knew who was determining raises and that undermined the authority of the doctor. I don’t ever want to work for someone who answers to the "company" and not me. Needless to say after a couple of years of more headaches than I bargained for, we ended the relationship. That spurned my interest in practice management. If a dentist thinks that by turning employee relations over to corporate headquarters he or she will have less problems, they are dreaming! Ask the manager of your local Burger King if he has less employee problems because he doesn’t own the franchise.
If a dentist is weak in business management skills consider hiring one of the many reputable practice management consultants to help organize their office. These companies work for a substantially lower fee and get the same results...and you are in control! To give you an example, I know of one DPMC that takes 50% of the increased profit as their fee, while a great consulting group we have worked with takes only 10% of the increased profit. That’s a 40% difference! There are naturally going to be more slices taken out of the profit pie by the DPMC’s so the dentist will have to work harder to show the same profit. Think about it.
When is it a good idea for a dentist to sell to one of these companies? If I was within 5 years of retirement and was unable to find a qualified associate dentist to join my practice, then this may be an option. I would also have to be in the position that I did not have to count on the income from the stock options paying off. The other time it may make sense is if the dentist was completely devoid of practice management and people skills and I know none of your readers are in that category. I have worked with an orthodontist who joined a DPMC. He has great clinical skills, but poor management skills. For orthodontists it is a little more straightforward. The organization has "taken him under their wings" and helped build his practice. For this orthodontist it is working...for the short term. Only time will tell what will happen 5 years from now. They could make unreasonable demands and if he refused he could be replaced.
I would encourage any dentist considering a move in this direction to think through all of their options and consider the worst case scenario. Then if they still want to proceed, get one hell of a contract covering all contingencies.
Craig Callen, DDS, The Cutting Edge, Mansfield, OH
Thanks
Mike,
I was trying to clean up my office this morning and while repositioning (I never throw anything away...I just move it to another pile) all the papers on my desk, I happened across one of your newsletters. I just wanted to take this moment to thank you for your insight and dedication to our wonderful profession.
Dentistry is meant to be enjoyed and should be a hobby that we just happen to make a very good living at. Unfortunately, as you well know, most dentists feel like a dark cloud looms over their daily lives with the only chance of escape being retirement. This is especially sad for the young dentists (35 – 50 years old) who will not be able to retire for at least 15 to 20 years. Most of these individuals have resigned themselves to be miserable for the remainder of their professional lives, often times dabbling in offshoot businesses to take their mind off of the misery of dentistry.
Having the opportunity to spend time with you and get to know you these past few years has shown me that you have the same optimistic mindset as myself. A mindset that will help open the eyes of thousands of dentists around the world that doing dentistry can be synonymous with having fun. The concept of having fun while practicing dentistry is so foreign to most dentists yet is easily within grasp if they would just open their eyes. I commend you on your attitude and positive outlook and the excellent attempt you are making at sharing this outlook with others.
I learned a long time ago that the easy part of teaching others is the clinical and technical skills. The most difficult are communication skills and enlightening others that it is alright to "step out of the box." One of the things that we stress at our PAC-Live programs is a change of philosophy so that dentistry becomes unbelievably enjoyable. At our graduation dinner in September, several of the administrative people from the dental school attended and when they heard the speeches given by the recent grads they were overwhelmed. They realized what I realized for the first time when I started teaching hands-on, live patient programs about 5 years ago in that this program is not only about dentistry. It is really about an opportunity to change your life. We have not created the door to enjoyment, but we have lead the way for many of these individuals to this door and even opened it for them. What they find on the other side is a world that breeds enthusiasm and enjoyment. A world that provides the atmosphere and environment necessary for these individuals to actually look forward to going to work Monday morning rather than desperately waiting until Friday afternoon.
Your newsletter and personal communications with everyone you touch certainly has the same effect. I wish you the best with genR8TNext Seminars and if there is anything I can personally do to enhance your success, please let me know.
Your friend,
David Hornbrook, La Mesa, CA
Bonding Is The Problem
I recently took a course with Frank Spear (Institute for Advanced Dental Studies) and most of the dentists present were far superior to the average clinician. I was the only clinician out of 12 who had no problem with bonding in the posterior of the mouth. The other 11 dentists were clearly interested in cementing crowns rather than bonding. Most of the indirect materials are wonderful but sorry to say most dentists are not.
The ADA believes that all dentists can, if they really wanted, be competent clinicians. I believe that bonding in the posterior region of the mouth is beyond the capabilities of most/many dentists and most manufacturers believe it also. Why else would Procera and all the new cements arrive on the market.
I believe that many of the problems stem from the fact that MOST DENTISTS STILL CANNOT PERFORM BONDING PROCEDURES using a no compromise step by step technique INCLUDING RUBBER DAM PLACEMENT.
The problems that you mention are much more fundamental than what you have addressed. I have placed thousands of indirect posterior restorations with 98-99 % success regardless whether the material is Concept, Empress, Targis, Artglass etc.
(Adrian Jurim just presented one of my cases in Chicago. It was a 14 unit case --#4 through #14--including 8 porcelain veneers and two bonded Sculpture/FibreKor bridges. I was also had involved in the pre-introduction testing of Targis for Voss Dental Lab, Buffalo, NY. and I have taken over 800 hours in cosmetic education and will receive a certificate of proficiency in esthetic dentistry from SUNY/BUFFALO in the near future. I was invited to join the cosmetic team of Dr. Edwin Williams III, head of plastic surgery at Albany Medical Center, as the only dentist in a 22,000 square ft building devoted completely to cosmetic treatment.)
If you have any questions, don't hesitate to contact me at my present office (518-279-1116).
Gerald C. Benjamin, Troy, NY
Email: gbenjam1@nycap.rr.com
Editor’s Response:
Gerald,
You are most certainly correct about the importance of being able to bond these restorations correctly. I agree with you that this is an often overlooked fact of why some of these things fail, but bonding alone will not cause the resin material to separate from the fiber material.
I applaud you for taking the time to educate yourself to excellence in clinical dentistry. Frank Spear & Robert Winter are good friends and their courses in Seattle are wonderful...as are John Kois', Peter Dawson's, Bill Strupp's, Larry Rosenthal's, Dave Hornbrook's, Bill Dickerson's, Ray Bertolotti's, John Kanca's, Gordon Christensen's and a number of other people who have set up centers of higher dental education. That's why I'm on the Crown Council...because one of the commitments we made when we joined was to better ourselves through continuing education.
I also know Adrian Jurium as he is one of the lab personnel who have committed to making genR8TNext work. He is a master craftsman and can do magical things with the materials. However, he is only as good as what comes into his lab to work with. I recently visited my lab techs Jim & Bob Spallino (Great White Dental in Santa Maria, CA, 800-441-3522) and had a chance to see what comes into their lab in the form of impressions. It's pretty scary! We should show pictures of some of these impressions for Halloween! I can't believe that they would even attempt to fabricate restorations on some of these things. And, before you think that they are some schlock lab let me tell you that they have many members of the AACD as their clients and supposedly real, high-end dentists. When I asked Jim & Bob "Why don't you just call these docs up and tell them you can't use these impressions?" They responded by saying "We did! And they told us they didn't want to get the patient back in and they didn't have the time to take another impression. We would just have to work with it the best that we could." The real sad part is that Great White Dental is an awesome lab. I know that Adrian has the same problem as does Microdental, Glidewell, DaVinci and all the other labs that are out there. The only people who have some control are the lab techs who pick & choose who they want to work with (ala Lee Culp, Matt Roberts, etc.) but even these guys have problems. The bottom line is this...no matter how great a clinician you believe you are...we all mess up every once in a while and we have to be secure enough with our big egos to allow our lab techs to call and tell us that our impression sucks...or they don't have enough clearance...or they can't mount properly with the bite...you know what I'm talking about. WE ALL MESS UP SOMETIMES...life goes on...get over it!
You mentioned Procera and all the new cements that are coming out. Be careful with Procera. It is a great material, but their recommendation that you can cement it in with conventional cement is misleading. You have to be sure that the cement you are using doesn't have a coefficient of expansion greater than 2%. If it does you will be placing stress on these restorations and will see failures in the form of cracked porcelain coming off the aluminous coping. Prep design and adequate reduction are important. Also, there have been reports of separation of porcelain from the Procera substructure. This is most likely caused by dental labs who are trying to use regular Feldspathic porcelain on the aluminous core. Nobel BioCare (besides coming up with a great marketing ploy and getting their hands in everyone's pocket by making all the copings in Sweden) has developed special porcelains that must be used to build up over the core material. If dental labs don't do this the regular porcelain will not "stick" properly to the core. Also, the dental lab needs to be careful that they don't contaminate the surface of the coping prior to placing the porcelain. Needless to say it is a very intricate process. The final result is beautiful...but again...it is being promoted heavily and all doctors are hearing is that they can cement these things in with regular cementation procedures. From what I've seen the best cements to cement Procera are resin cements...I'm sure Ray Bertolotti has a few recommendations (i.e. Panavia 21). Forget Zinc Phosphate, Polycarboxylate and/or Glass Ionomers. These will not work long-term with Procera.
It is truly an amazing world we live in. I would love to figure out a way to tap into everyone in the world's crown & bridge practice, but I'm not smart enough...yet!
