I would argue that one of the greatest faults in some traditional dental service organization (DSO) models is the use of quotas.
In other industries, from manufacturing to retail, upper management can use quotas as aspirational goals (i.e., wouldn’t it be great if we hit this target?) or as key performance indicators (i.e., you had better at least hit this target). Quotas have their risks. There may be a legitimate reason that a quota is not being reached. In manufacturing, there may be an issue with materials or equipment and thus pushing toward that quota could risk safety of personnel or a decreased quality in product. In the retail industry, which is customer-facing, quotas can lead to aggressive sales tactics that harm the customer experience.
Dentistry has all of the above risks associated with quotas, plus the additional consideration of the doctor-patient relationship. If my practice is told to produce 40 crowns per month (among other quotas), then it is not inconceivable that the quality of those crowns could be compromised or that patients might feel pressured to agree to and schedule crown procedures. But more importantly, I, as a clinician, would be inappropriately influenced to prescribe crowns for my patients. Large MOD composite? Nah, let’s just crown that tooth and get closer to my monthly quota. This would be a violation of the ethical principles that govern my relationship with my patients.
Is it better if the quotas are production-based rather than procedure-based? I don’t think so. There is still a target that I’m being incentivized to hit. Dentists should only be interested in taking the best possible care of their patients. Yes, we make a profit while doing so, but the concepts of “taking care of patients” and “running a successful business” are not oppositional. We can do both, ethically. Quotas, production goals, and any other term you’d like to use have no place in dentistry because they cloud the doctor-patient relationship.
What management at DSOs and groups practices can do is ensure high standards of clinical care and overwhelmingly positive patient experiences. Just like with private practice, the money will come along the way. There are many other ways for management to boost profits that don’t corrupt the doctor-patient relationship, such as lower certain costs, expanding capacity, providing more services, and so on.
I’ll close with an invitation to my upcoming live webinar on building systems, “The four types of systems for your practice playbook.” Join me on March 29 for a candid discussion about how we can build operational excellence that helps practices succeed without the need for quotas. You can register at this link.
Chris Salierno, DDS, is the chief editor of Dental Economics and the editorial director of the Principles of Practice Management and Group Practice and DSO Digest e-newsletters. He is also a contributing author for DentistryIQ and Perio-Implant Advisory. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists at ToothQuest. Dr. Salierno maintains a private general practice in Melville, New York. You may email him at [email protected].
