Inside Dentistry
April 2008
Volume 4, Issue 4

The Fully Integrated Practice—the Ultimate ROI

Alex Touchstone

The why, the how, and the now.

Dentistry is not just about margins, materials, and money—it is about being of maximum service to others. Our pathway to success comes not simply through writing a mission statement, owning technology, or attending a CE course given by the guru of the hour. In fact, these activities are impotent unless coupled with a personal commitment to endure the growth process that comes from developing and implementing a vision that is created from the inside out.

Moreover, while it makes us feel good to think of our practices as “state-of-the-art” and “patient-centered,” we often fall short in understanding how to put all of the pieces together in such a way that our patients see what we were striving for from the start—a perfect patient experience using the fully integrated practice as our vehicle. The fully integrated practice comprises people who share the same vision, where the focus is on providing optimum dentistry through excellent service. Participants in the fully integrated practice also understand how to implement technologies that support them in their goals.

Three essentials follow with regard to achieving the fully integrated practice: creating a vision that is uniquely yours, selecting and educating your team, and choosing technologies that serve as force multipliers in your pursuit of excellence. In this article, the author will provide an overview of the challenge of bringing the vision of a fully integrated practice to reality.


The father of success is vision. There exist many books of wisdom that speak to this subject and the author will not pretend to add any new revelation on the matter here. However, it is clear that visions fail because they were meant for someone else or born out of wrong motives. For instance, it is tempting to look at a colleague’s practice from the outside in and say, “I want that.” The problem with this line of thinking is that we are borrowing from someone else; we neither own it nor have we counted the cost of squatting on someone else’s land, so to speak.

So, a vision is aborted from the start unless we have thoroughly searched ourselves and discovered our purpose rather than emulating another’s. Another way to put our vision at risk is to focus on goals that are too self-centered. If all we are out to do is to keep statistics on how many new patients we see and to line our pockets, our vision will not resonate with others and, thus, we miss out on attaining the highest level of success—the opportunity to truly provide for those who depend on us: our patients, our team, our families, and our community.

If we cannot copy another’s vision, where, then, do we start? We start by assessing our talents and limitations. This exercise should be accomplished in writing, perhaps over a period of weeks or months, and with the help of trusted advisors who may include experts in finance, dental practice management, and spiritual matters. The paradox is that by looking beyond selfish motives and by taking a longer view, you will ultimately end up having exactly what you want and wanting what you have. The state of mind that results from living out this paradox is often referred to as one of abundance.

Taking a thorough and honest inventory inevitably results in your vision coming to life organically. Having a vision that is clearly defined gives you strength and motivation to work through the next steps of assembling your team and making the right choices as to technologies, systems, and other practice tools. Along the way, pass your considerations through a simple filter in the form of a question: “Will this decision support my vision and allow me to be of greater service to others?”

From the beginning, seek out ways to integrate the business of dentistry with the mission of being healthcare providers to those who are in need. One strategy is to set aside a predetermined number of scheduling hours per month to devote to charitable giving in the form of your professional services. In doing so, you balance the schedule wisely and maximize our resources. The concern for many of us when considering such an effort is proper screening of patients for need. Here, we need not go it alone; there exist many organizations that are set up to properly screen for us, including The Donated Dental Services program, The Salvation Army, domestic abuse shelters, and Dress For Success, to name a few.


The best, most enduring companies in the world share one common tenet: people matter most. Dentistry is no exception. The best dental practices embrace the belief that serving people is at the core of what we do. As dental professionals, we interact with people at many levels, from our patients to our team to the UPS delivery person. Each of these interactions is a point of contact, an opportunity to enrich the life of another while carrying your message. How your team uses these moments speaks clearly to your vision. Therefore, team selection is integral to the process of creating a fully integrated practice.

Interviewing and selecting a team member is an art. The skills required are not, however, difficult to learn. They are: Share the vision, listen, share the vision again, listen again, repeat as necessary until either complete alignment results or the realization comes that it is time to move on. When the team is in alignment, then the tasks of creating workflows, systems, and implementing technologies becomes a series of right choices that are intuitive and downright fun.

Once the critical steps of establishing your vision and assembling your team are complete, then you can begin to focus on selecting technologies that serve as force multipliers in your pursuit of excellence. Again, in filtering the possibilities, ask the question, “Will this decision support my vision and allow me to be of greater service to others?” Needless to say, you must also look at both the financial and educational costs.

As we begin to assess the value proposition of a technology, the four areas of impact we consider are our patients, practice, team, and lifestyle. A technology possessing a truly positive return on investment (ROI) will enhance all four.

Patients, for example, will benefit from right choices in technology through improvements in diagnosis, treatment, and longevity of the dentistry that is provided. Coupled with these, a patient should reasonably expect that chair time is minimized.

One useful barometer of successful integration as it relates to patients is the ratio of internal to external new-patient origins. Internally originated new patients are those who are encouraged to join the practice from existing patients, while externally originated new patients find the practice through advertising and/or marketing efforts. A fully integrated practice can reasonably expect the ratio to be greater than 5 to 1 for internal to external referrals. From a practice perspective, the selection of the correct technology will result in lower overhead, improved treatment outcomes, and make workflow as stress-free as practical. In these ways, the right technology choice will positively impact the practice as a whole.

As an example, consider the cost of equipping a four-operatory practice with large-screen patient-education monitors. The price tag of such an installation is somewhere between $2,000 to $3,000 per room for monitors, mounts, cabling, video cards, labor, etc. The reality, however, is that each of these monitors will be in use only sporadically and thus will sit idle for the majority of the time. A better choice is to equip the office with one or two tablet PCs connected wirelessly to the office network. Each tablet can be used anywhere in the office and one can access practice management software, imaging, patient education modules, the Internet, etc, thus increasing the utilization rate by comparison. Motion Computing (Austin, TX), for example, manufactures tablets that range in cost from $1,200 to $3,000 per tablet. Assuming you elect to equip your four-operatory office with two tablets, not only does your utilization rate increase, but your technology investment decreases by approximately 50% or more.

Team members must also personally believe in the technology’s benefit and efficacy. These conditions are absolutely essential to successful integration. Therefore, when considering a technology, team involvement is integral to the process. Your team is encouraged to commit fully to the learning opportunity and to embrace the changes that occur in tandem. An ideal technology will energize the team and reinforce the perspective that you are providing the very best dentistry our profession has to offer. In short, integration of the same conveys a spirit of excellence in all points of contact your team has with your patients.

Lastly, a technology with powerful ROI has congruence with your life plan for financial freedom, will move you closer to a practice transition, and supports you in achieving balance between your professional and personal lives. To fit these criteria, the right choice will make the practice more marketable, efficient, and profitable. While we may think we know when we will transition our practices, life circumstances often cause our timeline to change. We must, therefore, maintain our practices in a state of marketability such that we are ready for a transition today. Current dental graduates and practice seekers are increasingly looking for fully integrated practices as the next right step in their career paths. Therefore, our practice must respond to this market demand if we are to realize its maximum value upon its sale.

If the father of success is vision, then the child of success is abundance, having what we want and wanting what we have. Right choices such as the ones illustrated here will lead you down the path to converting your vision to reality (Figure 1, Figure 2and Figure 3, Figure 4 and Figure 5). The success that follows will result in the ultimate ROI: the fully integrated practice.

Figure 1 Patients do not see our dentistry at its highest level of detail, but they do see and feel the environmental elements. The impeccably clean faucet in the foreground sends a message that is as powerful as our clinical findings.
Figure 2 and Figure 3 A tablet PC can replace two to four monitors, serve as a portal to practice management, imaging, and patient education and, thus, offers increased utilization rates. Its compatibility with other new communication tools can help to increase patients’ understanding and acceptance of proposed treatments. Figure 4 and Figure 5 The fully integrated practice is comprised of people who share the same vision, where the focus is on providing optimum dentistry through excellent service.

About the Author

Alex Touchstone, DDS
Private Practice
Charlotte, North Carolina

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