An interview with Dr. Harshad Adhiya

   I have known Dr. H. D. Adhiya right since my student days & I have always viewed him as an icon of clinical, managerial & social skills. Dr. H. D. Adhiya has consistently set higher standards of clinical practice. Practice management is my favourite topic & all the time I am being asked questions about various aspects of practice management by dentists. I placed before Dr.H.D.Adhiya the commonly asked questions. Dr.H.D.Adhiya has spent quite a lot of his time & answered them beautifully. So read on:-

* Please describe the initial days of your career? I had to struggle. I was studying with library books, (finance being a major issue). I started practice with the last rupee that was borrowed. I had high goals in mind, both for working conditions & treatment outcomes; I wanted do what was available best in Mumbai, then India & later on in the world; I kept borrowings initially for basic needs but later for expansions, conferences & training in selected fields. Challenges are the opportunities in work suits.

* What kind of problems you faced in the initial days of your career? Over & above all mentioned above, I thought of positioning myself as a consultant. Contrary to the practice at that time I used to charge for consultations. This led to 65-70 % patients walking away from the entrance.

*Which skills are most important in success in private practice: Clinical skills, managerial skills or social skills? Clinical & managerial skills are of utmost importance.

* How important is the location of the practice? In initial years of practice, ease of approach counts a lot. Later on if one has proved one’s worth people travel anywhere to reach you.

* How important is the decor & layout of the clinic? It is very important to have a good decor & well maintained cleanliness & hygiene. Even if one is looking to practice routine dentistry, more so for higher end dentistry.

* Some ideas & tips to motivate patients for quality dental treatment? Use of communication skills at the best & spending sufficient time at the 1^st visit. Give insight into long term benefit of quality dental treatment.

* How important are the dentist’s social skills in building up a practice? Very important. Doctor patient relationship must start at the 1^st consultation. Receive the patient with greetings of the day, a smile & a warm shake hand & make the patient as ease so that he / she is totally relaxed. After that a few leading questions to get to the purpose of visit & diagnosis. After the session, while the patient is leaving the surgery, make sure to reassure the patient that dentistry is painless & wish good bye. In medical field these are labeled as bedside manners.

* How to filter out potentially unco-operative patients? The best way would be to tell the patient that your work demands special skills & being a professional would not like to complicate the problem by handling myself. I even do not know the person who can best handle the situation. “Please check for yourself with a couple of more senior / qualified persons or visit an institution”.

* Your experiences regarding patient un-co-operation? Attitudes do vary. I would insist on the scientific fact. Be more considerate to them, they need to be handled more delicately — charge them extra without announcing, they are most likely turning out to be co operative and loyal.

* What best can be done to identify problematic patients at the initial stages? How to phase out problematic patients? Understanding patient’s attitude & sticking to your viewpoint accompanied by diplomatic statement will take care of the issue.

* How do you handle window shoppers?  From day one our clinic charges a consultation fee in a 2 tier formula meaning X for regular consultations & 5 X for long consultations like implants / full mouth / major treatment plan. This way the clinic is not at a total loss. A chronic visitor is charged 5X at every consultation.

* How do you handle bargaining by patients? All of them are told this standard dialogue again from day 1 of practice “This is not a shop / business house. We have fixed rate as we have learnt at places wherever one bargains, both parties are wasting time & left unsatisfied. Patient feeling if I bargained little more I would have a better deal & the dentist feeling next time I would start at still higher amount, so please bear with us “.

* Changes in Indian dental scene over the years: From 1965 till the day there have been a lots of change in equipment, materials, techniques & patients awareness & attitudes.

* Your favorite dental procedure: Being a man with interests in newer challenges & treatments it has changed from crown & bridges to RCT to composites to light cures to veneers to finally implants.

* Anecdotes from your speaking career: At a lecture I had communicated that I need 2 Kodak Carousel type projectors with 2 screens. The time for me (being the only speaker) was entire morning session from 10:00 am to 1:00 pm with a small break. I was driven to the venue at 10:30 am to witness a single Kinderman slide projector. We had to wait till 11:00 am till some more members gathered. We started at 11:30 am, with a volunteer picked up from the crowd to assist me load the slides on one side & I collecting from the other side. The presentation had to be finished at 12:30 pm as the back benchers were signing for lunch. This was without mentioning the goof up. I did not rush & I showed only 20 % of the slides & still I managed to deliver. It was like converting a novel to a short story. I equally enjoyed the presentation.

* Anecdotes from your practice: 1)  In early days of practice quite a few patients on being advised for radiograph for diagnosis of deep decay in a tooth would ask how much will it cost for restoration, RCT & extraction & eventually ended up asking me to extract the tooth. It was a great task to convince them not carry on & come out of the situation. It tested & sharpened my communication skills.

2)  After few years when the practice was heavy, the schedule went haywire when a couple of emergency patients with pain had to be accommodated & no patient was accepting to be treated my associate. A VIP having a long appointment for bridge cutting was taken in on time. I explained him the situation I was going through & asked if he can wait for a while or would take a fresh appointment. The patient asked me what I would like to do. On telling the patient that you have a right & it’s my duty to start the work today but if we postponed, I will be able to better justice to the work. The patient easily understood, took fresh appointment & complimented me for honesty & courage.

* Some suggestions to train auxiliary staff: 1)    Prepare the existing person for new likely recruit (if already there).

2)    Explain the person the type of work, cleanliness, hygiene, time frame expected & the re-numeration being offered.

3)   Observation period for a couple of days the work to be carried out with 50% reward.

4)   Confirmation on satisfactory work.

5)   Regular dialogues / meetings.

6)   Regular increments.

* Some specific suggestions to stop patient attrition:1) No efforts must be spared for total patient’s satisfaction, clinically good work, patient’s comfort & mental make up. This comes through a good dialogue & communication skills. Never let a patient feel that you are rushing through. This is achieved by good planning & if necessary rescheduling some appointments.

2)   It is better not to accept / start a new work on a new patient before understanding patient’s needs, attitude to treatment & finance. If not followed up in this pattern, be prepared for attrition in spite of good clinical work.

3)   Let there be no / minimum waiting as every one is hard pressed with time.

4)   Let there be dialogue & reasoning in fees charged from time to time.

* How do you ensure that the lab consistently delivers quality work? 1)   Ideal impressions in consultation with the lab

2)   Clearly worded written instructions.

3)   A grace period for planning for you to check (& improve if need be) the work before patient comes in.

* Is it necessary for a dentist to undergo training abroad? Not really as there is sufficient facilities & the expertise available locally. We are at par with the world.

* How do you motivate patients for implants & cosmetic dentistry? For implants I always highlight the advantage of the modality; the main being stimulation to bone to prevent loss of alveolar bone. Especially its advantages in distal extension cases; retention of ill fitting lower full dentures, etc must be highlighted. For cosmetic dentistry I would tell the patient that cosmetic treatment is for your extra confidence and self esteem. It is ultimately your decision. You also may want to get cosmetic dentistry if your family and friends want. Here, one has to increase patient’s expectations for appearance. But never ever push a patient for any decision.

* Do you feel that excessive competition is hampering the growth of practices? Not really, in fact that has caused increased awareness & increase in total volume of work. If one takes it in the RIGHT spirit healthy competition he will benefit. The one who tries to undercut may end up doing compromised quality work, which can backfire. This is where magazines like DENTISTRY TODAY can help.

* Do you feel the correcting “messed up cases” by other colleagues is a good practice opportunity? No, in fact they are most difficult. I would always start with asking the patient get back to the old dentist telling them, “Many a cook spoil the broth”. I will agree to treat the patient only if I must & only after the patient has clearly understood the limitations / difficulties / chances of complication & failures.

* How to prevent success in practice from killing you? Planning work schedule to have breaks, avoid constantly the same posture, doing regular neck & back strengthening exercises, taking number of holidays & relaxation techniques, etc.

* Some specific suggestions to manage social friends & relatives who become your patients: Dental practice is poles apart from consultants & GPs. They have a very small input cost as compared to our high input costs & usages of dental consumables. The formula very successfully followed by our practice for many years & regularly being advocated by me is a formula of ” Letting them know the options available; actual treatment charges for patients & the percentage benefit / lump sump discount offered to them”. The regular dentistry percentage discounts are in 3 brackets 10, 20 & 30 %. In some cases like implants percentage cannot BE offered there is a lump sump discount offered. They are told this way diplomatically -” I am sure you will not like to take obligation & I will not like you to spend your hard earned money being wasted in buying me an expensive gift which may be duplicated / not useful to me & cannot offset the input cost. I will like to make it easier for both of us” Please believe me it had worked wonderfully well in firstly protecting them & for sure protecting me from unwanted negativity of frustration.

* Dental tourism. Is it a good practice opportunity? Yes, absolutely.

* Do you feel that an active social life is necessary for growth of the practices? Yes, with a good balance between social, clinical & family life.

* How long will you adjust a crown before discarding it? Maximum 3 minutes.

* What could be an acceptable rejection rate of prosthetic works from the lab? At the highest 3%

* Do you feel the need to extend discounts to long time patients? Strictly no. but do not miss an opportunity to convey to the patient that you are happy to see them back.

* How much time you spend in continuing education? I did spend much higher percentage of my working hours in my earlier days. I have learnt the hard way by going abroad and overboard. I would say 10 % of financial gain must be reserved for the purpose in present scenario.

* When should a dentist start planning for his retirement? There are different aspects of retirement plans a) Financial – must start at the earliest: Investment in different areas namely, cash savings, equity, bullion & property.  b) Social & family security like Life insurance plan / PPF / ULIP etc, which also must start as early as possible & c) Physical which can vary from 55 to 65 years of age personal needs , depending health, family history & back ground.

*How long a dentist should take to build up a strong retirement kit ? About 25 years: If  a dentist feels he is off track then he must take sufficient insurance so that the family does not suffer in the event of a mishap.

* Any ideas for the practice to gain momentum quickly especially in these days of hypercompetition? Internal & external marketing, in order of appearance. Internal is the most rewarding & satisfying. In early years of practice, one has all the time, invest well in patient education, evaluation of complaints & identifying with them.

* Some ideas & tips regarding receptionists & front office staff? This is the 1st contact a patient makes with the dental office. She / he has to be smart, diplomatic & courteous. They should be taught the way to control the time & energy bank of the dentist.

* What kind of training should a dentist acquire in implantology? For a fresh graduate there are many diplomas at the Universities / colleges are available in India. For the practitioners who cannot be away from the clinic for a long period, now the options available are many centres offering weekend extended programmes. Least to do is attend some hands on programme & attend whatever conferences / presentations available.

* Important points for success in implantology? Selection of ideal patient with no contra indication, uncompromised surgical technique; proper prosthetic planning; load distribution & regular follow up visits at least once in year with OPG, prophylaxis & bite adjustment safeguards the predictability and long term success.

* By what percentage should a dentist’s professional receipts increase year after year? A million dollar question. I would say one must try & achieve predictable dentistry as the main objective; as for the earnings we have little control on increase in patients. But always keep marketing strategies alive & keep revising the charges to fight inflation. I consider 10 % increase in fees & between 20 & 30 % increase in volume could be an ideal aim.

* What should a dentist do if he finds that his professional receipts are stagnating year after year? One must take an objective analysis of the causes. With super saturation, this is quite common question I hear. A constant effort to improve the services offered & using the marketing tools effectively. There has to be a constant effort to update skills & equipment and going the extra length wherever possible.

* Some ideas as to how to retain patients in your practice? Aim at satisfying each patient / family, both from satisfactory predictable dental treatment & using one’s communication skills to the best to let the patient accept deviation from expected goal.

* What kind of continuing education should a dentist take?  I would say attend all the conferences, small / extended courses in different subjects (to one’s liking) & reading literature & surfing net.

* Any specific practice management tips for women dentists? Not really, they are equal or even better in all the skills with an advantage of feminine touch which helps all the groups of patients. So they can succeed with greater ease. They must however understand their biological roles and hence know their limits and not to expect to put in more working hours.

* The contribution of your associates in the growth of your practice? Deputation of routine work is must. This can let you do more effective work.

* In retrospective do you feel that any associate has harmed the practice? No for sure. But I can hint here that a constant watch has to be there to monitor the quality of work rendered.

* When, how & where should a dentist introduce higher end procedures in his practice? I would say aim from day 1 to aim at the best if your place is so planned; If not create an opportunity to improve the set up to introduce for higher end procedure. Take training from various sources.

* What should be an ideal profit margin in a general dental practice? About 35 – 40 % of gross.

* Any suggestions to reduce the outgoings? Buying at conferences in good quantity & clubbing with friends.

* How to maintain quality on a continuous basis? Regular assessment of the work by checking at all stages, follow ups & the work assessment of the staff..

* Persons who have made positive contributions to your career? My teachers ( Dr. P.V. Diwanji & Dr. C.B. Daruwalla)  who warned me that “good students” are not very successful & not to take up something you are not confident of handling. Dr.Mahadevia for ever changing needs in laboratory support & my wife for moral support in initial years of struggle.

* Any specific suggestions for husband & wife dentists? To be in the same field needs more understanding of working together. Give each other enough breathing space, respect each other’s individuality & try not to extend the clinic talk beyond the walls of the clinic.

* On dentist lab communications? Need to be precise, written, legible (good handwriting / typing / formatted sheets) with records at the dental office for ease of follow ups & leave open all communication lines.

* You lute a crown & it comes out within two weeks?  What is to be done? Check the cause & correct the same, if necessary repeat after due alteration on preparations if needed. If the same crown is reluted make sure of sandblasting the luting surface.

* Do you feel that having two practices is beneficial? No.

* What is the main cause of patient attrition? What can be done to decrease patient attrition? The flux is a know phenomenon, but attrition needs a special insight to find out the cause & to take remedial action.

* HELP!!! There are six new dentists on my street. What should I do? More the merrier, you are senior to all of them. In all probability more dental work happening in the locality & one who proves better will tilt the scale in his own favour.

* HELP!!! There is a patient on the chair who wants to get his badly infected tooth out without antibiotic cover? What is to be done? Get down to the level of patient’s understanding & use the dialogue “I will be very delighted & rewarded for the extraction but I am worried for the complication that you will suffer. I am a professional person & not a businessman, please try & understand”.

* Your philosophy of practice management: I never made an attempt to increase my practice. It came about naturally. I concentrated on the basics. I always on predictable dentistry which is helpful to patients.

* HELP !!! Even after sixteen years of practice I am not living a luxurious life: Financial success & success in dentistry are two different aspects. You need to manage your investments properly. Quality dentistry may not be very profitable.

* HELP !!! My receptionist is incorrigible. She never wishes the patient: Throw her out. Spend a little more money and hire better person. If you wish to retain her than spend some time and train her properly.

GETTING PERSONAL:

 * An ideal Sunday: Easy on all schedules, lovely good lunch & movie / drama with family. In fact it’s worth mentioning here that I have not worked on Saturday evenings for over 25 years & that is reserved for dinner with few close friends.

* Your strengths: Dreamer, futuristic, helping others & positive thinking & good understanding of interpersonal relationships.

* Your weaknesses: Tendency to put on weight & sensitive to politics.

* Your favorite vacation spot: Matheran & Mahabaleshwar.

* Your favorite music: Instrumental classical music –Indian & western.

 * If you would not have been a dentist what would you have been? An engineer. My father & grand father have been engineers but the genetics helped me as dentistry is engineering at the best.

* Your philosophy: If your surroundings are happy, you could be happy; to give one’s best to others . Be it a patient or any relative or friend.

* You are passionate about: Quality dentistry, practice management & fitness.

* Philosophy of practice management: I never made an attempt to increase my practice. It came about naturally. I concentrated on basics. I always emphasized on predictable dentistry which is helpful to patients.

* Luxurious life: Financial success and success in dentistry are two different parts. You need to manage your investments properly. Quality dentistry is not a very profitable activity.

* Incorrigible receptionist: Throw her out. Spend a little money & hire a better person. If you wish to retain her, spend some time & train her properly.

* Your comments on DENTISTRY TODAY: Good selection of authors, their subjects of articles & the untiring efforts by Dr. Veerendra Darakh as experienced earlier while contributing articles & now for this interview.