Mini Smile Makeover course demonstrators, Dr Mille Morrison and Dr Stuart Ray, present the key differences between private and NHS dentistry and the challenges that arise in each sector.
The transition from the NHS to private practice is something that crosses the minds of many dentists. Many can find it a daunting process, consisting of years of training and practice in the NHS before starting to work in the private sector. With years of combined experience and knowledge, Dr Millie Morrison and Dr Stuart Ray are here to share their views on how to find a balance between the two sectors and make progress.
Dr. Payman Langroudi: We're here with Stuart Ray and Millie Morrison. We've just finished two long days of training dentists in composites. We wanted to talk about your journeys, what's working for you now, where you've come from and where you've come from. Let's start with Stuart. Give us a 30-second summary of your career.
Dr. Stuart Ray: It was varied. I spent my first 10-12 years in the NHS and actually became very disillusioned with it., because, honestly, it was destroying my soul. So, thank God, I found the private way to do things. I wanted to focus on quality, not quantity.
From there I left the NHS completely and have been in private practice ever since. Now it's about focusing on developing my private skills. So nothing specialist, I'm a generalist. This is where we are today, focusing on high-quality work, caring about people and their needs, and also enjoying ourselves, teaching.
Dr. Payman Langroudi: What would be your advice to someone who works in the NHS and wants to leave the system or wants to work more in the private sector? What advice would you give to someone who is in this situation?
Dr. Stuart Ray: I think a lot of people don't think NHS patients and NHS practices allow them to do private practice and I don't think that's true. I think if you have the time to talk to your own patients, your existing patients, because you've already built that relationship with them and the trust with them, that's the first place to start. It's not a case of jumping ship and going somewhere else. And I think that's true for any type of practice. Focus on the people you've put a lot of effort into, you've spent a lot of time building goodwill and trust with.
Dr. Payman Langroudi: But if I'm a young dentist, how many years of NHS should I do before I even think about it?
Dr. Stuart Ray: This is a good question. I think in the past, when I graduated, people used to always say you have to be in the NHS for 10 years. Now I don't see that anymore. I think the NHS has changed so much that the learning experience has diminished. I think that if you're in a position where you've prepared yourself properly, if you're there for a few years, there's no reason why you shouldn't consider leaving much earlier.
Dr. Payman Langroudi: Earlier than 12 years?
Dr. Stuart Ray: Two years earlier.
Dr. Payman Langroudi: Now, as a counterbalance, Millie?
Dr. Millie Morrison: I'm still in the NHS. I graduated in 2015 and started out doing a lot of work in the NHS. As you just said, Stuart, I didn't feel like I was talking to my patients about private practice. Maybe I didn't think they wanted it and weren't going to listen and accept the other options I could offer, so I branched out. I spent more time learning and slowly I started to approach my patients with a bit more openness, giving them all the options, and more people than I expected accepted. The more confident I was when talking about prices, about different techniques, and the better I could explain them, the more my patients began to understand.
“Because I spend more time in private work, it has allowed me to have more time to do better in the NHS, because I am no longer forced to reach 400 UDAs in a month.”
Then I was able to provide better and more regular treatment. I started doing a lot more Invisalign, and now my bread and butter is aligning, whitening, bonding, and on and on. Because I spend more time doing private work, that has allowed me to have more time to do better work for the NHS, because I no longer have to do 400 UDAs in a month. I don't need to do as many UDAs because I have private work, which takes up a lot of my time, and I can spend time with my NHS patients, giving them the good quality treatment that they deserve.
Dr. Payman Langroudi: Your progress to becoming an Invisalign instructor has been pretty meteoric. You just gave your first full-day lecture. So when you talk to dentists who do Invisalign, what are some common mistakes or misconceptions they have? What would be some tips to speed up someone’s Invisalign process?
Dr. Millie Morrison: If I tell you a little more about how I progressed through Invisalign, I think it will help you understand.
When I first got Invisalign, I was shocked at how little control I thought I had over the whole process (and I'm a control freak, if you ask anyone who knows me, I like the details), I really want to be there. I'm not very good at delegating and I'm a bit bossy. My sister has had this her whole life. I want control, I want to know what's going on. At first I thought Invisalign didn't give me that, so I did more of it because I can control every move. Then I spoke with my Invisalign representative, Alice, and she completely changed my perspective on Invisalign. I realized how much control I could get from the Invisalign system.
I started with simple cases, changing a few teeth, doing very simple movements, then I gained confidence and moved on to more complex cases. Now I use Invisalign as part of a full mouth rehabilitation. I do much more difficult movements.
Dr. Payman Langroudi: So your first advice is to talk to your representative?
Dr. Millie Morrison: No… well, actually, yes. That’s good advice, because I think a lot of times we see 4 blank walls and we don’t get to talk to other practitioners on a daily basis. When you have a bigger network and when you have a representative who talks to you and tells you what they can and can’t do, then you gain a little bit more confidence, and then you start to meet more people through that.
Dr. Payman Langroudi: There is a lot of information out there – itthe power that representatives have and I think it's something that's not thought about too often, because the representatives have a lot of information.
Dr. Millie Morrison: As dentists, we play the blame game. “It’s not my fault, it’s their fault, they didn’t approach me. Well, actually, it’s a two-way street, like any relationship, and we have to approach them and find out what information they can give us so that we can then move forward. In the first 12 months, I think I had 65 cases. And now I’m teaching and part of the Allina Consulting family and it’s wonderful. I have even more support now than I had when I started and it just snowballs from there.
Dr. Payman Langroudi: From a clinical perspective, give us some advice, or from a patient management perspective. Doing so many cases in such a short period of time.
Dr. Millie Morrison: A lot of it is marketing to bring in new patients. Also, what I found is that during the checkup, when I had the patient lying down, I would say, “oh, you have some calculus or tartar build up here. Have you ever thought about straightening your teeth to make them easier to clean?” Obviously, I would get out the mirror and ask, “Yes or no?” If they said yes, I would then approach the conversation at the end of the checkup. They and NHS patients you just convert and give them a treatment they really want, they just didn't know you were offering it. A lot of my patients used to say, "oh, you do this, but my other dentist doesn't do that"“. Most dentists can do this.
“What I do now is have a personal email address, which all my Invisalign patients receive.”
It's just about having the confidence to talk to their patients to let them know that I'm doing it. Then what I like to do or what I'm doing now is have a personal email address, which all my Invisalign patients get.
The day after the appointment, I send them an email telling them: “Thank you very much. It was a pleasure meeting you, I hope it was helpful. Here is my personal email address. Please contact me if you have any questions. What are the next steps? What do you need to do now to move forward?”. This was a big change, because suddenly the patient and I were working together as a team to reach their goals., without having to go through the reception, wait for lunch, be too busy to call them back.
Nowadays, people don't want to be called all the time. In fact, I always tell them that after 11:00, I won't answer and you'll have to wait. But no one makes fun of me, everyone respects the fact that I have a private life and that I have my own things to do.
Dr. Payman Langroudi: Stuart? From a patient management perspective, do you treat your private patients differently in that regard? Do you give your patients your phone number, your email? What do you do?
“The transition from the NHS to private and getting people properly cared for is a matter of time.”
Dr. Stuart Ray: I don't give them my email or my number. After hearing it's a great idea. For me, the most important thing, the switch from NHS to private and getting people the right care is time. It's not always about having the most expensive and the most amazing equipment. It's about sitting down and listening to what people say, listening to what they want. I think there are a lot of treatment plans and a lot of treatments done that dentists are good at, so they push what they are good at and actually patients leave unhappy. It's really about sitting down, listening, having a good chat and sometimes in a very informal environment outside the office.
We have a patient consultation room, which our treatment coordinator also uses. It's actually quite nice to sit there with a coffee, especially for larger treatment plans, and just chat, nothing formal. And actually, when you are in that relaxed environment, their true "desires" come out much more easily than if you are in a pressured clinical setting. For me, this is the most important thing.
When you are talking to a patient, if they are in the dental chair, make sure you look them in the eye. Don't look around the room, don't sit down, don't write things down. Someone else can take notes if you need to. I have found that if you sit a little lower, it means you are not dominating and imposing on the patient. Nervous patients are not a hand on the shoulder. It's about reassurance. It's old-fashioned care. It's about good manners and listening.
Dr. Payman Langroudi: You gave demonstrations at Mini Smile Makeover course throughout the past year, and Millie you have helped us throughout AACD and right from the beginning of the course. You see dentists going through this journey in two days, changing the way they look at previous statics and becoming less invasive. What are the most common things you find every time dentists do it that you need to correct?
Dr. Stuart Ray: I think so.The most common problem I see is that they become very focused on looking down at one tooth. They lack the vision to look at all the different angles. And for me, what I've said a lot today is to continue to check all your work. If it's previous work from an incisal perspective, that will give you the buccal-palatal relationship. You can see the line angles, you can see all the reflective and deflective areas. For me it's actually very simple. Don't focus too much and don't focus too much on looking at one tooth, make sure you move your head and look at it from all angles.
Dr. Payman Langroudi: Is this an important issue?
Dr. Stuart Ray: I think it's huge. I think it's amazing how a little adjustment made looking from the incisor can transform the look of a restoration, especially when you look at the positioning of the line angles. And the thickness, too. It's amazing how if you're just half a millimeter thicker than the adjacent tooth, it looks so much more dominant. I think that's the most important thing for me. Millie?
Dr. Millie Morrison: Yes, I agree with that. In practice, I always check from every angle with my mirror, but I also have my assistant check from her angle, because where we are sitting and where the assistant is standing is completely different. Sometimes we are so focused that we miss something and it is good to have the assistant's point of view, because she will be able to see things differently. It is also good to involve her, because when we wash and then carve for an hour and a half, she says: “I want to take a nap, can I have a cup of tea?”. The patient also really enjoys that you are working as a team and it is not just the dentist who does it, but you work together, chat a little or discuss the work, and he really feels that he is having a personalized experience for him, which he really likes.
The mistakes people make – I think some people try to rush through the initial steps so they can then put in all the fancy secondary, tertiary anatomy. What happens is that because they don't focus on the basics to begin with, by the time we get to the finishing and polishing, it's not quite right.
Dr. Payman Langroudi: Each step builds on the previous one, right?
Coming back to your observation about the nurses, I told the nurse that you decide who to call and you call. First of all, it made my job easier, but secondly, her involvement in this and the patient's appreciation that the office called (she would say, "Dr. Langroudi wants to know if you're okay"), the patient was always surprised and happy. The fact that she chose them, that she called them and that she got back... we wouldn't even have talked about it unless it was a problem. But she would constantly come back to me and say, "Mr. So-and-so was glad to hear from us.".
I quit eight years ago, and a lot of people still don't call their patients. It's such a simple thing to do, to call your patients afterwards. I was talking about calling your patients before their first visit. Nobody does that, and it's such a good idea. You go somewhere new, you know what to expect. The dentist calls you before you arrive to see if you have any concerns, and there are always a few things that worry you, whether it's cost, pain, etc. It's such a simple thing.
Dr. Stuart Ray: Do you think it's best for the dentist to do this? How about a treatment care coordinator?
Dr. Payman Langroudi: I think the ideal situation for the dentist is to do it. But if you're seeing 100 patients a month, maybe the dentist doesn't want to do it and you'll have to outsource it to the rest of the team.
Dr. Stuart Ray: Again, we're going back to old-fashioned values, aren't we? Trying to take care of people and not look at teeth as a source of income, but unfortunately some people focus only on that. A lot of the new patients I see in our office are because people are completely dissatisfied with the services they've been given; not the dentistry, but the services.
You often choose your surgeon based on the person you get along with best, and this makes no sense.
Dr. Payman Langroudi: I don't know if you've ever dealt with surgeons (I hope not), but often you choose your surgeon based on the one you get along with best, and it doesn't make any sense.
Dr. Millie Morrison: If I'm working on a multidisciplinary case and I know they have surgery on Wednesday, then I set reminders through the SOE software to send them an email or SMS.
Dr. Payman Langroudi: Before or after?
Dr. Millie Morrison: After. And I would just say: "How did the surgery go yesterday?".
Dr. Payman Langroudi: Before would be even better.
Dr. Millie Morrison: But it's not with me... they've had an implant, they've had a crown lengthening, or they're having a root canal with the specialist, and I might send them an email afterwards. So it goes back to the fact that you go to the specialist for that particular point in the treatment, but I add value as a restorative dentist because you (the patient) come back to me and I maintain that relationship.
Dr. Payman Langroudi: Very nice. Well, time has caught up with us. I want to thank you for the last two days.
Dr. Millie Morrison: Thank you.
Dr. Stuart Ray: Thank you for having us.
Source: enlightensmiles.com
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