Dental Corporates and their responsibilities

I might start off by actually saying the title of this blog is probably one of the most Oxymoronic I’ve ever thought of, but then that would probably give away the content and the thread of what follows.

However, I don’t really care if it does give away what follows; because I’m sure that many of my readers will understand just where I am coming from and why there needs to be something done about the environment we currently have in UK dentistry.

No-one can deny that corporate dentistry generally is becoming bigger and bigger as the years pass. I can remember the original clamour back in the mid 1990’s to buy the original corporate ‘shell companies’ that were legally able to provide dentistry under the 1921 re-organisation of the profession. I’m not sure anyone who was in practice in those times could have then foreseen the huge growth of the corporate, but the real change came when all practices were allowed to incorporate (as an aside, does any one else think it’s funny how the Dentists Act 1984 allowed this but still can’t work out how to take a monthly direct debit from us instead of an annual payment, but I digress…..). What is true however is that there is a significant amount of dentistry now provided under the auspices of corporate dental companies, of which some of them are quite large players. I will say here; this blog is not about any specific company; I am sure there will be some out there who have good stories to tell. However, there is no doubt that in some corporates in some places and some practices there is a culture that is not good, not healthy, and downright nasty.

Those of you on Facebook may well also be members of the ‘Mental Dental’ page. This is a hugely important page that has become an important outlet for its members to vent their concerns about a multitude of issues affecting them. By simple extrapolation, many of the issues floated here are likely to not just be unique to the original (often anonymous for good reasons) poster, but relevant to other professionals finding themselves in similar positions.

A good many of the posts on this page (and indeed on most dental specific social media groups) seem to revolve around issues that associates are having with their corporates. Whilst I am the first one to consider that there are always two sides to every story, there is also a common theme to nearly all the threads posted. Note that I didn’t actually say “Corporate Employers’ at this stage; but more of this later.

It is apparent that even if you take into account that not all the stories are likely to be entirely balanced, there are a significant amount of associates who are having problems with the working environment of the corporates. From faulty equipment not getting repaired, running out of materials, a lack of clinical freedom in referring, to outright bullying, the same themes come up over and over again. This can’t just be put down to only having one side of the story surely? The fact that these threads appear so often, from so many different contributors shows that there has to be something more behind the threads.

Some of the more concerning posts often involve bullying of associates. From target driven issues, to ‘you make waves and we’ll report you to the GDC’, this seems to often be driven by management teams within the corporate environment. There is NO place for bullying in any environment, and the fact that some people feel that it is acceptable to disguise this as performance management doesn’t make it in any way acceptable.

But how has this environment come about? I’m pretty sure the dental registrants at board level haven’t issued dictats to their managers condoning the bullying of their teams? However, the need to make money for the shareholders means that these directors have to ensure the business is profitable (although there’s another oxymoron – the profitable corporate..) and the ideas discussed at board level eventually filter down to the teams regionally and locally,

This is where the problem lies in my opinion. When the board comes up with an idea, it is down to those below it to implement this, and the board is not necessarily aware of the fine details in how this is done; just how that it needs to be done. It is down to the teams on the ground to implement that desires of the board. How they therefore go about this is part of the problem. With management teams that are often not fellow dentists (or even registrants on occasion), there can be a lack of understanding of how the profession truly works. Yes, these people can be given training in the dental industry, but they may not have the same ethical and moral compass, or even the need to be registered by the GDC, and therefore do NOT know what it means to be a real professional.

When you hear stories of associates raising concerns to management about slack appointment books causing them to not meet their UDA target, to then be shown edited data showing the books are now full, and threatening them with a counter concern about clinical treatment (that the managers know full well can result in a GDC case and a livelihood threatening result), then you have to consider that the whole structure of corporate dentistry needs re-addressing rapidly. This threat has been real, this is not hypothetical, nor fictional.

Now I’m fairly sure most of the REGISTRANT directors of the corporates are very ethical and still have the moral compass that is needed; but they don’t seem to be getting the message down to their teams very well. Whether this is because they are not being heard above the voices of the non-professionals who have no regulator to fear, or whether the management structure is so poor that the message is not getting through I don’t really care. What is certain however is that a good many of these registrant directors seem to be unable, unwilling, or unprepared to step in to deal with the problems that we hear about, otherwise we would stop hearing of them almost on a weekly basis.

Have these directors forgotten they can be held vicariously responsible for negligent acts and omissions? They seem to rely on the self employed status of associates in order to deny all knowledge of the problem. However, it is becoming more and more apparent that the associates who work in these organisations are less and less likely to be seen as truly self employed as a result of various court cases (Pimlico plumbers, UBER, to name but 2), and it is about time that they took their corporate responsibility a lot more seriously than they appear to. I’m sure a few minds would be somewhat more focused on their ultimate responsibilities if a few of them were found to be vicariously liable for a few clinical issues, or taken to an industrial tribunal by a disgruntled associate (which if you believe the stories on social media might not be a small number).

They cannot hide behind the excuses that they don’t know what is going on. There is enough spoken about in the profession about corporate issues that this is about as believable as saying they aren’t aware Elvis is dead. Whenever there is a problem posted on the various groups, I always recommend that the highest level clinical director be notified, rather than the middle management (which is often the source of the problem) in order to ensure the problem lands at the door of a registrant rather than a (sometimes over-promoted) manager. Recruitment seems to rely on the fact that younger registrants often have ludicrous debts to pay, and therefore will end up working for these organisations as they appear to have little other choice.

Registrant directors need to step up and take the responsibility for the mismanagement and bullying that appears to be a problem in their organisations, and deal with it decisively. If this costs money and time then so be it; but if it does it may well show some of corporates for the shallow and non-profitable businesses that they really are. Alternatively, if they don’t act, it’ll show the profession that these people might not have the integrity, ethics, and morals that are required to be members of our profession.

But if the latter is the case, then the GDC should be told. They should ensure that the need to act in the best interests of the patient is drummed into all those registrants who sit on the boards of the corporates. There should be no hiding behind the corporate structure of these businesses and claiming ignorance of the problem. When the majority of the entire profession seems to be aware of the magnitude of problems with some corporates, then the directors cannot feign ignorance.

The elephant (so big its actually more likely a Mammoth) in the room however is that if these directors were to be removed by the GDC, the remaining non-registrant directors would no longer be able to continue the practice of dentistry and the corporate would no longer be able to function under GDC rules. What this would do for the provision of NHS dentistry would be potentially shattering, with the loss of these businesses. Additionally, is there anyone reading this in any doubt that some corporates would seek to protect their viability by cutting loose the registrant directors and replacing them at the first sign of the GDC taking an interest in them? That would really show the profession just where the priorities of some of these companies lie.

Perhaps this is why there is no appetite to deal with the problem decisively, and instead this will continue to be a problem for years to come, with neither the Registrant Directors OR the GDC taking any form of corporate responsibility for the problems that seem to be within this area of the industry.

Image credit - Maria Eklind under CC licence - modified.

If you have a dental practice website then you want it to work, otherwise it's a completely wasted resource!

For a website to work, in my opinion you need to have 2 primary functions in place.

1. Traffic optimisation.
2. Conversion optimisation.

Without either of the above the website becomes ineffective.

If you had wonderful traffic optimisation and 100,000 visitors to the website per month yet only had a 0.001% conversion rate then you would only have 1 new patient per month. This scenario is highly unlikely to give you a good return on investment on your website.

Equally, if you had wonderful conversion optimisation with a 100% conversion rate yet only had 1 visitor per month then you would still only have 1 new patient per month. This scenario is equally highly unlikely to give you a good return on investment from your website.

You ALWAYS need traffic and conversion optimisation working hand in hand. If you work with a search engine optimisation company and all they do is get more traffic to your website then, in my opinion, this is completely worthless unless conversion optimisation is also worked on.

In my experience I have found that a dental website needs to be performing in the following areas:

Each of these five key areas provides an excellent way to audit your own website, so open your website now and compare your site with these performance areas.

Findability.

This is pure search engine optimisation and includes (but is not limited to) the following areas:

Website title, description & headers - these should accurately reflect the content of each page. Every single page on your website should have a different title, description and headers.

Image alternate tags - these describe images for people with visual impairment, Google is able to read the description and may give a slight boost your website if the descriptions are relevant.

Text - Google is (currently ) unable to read text on images. For the moment at least we need to ensure that we have excellent and expansive content on your website which uses a range of keywords and phrases that people type into Google. If Google isn't able to understand what your website is about and/or it is not relevant to what people are actually looking for then Google will not send traffic to your site.

Inbound links (votes) - if your website is good then people will talk about it, Google knows if people are talking about your website online because it will notice the links back to your site. The more of these links you have then the higher you will rank in the search results.

Link authority - but it’s not only about volume of these links. If you manage to get a quote about your dental practice and a link back from the BBC website then this link would have MASSIVE authority. With this one single link you would almost certainly see a huge improvement in your search engine results

Internal linking - Google is able to crawl around your website following all of the links. If you have orphaned pages (pages with no links) then this is an indication to Google that this page is not important, think about it, if you had a really important page on your website such as the dental implants page then you would obviously link to it from multiple other places within the site! If your dental implants page is an orphan, with no links from anywhere else then you are indicating to Google that your implants page is not very important… And Google may choose not to rank it very highly.

External linking - good quality links out from your website to high quality sources can help your website be seen by Google as a useful resource. Example, let's say you're talking about dental implants and want to communicate more about bone grafting, linking to a good quality bone grafting information website could help the way Google sees your site is a useful resource.

Usability

Good usability helps both the user and your search engine optimisation, Google ranks some usability factors quite highly.

Video -having videos on your website enables patients which like to see visual moving images and/or listen to audio engage with your site more. Particularly patient stories and testimonials.

Calls to action - in marketing terms this is telling someone what you want someone to do from your website, every single page should have a very specific action that you want the patient to do… This could be download a guide, request a free consultation, book an appointment, send you a message or phone you.

General enquiry - you should have an ability for a patient to make a general enquiry, this should be separate from the request an appointment form.

Request an appointment - you should have a specific request an appointment form which potential patients can complete requesting an appointment at the ideal day and time, this should then drop into an automated e-mail marketing system which follows up automatically.

Flow through the website - your website should flow smoothly and guide patients, try to think big and then narrow your thinking down, for example:

Straightening crooked teeth (the problem) > Invisalign (the solution) > Invisalign cost (potential questions about the solution)

As we granulate the problem down into solutions and questions you can have separate pages on the website, this means patients can be guided through from their general problem through to potential solutions and then answer the questions about those solutions.

Shareability.

Put quite simply social media is word-of-mouth marketing on steroids. Your website should have a simple facility (usually a button to click) which encourages patients to share the page they are on with their friends on social media… It sounds simple but can work really well to get your website shared.

Effectiveness.

Is your website focused around trying to sell treatments or help patients? A website that is dedicated around selling will be focused on YOU… A website which is dedicated around helping patients will be focused on the user. The latter will be considerably more effective.

Social proof - social proof is the technical marketing name for testimonials and reviews, you should be collecting these on Google and Facebook and then displaying a selection on your website. Testimonial videos can also be used to enhance this.

Longevity.

One of the things we want to do is to get your website working over the long-term for EACH user. Most websites only work whilst the visitor is on the site, the best websites manage to capture visitor details whilst the visitor is on the site, if we do this then we can continue to communicate with that person over the long-term. This means your website doesn't just work for the minute or so that each visitor is on, if you can capture their details then you can drop them into an automated and extremely gentle relationship building marketing system.

In the next blog posts in this series we are going to look exclusively at this gentle relationship building marketing system, we will look at how to use it on your website, how to automate it and how to ensure your website works 24/7, never sleeping, never tiring and continually providing new patients for the practice… Until then.