All right, listeners.
Please jump right into the Health Lifelines podcast.
Today we're going to be talking to Dr. Brian McKay.
This doctor has taught me more than anyone in dentistry over the last 40-plus years about
what's important about relationships and the culture of a practice.
I walked into his practice after quitting my job because I was burned out and I couldn't
take it anymore.
So I'm excited to have you hear from him how he has dealt with the age-old problem that
exists between hygienists and dentists.
The dentists are looking at how to make their hygiene department profitable and the hygienists
want to be paid more because they're doing all the hard work.
So let's jump right in.
So welcome, Dr. McKay.
It's nice to be here.
Thank you for joining us.
So I'm sure you're well aware of this conflict that's going on between hygienists and dentists,
particularly.
So I'd like to talk about that today.
And I know you have some very distinct beliefs about how you run your business because your
practice is a business.
So I'd like to know what kind of action you took to make that hygiene pay profit equation
work to be a win-win for the practice and for me as your hygienist and for the patient.
The patient always gets left out of this, don't they?
Well, I think that's a key point is that we forget that we work for the patient.
We don't work for the insurance company and we don't work for, you don't work for me.
We work together and hopefully for the benefit of our patient.
And if we can't benefit our patient, what the heck are we doing here?
And so it's all about aligning our belief system as to who we're going to be for our
patient rather than what we're going to do to or for our patient.
Exactly.
I mean, the whole concept of the term patient is antiquated and the definition of patient
is someone that can do nothing to help themselves.
This is really old thinking.
We need to recruit our patient to be a resource in their wellness and allow us to help them
achieve their wellness goals.
So they're not helpless.
They're critical to be involved.
I mean, people don't need cures for problems.
They don't think they have.
And so you can take a look in somebody's mouth and see all kinds of things and until
you can get them to understand that this is their mouth that we're working with and that
we have their interest in mind and we just want to know what they want, which is kind
of the key to the whole kingdom right there.
The four most important words that you could ever ask your patients is, what do you want?
Yes, that's for sure.
And then shut up, let them answer.
So does that wants dentistry kind of encompassed the culture of your practice and what we did?
Wouldn't you say?
Well, yes.
I mean, we dedicated ourselves to our patients and everything we could do to help our patient
achieve their goals, which of course we didn't know until we asked them what they wanted.
It was the key to the whole, to all the success we had over the many years because we couldn't
rely on the canard of hooking up to a insurance company or signing up for an insurance plan.
Are you on my list?
Well, for the last 27 years of my practice, I was not anybody's list.
I used to go say, how the heck did you find me?
Because I know I wasn't on your list.
Well, I went to your website or one of my patients is a, one of my friends is a patient
of yours or, I know Chris Duvall and she said I should call you and come in, you know, whatever,
doesn't matter how people get there.
You still are trying to serve them, not the insurance company.
And unfortunately, dentists have learned to become expert diagnosticians of your dental
plan and try to fit the solution to all your problems and do what's going to get covered.
And so when you ask a question about what can we do to make this better?
And you know, the solutions are only what's covered by your insurance.
So insurance does not match with people's needs or wants or their health objectives.
It's sort of help.
It's an important part to help.
You don't want to deny it or poo poo it or anything like that, but just say, I want to
help you.
We can figure out how to, how to bill your insurance.
So they most likely to help you with this.
But at the end of the day, it's all about what you want.
That is such a powerful approach to a culture, I think.
It really is.
It's so simple.
I've mentored dentists.
I've mentored physicians on going insurance free, whatever that is.
You never really are.
I mean, people are still attached to their insurance.
They want to get something out of it, but they also want to be well.
Or they have a reason for calling you.
People don't pick up the phone and call a dental office because they want to buy a Toyota.
Okay.
They call the dental office because they have a perceived need.
They want wellness.
They want health.
They want beauty.
They want, they don't want to lose their teeth like their parents did or what, there's variety
reasons.
You'll never know those reasons and say, unless you ask.
And the first thing is what do you want?
And then there's some follow up questions.
Why?
Why do you want to be a dental officer?
And they'll tell you.
Careful what you ask for because they will tell you.
And then you give it to them.
And oddly enough, the answer is usually dentistry.
They need dentistry to achieve those goals.
So there's no shortage of opportunity to diagnose treatment plan, present and have patients
accept care when they in fact ask for it on the way in.
By answering that question, what do you want?
I mean, if I, we could write everything I know on to, that's important on to a three
by five card.
It's none of it.
None of it is, people will say, oh, so it's so complicated.
What kind of patients do you guys get up there?
And I go, well, you know, most of them are alive.
But they have a perceived need.
They're leaving someone else's practice because their needs aren't being met.
Yeah.
And I think that my favorite question, and if I didn't know the answer to that question
before I went in to talk to a patient, you might as well put a three inch piece of duct
tape over my mouth because I had made the decision.
I wasn't going to make assumptions about what people wanted for themselves.
I think that's a big mistake.
But I loved asking patients, tell me about what you want for yourself.
And then like you said, just shut up and let them talk.
And if they say, well, I don't know.
Well, if you did know, what would it be?
Well, you're forgetting, you know, you used to ask a great question.
Because I heard you do it every day when you'd escort a patient from the reception area
to your, your operatory.
What did you ask them?
Tell me about something great in your life.
Hello.
Okay.
So, you know, what was the answer?
My teeth?
No.
Never.
It's my grand kid, you know, my son or daughter.
I, my, I just got a raise in my position.
I'm really excited.
You know, whatever, it doesn't matter, but you're connecting with people.
You know, social grace is, takes mere moments.
Yeah.
And people don't care how much you know until they know how much you care.
And so once you start connecting on a, on a heart basis, you know, now we're having a
conversation, now it's real.
And when you, when you say, okay, we're at a dental office, weird.
So I'm going to ask you a couple of dental questions.
What do you want?
What's most important to you?
And by the time our patients in our office had gotten to you, Chris, we'd already collected
records.
We'd already had to chit chat with our treatment coordinator about life in general, what's going
on.
Another one of my favorite things is, is, is the more you know about your patient, the
more they think you know about dentistry.
And so, so the, you know, the auger cat, boxers or briefs, whatever, the more we know about
our patients, the more they think that we know about dentistry.
And by the time they got to you, you had a little insight into some of those things.
And so then you could be, you just had a whole hour to be up close and personal and ask them
some follow up questions.
And it wasn't an interrogation setting.
It was, you know, I'm really curious, you know, you said, you said to Candice that you,
who is our treatment coordinator and you said, you know, this or that doesn't matter.
And so tell me more about that.
What do you mean?
And they would oftentimes tell you lots of interesting things that we would never have
guessed, let alone if we tried to be an assumption meter, which, as you know, only makes an
ass out of you and me.
So they'll tell you all the answers and all the enough that the, the, the answer to the
question is almost always dentistry.
They want something dental, whether it's appearance oriented, whether it's health oriented, whether
it's non, non-mercury oriented, whatever, didn't matter when we were going to meet that
need.
And it's so easy to fulfill their needs when they actually say, here's what I want.
Yes.
And I think another important thing that I learned early on was you have to be able to
hit the right motivator with people because I know from my own experience, I had a good
friend of mine that was a patient in the office and she was concerned about her teeth because
say we're starting to break and cracks and fillings were falling out.
And I said to her, oh, well, Dr. McKay can help you with that.
And I made the mistake of going and talking to her about aesthetics that we could help
her teeth look better, but she wouldn't give herself permission to do it.
And then you asked me that day, what does she want?
And I go, I'm not sure.
And believe me, this was like in my first couple of weeks of being in the practice there
because I learned very quickly.
But what her motivator was, was function.
Yes.
She wanted her teeth to function better.
If they looked better, that was great along the way, but she would not give herself permission
to engage in what we could help her with until she got her motivator of having her teeth function
better, until she had that.
And then she gave herself permission to engage in a full mouth process of making her teeth
function better and along the way, they looked better too.
Well, you know, that back to what I said publicly a couple of times about, you know, once you
find out what somebody wants, doesn't matter what it is.
But the answer, because they're in your office, they came to your office for a reason and
it's for dentistry.
They just don't know how to ask for that.
And they're not quite sure what to do.
They're not quite sure what's important.
They may want health.
They may want aesthetics.
Usually it's all of them.
But the answer is still the same thing.
Okay.
So yeah, we could help with that.
And here's what we do.
We fix these teeth and those teeth.
Oh yeah, all your teeth.
And then you have what you want.
You have function.
You have longevity.
You have aesthetics.
And sometimes they'd stop me and say, well, it doesn't matter to me whether they look
very good.
And I'd say, well, that's okay.
We can make them as unesthetic if you like.
Well, no, I mean, really, I kind of like them to do good.
But that's, you know, that's just kind of working through some of the people's preconceived
notions about what cosmetics is.
And oftentimes cosmetics, people see as a crutch.
I don't want, I want to do it just because it's good looking.
But if it's functional, we, I want that.
But if we, we address their functional issue, they made an aesthetic choice.
Yeah.
Well, and I think a lot of what we did was meeting people's expectations.
And you don't know unless you ask.
And that was the culture of the practice, you know, your, your vision and mission statement
was enriching lives by exceeding expectations.
And wow, what a great culture to set for your team.
And then it was so much more rewarding and easily to engage our patients into that vision
and mission statement and philosophy of care that came out of all of that.
Well, that's exactly right.
And let's not miss, you know, a big part of that.
And that is, as we're here talking about your role and, and, and hygiene in relation to the
overall wellness of the patient.
I mean, what percentage of our patients that went through comprehensive care didn't need
perinatal therapy to start their journey and to make sure that they were in excellent
health before we even started their restoration process, almost all of them.
Very unique to not have someone need therapy, which is what we call scaling and root planning
and without getting into us getting a root planning as an ancient procedure that was
done in, in advance of periodontal abatement surgery.
Yes.
And what periodontal says periodontal abatement surgery anymore?
I don't know.
No.
Almost none, I should say.
I mean, all the fine people that we've worked with over the years, they were the best implantologists
in town.
We didn't need them to do a periodontal abatement surgery.
I mean, people that have advanced periodontal disease, you know, there's different, there's
going to be different answers for them as far as achieving their goals.
And holding on to each tooth as it goes away slowly, but surely is not an answer.
It's not a solution.
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And now let's jump back into today's episode.
You know, going back to that profit and pay conundrum that we have in dentistry, I knew
very early on within the first week what your philosophy was with that and the culture of
the practice with that.
And you took me to lunch the very first week that I worked there.
Do you remember what you challenged me with?
Yeah, I said we need our patients to be healthy, and I need you to be the leader of their health.
And you can have whatever coaching or help or any education or supplies or equipment,
whatever you need to get that done.
Yes, yes.
And I took that as you didn't come right out and say it, but you helped me come to that
conclusion on my own, which I think is much more powerful than just being told what you
expected of me.
And what I heard you were saying amidst all that was you wanted me to paint a much larger
canvas of who I could be for our patients.
And that really made a huge impact on me and set me in a new direction and destination
of a place I'd never been before.
About who you could be for your patients and that you could have all the support you needed
and to get people healthy because dentistry has been upside down.
People have been doing bloody prophesies and chat and polish hygiene practices for decades.
This is nothing new, this friction between hygienists and dentists.
This is a really uncomfortable place because really we should be united behind getting
our patients well and having them be happy in their wellness.
I mean, all that you talk at some time, maybe in one of your own podcasts about wellness
based hygiene and being an advocate for the wellness for your patient extends way the
heck beyond calculus and pocket depth.
I mean, it's a profoundly impactful role in their lives and you had a giant impact on
people's lives as far as accepting their role as their wellness, their own personal wellness
advocate.
And the gateway was outstanding oral health.
And we had so many patients that had transitioned from chronic periodontal disease, case type
one or two, just not enough to warrant surgery back in the day because I'm old enough to
remember all that stupid stuff, but to guide them away from that from something that you
coined the danger zone because that's where they were.
They were just hanging out next to the edge, walking in tightrope next to the pool.
Sooner or later, you fall in and now you're in trouble and you got issues and it's not
good and you just guided them into the wellness place and they stayed there perpetually.
Yeah.
I mean, you know, a discussion of the percentage of procedures done by hygiene.
Since we know statistically that eight out of 10 people have some form of periodontal
disease, how come less than 10% of all disease, all procedures performed by hygienists and
dental offices are periodontal coded?
Yeah.
It's a fear, a fear to tell people what's really going on with their teeth and have permission
to be as honest with them.
Once you've asked them, what do they want?
I want to be healthy.
I want to keep my teeth and say, oh, well, then we need to, here's how we do that.
It was so easy and really very joyful.
It was just being able to help people.
I think the big overall picture was people aren't used to asking for help.
Patients aren't.
They just come in and they say, well, I'll do whatever he tells me to do or I won't take
it.
Yeah, for a couple of days.
Yeah.
My role really turned into being I was teaching them how to advocate for themselves, how to
speak up and ask for what they wanted and ask for help to get that.
So that was my big goal is to be their advocate, to teach them how to do that.
You enrolled them in a discussion that was an ongoing dialogue that they were the key
to.
Not you.
You were there to answer their questions.
But let's break through to the real thing that would happen.
What really happened was that as you started treating people's periodontal disease because
it was there and moved them into a wellness place and kept them in the 4910s and the other
codes.
Not that I remember a lot of that because I'm the artist formerly known as a dentist.
So I don't live in that world anymore, but what happened to your production?
Oh, my gosh.
It skyrocketed.
And what happened to your production too?
Well, yes, absolutely.
But the point I wanted to have people understand since we're on this for as a hygiene oriented
discussion is that not a lot has changed.
And I practiced for 42 crazy years.
And I've been out a few years now.
And the facts are still the same.
Hygienists deserve a third of what they produce.
I'm sorry, it's just the math.
You can be up and down a few percentage points.
But once you get out of whack with that, everything gets out of whack for the office or the hygienist.
And if something's not fair to both, it's not fair to anyone.
And then it doesn't work out.
And there's a lot of weeping and gnashing and upset and all that sort of thing.
So as your production rose, what did I tell you?
It's time for a raise.
Time for more money.
Yes.
You earned every bit of it.
And you came to me.
I remember you coming and saying, you know, I want to get this.
I think it was the Florida probe.
I think you want to get it.
And you go, okay, I want, I want the Florida probe.
And I go, well, I thought you were coming to me for a raise.
And so you definitely deserve a raise.
So which one do you want?
You want the Florida probe or you want a raise?
And I said, I want the Florida probe.
And you said, good end.
What did you get?
I got both.
Got a Florida probe and a raise.
You know, when the collaboration of patient first, you know, team, second, self, third
always improves the self way more than it's going to be when you're selfish.
And selfish just means out for yourself.
It's not a bad thing.
It just, you should advocate for yourself, but, but you came to me with facts and figures.
Yes.
And my favorite.
I've been here for six extra months and no one's given me a raise yet.
Yeah.
Well, you told me, you told me when you hired me, you had not an ounce of belief in cost
of living raises.
So I knew that was out.
So what I had to do was I figured I needed to increase my value to you in what patients
chose for themselves.
And that was my favorite thing to do with you was to come to you and say, not look what
I have done, but look what, what my patients have chosen for themselves this month.
All different.
Well, yeah, it is.
And the number stood up.
You know, when you stand up and do the right thing for your patients, the production, the
productivity, let's just call it that, it shows itself to be what it is.
Yes.
And that was undeniable.
We knew it was in front of us and we were both happy.
I mean, I don't know, you want to get into it.
I remember when you asked for a salary, you wanted to be paid the same every month.
I go, wait a minute, you're a producer.
You decide to get to get a part of your production.
You go, no, no, no.
Everybody else here's on a salary.
I want to be on a salary.
And so we figured out a salary that works for you and for me.
And it worked very well.
And it was a pretty damn good salary.
It was.
Yeah.
But I mean, that's the real fun is to have met your patients needs, exceeded your patients
needs and wants and have that relationship based practice that you had with your patients
and to have that much fun doing what we're doing because we know we're helping our patients
make made our lives simple and easy and straightforward and non adversarial.
And I would hope and wish that on everyone that they could get to that place where, where
they're producing.
And it's not just I took six.
White wings instead of four.
And so I've produced, you know, for this much more.
And we do an exam on everyone in fluoride and we do, you know, you probe everyone and we
all charge them all a cart, which is not so in my mind, you know, that just do what the
patient needs, charge a fair fee.
And we charge a fair fee for our procedures.
And since we weren't working with insurance companies, we had no assignment of benefits
with insurance.
We had no charge, whatever we wanted, which means people had to pay.
Yeah, they got reimbursed.
Yeah, we submitted their insurance for them.
Yeah, they got repaid, but they chose to come to us because of what they had learned when
they came to the office and they knew they were in the right place.
And they were happy and happy to pay.
You tell everybody what you train your patients to do when they walked in the door.
Well, a lot of them just handed me a credit card.
See, let's get that.
Remember you saying, let's just get the paperwork out of the way first.
And then, you know, when we're finished with our, with our care today, you're going to,
you can just jet out of dodge.
Yeah.
So, you know, it was a beautiful thing.
And when you, when you focus your care on the most important person is your patient and
have them guide you through the decisions, you get an opportunity to do outstanding care,
be paid well for it and, and patients gladly, happily pay for it.
Yeah.
We had some patients, a few patients that were on welfare that valued what we did so
much that they raised the money from family, friends, wherever, because they were not determined.
We played ball with them too.
And that was fine.
We're delighted to do it.
And so that's the real joy of the whole thing is being able to meet people where they're
at.
And especially when people want what you have.
And you can tell that they value that.
You figure out a way to help them make that work.
Well, Dr. McKay, thank you so much for joining me here today on health lifelines podcast.
And I just encourage all of you to really listen and take advantage and create a way
to help your patients get healthy.
And the best part about all this and the most important thing to us in our practice was saving
lives.
That was the big, the big goal.
So the lifeguard approach.
Yep.
Thank you so much, Dr. McKay.
I appreciate it.
It's been my pleasure.
Thank you.
Take care.
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