Episode 130: Requested Replay: Ethics in Dentistry

“How much are we willing to violate our ethics at the expense of the patients?”  ~ Dr. Maggie Augustyn

This special episode of the Investment Grade Practices podcast finds us at the intersection of ethics and productivity.

Dr. Victoria Peterson warmly welcomes Dr. Maggie Augustyn, a distinguished dentist and guiding light in ethical leadership within the dental profession. Together, they navigate the intricate landscape of ethical decision-making, sharing personal experiences that unravel the complexities of upholding ethical standards while tackling the nuances of hiring, retaining, and expanding in the dental field.

Embark on a journey through Dr. Augustyn’s practice as she imparts invaluable lessons and shares thought-provoking stories from her unique approach to hiring associates, to the profound impact of ethical considerations on team dynamics, patient care, and the bottom line. This episode is a captivating exploration of the role ethics plays in creating a true Investment Grade Practice.

As you immerse yourself in this episode, consider these key reflections:

• Ethics as a foundation for productivity
• Ethical challenges you might have faced in managing your team
• The financial implications and ROI of ethical practices

EPISODE TRANSCRIPT

Announcer: The Productive Dentist Academy Podcast Network

Dr. Maggie Augustyn: Profit over people.  Is it becoming the norm here? How much are we willing to violate our ethics at the expense of the patient?

Announcer: Welcome to Investment Grade Practices Podcast where we believe private practice dentists deserve to get the lifestyle today while building an asset for tomorrow. Join your host, Victoria Peterson, to design the practice of your dreams and secure your financial independence. Let’s get started.

Victoria Peterson: Welcome back to another episode of Investment Grade Practices. Have you ever found yourself in an ethical dilemma? That’s the topic that we’re going to explore today with Dr. Maggie Augustine. Maggie, you’re one of my dearest friends and biggest heroes in this industry. I love you so much. Thank you for your vulnerability and your willingness to just put everything out there people you have, I don’t know how many articles a year, you’re right, like 25o? Most voracious writer, you’re everywhere. You, you’re, you’re just got inducted, I’m going to talk about your induction and the icoi. And all the fun things you’re doing clinically and professionally. Welcome to the Investment Grade Practice Podcast.

Dr. Maggie Augustyn: Thank you very much. This is one of my favorite places to be it has been a journey to get myself to a point where I can stand proud with, with the PDA company and all of its values and everything it stands for snd it’s just been a tremendous honor and a road, well worth going down to come and stand here with you and yours.

Victoria Peterson: Well, I know we’ve podcasted before you’ve been on everyday practice, you joined our faculty this year, we’re so blessed for that and one of your latest articles was what was the title from $100 in the bank?

Dr. Maggie Augustyn: To generational wealth and less than three years.

Victoria Peterson: Yes. So I want to pull back the hood, you greedy woman? Something wrong, you must be unethical? How does that happen? How to, you know how do those stinking productive dentist get two times national average or three times national average and the productivity and we were having a great conversation, not even about productivity, but about hiring and the state of associate doctors and hygienist and things like that and at the heart of everything you do is ethics and your ethical code and so I want to begin there because you, you’ve proven, like what I couldn’t even put into words that to be productive, you must stand on a foundation of ethics. So I’m going to open up the window there and I want to invite everybody into your living room, because you’ve just had some fresh experience. That’s so much fun. So I want to look at the, you know, ethics and like how to live, how to thrive in this ethical turmoil we’re in right now and I want to go through the lens of trying to hire an associate doctor or a hygienist or retain these great people in your practice. So share with me your recent experience about interviewing for associates.

Dr. Maggie Augustyn: We have come finally to a point where we would like to share our vision, our patient, demographic, our servile leadership with another provider with another dentist and so I had put together an ad and I’ll tell you I posted it on dental nachos in job connect snd then I posted it but only online with Chicago Dental Society and I have gotten a lot of responses to it and it’s an ad that’s not written like every other one seeking In general dentists part time, we talk about culture and we talk about mentorship and those ads. I don’t talk about what hours I needed to work are really getting down to the basics and part of the ad, which Christine helped me right from from PDA is, what is it that we are here to give the associate as opposed to what is it here that we want from them and that that kind of a change in the way that we’d written the ad, I think, came back with such a strong amount of, of applicants and so the one, the one story that I want to share is I was interviewing a young woman and generally I start by I start the interview by saying, we’re going to talk about nothing related to dentistry for the first 10 to 15 minutes, let’s just get to know each other, you know, tell me your favorite color, all of that and she just kind of sits in front of me, and she kind of looks around, she takes her two hands, and she puts her hands on her knee and she said, “I just can’t I just have to tell you,” and I’m thinking, “What is she going to tell me?” And she said, “I just need you to know that the reason why I applied for this job is because you talk about ethical and I need to know if it’s true, right, and then I think PDA way, right? Tell me more about that, you know, where are you coming from? What is behind this?” And so even though we skipped past that initial relationship building, we began talking about what it is like for her and some of the other associates that I have interviewed to attempt to fall asleep at night and some of the stories that I heard were patients coming into a public aid clinic with PPO insurance, okay, that had an occlusal, one surface amalgam that are now being tucked into full indirect coverage over their last two molars. Okay, so 18, and 19, and 30, and 31 and the associate saying, “I’m not going to do this.” This is an office manager telling her you need you need to put crowns on these teeth, right?

Victoria Peterson: And her saying, there’s no decay in some of these teeth.

Dr. Maggie Augustyn: There might be a little bit of leakage around the occlusal. I don’t even know that there’s decay, but we’ll call it leakage. Okay, maybe some discoloration around the margins. Of course, I wasn’t there. This is a story of retailing. Sure and so the associate says I’m not going to do this and the case is given to another associate who does do the work and then for some reason is not present and then when this came back to that original associate, the patient comes back with a four crowns done, and TMJ issues. How’s that going to let you sleep at night? And then there’s, there’s just been multiple stories that have come through that have been like that and I just, I listened to it and I’m, and I’m looking at her and I’m thinking, I’m thinking back to kind of when I got out of dentistry when it was like, and I thought I had a bad night, then yeah, I’m looking at her and that and, and I’m just in complete disbelief. This is nothing that I have ever had to face because I have owned a practice for the last 18 years or so and once again, this is not a story that was just unique to her. Profit over people. Is it becoming the norm here? How much are we willing to violate our ethics at the expense of the patients?

Victoria Peterson: Wow, that’s so powerful. And this is exactly why I wanted to explore this topic with you because you’re very open about you know, life sucked financially. It was hard. We changed some systems, and it grew but knowing the ethical thread that’s behind it, I’ve never seen a consistently productive dentist that had issues with ethics. I mean, printers, production Mills, I guess we all have that fear but that’s not productivity. Productivity is like a tree bears fruit, right? It produces fruit, you go to the produce market and so what comes out is what is within you, that’s how you become productive. So it’s, it’s compassion, it’s connection, it’s doing the right thing and you made a really common a great comment before we started recording you said, in your ads, you actually say we’re an ethical office. Give us the disclaimer about that, like, I know you can’t say we’re the best or the state of the art, but how is it that you can say you arer ethical?

Dr. Maggie Augustyn: We just, I mean, I think and I don’t have the ad in front of me, I think I just, I just said that we put, we put what the patient deserves ahead of profit and we act in an ethical manner and if you’ve been searching for an office, where ethics and ethical treatment planning and and all of that is important, then we’d encourage you to find out more about us.

Victoria Peterson: All of us abide or should abide by the ADA code of ethics, right? If you’re, if you’re brought up on charges, you’re gonna go back and take ethics and jurisprudence and in that there is this really great graphic that shows the five pillars of dental ethics and first and foremost is veracity. Which means tell the truth, tell everything you say, don’t tell what insurance covers don’t don’t know what you’re looking for and so it sounded like this wonderful woman was in a clinic that had a process, right, there was a formulary. So we know what insurance covers. If it’s this, our standard is for that, you know, and there are quite a few formularies out there. I call that a philosophy of care. So your philosophy is formulary, billing code-driven, might be the right, right. There’s philosophies of worst, first, I’ll treat the one worst tooth and if it’s $3,000, fine. There’s another one that says infection first. So I might take that same $3,000 and treat five teeth just to get the decay out and stabilize them with composites and then come back over time to build them up. I mean, there’s all kinds of philosophies out there but if you stand on veracity of, I’m going to tell you everything I see and I’m going to try my best to help you make a good choice, which is the second part of the ethic is patient autonomy. So how do you ethically tell patients everything they need, and give them autonomy about the choice?

Dr. Maggie Augustyn: This is not been easy for me to learn and it took most of my career to do that. One of the things that I learned from from Bruce bear, Dr. Bruce Baird, is it at PDA? Is this is this sentence, D”o I have permission to present to you all of my findings?” And patients will react strangely to that some of them will be like, “Well, duh, of course,” and some of them would be like, “Wait, what? How much is there exactly? You know, like, what, why would you even ask me that question? Why hasn’t anybody asked me that question?” But we don’t teach our young dentists to approach things. That way, we don’t empower them to have the confidence in saying, “I’m gathering all this information and it’s leading me into discovering these things that I’d like to share with you,” and we’re also teaching our associates, or our dental students and our good dental graduates to go into the room and literally tell the patient everything that’s wrong with them, and then walk out and expect them all to do what we just said, or they’re just too timid to say, because they want to be like, “I just want you to like me, so I’m just going to tell you about one crown, because if I tell you about five, then you’re not going to like me, right?” So do I have your permission to do so you go through that, and they’ll react a certain way, and you’ll react accordingly and then once you do that, or even when you get towards the end of it, you say, “Look, this might be overwhelming but the truth is that this is your mouth, and you get to do whatever you want to do my job is just to give you information and explain to you how we can get from point A to point B, however you want to do it in whatever order you want to do it that is entirely up to you,” and there you have it, you have veracity, right, and you have patient autonomy. “I’m not pushing any of this on you. I just want to do whatever is comfortable.”

Victoria Peterson: I love that one that goes to the next two points, which is non-malfeasance, like first do no harm and some of these pre-formulated everybody gets this, you know, can do some harm like you were giving that example with the TMJ issues, and then beneficence what a great word like is this beneficial? And I find I’m not a dentist I’m you know, I’m a doctorate in humanities and spirituality. dentistry but as a hygienist I have been floored by the number of employers I worked for that didn’t want me to do fluoride and when I really push them on it, they’re like, “Oh, man, why would I want to prevent cavities? I’m going to do molasses trays,” or what I call the Weight Watchers, unlike, you know, Weight Watchers is, right and they’re like, like, what are you waiting on? What are you waiting on and, you know, under a glass of scotch, it’s like a while I’m waiting for it to get big enough to be worth my time, right and God bless the patients who have to wait until it’s a root canal. Right. So that’s the fifth pillar, which is justice. And I’m kind of getting on to saying some things that if we truly had, you know, a legal system that worked in medicine, we would probably be firing off on that one a little bit more for some of the things that are happening, but tell them everything you see, in a way that they can make a choice. That isn’t harmful, it’s beneficial, and it’s legal. That’s a pretty clean definition of ethics.

Dr. Maggie Augustyn: I think so too, especially as it as it applies here and we have a responsibility to our patients, of course, but also to the next generation of young dentists, to teach them to think this way. Yeah, right, and to act in this way, and ultimately to do whatever it takes to let you let you sleep at night because now I we are we’re looking at difficult times and it’s interesting as we’re speaking about this and that the ADA, in their journal just released a lot of information about how non-invasive dentistry is working and what’s really sad about it is that the following issue, they had to release data showing how non invasive treatment can be profitable, right? Like how awful is that, that they had to support it? “Okay, well, we want you to just treat these lesions with medicine,” and you’re like, “Why would I do that? I’ll just wait three months and do a filling or, you know, two years and do a root canal?” Well, it’s profitable for you to also, you know, use cura Don’s or icon or silver diamine.

Victoria Peterson: And how did they prove that it was profitable?

Dr. Maggie Augustyn: They showed the amount of time that it took for the dentist to do the procedure showed how how many of those procedures can be done by a dental hygienist and an assistant the overhead of the procedures. Just just real number crunching,

Victoria Peterson: I love Nonnberg revenue. It’s so much easier.

Dr. Maggie Augustyn: Imagine that. Imagine that.

Victoria Peterson: You don’t have to turn a handpiece and patients are taken care of. Well, you know what I would also I didn’t see the study but when you think about that, I mean, that’s what chews up your time and makes your day unproductive is doing single surface composites or, you know, classify buckle pits. So why wouldn’t you want to prevent some of that and do an aesthetic case or do something else? Yeah,

Dr. Maggie Augustyn: There’s plenty of patients on whom you could do aesthetic cases, right? You don’t have to fill your schedule with people that don’t want them or don’t need them. What’s also interesting is that as I have started to incorporate more of the non invasive dentistry over the last six months into my into my practice, I’m getting a lot of pushback from patients what why nobody’s ever told me this said, “Why would you want me to drill on a tube? If I touch the tooth, I’m going to aggravate the nerve? How many times can I do that before it gives out?” And then of course, comes the question of, “Well, why doesn’t the insurance cover it and if it’s so good?” Well, I mean, that’s a whole different conversation, right, but patients are just learning about these non-invasive therapies.

Victoria Peterson: Should we read dental insurance for the ethical? You know, it’s, there’s so much we could talk about, and I know this podcast has, you know, a limited timeframe. Man, when you think about building an Investment Grade Practice, let me pull this back into the practical, right, why ethics are profitable, because at some point, you want to be bank ready, or sale ready. And that might come in a plant succession plan. It might be that you’ve hired this associate and it’s time for the associate to buy in. It may be that you want to expand the building and you want alone. It might be that you get hit by a bus and your spouse has to do something with your practice. You know, these skeletons in the closet of code overutilization or patient complaint or refund or all of that just really kills our practice and sale value, and it kills your marketing with two and three-star reviews or low reviews, it kills the morale of your team. It’s not just the doctor who can’t sleep at night sometimes or as it’s your team, you know, they, they’re the ones faced with the complaints. It’s the one reason why you have turned over and all we did a lot of studies in 2022 on Team turnover as the talent words were ramping up, and people weren’t coming back to work. And for most dental practices that, that had excessive turnover and you know what I’m talking about, if you have three sisters, one that you just can’t hang on to because the other two pull against them, you know, that kind of thing there. It can cost you the equivalent of six months of new patients. So all the money you put into marketing, all that you do to bring them in and treatment plan and gets case acceptance. We’re focused on that but six turnovers in that six months, you’ve wiped out every bit of that goodwill, all the profit from those patients. So it hurts you on so many levels. You don’t have to get sued to have ethics have an impact on your practice.

Dr. Maggie Augustyn: And I know we started talking about you know, dental hygienists and dentists living within this questionably ethical world sometimes but it is really no different where every other position or every other team member, that turnover in terms of why people are leaving. Yeah, they might refer to it as toxic culture but I’m curious how often when they say toxic culture, they might be talking about the lack of ethical presence and another interview that I did today, just unrelated to the associateship, we were talking to an office administrator who said, I left because the doctor got certified and doing all on floors and he’d have a full schedule one day but then he had another case come in $50,000 to do all annex so he rescheduled all of his patients to another day just so that he could do that all on next case, right? So like it’s not just present between the dentist and the patient. Everyone in the office can feel it and can see it and then the word of mouth what happens with that? Off

Victoria Peterson: It’s over people. That’s I’m always I love Bo Barry Bellingham belling Gaines book, Small Giants and I think most dentists are Small Giants. So if you haven’t read that book, I’ll put that in the show notes too but it’s the people over profits model. Most small business owners most Small Giants really do strive for lifestyle businesses that treat people well and I know you treat people well. And we’re going down kind of a dark tunnel here because I’m hoping that it’s only a small segment of the marketplace but this isn’t a DSO problem, this isn’t a solo Doctor problem, this isn’t everybody’s problem we need to to restore the workplace and the culture and the ethics. I on the news the other night, I saw that 48% of jobs in America today are now virtual freelance work. 48%. So it’s not like you have this huge labor pool. Only 50% of the marketplace is working brick and mortar for a singular employer, like their virtual freelancers in control of their life and so it’s making it tough for her to attract and retain within the field. We had a hygienist the other day who left to start a party and planning a party-planning business. You know, she did it as a side gig and side gigs started paying more than being a hygienist and I mean good on you. You can throw birthday parties. So she’s thrown birthday parties for all these working moms who are too busy to do birthday parties for their kids. Society’s kind of gotten on a rat race here. So with Investment Grade Practice, it’s investing in yourself. It’s investing in your self care, your own mental mindset. I think it’s so easy to get in a mindset of just you know, got to make the donuts let’s Yep, I’ve seen that’s a crown we built for this and getting into that numbing out maybe a paying attention to what’s really happening with the patients so there’s no judgment here. It’s just an observation of of the week that it can leave you know, for patients health and our own colleagues mental health as we’re, we’re banking it okay to work in these conditions.

Dr. Maggie Augustyn: Yeah,that one that will destroy a young person’s zest and passion, and drive and willingness to learn and thirst for growing to be in a place like that and then for those of you that are for those that are interested, what is the ROI on doing ethical things? Well, it’s actually having people that are productive, that are interested in helping you grow, right?

Victoria Peterson: They they’re thriving. They’re the producer, the orange tree that’s producing oranges.

Dr. Maggie Augustyn: And they want to be there. They want to be there for you and for the patients, and for each other.

Victoria Peterson: Maggie, thank you so much for joining me. You’re a wealth of knowledge. I encourage everyone. Boy, how many magazines are you in? You’re in dental entrepreneur, you’re in dentistry today. You’re on nachos, you’re everywhere.

Dr. Maggie Augustyn: Thank you. It’s really fun for me to put together my thoughts on paper and I’m grateful to anybody that’s willing to either publish it or read it because for me it’s a process. That’s how I grow is I put the words on paper.

Victoria Peterson: Love it. What’s the best way for people to connect with you? If they’ve got I know you? You’re up for a cup of coffee almost any time how can people connect with you?

Dr. Maggie Augustyn: Find me on Facebook. That’s probably the easiest, Maggie Augustine. You can go to our website. myhappytooth.com and my email is pretty easy. It’s drmaggie@happytooth.com

Victoria Peterson: I love that and just a note a celebration tell us the accolades that you just received in September of this year.

Dr. Maggie Augustyn: I was right after our PDA workshop meeting in September that same weekend, I drove to a different hotel, and finally was able to get the fellowship and the International Congress of Implantologists

Victoria Peterson: Fantastic claret clinician, amazing mother, beautiful coach. Maggie, you’re the full package. Thank you for being here.

Dr. Maggie Augustyn: Thank you. Thank you, Victoria, humble

Victoria Peterson: And humble.

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