There's a 50/50 chance your clients will switch laboratories in the next five years. Want to know why they might jump ship? Read on.
The landscape of the dental profession is in transition. Dental school graduates are facing mounting debt. Reimbursement models are changing. Competition from corporate group practices is squeezing the solo practitioner. Capital expenditures to accommodate high-ticket digital technology are on the rise. But what isn't changing is what dentists look for from their laboratories: consistency is still king.
Since LMT began surveying dentists more than 25 years ago, they've repeatedly said that, by far, the most common reason for changing laboratories is inconsistent quality. Unpredictable work hits them where it hurts the most: it increases their chairside costs and negatively impacts their relationships with their patients.
The most troublesome technical issues are poor occlusion, open margins and long seating times. When technical problems occur, the majority of our dentist-respondents are inclined to express their feelings and iron out the problems to maintain the relationship. "I call the lab and explain my preferences regarding the margins, occlusion and porcelain shape, contour and shading. I have them track my remake percentages and whether the remakes are related to the same technician. I want a dedicated technician who does all my crowns and bridges and I want them all checked by a second party prior to shipping," says a dentist-respondent to LMT's 2013 Dentist Survey (conducted with Dental Economics) in which half the respondents say they have switched their primary laboratory—the one that does the majority of their work—in the past five years.
In addition to consistent quality, dentists are looking for consistent turnaround time. Several respondents comment that the length of turnaround time is less important than the predictability of it. "It doesn't matter what the turnaround time is, as long as it's consistent. I don't like it when the turnaround is 10 days for one crown, two weeks for another and then four days for the next," says a survey participant.
An honest, easy working relationship and good communication are also important factors dentists look for in their laboratories. This is really where you shine: the vast majority of respondents describe their relationships with their laboratories as "good" or "excellent." "My technician, Mike Sverdlov of Southland Dental Laboratory, makes me look good. The better work I can deliver to him, the better work he can deliver to me. A good, peer-to-peer working relationship is key," says Dr. Jay Luedde, Rolling Hills, CA.
Knowing that lab owners and managers have a wealth of knowledge and often see a much greater diversity of cases than dentists, almost 100% of respondents say they are receptive to technical advice from their laboratories, especially regarding material selection and restorative options. "We communicate often and I appreciate that the technician is part of my dental team and has special training in other aspects of dentistry. I'm open and receptive to advice from her," says Dr. Marie Fluent, DDS, Ann Arbor, MI.
The desire for personal service and easy communication is one of the reasons 79% of our survey participants don't want their work outsourced overseas. In addition to appreciating the one-on-one service they get from a local laboratory, these respondents are eager to support U.S. labs and want to maintain control over the materials used in their restorations. "I want to speak to my technician face to face if needed. I also want to be assured that the material used is what he says it is," says Dr. Jeff Peifer, Mesa, AZ. Other respondents note that offshore outsourcing is a deal breaker and would be the impetus to switch labs. (See "Dentist Opposition to Offshore Outsourcing is Strong" below.)
The Price Conundrum
While laboratories often complain about price-shopping dentists, only 26% of our survey participants say price was a factor the last time they switched laboratories. This dichotomy leads to the question: Is it that dentists don't want to acknowledge the role price plays in their choice of laboratory or is it that what laboratory owners perceive as shopping for price, dentists view as shopping for the best value for their dollar? "Price is not the key; high quality at a reasonable price with excellent communication is what I'm looking for," says a survey respondent.
Especially in a time when restorations are increasingly being seen as a commodity, dentists are welcoming laboratory owners' efforts to enhance the value of their services. Dentist-respondents tell us the value-added services they most appreciate are chairside assistance with difficult cases and adjustments, lab-sponsored continuing education, patient education materials and custom shading services.
When shopping for a new laboratory, high quality work, good communication and reasonable prices are these dentists' top priorities (see "Most Important Features Dentists Look for When Choosing a Laboratory" chart below). To find that new laboratory, they most often turn to their peers for advice. Almost 80% of respondents say a referral from another dentist has the most influence on their decision, a finding consistent with LMT's previous dentist surveys.
Face-to-face marketing strategies such as meeting at a study club, a lunch 'n learn program and sharing case samples are also effective ways to capture the dentist's attention. "A personal approach always works best for me," says Dr. Fluent. "I love to see examples, photographs and hear positive remarks from other dentists."
Dentist Oppostition to Offshore Outsourcing is Strong
Almost 80% of respondents to LMT's 2013 Dentist Survey don't want their work outsourced overseas, preferring to support U.S. labs, take advantage of the personalized service they can get from a nearby lab and ensure FDA-approved materials are being used. "I want my lab work strictly controlled. Outsourcing provides too many opportunities for less than high quality," says Dr. Brian McDowell, Fitchburg, MA.
Some dentists express concern about the issue of disclosure—both dentist to patient and lab to dentist. "I feel we would have to inform the patient if we outsourced, and it's not worth that conversation. A lab I worked with started shipping overseas without informing me, and I find that unacceptable without prior informed consent. The quality of the restorations dropped significantly and the laboratory lost my trust," says Dr. Travis Campbell, Prosper, TX.
However, 6% of respondents don't currently outsource but may consider it in the future especially for Medicaid and PPO patients. "I feel there are many great labs in the U.S. that I love to support which is why I don't currently use a lab that outsources. At the same time, I work for a clinic that sees mostly uninsured and Medicaid patients and controlling costs is extremely important. If, in the future, I cannot find quality work for a price that works for my patients, I may reluctantly look to outsourcing," says a survey participant from Chicago.
Technology to Watch in the Dental Office
While digital impression-taking systems and chairside CAD/CAM are being touted as the wave of the future for the dental operatory, the future seems a ways off for many of the dentists participating in LMT's 2013 Dentist Survey. Only 17% of respondents have a digital impression-taking system and 21% have invested in chairside CAD/CAM.
Of the two technologies, digital impression-taking systems seem to be more compelling, with 42% of dentist-respondents saying they likely will invest in one within several years. The time savings and accuracy of digital impression-taking systems are appealing but, to many, the capital investment is the deterrent. "I can still buy a lot of Impregum for the cost of a system," says Dr. Jay Luedde, Rolling Hills, CA.
Dr. Rance Davis, Sherman, TX, agrees. "The technology is too expensive, and that's coming from a guy who loves technology," he says.
Likewise, the cost of chairside CAD/CAM systems is a roadblock, and 63% of respondents have no plans to invest in one in the near future because of the expense as well as the learning curve and the fact that they're not interested in fabricating restorations in house. "I would be sorry to potentially put dental labs out of business. Plus, the technology is still expensive and milled porcelain restorations are not really suitable for every situation. If I were to invest in a system, I would feel like I have to sell/push those restorations to re-coup the cost," says Dr. Agnes Hibbs, So. Burlington, VT.
Survey participants who do have a chairside CAD/CAM system are mostly positive about the technology. Although they acknowledge some limitations—such as the learning curve and esthetic issues--they praise the systems because they give them the ability to provide better service to their patients. "Patients love it and after a learning curve, the results are lab-like," says a dentist from Virginia.
Age Proof Your Client Base
Thirteen percent of respondents to LMT's 2013 Dentist Survey plan to retire within the next five years. As baby-boomer clients begin to reach retirement age, lab owners need to target younger dentists to ensure a consistent workflow and a dynamic and diverse customer base.
So how young is young? Some laboratory owners say the "sweet spot" in the dentist demographic is the 30- to 50-year-old group because they're far enough away from retirement but have enough experience to be more productive customers.
But others see new graduates as prime candidates for recruitment. These laboratory owners offer themselves as a resource to students and new graduates by networking with dental schools, speaking at study clubs and inviting them into the laboratory for open houses and tours. You can stay abreast—via public record—of dentists who have recently earned their licenses.
One positive attribute of the new generation of dentists is that they've grown up in the digital age and are generally very receptive to new technology and materials. They're looking to the laboratory for advice and guidance in choosing which restorative options will be best for their patients.