The Mindset of Success: An Interview with Robert Margeas, DDS

Robert Margeas, DDS, truly believes that any dentist can be successful if they have the right mindset. He says success is not the key to happiness, but rather, happiness is the key to success. "If you are happy, you will be successful. If you are miserable going to work every day, it doesn't matter how much money you bring in, you're going to be miserable," he says. "You're not going to give what's best for the patient."

After graduating from the University of Iowa College of Dentistry in 1986, Margeas completed an Advanced Education in General Dentistry Residency from 1986 to 1987 at the University of Iowa and, thereafter, worked as an independent contractor associate until about 2001. Although he was not certain upon graduation where he wanted to practice, he did ultimately decide to live in Des Moines, Iowa. He moved there after completing his residency and worked as an independent contractor associate. This allowed him to have his own SEP (Simplified Employee Pension), with the advantage of being able to put more money away for retirement, without having to contribute for employees.

But for the first five years of his practice, he was very much in debt, he admits. The reason why was because he took more than 500 hours of continuing education during his first five years out of dental school. These CE courses were taught by Drs. Robert Nixon, Buddy Mopper, and John Kois, among others. If a patient presented to Margeas requiring a specific type of procedure, he wanted to be able to provide it.

"If I hadn't taken continuing education courses, I wouldn't have been able to treat that full-mouth rehabilitation case or implant case that came in," Margeas recalls. "I spent my money on continuing education, and you have to spend money to make money. I think you have to commit yourself to excellence."

In 2001, Margeas purchased the practice of Dr. Paul Polydoran, merged their practices, and formed Iowa Dental Group in Des Moines. In 2003, they built a 5,000-square-foot facility that includes seven operatories as well as a teaching center in the lower level for hands-on continuing education. Dr. Polydoran was a wonderful mentor, Margeas recalls. He had practiced for more than 40 years until his death in 2007. With more than 5,000 active patients, he currently has three full-time hygienists, a part-time associate, one dental assistant, and two front staff members, one of whom also doubles as a dental assistant.

After taking Dr. Buddy Mopper's direct bonding course three times, Margeas recalls that Mopper commented that he did very well and that maybe he would like to start helping him with his hands-on courses. Mopper was instrumental in helping Margeas begin lecturing and providing continuing education for other dentists.

"I can tell you that if you are just producing dentistry and doing it just to make money, you will not be successful. If you do what is right for the patient, money will come," Margeas emphasizes. "I know that sounds crazy or cliche, but I've never been driven to just make money. I've been very successful financially, but it's just come on its own, and every dentist can do it."

In this candid interview, Dr. Margeas shares insights into his practice and day-to-day operations, providing readers with a glimpse of his "Mindset of Success."

INSIDE DENTISTRY (ID): What technologies have you invested in that enable you to enhance patient care?

RM: I have digital X-rays in my office, and I think patients are impressed with the fact that there is less radiation. I do believe that in the future, CAD/CAM dentistry will be even more prevalent than it is today. I don't use that technology at the moment. In 1989, I did use the CEREC 1, which was sold by Siemens and was a very nice product. The current CEREC 3D is light years ahead of the CEREC 1. I just have not incorporated that technology in my practice because I'm up and down all day due to the hygiene practice I have. Because my overhead is around 50%, I have not really felt the urge to incorporate even more technology.

I do think that intraoral scanners make impression-taking more predictable at times. Initially, it takes a little bit of time to get started, but in the long run, I think it can make your dentistry better due to the accuracy. It's a tool to help you visualize your preparations. You send the digital impression in a file, the laboratory makes your model and your crown, and you don't have to take any traditional impressions.

ID: What additional procedures or treatment options have you added to your service mix over the years to help broaden your practice?

RM: The most profitable procedures per hour that I do in my practice are dental implants. I place simple implants when I have a nice thickness of bone and don't have to worry about the nerve. I don't do sinus grafts, sinus lifts, or block bone grafts. I take care of the easy ones, which are probably less than 25 a year.

For other cases, I have the oral surgeon place a tissue-level implant in the posterior and a bone level in the anterior, and then I can place a solid abutment or make an impression for a custom abutment. I have less than 15 minutes of chair time involved in that procedure, yet that's probably the most profitable thing that we do.

Implants have really come down in price as far as efficiency. You don't need all the equipment. You just need a torque driver, a screwdriver, and an abutment holder. There are many implant systems on the market, and I think dentists need to find a representative that they like working with who will service their area. The Straumann implant system has been part of my practice for more than 15 years.

ID: What has your experience been in terms of maximizing your hygiene department?

RM: This is probably my favorite subject to talk about. Sally McKenzie, a practice management consultant, has lectured about the hygiene department being a revenue producer and profit center. I incorporated her information into my practice, and that has been the single biggest thing I've done as far as my hygiene department being responsible for keeping the book filled. In addition, I include them in profit-sharing.

My hygiene department previously saw one patient per hour. The problem was that they would take that hour to do the hygiene appointment, but they would be done in 40 minutes. That left 20 minutes of downtime. I realized that if a patient comes in every six months and does not have periodontal disease, hygienists should be able to do that appointment in 45 minutes. So, we made our hygienists accountable for the profit of the office, like an associate. To be profitable, hygienists should produce three times their average daily salary. For anything above that, we give them a 15% bonus at the end of the month, after figuring out the total production and the number of days they worked.

Now, they cannot see patients every 15 or 20 minutes. The most they can see is one patient every 45 minutes. I want them to do it efficiently, yet what goes in that hygiene production are X-rays, fluoride treatments, sealants, bleach trays, and scaling and root planing. It's not unusual for my hygienists to have a $1,000 to $2,000 bonus at the end of the month. The biggest tip that I could give anybody is to run the hygiene department like a business.

ID: Have you incorporated any diagnostic tools or tests into the hygiene department that go hand-in-hand with production?

RM: Yes. We definitely do a periodontal examination. Our patients come in every six months. For patients who come in with pockets that are 4 mm to 5 mm or greater, those patients are scheduled for deep scaling and root planing or referred to a periodontist. A 45-minute prophy is for patients who present with healthy tissue. If the patient comes in and their tissue is not healthy, they would have a two-appointment procedure, or gross scale and then a fine scale. We're not losing income because somebody has a gross scale and they're charging for a prophy. A prophy is in the presence of healthy tissue.

One beauty of having a large hygiene practice is that if patients miss an appointment, they aren't getting in for a month or two, so they keep their appointments. We don't say, "Okay, come in tomorrow." We don't have any openings that way. I physically can't check more than three hygienists.

ID: Lastly, what does the "Mindset of Success" mean to you?

RM: I think that today, 2011, is such an unbelievable time to be a dentist. I think dentistry today is better than it's ever been. The Golden Age of dentistry is today, not 20 years ago, and I think most dentists would agree with that.

Never in my wildest dreams did I ever think from a successful financial standpoint or enjoyment of doing dentistry that I would ever accomplish what I have. In my almost 25 years of practicing dentistry, I've never had a year worse than my previous year. I've always been more productive, and yet the answer is just taking good care of your patients, not necessarily doing marketing and advertising. If you take care of your patients, you're going to be successful.

The dentist who has the best technique is not necessarily going to be the most successful financially. The dentists who can communicate with patients and have good technique, maybe not the best dentists, are the ones who will be successful because patients want to go to a dentist they like. If they like you and you happen to have good technique, you're going to be very financially rewarded.