Has Practice Management Changed Over The Past 75 Years?

This year, I’ll be writing about some of the most successful and simplified techniques for managing your practice and your patients. Seeing as we’re celebrating the Journal’s 75th anniversary, I think it’s only appropriate we begin by looking back to see what history can teach us.

How many times have we heard that saying “Everything old is new again?” Is this true, or is it just a saying that we all use to explain how things really don’t change that much?

After an informal study of dental practice management techniques over the past 75 years, I have come to the conclusion that, indeed, little has changed. For my research, I relied upon my father’s 50 years of experience and the interviews we have conducted with hundreds of dentists since I started working with him about 20 years ago. Many of the dentists we have represented are not active in practice now, yet we see many of them at the ODA convention each spring. A few that we speak with are 50-year ODA members. My most memorable conversation was with a 1930’s graduate, who shared some “old fashioned” advice he was given back then. He told me, “People are the practice, everything else is just paperwork!”

Another source of old wisdom is a textbook given to me by Dr. Bruce Glazier. It was written by George Wood Clapp, DDS, and is entitled Profitable Practice. It was published in 1916 by The Dentists’ Supply Company of New York. ( As you can imagine, the book is out of print, and my attempts to contact the publisher have been fruitless.)

The first thing that caught my eye was the word “Profitable” right on the cover. I think it was taboo to use the words “profit” and “dentistry” in the same sentence back in those days. Profit did not have a place in the language of a medical professional in 1916! However, I believe Dr. Clapp was a pioneer in his writing, and he had some controversial views about practice management.

One of the most significant paragraphs in his book reads:
“Men (and women) practice dentistry to earn a living and a competency. This object has been so confused with manner of such earning that it has often been lost sight of and violent discussions have raged about the methods employed, and left the principle untouched.”1

These words were written in 1916. I was so taken by them that I now refer to this 85 year-old text on a regular basis. Another significant statement runs:
“Truth carried to an extreme may become an untruth, and some of the speakers and writers who have grown up within the pale of the Code have carried some of its principles to nonsensical extremes which have been very harmful to dentists who have been misled thereby, and to the profession as a whole.”2

The common sense advice found in this book, and that of the “old school” dentists is simple; when it comes to dental practice, the most important thing is your patient.

Many of today’s dental practice management “gurus” talk about the “patient-centred practice” as though it were a new idea. Is the patient the most important aspect of dental practice? Are there other, more important issues we should examine? The answer is simple; without patients there would be no income and the practice would not exist. So why do we expend so much time and money on techniques to manage information, when patient management is the most difficult challenge in running a practice?

I agree with Dr. Clapp’s analysis that the business of earning a living in dentistry has become so complicated, that many times, the actual principle of being a dentist and serving patients is left behind. For example, I have heard about one-minute treatment plans and 30-second hygiene checks. These patients are your most valuable practice assets. Don’t they deserve more attention than this? I know the temptation is strong to increase production and keep up with the “movers and shakers” of the profession. You see these top producers on the lecture circuit every month. They claim to be able to produce huge fees in record times and can teach you their techniques.

We set goals and budgets in any business – this is common sense. The hundreds of other “pearls of wisdom” and management statistics we are told to use are purely optional. Do not forget to speak with your patients and listen to their needs. Do your very best dentistry for them and the economic results will follow.

Consider this comment from Dr. Clapp:
“The law holds a dentist responsible for knowing as much as the average dentist of his time and locality, and for exercising ordinary skill and care, but the conscientious dentist will hold himself responsible for far more than that. He will recognize his duty to inform patients as to whatever is necessary to the welfare of the mouth and for the proper performance of the functions of speech… The dentist is under no obligations to quote regular patients lower fees than will permit him to perform an operation well… if patients cannot pay the fees customary with the dentist, he may refer them to practitioners whose fees are lower, or alter the form of the work.”3

A more recent commentary about management is the identification of a trend towards “smart talk.” I read an article in the Harvard Business Review that coined this term. Essentially, it stated that many consultants talk up a storm and sound really important. They talk a lot about taking action, yet rarely do. One humorous discovery was that, while hundreds of consultants were using the phrase “new paradigms,” they could not produce an accurate definition when asked.

Another recent relevant quote from a veteran executive comes from Jack Welch, the infamous CEO of General Electric, who just announced his retirement. He was asked what his greatest skill was during his career with one of the world’s most profitable companies. He answered “The ability to get along with people.”

Is Welch’s job any different from yours or mine? Is there any magic to this fundamental principal? Dr. Clapp wrote this in 1916: “He profits most who serves best.” Think about that for a moment.

The patient or client-centered practice theory has been around for at least 75 years in dentistry, and for thousands of years in the field of economics. However, it is so simple that many have seen fit to leave it behind for the “new and improved” practice management theories of the new millennium.

It is understandable that professionals will require advice at certain times. When you need counsel about an issue relating to your practice, I suggest you look to the old techniques and focus upon your patients first.

Remember the practice management advice of that dentist I mentioned earlier: “People are the practice. Everything else is just paperwork’.”


1. Clapp, George. Wood, DDS. Profitable Practice. The Dentists Supply Company of New York, 1916, 11.
2. Ibid., 13.
3. Ibid., 15.

Ontario Dentist  – January 2001