This is part 2 of a series on how to create a successful Oral Appliance business. Last issue, Part 1 focused on the why of sleep apnea. Part 2 is about how to get the patients and Part 3 will focus on how to get paid at the highest level.
To review a bit from part one, I got involved in sleep because I wanted to be a different kind of dentist. Drill and fill seemed boring to me. So, when I saw a sleep apnea patient in the first week of my practice and changed her life I was hooked. Just as important, the overhead on the procedure was so low (a typical overhead in sleep is 18.5% as opposed to the usual 65%-85% in a general practice) and the profit margin so high, that it made all the business sense in the world.
After the first patient was treated successfully, I called my friend the pulmonologist and thanked her for the referral. I let her know that I cleared two half-day slots that would be kept open just for sleep patients only. Unfortunately, six months went by before the next patient was sent my way and 8 months till the one after that.
Now I had already decided (in my mind) that this was going to be my niche, but at that rate, I was going to have to get a second job at McDonald’s to support my family. So, I did what my dental mind told me to do. I took more courses on the subject, 8 courses in total – each course exactly the same with one small difference – the type of Oral Appliance used in the hands-on portion of the lecture. Each course I took was a day and a half of science, two hours with appliance X and a one hour lecture called “Marketing and How to Fill Your Practice with Sleep Patients.” All eight courses had the same exact “marketing” plan! The plan was to get your name out to the sleep doctors and sleep labs in town and let them know you are the dentists they should send their patient to.
This “marketing” plan generated 3 patients in a one year. So, I went back to the pulmonologist who got me involved with sleep and asked what should I do? She suggested a few things. First, I should become a Diplomate with the ADSM (known back then as the SDDS), and second I should come spend clinic day with her (every Wednesday) at the sleep lab so if a patient was deemed appropriate for oral appliance therapy they could see me directly. Lastly, I should join staff of all the local hospitals.
Back then my practice was not busy enough so I agreed to do it all. I took and passed the Diplomate exam and I spent every Wednesday at the sleep lab and joined up with all three local hospitals. My numbers did go up. I went from 3 patients a year to 1-4 patients a month.
Maybe your average Joe would have been satisfied with these results but I wanted to make this a full-time business. Can you imagine having a practice that did 1-4 crowns per month? Can you say “on the road to bankruptcy?”
I knew if I wanted to be different, I had to do something more drastic, so I started asking around. After all, I was sure someone had to be having success. I was not looking to re-invent the wheel. I just wanted to follow a proven formula. Unfortunately, this plan was not a good one. Dental sleep was in its infancy and a wheel had yet to be drawn up on the inside walls of the cave. So, I had two choices: continue on with a few referrals here and there or go out and invent the wheel.
For ten years I picked up referrals here and there. I never gave up and always planned on dominating sleep. In the meantime, I had built up a huge dental practice (my practice as a solo dentist averaged about 300K per month). But I had no luck with sleep. Finally, I decided I was going to go for it and figure out why I was not getting more sleep patients. When I was a young dentist, I heard Larry Rosenthal speak and before he became a huge success in the world of cosmetics. He told his wife, “If I am going to do this right, I have to really go for it.” So, I stole his line and told my wife the same exact thing.
I really went for it. I literally walked away from my booming practice and left it in the hands of my office manager (my wife) and my associate. I worked in the practice on Mondays only and the rest of the week, including the weekends, was devoted to figuring out how to make sleep apnea into a business. I met with everyone in the world of sleep. At the time, the world of sleep consisted of: 1) The referring physician 2) the Sleep doctors 3) The Sleep labs 4) The insurance companies and 5) The Durable Medical Equipment companies.
My goal was to find out what each one of them wanted and find ways to give them what they were looking for. The good news was none of them wanted oral appliances. The bad news was the world of sleep was an absolute mess. It turned out that the referring docs were almost completely ignoring the patients and had absolutely no screening mechanism in their respective offices.
Screening patients for sleep disorders was, and still is, step 1 in the process and it was completely ignored. Ignoring step 1, led a chain of events which put 99.9% of all patients lucky enough to be screened for a sleep disorder, on what’s known as a CPAP (Continuous Positive Airway Pressure) machine.
I came to the realization that if I was to wait for referrals in this business my business would never succeed. So, to review I am in a business where every specialist waits for referrals, none of them see more than a few patients a month and the entry to the world of sleep was a convoluted mess.
I went back the to the basics. I asked the Pulmonologist friend of mine why she did not send me more patients. She was very honest and said “I barely have enough patients of my own to survive. If I sent you all the patients you could treat, I would go broke and
have to close my practice.” The next sentence she said changed everything for me. She continued, “If you find a way to get me more patients, I will send you every mild and moderate case that you are responsible for sending to me.”
Now I had a plan of action! My goal was to get her more patients. You see sleep is different than everything we do in the dental world. The way the laws work, we as dentist, cannot diagnose sleep apnea nor can we prescribe oral appliance therapy. We need sleep doctors to work with us and they hold all the cards. Unless they decide to refer me a patient I could not legally treat a patient. In addition, every time a sleep doctor sends a patient to the dentist, it is the dentist who becomes the treating doctor of that patient. If they put a patient on CPAP they remained the treating doctor. So, it behooves sleep doctors to put a patient on CPAP otherwise they lose the patient.
I had to figure out how to get more patients referred to the pulmonologist and from there I would get patients sent to me. So, I started asking the referring docs why they did not send patients out for sleep test. They gave me a few reasons: 1) They were not taught sleep disorders in med school so it can’t be that important 2) There was nothing in it for them 3) even if they bought the idea that sleep disorders were important, they did not have any extra time in their already busy day to talk to patients about the process. I needed to create an answer to all three problems. Here is what we created.
1) We built a program which educated the doctors just enough, so they were able to talk to patients.
2) We built a sleep business for physicians, that created revenue of $50,000- $150,000 per year or more.
3) We put personnel in their office so the physicians did not have to waste any of their very limited time talking to patients.
It turned out that 90% of the patients in need of sleep studies, were not even being screened, so there was no shortage of patients. Almost every patient we tested was positive for sleep apnea. Because we explained everything to the patients in a very caring manner, they bought into the process in full. Because it was our personnel at the doctor’s office, almost all of the mild moderate patients came directly to my office.
If you are thinking of getting into this business, the legalities involved are very tricky. DO NOT GO INTO THIS BUSINESS WITHOUT THE ADVICE OF A COMPETENT HEALTHCARE ATTORNEY OR WITHOUT THE BACKING OF AN ORGANIZATION THAT UNDERSTANDS ALL THE LAWS.
This entire process turned out to be very tricky. It took us three and a half years, but it created what I have come to call “unlimited sleep patients.” Amazingly enough, I was only working with about 2% of the doctors in my area so there was still plenty to go around.
Dentists who learn this process and implement it properly see 20 or more sleep patients in their office every month. We teach this process step by step in our IAOS Reveal courses. If you would like to learn how to do this in your area, please visit our website at iaosleep.org and click on events. The Reveal event is given all over the US in a different location once a month. The sooner you get started on this the sooner you can become successful.
If you are interested in learning more, head out to the International Academy of Sleep Reveal 2.0 coming soon to a city near you. For more information, check us out at iaosleep.org and click on the events page.