Designing a Practice That Works for Your Life: Dr. Ruth Mannschreck on Systems, Culture & Freedom

Summary

Podcast Summary: Power Hour Optometry - "Designing a Practice That Works for Your Life: Dr. Ruth Mannschreck on Systems, Culture & Freedom"

Release Date: July 9, 2025

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Introduction

In the July 9, 2025 episode of Power Hour Optometry, host Eugene Shotsman welcomes Dr. Ruth Mantra, a pioneering dentist whose transformative approach to practice management serves as a blueprint for optometrists seeking efficiency, profitability, and personal freedom. This episode delves deep into Dr. Ruth's journey from a hectic five-day workweek to a streamlined two and a half days, all while boosting revenue and enhancing patient care.

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Background: Dr. Ruth’s Catalyst for Change

Dr. Ruth Mantra's career took an unexpected turn due to a personal crisis. Faced with her daughter's traumatic birth and extended hospital stay, Dr. Ruth was compelled to drastically reduce her work hours.

Dr. Ruth Mantra [03:15]: "I had to cut my schedule from five days a week to just two and a half to be with my daughter."

Instead of suffering financial losses, Dr. Ruth and her team not only maintained but increased their revenue. This experience ignited her passion for creating systems that allow medical professionals to achieve more by working less.

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Implementing Systems for Efficiency and Growth

Dr. Ruth emphasizes the importance of robust operating systems that streamline the patient journey from the moment they first contact the practice to their ongoing care.

Dr. Ruth Mantra [09:25]: "Start with the patient journey from the very first moment when you answer the phone, step by step, all the way to the end."

Key strategies include:

• Segmentation of Appointments: Morning slots are dedicated to high-production appointments, ensuring peak efficiency when the team is most effective. Afternoon slots handle lower-production tasks, maintaining workflow momentum.

• Role Delegation: Dr. Ruth stepped back from tasks that didn't require her expertise, such as handling financial arrangements, delegating these responsibilities to her office manager. This allowed her to focus on clinical excellence.

Dr. Ruth Mantra [11:02]: "I would present the treatment plan and investment but let someone else handle the financial arrangements."

• Utilization of Assistants and Floaters: By introducing additional assistants and floaters, Dr. Ruth ensured that processes like hygiene appointments remained thorough without extending chair time.

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Building a High-Performing Team

A cornerstone of Dr. Ruth’s success is her high-performing team. She transformed traditional hiring practices to cultivate a team that aligns with her practice’s goals and culture.

Innovative Hiring Practices

Dr. Ruth implemented communication assessments and role-playing scenarios during interviews to evaluate candidates' interpersonal skills and their ability to handle unexpected situations.

Dr. Ruth Mantra [15:52]: "We added role-playing to our interview process... you have to see them in action."

Examples include:

• Simulating irate patients to assess front desk candidates’ conflict resolution skills.
• Requiring candidates to summarize mock patient interactions to evaluate their ability to communicate effectively in writing.

Cultivating an Irresistible Culture

To attract and retain top talent, Dr. Ruth developed a winsome and growth-oriented culture:

• Continuous Development: Providing opportunities for continuing education and personal growth.
• Peer Recognition: Implementing a system where team members recognize each other’s embodiment of core values, fostering a supportive and collaborative environment.

Dr. Ruth Mantra [35:46]: "The most important part is that it helps people be recognized. Your team members want to feel appreciated by their fellow team members."

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Fostering Effective Communication

Dr. Ruth underscores communication as the glue that holds her practice together, ensuring that all team members are aligned and informed without the need for excessive meetings.

Morning Huddles and Daily Briefings

A 15-minute morning huddle reviews the day’s appointments, ensuring all logistical details are addressed and identifying any potential challenges.

Dr. Ruth Mantra [28:28]: "Our aim is to communicate as much as possible without having a meeting."

Detailed Patient Profiles

Maintaining comprehensive patient notes accessible to all team members ensures personalized and consistent patient interactions.

Dr. Ruth Mantra [50:04]: "You better be reading those notes before you start talking to a patient in our practice."

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Developing a Strong Culture Through Core Values

Dr. Ruth transformed abstract core values into actionable behaviors, making them tangible and recognizable within the practice.

Behavior-Based Recognition

Team members earn recognition not just for living the core values but also for acknowledging their colleagues' embodiment of these values.

Dr. Ruth Mantra [34:23]: "The behavior that they want is work smart, do your homework, and be prepared for all meetings..."

Engaging Practices

• Game Mechanics: Employees earn rewards by catching peers in action, reinforcing positive behaviors in a fun and engaging manner.
• Clear Demonstrations: Translating core values into specific, observable actions helps team members understand and internalize expectations.

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Leadership: Empowering Rather Than Directing

Dr. Ruth advocates for a modern, empowering leadership style that encourages team members to use their creativity within defined parameters, fostering independence and innovation.

Dr. Ruth Mantra [43:04]: "You need to be the leader that your team members need. It’s about giving them the freedom to use their creativity while ensuring safety and standards."

Balancing Guidance and Autonomy

While providing clear endpoints and safety parameters, Dr. Ruth allows her team the autonomy to determine the best methods to achieve these goals.

Dr. Ruth Mantra [45:47]: "I have to trust that their decision making and their skill set. I want to see them come up with the same thing I'm going to come up with, but I let them use their brain."

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Metrics: Beyond Revenue and Profit

Dr. Ruth's approach transcends traditional metrics, focusing instead on streamlined operations and enhanced patient experiences.

Increased Patient Volume Without Compromising Quality

Through efficient systems and optimized team roles, Dr. Ruth manages to see more patients within her reduced workweek without diminishing the quality of care.

Dr. Ruth Mantra [56:34]: "We're seeing more patients, but the patients get the same kind of appointment they got before."

Selective Scheduling for Optimal Productivity

Grouping high-production appointments in the mornings and handling lower-production tasks in the afternoons maintains workflow momentum and maximizes efficiency.

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Conclusion: A Blueprint for Modern Practices

Dr. Ruth Mantra's innovative strategies offer a comprehensive framework for medical professionals aiming to create efficient, profitable, and fulfilling practices. By focusing on robust systems, cultivating a high-performing and communicative team, fostering a positive and recognizable culture, and adopting an empowering leadership style, practices can achieve greater outcomes with less personal time investment.

Dr. Ruth Mantra [58:51]: "Visit our website work fewer hours.com for resources that delve deeper into these strategies."

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Notable Quotes

• Eugene Shotsman [03:59]: "Within the first year, we brought it back up to where it was originally and we grew from there."
• Dr. Ruth Mantra [09:25]: "Start with the patient journey from the very first moment when you answer the phone..."
• Dr. Ruth Mantra [15:52]: "We added role-playing to our interview process... you have to see them in action."
• Dr. Ruth Mantra [35:46]: "The most important part is that it helps people be recognized..."
• Dr. Ruth Mantra [43:04]: "You need to be the leader that your team members need..."

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Resources and Contact Information

• Dr. Ruth Mantra’s Practice: shorelinestrategies.com
• Resources for Listeners: workfewerhours.com

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Dr. Ruth Mantra's insights provide invaluable guidance for optometrists and other medical professionals striving to balance professional excellence with personal well-being. Her approach demonstrates that with the right systems and culture, it's possible to achieve more by working smarter, not harder.

Transcript

[Dr. Ruth Mantra]

Foreign.

[Eugene Shotsman]

Welcome to the Power Hour, Optometry's biggest and longest running show. We're in our 13th season and I'm your host, Eugene Shotsman. So last week on the show, we talked to the legendary Dr. Gary Gerber and we talked about building a practice that gives you the freedom to enjoy your life and how systems are also the key to both increasing your enterprise value and your time freedom. And, and this week I wanted to bring someone on the show who can help take that idea of systems from theory to execution, because honestly, she did it. My guest today is Dr. Ruth Mantra. She's a dentist and I love learning from parallel industries because her story is one that every practice owner needs to hear. So she had a personal crisis that forced her to cut her schedule from five days a week to just two and a half. Now, this was decades ago, and instead of losing money within a year, she made more, seeing more patients and spending half the time in her office. So in this episode, Ruth breaks down exactly how she did it. She, by the way, also teaches other people to do it now. So she's kind of got a system for the system that allowed her to run her practice without her. And she talks about how she built a high performing team, how she changes the way that she hired. She embedded this kind of concept of culture and leadership into every single part of the practice. I love some of the creative ideas that she shared. And this is kind of turns into a blueprint for any doctor that's ever felt overwhelmed or trapped by the day to day. And it's really filled with a lot of practical ideas that we can all implement right now. So quick reminder before we jump in, if you ever want to share your feedback, suggest a topic or just connect, head over to Eugene Shotsman.com or the power Hour website and make sure that you're subscribed on Spotify, Apple Podcasts, YouTube, or wherever you get your shows so that you never miss an episode. And now let's jump into the episode with Dr. Ruth Mantrek. All right, Ruth, welcome to the Power Hour. Excited to have you on the show.

[Dr. Ruth Mantra]

Thank you, Eugene. I'm really pleased to be here.

[Eugene Shotsman]

Well, so you have a really unique background and origin story, and I think that there's, as I mentioned in our intro, you are in the dental space and I love to look at adjacencies, and I think that what we learn in adjacent industries can oftentimes be applied in optometry. So I think it might make sense for you to just give us a little bit of background and tell the story of your practice, which ultimately led you to the work that you do with business owners today.

[Dr. Ruth Mantra]

Absolutely. I'd love to. So I'm a dentist. I started my practice from scratch. I had been practicing for a few years. We had two little boys. When my daughter was born, she had a very traumatic birth. She was in the hospital for almost six weeks. And when she came home, she had to see eight different doctors every week. And I was practicing full time five days a week. So something had to go. So I went to my staff and I said, we have to scrunch our five days into two and a half days so that I can be with my daughter. And we did it. It was the craziest thing I've ever attempted to do. And if it hadn't been forced upon me, I don't think I ever would have figured out how to make it work. And I always want to, always want to be sure. I say that it was an effort of my team and I, it's not like I was brilliant and came up with this wonderful idea of how to cut my hours in half. But we figured it out together. My daughter always wants me to.

[Eugene Shotsman]

Yeah, I know. So, so just digging into that, Ruth, when you cut your hours in half of your own time in your practice, what happened to the revenue?

[Dr. Ruth Mantra]

It took a dive in the beginning, but we, within the first year, we brought it back up to where it was originally and we grew from there. We, we never actually did go back to five days a week. Okay.

[Eugene Shotsman]

And you didn't hire an associate. Right. Like, you didn't. It was just.

[Dr. Ruth Mantra]

We did not. We did not. We. Later on, yes, we brought other people in, but not until after we had really found, figured out our rhythm, the right people, all of those parts. Then we expanded. Yes, but no one in the practice worked more than two and a half days.

[Eugene Shotsman]

Okay. So. And that, that includes your staff. So it's not your staff. We're not working five days a week either.

[Dr. Ruth Mantra]

Right, right.

[Eugene Shotsman]

Okay, so this is interesting. So you went from a full time practice to a part time practice, and within a year you recovered the revenue that you lost when you made that adjustment. And so you got 50% of your time back and you had the same amount of revenue. Now revenue is different than profit. What about profit? What happens to profit?

[Dr. Ruth Mantra]

Sure, our, we had always run really lean and within the 65, 35, which seems to be an industry average in dentistry. I'm not sure what it is in optometry, but we stayed within those, those boundaries and the the less I messed with the system, the better our profit margins did.

[Eugene Shotsman]

So what you're saying is you, when you got, when you went to two and a half days, did you get more efficient? Did you get more profitable as a result of this?

[Dr. Ruth Mantra]

Oh yes, and we got very strategic. So in the dental world we have what we call loss leaders. For example, our hygiene department hygienists are very expensive these days and we could never have charged an insurance company or a patient what it costs us to run an operatory for hygiene. We lose money every time somebody gets their teeth cleaned. And that's fine. I'm good with that because of all the other things that hygiene brings to my world as a dentist. So pardon me factoring that in the other things, we had divvied them revenue wise into different, for example, we had different hours of the day where we had a different required production number for an operatory. So our mornings were heavy with high production appointments. In the afternoons we had a lower production. But in general, when you put all of that into play, our, our profit margin for the practice stayed in the exact same place it was or it came back. It came back to the place that it was.

[Eugene Shotsman]

Yeah. Once it was a year in. Okay, interesting. So, and it's, and, and it's interesting the parallels you see between the industries and I didn't know this, but I guess now that, now that I know this I'll, I have deeper respect for the, for the way that the upsell operates inside of a typical, a typical dentist. And you know, every time I go, I always think about all the systems that they have in their practice. But my, but in, in optometry that tends to be the exam that is done with a vision plan. Right. So it's the same thing. Our reimbursements tend to be really low in optometry and you can't really run a practice just doing eye exams for vision plans. You have to make sure that you have a transaction, a cash pay transaction or something behind that that ultimately drives, drives the real revenue in the practice. So, okay, so we got the parallels and I'm, you know, I'm eager to dig into this with, in terms of the number of patients you're seeing, how you made your patients more profitable because, and really how you structured your practice. But maybe you should lead and kind of tell the full story. So what did you do and kind of what did you discover?

[Dr. Ruth Mantra]

So how we actually even got into the world of consulting was in my building when I was going through these big changes all the suites were doctors of different sorts. And the dentist next door caught me in a hall one day and he said, ruth, what are you doing over there? He said, you're never here. Your team runs even when you're not here and things are going great. What is going on? And he actually became my first client. As far as coaching other professionals in private practice how to design a business that would run without them. For the most part, you know, except for your expertise, I always expect a doc or an owner to provide something. Your expertise in a. Could be marketing, could be sales, or the service that's going to be provided. So we came up with five different areas in your practice that need to be addressed in order to have the doc not work so many hours or not have the team work as many hours. And we started that process with systems. The first thing you need if you want your business to run pretty much without you, is a robust set of operating systems. So I love to. I love to have an office. Start with what I call the patient journey from the very first moment when you answer the phone, step by step, all the way to the end. So that's through the scheduling, through the collecting the information, seeing, having the exam, providing services until they end up on what we in the dental world call the recall system. A system of bringing people back again and again, documenting all of those places and making sure that you don't need the doctor in all of those places, that everyone knows what piece of the process of the system is theirs, what their responsibility is, what the. This is going to sound weird, but what the culture of that step of the process is going to be? What do you want your patient to feel? What do you want them to experience while you're in that step of the process?

[Eugene Shotsman]

So what's an example in your world, in the dental world, where people get that wrong, where doctors. I can't imagine that a doctor is involved in answering the phone or recalling the patients or. But there probably are steps where the doctor is involved where they don't need to be. And give me an example of, like, how you transfer that ownership and maybe what you did in your practice.

[Dr. Ruth Mantra]

So the first thing that I had to step aside from was I would present the treatment plan of the work that needed to be done, and I would talk about the investment, but then I would step aside and my office manager would come in and do all of the financial arrangements and the scheduling and the everything. So that was the first place where I had to step back and. And give someone else the authority and the skill Set to carry the patient. I explained why, what they needed and why they needed it and how we were going to do it. But the actual financial arrangements were made by somebody else.

[Eugene Shotsman]

And before you made the change, you were doing the financial arrangements?

[Dr. Ruth Mantra]

I was, I was explaining. And I did it fast and well because it was all in my head. I knew how many hours I could spend in my operatory to work on a patient who had a given set of background. Some of our patients come in very needy, very high maintenance. They're terrified to be there or they're in great pain. And I would mentally make these adjustments in my head for how we could hold this person on their way through their treatment. And I had to teach my team how to have that compassion, how to evaluate the mental state of our patients when they walked in the door. Those are the things you don't think of. The rule was if I didn't need a handpiece in my hand, you know my drill. If I didn't need my handpiece or my dental license to do whatever it was that was part of the system, then I wasn't allowed to do it. We had to come up with. Sometimes we had to find new team members if we didn't have the skill set for accomplishing that part of the system. But I had to step aside and say that has to work without me. And then I realized it always could work without me. I just didn't believe it. I didn't think someone else could do it as well as I did or as thorough or as completely. I have a lot of perfectionist terms that I would throw at it. But once I got over myself and said I have to find someone who does it even better than I did, that was such a. Took a load off of me. And it was so wonderful to work with someone who was actually better at some of those tasks than I was.

[Eugene Shotsman]

So tell me more about. Give me a couple more examples of somebody who was better at something that you used to do.

[Dr. Ruth Mantra]

Well, I used to be the face of my practice when I practiced. You didn't advertise. I was a very tiny, wealthy community where I was. And you didn't advertise. You didn't. We didn't have social media, so networking and promotion was me going to my kids soccer games and chamber meetings maybe, but mostly going to church, meeting people in the grocery store. I mean, that's some real old fashioned promotion. And I had to step way, way back from that. So now your promotion is not about the brand of Dr. Ruth. It's more about the brand of my practice and, and how we as a group, a practice, care for our patients that come in and how we as a practice are different than the guy next door.

[Eugene Shotsman]

Okay, so telling that story makes sense, but then who's the person in the grocery store doing that? Is that your employees now?

[Dr. Ruth Mantra]

It's our team. It is. You know, and when you tell a candidate when they come in and you say, you know, everyone in the practice has a responsibility for bringing new patients in, into the practice, that's a different conversation, you know, because that's not the norm, at least in the dental world. And yet we've came up with a way to make it fun, to make it attractive, and to find the right personalities, because I. You can't, you can't take someone who is terrified of talking to people and say, you got to bring in some patients this, this year or this month. You can't. So it meant we had to find not just the best hygienist, but we need the best hygienist who was willing to learn how to talk to people and spread the word about how we accomplish things in our practice.

[Eugene Shotsman]

That seems like a great way to go drive new patient volume. So tell me more about the training that you guys do now to get your staff to advocate for you in the community.

[Dr. Ruth Mantra]

So the second piece. So the first piece is you have to have amazing systems. The second piece is you have to have a very high performing team. So someone who is just wanting to show up and clean teeth for three or four hours a day and go home is not going to cut it. And that was a really hard pill for us to take because there just aren't a lot of dental employees available. Dentists share hygienists sometimes because we have such a hard time finding enough staff. So we had to. The piece that makes it easier to find the right people is we had to create a culture in our practice that was winsome, that was irresistible for people that came in to interview for jobs. We had to make what we do and how we did it and how we cared for our patients had to be off the charts irresistible for them to come on in and say, sure, I'll learn how to talk to people in the grocery store.

[Eugene Shotsman]

Okay, so I need to know more about how you did that. So what was the display of that culture? And is there a different interview process? Because I think this is a really. Staffing is a really common issue across all medical industry.

[Dr. Ruth Mantra]

We totally changed the way we hired, the way we looked at hiring. We added I don't want to call them personality assessments. They were communication assessments. So everyone has a favorite way they like to be communicated to. So we did a lot of assessments on ourselves and on the people that were wanting to join our practice. Not so much that we would say, well, if you're a thinker or an examiner or any of the disc parts, you know, we didn't want to say, if you're a D, we really don't want you because you're hard to talk to. Whatever our team members were in their communication style, our goal was to teach them to think about the person they were talking to and what style is that person and how would they like to hear information put forth to them? You know, because I'll just give a quick example. Connectors love to tell stories. They want you to tell a success story about just about everything that you tell them. On the other hand, thinkers or examiners like, no time for stories. Just give me the facts. How much is it going to cost? How long is it going to take? Boom, boom, boom. And if you tell me a story, I'm going to get annoyed because I don't care about the story. So it was. We had to learn who we were as communicators, and then we had to take that and figure out the person that I'm speaking with, the patient or the other team member that I'm speaking with. How do they like to receive information? How do they like to be communicated with? And we would practice. We practice in our team meetings. We role play. When we have a different, a difficult situation between a team member and a patient, we'll role play it from different perspectives and practice learning how to communicate to people the way they want to.

[Eugene Shotsman]

Okay, so, yeah, yeah, I'm hearing you 100%. This is awesome. You. And at the same time, how do you get people who are willing to do that? Like, what did you change about your interview process to attract those people?

[Dr. Ruth Mantra]

Yes, so we, we did. We did some of the normal things. Like we would interview them. So I had to pull myself out of a lot of the interview process. We added role playing to our interview process. Like when we, when we interviewed someone to work at the front desk, we would have the office manager from the suite next door come into our office and pretend to be an irate patient who just got her bill and was not going to pay it. And we would take our new candidate and just throw them out there and say, what would you do? Show us what you would do. Now all they had to do, the goal, the Bar was all they had to do is ease the patient and get them out of the waiting room because they were making a loud racket in the neighbor in the waiting room. But we put people in positions and then taught them while they were interviewing, taught them how to deal with those people. So having an interview in our office was like a game. You never knew how people were going to react. In fact, we had a young man in our practice who, no matter what you did, the poor kid would just throw up. No matter what you put in his mouth, he just couldn't help it. So we'd have him come in. When someone wanted to be a chairside assistant because they got to know bad stuff happens when you're sitting there, just so we would have that scenario, we played through scenarios of what would you do if this happened? I don't want them to know all the answers, but first of all, I want them to know that weird things happen when you work in my office. It just does. And secondly, you're on. You're a part of our team, and your job is to make that person who just did a funny thing feel accepted and cared for and not horrible about the fact they just threw up all over you. I mean, so you don't have to go to those extremes, but to. To get your. Your candidate to let their guard down and start to react like a normal person so that you can see them in action.

[Eugene Shotsman]

So let me just get this straight. So you would schedule the office manager next door to show up as a fake patient? And. And everyone but the candidate knew she was coming or the candidate knew she was coming to and said, and said, you have an opportunity to role play in a few minutes. Or this was literally just like, hey, this is a pissed off patient. And go deal with that fake patient or go deal with that pissed off patient. They think it's a real patient at the state.

[Dr. Ruth Mantra]

They think it's a real person, a real patient. Wow. And we do say we're here to support, but whatever walks in the door, you get to deal with it.

[Eugene Shotsman]

Wow. Okay, great. So it's like a working interview almost. How long does this interview last?

[Dr. Ruth Mantra]

Oh, not very long. You can't do that to someone for very long. But it's. It does break the ice. It gets them to think outside the box. It gets them to say, you guys are weird, I'm out of here. Or wow, look how, look how much energy you're putting into me as a candidate. You don't even know if you want to hire me yet. You know And I haven't even met the doc yet. So that's one, one piece, one big piece that we added. Actually, that's two. So we added assessments and then we did role playing. The other thing we do is, and my team did all of this, I came in at the end, they would narrow it down to like three people and I would help with the final decisions. The other thing we did is have them do I need to know. And you probably do in your office too. I need to know that people can communicate on paper in paragraphs and make sense that they can follow a thought. So we would have them sit in our, in an operatory while I'm working and I'd have a conversation with someone pretending to be a patient. And then when we get done, we'd say, now write down a two paragraph summary of what, what just happened.

[Eugene Shotsman]

And they had no idea that they needed to do that.

[Dr. Ruth Mantra]

Right, right. Because you can't be distracted in my office. People can die in my office. I take the safety of my patients very seriously. So there's like no daydreaming in my office. We goof around, we have a good time, but when patients are there, we're on, everyone is on. And it's just the best way to get them used to. Just because we're leaning against a counter doesn't mean we're not paying attention. Being observant and making sure that we're caring for those patients because they are the ones that run the show in my office. Does that make sense?

[Eugene Shotsman]

So where was the bar? What would they have to be able to catch in order for you to say, okay, you're a good writer and also you are capable of identifying the details.

[Dr. Ruth Mantra]

So it was less about, did they have all the details correct? It was more about could they write in complete sentences or bullet points that made sense and did they capture everything in two or three paragraphs that made sense so that you could follow. If you started at the top and read through, it made sense. I'm not asking for them to be brilliant the first time out of the gate. I need somebody who can communicate on paper.

[Eugene Shotsman]

Yeah. This is fascinating. So the, the interview process now, you know, and I, I think about this in contrast to the things that I hear all the time is like, I just need warm bodies. Like, my techs are so understaffed. I can't, you know, I can't run my exams on time because my, I don't have enough people on the tech team. And so I need, I just need warm bodies. The obvious solution to, okay, well, you can get better people, but obviously you have to pay better for it. You know, you can't. You can't be both demanding and picky and also not. And also not have the salary component as part of that. So how much more than market were you guys paying for the roles that you're. For the roles that you're advertising for in? And also, at what point does the culture itself become so attractive that.

[Dr. Ruth Mantra]

There you go, there you go. Because so think about this. When there is a time in all of our lives when all we can think about when it comes to getting a job is how much am I going to get paid? I was like that in college. I was like that at the end of high school. I had to make money. I didn't care what I was doing. I was a waitress forever. I had to make money. So when people come in to my office and all they can talk about is how much money they're going to make, to me, that's not a horrible sign. I remember being like that. My job as. As the owner is to wow them with the culture in our practice. Because, yes, we do pay above what everybody else pays, but not that much, because instead I give them a fabulous culture to grow within. So we're talking people. We want people who. I'll help them pay for their continuing education. You know, I help them get personal development. Sometimes we teach kids how to balance their checkbook. You know, it's helping them be a better person and to develop in their chosen field. You know, sure, some people. And I have to say, I prepare people to leave our practice. I want someone to walk out of our practice and say, I worked here for three or four years. That's all I had. I'm leaving town. But I want them to go out singing, singing about how wonderful it was to work in my office. And we have debrief. We have exit debriefs with the people that leave, and we have testimonials. You ask your patients for testimonials, you should ask your employees for testimonials when they leave so that you can play those for your candidates that come in.

[Eugene Shotsman]

Okay, so at what point in the interview do you play those testimonials?

[Dr. Ruth Mantra]

Not till later. Those are actually on. So we had a website that had all of that stuff on there. So they could. If you go to that part of the website, you can apply for a job. You know, you can say open careers or open ears or whatever you want to call it, but there are testimonials on there from people in our practice.

[Eugene Shotsman]

Well. And I imagine you also get a bunch of employee referrals for other employees as a result.

[Dr. Ruth Mantra]

That too, yes.

[Eugene Shotsman]

Okay. So.

[Dr. Ruth Mantra]

And probably the first people we ask when we need a new chairside assistant, the first people I ask are my patients because they know our culture. They know how much they love Susie, who's been sitting next to me forever. So they want another Susie. That's how you know. So they're going to go look for the Susie that they know. That's a best place to get referrals as far as hiring new team members.

[Eugene Shotsman]

Super interesting. Okay. And I. And your patients can sense the culture in your office. How would you describe the culture? Because we've talked about the system, we've talked about the team. What's the third one, Ruth?

[Dr. Ruth Mantra]

The third one is actually communication. Because many practices that I consult with, they have what I call silos. Like on a farm, they have a silo for marketing, they have a silo for service delivery, they have a silo for sales. And on the farm, the silos connect up at the top. But in your office, your silos, your divisions in your office need to connect all the way up and down the silo. I think having communication built into all the steps of your process is just as important as the process, your systems themselves. So we now hear me. Having great communication does not mean more meetings. I don't like meetings. We try to have as few as possible. So we try to communicate as much as we can without having a meeting. So in the morning, we have what's called a standup morning huddle. Everyone stands up. You kind of see it at Costco. I'm not sure what they're doing in their little huddles, but they have them in the morning. But in our Office, we spent 15 minutes reviewing all the appointments for the day, making sure. Do we have all the lab work? Is everybody confirmed? Are there any holes in the schedule that we should work on? Are there any patients that any of the team would like assistance with? Sometimes we have extremely fearful patients who are unpredictable as far as how to handle them in the office. First thing in the morning is a great time to review those so that whoever is available and can help, they were cross trained so that everybody can help each other. And we know before. Before the day even starts and it gets crazy and you don't know what's going on, then we'd look at the next day and say, so what does tomorrow look like? Where are the holes in the schedule? What? Because we don't just fill holes. They have to be filled with specific revenue goal for those morning slots or the afternoon slots. So we talk about what's coming up. Is everything ready? Solves a whole lot of problems. And you can even do this in your office if you have part time people. Because I was only there two and a half days. Our team was not there full days. So you figure out how to communicate that information to people even when they show up three hours after your day started. That's a huge one. Then we have meetings for case review type things. So that would be once a week. We would have to go through how, how our case is progressing, where are their stumbling blocks, where is work getting stuck or where are patients getting stuck? And then once a month we had what I called a team meeting where we would just work on building our team, growing our team. It might be, and this is part of the culture piece, we have core values in our office, and those core values have been turned into what I call behaviors. So core values are nice. They're kind of useless. In most offices, you come up with core values, you pick four or five big words, you put them on a plaque on the wall, and then you never think about them again. So. So I wanted our core values to be everywhere in our practice. So we turned them into what you might call a code of conduct. We turned each core value into behaviors. And then we made a game out of it. And we had our employees catch each other displaying the core values that we have said are important to us. And it was a game. And so they were outdoing each other, trying to catch each other, because we had prizes for who could catch people living out our core values in front of our patients.

[Eugene Shotsman]

Wait a second. Okay, this is brilliant. So usually most companies, because core values is not a new concept, and I want to hear what yours are, but the brilliant pieces. The person, it's not the person who's exhibiting the core value that gets the reward necessarily. It's the person who catches somebody exhibiting that. So what does that sound like? Tell me what your core values are and then tell me what that sounds like in front of your patients.

[Dr. Ruth Mantra]

So I hate to say what my core values are, because every office has their own. And I don't want there to be better core values than others. What's more important for people to hear are what do those core values behaviors sound like? So I got to read this is from one of my clients. I have to read it. And the behavior that they want is work smart, do your homework, and be prepared for all meetings, calls, and appointments. Be organized and plan your work for maximum efficiency. Solve problems before they happen by anticipating future issues, planning for contingencies, and addressing them in advance. Think things through. So now that gives you a picture of something you can find when you're watching, when you're paying attention to your team members. So because we have this game going, there's no one sitting around playing on their phone because you could be missing what's going on with other people, other team members. So it very much creates a collegiality, a. A collaboration between the team members they're always paying attention to. What is Susie doing? Does she need help? How is she handling that patient? They listen, they observe it. It built a huge depth to our culture.

[Eugene Shotsman]

So. So in front of the patient, they might say something like, I just. I heard you say what you just said, and it's like, oh, hey, Susie, you're working smart, huh? And like, that's a. So that's now a point in my book that goes where. Like, it goes on a board somewhere.

[Dr. Ruth Mantra]

So we keep track. So they bring those. Those things to our team meeting at the end of the month, and we call out, you know, I caught Susie doing this. And this. I caught Sam helping this person do this, you know, whatever it is. And after a while, you have to really think it makes. It's like, well, we can't say that one again because we already said that six times in a row. So then you start thinking like, we have 30, 30 different behaviors. So it's not, yes, we only have four or five core values, but what behaviors can you. Because that's the problem. When you tell team members these are our core values, and they go, well, great, but I don't know what that means, except I should be nice and we should be honest. You have to make it very simple for them to just identify the. This looks like this when I see it in action, and I'm going to do this. And a lot of the practices that I consult with, they have. They have prizes for both sides for people that. The people that get caught doing the behaviors get an award and the ones that catch them doing it.

[Eugene Shotsman]

But I think the cool innovation is that. Yeah, exactly. The Catch them. But I like both because you. Because then, you know, if Susie is the only one who ever gets caught doing stuff. Well, like, she. You know, she. She's clearly living the core values, and she's the one who's on everybody's mind the most. And then everybody clearly hears that, you know, we need to model what Suzy is doing, or we need to use what Suzy is modeling in our own day to day behavior because they hear that recognition. How much time in your team meeting do you spend on core value recognition?

[Dr. Ruth Mantra]

Not very long. It's like 10 minutes. It's not a big long thing. And I just have to say this. The most important part is that it helps people be recognized. Your team members want to feel appreciated, not just always by the doc, but by their fellow team members. A lot of people, so many people as they're walking out the door, never to come back. As your team member say, you never appreciated all my hard work. You know, no one leaves because I loved them to death. They leave because we ignore them. We don't appreciate them, we don't validate them in front of other people.

[Eugene Shotsman]

So. And one more point about this core value stuff. Does anything get said in front of the patient?

[Dr. Ruth Mantra]

It's very interesting. When we have new team members, they hear it a lot. And so our patients are used to it. They know how we roll. It doesn't happen so much with team members who have been around so long, they'll wait and say it later. But it is interesting and it wows the new team member. But it also makes our patients smile because they see how we're caring for each other as the workers in the practice. It's part of that. It's the part of the culture that you can't broadcast. You just have to let people experience it.

[Eugene Shotsman]

What else on the culture front? Because I think you're bringing a really interesting nuance to this core values component. I love that 100%. And I think that there are some systems that talk about how you hire, fire and promote based off of adherence to core values. For sure. Let's talk about, you know, outside of core values, how do you keep that culture strong? What else do you have?

[Dr. Ruth Mantra]

Our. Our goal is to grow our team members. And again and again, my colleagues who look at it from the outside say, well, you're just going to lose a good team member because they're going to move on to something bigger and better. And we've just decided that that's what we're doing. We're helping people grow the most in the short amount of time that I have them in my world. I'm going to do everything I can to help them grow, help them be the best version of themselves. And I want them to excel in their given job as best I can while they're with me. But which means as the doc, I had to just embrace the Fact that I'm going to have transient employees, sometimes there are some who just say, great, thank you so much. I'm out of here. And you just have to be okay with that because the side product of that is you have this wonderful group of team members who actually stay because they say, I love this. I'm growing, she cares. It matters what I do here. And they stay. You just have to get over that mental block of, oh, they're all going to leave. They're not all going to leave. You are going to lose some, and it's okay. And I also teach that you need to be hiring always. You're just always going to need to keep someone on the back burner. So that should someone get a move out of the city or their husband gets. If someone leaves, you have to be able to fill that position without having it be a major trauma to your practice.

[Eugene Shotsman]

Super fascinating conversation. We're going to take a short break. After we come back from the break, I want to hear the rest of the five, and I also want to zoom in on key parts of practice performance. We'll be right back on the power.

[Dr. Ruth Mantra]

Hour, making it easy for me to do this. Thank you.

[Eugene Shotsman]

I'm enjoying the conversation a lot, Ruth. So we'll just cue ourselves back in here momentarily. And there's one left, right, that we didn't talk. So there's system, team, communication, culture, and leadership. Leadership. Okay, that's where we're gonna go. All right. Were there any parts of one that you wanted to go back to that I didn't. That I didn't talk enough about or that we didn't talk enough about?

[Dr. Ruth Mantra]

I don't think so. I don't think so. No. I think we did well.

[Eugene Shotsman]

All right, we're back on the power Hour. Ruth is just continuously educating us as to how you can run a more efficient practice, spend fewer hours. And we're going to come back to that point, because this is what it's all about, right. Is that at the end of the day, you're able to make the same amount of money or more from your practice working half the time. So we're going to come back to how you did that. But first, you were kind of going through this five pillars, if we may call them, of. Of the. Of the things that your practice needs to have in order to enable that. So what have we not talked about yet? I think we've talked about system, team, communication, culture. What's left?

[Dr. Ruth Mantra]

The last one is you need to be the leader of this whole thing. You need to be the kind of leader that your team members need. So this will, this will tell you how old I am. When I was learning how to be a leader, it was very much the top down kind of leadership. I'm the boss, so that means I'm going to tell you exactly what to do. And it's based on information. I'm the doc, I know how things have to be done. So I'm just going to tell you exactly how I want you to do it. Let me tell you, today's kids are not interested in that type of leadership at all. I have four kids, they're all millennials. They couldn't care less about what I know and that doesn't make me a leader. So it's been a great. And they're 100% correct. There's no reason to be a top down kind of a leader. It's not necessary. And today's kids or younger people thrive on being able to use their creativity. Now telling a young person in a dental office that they get to use their creativity is a very dangerous thing to do. And it makes me panic some days to think about it because like I said before, someone could die in my office. So I'm the one responsible. I have to make, I have to make sure that the instructions I give to my team are crystal clear. So it means if I'm going to teach somebody how to, let's say, sterilize instruments, it has to be done properly or people will get sick. So I have to paint an incredibly vivid picture of what the end product of sterilized instruments looks like and what the boundaries and parameters are. So you can do it however you want as long as you meet these criteria. It's all sterile when it gets done, doesn't have any debris on it, all the parameters. And it has to use the. You just have to design the endpoint and then say, go for it. Show me how you would do that. Figure out how to do this. They're going to figure out that my way is the best way to do it. But the fact that they got to use their brain and their creativity means to them that I appreciate that they have a brain and they can think.

[Eugene Shotsman]

So the counterpoint to that is, well, why don't you just show me how it's done and I'll just stand here and watch you do it.

[Dr. Ruth Mantra]

That, because I don't want little robots. That is, that is the way those of us who are like over 30 or 40, that's the way the world, it's faster. It's more efficient, but it's not helpful when you want. Remember, I want these people to run my practice without me. I don't want to be looking over their shoulder. I can't look over their shoulder. I have to trust that their decision making, I have to trust their skill set. So I want to see it in action when I'm there. I want to see that they come up with the same thing I'm going to come up with, but I let them use their brain. That seems silly to us, but to them it's so important.

[Eugene Shotsman]

So do you get variability in your practice of how somebody does a specific step versus how somebody does another step? And I think about an example, like scheduling a patient. Right. You could make the. I'm trying to think about how you would follow what you just said. You'd say, well, I want the patient on the schedule and this particular slot and this particular whatever. And I, I want to make sure that the patient feels really good about the conversation. I want to make sure that the patient feels fully accommodated and whatever. But you know, you didn't give them a script. So there's no set of words that they say the same way every single time, right?

[Dr. Ruth Mantra]

No, no. So that would be different because we do teach. That's what you just described is all about how you communicate to the patient. Because on the back end of that, when a patient needs a crown, we'll just say a crown. A crown is production value at X. And there are only so many slots in the appointment book for X. You can only put them in certain spots. So it's, there's not a lot of creativity in that part. What they can do is guide the patient. And this is so fun. Guide the patient. Find out what's most important to that patient. I have executives in my practice who want to be in the chair at seven o' clock in the morning. They don't care what we do, just seven o' clock, because they want to be out of there by eight and they can go to work and not miss any work at all. So only certain people get those slots. But we find out what's important to the patient. If a patient is concerned about money, we're going to divvy up their work differently and we're going to have a different language that we use with them when we schedule their appointments and we're going to make that conversation about this will spread your payments out better for you. We would never say that to an exec that wants a 7 o' clock in the morning appointment. We would Say to him, I have the 7 o' clock in the morning appointment for you because I know you want to start your day right after you see us. So the conversation that they have when they schedule the appointment is about finding out what's important to that patient and then using that language. Whether it's, I want to get out of pain fast, I need to make this work with my finances, or I need to go to work, so I got to be out of here by 8 o' clock in the morning. So that's part of the communication that goes on between my team. When you pass off a patient to someone at the front desk, you're telling that front desk person a whole lot more than Harry needs a crown. You know, Harry needs 7am appointments. This is a conversation we have through the computer. We don't say this in front of the. But when you look at the computer, you can see what's important to this patient. For him, it's, he wants a seven o'. Clock. That's it. He doesn't care about anything else. Sally wants her, her appointment spread out so there's more communication that happens so that the person at the front desk knows my language has to match what's most important to this patient.

[Eugene Shotsman]

So basically keeping track of patient preferences throughout all of the steps in communication. And your team is motivated to keep track of those steps and not just say, well, I know that because they understand it's a team approach.

[Dr. Ruth Mantra]

Right. And most. So you'll have to tell me about your scheduling software, but most scheduling software lets you keep those notes right there. Where, where any team, back of the house, front of the house has access to those notes. And you better be reading those notes before you start talking to a patient in our practice, you know, Interesting.

[Eugene Shotsman]

So we kind of went through this framework that you've built. The practice systems have a looking at your team differently, looking at the way that you guys communicate differently, building a culture, having kind of developing yourself as a leader and allowing your employees to kind of shine within a, within a framework of parameters. This is great. But at the end of the day, like everyone listening, they're doctors and they recognize that the only way you could make the same amount of money in, in a practice working half the time is you either are extremely efficient with the number of patients that you see, right? You're either seeing more patients per hour or you are seeing a different quality of patient, Meaning you stop taking the patients who are maybe lower value to the practice. And in addition to that, maybe you're. Yeah, I guess Maybe those are the two primary ways is revenue per patient and then number minutes spent per patient. I guess those are the two metrics. So what metrics were you tracking?

[Dr. Ruth Mantra]

See, in my world, those aren't the two metrics. That's what it looks like on the outside, but there's a lot more to it and it's not until you've had that pulled out from underneath you. So yes, we did figure out that our hygienist was, could see more patients if our hygienist had an assistant. So we not only had chair sides for the doctors, but we had chair sides for our assistants for our hygienists also. Then there are, there are certain times during a procedure where you it goes slow because you need an extra pair of hands. So we actually had a floater. So we would have two people, the doc and an assistant. And then when you get to this one point in the appointment, we had a floater who would come in and provide the two extra pairs of hands, two extra hands that you needed to make that process go faster. And then that floater would go do something else right after that. So we utilized our team differently and therefore got more production out of our days. Does that make sense?

[Eugene Shotsman]

Yep. So meaning fewer minutes per patient, ultimately less chair time.

[Dr. Ruth Mantra]

You need an extra chair. We did build an extra chair because it's not, it's actually not because our goal was not to rush people. I hate it when people can get their teeth cleaned in half an hour. That's crazy. You know, but if your hygienist is working on one and an assistant is preparing the next hygiene patient for her so you, she can go quickly to the next. Each one still got their 45 or, or 60 minutes for a cleaning and education and all the other things that go with it. No, we were determined to not speed things up. It is not about speed.

[Eugene Shotsman]

So you saw more patients, I guess in your office per hour.

[Dr. Ruth Mantra]

Right.

[Eugene Shotsman]

But not necessarily with fewer minutes per patient. And were you able to cherry pick higher value patients or did you just get better at, we'll call them production numbers.

[Dr. Ruth Mantra]

We, it was where we placed our production in the day. So our morning was very production heavy. And no, we just didn't have appointments for anything but high production in the morning. Then after lunch was the B and C type production, if you call it A, B and C. So that. Yeah, it just everything because in the morning is when the team is on the ball. All the fight, all the cylinders are firing. Everybody is in their rhythm of a dental office. There's a lot of rhythm in a dental office. And when you start putting in little appointments like suture removal or seating crown or all these little things that only take a few minutes, but it really messes up your momentum. And we had to learn to group those later in the day so that once we had that rhythm going in the morning, nothing interfered with that because I would never. I do want to make our appointments efficient, but I don't want people to feel like they're being rushed out the door or that they have to share my brain with the guy sitting next to them, you know, because some dentists go back and forth and back and forth and back and forth. And it's not how I want to practice dentistry. I want to have a conversation with the people I'm working on, you know, but we're efficient, we get things done and they're done, you know, so at.

[Eugene Shotsman]

The end of the day, Ruth, I still fascinated by the, by the numbers. It. If you're, let's just say when you're seeing patients five days a week, let's just call it two years later, are you seeing more patients or fewer patients? Because two years later you're two and a half days.

[Dr. Ruth Mantra]

Oh, I see what you mean.

[Eugene Shotsman]

Right. So you got your five days a week, you then went to two and a half days, and then you went through your dip that you described, and then you built this whole system, this amazing thing that you've described for us. And at the end of the day, you know, we're now two years into the future. Your system is running well. You've got a great team, you've got a great culture, you got good communication, you got good leadership. All of this is going well. How many are you in those two and a half days? Are you seeing more patients or fewer patients than you did?

[Dr. Ruth Mantra]

We're seeing more patients, but the patients get the same kind of an appointment that they got before. When I was sloppily spread out over five days, what we curtailed and shrunk was all the behind the scenes stuff. I have never been a speedy dentist. I don't ever want to be a speedy dentist. I go as fast as my skills allow me to do a great job. That's it. I don't even want to go faster. We got more people in, but it's because behind the scenes, there's so much that happens in a dental office behind the scenes. That is the part that we really nailed down. And because we did that, we were able to see more patients in a day. Yes, but we didn't give up the patient. Time for each, with each one. You know, most notably in hygiene, that is where. That is where relationships are built. That is where people decide if they like us or not. You know, is that time and energy and hygiene. So I never want their hygiene appointments to be half an hour and you're in and out and you haven't had it a decent conversation. You know, that's not what hygiene's for. If I'm going to lose money, I'm going to lose it. Well, you know.

[Eugene Shotsman]

Yeah, right. It needs to be the. The loss leader needs to drive the revenue. Ruth has been such an amazing conversation and I, I feel like we could probably continue it at some point in the future. And so I'm going to encourage our listeners to write in with questions. We're going to post all of Ruth's information into the show. Notes, you're welcome to kind of tell people where. Where they can find you in a moment, but the reality is that I think that you bring with you a layer of expertise, having done it in your own practice. That's really fascinating. And I wish we had a little bit more time today to dig into some of the, you know, some. Some of the stuff that fascinates me from business operations. But maybe we'll just have you back to the show if enough people write in and say, hey, they want to hear more from you. So, Ruth, so glad to have you on the Power Hour again. Tell me where, Tell people where they can find you.

[Dr. Ruth Mantra]

Our website is shorelinestrategies.com we do have some. We have a resource for your listeners. The website is work fewer hours.com and the website, the. The resource we have kind of goes through all the things we talked about today.

[Eugene Shotsman]

That's fancy. Very generous of you. Thank you so much for sharing that, Ruth, and, and thanks for sharing your time and your expertise with us. I think that this has been a really interesting conversation. Ruth, glad to have you on the Power Hour and again, really enjoyed the conversation.

[Dr. Ruth Mantra]

Thank you so much. It's a great time.