Dental Tribune USA

Starting fresh in the Black Hills

By Fred Michmershuizen, DTI
October 02, 2012

Rich Mounce, DDS, recently relocated his endodontic practice from Vancouver, Wash., to Rapid City, S.D. In an interview, he discusses the move, a new business venture he has launched, plus some of the differences in practicing in the Black Hills of South Dakota vs. the Pacific Northwest.

You moved your practice to Rapid City, S.D., from Vancouver, Wash., in 2011. How did that come about?
I was born and raised in Portland, Ore., and practiced in the area as an endodontist from 1991 to the end of 2010. I was ready for a new challenge and a lifestyle change.

From 2002 to 2010, I presented several hundred C.E. programs nationally and internationally, and I wrote a similar number of trade magazine features. Having achieved almost everything I set out to do having a presence outside my practice, it was a natural place to make a break when I did. In April 2011, I opened my new endodontic practice in Rapid City.

Laura, my wife, has family in the area. We now live in the Black Hills, about 12 miles from Mount Rushmore. We simplified our lives considerably by the move. The Black Hills are sacred to the Lakota Sioux, and I can see why. It’s a spectacular place to live.

Was it tough moving your practice and beginning again?
I would not say tough, but moving presented many choices — what aspects of my previous practice I wanted to keep and what needed changing. Endodontic practice is not a one-size-fits-all experience. From office design and esthetics to management software, there were many decisions to make. The design features and other aspects of the build-out were all custom, and I am very pleased with the results.

Does practicing in South Dakota differ much from the Pacific Northwest?
In some ways, yes. South Dakota does not have large group practices owned by non-dentists, and the economy in the Dakotas is robust. These two factors account for much of the difference I experience in the delivery of dentistry. For a host of reasons that are beyond the scope of your question, I am not a fan of large groups owned by non-dentists. Despite what advocates would say, this model of delivery care does not ultimately favor optimal patient care.

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We have a very high standard of practice in my area, provided by a dedicated group of private-practice clinicians. The turnstile-type “dental mill” present in some locations in other states is simply not present.

In setting up your new practice in South Dakota, what did you do differently than with your practice in Washington state?
Lots of things. I trained and got an IV sedation permit. I bought a cone-beam machine, and I started using new, self-generated internal systems for practice management.

The IV permit has given me an option with phobic patients that I obviously would not otherwise have. I favor IV sedation relative to oral sedation because with titration of IV drugs, our level of control is more predictable and, I believe, safer.

Cone-beam technology has helped add the third dimension to understanding what two-dimensional images are missing. It’s provided diagnostic information missing from conventional films. While not a panacea, guesswork on early vertical fracture presentations, atypical root forms, resorption and missed canals, for example, are all things of the past.

My new internal systems mean checklists for every vital function in the practice. For example, among many things, there is a checklist for every item needed to treat a patient, track inventory and determine whether patients have been called the day before. This level of monitoring every practice function helps prevent things from falling through the cracks. It also allows new employees to slot into their roles faster.

How is it going so far?
We’ve been blessed; the new practice has gotten off to a solid start.

Do you have any other projects in the works?
I am glad you asked. Laura and I are very excited about the launch of our new company, MounceEndo. Starting Nov. 1, we will be selling American-made rotary nickel titanium files in a controlled memory (CM©) form and a standard nickel titanium (SNT) form, the MounceFile. We will also sell stainless-steel hand files and burs made by Mani of Japan — one of the premium global sources of hand files and burs — and reciprocating handpiece attachments from W&H of Austria.

We will stock staple items, including assorted packs of NiTi files, K-files, H-files and reamers in common sizes along with reciprocating handpiece attachments. Other items are ordered in bulk. With a little bit of advanced planning, this represents a huge win for the doctor. Our prices and selection will be very tough to beat.

Aside from the basic items we stock, our sales are primarily bulk purchases requiring a minimum order and are fulfilled in four to eight weeks. We will not be all things to all people. If you want great prices and can wait for the products, we are a fantastic option. If you can’t wait, we are not the best option.

For example, take a pack of K-files that may be available elsewhere for $7.50 at a bulk sale price. At this time, initially, we will sell the same pack of K-files for between $3.25 and $4.50 per pack, depending on the quantity purchased and whether we stock the item. Our CM NiTi will sell for as little as $35 a pack for a 50-pack sale. Standard NiTi will sell for as little as $25 a pack, again for a 50-pack sale.

The competition we bring to the big players in the market is a good thing for clinicians. With all due respect, the big players in the market are not clinicians; they are marketers and business people. I am more tuned to the needs and frustrations of doctors in the chair because I am one. This translates to our customers as more responsive service, volume discounts, selling materials that I use every single working day, and specializing in one basic line of products — shaping root canal systems.

And there is one other added advantage to dealing with our company: We don’t have a sales force that needs to hit quarterly targets. We want to create customers for life, not for the most recent sales cycle.

What makes the MounceFile different than what is already out there?
I’ll tell you. As you and your readers know, I did advocate the Twisted File before, which is an excellent product. But there are many valid ways to shape root canal systems. Just as there are many popular car models for different tastes, there are many different tastes for endodontic file systems, and all of them work to one degree or another. It would be cheeky of me to tell you that my new file is “better” than someone else’s. That said, I put my name on the MounceFile because so far I have not fractured one clinically. These files are smooth and fluid in their tactile feel and come in a vast array of tapers, tip sizes and lengths. I’ll use Mani hand files and MounceFiles in my private practice going forward. Also, the research that has been published on the CM NiTi has been favorable.

And while cost is not the only issue in selecting a file system, cost is a concern. With six files in a pack, at $25 a pack for standard NiTi and $35 a pack for CM with minimum 50-pack orders, it’s tough to argue for paying significantly more for other files that come three in a pack, or even other brands with six files in a pack for significantly more money.

Can you offer some additional details about the MounceFile?
The MounceFile is square in cross section, has four cutting edges and cuts efficiently. Any electric torque-controlled endodontic motor can be used. Rotational speed is a matter of personal preference, anywhere from 350 to 900 rpm. I run them on the higher end, but many clinicians will use 500 rpm. Torque control and auto reverse are a matter of personal preference. They can be used step-back or crown-down. While the MounceFile assorted pack has six instruments, it is possible to use less than six files in anatomy that will allow it.

How are you going to run a practice plus your own endodontic supply company at the same time?
I will practice full-time moving forward. Hard work does not frighten me, and being in practice and overseeing MounceEndo is certainly doable. Laura is my secret weapon. She is an immensely capable partner in this endeavor.

We’ll also have more than adequate support staff to take care of our customers. It’s critical to me that we serve our customers at a higher level than the competition.

Changing subjects, what advice do you have for young endodontists to enhance their practices?
In short, take the “long view.” What ultimately matters to a practice is patients coming out of the operatory feeling well cared for. It’s a bit like the tortoise and the hare. While some might want to always focus on profitability, giving people a reason to want to come back over and over is a much more powerful long-term strategy for practice growth and satisfaction.

While there are a multitude of strategies for optimizing production and running the non-clinical aspects of the business, if the clinician does not connect with his or her patient, have the right human touch, compassion and a “patient first” mantra, financial success as one measure of practice success is going to suffer. The converse is true.

Having the right staff and the management systems is also critical to create an environment where great treatment can be provided. MounceFiles or not, if the clinician is running late, the staff is apathetic, informed consent is not provided, among a myriad of possible challenges, it’s very tough, if not impossible, to end up with a happy patient leaving your office.

One final question: There are now multiple file systems, a wide variety of sources, claims and counter claims in the marketplace. How do general practitioners optimally learn and progress in their technique in the midst of so many alternatives?
This is difficult for the endodontist, and it’s even tougher for the GP. The GP has to be passionate to sort the wheat from the chaff on endodontic instrumentation and obturation methods. As a start, GPs need to decide which cases they want to treat, how much risk they will take — in essence, what their “comfort level” is for cases potentially going pear shaped. In essence, all clinicians need to decide what is in the patient’s best interest as they “do unto others.”

My suggestions would be to talk with and learn from their endodontists, subscribe to the Journal of Endodontics, attend every class possible from every manufacturer offered at regional and national meetings, and practice extensively on extracted teeth until they are very confident.

And one final note, for both endodontists and general dentists: It is important to be patient with mistakes. We learn a lot more from things that go wrong than those that go right.

Note: This article was first published in Endo Tribune U.S. Edition, Vol. 7, No. 9, October 2012.

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