LMT interviews Terry Fohey, CDT, who has brought the concept of collaboration to a whole new level at NuCraft Dental Arts in Bogart, GA.
When he first started his career in the 1970s in a high-volume production lab, Terry Fohey, CDT, was quickly discouraged by the dentist-clients' lack of commitment to quality and unwillingness to give the laboratory what it needed. "I thought to myself, 'what a fraud' and considered looking for another career," he says. "But my father reminded me there are always two sides to every story. I started investigating other approaches and philosophies and discovered Dr. Peter Dawson."
During that time, Fohey also met Dr. Thomas McDonald, of nearby Athens, GA, who mentored him in the concept of high-end dentistry and introduced him to other like-minded dentists. Fohey had found his passion; he immersed himself in the teachings of those clinicians advocating a team approach and began to build his laboratory, NuCraft Dental Arts in Bogart, GA, with a philosophy of high-level partnership he now calls, "in the foxhole together."
LMT: Tell us more about what "in the foxhole" really means as a business model.
Fohey: In today's world, people are accustomed to the "give-it-to-me-fast-and-cheap" mentality. Over the years, I've found that it's far more rewarding both professionally and personally to resist this approach and, instead, work at developing deep and lasting relationships with my clients and their patients.
Being in the foxhole together is not just a partnership; it's the essence of collaboration. For it to work, dentists and technicians must truly understand each other's challenges and goals. That's when you see the best possible results and the most satisfied patients.
Let me tell you about an "a-ha" moment I had early in my career. I received a call from a client who wasn't pleased with the reduction coping I made. He told me, "Drive down here one day and I'm going to teach you where the pulp lives," so I did. And you know what? Not only did I learn how to do a reduction coping that day, but I realized something very important: that I needed to know what my clients know.
As dental technicians, we have to understand the masticatory system, how the dental practice operates and what the next step is in every procedure. Every technician should witness and experience tooth preparation and case delivery to learn first-hand what their dentist partners go through; it's an eye opener to see what the patients endure as well. We don't need to know how to practice dentistry, but we have to understand what needs to be done.
This shared knowledge base is inherent in the foxhole philosophy; it's something my clients and I believe in deeply and constantly nurture.
LMT: What are the various ways you and your clients pursue this knowledge base?
Fohey: We attend meetings together as well as high-end educational programs by Dr. Dawson, Dr. John Kois, Dr. Lloyd Miller, Walter Gebhard, Michel Magne and Willi Geller, for example. And when I hire world-class technicians to come into my laboratory to train me and my staff, I always invite my customers, too.
We really kick the teamwork approach into high gear with our two study clubs—one is for the "young guns"—the newer dentists—and the other is for the more experienced practitioners. We meet a few times a year, study each other's work, discuss complex cases and have a no-holds-barred discussion: "Why would you have approached it like that? Did you consider...." There's no so-called expert teaching us; rather, we're measuring what we've learned against real-world solutions.
Last fall, eight of the dentist-participants and I even traveled to Switzerland to visit Walter Gebhard, MDT, a world-renowned technician and educator whose laboratory is built on the concept of collaboration. We spent five days learning from him and it was so incredibly educational that we're going back next year.
LMT: In addition to the shared knowledge base, what else is essential to this philosophy?
Fohey: Another critical element: you and your clients must have a shared vision of what you want your business/practice to be and what kind of treatment you want to offer; only then is complete collaboration possible. If one of you is committed to a high-end, patient-specific approach and the other is more concerned about volume, it's not going to work.
Another example is how you respond to the rapid advancement of technology. It's easy to get caught up in "keeping up" just for the sake of doing so. But what we really need to do is keep up with our own values. Every time we're presented with a technological change, my clients and I measure it against our shared vision: Will it enhance our patients' treatment? Will it make our work last longer? Will it help my dental partner or staff? For instance, I've invested in CAD/CAM technology and I believe in it; however, I'm taking a wait-and-see approach with digital models because I don't think they're detailed enough yet.
LMT: How has this approach changed the trajectory of your laboratory?
Fohey: When I opened the lab 30 years ago, I was simply executing the treatment plans dentists sent to me. Gradually—as I gained confidence in my principles and in my knowledge of the masticatory system—I started making more and more suggestions and we saw some great results. By nurturing this collaborative approach, I was able to sow the seeds for the type of laboratory I wanted to have and, slowly but surely, worked my way out of lower-cost dentistry.
For the last 15 years or so, every case has revolved around a collaborative approach. My clients and I are constantly communicating and don't even start planning anterior or complex cases until I've seen the patient—whether it's in person or via Skype. (See Real-Life Cases from the Foxhole below for cases that illustrate this teamwork approach.)
The key has been developing both the knowledge and the communication skills to make the approach work. Walter Gebhard once said to me that American technicians never want to say to dentists, "this cannot be." But when you have the courage to tell your dentists when you believe they are compromising results, the better off everyone is. Today, my dentist-clients joke that if I call them and clear my throat, they should just start mixing the material for a new impression.
Working in the foxhole together requires not only that shared knowledge base and vision, but a mutual desire to create a lasting, meaningful relationship. In doing so, dentistry—which is never easy—becomes much more manageable and, dare I say, enjoyable.
Real-Life Cases from the Foxhole
The key components of Terry Fohey's foxhole philosophy—a shared knowledge base and shared vision—ensure that even the most challenging case is a success story. Here's a look at some of his most memorable cases that illustrate the power of total collaboration.
Dentist: Dr. Jimmy Cassidy, Macon, GA
Case details: This patient, in her 20s, had worn away 40% of her upper teeth. Having recently attended Dr. Pascual Magne's course on bonded porcelain veneers, Fohey recommended eight bonded veneers to Dr. Cassidy.
"We've always been taught not to have more than 2mm of unsupported porcelain on a metal framework, but Dr. Magne's research has found that rule doesn't apply when you're bonding to enamel," says Fohey. "I truly believed it was the way to go."
Fohey and Dr. Cassidy discussed the case at one of their study club meetings, along with a few other members who had also attended Dr. Magne's course. Dr. Cassidy was skeptical and concerned that the veneers would fail and crowns would have to ultimately be placed anyway.
"But I had faith in Terry, and knew he would get down in that foxhole with me and together, the two of us would make it work. Eight years later, those veneers look just as good as the day we put them in," says Dr. Cassidy. "When we have a challenging case like this, we diminish our risk by having that awesome shared knowledge base. When I met Terry, I noticed right off the bat he had an openness to learn anything. That's when we started our educational journey and really became partners in the deal."
Dentist: Dr. Denton Kimbrough, Huntsville, AL
Case details: An 18-year-old woman crashed into a pine tree while on her ATV. She suffered multiple broken bones in her face, knocked out some teeth and fractured others. She was airlifted to a hospital in Huntsville; an oral surgeon pieced her jaw together and, after healing, she was referred to Dr. Kimbrough for reconstruction.
While implants were the first option, there was too much damage to the bone to ensure their success. However, the patient was adamantly opposed to a removable appliance.
Accommodating the patient's desire for a fixed restoration was challenging because she had also lost part of her ridge in the accident. But the team devised a plan that allowed for a six-unit bridge, with Fohey using pink porcelain to simulate the missing area of her gums. The team members fabricated multiple diagnostic provisionals, getting the patient's feedback each time on the look of the pink tissue and the teeth because they were determined to give the young patient the smile she envisioned.
The result was a natural-looking, fixed restoration that so pleased the patient she ended up going to dental assisting school because it was such a good experience.
"This case really was the result of teamwork between the dentist, the lab and the patient. When they all come together on the same page, everything goes better," says Dr. Kimbrough. "Early in my career, I realized I couldn't do the type of dentistry I wanted to do without a true partnership with my laboratory. My relationship with Terry has been one of the best things that ever happened to my practice."
Dentist: Dr. Michael Loden, Warner Robins, GA
Case details: A woman with a cleft palate had been through multiple surgeries and had been wearing a flipper for over 30 years. She was tired of worrying it would fall out and desperately wanted a fixed appliance; however, she had been told it couldn't be done.
Although most cleft palate cases are treated with a removable prosthetic that seals out the defect in the palate, Fohey and Dr. Loden were determined to give her a fixed restoration. Studying photographs and models, they discussed a multitude of options and opted for a two-unit appliance—cantilevered off a single-tooth crown prep—with pink porcelain built up to cover the area of the palate that was still partially open. They both went into the case knowing it wouldn't be a straightforward approach and would require a lot of back and forth for try-ins. The result? A beautiful, stable restoration that has changed the patient's life.
"This was exquisite lab work. But I could never have just sent this case off to a lab and said, 'make this,'" says Dr. Loden. "Terry and I were constantly on the phone, sending photos and models back and forth. Our relationship-based approach is the only way this case could have worked. Because our business models are the same, we both see the value in maintaining the art of the dentist-technician relationship."