"It was probably twelve years ago," he says. "And I knew I needed to make changes in my practice, but not without being firmly convinced the changes would actually improve my practice.

"I had participated in a program in the early '60s which dealt mostly with how to budget your time and money. At least it was a start in dealing with the business part of dentistry.

"So later," says Dr. Giannola, "about 1985, I met Dr. Greg Hughes, the founder of Sterling Management, and went to a lecture of his. He invited me to see his Vacaville, California practice where he was using the Hubbard management technology. Well, at this point I said we needed a management program in my practice.

"And we did the Sterling program, and have been using the methods ever since.

"Originally, what I wanted was to really get my staff working as a team. We got the office organized, with everyone knowing their jobs and doing their jobs. We got rid of the overlapping, where more than one person thought they were responsible for the same areas. So everyone knew what they were supposed to be doing with their goals in mind.

"Then, of course, we got in management by statistics, because to run any business, there's no other way to do it except by statistics. And dentistry is a business: it is a profession, but it is also a business.

"One thing we implemented," says Giannola, "and which we're still doing 11 years later, is to have a meeting day, and once a month spend two hours with the whole staff going over what things we've done, things we're doing, things we're going to be doing. We figure how we can use our time more effectively, to better utilize the time in the appointment book."

At the staff meetings, Giannola says, they look at key statistics – office production, collections and new patients – and analyze what's happening and what they can do to handle any stalled or down statistics, and strengthen any increases.

"We continue to grow, despite the fact that we're not part of the Dental Management Organization thing; we want to remain a private practice. And that's important, I think, because in my opinion if we allow things to go the way medicine went, then we would see the best dentistry behind us."

Do Sterling clients have a better chance of prosperity than other dentists have? Dr. Giannola thinks so:

"First of all, I think people who go to Sterling are a cut above, they are part and parcel of a better group, they tend to be more optimistic and more in tune.

"Second, dentists are getting out of school and into the profession up to their eyes in debt and are grabbing at these DMO patients, because it's better than not having patients in the office. As a result, it's harder for us to remain independent as individuals."

And when things get difficult, says Dr. Giannola, only the management technology by Hubbard will put a doctor in control of his practice and let him take it where he wants it to go.