You skip lunch to see patients. You see patients well past quitting time. You come in on your day off to see patients. You have multiple chairs going for restorative procedures all day long. Your staff is stressed by the expanded hours causing higher than normal turnover. Staff issues overwhelm you. You have no time or energy to solve problems that are business related. Sunday evening starts a feeling of dread knowing what lies ahead on your schedule the coming week. A vacation or any time away from seeing patients stresses you. You live in a world of scarcity, focusing on seeing patients to generate cash flow to keep the business healthy. The patients will only see you, they own you, and the business owns you. You are burning out. The thought of 10, 20, or more years doing this drains you. Quality of life has deteriorated to a level wherein you lose yourself and your life to being owned by the practice.
Yes, you worked hard to get to this stage in your career. It is called the PROSPERITY STAGE wherein you have more patients than you can possibly and realistically see. Your cash flow is healthy, but you must maintain it in order to keep your business and home life financially strong.
Home life has become stressful with family and personal needs increasing. Family relationships are becoming more demanding and time consuming. Priorities are in conflict – out of balance.
As a dentist you go through various stages. From a SURVIVAL STAGE right out of dental school trying to find the right opportunity to grow and succeed. You work hard and long hours to reach the next stage called STABILITY. At this stage you are able to pay the bills and stay afloat financially. You continue to work hard toward a better life and a healthier business.
Finally it appears that you arrive. The practice has grown; you have sufficient patients to fill the daily schedule. This is called the PROSPERITY STAGE. It is the most crucial and intense stage of your dental career. What you do from here plays a major role on the rest of your life.
A dentist client called me from his family vacation. He was standing in a long line at Disneyland with his family. He called to let me know that he had done some numbers in his head telling him that he was losing about $3500 each day he was on vacation. He was stressed thinking about it. Wanted to talk. Then from the background I heard his wife exclaim, “Are you on the phone talking business? You get off that phone right now and be with family!”
Another dentist shared that he learned long ago that taking week long vacations killed his profits for the month in which he took that vacation. He had to work extra hard to make up for being gone. He then shared that his favorite vacations were now Memorial and Labor Day weekends. He got three days in a row out of the practice!
As a dentist you must focus on getting past the PROSPERITY STAGE. For your quality of life, for the sake of your family, for your health, for the benefit of your team and your patients, getting past this stage is of extreme importance to your life and career. You must realize you can’t do it all. If you try, it might kill you or destroy your life.
You must move on to the BUSINESS OR INDEPENDENCE STAGES.
Over several years a dentist client had also become a good friend. We enjoyed being together and sharing life. One day he openly confided in me about his experience as a dentist and how it all affected his family. He asked me to share his story with other dentists.
He and his wife had enjoyed many years together. With four children to raise there were lots of wonderful experiences seeing them grow and develop. He loved his family.
At a point in his career the business became quite prosperous demanding more of his time and energies. He became married to the practice. He assumed in his mind that if he worked hard and provided the many blessings and securities in life for his wife and children, then he was a good husband and father. He was driven to maintain a level of prosperity to provide well for his family. Vacations were short and intense. Time with family was sacrificed for time in the office.
As his children grew into adulthood, they made very poor decisions. One ended up in prison. Another had an addiction to drugs and run ins with the law. Another dropped completely out of school and family contact to pursue a different lifestyle. Another had children out of wedlock from multiple partners and was struggling with life in general. His wife had recently divorced him as she had found someone else to spend her life with.
He was devastated. His life was not what he had planned. He told me to tell dentists to please set your family first. Don’t let the business consume you.
Way too often I see this happening when the dentist reaches the prosperity stage in his or her career.
Just like it is a priority to you to have each of your children grow and develop a rewarding life, becoming independent and self reliant, you must think the same way with your business. It can become independent from you.
If your business owns you, it requires your constant presence and mental capacities to survive. You must build beyond this stage. Your mindset must be from your first day to build a business/practice that thrives while you are on vacation. This means moving into the BUSINESS STAGE. It is defined as developing systems and team members that self manage to grow the business. Thus allowing you to gradually reduce your time and energies at the office. It requires bringing in another dentist or two to work in the practice. They can be part time or full time associates or co-owners working with you. The practice most likely would need to increase active patient count, add evenings, Fridays, and Saturdays to the schedule. More hygiene days are needed as the patient count grows. You would need to master successfully bringing on another dentist to work in your practice. This can be a challenge at times (see article: Improve Your Life and Grow Your Practice By Successfully Bringing In an Associate Dentist – www.dba-usa.com).
At this stage you can schedule less chair time and more time as a business owner. Make more income by running the business in an efficient and professional manner. Hire a consultant or mentor to help you learn and apply the demands of this stage.
Doing clinical production is only half of the equation for developing income for the dental practice. The business side of the equation is crucial to grow further into the next stages. Gradually switch from focusing upon clinical procedures to becoming more of the business owner. Study overhead and how to keep it under control or reduce it. Can you lower your bank fees some how? Can you increase the reimbursement rates on the insurances you accept? Raise your fees. Do you verify your day sheet and reports to minimize the possibility of embezzlement or theft in your office? Do you know the numbers in your practice and how they compare to other dental practices? Can you cut supply or lab costs? What is the return on your marketing efforts? Is your online presence bringing in quality new patients regularly? Are you doing those things that legitimately keep your taxes lower? How many new patients are coming from referrals each month? What is your new patient referral rate? Do you have quality/self motivated team members working with you? Do your team members need more training? Take a CE course on how to better run your business. This list goes on. Find joy in mastering these questions and building the business.
Let me share a short, but powerful story. A dentist had lost his front desk team member. One of his trusted assistants came into the office and he announced that she was to be the front desk now. He simply encouraged her to jump in and do her best. No training was provided. She learned by trial and error.
The dentist worked hard, but cash flow always seemed to be weak. Many things were done to improve patient flow. Costs were evaluated. He invited us to be involved with growing his practice. Soon thereafter, the person at the front desk asked an unusual question.
She asked, “You know I have been here for about 7 years now, but I have had this question that I need to ask someone. Many patients have a limit on what their insurance pays in a given year. Most of the time it has been a limit of $1000. Once they reach that limit, I stop charging them and just write off the procedure. Is that okay?”
We showed that the dentist had lost between $300-400,000 over the last several years because of this. Also, he was shown the reports where write offs are occurring. All dentists should check those periodically and ask questions.
Too bad that as a business owner he didn’t take the time or energy to check basic aspects of his practice. Or that he didn’t have the knowledge to do so.
At the business stage you work through any problems that may be hindering the success of your office. You wear the business owner’s hat to improve upon efficiencies, train your team, build better systems, measure and improve upon key business measurements, and more. You continue to grow the practice now that you have more time and energy to devote to these items. You may merge another practice. You can develop a co-owner.
The real focus in owning a dental business now is building toward the next stage. This next stage is where you should consistently build towards arriving. At this stage you achieve a much higher quality of life, more freedom to choose your daily activities, more choices allowing you to accomplish more and having a more fulfilling life.
This Stage is called the INDEPENDENCE STAGE.
You are now a business owner. The clinical dentistry is the product or service being provided by this business. You can step in and do specific procedures that you enjoy. You can see those patients you choose to see. You can be absent from the practice as you may choose. You are running a profitable and successful business. You are not tied down doing all the production. You don’t micro-manage every aspect of the day. You have a great team of dedicated and self-managing team members. Quality of Life is achieved.
A young dentist asked me to visit him. He bought a practice recently after being out of dental school for a year. He shared how stressful everything was in owning and operating a business. I was then surprised by his request he made. He wanted my help to find a good bankruptcy attorney. He wanted out.
After weighing the consequences of such a dramatic step, he agreed on a course of gradually tackling each area of the practice that was causing too much stress. Step-by-step over time he began to master the business side of owning a dental business.
It took time, energy, commitment, and focus to move ahead creating a strong culture of success in his practice. The practice began to grow. After a few years, an excellent merger opportunity was found. This allowed a 50/50 ownership situation in the practice. The two then shared in business ownership responsibilities and took vacations when the other dentist was staying in the office. The practice never closed except on major holidays. With two people working together to grow the business, it began to succeed on a very high level. New patients flowed into the practice due to the positive word of mouth from existing patients. Endorsements on the Internet provided a huge boost to new patient flow. New patient generation programs were adopted. A consistent focus on the patient experience increased patient retention. The hygiene department grew. The practice decided to be open six days a week and some evenings to meet patient needs. Additional dentist associates and specialists were hired full or part time. Hygiene days were expanded to meet patient needs.
With this growth came the need for a larger space. A new location nearby allowed them to double the size of the facility and gave them much better exposure.
He chooses to be in the office almost three days a week because he enjoys being there seeing patients. Much enjoyment is received by being involved in the business operations. He also schedules regular time away with family, friends, or for dental CE courses. While gone, the business performs well.
This practice can generate over $4 million in collections annually. The owner has truly reached the INDEPENDENCE STAGE.
Dental Business Advisers (DBA) has a booklet titled: “Growth Guidelines For General Dentistry” that takes a dentist step-by-step through each of the stages in practice growth and personal development. Contact our office for a copy by calling 801-210-2522 or check the website www.dba-usa.com.
By Glen Jensen
Dental Business Strategist