A (True) Tale Of Four Dental Practices In The Heartland.
The story begins five years ago at a Dental School in the middle part of the US, not on an ocean and not bordering Canada or Mexico. Two first year students were being advised by a second year student who had already distinguished himself. For the sake of simplicity I’ll call them Mr. D, Mr. B, and Mr. H. All from the neighboring state, they would grow to be great friends.
Moving the timeline up three years, Mr. D had continued to excel at dental school and had become Dr. D while his friends were still one year away from graduation. He had decided to open a de novo practice in his hometown rather than associating with another dentist for a few years as his advisors at school had suggested. With a population of about 50,000 his hometown is a little more than an hour from Capitol City…not quite urban, but no longer rural, either. There were already quite a few dentists established there, and sadly, most were not very forthcoming when Dr. D attempted to make friends and seek advice. The exception wads Dr. A (new character in the story) who had been practicing for only four years himself. (Dr. A has a really interesting story, too, having decided on Dental School after almost 10 years as Capt. A in the Army.) Dr. A was not really happy in the partnership he had established upon graduation. He was earning a reasonable income for himself, wife, and two children, but the office was small and his partner and several staff members were driving him crazy. Dr. A was dreaming of building a new office and practicing alone. Consequently, Dr. A advised Dr. D to avoid Associateships and partnerships and open his practice solo.
Dr. D had opened his de novo practice and it matured into a still small but growing practice by the next year when his two friends from school were considering their options. Incidentally, Dr. A had become a really good friend and mentor during the year. (Let’s recap. Dr. D graduates from Dental School just over two years ago and meets Dr. A who becomes a friend and mentor. Mr. B and Mr. H are set to graduate.)
Mr. B became Dr. B and decided to open his de novo practice in a suburb of Capitol City. Dr. D had introduced Dr. B to Dr. A as a potential mentor. Dr. A’s advice helped confirm Dr. B’s decision to open his own practice. Mr. H became Dr. H and followed the advice to associate for a few years with a dentist in Capitol City. During the past year Dr. A had decided to shed himself of his partnership arrangement and hired a management advisory firm recommended by his dentist brother to assist as he built a new building and strived to pay for it. This had gone well for Dr. A, so he advised Dr. B to engage assistance before opening his de novo practice. Dr. B opened his practice in August of 2000, produced almost $20,000 his first full month, and due to his hard work and appropriate actions he was producing almost $50,000 per month by the end of his first year just a couple of months ago. Dr. H did well in his Associateship, but he was essentially an employee and Dr. B’s experience was very exciting. Dr. B urged Dr. H to take the chance and to follow his dream to open a de novo practice in another suburb of Capitol City. Dr. H decided in August of 2001 to follow this advice, hired the same management advisors, and his new five chair practice will open in late 2001. All indications are that Dr. H will be able to follow Dr. B’s model. Dr. B has already earned enough to repay most of the loan he secured to open his practice just 14 months ago, has made a sizeable dent in his school loans, has moved into a new house, and has become a father for the first time. Life is very good in the Dr. B household. (Let’s recap. Dr. B and Dr. H begin practicing. One is in a successful de novo practice and the other is in a successful, but limiting Associateship.)
Meanwhile, let’s go back to about six months ago with Dr. D and Dr. A an hour west of Capitol City. Dr. D’s de novo practice was almost 18 months old, and it had grown to between $15,000 and $20,000 per month. Unfortunately, growth was beginning to slow and net income was such that Dr’s portion was making him and his family to pinch pennies a little more than they would have liked. By May, he was getting very concerned because things were not getting better, possibly worse. Something had to change. Several of his friends had successfully engaged management assistance, but this was not an easy decision for him because finances were already tight. Incurring additional expense was definitely a gamble. Luckily, things began to improve almost immediately after he took the chance. Obstructions to success were eliminated and the practice began to experience growth again, shaky at first, but growth. In fact, from July through September the growth was $10,000+ per month. The realistic goal for the last quarter of 2001 is $35,000 per month. That will be almost twice the previous monthly average. As an aside, in the same city Dr. A has continued to grow even further and has now built his dream home in the better part of town. As the price tag was creeping toward $750,000 including a lot of cash along the way he became understandably nervous, but his practice is growing to absorb the new costs and calmness will return to the Dr. A household soon. And, what a home it is! In just a few years, Dr. A has built one of the nicest dental offices and one of the nicest homes in town. Both in excellent locations. Dozens of better-connected dentists in town are amazed and somewhat jealous. (Let’s recap. Dr. D languishes but then begins steady growth again as he celebrates his second anniversary in practice. Dr. A’s practice grows toward the $1,000,000 per year range, as he becomes a reluctant expert on brick & mortal, wallpaper swatches, grades of carpet, handmade cabinetry, AND extra costs.)
BE CAREFUL WHOM YOU USE AS AN ADVISOR. There is an ironic twist with Dr. D. He has been working closely with a local accountant since opening his practice. Recently, this accountant advised him that his expenses were climbing too high. In fact, the advice was to resist a full-time third person who is needed to handle the new growth. Since overhead had been monitored closely all along, this seemed an odd piece of advice. The problem is the accountant was averaging production for the first ten months of 2001 rather than the last three months only. If Dr. D were to take this advice, he would not continue to grow. He would be stalled and risk going backward again. Accountants are very good advisors for businesses. My undergraduate degree is in accounting, so obviously, I do not mean to denigrate the value of accountants. If they are performing their traditional role, their advice is based upon actual past performance. How can this not be good? Without doubt, the extremely aggressive businessperson very much needs this restraining advice. It is anathema, however, for most accountants to think outside the box. (There are exceptions. In the Carolinas there is an excellent firm which combines both solid reporting and creative advice.) Remember, most bookkeepers and accountants record history and worry all year long about not being audited. They are not hired to be dreamers. Reaching beyond past performance and into the realm of what appears impossible is not logical. Yet, that is precisely what one must do to reinvigorate a moribund practice.
Two rules are followed by general business executives when dealing with advisors…lawyers are seldom deal makers but usually deal breakers and accountants are essentially historians. Moderate this, however, with the knowledge that all successful business executives consult both frequently. Advice from all directions is important, but the business owner (dentist) must not lose his/her dreams. Very often, the difference between the dental practice that struggles to minimal success and the dental practice that is overwhelmingly successful is not in the hands of the dentist, nor in the mind of the dentist, but in the heart of the dentist. Don’t put unnecessary shackles on yourself and your practice. The wise dentist thinks (and dreams) before acting and then acts decisively.
I am not a Yankee hater. In fact, the Yankees though now going into their 37th World Series could be obnoxiously overbearing, but they could not be more likable as individuals. It is just that I am not from the New York area, and sometimes I would like to see my team hometown team play for the world championship of one of my favorite sports. I think most all of us expected the Yankees to be playing in the World Series before the first pitch was thrown. Overall, dominance by one team will hurt the sport. All that being said, with what has happened this year a fourth World Series for the New York Yankees seems appropriate. That is not to say that it will be easy. Curt Schilling and Randy Johnson could pitch four no hitters the way they have been pitching. Sorry though, Arizona I think the wind is blowing a different direction. Now, Washington is under attack, too, so it would be great for the Redskins to provide something for their fans. Reality must step in here, though.
Have a great weekend,
Hurston Anderson
813 963-7228
PS: I promised myself not to write about current events this week. However, it really is important to watch your practice really closely. There are too many casualties already. There is no reason for negligence and ignoring negative signs to make any more casualties. When times get bad the strong survive and prosper, but the hapless and sloppy fall by the wayside. If you do not know how to do this, email me.
Also, our workbooks really will help with internal organization, and have on five continents. For general subjects and quick thumbnail solutions to everyday issues including hundreds of samples, etc. get the Practice Management Cookbook at $199.95 plus shipping/handling. To organized and record for the entire practice protocols in specific areas consider the Protocol Series with titles on Scheduling, Hygiene, Finance, Personnel Management, and Marketing. Each is available for $179.95 plus s/h. Call 813 963-7228 or fax cc#, exp date to 813 963-5974.
The SMILE, America! Campaign is going great coast to coast. For info, refer to the last Weekly Tidbit or email.
“Smile America!”…Campaign
More than 95% of the distribution of these Weekly Tidbits is within North America primarily the US. The last 5% is spread throughout the world to English-speaking countries and English-speaking dentists in other countries from New Zealand to Iceland. Consequently, I very often write for the US audience. There are high quality dentists all over the globe from Bucharest to Santiago, so I am by no means trying to denigrate the quality of dentistry outside North America. However, for many reasons US patients invest as much as ten times as much in their dental health as in the rest of the world. Primarily, it is due to the good fortunate of having more discretionary financial resources, but for decades American (and Canadian) dentists have crusaded to raise the dental IQ of their patients, too.
Until about five years ago I spent a lot of time in Europe, Asia, Africa, and South America working with bankers. In fact, my doctorate is in International Business. In particular, I spent almost five years just after the collapse of the Iron Curtain traveling frequently to Russia, the Ukraine, Latvia, Lithuania, and Estonia. Those banks were quite active connecting into the worldwide electronic banking networks, and they provided wonderful business opportunities for Russian-speaking American businesspeople. This was at a time when there had been few Americans in these areas. The tourists had not begun to travel there in earnest yet, so quite often I was meeting natives of countries who knew little of Americans other than from movies. Areas where there are many, many American tourists often have discovered other attributes which can be rather irritating, but one thing shared by those who know Americans tourists well and those who know little of Americans is there admiration for the “American Smile”.
As an aside, I want to relate an eye-opening experience I had in Vilnius, Lithuania in the early 1990’s that may be of interest to Americans during this time. I arrived late one evening at the airport for a meeting with bankers in Lithuania and a Finnish business partner the next day. I was utterly exhausted after the flight from Moscow, so after collecting my bags I hailed a cab to the hotel downtown and some much needed rest. Speaking in heavily accented Russian, I told the cabdriver which hotel. It was late, and the streets were pretty deserted, but it was dusk rather that dark because Vilnius is pretty far north and the sun sets very late in the summer. We spoke casually and somewhat painfully due to my poor Russian. It was certainly obvious to him that my accent was from somewhere completely unique to him, so he asked me where. When I told him the United States he immediately stopped the car in the middle of the street and turned around to look at me as if I were an animal in a zoo. Tears welled up in his eyes, and he said that he was 46 years old and I was the first American he had ever seen. He continued to explain that he, his friends, and his family had kept their faith through the hard times of Soviet domination by surreptitiously watching pirated American movies and believing that someday America would help free them. He thanked me for his whole country, and he offered to take me to the hotel at no charge. In retrospect, I should have let him, I guess, but I just couldn’t. It is an experience that I will always treasure, and it is very useful to me now when I hear how a quarter of the world hates America. My guess is that there are cabdrivers in Teheran, Baghdad, and Kabul who would have similar reactions given an opportunity. Although, it appears that cabdrivers, if they exist at all, are rare in Kabul.
Oops, I wandered afield again. Back to my discussion of the “American Smile”. It seems that throughout the entire world, even if we Americans are not always recognized for loudly demanding a Budweiser or Marlboro at a news kiosk on foreign streets while wearing a Hawaiian shirt and Bermuda shorts, we are known for our healthy, straight, white teeth. The “American Smile” is recognizable because we show more of our teeth, and they are uniquely attractive. Once more, I want to point out that this is not meant to imply any superiority, but good financial fortune and a very a effective and active effort by the American dental profession to educate and treat their patients. (I would suggest also that our Canadian cousins get lumped into the “American” category often, and they are generally quite understanding, though it must be annoying.) This infectious smile which we take for granted is almost our “trademark” internationally, and one month after the terrorist attack we need to declare it okay to smile again throughout America.
I wish each and every dentist in America could be convinced to actively campaign to give patients back their “American Smiles”. Who is better qualified to do so? In newsletters, flyers, advertisements in newspapers, special signs in front of the building and inside the reception area, lapel buttons, ball caps, pencils, pens, and anywhere else possible the dentists of America should campaign. Nothing is more infectious than a smile. Nothing lifts the spirits of friends and even complete strangers like a heartfelt smile. Even the sourest sourpuss cannot resist a smile. If we let these blood-thirsty murders steal our smiles from us, they win. Certainly, there was a time to cry, to mourn, and even to reflect, but we now need to urge all Americans to SMILE. Maybe these terrorists have nothing to smile about, but we do. It is our patriotic duty to smile in the face of our enemies, and most Americans are dental patients. If dentists could encourage their patients to smile through this upcoming crisis, it would raise the spirits of the entire country, and maybe even raise consumer confidence. Heightened consumer confidence will pull the country out of the recession faster than any government bailout can.
Here are some ideas. Send a patient newsletter with a “Smile America!” theme explaining how important it is to smile right now. Pass out caps, t-shirts, sweatshirts, pencils, toothbrushes, lapel pins, bumper stickers, etc. to patients and even in malls or door-to-door with a subtext that defines your reasoning, such as “Pass It Along”, “It Helps Defeat Terrorism”, “It’s Good for the Country”, “Support The Fight Against Terrorism.”, etc. . Rent a temporary sign for a month or two and write on it, “Smile America!” with a varying subtext each week. Put up posters in your reception area or at the front desk.
Americans need to feel good again, and they need to feel they are doing something in the face of this war. What better thing could they do than to share a smile with their fellow Americans. In a recent news conference Osama Bin Laden reveled in the knowledge that “Americans are afraid, north to south and east to west”. Let’s use our best weapon to prove he’s wrong, the “American Smile”.
If you want more information on how to organize a “Smile America!” campaign, email or call. We have looked into this and have some more definitive ideas we are developing for our consulting clients that we would be glad to share. I believe this would be great for the country during this crisis, but it could also be a great reason to contact your patients and the general public at a time that dental production seems to be lagging in the 15% to 20% range. Combined with specials on whitening, cosmetics, etc. it could help those practices suffering a downturn to return to earlier levels or increase production. I do not suggest this for that reason, but because dentists are uniquely qualified to encourage smiling. However, contacting patients is always a good business practice.
Have a great day,
Hurston Anderson
813 963-7228
PS: We are still available to help practices by offering free Production Potential Analyses. Our excellent workbooks for internal operational improvement are available, as well as in-office practice management consulting Email or call for info.
Waging War In A Dental Office (Against Terrorism)
Pretty provocative title, huh? Actually, I have been in a lot of dental offices which seem to have the art of waging war down pretty well already. Unfortunately, it is a war between the front and back, or the doctor and hygienists, or the staff and doctor’s spouse, or any combination of these. This battle weary experience will be of absolutely no use for the future, though. We need to completely abandon these battles among ourselves and dedicate ourselves to the practice as our part of our civic duty.
It seems almost like normal when we get up and go into the office every day, but it really isn’t. The United States of America has been attacked directly and brutally, and the attackers have loudly and vociferously stated their intention to escalate. Their stated goal is to see our way of life including democracy, freedom of religion, sexual and racial equality, and peaceful coexistence destroyed, or they will continue to attack. They are isolated extremists who will accept no compromise. In their minds they are more moral, braver, more dedicated, smarter, and more worthy than we. Negotiations are pointless with extremists. They simply use them to buy time. Their entire message and the enthusiasm it generates depend on never compromising. Since they do not have the advantage of a huge war arsenal they will attack us psychologically through ever larger attacks on our civilian population. 6,000 massacred on September 11th is merely the first foray. Are we really as weak as they believe?
I know this is not a newsletter for current affairs, but this crisis is not just a “current event”. It will be part of all our everyday lives for years to come…entangled with our daily activities, and as business owners we have a unique responsibility to our staffs, our employees, our patients, our families, and our country. Everyone is a little nervous, and 2 out of 3 Americans are still dealing with depression. In addition, this crisis is not just in the US. It is in most of the 18 countries to which these Weekly Tidbits are sent.
The estimate is that there are 50,000 terrorists who have been trained by Bin Laden’s organization, Al Qaida. Besides Al Qaida’s terrorist camps in Afghanistan, there are training camps in Pakistan, Iran, Iraq, Syria, Lebanon, Palestine, Libya, Chechnya, Tajikistan, and probably elsewhere sponsored by the Islamic Jihad, Hezbollah, Hamas, and others we do not know. At this time (October 5, 2001) there are thousands of strikes being planned throughout the world against the West by three types of planners. Strikes are planned by state intelligence services like Iraq’s and Iran’s, they are planned by multi-national terrorists like Al Qaida, and they are concocted by independent entrepreneurial types looking for sponsorship and financing anywhere available. In an open society like ours we are unbelievably vulnerable. In fact, it is impossible to stop them from acting, if they are willing to die and to commit acts that have generally been considered unthinkable by civilized humanity previously. We can only choke off their money and support, and try to keep them constantly on the defensive. This will take unimaginable patience and determination.
Yet, as vulnerable as we are we have the upper hand in many ways. For instance, the terrorists need some support among their fellow extremists. So far, they have been able to strengthen their position with their “David versus Goliath” strikes. Even murdering 6,000 innocent civilians seems to fall within the acceptable range of anger that exists, but they must be careful about really disgusting acts like mass genocide from nuclear, chemical, or biological devices. It is hard even for the most ardent hard-hearted follower to justify the carnage that would be caused by these acts. The perpetrators are counting on our actions to incite additional rage among those who are less phlegmatic. Thereby, justifying their escalation with the ultimate goal of gaining the control of all Muslim nations, and the oil and military might. We probably can’t defend ourselves properly without some acts on our part which when interpreted through the filter of extremism will appear provocative. If we are fortunate, we can get some voices of moderation in the region to speak with a calming message. At this time they seem to have been “shouted down”, but they still wield a great deal of influence.
Although it is too soon for most to realize it, this is a whole new world, and it has a direct effect on our lives, our employees, our families, our patients, and our businesses. It has been said that this crisis has given the Baby Boom generation and subsequent generations an excuse to finally grow up. Those who have attained potentially high income positions like dentists now must prove why they are worth their income. There are leadership requirements involved that transcend the technical skills taught and practiced. A dental practice owner is a businessperson who has a unique opportunity in a free society, but who also has a unique responsibility to that society. We have pretty much had a free ride for years. Now, it appears that the bill is coming due.
It has become the fashion to find evil in the actions of big business CEO’s, but this crisis has pointed out that at the risk of their jobs and livelihoods many have made decisions for the collective good. With the extreme view of capitalism that is seen from Communism or the proponents of these extreme Theocracies this could not happen. For instance, on the morning of September 11th my wife was on an airplane on the runway in Atlanta ready to leave for Houston. All planes were grounded, and she had no way to get either home to Tampa or on to Houston. After trying Avis where we have our corporate account only to discover no cars and a drop-off fee of $800 for any car not returned in Atlanta she wandered down the aisle to get in line at Hertz. On her cell phone she told me that she could only get a car if she had a confirmation #. I got on the internet quickly and got her a reservation just as she was walking to the counter. So, she was fortunate and drove the 7+ hours home. When I returned the car the next day. Hertz charged only the $89 for one day’s rental. They had decided to help out and not charge the normal drop-off fee for a different city. Right now, I understand that they and the other auto rental firms have cars out of place all over America, and it will cost millions to get them back where they belong. Also, even with auto sales in question, several of the automakers are choosing to keep employees working even at a loss. These are just two of thousands of acts of sacrifices. The CEO’s of these companies are judged by their stock prices and profitability. Many will be vulnerable, and some will be fired over poor results next year. Yet, they stood up to be counted when it mattered.
We must do the same thing in our offices. The first objective is to stay financially viable. I discussed that last week, and I reiterate the importance. If our businesses fail, we will contribute to the unemployment and the burden on all other citizens. Should the recession cut into production, we must become proactive and take steps to reverse the trend. Certainly, incompetent, unproductive, and/or petulant employees must be dealt with appropriately, but if we are overstaffed due to the financial downturn we must try to keep our entire staff employed and struggle to grow back acceptable overhead limits. I know many of you wrote that you have not seen the downturn yet, but many more wrote that the 15% to 20% statistic was about right. Again, it is not necessary that there be any negative effect at all, but there will be unless decisive action is taken. Monitor the practice vital signs weekly. Communicate with your patients more frequently. Become proactive at filling hygiene and doctor’s schedules. No more waiting for the phone to ring and filling blanks in the schedule. Meet with the entire staff and discuss how the practice is going to change for the new situation. Fulfill your leadership role by taking positive action that will strengthen your practice. It is the time to grow up a little bit for all of us especially those of us in leadership positions. 6,000 have already been murdered, and many more will be giving their lives in combat to give us the opportunity to buy homes, cheer at ball games, cuddle our children, and conduct business. It is our patriotic duty to do the best we possibly can with these hard-earned opportunities. Otherwise, we are dishonoring their sacrifices and memories.
Warren Buffet who is the 2nd wealthiest person on the planet earned this enormous wealth by knowing what is going to happen in our economy and to specific stocks. He predicts a deeper recession than has been suggested by most others. He suggests it will possibly last throughout most of next year with negative growth three to four times greater than is being predicted by more optimistic prognosticators. Still, it will pass, and we do not have to be victims. We have everything necessary to prosper (or can get it), if we have the determination. Business as usual will not work.
Rickey Henderson broke Ty Cobb’s record for runs scored yesterday, and apparently he never was known to slide into second with his spikes crotch high, either. Surely, Barry Bonds will hit at least one more homerun in the next three games to break McGwire ‘s single season record of 70. With all this though, I think the greatest baseball “player” of all is whoever is responsible for player personnel for Seattle. They have lost more great players, Hall of Famers, than most teams will ever have such as Randy Johnson, Ken Griffey, Jr., and Alex Rodriguez. They should be stumbling, but they have already won 113 games this year with 4 left to play. That is almost ten games better than any other team in baseball. They should just get a bye all the way to the World Series, except Oakland has been even better in the last part of the year, I think, and Seattle has a great deal of trouble beating the Yankees in the post season. For all us baseball fans this is going to be fantastic.
Have a great week,
Hurston Anderson
813 963-7228
PS: One way to become proactive in your practice is to get additional management information. Our Practice Management Cookbook (@ 199.95 plus s/h) is the most widely distributed practice management reference book in dentistry today, and is being used daily on six continents. Our Protocol Series includes individual workbooks to organize the five major functions in a dental practice (Hygiene, Scheduling, Finance, Personnel, and Marketing). Each is available for 179.95 plus s/h. Fax cc#, exp date, and address to 813-963.5974. Also, we have nationwide in-practice management consulting available. Email or call with questions.
