Reflecting on A Crazy Year

Reflecting on A Crazy Year

Like many of us, I learned a lot in our year of Covid-19. Perhaps the most valuable lesson was not to take everything that went wrong as a personal failure.

From the shortage of nurses to teachers to supermarket cashiers, many businesses struggled mightily with staffing issues. It was no different at my nine dental practices and, quite frankly, it really caught me off-guard.

I thought I was a great boss with a happy and thriving staff when we all closed down for quarantine. When it was finally time to reopen nearly three months later, a lot of my staff didn’t want to come back. Some were afraid of catching the virus, some had been lured to other practices with higher pay, and others were making more money from unemployment benefits than actually working. 

Then it became a Catch-22 situation. I couldn’t find enough hygienists and assistants, a situation that was frustrating enough to cause one dentist to quit. A few others left when their spouses were forced to relocate for new jobs. My staff of 60 was down about 40 percent, but the phone was ringing off the hook with patients making appointments. Everyone was ready to come back to the dentist, it seemed, but no one wanted to come back to work. 

I realized I had to get creative to hold onto the staff members I particularly prized. Rather than view their position as simply a job, I wanted them to think of it as a career, so started a 401(k) for all positions. (I can’t afford it yet, but am looking forward to the day when I can match employee contributions.) I also raised the minimum hourly rate I pay, and guaranteed some employees that I would pay for a set number of hours each week, even if it turned out we wouldn’t work them. 

I also learned that I can only delegate so much – it was essential for me to be on site to show my hard-working staff that we were all in it together. That’s not easy with nine practices! To improve morale, I occasionally sent flowers or bought lunch for the team. I learned just how much people need to feel appreciated and to be told thank you. And it came from the heart.

I also had to extend that appreciation to myself. I was so hard on myself, thinking it was all my fault when everything seemed to be going wrong. In one particularly brutal week, a dentist, a hygienist and two assistants all gave their notice. I took that really personally. Why were they all leaving me? What was I doing wrong? It didn’t help that I was in the middle of a high-risk pregnancy and working six days a week.

Happily, that guilt tripping didn’t last too long and I finally came to see that I was simply trying my best to cope with unprecedented challenges. Change is inevitable and employees move on. There’s only so much anyone (including myself) can do to mitigate the circumstances.

Flash forward several months and happily, I’m back to being fully staffed and, most importantly, gave birth of Anna, my first child, on October 6.

So what did I learn through this crazy period? First, that it’s important to regularly show my staff how much I appreciate and count on them. Little things like a vase of flowers or small gift can go so far. Second, I learned that not every staff member was a perfect fit, and that there was nothing personal about it. 

And finally, I came to realize that each of us can only do our best. For someone who tends to overachieve, that’s a humbling lesson I have really taken to heart. It’s made me a better dentist, and a more appreciative and emphatic employer too. 

Staffing

You’ve Closed … Now What?

Part One: Staffing

“But we’ve always done it this way.” Really, is there a more dreaded phrase for the new owner of a dental practice?

Like it or not, chances are good you can expect to hear just that when you take over an existing practice. That’s because when the business is sold, often the staff is the last to know. And most people just don’t like change.

Acquiring a practice also means acquiring the people who come along with it. Since the doctor selling her practice wants to put everything in a positive light to make the sale, she may over exaggerate the staff’s experience, competence or satisfaction – promising you a well-oiled machine that patients adore. 

Whatever the reason a dentist sells their practice, you won’t get to meet the staff until the sale is final and they introduce you as the new owner/boss. I like it best when they do this immediately after dropping the bombshell that they are moving on, before too much behind-the-scenes gossip and speculation can occur. It’s only natural that people will want to know how this will affect them – will they get fired? Suffer a pay cut? Lose their benefits? 

It’s important to greet each new staff member with an open mind and to remember that while you have known about this sale for a while, it’s still quite new to them. I always start out by complimenting the dentist who is leaving and expressing how much I want to continue their legacy of excellent patient care. I am sincere, enthusiastic and speak from the heart. 

I also let the staff know that I am poised for growth and that I welcome their participation on this journey. Things will change, of course; as opposed to winding down and retiring, I am looking to expand the practice and do more with it. 

After acquiring nine practices, I can always tell, pretty much right off the bat, who will stay and who will go. I’d say about 25 to 50 percent of staff members end up quitting. Some don’t want the increased hours I often require, some don’t like working for a woman, and sometimes it’s just not a good fit. And yes, I brace myself for complaints that, “we’ve never done it this way before — we’ve always done it this way.” I will pull that person aside and respectfully let them know I just don’t want to hear it. I am now part of the we, and this is our new approach. 

I will most likely be offering a different health plan than they’re used to, but in the case of senior staff members I want to keep, I grandfather in their co-pay deal. And I strive to make their hourly jobs feel like a career by offering a more structured benefits package, performance-based bonuses, perks like a 401(K) and incentives to those who recommend a successful new hire.

Sometimes there is absolutely nothing you can do to win over a staffer and it quickly becomes obvious that it’s to both your benefit to part ways. I’ve come to learn that the last thing I want is an unhappy employee who may be badmouthing me to the patients, and that my practice will always grow, even when I am temporarily understaffed. That’s something I wish I could have taught my younger self, who took every resignation personally — and almost tragically.

Multiple Practices Can Mean Multiple Problems

Multiple Practices Can Mean Multiple Problems

When you’re the owner, it’s all on you

Fellow dentists often say to me, “You own multiple practices? Wow, that must mean a lot of passive income!” 

On paper, they’re not wrong. But as any business owner can tell you, there’s not much “passive” about it. Especially when a few of your dentists move out of state and you’re scrambling to fill the gap they left behind.

That’s the situation I found myself in last summer. Not only was I experiencing a high-risk pregnancy (which happily had the best of endings), I was filling in for two dentists who followed their spouses to new, faraway jobs. I was doing my regular schedule as both a hands-on dentist and the owner of nine practices, as well as seeing the patients of the two departed doctors. I added to the schedule of my remaining dentists and brought in some temporary help, but was still working six days a week, 10 to 12 hours a day. And I lost a few patients who did not appreciate seeing a new face every time they sat in the chair (and I don’t blame them one bit; consistency is very important to patients).

I learned a lot through that period – chief of which is that when you’re the owner, the buck stops with you. My wonderful staff was sympathetic and supportive, but virtually all of it came down to me. I was the only one who could jump in and keep things running. My staff was counting on me to smooth the waters and make payroll, patients were counting on me to ensure professional and comfortable treatments, landlords were counting on me for their rent, and the bank was counting on me to pay its note on time. And my unborn daughter was counting on me to stay healthy so she could thrive.

That crazy summer (which had the added challenge of the Covid pandemic) taught me that when it comes down to it, there is just no substitute for hard work, persistence and perseverance. 

Eventually I was able to hire new practitioners (more on that in a future blog) and enjoy four glorious months with my newborn daughter away from the offices. I still handled the myriad administrative duties of my nine practices from home, but I love that aspect of the business – keeping all the parts moving and growing is challenging and fun, like working a puzzle. 

So, what’s the takeaway? Owning multiple practices is not for the faint of heart, and it’s not for everyone. Is it right for you? Here’s some issues to chew on:

  • Are you willing to do whatever it takes to keep the offices going, including working so many hours that your arms are aching and you’re developing a stiff neck from so much hands-on work? 
  • On top of all that work in the chair, can you handle the day-to-day details like the supply chain, equipment and staff issues, scheduling and troubleshooting?
  • Most importantly, can you muster the energy and commitment to coolly and clearly predict new challenges and keep an eye on the big picture so you’re constantly growing the bottom line? 

Of course, ownership has wonderful benefits, too. I love running my own business, encouraging my staff to be their very best and, most of all, providing patients with state-of-the-art care. I wouldn’t change a thing, and that is the very best feeling in the world.

Lessons Learned Through Disaster

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We’re all struggling through the coronavirus pandemic and, beyond worrying about the health of our family and friends, are wondering when it will end and how it will affect our dental practices.

Though certainly less dire on the universal scale, I can’t help but think back to my own personal disaster in April 2018 when a semi-truck crashed through my dental office in Clarkston, Michigan. We were open at the time but thankfully (and somewhat miraculously) no one was hurt, and even the driver had only relatively minor injuries. But as a small business owner, I was in for a world of hurt that lingers to this day. My practice, one of eight that I own, was shut down for five months and I’m still dealing with the financial repercussions two years later.

I’d like to share some of the insights and lessons I learned from that incident.

  • When you buy or open a practice, you must also purchase insurance – but let’s face it, most of us do so blindly, just following our agent’s advice. I learned the hard way that I was quite underinsured on my building, which sustained significant damage. In fact, I just escaped being penalized by my insurance company for being underinsured. Do you understand, really understand, your practice’s insurance policy? It’s more likely than not that you are underinsured. Don’t put off finding out.
  • If you do need to make a major claim, consider hiring a public adjuster to negotiate and maximize your benefits with the insurance company. That proved to be one of the very best things I did, and they found coverage I didn’t even realize I had. For example, I had an “extra expense” policy that allowed me open a nice and suitable temporary location. (The insurance company first pointed me to a nasty portable clinic complete with dirty surfaces and rickety folding chairs.)
  • Banks are willing to help. It never occurred to me to reach out to my bank and ask for deferred mortgage payments on that practice and real estate. So even though I suffered a massive drop in income, I was still making my payments. Frankly, I was actually afraid to tell my bank for fear they would be so concerned about my financial stability that they’d call in my loan. In fact, they were eager to help – and happily, that’s also true during my shutdown during this pandemic.
  • Perhaps most importantly, don’t be afraid to reach out to your colleagues. I was so glad to learn that we dentists are a very tight and supportive community. One specialist generously offered me the use of his office when it was normally closed, at no charge. It was enough to at least keep our hygiene practice up and running. It was only 10% of the capacity I was used to, but it was something.
  • I chose to pay my employees for the five months we were down before opening our temporary office because I had assembled such a great team, I didn’t want to lose them to another practice. But honestly, it cost me a fortune! One of the biggest lessons I learned is how important it is to have deep reserves on hand. I thought I had plenty tucked away for a rainy day, but I had to turn to family for financial help to help me make payroll. Of course with this current crisis, it probably makes more sense to temporarily lay off your workers, though it’s a painful choice.
  • Reach out and keep in touch with your staff. They are scared and vulnerable, and they are worried about their future. Let them know you are thinking of them and will be up and running just as soon as possible. Encourage your core managers to do the same with their teams.
  • Consider sending an email or letter to your patients, too. Remind them to continue maintaining their oral health and that you’re eager to see them when this is all over.

As we all continue to encourage our staff and patients, don’t forget to take care of yourself. We are all in this together and we will come out of this better equipped for the future.

Please do not hesitate to reach out to me during this difficult time. I coach on all matters relating to dental practices and am ready and eager to help.

 

Use this Time to Ensure that You’re Insured

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As I mentioned in my last blog, I learned the hard way just how vital it is to have adequate insurance for your dental practice. I admit it’s not the most exciting of subjects, but it’s vital to the health and wellbeing of your business.

Insurance is the kind of thing we grudgingly buy, hope we’ll never use, and promptly forget all about. I get it because I was the exact same way – until a semi-truck smashed into one of my buildings two years ago. All of a sudden, that “confusing” insurance was the most important thing for my future.

Anyone opening or owning a practice of any size needs the following:

  • Professional Liability: Covers you and your business if a patient sues for malpractice.
  • General Liability: Covers non-medical items you could be sued for, such as a slip-and-fall accident or accusations of a HIPAA violation.
  • Business Personal Property Insurance: Covers all your business and personal property – the equipment, materials and other items you need to do the job day today – in the case of fire, theft or yes, a wayward truck. A good policy will also include “business interruption,” which covers the income you’re losing while out of commission; and “extra expenses,” which can help minimize your losses. My extra expenses clause was a godsend when I went to open a temporary practice. Rather than the insurance company calling all the shots and dictating where I would temporarily hang my hat, I was able to negotiate my own solution – which included a much nicer office with better equipment than the insurance company originally proposed.
  • Building Insurance: This is a must if your own the building that houses your practice. It covers everything that is “fixed” in the building, from the walls to the floor to the light fixtures.
  • Workers’ Compensation: Covers the cost of taking care of any workers injured on the job – be it from a faulty drill or a runaway vehicle.
  • Employment Practices Liability Indemnity: Protects you from employees who claim they were discriminated against or wrongfully terminated.

Don’t let your eyes glaze over. Use this list to ask the right questions about your coverage so you don’t just blindly trust your insurance agent or the Michigan Dental Association if you buy from them. This is not suggesting they are dishonest by any means, but it’s just common sense. And let’s face it, in these days of self-isolation, you have the time to tackle this.

I also highly recommend hiring a public adjuster if you do need to make a claim. This is an independent entity who will look out for your best interests as your claim is settled. They interpret and dig deep into your policy to get you the best possible outcome, and only charge a fee (about 8-10% of your settlement) when you get the check. Since it took me nearly two years to be made whole from my truck-vs.-building accident, that was no small thing.

One last thing to consider: Do you have enough insurance? I thought I was totally conscientious about all my policies so was shocked to learn that I was, in fact, underinsured. I just barely escaped being fined for under-coverage! Take inventory and revisit your policy at least once a year, especially when you purchase major equipment or add staff.

Pay careful attention to this often-overlooked aspect of your business. Hopefully, you’ll never need to use it, but if you do, you’ll thank yourself for doing the right thing.

 

Five Myths Dentists Believe about Owning a Practice

  1. I can’t afford it.
  2. Corporations will buy all the best practices.
  3. Owners have a less flexible lifestyle.
  4. As an associate, “it’s not my problem.”
  5. You’re on your own.

At the age of 15, I knew that I wanted to be a dentist and own my practice. This goal spurred me through dental school and impacted all of my decisions. I saw owning a practice as achievable and desirable. But the more that I mentor young dentists, the more I find that many believe owning their own practice is an unattainable goal, or at best, a long way off in the future. In the face of significant debt, lack of business experience, and limited funds, many new dentists believe that working as an associate is the only viable option. There are some myths about owning a dental practice that is widely believed. I want to take a moment and address the five most common misconceptions that might just be keeping you from stepping into success as a dental entrepreneur.

1.  I can’t afford it.

When you graduate from dental school with debt in the six-figure range taking on more debt to own a business can seem counter-intuitive. Who would give me financing to buy a practice? According to Dental Economics (The Case for Private Practice, Jan. 2019) banks are currently willing to loan money to those purchasing a dental practice, and small business loans are very attainable, even for those carrying large debt. This new debt is the kind that will enable the dentist to pay back their student loans and make a more significant profit.

Let’s look at some numbers. As an associate, your income is limited. You are an employee and earn a salary. Any personal expenses you incur cannot be legally written off on your taxes (i.e., meals, travel, car mileage). According to the Bureau of Labor Statistics, the average salary of a dentist as of May 2018 was $175,840. Of this, a large portion will go towards taxes and paying off student loans.

Fast-forwarding ten years, and a dentist working as an associate may have her student debt paid off.

If the dentist were to purchase a practice however, she can make significantly more. The MDA estimates that 49% of Michigan dental practices have incomes of a million or higher.

Instead of believing that you can’t afford to own dental practice, maybe the reality is, you can’t afford not to!

2. Corporations will buy all the best practices

So, you have your small business loan, and you’re ready to purchase a practice.  Aren’t you going to have to compete with large corporations who can write a check and buy a practice?

In actuality, the fact that you are NOT a corporation will play in your favor. Many retiring dentists would rather sell their business to one owner who will care for their patients and respect the character and culture of the practice.

3. Owners have a less flexible lifestyle

Many believe that owning a practice increases your level of responsibility, and the hours you must work to keep the business running. While some business owners feel the need to micro-manage, this does not have to be the case!

I currently own and operate eight dental practices. I built teams in each office and then empower them to work for my success. As an owner, I create my schedule and choose the hours and days that I want to work.

As an associate, there is less flexibility. You will always be at the mercy of the practice owner and the days and hours they want you to work. Taking time off to travel and enjoy personal pursuits will be limited to a narrow window.

So, in reality, the practice owner will always enjoy more flexibility and freedom than a hired associate.

4. It’s not my problem

It’s easy to assume that as an associate, you would bear less responsibility, both legally and within the organization. The prevailing thought is, “it’s not my problem!” As a respected member of the medical community, an associate is just as vulnerable to malpractice lawsuits.

In this age of social media, associates are just as susceptible to bad reviews on Twitter, Yelp, or Instagram in addition to online rating services like ratemds.com.

As an employee, it may not be your problem if the technology, systems, or equipment are not up to par, but it will affect your level of excellence.
And you will not be in a position to effect changes.

The business owner is empowered to solve problems and pursue the highest level of service.

5. You’re on your own

If I purchase a practice, don’t I have to be ready to run every aspect of the business? “I’ve never done payroll or purchased software or managed an office,” you might say.

You have just spent several year studying dentistry and preparing to be a medical professional and may feel at a loss when it comes to the realities of running and owning a business.

The good news is, you don’t have to do it all by yourself!

I can help coach you through the details and share what I have learned on my journey. Let’s talk! 

3 Proven Ways to Find a Dental Practice

When we want to buy a car, we go to a dealership or maybe a website like Carvana. If we need a home, we search to Zillow or we find a real estate agent. For almost any other item, we can usually find it on Amazon, and with Prime it will be there in 2 days.

But, where do we go to buy a dental practice?

1. Personal Network — Your Community

In my experience, when your community knows you are looking for a dental practice, the opportunity may come your way with little effort on your part.

Make sure that your friends know that you are actively seeking a dental practice. My personal network has been the source of several of my practice leads.

2. Trusted Advisors

If you have professional advisors in your life (accountant, lawyer, physician, financial advisor), utilize their networks.

Chances are they have other dentists as clients and may be aware of those desiring to retire. In 2014 the baby-boomer generation began to reach retirement age, so the number of retiring dentists is currently very high.

Advisors also have professional relationships that can assist you; my accountant connected me to a dentist that ended up selling me his practice.

3. Letter of Introduction

This idea may seem “old school” but can be very effective.

Acquire a list of current dentists from your state dental association and send out a letter introducing yourself. Explain that you are looking to purchase, and offer to connect by phone or in person.

Who knows, you may be precisely who a retiring dentist is looking for!

 

 

Challenges in Owning Your Own Dental Practice

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If you know me at all, you know that I am a huge advocate of dental entrepreneurship. I believe the autonomy of being your own boss creates a life of freedom, flexibility and the opportunity for unlimited financial success.

The reality is, there will be significant challenges along the way.  The biggest learning curves for me happened in the areas of systems organization, human resources, and vendor relationships. Ironically, patient care was the least of my troubles!

Dental school did an excellent job preparing me to care for my patients, but the majority of my business knowledge came in the form of on the job training.

1. Organization

When I transitioned from associate dentist to owning and operating my practice I jumped right into patient care. I was confident that I was serving my patients well, but I didn’t have systems in place for the daily operations of my business. As a result, I didn’t receive timely compensation. I was contacting each patient’s insurance company for the first time on the day of service. The patients were not being asked to pay upfront.

I have since learned that a bit of research into the leading insurance companies can streamline this whole process. Forms and documents are available online to register as a provider with the insurance companies, as well as the necessary forms for the patients.

Create a checklist for your staff, to confirm the insurance company has everything they need to process your request. You can receive electronic payments from most companies. This can reduce the wait time of compensation from weeks to days.

Before your doors open, spend some time researching how you will organize your systems. There are many software options available to ease daily operations and workflow, and it’s much better to have these systems in place before you ever see your first patient.

 2. Human Resources

As a new practice owner, I suddenly found myself hiring and managing employees.  From the person who greets the patients at your front desk, to dental assistants, hygienists, and associate dentists, each team member will affect the success of your practice. I was not prepared for the reality of hiring, firing, and the difficult conversations I needed to have regularly.  Dental school did not teach me how to confront employees who were not behaving professionally or how to negotiate salaries.

One piece of advice I can pass along is to have a clear job description for each staff role, as well as a salary cap. Know exactly who you are looking for to fill each position and an explicit parameter for each salary.

3. Vendor Relationships

To run a successful dental practice you will need to build relationships with a wide range of vendors. From website development to dental supplies and everything in between, knowing who to hire and how to negotiate can save you dollars and headaches. I learned the hard way that you can’t always trust people. I poured a lot of money into a website design only to find out that the marketing person plagiarized the content from another dentist’s site in Texas. You don’t know what you don’t know! Or as Maya Angelou said “When you know better, you do better.” Having a mentor who is experienced in running a dental practice is invaluable. A mentor can introduce you to vetted vendors and you can avoid making costly mistakes.

You can avoid the tough, new business owner lessons . I can help. Let’s connect.