Take it from a solo-doctor practice owner:
These 5 keys can bolster your business
“Am I really going to do this?” I thought. I was sitting in my 2001 Mazda Protegé, hands tightly gripping the steering wheel, parked outside the cheap motel I’d stayed at the night before. In 15 minutes, I’d be walking through the door of my future practice to meet my employees.
I had so many contradictory emotions flowing through my veins. I was excited and nervous; confident, but scared.
This was one of the milestones as a practice owner that I’ll remember for a long time: In tough situations, sometimes you just have to put it into “Drive” and get moving.
There’s a lot of doom and gloom being spread around the dental industry: “The golden age of dentistry is over.” “Corporate dentistry is destroying private practice.” “Insurance is killing the dental industry.” “Student loans are too high.” It’s not that those matters aren’t having an effect on dentistry, but there are many, many dentists who are crushing it in private practice despite them.
This article is directed to those who are ambitious, but also concerned about the possibilities of their future. During dental school, I spent many nights lying in bed, staring at the ceiling, wondering what my future would be like. I had big goals and ambitions but was unsure if, when or how many of them would come true. Fortunately, I’m on the other side of that now. After years of hard work, I’ve more than doubled my practice, while working fewer days per week.
Your life can go as far as your vision, dreams and actions will take you. That might sound cliché, but it is true and is evident daily in the lives of other dentists I work with. The task can seem daunting, but it’s very possible to have a thriving practice, earn a great income, and have the lifestyle you want.
There were several things I learned in my first year of ownership that I want to share with you.
The following is from Lewis Carroll’s Alice’s Adventures in Wonderland, when Alice meets the Cheshire Cat.
Alice: “Would you tell me, please, which way I ought to go from here?”
Cheshire Cat: “That depends a good deal on where you want to get to.”
Alice: “I don’t much care where.”
Cheshire Cat: “Then it doesn’t much matter which way you go.”
Although this was written more than 150 years ago, it applies just as much in our time. Many of us don’t have a strong vision of where we want to go—many dentists may feel that finishing dental school was the peak of their accomplishments, and that their degree will carry them the rest of the way.
It can often be difficult to keep the big picture in mind. As dentists, there is so much day-to-day filler that comes up that we struggle to remember our vision or purpose.
So, when it comes to setting goals for the first year of practice ownership, there are many unknowns, and it can be difficult to know where to set your goals.
As a practice coach, I’ve been able to see many different goals set by many different dentists. Here are some key principles to learn from those that have been successful.
Stretch yourself. Choose goals that will push you to high levels of action. Many people set goals that they believe are well within their grasp, because their fear of failure is stronger than their desire to push themselves to a higher level.
A dentist I recently started working with is very positive and proactive, but when we discussed his goals, I got the impression that he was holding back from what he really wanted. I brought this up and asked him to re-evaluate and consider, if nothing was off the table, where he’d really like to see himself. A few days later, he sent me his newly revised goals. And since then, he has doubled down on his commitment.
Believe. As well as setting a goal that will help you stretch, you must also believe that you can accomplish it. It’s not enough just to set high goals; if you pick an extraordinary goal but in the back of your mind doubt that you can actually reach it, you’ll be less likely to put in the effort necessary to pull it off. It can be a tough balance between these two. But with more practice in setting goals, you’ll become better at it.
Make a timeline. Goals must have timelines. Break down a large goal into what must be accomplished monthly, daily and even hourly.
When I purchased my practice, I thought that a very worthy goal would be to double the practice production and collections in my first year. There were a lot of areas to grow, so I believed this was doable.
In my first month, we almost doubled the average production of the practice. At that point, I knew that we would reach my goal, and I’d likely need to increase it. So I did—I changed my goal and raised it higher. I believed that it was achievable, and that it would push me to give 100%.
Well, I didn’t end up reaching my final goal; I ended my first year just short of it. I was disappointed that I hadn’t hit it, but I was also very proud of myself and my team, for what we had done in a relatively short amount of time.
What would have happened if, when I realized I would hit my original goal, I made no adjustments? I may have hit the original goal, maybe I would have been a little shy. I don’t know. But I do know that if I had kept that goal, I would not have put in the extra effort that I did. And that’s the key.
By the time that my first day of seeing patients arrived, I felt good about the staff, but by no means did I know them very well.
In a way, their world had been turned upside-down: They had a new boss who was 40 years younger than their previous one. They had to explain to patients that they could (and should) continue coming to the practice for their dental care. They had to reassure patients that the “new guy” was kind and gentle and would treat them well, even if they really weren’t 100% sure of that yet.
Even if you make zero changes in the practice, your staff is still having to adapt the way they’re doing things to support you as the new dentist in the practice. This is not the right time to start making every little clinical change to the protocols and systems you believe are best. If a system is already in place and you feel comfortable using it, try to adapt a little and keep it in place for the time being.
For example, the most important thing your assistants can be doing is reassuring patients that you are gentle and are great at taking care of patients. How well do you think they’ll be able to do this if they’re more concerned about setting up the new endo system you just bought?
Adapt as best you can to systems that are already in place. It will allow for a smoother transition. In an acquisition, it is usually best to be an “active observer” for the first few weeks. If you’re buying this practice, they must’ve been doing a decent amount of things right for several years; it may not be just the way you want it, but it will come with time.
Try to take the mindset that you’re in the practice, and you’re trying to learn the ways that they’ve been doing things. You can share with the staff that you will make some changes at some point, but right now, you just want to learn how they run the practice.
Keep some notes on the things you’d like to change and do differently, but try to put most of your concerns on the back burner. Be strategic about which changes you make first. If you start changing everything you want to, you’re more likely to burn out staff, and make changes that will be less beneficial to the practice.
Which leads to my next point ...
Prioritize the changes you make
After a few weeks, when things have started to settle in with the staff, pull out the list of changes that could be made and take a look at it.
When deciding which things to implement, here’s an exercise to determine which order to approach them.
Take a look at your list and give each item two different scores:
- First, give a score to each item based on how much it would be able to increase production and collections. Rank it between 1 (least likely to bring an increase) and 5 (most likely).
Go through the list again, scoring each item based on ease for staff to implement these changes. Rank it between 1 (difficult to implement) and 5 (easy).
Total up the scores for each item, then put them in order from high to low. This will be a good starting point for implementing changes.
Consider the following changes that could be implemented in a given practice:
Switching to a better practice management software.
Keeping more complicated endo or extractions in-house than seller had been.
Increasing marketing efforts.
Changing collections policy to try to improve collections percentage.
Buying and using an intraoral camera.
Now let’s go back through and give them scores based on the criteria previously described:
||Ability to Increase
|Switching to a better practice management software
||Most of the time, this is something new docs want to change because they understand a certain system better, or feel like one will have advantages and be a better fit. But when it comes down to it, it’s not likely to make a big impact in the ability to produce or collect.
||This is something that can definitely add stress to staff, especially when they’re already familiar with a certain software system.
|Keeping more endo or extractions in-house
||Many times, a seller may be pretty conservative in how much endo or oral surgery they do. By keeping more in-house, this can be a relatively quick way to increase production/collections.
||If staff have already been doing these procedures, it likely won’t be any more difficult for them to aid in some that are a little more complex. Score: 5/5
|Increasing marketing efforts
||This is dependent on the success of the marketing campaign, but increasing new patients in the practice can definitely make a large impact on production/collections.
||This may require a little improvement in phone skills, but if the practice is already converting new patients well, this will require no additional training.
|Changing collections policy to try to improve collections percentage
||This is fairly dependent on the practice. The worse the practice is at collecting, the bigger the potential to improve.
||This will require training staff on the new policies, but will also put a strain on patients who are being asked to do something different from what they’re used to.
|Buying and using an intraoral camera
||Using an intraoral camera can have a dramatic effect on case acceptance, and result in a significant bump in production/collections.
||In the beginning, it should be relatively easy for dentists to take pictures on their own, whether that’s by using software installed on computers, or even a tablet. As time goes along and staff become comfortable using it, they can.
If we add up the results of those, we would prioritize in the following order:
Buying and using an intraoral camera (Score total: 10).
Increasing marketing (9).
Keeping more complicated endo or extractions in-house than seller (8).
Changing collections policy (5).
Switching practice management software (2).
Remember, we’ll likely end up making all of the above changes. But in an acquisition, it’s critical to make good decisions on what to implement first. Making a poor change early on can lead to added stress, with opportunity cost. Making better decisions for changes can help keep staff positive and confident and increase the practice cash flow.
Be the leader your team needs
Most dentists who purchase a practice have not been business owners before; being a boss is new and can be very challenging. But it’s possible to be a good leader, without having honed all your leadership skills. Here are some keys to remember.
Be confident but humble. As you work with your team to improve the practice, your team will look to you for guidance. They will place their trust in you as they see your confidence. Sometimes, though, confidence may not be what you’re feeling. I’ve found that when I remind myself to smile, I start feeling happier and thinking more of others. Raise your head high, stand up straight. Extend a firm handshake. Avoid words like uh, well, just and try.
Even with your best efforts, others may have their doubts and questions. Rather than take offense to this, be open to their questions and concerns. Really make an effort to listen to your team members. It is very possible to show confidence in the direction you’d like to go while also being open to their feedback.
At one point, I had decided to change to a new software company that would manage some of our programs. I thought the staff would be excited about it, but they quickly opposed. My instinct was to put my foot down and tell them this was my decision, but instead I listened. They shared with me some improvements they had seen with our current provider and services they really liked. I had them show me and changed my decision. Many times, staff will be hesitant to change, but sometimes they may have good points. You’ll never know unless you listen.
There will also be times that you’ll need to ask your team to trust you and try out your desired system. Simply state, “I understand that there are concerns, but I truly believe this will improve patient care and make your jobs easier. Let’s meet again in two weeks and we’ll discuss how things are going and can make revisions if needed.” This is a great example of showing confidence and humility and moving forward with action, but also being willing to revisit this in the future.
Hold training meetings. In the beginning, it’s very important to work through things and talk together as a team. As time goes on, these meetings will likely occur less and less.
When I was first in my practice, we had weekly meetings to review our systems, make revisions and train on improving our skills in working with patients. Now, we have meetings once a quarter.
My goal from the beginning was to front-load the process. I wanted to put in as much time as needed to help take my team to the next level, getting them to perform at a higher standard. I knew that if I sacrificed and put in the time, down the road it would allow my practice to run itself and require less of my time and energy.
Share your vision. Do you have a vision for your practice? It was important for my staff to know from the very beginning that I wanted our office to treat our patients better than anyone else in town, and for my team to be better paid than any other office in town.
This was very motivating for me, and for them. It is critical to work together in unity toward a common goal. When I shared that with my team the first time, they began to see what my vision was, and where I wanted to take the practice. In a way, I was inviting them to hop along my “dream train.”
Don’t wait until you’ve “built relationships” to start presenting treatment
Many dentists and consultants tell new practice owners to hold back on treatment recommendations during the first one to two years in ownership. Their advice is to spend your efforts getting to know and building relationships with your patients; then, after you have a good foundation, you can start bringing up treatment that you think patients need.
Although I can understand the rationale behind this, I think this is one of the biggest bits of hogwash out there. If patients need treatment, they need treatment. Is the clinical condition of a patient’s dentition different depending on how well you know them? Of course this sounds ridiculous, but that’s what is being suggested.
This is suggested out of fear of scaring off patients if the treatment recommendations are different from the previous dentist’s. Let’s talk through this.
In my practice, this was the No. 1 reason for my immediate increase in production. We almost doubled in the first month, but we had no increase in number of new patients. Our rapid boost came from diagnosis, treatment planning and case acceptance. We lost hardly any existing patients.
One of the greatest keys to this is the role that I see myself in as a dentist. I don’t see myself as a high-pressure salesman, or the dentist who has a responsibility for his patients to have perfect teeth. I see myself as having the duty of informing my patients of what I see, letting them know what their options are and helping them commit to a plan.
When meeting new patients for the first time, spend a few minutes getting to know them. Learn what they enjoy most in life. Do they have a family? Pets? What do they do for work? Favorite hobby? Favorite vacation place? Even if you’re scrambling for time, act like getting to know that patient is the only thing on the agenda for the day.
After that, I’ll let them know that I’m going to take a very thorough look during my exam, will make some notes, and then sit them back up to discuss it with them. After diagnosing what I see and taking pictures, we’ll begin to discuss everything and what the patients’ options are.
If the patient has been coming to the practice for quite some time, I’ll often preface with, “I’m taking a hard look at things and have some options for you that will give you the best chance of having your teeth last the rest of your life.” Most patients want to keep their teeth for the rest of their life, so this is an easy point for them to agree with.
Dentists should view themselves as being mediators between what dentistry can offer patients and the patients themselves. Every person has different concerns. If you can learn someone’s specific issues—money, time, pain, etc.—you can help provide better solutions.
At times, patients may look overwhelmed when discussing treatment. Don’t ignore that—acknowledge it. Say something like, “I can see I might have overwhelmed you. I want you to remember that you always have the option to do nothing. I’m simply here to let you know what I’m seeing, what could be coming down the road, and how we can prevent that if you’d like to.”
In my experience, every time I say this, the patient gets a little more relaxed and realizes that this isn’t some high-pressure sales pitch but a discussion with decisions that I’m trying to help them navigate. I’m on their side, I want to help them find something that works for them.
Here are some other things I find myself saying that tends to help the conversation:
“I’m just letting you know what I’m seeing and what your options are. These are your teeth, not mine, so I want to help you find a solution that works for you.”
“I could just not bring any of this up and tell you everything looks fine. That would be easier for me. These can be difficult conversations to have. But if I didn’t force myself to have them, I wouldn’t be able to sleep at night. It’s totally up to you to decide what you want to do, but it’s my job to at least let you know what I’m seeing.”
If you can convey to patients that you care for them and are genuinely trying to be honest with them, they’ll appreciate it. They may be ready to jump into treatment, they may not. But either way, the majority will perceive your good intentions, and will continue to come back. This allows the dentist to treat those who are ready and continue to build relationships with all patients.
If there’s nothing else you take away from this article, remember this: You can have the lifestyle you want, and the practice you want. I have made—and still do make—plenty of mistakes. I am just an ordinary dentist like you. But if I can put in the work and reach the lifestyle I want, I know you can, too.
John Maxwell said, “It’s easier to go from failure to success than excuses to success.”
Commit to yourself. No more excuses. You are in control.
Decide where you want to go, and put it into “Drive.”