Be Ye Not Afraid, Ye Art a Dentist After All

Be Ye Not Afraid, Ye Are A Dentist After All Or Who Will Own The Dental Profession

Once upon a time, the medical profession actually belonged to physicians. Medicine was a cottage industry and most physicians managed their own practices, much like most dentists do today. Then something happened – the ownership of the medical profession shifted from physicians to big business. Physicians as a

group evolved into working for corporate owners and not themselves. Unfortunately, many physicians became unhappy

with this new arrangement of working for hospitals, insurance companies and medical PPO and HMO organizations. What caused this to happen? My guess is that physicians were lured by the prospect of not having to invest in buying or starting their own practice, or the arduous process of the day-to-day of management of a practice. While these were definitely risks and duties that most medical professionals were not trained in, suited for, or even rewarding, they are the price of practice ownership and the benefits that go with it.

So was it worth it? Medicine is now big business, much like major league sports. The purpose of business entities is to make a profit for the owners of the business. How is this done? The first strategy is to lower costs, and in any business, lowering salaries is the first cost

EARL DOUGLAS, DDS, MBA, BVAL Power To Succeed

cutting measure to consider. Business owners had to learn how to get more results for less cost, and something had to give. In medicine, the giving was done by the participants in the game with no control – the physicians and the patients.

their own practice. While a few students whose parents were dentists were joining them in practice, the remaining supermajority of dentists intended to become associates, working for other dentists. This is a major shift from the era when I graduated, when the most of us fully intended to have our own practices.

I am now seeing the process that changed

I first noticed the emergence of corporate dental entities in the 1980s. Many of those original companies are no longer in existence and corporate dentistry seemed to fade away. But at the beginning of this decade, I began seeing more and more corporate companies and the companies were larger and better managed. We are now accustomed to seeing the large corporate entities building practices and buying practices and hiring dentists to staff those offices.

the face of medicine

beginning to make headway in dentistry.

I am now seeing the process that changed the face of medicine beginning to make headway in dentistry. A year ago, my assistant Rebecca Kyatt and myself went to a student encounter at a major dental school. We met most almost every student from all four classes and asked everyone we met what their plans were after graduating. To our great surprise, only one person intended to buy or start

The question is, will dentistry evolve the same way medicine did, in which well-educated professionals who owned their own practices transition to work for big business, having little or no voice in the management of the practice? As of May of last year, there were an estimated 25 dental management companies employing an estimated 12,000 dentists, or 8 percent of the licensed dentists in the country. There is no doubt that dentistry is a target for entrepreneurs, and the entrepreneurs are no longer only dentists, but are now the businessmen who would make a living from the efforts of dentists.

There are many other corporate practices employing dentists. They are all not of the magnitude of the largest entities, but may be owned and managed by dentists who may or may not practice, or who

are licensed and are the sole owner and manager. Considering these additional entities pushes the number of employed dentists to some very high levels.

So that’s all very interesting, but what is the point of all of this? It’s not meant to bash any group or any entity, or dental practice management style or structure, but to remind us of the advantages of owning our own practices that so many dentists have overlooked as they choose a more comfortable but less rewarding option of working for someone else.

The name of this magazine, Dental Entrepreneur, implies that it is directed to the dentist who is entrepreneurial in their approach to their career. While there is no question that not every dentist is best suited to own and manage their own practice, I note that the proportion of entrepreneurial dentists is lower than it has ever been and continuing to decrease. I’m not purporting that there is any given percentage that the profession should maintain as owners, but to emphasize to students and dentists to look carefully at their choices.

We do acknowledge that there are benefits to practicing for someone else, including not having to manage and administer, not having to borrow money and be in debt, and the stress that goes with those items. For a dentist to take on those burdens, there must be some strong offsetting benefits.

First, there is the freedom to set your own course and philosophy of practice. You can create a treatment plan by your own standards, not by those set by managers who may put time and motion studies before patient needs. Your conscience and that of your patients will benefit greatly by this advantage.

You will set your own fees, being as competitive or as independent as you please. You will decide which managed care plans, if any, that you choose to participate in and in the process set the tone of your career.

You will decide who works for you. As an owner, you will hire the staff you feel is best qualified to assist you in your practice, train them to your style and your standards. If a staff member is not living

up to the standards of their job, you can return them to the community.

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There are substantial tax benefits from starting or purchasing a practice. As an associate, there’s no opportunity for tax relief from depreciating and deducting expenses which someone who invests in their own practice can do.

Another method that can borrowed from franchises are instructional audio/ video training materials (cheaply made and easily produced) which new employees must work through and be tested on (think of the time saving in this alone!).

You have the freedom to formulate and contribute to your own pension plan. Your contributions can be larger than those of an employee, and you can decide on the best plan for your circumstances.

The benefit of a well-organized training system for staff includes a shorter learning curve, stronger commitment to the practice and less need for dentist’s time – all of which means a healthier bottom line.

Practice owners also can enjoy many perks that are tax deductible, whereas employees do not have the flexibility of exercising these benefits.

Profit by Design – Predicable Profit Provides Stability

I have yet to meet a dentist who knows before year-end exactly how profitable they are, while a franchisee knows precisely how much profit is in everything on the menu. This lack of necessity to monitor margins can lead to waste, sloppy financial habits, chaotic cash flow and possibly bankruptcy. Dentists can avoid this by taking a mantra from fast-food franchises: monitor and control overhead! Payroll is a practice’s most significant cost and can be kept under control by 1) Creating a set scale for wages from starting wage up to increments earned by set achievements, and 2) Being prepared to prune excess hours, staff and non-productive employees.

Owners are able to choose insurance policies that best meet their own and their family’s needs. You choose the health, life, disability, long-term care and other policies that work best for you, and not the lowest cost, minimal benefit policies that may or may not be offered by your employer.

Some dentists feel there is a sense of security in working for big business, but the bottom line is, unless the employee is covering their overhead expense and making a profit for the employer, the employer will replace them with someone else. So my point is, if the dentist can make the employer’s practice and profit bigger, why wouldn’t they do that for themselves?

Operating a dental practice by reinventing the wheel or learning by trial and error is counter-productive and unnecessary. As a new dentist, you can avoid that trap. Simply look across the street at a busy fast-food franchise and ask yourself, “What would they do?” The answers are as close as your next cheeseburger! ■

There is a satisfaction that can only come from knowing that you are a member of an esteemed and important profession, and not simply an employee of big business, whose job is to make the most profit for its owners. I guess I really do believe that the profession of Dentistry should belong not to the MBAs and the CPAs, but to the doctors who practice it. ■

Kristin Nickells is a Certified Executive Coach working with dentists to make their practices better and easier to run. She makes learning business, communication and leadership skills fun. Her programs, Business Bootcamp for Dentists, Would You Like Floss With That? and Keep Your Staff Without Losing Your Mind are designed to help dentists and their teams stay sane in a crazy industry! Kristin speaks for dental groups and her articles have been published in leading dental journals. Contact Kristin at Nickellsilver Business Solutions Inc. (250) 248-1926; coachk@nickellsilver.ca www.nickellsilver.com

154th ADA Annual Session October 31 – November 3, 2013 New Orleans, LA

Greater New York Dental Meeting November 29 – December 4, 2013 New York, NY

149th Chicago Mid Winter Meeting February 20 – 22, 2014 Chicago, IL

102nd Hinman Dental Meeting March 27 – 29, 2014 Atlanta, GA

California Dental AssociationSpring Session May 15 – 17, 2014 Anaheim, CA

155th ADA Annual Session October 9 – 14, 2014 San Antonio, TX