The day of awakening

With his eyes full of despair, my client, David, whined, "Where has all the money gone? I`ve put in 25 years of practice, attended every CE course under the sun, own all the right dental stuff and I`m still going to have to work for another 25 years to retire. I`m going to drop dead chairside."

Dentistry is more than just a hobby that you master. Prosperity is a vital part of the fulfillment.

Paul Homoly, DDS

With his eyes full of despair, my client, David, whined, "Where has all the money gone? I`ve put in 25 years of practice, attended every CE course under the sun, own all the right dental stuff and I`m still going to have to work for another 25 years to retire. I`m going to drop dead chairside."

David`s wife, Karen, rolled her eyes. "Where has all the money gone?" she snapped. "Just look around you. You`ve spent it. And what you haven`t spent, you plan to."

David and Karen were not having a good day. In fact, they`ve had a string of bad days. First, a close personal friend and colleague lost a malpractice suit that sent shivers up everyone`s spine. Then, cancer struck another colleague and within three months, he was dead. To top things off, a long-time mentor suffered total financial collapse, which involved an ex-wife, a barracuda domestic attorney and the IRS - an explosive combination. David and Karen were close enough to that situation to get emotional "powder burns."

"It`s time to get our house in order before ..." David started to say as Karen jumped in. "Before we end up like our friends," she warned.

Wake-up call

Yes, change was in the air that day - the "Day of Awakening." The day when it suddenly occurs to us that prosperity is pushing past us, like a stranger in a crowd, and we wonder why. It`s the day an unmistakable anxiety settles on us and won`t leave us alone; a day that can teach us that we`re ready to grow - if we let it.

David and Karen were ready to get their house in order. Too many years had slipped by, and the unthinkable suspicion that maybe their house never would be in order fed their fears.

"Where do you think you should start?" I asked.

"Well, I`m thinking about taking one of those advanced endodontics courses," David offered.

This was a predictable response from a dentist who already held most of the fellowships from various academies. A response that many of us have had, believing that additional technical training holds the key to prosperity. Unfortunately, this response leads many of us down the wrong path. The Dental Gods are kind to us when they give us our "Day of Awakening." It`s their way of telling us that what we`re doing isn`t working. Here`s a clue: Additional technical training works against prosperity for many seasoned dentists who are working harder, but enjoying it less. Here`s why.

Prosperity`s beginnings

When we first enter private practice, our prosperity is directly proportional to our technical skills. We take courses in occlusion, prosthetics, cosmetics, implants ... the road to glory seems paved with the acquisition of new techniical skills. (See Area 1 of the chart on the next page.) Our practices grow, we add staff and we expand our facilities. Things are rosy and we seem bulletproof.

Then, one day, we have an entrepreneurial fit, a "vision" (Area 2). We think, "What if I go ahead and build that big office or buy that big house?"

We base this major financial decision on the illusion that our production will grow to meet the new demand for debt service. Not long after the dust has settled from our vision and the new mortgage payments begin to take their toll, we discover that our collections have leveled off (Area 3). The harder we work and push our practice, the harder our practice pushes back. We have hit a plateau in our earnings, and we are running painfully short of our expectations and cash-flow requirements (Area 4). That`s when the ghosts of our vision begin to haunt us.

Many dentists react to this haunting by resorting to the strategy that got him or her in this predicament in the first place - taking more technical courses (Area 5). It`s an easy decision to make because it`s become a habit. More technical courses can lead to more work and higher overhead, so now the noose tightens. Unfortunately, some dentists spend the balance of their careers pursuing collections, only to watch their dreams of prosperity go out the door with the accounts payable.

This is not to say that these dentists don`t enjoy their work. Many of them are masters of their art and gain incredible satisfaction from a job well done. But as the years wear on, they find themselves no closer to their dreams of prosperity. They are like the old man who builds ships in a bottle. You`ve seen him at state fairs and craft shows. His work is showcased around him. Intricately assembled, tall-masted ships, laced with taunt strands of rigging, posing in clear, thick glass bottles. He loves what he does! It`s what he knows ... but it has brought him no closer to his dreams of prosperity. He`s a hobbyist, like so many of us.

The hobbyist dentists

At some point, usually near the end of our second decade of struggling, the hobbyist dentists takes technical courses, not because they think it`s the right thing to do, but because they think they have to. It`s the only thing that temporarily relieves the ache of financial commitments. For a few days, these hobbyist dentists are OK. But, when they return to their office, the ache returns. The hobbyist dentists have now turned into addicts (Area 6). One CE course is too many and a hundred courses aren`t enough.

Many technically addicted dentists refuse to change, so they burn out. Phyliss Waite, a prominent West Coast consultant, put it best when she said, "Burnout is simply not having the courage to make necessary changes."

Another group of dentists reacts differently to the "Day of Awakening." Instead of making the habitual decision of taking more technical courses, they pursue a different path. This path is one that leads to different skill sets. These skills are the management of people, money, time and opportunity - entre-preneurial skills (Area 7).

Entrepreneurial dentists

With better entrepreneurial skills, the recurring cycles of escalating overhead, staff turn-over and stress can be controlled. For example, the dentist who has never-ending staff trouble and turnover is much better equipped to deal with it through the thoughtful management of people than the dentist who chooses to ignore the problem, blames the staff for laziness and a lack of commitment, and then runs off to take another course on cosmetic dentistry. Similarly, understanding time management is a far better way to deal with the pressures of multiple priorities than taking a course on implant dentistry.

The wonderful irony is that entrepreneurial skills facilitate and provide the foundation for new clinical skills. New clinical skills are easier to apply when they are implemented within a well-managed practice with great cash flow and abundant new patients (See Area 8). Dentistry can become fun again and our clinical quality will soar. Look at the careers of prosperous dentists. If you map out the contributing factors to their prosperity, you`ll see the clinical skills provided a good start toward prosperity. But it was the blend of entrepreneurial skills - facilitating advanced clinical skills - that contributed to the lion`s share of their prosperity (Areas 9 and 10). Many wise dentists have said, "Our best clinical quality begins the day after we reach financial security."

David never took that endodontics course. Instead, he and Karen found a financial adviser and confessed all their financial sins to him. Now, they`re spending less, investing more and they`ve noticed a twinkling light at the end of their tunnel.

"And I`ll tell you what`s the icing on the cake," David bragged. "My marriage has never been better!"

Karen winked, grabbed her gym bag and sailed out the door to her belly-dancing class.

The stages of `waking up`

Here are three giant steps for you to consider on your "Day of Awakening."

1. Get a comprehensive financial plan.

Start now. Find a financial planner familiar with dentistry and follow his or her recommendations. Develop realistic budgets and set short- and long-term goals. Time is not on your side if you don`t have a plan; it is if you do. Read financial-planning books and listen to audiotapes. Subscribe to a good financial-planning newsletter. Align your staff members with your plans. Lead them to get their own financial matters under control and raise the awareness of financial goals to everyone around you. Get your family involved with the financial plan. Make pursuing prosperity a habit.

2. Build your communication skills.

The demand on our language skills is compounding. Just look at what`s going on around us. Clinical and administrative technology brings a new vocabulary - surface passivity, RAM, URLs. Patients have become far more discerning and critical about health-care conversations with their dentists. The media are forcing dentists to defend themselves to patients. Now, more than ever, dentists and staff need excellent language skills. When was the last time you had training in language skills?

Enroll in a business communications course. Business-seminar companies have many communications-course packages. Lan-guage-skill audio programs are convenient and inexpensive. Join your local Toastmasters Club. Take courses in pubic speaking, persuasion, leadership, gender-sensitive communication issues and storytelling. Dentists with atrophied language skills are common. If you want your practice to have impact, you and your staff must have impact.

3. Focus on relationships and rapport.

Have you ever met someone you immediately liked or disliked? Your patients have had the same experience - with you. The level to which you`ll build your practice is dependent upon your ability to build rapport. To patients, rapport is quality.

Don`t get confused. I`m not pitting standard of care vs. personality to define quality - the patients are! Ask people what they like about their dentist. What do they say? They say things like "she`s good with children," "she listens to me," "he`s gentle," "I like the staff," "it`s an upbeat office" and "everyone`s so nice there." These are rapport issues.

Standard of care isn`t the part of quality that patients respond to. Prove it to yourself. Double what you believe to be clinical quality. Take every course you can find on any clinical topic you`d like. Will you double your practice? No. For decades, dentists have used the clinical-quality approach to build their practices. As a result, we have thousands of dentists who are terribly frustrated with their careers.

Now, try doubling your ability to build rapport and establish long-term relationships. You`ll find the biggest payoffs in overall practice development and prosperity are gained through efforts made in the area of rapport. With respect to your patients` perception of your quality, incremental gains in rapport-building far outperform incremental improvements in technical refinement. Do you want to lift off the financial plateau? Focus on relationships!

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