Dwight Jones, DDS
A few years ago, I thought I was getting burned out on dentistry. On one of my major stress days, I had an idea that seemed radical at the time. I realized that any dentist could go fishing six days a week if he wanted to. One day a week at a group practice could supply enough income to provide for the basic necessities of life. What we do with the remaining six days is entirely a matter of choice. If we choose to spend our lives working, that work should be at least as satisfying as fishing.
Over the following months, I tried to design a dental practice that would be "more fun than fishing" (MFTF). Money was no longer a big concern; I just wanted to enjoy dentistry again and do some good for my patients. Of course, I wanted the office to succeed financially, but group practice would always be an option if MFTF didn't work out. How many homeless dentists do you know?
We all have heard the saying "Do what you love and the money will follow." Does this sound like a recipe for financial problems? My take-home pay actually was quite low during the transition to MFTF. Much of what would have been profit went to pay for improvements to my office and to myself. Most of these expenditures were one-time expenses done on a pay-as-you-go basis. I felt that this was a better investment than enlarging my office.
Big-office dentists are stuck with a permanent overhead that ensures they always will need to do a high volume of dentistry. Working efficiently in a smaller office can be as profitable as killing yourself in a big one. After the improvements were paid for and given time to work, my hourly net income is about average for general dentists. This is true even though my fees are low and my office is a very laid-back and low --stress place to work.
A casual observer would see three things that should keep me from succeeding financially, but these are the very things that have helped my practice succeed:
- Small office in a poor location
- Very few big cases
- Don't work as hard as some dentists do.
Lets look at each of these "problems" in order.
I'm located next to a feed store in a low-income, rural community. We don't have a lot of demand for veneer cases, but there is a large demand for bread-and butter-dentistry and for pediatrics. The fees are low, but there is little competition and no capitation. In the end, all these things balance out financially. The "bad" location makes it possible for me to make a difference with kids who might not have a good dentist if I weren't here. This is more satisfying than doing cosmetic procedures that I wouldn't choose for my family or myself.
I saw an article by a dentist who claimed to make a higher hourly net from basic restorative work than he did from doing crown and bridge. I'm sure it doesn't work that way in every office, but it does illustrate the fact that we don't have any financial need to pressure people into treatment they don't need, don't want, or can't afford. Why not just be honest and let people choose what they want? Even in my low- income town, most people choose treatment that is a few steps up from what they would be getting at an HMO practice. Ironically, I do more crown and bridge now than I did when I needed to sell crowns.
Working efficiently in a two-chair office is not hard work. If things really go smoothly, you actually can make some money. To this end, it pays to watch as many dentistry videos as possible. Watching other dentists is the only way to pick up all the little tricks that help things go smoothly. An hour a week watching others is a good investment if we learn just one thing that improves quality and/or saves five minutes a week for the rest of our lives. Those of us who are really lazy should consider spending two hours a week learning from others.
Digital X-rays, high-speed curing lights, air-abrasion units, quality materials, continuing education, and great staff members - these are things that help us do more with the space we have and increase quality at the same time. Many dentists are reluctant to spend money on these things, but they are willing to spend money enlarging their offices. This frequently leads to getting stuck with a permanent overhead so high that it forces them to work harder and spend less time with each patient.
I will admit that there is a limit to what can be done in a small office, but we can do plenty if we are organized. It is better to run out of room for new patients than it is to run out of patients to fill new rooms.
Some may think that an average income is nothing to get overly-excited about, but I think it's significant if you consider the amount of fun I'm having. I do exactly as much dentistry as I want to do, my stress is way down, I get lots of vacation time, and I'm doing what I believe in. It's more fun than fishing!
Goals of a 'More Fun Than Fishing' Practice
Before sharing the goals of my MFTF practice, I should point out that your ideal practice could be different than mine or anyone else's. I like to work with children, but other people will enjoy other kinds of practices. That's OK - at least we aren't competing for the same patients.
Here are the goals for my MFTF dental practice:
- I will take care of people who actually need a dentist.
- I will see children about 75 percent of the time.
- I will be completely honest with patients, staff, and insurance companies.
- I will never do anything that I'm not good at.
- I will take more continuing education than necessary.
- I will like the people I work with.
- I will work a four-day week, take six 10-day vacations each year, and allow myself six 4-day weekends per year.
- I will never turn away a child who needs my help. This means that I do accept welfare and I spend a significant part of my day with foster children.
- My office will never be larger than two or three operatories.
- I will never sign with an HMO.
- My fixed overhead and living expenses will be low enough to ensure that I will never have to give up any of the other goals for my practice.
Dwight Jones, DDS, has been practicing for the past three and a half years at "Lake Los Angeles," Calif., a small town in the Mojave Desert. Prior to that, he spent some time with the Indian Health Service. Contact him by e-mail at email@example.com.