OWNING A PRIVATE PRACTICE: MY FIRST WEEK
On my first day of practice ownership, I realized my lone dental assistant had never assisted at the chair; the former assistant (the one who retired with the previous doctor) was actually the main chairside assistant. Welcome to human resources.
On my second night of owning a dental practice, my hygienist left a message for me on my answering machine: “Hi, Dr. Knowles. I don’t think this is going to work out. I am quitting.” Welcome to being the boss.
On the third day of owning my practice, the sewer backed up and the basement started to flood while I was seeing patients. Apparently the septic tank was overdue for being pumped out. Welcome to owning a building.
On Friday it was payday, and my team expected their checks. The problem: I had never completed a payroll in my life. Welcome to being a small business owner.
I needed a plan, and I needed a plan fast. Who was I kidding? There was no time for a plan. I was in complete survival mode. As one can tell, the early stages of owning my business were not too pretty. But, neither was dental school. If there was one really good thing that dental school did, it enhanced my ability to survive under pressure in uncharted waters. I was back in the boat again, looking desperately for dry land. Only this time, it was my turn to steer the ship and to make the rules that I would live and die by. I was scared and excited at the same time.
MY INITIAL PLAN
Rule No. 1: Develop a plan for long-term stability so that future weeks would never be like my first week in practice.
Rule No. 2: Make time to read every book and manual I could about business management and leadership development (an obvious weak area in the dental school curriculum).
Rule No. 3: Learn to laugh and/or cry more. Both are cathartic.
Rule No. 4: Establish an immediate support network including the following:
- A talented accountant who (preferably) has experience working with dentists
- An attorney familiar with small business law and employment law
- Fellow trustworthy dentists (often classmates, local dental society members, or study club members)
- Local and state dental association acquaintances.
Rule No. 5: Explain to family members that I would need more support, leeway, time, and help than initially anticipated; enlisting them in any way that may assist getting through the survival phase.
THE DECIDING POINT
It was amidst the chaos experienced early on in my practice that a heavy realization came over me: either my practice was going to control my life, or, I was going to control my practice and life. I had a choice.
On one side, there was the debt with the constant need to make money to pay the office bills and the staff. There was a desire to make the practice exactly the way I envisioned it while gutting my way through dental school. There was the desire to show the patients that I was just as good as their previous dentist. On the other side, our home was mortgaged, and my husband (who had just co-signed his life away) and I were often tired, in need of rest, good food, and time together. Oh yes, our 2 children also needed their “mom time.” In addition, there were neighbors to meet, charities to support, family events, household organizing, and schedules to arrange. Who, or what, would get the needed attention? And, how much, and when?
When we stop being intentional with regard to our choices, our practices can begin to take over our lives. We unintentionally begin to live by the fire fighter approach: put out fires, save as many lives as possible, and just hope for the best. This lifestyle is exhausting!
ON BEING INTENTIONAL
Being intentional is not only effective, it can be life saving. I really mean it! Too many dentists burn out early, have health problems, or simply begrudge going to work every day; that is no way to live. One of my early decisions was to have evening hours once a week to accommodate our patients’ commuter lifestyles. Instead of working every day from 9:30 am to 6:30 pm, we opened at 7:00 am on certain days in an effort to accommodate some of our patients before they went to work. Patients loved it! I hated it. I began to dread the long evening hours day. I did not mind the early morning day because I am an early riser, but my kids did not like leaving early one bit. We had already established a morning routine that included some time for love and comfort. This was missing on the days that we started at 7:00 am.
The pressure to make money and pay back loans was intense, so I did what I thought would help the practice thrive and grow. But, when I reflected, I realized I needed to be more intentional with my choices. I needed a compromise. I decided to change the evening hours to end at 5:30 pm, and opted to change the 7:00 am to a 7:30 am start. With these small adjustments, my quality of life improved, and the practice still produced the same amount of money. Oddly enough, this equation held true every time I changed my hours. We, as a team, became more efficient. Our systems became more organized, and we worked fewer hours, yet made the same, if not more, money.
Our scheduling became more intentional, too. Block scheduling became our norm after years of fighting this notion. In previous practices, the patients ruled because we would bend over backwards to accommodate their schedules. We would see back-to-back-to-back pediatric patients because it was the prime after-school time. We would work in emergencies almost anywhere to show that we were open and accepting of new patients.
Certainly I am no dummy with regards to customer service and I do recognize the need to provide ample opportunities for patients. But, there must be an intentional balance in this concept. The dentist must be accommodated, too, as a quality of life factor. The more tired I became with back-to-back pediatric patients, the more irritable I became, and the less satisfying I became to others. A “get ‘er done” mentality would creep in, rather than a mentality of care and concern. This notion of diminishing returns on investment became relevant in a number of ways. Put simply, I am no good when I am no good.
Quantifying this for a dentist is hard to derive, and it is different for everyone, and it can change. In the beginning, when I was in survival mode, I would sacrifice my soul to avoid bankruptcy. This novice way of thinking was real, and I was able to endure more procedures and longer hours, but only for the short term. My soul caught up with me. And I would have meltdown moments where I would lash out at my staff, my family, or myself. I was too busy. Every dentist has a breaking point and knows when that moment arrives. You simply have to recognize it when it happens (or even better, before it arrives), and change some things before you end up resenting your work, your family, or your office team. This takes awareness and intentional planning to change.
PAY ATTENTION TO YOUR DESIRES
So be aware: your abilities to fulfill your desires and dreams will change (you will not always be in debt) and, with those changes, you will likely want to change how you practice. If you ignore your desires, your practice will own you, and your quality of life will diminish. Trust that you can have both a fully functional business mind and emotional mind and know that making intentional changes to balance your life and practice can be a good thing. The better we are, the better they are.
Dr. Knowles’ interest in whole health dental care and communication grew throughout her extensive educational background at Alma College as a mass communication major, a student at the University of Michigan Dental School, and a resident at the Ann Arbor Veterans Hospital in Michigan. After 15 years in private practice, she founded IntentionalDental Consulting, a business that allows her to provide thought leadership and communication expertise to the dental community. She can be reached at (517) 331-3688 or via the e-mail address intentionaldental@gmail.com.
Disclosure: Dr. Knowles reports no disclosures.
