George Bailey, DDS vs. Henry Potter

Well, I just sat down to my ritual of watching "It's a Wonderful Life". I think it is airing on NBC next week, but we bought a copy a few years ago right after they stopped showing it four times a day for a month before Christmas. I guess we had become addicted and were afraid of withdrawal pains. Actually, my wife won't watch because it makes her cry too much, and the teenagers are way too cool to watch anything in black and white...so I watched alone...again.

Anyway, it started me thinking about how many of us look across town at the guy/gal driving the new Mercedes pulling into his/her huge parking lot at his/her enormous practice and feel a little like a failure, just like old George Bailey. There are some very nice and very happy dentists (not Henry Potters) with enormous practices, so I am not making that statement.

However, we should take a little bit of time as this year closes and another begins to be honest with ourselves. (Maybe, we can miss the Cumquat Bowl between Montana Tech and East Texas Normal this year). Sitting with a pen and paper we should write what really makes us happy. Sometimes, we get so wrapped up chasing symbols of what we think will make us happy that we lose sight of the point. Each and every individual is as different as snowflakes.

There are many dentists who need the hustle and bustle of a large, busy practice to feel fulfilled...and, there are dentists who work completely alone. Both may be perfectly happy. The hardest part is to honestly assess ourselves.

There was a study done of multi‑million dollar lottery winners several years after they won, and more than 90% said they were happier before their windfall. I'll be honest, I think I would be in the other 10%, too...but, maybe not. It is the striving, the journey itself that makes us happy, not the arrival at the destination.

Dentists are particularly susceptible to misdirection of goals, I think, due to above average intelligence and potential...conflicting with caring, giving natures. Since all surveys say that happiness (the real objective) is gained from family, friends, religious devotion, and feelings of self‑worth, why not simply concentrate on those areas, first. The joy and pride we feel as our child sings most of the words in the holiday program choir correctly (but off‑key) is not lessened at all, if we drive there in a Plymouth Voyager rather than a Rolls Royce. And, if we miss the whole thing because we are too busy meeting with architects on the new facility, what is the point?

Obviously, the practice must be solvent and stable. It is difficult to be very happy with a practice in turmoil and bill collectors beating down the doors. Solving that does not mean you have to gross $1,000,000+ in a 10,000 square foot facility though. Just get everything organized.

Henry Potter was not happy, and George Bailey was. He just seemed to lose sight of the true values. During this season, I think we should take a bit of time to assess our goals and dreams, and make certain we are not substituting symbols of happiness for real happiness. Then, for goodness sake take action. Do something different, if a change is necessary. (I mainly refer to the practice, however. Recent studies have conclusively proved that people who manage to stay married are ultimately much happier than those who jump from relationship to relationship. Also, the children we have produced with our society's encouragement of divorce are in deep turmoil. The studies show that the children are not better off...they are much worse off...we have just used that as a self‑indulgent excuse.)

While you're missing the Cumquat Bowl you might also want to set some realistic goals and plans for the practice next year. Planning is key to practice stability.

We are making our annual tour through hometowns to end up in Florida for a week or so. Will broadcast "tidbits" from there next week. Have a great week, holiday, and Wonderful Life..

Hurston Anderson

(813) 963-7228

PS: Stabilizing the practice means everyone knowing what to do in every situation. Our Practice Management Cookbook is designed to assist there (199.95 plus s/h 12.50) and our Protocol Series (Hygiene, Scheduling, Team Building, Marketing, & Finance) are to establish protocols, procedures, and systems in critical areas (179.95 plus s/h). Fax Visa/MC to (501) 223‑8557. "It's a Wonderful Life" is from Liberty Pictures available on NBC next week , I think, and at any video store. Clarence "the angel" is available only through discussions with the appropriate individuals in heaven.Order on line at our store.

Value In Teamwork And Mentors.

In more than twelve years of working with dentists in their practices I have met many who are leaving, would like to leave, or have left the profession. However, I have not met a single healthy dentist who wants to abandon the profession because he/she is discouraged with the clinical part of dentistry. It is always the business of dentistry that is the problem. And frankly, staff issues are probably the most common reasons for high stress for dentists.

These staff issues may also exacerbate other problems, of course, like financial difficulties; but, with a competent, enthusiastic staff I am convinced that almost any practice anywhere can prosper. We have seen struggling dental practices reach unimaginable heights of success simply with a slight change of personnel chemistry, and we have see the opposite happen, too. Generally speaking, the doctor can perform the dentistry if the patients are in the chairs. He/she cannot schedule, confirm, seat, bill, collect, sterilize, and dozens of other daily tasks, also. (There are a few rare exceptions of dentists operating all alone, but they are only subsistence level practices, or there is some unique situation.) 99.9% of dentists also must be managers.

The problem is that there is a vast difference between the personality types who are interested in care-giving and those who are attracted to management as a profession. Frankly, too many dentists are not able to feel comfortable with the type of personal relationship they should have with the staff. They either become too friendly or too aloof. It is almost impossible for the doctor and an employee to be close personal friends and still work effectively together at the office, and an intimate relationship is always a disaster. DO NOT DO THIS! Likewise, dentists should not be so cool to the staff that it appears almost like a servant and master situation. The appropriate relationship is somewhere in the middle and it varies slightly based upon the personalities of the individuals.

Part of the reason that dentists can be guilty of handling staff ineffectively is that there is almost never anyone to talk to when you are at the top of an organization. That is true whether you are Dr. Jones, a dentist with a staff of three, or Bill Gates, CEO of Microsoft. It is really not fair and potentially damaging to burden an employee with some of our insecurities and doubts, yet we all have them. As a business owner we have different pressures than does an employee. They must depend on us to receive their income. If we share concerns or fears with them it will weaken their confidence in their stability.

Yet, we cannot be expected to always know the right answer and the best way to handle issues, many of which we have never before seen nor anticipated. I have said often in seminars and elsewhere that I have faced physical fear of many kinds including a silenced 38 six inches from my head held by someone intent on shooting me. However, to me that fear did not compare to facing a payroll the next day for dozens of employees without enough to cover the checks. (Long ago in both cases which both worked out). It is indeed very lonely at the top no matter how large the organization.

Dentists need mentors, friends in similar situations, study clubs, continuing education groups, or something of the like just to have someone to talk to sometimes for advise, commiseration, unscrambling, etc. And it needs to be someone who will not be judgmental nor condescending. I strongly advise that every dentist, or entrepreneur of any type find someone with whom he or she can talk when there are difficult decisions to be made, whether clinical or in the business arena.

As an illustration of the value of teamwork (and mentors), I offer the following two examples.

Horse Pulls. In the past, and even still in some parts of the country there are such things as “horse pulls” (similar to a tractor pull). The idea is to see how much can be pulled by the participants. There is a phenomenon in “horse pulls” that is pointed out by the case of a particular team of horses. One horse could pull 9,000 pounds and the other could pull a little more than 8,500 pounds. However, as a team they could pull close to 30,000 pounds. It is almost inexplicable except that there is strength in knowing you are not alone, and that you are doing the right thing.

Sequoia roots. If you have ever traveled in parts of California, you can almost not believe your eyes when you get near the mighty red wood trees. (Sequoias, I think). They can reach in excess of 300 feet in the air with trunks nearing thirty feet in diameter. It is one of the most wondrous sights I have ever seen. Yet, I am told that the root system for these enormous trees goes down only five to six feet. In fact, the only way that the magnificent trees withstand the wind and sheer gravity is that their roots are entwined with those of all the others in the area. One could not stand alone. It takes the support of all the others to allow them to stand tall and strong for hundreds of years.

If I seem to have wandered afield here, I apologize. I am trying to point out the value of teamwork in the practice and some sort of outside mentor/peer/adviser for the person at the top. There is strength in numbers and two heads are better than one.

I wonder how many different movie versions of “A Christmas Carol” there have been? I just channel surfed past one on television last night with that guy who played Pickard in the second Star Trek series, Patrick Stewart. Actually, it was pretty good, I thought, but it made me wonder if that is one of the perks you get for getting famous in show business, doing your personal version of Scrooge. And how many of those do we need anyway? Let’s see, there was George C. Scott, Albert Finney, Bill Murray, Henry Winkler, and about five in black and white. One thing, though, the graphics are really a lot more impressive now. Wouldn’t Charles Dickens be collecting a lot of royalties if he were alive?

Have a great week,

Hurston Anderson

813 963-7228

PS: One of the advantages of working with us for in office consulting is that we can become your friend (and mentor) to call on business matters, and we have a good deal of experience and expertise with just about any type of issue that might arise.

If you would like to know what your practice is capable of producing and collecting, email or call 813-963-7228 for a free Practice Production Potential Analysis and/or a free Practice Evaluation. There is no obligation whatsoever, and you need to know what is possible in your practice…and how you are doing toward that potential.

Our Practice Management Cookbook ($199.95 plus shipping/handling) is used daily on five continents to assist in operational issues. In addition, more detailed assistance in specific areas of concern is offered in the Protocol Series (Hygiene, Finance (helps prevent embezzling), Scheduling, Team Building, & Marketing). They are $179.95 each plus s/h or the entire Protocol Series can be purchased for $750.00 plus s/h.

Order on line at our store.

Hiring Friends and/or Family is Tricky.

A dental office is an environment where the entire staff must function almost totally without supervision. Consequently, the team must be carefully chosen, trained, nurtured, and supported. You cannot employ individuals in a dental office who require intensive oversight. You also cannot afford those who are not self-starters. “High maintenance” personalities (defined by me here as those who need a lot of attention all the time) distract too much from the often hectic activity required in a dental office.

Sometimes, there is a temptation to hire friends and family in a dental office. After all, it makes a lot of sense. First, there is the mutual need. That is, they need to work and you need an employee. Also, there is the comfort of not having to meet and learn to work with a new personality. Actually, this can work just fine at times. However, there are some potential dangers. A relationship in the office must be some version of boss/employee. This is completely different from friend/friend or brother/sister or fellow choir member or whatever. Also, you should always think about how you would be able to let the person go, if it does not work out for well. Quite frequently, we keep someone around who is not good for the practice because it is hard for us to admit our friend/relative is a problem, and frankly we just simply don’t know how to solve the problem without hurting the personal relationship. When you are considering hiring a friend or relative, be extra careful. It is easy for the personal relationship to cloud our thinking about their qualifications for the job, too. Err on the side of being too reluctant, if you are to err in this area.

A productive team is created in much the same manner as a fence of rock or brick. In a dental office the doctor is the mason, the mortar, and also a critical part of the structure. Of course, that is why you make the big bucks...or should.

Brick Fence Analogy. A brick fence requires that all building material be exactly to a prescribed specification. The mason builds the fence by selecting any brick (individual) and adding the mortar (management). All bricks must be exactly as required for the fence. For this approach to work the greatest (almost impossible in people management) task is to find or mold the bricks. Inappropriately sized or shaped material must be either discarded or cut down to a particular size by trimming edges and reshaping, but much or most of the original strength is lost in order to become a particular size and shape.

This can be time-consuming and expensive. However, this is the most common approach used for team building in dentistry because it is the easiest. Unfortunately, it discourages initiative, creates turnover, and almost never works over the long-term. A staff of automatons who do their jobs by rote will become the only possible result of this approach. In a practice where there is great dissension and stress this may look like an attractive alternative to the chaos. And, in any practice this may seem more comfortable for the manager/doctor because he/she feels more in control. There is a better way.

Rock Fence Analogy. A rock fence accepts the fact that not all material is alike, as is really the case with human beings. The mason constructs the fence by first becoming acquainted with each available piece of material. He/she never loses the vision of the fence's overall required architecture, but he/she creates the fence utilizing the uniqueness of each to add to its aesthetics and strength. In management this means that personalities, talents, and expertise must not be identical, but they must be complementary. Since we are using all of the building material, there is little wasted. Creativity and individuality are encouraged so long as they fit within the overall architecture. Without a doubt the job of the mason is much tougher, but the result is more pleasing and stronger in the long run. Still the mortar is added to hold the fence together, and sometimes there is a spot that cannot be filled by any of the material requiring the mason to go in search of a particular, unique item.

Because we are working with the entire range of talents of the individuals we are more likely to get 100% of each person's capabilities. It usually takes fewer "rocks" using all of their potential than it does "bricks" molded to use only portions of theirs.

In the hundreds of offices we visit we find team dissension to be one of the greatest producers of stress and reducers of productivity. Consequently, about a third of our Practice Management Cookbook is dedicated to this area, as well as the fourth of our Protocol Series.

Three days of over-indulging over this Thanksgiving holiday has convinced me once again of how much I need to increase my exercise regimen. It is, unfortunately, at one of the busiest times of the year though. The irony is that at a time when the bountifulness of our world is at its peak, we often find ourselves suffering from too much good fortune. Oh well, this is fixable while the alternative is not.

Have a great day,

Hurston Anderson

813 963-7228

PS: If you would like to know what your practice is capable of producing and collecting, email or call 813-963-7228 for a free Practice Production Potential Analysis and/or a free Practice Evaluation. There is no obligation whatsoever, and you need to know what is possible. For goodness sakes, there is no need to worry about being opened up to a high-pressure salesman. We don’t know how to do that and don’t intend to learn; plus, we have no salesmen. The truth is that our clients increase their production by $10,000/month almost immediately, but it is because we are in an environment of mutual trust which is not possible where tacky selling methods are used.

A Very Personal Thanksgiving Message

In the US we will be celebrating our annual Thanksgiving holiday on Thursday with traditional meals of turkey, dressing, cranberry sauce, pumpkin pie, and lots of other foods. In many cases this will all be prepared while watching the Macy’s Thanksgiving Day parade from New York which always ends with the arrival of Santa Claus thus officially kicking off the Christmas season. Afterwards many will sit down in front of the TV and watch any number of football games. Friday after Thanksgiving is the traditional first day of Christmas shopping and the busiest shopping day each and every year. I love all these traditions and privileges, and I am thankful I am blessed to be able to enjoy them.

But this year I have one more thing than usual for which to be thankful. My gratitude, however, is tinged with sadness. You see, my son is a Freshman at Texas A&M and has worked on Bonfire almost every day for weeks. At 6’4” and about 280 he is always trying to hoist the heaviest logs and climb to the highest levels, within the strict rules of the tradition. Last Monday he guided me through the campus and proudly pointed out all the work they had already done on the three-tiered structure that was then still standing tall and strong in the Texas sky. On Wednesday night at 2:30am when the structure fell killing at least 12 students he had just completed writing a paper and was catching a few hours sleep before his duty began on the Stack. The news spread like wild fire through the campus and they all rushed to the site. It was too late, and no number of fellow students could free the dead and dying. The logs were too heavy, too numerous, and too well wired together. As he described the scene somberly, I think I then realized two things…I am an incredibly lucky father, and my little boy has become a man.

Obviously, we all have much for which to be thankful this season. The world in which we live is the most prosperous that it has ever been, since the beginning of time. Per capita, there is more food, more wealth, and more good health than has ever been the case on Earth. And almost all of us live better than man could even imagine two thousand years ago. If we are fortunate enough to have received an excellent education and a professional diploma, we are the most fortunate of the fortunate. In addition, many of us are blessed to be able to own our own businesses and practices. Yet, astoundingly instead of being thankful many of us moan and groan about what a terrible circumstance we have.

A few weeks ago I had a long conversation with an assistant in a practice in Florida who has moved from Poland in the past few years. He (yes a male), in addition to working as an assistant has an lawn care business which has allowed his family to acquire two cars and their own house. You would find no understanding of those who would complain about their circumstances from him. As he said to me, “How can all these people talk about how difficult it is to succeed. At least they can speak the language. Immigrants do not have that advantage even.”

So, we need to remember to be thankful for our situation. Maybe the practice is not going as well as it could, but at least you have a practice. And, if you own your own practice, you have the ability to make it perform to your dreams. It does require, though, that you take action. 1999 is pretty much over and done. Other than some pro-activity with insured patients, you can do very little to affect this year. However, you are extremely fortunate to own your own practice, and if you go into 2000 having had an unsatisfactory 1999 doing the same things and working the same way, you will accomplish about the same in 2000 as you did in 1999.

YOU must make the changes necessary. No one else will. In fact, no one else can. Take action. Think outside the box. Most of all, never forget to be thankful for your intellect, education, profession, health, nation of birth, and (as I believe) God. Take away any one of these, and you would find yourself in a much worse situation.

Say a prayer for the friends and families of those who were hurt and killed at Texas A&M. There is no sadness greater than losing a child, I suppose, and no terror greater than trying to find yours in the night knowing how dedicated he has become to the Bonfire tradition. Be thankful if you will be able to spend these holidays with your families. I know I am.

Have a great Thanksgiving holiday week,

Hurston Anderson

813 963-7228

Compromising Quality for Financial Considerations.

During the course of a year we will visit dozens of practices of clients, prospective clients, friends, etc. Personally, I am amazed at the fantastic dentistry that I have seen in pictures, videos, and in person. Obviously, the most apparent to the non‑professional are the restorative and cosmetic cases, but it doesn't stop there.

Yet, some of the dentists who possess such phenomenal clinical talents are often discouraged, practically bankrupt, and even forced to compromise their clinical principals simply to pay the bills. The net result is that the overall potential quality of dental care is being compromised because of the economic realities of income and expenses. (This is even without the pressure from insurance companies, PPO's, etc.) Unfortunately, too often, excellent dentistry is not performed because it takes too long, is too expensive, is unappreciated, etc. The shame is that it is almost always the business of dentistry that compromises the quality of dental care.

And, it is not necessary. When someone is as good as so many dentists are technically there can be a sense of self confidence in this area. These same individuals have usually excelled at other things in life also, and have rightfully developed pride in their skills. What do you think it does to them when they seem to be totally overwhelmed by the business portion of the practice? Discouragement, stress, feelings of inadequacy, even severe depression and worse. Unfortunately, these are often the least likely to look for help. "I should be able to get this to work."

Ask Michael Jordan...you don't have to feel like a failure hitting .200 in baseball when you are the best basketball player in the history of the game. Having contact with thousands of dentists worldwide, I hear some pretty discouraging stories. But the biggest problem is often the pride of the dentist himself/herself. There is always a way to get help regardless of the situation. Small business management is difficult, but it is not Rocket Science.

Get assistance from someone who can help especially if you are worried about compromising your quality for economic reasons. Management consultants can help. But please, stay away from those who would have you to change everything to do it their way. Many are peddling techniques with success stories that will work for about 10% of the practices. However, the true management professionals will spend the time to get to know the dentist, his practice, and his philosophy....and work around that. It is certainly not cheap to spend this amount of time, but it is the only way to succeed with the wide variety of practices around.

As I advised a young dentist recently, it is even worth borrowing to get the right assistance. Be very careful though...THOROUGHLY check out the company and many, many references. Then, for crying out loud, listen to their advise. Don't spend the money and expect that to solve the problem. You will have to change a few things. Again, don't work with someone who suggests that you become a different personality. That is impossible. Most practices only need a slight fine tuning to move from doldrums to phenomenal success. You can't be doing too much wrong or the doors would already be closed.

If it is just impossible to hire a specialist, look for mentors who have accomplished what you want to accomplish (Know for sure. Many out there look successful and are probably in worse financial shape than you are.) Read everything you can get your hands on. Study dental office management as much as you can. The main thing is...do not expect things to get better by themselves. Don't be like Nero...fiddling away while Rome is burning…or so the legend goes.

I still think the best thing is to hire a professional whether you have problems in your mouth or in your practice. But, whatever you do, don't let business difficulties contribute to lowering the quality of dental care that the public deserves. It is not necessary.

Sorry, this is a bit long this week, but I had some really heartbreaking contacts this week in this area of discussion. Sure, it is true that only your fellow dental professionals really appreciate excellence, but you should still deliver the best dentistry for which you are capable...and this does not have to be compromised due to financial pressures.

This year is pretty much over. There are still some concrete ways to strengthen your performance for the next six weeks, but they are diminishing. However, please do not enter another year…or millennium, for sure, just continuing on in the same way if you are not realizing your dreams for your practice. Make moves, and make the right ones.

I honestly find most of the Y2K hysteria a bit comical. My first job after college was as a computer programmer when we did program all digits in two bytes to conserve space. However, that need to conserve has not been gone for at least a decade. However, maybe I’m wrong. I just bought a new Lincoln and when I was in the dealer’s service area there was a big sign pointing out that all Lincolns are Y2K ready. Now, that never occurred to me. I guess I won’t go out this New Year’s eve except maybe by bicycle…first, I think I’ll call the Schwinn folks to be sure it is Y2K ready.

Hurston

813 963-7228

PS: This is the time that a lot of dentists begin to think about how to make their practices run more smoothly and produce more for next year-2000. Email or call 813-963-7228 for a free Practice Production Potential Analysis and/or a free Practice Evaluation. There is no need to worry about being opened up to a high-pressure salesman. We don’t know how to do that and don’t intend to learn, plus we have no salesmen. The truth is that our clients increase their production by $10,000/month almost immediately, but it is because we are in an environment of mutual trust which is not possible where tacky selling methods are used.

You cannot run a consistently successful practice without sound, written, understandable systems, procedures, protocols, etc. Our Practice Management Cookbook ($199.95 plus shipping/handling) is used daily on five continents to assist in operational issues. In addition, more detailed assistance in specific areas of concern is offered in the Protocol Series (Hygiene, Finance (helps prevent embezzling), Scheduling, Team Building, & Marketing). They are $179.95 each plus s/h or the entire Protocol Series can be purchased for $750.00 plus s/h.

Order on line at our store.

The Essentiality of CHANGE.

To do the same thing day after day in the same way and yet to expect the results to be different is foolhardy. If things are not going as we want them to, we must make appropriate changes. Some of us are like the fellow who drives the same way to work every day expecting to get there faster when he completely misses the shortcut because he is unwilling to take an unfamiliar turn.

It has become a cliché that we must always be looking for ways to change in order to improve. But, this is not only true clinically, it is also true in management. As we assist our clients nationwide, we have observed that there are two approaches to change which can cause difficulty in a dental office

First, there is the dentist who is so averse to change that you want to check his shoes for spats. In reality, this is probably a much more common attitude than we see directly because we wouldn't be asked into these office, usually. As we all know, the conditions around us are changing at a heated pace, we must adjust to survive...and, we must adjust quickly and appropriately to continue to grow and prosper.

Also, there are some dentists who change constantly with little or no direction. With this group changes are made so quickly and so constantly that it is impossible to know if the change is appropriate because another change is effected before legitimate results are measured. There is usually turmoil with the staff including high turnover, a new product of the week, and a storage room full of unused or cast‑off equipment, supplies, manuals, tapes, etc.

Both of these will get you into difficulty. Often we would all like to slow the world down and take a breath. Things are changing around us so much that we would like to at least keep our own environment in some comfortable form. When I was in elementary school outside Dallas my parents bought an old former farm house which was being absorbed even then by suburbs. Some decades before there had been a skeleton key to the house, but we never had it. For almost twenty‑five years before their retirement and move to East Texas they lived there without ever locking the front door. Not long ago this more than hundred year old house burned to the ground because drug‑crazed individuals had broken in and gotten into a fight. Things change...we have no choice.

The difficulty is often to know what changes to make and when to make them. Usually, those making too many erratic changes are concerned and know they must do something, but they are changing before getting control of where they actually are.

Make changes, but know your facts first. Ask yourself these questions.

"What problem am I trying to solve?"...or am I just uncomfortable and shooting from the hip?

"How, exactly, do I expect this to solve the problem?"...where am I now, where will I be after?

"Is there solid, realistic, verifiable proof that the cost is justified?"...too many expensive toys!

"Who can I check with who isn't being paid as a reference?"...NOT the salesman only.

A good source of advice is a successful mentor, but beware. Sometimes flashy, apparently successful dentists are struggling more than you are. A good mentor is proved over time, and is probably not "high profile". Also, search out seminars and workshops on the subject from those not selling anything. And yes, call in experts who have the benefit of exposure to trends and successful approaches from many different practices and environments to help you know what has been working and to customize what will work for you. Most dentists are not completely comfortable with management and don't have much time to invest in management changes with so many clinical changes in dentistry today. Why reinvent the wheel.

I spent most of last week in the southernmost city in the continental US with a new client (now friend) who has decided that it is time to make some changes. In fact, those changes may be essential for long term survival and success. This is not an easy decision for anyone. It takes a great deal of courage to go in a new direction, and it takes a great deal of faith. Dentists are blessed with much higher than average intelligence, and a high majority also possess great energy and tenacity. It is simply not possible to complete dental school otherwise. Sometimes though, that intelligence and stamina can almost be a burden in management. What do you do when you have situations that you can’t out think or out work? No matter how smart you may be you cannot control each individual on your team nor can you control a myriad of other elements which complicate the management of a business. There are things which must be done in a way different from any you have never tried. Consequently, it does not matter how smart or how hardworking, you will sometimes need to go in a direction that is not going to be comfortable, if you want to prosper. It is good to get advise if possible, but it is essential to adjust to the changing climate in dentistry and business in general.

There’s something I don’t quite understand about this antitrust witch hunt against Microsoft. If there is clear evidence that prices are lower for consumers and businesses (as the findings have been) and that there are no injured parties except maybe some speculative investors who feel there IPO’s were not allowed to skyrocket to multiples beyond 200 PE ratio, why has our government spent tens of millions trying to break up the monopoly. Do they really just not like big corporations in general regardless of the overall good that may be done? There seems to be a sudden realization that MS has a monopoly on operating systems. As our fifteen year old was say, “DUH!”. Oh well, maybe I haven’t really realized the great protection this will provide to me.

Have a great week,

Hurston

813 963-7228

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Dentists Are Like Other Business Owners

Dentists do not exist in the same business environment as physicians. It is true that quite a few dentists originally considered medicine, however their chosen profession has thrust them more into the business world than that of most physicians. In the past there were quite a few physicians who practiced much the same as does the dentist today, but now physicians are in groups managed by MBA’s, or whatever. The system is such that you cannot fail to succeed financially as a physician.

Probably very good lobbying. Dentists not only treat patients, but they also must be astute business owners. That is why so many companies which advise physicians are so inept at advising dentists. Physicians need not worry about the normal concerns of a typical free enterprise business owner, but as a dentist you experience exactly the same business issues as does the owner of a factory making widgets. For instance, below I have listed the top ten concerns of all business owners as surveyed by Ernst & Young (or whatever they are now) a few years ago. Read through and see if their concerns are not quite similar to your own.

1. Retaining key personnel (73%) (reducing turnover)

2. Enhancing customer service (71%) (gaining more referral patients)

3. Improving quality (71%) (being the best dentist in the area)

4. Gaining greater market penetration (70%) (raising production)

5. Controlling health-care costs (63%) (same)

6. Getting useful, timely financial information (56%) (same)

7. Managing cash flow (56%) (having enough money to pay bills on time)

8. Growing without loss of control (53%) (good systems and protocols)

9. Building personal wealth (52%) (college for the kids, retirement, etc.)

10. Recruiting key personnel (51%) (where are all the certified assistants, experienced hygienists, and good administrative folks?)

I added the parenthetical phrases at the end, but it is uncanny how similar the concerns of respondents to the survey are to dentists who own their own practices. One point I want to make is that you can expect reasonably good investment advice from those whose experience is primarily in advising physicians, but physicians do not deal with the business issues, so your advice (if you seek such) should come from general business and dental specialists. Unfortunately, investing is not the greatest concern to most dentists.

Now, add the stress that most business owners do not face. That is, that during the day while supervision and management is directly executed, the dentist is examining, drilling, seating crowns, etc. The dentist has an even greater burden. Having come from general business for many years and having now worked in dentistry for more than ten years, it does not amaze me that there are so many dentists who fight their businesses everyday like a new swimmer fights the water. Instead, it amazes me that there are quite a few who seem to have done so well.

It is tough to own and manage any business, and I suggest it is even tougher to own and manage a dental practice. You MUST have solid written procedures, systems, job descriptions, protocols, etc. in every single part of the practice to have a chance for continued success. And, for goodness sakes if you seek business advice don’t be tempted to turn to those who are specialists at working with “real” doctors. They might be able to steer you to a good investment in pork bellies, but they’ll be clueless about the importance of a good recare protocol.

It is terrible to see the loss of such a vibrant and likable person as the golfer Payne Stewart. Somehow it seems better to realize that he and those with him probably didn’t have the terror of knowing they were going to die. It apparently would have been almost instantaneous. We have a good friend whose husband died of a massive heart attack while riding his Harley. Somehow that seems better than a crash. This guy seems to have known his time was short, so he tried very hard to make peace with relatives and friends. Maybe we should all learn a lesson from this. It could happen at any time to any of us, and we may not get the opportunity to apologize, forgive, hug, write, call, or make things right. What are the really important things in life?

Have a very great week,

Hurston

813 963-7228

PS: This is the time that a lot of dentists begin to think about how to make their practices run more smoothly and produce more. Email or call 813-963-7228 for a free Practice Production Potential Analysis and/or a free Practice Evaluation. There is no need to worry about being opened up to a high-pressure salesman. We don’t know how to do that and don’t intend to learn, plus we have no salesmen. The truth is that our clients increase their production by $10,000/month almost immediately, but it is because we are in an environment of mutual trust which is not possible where tacky selling methods are used.

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Salaries vs. Bonuses

One of the things that is often difficult to explain and difficult to understand is why, when, and how to pay bonuses to employees. I am a proponent of bonuses. I think bonuses can be one of the most effective management weapons in a dentist’s arsenal to recruit, manage, and retain a top-notch team. That being said, I also think that many, if not most, dentists handle it in such a way that it actually becomes a dis-incentive…rather than the positive motivator it is meant to be.

A salary is earned for ordinary effort. When employees perform at minimally acceptable levels they deserve their salaries without negative comment and without threats. When employees perform repeatedly below minimally acceptable levels they should be warned officially, given the exact, measurable criteria for improvement, and released if they fail to improve to acceptable levels. No one should ever be made to feel guilty because they have received a salary, even if they do only minimally acceptable work. It is the manager’s responsibility to provide the training, oversight, leadership, and decisive judgment to ascertain if an employee is not salvageable. So many difficult employee situations can be resolved by simply stepping back from the day-to-day relationship issues, and soberly deciding if the employee is performing at a level that merits the salary.

Now my favorite subject! Sometimes you have a team that performs in an extraordinary manner, beyond that for which you are already paying them. This is the best of times, the time for paying bonuses and for heartily thanking each and every one of them personally for their efforts. By the way, bonuses are effective, but nothing is quite as effective as your personal thanks and sincere appreciation. Although it is undeniable that people are more mercenary than in the past, money is not really why people work…within the limits of fairness that is. Really great managers are not those who pay the highest salaries, but those who really, honestly care for the well-being of their employees. Sometimes that means not overpaying, too…but that is another subject.

Bonuses are for extraordinary effort beyond that which one would reasonably expect. In dentistry there are ways to quantify this which makes it easier. We, in our consulting business, face this circumstance with almost every client. In fact, if we do not have this problem, we have failed….in our minds. Because we have faced this so often, though, we have a great deal of experience with results. I can unequivocally state that a bonus is more effective than a salary increase, if handled properly.

Again, I maintain that a dental practice can pay fairly and keep total salary expense including hygiene and all benefits, etc. to 20% of adjusted production. However, whatever your percentage you should pay your employees with a smile on your face and without resentment. It is your fault if they are overpaid, not theirs. Either raise production to make it appropriate, or find employees who are not taxing your ability to pay, but do not ever demean or belittle an employee for receiving her salary. That is abusive behavior which has absolutely no place in management. You are the one who hired her.

Pay a bonus like a Las Vegas casino pays a big winner at the slots. Write a separate check and personally hand it to the employee. This is an event. Play it to the hilt. If your bonus plan is properly constructed, you are like the “house” in Vegas. You are the biggest winner, and you want them to win as much and as often as possible. You see, when they win one dollar you win four. Don’t ever resent or downplay bonuses you pay. It is the greatest investment for future morale and hard work you can have. Pay, smile, encourage, congratulate, and count your eighty cents on every dollar.

I have a section which is in our (unfinished) Team Building protocol about this subject which I will email to anyone interested. It is a bit more specific about when and how to pay bonuses in dentistry. And, I will be forced to complete this book if enough orders are placed. I have some orders, but obviously not enough to inspire me to finish. Email me, though, for the section on bonuses…or to get on the list for the Team Building Protocol.

Southwest Florida is great. You would have to be crazy to complain about the weather. I understand we have more days of sunshine in Tampa Bay than any normally habitable area on earth…plus the highest occurrence of lightning strikes per capita, for compensation I guess. When it rains, it is often angry, but we just had a bit of a nip in the air…not much by most standards, but it reminds me of the joy of the autumn breeze, of buttoning the jacket a little higher, and of the smell of burning oak in the fireplace. Happy autumn to all whether it means the first frost on the pumpkin or a drop into the upper fifties (about 17-18 celsius).

Have a great week,

Hurston

813 963-7228

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So one of the magazines asked me to submit it as an article. The version for them is below.

How To Handle Salaries And Bonuses,

And How They Are Not The Same Thing.

Salaries.

Salary is paid for doing a particular job. It does not matter if the salary is paid hourly, weekly, monthly, or as contract labor. It is still a salary. Salaries in a dental practice should equal 20% of total net production. Collections must be no less than 98% of production, and there is are no exceptions. If that is not the case, that is another subject. It is rare for that to be a problem in the 90’s, but if it is, I say, ala Joan Rivers, “Can we talk?”.

With 98% collections I am saying 20.4% of collections can be spent on salaries. Since almost all dentists are on a cash basis rather than an accrual basis in their accounting, it is likely that you deal more with collections on your financial reports than production. Someday, I will manage to convince dentists of the value of accrual accounting for operational analysis, but as of now, it is likely that your accountant has you on a cash basis, so we are talking percentage of collections. That means salaries including all benefits, even uniforms and boondoggling trips, must total no more than 20.4% of net collections.

If you are spending less, you are cheating your staff. If you are paying more, you either need to look at whether you are over-staffed, or if your production from existing staff is below acceptable standards. The only exception to this is if the doctor so treasures his staff and is willing to take money from his and his family’s proper portion to give to employees. That may be okay especially in the case where the staff includes family or has become as close as family. However, it is not good business, even if it is being a giving person.

There should be no bonuses unless the production is five times higher than total compensation including hygienists, but not including children and spouses, if they do not really work enough for their cost to the practice. Again, this is sometimes a very good idea from an IRS point of view, but do not confuse real operational dollars with tax dollars. Bonuses are paid when the production exceed 5 times compensation. Again, that is not 20%, but 20.4% in the case of collections at 98%.

Never raise salaries above that which is appropriate for the area for the job…no matter how much you treasure the employee. Pay in bonuses, it they deserve it. The problem with raising an employees salary above competitive rates is that you are ultimately doing them a disservice. Everyone begins to adjust their lifestyle based upon their income. What happens if they are forced, for whatever reason, to seek employment elsewhere. Will they lose their car, or their home? Pay fairly, but never use money to try to buy loyalty or devotion. It will not work, and it makes you look foolish.

Bonuses.

As the practice grows and prospers, and under careful management, there will come a time when salaries begin to shrink lower than 20% of production. Now you are taking advantage of your employees. One solution to that is to raise salaries so that they begin to equal that 20%. After all, only 80% really belongs to the practice including the doctor’s portion. If you take more than 80%, you are taking unfair advantage of the people working for you, and you are sure to eventually face turnover and/or low morale. It is best to look at the income from the practice as a pie. The first slice of the pie is 20% of production, or 20.4% of collections at 98%. This slice goes to the staff. That is their share.

Bonuses are paid in the situation where production rises to the level that total compensation to all real employees falls lower than 20%. This is a joyous time. This is a cause for celebration and hearty thanks. This is extraordinary. Most staffs throughout the continent cannot contribute to production five times their cost to the practice. Because it is a special time earned through extraordinary efforts it should never be downplayed or taken for granted.

Do not pay bonuses next month for this month’s work. That is too long to be effective. Pay at the end of the month. (Note: When paying bonuses always base it on at least one month’s average of production and collections.) Pay bonuses personally, in a separate check. Hand it to the employees yourself. In fact, the doctor should always personally sign and hand out pay checks, too. The employee should never forget who the boss is, and to whom is the ultimate allegiance. This is not a job for an Office Manager. Their job is to direct effort on a daily basis, but the money comes from the practice owner. It takes only a few minutes. Make the time.

Back to the subject of bonuses. When you have that exceptional situation where you have produced and collected so much that the total compensation shrinks below 20% you need a method to pay that excess to those who have earned it. They are an extraordinary team of individuals.

Two different categories of bonuses are best. First, there are the producers. (That is, dental associates and hygienists.) They should always have a special compensation plan, anyway. Associates are paid on a percentage of collections from their production…from 30% to 40% depending upon who pays the lab costs and other individualized issues. Hygienist compensation varies based upon the traditions and the approach used in the area. Some areas of North America require that there be a daily rate…say $150-250/day. Some areas are very much commission based. (That is, 33% of total production from hygiene.) Sometimes there is a hygiene assistant who must also be paid from hygiene production requiring a lower commission rate for the hygienist. Compensation to hygienists is not an easy issue without additional information.

In general, the hygienist should not be part of the non-producer’s bonus plan. However, I do agree that there are reasons to include the hygienist who is a good team member under the following circumstances. If the bonus to the hygienist would be less than the bonus to the rest of the team, and she is a great team member who is agreeable, finds lots of production for the doctor, and helps out in areas other than her own, then she should be included as a member of the practice-wide bonus pool.

Paying a hygienist should not be difficult. Hire her at whatever level is competitive in your area. Get the best you can find. Take her daily salary, add all benefits, and multiply this by three. If you pay her (including scrubs, insurance, etc.) $175 per day, her average production must be $525 or she is not earning her salary. No bonus is earned unless we exceed this, for sure. I admit there can be circumstance in the practice that the doctor must rectify in his/her position as boss to make this fair. Bonuses for the hygienist on her special program starts at $100 above three times compensation. Taking the $175/day hygienist, that means that the bonus starts not at $525, but at $625. Averaging hygiene production over a pay period the hygienist should receive one-third of the excess above three times compensation plus $100/day. Believe it or not this will all work out to keep total salaries within the 20% of production range…except in some rare hypothetical situations which are almost impossible in the real world.

Non-production employees (Assistants and administrative employees) are on a different plan from the hygienist, and the hygienist should only be included in the circumstance as noted above. Associates are a completely different matter, and they should never be included. This type of bonus should be paid in a very clear, understandable manner. Some of these plans I have seen are so complicated that you need a degree in accounting to figure them out. The only conclusion an employee can have is that it is designed to cheat them. Dentists are smarter than most of their employees, and they know it. There are certainly exceptions, of course, but they are not as likely to understand the intricacies of the complicated schemes as the dentist, and they frankly, and possibly properly, just think it is a scheme to cheat them.

Explaining a bonus plan should be as easy as saying, “If we reach $50,000/month averaged production and collections, $3,125 per day, every Assistant and Front Desk Specialist gets a special check for $100 (or whatever).” You will have to reduce this appropriately for part-time employees. This idea of raising salaries by 10 cents, or whatever, per hour next month based on this month’s production/collections only delays gratification. Delayed gratification is no gratification. Frankly, I cannot imagine the attitude of an employee who then goes back to the original salary the next month, but I assure you they do not come in to work in a positive mood. Bonuses should never be a dis-incentive. Again, it is for extraordinary effort and should be a special celebration. I know some dentists have a payroll service write payroll checks and cutting an addition check is an additional cost, but it is worth the cost. Also, if you reach a new goal for the first time such as $75,000 or $100,000 per month, do something very special like a banquet at the country club (thanks Montie), and do it quickly.

When calculating bonuses be sure to include pension plans toward the 20%. Also, make certain that the employee is actually part of the team. That is, past the probation time, etc. Pay bonuses at specific levels. Let's take a sample of salaries at $10,000/month. This means that we must have $50,000 in production/collections average for the month to pay bonuses. At $51,000 we get $200 toward bonuses. Assuming three employees qualify for the bonus, that means we pay $67 each at that level and an
additional $67 each for reaching each additional $1,000 level. Some have paid simply for whatever amount is above the break even rather than at $1,000 levels. That is a little less graphic, but works as well. For instance, in our example we would pay at $51,367 a total of $273.40 in bonuses, or $91.13 each

Also, consider non-monetary bonuses. A possibility is to save one-third of the bonus pool and schedule trips to events that are interesting to all from that. Of course, this pool is for employees’ costs only. Doctor pays his and families expenses. Also, make certain it is not just something the doctor wants to do. Taking all employees to play golf with their money if they are not golfers might be a little self-serving for the golfing dentist. When I managed departments for Ross Perot's company non-monetary bonuses were a major part of our reward system. I was on Wall Street then. We gave tickets to the Knicks plus a $100 bill for cab fare and let them go home early. We had a cabin in the mountains which we let families use for the weekend...completely stocked with food. We gave Broadway tickets, trips to Atlantic City, etc. Wow, did we ever build loyalty.

There seems to be an attraction to offering a cruise or trip to Disney World for reaching yearly goals. This is usually just a way for the dentist to justify a trip he wants to take anyway, or to hope to catch some employee in a bikini on a cruise ship. Do any of us really believe that an employee in mid-May is going to spend an extra hour making calls or being extra nice to a patient because she may be able to go to Cancun next February. We live in a world of thirty-minute sitcoms and fast food. Promises of some vague reward in the distant future is pretty much worthless as an incentive. Incentives must be paid almost immediately or they lose their effect.

It is not that difficult to make sure that this all fits into the overall requirement to stay within 20% of total production. Now, it is true that the hygienist’s separate compensation approach can cause a temporary skew in the percentages for a month or two, but it will all come back in line.

When the production rises such that a new employee is required this is discussed with the staff and an explanation for the decision is required. Why? Because this will increase the bonus recipients and reduce the bonus pot. This is the doctor’s decision, but it should be an open issue.

The truth is that designing compensation plans for a dental practice requires some knowledge of the exact circumstance, and an expert like our company could be very helpful. Nothing from this article should be used as an excuse for maltreatment of employees. However, the generalities contained are valid and based upon actual situations in hundreds of dental practices throughout North America for more than twenty years.

In conclusion, be fair…to the staff, to the doctor and his/her family, and to the future of the practice. If you find some cute little excuse to cheat the staff or yourself or the practice out of its proper share, you will ultimately regret it. Just keep if fair and keep it simple.

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Ross Perot Knows Management.

A few nights ago I was doing some channel surfing and clicked onto C-Span to catch Ross Perot speaking to a group of students at Colorado State University. I do not know what the occasion was, nor what he said before I began watching, but I could probably guess. This was a speech on business and management with no political topics whatsoever, and he refused to answer political questions. It was about how to build and maintain a business.

He started his business in 1962 to provide the software and expertise for IBM computers to government and industry. Immediately, he was sued by IBM, the largest company in the world at that time, where he had just resigned as a salesman. In fact, he was in a running feud with them for years. In less than 10 years he had become a billionaire. The political thing was much later, and not relevant to my point.

In 1966 at the age of 19, my second year of college, I got a job to pay for my schooling and to buy a new Mustang to impress some coed. It was as a night shift computer operator for EDS, Ross Perot’s company. He had only a few dozen employees then, so I was fortunate to spend quite a bit of time on occasion with him at night while jobs were running on my computer. Very education oriented then and now, he was as helpful as possible, so long as I got my eight hours work done. After graduation and government service I returned to the company, went through the management trainee program, and worked my way up to an Assistant Vice Presidential level in what was by then a rather large company owned by the wealthiest man in the world. I left to run a smaller company, got some more education along the way, and became something of a specialist at turning around ailing companies. One of those companies was a nationwide provider of computers to dentists (which I left long ago), and that is how I came into this business.

Listening to Ross the other night reminded me where I got almost all my theories of management and business. For instance, there is a belief in the world that successful businessmen got there through sneakiness and deceit. It is amazing how many movies depict the evil businessman as a bad guy. Yet, it is almost never the case. To be successful you have to be able to build from satisfied customers and referrals. In general business as well as in dentistry. There is a reason that scam artists and crooks move around so much. They have to because in a capitalistic society there is no reason to deal with someone you can’t trust. Successful businesses and successful dental offices require integrity from top to bottom. Be scrupulously honest in dealings with staff and patients. The staff will emulate your actions, and the patients will recommend you to friends and family. You could make a colossal blunder that would cost EDS thousands of dollars and the company would back you, but lie to, overcharge, or otherwise mislead a customer, and you would be walked to your car that day. The few dollars gained from dishonest dealings can cost you a hugely satisfying and prosperous business/practice.

Also, your personal talent is important, but you must have an extraordinary team to succeed. Teams are built and maintained through sincere respect and mutual trust. Amazingly, the best paid dental staffs are not the most productive. Fair pay is essential, but it is much harder than writing checks to create a highly productive, self-managing, high morale, low stress office…and it starts at the top. It is critical to honestly and sincerely care about each one of your staff members, but never to get too close to lose the employee/employer relationship. People will permit and respect an employer who appropriately urges them to strive harder, but they will resent that same action by a friend. As the employer you are not to lead from the rear but from the front. Never forget the statement from Coach Bear Bryant, “If we win the game the players did it, and if we lose it was bad coaching.”

Everyone needs to have fun because we all work harder and with more creativity if we enjoy our time at work. Since the Industrial Revolution there has been a factory mentality in management. A factory requires exact duplication of memorized tasks with no wavering. Too many dentists seem to think this same approach to management can be used in their offices, yet no job in dentistry can be properly done without a lot of individual initiative and creativity.

To succeed in a specific business you have to believe in what you are doing with your entire being. This belief with be contagious for the entire office, and to achieve success everyone must believe. I know what we do in our company is the best anywhere. I know it without reservation or reservation. To operate a prosperous dental office the dentist and the entire staff must believe in the quality, value, and benefits of the dental care being provided.

It is better sometimes to lose than to win with staff and patients. I hear too many people say that they want to make sure they don’t “leave some money on the table”. That is utter nonsense. If you want to keep a staff motivated, don’t pay the least you can get by with. Pay the most you can afford while still maintaining reasonable overhead. Act the same way with patients and vendors, too. The best arrangement for both parties in any situation is that they both feel good about the outcome.

Too many dentists actually believe that there is no way to prosper and succeed in their practices while still holding on to their standards, morals, integrity, and virtues. While the fact is that you cannot succeed in the long run without them. Usually, the reason for this attitude is that the practice seems to be running out of control with staff problems, patient problems, etc. Those operational issues can be solved. The solution may take some thinking “outside the box”, but it can be done. (This past week two different clients lost a key employee who had been with them for a long time. Usually, this can devastate a practice, but these two dentists will not even experience a slight reduction in production or growth. Their practices are completely organized with written and understood protocols in all areas, and the right new employee will step into her role in a well-oiled machine. When you are that well organized there is no temptation to compromise principles.)

Ross Perot is actually a rather small man in stature, and if you have ever seen him you know that he is not particularly handsome. He claims not to be smart, and in fact graduated rather low academically at the Naval Academy, I think. However, I have been in the room with him and large or small groups, and he is always the biggest man in the room. There was much to be learned from him, and I feel extremely fortunate to have been afforded that privilege.

Another lesson to be learned from Ross Perot is to stay out of politics, I think. No matter how sincere and genuine your motives, you might just end up being portrayed as a squeaky-voiced, jug-earned, wacko by the media. But maybe that isn’t the lesson at all. Maybe the lesson is that you can’t care how you are perceived by the media, if you really want to get things done. My admiration for Ross does not in any way mean I believe he would be a good President, nor does it mean that I agree with the Reform Party. However, I do believe that he is the best boss that anyone could ever have had, and his approach to business as stated at CSU and for forty years before that can be applied to dentistry to great benefit.

Well, another Hurricane (Irene) decided to pass us by here on the west coast of Florida after we were warned to be ready to run for the hills. I always wondered how people on the coasts could be so dumb as to stay around when a hurricane was heading their way. I think some of them just stopped believing after a while.

Have a great week,

Hurston Anderson

813 963-7228

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Embezzlement - Betrayal by a Trusted Friend is Devastating.

I grew up in a small town within sight of a large metropolitan area (at least the tall buildings were visible in the distance), but far enough away to completely escape the negative sides of city life. Since undergraduate school, though I have lived in cities. The truth is that it is friendlier, kinder, gentler, and more trusting outside the cities. My parents lost the key to our house when I was in elementary school. They retired and moved to a smaller place when I was overseas in the army almost twenty years later, and Dad had to have a new lock put on the house when he sold it because there was still no key. This would not have been uncommon for those times and that type of place.

There are people who cannot be trusted everywhere, but certainly there are more where there are more people, and specifically more strangers. So we lock doors, hire guards, install bars, and never really feel all that safe. Yet nothing completely inoculates us from the growing number of people who have little conscience and fear only being caught. In a sparsely populated area such people are easily identified and ostracized when recognized. Frankly though, without anonymity and the ability to prey on many different individuals it is difficult to be a thief repeatedly.

Through television, movies, and more mobility the entire society is becoming more jaded however, and we are definitely in an era where personal conscience and a sense of right and wrong have taken a back seat to self interest and expediency. A large majority of the population actually believes that right and wrong are less important that “not being caught” or not being “indictable”. Yet, deep inside we yearn for simpler more trusting times. We strive to surround ourselves with those whom we feel can be trusted wherever we live and practice.

Dentistry is a family business owned by and managed by people who are first caregivers and second (or last) business people. More than three out of every four dentists in North America will be victimized by embezzlement sometime in their careers. And, it is almost always someone