“From Dreams to Reality”

By Dr. Greg Psaltis

You dreamed of a successful practice all through dental school. Once out, with raw nerve endings and sweaty palms, you opened your office to realize your dream. Now, years later, your dream has come true, but may seem more like a nightmare. You may notice how your successful practice has taken on a new role. The tail has started wagging the dog. The success of your practice, toward which you have strived, has become a monster that has taken control of your life. You have many employees, many patients, more overhead and then you find yourself beholden to the very thing you felt would make you successful. You feel trapped. You can’t find anyone to come in to help, your patients demand your services and your employees expect a stable job. You sense that you don’t have time for your hobbies, your spouse or your family. What can you do now?

Most respondents to my September, 2005 Dental Economics article (“Start Retiring Now and Don’t Quit Working) wanted the same information—how can they change their professional lives, which demand too much of them and leave too little time pursue other life interests? Let’s consider one root of the problem for some of you who want more time off, but can’t see how to do it. Many factors are involved, including caring for your patients and employees or maintaining the quality of care or your own debt service. I believe it goes back to a more basic question. The real question must be: can you let go? This sounds simple enough, but once you try to make a major transition in your life, the road gets a bit bumpy. Let’s consider why.

What is this “letting go?” Dental school inculcates us with the discipline, drive and morality to maintain an ethical, professional practice that seems like our dreams come true. However, when our practices overwhelm us, we feel “must” serve our clients, employees and practices, even if it means that the quality of our own lives is diminished. We are taught that we, as doctors, have the “ultimate say” and must hold a tight rein on the entire operation. I disagree. There is a critical point at which we must recognize that a large, successful practice cannot be run by a single person. This is particularly true when that person is also the income generator, employer, future planner and, often, light bulb changer. We cannot be all things unless we are willing to sacrifice our own health and our own satisfaction to that end. I believe that by letting go of some of the responsibilities, we can create exactly what we want. Some dentists prefer to be totally in charge, but I have communicated with many others who wish they could escape from the “successes” they have built. For them, I suggest they decide which aspects of their practices are the ones for which they can stop taking full responsibility.

There are places in one’s business where sharing the loads is not only possible, but entirely appropriate. I plan to discuss four steps that can provide dentists the opportunity to regain one’s own health. After restoring so many teeth and so many other people’s health, is it time to consider restoring your own health? The four ideas presented in this article start small and get bigger. I suggest you take them in order—it will help you to learn how to “let go.”

The first concept concerns your employees. Mine are fully empowered, act accordingly and are called Team. Perhaps you still have a staff, which is a group of people who must be told what to do. Can you trust your loyal employees to make decisions? This is about Team building and cannot happen overnight. (See Dental Economics, Volume 92, Number 5, May, 2002, “Building Your Dream Team”). Empowering the people who care greatly about your practice is step number one toward your own freedom. It is possible, but only if you are prepared to “let go” of total control of your office. This is one reason why dentists feel trapped—they feel they must have total control even if it means having less control over their own lives! By empowering your Team, you will experience a sense of freedom and will also have more satisfied employees once they understand that they have your full confidence.

Working idea: give your Team complete say on an aspect of your practice that has previously been your responsibility. This might be planning where your next CE trip will be or whom to hire as the next assistant. This is not as simple as “just doing it.” It requires a framework of trust (on your part in trusting them) acceptance (on their part in accepting this new responsibility) and understanding (on both your parts that this is in the best interest of the practice).

The second step is realizing that your health is as important as the health of your practice, your patients and your employees. I recently experienced a significant setback when my practice partner of 12 years was stricken with a severe health problem and could no longer work. My dream schedule of working half time disappeared. One of my first realizations was how it impacted my ability to maintain my own health. I only came to fully appreciate what I had once I had lost it. I now realize is that my partnership schedule was the reason I could maintain my own health. I saw that by taking care of myself, I was able to provide the best of care for my patients because I wasn’t frustrated, burned out or exhausted. On the basis of letters received from dentists, I believe that some of us assume that our “best” can only happen when we provide that care in a weary, resentful or pressured way. Does this make sense? So the second step is letting go of the need to be at work “all the time.”

Working idea: Decide to take off one day per month for three months. Announce it well in advance and explain that it will be a normal work day for all employees other than the doctor. Make clear that all employees are expected to be in the office and working on projects that have stacked up, such as dead-filing old charts, catching up on overdue recall visits or, better yet, whatever they feel they don’t have time to do as things stand now. If you have done Step One, you can see how your Team will create its own agenda. Make your plans for the day relaxing or fun. Plan a restoration on your own health.

Just these two steps alone will make a difference. You will feel more enthusiasm and energy and your Team and patients will be supportive. Anyone who leaves the practice because you are “acting like a rich doctor and golfing” may be the exact person you have always wished would leave! Now you are ready to consider bigger steps that will bring you even more balance.

A third step is to let go of the idea that you are the only dentist who can provide the level of care you do. Nobody will do it the same as you, but many are capable of providing excellent care. This is difficult for dentists whose identities are firmly tied up to their technical work. Peers have told me that they cannot find another dentist willing to come to their area. My practice’s locum tenens lives more than an hour’s drive from Olympia, but now provides coverage for practices as far away as Arizona! If you are prepared to pay a substitute dentist a reasonable fee, he/she will travel. I recommend meeting the dentist, having a detailed conversation about practice philosophy and treatment styles and including your employees. If a “new” dentist just appears one day unannounced, acceptance will be poor. However, if you have planned everything openly and well in advance, you can have a seamless transition. My partner and I interviewed our locum tenens, introduced him to the Team and had him work a single day. We told the scheduled patients that both practice owners had met and the substitute doctor and had complete confidence in him. Additionally, we explained that our regular Team members would be present to support the patients in the usual way. With this approach, we experienced minimal resistance from parents of our patients. Our locum tenens is now scheduled often, particularly since my partner left the practice over a year ago. He has been a Godsend during this crisis and has played a significant role in keeping both the practice and me healthy. He has also introduced new ideas and techniques that have improved our patient care.

Working idea:  Begin with your state dental society and ask for listings of retired dentists. You may be surprised to find some who miss dentistry and want to work part-time. Don’t be limited by their home addresses. Dentists will travel. You can also call a practice management consultant who is in touch with many practices and practitioners. My consultant told me about my locum tenens—an invaluable piece of information.

The fourth concept is the most complicated, but potentially the most helpful. Can you let go of solo ownership? History hasn’t been kind to dental partnerships. I believe that the main reason for these failures goes back to our perfectionism and independence. We all want to do it our own way. Like a marriage, a business partnership is an intimate relationship that requires flexibility and communication skills. In my partnership, I experienced many challenges, mostly unforeseen. I described my partnership as 70% wonderful and 30% challenging. How do you view that? As a 30% failure? How would you describe your marriage? You may be lucky and have a 90/10 relationship or perhaps it’s 50/50. You aren’t likely to have a perfect relationship, even with your spouse. In considering a dental partnership, you must let go of the concept of the perfect arrangement. Many of us might fulfill our fantasy by having ourselves as a partner! Because dentistry is perfectionistic, we tend to notice what didn’t work. The same may be true for partnerships. We always assume that our technical care will be successful. Why isn’t this so with relationships? I propose it is our inability to let go of our own egocentrism. If we view the glass as half empty, we will always be thirsty, even though we actually still have a half glass to drink. My 70/30 comment was to illustrate that even after 12 successful years of partnership, I could recognize the difficulties. I celebrate the 70% success because even though that would never meet my clinical standards, the partnership enabled me to maintain my own health, my enthusiasm for dentistry and my ability to follow other interests. Did the 30% bother me? Of course—it required constant effort. However, I didn’t dwell on it. So the advanced course in letting go is sharing your practice with another person. This will challenge you greatly, but reward you at least equally, if you will allow it. Assume success, as we do with our clinical skills, and learn from the challenges and solve them. This might be the recipe for success in any relationship. In the end it will enable you to see your frustrations in a different light, it will allow you the opportunity to maintain your own health and will give you opportunities for growth that only sharing can provide.

Working idea: Develop your perfect picture of a partnership and write it down. Envision your plan actually happening and tell others about it. Think about whether you want a partner who will be younger than you (to carry the practice forward into the future) or a partner who is your age. Do you want a same or opposite gender partner? Decide if you want to mentor or if you prefer to have a partner equally experienced in dentistry and business. Does your partnership require growth of the practice, or do you want to share a “solo” practice with a second person? Is time more important to you now than money? Do you want to bring in a partner who particularly enjoys the aspects of dentistry that you dislike so that your practice can offer a broader range of care? As your vision and your goals become clearer, you can discuss this with other dentists and you may find someone who wants something similar. Don’t expect these plans to be identical! However, these conversations are the seeds of a new idea that could get you what you want. Even more exciting is the idea that someone else has a plan that is better than yours and you want to be a part of it. These possibilities will never occur if you keep your thoughts to yourself and your nose to the grindstone. Open up, let go and find out what can happen.

Another important point is that when you decide to commit to a partnership, you need help from an outside source. Unlike marriage, when you need only to say “I do,” a business partnership entails philosophies, ethics, money, and many other points that must be discussed with a consultant. In marital hard times, the couple has the possibility to simply kiss and make up. This is not a typical option for business partners, so the greater clarity you obtain prior to the commitment, the better the chances are that you will be successful. However, no amount of planning can make up for the willingness to let go of total control and the desire to be flexible with your new “significant other.”

It is critical to include your spouse in these conversations and planning. You must be clear about your goal in taking these steps—are you trying to escape the burden of your practice, or do you have a plan to spend your time in a specific fashion? The broader your vision, the more likely you will enjoy satisfaction in your new-found time. (See September, 2005 Dental Economics, pages 66-72, “Start Retiring Now and Don’t Quit Working”) Are you prepared to accept a cut in pay, if you go for the practice-sharing and time-cutting plan? These are issues that you must consider in moving in a new direction in your professional life.

My experience is that I have rediscovered joys and actualized longstanding dreams. I play the violin again and am studying Spanish. I have time to serve on my church council and have coached my sons’ baseball teams. I began my partnership with the goal of creating time to become a national speaker and have accomplished that goal. Some parts of my current life I could not have imagined, largely because my own vision was too small. I suggest that you dream big and set out on a path that will facilitate your plans. Once you see your first success, you will be led to the next one. Your ideas may get “wilder” as you grow and change while still enjoying your career. You may find yourself laughing at some of your ideas like I did. I believe that once you learn to let go and see your dreams become a reality, you’ll be happier and more likely to say, “Let’s go!”

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