Practice or Business Growth: Part Two

Despite the various interpretations you may put on the following, keep in mind dear reader that the reasons for our difficulties were ultimately of my own making.

Incorporating a second dentist into the practice, while appearing to be a strategy to reduce my own time in the office and reduce stress, soon seemed destined to produce just the opposite result.

From what I’ve seen, my experience is not unique. On office doors in my own building, on office doors in various medical-dental buildings around San Diego, I’ve seen the same thing repeatedly: a new name appears on the door under the name of the senior doc, and a few months later that second name disappears.

My limited research in the area of business development turned up one particularly interesting pearl. It was written by L. Ron Hubbard, the founder of Scientology. Do not think, because I mention Hubbard, that I accept the premise of Scientology as a religion; I don’t. Still, I have to admit that old Ron Hubbard wrote some very interesting business related material including his Conditions Formulas.

“Every new appointee to a post,” Hubbard wrote, “begins in Non-Existence, whether obtained by appointment, promotion or demotion.

“He is normally under the delusion that he is THE NEW (DOCTOR). He tries to start off in Power Condition….All others are utterly unaware of his having this new status.

“Therefore he starts in a condition of Non-Existence and if he doesn’t start with the Non-Existence formula as a guide, he will have all kinds of trouble.”

Hubbard then goes on to describe a number of dos and don’ts for the new hire or associate: Don’t assume authority. Don’t give anyone orders, those orders will be ignored and feathers will be ruffled! Don’t order supplies or make any financial decisions that impact the office (‘Wait a minute! Who ordered this? That new guy?’) Don’t assume any power.

Did I see very graphic evidence of this behavior in my office? Yes, and in spades. A key employee with 10 years experience in my office did not take kindly to any orders from the new person. “Why, the very nerve.”

Do communicate; find out exactly what’s needed and wanted and how to do it. Do promote. Do produce.

If you are a dentist who is thinking of adding an associate, or if you ARE the associate, consider looking up “The Conditions Formula” on your browser. Even after the Non-Existence formula is applied and successfully followed there are still two additional somewhat difficult conditions to go through before one reaches “normal” progress according to LRH.

I can see now, that none of the dos were accomplished and most of the troublesome don’ts were.

If I had come across this little gem a year ago, would it have made any difference in the long run? Honestly, I don’t know. But I would have gone into the situation with more awareness and decisiveness.

If the Non-Existence formula is not followed, the person will “stay in Non-Existence or worse,” according to Hubbard: “If a person fails to (follow the formula), he never comes out of Non-Existence…in the eyes of the organization, he is simply a zero.

“Orders being issued by him usually end up being cancelled.

“The bright hopes of such a person end up being hopes he will get transferred, the sooner the better. Everybody is against him.”

My wife, Andrea, and I took off to the mountains for a few days last month and had endless office meetings about the practice and our associate doctor all while walking in snow and discussing possible next steps.

I also read a couple of interesting books. The Fountainhead by Ayn Rand and Reinhold Messner: My Life at the Limit.

Now that is an interesting pair to read back to back! Andrea, when going over a draft of this post, asked why I would want to mention those books. Were they really relevant to the discussion? And I believe they are; I believe the lessons imparted in them tie into my practice decision making perfectly.

The fictional Howard Roark, highly competent architect, so egotistical that he doesn’t have to boast, so self assured that none of the slings and arrows of life faze him, is the hero of Ayn Rand’s book. It’s been said that he reasons from first principles, independently and from his own core values. The expectations of society don’t figure into his calculus.

Being aware that Roark is a fictional character from the mind of Ayn Rand, it was very interesting to follow that immediately with a real life version. I’m not sure Reinhold Messner himself would recognize his resemblance to Roark, but to me the independent reasoning and core values seemed uncannily similar. Reinhold Messner was the first person to climb Mt. Everest without bottled oxygen, for which he was praised in some circles and harshly criticized in others. He was the first person to climb Everest solo, another tremendous accomplishment that again garnered great disparagement, especially among climbers from Soviet Russia, where the collective was all important, and solo efforts frowned upon.

The characteristic of independent reasoning from his own values seems to ring through, just as it does in Roark.

Messner was the first person to cross Antarctica on skis; he was a member of the European Parliament. He may not have Roark’s political philosophy, but his attitude toward life certainly reminded me of that man of action from The Fountainhead.

Another Howard Roark-like personality you might be familiar with: Elon Musk, the Tesla and SpaceX guy.

Also in The Fountainhead you’ll find the antithesis in the character Peter Keating. So many reminders of our office experience came through in watching and listening to Peter Keating. And just who, in our little drama, reminded me of the weak character, Peter Keating? Both of us: the associate doctor and me. And I’m the one who needed to assume the mantle of leadership. I’m no Howard Roark, but I must say that he inspired me to step up.

That’s why I began by saying that the fault was mine.

“Suffering is a moment of clarity, when you can no longer deny the truth of a situation and are forced into uncomfortable change.” Naval Ravikant, quoted in Tim Ferris’s Tribe of Mentors.

In our little trail side office meetings, we had to confront that the office was suffering and that we needed to make a change. According to Hubbard, if the Non-Existence formula is not followed, the person will stay in Non-Existence “or worse.” Apparently there is a level below Non-Existence, and that is the condition of not even being there any longer. Our associate has left the building.


Practice or Business Growth—the transition or what the path becomes

Dr. Halligan
Dr. Halligan

“I used to resent obstacles along the path thinking, ‘If only this hadn’t happened life would be so good.’ Then I suddenly realized, life IS obstacles. There is no underlying path. Our role here is to get better at navigating those obstacles.” ~ Janna Levin

I knew at least two years ago that my niche dental practice—I focus on TMJ related problems and sleep disordered breathing only—was becoming too big, too busy, for me to handle by myself.

At the same time, our financial adviser pointed out that increased income might not be a game worth playing since a good percentage of any additional gain would go to taxes. “You’ve reached your Atlas Shrugged moment,” she said.

Although it might seem that I was faced with a number of choices, such as deliberately slowing the growth or even simply quitting, I never considered any option beyond allowing for continued growth of the practice.

Three words in that sentence are quite deliberate: Those words are Allow and The Practice.

Allow, because the practice seems to be growing without a specific marketing effort. Slowing the growth would require a deliberate effort. Slowing the growth would require not accepting many new patients and referring them elsewhere. Honestly, we have had to do that at times.

And the Practice but not necessarily my own income. I know, that seems counter-intuitive, but let me explain. In meeting with a transition consultant it became clear that continued practice growth would require additional practitioners unless I wanted to be there a lot more hours. But paying those people well might mean that I would take a reduction in my own income, at least for awhile.

And perhaps that pay cut would be substantial. Was I willing to do that if it meant that the practice itself would be better and stronger for the long term?

The answer was Yes.

And so with the help of that consultant the vision began to take shape and the path seemed to be clear before us.

“If you must play, decide on three things at the start: the rules of the game, the stakes, and the quitting time.” Chinese proverb.

Let’s define the game: It is transitioning from a Mom and Pop small but thriving practice into something bigger, yet retaining the same very personalized and thoughtful interaction and caring with each person who comes into the practice.

Did I start the game not knowing the rules, the stakes, or the quitting time? Correct. That’s exactly what I did.

I started the game, if you’ll allow me to use that term, a little over a year ago. Did I know the rules? Even with the help of the consultant I did not—hell, I’m still learning them.

Did I know the stakes? Yes, I believe I did. What I didn’t know were the odds. Maybe I still don’t. I should recruit some of the odds-makers in Las Vegas, who must be some of the smartest people on the planet, to help with that.

Stakes? If the practice couldn’t continue to grow even with the help of additional practitioners who could add days and hours to my already demanding schedule, the whole thing could collapse. Or at best return to modest Mom and Pop status until I simply walked away. High stakes indeed.

And quitting time? I have a date in mind, and though I won’t make it public here, my consultant reminds me that with enough help I could own this practice until I’m 80 or beyond—I’m 71 now.

As smart as I think that Chinese proverb is, I also think it’s totally unrealistic. It’s a Ready, Fire, Aim world according to Peter Drucker, and so be it.

In these pages, I want to share the trials and tribulations of moving a business or practice to a new and higher plateau, not for the entertainment value but for any lessons that you might find valuable.

If your business is a start-up or is in a stage of early development, this may not be for you. If you are just getting your feet wet in dental or other health care arena, this may not be a fit. But if you have a developed and successful business and wonder whether you should look at the path toward a new level of development, this might just prove valuable.

I’ll be as honest as I can about what works and what doesn’t, even at the risk of hurt feelings or making myself look like an idiot occasionally.

When the practice added one more practitioner about a year ago, I thought the path before me looked clear, simple and easy to tread. This part of the transition required months longer to implement than I thought necessary. I learned a lot of lessons along the way, but the primary one is that the path will change its character in unexpected ways.

Also, I think you’ll learn things about yourself that take you by surprise.

When a junior associate joined the practice, I never would have thought of myself as a control freak. And yet I found that I’m exactly that—for the good and the bad of taking control.

I also thought that teaching what I knew about this kind of practice would take, oh, a week or two. I was completely wrong. This isn’t meant to disparage the new doctor in the least—she is very knowledgeable and caring—but my own ability as a teacher, coach or consultant.

I am still in the process of recruiting yet another person and perhaps next time I can be more effective.

There are many consultants in dentistry who believe that having associates in a practice is a bad idea and that it never works. The truth is that it seldom works. But never is a big word and I keep believing we can find a way.

Some of the difficulties that have arisen so far are probably common and I’ll discuss them briefly now and then in more depth as the solutions are found—or not.

First, our front desk person, certainly a key person in the practice, liked the old Mom and Pop model just fine and would just as soon go back to it. Not that she sabotages the change, but I do find her guilty of dragging her feet significantly in helping foster the new vision. Dr. Laissez-faire (me) has to be much more managerial than I’d like in this regard. This may require some unpleasant confrontational interchanges.

Transferring trust to the new doctor, while occurring, is coming slowly and that should have been foreseen, but is also partly my own fault.

On a recent Monday, I took the day off and let my associate run the show at the office. I was on the phone with a colleague and casually mentioned that I was home, taking a day for myself.

“Oh, how do you like that?” he asked.

“Honestly, I feel like a dad who’s just given the car keys to his daughter and let her take that family car out on her own.” Then I paused a second and said, “Actually, I don’t own an airplane, but I could imagine how it would feel to own a nice light twin—a twin engine airplane—and giving my daughter the keys to that. Kinda scary, you know?”

“I bet your associate would not like to be compared to a young girl taking out the family car. Little control freak aspect, maybe? Got to let go of that one eventually.”

Sure. I had to agree.

Yesterday I was walking an established hiking trail in the eastern Sierra with Andrea when we came across this:

Yes that’s actually the trail. There had been a decent winter snow storm a few weeks before, and then, right around Christmas, a warm spell had melted tons of snow and the resulting melt had flooded hundreds of yards of trail. And then last week it got very cold again and the once easy path turned into one big slanted skating rink.

We stopped and just stared at it.

“Reminds me of the practice,” I said.

“Exactly!” Andrea said. We’d just been discussing the difficulties of the practice transition when we came to the ice. “It’s a perfect analogy. Now we’ve got to decide what to do.”

I’m telling you, dear reader, your path, so carefully laid out, so carefully planned, is also going to turn to ice at times. You can stop and turn around—I think a lot of people do just that. You can find your way around, or you can say ‘screw it!’ and just head out on the ice.

Andrea and I did both. She took to the woods. I couldn’t see her but I could hear the snapping of twigs and tree branches and occasional mumbled curses as she found a way forward but off the path.

Me? I strapped some grippers to my boots and headed straight out onto the ice:

Both approaches worked to make our way upward and onward on the mountain without falling on our asses. But how will it work back in the practice?

To be continued…


Would You Like Scaling and Root Planing With That?


Angela, a bright, pretty, 30 year old came to me for a TMJ exam last week and when I asked her who her general dentist was, she told me she didn’t have one.

“I just moved to San Diego from the east coast and I am looking for a new dentist. I went to Acme Dental Clinic (not the real clinic name) for a dental exam but I’m not going back there. I think they’re a scam.”

“Really? What happened?”

“They told me I needed 4 visits of deep cleaning for my periodontal disease and that I should also get my teeth whitened. They were selling those things pretty hard. I just got a bad feeling about them.”

I did six-point perio probing. This young lady had no visible calculus and I found one place—mesial of #3—that had a probe score of 4 mm. All the other scores were 2 or 3 mm. Healthy, normal gum tissue and no bleeding points whatsoever. Four quadrants of root planning? Totally unnecessary.

I put down my perio probe and Angela looked up at me. “Well?”

“Well, I’m just trying to find a polite word for BS. Sorry, I can’t think of one.”

Read more

40 Years of Passion for Dentistry

Yours Truly — future TMJ Specialist

When I received the phone call from a USC dental school classmate inviting me to a 40 year reunion, I was something way short of excited. I hadn’t stayed in touch with more than a couple of the guys—and I use that term generically to refer to both male and female-type dentists—and I wasn’t sure I wanted to see the results of 40 years of leaning over a dental chair and listening to the high-pitched whine of a handpiece.

Read more

Sand, Stars and The E-Myth

In our second bedroom is a bookshelf with quite a nice collection of books. The problem is: I haven’t read them all. One of those unread or partially read books is The E-Myth by Michael Gerber. I bought that book decades ago, opened it, read a few pages and put it back on the shelf. It just didn’t resonate with me. Maybe I was too young to get the message, or maybe I was just too darn dumb to pay attention. I never got rid of it however.

A few months ago my wife, Andrea, and I met Michael Gerber’s wife Luz Delia. She understands The E-Myth very well, so well in fact that it took her about 90 seconds to explain the nittty-gritty of it and how it definitely related to my practice. She gave us a gift: a new book entitled, The E-Myth Chiropractor. That book also sat around, but not for very long.

Read more

The Long View—thinking long-term about your practice

“I love dentistry. I’d even do it for free. In fact, sometimes I do. And so do you. The difference is I know when I’m doing it for free.”
~ Omer Reed

To The Dentist: Thinking about your practice long-term

[dropcap3]I[/dropcap3]n a recent column in his Dental Town publication, Howard Farran wrote that in our current economy a dentist should reduce fees and join the discount dental insurance plans in order to stay busy and survive the downturn. He also recommended using low cost—read “cheap”—dental labs for work that requires a laboratory. This week, I just want to throw in my 2 cents. My opinion? Howard’s wrong on this one. Since Dr. Farran has an MBA and is one very bright dentist,

Read more