By Dr. David Black
I am a “boomer.” I was raised in the 50s and 60s with all the optimism, opportunity and personal affluence of this era, in a Mayberry –type town in West Virginia. Early in my career I felt that everything was lovely, that prosperity would continue forever and that I did not have to face the hard truths about what it takes to actually stop working.
After I graduated form dental school in 1971, I set up a solo practice, as almost everyone did at that time. We all heard that we should start saving for retirement early in our career, but a lot of us got caught up in the day-to-day events that caused us to defer that part of our finances. Although dental school was much less expensive, I had some small school loans to pay off, along with the normal startup costs of a new office. I also elected to invest in my practice with new equipment purchases, continuing education and a bigger staff. The urgency of immediate gratification blinded me to the ambiguity of something in the distant future called retirement.
All of a sudden, I was 55! The year was 2001. Do you remember that year?
Two things happened that year that gave me a reality check: September 11, 2001 was a day that made most of us in America realize how fragile life is and how quickly our own lives can change. The second thing was the death of my mother later that same month. I realized that I needed to plan for the future. You cannot be sure of tomorrow; you need to have plans for retirement and possibly disability.
I had a great general practice that supported all of our needs except a plan for retirement. I was producing about $73K per month in a five-operatory office with a mortgage, had less than $100K in my retirement fund and had four unsuccessful attempts to bring in an associate. At the rate I was going, I also had no hope for retirement
I decided to figure out what my financial situation was, explore my options, look for the expert help I needed and execute the changes I needed to fix this problem. I studied to see what was profitable, what my market supported and how I could do more of my profitable procedures. In fact, our team, with the help of skilled consultants, went over practically every system in our office.
One of the roadblocks I continued to hit was hiring an associate as part of my retirement plan. That never worked out for me and I continued to spend a lot of money trying to get this part of the plan accomplished. It was during this part of my career that I hired good consultants—and it paid off well.
The expert team of consultants and professionals I used included practice management consultants, a retirement planning consultant, a financial planner/broker, an accountant, a business lawyer and a friendly banker. The two most important consultants for me were the practice management consultant and the retirement planning consultant.
Practice management consultants are there for every need imaginable. I hired two different consultants to help with new patient intake and treatment acceptance: A major national consultant to help with multiple needs for several years and a retirement planning consultant, who interviewed me, found what my financial situation was, designed a plan and helped me set up a profit-sharing plan to meet my goals.
Planning is good, but then we get to the execution of the plan. I had 10 years to execute the following:
- Set up the retirement plan.
- Develop the discipline to work the plan.
- Increase productivity to fund the plan.
- Improve office systems to work the plan.
- Market my “fee-for-service” practice effectively in an insurance-driven world.
- Find an associate or buyer to complete the plan
We made two big production changes during this time. First, we scheduled for production. That means we had two or three high-production procedures every day. What is high production? You have to decide. For us it was primarily crown preparations. You have to decide what your daily production needs are, what drives your productivity and set it accordingly.
Second, at our morning huddle, we reviewed that day’s recall appointments. Our goal was for each hygienist to identifying one high-production procedure from the unscheduled, previously diagnosed work. This filled the appointment book with crown preps from patients of record.
I also hired a regional broker to help me find a buyer, either an associate or someone to purchase the practice outright. They also did an appraisal, which was crucial, as they know the market and I did not. My practice was much more valuable than I had guessed, and I was able to successfully use it to validate the price that I asked for my practice.
What made my last five years my best years?
- With changes and effective use of consulting, I had a 30 percent increase in collections between 2005 and 2010, going from $880K to $1.25M in a solo practice.
- Since appraisals are usually based on most current three to four years, it positioned my sales price higher.
- Funded my profit-sharing plan to my projected need.
- I found a buyer for the practice, a young doctor wanting to form a regional group of practices.
- I sold the practice, and was able to work four more years to add to my nest egg.
- Enlarged and leased my building for ten years, and paid off the mortgage and improvements on the building.
- I had no management responsibilities working for the new doctor.
- They hired an associate to decrease my load during the transition.
- They kept my loyal, amazing staff. The seven employees had a total of 140 years of experience in my office.
- I was allowed to diagnose and treat my existing patients as I had always done.
- I worked myself out of a job, stopping new patients, then transfer existing patients to the new doctors and finally finishing up promised work to faithful, long-time patients.
As I meet and talk to 50- to 65-year-old doctors, I realize I am not the only one who let the immediate needs of my life interfere with my long-term needs. You may not be able to fix everything at that age, but you can improve your situation if you plan, find help and implement the necessary changes. The obvious fix is not to wait as long as I did to start my retirement plan.
In spite of my poor planning and slow execution I made a miraculous recovery. I was one of the lucky ones and I made my last five years the best five years of my dental practice.
Dr. Black’s 43+years of clinical experience, mentors such as Drs. Pankey and Dawson, and integration of information from four major consulting firms give Dr. Black expertise in a wide range of topics. He is certified in Waterlase and CEREC technology, along with the classic occlusal theory of the masters.