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Tough Choices in Dental Practice and Management

Life is all about making choices. As practicing dentists, we are not excluded. We must make choices regarding our lifestyle, our workplace, even how we treat patients.
 Often, one decision leads to another level of choices, and another, and another. The decisions you make today will create the environment you, your team, your patients, and everyone else around you enjoy.


Work Arrangements.

Not only do I have to make choices for myself, but these choices affect my family. A primary example is the decision to practice or not to practice. Clearly this is a huge decision, and one that creates very real consequences in your life and the life of your family. You may have the option to be home, however this is a very expensive choice. You may also choose to work a reduced schedule for more flexibility. You must choose how many days to work, and what hours to make yourself available.
Another big choice is the decision to own a practice or practice as an associate. There are pros and cons to each. You must decide how much you are willing and able to take on. As an associate, you will have to worry less about the business of the business. You will more or less be able to practice dentistry and go home. Practice owners generally earn more, but that additional income comes with a cost of time, energy, and stress. You must evaluate the pros and cons and choose the best fit for your situation.
Finally, you must decide if you will work in a group practice or go solo. Again, there are reasons for and against each option. In a solo practice you have the option to run it your way without having to get the other doctors or owners on board. However, the group practice allows more flexibility in schedule and provides coverage for time off. It also allows you to share in some of the risk and expense of practice ownership.


When I first bought my practice, I was also just starting my family. We had four kids in a little less than 8 years. I was passionate about my practice, but of course, more passionate about my family. I was determined to find a way to do both as well as I possibly could.
One of the things I quickly realized is that time and productivity have NOTHING to do with one another. I made a conscious effort to decrease my hours while learning how to increase my production. The ways that I did this were to determine what I could delegate, what I could automate and what I could eliminate. I am the sole owner of my practice, but I have two associate dentists and I have team members that I can trust and delegate many tasks and feel confident about those decisions.
 I am constantly faced with the choice of the field trip or a productive work day at the office. One of the ways that I balance this is to work in a lot of planning time for my family schedule and weigh my options carefully. I have also taken extensive training to make myself more efficient at work and at home.
 My kids are fine with my missing the occasional event, just so that they know that I always want to be there. They understand responsibilities and they have their own at home as well. They do many chores at home, as it was with our farm family of previous generations.


Clinical Dental Practice

Once you have settled on the type of work/life balance you hope to achieve, you must go to the next level of decisions. Beyond the basics of dental care, you must decide which procedures you will offer at your practice and which you will choose to refer. Obviously, referring patients on to a specialist takes money out of your practice. You may also decide to add some niche procedures to your practice. 
These niche procedures allow you the opportunity to attract new clients and receive referrals; however they also require special training. For example, in my practice we have chosen to add Invisalign and that has meant that I get to provide a service every day that patients love, rather than dread and attempt to put off their treatment.
 Continuing education is required to maintain your license. Many dentists choose to stay well within their comfort zone and choose courses specific to that comfort zone. Other dentists choose to try new things and branch out. Some dentists take only the minimum amount of continuing education that is required. Others take courses on a regular basis. These choices will affect the services and level of care you can offer your patients.
 Another choice you must make in the area of services is who will perform those services. You must choose what to delegate to the dental assistants and what services you will perform. This is a choice that can affect how many patients the practice can see in a day and how much time the doctor will spend with each patient.


Practice Management

You must choose how you will manage your practice and those who work in it. I have had many employees come and go, some better than others. Rarely do I lose someone that is a key component of my team. We have chosen to work hard on creating a work environment that is fun and profitable for everyone.
 When attending continuing education courses and practice management comes up, be careful about who you choose to listen to and who you choose to ignore. In my personal experience, I always prefer to trust another practicing dentist. Someone who is dealing with the same daily issues that I am as opposed to someone sitting behind a desk somewhere with theories and ideals, but no experience.
 Systems must be developed and implemented to create order and levels of responsibility. Things run more smoothly if you have systems. Everything is coordinated and each person has their area of responsibility. These systems ensure that all tasks are completed, follow-up is done, and everything will be ready to go the following day.
Another obvious choice is your team – and who will be on it. This choice also includes choosing if you need to remove someone from your team. Anyone who has a bad attitude, or lack of respect for you and the team should be removed. The first person I ever fired was a dental assistant that happened to be married to an attorney. That was not fun! I also remember the relief I felt after I did what had to be done. 


A final choice, and one that is less obvious is choosing a mentor. Very often, we fall into a mentor relationship. The doctor I bought my practice from was my mentor for many years. We did not always see eye to eye, but I always listened intently to his advice as I had a deep respect for his abilities and the practice he had created. In choosing mentors, reach out to those you respect in your community. I do not believe you will ever hear a “no” from someone you admire and respect.
When I first bought my practice, I ran my practice mainly out of fear. Now I choose confidence, and refuse to make decisions based mainly on fear of loss. Managing a practice requires a level-head so as to manage the choices you must make everyday. But keep in mind, the choices are yours to make. You control your choices and their results. Good luck and enjoy whatever you choose in your practice!

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