This is Why Dentists Feel Too Busy – Episode 108

Has your schedule gotten away from you? Have you thought about hiring another dentist to help you shoulder the load? In this episode of the Dentist Money™ Show, Reese & Ryan discuss some of the most common reasons dentists feel overworked and underpaid. They also explain why the source of the pain might not always be what you think it is.

Podcast Transcript:

Reese Harper: Welcome to the Dentist Money™ Show, where we help dentists make smart, financial decisions. I’m your host, Reese Harper, here with my trusty old co-host, Sir Ryan Isaac.

Ryan Isaac: Getting comfortable in new chairs today.

Reese Harper: I figured that the producers decided we must have finally made enough money to give us a seat to sit in.

Ryan Isaac: (laughs) yeah, except for we didn’t buy these, we just got them from another room.

Reese Harper: Oh, these were found in an old storage shed. For those of you who are not watching live in the viral YouTube channel that we launched, you do not know that we are sitting in comfortable chairs, but we are. We used to be in really uncomfortable stools.

Ryan Isaac: It started at a desk.

Reese Harper: It started at a wooden desk; they made us stand; occasionally, they poked us with a cattle pron and said, “dance, monkey, dance!”

Ryan Isaac: Is it really “pron?”

Reese Harper: Yeah… Prong?

Ryan Isaac: Prod?

Reese Harper: I think it’s prod, P-R-O-D.

Ryan Isaac: Oh, i thought you said pron, P-R-O-N.

Reese Harper: I think I did. Just so listeners know, I do make mistakes with word choice occasionally.

Ryan Isaac: Alright, but we’re sitting down and we’re comfortable today; it’s very nice to be here.

Reese Harper: And we’re going to talk about the other comfortable place you go: the doctor’s office.

Ryan Isaac: Yeah, so my daughter, I have an eight-year-old daughter who is named after a famous Disney Princess, Elsa– Queen Elsa.

Reese Harper: Yeah, you actually named her after you saw the movie Frozen, that’s what I heard. You enjoyed the movie so much.

Ryan Isaac: No, she was four when that movie came out, and no one believed her that her real name was Elsa after that movie came out. Everyone at school when we enrolled her in Kindergarten thought we were calling her that name because she wanted to be called that, because of the movie.

Reese Harper: Interesting. You should have called up Disney and told them they stole that name from you.

Ryan Isaac: They stole that name. It was a family name! It’s been in the family for hundreds of years. So, my eight-year-old daughter Elsa, and you know how this goes, so she was playing the classic game of “horsie” at recess one day–

Reese Harper: A vintage classic.

Ryan Isaac: A vintage classic! On all fours with her friends, they’re playing “horsie,” and she rolled on her wrist playing “horsie.” A little hole in the grass, or something. And so she said her wrist was hurting, and it was hurting for a couple of weeks, and she was having a hard time playing piano and writing. So we take her in to the doctor, just kind of a general doctor, I don’t know, it was one of those care centers–

Reese Harper: Family practice.

Ryan Isaac: Yeah! Family practice. And, he kind of pinches the side of her thumb by her wrist, and it hurt a lot, and so it was clearly a wrist problem, right? Like, I roll my wrist playing “horsie,” and so we run some X-rays, couldn’t really see anything in the wrist on the X-rays, but he put this… not a cast, but it was a pretty hard brace so that she couldn’t move her wrist, and it stopped about mid-forearm. So, she’s got this, like, restrictive thing on her wrist, so her hand can’t move, and it goes up to about her forearm. She has that on for like, three weeks, and every night she still complains about her wrist hurting. Now, though I feel really bad as a parent, she tends to be a little bit more of my emotional child, and so she likes to express herself through crying multiple times a day.

Reese Harper: So you thought she was exaggerating.

Ryan Isaac: So, me and my wife both thought she was exaggerating, like, every day about– she couldn’t write, and she didn’t want to play the piano anymore, but her wrist was stable–

Reese Harper: And you’re like, “you’re gonna write!”

Ryan Isaac: “You better play that piano!”
Reese Harper: “You’re gonna do this dang homework, and you’re gonna practice that instrument, and get to school!”

Ryan Isaac: This poor kid, man, so three weeks it goes on like this and she just still complains that it hurts and hurts. Finally, we take her back to the same doctor, and he runs another X-ray, he’s like “look, I still can’t see any break in the wrist, and we can cast it. Let’s throw a permanent cast on this thing, maybe just a more rigid cast would provide the stabilization and make it heal.” But he said, “gosh, before I do that, how about you just go see..” like an arm specialist, a wrist specialist? Who would that be?

Reese Harper: Well, do orthopedic doctors do that?

Ryan Isaac: Yes, that’s who it is.

Reese Harper: Yeah, I mean, I don’t know a lot about this, but–

Ryan Isaac: (laughs) we’re guessing. He just said go see someone who sees this stuff more frequently. So we take her there, and in less than two minutes, he grabs the wrist again, you know, “does this hurt?” And she’s like, “yeah, it kinda hurts.” And then he goes to the elbow, and he pinches the elbow, and she’s like “oh my gosh! That hurts!” That was clearly the source of pain. So, he went from the wrist up to the elbow and in like 30 seconds– as soon as the wrist hurt, he didn’t stop there. It wasn’t like, “oh that’s where it hurts, we’re done.” He went right to the elbow, kind of knowing that there’s other sources of pain. He’s obviously seen this before, runs an X-Ray, the elbow is broken, or one of the bones in the elbow… Again, non-expert here talking.

Reese Harper: Some kind of a tarsal.

Ryan Isaac: (laughing) some kind of a tarsal? What’s a tarsal?

Reese Harper: It’s a… metatarsal!

Ryan Isaac: That’s right.

Reese Harper: That’s in your foot though, so I don’t think that’s an elbow bone.

Ryan Isaac: (laughing) the ol’ metatarsal? So, it turns out that it’s a problem with the elbow. She gets this kind of brace that keeps her elbow locked in a bent position, then we wrap it, and she’s had that for a week, and she feels so much better. Like, the pain is actually gone; she doesn’t complain about the pain; she can kind of write with her hand, and she’s getting better. So we were talking about this, and how often times in a dentist situation, there’s pain that’s felt financially, right? It could be business; it could be in cash flow; it could be with taxes; it could be with investments; there’s pain that’s being felt. But a lot of times, we notice from conversations that the pain that’s being felt is getting blamed on a source that isn’t the real, true source of the pain, right? And it takes maybe just further analysis, or research, or an expert to look at the pain and then to actually find the real source to diagnose it properly, and give the real solution to fix it. So, not putting a wrist brace on an elbow problem.

Reese Harper: Yeah, I like it. Not putting a wrist, elbow brace–

Ryan Isaac: Tarsal (laughs).

Reese Harper: Yeah, okay, so I’m liking this metaphor, and I’m sorry to Elsa for her negligent father that was abusive for the last couple of weeks, just know that we all know where you’re coming from, Elsa. Sometimes Ryan pokes us and tells us to go back to work too.

Ryan Isaac: Like, get back to work, that’s not real pain.

Reese Harper: And I’m like, “I have a stomach ulcer! It really hurts!” and he’s like, “record your podcast! Get it done!”

Ryan Isaac: “Get in the studio! We got a new chair. Sit in the studio! Stop complaining.”

Reese Harper: So let’s talk about the first thing that we notice that is the first source of pain, and I can relate to this too. I was like reading this outline for our show and realized that you basically just like gave me the story of my life, and all the excuses I make. I think that’s where you got all these.

Ryan Isaac: Yeah, I’m like some dentists complain about this, but this is mostly Reese.

Reese Harper: (laughs) yeah, so first, there’s a pain of “I’m too busy,” or “I’m so busy,” or “I’ve got wayy too much going on.”

Ryan Isaac: Yeah, the pain is like “I don’t have enough time to get all my work done,” or a dentist might say “I’m neglecting the administrative tasks on my practice,” or “I’m not getting to marketing. I’m too busy! I can’t get to it all.”

Reese Harper: Yeah, or “I’m not advancing my clinical skills. I’ve just got too many things going on,” or “my personal life is suffering. I have no personal life. It’s just getting eaten up by the business.” One of these things is getting strained, and the assumption that most people make, at least I know that I make a lot of the times, is that there’s just way too much work for me, and for one person, and I can’t get to all of it. And that’s the immediate assumption. I think dentists make that one quite often, that usually the conclusion that they arrive at most often is that “if I could hire an associate, then it would solve the problem.”

Ryan Isaac: Just someone else to do my job.
Reese Harper: Yeah. Now, that may be the right conclusion, and I mean in my own circumstances, I know that if I wouldn’t have done that in several times, the business never would have grown. But it was really crucial to do it at the right time, and to make sure that I was solving the right problem.

Ryan Isaac: And to have some data backing up that assumption too.

Reese Harper: Yeah, mhmm. So, instead of it being the immediate conclusion you reach that if you’re busy, you hire an associate, what are some other thoughts that you kind of have seen, Ryan, that might be the solution to consider, and if there was a specialist like you analyzing it, I guess, what would you say, like before you just hire an associate, I want to make sure that these aren’t really the problem?

Ryan Isaac: Yeah, one of them would be… there’s been a lot of our clients who have done like an insurance analysis in their business, and they’ve realized that by being more efficient with the insurance… reimbursements that they accept in the practice, that they can maybe get rid of a few, and slow down a little bit. So, we’ve had clients who have done a good analysis of the practice, realize that they were taking insurance that they weren’t profitable on… they were doing a lot of busy work, but they weren’t making any progress, and by cutting a few or just making them more efficient, changing fee schedules, that they actually could see less patients, be less busy, but still be profitable and make the same or more amounts of money.

Reese Harper: Yeah, and it doesn’t have to be moved complete to fee-for-service, I mean, insurance is just a marketing decision that you’ve gotta make, but there’s always a more efficient place to get to on a spectrum from “accept everything” to “be completely fee-for-service.” That’s a scale that you’re always going to be able to progress to some degree to a better place, where you’re getting more money for each hour you’re spending. And you might find that if you did that for a little while, you actually felt better. You feel like you’re getting more money for your time, and you’re not quite as busy… you’re able to see a few less patients, and make a little bit more than you were.

Ryan Isaac: And spend higher quality time with your patients, which is what a lot of people want to do anyway.

Reese Harper: And you’ll get a little bit of that family time back, and get a little bit of that business admin marketing time back, you know? What’s another thing that might be a solution before we just hire an associate?

Ryan Isaac: Yeah, well another one might be, you might be too busy with non-clinical duties in the practice, and this kind of leads into– it was episode 26, called “Nine People Dentists Need to Know.” So, on the Dentist Money™ Show if you go to dentistadvisors.com/listen, you can go search for these, but episode 26 was nine people that dentists need to know. It’s basically who’s on your team of people that can help alleviate some of the tasks that are on your plate. Besides all you mentioned, keeping up on clinical skills and CE throughout our careers is super important, it’s crucial to the quality of work that the practice provides, but there’s a lot of other stuff outside of that with marketing, and admin, and HR, and kind of, like, team leading, and you have accounting, and financial planning, and investments, and legal. And so sometimes, it’s just a lack of having people around you that are delegated really specific things to work on.

Reese Harper: Yeah, I think for most people, there’s always, at least in my experience, like, at least in our business, I’ve seen how as time has past, and people get more competent and capable at their jobs, that changes the amount of pressure that I feel. They’re able to do more because they’ve specialized more, and become more proficient in their job, and as their job is more narrow and more defined, and more concrete, and the job description is more narrow, people are able to focus more and get better at their job, as opposed to have it be super broad, and you always feel like you’re running a bunch of different directions.

Ryan Isaac: Not able to focus on one thing, yeah.

Reese Harper: Yeah. A lot of times in a dental practice, you’ll have on person that has too many tasks, and sometimes that person might be overcompensated for the many tasks they do, and that job could be two jobs, or sometimes you might see that you’re underinvesting in a person, and expecting them to do too much, and you might even need to double the amount that you’re willing to spend on these admin, business management, and marketing front office responsibilities. That’s typically the more common solution. I mean, keep in mind that you could stay focused– if you’re this type of person that’s kind of finding yourself being dragged into the business operations, you’re time really can be worth as much as a thousand dollars or more an hour, and so you really need to view your time that way, and if it’s not worth that, let’s assume you’re working an average year, and just take what you made last year and divide it by that number of hours that you work, probably some of you work as many as 2,000 hours, and some of you work as little as 1,500 or 1,600 because you take three months off.

Ryan Isaac: Good for you.

Reese Harper: Good for you. Figure out what it is that you’re working approximately, divide your total income– your income is your salary distributions, everything. Net income, total income you make– by your hours, and figure out what you’re making on an hourly basis. Or, take your total collections as probably a more efficient way to look at it, and divide that by the hours that you’re working, and that gives you your total production per hour. You can kind of look at it both ways: your income per hour, your production per hour and kind of see how those are different. And then, you’re kind of able to tell yourself at that moment, you know, “almost anyone I can hire is going to be able to do a job better than I will be able to.

Ryan Isaac: And for less money.

Reese Harper: And for less money. I mean, even the most expensive attorneys, or most expensive consultants that I have to talk and work with are still hundreds of dollars an hour, and some of them are a very high hundred dollar an hour rates, but those are still less expensive to hire than me trying to do it myself and figure it out on my own.

Ryan Isaac: And more efficient.

Reese Harper: Yeah, I waste countless hours doing things I don’t really understand, and I think that’s what you’re pointing out with that podcast episode 26 as we really highlighted the value of each role, and how specialized these roles really are, and I think it’s really important for dentists to really outsource as much as possible to stay focused on high-production clinical activity, if your goal is to really have a profitable, efficient practice. And if your goal is to have many many many locations, then that’s a slightly different goal, but you still have to look and say “what’s the highest value per hour work that I can do?” and keep moving towards that. And that just involves replacing yourself with an associate and moving on to the next task that’s highest value to you.

Ryan Isaac: So the question then is what could have happen if you kind of just jumped to your first assumption? You know, “I’m too busy, I need to hire an associate, I need a partner, like, now”? What could have happened if you did that, assuming that was the real problem, and it wasn’t the real problem? What are some of the downsides that you’ve seen?

Reese Harper: Well, I think for me, one of them would be that you end up not making good use of those dollars, so you hire the associate, it just takes away from your personal production, you’re not able to replenish your schedule with enough new patients cuz you don’t have enough money going to marketing, and you don’t have a good new-patient inflow, and you just end up making less money.

Ryan Isaac: Yeah, you pass your production to the new guy to keep him busy.

Reese Harper: And then you find yourself in a–

Ryan Isaac: and that’s not uncommon.

Reese Harper: Yeah, that’s not uncommon. And so I think that there’s another factor that can happen is you just find that you rush into hiring the wrong person, so instead of taking your time to find the right cultural fit for your practice and find someone that your really get along with well and you that you just–

Ryan Isaac: You kind of take whoever’s out there asking for a job —

Reese Harper: Yeah, you’ve gotta find someone in the next sixty days, next thirty days, I’m just gonna hire someone– and then that results in you feeling like, I mean that just results in wasted cash, cuz an associate doesn’t really pay for themselves right out of the gate. It takes awhile for a dentist to effectively train, effectively delegate, get the schedule organized properly to where you’re really not just eating into one person’s production and passing it onto another. It takes months, and usually in the first few months you’re not really making money, and so if you don’t get the right cultural fit, it just ends up being a waste of time and money too.

Ryan Isaac: And you part ways eventually, and it’s kind of a waste. Okay, number two. A source of pain, or a pain point people frequently is that the practice doesn’t earn enough money, so the pain would be like, “I just don’t feel like I’m earning enough money. My income’s not high enough.” Maybe a little undefined, maybe a little generic, but that’s pretty common too. People feel like, “I’m just not making enough money.” And there could be a lot of different reasons for that. One of the assumed sources of pain is that we’ll hear that “my one location isn’t enough. I just can’t make enough money from this one location. There’s this guy over here or this company over here that’s made more money from more locations, so I’m not make enough money; I assume it’s because I only have one location, therefore the assumed fix for that is I’ve gotta have more locations.” So the question is– and that could be true… it could be true that that would help make more money. It could be true that that would be a good personality fit and a good skill set fit, maybe you’re really entrepreneurial in nature, and you do like that. So it could be a good fit for the practice, but also might not be. And there could be other reasons why you feel like you’re not making enough money. So let’s talk about some of the reasons that someone might feel like they’re not making enough money.

Reese Harper: Yeah. Well, I think you see this in the restaurant industry a lot, and you see it in retail, where business owners feel like they’re making enough money, and the solution’s always open another location. You see this with a lot of restaurant chains, and that’s not always– I mean, the only time it’s right to open another location is when you have something that is really unique and it’s well documented, it’s working in the first location making good money, and you’re just duplicating it. And that requires a good team, a good operations manual, good processes, good systems, it requires good marketing–

Ryan Isaac: And a personality.

Reese Harper: And it requires the right personality to continue to manage a larger and larger enterprise.

Ryan Isaac: Cuz the set of sacrifices and trade-offs you’re going to have to make by giving more locations, and even getting more money, and more revenue, more collections– the sacrifices you’re going to have to make in order to achieve that– not every personality type is willing or able to go through.

Reese Harper: I think that often times, it’s instead of needing to open a new location, it’s just profitability needs to be improved, or your taking, like you said, too many of the wrong kind of insurance plans, or your fees might just be too low, and you haven’t adjusted them in quite awhile, or maybe you’re earning enough profit, but collections just aren’t as high as they needed to be.

Ryan Isaac: Yeah, you’re in a location that does have more capacity through more efficiencies. Maybe you are profitable, but you do just need to grow your collections. So that could be, what? Like, a marketing issue, staffing issue–

Reese Harper: It could be a marketing issue, internal and external, it could be diagnosis, it could be treatment presentation, it could be high-use cell dentistry, I mean, there’s just– it could be the hours that you work, it could be maybe re-arranging your space to add another operatory in a creative way that allows you to have a more productive capacity– I think there’s a lot of things you’d want to explore before you just say, “yeah, it’s time to open another location,” cuz there’s some downsides of just doing it too quickly.

Ryan Isaac: Well I was gonna say too, and this is a frequent complaint, I think a lot of people can relate to that, just feeling like you just don’t earn enough money. But part of the problem that I notice too is that sometimes it’s just kind of a lack of organization, or a lack of a plan with the money that you do earn that makes you just feel kind of anxious about it. Like, “I don’t know where my money is going,” or, it just feels like there’s not enough left over sometimes, and sometimes when you break it down for people in what their net worth is and how it’s growing, or what money they do earn, and where it’s going and how it’s affecting them, just being more organized in having a bit more of a plan on where they’re headed can kind of alleviate that stress, you know? And the problem turns out to be: it’s not that you’re not earning enough money, you just are kind of unorganized and you don’t know where it’s going, and it feels really stressful.

Reese Harper: Yeah, and once you do have that plan, and you are making progress, and you see your net worth improving, and you see that you’re on track to where work’s going to be optional in the next few years, or at a point that seems early enough to you, then you just kind of don’t feel the stress. I agree with that.

Ryan Isaac: Yeah, so my question for you would be from an entrepreneur standpoint, if someone tries to push multiple locations solely for the fact of “I’ve gotta earn more money so I’m going to do this,” what are some of the downsides to doing that if that’s the only motivation and it turns out that the systems aren’t in place, or they’re not the personality type to go do what it’s going to require and take to achieve it?

Reese Harper: Well, I think that everyone has a certain amount of drive– everyone wants to do more. Everyone wants to do more in their life and and accomplish more.

Ryan Isaac: No one wants to feel stagnant. Even if it’s successful, you don’t want to feel like you’re stagnant.

Reese Harper: Yeah. And I think that some people define that differently than others, and if you’re highly driven by having more of a peaceful schedule, just more life balance, and you want to be able to get away from work and relax and have that peace of mind, like, to turn off the lights and to turn off the drill and the thing’s over… I mean the larger the operation you get, the less likely that reality is. The bigger your operation gets, the more complicated it will become for quite some time. At some point down the road you’ll be able to have nothing to do with it, but the bigger your operation gets, inherently the more it will require from you from a time standpoint. You won’t be able to just turn it off when you want to. And I think that’s a big driver for a lot of dentists, trying to figure out: are you the type of person that really enjoys systems and training and seeing other people doing what you’ve done, and seeing an associate come in and training them and teaching them? Are those kind of things motivating to you to be able to have it improve impatient care in a way that allows it to be bigger than just you? Sometimes those are motivations that drive a lot of dentists, and they love the idea of having an enterprise that replicates what they do, and I think that’s really motivational to a lot of people. But it’s not usually the money that’s driving that. Usually, it’s bigger than the money, and when you chase the money and when you just assume that by opening more locations that’s going to help you alleviate the “I want more money” problem, what I typically find is that people who want more money as the primary driver… they also want more money because they want more time because they want to have more flexibility–

Ryan Isaac: I was going to say those are the two competing interests when you start having a bigger and bigger business. You can’t want to hold on to all of your extra time and want to have a lot of extra money at the same time. They don’t go hand in hand right off the bat.

Reese Harper: Yeah. So I think that the general recommendation is never stop pushing yourself, never stop growing, but just continue to take incremental steps like we’ve talked about in previous podcasts. Incremental steps are always better than big changes, and opening a location is not the first incremental step to growing your income. I mean, again… measuring profitability, making sure you re-organize your insurance plans, looking at your fee schedule, looking at your efficiencies, looking at your office layout, looking at marketing, looking at your processes and systems and treatment presentation…. all that stuff is more important than opening that second location, but once you get that all done, then there’s this moment where now you’re going to be able to scale and move along.

Ryan Isaac: Okay, so let’s hit one more at kind of a similar pain point. The pain point would be “I feel like I’m always tight on cash. Cash flow is really tight.” But the assumed problem is debt. “Debt is causing me to feel tight on cash.” These are really common conversations, right? Someone starts to feel a little pinched in cash flow and the easiest scapegoat is always debt. You know, “if I just got rid of my mortgage, then that would solve the problem,” or “if I hurried and got rid of the debt a lot faster, then these problems would go away.” So the assumed conclusion, or the assumed fix is that I need to go pay off my debt as fast as possible, and often at the expense of other things, like growing the business, or investing for retirement. So let’s talk about– maybe we could talk about some of the questions you’ve had in the past where clients have felt that way: examples where they feel kind of tight with cash flow and immediately blame the debt, and just want to stop everything to get rid of it. Can you think of any that come to mind?

Reese Harper: Well I remember back in 2014 or 15, I got a phone call from a client that was really stressed out about their debt, and they wanted to pull all their money out of their retirement account and pay it off in order to finally feel like they could free up their cash flow. And that would have cost them… at this point looking back… they didn’t have huge balances, but it still would have probably been a six-figure mistake. I don’t want to say that’s not huge…. I mean that’s a huge mistake, you’re talking a hundred-thousand dollar mistake. I mean, it could have been worse. Between the penalties that they would have paid, and the lack of growth that they would have had over the last few years, they probably would have saved $20,000 in interest or something, but given up $100,000 in net worth to make that happen.

Ryan Isaac: But that exchange of getting rid of the debt, that’s so emotional. It feels so tangible that it almost outweighs everything else.

Reese Harper: Yeah, and I think a lot of people listening will be like “I would have never done that.” And I think it’s surprising. This person that called was super rational, and they listened to the advice that I gave, and they didn’t end up doing it, but that was the first reaction. And I think that a lot of us have that tendency that when we feel like we’re tight on cash, we attack debt as quickly as possible.

Ryan Isaac: I mean it’s logical. Yeah, if you didn’t have any debt payments around, you would have more cash flow. But if you didn’t have any debt around in most cases, you wouldn’t have the dental school education, or the practice, or the building, or the equipment, or the TI’s.

Reese Harper: Yeah, and I think a lot of times, there’s a point where debt reduction is essential, and there’s a point where you want to just stop taking as much risk, because that’s all debt. That’s what debt does: you borrow money to take a risk. You borrow money for school to take a risk. You borrow money for your practice to take a risk, and when you take that risk, you can keep taking risks indefinitely, and that’s what Bear Stearns did in 2008, and they got leveraged forty to one, and that caused them to go under. There’s a point where it’s like, alright. Stop taking so much risk. It’s time to start paying off the debt and de-risking your balance sheet. But that’s usually not the first reaction you should have when your cash flow is tight.

Ryan Isaac: So what are some other things that could be the problem when cash flow is tight? We’ve talked about if you imagine that periodic table of elements that we talk about, the middle row with four boxes, four elements in there, the middle row is where your money goes, it’s cash flow. Three of those are expenses. It’s your personal “burn rate,” it’s your personal spending. Another one is debt rate, which we’re talking about, and another one is tax rate. And so it’s quite possible that maybe it’s not the debt; often times it’s the personal spending choking out your ability to save money or ability to pay down a little extra debt.

Reese Harper: Yeah, sometimes you don’t realize that your personal spending is just way out of control. You just don’t have a reference point. And it doesn’t feel out of control to you because you’ve gotten used to it over the last seven or eight years, so it feels normal. But you might be spending five or six thousand more a month than the average person at your income level, and just have gotten used to a lifestyle that you didn’t realize that you’re going to have to start backing off of. And I think that that’s an unfortunate thing that a lot of us have to go through, whether it’s with dieting and exercise, or cutting our spending, or anything else that’s a habit that you’ve built over time. They’re not easy to change, but the fact that they’re not easy doesn’t mean that you don’t have to fix them. At some point, if your personal spending is 30% higher than the average person with your income, no amount of reduction or change or shift is going to solve that problem.

Ryan Isaac: Well I was going to kind of back up too, and mention that sometimes– and we just did an episode on this. It’s episode 102 about the snake venom and debt, how snake bites relate to debt.

Reese Harper: That was a good one. My kids liked the picture on the podcast episode. You had an orange snake on your arm.

Ryan Isaac: (laughs) I did. Do we know what kind of snake that was? Anyone?

Reese Harper: Some kind of a jungle snake.

Ryan Isaac: It was a jungle boa? I don’t know.

Reese Harper: It wasn’t even venomous. I think it was a fake snake that Jeff designed.

Ryan Isaac: It wasn’t real in studio? I didn’t really have that thing on my arm? (laughs) anyway, episode 102… sometimes that emotional need to just want to get rid of debt really fast, sometimes it just comes from a lack of understanding the role that debt plays in your situation, and the role that it actually has in a business owner’s life, and how sometimes it’s okay, and what are the parameters where it’s okay, and where it’s not okay. Sometimes, there’s kind of a lack of understanding about that.

Reese Harper: Yeah, like you said, sometimes in could be taxes that are the problem; it could be debt; it could be spending. But I think that the other side of this equation is — and I’m not advocating for avoiding the debt, the tax, and the spending, but I am saying that most of the problem with cash flow in my experience is because you’re not doing things right on the revenue side of your business. So you’re not making enough money. When people have tight cash flow, it’s because they’re typically not optimizing the investment they made in student loans and it their practice.

Ryan Isaac: So they practice in a facility that could be doing a million bucks, but they’re doing 650. And things have just got to change in the practice to make it grow.

Reese Harper: Yeah, and rather than pay off your debt, invest some money— I sent out this thing on Facebook last night that I thought gave some interesting feedback around this issue.

Ryan Isaac: Facebook gave some killer feedback. LinkedIn was like crickets, man!

Reese Harper: But I don’t think anyone responds on LinkedIn… They’re like “what? You want me to do something? I thought this was a place for posting magazine articles from Forbes. Anyway, I sent this question out on Facebook, and there was a student that emailed me this week and said, “I’ve got three schools to pick from.” And one school was the most expensive, and the other two schools were a little bit cheaper. One was like $580,000, one was going to be $380,000, and one was going to be $320,000.

Ryan Isaac: All the dentists in their 50s were like, “what?!”

Reese Harper: Yeah, everyone was like, “what happened?”

Ryan Isaac: Change your field!

Reese Harper: Yeah, there was people saying “don’t go to school…” There was someone that commented, and this was not a dental-related person at all and he said “any industry that would ask someone to borrow $500,000 dollars… I would reconsider my career.” I’m like “yeah, I get where you’re coming from, but… it’s a pretty good career that actually makes the highest average income in the country, but… you know.”

Ryan Isaac: Just guaranteeing yourself a 30 year trajectory of killer income.

Reese Harper: And all you have to do is sit through this clinical training and sit through school for these four years, and they you’re fine.

Ryan Isaac: Just sit there. That’s it. Just do your thing.

Reese Harper: But here’s the thing that I’m pointing out. There were some comments that I thought that were interesting about how sometimes, certain schools may not prepare students as well as others, and I think that’s a fair comment. I mean, you can’t say all consultants are the same; you can’t say all schools are the same. I think people make that argument quite a lot, like, “well every school’s all the same…” I mean, I didn’t go to the best schools. I wasn’t able to, I didn’t have the ambition to until later on in my life when I realized how important school was. So the schools I went to were good schools, I’d say they were high-quality upper-tier schools, but I didn’t have the vision or the desire– I wasn’t like, “I’m going to Harvard!”

Ryan Isaac: You weren’t at 15 like “I’m on an Idaho farm—” you weren’t picking potatoes one day like “I’m going to Harvard.”
Reese Harper: Yeah, and I think the common thread among peers is like “oh, it’s all the same. They teach you the same stuff. It’s all the same books.” And so in this thread in Facebook, there was this comment where somebody said “look. If you end up having to go back and do a ton of continuing education just to make for the lack of clinical training you had, and the experience you would have gotten from the right residency program… I mean you’re going to pay for it somewhere. You pay for it in a more expensive education, or you pay for it by having to go back to school to get more and more education.” To some degree, I don’t think there is any right or wrong answer here. I think it just depends on the individual, and how much natural ability they have to be a high-stamina, hard-working, personable dentist. And patients don’t really know where you went to school, it’s more about if it prepared you well. Do you need more training when you’re done, or are you ready? I think as it relates to this kind of concept we’re talking about with debt– and a lot of times if you’ve made this investment, maybe the school investment you made wasn’t as good as the next person’s school investment; maybe you really didn’t get as much out of school. And so when you got into practice, you also went right into practice ownership, didn’t have a lot of mentorship, and didn’t have a great associate job, and you got right into practicing, and you had a different school experience and less training after school, and you borrowed almost as much money as the person who went to the best program, and you borrowed just as much money to buy the practice as the next person, but you’re not quite as capable or as prepared… There’s nothing wrong with that. That’s happened in my life where I’ve had to pay the price for this at different points of my career, and now what you end up doing is you have to get some more help during your career in order to make up for some of the lack of skill that you might have in these various areas. And that’s where good practice management consulting can come in; that’s where good coaching can come in; it’s where a good financial advisor can help; a good CPA; a good attorney. If you get to the point where you feel like “I’m not making enough money, and debt is really the problem, and I’m going to turn around and pay it off,” it may be that you’re not collecting enough, and your income is not high enough, and in order for that to happen, you’re going to have to invest some money in some outsourced help and find the right team to help you grow and develop. Everyone has to do this to some degree, and there is nothing wrong with it. I just think that too many dentists think that’s giving up, or that’s quitting or that’s failure, or it feels too expensive– how could you possibly think about investing more money after all that you’ve already paid? And I think the truth is that someone who continues to grow and develop often has to put paying off debt to the side in order to continue to develop and grow for a while, and for an uncomfortable period of time. If you listen to Dave Ramsey’s show, you’ll hear a paradigm that’s driven to the average consumer around debt reduction, and how we should eliminate that as quick as possible. And there are millions of people, I mean tens-of-millions of people, probably even I would guess a third of the population, or even half of it– if you have them a choice to pay down debt or build some liquidity and invest for growth, they would attack the debt. And it feels to me like the more mature people get, they realize there is an excessive point where debt is too excessive, but for the most part, there’s a point where debt should be reduced and a point where it shouldn’t, and I think that when most people feel this pressure of cash flow around debt, it’s because they don’t have a healthy enough business, and that’s the issue.

Ryan Isaac: A couple of other little fixes I was thinking about too: sometimes the answer for the cash flow might be the debt, but it might not be “pool all your resources for the next fifteen years to get rid of it,” it might be just refinancing a couple of loans, or taking that huge practice loan that you thought you wanted to pay off in five years and stretch it out a little bit, because that’s a little bit unrealistic. Or the real-estate loan, or the equipment, or something.

Reese Harper: Or cut some of the overhead that might be good overhead at some point down the road but that is not essential for right now. I’ve had to do that several times, like “this would be a good place to spend money eventually, but not now.”

Ryan Isaac: So you refer to me usually. (laughs) Ryan is overhead line item three. But Monday mornings, that’s usually what you say first thing. “Ryan, I think that you’d be good to pay for one day, just not this week.” I work for free.

Reese Harper: I think that’s a really good thing to think about. It’s not always people, but sometimes it’s just things you’re spending money on. I can see a scenario where certain marketing expenses really are quite useful at some point down the road, but they’re not right now. So and example for us: there’s 17 to 20 different places we could spend money on marketing, but we’ve had to say, “well we can only afford three of them, and these are the three we are going to pick. Even though items 4-17 would help to bring in new patients, they don’t fit today.” I think that I lot of times in a dental practice, you’ll see people spend money on certain types of technology, certain types marketing, certain employees, certain patient-driven appreciation events that really are good, but they’re not essential.

Ryan Isaac: They’re not driving the new growth that you need.

Reese Harper: Yeah, if you don’t have an emergency fund, if you don’t have liquidity, if you don’t have a nice cash cushion, and you’re worried about eliminating debt to free up cash flow because that’s the level of stress that you’re feeling, then your practice isn’t healthy enough, and you probably just need to reassess why it isn’t as healthy as it could be.

Ryan Isaac: Okay, so to wrap things up, we’ll kind of talk about the moral of the story, back to the cast, and the arm, and the wrist, and the elbow, which is “an expert can identify a problem faster.” That’s the truth. If you think about the difference between the doctor who my daughter saw in the first place and the specialist we ultimately went to to solve the problem… was the first doctor a bad doctor, the general family doc? Of course not. He’s probably helped hundreds and thousands of people. But the specialist had that narrow focus; he only works on specific things and had seen that before. Without a doubt, he’s probably squeezed someone’s hand before and felt like, “oh, the pain’s there,” and known that it’s actually in the elbow. He’s probably seen that hundreds of times before. So going to someone who’s seeing your situation, whether that’s a marketing expert, or a consultant, or tax, or legal, or financial advice… it helps when someone has seen your exact situation hundreds of times over and over again.

Reese Harper: Yeah, big time. I just don’t think you can overemphasize that enough. I like the way you said it, how the specialist just knows how to solve the problem faster. And I feel like in one hour of conversation with a dentist, I can solve more problems than in ten hours with another occupation. And so I’m not saying a specialist is smarter in all areas; a specialist is only smarter in the area that he specializes in. So when financial advisors say “I specialize in high-income professionals,” I’m like “do you mean engineers? Doctors? Are you talking about employed doctors, or private-practice doctors? Dentists, or doctors? Attorneys, or partners in a firm?” It’s really generic! And it’s not that helpful.

Ryan Isaac: Yeah, because the wealthy oral surgeon is very different than the wealthy tech startup guy that has got everything tied in to these stock options or something. Those are two very different scenarios.

Reese Harper: Yeah, or a high-income executive, or even an attorney is very different from a dentist, even though they might be making the same money, and they both run practices. I think the thing we’re highlighting though is that the specialist has the ability to hear the pain and know that the solution is in a different area. And the pains that we’ve listed today… you can tell that they are not driven by some financial factor that we could apply to all people. They’re behavioral; they have to do with your occupation; they have to deal with choices that you’re making in your job. And we know that the important thing about any advice, and we’re not just talking about financial planning here, we’re talking about all types of outsourced services is they should be able to hear the pain that you have and know how to solve the problem faster. And that’s why you’re paying someone: it’s saving you time. Instead of having to go to the doctor two or three times like Ryan did before he finally was able to go and see the specialist–

Ryan Isaac: Well it made the problem worse. And that’s kind of the point too: if you apply the wrong solution, or apply a solution to the wrong problem, you can make the problem worse. In the case of my daughter’s arm, it was actually making it worse by having her wrist immobile and her elbow flopping around for a month. It made it worse. And we see that with people jumping right to implementation of financial products to fix a perceived pain point, and implementing the wrong type of product or strategy that actually makes the problem worse. Then you’ve gotta fix that problem and then address the real problem.

Reese Harper: Yeah, how many clients of ours end up coming to us with a fully-baked financial plan that you have to unwind? It’s like a third of our clients. Like, “something’s not right. I still have pain, and I don’t know what it is. But they told me– I went to the doctor (the financial planner) and he gave me this, and I thought it addressed the problem,” but really, you went to a general practitioner. That person gave you the general solution that he’s giving to everyone, and then you realized ten years in that this didn’t really solve my pain. And the thing about financial pain is that it’s slow, and it takes a long time to identify that it’s a problem. If you don’t start right out of the gate with the right specialist, you might be 10 or 15 years in before you realized that the solution that you’re applying to your problem is even the wrong one. Usually the people that come to us have this kind of long term pain– we’re talking about people in their late 40s, early 50s that started 15 years ago, and something’s feeling wrong now.

Ryan Isaac: They’ve been implementing this solution for a long time, but it’s not fixing the pain that they’ve felt the whole time.

Reese Harper: You can’t overemphasize how important that is.

Ryan Isaac: Okay, well I think that’s a good place to wrap up. Thanks everyone for listening today. Check out the Dentist Money™ Show on YouTube. You can see our new chairs that we’re sitting in; you can see visibly that we are so much more comfortable in studio.

Reese Harper: And they’re not new, but they are here. They look new!

Ryan Isaac: They look new, and they feel better to sit in. But check out the Dentist Money™ Show on YouTube and you can see these chairs–

Reese Harper: (laughs) You could check them out.

Ryan Isaac: You could check out the chairs, okay? Give a little thumbs up! YouTube has a little thumbs up, and thumbs down. Hit a thumbs up! It’s fun, it releases dopamine in your system to hit a thumbs up, and it gives us a little too. We’d appreciate that. If you want to talk to us about any of the financial pain you’re feeling, and what kind of solutions you’ve tried to implement, or what solutions might be most appropriate in your situation, go to dentistadvisors.com. At the top of the page, there’s a link to schedule a free consultation on our calendar. We’ll have a conversation and try to point you in the right direction. Or you can just call us the old-fashioned way.

Reese Harper: 833-DDSPLAN. You know what I want people to do? And I’m going to start doing this more frequently. I want to encourage people to email us or comment on the YouTube channel, or comment on our Facebook page on any of our posts: just tell us what question you have that you’d like us to discuss in the next episode. Email reese@dentistadvisors.com or or ryan@dentistadvisors.com . Just email one of use and ask us the question that you want to have covered in the next show. I just love to be able to get more of your questions covered. A lot of these episodes are based on questions that we’re taking that come in during the week, but I think we’re going to start actively soliciting more of these.

Ryan Isaac: So dentistadvisors.com/listen, you can go to the episode, leave comments there, email us, or find any of the social media posts that we do and leave a comment or questions there… we’d love to answer it. And thanks again for joining us!

Reese Harper: Carry on!

Practice Management