THE MILLIONAIRE DENTIST™

Exploring Dental Practice Pains and Symptoms

EPISODE TRANSCRIPTION

Announcer:
Hello, everyone. Welcome to The Millionaire Dentist Podcast brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue that may not be safe for work. Hello and welcome. This is Casey Hiers back at it again in The Millionaire Dentist Podcast studio with cohost Jarrod Bridgeman. How are you, sir?

Jarrod Bridgeman:
Hey, I'm good. How are you?

Casey Hiers:
Doing well. What's new in the life of Jarrod?

Jarrod Bridgeman:
Oh, not too much. One of the things I'm excited and scared for at the same time, as you know, we're doing an office fantasy football league. Last year, it was my first time ever doing it. And I came in second to last and the only person I beat was the one person who stopped participating whatsoever, but I barely beat him.

Casey Hiers:
So you're a little nervous. So I can tell you, I don't know a ton about it. I certainly don't pour much into it. I think I won it a couple years ago to the dismay of many people who spend a lot of time studying. So here's my advice, Jarrod. Don't study too much.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Just have fun with it. I'm actually, instead of fantasy, which I'm going to participate in, I've got to coach my six-year-old's soccer team Saturday for the first time. I'm the assistant, but I got a whistle because I don't know really what else to do. Kick the ball in the net. A lot of encouragement.

Jarrod Bridgeman:
At that age though, yeah, it feels like it's encouragement and just like corralling the kids. It's not picking grass or whatever.

Casey Hiers:
Yeah. I didn't want to say herding cats, but that's why I got a whistle because they get distracted easily.

Jarrod Bridgeman:
That's funny. My four-year-old son's starting a little indoor league. It's like little old kickers or something like that.

Casey Hiers:
Yeah. It's good for them when you run them. We promised the parents at the one practice we had, we're going to run them and they'll be very tired tonight. And the parents loved it. And by the end, the girls were like, "Is it good to sweat?" Yes. It's good to sweat.

Jarrod Bridgeman:
Yes. That's good. That's good. Listen, today, I want to talk about some things. I want to start with a lead into that, which would be, and I'm sure dentists easily would understand this, a patient comes in and they have, let's say a toothache. It's not really quite enough to just fix the problem. You need to know and learn how that ache came about. Is it a cavity? Is it a situation with gums? Was there something lodged in between the teeth? Or is it something the client or the patient continually has not done, has not kept up on their oral health? There's ways you need to learn so that way you can not only fix the issue but keep it in good health. Right?

Casey Hiers:
Are we wandering into a clinical hypothetical here?

Jarrod Bridgeman:
I know.

Casey Hiers:
All right. So for dentists, you get a patient, maybe there's a toothache, maybe there's some gum issues. Maybe it gets worse. God forbid it needs to be a root canal or an extraction, or where does it go? Is that of what you're saying-

Jarrod Bridgeman:
Yes.

Casey Hiers:
... as things sort of manifest or get worse and then, I'm sure our listeners can relate to this, you tell them what to do and they don't do it.

Jarrod Bridgeman:
Yep.

Casey Hiers:
Is that kind of what you were-

Jarrod Bridgeman:
I would say yeah, because then they're in again, six months later, a year later, maybe with the exact same problem or the work that you spend time on has now basically been wasted.

Casey Hiers:
So as an advisory firm, is it fair to connect the dots that what we do can have some comparison with this? Is that-

Jarrod Bridgeman:
I would say, because I do believe that your practice, your business could be suffering from pains and symptoms.

Casey Hiers:
Yeah. I like that analogy. We mentioned, well, we talked about this about three minutes prior. And I think that there is a really good correlation there. And when you put your clinical hat on as a practice owner, you know the right things to do. You know when something's bad when something needs fix from your patients, but you can't want it more than your patient wants it, but the patient has to realize that and take some ownership, right? And they might have to brush more and floss more and do some things ultimately for the betterment. Right? Would that be fair?

Jarrod Bridgeman:
That's totally fair. Yes.

Casey Hiers:
I had a root canal done when I lived in Southern California in Pasadena, and it was one of those dentists that probably should've referred it out to an endodontist, but wanted to be a jack of all trades, master of none. Mr. Canal, long story short, for years, there was just always frustration. And the solution ended up being extraction and an implant at a fairly young age, which was very frustrating. But clinically our listeners understand that analogy. What we want to tie that to is finance, right? Practice ownership. And so that really is what happens, right?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
When practice owners are in their thirties or forties, well, they've got some things here and there and you've seen them. What have you seen where practice owners maybe have some beginning toothaches on the business side?

Jarrod Bridgeman:
I would say part of it really, really could be your practice cash flow's poorly managed. You may not have barely any cashflow happening and that-

Casey Hiers:
Some have a ton and they don't know what to do with it.

Jarrod Bridgeman:
Or they're upset, yeah. They have too much.

Casey Hiers:
Not enough. Or we're sitting on 800,000 bucks and we don't know what to do with it. Both are a problem.

Jarrod Bridgeman:
Big time problem because if you have too much of it, you should probably point that money towards something else either way. I do think that's a big one. I do. Another thing I've seen and I've read about, and I've talked to people on our team about is sometimes their corporate income structure is wrong.

Casey Hiers:
I see a lot of that where they'll have one corporate entity, then they change it and they change and they don't know what's right for them. The person they work with just has a couple options. But yeah, you're right, the corporate structure.

Jarrod Bridgeman:
Yeah. And then with the income structure as well, if you're someone who's used to taking distributions, instead of having set up a nice balanced W2 where it's, I know what I'm going to get every pay period, you can plan ahead and you plan things out and get those numbers under control.

Casey Hiers:
So then let's say, gum inflammation, $50,000 tax surprise, right? Tax management comes that. No plan for transition, no plan for retirement. It's that feeling in the pit of their stomach, right? As a patient, when your tooth starts to ache, you go, uh-oh.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
I'm going to brush it a little bit more rigorously and quote, unquote hope, which is a terrible business strategy, hope that things work out.

Jarrod Bridgeman:
But they only do that... When you do that brushing vigorously, you probably keep up on that for like a week before you're just like, I'm tired of spending 20 minutes in front of the mirror.

Casey Hiers:
You want to get it so that it just doesn't hurt so that you can go on. And that's what we see with a lot of practice owners. They'll have tax frustration and income frustration, overhead frustration, insurance frustration, how their corporate structure or entity is set up frustration.

Jarrod Bridgeman:
A lot of people just slap on a bandaid and hope for the best.

Casey Hiers:
Yeah. And they don't know any other way. And we like this analogy because again, practice owners can relate to, oh, I remember that patient. They come in nine months later and it's a mess. And I told them what they needed to do, but they just didn't do it. And taking ownership, right? One of the big themes for our podcast is, if you're a listener, take ownership of the business side of your practice and of the financial side of your practice because it is really similar to what you do every day clinically. And if you ignore all of these areas that we've just mentioned, and probably another dozen, you're going to have those toothaches. It's not going to get better.

Jarrod Bridgeman:
It's only going to get worse.

Casey Hiers:
And then what happens is I'm going to go buy another practice. I'm going to bring on an associate. You start coming up with different ideas to try to fix it. And you first have to acknowledge and assess and diagnose what the origin of the problem is, right?

Jarrod Bridgeman:
That's right.

Casey Hiers:
I come in and go, my tooth hurts, Doc, fix it.

Jarrod Bridgeman:
Yep.

Casey Hiers:
Well, you're going to need to open the mouth and you're going to need to do a thorough examination and get some information and data.

Jarrod Bridgeman:
I mean, is one of the reasons why you've got such pain right now, is your overhead is too much?

Casey Hiers:
And most people don't know what their overhead is.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
But yeah, it's in the upper sixties, it's in the seventies and a lot of things is tied to that. If you don't floss, you're going to have a really hard time having good gum health. If your overhead is high, you're going to have a really hard time achieving your goals financially, paying your staff more, paying yourself more, feeling comfortable, being able to retire. No, I think that's exactly right.

Jarrod Bridgeman:
And when you have all these pains, just sitting in you and sitting in your business, it can cause a lot of other, I would say symptoms in terms of like every financial decision you have from here on out is going to be paralyzing because you don't have the cash flow. You don't have the savings. Really you're just so worried because like, it's going to be, oh, shoot, I'm going to have to get another credit card. I'm going to have to get more debt. And not all debt's bad and not all debt's good. There's good debt versus bad debt.

Casey Hiers:
Sure.

Jarrod Bridgeman:
But when you don't have the cash on hand or at least enough to-

Casey Hiers:
Well, you're not in a good mood. I mean, when my tooth hurt back, when that happened, I was a little pissy. I wasn't in a great mood. Right? And so again, this same analogy. Let's keep manifesting it. As practice owners, if you're not making the money, you thought you were going to make in dentistry, if you're not saving, if you don't know when you can retire, if you can retire, if you have those feelings in the pit of your stomach, it's going to affect your mood. It's going to affect how you are with your family, with your kids, with your colleagues. It's very similar. And it's real pain as a toothache, but this financial pain, it's not going away.

Jarrod Bridgeman:
No.

Casey Hiers:
And going and buying three practices. And we talked about EBIDTA last time, right? Having some of these schemes, I don't know, one out of 15 work. It's just-

Jarrod Bridgeman:
Not for best strategy.

Casey Hiers:
And I hear too many people trying to do those things where it comes down to basic dental health, basic financial health. You've got to address these things, right? I was in Denver last week and presenting on the business side of dentistry. And it comes down to, there's a whole bunch of little things you need to do or have your team do. And when you do them, you have a utopia. A dentist would tell their patients, you just need to do a handful of things. If you can do those things, you're going to have better dental health. Make the complex simple, right? It really is that simple.

Jarrod Bridgeman:
And once you get to that point, you'll be spending more time doing what you want to do, which is working in the practice and not on it.

Casey Hiers:
Yeah. When I get my teeth fixed, I'm not at the dentist office. I like that. When you have the business side mastered, because you've done the right things, you're not worried about it anymore.

Jarrod Bridgeman:
That's right.

Casey Hiers:
It doesn't bother you. You can spend your time on more fine things.

Jarrod Bridgeman:
But I would also suggest on top of that though, is once you've got it fixed, again, don't let it slide back. Don't stop brushing your teeth.

Casey Hiers:
And that's why you go to the dentist. That's why you have accountability. I mean, obviously here, there's a team that does these things so there is no backslides.

Jarrod Bridgeman:
That's right.

Casey Hiers:
Right? I mean, we're a little inside baseball. I mean, we talk about retirement savings a lot. And we have a client coming in this month that they were saving sort of a normal amount. And the amount they're saving is what most people collect in a year. That's what they're saving for retirement. And they simply are doing the right things. Clinically, they haven't changed, but they have a team that they're mastering all the little things. They're brushing, they're floshing, they're swishing, they're watching-

Jarrod Bridgeman:
I love floshing.

Casey Hiers:
Floshing. Flossing?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Yeah. It's a foreign word because I don't do it enough. It's like confession for me. But yeah, no doubt. Right? That's a big part of it. But for our listeners out there, if anything on the business or finance side of your practice is giving you quote, unquote pain, think about with your patients when they have some pain in their mouth, what steps do you take on what needs to happen? And it's interesting because I'll get on the phone and people will say, "Wow. How? How?" And I say, "Well, I can lay out all those steps. Right? But as a dentist, when you're in the mouth, do you want it fixed or not? I go, "I want it fixed. I trust you're the expert. Let's go."

Jarrod Bridgeman:
Exactly. Exactly. And once, going on with this whole, let's say things are fixed, you've found your pains. You've done the proper things to help clean them up, get them fixed. What would you say are some of the other benefits they may not realize they would get besides steady cash flow, steady paychecks, things like that?

Casey Hiers:
Knowing, right? The unknown is hard for practice owners right now. And so knowing, knowing what your picture financially looks like. Knowing what the practice looks like. Knowing that you don't have to sell out to a DSO. Knowing when you can retire, having financial freedom to retire, having a plan, that's the biggest thing. So many practice owners, successful, they just, they're not really sure. They did it last year. Fingers crossed we'll do it next year. And they don't really know that's a rough way to go about it. Right?

Jarrod Bridgeman:
And living with that fear of, oh, it's tax time, well, what do I owe?

Casey Hiers:
What's going to happen? Yeah. No, it can be frightening. No doubt about it.

Jarrod Bridgeman:
So imagine losing that fear. You don't have to fear tax time. Do I owe 30, 40, $50,000 a year?

Casey Hiers:
And unfortunately for patients, the tooth pain for some has to get really, really bad before they will do something.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Same thing with what we see, a lot of these practice owners, they just try to figure it out and the pain gets too much. And the hard part is when they have nothing saved when they're in their fifties and sixties, that's when you're talking extraction and implant and really extreme things. But that's what happens. If somebody can be good with their dental health at a young age, they're going to have better outcomes in the mouth.

Jarrod Bridgeman:
Yeah. Which is why I say it's never too early to at least contemplate the idea of transitions and retirement. Even if you're 30 years old, I don't think it's a bad idea to at least-

Casey Hiers:
Let's say 40.

Jarrod Bridgeman:
Okay, 40. Yeah.

Casey Hiers:
Various astute practice owners I've talked to and they're 40, 42, and they say, "Casey, I want to talk about transitions." And I say, "Great. We do a whole bunch of other things." And then all of a sudden they're, "Wow. Our overheads dropped. We're making more, saving more." But having that thought is a good thing in your forties. It drives me nuts when people call and say, "I'm going to return a couple of years. I need to start thinking about transitions." You're years behind. That needs to be thought about 10 years out and you start executing and implementing things five years out because you want that practice to what, have the lowest overhead. Your profit and loss statement looks good. Your balance sheet looks good. Right? You want all that pain out so that somebody wants to buy that practice. So yeah, it's an analogy that I think is worthwhile, but it's absolutely true. It's something that practice owners can relate to. Well, Jarrod, we've talked a lot about pain in the mouth and in the pocket book and-

Jarrod Bridgeman:
Which is different than what my mom used to call me. I was a pain in the... Nevermind. It was mostly neck.

Casey Hiers:
Okay, there you go. But yeah. And I would say, I don't want you to have any emotional pain with the fantasy football. Just know that I'm probably going to beat you.

Jarrod Bridgeman:
I'm sure.

Casey Hiers:
And we'll have a lot of fun [crosstalk 00:14:27].

Jarrod Bridgeman:
If you win, I'll buy you a drink.

Casey Hiers:
There you go. All right, bud. Thank you.

Jarrod Bridgeman:
Thank you.

Announcer:
That's all the time we have today. Thank you to our guests for their insight and for sharing some really great information. And thank you to you, the listener for tuning in. The Millionaire Dentist Podcast is brought to you by Four Quadrants Advisory. To see if they might be a good fit for you and your practice, go on over to fourquadrantsadvisory.com and see why year after year, they retain over 95% of their clients. Thank you again for joining us and we'll see you next time.