Decisions, Decisions: How Your Choices Shape Your Practice

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 and may not be safe for work.

Casey Hiers:
Hello and welcome. This is Casey Hiers back at the Millionaire Dentist podcast in studio with co-host Jared Bridgman.

Jarrod Bridgeman:
Casey, how are you today?

Casey Hiers:
Doing well.

Jarrod Bridgeman:
Looking pretty sharp. You got a nice suit jacket on there.

Casey Hiers:
I accept your compliment. My wife even complimented me on the way out the door.

Jarrod Bridgeman:
That's rare.

Casey Hiers:
She's a lovely, lovely wife.

Jarrod Bridgeman:
She is indeed. She is your better half, yes.

Casey Hiers:
What do you want to talk about today?

Jarrod Bridgeman:
Decision-making. I come to you often for advice, sometimes here in the office. You've been in the business world longer than I have, and I like to come and talk to you, and you're really good at sales and being a wordsmith. You're like the M&M of the office. You and I kind of talked about some of the things you've helped me with, ways to craft messages, the way to talk about things, but some of the underlying psychological feelings and things I might have that may cause certain decisions. And then you and I got on this big old tangent about dentists and practice owners and how certain decisions can really affect their lives.

Casey Hiers:
Decision making and cash flow.

Jarrod Bridgeman:
Right.

Casey Hiers:
They're intimately linked.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Have you ever made any bad decisions in your life, Jared, recently, this month?

Jarrod Bridgeman:
This month, yeah. I mentioned to you earlier today as a joke, but my wife was getting on me last night about how I never ask her how she is. And I said, "Yes, I do." And she goes, "Well, asking me what's wrong with you is not the same thing."

Casey Hiers:
You just need an interpreter like that Chat G, whatever.

Jarrod Bridgeman:
ChatGPT.

Casey Hiers:
They advertise on the phones where you say it one way, and then it polish it up. If you had one of those, you'd be in good shape.

Jarrod Bridgeman:
Yeah. I just need a little dude like Dr. Moreau's Island, and just have him speak for me.

Casey Hiers:
What a reference. Yeah. Yeah, there you go.

Jarrod Bridgeman:
But Casey, let me ask you, some of the things we're going to talk about today, I think, can pertain to just about anybody. But let's narrow it into what would be, let's say, four or five major things that we can discuss here. What's one of the number one things, a decision-making process that could really affect not only your life and your cash flow at home, but also your practice?

Casey Hiers:
Yeah, getting back to that decision-making and cash flow. And for our audience, a lot of this comes from conversations I have with dozens and dozens and dozens of practice owners every month. And obviously, our clients are on a really good track, but it really is those conversations where neither one of us have any expectations. We're just talking. We're learning. And I get a lot of content on this podcast from the dental community around the country.

Jarrod Bridgeman:
Do you find that you were getting more information from people in a simple conversation versus asking pointed questions? Do people sometimes slip more and let more reel out?

Casey Hiers:
It's not even a slip. Yeah, you just ask questions, and if they're being honest with themselves, it doesn't take long. And when you're talking to somebody you may or may not ever see again, or you're away from home, sometimes there's an element of just people not posing as much. And so I have a lot of interesting conversations, but this is a kind of conglomerate of those conversations, where when you think back to an outcome, typically there's a decision that was made at some point along the way that caused that outcome. We'll get into it later. I'll just call a top four. The first one, and I'm not saying this tongue-in-cheek, but divorce. Unfortunately, a lot of practice owners, maybe they find themselves in a unique position where they're not studying all the time in dental school, and they finally have a practice, and they have a little money. They're getting a lot of attention from the opposite sex in whatever capacity that is, and the decision-making of getting a divorce, that's going to hurt your cash flow, what, by 50%? Is that what they?

Jarrod Bridgeman:
Usually, at least. You know me. I've been divorced, and it hurt me a little in the wallet area.

Casey Hiers:
Hey, you're not collecting divorces, though, right?

Jarrod Bridgeman:
No, not for now.

Casey Hiers:
Sometimes things happen, we understand that. But you go back, and you think about decisions and decision making, and unfortunately, some of these happen because people are just caught up in being incredibly ego and selfish, right? Selfishness and pride, that's typically the root of divorce. But unfortunately, in dentistry, we see that a fair amount as somebody get their practice up and running. Maybe they got a second location, they're having some success, they're moving, they're shaking, they're feeling good about themselves. And for whatever reason, and this could be the spouse or the practice owner, but divorce sets in.

Some of those decisions absolutely affect cash flow. That's the softball of these four, meaning probably the hardest one to talk about. But my goodness, I see it way too often. Way, way, way too often, when they go, "I don't want to get the spouse involved in these financial conversations." And I go, "Well, that's a deal-breaker for us." We want to make sure that the spouse is involved in our betting process, and that's a red flag if they don't want them involved. And typically it comes to, and I've heard people say, had them say this word for word, "I don't know if we're going to make it the next 12 months, so I kind of want to see how it goes. I'm either going to come into this single or with a healthy marriage," and that's real, unfortunately.

Jarrod Bridgeman:
Yeah, because if you're not willing to share that information with your spouse or vice versa, what are you hiding there? Are you overspending in areas you shouldn't be? Are you-?

Casey Hiers:
Sometimes it's just shame. Sometimes it's just that shame of not-

Jarrod Bridgeman:
Maybe not doing as well as

Casey Hiers:
... not being great on the business financial side, and the spouse isn't involved in it. So sometimes that's the source of it. But there have been, I can count on more than one hand, that while some decisions have been made in my life, and I may be getting a divorce, that is going to crush cash flow.
But the second one I hear a lot... I hear these next three a lot in different combinations, but it goes back to maybe keeping up with the Joneses, wanting to have the appearance of being a successful doctor. Do I buy that lake house? Do I buy that beach house? Do I buy that third home or the sports car, or the yacht?

Jarrod Bridgeman:
Or maybe you want to upgrade to $3 million home or-

Casey Hiers:
Yeah, my million-dollar home is not good enough. I want to go build one that's three or four times X. So those things can be really fun and enjoyable if you've mastered the business and financial side of your practice in your life.

Jarrod Bridgeman:
I mean, all that stuff's wonderful if you-

Casey Hiers:
It's done the right way.

Jarrod Bridgeman:
... easily afford it. And then you have the extra cash flow, and you have all these other things going for you and the team working for you. But yeah, just, "Well, John got a lake home. I kind of want one too. That'd be cool to take off for the summer and hang out." But there's a lot of other factors there.

Casey Hiers:
Well, and again, it goes back to decision-making. If you don't have an intimate analytical view of your tax situation, of your cash flow, your profit and loss statement, your balance sheet, all the metrics within your practice, and the profitability and understanding of future expenses. If all that isn't a part of your decision-making for buying these things, then you're vulnerable. You're putting yourself at risk.

Jarrod Bridgeman:
And they're not considering the sustainability of those payments and things like that. You might be able to afford it right now at this second, but you're not in the long game.

Casey Hiers:
Well, in the times we've seen it's been where some people are too far gone. We don't offer to work with them. We get to know them. We like them, good mindset, achiever mentality. We look at their data, their numbers, and their practice. They've got a big practice, they're bringing money in. It's not about how much you make. It's how much you spend sometimes. And so these people are making $900,000 a year, which is excellent.

Jarrod Bridgeman:
True.

Casey Hiers:
But they're spending like they're making $1.9 million a year. And unfortunately, these same people, if they actually made 1.9 million-

Jarrod Bridgeman:
Maybe it's more like three.

Casey Hiers:
... then they'd be living like they're making four. So it's some of those big purchases, those big life decisions that I see people making, that again, well, my cash flow is tough. Dentistry is so hard. And then all the excuses come in. Well, if your decision-making on some of these examples, or maybe there's others-

Jarrod Bridgeman:
Are there some crazy potential hobbies or things that can fall under this roof too, that sometimes people get overly obsessed with and kind of-?

Casey Hiers:
Well, listen, we have clients that have expensive hobbies, and we have helped them be in a position where it's perfectly fine for them to do those because their retirement, their future, their practice, everything's clicking. But a lot of practice owners like aircraft; they like private aircraft. They want to either fly or own or both. Others like fast cars, racing. I mean, that's an expensive hobby.
And so yeah, those two things primarily really can get a practice owner's interest, and then in the world of dentistry. And if they're not mastering these things behind the curtain, yikes, that decision-making is going to crush their cash flow.

Jarrod Bridgeman:
So you're saying we should go back to a Ford Escort? Let's get one of those going.

Casey Hiers:
Listen, as a firm-

Jarrod Bridgeman:
I had one in high school.

Casey Hiers:
As a firm, working more and not enjoying life now is not part of our recipe.

Jarrod Bridgeman:
That's right.

Casey Hiers:
If that's the path we want to offer to work with, because that's not a path that's sustainable. So no, it's not about going back to the Ford Escort, but it's just giving an honest assessment of, does this make good financial sense? Not just the line from Napoleon Dynamite, "I want that." Do you remember it?

Jarrod Bridgeman:
Yes.

Casey Hiers:
Was it Uncle Whatever's his name is?

Jarrod Bridgeman:
Yeah. I forgot his name.

Casey Hiers:
And he's got the ship in the bottle, and he's selling something. And the wife's like, "I want that." And I think that sometimes that's just how people make decisions, I want it. I want it now.

Jarrod Bridgeman:
Yeah. That's why they put all the candy and sodas by the registers at Walmart and places like that, so you can add the impulse buy.

Casey Hiers:
That's strategy. I knew that.

Jarrod Bridgeman:
You didn't know that.

Casey Hiers:
That works on me.

Jarrod Bridgeman:
Reese's peanut butter cups, there I am.

Casey Hiers:
They're delicious. But then, some of the other, let's say, decision-making, there's a lot out there that wants to do it themselves, the DIY-er.

Jarrod Bridgeman:
Someone who... To me, these people whom I've come across seem like they have a hard time sometimes giving up control, like if I don't do it's not going to be done. Right?

Casey Hiers:
That's accurate. It also comes from... I mean, most dentists and specialists are smart. They're high achievers. They think, I can figure this out. Or it comes from, I've been burnt before. But then there also is maybe that lack of trust and that control, because again, nobody's done it as good or better than they have, meaning some of those business and financial things that need taken care of in the practice. And so it's not just control. That's certainly one of them. But it's those other examples sometimes, too, that come into effect. But again, you've made that decision, I'm going to take this on. Well, if there's three of you, you might have a shot, but there's not three of you. And if you want to be a good spouse, a good parent, a good dentist or specialist-

Jarrod Bridgeman:
A good boss.

Casey Hiers:
... a good friend and a good employer, and then somebody who actually has a life and some work-life balance, well, that's a lot to put on your plate. And so again, that decision of wanting to do it yourself can really cause a lot of frustration.

Jarrod Bridgeman:
Well, any one of those things takes up a large chunk of your life already. And then throwing more and more hats and more and more things on top of that, I mean, you're not wrong. I get the drive, and I get the understanding of wanting to do things yourself. Sometimes that can be that way, but there's also times where stepping back and realizing letting someone else handle things is a much better option.

Casey Hiers:
Well, wherever you are, getting to the next level, the next plateau, the next milestone, typically, you have to delegate some things to trusted sources to get to that next step. But it's where are your skills and talents best spent? Are they spent in QuickBooks and pining over financials and taxes, and decision-making in your practice? Well, certainly it should be a part of it, but boy, trying to do all of that yourself is hard. I heard it said once in terms of, I think it's being good at work, good at home, or having a good friend network, typically. Or working out of those four, you can probably do three.

Jarrod Bridgeman:
Which one do you think I skip?

Casey Hiers:
It's the working out.

Jarrod Bridgeman:
I'll tell you that much right now.

Casey Hiers:
You must have some decent genes, G-E-N-E-S, because you're fit-ish.

Jarrod Bridgeman:
Yeah, it could be worse. I fall under the fit-ish.
So, Casey, let's kind of go on the opposite end of the spectrum here. This next one, you and I talked about specifically, they may have been do-it-yourselfers at one point, but now they have really just kind of settled into the groove they're in for better or for worse. Kind of talk me through, we'll call them settlers, and I'm not talking pilgrims here. But they're the ones that they might complain about their staff or their casual situations, but they're not doing a damn thing to change that.

Casey Hiers:
The settling, that's a big one. And it can be hard because, let's say, your CPA is a good friend or a neighbor, and you like the person. But you keep getting big refunds or additional big tax notices where you owe a bunch of money, or your taxes are always being filed late, and it's more of a historical view. Well, you're making a choice. If you like the person and that relationship is worth more than your $80,000 tax surprises every year, then you've made that decision. But then it gets into, okay, well, I have high insurance adjustments in my practice. I have high overhead, my employee wages are high. Again, if you're not doing anything about it, then you're settling and they're real, they're real reasons. But don't turn them into your excuses that rationalize inactivity.

Jarrod Bridgeman:
I feel like some of it could just be being overwhelmed because a lot of times I feel like in our practice that they have one of these things, they have a lot of these things.

Casey Hiers:
A lot of times, people don't know where to turn. Well, maybe I'll go get some more practice in management and hope it fits. They're throwing these Hail Marys to try to fix it, and I've been saying this more and more: it's Whac-A-Mole. If you don't have a plan, if you don't have a strategy, if you don't have a team, then you're constantly putting out fires, and you put one out in two more pop up, Whac-A-Mole.
And we see that all the time. But it typically comes from the decision of well, change is hard. Maybe if I change the software, that'll fix something. But people just kind of settle, or they're adverse to change, so they're settling, meaning it's more comfortable. Their feelings it feel better in a weird way. But then all this stuff's getting neglected and not mastered, and it's going to only affect cash flow at home and in the practice for a practice owner.

Jarrod Bridgeman:
I mean, on some level, it could be; it's like a toxic relationship. You're too afraid to leave or too afraid to change things because you still, on some level, like what you're doing.

Casey Hiers:
Yeah, and you're going to go back and meet with your accountant next November and get hit with more bad news, and it's just you keep coming back for more. But yeah, it's the settling. It's the settling for the status quo. It's settling where you are right now. But again, I mean, this isn't life, right? We're not going to get too psychological, but decision-making matters. And for a practice owner, the stakes are that much higher, and what's at stake is cash flow and then stress, and then sanity.

Jarrod Bridgeman:
I was going to say that too, in your health and-

Casey Hiers:
It's a domino effect. I mean, stress it can really affect people. You can see physically. I can see it when I'm stressed physically. And so then you get into health, just like you said. And that's a real thing, too. And so all these practice owners that go, "Well, I'll just work until I'm 70," and that's their plan. Well, what happens if something at age 63 pops up that you weren't expecting? And again, all tough things, but it comes down to decision-making. What has caused you to get there? Now, hopefully, people don't go all the way back to, well, my decision to be a dentist. Listen, dentistry is amazing.

Jarrod Bridgeman:
When I was seven, my grandfather-

Casey Hiers:
Yeah, dentistry is amazing, but it's where you're at right now. What decisions can you affect? And ultimately, who can you delegate to who can help, aid, and assist you? Because it can't be all things to all people, and something will suffer.

Jarrod Bridgeman:
Casey, what do you think is the biggest and best decision someone can make that's listening to this right now?

Casey Hiers:
That's a loaded question.

Jarrod Bridgeman:
Here's what I'm going to say. If you live in Austin or Dallas, Texas, we have two events coming up in December. Our Bourbon and Real Financial Advice for Dentists from the specialist events. It's CE Credits, it's Bourbon, it's food, but more importantly, it's Casey and his team speaking on a lot of the things you hear on this podcast.

After that, we're taking a little holiday break. We'll be back in January in full force. We're going to be in Jacksonville, Florida, Fort Myers, and we're going to be in Boston as well, right before the Yankee Dental. If you're a practice owner or you're planning to be one soon, register for one of our events if you're in the area.

Casey Hiers:
It's a great first step.

Jarrod Bridgeman:
Yeah, and it's a great first step. You'll learn some things. Maybe you'll learn you're doing something right. Maybe you'll learn you're way the hell off base.

Casey Hiers:
I see what you did there with that loaded question.

Jarrod Bridgeman:
You like that?

Casey Hiers:
Yeah, I like that. Yeah. And we're going to be presenting, we're going to be doing lectures at the Yankee Dental Congress at the Hinman in March, which we love those big rooms. But at our events, we get a cozy up with 15 to 30 people. It's a lot more custom, a lot more personable.

Jarrod Bridgeman:
Well, and we've been hearing from some of our listeners. We kept going to the really big cities, and this next year we're taking a really focused look at hitting some of the more medium and smaller markets to really get the word out, spread the word out, and spend some time with people we normally don't get to see.

Casey Hiers:
Yeah, a good point.

Jarrod Bridgeman:
Thank you guys, so much, Casey. We'll see you next week.

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 and may not be safe for work.