Misdiagnosing the Black Mold in Your Practice Finances

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 tone 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 Jarrod Bridgeman.

Jarrod Bridgeman:
Casey, it's good to see you today. I'm excited; we've got a shorter week coming up. We've got Labor Day happening.

Casey Hiers:
Oh, yeah.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
For all the labor we do, we get a day off.

Jarrod Bridgeman:
That's right, that's right. I've been in here sweating non-stop, you know, all the physical labor I do at the computer.

Casey Hiers:
Well, you know, you just had a birthday, but you look a year younger. I don't know how you do it.

Jarrod Bridgeman:
Thank you. It's all the moisturizer.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Yeah. But, no, I'm excited to have three days off and, you know, hang out with the kids and do some of that kind of stuff. It's nice to get this little break right when school starts again, and then, I don't know.

Casey Hiers: Yeah, it's September now, everybody shifts gears, and...

Jarrod Bridgeman:
I mean, it's still 90 degrees outside, but...

Casey Hiers:
It's hot, but fall, and school's back, and, God forbid, people start talking about the holidays, and decorations are out, and it's just a hoot, but... What are we going to talk about today?

Jarrod Bridgeman:
You know, today I wanted to talk about practice management.

Casey Hiers:
Hmm.

Jarrod Bridgeman:
Yeah, and that's something that we don't super touch on a lot because it's not what we do. But it's a topic that comes up, I think, quite a bit, and I think there's a large misunderstanding out there in the world of practice management, even, and then like what we do.

Casey Hiers:
A lot of practice owners I speak with, they have or are using or have used practice management or, air quotes, "consulting". And there's a big difference between practice management and just call it general consulting versus a custom business advisor. Two very different things. Yet, sometimes people hope that one fixes everything, and sometimes there can be years of frustration.

Jarrod Bridgeman:
Well, and this isn't going to be a podcast where we're dogging on practice management because there is a place and time for that.

Casey Hiers:
Well, most of what we talk about comes from practice owners' conversations, what we learn, what we hear. So many of them, again, are using or have used practice management, and the overwhelming sentiment is, "I thought it was going to improve these areas, and it didn't quite do it." There's frustration...

Jarrod Bridgeman:
Is that a false sale almost, or just a misunderstanding of what practice management is? Because they hire these groups on or these consultants on expecting it's going to fix not only employee, you know, HR, all that kind of stuff, but on top of that, their cash flow and their money.

Casey Hiers:
Yeah, I think it's maybe, you know, expectations or a misdiagnosis of what it's going to actually do. And there's so much frustration with that because, again, people pay a lot of money for this, and there are times when we... some of our clients, they actually do need practice management. Now, they've already got their other areas corrected, but practice... again, there is a place for it.

But, boy, there's a... there's almost a misconception of, "I'm going to throw some money at this, bring in this practice management or, air quotes, consulting, and everything's going to get better" versus one or two things may improve, but holistically, most practice owners tell us, "I paid a lot of money. I'm not sure what I got out of it in terms of my income, my overhead, my cash flow, things like that." There's a big frustration there. It's almost like, again, a miscommunication or an expectation, a false expectation. And I don't know the origin of it, and that's...

Jarrod Bridgeman:
I like the term you used of "misdiagnosis" because they brought these spec- you know, quote-unquote "specialists" in, these consultants, and they paid a lot of money, but the sickness is still there. The pain is still there. It reminds me a little bit of... I had a friend, this was years ago, and she had chronic illness for years and years and years, and kept going in and being seen, and kept getting diagnosed and diagnosed and diagnosed, and then they found out that she had black mold in her house, and that was causing all the problem .

Casey Hiers:
And you said it was years of...

Jarrod Bridgeman:
Yes.

Casey Hiers:
...of that?

Jarrod Bridgeman:
Yes.

Casey Hiers:
So, and she paid and still felt bad, you know? So, think about that. You don't feel good; there's a problem, and then you go to some experts to try to fix it, and most likely, in the medical field, this happens a fair amount, right? You go to multiple different specialists or doctors, and nobody can actually fix the core problem. You kind of get passed around. You're getting different ideas and suggestions, and you're hopeful that something's going to correct it, but the core problem doesn't get corrected.

So, the black mold in dentistry could be overhead or insurance adjustments or terrible tax management, entity structure, decision making—all of those things are the black mold. Yet, the practice owner feels the stress. They're frustrated, and they keep bouncing around to these people. Yeah, that... I like that.

Jarrod Bridgeman:
Yeah, they keep taking, you know, their medicine. They're taking two in the morning and still not feeling good.

Casey Hiers:
Yeah, to your point, your friend spent years suffering, paying money, time and money, to try to correct a problem, but the core problem was never...

Jarrod Bridgeman:
Wasn't even... yeah! That's the part, too, you know what I mean? So, I wanted to ask you just a blanket-ass question here like, practice management versus business consulting. Like, what's the division there so our listeners who are still not sure exactly what one means compared to the other?

Casey Hiers:
Yeah, I mean, from our perspective, you want to handle the highest priority things first. Get your money right. Get your practice efficiency, systems, and processes right. Really focus on what is contributing to overhead. It's fascinating to me a lot of times practice owners aren't actually... they can't pinpoint the problem. They can't pinpoint the black mold. Some know they have the black mold, high overhead, but they're not sure what's contributing to it, and... and and that's... that's the hard part. Getting... getting your overhead right, that cash flow, your inc- getting your money right, do that first.

Then, some of these other areas can absolutely enhance the office, the staff. But here's the problem. The day- what's in their face every day? Staff. So, it's a day-to-day reminder and a frustration and a stressor, so they want to fix that. But in reality, the underlying challenges aren't actually getting addressed, so you don't get cured.

Jarrod Bridgeman:
Yeah, it's... you've mentioned this on multiple podcasts, the line of "the tail wagging the dog." You know, your staff may be happier, but you're the one that's still suffering. You're the one that's not making more money or making as much as you feel like you should be making at, you know, after years of experience and how much you're actually collecting.

Casey Hiers:
Yeah, there's some practice owners I've spoken with recently, and they're paying $60,000 to $100,000 in some areas that aren't actually curing the problem. And I always say it's the "Kumbaya Drum," right? Having the Kumbaya Drum and having harmony in the practice is really good with staff. But, my goodness, if it's just adding to overhead and taking money out of your pocket for people to feel better, there's an argument that is a terrible strategy.

Jarrod Bridgeman:
Right, and that's why so many, you know, many practice owners get burnt feelings on that. Later down the road, they feel that any other company that comes in that is a business consultant or something else that might actually help with overhead and cash, they're too stressed about it because they've gotten burnt on $60,000 to $100,000 before. PTSD, as we've talked about.

Casey Hiers:
Yeah, PTSD, they've been burnt before, so now they're like, "Oh, my gosh, then they're all like this, nothing's going to help." But, again, having that custom business advisor to go down to the foundation, right, the bones of the practice, and fully understand what all is contributing. Because systems and staff and practice management, that is part of the equation.

But it's odd in dentistry. Maybe they just do a better job advertising and being at all the dental events. I don't know.

Jarrod Bridgeman:
Could be. You know, they throw the money there. They've got the fancy, you know, table with the pens and squishies and calendars and all kinds of stuff. And as you've said, dentists have staff in front of their face every single day. They don't... they may not be thinking about their bank accounts until they get back home and are in... in QuickBooks, you know what I mean? So, that's usually... that's sometimes something you push out of your mind. "I'll think about that later." You can't think about staff later because, you know, Janine's pissed again.

Casey Hiers:
Yeah, I mean, the... the poor standard of care in accounting, that might pop up three times a year. And so, it's kind of out of sight, out of mind, except that is the biggest problem for some practices.

Jarrod Bridgeman:
'Cause, I mean, if you get your cash flow right, you get your overhead dropped a bit, and all that kind of stuff, then you can probably easily afford a good practice management that could help in those areas.

Casey Hiers:
Yeah, it's order of operation, order of importance. What's the highest priority?

Jarrod Bridgeman:
What's going to multiply your money? Yeah, that's the first one, isn't it? Multiplication, and then division.

Casey Hiers:
Yeah, yeah. But that, you know, that practice cash flow and overhead, that is, in terms of order of operation, you really need to understand that and have some custom business advisors that can really get down to the core, to the root, to understand it.

Then there is an argument that once your money's right, once those areas are trending in the right direction, then you can start to look at some of the other problems, right? Like, I can have a hangnail, and it hurts every day, and I look at it, and I touch it, and I feel it, but I've got some other major health issue in my body that I probably need to get that addressed first, but the hangnail I'm seeing, I'm touching, it's bothering me every hour of every day. There's... there's something there in dentistry that I think gets overemphasized. It's correcting the staff things because it's part of the equation of being a practice owner. It's harder than a lot of practice owners anticipate, and it's just in your face all the time.

Jarrod Bridgeman:
And they think they have their own cure sometimes, whether they're going to get into real estate or they're going to handle their own investing.

Casey Hiers:
No, there's a big difference. It all gets lumped into the same sort of the same group. And again, finding somebody who can really... it's tough because I don't want to... there's a lot of good consulting and practice management people out there. We have relationships with them; there are some good ones. But, unfortunately, sometimes they all get lumped into this same thing, and practice owners just go to the place of, "Well, nobody can help me. It can't be done; dentistry's hard," right?

Your friend, well, all these doctors can't figure it out, right? They're all bad, and what do I do until you find that one, maybe that endocrinologist or some autoimmune person that goes, "Oh no, this is actually the problem," and they're like, "I wish I would have known that years ago. I've been suffering, getting bitter, getting stressed, just absolutely suffering, and this person actually cured me. They properly diagnosed me. Now I can look to, you know, other areas. Now I feel better, my health is better, now let's fix the hangnail. Now let's go to the gym and lift some weights and do some treadmill..."

Jarrod Bridgeman:
And now I know to hire the company, the bio company that comes in and safely removes all the mold, you know what I mean? You need someone to come in and clear the path.

Casey Hiers:
Yeah, prescription without diagnosis is malpractice. So many times...

Jarrod Bridgeman:
What about just taking prescriptions you find on the floor?

Casey Hiers: No, that's a bad idea. But so many times, the prescription is, "Oh, you need something that..." There may be beneficial, but it doesn't cure the root problem because there was no actual proper diagnosis before prescription. They're throwing money at a problem, but it's not the core root problem, again, which can be...

Jarrod Bridgeman:
Which can be incredibly frustrating.

Casey Hiers:
Yeah. Well, most of our clients have been burned in the past by throwing money at something that actually isn't going to fix the root problem. And, you know, yes, we do this, but there's other entities out there that can help kind of locate the core problem of it, and then also a lot of...

Jarrod Bridgeman:
Or at least point you in the right direction.

Casey Hiers:
A lot of these groups, it goes back to something else we talk about a lot. If you want to make more, just produce more. A lot of times, they put a Band-Aid on a couple things, and then their big idea is "grow." Open more things, do more things. And, you know, your friend that was sick, it's like, "Oh, well, we put a Band-Aid on it, but you need to get in shape, so go run a half marathon."

Casey Hiers:
Well, no, why would you run a half marathon if your health is still not quite right? You're going to make the problem worse. Well, now what practice owners do is, "Well, let's... let's go acquire Old Man River's practice. Let me go open another practice. Let's throw money at fill-in-the-blank," right? Like, there's so many good... like, the sleep space...

Jarrod Bridgeman:
And if you acquire a new practice, all you're doing is inheriting its own set of problems on top of your current structure.

Casey Hiers:
Oh, you know, you just hit on something. Most people's number one challenge at our events: staff and team. And then the conversation will continue, and then all of a sudden, they get into the, "Well, multiples and scaling and growing," and it's like, hold on. Your core... one of your biggest challenges is staff, so you want to go double and triple your staff, and you haven't actually got yourself healthy, financially healthy, you know, the practice running well?

It's ass-backwards, unfortunately, and I get it. You're busy producing dentistry. You've got all these headwinds. You just want to fix the damn problem. But, like your friend, go to all these doctors, get these appointments, do all these things, pay all this money, and she's still sick because the core problem of the black mold, nobody thought to ask, nobody thought to look, nobody thought to go there.

You need a custom business advisor that looks at everything from Jump Street to make a proper diagnosis. That step is glossed over. Once you have that, then you can prescribe some different solutions. And then, yeah, you can still go grow and add and do all those things, but it's order of operations and pace and timing.

Jarrod Bridgeman:
And you can do it if you want to do it versus just thinking, "Well, if I did this, I would make money."

Casey Hiers:
Yeah, "I'm going to go do this thing to fix it." No, you're making it worse.

Jarrod Bridgeman:
No, you're peeling off the scab before it healed.

Casey Hiers:
Man, we're good at analogies, man. We're just... lot of... lot of good analogies.

Jarrod Bridgeman:
That's right, buddy.

Casey Hiers:
But it's, you know, this is... we're kind of all over the place here, but this gets brought up all the time when I speak to practice owners, and it's making the distinction of who can properly diagnose my core challenges in my practice. And breaking news, it's not just one. Normally, there's a half dozen things that are interconnected that need to be sort of parsed out and improved on. Then you start to get health- a healthy practice.

Jarrod Bridgeman:
You and your team are always out and about traveling, greeting dentists and presenting and having wonderful dinners and some bourbon tastings and stuff like that. In September, we're going to be... on September 17th, we're going to be in Grand Rapids, Michigan, and East Lansing, Michigan. And then in October, we'll be in Kansas City and Springfield, Missouri, followed by Chattanooga and Knoxville, Tennessee. Those are some pretty interesting spots.

Casey Hiers:
You know, Eastern Tennessee doesn't get any love. Memphis and Nashville, they get all the love. Eastern Tennessee, some of the nicest people I've ever met. Now, ironically, we're on here talking about our events, and if I'm listening, my mind's like, "Oh yeah, whatever, you just want me to go to..." Most of our events sell out. Like, most people listening, if you're in that area, you probably can't go.

We have a team that does some outreach and tries to invite practice owners and offices, but, you know, the office manager, the gatekeeper, they're just not interested. 100%. So a lot of times, the practice owners don't even see these invitations because they're just trying to keep up with patients, and who's canceling, and who has an emergency, and keeping the... and so, and they get targets on them. They get called all the time by, you know, Johnny Banker.

But we have a team that reaches out when we go to these areas; they are contacting offices...

Jarrod Bridgeman:
So if you're listening to this and you're in those areas and you haven't gotten an invitation yet, go to fourquadrantsadvisory.com and click on the "Events" button.

Casey Hiers:
Or ask your office manager or whoever answers the phone. "Hey, is this... has this Four Quad, Four Quadrants, Four Quadrants Advisory, anybody called about a bourbon tasting and some CE?" Because we're reaching out. Now, they're selling out because a lot of people realize, "Oh, I need to go to this."

And it's happening more and more because these challenges that we fix don't go away, right? And we certainly can't help everybody, but what we hear is this is some of the best continuing education or subject matter, topic, that we have heard all year or we've heard in multiple years because there's so much clinical. Again, they're trying to get variety and trying to get these other areas in, but we get told that.

I've even had people in the room that seem like the know-it-all, little professor, that, of course, they're above it, right? "Well, I'm amazing," and they want all their peers to know that in the room, but they say, "A lot of you could really benefit from this. And I go to all CE for everything, and this is some of the best things we've heard."

So, again, when we talk about where we're going, yeah, it's a little self-serving. That being said, it's damn good content that changes people's lives. At minimum, they're going to have a really fun time.

Jarrod Bridgeman:
Yep, so make sure to register if you're in those areas. We're hoping to see you soon. Thanks, Casey.

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.