The Jaded Dentist: Finding a Path to Renewal

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, Jarrod Bridgeman.

Jarrod Bridgeman:
Casey, good morning. How are you?

Casey Hiers:
Doing great.

Jarrod Bridgeman:
Doing great, doing great, huh? So in our office, we've got our fantasy football leagues going on. I wanted to ask how your team was doing.

Casey Hiers:
2 and 0.

Jarrod Bridgeman:
2 and 0, all right.

Casey Hiers:
I don't know half the people on my team.

Jarrod Bridgeman:
That's okay.

Casey Hiers:
I don't follow it much. Old man, get off my lawn, I used to be obsessed with the NFL and every player. And now, I don't know what it is, man, it's just getting old. I don't care as much.

Jarrod Bridgeman:
No.

Casey Hiers:
I still want to win.

Jarrod Bridgeman:
Right, but for different ... It's for-

Casey Hiers:
I don't know. I know half my roster. I was following it back when Peyton Manning-

Jarrod Bridgeman:
Sure, his brother and-

Casey Hiers:
Adrian Peterson.

Jarrod Bridgeman:
Drew Brees and all that.

Casey Hiers:
I know those guys. I go to draft them, and oh, yeah, they retired. Who are these new guys? I don't know.

Jarrod Bridgeman:
It's five years ago.

Casey Hiers:
I don't know who they are. What the heck is this?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Got guys scoring 30, 40 points. I'm like, "I don't even know where they went to college. I don't know anything about them."

Jarrod Bridgeman:
Either way, thank you.

Casey Hiers:
2 and 0, 2 and 0.

Jarrod Bridgeman:
All right. I'm pulling for you.

Casey Hiers:
I try not to put too much stock in it. Right?

Jarrod Bridgeman:
Right.

Casey Hiers:
People get mad. I saw there was a couple, and she basically was like, "Why is my husband mad for two days when the Eagles lose? The whole house has got a cloud over it. The kids are like, 'What's wrong with Daddy?'" And the husband's basically admitted, "Yeah, that's kind of foolish. What are we doing here?"

Jarrod Bridgeman:
That's so funny. So I'm guessing what you're saying is you're not hoping to win and use that win pool, pot of money for your retirement.

Casey Hiers:
Yeah, correct.

Jarrod Bridgeman:
Okay, all right.

Casey Hiers:
We're not supposed to talk about off the books money.

Jarrod Bridgeman:
That's right. I'm sorry. I mean ...

Casey Hiers:
It's all for fun.

Jarrod Bridgeman:
Casey, that's right. It's all for fun. Being that old man yelling at clouds, get off my yard kind of thing, that makes me think of a case that we run into here and there, which is the older, jaded dentist.

Casey Hiers:
Let's go negative today.

Jarrod Bridgeman:
Let's do it negative. We've been too positive to our listeners and it's time we really kicked them in the ass. But I wanted to get your opinion on that because you and your team, you again are the boots on the ground, you get to go out there and you're speaking daily with practice owners and dentists. What insight can you give me to the jaded dentist that maybe have shown up to an event, maybe at a conference, maybe you'd gotten on the phone with?

Casey Hiers:
Yeah. The people listening, if it's not you, you probably know somebody where they're burnt out in dentistry. They're jaded. They're cynical. They're frustrated. It can't be done. Dentistry today, it's impossible to be profitable. And I've been in rooms with these conversations. We're presenting on this subject matter and we get into some Q and A. And you come across somebody who you can just tell they have had it. And so we're going to unpack some of that today. Right? What are the things that they say, some reality, some excuses? What's that look like? Why?

Jarrod Bridgeman:
Right.

Casey Hiers:
Is it impossible to be profitable? And again, you'll have somebody burnt out, and somebody next to them is printing money and doing just fine.

Jarrod Bridgeman:
Right, right.

Casey Hiers:
So what's the difference between these two? Let's get into that.

Jarrod Bridgeman:
And obviously, this all falls right in line with who we are as a company and what we provide and what we do. But in my mind, the top thing that sticks out, I hear a lot of things about from everybody on our team, is what can really bring a practice down and make them feel so jaded and old and over it is the abundance of insurance companies and making pennies on the dollar as what you could be making.

Casey Hiers:
There's half a dozen excuses that ... It's a reality in dentistry. The margin for profit, the margin for success, or the margin for error is much smaller now. People talk about maybe their mentor when they were starting out, and the older dentists. The way dentistry was, it seemed like there was a way to make more money and enjoy dentistry, and not have all these headwinds, have all these obstacles in your way. But again, adapt or what?

Jarrod Bridgeman:
Or die.

Casey Hiers:
Adapt or die, is that the line? I mean, that's a little darker.

Jarrod Bridgeman:
Perish, let's say that.

Casey Hiers:
Hypothetically speaking, some of the things I hear from practice owners, it's sad because again, there are real challenges that if you do not address them, you're going to be frustrated.

Jarrod Bridgeman:
Right. And insurance can kick your butt. You know what I mean? It's not some thing we're kind of poo pooing over here.

Casey Hiers:
Yeah. Recently, I was out West, and this exact thing happened. You have a very nice person, but boy, when we started getting into the nuts and bolts of the business side of dentistry, you could just feel the frustration. Typically, it starts when, "How much longer do you want to practice?" I want to retire yesterday. That's kind of the tongue in cheek joke, but that's typically the first thing. And once you start peeling the onion back, insurance and staff are really easy. But as a practice owner, resist the temptation to just stay in that, and just act like there's no way out. Insurance is tough. Insurance reimbursements, you're producing a lot of dentistry, you're not getting paid. It's easy to be pissed off at insurance. I understand that.

Staff is hard. It's hard to get a good staff. I even heard one of, there's so much better oral care these days that there's just less tooth decay and less dentistry out there. I thought that was a stretch.

Jarrod Bridgeman:
That seems like a bit much. That's not plausible.

Casey Hiers:
Then it got tied into, so unless you are unethical and doing unnecessary dentistry, again, it's just impossible to be successful in dentistry these days. Dentistry's a dying ... It really goes to negative town again with a small percentage of practice owners, but it's something I wanted to talk about today.

Jarrod Bridgeman:
The better oral thing does seem to kind of throw me for a loop. I obviously am better about taking care of my teeth now than I was when I was 14, let's say, or whatever. But I still go twice a year, maybe I just don't have a mouth full of cavities anymore.

Casey Hiers:
Well, as a patient, it's, "Yay, I don't have cavities, and I had a pretty good checkup." I guess for the practice owner, all I'm doing is checking and cleaning minimal. I mean, that's where they were going with that excuse.

Jarrod Bridgeman:
Got it, okay.

Casey Hiers:
But I just kind of looked at him like, "Huh?"

Jarrod Bridgeman:
I feel like he's been thinking about that and searching for that real hard. Why am I not doing so well? It's got to be this?

Casey Hiers:
Yeah. Well, and it was even tied to in this environment of corporate dentistry and DSO, where they are potentially, not all, but some are maybe pushing excess dentistry and having a dentist say, "Yeah, I had somebody go to a corporate place and seven cavities and $20,000 worth of work," and they got a second opinion. They look at it and go, "No."

Jarrod Bridgeman:
So it's like taking your car to the mechanic. You know what I mean?

Casey Hiers:
Ooh, let's go down that road. Took my car to the dealership because the air conditioning goes out. $1700 later and they tell me all this other stuff's wrong, and then we take it to a local reputable shop and they go, "No, it's just this little thing here and there, but no, you're fine." It's like, "Huh? Two different opinions." Right?

Jarrod Bridgeman:
Yeah, yeah.

Casey Hiers:
And I think you've got to find your sweet spot as a practice owner, and again, decide what you want. But I would just say insurance is hard, so you can either retreat or you can address it. Staff's hard. Well, do you want to be your hygiene department and the dentist?

Jarrod Bridgeman:
You have so much control over the staff too.

Casey Hiers:
Pick something, choose your heart. We've been talking about this. These things are hard, so you can either step up and address them or you can just-

Jarrod Bridgeman:
Bury your head in the sand.

Casey Hiers:
And just waddle around in mud and be pissed off. I don't know. I mean, I said mud, it could've been-

Jarrod Bridgeman:
I love ... The word waddle made me laugh. That's what got me.

Casey Hiers:
Think about golf. Most golfers, when they talk about their game, they're frustrated. They're frustrated they're not better. It's hard. They'll have some good holes, some bad holes, a bad shot, a penalty, free putt. There's lots of things in golf that can be hard. Well, you chose to buy golf clubs and go to the golf course and pay to go play golf, and then all you're going to do is bitch and moan about how hard it is. And then the guy next to you, well, they actually go practice and they get lessons, and they work on it and they're better at golf. And they look at the bad golfer and they're like, "Well, you're throwing your clubs and you're throwing a fit and you're hitting the ball in the woods. Let's talk about the why. When's the last time you played? When's the last time you worked on your putting or your chipping?"

Jarrod Bridgeman:
Maybe you need to go to therapy. What's going on at home that's making you [inaudible 00:09:09]?

Casey Hiers:
Well, the analogy is get some lessons. Go to somebody who really is good and try to learn. But you can't just complain that you stink at golf and not do anything about it. And anything in life, that's the case. But in dentistry, I see it more and more because-

Jarrod Bridgeman:
It has a cycle too. I feel bad about this. I'm not doing as good as I want to. And then they just keep going hand in hand as you slip further and further down.

Casey Hiers:
Yeah. It can't be me. It has to be external, so it's-

Jarrod Bridgeman:
It's my clubs.

Casey Hiers:
It's my clubs. It's, "I had a bad lie," for the golf analogy, in a practice, same thing. You can use these excuses and not go anywhere with it, or you can decide to do something about it. I had a conversation recently with our COO, and he's like, "Again, so many people think it's volume. If I can just produce more and have more volume," and a lot of this ties around what we've already talked about. A lot of times, it's not a volume issue, it's an efficiency issue or it's profitability issue because we see people 2.5, 2.6, 2.8, three million, and their next idea is to simply grow, grow, grow because they're a one-trick pony. They don't know how to do it. You have to have a good balance of volume and efficiency and profitability. And make your choice, do something about it. But instead, they go to their dental society and just complain all night. And they just want to have this pity party.

Jarrod Bridgeman:
They complain to these younger dentists who are killing it.

Casey Hiers:
Well, some.

Jarrod Bridgeman:
Sometimes.

Casey Hiers:
There were specialists in the room and they're just like, "Yeah, it's really hard." And others, I could tell. And afterwards, they're like, "Hey, I'm really sorry about how negative some of those people were. I'm not having that experience. I didn't want to say anything." But it's not-

Jarrod Bridgeman:
If they did, it probably wouldn't have been a great scene because there would've been an argument between two people in the audience. But let me ask you. So we're talking about these older dated doctors, do you have any advice, or things to look at, or start with, that could maybe help them start to climb out of that feeling in their practice?

Casey Hiers:
Well, in golf, it's get some lessons and spend some time working on it. With what we're talking about, it's these are the headwinds. Again, what are we going to do about it? You have your choice. You can do nothing. You can just try one or two things.

Jarrod Bridgeman:
Well, yeah, you're right. It's what you said, it takes time. You need to take time to master or at least look at the numbers and look at what you need to do. Or you could just give someone like us a call.

Casey Hiers:
Obviously, we help master these things. But we can't help everybody.

Jarrod Bridgeman:
But a great golfer goes out and practices.

Casey Hiers:
Well, that's it. And you've got to know your numbers, and so if you're somebody that's frustrated, if you don't know your insurance adjustments, you don't know your overhead, you're income's low, your insurance, if all these things are unknown, well, there's your first issue. You have to get your arms ... You have to identify the problem and then make a decision. What are the next steps?

Jarrod Bridgeman:
Pulling out and looking at the bigger picture helps. For example, this week, my wife and I have been working on redoing our budget and looking at our spend and what we do. And she, in a very nice text, told me to stop effing shopping. That's what she told me. And I was like, "I don't feel like I spend that much," and so I went through and I was looking at my cards and all this stuff. And I made a spreadsheet. And then I looked at it, I was like, "Over the past nine months for the year, what have I spent on my hobbies?" And it was more than I expected. And so I was like, "Okay, you're right. Maybe I need to stop shopping as much. All right. I'll cut a third out." You know what I mean? The whole idea is month to month, I didn't feel like I was doing bad. But then I pulled back and I was like, "Oh, I spent this much?"

Casey Hiers:
Well, it's easy to complain. I just need more. Right?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Produce more dentistry, or in this example-

Jarrod Bridgeman:
Would be make more money.

Casey Hiers:
I just need to make more. And again, most people, that's not about what you make, it's what you spend. And you could triple somebody's income and they'd be in the same financial situation because they're just going to buy more stuff.

Jarrod Bridgeman:
I buy three times as many board games, yes.

Casey Hiers:
But you took the time to at least look at some data and go, "Huh?" I could've gotten defensive and just fought back and complained and said, "It's not possible," or look at it and go, "No kidding, maybe I did spend a little too much." That's a great first step. Instead of just complaining, understand where you're at.

Jarrod Bridgeman:
The point I was trying to make is at home, in your practice, wherever the case may be and what you're doing, knowing your numbers, or at least as close to a number as you can get, there's people out there like CPAs, CFPs, in our firm that will help you find these numbers and do those kinds of things. But if you have no knowledge of where to go or what to do, you're going to be stuck forever.

Casey Hiers:
But to your point about learning about numbers, it's interesting when you look at a hygiene department, how efficient or not efficient are they, maybe somebody has a part-time associate, maybe they take seven insurances and they're working all this time, again business model. We talk about this all the time. Do you want the volume shop? Or do you want efficiency and profitability? Dropping insurances, making sure you have right sized hygiene departments, making sure you don't have too many associates, making sure you have the right space. Why is your overhead high? Do you have a custom chart of accounts? Are your taxes filed on time? It's all connected. It's all connected, similar to golf, similar to different things we're talking about.

Jarrod Bridgeman:
And if you're not careful, one bad, bad day, one bad week, one bad tax surprise can snowball if you don't have other things in working order.

Casey Hiers:
The hard part is when I hear somebody complain, I'm empathetic because dentistry is hard. That's why we exist. That's why we educate. That's why we help people. There are challenges.

Jarrod Bridgeman:
There really are a lot of challenges, and we've covered a lot of them in this episode already. That's why have that empathy and we pride ourselves on being a dental business expert.

Casey Hiers:
I will say this. It's rare that somebody's geography, or the state of dentistry today, or just staff, or just insurance are the reasons why you're not achieving what you want to do. Those are all a part of it, but typically, it's a lot of areas that need addressed and it starts with you. Identify what those areas are and what you want. If you don't have a comprehensive team, meaning they're all talking and under the same roof, then it is on you. You're going to have to identify some things to your external team to work on because they're not going to pick up on that if you have kind of a piecemeal team.

Jarrod Bridgeman:
Yep. And I'm not going to lie, talking to CPAs and CFPs, that's like a foreign language to me sometimes. I'm like, "Okay, yeah. Whatever you say, pal."

Casey Hiers:
Yeah. I want to encourage practice owners, if you are frustrated, don't just stay in that place. Identify the problem. What are the steps to fix it? Don't be that jaded person. It's probably something you have a hand in, you're a part of, accountability and total accountability, that's what people are going to have to step up to then get better.

Jarrod Bridgeman:
Let's get that fixed and then you can complain about something new like your HSA or something. Not HSA, HLA. HLA.

Casey Hiers:
HLA. But there are a lot of practice owners that are doing very well. They have their own unique set of problems, but, man, the ones I hear, it's becoming more and more and more, which tells me, yes, dentistry landscape is harder to be profitable. Do you just want to complain the rest of your career and be cynical and jaded? Or do you want to do something about it?

Jarrod Bridgeman:
That's miserable.

Casey Hiers:
Because you have to take some accountability in this equation. There's a formula. The practice owner's a part of it. You can't just blame everything as external.

Jarrod Bridgeman:
Correct.

Casey Hiers:
Or that it can't be fixed, it can't be done. Well, that's not the case because we see it-

Jarrod Bridgeman:
Playing the victim.

Casey Hiers:
All the time, but there are real challenges that need addressed. But yeah, it's sad to see that beat down person that just dentistry, but it's easier for them to say, "It can't be done," versus, "I could've done some things better over the years and decades."

Jarrod Bridgeman:
Admitting your own fault, okay.

Casey Hiers:
I am in this position for a reason and I am a part of that. Why? What can I do?

Jarrod Bridgeman:
Casey, for those folks who aren't jaded, and they want to come and hear you speak, or if they're jaded and they just want to come and complain to you, where are we going to be soon?

Casey Hiers:
Well, your point, the first step's education. Right?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Is there a better way? Go learn. Go figure it out. Rarely is there no way out. There's normally a path, but you've got to identify that. Yeah, the first step's education. I mean, we're all over the place. There's lots of areas you can grab some learning.

Jarrod Bridgeman:
That's right. Now for example, for us, we're going to be coming up in Detroit area. We're going to be in Grand Rapids, Michigan. We're going to be in San Francisco. We're about to start advertising our Philadelphia area stuff very soon.

Casey Hiers:
Got some study clubs and dental societies in I think Milwaukee, Napa.

Jarrod Bridgeman:
Oh, I love Milwaukee.

Casey Hiers:
Wine country. So wine country, you're like, "Whatever." But Milwaukee, you love, that's funny.

Jarrod Bridgeman:
Yeah. I like Milwaukee. I've been there.

Casey Hiers:
You probably went to Summer Fest once and then ... I get it. No, we're all over the place. And ultimately, we are a resource for practice owners. For our clients, absolutely. But we're a resource. We have a lot of resources on the website. I just want to encourage people. Don't just stay in this, it can't be done, it's so hard, wah. Go do something about it. Now if you get all the golf lessons in the world and practice and play and do all those things, and you're still terrible, rarely does that happen.

Jarrod Bridgeman:
But, it does. Casey, thank you so much for stopping in. Folks, don't forget to visit fourquadrantsadvisor.com. And if you click on the events tab, you can see our upcoming events. If you're going to be ... We're going to be at a big conference pretty soon. Right?

Casey Hiers:
Yeah. There's an orthodontia conference in New Orleans.

Jarrod Bridgeman:
Yes, that's right, that's right.

Casey Hiers:
That we will be at as well, we're hosting a Wednesday evening event, just very-

Jarrod Bridgeman:
Very close to that conference.

Casey Hiers:
Yeah, yeah. Great venue and just kind of a nice little casual, personal event. And then we'll be at the show as well.

Jarrod Bridgeman:
Yeah. That going to be exciting. Thanks, Casey.

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.