When a Dentist Needs to Stand Up for Themselves

This week, Casey and Jarrod dive into the surprisingly high-stakes world of standing up for yourself as a dental practice owner — whether it’s with stubborn employees, pushy patients, controlling insurance companies, or the occasional overconfident DSO.

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:
What, hi, Casey. How are you?

Casey Hiers:
Your sweater is giving me a seizure. How many colors do you have over there?

Jarrod Bridgeman:
I don't know, 12. Listen-

Casey Hiers:
It's like Bill Cosby's sweater before Bill Cosby-

Jarrod Bridgeman:
Kind of-

Casey Hiers:
... went out of style.

Jarrod Bridgeman:
It's a little bit like a Bert and Ernie sweater, so all day people have been calling me Ernie.

Casey Hiers:
Yeah, that's probably a better-

Jarrod Bridgeman:
Which is fine-

Casey Hiers:
... comparison.

Jarrod Bridgeman:
I'm a Muppet fan, so it all works out.

Casey Hiers:
What have you been up to?

Jarrod Bridgeman:
I spent the weekend dragging the kids around, doing sports things. I should say they dragged me around. One of the things I was very proud of, my son is six and he's doing soccer, and he really worked hard to not score all the goals himself and help everybody else. So he kind of stood up for his teammates which was nice.

Casey Hiers:
Hashtag humble brag but listen to you.

Jarrod Bridgeman:
Listen, I'm excited for my kid to be successful since I'm here.

Casey Hiers:
Well, for the listeners out there, Jarrod doesn't really like sports and he's-

Jarrod Bridgeman:
I got spurned at our early age. I was terrible.

Casey Hiers:
Yeah, last kid picked, so now that his kid's having success-

Jarrod Bridgeman:
Chubby, asthmatic, all that stuff. And this kid's out of the gate phenomenal.

Casey Hiers:
And you're embracing it though. You're kind of liking it.

Jarrod Bridgeman:
Yep.

Casey Hiers:
That's good.

Jarrod Bridgeman:
Yep.

Casey Hiers:
But he was helping out his teammates. I like it.

Jarrod Bridgeman:
Yep.

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

Jarrod Bridgeman:
I wanted to talk, if you'd let me finish, I'd like to talk about standing up for yourself. Yeah, you like that?

Casey Hiers:
Still won't stand up for yourself.

Jarrod Bridgeman:
That's right.

Casey Hiers:
Don't let me bully you.

Jarrod Bridgeman:
That's right. Well, we talk about a bunch of these different things. We've talked about some of them separately, but we've talked about how a lot of times practice owners are non-confrontational. Now, standing up for yourself does not actually have to mean a violent confrontation by any means, but there is something that needs to be said or done at times. It could be with a patient, it could be with an employee, it could be standing up to DSOs or insurance companies. That's kind of where I wanted to go. Let's just shotgun it out there and get it all going.

Casey Hiers:
Yeah, I think podcasts over. Be courageous. Thanks.

Jarrod Bridgeman:
That's right. You're welcome. Done.

Casey Hiers:
No, you're right.

Jarrod Bridgeman:
I want to talk to you. As our listeners know, you're always out and about, commuting and talking with the common dentist out there. What's a major thing that you feel you just want to scream, "Stand up for yourself?" What's a topic?

Casey Hiers:
I just shared this earlier today with a new hire, talking about how so often insurance adjustments can be a real challenge in a practice, right? You'll produce 1.6, collect a million, $600,000 off the top. And I've talked to practice owners where we'll get into that and rather than address that issue, they've told the lie to themself of, "Well, yeah, but I'm helping people." and so it's almost one of those things that no, they need to address it.

Jarrod Bridgeman:
They feel like they're helping people on one side and the other side is, there's nothing I can do about it kind of thing.

Casey Hiers:
Yeah. Yeah. I think there's a lot of employee wages, insurance, those are probably the top two.

Jarrod Bridgeman:
Casey, and in the situation of insurances, do you have any good examples of potential ways a doc could stand up for themselves?

Casey Hiers:
Yeah, I think having the courage to actually look at it and know where your true fee schedule should be, what your true insurance adjustments are. We've talked about this before, not cooking the books. Don't bill, expect the collect. Make sure you actually understand what your true insurance situation and adjustments are, because if you're cooking the books, it looks like you have 6%, no, you have 26%. You're not putting it in the software. So really the first step is just understanding the situation and then looking at different metrics, patients per day, production per day, how far you're booked out. Is there an opportunity to do something here?

Jarrod Bridgeman:
I want to recoin or re-say one of your favorite phrases, which is, "What's worse than having bad information?"

Casey Hiers:
"What's worse than incomplete or incorrect data?"

Jarrod Bridgeman:
Yes, thank you. I re-coined it.

Casey Hiers:
Making decisions using incomplete or incorrect data, and then to your point, if somebody is not sure what their true insurance adjustments are, how are you going to fix that? You're going to keep taking six-figure haircuts every year because, and again, a lot of times it comes from they don't know what to do or how to change it. So it's easier to just say it's unchangeable than stand up for yourself, have your team do a deep dive and understand it better.

Jarrod Bridgeman:
You said a number two kind of thing would be a lot of times employee wages or just employee situations in general. What are some good examples? Now, wages I can obviously understand, which would be a long-time or even a short-term employee asking for more money and maybe trying to hold you hostage over that. What are some other situations where a doc may need to stand up to an employee?

Casey Hiers:
Yeah, we don't want any hostage situations. I mean, it can be culture. I mean, there's a lot of times that they'll know there's an employee that really is a cancer, but they don't have the courage to do anything about it and-

Jarrod Bridgeman:
And I feel like that's a common one in a lot of businesses too. There's always, not always, but sometimes you'll go into-

Casey Hiers:
That example's universal, I mean any organization-

Jarrod Bridgeman:
A bad seed somewhere.

Casey Hiers:
... anywhere, right, and so really making sure you have identified and rectified what you want your culture to be, and if somebody's not adhering to it, then what are those consequences? Again, it comes down to are you going to have an employee run your practice or are you going to take control, have the courage to run your practice. Now, that can trickle down to wages. That's a real touchy topic because underwhelming staff and team are demanding more money or they walk because they know there's a demand and supply issue with good workers.

Jarrod Bridgeman:
Correct.

Casey Hiers:
And so that's a real big one.

Jarrod Bridgeman:
I've heard some horror stories before about maybe a new doc buying a practice and keeping some of the older staff and how that can be an issue too.

Casey Hiers:
It's the boogeyman, right? So new practice and old staff, and you go back to junior high and you're worried nobody's going to dance with you, nobody's going to like you.

Jarrod Bridgeman:
I didn't have to worry about it. They just didn't.

Casey Hiers:
That explains so much but ultimately not wanting to change too much, and so then putting up with too much. Now there's pace to everything. We say that all the time, so you have to have strategy and good advice and good implementation of that strategy. But there are a lot of times where the old staff, they're trying to run the show and almost work against the new practice owner, and this could even be in year two or three sometimes.

Jarrod Bridgeman:
Right, because they have their habits and their traditions that they think are better, even if they're not.

Casey Hiers:
Yeah. A lot of employees overvalue their place and it's incredible how many people we talk to. They go, "I finally had the courage to part ways with an office manager or an assistant or two hygienists" and-

Jarrod Bridgeman:
And I can get how that can be scary.

Casey Hiers:
Absolutely. Yeah, I'm not discounting it, but ultimately what we're talking about, having the courage to stand up to it, to do the right thing. And then it was never as bad as they thought it was going to be in their head. Ultimately they were able to move forward and the net gain or benefit was so much better.

Jarrod Bridgeman:
Well, because if you're seen as a pushover in your own business, in your own practice, your other employees will see that and will potentially take advantage of it as well.

Casey Hiers:
Yeah. I mean, we're not practice management with leadership, but a lot of the things that we help our clients with, they then become better leaders. And then they also have a team that we can fall on that sword and help give that advice, but ultimately when people have the courage to do the right things, and normally it just comes down to doing the right thing. The thing you know in your pit your stomach that you need to do, if you do it, typically you're better off because of it versus the tail wagging the dog. And then all you do is complain about your team or your staff or even patients. I mean, there's some patients that I've heard a lot of these stories where they'll come in and they'll try to get discounts or free dentistry and complain or threaten that they're going to put a bad review out there. Again, you have to have strategy around when that happens, not if, because it's going to probably happen.

Jarrod Bridgeman:
I was going to ask about patients next. I like that you brought up the threat of a bad Yelp review, which I don't... It's not as big of a deal as some people play it out to be unless you're at a restaurant, I think. But one of the ones, and this is an episode from quite some time ago, we had talked about making patients accountable.

Casey Hiers:
Mm-hmm.

Jarrod Bridgeman:
And I think that's where also standing up for yourself could come into play.

Casey Hiers:
Yeah. We've got some people, I love it. They have their go-to couple practices that they say, "You know what? I really feel you're a better fit for Doc so-and-so down the road. And I'm going to go ahead and them know that you'll be contacting them and we're going to go ahead and close out your client file," and you say it really nice. Basically you're saying f-off, right? But you're saying it in a professional way. And again, having all these systems in place that when these things happen, what are you going to do? Because if you don't have a plan and if you don't have a team and you don't have any courage, you're going to be frustrated. Dentistry is not going to be what you thought it was going to be. You're going to be paying... Patients are going to be walking all over you. Your staff and team's going to be walking all over you. The insurance companies are going to be walking all over you, and then you go to your study club and just bitch and moan about how dentistry is terrible.

Jarrod Bridgeman:
Right, right.

Casey Hiers:
It's not terrible. It's beautiful. It's a beautiful thing.

Jarrod Bridgeman:
But, yeah, if you're not doing any of these right, I can see how that's definitely a painful...

Casey Hiers:
Well, it starts to add up. I mean, as a practice owner, you're getting it from all angles.

Jarrod Bridgeman:
And you're grinding. I mean you're working every day-

Casey Hiers:
You're also-

Jarrod Bridgeman:
You're working your ass off.

Casey Hiers:
... producing an incredible amount of dentistry, yeah, that's the-

Jarrod Bridgeman:
Then you get worn down to become that, what, that smooth stone?

Casey Hiers:
Well, and then we talked about standing up to DSOs.

Jarrod Bridgeman:
Yep.

Casey Hiers:
Again, there's a place for them, and we're not poo-pooing them.

Jarrod Bridgeman:
I'm going to.

Casey Hiers:
I mean too much.

Jarrod Bridgeman:
Poo-poo.

Casey Hiers:
But sometimes the corporate dentistry DSO route, they come in with a check and the practice owner doesn't feel like they have any other options.

Jarrod Bridgeman:
Right, they wave that in front of your face and then, yeah, expect you to jump.

Casey Hiers:
And if you can get your practice and house in order, then you can also always say no to them. But to stand up to them and feel good about it versus, "Oh, I don't want to upset them because this might be my only way out to sell my practice." I mean, just courage in general. Some people have it more than others and some are too courageous and do dumb stuff, so again, that word is a sliding scale.
But the PGA golf tournament in Valhalla in Louisville is this weekend and took my nine-year-old and my dad to the practice round.

Jarrod Bridgeman:
That was nice of you.

Casey Hiers:
Just a-

Jarrod Bridgeman:
Nice fellow.

Casey Hiers:
... gentleman and a scholar, but there was this area where all the players kind of funneled in and out, and there was kid area for autographs. And it was great but there were some adults in there and they were just pushy, and they're the ones that were trying to sell autographs. And my nine-year-old kind of forearm shivered one of them and kind looked up at them with a look and they were like, "Oh, I'm sorry," and moved. And I was so proud of her because innately she has that little bit of that courage to do that. And then she got Jon Rahm's autograph, Justin Thomas's autograph. Tommy Fleetwood. You don't know who those people are.

Jarrod Bridgeman:
I don't know who they are, well that's good for her. But listen, and I'm sure at the same time too, those golfers really appreciated that because they know these adults are just trying to flip and make some money. Well, there's actually kids here who are appreciative and they're heroes [inaudible 00:11:29]

Casey Hiers:
I don't know a ton of famous people, but I do know some people of notoriety and they tell me the kids they love, but the adults they can't stand because they know they're probably just going to sell the autograph or try to do something. But the kids, you're right, they flock to them and there was certainly a chuckle or two-

Jarrod Bridgeman:
Throwing those bows.

Casey Hiers:
That's right.

Jarrod Bridgeman:
That's right. Casey, we just had a really successful and great event down in... and actually two of them, going over the business side of dentistry. We are going to be visiting some other areas soon. We're going to be hitting St. Louis for two different events as well as Kansas City. So check those out, go to fourquadrantsadvisory.com, and click on events. We are going to be hitting our hometown area of Indianapolis, visiting Evansville, Indiana as well. A lot of really, really cool things coming up. I know we're going to be at the-

Casey Hiers:
IDA.

Jarrod Bridgeman:
We're going to be at the IDA.

Casey Hiers:
The state we reside in. The Indiana Dental Association meeting. A lot of our clients are presidents, past presidents on the board. Going to support that.

Jarrod Bridgeman:
That's right.

Casey Hiers:
Aren't we going out east too?

Jarrod Bridgeman:
I believe so.

Casey Hiers:
Hey, the only thing hotter is the Taylor Swift tour. Other than that, it's-

Jarrod Bridgeman:
It's the Four Quadrants at Millionaire Dentist tour.

Casey Hiers:
Boom.

Jarrod Bridgeman:
Boom. Thank 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.