When Success Creates Problems: The Hidden Stress of Thriving Practices

Announcer:
Hello, everyone, and 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 cohost Jarrod I Love the '70s Bridgeman.

Jarrod Bridgeman:
Casey, what's up? Yes, today I'm rocking it like I'm from the '70s. My wife got me some shirts from this website I like, where it's all '70s-esque.

Casey Hiers:
In the Brady Bunch, what's the dad's name?

Jarrod Bridgeman:
Was it Peter?

Casey Hiers:
No.

Jarrod Bridgeman:
It was Peter, Greg ...

Casey Hiers:
And Bobby.

Jarrod Bridgeman:
Bobby. Those are the kids.

Casey Hiers:
Was it just Mr. Brady?

Jarrod Bridgeman:
Mr. Brady, it could be.

Casey Hiers:
Yeah, you look like you got a little Mr. Brady going on there.

Jarrod Bridgeman:
All right, I'll take it.

Casey Hiers:
Yeah, a little throwback.

Jarrod Bridgeman:
You look sharp in your jacket.

Casey Hiers:
Thanks.

Jarrod Bridgeman:
You look nice. Yeah.

Casey Hiers:
Thanks.

Jarrod Bridgeman:
That's sexy, so they say. Casey, usually you and I come on here, and we have a good time and we talk about a lot of things. One of the things I wanted to touch upon, we have some listeners out there who maybe sometimes think that what we're talking about may not necessarily apply to them right now because they've already moved up a level. They're already pretty successful. Mo money, mo problems. When you're successful, you're just trading problems. Now that may be less stressful, but I want to talk to you, and your experience, and your forethought on having theses conversations with dentists and owners.

Casey Hiers:
There's different plateaus of success.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
There's different challenges. I was joking beforehand, this would be a stressful challenge. "Ugh, jet fuel price went up on my private jet, this is so stressful."

Jarrod Bridgeman:
Yeah.

Casey Hiers:
That's stress.

Jarrod Bridgeman:
Right.

Casey Hiers:
But that's different stress than most people have.

Jarrod Bridgeman:
Right.

Casey Hiers:
"Ugh, what luxury car do I drive today? Gosh darn it, I can't remember which one needs to be driven."

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Well, that's stressful if you don't drive your car and plug the battery in, you'll have problems.

Jarrod Bridgeman:
Right, right. But those sound like rough problems to have. See, and that's from my perspective, from someone who's not at that tier. It's like, "Wow, cool. Good for you."

Casey Hiers:
Yeah. From a personal perspective, Purdue Boilermaker fan, finally we go to the Final Four. Was I there, did I cry? Yes. Not important. Here's what's important. When you get knocked as a one seed by a 16 seed, you have a set of problems, "You stink, get better."

Jarrod Bridgeman:
Right.

Casey Hiers:
It's uncomfortable, you don't like those problems. Well now, you go to the Final Four, you have a new set of problems.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
How do you get the fan base there? Flights, hotels, tickets. There is so much stress this week from so many people I've talked to who ... But yet, it's good stress, you want the stress, you're excited.

Jarrod Bridgeman:
Yeah. You're stressed and you're not even going.

Casey Hiers:
Who says I'm not going?

Jarrod Bridgeman:
Are you going?

Casey Hiers:
We'll see.

Jarrod Bridgeman:
All right.

Casey Hiers:
But my point is there's challenges regardless.

Jarrod Bridgeman:
Right.

Casey Hiers:
When I travel, what do I hear? "Oh, my staff and my team are so hard, and insurance, and there's just no way to be rich in dentistry," and so many people just want to stay in that place.

Jarrod Bridgeman:
Right.

Casey Hiers:
But inevitably, there's people in that room who are like, "I collect one-eight by myself, my staff's fine."

Jarrod Bridgeman:
Right.

Casey Hiers:
They have different challenges. Let's get into those today.

Jarrod Bridgeman:
Right. Let me ask you. Let's say a practice has mostly moved on to fee for service, but is there such a thing as too many patients?

Casey Hiers:
Oh, I've had those conversations.

Jarrod Bridgeman:
Okay.

Casey Hiers:
Now, here's what's funny. Most dentists who don't experience this problem haven't heard this problem, because those that have it don't want to share it because they almost feel a little guilty.

Jarrod Bridgeman:
Right.

Casey Hiers:
But I talk to clients and other, yeah they're fee for service, they are producing and collecting a lot of dentistry, and they're booked out almost to eternity. That's a great ... Who doesn't want that problem?

Jarrod Bridgeman:
Right.

Casey Hiers:
I talk to some people with startups the other day and they're going to get there, but it's going to take time.

Jarrod Bridgeman:
Let me ask you, what are some inherent stresses that could come from being booked out too much, too far out? Or for eternity.

Casey Hiers:
Well, the domino effect is what do you do? Most practice owners like to work four days a week.

Jarrod Bridgeman:
Right.

Casey Hiers:
Do you work four-and-a-half, do you work five, do you work six? Do you have room to expand? Okay, well do I bring on an associate? Well, there's a whole new set of challenges.

Jarrod Bridgeman:
Right.

Casey Hiers:
Can I not expand, should I have a second ... There's a lot of zigging and zagging that that person has. But then if they're at their study club, talking about it, "Oh, woe is you."

Jarrod Bridgeman:
Yeah.

Casey Hiers:
It's a challenge that some of you out there might have. Then the question goes, well what do you do about it? Most of these challenges, there's the right thing to do based on your personal numbers and your practice numbers.

Jarrod Bridgeman:
Right. We're not going to give you actual, "Here's what to do" today because we don't know you and your practice.

Casey Hiers:
Yeah. But those challenges are real. Again, being insurance isn't an issue, patients aren't an issue, there are a lot of practice owners where those two aren't issues but their challenges are different.

Jarrod Bridgeman:
Are massively different.

Casey Hiers:
Absolutely.

Jarrod Bridgeman:
Okay, let's say you've recently moved more to fee for service, you're starting to bring in a lot more income, a lot more collections into your practice. What happens if your CPA has not prepped for this or has not really accounted for this situation? "Oh, it's great, I'm making hand over fist here, but my CPA had not foreseen that."

Casey Hiers:
Growth that is not accounted for, unintended by a CPA.

Jarrod Bridgeman:
Yes.

Casey Hiers:
Yeah, what do you do with that? Well, if your CPA is non-confrontational, they'll just create a shareholder loan and kick that can down the road.

Jarrod Bridgeman:
Right.

Casey Hiers:
But that is another challenge. Again, "I've grown so much that now my tax situation needs to be looked at," or, "Oh my gosh, too much growth."

Jarrod Bridgeman:
Right. You're either going to have a shareholder loan or you're going to end up with a large tax surprise.

Casey Hiers:
Unfortunately, those two are wildly common in dentistry.

Jarrod Bridgeman:
Right.

Casey Hiers:
Most people would think, "Oh my gosh, you grew your practice 30, 40 percent? That's amazing."

Jarrod Bridgeman:
That is amazing.

Casey Hiers:
It absolutely is.

Jarrod Bridgeman:
You should be very proud of that.

Casey Hiers:
But like we said, you're now trading one set of challenges for a new set of challenges.

Jarrod Bridgeman:
Right.

Casey Hiers:
"Price went up on my private jet fuel, haha." You're not going to get any sympathy at your study club, talking about all this growth, but we see that a lot, man. They're growing and then they just get crushed by a tax surprise. Or, "How do I handle this growth?"

Jarrod Bridgeman:
It can feel very depressing or sad.

Casey Hiers:
Lonely.

Jarrod Bridgeman:
Or lonely to the person who's like, "All this extra money's coming in and I'm just watching it fly right back out."

Casey Hiers:
Yeah. There's not people going to give you a ton of sympathy. A lot of people we deal with, when I mentioned plateaus earlier, they have hit a plateau of success.

Jarrod Bridgeman:
Right.

Casey Hiers:
A plateau of success that most of their peers cannot relate to.

Jarrod Bridgeman:
Right.

Casey Hiers:
They don't know what to do. Again, that's where getting your house in order, or a firm like ours, gets you to that next level, gives you that roadmap, and takes you there. But so many of these successful people, they've hit this plateau, it's rare air. They look around and go, "Crap, I don't know what to do because most people haven't experienced this. I can't call my buddy from dental school and get his opinion, because I don't want him to know all my success."

Jarrod Bridgeman:
Once you hit that certain upper percentage of the neighborhood, it makes me think of that TV show Arrested Development, when Lucille Bluth, the mom, was like, "It's a banana, Michael. How much could it cost, $10?" She had no idea, she hasn't done grocery shopping in 40 years.

Casey Hiers:
The first three seasons of Arrested Development is so good. "It's a $10,000 suit." Sorry.

Jarrod Bridgeman:
God, I do love that show. Okay, your practice has grown, you've got a high income coming in, but your practice has a wrong structure. We've covered this before in previous podcasts, with Steve Levy, our CPA and JD. But do a brief description of what that is, Casey. How does a wrong structure, entity structure, can affect your high income?

Casey Hiers:
Yeah, I've had these conversations where they're like, "I don't know how to pay myself. I have all this money sitting around, I could take it, but do I have the right entity structure, do I have the right income structure? Is my W2 and distributions set up that's right sized for me? Am I reducing debt, am I saving for retirement?" They don't know what to do with the income.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
If you take it the wrong way, again, there are negative tax implications that just can smoke you by the end of the year.

Jarrod Bridgeman:
Because you're going to be getting potentially double taxed on things.

Casey Hiers:
We have seen some situations that the practice owner had no idea that simply a better structure can help them save tens, and tens, and tens of thousands of dollars more for retirement and reduce tax liability by 30, 40, 50,000 bucks.

Jarrod Bridgeman:
That's crazy.

Casey Hiers:
They look up and go, "You've got to be kidding me. Nobody has told me this."

Jarrod Bridgeman:
And how many years have they been doing that, potentially?

Casey Hiers:
Ding, ding, ding.

Jarrod Bridgeman:
Right.

Casey Hiers:
That's exactly right.

Jarrod Bridgeman:
Okay, they've got the high income. Let's say they've got the structure fixed, their entity structure. But now that they look at their account balances and they're just flush with cash. They're sitting on a lot of money. That sounds great, and obviously is not a bad thing to happen is money. But why is that a stressor and why can that be an issue of having too much money in your account?

Casey Hiers:
Yeah, it's a challenge people are embarrassed to mention.

Jarrod Bridgeman:
Yeah. Again, because most people won't have sympathy for you.

Casey Hiers:
No, you're not. You don't hear many people with these issues, but your practice account balances are flush with cash, your personal cash flow and income, you feel like you have plenty of money, you can do what you want. Your personal bank accounts are high. You're looking around and you're not sure what should you do with it?

Jarrod Bridgeman:
Right.

Casey Hiers:
Nobody's really given you a roadmap. Should I zig, should I zag?

Jarrod Bridgeman:
Or if you had asked them, they might have just been a yes man and said, "Yeah, sure. Just go ahead and do whatever you want."

Casey Hiers:
We hear that so often.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
You go to one of your external team and you ask for some advice, and they just backup what you float as an idea. Where in reality, again people in this rare air of heavy success, they're looking for good advice. Tell me what I need to hear, not what I want to hear.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
What should I do with all this freaking money? That's a challenge for some practice owners out there.

Jarrod Bridgeman:
They know, we're all smart enough to realize that having it sit in potentially just a savings account earning a minuscule percentage is not ideal.

Casey Hiers:
Well, when I say zig and zag, I mean there's a lot of different things you can do.

Jarrod Bridgeman:
Right.

Casey Hiers:
But in totality, your team needs to have a very personal relationship with you where they understand retirement savings, debt reduction, cashflow at home, cashflow in the practice, reduce tax liability. That's just five factors that need to be looked at comprehensively and universally.

Jarrod Bridgeman:
If they're good and worth their salt, they'll also be able to tailor it to your interests as well. "You like doing X hobby, let's find a way to make that work into what you can do."

Casey Hiers:
Yeah, versus a CPA or a personal financial planner that just has the same plan for their 200 clients.

Jarrod Bridgeman:
Right.

Casey Hiers:
It's more of just a cookie-cutter, rubber-stamp approach.

Jarrod Bridgeman:
Yeah. Which might be fine for the normal person out there.

Casey Hiers:
The civilian out there, yeah.

Jarrod Bridgeman:
Yeah. All right, here I am, practice owner, I've got patients out the ass. I got cash coming out of my bum. Let's do every form of that word. I'm fee for service, I've got my structure fixed. What's next? Do I want to keep this golden goose opportunity that I have, or should I look into maybe it's time for an associate, or maybe a second location or beyond that?

Casey Hiers:
It's interesting you say that. You're crushing it, human nature, it's like, "Okay, what's next?"

Jarrod Bridgeman:
Yeah.

Casey Hiers:
You've mastered it. You've got this golden goose, as you said. There's a temptation to, "Well, I'm going to go bring on two associates, I'm going to add three locations. I'm simply going to multiple this thing and it's just going to be that easy."

Jarrod Bridgeman:
Yeah, to hope, hope it's going to be that easy.

Casey Hiers:
Hope is a terrible business strategy. But there are times where it could be appropriate for a growth strategy.

Jarrod Bridgeman:
Right.

Casey Hiers:
Again, it comes back to what's the practice owner wants. Most say, "If I can just keep my life simple and hit all of my goals, and maximize my profitability, I'll take that." Sometimes sticking with the golden goose is the best way to go.
But other times, it might make sense, again your team should be showing you business model options, to add another location in a different geography. Now, adult babysitting comes into play. Now you're going to go another one or two million dollars in debt.

Jarrod Bridgeman:
Right.

Casey Hiers:
These are things that you'll have a lot of cheerleaders at your side when you float these ideas, so you've got to be very, very careful. It's a challenge.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
I've dominated this part, do I try to make it a multiple? We've seen people that it has set them back five to seven years.

Jarrod Bridgeman:
Right.

Casey Hiers:
And their personal lives really suffered because of it.

Jarrod Bridgeman:
I can see that, for sure. It's hard to not bring stress home, no matter how good you are at it.

Casey Hiers:
But there's other people where, yes it makes sense to add another location, to bring on an associate, to expand your practice.

Jarrod Bridgeman:
Right.

Casey Hiers:
But people jump into those three things typically way too quick.

Jarrod Bridgeman:
Because it feels good. It's a checkmark you can make. It's like, "I opened a second location, I was able to do that." It's real tangible.

Casey Hiers:
"I did it once, why can't I do it again?"

Jarrod Bridgeman:
Yeah.

Casey Hiers:
A lot of folks get about 60% down that path and they go, "Uh, this emotional decision that felt good and seemed logical, I'm now hemorrhaging cash. All those challenges that I had, I don't have anymore, and fingers crossed, I really hope this works." Again, you need to have a plan and a team where you're more certain.

Jarrod Bridgeman:
Right. Is that worth potentially seven or more years of your time, playing catch up?

Casey Hiers:
Yeah. It can really set somebody back. But again, those challenges, you're probably not going to go your dental community events and, "Hey, everybody." You already make 800,000 in dentistry and save 250, and you're on track for $20 million, and your fee for service, and your staff and team are great, and your overhead's low and you want to do a second location. You'd probably get booed out of the place.

Jarrod Bridgeman:
Right, because most likely, they're still complaining about staff and insurance issues.

Casey Hiers:
Insurance, yeah. Those are real challenges, we talk about those. But they are not the only challenge.

Jarrod Bridgeman:
Right.

Casey Hiers:
I'm getting to a place where I've got to take a deep breath. Not here, but when I go to events, I just, "Oh, my insurance and staff, and where I live, and it's just impossible to be successful." I'm getting to the point where I'm hearing people on the back end of their career becoming bitter, and all they'd do is complain and just say it's not possible.

Jarrod Bridgeman:
Right.

Casey Hiers:
Then I'll talk to somebody in that same room that's younger and go, "Yeah, I'm good on that stuff, man. I don't know what to do with the half a million bucks I've got sitting in my practice account. Should I wipe out my debt in one fell swoop, or should I have balance to it?" That's the different challenges that we have.

Jarrod Bridgeman:
Casey, you actually, speaking of going out and speaking, you just got back from Nashville.

Casey Hiers:
Nash Vegas.

Jarrod Bridgeman:
That's Nash Vegas. How'd that go? Did you have a good time out there?

Casey Hiers:
Great venue, full house. They had to add a table. Yeah. Again, educating the dental community on this topic is the primary purpose. Do we want to meet people to talk and have offline conversations? Absolutely.

Jarrod Bridgeman:
For sure.

Casey Hiers:
We can't help everybody in the room, but if we find one or two that we can then we'll allow them to go through a vetting process. But no, it was fun. Oh, it's a good time. I got out of there, though. I'm getting too old to hit Broadway and do the Tootsie.

Jarrod Bridgeman:
You had some Blanton's, didn't you?

Casey Hiers:
What's that?

Jarrod Bridgeman:
Blanton's?

Casey Hiers:
Blanton's, what is that, a nice bourbon? Yeah, I plead the Fifth.

Jarrod Bridgeman:
That's right. Casey, coming up soon too, we will be in Boulder and Denver, both of those in Colorado, by the way.

Casey Hiers:
I had a summer internship in Denver once.

Jarrod Bridgeman:
Did you?

Casey Hiers:
Yeah, it's changed a little bit. They made something legal and every yahoo in a van decided to go live out there with no plan.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Now it's a challenge. Boulder, who used to be, "Keep Boulder weird," they used to be the crazy suburb.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Now they're almost as normal as Denver is.

Jarrod Bridgeman:
Right, right.

Casey Hiers:
But love the area, great area and a lot of good practice owners. We're packing that house, right?

Jarrod Bridgeman:
It'll be great, yeah. Honestly, go to fourquadrants.com/events and check it out. We have very, very, very few seats left for our tasting in Denver. For brunch, just a handful of seats left for that one, too. That one's going quick. Please get on there and register if you're interested in coming. You'll get to hear some great things, hear Casey speak, see all kinds of great things, taste some good things, eat some good things. After that, we'll be coming to areas like St. Louis, we'll be in Boston. We're really putting you through the wringer, Casey, and getting you out there.

Casey Hiers:
We have a stable of good presenters.

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

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Casey, anything else you'd like to add before you go today?

Casey Hiers:
Whatever plateau of success you're on, you don't have to stay there. If you're struggling, you can get out of that. If you're crushing it, you can get to the next level and retire five years sooner with millions more. Wherever you're at, get to that next level of success. Don't be complacent. Mediocrity should not be acceptable. Don't let the boogie man and those excuses keep you where you're at.

Jarrod Bridgeman:
Don't be afraid to reach out and talk to anybody you can, anybody that's a professional in that area. If you're afraid of, "My CPA's not doing what they need to do," maybe start researching, looking into a new one, give Four Quadrants a call. You know what I mean?

Casey Hiers:
I'm going to get off my soapbox and go watch an episode of the Brady Bunch.

Jarrod Bridgeman:
All right, have a good one.

Announcer:
That's all the time we have today. Thank you to our guests for their insight and for sharing some really great information. 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.