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Filling the void

By Members, Uncategorized

This blog is filled with flawed views and biased opinions. I’m probably wrong in what I have to say more than I am right. You can scream and shout at what I have written, but when you do, please refer to the first sentence. I’m generalising, from my own perspective, which in no way reflects your life at the moment. It also in no way should be considered advice, either financial, legal, or any other aspect.

In other words, don’t believe a word I say :)

You might have noticed there is a virus out there, the newspapers even mention it occasionally. Daily we are told how many people have died, without mentioning that so far this year 500,000 people have died of malaria, and 1.2 million people have died of HIV/AIDS. The more data I look at, the more people in the field of infectious disease I encounter online, the more I feel our response to this has been a tad of an exaggeration. We are told to stay at home to “save the NHS”, but you can’t save the NHS if the country is bankrupt. The NHS is funded through tax revenue and borrowing. Tax revenue is going to fall through the floor, and the weakened economy and increased emergency borrowing will hit the country’s credit rating…meaning it will be more difficult and more expensive to borrow money in the future. And that’s important because, in the UK, there are 350,000 people every year who require expensive cancer treatment and 7.6 million people with cardiovascular disease who need medication and constant care. If the funding to the NHS is hit due to firebombing the economy, those people will be hit the hardest.

From an economic standpoint, J-value assessment (used to calculate the value of a human life v risk v economic cost of mitigation), suggests that drop in GDP >6.5% will result in poverty and greater mortality than SARS-CoV-2. That basically means after a certain point the cure becomes more lethal than the disease

*For those reading this outside the UK, the NHS is our state-funded National Health Service.

But that’s not what I want to talk about today ;)

 

For those of you stuck at home, you will be in four camps:

  • Bored out of your mind and itching to get back to work because you miss the job
  • Desperate to replenish your rapidly depleting savings and itching to get back to work, not because you enjoy the job but because you need the money.
  • Stuck at home with a violent and abusive partner, or stuck alone with a violent and abusive mind
  • Loving every second of it

 

Category 1

If you are in this category, you can be assured that you have found your vocation in life. This lockdown will pass and you will soon be back at your passion. Some of you work from home, and for you it’s just another day to you. Surprisingly there won’t be that many of you.

Category 2

If you are in category number two, this is an opportunity to re-evaluate your situation. Everybody is where they are because of different choices and circumstance.

  • Some in this category drive fast cars and live in plush houses, but only through pushing what they earnt to the very limit. You overreached yourself, probably through the use of bad debt, and now you have been given a wakeup call. This is not me being judgemental, and this is perhaps life giving you an opportunity to alter your thinking.
  • Some in this category were already living on the breadline. Their expenses rose every year whilst the wage they earnt barely seemed to nudge higher. You felt ground down by the system, and some of you feel resentful at those who put you in this position. The veil of society has been lifted for you and more than ever you can see the challenges with exchanging your time for a fixed wage. IN this lock down, now is the time to go on YouTube and watch every video you can on wealth creation. To go on Amazon and get every book you can find (most of them can be found on Kindle Unlimited which allows you to get as many books as you can read for a modest monthly fee).
  • Some in this category were unfortunate. They were doing everything right, but they were in the middle of a business acquisition, or relying on money from investments.

Category 3

There are institutions and charities out there to help. Only you can say when it is right for you to safely contact these agencies.

Category 4

Here we have who this blog is aimed at. You are sat at home, free from the need to go into work every day. You have realised something, that so few people get a chance to see. Likely you don’t have financial worries because you have enough set aside. This has allowed you to wake up and smell the roses.

You’ve suddenly found the urge to write a book, take up exercise, play an instrument, learn a language, or rekindle a relationship. Whereas some parents are pulling their hair out at having their kids at home constantly, for you this is the best time. There’s no rush, no pressure, no need to do anything you don’t want to.

You aren’t bored because your life has suddenly filled with the joy of doing what you want to rather than what you have to. The 9-5 grind always wore you down, and now you find yourself smiling more, sitting out in the sunshine and just relishing this time.

When I told people I had sold my practice and was taking time off, invariably a question would crop up…”but what do you do with your time?” We are so trapped in the sleep, eat, work, eat, sleep routine that so many of us can’t see past it.

You are the awakened ones, who positioned yourselves either deliberately or by chance to stay in the eye of the hurricane. There are more of you than you think. There are also some of you in category 2, if only they had the funds to really enjoy it.

Because that’s what you are doing. You are enjoying life in a way that brings joy to your heart. When this is over, you are going to have a very different outlook on things.

 

There are some with a conspiracy mindset who say this is all a plot to bring in New World Order so that we will be forced to serve our “Reptilian Overlords”. But what if it’s the exact opposite. What if we are being given a moment to witness a different side of life, where those who are ready can step forwards and remove themselves from the materialistic, debt-ridden consumer society that has driven most of us to despair and unhappiness. We are dopamine addicts, driven by our need for significance, buying things we don’t need, with money we don’t have, to impress people we don’t even know.

Now you know we don’t need to live like that anymore.

  • What good is that £70K car if you can only drive it to the supermarket?
  • What good is that house with seven bedrooms if you only use two of them?
  • What use is that watch that took two month’s wages to buy when you can’t go out anywhere to wear it?
  • What purpose does that family beach home serve if you can’t even get to it?

 

And for those in business this will be the best and the worst of times. Some it will drive to financial ruin, but for others this will be the opportunity of a lifetime. We are now in a buyer’s market, for everything, and that will last for months afterwards.

The rules have changed. So you have to change too.

 

That’s the way it looks from here

 

 

You have been given an opportunity

By Members, Uncategorized

I’ve kept pretty quiet about this Coronavirus malarkey, mainly because I know my opinions on it won’t amount to anything. Plus I’m just a random bloke, so I’m probably wrong.

That’s not what this blog is about. Maybe when it’s all over I will write one about the way humanity has responded to this threat.

At the age of 24 (and I vividly remember this), it occurred to me that the pursuit of material goods was complete madness. That was when, working as a VT, I had managed to save up the grand total of £300, only for that to disappear into the midst of time and space due to the excess on car insurance and an unfortunate accident in a shabby Ford Escort.

You will all have had events that shape your personality. This was one of mine. It occurred to me, on that day, that the more expensive a car was, the more money it would cost to keep it on the road. I had also lost the buzz of that “ooh I’ve bought a new car” feel, the smell (that comes from a can) long since percolating away.

Now whilst it is possible to use expensive cars as an investment, most people squander vast sums of money on a box with wheels that they drive to impress people they don’t even know. From that moment forward I made a vow to never spend more than £X on a car, and I’ve stuck to that.

But we aren’t talking about cars here either. Today we are going to discuss the following phrases

“Hope for the best, plan for the worst.”

“Spend less than you earn, save and invest the difference.”

In my younger years, despite my philosophy on cars, I was foolish with money. I wasted a lot of it on ridiculous escapades whilst fooling myself that I was somehow “better” because I wasn’t buying fancy gadgets and designer knick-knacks. It was only when I bought a practice that I began to realise the cost of doing business, and once again, my mentality began to change.

If you read past through previous blogs, you will see the following mentioned countless times:

  • Have 6 months’ expenses in the bank
  • Don’t live off your overdraft
  • Build your business up from the profits you accumulate rather than the money the bank gives you
  • Put money away for your tax

If you want to buy something (none business-related) buy it with cash that you have saved up. Then calculate how many more months after your proposed retirement date you will have to work to make up that shortfall. Then calculate how much that money could make you if you invested it. Then ask yourself if you still want it.

When I sold my practice in 2017, I suddenly became very minimalist in my thinking. I sold my 4 bedroom house and moved into a 2 bedroom flat. I rid myself of clutter and simplified my life as much as possible.

Recently, on the rare moment when I am allowed to drive about, it occurred to me that most of the businesses that are presently shut are there just to give someone a job and to give someone the opportunity to spend money they probably don’t have. They don’t actually bring anything of value to your world.

Now that you are stuck at home, I wonder how many of you see it for the opportunity that it is?

  • Think of all the books you can read
  • What about the books you can write
  • You can finally start that exercise regime
  • What about starting that online business?
  • Now that you are basically trapped in it, does it matter how big your house is?
  • Some of you might even want to start that spiritual practice

What can you do, right now, to enhance your life? What can you do, right now, to increase your income whilst sat at home?

We may well look back and think that what we are seeing now is an overreaction. So far this year 120,000 across the world have died of flu and 500,000 have died of malaria. There are some who will thus be critical of the way the world has responded to Covid -19.

What I do know is that it has changed everything, just as 911 changed the world. The governments of the world, at the very least, have now had a dry run on how to deal with a pandemic. When the next one occurs, you know what to expect.

  • Will you and your business be ready?
  • Is the present model of dental practice viable in this new reality?
  • What industries are going to completely disappear because of it?
  • Can your retirement investments stand up to further shocks like the one that has just rocked the world’s stock markets?
  • Are you ready for the next one

 

Just some thoughts to see you through the weekend ;)

COVID-19

By Members, Uncategorized

This blog post isn’t about my thoughts on the Covid-19 response. Nor will it be a rant about the stupidy of panic buying muppets and power-crazed governments. It’s just some useful links to help you and save you some google searching time.

 

First the official guidance:

 

Now some other resources that can help:

I hope this helps.

 

 

 

 

Medical Emergancies

By Members, Uncategorized

We all hope that we never have to deal with medical emergencies.  I’ve been lucky in that regard throughout my career.  I’ve had a few “oh shit” moments, but never one of the big ones.  From memory, I’ve had to call an ambulance three times in 22 years of practice.

The main things we saw were faints.  Those are fairly easy to deal with.

A lot of this will be down to luck and the will of Odin, but I would also like to think that the systems I implemented helped head off some of the worst of it.  These systems included

  • Updating the medical history at ever oral health review.  Whilst we got them to sign a form, we asked them the specific questions.  This helped avoid, for example, the patient you have just numbed up for an extraction asking if it matters that they had a heart attack 3 weeks before.
  • Taking blood pressure of all patients we did any kind of surgery on.
  • Listening to the voice in the back of your head that tells you to avoid doing something like the plague
  • Getting to know the patients so they can be honest with you and not fear that their concerns will be dismissed or that they will be judged.
  • Giving pre and post-operative instructions that you actually go through with whilst the patient is there…before you numb them up.
  • Making sure the patient has eaten before any procedure (difficult with some religious fasting I know, but we managed)
  • Ringing the patient up at home after anything “nasty”.  You don’t need me to tell you what that means
  • Finding alternatives to ID blocks (patients loved us for it)
  • Being ready for if the shit hit the fan.  For example, having the drugs split into separate boxes based on the medical emergency instead of having them all rammed in together.

The last one is vital because, despite your best efforts, the unexpected will happen.  Now I’ve always thought that the “once a year” training was inadequate.  To be able to deal with a medical emergency takes practice.  Repetition is the mother of skill.

Remember the first time you tried to do a root filling? You were likely nervous, hesitant, worried about what you were doing.  The damn dam wouldn’t go on, and you couldn;t even find the canal.  Perhaps you were fortunate, or perhaps you were faffing around for half an hour before you even started.

So how would that translate to a medical emergency?

One of the best things you can do it get your team booked on one of the simulation suites across the country.  There’s one in Nottingham and Leeds for example.  It’s a mannequin that communicates with you whilst it goes through its medical emergency scenario.

You also need the proper kit and ensure it is in date and in good order.  It needs to be easily accessible, and everyone needs to know where it is.  Everyone needs to know what’s in it and how to use it.  Even with the CQC poking their noses into every crevice, some practices still aren’t up to scratch on this.

In my opinion, you also need to systemise the approach to such unwanted events.  Everyone needs to know their part, and it’s good to have printouts with the various aspect of your emergency kit so that anyone can refer to them to tell them what is used for when. When things go south, you can sometimes freeze, your mind can go blank and that isn’t very good for anyone involved.

Systems let you flow through your diagnosis into treatment.  It’s what I created for my practice, and thankfully I rarely had to use it. The system I created is now available on my website for purchase, link is at the bottom if you are interested.  Do know however this isn’t a one size fits all approach.  There is a reason it comes as a WORD document rather than a PDF.  The system has to be based on present guidance, and that guidance changes yearly.  So anything put together might be obsolete tomorrow.  Also, the recommendations vary depending on what part of the country you are in.

So this product is generic in nature.  To use this in your practice, you can’t just print it off and bung it in the cupboard.  You need to:

  • Check each and every aspect is correct for your part of the country
  • Check that the system works for your practice.  it may need alteration
  • Check it regularly to keep it up to date
  • Take ownership of the system, because you will be the one using it.  Remember, I’m just some bloke on the internet… what if I made an error in there?

So if you want something that involves no effort on your part, this definitely isn’t for you.  It’s a starting point to save you time and can also be a good reference point for where you are presently at with your emergency preperations.

Medical Emergency System

Social Media

By Members, Uncategorized

I am an old fashioned kind of guy.  I have belief systems that many would see as outdated and archaic.  I never really believed that Social Media had a place when it came to healthcare, and I still don’t.  Please note that I am distinguishing healthcare from health sell, the latter being a growing and dangerous trend.  And I know there will be those who disagree with me.  Many of you reading this will be shaking your heads and tutting at my backward ways.

Please remember that, just because I believe something, it doesn’t mean I am right.

Here’s the thing though.  I was never what you would call a “big earner”, and it was rare for me to take home more than £100K a year.  And yet I was able to put myself in a position where I could retire form chairside dentistry at the age of 45.  But that’s not what this blog post is about.

In the practice I part-owned, we didn’t put ourselves out as “cosmetic dentists”.  We didn’t do botox or fillers.  We didn’t do ortho or smile makeovers.  The practice I part-owned just concentrated on delivering reliable standard dentistry to families.  We concentrated on getting people healthy and keeping them that way.  We weren’t an amalgam factory either, never sheep dipping patients for maximum bums on seats.

I worked 4 days a week.  The staff of the practice were, combined, the practice manager.  They could all do each others roles, and they knew that customer care was the most important part of their job (keep the patients safe and make the customers feel like they belonged).  There were no £10K treatment plans, no Ferraris in the car park, and no egos running amok.  We built relationships with patients that made them feel welcome.

We just went to work to look after people.  Everything else flowed from that.  When I eventually sold my practice, the guys who bought it joked that all the patients were so well maintained that there was nothing for them to do.  For the whole practice:

  • Number of times sued = 0
  • Number of GDC complaints = 0
  • Number of written complaints during my 17-year ownership = 4
  • Amount spent on marketing in that 17 year period = less than £2K
  • No practice website and no social media profile.

There is a problem with social media.  It is generally toxic, with more and more people rejecting it.

https://www.theguardian.com/society/2018/aug/29/teens-desert-social-media

https://www.prweek.com/article/1459149/gen-z-quitting-social-media-droves-makes-unhappy-study-finds

There is something definitely brewing under the surface with regards social media.  This “look at me, look at me” society is breeding depression and a craving for material wealth that actually makes people poorer.  Dentists/patients are forgetting that making teeth perfect and white doesn’t make you happier.  More and more dentists are treating patients with unidentified body dysmorphic problems.  It’s time to step back and realise that the perfect smile is not the road to the perfect life.

I’m not saying don’t do it, but you need to understand that there is a dwindling patient base for cosmetic dentistry, but there will always be a growing demand for health.  I know, I know.  I’m wrong and I’m talking out of my backside.  Well when the EU sovereign debt crisis hits and the western economies tailspin into the long-overdue recession, don’t be surprised if the money to buy all this fancy cosmetic work disappears.  You practice should be geared for health delivery and long term survival, not quick monetary gain.

Just look at 10 practices in your vicinity and see how many concentrate on delivering HEALTH.  They will all answer cosmetics and sparkly things, but where is the emphasis on the important stuff.

If you are looking to build a stable and committed patient base, which will keep your business going through the long haul (through recessions and health scares like SARS etc) there are perhaps easier and cheaper ways to do it.  Build trust.  Build genuine rapport, not that fake sh*te that feels artificial and intrusive.  Treat the patient, not the mouth.  Make people know they are valued and show them how to look after their own mouths.

I have a personal philosophy of not buying things I don’t need, with money I don’t have to try and impress people I don’t even know.

You might want to be the next Newton Fahl or Jason Smithson though.  You might feel to do this you have to have thousands of followers on Instagram and Twitter.  But Social media is a double-edged sword.  It’s a minefield where the GDC are involved.  And you make one mistake on the wrong patient, and the whole world knows about it.  It can even be a road to riches, but only for those who get it right.  Most of those chasing this goal won’t make it.  They either won’t have the skills, they won’t have the social media presence, or will self-sabotage or be blown out of the water by that one patient they should never have treated.

Delivering health is low risk, and is also what the majority of people actually want.  If you do it correctly, it also allows you to keep your practice overheads down which means you can make a substantial income without sticking your head above the parapet.  If you think litigation is bad now, give it 5 years when the lawyers really get their teeth into how poor most dentists are at getting consent.

That’s my flawed and biased opinion and I’m sticking to it.

If you want to know more about how I ran my practice it’s all in my book

The Patient Journey

By Members

I’ve visited quite a few practices in my time and worked in maybe half a dozen.  Some get it, others don’t.

Get it?  What do you mean get it?

Well, dentistry, believe it or not, isn’t just about teeth.  It’s about the whole patient, and a lot of practices seem to forget that.  Let’s travel through a fictional dental practice to show you what I mean by “not getting it“.  This will be in the eyes of a new patient.

The start of the patient journey begins when the patient first learns about the practice.  This can be via a website, a recommendation from a  friend, or simply driving past one day.  Every one of those aspects forms an impression that will or won’t entice a new patient through your door.

So let’s say you have the patient hooked and they contact the practice.  How do they contact you?  Do they email, phone or walk in through the door to make an enquiry?  Do you have all those possible interactions covered?  Will the patient be impressed by how their enquiry is dealt with?  Was the receptionist a bit short on the phone?  Did they get a reply to their email?  Was there a long queue at reception with a receptionist who seemed harassed?

And what are your criteria for accepting new patients?  Do you know?  Are you accepting anything with a pulse, or do you qualify patients before they can join?

And if you are taking new patients on, how long do they have to wait?  What happens if they start to have problems in that waiting period.  Have you accepted a duty of care already, or do you feel that duty starts only on the day of examination?  Have you even considered that?

Okay, so the patient has made an appointment.  What paperwork do you want?  Medical History, diet sheet, smile questionnaire?  How do you ensure the patient brings these with them?  And how are you going to ensure the patient turns up?  Are you taking a deposit for private patients?  And have you informed the patient exactly how much their first visit will cost?

A lot of questions here I know :)

So the patient has turned up after having booked themselves in.  What is the environment of your waiting room like?  Is it warm and comfortable, or cold in winter with blastic bucket seats?  Are their magazines, and do they stem from the 1980s?  Perhaps you have a fish tank with a floater.  Peeling wallpaper?  Dirty toilet facilities?  Stains on the carpet?

Believe me, I’ve seen some shocking sights.

Then there is the layout of reception.  Can the patients have confidentiality when discussing matters with reception?  But how do you manage this if you want reception staff to engage with the waiting patients?  Some places create a friendly environment by… well being friendly.  And how are you going to manage someone who starts kicking off?  There is an argument that you should filter your patient base to remove such people, but that’s another discussion.

How long is your patient having to wait to see the dentist/treatment coordinator?  Will they be informed if the practice is running late? It is my flawed opinion that most practices don’t deal well with handling that anxious waiting period.  The waiting room just seems to be a place to store patients until the surgery is ready, a bit like planes stacking up to land at Heathrow.  Instead, why not have systems in place to ensure the waiting time is at a minimum.  And what kind of message about the practice is the patient getting by your reception and lounge area?  If you have lots of laminated A4 sheets plastered everywhere that sets a different feel than having your “vital” information professionally framed and mounted.

Coffee anyone?  I’ve been in some practices that feel more like a hotel…a nice, expensive hotel.  Does your “waiting area” scream cheap and nasty or reassuringly expensive?  There are some patients who will notice the blown lightbulb and wonder if you can actually deliver the treatment promised.

Notice that the patient hasn’t even met the dentist yet.  You can fail in the patient journey at every step.  The idea is to keep building the patients confidence to qualify YOU as the dentist and the practice they need to be treated by.

Ah, the dentist is ready and it’s time to collect the patient.  Who’s doing that?  And who is the patient sent to first?  Perhaps you want them to have a chat with the treatment coordinator, to establish more rapport with the practice.  I think if you are a private practice and you don’t have a treatment coordinator (or whatever you want to call them) then you are missing a trick.

Ultimately the patient will need to meet the dentist.  If you are a practice owner, do you just sit back and hope your associate knows what they are doing?  Don’t forget, they are representing YOUR practice.  Surely you have set systems on how the dentist/patient interaction should progress.  Or do you all just wing it?

And so it goes.

Look, what I’m trying to say in my flawed way is that the patient journey is vitally important.  Not just for new patients, but for existing patients also.  The NHS as an organisation is very bad when it comes to the patient journey, but patients seem to accept it because “it’s free innit“.  Grumpy receptionists, uncomfortable seats, lost referrals, harrassed clinicians.  The NHS is a creaking and crumbling institution…so why would you want to stay a part of it?  And if you do go private (assuming you haven’t already), how are you going to distinguish yourself, firstly from the NHS practice that you used to own/work in, but also the other private practices that are trying to attract the same patients.

You cannot compete on price and you shouldn’t even try.  To win this game you have to establish in the patient’s mind that

  • You can be trusted
  • Your practice is clean and well maintained
  • You know what you are doing
  • You will look after their health

There will also be some patients who are mainly interested in the cosmetic aspects of dental care, and as you would imagine, your patient journey for these has to be even more impressive.

So do me a favour.  Why not walk through every step of your existing patient journey and see how it looks.  You might be pleasantly surprised…or you might be horrified. And if you are an associate doing this, and you don’t like what you find…can you influence change in that practice.  or do you need to improve your skills and your communication abilities so you can move to a different practice that perhaps has more respect for the patient?

Oh didn’t I mention that?  If you aren’t giving the patient a comfortable environment, staffed by people who are intent of looking after them at every interaction, with clinicians who do the best they can…then what message are you giving the patient.  Is that new patient a valued and respected individual or are they an inconvenience?

 

SH

 

 

This is the way

By Members

This newsletter is aimed at the younger spectrum of my readership, although it might have some insight for any and everyone.  However, if you are one of those who becomes angry when you feel your view on the world is threatened, perhaps don’t read it.

So let’s get my inane and flawed thoughts out there

Did you know that you are being conned?  Society gives you several paths that you are supposed to follow.  By not following that path, your society tells you that you are somehow flawed, broken and possibly even dangerous.

Here is one such the path:

  • Get good grades
  • Go to university
  • Get a good degree
  • Join one of the professions
  • Work long hours and work your way up through the hierarchy
  • Year on year take on more responsibility so you can earn more
  • At some point, you should get married and settle down
  • You should buy a house and get a nice car
  • Perhaps have children so that they can be put in a nice school (and repeat the cycle)
  • You should buy nice things because you are worth it
  • Perhaps invest in the stock market in your ISA
  • Retire and live off the fruits of your labour.

Well let’s look at some of those points shall we because that’s A path not THE path:

  • If you go to university you will be saddled with a significant amount of debt that you will be paying off when you are at the beginning of your earning phase
  • What is your university degree in?  Obviously most of those reading this are dentists, but you may have noticed that the days when dentists could make vast sums just by being dentists are over.  It’s possible, but the silly money is now only for the top 10% at best.  So huge wealth shouldn’t be expected in this career although it is still attainable.
  • The professions used to be respected and looked up to.  That is no longer the case, many of them being vilified.  Even our medical friends are suffering in this regard, and most of them are abused by the state as well.
  • Ah yes, the hierarchy.  FD, to associate to partner/practice owner.  When I did it, it seemed to make sense.  I’m not so sure now, not with the prices being asked for practices.
  • I’ll not mention the divorce rate
  • Buying a house eh?  Again, the affordability of housing is an issue for many.  And the bigger the house, the more issues can arise.  I mean, how many rooms do you need.  You can only occupy one at a time.  And I know, you need somewhere to put all your stuff…but why do you need so much stuff?  You keep upgrading your box to a bigger box so that you can have more boxes to keep your boxes in.
  • And don’t start me off on cars.  Now I know, there are some of you who can make cars work as an investment.  But for most of us, we get the flash car with money that we don’t really have, often to try and impress people we don’t even know.  And then you find someone kes it in Waitrose car park.  The tyres cost more than some people pay in rent.
  • The nice things you buy do not bring you happiness.  They deliver a brief endorphin rush, which then needs to be topped up by more stuff.  Thus you end up in a never-ending spiral of consumption that forces you to earn earn earn so you can spend spend spend.

Society is designed to keep you trapped and cash poor.  The cost of doing business increases each year, which means you need to earn more to keep yourself at the same level.  at the same time the threats to your income increase through things like litigation, the GDC and ineffective social health care forcing you down the road of private health insurance.    It’s almost as if things were designed like this.

Back in the old fee per item days, we called this the treadmill.  For many, the treadmill still exists, and I know dentists who make almost obscene amounts of money compared to the average, and yet they have to keep that income churning because the cost of their lifestyle is very high.  One major illness, one GDC hearing, one broken limb, and they will be in severe trouble.

They are doing dentistry to service their lifestyle, which means they end up working more than they want to.  If you break the cycle where your expenses rise to meet your income, you find you have money left over which can then be invested.  These investments then start to bring a return which means you can earn less and less to cover your overheads.  Once you passive income covers your day to day living, you find yourself working because you want to, not because you have to.

Then you are free.

It’s easier to do this if you start early, so that compound interest works in your favour.

3.5 days a week.  That’s the optimum workweek for dentists according to the Pankey Institute.  Just think of all the other things you could do if you weren’t fetling around in someone’s mouth 6 days a week.

As the Mandalorian would say, “This is the Way” :)

 

SH

My thoughts on profitable dental practice

By Members

I hear it can be difficult to make a decent profit in dentistry these days.  When I talk to the few dental accountants I know, they all tell me that some practices are struggling, that dentists are having problems making their UDA’s and that practice expenses keep rising.

I keep hearing the same from dentists, more and more of the owners I know now selling up.

Then I look back to my own experiences and I find I don’t totally understand why this is (don’t get me wrong, I fully understand why nobody would want to own a practice anymore).  It’s probably because I’m biased in how practices should be run based on how I ran mine before I sold it.

This is what I keep hearing:

  • A lot of dentists spend too much money.  They often have cupboards full of gadgets that they never use.
  • They spend hundreds of pounds on courses and never implement what they learn.
  • They muddle through the patient consultation without having a proper system for communication.
  • Their personal expenses are often ego-driven rather than reality-based.
  • They consistently don’t put enough aside for tax

 

There’s a reason I was able to retire from chairside dentistry at 45.  I’m not suggesting this, by the way, I’m just saying it’s a better option to be in.  Being in the position to work because you want to, not because you have to has a degree of power behind it.

There was also a certain amount of good fortune to it.  I was able to buy my practice relatively cheap and sell it at the top of the market.  I worked in Chesterfield which meant I had low overheads compared to ridiculous places like London.  I was able to work with a UDA value better than most which meant I could do dentistry without having to worry about the udder games many dentists feel they are forced to play.

But those weren’t the main reason.   My ability to retire, I believe, came from the systematisation of my practice and my ability to keep my living expenses under control.  With regards to the former, I wrote flexible systems for the most common situations that kept arising.  Where possible, this allowed staff to deal with any issues without bothering me.  When people aren’t given guidance, they do their best with the resources they have.

Without systems, even the best staff end up winging it or bothering you when you are trying to find that difficult MB2.  Most practices have policies and procedures, but these invariably don’t cover things in a systematic approach.  And let’s be honest, most of this just ends up in a folder unread and ignored until the CQC come round.

It’s good practice to have a policy for whistleblowing for example.  But do you have a system for how to answer the phone, or to control the patient journey through the practice?  Do you have a system for how to get new referrals from existing patients or for what to do when the compressor breaks down?

Do you want a good example of a system?

Ask yourself what you would do in a medical emergency.  You would follow a step by step approach that determines what the emergency is and how you deal with it.

 

Wouldn’t it be better if you could just get on to do the dentistry?

And I will give you a tip.  If you want a fully systemised practice (which can even include setting out how dental procedures should be done so patients have consistent care from dentists within a practice) always involve your staff.  They need to be on board with the development and the reasons for the systems.  Otherwise, the systems will be ignored.

 

Now you could spend several weeks in front of a computer doing this.

Or you could give yourself a head start –

https://dentallawandethics.co.uk/products/practice-system-templates

 

Just a thought

SH

Are you worrying about the wrong thing?

By Members

Are you a bit of a ranter?

Do you go on Social Media and vent your spleen about the state of the

  1. Country
  2. Politics
  3. Dental education
  4. The price of fish
  5. Global warming
  6. [Insert random horror]

How does doing that make you feel?  Is your life improved by that?

Let me put it another way.  The thing you are obsessing about, watching youtube videos regarding and formulating opinions that often do not concur with your peers….have you any hope in hell of making any kind of change or impact in that thing that annoys you so much?

Take a deep breath now…

If you can’t change it, why are you bothering?  Why are you spending your life’s energy and producing cortisol for something that will carry on regardless?

Don’t get me wrong.  If you think you can have an impact, make an actual difference, then go for it.  But if you are like most of us in that you are just having a bit of a moan…what’s the point?  Can you perhaps even be harming yourself?  Can you be creating stress that is adding to your overall burden?

Some of you have noticed I don’t post as much as I used to on Social Media.  And there’s a reason for that… it all comes into this “staying off mobile devices” and distressing yourself craze that hasn’t started yet ;)

Unfollow the ranters on Twitter and Facebook, stop venturing down the YouTube black hole of doom and put yourself aside from all the useless opinions the Mainstream media are shoving down your throat.

As an example…Does it have any impact, on your life, that Trump said something bad on Twitter?  Would he care, one jot, that you protested about his last visit?  Could it be that he even enjoyed being the centre of so much attention?

Just something to think about.  But remember Social Media isn’t FREE, because at the end of the day, you the user are the product.

 

SH

Life is so hard…

By Members

Here follows more ramblings from my biased and possibly unhinged mind.  These are my opinions, they might be flawed and they might be wrong, so remember that if you feel the hate begin to flow.

There was recently a discussion on the facebook group “The Dentist” talking about how new graduates don’t seem to have any experience compared to the older generation.  Within that discussion, some people put forward the notion that dentistry has been ruined by the older generation.  This led to people saying that:

  • Practices are now unaffordable for younger dentists
  • Associate incomes are dropping
  • Dentistry is now too risky
  • Young dentists are scared of their shadows.

 

Times change, get over it.  When I bought a practice I got it relatively cheap.  The people who sold it to me got it even cheaper.  The person before them started it from scratch.  It’s the natural cycle of the market, some things increase in price to the extent that they become unaffordable, but other opportunities present themselves that weren’t available to the generation before.  So yes, the young dentists of today don’t have some advantages that presented themselves to me.  But technology and innovation move on.  Examples?

  • When my mother was a child she had to wash in an iron bath in front of the fireplace and they had no central heating
  • When I was a child there were three TV channels and no internet
  • My Mum and Dad bought their first house for £5000
  • My first phone had a battery life of about forty minutes and texting was the new revolution
  • When I graduated Stem Cell therapy had never even been heard of and implants?  Some mad wizardry from Scandinavia

The young of today will have disadvantages and advantages I never had.   Here are some of the latter.

  • Implant technology has made great strides
  • Composite technology and the ability to learn how to use it through courses has expanded far in excess of anything that was offered to me on graduation
  • The science and technology of marketing and data capture eclipses what I had in my graduation years
  • The existence of social media to create a loyal following and celebrity (is that an advantage lol)
  • The number of postgraduate courses is staggering. When I graduated all that was available was Tipton and Mike Wise.  Your ability to learn new skills is incredible.
  • Botox? Short term ortho?  What were they?
  • There had never been a greater opportunity to leave the shackles of the NHS

I think what I’m trying to say is that if you take on a victim mentality and moan about how the previous generation “ruined it for you” you trap yourself.  I can moan about how the generation before me “earned so much more”.  Believe it or not, from the perspective of what can be achieved with the materials and delivering care that is in the patient’s best interests, there has been no greater time to be a dentist.  Yes, if you want to make a high income, it’s more difficult now, especially on the NHS.  But is that a bad thing, really when you think about it?  Should the NHS be allowing associates to make a higher income than a child cancer specialist as was often the case in the 1990’s?  Should the taxpayer be funding that?  The NHS isn’t about making people rich, it’s about delivering effective care as cheaply as possible.

With notable exceptions, Dentistry in the 70’s, 80’s and 90’s was all about turning up and churning out volume.  This wrecked the dentist’s health and led to whole generations of patients who didn’t value the science of what dentistry “could be”.  Oh and it also made millions of people fear us, much of that fear created by a previous bad experience.  That has now changed.  More and more, dentistry is converting to a true patient led health field.  No more plastic bucket seats in reception.  No more “sheep dipping” patients in and out of the dental chair (not if you want to keep the lawyers at bay at least).  No more wiping down the bloody forceps with an alcohol wipe so it could be used on the next patient.  No more pulling teeth that can be saved.

The cost of delivery for dentistry has thus increased markedly, which means it becomes more difficult to make a profit, especially on systems funded by central government.  This means there will be less left over for the hapless associate.  But that just reflects the wonders that can be done now.  Finally, dentistry is becoming a meritocracy.  No longer can Joe Average make a fortune in the job, the lawyers and the regulators filtering out those who think they can trick the population with fancy mouth sounds whilst delivering sub-optimal care.  As the NHS slowly dies, now only the best of us will be able to make those eye-watering sums.  And we will do this from developing our skills, developing our approach to patient management and marketing and from developing ourselves.

Many of you younger dentists reading this will miss out unless you take matters into your own hands and become the best dentist you can be.  The courses are there.  The information is there.  The people ready to help and mentor you are there.  Business coaches, gurus and online CPD were all things I never had the benefit of.  So why not make the most of it?

So what are you going to do?  What action, today, are you going to take to try and get into that top 20% of the profession whose skill is truly reflected by the income they earn?

 

I merely ask the question

 

SH

 

Is it time to walk away from the NHS?

By Members

I said a few things about the NHS in my last blog post, but let me just clarify my own personal opinion and specific opinion on the matter.

I subcontracted my time to the NHS for 22 years.  In that time, I saw how the system changed, the noose gradually tightening around the necks of practitioners.  Despite having a good UDA value and a stable patient base, I felt I could no longer do dentistry to the standards I was happy with, so I sold up to let someone younger take forward the practice I had helped build.

I will never work as an NHS GDP again.  Why?

The NHS, as an organization, is underfunded, awash with unnecessary management, compliance officers and box tickers. The hierarchy often does not care about the actual patient care, and the patients often do not care about their part in causing the institution’s downfall. It has become a bureaucrat’s dream, health care often taking second place to the diktats of the inane and the corrupt. This has resulted in a demoralised and stressed frontline workforce, sometimes being forced to deal with litigious and self-righteous patients who care only for their own convenience (and yes, I freely accept that a considerable amount of the litigation we see is justified).

No place do we see that more than in dentistry, where financial compliance, contract uncertainty, regulation, clawback and patient non-attendance are now the biggest threats to NHS practice viability. The will to fix the problem at the level of central government is not there, instead a continuous procession of ‘pilots’ are unrolled, allowing the DOH (Department of Health) to kick the HTM (Health Technical Memorandum)-0105 compliant can down the road another few years, although there is a promise that a new contract will arrive in 2020 (I’m not hopeful). And all the time the NHS system deteriorates into something that Kafka would have been proud of, with vulnerable NHS patients being fined for not understanding what benefits they are on, as well as dentists unable to verify what is and what isn’t available under NHS contract. Over ten years in, even knowing the rules on how to deliver that treatment is like trying to thread a needle in a darkened room, whilst wearing thick woolly mittens … with the windows open in a hurricane.

It is my opinion that every primary care dentist working under NHS contract should formulate an action plan to extricate themselves from the financial mess that will inevitably unfold. I also believe that those in secondary care should consider doing the same. You are underpaid, underappreciated and undervalued. And yes, I know that is easier said than done but those who do this might be in a better position several years from now.

And let us not kid ourselves that it is just dental staff that are under siege here. Whilst many in the NHS structure overseeing the NHS contract are good, honourable people (doing the best they can in a difficult situation), good people can’t survive untainted in a broken system that was never fit for purpose. Many in NHS management structures find themselves under intolerable stress, ground down by a huge bureaucratic machine that cares only about maintaining the status quo and protecting itself from criticism. I imagine the same could be said for the various insurance schemes available in America.

The NHS is filled with good people working in an intolerable situation.

The idiots (I chose that word carefully) in government do nothing to change all this because many of them really do not care about you or your patients. Those rare individuals who do give a damn and who do try to improve things only find themselves ground down by the system that cares about one thing – protecting itself.

 

It’s time to get out before you get crushed by the machine.

That’s the way it looks from here, and remember this is my biased opinion.  it is not to be considered advice

 

SH

 

Thoughts on the upcoming NHS contract

By Members

To date we don’t really know how it will look, so I am basing the following opinions on my experience and history with the NHS over the last 30 years, as well as my history and experience with how government works.

This means my analysis might be flawed, wrong, off base… the writings of a complete basket case in other words.  It will also contain my inherent biases, both known and unrealised.  So of you were to make any future decisions based on what I have to say, it might mean you have rocks in your head :)

In many ways, the new NHS contract will be worse than what we have now.  Worse for associates, worse for patients, worse for staff and worse for the image of the profession as a whole.  It will, somehow, be beneficial to central government and corporates, as well as likely being tolerable to practice owners, especially those with large practices.

Why do I say this?  There is no doubt in my mind that progressive governments have felt that dentistry should be removed from the NHS, but nobody in Whitehall has had the political will or the guts to take that final step.  So they tinker and manipulate the profession, hoping that there will be a mass exodus so that the “greedy dentists” can be blamed for the demise of NHS dental care.  Why there is this reticence confuses me, because it occurs to me that dentistry is hardly a sacred cow that politicians risk sacrificing their careers for.  Likely it is just cowardice, but there might be other reasons that I am not seeing.

The NHS contract has corrupted care in the majority of practices, the dentists delivering that care lowering standards in many cases to try and “get the contract to work”.  I have seen first-hand how the goalposts and the rules were changed, often without the workforce being informed.  Said workforce reacted with fear and compliance rather than risking all by standing up to the general tide of oppression that was thrown over those “lucky” enough to be in possession of an NHS contract.

If you were to ask me, I would state that the NHS was no longer a vessel dentists should consider sailing in, with maybe an exception made for the salaried services.  Working under NHS contract is now filled with suspicion and mistrust, and unfortunately, a lot of that is down to the profession itself.  Some of you may shout your ire at me for that statement, but let me remind you that in the first year of the new contract, the provision of Band 3, single tooth partial acrylic dentures rose by over 70% compared to the years before the contract.  Dentists will make systems work, and often that is by taking whatever lifeline they can find, even though the end of the lifeline is often attached to a bear trap.

I remember in 2007 eating curry with 5 NHS practice owners who were all rejoicing in the way they could make money out of the contract.  None of that conversation, to my recollection, had anything to do with the actual care of patients.  I did my best to avoid such games, but it helped that I was in possession of a relatively high UDA value.  Others weren’t in that situation.  I won’t use the word lucky, because I entered the 2006 contract with a systemised plan.

In a time when the country is close to bankruptcy (the UK national debt grows by the rate of £5170 per second) is it any wonder provider and performer activity is being scrutinised under the most powerful of accounting microscopes.  We created a rod for our own back, and we did it willingly.

Here is what I predict will happen with the new contract

  • There will be a grace period as practitioners are allowed to adjust.  Flaws and loopholes will be found that will be exploited by dentists trying to keep their practice viable.  These will quickly be closed down, as the mechanism for oversight and monitoring will likely be maintained by NHS England (instead of being closed down as happened in 2006).

  • The % paid to associates will come under pressure.  I also feel the wording of the contract will further hamper the ability of NHS associates to claim self-employed status.  The NHS is heading for an employee model for non-practice owning dentists.

  • There will be vastly greater amounts of paperwork associated with the new contract.

  • Dentists will realise that really they should leave for the private sector, but too many of them will cling on for reasons only known to themselves.

  • The contract delivered will be inadequate and completely the wrong mechanism for delivering dental care to the population.

  • Workforce numbers will continue to fall and it will be increasingly difficult to fill positions as the younger generation of dentists realise their future is outside the NHS

  • The contract will be designed to be beneficial to corporates, but their own shabby business practices will see them destroy that perceived benefit

  • The contracts will be time-limited 

  • The new new contract will ultimately fail

If you presently own or work under an NHS contract, you might want to do your own risk analysis.  Whilst I have no connection with Practice Plan, an organisation like this might be a suitable mechanism for NHS practice owners to transition into the light.