For a cushy life it used to be sufficient to do a few years as an associate and then set up shop almost anywhere, sit back and watch the patients roll in. I don’t have to tell you that it’s a lot harder to run a successful practice now; treatments must be designed with the patient, not the dentist, in mind, and that means longer opening hours and better patient journeys.
All good for patients and the industry as a whole, and it’s hard to argue it won’t benefit dentists in the end, but in the meantime a lot of them are feeling squeezed, even while the market grows (UK private spending on teeth reached £1.86bn last year, up 27% since 2010).
According to the BDA, which cites the HSCIC Dental Working Hours, 2012/13 & 2013/14 Motivation Analysis report, there is ‘shockingly low’ morale among high street dentists in the UK, which is escalating thanks to heavy workloads, excessive administration, increasing bureaucracy, regulatory burdens and rising expenses.
It’s certainly true that everyone working in dentistry is under more pressure to perform than ever before. In any serious practice now every clinician’s daily yield is monitored and persistent failure to generate profit for the owner will not be tolerated. At the same time there is still a downward pressure on associate salaries because of an oversupply of clinicians, so it’s more work for the same or less pay. Not a great deal.
Meanwhile, all that competition from expanding corporates like IDH and Portman and supermarket dental chains like Centre For Dentistry, which are now really getting into gear, is increasing the pressure. So we know a large proportion of dentists in the UK are unhappy. They’re the ones who would prefer things to go back to how they were 10 years ago, and you can’t blame them.
At the same time, we know that happier people take more risks. If you’re feeling high on life, you see the odds as in your favour. As the economist and author Noreena Hertz put it, ‘When we’re happy we take more risks, are more trusting, more generous. It’s why a country’s stock market tends to rise off the back of a national team’s win at football.’
It’s perfectly possible to create a successful independent practice that can hold its own if you’re willing to be bold and take some risks. This isn’t blue sky thinking. At Breathe we have helped hundreds of people establish practices that satisfy their personal and professional objectives by cornering a specific market in their area.
So how does the demotivated, overworked and exhausted victim become a driven and happy dentist with a plan? Well, they usually need some help setting objectives to start with. Once they know where they want to live and work, how much they want to work, what type of work they actually want to do and how much they want to earn, it is a case of looking at what’s possible. Then it’s primarily about changing their attitude to risk. I often start by playing a trick on them. I’ll ask the practice owner to imagine he has just sold his practice to a corporate for 10% more than he was expecting. He has agreed to work for the corporate as the principal dentist for the next three years on a guaranteed salary of his last three years’ income averaged.
The corporate then says to him, ‘Bob, we would like to grow your practice by at least 30% in the next year but we really are not sure how to do this, can you please come up with the 10 things you would change or invest in to deliver this growth?’
Without exception, all of the participants love this exercise and quickly come up with 10 brilliant ideas. The question we then ask is why don’t they do these things in their practice right now?
The overriding driver behind making business or indeed life decisions is understanding and mitigating risk. Risk is not just the reason why people don’t do things; perversely, it is also the reason why they do them. The gambler loves the adrenaline rush of rolling the dice or waiting for the next card; it is the anticipation and the uncertainty, that drives them on to the next gamble or risk.
We are all risk takers to a greater or lesser degree, we all take risks every day, driving at 85 when the limit is 70 or flirting with strangers and we all get a bit of a rush when we take a chance. Strangely, not taking a risk can have a long-term depressing effect on your life, creating an irritating merry go round of thoughts in your head when things go wrong or are flat in your life: why oh why did you not take that associate job in Sydney back in 2001? If you had done, you would not be in this miserable NHS practice in Clapham on a rainy Tuesday afternoon in February with a waiting room bursting with ungrateful patients.
Your attitude to risk shapes your whole life. I am not suggesting you have to take huge risks to have a happy life, but you do have to take risks regularly if you wish to be successful in business. Many of the new clients we meet have been doing the same thing or a version of it for several years and have watched their practices gently slide as their turnover stalls and their costs go up.
These practice owners tend to be risk averse, and we know this because we use a psychometric profiling tool when we first meet them: 80% score between one and three out of nine (one being most risk averse). This means they like to mitigate their risk and they resist early adoption of new services or ideas. As they begin to feel anxious about where their business is headed they will become even more risk-averse because stress makes us prone to tunnel vision and less likely to take in all the information we need.
It’s a cruel paradox that at a time when dentists are reporting higher levels of stress than ever they are least likely to be taking the risks their success depends on. If this is you, don’t underestimate the danger of this creeping conservativism. Fight it, because it¹s far risker to do nothing. If you take a risk and fail, your business will develop. If your practice is already in gentle decline and you do nothing, guess what? It will be curtains in a few more years.
Assess the situation
I’m not suggesting you take risks for the sake of it, rather calculate the implications of each risk. If you are trying to decide whether to invest in a marketing campaign or hire a new associate there’s obviously a financial risk to both decisions – maybe the campaign won’t work or perhaps the associate will let you down.
So start with the reason you are taking the risk in the first place: what is the objective? Then list the consequences if it fails totally: the costs, the wasted energies, the impact on morale. Now, and this is the tricky bit, list all the unforeseen consequences associated with taking the risk. Is it a big list? Great.
The next step is to build a remedy or a workaround for each of the possible outcomes. It’s tiresome, but you will end up feeling totally different about taking the risk, however large. Realistically it would be highly unusual for a particular risk to be a total failure. You have now put yourself in a place where you manage or mitigate the risk because you have anticipated every single possible outcome or consequence. You are in control. You might also feel happier. Try it.
Dr Simon Hocken established three practices as a dentist before founding the dental consultancy Breathe Business in 2007, which combines life coaching and business performance reporting to make dentists happier and wealthier.