Live to work, or work to live? Simon Hocken wonders just what it is that dentists work for…

It is often said that many people live to work, rather than work to live. Sometimes it is easy to forget just why we dentists work so hard. An ex-government chief economist, Richard Layard wrote in his very readable book, ‘Happiness’ about the key factors that have proven to make us happy.

His top three are:
1. The quality of our relationships
2. Our financial situation, and 3. How satisfying we find our work.
With money at number two and work at number three, it’s clear that getting these right is key to our happiness.

1. A high income!

In my experience this is often the single most important want for many dentists. Associate dentists are earning less, year on year, and the most recent data shows UK associates earn on average £72k/year. Dental principals usually earn more and the spread is enormous. Amongst our current client base it varies from £40k to £400k/year. If you want to earn a high income as an associate you have to be able to gross £1,500/day or more. On a 45% deal this would earn you circa £110k/year. If you want to earn a high income as a practice owner, you need high-grossing associates, preferably at least two of them, as well as being able to gross £1,500/day or more yourself (these figures are the same whether the practice supplies NHS or private dentistry, or a mix of both).

2. Wealth!

A long time ago, my coach said to me that, ‘Unless you can grow assets from your income you will end up being both old and poor.’ And it’s still true today. Although many dentists earn relatively high incomes, many, many of them spend all of it and then struggle to pay their income tax bills. The point of growing your net worth is so that you can stop working before you are too old to enjoy stopping working!

Most of our clients work with a financial planner. Find one who you trust, who is clever and who practices what they suggest. And then do what they suggest! It’s a good idea to measure your net worth every year and take steps to grow your wealth and work towards the day you become financially independent, and then work only because you want to…

3. More time off!

A well-known coach used to promise his dentist clients ‘more profit in less time’. Being paid by item of treatment and being self employed means that many dentists work longer hours and take less time off than they want to. If you multiply the number of days in the week you really want to work (say four) by the number of weeks in the year you really want to work (say 45) then you have this number of days working per year (180 days in this example) to earn sufficient gross fees. Anything over £250,000/year gross should do it, meaning that in 180 days you need to gross more than £1,400/day. Clearly this is about working smarter, not harder! (See item 5) Choose holidays and pursuits that really rejuvenate you, and don’t take your work phone on holiday!

4. Not to be bored!

Many dentists, particularly those over 40, confess to being a bit bored with dentistry at times. It must be something to do with the repetition of basic procedures: check ups, fillings etc which once mastered and repeated endlessly make for a dull working life. So do less dentistry, take frequent holidays, become interested in your patients and not just their teeth. When you’re away from work, choose physical, adrenalised recreational pursuits which burn off the stress of being a clinician and leave little head space to think about work!

5. A practice that isn’t dependent on your gross!

If you’re the highest grosser in your practice, the practice turnover will suffer when you aren’t there. So don’t be! Better to have many medium grossing fee-earners than one high grosser and lots of low-grossers! Also, a practice with a high-grossing principal is really (really) hard to sell! For this reason (and many, many others) don’t own a single-handed practice, it’s exhausting and dispiriting!

6. Avoid management troubles!

Hire a clever, experienced, responsible operational and business manager and be willing to pay enough to get a good one. We often recruit these people from outside dentistry and it is rare to find someone who started life as a dental nurse who can now successfully run a complicated business with profits that are being squeezed. However, in my experience most dental principals spend too little time during their week paying attention to the leadership and management of their practice because they spend too much time earning fees… (see item 5). The real paradox is that the more time you spend working on your practice (and therefore the less time you spend in surgery) the faster your practice will develop and grow.

7. Steer clear of legal issues!

Otherwise known as not to be on the GDC’s radar or the radar of litigious patients. Understandably, the dentists I meet who are waiting for their day at the GDC are (usually) very stressed about their situation. My best advice to avoid this is to choose your patients carefully and then manage their expectations of any treatment you provide. When things go wrong, apologise and put things right if you can. Make friends with all your patients (it’s harder to litigate against friends). And, of course, be meticulous with written consent and with writing up patient notes. If you do get the letter, try and be sanguine about it and just get on with your life.

8. Have enough work/patients but not too much!

It’s a difficult balance, but it’s better to have a little less work than you need than too much. A little less work gives you space and flexibility in your diary. Having lots of patients seems like a good idea until you realise how much time you spend doing check ups and that you have too little diary space to fit the work in. Too much time spent on check ups (more than two and a half hours a day) will make it near impossible to have a high-grossing day.

9. To avoid large and/or surprise tax bills!

There are still accountants who tell their dentist clients how much tax they need to pay a few weeks before it becomes due. Of course, the dentists are usually culpable too, although not always. If this happens to you, tell your accountant that you require an estimate of your tax liabilities at least 12 months ahead of their due dates. Or change your accountant. Nobody welcomes surprise bills.

10. Peace of mind!

If you can achieve your version of this wish list then, for sure, you will sleep peacefully! Being on the way to achieving these objectives together with your personal objectives will create for you something we all yearn for, peace of mind. We all want some, some want a lot and dentistry can help you find it. By focusing on these objectives you will move towards peace of mind. A big claim, I know, but try working on these nine and see if I’m right!


Simon Hocken BDS established three practices as a dentist before founding the dental consultancy Breathe Business in 2007. He specialises in supporting principals and their management team in making change happen. He speaks regularly at major dental forums, as well as writing for leading publications, and lectures and writes for academic courses.
Tel:: 07770 430576
Email: [email protected]
www.breathebusiness.co.uk