Dr. A had just turned fifty years old. The doctor operated a successful dental practice that was grossing about $1,000,000 a year. His pre-tax net income was about 40% of his gross collections, which enabled him to provide a good living for his family. His staff was well trained, and turnover problems seemed to have been eliminated. He practiced four and a half days a week. His practice was stable and maintained a steady flow of new patients. He no longer felt compelled to work any evening or Saturday hours, and he enjoyed more time off.

Dr. A was married and had two children in high school. He played tennis two days a week and enjoyed reasonably good health. He had a nice house with a mortgage, and he drove a nice car back and forth to the office. He and his family took two weeks of vacation every year (usually where they were holding a continuing education course so the vacation could be written-off for tax purposes). He had a college fund set aside for the children and had recently begun putting money away into his retirement program. In short, he had achieved what everyone considers to be the American dream. The problem was with all these trappings of success; he was not happy!

You see, doctors are natural-born achievers, very goal-oriented people. Goal-oriented people tend to avoid responsibility while they are in pursuit of goals. Reaching goals is the objective. Pursuing goals mean that you avoid responsibilities except for those directly related to obtaining that particular goal. Goals are exciting; they provide a sense of accomplishment, something to be pursued. Responsibilities represent a burden, drag, something to be avoided. How can you possibly accomplish goals if you are burdened with responsibilities? Goals begin to be set as early as high school years, getting good grades to get admitted to the right college; once in college, students set academic goals for qualifying for admission into a doctorate program. The doctorate program's goal is to out-perform others and graduate as the best clinician in the class. These goals were more immediate, short-term, and replaced by new, even more complicated goals each year.

Upon graduation, the next goal is to have that successful practice we just described. There are the goals of building an office, drawing plans, supervising the construction, selecting equipment, etc. Everything is exciting. Each new goal is achieved quickly, and then on to the next one. The staff is hired, and the dentist learns how to operate and manage a practice. The goals for the first ten or twenty years after graduation seem endless. Goals include building and organizing the practice, paying off bank loans, buying a house and new car, getting married, having children, meeting new friends, and discovering new places to see. Everything is incredibly new, and those years are filled with so much goal-reaching activity that one seldom has time to think about where he is or where he is going.

Somewhere between the age of forty-five to fifty, something happens to this goal-oriented doctor. As each goal is accomplished, new goals don't crop up to replace those already met. After twenty years or so in practice, the goal of building the practice is over. Now it is a matter of having the responsibility to maintain it for the next twenty years. The purpose of building the family's dream house now becomes a responsibility to pay off the mortgage and maintain the house during the next thirty years.

Then there is the family. Each child's birth is an exciting event, but soon the children, while a joy to experience, become a demanding and on-going responsibility for both time and money. One is not free to travel as before, and besides, it is too expensive to take the children along on exotic vacations. The fun-loving girl he married is now a mother with the responsibilities of raising a family. While the family provides much joy and happiness, it also represents a great deal of responsibility for the next twenty to twenty-five years. The American dream is now accomplished, but now the entire dream has become a responsibility. Goals do become responsibilities!

Buying new cars or a vacation home adds excitement but is a short-term fix. Hunting and fishing trips and out of town meetings provide a means to get away from the office to forget those responsibilities. The doctor doesn't understand what is causing those feelings of frustration and occasional unhappiness. It's a mystery to the doctor and his family. Friends say it's a mid-life crisis. Suddenly the doctor becomes aware of his/her mortality. He looks back twenty or thirty years ago when he was in his twenties, and then ahead twenty years from now when he will be in his sixties or seventies! Yes, age and aging are a concern, but it is all part of life.

The Catch 22 Syndrome:
The goal-oriented doctor's biggest eye-opener is the realization that as goals are achieved, more responsibilities are incurred. The doctor feels that he has a heavier burden to carry than most people do, which is true to some degree. One of the reasons for this is that, as a goal-oriented person, the doctor spends much of his life pursuing those goals, which, when accomplished, then become responsibilities!!! Is there a way out of this dilemma? The answer is "absolutely" maybe! We will address the possibilities later.

Clinician Syndromes:
At this point, doctors may begin to display one or more of the following "clinician syndromes":
1. The Mammoth Office Syndrome: The doctor plans to construct a large, new office building. This project is a new goal, short-term though it may be. The bigger the building project, the longer it takes, and the more expensive it is, the more exciting it becomes. After it's completed and the doctor moves in, he may soon realize he has only strapped himself with more responsibility. He may not realize he has increased his fixed overhead without increasing his production. The responsibility for paying off this new mammoth office can be crushing.
2. The Mammoth Practice Syndrome: The doctor attends practice management seminars where he is told that happiness is building a $2,000,000 practice. He learns how to shave seconds from each procedure, and then he adds more staff (more fixed overhead expense). Once he has built this monster practice, he can no longer enjoy vacations because the additional fixed overhead expenses eat away profits in his absence. He has strapped himself with even more responsibility while in pursuit of this goal.
3. The Ambiguous Associateship Syndrome: The doctor hires an associate, offers no contract or a one-sided agreement, does not commit to the associate, and gets none in return. Then the doctor keeps most of the patients to himself. The associate leaves at the first offer of a better opportunity, so he hires another and then again another until he decides associateships don't work. (Doing it the wrong way and have it fail makes the doctor conclude that doing it the right way must not work either!). The doctor becomes responsible for all the future clinical work needed for the practice. More responsibility!
4. Specialty Syndrome: The doctor sells his general practice to enter into a dental specialty program. Entering this program sets him back many years financially and can add lots of stress to his life. Then he must start over in a limited specialty, providing services that many financially strapped general practitioners are providing themselves. It's a whole new struggle, a new goal, and although it's a lot tougher than most, it is not humdrum. That is until it's built, and then it too becomes another responsibility.

How can you keep this from happening to you? Set personal goals for yourself and make plans for your practice to provide the means for achieving those personal goals. Your practice should not dominate your life, but it should provide for YOU, as well as for your family.

What should those goals be? Well, for one, you should have goals that enhance your quality of life. For example, one goal should be to practice dentistry on whom you want and provide the dental services you want to provide and provide them only when you want to work. Sound too good to be true? Not so; it just requires proper planning.

Secondly, having freedom from the overhead expense that your practice represents. Freedom can be accomplished by having partners or associates practicing with you (or for you) to offset the negative cash flow caused by your absence from the office. You must give them a fair deal and a secure future with the arrangement obtained by more than "a verbal agreement and a handshake." The needs of both parties should be addressed contractually to make the arrangement mutually beneficial. Additionally, apply business concepts to your practice to provide operating profits, so you are not dependent upon your clinical production as your sole means of income. Get out of the "Solo Economic Dependency" trap.

Lighten the load, lessen the stress, but don't expect to eliminate it. Don't have unrealistic expectations, but do have a plan. If you have a plan, you can accomplish your goals. You need goals that are realistic and that do not add more responsibilities to your life. It won't happen by itself. You will have to make it happen. There are many business principles that you can apply that can maximize the economic benefits of practicing dentistry while decreasing, not increasing, your clinical responsibilities. Call AFTCO at 800-232-3826 or visit our website at www.AFCO.net. It's time to call AFTCO!

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