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Kill Your Practice Before it Kills You: An Interview With Dr. Ron Arndt

Posted May 24 2010 6:33pm

There probably came a time while running your practice when you felt like your practice was controlling you rather than the other way around. In fact, a fair number of you reading this probably feel this way today. Doing nothing isn’t really an option if your goal is to create or remain a successful practice. So, how can you re-establish control over your practice?

To find out, I recently interviewed a man that knows all too well the realities of losing control of his practice (and himself) – only to recover and eventually operate among the top 5% of practices nationwide. This man is renowned Master Certified Dental Coach, Dr. Ron Arndt.

Dr. Arndt practiced clinical dentistry for 20 years and spent another 5 years in various executive positions within a financial planning and investment firm. This Summer, Dr. Arndt is releasing a book entitled, “Killing the Practice Before it Kills You: How Throwing Out My Business Model Saved My Life.” In the book, Dr. Arndt will go into great detail about the strategies he used to turn around his dental practice.

So, without further ado, here’s the interview:

1. How do you know if your dental practice is killing you?

Take a moment right now and consider this checklist. Have you ever experienced any of these warning signs? Check off those that reverberate with you.

  • You find it difficult to get a good night’s sleep because you are thinking or worrying about the business.
  • Your attention is on home when you are at work and on work when you are at home.
  • You tell your spouse they are number one in your life when silently you are more focused on the success of your business. After all, it’s who you are!
  • You act happy and content on the outside. In reality, your insides are churning and you never feel in control.
  • Your energy level begins to fade, and you make excuses when you know you have not been taking care of yourself. You pass it off as something else.
  • You are too busy to play those “goofy” games with your kids, who are so hungry for your attention.
  • You read the newspaper or business journals when your spouse is talking to you because you have so much to catch up on. Then you fall asleep after twenty minutes, because you needed “just a little nap.”
  • On a weeklong vacation, it takes three to four days to unwind. You feel like a new person for one or two days, then the tension builds again, welling up uncontrollably, tightening every muscle. Sunday nights are the worst.
  • If you want something done right, you have to do it yourself. Only you can do it, because it takes too much time to explain and delegate a task to another person.
  • You hear this voice in your head: “I don’t need anyone else. I’m smart and can do it all on my own.”

If you checked off a single one consider this a “red flag”. Don’t pass it off as inconsequential. The accumulation of these signs slowly and insidiously over time can be deadly.

2. Why are developing personal core values so important to the success of a dental practice? How do they translate into working with patients and your office team? In other words, why would they care?

I found myself defining my sense of worth and value based on the success of my business. It fueled my ego and fed my belief that I was paying off bills and creating an economic future of choice for my family. That of course included a beautiful home, nice vacations, paying for parochial school tuition, saving heavily for college education, and planning for retirement. Does that sound familiar?

I found myself developing a practice where I was working for everyone else except me. I employed two administrative people, two Chairside assistants, two expanded-functions dental auxiliaries, and two hygienists. Big numbers, big production was the name of the game . . . or so I thought. After all, I was working to be the biggest, baddest, fastest, coolest, wealthiest, and most respected dentist in town. I was unaware at the time that I was learning the lesson that a manager cannot both lead the band and play all the instruments.

After my heart attack, I consciously began to shift in many ways: my outlook, my attitude. I chose to focus not on eliminating my type A behavior, but rather on replacing it with something different. I affirmed my new life direction by codifying my values in writing. I knew I had to identify my core values, the guiding principles around which I would make all of my business decisions. They would serve as the litmus test against which I identified what was “right” and “honest” for me. I knew that these core values would be the genesis of everything that I wanted to do in the transformation of my practice. I set aside several thirty- to forty-five-minute quiet-time periods, so I could work on identifying my core values.

As a basis for this process, I used the following elements: My core values are ideas that I want to publicly affirm;

- My core values are ideas that I greatly prize and have a positive influence on my life;
- My core values are ideas that I am willing to act on;
- My core values are ideas that I would repeat if given the circumstances again and again; and,
- My core values are ideas that I choose freely and with a clear understanding and recognition of the consequences of my choice.

Why would patients care or even know?

Simple, they would see and experience my commitment in the ways I behaved not only towards them but also my team members. Patients, guests want to know that you operate from a set of values that honors and respects them in all actions. In all our interactions with patients, if we have core values in writing and committed to by all team members, we get to go back to them any time we get stuck, have a tough situation, or are confused on what actions we need to take. Core values are HUGE in how we operate our business and treat those around us. Patients know a genuine and authentically caring dental home.

3. What was the significance of firing – and then re-hiring – employees? How did that help you define leadership?

It was much more than simply “firing” the team. It was a dramatic message that the old way of doing business was over. I was not leading my team successfully and the dental team was lulled into a mindset of entitlement…a deadly combination. By Killing the Practice I was burying the old and then offering up a new solution…a solution I wanted for the way I wanted my practice to operate. This was an all or none approach that was necessary to get everyones attention. The choice was entirely up to each individual employee if they wanted to re-apply for the available openings in my new practice.

After Killing the Practice I spent the next several hours detailing exactly how I was going to run the practice. I introduced them to my core values, explained what they meant, dissecting every word and sentence. I gave them the opportunity to ask questions. I did the same for my vision, clearly laying out for them where I wanted to take the practice, again reminding them that they didn’t have to own these, they didn’t have to buy into any of what I was explaining. But if they didn’t, they no longer had the opportunity to work with me or in this office.

For the first time ever, I became the real leader in my practice, a role that I should have assumed long ago. It had taken me years to realize that the ultimate responsibility of a leader was to facilitate their development as well as my own.

4. How can a dental practice raise their fees and not upset the patients?

I finally made the decision that I was going to be paid what I was worth and I expected to connect my compensation with the value, the love, care, and extra attention I brought to my patients’ dental health and life. No more of this conversation about if the insurance will or will not cover it. Or, that’s over “Usual, Customary, and Reasonable.” That old thinking had to go. My practice was not usual and customary; we were extraordinary. I declared: “We will train on our financial arrangements and how to discuss them with our patients . . . no more laissez-faire.” My expectation was to offer up financial options for our patients that were written, fair, explained in advance, and easy to understand. And of course, any patient who’d been previously quoted a case fee was grandfathered in.

The best way to overcome the “perceived” objections was to communicate and deliver “value” for the fee. Certainly there would be a small percentage of price shoppers that would be upset, yet they were not our ideal patients. I directed my administrative team to keep a yellow pad at the front desk and list those patients who were so upset that they were going to leave the practice. We never filled one full page…barely a half page. It is my belief that no matter what our fees patients will view them as “a little pricey” and I validated that with a study I did with my crown fees.

What I have learned is that if we deliver perceived (and real) excellence combined with true patient care and outrageous service, our patients will perceive the value and not only continue to visit us, they will refer. Don’t misunderstand, this is not about gouging people, it is about being compensated for delivering remarkable human service.

5. How does cutting some benefits completely, but increasing others dramatically work?

I took a new-world view…new in that I was breaking with the typical dental management thinking of give everything and anything to retain employees. Dentistry as a profession lives in a HR bubble. In the real employment world, employees are paid for performance. Greater performance dictates greater and higher compensation and of course the opposite applies, low performance, low pay or even dismissal. In dentistry, this statement is more enigmatic: “Dr., I have been here for another year and I am entitled to a raise.” My new world view was, no more entitlements. I explained clearly that the new wage offerings would be no less than what each was currently making, however, any future increases in wages would be as a result of increased output-performance-revenues.

No more benefits of paid time off that found my team taking advantage of my generosity that cost the practice revenues and raised my stress because I was often found on Monday’s (often the busiest day of the week) short handed by 25% of my workforce because they wanted an extended weekend (67% of called in days off were on Mondays). I eliminated the eye-care benefit. I made major adjustments to my benefits package, because it was being abused. It had become expected as an entitlement and was grossly unappreciated. And my staff costs had continued to escalate because of the generosity that I had built into my staff compensation package without any real consideration to what it was costing me to provide staff services.

I was now going to track my business expenses like a real businessman and compare them to industry averages to better enable me to make better decisions. I also declared that I would no longer pay for their exotic trips to St. Thomas, the Bahamas, and Dallas. No more excursions. I expanded the continuing education credit because it encouraged their personal growth, enhanced their value, better served our patients, and was simply good business. I made people clearly aware that they would be well paid, but I was firm in my expectation: you have to show up, and produce results. Compensation would now be performance based. Then I introduced my new incentive program: a Win-Win, Pay-4-Performance arrangement. It was team-centered and fair. Did it work? You bet it did. My final 5 years in practice were my most enjoyable and profitable and my remaining team members were making more money than they had ever done in the past.

6. What does practicing meat and potato dentistry mean? Why does it work?

Meat and potato dentistry is my name for the routine, common procedure mix of services the typical patient wants. My practice was not a high end cosmetic or full-mouth rehab business. That was not what the majority of my wonderful blue-collar patients requested. While I did selective challenging cases, I brought in an oral surgeon to help me with the implant process and an orthodontist as well to help me grow my young people part of my business. We were a “family practice” and as such served moms and dads and their kids along with their grandparents and neighbors.

Nothing fancy, yet extremely personalized relationship-based care. Our patients were give full, comprehensive evaluations and treatment plans and then given full authority to determine if they wanted some, none, or all of what we recommended. We phased our care as well so that they did not feel pressured to “have to” do something. I have learned that the scar of the unchosen surgery heals slowly. We did basic, solid, caring dentistry. For those dentists who can do the big restorative and cosmetic cases, we referred our tough cases.

7. What is one tip that you would give to someone starting out their own private practice?

Start with the end in mind….a Steven Covey mindset. I’m coaching right now a young starting pediatric dentist. My first bit of coaching was to get him to dream and envision what he wants! What will make the biggest difference, and yet one of the toughest things to implant into the head and heart of a new dentist, is to identify who you are via your own Core Values. When they write out, on paper and list what they stand for they then can take the next step to write their personal AND practice Vision Statement. Armed with their Core Values and their Vision Statement, the strategic plan magically begins to unfold as any time they get stuck…the refer to their values and vision.

Above all things, this is what I want for new dentists. My fear however, after talking to Junior and Senior dental students, they won’t take the time or devote the seriousness to this process. I have seen the results with many doctors…frustration, lack of direction, financial chaos, marital issues, misplaced arrogance, and an unhappiness with their life.

Have you ever felt that your practice was controlling you? How did you handle the situation? What will you takeaway from Dr. Arndt and try in your practice?

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