I Just Want to Practice Dentistry

The doctor's practice was located in a newer business park adjacent to a growing suburb. A busy
coffee shop anchored the park, and his office was flanked by the offices of other healthcare providers. Plenty of available parking and great signage on the building were the finishing touches on my very positive first impression of his practice.

When I entered, I was greeted by the doctor and his spouse. The inside of the practice was even nicer than the outside, including a well-designed waiting room and front desk, modern décor and paint, and even the obligatory photo of a beautiful family. After exchanging pleasantries, he began to explain the reason for the consultation.

"I chose dentistry as a career because of the lifestyle that it promised: excellent income and a great degree of personal freedom. Then, I discovered that I loved working on teeth and making people happy by restoring their smiles. My patients love my work, and the practice is successful," he said. "However, lately, I feel like a hamster running on a wheel, pandering to the demands of the insurance companies and my staff. I feel stressed out, both at work and at home. I am either worn-out, burned-out, or both. I just want to practice dentistry."

And there it was, "the big lie," flopping onto the table of our conversation like an ill-fitting denture at a corn on the cob eating contest.

In a classic episode of Seinfeld, Jerry begs prevaricator extraordinaire George Costanza to help him beat a polygraph test. "Jerry, just remember," advises George, "it's not a lie if you believe it." This dentist wasn't lying to me. He truly believed that if he could just do dentistry, he would be a happy dentist again. It was the business of dentistry that was causing his dissatisfaction.

This is the siren song of the dental service organizations (DSOs): "You hold the handpiece, and we do the rest." However, many dentists who believed that they only wanted to do clinical work and surrendered practice ownership often discover that they preferred handling or even enjoyed some of the managerial and entrepreneurial tasks that came with the freedom of being a sole proprietor.

In his book, The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It, small business guru Michael E. Gerber identifies three critical roles that owners must fill at small businesses, including dental practices:

• The technician. Technicians are responsible for getting the technical work of the business done. Technicians are the bakers making the cookies, the mechanics repairing the engines, or the dentists treating the patients.

• The manager. Managers are responsible for the day-to-day administrative tasks that keep the doors open and the lights on. Managers hire and fire, file taxes, negotiate with vendors, and sign contracts. Managers dot the I's and cross the T's.

• The entrepreneur. Entrepreneurs are responsible for growing the business. They seek out new products and services, track Google rankings, and engage with the community by doing things like sponsoring youth sports. An entrepreneur loves working on website designs and direct mail postcards. They do the "salesy" stuff that keeps the business successful.

Gerber argues that most small businesses are started by technicians. Technicians believe that because they know how to do or make something, they can run a business that provides that product or service. Gerber calls this the "fatal assumption" that causes many technicians to burn out and small businesses to fail.

If a dentist only wants to be the technician and do dentistry, he or she must delegate the work of the manager and entrepreneur roles. However, the big lie manifests itself when the dentist continues to execute those responsibilities, often without the knowledge of the delegate. These dentists refuse to completely let go of the nonclinical tasks, and then they become frustrated because they perceive that "the employee isn't effective," or that they are "wasting money with a consultant" without realizing that they are sabotaging the entire process by not letting go of the responsibilities.

If a dentist truly wants only to do dentistry, then he or she should take a job as an associate dentist, preferably at a corporate dental group, or join a DSO and perform dentistry when, where, how, and for whom they are told. Alternatively, deflated dentists can restructure their roles at their practices so that the joy of going to the office returns. Either way, they need to forfeit the freedoms and responsibility of ownership. There are seven steps that dissatisfied dentists can take to help them come to terms with their relationship with dentistry and properly delegate what they don't want to do.

List the things that you enjoy doing at the practice, regardless of which role those tasks belong to. If you love placing implants, responding to patient reviews, and filing quarterly taxes, put those things on your list whether you are currently performing those tasks or not.

Just because you like doing something doesn't mean that you are good at it. Look at your list from Step 1, and circle the things that you do well.

This step is about creating the critical list of things that you hate to do at the practice. The items on this list are robbing you of joy. Your feelings of being worn-out and burned-out originate from this list of tasks.

The operative word in this step is today. You might think, "I can't delegate my exams." But I would reply that you can hire an associate. Every task is delegable. There is no task occurring at or related to your practice that you could not delegate with the right people or processes in place.

Use the information from the preceding four steps to create your ideal list of responsibilities to have at the practice. This list is going to comprise things that you enjoy doing and things that you do exceptionally well. Imagine how you would feel leaving your home each morning to head to the practice to do the things on this list. If someone were to ask, "How was your day?" doing the things on this list should make you want to respond, "It was awesome! I crushed it again and can't wait for tomorrow!"

Rid yourself of thoughts that begin with phrases like "I can't find someone to," "I can't trust anyone to," and "I can't afford to." Yes, you can! Those phrases are excuses based on fear and/or arrogance. Stop negotiating against yourself.

• Can't find an associate to only do exams? You could look for a retired dentist who still has interest in the profession, such as one who has sustained an injury and can no longer hold a high-speed handpiece, and pay him or her an hourly rate to do exams.

• Can't trust anyone to handle the payroll or finances? Hire a third party or put a process in place that allows for checks and balances.

• Can't afford to hire an associate or a payroll company? Instead of doing exams or bookkeeping that you hate, do another crown (which you are great at and love doing) per week. Or do two. You will be able to afford to hire who you need with the increased production that will come with you doing the tasks that you are good at and enjoy. When you thrive, so does the practice.

Similar to the Alcoholics Anonymous 12-step process, the seventh step in this process involves embracing humility. Oxford Languages defines humility as "a modest or low view of one's importance." Humility is the key to success in delegation. Beliefs such as "I am the only one at the practice who can do (blank) correctly" are the opposite of being humble. Developing the humility to give control to others is one of the most empowering things that you can do as a business owner-and critical to getting off of the hamster wheel.

"I just want to practice dentistry," said the doctor.

"Easy," I said. "Go get a job as an associate."

"I have an interview on Thursday," he replied.

This dentist had gone straight to the seventh step without my help. I found his response refreshing. It was honest and humble. We spent the next couple of hours talking about what brought him joy and the sources of his frustration, however big or small. We talked about his options for his practice, such as bringing in an associate, selling it, or shutting it down. And then we talked about modeless crowns and laser curing lights because, at the end of the day, he was still a dentist.

Dentists who work through these seven steps will find that their "truth" will most likely involve an amalgamation of tasks from the technician, manager, and entrepreneur roles at the practice, and their job description will include more than just doing dentistry. Be honest as you work through steps one through four and humble as you finish the process. If you discover that you are one of the few dentists who truly wants to just do dentistry, this process will help enable you to do so, but on your terms as an owner.

Randy Leininger, MBA, is a business coach at Troutberry with nearly two decades of executive management experience.