The Value of a Second Opinion to a Dentist

Here is another thoughtful blog from our esteemed client Dr. Don Lurie.

It seems to me that every health care professional sometimes needs to take the same advice that he gives to his patients.  "I suggest that we get a second opinion on this…"

I have written many articles regarding the beginning of our practices and continuing to retirement.  As I have said, (The Profession of Retirement, May, 2013) the new career of retirement requires planning and thought including the obvious financial requirements  and also the emotional preparation (Emotional Preparation for Retirement, March 21, 2014).  I strongly believe that preparing for retirement should start with the onset of our practices and that careful management by the proper team of advisors is essential to accomplish this.  Like with most things, we get into a routine and things just continue to function and run - timely donations to retirement funds, investments, insurance, etc... 

However, I made the mistake and took it all for granted.  Things and circumstances do change.  Health can be a factor in your planning (or lack of same), personal goals, motivations, insurance needs and many other components that combine to make our new career of retirement frightening and foreboding.  It is my hope that you can learn from my mistakes and make this transition so more calming and smooth.  I think the key word here is "transition". 

About 10 years before I retired (after 50 years), my "CEO" who really was my accountant (and the head of the Team of Retirement, August, 2013), suggested that we examine several areas of my life and practice.  He also suggested that we get a second opinion on various subjects that incorporate the business of dentistry and oral surgery.  Did we have an accurate appraisal of the worth of the practice or were we hiding our head in the sand? Do we still need to continue large amounts of life insurance or can we scale back as the age increases and other investments take over? Do we have a team in place to advise us on how to Transition the practice, think about buyers, target the buyers, bring in an associate/buyer etc? Are the investments good for the short term (while in practice) or do we need to start looking for a different quality of investment or moderate style of investment for those retirement years so that there can be some inner peace without the volatility of "the gamble"? I thought that my accountant was really so wise to suggest second opinions and it proved to me that he was the correct person for the job of CEO by being unafraid to show and share our information to an unbiased group of advisors.  It is with this vision that I was able to make even better decisions, long before retirement, to make this retirement career seamless as the time approached.  Of course, the first 6 months were an adjustment but I was ready for them.  And after that period, my life has taken on a new purpose and joy that I could only hope would be the case for everyone.   Another big area that needed a second opinion was the role of the corporate attorney.  Were our documents in order? So a review of the articles of incorporation was carried out at that time.  This also helped me in finding the attorney that I thought would be the right person at the time of transition.  This was invaluable and helped to keep that stomach-ache at a minimum.  It was just one worry that was eliminated knowing that there was the right person to turn to at the given time. Another area in transition to be considered is insurance.  Do you have the right kind of life insurance, enough or too much, malpractice insurance (enough or too much), real estate insurance if it applies and are there other insurances that your situation requires? What about HIPPA? Do you have the right IT person to help you to transition? Does he need to install systems at home to help in the transition? The list of questions goes on. 

I always made it a rule when I was in active practice, that I would not be the treating surgeon after I gave a second opinion.  I made this clear to the patient initially and reinforced it.  This gave me clearance to be more objective and to sincerely want to help both the treating doctor and the patient in solving the problem or conflict.  I followed this rule when I receive my second opinion from the outside group of advisors.  They were helpful and, more importantly, reinforced my admiration for my lead accountant.  Both groups agreed that I needed a specialist in practice transition to get to where I needed to go. 

The detail of this team was amazing including instructions to staff on what to say to the patients, how to explain what was going on, where charts would be available, etc.  Actually scripts were written so that there would be consistency among the staff when answering questions.  I cannot emphasize enough the value of scripts.  They should be used throughout your entire career. 

So I would urge you to reevaluate your situation, get that second opinion and move on, either with your original team or perhaps with the new advisors.  It may be an amazing discovery.  The goal is to make this as smooth a process as possible but you too must have an open mind and be clear about your goals.  They should be written down. Keeping a journal is a valuable tool.  Remember, "You cannot live a positive life with a negative mind."

The Team of Retirement for me was key.  Outside advisors and specialists were brought in at various stages of my career and for their efforts, I am eternally grateful.

These are just some thoughts that were on my mind regarding practice transitions and the possibility of a need for second opinion.  We are all here to help one another.  Please do not hesitate to send me you thoughts and questions.  It would be an honor to help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

email:  donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

The Specialist and Dental Study Clubs

This is another guest post from our client Dr. Lurie.

It seems to me that the need and demand for continuing education is extremely important to our profession.  Obviously, so do the State Boards and licensing folks.  I would like to discuss study clubs and how to gain the most value for the time and effort it takes to begin a study club.  How to begin and maintain the viability of the entity is important but many other factors need to be considered.  I was fortunate enough to start a study club that was in place for about 18 years and was most successful and helpful to me personally as a specialist in Oral and Maxillofacial Surgery.  It was a venture that was close to my heart as are many endeavors that one creates from scratch.  This is a companion article which started from my recent post on the Specialist and Referrals. 

Continuing education has many virtues but comes at a price.  The large and major professional organizations have tons of meetings around the country and internationally.  The advantages are obvious but some disadvantages are also obvious.  One must leave the office for an extended period of time.  Some meetings are better than others and have greater draw; thus the partners in a group practice may bicker as to who gets to go and who stays and watches the store.  In addition to the time involved, there is a large expense for the meeting - food, hotel, transportation, tuition and time lost in production at the office.  There is no doubt that these large meetings with their fantastic instructors have a lot to offer.  In addition, the large attending group gives ample opportunity for exchange of ideas and experience.  Lunch time becomes an additional course of study as folks discuss what they just heard and how it is or is not applicable to them in their own particular situation.  Even so, I feel there is a great opportunity for the "Study Club" to also be part of this ongoing quest for information, knowledge, practice growth and expansion of referral base.  For the beginning specialist, it is a great supplement to the contacts and personal exchanges with the referral base.

I would suggest starting a study club that is narrow in its field.  This allows for expansion of topics as the club develops but keeps the group focused on a particular subject that can be creatively and exhaustively researched and expanded upon.  In my case, we created a club that was restricted to dental implants.  You must remember that this club was started at about the time that the first words of implantology were first spoken.  I was one of the fortunate ones chosen to take post- graduate training in this new field.  Now it is taught in dental school.  This peaked my interest and desire to share this with colleagues and referring doctors.  We had to learn a new field as best we could and take the courses that were out there - both good and bad.  The study club enabled our group to discern the good from the bad - what worked, was feasible, patient friendly and within our ability to achieve good results.  This process was ongoing throughout my career until retirement.  As the ability improved and the knowledge was enhanced, the complex cases became more routine and the results were more predictable.  Thus, the study club became an arena that open discussions, exchange of ideas, and special speakers embellished the information obtained from the formal courses given around the country.  So I would suggest that a beginning study club be a special interest within a specialty connotation.   

Invite prospective members who are within a 5 year (approximately) time of graduation with you so that you can grow together both educationally and socially.  I must comment on the wonderful relationships that the closeness of the club created.

I would also try to establish a membership that had other specialists in fields besides my own area.  After all, I am trying to create a referral base.  Input from ortho, perio, prosthetics, occlusion, TMJ, etc.  will add to the discussion and I found this to be true.  Everyone benefitted when we discussed implants from an occlusal standpoint for example.  I might invite another oral surgeon to present at a meeting but I certainly did not need one as a competing member. 

There are many ways to conduct a study club meeting.  You can have a classic lecture followed by question and answer.  It can be an actual hands-on class sponsored by one of the companies (with all their resources), a round-table discussion where everyone will present on the subject (as notified in advance) for 15 minutes per person, or even a field trip.  The possibilities are only limited by your imagination.  I would suggest allowing several minutes at every meeting for "good and welfare" so that logistics can be worked out and a consensus agreed upon. 

We actually had an evening where a patient was brought in (all consents signed), records, x-rays, treatment plans etc. presented, and the ability to examine the patient, ask questions---including fees and so on.  It was a fun night. So much so, that it was repeated once a year with a different doctor getting a patient for us to examine.  It was also invaluable when one of the patients was a problem from a treatment-plan standpoint and this gave the entire group the opportunity to help the doctor with the optimum treatment for his patient.  His patient was impressed with the help he was getting on his behalf and I think it was a mutual stimulating evening for everyone.

Always send out an agenda prior to the meeting.  Try to keep the meetings to an agreed upon time format (we used 2 hours).  Try to meet at the same, convenient location when possible with the exception being patient exams, field trips etc. 

Keep the format inexpensive and simple.  We started promptly at 7 PM.  This gave everyone time to get home, grab a bite, kiss the kids and get to the meeting.  We only met 6 times/year.  There were light refreshments in the back of the room at a convenient hotel in the area which included fruit, cheese, coffee, soda and cookies.  Thus, folks could go back and forth while presentations were occurring and not interfere with the presentation.  Our dues structure covered most of the cost of these arrangements.  I footed the bill for mailings and any other special needs. This was done to keep expenses in check.  We started with 12 members and ended with a mailing of 80 active folks.  As new members joined, we tried to get them to get their age-group peers to join with them and this was successful.

So, I think I have given you an idea on how to begin and your own imagination can do the rest.  It was a fun ride and I truly enjoyed every minute of it.  Needless to say, the learning process received was invaluable.  A great way to have "continuing education." with friends, and fellowship.

These are just a few ideas about "starting a study club" and I hope they are of help.  Please do not hesitate to send me your thoughts and questions.  It would be an honor to be of help. 

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie, DDS

email:  donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

The Dental Specialist and Referrals

Here is another guest post from our client Dr. Lurie. We are so fortunate to have him share the wisdom he gained for five decades as a dental specialist.

It seems to me that the dynamic of a specialist obtaining referrals has changed.  As we have all noted, private solo practice in the specialties has greatly decreased.  I have heard estimates of less than 7%.  As a retired Oral and Maxillofacial Surgeon, I have personally noted the change in referral patterns and, I think, understand what must be done to encourage referrals.  This wisdom comes from fifty years of practice.  No longer is it enough to take a generalist to lunch, or to have an annual Christmas party.  I think that the whole picture has to be viewed and rearranged.

Firstly, the specialist has to be extremely well trained. He has to be able to get the "word out" about how well trained he is. I would suggest  a curriculum vitae be sent with the announcement of the opening of his practice.  This is important and should be of the highest standards befitting the degree of their excellent training.  While it is important to let folks know where you are located, phone, email etc…, it is paramount to let them understand your qualifications.  This should be updated periodically as new honors and leadership positions occur.  Obviously, with social networking as keen as it is, it is imperative to have the correct team to help in this initial matter.  I have discussed the team concept in one of my previous articles (The Team of Retirement).  This is the first impact that you will have on your referring base.

It is to be assumed that most specialists will be joining an existing practice.  I would still recommend that this initial information (CV and other marketing) get out there so that the new "person" is not relying on the reputation of the existing practice.  Obviously, if the doctor is solo, then it speaks for itself. 

Incidentally, most of these ideas would apply to a generalist starting practice with the obvious difference being that his target marketing prospects would be different.

In the beginning of the practice, personal visits to the referral base is mandatory.  Now the doctor can place the name with the face.    I would also suggest that care be taken to find a convenient time to visit the doctor----check with his front desk and get to know them well.  Lunch is always good if it is possible but a coffee break at an off-time can usually be arranged.  You might want to stop in unannounced just to meet the front office, introduce yourself and make the appointment with them in person.  These first months will require a great deal of leg work and it is wise to plan this out so that you still have proper time to cover your new office and schedule (keep in mind the new IRS standard mileage rates as well – note all of your travel in a journal regularly).  It will be also mandatory that your new staff be well versed in what you are doing so that things run smoothly while you are out and about.  Again, the proper team will be helpful in putting that staff together.  Nobody said it would be easy. 

As time progresses, I would suggest a series of "Munch and Learn" sessions in your office.  This now completes the circle of announcement, face to face, and seeing your office location.  There should be a wall that displays your credentials-----do not make it obnoxiously obvious, but it is a must.  These sessions should be an hour or less and eventually may lead to further interactions (study clubs, etc…) which I will discuss in another article.  Keep them low-key with simple refreshments.  You might want to invite a speaker, present yourself, or even have one of the detail persons from a company at these gatherings.  It does not always have to be about your specialty per se, but could be a practice management tidbit, accounting novelty, equipment demonstration etc. 

I invented a little item that was a big hit and I will share it with you.  After a patient was seen, treated and eventually discharged, I sent them a thank-you note.  What?!? A thank-you note from a surgeon to a patient.  At the same time, a reminder note went to the generalist so that his patient could be kept in his system for recall and follow-up.  Too often, these patients were late in there general check-up because the referring office thought the patient was still under treatment.  Just a little tidbit but it was effective for me.  The marketing angle is to engage the patients to refer to you directly.  Obviously, you then have an opportunity to reciprocate with your referral base if the patient is not "attached" to a GP.  Always, always, always, try to market with your patients. 

I think that the specialist should take a look at the reports that he sends to the referring doctor so that they are sent in good time and are relevant.  I had a personal, handwritten quick note that went out the same day the patient was treated so that the doctor knew that treatment was on-going and active.  If it was a major case, this was followed by a complete operative note etc. so that it could be filed in the patient’s permanent chart.  This is just another means to get your name in front of the generalist and to establish good lines of communication.  This obviously can be done by email, fax etc.  The important thing is to document the treatment clearly and always ask for his feedback if necessary.

These are just a few ideas about getting started and I hope they are of help.  Please do not hesitate to send me you thoughts or questions.  It would be my honor to be of help.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie, DDS

email:   donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

In This Season of Thanks, This is How One Dentist Gives Back to His Community

Here is another guest blog from our client Dr. Don Lurie.

It seems to me that in this season of the year, our thoughts should turn to the ideals and morals of our history, of our parents and grandparents and even of the faith that has united and nourished us.  We all hear the expression ""I want to give back" but it is something that has to be nurtured, reflected upon, and then acted upon.  It must be sincere.  I guess that the sentimentality of this season of the year has given me the desire to share thoughts about this so-called "giving back." 

Last month, I discussed mentoring to both our younger practitioners and even to our patients.  This should be extended to anyone who might think that our experience, knowledge, and professional bearing might give them insight into their future and to help shape their career attitude to enable the practitioner to love his practice, his patients and staff, and to guard against the cynicism of just practicing for the dollar.  It is most difficult in this current climate to have these "noble" feelings and it is quite difficult to find the words to just address them.  I almost want to quote scripture to help me find the words and to share what I feel in my heart.  In my blog titled Mentoring Equals Outreach, I have started to share the ideal of gift giving and of thanks giving.  I have also suggested that this is, if sincere, a great function for marketing of your practice.  But do you know what? It just makes you feel good and that good feeling should be expanded.  As it was handed down to us by someone or at some place, the good that we have done, are doing, and should continue to do (even in retirement)  expresses who we really are and what is dear to our hearts.

A local group of friends and myself have started an outreach to patients who have difficulty getting around.  Their caretakers must spend time taking them to doctor visits, going to the pharmacy or many other mundane daily activities.  The caretakers, who are saints, are usually other elderly family, friends or neighbors who can only do so much and who, in turn, need to have a break.  Some of the doctor visits are just to have a BP, pulse, and other vital signs on an interim basis until their thorough check-up is due with their primary care physician.  These are easy visits for us since it is something that we do on a daily basis in our practice.  These folks welcome us, enjoy our visit, and feel like it is a social hour.  And you are right - it is a social hour of love and togetherness.  After taking vital signs, the doctor is called and, in 99 % of the time, that is all he wanted to know.  The patient is told to keep his normal appointment and the caretaker is told of the request also.  Actually, the caretaker has an hour off (haircut, personal errands) etc…  The group that I am in consists of active practitioners, nurses, retired docs, other health professionals including one EMT person (who gives one full day/week to this endeavor).  We call it a ministry or an outreach program but it so simple, so necessary, and has just been a joy to be part of it. And guess what? We learn from our visits, gain life experience in our conversations, and get more out of the visit than the shut-ins.  We now have increased our group to include non-professional types for things like drug store errands, haircuts, shopping, lunch, or just a plan visit so that the folks can change the scenery.  Our visitation includes seniors, recovering adults, folks home from the hospital, etc...  "There but for the grace of God, go I."

Next week is Thanksgiving.  Let it be a joy to share your love with family, extended family, and all your loved ones.  And when you are saying Grace at this festive meal, start thinking about how you are giving or going to give back.  I seems to me that this is what Thanksgiving is all about.

I would love to hear from you and share your ideas and experiences.  More Mistakes Made and Lessons Learned next time.

Dr.Donald B. Lurie

donald.lurie@att.net    

Phone:   717-235-0764

Cell:       410-218-2228

Dental Mentoring Equals Dental Outreach

Here is another guest post from our client, Dr. Donald Lurie.

It seems to me that part of the continuing attempt to refresh and recharge our enjoyment of practice is the chance to be a mentor.  In these times, there is an obvious decrease in the ability to sit back and enjoy the practice of dentistry and medicine.  Interference from many sources,  stress of compliance, making the numbers work are so problematic that the doctor can lose focus on one of the things that brought him into private practice in the first place.  These are indeed difficult times.  The solo practitioner is almost extinct and the mega practices have their own set of problems from a morale standpoint.  

One of the areas that I found to be energizing and helpful was mentoring.  It started with teaching of residents in the early years of practice.  This was a great way to relate and to also keep current.  As all teachers know, you learn more from teaching than as a student.  Not only is it challenging, but it is a great reward to bring the missing link to the "new doc" - experience.  To be in a group and acknowledge an "ah ha" moment is so rewarding.  For those who are fortunate enough to be in a university city with medical and dental students, there is ample opportunity to give (and to relate).  You will find that the student is greatly appreciative that you took the time to help and point the way.  You will also find that you return to the office or to your home with an exhilarating feeling yourself - remember, "it is better to give that receive."  From another view, these contacts become friends, referral sources, and associates that may lead to other projects and outreach possibilities. This is just another example of a means to refresh and recharge.

Knowing how good the feeling is to give a gift to someone, I also had a grand time in mentoring patients of mine.  Actually, my staff also enjoyed it and related to the mission.  There were numerous opportunities where a young patient, entering college, had no idea of his major or area of interest.  This was an opportunity to chat and just become a friend and counselor. We would actually make an appointment in a off time (lunch etc.) to meet and advise.  Did it happen every day?  No, but often enough that we were invited to many graduations (and even some weddings).  I am convinced that we know more than just how to be a good doctor and this ability can be a wonderful way to have that "feel good" day or moment.  So you want to talk about marketing.  This, if done from the heart, is number one in my mind. 

So, it seems to me that you can make some fun out of you practice and have it actually become a source of an outreach program.

I would love to hear from you and share your ideas and experiences.  

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net 

Phone:  717-235-0764

Cell:      410-218-2228

Dentists - Charge the Batteries and Change the Scene

Here is another guest post from our client Dr. Lurie on his "Mistakes Made and Lessons Learned".

It seems to me that in the course of practice, there comes a time to charge the batteries and change the scene. This can be both physical as well as mental (emotional). Allow me to ramble on this one for a few minutes. You leave the house at the same hour every day for a routine drive to the office, usually over the same route, and arrive at a destination that you have seen every day, with the same people, decor, aroma, and basic schedule. This goes on for days, weeks, months and years. It is, of course, the office and we accept this as our workplace and how it fits into our daily routine of work. Now, think about the few days that were different. Perhaps there was a traffic jam, an early morning meeting, a half day of continuing education, a birthday celebration that the entire staff is helping to celebrate. Was not this a day that was different and "charged the batteries"?

This leads me to think about ways and efforts that can be incorporated into our work lives that can do this on an occasion and have long lasting effects and advantages.  I remember a time when I could not stand my private office.  It was the same four walls that I worked in for many years.  I wasn't even aware that it was dragging me down until my wife popped in one day and suggested that we must do something about this.  And then, we turned it into an office project with the staff and a decorator, with input from everyone.  Of course, this would come back to haunt me later on.  Anyway, it was fun and it really did give me a tremendous emotional lift and it became a place where I could recharge the batteries, work, and interact with the patients in a non-dental setting.  So this is an example of a physical change.  Gradually, these changes took place in the waiting room, the business office, and, most importantly, the staff lounge.  This was a tremendous boost for all of us and we had again, found a sanctuary that we all could share.  Incidentally, this became the room for the "dreaded staff meetings" that I discussed in a previous blog.  But you get my point - a fun way to change the monotony of the place where so many hours are spent.   The added benefit of "team" input was great and this, of course, adds the emotional benefit of the revision.  The energy in the office was off the wall and lasted for years as we all became closer, knowing that this was our project and our stamp.  Obviously, our staff turn-over was minimal and staff was on-board for many years.  So the uplift in decor helped in many directions. 

With this in mind, I tried to think of things that would keep us energized and focused.  These would fall into the mental (emotional) category.  An example would include all special occasions that the staff wanted to share----birthdays, anniversaries, and other celebrations were welcomed and planned.  The planning of the event was the key and time was set aside in the work day for this.  I think that this is part of the whole recharging of the battery that I mentioned earlier.  The routine was changed, the day was different, and the effect lasted for quite some time.  These are just examples but I think you get the picture.  One could add: trips, meetings (both professional and social - i.e.museum of art trip with spouses), or joining with another office for a continuing education evening, or a fashion show at a department store, etc...  The possibilities are endless but I urge you to consider them for your own peace of mind and to add the activity of "fun" into the practice. 

Another area that I found had a profound effect on managing stress was an activity that we called "Mentoring of the Patients" and I will tease you with this and discuss it in my next article.

More Mistakes Mad and Lessons Learned next time.  As always, I would love to hear from you and share your ideas and experiences.

Dr. Donald B. Lurie

donald.lurie@att.net

Phone:  717-235-0764

Cell:      410-218-2228

Dentist and Spouse Roles - Financially Speaking

Here is another guest blog from our client Dr. Lurie.

It seems to me... the role of the wife (spouse) in a dental practice has not been discussed enough.  We take it for granted that the husband and wife are on the same page, but this is not necessarily so and has cropped up in discussions at many study clubs. Since I have written several articles on retirement preparation, I would like to interject that retirement begins with the start-up of practice. The role (or roles) of the doctor and spouse will obviously play a big part in the success and continuation of the practice and for the eventual plan that the team for retirement carry out.

There are several different scenarios to look into.  The doctor (male) with a non-working wife seems to be a common model.  When a good marriage is present, stable and open, financial interests will be discussed and the future planned for, with budgets for essentials and "fun", including shopping, vacation, hobbies etc...  Even with the so-called good marriage, sometimes the mate does not think that the cash flow will ever change or diminish and that status quo just continues.  Unfortunately, this does not always happen.  One of the problems is the lack of communication between the two.  Or worse, in unstable marriages, the lack of caring about the communication.  This can be a prelude for disaster.  Credit card debt is the killer and many doctors and wives are falling into the credit card debt chaos that then makes the practice a place where there is pressure to pay the personal debt along with the overhead of the practice itself (which, in today's times is getting more and more burdensome even for the mega practices.). One can only hope that the two can sit down and get a handle on this. Then, if needed, meet with the financial adviser to face the crisis and the facts.  Sometimes, it is the doctor who is the one who abuses the credit cards, or it may be the wife - or worse, both of them.  This added strain then makes the practice a pressure cooker and the joy of dentistry begins to fade.  We find that the emphasis is on paying the debt (at the sacrifice of quality) rather than reinvesting into the practice and escalating its return.  If the parties are not able to resolve this, then the situation might be doomed (as many of you know.) 

I have been there and was able, early on, to get the adviser to help us (and to reign me in since I was the abuser.)  We actually went a step further.  My wife started working in the office one day per week.  This was a great benefit in several ways.  The most important one was that she saw how hard I worked and what the overhead margin was all about.  It also enabled her to meet with the staff and she was directly under the supervision of the office manager.  This was made quite clear in the beginning.  She then was better qualified to work our personal household budget and to maintain our entertainment budget on a level compatible with the office.  The second benefit that we obtained was social security benefits that now (in retirement) really come in handy.  I was lucky (in that this conference with my team ) was early in my years of practice and marriage. 

Obviously, every practice (and doctor) has differences.  Not all doctors can have their wife in the office with them.  It can cause problems with staff if not addressed properly.  Conversely, it may be a benefit with staff knowing that the spouse is there. The communication and the personalities of the entire staff and doctor are the key. My Dental CPA has told me countless number of cases where credit card spending has caused practices to fail.  I urge you to look at this carefully and adjust wisely.  Remember that the beginning of practice is the beginning of retirement. There are many facets to this discussion and this is but one of them.  I wanted to share with you my personal story.

It seems to me… that we may have many variations on this.  I would love to hear from you and share experiences.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net

Phone:  717-235-0764

Cell:      410-218-2228

Lessons Learned as a Dentist - The Team of Retirement and Its Members

Here is another guest post from our client Dr. Lurie.

The "Team of Retirement" includes:

            The Accountant.   He is the Chairman of the Board.  In my opinion, the doctor is on the board, but the team as a whole makes the key decisions that generate and govern the progress of the practice.  He is also the day-to-day advisor and confidant and his staff aids him in the doctor's role as the "face" of the practice.  This is a concept that is difficult for many practitioners.  He is instrumental in budget, goal setting and steering a path that is the "dream" of the doctor's  plan as to where he wants to go and how this becomes a reality for him and his family.

            The Attorney:  This speaks for itself.  Obviously, an attorney with corporate law experience and knowledge is important. If you needed a general surgeon, would you go to a mid-wife? A good corporate attorney is knowledgeable about the business community, has access to business deals and transcends the practice into other areas including investments.

            The Insurance Broker:  This also speaks for itself but the doctor must be aware of constant tinkering with the plan as age, circumstances, family, investments, health and the like change and evolve.

            The Investment Counselor:  He is key to long term goals and he may be part of the Accountants team (on site) or he may be brought to the table for a particular area of expertise or exploration.  Again, his expertise and evaluation and recommendations will vary with the age of the practitioner and with goal-setting as maturity occurs.  At some point, needs and wants will come into play. 

            The Doctor and Spouse:  Obviously, he drives the ship.  He is the face of the practice as I stated above, but is also the dreamer, goal-setter, the provider, writes the checks and carries the weight of the entire "Team" on his shoulders.  That is why the team is so vital and it is so important to be in the correct hands.  This family of people must coordinate, cajole and formulate a cohesive yet comfortable plan for the doctor to go forth every day into his environment.  He needs their support and they both (doctor and team) must be able to listen and care.  Most importantly, for me, there must be love.  There must be a feeling that this is truly a team, a family, and a togetherness that is based on mutual love and respect and just not the words of insincerity or the business to make money.  If the latter is so, then there is no fun, no joy in what we do and no self-respect for ourselves and for the profession.  As scripture says "GOD IS LOVE".           

I was fortunate to have such a team working with and for me for my fifty (50) years.  So this is a Lesson Learned without a mistake! Did we make mistakes - of course.  But you get my point, "it seems to me". 

More Mistakes Made and Lessons Learned soon. 

Dr. Donald B. Lurie

email:  donald.lurie@att.net

Phone:     717-235-0764

Cell:         410-218-2228

Mistakes Made, Lessons Learned about Dental Office Staff Meetings

This is another guest post from our client Dr. Donald Lurie.

It seems to me that staff meetings and office planning are difficult and at best, one of the areas that I disliked the most.  To carry it a step further, this same planning and meeting is necessary while contemplating retirement, finances, future activities and endeavors and the like.  Again, as I have said before in some of my earlier blogs, the Team of Retirement is an important part of the process. 

I found it difficult to enjoy staff meetings due to the varied personalities that were present on my staff.  It was difficult for them to talk openly in front of their peers and in front of "the boss."  My staff was not large, but extremely qualified and trained - 2 RNs, 1 CRNA, Office Manager, and a secretary.  They were all female and really good people. However, when it came time to verbalize, critique the practice, correct our errors or attitudes or seek ways to "make it better", the room would get quiet and everyone was looking at the floor.  It seems to me that this situation is also carried out many times when having these open and introspective gut-wrenching discussions with the accountants - especially when getting ready for major decisions such as projections, practice evaluation, insurance issues (to join or not),  and even retirement.

I noticed in our staff meetings that it was difficult to be constructive.  The folks felt that there was a criticism of their work or their personality or even their effort.  I sometimes felt, that I was walking on eggs.  Who was working for whom.  How many hours, days, weeks etc... was enough for sickness, vacation, retirement funding and all the mundane aspects of "running the business" of a practice that had nothing to do with that which I signed up for----treating patients. 

Introspective discussion must be had with our advisors.  It is necessary to be open and receptive to ideas and suggestions that might not be what we want to hear.  The timing of retirement may dictate other strategies that were not planned for in the earlier years of practice.  As noted, other priorities (health, money, wife etc.) may have changed.  It is difficult to be criticized in these meetings or to perceive that you are being looked down on.  However, the really good Team of Retirement will not make it a personal attack.  The point is that we must be ready and available to look at our total work and life situation -  tweak it, shape it, and finally own it.  As I have stated in other blogs, this sharing of attitudes, this true meaning of creation of the next profession (Retirement), will  then be filled with anticipation, will be fruitful, and there will be calm and peace. These are just some thoughts, it seems to me.

More Mistakes made and lessons learned next time.

Dr. Donald B. Lurie, DDS

donald.lurie@att.net 

Phone:       717-235-0764

Cell:           410-218-2228

For more information, please contact info@dentalcpas.com

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Mistakes Made --- Lessons Learned in Owning a Dental Practice - Dealing with Isolation

Here is a another guest blog from our client Dr. Lurie.

It seems to me that there is a danger to dentistry that usually is never addressed.  This pertains to isolation and lack of socialization.  Dentistry by its' very nature is singular in that the doctor practices within himself to the very best of his ability.  He reports to his office, usually alone and if he is in solo practice, his interactions are with his patients and staff.  However, his inner thought processes, decision making, and perhaps his business decisions are made in a very narrow environment.  Does this sound like isolation?  To some degree, I think it is.  If he is in a group practice, the isolation is less but still present as regards his talent, self criticism, how he melds with his colleagues and staff.  Is he holding up his end of the workload, does the staff warm to him as much as his associates and so forth? It is difficult to write about this because it requires the same type of introspection that I am trying to bring attention to and perhaps solve.

Other health care professionals are in a different environment with hospital colleagues, much larger staffing, a general air of activity and motion, fellow practitioners available to discuss a case or personal issues and all other social activities that a group situation encompasses. Just being a dentist requires isolation in the field (mouth) that we work in, and the narrowness of our area of expertise (in the good sense) and the necessity to bring a critical eye to our work.  As has been said many times, there is an art to dentistry as well as the science of dentistry.  This might be one of the areas that differentiates us from other areas of health care providers.    When we are in a non-dental atmosphere (party, dining, sports etc), many dentists find it difficult to talk about anything other than dentistry.  How many of us have said that I don't want to go out with a bunch of dentists and talk shop all night? How many wives have said the same thing or that in going out, feel that it is part of the job  and not a fun or relaxing evening?

Over my fifty years, I have had these thoughts and also the arguments with my wife about this type of evening or even the general atmosphere of  "dental isolation"  Fortunately, I confronted this problem early on and discussed it at length with my CPA at one of our many meetings.  By facing the issue I was able to broaden my connections with the "outside world".  Hobbies were a big part.  I am an amateur photographer, and now in my retirement, assist a professional photographer on his many shoots.  My church activities certainly increased my socialization and again, in retirement, I am active and engaged in many outreach programs which require socialization.  It is interesting to note that in these non-professional groups, I am looked to for guidance and expertise.  I think this comes from the education and stature that we all possess but don't realize that we have.  These examples, of which there are many, have helped immensely with the social interaction with my fellow dentists and something I started doing and living long before I retired.  We actually have other things to discuss, question, ponder, and deliberate besides the mouth. 

Dentistry is our center and our love, but it can narrow our scope if we let it.  It should be number one during our work day, during out continuing education time and certainly in our relationships with colleagues.  However, be aware of becoming too narrow and don't be afraid to get advice from those who know you and love you.  These are just some thoughts... it seems to me. 

More mistakes made and lessons learned next time.

Dr. Donald B. Lurie, DDS

donald.lurie@att.net

phone:  717-235-0764

cell:       410-218-2229

For more information, please contact info@dentalcpas.com

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