Drawing on over 40 years of clinical experience, Dr. Black focuses on speaking and coaching through in-office consultation. Dr. Black has Pankey-Dawson clinical training and has retained staff an average of 20 years each. He has distilled the wisdom of major national consulting firms into a successful restorative and cosmetic practice in a small suburban town. Dr. Black brings these qualities and more to help both new doctors and associateships needing to increase their productivity by attention to systems. He has proven leadership and administrative skill, and is a dental leader in the local society and MOM’s projects, community boards, and state dental board of directors, committees and task forces.

David Black

	I am a big proponent of the use of personality profiles as a tool in being a better leader and manager in your dental office.

. However, my clients have not had the opportunity to have the level of training I have received, and in most cases, do not seem to be nearly as excited as I am about its usefulness.

	I was explaining to a client about how great this added service was going to be and how it would help her be a 

. She made a pained face and said, “Why do we need to do that? I have taken this test and know what I am. How is that going to be helpful?” I guess I needed to work on my explanation a little more.

	For a minute, let’s forget about you, the leader. You need to understand that knowing how you act and how you react is one of the keys to being a more effective leader.

Related article: What is emotional intelligence and how does it affect a dental practice? 

	This tool does you no good if you don’t use this to 

. We each have a tendency to act and react in a certain way. Your team members have a tendency to act and react in a certain way, which probably is different than your tendency.

	Where you get into trouble is assuming that your team has the same way of hearing and reacting to what you say or do as you hear and react. You may have a need for your team member to do something immediately, without any question or debate. Or they may have dropped an instrument at a crucial point in a procedure, slowing down what you are doing. How do you react?

Use the DiSC with patients: 7 behavioral cues that lead to increased treatment acceptance

	If you know how your team member is predisposed to act, you may act in a more appropriate way. That is not to say that you have to coddle your team if they make a crucial mistake, but if you understand how to get the best response to correction, you are using a leadership skill that will lead to a better long-term outcome.

	My client had not been given an explanation about how best to use this valuable skill in previous trainings. An inspirational book that I enjoyed started with the quote, “It’s Not about YOU”! The first part of using DiSC personality profiling is to learn about yourself, so that you can use the more important skill of 

Articles

Using the DiSC personality profile to work better with your team and manage them more effectively.

Know yourself to know your team

	I was recently discussing with a young doctor the importance of knowing his practice numbers. I was amazed that the doctor had so little knowledge about the basic accounting in his practice. He even asked me why it was important to know these numbers, since his practice was going fine and he had no financial distress that he knew of.

	He just sends his check log to his accountant every month and is sent a report, with little or no concern about what was going on. I ask him some basic questions about his goals and his financial situation, and he knew little to nothing about what was happening. In my opinion this is a flaw in leadership that will eventually lead to a financial disaster.

Related article: The latest trends in dental practice accounts receivable

	The 10 things you need to ask yourself about your understanding of your practice finances are:

			What do you understand and what do you need to understand? There are key things you need to know, and things you can leave to your 

			What reports do you get from your accountant? You can get the basic information from a couple simple reports. More is not always necessary. At minimum you need an income and expense report each month and a balance sheet, and you need to learn to interpret the information on each of these reports.

			What is your break-even to make a profit? Production is great, but with the 

 write-off’s, collections is king. You cannot spend what you haven’t collected. Are you showing a profit?

			What are your monthly expenses in each category? Are they close to the industry norm? Is anything out of line?

? Are you withholding enough, or will you get a big tax surprise at the end of the year?

			How much am I able to put away for my retirement each month? Is it enough? Do I have liability for employee contributions?

What are my monthly/yearly production and collection goals

			How many new patients are you seeing each month? Is that enough? If not, then what?

			What is my debt service each month and am I covering it correctly? How many years until I pay off the debt? Are we able to make new capital expenditures considering the debt I now have?

	Here are two useful clichés I enjoy, the first is: if you are starting on a trip, you need to know where you are going, so you will know when you arrive, and the second: you improve what you measure.

Related article: Should your staff understand your dental practice's finances? 

	I hope this young doctor sees the value in this discussion. I firmly believe a knowledge of where you are and where you want to go financially will guide you to more success than being blissfully ignorant of your finances. If you don’t understand these principles and skills, find someone who will help you, and you will become more knowledgeable and more successful.

10 important points you need understand about your financial report and why they are important for you.

10 important points you need understand about your financial report

	I have been reading and studying the difference between leadership and management, and was starting to feel that management was a four letter word. Yes, leadership is king; we all have to lead if our team is going to be great, and our practice is going to be in the top five percent of the practices in the nation, but leadership isn't everything.

	As I studied this, I had to come down to earth for just a few minutes and realize that there has to be a lot of management, right alongside our 

. As practicing dentists, we don’t have the time to answer the phone and make sure that you have enough composite, all while doing that crown prep. The bad news is that does not release us from the need to manage all the things that are necessary to run a practice.

	When does this happen, all this managing?

	Before work, after work, during lunch, on days off, on dedicated training days, at dental meetings, at staff outing and lunches, when you mark off time for a consultant to train. To a lesser degree it is sort of like asking, “how do we parent our children?” We do some of it on the fly, when others are watching us give them an example. That is the scary part: employees will watch us, see if we are consistent in our values and actions, and base their conception of our leadership on some of these day-to-day interactions.

	Systems and processes we have to manage are:

 all team members to commit to the practice goals and vision

. This means you have to actually have some written goals before you can expect others to commit.

			You have to get buy-in of the team to the vision and goals. This involves sharing and discussion of the what and why and how.

			You have to manage all the systems and processes you go through to run an office. That is everything from answering the phone to billing to buying supplies. Since you don’t have time to do this personally, you have to train and trust someone else to do this.

			You have to manage the focus on customer service and customer experience, and ultimately their satisfaction and their willingness to refer to the office.

			You have to manage all the resources of the office: time, people, supplies, office space, funds and patient care.

			You have to manage the organizational behavior and the culture of the office. This often takes training of the team and clear instructions from you.

			You have to manage the continuous improvement of systems, 

			You have to manage the training and continuing education of yourself and your team.

It's time to ask: Are you a leader or a manager?

	Up next: What do choose, leadership or management? 

	Management is something we DO, usually while simultaneously leading

	I am more than a little bit disappointed. Here I was, ready to be a leader instead of a manager.

	I was feeling that a leader was somehow a more highly developed species, and I was getting set to be superior to some people.

	Maybe a Fortune 500 CEO can only lead, but in dentistry, with a few people helping us run our small business, you can’t just lead. Our reality is that we have to do both. We don’t have the choice of being one or the other.

Related: 3 things dentists can learn from big (non-dental) corporations

	We can’t choose not to lead, only to lead well or lead poorly. We don’t usually have the luxury of not managing, unless our staff is so large that we have a bunch of managers. Most of us do not live in that model yet. So we do both, juggling production at the chair with on the fly managing of the issues that come up daily.

The best that we can do is try to equip our team with enough training

 that they can do 50-75-90 percent of what comes at us daily. This teaching takes place after work, during meetings and training, plus all the on-the-fly teaching we can do as we do our daily work.

Related: 6 tips for increasing staff performance

	Did someone mislead to you when you went to dental school? Did they lead you to think this was an easy job, just doing patient care and writing up charts?  I had an uncle that did that to me. He made it seem so easy, and I think that 50 years ago when I was watching him, that may have been the truth. But it’s different now.

	Leader or manager. What are you? You have two hats you have to wear. The reality in a small business is that you have the duty and the pleasure of being both. Our job often gives us a lot of freedom, so we need to enjoy that freedom and understand that we will be the key to the success or failure of our business.

Being a leader and being a manager can feel like two separate things, but you need to wear both hats if you want to run a successful practice.

Some days you just have to be the manager

	Hiring a consultant in your practice is a big decision. You have to decide if you want someone you hardly know to have access to all of your practice, and often, your personal financial information. You have to feel a need for something to change in your practice, and that can be an emotional moment.

	Then there is that commitment to actually doing the hard work of preparing information for the consultant to examine. After that, there are meetings to discuss the findings.

Related reading: 5 things to do BEFORE you call a consultant

	Perhaps the hardest part is to hear the things you need to change to improve the practice. If that isn’t hard enough, then there is the execution of the changes suggested.

	Hiring a consultant is not cheap, so to get your money’s worth, I have a few suggestions about what pitfalls to avoid.

	Continue to the next page to see the top four ways to waste your money...

	You may feel that the consultant is asking questions that are too personal and have nothing to do with the goals at hand. Withholding key information is like your patients intentionally refusing to tell you that they are allergic to antibiotics.

Trending article: 6 consultants you need to engage to plan your retirement

	 An example of that is if you have been financing expenses of the practice on credit cards that have a balance, but haven’t been charged as an expense to the practice. This throws the income and expense sheet off because the true expense is not shown.

	Things may look lovely, and in balance, when in fact, you took your whole team to Bermuda for a reward for good performance, but haven’t shown it as a continuing education expense yet. Nothing illegal, but just off the books for now.

	Delaying getting your homework to your consultant

	Consultants usually have contracts with a term that has a beginning and an end. Visits and projects are usually spaced so that the team has time to learn and absorb and apply the new information. If you are to work on a project and get the feedback to the consultant, you should work with the agreed upon deadlines. If you don’t, it pushes back completion of the project. One of two things happens then: You either do not get to all the projects projected for the timeframe, or it extends the length of time it takes to have full success.

Trending article: Today's top consultants tell you the one piece of advice you need this year

	Consultants have reasons for assigning certain projects in the order and timeframe they suggest. The better you comply the better and quicker you are successful.

	Life often interferes with your practice. I agree that you need balance in life and work, but you hired a consultant for a reason. If you passively don’t do what required, or just don’t see it as important enough, you are wasting your money. You need to assess if you really are ready for a consultant at this time. If you aren’t ready, just pray that you do not have a long-term contract.

	Some consultants work by the job, with a contract for a certain length of time, regardless if you decide this was a bad idea.

Trending article: 8 dental practice strategies to keep more money in your pocket

	Other consultants do an initial assessment for one price, and have a monthly fee for as long as you feel they are adding value to your practice and life. If you are not totally committed to the process, you may want to find a consultant who is more flexible. That does not mean this is an excuse to opt out of having a consultant because quite often you will find that keeping a consultant long-term has a value higher than doing a project and quitting. Having someone you are accountable to often is a long-term strategy for success. Professional athletes, who arguably do not need coaching, retain coaches throughout their life.

	Sometimes you just don’t agree with someone you asked for help. Consultants work with industry norms and their experience interpreting how they see their expertise in light of your situation. That is a reason to terminate a consultant.

	Alternately, there is when you just don’t do what they suggest. You may know that they are right, but it doesn’t feel right for you, or you just don’t want to do what they say. At this point, having a consultant is a total waste of money for you.

	I think you should have a way to decide at some reasonable length of time, to get out of a long-term contract if this particular consultant is not for you or you do not feel you are getting your money’s worth.

Trending article: How seasonality affects revenue in the dental practice

	Sometimes you just don’t get along with the particular consultant, or they do something to anger you or your team. This is a sure way to waste time and money.

	The time to make sure there is an escape clause is before you sign on for 12-18 months, with a penalty clause for escape.

	Consulting helped me become much more successful in my practice. I had good experiences, so much so that I decided to become a consultant after I pulled away from the chair a year ago. The important thing to do is to be able to have time to evaluate if you like the consultant personally, make sure you can work with him or her and, if you feel you are no longer getting full value, have a way to terminate the relationship without it being like a divorce.

Hiring a consultant is not cheap, so to get your money’s worth, there are several pitfalls you should be sure to avoid.

4 ways you may be wasting your dental consulting dollars

	Is there reason some clinically skilled dentists just don’t quite make it financially? What is the difference between two doctors who sat beside each other for four years in dental school? Some are experts in their diagnosis and treatment, but seem to struggle with the ability to convince patients they need comprehensive work.

	The same holds true in all businesses. Executives can have excellent schooling and their IQ is out the roof, but something separates those who have stellar careers and those who end up working for the stars.

	In the early 1980s, there was a concept born that EQ was equally important as IQ. Daniel Goleman wrote a book, “ Emotional Intelligence,” that theorized that knowing one’s own emotions, emotional self-control, motivation and persistence, recognizing emotions of others and successfully handling relationship, were characteristics that affected a person’s success as much as IQ.

More from the author: 7 behavioral clues that lead to increased treatment acceptance

	In the 1970s, Dr. Bob Barkley, wrote about “co-diagnosis,” talking about forming a relationship with your patients, gaining their trust, and together, coming to a mutual decision about what was the best dental solution for their long-term dental health.

	As I attended seminars by Dr. Peter Dawson and then the continuum at LD Pankey Institute, there was the part of the balance called “Know Your Patient.”

	I have attended numerous practice management seminars and had leading consulting firms come to my office to teach me about treatment presentation, new patient experiences, and the business systems that will help me become more productive. I have also studied DiSC personality styles and generational differences and the way I need to approach patients so that I can gain their trust and they accept treatment.

More from the author: 5 things to do before you call a consultant

	I think there is a very strong correlation with a person’s EQ and their ability to successfully “co-diagnose.” If we look at some of those qualities in a person, I think we can see why some people thrive and some don’t.

	Can I detect when I am upset and what it is that upsets me? If I don’t recognize that I am upset, I can project that to my patient. If I have had a poor interaction with someone, do I carry that over to the next person I see? Do I get nervous presenting a big case? Does that show? Self-identifying what affects me is essential to maximum performance.

	How do I react? Do I get upset when someone rejects my treatment plan? What about that “favorite” patient who sets off the whole office? Can I control how I react to negative stimuli? You can instantly lose a patient with one slip of the tongue, a sideways glance, or with some physical signal that you do not approve.

	Do you have a drive to be excellent? Will you keep after a project until you achieve your goals? What is your motivation? What is the answer to “why” you are a dentist? Your “why” is more important that the “what.” High goals and ideals are a big driver to success.

	This is a complicated mix of skills and attitudes that will lead to success or failure, a high-level performance or mediocrity.

More from the author: A dentist reflects on the best piece of advice he ever received

	Over the years, research has developed insights into these and other qualities that can be measured by instruments to show your strengths and weaknesses. The good news is that, unlike IQ which you pretty much are stuck with what you are born with, you can improve your EQ with study and training. This process has been going on in industry for some time. In dentistry, there has been indirect reference to these skills without specifically discussing the individual skills and how to improve them.

	Other tools to use in your interactions have to do with personality styles. If you self-identify your own tendencies and preferences in interactions with others, you will first understand how you prefer to act. If you add to that some skills in identifying other’s tendencies and preferences, you will see how to approach them when discussing treatment or problems they face.

More from the author: 6 consultants you need to engage to plan your retirement

	It is important to know that people may not respond to how YOU would like to be approached in solving THEIR problem. Seventy-five percent of people are different from your style. They have a way that they like to be approached, and this may be in conflict with your usual way of doing things.

	Several times, I hired consultants to help me improve my practice and my ability to get treatment acceptance. They would introduce the concept, and track whether we improved, but never really show us how to improve, other than just encouraging us to “just do it.”

	We now have training and testing and coaching to actually facilitate dentists and team members to identify these traits and skill, and to learn new skills to improve all aspects of our interaction and relationships with our patients, our team members, and even our families.

	Find a coach or consultant that can facilitate DiSC and EQ, so that you can identify how you like to approach others and how to improve your emotional intelligence.

Executives can have excellent schooling and their IQ is out the roof, but something separates those who have stellar careers and those who end up working for the stars.

What is emotional intelligence and how it does it affect a dental practice?

Some of us plan better than others. Some of us save better than others. In my years in dental practice, I knew three types of dentists.

The first type had a cash cow in the basement. These were usually my specialist referral doctors: endodontists, orthodontists and oral surgeons. They had such good practices they had few financial woes unless they had multiple marriages. The second were those that were very frugal from birth. This, I think is a genetic thing, or something taught early in life by their families. I never totally understood these amazing people. The third is the category I fell into: spendthrifts or late-bloomers. I always had something that could require that next dollar I was producing until I had an epiphany at about age 50.

I finally realized that if I did not change something, I would have to work until I died. It was a scary awakening, but luckily I found some good help to plan for retirement. Once I realized my plight, I sought out good advisors to guide me along the way to the proper planning. This is a list of the types of advisors I sought out and used to help me achieve my goal of adequate funds and a plan for retirement.

The first step in a plan is to know where you want to go. My planner showed me how much I needed to save, using my lifestyle and my cash flow. He helped me understand I needed to be more productive, and save most of that new production. He also showed me how many years it would take, and the financial instrument I needed to use to achieve this.

Most planners also have a broker service, but these two are different in function. The broker is responsible for the return on your investment, which ultimately determines if any of this plan will work. I used a personal friend at a big firm to achieve my goal.

I had several practice management consultants help me over the years. When I hired my last one, I was on a plateau in production and knew I needed to increase substantially what I was doing in able to save any money. With their expert help, I increased my production by about 30 percent over three years, doing two important things. I was able to save money for retirement because I kept my spending the same with more income. And the second thing was that I increased the value of my practice leading up to the sale of the practice.

In my case, my practice was my biggest asset. I had spent 40 years developing a patient base, outfitting my office and putting money back into the development of a good, thriving practice. The price you receive for you practice is often a multiple of how much you produce, coupled with where your office is located and economic conditions in your area. You need an expert to determine the worth of this asset. I sold my practice for more than I realized it was worth because I hired this consultant.

Find a good, knowledgeable lawyer, who can guide you through the maze of contracts and agreements. Once again, I used someone I knew, who had helped me with my wills and other associate doctor agreements.

Trending article: 3 non-financial ways to prepare for retirement

Luckily I had found a great private banker to guide me through my office notes and lines of credit when I was building up my office and buying equipment. Banks are a funny bunch. When you don’t need to borrow money, they are all over you wanting to do stuff with your money. I was lucky enough to have a relationship with a banker who understood my needs and trusted me enough to loan me the money when I really needed it.

The last step in this story is to figure out how much is enough. When I thought I finally had enough to retire, I went back to my financial advisor/broker and sat with him to look at the numbers. Numbers don’t lie. We looked at how old I was, my life expectancy, my standard of living and spending habits and finally how much money I had saved. We decided if I only took out of the plan a set amount that we agreed was reasonable, coupled with my other sources of income, I could retire.

The only caveat was that I had to promise not to live past 93 years old. With my family history, that will probably not be a problem. In the spirit of being a full-service broker, he also mentioned that if that was a problem, he had some old high-school friends from Jersey City that could help me out.

None of us want to use old high-school friends as part of our retirement plan. Very few of us have the expertise to do all of these different jobs required to plan and implement our retirement plan. Find good people to help you. It is more of an investment than an expense. It will pay big 

Some of us plan better than others. Some of us save better than others. In my years in dental practice, I knew 3 types of dentists.

6 consultants you need to engage to plan your retirement

	Most big dental consulting groups will use some version of DISC personality types to introduce a dental team to the fact that both the team and the clients have different personalities and react to information in different ways.

	The problem I had was it was an introduction only; they gave us the words but not the ability to use the information in day-to-day application. I will give a brief explanation of DISC and some tips on how to actually use the information.

More from Black: 5 things to do BEFORE you call a consultant

. There are four groups, and each has specific reactions to information. We are really a mix of all these types with one or two being our most dominant way of processing and using information.

	This person is forceful and action-oriented. He or she has projects and goals. Dominants want to get things done, and you should approach them in a no-nonsense way with a plan in place.

	The influencer is a person interested in personal interaction. He or she is most often friendly, accepting and warm and likes to be the center of attention. You may want to let them tell their story and show them empathy.

	Steady people try to help people get along, do not like change and are dependable. You may not want to pressure them to make decisions quickly. They like a high level of certainty and explanation of options.

	Conscientious people are very analytical and quality-conscious. You will probably have to explain how things are done. They do not like pushy people. You will need to prove your expertise.

	You can quickly figure out which of these personality types are sitting in your chair. You only have about 30 seconds to make this first decision:

			First, look at whether your patient is fast-paced and outspoken or cautious and reflective. Is he or she an introvert or extrovert? D and I personalities are more extroverted, and S and C are more introverted.
			
			

More from Black: Top 10 tips from the old guy to recent dental school graduates

			Secondly, evaluate whether the patient is questioning and skeptical or accepting and warm. D and C personalities are more skeptical, and I and C are warmer. Looking at these two will give you a possible quadrant type.

			An example of a D is someone who is fast-paced, outspoken, questioning and skeptical. While these are clues to the patient's type, but you can also read other factors that may give you clues to who he or she is and how he or she will react to your diagnosis.

			Energy is closely related to No. 1, but is sometimes easier to read. Some people just seem to be more energized, and they will be more often in the D and I category.
			

Interesting read: Four simple systems to get your office in tip-top shape

			Often the D and C personalities are more dressy or formal in the way they present themselves. I and S personalities will be more casual.

			Speech is a more intuitive impression. How does the patient speak? What are the social cues he or she gives you? Often, he or she will tell you if they want to get on with the program, obtain facts or be friends. This is something you need to observe and analyze to pick up on the cues.
			
			                        

More from Black: A retired dentist tells you 4 reasons why you may not be able to retire

			Body language is also important. Is the patient open or closed? Does he or she make eye contact? Is he or she hostile or friendly? Nervous or relaxed? Are they arrogant or inquisitive? 

	No system will be able to get a 100 percent correct read on all people. The best we can hope for is to better understand how to talk to people in a way they can hear us. With a little training by a facilitator, your team can have the tools to better understand your clients. With these tools, you are more likely to approach your clients in the most effective way, resulting in a better relationship with the client and better acceptance of the treatment you recommend to them.

Hot read: Why the benefits of using digital imagery and conebeam CT scans outweigh the risks

Most big dental consulting groups will use some version of DISC personality types to introduce a dental team to the fact that both the team and the clients have different personalities and react to information in different ways.

7 behavioral cues that lead to increased treatment acceptance

	Don’t get me wrong, consultants are great. I hired several over my long career. I like them so much, I became one.

	Before you make the call and sign the contract, there a few things you can do to jumpstart the process, or even delay your need for help for a while.

	Look at your production and collections. How many new patients do you see each month? What are your fixed and variable expenses? How do these compare to the national norms? You need to know these things before you can work on any deficiencies.

	First, assess what is a reasonable goal not only in the short term but also in the next year or two. A wise man once wrote, “What you track, you will improve.” The opposite is often the truth also. If you don’t know where you want to go, you will never know if you have arrived. For many years, I have set daily, monthly and yearly goals and tracked my progress toward the goal. I can tell if I am on track, and try to remediate midstream if there is a trend down.

	The two most common techniques I have used and recommended are: Block scheduling and two-column scheduling. Block scheduling is reserving certain times in the day for certain types of procedures. Often with this system the terms “rocks, pebbles and sand” are used to designate the types of procedures or the productivity attached to the terms. A “rock” is any procedure that you deem a highly productive procedure. I normally try to schedule two or three productive procedures each day. This will typically insure that you will meet your daily production goal for the day. A “pebble” is a procedure that has a moderate level of production, and “sand” is everything else that is necessary to run a dental office. The word picture for this is a vase that has the rocks put in first, then the pebbles that fill in around the larger rocks, and then the sand that fills every nook and cranny around the rocks and pebbles. You need to reserve the time to make sure each day is productive.

	Two-column scheduling is the utilization of two rooms, each with an assigned dental assistant, so that seating, numbing, tray set-up, follow-up and clean-up of the room can take place while the doctor moves to the other room to do the next procedure with the second assistant. This requires the doctor learning a different pace, but can make a remarkable increase in production with very little increase in stress.

	Do thorough new patient exams, utilizing your assistants and hygienists to the fullest

	Recording clinical finding, taking necessary X-rays, charting all existing restorations and taking intraoral images can all be done at the same appointment that the hygienist does the initial prophylaxis. This will give you the information you will need to do you initial assessment in a very short period of time. You can then decide if the patient has minimal problems or if they need to return for a more thorough consultation appointment. 

	Treatment consultations with a written treatment plan

	Any time there is anything of any consequence, you should sit down, knee to knee, to discuss what the patient’s needs are. There are many ways that this can be done, and you will need to figure out what your style is and how you are comfortable in presenting treatment. A skilled team member, someone I call a treatment coordinator, should do things like financial arrangements and scheduling of work. This person should have been working in dentistry long enough to understand what the discussion is about, treatment options, the financial options you offer in the office, how insurance works in your office and have the confidence to present the needed work and navigate all the obstacles that can come up in closing the sale.

	You can wait, and have a consultant tell you to do all these things and hold your hand through the process. The first two of these things will be things you will need to do in preparation for a consultant to come in. Why not get a jumpstart in your practice on your own, and get improvement sooner rather than later.  Most of what a consultant does is to tell you things you have heard before, possibly in a different way, and hold you accountable for doing them on a deadline.  

	Try this do-it-yourself technique. The worst that can happen is that you will realize you need help to work through these systems.

Don’t get me wrong, consultants are great. I hired several over my long career. I like them so much, I became one. But, before you make the call and sign the contract, there a few things you can do to jumpstart the process, or even delay your need for help for a while.

Don’t get me wrong, consultants are great. I hired several over my long career. I like them so much, I became one.

5 things to do BEFORE you call a consultant

Don’t get me wrong, consultants are great. I hired several over my long career. I like them so much, I became one. But, before you make the call and sign the contract, there a few things you can do to jumpstart the process, or even delay your need for help for a while.

Five things to do BEFORE you call the consultant

	I know an associate won't stick around for very long. I know because it happened to me several times for various reasons. It is not unusual for associates to leave the first position they take.

	I had seven associates over 40 years and experienced most every circumstance I can think of, with associates coming, staying for a year or two, and then moving on. I lost some to better opportunities, and I 

 some for working against the culture of our office. I had some who just couldn’t make the jump to buying in, and I even had some with medical issues who could not perform the tasks needed to practice.

 and often don’t stop to realize the investment a senior doctor has to make and the financial risk the senior doctor takes to create a position. This can result in the new doctor only looking at the amount of money they can make, right now, in an associateship, and not looking at the chance to have an excellent long-term job.

	More than once, I was not to the point of breaking even on the new doctor before he jumped ship. I had enlarged our 

 to go from one to two doctors. I have remodeled the office to upgrade. I obviously have bought more equipment, outfitted new operatories, bought extra instruments and hand pieces the list goes on and on.

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	That does not take into consideration the additional staff, the 

 of the staff, the diverting of new patients to the new doctor and the learning curve of speed and skill. Usually I had to subsidize the doctor’s salary the first few months to give them a living wage. Luckily they usually stayed long enough to get above the subsidy.

	The strange thing is that I continued to repeat this behavior for most of my career. Isn’t that the definition of insanity, repeating the same behavior and thinking I would get a different result? Or maybe it is just optimism.

	In retrospect, I don’t really blame the associates, except for the ones I fired. Most of them come in with good intentions, but are so scared of the debt; they may see something in the match at first that really doesn’t work for them over time.

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	They bear down, try to learn, try to get faster, but they have their eye on another opportunity that is a better fit for them. Once their initial fear is overcome, they can focus on what their real priorities are, where they want to live, how their social life is to be lived and how their family feels about what they are doing. It takes a while for those priorities to become clear.

	I somehow survived all the associate wars, the training, the parade of new faces in and out of my office, the 

 and the disappointment of failed relationships.

	The irony of the story is, I never got an associate to stay more than three years, but two young entrepreneurs came along, bought my practice, and I became the ideal, compliant, productive associate I had been looking for all those years.  

	Then I, like all my associates, got my eye on a better deal. After four years as an associate, I moved on to the next opportunity: Retirement!

I know an associate won't stick around for very long. I know because it happened to me several times for various reasons. It is not unusual for associates to leave the first position they take.