I find it extremely amusing how every dentist knows what the politicians on Capitol Hill should do to balance the budget and improve things for the USA. You say they need to cut overhead, scale back entitlements, raise taxes and deregulate. But, here’s what you need to understand: our government is paralyzed. They’ve seen what happens to smart guys who made difficult and calculated decisions that focused more on our long-term sustainability – instead of shortterm, ill-thought-out band-aids – and then lost the next election because of them. The government is not going to do what you know it needs to do to right the ship; the funny thing about all this is while the government isn’t making the tough decisions you know it needs to make, you’re not making any yourself. You all know how difficult it is to do effective dentistry, run a practice, keep paying your mortgage and keep food on the table these days. Do you really even need a reminder about this crappy economy? Here are a few things I see going on in dental practices around the country that make me think some of you need a wake-up call.

Get Your Staff in Gear
When I attend an Arizona Cardinals or Phoenix Suns game with certain dental colleagues who rant and rave about how stupid the team is for keeping certain players on the roster and that they should trade this guy for that guy, I get angry. While they’re going on and on about pro sports, I’m sitting there thinking to myself, “Are you kidding me?! Your receptionist is quite possibly the most slothful human being on the planet and you are fully aware of this, but even after 10 years she still does the same awful job for you, and you let it continue. You really think you can run the Arizona Cardinals? You can’t even run your own practice!”

Why is it some of you have the laziest, most unmotivated, dysfunctional staff in the world, but you hang onto them because of some emotional connection or because they’ve been with you for five years? Guys, listen up, it’s time to make some tough decisions! You need to evaluate your teams. What have they done for you lately?!

It’s tough out there, so it’s time to get tough! Some of you give your staff a dollar raise every time the earth travels around the sun. Your entire pay structure is based on the zodiac. Doctor, if you work hard, you see more money because you’re the dentist and you own the joint. Your bottom line directly correlates with your performance. Your staff doesn’t care if it works hard or not because it keeps getting paid no matter what. They are trading time for cash! It’s time to knock that off. Staff incentives need to be based on production. You need to make the decision and say, “I used to provide a 401(k). I used to provide health insurance. I used to give you a dollar raise every year but I am not doing any of that anymore until our collections reach this dollar amount.” Get your team focused. Give them the same incentives you chase. If the practice does well, then everybody does well. Let your staff know you are only collecting $50,000 a month and until it gets up to $60,000 not a single raise or bonus will be given. That’ll separate the wheat from the chaff pretty damn quick.

Get Personal
I tire of the complaints from doctors who say their practices are failing, but they drive a wicked sports car and live in a high-falootin’ mansion in the ritzy part of town. If this is you, take a good look at yourself in the mirror, doc. Think you made some good decisions? Are you not making tough decisions because you’re afraid how your wife is going to take it when you tell her it’s time to rein in your household spending? Are you afraid of disappointing your oversized ego by downsizing your house and trading in your BMW for a practical car? We hear over and over how important it is to market our practices to get more new patients, and I know a handful of dentists who say they can’t afford to undertake a marketing campaign, yet they lease a Mercedes Benz at $1,000 a month! Are you kidding me?!

Maybe putting your Rolex up for auction on eBay is a good idea. Not just because you’ll pick up a couple thousand dollars but because maybe you’ll start to understand you’re personally spending way too much. I’ll borrow a line from the movie Fight Club: “the things you own end up owning you.” You don’t need the boat. You don’t need the vacation condo. You don’t need the fancy cars. You don’t need a membership to the country club. You can’t afford a stay-athome spouse. You can’t afford to go out to eat four nights a week. You need to sit down and figure out how to cut your personal expenses because they’re also eating into your practice’s bottom line. Seriously, how good does it feel that you bought your wife that Gucci purse? That’s $5,000 that you could have reinvested in your dental practice. You could have bought two or three AMD Lasers for what you dropped on a handbag.

You need to deploy some capital and do some serious investing in your office. I have written about investing in CAD/CAM until my fingers bled. We’ve got continuing education courses about cone beam computed tomography (CBCT) and how nobody wants to go back to using 2D X-rays like a pano or a PA after using 3D CBCT. Why can’t you pull the trigger on these new technologies? Because you – just like your neutered congressmen – feel more comfortable kicking the can down the road another mile hoping things will change. Nothing is going to change until you start making some tough decisions.

Get Marketing
Every time you eat out for $100 that could have been $100 worth of Internet ads on Google or Facebook. My dental practice runs advertising on Google and Facebook and they cost us about a dollar a click. I would rather have 100 clicks to my dental office’s Web site than a fancy dinner. You need higher patient flow, which equals more cash. Every time you are supposed to go out to dinner, go to the grocery store and buy a box of Kraft Mac & Cheese for a dollar instead. Then go home and buy $100 worth of advertising on Facebook. The smaller your market the more effective your ads will be. I live in an area of Phoenix, Arizona, called “Ahwatukee,” and there are 3,600 people on Facebook that have Ahwatukee in their profile. Every time those 3,600 people log onto Facebook they see my ad. Most of the activity on Facebook is from women, and women make about 89 percent of all dental appointments. You can put two and two together…

Get Learning
We have 4,000 periodontists in the United States and every single one of them does a crown lengthening procedure every single day and you don’t even know how to do it? Why don’t you sell your Rolex watch, get on an airplane and fly to some pig jaw course that teaches you how to do crown lengthening especially because insurance pays 80 percent of it. Spend a little of your money wisely on new technologies or CE courses that make you better at dentistry in order to make more profit for yourself and your practice!

Get a Move On
I recently had some long, over-the-phone conversations with two despondent dentists. They are both from a town of 5,000, and the only factory in town – which employed all of the townsfolk – closed down a year ago. The town is drying up and 80 percent of their insured patients were people who worked at that factory. Now those people are not only unemployed but they are leaving the city because there are no job opportunities in town, they have no money and they need to downsize. I listened to these two doctors tell me they were born in that town, married in that town and their kids were born in that town. I told them it was time to make a tough decision. I told them they needed to move, plain and simple. I said, “Look at your ancestors. Damn near every American immigrant made a tough decision 50, 100, 200 years ago when they were sick of living in the country they were in. Maybe they hated the king or the noble landlords. Maybe they were squatter peasants and despised their lives. They knew about the opportunity in America and left everything they had behind. With just the shirts on their backs they took a boat ride for six weeks and landed on the shores of America with nothing (if they survived the journey) just for the mere opportunity for a better life. And you are afraid to leave a ghost town that used to have 5,000 people and move an hour away or to a different state for better economic stability?”

Get ’em Out of Your Pocketbook
Another thing I hear all the time that continues to bother me is dentists telling me they are about to literally go broke by putting their kids through college. Here’s what I say, “Doctor, did your dad pay for college? He didn’t? OK, does your son in college even have a job? No? Does he have an iPad and an iPhone? Does he have a credit card? Are you paying his car insurance? Why don’t you do your son a favor and tell him after this semester he is on his own. I was on my own, I made it, and I was a better person for it!” I would put all of my eggs in the basket of a self-made man any day over some daddy-did-it who was born with a silver spoon in his mouth.

Some of you have heard of the Five Ds. Design your plan. What do you have to do? What is your tough decision? Number two, drop everything that doesn’t matter. This isn’t the time to be in the Kiwanis Club, guys. This isn’t the time to be coaching your kids’ little league team. Get focused back on your business! Let’s delay everything we can’t drop. Let’s delegate everything that can be delegated so you can do your plan. Guys, the feather in your cap is this – unlike your government, you don’t have an election to worry about every four years. You can make the tough decisions to ensure your personal and professional success. Stop trying to make nice with everyone and start acting like a boss. If you and your practice fail because you didn’t make the tough decisions, do you think they’re going to help you out? No, because your staff is now out of a job and hates you for letting the practice tank; you were your family’s bringer of bacon, and they know nothing but “spend.” It’s time to end this craziness. The buck starts and stops with you.

I’d love to hear from those of you who were recently faced with making a tough decision – whether in your practice or on the home front – and I want to know what the outcome was. Send me an e-mail at howard@dentaltown.com, or post your tough decision on the message boards of Dentaltown.com or in the comments section under this article on Dentaltown.com.