Berning & Affiliates

Long Relationships Are The Best

I’ve had the privilege of being a consultant to the Council on Dental Practice for the ADA for many years. So many years I’m losing track! My re-appointment letter was received recently for the 2007 year. Receiving the letter caused me to reflect on the relationship I’ve had with the ADA. It started early on with the opportunity to submit a proposal with Dr. Larry Domer to present two new ADA courses, "Do’s and Don’ts of Associateship" in 1987 which was offered for 5 years and a later course, "Dental Practice Financing & Debt Management" had a similar run. Larry and I also have coauthored for the ADA the Valuing a Practice, A Guide for Dentists, and a second publication, Associateships, A Guide for Owners and Prospective Associates, both now in their 5th revisions. Along the way for many years I’ve been a volunteer non-compensated ADA lecturer for the Success program offered at dental schools. The rewards of the relationship have been many. I have enjoyed meeting many practitioners and the volunteer dentists that serve the ADA. It is a wonderful community made even better by the long association I’ve had with the ADA. You too may find that staying associated with community groups, professional associations and, of course, keeping up colleague relationships can be very rewarding, especially over many years. In my view, for any CEO, the long relationships are the best!

CEO Dreams Do Come True!

It is always wonderful to hear of doctors really getting all they want from practice and from their life. Here is an excerpt from a recent email I received.

Hello Randy,

Nice to hear from you!! All is well. I bought a large practice in June of 2006. 100% boutique
financing, and I'm making significantly more money in dentistry than I had at any time previously in 10
years!! I do owe a good deal of thanks to you and your lecture at Wired For Success... when you spoke of "The instant doctor". You're lecture inspired me to make a wonderful choice for me and my family. So, I've only been at the practice for 7 months but still managed to increase production over the year by an additional 500,000 dollars, than was projected previously by the old doc and his team. My monthly production averaged 110,000-120,000 before I came and now it is about 180,000 (per month)! I can't tell you how exciting this is! Imagine... I came from nowhere... 1000 miles away - doing medicaid dentistry in Pittsburgh ... I have no special abilities or techniques... I do just plain general preventative
dentistry. This is a dream for me! And every staff member stayed! -And I love em all! The funny thing
is.... there was nobody in line for the practice. (Except for the usual management companies) I did
however locate it, pretty close to the instant that it went on the market... I do confess that I had started
my search as you suggested 1 1/2 years before the practice actually closed. Since June of 2006...
dentistry has realized for me every promise I could have ever imagined. Man I'm lovin' life... and
FLORIDA! Thank you for your help. Now my wife is just beginning her search... but she is ortho and we are tied now to a specific area... but I'm sure something will surface!

Randy, Have a wonderful new year. And thanks again for being a friend and pointing me in the right
direction!

Sincerely,
Joe Shrager

How Can I Volunteer as a Health Care Practitioner?

Dr. Bob Rosenberg, former Dept. Chair of Endodontics, UCSF has provided the following insightful comments on being a health care volunteer.

"Volunteering to provide your services as a dental professional is one of the most rewarding aspects of your career in health care delivery. It is easy to get connected with a dental volunteer opportunity, whether the care is rendered in your own office or in a makeshift clinic half-way around the world.

Mike Anker, a retired endodontist from Schenectady, New York has volunteered on over a dozen trips in a variety of countries. His experiences have resulted in bonds of friendship that otherwise would never have happened. When recounting these experiences he is eager to motivate his peers: "You’ve been given a gift of intelligence and education, and it would be a shame if some of it wasn’t given back to people of lesser means."

If you are interested in a domestic volunteer opportunity a great place to start is the ADA Give Kids A Smile program that takes place on the first Friday in February. Volunteer dentists provide dental care for low income children who have no other access to dental care. Other opportunities abound from the Montgomery Volunteer Dental Clinic in Silver Spring, Maryland to the Inner City Project Dental Storehouse in Salt Lake City, Utah where volunteers provide pro bono treatment in their dental offices. Contact your local or state dental societies for local volunteer programs.

International dental volunteer programs provide opportunities in countries around the world, many in places that you would otherwise never get to see. Health Volunteer Overseas (www.hvousa.org) provides a variety of programs under their Dentistry Overseas component. A copy of their programs may be obtained by emailing international@ada.org and asking for their listing.

Another web site to explore is www.healthcarevolunteer.com. They list many opportunities around the corner and around the world.

Whatever your time availability, your area of expertise, your willingness to make new friends and experience different cultures, a dental volunteer opportunity has an open chair and grateful patient waiting for you."

Read Bob’s first and second "Dear Fellow Docs" letter under the title "Volunteer For Good Letter #2" at our free Berning Affiliates free Downloads section. http://berningaffiliates.com/downloads.htm

Doctor CEO’s Look Hard At Preparing For Retirement

We are so lucky to have another installment from Dr. Bob Rosenberg providing his perspective on preparing for retirement from an active career and practice. See my notes in this blog under the Category Personal Matters relating to Bob’s first letter, November 2006, with a link at Doctor CEO’s Should Think Past Any Transition or Succession. Bob notes on his second letter start as follows:

"In my November 2006 letter, I discussed some of the universal considerations that one examines when considering retirement. In my case, retirement was the only option , however I was able to phase out of practice over an eighteen month period. This provided some time to view the looming landscape of retirement.

As mentioned previously, one of the biggest obstacles that we face as health-care providers is the loss of patient contact and the feeling of contributing to the overall public health. If we stop to think about it, this notion of providing highly technical and, at the same time, compassionate health care is central to our well-being. It renders a reason to get up in the morning and feel good about ourselves at the end of the workday. As I began to see fewer and fewer patients, there were more and more mornings with less of a reason to get up and get out of the house. With the loss of patient contact came a loss of purpose that, for me, presented a significant challenge.

In previous generations, life may have ended at or around the age of fifty-six, but no longer. We are living much more active and purposeful lives after retiring and for many more years. I want those years to be fulfilling, not in the way that practice was fulfilling but in the knowledge that there is still plenty of time to make a societal contribution. The big question is "How can I bring meaning to my life now that the opportunities inherent in patient care no longer exist?"

Read Bob’s second "Dear Fellow Docs" letter under the title "Volunteer For Good Letter #2" at our free Berning Affiliates free Downloads section. http://berningaffiliates.com/downloads.htm

Life Stages Demand More

It used to be a constant that several defined steps were standard for the doctor just starting in practice. These steps included, planning with a budget, setting up an emergency fund, buying life insurance to cover a young family, getting a simple will and developing the practice administration and marketing plans. Mid-term doctors had some of the foregoing, but usually cast as a review process. We would add also for the mid-term doctors early estate planning, financing and refinancing of home mortgage with education funds and more sophisticated practice planning, early practice transition and execution. Today, whether a starting, midterm or senior doctor at the point of looking at a retirement time frame, we are rolling through a wider range of planning items. These include timing considerations for long term care insurance, estate and gifting consideration and appropriate asset allocation strategy with financial planning advice from trained advisors. Retirement planning starts very early with constant monitoring including looking at retirement income projections and asset goals. Today, whether you are an early, mid-term or senior doctor, being prepared both personally and for your practice demands earlier and consistent planning and review to make sure you secure the performance desired.

The Time Dimension

In the process of going through year end practice reviews and planning for the 2007 new business year with doctors there has been a lot of celebrating. Numerous practices have performed well this year and the CEO doctors are pleased. Aside from practice performance, whether it be reaching record revenue or implementing key changes, there is often discussed another important area. The area is time, not time as in patient scheduling or time in the practice, but personal and family time. My experience is that the importance of feeling right, of feeling you have the time you want to do justice to your personal interests and your family is critical for overall performance. Can you compress your personal time? Yes, for a while, but in the end the need for allocating personal time will eat away and demand attention. A big part of the planning exercises we undertake with higher performing doctors are aggressively targeted toward building in objectives that meet their need for personal interests and family.

Know What You Don’t Know

Recently an interview with Robert Toll, CEO of Toll Brothers, Inc. contained several of his tips on running a business. Although a number of them could be applicable to various kinds of CEO’s and their business, one struck me as universally applicable. "A wise man knows what he doesn’t know. (Never assume knowledge)." This phrasing was the way the tip was expressed in a sidebar by the interviewer. My observation of doctor CEO’s over the years finds that far too often doctors assume key information in the process of making important decisions. Many times what is assumed has to do with business, marketing, finance or personnel related areas. Seldom is an assumption of any kind made without a real understanding when it is related to clinical care. Take a tip from this very successful CEO, know what you know and if you say to yourself, ‘I don’t really know this aspect of what I am trying to decide’, seek out those knowledgeable to assist and guide you. Its cheaper in the long run!

Coaching CEO Doctors

There is no question that practices have developed and grown in sophistication over the past 26 years. In that time, my own capability to guide growth, development and succession planning has increased. Today, what it takes to guide growth (growth that is many times greater than what was realized with practices I worked with at the end of the 70’s and early 80’s) and plan for less stressful practice days is dramatic. But one aspect seems constant. Established, confident and intelligent doctors often fail to realize that the success that is behind them is no predictor of future success. As the practice entity changes to a larger and more sophisticated environment, the old systems, the old decision making process and the old planning by the seat of the pants becomes ever less effective. Here is what is important for doctor CEO’s and their practices on a going forward basis: interject a repeating process to critique CEO leadership, plan for the evolution of practice administration and nail succession planning, all a part of annual practice performance reviews. Check this service out http://BerningAffiliates.com/doctorceo.htm

Dead Fish and Great Conversation

Most of my professional life has involved a meeting, in one way or another, in a conference room, in my office, on the telephone or over a meal. When I have a choice, and the topic is not agenda or paper intensive but more reflective and coaching oriented, a meeting combined with a meal is a great combination. Even better is when a meeting is with long time friends. Last weekend Dr. Roddy Feldman and his wife Linda joined me at a most unusual restaurant they had suggested. Unusual can sometimes equal wonderful. In this case it did! The Dead Fish Restaurant promoted our good conversation over a dinner that involved picking through a monster Dungeness crab with a special cooking sauce in low key fun environment. Rod is the just past ADA Trustee for the 13th District and his wife is a past legal counsel for CDA. I’ve known Rod for 18 years at least, initially helped him in his practice, going on to enjoy mediation training with him at Harvard and just plain appreciating him and his perspective on dentistry. I suspect you’ll be hearing more from him soon! If you are in the Bay Area and looking for a fun place try The Dead Fish Restaurant at 200050 San Pablo Av Crockett CA 510-787-3323.  http://www.thedeadfish.com

Doctor CEO’s Should Think Past Any Transition or Succession

On Saturday, November 4th I visited with Dr. Bob Rosenberg, former Dept. Chair of Endodontics, UCSF at his home in Mill Valley, California. We had a wide ranging discussion about his own transition from practice and his years teaching. He has many heart felt points that can help any doctor that is facing a physical disability that forces retirement from practice, as Bob had, or is just at the age of thinking about succession planning. He took the time to commit his thoughts to writing and you can read his "Dear Fellow Docs" letter under the title "Volunteer For Good Letter" at our free Berning Affiliates free Downloads section. http://berningaffiliates.com/downloads.htm