TAKE CHARGE OF YOUR MONEY TAKE CHARGE OF YOUR LIFE
Ten Surefooted Steps for Achieving Financial Independence

By Steve Tiret, C.P.A.
Director of Financial Planning
Tiret & Company, CPAs

Dental professionals invest all their time, energy and brainpower in their practice. But they shortchange themselves, their families and their future comfort by ignoring this tough question: how are you going to replace the current income from your practice on the day you hang up your dental drill?

Or….and this is the tougher question….will you ever be able to afford to hang them up without worrying about how you are going to sustain your lifestyle?

Yet here’s the rub. Fewer than 2 percent of the dentists we meet with have spelled out a strategy that would liberate them financially. The other 98 percent simple figure if they work hard enough for long enough and make some investments along the way, they can pull the plug and coast comfortably for the rest of their life. As their accountants we can tell them and you that’s a pipedream.

But what is reality? Twenty years ago, our firm embarked on a 12 month study designed to give our dentist clients a roadmap to their destination….worry free retirement. What emerged isn’t an investment cure-all or an elixir that worked overnight. It is a disciplined…but comfortable….regimen for professionals who don’t have the time to manage their own money but who do want to turn it over to outsiders either.

It is based on research into three generations of wealth…from Henry Ford and Andrew Carnegie to Sam Walton of Wal-Mart. People who have two traits in common: a burning desire to be successful and a written plan they were absolutely committed to. They knew that an unwritten goal is a wish. From this research we identified ten specific actions or steps that, together, form the foundation for a solid financial plan. We call it The Tiret Ten. Couple them with a serious commitment to personal success and you have the vehicle for achieving financial independence…on your own terms and your own timetable. Here, briefly, is an overview of how they work:

Step One is to Create Yourself Financially Independent. This is a psychological commitment and not a financial tactic. We advise our clients to act like they are already financially independent. That doesn’t mean they are reckless spenders on an endless vacation. Just the opposite. Financially independent people have the time to plan their purchases more carefully and their spending reflects that disciplined thinking.

Step Two is Get Started Now. Procrastination is the age old sin everyone is guilty of, especially busy professionals with ferocious demands on their time. If there is a shorthand formula for financial independence it is “desire plus time plus money”. It takes all three and time….time to let money multiply….is just as crucial as your original seed capital. Nothing drives this home more dramatically than principal….and the power….of compound interest.

Step Three is Don’t lose Money. Sure this sounds simplistic but it is the one step that helps clients combat that destructive human urge we all have….greed. You will never navigate your roadmap if you do not understand your risk tolerance. Fundamentally put, do you feel comfortable taking risks with your money or do you need the security of the go..slow..but..steady approach? The younger you are when you start saving for retirement…the more risk you can take.

Step Four is Minimize Taxes. The best way to save for retirement is in a tax free or deferred account. With the power of compound interest your money will grow faster if you delay the tax bite. There are many creative tax deferred and tax free savings plans today….consult your CPA to explore them and get started now.

Step Five is to Insure Your Risks. Your health and your ability to practice is your biggest exposure. The odds are higher that you will become disabled prematurely…by accident or disease….than die early. This is why adequate amounts of disability insurance should be your top priority. Life insurance becomes important when you are married and begin your family and remember life insurance is not an investment it is protecting your family from the risk of you not being able to provide for them.

Step Six is to Create Your Plan to accomplish your goals. How much do you need for retirement and how do you amass it? What price are you willing to pay to reach your goals? In other words, prioritize. Remember, successful people are results oriented. They will do whatever it takes to win.

Step Seven is to build a Balance Investment Plan or portfolio. Your investment plan is the backbone of your financial plan. But first you and your advisor must jointly decide what kind of investor you are. There are four categories: growth investors; growth and income investors; income and growth investors and income only. A growth investor is one that needs growth from their investments and an income investor is one that needs income from their investments. Growth investments are stocks and real estate and income investments are CD’s and bonds.

Frankly, I don’t recommend that dentists become growth investors unless they have a cast iron stomach and the emotions of Clint Eastwood. Instead, consider a growth and income mix….65 percent stocks, 35 percent fixed income. It will deliver the highest return possible while taking the least amount of risk.

Step Eight is something you do daily…Manage Your Business. If you’re in private practice, it is absolutely essential that your practice goals are consistent with your financial goals. After all, your practice generates the income you need to fulfill your financial independence goals. If you have a written plan you should be able to calculate the daily production necessary to create adequate cash flow for attaining financial independence.

Step Nine is to make your pursuit of financial independence a Family Affair. Your spouse must be involved….and kept informed….for your plan to succeed. It has to be a joint effort and you must have that absolutely burning desire to manage your practice properly so you can put away that money for retirement. The entire family has to buy into the plan.

Step Ten and the final step is no surprise: Monitor Results. You need to review your financial plan once a year to update the plan and objectives. You want to make sure your original assumptions are valid in light of various economic and market fluctuations. Monitoring your results means that you always have a current action plan and one that can be adjusted as your needs, cash requirement or long term goals change.

That’s it. The Tiret Ten steps that, if taken in an orderly manner over a pre-set period of time, will set you free….financial and forever. The next step is yours.

HOT TIPS…FOR HOT WEATHER

Failed and short-notice changed appointments are serious problems at any time during the year, but can really play havoc on the summer months production, typically vacation months for doctors, and team members.

First let’s look at the major causes of broken appointments:

1) A lack of communication from the doctor and entire dental team to the patient regarding the importance of their next visit while they are sitting in the dental chair on their current appointment. If you have ever wondered why some practices have 3-4 times as many broken appointments as another practice, listen to the amount (or lack of) patient education regarding the next appointment in your own practice starting immediately.

If the office communication in your practice is 75% social and only 25% dental education, no wonder you have more than your share of open time which is totally non- productive. Reversing the conversations to 75% dental education and 25% social chitchat is key. All it takes is a 30 second eye to eye, heart to heart talk about the importance of keeping the next appointment, and VIOLA….a reduction in over HALF the amount of wasted time. While socializing with patients may be fun…it should never be more than 25% of the conversation and at that, focused on the patient, not the dental team member.

Parents and patients don’t intend to be less committed to their appointments but during the “lazy days of summer” let’s face it…if anyone makes them a better offer than going to the dentist, off they go, which means your scheduling coordinator works at top speed keeping the changes in the schedule filled. Not to mention the stress involved with the confirmed patient “no-shows”.

2) Non-motivated team member is another serious reason for open chair time. Their attitude is: I’m going to make the same amount of money today no matter how many people show up, so why work so hard? If you don’t already have an incentive bonus plan in place, I highly recommend one. Or the doctor could have a daily “bonus kitty” and drop a $10, $20 or $50 bill into the locked box or office safe for each day with zero to X number of open slots on the schedule. Each open slot costs the team their “fun-money” which is divided at the end of the month and pro-rated to part time team members. With an average of $30 per day times 16 days, this could be close to $500 per month!

3) Weak verbal skills and untrained scheduling coordinators determine why a large percentage of changed or failed appointments take place in a practice. There are three tones of voice that might be used when a patient calls to try and change or cancel their appointment: 1) happy, 2) neutral, 3) friendly disappointment. If employees like downtime, they will sound happy when an opening occurs. Because patients like to make the person taking the call happy, they will continue being a source of failed appointments because they know the team member actually seemed elated with the call.

If the patients receive a neutral or “vanilla” response such as “Oh, no problem at all Mrs. Webster, let’s see when I get little Samantha back in, How about this coming Thursday at the same time?” Again, if it is easy to change or cancel appointments because the caller feels it’s OK and no problem at all, look out…your practice will again have more than your share of broken and failed appointments. I have heard from some scheduling coordinators in my audiences that they spend a third of each day restructuring each day that falls apart!!

The only way to control wasted chair time especially in the summer months is always sound friendly yet firm when someone calls to ruin your schedule. “Oh Mrs. Webster, I’m sure that the trip to the lake that Samantha has been invited to participate in is very important, but so is her appointment with us. I have reserved the doctor’s entire late morning just for her bandings. As you know, it would be impossible for me to fill this amount of the doctor’s time on short notice. Is there any way we can work around Samantha’s invitation so that they may leave around noon instead of 10 AM?

If and when your scheduling coordinator develops the skill of being very friendly yet disappointed when patients try to fail or postpone their appointments, patients and parents begin to realize the inconvenience of this, especially the last minute changes. REMEMBER: An appointment will NEVER become more important to the patient than it appears to be to you”.

A good “test” is to have the doctor go across the parking lot with a cell phone while covering the mouthpiece with a handkerchief to disguise their voice. Call the office and pretend to cancel the most productive appointment for today or tomorrow and see just how it is handled in your office!

You may also list on the back of your appointment cards: A broken appointment is a loss to three people: 1) The patient who missed the valuable time. 2) The patient who could have used the valuable time. 3) The dentist who was fully staffed and prepared for the appointment time.

Summer “play time” does not have to ruin your production. Be pro-active…play it cool by having each member of the team improve his or her verbal communication skills. And remember it has to be congruent and everyone has to be committed to that goal. With verbal skills communication, “you are only as strong as your weakest link”.

Linda L. Miles, CSP, CMC, CEO
Certified Speaking Professional
Certified Management Consultant
CEO, Linda Miles and Associates
Virginia Beach, VA 1-800-922-0866

www.DentalManagementU.com
lindamiles@cox.net

Quality of Life Dentistry:
The Team Approach

"Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity"

— World Health Organization, 1948

In the dental industry, a new age is on the horizon! As the baby boomers of the United States (those born between the years 1946 and 1964) graduate to senior status, the dynamics of dentistry will greatly change. As this population continues to age, more and more specialized care will be required to treat chronic health conditions at an unparalleled rate. In 2003, the United States spent fifteen percent of the Gross Domestic Product, $1.7 trillion, on healthcare. Yet, this group has only yet begun to show its potential, as that by 2029, all of the baby boomers will be over age 65 and will account for over twice as many senior citizens as in today’s society. Dental health care professionals accustomed to providing highly technical and cosmetic procedures on the “healthiest” patients will be introduced to the new consumer: the senior boomer.

Unlike their parents (those born in the depression era), baby boomers have the benefit of extended life expectancy due to advances in the prevention and control in infectious diseases, improved access to medical care, earlier detection of disease, better treatment, high-level knowledge of disease risk factors, new medications, and expanded uses for existing medications. They are the first elderly population to have benefited from fluoridated water during their youth. Furthermore, they are also the first population to grow up in the age of television and have embraced the internet as well. Baby boomers, who watched television shows such as Star Trek growing up, believe medicine has no boundaries and these perceptions are validated when they are able to access pertinent medical and dental information on multiple internet search engines in seconds. The senior boomer will not be satisfied with a dental treatment plan that includes tooth extraction, they believe we can repair anything and if all else fails they’ve read on the internet that we can now engineer tooth buds in a laboratory!

Unfortunately, acute and chronic illnesses are unavoidable occurrences of aging and by 2029 there will be an estimated 69 million senior boomers (20 percent of the population). Certainly, an older population with fewer edentulous people will pose new challenges to dental health care providers - most importantly the task of managing a high number of patients with complex medical histories.

Although our patient pools are evolving dramatically, dentistry will have to reacquaint itself with some of the practices of the past and “slow its pace”, if not to avoid litigation, to remain competitive. Computers will have to bear more of the business burden (bookkeeping, appointments, insurance filing, record keeping, charting, communication, etc.) for the provider will need to devote more time toward thorough health evaluations. Undiagnosed medical conditions due to an overburdened healthcare system, is a realistic concern.

It will be critical that all members of the dental team realize their role in gathering accurate health information from the patient. As this group of medically complex patients continues to grow, it will be increasingly important for the dental team to work, as a whole, in gathering information regarding the patient’s medical needs as well as their dental needs. Statements that confirm competence, and create trust and loyalty will be more productive than double booking schedules.

The expectations of the “senior boomer” will be high; however, providing quality dental care is more than clinical expertise. Critical gaps of communication between the dental health care provider and the patient (or the patient’s medical provider) may result in injury or death.

One solution to this problem may already exist. In 1993, the CDC (Centers for Disease Control and Prevention) began research into the population health-related Quality of Life (HRQOL) and its effect on both physical and mental health. From this research, the CDC developed a set of validated questions called “healthy days measures.” Physicians and public health professionals use these set of questions to measure the effects of numerous disorders, disabilities, and diseases in various populations. According to the CDC, tracking HRQOL in populations, such as the elderly or medically compromised, can identify subgroups with poor physical or mental health and can help gear policies that improve the patients attitude and health.

By the year 2050, the senor boomers will be over age 85. Therefore, the change that dentistry will be forced to make will not be short-term. Because of multiple complex medical histories, dentistry could benefit from Quality of Life questions as is or in a modified form. These questions can be used as tools to improve patient/provider communication, as well as acceptance of treatment plan proposals. In addition to the four standard “healthy days” questions, additional questions are also available from the CDC and are beneficial for patient care. Understanding the current physical and mental health, especially in the elderly, will increase patient satisfaction as well as practice productivity. When a quantifiable measure of a patient’s health (both physical and mental) is applied and when the entire dental staff is held accountable for collecting medical history data, not only will treatment plans be successfully executed, the staff (as well as the patient) will find the experience positive and rewarding, but most importantly, successful.

For more information visit: http://www.cdc.gov/hrqol/index.htm

CDC uses a set of questions called the "Healthy Days Measures." These questions include the following:

1. Would you say that in general your health is
a. Excellent
b. Very good
c. Good
d. Fair or
e. Poor

2. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Dear Garby

Dear Garby, I would like to improve my marriage – better communication, better reaction to situations, not be as “hypersensitive” (as my spouse says), and stop getting my feelings hurt. Thin-skinned in Dallas TX

Dear Garby Dear Garby, I would like to improve my marriage – better communication, better reaction to situations, not be as “hypersensitive” (as my spouse says), and stop getting my feelings hurt. Thin-skinned in Dallas TX Dear Thin-skinned, If you really want better communication with your spouse, you have to be willing to hear what he has to say! Being “hypersensitive” is a sure way to close the door to communication: anyone who cares about you doesn’t want to upset you, which is the risk one would take in communicating with you.

It ends up being a lose-lose situation. If he communicates it will upset you; if he doesn’t communicate it will upset you. Keeping one’s mouth shut in this kind of situation is the lesser of the two evils.

How you get a “thicker skin” is to change how you listen to him (and others if applicable). The majority of people filter what they are hearing through the lens of “right/wrong, good/bad”. In other words, when someone tells you something, you listen for who is right? What did I do wrong? They think I’m bad. And so on. This immediately puts you on the defensive even when the other person is not attacking you! There is another, more powerful and effective way to filter what you hear. Instead of the right/wrong, good/bad filter, try to listen for what works/what doesn’t work. If your husband (or anyone for that matter) has something to tell you, you can presume it is because they want to be in closer relationship with you. The more permission you give him to speak, the more open you are to hear what he has to say without reacting defensively, the more harmony you will bring to the relationship and the more willing he will be to listening to you as well. You also open the door to creating mutually satisfying solutions to whatever problem is at hand. And when someone is willing to just listen and respect the other person’s experience of a situation, then both parties are left with the feeling of love!


Dear Garby, How do I successfully resolve uncomfortable comments or situations with friends, family and co-workers, for a favorable outcome. (Unfortunately, I was raised as a child that my feeling and thoughts don’t count. I am better as an adult but still struggle some.) Seen-but-not-heard in Santa Rosa CA

Dear Seen, My parents also lauded us with the “children should be seen but not heard” idea whenever we had company around. It was their way of telling us to go play outside or not to butt in on the adult conversations. (I guess I didn’t listen to them! Haha!) As children, we have a tendency to generalize these kind of directives, and interpret them to mean that our thoughts and feelings have little value. It’s great that you say as an adult you have handled it better. To move your progress along a bit, I suggest that when someone says something to you and you feel uncomfortable, in a kind way let them know that you’re willing to hear what they have to say if they could say it differently, i.e, change the tone of the voice or volume, use different words, etc


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