45 Days of Practice Ownership

I alluded to it in my last post, but I have officially purchased a dental practice in Greeley, CO.

The name is NorthStar Dental, and you can find me on the web in these locations:

Website: NorthStarDentalGreeley.com

Twitter: @NSDGreeley

Instagram: @NSDGreeley

Facebook: Click here

I've learned a few things in my first 45 days, but I mainly want to discuss the differences between military dentistry and civilian dentistry here.

1. Treatment planning

Military treatment planning is very conservative. This stems from the fact that we are often so booked out, that it's easier to push off that tooth with some visible fracture lines to next year, or do a big filling and hope it doesn't break in the meantime, rather than stuffing the schedule full of crowns.

In civilian practice, you can pitch the option of a crown as soon as you know a filling is a poor long term solution which means your crowns are going to be far more predictable and often not require a core buildup for the patient (which saves them $) if the existing filling is small.

2. Problem solving

The military has a multitude of issues but most of them are small. However, this constant small background annoyance is akin to a constant static slowly invading your work life. There's a lot of problems that you can't fix at all, or that take so long to fix that you just start to ignore them.

In civilian practice, problems get solved very quickly. There's a host of helpful people waiting to service your practice via equipment purchases, financing, supplies, etc. 

Example: It took 8 months to get new curing lights in the military. In my new practice? 4 days.

3. Administrative tasks

One big benefit of the military is that you have a lot of enlisted personnel to help with admin duties. But wait a minute, you also have your own! Writing notes, running programs, the list goes on and on. None of them are that hard, but again, it's like the constant static in the background.

In civilian practice, you have far less that you are "required" to do yourself (treatment notes are an obvious example here). Not to mention you can run your "programs" (referrals, etc) however you want! My admin burden is probably 10% of what it was in the military. My staff is small and efficient and takes most of this load away. Now, I do have a host of new issues to deal with, but with the right leadership background, I have had no problems at all with these new items and I have more down time (yep) than I did in the military.

My overall thoughts after 45 days:

I have been totally surprised at how easy the transition to civilian practice has been. The everyday joy of treating patients that actually chose to come see you cannot be understated. Having a very small team of highly motivated individuals makes you far more productive than having large military teams (ironically) bogged down with red tape and hours of extra non-dental work. The nearly total lack of administrative tasks in the civilian world is a dream. Solving problems instantly means that there's no buildup of stress "static". Being able to actually lead a clinic and have ultimate autonomy is wonderful.

I've loved it so far. If I had to put a number to it, I would say it's about 20% as stressful as I expected, and 2x as fun.

My big caveat: 

If you're thinking of getting out just to associate forever, think twice. The military has such a great end goal for those that can stay for 20 years, and many private offices hire associates too early which means you won't be busy enough. Working for a corporate office might work because they typically have a better pulse on their needs, but you may burn out quickly because you'll definitely be seeing more patients.

So let me encourage those that are considering getting out. Do it!

If... you want to own a practice :)

P.S. If you decide to get out, you *must* use an intraoral camera for *every* exam finding. Showing the patient what you are seeing is far and away the best tool for gaining trust and building rapport. 

The End of the Beginning -- And An Offer for Readers

I started this blog in February 2010 with the intention of chronicling my journey as an Air Force dentist and being a resource to help out people who had questions.

I was "scratching my own itch", if you will. I didn't see anything on the internet like what I wanted to read. So I made it myself.

500 emails, 250,000 page views, and a few phone calls later, I'd say it was quite a success.

After a long 10 years, I am finally in the process of leaving the military and acquiring a dental practice for myself. I can't say really anything more than that, but now you know. I've already learned a ton along the way, and I'm hoping to help military dentists get over the fear of transitioning into practice.

If you're a dentist (military or otherwise) considering transitioning to ownership, please contact me (my email is on the right side of the page)!

I would love to help you better understand if this is the right step for you and even do some help you look at different practice offers, associate contracts, or just brainstorm your next steps.



As for the future of this blog...

I've struggled recently trying to decide what direction to take it, if any, given the facts that:

1. I'm leaving the military (so the title doesn't work super well)
2. It makes me no money (so I can't sell it)
3. It's a very narrowly focused/designed blog (so there's not much else to explore)

However, I think it may be beneficial to continue my story in some way and I haven't quite decided if that will happen here at this domain or on some other blog that is tailored more towards my next phase in life. Stay tuned.

I've received literally hundreds of emails over the last decade and this blog has been a central location for those looking for information about military dentistry, the Air Force HPSP, dental school, and life in the military.

My email is still live, so keep the questions coming! Like I said at the top of the page, I'm welcoming any and all questions from those looking to transition to ownership.

It's been an honor and a pleasure, and I'm excited for the next step in my journey and helping you with yours.

10 Books that Have Helped - Part 1/3 of Organizing a Military Dental Clinic

Organizing a Military Dental Clinic - 3 part series

This is part 1 of a 3 part blog series called "Organizing a Military Dental Clinic"

I'm going to talk about what I've learned from running logistics at 2 bases over the last several years, and hopefully it will help some military (and even civilian) dental clinics! I was fortunate enough to be part of some awesome teams that have won MAJCOM and Air Force level awards, but those victories were a testament to the systems and habits we created, not the will of the people in the clinics. I don't claim to have all the answers, but I have tried a lot of different things and I'm a relentless experimenter so hopefully these posts can help spark some new ideas for you and your clinic.

Ordinary people can do extraordinary things with the right habits and systems. 

You don't need "superstars"; leaning on them may work in the moment, but things will crash when they are gone.

Let me say that one more time: this is not about the PEOPLE, it's about the SYSTEMS and HABITS you create and enforce over time.

There is a basic level of competency required, obviously, but I'm betting that most of the things your clinic does could be simplified significantly, making everyones job and life much more enjoyable.

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10 Books that Have Helped- Part 1/3 of Organizing a Military Dental Clinic

Books are the #1 way I've learned (with podcasts coming in at a close #2) what you're about to read in this 3 part blog series. Obviously, the knowledge must be applied, but I firmly believe that you can only imagine combinations of that which is already in your mind, and the best way to add new things to your mind is to digest knowledge from the great thinkers via books and podcasts.

Here's my list of 10 books, in no particular order, that can help you become a better thinker when it comes to organizing your clinic.

1. The Power of Habit - Charles Duhigg

A modern classic on "how" to think about what we do every day. We are our habits. Instead of trying to change people, change the structure and incentives to drive them to the result they want. We aren't trying to change people, we are changing their habits. This is not a "quick fix" book, but it can lead to permanently new habits, which is the ultimate goal.

2. Extreme Ownership - Jocko Willink

Stop blaming other people for failings that happen on your watch. If you're in charge, own it. This extends to your personal life as well, but is relevant here for your work, too. Discipline = Freedom. 

3. The Goal - Eliyahu Goldratt

This is a business book disguised as a novel (or maybe the other way around). It's a fun read that makes you think about how you can pull what you're learning into some real life actions for your business or clinic. This book gave me an actual idea for our supply chain at my first base that we ended up implementing and utilizing. For that reason, it had to make the list.

4. The E-Myth Revisited - Michael Gerber

I wish this was mandatory reading for all Air Force officers. This is the bible for how to think about any organization, even in a 1-person shop. The basic premise is to imagine your business/clinic as a prototype model for thousands more (even if you never plan to build a thousand more). The reason? This will force you to simplify things so aggressively that your business/clinic will start to run well almost regardless of who you plug into those spots. People will need less and less training and expertise to run your ever simpler clinic as you trim waste and make things better. This is a vital concept for military leaders when we don't know who will come and go. 

5. Principles - Ray Dalio

Another modern classic. This will be a book that will go down in history as one of the most dense and actionable books ever written. I can't say enough about it. It's a big book, but it gives so many unbelievable mental models to think about your life and business/clinic. I wanted to dip the whole thing in highlighter. My favorite concept? Imagine yourself as 2 people (because you ARE 2 people -- reptilian brain and neocortex). Most people run life on autopilot (reptilian brain) without stepping back and imagining themselves from the outside. 

If you've ever played a video game, this concept comes easily. You are the person playing the game and you are the character participating. Most don't realize this and just behave like the character, reacting to everything in life, without stepping back and making intentional choices. It's very akin to the concept of working "on" the business and not just "in" the business, as laid out in Michael Gerber's The E-Myth Revisited. 

6. The Life Changing Magic of Tidying Up - Marie Kondo

Nope, not a joke. This book was written to help people organize their homes, but I can tell you, it is much more than that. This book helps you re-think about how you see "stuff" in general. This is an essential read for those wanting to organize anything in their life, and I'm dead serious. This will change your relationship with "things" forever, and by extension, dental supplies. You'll be much more decisive at ridding waste from your life, leaving room for the things that really matter. What could be more critical when trying to organize a dental clinic? Trust me on this one.

7. The Checklist Manifesto - Atul Gawande

Ugh, not another checklist. Ok, look. I hate being told what to do with those silly things, too. But dammit, they work. I love it when a patient can get a consistent experience and ultimately, checklists are the best way to focus new hires, establish consistent protocols, and enforce processes. Checklists save brain power, they put everyone on the same page, and they eliminate confusion. This book will make you smile every time you see a well designed checklist, and it will make you much better at making them yourself to systematize your clinic. I love sneaking checklists onto all sorts of things without people even realizing what it is. More on that in part 2/3.

8. Essentialism - Greg McKeown

This book is all kinds of awesome from every angle. The big takeaway here is to help your mind focus on what's really important. Too many of us treat our entire to-do list as an emergency and we end up freezing or just getting the wrong stuff done. It will help you think more about first-order problems instead of fixing the surface-level issue (you know, like the problems you "solve", only to watch them pop up again in a month?).

9. Switch - Chip and Dan Health

I love this book so much. It was one of the first books I read on the subject, and I've gone over it several times since then. It will help you think more deliberately about how changing the environment itself can help drive the behavior you want. It's not just about changing the people, which often doesn't work, but changing the way they work to eliminate ways they could get off course. This book has been pivotal in my work over the last few years. Another book I wish was a mandatory read for Air Force officers. Shape the path!

10. Ego is the Enemy - Ryan Holiday

You're not that special. Seriously. Once you can separate your ego from what you're trying to do or create, the sky is the limit. The harder you hold onto what people think of you, the lower opinion they will hold of you. Strip your ego away, be definitive, make the hard decisions, and own the results. Apologize when you screw up, be transparent, and don't skirt responsibility. Those with inflated egos are typically the kinds of people that don't build systems, because they don't trust other people to run them or they are too insecure about what other people will think if it fails. Get over yourself ;)


Bonus! The Power of Consistency - Weldon Long

This was the book that convinced me I had to read more books. It's the best. I'll leave it at that.

I have a lot more books, so if you want more recommendations, don't hesitate to email me (see the right side of my blog for my email address).