Last man standing ?

 

Ok, I confess to loving spaghetti westerns, samurai movies as well as some of  Bruce Willis' movies. I also love movies with Don Quixote type themes. One man fighting against the odds in a corrupt and immoral  world.  My time spent in my dental practice and teaching  have reinforced this sort of world view. 

Five years ago , I shared my  floor with five  other dentists, an opthamologist, an internist and an acupuncturist. Now I am the last remaining of these tenants. My floor still has neighbors but they all have  moved to my floor in the last year. The fact is that the last three years have been a rather wild ride here in NYC and many people that I know, patients included,  have moved away from NYC. Others working mostly remotely from our suburbs. Thankfully they still come into to see us for their check ups and cleanings, just not as frequently as before when it was more convenient to see us since they worked 5 days per week in Manhattan. 

What is the secret to a business (especially Dental) standing tall in these trying times? Well I have seen my practice  go up and down over the years and the trick is keeping ones fixed overhead affordable at whatever financial plateau the practice is sustaining. Obviously the cost of operating a practice can not exceed its revenues for very long. In Manhattan, the three biggest fixed costs are staffing, rent and debt service. 

In my own case, I am not terribly leveraged financially.  Basically I only have a mortgage payment and a car payment each month. Staff salaries are my biggest outlay and in trying times its best to tighten ones belt and keep the amount of salaries commensurate with a practice collections. I try to keep my salaries running about 28% of Collections. Of course in tough times that percentage will be higher and a owner/dentists salary will be diminished to allow for maintaining ones staff. Keeping ones staff loyal and morale high is important since staff turn over can be disruptive and costly to a dental practice. 

Another big expense is rent and this can be costly in Manhattan. That is why "space sharing" is highly desirable. I have always tried to share my office with another dentist or two in order to keep my portion of the rent  more affordable. 

People say I have a nice "space" but truth be told its not very fancy. Of course we have most of the equipment that dentists need but we still have not purchased an introral scanner or a cone beam x-ray system.  

 Other large fixed expenses are insurance policies, monthly software support fees, telephone . Laboratory bills  are not fixed costs and vary with the amount and type of dentistry my patients need. 

 Many practice owners I know are resorting to working part time jobs to supplement their income and still others I know are considering doing so. I probably will add  an additional day of teaching next year  because I would like to make room in my practice for my son David who graduated dental school in 2022.

 Clearly dentistry is a business and dentists who don't keep this in mind probably will not have their practices stand the "test of time". Opening and maintaining a dental office of ones own has some risks attached to it and success is not guaranteed. But through hard work, continuing education and intelligent planning, dentists can still successfully have their own practices and do not have to become corporate employees in another practice. That being said, you can see why somedays I feel like Bruce Willis and other days more like Don Quixote!