Dental Practice Heroes

What Makes You Lose Sleep: Business or Clinical?

• Dr. Paul Etchison, Dr. Henry Ernst, Dr. Steven Markowitz • Season 3 • Episode 68

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One bad case can haunt you longer than a bad hire. But what’s really more unpredictable — the patient in the chair or people in your practice? This episode debates what causes more stress: clinical work or the business of running a dental practice. The DPH coaches share their experiences on both sides of dentistry and how they reduce stress in clinical procedures and day-to-day operations. This is a practical listen for building more confidence and predictability into your day!


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Paul Etchison:

Where are you more comfortable Doing clinical work or dealing with the demands of the business? Today, we're debating which side of dentistry is truly more unpredictable. Is it the procedures, the patients or trying to keep your practice just running smoothly? And what can we do to make both sides better so that we can have less stress and a little bit more joy? I am joined today with my DPH coaches and we've got plenty to say about this one. Let's get into it.

Paul Etchison:

You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair. I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I want to teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Welcome back to the Dental Practice Heroes podcast. Thank you so much for spending part of your day with us. I'm here, dr Paul Edgison is your host, and I'm joined by my co-host and coaches, dr Stephen Markowitz and Dr Henry Ernt, both owning large practices. Steve, owning many practices six practices, six practices. Steve.

Paul Etchison:

As of today, that's the number Six practices and Henry and I both are owning a large practice, but we are all dentists that have pulled ourselves out clinically to focus more on the business aspect. But we do still do some clinical and today we kind of want to talk about man. Does clinical dentistry suck? Because I think you can resonate with yeah, it kind of does. Let's pull it apart because I have some opinions, but I want to hear from you first, steve. I mean, does clinical dentistry just suck?

Steve Markowitz:

I think, paul, you wanted conflict. So I think clinical dentistry is freaking awesome. The problem is, you just see so many people, like you could see. In our organization we did over 80,000 visits last year Wow. In our organization we did over 80,000 visits last year Wow. If we were 99.9% perfect, we're still going to have I don't know the math, but a lot of things that didn't go right, and the human body is unpredictable. There are things that we may not have seen as clearly as we had hoped, and it sucks to deal with complications, but if we help or try to help enough people, there will be something that doesn't go how we expect and then we got to clean it up and make it right and that sucks. So, yeah, there are some parts of clinical dentistry that aren't predictable, but there's also a way and a method for us to not put ourselves in that position or try to limit the number of times we put ourselves in that position.

Paul Etchison:

Well, you being an owner. You got six practices managing a lot of people. Do you find that clinical dentistry is more predictable than the people side?

Steve Markowitz:

We'll try to turn this around on me. That's the question I was going to ask you. You're the one here on every single podcast that's saying clinical dentistry sucks. I'm saying it doesn't because I never said that.

Henry Ernst:

I've never heard.

Steve Markowitz:

I've never heard him say that Steve watch it Way more predictable way more predictable than how a tooth and bond is going to form together. It's again, it's not widgets, but we're closer to widgets than people with feelings and emotions and trying to predict how someone's going to respond to honest feedback. People suck, and I say that from the most loving place. Predicting how someone is going to respond in a situation is winning the lottery. There are so many ways for people to respond to certain situations. Again, I think that's part of the beauty of what we get to do as owners and leaders is truly influence and grow people. I love that part, but to say that it's as predictable as clinical dentistry is wild to me.

Paul Etchison:

Well, I feel like there's like I don't know who said this to me at some point, but somebody said you know, I have some days where I run my business and I have some days where I'm seeing patients. I never had a bad day running my business. And I was just like, yes, that is so true. And I feel like for me, like you know, yeah, people are unpredictable. But at the same time, man, I just find the clinical dentistry so much more unpredictable. I feel like I can do everything right and something still unexpected happens. And I feel, with people, I just for me, it's been much easier to the more I communicate with my team and address the issues. They just work, henry, like what's your experience man? Like business or clinical? Like what's more predictable?

Henry Ernst:

Oh, I am 100% business. So I disagree with you, steve, and maybe it comes from my personality, because, for those of you guys who know what a Colby score is, I'm that golden goose as far as Colby scores goes. I'm a mediator. I'm in the middle of everything. I'm not great at everything, I'm not bad at anything, so I just find it, my natural aura is just a mediator. So I feel like if I coach people, I can I don't want to say control them, but I know where they're going to go one way or the other.

Henry Ernst:

Dentistry is a great profession. We take care of people, we help people but things happen that you have no control over, and that's the problem we discussed in previous podcasts, where younger dentists are so freaked out because they expect everything to go perfectly and it doesn't. And mentally, as a dentist, especially as a younger dentist, you got to deal with this. You got to learn how to compartmentalize and understand that. Like you said, steve, which I agree with, you see tons and tons of patients. Our office has 18 operatories, five dentists. We see, like you know, a couple hundred people new every month. We've got like 18,000 active patients.

Henry Ernst:

When 1% or a half a percent of stuff goes wrong. It feels like it's like an 80-20 rule, but like all you care about is the 20 and all you know about is the 20, because I'm sure we could swap stories here and like what's the worst stuff you ever happened? And we remember stuff and it lingers with you and it eats you. And that's the problem with clinical dentistry, where in the business model, all right, somebody really pisses me off there. All right, they're gone, bring on somebody else, let's coach somebody else, whereas you're married to that tooth, that something happened bad, and it's like you're married to that person. You just hear their calls and this and that, and how are you going to get rid of this?

Paul Etchison:

But what I'm thinking about is that there's a lot of dentists that spend a lot of time on clinical and they don't spend time on the business and they're very uncomfortable having those difficult conversations with their team. And I'm starting to wonder well, maybe that's a very uncomfortable area for them, maybe they're the people that says that I think clinical is way more predictable. But then you got you Steve. You got a team of gosh. What like 150 people or something like that. How big is your team? 150. So if you hated the people part, you wouldn't have been like oh, let's have more people.

Steve Markowitz:

What I hear most is that people don't love to have the difficult conversations. But I bet if I were to ask your team both of you guys is. But I bet if I were to ask your team both of you guys is Dr Ernst and Dr Etchison good at having difficult conversations? They would say 100%, they are amazing at having difficult conversations. But if I bet, if I gave you some truth serum, those conversations that you're having aren't even difficult for you. No, no. So the business part of the conversation, or the difficult part, isn't actually challenging for you. So if you were to go in and have a difficult conversation with an assistant, you may not find that conversation that difficult. But if I were to go in and we were to start negotiating something that was really important to you, that was really high stakes, I guarantee both of you would suck at that conversation, and I do too. I guarantee both of you would suck at that conversation and I do too.

Steve Markowitz:

So when every time people tell me that I'm great at having difficult conversations, I go. You've never seen me in a difficult conversation because I'm just as shitty as you, and I think that's the level of business challenges that we're trying to overcome. Yes, they are very predictable at a certain spot. But, paul, let's switch seats for a sec. I would love for you to come sit in my seat and tell me which one is more difficult the DO on number 29 or running 150 plus person organization? I guarantee at first it would be this. You would take the DO on 29 every single time. So as we grow in our business or as we take on new challenges, clinically that is what's going to be the least predictable, because we're not as sound in what we're doing. If all you did was a crown on number five, that was root canal, I guarantee you would not have a lot of complications and you would think that is very, very easy.

Henry Ernst:

But that's not how dentistry is. That's not how dentistry isn't that perfect number five root canal. You got all kinds of shit that's coming to you Left, right, center, forward. It's all different.

Steve Markowitz:

That's because your scope of practice, henry, is so unique. But if all you did was bread and butter dentistry, you would sleep like a baby.

Henry Ernst:

I would be so bored as hell You'd be sleeping in the chair. If I did crowns and fillings all day long, I would be just a miserable soul, and that's a whole different conversation. Yeah, I totally agree, henry.

Paul Etchison:

Now you say the business part is more. I'm with you there, henry. I think the business part is more predictable. Steve, I just wonder, like, what advice would you have for someone who thinks the clinical part is less predictable than the business part?

Steve Markowitz:

Yeah, I would do two things. One, I would reduce your service mix until you feel like it is it is more predictable. So if the root canals or extractions or things that those are the pain points, I would not stop doing them, but find cases that you know are going to go smoothly and gain confidence in that part of your service mix. And then step two and this is a treatment plan philosophy part I would treatment plan as worst case scenario and that means if there's a chance that that tooth is not savable, don't try and save it. If there's a chance that that tooth needs a root canal, it needs a root canal. Create opportunities to set expectations with your patients so you can beat them and the unknown is what is causing you stress or making it less predictable and make those unknowns known to you.

Paul Etchison:

And Henry, would you say, I'll ask you the opposite question is for someone who finds the business very unpredictable what advice would you have for that?

Henry Ernst:

look at it like clinical is unpredictable and I'm so nervous about clinical. I think clinical has like really really high ceilings, but it also has really really low floors. Here I do so much stuff I do wisdom teeth, I do sedation, I do implants so I like that and that makes me happy. But there's a low ceiling. Like one time when I was a younger dentist maybe a couple of years in I had a patient who I removed and you always remember these things, you never forget them, right who I removed a wisdom tooth on. Everything went fine and dandy, no thought of anything, and she ended up being numb for like five months and you know what happened during those five months, like when I woke up in the morning I would think about it, I'd be on like a vacation or doing something happy, like throwing a ball with one of my kids, and in the back of my head it would just come there. So that's what I mean by it.

Henry Ernst:

There are some lows that you have to learn how to deal with and it can come like in that case everything was. It wasn't a challenging case, I was younger, it wasn't a big deal, but look at that floor there. It was like it took over your life and maybe as I've gotten older too, as I really really feel comfortable and it's about what you feel comfortable in I feel comfortable in uncomfortable conversations, right, because I live in that world. So you have to do what's in your comfort zone. So not just the expectations of, like the procedure mix or this or that, but look at your uncomfort zone and maybe try to analyze.

Henry Ernst:

I was a young dentist too in my early career and I said to myself man, I'm having so many problems with patients and I practice in Boca Raton, florida, for those of you who don't know, patients are really pains in the asses down there and I literally made like a list of all the patients that are my aggravation patients and I found like things that were very similar. So I said to myself you know what? You made this point before, steve, from now on, when I see these people, I'm going to be quick to maybe not be so quick to treat a plan and rush into a marriage with them. I'm going to walk the line.

Paul Etchison:

I think it's funny that you're making a list of your worst patients, Like it's like, what is this guy making this list for? What's this list for? I'm scared now. What are you going to do with this?

Steve Markowitz:

No, it's a mental list. Everyone has it. It's just your Rolodex of things that didn't go perfect, the things that randomly, 10 years later, you wake up in the middle of the night and be like why did I not torque that abutment? Screw in all the way. Or why did I take on that case where everyone has that Rolodex of patients that keep them up at night?

Henry Ernst:

Give us one of those things, mr Clinical Steve, like, give us one of those things that happened really shitty, that kept you up for five months.

Steve Markowitz:

Oh okay, the first angled abutment channel that I got. I didn't even know it was an angled abutment channel. I tried the screw in on my driver and I thought it fit. I put it in. I started hand torquing it and I went to torque. I I put it in, I started hand torquing it and I went to torque. I couldn't get it to engage and I called the lab and they were like that was an angled screw. What the hell is an angled screw? I didn't even know what that was and I didn't have the right driver and I couldn't untorque it. So it just sat there and then, like six months later, I tried to open it up and I couldn't.

Paul Etchison:

That still haunts me to this day, when I've had issues with cases like I'm thinking about this one. It was an adult with a crossbite and I'm like you know, you go to the Invisalign course and they go yeah, we can fix the crossbites, watch this. And then you try it At least me. I've tried out a number of patients and it doesn't work. I can't jump a crossbite with Invisalign. I mean maybe certain ones you can, but I just not going to get that level of expansion. I've always ended up having to put on braces or something fixed to at least get the crossbite jumped. And so we went to an expander and I told her turn this thing, you know one, turn twice a week and I'll see you back in six weeks. She turned it twice a day.

Paul Etchison:

And when she came back in six weeks it was like the molars and the posterior teeth were like 45 degrees out and I backed it up and when I was like taking that thing off I'm like we've got to get this thing off I was like scared I was going to rip the teeth out of her head and what was? I lost so much sleep over that, thinking all these teeth are going to need endo, all of them are going to have like a big like gingival defect from pushing out the bone, and I lost so much sleep over it. Now everything worked out great and the case ended up finishing perfect. But contrast that to when there's a lot of chaos at my practice and there's stuff going on in the business.

Paul Etchison:

I find if with stuff's going on in the business, I can dive into it and the more I spend more energy in it I can resolve it. You know it might take a day or two of more conversations, but it's just we're X amount of conversations away from fixing it With the clinical stuff. It takes time and you got to have the patience and there's nothing you can do, like you, I feel. That's where I feel like that becomes unpredictable. I've lost the control. It's out of my control.

Henry Ernst:

So I think the example I said about the floor, the floor is so low, so that case you're talking about, you lost sleep over it, right? Yeah, like business wise. I'll give you an example that just came into my mind. You know, I work two days a week in my practice now. So I work one week like Monday, tuesday, the alternate week like Thursday, friday, so sometimes there's like 11 days in a row where I'm not here at all.

Henry Ernst:

And so when I came back to work, like after being off for a while, there was one of our team members, a dental assistant, that missed her doctor's morning huddle. We have our doctors meet with each assistants and she was late. And apparently she had been late for a while and maybe like nobody doesn't say anything when substitute teacher, when I'm not here. So I've found her and I made the you know the choice to make have a difficult conversation, tell her why this is not good, can't be late, you can't do this anymore. And I was really blunt because it's been a while. I said if you can't come time the next time you come late, just turn around and go back. We can't come on time. The next time you come late, just turn around and go back. We can't have that here.

Henry Ernst:

So you know what happened that next day, that later that day she quit, and you know what? That was great, because now we got rid of that little bit of cancer and I handled that business stuff and it didn't bother me one bit. But that wisdom tooth that took five months, which resolved, and everything. I couldn't do anything about it at that point. I had to just wait and in your case you could fix what you fix. But I think that's the point that I was trying to make is that there is a floor that you don't have control over sometimes. Yeah, and did your patient.

Paul Etchison:

They eventually got their feeling back.

Henry Ernst:

Yeah, I'd have them come back every once in a while and I do all this stuff you're supposed to do and all of a sudden they came back and they said I'm feeling tingling. And I went to my office back door and I think I went outside and I was like, thank you God, tingling and you know. And then, like you know, a couple of weeks later came back. But that was really stressful and you know, for listeners out there, this stuff happens to anybody and everybody and you just have to find a way to live with it and learn how to deal with the stresses of dentistry when you're playing ball with your son. Don't let that get in your head. Enjoy that time, because you can't live like that.

Paul Etchison:

Yeah, I think that's. The moral of the story is that you've got to stay within your comfort level and also but we do need to be challenged and we need to grow. So we need to have realistic expectations but at the same time, we need to grow. So we need to have realistic expectations but at the same time, we need to grow and if we have something that's really finding it unpredictable, that's probably an indication to us that that's something we need a little help with, need to get a little bit better, more skilled, more proficient with. So if you're listening and you are thinking about having a practice where you can work less days and make more money, you should talk to some of our DPH coaches, dr Steve and Dr Henry. They are fantastic and we're helping people and we're taking on clients. So if you're interested in working with a coach, check out dentalpracticeheroescom. Thank you so much for listening and we'll talk to you next time.

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