Surviving Practice Challenges (Part 1)

Sue explains her initial venture into private practice, purchasing an existing practice from a burned-out dentist, and her initial attempts to grow the practice. She and David discuss her challenges in growing the practice, the positives and negatives to developing a niche practice, to moving the physical location and the difficulties of keeping good staff.

For the remainder of this first part of a two-part episode, Sue tells David about the challenges of keeping the practice afloat financially.  In part two, they discuss Sue’s decision to file bankruptcy for the practice after more than 20 years and her career transition thereafter.

TAKEAWAYS:

Takeaway 1: Dentistry Can be a Fulfilling Career, but it is Not Without Challenges

Dr. Sue Keller’s passion for dentistry was ignited at a young age, due to positive experiences with her own dentist and her curiosity about why others feared dental visits. “I always felt comfortable…They always told me I was a great patient. I got two prizes when I left. So I’m like, dentist, cool. This is great,” she said. However, she also acknowledged that many people have negative perceptions about visiting the dentist, something she aimed to address in her practice.

As she ventured into her practice, Sue quickly realized that managing a dental practice came with its own set of challenges. She pointed out that being underfunded was a red flag, as it hindered her ability to fully execute her vision for the practice. “That’s a red flag being underfunded for what you need to happen. Because when the move actually happened, I lost two thirds of my practice,” she noted.

Moreover, staff turnover posed another challenge. Despite her high level of education and desire to provide top-notch care, the constant turnover prevented her from fully utilizing her skills. “If I can practice at level 20, I’m actually practicing, struggling to practice at level seven because I keep rolling over people starting at zero, training them to five, having them leave, training them to three training then they leave,” she explained.

Takeaway 2: Financial Management is Essential in Running a Successful Dental Practice.

Sue’s experience brought attention to the importance of financial management in running a practice. From her perspective, dealing with debt and making sound financial decisions were crucial parts of managing her dental practice. “I was so burdened by the $70,000 plus the $135,000 loan I took out. I didn’t take a salary for the first three years of my practice. I just worked to pay down my debt. That was a huge mistake,” she confessed.

She stressed that young doctors should invest in themselves right away. “Young doctors, you to put money into your retirement right away because you cannot make up for the compounding interest that you lose by holding it off. You have to invest in yourself, and you have to do that right away,” she advised.

However, she acknowledged that the 2008 recession severely impacted her practice, demonstrating the importance of being prepared for unexpected financial downturns. “So now I’ve brought up a whole bunch of debt, right? And the market crashes, and I’m struggling. I refinance at least three times between 2008 and 2017,” she shared.

Takeaway 3: Specialization Versus General Practice in Dentistry Has its Pros and Cons.

Throughout her career, Sue grappled with the question of whether to specialize or maintain a general practice. Initially, she aspired to specialize in orthodontics but was swayed towards general practice upon realizing the potential monotony of specialization. “He liked to call himself the decathlon dentist because he did all the events,” she said about a dentist she admired.

However, when she decided to specialize in oral conscious sedation for anxious adults, she encountered challenges. “I was trying to hire staff in a new area and all that kind of stuff. So then the next factor is staff turnover… All this education I got, I actually could never put it into use other than the fact that I knew what not to do,” she said.

She concluded by advising other dentists to make use of specialists. “Use your specialists. They’re there for a reason. Have specialists that you sent to a regular basis, not just because you screwed something up or because something didn’t go the way you wanted it to. Use them all the time for their expertise,” Dr. Keller suggested.

INSIGHTS

• Sue shares her personal journey, mentioning her early interest in dentistry after having her first loose tooth at six years old.
• Sue had a positive childhood experience with her dentist, which fueled her desire to make dentistry comfortable for others.
• She discusses the transition in her career, starting her practice after a residency and eventually purchasing an existing practice from a burned-out dentist.
• In 1995, Sue took over a family practice and started building it up, noting challenges with old technology and financial constraints.
• She explains that her practice focused on treating anxious adult patients with oral sedation, creating a niche in an underserved area.
• She moved her practice in 2007, creating a comfortable environment in Northampton but encountered financial challenges in 2008 due to the financial crisis, including losing two-thirds of her patients after the move and facing difficulties hiring motivated staff, leading to constant turnover.
• Sue reflects on the decision to go fee-for-service and the financial pressures of taking insurance while striving to maintain high-quality care.
• Despite her advanced education, she struggled to implement complex treatments due to a lack of patients who could afford the care.
• Sue emphasizes the importance of utilizing specialists, even for bread-and-butter dentistry, to maintain quality and avoid complications.
• She outlines the ongoing financial struggles from 2008 to 2017, refinancing multiple times to stay afloat amid a tough market.

LINKS:

• Guest, Dr. Sue Keller’s Bio | Connect on LinkedIn
• Host, David B. Mandell’s Bio