Th 154576

Running a Practice While Raising a Family

July 1, 2004
One of the greatest joys and challenges for the woman dentist is motherhood.

One of the greatest joys and challenges for the woman dentist is motherhood. How do you run a successful practice and also allow for this wonderful personal commitment?

Holly Downes, DDS, and her daughter, Luci.
Click here to enlarge image

As a woman executive with two teenage daughters, I've always made it a priority to help female dentists studying with Pride Institute to continue running successful practices while raising their families. Without outside business advice on how to accommodate the changes motherhood brings, often the practice, family life, or the doctor herself suffers. In a quest to do everything for their family and practice, some "superwomen" dentists exhaust themselves. Motherhood can too easily result in a low-producing or inefficient practice or in children who recognize mom only by the back of her head as she leaves for work. Although running a business is demanding and requires extensive travel, I've always made quality time with my family and organization, although it's never easy — remember, I have teenagers. My own experiences as mother, wife, and CEO have stressed to me the importance of helping women dentists achieve balance in their lives.

A growing number of women are entering dentistry. Currently 35 percent of our clients are female. They come at every stage of practice — from start-up to mid-career to nearing retirement — and all have family issues. Having dealt with so many women dentists, we can say with certainty that they can maintain successful practices while taking time to raise families — and still take care of themselves. Although many women dentists embarking on motherhood decide to bring on a partner or associate, either temporarily or permanently, it is also completely feasible to remain a solo practitioner if the dentist so chooses.

In this article, I'll explain how to successfully combine motherhood with dentistry. But first, let's look at how NOT to approach important life changes:

Dr. Hasty wants to have a child, so she plunges right in. She makes good money and doesn't see the need for annual planning, leadership training, or practice management. She also thinks she's too young to save for retirement. She plans to get a replacement dentist when she gives birth and take three months off. While on maternity leave, what happens blind-sides her. The replacement dentist isn't working out, her patients are having difficulty getting appointments, her staff can't cope with the scheduling changes that affect their own hours and income, production drops, and Dr. Hasty hasn't set money aside for unforeseen circumstances. Her earnings drop, and her leave is cut short. She returns to work to face low production, a cash-flow crunch, patient dissatisfaction, and staff issues.

In contrast, Dr. Cautious also wants to have a child, but she's afraid to hire a substitute dentist who might not be accepted by her patients and staff. Her production could plummet. She could be forced to lay off staff. She could harm her income and practice. And if she rushes back to full-time work soon after giving birth, her child could suffer. Dr. Cautious is so hesitant that she postpones motherhood indefinitely and may lose her opportunity.

Dr. Hasty plunges in and suffers losses, setbacks, and stress. Dr. Cautious holds back and denies herself the joys of motherhood. Although they may seem like opposites, these two dentists are fundamentally alike. Both lack control of their practices, which means they lack the leadership and management skills to steer the practice in their desired direction, and they lack business planning and operational implementation to reach their goals.

In contrast, meet one of the female dentists studying with Pride Institute who uses entrepreneurial skills to successfully combine motherhood with a thriving practice — Dr. Holly Downes of Mill Valley, Calif. This divorced woman dentist studied practice management for six years prior to her life-changing decision to adopt a child and become a single mother.

"I always wanted to have children," recalls Dr. Downes. "But I had to be sure that I could do this financially and with integrity. I thought about it for a year, spoke to family and friends, and consulted with both Pride Institute and Brian Hufford of Hufford Financial Advisors. Then I decided to go ahead. I wanted to adopt in China, which was a two-year process. During that time, working with Amy Morgan and Brian Hufford, we strategized about what I needed to do to reduce my four-day workweek to spend a lot of time with my child."

It is now two-and-a-half years since Dr. Downes traveled to China to take home adorable one-year-old Lucienne. Dr. Downes has significantly reduced her work schedule, spends lots of quality time with her daughter, continues her viable practice, enjoys the support of her patients and staff, maintains her previous lifestyle, and is on track with savings for retirement and Luci's education — on a plan designed to accommodate her specific needs. As a mom and dentist, she's thriving!

"It's worked out really well," says Dr. Downes. "Not to say there aren't ups and downs. But if something happens that I can't handle, I have resources to help me. Adoption would have been very hard without these resources."

Following are some guidelines we used with Dr. Downes to strategically plan the steps to achieve the balance of life she desired for her roles as mother and dentist. (All quotations are from Dr. Downes.)

Step Zero: Define your vision

Dr. Downes clearly defined her goals: to be a mother; to continue as a dentist and practice owner; to reduce her work schedule at least through Luci's preschool years; to maintain her current lifestyle; and to save for her retirement and Luci's education. Each dentist must define the goals she wants to achieve — and no cutting back on your dreams! Be as specific as possible and the strategy will follow.

Step 1: Gain control of your practice

Changes in scheduling and production levels, the doctor's leave of absence, a substitute dentist, etc., can hit a practice like a tidal wave. To avoid capsizing, you must build a ship based on solid practice management.

"Before I had practice-management training, it was like not having a rudder in a boat. The winds are blowing you in a good direction, but you don't really know where you're going. I was making good money, but I wouldn't have been able to do something as gutsy as single-parent adoption. Practice management helped me to hone leadership skills and abilities I had no idea I had, financial skills to get my systems and numbers in order, and communication skills which gave me the confidence to address situations like conflict resolution, especially confrontation. I now feel more confident handling staff issues, like having the courage to say difficult things that might generate conflict, but to say them with love and care so the message is taken in a positive way.

"Honing the skills of communication and psychology chairside, being a leader, being well-organized, and being an employer all prepared me for motherhood. I also learned how to ask for help from my team, which has given me fresh, new ideas. I'm now enlisting a support team of friends, relatives, and business advisors who help me do the best for myself and Luci."

Step 2: Design an annual plan to implement your goals

In helping Dr. Downes prepare her practice for Luci's arrival, we not only had the challenge of maintaining production levels to support her and her staff, but because she was adopting from China, there was no fixed due date. How do you forecast when you will be called unexpectedly to travel across an ocean to pick up your child? (In fact, Dr. Downes' plans to pick up Luci were postponed over the Sept. 11, 2001, period, changing the schedule once again.) We had to create a schedule that completely cared for her patient base, allowed her staff to function full-time, and freed her to spend time with the baby. The answer? Creative annual planning and effective communication with staff and patients.

We recommended Dr. Downes take two months off, then work intervals of two days one week followed by three days the next week. She brought in an associate to see her patients on her days off. Hygiene continued to function normally. We developed production goals for her and her associate that would give quality care to patients and cover expenses. We forecasted reduced earnings during this period. Dr. Downes would still be able to maintain her normal lifestyle; however, she would contribute less than the maximum amount to her retirement. She was able to reduce her retirement contributions because with expert investment and cash-flow planning, she had been contributing for years to her retirement and was on the road to financial freedom.

Step 3: Design a financial plan to secure your future

"Because I reduced my pay, I have to stick closely to my three-, five-, and 10-year plan that allows for my not saving as much for retirement when Luci is a preschooler. But that's a decision I made. I know this isn't going to be the highest producing time, and that's OK. I value spending time with my daughter. When she goes to school full-time, then I'll work more hours. I also have a savings plan for Luci's education that her grandparents and I fund."

Not every dentist needs to be the highest producer in town. Dr. Downes made a choice that gives her the balance of life she values. Other women dentists may make different choices about their work schedule. Whatever your choice is, knowing your numbers and having control of your practice will help you reach your goal.

"I feel absolutely confident in my decision to work less because I have allowed for that in my financial plan."

Step 4: Alert staff and patients early and enlist their support

"I have staff who are really behind me. Most of them are parents themselves, so we work together to give the best care to our patients and to have fulfilling family lives."

Dr. Downes told the staff about her adoption plans well in advance and explained how the change would affect them, eliminating any worries that could have arisen from uncertainty about their futures. Dr. Downes retained her full-time staff and was even willing to carry an employee expense above the range norm for a time, if necessary, in order to keep her excellent team onboard. Her annual plan allowed for this, so she could feel comfortable making this decision.

The staff created a letter that was mailed to patients, explaining Dr. Downes' plans and introducing the new associate dentist.

"We invited patients to call and talk to our new practitioner. Because the letter went out three months before I left for China, I had a chance to talk to many patients when they came in and answer their questions. So the patients were pretty receptive. Now, if I go skiing or camping with Luci, they want to see pictures. They're really engaged."

Step 5: Be financially prepared for shortfalls

We also created a slush fund to finance Dr. Downes' two months away from the practice and to handle unforeseen issues. What a relief it is to have contingency plans for the uncontrollable.

"Some months we met our goals, and some we didn't. But I had set aside money to cover the shortfalls."

Step 6: Be ready for changes

After a while, Dr. Downes' associate had a change in plans that took him to another town, so her annual plan and schedule needed to change. Now she works three days every week without another dentist. The hygiene department has grown and continues to work four days. Dr. Downes has brought in another dentist on her day off to do hygiene, oversee the department, and cover emergencies.

Step 7: Implement your plan

"We became more efficient at scheduling on the days I'm here. Now we're booked out, whereas before we might not have been as diligent about filling gaps. If someone has to see me on my day off, I'll come in by special appointment. Before Luci arrived, I worked one night a week until seven o'clock. Now I only work until six. If someone absolutely needs me after hours, I'll see the patient. But most of my patients have been obliging in accommodating my new schedule."

Step 8: Measure results

Even if you have a plan to support your family goals, you'll feel insecure if you don't have effective statistical models to measure and analyze success and challenges. "As you can imagine, we watch our numbers like hawks. We have regular staff meetings to analyze them and improve the practice. At my current production level, I'm able to cover my expenses and lifestyle and save some, although not as much as I did before, toward retirement."

This is exactly what Dr. Downes had planned for, so her practice is on target. She hasn't lost any patients due to the adoption. There was a small, planned decrease in total production in the first year after Luci's adoption. This decrease was offset by reduced expenses, efficient scheduling, an expansion of hygiene days from four to six with a more active perio program, and yearly fee increases of three to four percent, which were also occurring prior to the adoption as a general business practice.

Step 9: Continue planning for the future

"I'd love to continue working a three-day week even after Luci goes to school."

In brainstorming with me and our transition specialists on ways to achieve this goal, Dr. Downes is considering partnering with another dentist in a solo-group arrangement in which each maintains a separate practice while sharing facility and staff expenses. A solo-group arrangement may be a way for Dr. Downes to contribute more toward retirement while keeping the reduced schedule and independence she loves.

Dr. Downes has created a unique, wonderful life for herself. She earns enough to have everything she needs and wants. She is funding her retirement and her child's future, shouldering a full-time staff, and addressing the needs of her entire patient base.

"I love being a mother. It was one of the best things I've ever done! I wouldn't have been able to do what I did without having control over my practice and my financial life. Without that, I would have been going into adoption blindly. I have so much confidence knowing that as a single woman I'm able to handle the practice, the finances, and the commitment of motherhood."

Dr. Downes' success in balancing motherhood and dentistry has spurred this gutsy woman to entertain another dream.

"Luci has been a bridge for me to other cultures. I'm now fascinated with medical anthropology. When Luci goes to school, I may go too — for a PhD in that field."

Regardless of whether your interests lie in motherhood or in something else, be true to your highest aspirations and live your life as fully as you can. Master your entrepreneurial skills, because they'll lead you to realizing dreams you never thought possible.

Develop the staff and systems you need to build the practice of your dreams. Learn from Pride Institute's consultants and client-dentists who conduct lively, information-packed, AGD-accredited seminars around the country. For dates and locations, call Pride Institute at (800) 925-2600.

Click here to enlarge image

Amy Morgan
Ms. Morgan is CEO and lead trainer of Pride Institute, a dental management consulting firm serving dentists nationally and internationally. A speaker at major dental conferences, she conducts seminars and workshops for dentists and their teams. Contact Ms. Morgan at (800) 925-2600.