Making your career secure takes guts!
By Rhonda R. Savage, DDS
If you're a female dentist, your options after graduation are the same as they are for a male dentist: become an associate, join the armed forces, be a public health dentist, work in a clinic setting, or own your own practice. Times have changed, though, since the 1980s and we see more women taking the leap forward and owning their own practices. How have times changed for women entering their dental careers?
In general, women prior to the '80s often felt locked into traditional roles.
Women weren't really given the opportunity to explore. But in recent decades, women have set a strong entrepreneurial precedent in our society that allows people to follow their own dreams. What's happening nationally for women-owned businesses? According to research from the Center for Women's Business Research published in the last year, more than 10.4 million women-owned firms nationwide employ more than 12.8 million people and generate 1.9 trillion dollars in sales. For the past two decades, women-owned firms have grown at around two times the rate of all firms — 42% vs. 24%. And women-owned firms accounted for 41% of all privately held firms in 2006. This year, Forbes estimated that 420 women across the nation are starting businesses every day, in industry that spans from human resources to construction.
In dentistry, the number of female dentists who own their dental practices, however, continues to lag behind their male colleagues. In a study of 4,950 dentists with a response of 2,362 dentists, the overall difference in practice patterns was statistically significant in the Early Career Group (1 to 5 years) and in the Intermediate group (6 to10 years). More women were dental school faculty or worked in private practice as employees or contractors.(1) The differences in the Established Career Group (over 10 years) were not statistically different. More males were practice owners in group practices; more women were in solo practices. In the two earlier career groups, women spent about twice as much time as men in child-care.(2,3)
Business ownership is risky and stressful, but taking that risk can have enormous long-term rewards. To do well in private practice, dentists must be salespeople who can sell themselves and the services they offer. They have to be teachers who can teach dental health to often unwilling patients. They also need to be personnel directors who can hire, train, and supervise employees. They need to be administrator-managers who can negotiate with landlords, suppliers, and equipment salespeople. They must be well organized and self-sufficient. Most of all, they have to have guts! Oftentimes, female dentists juggle the pressures of motherhood and business, which adds to the emotional stress as well as time-management issues. There are some differences in how women manage all these issues when moving into their own practices.
What exactly are those differences? Do female dentists have a more difficult time purchasing or obtaining financing for their own practices? Is it different for a female doctor to start a practice from scratch vs. purchasing an existing practice? Do female practitioners have issues with leadership? Some would say, "No, no, no!" to all of these questions. Female dentists are no different than male dentists. Forget about gender! It doesn't pertain! But some women say, "Yes," there is a difference.
The worry about obtaining financing is huge! Do female dentists have more difficulty obtaining financing? In speaking with major transitions groups and from my personal experience, the answer would be no. Do your homework prior to purchasing or starting a practice. Eliminate as much debt as possible to reduce your need for income initially. Have your credit in good standing and consider asking for family support if appropriate. Besides a standard bank loan, other options to consider would be an SBA loan, a home equity loan, or borrowing against a whole life insurance policy.
If necessary, consider asking a family member to cosign with you on your loan. My parents offered to cosign for me when I purchased my first practice in 1992, and offered again in 2003 when I built my new office. The bank didn't require them to sign, but it gave me confidence knowing that I had their signing power to back me up. Projecting confidence to a banking institution is very important. Besides your financial viability and that of the practice you may be purchasing, the bank buys into you as a person. Can you project confidence to a bank? Can you "sell" yourself as a person of integrity, compassion, warmth, and as a caring individual? Can you smile? Can you look the bank manager in the eyes and speak well? When you're asking for money, try not to over-borrow. Be frugal in the first five years, but don't be cheap. Purchase the equipment you need, but avoid spending money on gadgets. The definition of true overhead is the purchase of equipment that you don't use!
Looking at equipment and supply purchasing, I've been involved with gender research with a major dental supplier. Women make similar purchasing decisions about equipment and supplies as men. Women traditionally, however, do not tend to have the same mechanical knowledge as men, and may be at risk of being taken advantage of by a less than reputable dealer. Working with a contractor you can trust by reputation and credentials is important. Lining up an accountant, attorney, and marketing specialists will help make your new practice successful.
Your banking institution will appreciate your well-thought-out business plan. This may include the use of a pro-forma. A pro-forma is a projection of your first year's expenses and production/income. I had pro-formas generated for both the purchase of my first practice and for the construction of the practice I built from scratch. A reputable transitions firm can generate these estimates for you, as well as a good CPA familiar with dental practice operation.
Development of your business plan is very important to your success. Many studies have reflected on the fact that those who write out their plans have a higher success level than those who have it only in their heads. There are many online resources available. One such resource is BizPlan Builder 8: Writing a Winning Business Plan.
Develop your brand; your vision is your brand identity; develop a 5-year business plan. The best vision statements begin with the end in mind.
Knowing where you're headed and sharing your plan with your staff will make a huge difference in the success of your vision statement. Keep in mind that if your vision is "paying off my practice note in five years and buying the building," this will not be very motivational for your staff. Your vision statement should include the staff, the patients, and a healthy practice. Lead your team with your vision statement. If you don't know where you're headed, how can you, as the leader, lead your team? Leadership and vision begin and end with the dentist's attitude. As dentists, we're on stage every day in front of our patients and staff. It's up to us to determine the attitude of the practice. As Linda Miles says so wisely: "Your attitude determines your practice altitude." Many offices in today's economy are complaining of a downturn in their bottom lines. Just because it's a down time doesn't mean you have to go down with it. There's lots of opportunity. You've just got to find it.
Once you have your plan in place, focus! Many women dentists make the mistake of trying to go in too many directions. As a consultant, I've noticed that clients get into trouble when they divert from their plans. One young doctor asked me, "How much money should I pay myself each month?" I asked her about her personal expenses; what was her bare minimum necessary to pay her bills and take care of her family? I cautioned her to be frugal the first year and to gain a sense of the financial capacity of her practice. Instead, she saw the money sitting there at the end of each month as an opportunity to reinvest in her business. She overspent by giving all the staff large blanket increases in their pay, added full medical insurance coverage for her team members' families onto the group medical insurance, paid for several out of town trips for CE, and invested in a lot of new equipment. Unfortunately, once you commit benefits and pay, you cannot realistically take these away from your team without consequences. And even more unfortunately, she did not have the cash reserves necessary to pay her taxes the following year. A clear business plan could have helped her steer clear of more financial debt and stress.
For a business plan to be implemented successfully, you need your team on board. Without buy-in from your team, you'll find it extremely difficult if not impossible to succeed. Your team is your greatest investment! It's especially difficult for us as female practitioners to limit our giving. But we need to first consider the health of the practice as a whole, then the needs of our patients, and finally the needs of the team and the doctor.
The female dentists whom I've coached have been highly successful because we naturally have the ability to show warmth and are caring individuals. Where I've seen a need for coaching is most often in the areas of leadership, staff management, and the business of dentistry. These needs, however, are not gender-driven. Male and female dentists graduate from dental school with very little training in these areas. In defense of dental schools, there is so much packed into the curriculum that there is little time for these vital skills. How do we learn these skills?
I've found that we must constantly strive to learn about practice management and leadership by working at it every day. Carve out 30 minutes a day to read, listen to CDs, and watch DVDs; seek out a mentor; belong to organized dentistry; join AAWD! There are problems associated with getting started in private practice. The early years are pivotal. Mistakes in money matters, bad decisions in location, type of practice, type of office, choice of staff, and choice of consultants, can saddle a young dentist with problems he or she may never recover from. I do know from experience, however, that if you receive the professional advice you need and strive daily to become a better leader, you will be successful in private practice! Successful dental practice management is a matter of growth. By making decisions as they come and following good management strategies, you should be able to build your practice, increase your patient load, expand your facilities, and realize your full potential.See also "Women in Leadership: The Secret of Your Success."
1. Atchison KA, Bibb CA, Lefever KH, Mito RS, Lin S, Engelhardt R. Gender differences in career and practice patterns of PGD-trained dentists. J Dent Educ Dec. 2002; 66(12):1358-67.
2. Solomon ES, Hayes MJ. Gender and the transition into practice. J Dent Educ Aug. 1995; 59(8):836-40.
3. Blasius JJ, Pae EK. Work-pattern differences between male and female orthodontists. Am J Orthod Dentofacial Orthop Sept. 2005; 128(3):283-90.