Podcast Episode 39 | Cultivating Growth: Steps to Build Your Practice

Andrew Tucker JD, CPA, CFP, CIMA

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The Prosperous Doc™ podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Andrew Tucker: 00:00 The question really becomes, "How much can you change at any one time and for something to keep its identity?"

Intro: 00:08 From Spaugh Dameron Tenny, it's the Prosperous Doc Podcast. Real stories, real inspiration, real growth. A show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.

Shane Tenny: 00:26 Welcome back to this episode of the Prosperous Doc Podcast. I am Shane Tenny and glad to have you with us today. We know, from experience, that those of you listening are white coat wearers. Maybe residency, maybe training, associate business owner, practice owner. And within the dental community, statistics are showing us that about two-thirds to three-quarters of dentists are not only clinicians, but they own their business. They're entrepreneurs.

Shane Tenny: 00:52 The statistics are about inverted, for those of you in medicine, with about a third being private practice owners. And admittedly, for most of you that own a practice, there was a moment in your training or a moment in your career where you realized, "Wow, I'm not just a clinician and a healthcare provider, I'm a business owner." That is a different animal than what I thought I was getting into.

Shane Tenny: 01:16 So today, I'm really excited to join me in the recording booth, a good friend and a colleague, Andrew Tucker. Andrew is a double major in communication and poli sci from North Carolina State University, law degree from Campbell, with an emphasis in tax, master's in trust and wealth management. He's also a CPA, a CFP. He's got more alphabet soup behind his name than most of the folks in the Spaugh Dameron Tenny office. And he's got a deep experience in working with private practices. He's coached and advised on the transfer of over a hundred million dollars in practice sales over his career. He's been a guest speaker at a number of conferences. And as I said, I'm thrilled that he's a part of our team to help our clients, and today, help you as we talk about six things that you can do to launch your practice to the next level. So Andrew, thanks so much for being with me today.

Andrew Tucker: 02:09 Thank you for having me.

Shane Tenny: 02:10 All right. You wound up and ready for some fun?

Andrew Tucker: 02:12 I am, I am. Especially after that introduction. That was far more generous than I feel like I deserve, but I certainly appreciate that.

Shane Tenny: 02:19 Yeah, hopefully you can feel the standing O around the country. So you've got experience that's just invaluable for those in private practice. As you and I were prepping for today, we thought we might try to cover five or six things that are really just keys to having a productive and profitable practice, as opposed to just one that kind of sits like an albatross around your neck, dragging you down. Do you want to start at the top of the order today?

Andrew Tucker: 02:44 Yeah, I would love to. I think that as you kind of addressed on the intro, one thing that I've always found passion in is that there's something amazing about entrepreneurship. There's something amazing about the entrepreneurship opportunities in the United States. But I think that one of the things that I often see is that when people are coming in to the idea of ownership, what ownership is going to look like, particularly whenever you're coming from a trade where you're a doctor first or an accountant first or an attorney first, it's really hard to think about that role of entrepreneurship.

Andrew Tucker: 03:15 So that's actually number one is really have a serious internal dialogue. Talk to your friends, talk to your family. Do you want to be an owner? What are the things that make you want to lean towards ownership? Is it a desire to be able to control your ecosystem and do things the way that you want? Is it a desire to be more efficient? A desire to benefit from all of the columns of income that you can generate as a business owner? Is it because you've been attracted to the tax benefits? A lot of times I see people kind of chasing that carrot rather than that being the primary focus. So that's really the first thing I start with is, "Pen to paper, what are the things that really led you to want to become an owner?"

Shane Tenny: 03:55 It's a great point. You don't want to just take for granted that, "Because everybody else is a dentist that owns their practice, I guess I have to as well." Because the fact is there's a lot of benefits of being a business owner and being a practice owner, but a lot of stress that comes with that too. Talk for just a minute, what are some of the benefits of not being an owner?

Andrew Tucker: 04:13 Absolutely. It's funny because a big part of my practice is helping people exit. Not just figuring out the financial ramifications of it, but coming to grips with the fact that most of your career, you've been Dr. So-and-so. And you'll still be Dr. So-and-so, but so much of your identity is tied in that. I know that's how I am personally. So much of my identity is tied in my profession, so it's definitely a position of empathy.

Andrew Tucker: 04:37 But I think the thing I always hear the most from people, I always like to start with, "Why are you excited to get out?" It's always twofold. It's always, "I'm tired of being an HR manager," and, "I never realized how much bookkeeping I was going to be responsible for." Those are the two most common complaints. So unfortunately, whenever... Even in schools that are fortunate enough to have practice management courses in the curriculum, the intensity of having to mediate personnel issues and having to blend personalities together, those are all things that you have to deal with as an owner, that you really get the chance to insulate yourself from as an associate.

Andrew Tucker: 05:13 The other side too, from an associate perspective, is that if it's just not the right time in your life to be able to tackle running a whole business. Maybe you're just starting to have children or maybe you're entertaining the idea. You're just getting married. Maybe you're going through a difficult time in life, going through a divorce, loss of a loved one, whatever it might be. There's a lot of things that I think externally take that desire off your plate as well, and I think it's important to be realistic about those things as you approach it.

Shane Tenny: 05:41 Great points. Again, being an owner can sound glamorous and sound really appealing and has a lot of benefits, but it brings with it stress. And being an employee in a hospital system, in a practice, in a dental group, the concept that came to mind as you were explaining that is sometimes talked about as the benefits and the burdens of ownership. There are benefits, but there's burdens too.

Shane Tenny: 06:02 I'll punctuate, I guess, point number one here, which is to launch your practice at the next level, step one is just to take a minute and contemplate if this is really what you want to be doing. Now, with that said, we assume that if you're listening to this episode, you probably are in private practice already. So we're going to assume that you've taken that step and concluded the answer is yes, you do. If that's the case, Andrew, what's the second thing that you see from your work with practice owners around the country that can really help move things up a notch?

Andrew Tucker: 06:31 Yeah, and I think this one's nice. Like you said, really, most people who are listening to this have probably already entered into that format of ownership, regardless of what that looks like. Doing a personal inventory and really thinking... And this is remarkably... Shane, this is something that I see so many people gloss over it. And we're fortunate that...

Andrew Tucker: 06:49 I always joke that one of my degree's in undergraduate communications. Sometimes I find that oftentimes the most important thing that I have... And I think, Shane, you and I share that in common in that right. But I think one thing that often gets overlooked is just how realistic are you about your own limitations and your own personality. What are you good at? What are you not so great at? What do you know that you're going to need to outsource to other people to give others around you a great final product, a great patient experience?

Andrew Tucker: 07:19 If you've never heard of a SWOT analysis, an S-W-O-T analysis, it stands for strengths, weaknesses, opportunities, and threats. I think everyone should start with an analysis on, "What is my personal strength that I have to be able to provide to my patients? What are my weaknesses that I can go ahead and gauge that people might become frustrated or find challenging about becoming my patient or becoming my employee? What are the opportunities we have out there? What does my special skill set let me tap into? And what threats do I have? What are the things that I..."

Andrew Tucker: 07:54 Oftentimes, this is done in terms of looking at the extrinsic of things. So it has to do with maybe what all is going on outwardly. This one's really kind of an internal question. That's one of the things I love to do. And I think leadership style, getting a sense for what your leadership style is is absolutely essential before you step into that ownership role. Because that's one thing that you're certain of is as an owner, you are a leader. Whether you're inclined naturally to be so or not, you are a leader.

Shane Tenny: 08:19 Andrew, I think that this point of just taking a personal inventory is so critical for those who own their business or their practice, because it brings up this concept of making the space to work on your business instead of just in your business. And when you are in it day to day with the HR issues or the patient issues, the billing issues, the rent issues, the collections, the contractuals, granted, there's never an end to the work. But I think the best business owners and the ones who launch their career or their practice to the next level are those who are disciplined about finding time either every month, every week, whatever the case is, to think about it and do exactly what you have seen and are bringing up here, which is take that personal inventory of your skill set and how you can best leverage your unique ability.

Andrew Tucker: 09:13 Absolutely. I think in particular in the world that we live in, emotional intelligence is so highly valued. You might have seen a predecessor be able to skip over this and find economic success. I truly believe the professional world belongs to the emotionally intelligent in the next 40, 50 years.

Shane Tenny: 09:32 Well, that's a little disappointing. I'm not sure I'll qualify, but I think your point might be right, so...

Andrew Tucker: 09:36 I think you're selling yourself short, Shane. It's important. If you're listening to this and you're well kind of into your career at this point, this is a great way to have a little more longevity. If you're feeling like there's a lot of frustration with your staff right now and you're struggling to communicate, this is a great step to roll back and kind of get back to basics and tune things up a little bit.

Shane Tenny: 09:57 So where are we on our list here? Number one is to really take stock of whether or not ownership is what you're called to do and feel energized by, or whether it feels daunting and draining. Number two is make time to work on your practice, not just in it, by doing a personal inventory regularly to be self-aware as to where your own strengths or weaknesses. What's the third thing that you have seen over the years to really help launch a practice?

Andrew Tucker: 10:25 Yeah, so then the next phase turns to America's favorite game show, buy, build, partner, or hybrid. Are we going to buy a practice, build a practice, partner in a practice, or are we going to do some combination of the above? I joke that it's a game show because at the end of the day, the opportunities you have surrounding you are a bit of a game of chance. It's a bit of a game of luck. It's exciting in that sense.

Andrew Tucker: 10:48 I think that for many people who have taken this journey before, a lot of people will say, "I was in the right place at the right time." But the reality is there's opportunities opening up everywhere all the time, you just have to be ready and willing and open to see it.

Andrew Tucker: 11:02 This kind of is twofolded. It ties not only to the opportunities around you, but it begs the question of... It goes back to that personal inventory, that personal assessment.

Andrew Tucker: 11:13 I'll use an example. This is a recent example that we experienced. My colleague, Will Koster, and I are starting to work with someone. She's leaving a hospital job and she's looking to explore buying a practice. There was an opportunity to buy and an opportunity to potentially build. What we did was we asked the questions of, "If there's convenience in buying the practice and there's frustration in having to change it, does the convenience outweigh the frustration?" In her case, it actually came up that she was not going to buy the practice. It was different enough philosophy of treatment. It was a different school of thought, a different way of thinking kind of of her clinical career, and she ultimately decided that the amount of change that she would have to institute in the practice was too great for her to justify buying it. I think it was the right decision for her.

Andrew Tucker: 12:04 That's just one example of that. But another side of that equation is partnerships, of kind of getting into partnerships. That really, I think, is very important to talk through what is the partnership responsibility. I see more partnerships break up over the lack of communication on tasks that will be assigned and completed, and over the income and how income will be allocated and split, or at least income opportunities.

Andrew Tucker: 12:31 I think that that's important because as a doctor rising into ownership, you've got to realize, and I encourage this on both sides of the equation for selling doctors and doctors hoping to purchase, that owner-doctor who created and facilitated that practice, it's more than just servicing the patients. It's more than just treating the patients and seeing the patients and following through with treatment care plans. So really what that turns into is, "What else are you going to take off of that owner's plate in order to be able to do that? What else are you going to remove from the responsibilities that that doctor has to justify your partnership?" So that's just a few of the things to think about, but again, it really kind of boils down to what's available to you and what are you the most appropriately geared for.

Shane Tenny: 13:17 I'm realizing just the thread through these first three things is just intentionality and thoughtfulness of that.

Andrew Tucker: 13:23 You got it.

Shane Tenny: 13:23 Absolutely. Yeah.

Andrew Tucker: 13:24 Which I think, in one sense, can be rudimentary. And in another sense, it is the missing element for so many of the people I work with. So I mean the doctors I work with. We've kind of become such a derivative conclusory culture that the intentionality, the process of getting there has become a bit of a struggle. I think this is a helpful framework, hopefully, for people out there who are thinking about that next step.

Shane Tenny: 13:50 I think so, because you and I both know people that end up in their role just because it's what they expected, it's what their colleagues were doing, it's what the family business was. Then they realized they've been talked in, or guilted in, or shamed in to some of the... It just isn't for them-

Andrew Tucker: 14:07 That's right.

Shane Tenny: 14:07 ... based on their temperament. So number three there, to launch a new practice by playing the game show, buy, build, partner, or hybrid. What's number four? What's the fourth thing or suggestion you have?

Andrew Tucker: 14:18 Four is, and this is really kind of the breaking into. You'll notice there's a heavy foundation towards, "Is this the right opportunity?" I'll take a moment to say that don't question whether or not you should stick around in a situation that you don't feel like is working. Have a conversation with your partners. In particular, in a partnership environment. If you don't think something's working, have a candid conversation. They may be feeling the same way. And it gives you an opportunity to kind of redefine parameters and redefine the boundaries.

Andrew Tucker: 14:46 But if you're getting to this point you realize you've drifted away from a partner, there's no shame in mutually concluding a relationship. That's really the best way to do it rather than getting to the point where something comes to a head and a massive frustration causes a fracture. A clean, articulated cut is always better if we're going to part ways. I say that from the perspective of you may be at different points in your career, but it's always important to evaluate this first view.

Andrew Tucker: 15:14 When we pivot to four, five, and six, it really is anything that anyone who's in an ownership position can utilize. Number four is what needs to change inside of a practice. A lot of times this deals with purchases, but it also can deal with culture shifts, treatment modality or treatment planning shifts, treatment expansion, regional expansion, all things of that nature. With a financial game plan to accomplish those things, there needs to be a social plan, a continuity plan.

Andrew Tucker: 15:42 There's something called spatiotemporal continuity, which say that five times fast. There's this old thought experiment called the ship of Theseus from a Greek philosopher. The idea is that if a ship leaves a port and goes to battle and is damaged plank by plank over time, if it returns and has none of the original parts, is it still the same ship? When you first think about it, it's kind of a mind-blower. It'll literally blow your mind. But the question really becomes, "How much can you change at any one time and for something to keep its identity?"

Andrew Tucker: 16:14 So what our goal is is to find what are the things that you've got to change quickly. What are the things that can change with a little bit slower pace, but not impact the feel and the quality of treatment for patients? And then what are the things you appreciate about the practice? Because ultimately, if you're going to buy a practice, there needs to be something that's appreciated or enjoyed or preferred, or else you're better off starting your own, to be candid.

Shane Tenny: 16:37 So our number four here is just taking stock of the practice itself. What needs to change, or what can we do to improve? As opposed to just getting stuck in, "This is the way we've always done this."

Shane Tenny: 16:49 Now, I think I might add to this, there are some entrepreneurs that have a lot of energy for creating things and they can see, "This is what we ought to do. The furniture would be better. Our treatment plans would be better. Our billing would be better," and they have a lot of what we call quick start energy.

Shane Tenny: 17:05 But there's also some, by temperament, who don't have a lot of energy. Their strength is they just follow the same system. Very disciplined, very structured, that sort of thing. Those are the folks that I think can be most encouraged or most benefit from asking others around them, often staff, employees, maybe even select patients, "Hey, if you could change one thing here, what would you do? What do you think would take us to the next level?" So sometimes you have to get outside input to help you see what needs to change, or at least outside input to help you give you the motivation to change and [crosstalk 00:17:44].

Andrew Tucker: 17:45 Absolutely. Yeah, and shameless, guiltless plug here, that's one of the things that is great about our team. We've got a lot of... I'm guilty as charged from that quick start perspective. That's why I always try to surround myself with teammates who have that follow through, that systems orientation, because it's a little bit like a toddler in a candy shop sometimes in terms of the focus on one particular topic. But that joke aside, and that we'll jump into when we get to six and just surrounding yourselves with professionals that compliment you well.

Andrew Tucker: 18:16 I think the thing that I see as the most common point that has to change quickly is staff. Staffing issues, they're toxic. One bad apple ruins the whole bunch is the old phrase and saying. But when you've got a barrel of apples or you've got six apples, one bad apple ruining all six is pretty likely in that circumstance, as opposed to an entire barrel.

Andrew Tucker: 18:37 I think that's an important thing to realize that you don't want to go in and start rolling heads immediately, start terminating people immediately. You want to work to get to know people. But at the same time, if you have a bad sense about an employee that you've acquired, it's probably a bad sense for a reason, whether it's a mismatch in personality or whatnot. So it's oftentimes a better decision to find a way to part ways with those people early, but not do too much of that so we still can maintain continuity. So that's the first place I look whenever I'm in this step.

Shane Tenny: 19:09 That's a good point. I'll pile on to that and then we can move on. But one of the challenges of small business owners, because you only have three, four, five, six, eight, 10 employees, one of the biggest risks is getting held hostage by that bad apple. I've learned this from coaches we've worked with before and in the past. It's really the concept of tolerating unacceptable behavior because you have no other plan B, because you haven't spent the time or don't routinely stay open to new personnel, people that could work in your shop, people that have dropped off resumes, people you've networked with. Because you don't have a regular process or appetite for meeting new people, then you tolerate the person who only has a select skill set knowledge because there's no way to replace them. So that would be, I think, one element that I've seen and would encourage is to whether you're running an office of three people or an office of 33 people, either you or your chief lieutenant, let's have a culture of always looking for great people.

Andrew Tucker: 20:13 Exactly.

Shane Tenny: 20:13 Unless I'm mistaken, Andrew, I think that's really how we crossed paths, because of-

Andrew Tucker: 20:16 That's exactly right. That's exactly right.

Shane Tenny: 20:19 [crosstalk 00:20:19]. So that's fantastic.

Shane Tenny: 20:25 Do you have a financial junk drawer? Even before I describe it, you probably know what I'm talking about. Just like that proverbial drawer in your kitchen or laundry room. You know, the one filled with pens and pencils, screws and duct tape, matches, chopsticks, maybe even an old sock. The drawer filled with things that you didn't know where else they belong.

Shane Tenny: 20:47 Well, many of us, as we go through life, accumulate a sort of financial junk drawer filled with an insurance policy we bought from a college roommate after graduation, an old 401(k) that we never moved from an early job, or bank accounts that we opened to get a car loan or mortgage, even though we don't bank with that institution. The more products, accounts, and policies you have, the harder it is to create a centralized vision and progress towards the goals that you have. Whether you're working with a professional financial planner or trying to tackle these things by yourself, the more organized you can be, the more effective you'll be at making the changes and monitoring the results towards the goals that you have.

Shane Tenny: 21:34 If you need help in this regard, click on the show notes below and download our free guide, Five Steps to Organize Your Finances. I can't say it's a fun way to spend a weekend, but you'll be amazed at the progress you can make if you'll just start cleaning out your financial junk drawer.

Shane Tenny: 21:55 All right, number four there, being open to change and looking for change and having the courage to do it. What's number five? What's the fifth thing that owners [crosstalk 00:22:02]?

Andrew Tucker: 22:02 One thing I might land on with four too is I think we talked about it being really kind of structured around just changes in the day-to-day or the physical. But I think one thing that's helpful is creating a plan of what you think everyone in your organization is capable of producing. We have doctor production, we've got supporting professionals. So we have our PAs within the system. We've got hygienists in the system. We have associate doctors in the system. Being able to identify and quantify the productive value to a dollar amount that we think people will be able to provide really helps us plan for where we're headed. So I always like to do that too. That's one thing I want to throw out there before we move on.

Andrew Tucker: 22:40 But the fifth is what... Actually, there's a smooth transition into it, and that is once we've identified those productivity goals, which I think you could call a key performance indicator, number five is identify a select few key performance indicators. You'll often hear it described as KPIs. The old school, you just called them ratios, but that's basically the same idea. What are those KPIs, key performance indicators, for success? I think there's a couple of rules of thumb I like to use here on this. The first is track every piece of information you absolutely can. And if possible, do it from an automated perspective. So if you have an automated option to track something, do it. If you have a practice management software that helps guide you through your day-to-day operations, learn how to generate those reports. They can become wildly valuable later.

Andrew Tucker: 23:32 But I think that there's a flip to that. There's always a balance. Kind of a dichotomy in a sense. We also want to make sure that we've got a handful that we focus on, particularly related to the practice. That's really twofold. One could be industry-specific. So it could be the ratio on the production of your PA versus the physician. That could be a target in a particular industry. It could be a ratio of your hygiene production to a dentist is another example. But we want to be mindful of things that are industry-specific to us, and then we want to be mindful of shortcomings that we have professionally, right? Or the shortcomings the practice might have.

Andrew Tucker: 24:13 A good example is in a more affluent area, seems kind of counterintuitive, but in a more affluent area, treatment acceptance can often be lower for plastic surgeons, for dermatologists, for orthodontists, for people in kind of that luxury, that maybe optional, more aesthetically-oriented treatment that we can seek. Those things tend to see a lower treatment conversion because there's more second opinion, there's more doctor shopping in that process. So there's a big gap of what we call a pending pool.

Andrew Tucker: 24:44 That might be a thing for a doctor who's in Miami. A plastic surgeon in Miami, who does a lot of aesthetics, might be very mindful of that ratio. But a plastic surgeon in Texas, who does reconstruction, might not be so keen to worry so much about that ratio. So it's all specific to the practice. But I think the key thing here is the key of the key performance indicators is finding a few to focus on. Because if you focus on all of them, you end up in a circumstance where you stop being able to really understand everything that's going on, and it creates confusion rather than clarity.

Shane Tenny: 25:18 You're right. You want to track everything. I once heard the analogy of a cockpit. When you enter a plane-

Andrew Tucker: 25:23 That's exactly where I was going, actually. That's funny you say that.

Shane Tenny: 25:26 Is it? Okay, so-

Andrew Tucker: 25:26 Yeah, it was.

Shane Tenny: 25:27 ... I'll finish it and then throw the question.

Andrew Tucker: 25:29 I love that.

Shane Tenny: 25:30 You walk into a plane, you look to the left, the pilot's sitting in there and he's got a hundred gauges all over his head. And you think, "How in the world does he keep track of all of those?" The truth is he doesn't.

Andrew Tucker: 25:39 That's right.

Shane Tenny: 25:39 He looks at four or five of them. And if those five gauges are fine, he doesn't need to look at the other ones.

Andrew Tucker: 25:45 That's exactly right.

Shane Tenny: 25:45 If there's a problem with your altimeter or a problem with one of the other gauges, well, then I drill down on that by looking at the other things. So I think that's the-

Andrew Tucker: 25:53 Exactly.

Shane Tenny: 25:54 ... visual to your point about four or five key performance indicators. My question is going to be what do you see as kind of the most common foundational ones that a practice needs to be looking at?

Andrew Tucker: 26:03 If I had to pick certain ones that I think apply for everyone... And I love that analogy because we talked about automating as much data as possible. When one of these presents an issue, flags an issue, then knowing, "Yeah, okay, let's go find more information elsewhere and figure out what's going on."

Andrew Tucker: 26:22 So things that I think that are generally applicable across the board that are not necessarily specific to any one segment is understanding your receivables cycle. So understanding how from an income perspective. So if we have billing that's done, how much of that are we collecting? And within what timeline are we collecting?

Andrew Tucker: 26:41 Here's a great example of that altimeter versus other information example, looking at one ratio versus others. If that ratio is great, we don't worry about the subcategories. But if that ratio is poor, now all of a sudden we go, "Okay, is it our patients who are not paying us, or is it the insurance companies who are not paying us? What insurance company is not paying us? Is it because of denials or is it because of delay of the check? If it's because of denials, what are they denying us on? Are we seeing an overall trend in a particular type of denial?"

Andrew Tucker: 27:11 I've actually got a practice right now dealing with just that issue. They've identified it down to a specific company for a specific reason, and they're addressing that. But had they not tracked that information, they wouldn't necessarily have it. Not to get down a rabbit trail there.

Andrew Tucker: 27:23 So we've got my accounts receivable, what are the receivables that we have coming into the company, treatment acceptance. If we're coming up with a treatment plan for a patient, what is the amount of treatment that is accepted and what is the amount that's either pending or denied? What's the amount that someone says... And pending, really, is just a fancy way of saying, "Hey, I need to talk to my spouse about that. I'll let you know. Hey, I don't have my calendar. I'll schedule that later." So those are things that are pretty important for us to be able to explore. I'd say those two are universally accepted.

Andrew Tucker: 27:54 And then another one's just your general profit ratio of your business. What is the general profit ratio of the business? And then what are your variable expenses? What are the expenses that are kind of tied to what you're doing? If you can track those three and then find a few industry-specific things, that is going to answer 70% to 80% of every question you might have.

Shane Tenny: 28:13 Yeah, and I might throw in too that just came to mind while I was talking, I mean, super elementary, which is just, "What's your procedure mix?" What are you doing during the day, and how much of it are you doing? How busy are you?

Andrew Tucker: 28:25 That's right. Yeah.

Shane Tenny: 28:25 If you're a doctor, are you seeing 10 patients a day or 50 patients a day? Are you doing steroid injections or are we in the OR? Both of those, so again, really basic here, but how many patients are you seeing and what are you doing for them in addition to the collections ratios and the other things.

Shane Tenny: 28:39 All right, so Andrew, number six. What's the sixth thing that folks in private practice can do to really help them move to the next level?

Andrew Tucker: 28:47 Really the thing that really helps bring all of this home is surrounding yourself with a good team of professionals who understand your business and what you're doing. So that's it. Number six is what do you need to do in order to be able to surround yourself with a team who understands your business.

Andrew Tucker: 29:04 If we're kind of looking at their traditional list of what you need to add to that team, with relative, it's kind of like your... It's coursework. Whenever you're in school, you've got your requirements and you have your electives. So we've got things that are required. We know that you're going to need someone who is a planner. Organize all of your operations, all of your personal life, all of the accounting, all of the legal stuff. Make sure that there's no stone unturned and everything's taken care of. Then we have your CPA who's right up there in terms of importance, particularly for business owners, of being able to help with operations, understanding the financial impacts of certain decisions you make inside the practice, tax reporting. And then from an attorney perspective, we'd need to have someone who understands business law or entity law to be able to help make sure you keep everything in compliance on a year-to-year basis within the entities you have for your business.

Andrew Tucker: 29:58 Then there's a list of people who it's important to kind of have... This is the elective list. That you want to have someone that you know of or someone who you're familiar with for when the issue comes up. For instance, an estate planning attorney. It could be someone who's the same as your business attorney, but sometimes it's not. You want to make sure that someone's independently credentialed, independently appropriate to work on that issue. You also have practice transition specialists, people who can do the valuation services, attorneys who work in that transition space, potentially as a team.

Andrew Tucker: 30:31 There's also other people who you don't need to have specialization. For instance, your payroll provider doesn't need specialization or any kind of knowledge in medicine or dentistry to be successful. Shane, any others that you would think of potentially? What else?

Shane Tenny: 30:46 Typically, your corporate insurance, your business [crosstalk 00:30:50].

Andrew Tucker: 30:49 There you go. Yeah.

Shane Tenny: 30:50 Things like that are areas where just knowing how to do payroll is enough. Payroll isn't that different for a medical practice or an architectural firm. But I think to your point, I mean, you've got your core and electives, your CPA, your business attorney, your financial planner, and your business transition person. You want to find the people that know your discipline, whether it's dentistry, whether it's medicine. That specialization is valuable in that team of advisors. I think that's kind of the point you're making here.

Andrew Tucker: 31:19 Yeah, absolutely. I think another side of it too is that just because you can identify an issue as a professional doesn't necessarily make you equipped to handle it. Great example, we had a recent plumbing issue. Walked into the bathroom the other day after someone flushed it and walked away, there's water on the floor. I didn't need to be a plumber to realize that there was a plumbing problem. That said, I had to call a plumber to fix that problem because I am not equipped to be able to handle that. So that's a great example of just because someone can spot an issue doesn't necessarily mean they're equipped to handle it or have the knowledge in order to be able to solve the problem.

Shane Tenny: 31:54 Yeah, that's a good point, right. Any CPA is going to be able to read a P&L and know if there's something that doesn't balance, but the accountant that knows dentistry or the accountant that knows medicine is going to be able to drill deeper onto, "Okay, what's the accounts receivable issue? What's the income issue? Why is there not a balance here? What can we then do about it?" and those sorts of things.

Shane Tenny: 32:13 This is a great one. As you point out, perhaps a shameless plug, but surrounding yourself with a good team of advisors is definitely a valuable exercise.

Andrew Tucker: 32:22 That's right.

Shane Tenny: 32:22 Any parting shots here, Andrew, or I can wrap us up?

Andrew Tucker: 32:25 I think the thing that I would... There's really kind of two, and I think one of them would be if you're thinking about moving into ownership, but you're not sure, it's an amazing opportunity. There's an amazing amount of flexibility that creates. But like I said, if you have a good team around you, it takes a lot of the stress off of being able to create this.

Andrew Tucker: 32:42 So starting a team early is important. Working with people who understand that growth curve and are sensitive to that is important too. I love to build relationships with people who are fresh into the mindset of wanting to become an owner and help them get to that point.

Andrew Tucker: 32:57 Another side of it too is is that even if you are historically an owner and you haven't done some of these things before, this is something great to be able to implement now. Even some of the steps that are kind of pre-acquisition thoughts. It's not a bad move to go ahead and do that because just like you buy your house and live in it, you can renovate it at any time. This is kind of an emotional renovation, a philosophical renovation for your practice, if you so choose to do it. It's a great way to prepare yourself to be able to transition out of practice at some point in the near future too because a practice that's high in emotional intelligence is going to be more appealing to the generation buying practices in the near future.

Shane Tenny: 33:36 Excellent. Well, Andrew, thanks for making time for us this morning. I will say we'll put in the show notes a link to your bio. So anybody who's listening, if you want to connect with Andrew and talk more personally about your own situation, we'll make sure you can do that. You can track him down. Thank you for joining us today.

Shane Tenny: 33:51 Always invite you to subscribe to the podcast. If you subscribe, you'll end up getting an automatic notification when we release new episodes every other Monday, and you can find us on most social media channels.

Shane Tenny: 34:01 As always, I'd love to hear directly from you. If there's a guest you'd like to have on the podcast, if there's a topic you'd like to talk about, you can email me directly, shane@whitecoatwell.com. Thanks so much for joining us today. We'll see you back here next time.

Outro: 34:18 This episode of the Prosperous Doc Podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of the Prosperous Doc Podcast.