Sep 7, 2018

How to Become a Decamillionaire Doctor, Part I

Written By: Nate Williams

Who Wants to Be a Decamillionaire?

For over a century in the United States, “millionaire” has been the ultimate standard for financial accomplishment. Unfortunately, millionaire doesn’t carry the same “ring” to it as in decades past. Although it is always fun to see our clients’ net worth pass the 7-digit mark, to sustain a lifestyle that most doctors become accustomed to, they will now have to far surpass the millionaire mark.

At Practice Financial Group, we have been preaching for years now that the ideal financial status is to be debt free with a $5,000,000 to $10,000,000 in retirement investments. This number excludes your practice, your building (if you own it), and your house.

Does this sound lofty? Although we are optimistic by nature, we only set achievable goals. This goal of being debt free and having $5-10 million in the bank is quite achievable, but most doctors will not reach this mark.

To become a decamillionaire doctor, there are at least three aspects to this process in which you must succeed. If you fall short in any of these areas, you’ll fall far short of your financial potential, guaranteed.

  1. Become a clinical expert
  2. Learn to make money with your clinical expertise (i.e. run a profitable business)
  3. Learn to manage your money like a decamillionaire (i.e. get out of your own way!)

Step I: Become a Clinical Expert

This first step is intuitive. Your entire profession is based on patients coming to you for expert guidance and clinical skills. If you perform substandard work, you’ll fall short of your financial potential.

I always bristle when I talk to dental students who are more concerned about buying their first practice than they are developing clinical expertise. A dental school student should have one primary concern: Become the very best clinician imaginable during the time she/he is in school.

After school, the wealthiest doctors I know never stop learning and improving their clinical skills. They are either specialists or general dentists who have invested extensive time (and money) into learning specialty skills to further help and “add value” to their patients. If you line up 10 doctors in order from best clinical skills to worst clinical skills, then you rearrange that line from highest income to lowest income, the order of the line will look very similar.

In summary, if you want to become a decamillionaire doctor, you must become an excellent clinician.

Action: Take a quick self-evaluation and then make a plan to improve

  • What additional services or procedures could you learn to provide that you don’t currently offer?
  • What services or procedures are you interested in learning?
  • What services or procedures do you think your patients would procure from you if you offered them?
  • What training courses should you take in order to obtain those skills or improve on the skills you already have? (Tip: “None” is probably the wrong answer)

Step II: Learn to Make Money with Your Clinical Expertise

Becoming a clinical superstar is the first—but not the only—step in becoming a decamillionaire doctor. Once you have learned a trade, you then need to develop the skill of making money with that trade. This blog post is not designed to be an exhaustive study on this topic – a book would be more appropriate for that – but you need to catch the vision that the skill of making money with your trade is a different skill than the trade itself, and a skill that you need to master if you’re going to reach your potential.

Here are some key components of the skill of making money as a dentist:

1. Learn to Lead

There are few topics that have more text written about them than leadership. My purpose here isn’t to reproduce the volumes written on this topic, but to emphasize the importance of being a leader in your practice if you’re going to convert your clinical skills into sustained financial success. Many doctors shirk this responsibility; it takes time and deliberate effort to lead effectively. And sadly, some doctors just show up, do their clinical work, then go home without even talking to their employees. I’m sure most of you would like to do that, but believe me, the harder road to take is one in which you don’t lead your team because they will underperform and then leave.

The first thing you need to know about leadership is this: you can become a better leader. Yes, to some leadership comes more naturally; but you can learn. Here are a few key principles of leadership that anyone can apply:

First, a leader understands the people he/she leads. There are few things that inspire loyalty more than the feeling of being understood. As such, a good leader listens without being condescending and without jumping to conclusions. For more on this topic, read the chapter “Seek First to Understand, Then to be Understood” by Stephen Covey in 7 Habits of Highly Effective People.

Second, a leader appreciates the people he/she leads. A good leader will not only say thank you, but this person is filled with genuine appreciation for the people who support him/her. See this blog post for an excellent example of appreciation for those who enable your success:

Third, a leader is selfless, thinking more of the team than his/her own interests. Simon Sinek taught this principle masterfully in his talk: “Why Leaders Eat Last” (

Fourth, a leader leads by example and a good leader holds him/herself accountable for his/her actions and holds others accountable too. Leaders want others to perform. In order to empower performance, people need to be held accountable and it is nearly impossible to hold others accountable without holding yourself accountable to them.

The simple principles mentioned above are not intended to be exhaustive. They are intended to show that anyone can do this, anyone can be a leader. We often and incorrectly think of leaders as being the tallest, most charismatic person in the room; the reality is much different. Sometimes the best leaders are the most unassuming; the ones who don’t suck the air out of the room with their egos, and the ones who don’t demand all of the attention. Again, anyone can lead. But to become a leader will take time and effort to learn how, and then will take time and effort to implement. But the rewards are far worth the cost.

 2. Learn to Setup and Manage Basic Systems in Your Business

The book, “The E-Myth Revisited,” by Michael Gerber, tells of the common plight of the expert clinician in America who tries to take her skill of dentistry and turn it into a business. In this attempt, too often the clinician gets destroyed by the business, never getting the opportunity to fully showcase her clinical skills. We often see middle-age doctors, in the prime earning years of their career, giving up on their business due to burnout. As Mr. Gerber accurately describes, so much of this is due to the lack of design and implementation of basic systems in the business. If this is you, get help.

What are systems? Systems are simply a way of doing things. For example, there are different ways to answer the phone. You should train your people to answer the phone the right way, and to do it that way every time. A good system is one that is effective and implemented consistenly.

Dentistry is a very simple business, requiring simple business systems. You don’t have to be a Harvard MBA to run a dental practice, but you will likely need help from a qualified consultant to help you establish basic systems around these questions:

  • How do you answer the phones? (should be good and the same every time)
  • How do you greet patients when they walk through the door?
  • How do you bring patients to the back and get the images you need?
  • How do you perform exams, diagnose, and present treatment?
  • How do you perform the clinical work?
  • How do you chart your work?
  • How do you bill the patients and/or insurance companies and collect your money?
  • How do you check the patient out of your office and reschedule the return appointment?

Think of these processes like a well-oiled football team. In the huddle, the QB calls, “answer the new patient call on one, BREAK!” That play (answering a call from a new patient) is then run with perfect execution and with the same predictable, reliable outcome every time. That is the goal.

Perhaps there is not only one right way of doing things, but there are bad ways to do things, good, better, and even best ways to do things. You should be confident to know that you’re doing things the better or best way, every time. And again, you and your team need to be consistent.

The best example of this in business that I know of is McDonalds. They have their systems so refined that they know exactly how many sesame seeds are on their bun and grains of salt on their fries. And when you order a Big Mac, it tastes the exact same whether you order it in Portland or Puerto Montt. Your practice should be the same. Your patients should receive the same exceptional care whether they come on Tuesday or Thursday, or are greeted by Sandy or Susan.

3. Learn to Sell  (Click here to read another PFG article on selling dentistry)

Some doctors cringe at the thought of “selling” their work. We often equate “selling” to the sleazy guy at the fair who, with unrelenting pressure, tries to convince you to play his rigged game; or the car salesman who is trying to sell the car “as-is, no warranty” when he knows it’s a lemon. Because of these and so many other bad examples, the term “selling” has come to mean “trying to talk people into buying overpriced, crappy things they don’t want or need for the gain of the salesman.”

To me, that is not salesmanship, it’s conmanship. True salesmanship is high class and helpful. But instead of calling it “selling,” I believe that what your patients are looking for is a “trusted dental advisor” who isn’t afraid to ask questions and speak directly.

When it comes to being a trusted dental advisor, the process is simple. First, you are absolutely committed to a principle we call in our industry fiduciary. A fiduciary implies the highest level of integrity and is the professional term for the golden rule – that you advise your patients the exact same way you would advise yourself (and you are a dentist, so hopefully you have a high standard of oral healthcare).

With this fiduciary standard in your mind and heart, you then determine what the patient’s goals are for his/her oral health. Ask questions, then listen… Do not assume that you know what the patient wants. Instead of assuming the patient is happy with no cavities, you might ask:

“Is there anything at all that you would want to change about your smile?”

I’m not talking about over-diagnosing (remember the golden rule), I’m talking about the fact that modern dentistry is a luxury, and there is nothing wrong with talking to your patients about the possibilities of your work beyond what they need to avoid root canals. For example, at one of our highest producing client’s office, the hold “music” is a recording of the doctor saying things like, “Have you ever noticed a movie stars’ smile? Do you know that they probably paid for that smile? Ask us about the possibilities in your own mouth…”

Most people don’t know what is possible in modern dentistry and even if they do, they will not know what you can do unless you tell them! And don’t be afraid to “sell” them a $50,000 full-mouth makeover. Many people will pay that much for a new car every few years; wouldn’t they then be willing to pay that for a new smile that will last a lifetime? Probably not if you don’t ask them!

After spending some time to understand what the patient really wants for their oral health, and after performing a thorough diagnosis, you determine the gaps between their ideal and their reality (e.g. I want to keep my teeth forever, but I have early onset periodontal disease). Then you persuasively help the patient choose to do the work necessary—work which you would recommend and perform on yourself—to get on track with their ideals.

Remember, your patients do not speak your professional language and they do not have all the knowledge to make the right decisions for their oral health. As such, they don’t want you to give them a bunch of options; instead, they want you to give them recommendations of what you would do for yourself.

4. Do Your Work Fast

Recently I spoke to a client who was struggling to meet his financial goals. After some discussion, I asked him how long it took to build up and prep a crown. He said that he has no idea how long it takes, but he usually schedules 90 minutes for that procedure, spends the whole time with the patient, “but I often finish before the 90 minutes is up,” he said. While we were on the phone, I told him that I was going to text a few of my highest producing doctors and would ask them the same question. Here are some of the responses I got:

Response #1: “Buildup: 5 min. Crown prep: 5 min. Pack 2 cords for retraction: 2-3 min. Refine prep: 2 min. Scan: 2 min. Assistant makes temp.”

Response #2: “10-15 minutes. The patient is already numb and then that time starts.”

Response #3: “My time, 15-20 minutes. Total appointment time 1:30.”

What’s the point? First, these doctors delegated everything possible and they performed their work fast! Second, all of them knew exactly how much time this procedure takes them. This is not revelation or an opinion, it’s math. If it takes you twice as long to do a procedure, you’ll make half the income.

The same client (back to the phone call) then told me that he would feel uncomfortable charging his fee if the procedure didn’t take a certain amount of time. In other words, he believed that the patient would feel better about paying more if the work took longer. Consider this from the patients’ perspective for a minute: the patient is lying on his back, with his mouth forced open, and you’re drilling on his teeth. Do you think he is thinking: “Gosh, I sure hope the doctor takes her sweet time?” If you can accomplish the same high-quality work faster, I’m sure your patients will understand, and even appreciate you for it.

If you want to come anywhere close to reaching your financial potential, you’ll need to learn to lead, learn to setup and manage business systems, learn to sell, and perform your work quickly. Doing these things well, and constantly striving to improve, will help you turn your excellent clinical skills into dollars in your account.

Action: Take an evaluation of these different aspects and make a plan to improve.

  1. Learn to Lead. Check out these resources:
    1. The talk, “Jesus: The Perfect Leader,” by Spencer W. Kimball (
    2. The book, “Leadership and Self Deception,” by the Arbinger Institute
    3. Simon Sinek’s, “Why Leaders Eat Last” (
    4. The Facebook show, “Tom vs. Time,” episode III: “The Social Game.”
    5. The internet is FULL of excellent, free resources on leadership. Just take the time to study, learn, and to become a better leader.
  2. Learn to setup systems:
    1. Make a list of each activity that you do repeatedly in your office (see list above)
    2. For each listed activity, determine if you have a standard procedure to do that activity (a set way of doing things).
    3. Is the procedure in writing?
    4. For phone calls, do you have scripts written to address common questions?
    5. Consider hiring a consultant to come help you establish systems (most of the best doctors have hired consultants at some point)
  3. Learn to sell:
    1. Start tracking this ratio: total production / total recommended production (the percentage of your accepted recommendations). Don’t worry about comparing this to someone else; instead, compare it to yourself overtime and strive for improvement.
    2. When you’re presenting a treatment plan to your patients, ask an assistant to listen in and provide feedback.
    3. Consider reading a book about selling, like “Integrity Selling for the 21st Century” by Ron Willingham.
  4. Do your work fast:
    1. For this, the action is simple, but will require discipline: start timing your most common procedures (if not all of them). Record the times.
    2. The simple process of recording your times will increase your awareness and your speed.

In conclusion, once you have become a clinical expert, the next step is to learn to make money with that expertise. The two are interdependent, but not the same. To acquire the skills necessary to do both, almost all of you will need help. The best doctors do not DIY their professions, they get help.

Step III: Learn to Manage Your Money Like a Decamillionaire

(To be continued).

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