If you’re being overwhelmed by the demands of your practice, Dr. Rick Steedle offers a way out by focusing your efforts on your essential roles and responsibilities



The problem–too much to do, too little time
It’s all so overwhelming, finding time to do everything we need to do in our practice. On  one hand, we spend most of our time in the office with patients. But as we go through the day, we notice that certain aspects of our practice are not operating well, and we make a mental note to do something about it, all the while feeling pulled in so many directions.

We’re always busy, but not always effective. If we pause for a moment to look, we see that:

•    some important things are not getting done well; other important things are not getting done at all,
•    there’s little time to plan significant improvements, little time to explore new opportunities, and,
•    our practice may be intruding on our personal time, upsetting our work/life balance

The problem is not that we have too much to do; the real problem is that we’re trying to do it all. The purpose of this article is to clarify which roles and responsibilities are exclusively ours, giving us a way out of these overwhelming demands. Then, by delegating our nonessential tasks, we can become more effective with less time and effort. So, how should our time be spent in our practice? How can we escape from being overwhelmed by all the mundane tasks, giving us more time to organize, plan, or simply unwind?  

The perspective–the three “hats”
We’re so busy in our practices because we wear so many “hats.” We’re the specialist, the staff leader, the one everyone comes to when problems arise in the office. We may do payroll, help with ordering supplies, answer questions about insurance, and decide how to handle overdue accounts. The list seems infinite. So, what “hats” should we wear to be most productive, and what steps do we need to free up our time?

Before we can move from busyness to greater effectiveness, we must change our perspective about our critical roles in the practice, making three adjustments to our point of view:

•    First, we must make a clear distinction between working in our practice and working on our practice.  We are working “in” our practice when we are doing the day-to-day “work” that needs to be done. That includes delivering care, managing the payroll, ordering supplies, calling dentists, talking with patients, etc. We are working “on” our practice when we are focusing on long-term planning (the strategic objectives) of the practice and developing better ways (systems) of doing what needs to be done. The primary objective is to spend less time working “in” our practice so we can spend more time working “on” our practice.

•    Second, we must understand that there are different rules when working inside our practice (as the specialist) and working outside our practice (as the owner). When we work “inside” our practice, we must abide by all the rules of behavior that we require of our staff. If not, we will lose credibility and respect. So, if the staff must be on time, then we must be on time. If they must minimize personal calls, then we must minimize personal calls. We must provide a role model for proper behavior, because “what we do” speaks more loudly than “what we say.” When we are working “outside” our practice, we can make the rules, deciding how many days to work, when to take vacation, and whether to hire or fire staff.

•    And third, because of the first two perspectives, we can now recognize that we have three key roles1 in private practice—the three “hats” we should wear. Above all, we want to concentrate on being the best clinical specialist, the most effective practice leader and manager, and a successful business owner. By knowing the key responsibilities of each, we can then delegate everything else to competent staff.

Our three essential roles are:

1.    The master clinician (working “in” our practice from the “inside”)—focusing on becoming a better clinical specialist (technical expert) through continuing education, introducing new treatment modalities, developing treatment protocols, and training assistants.

2.    The inspirational leader (working “on” our practice from the “inside”)— focusing on becoming a better leader though building a cohesive high-performance team, developing staff leaders, designing better clinical and office systems, and fostering great relationships inside and outside our practice.

3.    The visionary owner (working “on” our practice from the “outside”)— focusing on becoming a more successful business owner by making good strategic decisions for the practice–long-range decisions that determine the overall direction and success of the practice. Where are we going, why are we going there, and how are we going to get there?

The solution
So, how can we stop feeling overwhelmed and become more effective with our time? Primarily, we must discipline ourselves to give up responsibilities that can be done by others. The guiding rule is, “Do only what only you can do.”  Although this transition may require some initial effort, once begun, the time we “save” delegating nonessential duties can be “reinvested” towards becoming increasingly more effective. We decide what to give up by understanding the primary focus and direction that we should take in each of our three key roles (Figure 1):

Role 1—As master clinician, we must separate our “essential technical work” from our “nonessential technical work,” concentrating on only those tasks that require our training and experience. So what “essential technical work” is ours alone? We should concentrate on two areas: our key clinical responsibilities (improving the delivery of patient care) and the indispensable nonclinical responsibilities (such as communicating with parents, patients, and other dentists).

So, what then is our “nonessential technical work?” It’s all the work that potentially can be delegated or outsourced (that is, anything that violates the “Do only” rule). That includes doing payroll, ordering supplies, constructing appliances, and processing nonclinical paperwork. It’s also many of the other things that we do when we stay late at the office or come in on our day off. Ultimately, as our practice grows, we should delegate all of these responsibilities to competent staff.

Strategy 1 — Start with the “Do only” rule. Identify the nonessential technical work you are doing now by making a list of all the responsibilities that you have which, with proper training, can be delegated or outsourced. Pick your biggest time-frustration and find ways to reduce your time commitment to it, either by delegating it to competent staff or creating a new more efficient system for getting it done yourself. For example, if you spend an hour per day with paperwork, then you are spending approximately 200 hours per year at this task. Is there a way you can streamline this process? Always ask the questions: What is my time worth (income/hr), and is this task worth my time?

Role 2 — As an inspirational leader, we must reallocate our time from “technical work” to spending more time doing “strategic work.” Strategic work is all the management decisions and leadership responsibilities that ensure the smooth operation and continued success of the practice. We fulfill this role when we are designing better practice systems, developing staff leaders, leading the staff team and building relationships inside and outside of the office. Eventually, as the practice matures, even much of this strategic work can be delegated to your Practice Manager.

Our focus here should be on “getting results” rather than on “maintaining control.” When we insist on control, we believe that “If it’s going to be done well, I have to do it myself or determine how it should be done.” When we concentrate on results, we say, “These are the desired results I want; let’s work out a way to achieve them together.”

Strategy 2 — As you free up time by delegating your nonessential technical work, reallocate more time to the leadership role. Begin to meet with your staff more to resolve chronic issues, selecting the most important project to improve the practice, developing better office systems, solving problems, and, at the same time, cultivating staff leaders and building responsibility on your team.  Also, don’t reinvent the wheel. Whatever you want to do, some other practice is already doing well. Discover their system, copying and modifying it to meet your needs.

Role 3 — As a visionary owner, we must allocate time to do “strategic planning” either alone or with our business partners, staff leaders, life partners, and family, carefully considering our long-range plan with regard to work-life balance and our practice’s values, vision, and strategy. It’s the preparation and planning that sets a clear direction for the practice, making everyone more productive.

We focus here on the long-range decisions that determine the overall direction and success of the practice as it responds to the practice’s ever-changing environment. These “environmental” changes may be a new competitor, a difficult economy, or a new associate, satellite, or treatment system. The new challenges may be predictable, unpredictable, or even unknowable, but the opportunities and threats must be recognized and decisions made if the practice hopes to thrive.

Strategy 3 — Designate more time to do strategic planning. Schedule a yearly retreat with your staff. Develop a strategic planning group within the practice with the Practice Manager and key staff leaders, meeting regularly to resolve problems and plan for the future. Outside the practice, seek out others inside and outside of dentistry who are like-minded and in the same stage of life/career. Take time to sit down with the significant people in your life and look ahead. Also, especially for professional women, develop relationships with others who share your unique issues and concerns.

Conclusion
It’s easy to become overwhelmed in private practice. We spend so much time working “in” our practice that there is precious little time left to spend working “on” our practice to be more effective and limit our commitments there. But by getting clear about the three key roles in our business and clarifying our primary responsibilities in each, we can move toward devoting less time and still being as productive.

This transition may take time. There is no quick fix to complex, long-term problems. Significant changes require significant time and, as specialists, we should understand this better than most. With persistence and patience, though, it is possible to have a highly productive, low-stress practice by “doing only what only we can do” and delegating the rest.

Bio

Rick Steedle, DDS, MSEd, MS, received his dental degree with honors from the University of Pennsylvania, concurrently completing a Masters Degree in Education. He received his Masters Degree in Orthodontics at The University of North Carolina at Chapel Hill where he was awarded the Morehead Fellowship in Post Graduate Dentistry and an NIH research training fellowship. After orthodontic residency, he served on the faculty of the Wake Forest University School of Medicine for 4 years before entering private practice. During the next 20 years, he and Dr. Bruce McLain built a three-office orthodontic practice with a staff of more than 25 employees in Winston-Salem, NC. In 2005, Dr. Steedle joined the part-time faculty at the Department of Orthodontics in Chapel Hill. Since then, he has developed a 3-year curriculum in Practice Management for the residents, complementing the work of Dr. Robert Scholz there. UNC now has one of the most comprehensive Practice Management residency courses in the country. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Gerber ME. The E-myth Revisited – Why Most Small Businesses Don’t Work and What to Do About It, 2nd ed. HarperCollins Publishers, New York: 2001.

2. Attributed to Edsger W. Dijkstra (1930-2002), Computer Scientist.

3. Steedle JR (2010) Leading an all-star staff. J Clin Orthdod 44(8):487-494.