Spare a thought for the boss
They’re always whining on about costs. Associates not working hard enough. Nurses chatting in the stock cupboard. Patients not paying their bills. Their woes are many, yet they manage to be on more holidays than you. How does that work?
Well, HMRC stats suggest that principals gross about a third more and have an equivalent increase in taxable income. The nature of (most) dental practices is that the principal does more clinical work than the associates. We are increasingly entering the ‘corporate’ world. Not just the DBCs but owners with multiple practices. One dentist being the highest grosser in all their practices is impossible but it’s quite likely they’ll still have a very significant ‘dental’ commitment on top of the work required to run their businesses.
So ask yourself, if they still have to do the same or more clinical work than you, and you find that stressful enough, what else is really going on? A lot of practices will tick along without too many issues that are immediately apparent. They won’t cause you to be reaching for your box of tissues to empathise with your boss. They just annoy the hell out of you. Why hasn’t he/she fixed this? Got me more instruments? The new endo motor? And when am I getting those extra 500 patients they promised and why has the new chair with the super light and LED handpieces not arrived?
Well I’d speculate your boss is in the midst of the mire of legislative change, the latest guidance and what the hell is going on with Brexit and the OHIP. These all impact the practice business plan. Yes, there probably is one. It might be a massive spreadsheet or the back of a fag packet but it’s probably on hold just now. Large and small-scale financial investments require a degree of consideration. Smaller investments need cashflow to be stable. They need you to be delivering regular income. You get annoyed by the fluctuations in your gross and your boss can’t rely on them. Then there’s the big ticket items like new surgery kit, more staff. This could involve raising finance. That needs even greater stability of income but also consideration of where the financial markets are going over the next 10 years. I’m guessing your boss isn’t a corporate banking risk manager on the side?
So, the financial implications of your internal practice economy and the wider financial situation are important. Then there’s the Scottish Government and the lack of CDO and what the OHIP might do. Are there more unavoidable costs like auto-enrolment. Then there’s the constant demands for wage rises by staff and government raising the minimum wage and (hopefully more applicably) the living wage. This is ignored year on year by the DDRB (payment review: too much to say to include here) meaning that our fee increases simply don’t keep pace with the increased requirements, let alone general inflation.
There are things that don’t directly affect finances. There’s constant concern surrounding patient care and reputation. It is very hard to control associates and monitor their performance (other than financial). A poorly performing associate could be hugely detrimental to the reputation built up (or purchased) by the principal. Maintaining quality of clinical work is paramount to the maintenance of the practice value, and the principal has to rely on their associates for this. The bigger the practice or practices, the greater the risk.
Staffing has a similar impact. Admin and nursing staff have a huge impact on the viability and reputation of a practice. Again, one staff member leaving, for any reason, can destabilise the running, ethos or feel of a dental practice. Worse still is the possibility of someone leaving for troubling reasons. GDC issues or even criminal proceedings could create a huge level of uncertainty. The boss has to protect the patients, service provision, quality of care, financial stability and keep on track for the long-term plan.
The profession is starting to feel the recruitment pinch again and, with Brexit, the European source of dentists is very likely to dry up, if it hasn’t already. This appears to be for all clinical staff. Student numbers are reducing and workforce planning may create further problems. This all plays on your boss’s mind and the fine balance between all these threads can lead to huge stress and financial uncertainty. So when your boss is grumpy or displaying more grey hairs than you remember, spare a thought for what’s going on inside their head.
Perhaps you should ask how they’re doing? If there’s something you could help with? Maybe, just maybe, they might share some of their precious future plan. If you’re part of it, or you’d like to be, then telling them that could help. Everyone needs a future. Everyone has some thought of what that might look like. If you never put yourself out there, then who’s to know?
This is sounding like the plot of an eighties teen flick. But we all need progression, security, development, an exit strategy. So spare a thought for your boss. Take a step towards your future and securing the ongoing care of your patients. You may be the person the boss needs to firm up those plans, develop the practice and take care to the next level?
Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email arthurdent@sdmag.co.uk, or leave a message in the comments.
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