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Kiera and Kristy break down a few reasons why your practice might not seem (or might not be, period) to have any money. They touch on how to find your profit point, knowing your debt, staying on top of collections and AR, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners, this is Kiera. And today I have Kristy with me and I'm super excited because today is one of my favorite things to do as consultants and I call it office autopsy. ⁓ Don't worry offices, this is a mix of a few offices because believe it or not, offices think that they're on individual islands and believe it or not, you're not. ⁓ Multi-practices actually struggle, they actually do the same things that you struggle with. And so we just wanna make sure that we bring, we're not going to ever disclose who this office is. We will mix a few offices together, but I think for people to see what the office's pain point was and then what as consultants were able to do. Kristy, we have some really fun ones. so Kristy and I decided we wanted to podcast today about some office autopsies of what, hopes to help more offices. So Kristy, welcome to the show today. How are you? DAT Kristy (00:48) Good, thank you. Pleasure to be here. The Dental A Team (00:50) Of course. Well, I'm super happy because I think the one that we run into a lot ⁓ is we call it cash flow row or cash flow woes, like whatever you want to talk about. But it's really when an office comes to us and they seem to not be able to figure out what's going on. ⁓ They feel like they're producing. Sometimes they're producing, sometimes they're not. So we'll kind of discuss like how to know if you're producing enough or not. But then they feel like they just like have no cash. And so giving some background. Like I said, I'm going to blend a couple of practices together, but we have kind of going to do like two simultaneous ones. One practice was producing really, really well, but literally the owner felt like they had no money. We're talking like flat broke, felt like they were completely going to go under, had no money, but yet their production numbers were really good and their P &L looked really good. And we're just like, it showed on the P &L. I think, Kristy, you'll find this too, offices get so frustrated. I got so frustrated and angry with my CPA when they said, well, Kiera, like according to the numbers, you have money. And I'm like, great, high five, jerk. I have no money in my bank account. Like it's the most infuriating feeling in the world of my CPA tells me I should have money, but there's no money. Flip that too on the other side when a practice isn't quite producing what they need to be producing to pay for their expenses. And they feel like they have no money and they are flat broke, which in reality that practice is flat broke because they need to produce more or they need to cut. So we're gonna kind of dig on both sides of these with office autopsies of what we see, what we've been able to do. And let's start, Kristy, on the side of what do we do? Like, okay, first step, how do we find like the profit point? Like, how do we figure out what should an office be producing? Because I think that's also infuriating when doctors are like, but I'm just producing. I feel like I'm trying to out-produce my problems. Like, I don't know how to produce more. ⁓ how do you, Kristy, as a consultant, come in and help offices just gain that clarity? Because I think sometimes when we know the North Star and we know what we should be targeting, it actually becomes a lot easier to then build block schedules and then figure out what our overhead should be. But how do you help offices even dig into that? As point one to figure out, let's autopsy both of these practices, I think this is step one to really getting clarity. DAT Kristy (03:00) Absolutely. I agree with you, Kiera. ⁓ The first step is to understand how much we're paying for things. What is the cost to keep the doors open? You know, we talk about overhead, right? But what is overhead? It's everything that we have to pay within a month. Rent, utilities, staffing, right? The other thing that I want to point out is many doctors don't include themselves in that. And I definitely want to pay them The Dental A Team (03:16) you DAT Kristy (03:30) Just like if they were an associate in the practice and so we want to include that in that overhead cost if you will and find that What I like to call profit point so we know where we're what's our? BAM right The Dental A Team (03:48) bam, that bare ace minimum, like what do we have to do? It's kind of like in real life. I mean, I think all of us have a bam in real life. You know what your mortgage or your rent is. You know how much it costs you to like do your groceries. You know how much daycare is, you know how much it costs you for like your Amazon spending. And some of those are fixed costs. So fixed are like your mortgage or your rent. You can't really change those. Those are fixed for you. Yes, like I get it. The semantics, we're not CPAs here. We're not like, that's not our world. The semantics are can you change your rent? Potentially you could go find somewhere else. That is an option you could do. But most of the time those are pretty fixed. Just like our utilities are pretty fixed. You can be like my husband where literally our AC goes off at 6 p.m. at night. He freaking freezes us until 6 o'clock to save on these utilities until 9 o'clock. It drives me wild. I'm like in a hoodie freezing, shivering. And then the AC goes off and I'm like roasting. It's really entertaining because he wants to save the $3. But genuinely speaking, like you're not really going to be saving on those fixed costs. are some fixed ones. Staffing is usually pretty fixed. However, we could add team members or take team members away. So therefore it's not as fixed. But like you said, Kristy, I think it's figuring out in a practice and agreed, doctors should be paid. Like nobody, think that that actually causes more stress for owners. If you don't even know what your paycheck is or you're just taking draws, because then how do you budget your life on a up and down volatile paycheck? I think that creates a lot of stress versus like, okay, great. Let's just put you at a hundred grand or let's put you at whatever is a reasonable salary. Talk to your CPA. They'll be able to give you that. ⁓ And that can be agreed with Kristy. I like to pay you as an associate, but if right now the practice can't support that minimum should be a reasonable salary of say a hundred grand. So that way you can at least bank on that of getting that paycheck in your practice. Sometimes you have to adjust that, but generally speaking, if we at least give you some type of certainty and clarity, that's going to help you then be able to budget your life around that too, in addition to budgeting your practice. DAT Kristy (05:49) Absolutely. In fact, Kiera, sometimes even with startup doctors, I like them to even keep a spreadsheet of their production as if they were paying them as an associate. And then when they start to get profitable, we can back pay those wages. But definitely they have to take care of themselves first. ⁓ I've even seen where they get a little bit of animosity if not, right? Like, staff's driving these cars and they're getting their nails done and they're doing The Dental A Team (06:00) Agreed. Mm-hmm. DAT Kristy (06:19) and I can't even pay myself. So I think it's very important that we understand what that is and work toward that, number one, if we're not there. And then if we are there, adding additional ⁓ percentage to that, which us as consultants can help guide that depending on your goals. If it's paying down debt, paying you as an owner doctor. ⁓ And you know, we follow the EOS system, so adding those buckets for taxes and those sort of things that come up and we can be prepared for. The Dental A Team (06:55) Yeah, no, I think it's brilliant, Kristy. And when you said that, I agree. You don't want to not be paid in your practice, because that gets, A, it's stressful, and B, it's annoying, and C, you've got all this debt on you. ⁓ But I also think when we're looking at our practices, there are pieces, so when doctors are like, I'm not getting paid, I just want to remind that sometimes we're being paid through things running through our practices. And so we've got to be careful, because that is, Like if you didn't have your practice, you'd be paying for that out of pocket. And so that is technically part of your salary, doctors. And I don't want to be the like balloon pop girl over here. I do want to be realistic because a lot of times doctors are like, I'm not making money. And I'm like, but you forgot that these things are running through your practice. So you are being paid for those or those things are no longer coming to you, which is totally fine and legal. Talk to your CPA. Like we want you to do that. There's nothing wrong with it. But when we're looking and we're like stomping our foot saying we're not being paid, sometimes I even have to remind myself of like, yes, but Kiera, if you didn't have the business, all those costs would be coming out of your W2 paycheck, not your business right off. So agreed with Kristy, when we're looking at this, step one is let's find that BAM, let's find that profit point, let's find out what you have to produce. And then from there, what we need to find out is also in addition to that, how much is our debt? Because a practice should not have to be covering your debt, but you as a human needs to be covering your debt. So if your student loans, your practice loans, things like that, the practice isn't necessarily a poor performing practice. You just have all this excess of like, my gosh, I have to pay this off, which that's real life for you. And I think that's the difference of a CPA's bookkeeping for you versus your real life living through it. And I can tell you from personal experience, like this is very hard. Sometimes practice loans do go through your your practice profitability. Again, this is pending on your CPA and how they recommend you do it. But most of the time your student loans and different things like that don't run through the practice. So, but you as a human need to have enough money to be able to pay for all those things. So I think it's finding out the practices, BAM, like Kristy said, finding out your personal BAM, because that might be different. And then from there, let's tack on 10 to 20 % beyond that. So let's say you know you've got to produce 50,000. Well, awesome. 10 % of that would be 55, adding 20 % excuse me, so 10 % of that is going to be an additional $5,000. To do 20 % of that's going to be an extra $10,000. So if I know I've got to do 50, I've either got to produce 55 or 60. Now that becomes much easier and I know beyond that I'm going to have 10 to 20 % leftover of the practice after everything's spent. Our ideal is to get it to where your 50,000 is 50 % of your practice and there's 50 % quote unquote profit beyond that. Now again, that profit is a little bit funny because if we're doing a 50 % overhead and 50 % profit, doctor salaries usually are not included in that. If doctor salaries are included in that, then usually it's a 20 % profit at the end of that. So I know those two numbers feel a little like disjointed. They've been very disjointed for me. So if you're doing true overhead, we want it at 50%, 30 % doctor pay, 20 % profit. If you want to combine it all together, then it would be 80 % quote unquote overhead, 20 % profit. Now that 20 % profit though, does technically pay for debt services. So watch that. You might need to scale down our 50 % down a little bit more or 80 % to then be able to offset that. So hopefully that wasn't too confusing for everybody. This is why we're consultants. This is why we help you. But I think when you understand like either need a 50 or an 80 % ultimate goals, we're trying to get 20 % cashflow at the end of the month. think for me, that's like the easiest thing. Like, okay, if I'm producing a hundred grand a month, I want 20 % of that, so that's 20 grand. So like I'm trying to do easy numbers for all of you. I want 20 grand after everything's paid to still be remaining. Now, one other kicker as a business owner is that 20 % is also taxed. So don't forget that that gets taxed. So if you're at a 30 % tax bracket, well, you gotta take 30 % of 20 grand and then the rest of that you can spend. And this is why I think owners get so frustrated, because it's like, oh my gosh. Like just tell me how much money I can have. And when I talked to a CPA and Kristy, I think you come across this, like our whole lives up until owning businesses, we've been paid at the W-2. So everything we got paid, we were able to use. Well, now as business owners, everything we're paid, we don't get to use. That's not the way the game works. ⁓ And it's due to write-offs and different pieces like that. So I think just knowing the rules of the game, I remember being so fresh with my CPA and I said, I like you're playing Monopoly with me. Like just tell me the dang rules. So, and like, don't tell me like, no, you can't pass go, but you can pass go if you do X, Y, Z, but then like, no. So it's really, you've got to have a profitable practice of overhead. That's what we as consultants are really obsessed with. You also as an owner need to be responsible of how you spend. That's not to say you can't spend, but you do need to spend responsibly and you do need to set aside your taxes. And I think when you have all those pieces set up, then you can have guilt free spending because you're paying yourself. Plus, you know what your true profit is. You've saved for taxes, you've saved for a rainy day, like Kristy was saying. We can put buckets into place to pay down more debt. You can put buckets in place for emergencies in your practice. You can put buckets in place for ⁓ vacations. I have a doctor I was just talking to on Alaska cruise and I was like, how's that bucket working out for you? And he's like, I love it, Kiera, you set it up for me. And I know how much I can spend on vacations. I know how much of my paycheck goes into that portion. He also used to spend an absurd amount on CE. So we set a true budget of how much CE money he could use. But that's kind of where you then as owners aren't just trying to waffle through this and actually can figure out those profit points. And I do think, Kristy, like as much as we've belabored this so much at the beginning of this podcast, I feel this foundational piece is what makes owners crazy because they don't know the rules of the game. So they start spending all the money. Then you get this huge tax bill. Then you feel mad. Then you feel like you have no money when it's like, no, you did have money. just we accidentally spent it. So now we got to make up for it later because we didn't put these rules of the game into play. Kristy, you might have a simpler way to do that. What are your thoughts around that? DAT Kristy (12:49) No, I agree with you 100%. Otherwise, what I…
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