Dental CEO Paradox
When I was white boarding a strategy for a solo practice to protect its market share against a DSO, I discovered what I call the Dental CEO paradox. This realization occurred when I began comparing comparing the organizational charts between a DSO company with that of a solo practice with less than 20 employees. Just because a role is not big enough to justify a dedicated employee to it does not mean that the role does not exist. It just means that the frequency of the need for an undefined position is low enough to handle as needed. You should be able to fill in every seat of a DSO’s organizational chart with the names of the employees in the solo practice. The only difference is that the same few names will be repeated numerous times. If a solo practice has not specifically assigned a responsibility to an employee, the responsibility should default to the owning dentist. You should never assign two people to the same role but it is perfectly acceptable for someone to be assigned to more than one role. During my time as CEO, I also served as our marketing director along with numerous other positions. As I continued to fill in the owning dentist’s name under several roles, I began to notice that the dentist was serving in roles that created a conflict of interest between them. These conflicting roles are the originating source of the Dental CEO Paradox. The primary conflict occurs when the same person is serving the roles of the producing dentist, CEO and owner of the practice.
A producing dentist who runs and owns the practice is the equivalent of the star quarterback being his own coach and the owner of the franchise. If one person is making all of the decisions, which of the three roles is actually influencing the solution? I have found that the deciding voice tends to come from the practicing dentist and not from the CEO or Owner’s perspective. The dentist is biased toward focusing on what is best for the dentist because most people went to dental school with the desire to be a medical professional first and a business owner second.
Here are a few of the most common bias challenges that a provider led CEO faces.
Protecting company culture: I'm sure you have found yourself in this scenario. You have a clinical assistant who does a great job with the patient and with your instruction. Yet, this employee is consistently tardy or causing issues among peers in the break room. The CEO minded leader would terminate this employee for the toxicity they were bringing into the office. The Doctor minded leader, who does not want to train a new hire and lose the efficiency of a good assistant, would rationalize that since the assistant is good at the main part of the job the other elements aren't important enough to justify termination. The problem with this mindset is the effect the problematic employee has on the rest of the team. If this employee can get away with "bad behavior", what other employees will then pick up on these habits? This leads to the entire company suffering, not just the efficiency of the doctor.
Business Decisions: You notice in your market that no competitor offers extended evening hours, including your practice. The CEO minded leader would want to expand hours to be open later to accommodate patients to help them avoid missing work to attend appointments. This new competitive advantage could really help grow the company. The Doctor minded leader would be reluctant to expand hours because that would mean potentially longer clinical hours or even if the practice opens later, the doctor has to give up personal time in the evenings.
Perspective: When you are working on someone’s smile, perfection is the standard. Dentist are trained to pay attention to every minute detail. When you are running a company, you need solutions that work the vast majority of the time that are capable of being delegated to your employees to execute. When designing a policy, do you create a complex solution that covers every perceived variable or do you create an easy to implement plan that handles most common variable but has grey areas? An easy example is how to create the template for your patient schedule. If you have 10 appointment types that all require 30 minutes of chair time, do you create 10 unique appointment types or one 30 min appointment slot? One solution is very precise but difficult for new employees to grasp and the other is extremely easy to learn but is not as precise.
Profitability versus Investment: Dentists have to spend years in school, which typically causes them to accrue large amounts of debt, plus the costs of owning a practice. The years of preparation lead to an understandable desire to reap the benefits of the company’s profits as soon as possible. But if you are also the owner of the company, how do you decide when it is best to make a new investment to grow the company for bigger long term profits or to reward yourself so that you feel motivated to continue producing at a high level?
Upon discovering these conflicts of interests between all of the roles a producer led CEO holds, I created a solution in the Rising Tide Operating System design to help identify which role should be making the decision based on the area for the solution. The operating system teaches the owner how to allocate time for each role and which role makes the decisions. Gaining a deeper understanding of this conflict helps you achieve better clarity when making decisions.
