Practice & Financial Management for Dentists – Pandemic Special

In this article, the current COVID-19 situation will be seen from the point of view of a dentist – in terms of practice and finance. Possible solutions for practice management and financial management will be suggested.

1. Coronavirus & dental practice – What we do now will shape our future.

The most common reason we Indians cite for not fulfilling any work on time is the LACK of TIME.

The corona virus has now provided all of you with AMPLE time.

Many of us are either closed or winding up operations or attending to only emergencies.

It is a good time to reflect upon yourself which I fondly call as ‘Me Time.’

The new financial year 20-21 began with the lockdown. With that the norm for various paper-work have changed and so have the statutory regulations.

Those who don’t know, understand– ignorance is not always bliss.

Here’s what you can do –

1. Get your paper work in order
2. Make your own customized consent forms
3. Get your record keeping right – the OTHER side of patient care (3 E’s) – Efficaciously, Effectively and Efficiently
4. Get your accounts right (The system of controlling the finances)
5. Keeping separate accounts for separate transactions
6. Plan accounting – internet banking allows everything these days
7. Don’t mix and match – the sooner you do it, the more simplified life you will get easily in the NEW FY 2020-21.

Lastly, dwell on the GRAVEST Problems (Clinic or personal) that are impeding/blocking your professional progress and affect your working a great deal.

The problems can be –

• Skill based (You don’t know implants/endo/surgery etc.)
• Administrative based
• Staff based
• Patient based or even
• Self-based.

Brainstorm on the same in your free time to short list 2-3 solutions for same and be ready with pros and cons of each and then TAKE ACTION as soon as things are normal.

The Future is really in our hands NOW as to how we want to shape it!

2. Current financial situation – banking & investments.

Last month, the markets ended in a green zone.The mayhem temporarily seems to be halted for now. But I still do foresee, the sensex touching new bottoms.

Last few weeks have seen massive wealth destruction worldwide as equity markets have corrected around 30% in India too.

Your investment portfolio might have also taken a hit and you must be worried about the current scenario and thinking what to do.

Every one is in deep anguish and pain when they see the portfolio getting hit by such falls. It all happened so fast around the globe due to corona virus scare that there was little time to take any suitable measures to protect the fall in value for most of us.

But events like these are black swan events which happen once or twice in a decade – so rather treat this is an opportunity (once in 8-10 years and not as an accident). History suggests that things eventually improve after such events.

What I suggest for your banking & investments currently –

1. At this stage, changing the asset class from equity to debt doesn’t seem to be a good choice.
2. I strongly urge you to sit tight on your investments.
3. I further strongly suggest continuing your SIPs as they are helping you buy at lower levels.
4. Please do know that buying cheap is the essence of getting higher returns and so I would also suggest you to consider buying lumpsum in 2-3 trenches if markets go down further.

I know it is not easy and if you would like to give it a pass, it is very well understandable.

Every one of us who is linked to Markets (shares or mutual funds) should keep a close eye on the developments and should reach out to our financial advisor if any action is required.

We all will come out of this situation and see good days for the portfolio in the near future for sure.

3. Dentist’s Financial Freedom – Shun the Negativity and Insecurity

COVID-19 has indeed given all population all over the world a very difficult time in terms of economy, future and must of all; survival. The two components that are presently in abundance all over the world now is time and internet data! On a daily basis we hear things like –

• The world is going to end.
• The world will be there, but I am going to end.
• I will be there, but my business/profession will end.
• My business/profession will be there, but I will be financially ending or almost broke.
• I may not be financially broke, but I will have no security over my finances left for future for my family.

The above list is endless.

All of us have got sucked into too much negativity owing to ‘lack of work’. The most surprising thing is that all of us desperately wanted a break with lots of time; rather we kept on wishing for it and when the same has been granted, we are WASTING it in such imaginative stories. Such are the vagaries of human nature. We had been committing a lot of atrocities on Mother Nature and when she decided to re-boot herself, we are perturbed beyond imagination. Imagine the quality of air, the thickness of ozone layer after the lay-off, the environment in which we are breathing currently, isn’t it bliss?

Be it dentists or my other friends, I am really sick of hearing that they will be financially doomed. Really? Why do most of us underestimate dentistry?

I always thought dentistry is such a powerful profession because it has the ability to reverse situations quickly. For example, when the OPD’s remain on lower side even 24-25 days of a month; the rest 6-7 days have the power to make us earn up to 3X or even more (supposing X is our regular monthly income).

We sometimes behave like daily labourers being mentally insecure as if we can’t survive from our pocket for a couple of months! If your income is down, remember that so many of your expenses are down or almost zero as well like material bills, lab bills, clinic cleaning and maintenance expenses, electricity bills (All professional); eating out, movies, vacation, shopping, gadgets, big billion day buying etc. (All personal) and many more. Remember, a few of the above will continue to be drastically down till a few months from now (if not Zero), so there is no dire need to throw in the towel yet.

If you are feeling weak financially, you need to do a few things to set the house in order –

1. Understand your boundaries and limitations especially for your income vis-à-vis expenses.
2. Place your needs always first and curb your wants for sure.
3. Follow the Budgeting principle of 50/30/20 or the Bhavdeep formula of 45/15/40.
4. Learn to diversify your investments – all your money only in MF is not the only solution, but on the flip side, all in FDR or SB A/c is not the answer as well also; the pinkies (2000 Note) buried in your trunk or in house, definitely NOT.
5. Emergency fund of 6 months is always mandatory.
6. Plan your professional and personal life for such uneventful expenses.

If your profession doesn’t allow you to do any of the above, I am afraid, either your habits are wrong or your chosen profession is wrong.
Try changing either of the same. The former is cheap and easy, the latter not!

4. Costing In Practice Post Lockdown

Dentistry in future (Post-COVID-19 era) is never going to be the same as the Pre-COVID-19 era. Dentistry was already cited as one of the costliest professions in India, by Indian patients; believe me, this bar is all set to go higher!

Now, let us talk of the present circumstances of Covid-19 and probably, the challenges of COSTING associated with it in the post Covid-19 era, whenever the working resumes. In the post Covid-19 era, improving personnel safety in healthcare environments through appropriate use of Personal Protective Equipment (PPE) would be most mandatory for every dentist all over the world. PPE like body cover-alls, gloves, gowns, goggles and face masks as well as diagnostic and surgical products would be needed by all of us in bulk.

We will have to mandatorily provide appropriate PPE for ourselves and our employees / staff (whatever the GSM requirements finally get settled and approved) and ensure that PPE are either disposable or if reusable (highly unlikely for COVID-19) and are properly cleaned, laundered, autoclaved and stored (they are usually for other diseases). The compliance concerning PPE is often dependent on personal preferences. However, increased comfort (better fit, ergonomics, less allergies and body temperature regulation) is directly equitable to the cost in India for those being manufactured here.

We are having PPE kits from INR 100 (IIT Kanpur) to INR 5000 (imported ones from Europe / American subcontinent) with about 10 options in this price range . An ideal or some sort of comfortable PPE kit is in the range of Rs. 800 (Indian make) which means minimum one for you and one for your assistant and if you are fond of 6-handed dentistry, two for your assistants. As per reports or studies coming in, the PPE kit has to be one for each patient and disposed of after that. Just assume a patient coming in for a restoration (filling) for which you earlier charged Rs. 1000 (suppose as an example). Add up the bare minimum cost of 2 PPE’s of you and your assistant to the procedure.

Won’t the landing cost of one simple restoration zoom up to around Rs. 3000?

Would it be feasible and practical?

The costs of setting up a dental clinic is high as the exterior also needs to be done with along with the interior and of course, providing quality work which anyways is the prime requisite. Most of our medical colleagues have just got the bench and chairs in their clinic for the patients but when it comes to dentistry, patient expectations change quite a lot.

Calculation and management of the costs and expenses relating to clinic (business) overheads, especially when done on a monthly basis is the one of the most important tools for success in any dental practice. The commonest business principle which is followed otherwise in business circles to decrease overhead is to increase the production by

• working more hours
• improving scheduling or
• increasing selling price (fees, in our case).

Sadly, the principle of working more hours defies logic as per the 80-20 Parreto principle. Let us presume a scenario, where we start promoting our clinic and are having an increased footfall. When we check more new patients generally, that would result in us; allocating and spending lesser time with each patient at their initial visit and by doing that, we are either not counselling them completely or overwhelming the new patient with rushed information. The most likely result in such a scenario is fewer turn-ups of the patients for actual treatment or poor conversion ratio. This is also known as the “roller-blading” method of dentistry which may temporarily result in higher production but does have the perennial side-effects of high overheads, fatigue, poor health and unhappiness in clinical practice life.

Our running costs are going to grow manifold and the incoming cash collection won’t be coming at the same pace and volume as before due to the decreased purchase power of the patients. So, every such decision of investment in clinic; be it, the buying of a new equipment or an expensive material has now to be backed by a scientific logic, basic understanding of your figures and numbers and calculation of costs.

The FOUR Most important aspects required will be:

1. Unity at one platform (in our hand)
2. Accepting and upgrading as per latest norms (in our hand)
3. Vaccine against COVID-19 (NOT in our hand)
4. Dental insurance – strong need of the hour (NOT in our hand)

Common sense says, if costs go up, Govt. services will be seeing a surge in OPD levels. But whosoever sees health as a priority, will avoid the same and prefer private setups (I am not saying Govt. setups won’t upgrade – but the system is slow and takes much more time than us)

This is thus, the opportune time for dental insurance in India which can take care of both of us (patient and dentist). Insurance brings so much parity all around and enhanced standardization in most clinics. The same can be set up as a PPP model (Public Private Partnership) for trial purpose. The models of western countries are before us, so not much of homework would be required

But for that the representation and suggestion have to be made to the Govt. 72,000 (1/4th) members of IDA can’t do that but 3 lac plus (total) dentists of India can surely do that by signing a petition on Change.org.

References

1. The Top Floor of My Body – The Brain

Contact Details – The guest author, Dr. Bhavdeep Singh Ahuja can be contacted on 98761-93039 (Call/Whatsapp) or on drbhavdeep@gmail.com (email).

Disclaimer – Few parts of this article have been circulated by the guest author on his personal social media platforms prior to publishing. DentalReach respects the intention of the author to publish the article in entirety on a neutral platform like ours for global readership in these difficult times. The views and opinions expressed in this article are that of the author alone and does not necessarily reflect the official policy of DentalReach.

Dr. Bhavdeep Singh Ahuja is a general practitioner. He has specialized in Implants from BioHorizons Inc. USA in 2004-05 & in Advanced Course from LACE-ICOI, USA in 2006. Apart from Dentistry, he holds a Triple M.B.A. in Hospital Management, Finance/Human Resources (dual) & Marketing from the IIMM Pune, IGNOU Delhi & Annamalai University, Chennai respectively. He also holds PG Diploma’s in Medical Law & Ethics (NLSIU – Premier LAW School of India), Clinical Research, Cyber Law, IPR’s (Intellectual Property Rights), Disaster Management, Financial Management, Bioinformatics amongst many more from different Universities. He is a Certified Health Care Waste Manager from IGNOU & is qualified in Consumer Law as well.