Startup to Stay Up

How to Build a Business for the Next Ten Years

I LOVE our startups.  It’s been our company’s largest area of growth over the last two years - which is no surprise given the startup boom happening in dentistry right now.  I love coming alongside someone’s vision and dream and helping them make that a reality.

While the startup space is fast-paced and exciting for sure, it comes with its share of risk.  It’s really easy to look in the Facebook groups right now and think that launching a startup is easy, glamorous or even guaranteed success.  The truth is, it’s not.

I recently saw a post in a group that said, “I’m six months into my startup and while I’m not where I thought I would be, I’m happy with the progress.” You could sense the disappointment from the doctor of not meeting the expectations of a social media world.  And at the same time, struggling to recalibrate to the truth of his reality.  There are SO MANY factors that affect a startup practice. It’s unrealistic to compare yourself to someone else in a different part of the country. Just because you didn’t hit the same milestones that others bragged about, doesn’t mean you’re less successful.

“There are SO MANY factors that affect a startup practice. Just because you didn’t hit the same milestones that others bragged about, doesn’t mean you’re less successful.”

Being the owner of a startup myself, I can tell you that it’s an incredibly difficult process.  I still remember my first  panic attack.  Towards the start of our company, we had somehow missed invoicing a key client for a project and payroll was due.  I couldn’t sleep and began waking up in the middle of the night with my heart racing, struggling to catch my breath.  My wife sensed the anxiety and said, “I think you’re experiencing a panic attack.”  I had never had one before.

We were fortunate to get through that time.   We made payroll for the team, but I had to delay mine.  Overall, we’ve managed to be fiscally conservative in the way we operate.  We’ve never had to miss the team’s payroll, but there were a few times I had to come home and tell my wife that I wasn’t getting paid that week.  

This article is NOT about the principles of success for a startup practice. It’s more about my observations.  If you asked me what I thought were some of the keys to us getting through the initial startup phase, here’s what I would tell  you:

1.  Be Patient

Starting a business is a long game.  In the beginning it’s lived day to day, but the reality is you’re building something for the next twenty years… and ideally longer.  Try to keep your eyes lifted up.

I’ve run quite a few half marathons in my life and even finished a full marathon once.  When you start running long distances, the number one key to success is your pace.  It’s everything.  If I went out right now and ran three miles, I could probably finish at a 7:30 per mile pace.  If I started a marathon at that rate I would be toast before I even got to mile five.  I wouldn’t be able to sustain that speed and the expenditure of energy would end my race early.

When I decided to run my first marathon, I set a goal of finishing in four hours or less (9:09 per mile to be exact). At the start of the race, I had to intentionally slow my pace to around 8:45 so that I set myself up to win at the end.  If I’m being honest, to limit yourself like that is brutal .  This is a race and I’m intentionally slowing myself down?  I’m full of energy and all the other runners are passing me, but I have to trust the process.  I have to trust my pace. Finishing is more important than starting.

Side note: I ended up finishing that marathon in four hours and 23 minutes.  I was on pace to finish in under four hours until mile 22.  The last four miles fell apart :)

“Starting a business is a long game.  You’re building something for the next twenty years.  Try to keep your eyes lifted up.”

One thing that has helped me along the way is understanding the difference between setting goals and forecasting.  It’s easy to pull a goal out of the air and set that up as the measure of success (e.g. $1M in your first year), but in a startup you have no context for that number.  There’s been no history of data from which to make an educated prediction.

Forecasting is a better approach.  Look at the last month, the last quarter or the last year.  Try to identify the patterns and trends.  Calculate your average rate of growth and then play it out over the short-term and long-term future. Now, base your decisions on that.  This keeps you from getting out ahead of your cost structure and helps you predict manageable growth.  Plus, it decreases the stress of trying to hit some imaginary (and often irrelevant) goal.

Here are a few practical tips to help:

1. Set realistic goals.  Hitting $1M your first year might seem awesome.  Living with that pressure often isn’t.
2. Control the expenses.  Running a business is difficult enough.  Don’t add the stress of overdue bills.
3. Celebrate your milestones.  Be intentional those first few years to celebrate the small wins personally and with your team.  

2.  Separate Yourself from the Business

You are not your business.  Your business is not you.

It seems obvious enough when I say it, but you’d be surprised how easy it is to get wrapped up in that myth.  When business is going great, you feel great about yourself.  When business sucks, you suck.  The fact is, neither of those are true.  Give yourself permission to put some distance between the two.  

I’ve often said that when you’re an entrepreneur, the highs are higher and the lows are lower.  It’s easy to get caught in that cycle.  You just landed a big case or had a great month.  You feel amazing and decide to make a purchase or hire a new team member.  The next week, the hygiene schedule falls apart and a team member quits. You go home carrying the weight of depression and pour yourself three glasses of wine so you can fall asleep that night.  Neither of those are healthy.  Your personal identity needs more distance from your professional success.

One truth that I’ve had to come to grips with is that I am now a full-time fixer.  I fix problems full-time, all the time.  Like, there is never a moment where there isn’t a problem to fix.  In fact, the list is so long that I actually have to schedule them out into the future.  I’m not kidding.  There is never a shortage of processes that need changed or procedures that need implemented.  I have come to grips with the fact that I will never catch up on all the issues that business creates. I have to line them up, prioritize them, and then take them on one at a time.

“Being a business owner means that you are now a full-time fixer.  You fix problems full-time, all the time.”

Our quarterly goal process has been a solution that helps me clear my head from the overwhelming sense that I’ll never get caught-up.  As a team, we decide on six to eight issues we’re going to take on in the next 90 days and then we tackle those.  Any other issues simply have to wait for the next quarter where we do the same thing: identify what needs attention, prioritize them in order of importance and then solve.  I have a note in my phone for each quarter of the year and when an issue rises, I dump it into the next quarter.  It’s a quick, simple hack to help me separate my mental health from something that always needs work.

Here are some of my practical tips for separating yourself:

1. Have a hobby.  Do something to get outside on a regular basis.  You’d be surprised how much that alone can reset you.
2. Maintain your friendships.  I cannot count how many entrepreneurs end up isolated after the first few years.  Don’t neglect your friends while building a business.
3. Invest in self-care.  Take care of yourself through this process.  Find things you love and make sure they are a regular part of your life.

3.  Build Processes

You can beat your production goals every month.  Congratulations, you have a job.  Or you can implement a predictable process.  Congratulations, now you’re an entrepreneur.

By definition, an entrepreneur is a person who builds a business.  A business is an automated system that produces cash flow.  Therefore, your job is to create the systems that allow your business to function autonomously.  I have found that anytime you can slow down to implement a process, you’ll experience a 10x return on that system down the road.  It’s better to build one reliable process than it is to out-produce your goals for the week.  

As a business owner it is likely that you are also a visionary – that’s why you decided to launch a startup.  Visionaries are typically full of great ideas.  The problem that I see over and over again in startups isn’t a lack of great ideas, it’s a lack of systems built around great ideas.  Ideas are not systems and they’re not necessarily healthy for a business.  Too many ideas can actually be damaging. They can destroy other processes that have been put into place to ensure predictability.  

“Ideas are not systems and they’re not necessarily healthy for a business.  Too many ideas can actually be damaging.”

As a business owner, your number one role is to ensure a predictable experience for every patient.  You want each patient to experience the “magic.” That only happens when strong processes are put in place at the foundation.  I routinely tell our team that having predictable processes in place frees up the cognitive space that allows us to be creative.  The same is true for a dental practice.  Predictable processes free up cognitive space that will allow your team to authentically interact and care for your patients.

Here are some tips for implementing processes into your practice:

1.Brainstorm the top 12 systems you need to create for your practice. What areas are producing the most unpredictable results?
2. Schedule one process a month for the next 12 months.  There’s no need to take these on all at once. Line them up by order of priority.
3. Work with your team to build out and document these processes .  At the end of the year you’ll have the makings of your first procedural manual.

4.  Invest in Leadership

We all know that dental school didn’t prepare you to run a business, however it prepared you even less for being a leader.  From my perspective, leadership may be the biggest issue facing dentistry right now.  Especially as we get into multi-location models.  Unfortunately, there’s not an easy way to solve this problem.  You’ll have to find the resources and people to invest in your leadership development.

Leadership is your ability to communicate your vision.  It’s your ability to get people to follow you.  It’s the ability to create healthy culture in your practice and alignment towards a common goal.  You can be a great clinician, but can you be a great leader? That is the question I am running into over and over again with young doctors.  Often times the vision of what they are seeing in their head is greater than their ability to get to it.  

“You can be a great clinician, but can you be a great leader? Often times the vision of what you are seeing in your head is greater than your ability to get to it.”

This is the number one question I ask when our clients launch their second or third location.  You can often build one successful practice around your ability as a good clinician, but the success of the second and third location will be based on your leadership.  That’s a whole different skill set.  

Here are a few tips for being a better leader:

1. For every clinical CE course you take, read one leadership book. Invest equally in both.
2. Create moments of appreciation with your team. Find time to regularly express appreciation for what they have sacrificed to help build your practice.

I personally believe healthy businesses are a light in our world.  They have more ability to affect change than any other system or force.  Entrepreneurs change lives.  That’s ultimately why you're doing this.  It’s a calling we should take seriously and protect, so that we get to the end proud of the strong, healthy business we’ve built.

Hopefully this article gives you permission to slow down a bit, to separate yourself personally from the organization your building, to be disciplined to implement strong processes along the way and to encourage you to invest in your leadership.  Building a business is a noble endeavor.  Take a moment to recognize that and reset your vision for the long haul.

Learn More

The dental practice landscape is changing at an ever faster rate. Protect your investment by putting together a strategic marketing plan customized to you. Schedule your consultation with me.

How can I help?

Based on my sixteen years of marketing experience in the dental industry, we’ll create a long-term strategy for your practice to rise above the competition and meet your growth goals. My team and I will actively monitor the strategy through regular meetings and track your growth along the way.

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