Episode 240 – Bridging Vision and Reality

“If we don’t have a strong foundation in our practice or in our life, everything that sits on top of it can begin to show wear and tear.” ~Regan Robertson

Welcome to the first part of a special four-part crossover series of Everyday Practices Dental Podcast and the Investment Grade Practices Podcast. This collaboration brings together the expertise and insights of Everyday Practices co-host Regan Robertson, and Investment Grade Practices host Dr. Victoria Peterson as they marry high-level visionary planning with essential nuts-and-bolts day-to-day practice management. 

In this episode, Regan and Dr. Victoria talk about the concept of above-the-line vs. below-the-line thinking – a framework that distinguishes between strategic, aspirational planning and the practical, often challenging aspects of implementation. Throughout their discussion, you’ll hear about the vital importance of establishing a robust practice culture that supports both the business and its people. They highlight the necessity to create an ecosystem where visionary ideas can thrive, supported by meticulous management and a strong, cohesive team. 

In a time when dental professionals are increasingly experiencing burnout, Regan and Dr. Victoria offer invaluable advice on how to maintain balance and avoid the pitfalls of stress and overwork. They emphasize the need for self-care and the importance of proactively addressing mental health.

As you listen to this episode, we want you to think about the following questions:

  • What can I do to better integrate my long-term strategic goals with the daily operations of my practice?
  • How can ensure that my practice culture aligns with my vision and supports my team’s well-being?
  • Am I or my team members experiencing signs of burnout? What can I do to address this proactively?
  • How well am I communicating my vision and expectations to my team? How can I improve?


Regan Robertson: Welcome to a very special four-part series of Everyday Practices Dental Podcast marries Investment Grade Practices Podcast with Dr. Victoria Peterson, Victoria, welcome.

Dr. Victoria Peterson: Good afternoon, Regan. It is so great to be here with you.

Regan Robertson:  Thank you. You know, with Investment Grade Practices, your award-winning podcasts, we know that you tend to focus on above-the-line conversations like leadership, empowerment, five, five-year forecasts in the future and I know it’s really fun to do that and to be up in the clouds and imagining everything until it can come to execution time, that’s when the rubber meets the road and really we’re finding out right now that above the line, visionary leaders will do well, uh, to come down below the line. It will serve them and benefit them in many ways and you and I’ve talked about this quite a bit, which is why we are here today. Uh, because if we don’t have a strong foundation in our practice or in our life, everything that sits on top of it can begin to show wear and tear and before you know it, you’re on that hamster wheel wondering why you’re working so hard and that’s where Everyday Practices comes into play. Victoria, I know that you are going to dip down below the line to figure out what we can shore up this summer and get really happy, healthy practices and I’m going to talk about how we can focus on those things to accelerate the results above the line so that we’re both sort of married here. How does that sound?

Dr. Victoria Peterson:  I love that so much and I’m glad that you and I are dedicating this to a four-part series because in Investment Grade Practices, we do have a four part series. There’s business value and what it’s going to be in the future being bank ready, investor ready. There’s operations and all the below-the-line pieces, uh, that have to get executed each day, there’s communications through authentic storytelling, not only to, you know, you have two customers, you have your patients and you have your team. So how are we communicating to our team? How are we communicating to our patients and then the last quad is culture, what is the ecosystem that we’re living in. So breaking it down into those four quads is going to be a lot of fun. I’m so happy to marry our podcast here for this series.

Regan Robertson: Me too. So we should give a shout-out to Skip Miller as well. Uh, he taught us above and below the line. Uh, he’s a celebrated author and has taught both of us over the years that technique. So Victoria, how do you describe above and below the line?

Dr. Victoria Peterson: Well, um, above the line are those things are aspirational And business planning, it goes into future forecasting, planning strategy. When you’re in the above-the-line conversations, you’re in that part of your brain that’s very creative and is looking out and saying, “Man, Amazon is coming to my area, how do I want to play in that field?” And it’s looking out and saying, uh, you know, working with people to understand what are the insurance mixes or the revenue mixes or the employer mixes in my area and how as a dentist, do I play in that field? You know, do I want to ignore it and keep my current patient base? Do I want to expand my building and prepare for the growth? Do I want to have a second location? Do I want, you know, all of those fun sort of strategic planning and marketing things come and when you put it through the framework of financial freedom, what will it take for me to build financial freedom, then you can execute on a five-year, 10-year lifetime sort of frame and keep up with the microeconomics of your area, as well as the bigger trends of it. So when we work with doctors and they’re in the planning mode, it’s so much fun because you haven’t executed anything and it’s on paper and but then you have to bring it to life and that’s all the below-the-line, that’s the management part. So when I work with doctors, I find they all love leadership and nobody likes management because that’s the day-to-day details.

Regan Robertson: Wow.

Dr. Victoria Peterson: That has the work done.

Regan Robertson: That’s absolutely true. You have to take a lot of responsibility when you step into the true leadership pieces and, and I think it can be frustrating at times also, because as, as the visionary, uh, I can speak to you as a CEO, you have, like your gift is getting downloads of what’s next and best what’s next in the market, where are we going? Like you said, if Amazon’s coming in town, how do I want to position myself to that? So you have the gift of that. The other piece of it is that execution piece and you know, already for most of us, everybody listening anyway, it has likely been in practice for a while. So I know myself as a leader too, I will make assumptions and think, “Okay, well, I communicated this X amount of years ago and so why isn’t it being done now?” Even though we’ve, you know, team turnover has happened. We haven’t maybe onboarded that particular detail. Like, you know, when you really get below the line and you start thinking about those little details that can pull us down and get us out of that above line. So I know in this first part series, we’re going to talk today about culture, team culture, practice culture, and looking, uh, above the line and what that means and below the line. So Victoria, we’ll start above the line and leadership. What does this mean to you and how did, how does it apply to culture for you?

Dr. Victoria Peterson: Um, I’m going to say that there has been a marked difference pre and post-pandemic and what it means to show up as a leader and It’s more complex. You know, we have four or five generations sometimes working in the same practice. Minimum three. So you’ve got Baby Boomers, Gen X, Millennials, and whatever below the Millennials are.

Regan Robertson: Gen Zs.

Dr. Victoria Peterson: Gen Zs. Yeah.

Regan Robertson: And then Gen Alpha, which is right nipping on the hills.

Dr. Victoria Peterson: Oh my gosh and I’m clearly the tail end of Boomers, the beginning of Gen X and what I love about this is that the millennials and Gen Z is, are really activating on the lifestyle goals that we purported. So baby boomers wanted life balance, this and that, but we were raised by people of the depression area of work hard, work hard, work hard and we’re overly aggressive and work and 80 hour weeks and this and that younger generations aren’t putting up with that. So above the line leadership for me right now means how can I role model what I want to have and so if I want, you know, life balance or life blending, or I want to recognize that I’m a full human first, and my business is there to provide financial outlet, emotional outlet, you know, those things, being inclusive that your policies are good for as many people as possible on your team. So one of the things that you’ve done that helps leaders so much in the PDA ecosystem is brought in Donald Miller, storytelling, business made simple and one of the things that we take our leaders through is identifying the three key characteristics of their ideal employees and I think that is a gift for leaders to get really clear on who do I work well with because they serve my patients well and that leads to the other piece, which is how do we want to serve? You know, what is my standard of care? What is my philosophy of care? If you’re in Medicaid or HMOs and you don’t want to be there, there’s a way out. You know, getting off the rat race is a key to building great culture and the only the leader can do that your team can’t they may desire that but they can’t execute on that and

Regan Robertson: They don’t know where to execute to. I think that’s the gift of that key characteristic is it gives, it gives employees, um, guideposts and it gives them a way to stay between the navigational beacons and that, you know, understand that the doctor. So for example, at PDA, ours is knowledgeable, relationship-driven and responsive and we’ve had those for about two years now, and we’re coming up and we’re going to revisit those again and ask the question, are those serving us but every employee knows in that particular order, this is how I’m expected to show up and then the secret to this, which is really, you need to hear this right now. The secret isn’t just the word. The word actually is, it’s, it’s, it’s a word knowledgeable. The secret is how the leader defines it.

Dr. Victoria Peterson: Knowledgeable in what?

Regan Robertson: Knowledgeable in what in what way? Yeah. So going through that exercise of asking yourself what characteristics matter and, and will help me achieve my goal, my big vision, and then pulling that down into how do I personally define this? That is such a gift to your team because then they can understand this is where I’m supposed to go and this is how, how we’re going to define this.

Dr. Victoria Peterson: And I think that’s where the leadership vision of, you know, defining who we are, who we serve, where we’re going, it then dips below the line into what are my daily actions and I think there’s a great example of this. So if we say, um, one of our key characteristics is comprehensive care, for example, right, so now all my marketing messaging, everything is lined up to attract that patient that has complex dental needs, that is looking for comprehensive care, not just, you know, the one crown that my insurance might pay for. That’s a very specific philosophy and standard of care. So then the, there’s a key characteristics of how do we deliver on that and then there’s the daily actions. So the below the line piece might be we comprehensive diagnose all new patients. The second behavior may be, we follow up on all unscheduled patients.

Regan Robertson: That’s it. Those are daily actions. Yes. Those are below-the-line tangible.

Dr. Victoria Peterson: And so what I’m seeing above the line is doctors are still on this roller coaster of high and low production and it’s because they don’t have a cadence or and I don’t want to get into the cadence later and the metrics later, but the ecosystem for the team to play in, like, how do I succeed, how do I ring the bell is oftentimes missing. So I think sometimes we go too fast in metrics and we skip the relationship part.

Regan Robertson: We absolutely often overlook and skip the relationship part. I think relationships are one of the elements in dentistry that can get overlooked the most and also can be treated, uh, like they are insignificant because we are in a society where a lot of it is go, go, go. And we see a lot of marriages fall apart in dentistry. We see a lot of, um, damage being done and a lot of turnover happening and I really do chalk it up to how you weigh relationships and check-ins, uh, with your team, with your patients and with yourself. I think it all definitely starts at the, the question that you have posed often Victoria, and that is, uh, you know, “Is everything that we’re doing benefiting the patient? Is it all for the benefit of the patient?” That right there as an anchor statement. Is something that everyone can come to every day and look at their own role and ask themselves how they are showing up. Are we in relationship with our patients? You know, I, I think of, like you said, the, the back door, I think of the back door right away, our patients coming and they’re not coming back. Like we can run reports for that. It’s easy to marry data to the feeling around it and there’s clues, you know, just like a health diagnosis that lets us know, maybe we’re not in.  As great a relationship as we thought is our team calling in at the very last minute, or not even that they’re just texting and like, by the way, I’m just not going to show up today. If you’re in really good relation with your team, likely they will not do that unless something catastrophic has happened, you know, so those little clues can tell us how good of relationship we are in, uh, with our patients and our team and then of course, ourselves too. I think that’s very important. We put ourselves last many times and a few episodes back. Uh, I’ll put it in the show notes. There was a book that Chad and I reviewed and it talked about our different buckets. There’s, you know, our physical bucket, our mental bucket, our spiritual bucket, and what are we doing to maintain each of those things and it is no secret, I’ve shared many times on everyday practices, my own journey that I have taken over several long years to helping, you know, make sure that my buckets are full and I’m taking care of myself. So I can be a good leader and I can be a good parent and a good spouse and a good friend, all of those things.

Dr. Victoria Peterson: Yeah. Um, I’ve been in dentistry since 1979 and I can remember

Regan Robertson: The year I was born.

Dr. Victoria Peterson: Oh my goodness. I love that so much. So I’ve been a hygienist since you were like a toddler.

Regan Robertson: Yeah. You were very, very young. Let’s be fair.

Dr. Victoria Peterson: Yeah. True. I, I was 17 when I came into dentistry, but, um, There were times, you know, like in the 80s when interest rates were high, a lot of doctors were going bankrupt, there were times in the 90s where we heard about burnout. But I honestly didn’t think that it was burnout. It was more like rust out. Doctors were bored and or financially not savvy. We are truly seeing mental health burnout right now and it is because of this cycle. You know of social media and everything that we’re running in and oftentimes people think about being a productive dentist as being busy or productive business and it’s absolutely the opposite.You have to clear the clutter on everything that drains you mentally, physically, and energetically in order to slow down and serve well. So some people are tuned like they’re a Ferrari, and they’re tuned to seeing 16 patients a day, like they just, they’re like this, this is their tempo.

Regan Robertson: Yeah.

Dr. Victoria Peterson: And make sure that you’ve got a tempo of high, high-tempo people with you and that practice will run well, you know, the, and the patients will be appreciative if you at least slow down long enough to make eye contact and say, “I’m so glad that you are here today. I know we appear very busy, yet you are really important to me.” So again, you can focus on patients in a high volume practice and a slower practice, a boutique practice, as long as you create the ecosystem for your team to thrive and that’s what I want to say about above and below the line around culture is knowing, and you brought this up Regan, knowing yourself and your temperament and what your expectations are and please, if your temperament is anger all the time, go to therapy, go to counseling, get a life coach, get an anger management coach. Our society as a whole is so traumatized. I think we have global PTSD. Like, do your work.

Regan Robertson: I laugh, but it’s serious and I, and you are correct

Dr. Victoria Peterson: Because your team will follow you. So if your team is angry, upset, and bitching at each other, you do have to take a look in the mirror and that is the hard part and so get the support you need. Success always requires support. So from the top down, think about your life, slow down, envision what you want and find a framework  for communicating to that team and set them up with the tools they need to be successful. Um, it’s not always easy, but it is simple.

Regan Robertson: Well, thank you, Victoria, for joining me jointly on this special episode of Investment Grade Practices meets Everyday Practices Dental Podcast. We look forward to releasing our next episode coming up very soon. Thank you.

Dr. Victoria Peterson: Thank you.

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