Dental Associates – Tax Status

The dental community, like other groups can be described in these words, “There three types of people in the world, those who make things happen, those who watch things happen and those who say, “what happened?”.

The winds of change have been threatening the default status of dental associates for a decade and a half – or more. I have been talking and writing about it in no uncertain terms during that time. The background is that the relationship between dental principals and associates has evolved and continues to evolve, especially with the change in NHS contracts in 2006. I am not here to judge anyone or their financial set up, I am here to advise. What you do is your choice and yours alone, that is what being an independent practitioner is all about.

The way that HMRC (the UK tax authorities) defines self employment is constantly changing, after many years they are taking a much harder look at the relationships between dental practice owners and others who work in the practice. It could be that there will be a significant change in relationship contracts, they may only make minor changes and clarify things.

The advice as always is: 1) Don’t panic. 2) Ensure the contract between you and your principal or associate is clear and legal with as few ambiguities as possible. 3)Employ an accountant who understands the law and any updated interpretations, and with whom you have a good open working relationship. 4) Keep clear records so that should your affairs be investigated it is easy to see what has been going on. 5) Be prepared, prompt and personable when dealing with the Revenue.

Watch this video, sign up to UNW’s newsletter (other specialist dental accountants are available) take a look at NASDAL’s website. Above all don’t let a change happen to you and find yourself saying, “Duh! What happened?”

The trap of perfectionism

One of my roles with clients could be described as “reassurance”, defined as the action of removing someone’s doubts or fears. I doubt that I ever completely remove anyone’s doubts but I hope I help to reduce, if not eliminate, their fears. Dentists increasingly work within silos, although peer review is encouraged I don’t believe it truthfully takes place in many lives, it certainly didn’t in mine when I was a clinician. The closest I endured was from someone, now deceased, who shall remain nameless, with whom I shared emergency cover during our holiday periods. His favourite way of giving feedback was to draw an “x” on a radiograph and to tell the patient that he had marked what I had missed.

In our contemporary climate of doling out the blame on others before they get a chance to dump it on you, it is hard to stay satisfied and relaxed with our day-to-day lives. With a referral to the General Dental Council now being a common way of escalating personal disputes there is no surprise that paranoia stalks dental surgeries.

An article in 1843 (The Economist long reads) poses the general question, “why have we become so dissatisfied with being ordinary?”. In the piece is reported the case of an undergraduate who couldn’t hand in his work for evaluation because he “knew” it wasn’t good enough.

Back to clients, a common conversation goes along the lines of dentist thinking their work isn’t good enough, often because they have seen some “Wizz-kid’s” composite on a Zoom call. I usually ask them how long did they think it took to produce this “work of art” and if they took as long could they improve? I remind them of patient and case selection (a not unknown bias in our Key Opinion Leaders) and then remind them that they had been complaining of how busy they were and we were working on managing their time.

The fear that someone else will be perfect leads us to believing that as we are less than perfect we are not good enough at all. I am not trying to diminish a passion for excellence but it has to be finite (perfectionists will of course disagree). The move from no magnification to flip down magnifiers, and on to loupes with illumination made me feel that I had been inadequate before, but I resolved not to lose sleep as I had done the best that I could. When a client told me that he had started doing examinations with his microscope I wasn’t sure what to say.

The article is worth a read because I do think that there are some dentists who display perfectionism with elements of OCD and for whom reassurance is needed, lest neurosis follows. I should also remind you of being aware of the patients who seek “perfection”….

Photo by Brett Jordan on Unsplash

Time to take gum disease seriously: The societal and economic impact of periodontitis

From Economist Impact – Good to see Perio getting serious attention.

This report describes the methods and main findings from The Economist Intelligence Unit’s research which assesses the evidence linking improved periodontal health to better overall health outcomes, and showcases the economic and societal implications associated with periodontal health across six European countries: France, Germany, Italy, the Netherlands, Spain and the United Kingdom. These countries were selected for their geographic, demographic, epidemiologic, and socioeconomic comparability.

Executive Summary

Periodontal (gum) diseases are strikingly common across the globe, but also largely preventable. Left untreated, they are the main cause of tooth loss and considered one of the main threats to oral health. In Western Europe, a region which offers some of the most advanced healthcare services to the general public, developments in the prevention and management of periodontitis appear stagnant. The prevalence of periodontitis has remained largely unchanged over the last 25 years. The evidence-base shows periodontitis, which is the severe form of gum disease, has associations with diabetes, cardiovascular diseases and over 50 non-communicable diseases. Recognition of these mutual risk factors and knowledge sharing between dentistry and general health are scarce in clinical practice. Similar to general health, poor oral health is also strongly associated with lower socioeconomic status. Unlike accessing the General Practitioner (GP), which in most of Western Europe are free at the point of access, many report avoiding dental check-ups due to the upfront costs. This avoidance only exacerbates poor oral health in socio-economically deprived neighbourhoods.

Heres the link.

“Facebook Is an Authoritarian State”

Increasingly I have been calling myself “The antidote to (Dental) Business Coaches”, not because I am anti “coaching” per se, that’s another story, rather because it is an area that is being dominated or at least heavily influenced by shouty marketeers. These individuals seem to think that success depends upon attracting an endless supply of consumers (vs patients) who will buy “things” as opposed to skills and service. The majority of their marketing seems to depend upon social media, where the biggest player, of course, is Facebook. Occasionally I turn off my ad-blockers to experience the sheer p-i-a of the experience. Of course my marketing friends (the majority of whom I know to have far more to their skills than jumping on to bandwagons) assure me that “I am not the target audience”. …but I often wonder if that is the case, why are they aiming at me?

The piece below is from John Naughton’s blog this morning.

Facebook is acting like a hostile foreign power; it’s time we treated it that way, writes Adrienne LaFrance in The Atlantic.

Mark Zuckerberg, unlike Einstein, did not dream up Facebook out of a sense of moral duty, or a zeal for world peace. This summer, the population of Zuckerberg’s supranational regime reached 2.9 billion monthly active users, more humans than live in the world’s two most populous nations—China and India—combined.

To Zuckerberg, Facebook’s founder and CEO, they are citizens of Facebookland. Long ago he conspicuously started calling them “people” instead of “users,” but they are still cogs in an immense social matrix, fleshy morsels of data to satisfy the advertisers that poured $54 billion into Facebook in the first half of 2021 alone—a sum that surpasses the gross domestic products of most nations on Earth.

GDP makes for a telling comparison, not just because it gestures at Facebook’s extraordinary power, but because it helps us see Facebook for what it really is. Facebook is not merely a website, or a platform, or a publisher, or a social network, or an online directory, or a corporation, or a utility. It is all of these things. But Facebook is also, effectively, a hostile foreign power.

An interesting way of viewing the corporation. Thomas Hobbes would have seen it that way too.

The Monday Morning Quote #678

A few on the subject of change….thanks to Dr Mardy for the inspiration ….and material.

“To change one’s life: 

1. Start immediately. 

2. Do it flamboyantly. 

3. No exceptions.”  – William James

“You can’t change people,
but you can effect a change in them by your behavior.” — GARRISON WYNN

“Whereas I formerly believed it to be

my bounden duty to call others to order 

I must now admit that I need calling to order myself,

and that I would do better to set my own house to rights first.” – Carl Jung

The Monday Morning Quote #677

“Strategy is not just where you are going. It is also how you are going to get there. Often, people think that if they tell you where they are going, then they have a strategy – no, they have a statement, not a strategy.”

Camille Fournier

The Monday Morning Quote #676

“When the last tree is cut, the last fish is caught, and the last river is polluted; when to breathe the air is sickening, you will realise, too late, that wealth is not in bank accounts and that you can’t eat money.”

Alanis Obomsawin

Filmmaker Alanis Obomsawin, is pictured in Toronto on Sept.12, 2002. There’s an urgency to Alanis Obomsawin’s politically charged work, so much so that the veteran filmmaker says she’s had no choice but to take on five different projects more or less at the same time. THE CANADIAN PRESS/Frank Gunn

The Monday Morning Quote #675

“Life is like a game of cards.

The hand that is dealt you represents determinism; the way you play it is free will.”

Jawaharal Nehru

The Monday Morning Quote #674

“The difference between the novice and the master is simply that the novice has not learnt, yet, how to do things in such a way that he can afford to make small mistakes. The master knows that the sequence of his actions will always allow him to cover his mistakes a little further down the line. It is this simple but essential knowledge which gives the work of a master carpenter its wonderful, smooth, relaxed, and almost unconcerned simplicity.“

Christopher Alexander

The Monday Morning Quote #673

“Life moves on, whether we act as cowards or heroes. Life has no other discipline to impose, if we would but realize it, than to accept life unquestioningly. Everything we shut our eyes to, everything we run away from, everything we deny, denigrate or despise, serves to defeat us in the end. What seems nasty, painful, evil, can become a source of beauty, joy, and strength, if faced with an open mind. Every moment is a golden one for him who has the vision to recognize it as such” 

Henry Miller – writer.