“Financial planning provides you with confidence that you are on the right track.”

--Columbus, OH pre-retiree.

Creating Financial Independence and for Dentists

By Christina Povenmire, CFP and Barry Jamieson, CFP candidate

CMP Financial Planning DEDICATION

his book is dedicated to the happy, healthy, and prosperous futures of the dental professionals we have had the pleasure of Tworking with and to those we still hope to meet. We thank all the dentists who took the time to talk with us and who responded to our survey—your time, honesty, and candor are appreciated.

ACKNOWLEDGEMENTS: We have a great deal of appreciation for the professionals listed below for sharing with us their knowledge and input.

Dr. David Austin DDS, MS, American Pain & Sleep Center, President of AGD/Clinical Assistant Professor Ohio University College of Osteopathic Medicine

Jennifer Bruner, Transition Consultant, Paragon Dental Practice Transitions

Dr.Timothy March, DDS, MS, March Dentistry/past President Columbus Dental Society

Karen Marshall, Founder, Vero3 Consulting

Polly Mowery, Director, Columbus Dental Society

Dr. Jason Stoner, DDS, MS, Stoner Periodontic Specialists

2 TABLE OF CONTENTS 4 INTRODUCTION

6 CHAPTER ONE Strong teeth, decaying finances: challenges faced by dental professionals today

13 CHAPTER TWO Say ahhh: survey results: dentists are stressed

22 CHAPTER THREE Taking control: preventive financial care for dentists

31 CHAPTER FOUR Putting your money where your mouth is: process and key components of effective financial planning

35 FINAL THOUGHTS: BONUS MATERIAL FOR PUTTING KNOWLEDGE INTO ACTION Give me a big smile: creating a comprehensive for me

38 AUTHOR BIOS

39 APPENDIX Table Ia. The Dentist’s Financial Planning Lifecycle Table Ib. Looking back: Advice from Experienced Dentists Table IIa. Ohio Dentist Survey Questions Table IIb. Key Results from Survey of Ohio Dentists

42 ENDNOTES

44 ADDITIONAL SOURCES

3 INTRODUCTION

ental professionals are a unique demographic. They are highly educated, focused, and typically entrepreneurial in spirit, which Doften drives them to start their own practices. In fact, more than 80% of active private practitioner dentists own (or co-own) their practice. Since these practitioners add so much to the practice of dentistry, helping protect and preserve the dentist -owner is important. According to an article in The Journal of the American Dental Association, dentists in solo and small-group practices (in contrast to larger group practices): • Expressed higher levels of satisfaction with their ability to stay current with the latest advances in dentistry • Were much more likely to report that they felt driven to produce high-quality clinical work1

Dentists have potential for high earnings and wealth accumulation. Yet their practices can be affected by the economy as well as a host of other factors, both within and outside of their control. Despite medical needs, a large percentage of the population foregoes regular dentist visits for financial reasons or convenience. Consumers are increasingly savvy as to how they choose their dentist, resulting in increased competition. While dentists have invested a great deal of money, time, and energy into setting themselves up for successful careers, they face a host of challenges that, if not handled strategically, stand to threaten their long- term financial . How dentists handle financial decisions today affects their financial futures and their ability to take care of and protect what’s most important to them, most often their families.

While dentists are highly educated, neither financial nor business skills are emphasized in dental school. (Some schools do offer courses on practice management, which overlaps somewhat with financial management but is distinctly different.) In fact, the American Dental Association task force recommends the development of a financial portal to educate dental students on financial literacy and life-long financial and career planning.

4 Many dentists and other business owners fail to recognize the significant positive effect financial planning can have on their future. We’ve all heard the old adage, “No one plans to fail, but many fail to plan.” The good news is that financial planning can help dental practitioners and other small business owners get on the right track and alleviate a great deal of financial stress.

In this e-book, we explore the challenges faced by dentists today: financial, economic, and personal. We reveal the results of our study of 42 dentists who shared with us many of the sources of their financial stress and how these stressors affect them. Finally, we share how having a comprehensive financial plan can help dentists meet their goals and optimize their resources, particularly for retirement. Our intention is to illustrate to dental professionals how financial planning can position them for a future that allows them to retire when they want and take care of their loved ones and families as they wish.

5 CHAPTER Strong teeth, decaying finances: challenges faced by dental professionals today 1

• Approximately 190,000 dentists practice in the US today; 92% of them work in a private practice. More than 80% of active private practitioner dentists own (or co-own) their practice.2 • While 64.4% of survey respondents reported rising dental practice production, 38.3% also experienced high or extremely high stress.3

ental professionals today face mounting challenges to their ability to save for retirement and achieve financial independence. DShrinking insurance coverage, increasing competition, and rising costs create extreme revenue pressures and add to the complexity of owning and running a practice. Many dental practitioners find themselves working far longer than they’d expected. Many have been unable to save enough for retirement and/or have endured frequent setbacks, especially during the Great Recession following the market crash of 2008. These financial pressures and stressors ultimately can creep into their personal lives, adversely affecting health, family, and overall wellbeing.

6 Let’s examine some of the financial and psychological challenges faced by private practice dental professionals today:

1. Dental insurance coverage is shrinking.

Nationally, the percentage of employees with private employer dental insurance is shrinking, declining to 56% in 2010 from 62% in 2001, according to data from the Medical Expenditures Panel Survey.4 Additionally, patients who still have dental insurance find they must cover more costs themselves--or do without procedures. Insurance companies have lowered reimbursement rates by as much as 15% over the past few years with more cuts likely.5 The dentists we surveyed ranked low reimbursement rates as their highest source of stress. Many insurance companies also “down code” bills, changing the price of procedures to less complex and lower-cost procedures than those reported by the dentist.6

• Every practitioner we interviewed expressed concerns over low insurance reimbursements! • Private employer dental insurance declined to 56% in 2010 from 62% in 2001.

Increasingly, patients rely on public insurance created by the Affordable Care Act or on their own out-of-pocket payment to cover their dental visits. (As a positive side note, the Affordable Care Act has led to an increase in Medicaid payers for both child and adult populations as states move to expand Medicaid coverage to children, especially to include dental care.) While the number of Dental Preferred Plans—plans that lower costs for patients treated by doctors within a network—has increased, a seemingly good thing for dentists, this increase creates leverage for insurance companies to negotiate lower reimbursement rates.

7 2. Declining insurance coverage means slower patient growth.

The number of adults, age 19-64, who visit a dentist in any given year declined to 35.1% in 2011 from 41% in 2003. Dental care-seeking behavior is strongly correlated to having dental benefits, so it’s not surprising that we’ve also seen a decline in the number of patients who visit dentists each year. Individuals and families without insurance are often selective about when they visit the dentist (only 18% of the uninsured visit the dentist in any given year10) and preventive care • More than three-fourths of is often considered an optional purchase. uninsured adults visited the dentist just once or not at all When the economy is in decline, we 7 see reduced demand for virtually in the last 10 years. all dental services. Existing patients fail to keep a regular maintenance • The percentage of adults schedule, and new patient growth aged 19-64 who visited a slows. Practices experience more cancellations and no-shows, as well dentist within a given year as problems collecting money they declined to 35.1% in 2012 are owed by patients. 8 from 41% in 2003. For the dental profession, reduced insurance coverage has led to more • The two most common empty chairs—as well as a tougher reasons for delaying dental time getting patients to pay. care are financial barriers and not knowing how much treatments cost.9

8 3. Fierce competition and consumerism are changing the game.

Dentists practicing today compete against a growing number of competitors—and must satisfy an increasingly savvy dental consumer. Each year we see rising numbers of dental school graduates. We’ve also watched the exponential growth of corporate dentistry as well as the popularity of “Dental Service Organizations” (DSOs), a dental business model in which independent practices band together to create greater economies of scale. DSOs typically enjoy tremendous financial resources, allowing them to offer lower prices, use the most cutting-edge technology, and negotiate better reimbursement rates with insurance companies. As a result, DSOs often dominate market share.

Additionally, often as a result of dental practitioners not being able to save and invest enough for retirement, many dentists practice 8 to 10 years longer into what they’d hoped would be their retirement years.11 More practicing dentists means more competition.

The increasing number of dental practitioners also means that patients enjoy more choices. Prospective patients have become savvy consumers, proactively shopping for value “Dental Service and quality. As they must pay out of pocket for dental care much more so than with medical care, dental patients tend to pay more Organizations (DSOs) are attention to costs. Younger adults, who are the least likely to have affecting patient flow to dental insurance, increasingly make use of websites that allow them to compare dentists. As technology makes it easier for patients accommodate insurance, to access information on specific dental providers, comparison making it tougher for the shopping will become even more prevalent.12 small practitioner.”

-Columbus, OH transition consultant

9 4. Operating a successful private practice demands business acumen, yet dental students don’t learn business skills in school.

More than 80% of active private practitioner dentists own (or co- own) their practices. And, private practice dentists face many of the same challenges as other small business owners.13 The average small business, for instance, survives only five years; only one-third “Run your practice of all small survive ten years or more, according to the efficiently. Don’t Small Business Association. To survive—and thrive—private dental overpay staff. Watch practitioners need business acumen, and yet many dental professionals do not possess the business savvy to run a profitable business. Some costs.” dental schools do teach practice management courses, however, it’s typically a minor part of the curriculum. -Advice from a Columbus, OH Among the many business challenges are: dentist to younger practitioners. • Cash flow. As discussed earlier, insurance reimbursements aren’t going anywhere but down. Moreover, delayed reimbursements also slow the inflow of cash. Often private practice dentists do not have the financial experience or savvy to manage their limited cash flow wisely.

• Shrinking margins. Declining insurance coverage, down-coded payments, and competition from larger practices with stronger efficiencies often leaves the private practitioner with squeezed margins.

• Cost of equipment and technology. Setting up a new practice and maintaining up-to-date equipment can cost a semi-fortune. A three-chair, 1,800-square foot office, for instance, can cost more than $600,000 to set up—before you even turn on the light switch or hire staff. Reducing costs while feeling pressured to keep up with the competition can be difficult. Dentists who invest too much in their practices too soon can find themselves with troubling .

10 • Hiring, training and managing staff. Building an office means hiring, training, and managing the right people—on an ongoing basis. Managing staff takes time and money—and requires competent managerial skills. Moreover, when you compete against larger practices that can offer higher and benefit packages, it can be difficult to attract and retain top talent. One local dentist we interviewed reported overpaying his long-term employees as a result of annual raises that eventually grew to salaries far above market. A practice transition consultant we interviewed reported that when dental practices are substantially mismanaged, dental hygienists often take home more than practice-owning dentists.

• Health insurance and retirement plans. Setting up retirement and health care plans for practitioners and staff can be complicated and time consuming. Yet it’s not only critical for protecting yourself and your staff, it’s key to attracting and retaining quality staff.

• Risk mitigation costs. Business owners must protect themselves with liability and malpractice insurance. Not having the proper protection in place can be devastating.

• Patient marketing. While most private dental practitioners purchase a practice with an established patient base, obtaining and retaining patients still takes work. Most private practitioners feel pressure to keep their chairs filled. Dental practice “marketing” efforts often focus on referral relationships. General practice dentists may develop long-term relationships with their patients who generate referrals. However they shouldn’t automatically expect loyalty: today’s increasing competition means it’s simple for patients to switch dentists. Specialty practices, such as orthodontists and endodontists, may have the benefit of obtaining patients from referral relationships with general dental practitioners, yet their patient relationships are typically shorter in length. Because they do not build long-term patient relationships and therefore do not build up an established patient base, their practices are typically less valuable.

11 • Selling a practice and establishing a succession plan. Dental practice values, particularly for specialty dental practices, have dropped significantly. Long before retirement, dentists need to take steps to maximize the value of their practice to obtain the highest price when they are eventually ready to sell. To reach a secure retirement, dentists must engage in thoughtful retirement and succession planning.

5. Young dentists carry enormous dental school debt.

The growing rate of dental school debt mirrors trends in other professions, including in medicine, law, and pharmacy. Between 1994 and 2011, dental school costs rose 7.8% for public schools and 5.6% for private schools, on average, each year. The average dental student graduates with upwards of $247,000 in student —an increase of more than 66% in the last decade, vastly higher than increases for the general student population, according to the American Dental Education Association (ADEA). To offset increasing tuition rates, dental students are borrowing more. New dentists often start their careers shouldering a tremendous financial burden – one that can delay their ability to save and create financial independence.

The average dental student graduates with upwards of $247,000 of debt.14

12 CHAPTER Survey Results: dentists are stressed 2

s we’ve met with independent dental professionals over the years, we’ve observed that there are distinct patterns to their Aconcerns. In helping them resolve issues, we’ve tried to uncover the root causes of their financial stress. By better understanding their unique career and personal challenges, we think we can design better financial planning solutions.

In this light, we surveyed 42 Ohio-based independent dentists about the challenges they believed most affected their stress levels. We also asked survey respondents whether they had a comprehensive financial plan, worked with a financial advisor, and what advice, looking back, they would give younger peers. In developing our survey questions, we consulted various professionals/practitioners, many of whom belong to The Columbus Dental Society, to ensure we covered the most common issues affecting the profession. The complete survey instrument can be found after Appendix Table Ia of this e-book. A summary table of responses of key questions of the survey, often referred to in this book, can be found in Appendix Table IIb.

Responses to our survey were categorized into four groups so that we could assess whether individual stressors were more prevalent in distinct stages of dental careers:

1. “Early career” (post-graduation, ages ~25-32, practicing ~3-6 years) 2. “Mid-career” (ages ~30-55, established in their career path) 3. “Transitioning into retirement” (ages ~50-70, transition process of 3-7 years) 4. “Retired” (ages ~60-100)

13 The results of our survey gave a revealing glimpse into the careers of Ohio dentists and the unique stressors they face. Here’s what we learned:

1. Dentists worry about money … a lot.

Not surprisingly, dentists worry about their net income, low reimbursements, growing their business, and cash flow. But what may surprise you is the degree to which dentists worry about each of these money factors.

Dentists aren’t happy with their net income.

About one-third of dentists (31%) are not satisfied with their income. Dentists are the least satisfied with income compared to any other factor.15 Importantly, those dentists who do not work with a financial advisor are the least satisfied as a group with their net income.

Dentists are stressed about decreasing reimbursements.

As we discussed in the previous chapter, private dental insurance coverage is declining for many practices. Insurance companies have reduced reimbursements by as much as 15% over the past few years with more cuts anticipated, resulting in uncertainty and decreased cash flow. Accordingly, 69% percent of dentists surveyed cite low reimbursements as their primary source of external stress, more than any other stressor in the survey.16 An additional 43% of dentists surveyed report feeling stressed about cash flow.17

Dentists are stressed about growing their practices.

As shown below in Figure 1, a clear majority (52%) of respondents cite growing their practice as a significant source of stress. However, Appendix Table II shows that this stressor varies widely dependent on the career stage and gender of the respondent and whether the respondent has a financial advisor. As practitioners approach retirement, they tend to be less concerned about growing their practices and more concerned about supporting the value of the businesses. The second highest stressor was cash flow at 38%. This result is not surprising. Cash is required to fuel growth in an expanding business and is therefore directly tied to the stress of growing a practice overall.

14 As mentioned previously, stress varies widely by various subgroups. Female dentists list staffing issues (56%) and transitioning into retirement/selling their practices (56%) as their most significant sources of stress.18 Older dentists transitioning into retirement worry most about updating technology (43%) and cash flow (45%).19 Those who receive no financial planning advice show higher levels of stress across the board, including concern about growing their practice (70%), developing their skills (70%), and cash flow (60%).20 The stress that stems from growing the dental practice undoubtedly relates to the growing complexity that occurs in running a multi-faceted small business.

Figure 1: Sources of Business Stress for Dentists

Cashflow 43%

Transition to Retirement 24%

Staffing 38%

Developing Skills 33%

Growing Practice 52%

Repaying Debt 29%

0% 10% 20% 30% 40% 50% 60%

% Very or Somewhat Stressed (See also Appendix Table IIa and Table IIb, question 14 from Ohio Dentist Survey)

15 2. They’re dealing with family issues, too.

Figure 2 shows the stress related to the personal challenges that dentists face. Not unlike other career professionals, balancing work and personal priorities is increasingly difficult as technology widens the array of choices but also makes increasing demands on our time. Nearly four in ten (38%) cite caring for an elderly parent as a personal stress factor, more than any other source of personal stress. An additional 38% express concern about having sufficient personal time.

Figure 2: Personal Stressors of Ohio Dentists

40% 38% 38% 33% 31% Immediate Family 30% Caring for Parents 24% 21% Health 20% Wedding

Sufficient Personal Time 10% Personal Finances

0%

% Very or Somewhat Stressed (See also Appendix Table IIa and Table IIb, question 15 from Ohio Dentist Survey)

16 As with other career concerns, the survey shows female respondents experience not only more stress, but also a somewhat different set of worries compared to their male counterparts. Among female respondents, 78% cite caring for immediate family, 78% cite having sufficient personal time, and 67% cite having insufficient savings as being very or somewhat stressful.21

Illustrating the different set of worries, female dentists in our survey:

• Tend to be more stressed than men about personal matters that involve family (78% vs. 21%) and caring for aging parents (67% vs. 30%).22

• Are more likely to be stressed regarding staffing (56% vs. 33%) and transitioning their practices, while males are more concerned about growing practice and cash flow. Female dentists in our survey tend to work in multi-practitioner settings where staffing is more of an issue.23 • Are more stressed about transitioning to retirement (56% vs. 15%)24

• Expect to retire earlier than their male counterparts (89% vs. 36%)25

• Are more likely to live on less than they can afford (44% vs. 61%)26 and have a formal financial plan despite their age (78% vs. 52%)27

• Looking back, would have emphasized work-life balance more and would have sought more advice from financial professionals.

In general, these results support findings that suggest that women, although they have grown in equality to men in terms of compensation and workplace leadership, still often remain largely more responsible for maintaining a smooth transition between work and family.28

17 3. Dentists experience more stress in the middle of their careers than at the end.

Perhaps not surprisingly, given the high degree of worry about finances, mid-career dentists report much more stress than dentists transitioning into retirement.

Mid-career dentists experience more stress overall—especially in the area of practice growth.

Mid-career dentists are almost twice as likely to cite growing a practice as a stressor compared to transitioning dentists (57% versus 36%).29 Perhaps due to the presence of school-aged children and elderly parents, dentists in the middle of their careers are much more likely than transitioning dentists to cite caring for immediate family as a stressor (57% versus just 14%) A slightly larger number of mid-career dentists (43%) compared to transitioning dentists (36%) cite caring for parents as a stressor. And, again, mid-career dentists (57%) are nearly twice as likely as transitioning dentists (29%) to report insufficient personal time as a stressor.30

Transitioning dentists worry about staying current.

Dentists reaching the end of their careers feel less stress, generally, than their younger peers (despite of the fact they are working 8-10 years longer into what they’d expected would be their retirement years). The one area where their stress outpaces that of their mid-career counterparts is technology. A significant percentage of transitioning dentists (43%) cite updating technology as a stressor compared to just 19% of mid- career dentists, likely because updated technology is a factor in valuing a practice soon to be sold.31

4. Small group practitioners face more stress … and plan to retire sooner.

Overall, we found that dentists practicing in a small group (with two to three partners) have more stress than their peers operating as solo practitioners. About twice as many group practitioners vs. solo practitioners worry about developing skills (50% vs. 24%).32 Another 42% of group practitioners cite having sufficient personal time as a stressor versus just 28% for solo dentists. A significantly larger percentage (42%) of group practitioners cites personal finances and lack of savings as a stressor compared to solo dentists (24%).33

18 Dentists in group practices retire earlier.

Perhaps as a consequence of having more stress and less control over their businesses than solo practitioners, dentists in small group practices plan to retire sooner. Just 42% of group practitioners plan to work past age 65 compared to 48% of solo practitioners.34 Group practitioners tend to have less control over their work schedules and therefore less freedom to practice in a manner that suits their skills and preferences. Those in group settings may need to compromise to meet the needs of their partners or business owner. This can lead to more stress, and less satisfaction, overall.

5. Nearly all dentists want to pay off debt, set goals – and save for retirement.

Figure 3 shows that dentists overwhelmingly cite paying off debt (100%), saving for retirement (98%), and goal setting (95%) as personal success factors. And not coincidentally, each of these areas can be addressed with comprehensive financial planning. In chapter four and in the bonus section, we will discuss how comprehensive financial planning is useful in coordinating the various goals dentists have.

Dentists regret not saving earlier in their careers.

While dentists can address these vital success factors with financial planning, our study shows that many simply aren’t taking control over these financial issues as well as they could. Some 55% of dentists surveyed wish they had started saving for retirement earlier. Another 38% regret not seeking out the advice of a financial professional.35

Figure 3: Success factors as perceived by dentists surveyed

100% 98% 100% 95% 93% 90% 88% Paying Off Debt

80% Saving Early 64% Planning/Goal Setting 60% Using Mentors/Advisors

40% Study Group Meetings

Networking 20% Outsourcing 0%

(See Appendix Table IIa and Table IIb, question 33 from the Ohio Dentist Survey)

19 6. Most dentists haven’t saved enough. 7. Dentists who work with financial advisors feel more confident. A significant percentage of survey respondents Figure 4 shows that dental professionals who (43%) report that their retirement work with a financial professional report aren’t what they had hoped they would be36, significantly less stress than those who do not and a majority wishes they could have done work with a financial professional. Just 47% things differently to save more at an earlier of dentists working with a planner cite being age.37 Dentists overwhelmingly expect to use stressed about growing their practice compared retirement accounts and to fund their to 70% of those who don’t utilize financial (as opposed to funding retirement by professionals. Similarly, 38% of dentists who work selling their practice).38 with a financial professional report being stressed about cash flow compared to 60% of dentists who Not surprisingly, the lack of adequate savings aren’t working with a financial professional. Just forces many dentists to delay retirement – and 22% of dentists working with an advisor cite being that realization hits them more profoundly as they stressed about developing skills versus 70% for get closer to the end of their careers. Mid-career those without a financial professional. dentists generally plan to retire much sooner (age 60-65), for instance, while transitioning dentists expect to retire after age 66 or older.39

Figure 4: Association between working with a financial advisor and various stressors

Fraud No financial advisor Meeting ER Quotas Uses financial advisor Updating technologoy

Cashflow

Transition to Ret.

Staffing

Developing Skills

Growing Practice

Repaying Debt

0% 10% 20% 30% 40% 50% 60% 70% 80% % Somewhat or Very Stressed 20 (See Appendix Table IIa and Table IIb, questions 14 and 15 from the Ohio Dentist Survey) Those dentists with a work fewer hours and are more likely to have a formal retirement and estate plan in place. In fact, those with a financial planner as a group work fewer hours than the group of female dentists and even the group of early-career dentists surveyed.40 Finally, consider also that 65% of those working with a financial planner have assets higher than or at expected levels vs. just 50% of those working with an investment manager only.41 (In the next sections we will discuss in detail the benefits of comprehensive financial planning versus investment-only financial management.)

Having a financial planner may allow dentists to focus on their strengths and free up time and emotional energy. Working with a financial planner ranked number two (second only to saving more for retirement) on the list of things dentists would have done differently looking back.

So while as a dental professional you have a myriad of stressors that can leave you feeling out of control, there are steps you can take to help put yourself in the control seat and position yourself for a bright future. In the next chapter we’ll discuss specifically how comprehensive financial planning can help you do just that.

21 CHAPTER Taking control: preventive financial care for dentists 3

Your assets—not you—should be working harder and smarter for your future.

s we discussed in the last chapter, we know dentists worry about their finances … a lot. If you’re like most dentists, you worry Aabout your net income and low reimbursements, as well as about growing your business and maintaining cash flow. Our survey shows dental professionals who work with a financial professional report significantly less stress than those who do not work with a financial professional. Yet, just as important as working with a financial professional is the type of advice you receive from that professional. According to a 2013 survey of respondents age 18+ from across the country, 91% percent of those surveyed report they want their financial advisor to take into account their total financial situation, and 70% reported they would prefer to work with a financial advisor who provides comprehensive financial planning services, compared to 30% who cite wanting to work with someone who specializes only in one area, such as retirement.42 “Looking back, maybe I would have gotten advice proactively rather than when there was a problem.” -Upper Arlington, OH, dentist looking back at what he might have done differently.

22 As we touched on in the last chapter, comprehensive financial planning is different from investment management, which focuses only on growing your investments, without holistically and systematically addressing your entire financial situation, including goals, objectives, taxes, etc. This type of holistic financial advisor, referred to as a comprehensive financial planner, is a certified practitioner who takes into account your entire financial picture. As cited in the last chapter, 75% of those working with a financial planner have a formal financial plan versus 58% of those working with an investment manager only.

Why do people have such a strong preference toward comprehensive financial planning? Simply put, comprehensive planning brings an Your assets—not you—should be working assurance that all your goals are being considered while your resources are being optimized to meet your goals. Think of it as devising a game plan for your life. You work with professionals to organize and harder and smarter for your future. coordinate all the moving and interrelated parts of your financial life. By crafting a cohesive plan with reachable goals that takes into account the interrelationships of your finances (including, for example, the tax impact of one investment choice versus another when designing your investment portfolio), you can help ensure that you have enough money for your priorities. Not coordinating your decisions between the important financial planning areas—investments, estate planning, charitable giving, insurance, taxes, etc.—could effectively delay your financial independence and retirement by years.

While some dentists and other professionals believe they can develop their own financial plan, for the busy dental practitioner with resources, outsourcing this task can free up time and energy to focus on core strengths and their personal lives. This most likely explains why the majority of those dentists surveyed indicated that they had a comprehensive financial plan and had either a financial planner or investment advisor.

Managing your complex financial picture can seem overwhelming. If you’re a solo practitioner or work in a practice with one or two partners, you face decisions about staffing, technology, and practice growth – all of which create financial pressures. A knowledgeable comprehensive financial planner can assist you in planning for growth, maximizing your wealth, minimizing your risks, and preparing for the future.

23 More than investing

As we’ve discussed, financial planning involves far more than just managing investments. “Investment management” involves selecting, monitoring, and managing specific investments, such as and Financial bonds. Financial planning considers your entire financial life (goals for planning can retirement, education, investing, insurance, etc.) while organizing and help manage and positioning financial instruments to achieve your goals. Coordinating all aspects of your wealth is critical to ensuring that different investment mitigate many of strategies complement each other and that, for example, you don’t dentists’ common create more taxation than capital gains and are protected against potential catastrophic occurrences that could be offset by insurance. stressors.

Financial planning takes into account both short- and long-term goals so that while you plan for your retirement, you may also, for example, plan to fund your children’s education or weddings, or any other “sub- goals” you may have along the way. Developing a comprehensive financial plan offers the following benefits for you, your family, and your practice:

1. Provides confidence and clarity.

Financial planning helps you envision the future you want for you and your family, so you can better align all your resources. After helping you to ascertain your goals and priorities, this process involves running projections, assessing what you have accumulated, your savings and investing rates, years until retirement, taxes, and other factors. This roadmap allows you to feel more confident about the lifestyle you can afford, when you can retire, and how much you could potentially leave for future generations. A solid financial plan turns uncertainty and chaos into clarity and confidence. Even if you can’t remove every one of life’s potholes, you can at least create detours of your own choosing. And life is more fun when you don’t have to worry so much about your future.

“Contribute to and maintain retirement plans to minimize taxes, maintain healthy lifestyle, and balance work/play.”

-Columbus, OH dentist

24 “Determine your path, and be sure to follow what you like best.” -Columbus, OH dentist

2. Puts you back in charge.

As a small business owner and dental practitioner, you wear many hats—but you only have so many hours in the day. Sometimes you may feel like your practice is running you and consuming your life. Working with a professional to help you manage your financial affairs can enable you to spend more time doing what you do best – attending to your patients. A comprehensive financial planner provides financial expertise and also serves as the “quarterback” or “CEO” of your financial life, coordinating with multiple advisors, including your CPA on tax planning, your insurance agent on risk management, and your attorney on the structure of your business. Your financial planner may recommend reputable financial professionals or work with your existing advisors. A comprehensive financial planner will also advise you on accounts that are not currently under their management, such as your spousal 401(k) or college savings accounts. When a team of financial professionals all are focused on meeting your goals, it means less worry and more free time for you. Our survey clearly shows that dentists want more personal time with family and friends but feel pressure to work harder to manage their practices effectively. Thirty-eight percent of the dentists we surveyed cite “having sufficient personal time” as somewhat or very stressful to them. Comprehensive financial planning reduces that stress—and puts you back in charge of your life.

25 3. Establishes short- and long-term .

Many dentists, especially those stressed about monthly cash flow, wonder how much they can afford to spend on their children’s college education or a vacation home—or when they should purchase their practice or invest in new equipment or technology. Even if you’re not particularly worried about short-term cash flow, major spending decisions affect your financial future. Financial planning can help you establish a for short- and long-term spending, to better weather unsteady cash flow and to stick to a budget. Budgeting helps you stay on track to reach your target retirement date and meet other important goals.

“Pay early, live below your means, save, and

invest conservatively” -advice from a Columbus, OH dentist

4. Manages (and helps reduce) your risk.

Virtually all investors worry about market returns. And while financial planning can’t control market returns, it can control our exposure to market risk. Market downturns occur regularly and not only have an effect on the dentist’s savings and investment accounts, but also on their patients’ accounts, resulting in fewer dentist visits when the chips are already down. A comprehensive financial plan takes these inevitabilities into account, factoring in best- and worst-case market scenarios so that you stay on track for meeting your long-term goals, regardless of market conditions. Perhaps more importantly, financial planning attempts to optimize your risk and return. For example, as you grow older and near your retirement date, your financial plan helps you decrease your exposure to higher-risk investments, such as stocks, and increase your exposure to lower-risk investments, such as bonds or cash. This type of risk management is a major component of financial planning.

While we can’t control market returns, we can control our exposure to market risk.

26 5. Limits the financial impact of unexpected events.

Financial planning covers insurance and estate planning so you can be assured that you and your family are adequately prepared for life’s unexpected events, such as disability or long-term illness. Consider that an unexpected physical disability—such as a hand injury—could end a dentist’s career, so disability insurance is crucial. Financial planning helps you provide for yourself and your loved ones by managing risk. Financial planning can’t prevent the unexpected or preclude the inevitable, but it helps you take control over what you can control, in much the same way that you can take charge of your diet and exercise to better your odds of longevity. Financial planning helps you build a strong financial foundation for whatever situation may arise at any given moment.

We’ve all heard stories of those who were diagnosed with fatal illnesses and went bankrupt because they lacked adequate, continuous health insurance. And we’ve heard the stories of untimely deaths that left families without sufficient life insurance— or of estates thrown into legal chaos because of the lack of estate planning. Unfortunately, so many fail to plan ahead, yet few can afford the consequences of not planning. Risk management ensures you have the right insurance policies (such as disability, long-term care, and property loss and casualty) in place to protect you against unfortunate and untimely negative events. As a dentist, you likely also will need specialized insurance to cover you against lawsuits, workers’ compensation claims, or business interruption resulting from a natural disaster, death, or disability.

Financial planning helps put your financial life in order and protects you from worst-case scenarios so you are financially prepared for whatever may arise.

6. Manages and helps minimize taxes.

Taxes affect virtually all areas of your financial life, including the net return on your investments, the cost of property or equipment, and the ultimate size of your retirement nest egg. Comprehensive financial planning helps you organize your assets to minimize taxes. Among the many strategies for reducing taxes are timing large purchases and sales, setting up the right legal structure for your practice, and taking advantage of retirement accounts.

27 For example, we found that many dentists who came to us for financial planning were not taking full advantage of qualified (tax-advantaged) retirement plans. Many dentists and other small business owners don’t realize that the more money they contribute to their tax-advantaged retirement plans, the more they will save in taxes. They’ll save so much, in fact, that their additional tax savings will more than offset the cost of plan and matching contributions for employees—a win-win situation for everyone.

Additionally, strategic “ location,” which refers to how you distribute investments across different types of saving vehicles such as taxable, tax-deferred, and tax-exempt accounts, can significantly reduce how much you’ll pay in taxes when you eventually take distributions for retirement.

While you won’t be able to eliminate your taxes, comprehensive financial planning helps you minimize them and eliminate surprises. Minimizing expensive surprises can certainly help reduce stress.

7. Sets your “financial independence” or retirement date.

Our survey shows that most dentists don’t think that they’ve saved enough for retirement. Even the best savers and investors sometimes don’t know exactly when they’ll have enough to retire. Financial planning helps you put an exact date on your retirement, removing the uncertainty of how much you’ll need, as well as how much you’ll need to save each month to get there. Establishing your preferred retirement date involves forecasting and analysis, careful budgeting for expenses, setting up insurance policies to protect against unforeseen circumstances, and using the most tax-advantaged types of accounts for your situation. In the process, you’ll also address important intermediary financial goals, such as paying for your children’s college educations, weddings, vacation homes, etc.

“Once I knew that I had enough money to retire, many of my workplace worries didn’t seem to matter so much anymore. Working another couple of years was ok.” –Upper Arlington, OH retiree.

28 Incidentally, while many people don’t save enough for retirement, financial planning also benefits those who may unknowingly save more than they realized they needed, based on the retirement lifestyle they imagined. Clients have come to us over the years for financial planning without a concrete understanding of how much they would need to retire and maintain their lifestyle. Projections revealed that at least a few of our clients who expected to retire years into the future could retire immediately and maintain their lifestyle throughout a lengthy retirement. In one case, we helped a client who expected to work another five to ten years retire within 60 days of our delivering the news that he’d in fact saved more than enough to retire.

We’ve had more than one client comment that once they knew that work was optional and financial independence was on their horizon, many of their stressors seemed to just melt away.

8. Helps ensure your family and business are taken care of after you’re gone.

Estate planning is an important component of financial planning. It involves coordination and organization of basic documents such as your will, health care directives, and power of attorney. Your estate plan names your beneficiaries and life insurance recipients and clearly outlines all your final arrangements. This gives you peace of mind, knowing that when you are no longer around, your wishes will be carried out and you will be able to leave a legacy for your heirs.

While estate planning may seem like something only older dentists need be concerned with, younger dentists with families need to be just as concerned with their estate planning as senior or retiring dentists. For dentists and others who own businesses, estate planning is crucial. Consider that a significant portion of many dental professionals’ net worth is typically tied up in their practice. Dental professionals and other business owners need sophisticated financial and estate planning

29 strategies to ensure business continuity after their death, to reduce estate taxes, and to provide liquidity to their heirs. Transferring wealth effectively and efficiently involves many different factors, including naming beneficiaries on your accounts and/or setting up trusts to ensure your assets avoid the lengthy and expensive probate court process. According to our survey, those dentists with a financial planner are more likely to have a formal estate plan in place.

While clearly worthwhile, incorporating and coordinating basic financial planning components is a complex process requiring time and effort. Throughout this research project, the theme of “when- to-tackle-which-component” as a dentist progresses throughout his or her career became apparent. Appendix Table Ia provides financial planning guidance as to which component to pay particular attention at each career stage.

We also compiled practitioner financial planning advice for other dentists by career stage. Those comments are outlined in Appendix Table Ib.

Although it’s never too late to develop a financial plan, it makes sense to begin early, before the mid-career stressors start. Our survey respondents identified mid-career as the most stressful career stage. Now that you understand how financial planning helps you take control of your life and reduces your stress, we’ll look more closely at the process so you know what to expect and how it works in the next chapter.

30 CHAPTER Putting your money where your mouth is: process and key components of effective 4 financial planning

ow does comprehensive financial planning work? There are several key components of the financial planning process. In this Hchapter, we’ll discuss the actual process of financial planning. (In the next section, we discuss how to choose the right advisor and the importance of using an advisor with a Certified Financial Planner [CFP™] designation.) One of the most critical components of financial planning and wealth management is the discovery process.

Discovery process.

Every dental practitioner, along with his or her family, is unique and different from others—with different sets of dreams, goals, and challenges. The financial planning process begins on a consultative basis to help you clarify your goals. The next step is to gather a detailed inventory of your financial assets in order to clearly view a complete financial picture before making any recommendations or decisions.

Financial plan development.

A comprehensive financial plan involves planning for six key disciplines: investment management, cash management, risk management, tax planning, , and estate planning. Only after gaining a thorough understanding of your financial picture and analyzing all the component parts in depth can an effective financial plan be created.

31 Many families think the key to reaching retirement or financial independence is to simply save more by lowering their current living expenses and possibly their standard of living. There is no doubt that this is a key step, but often it’s more important to take what you already have and make it work harder and smarter for you. Not everyone can save more. For example, consider the practitioner who can’t save much due to having debt repayment obligations while putting two children through college. The practitioner receives an unexpected $100,000 inheritance. Rather than just investing this money into a taxable brokerage account, it could be funneled into retirement accounts by setting up a company 401(k). This could result in saving $15,000 to $20,000 in taxes for several years, even after accounting for plan expenses and employee matches. By repositioning the inheritance received, he would be able to achieve financial independence sooner. However, planning for individual factors separately without considering their interrelationships can mean missed opportunities for creating greater wealth. This is what we mean when we say that your assets—not you—should be put to work harder and smarter for your future.

Your financial plan outlines your financial goals and how to reach them, despite any unexpected hardships which may occur along the way. You want to make sure you plan for and protect everything in your financial life. Some do-it-yourself investors choose to take their plan and implement it themselves; others choose to delegate the process to a professional.

Investment planning.

Your investment plan supports your financial plan and specifies the amount of investment risk that is appropriate for your goals and risk tolerance, factoring in most beneficial types of accounts, taxation, assumed rates of return, and more. Your investment plan, also called your asset allocation, details how your assets are divided among stocks, bonds, and other asset classes and categories.

32 Once your investment plan is formulated, individual investments may be selected to support the plan. In selecting investments, the following should be taken into account:

• Fees. Many Wall Street firms offer products based on active management, where the firms insist that their offering will provide greater returns due to superior investment knowledge and predictive skills. Unfortunately, the extra time and efforts these firms expend can translate into substantially higher costs. Academic and evidence-based research does not support the premise that these expensive efforts produce results that overcome their associated costs. It’s not unusual for a fund manager to outperform the market for several years but then produce average or even below-average returns. While it’s okay to pay for advice and service, you don’t want to get caught paying for luck. Since costs matter, you’ll want to take great precaution to ensure your costs do not erode the value of your investments. Costs include expenses you pay for management, trading, as well as taxes incurred when you earn profits.

• “Asset location” and investment type. While we all hope to receive the highest possible returns from our investments, we don’t want to lose more than a fair share of those gains to taxes. Asset location involves choosing the right investments, as well as the most tax-advantageous account type to hold the investments. The goal of asset location is to minimize taxes immediately as well as into the future when you will draw retirement income. This is part of the process of making your assets work harder and smarter. For example, securities taxed at historically higher ordinary income rates ideally should be held in tax-sheltered retirement accounts. Securities that depend on appreciation for growth should be held in taxable accounts to take advantage of capital gains rates, which historically have been lower.

• Coordination. You should also coordinate your other accounts outside of your financial advisor’s management—such as 401(k) or 529 accounts—to eliminate redundancy or excessive risk or to take advantage of asset location strategies. You’ll want to make sure all your accounts are invested efficiently and coordinated with the rest of your portfolio.

33 • Rebalancing and monitoring. The use of distinct asset classes and categories, a strategy to maintain or enhance investment returns while reducing risk, means that portfolios will deviate from their desired allocations over time. Periodic rebalancing restores the original allocations and forces investors to “sell high and buy low.” Occasionally you’ll want to adjust the risk levels of your overall portfolio to accommodate changing time horizons or goals.

Advanced planning

Because financial planning involves many interrelated areas, most families require the services of several professionals who are experts in their respective fields, such as estate attorneys, insurance specialists, tax preparers, etc. Dentists and small business owners whose situations can be complex typically require an even wider range of specialists. Effective wealth advisors collaborate with a number of related professionals. Typically the wealth manager plays the role of the quarterback or CFO of the team to pull together client solutions and to identify gaps, vulnerabilities, and opportunities. Often, wealth managers will have an outside network of highly specialized experts in place who can take the information learned during the discovery process to help provide a range of solutions. Though strictly independent of each other, it’s customary for these advisor network professionals to interact collaboratively for greater insights and holistic client solutions.

Ongoing monitoring and communication.

Your plan, your accounts, and your situation should be monitored continually so that changes made to your financial and investment plans meet the changing circumstances of your life. You and your advisor should communicate regularly, meeting between two to four times per year depending on the complexity and changing nature of your situation.

We have shared with you the financial challenges and stressors dentists currently face and how comprehensive financial planning can help address these concerns. The benefits are clear: those who work with financial planners over the course of their career will more likely experience less stress and experience better outcomes than those who do not. Any discipline, however, starts with overcoming initial inertia. Dentists, particularly those who have yet to engage a financial planner, are encouraged to overcome these barriers and develop a life-changing comprehensive financial plan. Most busy professionals prefer to work with an advisor for comprehensive planning

34 FINAL THOUGHTS: Bonus Material for Putting Knowledge into Action

What’s a CFP? rather than opting for a do-it-yourself method. Again, of those practitioners in our survey who had a comprehensive financial plan, How do I 92% were working with a financial planner or advisor. Since there are many different types of financial planners to choose from, it is choose the important to understand the different types of financial professionals. right financial “Certified Financial Planner®” or “CFP®” designations are earned by professional those financial planners who achieve a high level of competency, ethics, and professionalism and complete a comprehensive course of study for me? approved by the CFP Board. This is a universally recognized, minimum credential. When it comes to ethics and professional responsibility, CFP professionals are held to the highest of standards. They are obliged to uphold the principles of integrity, objectivity, competence, fairness, confidentiality, professionalism, and diligence. Their rules require that they put your ahead of their own at all times and provide their financial planning services as a “fiduciary”—acting in the best of their financial planning clients. When seeking outside help, it’s critical to work with a professional who is certified and specializes in creating comprehensive financial plans.

While a CFP credential represents the gold standard in financial planning education and is a basis for offering comprehensive planning, many CFPs don’t actually practice comprehensive financial planning. Rather, they choose to remain specialized in an investment-only practice. While they are in a great position to provide a higher level of coordination, their primary focus lies primarily in growing investments, without attention to other interrelated components necessary to build a comprehensive plan, such as taxes and estate planning. These considerations are more important for business owners, however,

35 since their financial complexities and opportunities to build wealth are far greater than those for non-business owners. Dental professionals in particular are often best served with a financial planner who is experienced in working with small businesses. These planners serve as a quarterback for all their clients’ financial needs, coordinating with other professional advisors to address tax minimization, trust management, wealth transfers, real estate management, portfolio performance analytics, and more.

When selecting a professional with the right credentials, it’s also important to determine how your advisor is compensated. We often hear the media conveying the message to “avoid paying fees” or “make sure you pay only low fees”, yet this message can be a bit misleading. While you want to minimize sales charges, you should expect to pay for quality advice. Planners may be paid through fees or commissions, or a combination of both, and it’s imperative that your advisor make it clear how they will be paid for their services. Advisors who charge on a “fee-only” (no commission) basis ensure that their interests are aligned with yours. They are required to provide a fiduciary standard of care rather than meeting the lower standard of suitability. Advisors who are compensated on a fee-only basis are better able to provide objective, unbiased advice.

A CFP can help you plan to take care of what’s most important to you throughout your life. This may be planning for your retirement, your children’s education, making sure your heirs are taken care of after you are gone, taking care of special needs children, or transferring wealth to the next generation. When evaluating CFPs, you’ll want to ask questions and talk to them about everything that affects your finances, and everything you’d like your finances to accomplish. Since sharing your finances is such a personal matter, make sure you feel comfortable with the CFP professional you ultimately choose.

Your financial planner should give you confidence that you’re on track to reach financial independence and a comfortable, secure retirement.

36 As a dental professional in today’s uncertain marketplace, you have many stress-inducing challenges to overcome. With a little planning, you can set yourself up to succeed financially and to turn financial uncertainty into clarity and confidence. Work smarter, not harder. Make sure your assets are maximized. You’ll obtain a firm gauge on what you can afford, how much you need to save, when you can retire, and what you’ll leave to your heirs. You’ll rest assured that protections are in place to minimize the financial impact of planned as well as unplanned life events—you’ll be prepared to tackle change. According to our survey, dentists who work with a financial planner feel significantly more confident about money than their peers without the services of a comprehensive financial planner. Why? Comprehensive financial planning helps you to take control of your practice, and your life.

37 AUTHOR BIOS

hristina Povenmire is the founder of CMP Financial Planning and a long-time resident of Columbus, Ohio. She believes that Ccomprehensive financial planning not only increases her clients’ wealth but helps them gain much-needed confidence and control over their future. An enthusiastic educator, Christina has taught undergraduate and graduate-level financial planning at Franklin University, DeVry, and The Ohio State University’s Certified Financial Planning (CFP) certification program. She also sponsors health-related and financial planning workshops for her clients and friends. She enjoys speaking at various community adult education and non-profit events and she has published articles in The Columbus Dispatch, Business First, and other publications; has been profiled in the Wall Street Journal and quoted in the Chicago Tribune, Forbes, and Huffington Post. She loves being in nature, mountain and road biking, and playing tennis. Living a healthy lifestyle is very important to her as she would like to live a long life and be present to help her three daughters and her clients for as long as possible.

arry Jamieson is an associate planner for CMP Financial Planning, responsible for data analytics, producing client plans, developing Bclient projections, and working with clients to help them achieve their retirement goals. Barry has a particular interest in helping families with special-needs children and has presented to a number of disability advocacy groups over the years. Prior to working with CMP, Barry worked in the healthcare policy field for more than 25 years. While working at the Ohio Colleges of Medicine Government Resource Center, Barry provided expertise in long-term care, disability policy, and health services research. He also directed health policy and research efforts at two trade organizations. His healthcare policy background gives him expertise in these important areas of financial planning, long-term care and disability, as well as a broad base of knowledge of Medicare and Medicaid. Barry earned his Master’s degree in economics from The Ohio State University. He loves developing plans for clients that provide peace of mind and confidence in the future. Barry is a long- time resident of central Ohio, is married and has three grown children. He enjoys reading, gardening, and staying physically active.

38 APPENDIX

Table Ia. The Dentist’s Financial Planning Lifecycle.

Financial planning is a complex process that requires time and effort. Determining when to tackle what can be tricky. The table below is based on the results of our research and was created to provide guidance for dental practitioners regarding when they should tackle the various components of financial planning throughout four defined career stages.

Early career (ages ~25-~32) Mid-career (ages ~30-55) Transitioning to retirement Retirement (ages ~60-100) (ages ~50-70) Accumulate wealth and pay Grow wealth Transfer wealth off debt Retirement/Spend

Create basic financial plan Implement “big picture” Estate planning Charitable giving with saving and debt- financial and investment plan repayment goals Business succession planning Business succession Asset allocation Basic investing plan typically Technology updates Estate planning and utilizing a riskier asset Tax planning distribution allocation since the dentist is Family wealth planning, younger Insurance: Protect family with thinking about what you Monitoring and tweaking your disability, health, life would like to do for future plan as real life happens Business planning: generations determining compensation College planning Enjoy lengthy retirement, and benefits packages Adjusting investment asset emphasizing what you love Retirement planning, allocation, typically reducing and enjoy, and focusing on Pay attention to work/life estate planning, special risk making healthy choices balance and healthy choices emphasis on family Planning for retirement Business continuation in the income: choosing event of death/disability payout as well as income and withdrawal planning from Pay attention to healthy investment and retirement lifestyles for yourself, spouse, accounts and children

39 APPENDIX

Table Ib. Looking Back: Advice from Experienced Dentists.

In our survey, we also asked older dentists to reflect back on their lives and offer advice to younger dentists in each of the four defined career stages. The following survey reveals some of their advice.

Transitioning to retirement Early career (ages ~25-32) Mid-career (ages ~30-55) Retirement (ages ~60-100) (ages ~50-70)

“Pay debts early, live below “Private practice is very “Maintain an efficient “Proper nutrition and your means, save, and invest fulfilling if you take time to practice.” exercise” conservatively.” listen to your patients.” “Maintain a healthy lifestyle.” “Maintain joyful hobbies.” “Do not look at numbers only. “Run your practice efficiently. Work hard to establish trust Don’t overpay staff. Watch “Identify prospective buy-in “Give back.” with patients and staff. The costs.” partners before your practice numbers will then come.” starts to deteriorate.” “Contribute to and maintain “Determine your path, and be retirement plans. Minimize “Contribute maximums to sure to follow what you like taxes. Maintain healthy retirement plans.” best.” lifestyle and balance of work/ play.” “Start saving early. If purchasing a practice, try to do it earlier in your career.”

40 APPENDIX

Appendix Table IIa: Survey questions asked of 42 Ohio dental professionals.

1. What type of practitioner are you? Response Options: • General Dentist • Endodontist • Orthodontist • Periodontist • Oral/Maxillofacial Surgeon • Pediatric Dentist • Prosthodontic Dentist

2. What type of practice do you, or did you (if retired), primarily work in? Response Options: • Independent practice (you are/were an owner, partner, or are in process of buying into) • Independent practice (you are an employee of)/Corporation (employee of) • Non-Profit Clinic • Government/military/Academic/University

3. Do you expect to purchase or buy into your own practice/partnership? Response Options: • Own your own practice now • No, never • Never purchased, now retired • Did purchase, now retired or in process of retiring or are in the process of purchasing • In 3-5 years • In 5+ years • In process of selling

4. What stage of your career would you consider yourself? Response Options: • Early years/post graduation • 3-6 years while desired career path is identified & begun, (approx. age range 25-32) • Mid-Career, established in desired career path, (approx. age range 30-55) • Transitioning into retirement, process often takes 3-7 years, (approx. age range 50-70) • Retired (approx. age range 60-100)

5. What is your age?

6. How many years have you been in practice?

7. What is your gender? Response Options: • Male • Female

8. Which professional organizations do you belong to? Check all that apply. Response Options: • Columbus Dental Society • ODA/ADA • Alpha Omega Dental Fraternity • AGD • Other professional organizations

41 Appendix Table IIa: Survey questions asked of 42 Ohio dental professionals (cont.).

9. Which study groups do you belong to?

10. How many fulltime practitioners are in your practice or place of ? (2 part time dentists are equal to 1 fulltime) Response Options: • 0-1 • 2-3 • 4-5 • 6-10 • More than 10

Work-Life Balance

11. How satisfied are you with each of the following? Response Options: • Please rate according to: Very Satisfied/Somewhat Satisfied/Somewhat Dissatisfied/Very Dissatisfied • Your current net income • Amount of leisure time • Progression of your career • Your career in dentistry • Contribution to broader community • Work/life balance

12. During a typical seven day week, about how many hours do you spend on the following activities? Response Options: • Working in career, including continuing education and further education • Participating in community, volunteering, or charitable activities • Re-charging yourself (fitness, hobbies, spiritual) • Managing your personal finances & future goals • Participating in educational/personal development activities • Participating in activities with family and friends (weekdays and weekend)

Challenges and Obstacles

13. External Factors: How would you rate each of the following factors in terms of stress? Please rate according to: Very Stressful/Somewhat stressful/A little stressful /Not stressful/N/A Response Options: Competition from midlevel providers Competition from corporate dentistry Revenue pressures from low insurance reimbursements Competition from other dentists expanding services provided

14. Professional Factors: How would you rate each of the following factors in terms of stress? Please rate according to: Very Stressful/Somewhat stressful/A little stressful/Not stressful/N/A Response Options: • Repaying debt: student loans, purchase of practice or equipment • Growing practice or patient load • Staffing • Cash flow • Meeting employer quota of patient services billed • Fraud by staff or vendor • Developing dentistry skills • Speed to practice in the profession • Transitions to retirement • Selling practice • Finding junior associate • Updating/keeping up with technology

42 Appendix Table IIa: Survey questions asked of 42 Ohio dental professionals (cont.).

15. Personal Factors: How would you rate each of the following factors in terms of stress? Please rate according to: Very Stressful/Somewhat stressful/A little stressful/Not stressful/N/A Response Options: • Immediate family • Care for parents • Health (yours or family) • Wedding or college expenses • Repayment of debt (home/auto/vacation home/etc) • Having sufficient personal time • Personal Finances • Insufficient savings

Retirement Planning

16. Realistically, at what age do you expect to retire? Response Options: • <60 years • 60-65 • 66-69 • 70-75 • >75 • Never retire • Already retired

17. Do you currently have an ongoing relationship with a professional financial advisor who helps you with your finances or invest- ments? Response Options: • Yes • No

18. If yes to 17, what type of advice do you receive? Response Options: • Investment only (i.e. investment broker) • Financial planner (looks at many factors including investments, tax consequences, savings required for retirement, college funding, estate planning, etc.)

19. If yes to 17, how often do you meet with your financial advisor? Response Options: • Twice a year or more times per year • Once a year • Less often than annually

20. If no to 17, why not? (Please select all that apply) Response Options: • Don’t have sufficient assets • Disorganized • Lack time • Not a priority • Don’t know to whom to turn for a full financial review • Lack of trust in current professionals • Don’t wish to disclose my financial information to a third party manage my own finances • Too expensive • In process of engaging financial advisor

43 Appendix Table IIa: Survey questions asked of 42 Ohio dental professionals (cont.).

21. Are your current level of retirement assets where you thought they would be in your life at this point in time? Response Options: • Much higher than expected • Somewhat higher than expected • About what you expected • Somewhat lower than expected • Much lower than expected • No expectations

22. How do you expect to, or currently, fund your retirement? Please check up to 4 boxes that could each represent 25% or more of your retirement income. Response options: • Sale of practice • Retirement accounts and investments • Spousal pension/retirement benefits • Social security/other pension • Investment real estate • Inheritance • Other sources

23. Generally, does your family live a lifestyle: Response Options: • Less than you can afford • What you can afford • More than you can afford

24. In what stage have you sought advice from the following professionals? (Leave column blank if you haven’t experienced the stage!) Please rate according to: Stage 1 - Post Grad (approx. age range 25-32) Stage 2 - Mid-career (approx. age range 30-55 Stage 3 - Transition to retirement (approx. age range 50-70) Stage 4 - Retirement (approx. age range 60-100) / Response options: • Tax or accountant • Personal banker • Attorney – business • Attorney – personal (estate or other) • Practice management consultant • Practice transition consultant • Investment advisor (investment only) • Financial Planner (investment and planning) • Life coach • Other dentists (informal)

25. Have you (or your spouse/partner) ever tried to figure out how much money you would need to have saved when you retire to live comfortably in retirement? Response Options: • Yes • No

26. Do you have a formal, comprehensive retirement plan? Response Options: • Yes • No

44 Appendix Table IIa: Survey questions asked of 42 Ohio dental professionals (cont.).

27. Are all of your estate documents up to date? (i.e., will, trust (if applicable), POA financial, POA durable health, living will) Response Options: • Yes • No • No documents • Documents in process of completion or need minor update • Have documents, but need major update • Documents are up to date

28. How much thought have you given to each of the following aspects of retirement? Or if retired, did you give prior to retirement? Please rate according to: A lot of thought/Some thought/A little thought/No thought Response Options: • What your budget (will/would) look like in retirement • How you (will/would) live in retirement • How you (will/would) replace the meaning you receive from work in retirement • How you (will/would) spend your time in retirement • What impact retirement (will/would) have on your relationships with family and friends

Solutions & Recommendations for Future Generations

29. Have you been successful at running a profitable and efficient practice? Response Options: • All of the time • Most of the time • Sometimes • Rarely • Never • N/A

30. Looking back, what would you have done differently to have had a more satisfying career? Response Options: • Wish I had done more or earlier • Did it about right • Wish I had done less or waited longer • Not sure • N/A • Emphasized work- personal life balance • Spent more efforts on further professional education or training • Saved for future • Reinvested in practice • Outsourced more business functions • Sought advice of practice management, coach, or transition professionals • Paid off debt (business or personal) • Sought advice of financial professionals (tax, financial planner, broker, etc)

31. Please rate the importance of each factor in helping you achieve greater success/profitability. Please rate according to: Very important/Somewhat important/Not important N/A or too new to profession to evaluate Response Options: • Planning/setting goals. Organizing. • Saving early • Paying off debt • Creating a team or networking approach with staff, advisors, or referral systems • Getting outside help from mentors and advisors • Outsourcing functions rather than managing in-house • Attending professional or study group meetings

32. What advice would you give to dentists who are younger than you?

45 APPENDIX

Appendix Table IIb: Key Results from Survey of Ohio Dentists

Respondents Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

AVERAGE AGE 51 42 54 46 62 54 42 52 57 54 52

N = 42 9 33 21 14 32 10 12 20 25 12 q11: How satisfied are you with… All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Net income 31% (13) 33% (3) 30% (10) 43% (9) 21% (3) 28% (9) 40% (4) 33% (4) 25% (5) 32% (8) 25% (2)

Amount of leisure 10% (8) 44% (4) 12% (4) 29% (6) 22% (2) 16% (5) 30% (3) 0 25% (5) 16% (4) 8% (1)

Work life/balance 21% (9) 44% (4) 15% (5) 29% (6) 14% (2) 16% (5) 40% (4) 0 25% (5) 16% (4) 17% (2)

Progression of career 21% (9) 22% (2) 21% (7) 33% (7) 7% (1) 16% (5) 40% (4) 8% (1) 20% (4) 20% (5) 17% (2)

Career in dentistry 14% (6) 22% (2) 12% (4) 19% (4) 7% (1) 6% (2) 40% (4) 0 10% (2) 8% (2) 17% (2)

Broader contribution 10% (4) 22% (2) 6% (2) 14% (3) 7% (1) 6% (2) 2 8% (1) 5% (1) 4% (1) 17% (2) q13: Prof External Stress 69% (29) 28% (7) 67% (22) 71% (15) 64% (9) 66% (21) 80% (8) 33% (4) 85% (17) 72% (18) 67% (8) q14: Prof Internal Stress All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Repaying Debt 29% (12) 11% (1) 33% (11) 24% (5) 14% (2) 22% (7) 50% (5) 17% (2) 25% (5) 28% (7) 33% (4)

Growing Practice 52% (22) 44% (4) 55% (18) 57% (12) 36% (5) 47% (15) 70% (7) 33% (4) 55% (11) 48% (12) 42% (5)

Developing Skills 33% (14) 44% (4) 30% (10) 38% (8) 21% (3) 22% (7) 70% (7) 17% (2) 25% (5) 24% (6) 50% (6)

Staffing 38% (16) 56% (5) 33% (11) 52% (11) 29% (4) 34% (11) 50% (5) 25% (3) 40% (8) 28% (7) 33% (4)

Transition retirement/selling practice 24% (10) 56% (5) 15% (5) 24% (5) 29% (4) 25% (8) 20% (2) 17% (2) 30% (6) 24% (6) 25% (3)

Cashflow 43% (18) 33% (3) 45% (15) 38% (8) 43% (6) 38% (12) 60% (6) 33% (4) 40% (8) 40% (10 50% (6)

Updating technology 26% (11) 11% (1) 30% (10) 19% (4) 43% (6) 22% (7) 40% (4) 25% (3) 20% (4) 28% (7) 17% (2)

Meeting ER quota 17% (7) 33% (3) 12% (4) 19% (4) 14% (2) 13% (4) 30% (3) 17% (2) 10% (2) 8% (2) 25% (3)

Fraud 12% (5) 22% (2) 9% (3) 14% (3) 7% (1) 9% (3) 20% (2) 8% (1) 10% (2) 8% (2) 17% (2) q15: Personal Stress All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Immediate family 33% (14) 78% (7) 21% (7) 47% (12) 14% (2) 34% (11) 30% (3) 33% (4) 30% (6) 32% (8) 17% (2)

Care for parents 38% (16) 67% (6) 30% (3) 43% (9) 36% (5) 41% (13) 30% (3) 50% (6) 25% (7) 32% (8) 25% (3)

Health (yours or family) 24% (10) 22% (2) 24% (8) 19% (4) 29% (4) 19% (6) 40% (4) 17% (2) 20% (4) 20% (5) 17% (2)

Wedding, college expenses 21% (9) 33% (3) 18% (6) 33% (7) 14% (2) 19% (6) 30% (3) 25% (3) 15% (3) 16% (4) 25% (3)

Sufficient personal time 38% (16) 78% (7) 27% (9) 57% (12) 29% (4) 34% (11) 50% (5) 25% (3) 40% (8) 28% (7) 42% (5)

Repayment of debt 33% (14) 33% (3) 33% (11) 33% (7) 21% (3) 28% (9) 50% (5) 25% (3) 30% (6) 32% (8) 42% (5)

Personal Finances/Insufficient 31% (13) 56% (5) 24% (8) 33% (7) 21% (3) 28% (9) 40% (4) 33% (4) 25% (5) 24% (6) 42% (5) savings q16: Expect to Retire All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Less than 60 years 2% (1) 0 3% (1) 5% (1) 0 0 10% (1) 0 0 0 0

60-65 48% (20) 89% (8) 36% (12) 67% (14) 14% (2) 50% (16) 40% (4) 50% (6) 50% (10 40% (10) 58% (7)

66-69 31% (13) 0 39% (13) 19% (4) 50% (7) 28% (9) 40% (4) 25% (3) 30% (6) 32% (8) 25% (3)

70 or over 19% (8) 11% (1) 18% (6) 5% (1) 36% (5) 19% (6) 0 17% (2) 20% (4) 16% (4) 17% (2) q21: Assets Higher than Expected All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Much & somewhat higher 14% (6) 33% (3) 3 (9%) 24% (5) 7% (1) 16% (5) 10% (1) 0 25% (5) 16% (4) 0

About what you expected & no 14% (18) 11% (1) 52% (17) 33% (7) 50% (7) 44% (14) 40% (4) 50% (6) 40% (8) 44% (11) 33% (4) expectations

Somewhat & much lower 43% (18) 56% (5) 39% (13) 43% (9) 43% (6) 41% (13) 50% (5) 50% (6) 25% (7) 60% (15) 75% (9)

46 Appendix Table IIb: Key Results from Survey of Ohio Dentists (cont.)

q22: Fund retirement All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Sale of practice 50% (21) 22% (2) 58% (19) 67% (14) 36% (5) 44% (14) 70% (7) 17% (2) 60% (12) 56% (14) 42% (5)

Retirement accounts & invests 90% (38) 67% (6) 97% (32) 81% (17) 100% (14) 94% (30) 80% (8) 92% (11) 95% (19) 92% (23) 92% (11)

Respondents Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 Spousal pension/retirement benefits 40% (17) 33% (3) 42% (14) 33% (7) 50% (7) 44% (14) 30% (3) 33% (4) 50% (10 48% (12) 25% (3)

AVERAGE AGE 51 42 54 46 62 54 42 52 57 54 52 Social security/other pension 52% (22) 22% (2) 61% (20) 48% (10) 71% (10) 50% (16) 60% (6) 58% (7) 45% (9) 52% (13) 50% (6)

N = 42 9 33 21 14 32 10 12 20 25 12 Investment real estate 26% (11) 22% (2) 27% (9) 19% (4) 36% (5) 28% (9) 20% (2) 33% (4) 25% (5) 32% (8) 25% (3) q11: How satisfied are you with… All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 Inheritance 21% (9) 33% (3) 18% (6) 29% (6) 21% (3) 25% (8) 10% (1) 17% (2) 30% (6) 16% (4) 25% (3)

Net income 31% (13) 33% (3) 30% (10) 43% (9) 21% (3) 28% (9) 40% (4) 33% (4) 25% (5) 32% (8) 25% (2)

Amount of leisure 10% (8) 44% (4) 12% (4) 29% (6) 22% (2) 16% (5) 30% (3) 0 25% (5) 16% (4) 8% (1) q23: Live lifestyle All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Work life/balance 21% (9) 44% (4) 15% (5) 29% (6) 14% (2) 16% (5) 40% (4) 0 25% (5) 16% (4) 17% (2) Less than you can afford 33% (14) 44% (4) 30% (10) 8 36% (5) 13 10% (1) 33% (4) 45% (9) 36% (9) 25% (3)

Progression of career 21% (9) 22% (2) 21% (7) 33% (7) 7% (1) 16% (5) 40% (4) 8% (1) 20% (4) 20% (5) 17% (2) What you can afford 57% (24) 44% (4) 61% (20) 48% (10) 57% (8) 50% (16) 80% (8) 58% (7) 45% (9) 48% (12) 75% (9)

Career in dentistry 14% (6) 22% (2) 12% (4) 19% (4) 7% (1) 6% (2) 40% (4) 0 10% (2) 8% (2) 17% (2) More than you can afford 10% (4) 11% (1) 9% (3) 14% (3) 7% (1) 9% (3) 10% (1) 8% (1) 10% (2) 12% (3) 0

Broader contribution 10% (4) 22% (2) 6% (2) 14% (3) 7% (1) 6% (2) 2 8% (1) 5% (1) 4% (1) 17% (2) q26: Formal plan All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 q13: Prof External Stress 69% (29) 28% (7) 67% (22) 71% (15) 64% (9) 66% (21) 80% (8) 33% (4) 85% (17) 72% (18) 67% (8) Yes 57% (24) 78% (7) 52% (17) 52% (11) 64% (9) 69% (22) 20% (2) 58% (7) 75% (15) 52% (13) 67% (8) q14: Prof Internal Stress All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 No 43% (18) 22% (2) 48% (16) 48% (10) 36% (5) 31% (10) 80% (8) 42% (8) 25% (5) 44% (11) 33% (4)

Repaying Debt 29% (12) 11% (1) 33% (11) 24% (5) 14% (2) 22% (7) 50% (5) 17% (2) 25% (5) 28% (7) 33% (4) q27: Estate Docs All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Growing Practice 52% (22) 44% (4) 55% (18) 57% (12) 36% (5) 47% (15) 70% (7) 33% (4) 55% (11) 48% (12) 42% (5) No docs 31% (13) 22% (2) 33% (11) 33% (7) 7% (1) 19% (6) 70% (7) 17% (2) 20% (4) 28% (7) 33% (4)

Developing Skills 33% (14) 44% (4) 30% (10) 38% (8) 21% (3) 22% (7) 70% (7) 17% (2) 25% (5) 24% (6) 50% (6) In process/minor update 17% (7) 22% (2) 15% (5) 14% (3) 14% (2) 22% (7) 0 50% (6) 5% (1) 12% (3) 25% (3)

Staffing 38% (16) 56% (5) 33% (11) 52% (11) 29% (4) 34% (11) 50% (5) 25% (3) 40% (8) 28% (7) 33% (4) Major update 12% (5) 11% (1) 12% (4) 14% (3) 14% (2) 13% (4) 10% (1) 8% (1) 15% (3) 12% (3) 8% (1)

Transition retirement/selling practice 24% (10) 56% (5) 15% (5) 24% (5) 29% (4) 25% (8) 20% (2) 17% (2) 30% (6) 24% (6) 25% (3) Up to date 40% (17) 44% (4) 39% (13) 38% (8) 64% (9) 47% (15) 20% (2) 25% (3) 60% (12) 44% (11) 33% (4)

Cashflow 43% (18) 33% (3) 45% (15) 38% (8) 43% (6) 38% (12) 60% (6) 33% (4) 40% (8) 40% (10 50% (6) q28: Thought to retirement All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Updating technology 26% (11) 11% (1) 30% (10) 19% (4) 43% (6) 22% (7) 40% (4) 25% (3) 20% (4) 28% (7) 17% (2) Retirement Budget: A lot or some 74% (31) 78% (7) 73% (24) 76% (16) 79% (11) 78% (25) 60% (6) 83% (10) 75% (15) 64% (16) 75% (9)

Meeting ER quota 17% (7) 33% (3) 12% (4) 19% (4) 14% (2) 13% (4) 30% (3) 17% (2) 10% (2) 8% (2) 25% (3) Live in retirement: A lot or some 74% (31) 78% (7) 73% (24) 67% (14) 86% (12) 78% (25) 60% (6) 83% (10) 75% (15) 68% (17) 75% (9)

Fraud 12% (5) 22% (2) 9% (3) 14% (3) 7% (1) 9% (3) 20% (2) 8% (1) 10% (2) 8% (2) 17% (2) Spend time in retirement: A lot or 60% (25) 67% (6) 61% (20) 52% (11) 79% (11) 69% (22) 40% (4) 67% (8) 100% (20) 52% (13) 67% (8) some q15: Personal Stress All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 Replace meaning of work: a lot or 43% (18) 44% (4) 42% (14) 33% (7) 50% (7) 44% (14) 40% (4) 58% (7) 35% (7) 36% (9) 50% (6) Immediate family 33% (14) 78% (7) 21% (7) 47% (12) 14% (2) 34% (11) 30% (3) 33% (4) 30% (6) 32% (8) 17% (2) some

Care for parents 38% (16) 67% (6) 30% (3) 43% (9) 36% (5) 41% (13) 30% (3) 50% (6) 25% (7) 32% (8) 25% (3) Retirement impact on relationships: 50% (21) 44% (4) 52% (17) 38% (8) 64% (9) 53% (17) 40% (4) 75% (9) 40% (8) 48% (12) 50% (6) a lot or some Health (yours or family) 24% (10) 22% (2) 24% (8) 19% (4) 29% (4) 19% (6) 40% (4) 17% (2) 20% (4) 20% (5) 17% (2) q29: Successful at running practice? All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 Wedding, college expenses 21% (9) 33% (3) 18% (6) 33% (7) 14% (2) 19% (6) 30% (3) 25% (3) 15% (3) 16% (4) 25% (3) All or most of the time 71% (30) 67% (6) 73% (24) 76% (16) 79% (11) 78% (25) 50% (5) 83% (10) 75% (15) 72% (18) 67% (8) Sufficient personal time 38% (16) 78% (7) 27% (9) 57% (12) 29% (4) 34% (11) 50% (5) 25% (3) 40% (8) 28% (7) 42% (5) Sometimes 19% (8) 11% (1) 21% (7) 19% (4) 14% (2) 13% (4) 40% (4) 17% (2) 10% (2) 20% (5) 8% (1) Repayment of debt 33% (14) 33% (3) 33% (11) 33% (7) 21% (3) 28% (9) 50% (5) 25% (3) 30% (6) 32% (8) 42% (5) Rarely/Never 2% (1) 0 3% (1) 0 7% (1) 3% (1) 0 0 5% (1) 0 8% (1) Personal Finances/Insufficient 31% (13) 56% (5) 24% (8) 33% (7) 21% (3) 28% (9) 40% (4) 33% (4) 25% (5) 24% (6) 42% (5) savings N/A 7% (3) 22% (2) 3% (1) 5% (1) 0 6% (2) 10% (1) 0 10% (2) 4% (1) 17% (2) q16: Expect to Retire All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 q30: Done differently (done more) All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Less than 60 years 2% (1) 0 3% (1) 5% (1) 0 0 10% (1) 0 0 0 0 Work life/balance 31% (13) 56% (5) 24% (8) 33% (7) 29% (4) 31% (10) 30% (3) 17% (2) 40% (8) 16% (4) 42% (5)

60-65 48% (20) 89% (8) 36% (12) 67% (14) 14% (2) 50% (16) 40% (4) 50% (6) 50% (10 40% (10) 58% (7) More education 33% (14) 22% (2) 36% (12) 29% (6) 43% (6) 31% (10) 40% (4) 17% (2) 40% (8) 32% (8) 25% (2)

66-69 31% (13) 0 39% (13) 19% (4) 50% (7) 28% (9) 40% (4) 25% (3) 30% (6) 32% (8) 25% (3) Paid off debt 19% (8) 22% (2) 18% (6) 24% (5) 14% (2) 22% (7) 10% (1) 33% (4) 15% (3) 24% (6) 17% (2)

70 or over 19% (8) 11% (1) 18% (6) 5% (1) 36% (5) 19% (6) 0 17% (2) 20% (4) 16% (4) 17% (2) Saved for retirement 55% (23) 44% (4) 58% (19) 52% (11) 57% (8) 59% (19) 40% (4) 58% (7) 60% (12) 52% (13) 58% (7) q21: Assets Higher than Expected All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3 Reinvested in practice 19% (8) 22% (2) 18% (6) 19% (4) 29% (4) 22% (7) 10% (1) 33% (4) 15% (3) 20% (5) 17% (2)

Much & somewhat higher 14% (6) 33% (3) 3 (9%) 24% (5) 7% (1) 16% (5) 10% (1) 0 25% (5) 16% (4) 0 Outsourced business functions 21% (9) 44% (4) 15% (5) 29% (6) 14% (2) 19% (6) 30% (3) 25% (3) 15% (3) 12% (3) 17% (2)

About what you expected & no 14% (18) 11% (1) 52% (17) 33% (7) 50% (7) 44% (14) 40% (4) 50% (6) 40% (8) 44% (11) 33% (4) Financial professionals 38% (16) 56% (5) 33% (11) 33% (7) 36% (5) 41% (13) 30% (3) 42% (8) 40% (8) 24% (6) 58% (7) expectations Practice management coaches 24% (10) 33% (3) 21% (7) 29% (6) 14% (2) 22% (7) 30% (3) 25% (3) 20% (4) 20% (5) 25% (2) Somewhat & much lower 43% (18) 56% (5) 39% (13) 43% (9) 43% (6) 41% (13) 50% (5) 50% (6) 25% (7) 60% (15) 75% (9)

47 Appendix Table IIb: Key Results from Survey of Ohio Dentists (cont.) q33: Factors in success All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Planning/goal setting: Very or 95% (40) 78% (7) 100% (33) 90% (19) 100% (14) 94% (30) 100% (10) 92% (11) 95% (19) 92% (23) 92% (11) somewhat

Saving early 98% (41) 100% (9) 97% (32) 95% (20) 100% (14) 100% (32) 90% (9) 100% (12) 100% (20) 96% (24) 100% (12)

Paying off debt 100% (42) 100% (9) 100% (33) 100% (21) 100% (14) 100% (32) 100% (10) 100% (12) 100% (20) 96% (24) 100% (12)

Networking team 88% (37) 89% (8) 88% (29) 90% (19) 86% (12) 88% (28) 90% (9) 92% (11) 85% (17) 84% (21) 83% (10)

Outsourcing functions 64% (27) 56% (5) 67% (22) 62% (13) 64% (9) 59% (19) 80% (8) 42% (5) 70% (14) 60% (15) 67% (8)

Mentors and advisors 93% (39) 78% (7) 97% (32) 90% (19) 93% (13) 91% (29) 100% (10) 100% (12) 85% (17) 92% (23) 92% (11)

Study group meetings 90% (38) 89% (8) 91% (30) 95% (20) 86% (12) 91% (29) 90% (9) 92% (11) 90% (18) 84% (21) 92% (11) q12: Hours spent on activities All Female Male Midcareer Transition Fin Adv Yes Fin Adv No Invest Only Fin. Plnr Size: 0-1 Size: 2-3

Work in career 45% (37) 50% (31) 45% (38) 47% (38) 50% (35) 36% (25)` 51% (42) 41% (32) 46% (37) 44% (40) 41% (25)

Community/charitabe 5% (4) 5% (3) 5% (4) 4% (3) 4% (3) 6% (4) 4% (3) 6% (5) 4% (3) 5% (5) 3% (2)

Re-charging 15% (12) 10% (6) 15% (13) 10% (8) 14% (10) 15% (11) 13% (11) 21% (16) 12% (10) 15% (14) 16% (10)

Personal finances/goals 6% (5) 6% (4) 6% (5) 7% (6) 6% (4) 7% (5) 6% (5) 5% (4) 6% (5) 7% (6) 5% (3)

Personal educational 5% (4) 3% (2) 5% (4) 4% (3) 6% (4) 4% (3) 6% (5) 5% (4) 4% (3) 4% (4) 5% (3)

Family/friends 24% (20) 26% (16) 25% (21) 28% (23) 20% (14) 30% (21) 20% (17) 22% (17) 28% (23) 24% (22) 30% (18)

TOTAL HOURS 82 62 85 81 70 69 83 78 Fin. Plnr Size: 0-1 Size: 2-3

48 ENDNOTES

1 Lo Sasso, Anthony T., PhD; Starkel, Rebecca L, MA; Warren , Matthew N, MA; Guay, Albert H, DMD; Vujicic, Marko, PhD, Journal of the American Dental Association, August 2015,603 2 Diringer, Joel; Phipps, Kathy; Carsel, Becca. Critical Trends Affecting the Future of Dentistry, Prepared for the American Dental Association, May 2003, 16. 3 Levin, Roger P. The Eight Permanent Game Changers. www.levingroup. com 4 Diringer, Critical Trends Affecting the Future of Dentistry, 10. 5 Levin, The Eight Permanent Game Changers. 6 Rowlette, James. Today’s Dentists: their Financial Challenges and Wealth Management Approach, September 1, 2010, 5. 7 The American Dental Association, A Profession in Transition, August 2013, 9. 8 Nasseh K. and Vujicic, M. American Dental Association research brief, Dental Care Utilization Rate Highest Ever among Children, Continues to Decline among Working-Age Adults, October 2014, 4. 9 Levin, Roger P. The Eight Permanent Game Changers. 10 Nasseh, Dental Care Utilization Rate Highest Ever among Children, Continues to Decline among Working-Age Adults, 7. 11 Levin, The Eight Permanent Game Changers. 12 The American Dental Association, A Profession in Transition, 9. 12 Diringer, “Critical Trends Affecting the Future of Dentistry”16. 13 Diringer, “Critical Trends Affecting the Future of Dentistry” 16. 14 Levin, The Eight Permanent Game Changers. 15 Survey of Ohio Dentists, 2016. Question #11. 16 Survey of Ohio Dentists, 2016. Question #13 17 Survey of Ohio Dentists, 2016. Question #14 18 Survey of Ohio Dentists, 2016. Question #14 19 Survey of Ohio Dentists, 2016. Question #14 20 Survey of Ohio Dentists, 2016. Question #14 21 Survey of Ohio Dentists, 2016. Question #15 22 Survey of Ohio Dentists, 2016. Question #15 23 Survey of Ohio Dentists, 2016. Question #14

49 24 Survey of Ohio Dentists, 2016. Question #14 25 Survey of Ohio Dentists, 2016. Question #16 26 Survey of Ohio Dentists, 2016. Question #23 27 Survey of Ohio Dentists, 2016. Question #26 28 Emslie, C. and Hunt, K., Live to Work and Work-Life Balance among Men and Women in Mid-life, Gender, Work and Organization, Vol. 16 No. 1 January 2009. 29 Survey of Ohio Dentists, 2016. Question #14 30 Survey of Ohio Dentists, 2016. Question #15 31 Survey of Ohio Dentists, 2016. Question #14 32 Survey of Ohio Dentists, 2016. Question #14 33 Survey of Ohio Dentists, 2016. Question #15 34 Survey of Ohio Dentists, 2016. Question #16 35 Survey of Ohio Dentists, 2016. Question #30 36 Survey of Ohio Dentists, 2016. Question #21 37 Survey of Ohio Dentists, 2016. Question #30 38 Survey of Ohio Dentists, 2016. Question #22 39 Survey of Ohio Dentists, 2016. Question #16 40 Survey of Ohio Dentists, 2016. Question #12 41 Survey of Ohio Dentists, 2016. Question #21 42 http://www.cfp.net/news-events/latest-news/2013/08/20/consumers- want-advisers-to-focus-on-financial-planning

50 ADDITIONAL SOURCES

Bailit, Howard L. “The Fundamental Financial Problems of Dental Education and Their Impact on Education, Operations, Scholarship, and Patient Care.” Journal of Dental Education 72.2: 14-17. Feb. 2008.

Business Information Group. “New Dentist’s Guide to Financial Independence.” New Dentists. Dental Practice Management. Sept. 2007.

Butler, Jen. “In Your Face: Facing the Realities of Stress in Dentistry.” Dentaltown Nov. 2013: 56-59.

Norman, Charles H. “The ADA Examines Student Debt.” J Esthet Restor Dent Journal of Esthetic and Restorative Dentistry 25.6 (2013): 365-66.

Schumann, Theodore C. “The Top Ten Financial Mistakes Dentists Make.” Academy of Dental CPAs.

51 52