I Can Do It Myself
Dr. Richard Mandale—Case Study #242
Dr. Mandale’s Concerns:
After being in practice for 30 years, Dr. Mandale’s practice was in decline with fewer new patients, and his staff was disenchanted with his lack of concern. But Dr. Mandale’s primary issue was that he really didn’t care about going to work anymore!
Dr. Mandale was not a happy dentist because he had already retired emotionally and it was reflecting in his practice statistics.
Let’s review some historical figures for Dr. Mandale’s practice:
Year Net Collections # of New Patients
1995 $51,000 21
2000 $54,060 18
2005 $55,415 12
2007 $56,000 10
Don’t let the slight increase in the collection column fool you. Even with a small 2–5% increase a year in his fees, his practice is not growing enough to offset the ever-increasing overhead. The number of new patients is declining each year, and not keeping within industry standards of 25 new patients a month per dentist. Dr. Mandale’s practice is not in a good financial situation at this point in his career.
On a positive note, he has been very diligent over the years to make the most of his 401K and he owns the building. He is in an excellent position to retire… but what about his practice?
What needs to happen in each of these scenarios?
Work another 3 years…
In order to turn his practice around in 3 years, changes need to be made:
All the above will still need to be done, but it could be more difficult to find an associate interested in buying the practice as it is now.
Start looking for a buyer today…
Without making any changes to the practice, the value will be based on the past several years of collections, the value of the equipment, etc. How long will it be before a buyer is found? It could be weeks, months or years! It is a buyers’ market now with so many dentists retiring, so it is not the best time to be selling a tired, non-performing practice.
What was his decision?
After giving the options much thought, Dr. Mandale elected to change his attitude with the understanding that his goal was to work 3 years to increase the practice profitability, make the necessary changes to draw new patients to his practice, start marketing to his existing patient base for referrals of their family and friends and, most important, rediscover his love for dentistry by taking some hands-on training for new procedures that he can add to his treatment options.
His decision was shared with his team. They were very excited to know that the practice had a direction now and they were secure in knowing that the practice wasn’t closing its doors.
Dr. Mandale participated in the McKenzie Management Practice Enrichment Program and implemented all the changes that were addressed. He has added Invisalign and implants to his list of services and his net collections are up 35%!
He has a vision now, and realizes the positives about his dentistry and his practice. He again enjoys going to work and arrives early enough to handwrite his “thank you” cards and attend the morning meetings.
If you find that you need to start making some changes in order to prepare for the rest of your life, contact McKenzie Management for a consulting program that meets your needs.
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In Part 1 of this article, we discussed the organ shortage and living donation. Through extraordinary acts of human kindness, living kidney donation now accounts for almost half of all kidney donors in the United States. In some states like Arizona, there have actually been more kidneys donated from living donors than from deceased donors. Yet, there are still over 76,000 people currently waiting for a kidney1.
Why Donate Now, While Still Living?
The main advantage for a person to become a living kidney donor comes from knowing they are helping someone who needs a transplant now. The main advantage for the recipient is that they can receive a healthier kidney now, before becoming ill. This process can also help the recipient avoid dialysis all together, or at least shorten the term on dialysis, so the patient can be stronger and healthier going into surgery.
The greatest advantage in living organ donation is that a living organ is considered to be a healthier organ when taken from a living donor, because it has continuous circulation prior to removal. This can differ greatly from deceased organs, where the body may have experienced trauma caused by the death. Moreover, there are long-term benefits; the average living kidney is likely to function for an average of 15.5 years, whereas a deceased kidney may only last half as long2.
How Can I Become a Living Kidney Donor?
Generally, people can become living kidney donors if they are between the ages of 18 and 65 years old and do not have any major medical or psychiatric illnesses. They donor cannot be pregnant at the time of surgery, and preferably should not be overweight (although they may still be potential donors after losing weight). If the donor currently smokes, he/she is asked to quit six weeks prior to surgery3. Donors must also be able to understand the risks of this surgery, and be able to comply with medical care and follow-up.
If a person is considering living kidney donation, it is best to contact a social worker at a transplant hospital to see about becoming a candidate. The first step typically involves a brief health screening and interview over the phone in which the potential donor is encouraged to ask questions. If the potential donor gets the initial go-ahead after the telephone screening, the next step is to complete a medical questionnaire and provide confirmation of blood type.
Upon review and approval of this preliminary information, the potential donor will then be asked to complete a medical evaluation by a physician who serves as a “donor advocate” with only the donor’s best interests in mind. Additional tests, such as blood and urine tests, a chest X-ray and an EKG, will also be performed, along with additional tests to ensure the potential donor is healthy and has two healthy kidneys3 to enable a normal life afterwards with just one.
Financially speaking, the donor should not incur any medical expenses related to the evaluation, surgery, hospitalization or immediate postoperative care. These charges are billed to the recipient’s insurance company3.
How Is a Kidney Removed?
Living donor kidneys are removed laparoscopicly4,5, through a minimally invasive approach. Typically, this approach is one that involves a few small incisions that allows video equipment and instruments to visualize, dissect, clip and staple appropriate areas.
Once the kidney is freed from its attachments, it is then put on ice and flushed with a cold preservative solution for “harvesting.” Most amazingly, the kidney can be preserved in this solution for 24-48 hours, but the sooner the transplant takes place, the greater the success4,5.
How Is the Donated Kidney Implanted into the Recipient?
An incision is made to the patient’s flank area where the surgeon will implant the new kidney. The new kidney is positioned above the pelvic bone and below the existing non-functioning kidney, by suturing the kidney artery and vein to the patient's iliac artery and vein4,5.The final step involves attaching the urethra of the new kidney to the recipient’s bladder4,5.
The key advantage in transplanting a living kidney is that it starts working immediately after transplantation, whereas a deceased kidney can be slow to function 4,5.
One of the most common challenges for potential living donors is that they find they are not an acceptable match for their intended recipients’ blood type. In Part 3 of this article, we will discuss a brilliantly creative solution for this very common dilemma.
1. United Network of Organ Sharing Data: www.UNOS.org/data
2. Alliance for Paired Donation (APD) www.paireddonation.org/donor-info.htm
3. UCSF Medical Center Transplant Service, Becoming a living kidney donor. Question and Answer Pamphlet.
4. University of Southern California Department of Surgery. Kidney Transplant Program. http://www.kidneytransplant.org/
5. Answers.com. Medical Encyclopedia: Kidney Transplantation
*To document your decision and ensure no one will over-ride it, visit www.donatelife.net
About the Author: Risa Simon is a certified management consultant, professional speaker and published author who inherited a rare cystic kidney condition that has positioned her among the many in need of a kidney transplant. After observing family members and friends with PKD struggle with dialysis and unrealistic waitlists (and started to experience her own challenges in trying to find a compatible donor), she decided to join a movement to increase awareness in the humanitarian call for “living” and “paired” donation. For more information contact firstname.lastname@example.org.