Many entrepreneurial dentists who commit themselves to building large DSOs never make it. They get to four, five, or maybe even six practices — and then struggle or fail. At this point, they either reduce their number of practices, or sell to the highest bidder. What is the missing element? Why aren’t they able to build successful, substantial managed-group practices?
When asked, these entrepreneurial dentists say the same thing — they’re underfinanced; there are not enough good people; the lack of systems and structures to get it done. But when I look, I see that the most glaring problem is the kind of leadership they provide.
Now, I also want you to know, having worked in many other industries with entrepreneurs, this is also true for them as well. They fail for the same reason — failure to ascend to the next level of leadership.
What Makes a Good Entrepreneurial Dentist?
In the beginning, entrepreneurial leaders are autocratic. An autocrat is defined as “a person (such as a monarch) ruling with unlimited authority; one who has undisputed influence or power.” Everything runs through them. They exert overriding control. Everyone reports to them. No one makes a move without somehow getting the permission of the autocrat. And that works — up to a certain point.
One problem is with autocracy is that there is no accountability. Autocracy displaces accountability. Without accountability, you can’t grow a company beyond the autocratic leader. They act as a ceiling on potential growth.
To have accountability, you must first have authority. You can’t be accountable without authority. Because the autocrat is the supreme authority, they have made themselves the ultimate ruler — which means you can’t make a move without them having the final say.
Accountability requires autonomy, a granted level of independence, a local level of sovereignty. Under an autocratic leader, someone who must have their hands on everything, autonomy is not possible. To have autonomy requires the ability to self-direct and make independent decisions, which is not available under an autocratic leader.
The culture of an autocracy seems to work, until the company reaches a particular growth point, at which the autocratic leader cannot keep their hands on everything. Because the autocrat desires total control, they must keep things contained to maintain that control. Growth is stymied. Even more damaging: the autocratic leader doesn’t recognize that control displaces trust. So inherent in an autocracy is a lack of trust that people will do the right thing at the right time. Therefore, autocracy squelches personal responsibility, self-confidence, and self-development because the autocratic leader must somehow touch everything.
Ultimate Authority
You can see that autocracy is fully entrenched when you hear managers say, “I need to check with the leader first before I accept your request.” That means people can’t make and negotiate legitimate requests or promises without the consent of the leader. It’s a one-way street with a traffic jam building up.
When autocracy is in full bloom, people often start blaming and faulting others in the company. Things start falling through the cracks. Everyone is vying for the attention of the autocratic leader, which is not possible at this point. Anger and frustration cause turnover, which leads to chaos, and effective and coordinated actions are lost. The company loses the power to grow.
The transition from an autocrat to a corporate leader is attainable, but requires significant soul-searching, self-awareness and self-examination. Having coached leaders through this process, I can say it is a very difficult passage for them. But until the leader fully realizes they are operating as an autocrat, understands why they need all-encompassing control, and recognizes the cost to themselves and others around them, they will not change. And if they do not change, the costs to the company and its people will be devastating.
— Marc
