It was a first for me.
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After thirty years of practice as the only dentist in a small town in rural Mississippi, I fired an employee. I’ve had employees retire, employees move on to other jobs, and have had some employees who, by mutual agreement, decide that a dental office wasn’t a good fit for them, but I’ve never had to fire one. I didn’t want to terminate someone that I needed and valued but I really didn’t feel that I had another option.
I hated the experience.
First, a little background. Furniture manufacturing was once the linchpin of the economy in this area. The majority of those jobs are now in China. Then the recession hit. In 2011, the unemployment rate here was 13.5%. In the next county it was 20.1%. Unemployment has decreased slightly but most are still waiting on the recovery. Folks around here don’t talk about income equality; they talk about income, period.
My practice serves lower and middle income patients. I don’t have a high-end, high-fee practice like some dentists in more affluent areas. That is by choice. I grew up in a small town, I love the people in a small town, the sense of familiarity and community. I guess I’ll die in a small town but it is not an easy way of life. Years ago, my cousin, a Harvard-educated architect, spent the summer here in order to design and build my dental office. As the building neared completion he turned to me and said, “People say that if you can make it in New York City, you can make it anywhere. They’re wrong.” He pointed to the ground. “If you can make it HERE, you can make it anywhere.” So true.
My point is this – I have to run my practice as a business. I have to watch my pennies, compare prices on supplies to find the best deals, run my practice as efficiently as possible. I constantly monitor and manage all aspects of my business so that I can provide a bright, clean, affordable, and safe professional environment for my patients and employees. In spite of all my efforts there are some things I can’t control.
The one expense that has skyrocketed over the last five years is the cost of my employees’ health insurance. Prior to 2009, health insurance premiums grew at a rate comparable to other expenses. Since the Senate passed the Affordable Care Act in 2009, the premiums have increased by almost 65%, this in spite of switching to a plan with a higher deductible. Last month I received notice that they will rise again on January 1st, an increase of 90% since 2009.
This kind of inflation wrecks the balance sheet in a small business. It was painful, but the math told me I would have to fire someone. If I could have kept just half of the premium increase, I could have found a way to keep my employee.
In addition to health insurance, I provide my employees with a retirement plan. Last year I fully funded the plan for my staff. I can’t say the same for myself. I’m 57 years old and I need to sock away as much for retirement as I can but last year I didn’t make enough to fully fund my own retirement plan.
I have raised my fees slightly to compensate but in an area hit hard by the economy, the more I raise fees the harder it is for struggling families to get the care they need.
My staff did not get a raise this year. They won’t next year, either. Their raise will be eaten up by the cost of health insurance. I can’t fund my retirement like I should. I had to fire someone that I didn’t want to lose.
Math is an exact and inflexible science. Numbers do not lie.
And the math is telling me that I can’t afford the Affordable Care Act.