Dental Update – apologies to my children

WIN_20160511_16_11_45_ProLike most of us I was taught (and taught my kids) to brush their teeth after meals, at least twice per day. Apparently modern dental science has updated the optimal care and it is no longer necessary and possibly harmful to brush your teeth straight after eating.

Here are the new guidelines:

Don’t brush your teeth straight after eating.  Chewing food stresses the enamel coating on teeth and it takes several hours of bathing in saliva for the coating to be restored. Brushing within this time-frame is a second episode of stress on the weakened tooth protection system. Wait at least a couple of hours following eating.

Use a circular action electric toothbrush. Most of us are too vigorous with a manual brush and can damage the gum line.

Apply the toothbrush to the gums not to the teeth. Brushing the gums stimulates blood flow and ensures you access the deeper crevices. The teeth will be flushed with the run-off (like a shower) and be cleaned without insult.

Once a day is enough for brushing. Seriously? Yes. The damage to teeth and gums is due to bacteria on the surface. The bacteria take several days to mature and begin to damage the tooth structure. Provided you brush well within the two to three day window you can remove immature bacteria before damage is done.

Your tooth care routine should take around four minutes. This includes a couple of minutes of picking and flossing followed by two minutes of gentle, circular brushing and rinsing. Dislodge the food scraps first then brush them away.

Mouthwashes (antiseptic or fresheners) are a well marketed but unnecessary part of the dental hygiene routine. Spend your money on a better toothbrush.

See your dentist at least once per year for a super clean and inspection. Then stick to the four minutes per day routine to maintain a quality mouth environment.

Special sensitive toothpaste does work to reduce sensitivity but is often very abrasive. Better to brush with regular toothpaste then when finished apply a small smear of the sensitive past to your gums using a finger. Then rinse.

There you go – an update based on current dental science. So, apologies to my children for being a ‘Tooth Nazi’ – turns out I was a bit over the top.

Craig Allingham
Men’s Health


Movember 2015

As Movember draws to a close for 2015 I note that each year brings me more speaking engagements on men’s health. This year there were 7, with three in the final week. Topics included my ever popular 7 Dwarf’s Guide to Men’s Health, High Performance Age Proofing, Indigenous Men’s Health – closing the gap,  Nutrition session at local men’s shed including cooking lunch, men’s group at Buderim cancer support centre, the one day workshop for physios in Brisbane training professionals alongside Peter Dornan, Jo Milios and Stuart Baptist and of course recovery from prostate cancer. I have enjoyed meeting a whole bunch of blokes and helping them take a new look at their health attitudes and behaviours, and feel I have made a real contribution to men’s health having connected with well over 300 men across the month. Can’t wait til next year.

Men’s Health Week – Tip 1 – Posture

The only cost of improved posture is effort. The effort of working against gravity which continually drags you down into a lazy slouch.

Strong posture is a tall but relaxed stance or seated position where your sternum (top of your breast bone in your chest) is elevated but your shoulders are loose and relaxed.When teaching clients I asked them to imagine a string attached between belly button and top of sternum and to keep the string taut at all times – when standing, sitting, walking, driving, lifting, coughing, pushing a shopping trolley, wherever

The benefits of a strong posture are well documented and it is the foundation upon which all your body language is delivered – your posture can reinforce or undermine your language, messages and signals without you even being aware. Just as others’ posture colours their communication. Imagine if James Bond slouched into a hotel lobby instead of arriving with a strong and relaxed posture which commands respect and attention.

Healthwise, a strong posture improves breathing function, oxygen supply to the brain and possibly clearer thinking. It aligns your joints and muscles into their most optimum position for action and protection. It improves transit and absorption in the gut, improving digestion. A strong posture engages the muscles that control pelvic floor, balance the head and stabilise the lower back (curiously, they are the same muscles!).

Employers, negotiators, judges and mothers know the value of a strong posture, meaning you are likely to improve your job prospects and salary, win a debate, be found innocent and make your mum proud if you fight against gravity and don’t slouch.

Finally, if nothing else tips the scales (pun intended) you will look slimmer and taller with strong posture. Try it for a day and discover how many people remark that you have lost weight!

So if you want to be more healthy, successful, attractive and make your mum proud without spending any money – just straighten up.

More men’s health week tips each day this week.



How Many Clients is ‘Too Many’?

Is it possible to have too many clients? The initial response is typically, ‘no way, the more business the better’. But what if there is a point at which any additional client actually costs more to service than the fee you receive in return? Welcome to the world of marginal analysis.

So how can this happen? How can you actually lose money by servicing additional clients? And is this necessarily a bad thing?

Let’s work through an example, using any service based enterprise where you pay staff to deliver a service to clients. It may be a clinical service, hairdressing or some other time based service (where the customer charge is related to time spent with them or their project).

Firstly consider your fixed costs, the rent, insurance, telephone, bookkeeping, cleaning and other business expenses that are not related directly to delivering a client service. These costs exist whether or not you have any clients at all, and must be paid from cash flow or cash reserves (when times are slow). The other costs are variable; they are only incurred when a client is being attended to. Examples include practitioner wages, consumables (gloves, gels, oils, etc), and any extra energy or occupancy costs that arise if a service is delivered outside of your core business hours.

A brief word on practitioner costs; if you employ staff on salary for fixed and regular hours per week they are a fixed cost up to this limit. If however they are required to work overtime or out-of hours any additional wages are a variable cost as they are directly related to client service.  If you pay your team on a casual or contracting rate whereby all their income is dependent on client flow then the whole amount could be considered a variable cost. If you have a blended package of a retainer and commission there is elements of both.

Our first assumption is that you get to set your own pricing structure, and that this is based on some logical calculation to cover all your fixed and variable costs and hopefully have some left over (known as profit, see this earlier post for more on fee setting).  Now the clients start to flow in, and the income generated is quickly burned off by all your fixed costs. Once these fixed costs are covered you can now attribute cash flows to meet the variable costs for each consultation, visit or job. Again, your price structure will have some room for these costs up to a point, and this point is generally your usual operating hours, appointment frequency and staff allocation. But what happens when you have the opportunity to supply beyond this point? When the demand for your services exceeds your usual capacity to supply and you ask staff to extend their hours (overtime) or pay them more to do more (increased commissions).

The temptation to extend your scope to take advantage of the increased demand is strong, but does it make sense from a business perspective? Your fixed costs don’t increase, but your variable costs do as does your cash flow (income). There is a marginal increase in costs to provide this additional supply (extra wages, energy costs, admin support at front desk, consumables), and a marginal increase in revenue from the additional service. However if the marginal costs exceed the extra marginal revenue generated you will actually be providing the service at a loss.

Still doesn’t seem possible, does it? How can you be charging out one or more extra jobs but not make any money from them?  It now comes down to a concept known as marginal analysis. The marginal cost is the change in total costs (fixed and variable) divided by the change in quantity of supply (the extra services). So if your fixed costs per client service (easily calculated from your history of expenses and number of services billed for) are $45 and the variable cost is usually $35 your client fee of $90 leaves you with a $10 surplus.  However when you have additional variable costs to get that one extra client, they increase to $45, you are now breaking even.  If the variable costs go beyond this, if the additional cost exceeds the marginal increase in revenue, you are now operating at a loss for each additional client.

I have seen this problem arise in clients’ practices where the commission for a therapist bumps up when they achieve a target number of client services for the week. In one example, the per patient commission rose from $20 to $50 once 90 treatments were achieved in a working week, yet the fee paid by the client did not change. Consequently the business was losing $25 per appointment after 90 treatments, to the advantage of the therapist. The therapist was strongly motivated to achieve their target because beyond it lays the riches of doing the same job for more than twice the commission. Interestingly, this therapist became very skilled at working longer hours early in the week, making target by Wednesday and reaping the benefits for the next two days.

There are two interpretations here; firstly you may consider a small loss quite tolerable in building the business with a view to expanding staff numbers down the track. Or you may seek to recover the increased variable costs by loading the client fee for example adding an ‘after hours’ or an ‘emergency consult’ premium.

The main issue is to be aware of what each consultation costs and ensure the fees charged more than cover that amount.

Craig Allingham EMBA APAM

Setting Your Price

In my experience (personal and observing others) setting the price for professional services in health is one of the greatest stressors in business. It generates much angst as reflected by questions I am commonly asked in workshops and mentoring:

  • How much should I charge?
  • When should I raise my fees? By how much?
  • Should I discount? If so, on what basis?
  • Will differential pricing work for me?
  • Should my prices be linked to service quality or time units?
  • Why am I not making a decent profit?

The idea of pricing in the private market is coloured by two attitudinal handicaps. Firstly, we practitioners are generally altruistic, helping people who chose our career for non-financial reasons; business doesn’t come naturally to us. Secondly, the market place has a mentality of publicly subsidised health care – the prevailing expectation that the government should pay all or some of the costs of illness or injury.

That said, private practices must generate a surplus of cash to enable them to offer any services to anyone in the long run. Their income must exceed their expenses – all the expenses including the value of time donated by the owner (which is a whole different story).

So what pricing strategies are available and how are they applied? Here we go….

  1. Mark Up – determining what it costs to deliver the service, both the fixed and variable expenses, and then choose your mark up margin. For example, you might mark up your merchandise by 40% from wholesale to retail price. You could do the same calculation on your services – cost of delivery X 40% to give you a standard fee.
  2. Targeted Return – budget ahead on how much you need to earn to cover expenses plus how much extra you would like to make to compensate for risk, stress or just a return on your investment. Then price your units of service (at your usual saturation rate) to give you the amount you need to recover for each delivered service to achieve your budget target. That figure is your standard (minimum) price.
  3. Perceived Value – what value do your clients place on your service? Are you perceived as luxury, budget or somewhere in the middle? Do you consciously add value to the expected level of industry service through facilities, staff training, coffee machine, quality reading material, email education and support, state-of-the-art equipment, level of care, environmental responsibility and so on? If so, the price should signal this added (or reduced) value.
  4. Going Rate – contact the local competition to find out what their price is, then match it exactly or nearly so. This is the going rate for price and you need only match the going rate for quality to be pretty much indistinguishable from the others.
  5. Auction Type – not common in service industries: ask your clients to pay what they think the service is worth. You might like to apply a price signal, saying ‘Our usual fee is $x, but we will accept what ever you feel is fair value’. Success here relies on the power of your relationship marketing combined with total ‘WOW’ commitment to service consistency. And the reluctance of clients to be considered cheap by underpaying.  For the courageous.

These are five of the common methods of price determination. You can select based on your comfort factor as to what feels right for you, or on more solid business foundations such as covering expenses plus a profit margin. It is your business and your pricing strategy is entirely up to you, but remember whichever you select must deliver a cash flow to cover:

  • all fixed and variable costs,
  • future investment and development for the business,
  • compensate for depreciation and inflation,
  • PLUS provide a commercial rate of return on your investment (or better).

The other issues listed in the questions asked (top paragraph) will be covered in future newsletters. Or if you can’t wait they are included in ‘Book More Clients’.

5 Hints for Successful HR

Human Resource Management evolved from personnel departments which were previously called common sense. However the gradual  disappearance of common sense from modern life has allowed a new professional body to arise who are experts in managing humans for improved performance.

My experience working at the pointy end of sports science and medicine for twenty years brought me into contact with coaches who are masters of this dark art and other who were technically skilled in their sport but could not bring it out in their teams or athletes.

So in an effort to short cut your learning process in Human Resource (people) management here are five key points to take on board.

  1. People generally don’t or won’t manage themselves. Never assume because a person (employee, partner, contractor, patient, referrer) is intelligent, conscious and cooperative that they will manage their efforts in any way to your advantage.  You will need to provide a structure and systems to ensure their performance is contributing to your goals as well as their own.
  2. Hire attitude over talent. It is much easier to teach skills than it is to teach personality. When looking for staff be very clear on the skills you are seeking and once the base line for those has been met turn your attention to which remaining candidate possesses the right balance of values, aptitude, attitude and capacity to deliver within your organisation.
  3. People don’t leave jobs, they leave people. The most common reason for loss of quality staff (the only ones you will miss) is some conflict or discomfort in the workplace. It may be a workmate or it might be you. Recognise the problem and if you can’t change the dynamic to the advantage of both parties one of them will leave. Be very clear who you want to keep and why.
  4. Workers contribute to their maximum when they feel valued. Not when they are valued, but when they FEEL valued. If the first acknowledgement of value appears in an employees departing reference it is way too late. Shame on you. Take the greatest care not to be so busy with your own tasks and roles such that you don’t see and remark on the ordinary efforts your team puts in day after day. And if there is an extra-ordinary effort CELEBRATE it in front of everyone.
  5. Money is rarely the strongest motivator for improved performance. There is no doubt money is important as we all need to meet our obligations, but  beyond a certain level more money won’t create engaged, motivated and high performance employees. A fair compensation package will bring adequate performance, but add some of Number 4 (above) and you will see a greater return from your human resources (people).

Across all professional disciplines that I have worked with (allied health, legal, finance, personal care) the common woe is how to manage the people in their business. How to recruit, train, manage, engage and dismiss the right people to ensure the business grows and the day to day worries are reduced. This is not easy, and it is not a skill business owners are trained in. But if you are interested in improving this area of your business I believe you will get great value from my workshop on herding cats. To find out if this workshop is scheduled soon go to and check out the upcoming events column.

Mastering The Martians

Along with three fabulous physio colleagues I am organising a one day workshop on men’s health physiotherapy in Sydney on March 22, 2015.

This will be a tremendous program covering a range of topics – the other three are really smart and involved in research and innovation in men’s health. I will be the MC and talk about why men are such tough nuts and how to better work with them in the clinical situation. Plus the role of exercise in cancer survival. Check out the ad below and if you are a physio interested in expanding your work in this direction, click here to register now.

Mastering The Martians 2015

The Leader Once Removed

A new book looks at the challenging and influential role of those who choose to lead from a position of second in charge.Consiglieri , Hytner, Richard

Written by Richard Hytner (2014 published by Profile, UK and Allen & Unwin in Australia), Consiglieri: Leading from the Shadows analyses the skills, ambitions, benefits and risks of those who work alongside leaders and who may or may not harbour ambitions for the top job. While the characteristics of those shooting for the top may well parallel those they seek to replace (sorry, succeed), there is a legion of leaders who apparently do their best work in the role of first assistant.

What I find particularly interesting is Hynter’s typology of the different ways in which these advisers operate. He lists them as-

  • Caddies – supplying information and tools, helping focus attention and strategy
  • Roadies – organisers
  • Undermen – load sharers
  • Cornermen – giving direction from the sidelines
  • Sherpas – having deep understanding of the upcoming project or campaign
  • Philosophers – independent, reflective thinkers who enhance decision making

Each has particular talents and I suppose an individual could span more than one style, perhaps depending on perceived need or situation.

Why is this of interest? To me it is the notion that talented people can progress their mission without being in the leaders chair, and by doing so can create a better leader. A leader with a better world view and extended comprehension based on incoming advice and guidance. Of course, the consiglieri could also be a filter to actually limit the exposure of the leader to necessary information, so it is vital both are working to the same set of values and organisational goals rather than pursuing an individual course.

Confession: I have not read the book, but plan to do so shortly. The reviews and interviews suggest it would not be a wasted effort. There you go, a book review may be the literary equivalent of a consiglieri, bridging the gap between author and audience.

Active Surveillance: is it for you?

The decision facing many blokes upon diagnosis of prostate cancer is difficult. Should he opt for surgery, some other treatment or simply monitor the numbers and hope it stays stable or slow growing. The research reported below may help you in your decision. At least it gives you some background when discussing your best options with your urologist and GP.

STOCKHOLM—Active surveillance (AS) for patients with favorable risk prostate cancer (PCa) is safe long-term, with patients much more likely to die from causes other than PCa, according to study findings presented at the European Association of Urology 29th annual congress.

The study, led by Laurence Klotz, MD, of Sunnybrook Health Sciences Centre, University of Toronto, included 993 men (median age 67.8 years) with favorable or intermediate PCa who underwent AS for a median of 8.1 years. A total of 206 men were followed for more than 10 years and 50 were followed for more than 15 years.

Of the 993 men, 149 died (15%), 15 (1.5%) from PCa. The 10- and 15-year actuarial cancer-specific survival rates were 98.1% and 94.3%, respectively. Patients were 9.2 times more likely to die from other causes than from PCa.

In addition, at 5, 10, 15, and 20 years, 75.7%, 63.5%, 55.0%, and 55.0%, respectively, remain untreated and on AS. Metastatic disease developed in an additional 7, who either died of other causes (5) or are alive with disease (2). Post-treatment failure occurred in 6.3% of the total cohort.

“Active surveillance for favorable risk prostate cancer is feasible and appears safe in the 15-20 year time frame,” the authors concluded in their poster presentation.

At entry into AS, patients had a Gleason score of 6 (or 7 for men aged 70 and older), clinical stage T1b-T2b N0 M0, and a PSA level of 10 ng/mL (15 or less in men aged 70 or older). All had elected to be managed with AS. Clinicians offered intervention to patients if they had  Gleason score progression, a PSA doubling time of less than 3 years, or unequivocal clinical progression.

Although AS may be a safe option, a study published recently in the New England Journal of Medicine (2014;370:932-942) found that men with localized PCa are less likely die from the disease if they undergo radical prostatectomy (RP) instead of watchful waiting, especially if they are younger than 65 years. At 18 years of follow-up, RP was associated with an overall significant 44% decreased risk of death from PCa compared with watchful waiting. Men younger than 65 years had a significant 55% risk reduction, whereas older men had a non-significant 25% decreased risk.

Dr. Klotz told Renal & Urology News that the patients on the watchful waiting arm of this study did not have serial biopsies or the opportunity for delayed definitive therapy upon risk reclassification. In addition, most of the patients who died from PCa had intermediate- or high-risk disease at diagnosis.

It Changed Our Thinking…

It must be at least fifteen or twenty years ago when I first heard the term ‘under-recovery’. Until then we had labelled chronic, repetitive microtrauma injuries as ‘over-use’ injuries. Believing that the tissues were damaged due to repeated, frequent overloading.

Under-recovery suggested that the loading may have been quite appropriate, provided the tissue (tendon, fascia, muscle, bone, sheath, etc) had sufficient time since the last loading cycle to recover.

The ability to absorb more loading was reframed from one of being too hard on the body, to instead being too impatient and not allowing the normal cycle of post-training stress recovery reach completion.

So we started managing the recovery cycle with the same diligence and vigilance as we did the work cycle of training. Not only did we reduce the injury stress, but it turns out the level of performance would often go up as well. Whether this was due to the change of cycles directly or due to the longer period of training possible because it was not being interrupted by injury is difficult to say, and possibly irrelevant.

However this was a short won victory for common sense. Once the coaches realised sports science could improve the quality of the recovery cycle they increased the frequency and intensity of the loading cycles to maximise training adaptations. Active recovery strategies led to increased loading cycles and the injury and burn-out complications reasserted themselves.

I find the same thing happens in a busy life of work, family, recreation and chores. When I raise the efficiency of managing my tasks I then see gaps into which I can add more tasks…

So, how are YOU doing? How is your RESILIENCE?

Resilience: the current buzzword in business training and life management is RESILIENCE. It is not new, just a rebadging of the ability to bounce back, to roll with the punches to pull yourself up by the boot-straps, and other meaningless babble.

But actually it is not so much overload as it is under-recovery in terms of not quite regaining your equilibrium between the challenges that life will inevitably throw your way.

Each of us will handle this in their own way. Maybe not a rational or appropriate way, but the way we have always used (habit) probably learned when our minds were most plastic (childhood and adolescence).

Recognising your resilience is compromised is the first stage of avoiding burnout, depression, anxiety or other such failures of your coping mechanisms. Taking action and seeking assistance is the next step. Action and time to allow your recovery cycle to prepare you to step back into life’s fray.

Looking on from outside, you may not fully appreciate the range or depth of others’ overloading and risk judging them harshly for what you perceive as failings. Really, really try not to do that. It is not helpful for either of you. Ask how you might help (not fix, just help) them share the load. And if you are part of the problem, get out of the way without taking it personally (tough ask).

Finally, keep an eye on each other – your loved ones, your family, your team mates and employees. Your professional colleagues, teachers, students and most importantly yourself. Be mindful of how others are coping and dealing with their loads before you dump some of yours.