I’m reading a novel by the French writer Michel Houellebecq who, to put it mildly, takes a dim view of the human spirit. Among many devastating lines in Serotonin, I had to write down this one: “Is it a serious matter for something to commit suicide if it’s already dead?” I think we all dip in and out of dark thoughts, especially when there’s a mountain of work to do and no guarantees things will be OK. Brutal honesty in these moments can be invigorating. Take, for instance, escalating global economic and fiscal problems, an exploding debt crisis fuelled by low interest rates, and mounting system-wide fragility. These issues were there already but we notice them since they’ve been turbo-charged by Covid-19.

If the economy was already on borrowed time, what exactly is the problem? Yes, your income, your assets, your pension are not what they were but, if we accept that a major correction was coming anyway, they weren’t all that before either. Right now you face challenges in the short term like adapting to new PPE regulations and increased treatment times (although our clients in Ireland tell us these are tacitly slimmed down to workable levels within a week). You need to meet these challenges, so I’m not saying don’t focus on the immediate future, but see it as a necessary evil to endure rather than something you can plan perfectly for.

You have little control over the situation because it is defined by government decision making. What I am saying is take this opportunity to make a mindset shift voluntarily before you are forced to make it. You can no longer have your cake and eat it in dentistry. It has been an inherently dysfunctional area of business, with mixed practices still populating the field in early 2020. In February a mixed practice could still make a profit because private dentistry was so profitable. You could run your business blind without financial reporting. You could be poor at marketing and still have your business perform well.

All that is over now. These changes were coming but it was going to be more like 10 years before the whole market was retailised, tighter, and better businesses were providing dentistry across the board. Now that transformation is going to sweep through mid-level dentistry fast. It’s no longer about your dentistry provision, it’s about your business. You won’t get by on just being a good dentist if you own a practice. So you have to decide: are you in or out? Are you a business person or a dentist?

Now the market’s harder, maybe it won’t be as simple as that, perhaps you’ll need to decide what type of dentist. There will be many employed positions available when practices reopen but you are going to take a hit on income. Perhaps settling for a £50k salary in the third quarter of 2020 is going to be a desirable outcome for many dentists with financial obligations who see the predictability and stability of a guaranteed income as desirable. Don’t write this idea off, £50k is a fantastic salary and you should be able to hit reasonable income and wealth metrics with it (although of course it depends on your expectations and age). You can certainly do something with it.

Your other option is working as an associate on a lower rate than was normal before. You will probably be expected to do more than was normal before such as hit ADY targets, be a great communicator, do aftersales stuff, things that turn people green but that might get some excited if they’re interested in a high income without the onerous burdens of business ownership in a compliance-heavy industry. Remember, the world is gone in which you could run a practice badly, with your life tied up in it and, whenever you liked, sell up, be debt free and have a cherry on top no matter how poorly you’d done. Now a serious proportion of the market is discovering that to exit and be debt free looks appealing, and won’t necessarily be possible.

If you ever needed a rude awakening that you’re the only person in charge of your destiny, here it is. There are many things you can’t control but you do get to make a choice today about what you want. This upheaval in dentistry was coming into your life, even if it wasn’t coming so suddenly. Perhaps we’ve become so inured to living without risk that we were not living at all, as Houellebecq’s protagonist intuits. If risk was pathologised pre-Covid, perhaps that was making us ill. We medicalise death but can’t avoid it. And we can’t avoid risk, although we can of course live skilfully in denial. Another scathing cultural commentator, HL Mencken, wrote: “The average man does not want to be free. He simply wants to be safe.” Which is it for you?