Dental Entrepreneur CLASS OF 2015 | FALL ISSUE
Business Beyond the Classroom
Gary Palsis Jr. D.M.D. Success in the Windy City
The Cost of Failing to Plan How to Find the Practice that is Right for You Choosing a Dental CPA
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Fall 2014 VOLUME 17, ISSUE 1
Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Production Ruthie Gordon Publishers Press Inc. Editorial Board Dr. Gene Heller Dr. Harold Sturner Dr.Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH,BS. Dr. Tom Snyder Derek Champange Layout and Design John O’Connor
Class of 2015 Contributors Gary Palsis Jr., DMD
Mark Hollis, CEO
Scott Brewster, DDS
Kristin Nickels, CEC, ACC
Roger Levin, DDS
Gene Heller, DDS
Victor O. Holloway, MBA
Allen Schiff, CPS, CFE
Charter Sponsors Oral-B Laboratories Ultradent Products Inc. Procter & Gamble Wm. Wrigley Jr. Corp. Glidewell Laboratories Benco Dental Co. Tess Corp. Dental Care Alliance
The Pride Institute The Snyder Group McKenzie Management Caesy Education Systems, Inc. Warner-Lambert Co. Phillips Health Care Oxyfresh Worldwide
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CLASS OF 2015 FALL ISSUE VOLUME I
Greetings to all you prospective dental-school graduates out there! Congratulations on nearing the end of the tunnel of your higher education. I found myself thinking about that process when I was in the salon the other day, waiting for my color to process for about 30 minutes. I was sitting with two other women a little younger than me. I noticed all of us stared at our mobile devices for the first half of my time there, and then I put my phone down and picked up a Bazaar Magazine. The first thing I noticed was that some of the models’ smiles were healthy and the teeth were crooked (leave it to a dental professional to pick that out). Secondly, I noticed the feel of the paper in my hand, the simplicity of the font and the layout of the content. I relished the time I had to turn the pages. I have to say I am a lover of print, paper and the old-fashioned magazine. However, I also like a magazine that is sexy and feels good. This is one of the reasons we have changed a few things going forward. The new look is for you. We want you to want to pick us up, feel the pages, contemplate the content and enjoy the time to be patient and present. After all, you are online for most of your lives. Why not take a private moment and enjoy something that is tactile, that you can actually flip – and not swipe – through. But while the look and feel of the latest edition of Dental Entrepreneur: Business Beyond the Classroom is different, the spirit remains. As always, we strive to connect you with experts in the dental industry – not necessarily in practice, but in the ancillary fields from which aspiring dentists can benefit. We’ve tabbed our Gary Palsis, a young dentist practicing in Chicago who wrote about finding his way to an associateship in Chicago. It was a winding road, but Gary is certainly happy where he is now, and I believe his positivity in infectious. To help you get there, Gene Heller contributed an outline that dental-school graduates can follow to aid in finding the right post-school employment. Who knew there were so many pitfalls in failing the simple task of planning? And have you thought about teaming with a CPA that is truly focused on dentistry? Allen Schiff, managing member of Schiff & Associates, discussed the importance of finding an accountant that has your best and specialized interests in mind. Those are just a small sampling of the resources included in this Fall 2014 issue. I sincerely hope you will reach out to our writers, our advertisers and our partners. I mean it when I say that we are all eager to help you on your way to greatness. Oh, and I am also excited to announce that we will be now be publishing Dental Entrepreneur three times a year! That means we can truly fulfill our promise to have the most up-to-date business content that you can absorb as you look to make the next move. I wish you all the success in the world, and I hope we can. All the best,
Anne M. Duffy Publisher 2 Fall 2014 Dental Entrepreneur
Contents Prologue 4
Success in the Windy City: Where I Was and Where I am Going Gary Palsis Jr. DMD
Back to the Beginning Scott Brewster, DDS
How to Find the Practice that is Right for You Bill Shattuck, DDS/written by Amy Bowman
Getting Started 10
The Cost of Failing to Plan Gene Heller, DDS
Gateway to Private Practice Excellence – What You Need to Know When Selecting an Opportunity Sarah Lynch
Choosing a Dental CPA Allen Schiff, CPA, CFE
Business Fundamentals 24
How Mobile Technology Interacts with a Modern Practice Mark Hollis, CEO
Payday Flu – A New Approach to a Big Expense Kristin Nickels, CEC, ACC
Increasing Case Presentation Effectiveness Roger Levin, DDS
The Power To Succeed 34
When the Typical Path Meets the Unexpected Reality Andy Upchurch and Victor O. Holloway, M.B.A
Dental Entrepreneur Fall 2014 3
Success in the Windy City: Where I Was and Where I’m Going Gary Palsis Jr., DMD
he last time I wrote an article for Dental Entrepreneur, I wrote about the difficulties that a first year graduate faces in the early phases of real-world practice. At the time, I remember thinking about how insurmountable my student loan debt seemed and how owning my own practice was just a pipe dream. After three years of practice as a general dentist, my perspective has become a bit more optimistic. After graduation, looking for a job can be difficult because new graduates have no experience, and many private practices are wary of hiring someone that may take time to refine their clinical skills. Plus, there is a limited amount of time to look for a job before new graduates have to make that first month’s loan payment. This is where a lot of the corporate dental chains have the advantage. They are willing to hire the eager, inexperienced and heavily indebted young dentists. They let you focus on building your clinical skills while they take care of the business management side of a dental practice. Some of these corporate practices even offer benefits and continuing education for their dentists. It’s a tough package to turn down. I know because I worked for a company like this. Corporate dentistry turned out to be a really great stepping stone in my career. After two years of working 5-6 days a week at a primarily Medicaid dental office on the south side of Chicago, I felt that I had gained enough clinical experience to search for another opportunity. Don’t get me wrong; I loved the patients I worked with. They were extremely appreciative of my work and filled me with a sense of pride every day. The trouble with Medicaid is that it doesn’t pay for many services, which made patient acceptance of optimal treatment plans very difficult. I struggled to find options for these patients that didn’t leave me feeling guilty about the choices they had to make about their health due to finances. I decided it was time for a change. I wasn’t necessarily looking for more money, just a different style
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of practice. Armed with these two years of experience, I scoured the ADA online ads, called practice placement services and even looked on Craigslist for job opportunities that sounded promising. To my surprise, I found an office in the heart of downtown Chicago that was looking to replace a dentist who was leaving. I emailed my resume, and I was offered an interview soon afterwards. I was blown away by the beautiful city views and the glowing online reviews for this practice. As one of the premier practices in Chicago, keeping a good reputation through patient satisfaction is important to everyone who works there. The doctors there seemed happy and their work was top notch. There are literally hundreds of dental offices in downtown Chicago, and to find one with so many positive attributes was a blessing. I am happy to report that I have been working at this downtown Chicago practice for over a year now. I’ve experienced
growth as a dentist in ways I never thought possible. In the last year alone, I’ve gained valuable experience in technology I didn’t have access to at my previous job. For example, our office utilizes 3D CADCAM technology for Cerec crowns. I’ve completed full Invisalign cases, which I learned in school but never attempted at the Medicaid office. I have had the incredible opportunity to work directly alongside a periodontist and an endodontist, both of whom work in our office a few days per week. Needless to say, I know that I still have plenty to learn, but my clinical skills and decision-making are getting stronger every day. So where do I see myself going from here? Well, a lot has happened in my personal life in the last few years that plays into this. I recently got married and my
wife has a great career here in Chicago. We are both working to pay off our student loans together, and we hope to be finished in the next few years. With that in mind, the idea of owning my own practice is certainly something that I want for myself in the future. With my current practice, I have seen more of what it takes to run the business side of a dental practice. I know there are late nights, early mornings and weekends of billing, scheduling, returning emails and phone calls from patients, maintaining equipment, coordinating lab cases… the list goes on. The question is whether I could supervise all these tasks while being an attentive clinician for my patients. Of course, this is why a well-trained staff is extremely important in the success of any dental office. If I started my own prac-
tice, I know it will take much more than being an excellent dentist to succeed. It takes a leader. Gary Palsis is from Indialantic, Florida. He received his undergraduate degree from University of Florida in 2007, majoring in Microbiology and Cell Science. He graduated from University of Florida College of Dentistry in 2011. Gary is licensed in Florida and Illinois, and is currently practicing general dentistry as an associate in a group practice called Studio Dental in Chicago, Illinois. His hobbies are football, basketball, soccer, photography and piano.
Dental Entrepreneur Fall 2014 5
Back to the Beginning Scott Brewster, DDS
ot all dentists wait until graduation to officially begin their journey into dentistry. I was fortunate enough to get an early start to my dental career, as I worked as a dental assistant at Neibauer Dental Care even before stepping into dental school. Early on, I had a passion for art, science and helping others, so I knew dentistry would provide the perfect mix of those desires. While applying to dental school, I wanted to seek out as much knowledge in the field as I could. As a dental assistant at Neibauer Dental Care, I fulfilled that goal. Working with the senior doctor and staff, I learned a lot about both clinical care and the atmosphere of a dental office. It was an incredibly valuable experience to have early in my career. Carrying this early knowledge and experience, my next stop was the Howard University College of Dentistry in Washington D.C., where I graduated with my Doctorate of Dental Surgery. Subsequently, I completed a general practice residency in San Francisco, and I was primed to move forward. Based on my previous experience at Neibauer Dental Care, I knew I wanted to work in practice that had a similar mindset, focused on continuing education and promoting doctor leadership. After learning that Neibauer had affiliated with Heartland Dental, I decided to seek out opportunities to affiliate with the organization.
6 Fall 2014 Dental Entrepreneur
I first met the Heartland Dental recruiting team at an Academy of General Dentistry convention. After speaking with them, providing my information and interviewing a week later, I officially became an affiliated dentist. In addition, I returned to Neibauer Dental Care. From the start, I knew I made the right choice. On my first day back with Neibauer, I filled in for another dentist. This was a little scary; being without a senior dentist to consult with, helping patients who didn’t know me and who were expecting their regular dentist. However, my team and administrators’ support made it painless. I left feeling accomplished that I met the challenge. There is no where else I would have received that level of commitment. Now at Neibauer Dental Care in Bowie, Md., I’ve continued to build upon my skills each day, learning things not always available in dental school, such as becoming a leader and communicating with team members and patients. I have a small army of people helping me out personally and professionally, including my team, administrators and Heartland Dental’s home office support. Everyone seeks to help me learn more and be the best dentist I can be while providing whatever I need. The support of fellow affiliated dentists is also only a call or click away. While completing my residency as a new graduate, trying to find a position where I was living was a daunting task. Basically, I was fighting for positions that would
only allow me to practice two days a week, with no benefits or malpractice insurance. Now I feel like it’s a 180-degree difference. I have stability, and my credentialing and insurance is taken care. Also, if I wanted to relocate, I would have that option. With so many affiliate opportunities throughout the country, I have the flexibility to move to a location of my preference and stay with the same company. I come to work in the morning at a state-of-the-art office with a great team, a team that I put together and helped train, a team that operates as one fluid unit and functions efficiently. From starting as a dental assistant and returning as a dentist, I look forward to growing further alongside the company with which I began.
Scott Brewster, DDS, is a Heartland Dental affiliated dentist who practices at Neibauer Dental Care in Bowie, Md. He is a graduate of the Howard University College of Dentistry in Washington, D.C. In addition, Dr. Brewster has completed Advanced Education in General Dentistry at the University of the Pacific Arthur A. Dugoni School of Dentistry. He is also a member of the American Dental Association and Academy of General Dentistry.
How to Find the Practice That’s Right for You Bill Shattuck, DDS – written by Amy Bowman
ill Shattuck, DDS, is a Texas native who knew he wanted to study medicine when he entered college. As a member of the pre-medical society, he stumbled upon several pre-dentistry meetings, where the seed for his future career was planted. It wasn’t until after completing his undergraduate program at Texas A&M that the seed sprouted into a serious desire to study dentistry. The opportunity to provide quality patient care, the wide range of specialty options from implants to orthodontics and the opportunity to work with pediatric patients sealed the deal. After graduating from the dental program at the University of Texas at Houston in 2012, Shattuck narrowed down his practice search to three criteria that he felt were most important: • Staff members – an excellent staff with the knowledge and drive to make the treatment process a positive experience for both doctors and patients. • Technology – the opportunity to work with updated technology that would allow him to grow as a dentist. • Growth − the opportunity to begin working on patients right away, and a senior dentist willing to become a mentor in order to help him develop in the profession. He was offered several associateships in major metropolitan areas, but only two of his three criteria would be met. It was the job offer in a small, rural town in Oklahoma that had everything he needed. He accepted the position in 2013, moved his family to Oklahoma and hasn’t looked back. Having recently been through the job search process, Shattuck has valuable advice for recent dental school graduates. “Determine what’s most important to you and find those things,” he said. “Don’t listen to other people’s opinions about what’s right for you. It’s important to look and stretch yourself and find a place that feels comfortable for you because what you need isn’t going to be what everyone else needs.” Shattuck said when looking for a practice, it’s important to cast a wide net, to seek out a practice that has invested in itself through technology, and a senior dentist who values patient care
8 Fall 2014 Dental Entrepreneur
above all else. When interviewing, talk to the staff. Ask them what the focus of the practice is, and what they like about the office and the practice owner. If one of their first answers is quality of patient care, chances are technology is one of the foundational principles of the practice. According to Shattuck, new graduates should be wary of a practice that simply claims to value technology. You should look for a practice invested in technology that is used to more accurately diagnose disease, improve treatment outcomes and help motivate patients to pursue treatment. Not only does technology allow you to provide the best patient care, it can accelerate your learning and growth. Recent graduates are at an advantage. After spending the past four years learning, you are still hungry for knowledge and open to learning new technologies, so it is vital that you take advantage of this time to learn and grow. Beginning your professional career by learning how to operate and integrate new technology into the practice can help you gain the confidence to tackle more complex cases that you might otherwise be hesitant to accept, which will improve your skills as a practitioner. As you integrate newer technology and show patients how it
helps improve oral, and overall health, it impresses upon patients how seriously you take their treatment. It also improves patient compliance, and can lead to increased word of mouth referrals, which is great for practice growth. Lastly, Shattuck said that recent graduates should be careful not to be blinded by the glitz of a dental office that has invested only in fancy décor, a nice waiting room, or an expensive building. There are many great practices where the dentist has invested in what’s inside the operatories rather than what’s on the outside. Although living in a small town has taken some getting used to, Shattuck said that he wouldn’t change his decision for the world. “There’s no doubt in my mind that I’m where I need to be right now,” he said. He described Kristen A. Burris, DDS,
Family Dentistry, the practice where he landed, as a diamond in the rough because although it doesn’t have the ritzy location or the fancy trimmings often found in typical “boutique offices,” the practice has everything necessary to provide exceptional patient care, including digital X-rays, cone beam technology, intraoral cameras, CAD/CAM technology, sleep dentistry and multiple intraoral scanners. The senior dentist at the practice is Kristen Burris, DDS, who hired Shattuck after agreeing that he would eventually take the practice over for her. “She has done a great job of guiding me,” said Shattuck. “She knows where I can jump into the deep end and where I should really pull back to allow a more experienced practitioner to take the reins.” The two recently signed papers agreeing
that Shattuck will take over the practice in several years. Until then, Shattuck’s goals are to keep improving and keep growing. “If you’re not growing, you’re moving backwards,” he said. “It’s important to live and grow and become a better person than you were the day before.” As it turns out, the seed planted years ago has grown into a successful career at a small-town practice that offers more than Shattuck could have ever imagined.
Amy Bowman Patterson Companies, Copywriter Amy Bowman writes articles, marketing copy, and online content for Patterson Companies. She lives in Minneapolis and can be reached at email@example.com
“EARLY ON IN YOUR CAREER, YOU’RE TRYING TO MAKE A NAME FOR YOURSELF AND YOUR PRACTICE. YOU’RE TRYING TO GET YOUR SYSTEMS IN PLACE. THE RIGHT DISTRIBUTOR MAKES ALL THE DIFFERENCE.”
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Dental Entrepreneur Fall 2014 9
The Cost of Failing to Plan Gene Heller, DDS
ost of you have heard the adage, “If You Fail to Plan, You Plan to Fail.” Just as many of us fail to take the time to plan any major decision, we also fail to understand the cost of this failure to plan. Let’s face it. Whether consciously or unconsciously, none of you got to where you are today without planning. And the better the plan, the better the outcome. From the time you were children, many of your parents “planned” on making certain you could get into college and beyond. Their plan included saving for future college expenses (or at least they tried to) and encouraging you to get good grades so you would qualify for entrance. If they didn’t already know it, they quickly realized the better your grades, the more quality colleges would be willing to accept you, and furthermore, better grades made you eligible for scholarships to help with the financial cost. Subsequently, various methods of encouraging good grades were written into their plan. As you got closer to graduation from high school, you began getting actively involved in the planning process. You began selecting and applying to various colleges. You began thinking about long-range careers. Because many of you were already looking at dental school with a career in dentistry as your endpoint, once accepted into college, you began planning your schedules to include the necessary predental curriculum courses. For some of you, a “failure to plan” dentistry as your final career during your early college years resulted in the cost of both additional time and tuition to obtain the necessary required pre-dental courses. Finally, you were accepted into dental school. You immediately began new plans. All of your focus, time and energy were now directed at planning how you were going to pay for each semester’s tuition and how you were going to complete the requirements for graduation. Towards the end of your dental school experience, in an effort to finish your educational requirements, many of you began to look for and made plans to attend various GPR’s or Specialty Training Programs. Graduation day comes, and now there is a new question: 10 Fall 2014 Dental Entrepreneur
“What’s next?” expensive.
This is where failing to plan gets needlessly
Planning Mistakes Why do people fail to plan? There are four primary reasons: procrastination, excessive time demands (too busy), perceived complexity of the planning process and failure to fully understand the cost of not planning. Procrastination is beyond the scope of this discussion. The busiest people are typically the most productive and successful people. And they attribute much of that suc-
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cess as the result of their planning. These successful, busy people have learned that planning need not be complex or take a lot of time, if a few simple guidelines are followed. Whether graduating from dental school or some other post-dental school training, for many, in their final year of career education, future career planning stops or significantly slows. All of the new dentistâ€™s time and energy is focused on just completing their requirements, graduating and passing their boards. However, planning is in and of itself a lifelong process involving every aspect of our lives. The timing of when the planning is done (how far in advance of the need should plan formation begin) is sometimes just as important as the plan itself. The first mistake many have is not having a system for handling and developing an organized plan for major decisions or goals. Once identified, a practical plan and timetable is never developed. If some kind of a plan is in fact developed, the timetable is not followed. When the anticipated deadline arrives, the emotional and financial crisis begins. The further in advance of the desired outcome the plan is made and followed, the better the outcome. Plans formulated and developed during a crisis rarely have adequate, the same, or better outcomes than those plans developed long before the deadline and subsequent crisis. What are the Planning Failure Costs for New Dentists? The two most important costs of failing to plan (or thoroughly plan) are typically both emotional consequences and financial. The level of severity is directly tied to the magnitude of the subject. We have all experienced the stress of something not going according to plan or because there was no plan. The level of stress can vary from a mild annoyance to an all-out psychotic breakdown or stress-induced heart attack. Dealing with the emotional costs is not the intent of this discussion. Readers will need to seek their own counseling for that subject!
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The two most important costs of failing to plan (or thoroughly plan) are typically both emotional consequences and financial. What I want the reader to understand and have is a better picture of the financial costs of NOT planning. Many times a very minor detail in a plan can save us tens of thousands of dollars later. As an example, while building my own dental practice facility many years ago, my architect pointed out that moving a one-half inch line on the building plan now would cost about $20,000 less than moving the wall later because the wall was in the wrong place, along with the plumbing embedded insidee. The first major failure to plan that we see with new dentists is related to post-dental school employment. Henry Schein has a dental placement division for dentists seeking associates and associates seeking employment opportunities. Of the approximately annual 5,500 dentalprogram graduates, this division receives approximately 1,500 applications from new dentists seeking employment. So, what is the problem? The first problem is not planning for post-graduate employment in a timely manner. These applications come in from May to August of the graduation year. Typically, however, it takes six or more months to locate an employment opportunity. Therefore, these new graduates are even further financially crushed after graduation because of their lack of employment, and/or they accept less than desirable employment opportunities in locations where they do not want to practice just to have an income flow. The second primary planning problem I have observed over the past 20 years relates to planning for practice ownership. Many new dentists wait until well into
their post-professional school employment to begin the preparation process for practice ownership. As a result, ownership is delayed, sometimes for years, while the new dentist makes necessary preparations. The average practice owner earns 3-4 times as much as an employeeassociate dentist. Subsequently, by the most conservative estimates, the ultimate after-tax net income loss as a result of delaying ownership is a minimum of $10,000 per month. Instead of planning, securing employment effective one month after graduation and entering practice ownership as soon as possible, we all too frequently observe a different than desired outcome. The new graduate, beginning the search for employment after taking a month (or several) off post-graduation to celebrate the end of their college careers, eventually faces financial reality. Beginning the search for employment a year earlier would have taken virtually no time from their schedule. From a practice purchase perspective, most lenders feel comfortable lending the necessary funds for practice acquisition and/or startup practices within one to two years post-graduation. Based on the successful history of tens of thousands of dentists, it is their belief that the new graduate has the required skills to own and operate a dental business. However, we are seeing increasing numbers of new dentists postponing practice ownership for 3-7 years post-graduation. Using the above $10,000 per month, this represents a post-tax income loss of $360,000$840,000. Simple Planning Process Whatever the subject or project, the first step is to write it down as a goal. Personally, I maintain a file marked Goals and Plans (currently on my computer desktop). As soon as the goal is written, the second step is to assess the timing for its completion. The third step is to list any known major steps required to completing the goal and prioritize based on the timing. Next, list a rough timeline assigned to the necessary steps to com-
plete the goal in a timely manner. This initial entire process should take less than five minutes, even for a major goal such as the acquisition of a dental practice. The last step is to mark your calendar relative to when you must come back to your plan to begin work on the details and put the plan into action. Example: Goal: Post-Graduation Employment Desired Start Date: Aug. 1, 2015 Anticipated Time Required to Accomplish Goal: 12 months Steps: 1. Identify City/State desired: Timing Immediate 2. Post Resume/Register Availability: Timing - 6-12 months prior to desired start date
a. Notify local dental supply companies of availability b. Post availability on employment job boards/websites c. List availability with dental recruiting companies d. Contact individual dentists/dental clinics directly in desired community 3. Assess personal financial needs to determine bare minimum required compensation: Timing - Prior to first interview Next plan review date: Aug. 1, 2014
problem is a failure to have at least minimal planning regarding their post-graduate employment and post-graduate practice ownership needs/desires. Planning does not need to be complex. However, these two major goals for most new dentists does require a timeliness of action, or the resulting costs can be substantial as a result of delay and implementation.
Dr. Eugene W. Heller is the VicePresident of Professional Practice Transitions, a nationwide dental practice sales and consulting organization. He can be reached at 1-888-477-8552.
Timely Planning is Key This discussion was not intended to be an exhaustive discourse on planning. It was designed to point out an expensive problem for many new dentists. That
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Dental Entrepreneur Fall 2014 13
Gateway to Private Practice Excellence
What you need to know when selecting an opportunity! Sarah Lynch
t can seem daunting to start the hunt for the right dental practice to acquire or take a position as an equity owner. Having visited hundreds of different practices each year (for the past 19 years) and worked with hundreds of practice owners and owners to be, I have a unique perspective on where to find true practice opportunity gems and what situations to avoid. Let’s face it, time is our most valuable asset, and we all want to optimize our time in daily life. It takes time to get comfortable with the process to find the right practice, and no one wants to miss the boat on a solid opportunity. Classified ads for practice opportunities in the digital age can seem cryptic and uninviting due to confidentiality constraints. However reading between the lines, I can give you a few tips as to which ones may be worth pursuing. For example: PRACTICE #7750: Long established general practice now available due to owners planned retirement. Collections steady at $600,000 per year. Strong hygiene department, production mix 50-percent hygiene, 50-percent doctor. Four treatment rooms, leased space with favorable terms, located in college community. To me this ad screams “Practice Goldmine” interpretation, stuffed with reliable hygiene patients, a doctor who is working at a moderate pace and room for a new owner to comfortably take over and not get clobbered with expensive occupancy costs. Definitely worth looking at, even if some equipment may possibly need upgrading. PRACTICE #8845: Ultramodern state-of-the-art practice with all the bells and whistles. Ten treatment rooms, a prime location, 14 Fall 2014 Dental Entrepreneur
new patient flow averaging 30 per month, 85-percent insurance, long term lease with assignability provision near major medical center. This is worth a look if one is interested in owning a large practice and having associates. But you should ask why the owner
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is selling or offering an equity position. great frame of reference to narrow down How readily available are associates for the final selection. The next phase in the hire? If the owner is offering an equity process is what I call the Fit, Feel and position, how much debt is there on Finances. If a practice opportunity has a the practice? Occasionally, we find some similar practice philosophy or if it is what practice owners are highly leveraged with a new doctor aspires to achieve, generally debt load from new office build-out and it is going to be a good fit. If the practice equipment. Their motive is sometimes to tempo or philosophy feels alien, it might find someone to buy half the practice and be best to pass and look at other situations share the debt load. Caution: if there are before rushing into making a decision to not enough patients in the practice or a move forward with it. The final qualifier strong marketing protocol, this can be is financially related. The big question I financially burdensome and stressful for hear from dentists is, “What is left over all parties involved. for me to live on if I buy this practice?” PRACTICE #9230: Well-run, rockWith the practices I represent, I always solid modern solo practice, profitable nets run a realistic sample cash flow scenario 45 percent to the owner. Excellent work to show a potential buyer what is going schedule, four days, FFS (Fee for serto be left over to live on while the practice vice). Annual gross revenues approaching is being financed. Sometimes the bottom $1.5M, two full-time RDH, state-of-the-art technology, six treatment rooms. Dream Cash Flow Analysis practice in desirable community. 2013 Practice Tax Returns Interpretation: “ Success Gross Receipts: Haven.” This practice is going to sell for a premium. Additionally, I guarADJUSTED NET INCOME: antee you the seller/owner Net Profit digs dentistry, may possess Officer Compensation an advanced skill set, has exceptional management Depreciation: systems, a superb staff and Pension & Profit Sharing plan 70% marketing protocol in place. Travel With six treatment rooms, Amortization there is enough room for the owner to stay on and do a role reversal as an associate for the new owner if that is the desire of the purchaser. These practices are worth paying a premium for, as all the kinks have been worked out and the owners want to see their successors do well. They are likely willing to thoroughly educate them on practice management systems and all the other success nuances. I always suggest that new dentists visit as many practices as possible that spark their interest to develop a
16 Fall 2014 Dental Entrepreneur
line is the pass/go qualifier. Similarly with searching for an associate position, one wants to feel comfortable and supported in the work environment. Are there ample patients to support a fully scheduled day for a new dentist in the practice? Or are you required to go out and build your own patient following? If doctor compensation is tied to collections, is the staff doing a great job collecting revenues on a timely basis? Illustrated below is a fairly normal looking sample cash flow scenario looking at a 2013 practice tax return and seller interview answers on personal items expensed in the practice:
Practice ME2292 $792,678
$26,162 $210,900 $1,508 $51,139 $974 $157
Meals & Entertainment
Total Adjusted Net Income:
Sample Financing Scenario: Finance practice $550,000 for 10 years @ 5.25% interest = $5,901.06/mo. Annual payments =
2013 Adjusted Net Income = Dollars available to new doctor =
Minus Annual Loan Payments =
-$70,813 Remainder for new buyer =
I have observed over the years that the most successful practices have a totally engaged owner who is committed to being a successful business owner dedicated to the delivery of dental care. This translates to cultivating the best staff possible. Most of the practice owners I interview attribute their practice success to their dental team. They deeply appreciate their staff members who support their mission. They have effective systems and processes in place to take excellent care of their patients and attract new ones. Hang with the bright stars, and you will be a bright star too! The company one keeps is important. Many of the successful practitioners actively participate in study groups, mentor programs, share and teach what they learn to others. When investigating practice opportunities, ask the practice owners as many questions as possible pertaining to the metrics of the practice, such as the process
of arriving at the asking price, procedure mix, patient attraction methods, marketing, staff mix, benefits, pension plan, scheduling, new patient flow, demographics, practice management style, staff meetings, handling financials accounts receivable (who applies the cash) and accounts payable (who pays the bills). Ask about the occupancy. Is there a lease available? Is relocation necessary, or can building be purchased? Also be sure to ask the practice owner what their timetable is for transitioning out of practice or bringing someone in. Assess your own goal timetable and see if there is alignment or misfire. As always, the devil is in the details. Time is precious and opportunities abound. It is my personal mission to help dental professionals be successfully self-employed. I am here as a resource to assist those in transition. I wish every reader of this article continued success!
Sarah K. Lynch is managing partner of Jim Kasper Associates, LLC. A regional practice brokerage and transition firm serving dentists in New England and New York State since 1981; specializing in valuations and sales of dental practices. She has appraised and sold hundreds of dental practices in the Northeast. She is coauthor of Profitable Practice, and contributing author to Business Valuation Resources Guide to Valuing Dental Practices. She is past president of ADS Transitions, Inc., and currently serves as chair of the ethics committee and Vice President of Technology. She and can be reached at 603-355-2260 x- 203 or email@example.com.
ADS HAS THE LOCAL MARKET EXPERTISE AND A HISTORY OF OVER 2.8 BILLION DOLLARS IN PRACTICE TRANSITIONS.
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ADS companies are each independently owned and operated.
Resource Guide ADS Dental Transitions (888) ADS-4237 www.ADStransitions.com ADS is the nationwide leader in dental practice sales, associateships, buy-in/buy-outs, partnerships and appraisals. ADS is comprised of the industry’s most experienced professionals, including dentists, attorneys, and CPAs. We can help you with each step of your next transition. To view a complete list of practice opportunities available in your desired area, visit us at ADStransitions.com. Please see our ad on page 17.
ADS Dental Transitions South 770-664-1982 www.adssouth.com ADS South is the premier dental transition organization in the Southeast. We provide associateship placement, dental practice sales, appraisals, and expert testimony services. Our company was founded over 26 years ago by Earl M. Douglas, DDS, MBA, BVAL, and we continue to control the cutting edge of transition technology. Please see our ad on page 5.
Henry Schein Nationwide Dental Opportunities 866-409-3001 www.dentalopportunities.com Henry Schein Nationwide Dental Opportunities is the perfect solution for your Dental Associate recruitment needs. Call 1-866-409-3001 today to learn more about improving your opportunities or success. See our ad on the back cover.
Henry Schein Professional Practice Transitions (PPT) 1-800-730-8883 firstname.lastname@example.org www.henryschein.com/ppt Henry Schein Professional Practice Transitions (PPT) is the practice sales division of Henry Schein, Inc. Our affiliation with the largest dental supply company in the country—intent on servicing the practice buyer’s future supply, equipment and service needs, makes PPT the only company with a vested interest in the buyer and a career long trusted relationship with the seller.
IgniteDDS Aspen Dental 877-330-1349 www.AspenDentalJobs.com At Aspen Dental we recognize that our success is a direct result of empowering and supporting ambitious dental professionals. We provide a professional, fast-paced, entrepreneurial work environment based on a mutual respect that keeps our interests aligned together, we build and develop successful, patient focused dental practices. Please see our ad on page 9.
Comfort Dental www.comfortdental.com The Best of Both Worlds At Comfort Dental, we combine the old-style neighborhood dental practice with today’s modern group practice. Equity ownership, autonomy, management of your own business, and long- lasting relationships with your patients is combined with our economics of scale, prime locations, mass marketing, and overhead control. It truly is the best of both worlds. See our ad on page 15.
18 Fall 2014 Dental Entrepreneur
716-912-7970 email@example.com Building the bridge between dental school and tomorrow’s most successful, quality-conscious private practices Mission: Fueling Passions Beyond The Classroom for dental students, new dentists and new dental team members Description: igniteDDS empowers the next generation of dental professionals with the knowledge and resources you’ll need for tomorrow’s treatment and practice decisions!
MacPractice, Inc (402) 420-2430 MacPractice.com MacPractice DDS is the leading practice management and clinical application for dentists who prefer to use a Mac, featuring electronic insurance submission, Mac native digital radiography and photos, charting, Electronic Dental Records, Kiosk, Web Interface, iPhone Interface, speech dictation, and Mac stability and ease of use. Please see our ad on page 27.
Business Beyond the Classroom The Medicus Group
Sirona Dental Systems, LLC
At the Medicus Group, we help our dentist clients throughout the country build robust, impenetrable balance sheets. Our Unique planning approach coupled with our specialized knowledge of the dental industry, helps us create significant value and measurable bottom line growth for our clients, all while protecting their most valuable assets. Please see our ad on the inside back cover.
CEREC AC from Sirona is the most advanced dental CAD/ CAM system available. With its Bluecam, capturing fast, precise digital impressions and then creating high quality esthetic restorations is a reality. CEREC AC delivers access to efficient, precise, scalable and affordable solutions, including CEREC Connect. Call 1-800-659-5977 or visit www.cereconline.com. Please see our ad on page 29.
PARAGON Dental Practice Transitions www.paragon.us.com 866-898-1867
The Artist Evolution LLC/Practice Image Builders
Offices located Nationwide. PARAGON offers professional consultation and related services to healthcare professions with primary emphasis on the dental profession: comprehensive dental practice valuations (including a written valuation and analysis report); practice sales; pre-retirement sales; practice acquisitions; practice mergers; associateships; partnerships; practice consolidations and practice management. References available by request. Please see our ad on page 29.
The Artist Evolution is a full service, strategic marketing and design firm with a passion for helping practices around the country to communicate effectively with their target patients, to develop an identifiable brand, and to meet their objectives in a cost-effective way. Please see our ad on page 25.
Toll Free: 866-610-5334 www.theartistevolution.com
Wells Fargo Practice Finance Patterson Dental 800 873-7683 www.pattersondental.com Patterson Dental Supply Inc. is a full-service distributor of a complete range of dental products and services to dentists, dental laboratories, institutions and other healthcare providers throughout North America. As one of the nationâ€™s largest dental distributors, Patterson Dental sells consumable dental supplies, digital and other dental equipment and practice management software. Please see our advertisement on the inside of the front cover and page 1, and page 21.
1-888-937-2321 wellsfargo.com/dentists firstname.lastname@example.org Wells Fargo Practice Finance provides customized financing supported by experienced specialists and practical planning resources to help dentists acquire, start and expand their practices. The only practice lender selected especially for ADAÂŽ members and endorsed by ADA Business ResourcesSM, we understand the business of growing successful practices and are here to help you achieve your goals. Please see our ad on page 7.
Dental Entrepreneur Fall 2014 19
Choosing a Dental CPA Allen Schiff, CPA, CFE
20 Fall 2014 Dental Entrepreneur
id you ever hear the saying, “You get what you pay for?” This is so true when it comes time for you to engage an accountant to assist you in understanding your practice’s finances. There are a lot of choices out there for you regarding who will represent you as you move into the dental entrepreneurship stage of your career. This article is intended to assist you in the selection process of hiring and engaging, not an accountant, not a CPA, but a “Dental CPA.” So let’s examine the differences between the three and help you with your selection process. An accountant is an individual who has decided to provide financial services to you, but who has not been certified by the American Institute of Certified Public Accountants, www.AICPA.org. Since these individuals are not certified, they will not be able to represent you before the Internal Revenue Service, for example. A CPA is an individual that has passed the CPA exam given by the American Institute of Certified Public Accountants. The CPA exam is one of the most difficult professional exams, if not the toughest,
given to all individuals that are looking to further their profession. The CPA in the financial world is looked at as one of your most trusted professional (business) advisors. A Dental CPA is a CPA who has chosen to dedicate his or her entire professional career representing just one industry, that being dentistry! The Dental CPA has a significant client base in dentistry, somewhere approaching 200-400 clients, if not more. The Dental CPA has made a conscientious decision to specialize in the dental industry by lecturing at dental schools across the nation, writing articles for various dental trade publications, lecturing on a national basis to organizations such as the American Dental Dental Association (ADA), the Academy of General Dentistry (AGD), the American Association of Pediatric Dentistry (AAPD), the Chicago Dental Society (CDS) and others. So do take the time when interviewing your accountant to make sure he or she has the credentials as listed above, if not more. Some of the questions you may want to consider asking the accountant during the interview phase are as follows:
• Are you a Dental CPA? • In your mind, what makes you a Dental CPA? • Why have you chosen to represent just dentists/dental practices? • If a potential client were to choose you, what would separate you from the traditional accountant? • As a Dental CPA, what services do you offer your clients? • Why do dentists seek your services? • What wealth management services do you offer, that will allow your dental clients to retire? • What continuing educational courses do you attend, that will further enhance the dental practice management services you offer? Locating a Dental CPA So you may ask yourself, “I like the idea of engaging a Dental CPA, but where would I locate my Dental CPA?” You can visit the Academy of Dental CPA’s website, www.ADPCA.org, to locate a Dental CPA near you.
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Services Offered as an Accountant or CPA The tradition services offered by an accountant or CPA are more of compliance in nature, and can be any of the following: • Preparation of your individual income tax return • Preparation of your business income tax return • Preparation of your state’s personal property tax return • Preparation of your quarterly payroll tax returns • Preparation of your financial statements • Preparation of your monthly bank reconciliations The Dental CPA will go beyond these traditional compliance services and offer any of the following services, if not more. You will notice from the following that these services are more focused on your practice and more specifically consulting services in nature. Fees by ADA Procedure – Your Dental CPA will have a database of ADA fees by procedure for the locale in which you practice. Using this information, the Dental CPA can assist you with setting your fees. This one service offered by the Dental CPA alone can be the difference between a marginally profitable practice and a practice that is extremely profitable. Cost of Capital – Your Dental CPA will have access to extremely attractive interest rates with resources that provide capital to your practice. Recently when consulting with a new client of my firm, the dentist mentioned to me that she felt she was spending unnecessary dollars on her cost of capital. During the interview process, she mentioned to me she had met with her CPA about her concerns, but it fell on deaf ears. Once she engaged us, we made this opportunity a very high priority within my firm. Today, I am pleased to inform you, I was able to negotiate an interest rate modification with her existing bank going from 6.75 percent to 4.25 percent, a savings of over $24,000 of the remaining life of the loan.
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A CPA is an individual that has passed the CPA exam given by the American Institute of Certified Public Accountants. As a Dental CPA, I had resources along with a relationship with this particular bank, which assisted me in getting a more attractive rate for my client. Needless to say, the dentist was extremely satisfied with the result. CAD CAM Dentistry – As Dental CPAs, we are trained by the leaders in CAD CAM dentistry. We simply understand it, and we are capable of having an intelligent conversation with you about it. In fact, we as Dental CPAs can tell you the difference between the CEREC and the E4D technologies and why we may prefer one over the other. We are often given special pricing that can be passed on to our clients, simply because of our professional relationships with the major vendors that service this part of the industry. Dental Overhead –Dental CPAs know what your dental overhead should be. We know this not just for general dentistry, but also for all of the dental specialties – oral surgery, endodontics, orthodontics, periodontics, pediatric and prosthodontics. A few percentage points the wrong way can be the difference between funding your retirement plan on an annual basis and not funding your retirement plan at all. Retirement Planning – A Dental CPA can assist you in the design of your retirement plan, so the majority (if not all) of the annual contribution goes to you. You have many choices when it comes to retirement planning: SEP, SIMPLE, profit sharing plan, 40lk plan, 401k with
profit-sharing, defined-benefit plan and cash-balance plan. Of all of the plans that are available to you, which is the best plan for you and your practice? Your Dental CPA can assist you in making this very critical decision. Wealth Management – Your Dental CPA is well-versed in investment strategies that can save you countless dollars as well as sleepless nights. Many of members of the Academy of Dental CPAs are also Registered Investment Advisors (RIAs). RIAs are held to a higher standard when it comes to providing wealth management services. This standard is a fiduciary standard, whereby the RIA makes decisions on your behalf. Your stockbroker does not operate under these fiduciary standards. Their decisions are considered suitable on your behalf. If the stockbroker can justify their decisions, they may be suitable, but they also may not be in your best interest. The Dental CPA takes this worry away. They have resources within their firms that make this service a part of the onestop shopping experience within their service offering menu. Marketing of Oral Healthcare Services – A Dental CPA has been trained by the best dental marketing experts from across the nation. The Dental CPA brings this knowledge to each and every engagement. This allows the Dental CPA to consult with you and set your practice apart from any local competition. Through the Dental CPA’s training, they can assess your marketing strategies and bring fresh marketing ideas to the forefront that will help you position your practice for future growth. Leasing – A Dental CPA will have professional relationships with a number of leasing agencies in your market. These relationships are essential when choosing between locations A, B and C. The dental lease expert will share their reasons as to why a location (A, B, or C) will be more likely succeed than an alternative location. The Dental CPA has relationships with these folks in your market that foster trust and confidence in the decisionmaking process of choosing a location over one or the other.
In conclusion, when selecting your most trusted professional advisor, the Dental CPA, get the information and direction you richly deserve in running your dental practice. Please, do not settle for, “You get what you pay for,” and don’t be penny-wise and dollar-foolish! I wish you lots of good luck with your search!
Allen Schiﬀ is the Managing Member of Schiff & Associates, LLC (S&A). Prior to forming S&A, Allen was a Partner with Smart & Associates (formerly Grabush, Newman) for 30 years and was their Practice Leader for Dental Practice Management Services. Allen has over 35 years of experience in the areas of dental practice management. Allen’s services include business planning to include obtaining financing, succession planning, exit strategies and long-range planning. Allen has assisted dentists with practice acquisitions, start-ups, operational analysis and associate contract analysis. Allen received his BS degree in accounting from the University of Baltimore (June 1975) and is an accomplished speaker on topics such as dental practice management, transition planning, choosing a Dental CPA, obtaining financing, identifying embezzlement in the workplace and business start ups. Recently, Allen has received the SMART CEO award 5 out of the last 6 years as one of the Top CPAís in the State of Maryland, most recently awarded in 2011. Allen is a founding member of the Academy of Dental CPAs (www.adcpa.org). This group of very knowledgeable CPA firms across the nation specializes in practice management services to the dental industry. He serves on the ADCPA Executive Committee and is Chairperson of the ADCPA Marketing & New Members Committees. The ADCPA combines its outstanding resources and expertise to share information and jointly develop resources to better serve the dental community.
Business Fundamentals Mobile Apps interoperate with Desktop Software to Save Practices Time and Money Mark Hollis, CEO
t’s clear that smartphones, tablets and laptops are everywhere in today’s society. We use them at home and for fun, but more and more, we are using them at work for business. But can Mobile devices and apps benefit a dental practice? Who benefits? The patient? The doctor? Staff? The reality is everyone can benefit from the use of mobile apps that interoperate with desktop software (and by interoperate, I mean using a mobile device to add to or change a patient’s chart, and the change is also made in the practice management software – all in realtime). Below are some real-world examples. As you read this, keep in mind that your practice-management software may or may not be able to do everything mentioned in this article. I suggest checking with your software provider to find out its abilities and limitations – or call MacPractice and they’ll show you how MacPractice and its family of apps for iPad and iPhone interoperates seamlessly with MacPractice DDS. Like every business, dental offices rely upon computers and software for business-critical tasks like scheduling appointments, creating and maintaining patient records and billing. We all know you cannot run a business these days without computers and 24 Fall 2014 Dental Entrepreneur
75% ] of U.S. doctors use an Apple device of some kind.
JUST WHAT THE DOCTOR ORDERED With 30,000 users worldwide, more and more dentists are running their practice on Apple computers and iPads and trusting MacPractice for their software.
io n als u s
a hc ] o f h e alt e
or w ork.
] 94% of healthcare organizations adopt Apple devices when provider preference is the deciding factor.
us e a n iPh
ST. STEVENâ€™S MEMORIAL HOSPITAL
] Traditional PC shipments have declined 11%.
] Smart tablet shipments have increased 68%.
Call (855) 679-0033 - WATCH WEBINAR & DEMOS MacPractice.com/company/events Sources: A Manhattan Research study claims 75% of U.S. physicians own Apple products. Vitera Healthcare reported that 60% of healthcare professionals use an iPhone for work, and 45% use an iPad. A KLAS study found that 94% of healthcare organizations adopt Apple devices when user preference is a factor. Samsung was the second most frequently adopted technology in this study with just 26% of organizations having at least one device. Gartner detailed market forecast data - "Forecast: Devices by Operating System and User Type, Worldwide, 2010-2017, 2Q13 Update."
capable software. In addition to the business side, most dental practices today use computers and software to acquire X-rays and photos, for restorative and periodontal charting, and to record clinical notes. Dentists also use computers to present and discuss present conditions and proposed treatment with patients in examination rooms. Interoperable mobile technology has the potential to enhance every aspect of the business of dentistry. Let’s start with how mobile technology can improve the patient experience when they first arrive in the office. In a traditional “paper office,” when a patient arrives they may write their name on a sign-in sheet, especially in an orthodontic practice, before they are handed a clipboard with blank paper forms to fill out. Once the patient has completed their paperwork, they return the clipboard to the front desk and take a seat in the waiting room where they wait for staff to enter their data into the practice management software before they can be seen. This
26 Fall 2014 Dental Entrepreneur
process hasn’t changed much in 50 years and consumes lots of paper and requires redundant effort, not to mention office space dedicated to file storage and manpower dedicated to creating, maintaining, retrieving and returning files. Alternatively, using mobile technology and a mobile app, the patient can not only check in upon arrival without any staff assistance, but also automatically notify the dentist, the hygienist and the front desk of their arrival. Since the app interoperates with the practice-management software, it exchanges data and changes the appointment status in the schedule on every computer, no matter where it is located. Not only is checking in more efficient, it satisfies HIPAA guidelines because the patient can only see their own information. There is no question, this is a better way. Next, instead of preparing a clipboard with photocopied or laser-printed blank paper forms to hand to the patient, front desk staff hands the patient a mobile device (such as an iPad) with the appropriate
forms selected for them in a mobile app. Again, since this app interoperates with the practice management software, the patient’s name, phone and other information taken when the appointment was made is in their forms, ready for their review. The patient can register, provide their health history, sign their HIPAA release and insurance authorization, complete any custom forms required by the practice, and take their own photo using the iPad. They will review their information, and when they are satisfied they will tap an icon that enters all their patientgenerated data into its proper place in the practice management software. Besides scanning an insurance card and selecting the correct insurance plan, the front desk does need to enter any patient data. The patient has done it for them. And on subsequent visits, if using Clipboard, the patient can review their demographic information on an iPad and make changes to update their record in MacPractice DDS.
In the treatment rooms, more and more dental practices are adopting Electronic Dental Records (EDR/EHR) on computers and mobile devices to record visit notes and as a communication assistant for use with patients. Once again, clinical information the patient entered on an iPad is automatically present for use by the hygienist and the dentist as well as being present in an EHR program. Now, the clinical staff can review the patient’s health history with them on either a Mac or on an iPad, or both. For example, the dental assistant or hygienist could review on the iPad and the dentist could record visit notes on a Mac. Dental offices that are using mobile technology believe this technology interaction fosters a closer relationship with their patients while promoting a stronger, more high-tech brand for the practice. Good rapport with a patient is especially important when discussing present dental conditions and proposing treatment plans. For example, if the office has acquired X-rays or photos during the visit, the dentist can show them to the patient on a mobile device such as an iPad. When a patient views their own dentition on the iPad that they hold in their hand, they tend to make a connection and take ownership of their condition and the treatment being proposed to them – leading to higher case acceptance. All this is made possible by the interoperability of mobile apps with practice management software. But the use of mobile technology doesn’t end there. Once the examination is complete, the clinical staff can electronically prescribe if necessary and send the procedure code(s) for today’s visit to the front desk for their review and for posting so they can print a walkout statement and insurance form, or send an electronic claim. This further streamlines and enhances the patient visit, saving more staff time and fostering communication and productivity in the office. All these benefits are realized by leveraging mobile technology that interoperates with dental practice management and clinical software.
The future is very bright for mobile technology in a dental office. In June, at its World Wide Developer Conference, Apple previewed Yosemite, a new desktop operating system, and iOS 8 for iPad and iPhone, both to be released in the fall. Among hundreds of new capabilities, three new iOS 8 technologies are the most likely to impact healthcare, including dentistry. Firstly, HealthKit is an iOS 8 Software Development Kit (SDK) already in the hands of thousands of Apple developers that is being used by several major hospitals and medical schools to collect data from medical devices and make it available to EHRs and to patients. The availability of HealthKit and a recently announced collaboration of Apple with IBM to deliver solutions to the healthcare market are likely to have a major impact. Secondly, new extensibility for IOS 8 developers that facilitates apps easily leveraging the key functionality of other apps has the potential to drive new and rapid innovation for the platform. Thirdly, Yosemite features tighter integration and “handoff” sharing with IOS 8, which could result in a higher level of mobile interoperability with desktop. Mobile technology is becoming more and more relevant for business every year, and those practices that understand and use it will be ahead of the curve in the coming years. And only software companies with a commitment and dedication to software development, and with software engineering resources, continuously innovate and offer the latest features and benefits. BTW, EHR Update – Using 2014 Edition certified dental software, such as MacPractice DDS MU, dentists who accept Medicaid may qualify for $63,750 in government incentives. Dentists who bill for Medicare procedures, also eligible for incentives, may avoid payment reductions in 20015 and later years by demonstrating Meaningful Use in 2014.
Mark Hollis is the cofounder and CEO of MacPractice, Inc. and provided practice management consulting services to 650 practices over 25 years. Mark represents MacPractice as member of HIMSS Electronic Health Records Association (EHRA), which advises the CMS, ONC and HHS, and as a contributing member of Commonwell, a non-profit created by top US EHR vendors to address the national challenge of patient identity related to EHR interoperability.
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Dental Entrepreneur Fall 2014 27
PAYDAY FLU – A New Approach to a Big Expense Kristin Nickels, CEC, ACC
hen you are in your first year of practice, you will have a million things filling up your mind and your day; honing your skills, learning the business, coping with debt, developing your chair-side manner, payroll. Wait…..payroll?? Why on earth would payroll be top of mind for you right now? Whether you are a salaried dentist, a commissioned associate, have your own practice or hope to one day, payroll and your approach to it will be one of your greatest challenges as a practising dentist. You have the opportunity and the advantage as a new dentist to adopt a fresh mindset to paying employees, early in your career, which will benefit you in myriad ways for your entire professional life. Staff wages make up about a third of the cost of running a dental practice. Ouch! If you want to own your own practice one day, your job in the early years of your career is to keenly observe what works about the running of a practice and what doesn’t. This is where your opportunity comes in. Have you ever had to pay for a nonwinning lottery ticket after the draw is over? Many dentists feel that way about signing their employee’s paycheques. High wages, possible poor performance, or the fact that payroll takes such a big cut out of profits can all contribute to dentists having a negative mindset and grumbling about having to pay staff. I call this the “payday flu.” At best, many dentists feel defeated or resigned to having to sign those paychecks. At worst, they may feel resentment, anger, or frustration. Approaching paying staff in a resigned or resentful manner sends a negative message to employees 28 Fall 2014 Dental Entrepreneur
about their value and adds stress and tension to the relationship. There is a better way. What do you expect when you put money into an investment? You expect a return! You contribute to the investment, monitor its
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growth and hopefully watch your money work for you. You can approach paying staff with the same concept by slightly shifting your perspective in specific ways. Reset your mindset now as a new dentist. Doing so will help you to motivate employees, build your practice, ensure that you get the most out of your payroll dollars and enable you to leave a legacy of leadership that you might not have believed possible. As with anything that you want to build upon, you must first begin with a good foundation – a fair and equitable wage. Too low and you are not going to attract the right people. Too high and there is no wiggle room with which to grow. I believe in paying a fair base wage for each position in a practice. I also believe in establishing this base wage before hiring and then sticking to it. By the time you have adopted the following four ways to turn your payroll dollars into an investment, you will have top-notch employees knocking on your door, very willing to accept your fair wage! Build on your foundation by asking yourself what you can add that will benefit your employee in some meaningful way and at the same time will bring a benefit back to your practice. The key for this shift in approach is to build in the return to your practice. EDUCATE! No-one can dispute the benefit of continuing education. As a leader, you can participate in your employee’s development by investing in their learning. Offer to pay the tuition for employees who want to take courses, advance their skills and attend study clubs and conventions. You might be thinking, “Why should I pay to educate employees only to have them leave?” Remember, the key is to build in a return for your practice. If you take your staff to a dental convention, choose courses that each department attends together and have them provide a lunch ‘n learn to the other staff. Attend a course as a team and have a roundtable discussion afterwards with a plan to implement the learning in your clinic. If an employee wants to upgrade his/her skills, have them create a plan to incorporate the skills into your office policy. There are many ways to ensure that the dollars you invest in your
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To empower an employee is to hold them capable. In other words, believe in their abilities. staff’s education provide a tangible, measurable return to your practice. ENGAGE! To engage means to actively participate. So often, employees come to work, do their job and go home, each person working in an isolated silo rather than as a team. When a team is dysfunctional a practice is diminished. Instead, invest in team building activities such as retreats, social gatherings, workshops, mentoring, guiding and team exercises. When you invest dollars, time and energy into an employee, you get it back in spades. Your practice becomes stronger and everyone benefits. ENERGIZE! A healthy employee (mind, body and spirit) is an energized employee. Rather than always rewarding employees with wage raises, consider investing your payroll dollars in their health and wellness. There are many ways you can accomplish this; gym memberships, spa certificates, extended healthcare plans or insurance premiums, life insurance, or providing dental treatment for them and their families. Use your imagination and find creative options that are meaningful for your employees. Peace of mind is also a significant benefit for you and your employees. One of my clients, whose practice is in a small town, attracts good staff from neighbouring communities by paying a travel allowance to commute. Another client ensures that employees with small children will be available for shifts by offering job sharing options and/or daycare allowances. When you invest in the health and wellness of your staff, you invest in the health and wellness of your practice! EMPOWER! To empower an employee is to hold them capable. In other words, believe in their abilities. We tend to live
up or down to a leader’s expectations. Empowering means that you believe your employee is capable of excellence. You can put your money where your mouth is by providing all the resources they need in order to achieve excellence; adequate training, mentoring, challenges, responsibility and perhaps even coaching. Delegate by assigning tasks as well as authority to make decisions, then follow up. Include them in creating protocol, policy and establishing the practice’s values. Incorporate accountability by inviting employees to create their own solutions to any disciplinary challenges. Celebrate accomplishments and milestones. By investing time, energy and leadership in empowering your employees, you reap the dividends of a team that is motivated, shows initiative and is dedicated to you and your practice. It may seem easier to throw money at your staff on the incorrect assumption that cash is king, but it doesn’t pay off in the long run. In a recent Harvard Review survey of 3,000 employees to determine the top four reasons why employees leave a job, money ranked dead last. The top three were lack of leadership, not feeling valued and no challenge. With a powerful, yet slight shift in your perspective, you can reset your mindset now to approach your payroll expense differently. Rather than resentful grumbling about what will be your largest direct practice expense, choose instead to take an investment approach that will benefit both employees and your practice; build in the desired return and reap the interest and dividends! Now is the time to begin.
Kristin Nickells is a Certified Executive Coach who draws from 30 years of business of dentistry experience to help dentists, particularly in their first years of practice, find relaxed confidence as business owners and bosses. As well as coaching, she is an author and speaker.
Want to focus more on patients? You have our full support. At Aspen Dental, nothing stands between you and what you love doing most: helping patients. • Enjoy full operational and business support • Expect a reliable flow of new patients • Grow with our mentoring and development programs Ready for a better future? Call 877.330.1349.
Dr. Chandan Chadha
9/10/14 7:14 PM
Increasing Case Presentation Effectiveness Roger P. Levin, DDS
Introduction After years of rigorous study in dental school, learning an enormous amount of technical information and developing clinical skills, you will be prepared to perform dentistry. However, you will probably know very little about how to present it to patients for their approval. They won’t understand the technicalities or be able to judge your skills. The qualifications you worked so hard to attain, though prerequisites for your professional success, have little or no influence on patients during case presentations. In short, new dentists interested in increasing production quickly should make case presentation skills a continuing education priority. The first lesson frames the subject and should guide how you present cases, now and for the rest of your career: Patients are motivated not by clinical features but by benefits. The decision to accept treatment may be complex, and it will certainly depend on whether patients trust you to perform well. But the benefits they will receive as a result of the proposed treatment must be clear before they will say “Yes.” In other words, you must answer the patients’ question, “What’s in it for me?”
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How to Present Cases More Effectively Working with thousands of dental practices since 1985, Levin Group has developed a comprehensive set of guidelines for making more successful presentations. These alone will not make you an expert presenter, but they will provide a solid foundation. Stay on schedule. If you do not start a consult on time, you’ll be getting off to a bad start—from which you may never recover. Keeping patients waiting causes three serious problems: 1. Patients have schedules, too. If they have planned to pick up their children, see a friend for lunch, or return to work, your lateness will cause anxiety and distract them from the subject at hand – your treatment recommendation.
2. At the very time you want patients to trust you and believe that you truly care about them and their oral health, you are sending a contradictory message. In effect, you are saying, “I have something more important to do than seeing you at the agreed-upon time. As far as I’m concerned, it’s okay to keep you waiting.” Some patients may tolerate being held up, but many more will feel irritation or even anger at the disrespect you convey by not showing up on time. 3. When you start presentations late, both you and your patients are likely to feel rushed. You will be less persuasive, the patients will be less receptive, and case acceptance is far less likely. What’s more, a rushed presentation may make you appear less competent and caring. You could end up losing not only the case but the patient. Establish a “do not disturb” rule. Instruct your staff that they are not to interrupt you except in the case of a true emergency. As with starting late, interruptions cause multiple problems. First, a well-planned presentation has structure and flow, which any interruption will disrupt. Any momentum you have built will be lost, and patients will remain unpersuaded. Second, if you put your presentation on hold to deal with some other person or issue, you are sending a negative message: this patient is not your top priority. Anticipate any possible questions or objections. Patients will have questions, and many of them will also raise objections to what you are recommending. You need to be prepared with good answers… and with the right attitude. Rather than reacting defensively or dismissively, take the time to respond positively. Skilled presenters can often turn a seeming challenge into a positive exchange and, regardless of the subject, the manner in which you respond can have a major impact on the outcome of the presentation, for better or worse. With experience, you will have ready answers for any questions that may come up. In fact, you will eventually be
able to answer questions they are hesitant to ask (often related to financial matters). Keep patients informed about services. Though usually not part of presentations, educating patients about all of the practice’s services can ultimately lead to higher case acceptance rates. Posters, brochures and other communications materials around the office where patients can see them will go a long way toward accomplishing this. All team members should also be familiarized with the practice’s services so that, if asked by patients, they can give accurate and enthusiastic descriptions. Hygienists can be especially helpful in keeping patients informed. Already responsible for educating patients about home care, they may also have opportunities to discuss other practice services that might be of interest. Use visual aids to dramatize what you are presenting. There’s an old axiom about making TV commercials: don’t just tell them, show them. That’s also good advice for presentations. You can help people understand their dental conditions, recommended procedures and – most important – the benefits of treatment with visual aids. Before-and-after photos, videos, posters and displays in the consult room… all of these can help make presentations more persuasive. Offer a range of payment options. For many patients, especially since the Great Recession, the fee may be the greatest obstacle you will need to overcome in your presentation. Make sure you offer a meaningful array of payment plans so that almost all patients will find an appealing option. You’re in no position to judge what patients would prefer, so offer all options to all patients. For those who like getting bargains, offer a discount for payment in full upfront. Accept major credit cards, so patients who buy everything with cards can do so at your practice. And, for major cases, offer outside financing by a reputable lender. Plan to follow up. Patients who do not conclude your presentation with a
“Yes” or a firm “No” may yet consent to treatment… if you give them the chance by following up. This might consist of you calling patients a few days after the presentation to see if they have any questions. It may mean discussing the treatment presented when the patients come in for their routine hygiene care. If patients say they need to discuss the matter with their spouses, offer to call some evening to discuss it with both of them. If patients say they can’t decide until three months later, contact them at that time. Often, a “maybe” becomes “yes” thanks to good follow-up. Schedule no-charge appointments when needed. It is better to make presentations when patients are already in the office for an exam. However, if there simply is not enough time to make a presentation properly, schedule another visit – within seven days if at all possible – for the express purpose of presenting treatment. If these appointments are handled correctly, most patients will accept treatment and practice production will increase. By following these guidelines for case presentation, dentists can raise their case acceptance rate and production, setting the stage for long-term growth.
Sign up everyone on your team to receive the Levin Group Practice Production Tip of the Day every morning in their inbox, at www.levingroup.com/tipoftheday
Dr. Roger Levin is a third-generation general dentist and the Chairman and CEO of the largest dental practice consulting firm in North America, Levin Group, Inc., which has served more than 22,000 dentists and specialists since 1985.
Dental Entrepreneur Fall 2014 33
Power to Succeed
When the Typical Path Meets the Unexpected Reality Andy Upchurch and Victor O. Holloway, M.B.A
met Dr. Randy Griffin in the Spring of 1994. Randy was a typical fourth-year dental student at the Indiana University School of Dentistry. He was typical in that he had the same concerns with finding board patients, finishing requirements and beginning his life as a practicing dentist. Four years of undergrad and four years of dental school, as well as a multiple six-figure investment, were about to culminate into his life-long career goal coming to fruition. The typical path continued, as Dr. Griffin paused briefly at an associateship before purchasing his own practice in June of 1996. After receiving notice that his building had been sold to CVS and was slated for demolition, Dr. Griffin moved his practice seven miles north in 2004 to one of the fastest growing communities in the Midwest, Fishers, Ind. At this point, it’s important to note that my first professional contact with Randy was in dental school, as he secured disability insurance to protect Life after dentistry, his most valuable asset: his ability Paragliding in Nepal. to practice dentistry. Our relationship grew as Randy’s practice grew, and he approached his financial planning with a high level of maturity and discipline. His insurance portfolio was always upto-date and funded appropriately. He was typical in that he didn’t particularly enjoy paying premiums, but he understood their merit. College savings accounts for his three children were started early on, and his investment and savings accounts were always a priority. Our singular goal for our clients is to help them build a robust, impenetrable balance sheet. The Griffins lived well within their means and subscribed to this virtue. In the fall of 2010, while cleaning out a clogged section of gutter on their family home, Randy fell and severely fractured the wrist on his dominant hand. This fracture left Randy’s hand and fingers numb and made fine motor skill work painful. After multiple hand surgeries to try and correct the nerve damage, it was deter34 Fall 2014 Dental Entrepreneur
mined that damage was irreparable. At the age of 45, Randy was forced to sell his practice and retire from dentistry. On the surface, this story may seem sad. Yes, being unable to practice the craft that you invested so much into, is sad. The story, however, is so much more about life after dentistry, planned or unplanned. As mentioned previPost surgery x-ray of Dr. Griffin’s hand. o u s l y, Close inspection will reveal the screw building holes as well as incomplete healing. a robust, impenetrable balance sheet is key. At some point in the future, we will all be looking to our balance sheet to support us for the rest of our lives, and in many cases, provide a legacy to future generations. It’s extremely important, however, that you don’t narrow your focus on just the “robust” portion of that statement and neglect “impenetrable.” What is often overlooked in traditional financial planning, is the fact that we don’t always get to choose when our balance sheet must take over. Contingency plans for life’s unexpected detours are critical to insuring that your family’s balance sheet won’t be derailed. The stakes are too high, and failure cannot be an option. Fortunately, these contingency plans were in place for the Griffins. Because of prudent planning, financial concerns are not on their radar screen. Volunteering for their church, family travels
and living a life of significance are their daily concerns. College is funded for their children, investment and life insurance accounts are funded and in place, and a lifetime income stream is guaranteed. Moreover, appropriate levels of Business Overhead Disability Insurance allowed Randy to bring in a replacement dentist to keep his practice and his charts current and marketable for sale. Is this the path that Randy would have chosen? Is it the path you would choose? Probably not. Randy loved practicing dentistry and owning his own business, just like many other typical Dental Entrepreneurs. The reality is simple. You don’t always get to choose when you
I miss the satisfaction of accomplishing something for a patient. I don’t miss the insurance and employee issues!
Please reach out to our authors and our advertisers. They care about you and keep us in print!
retire, but you do get to choose what your retirement will look like. Choose wisely.
If you have any questions, comments, or Andy Upchurch and Victor Holloway are partners with The Medicus Group, a dental-specific financial firm based in Charlotte, NC. With over 30 years of combined experience, Andy and Victor provide financial direction to Dentists throughout the United States, and can be reached at email@example.com.
responses to our magazine, please connect with us on Dental Entrepreneur Magazine — our official Facebook page! Read us online at dentalentrepreneur.com Send your questions or comments to firstname.lastname@example.org
Registered Representative and Financial Advisor of Park Avenue Securities, LLC (PAS), 4201 Congress Street, Suite 295, Charlotte, NC 28209, (704) 552-8507. Securities products & services and advisory services offered through PAS, member FINRA, SIPC. Financial Representative, The Guardian Life Insurance Company of America (Guardian), New York, NY. PAS is an indirect, wholly-owned subsidiary of Guardian. The Medicus Group is not an affiliate or subsidiary of PAS or Guardian.
Dental Entrepreneur Fall 2014 35
Dental Trade Shows 155th ADA Annual Session October 9 – 14, 2014 San Antonio, TX
National Dental Student Lobby Day
April 13-15, 2015 Washington, D.C. ASDAnet.org/LobbyDay
Greater New York Dental Meeting November 28 – December 3, 2014 New York, NY
ASDA’s National Leadership Conference
Yankee Dental Meeting January 28 – February 1, 2015 Boston, MA
Oct. 31-Nov. 2, 2014 Chicago, Ill.
Chicago Mid-Winter Meeting February 26 -28, 2015 Chicago, IL 103rd Thomas P. Hinman Dental Meeting March 26 – 28, 2015 Atlanta, GA California Dental Association – Spring Session May 12 – 14, 2015 Anaheim, CA
The American Student Dental Association is hosting its National Leadership Conference, Oct. 31-Nov. 2 in Chicago. For details visit ASDAnet.org/NLC. The event will provide leadership and business training to dental students across all years. Other benefits of attending: • Experience training in people management, public speaking and presenting, personal finance, practice negotiations, mentoring others and more • Increase the understanding of key issues in dentistry and dental education • Network with students from 60+ U.S. dental schools • Build relationships with exhibitors to fulfill current and post graduation needs Dental Entrepreneur: Business Beyond the Classroom will be there to meet the leaders attending. Please look for us!
Index of Advertisers ADS Dental Transitions South ......................................................................................................... 5 ADS Dental Transitions…………………………………………………………… ................................... 17 Aspen Dental.............................................................................................................................. 31 Comfort Dental ........................................................................................................................... 23 Heartland .................................................................................................................................... 7 Henry Schein Nationwide .................................................................................................Back cover MacPractice ............................................................................................................................... 25 The Medicus Group ......................................................................................................... Inside back Paragon ..................................................................................................................................... 21 Patterson Dental ................................................................................9, Inside front cover and page 1 Practice Image Builders ............................................................................................................... 13 Sirona ....................................................................................................................................... 29 Wells Fargo ................................................................................................................................ 11
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The perfect solution for finding Associateship Opportunities • Providing the skills and facilities to place Associate candidates in private practice, clinics, and dental organizations of every category • General dentistry and specialty positions available nationwide • Proactive, efficient, and results driven • Personal attention to all the details of the search and placement process
Get optimal results to support your professional goals!
Speak with a Henry Schein Nationwide Specialist today!
1-866-409-3001 Henry Schein Financial Services is not a bank, does not represent itself as such, and does not conduct banking activities. © 2014 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.
or e-mail: email@example.com www.dentalopportunities.com
Dental Entrepreneur Fall 2014 Issue