Dental Entrepreneur Winter 2017

CLASS OF 2017 | WINTER ISSUE

DENTALENTREPRENEUR.COM

Business Beyond the Classroom

Crash Course for the New Dentist

Sam Shamardi, DMD

My Story

Ten Elements for Practice Success!

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IT’S IT’STIME TIME TO TOPUT PUT PATIENT PATIENT SAFETY SAFETY FIRST. FIRST. Deep-discount Deep-discount dental products dental products that appear that appear “too good “tootogood be true” to be aretrue” often are just often that.just While that. While low prices loware prices appealing, are appealing, the risksthe may risks outweigh may outweigh the rewards. the rewards.

Protect Protect your dental yourpatients dental patients from potentially from potentially unsafe gray unsafe market gray and market illegal andblack illegalmarket black products. market products.

Learn more Learn about more about . . gray market gray dental marketsupplies dental supplies and Patterson’s and Patterson’s commitment commitment at DentalSupplyIntegrity.com at DentalSupplyIntegrity.com

*“Dental Equipment *“Dental Equipment and Supplies andManufacturing Supplies Manufacturing in the U.S. and in the ItsU.S. International and Its International Trade” Supplier Trade” Relations SupplierUS, Relations LLC, Irvine, US, LLC, CA, February, Irvine, CA,2014.

February, 2014. **“Shades of **“Gray” Shades Mentor, of Gray” Santa Mentor, Ana, Santa CA, December, Ana, CA, December, 2013.

2013. ***“Are you ***“ using Are‘gray-market’ you using ‘gray-market’ or counterfeit or counterfeit dental products?” dental products?”

Journal of American Journal ofDental American Association, Dental Association, June, 2010.June, 2010.

P151409 (3/15) P151409 (3/15)

PATIENT SAFETY IS AT STAKE Potentially unsafe “Gray Market” or illegal “Black Market” refers to products and materials often found at deep discounts through unauthorized channels. These include products that are: Recalled

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Winter 2017 VOLUME 19, ISSUE 2 Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Content Strategist Michelle Perrit Production Ruthie Gordon Publishers Press Inc. Editorial Board Dr. Dirk Fleischman Dr. Gene Heller Dr. Harold Sturner Dr. Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH, BS Dr. Tom Snyder Derek Champange Dr. David Rice Dr. Hugh Doherty Layout and Design John O’Connor

Class of 2017 Contributors Jayme Amos Dr.Christiana Blatchford Joseph Dowdy Gary Kadi Dr.Wayne Kerr Dr.Thomas Larkin

Dr.Jane Puskas Dr.David Rice Dr.Sam Shamardi Gavin Shea Bob Speil Dr.Thomas Snyder

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

Editorial Office

12233 Pine Valley Club Drive Charlotte, NC 28277 704/953-0261 Fax 704/847-3315 anneduffyde@gmail.com Send materials to: Dental Entrepreneur Magazine 8334 Pineville Matthews Road Ste. 103-201 Charlotte, NC 28226 When you have finished enjoying this magazine pass it along to a friend and PLEASE RECYCLE Copyright 2017 Dental Entrepreneur, Charlotte, NC Material herein may not be reproduced, copied or reprinted without prior written consent of the publisher.

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Welcome

CLASS OF 2017 WINTER ISSUE VOLUME II

I need your help. We have been publishing Dental Entrepreneur magazine for 18 years, and I hear from you that you love our content and look forward to receiving it four times a year. However, there are two schools that won’t distribute us because, well, they are simply too busy and/or not interested. That was disappointing.

I ask you to help me help you. Please share our website, www.dentalentrepreneur.com, with your colleagues so they can be successful, too. So let us know what questions you have. We will continue to do our best to find answers from the experts we know. Weigh in with us. Let’s work together to make your chosen vocation rewarding.

You too might work your heart out on some days and feel unappreciated.

We’ve all been there, even after decades in the industry. Stay focused. You are dedicated to doing well for people. Teeth are so important! How exciting it will be to one day save teeth and improve the lives of others? (Shout out to Veterinary dentists too!)

I like to keep the phrase “short term pain for life long gain” in mind. Soon you will graduate to the next phase, and it will all be worth it.

You will like this issue …

For starters, Dr. Sam Shamardi truly carries the entrepreneurial spirit in his heart. It may not always be easy, but being open to opportunities that you are interested in makes the time spent worth the effort. His testimonial really moved me, and I’m sure it will move you, as well.

We’ve also got an excellent contribution from Dr. Tom Snyder, who breaks down the information you need to consider when purchasing a practice. There are likely many questions you haven’t considered when making this important decision, and his insight is invaluable.

Dr. Jane Puskas, an inspiration for our new publication DeW.life, shares what going to a conference can mean to you in the start of your career. Can you believe she is the first female chairman of the Thomas P. Hinman Dental meeting? I’m very excited she chose to be a part of this edition.

And then as always, Dr.David Rice closes things out with a few words to keep you on track. When he speaks, it’s impossible to not want to follow! Read more about him at Ignitedds.com.

This year, we’re also proud to start DeW.life, which seeks to empower women in dentistry though practical knowledge and inspirational stories of females carving out their respective paths to success.

Remember, a rising tide raises all ships. And we here at Dental Entrepreneur are committed to ensuring that the next generation of dental professionals is prepared for prosperity!

All the best,

Anne M. Duffy Publisher 2 Winter 2017 Dental Entrepreneur

DentalEntrepreneur.com

Contents Prologue 4 My Story

Sam Shamardi, DMD

Getting Started 6 3 Considerations When Choosing Your First Practice Management Solution Joseph Dowdy

10 Starting a Practice or Buying an Existing Practice What is the right decision for you?

Jayme Amos and Thomas Larkin, D.D.S.

14 Do Your Homework When Purchasing a Dental Practice Thomas L. Snyder, DMD, MBA

18 Dental Conferences: The Next Step in Your Continuing Education Jane Puskas, D.M.D.

Practice Builders 30 Ten Elements for Practice Success!

Wayne Kerr, DDS

Business Fundamentals

The Power To Succeed

20 Crash Course for the New Dentist

32 Chasing and Finding Balance

Gary Kadi

24 Leadership skills Need Attention Too! Gavin Shea

Christina Blatchford, DDS

34 How Not To Fail Miserably in Clinic David Rice, DDS

26 Rethinking Leadership: Flip Your Focus and Change Your Life Bob Spiel

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Dental Entrepreneur Winter 2017 3

Prologue

My Story Sam Shamardi, DMD

W

hat is the dental dream? After seven years of dental and periodontal training, one year practicing in Southern California and now in my second year working in Boston, the simple question is still unanswered in my mind. It wasn’t that I never had an answer … I had thought of many over time, yet none of them stuck.

I knew what we were taught to aspire to in dental school—graduate, own your own office one day and work for 35 years until you retire!

That was the gold-standard plan. More ambitious colleagues had the different approach of buying multiple offices over time and building them up until they would have enough to hire associates and just oversee them. It was higher risk, but if it worked as planned, that route had a very high reward. That’s IF it worked, and from what I had seen thus far on both coasts among friends and colleagues, the odds weren’t as strong as they sounded.

Being a periodontist isn’t what it used to be either. The whole world is pushing their way into implants and “easier” perio procedures, thus opening your own perio practice with expectations of a strong referral base would be a significantly greater challenge today than it was a generation ago.

I was always teased by my dental school friends that I should never have been a dentist, as I had a political science degree and would spend much of my time imitating faculty members. It wasn’t that I didn’t enjoy any of it, rather that I wanted to do more than treat patients forever. I came across a book titled The Four Hour Workweek just weeks after finishing dental school that left a permanent impression on me and went against everything I was ever told or taught. The ultimate was goal wasn’t to accumulate more degrees, more offices or more titles.

Instead, it was to have a self-sustaining business and create more free time for yourself!

Yet dentistry, unlike the majority of businesses, does not allow for much flexibility, remote work opportunities or a shared chain of command. From the beginning it’s on you, and you have to choose where to lay roots and spend years making it grow. Thus, I would have to find another way to succeed within the dental-career structure. In the spirit of this, I found a calling to address needs in the dental field. After many years of brainstorming and thinking of countless ideas, taking a commercializing science course at Harvard Business School finally made

4 Winter 2017 Dental Entrepreneur

things click, and soon after, Dental Innovations LLC was formed.

The process of creating a company and a product is long and costly.

Legal fees to setup an LLC, register as a corporation with your state, corp taxes, intellectual property and trademark paperwork, and manufacturing/prototyping was just the tip of the iceberg. Once my first product, the DI15 High Fidelity Electronic Earplug, was launched, the much larger challenge of educating the field, marketing the product and generating sales came into play.

The fact is, doing this on your own is very expensive and takes a tremendous amount of your time and energy. Ideally, you want to

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start the process with a solid business plan and long-term strategy. Are you hoping to grow the company and create multiple products with your own workforce, or build the name and sell your product for profit? Have you tested the market for a fair price point and seen if a short online campaign creates enough hits to confirm interest? The greatest ideas, regardless of what you personally feel, only can work if others ultimately feel the same way. Hearing loss is a significant unaddressed issue in our field with decades of literature and thousands of dental professionals affected each year, yet you are still fighting an uphill battle.

Since launching the product in November 2014, we have signed distribution deals with Patterson Dental and Crown Dental in New Zealand, with other possibilities for the future. Like everything in the dental field, the initial pushback is there, but I am convinced this technology will soon become standard of care as dental loupes became many years ago. Ultimately, nothing in dentistry comes easy, not even when you actually try and help dentists themselves! Until then, I will continue pushing forward with my goals and am excited to see if I succeed in creating free time for my future.

Dr. Sam Shamardi was born in Malaga, Spain and raised in Newport Beach, California. He attended Corona del Mar High School, becoming Class President in his senior year and finishing with a 4.0 GPA and as a 4-year Varsity tennis letterman.

He moved to La Jolla, California to attend the University of California, San Diego and majored in Political Science with emphasis in International Relations. While simultaneously completing the rigorous science classes required for dental school, Sam was recognized for his academic achievements in Political Science and immersed himself in community activities by joining the Alpha Phi Omega community service fraternity, taking part in numerous events to help the less fortunate.

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Sam next traveled to Boston, earning his DMD degree at Tufts University School of Dental Medicine. While at Tufts, Sam had the honor of being elected Class President for each of his 4 years. This position was tremendously gratifying and taught him valuable lessons in time management and leadership. His experiences at Tufts culminated with the honor of addressing his peers at Commencement and have continued with lifelong friendships with faculty and classmates.

Dr. Shamardi trained for his Periodontal certificate at the prestigious University of Pennsylvania Periodontal Program.

During this training, he had extensive nonsurgical and surgical experience for procedures such as sinus lifts, implants, mucogingival surgery, crown lengthening, osseous and guided bone and tissue regeneration. Additionally, the exposure to the unique Periodontal Prosthesis program has allowed him to better understand the restorative aspect of the profession and the importance of proper treatment planning. Having graduated in 2010, Dr. Shamardi returned to California, spending one year working in multiple practices and becoming a Diplomate of the American Board of Periodontology, the highest honor in his field. He then returned to Boston in July 2011 and has since been working full time and teaching part time as a Clinical Professor at the Harvard University Periodontics Department.

Dr Shamardi currently lectures both nationally and internationally at several major dental meetings each year, and in January 2014 he founded and launched Dental Innovations LLC, a start-up dental company. He is set to debut his first major product at the Greater New York meeting this fall.

In his spare time, Dr. Shamardi enjoys to travel extensively and play multiple sports while following his favorite soccer club Real Madrid. He is fluent in three languages and still enjoys following current affairs and politics.

Please reach out to our authors and our advertisers. They care about you and keep us in print!

If you have any questions, comments, or 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 anneduffyde@gmail.com dentalentrepreneur.com

Dental Entrepreneur Winter 2017 5

Getting Started 3 Considerations When Choosing Your First Practice Management Solution Joseph Dowdy

L

ongtime dental practice owners often find themselves asking what they would do differently if they were to open a new practice tomorrow. How could they use their years of experience to put their practice on the right path from the start? The answer, in part, is to set up the practice-management software to empower the office to focus on the patient and dentistry first.

In the not-too-distant past, practice-management software was essentially a fancy calendar and filing system. And for many practices, that’s where software utilization stopped. In reality, today’s best software systems are powerful tools that integrate clinical and front-office functions into a seamless workflow.

Selecting the right first software will not only save time, energy and expense, but will actively create new opportunities for improved patient care and practice profitability.

As the central nervous system of your practice, your first software has to be able to communicate with all the different technological aspects of what you do—from charting to marketing. Anything less forces you (or a team member) to do more work manually, inputting data or

6 Winter 2017 Dental Entrepreneur

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running analysis through multiple systems instead of one. Here are three features to look for and the questions to ask when considering your first software system:

Your practicemanagement system is the heart of your practice that will be used in different ways by all team members.

Power and Flexibility It’s important that your system provides the features you need and can adapt to your workflow and grow with your practice.

Historically, one of the biggest complaints about practice-management software was that it forced practice administrators—and entire practices—to shift their workflow to meet the requirements of the software.

Today, systems such as Eaglesoft 18 from Patterson Dental allow you to customize the software to match your workflow. This is a ADS.south209

2/25/09

1:42 PM

crucial feature and one that is well worth the investment in a premium system.

Support and Partnership Just as you want a software system that can change and adapt with your needs, you also need a system that is backed by people who are focused on staying ahead of—and delivering solutions for—the rapid changes shaping modern dental practices.

From technological advancements to government regulations and insurance restrictions, the demands on a dental practice sometimes seem to change on a daily basis.

Partnering with a technology provider that’s focused on predicting and solving these problems for you means you can focus on what matters—serving your patients and running a profitable practice. It’s difficult to put a price on the peace of mind that

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Practice Makes Perfect “Dr. Earl Douglas and the staff at ADS South have been real helpful in steering me in the right direction in the purchase of my first practice. Dr. Douglas’s experience, organization and detail-orientation, pointed out to me where improvement is needed and how to go about achieving it.”

Elizabeth H. Guerrero, DDS Get off to the perfect start. Call your ADS transition specialist for AL, GA, LA, MS, NC, SC, TN and VA today.

ADS South (770) 664-1982 ADSsouth.com

comes from knowing you have a dedicated support team working to keep you ahead of the changes. The best technology providers continuously research and upgrade their systems to address changing needs, and they consistently deliver innovative solutions that give you new ways to serve your patients and measure and manage your business.

Ease of Use This is a no-brainer. Your practice-management system is the heart of your practice that will be used in different ways by all team members. You want it to be powerful, flexible and, above all, easy to use.

But sometimes, achieving seamless simplicity is complicated.

The best systems are built by companies that actively innovate and don’t rely on patching together third-party solutions.

These systems are built on a foundation of intuitive design and simple integration.

They make it easy to follow the patient’s progress from initial contact through postvisit follow-up and pre-scheduling. They seamlessly integrate with clinical tools like digital radiography. They provide anytime/ anywhere access to the information you need. They provide a single-patient record that can be accessed and updated by each staff member according to his or her specific role. They are simple for a new hire to learn, and they provide clear paths and resources to improve team members’ utilization of advanced features.

This may be the single most important consideration in your decision, because the most powerful tools are worthless if you don’t use them to their fullest ability. And if they are difficult to use, you will not use them.

Never choose a practice management system without a thorough live demonstration of the software and never take a live demo when you and your staff are distracted by other things. This is an important decision—and one that deserves your team’s full attention. https://www.pattersondental.com/Equipment-Technology/Practice-Management

8 Winter 2017 Dental Entrepreneur

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Proud Chartbreaker.

Eaglesoft’s Charting Module instantly ends your frustrating relationship with paper charts, and brings your practice to a new level.

EXPERIENCE TOOTH AND PERIO CHARTING, CLINICAL NOTES AND COMPREHENSIVE PATIENT IMAGES IN A SINGLE, DIGITAL PATIENT RECORD. Streamline your patient information to enhance your practice.

Call the Patterson Technology Center at 800.294.8504 to learn more today.

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WWW.EAGLESOFT.NET

Getting Started

Starting A Practice Or Buying An Existing Practice What is the right decision for you?

Jayme Amos and Thomas Larkin, D.D.S.

D

octors considering practice ownership are often faced with the complex choice between starting their own practice or buying someone else’s.

Most young dentists don’t want to remain associates for their entire career. They recognize the opportunity to create more control, income and independence through practice ownership.

Rightfully, they see the opportunities for personal and professional satisfaction as unparalleled.

As we contrast startup practices and acquisitions, consider how these topics will better prepare you for an enjoyable and fulfilling career without the unnecessary mishaps of certain practice failures.

When starting a practice from scratch, doctors experience a oncein-a-lifetime process.

Each step is customized to meet your personal standards, vision, tastes and desires. From the location selection, to the development of proper protocol, to floorplan design, branding, marketing, team development and processes—all are built with the values and the personal touch of the owner. By choosing and creating a customized clinical environment, doctors can have a business that represents them on a personal and professional level. It’s a fulfilling process of imagining a successful practice and then seeing it come to life Startup Pros on your own terms.

However, there are important warnings to consider. Customized practice from clean slate Long gone are the days when a scratch startup practice One of a kind floor plan for efficiency can expect success by haphazardly choosing a location Development of systems from clean and hanging a shingle. Fortunately, when a location is slate chosen with precise demographic data and proper real Culture—Your vision for your practice estate negotiations, the right location will help propel a culture is custom-created, not inherited Clinical Standards—developed by you practice to tremendous growth in its first year.

The complications of PPOs, demographics, taxation and business systems all make following the proper Patient Demographic is pre-chosen planning stages more impactful than ever before for startups. In recent years, competition from larger practices has created geographies of high concern that Technology is new Real Estate—Leases are negotiated should not be considered for startup practices.

With hundreds of variables that must be factored, six on your terms, not inherited terms.

Ownership of real estate is possible key elements for startups are: without a down payment.

10 Winter 2017 Dental Entrepreneur

Startup Cons Debt of $400,000 to $700,000 Proper business training needs Cash-flow planning requirements for a 6-12-month profitability plan Case acceptance can be lower until rapport is built with patients Necessity for a proven process in a complex planning environment Assembly of dozens of vendors with an average of a year of coordinate to complete the project

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1. Proper analyses of current-day demographics studies 2. Floorplan layout alignment with your clinical standards, not equipment sales 3. Real estate selection that is functional for a private practice 4. Negotiations in equipment and construction that consider national pricing 5. Banking and profitability planning with a business plan customized for your vision 6. Tested marketing and hiring processes to grow quickly Wayne Gretzky, arguably the best professional hockey player in history, said much of his success was due to his uncanny ability to “anticipate where the puck is going.” Proper planning with all the key factors allows you to forecast and “anticipate” growth, like the Gretzky of dentistry. Forecasting in this way puts startups in a category by themselves.

In other words, startup practices, when planned properly, can experience growth that is smooth and predictable.

Floorplan design is also a unique experience for startup practices owners. Floorplans, when created well, significantly increase productivity. Purchasing an existing practice may trap you in a practice designed in the days of film dip tanks. A brand-new startup, however, benefit from one-of-a-kind custom designs that help your practice stand out among competitors. Floorplans also affect practice efficiency with all the modern advances in technology, practice flow patterns and custom ergonomic preferences.

As an added benefit to startups, “line of sight” spacial planning concepts and creative design touches can be used to highlight your personal values.

Office protocol and systems are also designed from the ground-up in startups.

This concept of smooth running office systems is of high interest to doctors who

are turned off by changing dysfunctional, deeply ingrained processes found in some older practices.

What about profitability? Many doctors express concern about reaching profitability with a startup. With a full, legitimate business plan that incorporates precise demographics, staffing plans, business protocol and financial projections, many startup practices reach profitability within their first six to nine months.

The biggest regret of startup practice owners is the failure to follow proven planning stages, leading to drastically higher costs and much lower profits.

Buying an Existing Practice Alternatively, buying an existing practice can create success by allowing for the purchase of an existing patient base, systems, staff and equipment all at once. Ideally, you can acquire a practice that you can own, run and profit from, beginning on your first

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day of ownership. When the right practice is acquired the right way, this is possible.

However, it is important to point out two deeply misunderstood concepts in acquisitions.

1. Buying a practice is very different from buying a successful practice. In other words, ownership should not be your goal. Buying a practice that will be successful is the goal. A proper, outside analysis will reveal this. Don’t settle for an acquisition for the sake of being a practice owner. Doctors who make that mistake regret it for many years.

2. Buying an existing practice should not be assumed to be “low risk.” Many young doctors incorrectly believe acquisitions are inherently low risk. Nothing could be further from the truth, no matter what any vendor in the process tells you. Thorough analyses from unbiased parties should always be the top priority in this process. It is recommended to avoid the interactions with and opinions from the seller or the seller’s broker. Those who take this lightly often find themselves trapped with very expensive, very messy surprises.

Some of the surprises that buyers find out after the purchase has gone through are: • Large volume of patient loss. You should expect at least 10-20 percent.

• Staff turnover. You can expect at least one key employee to leave.

• Unplanned repair costs. Remember, older equipment is costlier to repair.

• Poor business systems. An older practice run on old systems is harder to

transition to newer systems and technology.

• Undesirable patient habits. What levels of case acceptance exist?

• High dollar costs to improve the facility. Will there be construction needed, does the clinical portion of the practice need to updated?

• Problems with landlords. Are the terms of the lease protecting you?

Any of these surprises can be devastating financially and emotionally. And many doctors find themselves in need of a part-time associate position to afford the costs of loan payments, though they were told their acquisition was low risk. Doctors should be trained and adequately prepared on the skill of practice acquisition well before beginning their search. Doing so will help avoid these common surprises. But far too few young doctors are properly educated on the costly and high-stake world of practice acquisitions.

Acquiring an existing practice can be wonderful and profitable. Ownership can happen almost immediately and growth will occur if planned properly. An important piece of early growth hinges on the transition from seller to buyer taking place smoothly. But acquisitions are also a costly process with a level of inherent risk that many buyers wish they had taken more seriously prior to closing.

We would like to point out that regardless of the type of practice ownership you chose, having creative control over how you want

Acquisition Pros

Acquisition Cons

Purchase of existing patient base

Out-dated floorplan, facility and equipment

Inheriting Staff

Inheriting Staff

Immediate cash flow when purchasing a profitable practice

Aging and distressed demographics

Systems already in place

Dysfunctional systems

Less debt than startup

Difficulty changing the vision and philosophy of patients and team

12 Winter 2017 Dental Entrepreneur

to practice is a game-changer. Rightly so, practice ownership is a major motivator for young entrepreneurial dentists.

The ability to build a relationship based practice versus the typical transaction based practice is something that the big-box dental corporations cannot compete with. Most practice owners would agree that practice ownership was the best choice of their career, granting them freedom and control with both clinical and personal rewards.

When done properly, both Startups and Acquisitions can lead young doctors to transform into more confident, bold and accomplished individuals. Owning a practice that represents your clinical standards creates pride of ownership and fulfillment unlike any other part of dentistry.

Get your copy of the “Startups vs Acquisitions” Video and Audio course at: www.idealpractices.com/ownership This is available exclusively to the readers of the ADA Practice Success Newsletter.

Jayme Amos is the bestselling author of Practice Location, founder of HowToOpenADentalOffice.com and Ideal Practices. He and his team have helped doctors across the country open highly successful practices.

Dr. Thomas Larkin is the Clinical Director for Ideal Practices. As a practicing dentist with decades of experience, he has bought, sold and started practices.

He started and sold his first practice before completing dental school.

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Wells Fargo Practice Finance

Thinking about practice ownership?

Let’s talk about your options.

When you’re ready to purchase or start a practice, count on Wells Fargo Practice Finance to help you achieve your goals: · Up to 100% financing to help you acquire an existing practice or start one from scratch · Competitive fixed-rate loans with preferred pricing for ADA® members

Download your free copy of Preparing for Ownership. wellsfargo.com/demagazine

· Complimentary planning resources and professional support to help your practice thrive

To get started, call 1-888-937-2321 or visit wellsfargo.com/demagazine to request your free Preparing for Ownership workbook.

Wells Fargo Practice Finance is the only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM.

All financing is subject to credit approval.

ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association. © 2017 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. 3153-1216 WFPF-Ad-Dental-Entrepreneur-Winter-2017

Getting Started

Do Your Homework When Purchasing a Dental Practice Thomas L. Snyder, DMD, MBA

W

ill 2017 be the year that you decide to purchase a dental practice? Whether the practice will be purchased using the services of a practice broker or if you find one through your own efforts, you will have to invest time and money in conducting proper due diligence prior to buying that practice.

One of your first steps should be retaining an accountant, preferably someone with dental experience, to assist in reviewing the practice valuation report as well as any financial information of the practice you intend to purchase.

The next step is retaining an attorney, again, preferably with dental experience.

This is serious business, since purchasing a dental practice will be the largest investment that you will make in your dental career! So “pulling out all stops� is essential to ensure that you minimize errors that may cost you greatly and that may have a long-term financial impact. In fact, some purchasers will have a transition consultant to assist them in the due diligence process.

Here are several of the key areas that must be addressed in your due diligence process: Active Patient Count The size of the patient base that you will acquire is an extremely critical component. For those few dentists who have encountered financial problems when purchasing a practice, it is often related to a significantly lower active patient count than they assumed. So it is incumbent upon you to verify the true size of the active patient base. Determining a time-frame for a patient visit is the first step in conducting your patient count due diligence. The most common timeframe for a patient visit is between 12 to 18 months. We prefer 18 months as the timeframe when a patient has made at least one patient visit. The easiest way to determine an active patient count is to run a computer scan for the prescribed timeframe, requesting

14 Winter 2017 Dental Entrepreneur

at least one patient visit over that measurement period.

Another way to determine the active patient count is to conduct a chart audit. A complete chart audit requires a review of every patient record. This is impractical as well as a very time-consuming process. A practical alternative to conducting a complete chart audit is to use sampling techniques. This can be done by taking a sample of 100 patients. The sample needs to be a continuous group of patients at any point in the alphabet. Within the sample size determine whether a patient has visited the practice within your selected timeframe at least once. There are guidelines to adhere to as to recording this review in the patient chart or in the electronic record. You should confer with your attorney as to appropriate protocol. Next, calculate the percentage of patients who visited the practice within your sample and multiply that percentage by the total patient count. This can give you a reasonable estimate of active patients in the practice.

If you want a better understanding about the composition of your patient base, it is wise to run a demographic analysis report.

For example, if you are considering purchasing a practice in a small town, this will give you an idea of where the majority of patients

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reside. This can be useful information, especially if the owner has been practicing 30-plus years. Often, we see this type of practice having a good number of patients who are second- or possibly thirdgeneration patients who may not live in the immediate area. They may have elected to travel considerable distance to visit their dentist of many years. However, if the distances are substantial and the seller is retiring immediately after the sale, there is a high probability of attrition, as many of these patients may decide to find a new dentist closer to home. This analysis, of course, is not as critical in urban or suburban communities, since many patients may travel from their business location to the practice rather than their residence.

Also, knowing the age distribution of your patients may be useful based upon the type of services you are planning to provide.

New Patient Inflow New patient inflow gives you a clear indicator of a practice’s vitality. In practices where the owner has been reducing clinical time and possibly not accepting new patients, it may be a real problem. For example, purchasing a practice that averages three to five new patients a month will require a substantial investment in internal and external marketing programs. Since patient attrition is a common occurrence in any practice as it can vary anywhere from 10 to 20 percent annually, based on the practice location. So consider purchasing a practice with a good patient inflow, for example, in the range of 20 to 30 new patients a month, would be preferable.

Clinical Production Analysis Analyzing the last two years of clinical production is another important task in the due diligence process. For example, if the retiring dentist has been focusing for the last several years on providing complex restorative services, it won’t be surprising for you to see a 50 to 60 percent ratio of total seller production in that area. That may be a warning bell, particularly if the new patient inflow is minimal. It could

be a harbinger of a slower or no growth practice. Reviewing all hygiene procedures is key to determining the potential for growth in the hygiene area. Determine the ratio of hygiene services to total practice production. It should at least be in the 25 to 30 percent range for a general practice.

If less than this range, it may mean that there is room for improvement in the recare program. Next, calculate the ratio of perio procedures to overall hygiene production. This will give you an indication of the practice’s perio orientation. If this is a very low ratio, less than 5 percent, chances are that you may be able to see significant growth of perio services. You can learn a lot about the seller’s referral patterns by reviewing the production report.

For example, a lack of endo procedures in a general practice bodes well for you as many of these procedures can be provided by you. Thus, another way to increase revenue!

Equipment/Technology Inspection Not all dental offices for sale have relatively new equipment and state-of-the-art technology. So it is critical that you retain the services of a dental equipment specialist from a dental supply company to perform an inspection of all major dental equipment items. You want to ensure that everything is in good working order and that no repairs are required. If there are problems they should be corrected before settlement. If the practice has an abundance of clinical technology devices and equipment, make sure that everything is functioning properly.

Finally, make sure that you have an equipment list inventory for each treatment room. This inventory should also be included as an attachment to your Practice Purchase Agreement. Unfortunately, we know of situations where certain pieces of critical equipment and/or technology that the purchaser understood was being purchased, mysteriously disappeared after the sale was completed … and before you begin your first day of operation!

Financial Analysis As mentioned earlier, retaining an experienced accountant to assist in your due diligence is key to ensure that you are making a worthwhile investment. Many accountants will also prepare a cash flow analysis to illustrate a financial forecast protecting future income and expenses.

Some accountants prefer reviewing bank statements to verify certain expenses as well as correlating them with tax returns.

In some instances, accountants have discovered irregularities between seller’s production reports, insurance reports and financial statements. If there are irregularities, it may mean irregularities in insurance billing. That could be a potential problem, especially if there is a future insurance company audit. There have been instances where insurance carriers discover fraudulent practices of the former owner and although no longer with the practice, it may prohibit the new owner from participating as a provider with that company!

So, you can see purchasing a dental practice does require a lot of hard work on your part as well as your advisory team.

However, if you take the time to conduct proper due diligence you are lowering the risk of future problems. Taking shortcuts and not investigating thoroughly some of the areas presented may end up costing you much more in the long run!

Dr. Tom Snyder is managing partner of The Snyder Group LLC. A transition services consulting firm that specializes in practice valuations, practice sales as well as designing associate and partner relationships. He can be reached at (800) 988-5674 or email: tsnyder@snydergroup.net.

The firms’ website is www.snydergroup.net

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Getting Started

Dental Conferences: The Next Step in Your Continuing Education Jane Puskas, D.M.D.

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raduation from dental school is the final step in your journey to become a dentist. Or, is it? Technically, yes, but it’s not the end of your education as a dentist. You will continue your dental education throughout your career – as both a requirement and a necessity to deliver the best possible care to your patients. Continuing education courses and conferences also prepare you to start and manage a dental practice, learn best practices from experienced dentists and stay abreast of the latest developments in the profession.

If you plan to start a practice or join an existing practice, there are many questions and challenges ahead. Groups like the Hinman Dental Society can help prepare young dentists to overcome these challenges and provide a professional network you can always turn to for assistance and support. Dental associations/societies and the conferences they organize can help young dentists in a number of ways, including: • Continuing Education Customized for New Dentists Most of the larger dental meetings host special programs tailored for students and emerging dentists that often are complimentary and impart valuable advice on getting started in the profession.

Hinman’s G.O.L.D. (Graduates of the Last Decade) Program is designed specifically for new and emerging dentists who graduated from dental school less than 10 years ago, as well as current dental students and residents. The program is a full day of lectures and discussion with a Hinman Dental Society member table host, that provides clarity on the state of dentistry as a profession and business, gives concrete advice on how to define your objectives and establishes the right path for a deeply rewarding career.

• Professional Networking Dental organizations and groups also provide a network of professionals that you can rely upon and turn to for advice and support. If you are active in a dental association or society, you have access to others who can share best practices, consult with you on difficult or challenging cases, or provide advice on new technologies, equipment and services in the profession. Just because you are a sole practitioner doesn’t mean you have to “go it” alone.

• Latest Developments & New Technology Just like any profession, dentistry is constantly evolving and changing with new developments and technologies being introduced daily. To stay abreast of the latest, most major dental conferences and meetings make it easy by hosting hundreds of companies in an exhibit hall where you can explore new equipment, services, 18 Winter 2017 Dental Entrepreneur

technology, etc. Often, you can receive hands-on instruction and see demonstrations of the products and equipment before you decide to invest in them for your practice.

• Employment Opportunities Dental organizations like Hinman also can be a valuable resource for you if you are searching for a practice to join or professionals to hire to help grow your practice. Hinman hosts Career Connections

by Hinman every year. It’s a great way to network and connect with top dental practices. You can review job openings, prioritize the employers that you want to visit and prepare a quick introduction online prior to attending the meeting and networking with potential employers.

• Access to Free Continuing Education The major dental conferences and meetings, like Hinman, offer many opportunities for free continuing education courses. For students, registration is often complimentary, too. You can attend courses that range from clinical, hands-on workshops to practice management and everything in between. Approximately 85 courses are free at Hinman 2017, including a CRDTS Dental Examination Review that provides an introduction to CRDTS content and important changes for the dental examination.

Dental meetings and organizations clearly provide resources for new dentists that can’t be found elsewhere. They can provide the tools you need to embark on your career in dentistry and set you up for success. In addition, you can begin your journey of lifelong learning so that you can provide the best possible care to your patients. While there are many options for CE out there, dental meetings and organizations like Hinman offer unprecedented value, especially for new doctors who are just getting their start.

Dr. Jane Puskas is a practicing dentist in Atlanta and a long-time member of the Hinman Dental Society, currently serving as the first female General Chairman of the Thomas P. Hinman Dental Meeting.

She also is a member of the ADA, Georgia Dental Association, Pierre Fauchard Academy, American College of Dentists and International College of Dentists. Dr. Puskas is a graduate of the Harvard School of Dental Medicine.

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A L I F E T I M E O F A D V I C E I N O N E D AY

G.O.L.D. PROGRAM – Graduates of the Last Decade Course Fr500 | Fee: Dentists $75, Dental Students and Residents No Fee Friday, March 24 Course: 8 a.m. – 5 p.m. | Networking Reception: 5 – 5:45 p.m.

If you’ve been in dentistry for ten years or less, or if you are currently in dental school, this program is a must. Our renowned speakers provide clarity on the state of dentistry as a profession and as a business, give concrete advice on how to define your objectives and establish the right path for a deeply rewarding career.

Welcome & Keynote Address 8 – 9:15 a.m.

Lunch is on your own from 12:30 – 1:30 p.m.

Risk is an Essential Part of Success Dr. Scott Parazynski Dr. Parazynski is an astronaut and physician who was recently inducted into the Astronaut Hall of Fame. He has taken seven space walks, summited Mount Everest, completed deep-sea dives around the world and even descended into the world’s newest lava lake (in Nicaragua). Accepting a degree of risk is an absolutely essential part of success. Dr. Parazynski will share the keys to assessing and managing those inevitable risks. Find out from this incredibly inspiring speaker the real secrets of planning to succeed, but also being prepared for setbacks along the way.

Formulas for Success John McGill 1:30 – 2:30 p.m.

How can you achieve financial success with all that student loan debt? Learn how to avoid costly financial mistakes and achieve financial success by using optimum strategies for paying off student loans and other debt.

Determine whether to use funds to accelerate debt repayment, retirement saving strategies, obtaining necessary insurance coverages and winning investment strategies.

W E L COM E TO H I N M A N

Your Hopes and Your Fears Imtiaz Manji 9:15 – 10:15 a.m.

The first years in practice are filled with many choices and new doctors just want to focus on delivering patient care. It’s important to be in the right place both clinically and business-wise to achieve what you want. Learn how to put yourself on a guided path for today’s successes and future opportunities.

4

Why You Must Own in Dentistry!

Charles Loretto 10:30 – 11:30 a.m.

This is a must hear lecture on the benefits of ownership. You will see and hear the critical steps that you need to get right as a new dentist. You will see the math of owning versus working as an employee and learn when and how to deal with dental school debt. There are more career considerations than ever before in dentistry. Compare and contrast the options every new dentist needs to know.

If You Don’t See It, You Can’t Treat It Dr. Ricardo Mitrani 11:30 a.m. – 12:30 p.m.

A skill that all the best dentists cultivate is the ability to see comprehensively when the patient opens wide. This is your chance to hear some real-world advice from an accomplished prosthodontist and clinical educator about what to look for, how to treatment plan and how to get patients to see it too.

Better Together: The Power of Interdisciplinary Cooperation Dr. Mollie Winston 2:30 – 3:30 p.m.

In a profession where it is easy to become isolated within your own practice, it is the clinicians who break out and team up with their colleagues who ultimately provide the best patient experience. Hear about great cases, the power of clinical partnerships and the special value every dentist can realize by building strong relationships with their professional colleagues.

Igniting the Leader Within You Robert Spiel 3:45 – 4:45 pm Being a successful dentist is about more than providing great dental care.

It’s also about thinking entrepreneurially and being an effective and inspiring team leader who can communicate a practice vision. Join Mr. Spiel to learn how to develop these crucial leadership skills.

Closing Remarks by Emcee, Imtiaz Manji, “So What Do I Do on Monday?” 4:45 – 5 p.m.

Join us for a networking reception after the course from 5 - 5:45 p.m. to mingle with other dentists and continue the conversation.

PRE-REGISTRATION INFORMATION

Business Fundamentals

A Crash Course for the New Dentist Gary Kadi

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f you missed that half hour as a senior where your professor taught you about leadership and running a business, you were up the creek without a hand piece.

As a graduate, you are armed with a great skill that improves lives, but how do you run a successful practice?

I’m going to give you a crash course that will have you ahead of 90 percent of the practitioners running successful practices right now.

There are seven divisions every practice has that you need to be accountable for.

That doesn’t mean you need to do everything, but you do need to delegate where appropriate.

Here are your seven divisions: The Executive Division of a dental practice includes two primary areas, executive and management. You, as a Dental CEO, are responsible for the executive level. Being an executive means being a leader. Leadership embodies the two I’s: Inspiring the team and Influencing the team. Inspiration comes from who you are “being,” not what you are “doing.” Being is also known as your context, or the philosophy you are putting behind all of your thoughts and interactions.

A leader creates inspiration by emotionally taking the team to a place they have yet to experience. On a daily basis, the leader is responsible for motivating the team from the inside out. In order to cause that, you must understand each team member as an individual, and then your team as a whole.

As a leader, you are to keep the vision alive in the practice. This provides an exciting future for the team in which to live. Your vision is what you are committed to creating for your practice and community. It is also tied to your personal purpose. You will inspire people by bringing them forward into a common vision that everybody shares.

In order to Influence people, your word must have power. In order for your word to have power, you need to follow through on what you say you are going to do. You know this as integrity. You must honor your word as your word. If your agreements are being broken, as a leader, you acknowledge your broken promises. This will allow you to restore your 20 Winter 2017 Dental Entrepreneur

word and be a great influence on those around you. When your team knows your word matters, when you speak and make requests of your team, patients and community, they know you are serious and will be inspired to follow through.

Management is the second level in the Executive Division. Your team leader is accountable for this level. Management consists of the three M’s; Measure, Monitor and Make things right. In order to measure, we create tangible results; DPOs, case acceptance, BBM, etc., for each area of accountability, including individual positions and as a team. The daily

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monitoring systems are your DPO tracker, treatment tracker, case acceptance and daily production and collections. “Making things right” is trouble-shooting if the integrity or metrics are not being met in the practice. This allows the doctor to be a CEO and focus on dentistry. The team leader provides a state of the union regarding the practice to the doctor during an hour meeting at the end of each week.

The doctor, therefore, remains in control of the practice, while not having to micromanage and lack certainty on the status of the practice.

Next, is the Administrative Division. This division has three primary components. First is the area of human relations, or personnel.

This includes the employee manual, practice agreements and individual agreements team member has within the practice. To run this successfully, have software similar to a patient chart with all the key information pertaining to each team member’s employment.

The Executive Division will manage from these agreements rather than from emotion.

The second area is facilities. It is virtually impossible to deliver world-class dentistry in a world-class setting without world-class facilities.

Review your physical environment checklist twice a year to ensure proper facility representation. Third is equipment. Choose one or two team members to oversee the status and efficiency of all dental and office equipment.

This will empower you to deliver world-class dentistry and customer service in a world-class environment.

The third division is Marketing. Marketing is both internal and external. Examples of internal marketing include implementing the NextLevel methodology, the success of the hygiene department and anything that’s done inside the four walls with your existing patient base. External marketing is done outside the four walls to people you don’t know. External marketing brings in new patients and creates a name for your practice in the community.

The Sales Division is what we call “case acceptance.” That’s where a patient agrees to treatment, has a payment arrangement agreed upon with your treatment coordinator and an agreed scheduled time for treatment. The patient understands the problem, consequence

22 Winter 2017 Dental Entrepreneur

and solution for their treatment. This includes “total” case acceptance. The treatment coordinator has a benchmark of 67-percent case acceptance. The treatment coordinator reports to the team leader (may be the same person) on a weekly basis with their metrics and findings to ensure the team leader can measure, monitor and make things right.

The next division is Production, or Scheduling, which is managing the schedule. The appointment coordinator, along with the support of hygienists and “NINJAs” (No I’m Not Just an Assistant), is accountable for maximizing production time and utilizing the NextLevel scheduling philosophy. The appointment coordinator is to adhere to, and focus on, causing results. This is critical in order to maximize your time in and outside of the office, and create the triple-win with patients, team, and doctor.

The next division is the Finance Division. A dental CEO is accountable for culture, vision and solvency. In the Finance Division, you maximize cash flow and accountabilities in order to manage overhead and solvency, in addition to ensuring the complete financial success of the practice. Having certainty around your current and future finances allows you to manage the growth of the practice and fulfill on the needs of the patients, the team members and the doctors.

The final division is Quality Assurance.

This division has two levels, quality assurance for your internal customer (your team) and for your external customer (the patient). Quality assurance with your patients is to ensure your patients show up, carry a zero balance with the practice, stay for as long as they live in the area and refer other patients. Quality assurance will give you certainty on your patients’ expectations and allows you to serve them beyond their expectations.

Expectations can come in different forms; time, money or customer experience. Surveying patients after each visit will reduce attrition and give you a course-correction plan that allows you to expand responsibly. You will be able to isolate each individual patient’s needs and customize your care for them. With your team, there are many different areas that team members

need to feel inspired and motivated. Conduct team member reviews every six months to gain insight on what each team member needs to feel inspired and to co-create a plan to live in to within the practice. Team member reviews also give you an opportunity to educate your team member on their performance in the practice and where there is opportunity for growth. An annual survey for your entire team is critical for you to be assessed in your role as a leader in the practice.

Well there ya go, dental CEO! My personal advice to you is to find someone to be your mentor and duplicate excellence by getting support versus trying to create mediocrity. No one wins alone!

Gary Kadi has been a devoted advocate for the dental community, their families, and their patients for over 20 years. A speaker, author, and researcher, Gary reenergizes practices and helps dentists implement systems and raise their profit margins. Gary has authored several books, the first of which, Million Dollar Dentistry, has been distributed in 37 countries with over 80,000 copies in print.

He most recently wrote a book for Periodontists, Stop! The Bleeding: The Seven Steps to Scaling Your Perio Practice. After years of studying the reoccurring challenges facing dentists, he created NextLevel Practice to implement the Complete Health Dentistry™ business model. NextLevel Practice is an Inc. 500, 5000 company. Gary is a Leader in Dental Consulting by Dentistry Today, a member of The Academy of Dental Management Consultants, and an honored Board Member of Alliance for Oral Health Across Borders.

For your complimentary copy of Gary Kadi’s book, Million Dollar Dentistry, please visit: www.nextlevelpractice.com/demdd

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MacPractice acPractice Simplicity in practice Simplicity in practice

MacPractice acPractice Simplicity in practice Simplicity in practice

FACT: PCs cost 3 times more!

IBM Saves $535 per Mac, 81% Less Onsite IT, 73% Prefer Macs MacPractice saves dentists $1000s every year over PC solutions with the lowest IT costs, savings of $535+ per Mac, 81.5% less onsite service, macOS built in encryption and security, greater self-reliance and satisfaction, and Macs that last years longer than PCs.* MacPractice DDS is macOS native dental management software with native digital imaging, next-generation charting, interoperating native iOS Apps for iPad, secure messaging, network efax, online registration and scheduling, and best of class reputation marketing, all ‘built in’. MacPractice built in AES encryption so patient data is safe and your practice can qualify for HIPAA’s Safe Harbor. Escape susceptibility to Ransomware, other malware, and the barrage of DDoS, IoT and other Internet attacks predicted for 2017 by keeping your data on premises and remotely accessible.

REGISTER FOR WEBINAR - ‘Why MacPractice Is Right For My Practice’ *Learn How IBM Saves Money and Time with Macs v. PCs www.macpractice.com/dental-apple-advantage | (855) 679-0033

Business Fundamentals

Leadership Skills Need Attention, Too! Gavin Shea

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t goes without saying that excellent clinical skills are required for achieving dental practice success. In fact, if you are like most doctors, you attend CE courses every year to keep your license current and refine your techniques. But don’t forget that your leadership skills are important, too! Here are five ways that effective leadership can positively impact your practice: 1. Helps maximize productivity. The ability to inspire others to follow you is one of the key definitions of leadership. And indeed, having a team that is willing to accept your lead and direction is critical to maximizing productivity within the practice. By clearly guiding your team in the ways they can best perform their roles and meet your expectations, you help to ensure that the practice is gaining the greatest benefit from its investment in staff time. As each team member

24 Winter 2017 Dental Entrepreneur

begins to operate more efficiently under your direction, your practice increases its potential for greater productivity through coordinated delivery of patient services.

2. Supports constructive change. Change is inevitable in business, and effective leaders are better able to absorb and manage change both within the practice and from outside influences. With strong leadership, you are more likely to develop stability and resilience within your team so that it becomes easier to avoid disruption during challenging transitions, such as expanding your office, adding an associate doctor, or selling your practice. And because your staff is secure and committed under your guidance, you may be better prepared to capitalize on opportunities as they arise, like an added location or new clinical techniques. With steady leadership, change can become an oppor-

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tunity for growth rather than a destructive influence.

3. Enhances the patient experience. Your patients recognize and respond to the environment in your practice, and a harmonious office that runs smoothly under the direction of a good leader tends to deliver an enhanced patient experience. A friendly team, timely appointments and efficient procedures all contribute to a positive atmosphere for patients–and in the end, happy patients may bring more referrals, fewer no-shows and overall increased growth for your practice.

4. Motivates your team. Effective leadership can also enhance the employee experience. By providing a vision for your team to follow–whether it’s to create a family environment or deliver the latest technology–you can help motivate staff members to perform their best work. You can give them a sense of ownership of their personal responsibilities and the quality of service that they provide. Leading by example–demonstrating patience, fairness and commitment–can help build a work setting that team members are proud and enthusiastic to participate in every day.

5. Creates future leaders. The most effective leaders are excellent delegators. By handing off meaningful responsibilities to your team members, you help build their confidence and develop their skills. Ultimately, you are working to develop your key team members into future leaders–individuals who can influence others to follow their positive example. Investing in your staff’s future by delegating responsibility may lead to greater employee satisfaction and loyalty to the practice.

It should be clear that leadership is not a quality that can be outsourced–it is solely an inside job. However, as with your clinical skills, it’s a characteristic that can be learned and developed. Following are several ideas for practicing and demonstrating good leadership skills with your team, right now: - Define your vision. Work to develop a vision or mission for your practice, and then pursue it with consistency. Even better, make

this part of a broader business plan that helps ensure your practice is competitive, has a plan for growth and is well positioned to achieve business goals. For help developing a business plan, click here to read the online article, Recipe for Creating an Effective Business Plan.

- Listen to your staff. Your employees may have valuable insights into how to best address patient needs and stay competitive. Conduct regular staff meetings or take advantage of your daily huddle to gain employee input about operations.

- Take risks as needed. Take necessary but reasonable risks to establish and grow your practice, such as expanding your location to accommodate a consistent influx of patients.

Consult with your financial advisor before committing to any significant investment or change in direction.

- Create a support team. Having access to a group of professionals who are familiar with your unique challenges as well as the dental industry can help you stay on track.

Consider including a dental lender, CPA, practice management consultant, real estate broker and attorney.

- Improve your communication skills. This will also help to improve your relationships with both team members and patients.

Practice active listening–hearing what others have to say without prejudgment or interruption.

- Take time to celebrate. Acknowledge small wins every day–a new patient referral, on-time appointments all day, an uptick in collections. A quick staff meeting or “pat on the back” may be all that’s needed.

To a great extent, your personal style of leadership will determine how you approach the challenge of directing your team. For example, do you prefer to demand immediate compliance from your employees, or mobilize them towards a common goal? Do you tend to create emotional bonds with your staff, or expect self-direction from each team member? For an understanding of different leadership styles, see Leadership Styles and How They Impact Your Success.

By giving your leadership skills as much

priority as your clinical skills, you may soon find that you are not only improving the patient care you provide, but also the overall environment of your practice.

Gavin Shea is the Senior Director of Sales and Marketing for Wells Fargo Practice Finance. With more than 17 years of banking experience with an emphasis in practice lending, he leads sales and marketing strategy development and implementation throughout the national footprint.

Please reach out to our authors and our advertisers.

They care about you and keep us in print!

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Business Fundamentals

Rethinking Leadership:

Flip Your Focus and Change Your Life Excerpts from the soon to be released book: Flip Your Focus: Igniting People, Performance and Profits through Upside-down Leadership.

Bob Spiel

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othing in life brings us more face-to-face with ourselves than owning a business. Things like sports, schooling, marriage or raising children don’t cause us to confront who we are, what our strengths and weaknesses are, and what drives us quite like business ownership. It acts as the perfect amplifier of our skills, motivations, self awareness, thirst for knowledge, ability to communicate, tenacity, planning, leadership and teambuilding abilities because there is no such thing as a no-fault business.

Consequently, the demands placed on practice owners are huge.

And this is never more true than in a growing practice where the title of “owner” can soon mean “chief everything officer.” As patients are gained and employees are hired, often expectations are unclear, accountability is weak, feedback and appreciation is lacking, systems are created by default, what was once simple becomes more and more complex–and it appears the only way to confront these dynamics is to tighten the grip even more. Employees then fall into two camps: over-performers who are burnt out and unhappy, or underperformers who are entitled and unhappy.

Along with the ever-constant cash flow worries, there is the fear of failure—and paradoxically—the fear of success. The mounting stress cannot even be escaped at home, but is only momentarily numbed through mindlessly surfing the web or watching a sitcom late in the evening. It seems there is never enough time or energy to get everything done. The hope that launched the practice seems to fade into the background as the personal and organizational stressors grow. As the chaos mounts comes a mid-night cry from within: “I want my life back!”

Trying to hold on, it is common for practice owners to resort to what I call the Seven Deadly Sins of Management: 1. Issuing threats and ultimatums 2. Comparing to prior staff members 3. Consistently being inconsistent 4. Not backing their team 5. Micromanaging and not prioritizing 6. Breaking confidences and creating “drama triangles” 7. Being chronically negative But there is a way out of this, and it is called leadership. Specifically, it’s a way of leading that flips a practice owner’s focus to become the leaders they have always dreamed of becoming.

26 Winter 2017 Dental Entrepreneur

The Leadership-Business Success Connection In times of chaos—and in times of stability—there is an unmistakable connection between leadership and business success. In times of chaos, leadership is the single greatest element that can successfully pull the group through to get to the other side. And in times of stability, leadership provides the clarity of purpose and direction, while creating a culture that is largely self-sufficient and self-sustaining—as the practice thrives.

Why is leadership required for practice success? To begin with, as human beings whether it is by nature or nurture, we are hierarchical beings. Social structure is a part of our makeup and we look to leaders for fundamental activities. The first is to set the vision and direction.

In my work, I have found everything else a leader does—besides their personal highest and best purpose—can be delegated except for vision and direction. No one else can do this. No one else can set the course, shape the direction and create the compelling vision of where a group is going and why.

There is a third fundamental element leaders are also wholly responsible for, whether knowingly or unknowingly, and that is setting the pace. Pace is the internal rhythm, sense of urgency and rate things are accomplished. And the pace of a group is a direct reflection of the leader’s very own pace. Teams cannot run faster than their leader. It is impossible to do.

Acknowledging this connection between leadership and success can be a frightening truth, or the most liberating thought ever for a practice owner. When a leader accepts responsibility for their own situation, their own development, and then decides the time is now to begin to raise the level of their game and create change within themselves so change will happen in their organization, amazing things take place.

For a practice owner, personal development is the key for organizational development. And like a pebble being dropped into the pond, the ripple effect is real and profound.

Traditional Top-Down Leadership Let’s define what I mean by an upside-down leader. This management model is best understood through contrast. Ask the average owner what leadership and business looks like and you’ll likely hear a description of the traditional organizational pyramid. Indeed, most practices resemble this top-down structure. At the pinnacle of this pyramid is the owner/doctor. Everyone lower than them ultimately

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exists to see the person at the top succeeds.

Leaders in this traditional organization view their role as being a boss, giving orders, issuing commands and making things happen because no one else in the practice cares or knows as much as they do.

But operating in this structure brings a host of problems for the leader, to say nothing of the underlying employees. Chief among these problems for the practice owner is the tendency to burn out. As we discussed earlier, being a “chief everything officer” is exhausting. When a practice grows, so too do the demands and to-do list of an owner who is trying to hold fast to the reins. Often, health and family life take a backseat to work. Yet despite the efforts of the leader to create a successful business, the workplace culture is unstable and, frankly, sick. Morale is low, turnover high. The question that wakes these business owners up in the middle of the night is, “Isn’t there another way?”

Upside-Down Leadership The answer is a resounding “Yes!” Upsidedown leadership allows practice leaders to support their team in becoming their best, provide vision while setting the pace of their organizations and create a business and life of significance—while being successful and having balanced lives! As leaders and their teams flip their frame of reference from control to abundance, from top down leadership to upside-down leadership, with clear expectations, clear roles and goals; and with the end goal to create a self-perpetuating culture of unselfish teamwork—the results are life changing personally and professionally. Upside-down leadership is the answer to the midnight cry for help, because it transforms a business from being owner dependent, to organizationally and culturally dependent. CEO then means “chief empowerment officer.”

What does it look like to flip your focus from a traditional leadership perspective to a model of upside-down leadership? The

changes are dramatic: • From boss to coach • From fear to freedom • From focusing on survival to success and significance • From scarcity to abundance • From chaos and confusion to clear expectations and accountability • From perfection to excellence • From a culture of control to a culture of participation and ownership; from director to facilitator • From individual employees to becoming a team Flip Your Focus … and Change Your World We’ve seen the results of the traditional top-down organization. Arthur R. Jones once said,“All organizations are perfectly aligned to get the results they get.” Paraphrasing this slightly, I believe every leader is perfectly aligned to get the results they are getting. And

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Dental Entrepreneur Winter 2017 27

what type of results has top-down leadership created in America today? Statistics show 70 percent of employees will admit they are not engaged at work, while a staggering 17 percent are actively disengaged and regularly sabotaging productive work. When success is all about the person at the top, those who want to contribute their highest and best will check out of an organization—and most of those who don’t leave have already quit their jobs; they just still get a paycheck.

But there is another way. And what it takes is to flip your focus and way of thinking about leadership. Take that traditional organizational triangle and flip it over in your mind, and don’t let it move. This is how upside-down leaders think. Differently.

Rather than everybody existing to see that the person at the top succeeds, in an upsidedown organization, the leader or leadership team exists to see everybody in their organization succeed. These leaders have a long-term focus and strive to empower their team knowing true empowerment achieves miracles. They are committed to surrounding themselves with the very best and the brightest talent, knowing their job is not to have all the answers … but know how to facilitate and pull the answers out of their team. And they lead from a standpoint of hope, not fear. The seven deadly sins are clearly on their “To-Don’t” list. In fact, they do the opposite. They know their job is to help everyone in their organization to do their best and be their best. Their list looks like this: 1. Coaching with hope 2. Believing in each person 3. Being measured and consistent 4. Supporting their team 5. Empowering and prioritizing 6. Creating a culture of trust, responsibility and accountability 7. Finding the best in people and situations As a leader or owner accepts this mindset and leaves the top-down culture forever in the dust, the success that takes root and then occurs within their organization is exponentially greater than in a traditional

28 Winter 2017 Dental Entrepreneur

organization.

Upside-down leaders look at business from an entirely different perspective. Of course, they are running a business and are aware of the bottom line, but that doesn’t drive their every action. Their bottom line is the result of consistently doing the right things. Indeed, they have a more organic approach—focusing not only on operations, but also on the people who work for them.

That flipped focus naturally leads, and even surpasses, their desired outcomes. You don’t build a business. You build people, and then people build your business,” Zig Zigler once said.

What Now? Leadership can be mastered. Often there is a question of whether leaders are born or made. I don’t agree with either question.

The ability to lead is found from within through the process of committing to personal change—looking succinctly and honestly in the mirror and coming to the realization that whatever it has taken to get you where you are, it is not going to be enough to get where you need to be. So, assess where you are right now. Evaluate the culture of your business. Between the two choices below, circle the one that most accurately describes what you see going on today. Be totally honest.

Contention or collaboration.

Finger pointing or accountability.

Burnout or fun.

Fear or hope.

Scarcity or abundance.

Entitlement or Empowerment.

If you circled three or more words on the left, don’t get discouraged. You are in good company because most practice cultures look and feel like this. If you scored three or more on the right—you are already on the path of an upside-down leader.

Stop what you are doing now and list some concrete goals to start from wherever you are—to get to where you want to go.

Make some very clear commitments. With these commitments you will find a desire to be coached. All great athletes and per-

formers have coaches because all of us have blind sides. It is impossible for us to see fully everything we need to see to continue to have further success and improvement. My new book will be a start to that coaching.

Other books can help begin the process, as well, including Stephen Covey’s Seven Habits of Highly Effective People, Jim Collins’ classic Good to Great and a little volume from Dr. Timothy Clark called The Leadership Test.

Above all, remember, “If nothing changes, nothing changes.” Start that change process today to becoming the leader you’ve always wanted to be. You will reap the rewards.

Bob Spiel is the author of the soon to be released book Flip Your Focus: Igniting People, Performance and Profits through Upside-down Leadership. Bob is a team builder whose passion is developing genuine leaders and building high performance teams. His firm, Spiel & Associates (www.Spielconsulting. com) transforms general and specialty practices by building leaders at all levels through a process of Transfacilitative Coaching ™ -- acting as a catalyst for practice owners and their teams to discover, connect and commit to new levels of personal and team performance.

In his over 10 years of consulting and speaking, Bob has seen time and time again that leadership can be taught and teams can be remade – what it takes is genuine desire, the willingness to be coached, and an unwavering commitment for growth. Throughout his 30-year career Bob he has been called “Mr Team”, and has had the opportunity to take on tough turn-around situations as a hospital CEO, Surgical Center CEO, and also as an Operations Director for two Fortune 500 companies where he led teams of up to 500 people while establishing world class systems and cultures. He now consults dental practices nationwide. He can be reached at Robert@ spielconsulting.com .

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Practice Builders

Ten Elements for Practice Success Wayne Kerr, DDS

W

hen I reflect on my first few years of practice, I sometimes wonder how I ever succeeded. Now, with 35 years of fee-for-service private practice experience behind me, I realize I’ve learned a few things. Indeed, it has become my passion to shorten the learning curve for today’s young practitioners.

It’s my sincere hope that you find the following commentary helpful!

1. Understand Your Software Dentists traditionally rely on their business staff to perform the dayto-day operations required by the practice, and either skip software training or fail to use it enough to really understand and benefit from it. Additionally, not knowing your software limits its usefulness to the practice owner (particularly with regard to practice statistics) and leaves you wide open to embezzlement.

2. Know Your Practice Numbers and What They Tell You About Your Business At the very least, calculate your break-even point so you can plan for profitability. Use a financial software program like Quickbooks and enter each month’s practice expenses by category to create an operating statement. Then, compare your monthly practice expenses to a table of “best practice averages” to determine your strengths and weaknesses, and then make adjustments as needed.

3. Recognize What Business Cycle Your Practice is In Understanding whether your business is growing or plateauing significantly impacts your practice reinvestment decisions. Issues of capacity must be recognized and understood in order to resolve them. Does the practice need an enhanced facility, additional equipment or team members, or some combination of the three? Will the monthly investment to expand capacity to grow the practice be less than ten per cent of the monthly gross?

4. Invest in Team Training Not only do dentists traditionally fail to spend money to give advanced training to their employees, they often hire candidates with “experience” because they don’t know how to train them in the first place! It’s critically important that the doctor realizes that he or she is only as good as their team! Every employee should have software and

30 Winter 2017 Dental Entrepreneur

job-specific training with DVDs and manuals, or clinical protocols and materials manipulation, plus cross-training before they ever go “live” with a patient. Numerous resources are available for in-house training.

Use them!

5. Time Your Procedures Research conducted by Futuredontics indicates that being seen on time largely impacts whether a patient will or will not return. Time your most common procedures to determine how long they typically take.

Use software with 10-minute intervals in the appointment book for greatest flexibility. Add an additional unit or two of time when working on a particularly challenging patient, or for a difficult procedure. Finally, always keep an empty operatory for that patient-of-record that must be worked in for an emergency, or for that hard-to-numb patient that always requires extra chair time.

6. Start Every Day With a Team Pre-Treatment Conference or Huddle Much of the day’s success will be determined by the information and energy shared between team members regarding the day’s patients. Are we seeing someone new? What do we know about them? Is anyone being seen in hygiene with incomplete treatment? If so, why? Is it financial or insurance driven, or did we fail to create value for our recommended care? Will anyone go to hygiene from treatment? Will they be numb or have a temporary? Is anyone having a birthday or special event? Is there a practice Facebook opportunity today?

7. Schedule the Morning’s Production to Meet or Exceed Overhead

by Lunchtime If 82 percent of production after overhead is met, it goes to the bottom line. Treatment plan quadrant dentistry for two patients each morning, and watch your profitability soar!

8. Check Your End-of-Day Report Every Day Verify that the deposit and day sheet match. Do your own banking and pay your own bills, or delegate those tasks to your spouse. If you delegate, pay your spouse, as that lowers your federal tax liability, and keeps wealth in your family.

9. Update a Personal Financial Statement Annually

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Do this at the same time each year to give yourself a “global� view of your financial progress. Doing so will help you balance practice versus family decisions. Do we buy another digital sensor for hygiene, or finally put in the family pool?

10. Educate Your Spouse If your spouse does not work in the practice, ensure that he or she knows the management software, all user IDs and passwords, and has signature access to all business accounts. Consider establishing a relationship with a transition specialist early in your career, or adding a codicil to your will to protect the practice and your loved ones in the event of an untimely death.

Good luck, and best wishes for your continued success!!

Wayne Kerr, DDS Sharing thirty-eight years of clinical and business experience with the dental profession, Dr. Kerr earned a Mastership in the Academy of General Dentistry, and was honored by the Academy in 2011 with its presentation of the Life Long Learning and Service

Recognition Award.

In addition to his private practice, he helped establish a free clinic for the indigent, and served as a Field Evaluator for CRFoundation for twenty-three years.

He has been awarded Fellowship in both the American and International Colleges of Dentistry, as well as the Pierre Fauchard Academy. Additionally, he is a member of the Hinman Dental Society, an Honored Fellow of the Georgia Dental Association, and has been recognized by state and local organizations as Dentist of the Year, Small Business Person of the Year, and Citizen and Professional of the Year.

Power to Succeed

Chasing and Finding Balance Christina Blatchford, DDS

I

want to have it all! How can I balance a professional life, my family and my friends to have any personal time for me, my health and happiness? Men and women struggle the same, and this is the biggest challenge, finding the right life balance.

With a little work and discipline, you can have it all. But first, you must define “all.” What areas are most important to you? What does practice success look like? What is the depth and quality of family time you desire?

What are your goals for health and spiritual life? Map them all out and put some numbers, hours and goals behind your list.

In 2017, personally, what do you want to accomplish? Write it down and break it up into workable parts. Saying you want to “spend more time with the family” is lovely, but what does that mean on a weekly and daily basis. What are you willing to do to make that happen?

As a professional person, to make more time for your family, you may want to make more money in less amount of time, which is definitely attainable. To have meaningful time for your family, you might consider having a person grocery shop, make dinner and clean up on the days you work. Would that provide you with some of the family time you want, or would you end up answering emails and reading dental blogs?

Since your work is how you make a living, let’s reach a degree of satisfaction in your practice. A better balance will occur when the engine running your life is operating successfully. Define success in your practice. Is your take-home what you expected?

Is your team performing with your leadership? Is there passion present? Are you using effective scheduling? Is your team cross-

32 Winter 2017 Dental Entrepreneur

trained and willing to fully participate? Are they selling dentistry?

Finding balance between your professional and personal lives becomes messy and frustrating when you try to mix the two. The division of your practice life and personal life will be more successful if you create barriers and guidelines to separate the two.

According to Strategic Coach, define your days as focus days, buffer days and free days … and don’t mix those days. This requires discipline and balance. In your practice, define focus days as patient contact days or “hands in the mouth.” You are scheduled to goal, your team is accountable for their results and there are no interruptions of non-work details. You can totally focus on patient care.

Buffer days are preparation for work days, and this is when you network in the community, cross train your team, work on sales conversations, create solid systems, study numbers, make big decisions, communicate and read. There are no patients. You need one day or half-day to fully prepare for focus or work days.

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Free days are the most difficult to discipline. Free is free. There are no work phone calls or emails, no paper work, and no visits to the accountant. This is free time to take for yourself, your family and your friends. Many times we hear from doctors who say, “I want to get back to the person I used to be—relaxed, crazy fun with my friends and interesting.” This is the real you doing what you enjoy. Plan these days. Let your family know your parameters and they will help you keep your time free.

In these changing times, some dentists’ first impulse is to spend more time at the office to bring in more income. Unless you are turning people away and simply can’t treat them, spending more time at the office is a fallacy. Blatchford Block Booking is team-working with a goal and repeating every focus day. Especially during challenging times, we need balance to be refreshed and ready for a full day of patient care.

We are caught up in the electronic age, never really having a full vacation or taking time for an original thought. If we allow it, someone can reach us every minute. We love it, we hate it and we can’t seem to escape it. We use our work to remain so involved. Achieving balance requires discipline. Do you want balance enough to separate yourself from your devices? At work, can you check your emails at noon?

What do we really accomplish by being a slave to the Internet? Are we real or becoming robots or automatons?

How do we live in today’s world and keep it balanced? There needs to be motivation to make a change to better balance. We are in control of our time.

We make the choices. Some people say, “I wouldn’t know what to do with a free time,” or, “I need to be more successful so I can take time off,” or, “I don’t feel comfortable unless I am working,” or, “I

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Dentistry is the best profession for making your life happen well. feel guilty taking time off.” We actually sabotage ourselves from being balanced.

We are choosing to work instead out of guilt, fear or the unknown. We are choosing imbalance.

Choose balance by creating a practice where you are in charge and not a slave to your work. Most dentists have daily schedules with a silent goal or no goal.

Having solid goals and communicating them allows team members to participate in your excitement. If you could produce the same amount of work in one less day a week and pay your team as they are now being paid, what would be the reaction of your team?

It takes impassioned leadership, communication, mastering sales skills and having solid systems (scheduling, financial arrangements, patient care) in place so there is consistency and fool proof care. This is a focus day, and everything is organized and on point. There is calm and joy because everyone is cross-trained and can make decisions based on the leader’s vision. The dentist is totally focused on patient care and does major work during the morning blocks.

I also think it is important to balance your whole life. Are you on a path to work very hard for 25 years and then retire completely? Not everyone adjusts well to this abruptness. Another option is to practice well three days a week throughout your practice life, taking six to eight weeks off a year and be balanced in home and practice. This style of practice will allow you to continue practicing at your own pace for as long as you want. We call this “Retire As You Go.”

Besides controlling your Internet time, other aspects of creating balance is learning to decline to everything you find superficial or non-essential, things that don’t add value to your life. Watch your health and take all the tests available as well as the vaccinations. Learn to sleep well. Get rid of toxic people who can surround you and usurp your energies. These include whiners, negative energizers and drama persons. Choose successful people instead. Fight for alone time for meditation, read, yoga and growth.

Improve quality time with your family. Turn off the television and talk. How about outsourcing your errands like grocery shopping, lawn mowing, and dry cleaning? Treat yourself well with massages and pedicures. Take a new route to work. Try walking or biking. Take a class for your own enjoyment like photography or cooking. Learn to laugh hard and often. You need some belly laughs.

Dentistry is the best profession for making your life happen well. As an owner, you have flexibility to lead in the direction you choose, and your practice can support those choices. Many dentists rate the practice as No. 1 and rarely have any time or money left over for their life.

Blatchford Solutions can help you make your life your top priority and make the practice support that with more time and net return.

Dr. Blatchford has a private practice in Milwaukie, OR. See her articles on DentistryIQ and DrBicuspid as well as in Dental Economics.

Their latest book is Bringing Your ‘A’ Game 2.0 and available at (541) 389-9088 or Blatchford.com. Her email is drb@ChristinaBlatchford.com

Dental Entrepreneur Winter 2017 33

Power to Succeed How Not To Fail Miserably in Clinic David Rice, DDS

I

I shared the quantity of questions that rain in daily asking how to best succeed as a dentist, I’m pretty sure you’d fall over. That said, the answer ties to the title above, and the “why” behind the C in igniteDDS’s CRUSH acronym.

Your Clinical Education is THE foundation to your success!

You and I have to walk our clinical talk or all the brilliant business moves in the world become one-hit wonders … and let’s face it, VH1 aside, none of us care about one-hit wonders.

So how do you not fail miserably in clinic?

Here are three simple and simply critical rules: 1. Come Prepared Set yourself up for success with your faculty and your patients by studying up on whatever it is your patient is coming in for.

When a faculty member asks what you’re doing today and you don’t know … YIKES! As a former faculty member, nothing made me feel better about you than knowing you did your homework. And nothing put you further behind the eight-ball than when I knew you were winging it. Seriously, all these years later, I can name the top 10 and bottom 10 students I worked with based on how prepared or unprepared they were. It matters!

one winner? Well, if you’re anything like the 5,000-plus who emailed us over this last year, I’m guessing you have better things to do.

So here’s the scoop. I get it—watching a short video is king compared to reading textbooks.

Would you like the best clinical videos in dentistry? From the international leader in dental clinical CE? And the top clinicians in the country? Yeah,, me too. In fact, so much so, I pay $3,000 a year for access.

But, because you’re reading this in Dental Entrepreneur, I have a HUGE gift for you. Go to the link below. It’s your golden ticket … your dental Wonka Bar of sorts … to FREE CE from our friends at Spear Education. We’re so pumped to gift this to you! https://ignitedds.com/app/clinical/ Oh, and if you do the same with this link [https://ignitedds. com/app/ebooks] there’s even more content in ebook fashion.

Our treat.

If you want to be a true dental entrepreneur, remember that it starts with the clinical foundations you’re learning right now in school. Be prepared. Ask don’t tell. And trash the YouTube. Until next time …

Together We Rise!

2. Ask, Don’t Tell Remember this. You may dominate a conversation by telling, but you control a conversation by asking. So when you want to understand the inner workings of your faculty’s brain, once you’ve showed them that you are 100-percent prepared for the day, ask them a question that shows you get it. Now I’m stoked that you prepped, and I’m excited you are, too.

To that same point, if you want your patients to say YES to your treatment plans, stop telling them about their dental problems and start asking them about how you can best help them accomplish their goals. Then do yourself a solid—stop talking, just listen. I promise you they’ll tell you everything you need to know to help them to YES. And I don’t know about you, but yes sounds so much better than no.

3. Trash the YouTube Videos What????? Oh yes I did. Seriously, how many hours are you spending searching through hundreds of busted videos to find

34 Winter 2017 Dental Entrepreneur

Dr. David Rice graduated cum laude in 1994 from The State University of New York at Buffalo’s School of Dental Medicine. In 1995, he completed his general practice residency from the Allegheny General Hospital in Pittsburgh Pennsylvania. With a strong belief in continuing education and mentorship, Dr. Rice went on to complete continuums at the Pankey Institute, The Dawson Center and The Spear Center all while building the Restorative Practice of his dreams and maintaining an associate clinical professorship at the SUNYab School of Dental Medicine.

Dr. Rice combined his passions for teaching, mentoring and making a difference and igniteDDS was born. Today he continues to maintain his private practice and travels the country inspiring dentistry’s future to live their dream, have great success and to make that same difference that has brought him so much joy.

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The National Leadership Conference provides leadership training to dental students across all years and predentals. Attendees can create customized schedules based on their personal knowledge, experience and interests, in order to benefit them as dental students and future practitioners, as well as leaders in organized dentistry. Last year, almost 600 student leaders came together to: • Build relationships with leading dental organizations • Develop leadership skills that they’ll use throughout their dental careers • Increase understanding of key issues in dentistry and dental education • Connect with vendors during breakout sessions, on the tradeshow floor of the dental expo, and during various networking breakouts throughout the program • Attend sessions on chapter management, public speaking, personal finance, practice negotiations and more

Index of Advertisers ADS Dental Transitions South……………………………………………………………............................. 7 ADS Dental Transitions…………………………………………………………….................................... 11 Comfort Dental Dentist Advantage................................................................................................. 21 D5............................................................................................................................................. 35 DeW.Life..................................................................................................................................... 38 Henry Schein PPT ....................................................................................................................... 17 Henry Schein Nationwide ............................................................................................................. 37 Hinman ..................................................................................................................................... 19 MacPractice................................................................................................................................ 23 Orascoptic .................................................................................................................................. 16 Paragon...................................................................................................................................... 29 Patterson Dental.......................................................................Inside front cover/page 1, and page 35 Patterson Advantage.................................................................................................................... 27 The Progressive Dentist................................................................................................................ 31 Wells Fargo................................................................................................................................. 13 36 Winter 2017 Dental Entrepreneur

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