Dental Entrepreneur Spring 2013

entrepreneur

class of 2013 | SPRING issue

dental

Business Beyond the Classroom

Hurdles of a First Year Dentist

Getting Your Financial House in Order The Sex Talk – How to be a Great Lover / 100% Treatment Case Acceptance

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entrepreneur Spring 2013 Volume 15, issue 2 Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Production Ruthie Gordon Publishers Press Inc. Director of Advertising A.Marie Linesch Editorial Board Dr. Gene Heller Dr. Harold Sturner Dr.Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH,BS. Dr. Tom Snyder Layout and Design John O’Connor

Class of 2013 Contributors Dr. Naomi Sever,

Rachel Wall

Dr. Earl Douglas

Dr. Roger Levin

Joseph D. Jordan

Wes Jankowski

John McGill

Allison Farey

Dr. Charles Blair

Mark Hollis

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 ADuff2@aol.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 2013 Dental Entrepreneur, Charlotte, NC Material herein may not be reproduced, copied or reprinted without prior written consent of the publisher. Acceptance of advertising does not imply endorsement by the publisher.

Welcome to Dental Entrepreneur

class of 2013 SPRING issue

G

reetings and congratulations to all the dental school graduates hitting the open market this spring.

Lord knows we’ve been there – leaving school with the knowledge that countless classes and text books can impart but with the trepidation of applying our learned smarts to the “real world.”

You’ve thought about that, right?

The reason I ask is because I – to be honest with you – didn’t.

I thought I’d just easily slide into the workplace. Finding a job would be easy. Finding my career path would be a cinch. While I did score a gig, I saw so many who were not so lucky. And so many who weren’t sure what they wanted to do once they found their choice spot.

But, I had the honor of attending the first ASDA National Leadership Conference in Chicago last November. What I noticed in the majority of the 350-plus students was an energy and professionalism that they had made the right choice to pursue their dream of becoming a dentist and contributing to the profession in the future.

Are leaders born or are they made? Well, I believe a little of both, and those that attended the conference advanced their own unique leadership skills. Believe me, the effort to get there will surely pay off in the future.

After all, your patients and your staff will look to you for all sorts of answers, and I feel honing your leadership skills will prepare you for the road ahead.

That’s where we at Dental Entrepreneur: Business Beyond the Classroom would like to help. Sure, you’ve done the clinical work, and you’ve read everything you possibly could about the practice of dentistry.

But what about the business side of things? I’m talking about the numbers. I’m talking about insurance choices. Even the best way to utilize social media to build your practice – whether that is as an owner or associate.

To give you a hand, we’ve reached out to a select group of experts in several fields who can answer the questions you might not ever have known to ask.

I am happy to announce that Ryan Dulde, ASDA’s former president, will be joining our editorial board. He is not far from where you are right now, in his second year of practice, and his understanding of what you need to know is invaluable. You don’t know what you don’t know, and we here at Dental Entrepreneur will do our best to reach out to the experts in the field to help you speed up your learning curve.

Take someone like Mark Hollis. With 25 years of practice management consultancy under his belt, Hollis provides several reasons as to why going paperless in your future practice can solve a lot of issues – and help save the environment.

“There are new technologies a dentist can implement that will minimize their office’s use of paper and, by doing so, save quite a few trees while lessening office supply expenses,” he writes.

In addition, Earl Douglas offers excellent insight into the decision between owning your own practice and joining on as an associate in his article that is simply titled “What’s Next?”

There are several other heavy-hitters in this issue of Dental Entrepreneur, as well.

I invite you to get in touch with them all – we’ve conveniently listed their information in our contacts list – but people like Well Fargo’s Alison Farey and industry stalwarts Charlie Blair or John McGill, for example, are more than willing to offer even more advice.

At the end of the day – and your dental-school career – we just want to continue to be a resource that you can refer to.

Our magazine might not be as thick as a text book, but with out contributing experts, I believe we carry just as much weight.

Good luck!

All the best,

Anne M. Duffy Publisher 2 Spring 2013 Dental Entrepreneur

www.dentalentrepreneur.com

class of 2013 SPRING issue Volume II

dental

entrepreneur’s

Contents Prologue

4 Hurdles of a First Year Dentist Naomi Sever, DDS

Getting Started 6 What’s Next?

Earl Douglas, DDS, MBA, BVAL

8 Getting Your Financial House in Order Alison Farey

Business Beyond the Classroom Practice Builders 26 5 Ways to Support a Profitable Hygiene Department Rachel Wall, RDH, BS

30 Growing a New Practice in the New Dental Economy Roger Levin, DDS

Business Fundamentals

The Power To Succeed

12 Restrictive Covenant Considerations for

34 The Sex Talk – How to be a Great Lover /

the Associate Doctor Joseph D. Jordan, JD

100% Treatment Case Acceptance Wes Jankowski

16 The Future of Dentistry (Part 2) How Will Changes in Insurance and Managed Care Affect Your Practice John McGill, CPA, MBA, JD and Dr. Charles Blair

22 Using Technology in the Office to Streamline Workflow toward Becoming Paperless Mark Hollis, CEO

www.dentalentrepreneur.com

Fall Entrepreneur Spring 2013 3

Prologue Naomi Server, DDS

Hurdles of a First-Year Dentist

E

arly in my fourth year of dental school, I started thinking about options post graduation. I knew within 10 years I wanted to be owner of my own practice. Yet that wasn’t something I wanted to jump into my first year as a new dentist. I felt confident that my education at San Antonio trained me to be an excellent clinician and gave me a solid foundation to build upon. I was also acutely aware that I lacked the experience that years and thousands of patient interactions provide. In addition, I knew dentistry in the “real” world would be a different experience than the sheltered world of dental school. Speed of my skills, independence in making treatment decisions, and working with assistants, hygienists and front office staff were all areas that I knew I needed to acclimate in order to become a more proficient dentist.

With those concerns in mind I began looking at options and speaking with recent Naomi Server, DDS grads about their experiences employed as a new dentist. I was surprised to hear of the number of people that had changed positions after only a few months at a job, or had to work in several offices in order to get a full work schedule.

When we are trained to do a job as specific as a dentist there shouldn’t be that many variables, right? As I’ve learned over the past year there are differences in every position, and it can be challenging to find a job that is a match long term.

After a lot of research and interviews I accepted a position in a private office as a full-time associate. There was a verbal agreement that over time as the practice grew I would buy in as a partner. I relocated back to the west coast and started working full-time in the office. After only a few short months it became apparent that there was not

4 Spring 2013 Dental Entrepreneur

the patient base available in the practice to keep me busy full time, nor provide enough financially for me to cover my student loan payments that would be starting any day. I was down to three days a week and more than half of my schedule was booked with recall prophy appointments.

More importantly, I began to learn more about the practice philosophy and values and was having internal battles because those values did not align with mine. I was starting to define my own values of highest ethical standards and patients as priority. I was seeing how these were not the same values of the practice on a daily basis.

I knew it was time to move on and look for another position that would be a better fit.

As I explored different opportunities, I opened up my search to more locations and types of practice. That allowed me to find a community health clinic in rural Kansas. It was full-time, I was the only dentist with an experienced staff, consistent salary and potential for loan repayment. I took the job as an adventure and a chance to provide for patients that otherwise would not be able to receive care. In less than a month at the clinic, my skills improved exponentially. My speed increased, my comfort working with assistants, my ability to see patients out of multiple rooms and my patient communication skills became even better. And I felt a sense of personal happiness providing dental care to the lower income population. As the months went on, burn out began to set in, and disagreements about treatments started with the administration. My direct supervisors had no background in dentistry and would repeatedly raise objections about treatment provided and prescriptions written. After several encounters, I started a job search to return back to a private office as an associate. The community clinic was a wonderful experience and helped me solidify that I wanted to work with and learn from another dentist.

I filled in as an associate at Boynton Family

Dentistry in Wichita for about six months where Dr. Kreg Boynton was my mentor. The experience is exactly what I needed to regain my love of dentistry and realize that there are practices where my values will align and that I don’t need to compromise those values.

After this long, crazy trip with several stops over the past year and a half, I have finally found a home, both personally and professionally. I landed in Colorado Springs, Colo., and am an associate at the Center for Family and Cosmetic Dentistry, working for Dr. Andrew Miller. We share common values and future goals. I enjoy every day at work, which allows me to provide the best patient care. We have begun discussions of partnership because I know this is an excellent fit for me and my career.

In my last years of dental school, I never would have thought I would take this route to finding a permanent position. Yet, I am grateful for the experiences I have had because it reinforced my core values and helped me to define who and what I want to be in my profession. If I could go back to my fourth year of dental school and give myself a piece of advice in the job search it would be to not compromise and be patient.

The right position is out there. It just takes time and knowing yourself to find the proper fit. ■

Dr. Naomi was born and raised in Southern Oregon; from there she went to Medford Massachusetts and completed her undergraduate education at Tufts University. After several years of a career in dental product sales she went on to obtain her Doctorate in Dental Surgery from the University of Texas at San Antonio graduating with distinction in dental education and research. Some of her professional memberships include: American Dental Association, Colorado Dental Association and the Colorado Springs Dental Society.

www.dentalentrepreneur.com

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Getting Started Earl Douglas, DDS, MBA, BVAL

What’s next?

I

remember many years ago what was going through my mind at this time of my senior year in dental school.

“What will I do next?” was the burning question. My first plan was to start a new practice with a classmate. That plan fell through when my friend decided to open his own practice in another town. That left me with the option of opening my own solo practice.

I went through Earl Douglas, DDS, the process of MBA, BVAL choosing a space, designing the office, picking equipment and so on, but those plans hit a brick wall when I could not find financing for my start-up. That was probably a good thing, as I could have been drafted into the military, leaving my new start-up practice unattended and payments still due. Then I applied to the military. The Navy and Air Force had their quota of dentists, but the Army was accepting new patients and new dentists. And that is how, quite by elimination, I started my dental career.

Looking back, I have to say that those Army years were excellent in preparing me for my eventual civilian private practice, at least in honing my clinical skills. At that time though, nothing could have prepared me for the business part of private practice other than just taking the plunge.

But enough about me, how are your plans coming along? When I lecture to senior dental students about their options after graduation, most students tell me that they plan on becoming associates.

There are a number of students planning 6 Spring 2013 Dental Entrepreneur

on going into residencies, and only a few people plan on going into their own practice. The greatest majority of students say that they eventually want to own their own practice, but have chosen to postpone that step.

The decision of most students to become associates is of concern to me.

Since the economic downturn of four years ago, many practices have stagnated or declined in revenues. Many practices with associates saw that their associates’

production declined and even resulted in associates being terminated. In my current experience, I am seeing less demand for associates by practitioners since there is still more economic recovery to be made before there is enough excess treatment which would require hiring associates again. This is closely analogous to American business at large, which is still cautious about hiring new employees.

These circumstances cause me to wonder how the majority of new graduates will www.dentalentrepreneur.com

find successful positions to join.

There is an alternate source of associate positions that has been recently growing.

These are the dental management companies that own multiple practices. The growth of these companies has resulted in many opportunities for dentists seeking associate positions, and the best of the companies offer many opportunities for continued professional, clinical and educational growth.

The military still represents a source of positions for dentists and can provide residencies and other opportunities for professional growth. My military experience provided me with a wealth of dental experience, pilot licenses and a three-year tour of Europe.

I am most gratified, however, by the students who do choose to make practice ownership their first step. I do have a strong bias in that I believe this step should be in the form of buying an existing practice rather than starting a new practice. There are many challenges in entering into one’s own practice, and I believe in minimizing the number and impact of them. The advantages of buying a practice over a start-up are numerous.

The first advantage of buying a practice, which did not exist when I got out of the Army and bought my practice, consists of the dental specific professionals who can analyze practices for buyers.

Dental practice brokers, dental-specific accountants and attorneys, and dentalspecific lenders can examine prospective practices for buyers and ensure that buyers understand each opportunity fully.

They can point out the strengths and any weaknesses that need correcting and how to correct them. Risky ventures will be exposed, thus protecting buyers as much as possible from getting into a bad situation. See examples of practice descriptions and how critical data is presented at www.adssouth.com.

An extremely valuable benefit of a practice purchase is the instant cash flow, so buyers can start making an income from the first month, rather than spending more than they collect for a number of months, as in a start-up. There is an existing patient base to treat and to stimulate for referrals. Rather than startwww.dentalentrepreneur.com

ing with no patients, there may be a base of 600-1,000 patients. One of the best benefits to practice purchase is that in the great majority of practices that I examine, the profit from the hygiene department – after paying the hygienist salary – will equal or exceed the loan payments for buying the practice. This rarely happens, if ever, in practice start-ups.

A very important advantage of purchasing a practice is the presence of a trained, experienced staff that knows how to make the practice run efficiently, and very importantly, knows the patients personally. The staff and the existing management systems result in a huge advantage over a start-up situation in which the owner must establish management systems and hire and train a new staff, while the start-up dentist may not even have the information or the skills to perform these tasks.

Another benefit of a practice purchase is the seller themself. The seller is a great source of knowledge, skill, and experience that the buyer can benefit from.

From questions about the equipment, the patients, the staff, marketing, computers, treatment plans, insurance companies and much more, the seller can help the buyer work efficiently through the ownership process and avoid the many mistakes a start-up dentist could make.

Another resource for new owners is the availability of management consultants.

These resources did not exist when I went into practice, so I had to try to figure out how to run and manage my practice by myself. New owners can benefit greatly from consultants who can teach and even implement management, marketing, treatment plan acceptance, scheduling, hiring and terminating staff, and other critical areas of practice management.

They bring proven principles to their clients and invariably pay for themselves in a few months from the increased revenues that they bring about.

Another important benefit, although hopefully it is not needed, is that the value of a purchased practice is pretty much the same after the purchase as before. Contrast this to a start-up which usually carries much more debt than the practice could possibly be sold for in its

early years. In the event of a death or disability or other need to dispose of the start-up, it may be impossible to sell it for anything near what is owed, whereas a purchased practice could be sold for very close to what the owner owes for it.

There are some disadvantages to purchasing a practice, though. A buyer cannot always find exactly what kind of practice they want, or where they want to be, or when they are ready to buy.

Compromises may need to be made in identifying and acquiring a practice.

Equipment may not be what the buyer would like to have, and systems and software may need updating. Some staff members may need further training or even replacing. Office lease terms or sale terms may pose a problem, as would the presence of associates or partners in the practice. Sellers may want unrealistic transition periods which could impact the buyer’s cash flow, or not be available when their presence may be required for maintaining productivity.

In my experience though, dentists who own their own practices are the happiest and most financially successful. They control their own destiny and the profit they make and the growth they bring about is theirs and not someone else’s.

Owners enjoy the tax benefits that come from a purchase and greater flexibility in deductible expenses than an associate would have. Today’s environment is more supportive of practice purchases than in previous years, with interest for loans at an all-time low, excellent availability of financing, excellent tax benefits, access to professionals who can help in every aspect of the practice, and the opportunity to acquire a practice that should grow as the economy is recovering. What are you waiting for? ■

Earl Douglas, DDS, MBA, BVAL, is the founding president of ADS, a company with independent practice brokers, appraisers, and consultants nationwide. His company, ADS South serves the Southeast and South Central US. He can be reached at 770-664-1982 or at douglas@adssouth.com. Visit the website at www.adssouth.com Dental Entrepreneur Spring 2013 7

Getting Started Allison Farey

Getting Your Financial House in Order

I

f you’re thinking about purchasing or starting your own practice within the next few years, now is the time to get your financial house in order. This means ensuring you have a strong financial profile that generates borrowing power and a strategy for creating long-term financial success.

Importance of a Healthy Credit Report Developing a healthy credit profile is the first step in building financial strength.

Credit is the basis for virtually all large financial investments, whether you’re buying or building your first dental practice — or your first home.

Personal lifestyle choices, from boats Allison Farey and RVs to second homes and property, are typically driven by the ability to obtain credit.

The credit reports generated by the national consumer reporting companies Equifax, Experian and TransUnion form the basis of your credit profile. The credit report is one of the key documents that lenders use to determine your credit worthiness and includes information about where you live, your debts, your payment history, public record information and all inquiries about or applications for credit.

The consumer reporting companies sell your credit information to companies other than lenders as well, such as mobile phone companies, insurance companies, employers and landlords, for their use in evaluating the level of financial risk or 8 Spring 2013 Dental Entrepreneur

responsibility you represent.

A poor credit report can limit the amount of financing available to you and constrain the repayment terms of your financing package.

Understanding Your Credit Rating Your credit rating or score is separate from your credit report and is another aspect of your financial profile. It is a numerical expression of your credit worthiness based on a statistical analysis of your credit files. Officially called a FICO score (from the former Fair Isaac Corporation, which invented the score), credit scores range from 350 to 850, with 723 being about average for the U.S. Those with scores below 600 are typically considered high risk borrowers. People with the same credit rating can have very

different credit profiles depending on such factors as how many accounts they hold and how much available credit they use.

How Credit Scores Affect Interest Rates Your credit score directly impacts the interest rate you receive on a loan. The most critical factors for your lender when evaluating your loan application for a practice purchase or start-up are the amount of your personal debt and your overall credit rating. Credit decisions for practice acquisition loans are usually based on an assessment of practice cash flow and your ability to repay the loan while covering your business and personal expenses. Credit decisions for practice start-up loans are primarily based on your www.dentalentrepreneur.com

Impact of Credit Scores on Interest Rates Credit Score

Rate

Practice Loan Payment (sample only)*

766+

5.55%

$3,263

765 – 726

5.95%

$3,323 (+$7,000 over life of loan)

725 – 665

6.35%

$3,384 (+$14,000 over life of loan)

Below

Applicant will probably be turned down

*Payments based on a 10-year, $300,000 practice loan debt-to-asset ratio. The amount of your personal debt will factor directly into both equations.

Generally, a low level of debt and average to good credit rating yield a higher credit limit and lower interest rate. A higher debt and average to poor credit rating usually mean a lower credit limit and higher interest rate.

When you are charged a higher interest rate for a more limited financing package due to an unhealthy credit profile, you ultimately have less cash flow to effec-

www.dentalentrepreneur.com

tively manage and grow your business.

The impact on the future of your practice can be significant in the following ways: • Less funding to purchase or start the practice you truly want • Inability to fully develop a competitive operation with equipment and technology investments • Fewer funds for start-up salaries, marketing and overhead • Smaller profit margin due to higher loan expenses

• Potentially a higher hurdle for achieving meaningful financial success

Five Actions That Can Ruin Your Credit Score FICO has cited five credit actions that can ruin your credit score — actions you should completely avoid if possible. The chart below shows the negative impact these actions typically make to two sample credit scores.

-- “Maxing out” a credit card is considered a sign that you are in over your head. It doesn’t matter to the score formula whether you carry a balance or pay off the card when you get your bill – the impact to your credit score is the same.

-- Skipping a payment can be a problem if you miss an entire payment cycle. Consider setting up automatic payments, particularly for large debts.

-- Settling a credit card debt can take a bite out of your credit score

Dental Entrepreneur Spring 2013 9

Actions that Can Ruin Credit Scores Credit Action

680 Score Impact

780 Score Impact

Maximized credit card

-10 to -30 points

-25 to -45 points

30-day late payment

-60 to -80 points

-90 to -110 points

Debt settlement

-45 to -65 points

-105 to -125 points

Foreclosure

-85 to -105 points

-140 to -160 points

Bankruptcy

-130 to -150 points

-220 to -240 points

Source: FICO: 5 Ways to Kill Your Credit Scores, Liz Pullam Weston, MSN Money, November 12, 2009 with each missed payment while you work out a settlement. Try negotiating a monthly payment plan instead.

-- Losing a property to foreclosure is a severe blow to your credit score and may have implications for your future ability to get a mortgage.

-- Filing for bankruptcy drops your credit score significantly and makes new credit extremely difficult to obtain.

10 Simple Steps to Good Credit The good news is that you have the ability to build and manage a strong financial profile. Following are 10 simple steps you can take right now to improve your credit report and rating: 1. Maintain at least two or three revolving credit accounts (such as credit cards and lines of credit). This indicates you are credit worthy and able to manage debt.

2. Avoid applying for credit from too many lenders. Multiple credit inquiries made within a short timeframe will negatively impact your credit rating.

3. Demonstrate that you know how to use your credit wisely by not using all the credit available to you.

4. Make on-time monthly payments on credit cards, mortgages, installment loans and student loans. Remember, most service providers such as doctors’ offices and cell phone companies do report late payments and collections to credit bureaus.

5. Consolidate your personal loans in order to improve your cash flow and 10 Spring 2013 Dental Entrepreneur

financial profile.

6. If you are in dispute with a creditor, continue to make minimum monthly payments while you work towards a resolution.

7. Notify creditors in writing of your address change.

8. Avoid co-signing or guarantying a loan for a friend or family member, as it has the same impact on your credit as being the primary borrower.

9. Review your personal credit report at least twice a year to ensure accurate reporting of all accounts. Inform all credit bureaus in writing of any discrepancies.

10. Keep copies of all agreements, documents clearing judgments or liens, and letters from creditors clearing incorrect information reported on your loan history. Remember, all credit information stays on your records for up to ten years.

Developing a Strategy for Financial Success Financially successful business owners understand how to recognize and solve problems as they arise, and take advantage of opportunities that present themselves.

They create a plan for their future, modifying the plan as circumstances require.

Following are general guidelines for developing a strategy for long-term financial success for your practice. For a complete financial plan, meet with your CPA or financial advisor.

• Do not take on more debt than you can comfortably handle. Work with your CPA to determine the appropriate amount of debt for your situation.

• Create business and marketing plans that specify how you will achieve annual growth in number of patients and level of production.

• Create a regular schedule for reinvesting in your practice to keep it current and competitive, for example, with equipment and technology upgrades.

• Monitor your practice statistics on a monthly basis so you can quickly spot areas of weakness.

• Work with your tax advisor or accountant to take full advantage of tax benefits for small business owners, such as the Section 179 deduction for equipment purchases.

• Create a realistic plan for retirement that does not rely exclusively on the sale of your practice, but includes other investments, as well.

• Partner with a lender who understands the dental industry and can structure a financing package that satisfies your particular needs.

Having a well-managed financial profile helps secure the financing you need to purchase or build the practice you truly want, while a strategy for financial stability works to ensure the long-term success of your practice. Don’t procrastinate — it’s never too soon to start getting your financial house in order. ■ Allison Farey, President of Wells Fargo Practice Finance, has more than 25 years of experience in dental practice lending. Wells Fargo Practice Finance specializes in helping dentists acquire, start and expand their practices with its customized financing and signature Practice Success Program. For more information, call 888.937.2321 or visit wellsfargo.com/dentists. www.dentalentrepreneur.com

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Up to 100% financing to help you acquire an existing practice or start one from scratch Preferred pricing for ADA® members with rates at historic lows Expert project support by experienced practice financing specialists Complimentary business planning tools, educational resources, and practice management consulting to help you successfully manage your transition to ownership

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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.

All practice financing is subject to credit approval. © 2013 Wells Fargo Bank, N.A. All rights reserved.Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

Business Fundamentals Joseph D. Jordan, JD

Restrictive Covenant Considerations for the Associate Doctor

A

In today’s litigious environment, more and more doctors are deciding to protect themselves when it comes to bringing on an associate doctor. This protection, more often than not, is in the form of an employment agreement, which is executed by both parties. For many associates, this agreement is viewed as little more than a hurdle between them and the ultimate start date.

However, as these agreements become Joseph D. Jordan, JD more common, it is important for any associate to give these documents the time and consideration they deserve. Although many aspects of the agreement are important, there is one that has far reaching ramifications for the associate doctor: the Restrictive Covenant.

Simply defined, a restrictive covenant is the associate’s promise to refrain from action, for some period of time, within some geographical location. They are generally made up of two promises: First is the promise that the associate doctor will not compete against the host doctor during employment or after the employment is terminated. This is considered the “non-compete” agreement.

The average non-compete prevents the associate doctor from acting as an associate, independent contractor, owner, stockholder, or any other position allowing the associate to offer services to patients that would compete with the host doctor.

Depending on the jurisdiction, some noncompete agreements may also contain 12 Spring 2013 Dental Entrepreneur

a “non-treat” provision. Although not enforceable in all jurisdictions, a non-treat prevents the associate from providing services to a prior patient of a practice, regardless of the location and whether the patient sought out the associate of their own free will. Non-treats are less common, but should be kept in mind when reviewing any non-compete.

Second is the promise that the associ-

ate doctor will not solicit the patients or staff of the host doctor. Much of the value of any dental practice is the patient base, and most host doctors will go to great lengths to ensure that the patient base is protected. When an associate doctor agrees to refrain from soliciting patients of the practice, they are agreeing to not contact the patients in any way, during employment or after the terminawww.dentalentrepreneur.com

tion of the employment agreement, for the purpose of having the patients visit another dental office or doctor. This can be as simple as a blast email to an associate’s former patients, letting them know where the associate is now working. Some non-solicitation agreements will contain specific language as to what is considered a breach of the agreement and what is not. For example, under one agreement, running a newspaper add announcing the associate’s joining with a local office may breach the non-solicitation, and under This applies to the associate attempting to another, it may not. It is clear to see directly hire the employee or attempting why it is important to understand your to convince an employee to seek employspecific agreement prior to taking action. ment with any other doctor. Alliances are Staff, also being an important asset of often formed with staff members during a dental office, will be equally protected employment, however, more often than under a non-solicitation. Much like the not it would be a breach of the associrestriction on soliciting patients, an assoate’s covenant to attempt to take away ciate promises to refrain from attempting staff members after termination for the ADS.south209 2/25/09 1:42 PM Page 1 to hire away employees of the host doctor. restricted time period.

Restrictive covenants can drastically impact what an associate is able to do after an employment agreement.

Because of this restraint on the actions of the associate, they must be “reasonable” and “enforceable” as a matter of law. The terms “reasonable” and “enforceable” are defined differently from location to location, but there are a few things to keep in mind when reviewing any restrictive covenant, the first being location. Depending on where the office is located, different sized restricted areas may be enforceable. For example, a five mile restrictive covenant may be overly broad and unenforceable for a practice located in a downtown metropolitan area.

However, a twenty mile restrictive covenant may be enforceable in a very rural area. Courts often consider the number of other dental practices that the associate is restricted from by the covenant when determining its reasonableness and enforceability. Second factor to consider is the time period for which the associate

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 www.dentalentrepreneur.com

Dental Entrepreneur Spring 2013 13

will be under the covenant. These restrictive periods vary, but are not as greatly varied as the restrictive areas. Typically an associate can expect to have a restrictive period of twelve to twenty-four months.

Going beyond twenty-four months in an associate agreement has not been viewed favorably by the courts or open negotiations. On the other hand, longer terms are regularly upheld for doctors selling their practices due to the benefit they receive. The courts are demonstrating there is a strong public policy that people be able to work. In order to protect that public policy, overly broad or lengthy restrictive covenants will not be upheld.

In some states restrictive covenants are even unenforceable by law.

Having defined restrictive covenants and understanding that they are generally enforceable, prospective associates should know that the breach of a restrictive covenant can carry a heavy price. Most agreements will provide for a number of legal remedies for the Host doctor in the event of a breach. The most common remedies are injunctive relief and liquidated damages. In the event of a breach, a host doctor may ask the court for an injunction, which prevents the associate from working in the area that is in question, until the issue is resolved. Liquidated damages lay out a clear monetary cost for breaching, in some cases it is a total amount, for example $150,000.00, or it can be on a per patient or employee basis for the breach of a non-solicitation. Due to the heavy costs of breaching, and the loss of revenues in the event of an injunction, being proactive and planning around a restrictive covenant becomes necessary.

Be aware that most associates are going to face a restrictive covenant at some point in their professional career.

Planning ahead for the restrictive covenant becomes a necessary step in order to prevent unnecessary restrictions on a future practice. As a general rule, associates should seek associateship opportunities outside of the area they ultimately want to practice long term or own a practice. For example, Dr. Smith recently received her license to practice dentistry and is seeking an associate position. Dr. Smith knows that she ultimately wants to 14 Spring 2013 Dental Entrepreneur

own her own practice in the small town in which she grew up. It would be unwise for Dr. Smith to seek an associateship opportunity in that small town, knowing that when she decides to pursue her own practice, she will be restricted from that area for a certain timeframe. It would be more appropriate for Dr. Smith to seek an opportunity ten to fifteen miles away from where she would like to establish her practice to avoid any future delays.

Another way to plan for your restrictive covenant is to aggressively negotiate the time and distance. Although not always successful, most doctors will reduce the size of the restricted area, or the duration of the restrictive period, in open negotiations. Being proactive during the negotiation phase of the associateship agreement can pay dividends in the long run.

Restrictive covenants are often the price of doing business in dentistry. Associates should expect covenants and should be proactive regarding the negotiating and understanding of their covenants. It is important to realize that pre-planning can help one avoid the costs of a breach, and that there are constraints to be acknowledged. This will help any associate avoid unnecessary pitfalls in the important first few years of practice. â–

Joseph D. Jordan JD, is the President and founder of Jordan Practice Advisors, Inc., a transition service that provides assistance with transitions in the dental community.

Joseph D. Jordan JD, is an attorney who is focused in the dental field and provides assistance in a range of subjects, from contract reviews to helping place associates. His unique law experience and studies under veterans of the dental industry make him a perfect choice for the needs of the dental community. Mr. Jordan may be reached at (704) 827-5676 or by email: jjordan@legaldent.com. The company’s website is www. jordanpracticeadvisors.com.

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The easiest Dental Exam you’ll ever take

DENTAL MALPRACTICE EXAM When selecting dental malpractice insurance, you should choose: The company with the strongest claims defense The most experienced company The dental malpractice company with the highest financial ratings Medical Protective is “All of the Above”

Before you see your first patient, you’re going to have to choose dental malpractice insurance coverage.

Some new dentists give it little thought and automatically settle for the first insurer they hear about or use their employer’s company. But it’s your career on the line, and there are significant differences in the quality and value of companies and coverage available. Choose the company that more dentists have trusted since 1899 to protect their reputations, practices and assets. Choose the strongest malpractice insurer — Medical Protective.

Ask about our malpractice protection specifically designed for new graduates. dental@medpro.com www.medpro.com 800-4MEDPRO ©2011 The Medical Protective Company®.

Trust the dental malpractice experts.

Business Fundamentals John McGill, CPA, MBA, JD and Dr. Charles Blair

The Future of Dentistry (Part 2) How Will Changes In Insurance And Managed Care Affect Your Practice?

W

hile the percentage of Americans covered by dental insurance has changed little over the last decade, the coverage levels under the different types of plans have changed significantly.

Coverage under fee-for-service indemnity policies has dropped dramatically, while PPO coverage has exploded. Below, Dr. Charles Blair discusses future changes and how they will impact your practice’s profitability and future sale value.

The overall perJohn McGill, CPA, centage of the MBA, JD U.S. population covered by some form of dental benefits has remained relatively fl at over the last decade. In 2001, over 154 million Americans, or 54 percent of the Dr. Charles Blair total population, were covered by some form of dental benefits. Dental coverage peaked in 2008, according to the National Association of Dental Plans 2012 Coverage Summary, with over 177 million Americans covered, or 58 percent of the population. Coverage plummeted by almost 10 million in 2009 as a result of the Great Recession, and then recovered slightly in 2010. Currently, over 175 million Americans have some form of dental coverage, or 57 percent of the population.

Meanwhile, the type of dental plans through which patients have coverage has

16 Spring 2013 Dental Entrepreneur

changed dramatically over the last 10 years, as evidenced by the following chart, says Blair. Dental HMO (DHMO) plans have dropped dramatically from 15 percent of the market in 2001 to only 8 percent in 2010. Blair foresees continued decline for this ethically challenging model (DHMO doctors make greater profits by providing less, rather than more, services to their patients) that neither employer, patients, or dentists particularly like. In addition, Blair also sees no future for the Direct Reimbursement Model as advocated by the dental profession, since it lacks any cost containment features or commercial support, and presently holds less than a 1 percent share of the market.

The percentage of “Cadillac� indemnity plans has dropped dramatically from 38% in 2001 to only 11% in 2010, and is now close to 9%, says Blair. Their market share decrease has been consumed by PPO plans, which have exploded from a 39% market share in 2001 to 74% in 2010. Blair estimates that PPO market share is now

approaching 80%.

Reasons For The Change Blair says several factors account for the explosive growth of PPOs over the past decade. Employers looking to cut costs in this ultra-competitive global economy are the leading factor. While most doctors rebuffed managed care overtures in the highly profitable 1990s, the economic downturn and related busyness problem have spurred many to begin participating.

New dentists locating in urban, not rural, areas have created even greater mal-distribution and competition. Also, the dramatic increase in dental graduates, most heavy-laden with student loan debt, has also sparked an increase in participation as these doctors seek to build a patient base rapidly in the highly competitive marketplace.

Growing corporate ownership has also spurred the PPO rise, since most corporate-owned/managed practices accept PPO plans, Blair adds.

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Schedule DR (Digital Radiography)

Chart

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MacPractice Interface for iPad/iPhone

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EDR (Electronic Dental Record) Orthodontic / Endodontic Charts

Notes

Attachments

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Visit MacPractice.com or call (402) 420-2430 for product information, trade shows, presentations, screenshots and a demo.

Business Beyond the Classroom

Resource Guide

ADA Insurance Plans 888-463-4545 www.insurance.ada.org

Aspen Dental 877-330-1349 www.AspenDentalJobs.com

For loan collateral, debt protection, and financial security, dentists rely on the ADA Insurance Plans for best-in-class life and disability insurance, including free coverage for ASDA members during dental school. ADA members benefit from group rates that keep premiums low and hard to beat. GreatWest Life & Annuity Insurance Company insures the ADA Insurance Plans, and protects more than 130,000 dentists, dental students, and their families every year.

At Aspen Dental we recognize that our success is a direct result of empowering and supporting ambitious dental professionals. We provide a professional, fast-paced, entrepreneurial work environment based on a mutual respect that keeps our interests aligned together, we build and develop successful, patient focused dental practices. Please see our ad on page 5.

ADS Transition Specialists (888) ADS-4237 www.ADStransitions.com ADS is the nationwide leader in dental practice sales, associateships, buy-in/buy-outs, partnerships and appraisals. ADS is comprised of the industry’s most experienced professionals, including dentists, attorneys, and CPAs. We can help you with each step of your next transition. To view a complete list of practice opportunities available in your desired area, visit us at ADStransitions.com. Please see our ad on page 23.

ADS Transition Specialists South 770-664-1982 www.adssouth.com ADS South is the premier dental transition organization in the Southeast. We provide associateship placement, dental practice sales, appraisals, and expert testimony services.

Our company was founded over 26 years ago by Earl M. Douglas, DDS, MBA, BVAL, and we continue to control the cutting edge of transition technology. Please see our ad on page 13.

The Artist Evolution LLC Toll Free: 866-610-5334 www.theartistevolution.com The Artist Evolution is a full service, strategic marketing and design firm with a passion for helping practices around the country to communicate effectively with their target patients, to develop an identifiable brand, and to meet their objectives in a cost-effective way. Please see our ad on page 33.

BB&T Visit BBT.com BB&T is one of the largest financial services holding companies in the U.S. with assets of more than $183.9 billion, more than 32,000 employees and approximately 1,800 locations in 12 states and Washington, D.C. A Fortune 500 company, BB&T is consistently recognized for outstanding client satisfaction by J.D. Power and Associates, the U.S. Small Business Administration, Greenwich Associates and others.

Please see our ad on page 31.

Comfort Dental www.comfortdental.com The Best of Both Worlds At Comfort Dental, we combine the old-style neighborhood dental practice with today’s modern group practice. Equity ownership, autonomy, management of your own business, and long- lasting relationships with your patients is combined with our economics of scale, prime locations, mass marketing, and overhead control. It truly is the best of both worlds.

See our ad on page 29.

Dental Dreams, LLC Dental Dreams, LLC provides families with high quality dental services in a modern technologically-advanced setting.

Because we understand the tremendous value of our associate dentists, we ensure that their compensation package is amongst the best. Our doctors take home an average of$230k/year plus benefits! See our ad on page 9.

Henry Schein Nationwide Dental Opportunities 866-409-3001 www.dentalopportunities.com Henry Schein Nationwide Dental Opportunities is the perfect solution for your Dental Associate recruitment needs. Call 1-866-409-3001 today to learn more about improving your opportunities or success. See our ad on the back cover.

18 Spring 2013 Dental Entrepreneur

www.dentalentrepreneur.com

Business Beyond the Classroom Henry Schein Professional Practice Transitions (PPT) 1-800-730-8883 ppt@henryschein.com www.henryschein.com/ppt Henry Schein Professional Practice Transitions (PPT) is the practice sales division of Henry Schein, Inc. Our affiliation with the largest dental supply company in the country—intent on servicing the practice buyer’s future supply, equipment and service needs―makes PPT the only company with a vested interest in the buyer and a career long trusted relationship with the seller. (Please see our ad on the inside back cover.)

Resource Guide Patterson Dental Supply Inc. 800 873-7683 www.pattersondental.com Patterson Dental Supply Inc. is a full-service distributor of a complete range of dental products and services to dentists, dental laboratories, institutions and other healthcare providers throughout North America. As one of the nation’s largest dental distributors, Patterson Dental sells consumable dental supplies, digital and other dental equipment and practice management software. Please see our advertisement on the inside of the front cover and page 1.

MacPractice, Inc (402) 420-2430 MacPractice.com

Patterson Advantage (800) 328-5536 www.pattersondental.com

MacPractice DDS is the leading practice management and clinical application for dentists who prefer to use a Mac, featuring electronic insurance submission, Mac native digital radiography and photos, charting, Electronic Dental Records, Kiosk, Web Interface, iPhone Interface, speech dictation, and Mac stability and ease of use. Please see our ad on page 17.

Patterson Dental, a leading distributor of dental products, equipment and technology in North America, is the largest business in the progressive, global Patterson Companies family of businesses. Dental professionals who partner with Patterson enjoy the convenience and assurance of relying on one trusted source for everything they need. Please see our ad on page 27.

Oxyfresh Worldwide Inc. 800-333-7374 ref# R23037601 aduff2@aol.com Since 1984 thousands of dental professionals have discovered Oxyfresh’s safe and effective oral health products for use in long-term care and maintenance of their patients. Retail sales, wholesale rebates and “free product” programs allow you to get paid appropriately for providing professional guidance and instruction to your patients. Ad on page 31.

PARAGON Dental Practice Transitions www.paragon.us.com 866-898-1867 Offices located Nationwide. PARAGON offers professional consultation and related services to healthcare professions with primary emphasis on the dental profession: comprehensive dental practice valuations (including a written valuation and analysis report); practice sales; pre-retirement sales; practice acquisitions; practice mergers; associateships; partnerships; practice consolidations and practice management.

References available by request. Please see our ad on page 25.

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Sirona Dental Systems, LLC 800-659-5977 http://www.cereconline.com CEREC AC from Sirona is the most advanced dental CAD/ CAM system available. With its Bluecam, capturing fast, precise digital impressions and then creating high quality esthetic restorations is a reality. CEREC AC delivers access to efficient, precise, scalable and affordable solutions, including CEREC Connect. Call 1-800-659-5977 or visit www.cereconline.com. Please see our ad on page 21.

Wells Fargo Practice Finance 1-888-937-2321 wellsfargo.com/dentists practicefinance@wellsfargo.com Wells Fargo Practice Finance provides customized financing supported by experienced specialists and practical planning resources to help dentists acquire, start and expand their practices. The only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM, we understand the business of growing successful practices and are here to help you achieve your goals.

Please see our ad on page 11.

Dental Entrepreneur Spring 2013 19

Predicting The Future Blair predicts continued market share growth for PPOs in the future, at the expense of all other models. The increasing number of new graduates promises greater competition in the future, aiding further PPO penetration. Escalating student loan debt will also motivate more new doctors to join the PPOs for immediate cash flow. Likewise, continued growth of corporate dentistry and enhanced employer cost containment efforts will boost PPO participation.

Currently, more than four out of five dentists participate in at least one PPO plan (including Delta Dental Premier), and innetwork participation is increasing, even for established practices, says Blair.

Since PPOs have gobbled up the vast majority of the insurance market, how will they continue to expand in the future? Blair predicts that since the employer-sponsored plan market appears saturated and fairly flat, they will target a direct to the consumer (patient) approach for future growth. Given that 43% of Americans do not have any dental benefit coverage, Blair expects competition to heat up in the uninsured market. He foresees insurance companies marketing their PPO networks aggressively to consumers without dental insurance, for a small annual fee (i.e. $75-$100 a year). While this discounted dental market share has decreased somewhat the last several years, he expects some marginal growth in this area as insurance companies look to expand outside the historical employerbased coverage model.

Blair notes that some dentists are now marketing their own in-house discount “club” dental plans to uninsured patients, which typically provide two comprehensive checkups for a flat fee, plus a fixed discount (15-20%) on additional treatment. Some dentists are also marketing a free discount card to small businesses locally that are unable to provide dental insurance to their employees. Thus, inhouse discount plans will increasingly compete with the insurance industry’s discount cards.

20 Spring 2013 Dental Entrepreneur

The Impact Of Managed Care’s Growing Penetration The biggest impact of growing managed care penetration has been its negative impact on fees. In order to penetrate a market initially, managed care plans may use a “Trojan horse” approach, offering to match one or more doctors’ current fee schedules to gain their initial participation. Once they gain additional market share, annual fee increases usually become non-existent (frozen fees) or minimal (1-2% a year), far below the

Once they dominate a dental market, managed care plans often seek to manage the clinical care itself, not just the fees charged, or the coding protocol. level necessary to keep pace with inflation. Blair says that the typical PPO plan he reviews provides fees that are 35-45% below a fee-for-service schedule positioned at the 85th percentile.

Recent developments have been even more troubling, says Blair. In 2011, a major corporation demanded a 15% decrease in provider network costs to continue their coverage with Delta Dental in Washington state. Delta agreed and promptly notified its provider doctors that it was cutting reimbursements to them by 15%. Delta Dental of Idaho similarly cut reimbursements 5-15% to providers, depending on geographical location. Also, Delta Dental of N.J. and Connecticut have recently announced future fee reductions. Blair expects other Deltas to follow suit within the next 1-2 years.

These reimbursement cuts will force participating doctors to work harder and/

or extend hours to boost production by at least 25% and/or cut costs to maintain the traditional levels of profitability. He sees these reimbursement cuts could drive practice sale prices down by as much as 20-25% over the longer term as the sales market adjusts.

Moreover, Delta Dental of California and Northeast Delta Dental (Vermont, New Hampshire and Maine) are now requiring new enrollees to join their PPO network if they wish to join Delta Premier. This trend, no doubt, will continue.

Managed care’s growth also affects doctors’ coding for reimbursement. When doctors sign on to a managed care plan contract, they are automatically agreeing to abide by the plan’s processing policy manual. Often, participating doctors are surprised to learn that they will not be reimbursed for crown build-ups, that composite restorations are reimbursed at the amalgam rate, and the least expensive alternate service is paid rather that the requested service. Plans often request ALL services rendered to be submitted for scrutiny, even non-covered services.

In some states and for self-administered plans, the fee for a non-covered (reimbursed) service may be controlled.

Once they dominate a dental market, managed care plans often seek to manage the clinical care itself, not just the fees charged, or the coding protocol.

Insurance companies have submitted provider data to several new database companies who capture and analyze procedures submitted by over 150,000 practicing dentists to determine clinical “norms.”

Doctor-providers are then compared to the “norms” to identify over-utilizers (e.g. too many crowns provided relative to restorations placed, excessive corebuildups, SRP overtreatment, too many surgical extractions, etc.). These over-utilizers are then targeted for audit (focus) reviews and possibly legal action in extreme cases.

This utilization data may also be used to recruit cost-effective doctors (underutilizers) into lower-cost provider networks. Over-utilizers will not be accepted

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into these networks, and may be terminated from existing network coverages.

New associates may have to be credentialed prior to hiring as a condition of employment, because they could be rejected due to prior clinical treatment intensity issues. Blair advises doctors to be wary…Big Brother (insurance companies) is watching!

Next month we will review the rise of corporate dentistry in Part 3 of our Future of Dentistry series. ■

“The above article was reprinted with permission from The McGill Advisory, a monthly newsletter with online resources devoted to tax, financial planning, investments, and practice management matters exclusively for the dental profession, available for $227 a year from John K. McGill & Company, Inc. Special subscription offers available for residents/ new doctors; call 888.249.7537 for further information.”

John K. McGill is a tax attorney, CPA and MBA. He serves as CEO of The McGill & Hill Group, LLC in Charlotte, NC, a partner with the law firm of McGill & Hassan, P.A., and President of John K. McGill & Company. He is also editor of The McGill Advisory newsletter. His company has been providing customized tax and business planning services exclusively for the dental profession for over 30 years. For more information, visit www.mcgillhillgroup.com, or call 877.306.9780.

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

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Dr. Charles Blair offers strategic planning, coaching to new dentists regarding training on proper fee alignment, correct insurance coding, and analyzing practices, existing or recently purchased. His newly updated insurance coding handbook, “Coding with Confidence: The Go-To Guide for CDT 2009/2010” is available on his website at www.drcharlesblair.com. For more details, email him at charles@drcharlesblair.com or call 866.858.7596.

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For more information and to schedule a complimentary in-office demo, contact your Patterson representative directly or call 800.873.7683.

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Dental Entrepreneur Spring 2013 21

Business Fundamentals Mark Hollis

Using iPads in the Office to Streamline Workflow Toward Becoming Paperless

M

any dentists want their office to be “paperless.” Becoming paperless is a process.

There are new technologies a dentist can implement that will minimize their office’s use of paper and, by doing so, save quite a few trees while lessening office supply expenses. Just as importantly, if not more so, these same technologies hold the potential to enhance a patient’s experience in the office, minimize staff data entry time, reduce data entry errors and streamline office processes by eliminating redundancy for patients, staff and doctors.

When a patient calls to make a dental appointment, typically the front desk staff creates an account and an appointment in their practice management software by entering preliminary demographic information, for example: first and last name of patient (parent in a pediatric practice), phone number and insurance plan if Mark Hollis the practice accepts insurance.

During this initial contact, some practices direct their patients to a web site where they can complete registration forms. Ideally, patient data is then sent to their account in the office’s software. This kind of functionality has been available for some time, and a significant percentage of practices have adopted it.

There are new solutions available designed for Apple’s iPad and iPad mini for practices that wish to adopt new technology. This technology best mimics tra-

22 Spring 2013 Dental Entrepreneur

ditional, personal interaction to which patients are accustomed and also provides for increased efficiencies.

Patient Check In – Many busy dental practices like to track when patients arrive in the office and when they are seen. Orthodontic software has offered electronic patient check in on a Mac or PC for years. Some general dental and other specialty practices have used a sign-in sheet at the front desk. The recently-released Patient Check In App for iPad integrates with desktop practice management software MacPractice DDS to

automatically update the patient’s appointment status. By “checking www.dentalentrepreneur.com

in,� the patient instantaneously announces their arrival to all doctors and staff throughout the office. No staff attention or time is required to accomplish this.

Clipboard – At initial dental and medical office visits throughout the world, patients are commonly provided with a clipboard upon their arrival and are requested to complete and sign the attached registration form, HIPAA release and insurance authorization, as well to provide their health and social histories and medications. Typically all the forms provided to them are blank, even though the office recorded some of their demographic information when making the appointment.

Making it possible for the dental office to use an iPad to replace the conventional clipboard, MacPractice Clipboard App enables the front desk to hand the patient an iPad upon their arrival with all necessary forms ready to be completed.

Because Clipboard interoperates with MacPractice DDS in the office, information previously provided by the patient over the phone is already displayed in the forms. This gives the patient a feeling of personal attention, saving them time and offering them an opportunity to make corrections. After selecting the proper patient and appropriate forms for the visit, no additional staff attention or time is required to accomplish this.

Perhaps most

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ADS companies are each independently owned and operated.

Dental Entrepreneur Spring 2013 23

importantly, once the patient has completed their registration and health forms, when they tap a button on the iPad their information is instantaneously entered into the practice management software along with their photo. While staff can review data entered by patients, it is the patients who have done the heavy lifting, saving the staff time, eliminating redundancy and minimizing data entry errors.

Dental offices know that accurate patient information in their paper and electronic systems is essential and requires constant maintenance. Many offices require patients to complete new paper registration forms annually, and more often than not these forms are once again‌ blank. Not only is this practice onerous and unimpressive to patients, it also creates for staff the burdensome daily task of manually comparing and updating patient data. MacPractice Clipboard App not only improves the process of keeping patient data current for both the patient and the office, it even

24 Spring 2013 Dental Entrepreneur

Dental offices know that accurate patient information in their paper and electronic systems is essential and requires constant maintenance. leverages patient data entry to do so.

An office using the MacPractice Clipboard App can provide patients with their registration forms that include all the information already contained in their record. The patients merely review their own information and update it as necessary. This can easily be done prior to every patient visit if the office wishes. Once

again, after selecting the proper patient and appropriate forms for the visit, no additional staff attention or time is required to accomplish this laborious and error prone task.

Electronic Dental Record (EDR) – EDR is an acronym initially introduced

by MacPractice and some other dental software developers. It is the dental equivalent to EMR (Electronic Medical Records) or EHR (Electronic Health Records) used for physicians. The patient’s EDR includes medical and social histories, current conditions and medications. This information is typically provided by the patient on a paper form completed in the office prior to seeing the dentist or hygienist. The form is then reviewed with the patient by the clinician before examination or treatment.

In December 2012, MacPractice introduced MacPractice iEHR App for iPad that interoperates with MacPractice Clipboard.

All of the information provided by the patient upon registration in Clipboard is

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available automatically as discreet data in the patient’s record in iEHR. Once again, the patient has entered their own data into their own record. No staff effort whatsoever is required.

As the data in the patient’s health record in iEHR is discreet, the dentist or the hygienist can modify the information entered by the patient as necessary during an initial interview before locking the record. All the patient’s unedited forms were already stored in MacPractice DDS. Once the dentist has completed the visit notes, a narrative is automatically created by iEHR and sent to the practice management software where it also can be viewed.

MacPractice plans a future release of iEDR for iPad that will incorporate restorative and periodontal charting for those dentists who would prefer use the iPad for that purpose as well.

The Office of the National Coordinator has spearheaded an initiative to provide $19 billion in financial incentives to Eligible Professionals, including dentists who qualify, for the adoption and demonstration of Meaningful Use of an ONC-ATCB Certified EHR such as MacPractice DDS. In addition, the ADA is promoting the adoption of EHR by all dentists.

While there are no federal regulations requiring any doctor to adopt EHR, there

is a 2-percent penalty on Medicare reimbursement for those doctors who do not eprescribe, and there will be a maximum 5-percent Medicare reimbursement penalty imposed gradually over several years starting in 2015. More information about these programs and how they apply to dentists may be found at MacPractice.com, ADA. org/paperless and CMS.gov.

Note: While I have used MacPractice DDS, and other MacPractice products to illustrate the use of iPads and iPad Apps to minimize the use of paper in the dental office, MacPractice is not the only software developer that is focusing its resources to develop solutions for this purpose. MacPractice, MacPractice DDS and MacPractice’s iPad Apps serve as illustrations of how Apple’s iPad and iPad mini may be used in today’s dental practice to reduce the use of paper, minimize staff labor, eliminate redundancy, reduce data entry errors and improve the patient’s experience in the dental office. ■ Mar Hollis, cofounder and CEO of MacPractice, Inc., served as a practice management consultant to 650 practices over his 25 year carreer and haslectured at dental schools and dental conventions.

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Send your questions or comments to aduff2@aol.com Read us online www.dentalentrepreneur.com

Don’t Worry About Your Future...Own It!

The Paragon Progressive Ownership (POP) Plan provides a proven means for a new dentist to gradually enter into a co-ownership relationship with an experienced dentist.

Call Paragon for a personal consultation to see if POP is right for you.

866.898.1867 Visit PARAGON.US.COM to sign up for our free newsletter.

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Dental Entrepreneur Spring 2013 25

Practice Builders Rachel Wall, RDH, BS

5 Ways to Support a Profitable Hygiene Department

W

hether you are joining an existing practice or starting your own, you will eventually get to the point where you are working with a hygienist. Developing a strong relationship with your hygienist will set a firm foundation for the growth of your practice. A thriving hygiene department can be a wealth of passive income for the smart, progressive dentist.

Rachel Wall, RDH, BS A strong relationship based on mutual respect creates an environment in which your hygienist eagerly supports your treatment recommendations and encourages patients to proceed with treatment. Support your hygiene team in using their skills to the maximum capability and you will create a winning situation for both you and your hygiene team.

There are a few key ways in which you can work with your hygienist to develop a hygiene department that delivers high quality care in a productive environment.

Here are a few tips to keep in mind when you begin working with a hygiene team: 1. Invest the Time In an attempt to increase hygiene production, teams may make the decision to shorten hygiene appointment time to squeeze in more patients. Avoid the temptation! What often happens is that as days get busier and crazier, critical steps in diagnosis and treatment may be unintentionally short-changed or left out all together. This results in lower levels of care and it actually reduces 26 Spring 2013 Dental Entrepreneur

productivity. Every team I have coached to increase their hygiene appointment time has increased their effectiveness in delivering high quality care and increased hygiene production.

In real terms, investing in time means reserving 60 minutes for most adult hygiene visits.

This doesn’t mean that your hygiene team can’t customize appointment time if they choose to. A commitment to invest the time must be accompanied by a firm commitment from each team member to make every one of those 60 minutes count. Putting in place an outline for what takes place at each hygiene visit is a good place to start. You can find a free Hygiene Exam template at www.

InspiredHygiene.com/ultimatehygexam.

2. Create a Practical Perio Program The No. 1 reason for low hygiene production is a low level of perio care. Just like a dentist that does single surface fillings all day long, a hygienist that does one prophy after another is going to get bored and frustrated and won’t be maximizing his or her potential for taking care

of patients. If you often notice that there has been heaving bleeding during the prophy when you check hygiene or that the number of perio procedures is very low, it might be time to take action.

First, sit down with your hygienist and share with them how important it is to you that complete periodontal charting (recording every number, bleeding, recession, etc) is recording on every adult patient at least once per year. With a commitment to this critical assessment tool, any changes in periodontal health will be caught early and treated conservatively.

Next, be sure you have a clear protocol for periodontal treatment that is based on science and that you believe in.

3. Increase the Level of Hygiene Co-diagnosis So what is hygiene co-diagnosis anyway? It is a talented hygienist using their skills and knowledge to educate patients about their dental health. Empower your hygienists to practice this skill. Give them permission to evaluate the health of the teeth and existing restorations, not just the gums. www.dentalentrepreneur.com

PRACTICE ExPERIEnCE . . .

WITH PATTERSOn DEnTAL

Revolutionize how youR team and patients expeRience dentistRy.

ty and r no. 1 priori tients is you pa g n e job done. ti ea th d that tr ls to get n o a to st r u er d yo n u we nology are ent and tech that equipm the most of t you need to make service and suppor e th ide ov pr guarantee. we y ion this is wh t satisfact well as a 100-percen as s, nt me est inv e your practic

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le whether you are a small office or a large office with multip ists special and locations, our skilled sales representatives can assist you in providing expert dental care.

» The Patterson Advantage® member loyalty program » Patterson Technology Center training and support » Localized service from thousands of dedicated representatives across the U.S. PRACTICE ExPERIEnCESM WITH PATTERSOn DEnTAL. Call 800-873-7683 or visit www.pattersondental.com to start living your dental dreams.

The first and most critical step to encouraging more co-diagnosis is to sit down with your hygiene team and be very specific about your treatment philosophy.

Share with them why you would recommend a crown rather than a filling. Pick a few patient charts and review them together. Go through each step of your assessment, diagnosis and treatment planning. Of course, you will make the final diagnosis but it is a tremendous help when your hygienist has already begun to educate the patient about his broken tooth.

The ability to empower your hygienist to use his/her co-diagnosis skills is one of the most important tools in building a thriving practice by delivering restorative treatment to your schedule with minimal effort on your part. It makes for efficient doctor exams, builds the hygienists’ credibility and helps patients complete needed treatment before they get into an emergency situation.

-Breath management systems -Whitening (in-office and at home) -Desensitization therapy -Sealants -Temporary occlusal guards (fabricated by hygienist, approved by dentist) 5. Work Together to Create a Passive Profit Center Patients ask for our advice about homecare products every day. With a strong professional recommendation, patients feel the team’s commitment to their health even when they are at home. Another benefit of recommending home care products is that it sets your office apart as a center for dental health, not just a place they come to have their teeth cleaned or “fixed.” Wouldn’t you rather your patients visit your office to purchase their homecare supplies than go to the local retail store? These frequent visits create an opportunity to continue to build the patient-dental team relationship and keep them active in your practice, not to mention contribute to the annual practice revenue.

Work with your hygiene team to find the products you all believe in and then support them wholeheartedly. Recommend these products not only in hygiene, but also as you complete restorative procedures as well.

The end of a crown delivery appointment is the perfect time to recommend home fluoride use, for example. It is not unusual for patients in temporary restorations to develop mouth odor. Sending them home with an anti-microbial paste and rinse to combat those odors will make the experience much more pleasant.

Set aside space in the office to display the items you recommend and include support materials for patients to read. Utilize these products for pre-procedural rinsing, irrigating and as a soothing mouth freshener after all procedures. The following formula demonstrates the potential for passive income that a product center can create:

4. Support a Healthy Service Mix The service mix of your hygiene department is made up of the various services your hygiene team provides, other than the standard prophy. A mix of procedures such as sealants, fluoride therapy, periodontal care and homecare products contribute to a healthy service mix. These adjunctive procedures contribute to the health of patients, as well as the health of your practice, by providing a source of passive income. Many of these procedures take no more time and minimal effort by the hygiene team to deliver. As a dentist, it is important to work with your hygienists to develop a common belief in procedures and products delivered through hygiene.

Read the research, conduct your own inoffice trial and determine which of them you believe support your efforts to keep patients healthy. Below is a list of procedures and products you should expect to see performed in the hygiene department.

Product Hygiene Service Mix Power Brush -Professional strength fluoride treatOral Irrigator ments (in-office and at home) Toothpaste -Power toothbrushes and flossers -Periodontal therapy and maintenance Mouthrinse including locally applied anti-infectives Oral Health Kit -Home care products Home Fluoride 28 Spring 2013 Dental Entrepreneur

If you sell the following: One Oral Irrigator or Power Brush per day (16 per month) Average $45 profit = $720 profit per month Three Oral Health Kits per day (48 per month) $10 profit per kit = $480 profit per month Three tubes of toothpaste and three bottles of mouthrinse per day (48 of each per month) $5 profit per paste + $5 profit per rinse = $480 profit per month Three tubes of home fluoride per day (48 per month) $8 profit per tube = $384 profit per month Power Brush/Irrigators Oral Health Kits Toothpaste&Rinse Fluoride

$720 $480 $480 $384

Total Profit (monthly)

$2064

That is an annual profit of $24,768

As owner of Inspired Hygiene, Rachel and the Inspired Hygiene team assist dentists to tap into their hygiene profit potential. In addition to private coaching, Rachel draws from her 20 years of experience as a hygienist and practice administrator to deliver to-the-point clinical articles and speaking programs. She has spoken for numerous groups and events, including RDH Under One Roof and the AACD Annual Session. Rachel has written for, and been featured in, numerous industry journals including Dental Practice Report, Dentistry Today, Progressive Dentist, RDH, and Hygienetown. She recently received the 2012 Dental Excellence Award from DrBicuspid.com for “Most Effective Dental Hygienist Educator”. Inspired Hygiene’s programs include in-office coaching, a free weekly e-zine, the Hygiene Profits Mastermind group and the Profitable Perio Online Workshop. Inspired Hygiene is the preferred hygiene coaching Profit/Unit group for the Productive Dentist Academy $50 and a corporate partner with Philips Soni$40 care. Contact Rachel via email at Rachel@ $5 InspiredHygiene.com or call 877-237-7230.

Cost

Retail

$75

$125

$65

$100

$7

$12

$8

$13

$20

$30

$10

$8

$16

$8

$5

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The Best of Both Worlds At Comfort Dental, we combine the old-style neighborhood dental practice with today’s modern group practice. Equity ownership, autonomy, management of your own business, and longlasting relationships with your patients is combined with our economics of scale, prime locations, mass marketing, and overhead control. It truly is the best of both worlds.

$360,000 average annual income* Comfort Dental’s franchise business model maximizes your earning potential. Our dentists earn in the top 5% nationally, which is 2 to 3 times the average dentist in the U.S. according to the ADA. By taking advantage of economies of scale, our monthly overhead is far below industry standards, with an average overhead of just 43%.

We will pay your student loan** We don’t offer jobs – Comfort Dental offers full equity ownership from day one. No vesting period, no waiting 2-3 years or more for "partial" ownership. Partners recapture their equity upon retirement or other departure with substantial tax benefits. Comfort Dental’s business model offers the opportunity for passive income. We offer very affordable purchase price and 1-year fully refundable franchisee trial period.

A prescription for success Comfort Dental’s business model is recession proof and offers long-term success. Our focus is on affordable, quality care and convenient hours. We’re open evenings and Saturdays. We work hard and believe in being nice to patients. Our office success rate is 100%. We’ve never closed an office in more than 30 years. Comfort Dental’s partnership concept allows for a 66-hour clinical schedule with no downtime. Our dentists have flexible schedules, and have plenty of 3-6 day “long-weekends” without loss of income because the office is covered by your partner(s). That means you’ll have more personal time!

50-60 new patients per doctor, per month Comfort Dental’s aggressive marketing generates 205,000 new patients annually. We have a management support network team led by Dr. Rick Kushner, the nationally recognized expert on practice management. Comfort Dental promotes a partnership support network within the office. Our symbiotic doctor income distribution system promotes healthy, positive competition within the partnership. If your partner succeeds, you succeed.

Put some teeth into your career!

ComfortDental.com *327 dentists practiced at Comfort Dental for at least a portion of 2012. Of the 233 dentists who practiced the entire year in the same office, 98 or 42% earned a net income of at least $358,031. 15 partners earned $500,000 or more in 2012, with our top earner netting $1.2 million. There is no assurance, however, that you will do as well. **Restrictions apply.

Practice Builders Roger P. Levin, DDS

Growing a New Practice in the New Dental Economy

I

enjoy speaking with young dentists about the career they have chosen and urging them to avoid picking up bad habits, adopting outdated approaches, or wasting time and money on ill-conceived strategies.

Young dentists who have already opened their own practices have presumably already drawn up a proper business plan and created an annual operating budget. If so, they are ready to increase production rapidly by focusing on marketing.

Grow Your Practice from the Ground Up Fortunately, unlike quite a few older dentists, the new generation accepts the necessity of marketing their practices.

Unfortunately, this makes them more vulnerable to misleading promises of success using

By Roger P. Levin, DDS external marketing techniques.

Many of these are promoted by marketing “experts” who reap large profits for themselves from ads, mailers and other media aimed at a broad “external” audience.

Typically, such efforts fail to even pay for themselves 80 percent of the time.

The alternative, internal marketing, when executed properly pays a return on investment 98% of the time according to the Levin Group Data Center™. But there’s a catch. Internal marketing involves persuading existing patients to refer new patients to the practice, and new dentists do not yet have enough patients for internal 30 Spring 2013 Dental Entrepreneur

marketing to work fast enough. How, then, does the young dentist get the ball rolling?

With some judicious spending and a lot of “shoe leather” marketing. Strategies for attracting patients include: • Introductory Offer for New Patients This could be a free first exam, reducedcost hygiene visit, free whitening after first appointment, etc. It should be an offer that will catch people’s attention and entice them into the practice. The offer can be used in a number of ways, some of which are discussed below.

• Community Outreach Spend as much time as possible out in the community, meeting people and letting them know there’s a new dental practice in the neighborhood. Join community groups, serve on boards and committees, attend local sports events and sponsor teams, etc. Give your card to everybody, along with a

small brochure or flyer featuring your introductory offer.

• Staff as Ambassadors Encourage the staff to go out in the community during practice hours when patients are not scheduled. They, too, should introduce themselves, talk a little about the new practice and give out cards and the offer flyer.

• Announcement Ad with Offer If you decide to spend money on an announcement ad, do more than simply announce the practice has opened.

Feature the offer to attract patients to your office.

• Support Network Get family members and friends involved in acquainting everyone they know about the practice. Ask them to mention your practice at work, social events, community gatherings—anywhere they can. They may even be www.dentalentrepreneur.com

Home Mortgage

Physician Loans

BB&T has helped countless professionals in the dental industry to better manage and expand their businesses while improving their personal finances as well. We offer home financing options designed exclusively for physicians.1 For example, with a BB&T Physician loan, you can borrow 100% of your loan amount, up to $650,00, with no money down. Other features include: BB&T PHYSICIAN LOAN PROGRAM Maximum loan to value (LTV)

100% up to $650,000 / 95% up to $850,000

Maximum Loan Amount*

$850,000

Private Mortgage Insurance

Not required

Minimum FICO

LTV > 90% = 720

Student Loans

Excluded from ratios if deferred for 12 months

Escrow for Taxes & Insurance

Required

Occupancy

Primary residence only

Eligible Property Types

One-unit single family detached, warrantable condos and PUD's

Eligible Products

15- and 30- year fixed rates, 5/1, 7/1, and 10/1 LIBOR ARMs (fully amortizing)

LTV ≤ 90% = 700

*Consult your BB&T mortgage loan officer for details. Maximum loan amount subject to change without notice.

Added benefit from BB&T

Apply before September 6, 2013, and we’ll reduce certain lender fees up to $500.

2

To take advantage of this offer simply mention the promo code SMILE. To apply online or locate the mortgage loan officer nearest you please visit BBT.com/mortgage.

BB&T, Member FDIC and an Equal Housing Lender.

Loans are subject to credit approval.

1 Offer available to the following medical interns, residents, fellows, and licensed physicians who have completed their residency, internship, or fellowship within the last 10 years: Medical doctors, doctor of osteopathy, doctor of dental surgery, doctor of dental medicine, doctor of optometry, and doctor of podiatric medicine.

For comparison purposes, a 10- year variable-rate mortgage of $850,000 with a 5% down payment at a variable APR of 3.697% with no points and no origination fee would result in 360 equal payments of $3,936.48. These payments do not include tax or insurance costs; the total payment obligation may be higher. This is a representative example based upon rates that were effective as of 7/18/12. Rates may change at any time. Rates may increase after consummation.

For comparison purposes, a 30- year conventional, fixed-rate mortgage of $650,000 with a 0% down payment at an APR of 4.57% with .375 points and no origination fee would result in 360 equal payments of $3,293.45. A 30 year conventional, fixed rate mortgage of $850,000 with a 5% down payment at an APR of 4.313% with .375 points and no origination fee would result in 360 equal payments of $4,181.49. These payments do not include tax or insurance costs; the total payment obligation may be higher. This is a representative example based upon rates that were effective as of 7/18/12. Rates may change at any time.

2 BB&T will pay up to $500 toward reducing certain lender fees (underwriting, origination, commitment, processing, courier/mail, doc prep or loan handling fees) you may be charged. Other fees may also be assessed, but are not eligible for this reduction.

Property, and if applicable, flood insurance must be in effect on property securing the loan. © 2013, Branch Banking and Trust Company. All rights reserved.

willing to hand out your cards if you ask them.

• Database Building During all these activities, be sure to collect names, addresses, email addresses, etc., from the people contacted so that you will be able to get them to “like” your practice on Facebook and encourage them to let their acquaintances know about your practice.

Promote Exponential Growth with Internal Marketing Once the patient base begins to grow, the science of internal marketing can begin to play a role in building the practice and creating exponential growth.

Internal marketing is aimed primarily at current patients. Contrary to what some dentists apparently think, a few old gimmicks used sporadically do not constitute an internal marketing program. To be effective, a program should consist of a variety of different strategies, custom-selected for the practice and used consistently throughout the year. Longterm experience with practices of all types all across the country has shown that using multiple strategies (we recommend a minimum of 15) works more effectively for two reasons. First, it usually takes a number of attempts to cut through the clutter and actually reach people, and it often takes more than one exposure to persuade them to respond. Having more strategies working for your practice simultaneously enables you to achieve the necessary reach and exposure levels to get the desired response, i.e., giving the practice a referral.

It is equally important to use a variety of different strategies because different approaches will appeal to different people.

Categories to include are: • Educational – interesting information about dentistry and other subjects • Fun – contests, raffles, games and other activities • Public Service – involvement in programs that benefit the community • Family & Friends – vouchers for free services given to patients to pass along • Social Media – a powerful communications vehicle that can be used to reach, 32 Spring 2013 Dental Entrepreneur

It is equally important to use a variety of different strategies because different approaches will appeal to different people. interact with and engage many potential and existing patients The Levin Group target is for 40-60 percent of all current patients to refer at least one new patient per year. If a young dentist has 300 patients, for example, and 50 percent of them refer, the patient base will more than double in two years from this strategy alone, totaling approximately 675 patients.

Maximize Growth with Excellent Follow-Up and Customer Service One very important point for young dentists to learn is that some aspects of practice operations which are not labeled as “marketing” can have a tremendous effect on marketing success. Examples of this include: • The front desk coordinator must be trained, scripted and prepared to convert a one-time shopper into a long-term patient. This must be proactive process. You cannot afford to wait for prospective patients to ask for appointments. Even if they like the practice and intend to come back if they need any dental work, that interest will fade if the practice does not ask for the commitment.

• Follow-up with every patient every evening.

Calling patients at night to see how they are feeling, regardless of what procedure they had done, is a very powerful strategy. This type of outreach will make an excellent impression, especially if the conversation is guided by a script such as, “It is

our pleasure to have you as a patient.

As a young practice, we would be pleased to welcome any of your family or friends as part of our No-Cost First Exam Program.” Using a name such as this makes it seem more valuable, and also avoids sounding like the practice is desperate for referrals. It adds muchneeded credibility for the new dentist.

• Customer service lays the foundation for effective internal marketing strategies. Patients who are extremely pleased with how they are treated at your practice will be naturally inclined to recommend you to anyone they know who may need dental care.

Ask them for referrals and they will respond.

Conclusion Marketing is a multi-pronged, ongoing activity that should be fully integrated into every aspect of practice operation.

No single idea provided here will create rapid practice growth for the young dentist all by itself. However, brought together in a robust marketing program, these techniques will position the young practice for many years of growth, success and professional satisfaction. ■ To learn how to run a more profitable, efficient and satisfying practice, visit the Levin Group Resource Center at www.levingroup. com. You can also connect with Levin Group on Facebook and Twitter (@Levin_Group) to learn strategies and share ideas.

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We connect your practice with new and existing patients through brand development, premium websites, social media development and management,

Build Your Practice

and strategic marketing campaigns.

• Comprehensive Brand in a Box • Social Media Made Simple • Premium Websites • Fan Base Management • Marketing Campaigns

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Power To Succeed Wes Jankowski

The Sex Talk – How to be a Great Lover/ 100% Treatment Case Acceptance

OMG! An article about sex in a professional trade magazine? Relax, this is not another COSMO survey. Rather a discussion on the philosophy and principles of building extraordinary relationships.

After years of research, attending seminars and reading articles and books on the topic of relationships and communication, as well as 26 Wes Jankowski years of marriage to the same person, I have boiled down the art of how to be a great lover to four steps. It’s just not that complicated.

2. Ask Them, “What Do You Want?” and, “How Do You Want It?” Anyone blushing yet?

Everyone has an opinion on what you “should” do and what you “should” have.

When was the last time someone asked you, “What do you want?”

Even in the area of love, relationships, and yes, even sex (remember, we’re talking about how to be a great lover), most people approach the partnership from their personal wants and needs instead of their partner. However, building a great relationship isn’t only about you, it’s about your partner.

An outstanding book on this topic is The Five Love Languages by Gary Chapman. The author explains that people feel “loved” differently. While some people feel loved when they receive gifts (for example, flowers or tickets to a sporting event), others feel loved when you spend quality time with them, or offer them words of encouragement and affirmation. The key is to find out what your partner wants and needs, not what you want to give them.

As a side note, in 1974, Burger King changed the fast food industry by incorporating the slogan, “Have it your way!”

1. Establish Rapport Stop laughing! I told you, it’s just not that complicated. Read on.

Rapport occurs when two or more people feel that they are in sync or on the same wavelength because they feel comfortable together or relate well to each other. A connection exists and they may realize that they share similar values, beliefs, knowledge, or behaviors.

Rapport only takes a few moments to create and/or recognize, but without it, the relationship isn’t going any further. Guys, no woman ever said, “There’s really no chemistry between us. I think he may be the one!”

34 Spring 2013 Dental Entrepreneur

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3. Give It to Them!

Do we really need to talk about this one?

4. Ask Them, “Did You Like It?” If they said, “Yes,” do it again! If they said, “No,” ask them for clarification and change your approach.

Well, there you have it – four steps to becoming a great lover. Pretty simple.

But you’re probably wondering how this relates to dentistry and treatment case acceptance.

Oddly enough, the principles are exactly the same.

1. Establish Rapport As we discussed, in order to build a long-term, romantic relationship, you must first establish rapport. It’s no different in a professional relationship between the dentist and their patient. If a connection that includes empathy and trust is not established, case acceptance will suffer and the patient will always wonder if there is something better out there.

As a dental practice management consultant, I often interview patients who’ve left a practice to find out what went wrong. Common themes include insurance issues and cost. But just as often, I hear that the patient didn’t feel connected to the dentist or didn’t receive enough quality time.

2. Ask Them, “What Do You Want?” and, “How Do You Want It?” As a clinician, you were trained to identify problems/issues, present the findings and expect that patients would do what was necessary and recommended.

If it were only that easy. Most patients resist accepting treatment because they don’t want to spend the money on dental health. They’d rather go on vacation. As a clinical team, you find yourself trying to sell or convince patients to accept treatment. But, how much selling or convincing would you have to do if you just gave the patient what they want and how they want it?

Learn to ask great questions. Every health history form has some variation of the following question, “If you could

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change one thing about your smile, what would it be?” Most patients never fill out the answer and most dental teams never ask the question. What if you knew the answer and the reason behind the answer.

Patient: “I wish my teeth were whiter and straighter. I’m a Sales trainer and in front of people all day/every day. I’ve always been a little self-conscious of my smile.”

Anytime a patient acknowledges you, your team, or your practice for great service, ask for referral.

Again, I’ll ask, how much selling or convincing will you need to do in this situation?

Other questions you can ask, “What is most important to you in your overall dental health?” (function, longevity, etc.), or, “What’s important to you about achieving optimal dental care?” (cost and affordability, quality and excellence, etc.).

With answers to these questions, you can tailor your treatment and presentation to the specific wants, needs and expectations of the patient. No selling required!

Another patient interview went like this: Patient: “I don’t want to ever lose my teeth. I was at dinner with my father recently and he loves steak. I watched as he cut it into tiny pieces so he could swallow each piece. He never took care of his teeth growing up and now wears dentures.”

Remember: Everyone has a story to tell, and it’s our job to get them to tell it.

You know what they need. You know what they want. Connect the dots for them. Show them how the treatment they need meets their wants.

4. Ask Them, “Did You Like It?” If they said, “Yes,” do it again! If they said, “No,” ask them for clarification and change your approach.

Oh, by the way, if they say, “Yes, I liked it!” there is one more step: 5. Ask for a Referral The easiest way to grow production/ collection revenues in a dental practice is to find new patients. Practices spend thousands of dollars each year on direct mail, website development and other external marketing programs to achieve new patient growth. This is very expensive and a lot of work. In addition, building relationships with a stranger is more difficult and time-consuming then with people that were referred to your practice.

Most practices passively invite patients to refer friends and family by posting a sign reading, “Your referral is our greatest compliment.” This approach works, but an active request for referrals produces much better results.

Anytime a patient acknowledges you, your team, or your practice for great service, ask for referral. Simply say, “You know Mike, I wish I had a whole practice of people who are just like you. If you know anyone who’s looking for a great practice, I hope you’ll send them our way.” You’d be surprised how many of your patients are just dying to help you grow your business.

A word of advice – when striving to be a great lover, do not ask for a referral. This will only backfire and cause strain on the relationship. ■ Wes Jankowski is a business strategist and Founder/CEO of StraightLine Professional Development - providing business, leadership, and team-building skills training for dental practices.

For more information about the company and services go to http://www.straightlineprodev.com

3. Give It to Them!

Again, do we really need to talk about this one?

Dental Entrepreneur Spring 2013 35

Dental Trade Shows

National Dental Student Lobby Day

101st Hinman Dental Meeting March 21 – 23, 2013 Atlanta, GA

ASDA members can make a difference by lobbying dental legislation. Attend National Dental Student Lobby Day in Washington, D.C., April 15-16, 2013. Register by March 13, at www.ASDAnet.org/LobbyDay.

California Dental Association– Spring Session April 11 – 13, 2013 Anaheim, CA

ASDA’s National Leadership Conference

154th ADA Annual Session October 31 – November 3 2013 New Orleans, LA Greater New York Dental Meeting November 29 – December 4, 2013 New York, NY

The American Student Dental Association is hosting its second National Leadership Conference, Nov. 15-17, 2013 in Chicago.

For details visit www.ASDAnet.org/NLC. The event will provide leadership training to dental students across all years. Other benefits of attending: • Experience training in people management, public speaking and presenting, personal finance, practice negotiations, mentoring others and more.

• Build leadership skills that will be beneficial throughout their dental careers • Increase the understanding of key issues in dentistry and dental education • Build relationships with exhibitors to fulfill current and post graduation needs Dental Entrepreneur: Business Beyond the Classroom will be there to meet the leaders attending. Please look for us!

Index of Advertisers ADS Dental Transitions South........................................................................................................ 13 ADS Dental Transitions…………………………………………………………….................................... 23 Aspen Dental................................................................................................................................. 5 BB&T/Oxyfresh............................................................................................................................. 31 Comfort Dental............................................................................................................................ 29 Dental Dreams.............................................................................................................................. 9 Henry Schein ............................................................................................Inside back and back cover MacPractice................................................................................................................................ 17 Medical Protective....................................................................................................................... 15 Paragon...................................................................................................................................... 25 Patterson...............................................................................................Inside front cover and page 1 Patterson Dental Supply............................................................................................................... 27 Practice Image Builder................................................................................................................. 33 Sirona........................................................................................................................................ 21 Wells Fargo................................................................................................................................. 11 36 Spring 2013 Dental Entrepreneur

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Are you fully prepared for your professional journey?

Transitioning a career takes planning. Have you taken steps to ensure that you will make the right decision when retirement is at hand? Do you know what it takes to plan an exit strategy?

Sell a practice? Hire an associate? Bring on a partner?

It takes expert guidance from a team of people who have your best interests in mind.

Henry Schein Professional Practice Transitions (HSPPT) provides a full range of nationwide dental practice brokerage, practice valuations and transition planning services to help dentists achieve their professional goals. HSPPT will support you with practical advice and customized strategies that will ensure your success.

• Appraisals • Practice Sales and Purchases • Associateships, Partnerships and Mergers • Retirement Planning • Business Structure Consulting

Speak with a Henry Schein Practice Transitions Consultant today!

1-800-730-8883 Henry Schein Financial Services is not a bank, does not represent itself as such, and does not conduct banking activities. © 2012 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.

or e-mail: ppt@henryschein.com www.henryschein.com/ppt

The perfect solution for your Dental Associate recruitment and placement needs • Providing the skills and facilities to place Associate candidates in private practice, clinics, and dental organizations of every category • For Associate candidates as well as employers • Proactive, efficient, and results driven • Personal attention to all the details of the search and placement process

Get optimal results to support your professional goals!

We have hundreds of Dental Associate opportunities available!

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