CLASS OF 2015 | SPRING ISSUE
Business Beyond the Classroom
David Rice, DDS
Together We Rise
The New Normal: Employee to Owner 5 Things You Must Do to Successfully Market Your Practice
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I didn’t realize we would get to this point this fast. DR. DEE DEE MEEVASIN DEE FOR DENTIST LAS VEGAS, NEVADA
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OFFTHECUSP.COM/CHANGINGLIVES. Patterson supports dentistry’s ability to positively change lives. If you’re ready to lead your patients, staﬀ and practice into a new era of dental care, contact your Patterson representative today!
PATIENT EXPERIENCE, PRACTICE LIFESTYLESM PATTERSONDENTAL.COM | 800.873.7683
Spring 2015 VOLUME 17, ISSUE 3
Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Production Ruthie Gordon Publishers Press Inc. Editorial Board Dr. Gene Heller Dr. Harold Sturner Dr.Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH,BS. Dr. Tom Snyder Derek Champange Dr. David Rice Layout and Design John O’Connor
Class of 2015 Contributors Jayme Amos Charles Blair, DDS Christine Brooke RDH Amy Bowman Edward Chalberg, CPA
Roger Levin, DDS, MBA Kristie Nation David Rice, DDS Tom Synder, DMD, MBA Dale E. Wagman, DDS
Charter Sponsors Oral‑B Laboratories Ultradent Products Inc. Procter & Gamble Wm. Wrigley Jr. Corp. Glidewell Laboratories Benco Dental Co. Tess Corp. Dental Care Alliance
The Pride Institute The Snyder Group McKenzie Management Caesy Education Systems, Inc. Warner‑Lambert Co. Phillips Health Care Oxyfresh Worldwide
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2 Spring 2015 Dental Entrepreneur
CLASS OF 2015 SPRING ISSUE VOLUME III
What a great time of year, the spring is. The snow is (hopefully) melting, the colorful blooms of flowers start peeking out and there is ample sunshine to more fully enjoy your days. There is energy, enthusiasm and optimism bubbling over, for sure. And I think it’s appropriate that this season coincides with graduation for the Class of 2015. You’ve put in the hard work in the classroom, and now the Real World awaits. As I was preparing our latest issue of Dental Entrepreneur: Business Beyond the Classroom, I thought of a story that fits this spirit. It was no surprise that I found our cover doc, David Rice, at a table at the first ASDA National Leadership Conference in the fall of 2014. He was so excited and, well, ignited to be there. He was with two buddies, both dentists, that had literally arrived an hour before the event began after driving an incredible 10 hours from Buffalo. Their energy and sincere generosity was contagious. He could hardly wait to talk to these future dentists and charge them up. Dedicated to our profession, he is making a difference by addressing the way the graduating dentist can view his/her career. Rice, from IgniteDDS, is fueling passion beyond the classroom! Of course, I knew he would be a perfect fit for our magazine. We have several other excellent contributors to this edition of DE, as well. We continue to work closely with experts with the knowledge that will assist you in taking your calling to the next level. It’s interesting that when I read Roger Levin’s article on leadership, because I thought he could be speaking about David Rice. That’s cool. I wonder if it could be you as well. How would you like to lead your team and your office to be their best, both individually and wholly? How would it feel to have your finances secured and be in growth mode? How well will you market your practice? Levin’s piece offers seven key points that all practice owners should consider to better answer those questions. Now, how do you become an owner? Our friend Tom Snyder wrote in with an interesting take on what is the “new normal” when it comes to practice ownership. As education debts continue to rise, he understands that ownership might be not be in some of your plans. Still, Snyder believes otherwise. “The opportunities to create significant wealth are there for the taking, and that means that you do not have to consider finding a good-paying job for the next 10 to 20 years as your only path to financial freedom,” he notes. Thoughtprovoking, for sure. Listen, I could go over each and every one of the mentors we’ve tabbed to feature in this publication. But I won’t. Instead, I encourage you to dive deep into the content we’ve provided in DE, from our writers to our sponsors. Everyone is on board to provide the resources you need to not only become a success, but also make sure that the future of our industry continues to shine as bright as ever. Take a big, heaping breath of that fresh springtime air, because things are about to get interesting in your respective careers. I am confident you will make the right decisions to revel in all the seasons of your life.
All the best,
Anne M. Duffy Publisher
4 At Dee for Dentist, Technology Makes the Difference Amy Bowman
Getting Started 8 Top 2 Concerns for Future Practice Owners Jayme Amos
12 The Times They Are a Changin Christine Brooke, RDH
Business Fundamentals 14 Should PPO Fees or Full Fees Be Reported on Claims?â€? Charles Blair, DMD
16 The New Normal: Employee to Owner Tom Snyder, DMD, MBA
22 The Last Number First
The Power To Succeed 34 Together We Rise David Rice, DDS
Dale Wagman, CPA
26 Strategies For the Challenges Ahead in Private Practice Edward C Challberg, CPA
Practice Builders 28 5 Things You Must Do to Successfully Market Your Practice Kristie Nation
32 7 Leadership Skills Every Practice Owner Should Develop Roger Levin, DDS, MBA
Dental Entrepreneur Spring 2015 3
At Dee for Dentist,
Technology Makes the Difference Amy Bowman
n her path to becoming a dentist, Dee Dee Meevasin, DMD, had a lot of good fortune. Now she’s paying it forward. Her journey started with her childhood dentist, turned employer, turned mentor – Dr. James Saycich. “I worked as his assistant while in high school,” said Meevasin. “He was just so passionate about dentistry. He was fun and enthusiastic, even a little kooky sometimes. I loved seeing him interact with patients – he inspired me to become a dentist.” After graduating from the University of Las Vegas, Nevada dental school in 2007, Meevasin worked as an associate to Saycich for five years. She rented space at his practice, built a clientele and was given responsibilities including billing insurance, handling payroll, and managing front office staff. “James taught me how to run a practice,” said Meevasin. “But the most important thing he taught me was to always do my best. He said that if you do your best and do what’s right, nothing can go wrong. I think about that every time I see a patient.” Although the two dentists shared a similar philosophy, they were on very different paths. Meevasin was anxious to work with new technology − a goal that her mentor, who was running a successful practice and nearing retirement, didn’t share. Instead, he encouraged Meevasin to branch out on her own and practice exactly the way she wanted. That’s when Meevasin and her husband, Mike Cruz (who is also her office manager) began searching for the perfect space to fulfill their vision: a modern, green, technology-driven practice with
4 Spring 2015 Dental Entrepreneur
cutting-edge equipment. After looking at nearly 20 locations, they found a former dental office with existing technology. “It just felt right. The price was right and the space offered room to grow,” said Meevasin. In December 2011, the couple opened Dee for Dentist in Las Vegas. They gave the space a modern look with a redesign and fresh paint, but technology is what has made the difference. “Technology sets the tone for your practice,” said Cruz. “It’s one of the big ways to differentiate yourself. But most importantly, it works. The right technology can help diagnose and treat patients more efficiently. These are the things that make a practice successful.” The newly purchased space came with computers, workstations, a Sirona XG5 digital panoramic, Sirona C8+ chairs, autoclaves and Eaglesoft, which Meevasin and Cruz updated to the newest version. Eaglesoft simplifies scheduling, insurance and the tracking of important forms including HIPAA paperwork and updated medical history forms. “It’s really organized; it dates and catalogs images, notes and treatment plans,” explained Cruz. “It’s a great system that makes everything quick and easy, providing staff members access to the information we need.” When deciding what new technology to add, integration is key. “If it integrates smoothly, it saves steps, saves time, is easier to use and easier to train staff on,” said Cruz. That’s why Schick WiFi Elite sensors, which are versatile, portable, wireless and provide great images, were one of the first additions at Dee for Dentist. In August 2013 Meevasin and Cruz purchased a CEREC, which tripled the number of crowns Meevasin places. “Without a doubt,
it’s made the biggest impact on our practice,” Cruz explained. “We purchased it knowing it would be useful, but didn’t expect it to be as productive as it’s been. It changed the way we diagnose, changed treatment plans, and has increased case acceptance dramatically.” Because Meevasin wanted to do guidedimplant surgery, the couple purchased a Galileos in September 2014. Many of the machine’s capabilities have yet to be released, but its easy integration with CEREC and ability to diagnose more than ever have made it a favorite. “If I were to give advice to a dental graduate seeking an associateship, I would say to look for a forward-thinking practice that stays up-to-date with technology. The pace of change is exponential, so you want to get in as soon as you can,” said Meevasin. “And if you’re looking at starting a practice, include technology in your business plan so you can start out on the right foot. Technology is expensive, but if you’re investing in it to make yourself a better clinician, the investment will be completely worth it. Your patients will be able to see that you care about providing them with the best treatment possible and it will set you apart.” Opening Dee for Dentist has allowed Meevasin to use the updated technology she wanted, and gives her the chance to pay it forward. The practice runs a charity program called Fills Good with the goal of raising $1,500 every three months for a local non-profit organization. Each quarter, 100 percent of cash received for filling services goes toward the program until the goal is reached. More than $7,500 has been donated to five organizations since late 2013. In addition, Meevasin and her team regularly volunteer their time and even open their doors to provide free dentistry for members of the community who otherwise could not afford the care. Meevasin was named alumna of the year at her alma mater in 2014 for being technologically advanced and for giving back to the community. “For me, it’s
important to give back,” she said. “It’s an awesome feeling when people who can’t afford it are able to get the care they need.” Meevasin is paying it forward as she continues on her journey, and it seems her good fortune just keeps growing.
Amy Bowman writes articles, marketing copy, and online content for Patterson Companies. She lives in Minneapolis and can be reached at email@example.com.
“MY PHILOSOPHY IS TO TAKE CARE OF CHILDREN AND GET THEM TO A HEALTHY, STABLE DENTAL STATE. AND HOW YOU DO THAT SOMETIMES TAKES A LOT OF CREATIVITY.” DR. DARCY RINDELAUB Riverdale Pediatric Dentistry | Coon Rapids, Minnesota
THE POWER TO CHANGE LIVES SEE HOW PATTERSON SUPPORTS DR. DARCY BY VISITING OFFTHECUSP.COM/CHANGINGLIVES.
Patterson supports dentistry’s ability to positively change lives. If you’re ready to lead your patients, staff and practice into a new era of dental care, contact your Patterson representative today!
PATIENT EXPERIENCE, PRACTICE LIFESTYLESM PATTERSONDENTAL.COM | 800.873.7683
Dental Entrepreneur Spring 2015 5
Top 2 Concerns for Future Practice Owners Jayme Amos
ractice ownership can be the best choice in your career. The pride of accomplishment, the satisfaction of being your own boss and the high income potential are benefits within your reach. The truth is that it’s easier to step into practice ownership than some would have you think. But there are a pair of issues about practice ownership that must be addressed – even before you take your first job. That’s right. Prior to taking your first associateship, there are crucially important topics that must be considered if you hope to own a practice in the future. If you’ve considered a startup practice or buying an existing practice, you know there are hundreds of skills and knowledge you’ll need to run the practice successfully. Bonus Material: Get Free Student Access to the Startup vs Acquisition course (a $597 value). Which path is right for you? Find out with the newest research. Get the Startup vs Acquisition Course here: www.HowToOpenADentalOffice.com/studentaccess Below, we’ll look at the top-two concerns for doctors who plan on a future position of practice ownership. Today’s Job = Tomorrow’s Risk If you’re like most doctors, you’ve thought about owning your own practice. Have you thought about how your current position could be risking that future? It’s a surprise to most doctors that your current employment could deal a crushing blow to your new practice dreams. Top-Two Concerns for a Future Practice Owner As you consider your new office, consider the following before you accept a new employment position:
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No. 1: The Dream-Town Exclusion First, avoid what I call the “Dream Town Exclusion.” Most employment contracts include a provision that will legally exclude you from working near your employer for a defined number of years after your employment. For example, if you accept a position in Harrisburg, Pa., you’ll likely be legally disallowed to work anywhere in the official city limits for five or more years. If you had your heart set on opening a practice in Harrisburg since childhood, you would be quite upset if you found out your current employer has the legal right to stop you from opening anywhere in the city limits. Most would call this clause of an employment contract a “noncompete,” but many doctors come to understand why we call it the Dream Town Exclusion only after being locked out of a region on which they had their heart set. Avoid getting locked out of your dream town by considering your future region and aligning it with any non-compete clauses.
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No. 2: The Olympic Ring Zone The second important aspect for consideration is relevant if you consider working for a group practice. Working for a group practice can have fantastic benefits, but if you do, you must be wary of the “Olympic Ring Zone.” The Olympic Ring Zone compounds the problems you might face in the Dream Town Exclusion, potentially preventing you from working in an entire state. Often, group practice non-compete agreements disallow you from working five miles from any of their existing or future locations. Ignore the Olympic Ring Zone at Your Own Risk… “His hopes of opening a practice - even one 10 miles from his current location – were crushed.” Imagine the picture of the Olympic Rings: those five rings all intersect and overlap. Now imagine each of those rings represents a five-mile radius on a map, overlaying the non-compete areas mentioned in your employment contract. With that picture in your mind, you can begin to sense the problem this would cause in your hopes of opening a future practice. You would be excluded from working within five miles of your current practice location AND all of their other locations. What if that group has 10 rings. Or 20? Recently, a doctor proudly showed me his non-compete clause. I was impressed because too few doctors keep a copy of their contract (make sure you keep a copy!). Unfortunately, the doctor’s pride turned to shock when he discovered his future options included leaving the entire 18-mile radius surrounding his major metropolitan area. His hopes of opening a practice - even one 10 miles from his current location - were crushed. Be careful with the Olympic Ring 8 Spring 2015 Dental Entrepreneur
Zone. More and more group practices are expanding with additional locations. As this happens, the area from which you could be disallowed to open your new practice could be a much larger portion of the map than you knew. As you dream of opening a practice someday, be sure your future vision is in alignment with your current employment situation. When the time comes to choose your future ideal location, you can analyze hundreds of concepts and tools at www. HowToOpenADentalOffice.com. Bonus Material: Get Free Student Access to the Startup vs Acquisition course ($597 value). Register Here: www.HowToOpenADentalOffice. com/studentaccess
Jayme Amos is a dental practice consultant specializing in ownership success. He is a bestselling author and the founder of www. HowToOpenADentalOffice.com Find strategies to open your practice at his website, where thousands of people read his articles each month. Living in Philadelphia with his wife and two children, Mr. Amos can be contacted directly at email@example.com.
Please reach out to our authors and our advertisers. They care about you and keep us in print!
Note: While this article includes suggestions, nothing herein is to be considered legal advice. Consult an attorney for all legal matters.
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The Times They Are A-Changin’ Christine Brooke, RDH
ou can breathe a sigh of relief as your final clinic patients are complete and national and state boards are behind you. Perhaps you can finally get lost in a book, purely for pleasure. You’re young, brave and filled with new ideas as you carve out the prospects of creating this next chapter in your life as Dr. ______. Congratulations! As you make your way to the path of success as a fresh new dentist, you follow in the footsteps of many who have come before you. Those before you faced many challenges that can now serve as a rich source of experience for you. You’ll find, many of those challenges are not much different from the ones ahead of you. However, it is clear that the landscape in the delivery of care is shifting and providing some new challenges along with opportunity like never before. I invited a colleague and friend, Dr. Dennis Pezzolesi to join me as we explore a few critical challenges and opportunities in an effort to support you in making your next big move. Student Loans and Expenses According to the American Dental Education Association (ADEA), the cost of dental school education has doubled since 2000, leaving a heavy financial burden on you and your colleagues. The result is student loan debt in the neighborhood of $200,000 to $300,000 -- translating into a $2,000 to $3,000 monthly bill for 15 years. Sadly, this is not uncommon. Add to it the estimated budget for the start of a dental practice at roughly $500,000 and you’re likely to doubt your chances of success in opening a solo practice. It is not completely out of reach if it is truly an option you want. However, what is crucial is creating a game plan to make it happen. Managing debt and making powerful financial decisions now will support you in building the foundation for your long-term success in dentistry. You can do that by surrounding yourself with key people
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who will mentor and support you through the process of setting goals and designing a course of action to achieving your desired outcome. Keep in mind, you don’t know what you don’t know and getting connected to the right people can unlock a lot of mystery and possibility for you. Clinical Competency - Getting Fast ... Fast! Practicing dentistry in an office is an entirely different ballgame from the safety net of the clinic floor in school. Getting into the swing of a practice -- keeping pace, working with a team, managing new systems and flow – all while maintaining a high-level of quality care can seem overwhelming. However, getting good and fast at what you do will accelerate your growth and bring you closer to achieving your goals. Dr. Pezzolesi adds, “...bottom line in this business is, you need to get good at what you do and quickly.” He believes the three key areas to develop, following clinical skills, are: • time efficiency • communication • treatment planning
Want to focus more on patients? You have our full support. At Aspen Dental, nothing stands between you and what you love doing most: helping patients. • Enjoy full operational and business support • Expect a reliable fow of new patients • Grow with our mentoring and development programs Ready for a better future? Call 877.330.1349.
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“All of this comes with experience and the more you can do that early on the better you will become,” he says. “Anyone coming out of school that will not be doing a residency, I absolutely recommend she/he consider taking a couple of years to practice in a large group setting, if for nothing else, for the experience of the number of patients s/he will see.” Owner Versus Associateship Dilemma Your dreams may see you in your own private practice and yet, the reality may be taking an initial step as an associate. This doesn’t have to be a conflict. However, it is a component in making those powerful financial decisions and how that can directly impact your long-term success. Here are some things to consider as an associate: • offers a built-in mentor • often need to settle for lower-paying hygiene positions if the prospects to hire on as an associate are not available • common expectation is the new associate will build a patient base with the existing new patient flow and/or bring in his/her own new patients; resulting in the added responsibility of marketing and generating new patients • smaller private practices may not have the systems and protocol to support highefficiency and volume • due to the expense of high technology, the smaller private practice owner is often limited in keeping up with the demand to utilize the finest products and materials and deliver state-of-the-art procedures • as a new associate, you are often expected to work with a team in which you did not choose and may find yourself in an environment of unmanaged and untrained team members, frequent turnover and HR issues As an owner: • for many, the idea of buying or starting a new practice is financially inconceivable and • overwhelming without the right mentoring and support • cost of hiring and developing a quality team • managing HR, overhead, marketing and generating new patients • invest in coaching and consulting for establishing operating systems and clinical protocols 12 Spring 2015 Dental Entrepreneur
I believe the opportunity to own is always a viable option available to you. However, as a new grad, it’s critical to take the time to plan, network and use the support and counsel of a successful dentist and then invest in a financial and business team to support your long-term goals. Influence of Corporate Dental Group Practices One influence shifting the landscape of dentistry is the rise of large group practices. One concern is how some private practice owners are viewing this change. I’ve often heard many refer to these groups as, ‘the Walmart of dentistry’ and express their fear of how this rise will be a threat to their practice and overall patient care. While I have nothing against Walmart, I think we can agree at which the tone implies. Based on my research, reputable dental group practices are not lacking in any area of patient care. In fact, Dr. Pezzolesi shares his personal experience, noting, “These practices are scrutinized more closely than any private practice. Currently, I work with the most well-rounded and progressive soft tissue management program that I have ever experienced in private practice. If anything, large group practices are setting the bar for a high-level, proactive approach to diagnosis and treatment.” Perhaps their lead could alert our industry to up our game. Examining and making adjustments to diagnose and treat disease with a more progressive approach ultimately serves the best interest of the patient. In viewing the large group practice as an opportunity, here are some key benefits to consider: • build clinical skills and speed • offers a built-in mentor • solid income and strong benefits package • pay off student loans without the stressors of owning a private practice • opportunity for future ownership (percentage of profits or equity) – without having to deal with the management aspect of the practice • future option to purchase a practice or become a partner with affordable inhouse financing and support • deliver enhanced patient care with the most state-of-the-art technology and products – more affordable for group practices to invest • become proficient with charting, software
and computer use, proven protocols and systems, presenting treatment and communicating benefits to patients • organizational consistency and increased quality assurance • experience working with a high-level trained team • less interaction with insurance, HR concerns, OSHA and HIPAA compliance, collections, managing equipment, ordering and supplies, marketing, referrals, and generating new patients Dr. Pezzolesi’s vast experience and insight is built on 28 years as a practicing dentist. Therefore, I asked him to share his perspective of large group practice and what led him to where his is today. Here is what he has to say: “After years of practicing dentistry in every conceivable way -- solo practitioner, boutique practice, partnership and HMO clinic setting -- what I found was that large group practice was my best fit. Aspen’s Practice Ownership Program (POP) was the best way to get that group practice with ownership. I get to do all phases of dentistry, see numerous new patients per day, have autonomy in my choice of supplies and labs all with the advertising and purchasing power with Aspen as my partner. Most, if not all, the management part of dentistry is performed by highly trained team members that become part of my team. I get to do my dentistry and go home, all while owning a busy practice that is growing every year.” Ultimately, the experience of working with a large group practice out of school can be a springboard into developing your own practice. With the gained knowledge in the operations and what it takes to develop a successful practice – enhanced clinical skills, know what you want and how you want it from the layout of the office, to software and technology, to hiring and developing a winning team – you can be ahead of the game once you’re ready to operate your own practice. The Difference for New Grads An area that could make a tremendous impact would be a rise in the mentoring and leadership of mature private practice owners. Today, many private practices are not financially prepared to bring in an associate to expand the practice. The idea of bringing in an associate, under the wings of the practice owner, to mentor and support is lacking. This
simple practice would support new grads in growing quickly as successful dentists and have a positive and direct impact on patient care as well as the growth and strength of the dental industry. I strongly recommend that new grads actively participate in their professional organizations, commit to leadership and mentorship development, engage in networking opportunities, continue their education and inspire involvement from practice owners with students and new grads. Lastly, the rise in the cost of education is hindering new dentists from expanding their options and growing quickly. Lobbying for revised tuition and addressing scholarship challenges that students face can have a direct impact in paving the way for a smoother transition.
Despite the challenges, there is always opportunity. These are exciting times for you. Get mentored, plan and get crazy! “Because the people who are crazy enough to think they can change the world are the ones who do.” -Steve Jobs Dennis Pezzolesi, DMD Tufts University of Dental Medicine, 1987; Practice owner at Aspen, Natlick, MA; Member of ADA, MASS Dental Society, Fellow Academy of Comprehensive Esthetics
Christine Brooke is a Southern California-based dental hygiene coach and founder of Hygiene by Design, committed to empowering dental teams to develop an extraordinary and profitable dental practice. Christine is all about the discovery process of what’s possible and laying the groundwork for you to blend practice and life rich in purpose and passion. To begin your path to long-term practice growth, productivity and designing the life and practice you love, go to www.hygienebydesign.com to download FREE your Roadmap to a Wildly Successful Hygiene Department.
Should PPO Fees Or Full Fees Be Reported On Claims? Charles Blair, DMD
hile it may be easier to bill the PPO fee when submitting claims, this is not wise from a business management point of view. The ADA encourages dentists to bill their full fees on all dental claims and take contracted write-offs after the claims have been paid, and so do I. Here are the reasons why you should always submit your full fee: 1. Sometimes a PPO plan will raise its allowable fees. If the plan fails to notify contracted providers of this increase, the provider will be paid its reported fee. Billing your full fee will ensure that the practice receives the highest PPO fee available on that service date. 2. Most large dental insurance carriers monitor the fees submitted on dental claims submitted for payment. The carriers analyze those fees submitted to help establish “UCR” fees for the participating doctors in a given market. If you always bill your contracted fee rather than your full fee, you bring down the “average” fee in your market area. 3. Some secondary payers are required (by contract law or state law) to coordinate up to their allowable fee if it is higher than the primary dental plan’s allowable fee. However, the secondary plan will never coordinate up to a higher fee than you charge on the claim form. If you charge your full fee, you may find that some secondary plans will coordinate payment up to the practice’s charges. Thus, under some scenarios with two or more plans, the secondary payment results in the practice receiving its full charges—in spite of the low fee schedule of each PPO. 4. From a management perspective, it is essential to be able to perform an apples-to-apples comparison of PPO networks to determine which ones are better than others. This involves not only comparing fees, but also monitoring how a carrier’s processing policies or hassles trigger write-offs. Reporting full fees on claims and analyzing the total write-offs compared to total charges for each PPO network allows a dentist to understand the true costs and benefits of participating in each network. PPO plans now represent approximately 77 percent of the dental benefits market
14 Spring 2015 Dental Entrepreneur
and continue to grow, while 85 percent of dentists participate in one or more plans. Dentists should evaluate their write-offs periodically and determine the benefits/risks of continued participation in less-profitable PPO networks with burdensome administrative constraints. Eliminating those less-profitable plans may help to accommodate patients from more profitable PPO networks. As the number of patients covered by PPO plans increase, reimbursement becomes more restricted. With insurance administration complicated by more and more complex restrictions and limitations, business staff must be given the training and coding tools necessary to maximize legitimate reimbursement for its patients. Without adequate tools and training, what is the end result? Money is left on the table, something that no practice wants or needs. The bottom line: Always submit your full fees and only post write-offs after all payments have been received. 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 firstname.lastname@example.org or call 866.858.7596.
The New Normal: “Employee to Owner” Tom Snyder, DMD, MBA
s dental-education debts continue to rise, more graduates fear that practice ownership may not be in their plans. With the average dental school debt as of 2013 at public institutions averaging $209,000 and those at private institutions averaging $284,000, it is no small wonder why today’s graduates feel that way! This is not the time to feel sorry for yourself, because the public does not view us as a profession who will not be successful financially. In fact, US News and World Report reported in its January 2015 edition that being a dentist is considered the best job in 2015. So we are ahead of the pack! Now understandably, your immediate concern about paying off these education debts is a major financial hurdle that many of you will have to face upon graduation. But the opportunities to create significant wealth are there for the taking, and that means that you do not have to consider finding a goodpaying job for the next 10 to 20 years as your only path to financial 16 Spring 2015 Dental Entrepreneur
freedom. In fact, the recent survey of the Class of 2013 taken by the American Dental Education Association shows that the majority of these graduates valued “control of time” as the top reason why they choose dentistry. “Service to others” ranked second and “selfemployment” ranked a close third. The survey also showed that 48 percent of this class were immediately pursuing private practice upon graduation. Sixty-five percent of this group planned to be employed as an associate, and 23 percent were planning to be employed in a corporate group practice. Granted, the option of employment both as an associate in either private practice or in a corporate group setting does not have to be a career-long event, but rather a stepping stone to eventually becoming a practice owner. Many graduates enter residency and/or specialty programs but practice ownership is still the long-term choice. Every entrepreneur has heard the adage “you’ve got to spend money to make money.” The enormous benefits of acquiring a
Looking to purchase an existing practice or start one from scratch? We have the financing you need to make it happen. You can rely on the industry leadership and experience of Bank of America Practice Solutions. We have provided financing for thousands of healthcare professionals and understand the challenges that accompany them. Let us help you. We encourage you to call the experts at Bank of America Practice Solutions to discuss.
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• Working capital to help you get started • Competitive terms
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• Demographic Site Analysis to help you select the ideal location and attract the patient base you want†
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* All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. The term, amount, interest rate and repayment schedule for your loan, and any product features, including interest rate locks, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. Bank of America may prohibit use of an account to pay off or pay down another Bank of America account. ♥ Bank of America Practice Solutions makes no express or implied warranties with respect to any aspect of the Practice Heartbeat® program, nor does it guaranty any success or promise any results, and hereby disclaims the same to the extent allowed by law. The opinions of Bank of America Practice Solutions are based upon prior experience, and it makes no promise or guaranty that you will achieve any particular measure of success or results by participating in the program. You are not bound by any recommendations provided under this program and retain full responsibility for the results achieved by your professional practice. † Bank of America Practice Solutions engages Scott McDonald & Associates, a national marketing firm specializing in demographic research, site analysis and profile reports for health care professionals to produce a demographic report to assist health care professionals in evaluating where to locate their professional practices. Scott McDonald & Associates charges a fee for this service, which is passed on to the customer. Bank of America Practice Solutions tool within this advertisement requires Internet access. Bank of America does not offer or provide an Internet service provider for your personal access and usage purposes. Please check with your Internet service provider due to charges and fees which may apply. Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2015 Bank of America Corporation | AR9AB890 | Rev 12/14
Resource Guide ADCPA
Bank of America Practice Solutions
www.ADCPA.com The Academy of Dental CPAs (www.adcpa.org) is the nationally recognized, authoritative source for enlightened and proactive tax, consulting and accounting resources for dental professionals. Our mission is to add value by assisting our clients to improve profitability, business success and quality of life, and to continually improve the value that ADCPA members can deliver to their clients through sharing resources, intellectual capital and best-practices. The ADCPA is comprised of 24 firms, representing in excess of 8,000 Dental Practices throughout the nation.Please see our ad on page 29.
800.428.2847 www.bankofamerica.com/practicesolutions Dental practice financing designed to help you succeed. Bank of America Practice Solutions offers a full range of dental practice financing options from purchasing an existing practice or starting your own practice. We provide critical knowledge you need to establish and develop your business. See our ad on page 17.
ADS Dental Transitions (888) ADS-4237 www.ADStransitions.com ADS is the nationwide leader in dental practice sales, associateships, buy-in/buy-outs, partnerships and appraisals. ADS is comprised of the industry’s most experienced professionals, including dentists, attorneys, and CPAs. We can help you with each step of your next transition. To view a complete list of practice opportunities available in your desired area, visit us at ADStransitions.com. Please see our ad on page 31.
ADS Dental Transitions South 770-664-1982 www.adssouth.com ADS South is the premier dental transition organization in the Southeast. We provide associateship placement, dental practice sales, appraisals, and expert testimony services. Our company was founded over 26 years ago by Earl M. Douglas, DDS, MBA, BVAL, and we continue to control the cutting edge of transition technology. Please see our ad on page 33.
Aspen Dental 877-330-1349 www.AspenDentalJobs.com At Aspen Dental we recognize that our success is a direct result of empowering and supporting ambitious dental professionals. We provide a professional, fast-paced, entrepreneurial work environment based on a mutual respect that keeps our interests aligned together, we build and develop successful, patient focused dental practices. Please see our ad on page 11.
18 Spring 2015 Dental Entrepreneur
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 13.
Dentist’s Advantage 1-888-778-3981 www.dentists-advantage.com Since 1949, Dentist’s Advantage has provided dental practitioners with access to a comprehensive professional liability insurance program that offers a vigorous legal defense against allegations of dental malpractice. More than 17,000 dentists across the nation depend on Dentist’s Advantage to protect their practice, their license and their financial security. See our ad on page 21.
Henry Schein Nationwide Dental Opportunities 866-409-3001 www.dentalopportunities.com Henry Schein Nationwide Dental Opportunities (HS NDO) offers Dental Associate recruitment and placement services that pair job opportunities listed by dental practitioners with qualified, prescreened dental associate candidates. HS NDO matches dentists based on skillset, practice philosophy, and style to ensure a high success rate. We are specialists who work confidentially to help doctors fill critical roles within their office by defining the job, attracting qualified candidates, and managing the interview/placement process. Dentists can make a decision with confidence, knowing that we have helped them through the process. And candidates can rest easier knowing that there is never a fee charged to them. We work to make the match a win-win situation for both the hiring doctor and the Associate with our personalized placement service and years of success. See our ad on page 37.
Business Beyond the Classroom Henry Schein Professional Practice Transitions (PPT) 1-800-988-5674 www.henryscheinppt.com/ Henry Schein Professional Practice Transitions is the leader in dental practice brokerage (sales and buying), transition services, and practice valuation. We have a broad range of dental practice listings nationwide and have closed sales in all 50 states, yet have the expertise and knowledge of your local area. Our responsive support gives you a clear advantage and we can help you to refine your plans and create new options as your practice goals change. We offer valuable webinars, seminars, and other resources to support dentists throughout their career, as well as many value-added services such as practice valuations. See our ad on the back cover.
IgniteDDS 716-912-7970 email@example.com Building the bridge between dental school and tomorrow’s most successful, quality-conscious private practices Mission: Fueling Passions Beyond The Classroom for dental students, new dentists and new dental team members Description: igniteDDS empowers the next generation of dental professionals with the knowledge and resources you’ll need for tomorrow’s treatment and practice decisions!
MacPractice, Inc (402) 420-2430 MacPractice.com MacPractice DDS is the leading practice management and clinical application for dentists who prefer to use a Mac, featuring electronic insurance submission, Mac native digital radiography and photos, charting, Electronic Dental Records, Kiosk, Web Interface, iPhone Interface, speech dictation, and Mac stability and ease of use. Please see our ad on page 25.
Patterson Dental 800 873-7683 www.pattersondental.com Patterson Dental Supply Inc. is a full-service distributor of a complete range of dental products and services to dentists, dental laboratories, institutions and other healthcare providers throughout North America. As one of the 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 page 5.
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 1-800659-5977 or visit www.cereconline.com. Please see our ad on page 27.
Wells Fargo Practice Finance 1-888-937-2321 wellsfargo.com/dentists firstname.lastname@example.org Wells Fargo Practice Finance provides customized financing supported by experienced specialists and practical planning resources to help dentists acquire, start and expand their practices. The only practice lender selected especially for 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 9.
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 23.
Dental Entrepreneur Spring 2015 19
successful, profitable dental practice certainly can place you on track to retire your student debt comfortably as well as meet your financial obligations of purchasing a practice. Furthermore, if you have the clinical experience to produce in excess of $35,000 to $40,000 a month, start thinking about purchasing a $700,000 or $800,000 practice. In fact, you may be able to purchase a higher-grossing practice, especially if the Seller remains after the sale. When you purchase a successful practice, you are purchasing a dentist’s historical earnings. As long as you continue to maintain the practice revenue and eventually grow the practice, your financial success can be easily achieved. Before the Great Recession, many banks were funding start-ups at a very high rate. Recently, practice start-ups have declined, particularly in economically hard hit areas of the country. However, a start-up is still a viable career option in the right market. Yet, for many graduates, purchasing an existing income stream via a highly profitable practice is always a winning proposition! The good news is that all of the major dental lenders understand your plight and are ready to loan money for a practice acquisition as soon as two years after your graduation. These lenders are in the business of providing funds for dental practice acquisitions because you are their market. The ability for recent grads to obtain sizable loans is a reality! Bank underwriters consider several factors; your credit, your amount of debt, your clinical production history and most importantly, the financial condition of the practice you are purchasing. With interest rates still in single digits for the foreseeable future, it is a good time for taking advantage of these market conditions that allow purchasing a highgrossing practices a real possibility. Lower interest rates also translate into more purchasing power for you. When comparing being a long-term employee versus purchasing an existing practice, you must consider the long term
20 Spring 2015 Dental Entrepreneur
Not pursuing an ownership model for several years after graduation is not a bad decision. cumulative potential for wealth accumulation. To illustrate this point, assume that you purchase an $800,000 practice, which has a profit margin of 40 percent. That equals $320,000 of income per year (before debt service). Over a 20-year period, without even considering any growth in your annual income, the total income you can generate over that 20-year time-frame translates into $6.4 million! Let’s assume that you paid $600,000 for this practice (including working capital). The loan term is for 10 years at an interest rate of 6.0 percent. That translates into annual payments of $79,900 over the course of the loan. So is borrowing $600,000 for a practice that can produce potentially over $6.4 million in career earnings a worthwhile investment? The answer, of course, is yes. So now, let’s compare ownership versus employment over the same 20 year period. If you work your way up the ladder in a large group practice, what kind of income stream can you expect to earn? For example, let us assume you work in a practice at a commission rate of 30 percent of collections and you earn $250,000 per year on average. Your annual collections needed to earn this income would be about $835,000. Ironically, this is more revenue than the $800,000 practice that we just discussed as a potential purchase. Granted, comparing the two scenarios over 20 years shows that in the employment example, you could earn $5.0 million in your career. But, the big question to ask is,will that employment opportunity be guaranteed
for your entire career? The simple answer is NO! Ownership may change, the practice could be sold and your employment no longer required. Numerous scenarios that may impact your ability to generate that type of income over a long period of time as an employee. Another glaring omission from the employment model is the absence of any profit-sharing from business operations.. Ownership certainly gives you that advantage! Not pursuing an ownership model for several years after graduation is not a bad decision. Working in an environment where you can earn a good six-figure income and gain valuable clinical and management experience is not all bad. For several years you may be able to put a dent in your educational debt! But do not take your eye off the ball from becoming a practice owner. Practice ownership is the long-term proven path, especially if you have any entrepreneurial spirit!
Dr. Tom Snyder is a nationally known speaker, author, and consultant who has been advising dentists for more than 30 years in areas relating to dental practice transitions, strategic planning, and financial management. A frequent lecturer at state and national meetings, Dr. Snyder is known for his outstanding ability to simplify the complex topic of practice transitions. He is also a regular contributor to Dental Entrepreneur magazine, and Dental Economics. He also writes a monthly column for The Dentist Network , an e publication. Dr. Snyder is also a member of the faculty of the University of Pennsylvania, School of Dental Medicine as well as a member if the Executive Committee Penn Dental’s Alumni Association.
2015 Graduates and Residents: New AGD Member Insurance Benefit
“Have you heard? The AGD
New Graduate Professional Liability Insurance Coverage will provide up to 12 months of professional liability insurance coverage at no cost to you!”*
“Yes, and the cost of the coverage is assumed by the AGD and is available through Dentist’s Advantage.”
Find out why people are talking about the latest member benefit… Along with easy and affordable practice protection, the AGD New Graduate Professional Liability Insurance Coverage will offer you all of the benefits Dentist’s Advantage program is recognized for — unparalleled financial security, $1 million/$3 million coverage limits, and comprehensive risk management support — plus Dentist’s Advantage is an AGD Member Savings & Offers program participant, and Lead Corporate Sponsor.
Give us a call or visit us on the web to hear more about this exciting, new insurance benefit for new grads!
Enroll Today! Professional Liability Insurance
*Qualified applicants must graduate from an accredited U.S. or Canadian dental school or complete an accredited U.S. or Canadian general dentistry residency program between Jan. 1 and Dec. 31, 2015; be entering their first year of licensed dental practice in the U.S.; be an active AGD member at the time of enrollment; and maintain active AGD membership through Dec. 31, 2015. Dentist’s Advantage is a division of Affinity Insurance Services, Inc.; (TX 13695); (AR 100106022); in CA & MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency. © 2015 Affinity Insurance Services, Inc.
The Last Number First Dale Wagman, CPA
ou are thinking about buying your first practice, and your stress meter is red-lining. Youâ€™re lying awake at night with numbers tumbling in your head. Youâ€™re trying to get through your day, but the numbers keep flashing through your mind. The ratio of the lab bills to the overall collections, the ratio of staff salaries, the rent, the supplies, the equipment have twisted themselves into a giant knot that bangs around in your head like a super-charged ping pong ball. Chief among them, of course, is the selling price - that massive, bold number that stood out on the page like a gigantic mushroom cloud of doom on day one. It was the first number you saw when
22 Spring 2015 Dental Entrepreneur
this all began, and it is still the first number you think about whenever you contemplate the project. It is the number you have questioned more than any other number you have about the practice. Is it fair? What should it be? How did they calculate it? How can I be assured that I am not paying too much? Here is the irony: the price of the practice is probably the last number you should be looking at when you are planning your career as a practice owner. Wait! Does that mean the price is not important? It is probably the biggest single number you have ever considered paying for something in your life! It is, in essence, the debt you will be tying
yourself to for a long time. We all know debt is bad and it is already everywhere in your life. You’ve got student loans. Your car is coughing for some unknown reason. You’d like to have a family, and that means you will need a home and a mortgage. Debt. Debt. Debt. You’ve got enough debt! Of course the price is important. It does represent a significant amount of debt, but in the end, it is not the most important number you should be considering and certainly not the first number you should look at when you are considering a practice purchase. The first number you should be looking at is usually the last number you see in any financial examination of a dental practice - the net, after expenses, after debt-service cash that you could put in your pocket after a year of operating the practice. It is essentially your paycheck before taxes! Knowing how much that is going to be will help you determine just how significant any of the other numbers are – including the price! Before we talk more about your paycheck, let’s examine that debt issue a little. Yes, generally it is wise to avoid debt. However, a tremendous difference exists between debt that decreases your paycheck and debt that increases it. While they may enhance your lifestyle, credit card debt, non-essential automobile debt and Dental Entrepreneur.pdf
First, assume that you will be able to do the same amount of dentistry and collect the same amount after you purchase the practice as the owner did in the previous year. depreciating asset debt (like boat debt, for example) all decrease your paycheck. However, debt incurred to buy a lucrative dental practice can definitely increase your paycheck … sometimes by far more than you ever imagined. So, how can you figure out what that paycheck will be? Well, any good Dental Transition Company should give you a reasonably good notion about that immediately – actually before they give you the sales price of the practice. They should have sifted through the practice numbers and ferreted out the truly significant ones. But, if they don’t, here is how you can take
a fairly good guess at how much that allimportant number will be. First, assume that you will be able to do the same amount of dentistry and collect the same amount after you purchase the practice as the owner did in the previous year. (f you don’t think you can, then perhaps this is not the right practice for you to buy in the first place. Then, take any “compensation of officers” listed on the tax return of a Corporation or an LLC and add to it the “taxable income” listed near the bottom of the first page of most corporate tax returns or the “Profit” listed near the bottom of the Schedule C of a nonincorporated owner. One way or another, that money will eventually end up as part of the money that goes in your pocket. That’s it? Add two numbers together and you have it? Not quite. In most tax returns, there are many other items that were expenses to a seller, but could easily be considered income to you. The IRS allows certain personal expenses or a portion thereof, to be included among the general expenses of a business to reduce the overall tax burden incurred by that business. It is good to be an owner! Some sellers take advantage of this opportunity, some do not, and still others abuse the privilege. Regardless, many of the personal items included in the expenses
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Dental Entrepreneur Spring 2015 23
Please reach of a practice are essentially money that could be in your pocket. Let’s look at a simple example. Often there will be an entry in the tax return for “Repairs.” There are always repairs that need to be made in a dental practice – some simple, some drastic. Say a suction machine could not be repaired and had to be replaced for $5000. It would be reasonable to expect that the new suction machine will last for many years and you will not have to pay that particular expense again for a long time. That $5000 could be added to your list of income. It is money you will save and therefore, money you will have available to spend on something else. Expenses for employee pension and profit-sharing plans are often allowed by the IRS and are also included in the seller’s expenses. However, it is not uncommon to find contributions made into these plans for the seller of the practice as well. That portion of this expense can also be considered income to you. There may also be expenses incurred by a seller, which you will not incur, simply because you don’t have to. Doing the payroll and cutting the paychecks every week or two is a good example. Actually doing it is not difficult. The guidelines for withholding and FICA calculations are readily available and the math is not hard to do. Finding the time to do it or having the inclination is another thing altogether. Frequently, veteran sellers will hire companies to do this for them. In your lean years, it may be something you could do yourself and avoid the expense and thereby add the money you would save to your paycheck. There are usually two sides, so keep in mind the old adage “All that glitters is not gold.” It is not uncommon to find situations within a particular practice that will cost you money rather than save it. You may have to pay more for some things than a seller would. Take for example a seller whose wife works in the practice in some
24 Spring 2015 Dental Entrepreneur
out to our It is not uncommon to find situations within a particular practice that will cost you money rather than save it. capacity and does not take a salary. If she leaves when he leaves and the remaining staff cannot pick up her duties, you will have to hire someone who can. This will increase your expenses and decrease your pay. And then, there is that pesky debt thing. Yes, you will have to pay it and those payments will definitely reduce the cash you can derive from the practice. But, there is a silver lining. Every payment you make will reduce that debt and increase the equity you have in the practice. Your increasing equity, coupled with the tax benefits you will accrue, and your paycheck will add up to the Total Economic Advantage you will attain from owning the practice and that is truly the first number anyone contemplating the purchase of a dental practice should consider!
authors and our advertisers. They care about you and keep us in print!
If you have any questions, comments, or responses to our magazine, please connect with us on Dental Entrepreneur
Dale E. Wagman, D.D.S. has been a PARAGON Dental transition Consultant since 2007. He owned and operated a large dental practice for almost 30 years. He has authored numerous dental management articles, as well as a best-selling textbook on the history and self-management of Dental PPOs. He lives with his wife in Northwestern Michigan. He can be reached at 517-375-3740.
Magazine — our official Facebook page! Read us online at dentalentrepreneur.com Send your questions or comments to firstname.lastname@example.org dentalentrepreneur.com
75% ] of U.S. doctors use an Apple device of some kind.
JUST WHAT THE DOCTOR ORDERED With 30,000 users worldwide, more and more dentists are running their practice on Apple computers and iPads and trusting MacPractice for their software.
io n als u se
a hc ] o f h e alt e
or w ork.
] 94% of healthcare organizations adopt Apple devices when provider preference is the deciding factor.
us e a n iPh
ST. STEVENâ€™S MEMORIAL HOSPITAL
] Traditional PC shipments have declined 11%.
] Smart tablet shipments have increased 68%.
Call (855) 679-0033 - WATCH WEBINAR & DEMOS MacPractice.com/company/events Sources: A Manhattan Research study claims 75% of U.S. physicians own Apple products. Vitera Healthcare reported that 60% of healthcare professionals use an iPhone for work, and 45% use an iPad. A KLAS study found that 94% of healthcare organizations adopt Apple devices when user preference is a factor. Samsung was the second most frequently adopted technology in this study with just 26% of organizations having at least one device. Gartner detailed market forecast data - "Forecast: Devices by Operating System and User Type, Worldwide, 2010-2017, 2Q13 Update."
Strategies For the Challenges Ahead in Private Practice Edward C. Challberg, CPA
he dental profession is undergoing fundamental changes. The ever increasing presence of dentalmanagement companies, i.e. â€œcorporate dentistry,â€? the decrease in the number of private practices, shrinking dental-insurance reimbursements and ever-growing debt required to get a dental degree are some of the issues facing young dentists who intend to enter private practice. So what should a young dentist do? The successful dentist in private practice of the future will likely: 1. Be more engaged in personal financial planning 2. Be much more savvy at marketing 3. Develop greater business and management sophistication Financial Planning The American Dental Education Association (ADEA) reports that 80 percent of the Class of 2014 is in debt for their dental school education, and that debt averaged $247,227. Over 30 percent of the Class of 2014 is in debt over $300,000. If you have school debt, should you consolidate? Should you refinance to a variable loan at a lower interest rate or stay with a fixed higher rate loan? A 1-percent interest rate difference on a $300,000 6-percent loan repaid over 20 years results in a $42,000 interest cost so the stakes are high. Should you take advantage of one of the numerous federal and state debt repayment programs? Is it wiser to enter private practice or take a position in corporate dentistry to manage your school debt? Are there tax considerations? Does it make sense to prepay the loans? There are many issues to address, and this is just school debt. The typical dentist who opts for private practice will not only be facing large school debt but will also be financing the purchase of a practice or practice interest, facing increasing competition in the marketplace, financing the purchase of a home, raising a family, saving for their childrenâ€™s college education, saving and investing for retirement, and striving to maintain a comfortable lifestyle. Managing all that well and protecting it from loss requires a wellthought-out, realistic and effective game plan. Establish it early, then constantly monitor and adapt the plan to changing conditions. A 2010 survey of 11,998 dentists by the ADA found that the
26 Spring 2015 Dental Entrepreneur
average decline in retirement plan portfolio value after the 2008 economic downturn was 26 percent. As a result, dentists delayed their retirement by an average of 5.4 years. In other words, it just takes one economic event to upset your financial plans. Attaining your financial goals has little margin for error. Flexibility and the foresight to do it right the first time are paramount. Marketing Savvy Corporate dentistry is claiming a larger and larger share of the dental marketplace. What is corporate dentistry? Though certainly not homogenous, corporate dentistry is generally comprised of large organizations often managed by nonprofessional corporations and often funded and controlled by private equity groups. They have sophisticated business models and very large marketing budgets. The corporate trade group Association of Dental Support Organizations claims 32 members operating in 4,000+ dental locations in 46 states with more than 8,000 affiliated/owner dentists employing 32,000+ employees. The McGill Advisory June 2014 Issue states that corporate dentistry currently has 5-7 percent of the dental market and will likely increase to 20 percent in 10 years. In the future, private practitioners will have to employ more sophisticated marketing strategies to set themselves apart from corporate dentistry and attract patients. Scott McDonald of Scott McDonald & Associates, a dental marketing firm, states,
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â€?Corporate dentistry has done a much better job than MOST (but not all) solo practices in the way that they market and manage their offices. I believe that there is much that solo practices can do to use their differentiation to win-out over their corporate competition. But the solution requires attention to the local market conditions along with stepping up their game of messaging, promotion and administration. There is no answer that I can give that would apply to all markets, however. What we usually do when we are looking at marketing a practice (which includes internal and external practice promotion) is to find out the demographic and psychographic profile of the patient base and go from there. The answer lies in understanding the basic needs and wants of local people.â€? At DentalTown.com (April 2014), Michael Barr, DDS, who has worked both in corporate dentistry and private practice, makes the argument that dentistry is a highly personalized service requiring the nurturing of relationships. The corporate profit-driven orientation often does not support that. Therefore, as long as private practitioners focus on developing patient relationships, there will be a place in the market for them. Business Sophistication The number of solo private practices is declining. In 1991, Kent Nash, Ph.D., wrote in the Journal of the American Dental Association that dentists in ownership positions represented 91 percent of all practicing dentists, and solo practitioners accounted for 67 percent of all dentists. In 2012, the ADA Health Policy Institute reported that the percentage of dentists who are owners decreased to 84.8 percent and the percentage of all dentists in solo private practice declined to 57.5 percent. Private practice is evolving into more group dental practices. Marc B. Cooper, DDS, of The Mastery Company attributes more group dental practices to six factors:
28 Spring 2015 Dental Entrepreneur
In the future, private practitioners will have to employ more sophisticated marketing strategies to set themselves apart from corporate dentistry and attract patients. 1. Dentistry always follows medicine. Although the economic engines are somewhat different, the basic practice models are the same. With increased government oversight through regulations and mandates, with third parties squeezing harder, and with the cost of doing business going up, solo dental practice is going to have trouble managing these forces. 2. Costs continue to go up. Equipment, staff, fixed costs, variable costs, supplies. Revenues are flat or declining. The only way to beat this is through economies of scale, which is only available in managed group practice (MSOs/DSOs). 3. Third parties will continue to exert downward pressure. PPOs are now 80 percent of the insurance landscape. More than 50 percent of the population has dental benefits. Of these 50 percent, 70 percent to 80 percent are the ones who see a dentist. 4. The dental industry is severely fragmented with 86 percent of the dentists (in private practice) practicing solo. Corporate dental companies see a clear financial windfall in coalescing these individuals into group expressions. 5. Dentistry as an industry is reces-
sion-resistant, growing at an annualized rate of over 5 percent. Capital investors, entrepreneurs and professional senior executives see tremendous opportunity in managed group practice. 6. Dental school debt can be as high as $250,000 or more. The door is closing to entering dentists, which might explain why fewer than 20 percent of graduates are seeking practice ownership. And the door is closing on exiting dentists since there are fewer buyers. Managed group practice looks like the answer. Group practice by its very nature requires a more complex and sophisticated business model than solo practice. Managing people, setting and monitoring performance goals, strategic planning, and marketing for a group practice require greater sophistication and reliance on advice from business advisors. To succeed in this new world of dentistry and reap the rewards that dentistry has to offer the successful young dentist will: 1) Get more engaged in personal financial planning 2) Become more marketing savvy, and 3) Develop more sophisticated business and management skills An experienced and knowledgeable CPA who understands the dental profession can help.
Edward C. Challberg owns and manages a CPA firm in San Rafael, California that exclusively serves dentists. Ed is a member of the American Institute of Certified Public Accountants (AICPA), the California Society of CPAs, and has been an active member in the Academy of Dental CPAs (ADCPA) since 2001.
5 Things You Must Do To Successfully Market your New Practice Kristie Nation
eginning the next phase of life as a new dentist is exciting, but careful planning is required to ensure you have priorities straight, realistic expectations and a (at minimum) a five-year plan. Whether you are starting your practice from scratch or purchasing an existing one, a cornerstone of your plans for the future – both short- and long-term – must be marketing. You must be prepared and ready to sell your brand – which, in dentistry, is a combination of both yourself and the practice you run. There are thousands of things you can do to increase your chances of marketing success; but there are five things you must do, without which other efforts are useless. 1: Allocate a Budget A realistic marketing budget can range from $25K for an established practice in a region with little competition to $250K or more for a brand-new practice in a highly competitive area. Seem like a lot of money? It is. Building a brand isn’t cheap. A huge factor when it comes to marketing costs is one that too few dentists think of when deciding where they want to practice – in many cases, they choose where they want to live first and then look for the closest spot available to establish or transition a practice. They fail to research each potential location, scope out the competition and weigh in the cost of necessary marketing. If you will be the only option within a decent mile radius (normally less than 50 miles and in some cases less than 25) people are more likely to default – but that’s not a guarantee. People feel strongly about certain health care providers and are often willing to drive distances to use a dentist they are already familiar with and whom they trust. However, if you are planning to practice in any decently sized city, town or suburb, there are likely to be established practices already in position. Convincing residents to switch can be difficult, and obtaining new patients can be expensive. In either situation, a budget is an imperative – and you can’t count on simply dipping onto whatever working capital is left from your initial funding. Marketing needs to be part of your strategy from day one, and a generous allotment to cover the first year should be included in your acquisition costs.
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2: Understand what “Brand” Really Means Your brand is your reputation, not a logo, slogan or picture of you. Unlike Nike or Pepsi, you can’t assume people will automatically have a reaction. It’s important to recognize that an established practice isn’t guaranteed to have a brand you like and, more importantly, a brand that patients will continue to trust after he is gone. Brand management takes consistent effort and the current owner may have let it slide in recent Do your research to figure out how much effort (and cost) you are in for. Your goal is to be the dentist most recognized by your target audience – and for all the right reasons. This means building yourself and your practice up as the best option (not necessarily the most affordable). A good brand can take 5-10 years to build, which is why you need to embrace both short- and long-term marketing tactics. 3: Use the Web - It Exists for a Reason In the Internet age, you’d think having a practice website is a no-brainer, but it isn’t. Many, many practices are out there with little or no web presence, when a great website is a must. Your site should be well designed and intuitive, so don’t cut corners when having it built. Make sure your web development team includes both reputable designers and expert copywriters. Then look for SEO / SMM specialists to help you build your website and practice image up on social media and search engines. You want to rank online not only for searches for dentists in your local
area, but for your name – word of mouth still hinges on “Go see Dr. so-and-so. He/ she is the best!” This is a long-term marketing investment. When you pay for a commercial, a radio ad or some space in the local newspaper, your marketing dollars pay for “limited-time” exposure. Money spent on building your online presence not only has a better short-term ROI (return on investment) than advertising, but it can keep working for you year after year. 4: Advertising isn’t the Devil While building your online reputation should be a priority, advertising still has a valid role – especially for a new practice. If you don’t have any patients, advertising is the way to get them. It’s effective, especially if you have a broad demographic. That said, most dentists don’t have the budget required for sustained commercial
advertising, on or off-line. Direct marketing can give you more bang for your buck. It’s less expensive, allows you to control both the message and the audience, has a significantly higher ROI and doesn’t waste thousands of impressions on an indifferent audience.
events, sponsor a youth sports league or hold your own charity drive. Let your patients get to know you, your team and your passions. If you build your marketing plan around these five ideals, you can ensure both short- and long-term success as your branch out on your own. Remember, it’s not just, “If you build it, they will come,” but, “If you don’t market it, no one knows it is there!”
5: Get Personally Involved Going to the dentist is scary enough without feeling like the person with their hands in your mouth is an unapproachable stranger. Dentists tend to worry about “corporate dentistry” taking over, yet fear to show the personal side of their practice. They don’t realize that transparency is the key to local success. Personal doesn’t have to mean unprofessional. One of the best ways to gain acceptance in your community – which is also your most valuable source of patients – is to get involved. Show up for local
Kristie Nation Ms. Kristie Nation is the founder and CEO of myDentalCMO, a marketing consulting firm that provides strategic marketing evaluations,education, and marketing advice for dental practices..
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Seven Leadership Skills Every Practice Owner Should Develop Roger P. Levin, DDS
s a new practice owner, you need to build a strong foundation to ensure your practice’s future success. Providing excellent dental care is a given, as always. But it must now share the spotlight with other subjects not emphasized in dental schools. In addition to choosing the ideal location, purchasing the right equipment and recruiting and hiring the best people, you’ll also need to cultivate your leadership skills. You may not have learned how to lead a team, but that’s exactly what you will be doing as the owner of a practice. To prepare, focus on honing your ability to perform the following seven activities:
descriptions you establish for each position at the practice. For example, if the front desk coordinator makes confirmation phone calls, she may be responsible for reaching a certain number of patients per day to ensure that the practice attains a no-show/cancellation rate of less than 1 percent. Convey goals in writing and in person so that the entire team is clear about their responsibilities, both individually and collectively. Assigning accountability empowers team members to achieve their full potential. When they understand clearly what is expected and that they are accountable to the entire team for meeting that expectation, motivation is increased and performance is improved in almost every case.
1. Inspire Others with a Vision Whether you see yourself as a leader or not, your staff members do, and they will look to you for guidance. First, decide where you want your practice to be in three years. Do you want to be the premier choice for quality dentistry in the area? Do you want to sponsor a number of community events each year? How much profit do you want the practice to make? Next, write a statement (a few sentences or paragraphs) describing this vision. Finally, share the vision with your team to provide them with a common future they can all work toward together—discuss it, post it where staff will see it often and refer to it during staff meetings.
4. Review Team Performance Performance reviews go hand-in-hand with job descriptions and assigned goals. Every year, conduct reviews with each member of your team to verify that the whole practice is working in concert to reach the vision. These one-to-one meetings provide a valuable opportunity for you to address any shortcomings that might hinder progress. Keep in mind, however, that these discussions are meant to be positive, growthoriented and informational. Reviews also give you a chance to listen to employees — encourage them to do 80 percent of the talking. Don’t wait until a review to compliment staff members who are doing well — a quick affirmation or thank you goes a long way toward building morale and boosting confidence.
2. Set Goals Once you’ve created a vision statement, your team will need to take action to realize that vision. While the vision describes where you want the practice to be in three years, goals make up the road map to achieving it. CEOs often use goal setting to drive performance and attain greater success. The first step is to document measurable goals that will move your practice in the right direction. Set a deadline by which the team should reach each goal. Then, assign each goal to the appropriate team members for accountability.
5. Listen Team members have firsthand knowledge of how the practice functions on a daily basis. As one person, you cannot be everywhere at all times, and in fact you should delegate 98 percent of administrative duties to others so that you can spend the majority of your time chairside. Let staff members know that you welcome their feedback on non-clinical matters and ask periodically how things are faring on the “front lines.” Then, be prepared to hear and act on what they tell you.
3. Communicate with Staff Members It is extremely important that you learn how to communicate effectively with your team. You should word your requests in a way that the team understands what you want and is motivated to act. Clearly articulating the practice vision, identifying measurable and specific goals, and asking the team for comments and feedback are simple steps that can greatly clarify expectations and produce excellent results. The goals you create should also become part of the written job
6. Provide Your Team with Systems and Scripts You wouldn’t expect your team to perform without the proper tools (such as computers for the front-desk team), and neither should you expect them to function without pertinent management systems and scripting for patient interactions. Implementing documented systems enables you to spend more time on direct patient care while the team effectively runs the administrative side of the practice. From scheduling
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to collections, case presentation to customer service, step-by-step systems establish how team members should carry out non-clinical tasks of every description. Each system should be thoroughly documented so that if a team member is absent or leaves the practice, she doesn’t take that knowledge with her. New team members can then be trained much faster and easier, as well. Systems involve patient-doctor or patientstaff interactions at every turn. Excellent scripts prepare staff members with influential ways of speaking that don’t always come naturally in the moment. With role-playing, scripts will become second-nature and will build team members’ confidence, not to mention help the practice get the desired results from patients. The right scripts will boost patient loyalty, increase case acceptance and encourage referrals to the practice.
the team how they are expected to behave at the office. Displaying a positive attitude even when things go wrong, maintaining a calm demeanor no matter how difficult the situation and leaving personal problems at home are just a few of the characteristics dentists can model for their staff. A positive outlook, no matter what’s happening, goes a long way toward building morale in a small practice where staff members work closely together.
7. Exhibit a Positive Attitude As the practice owner, you 1:42 need to ADS.south209 2/25/09 PMshow Page
Conclusion As John Quincy Adams once said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” The fact is that perfect teams are made, not hired. You can motivate your team members to achieve success with a three-year vision, corresponding goals and an upbeat attitude. Providing them with specific job descriptions, annual performance reviews, management systems and scripts will train 1them to go above and beyond when com-
pleting their daily tasks. Hear their suggestions and feedback, and together you will be able to achieve more and more as you create the best possible practice. To learn more about how to run a more profitable, efficient and satisfying practice, subscribe to Tip of the Day for free daily emails from Dr. Levin.
Dr. Roger Levin is a third-generation general dentist and the Chairman and CEO of the largest dental practice consulting firm in North America, Levin Group, Inc., which has served more than 22,000 dentists and specialists since 1985.
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 DentalEntrepreneur.com
Dental Entrepreneur Spring 2015 33
Power to Succeed
Together We Rise David Rice, DDS
remember it like it yesterday. It was Thanksgiving break my first year of undergrad, and I had the opportunity to spend the day at a friend’s father’s business. I showed up just as lunch was wrapping up and watched Denny, my friend’s dad, hand out turkeys to all 100 people who worked for him. It was something to witness. Some of Denny’s people were laughing, some were smiling and some were crying tears of joy. Whatever their emotion, two things were apparent: The turkey-getters were grateful, while the turkey-giver … even more. As everyone went back to work, I watched Denny pull one employee into his office. I wasn’t sure why, but it looked pretty serious. A few minutes later, the young lady emerged. Tears in her eyes, she smiled as she passed by and went back to work. All I could imagine is that for some reason, she’d lost her job. Before I knew it, Denny rushed by, late for a meeting and handed me off to his assistant, Adele. The look on my face must have said it all, because Adele wasted no time to share what I needed to know. How did we go from 100 happy people enjoying lunch and Thanksgiving Turkeys to secret meetings and tears? What I learned next ignited my passion forever more. Adele said, and 27 years later I quote, “David, that is one of the greatest men I have ever known. Do you have any idea what he does for his people?” In my head I thought, “Yeah, he feeds his people turkeys and then fires them at Thanksgiving.” Turns out, the woman he met with was a single mom, had a son in college and a tuition bill she couldn’t manage. Turns out, Denny gave her a check, a gift for the entire semester. And turns out, although every one of those 100 people who worked for him had different needs, at one point or another, he had stepped up to the plate and done something extraordinary. People often ask me what igniteDDS is and why we do what we do. They want to know why a guy with a highly successful private practice in Upstate, N.Y., would travel the country week in and out to give back. They want to know what’s in it for me. I am honored to share those answers with you today. What is igniteDDS?
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First, please understand, there is no answer to what is igniteDDS. I can however answer, who we are. WE are you. We are a community of dental students and dentists from all over the country at different stages of our careers. We know dentistry is at a crossroads. Student debt is at an all-time high; the traditional associateship opportunities seemingly at an all-time low; corporate dental practices are hungry; tertiary providers and hygienists want a piece of our pie. I could go on, but you, more than most, know the story well. Our core mission is to give you a 10-year jumpstart on your success. We’ll come to you live. We’ll meet via the web. We’ll do whatever we need to do to arm you with the tools of success and what matters most to you! Why do we do it? I learned two great lessons from Denny that day. The first is this: There are two types of people in this world. Those who look out for No. 1, and those who truly believe we are all in this together. Denny gave me that gift that day. And he gave it to me with his actions, not his words. So for me, the why is quite simple. I believe in you. I believe the future of our great profession lies in your hands. You have the power to take dentistry to amazing places! And I believe my story and the story of all the incredible dentists igniteDDS networks with can help you get there. Imagine mentors who not only guide you along your path,
but step up with their own practices and give you the opportunity of a lifetime. Sounds good doesn’t it? I’m glad. And lastly, what’s in it for me? I graduated in 1994 from SUNY at Buffalo’s Dental School. Since then I’ve been blessed to complete a GPR, be an associate, an owner and a partner in a practice with a team of people I adore. But the truth is every moment I spend with you and igniteDDS, I get to live my dream. You see, Adele wasn’t the only one who thought Denny was one of the greatest men out there. I did too. Thank you for allowing me into your life and the opportunity to share in your success. It is the greatest honor you could ever afford me.
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Together We Rise, David
Dr. David Rice graduated cum laude in 1994 from The State University of New York at Buffalo’s School of Dental Medicine. In 1995, he completed his general practice residency from the Allegheny General Hospital in Pittsburgh Pennsylvania. With a strong belief in continuing education and mentorship, Dr. Rice went on to complete continuums at the Pankey Institute, The Dawson Center and The Spear Center all while building the Restorative Practice of his dreams and maintaining an associate clinical professorship at the SUNYab School of Dental Medicine. Seven short months ago, Dr. Rice combined his passions for teaching, mentoring and making a difference and igniteDDS was born. Today he continues to maintain his private practice and travels the country inspiring dentistry’s future to live their dream, have great success and to make that same difference that has brought him so much joy.
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Dental Entrepreneur Spring 2015 35
Dental Trade Shows
National Dental Student Lobby Day
103rd Thomas P. Hinman Dental Meeting March 26 – 28, 2015 Atlanta, GA
April 13-15, 2015 Washington, D.C. ASDAnet.org/LobbyDay
California Dental Association – Spring Session May 12 – 14, 2015 Anaheim, CA
ASDA’a National Leadership Conference Oct. 30 – Nov. 1, 2015 Boston, Mass.
ADA Annual Session Nov. 5 – 10, 2015 Washington, DC Yankee Dental Meeting Nov. 27 – Dec. 2, 2015 New York, NY
The American Student Dental Association is hosting its National Leadership Conference, Oct. 31-Nov. 2 in Chicago. For details visit ASDAnet.org/NLC. The event will provide leadership and business training to dental students across all years. Other benefits of attending: • Experience training in people management, public speaking and presenting, personal finance, practice negotiations, mentoring others and more • Increase the understanding of key issues in dentistry and dental education • Network with students from 60+ U.S. dental schools • Build relationships with exhibitors to fulfill current and post graduation needs Dental Entrepreneur: Business Beyond the Classroom will be there to meet the leaders attending. Please look for us!
Index of Advertisers ADCPA........................................................................................................................................ 29 ADS Dental Transitions South……………………………………………………………........................... 33 ADS Dental Transitions…………………………………………………………….................................... 31 Dentist’s Advantage..................................................................................................................... 21 Aspen......................................................................................................................................... 11 Bank of America……………………………………………………………............................................. 17 Comfort Dental............................................................................................................................ 13 Heartland ................................................................................................................................... 15 Henry Schein PPT ............................................................................................................Back cover Henry Schein Nationwide ............................................................................................................. 37 MacPractice................................................................................................................................ 25 Paragon........................................................................................................................................ 5 Patterson Dental.....................................................................................Inside front cover and page 1 Practice Image Builders.................................................................................................................. 7 Sirona........................................................................................................................................ 27 Wells Fargo................................................................................................................................... 9
36 Spring 2015 Dental Entrepreneur
We have a high rate of success recruiting and placing all types of Dental Associates.
Hiring and placing the right Associate is crucial. At Henry Schein Nationwide Dental Opportunities, our unique relationships, experienced staff, and confidentiality lead to great results. We reduce stress and achieve win-win situations every day. Thereâ€™s no fee to the Associate and we offer a placement guarantee to the hiring practice.
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