CLASS OF 2017 | SPRING ISSUE
Business Beyond the Classroom
So, Whatâ€™s My Best Option?
Neha Garge, DMD
7 Things to Identify the Right Dental Practice
A New Way to Look at Dental SEO
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IT’S IT’STIME TIME TO TOPUT PUT PATIENT PATIENT SAFETY SAFETY FIRST. FIRST. Deep-discount Deep-discount dental products dental products that appear that appear “too good “tootogood be true” to be aretrue” often are just often that.just While that. While low prices loware prices appealing, are appealing, the risksthe may risks outweigh may outweigh the rewards. the rewards. Protect Protect your dental yourpatients dental patients from potentially from potentially unsafe gray unsafe market gray and market illegal andblack illegalmarket black products. market products. Learn more Learn about more about . . gray market gray dental marketsupplies dental supplies and Patterson’s and Patterson’s commitment commitment at DentalSupplyIntegrity.com at DentalSupplyIntegrity.com
*“Dental Equipment *“Dental Equipment and Supplies andManufacturing Supplies Manufacturing in the U.S. and in the ItsU.S. International and Its International Trade” Supplier Trade” Relations SupplierUS, Relations LLC, Irvine, US, LLC, CA, February, Irvine, CA,2014. February, 2014. **“Shades of **“Gray” Shades Mentor, of Gray” Santa Mentor, Ana, Santa CA, December, Ana, CA, December, 2013. 2013. ***“Are you ***“ using Are‘gray-market’ you using ‘gray-market’ or counterfeit or counterfeit dental products?” dental products?” Journal of American Journal ofDental American Association, Dental Association, June, 2010.June, 2010. P151409 (3/15) P151409 (3/15)
PATIENT SAFETY IS AT STAKE Potentially unsafe “Gray Market” or illegal “Black Market” refers to products and materials often found at deep discounts through unauthorized channels. These include products that are: Recalled
$6 BILLION The U.S. dental supply market is a $6 billion industry*
15% Some estimate nearly 15% of the U.S. dental market is gray or black**
One manufacturer estimated 5-8% of products carrying their label were in fact counterfeit***
Spring 2017 VOLUME 19, ISSUE 3 Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Content Strategist Michelle Perrit Executive Assistant Patti D’Agata Production Ruthie Kelty Publishers Press Inc. Editorial Board Dr. Dirk Fleischman Dr. Gene Heller Dr. Harold Sturner Dr. Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH, BS Dr. Tom Snyder Derek Champange Dr. David Rice Dr. Hugh Doherty Layout and Design John O’Connor
Class of 2017 Contributors Dr. Neha Garge Jordan Thomas, D4 Drs. Ryder, Waldron and Troy Shanna Morales, CPA Lindy Benton Dr. Dale Wagman
Mark Holllis Bruce Byren, CPA Dr. Earl Douglas Mike Pedersen Brian Swilling Ryan Whitley Dr. David Rice
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
12233 Pine Valley Club Drive Charlotte, NC 28277 704/953-0261 Fax 704/847-3315 email@example.com Send materials to: Dental Entrepreneur Magazine 8334 Pineville Matthews Road Ste. 103-201 Charlotte, NC 28226 When you have finished enjoying this magazine pass it along to a friend and PLEASE RECYCLE Copyright 2017 Dental Entrepreneur, Charlotte, NC Material herein may not be reproduced, copied or reprinted without prior written consent of the publisher. Acceptance of advertising does not imply endorsement by the publisher.
CLASS OF 2017 SPRING ISSUE VOLUME III
I should be writing my editorial, but instead I find myself watching Michigan State and Kansas play in the second round of the NCAA Tournament. It gives me pause. I can see the will to win in these players’ eyes. All of them. They have worked so hard for this moment. They believe they will win. In the end, the will to win is the key, right? Think about being one of the top dental practices in the country. How many are there? Do you know? Have you studied them? Do you want to be a winner? If you do, then you’ll like this issue of Dental Entrepreneur. What we’ve done is assemble a team of our own to help you on your winning path, a team of experts in and related to the dental industry. Yes, these authors will answer your questions, but they’ll also point out some of the questions you might not have thought of asking. Not knowing what you don’t know is critical to your professional development, especially at this early stage in your burgeoning careers! I believe you are in the best profession on the planet. Yes, you chose it, but dentistry also chose you. You studied, you applied and you are now ready to take those skills to people that want them and, most importantly, need them. “You can change the world with their smile.” That, my dear ones, is a shout out to the late, great Mary Tyler Moore. In this edition of DE, we start with Dr. Neha Garge, who candidly offers her story of getting out of dental school at Boston University and how she kept from feeling overwhelmed as she realized the mountain of things she still needed to learn. We also got a great offering from Jordan Thomas, who took a very unique and D.I.Y. approach to acquiring a practice. I am so impressed with his spirit, and his column might inspire you to take a similar approach. Dr. Dale Wagman weighed in on the practice acquisition topic, as well. As you are looking, there is one thing that could seriously limit your earning potential, and Dale dissects that exact issue. And once you do join or purchase a practice, you’re going to want to make sure your online presence is giving you the most bang for your buck, so we asked Mike Pederson, CEO of The Dental Boost, lays out a plan to bring your SEO up to 2017 standards. That’s just a handful of our DE contributors featured in these pages. I hope you consider all the content, as one article plays off another, just like a welloiled team trying to make it through March Madness. As you run towards your championship, I wish you nothing but success and am proud to be a part of your team. Ignite your passion! The future is yours! All the best,
Anne M. Duffy Publisher 2 Spring 2017 Dental Entrepreneur
Contents Prologue 4 My Story
Neha Garge, DMD
Getting Started 6 Let’s Find a Dental Practice – How I Did It Jordan Thomas, D4
8 When We Were in Dental School … Drs. Ryder, Waldron and Troy
12 Student Loan Debt – Ways to Cope Shannon Morales, CPA
Business Fundamentals 14 Tips for Hiring an IT Professional for Your Dental Practice Lindy Benton
Practice Builders 30 A New Way to Look at Dental SEO Mike Pedersen
18 Career Suicide – The Easy Way Dale Wagman, DDS
20 IBM vs. Mac: Why Does It Matter to a Dentist? Mark Hollis
24 Age, Experience, Income, Debt Service and Retirement Bruce Bryen, CPA
26 So, What’s My Best Option?
The Power To Succeed 32 7 Things to Identify the Right Dental Practice Brian Swilling and Ryan Whitley
34 How to Not Fail Miserably as you Graduate David Rice, DDS
Earl Douglas, DDS
Dental Entrepreneur Spring 2017 3
My Story Neha Garge, DMD
ou don’t know what you don’t know. Over the years, I have heard this more times than I can count. So simple but says so much. I look back in my rear view mirror at myself as a dental school applicant, a dental student, a new graduate in her first job. Each stage has brought new challenges, new growth and new insight. Along the way, I was learning things I didn’t even know I needed to learn. I still find myself on that kind of journey everyday. After double majoring in English and Biology at Tufts University, I received my DMD at Boston University. Over the next three years, I worked in many different practice settings: group practice, corporate dentistry, and boutique private practice. I have practiced in city and suburban neighborhoods in Massachusetts and Southern California. Until moving to Northern Virginia and finding a full time private practice associateship, I had always worked two parttime jobs at once. This gave me an incredibly varied work experience straight out of school. The amount I learned about dentistry in the first three years after graduating was exponentially more than I had learned in four years of dental school. While in Los Angeles, I started thinking how I wished I would have had a resource that condensed down the major lessons that I could have used to prepare myself for the real world. From the first day of my practice, I kept an Evernote journal to record all important lessons, information, diagrams, materials, personal contacts, and CE resources I had come across and found useful. After three years, it was nearly 50 pages long and full of information that I would have thrived from had I received it on graduation day. It would have given me a three year head start to launch my career. That is what inspired me to write my book - to try to give young dentists that same boost. I told myself that I would try to write the first chapter and then re-evaluate the book’s value-add. Before I knew it, within a matter of weeks - 160 pages had written itself. The book covers many topics including searching for a job, licensing, legal coverage, the interview process, clinical tips, most commonly made mistakes, stress and health, communication, patient and practice management, financial tips, CEREC 101, continuing
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education resources, people to follow on social media and much more. This is a book I wished I had when I graduated and will hopefully help make your transition from school to the real world a little smoother. My advice to new dentists is simple. Graduation day is just the green light to start the real learning. Dentistry is so much more
than ideal GV Black outline forms, perfect crown tapers and Kennedy classifications. It is a behavioral science and one that relies on a people skills, communication, leadership, planning and vision, organization, and work life balance. Dental school gives you the foundation to practice clinical dentistry. It’s up to you to hone the rest of those skills. One of my favorite sections of the book is the one on Continuing Education. I list all the books, magazines, online publications, YouTube channels, Instagram accounts, free and paid CE courses, and message boards that have helped me the most along the way. They cover all areas of professional improvement: clinical, financial, lifestyle, management, and more. It took three years for me to gather these resources, it doesn’t have to take you that long if you know where to look and look early. The other advice is to not let yourself become isolated. Dentistry can get lonely, and it’s a lot of pressure sometimes. Pressure to perform, pressure to produce, pressure to please, pressure to achieve perfection. On tough days, it helps to be surrounded by people who understand your struggle. Start building a professional network that you can rely on. Mentors and peers will give you a balanced perspective on where you are and where you’re heading. Another piece of advice would be to start thinking about your financial well-being now. Too many new graduates don’t think about their financial future early enough. Start planning early and often. This means different things to different people, but it’s important to think about as soon as possible. There is an entire chapter just dedicated to financial management in The New Dentist’s Guide. And finally, take experience over money when you are just beginning. The money comes, but you’ll never truly be successful without a great foundation. Learn as much about what you don’t know as you can. Don’t trap yourself into a job that forces you to work under suboptimal conditions, doesn’t set you up for real success, or causes you to start establishing bad habits early on in your career. It
often takes a few tries to get it right, just don’t stay in something that doesn’t feel right. I was recently at a national ASDA meeting and was so overwhelmed by the awesome young dentists I met. Their enthusiasm and energy was infectious. If that is the future of our profession, I think it’s going to be in great hands. I am so excited to call you all my colleagues soon. Please feel free to reach out to me with any questions or just to chat. I was in your shoes not too long ago, you’re in for quite a ride… and you’re ready. Good luck! Favorites: Books – How to Win Friends and Influence People by Dale Carnegie, Think and Grow Rich by Napolean Hill, 7 Habits of Highly Effective People by Stephen Covey Magazines – DentistryToday, DentalTown, Dental Entrepreneur Equipment – Isolite, Sonicfil, Garrison Ring System Scrubs – Jaanuu and Figs Podcast – DentalTown and The Thriving Dentist Show CE I’ve Taken – Anything Invisalign related
Please reach out to our authors and our advertisers. They care about you and keep us in print!
If you have any questions, comments, or responses to our magazine, please connect with us on Dental Entrepreneur Magazine — our official Facebook page! Read us online at dentalentrepreneur.com Send your questions or comments to firstname.lastname@example.org dentalentrepreneur.com
Dental Entrepreneur Spring 2017 5
Let’s Find a Dental Practice – How I Did It Jordan Thomas, D4
any dentists develop the desire to own a dental practice at some point in their career. Some discover this desire while in school, some a few years out and others, like me, were thinking about the path to ownership before ever having an acceptance letter in their hands. Before anyone is able to own a dental practice, however, you must first find one. The following article will describe some details related to my search for a practice, highlighting what I did, why I did it and what I’ve learned along the way. If you were to ask most people the question, how should I go about finding a dental practice to purchase, there’s a decent chance you’d hear this basic response: “Start by contacting your local dental-supply representatives and transition companies. Because they’re in and out of offices every day, they’ll be the best source of information regarding what’s available out there.” Though I agree there’s truth to this, I decided to take somewhat of a different approach. As a second-year dental student, my first task to complete in my journey toward dental practice ownership was to create a road map. I needed to decide what path would allow me to aggressively move toward ownership, while simultaneously combating the financial and clinical challenges that may lie ahead. Basically, I had little money to my name, a pile of debt growing daily and hadn’t even seated my first crown yet. So I began questioning what path had the greatest potential to both increase my clinical skills and place me in a position to successfully secure financing from a bank. I considered specializing, completing an AEGD, joining the military or possibly even attempting to purchase a practice right out of school. After several months of incessant research and deliberation, I’d finally made a decision. For myself and my family, the best option was to pursue a short-term associateship for approximately 12 months, followed by a complete purchase of the practice. Though there were many reasons why this option prevailed over the others, one major one was that banks are significantly more likely to loan to someone with more than one year of experience. That would provide me some time to improve my clinical abilities, and there’d be a defined timeframe detailing when I would purchase the practice. Now that my end goal was set, it was time to figure out how I’d get there. The first question I asked myself was how to best com-
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municate my desires with a potential seller? Or in other words, how will I market myself? I wanted to find something that, in a matter of seconds, would catch the readers eye, create a personal connection and communicate exactly what I was seeking. I decided this could be accomplished by designing a rack card, which is essentially a big post card. On the front, there was a picture of my wife Ashley and I, below that the title “UNC Student in Search of General Practice Acquisition Opportunity” and three bullet points summarizing my goals on the bottom. On the back, I wrote a short letter to the doctor, introducing myself and explaining a bit further what my intensions were. It was simple and professional—short, sweet and to the point. The next question to ask was, where will I market? Originally from Northeast Ohio, we knew we were planning to stay in North Carolina, but didn’t know exactly where in the state we should go.
To give us the best possibility of seeing all options and making a wise business decision, we strategically began with a broad search. Over my third-year Christmas break, Ashley and I spent several evenings creating a basic demographic analysis of all 100 counties in the state. My primary inspiration and direction for doing this, came after reading the book Choosing the Right Practice Location by Jayme Amos. I created a spreadsheet with nine headings, including population, projected annual growth through 2019 and dentists per 10,000 people. I gathered the data from both the United States Census and North Carolina Department of Commerce. I took each of the nine headings and assigned them a numerical score. Generally, if the county stats beat the state averages for a specific heading, that county would be awarded the points. I then totaled the points together to give each county a score. This provided me with a standardized method of comparing one county to another. After identifying which counties scored the best, I further analyzed to see what strong counties were also surrounded by other strong counties. My thought process for choosing geographic locations that showed economic strength beyond a single county was twofold. First, I believed this would limit my chances of choosing a poor individual location. Second, I felt this would help position myself to maximize the potential future opportunities for owning multiple practices close to where I already lived and worked. After I figured out how and where I would market, I needed to focus in on who I would market to. I accomplished this task by reaching out to the North Carolina Board of Dental Examiners. For approximately $100, I was able to purchase a list of every licensed dentist in the state. The information they provided also included data such as where they practice, when they were licensed and if they were listed as a specialist. This was invaluable information because it allowed me to better identify my target market. I immediately deleted from the list all specialists, anyone who graduated within
the past seven years, anyone in public health or academics and anyone not practicing in the counties I’d previously identified. When I was done, what remained was a more focused and manageable list of potential sellers. Once I had the who, the what and the where figured out, we hand wrote addresses on envelopes and tossed the rack cards in the mail. In the end, there were approximately 80 doctors who responded to the marketing campaign. From those 80 doctors, around 60 of them were interested in discussing potential transitions. Beyond that, there were a handful of doctors who actually offered me a job as an associate, in the event my search didn’t pan out. Since then, Ashley and I have met with over 15 doctors, allowing us to better understand what a potential transition with them might look like. We are now blessed with the difficult task of deciding which opportunity may be right for us. As I’ve journeyed through this process, it’s become more and more apparent, that there are some very unique benefits to approaching my search in the way that I did. One significant benefit to finding a practice this way, is avoiding the brokers commission. The primary focus of a dental practice broker is to connect a buyer with a seller. If a transition takes place, the broker is paid a commission based on the selling price of the practice. If I’m able to secure a deal with a practice I’ve found on my own, there could be a potential savings of thousands of dollars to the seller. This savings can then be used to negotiate a lower selling price of the practice. Another benefit—potentially the most important—is unidentified opportunities. In the majority of cases, I was the first and only person that the doctor had spoken with regarding a transition. These practices were not on the market, and the doctor’s intentions had not been discussed with supply reps or transition specialists. So if I would have simply gone the traditional route and relied only on local dental industry professionals, I may have never identified these opportunities.
In my opinion, this search has been a huge success, a great learning experience, and honestly, a whole lot of fun. Ultimately, whether you are searching for a practice to purchase or for an associate position, I hope my journey will encourage and inspire you to think outside the box as you search for your own opportunities. Originally from Northeast Ohio, Jordan moved to Chapel Hill with his wife, Ashley, in 2013 to begin his dental education at the University of North Carolina School of Dentistry. He holds a Bachelor’s Degree in Business Administration and had the privilege of working as a self-employed insurance consultant throughout his undergraduate stint. His interest in business started from a very young age, and though there are many reasons he chose to pursue dentistry, the opportunity for business ownership was among the top. Please feel free to reach out to him at email@example.com.
When We Were in Dental School … Drs. Neff, Stevens, and Waldron
hen we were in dental school, we were under the assumption that dentistry was easy: a dental student graduates dental school, enters private practice, patients willingly and happily come to see the new dentist, the same patients gladly pay their bills in a timely manner, and the dentist goes home at night stress-free. When we talked to practicing dentists before and during dental school, this was the picture they painted. But after several years of being in private practice, we realized that the three of us were experiencing the same growing pains as dentists and found ourselves wishing we had been better prepared for real-world dentistry while in dental school. Our trials in dentistry led to our desire to help other dentists avoid many of the unnecessary pitfalls we experienced. To do so, we wrote the books So You Want To Be A Dentist? and So Now You’re A Dentist?, and we also started the Dental Realist Podcast. There are many things in dentistry that a dentist needs to experience to become a better dentist. Obviously, the more crowns one preps and the more fillings one places leads to better proficiency in restoring teeth. But there are many other areas in which dentists fail that we believe could be easily taught in dental school. Debt is Real Dental school debt is often a necessary evil. Most students entering dental school don’t have the means to pay hundreds of thousands of dollars for their education without borrowing the money. However, after dental school there are many more decisions that you must make when it comes to borrowing money. Borrowing more and more money affects a dentist’s ability to take home a higher income, but oftentimes more debt is taken on without a thorough evaluation of how it will affect the bottom line. Dental suppliers and sales reps will eagerly tell you that you need the latest and greatest dental equipment and technology and that it will increase your office’s production and in turn increase your income. But this isn’t usually the case. A new crown milling machine 8 Spring 2017 Dental Entrepreneur
will not increase the amount of crowns your patients need, and the latest endo handpiece will not cause your patients to have more toothaches. But the debt that is incurred from purchasing these items can cause more headaches for you. When you take on debt for that new milling machine, the payment is due each month whether you do five crowns or 100. More debt is not always necessary, and usually it will not increase your professional happiness. Don’t Ignore the Small Stuff While it is important to provide high quality dentistry, there are two things that patient will remember the most about their experience at your office—if it hurt and how you made them feel. Some dentistry is uncomfortable. Try to minimize the discomfort, but you can’t eliminate all pain. But making patients feel important and cared
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All financing is subject to credit approval. ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association. © 2017 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. 3153-1216 WFPF-Ad-Dental-Entrepreneur-Winter-2017
Please reach for is almost always in your control. Make sure you use good manners and insist that your staff do the same. Thank patients for coming to your office and let them know you want what is best for their oral health. It goes a long way in letting them know you appreciate them and makes them want to come back. It is our firm belief that it is incredibly disrespectful of the dentist to not run on time. Who in their right mind wants to go somewhere where they are disrespected? In contrast, we love going places where we are treated with respect and things run efficiently (think Apple Store). We happily return to places where we know they value us, our money and our time. How do you run on time? It’s really not that hard. It takes some effort at first, but once you get it down, it’s simple. Figure out how long your procedures take to perform. Also, make sure you have sufficient staff to run efficiently. Then schedule your appointments accordingly. Don’t be afraid to let your patients know that you are reserving the chair time exclusively for them, that you will be running on time for their appointment and that you expect them to be on time. Nowadays, it is almost expected that when someone goes to see a doctor or dentist, they will have to wait well past their appointment time to be seen. You will wow your patients if you make it a goal to run on time. Be polite to your patients and run your office on time. Be respectful of your patients and their time. They will in turn have greater respect for you, and you will build a stronger practice. These may seem obvious, but you’d be surprised how many dentists ignore them. Dental Insurance Limits Your Freedom It’s unrealistic in today’s world to think that you can practice dentistry without accepting dental insurance as a form of payment. It’s been around so long and so many people rely on it that you pretty much have to accept it. However, you must know that 10 Spring 2017 Dental Entrepreneur
by signing up as a PPO dentist the insurance company, not you, will have the bigger influence with your patients in a lot of areas. The insurance company, not you, will determine what is a fair and reasonable price for your services. The insurance company, not you, will determine what treatment is best for your patient. And like it or not, a lot of patients will listen to their dental insurance carrier when deciding what treatment to receive. Many patients look at dentistry as just another commodity or service that you should try and get at the best price. And because their dental insurance pays for their dental care, they often choose to do what the dental insurance will pay for. Signing up with dental insurance companies is likely necessary. But know that in so doing, you will likely limit your ability to practice dentistry on your terms and get paid what you legitimately deserve. Some of your freedom is the price you will pay. Dentistry is a career that offers many wonderful, well-known benefits and can bring a lifetime of happiness. But there are also many pitfalls that can derail that happiness. With some early preparation and awareness, or even mid-career re-evaluation, these pitfalls can be avoided. Avoid unnecessary debt at all costs, treat your patients with the respects that they deserve and expect, and understand how dental insurance will affect your career. With those bases covered, you will have the head start you need.
Drs. Neff, Stevens and Waldron are practicing dentists are co-authors of the books “So You Want To Be A Dentist?: What you Must Know to Succeed in Dentistry” and “So Now You’re A Dentist?”. They also co-host the Dental Realist Podcast.
out to our authors and our advertisers. They care about you and keep us in print!
If you have any questions, comments, or responses to our magazine, please connect with us on Dental Entrepreneur Magazine — our official Facebook page! Read us online at dentalentrepreneur.com Send your questions or comments to firstname.lastname@example.org dentalentrepreneur.com
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Student Loan Debt – Ways to Cope Shannon Morales, CPA
t’s no secret that student loan debt for graduating dentists has been spiraling out of control. According to the American Student Dental Association, in 2016, the average dental student graduated with $261,097 of loans. While this number may be staggering, many students graduating from specialty residency programs have student loan debt of $600,000 or more! As accountants, we are asked regularly what doctors can do to help lower their debt payments, increase their cash flow or how to make these suffocating loan payments. Over the past few years, we have spoken with many new graduates who consider either private practice or working for corporate dentistry. Most students do not consider buying their own practice due to the tremendous debt they’re already carrying. Corporate dentistry offers the doctor a set salary to budget for those staggering debt payments. Graduates might start off with corporate dentistry to help cover their loans, costs of living, etc., but many will switch to owning their own practice in later years once they determine how they want to practice. While the stability of corporate dentistry may be attractive, many find it is more beneficial to own their own practice than to work for corporate dentistry. Graduating doctors should know about the increased earning
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power and other benefits of owning a private practice. For example, assume a graduating general dentist is capable of producing $750,000 annually. If that doctor accepts employment in corporate dentistry, he or she will typically earn $187,500 or 25 percent of production. If that doctor were to purchase a practice that earns $750,000 in collections, the purchase price would be around $487,500, based on a value of 65 percent of collections. If the doctor finances the $487,500 over 10 years at a 5-percent interest rate, payments would be $5,170 per month, or $62,040 per year. Assuming the practice will net the industry average 40 percent of collections or $300,000 before the doctor’s salary, benefits and perks, the purchasing doctor would have $237,960 left over after paying the practice purchase debt payments. That is gross collections of $750,000 multiplied by 40 percent = $300,000 less debt service of $62,040 = $237,960. This is more than 25 percent higher than the corporate dental counterpart. Moreover, at the end of 10
years, the practice debt would be paid off and the purchasing doctorâ€™s net would then be $300,000, or 60 percent higher than a corporate colleague. The doctor could then use this excess income to repay student loan debt faster or begin saving for the future with a pre-tax retirement plan contribution to a 401k plan or Simple IRA. Furthermore, an asset (practice value) is now available to sell in the future to help provide financial security in retirement. As a doctor, you should also know that your income will be too high to deduct the student loan interest. The deduction is lost on your personal tax return once you reach an income level of $80,000 for single filers and $160,000 for married filers. As you can see, no matter what option you choose for your career, corporate or private practice, you will lose this deduction almost as soon
as you graduate from dental school. A student loan repayment assistance program is a more recent development in student loan debt repayment that will impact new graduates. Large corporations have started assisting their new employees with this benefit to help alleviate the loan burden. Corporate dentistry has started using this benefit to attract more graduates. Private practice dentists can add this benefit as well. Unfortunately, these benefits are normally taxable if they are received from anyone other than a state or local government. Under proposed Federal tax regulations (Student Loan Repayment Assistance Act), this program could help provide up to $6,000 per year to an employee, with a lifetime limit of $50,000. Again, these are proposed, so many changes could occur in the future before we have final regulations.
As a graduate of dental school, you need to be informed of your options. You need to hear the pros and cons of both private and corporate dentistry in order to make the best decision for yourself. Our article only touches the surface, so do your research and ask questions. Shannon Morales With more than 15 years of experience, Shannonâ€™s professional career has been focused on the tax issues and concerns that arise for small business owners. She focuses on dental practices and likes to help doctors grow and prosper even in down economic times.
DENTAL PRACTICES FOR SALE ADS DENTAL TRANSITIONS HAS EXCELLENT PRACTICE OPPORTUNITIES AVAILABLE. TAKE THE FIRST STEP IN BECOMING A PRACTICE OWNER AND VISIT:
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Tips for Hiring an IT Professional for your Dental Practice Lindy Benton
s the leader of a healthcare technology company providing services that help dental practices communicate information to payers more efficiently and securely—and with many years in the business— I’ve developed a certain knack for understanding the technology needs of the modern practice. Practices seek software solutions to make their business lives easier. Software is designed and sold in similar fashion: to streamline workflows, eliminate needless tasks, enhance security and remove inefficiencies and obsolescence. Many voices contribute to the conversation about how much and what type of technology a practice needs, not to mention how a practice should use that technology. There are far fewer conversations about the resources—employees— a practice must use to implement, manage and care for the technology. Most dental practices, especially smaller ones, don’t have time or resources to manage IT without some outside guidance because they are primarily focused on the delivery of care. The hiring process for new employees for such roles is often overwhelming and sometimes gets rushed along. When hiring, you need to keep in mind the basic requirements of the position while also thinking beyond just the basics. Ask questions to test the forward-thinking abilities of the candidate. Anyone who works in IT should have a basic knowledge of information technology terms and protocols, but not everyone has the vision for how what they do can impact the business in which they work. With technology driving so many of the revenue streams in today’s dental practices, it’s critical that your IT team has ideas and experience to help maximize revenue while eliminating old technology and processes holding back the practice. Ask if the candidate is aware of the trends currently taking place in the dental industry. The candidate should have in-depth knowledge of the relationship between IT and HIPAA compliance and how best to secure your practice’s data. It’s your responsibility to extrapolate that information
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and make sure the candidate you hire knows not only technology, but also the special requirements of the dental industry. A candidate’s understanding of the laws around data security is something you should discuss in-depth. Next, make sure that the candidate has people and technical skills. It’s inevitable that IT will be called upon at some point to provide advice and assistance to individuals throughout your practice and that those individuals may have varying levels of technical expertise. Whomever you hire needs to have knowledge, patience and the right personality to work effectively
with other team members. They must be able to develop protocols and provide guidance for such issues as a system crash or outages. How will these challenges be addressed? Another thing to look for in candidates— other than basic credentials such as years of experience, education required and certifications needed—is interest. Do the interviewees show any real interest in the position? Do they seem to understand the landscape and the lingo needed to successfully lead the IT operations of your practice? Demonstrated knowledge means their heads and their hearts are in the game and will be on board with you to do whatever it takes to win. Finally, dive in. Get into the meat of the interview by providing relevant questions that help extrapolate the candidates’ information and demonstrate how they would handle certain situations, under a deadline, when needed. Consider having the candidate list or draw
out what they’d like to establish in the organization’s IT infrastructure, or even have them submit a proposal prior to a job offer so you can review the information with advisors to determine if the plan, and employee, are up to your expectations. Test the candidate with a real-world example your practice is currently taking on now. Ask for examples of their previous work and what they have done. What do they consider their specialty: security, implementation, maintenance, etc.? And remember that a friendly personality is just as important for someone who doesn’t work directly with patients as it is for those who are 100-percent patient-facing. Just because your IT service professional won’t be chair-side caring for patients, there’s still a good chance that they’ll interact with patients at some level. Do not succumb too quickly to the need of filling the vacancy. Don’t rush to add an employee simply to fill a gap; hiring the wrong
person will only exacerbate problems in the long-run. If during the interview process you need a little support or assistance, consider bringing in someone from the outside who understands IT terminology and techniques. They can help you objectively identify potential disconnects between a candidate’s resume and his or her actual experience, qualifications and accomplishments. Lindy Benton is CEO and president of Vyne, a provider of secure healthcare communications, electronic attachment and health information exchange solutions for hospitals and dental practices. Vyne serves more than one million providers in the U.S.
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Did you know that Eaglesoft Practice Management software can reach into every aspect of your practice to build efficiency? And it’s true – when you can manage patient information better, you can spend more time taking care of people.
Career Suicide – The Easy Way Dale Wagman, DDS
t’s easy to kill a practice. You can over-treatment plan. You can overcharge. You can insist on treatments patients don’t want. You can refuse to honor insurances. You can have an unpleasant chairside manor. You can mistreat staff. The list goes on. Unfortunately, you can kill an entire career even more easily–often before you ever get one started–by making one critical mistake. Almost every month, transition consultants will typically get a call from a young dentist who is working on killing his or hers. They tell the consultant that they have been an associate for the last three or more years and have increased their speed and knowledge exponentially since graduation. They will mention the hours of continuing education they have had. They will expound on their skills and ability to perform a vast array of dental procedures. They may discuss their financial situation and credit possibilities. Some may even claim to be pre-qualified by some bank for a purchase. Naturally, the consultant is thinking, “This is a client I can help.” Then, the young dentist drops the inevitable bombshell. “Oh by the way,” they 16 Spring 2017 Dental Entrepreneur
will say. “The practice I am looking for must be located within 30 minutes from the intersection of Fifth and Main Street.” Bam! One sentence and this young dentist may have just destroyed their entire career potential. They may have doomed themselves to mediocracy by eliminating a potential opportunity that may have rocket propelled their financial viability for years. They may have become one more among the many waiting for success to find them. Realistically, the average dentist has between 30-40 years to practice. During that time, they have to pay off student loans, pay off practice debt, raise a family, pay off a home, build equity in a practice that they can sell later, save up some extra money for retirement and maybe, if they are lucky, actually live a little–by traveling or perhaps by buying a toy or two. Moreover, they have to do all that while paying taxes, fighting competition, resisting corporate challenges, acquiescing to staffing realities and surviving continual pressure from insurance companies and other third parties. Let’s face it! They really can’t afford to waste time, and they certainly can’t
afford to trap their future by building artificial geographic walls around their potential. Sure, the urge to live a normal life is strong after dental school. You want to have a home and settle down. You want to have some kids and get a nice family started. You want to start staking out some territory. You want to stick your chest out and start letting the world know you are finally free - no longer a prisoner of academia and ready for the world. And, of course, if you have a spouse, he or she will want to see you do all of that too—and probably much more. However, you have to be realistic. It could take years for even a mediocre opportunity to become available in any pre-defined location almost anywhere in the country. Finding a good one could take even longer. Just simply settling on something because you are tired of waiting could be a huge, life-defining mistake. Let’s look at just one example. According to data available at the time of this writing, the population-to-dentist ratio in one very desirable Midwestern county, in which many young dentists want to live and practice, is approximately 844-to-1. An 844-patient practice is just a two-day per week practice to a new dentist who can see only eight patients a day. It is not even a two-day practice to a dentist who can see just 10 patients a day. The irony here
is that just two counties away—a little over an hour drive—the population to dentist ratio is approximately 2557-to-1.
Realistically, the average dentist has between 30-40 years to practice. How many patients can you see in a day? Probably many more than 10, right? How long are you willing to wait for a practice that has only the bare-minimum number of potential patients? At that pace, how long will it take you to pay off all your debt and put together a decent retirement plan? If 844-to-1 is the mathematical norm for a particular area, how long will it take to find a practice that has twice that many patients–a full week of patients, say? And, more importantly, with how many other dentists will you be competing, just to get a shot at buying it? Essentially, you could find yourself standing in line to buy half a practice and unless you are very skilled at building practices, you will end up with half a career. The key to business success is flexibility. It
is also the key to career success. When good opportunities–ones that will provide sufficient revenue to reach all of your goals–become available, you need to be able to react quickly and take advantage of them. You often can’t afford to wait until you sell a house. You can’t afford to wait until your kids matriculate from one school to another. You can’t afford to wait–period! Opportunity knocks very softly sometimes, and it doesn’t always knock on the door you want it to. The old adage, “Money won’t come to you, you have to go to it,” is very true. Don’t limit your success by limiting your geography.
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
Buying your first practice doesn’t have to be painful. PARAGON cultivates relationships, not just clients. We’ll match you with the opportunity that fits your career aspirations, and guide you through every step of the process.
Start your practice with a smile. Call now.
866.898.1867 email@example.com paragon.us.com
Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 4/1/2016 to 3/31/2020 Provider ID# 302387.
DentalEntrepreneur.com Dental Entrepreneur – OCTOBER 2016 – 1/3 Page 4/C – 7”(W) x 3.3125”(H)
Dental Entrepreneur Spring 2017 17
Resource Guide ADS Dental Transitions 888-ADS-4237 www.ADStransitions.com ADS is the nationwide leader in dental practice sales, associateships, buy-in/buy-outs, partnerships and appraisals. ADS is comprised of the industry’s most experienced professionals, including dentists, attorneys, and CPAs. We can help you with each step of your next transition. To view a complete list of practice opportunities available in your desired area, visit us at ADStransitions.com. Please see our ad on page 13.
ADS 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 27.
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 23.
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 on the inside back cover.
Henry Schein Professional Practice Transitions (PPT) 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 page 25.
DeW www.dew.life Dew Life magazine is both a digital and a print publication devoted to highlighting women in dentistry. Our goal is to inspire women to connect and move each other forward lifting one another up to heights they only dreamed possible, through beautifully penned stories and stunning photographs. We are delighted to receive general submis- sions from you, women in dentistry. What is your story and how can you inspire us? What are some of your ‘top of mind’ questions or comments about the dental profession? Is there a topic you would like to explore that could be introduced on our website as a blog or as a feature in our print edition? We want to hear from you and share your narratives.
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Business Beyond the Classroom IgniteDDS 716-912-7970 firstname.lastname@example.org 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!
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 front cover and page 15.
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 21.
Orascoptic 800-369-3698 Orascoptic.com CustomerCare@Orascoptic.com A pioneer in medical vision for over 30 years, Orascoptic™ designs award-winning dental loupes and headlights that focus on magnification, illumination and ergonomics. Engineered with performance in mind, Orascoptic loupes employ rich details such as adjustable nose pads, flexible temple hinges and working distances refined in half-inch increments. Please see our ad on page 11.
Wells Fargo Practice Finance 888-937-2321 wellsfargo.com/dentists email@example.com Wells Fargo Practice Finance provides customized financing supported by experienced specialists and practical planning resources to help dentists acquire, start and expand their practices. The only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM, we understand the business of growing successful practices and are here to help you achieve your goals. Please see our ad on page 9.
PARAGON Dental Practice Transitions 866-898-1867 www.paragon.us.com 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 17.
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IBM vs. Mac: Why Does It Matter to a Dentist? Mark Hollis
f you missed that half hour as a senior where your professor taught you about leadership and running a business, you were up the creek without a hand piece. If you’re an open-minded dentist in private practice wanting to save money, save time and be more efficient, you will find this article informative and eyeopening. If you are among most dentists who have graduated from a dental school where the Mac is the primary computer and you favor Apple devices, your intuition about computer technology will be confirmed. Mac@IBM Confirms Macs Save Money Macs cost less than PCs, not more. Dental IT consultants with an expertise in Windows and Windows software developers have misled dentists to accept for years that Macs cost more than PCs. And while a Mac may cost a little more than a PC to acquire, the total cost of ownership (price plus support and maintenance over four years minus residual value) is the true cost of a Mac or PC in business. IBM, one of the largest enterprise computer users in the world supporting more than 500,000, and the largest user of Macs supporting more than 100,000, set the record straight once and for all. In October 2016, Fletcher Previn, the Vice President of Workplace-asa-Service at IBM, reported to the JAMF National User Conference the statistical findings of the Mac@IBM team who over 17 months enabled and supported 90,000 IBMers who preferred Macs. IBM’s goal, set in 2015, is to change their IT culture of enforcing versus enabling. The change 20 Spring 2017 Dental Entrepreneur
required IBM to “give users the device they want, manage those devices in a modern way, and drive self-sufficiency in the environment.” Here are some statistics from the October presentation: • IBM supports 90,000 Macs and adds approximately 5,000 more per month • PCs are three times the cost to manage and drive two times the number of support calls • Employee satisfaction is up • IT costs are down • Every Mac model IBM buys yields a significant net savings compared to similarly configured Windows models Encryption, antivirus, security is macOS native. For each Mac introduced, there are reduced costs for hard-drive encryption (macOS native FileVault versus PGP); reduced costs for antivirus (macOS native XProtect versus third party software for Windows); as well as reduced costs for
MacPractice acPractice Simplicity in practice Simplicity in practice
MacPractice acPractice Simplicity in practice Simplicity in practice
FACT: PCs cost 3 times more! IBM Saves $535 per Mac, 81% Less Onsite IT, 73% Prefer Macs MacPractice saves dentists $1000s every year over PC solutions with the lowest IT costs, savings of $535+ per Mac, 81.5% less onsite service, macOS built in encryption and security, greater self-reliance and satisfaction, and Macs that last years longer than PCs.* MacPractice DDS is macOS native dental management software with native digital imaging, next-generation charting, interoperating native iOS Apps for iPad, secure messaging, network efax, online registration and scheduling, and best of class reputation marketing, all ‘built in’. MacPractice built in AES encryption so patient data is safe and your practice can qualify for HIPAA’s Safe Harbor. Escape susceptibility to Ransomware, other malware, and the barrage of DDoS, IoT and other Internet attacks predicted for 2017 by keeping your data on premises and remotely accessible.
REGISTER FOR WEBINAR - ‘Why MacPractice Is Right For My Practice’ *Learn How IBM Saves Money and Time with Macs v. PCs www.macpractice.com/dental-apple-advantage | (855) 679-0033
security (macOS native Gate Keeper and SIP). Macs outlast PCs 2X or more. “Apple technology benefits a new dentist or a younger dentist because your initial investment in technology, where that be a number of iMacs or whatever it may be, hardware-wise, will last much longer. I opened my practice over seven years ago and the same computers I bought on day one are still in service. I haven’t had to replace them. I’ve had to add some on as we’ve expanded, but not having to reinvest in new computers every two or three or four years really helps the bottom line. At a time when your practice is only 3 years old, and now you’re having to look at buying a whole new set of computers, it is really challenging. Whereas if you invest in Apple, you know that investment is going to carry you through the startup years of your practicing and beyond.” Josh Austin, DDS, Fagd - San Antonio, Tx Note: FileVault and Gatekeeper can easily be turned on by your practice’s administrator, which is typically the dentist or practice owner, or the employee, who is the practice’s HIPAA compliance officer, in macOS system preferences. XProtect works in the background in macOS and virus definitions are automatically updated by Apple. Support for Macs is less needed, less costly and more effective. Previn observed, “Fewer support problems yields better quality support.” IBM has reduced helpdesk staff for Macs contributing to a reduction in costs, yet there is 91-percent Mac user satisfaction with help versus 83 percent PC user satisfaction. “Five percent of Mac callers ever require a tech to come to their desk to support and help versus 27 percent of PC users,” Previn said. There is higher satisfaction from support for Macs versus PC, even though the group is so small (50) because when the call is received the help needed is provided, unlike the PC support where users are commonly passed from tier 1 to tier 2 and possibly further before their issue is resolved. “There are just fewer problems” and “you get your problem fixed,” Previn said of Mac support.
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There are so many reasons Macs and macOS native software can save money and improve your practice’s productivity and effectiveness. “fewer… problems yields better quality support… there are…fewer (Mac) problems” As we have seen, 20 percent of IBM employees use Macs, but they account for only 5 percent of the support calls. PC users account for two times the support calls versus Mac users. Five percent of the Mac users call the helpdesk whereas 40 percent of PC users call, said Previn. Note: IBM allocates just 50 helpdesk staff to 90,000 users for a ratio of 1:4500. Gartner’s statistics show the optimal number of IT (non Mac) to employees is 1:70 and the average is 1:242. What a difference a Mac makes! Macs increase productivity versus PC. Besides quantifiable savings, IBM sees productivity gains due to workstation performance, backup/restores and other factors. Note: An employee at IBM, like an employee at your office, that spends less time on the phone with support or being interrupted by in-person IT support and is more self-sufficient is more productive as well. How much is this gain in productivity of Mac versus PC worth? The availability of Macs helps IBM hire and retain ‘top talent’. Keeping operating systems current, especially for security, 104 fewer times for macOS. There were 135 major critical patches of Windows 7 in 2015 versus 31 on Mac; 49 non security patches on Windows versus 20 on Mac; 86 critical security patches on Windows versus 11 on Mac, “which really means we have to go out and manage the Mac environment 104 fewer times per year. Well-run networks make the job of an attacker a lot more difficult,” said Previn.
135 major critical patches of Windows 7 v. 31 on Mac; 104 fewer (updates) for macOS On the day of the presentation, 33 percent of Mac users had updated to macOS Sierra within 72 hours of release, 47 percent were on El Capitan, released one year before and 20 percent were on Yosemite, released two years before. One percent of Android users were on the 7.x, release in August and 20 percent were on 4.x, released in 2011. Conversely 65 percent of IBMers were on iOS 10 which was released 28 days before. From the software side, every PC costs three times the cost of a Mac. “Our total cost to upgrade (users) from Windows XP to Windows 7, for example, it ended up that it would have just been cheaper to buy everybody new laptops,” said Previn. Note: Keeping software current with security holes plugged is essential at IBM as it must be in your practice. Dentists using Macs never retain onsite IT to install Apple patches, and most update to a new macOS themselves. “Every IBM Mac user is a local administrator (of their Mac) and Mac is approved for privileged users at IBM,” said Previn. Previn noted that Apple malware is more expensive on the black market: $100 thousand vs. $1.5 million, which explains why iOS devices do not have the problems Android does. “Another thing that Apple computers can help new dentists with is helping to start up and energize their brand to set themselves apart from other dentists in the area. There’s definitely sort of a je ne sais quoi about a patient walking in and seeing Apple products everywhere and the initial assumption that, oh I’m in a really technologically up-to-date place. I think the sort of boost of your brand is another important aspect to think of when you’re thinking of choosing Apple computers for your practice.” Josh Austin, DDS, Fagd - San Antonio, TX Mac hardware is more satisfactory. Employees with Macs seem to be more satisfied with their display, keyboard and mouse, therefore they require the purchase and support of fewer third party peripherals. 73 percent of IBMers prefer Macs, and
that’s increasing. “The Mac users (surveyed) are a lot more satisfied than the PC users”, Previn reported. In December 2015, 65 percent of all employees stated that given a choice, they prefer that their next computer be a Mac. In May 2016, 73 percent stated that given a choice, they prefer that their next computer be a Mac. 64 percent of Windows users would consider switching to Mac in light of Windows 10 privacy issues: Comparitec report Every Mac purchase makes money and saves money. IBM sees $535 in readily measurable savings per Mac over four years. During his presentations Previn stated, “The incremental purchase price of a Mac pays for itself several times over the life of the device in reduced support burden … the longer this program runs, the more compelling the business case becomes … I can confidently say every Mac we buy is making and saving IBM money.” $535 measurable savings per Mac. “… every Mac we buy is making and saving IBM money.” In conclusion, Previn announced, “IBM Japan has now made the decision that Macs are the standard choice and PCs require an exception.” There are so many reasons Macs and macOS native software can save money and improve your practice’s productivity and effectiveness. To see the full IBM presentation and to learn more visit www.MacPractice.com/dental-appleadvantage
Mark Hollis is the cofounder and CEO of MacPractice, Inc. and provided practice management consulting services to 650 practices over 25 years. Mark represents MacPractice as member of HIMSS Electronic Health Records Association (EHRA), which advises the CMS, ONC and HHS, and as a contributing member of Commonwell, a non-profit created by top US EHR vendors to address the national challenge of patient identity related to EHR interoperability.
Age, Experience, Income, Debt Service and Retirement Bruce Bryen, CPA
aybe you are a recent graduate from dental school or have been working as an associate. You may have acquired your own practice and wonder about what to do with your debt. Either of these scenarios probably entails having obligations to pay for education. Those owning a dental practice or considering an acquisition face not only educational debt but also loans used for its transition. That office will be used as the base generating the income for the standard of living desired for the dentist and his or her family and for the near future and retirement. Its earnings are used to pay what is owed from all sources, including educational borrowings. A house may be owned or under consideration for purchasing, which will probably require a mortgage. With the amount of money owed and the various reasons for it, certain points are reached during the career of how to approach the payment. As the dentist matures, that aging will enhance experience and additional earnings should occur. With this additional income, dental advisors will discuss the implementation of a retirement plan. Let’s examine some approaches to these concerns and address a tax efficient manner in which to resolve these issues. What Comes First in This Dilemma? Is It the Chicken-orEgg Theory? Without the debt for the education to become a dentist, there would be much less income now and in the future. Without the income, there would be less money to amortize the debt and could save for retirement. Neither appropriate housing nor a dental practice could be acquired. The answer to the question to analyze is what is financially wise including the tax effect. A detailed explanation is needed to fully understand this theory, but after some analysis, it should allow the dentist to think both short term and long term goal orientation. Financing, investing and planning for current income taxes and the future will be accomplished with a better comprehension of how taxes sometimes should override interest rate concerns. Retirement plans can be used to benefit the dentist and explain how he or she can enhance the fruits of their labors now and when considering retirement. There are hypotheticals that must be taken into account since each dentist’s situation is different. We’ll begin with a set of circumstances and the dentist can factor in his or her own situation to determine how these explanations will impact them.
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Experience, Income, Debt and the Future With experience comes better income. With better income, reputation is more of an accepted factor so that more patients, more income and a better lifestyle become a reality. The ability to pay obligations with funds available or to proceed in other directions with these funds becomes a dilemma for the dentist. What course should be taken with these funds? To pay additional payments to retire the debt or to use the funds in other manners is the question. The experience, income, debt and the future all impact each other. Let’s first deal with the dentist’s experience and income. There should be an acceptance that the dentist’s income will increase with experience. A realization that is difficult to comprehend is that when a debt is paid, there are few sources from which payment can come that don’t affect income. One source is that the loan may be refinanced. This happens when an interest rate decrease is available or the term of the obligation can be shortened or the monthly payment reduced. When the debt is refinanced—hypothetically a $100,000, 8-percent loan is replaced with the same amount of debt but with a 5-percent interest rate— there is no tax effect. However, the only other approach to reducing a debt taking the principal payment from the obligor’s income. This excludes inheritance, gifts and items such as those that are not in the normal course of business. If the loan is amortized from income, there is a tax due that the borrower realizes at times too late. An example is a mortgage. Most dentists don’t accept that the principal of the mortgage is not deductible since almost the entire mortgage payment for at least the first third of its life is primarily interest, which is deductible. Think about the principal portion of the payment. That is not deductible. Where does the money come from to pay it? If the dentist has a salary, after paying taxes on that income, the money left is used to pay the principal. The amortized portion of the educational loan is paid from income, if not refinanced. That part is not deductible. It comes from the dentist’s income. Think of a dental practice loan. If the structure of the acquisition was not properly addressed, the principal portion of the debt comes from income and the dentist pays a tax on it.
Analysis of Debt Payment and the Tax on That Amortization If the dentist with a taxable income of $118,500 (and without a house) owns his or her own practice, there is a selfemployment tax of double that of an associate that is equal to 15.3 percent, including Medicare. The personal federal income tax marginal rate, plus the 15.3 percent, plus if you live in a state with an income tax, your total income tax rate for 2016 would be about 46 percent. The wise dentist with an advisor providing this information may then discuss delaying additional principal payments and looking for an alternative. Suppose the interest rate on the loan is 9 percent, and the tax rate is this hypothetical 46 percent. An additional $10,000 payment to amortize the loan would cost $4,600 in income tax. The interest savings would be at 9 percent, or $900. The dentist would have paid the additional $10,000 against the outstanding balance of the loan so
that the $10,000 is no longer available. He or she would have saved $900. The tax on the $10,000 payment would be $4,600, so that the total out-of-pocket amount from the dentist would have been $14,600 to save $900.
a discussion with a dental CPA about age, experience, income, debt service and retirement should be addressed so the dentist’s knowledge can be increased about debt payment for his or her betterment.
Is There an Alternative? With careful planning and a good comprehension of the dentist’s overall financial approach to debt, taxes and retirement, a dental CPA can assist with a current plan. Something to brainstorm is the implementation of a retirement plan for the dentist now, rather than waiting. A hypothetical use of the $10,000 example available to pay into the retirement plan is the amount deferred in tax. The $10,000 would be in a retirement plan for the benefit of the dentist, and its earnings not taxed until withdrawn, leading to a more secure retirement. What Comes Next? Whether it’s the chicken or the egg,
Bruce Bryen is a CPA with over 40 years of experience. He is the Managing Partner of his accounting firm, Bryen & Bryen LLP, based in southern New Jersey. Mr. Bryen specializes in deferred compensation, such as retirement planning design; income and estate tax planning; asset protection and structuring loan packages for presentation to financial institutions. Mr. Bryen is experienced in providing litigation support services to dentists with expert witness testimony in matrimonial disputes cases. You may contact Bruce Bryen at 856-985-8550, extension 112.
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So, What’s My Best Option? Earl Douglas, DDS
t won’t be long now. Graduation is fast approaching, and you’ll soon be leaving the preparation phase of your career. But it can seem strangely confusing at this late time trying to determine the next step. Many years ago, dentists’ decisions and options were quite standard. Graduates opened their own practice or purchased a practice. Many of today’s options did not even exist in those times. Today’s graduates face an array of opportunities and they may have limited or even incorrect knowledge about each of them. Let’s take a look at a few of them. In considering options, keep in mind that one size does not fit all. Each graduate will have their own set of abilities, resources, skills and emotional and rational wiring. Don’t worry if your best friend decides on one career option and your choice is entirely different. You can both be right in your own differing decisions.
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Buying a practice is one option. Surveying senior classes where I lecture, I find that only a handful of students indicate that they plan to own a practice soon after graduation. I don’t know what has changed graduates’ motivation over the past 40 years, but there has definitely been a pronounced shift. Graduates probably feel many doubts about going into their own practice, including concerns such as not being able to afford a practice, not being able to get financing, not knowing how to run a business and not being ready to make such a large commitment. I recently helped a buyer prospect discover that he was not all-in committed to owning a practice, and he therefore withdrew from the purchase. This critical decision on his part no doubt saved him from a very unpleasant experience. Not everyone is a candidate for practice ownership. It requires an absolute total commitment. Owners cannot just walk away if they
don’t like how things are going at any given time. Owners require a strong positive outlook and the attitude that they can overcome any and all problems. Owners need excellent people skills in order to motivate staff and patients alike. They should have a sense of financial matters. Owners need to be able to delegate. When a client buys a practice, I remind them that part of their job will be fixing teeth, because their actual job will be running a business. It is not easy for a new graduate to buy a practice, but it is generally possible for the determined person. Financing can be obtained relatively easily for dentists who have been licensed for two years, but I have gotten financing for newly licensed dentists as well, typically through the SBA. Today we are especially fortunate to have ADS.south209
expert management consulting services available that can help new dentists manage a practice better than if they had spent 20 years perfecting their mistakes as do many dentists.
It is not easy for a new graduate to buy a practice, but it is generally possible for the determined person.
A huge benefit of purchasing a practice is the acquired staff. The staff conducts 90 percent of the daily business of a practice, so the
new owner need only let the staff continue doing their job. Another huge potential resource is the seller. Sellers can counsel purchasers on every phase of practice life–the staff, the building, the equipment, patients, materials, laboratories, techniques, study clubs, dental societies and just about anything else. The lenders that finance most practice purchases today specialize in dental acquisitions. They have resources to help purchasers who may get into a spot of trouble and will work hard to help avoid a failure. Today’s purchaser has multiple safety nets and layers of support to enable them to go straight into practice and succeed. This is borne out by lender statistics of a default rate of only 0.5 percent so their borrowers have a 99.5-percent chance of success. Purchasers question how they will ever
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 2017 27
pay for the practice. Take for example an actual practice we are currently marketing in North Carolina. It has a gross income of $530,000. The hygienist performs $165,000 of that gross and the purchaser would produce $367,000, a very manageable amount for a new graduate. The annual payments for the practice loan are $53,000. Now consider that the profit from the hygiene department, after paying the hygienist’s salary, is $93,000. In this practice, the hygienist is providing the payments to buy the practice for the purchaser twice each month! I have even had recent graduates purchase a practice and the building as they enter their career. How can a purchaser afford both a practice and a building? In this practice, there is still a $40,000 hygiene profit after paying the practice loan that can be applied to a mortgage payment for a building. If that were not enough to pay the entire mortgage, the savings in not having rent payments would certainly provide any needed cash flow. In most practices I see, mortgage payments to purchase the building are about the same or less than rent would have been. Owners have another very significant advantage that compensates for the hassles and commitment factors of ownership, and that is profit. Profit is not the money owners earn for the work they do, but rather it’s the money that results from ownership. Imagine owning stock in Google that pays dividends. You don’t have to work for Google to get dividends, but simply own some stock in the company. In this practice, paying the purchaser 30 percent of their $367,000 production provides a salary of $110,000. After paying the purchaser salary plus all the practice overhead, there is a practice profit of $179,000. This profit is purely a benefit of ownership, in addition to and over and above the purchaser’s $110,000 salary for working. This $179,000 Profit represents a return on investment of 45 percent, and it continues every year! Now you can see why entrepreneurs and corporations are scrambling to buy practices and hire dentists to work for them. And if that were not enough, purchasers
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invariably deduct and depreciate the entire practice price. The tax savings amount to ~40 percent of the practice price, a great gift from Uncle Sam. Warning: While this is an actual practice and these are actual figures, not all practices are as profitable as this one. Purchasers are advised to seek competent help in understanding the specific cash flow of any given practice.
Owners have another very significant advantage that compensates for the hassles and commitment factors of ownership, and that is profit. Another ownership benefit is being “the boss”. You decide who to hire, what materials to buy, what laboratory to use, what marketing to employ, what benefit plans to provide, what image your practice projects, what advisory professionals to use and all other aspects of your practice. Now let’s examine another quite popular career option, working for another dentist or a DMO corporation. The benefits of this option include having no debt and no risk. You don’t need to borrow money, and if you don’t like it, you can leave, subject to termination provisions of your contract. Associateships are excellent for individuals who don’t have a total commitment to their career quite yet, or who are not as endowed in people skills and financial savvy as they feel they should. Associateships provide an opportunity to build speed and skills and to see how other owners manage a practice, discovering both good and the bad tactics. This option is also an excellent holding
pattern where you can earn income and build skills while waiting for a practice to become available where you want to practice. Associateships can be a safe and gentle transition to hard core ownership, and can help graduates discover how they are wired up and what direction they want their future to take. Associateships do have their downsides though. You definitely are not the boss, so you shouldn’t expect the boss benefits of ownership we just discussed. Another difference is that associates do not receive Profit. Profit belongs to owners and not associates. Further, associates do not receive the tax benefits that purchasers receive from depreciation and write-offs. These last two items can result in associates earning significantly less than their owner counterparts for the same amount of work. That may mean working for a longer period of time before retiring on the same income as an owner would have. So in examining your options, it’s critical to understand yourself very well. Are you ready to make a huge commitment and keep it? Are you willing to take on debt in exchange for receiving Profit? Do you want to be in control of your career or are you willing to let someone else control it for you? Everyone has the right answers inside them, and many times having a competent advisor can be helpful in identifying, but never making, those key decisions. Good luck. Earl M. Douglas, DDS is the author of many articles on dental transitions. He has also authored software for the financial analysis of dental practices. His company, ADS South, LLC, is engaged in the valuation and sale of dental practices in the Southeast. He can be reached at 770-664-1982 or firstname.lastname@example.org
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A New Way to Look at Dental SEO Mike Pedersen
o grow your practice revenues and new patient numbers, you must have a digital marketing strategy to bring visitors to your dental website. The dental industry is a little behind when it comes to marketing, and for you to survive and thrive, you must embrace it and realize it is a must. Dentistry is bombarded with sales and marketing companies promising the world and not producing the results, lending to massive disappointment by the hopeful dentist. Having spoken to hundreds of dentist the past six years, I feel your pain. It is a tough pill to swallow to invest in marketing (and advertising) to not see the outcome (ROI) you had been told or hoped for. People Use Google One of the biggest, most cost-effective marketing methods you should strongly consider is SEO (search engine optimization). More than 70 percent of people looking for a local business use the Internet, and more commonly Google. That is why Google has become a massive company via their online advertising platform referred to as “Google AdWords”. Unfortunately, advertising using Google AdWords can be quite expensive and take a lot of nurturing, testing and tweaking. Because Google makes much of their revenue from advertising, they are constantly changing how the search results pages look. And the common theme is more and more ads. The choice for you as the business owner is to play their game and invest in AdWords or invest in SEO. Statistics have shown that AdWords drives 10 percent of web traffic to a local business. That leaves up to 90 percent for the organic section of the SERPs (search engine results page). This is a massive opportunity for your dental practice to grab that 90 percent of visitors who ignore the ads and go down to the first few organic results. If you get your practice in those spots for dental keywords, you
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have a good chance of getting the call over your competitors (if you have a website that has been designed for conversions). Old Dental SEO Isn’t as Effective Anymore I’ve had more conversations than I care to count with dentists who have been misled and even deceived by SEO companies that have not produced any results (rankings and phone calls) for their practice. The standard approach to dental SEO is to go after search phrases like “city dentist”, “city Invisalign”, “city dental implants” and so on. The flaw in this approach is several issues: 1. Every dentist in your city is also going after those phrases, making them very competitive. 2. Depending on your current rankings in Google, it could take six months to a year to see any results, and we’ve seen many that didn’t get the results even after a year. 3. We’ve determined these general dental terms don’t necessarily bring a warm visitor to your website who is ready to call your practice. 4. When you add them up there are only around 20 of these terms, when you add up all your services, then add dentist, then maybe cosmetic dentist. The conversation each month with your SEO company can be excruciating, as the explanation is something like, “We are seeing progress,
and are very encouraged that we can get you to the top of the organic rankings.” Does this sound familiar? A More Cost-Effective New SEO Method We’ve done exhaustive research into how people use Google to search for their specific dental need. What we found was quite interesting and very exciting. Through our research using Google Tools, we have determined over 400 “buyer intent” dental keywords. And this just scratches the service. This is our Phase 1 SEO program for dentists just coming aboard with our agency. We have also tirelessly pushed to come up with procedure-specific buyer intent phrases, and here is where it gets kind of crazy. We have created what we call “keyword clusters”. For example, Invisalign is a cluster. Orthodontics is a cluster. Sleep Apnea, Sedation, Wisdom Teeth, Cosmetic, Dental Implants and more. The total number we’ve come up with is over 5,000 buyer intent keyword phrases. These clusters are what we call “add-ons” to our Phase 1. How Consumers Use Google I want you to think for a minute when you go to Google and search for something. Do you type in two words or have you learned that if you get more specific (three or more words), you get a better search result, which saves you time, one of your most valuable
commodities. For example, when I have a dentist on the phone, I’ll share my computer screen with them and analyze their online presence and website for improved conversions. But I’ll also do some searches as examples. So let’s say you are looking for a plumber. You’ve got a clogged bathroom sink. Would you just type in your “city plumber”? Or, would you add your specific need like “clogged bathroom sink”? Really think about how you search. You’ll soon realize you are adding words to your search to refine your results. Many times, the end phrase you use doesn’t even make grammatical sense. You just adding words as they came to you. Ranking for Your City And Surrounding Areas One thing I hear a lot is, “We draw patients from outside our main city.” And this is where the opportunity gets even more exciting. It is more realistic, with the right approach, to rank for those keyword phrases for surrounding areas, as many of your competitors will not have the knowledge to go after them, making them less competitive. Faster Rankings It is also feasible to get rankings faster due to the lesser competition of these phrases. We are seeing results in three to four weeks, so much different than the standard three to four months, if not longer.
Landing Bigger Cases Another thing I want you to understand and get excited about is the opportunity to land big cases and bring in much great revenues each month. When people are typing in these buyer intent specific phrases, they have a need. And they just want to find a dentist that can fulfill that need. Is This Long-Tail SEO? So many SEO companies reading this will tell their dentists that this is just long-tail SEO and the search volume is extremely low, as most people will not be typing these phrases in Google search. As mentioned earlier, we have determined buyer intent phrases that we would not consider long tail phrases. But … we cover the entire sum aggregate, which when added up, can be a greater search volume number for your practice than just ranking for the very difficult (and often impossible) general keyword phrases. Look at the image early on in this article to see the graph. It’s an eye-opener. I hope if anything, you are more informed, when you hear about dental SEO.
Mike Pedersen, is the CEO of The Dental Boost, a cutting-edge SEO and Design agency. Mike will do a Digital Assessment of your website and online presence by sharing his computer screen with you via a phone call. You can go to www.TheDentalBoost.com/getstarted/ to schedule your assessment.
Power to Succeed
7 Things to Identify the Right Dental Practice Whether you are an associate dentist considering purchasing your first practice, an existing practice owner purchasing additional practices or a late-career dentist considering selling to the next generation, knowing the following seven things when buying or selling a practice can make a huge difference …
Brian Swilling and Ryan Whitley
1. General Practice Information • Ask for a practice profile—an information sheet about the practice, building, employees, office hours, procedures and makeup of the practice. • Investigate what is going on in the immediate area, as far as development or changes. • Research the area demographics, growth and existing competition. • Contact the city office that handles development or access the city or county website to read about the community master
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plan. This maps the future growth and where it will occur. It lists areas of future development and expected zoning changes. This is an excellent resource for long term potential of any practice. 2. Financial Data • Request a recent Profit & Loss statement to measure current income and expenses. • Request a production by depart and provider reports to determine where the production is generated.
• Ask for the past three years of complete tax data. This is a good reference to establish past performance, but the last 12-18 months of data offers more information as to the health of the practice. • Request a report to determine how many patients were seen in the last 12-18 months. 3. Building Lease/Purchase • Is the office in a setting where it can be expanded if needed instead of having to relocate? • Is the building lease an assignment to you or will the landlord require a new lease? • If a new lease—will the terms and costs change? • Inquire about renewal options for both an assignment and a new lease. • A minimum lease of 10 years will be required by most lenders, but you should also secure as many options as possible to best allow for your future growth plans. 4. Staff/Associates • Ask for the payroll records to determine what the staff were paid for the last few years and current year. This is helpful to accurately understand the net cash flow if there have been any recent changes. • If the office manager, associate dentist or any other key staff are new, why did the prior staff leave? • Determine if there has been any patient erosion since the departure of these key employees. • Based on the cash flow of the practice, will there be a required payroll change? • If the cash flow is weak, what options are there to reduce the immediate costs without losing staff? • If it is known in advance that a reduction in staff will occur, determine the potential risk of patient loss.
There are many factors which come into play when considering purchasing a practice, and we encourage you to consult with your team of advisors as you navigate this exciting and stressful process. 5. Associate Dentists • If the seller employs an associate dentist, make sure there is an assignable non-compete in place or if the associate will sign a non-compete prior to the closing. This is normally required by a lender to ensure minimum impact on the patients and practice revenue post sale. 6. Procedures and Patient Approach • Does the seller seem to have a similar philosophy as to patient treatment and procedures? • Is the office adequately equipped for the procedures you plan to offer, and will there be any additional equipment needed? What will that cost be? 7. Transition • Will the seller offer you a comfortable transition as you feel is needed to get familiar with the practice operation, systems, patients and staff? • Is the seller available to provide support for several months after the sale?
• How long is the seller willing to offer assistance or possibly fill in for you after the sale? There are many factors which come into play when considering purchasing a practice, and we encourage you to consult with your team of advisors as you navigate this exciting and stressful process. Please keep in mind that each practice is its own unique entity and offers its own individual opportunities and challenges. We act as a resource for our clients and their team of advisors as they move into practice ownership, and this is a great starting point for any potential buyer or seller.
Brian Swilling and Ryan Whitley, CFP® are Financial Advisors whose practice works primarily with the dental community. Brian and Ryan have over two decades of experience advising business and practice owners in addition to ultrahigh net worth clients. Having grown up and marrying into families of dentist, Brain and Ryan have seen the many successes and struggles of being a practice owner. As a result, their focus is helping dentists advance their practice through organic growth and strategic acquisitions while developing the ability to be financially independent outside of their practice. The ultimate goal for their dental clients is to have the ability work in the profession they love while running a successful and profitable practice. Brian and Ryan welcome the opportunity to connect to advance your practice. bswilling@ wradvisors.com, email@example.com 704.553.7220
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Power to Succeed How to Not Fail Miserably as you Graduate David Rice, DDS
4’s, get ready … the homestretch is ahead. To the D1-D3’s, getting ready early is exactly what you need. As a D23, practice owner and founder of igniteDDS, every day I get asked what the most successful young dentists do differently. The short story is that they become president and CEO of their personal corporation. Translation… Like all top CEO’s, these students formalize their inner circle. In other words, they build a personal advisory board. Here’s the skinny on how to achieve that: First: 1. Name two people whose lives represent who you want to be 2. Name one person you trust who sees life like you do 3. Name one person you trust who will challenge your choices
Second: 1. Secure a financial advisor 2. Secure an accountant 3. Secure an attorney Third: 1. Ask those seven to join your advisory board 2. Set an initial 30-minute virtual meeting 3. Get a commitment on a standing monthly meeting time Remember: As you lead, your board will follow. Or it won’t. You’ll want your meetings to be concise, creative and collaborative. That said, these meetings are really checkpoints and a measure of accountability. The real work happens in between via each board-members’ suggestions, findings and recommendations. Creating a shared Google Doc or working with apps like Asana streamline this process. 34 Spring 2017 Dental Entrepreneur
The Initial Agenda: 1. Welcome; thank you; quick intro (You for two minutes) 2. Board member intros (You lead the order, they speak, 14 minutes) 3. Share your vision (You for two minutes) 4. Ask each board member for one initial thought. (You lead, all answer, 11 minutes) 5. Thank you/verify next meeting time (You for one minute) Want to learn more? • Check out our latest edition of CRUSH and other ebooks at https://ignitedds.com/app/ebooks • Email me directly at firstname.lastname@example.org and Dental Entrepreneur and igniteDDS will show you the way Until then… Together We Rise!
Dr. David Rice, DDS graduated cum laude in 1994 from The State University of New York at Buffalo’s School of Dental Medicine. In 1995, he completed his general practice residency from the Allegheny General Hospital in Pittsburgh Pennsylvania. With a strong belief in continuing education and mentorship, Dr. Rice went on to complete continuums at the Pankey Institute, The Dawson Center and The Spear Center all while building the Restorative Practice of his dreams and maintaining an associate clinical professorship at the SUNYab School of Dental Medicine. Dr. Rice combined his passions for teaching, mentoring and making a difference and igniteDDS was born. Today he continues to maintain his private practice and travels the country inspiring dentistry’s future to live their dream, have great success and to make that same difference that has brought him so much joy.
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Index of Advertisers ADS Dental Transitions South……………………………………………………………........................... 27 ADS Dental Transitions…………………………………………………………….................................... 13 Comfort Dental Dentist Advantage................................................................................................. 23 D5............................................................................................................................................. 35 Patterson Eaglesoft ..........................................................................................................Back cover Henry Schein PPT ....................................................................................................................... 25 Henry Schein Nationwide ............................................................................................................. 37 MacPractice................................................................................................................................ 21 Orascoptic .................................................................................................................................. 11 Paragon...................................................................................................................................... 17 Patterson Dental.......................................................................Inside front cover/page 1, and page 35 Patterson Advantage.................................................................................................................... 15 The Progressive Dentist................................................................................................................ 29 Wells Fargo................................................................................................................................... 9 36 Spring 2017 Dental Entrepreneur
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