Dental Entrepreneur Winter 2019

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Business Beyond the Classroom

Dirk Fleischman, DDS

John Zalesky, DMD

The Hidden Link Between the Dental Lease and Practice Profitability

Finding Valuable Opportunities to Give Back in Dentistry

5 Reasons Why Dental Membership Programs Rock! Like us on Facebook!

Building Your Practice From the Bottom Up Follow us on Twitter!


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WINTER 2019 VOLUME 21, ISSUE 2 Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Executive Assistant Patti D’Agata Production Curative Group 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 Layout and Design John O’Connor

Class of 2019 Contributors Jordan Comstock Jonathan Dubin, DMD Dirk Fleischman, DDS Pamela Gelfand Sheri Kay Kim Larson Scott McDonald Christopher Phelps, DMD David Rice, DDS Burt Szerlip Dale E. Wagman, DDS John Zalesky, DMD

Editorial Office

12233 Pine Valley Club Drive Charlotte, NC 28277 704/953-0261 Fax 704/847-3315 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 2019 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.

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As I type this editorial, I am in the hospital with my husband. His colon decided to rupture last week, and now he has an abscess that is blocking things. The moral of this story is that abscesses can shut down the body. An abscess in the mouth is as serious as an abscess is the colon, and both require medical attention. Dentistry and medicine have to tie the knot. They have to stay married when they do finally accept the conditions. For better or for worse, richer or poorer, and in sickness and in health. What I do know is that good care is priceless when you are trusting someone with your health. Knowing the mouth is the gateway to the body, you must keep learning, collaborating and connecting. As dental professionals, we must trust each other and believe in the fact that we are the people that others trust with their healthcare. Just like our wonderful cover docs, Drs. Dirk Fleischman and John Zalesky! They understood that early their special mentor/mentee relationship. It’s so awesome that they didn’t drop this relationship at graduation. And even as Dr. Zalesky continued to progress out of a special mentor/mentee relationship with Dr. Dirk Fleischman when he was younger into a new career, he still considers Dr. Fleischman a close confidant. This is their journey, and you will love their update. Who are your mentors? There is no better time than now to seek them out and carry them with you moving forward. It will make you a better everything, as Dr. Dale Wagman states when you read his article about the friends you need in your dental career. Who is your best friend going to be? Dale delivers an excellent message, as I have seen first-hand the downside of not taking this to heart. I’m excited to include Kim Larson in this issue. She breaks down some of the misconceptions surrounding DSOs. If that is the path you choose to go down, Kim discusses some of the tough questions that you’ll need to ask to find the right one. And finally, we have the incredible David Rice anchoring Dental Entrepreneur once again. David’s advice will help you be accountable as you figure out where you want to go and how to get there. To wrap up on an amazing note, we are uber-excited for our spring edition. So many deserving candidates have been nominated for our remarkable cover contest. Get your votes in ASAP. We will celebrate our winner soon, so be on the lookout! Go ignitedds and our DE family! Notify your colleagues and deans for the next edition, because it could be you! Cheers to your success,

Anne M. Duffy Publisher

Contents Prologue

4 Mentor Mentee: Update! John Zalesky, DMD and Dirk Fleischman, DDS

Getting Started 6 You’re Finally a Dentist! Now What? Kim Larson

10 Places with Promise and Places with the Kiss of Death Scott McDonald

Business Fundamentals 14 Drilling Down on Cyber Security Burt Szerlip

16 The Hidden Link Between the Dental Lease and Practice Profitability Pamela Gelfand

20 With a Little Help from Your Friend Dale E. Wagman, DDS

24 5 Reasons Why Dental Membership Programs Rock! Jordan Comstock

26 Building Your Practice From the Bottom Up Sheri Kay

The Power To Succeed 28 Finding Valuable Opportunities to Give Back in Dentistry Jonathan Dubin, DMD

30 A New Way to Know If You Have the Right People in the Right Seat On The Bus Christopher Phelps, DMD CMCT and Kolbe Certified® Consultant

34 Outlast Cynicism David Rice, DDS

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Mentor Mentee: Update! John Zalesky, DMD and Dirk Fleischman, DDS It seems like yesterday … I was a young man and future dentist with an unsure career direction and life path. Many long phone sessions, sleepless nights and heart-to-heart dinners later, I have developed into a so-called “mini-me” that Dr. Fleischman says he couldn’t be more proud of. In the fall of 2015, I was a Chief Resident in the General Practice Residency program at the University of Colorado School of Dental Medicine focusing on implants and prosthodontics. Now, I am an associate in an aesthetic, family oriented practice called LêDowns Dentistry in Denver, Co. Where has the time gone? Dr. Fleischman and I had discussed both short- and long-term plans for the two of us, with the ultimate goal of going into practice together. However, no matter how well you plan ahead, you never know whom you will meet or what opportunity you will be presented with. That opportunity presented itself during the second half of my Chief Resident year when I met Dr. Bill Black, a retired Oral and Maxillofacial Surgeon from Scottsbluff, N.E. Under the watchful eye of Dr. Black, I completed many wisdom tooth surgeries under IV sedation, as well as planned and executed numerous complex implant surgeries. During my time with Dr. Black, he passed on his knowledge of how to be a competent, precise and caring surgeon. He genuinely had a knack for teaching and desire for me to get to a level higher than I thought I was ever capable of. All the hard work eventually paid off when Dr. Black asked me one day what my plan was for next year. He also asked if I was looking for a job. He proceeded to hand me a note with a date, time and restaurant on it that read, “If you have any plans, change them and be here to meet this doctor and bring your resume.” I called Dr. Fleischman right away and discussed these unexpected events. He said, “Go explore this opportunity and see what it’s all about with an open mind, but do not commit to anything”. As a resident, there isn’t much time for extracurricular plans, so I showed up, very anxious, excited and open-minded. That afternoon, I met Drs. Jim Downs and Nickie Lê, the husband and wife team of LêDowns Dentistry. Come to find out, Dr. Bill Black and Dr. Jim Downs teach implant courses for the Dr. Dick Barnes Group in association with Arrowhead Dental Lab in Sandy, Utah. In addition, Dr. Downs teaches clinical hands-on, full arch reconstruction and everyday occlusion courses there, as well. Needless to say, dinner was a long discussion about my path into dentistry, where I came from and how

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I got to where I am. I left this enjoyable meeting with a lot to think about. I felt like I was back to the same position I was in a few years ago, an unclear and undefined career path and future. Of course, I call my No. 1, Dr. Fleischman, and had the longest phone conversation in our eight years to date. After much discussion and numerous scenarios played out, I was at a crossroads. I was offered an associate position at LêDowns Dentistry, and I decided to take it with Dr. Fleischman’s utmost support. He and I felt, after much deliberation, that this was the right career path to travel down. It was a tremendous opportunity for me to learn, grow and excel in a private practice environment under close mentorship from Dr. Downs. I started working Saturdays, doing hygiene while finishing out my Chief Resident year. My focus for the second half of that year had a more relaxed feeling, knowing I was in a position where I would continue to learn, improve, grow and, most importantly, help people. However, I realized I couldn’t coast through the rest of the year. I knew I had to work even harder, because I was stepping into a demanding and high-paced practice with expectations to fill. Thus, I continued to soak up as much as I could from Dr. Black, and he and I have forged a close friendship outside of the dental world. In addition to finishing my cases, I completed a project that became a dental CE course with Head and Neck Oncology at UC Health Hospital entitled: The Collaborative Relationship for Patient Treatment Between General Practice Dentist and Radiation Oncologist. Upon finishing residency, I was asked to return as a faculty member at the University of Colorado Dental School as a Clinical Assistant Professor in the Department of Surgical Dentistry, where I teach twice a month in the Emergency Department and General Practice Residency Program. Over the course of the past two-and-a-half years in private practice, I realized just how much I still didn’t know and that learning will occur until the end. You just have to be open to it. Dr. Downs still tells me to this day, “You don’t know what you don’t know, and just when you think you know, you get another t-shirt.” I have found that one gets humbled rather quickly. You think that with two years of residency and extra training that you know it all and can get through it in cruise control. In actuality, there was so much more to learn … so many situations presented that I didn’t know how to handle. It is forever an uphill climb to learn, grow and offer the best care for your patients.

The decision I made – again, with Dr. Fleischman’s support –to join LêDowns Dentistry and gain another tremendous mentor in Dr. Downs has taken my career and me to the next level. I added a plethora of knowledge, tools and predictability to my armamentarium, which includes recognizing and understanding how to prep teeth for success from everyday class II’s and crowns, to full arch reconstruction, the use a CO2 laser, TSCAN for occlusion and TMD and, most importantly, how to read and understand people and their personalities. One of the most critical skills is knowing how to navigate patients to improve case acceptance.

I have learned that the dentistry is not what’s difficult. Rather, it is patient management. To this day, Dr. Fleischman and I talk almost daily. The roles have somewhat reversed, which makes both of us extremely happy. Performing procedures and completing various cases, such as reconstruction, implants and The Chao Pinhole Technique, allows me to teach and explain to him my rationale, protocols and outcomes. His experience of over 35 years still trumps me at this point, which pushes me to continue striving for excellence. As I look into the future, I don’t know what is on the horizon. I look to continue

down my current road getting better each day, gaining all the knowledge and experience I can. What I do know is I have a tremendous group of mentors in Drs. Black, Downs and Fleischman motivating me because they see what I’m capable of and what I can be. I just have to accept the fact I will gain a few more t-shirts along the way and to not be so hard on myself when those situations present themselves. I have come to see that dentistry is both rewarding and fun, and as Dr. Fleischman once told me, “If you enjoy what you do, you will never work a day in your life.”

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Getting Started

You’re Finally a Dentist! Now What? Kim Larson


hen you receive a DMD or DDS degree, you will have acquired well-honed clinical skills, a wealth of dental knowledge and most likely a great deal of debt. However, your training may not have covered the business management skills needed to be a successful business owner, team leader and people manager. Real-Life Problems The business acumen required to run a successful dental practice can be overwhelming, especially since most dental students have an education based in science, not financial management, insurance negotiations, marketing, IT or human resources. The business side of dentistry is often done after patient hours. Dentists entering the field, including growing numbers of women who often want a work-life balance that business ownership doesn’t necessarily provide. Younger dentists are leaving dental school more deeply in debt than in the past, sometimes carrying half a million dollars in student loans. This debt, coupled with startup costs including securing real estate, hiring staff and buying expensive equipment prevents many from opening their own practices. Real-Life Solutions Many graduates will end up working for a dental support organization at some point in their career. Upon graduation, well over 30 percent of all dental school graduates will join a DSO or multi-location group practice, and that number grows yearly. Working for a DSO upon graduation can not only assist the recent graduate in building clinical skills and confidence, but also allow them to expedite paying down loans and accumulating capital. DSOs are not just training grounds for new graduates. In fact, according to a 2017 ADEA study, a significant percentage of new recruits were experienced dentists. You may know some perceptions of DSOs and some general information about DSOs, but do you know what a DSO really is? Are you fully equipped with the knowledge to know if a DSO is right for you? Do you know how to choose the right DSO?

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DSO 101 DSO is an acronym which can stand for either dental support organization or dental service organization. Regardless of whether the “s” stands for support or service, the meaning is the same. A DSO is typically a stand-alone legal entity, built specifically to handle the non-clinical functions of the dental offices which it manages. These non-clinical functions include human resources, accounting, legal, marketing, risk management, compliance, recruiting, payroll, IT, procurement and several other non-clinical services. When a dentist decides to work for a DSO, one of the major draws is the fact that the dentist can focus on the clinical side of dentistry while leaving the administrative side to a team of business experts. You go to dental school to change people’s lives through the art of dentistry, not necessarily to become a CEO (chief everything officer), skilled in insurance, procurement, equipment maintenance/repair, payroll, HR, marketing and other business practices that are key a healthy dental office. The right DSO can be a great place to start your dental career and fine tune your clinical skills without the sometimes-overwhelming distraction of figuring out and managing the business side of dentistry. Aren’t All DSOs the Same? Regardless of what you may have heard (good or bad) about working for a DSO, it is important to remember that each group or dental support organization is different. Each has its own culture, its own unique business model and its own opportunities and challenges. There is an industry expression, “When you’ve seen one DSO, you’ve seen one DSO.” But they can vary in many ways, including: • Geographic footprint • Career path and opportunities • DSO ownership structure • Company culture • Doctor compensation models – salary, pay for production, student loan repayment • Potential ownership opportunities for dentists • Mentorship and training programs

• Charitable causes • Career opportunities beyond the chair • The type of dentistry performed • Payor – fee-for service, Medicaid, capitated, mix • Mission • Business growth and exit strategies With 1,100 DSOs to Choose From, How Do You Decide? Much like each solo practice operates differently, each DSO also operates differently. According to The Association of Dental Support Organizations, there are 1,100 DSOs to choose from, and their numbers are growing. Since DSOs come in all shapes and sizes: emerging, mid-market, and large; all offering different cultures and support philosophies, it is important to understand how you align with their culture, philosophy, and value system. Opportunities abound for you, and you need to make sure that you choose the right DSO, not necessarily the first DSO you contact or the one that has free cocktails and dinner at a campus recruitment. It is valuable to attend DSO campus events and become familiar with recruiters and their DSO’s culture. Talk to every DSO that comes to your campus. Go prepared to ask them the tough questions. Do they fit into your life plan? Do they meet your requirements? Do you share values and a common life philosophy? You also need to perform your due diligence online. Visit and join some of the many social media groups specifically geared for dentists on Facebook and LinkedIn. Use these groups to find other dentists that have worked for a DSO you may be considering and get their opinion and experience. But don’t just rely on one person’s opinion. You may be more familiar with some of the larger DSOs, since they tend to have more doctor recruiters who can attend and sponsor various campus functions,

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however there are hundreds more to choose from. Don’t limit yourself. DSOs are not all created equal. Bigger is not necessarily better. Gather information to make an informed decision. Research other smaller, emerging or mid-market DSOs that may be more regional in nature and offer unique benefits or opportunities in order to compete with the larger DSOs. Online resources like the Association of Dental Support Organization’s website – as well as our websites, JoinDSO. com (with a free job board) and’s free newsletter – will help you navigate the abundance of opportunities and give you more information to help you make the best decision. Interview them and ask the tough questions like: • What are your student debt repayment opportunities? • How are patient treatment plans determined, managed and executed? • What is your DSOs business model, and how does a new dentist fit into it? • Do I have an opportunity to buy into the DSO or own a percentage of a practice(s)? • What type of charitable and philanthropic work or community outreach does your DSO do? • What does the work-life balance look like? Work hours flexibility? • Are there advancement opportunities beyond the chair? • What is your DSO’s growth strategy? • Who owns the DSO, and how does

that influence how you operate? • Besides being patient-centric with centralized administrative functions, how do you differentiate yourself from other DSOs? • What type of training do you offer? Continuing education opportunities? • Is there a mentorship program? It may be true that newly graduating dentists have incurred a historic amount of debt. However, the good news is that there are more debt repayment options and countless career paths to explore and follow. You’ve worked hard. You’re finally a dentist. And now your options are limitless. You can chart the course that is uniquely right for you!

Kim Larson has been involved in the healthcare industry for 25 years. In 2014, after she recognized a need for a digital publication devoted to the DSO and group practice space, she helped launch Group Dentistry Now and JoinDSO and is the CMO of both. She also consults for the ADSO, and several DSOs and emerging dental groups. Kim has spent the last five years exuberantly focused on the DSO space, committed to its success, and has a huge following of DSO and dental industry fans. Connect with her on LinkedIn.

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Getting Started

Places with Promise and Places with the Kiss of Death Scott McDonald


ur business is to evaluate the potential of sites for practice. This is what the 2018 list looks like. When someone asks for the good news versus the bad news, most people seem to want the bad news first. What are the places that you do NOT want to consider for a start-up. It goes without saying that it is generally true that the bad places are also going to come with a larger than average number of negatives for someone wanting to purchase a practice. It does not mean, however, that one cannot or should not practice in these places. Far from it! A great practice with a good value, healthy production and favorable new patient count is always to be desired. But these communities are facing headwinds that cannot be denied and that is why we caution those considering these for start-ups. Perhaps rather than branding them with the “kiss of death,” it would be wiser to say “exercise caution.” It may surprise you, but San Jose and San Francisco didn’t make the cut. They have lots of problems, but are still enjoying business development which is always a big advantage. They are still viable, even if they both are expensive areas., and we all know the cost of doing business can cause headaches. So in reverse order, here is the list of best potential sites for practice from 2018: No. 10: Jackson, Mississippi – With little growth, huge poverty and long-term unemployment, Jackson is not the place to go. But I should also say that Jackson is working hard to grow and to develop, and in a year or two, it might be much better. No. 9: Albuquerque, New Mexico – The oil and gas business that makes up the economic base of Albuquerque is shaky. Worse, the city has not diversified its employment base. Unemployment is high and will likely remain so. No. 8: Louisville, Kentucky – We honestly love Louisville, but with a median household Income below $45,000, increasing poverty and low growth and development, it’s hard to recommend it. Still, those who are visionary see a future Louisville doing better because the costof-living is so low and Kentucky has just switched to a right-to-work state. In essence it COULD come back. But look for its suburbs to lead the way. No. 7: Providence, Rhode Island – This is the poster child for a community that is committing suicide. It has eight colleges and universities (which is great). But as soon as they graduate, they move somewhere else because there is nothing to keep them. Very low growth, very high taxes. Remarkably high cost of living AND cost

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of doing business. No. 6: Fresno, California – I was wrong. I thought Fresno would do better. The poverty rate is twice the national average. The median household Income is $41,458. The city and county are trying to be clever in offering incentives for businesses to come here, but I don’t think anyone trusts them. Certainly a practice can thrive in Fresno, but we are taking about start-ups and therein lies the rub. It will be very hard to make a go under current circumstances. No. 5: Santa Rosa, California – Yes, this is the same place that was nearly burned out in the recent fires. But the city and county officials got the idea that the city was full of wealthy people, so they raised taxes and allowed property values to rise quickly, thus hurting growth and development. I believe it deserves better than the way this city has been managed. No. 4: Allentown, Pennsylvania – While other steel and mining towns were making adjustments in a changing economy since the ‘70s, Allentown decided the world would have to change instead. Its growth rate is very low, and the unemployment rate is high. And ironically, the cost-of-living is average at best. This place needs employment-friendly policies, and it looks like it isn’t going to get them any time soon. No. 3 San Bernardino, California – Some people assume that the high poverty rate (34 percent) was the reason the city is in such trouble financially. Rather, it is the unfunded mandates of public sector

employees that have hurt this community. The first thing the city did was to cut back on police and fire services. The wildfires came as a surprise at the worst possible time. The cost of living is high, and the local tax rates are rising to meet the city’s obligations. Ironically, the competition rate is not that bad for dentists. No. 2: Modesto, California – This area has a high cost of doing business and aboveaverage cost of living. There is simply no way that an agriculturally based economy can tax itself back into the black. Granted, the drought hurt many central valley communities, but the State of California does not seem interested in getting these cities back on track. No. 1: Stockton, California – This is another poster child of how to mismanage a city. Wages are low. Educational attainment is low. But the unfunded mandates which reduce community services like police and fire, as well as public infrastructure, including road maintenance, make practicing here extremely risky. If you own a successful practice, the tax man sees a big target on your back. That is why fees and regulatory costs make these ten locations a poor investment. I take no pleasure in publishing this list, but I get many questions for our clients, students and friends about them. I just want you to avoid locations that can really put a damper on your investment in a practice. Take heart, there are lots of other rising cities on this list (which we will publish in 2019). It is not all bad news out there, and we’ve made note of several more positive markets. But I do have to mention something important: Not every neighborhood in these locations is equally positive. Often, there is a bad section of town you want to avoid or a gold mine to consider. Obviously, it is our job to help identify the gold mines, so you may want our help in refining your search area. It is what we do at Doctor Demographics. Don’t be surprised if there are other practices nearby. Trust me, you are not the first dentist thinking about establishing a practice. But the favorable growth

and other demographic factors will help overcome these challenges. Here are the 20 markets with the growth, stability, “animal spirits,” employment and overall business development that make

them more reasonable for start-ups and favorable for practice purchase (in reverse order)” No. 20: Seattle, Washington – YES, there is competition and a high cost of

Calling All Dentists:

Is it Time for an Insurance Check-Up? By Burt Szerlip, President, B.C. Szerlip Insurance Company Whether you are starting a new dental practice, or already in one, you know that your day will be hectic. Protecting yourself, while protecting your patients’ pearly whites, is the last thing on your mind. It is critical to have a comprehensive and economical insurance plan for the unexpected. Below are just a few of the most important plans. • Malpractice Insurance: Malpractice insurance is the most common insurance for any medical practitioner to have. Under the pressure of your reputation and the health of the patient. But even if you assume that you will never make a mistake or a wrongful act, it’s often better to be seen with malpractice insurance than without. A patient will often prefer a professional with malpractice insurance, as it insures the patient that if malpractice were to occur the proper outcomes would follow. It is an insurance policy that insures the patient just as much as it insures you. • Worker’s Compensation: As any hygienist will tell you, the human mouth is riddled with germs. Couple that with sharp metal tools, and the occasional anxious and squirmy patient and a proper worker’s comp plan is almost a necessity. Most states require businesses to offer worker’s compensation. Even if your state doesn’t have that requirement, there’s no reason to not prepare, as workman’s comp will cover medical care and disability payment while an employee is unable to work. • Disability Income Insurance: A good disability income insurance will cover 50 to 65 percent of your base salary. This is enough to keep you and your loved ones comfortable, and your medical bills paid, as you get back up on your feet. • Office Property and Liability: Anything that has value can be insured, from computers to medical equipment, and even the building itself. It’s important to protect your most valuable and least easilyreplaceable assets from threats like fire, vandalism, and theft. There is also the liability of someone tripping and falling on premises. A good insurance plan will give you all the coverage you need. • Cyber Liability: In this day and age, threats aren’t always just physical, but electronic. Because most offices are unequipped to handle these kinds of incidents, it becomes a liability. A liability that, on average, costs over half of a million dollars to recover from. Luckily a good cyber liability insurance policy will help protect you from these damages by covering liabilities arising from loss of data, cyber extortion, business interruption, regulatory fines and law suits against you on loss of information. • Employment Practices Liability: If you have a large business, odds are you have a legal team to help mitigate any legal claim made against you. However smaller businesses are at a much larger risk. Good employment practices insurance can help to give peace of mind against a careless mistake, purposefully predatory lawsuit, and wrongful termination, discrimination and harassment claims. While these are some of the key insurance policies dental offices can hold, it’s important to consider the risks, the costs, and what the best policy would be for you and your practice. Contact your insurance provider and see what they can do for you.

34 Sycamore Avenue • Little Silver, NJ 07739 732-842-2020 • •

Dental Entrepreneur Winter 2019 11

doing business. YES, some neighborhoods are terrible. But within the Greater Seattle market, there are new homes, new residents and lots of jobs. Sorry, I just can’t deny it. Just choose your neighborhood carefully and get a demographic report! No. 19: Las Vegas, Nevada – A few of you may recall that Las Vegas was on death’s doorstep. Reasonable taxes, job friendly environment and a community that seems to have tamed its profligate spending is worth a second look. And not just in Summerlin. No. 18: Salt Lake City, Utah – It has low unemployment, moderately low taxes and a boat-load of young entrepreneurs. The south side of the metropolitan area is going through some serious changes and improvements. The West Valley is also looking promising. Just stay away from the area between Temple Square and the University of Utah! No. 17: Atlanta, Geogria – Lots of growth has occurred from out-of-state migration. Birth rates are increasing. Job growth is continuing. For former residents of Georgia, it is time to look back to the old homestead. The best potential is actually just north of the city (on the northwest and northeast). No. 16: El Paso, Texas – One of the saving graces of this moderate-sized city is the very low cost of living and the favorable unemployment rate. This is one of the best border towns with Mexico. Sure, it has had some challenges, but it seems to be doing well. No. 15: Sarasota, Florida – The quality of life, cost of doing business, growth and reasonable local taxes make this place hard to ignore. It seems to have avoided much of the seediness some have come to expect from Florida. And it doesn’t hurt that it is easy to get to but not TOO easy. No. 14: Raleigh, North Carolina – The educational attainment scores of residents and the higher-than-average wages make it a place to consider for folks who want good weather and a reasonable cost of living. In many ways, the greater Raleigh market has done so much right to attract employers and 12 Winter 2019 Dental Entrepreneur

Locals call it “The District” because it lies within some relative artificial boundaries. You can make a good living with an upscale practice that appeals to the people who work in the district. residents. Just keep in mind, this is a BIG geographic area to consider. No. 13: Colorado Springs, Colorado – This isn’t the only Colorado market to consider, nor the only one I like. But it is a good example of why Colorado is growing and what a town with growth and favorable cost of living and low unemployment looks like. One of its benefits is it looks better than most other big towns in the west. No. 12: McAllen, Texas – This market is really a series of towns near the Gulf of Mexico on the Mexican border. Like El Paso, it thrives being in a busy and dynamic choke point between two large countries. Granted, there can be some poverty in these places, but there is also a thriving retirement and business community. No. 11: Richmond, Virgina – By American standards, Richmond is an old city. But it’s also a place with a good quality of life (which means its weather and cost of living are good) that attracts many residents from other states. It has proximity to almost everything. In short, Richmond’s central location is making lots of very big employers consider this market for new factories and plants. But just don’t get stuck inside the city limits. The surrounding area has great potential.

No. 10: San Antonio, Texas – Not only is this one of America’s most attractive cities, the cost of living and the cost of doing business are serous advantages. Those are big reasons for its growth. In addition, the favorable tax rates don’t hurt at all. No. 9: Des Moines, Iowa – Mid-America is doing well overall. Des Moines is leading the way. Great unemployment numbers, cost of living and more make it a good choice for dentists looking for a family friendly environment. Unfortunately, higher-than average corporate tax rates are slowing its potential. Just keep in mind the many smaller cities that dot the landscape as potential sites. No. 8: Dallas, Texas – I will admit at the outset that Dallas’ urban center is no picnic. You really have to consider the outlying suburban communities for practice. And yes, Plano is full! Still, the huge job growth, wonderful airport, freeway beltways, and the aggressive new building make it a place for dentists to consider as a place to start their searches. Fort Worth has been picking up (along with its suburbs) so you have to put it on your list for consideration. But increasingly, Dallas doesn’t quite feel like Texas. No. 7: Ogden, Utah – It’s odd just how often demographers are talking about Ogden. Its economy, cost of living, cost of doing business and inexpensive land keep it on the charts. It is certainly growing. For those who don’t know, Park City and Ogden have far less LDS influence than other parts of Utah. This can be considered both a liability or an asset. No. 6: Houston, Texas – When the rest of the nation was going through a housing crisis and a dip in employment, Houston dodged the bullet. This is one of the most ethnically and racial diverse cities in America. True, it’s dependence on the energy market has spooked some, but its reasonable taxes and cost of doing business have keep it on many lists. No. 5: Charlotte, North Carolina – I recently spent a weekend here and found it to be terrific. Taxes and the regulatory practices of government seem to be favorable for

dental practices. It has very good growth. No. 4: Denver, Colorado – To be honest, I am not in love with Denver. The deregulation of marijuana has brought in both money and a negative “element” that I don’t love. Still, growth is undeniable as is the thriving economy. I am just not as crazy about the lifestyles at this time. The other note of caution has to do with competition. That is why choosing the right neighborhood is particularly important. No. 3: Washington, D.C. – Locals call it “The District” because it lies within some relative artificial boundaries. You can make a good living with an upscale practice that appeals to the people who work in the district. Appealing to most of the people who live here is another matter. Unemployment is low. Growth is good but churning is outstanding. Still, the cost of doing business is ADS.south209


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getting out of control. And did I mention that Amazon is moving a headquarters nearby? No. 2: Provo, Utah – This is one of the best places on earth to raise a family. It has the reputation of being one of the healthiest places on earth. Unemployment is tiny. Costs of living and business are tiny. Reimbursements are also tiny. It is likely that all of these are related. I define this area as including all of Utah County. And that is where the real opportunities can be found. No. 1: Austin, Texas – It surprises some people who know Austin that this is such a great place to locate a start-up. But let me be clear: the city of Austin is not cheap and neither is the competition absent. But there are tremendous opportunities in the surrounding suburbs and communities. It continues to have great potential.

In conclusion, this is a solid snap-shot that is going to change, so stay tuned!

Scott McDonald is the owner of DoctorDemographics. com. Follow us at Doctor Demographics on Facebook or check out our web site at Our weekly Perfect Place to Put a Practice Podcast on ITunes, Dentaltown, and YouTube is a free resource to find out what is happening right now. And don’t forget to visit us at to get a free copy of our book on the General Dentist Site Selection Handbook.

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

Dental Entrepreneur Winter 2019 13

Business Fundamentals

Drilling Down on Cyber Security Burt Szerlip


n 2017, the World Economic Forum survey ranked cybersecurity as the biggest threat to a business. This is a risk deemed more threatening by top businesses than a fiscal crisis, financial bubble bursting and even terrorist attacks. The reason for this? According to the report, as the world grows more connected through technology, so do the threats. And with the number of estimated interconnected devices expected to more than double by 2020, the threat won’t go away anytime soon. The Securities and Exchange Commission says that small businesses are at great risk of attack, and the dental and medical communities are not immune. Just this summer, a Kansas City law firm filed a class action lawsuit against a children’s hospital after the private information of some 60,000 individuals was breached, as part of an email phishing scam that targeted hospital employees. Here’s what you need to know to keep your practice safe: Cyber-attacks can come from one of two places. The first is an outside attack, propagated by a malicious hacker from outside your company. This is a person whose goal is usually to take your company or your customer’s hard-earned money. Often an external cyber-attack can come in the form of a non-threatening, or even urgent, email from a supposedly legitimate source. This email will entice whoever has received it to input personal information such as passwords, credit card information, and even personal information, and can put your company and its customer’s security at risk. This kind of attack is called phishing, but it’s not the only cyber vulnerability you have to worry about. Attacks on your system only require one click to do their dirty work, and that click can come from anywhere. Even an illegitimate website or a scam email, when done by a professional, can trick one into putting their guard down. After that, customer credit cards and identities could be at risk, or a “backdoor” could be created to allow a hacker into your system without a password, and without anyone ever knowing. You can even have access to important files or programs blocked until you pay the hacker if you accidentally install ransomware. And this isn’t the end of external cyber security threats. If you can think of a way a hacker can make money off of you, then hundreds of hackers have already thought of it years before you did. But the biggest threat isn’t external. Much like how the call comes 14 Winter 2019 Dental Entrepreneur

from inside the house at the climax of a horror movie, your biggest cyber-security threat comes from inside your own company. In a 2016 study on cyber security, IBM found almost 58 percent of attacks came from inside the company. Insiders, of course, may have special permissions or information that makes cyber-attacking easier. Insiders may be able to trick non-malicious employees into revealing their passwords or granting them special access. These risks are only heightened when too many unnecessary employees have access to privileged systems. But you don’t have to have an in-depth knowledge of computer hacking to be a risk, because most insider cyber-attacks are caused by underprepared employees. Every day, over 4,000 cyber-attacks are attempted on businesses nationwide, and this number is only growing, according to the FBI’s Ransomware Prevention and Response. But for a hacker to get into a computer system, they don’t need intricate knowledge of what they’re looking for. They just need an under-prepared employee. As technology changes quicker and quicker, it becomes harder for many to keep up. Long-time employees who might be used to one system are especially at risk for unsafe practices, such as inadvertent password sharing and inability to recognize or stop a threat. And this is every hacker’s dream – an employee who, through the best intentions, doesn’t even realize that they’re letting someone into your and your patients’ private information. These disasters can be mitigated, however, with a comprehensive plan. First, it’s vital that your employees stay up-to-date with the latest

cyber-security threats, what they look like and how to avoid them. Teaching employees to recognize suspicious links, keep their passwords private and difficult to figure out, and being able to tell if another employee is suspicious is a must. Second, an updated security system is your best defense against an outside threat. A general rule of thumb is that hackers will always be up-to-date when it comes to cyber-security systems. This is how they know what to exploit. It’s up to you to stay ahead of the curve so that they don’t have the chance to exploit a weakness. Make sure that all of your computers’ drivers are updated and you have the latest anti-virus and firewall software installed. If you don’t know how to do this yourself, that’s perfectly fine. A reputable and experienced IT professional should be able to properly secure your system in a less than a day. Finally, it’s important to remember that even the best-laid plans of mice and men often go awry. While training your employees and having a good defense will help in the long run, nothing is 100 percent because cyber-threats are always changing in unpredictable ways. To protect your patients, your assets and your business, a good insurance plan will go a long way. Any good practice will have insurance for a slew of unpredictable events. If your business is near the water, flood insurance is a must, and on the West Coast, earthquake insurance is a no-brainer. Fire, theft and property damage insurance are all staples for peace of mind and asset protection. So, too, is cyber insurance. A knowledgeable cyber insurance provider should understand all these pitfalls and the biggest threats to your practice. A good insurance provider will not only give you peace of mind with their expertise, but also with their coverage. Typically, a good cyber insurance policy should cover any legal fees and expenses caused by the cyber-attack, but this is just the beginning of the benefits of cyber insurance. By restoring compromised data or patient identities, a good insurance plan can make it like the attack never happened. Your insurance provider will notify

your patients of the data breach and personal information that may have been affected them. This not only saves your company time, but it also saves face. After all, a mismanaged security breach can permanently ruin any company’s reputation, so it is absolutely vital to nip it in the bud quickly and effectively. A key business strategy is to stay up to date with technology, especially in the medical sector, but as technology increases, so do the threats that come from it. Avoiding a cyber-attack may sound tricky at first – after all, hackers make it their job to stay one step ahead – but with careful planning, it’s possible to minimize the risks. Strong, up-to-date cybersecurity software will help keep hackers on their toes. When it comes to human risks, knowing who you hire, how to spot warning signs and proper training can be even more important than a good firewall. Nothing is certain, however; and even the most comprehensive strategies are never fully airtight. But, you have a dental practice to oversee. You can’t concern yourself with security breaches all the time, and with a comprehensive insurance plan built by professionals, you can keep your peace of mind knowing that no matter what happens, you’re covered. Burt C. Szerlip, Certified Insurance Counselor, is president of B.C Szerlip Insurance Agency, Inc., established in 1995 and specializing in all forms of insurance for healthcare providers. With more than 35 years of experience insuring healthcare providers, Burt understands the risk and exposures associated with today’s practicing dentist and through the B.C. Szerlip Insurance Agency, Inc’s large portfolio of the country’s premier insurers, he provides the utmost in affordable insurance protection. Burt Szerlip, President BC Szerlip Insurance Agency Inc., Little Silver, NJ., Phone: 732-842-2020; Email: bcs@bcszerlip. com

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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 Send your questions or comments to Dental Entrepreneur Winter 2019 15

Business Fundamentals The Hidden Link Between the Dental Lease and Practice Profitability Pamela Gelfand


here are many important decisions that new dentists are faced with after having completed the hurdle of graduating from dental school, becoming licensed to practice and earning an income. Most dentists are eager to become a practice owner after working as an associate. It’s safe to say that very little time is devoted to the “business of dentistry” in dental school, and especially in the real estate realm. The big picture is that the real estate costs connected with practice ownership are second only to those of payroll, which makes real estate a major slice of the “ownership pie.” Most dentists start their practices from ground zero and enter into a lease, because it’s much more attainable for the practitioner rather than tying up working capital in real estate ownership. Leasing can secure the space for a long time, yet allow for future flexibility should area demographics change. Obtaining financing for a practice purchase is more difficult than obtaining financing for a lease. Purchasing a practice requires a much higher loan amount, and many banks are unwilling to risk financing a dentist that has limited experience in practice operations. Opening a practice is always a risk – financially and emotionally. All practice owners have two main goals: personal fulfillment and practice profitability. In terms of practice profitability, a dynamic location and marketsavvy lease economics are significant factors in the financial health of a dental practice. Other factors in practice ownership, outside of the real estate portion of a practice, certainly affect profitability, as well. What else directly affects practice profitability? There is a hidden link between the dental lease and practice profitability, and it is business protection within the lease. Dental tenants take on twice the amount

16 Winter 2019 Dental Entrepreneur

of financial risk than landlords, thus the need for a heightened level of business protection, which can be achieved through a well-negotiated lease that secures long-term rights and privileges. The key to understanding this concept lies in recognizing what a lease really is and the important part it plays in profitability: A lease is a binding agreement between a tenant and a landlord. It’s a risk-shifting structure full of complexities. Leases offered by landlords are always skewed to favor the landlord by shifting risk to the detriment of the tenant. A lease can be a tenant’s best friend or mortal enemy, and it’s largely dependent on how it is negotiated prior to final agreement. Should a conflict arise, all parties look to the lease for resolution. It is comprised of two operative functions: legal and business. The legal function should be handled by a licensed attorney experienced in dental leases to make sure all stipulations are legally valid in nature, both in verbiage and in enforcement ability. A dentist should always obtain legal review prior to signing a lease. The business function addresses the business stipulations in a lease that are outside the legal framework. Many hidden business



MacPractice beats Dentrix, Eaglesoft, and Softdent in CR Reports User Satisfaction Survey* - Read full report at * CR Choice designation in the March 2017 issue of the Independent Clinicians Report

stipulations contained in the dental lease can threaten the financial stability of a practice. They are perfectly legal but BAD BUSINESS for the dental tenant. A Few Business Stipulations That Can Wreak Havoc on a Practice’s Financial Health 1) With short notice, the landlord can mandate that the tenant move their practice to another suite within the building without compensation for lost revenue, loss of visibility and access, loss of time to move (furniture, equipment, records), equipment re-installation, continuation of employee payroll while the practice is not open for business, printing of new business literature, printing and mailing of “new address” notice, and revising the online marketing system. The same size of the space is only the tip of the iceberg. It’s known as the Relocation Clause and IT’S LEGAL in a lease, but is detrimental to any dental tenant. THE RELOCATION CLAUSE MUST BE NEGOTIATED TO PROTECT THE TENANT’S CAPITAL INVESTMENT. MANY TIMES, IT CAN BE ELIMINATED ALTOGETHER. IF NOT ELIMINATED, IT SHOULD BE NEGOTIATED TO MAKE IT VERY COSTLY TO THE LANDLORD IF THEY WISH TO EXERCISE THAT RIGHT. 2) Building foreclosure can have a devastating affect on the dental tenant. In most states, in the event of a building foreclosure, all leases are voided. Without a businessprotective stipulation, the dental tenant is forced into renegotiating the lease with a new owner regarding the lease rate and any other stipulations that were in place prior to the foreclosure. Worst-case scenario: the new owner could decide to repurpose the building and force the dental tenant to vacate. A huge bank loan still exists, and the dental tenant is not only unable to obtain more financing for another office, they are

18 Winter 2019 Dental Entrepreneur

There are lots of myths out there about commercial real estate. It’s not a onesize-fits-all profession. also unable to produce the same revenue. Credit can be ruined. Nearly as bad, the lease rate is increased and the dentist will be trapped because they can’t afford to move and get another loan to rebuild elsewhere. THIS IS LEGAL, but can be devastating to the dental tenant without the inclusion of an important agreement in the lease. DON’T SIGN A LEASE WITHOUT THIS PROTECTIVE AGREEMENT! CONSIDER IT A DEAL-BREAKER! 3) In the event that the dental tenant wishes to sell his/her practice, the landlord has the right to void the existing lease and negotiate a new lease with the practice buyer. Because the clause existed in the original lease, the practice seller can be forced to lower the selling price in order to compensate for the additional rent required by the new owner to lease the space at the new increased rate for the remainder of the lease term. Because of the exposure to loss in the event of a practice sale, A TENANT SHOULD NEVER AGREE TO THIS LANDLORD’S REQUIREMENT! DON’T SIGN A LEASE THAT CONTAINS THE CLAUSE THAT GIVES THE LANDLORD THE RIGHT TO RECAPTURE A LEASE! Business protection is a defining feature in any well-negotiated lease, especially for dentists – it’s a real game-changer, because it’s a major factor in practice profitability. Many of these business risks can be shifted away from the dental tenant with proper negotiation. Yet, the concept of business protection is most often overlooked during the course

of a dental lease transaction. Why? Many commercial brokers and some attorneys are unaware of the hidden business stipulations that are particular to dental practitioners. Dentists need for a heightened level of protection due to the large capital investment in start-up costs, as well as shouldering the ongoing responsibilities required in day-to-day operations. There are lots of myths out there about commercial real estate. It’s not a one-sizefits-all profession. Here are thre top three myths that cost dentists thousands of dollars: 1) All commercial leases are the same 2) All commercial real estate brokers are the same 3) The landlord will offer a discount to the tenant if the tenant as no broker – in other words, the dental tenant is wading into unchartered waters, having no one to watch his/her back. Don’t Drink the Kool-Ade! Dental leases are complex and contain many ambiguities that place the dental tenant at a much higher risk than a general commercial tenant due to the large investment in building improvements. Make sure to hire a broker who knows dental leases and the importance of business protection that is outside of the legal realm. All parties to a real estate transaction have the right to licensed real estate representation. It levels the playing field between the parties. Written appointment of an exclusive tenant broker will protect against conflicts of interests and should define fiduciary responsibilities to protect the dental tenant. There are hundreds of horror stories told by dentists that blindly believed the above three myths mentioned above. The results? Low-performing locations, over-market economics lacking in build-out and other landlord allowances, and committing to a lease that didn’t contain the necessary business-protective stipulations. Dentists have lost their leases through no

fault of their own, with no way to recover their capital investment. They have had latent defects occur in the building structure that cost them employees and patients. They have even had their financing ability inhibited. The list can go on and on. These horror stories can rob wallets and cause sleepless nights. These horror stories could have been avoided with tenant-protective stipulations within the lease agreement. A tenant broker who specializes in dental leases will know the keys to selecting the right location, will negotiate marketsavvy economics favorable to the tenant, will understand that the dentist is in a heightened risk situation and will make sure to incorporate business-protective agreements into the lease that are 100 percent outside of the legal realm. It’s all about business risk avoidance for maximum protection in the here-and-now, as well as far into the future.

There are no predictors in life. Expect the best, plan for the worst. Dentists should be able to focus on case acceptance and patient treatment - free of worry about the real estate portion of their practice.

Norman Gelfand has 30 years of experience as a commercial real estate broker. Pamela Gelfand joined the firm in 2001. Together, they’ve represented over 600 tenants in lease negotiation. Both have exclusively represented dental tenants and buyers for 17 years. They help dentists in securing ideal locations, negotiating moneysaving, market-savvy economics, and tenant-

protective lease negotiation. The firm’s unique lease negotiation begins with the identification of hidden business risks within the lease that are outside of the legal framework, and are typically not addressed by most brokers and many attorneys. They negotiate tenant-protective leases by shifting these hidden business risks away from the dental tenant to safeguard the tenant’s capital investment – a key element in profitability and practice value. Nationwide, No-Cost Real Estate Services for Dental Tenants & Buyers only. 512-833-5300 or 512-468-1938


ADS companies are each independently owned and operated.

Dental Entrepreneur Winter 2019 19

Business Fundamentals

With a Little Help from Your Friend Dale E. Wagman, DDS


uying a practice – particularly your first – can be a little frightening. Well … downright terrifying, actually. It can be a bit isolating, too. You often find yourself alone, wandering around in your own head, bumping into one nightmare after another. You holler out, but only echoes return. The good news is that you have friends – especially one friend who is frequently left out of your inner circle. In fact, he or she should be and can be, your very best friend. Let’s look at the list. First, there is your accountant. Many can be a tremendous source of valuable information and someone to whom you can turn for explanations of tax and structural business strategies that you may not be aware of. However, don’t expect that they will do anything other than make suggestions and fill in gaps. They can’t make your practice successful. Only you – and maybe your best friend

20 Winter 2019 Dental Entrepreneur

– can do that. The same thing holds true for an attorney. They too can be a voice out there in the darkness, but once again, they are probably not going to make your practice more appealing to patients. Actually, you can do an entire practice purchase without the services of an attorney. That’s not to say you should, but you can. How about a dental supply person? They can be a great friend. You will need supplies and maybe even some new equipment from time to time. It’s their job to make sure you have what you need and steer you toward ways to get it in a cost effective manner. A good lab tech is worth their weight in titanium and can be a very good friend. You can expect to have a conversation about something or other with your lab person just about every week – sometimes more! Keep in mind, they often will have taken the technical CE

courses you should have, but haven’t … yet. And then, of course, there is your transition consultant. Few friends are worth more than they are. It is important that you don’t think of them as simply the guy or gal who sold you your practice. The good ones make themselves available long after the transaction occurs, and they can be a huge source of information about both the industry as a whole and your particular geographic region. They are in the unique position of being able to feel the inner pulse of many different practices and generally can make many suggestions about how the heart of your practice should beat. Remember, their success is both directly and indirectly dependent on your success. So, it’s not quite as lonely out there as it may seem, and we haven’t even begun to talk about your one very best friend in any dental transition – the seller. Think about it. Who knows more about your soon-to-be patients than they do? Who knows the staff better? Who knows the community better? None of your other friends can even come close to knowing more about the truly important stuff about your practice better than the seller does. Most of what

you buy when you purchase a dental practice is the goodwill the seller has established with the patients and the staff. Forget the equipment. You will probably replace it all at some point in your career. The goodwill – an intangible – is where the true value of the practice lies. Yet, in many cases, it seems like the new buyer does everything they can to actually alienate their best friend. Worse, some buyers take this combative posture to the point where the seller actually becomes an enemy. This is a huge waste of marketing potential. Just because your seller steps away from your practice doesn’t mean they step away from the patients. They bump into them at the grocery store. They see them at sporting events. They have become personal friends with many of them and see them on the golf course or at dinner. And, whether you like it or not, some of their former patients – now your patients – will call them on the phone and ask for advice. Don’t think that actually happens? Wait and see. We communicate with one another in multiple ways – verbally, with voice inflection, with pauses between what we say, with facial expression, with body language, with

posture, with eye movements – many ways. When your seller meets any of your patients in any setting, you want the message they send with whatever method they send it, to be positive. All it takes is one tiny negative spore to spawn an entire colony of doubt in the subconscious of that patient. You can’t afford to let that happen. You want them out in the public acting like an auto-marketing machine! Here is a blueprint, guaranteed to alienate your best friend (and if you are smart, you won’t follow it): Try to Negotiate the Purchase Price As long as it is within reasonable limits, trying to lower it is an exercise in poor focus. Sharp business people usually just glance at it. They are far more focused on what the net (after expenses and debt service) amount is to them– the cash flow (the EBITA, if you will) essentially the money they actually can put in their pocket (before taxes). That is the most important number to know in any investment – especially when a third party, like a bank, is willing to loan them the money and they don’t have to come out of their pocket to do it! Many

You have goals. PARAGON can help you reach them. Are you thinking of buying a dental practice, merging, or selling your practice? The future you want is closer than you think. Our guidance makes all the difference.

Take your next step with confidence. Call PARAGON today.


Dental Entrepreneur – SEPTEMBER 2016 – 1/3 Page 4/C – 7”(W) x 3.3125”(H)

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.

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

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22 Winter 2019 Dental Entrepreneur

dental buyers seem to look at the purchase price first, but the irony is that proposing a double-digit percentage reduction in the sale price increases the cash flow to a buyer by just a low single-digit percentage. All this really does is leave a sour taste in the seller’s mouth that patients are certain to smell on his breath. Nickel-Dime the Seller Say you’re not buying their accounts receivable. Not helping them collect that money or charging them a fee to do so will certainly irritate them. When funds due them come in, your staff (formerly their staff) has to adjust the patient records in every case, anyway. Don’t try to charge them for it. It’s their money. They sweated over it and spent time with it. They earned it. Taking part of it is a sure slap in the face. You’ll appreciate that more after you’ve been in practice longer. Nitpick the Seller Constant contradiction will ultimately cause trouble – subtle trouble, but trouble nonetheless. Trying to change every little thing during the transition could be that one tiny bit of negativity that takes root in the seller’s mind. There is no such thing as the perfect practice. They all have something wrong with them. You’re probably going to change many things during your term of control. And, guess what? The practice you end up with will still have something wrong with it. Worse, the pattern of nitpicking can lead to an even worse syndrome, Analysis Paralysis, which could easily mean you will never find the right practice for you. Criticize the Seller’s Work If you’ve been in dentistry for longer than a minute, you should know not to do this – and not for the reasons you would expect, like it being unethical. You don’t want to do this because you will soon find yourself treating that patient, and some patients simply can’t be treated properly. They are often easy to spot. They’re the ones with the worst dentistry because they’ve made it impossible

for anyone to work on them. That said, fillings do break and fall out. Porcelain does shatter. Decay does recur along crown margins. That’s dentistry. And herein lies one of the greatest marketing opportunities you will ever see. Spin any issues you see in the seller’s more recent work to the positive. Assure the patient that the seller did nothing wrong and that this kind of thing occurs frequently in dentistry. Then, fix it for them – for free or at least for a reduced fee, like for just the lab bill. The return on investment you will enjoy from this one simple act will far outweigh the return on any other marketing you will try – flyers, billboards, radio, TV, direct marketing – anything. While the practice of dentistry certainly fulfils the simple mandate of providing needed services to patients, in the end it is a business. All businesses rely on a friend or two for help from time to time. Don’t overlook your most obvious friend. Keep the seller happy, and they will become the best friend you’ll ever have.

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 selfmanagement of Dental PPOs. He lives with his wife in Northwestern Michigan. He can be reached at 517-375-3740

WE ARE HERE TO SUPPORT YOU. For over 100 years, Patterson Dental has built relationships with practices of all kinds, listening to needs and delivering industry-leading solutions. From office design to dental supplies, we offer the help you need to create the ideal practice environment. And a de-stressed office means you’re free to provide the best possible care to every patient.


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Business Fundamentals

The continued battle against patient anxiety Patterson Dental – ADVERTISMENT


ental anxiety is not a new topic. Still, it seems that every year, more and more decisions in dental practices are made based on avoiding dental anxiety. Nearly every aspect of today’s patient experience has been shaped by dental teams trying to minimize the stress of the dental visit. And that’s a good thing. The rise of the modern dental practice has seen the creation of patient-friendly, welcoming spaces that reject the stereotype of the cold, scary dental office. “We’ve all read about it and talked about it and it’s a topic that has been covered from every angle. Nobody wants to come to the dentist,” said Dr. Jay Stockdale of Renaissance Dental Care in Rancho Cucamonga, California. “I’ve had hundreds of women tell me they’d rather have a baby than have their teeth worked on. We know that we have to provide the best experience possible if we have any chance of growing our practices and making more people want to come to you.” Like other dentists, Stockdale took steps to make his practice as comfortable as possible, create a pleasant environment with kind team members and, most importantly, do right by the patients clinically. And while the patient experience has changed in recent decades with the attention to dental anxiety, Stockdale felt that it could be even better. The source of much of the anxiety is the same as it’s always been: the drill and the administering of local anesthetic. “I find that people don’t like the drill, but it’s really the needle that they’re afraid of,” Stockdale said. “As far as relating to apprehension and pain, I’ve had many patients over the years tell me, ‘Doc, you have to invent something so I don’t have to get the shot.’” For many patients, that fear was initiated by a bad childhood experience at the dentist. Stockdale said he regularly sees it in aging patients. Some dental practices in the mid-20th century charged one fee for fillings and a separate fee for the local anesthetic, he said. When families couldn’t afford both, the procedures still needed to be done. That meant opting out of getting numb, and that meant children being scarred by a traumatic, painful dental experience. “Part of our goal in reducing the level of anxiety patients feel is to get young patients off on the right foot,” Stockdale said. “Then they won’t develop the fear of dentistry and they won’t avoid dental care later in life.” 24 Winter 2019 Dental Entrepreneur

Avoiding the drill and the needle Across the board, dental technology has transformed time and again since the mid-20th century. But Stockdale encountered something entirely new in his latest effort to reduce patient anxiety while increasing his practice’s efficiency: the Solea Laser. Solea is a CO2 that is fast, precise, virtually noiseless and anesthesia free for most procedures. Better yet, it eliminates the drill and the needle for many procedures. While patients love the experience, dentists love the improved efficiency and practice growth. And with the fact that so many procedures are anesthesia free, multi-quadrant dentistry is possible. “Solea gives us the opportunity to do more work during the same visit,” Stockdale said. “That gives us more flexibility and changes the way that we treatment plan patients. Everybody wins. You can do more in each visit so there are fewer patient visits, and it’s more convenient for us.” Solea’s unique wavelength enables precision cutting of both hard and soft tissue. Since it is also equipped with a simple user interface, Solea is easy to use for working on everything from gingiva and dentin to enamel and bone. Users simply press harder on the variable-speed foot pedal to cut faster, and softer on the foot pedal to cut slower, giving them total control. It’s yet another tool that can be used to help reduce dental anxiety, for generations to come. “Providing the patients a good experience is old news at this point,” Stockdale said. “But Solea does it in a new way. I never thought I would be in dentistry long enough to see something like it.”




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Business Fundamentals

Building Your Practice From the Bottom Up Sheri Kay


othing makes me smile bigger than walking into a practice that clearly differentiates themselves from every other practice. Yet, there are fundamentals consistently found in high performing teams that minimize the need to “re-invent the wheel” when in search of organization and predictability. So yep, there is a way to follow the yellow brick road AND create your very own individual Oz at the same time. Having worked with over 300 practices across North America, I have learned there are integral steps that can lead you to a practice that is rewarding, individualized, structured, effective and profitable. Oftentimes, what I find is that dentists want to move through these steps quickly, or in an order that may not be the best in the longterm interest of the practice. Let’s take a look together at this purple pyramid model to explore the layers and the rationale behind them. In our current culture, there is a high awareness around the idea of work/life balance. That being said, I like to start with the notion that

26 Winter 2019 Dental Entrepreneur

it really is possible to find. Because I look at balance as something that I’m always moving toward rather than maintaining, I have found that starting with a clear vision of what you want for your life as the base of this pyramid makes the most sense. It’s tempting to simply jump into a practice with both feet for the purposes of having a place to practice, earning a living or repaying any debt. Other details to consider include actually enjoying your work, having specific times for interests outside of the office and being able to spend time with family, friends, vacation, mission work, etc. One of the first things I do when I meet a new dentist is ask what they enjoy outside of their practice. All too often, what I hear is that there are not enough waking hours to fit everything in. Just imagine how your life could be enhanced if you DID plan and carve out time from work to enjoy other aspects of your life from the very beginning? The second base layer is about your actual practice. Being clear and articulating specifically what the three aspects of your practice could be like: Business, Team and Patients. This part of the exercise is

where you literally put to paper your desires and expectations of how you want your practice to look, feel, function and perform. Consider what is ideal for you in terms of demographics and the types of people you want to surround yourself with both in and out of your chairs. Think about your physical space, relationships, specialties, quality of clinical care and level of hospitality. These things can be planned for rather than figured out along the way. Cool concept, right? I love the notion that your vision actually becomes the guidepost for all behaviors and decisions made in your practice by you AND by your team. Your vision presents as a common theme, a clear direction to lead from. Level 3 supports the idea that you and your team share common values for personal and professional learning and growth. It’s this growth mindset that supports a model of continuous improvement, engagement and commitment to the vision that called you all together. When a group of individuals are working, learning and growing together toward a coming vision … that’s when magic happens. All three of these lower levels represent mindset, values, belief and purpose. Although you may not be able to touch or see these things, they are always foundational in what drives us, what inspires us, what connects us to something greater than ourselves. These lower levels are what separate the high performers from the folks who wake up just to go get a paycheck. It’s the middle piece of this model that holds the key to consistency, follow through, clear expectations, accountability and innovation. Literally creating a manual of written standard operating systems is no easy task, and yet it is always worth the time and energy involved. The most important part of this is to have the team co-create the development and initiation of the systems that get written. When systems emerge rather than being imposed, the level of ownership and responsibility to them can be extraordinary and sustainable. This is the piece of the

puzzle that helps to improve communication and ensure that the day to day activities align with the vision. Although not an easy process, it truly is priceless. One of the goals of any successful practice is to create a consistent positive patient experience. At this level you have an opportunity to pay attention to all the details that can contribute to that actually occurring. This level is about asking for feedback and gaining confidence that your patients will become missionaries for you, dragging their friends and families because you’ve met and exceeded their expectations of what a dental practice can be. You’ve gained trust and built solid relationships. Now is the time to market! For fear of sounding like the flight attendant on American Airlines, patients have many choices about what dental practice they will visit. Help them find YOU. Help them choose YOU. Whether it be optimizing your website or creating a video to play at your local move theater, patients need to be able to find you. Make yourself visible and be sure that all marketing is aligned to very directly reflect the vision and values that you created a few steps ago. One of the worst things that can happen is attracting patients that are different from those you want. Many people ask me why the marketing doesn’t happen sooner. To be honest, sometimes it can. Especially if you have a brand new quickly building practice. In my perfect world, all of the previous steps will be in place. Marketing prior to having your self together organizationally can lead to confusion, failed expectations, stress and frustration on everyone’s part. Tried and true, this model works well in the designed format and order. The cherry on top is where your success lives and breathes, and the best part is that you’ve defined what that means to you. I always encourage my clients to define personal success first, and it’s amazing how this entire model can just about build itself to support you getting there. The last piece of this pyramid that I

appreciate so much is how it can be used as both a planning and a diagnostic tool. If/ when you recognize that something is not working, all you have to do is look down the rows. For example, if patients are not having a consistent positive experience, I’d look first to see if our systems are in order. If systems are effective, time to look at the team and doctor’s commitment, and down she goes. Isn’t it beautiful? Build from the bottom up, assess from the top down. I call this: Everything you ever needed to know about practice management in one purple pyramid. Keep in mind that it can take years to master this pyramid. It takes a huge commitment to go up and down over and over again … because you will change, and your practice will change. For me the most important part of having a practice is remembering that it is your practice, beginning with your vision. Who knows, maybe the purple pyramid will take you to someplace even more magical than Oz.

Sheri Kay is a published author and voted as one of the Top 25 Women in Dentistry by DPR magazine in 2011. As owner of Sky Dental Practice Coaching, Sheri has impacted hundreds of practices and takes pride in helping team members maximize their contributions. Starting in dentistry in 1980, Sheri has gained experience in every aspect of the dental practice as hygienist, assistant, and administrator. With a passion for service, Sheri enjoys volunteer work in her local community, mentoring women across the country, and is always looking for ways to make a positive difference in the world. She has been a spokesperson for the American Cancer Society, has been rescued by a pit bull named Lego, and when not working can most likely be found either teaching or taking a yoga class.

Dental Entrepreneur Winter 2019 27

Power to Succeed

Finding Valuable Opportunities to Give Back in Dentistry Jonathan Dubin, DMD


ccording to the ADA, more than 180 million Americans won’t visit a dentist this year. And many have dental issues that can lead to even bigger problems. The CDC reported that 19 percent of children age 5-19 years-old have untreated dental caries and 32 percent of adults age 20-44 years-old aren’t receiving treatment for their dental caries. This report doesn’t even take into consideration gum disease, oral cancer and other untreated dental conditions. Obviously, there’s a need for regular dental care, but many (approximately 100 million) don’t have dental insurance, and unfortunately, there are far too many Americans who don’t have access to care. There are programs available to try to bridge the 28 Winter 2019 Dental Entrepreneur

gap and events such as Missions of Mercy and Give Kids a Smile that attract dentists who provide nearly $2.6 billion in free care each year. In many cities, there are also charitable clinics like Atlanta’s free Ben Massell Dental Clinic, which is the country’s oldest and largest charity clinic. The Ben Massell Dental Clinic recruits volunteer dentists in the greater Atlanta area to serve in the clinic for a half-day each month. They also work with the local dental school, the Dental College of Georgia in Augusta, to provide externships for most fourth-year students. This program not only benefits the community, but also the dental students who gain valuable, hands-on experience outside of the classroom.

I got involved with the clinic through a three-week summer externship when I was in dental school a “few” years ago. After graduation and before I worked at a practice, I would go and work for a couple of days a week. After I began practicing, I continued to volunteer one day a month. Now, I serve on the board and volunteer along with other Hinman Dental Society member dentists. There are approximately 150 volunteer dentists (almost half of which are Hinman members) who, along with students and residents, perform more than 20,000 dental procedures a year. This treatment is valued at $4.6 million, but more importantly, keeps our indigent patients out of local emergency rooms and increases the self-sufficiency and quality of life for our most marginalized neighbors. Over the years, many Hinman members and their sons and daughters have volunteered at the Ben Massell Dental Clinic. Dr. Richard Weinman and I help guide a program where students do externships – 14 rotations throughout the year, each two weeks at a time. It’s important for dental students to have an opportunity to work outside the dental school, but still under the supervision of a practicing dentist. At the Ben Massell Dental Clinic, students will work with a different doctor – sometimes a specialist and sometimes a general dentist – every day. This process exposes them to different philosophies and experiences. They learn lots of tips and tricks from the dentist volunteering that day. It’s a wonderful experience to take advantage of while providing a much-needed service in the community. I learned a great deal from some of the doctors who supervised me when I was a student. I continued to reach out to them for advice in the years that followed. My son Zach is now a volunteer student at the Ben Massell Dental Clinic. He recently completed his first two root canals at the

It’s important for dental students to have an opportunity to work outside the dental school, but still under the supervision of a practicing dentist. clinic, which gave him hands-on experience with a procedure he might not otherwise have had at this point in his young career. A 100-Plus Year History The Ben Massell Dental Clinic has been in Atlanta as long as the Hinman Dental Meeting. It was started 107 years ago by philanthropist Morris Hirsch. Oral health became the focus in 1929 to provide dental care to those who couldn’t afford services. In 1956, Dr. Irving M. Goldstein, an Atlanta dentist and former Chief of Staff at the Morris Hirsch Clinic, and Dr. Marvin Goldstein, his brother and successor, moved the clinic from its original location. With the help of Ben Massell, one of Atlanta’s most prominent builders and developers, and the Jewish Federation of Greater Atlanta, the clinic was expanded and relocated to offer fullservice care. In 2008, the clinic was updated and modernized with the help of the Jewish Family & Career Services, the clinic’s parent organization. A $5.5 million capital campaign chaired by Cathy SeligKuranoff, granddaughter of Ben Massell, allows the dental clinic to offer 16 treatment rooms with state-of-the-art equipment. The clinic added an AEGD program in partnership with Grady Memorial Hospital and the HIV/AIDS outpatient clinic teaching four residents each year.

Clinics like the Ben Massell Dental Clinic are a vital part of the community. This clinic alone sees more than 3,500 patients and fills a great need in Atlanta. It’s also a wonderful opportunity for emerging dentists to gain significant clinical experience while giving back to their community like the volunteers who are Hinman members. To find more opportunities like this one: Attend National Dental Meetings: You’ll find at most national dental conferences, like the Hinman Dental Meeting, that organizations such as the Ben Massell Dental Clinic will have a booth in the Exhibit Hall. • Contact State Dental Associations: Contact your state dental association to see if they can direct you to volunteer opportunities like this one. • Call State Department of Public Health: Your state’s Public Health Department can direct you to dental volunteer events and organizations.

Jonathan Dubin, D.M.D. is General Chair of the 2019 Thomas P. Hinman Dental Meeting in Atlanta. When Dr. Dubin isn’t practicing dentistry with his associate, Dr. Tammy Bregman, at Laser Assisted Cosmetic & Family Dentistry in Atlanta, he is volunteering for a variety of dental organizations. He serves on the board of directors for the Ben Massell Dental Clinic and the Fisher Foundation for Dental Education, and is clinical director of the Special Smiles program for the Special Olympics. He also is co-chair for the GA Mission of Mercy, and of course, spends countless hours in support of the Hinman Dental Society and Hinman Dental Meeting, as well as the Georgia Dental Association. Dr. Dubin and his wife Traci have two sons, Zach and Seth, and a daughter, Mylee.

Dental Entrepreneur Winter 2019 29

Power to Succeed

A New Way to Know If You Have the Right People in the Right Seat on the Bus Christopher Phelps, DMD CMCT and Kolbe Certified® Consultant


n my travels, I’ve had the pleasure of speaking with dentists from all over the United States, Canada the United Kingdon and Australia. While there are a lot of differences I’ve found between the way we run our practices and the way they run theirs, I noticed one unifying feature. Regardless of where you are in the world, if you own and run a dental practice, your biggest source of success and frustrations comes from your team.

So how come some practices have figured it out, while so many others struggle? In Jim Collin’s best-selling book, From Good To Great, he talks about how critical it is to get the right people on the bus, the wrong people off the bus and the right people in the right seats. But what does that really mean? How do you get the right people on the bus? How do I know if this person really is the right fit for this seat on the bus versus a different seat on the bus, or do I really just need to help them off the bus? For me, I found the answers with the Kolbe assessment test,

the driver of the car is your IQ. Sometimes, your personality takes the wheel. Many times there is conflict between the two. You may know – a.k.a. your IQ talking – that you should do this, because that’s how you’ve been trained. But sometimes your personality and motivations take the wheel, making you want to do something different. Haven’t we all had some version of that conversation in our heads? Well, to really understand Kolbe, we have to go back to the Ferrari, and you first have to ask yourself this question: “Can I take this Ferrari driving down the highway and start driving it off road?” You may, at first, think you can’t, but the truth is you can! You know or have been trained on how to drive it off road, right? Just turn the wheel, and there you go! Jumping hills, tearing up grass, dirt flying high in the air. You may want to drive it off road just to see if you can, for the excitement or thrill of it. But let’s think about the Ferrari for a second. Is it built for this activity? What’s going to happen to this high-performance vehicle the longer you keep driving it off the road? Eventually, it’s not going to last, and it’s going to break down. Well, this is what the Kolbe A assessment test measures. It measures the car – or your natural strengths and instincts. To understand why the best of the best teams are successful in their jobs you have to ask yourself if it’s the way you’re built, the car (in essence), built for the job tasks and duties you’re required to do every day? Are you driving it on the highway, or are you driving your car off road? Your team member may know how to do the

What’s Kolbe? Imagine you’re driving a Ferrari down the highway. Sometimes,

30 Winter 2019 Dental Entrepreneur




job, because they’ve had the training and experience thus far. They may want a job, because they need to support their family, but ultimately, if they’re not instinctively built for that job and given enough time, they’re going to break down. They won’t last. It’s this conflict that typically results in people calling in sick all the time. This conflict can lead to people working for you try anything to not do their job. Ultimately, they won’t last, as you’ll usually have to help them off the bus. They might even help themselves off the bus and quit. What Does Kolbe Tell Me About Me and My Team? The Kolbe A assessment measures your striving instincts in four main categories or action modes. Your fact finder (RED line) mode measures how you gather and share information. Do you strive for more facts and details to understand a concept, or do you strive to know just the bullet points? Your follow thru (BLUE line) is how you arrange and design your

32 Winter 2019 Dental Entrepreneur

world. It’s about getting stuff done and implementing things. Do you strive to multi-task, or do you strive to start a task, finish that task and then move on to the next task? Your quick start (GREEN line) is a measure of how you deal with risk and uncertainty. Do you adapt quickly to change and uncertainty, or do you strive to maintain the status quo? Your implementor (YELLOW line) is about how you handle space and tangibles. Are you more of an abstract or concrete thinker? Every number is an instinctive strength and every number is perfect for you. There is no score better than another. It’s about understanding who you are at your core and doing things that work within your strengths instead of those that force you to work within your challenges. What Kathy Kolbe, founder and author of the book Conative Connection, has shown in her research is that if you are working in a job whose tasks or duties fall under your Kolbe Strengths, then it takes very little of your mental energy to do those tasks. Therefore, you’ll be more productive,

efficient and happier performing those items. On the other hand, if the job task or duties go against your Kolbe strengths, then over 70 percent of your brain lights up with activity to perform those items and thus leaves you drained, unproductive and likely to burn out, quit or be fired from said job. What Does It Teach Us About Our Team? So when I stared in clinical practice in July of 2003, I joined an office whose office manager had achieved this role through her 15 years at the practice, mostly because she had outlasted all of the other previous employees. While she was really great at going in and talking to patients, finding out what barriers they had to accepting treatment and creatively figuring out a way to help them around those barriers to accept treatment, I discovered a major problem. I spent a lot of money that first year on creating marketing campaigns that helped converting new patient opportunities in my chair. That’s

how I doubled the production/collections number that year from the previous year before I started. The problem I noticed is that our patient attrition rate dramatically rose. The patients I invested all that marketing in were now not returning for the hygiene visits. Being a curious person, I picked up the phone and called them to ask why. What I found changed the course of our practice forever. They told me that while they understood why we were a fee-forservice office, they also understood that because we filed their insurance for them that they should have received a check from their insurance company directly, reimbursing them for what they spent in our office. The bad news I discovered was that while the patients were accepting of our payment policy, the insurance company wasn’t reimbursing our patients for what they owed them. When I dug into the WHY behind this, I discovered it was simple little things (like when my office manager filed the claims), some small details were off on the claim form. The birthday was wrong, the group number was off by a digit, etc. All the ammo the insurance company needed to deny the claim or leave it outstanding in limbo forever. The next problem we had was that my office manager never created a system to track those claims and follow up to make sure our patients were getting their reimbursement money. The result? They stopped returning to the practice. Once I saw her Kolbe, I immediately knew what the problem was. It wasn’t that she wasn’t trained in how to file those claims or didn’t have the experience, because, after 15 years in dentistry at the front, she did. It wasn’t a personality conflict, as she wanted to do a good job for me and my partner and wanted to be the personality of the practice. No, the problem there, which I had never known until the Kolbe A showed me, was that she wasn’t instinctively built to do the job we had her doing. Thus the results we were seeing.

Knowing this, I educated her about her Kolbe results and drew parallels to the challenges we were seeing. I also showed her how we saw her strengths. She could identify barriers to patient treatment and would figure out how to help them get around those barriers to affirm treatment. Thus, I offered her a chance to give up the office manager role and move her to a different seat on the bus. The new financial coordinator role I created for her. While most might have fired her or chastised her for her results, I saw it for it was. I should have never put her in a position to fail. So what happened? She gave up the office manager role. I influenced her into a commission role and gave her a chance to double her income every month from the year before. The first month in this new role, which fit her Kolbe strengths, the office increased production/collections by over $50,000 per month when it hadn’t grown in the last four years. That’s the power of what can happen when you get the right people in the right seat on the bus. When I talked to my office manager’s husband, six months after the new role had begun, he pulled me aside and told me that, at first, he didn’t agree with my decision and advised her not to take this new role and leave. She told him that she trusted me. I’d only put her in a position to succeed, and it was worth the risk. He then told me that it was the best decision and genuinely thanked me for doing it. He said, “I didn’t realize how much stress the job as office manager was putting on her, because she wouldn’t show it. That was her personality, but since she’s been in this new role, she’s been a better wife to me but more importantly she’s been a better mom to my son. I can’t thank you enough.” I was already sold on Kolbe because of the science and predictive nature of it, but that solidified it for me and its power forever. When Jim Collins talked about getting your people in the “Right Seat on the

Bus,” Kolbe was the first assessment test I’d run across that was based in research and gave me language to describe why this person was going to be a good fit for this seat on the bus or why they’d be a better fit for a different seat on the bus or maybe why we don’t need to let them on the bus to start. That’s why the Kolbe is my go-to assessment when defining my team’s real strengths and what’s keeping us from being able to grow.

Dr. Christopher Phelps is a general dentist, amazon best selling author and entrepreneur with an active private practice in Charlotte NC. In his first 7 years of practice he grew the revenue of his practices by a factor of 10X going from 1 practice location to 4 locations. After selling two of those offices for profit, Dr. Phelps focused on maximizing the capacity of his remaining 2 practices and had 2 consecutive years of $1,000,000 revenue growth at each of the two practices, effectively collecting with 2 offices what he had collected when he owned 4 offices. A major part of this success was the Call Tracker ROI and Golden Goose Scheduling programs he developed out of his own marketing needs and issues. With it, he was able to increase his new patient numbers from 60/ month to averaging over 300/month; all the while decreasing his marketing expenses by 74%. In addition, Dr. Phelps is a Cialdini Method Certified Trainer (CMCT) and an expert in how to use the science of influence and persuasion to solve the problems in the dental practice.

Power to Succeed

Outlast Cynicism David Rice, DDS If you’re looking to become an elite dental entrepreneur, I have two words for you to focus on this issue … Outlast cynicism! As a dental student, I don’t have to tell you this. The world is full of people who wittingly or unwittingly try to bring you down. They’re everywhere, they’re relentless and they don’t tire. Let’s face it. The path of least resistance is resistance. When’s the last time you met a complainer who told you they were just too tired to complain anymore? That finding the cloud in the blue sky was just too hard? That they simply couldn’t fight the power of positivity one more day? Whatever your personal definition of dental entrepreneur is, you will be leading a team and you will encounter more people than you’d like to believe who challenge your positive attitude. Outlasting cynicism. Of all the profound principles I’ve embraced in my 25-year career, one that Brian Kight, CEO of Focus 3, reminded me of this past week may be the most valuable. Principle in play, the question becomes, “How?” What’s the strategy to day-in and day-out bring your best game, in spite of what people may bring you? Step 1: Be Siri If there’s one thing we can all count on, it’s Siri guiding us to our destination. We have to do the same as dental entrepreneurs. We have to guide our teams. We have to establish our starting point, our vision. Then we have to share it just like Siri or any other GPS. Everyone on our team has to know: • Where are we going? • Are we driving, ride-sharing or walking? • Are we taking the highways or the side streets? • Do we look for the fastest or the scenic route? Clearly define where you’re going and how you’re getting there, and you successfully engage, educate and empower your team. Step 2: Build an Accountability Plan The kiss of death as an elite dental entrepreneur is having an incredible plan, sharing it and then not sticking to it. Unfortunately, it happens all too often, because most dentists want their teams to like them. So they swallow hard when people are late, they get frustrated when team members don’t do what they promise and they let it slide, hoping it doesn’t happen again. Here’s what I recommend: • The first time a team member doesn’t do what they have promised to do, sit down and ask them if they remember what you all, as a team, promised to do. 34 Winter 2019 Dental Entrepreneur

• The second time it happens, sit down again and formally write up said team member. • The third time (and this is the hard one), they leave their keys on the table and are no longer a member of your team. Here’s my promise: • If you bring this accountability plan to your team on the front end, they’ll all think it’s an amazing idea. • If you ever do have to let a team member go, you’ll never have to do it again. Your team will know how valuable your vision and your word are to you. Step 3: Have an Accountability Partner for You Here’s my second promise: When we first implemented this strategy, it sounded fantastic, until we had to follow through and do it. The great news for my partner Mark and I is that we had each other to lean on. As easy as it would have been to give said teammate one more chance, we didn’t. That is incredibly important, because your team is watching! All your teammates who are trying to outlast you, and those who likely have outlasted many people in their lives just need their one moment! One time to prove that their cynicism will prevail. One time for them to know they’ll get that one more time … every time. As bad, if not worse is this: All your teammates who day in and out have been your biggest fans – all the ones who cheerlead for you – they’re watching too. And what do you believe happens when they see the cynics win? At what point do the cynics outlast them? At what point do they join them? And how much harder does your ability to stay the course get? In conclusion, if you have a partner in your biz, make a pact. If you don’t and you have a friend or a mentor, do the same. Lastly, if you want or need a mentor or a buddy to make this system sing, an accountability partner to help you outlast cynicism, just ask! Register at, and I promise you, I will be that guy. Till next time … Together We Rise!

Fortune Management

extraordinary practice. extraordinary life.



See it, Plan it & Do it. Don’t wait another second…your future depends on it!

Do you understand where you are going? Can you see the lifestyle you want? Don’t wake up 5 years from now wondering what you should do with your career. I wish I had this available to me as a young dentist. - David Rice, Founder of Ignite DDS

Enroll in the Fast-Trak Program & Accelerate your Journey to Success. As your vision for your dental career continues to evolve, you don’t have to figure it all out on your own. You are not alone. It doesn’t have to be a daunting, complicated process filled with hard lessons learned along the way. This is why igniteDDS and Fortune Management have teamed up to build a program tailored for the young dentist, guided by mentors and practice success coaches. Join the Fast-Trak community and begin your journey with a defined destination, and a clear, direct route paved by the experience of those who have traveled the same path. We’ve built a program help you Fast-Trak your success. Meet with us and your peers for three live workshops and stay connected throughout the year in the private on-line community.

Fast-Trak Online With enrollment in the Fast-Trak program, you will gain access to the private Fast-Trak Online community. It’s designed to prepare you for the live workshops, reinforce curriculum, and provide access to success coaches. • Private Forum • Access to practice success coaches • Resources: – Articles – Blogs – Case Studies

Fast-Trak Live

Attend the Fast-Trak Workshops in Charlotte, NC May 10-11, 2019 | September 27-28, 2019 | January 10-11, 2020 Receive 24 CE Credits

Course 1

Course 2

Designing Your Future

The Business of Dentistry

• Determine your career path • Develop leadership skills • Build your personal brand • Create your business plan • Financial goal setting • Debt analysis

• Financial statements • Scheduling productivity • Hygiene – lifeblood of the practice • Successful recruiting & hiring • Develop team culture • 3 ways to grow your practice

Course 3

The Marketable Patient Experience • Develop clinical diagnosis criteria • Handling objections • Making care affordable • 5 steps to treatment acceptance • Experiential marketing • Effective treatment planning

Interested? Enroll at

Dental Trade Shows Chicago Midwinter Meeting McCormick Center February 21 -23, 2019 Chicago, IL

Yankee Dental Congress January 31 -February 2, 2019 Boston Convention & Exhibition Center

Winter 2019

How I Learned To Always Invest In Myself The Thomas P. Hinman Dental Meeting March 21-23, 2019 Georgia World Congress Center Atlanta, GA

Speakers Consulting Network June 7 – 9, 2019 Kansas City, KS

Dr. Hazel Glasper

BrownGirl’s Story Martelle Cook

Scarcity: Life's Key To Abundance Vicki McManus Peterson

Spousetales...Because You Can't Make This Stuff Up JoAn Majors

LIVE West Coast Dental Team Training Front Office Rocks Time: March 29 @ 9:00 am – March 29 @ 5:00 pm 8757 Rio San Diego Drive San Diego, CA 92108

Tooth & Ale April Sluiter

Index of Advertisers ADS Dental Transitions South……………………………………………………………........................... 13 ADS Dental Transitions…………………………………………………………….................................... 19 America’s Tooth Fairy..................................................................................................................... 7 BCSZerlip.................................................................................................................................... 15 DeW.Life .........................................................................................................................Back cover Henry Schein Nationwide ............................................................................................................. 37 Hinman...................................................................................................................................... 31 Ignite.......................................................................................................................................... 35 MacPractice................................................................................................................................ 17 Orascoptic................................................................................................................................... 25 Paragon...................................................................................................................................... 21 Patterson Dental.......................................................................................................................... 24 Patterson Dental........................................................................................... Inside front cover/page 1 Wells Fargo................................................................................................................................... 9

36 Winter 2019 Dental Entrepreneur



PREPARE TO FIND AN EXCEPTIONAL DENTAL ASSOCIATESHIP! Our top 10 recommendations for a successful search: 1.

Determine your goals, objectives, and priorities (e.g., What are your financial needs? Do you want a practice ownership opportunity?)


Start early (i.e., Start 6 months to 1 year prior to availability.)


Prepare a professional curriculum vitae and cover letter (Check spelling and grammar)


Reach out to potential references (i.e., Ask their permission, confirm contact information)


Before an interview, research the practice and owners/principals (e.g., Social media, website)


Prepare questions for the interview (i.e., You are interviewing them too, you want to show interest)


Make sure the practice is ready for an associate (e.g., Do they have the space, equipment, support staff, and a sufficient number of patients?)


Ask for next steps and timing at the end of the interview


Send a “Thank You� after the interview! (Mailing a personal note is best.)

10. Align your resources. Be ready for an opportunity. (i.e., Find an attorney for employment agreement review)

To find the best dental opportunities, contact: HENRY SCHEIN NATIONWIDE DENTAL OPPORTUNITIES

866-409-3001 or Nationwide Dental Opportunities service is 100% FREE to candidates (job seekers)!


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