Dentistry North Texas
a business and lifestyle magazine for north texas dentists
Practice Management Satellite Economics
Saving Money on Healthcare
A Case for Professional Management
Dental Anesthesia Specialists
Dr. Shawn Seifikar Dentist Anesthesiologist
Tools to improve your smile.
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Dentistry North Texas
Dentist Anesthesiologist on the Go
ON THE COVER
Dr. Shawn Seifikar, Dental Anesthesia Specialists
5 BAYLOR COLLEGE OF DENTISTRY
COVER FEATURE: Dr. Shawn Seifikar has an ambulatory anesthesia practice serving the DFW area and provides anesthesia services for pediatric patients, special needs patients and phobic adult patients in both an office and hospital setting.
COVER Photos: Ray Bryant, Bryant Studios Lower right photo courtesy of Dr. Shawn Seifikar
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Two Faculty Members, Two National Organizations and a First for TMHSC-BCD
How to Maximize Your Pay-Per-Click Advertising ROI
SPECIAL ISSUE Q&A
Creating the Ultimate Dental Practice A guide for dentists
How to Avoid Being Suckered in a Protracted Buy-Out Scenario
Build a Bridge, Save a Life Helping breast cancer patients
2012 SBANT Bowlathon Have fun and raise money for the Spina Bifida Association of North Texas
THE TEXAS MEETING
Texas Dental Association Annual Session
Saving Money on Healthcare Stretching your healthcare dollars
The Case for Professional Management Reducing practice overhead
Satellite Economics Accelerate your plans for retirement
NORTH TEXAS DENTISTRY
from the publisher
Dentistry North Texas
Publisher | LuLu Stavinoha Photographer | Ray Bryant, Bryant Studios Contributing Writers | Tina Cauller, Marc Fowler, Jennifer Fuentes, Kirk Huntsman, Dr. Richard Lyschik, Joseph L. MacGregor, Bob Michaels, Terri Wilson-Gray
Welcome back to North Texas Dentistry! Spring is on the way, flowers are beginning to bloom and it is a beautiful time of year.
For this issue North Texas Dentistry hit the road as we traveled with Dr. Shawn Seifikar. Dr. Seifikar is “on the go” as he provides anesthesia for patients needing sedation for various dental procedures. He provides sedation services for special needs patients at the Ford Clinic, pediatric hospital cases at Our Children’s House at Baylor and in private dental offices for patients of all ages. We observed and appreciated his caring manner and professional technique with the patients.
In the light of current economics, nonprofit organizations are working diligently to raise funds for their programs. North Texas Dentistry is pleased to give a little press to help promote these causes. The programs featured in this issue are varied and serve different populations, so please check out the information for the Bridge Program, the Spina Bifida Association of North Texas Bowlathon and the Bryan’s House Open. We encourage you to participate and make a difference!
The practice of dentistry is forever changing. Check out different points of view on practice opportunities in The Case for Professional Management by Kirk Huntsman and Satellite Economics by Dr. Richard Lyschik. If you are an associate or considering having an associate you will
be interested in the article, Long-Term Transitions: How to Avoid Being Suckered in a Protracted Buy-out Scenario by attorney Joseph McGregor. It is important for all parties involved to have a contract. In another article, Saving Money on Healthcare by Bob Michaels, pick up some tips on reducing healthcare costs.
The Ultimate Dental Practice Special Issue is on the horizon. Check out the Q&A in this issue to find out the details. Then contact North Texas Dentistry to be part of this issue!
Update on Smiles in the Spotlight… I have had questions about the cost of presenting a case in this feature. The purpose of this feature is to share procedures with your colleagues and there is no charge. If you have high quality photographs and interesting cases, sign up today to share your Smiles in the Spotlight presentation. Thanks to all of you who support North Texas Dentistry and make its publication possible! Keep smiling and have a great day!
Lulu Stavinoha, RDH Publisher
4 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Although every effort is made to ensure the accuracy of editorial material published in North Texas Dentistry, articles may contain statements, opinions, and other information subject to interpretation. Accordingly, the publisher, editors and authors and their respective employees are not responsible or liable for inaccurate or misleading data, opinion or other information in material supplied by contributing authors. Copyright 2012. All rights reserved. Reproduction in part or in whole without written permission is prohibited.
Advertise in North Texas Dentistry For more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 or email firstname.lastname@example.org. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225
FACULTY MEMBERS NATIONAL ORGANIZATIONS and a first for TAMHSC-BCD By Jennifer E. Fuentes It was a late March afternoon when Dr. Gerald Glickman gave his incoming address as president of the American Dental Education Association in a ballroom at the Hilton Orlando Bonnet Creek.
Just days later and less than 100 miles away, Dr. Rena D’Souza was installed as president of the American Association for Dental Research during the organization’s 2012 annual session at the Tampa Convention Center.
The occasion is one for the dental school’s history books. For the first time, two current, full-time Texas A&M Health Science Center Baylor College of Dentistry faculty members simultaneously hold the presidencies of both AADR and ADEA. In fact, as D’Souza points out, it’s the first time the leaders of both highly influential dental organizations are separated by — literally — one floor, which gives her hope that AADR and ADEA can collaborate on mutual goals. So what happens now?
Chairs D’Souza and Glickman, of Biomedical Sciences and the Department of Endodontics, respectively, have served their organizations for the past two years, most recently as president-elect, so when it comes to their goals for AADR and ADEA, each of them has a sharper focus than ever before.
Dr. Rena D’Souza
AADR served as D’Souza’s ‘window to the world’ during her years as a developing faculty member. That fact may explain her zeal for strengthening its membership, reaching
out to dental schools that lack research infrastructure and developing opportunities for junior researchers to network with seasoned professionals. (CONTINUED ON PAGE 22)
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Dentist Anesthesiologist on the Go Dr. Shawn Seifikar by Tina Cauller
Dr. Seifikar provides dental anesthesia services in conjunction with a variety of dentists and dental specialists, including pediatric dentists, endodontics, periodontics, oral surgeons, and dentists with special needs patients. Anesthesia in dentistry
The profession of dentistry introduced safe and reproducible anesthesia to the world in December of 1844, a year before the state of Texas was established. In 1848, the American Medical Association gave the first of several recognitions that dentistry introduced anesthesia to the world, more than 30 years before the American Society of Anesthesiology was established. Dr. Leonard M. Monheim established the first autonomous Department of Anesthesiology within the University of Pittsburgh School of Dental Medicine in 1949 and initiated the first postdoctoral training program in anesthesia for dentists.
Dentist anesthesiologists have been providing various types of anesthesia for decades now and have many modalities available to them for patient management including oral sedation with local anesthesia and nitrous oxide, intravenous conscious sedation, 6 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
total intravenous anesthesia and inhalational general anesthesia. Their special training and expertise has made access to care a reality for a variety of patient populations that otherwise could not be attended to.
After obtaining his DDS degree from Baylor College of Dentistry in 2006, Dr. Shawn Seifikar completed a three-year post-doctoral dental anesthesiology residency program, a unit of the medical anesthesiology residency program administered through the University of Pittsburgh Medical Center (UPMC) medical education program. His education and training experiences were directed and coordinated by the faculty of the department of Dental Anesthesiology within the School of Dental Medicine and the department of Anesthesiology within the School of Medicine. His anesthesiology training consisted of medical rotations in internal medicine, critical care, chronic pain and anesthesiology at UPMC Presbyterian
Photos by Ray Bryant, Bryant Studios
Hospital, Montefiore Hospital, Magee Women’s Hospital, Saint Margaret’s Hospital, Children’s Hospital of Pittsburgh and the Center for Special Needs Patients at the University of Pittsburgh’s School of Dental Medicine.
Today, Dr. Seifikar has an ambulatory anesthesia practice serving the DFW area and provides anesthesia services for pediatric patients, special needs patients and phobic adults in both an office and hospital settings. Dr. Seifikar provides anesthesia and sedation services at the dental office, minimizing patients’ fears and ensuring that anxious children and adults will cooperate to allow the dentist to complete their dental care. Beyond the simple oral sedation or nitrous oxide typically provided in “sleep dentistry” clinic settings, deep sedation or general anesthesia is provided by licensed dentist anesthesiologists. These forms of anesthesia allow the patient not just to relax, but to actually sleep during the procedure, resulting in a safer, more comfortable and productive appointment. The safety record of advanced anesthesia services by dentist anesthesiologists is unsurpassed in today’s healthcare industry. Recent anesthesiology literature estimated the risk of anesthesia performed by a dentist anesthesiologist for dental procedures ranges from 1 in 2,000,000 to 1 in 4,000,000.
Dr. Seifikar is committed to ensuring that safety is the single highest priority during every procedure. All patients are vigilantly monitored with state of the art equipment including NIBP (NonInvasive Blood Pressure), Pulse Oximeter, EKG, and Precordial Stethoscope. Emergency equipment equivalent to that carried by the EMS (Emergency Medical System) is brought to every appointment. Dr. Seifikar provides individualized support to his partner dentists, offering thorough instruction on optimizing safety so they are prepared and confident should an emergency arise. He is involved in lecturing and provides continuing education on topics of general anesthesia, lV sedation, enteral sedation and office based medical emergencies. He holds certifications as an instructor in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).
for young patients and their parents. His specialized training in both the office and hospital setting allows the pediatric dental team to perform procedures with the patient under anesthesia with a breathing tube or laryngeal mask airway (LMA) or sedated with an open airway. TYLER’S STORY
When Tyler, an adorable three-year old, fell and bumped his front teeth, they fractured because of extensive caries on the lingual surface that had gone undetected. His dentist’s efforts to treat him with oral sedation and nitrous oxide were unsuccessful. After presenting parents with anesthetic options his dentist called on Dr. Seifikar, who came to the office to ensure that Tyler cooperated and was comfortable throughout the procedure. With the help of a topical numbing spray, an IM injection was given, allowing Tyler to achieve a dissociative state while he was still in his mother’s arms. Tyler was then gently taken to the dental operatory and connected to all monitoring equipment. Venous access was obtained and infusion of intravenous medications allowed Tyler to become sedated and sleep throughout the procedure. At the completion of procedure, IV infusions of medications were stopped and Tyler emerged from the sedative state. He was then returned to his mother just before becoming fully awake and alert, completely unaware that a separation from her had taken place. Tyler’s bright smile was restored without a single tear or any distress. “I have enjoyed working with Dr. Shawn Seifikar. I am impressed by his compassionate care of my pediatric patients. He is dedicated to the practice of anesthesia with a strong emphasis on safety.” – Dr. Mila Davis, Frisco Pediatric Dentist
The pediatric population
The fear of a protracted dental treatment and multiple local anesthetic injections can turn an otherwise cooperative child into a frightened and inconsolable patient. Early negative experiences can lead children to have anxiety about seeing the dentist and many children will carry these fears into their adult lives, compromising their comfort with even routine preventive care. Anesthesia can be a helpful adjunct to treatment for fearful children.
Dr. Seifikar is a staff dentist anesthesiologist at Our Children’s House at Baylor and has been working closely with the Baylor College of Dentistry’s Pediatric Dental Department. Having hospital privileges enables him to provide his anesthesia services in a JCAHO-accredited surgical center. He also provides anesthesia services in the pediatric dental office setting, and finds that the familiar surroundings support optimal comfort and confidence
Dr. Seifikar performs a thorough evaluation and physical exam on every pediatric patient. He explains the anesthesia plan to the parents and answers any questions prior to start of the procedure. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Photo courtesy of Dr. Shawn Seifikar
Fearful adults and adolescents
For particularly fearful or claustrophobic patients or those with hyperactive gag reflex symptoms or difficulty getting numb, intravenous sedation can a helpful solution. As Dr. Seifikar explains, “Intravenous sedation offers fearful patients a way to get the dental care they need and have a relaxed, pleasant experience. One of the wonderful features of IV sedation is its ability to be customized to the specific desires of both the patient and the treating dentist. Patients can be awake and relaxed or sedated and dreaming of their favorite vacation.”
All types of dental care, including restorative, fixed, exodontia, endodontic therapy, implants and cosmetic dentistry can be performed with office based IV sedation.
Photo by Ray Bryant, Bryant Studios
Dr. Seifikar monitors all patients with state-of-the-art monitoring equipment, utilizing NIBP, pulse oximeter, EKG, end tidal CO2 and precordial stethoscope.
Besides the extra comfort it provides, office based dental anesthesia affords appealing convenience for patients with time constraints who need extensive treatment. With IV sedation, multiple visits can often be condensed into a single appointment, so patients don’t have to miss work, school, or other important activities to come to several appointments and can be treated right in their own dentist’s office. The dental team has an expanded window of time to complete multiple procedures safely, and the added efficiency enhances productivity.
For particularly fearful patients or those with hyperactive gag reflex or difficulty getting numb, intravenous sedation can be a helpful solution.
8 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Photo by Ray Bryant, Bryant Studios
Laura, a business professional in her mid-50s, had painful, traumatizing dental experiences as a young child that left her with devastating emotional scars. Her reluctance to visit the dentist caused her to avoid routine dental treatment. She typically waited until she was in severe dental pain to seek help and as a result required endodontic treatment. Recently, she was referred to an endodontist who consulted with Dr. Seifikar to complete her dental team. As her husband explains, “Laura requires anxiety-relieving medications prior to any dental appointment and due to her anxiety and phobia, she typically does not sleep the night before her dental appointments.” In her pre-operative consultation with Dr. Seifikar, he observed that she was extremely anxious. After explanation of the anesthesia plan and some reassuring discussion, Dr. Seifikar accompanied Laura to the dental operatory where all monitors were connected and IV access obtained. Anxiolytic and sedative medications were administered and titrated carefully, allowing Laura to sleep comfortably for over three hours while her endodontist completed root canal therapy on two molars. Laura was relieved that her procedure was completed without having any recall. She was recovered and monitored for twenty minutes and then dismissed. Her positive experience has given her the confidence to seek routine dental care in the future.
One of the wonderful features of IV sedation is its ability to be customized to the specific desires of both the patient and the treating dentist.
Patients with special needs
For patients with autism, speech delay, Alzheimer’s or dementia, ADD/ADHD, Down syndrome, cerebral palsy, or other physical or mental disabilities, finding access to dental care can sometimes be a daunting challenge. These patients sometimes have complicated health histories or special behavioral needs and, as a result, caring for them requires special considerations beyond an ordinary approach to dentistry. It also demands exceptional compassion, patience and understanding. Because many dentists do not feel confident in their ability to effectively or efficiently provide care to the special needs population, these patients are often turned away, even for routine hygiene. For this population, dental anesthesia is often the only realistic avenue to receive safe, comfortable dental care. “Dr. Seifikar is a professional and a highly skilled anesthesiologist. He is dedicated to my patients and their needs. I work with many special needs patients who have complicated health histories and behavioral needs. Dr. Seifikar handles this group of patients and others with a high level of care. Patients and their families love his attentive and compassionate nature. I would highly recommend him for any patient care needs with sedation.” – Dr. David Sorokolit, Fort Worth General Dentist www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Photos by Ray Bryant, Bryant Studios
John is a healthy 61-year old man born with an intellectual disability that affects his cognitive function and daily living skills. His functional level makes it a challenge for him to maintain a good regimen of daily brushing and flossing. He lives in a group home and his sister, who is his guardian, accompanies him to doctor visits to help him communicate and serve as decision-maker. Because it is difficult for John to hold still and keep his mouth open for a dental exam, it took years for him to find a regular dental care provider. As a result of inconsistent hygiene and delayed restorative care, nearly a dozen of his teeth had been extracted. By the time his family finally found a dentist that serves patients with special needs, dental neglect had taken a significant toll on John’s oral health. Dr. Seifikar, who treats special needs patients in a dental office setting, has been working with John’s dentist for over two years taking care of special needs patients similar to John.
On the day of appointment with Dr. Seifikar, John’s medical history and medications were reviewed with his sister. A focused examination was completed by Dr. Seifikar in the pre-operative area and then John was wheeled to the dental operatory. Monitors were placed and venous access obtained. Anxiolytic medications were administered, allowing John to cooperate with x-rays and oral examination, which revealed the need for two restorations and a deep cleaning. Shortly after, an induction dose of a general anesthetic drug was administered and a Laryngeal Mask Airway (LMA) was placed and connected to the breathing circuit. John was monitored closely and remained stable throughout the case. At the completion of the procedure, John slowly emerged from a state of general anesthesia and was transported to the recovery area to be with his sister. John’s first experience was a complete success and he is comfortable coming back to see Dr. Seifikar once a year.
Dr. Seifikar is placing a flexible LMA after induction of anesthesia. The LMA allows the patient to have an airway throughout the procedure connected to a breathing circuit. Synergy of teamwork
Dr. Seifikar provides his anesthesia services in conjunction with a variety of dentists and dental specialists, including pediatric dentists, endodontists, periodontists, prosthodontists, oral surgeons, and dentists with special needs patients. Partnering with the dentist anesthesiologist creates synergy and expands the scope and capabilities of the practice, enhancing patient loyalty and boosting productivity.
Since Dr. Seifikar was a practicing dentist before becoming a dentist anesthesiologist, he is intimately familiar with the intricacies of dental procedures and can orchestrate anesthesia that perfectly anticipates each stage of the procedure. Recognizing which portion of the procedure is the most stimulating allows him to bump the level of anesthesia at precisely the right time to keep the patient optimally comfortable.
When Dr. Seifikar brings his dental anesthesia services to a private practice, he comes into the office as a colleague. Dentists appreciate his mindful and courteous approach to teamwork. “I am there to render a service and serve as part of a team,” he notes, “but I recognize that I am a guest in the office. I bring what I need and I clean up when I leave. The patient comes away with a positive experience and practice loyalty is reinforced.”
Special needs patients sometimes have complicated health histories or special behavioral needs and dental anesthesia is often the only realistic avenue to receive safe, comfortable dental care.
10 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Dr. Seifikar is a professional member of American Society of Dentist Anesthesiologists, Society of Pediatric Anesthesiologists, North Texas Dental Society and Dallas County Dental Society. n For more information or to schedule an appointment please call (972) 591-3355 or visit www.daonthego.com.
How to Maximize Your Pay-Per-Click Advertising ROI
by Marc Fowler
We hear from a lot of dentists that they’ve tried PPC (pay-perclick) advertising in the past and it didn’t work. That’s not surprising since most PPC is done poorly. What generally happens is a few generic, boring ads are created, the clicks/visitors are taken to the home page of the practice’s website, a daily budget is set, then the campaign is put on autopilot and forgotten.
This approach will always generate lackluster results, particularly here in North Texas. We work with dentists across the U.S. and a handful in Canada and the online advertising market in North Texas is one of the most competitive we have worked in. The main reasons for this are the number of dentists coming out of Baylor that want to stay in the area and more local dentists allocating their marketing dollars to the internet. Given this competitiveness, North Texas dentists have to work harder to achieve online success than their counterparts in other areas of the country. Why most dental PPC campaigns fail
Most online advertisers make the mistake of sending visitors to the home page of their website. Others who are more sophisti12 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
cated know to at least send them to the page of their website that matches the search term (for example a search for “dental implants” sends them to the dental implants page of the practice website).
There are problems with both of these approaches. First, if the visitor was searching for dental implants and ends up on the home page, they may get distracted before they ever get to the page about implants. Even if they were sent to the implants page, there is still all the navigation to the other pages of the site and they could again, get distracted.
Compounding the problem, most dental websites don’t have a clear call to action – they don’t lead the visitor to the desired action (setting an appointment). In many cases, you have to hunt to even find a phone number. Utilizing landing pages for maximum ROI
If you are serious about maximizing your advertising dollars, you need to create custom landing pages for each service you are promoting. If you want to focus on Invisalign, implants and
sedation, then you should have a separate landing page for each of them.
This provides the searcher a consistent flow from the search term they type in, to the ad they see, to the page they land on after clicking the ad. Additionally, having relevant landing pages will improve your PPC campaign’s quality score, which results in paying less for each click.
Here are a few landing page best practices:
• Have a compelling headline. You only have a few seconds to grab their attention before they hit the back button.
• Keep the copy focused. Only talk about the one service that page is focused on
• Have a clear call to action. Make it very easy for them to determine next steps.
• Have a compelling story. Why they should call you vs. the next dentist in the Google results.
• No navigation on the page. Don’t give them the option of clicking to other unrelated pages.
• Have a strong offer. Give them an incentive to choose you.
Hold your PPC campaign accountable
In addition to testing, you should also have tracking methods in place. Some testing is built into Google and Bing’s PPC platforms, for example – click-thru rate (CTR) tells you which of your ads produces the highest percentage of clicks.
The challenge with online dental advertising is that unlike many industries, your primary call to action is a phone call to your office. So, there is often no actionable event that takes place on the website – like filling out a form or clicking a buy button. This makes tracking a bit more challenging.
This is where call tracking numbers come into play. These are phone numbers that are assigned to different landing pages so you can tell which page(s) produce the most calls. The calls can be recorded so you can go back and listen to how the phone was answered, most commonly asked questions, whether they were a good lead or simply a tire kicker, etc.
The next step is to calculate the ROI of your PPC campaign by looking at variables such as; cost per click, cost per lead, case acceptance rates, average value of a patient, etc. We’ll save that for a future article. n
Marc Fowler is President of Bullseye Media, LLC, a McKinney, TX based full-service digital marketing agency that specializes in helping dentists leverage the internet to grow their practices. He can be reached at (214) 592-9393, email@example.com or by visiting OnlineDentalMarketing.com.
• Only use graphics that support your desired outcome. Forget the stock photos of smiling models. • Make sure your core message and call to action are above the fold. They shouldn’t have to scroll down the page.
Assume nothing – Test everything
Just because you believe a certain offer sounds irresistible, or you love a headline, doesn’t mean your prospective patients will. Testing takes the guesswork out and lets your target audience vote with their clicks and phone calls.
A/B split testing is where you test two variables against each other. For instance, you send half of your visitors to a landing page with headline 1 & the other half to a landing page with headline 2. Once you have a statistically significant number of visitors, you determine the winner. The winning headline then becomes your control. You can continue to test it against another headline or test another variable such as the offer. The key is to only test two variables at a time so you know which one made the difference.
NORTH TEXAS DENTISTRY
Helping dentists buy & sell practices for over 40 years. AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.
Masoud Attar, D.D.S. has joined the practice of (University of Minnesota 1991)
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Toni P. Hamilton, D.D.S. has acquired the practice of (University of TX Health Science Center - Houston 2007)
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AFTCO is pleased to have represented all parties in these transactions.
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Dentistry North Texas
a business and lifestyle magazine for north texas dentists
Creating the Ultimate Dental Practice
Putting it all together
Q: What is the purpose of this issue?
A: North Texas Dentistry wants to develop a handbook for the dental community to use as a guide to the many facets of the successful practice. Creating the Ultimate Dental Practice will present leading companies and individuals in the community and will be a reference doctors refer back to.
Q: Who should be part of this guide?
A: Businesses that sell products and provide services to the dental profession will be featured in the issue.
Q: How will the guide be formatted?
A: The issue will be divided into sections to showcase the specific industries that impact dentistry. The categories are: The Building (real estate, architecture, construction and design), The Finances (banks, accounting, wealth management, insurance), The Equipment (dental supplies, specialty equipment), The Practice (personnel, marketing, management, sales and transitions), The Technology (computers, software, networking, audiovisual) and The Laboratory (full service, CAD/CAM, implants).
Q: What marketing options do I have?
A: Print advertising and Custom Profiles will spotlight Individuals, Companies or Products. You may supply your own content and photography or let the team of North Texas Dentistry assist you for an additional charge.
Q: What other editorial will be part of the guide?
A: The editorial team of North Texas Dentistry will contribute a feature for each section which will include input from those individuals participating in the issue.
Q: What is the deadline for this Special Issue?
A: The last day to reserve space in this special issue is April 27, 2012. Contact firstname.lastname@example.org or call LuLu Stavinoha at (214) 629-7110.
Creating the Ultimate Dental Practice North Texas Dentistry Special Issue
Long-term Transitions: How to Avoid Being Suckered in a Protracted Buy-out Scenario By Joseph L. McGregor
The horror stories seem to be piling up.
An increasing number of dentists coming through my office are limping away from a lengthy associate position that was initially pitched under the promise of purchasing all or some of the practice after a few years of service, but who eventually became disenchanted or disenfranchised during the process. Overwhelmingly these are young practitioners. Typically each started work at a practice where the owning dentist promised the option to “buy in” after five years, but the existing dentist realized five years later that he had ten more years of
16 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
earnings to generate before retirement became a realistic option, so the “buy in” timetable got pushed back. Or, just as frequently, once year five rolled around, the associate was shocked to learn the sticker price, a price based on value the associate was either significantly or solely responsible for creating. And so far, each case could have been avoided with better planning and a better understanding of the dynamics of a long-term transition.
Maturing doctors often introduce a young associate into the practice to accommodate increasing production, generate additional revenue, and hopefully shorten time to retirement. Frequently the doctor instills incentive in the incoming associate to perform at the highest level by either directly or indirectly suggesting that the incoming associate will have the opportunity at some point in the future to buy into the practice, or buy the existing doctor out.
On its face, this arrangement is ideal. It allows both dentists to learn each other in order to better gauge “fit,” allows the incoming associate to get familiar with the practice and its patients, and minimizes the risks attendant to most practice transitions. Moreover, it is often the case that the existing dentist is not at a point where selling is desirable, nor is the incoming associate fitted with resources enough to purchase or start a practice.
While this seems an ideal scenario, rarely is this transaction planned thoroughly enough to avoid the natural pitfalls inevitable in this economic arrangement.
It should first be noted that there is a fundamental question as to the nature of this economic transaction. The existing dentist is introducing an associate to generate additional revenue, and thereby enhance the practice’s future value. The incoming associate, however, will likely purchase that future value, and therefore has an incentive to keep that future value lower. What then, is the associate buying: the value that he himself creates, or the value of the practice representing the production and contribution of the existing dentist?
The answer to this question is not nearly as important as raising it in the first place. Essentially, there is not necessarily a right answer; failing to adequately address the question, however, is clearly the wrong approach. When reviewing this issue with my clients, it is evident that simply initiating this conversation with the existing doctor seems to be the most significant roadblock. Most associates either do not know what questions to ask, or are nervous that asking what seem like awkward questions will fracture the relationship before a single drill starts spinning. Both doctors should realize, however, that it is in everyoneâ€™s financial interest to thoroughly outline expectations.
IMPACT LIVES THROUGH THE ART OF DENTISTRY AND START OUT DEBT-FREE
First, a timeline must be established. The easiest timeline is a fixed one where a purchase may occur after x many years. It is arguably more advisable to install â€œtriggers,â€? where a purchase may occur after certain pre-established benchmarks are achieved.
With that understanding, it is almost mandatory that the doctors order a practice evaluationâ€”the more detailed the better. From there, it is advisable to enter into a memorandum outlining how any future evaluations will be updated. It is much easier to determine the future value of the practice by establishing the criteria in the present.
The parties should then consider entering into a pro forma purchase agreement encapsulating these understandings. Itâ€™s important that both parties have the option to walk away at any time, but the arrangement must also allow the existing dentist to withdraw from the relationship without the associate wasting the years put into building the practice, and not allow the associate to withdraw and vacuum clients away and force the existing dentist into restarting the process. Conversely, there should be mutually beneficial provisions that provide for death, disability, and accelerated retirement.
Once an agreeable pro forma purchase plan is negotiated, the next step is to enter into an associate contract that contem-
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plates the arrangement in place. Associate employment agreements should protect the â€œat willâ€? status of the associate, but also feature compensation and performance standards that reinforce the planned transition. This should be balanced with a healthy covenant not to compete.
The long-range transition can be an ideal practice exit strategy so long both the existing doctor and incoming associate have frank, open, and honest creative discussions to ensure fairness. n
Joseph L. McGregor is an attorney based out of Dallas, Texas who focuses on dental business transactions, particularly practice acquisitions. Mr. McGregor is a graduate of Brigham Young University Law School.
NORTH TEXAS DENTISTRY
BUILD A BRIDGE,
SAVE A LIFE T
by Terry Wilson-Gray
he concept of The Bridge Breast Network was born in 1992 and was nurtured by a group of breast cancer survivors who met in the office of Dr. Sally Knox, M.D., a breast specialist at Baylor University Medical Center in Dallas, Texas. Dr. Knox often donated her services to her patients who lacked the resources and insurance coverage for breast cancer treatment, but funds were needed to cover the costs of facilities, labs, imaging, and oncology services.
Twenty years later, the non-profit organization that was started because of one doctorâ€™s vision, has touched the lives of over 130,000 North Texans. Today, the medical network includes over 200 providers, medical facilities, and community partners. During the 2010 - 2011 fiscal year, The Bridge Breast Network medical providers donated over $5.6 million in services to The Bridge clients. What started out twenty years ago as a professional courtesy, is now an extensive medical network of dedicated professionals working together to provide uninsured women in 16 counties with life-saving breast cancer and breast health services. The Numbers Are Growing
Cancer is a growing health concern in the United States, and the latest data shows breast cancer is becoming a critical health problem in Texas. The 2003 - 2007 Texas Cancer Registry shows that breast cancer led cancer diagnoses among women
18 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
in Health Service Region 3 at a rate significantly higher than the state average. Health Service Region 3 includes the Dallas/Fort Worth area. There is a need for comprehensive mammography and follow-up programs to ensure women receive regular screenings and that those receiving a positive diagnosis receive treatment services in a timely manner. The Bridge Breast Network has provided breast health education and awareness, access to breast cancer diagnostic and treatment services and compassionate patient navigation services to over 130,000 North Texas residents with Health Service Region 3 for 20 years.
Access to healthcare is essential to our lives and community. Preventative and routine healthcare access allows women and their families to stay healthy and take responsibility for their well being. However, for individuals who may lack knowledge and/or access to financial resources, maneuvering the healthcare maze is challenging and many times discouraging. The Bridge Breast Network provides vital services needed to ensure individuals receive medical care and empowers them to make better healthcare choices. Services
In 1993, The Bridge Breast Network served 50 clients with diagnostic services and breast cancer treatment services. By
2002, the number of clients had grown to 430 served. In 2011, The Bridge Breast Network served 2373 clients. 2011 statistics show that nine clients between the age of 13 and 19 were served by The Bridge Breast Network; clients 65 and older totaled 36; and the majority (1388 of 2373) of clients served by The Bridge Breast Network were between the ages of 40 and 49. These 2373 clients received services that include mammograms, sonograms, breast MRI, biopsies, surgery, medical oncology, radiation oncology, and follow-up. Vision
Women and men with breast cancer who lack financial resources will have access to medical services and a quality client experience. This is made possible through our expansive and growing provider network, an increased operating budget, a cohesive marketing plan, and a sound fundraising strategy. Mission
To save lives by providing access to diagnostic and treatment services for breast cancer to low income, uninsured, and underinsured individuals. Why Support Matters
For every dollar donated, The Bridge Breast Network clients receive nearly 10 times that amount in medical care. Hundreds of physicians and medical facilities specializing in breast cancer
treatment either volunteer their services or drastically reduce their fees in order to serve The Bridge Breast Network. In 2011, a grant for nearly $1 million from the Cancer Prevention and Research Institute of Texas (CPRIT) was awarded to The Bridge Breast Network. This grant will be used to provide education, screening, and diagnostic services in six counties. Also in 2011, grants totaling $632,693 were awarded to The Bridge Breast Network by Susan G. Komen for the Cure Dallas, Greater Fort Worth, and North Texas Affiliates. These dollars will provide diagnostic and treatment services in eight counties. Build A Bridge, Save A Life
In 2012, The Bridge Breast Network announced plans to go green! The 20th anniversary was celebrated with A Night In The Emerald City at the annual Fly Away With The Bridge fundraiser in February. Along with the celebration of donor generosity, and the dedication of medical providers, volunteers and staff, The Bridge Breast Network is offering an invitation to those who can help grow the current donor base, and sustain fundraising efforts by becoming a part of the 20 x 20 Emerald Club: find 20 people to donate $20/month for 12 consecutive months. The goal of the campaign is $600,000 and an extended donor base for future generations of North Texans. For more information, please visit www.bridgebreast.org or contact Executive Director Terry Wilson-Gray at (214) 821-3820. n
Protection is our Business Disability Life Health Long Term Care Malpractice
Our only business is working with TDA Members and their staffs. We are committed exclusively to servicing TDA membership’s needs. Let us review, compare and provide options for your coverage. Bob B b Michaels, Mi h l CLU Local Associate 214-696-5103
www.tdamemberinsure.com 1-800-677-8644 www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
2012 Itâ€™s time for the Annual Bowl-A-Thon to benefit the Spina Bifida Association of North Texas. We invite you to have fun and help support the great things SBANT does for kids and families in our community!
This is a great opportunity to build camaraderie with your co-workers, get competitive with your friends, and entertain your family â€“ all while supporting a great cause!
pina Bifida is the most common permanently disabling birth defect in the United States. It occurs when the spinal cord fails to close during the first months of pregnancy. Spina Bifida causes abnormalities of the brain and spine resulting in life-long disability. More than 250,000 Americans live with Spina Bifida every day.
SUPPORTING A GREAT CAUSE
The goal of Spina Bifida Association of North Texas (SBANT) is to raise awareness of Spina Bifida and give children, families and adults the tools they need to be advocates for themselves, independent and active individuals with Spina Bifida, and to have a strong, supportive community. The organization promotes the prevention of Spina Bifida and enhances the lives of all affected by SB.
The activities sponsored by SBANT help make it possible for families with chil-
dren to gather and exchange ideas. It is especially beneficial for children with SB to meet other kids like them.
In addition to hosting a holiday party in December, SBANT holds an Easter Egg Hunt and a picnic for families with younger children during the year. Parents frequently get together and long-lasting friendships have been forged between parents and children.
Each June, SBANT sponsors a six-day residential camp at Camp John Marc, a beautiful, accessible camp located in Meridian, Texas, about 75 miles south of the DFW area, for children with Spina Bifida ages 8 to 15. Doctors and nurses from the SB clinic at Texas Scottish Rite Hospital for Children organize and supervise the medical care provided at camp. The campgrounds have been designed to be completely accessible, and are home to a state-of-the-art thera-
20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
peutic camping facility with a specially trained staff. Days at camp are filled with swimming, boating, fishing, horseback riding, arts and crafts, photography, dance, singing, sports and games and other fun activities. This is an excellent opportunity for parents to allow their child with SB to experience greater independence, and to meet other kids facing the same challenges.
SBANT also sponsors two family camps each year at Camp John Marc. In the spring, our Spanish-speaking families gather for a weekend of fun, relaxation and sharing. Some child care is provided so that parents can meet and discuss important health and other issues related to the challenges of life with SB.
In the fall, SBANT holds a weekend camp geared for families with children under eight years of age. Fishing, hiking, arts and crafts are offered.
Saturday April 28th 11:00am to 3:00pm
International Bowling Center & Museum in Arlington, Texas
TWICE THE FUN
This spectacular event includes both the bowling and museum facilities. Experience the history of bowling in a fun, interactive museum and bowl in a state-of-the-art professional training facility, all while raising funds to support the programs and services of SBANT!
TO START OR JOIN A TEAM REGISTER ONLINE AT: https://spinabifidant.myetap.org/fundraiser/ sbantbowlathon2012/
Fundraising Goals: Individual $125 or Team $625 Door prizes, prizes for top fundraisers and more! Rewards for meeting and exceeding goals!
Early Bird Registration: Pay registration fees by April 1st and get a bonus door prize ticket! $25 registration fee per bowler. Includes event t-shirt, lunch, one game of bowling (more if time and space allows) and goody bag.
International Bowling Center & Museum 621 Six Flags Drive in Arlington, TX
For location information and maps, visit bowl.com/itrc and bowlingmuseum.com
This fundraising event includes: n Family and Team Bowling n Entertainment & Activities for all ages n Lunch n Awards & Prizes for Top Fundraisers & Team Goal Accomplishment n Door Prizes for Participants
WE WELCOME YOUR DONATION
“I found Structures and Interiors’ staff of construction professionals extremely easy to work with. Structures and Interiors did a wonderful job designing my office and building it out in an amazingly short time period for this type of detailed construction. I am very pleased with their work and their always pleasant attitudes and eagerness to get things right and in the exact way I wanted them.”
You can also simply donate to the BowlA-Thon goal directly or search for participants and donate toward their goals. Sponsorships and in-kind donations are needed as well! SBANT appreciates and acknowledges all levels of donation. As a 501(c)3 non-profit charity, your donation is tax deductible. Make your payment securely online via our website or mail your check directly to our office at 705 W. Avenue B., Suite 409, Garland, Texas 75040. Without the support of companies and individuals, we would not be able to fulfill our mission. We welcome both corporate and individual volunteering. As an organization that relies on volunteers for most of its programs and services, we need you! Visit the website to explore opportunities to volunteer and find more information:
- barrie barber choate dds, msd, pa pediatric dentistry
www.structures-interiors.com 817.329.4241 www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
(CONTINUED FROM PAGE 5)
Research and education are inextricably linked to the practice of dentistry,” D’Souza says, which brings her to another goal: seizing the opportunity to work with Glickman, a longtime friend and colleague, on key issues pertinent to both organizations.
Most recently, D’Souza oversaw the organization of the 2012 AADR Annual Meeting and its activities. During the four-day session, she had the opportunity to introduce some of the organization’s newest initiatives. Dr. Gerald Glickman
It’s a Monday in mid-February and Glickman, on the heels of a two-day read-
justment following his return trip from Saudi Arabia – where he was one of the featured speakers at the King Saud 14th International Dental Conference – is back in full swing in the college’s endodontics department.
On the cabinet above his desk is a diorama that reads “Landscape of Learning: 2013 ADEA Annual Session and Exhibition.” It bears the image of a tree, and above its branches, in the shape of an arch, are the words ‘reflection, interprofessional education, assessment and innovation.’ Glickman elaborates on its meaning. “My focus is two-fold,” he says. “The focus essentially will be on lifelong learning and self-reflection. With current students, this
means how do we instill in them the lifelong skills they’ll need once they leave?
“We as a profession are concerned about learning once students leave their institutions. We want to provide the tools that motivate students to continue to learn.”
The second focus: working to create vibrant, proactive ADEA student chapters. This means establishing chapters at dental schools without them and further developing those that are already in existence. Currently, TAMHSC-BCD has several dental and dental hygiene student delegates to ADEA.
“Since students represent the majority of the membership of ADEA, we really want to focus on how we can make ADEA more user-friendly for them and help guide them towards careers in leadership, academics and research,” Glickman says. n Jennifer Eure Fuentes is a communications specialist at Texas A&M Health Science Center Baylor College of Dentistry. A 2006 graduate of Texas Christian University, she has worked in the communications and editorial field for five years.
Founded in 1905, Baylor College of Dentistry in Dallas is a college of the Texas A&M Health Science Center. TAMHSC-BCD is a nationally recognized center for oral health sciences education, research, specialized patient care and continuing dental education. The TAMHSC serves the state as a distributed, statewide health science center that is present in communities throughout Texas.
22 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
THE TEXAS MEETING Bigger and Better in Texas!
142nd Annual Session of the Texas Dental Association Henry B. Gonzalez Convention Center, San Antonio, Texas
May 3-6, 2012
he 2012 TEXAS Meeting is fast approaching! Join your fellow Texans from all over the state as they head to San Antonio for the largest dental meeting in Texas! In the Lone Star state we have become accustomed to the phrase “Bigger and Better” and that is no exception when it comes to the TEXAS Meeting. You and your staff will have opportunities to choose quality continuing education, network with colleagues, and shop at the largest exhibit hall in Texas. Treat yourself and your staff to an exciting and rewarding three days in beautiful San Antonio for the TEXAS Meeting. The Council on Annual Session has planned an incredible dental meeting for you. At the TEXAS Meeting you and your dental staff can fulfill all of your state CE dental requirements. Take advantage of one of your incredible TDA member benefits – no conference pre-registration fee for you and your staff. If you are not a TDA member, come see what the TEXAS Meeting is all about for a one-time only special conference pre-registration fee of $75, instead of $995 – details available at texasmeeting.com.
The TEXAS Meeting is proud to present a wide array of 95 nationally recognized speakers. The speakers will present dental seminars, certification classes, and participation workshops for the entire dental team. Topics will include Cosmetics, Restorative Dentistry, Pediatrics, Implants, Lasers, Periodontics, Endodontics, Oral Surgery, Occlusion, Practice Management and much, much more. But the fun is just starting.
More than 350 exhibitors have been contracted and are eager to share information on “Bigger and Better” dental products and services. The TEXAS Meeting exhibitors provide a variety of meeting specials and the latest technology for you and your dental practice. The bustling exhibit hall will have many activities taking place during the meeting. Visit the special artist who digitally sketches a portrait of you and your friends, bid on a unique item at the DENPAC Silent Auction, learn about your practice opportunities with TDA Perks, and check-out the many charitable events supported by the TDA Smiles Foundation. After your classes and workshops, unwind at the Thursday and Friday happy hours
where you will enjoy complimentary beer and wine in the exhibit hall from 4:30 p.m. to 6:00 p.m. Thursday evening showcases the famous “Texas Party” with live entertainment from the band “The Klocks”. Come kick up your heels with complimentary food and beverages at this social event, plus a cash bar. Remember your TEXAS Meeting badge is your entry to the party.
What a great festive agenda set in the backdrop of the scenic San Antonio Riverwalk and the historical Alamo. Come enjoy the “Bigger and Better” TEXAS Meeting, May 3-6, 2012!
Please visit texasmeeting.com for more details or contact Donna Musselman, email@example.com, Ann Pargac, firstname.lastname@example.org or call (512) 443-3675. n
NORTH TEXAS DENTISTRY
Saving Money on Healthcare
By Bob Michaels, CLU
s a result of rising medical costs and health insurance premiums, many have increased their deductibles and coinsurance or eliminated such features as office or prescription drug copays. Healthcare Reform has not changed the cost curve, and the uncertainty about national healthcare will probably not be resolved until after the 2012 elections. What are some options that may help with potential costs and also save you some money? Here are some you may want to consider: Qualified High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)
This is a health insurance policy that pays medical expenses, including prescription drugs, only after the deductible has been met. These plans are designed to give you a lower premium while protecting you from catastrophic claims. As a result of the Patient Protection and Affordable Care Act the following mandated benefits are now included: no lifetime benefit limits (based on dollar amounts); first dollar preventive care for essential benefits – including physicals, well woman exams, well child care, and immunizations – all without an office visit copay or deductible if they are done in-network; no restricted annual limits (on the dollar value); and dependent coverage up to age 26.
Anyone under age 65 is eligible to establish an HSA, provided there is a Qualified High Deductible Health Plan in place, and no coverage under another health plan. And although you are not required to contribute the maximum amount per year, or even make a contribution, this is almost too good an opportunity to pass up. For 2012, the maximum contribution allowed is $3100 for an individual plan and $6250 for a family plan. Contributions not used for medical expenses during the year can be rolled over to the following year – it’s not “use it or lose it” as it is in healthcare flexible spending accounts. Persons between the ages of 55 and 65 can make additional “catch up” contributions of up to $1000 a year for 2011 and later.
24 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Contributions can be made as late as April 15th of the following tax year.
What you don’t use from the HSA each year is yours to keep. The balance continues to grow on a tax-sheltered, compound basis. Once you reach age 65, the account can basically be used like a traditional IRA, but is not subject to distribution limitations or penalties and distributions for eligible expenses are still tax free. And, just like an IRA, upon death the funds in the HSA can be transferred to a beneficiary. If the beneficiary is a surviving spouse, the transfer is tax-free. As with any tax issue, always check with your CPA or tax professional to make sure this makes the most sense for your particular situation. Critical Illness Insurance
Critical Illness insurance pays a set amount to the insured when a qualified event occurs. Critical Illness insurance typically provides the full policy benefit in a lump sum payment upon diagnosis of a critical illness listed in the policy, such as heart attack, stroke, cancer, Alzheimer’s disease, or organ transplant.
There is no coordination of benefits with other health or disability insurance. The money can be used to pay medical bills, cover a mortgage, or anything else you want. You are in complete control of how the funds will be used. Critical Illness insurance bridges the gap between the health insurance policy and the actual expenses incurred. Premiums for Critical Illness insurance are normally between $25 and $50 per month for around $25,000 of coverage, so it is a way to provide some additional protection at a low cost. Discount Prescriptions & Other Savings Plans
Everyone likes to save money. You can maximize your savings by using discount programs offered through most pharmacy chains or through professional associations like the TDA. When you purchase prescriptions, simply visit a participating PPO dis-
count pharmacy (most major chains participate) and pay the discounted amount on the spot, either by debit card or check directly from your HSA. For greater savings, use the bulk priced Rx mail service, use generic or over-the-counter meds or pill splitting when appropriate to get more meds for the dollar.
There are other discounts cards available that for a low monthly cost, gives you access to discount medical programs offering significant savings from healthcare providers across the nation. These include: vision products and services (including glasses, contacts and even LASIK surgery), chiropractic care, lab and imaging services, diabetic supplies, vitamins and many other products. Also offered through professional associations like the TDA, is the Teladoc service, which is a national network of board certified physicians who use electronic health records, telephone and online video consultations to diagnose, recommend treatment and write short-term prescriptions when appropriate. Teledoc physicians are available 24 hours a day. There are no waiting periods or restrictions on these plans and for less than $20 per month you can have access to a range of discount products and services for the whole family. This is also an inexpensive employee benefit so keep it in mind for your staff.
supplementing this with other types of coverage and discounted products, you can save on your premiums and still be covered in the event of a big claim.
If you would like to receive more information on any of these programs for you, your family, or office staff, please contact me at (214) 696-5103 or email me at bmichaels@TDAmemberinsure.com or visit our website at www.TDAmemberinsure.com. n
Bob Michaels, CLU has been in the insurance business in Dallas, Texas for over 40 years. He has been an Associate with the TDA Financial Services Insurance Program for the last eight years. Bobâ€™s scope of operation in the TDA Insurance Program includes life, health, disability income, employee benefits, long term care, and malpractice insurance.
Like most things, there is not one right answer. However, there are ways to save money on premiums and health care expenses. Insurance is about managing risk. By increasing your deductible, or utilizing an HSA with a High Deductible Health Plan, and
For more information, visit www.TDAmemberinsure.com. You can contact Bob at bmichaels@TDAmemberinsure.com or call (214) 696-5103.
Dentistry North Texas
Provided by Leading Doctors in North Texas n High Resolution Photography n Step by Step Details of Treatment For more information on sharing your expertise in a future Smiles in the Spotlight contact
SMILES IN THE SPOTLIGHT CASE PRESENTERS DO NOT PAY A FEE FOR INCLUSION IN THIS FEATURE
NORTH TEXAS DENTISTRY
The Case for PROFESSIONAL
MANAGEMENT by Kirk Huntsman
these issues take is heavy. No wonder most dentists report working chairside less than 34 hours per week—they’re exhausted!
ver since the dental profession began setting up shop in solo practices over 100 years ago, doctors have wrestled with the never-ending and exhausting demands of running a successful practice. Not only do modern dentists bear the legal and ethical burden of providing the very best possible clinical care for their patients, but they have all of the peripheral practice issues to deal with — hiring and retaining the right staff, compensation issues, insurance company interference, managed care inroads, marketing, regulatory compliance, web site development, facility issues, employee conflict, computer systems, continuing education, practice financing, collections, federal and state taxes, case acceptance, associate concerns, rising operating costs, lab work that is substandard, equipment maintenance and repair, embezzlement, etc. The list of ongoing responsibilities and concerns for the sole practitioner is practically endless, and the toll all
26 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
And let’s face it, dental practice today is far more complex than it was even 10 or 15 years ago. Costs are higher; fees are under constant pressure; insurance plans more diverse and difficult to understand; employees more demanding; regulatory compliance more daunting; and patients more difficult. And now with the proliferation of well-funded corporate DMSOs, competition is intense and patients more scarce. With all these headwinds, it’s no wonder so many dentists are looking for real solutions.
One solution that has gained considerable notoriety of late is the corporate-sponsored DMSO model. Love them or hate them, these organizations present a compelling value proposition to a profession that is stressed out and worn down by all the rigors of solo practice. Essentially, they offer the promise of relief from all the non-clinical concerns that solo doctors face on a daily basis. In the DMSO model, doctors focus on clinical care and treatment, while other business related tasks and obligations are delegated to business professionals. When this model works, it works well — although at a very high cost to the doctors. DMSO’s have a long and rather impressive track record of growing revenues and lowering costs in the practices they acquire.
Just how well these professional practice managers have performed will likely come as a surprise to most solo doctors. Overhead in a DMSO practice can easily drop to 50% or less due to leveraged purchasing power and other economies of scale. Annual revenues per location also average $500,000 higher than in the typical non-managed solo practice. Higher revenue and lower costs provides considerable advantages to these profession-
ally managed practices. Unfortunately, in most DMSO business models, the corporation that creates this added value also ends up with the lion’s share of the profits. And while such impressive performance may be great for the DMSO and their Private Equity shareholders, what about doctors who prefer to remain independent?
What if independent dentists could realize the same kind of practice performance that the DMSOs deliver without resorting to having to sell their practice and lose control? Until recently, that really wasn’t an option. Now, however, solo doctors and small group practices can access the very same caliber of world class resources, training, and performance strategies employed by the large corporate groups — and all at a very reasonable cost.
Let’s take the typical dental practice grossing $700,000 per year with a 67% overhead. That doctor will net about $231,000 per year. Now, let’s say she hires a ‘virtual DMSO’ management firm (one that doesn’t require ownership) to come in and help her improve and grow her business. They would first evaluate her practice to see where the opportunities for improvement might exist, then begin a targeted approach to re-train, re-direct, and grow the business. It’s not unusual for doctors to see immediate and lasting improvement in areas where they thought they were doing everything possible. One such dentist recently wrote that after just two days of training, his hygiene department was on pace to produce an additional $311,700 this year! Moreover, his patients were delighted with the improvement in care and service, and his team was more motivated than they’d been in years. Typically, in a professionally managed dental office, operating costs drop down to around 55% or less, as lab, supplies, labor, and fixed costs all drop due to leveraged purchasing power and higher productivity.
As with everything in life that is worth having, these practice gains come with a price. In most cases, the costs range between 3% and 9% of gross revenues, depending on the degree of involvement. But even on the high end of the cost range, the net to the
owner/doctors can be substantial. In the practice cited above, the doctor should earn an additional $160,000 this next year, after all fees to the management company (at the high end of the range). That math works.
None of what I’ve just described is magic. For those who know how, it’s just what happens when sound business principles and best practices are consistently applied by
professionals who know what to do. If your practice isn’t performing the way you’d like, or if your income from dentistry isn’t what you’d hoped for, it may be worth looking into getting some professional practice management help from a company that can do far more than cheerlead from the sidelines. n
R. Kirk Huntsman has been active in the dental industry for over 23 years. In 1988, he became the Dallas/Fort Worth licensee for AFTCO Associates, a dental practice brokerage company with over 65 offices nationwide. Within two years, his was the top performing office in the nation. In 1991, he acquired the Houston license and continued to rapidly expand. By 1995, he was ready to begin owning and operating practices, so he launched Dental One as a dental management services organization, or DMSO. Under Mr. Huntsman’s leadership and direction, Dental One (now Dental One Partners) grew from scratch to over 150 offices in 14 states.
After leaving Dental One Partners in the spring of 2010, Kirk began working closely with Morgan Stanley Private Equity in their acquisition of ReachOut Healthcare America, the nation’s largest mobile dentistry provider. Mr. Huntsman recently left ReachOut in order to form Nexus Dental Group, a virtual DMSO providing a wide range of DMSO-type resources and services to independent dentists.
Mr. Huntsman is a 1981 graduate of Brigham Young University’s Marriott School of Management.
NORTH TEXAS DENTISTRY
Accelerate Your Plans For Retirement by Richard V. Lyschik, DDS, FAGD
our practice is not growing as fast as you’d like, or perhaps your practice has reached a production plateau and there are not any indicators that growth is about to happen again anytime soon. You are working four days a week, but when you look at your schedule you realize that you actually could do all of this production in two or two and a half days each week. Your staff need their full time jobs, so they just continue to let the patients decide what day of the week to come in for treatment and you end up spreading two or two and a half days of treatment over four or five days.
You’ve talked to some of the other dentists in town and many of them have the same complaints – too much open schedule time and not enough patients to fill it. As a result, the overhead percentage for your practice continues to increase while production drops because most of your expenses are fixed. The less money you take in, the higher the overhead becomes as a percentage of that income. Higher overhead and lower net income may have you thinking, “Do I do something about this now, or ignore the signs and go down with a slowly sinking ship?”
Practice mergers are always the best answer, because they offer the best fix to this declining revenue problem (actually the only fix). Buying and merging a nearby dental practice can immediately increase your patient flow and patient revenues. Most of your existing practice expenses are fixed (including staff salaries in this case), so two thirds of the additional patient revenues from the merged practice represent net profit for the purchaser. A practice merger is the best investment a dentist could ever hope to make in his/her practice lifetime.
But suppose you live in an area where there are no practice merger prospects, what do you do? Time is money. The doctor is the Number One income producer for the practice and if the doctor has down time, then the doctor is losing money. The next best thing to a practice merger then is to purchase an existing practice in another area and operate it as a satellite office. You will not need to hire the staff of the acquired practice, which saves you one-half of the overhead costs of the average practice. Your current staff will run both offices (forwarding telephones and appointment scheduling, etc.), which will represent a substantial overhead savings.
28 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Your current staff will need to take better control of scheduling so you can see all your patients in two or two-and-a-half days per week in your current office and the same number of days in the satellite office. You can alternately be available to your patients four days a week for each office with a custom Three Day Overlap Scheduling Program. It will just depend on which week you are at which office.
Depending on the total active patient count of both practices, acquiring a satellite office could also present you with an opportunity for adding an associate to your now two-office practice. It’s possible you could establish an order of succession for yourself when you wish to retire in the future, and you could even pull out a significant amount of cash from your existing practice while maintaining ownership. Time lost is money lost, and you need to get busy and stop losing money. Accelerate your retirement plans with Satellite Economics. n
Richard V. Lyschik, D.D.S., FAGD is one of AFTCO’s leading innovative Senior Analysts who has helped over 2,900 dentists in associating, buying, expanding, or merging and guided older, disabled and/or “burned out” dentists to sell their practices. Dr. Lyschik’s clients have seen the considerable benefits of incentive programs, pension funding plans and increased productivity through his guidance. There is no substitute for experience in this business. Who better could you choose to talk to about your future transition plans than a seasoned fellow dentist, a recognized premier transition expert, and AFTCO Analyst of the Year Award winner? Check out the impressive AFTCO website at www.AFTCO.net, then call for a free appraisal and a no-obligation consultation with Dr. Lyschik at your office or the AFTCO office in Dallas, TX at (214) 893-0410 or 1-800-232-3826.
Bryan’s House Bryan’s House provides early childhood education focused on the developmental needs of children with special health needs and those affected by HIV/AIDS. Bryan’s House also provides critical social services to their families, such as counseling and referrals, donated goods and emergency financial assistance.
Their nationally acclaimed program is innovative, compassionate, and cost effective. Last year Bryan’s House served over 1,100 clients, 350 of them children in their child care programs. Over and over again, clients say that Bryan’s House is different from other agencies because they are there not only for the children, but the entire family, many of whom have no place else to go for the services they need. n
NORTH TEXAS DENTISTRY
Acclaim Networks....................................................22 AFTCO....................................................................14
Bob Michaels, CLU .................................................19 Bryan’s House.........................................................29
Bullseye Media .......................................................30
bloom a flower studio l
FRESH FLORAL ARRANGEMENTS TO BRIGHTEN YOUR RECEPTION AREA
FLOWERS FOR ALL OCCASIONS
30 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Dental Keynote Concepts .........................................5
Dental Logic ............................................................13
Destiny Dental Laboratory ......................................30
Dr. Ravi Doctor........................................................22
Legacy Bank....................................inside front cover Med Dent Advisors..................................................27
Med+Tech Construction .............................back cover
Nexus Dental Alliance .....................inside back cover Ray Bryant Photography .........................................11
Structures and Interiors...........................................21
US Navy Recruiting.................................................17
Are overhead costs draining your profits?
LIMITED TIME OFFER:
Confidential FREE analysis of YOUR practice overhead
This No-Cost, No-Obligation, Personalized Overhead Analysis is performed by professional practice managers at Nexus who know all about practice overhead. After all, we have actually operated HUNDREDS of practices on a national scale at an average overhead of around 50% (pre-doctor comp).
• Learn how your practice overhead stacks up to key national and local benchmarks. • Learn the 4 essential keys to lowering a typical practice overhead, increasing personal income by an average of $70,000 to $100,000. • Learn how to drive supply costs down by 20 - 40% or more. • Learn how to cut your lab bill 40 - 60% without compromising quality. • Learn why “FIXED” costs don’t have to be “FIXED” after all. • Learn how large corporate DMSOs drive their practice level operating costs to 50% and better! NEXUS DENTAL ALLIANCE is committed to helping private practitioners across the country experience a whole new way of practicing. The Nexus practice model features higher revenues, lower operating costs, and the prospect of high levels of PASSIVE INCOME from dentistry. You owe it to yourself to see what you’ve been missing.
LEARN MORE ABOUT US
Register for an upcoming seminar: April 10 Omni Hotel
1300 Houston Street Fort Worth, Texas 76102
May 8 Sheraton Arlington Hotel
1500 Convention Center Drive Arlington, Texas 76011
All seminars are 7:00 to 9:00 p.m. Cost $95 Registration begins at 6:30
LIMITED SEATING - REGISTER TODAY!
Call (817) 328-6150 or
WIN AN iPAD!
Visit us at Booth 6092 at the TDA meeting in San Antonio May 3-5 and register to win an iPad!
to our Hospitality Suite at Grand Hyatt San Antonio May 4, 4 - 8pm!
Cover Story features Dental Anesthesiologist, Dr. Shawn Seifikar. Articles on Practice Management, Practice Marketing, Practice Trends and...