DCSIMG
Header Logo Band

One technique to address five features in dentistry

It is mechanized isolation and suction. We have all heard about it, seen advertisements, read about it, and many dentists are now using it. I won’t mention specific brand names or expound on the different systems but I do want to go over the topic of mechanized isolation systems.

Dr. Moon

Dr. Moon

Developments in isolation and procedure techniques are changing dentistry — FAST. For centuries, dentists have been trained and coached in treatment delivery techniques that employ a four-handed approach requiring an assistant to be consistently present chairside. However, things change. Whether it is automobile manufacturing processes or heart bypass surgery techniques, things change over time. I believe dentistry is in the first 10 years of what will probably be at least a 20-30 year process of transitioning to consistently employing and teaching mechanized suction and isolation techniques.

Though human assistants are vitally important to the delivery of dentistry and will probably always be needed for certain aspects of care, consistent use of mechanized isolation systems quickly addresses at least five crucial areas in an ever-changing field:

1. Consistency: Use of mechanized isolation systems does not eliminate human factors but it does decrease their impact. Consistently being able to “work in” an emergency patient although your assistant is busy can help in an environment where it seems many patients are less loyal to their long time provider and ready to see the first dentist that will get them in for treatment.

2. CAD/CAM: Mechanized isolation systems are not only good for the dentists. Anyone, including assistants, working with modern CAD/CAM dentistry or digital impression techniques can benefit.

3. Overhead Expenses: Costs of supplies and providing treatment consistently go one direction—up. Save on overhead by using mechanized isolation systems, or put that savings toward paying that really great assistant or hygienist to help you in multiple rooms instead of sitting chairside throughout entire procedures.

4. Resin Restorations: I was consistently taught in school that though most people don’t really want amalgam restorations these days, amalgam restorations are beneficial because they can be stronger to occlusal forces over time, and sometimes-in a wet environment-you just can’t place a good resin restoration. Well, the wet environment situation just doesn’t happen as often when I use mechanized isolation techniques and I have found 90  percent of my patients prefer “tooth colored” restorations.

5. Surgery: Performing surgical procedures for patients in need can not only help a lot of people, but also be a huge practice builder. I have found that I can consistently perform surgical procedures with mechanized isolation and suction that would definitely require sedation and a throat-pack otherwise. The difference for the patient can be thousands of dollars saved, and weeks less of discomfort. People seem to be getting less patient and more “Who can help me NOW?” oriented. When you can produce consistent safe results for patients in emergency situations everyone wins.

Incorporation of mechanized isolation systems and delivery techniques can be very beneficial to patients, dentists and dental team members. Give it some thought.

Dr. Brenden Moon is a New Dentist Now guest blogger and currently serves as Chair of the Illinois State Dental Society New Dentist Committee and sits on the Board of the Illinois Academy of General Dentistry. He began practicing in western Illinois after completing dental school at the University of Mississippi in 2007, and enjoys participating in organized dentistry on the state and national level. Dr. Moon practices in both Public Health and Private Practice settings and is a Fellow of the Academy of General Dentistry, International College of Dentists, Academy of Dentistry International, and the Pierre Fauchard Academy.

So you want to be a practice owner someday: Managing debt to ensure practice success

Editor’s note: This is the seventh and final article in a summer series of New Dentist Now blog posts on practice ownership from Wells Fargo Practice Finance, the practice lender endorsed by ADA Business Resources. To read other articles from the series, click here.

Wells FargoFor most dental professionals, incurring significant debt while completing dental school and acquiring a practice is an inevitable part of becoming successful. The trick is to recognize the types of debt so you can effectively evaluate where you stand – and manage your debt to your best advantage. It is common to think that you are better off financially if you eliminate your debt, which is true with regards to credit cards, auto loans, student loans or other debt that does not help to generate revenue. But there is such a thing as “positive debt” – debt that is used to invest in income-producing activity.

Some types of debt can overwhelm your success

Let’s say that after purchasing your dental practice, you are paying $5,856 per month to cover both business and personal debt, including an office remodel, auto loan, student loan and home mortgage, for a total loan balance of $450,000. Now assume you want to buy a new, advanced piece of equipment priced at $125,000 and the vendor is offering financing with payments of $2,610 per month. This would bring your combined monthly payments to $8,466.

Originial loan

Suppose this new payment wipes out any excess funds you were planning to put towards your retirement. You would now have to consider whether to wait to purchase the new equipment so that you do not jeopardize your retirement funding, cover the additional payment with increased production, or put off saving for retirement. The new equipment loan can therefore hamper your ability to save.

To avoid this kind of debt management crisis and ensure you’re effectively managing your debt situation, work with a Certified Financial Planner (CFP) to develop a broad financial picture of long-term personal and business goals. Be sure your plan includes an assets and liabilities spreadsheet, profit and loss statement, and a plan for large annual debt expenditures.

Working with your lender to create “positive” debt

A specialized dental lender can help transform a financial liability into “positive” debt that still allows you to accumulate security and wealth. This may be accomplished through a consolidated loan that minimizes interest and total payments.

Using the example above, assume your lender offers a consolidation loan for $225,000 to cover new equipment and remodeling, and a home equity loan with a somewhat longer term to cover your auto and student loans. The new loan reduces your total monthly payment to $6,891, for a savings of $3,001 a month.

Consolidated Loan

If you invest this difference monthly, you may eventually have a healthy fund for your retirement. Or, you can use this savings to reinvest in your practice, including:

  • Technology investment. You might use your new-found funds to leverage the purchase of advanced technology that allows you to expand your services and make your practice more competitive.
  • Enhanced marketing. Reinvesting your added cash in a well-thought-out marketing program can potentially lead to more patients and procedures for your practice. If well-planned and executed, your expanded marketing efforts should generate additional cash flow.
  •  Accelerated Debt Payoff.  Some doctors take advantage of lower interest rates to accelerate their debt reduction program and become a debt free practice more quickly.

By managing your debt situation through the use of long-term financial planning and, if necessary, loan consolidation with a specialized dental lender, you can move a long way towards building a successful practice that meets your ultimate goals.

¹Interest rates cited are indicative only. Actual interest rates depend on your creditworthiness.


Research: Practice setting may determine dentists’ satisfaction

HPIBig or small, there are pros and cons to working in various dental practice settings, and dentists measure their career satisfaction in different ways.

Researchers found that dentists working in large group settings reported more satisfaction with income and benefits than dentists in solo practices, as well as less stress compared to dentists in solo or small practices, according to ADA News.

The ADA Health Policy Institute released a study analyzing dentists’ job satisfaction within different practice settings, finding that those working in small group settings reported the highest overall career satisfaction.

HPI also released two additional studies on group practices, with one finding differences among two types of large group practice settings and the other discussing the growth in large dental practices’ market share.

“In large practice settings, providers may lose autonomy and feel enhanced pressure to produce revenue when making treatment decisions,” according to the authors. “They may have less flexible hours and schedules that could cause dissatisfaction. Conversely, they may benefit from administrative assistance, which can allow for having more predictable income and hours.

“Dentists working in solo or small group practices may have more autonomy; however, they are not immune to pressures to produce revenue, and they may have to perform more administrative tasks on top of their clinical duties. Running a small business may not suit every dentist; the burdens of financing, fixed costs and reimbursement could lead to dissatisfaction even among dentists in solo practice.”

To read more on the study, click here.

Dentist employment agreements seminar video

Jeffrey Fraum, senior associate general counsel for the American Dental Association, presented an overview of dental employment agreements to dental students at the University of Illinois at Chicago.

signing a document“You guys deal with contracts all the time. You click through contracts [online] and you get them at the bank. Nobody’s got the time to read them all, but your employment agreement is one you should really look at,” Mr. Fraum said.

In his 30-minute presentation, posted in the ADA Center for Professional Success website, Mr. Fraum addresses key legal provisions in dental employment agreements. He ends his presentation by giving the attendees a copy of “Dentist Employment Agreements: A Guide to Key legal Provisions.”

To view the presentation, click here.

Creating positive space: An essential for your office environment

This post is for Tiffani Horton, and for everyone else who is fighting a battle on the inside.

I’m against watching the news. Other people can watch the news all they want to. That’s fine. I just don’t want to watch it myself.

Dr. Vaughn

Dr. Vaughn

I don’t want to watch the news because buried in every news reel is a sad story. A story that reminds me I’m not invincible, I live in an imperfect world, and that sometimes bad things happen that I cannot control.

And unfortunately, regardless of whether or not you watch the news . . . sometimes a sad story still finds you.

In dental school, you rotate through many clinics. You meet a lot of faculty and a lot of patients and a lot of staff. And what’s nice about all this is that the conversations aren’t always about what X-rays you want to take or whether or not you’ve made the right diagnosis. Sometimes you talk about your weekend or what you plan to do once you graduate or how good the new restaurant in town is. You form this unique bond with all these different people, and it eventually creates this special thing with its own label.

The other night, a good friend sent me a message that told a sad story. Someone from my dental school had just lost her battle with cancer. Her name was Tiffani. A dental assistant that I, along with everyone else in my class, had weekly interactions with.

Ms. Tiffani Horton

Ms. Tiffani Horton

Tiffani was more than a name or a dental assistant. She was a friend, a wife, a mother, a person with thoughts and wants and emotions and ambitions. She talked to some of us like she had known us for years. She helped some of us get patients so we could take our licensing exam and become dentists. She was very much a part of our dental school family.

But the thing about all of this is that I had no idea that Tiffani was fighting this battle. She had liver cancer and was undergoing chemo. All while I was still in school. There were conversations I’m sure that we had, where she was living with this horrible disease . . . and I did not know.

Buried in every news reel is a sad story. But what I’m learning is that buried in every sad story is a truth that I need to know.

Because me and you and everyone we know are all the same. We all have bad days. We get bad news. We go through hard times. We hit rock bottom. And then we have to go out in public and try to be strong and keep it together.

Tiffani teaches us that you never really know what someone is going through.

What does that mean for us as we try and figure out this New Dentist world? It means that we have the vital responsibility of being aware. Of keeping social sensitivity as a priority within our practices. Because our staff will have bad days. Our patients will tell us horrible stories from their pasts. Our business partner might be dealing with chemo treatment or secretly going through a heart-wrenching divorce.

And as people who have dedicated their careers to serving others, we need to create space that allows people to escape the troubles of their daily lives. What does this look like? At its core, it’s being aware and paying attention. Picking up those social cues from your staff. Treating everyone in your office with the care and respect they deserve. Not letting your own troubles affect the way you talk to and interact with the people around you.

From the modern corporate office in Chicago to the paper-chart practice in rural Alabama, you can contribute to making the world a better place just by changing the environment of your dental office. A good dental office is one where honesty, respect, care and love are infused in its fabric.

Because you never really know what another person might be going through.

Dr. Joe Vaughn is a New Dentist Now guest blogger. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, where he attends the General Practice Residency at the University of Washington. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!

So you want to be a practice owner someday: Building and managing your cash flow

Editor’s note: This is the sixth article in a summer series of New Dentist Now blog posts on practice ownership from Wells Fargo Practice Finance, the practice lender endorsed by ADA Business Resources. To read other articles from the series, click here.

Wells FargoYour dental practice is a valuable and beneficial investment that can be an important resource for generating cash flow. Simply defined, cash flow is the difference between your monthly revenue and monthly expenses. This is the figure that determines your net income, or the amount you will earn from running your business. Here are a number of ways to build and manage your monthly cash flow from Wells Fargo Practice Finance, the practice lender endorsed by ADA Business Resources.

Manage your financing term

The financing term, meaning the time over which your debt is payable, for your dental practice purchase or start-up may be more important than you imagined. A dental practice is a cash flow based business, and choosing financing that supports your cash flow can be critical to creating a sound financial future.

Most lenders or banks provide a maximum loan term of seven years, which may in fact allow enough cash flow to pay expenses and income while paying off your debt in a shorter period of time. However, if you could have a term that was almost 50 percent longer, such as a 10-year term, you would have a substantial increase in your monthly cash flow. For example, when you borrow $300,000, the difference between a seven-year note and a 10-year note is approximately $1,200 per month. If you opt for the 10-year term, the added savings to your annual cash flow would be approximately $14,400 per year! And, all of the interest you pay on the note can be used as a line item expense and written off against the revenue of the practice, along with the depreciation of the principal amount.*

Consolidate your debt

If you have existing debt that’s over five years old, another option for creating cash flow is a debt consolidation loan. By taking advantage of lower interest rates, you can lower your monthly loan payment and redirect your savings towards your dental practice. However, it would be wise to move quickly on this option as interest rates are poised to rise.

To qualify for debt consolidation financing, you will need to maintain an excellent personal credit profile and be able to demonstrate that your cash flow can support and meet a lender’s minimum standards for the level of financing for which you are applying.

Expand practice capabilities

On its face this may seem counterintuitive: How does taking on new debt to expand your practice help generate additional cash flow?  The key is to structure your expansion so it pays for your debt.

Adding square footage as well as new dental services generates both higher fees and increased patient flow.  While you may need to consider bringing in an associate to help manage increased patient flow, more overall production for your practice ultimately means greater cash flow. And if you are able to add specialty services while expanding your practice, you have doubled your opportunity to improve your income. The debt you incur to expand your practice can usually be paid for by the increased traffic flow and level of services – particularly if combined with a Section 179 tax deduction.*

Reinvest with a practice equity loan

If you have owned your practice for three or more years, you have equity that you can use to generate cash flow and reinvest in your business. Whether you need to purchase equipment, fund a partnership transition, or pay for education, tapping into your equity may give you the cash flow you need to work towards growing your business or securing your future. Some lenders offer practice equity loans up to $500,000 depending on the value of your practice, with terms up to 10 years.

*Consult your tax advisor and/or accountant for a statement of tax and accounting rules applicable to your particular situation and for all other tax and accounting advice.

New dentist among ‘Top 25 Women in Dentistry 2015’

Dental Products Report named Dr. Andrea Janik, District 15 ADA New Dentist Committee member, among the “Top 25 Women in Dentistry 2015.”

Dr. Janik

Dr. Janik

In its sixth year, the list was designed to recognize women from across the dental industry, including dental professionals, industry leaders and practitioners.

Dr. Janik, of San Antonio, is a dental practice owner in the Pacific Dental Services Group.

“Her practice is one of the top performing practices in the company,” according to her nominator. “She also serves organized dentistry at all levels.”

To read more about Dr. Janik and the others on the list, click here.

Each of the honorees will be featured in the October edition of Dental Products Report.

3 months before opening checklist – part 1: Finance

In previous articles, I’ve covered some of the very first things you’ll do as a new dentist who is planning to open a new practice. These included forming a legal entity and then actually setting one up.

Rich McIver

Rich McIver

In this article we’re shifting gears and turning to the first of three articles covering some of the more practical steps you’ll need to take approximately three months before opening your practice, and some things you should consider when taking on these tasks. This article will focus on finance related tasks:

1. Bookkeeping:

It may seem like overkill to hire a bookkeeper (or if you’re doing it yourself, to buy Quickbooks and set up a file) months before you actually open, but a lot of your most important bookkeeping work is done in well before you actually open for business. That’s because you’re going to be making large equipment and fixtures purchases (that should be properly capitalized), and you’re going to be incurring initial expenses (that should be properly categorized into custom expense categories), among other considerations. Not setting up your account properly means that while you may be able to accurately file your taxes, you won’t have accurate financial reporting, which will become necessary as your practice grows.

My Advice:

The temptation for most new dentists is to try to do your own bookkeeping initially, or at a minimum to hold off on hiring a bookkeeper until after you open in order to save money. While the motive to save money early is smart, fight the temptation here and pay for a bookkeeper. I can virtually promise you, you will screw up your Quickbooks file by not setting up expense categories properly. And then when you do end up hiring a bookkeeper, they’ll have to manually backtrack to fix everything you did wrong, and end up charging you nearly as much as if they would have just handled it for you from the beginning. To the extent you can, find a bookkeeper that has experience with dentists, as they’ll know industry norms and can help guide you, and will know a lot of the suppliers already, so they’ll be fewer questions from your bookkeeper each month asking “what was this charge for?”

 2. Credit Card Processing:

This is something a lot of dentists forget to do until the week before they’re opening for business. Normally for existing businesses, switching credit card processors just takes a couple of weeks. But for new businesses, particularly where one of the owners has less than ideal credit, it can take a couple of months.  Given that not being able to accept credit or debit cards effectively means that the majority of your patients won’t be able to pay you, starting early is a good thing, and you can usually get them to waive any monthly fees until you’re actually ready to start accepting payments anyway.

My Advice:

Dentists generally fall into a pretty good risk category, so you can get pretty cheap rates even as a new business. But to get cheaper rates, in general, you will have to obtain service through an actual credit card processing company rather than your practice’s bank. When you do get quotes, unfortunately, credit card processing is priced so confusingly that it can be hard to compare offers across multiple providers. So, I recommend either using a third party negotiating service, or demanding that any offer be presented in the more transparent interchange plus pricing format.

3. Business Checking Account:

Getting a business checking account is very similar to a personal checking account, it’s quick and easy. That said, you still need to do it early, before you start incurring expenses. Otherwise the temptation will be for you to pay for things out of your personal accounts, which will complicate your taxes and accounting immensely down the road.

My Advice:

You can find still banks with no monthly fees, and you should consider that. But perhaps more important is finding a bank with a banker you can actually get a hold of, and who is competent enough to get things done for you. As a dentist, you won’t need much, but getting a wire sent out without having to go into a branch, a hold placed on a check via a two minute phone call, or getting a phone call from your banker in lieu of an overdraft fee, are, in my opinion, what separates a good bank from a bad one.

Conclusion:

These three items are each things are the sort of mundane details that you may overlook entirely when mapping out your new practice. They are, however, very important, and cannot be done last minute. As far as product recommendations go, it’s a good idea to ask around for recommendations from your colleagues. The ADA, and perhaps your state dental society, offers endorsed providers (check out ADA Business Resources) for some products and this is a good place to start.  For provider recommendation information in each of these items from me, contact me. In the next article in this series we’ll discuss three operational tasks that you should do three months prior to opening your practice.

Rich McIver is a New Dentist Now guest blogger and the founder of MerchantNegotiators.com, a company that helps businesses obtain cheaper and better credit card processing. He also assists his wife, Dr. Holly McIver at her orthodontic practice, Kingwood Orthodontics. You can follow him on Twitter and Google+.

Stressed? Create and maintain a health balance

Prioritizing the demands of work and your personal life can often lead to stress, unhappiness and reduced productivity. While stress can sometimes help us perform under pressure and motivate us to do our best, there are real physical and mental consequences associated with chronic stress.

eating lunch at a deskIn the dental office, you may face various stressors. Handling patients, performing intricate procedures or managing tons of paperwork on a daily basis could all lead to increased levels of stress.

There are a variety of steps you can take to reduce both your overall stress levels and the stress you find on the job and in the workplace, according to the ADA Center Professional Success. These include:

  • Track your time. Pay attention to your daily tasks, including work-related and personal activities. Decide what’s necessary and what satisfies you the most. Cut or delegate activities that are unnecessary or can be completed by other members of your staff.
  • Leave work at work. Make a conscious decision to separate work time from personal time.
  • Manage your time. Organize household tasks efficiently, such as running errands in batches or doing a load of laundry every day, rather than saving it all for your day off. Put family events on a weekly family calendar and keep a daily to-do list. Do what needs to be done and let the rest go.
  • Bolster your support system. At work, join forces with co-workers who can cover for you — and vice versa — when family conflicts arise. At home, enlist trusted friends and loved ones to pitch in with child care or household responsibilities when you need to work overtime or travel.
  • Eat right and sleep well. Eat a healthy diet, include physical activity in your daily routine and get enough sleep. Set aside time each day for an activity that you enjoy.
  • Develop an appointment schedule that best suits you. Most of us go through the day using a “push through” approach, thinking if we work the full eight to 10 hours, we’ll get more done. Instead, productivity goes down, stress levels go up and you have very little energy left over for your family. Schedule a break throughout the day to walk, stretch or just relax.
  • Influence others. If you notice that a patient is anxious or fearful about a procedure, tell them you understand and instruct them to breath with you. Bringing down their anxiety levels will allow you to be at ease during the procedure.

So you want to be a practice owner someday: Planning for growth and expansion

Editor’s note: This is the fifth article in a summer series of New Dentist Now blog posts on practice ownership from Wells Fargo Practice Finance, the practice lender endorsed by ADA Business Resources. To read other articles from the series, click here.

Wells FargoMost new practice owners don’t open their first practice with thoughts of immediate growth in mind. Nevertheless, it’s critical to layout future plans early in your career so you are prepared when the time comes to expand. While there are some clear indicators that will tell you when it’s time to update, expand or relocate your office, getting ahead of the process so you are in control will make the process easier, and the outcome more rewarding.

There are three facets to growing your practice – increasing the number of patients you treat, increasing the types of services you provide, and expanding your physical space to accommodate these patients and services. Your plan for growth needs to address all three aspects, using the following guidelines.

Put your growth plan in writing

The first task in preparing for growth is to have a written plan that outlines your vision for your practice. For instance:

  • How large do you ultimately want your practice to be? Specify the number of patients, operatories and associates you envision for your practice, and the amount of revenue you would like to achieve over the next five years or so.
  • Outline how you will attract new patients. Will you use local advertising, internal marketing, promotional programs?
  • Can you manage this growth in place with your current office set-up or an expansion, or will you need to move your practice location?
  • What kind of financing will be required for a practice expansion or relocation? Is your financial profile robust enough to ensure you can fund future growth?

Putting these details in writing mentally prepares you to take all the necessary steps for making a smooth transition to a larger practice when your growth plans succeed.

Understand the growth indicators

How will you know when it’s time to expand to a larger practice? Some key growth indicators for triggering an expansion might be:

  • Your space is not adequately meeting patient demand, with appointments booked out for two or more weeks. Generally speaking, if you are at 85% of capacity in your current facility, it’s time to start thinking about expanding or relocating your office.
  • You are referring too many patients out for specialty services. This represents lost revenue that could be kept in-practice if you can add an associate who offers these services.
  • Your technology is not keeping up with the competition. If your equipment is clearly dated and incapable of delivering a high level of efficiency and performance, it’s time to expand your services with a technology upgrade.

Prepare for the impact

Remember that an increased patient load not only impacts your facility with potential overcrowding and traffic flow issues, but also your staff and operations.

  • Staff– Be sure you have capable staff that can continue to provide excellent service to your full patient base. Consider including part-time or temporary staff positions to maximize your cash flow and build flexibility into your payroll until your patient base stabilizes.
  • Support – Don’t forget that more patients means you will be making a greater demand on your dental laboratory. Make sure your laboratory can continue to provide the turnaround time you expect, and add an additional lab to your support team if necessary.
  • Dental tools – Your computer software should be able to absorb an increase in patients, but not necessarily your dental tools. Take an inventory of your equipment and determine how many units you need of each tool to service your existing patient base. Then determine how many new patients you have added or plan to add this year – say, an additional 15%. Multiply your current inventory by 15%  and this will tell you the equipment purchases you will need to include in your practice growth budget.

Once you have carefully outlined a plan for the growth of your practice, understood the key growth indicators, and primed your facility for increased traffic, you have taken some of the key steps in preparing for the success that is bound to come your way.