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After Dental School

Take action to support student loan reform

2014 Dental Student Loan DebtContact your member of Congress and urge him or her to cosponsor the Student Loan Refinancing Act of 2015, H.R. 649.

The American Dental Education Association estimates that the average graduating dental student’s debt was over $247,000 in 2014.

H.R. 649 will allow borrowers, under the federal student loan program, to refinance their existing loans multiple times. If the current interest rates are below the rate they are paying, they can refinance their loans. This would assist new dentists in reducing their overall debt, thereby opening opportunities to practice in areas of need.

Fill out the form here.

What type of entity should a dentist consider selecting and why?

In my previous blog post, I explained why, as a new dentist you may wish to form a legal entity to run your practice instead of running it as a sole proprietorship. In this article, I’ll explain what type of entity you should consider forming, what tax elections you should consider making when forming that entity, how to actually do it, and how much it will cost.

Rich McIver

Rich McIver

What type of entity you should consider forming

There are a lot of options when selecting what type of legal entity you will operate your practice out of. There is a traditional corporation (denoted by “Inc.”), a professional corporation (“P.C.”), a limited liability company (“LLC”), a professional limited liability company (“PLLC”), a limited partnership (“L.P.”), a general partnership (“G.P.”), a limited liability partnership (“L.L.P.”), and in some states a limited liability limited partnership (“L.L.L.P.”), along with a number of other industry specific entity types.

When you form your entity, you need to select one of these types, each of which operates under a different set of laws and tax rules thus each of which has different advantages and disadvantages. Because of the different laws and tax rules, you are urged to consult with your personal attorney in the state in which you will be practicing before making a final decision on the type of entity to form.  Once you select one you’ll need to append it to the legal name of your practice (e.g. “Dallas Dentistry PLLC”).

Professional Corporation

A Professional Corporation (“P.C.”) is simply a corporation for professionals such as doctors, lawyers or dentists. It operates just like a corporation (“Inc.”) with a few differences that aren’t relevant to this discussion. P.C.s using an S-Corp election (discussed further below) were the original option for dentists who wanted to form an entity. The P.C. with an S-Corp election provided a liability shield, cleaner tax accounting, the ability to distinguish between a dentist’s income and the practice’s profits and thus pay less in Social Security (10.4 percent of self-employment income up to $117,000) and Medicare taxes (2.9 percent of self employment income uncapped) than under a sole proprietorship. Plus a number of other benefits. Unfortunately, because P.C.s are a derivative of corporations (“Inc.”) they also generally require more paperwork, formal annual meetings, and other administrative hassles that traditional corporations require.

Professional Limited Liability Company

Certain administrative and tax burdens associated with a traditional corporation (and thus P.C.s) led states to create a new type of entity, the Limited Liability Company (“LLC”), and in its professional form the PLLC. A professional limited liability company (“PLLC”) is simply an LLC for businesses involving professional services. The benefit of a PLLC is that it generally has less burdensome administrative requirements than a P.C. This lower administrative burden made PLLC’s very attractive for dental practices (except in a few states, most notably California, where LLC’s cannot be used to practice medicine) . The downside of a PLLC relative to a P.C., however, was that a dentist’s Medicare and self-employment tax liability couldn’t be capped at his or her self-employment income, but instead was based on the overall profitability of the practice. This meant that dentists under a PLLC might be paying an extra 2.9-13.3 percent in self-employment taxes.

Professional Limited Liability Company With S-Corp Election

Obviously a combo of these two entity types, the P.C. with its caps on self-employment taxes, and the PLLC with its low administrative hassles, could be advantageous. Thankfully, that is possible with the PLLC with an S-Corp election.

States now almost universally allow PLLC’s to elect to be treated as P.C. or S-Corp’s for tax purposes (again, notably not in California). So, in effect, they are treated as an LLC from a corporate perspective, but when it comes to taxes they’re an S-Corp. This means that a dentist who forms their entity as a PLLC with an S-Corp election gets the benefit of lower administrative legal hassles, with the self-employment tax savings of a corporation. As such, this has become the default answer for many dentists when considering what type of entity to form.  However, as noted above, a dentist would be wise to consult with his or her personal attorney in the state in which he or she will be practicing before making a final decision on the type of entity to form.

How to Form an Entity

Now that you’ve selected the type of entity, you need to decide where to form it. For many dentists, the right answer is usually the state that you will practice in. That’s because if your state is reasonably business friendly, the advantages you can get elsewhere may be outweighed by the convenience and cost savings of not having to hire an out of state agent. But, there are valid reasons for deciding otherwise, so take your time and consider all the factors, perhaps after discussions with your personal attorney. (http://www.nolo.com/legal-encyclopedia/where-form-your-llc.html).

Once you’ve selected a state, actually forming an entity is really easy. For some states you need to first contact your licensing board and get documentation proving you’re a licensed dentist.  Then, just visit your state’s secretary of state’s website (find your state’s here)  to find the forms, download them, complete them and send them in. In many states the application can be completed all online, and in total it’ll take you about 5 minutes. The cost of forming an entity depends on the state, with some as cheap as $45 and others as expensive as $800 (for a state by state cost breakdown read this). You can pay via check, or in some states via credit card online. Note: In a few states, like New York, there is an additional publication requirement to complete formation which can cost up to an additional $1,600.

Once you’ve completed the application, the Secretary of State’s office will review it, and assuming it’s completed correctly, send you a stamped copy in the mail (or increasingly online). With that stamped copy, your entity now formally exists, and you can start doing things like obtaining a bank account, credit card, signing contracts with vendors, etc. all in the company’s name.

In the next article we’ll discuss some of the first vendors and service providers you’ll need to contract with to begin your practice.

For information on ADA legal resources, click here.

Rich McIver is a New Dentist Now guest blogger. He graduated from the University of Notre Dame in 2005 and obtained his law degree at the University of Chicago Law School in 2008. After graduating law school, Rich founded and managed three tech startups that were each acquired through private equity, private sales and a merger, respectively. In 2010, he founded and managed a Houston-based plaintiffs law firm which he sold via a buyout in 2014. In 2013, he and his wife, Holly McIver, an ADA member dentist, founded Kingwood Orthodontics, where he continues to manage back-office operations. His current project is running Merchant Negotiators, a Web startup that reviews credit card processors. Rich provides practical actionable advice for new dentists based on his experience starting and building successful businesses.

Disclaimer: The purpose of this article is to promote awareness of legal and other issues that may affect dentists and dental practices, and is not intended to provide either legal or professional advice. Dentists are urged to consult directly with a properly qualified professional or with an attorney admitted to practice in their jurisdiction for appropriate legal or professional advice.

Rich McIver is a New Dentist Now guest blogger. He graduated from the University of Notre Dame in 2005 and obtained his law degree at the University of Chicago Law School in 2008. After graduating law school, Rich founded and managed three tech startups that were each acquired through private equity, private sales and a merger, respectively. In 2010, he founded and managed a Houston-based plaintiffs law firm which he sold via a buyout in 2014. In 2013, he and his wife, Holly McIver, an ADA member dentist, founded Kingwood Orthodontics, where he continues to manage back-office operations. His current project is running Merchant Negotiators, a Web startup based in Houston. Rich provides practical actionable advice for new dentists based on his experience starting and building successful businesses.

Access JADA articles, online CE with ADA username and password

Beginning March 25, ADA members can log in to obtain access to JADA Online as a benefit of membership by clicking the ADA Member Login link on the website and entering their ADA Member ID and password.

JADAADA members receive a 50 percent discount on JADA 2015 Online CE, which will be applied automatically when they log in via the ADA Member Login link. The member price is $10 for three CE credits. The nonmember price for three JADA Online CE credits is $20.

For assistance with ADA member ID and password issues, contact the ADA Member Service Center at the toll-free number on your member card or call 1-312-440-2500. ADA Member Service Center advisors are available Monday through Friday; 8:30 a.m.-5 p.m. CST. Or email mscpassword@ada.org.

Nonmembers may purchase a one-year subscription for $179, which includes access to JADA content from 1913 to present; purchase a single article access for $31.50; or join the ADA to receive access to JADA Online and Online CE discounts at ADA.org.

How to contract with third-party payers

Contracting with third-party payers can prove complicated but with some diligence and attention, new dentists can feel confident they were thorough in their decision.

Patients are two and a half times more likely to visit the dentist if they have dental benefits. Nearly 187 million Americans were covered by some form of dental benefit in 2012, according to a report from the National Association of Dental Plans and the Delta Dental Plans Association.

In 2013, a typical dental practice had nearly 72 percent of its patients with some form of a dental benefit, making it challenging for dentists to decide whether to participate in a network or not. On average, dentists participate in five and a half managed care plans.

Here are some steps the ADA recommends new dentists take when beginning the process of contracting with a dental benefits company:

• Figure out the volume of patients you expect to see and whether the fees proposed by the third-party payer work for you. The ADA Benefit Plan Analyzer allows dentists to run “what if” scenarios that will illustrate the financial impact to their practice. It’s available on the ADA Center for Professional Success website at Success.ADA.org.

• Carefully review the contract between you and the thirdparty payer. A contract is a legal document and by signing it, you are making promises that you must keep.

• Consult with your personal attorney before signing. The ADA Contract Analysis Service is also an option. Members may submit a contract to their state or local dental societies, who will forward it to the service, which provides a plain language explanation of contract terms of each agreement analyzed. The service does not provide legal advice or recommend whether a contract should or should not be signed.

• Determine whether the contract presented includes terms such as an all affiliated carriers clause, most favored nation clause or hold harmless agreement. Also pay attention to the carrier’s processing policies, which may or may not appear in the contract.

• Review the plan’s website and provider participation manuals carefully. Understand how changes to these will be communicated to you and your rights when changes are made. If you still have questions, talk to a representative from the plan to clarify.

The ADA Center for Professional Success has a series of videos that will help dentists understand how third-party payers interface with dental offices. Click here, to watch the tutorials.

Bang for Your Buck! Prioritizing CE opportunities as a new dentist

We knew all along. We knew there were things we were not learning while we were in school. Now, we’ve made it out. We are practicing dentists. We’ve climbed the mountain, celebrated, taken a deep breath, and turned around to find ourselves at the bottom of another mountain. We know there are things we don’t know. Now what? How do I decide where to start? How do I prioritize what CE warrants my time, effort and money?

Dr. Moon

Dr. Moon

Before elaborating on choosing CE, let me say this: First of all, give yourself a break. You don’t have to save the world your first year as a practicing dentist (even though it kind of feels like you can once you’re treating more than 2-3 patients per day). Use your training to approach cases and treatment conservatively as you build up your confidence and skill level. Don’t get in over your head early. Personally, I believe I spent about six months focusing on my job prior to taking any CE after school.

Once you’re ready to get back at it, make CE choices that benefit you and your patients. After some time practicing, you should have a feeling in your “gut” that if you just knew how to __________ or ________ your patients would benefit and you would feel like a more proficient dentist. Once you have that feeling you are more than halfway there.

I have found that asking myself the question: “Is this good Bang for My Buck?” has consistently helped me make good decisions about how I prioritize my CE. I consider three areas when answering this question to myself:

1. Will learning ____________ benefit the majority of my patients, or a few?

2. Is this topic something very limited or specific, or something I can build upon in the future?

3. Is there a hands-on component to this course, or will I potentially leave this course without the confidence I need to implement what I was suppose to learn?

Answers to these questions usually guide my decisions. I prefer to attend CE that offers benefit to the largest number of patients possible, on a topic or area that can consistently be built upon or integrated into multiple procedures, and especially those that include a hands-on component.

Early on in my career, I found myself focusing on CAD-CAM dentistry and bone grafting procedures. I had come to the realization that the majority of my patients would benefit if I increased my skills in these areas. Also, a basic foundation in these topics is beneficial, but you can learn an extensive amount with either, and continue to build your skills and expand the number of billable procedures you provide. Again, once you know what you want to learn, incorporating a hands-on component will make you that much more confident as you implement your knowledge and new techniques in clinical practice.

For new dentists looking to pick up some valuable CE, I suggest that these two areas are not a bad place to start. Incorporating CAD-CAM dentistry into your practice opens up a lot of treatment options and office scheduling benefits that are not available without it. Also, implant dentistry continues to develop and become a more commonly selected treatment option. Bone grafting and socket preservation procedures help patients obtain optimal treatment results, can often be performed quite easily, and will in many cases be the difference between success and failure concerning fixed prosthodontic and/or implant treatment options. Go get that Bang for Your Buck!

For more information on online and in-person continuing education opportunities, click here.

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

After earning dental degree, new dentist wants to return to Zambia to open clinic

The Dallas Morning News profiled the extraordinary story of a new dentist, Dr. Given Kachepa, who just graduated from Texas A&M University Baylor College of Dentistry, and his hopes to return to open the first dental clinic in the city where he was born — Kalingalinga, Zambia.

According to the article, Dr. Kachepa was brought to Texas by traffickers at age 11. In 1997, he joined a boy’s choir that would tour the U.S. through a ministry called Teaching Teachers to Teach: Partners in Education, which promised to send stipends to the boys’ families and raise money for Zambian schools. The ministry, however, poorly treated the choir members — if they didn’t sing, they weren’t fed — and never paid the boys, Dr. Kachepa told Dallas Morning News.

A former volunteer, Sandy Shepherd, ultimately reported the ministry to authorities and the Zambian Embassy in the U.S. Ms. Shepherd became Dr. Kachepa’s foster mother. They recall, in the story, that enrolling in the eight grade was difficult for Dr. Kalingalinga.

“When you’re missing the foundation, I think it’s very hard to recover,” he said. “I was limited in my language. Nobody ever sat down with me in Zambia and taught me to read. Sometimes, it took me many, many hours to finish the homework.”

Dr. Kachepa became interested in dentistry after getting braces. In 2013, while visiting Kalingalinga, his cousin went to a clinic over a toothache and needed an extraction. According to the article, the dentist had two men hold his cousin down because there was no anesthetic.

While it’ll take Dr. Kachepa few years to pay back his student loans, he said he’s already preparing for his clinic in Kalingalinga.

To read Dr. Kachepa’s story, click here.

Part 3: Taking the leap to practice ownership? These ADA resources can help

Let me start off by saying that opening my own practice from scratch was one of the scariest moments in my life thus far. I knew I had a good portion of dental knowledge amassed over the last few years, but what did I know about running a business? I could sit down and talk to patients about decay and occlusal wear; however, could I sit down and talk to a team about the goals of the practice and how to achieve them? What about how much my fees would be for my services, and what insurances I should take? How would I go about preparing my office for HIPAA and OSHA protocols?

Dr. Sinclair

Dr. Sinclair

Many of these questions I later found out could be answered through various departments and locations through the ADA’s resources. In this article, I will be discussing several of those resources that can be huge assets when you decide to make the leap into practice ownership.

The ADA Catalog

Another benefit from the ADA I would like to discuss is pretty self-explanatory. What if I told you that before the practice doors even opened you had to make sure all HIPAA and OSHA guidelines were being followed, and if not, you could be subject to fines which could end up costing you tens of thousands of dollars? A few months before I opened my doors, I would have had a blank stare on my face.  Once again the ADA came to my rescue by having both HIPAA and OSHA compliance manuals readily available. The manuals gave me implementation protocols and procedures to make sure my office was up to date and compliant before anyone even stepped foot inside the door. The ADA Store is an excellent resource where you can find almost any must have item for your practice. Some examples include brochures for patient education, CDT code books updating the latest dental codes, and information regarding creating an internal marketing program. Many of the items are also customizable.

RELATED: Part 1 & Part 2

Starting out I mentioned that opening my practice was one of the scariest moments in my life, but I can also say that it has been one of the most rewarding. With the help of the ADA, I have created an environment that I, as well as my team members and patients, look forward to every day. I know that I will still have plenty of successes and failures along the road, but I look forward to sharing and celebrating these moments with all of you, my fellow colleagues.

This blog post, reprinted with minimal edits and permission, originally appeared in the Virginia Dental Association journal. Dr. Cappy Sinclair is a New Dentist Now guest blogger and a 2009 graduate of Virginia Commonwealth University. Dr. Sinclair currently serves on the Board of Trustees at the Academy of Cosmetic Dentistry, as member of 3M’s Council for Innovative Dentistry, and as an ambassador for the Dawson Academy. He started his own practice Coastal Cosmetic Dentistry 3 years ago from the ground up and is more than happy to share his success and failures with fellow new dentists. He is a member of the American Dental Association and the Virginia Dental Association. To contact Dr. Sinclair, email him csinclair@smilevabeach.com.

Job hunting? Searching for employees? Visit the ADA CareerCenter

The ADA CareerCenter is the official online job board of the ADA and is a great resource for searching dental career opportunities or for recruiting dental professionals.

Screen Shot 2015-05-01 at 10.37.32 AMAt careercenter.ADA.org, users can search or post job opportunities for dentists, oral surgeons, orthodontists and other dentistry related career opportunities.

Both job seekers and employers can benefi t from this resource. Those looking for a job can sign up for free on ADA CareerCenter to find dental profession jobs listed by location, company and job type; upload resumes; receive new job alerts via email; save and track jobs and apply online. Even more job opportunities can be found offl ine in the Journal of the American Dental Association’s classified pages.

Meanwhile, dental employers and recruiters can use ADA CareerCenter to choose from a wide array of online options to showcase open positions, including basic and featured job postings or Featured Employer upgraded accounts.

For more information, visit careercenter.ADA.org.

Part 2: Taking the leap to practice ownership? These ADA resources can help

Let me start off by saying that opening my own practice from scratch was one of the scariest moments in my life thus far. I knew I had a good portion of dental knowledge amassed over the last few years, but what did I know about running a business? I could sit down and talk to patients about decay and occlusal wear; however, could I sit down and talk to a team about the goals of the practice and how to achieve them? What about how much my fees would be for my services, and what insurances I should take? How would I go about preparing my office for HIPAA and OSHA protocols?

Dr. Sinclair

Dr. Sinclair

Many of these questions I later found out could be answered through various departments and locations through the ADA’s resources. In this article, I will be discussing several of those resources that can be huge assets when you decide to make the leap into practice ownership.

The Center for Professional Success

There are very few places where one may find legitimate answers to questions that arise when opening a practice. One of the best resources I have found is the ADA’s Center for Professional Success (CPS). Here you can find several must-know items such as: how to design your office if you are building a new building or remodeling an older space; how to adhere to government regulations regarding human resources issues and employees; and how to navigate the world of filing dental benefits for patients.

Personally, I used this resource to help with the initial design of my office as well as coming up with an employee manual. Furthermore, the CPS also includes articles that discuss items outside of work that are still just as equally important.

One section I highly recommend everyone check on a regular basis is the link that gives suggestions on achieving a work and personal life balance. As the owner of a business, I have found it very easy to be consumed by dentistry alone and not make time for your personal life. With all of these amazing resources under one roof, the ADA is truly aiding in setting dentists up for both personal and professional success.

To read Part 1, click here.

This blog post, reprinted with minimal edits and permission, originally appeared in the Virginia Dental Association journal. Dr. Cappy Sinclair is a New Dentist Now guest blogger and a 2009 graduate of Virginia Commonwealth University. Dr. Sinclair currently serves on the Board of Trustees at the Academy of Cosmetic Dentistry, as member of 3M’s Council for Innovative Dentistry, and as an ambassador for the Dawson Academy. He started his own practice Coastal Cosmetic Dentistry 3 years ago from the ground up and is more than happy to share his success and failures with fellow new dentists. He is a member of the American Dental Association and the Virginia Dental Association. To contact Dr. Sinclair, email him csinclair@smilevabeach.com.