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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.

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.

Social media: Five rules of engagement

Does your practice maintain a website or social networking page?

Twitter_logo_blue           FB-f-Logo__blue_512If so, according to the ADA Center for Professional Success, the person who manages content—you or someone from your staff—should keep these five rules of engagement in mind:

  • Do not post copyrighted or trademarked content without permission from the content owner or a citation, as appropriate.
  • Do not disclose any of the practice’s confidential or proprietary information.
  • Do not post information about a patient, employee, or another individual, including a testimonial, photograph, radiograph, or even a name, without the appropriate written consent, authorization, waiver and release signed by the patient (or the patient’s guardian).
  • All postings on your social media sites should be monitored for compliance by a designated individual in your practice. Keep in mind that if your practice has a policy to monitor media sites and fails to do so (or fails to act on information discovered through monitoring), it could be exposed to liability. Inappropriate, derogatory, or disparaging postings should be removed at your discretion—err on the side of caution.
  • Maintain final approval on postings, even if you designate an employee to monitor and manage social media. Employees shouldn’t speak on the practice’s behalf unless you have authorized them to do so.

For more information on social media engagement, visit success.ADA.org.

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

10 steps to collaborating with pediatric medical providers

Looking to work with pediatric medical providers in your area?

Here are 10 steps to help you with your outreach effort, courtesy of the ADA’s Action for Dental Health, a nationwide, community-based movement aimed at ending the dental health crises facing America today.

Pediatric Dentistry

  • Step 1: Invite a pediatrician or family practice physician to lunch to discuss how you might collaborate to build an interdisciplinary approach to better health for the patients who frequent one or both of your offices. Discuss the patient’s seen and what their oral health needs are.
  • Step 2: Discuss patients ages newborn to five, who have not yet seen a dentist. Discover if your medical colleague discusses oral health questions/issues with the child’s parents or caregiver.
  • Step 3: Introduce the medical provider to oral health resources such as the American Academy of Pediatrics’ Chapter Advocacy Training on Oral Health.
  • Step 4: Discuss what it means to the oral health of a child to add a caries risk assessment, anticipatory guidance, placement of fluoride varnish as appropriate and a referral to a dentist by one year of age are routine part of a well-baby visit.
  • Step 5: Check with the state/local dental society and/or American Academy of Pediatrics chapter to see where similar collaborative oral health programs are working.
  • Step 6: Discuss successful programs that have demonstrated success in this area, such as North Carolina’s “Into the Mouth of Babe” (http://www.ncdhhs.gov/dph/oralhealth/partners/IMB.htm) program.
  • Step 7: Discuss how medical providers can be reimbursed for these services.
  • Step 8: Offer to present an in-service to the physician’s staff on the importance of good oral health for young children. Discuss why “baby teeth” are important and the dire consequences of rampant decay in youngsters.
  • Step 9: Discuss how you might engage others within their community to support your efforts. These groups might include senior citizens, Early Head Start and Head Start teachers, and pediatric residents within the local hospital.
  • Step 10: Share your success stories with the local dental and medical societies demonstrating the value of collaboration.

To read the full 10-step process, click here.

For more information about the ADA’s Action for Dental Health, visit ADA.org/action.

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.

OSHA updates workplace poster

Are you an employee dentist? Do you know your rights?

The federal Occupational Safety and Health Administration unveiled a new version of the employee-rights poster OSHA-covered dentists and other employers must display in a conspicuous place where employees can see it but said employers need not replace previous versions of the posted notice.

OSHAThe new version of the poster “Job Safety and Health – It’s The Law!” is available without charge and in English and other languages at osha.gov or by phone at OSHA’s toll-free number 1-800-321-6742 or the OSHA publications office (202) 693-1888.

The poster is available in Chinese, Korean, Nepali, Polish, Portuguese and Spanish. The Polish and Portuguese versions are available online only. OSHA regulations do not specify or require employers to display the OSHA poster in a foreign language. However, OSHA encourages employers with Spanish-speaking employees to also display the Spanish language version.

For employers in a state with an OSHA-approved state plan, there may be a state version of the OSHA poster. Federal government agencies must use the Federal Agency Poster.

The poster informs workers of their rights and employers of their responsibilities under the Occupational Safety and Health Act. The poster was updated to include new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all employees in a language and vocabulary they can understand, comply with OSHA standards and post citations at or near the place of an alleged violation.

The last poster update was published in 2007.

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.

Part 1: 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.

ADA Benefit Plan Analyzer 

Shortly after setting up my own practice, I was contacted by one of the local representatives of a dental benefit plan. They wanted to know which carriers I would be in network with and also inquired about participating with them.

Since I was just starting out my own practice without any patients, I knew that participating with insurance plans would provide me with an influx of patients. However, I wondered what it would cost me down the road. Just as a refresher, if I became a contracted provider with this insurance company, I would be held to their fee schedule and would only be allowed to charge a patient what they had deemed an appropriate fee. For example, let’s say if normally I were to charge $1,200 for a crown but the insurance company only allowed a charge of $800 for their patients; then I would be looking at a loss of $400 in profit without even picking up the hand-piece. Looking on the opposite spectrum I also had to consider that by becoming a participating provider I may have an increase in 25 new patients a month as opposed to 5 without participation.

This arises the question of how do you know when it makes sense financially to participate with an insurance company? Well, good news, the ADA has developed a benefit plan analyzer that gives you information to see if participation with a certain insurance company makes sense for your office. The program will actually sync with your current system and give you a rating from one to 100—100 being in the best interest and financially speaking for the dentist to participate with the plan. There is nothing worse than starting a practice participating with 10 or 15 insurance plans only to be busy but not productive. It can be a very tough road to recovery from there, which is why I recommend you take a look at this program to help you make those decisions from both a capacity and financial perspective.

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.