Transitional Partner to Co-Owner… Is This the Right Choice For Your Practice?
Kathy Lamont
The Single Most Problematic Issue In Dentistry That You Likely Have Not Thought About Dr. Bryan Laskin
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Spring 2023
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Anne M. Duffy, CEO, RDH
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Editorial Board
Mary Fisher-Day
Travis Rodgers
Barb Stackhouse
Dr. Lucas Shapiro
Dr. Dirk Fleischman
Dr. Earl Douglas
Dr. Tom Snyder
Derek Champange
Dr. David Rice
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Layout and Design
Brian Rummel
Spring 2023 Contributors
Brian Coloa
Doug Fettig
Dr. Ajeet Ghumman
Kathy Lamont
Dr. Bryan Laskin
Dr. Roger Levin
Dr. William J. Moorhead
J.W. Oliver Jr.
Dr. David Rice
Travis Rodgers
Dr. Lucas Shapiro
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Welcome
It’s no secret that the world is evolving at a rapid pace. Since the emergence of the internet, new tools, discoveries, and advancements have made strides – especially in the dental arena. And navigating it all can feel daunting, overwhelming, and downright scary.
During times like these, I find myself constantly held and supported by those in my community. Because as dentists and entrepreneurs, all the resources and knowledge we need can be found among ourselves. We just need to know what to look for, what questions to ask, and who the perfect guide is to steer our curiosity ship.
This issue is exactly that. From Travis Rodgers’ empathetic and human-first view on the ethics and usage of AI in dentistry to Brian Laskin’s insight into a severely overlooked problem in dentistry, we hope that you find the guidance you need between these pages.
We hope that you find the guidance you need between these pages. I have had the great pleasure of getting to know our cover dental entrepreneur, J.W. Oliver. His article, along with our featured authors, gives an insight into a life well lived and thought out. It is my honor to share his thoughts on building a foundation that is rock solid to hang from, as noted in the picture on page 8. He inspires me to align my vision and values first and foremost. Most of all, I’m grateful for his reminder to protect our most precious asset as entrepreneurs, dental professionals, and humans – our time.
After reading the proof cover to cover in one sitting, the common thread is asking yourself where you were, where you are, and where you are going. If we truly get that answered sooner than later, our life and life’s work will thrive. I am grateful for the vulnerability and authentic sharing that these pages provide.
Kathy Lamont gives you the major points of consideration when it comes to your practice, so you can make the most informed choice between co-ownership or a transitional partnership when hiring an associate. Brian Colao gives us the facts about doing your legal due diligence, setting you up for a smooth dental transaction.
When it comes to empathy, understanding, and compassion, William J. Moorhead takes the lead in comforting frightened, fear-patients, turning them into lifelong patients. This issue contains wisdom to help you navigate the advancements in dentistry and entrepreneurship, both today and in the future.
All in all, this issue poses a question worth lingering on yesterday, today, and tomorrow – “What will you do with the time you have in front of you?”
INNOVATION
Time Ain’t Free
J.W. Oliver Jr. – Managing Partner
at SupportDDS
Time!
As an entrepreneur, business owner, leader, or manager, time is one thing money cannot buy.
There are scores of books, blogs, videos, and seminars, all centered around using your time wisely. I have picked up "tidbits" of useful information from dozens of sources over the course of my career. I have invested money (and, coincidently, time) into these resources to make them more fruitful and to better organize and utilize the time we have been given. Just today, I read a verse in my morning devotional that made me think of this very subject.
" …MAKING THE MOST OF THE TIME…" EPHESIANS 5:16.
I must admit that this is taken a bit out of the context of the writer, but it simply stood out as I was gathering content for this editorial. But the bottom line is–we are simply BUSY! Most would agree that we are too busy to make time for the things that really matter.
The tasks that take up most of an entrepreneur's or leader's work time can vary depending on the stage of their business and the nature of their industry. Here are some common activities and responsibilities that typically take up the majority:
1. Business Development
2. Marketing and Sales
3. Financial Management
4. Hiring and Managing Employees
5. Administration and Operations
Overall, entrepreneurs need to wear many hats and manage a wide range of tasks to build and grow their businesses. The specific tasks that take up the most time will depend on their business's unique needs and priorities. It is most important to find your role and surround yourself with others who can help elevate you and your business to the next level.
SYSTEMS:
Our companies, SupportDDS and ZimWorX, subscribe to the EOS Model (Entrepreneur Organizational System) developed by Gino Wickman. There is even a dental business-specific version called "DEO MAP," (highly recommend it for any business, however, there are many options.) This focuses on attributing your specific skill set to your organization and staying in your lane. For me, I have been a serial entrepreneur (many failures, I must humbly add) and, for many years, tried to perform multiple roles that began to be devastating to the business. This behavior leads to distrust and puts your leadership in a position where they can feel emasculated to make day-to-day business decisions. This creates confusion, but more importantly, it leads to hitting the inevitable "ceiling.”
It's real, and I have experienced this multiple times. In the EOS
model, I am the visionary. I am skilled at creating new ideas for sales and marketing the business, creating leaders and a culture that others will rally around. (Yes, I am that “Rah Rah” guy.) But what I am not good at is the details of operation manuals, accounting, process development, follow-up, etc… What I have found, however, are people who are great at those roles. We have an amazing Implementer who can lead and drive the areas with particular skill sets in, with which I am not blessed.
ELIMINATE, DELEGATE, AUTOMATE, CONCENTRATE:
Rory Vaden wrote a really good book, Procrastinate on Purpose. The concept that stuck out the most for me is that every item we are tasked with falls into one of the four categories:
1. Eliminate: Do I really need to do this? Will it bring me closer to the goals I have set for my day/week/month/year/ life?
2. Delegate: Is this something I really need to do? Could someone else be better skilled or suited to complete this task? Even if they can only complete it with 80% of the effectiveness of what you can, let them do it. This gives you back time to fill your role the most effectively.
3. Automate: Is there a software, a process, or something in your CRM that would allow this task to be automated?
4. Concentrate: If you are going to accept the task, then allocate the proper time to complete the task or project effectively.
Rory Vaden states that even if it takes you 30x times as long to train another person or automate a task, it is still an amazing ROT (Return On Time). Are you taking the time to evaluate each task/ project that comes your way to see if you really need to be doing this one? Maybe you do, but is that now? (Rory has a 5th one,
"procrastinate", hence the book title.)
SupportDDS has found success because we have filled the roles in a dental office that can help "elevate your team and grow your business.” This outsourcing function is performed by remote/ virtual, highly qualified, university-educated, dental-trained team members who speak "Queen’s English.” (Feel free to substitute "King's English" if that floats your boat…smiles)
These roles include:
Executive/Personal Assistant
Bookkeeping/Accounting
Director of First Impressions
Scheduling
Insurance Verifications
Re-care/Reactivation
Social Media/Marketing
Lead Management
Revenue Cycle Management
Etc…
Personally, our remote/virtual center has allowed me to become a better leader and visionary with three roles that previously took 115% of my time. (Ok, slight exaggeration, but it was a ton of my time.) These roles can be performed at 50–70% savings with our center in Zimbabwe and Costa Rica.
Executive Assistant: Handles all my meetings, calendar, emails, travel, return calls, etc...(Kudos to Clara for putting up with me for 5 years.)
Brand Manager: Helps promote my brand within our company through social media, blogs, website, speaking, podcasts, and more.
Project Manager: These are large projects that take tedious time and effort (and a better skill set than mine). For example, we opened a center in Costa Rica for our Spanish-speaking teams. Our project manager handled the details and did it well. That project alone lasted six months (and took a ton of time).
Now hold your horses before you start saying you cannot do that, it costs too much, I wish, etc... Maybe not all at once, but start small and grow. I didn’t start with these three roles, but over the past five years, we've grown into them!
PRIORITIZE "THIS IS HOW WE DO IT":
I recently heard former HIP-HOP icon Montell Jordan (now a pastor) and his wife Kristin speak on marriage (a good book they wrote, This Is How We Do It! Making Your Marriage A Masterpeace), it was how to prioritize what’s most important. Yours may
be different, but you can use this as a guide:
1. God
2. Spouse
3. Children
4. Church
5. Family/Friends
6. Work and Career
7. Hobbies/me time
Whatever system you use, there are a few tips I have learned through my career that I believe you, too, can find helpful:
Creative time: Needs to be early while most are rested, and you must clear your plate and stay focused. This is when you can master and complete those projects/writing/ideas that advance your business and personal lives.
Phone Calls: Do these back-to-back. Also, ask yourself, do I personally need to make that call, or can someone else?
Emails: Do not check them every time it "DINGS." Check them all at once. (I am terrible at this, but I did turn the "DINGER" off.)
Meetings: Decide if you really need to have one, or if you really need to be there. Let others lead 90% of these, and let them decide and send you the summary. Promise, you and your business will not die/fail! It may just GROW!
Fire the bad clients/patients: We recently had to fire one of our larger clients. We took a significant hit on revenue, but they did not align with the "Mission and Core Values" of our organization. Promise you one thing, 2% of your clients will cause you 95% of your problems!
Time is all we really have. We cannot buy more, and we cannot get a refund for the time wasted. Develop a system that works for you, write it down, review it daily, and share it with your "confidants" (close friends, spouse, and God). This will allow you to live your passion, enjoy life, focus on what you are good at, and do what you love.
J.W. Oliver Jr. is the Managing Partner for SupportDDS – ZimWorX, with support centers in Zimbabwe and Costa Rica. ZimWorX has a vision to employ 20,000 team members by December 2031.
His passion is assisting organizations to leverage growth, increase productivity, manage costs, and free up time by utilizing remote/virtual teams. He is proud to be a Christian-led entrepreneur while adopting a Win-Win-Win philosophy. Creating professional opportunities, and helping businesses be their very best, all while making a Global Impact for the kingdom by donating 51% of profits to ministries around the globe.
J.W. has completed two ½ Iron Men races, twelve Half Marathons, hiked 6 days from Cusco to Choquequirao to Machu Picchu, and trekked to Everest Base Camp, all after the age of 48. He is a private pilot, philanthropist, ordained minister, author, podcast host, and he loves to sing. He works hard to see others laugh and smile, and he desires most of all, to uplift and encourage all he encounters to show them the love of Jesus. He has been married to his amazing “bride” since 1994 with two awesome adult children.
Transitional Partner to Co-Owner… Is This the Right Choice For Your Practice?
Kathy Lamont, RDH
Did you know that the average time before a dental associate leaves is 18 months? Any idea how much replacing an associate costs today?
The turnover of an associate dentist is both financially and emotionally costly. Imagine continuing this same cycle with a string of dental associate failures – what does that tally come to? Think about that for a minute.
For example, If your associate makes $150,000 a year, the estimated cost to replace them can be upwards of $320,000.1 If you have to hire and replace a second associate, you are now looking at well over $500,000. This may be shocking to you, but the fact is dentist owners don’t take into account the following costs associated with associate turnover:
• Loss of productivity as the associate becomes disconnected after deciding to leave.
• Diminished employee productivity, who see high associate turnover.
• The cost of hiring a new associate, including the recruiting cost, advertising, interviewing time, and attorney fees.
• It takes time for the new associate to ramp up production.
• Cost of onboarding a new person, including clinical and non-
clinical training.
• Trust impact—Whenever someone leaves, other employees and patients ask, "why?"
To stop the revolving door of associates, we need to understand why they leave.
• Rising student debt - The average debt per graduating senior in 2020 was over $300,000, according to the American Student Dental Association.2 This high level of debt can jeopardize a new dentist’s ability to choose their preferred career path.
• Practice is not prepared; lacking in systems and protocols –Most dentist owners do not consider if the practice is ready to add an associate. Practices lacking well-defined and executed systems and protocols make it almost impossible to have a long-term successful associate. These offices are often chaotic, and adding an associate is not the answer to the chaos of any practice.
• Not enough patients to add an associate – I often hear from associates that the reason they left was due to the doctor owner seeing the majority of the patients and moving treatment from the associates' schedule to theirs. This is a clear sign the practice
does not have enough patients to add an associate.
• Poor communication with the team – Team engagement is essential to the success of your associate. The team is often left out of the equation when bringing in an associate. If the team has not been given the tools and scripts to answer patient questions, it can cause anxiety and resentment.
years.4 This rapid growth of the DSO market can be attributed to signing bonuses for paying down student debt, freedom from ownership debt, the ability to focus on dentistry and patient care, and most recently, equity or profit sharing for their associate dentists.
“If the private practice owner is going to thrive in the growing DSO market, the mindset must change. ”
• No onboarding or integration plan for the Associate – Post signing the employee agreement, there is very little thought and planning to onboarding and training the associate. Teams tell me they feel unappreciated and resentful and feel responsible for training the associates. Some of your team may begin to feel like the new associate is a subordinate and treat them as an underling.
• No clinical mentoring plans - No written clinical mentoring plan. New dental school graduates are looking for mentorship. In the absence of mentoring, there is often frustration for both the dentist owner and associate.
• No scheduling protocol – How will patients be shared? When the scheduling protocol is nonexistent, there is often conflict with the business team, dentist owner, and the associate.
• No clear path to ownership – Often, there are loose or vague mentions of possible ownership. I can’t say this enough, but don’t leave this to a handshake or verbal agreement. Nothing good comes from this but unrealized expectations and a feeling that both parties have wasted their time and money.
In the last 20 years, there has been a significant shift in private practice ownership. Private practice ownership has declined to 76%, with solo ownership down to 46.2 %.3 In contrast, dentists affiliated with a DSO have risen from 7.4% to 10.4% in just 3
It is time for private practice owners to sit up and take notice of the changing times. If the private practice owner is going to thrive in the growing DSO market, the mindset must change. I want you to consider moving from solo private practice to a partnership.
Look at this scenario - A solo dentist practice collecting $1,000,000 has a profit of 40% or $400,000 a year5. A two-dentist partnership can have profits of $580,000. This increase in profits is due to the sharing of fixed expenses and economies of scale when purchasing sundries, equipment, and lab fees. As a result of the increased collections, your practice value will rise.
Partnerships offer other advantages other than increased profits and a higher practice valuation. It also offers the freedom to take time off, go on vacation, and take maternity or medical leave without the financial burdens of the office overhead. It becomes easier to offer 401k, profit sharing, or health insurance for your team.
When dentists change their mindset and consider an associate as a potential partner rather than someone who is going to pass through in 12 months – that can be the game changer.
I challenge you to open your mind and blaze a new path for your private practice to survive, thrive, and stop the insanity of the revolving door of the dental associate and stave off the rapid
growth of the DSO market. This new path must be intentional and include planning, action, and accountability for sustained success.
Transitional Partnership to Co-Ownership is not a new concept, but it is reimagined. The addition of a Transitional Partner gives you a chance to work together before becoming partners. The details of a future co-ownership, percentage of practice buy-in with a predetermined value, and length of trial period, are agreed upon prior to execution of the Transitional Partner agreement. Doing this avoids the ambiguity of a verbal agreement. Before beginning to recruit, it is wise to evaluate your practice and team readiness. Doing this ensures you the best opportunity for a successful long-term partnership.
Evaluate your practice readiness – Give a thorough and honest assessment of your practice readiness. You might need to improve production, systems, and protocols prior to adding an associate. You may need to engage outside professionals to help you with this assessment. (Download your free Practice Readiness Assessment at https://www.kathylamont.com/landing)
Once you know your practice is ready to add an associate, you will need to design an employee agreement that will attract and retain the best of the best candidates.
The Transitional Partnership Agreement – What is the Transitional Partnership Agreement? Simply put, it is a traditional associateship with the ability to buy into a partnership. This agreement offers a clear path to ownership. Most student dentists aspire to own a practice one day, so why not create a transitional ownership path? If a dentist chooses dentistry for its potential for entrepreneurship, then we know the outcome of the associate relationship will eventually end. If you are not offering a partial –full ownership path, you may lose your associate to buying a solo private practice or to a DSO that offers ownership equity without the burden of enormous debt.
You might be thinking, “I don’t want to give any equity in my business, and I don’t want a partner.” You’re not giving away anything, you will be selling a percentage of your practice and can retain majority ownership, leaving you to be the sole decision maker. You can sell any percentage you like, but 20% or more is the most effective at retaining your transitional partner.
The Transitional Partnership Model is attractive for many reasons, but the top reasons are to attract and retain the best of the best dentist partners, grow your practice, increase your income, and have the work-life balance you desire.
As with the associate dentist, partnerships can fail too. Most partnerships fail because both parties jump into a partnership too quickly. You can mitigate the risk of a partnership failing
by detailed planning, practice readiness, and team engagement followed by a transitional partnership period before the co-ownership agreement is executed.
In 4 decades of being in the dental industry, it has become clear that the future of private practice is changing. We can no longer continue to do the same thing, expecting different results. That is the definition of insanity.
I know there is a better way, The Transitional Partnership is the future of private practice growth and succession. Remember that, planning, action, and accountability, trumps hope for the best every time!
Sources:
1Dentistry IQ, September 24, 2018, Quyen Pham, DDS
2American Student Dental Association, ADEA Survey of Dental School Seniors, 2019 3ADA, Health Policy Institute, March 2022 4ADA, Health Policy Institute, December 3, 2021 5Dentistry IQ, May 2003, Flossie Reiser
Kathy Lamont, RDH, is the Practice Transformation Catalyst. She has almost 4 decades of dental industry experience. Her experience ranges from clinical dental hygiene for more than 20 years, 3M ESPE dental sales, Regional Director for a DSO, Director of Operations and Training for small dentist-owned groups, and most recently, launching her own dental coaching and consulting business.
www.kathylamont.com
To book a call with Kathy - www.kathylamont.com/bookacall
The Importance of Legal Due Diligence in Dental Transactions
Brian Colao
The dental industry is in the midst of a great evolution that is more than 10 years old. This great evolution of dentistry from solo offices and groups to DSOs has involved an unprecedented amount of mergers and acquisitions. A critical component of any merger or acquisition must be legal due diligence.
Legal due diligence is a critical part of the process whereby the buyer makes a determination as to the ultimate value of the dental organization being acquired. If the soon-to-be-acquired organization is not regulatory compliant, then that could materially affect its value and may result in a reduced purchase price or, in extreme cases, the cancellation of the transaction.
Comprehensive legal due diligence covers a number of issues, including but not limited to the organization’s:
Legal structure; Legal agreements; Contract compliance; Patient and employee incentive plans; Advertising and marketing arrangements; Patient finance arrangements; Intellectual property; HIPAA compliance; OSHA compliance; Labor and employment practices;
Associate employment agreements; Leases and other property arrangements; Licenses permits and certifications; Insurance coverages; Privacy and data protection regulations; Billing and collections practices; Benefits plan review; Medicaid compliance (if applicable); Medical records compliance; and Litigation, liens, and investigation history.
Comprehensive legal due diligence often uncovers issues that can materially affect the value of the soon-to-be-acquired dental organization, which properly results in purchase price adjustments or closing conditions that must be met for the transaction to occur.
Some commonly discovered issues are:
A Non-Compliant Legal Structure — State laws mandate that a dental organization meet certain legal requirements. Failure to properly structure a dental organization can result in civil and criminal actions as well as insurance and Medicaid claims being disallowed. Therefore it is critical that any soon-to-be-acquired organization be properly structured.
Non-Compliant Agreements — State laws regulate the relationship between 1) DSOs and dental practices, and 2) dental practices
and clinical and non-clinical employees. Failure to comply with state laws can result in severe fines and penalties, as well as having to redraft agreements.
Noncompliance with Contractual Terms — It is critical that any dental organization comply with its existing agreements, or it runs the risk of lawsuits and other legal actions for breach of contract.
Non-Compliant Advertising and Marketing Programs — State and federal laws prohibit illegal advertising, marketing, and patient referral plans. It is critical that any dental organization follow these rules or risk civil and criminal actions along with class action lawsuits.
Non-Compliant Patient Finance Plans — State and federal laws require that dental organizations conduct any patient finance plans (even those that do not charge interest) in a regulatorycompliant manner. Failure to do so can result in severe civil and criminal penalties.
Failure to Document and Protect Intellectual Property — It is critical that dental organizations protect their intellectual property, including tradenames, proprietary systems, copyrights, and patients. Failure to do so can result in these rights being forfeited.
Noncompliance with HIPAA and OSHA — It is critical that all dental organizations comply with HIPAA and OSHA, and failure to do so can result in severe fines and penalties from the governments.
Noncompliance with Labor and Employment Regulations — State and federal law governs all employment and independent contractor relationships and hourly and exempt employment relationships. Likewise, associate employment agreements must protect the practice. Failure to follow the regulations can result in significant fines and penalties, and failure to protect the practice’s interest in associate contracts can have a severe impact on the value of the organization.
Problematic Leases — Leases that contain problematic terms can threaten the financial viability of the organization and the ability to grow and expand.
Failure to Obtain Licenses, Permits, Certifications, and Insurance Coverages — It is essential that every dental organization maintain all required licenses, permits, and certifications as well as maintain proper insurance. Failure to do so can dramatically affect the overall value of the organization.
Noncompliance with Privacy and Data Protection Regulations — Failure to comply with applicable privacy and data protection regulations can make the organization extremely vulnerable.
Noncompliance Billing and Collection Practices — Failure to comply with billing and collecting regulations can dramatically lower the value of the organization.
Non-compliant Benefits Plans — Failure to comply with state and federal laws governing benefits plans can subject the organization to civil and criminal fines and penalties.
Noncompliance with Medicaid Regulations — Organizations that participate in Medicaid must comply with numerous state and federal regulations, and failure to do so can result in serious civil and criminal fines and penalties, and recoupment, all of which can significantly lower the value of the organization.
Problematic Litigation, Liens, or Investigations — Organizations that are involved in certain types of litigation or government investigations or have problematic liens can see their value dramatically reduced.
Based on the foregoing, it is imperative that any potential buyer conduct thorough legal due diligence on the potential merger or acquisition target. The failure to do so could result in the acquisition of an organization that is worth far less than the purchase price, which can have devastating consequences for would-be buyers. It is also critical that any potential buyer utilize competent legal counsel with significant experience in the dental space, or else run the risk of a negative outcome. The dental space is very specialized and unique. There are a relatively small number of law firms that truly understand the dental space, and if you use a firm that lacks experience in dental, very important due diligence and legal issues can be missed, and the buyer could end up overpaying for an asset that is worth much less.
Ideally, the buyer will conduct their due diligence early before spending significant time on the transaction so that any problematic issues can be addressed before the parties expend significant time and effort on the transaction. That way, if the issues cannot be resolved, then it is very easy for the buyer to cancel the transaction.
Conducting comprehensive legal due diligence, coupled with utilizing a law firm with significant experience in dental transactions, provides the best chance for a smooth dental transaction that is fair to the buyer.
Brian Colao is the Director of Dykema’s Dental Service Organizations Group. He has been serving the dental industry for nearly 30 years and is widely regarded as one of the foremost authorities in the United States on DSO formation, DSO business structures, DSO-related mergers and acquisitions, and the full array of regulatory compliance requirements for DSOs. Brian was named a “2019 DSO Influencer” by Group Dentistry Now.
5 Ways to Increase Staff Longevity
ROGER P. LEVIN, DDS
Since 2021, dentistry has been experiencing a staffing crisis. In fact, we have never had a shortage at this level before. Levin Group data indicates that up to 10% of full-time dental hygienists have left the profession. In a recent national survey, we also found that 64% of practices are currently seeking to add at least one team member. This is not an appealing prospect for any practice. Taking time out of your busy schedule to advertise for and find the right team members can be inconvenient and, let’s face it, highly unenjoyable. One of the ways that practices can reduce their instances of having to replace team members is to work proactively on retaining the dental team for as long as possible.
Is having a long-term team based on good luck? I was recently asked whether or not luck played a role in staff longevity. Of course, there is certainly bad luck, such as a team member retiring, moving, or becoming ill and leaving the practice. However, this is not the main reason for low staff longevity in most practices. The main reason is more about leadership and skill than luck. In a world where team members can find a new position very quickly, you must be proactive in developing an environment that creates a desire for team members to remain with the practice. This is an environment where team members would be upset at the very
thought of having to leave the practice because they value and enjoy their job. Here are five recommendations to help you create this type of culture and increase you staff longevity:
FIVE RECOMMENDATIONS TO INCREASE STAFF LONGEVITY
1. Develop a well-run practice. A concept that has not changed in 40 years is that the key to a smooth-running practice is excellent practice management systems. The better the systems, the better the practice will run and operate and be more enjoyable for the team. Systems are also the training program for current and new team members. In the event that you do add a new team member, excellent systems offer the fastest way to train them. If you have the right systems and they are followed, you will have an outstanding practice. Levin Group’s 30-year ongoing study of top 10% producing practices has identified 17 principles that these practices generally have in common. One of the principles is that they have excellent, documented systems and update them regularly. This is the first step of building an overall environment that is easy, effortless, and
enjoyable for the team.
2. Become an exemplary leader. The word exemplary is a derivative of the word example and one of the best principles you can follow as a leader is to be the example of what you want your team to be. Levin Group asks each dentist to identify five specific characteristics that they want to see in their team. This list of characteristics has included honesty, integrity, dedication, helpfulness, and positivity. Whatever your five characteristics are, you need to begin to display them all the time. The easiest way to do this is to pick one characteristic a week for five weeks and add it to your leadership persona. Don’t announce it, just become it. By putting this into practice, you will gradually become the leader that many team members will want to stay with long-term.
3. Create a positive environment. Dental practices are hard-working, fast-paced, and often stressful environments. Most people come to work hoping nothing will go wrong, which is unrealistic. In most practices, it’s fair to say that at least one thing will go wrong every day and on some days many things will go wrong. It’s human nature for people to be upset by those exceptions and unexpected scenarios, rather than simply viewing their job as dealing with it and moving on.
In a positive culture, the leader and team have in-depth discussions about how to handle everything in the practice. Having a team attitude of everybody pitching in to help everybody else goes a long way toward reducing stress and tension. Unexpected challenges always come up. There will always be no-shows, patients who do not pay, late patients, patients who come on the wrong day, or patients who make demands that are unreasonable. This is a normal part of life in a dental practice; however, having a positive culture and environment will help you to overcome all of these issues. One strategy that we have for bolstering positivity is to start every day with an inspirational story or saying at the beginning of the morning meeting.
4. Communicate, communicate, communicate. People today want transparency, information, and communication, and they want it as early as possible. You want the team to know that you trust them enough to share important practice information right away. I once asked a 24-year team member who was still performing at an extremely high level why she was still at her current practice. Her answer was, “Because our doctor trusts me.” People enjoy being trusted because it makes them feel important, responsible, and desirable. These are emotions that help many people develop a strong desire to stay with the practice.
5. Provide fair compensation. If your staff feels underpaid, they will feel underappreciated, and this will decrease staff longevity. Read the online recruiting sites to gain a sense of what is offered in the open market, especially in your area. Longer-term staff tend to have regular increases in compensation and generally end up being paid at close to the top or above the top market rates. This is actually an effective strategy for helping to maintain a team longer. Since the pandemic of 2020–2022, dentists have had to increase their team compensation in order to compete with increases in overall staffing costs. In a survey of 2022 compensation, we found that staffing costs had increased approximately 10% and we are confident that they will never be reduced. By offering fair compensation, practices will have less staff members interested in finding other positions for higher compensation.
SUMMARY
Maintaining a long-term staff or increasing staff longevity is psychologically and financially easier than many dentists and office managers think. Rather than being frustrated and annoyed at the staffing situation, a good leader embraces the necessary concepts to build higher staff longevity and takes the appropriate steps. The right attitude and the above recommendations will help any practice to increase staff longevity, which simultaneously creates an easier, more effortless, and enjoyable practice.
Roger P. Levin, DDS is the CEO and Founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on dental practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world.
To contact Dr. Levin or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit www.levingroup.com or email rlevin@levingroup.com
Artificial Intelligence: Revolutionizing Dentistry & Mental Health
Travis Rodgers
This week, my 10-year-old son, Blake, asked me if he could use ChatGPT to do his homework. I usually follow a strict parental guideline that, in my family, we call “The Rodgers Guiding Principles,” which would quickly answer NO to such a question. Instead of saying yes or no, we discussed ChatGPT, OpenAI, Artificial Intelligence (AI), and the ethical use of technology. I believe children and humans need to have a mind of their own, and they should be taught skills for critical thinking. The other side is that we should not hold our children and employees back from utilizing technology to their benefit. My discussion with Blake about using ChatGPT was enlightening, and I will let you know my conclusion at the end of this article.
The forecast for AI in healthcare projects a formidable growth trajectory, with the industry’s global value just within AI being poised to eclipse $187.95 billion by 2030. Dentistry is poised to be a significant beneficiary of this growth as it leverages AI technologies to enhance various operational areas, from patient interactions to diagnostic precision.
The highest growth opportunity in AI is within the mental health area. That segment is expected to grow by 37% from 2023 to 2030. We are seeing products like Shine AI by Mental Wellness Impact with configurable AI avatars that speak to patients and provide relevant resources and real-time scheduling with mental
wellness providers. Similar technology is also being developed in dentistry.
Artificial intelligence (AI) has emerged as a potent force in modern healthcare, transforming numerous facets of medical practice. As an integral part of this landscape, dentistry has not been an exception to this influence. The application of AI has brought about significant advancements in dentistry, enhancing its efficiency, precision, and scope.
AI: THE BEDROCK OF MODERN DENTAL PRACTICE
With its capability to analyze vast amounts of data, AI has revolutionized how we approach dental health care. Its influence is not limited to patient care alone but extends to administrative tasks, research, and dentistry education.
AI has mainly made a mark in the clinical aspect of dentistry. Incorporating AI in diagnostic tools has already been a gamechanger in the dental industry. It's common for AI to detect anomalies in dental radiographs that human eyes may overlook due to fatigue, distractions, or limited time. AI bolsters the diagnostic process by providing an extra layer of scrutiny, ensuring thorough and meticulous assessments. It's noteworthy that AI, while providing insightful data, is an adjunct to human expertise and not a replacement for it. The final decision-making power still rests with the trained dental professionals, who utilize AI as a support tool in their practice.
The use of AI in dentistry extends to dental administration. AI aids in streamlining insurance claims and enhancing record-keeping. Its ability to monitor patient progress and compare performance across multiple practices is invaluable in a data-driven healthcare system. Products like OneClick Referral utilize AI for managing referral colleagues and patient communication during the referral process. AI matches personality types to how the practice communicates with each patient based on their personality type.
Furthermore, AI has shown promise in unveiling potential correlations between dental and general health. By sifting through large volumes of data, AI may identify patterns that could lead to a more holistic and preventative approach to healthcare.
AI'S INDISPENSABLE ROLE IN DENTAL EDUCATION
The role of AI isn't limited to the confines of the dental clinic. It has made significant strides in the realm of dental education as
well. In the hands of educators, AI can be a powerful tool that provides an interactive and immersive learning experience for students. This is particularly pertinent in an era where virtual technologies have accelerated due to the pandemic, paving the way for AI systems like ChatGPT to be integrated into educational settings
In the evolving landscape of dental education, AI applications are being leveraged to enhance traditional learning strategies. As a result, dental schools are beginning to recognize the need to update their curriculum in response to these advancements. Implementing AI-based strategies, such as peer learning and search for resources, can be integrated into the curriculum to better align with student learning strategies.
The advancement of AI in dental education has also prompted discussions on the need for a core curriculum on AI in dentistry. The objective is to equip dental students with the knowledge and skills to critically evaluate and effectively use AI applications in their future practice.
CHATGPT: A LEAP FORWARD IN DENTAL PRACTICE AND EDUCATION
Among the various AI tools, ChatGPT by OpenAI stands out as a transformative tool for the dental industry. It has demonstrated its potential by enhancing diagnostic accuracy, answering patient queries, and facilitating complex conversation flows. The stateful nature of ChatGPT, which allows it to learn from previous interactions, makes it a valuable tool in patient care, dental education, and research.
ChatGPT can provide a comprehensive patient education tool capable of answering questions on dental conditions, procedures, and general oral hygiene. Its human-like conversation ability can alleviate patient anxieties, and it can also manage appointment scheduling and follow-ups.
ChatGPT is being utilized as a dynamic teaching tool in the educational realm. It can assist dental students in understanding complex topics, engaging in interactive case discussions, and developing their diagnostic skills. Additionally, AI can be used to simulate patient interactions, helping students hone their communication skills. AI-enabled learning can prepare students for real-world scenarios, equipping them with a robust skill set for their future practice.
continues to evolve, it will undoubtedly continue to reshape the landscape of dentistry, bringing new opportunities and challenges. As we navigate this transformation, we must ensure that AI is used responsibly and in the best interest of patient care. The future of dentistry is bright, and AI promises to play a significant role.
My answer to Blake about using ChatGPT to help him with his homework: "The purpose of parenting and school and teachers is to prepare you and give you the life skills to be successful and
THE FUTURE OF AI IN DENTISTRY
The impact of AI on dentistry is set to grow even further. Developments in AI are expected to facilitate the creation of an advanced comprehensive care system, which will enhance patient care and spur innovative research and development in dentistry. Innovative inter-professional coordination among clinicians, researchers, and engineers will likely be instrumental in driving AI development in this sector.
Technologies such as 3D scanning and smartphone applications are already commonplace in the dental industry and continue to evolve. The dental community has shown interest in leveraging the metaverse, a virtual environment that simulates the natural world, for dental education and telemedicine consultations. This could transform how dentistry is taught and practiced, bringing a new dimension to the field
AI's potential in dentistry is vast, but it's essential to address the ethical and legal implications of its implementation. This includes concerns about patient privacy and the potential for misinterpretation of data. Ensuring that AI is used responsibly will be critical to successfully integrating it into dentistry.
CONCLUSION
AI, with its immense potential, has been a transformative force in dentistry. It has not only improved the efficiency and precision of dental practice but has also enriched dental education. As AI
happy. AI and ChatGPT are here to stay. If you can become an expert and utilize AI to have a positive impact on your life and career, then you should start to learn them now. So YES, you can use ChatGPT to do your homework, just as long as you are reading and learning the information, utilizing it for good, customizing the content output enough to make it yours, and it is ok with your school and teacher.”
Travis first developed his love of artificial intelligence at IBM from 2011 to 2014 when his team at IBM developed some of the first artificial intelligence solutions for “cloning talent” to identify the best match for enterprise talent acquisition teams. In the dental industry, Travis and his team at DrDDS Innovations have continued to utilize AI for their database product, referral product, marketing automation, and others. In 2024, Travis will be launching an AI-based mental wellness application to address what has become the most significant growing issue in healthcare.
PODCAST: Referrals Save Lives, with Travis Rodgers
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Turn Frightened Dental Callers into Lifelong Patients
IV Sedation Adds Profitability Tools for the Future of Your Practice
William J. Moorhead DMD
Treating fearful dental patients can be very rewarding. The average dental fear patient needs over $2000 in dental work for every year they haven’t seen a dentist. Since many of these patients have avoided a dental visit for over a decade, case sizes quickly mount up.
Sedation has proven to be an effective tool for fearful patients, patients with strong gag reflexes, special needs patients, and lengthy procedures. With the popularity of dental implants rising, there is even more call for IV sedation in general practice.
Dental fear patients offer a unique opportunity but also can create unique challenges to your practice. More than one in five avoid dental care altogether due to fear and anxiety – that’s over 60 million Americans. When anxiety, stress, and fear become the dominant motivations driving your patients, it can be close to impossible for you to help your patient back to health. Practices performing IV sedation attract patients that increase practice productivity, and advance the image of a dental practice as a leader in the level of care offered in the community.
By adding sedation to your practice, your future dental practice can be transformed into a market leader. Adding sedation to your
practice shows your potential patient you are better trained and ready to address dental fear – the number one problem that keeps patients away from your office.
Without the right tools, treating sedation patients can cause stress – for the patient, the team, and the dentist. Knowing what to say from the very first contact with your potential patient - on the new patient phone call - and knowing the questions to ask during the new patient interview will give you the tools to convert frightened patients into lifelong patients.
A new patient phone call with a fearful patient can be lengthy. If your front office team is short-staffed and can’t give the potential patient the time they need, you risk losing them. These patients require empathy and caring, and they need someone that will listen to their concerns and reassure them. If you are fortunate enough to have someone in your front office that has been sedated by your team in the past, these lengthy phone calls can magically be cut in half just by being able to say, “Dr. (Smith) sedated me for my work and I was amazed at how easy it was.”
Once the fear patient makes it in your office, asking open-ended questions to learn their priorities and their obstacles can be key to
gaining case acceptance. Here are the questions we use in my office to improve the likelihood the patient will say “yes:”
• Ask for the chief complaint and record the patient’s exact words. You will want those exact words during your case presentation.
• “Overall (excluding any specific problems), what is most important to you concerning your teeth?” This question’s goal is to learn their motivating factors. The most frequent motivating factors are avoiding pain, avoiding tooth loss, cosmetics/ appearance, health, cost, and function. Repeating this learned information when the patient is making treatment decisions will increase your success.
• Ask a question to learn about the patient’s perceived obstacles. “As you are considering having your treatment done, is there anything that gets in the way?” For the dental fear patient, you can expect dental fear will be listed, but there may also be other obstacles such as busyness, scheduling, costs, or trust issues, which often go hand in hand with dental fear. You can only address these obstacles when you become aware of them.
• Consider taking digital photos before the new patient interview. Once the photos are uploaded to the patient’s chart, display their retracted smile photo, then ask “is there anything you would like to change about your smile?” Many patients are unaware of their cosmetic issues, and self-discovery is a valuable tool in patient motivation. Before they will consider addressing any cosmetic concerns, you may have to resolve their dental pain first so you can show them you are able to treat them comfortably
• Even though you know the patient is fearful, asking a question to learn their specific concerns will help you better know them. I like to ask “would you share with me what happened in the past that caused you to be anxious about coming to the dentist?” If you and your team have tools to address their specific concern, let them know up front. For instance, injection pain can be decreased dramatically with a dental anesthetic buffering system such as Onset®. And if you are already trained in moderate sedation, share stories that previous patients have shared with you.
• Ask questions about pain or sensitivity to find out additional information beyond the patient’s chief complaint. Like earlier, do your best to record the patient’s exact words, as they can be strong motivators when presenting treatment.
• Consider asking questions about bite related issues, sleep apnea screening and caries risk assessment.
• Last of all, apply principles of personality assessment surveys, such as DISC, to learn how the patient makes decisions. Patients that are direct/assertive (classic “D” and “I” personality types) are more likely to want to decide that day, and your case presentation should be geared toward that. Conversely, more indirect/non-assertive/passive personalities (classic “C” and “S” personalities) often need time to process the data, and pushing them to make a decision can actually push them out the door.
Start using these open-ended questions during your comprehensive exams today and watch your case acceptance increase, both with your dental fear patients as well as your routine new patients.
SUMMARY OF PATIENT INTERVIEW OPEN ENDED QUESTIONS
Chief Complaint:
What are your biggest concerns you want to make sure we address during your visit?
Motivating Factors:
Overall (excluding any specific problems), what is most important to you concerning your teeth?
Obstacles:
As you are considering having your treatment done, is there anything that gets in the way?
Pain/Sensitivity:
Have you come today for the relief of pain? Are you experiencing sensitivity?
Cosmetic Goals:
Is there anything you would like to change about your smile?
Caries Risk:
• What is your favorite drink?
• Do you sip on a drink frequently?
• Do you snack regularly between meals?
• Do you notice plaque buildup on your teeth between brushings?
• Do you have a dry mouth at any time of day other than while sleeping?
Past Dental Experience:
What is your reaction to having dental work done? What happened in the past that caused you to be anxious about coming to the dentist?
Personality Type:
Top of Form
If we were going to do a project together, would you want to know:
• the big picture? (Personality type D or I – Direct/ Assertive)
• all the details? (Personality type C or S – Indirect/Non-Assertive)
William J. Moorhead DMD has developed and teaches systems and strategies for treating high fear patients. With over twenty years’ experience in sedation dentistry, Dr. Moorhead teaches practical ways to make sedation safe and effective in your practice.
Sometimes affectionately referred to as “Dr. Checklist,” Dr. Moorhead speaks across the United States on topics related to systems management, clinical efficiency, dental technology, medical emergencies, treating anxious patients and leadership. He is also the founder and owner of StreamDent® software.
PODCAST: Treating The Fearful Patient, with William J. Moorhead, DMD
The Single Most Problematic Issue In Dentistry That You Likely Have Not Thought About
Dr. Bryan Laskin
As dentists and, by default, leaders in a dental practice, we get inundated with urgent issues all day, every day. There is always someone on the team whose morale seems low, a patient that is upset, a lab case that is late, a sick kid at home, or a slow month to turn around. So, in the dayto-day battle of delivering the highest quality care for our patients and providing the best home life for our teams and our families, it is difficult, if not impossible, to take a step back and examine the most important issues affecting the oral health of our patients (and therefore the financial health of our practices).
I would like to propose to you what I believe to be the single most problematic issue in dentistry that you likely have not thought of and the significantly impactful solutions we have to directly address this issue.
At first glance, the issue that is choking our offices, harming patient care, and blocking innovation in dentistry may seem boring or not as destructive as it truly is. But allow me to point out some of the horrific realities that are a direct result of this obstruction to quality care:
More than 2 million dental-related issues in the US end up in
hospital emergency room visits, costing American patients a useless $2 billion annually (P. Owens, R. Manski, A. Weiss, Emergency Department Visits Involving Dental Conditions, 2018, Healthcare. Cost and Utilization Project, Agency for Healthcare Research and Quality, August 2021)
For millions of patients, their electronic Personal Health Information (ePHI), including critical information, such as medical history data, is locked from being written into the dental practice “Practice Management System” (PMDS) - literally putting their lives at risk.
In the typical Dental Service Organization (DSO) using a cloudbased PMS, due to no fault of their own, anyone at the corporate center likely has access to all of the ePHI of every patient that is seen in any of the hundreds of offices that that DSO operates.
If you added up all the crucial information that we, as dentists, get from the innumerable and valuable datasets that are transferred over the broad information exchange networks that our friends in medicine leverage to improve the care of their patients, it would add up to the impressive, depressing number zero.
Therefore, it may be obvious that what I think is the biggest problem in dentistry, that shockingly no one is talking about, is the lack of data interoperability.
If you haven’t been exposed to the term before, interoperability is the ability of computers or software to exchange information. Have you ever thought about who actually owns all that information that you input into your PMS every day that likely sits in a server in a closet in your office? Allow me to answer this question, as it turns out it is a significant factor in our discussion about interoperability.
dentist at this conference!”. Turns out he was having a weekend partying with his friends…
At every single one of the healthcare conferences I attend, there are three connected issues that take over the majority of the panel discussions; data interoperability, regulation compliance (HIPAA and the Cures Act, primarily), and patient care. Of these topics, in dentistry, we have completely ignored the discussion on data interoperability for far too long.
Here is one, simple example of how the lack of interoperability
“If, at this point you are thinking, ‘why have I never heard about this before’, don’t feel bad.”
As far as I am aware (and I have researched this topic extensively; however, I am a dentist… not an attorney), the patient legally owns their own ePHI within your PMS. You, as the dentist of record, are a steward of this important resource of the patient. So why, then, is it impossible to transfer the patient records between us? The answer is that PMSs have been acting like this data is theirs, essentially creating a prison of this information that prevents patient care in the interest of keeping you hostage to their archaic systems.
If this seems controversial or accusatorial, I only point out this reality because it is important to clearly understand the blockages in order to directly address the problem and why there has been recent regulation that “forces” a solution. That regulation is the 2016 21st Century Cures Act, which carries a provision that went into effect late last year (10/6/22, to be exact) called the “Information Blocking Rule,” designed to specifically address the issue of lack of interoperability in healthcare.
If, at this point you are thinking, “why have I never heard about this before”, don’t feel bad. Actually, when I met the prior head of the Department of Health and Human Services late last year, she also had NO idea how bad things were in dentistry. Being in the narrow lane of “dental data information exchange” that I am currently working in, I often find myself as the sole dentist at an innovative health care conference. In fact, last year, I was excited to see a dental school classmate of mine on the casino floor of a Las Vegas hotel and called out, “Wow! It’s great to see another
fundamentally changes the quality of care that we accept as “normal today.” Let’s say a patient, named Lisa, moved from Oklahoma to your town and presented to you as a new patient with pain in the lower left. What would you do? Likely, take a radiograph, right?
Let’s stop there. Why don’t you pull up Lisa's medical history, compare what she filled out in your practice with what is on record with her physician and review her medical and dental history, including the prior treatment in the lower left with radiographs? That, surely, would be very helpful. It just isn’t possible because of our lack of interoperability.
So, we take a radiograph (panorex, CT or PA? Really, we don’t know because, well, you know…). Then you test Lisa’s teeth and determine that there is a failing root canal on tooth #19. There is no obvious issue with the endo or restoration of the tooth. So, what is the treatment plan?
Turns out, if you had called the prior dentist or had access to the dental records, you would have found out that when the endo was done on tooth #19, there was a hairline fracture noted on the pulpal floor of the tooth. If you were like me, you would have likely punted to the endodontist to make this decision, who would have treatment planned to redo the endo, and Lisa would go through multiple rounds of treatment, costs, and discomfort, only to lose the tooth quickly thereafter.
And we haven’t even discussed the lack of information that gets transferred from my office to the endo office.
So, what can be done about this problem? The answer is creating Standards and technology that align the profession and create secure, yet simple ways to transfer our patients’ data (remember… it is THEIR data). That work is currently going on at the ADA, Dental Standards Institute (DSI) Standards Development Organizations, as well as at innovative technology companies (that you may not have heard of yet) that are creating the network that will facilitate the reality of secure, open interoperability of Connected Dentistry ®, connecting dentistry, as well as connecting dentistry to medicine.
There is a lot of work to be done, for sure, but we are making rapid progress toward solutions. Solutions you will likely be hearing a lot about in the coming months and years.
If you would like to be involved in helping address the issue of dental interoperability, as an advocate of the mission, or actively involved in Standards development, feel free to reach out to me or any other ADA Standards Committee member.
We, in dentistry, are starting to focus on medical/dental integration, trying to connect the dots in everything from sleep issues to diabetes/periodontal disease connection. However, we cannot have medical/dental integration without both medical/dental interoperability, as well as collaboration with our physician friends.
So, please join me in attending a healthcare conference that is not “dental specific.”It is not just an eye-opening experience, but one that I firmly believe will allow dentistry to lead the way to better healthcare.
THINGS TO DO, PLACES TO GO
The Dental Culture Con Virtual June 15 -17, 2023
Speaking Consulting Network June 16 - 17, 2023 Nashville, TN
McCormick Place - West Building, 2317 S Indiana Ave Chicago, IL
CE on the Beach July 13 – 14, 2023 Turks & Caicos
Under One Roof July 20- 23, 2023 Nashville, TN
Dr. Bryan Laskin is on a mission to reduce the stress of both dental teams and patients by upgrading care through innovation, education, and Standardization. Creator of Upgrade Dental, Digital Nitrous, OperaDDS, co-founder of Toothapps, as well as author of the Amazon best-selling book “The Patient First Manifesto," and host of "The Patient First Podcast," Dr. Laskin excels at helping others integrate technology and teamwork into their practices.
Dr. Laskin serves as CEO and Chairman of the Board of Dental Standards Institute, as well as Co-Chair for American Dental Association SCDI Workgroups focused on innovation and patient advocacy and serves as counsel for the most innovative companies in dentistry. bryan@toothapps.com
Dykema July 20 – 23, 2023 Denver, CO
ADA Smile Con Oct. 5-7, 2023 Orlando, FL
Orange County Convention Center
If you want to arrange a meetup, please email anneduffy@dentalentrpreneurmedia.com
We’d love to see you!
My Story
Ajeet Ghumman, DDS, Cert. Ortho
An Orthodontist, a business owner, an instructor, and an entrepreneur. Dream big and surround yourself with those that support you in every way.
Born and raised in Calgary, Alberta, Canada, to immigrant parents, I had a simple upbringing in a good community with a great set of friends. I was an avid soccer player, wildly creative, and my hobbies at the time included arts and computers.
It was in my early university days, that I decided to pursue a career in dentistry. I had a knack for medicine but was drawn to dentistry, where I could utilize my talents along with my affinity to connect with others to be able to help individuals while feeling a sense of fulfillment at the same time.
After completing my university degree, I gained acceptance to Howard University, School of Dentistry in Washington, DC, which was the stepping stone to where I am today. A dental school like no other, where the skills learned will shape you, prepare you, and provide you with the fundamental know-how to excel in any situation. Very quickly after entering dental school, I knew that Orthodontics was to be in my future, but to achieve that goal, I had to graduate with the highest scholastic average amongst my peers, and rank first amongst the entire class - and I did, along with receiving a full tuition scholarship due to my achievements both academically and clinically. I worked hard but more importantly, met a group of friends that became family, and we ensured that we would all support each other toward success. Coming from completely different upbringings, backgrounds, and eras, I am grateful for the support I received from Dr. Ron Brun, Dr.
Chris Burton, and Dr. Syed Rahman.
After dental school, I had the pleasure of attending a General Practice Residency at Hartford Hospital, Connecticut. This prestigious one-year program helped to expand my dental skills into all facets of dentistry and related areas of medicine. It was in this program that I was able to perform complex multi-specialty and multi-disciplinary work under a group of accomplished and renowned individuals seasoned in their careers. The work I was able to provide ranged from general dentistry, pediatric sleep dentistry, oral surgery, periodontics, implantology, emergency medical care, orthognathic surgery, and facial plastics.
Counting the years of my undergraduate degree, dental school, and general practice residency, I had already accumulated 9 years of post-secondary education, ultimately being accepted to the University of Medicine and Dentistry of New Jersey, now formally known as Rutgers School of Dental Medicine, for three additional years of schooling. Being only 1 of 4 students to be accepted, it was an honor to be able to achieve such an accomplishment after years of hard work and fortitude toward the vision I had set in my head. Being known as the most "read student," my Orthodontic skills began to truly develop under the apprenticeship of Dr. Robert Binder, Dr. Rene Johe, Dr. Anil Ardeshna, Dr. George Langer, Dr. Robert Montemurno, Dr. Isaac Post, Dr. Jeffery Cooper, Dr. Peter Antonellis, Dr. Joe Lohner, Dr. Susan Rider, Dr. Todd Sherwood, Dr. Richard Bloomstein, and Dr. Frank Bogdan. In listing the above individuals, I cannot forget to mention my co-resident, Dr. Adam Cohen, who had the same desire to strive for success as I did, and was a soundboard to my daily endeavors as a resident.
THE TURNING POINT
After 12 years of post-secondary school, I felt beyond prepared to embark into the world. Naive and full of knowledge with a passion for excellence, the simplest step was to obtain an associate position to help enhance my clinical skills, speed, and patient experience. It was this anti-climatic moment that became one of the biggest turning points in my career. The basic fundamental premise of an associateship is to enhance one's skills along with clinical and career mentorship, and regrettably, this was not the case in my situation. Unfortunately, the assurances made to me were overly embellished, which is not uncommon as many new graduates face the same situation time and time again.
Luckily, I was able to withdraw from this situation to find myself working alongside Dr. Walinder Dhol, a true expert in his field, who remains a mentor to me today. Dr. Dhol provided me with the framework that I needed to expand my knowledge into early preventative orthodontic treatment, airway, myofunctional therapy, and neuromuscular dentistry.
Despite feeling reassured of the mentor-to-mentee relationship, I found there was bitterness left behind from the initial letdown as a new graduate. I knew my path was eventually ownership, but I now wanted to do something different. I wanted to ensure that anyone under my eventual mentorship would be given the tools of greatness. Not only to be shown "what to do", but, more importantly, shown "what not to do," by being open and honest about the realities of clinical treatment, ownership, and entrepreneurship, inclusive of the highs, the lows, the struggles, and the triumphs. It was this, "aha moment", that helped formulate one of the guiding principles that I operate under today, which is "People First."
THE BIRTH OF DENTAL WORKS 4 KIDS & ALIGN ORTHODONTICS
In 2012, after consideration of many opportunities, I decided to move to Toronto, Ontario, to embark on a business ownership opportunity. In preparation, I spent years attending various dental education lectures on business and business management. The opportunity had presented itself to purchase, what at that time was Dental Works 4 Kids, a small pediatric dental office providing a high level of pediatric dental services and being the first office in Ontario to provide in-office general anesthesia services.
The practice had potential, and I clearly saw that the vision of what I wanted for my patients, their families, and the team that I worked with could become a reality. The previous owner helped make the transition as seamless as possible, and I was able to quickly grow the practice to what is now known as Dental Works 4 Kids & Align Orthodontics. A multi-specialty practice, with three locations in the Greater Toronto Area of Ontario, providing Pediatric Dentistry for infants, children, and individuals with special needs, Orthodontics, General Anaesthesia, Speech Therapy, Myofunctinoal Therapy, Nutritional Counselling, and specialized Teen Dental Treatment.
EMBARK ON THE VISION AND EMBRACE THE TEAM
My vision had always consisted of a multi-specialty, multi-location group of practices for a few reasons. As an Orthodontist, or dentist for that matter, we are afforded the opportunity to build long-lasting relationships, and, because of this, we’re able to affect positive change in the lives of those that we meet. It was this reasoning, along with the willingness to be able to do something better for the team members involved in the direct growth of the practice, that gave me the drive to be able to get to where "we"
as a team are today. From the administrative team to the clinical team, to the associate doctors that I have the pleasure of working with, I felt a strong duty and responsibility to be able to do something better for them. Providing them with a place they can call "home", a place where they can grow their careers, provide for their families, pay off their loans, improve their skill sets, expand their knowledge, and eventually grow into other areas of the practice eliminating the so-called "growth ceiling." The number of hours spent on leadership, training, educating, and motivating, were tiresome at the time, but beyond rewarding. Any time I felt "we" as a team took one step backward, we were, in actuality, taking two steps forward.
As a natural part of business and life, there will be those few individuals that just may not take refuge in your vision, or have self-serving needs above the team as a whole and are looking more for short-term gains versus long-term success and stability. There are individuals, no matter how well your intention is, who will not understand what truly motivates and drives you. They may have at one point in time, but as you grow, adapt, and change, you may outgrow them, and that is okay. However, you will find many individuals, if your intentions are true, that will gravitate towards you. Circle yourself with those individuals, and give them your everything. If you do, you will find that you will be rewarded in ways you had never imagined.
THE ENTREPRENEURIAL HAT
In a fast pace world, where we are constantly fighting for time, I found that one of our challenges was scalable solutions to improving efficiencies in the practice, and effectively creating systems in everything we do. An idea spawned through discussions with my team leads - How can we make our lives and the lives of our team easier as we grow and expand our practice? How can we promote independence while keeping our finger on the pulse of the practice ensuring the team is being held accountable to underlying policies and procedures set out to guide them towards a common goal? Our answer came in the form of Clinch, a cloudbased platform we created to allow us to automate our daily tasks, eliminate redundancies, cut costs, and improve the value of our practice. To my surprise, the system showed to be much more useful than first imagined, and today is the backbone of our practices. Through the recognition and support of some of the largest dental product and supply organizations and specifically, Don Grant, who has held various sales and management roles within these organizations, we have been able to make Clinch publically available to all dentists and dental practices, that felt they could benefit from its need and necessity.
While growing Clinch to help improve the daily functions of dentists and their team members, and bring value and cost-cutting to their expenses, we found that there was also a need to better educate the dental team to be able to support any dentist and dental
practice in the way those individuals had envisioned. Keeping this in mind, Clinch has now expanded into Clinch and the Clinch Learning Center, where dentists can send their administrative and clinical team members to be trained and upskilled to help their dentist and dental practice reduce stressors, reach goals, and achieve ultimate success.
WHAT'S NEXT
I consider myself fortunate to be in the field of dentistry, which has allowed me to take my hobbies, talents, knowledge, and character traits along with the morals and values I have developed along the way and be able to reflect this on to my patients, families, team members, and colleagues to be able to truly support them.
Currently, I own 3 multi-specialty practices that operate with 8 doctors that are constantly improving their skills, knowledge, and lifestyle while providing the highest level of care to our patients that go beyond the standards of routine dentistry. I work with a dedicated team of about 40 individuals who have been able to provide for their families and grow their careers within our organization. I am a part owner and shareholder in a cloud-based platform and learning center providing tremendous value, training, education, and mentorship to those who are currently using it. Lastly, I have a tremendous support network that never gets enough recognition for assisting me to get to where I am today.
The success I have achieved has been beyond what I could imagine, and I truly thank those that have supported me along the way. When focusing on growth, focus on "People First."
As for what's next ... mentorship is an ongoing commitment. With a focus on team care, customer care, data/compassiondriven decisions, and scalable solutions, my priority will be on connecting and supporting peers.
Ajeet Ghumman, DDS, Cert. Ortho., FRCD(c), is on a mission to improve the profession with a “people first” attitude. Dr. Ghumman is a business owner, an instructor, and an entrepreneur, focused on mentorship, educating, and supporting those around him, whether it is his patients, team members, associate doctors, or peers. His priority is on leading through a selfless attitude and affecting change in those individuals he connects with.
www.dw4k-align.com www.clinchcm.com
Overcoming Imposter Syndrome in 2 Easy Steps
David Rice, DDS
Imposter syndrome. I have to be honest–I’m not a fan of the phrase. Alas, it's a thing even though it’s been a thing since the dawn of time–some marketer just needed to coin it like a Hallmark holiday to help you feel bad about yourself. Off soapbox. Like it or not-I felt it when I was you -you feel it today–let’s overcome it together.
STEP ONE: EXIT SURVIVAL MODE AND ENTER THRIVE MODE.
First, I know this is not an easy ask of you. Whether you’re a D1, 2, 3, or 4, I get it. Job one is head down and get your DDS OR DMD. I also know dental school isn’t always the safest space. It isn’t always the least stressful place. And it isn’t always what you want to wake up and face. In truth, I still have random pre-clinical flashbacks of crushed waxups, and the overwhelming feeling that I’m not good enough.
That said, I remember a very specific early fall D2 day. We had a few holdbacks join our class. They, of course, had friends who moved on to D3. As we sat around and talked, I remember thinking, “If that crew advanced to D3, so can I.” That moment was a defining one. That strategy became a mantra as I looked one, two, three years ahead at every goal I had. “If they can do it, so can I.”
That was for me and can be for you–the first step to thriving. Knowing as hard as it seems, that you can and you will do it. From there, if you’re going to overcome imposter syndrome, I need you to actually look to your future. I need you to imagine your life as a young dentist. Think about who you want to be. Think
about what kind of dentistry you want to do. Don’t worry about your inexperience. Don’t worry about changing your mind. Don’t worry or overthink any of it. Just think, as you sit here in this moment, who do you want to be as a dentist, as a leader, as a teammate, as a person? How do you want people to view you? What do you want them to say about you when you’re not around? If you could draw up YOUR perfect dental day as you sit here now, what does it look like? What procedures do you picture doing (even if you’ve only seen them in class)? Picture your practice. What’s your style? Modern? Traditional? Are you comfortable with tried and true? Do you see yourself being cutting-edge? Do you love people and want a small team? Larger team?
Do you like a consistent week? Do you prefer to mix it up?
Take some time alone. Answer those questions for you. There’s no wrong answer. There’s only your ideal answer. Summed up, that’s called your vision.
From there, why do you want what you want? Is it to have balanced time? For family? Friends? Travel? Is it that at all? Maybe you want a 70-hour/week, all-in, dentistry-focused life. All of it is right. As long as it’s right for you. You see-regardless of our different whys, I believe we all seek the same thing. A self-determined future.
Build your mental picture of what you want, where you want it, when and why, and you’ve just completed step one in overcoming imposter syndrome. When you know where you’re going, you have the power to define who can help and how you’ll get there.
It’s always been easy to see graduation as a finish line rather than a starting point for learning. It’s even easier to view it that way today when one adds up their debt and several social media groups pouncing on the fact that schools should be better.
Don’t get me wrong–dental school needs to provide us with a strong foundation. It cannot, no matter what you’re hearing or experiencing, provide you with more than that.
Sorry…facts.
Most dental schools arm us to do basic restorative basically well. Some arm us with some prosthetics, including implants. There’s a win in those schools. There’s also a caveat to all of it. Procedure reps help us on the mechanical side. So yes, as a student, the more reps, the better. But why you do the what and how you do it matters more. Please re-read that. Why you and I do what we do and why we do it the way we do it matters more than the reps.
It’s the difference between a professional, a doctor, and a tooth mechanic. You do not want yourself or our profession to be viewed in that light. That is how we fall into a lesser division of medicine. That is how and why insurance companies dominate choices many of today’s dental pros operate.
Go on Facebook, and you’ll see two dozen experts selling you the “how to fix”:
• Poor insurance reimbursement
• Lack of patients
• Less than stellar associate treatment
• Poor case acceptance Your need for speed
That’s nice. But you know what’ll help you far more? What will crush your imposter syndrome?
Investing in your diagnostic and treatment planning abilities so you can confidently walk into any room and prescribe (even if you’re referring out because the experience hasn’t come yet).
*This is how you gain 95% complete care-case acceptance.
**This is also an incredible path to building patient referrals from specialists, by the way!
When the top docs see you as a top doc, they’ll send you endless referrals.
Understanding material science: Few dentists have a real grasp on when to use what materials on which patients and why. When you’re one of those few, patients and colleagues will respond.
Working on your communication skills: If I told you how many dentists (of all ages) believe patients say no, maybe, or yes, and then cancel because of money or insurance – you’ll fall over. Patients say no or yes based on our ability to build real value for what we do. When they understand what we understand, as deeply as we understand, they say yes. The key is understanding their why. When you and I know every individual reason why patients choose what they choose, we hear yes almost every time. Imagine how hearing yes all day, every day, will cure that insecure feeling you have.
Do the work
If you’ve heard me speak before or read any of my articles, this will sound familiar to you. It’s not going to be easy. But it is going to be worth it. The top 2% in any profession, not just dentistry, know they must do the work.
You are capable of being in that top 2%!
So…
Head back to the beginning of this article.
Make a list of all the questions I asked.
Answer them for you.
Give it a week and go back to them to make sure it all makes sense. If it does, proceed; if it doesn’t, tweak.
If you have questions-DM me @ignitedds on Instagram.
Then re-read our second step. What can you commit to learning more of RIGHT NOW?
What can you prioritize learning immediately following school?
Have it under control? Great. Have questions on where to learn what you want to learn? DM @ignitedds on Instagram. We know the best of the best in all lanes of dentistry–it’s why a team of dentists who graduated anywhere from a year ago to twenty-nine years ago gets us. :)
Look in the mirror and smile. You have already done a lot of the work! The actual future learning and future reps will come easily now that you’ve invested the time to build your playbook. Great job!!
Imposter syndrome, as I said, is a phrase I’m not a fan of. Alas, we called it out, and we built a plan to overcome it. Sprinkle in a few great mentors to keep advising you, keep encouraging you, keep pushing you to be your best, and keep picking you up when you fall, and you’re in a great position to succeed. I only have one question for you before we part ways today…
Will you do it?
David Rice, DDS, is on a mission to improve our profession by leading the next generation of dentists to grow successful lives and practices.
The founder of igniteDDS, Dr. Rice speaks to over 35 dental schools and residency programs a year on practice building, team building and wealth building. Dr. Rice is a private practitioner, educator, author, and mentor who connects students, young dentists, and professionals from diverse dental-related businesses, “fueling passion beyond the classroom.” ignitedds.com PODCAST:
Think Like a CEO and Unlock the True Power of Your Practice
Doug Fettig, CPA, MBA
In my travels across the country speaking to your fellow dental colleagues, I sometimes encounter an attitude of… RESIGNATION.
Resigned to working longer hours to maintain the same level of income. Resigned to dealing with endless turnover and staffing shortages within your dental team. Resigned to accepting what insurance plans decide your skills are worth. Resigned to feeling inadequate as you juggle bringing in a producing dentist, running your business, being there, and enjoying the moments with your family.
I believe that these unfortunate scenarios are the result of a very simple, yet very powerful, dynamic. You don’t view yourselves in the correct context. You see yourselves as being victims of forces beyond your control (e.g., DSO expansion, insurance driving down reimbursements, rising student loans).
You don’t appreciate the incredible value that your skills have in the marketplace. You live your life with a scarcity mindset rather than an abundance mindset. You fail to see that you are the leader of a dynamic and vibrant workplace.
YOU LACK THE AWARENESS AND APPRECIATION THAT YOU ARE THE CEO OF YOUR PRACTICE!
Think about that for a second. You are the CEO of a business just like any other business owner. You can create a vibrant, dynamic workplace and positively impact the lives of your team, your patients, and your community. WHAT A GIFT!
I realize that you did not receive much (if any) training in dental school on how to run a business. I realize that the emphasis was to get through dental school so you could earn a paycheck and start making payments on your skyrocketing student loans balances. I realize that you weren’t imbued with the idea that you would become a business leader, a CEO, whose most joyful path to a fulfilling and profitable career would be as a great leader of your own company.
But, as much as we’d like to, we can’t change the past. However, we can learn from it. We can assess what needs to be done, and what needs to change, from this point forward. You must disassociate yourself from the idea that your goal was achieved when you graduated from dental school. That “If I build it, they will come.” The idea that if I hang out a shingle the rest would take care of itself.
That doesn’t work anymore – the competition is too fierce, and the financial and emotional stakes are too high for you to be in a passive role regarding how your professional life will play out. Not to mention the impact it has on your personal life.
WHAT DOES IT MEAN TO BE THE “CEO” OF YOUR PRACTICE?
When I speak to dentists, I ask the practice owners to raise their hands. Then I say something like, “Congratulations! You are now all CEO’s! From this day forward you will think of yourselves as CEO’s! Never again will you think of yourself as ‘just a dentist’”.
Gee that’s great, Doug, but what does it mean to think like a CEO, and why does it matter?
Glad you asked - there are many traits and positive aspects to altering your self-perception and thinking to that of a CEO including:
• Inspiring you to start running your practice like a true business
• Making you more willing to utilize benchmarks and set incentives/goals for your team
• Opening you to the power and benefit of bringing in dental industry experts to help you run your practice more efficiently and profitably
• Providing the discipline to use ROI (return on invest-
ment) calculations when considering decisions to invest in technology
• Unlocking the use of tools such as a SWOT (strength, weakness, opportunity, threat) quadrant to assess your practice holistically and strategically – running your practice proactively rather than reactively
• Seeking formal leadership training to enable you to create a great work environment for your team
• Thinking outside of your individual “island” and joining with other independent practitioners to gain economies of scale for services and supplies
Think for a second about those bulleted items above. They are all tools and techniques that CEOs around the world use to run their businesses more efficiently and profitably. Why should you be any different?
Think what it would be like to have the decision of a major investment (not expense!) in technology to be considered by determining whether the return is worth the investment. Instead of listening to the argument that the investment (not expense!) is “not in the budget”. The budget is irrelevant if the investment will generate a return far greater than your monthly payments – it would actually improve your cash flow! One of my favorite sayings is, “You can’t cost cut your way to prosperity.” It’s never been done.
Think what it would be like to structure a compensation and bonus plan that creates positive incentives for your team to maximize overall productivity, profitability, patient satisfac-
tion, and patient care? What would the impact be if your team’s behavior was motivated to align with the goal of providing excellent patient care and collaborating with each other for growth?
Think what it would be like to receive top-notch leadership training and to use your enhanced leadership skills to create a more positive work environment. Might that have a positive impact on your staffing issues and any team “drama”? Don’t you owe it to your dental team (and to yourself, to your family, to your community) to create the greatest work culture that you can for your team?
Think what it would be like to take a broader view of your industry and your place in it. There is a growing movement among independent practitioners to band together to achieve leverage and economies of scale that can only be achieved in the marketplace via size and influence. That’s why DSOs are a successful business model – they gain efficiencies and increased profitability through economies of scale. Solo dentists or small group practices are now joining forces in a variety of business structures and groups such as GPOs (group purchasing organizations), dental buying clubs, DPO’s (dental partnership organizations) and the like.
Think about utilizing industry experts to help you grow, just like every other CEO in the world, be it in areas like marketing, legal, accounting/finance. Think about embracing the skills
and knowledge of your dental rep, to view them as a consultant versus an order taker, to help you grow your practice. If you win, your dental rep wins! And yes, experts cost money – they need to eat too! But if your dental expert isn’t bringing you more value than they cost well…you are using the wrong expert!
YOU ARE ALL ENTREPRENEURS – YOU ARE ALL CEOS. EMBRACE YOUR POTENTIAL!
Perhaps they forgot to mention/emphasize to you in dental school that you were all CEOs in the making. That you would have the privilege of running a business and impacting the lives of others. That you had control over your destiny and your future.
It’s time for you to join the vibrant, dynamic, creative community of your fellow CEOs from around the world. Changing your mindset and seeking out the resources to help you unlock your potential as a leader will bring untold benefits to you, your practice, your team, your family, and your community.
By the very nature of what you have achieved – running a business – you are already a CEO. Now it’s time to start leveraging your role and reaping the rewards, both financial and emotional, that will follow!
Doug’s passion is inspiring dentists to “Think Like a CEO”, unlocking the keys to becoming a dynamic leader, growing their practice, and achieving their retirement dreams. Doug utilizes an engaging and humorous style in presenting to dentists across the country about the business of dentistry, leadership, the power of technology and tax incentives, and retirement strategies. To book Doug for your next event you can reach him at dougfettig@dentaldollarsandsense.com or via his website at www.dentaldollarsandsense.com.
“Dr.
Elizabeth H. Guerrero, DDS
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