Dental Entreprenuer Fall 2017 by Dental Entrepreneur Media

CLASS OF 2018 | FALL ISSUE

DENTALENTREPRENEUR.COM

Business Beyond the Classroom

Matthew Pelais, DMD

Tyler Bolin , DMD

My Story

Your Fundamental Choice: Making a Living or Making a Life?

The Inequities of Earned Equity

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Fall 2017 VOLUME 20, ISSUE 1 Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Content Strategist Michelle Perritt Executive Assistant Patti D’Agata Production Ruthie Kelty Publishers Press Inc. Editorial Board Dr. Dirk Fleischman Dr. Gene Heller Dr. Harold Sturner Dr. Ryan Dulde Dr. Earl Douglas Rachel Teel Wall, RDH, BS Dr. Tom Snyder Derek Champange Dr. David Rice Dr. Hugh Doherty Layout and Design John O’Connor

Class of 2018 Contributors Jayme Amos Dr. Tyler Bolin Dan Croft Bridget Fay Elizabeth S. Fitch, CPA/US Laura Hatch Dr. Matthew Pelais

Dr. Erinne Kennedy Christy Ratcliff, CPA Dr. David Rice Dr. Kyle Roth Angie Svitak, CPA Bob Spiel, MBA Dr. Dale Wagman

Charter Sponsors Oral‑B Laboratories Ultradent Products Inc. Procter & Gamble Wm. Wrigley Jr. Corp. Glidewell Laboratories Benco Dental Co. Tess Corp. Dental Care Alliance

The Pride Institute The Snyder Group McKenzie Management Caesy Education Systems, Inc. Warner‑Lambert Co. Phillips Health Care Oxyfresh Worldwide

Editorial Office

12233 Pine Valley Club Drive Charlotte, NC 28277 704/953-0261 Fax 704/847-3315 anneduffyde@gmail.com Send materials to: Dental Entrepreneur Magazine 8334 Pineville Matthews Road Ste. 103-201 Charlotte, NC 28226 When you have finished enjoying this magazine pass it along to a friend and PLEASE RECYCLE Copyright 2017 Dental Entrepreneur, Charlotte, NC Material herein may not be reproduced, copied or reprinted without prior written consent of the publisher. Acceptance of advertising does not imply endorsement by the publisher.

Welcome

CLASS OF 2018 FALL ISSUE VOLUME I

October is my favorite time of year. My husband thinks it’s because I share my birthday month with our oldest son. And while I do love presents and celebrating birthdays, it’s more about the excitement of change in the air. The colors of the season are showing their beauty, and the holidays are on the horizon. Now, it’s time to be thankful for how we’ve grown and the coming of new opportunities. Fall a is good time to take stock of where you are and where you’re going. You have put time, talent and treasure into your education. You are starting to envision your career beginning and forming your vision for your future. Whether you’re just starting your dental education, graduating in 2018 or have been practicing for a few years, this issue will help you decide where you need to focus to succeed. Embrace the change that is upon you! Our cover docs are true dental entrepreneurs. Drs. Pelais and Bolin share their enthusiasm with you. It takes girt to plunge into a startup right out of the shoot. As they say, “If we can do it, you can do it!” Their story could be yours if you are game and follow some of the advice in this issue. Be open to opportunities that present to you and build on your strengths. I especially loved Jayme Amos and Bridget Fay’s article on location and signage. It will entice you to look further. Check out their links. I personally was surprised at their take. Bob Spiel elaborates on leadership at its core. His new book, Flip Your Focus, is a must for all of us. Almost 50 percent of the graduating dentists are women. Angie Svitak and Christie Ratcliff give hope that it is possible to have it all while being a Dental Entrepreneur Woman (DeW). Speaking of DeWs, Dr. Erinne Kennedy makes a case for working in public health. Have you ever thought about that? There are many opportunities that females in the industry might not have considered, and Erinne dissects one of those areas. My husband, a business owner himself, was particularly drawn to Dr. Dale Wagman’s article on earned equity. This will give you much to consider as you look at new associateships from both sides. And, of course I love how our pied piper, Dr. David Rice, wraps up in his Power to Succeed contribution. In fact, each author gives you something to ponder. Please reach out to them with your questions. They are here to help and write to inspire. Reach out to our sponsors, for without them this free publication would not exist. They deserve your business and respect. As the seasons change, so could your career path. I sincerely hope and believe this issue of Dental Entrepreneur can serve as a guide as you continue your journey.

All the best,

Anne M. Duffy Publisher 2 Fall 2017 Dental Entrepreneur

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Contents Prologue

4 We Did It and So Can You! Our Story Tyler Bolin, DMD and Matthew Pelais, DMD

Getting Started 6 Have You Thought of a Career in Public Health? Erinne Kennedy, DMD

10 Your Fundamental Choice: Making a Living or Making a Life? Bob Spiel, MBA

14 Ready to Own Your Own Dental Office? It Isnâ&#x20AC;&#x2122;t for Everyone! Kyle Roth, DMD

18 2 Dental Location Strategies Worth $500 .... Just for Startups Jayme Amos and Bridget Fay

Business Fundamentals 22 Purchasing, Starting or Expanding a Dental Practice: Investments in Technology Are Key for Entrepreneurs Dan Croft

26 The Inequities of Earned Equity Dale Wagman, DDS

Practice Builders 30 Winning in Dentistry Laura Hatch

The Power To Succeed 32 Women in Dentistry: The Flexibility and Reward of Ownership Angie Svitak, CPA and Christy Ratcliff, CPA

34 Your Pathway to Practice David Rice, DDS

28 Are You Financially Exposed: Navigating the Cyber Avalanche Elizabeth S. Fitch, CIPP/US

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Dental Entrepreneur Fall 2017 3

Prologue

My Story Tyler Bolin, DMD and Matthew Pelais, DMD

e’re just under two years into our start-up, but our journey is far from over! We are the owners of Commonwealth Dentistry, a private practice dental office in Lexington, Ky., and we fooled someone into letting us on the cover of Dental Entrepreneur. We are Dr. Matt Pelais and Dr. Tyler Bolin. Dr. Pelais completed his undergraduate education at the University of Virginia and his dental education at Virginia Commonwealth University, and Dr. Bolin completed both his undergraduate and dental education at the University of Kentucky. We met while completing a two-year general practice residency at UVA after graduating dental school in 2013 and quickly saw our values and goals aligned. So, what better way to continue that journey than to start our own dental practice from the ground up!? It’s not often you see a start-up dental practice in today’s dental environment, but we saw an opportunity and went all-in. We began our business venture talking to countless mentors and surrounding ourselves with people who have taken on similar challenges while we were finishing our residency program. We sought opinions in every direction on how to do what we wanted to do and quickly learned there was more than one way to reach our goal. The same route is not right for everyone. We learned from others’ experiences ... the good and the bad ... and we’ve had plenty of our own good and bad along the way. While we formulated our business model for Commonwealth Dentistry, we went to the Graduates of the Last Decade (GOLD) Program at the Hinman meeting in 2015. It was at this meeting in the elevator of our hotel that we met Anne and Tom Duffy and explained our vision and our path that had led us to this point. Since then, Anne has kept up with us and followed our practice from the beginning, well before our grand opening in January 2016. She told us if we had a story worth telling, she would feature us in Dental Entrepreneur! Well,

4 Fall 2017 Dental Entrepreneur

here we are rounding the two-year mark of Commonwealth Dentistry, and we tricked her into including us in this very issue. So before we go any further, thank you for reading our story. We have learned a ton from our experience, and our goal is to share that knowledge and promote the benefits of keeping dentistry in the hands of dentists! We hope you will learn the following from the remainder of our ramblings: • First, we want everyone to know that owning your own practice is still possible, even in this age of large corporate dental offices. • Additionally, we want to acknowledge that there will be challenges, but if you maintain your vision and simply treat people how you want to be treated, success will follow. • Finally, every path is unique with its own set of ups and downs. If you have a well-thought-out plan and stick with it, you will persevere! That first point is probably the most overarching remark in this article. Yes, it is still possible to own your own practice, even as a young dentist or a recent graduate. There are a lot of obstacles to starting a practice from scratch or acquiring an existing office. Many times,

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there may be even more tempting and more immediately financially-rewarding options, but we are here to encourage you to own up and be your own boss. It may take some creativity and thinking outside of the box to determine how you can make it work. Owning a practice has been one of the most challenging experiences of our lives, but it has also been the most rewarding. We are still in the infant stages of our business, having only been operating just shy of two years now. So far, it has been a blast. We love showing up to work everyday. We love working with our team, we love meeting our new patients and we love growing with our established patients. It has been extremely rewarding in just a short period of time. The second point we mentioned is simply the Golden Rule. Treat people how you want to be treated. When we decided on a location for our office, we picked probably one of the most saturated markets in Kentucky. Many people told us we were crazy to open in Lexington, and most people told us to move into some of the smaller surrounding counties where the market was less saturated. Maybe we are poor businessmen and maybe we are naïve, but we believed that if you simply treated people right, the business would take care of itself. We wanted to worry about our patients, not our numbers. One mentor told us there were definitely enough dentists in Lexington, but you could never have enough GOOD dentists in Lexington. That resonated with us and kept our motivation alive to follow the Golden Rule. We have stuck with that and find we are much better when we are worrying about our patients more than the numbers. And when you treat people right, everything tends to take care of itself! Finally, there is managing the stresses of business ownership. When we say do not worry about the numbers, we may be slightly kidding ourselves. It is impossible to ignore. There will be highs and lows with any business venture you take on, especially a start-up.

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It is easy to feel on top of the world when you have your highest producing month, and it is easy to think your business is going to crumble after a lower producing month. You have to take everything in stride and keep a level head, as difficult as that is. You cannot let your emotions get too high with the highs or too low with the lows. Not to sound cliché, but life is a marathon, not a sprint. Always focus on the big picture and know that life is not entirely about where you end up, but how you got there. What did you do with the challenges that were thrown in your way? Did you rise to the occasion? We continue to experience many growing pains, and this journey has been a roller coaster ride for sure, but seeing where we are now, we wouldn’t have it any other way. We have made some wise decisions and some we’d like to take back. We have been proud of “past” Matt and Tyler and angry at “past” Matt and Tyler. We try to learn from each of these hoping that our next office will benefit and result in more of those wise decisions and less of those that leave us scratching our head. We know young graduates are stretched with large debt loads. We know having a nice salary right out of dental school is attractive. There are pros and cons to any direction you take. But talk to your mentors, network with colleagues who are in positions where you want to be in the future. Be involved in organized dentistry, attend dental conferences, have an open mind and listen to everyone! With some creativity, you can formulate your own plan for practice ownership, and we cannot encourage you enough to do that. It has been an awesome adventure and we are so grateful that we get to tackle it with each other and share it with you. Have faith!

Please contact us at: www.commonwealthdentistry.com/ and matthewpelais@gmail.com

Please reach out to our authors and our advertisers. They care about you and keep us in print!

If you have any questions, comments, or responses to our magazine, please connect with us on Dental Entrepreneur Magazine — our official Facebook page! Read us online at dentalentrepreneur.com Send your questions or comments to anneduffyde@gmail.com dentalentrepreneur.com

Dental Entrepreneur Fall 2017 5

Getting Started

Have You Thought of a Career in Public Health? Erinne Kennedy, DMD

re you reading this article because you are interested in dental public health? Or perhaps public health in general? I hope so, because the field of public health is growing and looking for passionate, forward thinking, generous professionals like yourself. The information provided is derived from personal experience and from the wisdom of my great mentors at Nova Southeastern University and the Harvard School of Dental Medicine. The field of dental public health is small, so the women who helped contribute to this article are examples of some of the great mentors that you will have if you choose to follow this path. In fact, Mary Tavares of the Harvard School of Dental Medicine says that her favorite part of dental public health is “the people. My colleagues in this field are a diverse, well-rounded and interesting group with an amazing commitment to their work. My students also fit that description, and it is very gratifying to help them find their path in this field.” I echo these sentiments. Being new in the world of public health, I’ve been welcomed with open arms. Here is a list of the amazing women who contributed to this article and continue to enrich the profession of dental public health: • Linda Niessen, Dean of Nova Southeastern University College of Dental Medicine • Monina Klevens, Director of Research and Evaluation Bureau of Infectious Disease and Laboratory Sciences at the Massachusetts Department of Public Health • Mary Tavares, Program Director of the Dental Public Health Residency at the Harvard School of Dental Medicine • Kathryn A. Atchison, Professor UCLA School of Dentistry • Jane A. Weintraub, Alumni Distinguished Professor, UNC School of Dentistry and former UNCSD Dean. What Is Public Health Dentistry? Public health dentistry is one of the nine recognized specialties by the American Dental Association. “Dental Public Health (DPH) is that part of dentistry providing leadership and expertise in population-based dentistry, oral health surveillance, policy development, community-based disease prevention and health promotion, and the maintenance of the dental safety net.”1 Dean Linda Niessen of Nova Southeastern University knew that when she was drawn to dental public health early in her career. Early

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in her career she wondered, “Why do certain populations have more dental diseases than others? Why was oral cancer more prevalent in African Americans? Why were the Pima Indian people more likely to get periodontal diseases? Why did certain population groups seem to have less access to dental care?” Do you find yourself asking the same or similar questions? If so, maybe a career in dental public health is your dream career. I love public health dentistry for the constant diversity it offers. If you ask 10 orthodontists what they do, you might get a pretty similar answer. “I have a private practice in …” But if you ask 10 public health dentists what they do, it will seem like you spoke to professionals with 10 different degrees. The versatility in this specialty is unique and something that I personally needed. I am always looking forward to my next project, and every project seems to be totally different

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from the last. Beyond the flexibility in career choices it offers, it speaks to my passion for giving back to humanity. I have the opportunity to offer my time and care to patients, but I also have the education to help change the policies behind what affects oral health and access to care in our communities. While conducting these interviews, I learned that these six women have worked as dentists at neighborhood health centers, private practices, and hospitals. They have been employed at the Massachusetts Department of Health, conducted dental sealant programs, conducted research, worked at the Department of Veteran Affairs (VA) and the Indian Health Service (IHS). They have led other government organizations, had fulltime academic careers, part-time academic careers, worked as a Chief Clinical Officer for a global dental product company and have had careers as academic provosts or deans. In my opinion, career diversity is an underappreciated aspect to dental public health. One unique story is that of Dr. Klevens. She was completing her MPH years ago when she heard about the Epidemic Intelligence Service (EIS) through the Centers for Disease Control and Prevention (CDC), and she was encouraged to apply. She did so and “24 years later, I can say that the EIS program and a career at CDC transformed my interests and skill set. Anyone interested in learning more about it can visit the website2.” If you are truly interested in public health, take a look at the competencies for a master degree in public health3 and a dental public health specialty4. They are the cornerstones to many other educational programs across the country. If these topics leave you salivating and dreaming up ideas in your free time, this is the right career choice for you. How Can You Make an MPH Fit in Your Schedule? There are multiple reasons why students don’t go on to pursue an education in dental public health. One is the perception of possibly receiving a lower income, and the other

8 Fall 2017 Dental Entrepreneur

MPH

DPH

Degree

Master’s in Public Health

Certificate

Length

1-2 years

Specification

Ability to specialize in a specific master’s track

Dental Specific

Ability to board certify in No Dental Public Health?

Yes

Number of Programs

A multitude

is the time that it takes to achieve another degree. In my opinion, there are four ways to incorporate an MPH into your lifestyle: • Participate in a dual DMD/MPH track during dental school. Today, many schools offer a dual degree through their dental school. Be sure to ask your administrators if this is offered through your school. • Take a quick one-year sabbatical! In the grand scheme of life, one year is a blip, and there are numerous MPH degrees that you can complete in one year. The top two in the country are John’s Hopkins (Baltimore) and Harvard (Boston).5 Take a look at programs in your area and see if they have a one-year track. • Take night classes. Many of you cringe at the thought, but this was the absolute best option for me. Nova Southeastern University offered an online/onsite hybrid program where I could go home and take certain classes in the evenings and complete my capstone project onsite. Depending on where you do your MPH this might be a great option. You could even do this while working or during a two-year residency program. Just so you know, since you will be going in the evenings part-time, this program usually takes two years. I completed mine in four semesters and one summer, during which I took 1-2 classes. • Lastly, take an extended

GPR. One of my good friends decided to do a two-year GPR that involves special-care dentistry. While she was in the residency, she pursued her MPH in the evenings, and ta-daa, completed both degrees on time! An MPH is the stepping stone to starting your dental public health residency. You can see in the chart above how they compare. Very few MPH programs offer an emphasis in dentistry, however the program at A.T. Still University located in Arizona does! If you are interested in specifically working in dental public health, you may want to look into one of the 16 residencies across the country. Many students ask if you do dentistry in a DPH residency. I think that’s a great question. A dental public health residency is a specialty program just like periodontics, orthodontics or endodontics. When you apply, most programs require an MPH prior to admittance. Some programs have clinical components, and other programs are more focused on research and didactic learning. Most programs have a yearly tuition that ranges from $30,000-60,000. Most dental public health residencies accept foreign trained dentists, but be sure to check the ADA Pass website prior to application. The majority of programs accept dentists to either full-time or part-time positions, which makes it easier to work into your schedule. On average, full-time residencies can be completed in 12 months, and part-time residencies can be completed in 24 months. The way I like to summarize the differ-

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ences between an MPH and DPH is that an MPH is the stepping stone to a dental public health residency (DPH). Many students receive the MPH prior to becoming a dentist if they took a year to re-apply to dental school and strengthen their application, or they applied for a dual-degree program. Many professionals with an MPH and a DMD/DDS work in public health, and those who pursue a specialty degree are looking for training to be qualified for more intense research roles, leadership roles, or advanced roles in academia. The students I mentor always ask me if they need an MPH. My answer is that it depends on what your goals are. Former Dean Jane Weintraub from UNC School of Dentistry helped answer this question. She said, “It is a big advantage to have an MPH degree if you want to pursue a career in public health. You will gain a population perspective that is different from the individual patient care focus that is emphasized in dental school. If you want to pursue a research career, a PhD or equivalent, it is increasingly helpful and recommended for obtaining an academic position, but it is not absolutely necessary if you have strong research mentors and obtain research experience in another way. “I recommend thinking about what makes you get up and go every day, what really invigorates you? This will help you design a vision for your career and education.” I love how Katherine Atchison from the UCLA School of Dentistry stated, “Whether as a student or dentist, you can start by getting involved in community-based activities, because as a dentist there is so much need out there! I learned as a young dentist that nursing homes and public schools always need guidance in oral health. Your local dental society and departments of public health often have programs to provide dental care, administer exams or participate in a sealant program. Many dental schools offer programs to let dental students explore each of the dental specialties. Get involved in a research study and submit an abstract to the National Oral Health Conference—the

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most exciting DPH conference.” For many, you are starting these projects while you are in school. Don’t forget, even when you graduate from dental school, communities need dentists like you to be involved. Stay involved in your local environment and continue to give back in a positive way. Over the years, you will see what a positive impact you can make on the smiles of mankind. On the other hand Mary Tavares, reminds us that “it is important to learn as much as possible about the field of DPH and realize that it goes far beyond community outreach projects that are common in dental school.” She explained, “Joining a student chapter of AAPHD and attending their national meeting (National Oral Health Conference) is a very good way to learn more. Also, reading the Journal of the AAPHD can highlight the vast variety of activities that encompass the DPH profession.” Lastly, one of the many benefits of the field of dentistry—and more specifically dental public health—is the ability to maintain a work/life balance. As a female dentist, Dean Niessen offered great advice. “Balancing career and family is an art and a science,” she said. “You learn quickly that you don’t have to get an A+ in everything. Sometimes balls drop but the sun still rises in the east the next day.” For many women, not getting an A+ is a difficult transition, remembering the big picture of your life and your career are important. Raising children who grow into young professionals and seeing positive change in the communities that you serve are great reminders that the key to life is to not worry about the ball that dropped, but get up and be ready for the next one coming. Hopefully, this guide to dental public health serves as a starting point for you to begin exploring, asking questions and digging deeper into your future career serving in dental public health. And if you are ever on the fence remember, “Just DeW it!”

Erinne Kennedy DMD, brings to you real life experience in public health, wellness, and leadership for women. She graduated from Nova Southeastern University’s College of Dental Medicine in 2015 and then attended a one-year general practice residency at the VA Hospital in Baltimore, MD. Erinne has a passion for giving back, and is currently working toward a dental public health specialty at Harvard University in Boston, MA. She is currently a blogger for IgniteDDS, an alumnus writer for ASDA, a contributing editor for Dental Product review, and on the Junior Editorial board for DeW. Facebook: @erinnekennedydmd Instagram: @erinnekennedy LinkedIn: https://www.linkedin.com/in/ erinnekennedydmd IgniteDDS Blog: https://ignitedds.com/ app/profile/2354 Email: erinne.kennedy@ignitedds.com

References: 1.“Oral Health Topics.” Dental Public Health. American Dental Association, n.d. Web. 28 Apr. 2017. 2.“Epidemic Intelligence Service.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Apr. 2017. Web. 28 Apr. 2017. 3. “Core Competencies in Public Health.” Master Public Health. N.p., n.d. Web. 28 Apr. 2017. 4. Altman, Donald, and Ana Karina Mascarenhas. “New Competencies for the 21st Century Dental Public Health Specialist.” Journal of Public Health Dentistry 76 (2016): n. pag. Web. 5.“Top Public Health Schools - US News Best Graduate Schools.” U.S. News & World Report. U.S. News & World Report, n.d. Web. 28 Apr. 2017.

Dental Entrepreneur Fall 2017 9

Getting Started

Your Fundamental Choice: Making a Living or Making a Life? You make a living working for someone else. You make a life working for yourself. Bob Spiel, MBA

uman life has always been lived on the edge of a precipice,” wrote C.S. Lewis, the author of The Chronicles of Narnia. For new and recent dental grads, today’s precipices may seem more daunting than ever before, including six-figure student loan debt and the worry of paying it off over the next 7-10 years, the increase in the use of PPO plans and the impact that has on reduced reimbursements, as well as the rise of Dental Service Organizations with the possibility they have of being the future face of dentistry. Lewis, however, also said, “Human culture has always had to exist under the shadow of something infinitely more important than itself. If men had postponed the search for knowledge and beauty until they were secure, the search would never have begun … life has never been normal.” 10 Fall 2017 Dental Entrepreneur

Indeed, when we are in the middle of it life doesn’t seem truly secure and never feels “normal.” Every era has its own unique tests— and these tests never go away. Today’s challenges have a magnitude that may seem intimidating, but these worries are no different than those faced by new grads 20, 30 or 40 years ago: • How do I get started? • How do I make enough to keep going? • How do I take these skills and make something of them? • How can I best serve and heal others? • How do I create a career that is rewarding and fulfilling, while also having a life at the same time?

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While the worries, when you boil them down, fundamentally are the same, so are the solutions. As my good friend Mark Hyman, DDS, says frequently, “Success leaves clues.” And when it comes to creating a career and a life that fulfills your dreams, the bottom-line is: You don’t make a living by working for someone else. You make a life by working for yourself. The path to long term financial freedom, personal and professional fulfillment, clinical growth, personal progress, and a fulfilling career is owning your own practice. Whether the ownership is solo or multi-doctor is a matter of personal preference or opportunity. The key point is something changes inside when you are the owner (or co-owner) of your practice. This change demands more of you, stretches you more, literally shifts the way you think and places you in a position to have to be better each day. Ownership calls for consistent, positive efforts—knowing you are daily competing against who you were yesterday. Getting started along the path of ownership also has clues that the committed will find. The first is discovering what may be holding you back from desiring ownership in the first place, and then challenging that. Often, this comes from limiting beliefs we hold about the fear of failure and taking financial risks. In the work I do with new and recent grads, until these elephants in the room are brought out, addressed and excused, no real progress takes place. But once these are put to the side, real progress begins. The second clue is to define (or refine) your personal vision. The more a person is in tune with their vision of the future and that vision is, first, both inspirational and aspirational, and second, has emotional meaning and context to them (and in writing), the clearer their behaviors will be toward fulfilling that vision. Make sure that vision helps you define the intersection of your knowledge, experience and passion, because that’s your “sweet spot” professionally. It is where work becomes a calling.

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The third clue is to find wise advisors. Employing the help of an experienced dental CPA, not to mention an experienced dental business coach, will be one of the most important investments you can ever make. These advisors will help you with asking the questions you don’t know to ask and find opportunities that may not be visible to an untrained eye.

The path to long term financial freedom, personal and professional fulfillment, clinical growth, personal progress, and a fulfilling career is owning your own practice. The fourth is to create a plan for ownership, while being flexible. You may decide that starting from scratch is the path best suited for you, but then a practice purchase opportunity arises from out of the blue. Be open to what life presents to you and use your advisors to help refine and adjust your plan. The fifth clue is realizing leadership and entrepreneurship go hand-in-hand. Both of these “ships” have one destination: to build a life that is lived by design, instead of by default. Two resources I can pinpoint to help dive into these ships in much more detail are my recently published book, Flip Your Focus – Igniting People, Profits and Performance through Upside-down Leadership (you can order it at FlipYourFocusBook. com), and Gino Wickman’s book, Traction: Get a Grip on Your Business. In the opening

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Dental Entrepreneur Fall 2017 11

chapters, Flip Your Focus dives much deeper into challenging limiting beliefs and creating a personal vision. The later chapters go much deeper into leadership itself, because leadership isn’t a gift. It can be taught if the student is hungry and humble. There’s no question business ownership is challenging, but the personal and professional rewards far outweigh the risks and

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the work. I was a paycheck guy my whole career until the words “you’re fired” woke me up and challenged this sense of security. After successfully serving as a hospital and surgical center CEO, turning two entities around from bankruptcy and putting them on a firm footing, those were tough words to swallow. I will forever be thankful they happened, however. I’ve been the CEO

and President of Spiel Consulting now for 12-plus years and will never go back to being employed by someone else. The opportunities and freedom that come from ownership are far too great. In this journey of ownership, remember you don’t go alone. An African proverb says: If you want to go fast, go alone. If you want to go far, go together. One of the singular strengths in dentistry is the network of meetings, associations and resources dedicated to helping doctors continue to raise their game by being together and going together. The critical step in this is to do your homework up front, know your goals for participation and be very strategic with where you invest your time and money. Talk to those who have taken part in different associations, programs and CE. Find out what changes they made in how they practiced and/or ran their business. Your goal for each should be to experience excellence in order to learn how to ask the right questions. School provided the foundational tools to get started. It is your job to build on those tools and to learn to see what you didn’t see in the past. In closing, this spring I had the unique opportunity to speak to a group of about 300 new and recent dental-school grads as a part of the Thomas. P. Hinman 103rd annual meeting. For the past three years, the Hinman organizing committee has hosted the GOLD (Graduates of the Last Decade) program—a day long, power-packed session of 7-8 different industry experts focusing on different aspects of practice ownership and career development. I highly recommend it for any graduate since 2007, because it is so beautifully run, information filled and free for doctors who are graduates of the last decade to attend. As a part of my closing presentation, I had a chance to highlight Dr. Hinman himself. He was an incredible man who believed in himself and the nobility of his profession. One of his favorite sayings was:

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Bob Spiel is the author of the soon to be released book Flip Your Focus: Igniting People, Performance and Profits through Upsidedown Leadership. Bob is a team builder whose passion is developing genuine leaders and building high performance teams. His firm, Spiel & Associates transforms general and specialty practices by building leaders at all levels through a process of Transfacilitative Coaching ™ -- acting as a catalyst for practice owners and their teams to discover, connect and commit to new levels of personal and team performance.

“Remember that poor men stay at the bottom; The mediocre men climb but half way up the ladder; AND that there is ALWAYS room at the top.” - T.P. Hinman

Challenge your limiting beliefs about ownership, clarify your vision, enlist wise advisors, create a flexible plan, focus energies on learning about leadership and entrepreneurship, and don’t let go of the goal. I’ll see you at the top!

ADS.south209

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1:42 PM

In his over 10 years of consulting and speaking, Bob has seen time and time again that leadership can be taught and teams can be remade – what it takes is genuine desire, the willingness to be coached, and an unwavering commitment for growth. Throughout his 30-year career Bob he has been called “Mr Team”, and has had the opportunity to take on tough turn-around situations as a hospital CEO, Surgical Center CEO, and also as an Operations Director for two Fortune 500 companies where he led teams of up to 500 people while establishing world class systems and cultures. He now consults dental practices nationwide. He can be reached at Robert@spielconsulting.com.

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Practice Makes Perfect “Dr. Earl Douglas and the staff at ADS South have been real helpful in steering me in the right direction in the purchase of my first practice. Dr. Douglas’s experience, organization and detail-orientation, pointed out to me where improvement is needed and how to go about achieving it.” Elizabeth H. Guerrero, DDS Get off to the perfect start. Call your ADS transition specialist for AL, GA, LA, MS, NC, SC, TN and VA today.

ADS South (770) 664-1982 ADSsouth.com DentalEntrepreneur.com

Dental Entrepreneur Fall 2017 13

Getting Started

Ready to Own Your Own Dental Office? It Isnâ&#x20AC;&#x2122;t for Everyone. Kyle Roth, DMD

here are dozens of very difficult decisions that dental school graduates have to make in their careers. Many students graduating from dental school start their careers as associates. The most common question they ask themselves is whether to remain an associate or open their own practice. Many new dentists have a hard time contemplating this life-altering decision, and there are compelling arguments for both ownership and associateship. Letâ&#x20AC;&#x2122;s review some reasons to remain as an associate or to take the plunge and purchase your own practice! To help you answer your questions of associateship versus ownership, you should ask yourself the following:

14 Fall 2017 Dental Entrepreneur

Would you love to work from essentially 9:00 a.m. to 5:00 p.m. and forget about work until the huddle prior to the following business day? A practice owner ideally has to be immersed 24/7 to ensure clinical operating procedures are being followed, employees are happy and are showing up for work, cash flow is adequate, ample patients are in the chair, accounting and tax work is organized, payroll is complete, bills are paid, etc. If you purchase your own practice, you can count on being fully devoted to it for years. In the early years ownership, it may be difficult to find time to concentrate on anything other than your practice. As an associate, your job ends at being on time, being

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UltraFit tray after just 10 minutes in the mouth

involved in team meetings and providing quality patient care. Once you walk out the door at the end of the day, you can leave everything behind until the next business day. Do you prefer a neat, laid-out schedule prepared for you, without the worry about how the schedule gets filled? An amazing amount of work can go into ensuring a full schedule at all times. It takes an entire team approach, continuing education, internal referrals, marketing and sheer determination to make sure that everyone is busy … and stays busy. As an associate, your involvement in this entire process is minimal, and for the most part, it’s a simple matter of showing up and working on your scheduled patients. Would you prefer to be responsible for your work only or take on the responsibility of being liable for every person working in the practice? This is a huge responsibility! As a practice owner, you are liable for the work and quality of every employee working in the practice. If there are board proceedings or litigation concerning any of the employees, you will definitely be neck-deep in it as well. Continuing education and constant quality assurance monitoring will help make sure that you have limited items to worry about within the office. Would you like to take occasional vacations for more than a few days at a time? This is a big one. New practice owners seldom get to take more than a day or two here and there. You will need to be generating enough cashflow to pay your loans, new equipment upgrades, fund payroll, rent, etc. Additionally, your employees need to work enough hours in order to pay their own bills or support their family. If you don’t provide enough working hours for your employees,

16 Fall 2017 Dental Entrepreneur

Some new dentists had previous careers before dental school as managers and business owners that might give them a significant advantage in owning their own dental practice. you may find your employees temping at other offices and subject to being recruited away from you if your office is closed for a significant amount of time. There will be several households and families dependent on the decisions you make as an owner. Are you skilled in reading profit and loss statements, tax returns, payroll reports, accounts receivable reports, etc.? If you aren’t, you must educate yourself, because it will require paying close attention to these reports in order to grow your practice. Previous business or management experience will provide you with a big advantage when it comes time to running your own business. Do you want to devote time to marketing, bill paying, employee coaching, equipment repair and facility maintenance of your office? Aside from the knowledge required to do this, there is a large investment in time necessary to accomplish these very important tasks. It’s definitely not for everyone. Regardless of whether or not there is an office manager in place for assistance, you will still need to know the procedures involved for each one of these items, in the event your office manager is ill or suddenly

quits. You will need to hone in on becoming a marketing guru, personnel manager, handyman and janitor. And, oh yeah ….be an amazing dentist with high quality and an excellent bedside manner! Does the idea of not receiving a paycheck scare you? Many times as the owner of a new practice, you will receive unexpected repair bills, equipment upgrades, new computer upgrades, patient refunds, and so on. Maybe the schedule is unexpectedly slow or maybe your staff has recently taken costly continuing education. Sometimes it results in the owner not taking any paycheck whatsoever for the month. If that happens to you, do you have the cash savings to pay your bills and maintain your lifestyle? If you answered yes to a majority of these questions, then you might want to consider remaining an associate. For the most part, you will have a set schedule, you will only be responsible for yourself and not the employees around you, you can take vacations without having to stress about the practice, you do not need to be a skilled business person, nor do you need to become a payroll expert, motivational speaker, repairman, accountant and marketing expert. While there may be many overwhelming reasons for remaining an associate, there are a tremendous amount of benefits to becoming an owner. In addition to the items discussed above, maybe you should ask yourself the following questions: Do you have management, leadership, accounting, or personnel experience from a previous job that would help you excel as a business person? Some new dentists had previous careers before dental school as managers and business owners that might give them a significant advantage in owning their own dental practice. A previous owner or manager of any type of business with several employees will have a distinct advantage over the stu-

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dent who went straight from an undergraduate program to dental school. Would you enjoy the feeling of being in charge of the entire operation? While this makes some people cringe, others are excited at the thought of being at the helm and steering their office towards excellence and profitability. You have the ability to take your office in any direction desirable. Perhaps you already have an idea on what types of dentistry you would like to perform, the types of decor, the uniform selection … things like that. Maybe you want to employ the use of specialists. Maybe you want to do cosmetics. You can do anything your heart desires as long as your financial resources can support your ideas. The sky’s the limit! Do you like the idea of having no limits on income? This is one of the greatest reasons for owning your own practice. The average associate makes $144,000. While some practice owners don’t make significantly more than that, the top producers can easily take home $500,000 or more, which is nearly impossible to earn as an associate. Some even earn in excess of $1,000,000 per year! While most income as an associate will come from your own production and collections, as an owner, you will be earning money based on the collective work of the group. If you feel like a leader, have the entrepreneurial spirit and answered yes to most of the above questions, you might want to consider pulling the trigger on the purchase of your own practice. While this decision may require a big investment and excessive involvement in the practice, it will usually pay off tremendously as your practice thrives and experiences success. In theory, there is no limit on what your practice can earn and what your ultimate profitability will be. If you’re a real entrepreneur, or at least have the spirit of an entrepreneur, then maybe you should consider ownership. You don’t need to be the world’s

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best dentist, but you need to aspire to be the best. You will need to nurture relationships, be a great decision maker, be a CEO (Chief Everything Officer)—a.k.a. wear many hats—be a great planner, goal setter, money manager and customer service expert. You will need to build and lead an amazing team and become an expert among your peers. You need to invest in yourself and set yourself apart from the competition. You will need to build a rock-solid reputation! Associateship versus owning your own business has clear pros and cons on both ends of the spectrum. Associateship clearly has the advantage of convenience and a stress-free environment. It takes away fear of the unknown and can even be parlayed into a part-time position. Ownership, on the other hand, is extremely involved and not for the faint of heart. There are limitless opportunities, but along with it comes a certain degree of risk. Whatever you decide, will require a certain degree of soul searching, but in the end, both choices can be incredibly rewarding. Make the call! What will it be?

Kyle Roth, DDS has been a practicing dentist since 1999. He has owned and operated 33 offices since graduating from the University of North Carolina at Chapel Hill. He is an owner and President of Encompass Transitions, one of the fastest growing dental transitions companies in the United States. His first career was in accounting and finance for ten years, which has provided him with a keen insight into the business of dentistry. He is an author and a speaker, and can be reached at dental.encompass@gmail.com, or you can visit his website at www.encompass-ihc.com

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Dental Entrepreneur Fall 2017 17

Getting Started

2 Dental Location Strategies Worth $500 .... Just for Startups Jayme Amos and Bridget Fay

any dentists prefer to own their practice but too many are trapped in positions where the options don’t match what they hoped for in practice ownership. For example, if you’ve ever wondered “where” to open your practice, you’ll need to become acutely aware of two core concepts. But more specifically, you’ll need to understand how those concepts relate to startups. Those two concepts are Visibility and Signage. In this article, you will be exposed to jarring truths about visibility and signage. Here, you will gain a perspective that can accelerate your growth, creating a very profitable first year in startup practice ownership. For example, one of the case studies we explore together will show how one of our High-Level Consulting Clients regularly attracts over 100 new patients per month while saving 50 percent on real estate costs. The fascinating part is that she has virtually no signage or visibility. You’ll see why you might not need them in your startup practice either. Visibility Should you choose a location with visibility like McDonalds? Not necessarily. Contrary to popular belief, you don’t need to do that in order to be successful. When you read to the end, you’ll learn about a startup dentist who cut real estate costs by half and got so many new patients that she was forced to pause marketing efforts. It starts with ignoring the advice from people who pretend to know how startup practices succeed. Those with opinions are not the same as those with experience. We call those people the “peanut gallery.” This group of people has strong opinions about startups without a few hundred case studies to teach from. This group could include vendors, colleagues and even loved ones. They have good intentions, but their sample size of startup practices is so small that their advice can hurt more than help. It’s important to ask yourself if you really take the opinion on such an important topic from someone who hasn’t helped hundreds of dentists create successful startups. For example: What about advice from someone like an equipment sales person? Did that person create the successes they speak of or just sell the equipment? Their compensation comes directly from an equipment sale, and I have yet to find an X-ray unit that determines the success of a startup practice. 18 Fall 2017 Dental Entrepreneur

What about the opinion of a colleague who opened a practice 10 years ago? That colleague’s experience with a single practice may not be relevant for your practice, in your town, built for your clinical experience in practice ownership. With a sample size of just one, be highly cautious of following the advice. Today’s successful startups are creating rapid growth by addressing the realities in this new era of dentistry. Current growth strategies have evolved and when implemented well, the results can create a strong trajectory for years of growth. To achieve this, ensure the peanut gallery doesn’t impact your planning stages. There is no topic more filled with peanut gallery wisdom than that of your practice’s visibility. Location, Location, Location Dentists have been told by infomercials, realtors and so-called “experts” that location-location-location should be your priority. They make suggestions to prioritize opening on busy intersections or the heaviest traveled roads. Below, we will share an example from one of our High-Level Consulting Clients. Her case study will reveal to you why those suggestions are factually incorrect. Through the process of negotiating, buying and opening this client’s practice, she is now able to own a building she loves. Her practice is located on the back-side of a building on a slow road. Her startup and is exploding with growth, as you’ll see in the numbers below. Take a look at her building here:

Her result? She attracts over 100 new patients per month ... in her startup ... without pricey real estate. In fact, through her first year in business, she surpassed an average of 100 new patients per month in every single month. An interesting byproduct of her rapid growth is her dramatic decrease in her marketing budget. Recently, she told the marketing agency to pause the marketing campaign because she has too many

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patients (over 1,500 in 14 months). Surprisingly, she’s on the back side of that building. It is on a side road just outside of town; visibility not included. The solution is not to buy the expensive McDonalds corner location. Businesses like McDonalds buy corner locations because their business must attract the impulse-buyers. As you know, impulse-buyers are good for coffee and fries, not crowns and prophies! What about potential cost savings? Instead of paying a million dollars for the expensive corner real estate, you would spend less than half that. See, commercial real estate prices can drop by 50 percent and over when you’re just one block off the main street. Your building can still be an icon in the community, grow rapidly and avoid overspending on corner location property. The Texas Case Study In this Texas Case Study, you’ll see the brown building from one of our clients the picture below.

Do you see the brown building up on the hill? As you can tell, there is very little visibility here. He just surpassed his six-month income goals in just three months without visibility. Allow me to reinforce the point again: six months of income in his first three months, all while being on the third floor of a commercial building without visibility from the main road. That’s why we are telling you to not believe the so-call experts who say visibility is your top priority. It’s just not true. Signage After negotiating millions of dollars of real estate deals all over the country, we’ve learned a lot. Signage is one of those topics that people believe has an absolute answer.

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Look at this image of a practice in my hometown, just outside of Philadelphia (in full disclosure, this is not one of my clients, though I’ve met the owner multiple times).

Exhibit B

This doctor took the advice from others, buying a building with good visibility, road frontage and a sign. Those things sound good on paper, fitting the proverbial checkboxes. Unfortunately for her, those checkboxes have not worked well. The problem is in her results. She attracts just 10 new patients per month, less than half of the monthly national average for new patients. This poor doctor even got the largest sign, legally allowed in her town.

You may remember the brown building up on the hill in Texas. This image shows a closeup view of the structure. As you might notice, there is no signage in site, preventing you from knowing even which floor his practice is on. Yet, paradoxically, he’s the doctor who reached his six-month income goal in half the time we planned. The point is that signage has played no role in his growth.

I hope these case studies create a lasting feeling because I want you to remember that the typical advice from the Peanut Gallery isn’t right for startups. While great signage is a good thing, most signage is worthless. Let’s take a look at our other two examples and see what kind of signage you can find. Exhibit A (look familiar?)

If you take a close look at the sign, you won’t see her name because it’s not there. The contractor didn’t finish her sign in time for the Grand Opening, so she opened her practice without one. Even without the sign, she still had 96 new patients in her first month. She now has more patients than she can handle after just 14 months.

The Winning Plan for Startuups When considering a startup, the stakes are high. But it’s worth investing the right amount of time and energy in proper planning because the rewards of success are even higher. Proper financial planning is imperative. Learn about proper startup budgets in this ground breaking article covering startup cost. [link: http://howtoopenadentaloffice. com/dental-practice-start-up-costs/] Don’t let the peanut gallery tell you to expect success from any single topic like visibility or signage. By avoiding that kind of advice, you can easily cut your real estate costs in half and increase your new patient flow to over 100 per month. The solution is to follow the proven 13 Stages of a startup, not just one topic like visibility. Get a free copy of the 13 Stages Video training here. [www.idealpractices.com/13] Incredible success stories are being made all across the country—and disasters are being avoided—by simply focusing on the entire process and implementing it the right way. For doctors who are considering opening a new office, we are offering one copy of a demographics article I created for your

Dental Entrepreneur Fall 2017 19

research. In my bestselling book, Choosing the Right Practice Location, I cover dozens of concepts related to this topic. You can learn more about those principles in this article on our website. http://howtoopenadentaloffice. com/dental-demographics/ Good luck to you and your future in practice ownership! Jayme Amos is the founder of Ideal Practices, Dentistry’s elite Startup-Practice consulting firm. He and his team work with a limited number of private practice dentists each year to open highly successful new practices.

20 Fall 2017 Dental Entrepreneur

He is the bestselling author of Choosing the Right Practice Location, host of the Ideal Practices Podcast, founder of HowToOpenADentalOffice.com and creator of the Startup Practice Blueprint Course. He’s the overly proud dad of two and husband to his wife Lisa. Together, he and Lisa are passionate about serving people in need overseas. Jayme can be reached at jayme@HowToOpenADentalOffice.com Bridget Fay is a Startup Practice Advisor with Ideal Practices, preparing practice owners for the business of practice ownership. Her background in practice management

and insurance guides doctors through the creation of protocol and systems that match their customized vision for practice ownership. She speaks and blogs on important practice management topics. Bridget holds a Fellowship with the American Association of Dental Office Management and a Bachelor’s in Business Management. When not working she can be found outside enjoying the fresh air either on her bike, or hiking with her pup. Bridget can be reached at Bridget@howtoopenadentaloffice.com.

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Visit us at: dew.life

Business Fundamentals Purchasing, Starting or Expanding a Dental Practice: Investments in Technology are Key for Entrepreneurs Dan Croft

he next decade in dentistry will be full of change, as 42 percent of dentists over age 55 are estimated to retire. This gap in professionals, combined with a renewed focus on technological and equipment investments to update practices, creates a prime opportunity for change. Younger dentists are especially wellpositioned to make such investments, which should translate into better customer service and more valuable practices overall. These predictions are based on a recent survey from TD Bank, which asked dentists about their practice management plans and overall business confidence. According to the survey, dentists are optimistic about the future, with more than two-thirds (67 percent) expecting their practice revenue to grow over the next two years. This confidence sets the stage for strategic investments in technology for their practices. In terms of priority investments, the survey found that upgrading equipment is top of mind for dentists. Nearly half of respondents (42 percent) plan to invest in new equipment over the near-term, trailed by marketing (27 percent) and hiring (26 percent). It’s no surprise that dentists are ready to give the equipment in their offices an upgrade, which will improve the overall health of their practice. The survey also revealed that dentists are concerned about ways to keep up with the latest technological advances, with 27 percent of dentists pointing to this as a top challenge. 22 Fall 2017 Dental Entrepreneur

In today’s competitive marketplace, new dentists should prioritize efficient technological investments to help enhance the overall customer experience and add value to their practices. From the get-go, younger dentists have an advantage over older practitioners when incorporating tech into patient care, because they have been trained on new technologies in dental school and throughout their residencies. They already have had greater exposure to and seen the benefits of the latest tools and devices, giving them a significant head start. From a treatment perspective, investing in the most modern equipment is critical for providing patients with the most accurate diagnoses and treatment options. These technologies present opportunities to drastically save time, improve the quality of care and expand a practice’s procedure mix, all of which allow a dentist to see more patients and take on more high-end procedures and subsequently increasing the business’ revenue potential.

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MacPractice Simplicity in practice

DOES YOUR SOFTWARE MATTER? DOES BEING THE BEST CLINICIAN MATTER IF YOUR OFFICE ISN’T RUN AFFORDABLY AND EFFICIENTLY. DOES EFFICIENCY MATTER IF YOUR SOFTWARE DOESN’T PROTECT YOU FROM VIRUSES AND RANSOMWARE AND MAKE EVERYONE IN YOUR OFFICE FEEL EMPOWERED TO BE THEIR BEST? DOES INNOVATION MATTER ANYMORE? AT MACPRACTICE, WE BELIEVE IN THE UNBELIEVABLE. IT’S WHY WE BUILD THE BEST SOFTWARE YOUR MONEY CAN BUY. AND TOMORROW IT WILL BE EVEN BETTER. YOU BETTER BELIEVE SOFTWARE MATTERS.

(855) 679-0033 | www.macpractice.com WEBINARS, DEMO VIDEOS AND MORE

MacPractice beats Dentrix, Eaglesoft, and Softdent in CR Reports User Satisfaction Survey* - Read full report at macpractice.com/dds * CR Choice designation in the March 2017 issue of the Independent Clinicians Report

MacPractice Simplicity in practice

There are many innovative technologies that will help give dentists an advantage among competitors. For example, Digital Radiography provides detailed, low-radiation X-rays that appear on a computer instantly. Intra-Oral Cameras allow patients to see their dental work and issues like a decayed tooth on a flat screen, resulting in better treatment planning, acceptance and patient education. There’s also CAD/CAM technology (computer-assisted design/computer-assisted manufacture) that help practitioners produce an accurate and safe dental crown, inlay or bridge in just one visit. This same-day dentistry option responds to the generational demand for faster, efficient services and eliminates a follow-up procedure visit, creating a happier patient and saving the practice time and money. Other technology to consider includes Cone Beam or 3D CAT scans that offer the most effective diagnostics to establish the patient’s suitability for dental implants, while also enabling many general dentists, for the first time ever, to make precise placement of the implant possible. Finally, Panorex Digital X-Rays, dental lasers, air abrasion, magnification loupes, digital photography and digital practice management software that save the office time and money while increasing quality and comfort for patients. Investing in these emerging technologies will of course present a relatively high start-up or expansion/replacement cost (especially for a young practitioner), but will result in performing dental procedures with greater precision, comfort and efficiency than ever before. While using the newest tools in patient care is critical, dentists also need to make patient communication a priority. First and foremost, a dental practice should be accessible across a variety of communication channels. Tech-savvy dentists are well-positioned to take this into consideration and meet the strong demands and expectations of millennial patients. Dentists should ensure that patients are able to communicate with a practice through all major social media channels as well as via e-mail and SMS messaging. It is also worth taking the time to create a mobile-friendly version of a practice’s website so patients can check in while on the go.

24 Fall 2017 Dental Entrepreneur

On top of expanding communication capabilities across all online channels, dentists should also continue to be responsive over traditional ways of communication, keeping the phones manned at all times and making it very clear to patients how to communicate outside of general practice hours. By keeping a variety of communication channels, dentists will be able to keep in closer touch with patients and cultivate stronger relationships. Connecting

The myriad of financial challenges faced by millennial dentists likely explains why they have so far been more hesitant to replace older generations. with patients in a variety of ways and making investments in the latest dental technology and gadgets are keys to patient retention in the dental industry. When considering buying or leasing new equipment, dentists should first speak to a financial partner with specialized dental industry expertise. A strong, reliable advisor will understand the short and long-term implications of technological outlays, and can help dentists plan for a prosperous future. They will be able to provide strategic advice on how to stagger dental investments appropriately and break down the high costs of initial investments, facilitating the needed loans and lines of credit for practice owners. In addition to highlighting plans for equipment investments, the survey also uncovered a current buyers market within the dental industry. More specifically, nearly one-third of respondents (29 percent) are considering selling or merging their practice in the next few years. However, relatively few millennials are stepping forward and buying up the practices for sale, instead choosing to remain as employees

of other practices. What could be the reason for this? The myriad of financial challenges faced by millennial dentists likely explains why they have so far been more hesitant to replace older generations. Increasing student loan debt and start-up practice costs are the biggest drivers pushing dentists into working for Dental Service Organizations (DSOs) and putting off owning a practice. The survey data reported that younger dentists are apprehensive about being held responsible for rising overhead costs, in particular wages, dental supplies, lab and rent. At the same time, they are often attracted to work at DSOs by certain positive attributes, such as the potential for higher incomes, more flexible work schedules and the mentorship options available within larger corporate practices. While there are benefits to working at DSOs, as independent practitioners retire, millennial dentists will be presented with an opportunity to embrace their ambition, autonomy and creativity through practice ownership. Investments in new dental technologies and greater familiarity with modern communication channels will help them to reach the burgeoning millennial audience and build a strong and loyal client base. Now is the time for the younger generation to see the available practices for sale as an attractive opportunity to slowly reinvent the next-generation dental practice and create a long-term relationship with a strategic financial partner who can help boost their success.

Dan Croft is Head of Healthcare Practice Solutions Group, TD Bank, overseeing the bank’s practice finance segment, which specializes in working with dentists, optometrists, veterinarians and physicians. He has 20 years’ experience working with medical, pharmaceutical and CPA businesses. Croft holds a bachelor’s degree from the College of the Holy Cross. He is based in Cherry Hill, N.J.

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Business Fundamentals

The Inequities of Earned Equity Dale Wagman, DDS

et’s start at the beginning. Earned equity (a.k.a. sweat equity) is the assumption by an associate (who is now contemplating purchasing either a partial or total ownership position of a dental practice) that because of his or her tenure in the practice, they should be granted a discount of the fair market value of the practice. The thought is that because the practice was collecting say $1M when they joined it and now, 10 years later, it is collecting $2 million the associate was at least partially responsible for the $1 million in collection growth and should be credited accordingly. No one wants to pay for something that, on the surface, appears they have already earned. Unfortunately, many associates, as well as sellers, wait until the time when a buy-in seems appropriate to begin the discussion of earned equity. That discussion should be initiated at the beginning of the relationship rather than at the end. Don’t be fooled by an increase in collections. While a discount may or may not be indicated, using collections as a sole measurement of growth and thereby practice value may be flawed logic. Collections are certainly an important component of market value, but they are not the only component. Let’s take a glance at some other factors that may negate an associate’s claim. The value of anything is in no small degree dependent on the ancient economic principles of supply and demand. The value of a practice collecting $1 million in an area where there is a surplus of buyers may be more than a practice collecting $2 million in an area with no buyers–a clear function of supply and demand. It is possible that any growth in the value of a practice could simply be the result of external market growth and have nothing at all to do with the efforts of any individual provider in the practice, including the current owner. The number of patients is another good indicator of growth. A practice that had 2,000 patients when an associate joined and still has 2,000 patients 10 years later hasn’t grown at all, even if collections have. It has recycled, but it hasn’t grown. A practice that had 2,000 patients and now has 3,000 patients has clearly grown. However, the challenge is determining how many of those new patients can be directly linked to the efforts of the associate. Associates seldom bring patients with them, but instead are given patients by the seller. Just showing up doesn’t necessarily translate into an increase in new patients. Any increase could have been simply due to an increase in the population of the community, perhaps new factories or other job-producing ventures that tend to draw people from other areas. The loss of a competitor may have similar albeit passive effect by

26 Fall 2017 Dental Entrepreneur

increasing the size of the available patient pool within the existing population. And it would certainly be unrealistic to assume that either of these events were the direct result of something attributable to the efforts of any individual within a practice. Often the addition of another employee—a personable hygienist, for example—may lead to a significant increase in new patient numbers as well as an increase in recall visits from the existing patients of the practice. Not only then does the direct hygiene revenue increase, but the revenue of the practice as a whole increases because the doctors have more opportunities to diagnose and treat potential or existing dental maladies. It would be a mistake, however, to charge the increase to the associate claiming a discount, when in fact it was due to the efforts of someone else. Fee increases can also significantly affect collections. Anyone practicing in today’s world knows that third-party payers play a noteworthy role in how much of an effect a fee increase may have on the collections of a dental practice. However, it is certainly safe to assume that over time, some effect would accrue to the overall collections of a practice by fee increases. The cumulative percentage of any increases over the length of time an associate has spent in the practice must be accounted for in any calculation made to help determine a discount in value. And finally, an argument can be made that if an associate has earned equity in a practice, he or she also will have been paid for that equity. If an associate does a single crown, which the practice would not have done without the associate, he or she has certainly contributed to the growth of the practice. However, the associate most certainly will have been paid for it as well. When viewed in this light, being paid for earned equity by means of a discount is very much akin to being paid twice. So, is an earned equity discount ever justified? To be fair, we should focus on what may be some perfectly legitimate reasons why a discount in the buy-in amount for an associate should be considered. If an associate provides a service not ordinarily provided by the current practice owner–endodontics, orthodontics, oral surgery – virtually all of the collections generated by those services should be weighed into the calculations made to establish the market value of the practice and subsequently considered when justifying a discount. Also, while just showing up doesn’t necessarily warrant consideration for a discount, being available on additional days to treat new patients, emergency patients and possibly even regular patients does. If an associate makes additional treatment time available and the cur-

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rent owner is as busy as he or she always was, then clearly any collections generated during that time should be factored into the market value and considered associate generated growth, as well. Obviously, the earned equity discount can be negotiated. However, the parameters by which the discount will be considered should not be made solely at the time of the sale, but rather at the time the associate hires in. Giving consideration to these variables at the beginning may soften the negotiation process at the end or better yet, eliminate it entirely. If you are a practice owner who is taking on an associate with the thought of making that associate an owner in the future, or if you are an associate eying an eventual ownership position, take some steps before you begin your relationship to prepare for the inevitable earned equity negotiation later. Waiting to address these issues until the actual time of a potential equity purchase is usually a little too late. Here are some samples of things that should be considered before the associate’s buy-in scenario ever begins: • First, have the practice appraised by an experienced transition consultant who will look at all of the different compo-

nents that contribute to practice value and establish a basis of value to use for comparison later. • Establish a base rate of growth that the practice has demonstrated before hiring the associate. If the practice has been growing at say 5 percent per year and is still growing at 5 percent or perhaps less per year during the associate’s tenure, there may not be any growth attributable to the associate at all, if everything else has remained relatively equal. • Devise a method of tracking patients. How many new patients specifically ask to be treated by the associate, either because others have referred them or because they don’t want to see the current owner? How many don’t care which doctor they see? How many regular patients does the new doctor see because they are unable to see the owner due to scheduling issues? • If the associate is to work days that have traditionally not been worked in the practice, devise a method of recording the number of patients seen on those days, as well as the collections generated.

• Along the way, take note of changes in your particular community that may affect the number of patients your practice sees. • Keep track of collections and new patient numbers that can be directly attributed to other providers who may join the practice after the associate does. • Plan to discuss how earned equity will be handled at the time of an ownership acquisition. Earned equity discounts may be fair and justified. They also may be unfair and unjustified. What they are not is simply a given.

Dale E. Wagman, DDS has been a PARAGON Dental transition Consultant since 2007. He owned and operated a large dental practice for almost 30 years. He has authored numerous dental management articles, as well as a best-selling textbook on the history and self-management of Dental PPOs. He lives with his wife in Northwestern Michigan. He can be reached at 517-375-3740

Buying your first practice doesn’t have to be painful. PARAGON cultivates relationships, not just clients. We’ll match you with the opportunity that fits your career aspirations, and guide you through every step of the process.

Start your practice with a smile. Call now.

866.898.1867 info@paragon.us.com paragon.us.com

Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 4/1/2016 to 3/31/2020 Provider ID# 302387.

Dental Entrepreneur – OCTOBER 2016 – 1/3 Page 4/C – 7”(W) x 3.3125”(H) DentalEntrepreneur.com

Dental Entrepreneur Fall 2017 27

Business Fundamentals

Are You Financially Exposed: Navigating the Cyber Avalanche Elizabeth S. Fitch, CIPP/US

ecent high-profile data breaches are indicative of the avalanche that has arrived. For every Anthem, Primerus and Excellus, health and dental professionals everywhere are victims. Recent surveys have produced eye-popping data. According to the 2016 Net Diligence Study, the average payout was $1.2 million with average legal costs of $434,000 and crisis services cost of $539,000. Healthcare is the sector most frequently breached. When it comes to a cyber breach, it’s not “if.” Rather, it’s “when.” The Importance of Cyber Security and HIPAA Compliance Federal and state governments have enacted privacy laws to protect personal and health information. Congress has passed privacy legislation that governs the healthcare sector, but they are complex and difficult to understand. Similarly, federal agencies that have regulatory authority over the healthcare sector have promulgated rules and regulations and have increased their regulatory enforcement, seeking fines and penalties. The Office of Civil Rights (“OCR”) enforces HIPAA and HITECH. OCR has investigated and resolved 24,501 cases. OCR has assessed $45,889,200 in fines and penalties. Effective March 21, 2016, OCR announced began random audits of healthcare professionals. Private practice groups are the most common covered entities required to take corrective action. On Feb. 3, 2016, an administrative law judge ruled in favor of the Office of Civil

Rights and levied $239,800 in sanctions against a health care provider for HIPAA violations, showing that data security is at the forefront of federal enforcement actions. Currently civil penalties range from $100 to $50,000 per violation: In addition to OCR enforcement actions, 48 states have enacted breach notification laws, and all 48 mandate notification to individuals whose personal information may be compromised. But key differences do exist. Fifteen states require notification to governmental agencies, and 27 states require notification to national credit-reporting agencies. Couple this with complex third-party litigation, and healthcare professionals are experiencing information overload. This is further complicated by statutes and regulations, inconsistent case law and procedural peculiarities throughout the United Violation Penalty States. Technology is rapidly The covered entity or individual did not know (and by $100-$50,000 for each violation* exercising reasonable diligence would not have known) changing, hackers are becomthe act was a HIPAA violation. ing more sophisticated and the laws are constantly The HIPAA violation had a reasonable cause and was $1,000-$50,000 for each violation* not due to willful neglect. evolving. While most dentists profess to understand The HIPAA violation was due to willful neglect, but the $10,000-$50,000 for each violation* violation was corrected within the required time period. technological basics such as word processing, email and The HIPAA violation was due to willful neglect and was $50,000 or more for each violation* electronic medical records, not corrected.

28 Fall 2017 Dental Entrepreneur

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most acknowledge that they have no understanding of the HIPAA mandated security controls used to protect health information. Conversely, hackers have embraced the technology revolution and continue to develop more sophisticated tactics to prey upon people’s trusting nature. Spoofed emails lead dental-practice staff to visit infected websites designed to appear legitimate. Secretly installed spyware then tricks dentists or their staffs into divulging personal information such as credit card numbers, passwords and social security numbers. Hackers are leveraging social media to learn personal details about targeted individuals, and then carefully crafting emails to trick employees to turn over valuable data and give access to bank accounts. Hackers are particularly targeting dental practices because of the lax security protocols and the sales value of protected health information on the dark web is higher than other types of data. What is the Greatest Cyber Threat? Ignorance. When thinking of cyber exposures, what comes to mind are systems failures, and the human element is often overlooked. But according to the Poneman Institute, 35 percent of cyber breaches are due to human failings. Eighty-five percent of office workers, for example, have been duped by social engineering. Employee ignorance is one risk factor, but ignorance at the ownership level is even more disconcerting. Most dentists are under the misimpression that cyber risk is an IT problem. Yet, system glitches account for only 29 percent of data breaches, so relegating the responsibility of mitigating cyber risk to an administrative employees or outside IT vendors fails to address 70 percent of a dental practice’s vulnerabilities. HIPAA compliance is not limited to technical security, but requires stringent administrative controls, commitment from the dental providers

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and ongoing training of employees. Cygiene™ Best Practices Is Mission Critical to Mitigating the Cost of Cyber Breaches and Regulatory Enforcement Actions. Cyber risk mitigation poses unique challenges, from adopting HIPAAcompliant best practices to managing vendors and maintaining appropriate cyber insurance. Dentists do not need to be subject matter experts in cyber security, but having a basic understanding of cyber threats, vulnerabilities and financial risk is critical for risk mitigation. Cygiene™ is no different than dental hygiene. Just as daily dental floss use mitigates the risk of tooth decay and gum disease, employee training and implementation of cyber best practices minimizes the risk of financial ruin from a cyber breach or a regulatory audit by the Office of Civil Rights. To mitigate against cyber security breaches and the potentially devastating financial costs, dental practices should implement at a minimum the following Cygiene™ practices: • Assess risks Every dentist should understand the pervasive nature of cyber threats, from hacker attacks to employee mistakes. It is equally important to understand the dental practice’s cyber vulnerability, which can be the result of on-going poor cyber hygiene practices. • Get educated Dental practitioners should be wellversed in cyber security basics and understand the applicable federal and state regulations. Knowing the fundamentals is critical so that in the event of a breach, the right questions are asked and the right experts retained. • Invest in the best-practices training The greatest cyber threat is employee ignorance. According to the Poneman Institute, 35 percent of cyber breaches are due to human error. Social engineering is also a powerful means to

steal data, reportedly duping 85 percent of office workers in recent findings. Proper and ongoing best practices training is not only required for HIPAA compliance but also reduces cyber threats due to employee error. • Have a plan Swift action is required for compliance with breach notification laws. Every dental office should have in place an early response team and a breach response plan. • Shift your financial exposure Procure cyber liability insurance. Traditional insurance products are insufficient to protect against cyber incidents. • Employ the right tools and experts Protecting a dental practice’s protected health information is complex. It is recommended that every dental practice retain lawyers and outside cyber consultants to develop and help implement best practices to ensure HIPAA compliance and prepare for or to combat a cyber breach. Beth Fitch is a founding member of the Arizona law firm, Righi Fitch Law Group. She is a trial attorney with 30 years of civil defense experience and has the AV Preeminent Rating. Beth has defended numerous multi-million dollar cases ranging from catastrophic injuries to construction defect. She has represented all types of professionals from lawyers to architects. In 2016 she was again recognized as a Super Lawyer and is a member of Arizona’s Finest Lawyers. Beth is certified by the International Association of Privacy Professionals., is the Co-Chair of the Arizona State Bar’s Cyber Liability Committee, Co-Dean of the CLM Cyber Claims College and Vice-Chair of the IADC Technology Publications Committee. She counsels companies and insureds on cyber hygiene, best practices and responding to data breaches.

Dental Entrepreneur Fall 2017 29

Practice Builders

Winning in Dentistry Laura Hatch

ou’ve overcome a lot of hurdles to get where you are today. First, you made the decision to apply to dental school and had to wait to hear whether you were accepted. Then, you made it through the program and passed the boards. After that, everything becomes focused on the biggest decision of all—continue with your education, buy an existing practice, start a practice of your own or work for an owner as an associate. I’m familiar with these hurdles. When my husband graduated in 1999 from the University of Maryland, he decided to work as an associate for a few years before we opened a scratch practice together in 2002. (Later, I experienced business ownership a second time when I took my office manager experience and started Front Office Rocks, an online training resource that helps dental practices increase revenue by improving their day-to-day operations.) My husband and I shared a lot of ups and downs during that time. What I learned during those years of watching my husband associate at another practice, opening our own new practice and speaking with our friend about buying an existing practice, is that the biggest hurdle to overcome in all three scenarios isn’t doing the dentistry—it’s dealing with the people. You went to school to work on teeth, and you have a goal of helping people keep their teeth for life, but it’s hard to help patients if you can’t get two groups of people on your side: the staff and the patients. At this point, we hired a few associates over the years, and I’ve made it my mission to help them acclimate to private practice based on what we learned in those early years. Most of you will have to overcome this hurdle yourself soon, and I want to offer some advice to you, too. Win the Trust of Your Staff Whether you work for another dentist or own a practice, if you want to gain your patients’ trust and take care of their dental needs, you must win over the staff first. Why is this so difficult? Typically, the existing employees are loyal to another dentist (either the owner-dentist or the dentist who previously owned the practice) and they see you as the new kid on the block. They don’t know you or how you work. Until you have tried to blend into their world, you’ll be compared to the other dentist. If you don’t make yourself known to the staff and form relationships with them, they won’t be effective in filling your schedule or following your instructions the way they do for the other doctor.

30 Fall 2017 Dental Entrepreneur

There are two ways to make inroads with your employees. First, get to know them individually. They need to know you as a person, not just as the new dentist. Find a time to get to know each of them. I am not suggesting you stand around the office making small talk with them— in fact, as an office manager who needs to keep a schedule running smoothly, I am begging you not to do that! However, seek out ways to talk with them one on one. Offer to take them to lunch or try to take your lunch break at the same time as the staff and talk with them in the break room. Share with them who you are and make a real effort to learn more about them. When you go out of your way to form individual relationships with staff, they will warm up to you and grow to like you for who you are. The result of this budding relationship is assimilation and mutual respect. Build rapport with the team by inviting them into your dental chair. Once they have experienced your bedside manner and your clinical skills, they will trust you to a greater degree. Moreover, they can share the experience they had with you as a dentist with patients and describe what great care you provided while they were the patient. Even if it is just for a cleaning or an evaluation for a specific issue, getting each staff member in your chair will help them evaluate you as a dentist, build their personal trust in you and (as a bonus) help them convey that trust to the patients. Win Over Patients as a New Dentist Now that the staff supports you, it’s time to win over the patient. You will have a similar situation with the patients as you did with the staff, and you need to take the time to win them over. You won’t accomplish this by using big clinical terms or sharing your amazing knowledge. You’re the dental expert, but so is every other dentist in your city. Instead, win them over by taking the time to get to know each of them on a personal level. Take the time to discover a little about them and see what you may have in common. It could be something as small as sharing the love of a hobby or having both traveled to the same place. Once the patient starts to see you as a person and you find something in common, you can wow them with your clinical knowledge and exceptional dentistry skills. Patients will remember how comfortable and positive you made them feel with that personal connection and they will believe in you as a dental expert. Finally, if you’re working for an owner-doctor or if you are transitioning into a practice purchased from another dentist, discuss your thoughts,

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concerns and game plan with the current owner-doctor. You should explain your need to build trust and respect with the staff and patients and then describe how you intend to do it. Likely, the owner-doctor won’t mind supporting your plan because they brought you on to either take some of the workload off them or to smoothly transition out and have you take over. The current owner-doctor wants you to succeed just as much as you want to be a success in this new role. What’s the bottom line? Remember, as much as we are in the tooth business, we really are in a people business. Those people are why I started Front Office Rocks—to provide dentists with a simple way to train staff how to put customer service first. In the case of starting out as a new dentist, it’s vital to treat both patients AND staff as valued customers. They want to be viewed as a person with unique needs, not just a tooth number

or a one-dimensional job role in the practice. Take the time to get to know both staff and patients and share your honest self with them. Do that, and you will have the opportunity to get more teeth on your schedule to do the work you love.

Laura Hatch has committed years of study to learning how to manage and empower team members and partnered with her husband to build and manage two fee for-service dental practices. Twelve years later, she founded Front Office Rocks, which offers webbased, on-demand front office training for dental practices. As the leading authority on virtual dental front office training, Laura helps dental profession-

als who want to be better at what they do gain the training they need through online video courses, live seminars and coaching. Laura has been published in Dental Assisting Digest, Dentaltown, and Dentistry IQ. She is also a fellow of the American Association of Dental Office Managers, a national and international speaker on dental practice management for leading dental authorities, state and local dental societies, study clubs, and an advisor to several companies within the dental community. She is a member of the National Speakers Association and the Speaking Consulting Network. Laura was recognized as one of DPR’s Top 25 Women in Dentistry in 2016. When Laura isn’t managing at the practice, you can find her on Dentaltown or in her own “Ask Laura” forum, where she responds to dental team members’ questions and shares her experience and expertise as a dental office manager

RELAX,

You’ve listed your practice with Henry Schein Professional Practice Transitions. Deciding to sell your practice is difficult. We make it easier. Our experience, knowledge, and national network will help you get the best price, close the deal, and give you peace of mind.

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Dental Entrepreneur Fall 2017 31 5/6/15 5:41 PM

Power to Succeed

Women in Dentistry: The Flexibility and Reward of Ownership Angie Svitak, CPA and Christy Ratcliff, CPA

he choice to own your own dental practice is, of course, applicable to both men and women. However, even today it is hard to deny the extra sociological pressure that a woman carries in the workforce. Much of the time, women put pressure on themselves to “do it all,” and the thought of the associated risk of ownership adds to that stress. But, consider the facts when contemplating ownership versus associateship. Same Dentistry, More Money It’s no secret that ownership leads to more compensation. Think about it this way—most women in dentistry will work approximately 35 years. Let’s presume you worked at a one-doctor practice that produces approximately $62,000 of doctor production a month. This is, on average with hygiene, a $1 million practice. As a long-term associate paid 30 percent of your doctor collections, you may average somewhere around $223,000 annually. On the other hand, if you were an owner of that same practice and presume an overhead of 60 percent, you could make $400,000. You would make considerably more money as an owner for the same amount of dentistry.

YEARS = 72 / Rate of Return Now you’re back to imagining an extra $177,000 in your pocket per year. Based on the Rule of 72, if we assume your investments are receiving a 7.2 percent rate of return, your money would double every 10 years. 10 (years) = 72 / 7.2 (rate of return)

Does Reward Outweigh Risk? Imagine what that extra $177,000 per year could do for you and your family over the long term. That income, used strategically, could accelerate the time towards reaching your personal and retirement goals. To illustrate this, let’s look at the Rule of 72—a common tool used by financial planners. It is a simplified way to determine how long an investment will take to double, given a fixed annual rate of interest. It says that if you divide the number 72 by your annual investment rate of return, the result is equivalent to how many years it will take for your investment to double.

32 Fall 2017 Dental Entrepreneur

If you work for 35 years, your money will double three-anda-half times. Assuming you save all your additional earnings, doubling $177,000 three-and-a-half times results in $2,124,000 of accumulated wealth. Which means the decision to not be an owner in a practice for one year is now not just a $177,000 decision, but a cumulative total of $2,124,000 based on only one year of additional earnings alone. Other opportunities of ownership include future financial flexibility and the opportunity to build equity in your dental practice. Building ownership in a practice that you can sell down the road will help build your nest egg for retirement. You will also

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have the ability for more efficient tax planning, as ownership can mean more opportunity for tax write-offs. Then there is the additional flexibility with retirement planning. By maximizing a 401(k) retirement plan, you have the ability to save $54,000 every year into a retirement plan and receive a tax deduction for it. Assuming you are in the highest Federal tax bracket, that amounts to $21,600 of Federal tax savings every year. Beyond the Financial Freedom: The Beauty of Partnership Truth is, money isn’t everything. Increasingly, time and flexibility have become more important in our society. Balance is essential and means something different to every person. Whether it be family, personal or social obligations, more and more women are hesitant to start a new business because they don’t want it to consume them. Yet, as a strong woman with a drive to be a leader in your community and dentistry, do you have to make that choice? What if you could have both? Here is where the beauty of a partnership comes in. There are solutions that can attempt to resolve this battle between realizing the benefits of ownership and mitigating the risks of being the sole provider for your office family. The saying “two heads are better than one” is also true in ownership. More frequently we see two colleagues, especially women in dentistry, merging forces to create a single practice which allows them both to be in control of their dentistry and destiny. They share the burden of running the business, which allows them to reap the financial benefits of ownership. So how does it work? The beauty is that there are many ways it can work and many ways to structure it. The goal is to create a partnership that has a structure and ownership that fits what you need. More often we see women in dentistry buying into a practice in stages, which

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allows for flexibility in ownership--something you may need depending on your phase of life. Look at this scenario—it’s early in your career and you need more time at home for family or personal activities. You could buy into a practice at 33-percent ownership, then as your children get older or your personal activities at home change, you may choose to buy an additional percentage to get you to 50-percent ownership. As you near the end of your career, you may wish to slow down again and reduce your ownership to begin transitioning into retirement. Strength in Numbers Not only does this type of ownership allow you to manage your individual production, but it also allows you to mitigate some of the business risk and responsibility. Not only can you share the administrative functions and expenses, but you also have another trusted person to share in your vision of the practice and to lean on when you need time off or things of that nature. Based on the CWA 2016 How Does Your Practice Compare? report, a typical one-doctor general practice has a profit margin of 40 percent of their collections. A typical two-doctor general practice profits 46 percent of their collections. This increase in profit is due to the ability to share the fixed expenses. With a partnership, not only do you receive the increased benefits of flexibility, but you can also be more profitable. There truly can be strength in numbers. As you can see, like any self-employed individual, harnessing the entrepreneurial spirit can allow women in dentistry the opportunity to create a practice and ownership solution that works for their life, both professionally and personally. Ownership can be daunting, but it can also be fulfilling and rewarding—you just have to find the path that works for you.

Angie Svitak is a Certified Public Accountant and Financial Planner at Cain Watters and Associates (CWA). She works with dental practice owners all over the nation to guide them on the path to reach their goals and feel confident about their future. She spends her time outside of work baking, cooking, and enjoying time with her husband and two sons.

Christy Ratcliff is a Certified Public Accountant and a Certified Valuation Analyst. She leads the valuation and consulting team at National Dental Placements (NDP), an affiliate of CWA where she works with both young and established dentists as they transition into or out of dental practice ownership. Outside of the office, Christy enjoys spending time with her husband and two young daughters, when she has free time she enjoys cooking and reading a good book. Cain Watters & Associates LLC (CWA) is an investment advisor registered with the Securities & Exchange Commission. CWA and National Dental Placements (NDP) are affiliated firms. Information provided does not take into account individual financial circumstances and should not be considered investment advice to the reader. Request form ADV Part 2A for a complete description of CWA’s financial planning and investment advisory services. There is no assurance that other client actual results will be similar to information presented. Estimated future results may not be obtained due to economic, business and personal circumstances.

Dental Entrepreneur Fall 2017 33

Power to Succeed

Your Pathway to Practice David Rice, DDS

pinions, well … you know what they say. Magnify that with today’s social media mania, and you get the world trying to convince you their way is the way.

Shenanigans!

You’ve worked your tail off to get here. You’re in debt, you’re drinking gallons of coffee to stay up and study and your meditative breaths when clinic faculty make you shave three enamel rods off an already perfect prep to satisfy their ego. Enter this article: Pathways to Practice. There are multiple roads to success, and there’s a recipe to follow for each one. We’ll outline them all in future issues of Dental Entrepreneur. For now, here are three key principles that apply to any path you take: 1) Vision There are too many practice-management consultants out there willing to charge you $30,000 to help you define your vision and mission statements. Drives me cray-cray! Although I’m a firm believer in having a coach, you don’t need to pay $30,000 to anyone for this. So if you believe in you as much as I do, find your happy spot and answer the following questions. Your answers are THE MOST important part of your vision. And, if you’re into it and want more, message me on ignitedds.com. There’s a hot button that kicks to my cell. I’m happy to walk you through this process for FREE. • In your perfect world, where would you like to wake up every day? Ocean? Mountains? Urban? Suburbs? Rural? • In that same perfect world, what kind of dentist do you want to be? General or specialist? What does your practice look like? Big? Small? Somewhere in the middle? High-tech? Hightouch? Both? • And how about your team? Big? Small? 2) Focus There are plenty of squirrels to chase in life. Some will be an obvious waste of your time. Others will be disguised as really cool or really lucrative opportunities. Thousands of dentists fall into the trap of chasing squirrels. One of the most valuable takehomes I could ever give you is this: Once you’ve defined your vision—once it’s crystal clear to you what will bring you the most happiness—make 100 percent of your decisions based on it.

34 Fall 2017 Dental Entrepreneur

When opportunities present, if they align with your vision, say yes. When an opportunity presents and does not align, no matter how good it looks, no matter how much money you think you’ll make, say “No thank you.” It’s going to be hard, but it’s going to be worth it. 3) Patience There’s a simple principle in economics. Incredibly, it applies to most things in life and has stood the test of time. For you, it means 20 percent of new grads will have an easy road, but 80 percent will stumble a few times. Measure your success by how well you fulfill your vision in your timeframe. Some of my friends blazed a trail from day one, and some of my friends wandered their path for a few years. Today, the most successful of us all, despite who was the tortoise and who was the hare, were the ones who defined their vision early, focused and stayed on their path. The others, despite the same, still flounder 20 years in. It’s OK if it takes you a few years to see the fruits of your labor. Stay patient, and if you want help defining and executing your pathway, just ask. Till then… Together We Rise!

Dr. David Rice, DDS graduated cum laude in 1994 from The State University of New York at Buffalo’s School of Dental Medicine. In 1995, he completed his general practice residency from the Allegheny General Hospital in Pittsburgh Pennsylvania. With a strong belief in continuing education and mentorship, Dr. Rice went on to complete continuums at the Pankey Institute, The Dawson Center and The Spear Center all while building the Restorative Practice of his dreams and maintaining an associate clinical professorship at the SUNYab School of Dental Medicine. Dr. Rice combined his passions for teaching, mentoring and making a difference and igniteDDS was born. Today he continues to maintain his private practice and travels the country inspiring dentistry’s future to live their dream, have great success and to make that same difference that has brought him so much joy.

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Dental Trade Shows ADA Annual Session October 19 – 23, 2017 Atlanta, GA ada.org Greater New York Dental Meeting November 24 -29, 2017 New York, NY Yankee Dental Conference January 24 – 28, 2018 Boston, MA 2018 Mid-Winter Meeting of the Chicago Dental Society February 22 – 24, 2018 McCormick Place, Chicago, IL Thomas P. Hinman Dental Meeting March 22-24, 2018 Georgia World Congress Center, Atlanta, Georgia

The ASDA National Leadership Conference is being held on Nov. 16-18, 2017 at the Chicago Hilton Hotel. The National Leadership Conference provides leadership training to dental students across all years and predentals. Attendees can create customized schedules based on their personal knowledge, experience and interests, in order to benefit them as dental students and future practitioners, as well as leaders in organized dentistry. Last year, almost 600 student leaders came together to: • Build relationships with leading dental organizations • Develop leadership skills that they’ll use throughout their dental careers • Increase understanding of key issues in dentistry and dental education • Connect with vendors during breakout sessions, on the tradeshow floor of the dental expo, and during various networking breakouts throughout the program • Attend sessions on chapter management, public speaking, personal finance, practice negotiations and more

Index of Advertisers ADS Dental Transitions South……………………………………………………………........................... 13 America’s Tooth Fairy……………………………………………………………....................................... 25 D5............................................................................................................................................. 35 DeW.Life .................................................................................................................................... 21 Henry Schein PPT ....................................................................................................................... 31 Henry Schein Nationwide ............................................................................................................. 37 MacPractice................................................................................................................................ 23 Orascoptic .................................................................................................................................... 7 Paragon...................................................................................................................................... 27 Patterson Dental........................................................................................... Inside front cover/page 1 The Progressive Dentist................................................................................................................ 20 Ultradent ................................................................................................................................... 15 Wells Fargo......................................................................................................................Back cover 36 Fall 2017 Dental Entrepreneur

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Wells Fargo Practice Finance

Thinking about practice ownership? Let’s talk about your options.

When you’re ready to purchase or start a practice, count on Wells Fargo Practice Finance to help you achieve your goals: · Up to 100% financing to help you acquire an existing practice or start one from scratch · Competitive fixed-rate loans with preferred pricing for ADA® members

Download your free copy of Preparing for Ownership. wellsfargo.com/demagazine

· Complimentary planning resources and professional support to help your practice thrive

To get started, call 1-888-937-2321 or visit wellsfargo.com/demagazine to request your free Preparing for Ownership workbook. Wells Fargo Practice Finance is the only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM.

All financing is subject to credit approval. ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association. © 2017 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. 3153-1216 WFPF-Ad-Dental-Entrepreneur-Winter-2017