Dental Entrepreneur Fall 2015 by Dental Entrepreneur Media

Dental Entrepreneur CLASS OF 2016 | FALL ISSUE

Business Beyond the Classroom

Dirk Fleischman, DDS and John Zalesky, DMD

Mentor and Mentee: A Story About How It Is Done!

4 Mistakes Every Young Dentist Should Avoid

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Be Debt Free and Own Your Practice Outright in 5 Years

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Fall 2015 VOLUME 18, ISSUE 1

Editor & Publisher Anne M. Duffy RDH Assistant Editor Michael Duffy Production Ruthie Gordon 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 Layout and Design John O’Connor

Class of 2016 Contributors Cindy Bickers Charles Blair, DDS Amy Bowman Johnathan S. Carey, DMD Dirk Fleishman, DMD Gary Kadi

Roger Levin, DDS, MBA Tracy J. Pearson, JD David Rice, DDS Gavin Shea Chad Widensky John Zalesky, DMD

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 2014 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.

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Welcome

CLASS OF 2016 FALL ISSUE VOLUME I

What I love about reaching a certain age is the opportunity to look back and be satisfied with where I am, right now, in this moment. One day always leads to another, and it truly isn’t about what you get out of the previous 24 hours, it is how you handle what you get. To “handle” life with grace and purpose is undoubtedly easier when you surround yourself with people that you look up to and admire. People you can turn to when life becomes hard and you face an impasse on your road to success. Looking back, I think of all the people who have inspired me, coached me and believed in me. I truly cherish those times when a friend, relative, or colleague has stepped in with a kind and supporting word or action. I am thankful that I recognized their generosity and had my ears and eyes open to their insight. I believe in creating many opportunities to be a mentor and/or mentee. You know it takes two to tango. And it takes two to form a mentor/mentee relationship. That is why I am so excited to introduce you to our cover guys, Drs. Dirk Fleischman and John Zelesky. Their story is special and it could be yours, if you are as attentive as I was when I first heard it from Dr. Fleischman, who has played an important role in John’s career from student at Nova Southeastern University to now, where he’s the Chief Resident at Colorado University School of Dental Medicine. In this edition of Dental Entrepreneur: Business Beyond the Classroom, we have featured a slew of other potential mentors to help you on your journey. Cindy Bickers, the Manager for Henry Schein Nationwide Dental Opportunities, recalls her 15-plus years of expertise to break down the key factors you must consider if interested in pursuing an associateship. Gavin Shea, Senior Director of Sales and Marketing for Wells Fargo Practice Finance, and Chad Widensky, Vice President and Regional Business Development Officer at Bank of America Practice Solutions, offer invaluable financial insight. Shea discusses how to avoid the pitfalls many dental professionals make when dealing with the significant monetary investment of practice ownership. And Widensky illustrates why it is important to understand the concept of cash flow. Both are critical pieces of advice. I am fascinated with the idea that good people find good people, and in our very own dental profession there are lots of good people! Start by reaching out to our authors and advertisers in this edition. They want to guide you with their words and ideas, and if they resonate, reach out and start to build a relationship. They do want to hear from you. It’s all about relationships in the end. Here’s to leading a life of grace and purpose! All the best,

Anne M. Duffy Publisher

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Contents Prologue

4 Mentor and Mentee: A Story About How It Is Done! Dirk Fleischman, DDS and John Zalesky, DMD

6 The Importance of Mentorship Amy Bowman

Getting Started 8 Associateships: Everything You Need to Know Cindy Bickers

12 Be Debt Free and Own Your Practice Outright in 5 Years Gary Kadi

16 Owning Your Own Practice – How to Avoid the Pitfalls Gavin Shea

Business Fundamentals 20 Understanding Cash Flow Chad Widensky

22 Owning a Practice and Liability for Others’ Treatment Tracy J. Pearson, JD

28 Corporate Dentistry’s Impact on

Practice Builders 30 Sixteen Critical Strategies to Increase and Maintain Practice Revenue Charles Blair, DMD

32 4 Mistakes Every Young Dentist Should Avoid Roger Levin, DDS, MBA

The Power To Succeed 34 Prove It! David Rice, DDS

Practice Sales Johnathan S. Carey, DMD

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Dental Entrepreneur Fall 2015 3

Prologue

Mentor and Mentee A Story About How It Is Done! Dirk Fleischman, DDS and John Zalesky, DMD

ong before Dr. Fleischman was a dentist, he had a talk with his college advisor at the State University of New York at Stony Brook that would change the lives of countless future dental professionals. But this conversation was not the supportive kind that one would expect from a person in such a leadership position. The university official actually attempted to discourage Dr. Fleischman from pursuing a career in medicine or dentistry. “This is a quote,” he said, “Fleischman, you don’t have what it takes to be a doctor. Don’t bother applying to any professional program because you’ll never get accepted.” Dr. Fleischman couldn’t believe what he had heard from his academic advisor. Those two sentences sparked Dr. Fleischman’s sense of determination, and the former Stony Brook hockey player embarked on a path that would lead him to Howard University College of Dentistry, where he graduated at the top of his class, and a lengthy and fruitful career practicing general dentistry in South Florida. As the story goes, Dr. Fleischman opened his first office in Miami, Florida in 1983. A modest affair that grew into something much bigger than even Dr. Fleischman could have imagined. Looking back, Dr. Fleischman remembers another poignant conversation that he had in a leadership role. Dr. Thomas Jeter, who first crossed Dr. Fleischman’s path as his oral surgery professor at Howard University College of Dentistry’s Department of Oral Surgery and who eventually became the school’s Dean of Admissions. This relationship was lifelong until Dr. Jeter passed away about eight years ago. Dr. Jeter confidently informed Dr. Fleischman that he would one day teach. This was something that Dr. Fleischman had never considered. To this, Dr. Fleischman responded to his mentor, “Seriously? I’m no teacher!” But as Dr.

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Fleischman kept moving forward in his career, he heard his mentor’s voice telling him, “You’re a natural.” As the years went by Dr. Fleischman realized that teaching was actually something he could do, and moreover, wanted to do. Even as a seasoned professional, he still wanted to make his mentor proud. It was apparent to Dr. Fleischman that he deeply wished to pay it forward and mentor future dentists in the way Dr. Jeter had mentored him. Dr. Jeter wasn’t the only mentor who impacted Dr. Fleischman in those early days. He also recalled longtime office manager Mary Frame, who convinced him to build his own dental office building in Miami when the original practice needed more room. “She was a wonderful inspiration for me, and taught me a lot about life and business,” Dr. Fleischman said about Frame, who retired after 15 years with Dr. Fleischman’s practice at 81 years young. When the practice was outgrowing its space in a shopping center, and the owners didn’t want to provide a larger space at a reasonable rate, Mary came back from lunch one day and informed her boss, “I found us a piece of land. We are moving out and building our own dental office building, and will control our destiny from now on.”

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The new dental office building, with nine operatories, was opened February of 1990, where Dr. Fleischman’s practice remained until he sold his practice and building in December, 2013 and semiretired. As more and more patients came through Dr. Fleischman’s office, the daughter of one of his patients came to him asking if she could shadow him. She explained that her college pre-dental advisor, who was a dentist that she was currently shadowing, essentially relegated her to filing papers. This did not sit well with either her or Dr. Fleischman. Dr. Fleischman informed the student, “If you come to my office, you are going to be chairside with me; I don’t believe in longdistance dentistry.” With patient consent, Dr. Fleischman let her hold his hand while he removed decay from a tooth. He taught her dental nomenclature. He allowed her to drill on already extracted teeth in the hope that she could get more hands-on experience and a better understanding of what dentistry is all about. The experience was amazing for both mentor and mentee. “That really opened the flood gates,” Dr. Fleischman stated with a laugh. As more and more pre-dental students crossed Dr. Fleischman’s professional threshold to seek his counsel and mentorship, he decided to formalize the process even more and, in 2002, he established a dental mentoring program entitled the South Florida Intergenerational Study Club. Its mission was “to bridge the gap between experienced dental professionals today and future dental professionals through mutual learning and mentorship.” At the time, Dr. Fleischman was a full-time dental practitioner and donated his time working as the team dentist for the Florida Panthers NHL hockey team, working with the University of Miami and Florida State University’s sports teams, and working with dental students at Nova Southeastern College of Dental Medicine. Young, would-be dentists came out of the wood work to seek Dr. Fleischman’s

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mentorship and he worked tirelessly to not only teach them the finer points of the business of dentistry but also to help them get into the right programs that would further their dental careers in the best way possible. That happened both chairside and at regular dinner meetings that Dr. Fleischman would host at his home. As the number of students increased, these working dinners evolved into largescale dental dinner functions that included pre-dental undergraduate students, dental students, dental faculty from Nova

Dr. Fleischman says he will never give up his teaching and will both teach and be the business side of the future practice. Southeastern University, and even a few interested high school seniors. Later functions saw the addition of dental specialists in the community who wished to help mentor students interested in specializing. “It just developed into this wonderful thing that was a pipeline for Nova dental school. I was able to recommend qualified students to the school. I was able to connect first year students with upperclassmen, and I was able to help graduating dentists feel more informed about and supported in their next steps.” In 2007, Dr. Fleischman began employing young dental associates into his practice and accepted a part-time clinical assistant professorship at Nova, to carry his teaching and passion for dentistry and mentorship to the clinic floor. “I am so proud of the fact that all of the kids that I have helped along the way have been accepted into both dental schools and post-graduate dental residency programs.

I only ask that they don’t forget where they came from and that they pay it forward when asked for guidance in the future.” At Nova Southeastern dental school, Dr. Fleischman connected with many students. One in particular was John Zalesky, who he continues to mentor today. John was in his third year at Nova and Dr. Fleischman was leading a course on cosmetic dentistry when he promised to treat to dinner any of the students who achieved an “A” in the class. As a hungry 20-something with student loans, Zalesky had some extra motivation. “A free dinner is nice when you’re a student,” the now “Dr. Zalesky” joked.” That was the beginning of a lifelong relationship. Dr. Zalesky would have dinner with Dr. Fleischman twice a week, not only picking his brain about dentistry, but talking about life in general. The things that dental school really doesn’t cover. “It really has shaped me as a person,” said Dr. Zalesky, a graduate of Fairleigh Dickinson University and Nova Southeastern College of Dental Medicine. “I appreciated the fact that I had seen what Dr. Fleischman had done with his career in Miami and that he helped me understand things when he went to sell his practice. We had frequent dinners at his house to discuss what to look for when you’re selling a practice.” This has always been Dr. Fleischman’s goal; to give future dentists an understanding of the big picture and to be a true mentor. “Dr. Fleischman became my second father and he considers me the son he never had, as he has three daughters,” Dr. Zalesky says with a laugh. “I was very lucky. My other classmates didn’t have a Dr. Fleischman in their lives. At dinner, we’d talk about dental stuff, but we’d also talk about where I wanted to go in my career and how to get there. They don’t teach you this in dental school. He allowed me to see a different side of dentistry.” Now, Dr. Fleischman and Dr. Zalesky are working closely in Colorado, where Continued on page 35 Dental Entrepreneur Fall 2015 5

Prologue

The Importance of Mentorship Helping you get from where you are, to where you want to be Amy Bowman

he dictionary defines a mentor as “a wise and trusted counselor or teacher” and “an influential senior sponsor or supporter.” For many professionals working in industries across the board, a mentor is someone who simply helped them get from where they were to where they wanted to be. For Dee Dee Meevasin, DMD, that person was her childhood dentist, Dr. James Saycich. During high school, Meevasin worked as an assistant to Saycich, whom she credits with encouraging her to become a dentist. “He was just so passionate about dentistry – he was fun and enthusiastic,” said Meevasin. “I loved seeing him interact with patients – he inspired me to become a dentist.” Meevasin credits her mentor not only for encouraging her to pursue dentistry, but also for teaching her how to run a practice. While working as an assistant to Saycich for five years after graduating from dental school, Meevasin was responsible for doing her own insurance billing, managing her assistant, managing the front desk and doing payroll. “In addition, if I had a technical question Dr. Saycich would look at the X-rays and go through all of the steps with me,” she said. By 2011, Meevasin was ready to branch out on her own, which led her and her husband (who is also her office manager) to open Dee for Dentist in Las Vegas. The importance of having a mentor is not limited to those in the dental field. Studies have shown that a mentor can make a significant impact on a person’s career. In fact, the results of a 2014 Gallup poll show that “graduates who had a professor or professors who care about them as a person – or had a mentor who encouraged their goals and dreams, and/or had an internship where they applied what they were learning – were twice as likely to be engaged with their work and thriving in their overall well-being.” The results were based on feedback from close to one 6 Fall 2015 Dental Entrepreneur

million Americans of varying ages and with different educational backgrounds. Finding a mentor can be challenging, and many students feel that they’re too busy studying to pass classes and secure their first jobs to put the effort in. But the payoff can be great. A mentor can help you with practice management, interpersonal skills and real world experience that is not normally taught in dental school. He or she can help motivate and inspire you to keep going when times are tough and help you to see the “big picture.” A mentor can help you discover the easiest, best way of doing things and can help you to avoid having to learn more lessons the hard way. When seeking a mentor, it’s important to look for someone who has a good reputation among his or her peers and in the community. It also helps if he or she has a higher level of involve-

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ment in organized dentistry. Because you might face many new problems and challenges as a new dentist, it’s important to feel like you can contact your mentor at any time, which is why it helps if the mentor has the time and availability to work with you. For some, this means regular face-to-face meetings. For others, communication via email and few faceto-face interactions is more realistic. For Bill Shattuck, DDS, an Oklahoma dentist who graduated from the University of Texas at Houston in 2012, his mentor was helpful when important career decisions needed to be made. After interviewing for an associate position at Kristen A. Burris DDS Family Dentistry in a small, rural town in Oklahoma, Shattuck sought the advice of the head of the restorative department at his alma mater for guidance. When Shattuck described the career

opportunity that would allow him to work with the latest technology and to eventually purchase the practice from the doctor, who was planning to retire within the next 3-5 years, his mentor encouraged him to accept the position. “He said that I would be crazy not to take advantage of this opportunity,” recalls Shattuck – who later did take the job and has already signed papers to take over the practice in several years. Although some dental students are lucky enough to find a mentor while in dental school, many others find a mentor after they’ve already begun their careers. If you’re seeking a mentor, there are a variety of resources to consider. You can start by talking to a dentist in your community, or contact your state dental association. By joining a professional organization, you’re more likely to be introduced to

professionals who may be available to mentor you, or who may know someone who could serve as a mentor. Visit ADA. org for career mentoring web resources. Don’t forget to be open to possibilities and to meeting new people. A wise and trusted counselor could be waiting to help you find success – no matter how you define it.

Amy Bowman writes articles, marketing copy, and online content for Patterson Companies. She lives in Minneapolis and can be reached at amy.bowman@pattersoncompanies.com.

“MY PHILOSOPHY IS TO TAKE CARE OF CHILDREN AND GET THEM TO A HEALTHY, STABLE DENTAL STATE. AND HOW YOU DO THAT SOMETIMES TAKES A LOT OF CREATIVITY.” DR. DARCY RINDELAUB Riverdale Pediatric Dentistry | Coon Rapids, Minnesota

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Dental Entrepreneur Fall 2015 7

Getting Started

Associateships

Everything You Need to Know Cindy Bickers

oday, most dental school graduates go one of two directions after graduation. Many go on to GPRs or other specialty school training. Most of the rest go on to an associateship. Upon completion of their GPR’s, most of the GPR residents also go on to an associateship, as well as those graduating from specialty programs. Why does this happen? The answers are pretty standard – “I need to make some serious income, I need to pay off my school loans, I need to continue my clinical education and I need additional clinical experience and business knowledge before looking into practice ownership.” We hear that statement – or a combination of it – a lot. To summarize, for most new graduates, the reason for the associateship falls into four categories: 1. Income 2. Experience 3. Additional Knowledge/Education 4. Pre-Ownership Employment Once the above categories are prioritized, the new graduate can more clearly identify the goals and purpose of the associateship. Different goals usually dictate where to begin the search for an associateship. The Search The matter of when to begin the search is dependent upon the primary goals. If the first associateship intended purpose is income, experience, or education, 6-12 months before the candidate is available for employment is the ideal time to begin the search. However, if the desired intent is to work in a practice that may be considered for future ownership as the goal, then 1-2 years in advance of the starting

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date, especially if a return to the new dentist’s home geographic area is the desire, is the ideal time. Where to begin the search starts with desired geographic location. Where in the country do you want to work (and live)? This desired location dictates the target areas as various resources are consulted to search for opportunities. Associate opportunities can be located from multiple sources. There is no one “best” source, and the following are not listed in any particular order of importance or likelihood of success. As many sources as can be possibly be found should be considered. Associate placement companies specialize in finding jobs for new dentists. These companies are used by all levels of practice owners from sole practioners 100+ practice groups to recruit associates. For the practice owner using the associate placement company, recruiting takes a lot of time and resources that they simply do not have. The associate placement company also provides additional consulting to facilitate the process, frequently providing sample agreements and facilitating additional areas to be considered. Some employment opportunities will subsequently offer ownership, and the placement

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company can also assist in this area. Many dentists post their associate opportunities at local dental schools. In addition, some will use online job boards. Local dental supply companies, dental school opportunity postings, local dental society publications, the internet and DSO Recruiters all offer additional opportunities. In large metro areas, the local newspapers should also be reviewed for help-wanted ads. Types of Employers The dental business model has undergone major changes over the past 10 years. Historically, about 80 percent of practicing dentists operated their practices as sole proprietorships (or, for tax and legal reasons, as one dentist professional or service corporations or limited liability company). The remaining 20 percent of dentists practiced in partnerships or small or solo group practices, with 1-3 owners and/or 1-3 practice

locations under one ownership group. Historically, these practices were the only ones offering employment to the new dentist. These practices continue to offer employment opportunities for the new graduate. For solo dentists, or partners in the group practice setting seeking retirement, the intended goal for many of these associate opportunities is the eventual transfer of ownership to the associate, either as the sole owner or as a future partner. Today, dental service organizations (DSOs) or dental management organizations (DMOs) with 20-500-plus practices, usually corporately owned and operated, have become a major employer of new dentists. Some of these organizations may eventually offer ownership, but for others, these positions offer employment only with no future ownership available. However, for those new graduates seeking experience or additional education and training, and

immediate risk-free income, these opportunities provide an excellent vehicle. The final and newest-developing group of dental organizations are what have been called mid-level group practices By definition, these are group practices with 3-20 practices typically owned by one or more dentists, or in some instances, new corporately owned group’s still adding practices to their existing group. These practices are also frequently looking for associates, and some will also offer future ownership/partnership. The last significant group of employers are practices operated by local or federal government organizations, including clinics in otherwise underserved areas or clinics located in prisons. These practices typically offer employment only, but no ownership. Critical Employment Agreement Elements Compensation is, of course, the most

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important element of any associate position. The current typical range of compensation is 25-35 percent of the associate’s production or collections. For most associates, some level of minimum-guaranteed annual compensation is equally important to insure that the associate will have sufficient income to meet their personal expenses. The typical guarantee for general dentists is $60,000-$100,000, with a range of $100,000-$150,000 for specialists. The contract also contains a provision that says the associate will receive the greater of their guaranteed minimum or 25-35 percent, whichever is higher. This type of compensation arrangement provides protection for both the employer and the associate. For the employer, this allows budgeting and a known minimum cost exposure. In addition, for both the employer and the associate, this provides an incentive for the associate to produce more than the minimum. And finally, for the associate, this provides an assurance that if they work hard, they will receive additional compensation from the receipts they produce on behalf of their employer. The issue of who should pay the lab bills is part of the compensation discussions. Normally, there is some type of split as it relates to lab expenses. One common method utilized is a concept known as “Lab Off the Top.” Under this arrangement, the employer pays the lab bill, but the compensation formula requires that this lab bill is subtracted from the total production/collections generated by the associate before the compensation percentage is applied. The following example explains how this calculation works. The net effect of this method is that the amount of the lab bill paid by the associate is equal to their Associate Production/Collections Employer Paid Lab Bill = Receipts Minus Lab Associate Compensation % = Compensation Due Associate

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compensation percentage, paid through a compensation reduction. As it relates to additional fringe benefits for the associate, these are negotiated prior to the drafting of the final employment agreement being offered. The principle items that need to be addressed are who pays for malpractice insurance, continuing education expenses and medical insurance coverage. Another question that is frequently asked is whether the associate should be an employee or an independent contractor. From the associate’s perspective, either classification is acceptable. However, the compensation percentage should be increased by 3 percent of production to cover the matching FICA and Medicare tax if the classification is independent contractor However, from the practice owner’s perspective, the associate should normally be classified as an employee. If the employer is audited by the IRS, they will usually determine that any independent contractor should have been classified as an employee, and if that happens, the employer will be subject to substantial interest and penalties for the entire period of the associateship because in the IRS’ view, the associate was miss-classified, delaying the payment of taxes due the IRS. The final important component of an employment agreement is the restrictive covenant. A practice owner cannot afford to hire an associate for a 1-2-year period of time, only to have the associate leave the practice to establish a nearby competing practice. The risk to the employer relates to employer practice patient loss as a result of the patient base seen by the associate while employed following the associate to the new location. Not only would this result in a significant drop in the value of the employers practice, but it would $11,000 also prevent the employer from -$1,000 selling the practice in the event near future retirement was the goal. $10,000 This period is at least a for two X 30% years following the termination of employment, because banks will $3,000 simply not provide the subsequent buyer with the necessary financ-

ing to obtain that practice until the seller’s receipts have stabilized. If future ownership is an option, the other needed document is some type of a letter of intent (LOI). This LOI should include the future purchase price – or in the least a formula that will be used to determine the sale value – and the proposed sale date. If the parties cannot agree on the price at the start of the relationship, experience has shown there is little chance they can reach agreement at the time of sale. This LOI is nonbinding, so the employer is not required to sell, and the buyer is not required to buy. The price, however, is locked in. The price is always the stumbling block at a later date, so this must be addressed at the start. Summary The biggest mistake a new dentist makes is not starting the process early enough. While there are an abundance of employment opportunities available, it takes time to locate the right or best opportunity. You should give yourself at least six months of time to search. The desired type of opportunity should be based on the reasons the associate is seeking employment, i.e., income and experience, additional education and training, or possible future ownership. Careful planning and an early start will result in the best outcome.

Cindy Bickers is the Manager for Henry Schein Nationwide Dental Opportunities. Her 15+ years experience in Dental Associate Placements has resulted in the placing of hundreds of dental associates. She also works closely with Henry Schein Professional Practice Transitions, the dental practice sale division for Henry Schein. Ms. Bickers can be reached at 866-409-3001 or Cindy.Bickers@henryschein.com

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Getting Started

Be Debt Free and Own Your Practice Outright in 5 Years Gary Kadi

n Vegas, the casinos only have a one-percent advantage over the gambler, and the industry yields billions for the house each year. Wouldn’t it be amazing for a newly minted dentist to get that one-percent edge in the same fashion to pay off school debt and result in his or her owning a practice outright? Well, it is absolutely possible - once you get up to speed to do the bread-and-butter dentistry - crowns, fillings, molar endo and perio in a timely manner. A great way to do this is to do your time as an associate in a highvolume practice. Once you’re cruisin’ along at your speed, the next thing I’m going to share with you is the career game-changer: The New Dentist Edge As a new dentist, you have a huge Las Vegas edge here. Most practice evaluators take the gross collections of a practice and then take 70-100 percent. The real practice value is what a seller is willing to sell at and what the buyer is willing to pay. Sounds fundamental but it’s true. There are a lot of unmotivated, tired Baby Boomer doctors who are exhausted and looking to get out. This is largely due to the lack of a desire to handle the business side of dentistry. Most dentists never get any advice on how to recruit lifetime patients who want to accept the treatment they need, so their collections are based upon what they can present, close and get paid for. Case studies show that if you do not have a business model that gets the whole team on board to educate and close the patient, the average case acceptance is 15 percent for new patients and 34 percent for existing patients. You see, there are three ways to build a practice, and most oldschool docs are on the new-patient treadmill. They think the only way to practice growth is by acquiring new patients. But you’re a new dentist, and this is your edge. You’re in the Vegas one percent! Growing a Practice The three ways to grow a practice are as follows: 1. New patients 2. Increase patient retention 3. Increase case acceptance

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So, let’s take a numerical dive to illustrate your edge. Ol’ Richard the dentist collects $1,000,000 a year and wants $800,000 for his practice. He has the following: • 3,000 patients • PPO fees • Gets $1,000 for crowns • Collects $150 for hygiene exams • Prophy and X-rays • He gets 20 new patients a month. Let’s go inside to see the true value of his practice. When you change your focus from acquiring new patients and zoom in on building your practice from the inside-out instead, with the emphasis being on complete health, you will increase your hygiene retention and case acceptance.

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The benchmarks for practices that do this generate per patient: One crown Two hygiene visits Average annual value of a patient

$1,000 $300 $1,300

With 3,000 patients of record x $1,300 average annual value of a patient, the yield is… $3,900,000. You will need an associate to help you deliver dentistry once you get to about $1.5$2 million, depending on how you want to and are able to work. You can see that the selling doctor is only running at one-quarter of his capacity. His untapped asset is his patient base, and his or her focus has not been on increasing retention and case acceptance. We know this because retiring doctors routinely come to us to increase their collections this way so they can sell the practice at a higher number. So, how do you move from being on the new-patient treadmill to increasing case acceptance to 67 percent and patient retention in hygiene to 80 percent? Allow me to share with you the Five-Step Healthy Patient BlueprintTM. This methodology includes five steps, collectively designed to remove your sense of constantly having to sell your services, creating a simple communication system that allows you come from a place of education and permitting the patient the freedom to choose to move forward or not with treatment. It eliminates the guilt or “underserving feeling” that most new practitioners experience when presenting a care option - a feeling that some practitioners never overcome, right up to the day they retire! Imagine being able naturally to disconnect from making the patient’s problem or condition your problem, to present as an authentic and caring total healthcare giver, and finally, giving yourself permission to lay your head on your pillow, knowing you are doing well by doing good. The tenet behind these five steps is the concept of enrollment. Enrollment is a process that involves speaking, behaving and

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operating in such a way that the patient (team member, partner, child) is inspired to make a conscious choice to take action. This is the opposite of pushiness, manipulation, or persuasion. Think of it as holding your patients’ hands and guiding them to the place they want to go. Step 1 involves locating the patient’s “personal motivator.” The personal motivator describes what is most important to the patient. It is the emotional reason that brings them to your office. The three things every person wants are: • Success • Family • Health These are all depending on where he or she is in their lifecycle. Locate this emotional source of desire that already exists within the patient and consciously connect dentistry to one, two, or all three. How do you do this? Often you can gauge the patients’ motivators from the first topics, they talk about when you ask them how they’re doing, or more pointedly, when you ask about the things that are most important to them at this stage of life. Step 2 is built around a tool called the Healthy Mouth BaselineTM. Most patients do not know what a healthy mouth truly is. If you don’t establish a healthy mouth benchmark with the patients on every visit, they will more than likely think you are paying off your student loans by working on their mouths. Get together with your team and get agreement on what is healthy from a soft tissue, hard tissue, lifestyle and whole-body perspective. Create a graphical Healthy Mouth Baseline representation on an 8.5” x 11” sheet with your logo and use it to begin each recare visit. Always include it in your new patient protocol to review interactively with the patient. You will dramatically increase case acceptance and reduce hygiene no-shows. Step 3: Problem, Consequence Shhhhhhh. People don’t buy solutions to problems

they don’t think they have. Using the intraoral camera to educate every patient on every visit is a must. Patients process health information mostly through visual representations. When a patient grasps the long-term health implications of oral-inflammatory disease, you are better able to enroll them into asymptomatic care. Visual evidence drives home the message that when you get the patient orally healthy, it will affect their overall health. The patient also can’t see what you see, having your assistant or hygienist take photos and graphically explain the patient’s oral health situation raises awareness. The patient is then able to focus on the problem and understand the consequences of taking no action. This ties in to the patient’s personal motivator, which means they will begin asking you for the solution to the problem. BUT - shhhhhhhhhh - until the patient says, “How do I get this out of my mouth?” or, “How much does my insurance pay?” then, and only then, should you venture to offer them the solution. Step 4 is called the Trust Transfer. One of the biggest “bleeding points” in a practice is the conversation that happens in the back office, when there is no stepby-step system to hand off the patient to the front office. It is essential that the team member up front knows the patient’s personal motivator and also the overview of the discussion that happened during treatment. When the patient knows that the front office team member comprehends the situation, it’s easier for the team member up front to handle objections when the patient poses challenges. Step 5 is all about fitting the treatment into the patient’s lifestyle. No one has a budget for dentistry, so it’s misleading to claim that you can fit all the needed treatment into a budget framework. We all find the time and money for things we want. When you follow the first four steps in the process, it becomes a more effortless project to achieve this final step. You have enrolled the patient into the idea of investing in something they want, as opposed to something you told them they Dental Entrepreneur Fall 2015 13

need. At this point, he or she should connect with your CareCredit representative and download the financial options sheet. This is a tool that beautifully breaks down the total investment, the insurance portion and then the patient’s responsibility. It automatically calculates a pay-today courtesy for full payment at presentation, and it also breaks the total payments down into bite-size monthly payments that take a $5,000 investment - less a $1,000 insurance estimate - to as low as $199, interest free per month. So, if you are looking to get patients healthy and do not want to be a tooth-mechanic your whole life - AND if you want to pay off your debt, OWN a practice, get married and have a family and retire early, follow these five steps: 1. Get up to speed 2. Buy a practice with a high patient-base that is valued by a percentage of collections Implement the 5 Step Healthy Patient BlueprintTM. 3. Rinse 4. Repeat That’s it – be debt free AND own your own practice outright in five years. This is your reality!

Gary Kadi has been a devoted advocate for the dental community, their families, and their patients for over 20 years. A speaker, author, and researcher, Gary re-energizes practices and helps dentists implement systems and raise their profit margins. Gary has authored several books, the first of which, Million Dollar Dentistry, has been distributed in 37 countries with over 80,000 copies in print. He most recently wrote a book for Periodontists, Stop! The Bleeding: The Seven Steps to Scaling Your Perio Practice. After years of studying the reoccurring challenges facing dentists, he created NextLevel Practice to implement the Complete Health Dentistry™ business model. NextLevel Practice is an Inc. 500, 5000 company. Gary is a Leader in Dental Consulting by Dentistry Today, a member of The Academy of Dental Management Consultants, and an honored Board Member of Alliance for Oral Health Across Borders. For your complimentary copy of Gary Kadi’s book, Million Dollar Dentistry, please visit: www.nextlevelpractice.com/demdd

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14 Fall 2015 Dental Entrepreneur

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Getting Started

Owning Your Own Practice How To Avoid The Pitfalls Gavin Shea

ou’ve trained for years to become a dental professional and now it’s time to make the leap into practice ownership. Whether purchasing your first practice or building from scratch, it’s important to move ahead with confidence and not hold back on your dreams from fear of failure. The truth is, most dental practices ultimately succeed – in fact, moreso than many other independent professions.* Nevertheless, you are making a significant monetary investment in practice ownership, so naturally there will be stumbling blocks along the way. What are the potential pitfalls you need to avoid? Not surprisingly, most of them involve how you manage your finances, both the funding from your lender and your practice income. What follows are some of the most common obstacles to be aware of and guidelines on how to protect your investment to ensure a successful outcome. Inadequate Build-Out Funding One of the key risks for dentists building their first practice is an inaccurate estimate of the amount of funding required to fully complete the project. They may overlook some of their less-obvious needs, such as a parking area for easy access in a crowded downtown location. Or perhaps they’re relying on an inexperienced professional team that does not fully grasp the unique requirements of the dental office, such as specialty plumbing and enhanced wiring for today’s digital equipment. To find yourself short of funds before your project is complete can produce considerable stress as you choose between cutting back on your plans or taking on greater debt. Ultimately, it can lead to poor decision-making. Shortage of Practice Income As you’re getting your new start-up underway, it is not uncommon to face difficulties during the first year or two in generating adequate patient flow and income to cover expenses. When you

16 Fall 2015 Dental Entrepreneur

are introducing a new service to a community, it takes a good deal of marketing and networking to gain visibility, attract patients and generate loyalty. Indeed, it can take 2-3 years to build a self-supporting patient base capable of sustaining a full-time dental practice. Expect to balance your schedule with a part-time associateship as you build your business to ensure you have enough revenue to cover your practice overhead as well as your debt. Overpaying for a Practice Some new doctors attempt to manage the acquisition process themselves in order to save on the costs of purchasing a practice, rather than working with a professional practice broker. In doing so, they often rely on the selling doctor’s valuation of the business and terms of agreement. This can be a significant misstep, potentially resulting in a higher price for your practice than its actual worth. To avoid overpaying for a practice, at the very least, hire a professional appraiser who can establish the true and fair market value of the practice, and work with a broker specializing in dental practices who can guide you to the best offerings. Declining Revenues After Transition It is not uncommon after purchasing a new practice to experience declining revenues after the transition. Bringing a new doctor

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on board often serves as an invitation for patients to shop around, perhaps for a practice closer to home or with bundled specialty services. The key for you is to understand the cause of your drop in revenues and determine how to get back on track. Before transitioning to your new practice, reach out to patients with a personal letter describing your background and services. Offer a promotional discount on hygiene for the first few months to bring existing patients back into the practice. Understand your practice numbers in order to properly evaluate the reason for patient attrition. Seven Steps to a Smooth Transition An important lesson from these examples is to have a definitive back-up plan should you run into problems during your transition. The point is to not waste time floundering, but get busy with the solution. Here are seven key steps to help ensure a smooth transition: 1. Activate your team. The very best way to avoid these transition risks is to work with a team of practice acquisition or start-up professionals before you begin your project. Don’t wait until you run into problems to call on your team members – work with them from the very beginning and through the entire project to ensure your interests are protected. It is your team’s job to safely guide you through a significant project like a practice purchase or start-up without becoming entangled in preventable obstacles or frustrations. Your team should include: • Acquisition: Attorney, practice broker, lender, accountant and insurance broker • Start-up: Attorney, general contractor, lender, accountant, equipment supplier, insurance broker 2. Complete your due diligence before purchasing or starting a practice. You can help prevent unpleasant surprises by asking to see charts, reports, inventories and

schedules – any information that will help detail the daily operations of the practice you are purchasing. For a practice start-up, a due-diligence exercise ensures that you have a realistic and comprehensive plan for technology development, staffing, marketing, Occupational Safety and Health Administration (OSHA) guidelines, and other critical business requirements of your practice. Another factor in your due diligence should be understanding the size of the population in the area and how their dental care needs are currently being met, or not, by existing dentists in the area. 3. Monitor practice performance. Examining your practice statistics regularly is a critical tool for maintaining the health of your dental practice. Profit and loss numbers help you diagnose and treat problems, much like an X-ray helps you diagnose dental decay. In order to understand the strengths and weaknesses of your practice and systems, use the Milestones program from Wells Fargo Practice Finance, a practice monitoring tool that helps you establish baseline measurements for everything from production to operating expenses. 4. Manage your cash flow. Any business, large or small, finds itself with cash flow shortages at times. Make a plan to manage your cash flow by setting daily and monthly production goals, paying down outstanding debt, and saving 10 percent of income after expenses are paid. This will help ensure you have cash on hand in case of a bad month or an unanticipated expense. 5. Beef up your marketing. Whether you choose to utilize an agency or consultant, or handle these efforts yourself, it’s helpful to create a consistent marketing program that helps build awareness and recognition of your practice. As your budget allows, explore internet ads, newspapers, billboards, or even radio and television. Send personal letters to members of the community to introduce yourself and

directly ask for their business. Request referrals from your current patients – it’s one of the easiest and least expensive methods of marketing. Don’t overlook social media. Having a Facebook page, for example, can be a great place to create community and gives your patients a place to comment and refer others. 6. Improve your treatment-presentation skills. Work with your staff to improve your verbal skills in presenting treatment to patients and handling objections. Keep track of the treatment you present and whether or not the patient accepts your recommendation. Document the reason given for accepting or rejecting treatment. It helps to know what techniques you and your team are doing well and which need practice. 7. Know your strengths and build on them. Surround yourself with specialists and staff who complement your skills. While you work to improve your weaknesses, let your strengths take the lead in guiding the tone and style of your practice. You’ll be happier in your work as you succeed while being yourself. Transitioning to practice ownership can indeed have its occasional pitfalls. But by relying on your team of professional advisors and planning your success well in advance, you’ll likely find before long that you have made the transition not only effectively – but profitably.

Gavin Shea is the Senior Director of Sales and Marketing for Wells Fargo Practice Finance. With more than 17 years of banking experience with an emphasis in practice lending, he leads sales and marketing strategy development and implementation throughout the national footprint. *Source: Money, November 2010

Resource Guide ADS Dental Transitions

Dentist’s Advantage

888-ADS-4237 www.ADStransitions.com ADS is the nationwide leader in dental practice sales, associateships, buy-in/buy-outs, partnerships and appraisals. ADS is comprised of the industry’s most experienced professionals, including dentists, attorneys, and CPAs. We can help you with each step of your next transition. To view a complete list of practice opportunities available in your desired area, visit us at ADStransitions.com. Please see our ad on page 14.

888-778-3981 www.dentists-advantage.com Since 1949, Dentist’s Advantage has provided dental practitioners with access to a comprehensive professional liability insurance program that offers a vigorous legal defense against allegations of dental malpractice. More than 17,000 dentists across the nation depend on Dentist’s Advantage to protect their practice, their license and their financial security.

ADS Dental Transitions South 770-664-1982 www.adssouth.com ADS South is the premier dental transition organization in the Southeast. We provide associateship placement, dental practice sales, appraisals, and expert testimony services. Our company was founded over 26 years ago by Earl M. Douglas, DDS, MBA, BVAL, and we continue to control the cutting edge of transition technology. Please see our ad on page 35.

Aspen Dental 877-330-1349 www.AspenDentalJobs.com At Aspen Dental we recognize that our success is a direct result of empowering and supporting ambitious dental professionals. We provide a professional, fast-paced, entrepreneurial work environment based on a mutual respect that keeps our interests aligned together, we build and develop successful, patient focused dental practices. Please see our ad on page 27.

Bank of America Practice Solutions 800-428-2847 www.bankofamerica.com/practicesolutions Dental practice financing designed to help you succeed. Bank of America Practice Solutions offers a full range of dental practice financing options from purchasing an existing practice or starting your own practice. We provide critical knowledge you need to establish and develop your business. See our ad on page 21.

Comfort Dental

Henry Schein Nationwide Dental Opportunities 866-409-3001 www.dentalopportunities.com Henry Schein Nationwide Dental Opportunities (HS NDO) offers Dental Associate recruitment and placement services that pair job opportunities listed by dental practitioners with qualified, prescreened dental associate candidates. HS NDO matches dentists based on skillset, practice philosophy, and style to ensure a high success rate. We are specialists who work confidentially to help doctors fill critical roles within their office by defining the job, attracting qualified candidates, and managing the interview/placement process. Dentists can make a decision with confidence, knowing that we have helped them through the process. And candidates can rest easier knowing that there is never a fee charged to them. We work to make the match a win-win situation for both the hiring doctor and the Associate with our personalized placement service and years of success. See our ad on page on the inside back cover.

Henry Schein Professional Practice Transitions (PPT) 800-988-5674 www.henryscheinppt.com/ Henry Schein Professional Practice Transitions is the leader in dental practice brokerage (sales and buying), transition services, and practice valuation. We have a broad range of dental practice listings nationwide and have closed sales in all 50 states, yet have the expertise and knowledge of your local area. Our responsive support gives you a clear advantage and we can help you to refine your plans and create new options as your practice goals change. We offer valuable webinars, seminars, and other resources to support dentists throughout their career, as well as many value-added services such as practice valuations. See our ad on page 9.

www.comfortdental.com The Best of Both Worlds At Comfort Dental, we combine the old-style neighborhood dental practice with today’s modern group practice. Equity ownership, autonomy, management of your own business, and long- lasting relationships with your patients is combined with our economics of scale, prime locations, mass marketing, and overhead control. It truly is the best of both worlds. See our ad on page 25. 18 Fall 2015 Dental Entrepreneur

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Business Beyond the Classroom IgniteDDS

Sirona Dental Systems, LLC

716-912-7970 david.rice@ignitedds.com Building the bridge between dental school and tomorrow’s most successful, quality-conscious private practices Mission: Fueling Passions Beyond The Classroom for dental students, new dentists and new dental team members Description: igniteDDS empowers the next generation of dental professionals with the knowledge and resources you’ll need for tomorrow’s treatment and practice decisions!

800-659-5977 http://www.cereconline.com CEREC AC from Sirona is the most advanced dental CAD/CAM system available. With its Bluecam, capturing fast, precise digital impressions and then creating high quality esthetic restorations is a reality. CEREC AC delivers access to efficient, precise, scalable and affordable solutions, including CEREC Connect. Call 1-800659-5977 or visit www.cereconline.com. Please see our ad on page 15.

MacPractice, Inc

Ultradent

402-420-2430 MacPractice.com MacPractice DDS is the leading practice management and clinical application for dentists who prefer to use a Mac, featuring electronic insurance submission, Mac native digital radiography and photos, charting, Electronic Dental Records, Kiosk, Web Interface, iPhone Interface, speech dictation, and Mac stability and ease of use. Please see our ad on page 11.

800-552-5512 www.ultradent.com info@ultradent.com Ultradent Products, Inc. is a leading developer and manufacturer of high-tech dental materials, devices, and instruments, world-wide. Founded in 1978 as a family-owned company, Ultradent’s vision remains to continue to improve oral health globally by creating better dental products that set new industry standards. Ultradent also aims to improve quality of live and the health of individuals through financial and charitable programs. Please see our ad on page 23.

PARAGON Dental Practice Transitions 866-898-1867 www.paragon.us.com Offices located Nationwide. PARAGON offers professional consultation and related services to healthcare professions with primary emphasis on the dental profession: comprehensive dental practice valuations (including a written valuation and analysis report); practice sales; pre-retirement sales; practice acquisitions; practice mergers; associateships; partnerships; practice consolidations and practice management. References available by request. Please see our ad on page 29.

Patterson Dental

Wells Fargo Practice Finance 888-937-2321 wellsfargo.com/dentists practicefinance@wellsfargo.com Wells Fargo Practice Finance provides customized financing supported by experienced specialists and practical planning resources to help dentists acquire, start and expand their practices. The only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM, we understand the business of growing successful practices and are here to help you achieve your goals. Please see our ad on the back cover.

800-873-7683 www.pattersondental.com Patterson Dental Supply Inc. is a full-service distributor of a complete range of dental products and services to dentists, dental laboratories, institutions and other healthcare providers throughout North America. As one of the nation’s largest dental distributors, Patterson Dental sells consumable dental supplies, digital and other dental equipment and practice management software. Please see our advertisement on the inside front cover and page 7.

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Dental Entrepreneur Fall 2015 19

Business Fundamentals

Understanding Cash Flow Chad Widensky

oo often, we banker types throw around terms like “cash flow” and “cash flow analysis” as if they were common in everyday conversation. The reality is quite the opposite, and we’re doing our clients a disservice if we don’t take the time to explain what these terms mean and why they are so important to a successful business. At its core, cash flow is the difference between the money generated by a business (cash inflow) and the cost to run the business (cash outflow). When considering a small business loan, banks commonly go one step further by incorporating personal obligations as part of the cash outflow. A cash-flow analysis measures a company’s financial health and a borrower’s ability to meet their business and personal obligations. It provides the information upon which lending decisions are based. To better illustrate why it’s important to understand cash flow, let’s review an example that shows how a minor change in a borrower’s obligations can make the difference between a loan being approved or declined. For this example, we’ll assume that a borrower is purchasing a dental practice that collected $750,000 in 2014. These collections (not production) represent the cash inflow in our cash flow analysis. After deducting all business expenses that will be assumed by the buyer (business cash outflow), the practice showed an operating profit of $247,500 for the year. Business expenses, such as interest payments and auto expenses, are not assumed by the buyer and are therefore not included in the cash flow analysis. This $247,500 is also referred to as the practice’s operating cash flow. Once we’ve determined the amount of money a borrower can expect to generate from the practice, we factor in the payments on the loan needed to purchase the practice as well as the borrower’s personal obligations. These obligations may include payments for mortgages, student loans, autos, credit cards and taxes as well as a cost of living estimate. In our example, the borrower has total obligations of $200,000 (personal cash outflow). Now that we’ve accounted for all of the cash inflows and outflows, our cash flow analysis shows that the borrower will have $47,500 in excess of his/her business and personal obligations. To put it another way: for every $1 in business and personal obligations, the borrower will generate $1.24 from the practice. To

20 Fall 2015 Dental Entrepreneur

approve a loan, many banks require that borrowers generate no less than $1.20 for every $1 in expenses. This borrower was close, but at $1.24, the cash flow analysis resulted in an approval! But what if the borrower’s expenses were slightly higher? Today, almost all dental students graduate from dental school with a sizeable amount of debt and most are anxious to pay it off. The borrower in the example above chose to pay his/her loans off over 30 years and made annual payments of $48,000. At the time the borrower started repayment, there was a 15-year option at a slightly lower interest rate that required annual payments totaling $72,000. While this alternate option would have saved the borrower some interest, the required larger payment would have reduced the borrower’s excess cash flow by $24,000. This minor change would have resulted in the borrower generating only $1.08 for every dollar of expenses and the loan request would be declined.

Chad Widensky is a Vice President for Practice Solutions, Bank of America’s healthcare financing division. Chad joined Bank of America in 2009 as a financing specialist for dental practice and commercial real estate acquisitions in New York and New Jersey. He has been involved in hundreds of transactions over the course of his tenure with Bank of America. Chad has repeatedly been recognized for superior service and commitment to his work. Most recently Chad was recognized as Practice Solutions Top Healthcare Lending Specialist for 2014 and as a member of Bank of America’s 2014 Pinnacle Club.

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Looking to purchase an existing practice or start one from scratch? We have the financing you need to make it happen. You can rely on the industry leadership and experience of Bank of America Practice Solutions. We have provided financing for thousands of healthcare professionals and understand the challenges that accompany them. Let us help you. We encourage you to call the experts at Bank of America Practice Solutions to discuss.

Practice acquisition*:

Practice start-up*:

• Up to 100% financing for your practice — up to $5,000,000

• Up to 100% financing for everything — architectural fees, construction, equipment, cabinetry and more

• Principal reduction and early payoff options • Practice purchase and real estate combination loans

• Working capital to help you get started • Competitive terms

• Working capital to help you with the transition

• Rate lock through the project build-out phase

• Competitive terms

• Demographic Site Analysis to help you select the ideal location and attract the patient base you want†

• Practice Heartbeat® program access at no cost♥

Let’s talk For more information, contact one of our Practice Specialists:

Call 800.428.2847 Visit bankofamerica.com/practicesolutions or scan the code to learn more

* All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. The term, amount, interest rate and repayment schedule for your loan, and any product features, including interest rate locks, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. Bank of America may prohibit use of an account to pay off or pay down another Bank of America account. ♥ Bank of America Practice Solutions makes no express or implied warranties with respect to any aspect of the Practice Heartbeat® program, nor does it guaranty any success or promise any results, and hereby disclaims the same to the extent allowed by law. The opinions of Bank of America Practice Solutions are based upon prior experience, and it makes no promise or guaranty that you will achieve any particular measure of success or results by participating in the program. You are not bound by any recommendations provided under this program and retain full responsibility for the results achieved by your professional practice. † Bank of America Practice Solutions engages Scott McDonald & Associates, a national marketing firm specializing in demographic research, site analysis and profile reports for health care professionals to produce a demographic report to assist health care professionals in evaluating where to locate their professional practices. Scott McDonald & Associates charges a fee for this service, which is passed on to the customer. Bank of America Practice Solutions tool within this advertisement requires Internet access. Bank of America does not offer or provide an Internet service provider for your personal access and usage purposes. Please check with your Internet service provider due to charges and fees which may apply. Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2015 Bank of America Corporation | AR9AB890 | Rev 12/14

Business Fundamentals

Owning a Practice and Liability for Others’ Treatment Tracy J Pearson, J.D., Claims Specialist

s the claims administrator for the Dentists Advantage Program, Intercare Insurance Services handles a wide variety of dental claims, including those that arise from an employee dental treatment. One question we often receive is, “Am I responsible for the dental services that another dentist provides in my office?” The answer depends upon things such as the type of employment relationship you have with the treating dentist, the laws in the state in which you practice and whether the issue is limited to the conduct of the treating dentist, or if it also involves the actions of your staff or your office policies and procedures.

22 Fall 2015 Dental Entrepreneur

Legal liability for another person, such as an employee, is called vicarious liability. When you report a claim arising from treatment rendered by a dentist who practices in your office, your claims specialist will ask several questions to determine whether you may be vicariously liable for the other dentist’s treatment. One of the first questions your claims specialist will ask is whether the treating dentist is an employee or an independent contractor. The reason the distinction is important is because most states’ laws as to vicarious liability set forth that an employer is legally liable for her employees’ wrongful conduct as long as the employee was acting within the scope of his or her employment.1 Although

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there are state-specific laws that provide exceptions, if the dentist who provided the treatment at issue is your employee, you will likely be vicariously liable for his or her alleged negligent treatment. This does not mean that the employee dentist is not also responsible for their own conduct, but you, as the employer, will also be responsible. In situations in which the treating dentist is an independent contractor, the general rule is that the practice owner is not vicariously liable for the wrongful conduct of the treating dentist. However, there are many exceptions to this general rule. The most common exception is how much control you, as the practice owner, have over the dentist’s treatment. Some of the things that may indicate you have control over another dentist’s treatment is whether you supply the instruments, whether you set the working hours and whether you have control over the practitioner’s schedule. Again, if the court were to determine that you are legally liable for an independent contractor’s treatment, it means you share in the responsibility of the wrongful conduct along with the treating dentist. Regardless of whether the treating dentist is an employee or an independent contractor, another important piece of the puzzle must be considered - the contract you have with the treating dentist. The language set forth in the employment contract can be the difference between your policy paying hundreds of thousands of dollars to an injured patient and paying nothing. Accordingly, when you report a claim or lawsuit to Intercare that involves treatment by an employee dentist, the second question you will likely get is, “Do you have a written contract with the treating dentist?” Although even the most artfully drafted employment contract will not magically remove the legal liability your state’s laws may place upon you, the language in the contract can shift

24 Fall 2015 Dental Entrepreneur

In situations in which the treating dentist is an independent contractor, the general rule is that the practice owner is not vicariously liable for the wrongful conduct of the treating dentist. onto the treating dentist the financial responsibility of defending you in a claim or lawsuit and paying the settlement (or jury verdict). Your claims specialist will be looking for what is called the “defense and indemnification clause” in the employment contract. Most employment contracts will include this clause, which generally requires the treating dentist to pay your legal fees and any settlement or verdict monies you must pay arising out of the treating dentist’s conduct. If this clause is enforced, this will prevent your (or the practice’s) policy from making payments for defending a claim that results from another doctor’s treatment. Again, the specific language in the contract will be different from state to state, as the contract language will need to comply with the local laws of the state in which your practice. In addition to looking for a defense and indemnification clause in the employment contract, your claims specialist will also be looking for language setting forth that the employed dentist maintain their own liability insurance. This is also a very important provision that should be included in the employment contract and

can increase your chances that your policy does not pay for the errors of another dentist. Regardless of whether you may be vicariously liable (legally) for the treating dentist’s wrongful conduct, if the treating dentist also has her own insurance policy, when settling a claim, your claims specialist will push to have the treating dentist’s policy pay for the entire settlement. Avoiding payment from your own policy can shelter you from the consequences of having a settlement paid by your policy such as reporting and insurability issues.2 If the employed dentist does not have their own policy, even if your liability is questionable, it is not uncommon that the practice owner’s policy will end up paying the entire settlement. Even if a claim arises from an appointment with an independent contractor who carries their own insurance, there are times when you could face some legal liability for claims relative to the employed dentist’s treatment. Many times, claims do not arise solely from dental treatment, but also include alleged injury while on the dental office premises (trip and fall), violations of HIPAA, billing errors, or conduct of the staff. As the owner of the practice, you may be liable for claims arising from the foregoing, even if the patient presents to your practice to be treated by an employed dentist. Generally, the owner of the practice bears the responsibility to ensure the office premises are safe for patrons, that patient’s personal health information is secure, that the billing of insurance companies for services is performed correctly and the staff employees are providing adequate services (including those licensed employees such as dental hygienists, and in some states, dental assistants). One common issue that arises in dental claims is when a patient is injured while receiving treatment by a dental assistant. Many times, when an independent-contractor dentist treats patients, he or she works

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with dental assistants who are employed by the practice as opposed to those who work solely for the employed dentist. In most instances, if a patient is injured by a dental assistant, even if that individual is assisting an independent contractor dentist, the employer clinic owner will end up bearing some responsibility for the patient injury. This is the vicarious liability concept described above. If the dental assistant was acting within the scope of her employment (even if being supervised by another non-employed dentist), you, as the employer, may be liable for their conduct. This is another situation in which the treating dentist and the practice owner may share responsibility

To reduce your risk of becoming responsible for another dentistâ&#x20AC;&#x2122;s treatment, your first line of defense is a well-written employment contract. for paying a settlement or verdict to an injured patient. However, in matters in which the employed dentist has very little input, such as office policies/procedures or the safety of the premises, the owner of the practice will generally end up paying the entire settlement amount.3 In summary, although there is not necessarily an iron-clad way to completely protect you from liability arising from an employed dentistâ&#x20AC;&#x2122;s treatment, one way to reduce your risk is to consult with an experienced local attorney to draft an employment contract that includes a defense and indemnity provision and the requirement that the employed dentist

Please reach out to our carry her own liability insurance. It is surprising how many claims come in to the Intercare office in which the practice owner advises us that there is no contract at all between the practice owner and the employed dentist. To reduce your risk of becoming responsible for another dentist’s treatment, your first line of defense is a well-written employment contract. Intercare works with attorneys in nearly every state who specialize in working with dentists and other health care professionals, and we are happy to provide referrals. A second line of defense is ensuring that your office policies and procedures are adequate to protect you from legal liability arising from patient injury, regardless of which provider that patient is seeing. The attorney who assists you with drafting an employment contract can also educate you on the local state laws and provide advice as to what types of policies and procedures you can employ in your practice (such as reducing the control you have over the dentist’s practice) to further protect you from vicarious liability for an independent contractor’s wrongful conduct. 1 Each state has its own laws regarding vicarious liability for employees and independent contractors; contact a local defense attorney to discuss your specific circumstances. 2 Whether Intercare is required to report the payment of a settlement or a verdict depends upon federal law as well as state laws that vary from state to state. 3 Be sure to discuss with your insurance broker which types of claims are covered under your Dentist Advantage policy and whether you should seek a separate Business Owners Policy for potentially uncovered claims.

26 Fall 2015 Dental Entrepreneur

©Dentist’s Advantage, 2015 © The National Society of Dental Practitioners, 2015 Risk Management services are provided by Dentist’s Advantage and the NSDP to assist the insured in fulfilling his or her responsibilities for the control of potential loss-producing situations involving their dental operations. The information contained in this document is not intended as legal advice. Laws are under constant review by courts and the states and are different in each jurisdiction. For legal advice relating to any subject addressed in this document, dentists are advised to seek the services of a local personal attorney. The information is provided “AS IS” without warranty of any kind and Dentist’s Advantage and NSDP expressly disclaims all warranties and conditions with regard to any information contained, including all implied warranties of merchantability and fitness for a particular purpose. Dentist’s Advantage and NSDP assume no liability of any kind for information and data contained or for any legal course of action you may take or diagnosis or treatment made in reliance thereon. Reprinted with Permission. This article originally appeared in the Volume 29, No 3 issue of NSDP Risk Management Newsletter.

Ms. Pearson handles professional liability claims for a wide array of health care providers including dentists and dental hygienists. She practiced as a dental hygienist for 15 years in Arizona and Washington State. Ms. Pearson attended law school in Seattle and thereafter joined a law firm that specializes in representing health care providers, primarily dental professionals. She defended dentists and dental hygienists in civil suits and disciplinary proceedings before joining Intercare to handle pre-litigation disputes.

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Business Fundamentals

Corporate Dentistry’s Impact on Practice Sales Jonathan S. Carey, DMD

he debate about big corporations taking over dentistry is certainly not a new one. Corporations and dentalmanagement service organizations (DMSO) have been around for decades. The discussions about how these entities will affect dentistry and the sale of dental practices have been going on just as long. I’d like to address the top-four myths that most of these “doom-and-gloom” discussions revolve around.

loan assistance, etc. These are all great reasons. However, many of them choose to leave these jobs to buy their own practice once they’ve gained enough experience and saved enough money to do so. This is because they realize that in the long run they will be far more profitable owning a practice themselves. Fortunately, these jobs can also help them do that in as little as one year! Sounds great, but how do they do that? See the busting of myth No. 2 below.

Myth No. 1: New graduates are in so much debt that their only choice is to join a “dental chain.” Many new graduates are indeed choosing to work for a “dental chain” for obvious reasons such as: guaranteed salary, benefits, student

Myth No. 2: Young dentists can’t get a loan to buy a practice. There are indeed some young dentists that simply can’t get a loan to buy a practice... yet. However, many of them can now, and with the right amount of time and planning they all can eventually. Dental

28 Fall 2015 Dental Entrepreneur

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lenders are still offering 100-percent financing plus additional working capital for practice acquisitions. The size of the practice that a young dentist can afford will obviously vary, but they can still get loans for practices – even large practices. It just depends on their personal financial situation, productivity and liquid cash assets. Maintaining factors like low rent/mortgage payments and car payments is essential. A young dentist should also eliminate all revolving credit card debt because lenders hate that! Their productivity should come close to matching what the seller is producing or at least what the buyer is expected to produce after accounting for any post-sale seller production. Lastly, while they should make sure all student-loan payments are paid on time, they should focus more on saving cash than on aggressively paying down student loans. Lenders place much more emphasis on liquid cash assets than they do on student loan balances. A good amount of cash to shoot for is 10 percent of the purchase price of the practice, but that’s not necessarily a requirement. Jobs at dental corporations can help a young dentist achieve all of this by typically paying a good salary plus production dental_entrepreneur.pdf

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bonuses and allowing a young dentist to be very productive right away. After all, they’re usually taking over for another young and productive dentist that just left to buy a practice! Myth No. 3: The corporations are taking over. Dental corporations and dental-management service organizations (DMSOs) aren’t going away any time soon and have certainly gained some market share in dentistry over the years, but they haven’t come close to taking over. In fact, there have been some that have gone out of business because they couldn’t maintain patients for reasons such as high dentist turnover, high staff turnover and poor quality of service. Myth No. 4: The solo practice will be a thing of the past in 5-10 years. I personally think that there will always be a place for the solo and small group practice. Dentistry is a very personal and serviceoriented business, and there will always be plenty of patients seeking out and staying with practices that can serve them on a personal level. The traditional model of buying a dental

practice (working as an associate right out of dental school/residency and eventually buying that practice) has certainly changed, and dental corporations and DMSOs have played a part in that. However, there are plenty of great solo practices to buy or small group practices in which to become an equal partner. If you are considering practice ownership, you should consult with a reputable transition company to help you navigate the process. It may not seem easy, but great things rarely are!

Dr. Jonathan Carey is a graduate of Boston University Goldman School of Dental Medicine. He maintains a private general practice in Webster, NY and has been a transition consultant with PARAGON Dental Practice Transitions for 12 years. He is the Senior Transition Consultant for the State of New York and is a 2 time PARAGON Consultant of the Year award winner. Dr. Carey takes great pride in helping his dental colleagues successfully achieve their practice transition goals.

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Dental Entrepreneur Fall 2015 29

Practice Builders

16 Critical Strategies To Increase Or Maintain Practice Revenue Charles Blair, DMD

here are a number of strategies to boost practice revenues, while trying to survive in a PPO environment. Listed below are 16 key strategies. By working on your practice, instead of in it, the dentist maximizes revenue results while avoiding trouble! 1. Add an unbooked operatory: Extra, unbooked operatory will lower stress, improve on-time performance, and provide “impulse” and “work-in” same day revenues. There is an 80-90-percent profit in working in an extra procedure today, since the overhead is fixed except for dental supplies and related lab expense, if applicable! That extra operatory won’t be used much during the day, but when it is, it’s extremely profitable. When the cost of the operatory is amortized over six years, it only costs about $30 per work day plus supplies to add a lot of revenue to the bottom line with an 80-90-percent profit margin! 2. Ditch a low reimbursement PPO: When participating in several PPOs, consider ditching the worst. Compare fees paid, then quality of patients in the plan, market share of plan and finally the associated clinical or administrative hassles. Decide which plan to drop in sequence, but prepare first. Notch up your diagnostic and communicative skills while adding a new service or two, plus marketing to make up for the loss of the PPO. In some cases, add a better PPO. Your staff members and you will feel so good afterward. 3. Raise fees annually and eliminate schizophrenic fee schedule: Don’t miss a modest increase in fees that can be acquired every year, routinely, without exception. If you raise fees 2-3 percent then you are only keeping up. If you rise above this percentage, you will raise your percentile in relation to others. Raising fees a fixed percentage floats all the boats. Some fees may be lower than optimum so some fees may need a 5-15 percent or more increase on a one-time basis. The rebalancing process yields high cash flows. Use an expert to get it all in place. With secondary insurance coverage, in some cases you may receive up to your full, unrestricted fee. PPOs control patient charges, but don’t control total reimbursement when coordination of benefits applies. Coordination of benefits is controlled by state law or the self-funded plan under federal law.

30 Fall 2015 Dental Entrepreneur

4. Increase conversion rate: Patients will be more accepting if the case presentation includes adequate time for explanation, empathy, intraoral photos, digital x-rays, study models and thirdparty financing for affordable payments. 5. Improve crown and bridge operative ratio: Many dentists don’t diagnose, sell, or gain proper patient acceptance for crown and bridge procedures. Merely check the crown and bridge units to operative unit’s ratio to check this important monitor. One crown per three operative multi-units is performed in the typical practice (exclude one and two surface operative units in this calculation). 6. Work “on” the practice, not just “in” it: Many dentists measure their worth by the amount of clinical work hours. Yet time spent for in-office training and outside of the office will pay off in spades. An old Chinese proverb says, “When the student is ready, the master will appear.” Open up your thinking and ditch the preconceived notions. 7. Expand procedure mix: The more procedures, the less patient flow is needed to produce a given revenue level. Many dentists get complacent or in a rut. They say, “I don’t want the hassle,” and decrease services offered. They literally become a “refer-o-dontist.” The more procedures provided, the busier the practice. Explore adding procedures such as simple oral surgery, occlusal guards, Invisalign®, sedation, cosmetics, mini-implants, automated endodontics, soft tissue program, etc., to increase in-office activity. The typical dentist performs about 90 different procedures a year, while the refer-o-dontist does 60. The decathlon dentist does about 120 procedures a year. 8. Maximize treatment revenues per visit: Present quadrant treatment and extend third-party financing to produce more revenue per visit. Longer appointments will reduce stress on the doctor and staff. The clinical goal is both high dollars-per-hour and high dollars-per-visit. This is an important concept in a PPO environment. 9. Define hygiene protocols: Establish protocols for proper diagnosis while increasing revenue. For instance, generally take two bitewings for children and four bitewings for adults. Establish when to take a pan plus bitewing combination and when a full series would be appropriate. Establish the criteria/age for switch-

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ing from the child to adult prophy: for instance, use age 14 or when primary teeth are lost. Establish timelines for new patient exams and recalls with, and without, x-rays. In essence, have a plan that is concise and understandable for all staff that results in better care for the patient. 10. Report the CDT-2015 codes properly: Dental offices don’t usually spend time studying the proper procedure codes. Always report exactly what you do. The typical practice leaves $100-$500 a day on the table by not coding properly or having an improperly positioned fee schedule. Report periodontal procedures properly, avoiding over or under treatment. CDT2015 has 72 total coding changes. Give the business staff the new coding tools when published each year. 11. Return an in-office, on-site consultation: When the office is required to shut-down for training by an experienced consultant, revenues jump. My experience is that the superior approach is for the staff to be trained onsite, without travel or other distractions – in your own office. But, offsite training is a plus. Spend money to make money. Don’t be cost-based, but revenue savvy! 12. Visit other colleagues’ offices to improve your own: A visit to a colleague’s office will yield many ideas and expand your thinking. It’s free, and your colleague will gain value in visiting your office. Approach a dentist in your study club for a swap today. 13. Effectively use the intraoral camera: Many offices have an intraoral camera; however an office may use it inappropriately or not at all. Take the time to train the staff in the proper use of the camera, as well as confirm that it is being used appropriately and routinely. With insurance, document, document and document. 14. File a full fee on the claim form every time: ALWAYS file your unrestricted (full) fee on the claim form even when participating in a PPO plan. Why? You

want to know what the write-offs are, are essential to thrive in a changing PPO and you want to file the full fee so that and corporate marketplace. However, any increase in PPO plan reimbursement you must take the time to identify and is always picked up. It is important that implement them. the full fee be on each claim form when there is secondary coverage for maximum Dr. Charles Blair reimbursement, up to your full fee. offers strategic plan15. Avoid the two top fraudulent pracning, coaching to new tices: If you offer a 5-percent discount for dentists regarding cash, enter the actual fee charged on the training on proper form. For instance, if the fee is $1,000, fee alignment, corbut the patient actually pays $950, the rect insurance cod$950 should go on the form to avoid an ing, and analyzing overpayment. If you offer an isolated fee practices, existing or recently purchased. His co-pay forgiveness to insurance patient newly updated insurance coding handbook, (for instance, a patient in need), you “Coding with Confidence: The Go-To Guide must disclose it to the third-party (insurfor CDT 2009/2010” is available on his website ance company). Enter “the patient is not at www.drcharlesblair.com. For more details, participating in the cost of care” in the email him at charles@drcharlesblair.com or call remarks section of the ADA claim form. 866.858.7596. Federal and State laws and PPO contracts have language prohibiting copay and deductible forgiveness. 16. Run daily reports: Conduct a daily review of all procedures performed versus is to help you navigate the what is charged challenges of building and sustaining a successful out to detect dental practice. errors and review production and We have developed a comprehensive array of procedure mix products and consulting services designed to ensure goals for dentist that every aspect of your practice is optimized to and hygienist. achieve maximum profitability and personal income Applying while delivering the highest quality patient care. these strategies to your practice • Coding with Confidence: The "Go To" will result in Dental Coding Guide increased rev• Administration with Confidence: The "Go To" enues and profInsurance Administration Guide itability, better • Diagnostic Coding for Dental Claim Submission customer service, • Practice Booster improved clinical • Insurance Solutions Newsletter treatment and a better sense of self-worth. They

VISIT PRACTICEBOOSTER.COM TO LEARN MORE

Practice Builders

4 Mistakes Every Young Dentist Should Avoid Roger P. Levin, DDS

he start of your clinical career will rank as one of the most exciting times of your life. But you will make some mistakes. We all did when we were young, inexperienced and finally getting the chance to be the doctor chairside, entrusted with the care of patients. A certain number of non-clinical mistakes can have a beneficial impact on your overall success. I believe it’s in the nature of a typical dentist to acknowledge (at least to oneself) and learn from early missteps. They prove you’re not perfect, which is healthy, and at the same time drive you to achieve perfection. There are, however, some mistakes that are so big and potentially harmful to your financial success and professional satisfaction that you must avoid making them at all costs. In this article, I explore four mistakes that young dentists often make — to their lasting regret. I present them here in no particular order. All are equally important. 1. Don’t think that your clinical training has prepared you for success. You can’t be a dentist without those hard-won skills, and you can’t succeed financially without them, but they do not, by themselves, guarantee anything these days. As you surely know, the new dental economy is far more demanding than what dentists and specialists

32 Fall 2015 Dental Entrepreneur

experienced as recently as seven years ago. Dramatic changes in the market for dental services have altered the ground rules, making business knowledge and skills essential for even moderate financial success. Yet most young dentists arrive on the scene unprepared for the management aspects of practicing dentistry in the real world. Dental schools necessarily structure their curricula to focus intensely on clinical training, leaving little time for anything else. As part of a recent research project, the Levin Group Data Center™ found that, on average, dental students spend only 1.5 percent of their class time on subjects related to practice management. Though not surprising, this sobering statistic illustrates why young dentists can have such difficulty establishing operational protocols and leading their teams effectively. The sooner you acquire basic management and marketing skills, the

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greater your income and professional satisfaction will be. Make business seminars and other forms of study part of your personal CE program. And, hesitant as you may be to take on more debt while still trying to pay down your student loans, consider investing in a consulting program designed to lay the groundwork for long-term success. Some young dentists build the cost for this into their loans when they buy or start up their own practices.

building a practice from scratch, to buying one, to becoming an associate, to forming a partnership, there are many variables to consider. Financial matters, degrees of autonomy and control, timetables for transitions, market factors, personalities — all have make-or-break potential that you’ll need to evaluate carefully. Jump impulsively into a change-of-ownership situation and you could rue the day, especially if contractual obligations tie your hands.

2. Don’t leap into the first opportunity that presents itself. You may have already given careful consideration to the path you should take to fulfill your vision and reach your career goals. You may even have taken your first step in that chosen direction. Nevertheless, you should still keep an open mind about the possibilities — especially considering the profound changes that have been transforming the dental economy. What seems like an excellent plan right now might be rendered obsolete before long by forces beyond your control. If you’re still contemplating your first move (or having second thoughts about a commitment you’ve already made), think it through as thoroughly as you can. Look beyond your most immediate needs and calculate mid-range and even long-range implications. For example, dental support organizations (DSOs) and other multi-doctor, multi-office operations are playing a growing role in the delivery of oral health care across the country. They represent employment opportunities that will certainly turn out to be an excellent choice for a number of your dentists. The question, which only you can answer, is whether the DSO route will prove to be a good one for you. Do you have a strong entrepreneurial streak, or do you desire to maintain your independence? If you’re a budding young dental entrepreneur, solo practice may be a better choice for you. As you know, there are several ways to approach this… and you should think carefully about the pros and cons of each. From

3. Don’t pick up bad habits from colleagues. As a novice, you may naturally observe how established dentists manage their practices. You may even be obliged to learn and use their management techniques if you hire on as an associate. Be careful. You may be studying the ways of a late-career dentist who has done well in an easier economy and still seems to have a thriving practice… but who actually lacks the management skills, strategies and systems that you will need to develop if you are to succeed. The danger of adopting bad or simply outdated habits is especially great if you have an associateship in a practice that you will eventually own. When you first join the practice, you’ll have to learn how the doctor and staff work and what protocols are in use. You’ll strive to fit in, not create problems for your coworkers, and become a productive part of the team. You’ll eventually influence how the office operates, but before that you will become accustomed to the status quo. It may be harder than you think to step back and evaluate how everything’s been, define how you want it to evolve, and then move the team (and perhaps patients, too) toward a new way of working. By that time, you will likely have some engrained habits and blind spots that can be overcome only with a conscious effort on your part. Fail to shed the old ways and you could seriously slow the advance of your career.

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4. Don’t be shortsighted when setting up systems. Some young dentists who are just starting

their own practices don’t immediately appreciate my insistence that they need to design and implement highly efficient management systems. I’m talking about crafting a scheduling system to combine maximum capacity with minimal stress at a time when they have too few patients to keep them busy every day. Why, they wonder, should they spend time creating a schedule that they can’t fill? The answer is that it’s as bad to develop bad habits of your own as it is to learn them from others (as discussed in Number 3 above). You could throw together systems now that may not cause immediate harm, but as time goes by and they become entrenched, you and your team may start paying a heavy price in the form of inefficiencies, lost growth opportunities and stress. My advice is simple: start with smart systems that your practice can grow into — systems that will actually drive that growth. Conclusion As you move through your dental career, you’ll learn a great deal about how to run a dental practice… some of it the hard way. But if you can avoid the mistakes discussed here, you’ll be off to an excellent start and will reach your financial and professional goals sooner.

To learn about how to run a profitable, efficient and satisfying practice, attend one of Dr. Levin’s all-new seminars. For dates and locations, go to: www.levingroup.com/gpseminars

Dr. Roger Levin is a third-generation general dentist and the Chairman and CEO of the largest dental practice consulting firm in North America, Levin Group, Inc., which has served more than 22,000 dentists and specialists since 1985.

Dental Entrepreneur Fall 2015 33

Power to Succeed

Prove It! David Rice, DDS

here’s a reason great companies achieve greatness. There’s a reason that own one or not, few would argue that Mercedes Benz is one of the greatest automobile makers of all time. So what is it about them? What makes Mercedes stand apart? Is it their style? Their engines? Safety? Or is there something else? Is there an underlying current of who Mercedes is? One of my favorite quotes is by Maya Angelou. “People don’t care how much you know, until they know how much you care”. Chew on that quote for a minute. Digest it. Profound wisdom and words my team and I live by everyday in my practice and everyday at igniteDDS. On the flipside, most dentists spend the better part of their day trying to educate their patients, trying in effect to relay how much we know, as opposed to how much we care. It doesn’t make us bad or wrong. In fact, why we do it is for all the right reasons. At heart, most of us are teachers. And we’re doing our best to educate. But what if Maya Angelou is right? If people don’t care until they know how much we care, are we missing it? I’d argue that we are. So I’d like to share one of the most incredible and selfless stories I’ve ever heard. At the end of it, I’d like for you to ask yourself one question: Would you do the same? If the answer is yes, I bet you’re crushing it in dental school and in life already! If the answer’s no, maybe after you read this, you’ll get to yes. In the late 1960s, the average driver didn’t wear a seatbelt, and creating laws like we have today, well, ask your parents. It was the ’60s. So, industry leaders that they were, Mercedes did what they’d always done...they innovated. Long story short, they developed and patented the airbag. Now, I know what you’re thinking. That’s a heck of a story about a great company being great because they innovate. There is truth in that.

34 Fall 2015 Dental Entrepreneur

However, the story behind the story is this: hold the patents or not, what Mercedes did next is what defined them then and what defines them now. They gave the patents away! Imagine that for a second that you held the key to every car company in the world putting airbags in their cars. Imagine that they held the key to everything regarding safety in the automobile industry. What was that worth? Why did they do it? Simple. To save lives. Mercedes chose the greater good over the fatter wallet. They chose the safety of all, over protecting their own interests. They chose to do the big thing over showing big profits. Now imagine Mercedes was a dental practice. Imagine it was your dental practice. Imagine how your patients would respond. How your team would respond. How your community would respond. So I’ll ask you one last time and challenge you in your future, your friends, your family... Would you do the same? Dr. David Rice 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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Continued from page 5

Dr. Fleischman and his wife and youngest daughter moved in 2014. The mentor is now a Clinical Assistant Professor at the University of Colorado School of Dental Medicine and the mentee has become the Chief Resident of the General Practice Residency Program at the same location, after completing a year of general practice residency at Denver Health, Denver, Colorado. Dr. Zalesky credits University of Colorado’s Director of General Practice Residency, Dr. Robert Skoretz, for helping him navigate his current role where he focuses on implants and prosthodontics. And while Drs. Fleischman and Zalesky have plans to go into practice together once Dr. Zalesky’s residency is completed, Dr. Fleischman says he will never give up his teaching and will both teach and be the business side of the future practice. Dr. Zalesky is also taking 1:42 a pagePMoutPage of ADS.south209 2/25/09

Dr. Fleischman’s book and now mentoring his younger colleagues. “I feel like I can pass some of these lessons on to some of my fellow students and co-residents,” says Dr. Zalesky, who aims to own a multi-specialty practice with his mentor that can handle any dental need. “Even though I am not out of school for that long and don’t have that much experience, I feel like I can already pass on some of this experience to my co-residents and dental students to help them as much as I can to realize the importance of having a mentor.” Seeing Dr. Zalesky take on the role of mentor so early in his career is fulfilling for Dr. Fleischman, who isn’t finished guiding future dental professionals. In addition to Dr. Zalesky, Dr. Fleischman is proud to have four other former students who are now Nova Southeastern dental graduates attending the University of Colorado School of Dental Medicine’s

Orthodontic and General Practice residency programs. “For someone who was told that he’d never get into dental school to be able to have a successful career, to be able to teach in two dental schools, and to be able to help kids get into dental schools and residency programs as well as start their careers, is a tremendous source of pride,” Dr. Fleischman asserted. “It feels so special. I love the fact that I can watch today’s doctors grow up in front of my eyes and know that I had a small part in their professional success. This is what I am most proud of in my career – paying it forward as my mentor did for me. It gives me so much satisfaction knowing I can leave this earth a better place than when I entered it.” Please reach out to Dr. Fleischman at Dirk. Fleischman@ucdenver.edu You can reach Dr. John Zalesky at johnzaleskydmd@gmail.com

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 2015 35

Dental Trade Shows

National Dental Student Lobby Day

ADA Annual Session 2015 November 5-10, 2015 Washington, D.C.

April 11 -12, 2016 Washington, DC

Yankee Dental Meeting November 27 – December 2, 2015 New York, NY

ASDA’a National Leadership Conference Oct. 30 – Nov. 1, 2015 Chicago, Illinois

2016 Mid-Winter Meeting of the Chicago Dental Society February 25-27, 2016 McCormick Place, Chicago, Illinois

Thomas P. Hinman Dental Meeting March 17-19, 2016 Georgia World Congress Center, Atlanta, Georgia

The American Student Dental Association is hosting its National Leadership Conference, Oct. 31-Nov. 2 in Chicago. For details visit ASDAnet.org/NLC. The event will provide leadership and business training to dental students across all years. Other benefits of attending: • Experience training in people management, public speaking and presenting, personal finance, practice negotiations, mentoring others and more • Increase the understanding of key issues in dentistry and dental education • Network with students from 60+ U.S. dental schools • Build relationships with exhibitors to fulfill current and post graduation needs Dental Entrepreneur: Business Beyond the Classroom will be there to meet the leaders attending. Please look for us!

Index of Advertisers ADS Dental Transitions South……………………………………………………………........................... 35 ADS Dental Transitions…………………………………………………………….................................... 14 Aspen......................................................................................................................................... 27 Bank of America……………………………………………………………............................................. 21 Comfort Dental............................................................................................................................ 25 Henry Schein PPT ......................................................................................................................... 9 Henry Schein Nationwide ............................................................................................................. 37 MacPractice................................................................................................................................ 11 Paragon...................................................................................................................................... 29 Patterson Dental.........................................................................Inside front cover/page 1, and page 7 Practice Booster.......................................................................................................................... 31 Sirona........................................................................................................................................ 15 Ultradent.................................................................................................................................... 23 Wells Fargo................................................................................................................................. 38

36 Fall 2015 Dental Entrepreneur

DentalEntrepreneur.com

Your patients care about your new Associate as much as you do.

You can trust Henry Schein Nationwide Dental Opportunities to find the right Associate for your practice. We pre-screen and place candidates even in the most challenging markets. There is no fee to the Associate and we guarantee placements for the hiring practice.

1-866-409-3001

ndo@henryschein.com www.dentalopportunities.com

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Wells Fargo Practice Finance

We’re here to help you take the next step

Whether you’re preparing for ownership or planning for growth, Wells Fargo Practice Finance can help you achieve your practice goals: · Up to 100% financing to help you acquire, start or expand your practice · Competitive fixed-rate loans with preferred pricing for ADA® members · Complimentary business planning tools, educational resources, and practice management consulting to help you successfully manage growth

Let’s talk. Call 1-888-937-2321, go to wellsfargo.com/ demagazine, or come see us at ADA 2015 — America’s Dental Meeting, booth #1531. Wells Fargo Practice Finance is the only practice lender selected especially for ADA® members and endorsed by ADA Business ResourcesSM.

Going to ADA 2015 — America’s Dental Meeting in Washington D.C.? Join us for a variety of CE courses, including: • Preparing for Practice Ownership, course 6311 • Buying & Selling a Dental Practice, course 7325 • Find, Design & Build: Constructing a Dental Office, course 5370 Learn more about these courses and others, as well as the Dental Office Design Center, at ada.org/session.

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. © 2015 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. 2675-0815-DE-Ad-Fall-2015