Dental Practice Management Fall 2009 by Annex Business Media

Dental Practice

CANADA’S CANADA’S LEADING LEADING BUSINESS BUSINESS & & LIFESTYLE LIFESTYLE MAGAZINE MAGAZINE FOR FOR DENTISTS DENTISTS

FALL 2009

SUNRISE

MANAGEMENT MANAGEMENT

The new graduate dentist and the ASSOCIATE EXPERIENCE Five tips for a better practice purchase Dental-legal pitfalls TOP 10 Technology Upgrades FINANCIAL ROADMAP to-do’s and traps to avoid

Legal matters for THE RETIRING DENTIST Retirement can be the GOLDEN PARACHUTE if you plan ahead DENTAL PRACTICE VALUES — A double edged sword? Five tips for a better PRACTICE SALE

sunset w w w.oralhealthjournal.com Canada Post Product Agreement No. 40069240 ISSN 0827-1305

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Dental Practice

DPM Guidebook for the NEW DENTIST and the TRANSITIONING DENTIST

MANAGEMENT

Fall 2009

Features SUNRISE / SUNSET

The DPM Guidebook for the New Dentist and the Transitioning Dentist

10 Dental Practice Values — A Double-Edged Sword?

Bernie Dolansky, DDS

14 Legal Matters for the New Dentist John McMillan, LLB

15 Legal Matters for the Retiring Dentist John McMillan, LLB

17 The New Graduate Dentist and the Associate Experience

Timothy A. Brown

22 Financial Road Map for the New Dentist — To Do’s and Traps to Avoid David Chong Yen, CFP, CA

23 Retirement can be the Golden Parachute if you think ahead

David Chong Yen, CFP, CA

26 Five Tips for a Better Practice Purchase Derek Hill, C.A., Broker of Record

27 Five Tips for a Better Practice Sale Derek Hill, CA, Broker of Record

30 Top 10 Technology Upgrades for New Dentists Craig Wilson

31 Top 10 Technology Upgrades for Retiring Dentists

Craig Wilson

32 Dental-Legal Pitfalls Facing the New Dentist Rollin M. Matsui, BSc, DDS, LLB

33 Dental-Legal Pitfalls Facing the Retiring Dentist Rollin M. Matsui, BSc, DDS, LLB

Departments 5

Editorial Why a Dentist?

News Briefs U of T continuum; CICDE report

Office Design Forest Hill Children’s Dentistry

Dental Marketplace

Dental Practice Management

Fall 2009

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1. "TD Prime" means the annual interest rate established and reported by TD Canada Trust to the Bank of Canada from time to time as a reference rate of interest for the determination of interest rates charged to customers of varying degrees of creditworthiness in Canada for Canadian Dollar loans. 2. Subject to complying with TD Canada Trust lending policies and criteria, including confirmation of good personal credit history. Certain business documentation is required. Other conditions may apply. 3. Eligible family leave means parental leave, or time away from work due to illness of the dentist or his/her spouse or children. Eligibility is determined solely by The Toronto-Dominion Bank. 4. First year annual fee waived for Primary Cardholder only. All other applicable fees and charges continue to apply. Interest rates, fees and features are effective as of May 9, 2008 and are subject to change. 5. TD Waterhouse Private Banking services are offered by The Toronto-Dominion Bank. Eligibility requirements will apply. *Visa International Service Association/Used under license. 8Trade-mark of The Toronto-Dominion Bank.

Editorial

Why a Dentist? Y Catherine Wilson, Editor

ou’ve been spat upon, kneed in the • A career in dentistry is personally fulgroin, gagged at, cursed at, slapped, filling...dentists enjoy the challenge threatened and sued. And those are just of a lifetime of learning. Tomorrow’s the patients who like you! dentists will be at the cutting edge of Your senior hygienist is dating the high technology, making the practice office manager; the strip mall you’re in of dentistry even more exciting and has been rezoned; some dental magarewarding than it is today! zine says your practice is nowhere if you • Although dental school may seem don’t invest in cone beam volumetric expensive, recent studies indicate that imaging and some new office furniture; dental school is a good investment... oh, and you’re way behind in those conone study showed that dental offices tinuing education points! were the third highest-ranking category of start-up businesses most likely I Googled the phrase ‘so, to survive. What does you want to be a dentist’ and here is a sample of what And what ‘special’ attributes the perfect does one require to become appeared: • The dentist’s typical day is a dentist? dentist diverse and interesting; • The ability to work • Dentists are artists as well for long hours continuously; look like? as scientists; • The ability to work Is the • D e n t i s t s a r e h i g h l y under pressure; respected within the com• A fair amount of perfect munity...dentists are physical dexterity...if you skilled, conscientious, five thumbs on each dentist born have civic-minded individuals hand, do not hope to become who work with commua prosthodontist; or made? nity leaders, educators, • You need to like What other health professionworking with your mind and als and government offiyour hands. cials. They often volunteer characteristics services to school health are learnable Confucius said, “Choose programs and to elderly, a job you love, and you will handicapped or poor citinever have to work a day in and what zens, demonstrating a selfyour life.” are innate? lessness that is a hallmark of professionalism; On the other hand, as one • Dentistry allows you to Alaska-based dentist said be your own boss. Dentists can bal- regarding ‘burnout’... “Sell everything! ance their personal and professional Let someone else treat all the wimpy lives to meet their individual needs patients....get a job mowing lawns..” and desires; DPM

Dental Practice Management

Fall 2009

News Briefs

Caregivers Don’t Understand Importance of Primary Teeth OAK BROOK, IL—Most American children don’t see their family dentist until they are well over two years old, far later than is recommended by both dental and medical professionals. That’s one of the key findings from a survey of American children’s oral health, conducted on behalf of Delta Dental Plans Association. The survey of primary caregivers revealed that, for those children who had seen a dentist — and 34 percent had not — the average age at the initial visit was 2.6 years. The American Academy of Pediatric Dentistry (AAPD) recommends that a child go to the dentist by age 1 or within six months after the first tooth erupts. “Many Americans don’t understand how important their children’s baby teeth are to lifelong oral health,” said Jed J. Jacobson, DDS, MS, MPH, chief science officer and senior V.P. at Delta Dental. “There’s a continuing need for more education to teach practices that will ensure lifelong oral health. And, since people overwhelmingly prefer the dentist and dental hygienist as their primary oral health information sources, dental benefits that encourage visits to the dentist are crucial.”

Cosmetic Dentistry Continuum 2009 Toronto—The Canadian Institute for Cosmetic Dental Education (CICDE) is offering a cosmetic program beginning October 31, 2009, that encourages growth in the art and science of modern dentistry. Each of the 12 modules in the CICDE Hands-On Continuum is designed to build on the previous one. This precise approach will allow you to effectively integrate all course content, thereby guiding you from your basic or current understanding to a more advanced skill level. The Continuum is designed to bring the aspiring dentist and team to a much higher skill-set level. The program was created to elevate your skills, knowledge and innovative techniques so that you will be able to tackle the majority of cosmetic challenges with the utmost of confidence and complete understanding. Each day at The Continuum consists of both lecture and hand-on components to give you the maximum value in learning exciting, new, proven and evidence-based, minimally-invasive techniques. Space is limited to 20 doctors...contact www.cicde.ca for complete information.

U of T’s Restorative Esthetic Continuum Toronto—The goal of the University of Toronto Advanced Restorative Esthetic Continuum is to provide participants with a logical and insightful perception as to how to examine, treatment plan and deliver dentistry to their patients that is functional, esthetic and optimally maintainable. Participants will receive a certificate from the University of Toronto Faculty of Dentistry Continuing Dental Education Department upon completion of seven programs over a period not exceeding three academic school years. Each of the seven programs will take place on a Friday and Saturday in Toronto, Ontario. Each 2-day program will consist of a lecture and a hands-on component. The hands-on component will allow each participant to fully understand and practice what they have learned and to satisfy the University requirement to be able to give a certificate. Space is limited to 32 participants per session. For complete information, contact www.cde.utoronto.ca or call 416-979-4902.

Fall 2009

Dental Practice Management

A BUSINESS INFORMATION GROUP PUBLICATION Editorial Director: Catherine Wilson 416-510-6785 cwilson@oralhealthjournal.com Art Direction: Andrea M. Smith, Valerie Perrott Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca Consumer Ad Sales: Barb Lebo 905-709-2272 barblebo@rogers.com Classified Advertising: Karen Shaw 416-510-6770 kshaw@oralhealthjournal.com Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@oralhealthjournal.com Associate Publisher: Hasina Ahmed 416-510-6765 hahmed@oralhealthjournal.com Senior Publisher: Melissa Summerfield 416-510-6781 msummerfield@oralhealthjournal.com Vice President/ Canadian Publishing: Alex Papanou President/ Business Information Group: Bruce Creighton OFFICES Head Office: 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Telephone 416-442-5600, Fax 416-510-5140. Montreal: 1 rue Holiday Street, East Tower – Suite 705, Pointe-Claire, Quebec H9R 5N3, telephone 1-800-363-1327, 514-630-5955, Fax 514-630-5980. Dental Practice Management is a quarterly publication designed to provide the entire dental team with business management information to make practices more successful. Articles dealing with investment planning, personal finances, scheduling and collection procedures, in addition to lifestyle issues, are geared to all practicing Canadian dentists, hygienists, dental assistants and office managers. Please address all submissions to: The Editor, Dental Practice Management, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Dental Practice Management (ISSN 0827-1305) is published quarterly, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Subscription rates: $10.00 single copy Canada. One year: ON & rest of Canada $26.70; QC $28.70; NB, NF, NS $28.69; U.S.A. US$27.95; Foreign US$45.95. Dental Guide $18.40 in ON, QC, NS, NB, NF; rest of Canada $17.12; US & Foreign US$16.00. Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 1-800-668-2374; Fax: 416442-2191; E-mail: privacyofficer@businessinformationgroup. ca; Mail to: Privacy Officer, Business Information Group, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Canada Post: Return undeliverables to Circulation Dept. – DPM, 12 Concorde Place, Suite 800, Toronto, ON M3C 4J2. Canada Post product agreement No. 40069240. Dental Practice Management, USPS 019-616 is published quarterly by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-to-business information services. US office of publication: 2424 Niagara Falls Blvd., Niagara Falls, NY 14304-0357. Periodicals postage paid at Niagara Falls, NY. US postmaster: Send address changes to DPM, P.O. Box 1118, Niagara Falls, NY 14304.

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Office Design

Fall 2009

Dental Practice Management

Office Design

Forest Hill CHILDREN’S DENTISTRY hat Forest Hill Children’s Dentistry is committed to providi n g high quality dental care to children in a caring and cheerful environment, is evident immediately upon entry. Located on the ground floor of a pre-war four-plex in Toronto, the practice was recently expanded into the adjacent unit, and the entire space renovated to create an inviting, relaxed atmosphere for both parents and children. “My staff and I, who really are all kids at heart, recognize there are many things today competing for a child’s attention, so we wanted a design that would make a child say, “Wow... this place is different and exciting,” says Dr. Brett Saltzman. Because music is universal — crossing barriers of age and background — and is also a personal passion of Dr. Saltzman (he is often heard singing to his patients during procedures), music seemed an ideal concept for the new office. “Children are being introduced to music in

new ways today — through cartoons, TV’s “Idol” shows, movies, video games — I wanted to harness that energy,” he adds. A concert stage mural was incorporated in the waiting room, complete with miniature theatrical lighting, generating an air of excitement and fun. The doctor’s collection of music memorabilia and the happy, bright colours of the finishing scheme results in a warm and up-beat atmosphere. Spacious and clean, the office flows well. Operatories are bright and inviting, with no instrumentation in the patient’s site line, and, though plumbed with nitrous oxide and oxygen sedation, all tanks and tubing are hidden. There is also an onsite surgical suite and private recovery room for patients requiring general anaesthesia. “I really think the design has exceeded my expectations. The office is a fun place to be, but more importantly, it’s a place that children look forward to coming back to,” concludes Dr. Saltzman, thanking the team that helped achieve his vision: Jean Akerman Interior Design, David Jagger and Scott Lyall of Sinclair Dental, and Edges Contracting. DPM

Dental Practice Management

Fall 2009

Sunrise / Sunset

here is a truism in the process of purchasing and selling of dental practices that those things that disadvantage the seller will benefit the buyer, and vice versa. Let’s examine some of these factors that are ‘two-edged swords’ to see which are the factors that create a win-win for both parties and which situations produce a winner and a loser.

Timing and Planning

It has been said that in business, indeed in life, timing is everything. Certainly, whether you are buying or selling a dental practice, you need to allow enough time to think through and plan in order to set appropriate goals and achieve them. For the seller, this process should include several activities including: getting professional advice on retirement financial planning; arranging for a professional practice appraisal to establish the present value of the practice; and equally importantly, deciding on the type of transition out of practice that will best meet their needs. The refrain that I hear the most often is “I still enjoy my profession but I want to slow down and I’m getting tired of the management part of dental practice”. For the buyer, there are decisions about where he/she wants to put down roots, and whether to buy an existing practice or start a new practice. Most consultants agree that the key element in the decision as to whether to buy a practice or start a new one is the cash flow that comes with an existing practice versus the time required to create cash flow in a start-up situation. The purchase of a good practice at a fair price is almost always the best option. However presently in many parts of Canada that is easier said than done. That is because market timing is also a factor that differs for buyers and sellers. Since the mid-nineties, we’ve had a seller’s market in most urban areas of Canada. What this means is that there are more dentists seeking to buy practices in Canadian cities than there are sellers. This, of course, benefits vendors with higher prices for their assets. It also means that working as an associate or setting up a new practice may be the only option for the newer practitioner even though it will probably result in higher overhead percentages for the sometimes prolonged time period that is required to attain the cash flow necessary to cover overhead and provide for adequate income to the dentist.

Fall 2009

Dental Practice Management

Dental Practice Values

A Double-Edge Location

There is an old real estate adage that says the three most important factors for determining the value of any property are location, location and location. A dental practice is a property and therefore location is a very key determinant of value for a dental practice, especially when we recognize that the location of a dental practice interacts with the supply and demand for dentistry in a given area. As stated earlier, an important element in a purchaser’s decision as to whether to buy an existing practice or set up a new practice is how quickly the location of a new office will allow a ramp-up of new patients and the cash flow that results from that patient load. Thus the actual market value of the assets that are identified in the practice valuation will always be influenced by the supply and demand for dental practices in any given location. There is also a very real dichotomy between the value of a dental practice in most rural areas versus most urban areas. This can be of advantage to the buyer, because the lower demand for rural practices will produce much more bang for the buck. Lifestyle also enters into determining where people want to live, raise a family and put down roots. Presently the great majority of dental graduates seem to favour cities.

Sunrise / Sunset

Bernie Dolansky, DDs

Taxes

Edged Sword? There is an old real estate adage

It seems to be impossible to talk about most business topics without the issue of taxes cropping up. The subject of how to get the greatest tax efficiencies in a buy/sell situation is very complex, and experts in this field should be consulted. However, there is one area of obvious advantage between the purchaser and vendor, and that is the sale of shares versus assets. Briefly, if dental practice assets such as equipment and leaseholds are sold, the chances are high that the seller will have to pay taxes on the recapture of the previous depreciation taken on those assets at the highest marginal rate. Conversely, the buyer gets the opportunity to write off the depreciation of those purchased assets against their dental income. Conversely, when the practice to be sold is incorporated and the shares of that corporation are then sold rather than the assets, then the selling dentist has a capital gain that, as a small business owner, they are allowed to shelter completely from taxes, up to a limit of $750,000. But in this case, the buyer loses out as they wonâ&#x20AC;&#x2122;t have the opportunity for depreciation against other income.

that says the three most important factors for determining the value of any property are

Options

Both buyers and sellers should be aware of the availability of options other than outright purchase and sale of a practice. What is the difference between the two? In a sale the vendor leaves immediately while a transition creates a situation where there is an opportunity for both parties to benefit from practicing together for a certain period. Both scenarios can work well although I profess a bias towards the true transition because most dentists who want to sell their practices seem to express the desire to continue practicing if they can also have the ability to â&#x20AC;&#x2DC;stop and smell the rosesâ&#x20AC;&#x2122; while doing so. For many dentists contemplating retirement the economic downturn has had a very negative effect on their plans due to the investment losses that they have suffered. In this situation the idea that an outright practice sale is the only alternative to carrying on with what may be a physically or mentally

location, location and location Mix of Services

Buyers can generally gain an advantage in the area of the mix of services because in most well-established practices mature dental practitioners tend to perform the aspects of dentistry that they like, and refer out the rest. For the younger buyer, this means that treatments such as endodontics, periodontics and surgery can be bought at a discount, because evaluations are based on actual cash flow. Potential cash flow can be factored into the valuation but at a lesser value.

Dental Practice Management

Fall 2009

Sunrise / Sunset

When the expression ‘a two-edged sword’ is used it implies that there needs to be a winner and a loser

stressful practice situation can leave the dentist feeling trapped. Thankfully, there are excellent, tried and true, methods for accomplishing the sellers’ wishes and also benefiting the purchaser.

Let’s look at two scenarios

The first situation would apply to the seller who: wants or needs to practice for another three to six years; take more time off; maybe cut back to working three days per week; and wants to share the administrative burden of managing a practice. In this approach, it is suggested that a portion (usually fifty percent) of the practice be sold. This is done in a preplanned, highly structured manner where the interests of both parties are respected and protected. For the right buyer, this represents a wonderful opportunity to get 100% patient retention and cash flow. It is also a great way to acquire mentoring and management skills with a minimal risk of making errors. And both parties

Fall 2009

get the benefit of lower overheads and therefore higher net incomes. In the second situation, the practice owner has the same goals as in the previous example, but only wishes to practice another one to three years. In this case, a sale of 100% of the practice is arranged, with the previous owner staying on as an associate dentist, usually for two to four days per week. Again, for the buyer, there is the benefit of very high patient retention and cash flow. As well, the buyer will also benefit from the very substantial income generated by the former owner practising as an associate. In both situations the seller continues to do the dentistry that they enjoy doing, take more time off, and all this without the stress of being the sole manager of the business of dentistry. When it is properly arranged and managed, dentists who transition out of their practices in this way say that it is the best part of their careers. For the purchasers who acquire these practices it removes a lot of the anxiety and risk inherent in

Dental Practice Management

the major decision to purchase a dental practice. Where’s the catch? Is it too good to be true? The potential for difficulties in this type of transition can be summarized in one word, relationships, as it all comes down to finding professionals who are compatible and then creating the properly structured legal agreements that eliminate beforehand potential sources of conflict. When the expression ‘a two-edged sword’ is used it implies that there needs to be a winner and a loser. For some aspects of dental practice transitions this is true. However, for the right people, with the right agreements it is also possible to create win/win strategies for the vendors and purchasers of dental practices. DPM

Dr. Bernie Dolansky is a past president of the Ontario Dental Association and The Canadian Dental Association. He has been involved in all aspects of dental practice transitions for over 10 years. Currently he is a Transition Consultant with Tier Three Brokerage Limited (www.tierthree.ca).

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Sunrise / Sunset

Legal matters for the

NEW DENTIST John McM illan, llB

entistry is a profession and a business. As a new dentist, prepare yourself for imminent business and legal matters that will arise in the first few years.

Associate Agreements

The terms and conditions of Associate Agreements are not “standard” and they can vary widely. Key terms and conditions might include: 1. Are you an employee or independent contractor? 2. Which party pays for what (i.e. supplies, continuing education, membership fees etc.)? 3. When and for how long can you be away? 4. How long is the Agreement? Does it renew automatically unless terminated? 5. Termination rights — Do you have a right to terminate without cause on prescribed notice? Does the Principal Dentist have that right? Can you or the Principal terminate immediately for cause? 6. Are you paid a percentage of billings or of collected billings? What about hygiene examination fees? Are lab fees deducted? What are the payment intervals? Are any amounts held back? 7. Are you restricted from practicing at another location during the term or within a certain radius after the term of the Agreement? Are you restricted from soliciting patients? The law relating to restrictive covenants has and continues to evolve. Consult with your solicitor. 8. Who owns the charts for patients that you treat? What about patients that you introduce? What about friends and family?

Incorporation

You may have heard that incorporation is not worth your while until later in your career, for the reason that “there is no benefit if you cannot leave money in the corporation (to defer taxes).” However, there are scenarios that could still justify early incorporation. For example, as family members of dentists are now eligible (in many provinces) to hold shares in the dentist’s professional corporation, payment of dividends to lower income family members can be a very effective strategy in moving taxable income over to their lower tax brackets for sizable tax savings. It is also possible in certain cases to incorporate while an associate. Consult with your accountant.

Practice Ownership?

If practice ownership is your aim, give yourself at least two

Fall 2009

Dental Practice Management

years of lead time to fully explore your options and to make the transition. In addition to your lawyer and accountant, get acquainted with lenders, practice consultants and practice brokers, as they are a wealth of information and market intelligence.

Start-ups

If you are considering starting your own practice, there are a number of legal matters that will need to be addressed, including commercial leases, equipment leases, loan agreements, design and construction contracts, employment and associate agreements.

Practice Purchase

If you are considering a practice purchase, there are aspects beyond price that must be carefully reviewed and considered, with the assistance of your accountant and lawyer: 1. Whether you are purchasing assets of the practice or shares of a professional corporation. Significant tax implications can arise from this question. 2. Due diligence (books and charts) 3. The current premises lease 4. Equipment leases 5. Existing associate and employment arrangements

Group Practice Arrangements

While considerable savings can arise from entering into a group practice arrangement with other dentists, there are significant tax, liability and other legal implications that can come with these types of arrangements. For example, there is an enourmous difference between a “cost-sharing” arrangement and a “partnership” from both a tax and liability perspective. Also be mindful of this if a “buy-in” is proposed by your principal. Carefully review all of your options with your accountant and lawyer.

Call Before You Sign

It is critical that you consult with your lawyer and accountant before you sign any document and preferably before you enter into any form of negotiation. DPM

John McMillan, LL.B. of McMillan Law Professional Corporation is a Toronto corporate / commercial lawyer serving dental professionals. He can be reached at 416 364 4771 or johnmcmillan@bellnet.ca.

Sunrise / Sunset

ith your retirement approaching, now is the time to begin preparing your practice for sale. Clean (in every respect), well managed practices are in high demand and a few measures on your part can go a long way towards ensuring this. A significant portion of the value of your practice is the goodwill (the future ability to earn income), which is reliant upon your ability to: 1. Remain at your current location, 2. Limit competition, 3. Retain patients, 4. Maximize revenues and minimize costs, 5. Reduce or eliminate risk of liability. It is advisable to conduct a full legal audit of all written, verbal and implied legal contracts to ensure that value is maximized.

Premises Lease

If your premises is under a lease, that lease can be your most valuable asset or the greatest threat to the value of your practice. As you approach the sale date, you will want to ensure that the current term of the lease combined with all available renewals is ten years or greater. At minimum, you will need the term plus available renewals to be equal to or greater than the term of longer that the term of the purchaser’s loan (typically 7 to 10 years), as this is usually a lender’s requirement for financing. From a business perspective, ten years total would be ideal. In some circumstances (but not all), it is also important to have “exclusivity” to practice dentistry in the building (thereby limiting competition). Also watch for and attempt to negotiate for the removal of sinister provisions such as demolition or relocation clauses or the right of the Landlord to terminate the lease in the event of a request for an assignment (assignments are invariably required by a practice purchaser).

Patient Retention

A prospective purchaser will also wish to verify that there are no threats of patient loss post-sale and much weight would be given to the following: 1. Whether there are reasonable and enforceable restrictive covenants given by associates, 2. Whether hygienists (now that they may operate independently in many provinces) have given restrictive covenants and have acknowledged, in writing, that they have no right to or interest in patient charts.

Employees Employees can be seen by a purchaser as an asset or as a liability. Many dentists are not in the practice of entering into written agreements with their employees, the effect being that statutory and common law entitlements would apply. Consider consulting with an employment lawyer in relation to all present and future employees, with the view towards the following: 1. Developing an employment agreement for all new employees, 2. Developing a Workplace Policy Manual, 3. Dealing with any problem employees in a prompt and cost-effective manner.

Systems and Operations Audit

Preliminary due diligence by a purchaser can unearth concerning and even embarrassing information. Conduct a full audit of all systems in order to: 1. Verify and ensure that reasonable efforts are made to collect all co-payments, 2. Review general collection practices, doubtful accounts and ageing receivables, 3. Detect fraud (consider consulting with a fraud prevention expert), 4. Ensure compliance with privacy legislation.

Practice Appraisal

It would be helpful to consult with a qualified practice appraiser to obtain a current value of the practice and to understand the underlying factors of practice value. Appraisals can be subsequently updated as you approach your sale date and after you have completed the above preparatory steps. Appraisals are also a good reference for lawyers and accountants.

Tax and Estate Planning

In your advanced years and as you approach retirement, you must also consider the tax implications arising from your practice sale and beyond or, heaven forbid, your untimely death. Consult with your lawyer and your accountant on the following matters: 1. The benefits of selling shares of a professional corporation versus the assets of your practice. 2. Ensuring that you remain qualified for the capital gains exemption on the sale of the shares in your professional corporation. 3. Multiple Wills, with a separate Will for shares of your DPM professional corporation (to reduce probate tax).

John McM illan, llB

Legal matters for the

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Sunrise / Sunset

TimoThy A. Brown

Graduate Dentist Associate Experience The New and the

he long process of becoming a qualified dentist is over. Now what to do? Some dentists will go directly into postgraduate studies or internships. Others take the long deserved vacation, but most will go into practice as an Associate. Associating has many advantages: No additional financial burden — the Principal pays all the bills and invests in the facility and equipment — thus

the new graduate has the opportunity to pay off student debts or to save for future needs. Little management responsibility — the Principal is the practice manager — thus the Associate is able to focus on building clinical competency and patient management skills. Freedom to move on short notice and to pursue other opportunities — most Principals ask for one or two months notice — unfortunately, many Associates leave on very short notice.

This practice is not recommended as it invariably creates hard feelings and potential future repercussions. The disadvantages are: Lack of authority for major decision making — the Principal controls the new graduate’s schedule and patient flow — sometimes to the point where he /she is working at a much slower pace than desired. A slow increasing income curve — it takes a year or two to earn the trust of

Dental Practice Management

Fall 2009

Sunrise / Sunset

the Principal, staff and patients before the Associate is working at the pace required to earn what is necessary for rapid debt reduction or savings. Short notice terminations are common when the Associate and the Principal have a different philosophy that leads him or her to be out of work when he or she could be earning income. Many Associates work in multiple practices as most Principals can only offer two or three days of patient flow. The alternatives are to set up a new office from scratch or to buy an established practice to eliminate these disadvantages. Historically, the new graduate is not ready for either of these commitments for at least three to five years. Thus, the Associate-ship is the choice of the large majority, even with the obvious shortcomings.

The Associate Buy-In (a.k.a. “hire the buyer”)

Some Associate positions are undertaken with the intent to buy into the practice at a later date. Some Associate agreements have the time and price more or less agreed upon at the outset. Unfortunately, these intentions are often postponed or abandoned as the relationship between Principal and Associate develops. Like many marriages, the intentions are for a long-term commitment, but often this is not the case. People and professionals may grow apart in their plans and dreams and many agreements are broken off prematurely. Principals are advised to avoid any promise of ownership

The

when hiring an Associate dentist. Principals often use the promise of ownership to attract a suitable Associate. Usually, they expect the Associate to work evenings, Fridays and weekends. They give the Associate difficult patients and difficult procedures. A case, in point, involved a dentist who hired an Associate for the above reasons. The Associate demanded an ownership offering after one year. Reluctantly the dentist conceded. However, after a short time, the arrangement made was unsatisfactory. The Associate sued for a constructive dismissal and received a sizeable settlement. Interviews with many young Associates reveal they agree to a commitment to buy in because they want the position to gain experience and earn income. One unscrupulous Associate admitted he had copied the computer records of the Principal’s practice and was planning to open an office nearby. He confessed that some of the staff were prepared to move with him and in effect a “mutiny” was in the making. Principals are advised to be wary and ascertain the true intentions of their Associate. Obviously both the Principal and the Associate should adhere to fair business practices. Many young graduates are not ready for an ownership agreement because of their personal circumstances. Some will marry and start families and may not want to stay in a particular area. Ownership demands a commitment and a sense of permanence. Associates who choose to align with a Principal are

Career Associate Locum D and the

The Career Associate

duction is usually maintained at similar levels, thus keeping the practice vibrant while the Principal is off. Medical doctors have been practicing as Locums for decades. Many Associates never plan or want to own their own practice. They come and go, as required, and are content to do so. Many dentists are on the verge of adopting this career choice.

Locum Dentists — an emerging career choice

The benefits of being a Locum, much like that of an Associate, are: • No financial commitment • Intermittent work — say one or two months on, then one or two months off • No ‘burden’ of management — the Principal makes the decisions • Freedom — some mature Locums have limited family commitments and welcome the freedom to travel, pursue hobbies or live an alternative lifestyle

There are many very successful Associates arrangements whereby neither party wish to be partners and the junior is happy to remain as an Associate for life. Female dentists often seek this arrangement to allow them the opportunity to raise a family. Most wish to establish their own practice but often at a later time in their career. The presence of the temporary dentist (the “temp”) in the workplace has become more and more commonplace. Often these dentists have sold their practices but still wish to continue to practice, but at a reduced rate. Typically, these dentists have registered with a Locum service (some “temp” for the person who has bought their practice, when the purchaser takes holidays or temporary leaves for maternity, medical, or other reasons). This makes perfect sense as patients and staff are most accepting of the former, and familiar, dentist. Pro-

Fall 2009

Dental Practice Management

advised to seek an Associate Agreement. The Agreement (see appendices for a sample copy) should not contain any mention of buying in or buying the practice outright. This would be premature for both parties. The Associate Agreement should be a contract focusing only on the employment conditions. Agreements to purchase should be negotiated at a later date, once compatibility has been determined and suitable time lines can be defined. This is typically a one or two year process. Despite the importance of such agreements, research suggests that less than half of Principal and Associate relationships do not have a signed agreement in place. This is a recipe for disaster as either party could terminate the relationship at any time. This agreement should define many common practices. For example, Associates typically feel ‘entitled’ to contact the patients they have brought into the office, while Principals often feel that such patients belong to the practice. So who is correct? The regulatory colleges have strict guidelines as to how and when dentists can contact patients for commercial purposes, but they normally do not intervene in commercial disputes. Thus, when departing dentists begin the fight over patients, an expensive law suit often results. A written agreement may have prevented this wasteful and often humiliating struggle. ROI Corporation surveys show many dentists’ friendships have been lost in this way.

m Dentist •

The primary benefit of hiring a Locum dentist is the ability to take a leave. Maternity leaves, due to the proliferation of female dentists, are about to increase substantially. Who will cover for these expectant mothers? Locums are needed!

Baby boomer dentists (those who are 40 to 60 years of age) are the majority of today’s practitioners, and they are the most likely to experience a disability. Hundreds of interviews with dentists who are selling their practices reveal a large majority are doing so because of a disability. The Locum is the ideal source of interim labour to maintain patient care and assure the disabled dentist of income. Disability insurance will cover some of the expenses, but in most instances it is insufficient to maintain a full compliment of staff. One client interviewed needed immediate surgery. The recovery period was estimated at one month. She chose to close the practice, temporarily lay off her staff,

Dental Practice Management

Fall 2009

Sunrise / Sunset

Dentists are advised to protect their practice and hire a Locum. They can be called on short notice and relied upon until complete recovery occurs. and notified the patients she would be back in a month. Her thinking was that very few, if any, patients would not be able to ‘wait for just one month to see me’. Emergencies were referred to the local service. She suffered a relapse and notified her staff and patients about a further delay. Sadly, her health diminished further, and she had been closed for two months! Her short-term disability insurance was about to expire. A Locum was found to carry on her practice. Luckily, after this two-month closure, none of the staff had found other employment and were willing to return. Only a handful of her patients had sought another dentist and the practice was back on track within weeks. This is a fortunate situation and it was possible only due to the lack of nearby competitors. The practice was situated in a smaller community and there were limited options for the patients to seek treatment elsewhere. In a larger city,

where dentists are marketing for new patients much more assertively, this practice would have suffered a substantial loss of patients in this two month period. Too often, dentists are overly optimistic about recovery from a disability. Dentists are advised to protect their practice and hire a Locum. They can be called on short notice and relied upon until complete recovery occurs. DPM

Timothy A. Brown is the President & C.E.O. of ROI Corporation & ROI Capital, companies that specialize in dental practice appraisals, brokerage, consulting, Locums placements, Associate-ships and practice financing across Canada. Timothy can be reached at (905) 278-4145 or timothy@roicorp.com This article is excerpted from Profitable Practice — Why a Dental Practice is an Exceptional Investment, Timothy A. Brown CONTINUING EDUCATION

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Fall 2009

Dental Practice Management

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ATTENTION DR. “50 SOMETHING” Do you: Love Dentistry? Have great Patients? Want more personal time? We have immediate demand for good practices in Southern Ontario. Sell to a Dental Practice Investor and stay on as an associate/mentor for at least 3-5 years. They would manage the office and handle all the “administrivia” that bogs you down. You do what you do best… provide your patients with excellent dental care. If this sounds like a nice way to wind down your career, give us a call to find out more.

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Sunrise / Sunset

New Dentists Financial Road Map To Do’s and Traps to Avoid DAVID CHONG YEN, CFP, CA

fter obtaining your license to practice dentistry, which is an important milestone, one needs to consider how they will pay for their education and build a career/business.

LIFECYCLE OF A DENTIST

Our observations indicate the typical “life cycle of a dentist” Years Since Graduation 0-2 3-10 11-15 16-25 26-35

Activities Associating, honing clinical and interpersonal skills, paying off student loans Buy own practice; a few open their own practice; buy home Buy own building where practice is located; more than a few get separated or divorced. Some buy a cottage Peek earning years; retirement and estate planning are prominent issues Maximizing the value of one’s prized retirement asset (dental practice) in the most tax efficient manner

Mature graduates, some of whom received their training in a foreign country, but who have to complete a course of study in Canada, are more likely to buy or open their own practice sooner than later.

Consider the following lifecycle of a dentist

Visualize where you want your career to be in 10 or 20 years time; then with the end result in mind, begin your quest to achieve same. Determine your current and future personal expenses; then multiply this amount by three; your targeted income before taxes should be at least this much.

Associate

Issues to Consider When Evaluating an Associateship: • Does it meet your financial, clinical and practice management goals? • What do previous associates think and why did they leave? • Day sheets? This may indicate the type of work being done, the level of volume, etc. • What services are being referred out versus performed in house? • Determine number of active patients and new patients per month. • Determine age and ethnic mix of the patients; what language do patients speak? • Determine if co-payments are being collected • Determine which fee guide the dental office uses. • Determine the amount of patients on social assistance. Continued on page 24

Fall 2009 Dental Practice Management

DPM Fall09 p22-24 Chong.indd 22

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Golden Years

Retirement can be the Golden Parachute if you Plan Ahead DaviD Chong Yen, CFP, Ca

fter spending years nurturing your dental career/ practice, it is time to harvest the fruits of your labour. Retirement takes years of planning.

HOW DO YOU PREPARE YOURSELF?

• Plan ahead — Plan at least 2 years, but preferably 3 years, prior to the sale. • Meet your financial advisors (financial planner, insurance agent, banker, lawyer and accountant etc.) — Agenda? • Discuss your retirement plans • How much money do you need to retire? • Does your retirement nest have sufficient assets to support your retirement plans? • What about timing of the transition into retirement? Is there a better time to sell? • Are you selling all or a portion of your practice? • What about the tax implications (i.e. tax bill) on the sale and retirement income? • Do you have the right ownership structure or corporate structure to minimize your tax bill on the sale? Should any tax restructuring be done prior to the sale? • What would you be selling — shares of your corporation(s) or assets of your dental practice? Are you

and your family members entitled to the life time capital gains exemption of $750,000? • Do you have a current will and power of attorney? • Prepare your practice for the sale — Do you have to renovate or get new equipment prior to the sale? How do you boost your revenue? What will affect the value of your practice? Consider maximizing revenues and profit during the three year period prior to sale. These years will greatly determine the value of your dental practice. • Valuation — What is it really worth to the purchaser? Have your practice and/or your dental building appraised by independent parties (i.e. practice and real estate broker). The appraisal will substantiate your asking price as well as the price allocation. This will facilitate negotiations. • Avoid equipment leases which contain large prepayment penalties; the buyer may not want to assume equipment leases resulting in vendor paying large penalties. • Retiring Allowance — Any employees including spouse, etc. who have worked at your office prior to 1995 might qualify for a retiring allowance. The allowance amount is tax deductible while the employees/recipient might pay no Continued on page 24

Dental Practice Management Fall 2009

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Continued from page 23

Other issues to review:

• Where to practice? Dentists in rural areas tend to make more money than dentists in densely populated areas where the competition among dentists is great. • Associate agreement? Non compete/non solicitation clause? • What about Goods and Services Tax (GST) exposure? • Are you an “employee” or “independent contractor”? What is the tax implication? • Professional corporation — are you taking advantage of this structure to save taxes?

Principal (be your own boss) • • • • • • • • • • •

Issues to consider Where to practice? Opening or buying a dental practice? How to buy a dental practice? Buying a practice, although it may cost more, is a safer investment than opening a practice. Where to find a dental practice? Is the practice overpriced? What are you buying? Shares or assets? Should you go into a partnership or cost sharing? How to obtain financing? What interest rate are you being charged? Professional/hygiene/technical corporation(s) — do you have the right corporate structure to minimize your tax bill? How to market?

• Premises lease? What should the terms be? • How much to spend on renovation?

Where ever your career leads you, you should avoid the following traps:

Gambling, divorce and drugs have ruined many careers • Borrowing to buy expensive car/home before buying your dental practice • Getting divorced without a marriage/co-habitation contract • Spending more than you earn; many dentists base their spending on their collections. They often ignore their expenses or the taxes they owe. Each month, consider having your taxes, RRSP’s, funding for children’s education and investments automatically withdrawn from your bank account. What you do not see, you will not likely spend • Pretending to be an expert in all fields; know your strengths and weaknesses; research those who can assist in compensating for your weaknesses; then hire them. Concentrate on those things which you do best • Keeping up with the Jones’ often lead to financial disaster; run your own race as you are your best competitor. • Be careful of the golden handcuff, i.e. where you associate too long and your lifestyle is based on this income. It is difficult to reduce one’s lifestyle. Hence, it will be difficult to venture out on your own. • Non tax deductible debt including home, cottage, mortgage, education and boat loans — pay off A.S.A.P.

Continued from page 23

• Consider having your Professional Corporation (PC) pay immediate tax on the income. for and deduct contributions to your retirement via an • Sale terms — do not sign any agreement without your Individual Pension Plan (IPP). This strategy could also advisors’ review. Do you, the vendor, have any liability reduce excess cash inside your PC. after you sell the practice? • Consider having your spouse and/or children as shareholders of your PC. This may multiply the capital gains exempAssociate Agreement — Negotiate your associate agreement if tion of $750,000. i.e. you may be able to sell your PC and you intend to work with the new owner. The agreement should avoid income taxes on the gain. specify the weekly schedule (i.e. day and hours), potential holidays and the associate fees (percentage). Consult your legal • Ensure you have a premises lease with a term and renewal options totaling at least seven years as the banks will advisor on the non competition or solicitation clause. need this in order to finance the purchase. Ensure that • Building — If you or any related person owns the dental your premises lease does not contain a demolition clause, building but you are not selling the building at this time, i.e. the landlord can demolish premises. you should check with a local reality agent regarding the going market lease rate for your building and then secure a • Ensure you have an associate agreement with your current associates which contains a reasonable non-soliclease agreement with the purchaser. At times, the purchasitation/competition clause as this preserves your pracer might ask for a first right of refusal or an option to buy tice’s value. the building; it is your choice to grant this option. David Chong Yen, CFP, CA of DCY Professional Corporation Chartered Accountants, has completed the CICA In-Depth Tax Courses and has been advising dentists for decades. Additional information can be obtained by phone (416) 510-8888, fax (416) 510-2699, or e-mail david@dcy.ca. www.dcy.ca. This article is intended to present tax saving and planning ideas and is not intended to replace professional advice.

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Dental Practice Management

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Sunrise / Sunset

TIPS for a better

Practice Purchase

uying your first dental practice is a big deal; maybe not as big a deal as getting married but certainly as big a deal as buying your first house. What makes buying your first practice tricky is that there is probably a lot of business “stuff” that you don’t know or haven’t experienced. Additionally you are at a stage where you feel like you don’t have a lot of money to spend on good advice. Starting your career with a good practice purchase however is much more important than you might think and certainly worth more than the costs needed to avoid a bad purchase. I have set out five points (by no means all inclusive) that if followed should help you make a good purchase and avoid a bad one.

Advisors

Perhaps the most important thing to do when considering the purchase of your first practice is to get a good accountant. You need an accountant who handles lots of dentists and other professionals, preferably one who specializes in professionals and dentists. It is quite likely that you may end up with an accountant from out of town. Most of the accountants who specialize in professionals have clients scattered throughout a province and not just in their local area. You will also need a lawyer and again should pick one that is experienced with the dental profession. A good place to get a legal referral is from your accountant. If

Derek H ill, C.A., Broker of r eCorD

Fall 2009

Dental Practice Management

you can, find out if a prospective lawyer has a reputation for facilitating deals or killing deals. What you want is a win/win lawyer. Win/win professionals are the ones that understand the importance of both parties succeeding in any transaction. Look for win/win professionals.

2 3

What Kind of Practice?

It is very important to know what kind of a practice you want. Do you want to practice alone or with one or more other dentists? Do you want a big city practice or a rural practice? Do you want a “fixer upper” or a practice that has already been “fixed up?” The answer to these questions will be crucial in helping you determine what to look for. There are big differences between all of the options noted above. If you start your search knowing what you want, you will save a lot of time and money and avoid the possibility of buying the wrong practice.

Due Diligence

Once you have found the practice you want, you will have an opportunity to do what is called due diligence, which is your opportunity to verify the information that is set out in the appraisal. Your accountant should be able to help you verify much of the financial information. All good accountants specializing in professionals will have specific procedures that they will want to do for you during the due diligence phase. The most important thing for you to do is to review and audit the charts. You need to make sure that there Continued on page 28

Sunrise / Sunset Derek H ill, C.A., Broker of r eCorD

elling your dental practice can be a very emotional process and one that is fraught with traps and mistakes, which can be easily avoided by following a few simple rules. In the following article I have set out five points (by no means all-inclusive) that if followed will help make the sale of your practice easier, more pleasant and a much more fruitful experience.

Appraisals

The starting place for any practice sale process should be getting a good appraisal. It needs to be a document that you, the purchaser and the purchaser’s advisors and lenders can all rely on to be a fair representation of real value of your practice. The appraised value of any dental practice should be largely a function of the return on investment that it will provide to the purchaser based on its current operations and short term future operations that can be credited to the seller. An over inflated appraisal will likely mean that your practice will sit unsold on the market for a longer period than if it was correctly appraised. Unreliable appraisals not only make buyers and their advisors wary but also have the same effect on lenders who will discount appraisals that are not based on solid business principals. Always ask your appraiser how your practice will be appraised and verify with your accountant that the methodolog y suggested by the appraiser is based on sound business principals.

Develop a Plan

With your appraisal in hand sit down with your accountant, broker and possibly financial planner and determine how you are going to sell your practice. Are you going to “take the money and run”, are you going to work for a short period or a long period as an associate, is it important who you sell your practice to, are you ready to sell your practice - maybe you need to wait for a year or two? These are all questions that you need to have answers for. You will also need to determine what you are selling, shares, assets or a combination of both. The best

person to advise you on this is your accountant as these decisions are largely tax related. Make sure that you have good advisors and that you listen to them. Choose accountants, lawyers and brokers who are well respected in the dental industry. Hopefully your accountant is well versed with the details of a dental practice, your real estate lawyer however will probably be a poor choice to help you sell your dental practice. There are a good number of accountants and lawyers across the country who specialize in providing services to medical professionals. If you don’t know who they are try asking a local practice broker or even your banker. Before you put your practice up for sale make sure you and all your advisors know what you are selling and how you want to sell it.

Unnecessary Secrets

One of the questions most often asked by sellers is when do they tell their staff and patients that they are selling their practice. There are strongly held beliefs that the process should be a secret until the very last minute to avoid a loss of patients and staff. On the other hand, rumors are always perceived more seriously than the truth and once your practice is on the market it is very hard to keep it a

TIPS for a better Continued on page 28

sale

Dental Practice Management

Fall 2009

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Continued from page 27

are as many charts as set out in the appraisal. You also need to review the charts to ascertain the quality and quantity of dentistry the patients have been receiving from the seller. If the standards of care are very poor then you may have a problem educating and introducing patients to your standards. You may find a practice where virtually all of the dentistry has been done. What you are paying for when you buy a practice is the future revenues that will be generated by providing services to the patients of the practice. You need to ensure that there are actually patients there and that they still have work to be done and that the treatment planning and presentation of such work has a good chance of being accepted by the current patients.

secret. There may be specific reasons for keeping the sale of a practice quiet and if so then that should be the strategy. However, once all your plans are made and your practice is about to be listed, if there are no overriding reasons for keeping your intentions a secret it is probably more beneficial to first tell your staff and be honest with patients if asked. In most cases the employment of current staff by the new owner will be on the basis of “continuous employment”and will form part of the sale agreement, so staff should not worry about the security of their jobs. The last thing a purchaser wants is for the staff to leave. Let your staff know that you are carefully picking a successor who will carry on the current traditions of the practice and treat the staff and patients in the same way as you have been treating them. It will be better for them to hear the truth from you than rumors from someone else. Similarly, be honest with patients when asked. Remember they come to you for their very personal dental care because they trust you. When you tell them that you are carefully picking out your successor they will also trust you with that. Of course, at some point you will need to introduce the new owner to them either by way of letter or in person and you may be surprised at how unsurprised most of them will be. Honesty is always the best policy.

4 5

Integration Plan

Before you actually buy your practice you need to make sure that you have worked out an effective plan to integrate yourself into the practice. Usually, this will require some co-operation from the selling dentist. Practice sales that are executed without much thought to the integration of the new owner into the practice tend to suffer from high patient attrition, which means that you will be left with fewer patients than indicated in the appraisal or even determined during the due diligence. Ideally, you should develop a plan whereby the retiring dentist can personally introduce you to the patients of the practice. Different practice environments call for different introduction strategies and this is an area where your broker should be able to assist you in determining the most effective way of introducing you to the patients. To ensure that an integration is actually executed make it a condition of the purchase agreement.

Making Changes after the Purchase Inevitably, after you have purchased the practice you will want to make some changes to its operations and protocols. In many cases, these changes will ultimately be very beneficial to the practice and the patients, however they should be made with caution. The first changes you make should be ones that are clearly beneficial to the patients. The last changes you should make are ones that are obvious and look expensive with little perceived value on the part of the patient. If the fee guide is a couple of years behind the current guide, increase the fees slowly over two or three years. The general concept is to not give the patients the sense that “the new guy is more expensive or more pushy than the old guy.” If you make your changes too fast with no perceived value to the patients, they will leave. If you think the practice needs to make some changes but you are not sure what they should be or how to make them, hire a consultant. All of the most successful Continued on page 29 top left hand side

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4 5

Focus on Your Outcome

Once you have decided how you are going to sell your practice and have determined what price you are prepared to accept for it, do not get sidetracked with irrelevant details or “noise.” Noise is anything that distracts you from your objective which in this case is to sell your practice as planned. Most people are very susceptible to noise, avoid noise at all costs. Different advisors will use different negotiating tactics. Do not take any comments from a negotiation personally and do not let any comments distract you from your objective. Similarly you may find many of your colleagues have instantly become experts in the area of practice sales and valuations with lots of free advice. Do not get distracted by well intentioned friends. One of the big advantages of having a properly prepared appraisal and a well thought out selling strategy is that it can help you from getting distracted by noise.

Time Is of the Essence

Finally, you should know that the longer it takes to get a deal done the less likely it is to actually happen. Once you have found your buyer, instruct your advisors (usually the lawyers) to close your sale as quickly as possible. The longer it takes to actually get a deal closed the more time there is for unforeseen and unnecessary issues to arise. Continued on page 29 top right hand side

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Continued from previous page right hand column

practices have used the services of practice management consultants at one time or another. Often the cost of using a consultant immediately after or as part of a practice purchase, can be factored into your acquisition loan so that the impact on cash flow will be minimal. Owning a dental practice is probably the best investment you will ever make if you get what you expect and pay a fair price. The effort and cost required to ensure that your investment is a good one is minimal compared to the return you can expect. DPM

Legally speaking, the squeaky hinge gets the oil. Real estate transactions, because people are moving etc. etc., tend to almost always close on time, the lawyers make sure of it. Dental transactions often take second or third place in a lawyers priority list. If you want your deal to close on time make sure you and your broker stay on top of both sets of lawyers to make sure that happens. If you follow all of the points described above, I guarantee the sale of your practice will flow more smoothly and successfully than if you donâ&#x20AC;&#x2122;t. DPM

Derek Hill a co-founder of The Hill Kindy Group Inc., and the Broker of Record for Hill Kindy Practice Sales & Realty inc., Brokerage specializes in the design and facilitation of all Prac-

tice Sales and the personalization and execution of all Transition or Stepped Sale Strategies. Hill Kindy Practice Sales & Realty Inc., Brokerage, St. Catharines, ON. T: 905-984-581

090415-19985

OCT 09

Dental Practice Management

Fall 2009

Sunrise / Sunset

Top 10

technology upgrades for

NEW DENTISTS Craig Wilson

1 2 3 4

Regardless of the speed or order of implementation, there are certain technologies that are beneficial to a growing and successful new practice. Some are self evident, such as telephones, a web site, email, fax, etc. Here are the top 10 overlooked, contentious, or underutilized technology upgrades.

Upgrade to digital imaging

affect a patient’s perception of the service provided by the practice. Track what you can and use a computerized system to keep notes on everything and anything that might improve perceived service.

Upgrade antiquated equipment If you expect your patients to describe your practice with terms like ‘modern,’ ‘high-tech,’ or ‘up to date,’ you’ll need to look the part. If a technology item looks like something from the previous century, your patients will notice. Replace it. By eliminating older technology items, you will likely make your staff more productive and also reduce energy usage as well.

Get involved with 3D imaging Implement cone beam volumetric imaging in your practice now. If that’s not possible, either due to financial or legislative reasons, get as involved with 3D imaging as you can. This means sending patients for 3D studies, working with the actual 3D volumes, learning how to diagnose and treatment plan with them, and using the volumes to educate patients. Short of juggling flaming chainsaws, there is nothing that will impress your patients more than the manipulation of their 3D volumetric data while you discuss their treatment plan.

7 8 9 10

Upgrade now. The longer you wait, the longer you miss out on the advantages to be gained by using digital imaging. In addition, purchase a good digital camera for dental use, and learn how to use it. Evaluate ROI and purchase the appropriate digital extraoral radiography equipment as soon as prudent. The longer you wait, the more opportunities you will miss.

Use technology for a better patient experience

Use images to create reports and handouts

Backup, backup, backup

One of the best reasons to use digital imaging, and one of the ways that it is most underutilized, is for the creation of reports and other handouts for patients. Create reports that can be printed for each patient who visits the practice. Simple letters that thank the patient for their trust and include their photos and/or radiographs are easy to produce and highly appreciated by the patient. Systematize the creation of these types of letters and reports.

The potential for catastrophic system failure exists. Virus protection, data protection, usage policies, access policies, security, documentation, and recovery plans are necessary although unexciting realities for any modern dental office. Make sure that your data is being backed up, and make sure that someone is checking that backup.

Environment — what’s your impact? In today’s environmentally-conscious world, every business needs to carefully evaluate their environmental impact. Digital imaging, paperless charting, paperless medical questionnaires, green computing, power conservation, and aggressive recycling are all examples of relatively simple green initiatives that every dental practice would be wise to implement. Once implemented, find creative ways to draw attention to these initiatives.

Computerized contact management Patients care about how they are spoken too, how long they wait, the mood of the staff, the way the phone is answered, how quickly their questions are handled, all

Fall 2009 Dental Practice Management

The patient experience is as much a function of the environment and atmosphere in the practice as it is about the clinical services provided. Movies, music, recorded television programming and educational content can all be delivered on demand, and customized to each patient’s preferences.

Practice management software

The choice of practice management software is probably the most important single decision that impacts the administrative functions of the practice. Making an incorrect choice can be devastating. Evaluate practice management applications carefully, and make a decision based on features, support, appropriateness, and quality. Don’t choose based on price alone.

Appropriate use of technology

5 6

The greatest assemblage of technology items will do nothing to help your practice or impress your patients if they are not used well and appropriately. Make use of any training resources available, which are appropriate to your systems and setup, and seek out new training opportunities. Use technology to communicate with patients as is appropriate to each of them. DPM

5 6

7 8 9 10

Sunrise / Sunset materials. In addition, wherever time and money permits — use the logos and artwork that reflect your brand in creative ways digitally.

Upgrade CRT TVs & monitors to LCD/Plasma

Top 10

technology upgrades for

RETIRING DENTISTS

1 2

3 4

Upgrading certain technologies in a practice that you are preparing to leave makes good sense. In most cases, today’s prospective purchasers of dental practices will be much more fluent in the use of current technology than the seller. Preparing a practice for sale is about creating perceived value. Recognizing that your target market may have certain technology expectations can help you evaluate possible upgrades, which create that value.

Use email and text messaging personally

The most influential factor impacting the perceived value of the brand is the dentist with whom the existing patient base has a relationship. The next generation of dentists simply assumes that everyone uses email and text messaging, and can’t imagine anyone being effective without these tools.

Internet and email access

To facilitate the use of email, it is important that Internet access is available in the office. Can you believe that some dental offices still don’t have Internet access?

Create or update your practice website

The practice is a brand, and when people are evaluating a brand they go to the Internet first. If you haven’t already done so — have a professional looking website created for your practice. Employ the services of a graphic artist to create a custom logo and artwork.

Use your logos and artwork everywhere Although business cards, brochures, letterhead, and mailers are not strictly ‘technology’ upgrades — make sure that your brand is represented in a variety of print

Technology becomes dated very quickly. If you have CRT based TVs in the reception area or the operatories, or CRT monitors at the computer workstations — upgrade them to LCD or Plasma units.

Computer(s) in the office Some practices don’t use computers in the ops or for practice management. If that’s the case with yours — don’t try to computerize everything now. The ROI is likely not there. However, to not use computers for reports, patient correspondence, email and other routine administrative activities is simply not good business.

Digital imaging

If your practice has not upgraded to digital radiography, it’s likely not prudent to do so simply to sell the practice. However, there are just so many ways that images, particularly digital images, are critical to dentistry, patient care, and the extension of the practice brand that this is simply not a technology that can be ignored. If you are still using film-based radiography, purchase a scanner to allow the acquisition of digital versions of the films. If you’re not currently using a digital camera for case documentation, purchase one and learn how to use it.

Brand your patient reports

5 6 7

8 9 10

Review your systems

Get passionate about the details again, and make sure everything is the best it can be. Look at your technology from the buyer’s point of view, and recognize that the little things that have been neglected during your day to day routine, might become the red flags that highlight areas of concern for a prospective purchaser.

Use technology well — or not at all

Finally, remember that the purchaser is buying a business, not a collection of technology items or even a collection of names. Learn how to get the most out of the technology that you have currently, and upgrade small pieces if appropriate. Now is not the time to make big changes, but the time to refine what is currently in place. DPM

Craig Wilson is president of Compudent Systems Inc., a company providing support services for organizations and individuals involved with dental and medical imaging applications.

Dental Practice Management Fall 2009

Sunrise / Sunset

Dental – LEGAL

pitfalls

facing the practicing dentist

NEW

s a New Dentist, you have probably received basic information on the various types of commercial agreements / contracts, which dentists can legally enter into regarding the practice of dentistry. For the purposes of this brief article, I will assume you understand the fundamentals of Associate Agreements, Cost-Sharing Agreements, Management Agreements, Preferred Provider Agreements and Purchase and Sale Agreements and offer some important risk management “tips” you should consider in these regards:

Associate Agreements

You may have been told that as an Associate, restrictive covenant clauses (eg. non-solicitation and non-competition clauses) are unenforceable and therefore you don’t need to worry about them. This is incorrect. Remember that when you sign a binding contract such as a written associate agreement, whether or not such restrictive covenant clauses will be enforced by a court of law will depend on the facts of the particular case and the wording used in the specific agreement. Therefore it is unwise and very risky to sign an associate agreement containing such clauses assuming that they will not be enforced in a legal dispute with the principal dentist. Be sure to seek legal advice before signing any associate agreement especially where there are restrictive covenant clauses in the contract.

Cost-Sharing Agreements

If your key goal in working with another dentist is to share the expenses related to running a dental office such as rent, equipment, supplies and staff while enabling you to develop your own goodwill in your own dental practice which you can take with you when the agreement terminates or expires, then you should consider this type of commercial agreement. In these types of agreements, there should be less concern with restrictive covenants. However, cost-sharing “partners” can face serious legal liability issues when employee disputes related to “shared” staff occur and when one or more parties wish to hire associate dentists or wish to sell their respective practices. If you are going to enter

Fall 2009 Dental Practice Management

into this type of business relationship, be sure to seek legal advice so that you protect your interests.

Management Agreements

Only a dentist can own a dental practice. Therefore be very careful when considering business relationships with non-dentist entities such as management and technical services companies and make sure that the non-dentist entity does not own your dental practice. Dentists can be confused as to what this means. Dentists cannot split income with, or be employed by, such non-dentist entities. Dentists cannot allow such non-dentist entities to have a percentage interest in their dental practice. Be sure to seek legal advice when negotiating these types of agreements and before signing same.

Agreements with Dental Hygienists

With the recent amendments to the Dental Hygiene Act in 2007 allowing dental hygienists in Ontario to self-initiate scaling and root planing procedures without the order of a dentist, dental hygienists are now entering into business agreements with dentists not commonly seen previously. These agreements can be beneficial for both dentists and dental hygienists alike. However, as a New Dentist, if you are going to consider such a relationship, it will be important that you ensure that the dental hygienist not have any ownership interest in your dental practice. Furthermore, your working relationship with the dental hygienist will have to be carefully set out to ensure that you are not committing professional misconduct. Restrictive covenant clauses are very important issues to be addressed to protect your interests. Be sure you understand the terms of any such agreement and obtain legal advice before signing any written contract.

Preferred Provider Agreements

This typically refers to business agreements between a dentist and a business entity wherein the dentist agrees to treat Continued on page 34

Sunrise / Sunset

Dental – LEGAL

pitfalls

facing the

retiring Rollin M. Matsui, Bsc, DDs, llB If you are a dentist who is planning to sell your dental practice when you retire or as you wind down your practising career (the “Retiring Dentist”), this article is intended for you. In my experience as a dentist / lawyer providing legal advice to dentists in my law practice, the primary concerns facing Retiring Dentists tend to focus on the sale agreement related to the Retiring Dentist’s dental practice and what can / may happen following the completion of the sale. As such, this article is intended to highlight some key issues on this topic.

Selling Your Dental Practice

On the one hand, selling your dental practice when it is time to retire can be the “simplest” transaction to execute and complete especially when you plan to stop practising altogether or only intend to practice dentistry to help transfer the goodwill of your practice to the purchaser after which you will not practise any longer. From the vendor’s perspective, if you are only interested in obtaining a fair return on your dental practice investment and you have no “skeletons” or “problems” regarding your practice which may complicate the transaction and make it harder to find a purchaser, the proposed sale may be quite attractive for the “right” purchaser. On the other hand, when a Retiring Dentist sells his or her practice, often the purchaser will be concerned with a number of issues inherent to such transactions, including but not limited to, the type and quality of dentistry performed, the types of patients treated, whether or not assignment of patient benefits is accepted, the amount of accounts receivable, the degree of office computerization, how modern the facility, premises, equipment and supplies are, what creditors exist, what the lease terms and renewal options for the premises are, details regarding any associate dentists and dental hygienists working at your practice, the future income potential of the practice and a multitude of other issues all beyond the scope of this article.

practicing dentist

Here are some suggested risk management tips to consider in order to try and avoid legal pitfalls confronting the Retiring Dentist when selling your practice. With respect to the preparation, execution and closing of the Sale Agreement: — Be clear on your primary goals and purpose of the transaction. Your tax advisor will advise you on the advantages and disadvantages of how you should sell your practice. If you are a sole practitioner, should you form a professional dentistry corporation first and sell the shares of your corporation or should the transaction be an asset sale including goodwill? Do you want to sell all of your practice or only a portion? If you intend to practice dentistry on a limited basis post-closing, will this be as an associate, cost-sharing “partner” or as a true partner of the purchaser or through some other arrangement? Anticipate that your goals will of course determine the type of purchaser attracted and willing to buy your practice. The purchaser’s interests are intrinsically contrary to yours. Legal complexities can arise depending on how complicated the transaction is being structured. If you are in doubt about what you really want, it is strongly recommend that the prudent Retiring Dentist obtain appropriate business, tax, and legal advice to discuss options and determine what is in your best interests before offering your practice for sale. — If you are in a true dental partnership or a costsharing “partnership,” be sure to read your relevant written contracts to see how you can “retire” from practice. Usually the contract sets out the process to be followed. — If your primary concern is to receive payment on closing, it may not be in your best interests to accept any financing proposals from the purchaser. If you do agree to deferred payment of the purchase price over time, beware that if post-closing problems occur (see below), the risk of you not receiving future payments increases and the need for litigation in order to enforce payment Continued on page 34

Dental Practice Management Fall 2009

Sunrise / Sunset Continued from page 32

Continued from page 33

a group of patients using a fee structure which is different from the typical “fee for service” relationship the dentist has with his or her other non-group patients. In Ontario, the professional misconduct regulations set out the rules applicable to dentists regarding financial agreements with patients. If a New Dentist wishes to enter into this type of arrangement, it is important that the dentist seek legal advice to ensure that the dentist is not breaching any applicable professional misconduct regulations before signing any such agreement.

may be required. — Make sure your practice financial statements accurately represent the income and expenses of your dental practice. A bonafide purchaser will want to perform due diligence to satisfy himself or herself as to the type of dentistry performed in your practice, the “quality” of your practice and that the future income potential warrants the purchase price being asked. — Recognize that prudent purchasers may well expect the Sale Agreement to contain appropriate representations, warranties and covenants consistent with what you are saying about your practice and require contract clauses be inserted to remedy any deficiencies the purchaser discovers post-closing. If you want to have as smooth a closing as possible with minimum post-closing problems, the prudent Retiring Dentist will pay attention to such details when negotiating the Sale Agreement. — Since most purchasers of dental practices will usually require third party financing (eg. from a bank), the Retiring Dentist should be proactive and anticipate what documents the purchaser will require for such purpose and have them ready if possible and in your best interests. For instance, the availability of an appropriate appraisal document and a favourable lease of the premises with excellent renewal options can be key factors in this regard. The Retiring Dentist should seek appropriate legal and other relevant advice on these issues so that an appropriate strategy can be developed when preparing for the sale of your practice. — If you are the type of dentist who will be upset if you sell your practice to a purchaser who does not “look after” your patients as you did, you may wish to consider what due diligence you wish to perform regarding a prospective purchaser and what options you wish to exercise should you discover information about the purchaser which does not meet your satisfaction. Be aware that Retiring Dentists can be faced with very stressful and ethical concerns when, to their surprise, after the closing of the Sale Agreement, the purchaser starts to change the way patients are being treated which are not to the Retiring Dentist’s liking. Depending on the terms of the Sale Agreement and the relationship of the Retiring Dentist to the purchaser in any post-closing working agreement, the Retiring Dentist may be facing professional liability and legal issues as well. DPM See Part II of Pitfalls Facing the Retiring Dentist in the Winter issue of DPM.

Purchase and Sale Agreements

Generally speaking, when a dentist is purchasing a dental practice, he or she is more at risk than the vendor. This is because the purchaser is investing a large amount of money for the purchase and wishes to be sure that he or she obtains what was bargained for. A New Dentist can be even more at risk because he or she does not have the benefit of practice and business experience and may not know what terms are necessary in the purchaser’s best interests. It is assumed that the New Dentist will perform the necessary due diligence in assessing the assets and goodwill of the vendor’s practice, however there will be issues which that typical New Dentist may not have the requisite knowledge or expertise in (eg. tax, professional and legal matters). In addition, there can be problems which only arise after the completion of the sale transaction (eg. the New Dentist determines that the quality of dentistry performed in the vendor’s practice is not that which was expected or the vendor attempts to solicit patients back again at the vendor’s new practice location). The prudent New Dentist should be aware of the relevant issues which are to be addressed during negotiations with the vendor and before executing the written purchase agreement. Seeking appropriate legal advice at the appropriate time can assist the New Dentist in a timely fashion and save the New Dentist unnecessary anguish and cost by helping the New Dentist avoid mistakes which he or she will regret later. Caveat: The aforementioned “tips” are not intended to be exhaustive and the reader is reminded that there are a myriad of issues specific to each type of business agreement one can enter into which should be addressed when contemplating such business transactions, which are beyond the scope of this article. You are encouraged to have any concerns or questions you may have answered by lawyers competent in this field of law. DPM

Rollin M. Matsui received his dental degree from the Faculty of Dentistry, University of Toronto in 1979 and his LL.B. law degree from Osgoode Hall Law School in 1991 and was called to the Ontario Bar in February, 1993. He provides dental-legal lectures to third and fourth year dental students at the Faculty of Dentistry, University of Toronto as well as to dentists in the numerous continuing education courses which he has conducted over the past 16 years. He maintains a full-time law practice in Richmond Hill, ON and a part-time dental practice in Toronto. In his law practice, he primarily acts for dentists in patient disputes, dental insurance claim inquiries / audits, College complaints, College investigations and professional misconduct related matters and provides legal advice regarding business agreements involving dentists in various working relationships. E-mail: lawyer@drrollinmatsui.com Website: www.drrollinmatsui.com

Fall 2009

Dental Practice Management

Dental Marketplace Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: kshaw@oralhealthjournal.com Toll free: CDA 1-800-268-7742 ext 6770 • Toll free: USA 1-800-387-0273 ext. 6770

Professional Services JOHN McMILLAN — Barrister & Solicitor Serving Dental Professionals Professional Corporations • Practice Purchases and Sales Professional Agreements • Commercial Contracts Commercial Leasing • Regulatory Matters 8 King Street East 416 364 4771 Suite 1807, Toronto johnmcmillan@bellnet.ca McMILLAN LAW PROFESSIONAL CORPORATION

P R A C T I C E & T R A N S I T I O N A L FINANCING

Up to 100% financing available to qualified buyers from Scotiabank, the financial resource you can rely on. Call Scotia Professional Plan: Patty Scrase (Manitoba & West) at (604) 619-4699, e-mail: pat.scrase@scotiabank.com Susan Shulist (Ontario & East) at (647) 287-5328, e-mail: susan.shulist@scotiabank.com ® ® Registered Trade-mark of The Bank of Nova Scotia

www.scotiabank.com/smallbusiness

Dental Practice Financing

DENTAL IMAGING WITH CT IMAGING

B.C./Prairies Mike McGillivray Ontario Colin Ross, Steve Wasylyszyn, Chris Lowry, Mitch Van Rassel Quebec Jean Trottier Maritimes Susan Redmond Manitoba/ Francesco Colosimo Saskatchewan

Dental CT image data is processed in-house at St. Michael’s Hospital with SimPlant ® software Features of Reformatted CT scans: • No Distortion • Accurate Measurements • Visualization of Internal Structures • Determine Bone Quality CT Scanning and SimPlant ® : • Can Increase Case Acceptance • Provide Case Predictability • Increase Referrals • Improve Cost Effectiveness • Reduce Overhead Reasonable fees – Mandible or Maxilla $300 – Both $500 FOR APPOINTMENTS OR MORE INFORMATION PLEASE CALL BETTY ANN LEBLANC 416-864-6060 x6112 www.stmichaelshospital.com/content/programs/medical_imaging/index.asp

1-877-590-7356

ONTER CONSTRUCTION • Specialized in dental office design & construction. • In-house architect and interior designer. • We are qualified code consultants to review all drawings and make your building permit application easy. • Own millwork facilities for best quality of custom built cabinets and time control of your project.

Tel: (905) 793-2344

Alglobe

www.onterconstruction.com

Construction Company

20 years construction experience • Dental office construction and design + cabinet making. • Provide turn key operation to dental office. • Reliable construction timing, • Good following up service after construction. Call: Stanley • New dental location and lease negotiation. Tel: (416) 321-3313 • Save time, save money. www.alglobe.com

Dental Practice Management

Fall 2009

Dental Marketplace Professional Services

Associateships IQALUIT, NUNAVUT

Careers WEST OF TORONTO – LOCUM Dentist required for mat-leave position in well-established, family practice. Feb-June, 2009. Full-time, M-F hours (no evenings, or weekends.) Experience preferred. Reply to berminghams@rogers.com, or call 905-878-0555.

AJAX, WHITBY, OSHAWA, COURTICE Join our Specialty Practice at The Airport Dental Centre.ca. Positions are available for: Pediatric Dentist General Anesthetic Nurse Orthodontic Hygienist email: vmnguyen@rogers.com or (905) 434-5486

Practices & Offices

EASTERN ALBERTA

Busy, well established, high revenue practice for sale in a nice oil town. Very convenient location, 4 operatories, low rent, low overhead, hospital privileges. Owner can stay on for a smooth transition. Phone: 403-918-3334 or e-mail: albertapractice4sale@gmail.com

VICTORIA, B.C. Well-equipped dental practice in the beautiful Oak Bay area of Victoria. The office has four operatories, a private office, lab and staff room. It is a well-established adult practice with an emphasis on rehabilitative, general and cosmetic dent istry. The office is located at street level, with wheelchair ac cess. There is adequate, free parking. The principal is LVI trained and is willing to share knowledge and stay on for a smooth transition. If you wish to practice quality dentistry in Canada’s finest climate with excellent year round boating, fishing and golf and a good income, this may be for you. A fairly recent ROI appraisal and thorough financial statements are available. Please contact oakbaypractice@gmail.com

Fall 2009

OPPORTUNITIES IN OSHAWA AND COURTICE, ON

Looking for dentists with existing patient base to come work with us. Will buy your practice. Call 416-726-1469 or e-mail: drmint@rogers.com

EXCELLENT OPPORTUNITY IN KAMLOOPS, BC

Practice for immediate sale due to owner’s heath. 3 operatories, seperate hygiene, fully equipped, great location in town. Beautiful place for living, ideal to raise a family. Please reply by fax to: 250-377-8436

WINNIPEG, MB.

Established general practice in North Winnipeg. Owner moving out of the province and looking for immediate sale. Priced to sell! Friendly, well trained, long-term staff, plenty of free patient and staff parking, and low overhead. Three fully equipped operatories plus one fully plumbed operatory ready for future development. Serious inquiries only. Call: (204) 797-4655.

PRACTICE FOR SALE

Orthodontic practice for sale with sat ellite in the Golden Horseshoe. Excel lent growth opportunity and ideal area to build a career and family. Senior orthodontist willing to transition. Please contact oliver249@yahoo.ca

Dental Practice Management

Associate position(s) available for immediate start. Established clinic offers generous package and full appointment book to associates. All round clinical skills are your ticket to a wide range of recreational activities! No travel required and housing available in Canada’s newest and fastest growing capital city. Please apply to Administration, PO Box 1118, Yellowknife, NWT X1A 2N8 or call (867) 873-6940, fax (867) 873-6941.

IMMEDIATE OPENINGS FULL/PART TIME

HALIFAX, N.S. - Near water or nature with a long term career in General Dentistry. We have great opportunities for those experienced wanting to dive/ walk right in. Call Today – Positions must be filled 902-835-4222, ext. 223

WHITEHORSE, YUKON Associate Wanted

Required for a 5 op., growing, modern practice. We require an individual who is skilled, confident, with an affinity for teamwork. Whitehorse is a rich, dynamic city, a centre for sports and the arts. Murraya Dental Centre, 4069 4th Ave., Whitehorse, YT Y1A 5W5 Tel: 867-633-4401, fax: 867-633-4402 murrayadental@northwestel.net

BRAMPTON, ON Very busy progressive dental office is looking for an energetic, dynamic associate with excellent rapport skills. This is an excellent opportunity if you want to be busy from day one. Please fax resume 905-799-1137.

BARRIE, ONTARIO

We are looking for an energetic dentist to join our busy family practice working in all aspects of general dentistry. This is an excellent opportunity to be part of a successful team. This part-time position can quickly lead to a full-time opportunity for a motivated candidate. Please forward resumes to: P.O. Box #20163 Barrie, Ontario L4M 6E9 or Email: associatedds@hotmail.com

Dental Marketplace

Calgary Dental Practice We are currently accepting applications for the following: • Pediatric Dentist • General Practitioner with I.V. Sedation Certification • Periodontist • Surgical Dentist Full-time, experienced associates required for busy, progressive, non-assignment practice. We are a state of the art facility that provides exceptional patient care. We value the diverse talents and abilities that our Dentists bring to our practice which allows us to build a stronger and more competitive organization. The right individuals will have potential to bill between $60,000 and $100,000/month. Our operating model provides you with unlimited earning potential and unlimited growth opportunity, a unique practice ownership program and the support to make it all happen. If you believe an associate should have an entrepreneurial mentality and be committed to continually improving levels of service, then please send resumes to box8282@gmail.com. ASSOCIATE GTA Busy mall practice on the border of Toronto and Scarborough is looking for an eager and caring associate. Minimum of 4 years experience. Wednesdays 11 am to 8 pm and/ or Fridays 8 am to 5 pm. Applicant must be conscientious and show great care and responsibility for his/ her patients. Must be well versed in all aspects of dental care and be willing to work as part of a team within our office. If this describes you, please fax your CV to 416-447-4401

OTTAWA, ONTARIO

Do you want to be an Associate with the opportunity of becoming a partner? If so, we are a busy, progressive practice looking for a people oriented dentist seeking to associate with the opportunity of becoming a partner. Please fax resume to 613-523-5318.

BRAMPTON, ON Paediatric Dentist wanted to join our children’s anaesthesia practice in Brampton. Our modern facility needs a part-time Paediatric dentist to join our team. Call Dr Kal Khaled for details (647-224-2117) or email : kkhaled@aol.com see our website: www.childrenssleepdentistry.com

OSHAWA, ON ORAL SURGEON NEEDED

Part-time oral surgeon needed for busy Oshawa practice. Flexible hours. Call 416-726-1469 or e-mail: drmint@rogers.com

BRAMPTON, ON

Associate opportunity in Brampton for a quality minded, highly motivated, caring individual. Please outline days available. Experience preferred. E-mail resume to dentalspots@gmail.com

OTTAWA, ON KITCHENER-WATERLOO AREA Large practice/small town — dynamic individual for busy office. 3 days week — no evenings or weekends. Email CV to jawman_24@yahoo.com.

BARRIE, ON

Full-time experienced associate to join our successful, long established dental practice. Newly constructed with stateof-the-art equipment. Non-assignment practice. Located in Barrie, offering all the amenities and lifestyle choices. Minutes to 400 extension. Equity option available. Please reply to DENTAL PRACTICE MANAGEMENT, Box 953.

Family practice located in Barrhaven is looking for a highlymotivated associate for our fast paced, hi-tech dental office. If you are eager and would like to experience working in a fast paced, growing dental office then we are looking for you! You must have 2+ years experience, if so please send your resume to 613-823-2930. NANAIMO, BC

Part/Full-time associate needed for busy, progressive, modern practice. Great patients and staff. Digital radiography, Laser, K7 and more. Experience preferred. Buy-in option for the right candidate. Tel: 250-722-9448 cvdc@shaw.ca

Dental Practice Management

Fall 2009

Dental Marketplace

SW CALGARY, AB

Exceptional opportunity for an Associate Dentist to join our busy, high tech family and cosmetic practice in rapidly expanding SW Calgary. Comprehensive Mentorship will be provided encompassing all aspects of dentistry including clinical techniques (injections, prep’s etc.) and effective patient communication. Our state-of-the-art practice includes a well established hygiene department, 8 operatories, Cerec, Accredited IV Sedation facility, intra oral cameras in each op, digital camera and digital x-rays. Proficiency in endodontics required although all aspects of general dentistry will be performed. Email resume in confidence to kamal@coachhilldental.ca ASSOCIATE REQUIRED

Growing practice 45 minutes north of GTA requires a highly-motivated dentist skilled in most aspects of dentistry. Min. 3 years experience. P/T leading to F/T evenings and Saturdays. e-mail: rmsolisd@yahoo.ca

DENTAL ASSOCIATE

Looking for an ethical, motivated, and caring dentist. Busy downtown office with the latest dental technologies is looking for such an individual, evenings and weekends required. New grads are welcome. Fax CV to (780) 424-3210 or email to hdg99@telus.net

ASSOCIATE REQUIRED Seeking P/T periodontist for busy Mississauga office. Please call (905)464-4341.

SCARBOROUGH / OSHAWA, ON

Associate opportunity for a highly outgoing, motivated individual to join our busy, growing office. Reply to ORAL HEALTH, Box 936.

P/T PERIODONTIST BRAMPTON, ON

Busy, fast growing family practice with 2 local offices seeks p/t periodontist. Please fax resume to Christin (905) 799-1137 or email: smile@sterlingdentalsmile.com

Fall 2009

EXCELLENT OPPORTUNITY, PENTICTON BC

Have you been waiting for the right opportunity in the best place of all? We are a busy dental clinic in Penticton, BC, and we are looking for an enthusiastic individual to take over an associate position in our office, with the aim of eventual buy-in. We offer a great facility, an existing patient base of your own of over 1500 charts, and complete autonomy to practice as you see fit. This is a future buy-in position, timing negotiable. Check us out at pentictondental.com and send an email or give us a call for more details.

BEAUTIFUL THUNDER BAY, ONTARIO GENERAL DENTIST WITH PROFICIENCY IN ENDO, PAEDO, ORTHO., QUAD DENTISTRY. Why persists in the struggle to survive in the over-populated, over-serviced, metropolises of Canada? Come to Beautiful Thunder Bay, where the air is clear and the lakes are pristine, and our office has patients waiting to be seen. Our office has nine operatories, two fulltime general dentists and two fulltime hygienists; i.v. sedation; digital X-rays, intra-oral cameras, patient education programs, computerized records. For more information, fax resume to 807-626-8001, or email to tbaydentist@hotmail.com

Equipment

EARN UP TO 50% PRODUCTION!

Be your own boss with the freedom of an associate. Busy practice booking 4 months in advance. Digital x-rays, rotary endo. In fast growing city of Lloydminster, AB. Contact azhrdental@gmail.com.

MISSISSAUGA, ON

Experienced periodontist and endodontist needed for a busy Mississauga practice. Please reply to Oral Health, Box 972.

MILTON, ON Polish speaking associate wanted for a modern Milton practice — experience is an asset. Fax resume to 905-875-1008.

DENTAL REPOSSESSION SALE!! – Quantity of Planmeca patient chairs – Ritter Lights and X-ray units – Delivery units – And an assortment of hand pieces All in like new condition! Please call John Jr at Serv-Tek Asset Management Services Inc. 905-602-8300 between the hours of 8:30 - 5:00 Mon - Fri (EST)

EQUIPMENT FOR SALE: 5 OPERATORY CLINIC

2 Operatories and Pan/ Developer; 2 M&CC Operatories with Marus chairs/ delivery units/lights/stools Gendex x-ray unit, Gendex Pan; Whemer Ceph, AT2000 developer, Dentsply Triad system, 5 Phatelus highspeeds with fiber optics; various smaller equipment. Phone 778-426-0989.

Ad Index

ABELDent Inc. ................ 13 Crest Oral-B, P&G ........... 2 Henry Schein .................. 39 Maxim Software ................ 7 Professional Practice Sales (Ontario) Ltd ...... 21 RBC – Royal Bank of Canada .................... 16

Dental Practice Management

Synca Marketing Inc ....... 40 TD Canada Trust .............. 4 Tier Three Brokerage Ltd .............. 29 Transatlantic Institute of Oral Implantology .... 20 Tucci Management ......... 19

THE RENAISSANCE THE RENAISSANCE

™ ™

COLLECTION COLLECTION

Design the practice of your dreams today Design the practice of your dreams today

Pelton & Crane’s Renaissance™ collection of dental furniture was created in close collaboration with dentists, Pelton & Crane’s Renaissance™ collection of dental furniture was created in close collaboration with dentists, dental assistants and hygienists. The result is a beautiful environment that will energize dental professionals and dental assistants and hygienists. The result is a beautiful environment that will energize dental professionals and put patients at ease. A host of innovative features improve in-procedure movements, enhance access to technology put patients at ease. A host of innovative features improve in-procedure movements, enhance access to technology and optimize storage to improve operatory ergonomics and efficiency. and optimize storage to improve operatory ergonomics and efficiency.

For more information, contact the Pelton & Crane sales representative in your area or your Henry Schein representative. www.pelton.net/renaissance 1-800-659-6560

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www.henryschein.ca 1-800-668-5558

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Multimedia imaging software

FOR CADI

x-ray sensor system

It doesnâ&#x20AC;&#x2122;t get any better! With over 7,000 installations worldwide, CADI has set the standard for user friendly, dental imaging software. Now Gray Falcon for CADI sensors offer breathtaking diagnostics and ultimate patient comfort. Contact your local Sinclair Dental representative for more information. Visit: www.cadi.net

1-800-663-7393 www.sinclairdental.com