New Dentist Fall 2012 by The New Dentist

THE #1 JOURNAL FOR NEW DENTISTS

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FROM THE PUBLISHER’S DESK

FA L L 2 012 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Dear Readers,

Picante Creative http://www.picantecreative.com

Welcome to the fall issue of The New Dentist™ magazine.

Tess Fyalka Tess@thenewdentist.net

MANAGING EDITOR

SALES AND MARKETING

ertainly, some of the most difficult decisions new dentists must make involve determining which types of technologies they should purchase and when to integrate them into the office. From practice management software to intraoral cameras to digital radiography, the choices are many. On p. 16, dental

For display advertising information, contact ads@thenewdentist.net or 877.777.6151. Visit our digital media book at www.thenewdentist.net/ mediabook.htm

technology expert Dr. Lorne Lavine offers practical advice for new dentists, including a list of key product recommendations. Trying to figure out why some practices cost a king’s ransom and others a mere pittance? Dr. Tom Snyder explains why top-dollar digs command the big bucks, p. 22. Also in this issue, it’s no secret that many personal relationships begin in the workplace. The problem: those seemingly harmless friendships can turn into costly lawsuits. You won’t want to miss what human resources experts recommend you do to steer clear of a nasty sexual harassment claim, p. 6. Finally, please join me in welcoming the members of The New Dentist™ Advisory Board, listed on this page. We look forward to the valuable contributions they will make in shaping the future of the magazine and its website. Turn to p. 28 and learn more about our featured board member, Dr. Charles Cheney. And be sure to visit www.thenewdentist.net. In addition to regular practice management and clinical blogs, you’ll discover a wealth of FREE information and materials to guide you at every step throughout your dental career. Fondly,

Sally McKenzie, Publisher

New Dentist™ Advisory Board

Dr. Josh Austin San Antonio, TX UT San Antonio Dental School 2006

Dr. Charley Cheney III Dr. Katie Montgomery Newnan, GA Marysville, OH Tufts University School Ohio State College of Dental Medicine of Dentistry 2004 2006

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The New Dentist™ magazine is published quarterly by The McKenzie Company (3252 Holiday Court, Suite 110, La Jolla, CA 92037) on a controlled/complimentary basis to dentists in the first 10 years of practice in the United States. Single copies may be purchased for $8 U.S., $12 international (prepaid U.S. dollars only). Copyright ©2012 The McKenzie Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the publisher. Authorization to photocopy items for internal or personal use is granted by The McKenzie Company for libraries and other users registered with the Copyright Clearance Center. Disclaimer – The New Dentist™ does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damages incurred by readers’ reliance on such content. The New Dentist™ cannot be held responsible for the safekeeping or return of solicited or unsolicited articles, manuscripts, photographs, illustrations, or other materials. The opinions, beliefs, and viewpoints expressed by the various authors and contributors in this magazine or on the companion website, www. thenewdentist.net, do not necessarily reflect the opinions, beliefs, and viewpoints of The New Dentist™ magazine or The McKenzie Company. Contact Us – Questions, comments, and letters to the editor should be sent to Tess@thenewdentist.net. For advertising information, contact ads@thenewdentist. net or 877.777.6151. Visit our website at www.thenewdentist.net to download a media kit.

Dr. Kevin Rhodes Round Rock, TX UT San Antonio Dental School 2005

Dr. Mary Shields Louisville, KY University of Louisville Dental School 2011

Dr. Jared Simpson Bakersfield, CA UT San Antonio Dental School 2005

LET’S REDEFINE EXPERTISE

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TABLE OF CONTENTS

FALL 2012

FE ATU R ES

6 Sex and the New Dentist:

When Employee Relations Get Too Personal Tess Fyalka, Managing Editor

10 What is Smile Reminder Doing

for Today’s New Dentists?

14 Been There, Done That:

Delay Gratification, Urges Cosmetic Expert

16 ‘Must-Have’ Technology for the New Dentist

22 Why Practice Values Vary Around the Country Tom Snyder, DMD, MBA

24 What Dental School Didn’t

Teach You About Your Dental Office Lease Jeremy D. Behar, President & CEO of Cirrus Consulting Group

28 Meet Dr. Charley Cheney III, Advisory Board Member

D E PA RTM E N TS 2 Publisher’s Message 26 Dental Students:

What’s on Your Mind?

32 Skinny on the Street 32 Index of Advertisers

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4CV ?LB RFC /CU %CLRGQR When Employee Relations Get Too Personal

t all began innocently enough; they were just having a little fun. It was a joke that was intended to be perfectly harmless. It resulted in a very expensive lawsuit. The new employee “Jim” joined the small practice staffed primarily by women. It was a tight-knit group. The women had worked together for a while and thought it would be fun to play a joke on their new male co-worker. It would be a little “initiation.” It turned out to be hazing. The women repeatedly sent lewd photos to his workplace email. They regularly left an assortment of ladies’ lingerie at his work station. And they thought it was all very amusing. “Jim,” however, was so uncomfortable that he soon quit his job and left the practice. Shortly thereafter the doctor received a complaint of sexual harassment and hostile work environment. Johanna vanManen is a regional manager for Paychex, Inc., which is a leading provider of payroll, human resource, and benefits outsourcing solutions for small- to medium-sized businesses. She explains that Paychex worked with the practice 6 WWW.THENEWDENTIST.NET FA L L 20 1 2

By Tess Fyalka, Managing Editor

in response to the claim and provided necessary training to ensure that a similar incident never happens again. “The practice had to pay the ex-employee forward wages. This individual left the work environment because it was such an extremely uncomfortable situation for him.” Had it been someone else, perhaps he or she would have gone along with the joke and thought the whole thing was funny. But for “Jim” it wasn’t funny, it was harassment. And as Ms. vanManen emphasizes, it is an excellent example of what is seemingly harmless to one person can be construed as sexual harassment by another. According to The Equal Employment Opportunity Commission: Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act of 1964. Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance, or creates an intimidating, hostile, or offensive work environment. CONTINUED ON PAGE 8 >>

Sexual Harassment

NON-HARASSMENT – BEST PRACTICES FOR LIMITING EMPLOYER LIABILITY

Sexual harassment can occur in a variety of circumstances, including but not limited to the following: • The victim as well as the harasser may be a woman or a man. The victim does not have to be of the opposite sex. • The harasser can be the victim’s supervisor, an agent of the employer, a supervisor in another area, a co-worker, or a non-employee. • The victim does not have to be the person harassed but could be anyone affected by the offensive conduct. • Unlawful sexual harassment may occur without economic injury to or discharge of the victim. • The harasser’s conduct must be unwelcome. ...

(Courtesy of Paychex)

continued from page 6

Intent “What’s important to remember is that it’s not the intent of the harasser that counts, it’s the impact of the behavior. Things like offensive jokes, pictures, and graffiti, as well as rude treatment of women or men just because of their gender, unwanted flirtations and quid pro quo – an exchange of something for a sexual favor, such as a favorable work benefit – all can be considered harassment,” says Ms. vanManen. Even a friendly hug could be construed as harassment if the individual receiving the hug finds it offensive, Ms. vanManen notes. In small businesses, such as dental offices, the most common form of sexual harassment is quid pro quo. “It is typically initiated by a person in power, such as the dentist.” According to Ali Oromchian, CEO/co-founder of HR for Health based in San Ramon, CA, in small businesses, such as dental practices, it’s the staff gatherings that inevitably generate the most harassment complaints. “Parties and social events where everyone is drinking and having a good time are often where problems begin. Things are said, and the situation can get out of control. That’s the biggest culprit. We have a seminar before the holidays to bring these kinds of things to doctors’ attention because every year around the holidays we see the greatest number of complaints.” Additionally, he notes that male employees tend to misinterpret comments and actions. “They tend to think that if a co-worker touches them, it’s a license to touch back.” Should an allegation of harassment arise, taking prompt action is critical. “First thing, call an attorney or a professional human resources investigator so that the doctor can separate himself or herself from the situation. This person should come in and gather as much informaCONTINUED ON PAGE 30 >>

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To help avoid liability in harassment claims, employers should consider the following: Have effective, strongly worded policies prohibiting all types of workplace harassment, including sexual harassment and harassment based on any other protected class at the federal, state, or local level. Distribute copies of the company’s sexual harassment and non-harassment policies to all employees on an annual basis and obtain signed receipt pages from the employees. Provide non-harassment training for all employees on an annual basis. Provide additional training for managers and supervisors on recognizing harassment and steps to take if harassment occurs. Ensure the company’s sexual harassment and non-harassment policies are enforced and that any questionable behavior is addressed and discouraged. Take all complaints seriously and conduct prompt, thorough, and objective investigations. Keep employee complaints confidential to the greatest extent possible. Assure no retaliation for employees filing a complaint or participating in an investigation of alleged harassment. Document all steps of the investigation process and any action taken. Take prompt corrective action against employees who violate the company’s sexual harassment or non-harassment policies. Follow up after an investigation to ensure harassment has ended and no retaliation has occurred. Check references when hiring a new employee to ensure the individual does not have a history of harassing or discriminatory behavior. Keep inappropriate materials out of the workplace.

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ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association. All practice financing is subject to credit approval © 2012 Wells Fargo Bank, N.A. All rights reserved.Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

What is Smile Reminder Doing for Today’s New Dentists? The New Dentist™ magazine recently spoke with Michael Mosley, director of marketing, about what Smile Reminder has to offer new dentists.

How has the market changed for new doctors since Smile Reminder introduced patient messaging? Ten years ago this type of communication was a “nice-tohave” in practices. Now it is a must-have patient engagement system that is efficient and effective. Patients insist on being contacted through their mobile devices and new practices need to maximize financial resources. Smile Reminder does both. What is one of the biggest misconceptions new dentists have about patient messaging? Some new dentists look at electronic communication based on their own preferences and not the preferences of their patients. If a doctor doesn’t text or communicate within a social network, that doesn’t mean it’s not a viable or valuable tool to reach out to his/her patients and potential patients. Some new doctors view this type of service as “just another monthly office expense” that they cannot commit financial resources to. Is there really a tangible return on this type of investment? Yes. We have tracked both cost reductions and revenue increases in practices and found that, on average, the effective return on our service is around 20 to 1. That’s significant for any practice and even better for a new practice trying to maximize every dollar. Who wouldn’t take a $20 bill for a $1 bill?

Most of our doctors would say they don’t have time to manage another system in their new practice. One of the things we learned early on is that our service needed to acquire, retain, and reactivate patients while decreasing the staff time to accomplish these efforts. Most of our features are automated to make the staff more efficient. Part of our “secret sauce” is assigning a customer service representative – we call them Solutionaries – to each practice for training, ongoing support, and to help create educational or marketing campaigns. Solutionaries are the most innovative, highly trained team in the industry and they constantly get rave reviews from our customers. They are like another member of the practice team. How do patients respond to getting email and text messages from their dentist? The overwhelming majority love it! They are thrilled their doctor is willing to communicate with them on their terms and through their preferred devices. It’s amazing how often a practice mentions learning of our services through their patients! We constantly hear stories of happy and impressed patients who are ready to spread the Smile Reminder love. There are so many practice management systems out there. Can you interface with all of them and how easy is it to implement? We have more than 300 different integrations with practice management software programs that in most cases can be CONTINUED ON PAGE 12 >>

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Smile Reminder continued from page 10 installed and running in under an hour. We make it easy for new doctors to implement our system with their practice management software right from the start.

The company has evolved well beyond messaging. Do you still see Smile Reminder as a messaging company? When Smile Reminder created this market it was purely about communicating directly with existing patients. As the Internet matured, our solution became more about patient engagement and helping practices acquire, retain, and reactivate patients through video, social networks, reputation and review sites, etc. Our mission is to improve the doctor/patient relationship and to help practices be more successful. Where is the patient engagement industry headed? The old saying, “Fish where the fish are” still holds true. To really engage patients, practices need to promote them-

0RACTICE -ADE Perfect

... ON AVERAGE, THE EFFECTIVE RETURN ON OUR SERVICE IS AROUND 20 TO 1. ... WHO WOULDN’T TAKE A $20 BILL FOR A $1 BILL? selves in the places where their patients are. Patients are doing their homework before choosing a dentist. There are a variety of online review sites giving firsthand experiences and opinions about healthcare providers. Social media and mobile are here to stay and it’s easy to get overwhelmed. So do a little homework too – ask your patients how they prefer to be contacted, actively check out and reply to patient reviews, use the many effective marketing tools available in the Smile Reminder service, and don’t underestimate the importance of word of mouth and a positive patient experience. The “if you build it they will come” opportunities for a new doctor have come and gone, so get out there and start engaging! For further information, call 866.605.6867 or visit www.solutionreach.com

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BEEN THERE, Done That

Delay Gratification, Urges Cosmetic Expert “Upon graduating from dental school, new dentists are given a license to learn. They have the basics and that’s it,” emphasizes Dr. Ronald D. Jackson, internationally recognized author and lecturer. This general practitioner and graduate of West Virginia School of Dentistry focuses on aesthetic restorative and cosmetic dentistry in Middleburg, VA, and is an instructor at the Las Vegas Institute for Advanced Dental Studies.

r. Jackson emphasizes that one of the most difficult but most important steps new dentists can take to ensure a successful future is to exercise restraint. “You’ve delayed gratification for many years going to college and then to dental school. When you start practicing, you want to live life, but you have to build your barn before you build your house. In other words, invest in your practice and yourself and delay getting your expensive car a little while longer. It’s this time in your career that will make a huge difference in how far you go and what you achieve in the long run.” He urges new practitioners to recognize that the learning process has only just begun. “I know that new dentists have already invested an enormous amount of time and money, but that’s barely a down payment. Dental schools can scarcely cover the basics. New dentists have to look at continuing education (CE) as an investment. I believe they should attend one CE course a month and begin right after graduation,” says Dr. Jackson. He notes that dentistry has rapidly advanced to an extremely high level and is evolving much more quickly than ever before. “The treatments we are able to deliver and the level of care we can provide is progressing higher and higher and at a faster and faster rate. There was a time when one or two CE courses a year was enough to keep up; now you can barely keep up with one or two a month.” He notes that while there is a lot of very good continuing education available to dentists, he also recommends and emphasizes the value of the hands-on experience, such as that offered at the Las Vegas Institute (www.lviglobal.com), where he lectures regularly.

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And attending annual meetings of the American Dental Association (www.ada.org), the International Association of Comprehensive Aesthetics (www.theiaca.com), the American Academy of Cosmetic Dentistry (www.aacd.com), and various regional meetings is also useful. “Find out what areas of dentistry you particularly like and join the organizations that focus on them,” urges Dr. Jackson.

Be Honest with Yourself Dr. Jackson emphasizes that it is essential for new dentists to objectively evaluate the dentistry they perform. “Before you congratulate yourself for a job well done, ask yourself, ‘How can I do it better the next time?’ There is no limit to the level of excellence you can achieve, but you won’t make the effort until you take a close look and consider how the procedure can be improved.” CONTINUED ON PAGE 18 >>

Dr. Ron Jackson has published many articles on esthetic, adhesive dentistry and has lectured extensively across the United States and abroad. He is a Fellow in the Academy of General Dentistry, an Accredited Fellow in the American Academy of Cosmetic Dentistry, a Diplomate in the American Board of Aesthetic Dentistry, and Director of the Mastering Dynamic Adhesion program at the Las Vegas Institute for Advanced Dental Studies.

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‘Must-Have’ Technology for the New Dentist

r. Lavine is the founder and president of The Digital Dentist, which provides a full range of services relating to the implementation of technology in the dental practice. He notes that “The challenge for a lot of new dentists is that they see the really cool technology and all this high-end stuff, but they are saddled with an unbelievable amount of debt. It’s just not practical for a dentist to invest $75,000-$100,000 in a single piece of equipment when they are just starting out.” Dr. Lavine urges new dentists to establish their technology priorities starting with three key areas: practice management software, digital radiography, and an intraoral camera. “Of all the decisions new dentists must make as far as hardware, networking, insurance management, data backups and the like, they are all related to the practice management software, so in my mind that is the first and most critical technology decision for them to make.” Dr. Lavine notes that there are three major practice management software vendors: Schein, which sells Dentrix; Carestream Dental, which sells CS Practiceworks and CS Softdent; and Patterson, which sells Eaglesoft. “Those three make up about 75% of the practice management software market. They are well established companies and have a long history of support. The challenge for the new practice is that the software packages that these companies sell are on the higher end of the price scale,” says Dr. Lavine. However, there are a number of other quality practice management software options available for new dentists that don’t carry as hefty a price tag as some of the more wellknown options. “Open Dental is one of my favorites. It is a good product with a relatively long history of support that won’t break the new dentist’s budget. MaxiDent also is an 16 WWW.THENEWDENTIST.NET FA L L 20 1 2

excellent practice management software program that can help an office become almost completely paperless. It has many additional features, such as electronic patient forms and patient reminders. They are not as well known as many of the other software companies, but certainly would be a company that new dentists should look at.” Another option that is gaining in popularity are the web-based software programs, such as Denticon.com or Curve. “This is an intriguing option for a lot of practices because it eliminates the need for a dedicated server, the need for data backup, and the need for higher-end computers, so it has a lot of appeal,” explains Dr. Lavine. In the short term, the web-based programs will be less costly, which is part of their appeal to new dentists who are very focused on bottom-line costs. “However, in the long term they will be more expensive because they are subscription services and users pay a monthly fee, which will cost more after two to three years than the server-based systems,” says Dr. Lavine.

DIGITAL RADIOGRAPHY Second on his recommended list of technology priorities is digital radiography. “Yes, it is a little more expensive than film, but with so many offices and so many referring practices expecting to have digital X-rays sent to them, it makes sense to invest in this early on,” says Dr. Lavine. When it comes to digital radiography, like practice management software, the three major players also are the leading

PHOTO COURTESY OF CARESTREAM DENTAL

Close your eyes. Picture yourself at the biggest and best dental meeting of the year. There you stand at the entrance to the showroom floor. Thousands of vendors of the coolest gadgets, gizmos, must haves, and more line row after row after row of booths, elaborate stations, and tempting hands-on displays. And you, with your dental degree and an office to equip, are salivating. The 3-D cone beam calls, the newest in massage chairs beckon, and the lasers beg you to take just a look. All that stands between you and the latest, greatest, and most expensive equipment for your practice is a credit card … and that, says Dr. Lorne Lavine, is what gets far too many new practitioners into trouble.

companies in digital X-ray. Schein sells DEXIS digital radiography. Patterson sells Eaglesoft digital imaging and Schick sensors. And Carestream sells RVG sensors. Dr. Lavine notes that the biggest decision practitioners face when making this purchase is whether to purchase the image software from the practice management software company or consider a third-party vendor. “The advan-

Dr. Lavine has worked with a multitude of products and dental practices over the past several years. Below is a summary of a few of his favorite technologies available to new dentists today and what he believes sets these apart from others.

✓Consult-Pro – Too many practices make the

mistake of leaving the patient to watch a video about a specific procedure. But patients aren’t buying the procedure; they are buying you, the doctor. Consult-Pro involves the dental professional in the patient education process.

✓Demandforce and DentForms – For practices

that want to go paperless, these add-on programs supplement the practice management software and offer a variety of options such as completion of forms online, sharing HIPAA-compliant digital images with other practices, patient reminders, and other features.

✓Loyal Patients, Inc. – This program rewards loyal

patients. No-shows and cancellations cost practices a fortune. It’s a whole flip-flop from the punitive cancellation policies that many practices have.

✓Panoramic Corp. – This company sells digital

panoramic X-ray. While it is not a purchase that new dentists will make right away, when the time comes this is one to consider.

✓QSIDental Practice Management Software –

Their product is geared toward multi-location practices. They recently developed a web-based software program. For a new dentist coming into a multi-location practice, this is a good option to consider.

✓XDR Radiology – It’s easy to use and easy to

learn. Support is very good and pricewise they are very competitive.

PHOTO COURTESY OF QSIDENTAL

tage of purchasing from the practice management software vendor is you will have a high level of integration between the practice management component and the digital radiography component. However, you also have a relatively high cost as well because you pay a premium for that level of integration. You also eliminate a lot of flexibility because if you want to go out of that company’s product family for sensors or other accessories, you will be limited.” Because of the limitations, many offices consider thirdparty digital radiography options such as XDR or Apteryx. However, Dr. Lavine says the disadvantage is “you don’t have as high a level of integration, so another step will be involved. But in most cases, that extra step is likely to be just one mouse click. The main advantage is that you have more flexibility and you can mix and match intraoral cameras, digital cameras, sensors, scanners, and they can all work together.” Additionally, notes Dr. Lavine, “The cost of purchasing from a third-party vendor is likely to be considerably less than from one of the big-name software companies. Dentists like to have choices and while they may know what they want right now, down the road they may want to change that. Having the flexibility to make changes, as dentists like to do, has a great deal of appeal to many,” explains Dr. Lavine.

PHOTO COURTESY OF IMAGIN

DR. LAVINE’S TECHNOLOGY FAVORITES

INTRAORAL CAMERAS Coming in at number three on Dr. Lavine’s list of “must haves” for the new dentist’s practice is an intraoral camera. “In my mind, an intraoral camera offers the best, quickest, and longest return on investment of any technology a new dentist could have. A good camera is going to pay for itself in maybe a week or so.” When it comes to choosing the right intraoral camera, they fall into two categories. First are the diagnostic cameras that are designed to uncover recurrent decay or endodontic canals. “Those cameras are priced from $3,000 to $5,000. The CONTINUED ON PAGE 20 >>

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Dr. Jackson continued from page 14

“A high level of skill has high value, leads to confidence, is recognized by patients, and results in professional fulfillment.”

Find a mentor. He strongly recommends that dentists in the first 10 years of practice look to someone whose practice they admire and seek him/her out as an advisor. “I find that most successful dentists willingly share information. Choose someone who has done well, and in most cases they are more than willing to help,” says Dr. Jackson. Choose equipment and products wisely. Dr. Jackson has found that some products and equipment are essential for new dentists to consider. You need to get a digital camera and photograph your work. The quality of the picture has gone up and costs have gone down. These companies specialize in dental photography: Norman Camera (www.normancamera. com), Washington Scientific Camera, and Photomed (www. photomed.com). Photography is critical in patient communication, lab communication, and legal documentation. “Dr. Greg Lutke gives a fantastic course in digital photography (www.dental-solutions.com).” Dr. Jackson notes that he uses the Orascoptic Revolution loupes with LED light attachment, which he says is excellent, but there are many other companies offering loupes and lights as well. “Quality magnification

and lighting are essential in preventing ergonomic problems down the road and your dentistry improves because you can see it better.” Additionally, he says he couldn’t practice without a soft-tissue diode laser. “They are low enough in cost that new dentists should be able to invest in one.” Digital X-rays are also a valuable investment. “They are expensive, but that should be a definite goal when a dentist becomes established in his or her own practice.” Dr. Jackson explains that Kerr’s Sonicfill*, which is a product and a technology in one, is designed to perform posterior composite restorations faster and easier and with better adaptation and fewer voids, thereby lowering operator error. “I use this product every day in my practice. About 20-25% of procedures performed are posterior fillings. The vast majority of today’s patients want natural looking tooth fillings. Composite fillings outnumber amalgam 2-to-1. Placing posterior composite is somewhat more exacting than amalgam, but Sonicfill works very well in reducing the time and effort involved in placing the posterior composite, which increases productivity.”

All Insurance Plans are not Alike Be cautious when accepting insurance, urges Dr. Jackson. “Many of these plans are easy to get into but difficult to get out of, and some have become abusive.” He explains that one national insurance company has recently lowered reimbursement fees to dentists by 15% across the board. That comes off the top. If your overhead is 70%, your profit is 30%. So a 15% reduction cuts your profit 50%. “Dentists think they need to sign up for all these plans and they don’t. They need to screen them. Too many dentists think that what they will lose in payment they will make up in volume. It doesn’t work that way.” The ADA provides a service to help dentists evaluate insurance plans. Take advantage of that. This is also where having a mentor in your area is very helpful. “Remember, just because you haven’t contracted with a patient’s dental plan, that does not necessarily mean they cannot come to you for care.” Get good at what you do, urges Dr. Jackson. “Don’t get caught up in the rat race, where you run from one chair to the next. You can be pushed to keep doing things faster and faster and you can forget what you are there for and that is to get good at what you do and give each patient your best. Do the right thing and do it right. A high level of skill has high value, leads to confidence, is recognized by patients, and results in professional fulfillment.” *Dr. Jackson served as a paid consultant in the development of Sonicfill composite. 18 WWW.THENEWDENTIST.NET FA L L 20 1 2

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Must-Have Technology continued from page 17

other category is a very cheap version that is easily found on eBay. The quality is not very good, but the price is so low that people will buy them. I don’t recommend the cheap cameras found on eBay. They don’t have FDA (Food and Drug Administration) approval. The image quality is below what you should get with a diagnostic camera.” When exploring intraoral camera options, Dr. Lavine recommends new dentists consider the Claris Camera made by Sota Imaging, ImageMaster, which is manufactured by Imagin, and DigitalDoc.

EXPLORE PROS AND CONS OF TECHNOLOGY When considering technology options, Dr. Lavine urges new dentists to talk to independent experts in the technology field and explore the pros and cons of various options. He notes that there are so many variables to consider when properly equipping a dental office with necessary technology that go well beyond choosing the software and imaging systems. “You have to think about the infrastructure as well, the computers, monitors, the mounts, the server, and how are you going to network everything together. There are HIPAA compliance issues that come into play as well as ergonomics. And you have to make sure that you have a data backup protocol and a disaster recovery plan in place. It’s overwhelming, so unless the dentist is very computer savvy, there’s a lot that goes into equipping the practice. If you’re not going

visit www.thenewdentist.net #1 Web-site for New Dentists 20 WWW.THENEWDENTIST.NET FA L L 20 1 2

“Serving as the IT department for your practice is not an efficient use of a new dentist’s time.”

to work with an independent consultant, at least work with someone who has experience with dental offices and knows what goes into equipping them.” The other issue for new practitioners to keep in mind is if they install their own computers and computer network, they then must service their own information technology needs. “Serving as the IT department for your practice is not an efficient use of a new dentist’s time. Your time is better spent on marketing and building your patient base.” As new dentists advance in their careers, Dr. Lavine urges them to carefully consider what will be their return on investment with every new technology purchase. “It’s not a matter of can you afford the 3-D cone beam or other high-end technology, it’s do

you perform enough procedures that will ensure you have a return on your investment. I think the mistake that some dentists make is believing that if they purchase the technology, they will do more of a certain procedure. It doesn’t usually work like that.” Lorne Lavine, DMD is the Founder and President of The Digital Dentist. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design, and installation. The Digital Dentist provides dentists a full range of services relating to the implementation of technology. He can be reached at drlavine@thedigitaldentist.com, www. thedigitaldentist.com, 818-788-3958, or 866-204-3398.

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Why Practice Values Vary Around the Country BY THOMAS L. SNYDER, DMD, MBA DIRECTOR, PRACTICE TRANSITIONS THE SNYDER GROUP/ HENRY SCHEIN PROFESSIONAL PRACTICE TRANSITIONS

ftentimes, potential purchasers refer to articles that they have read, stating that most dental practices that are for sale should not be worth more than 60-65% of last year’s gross revenue. This is an incorrect assumption, in general, as dental practice values can vary anywhere between 40% and 100% of the last year’s gross receipts based on the location of the practice. There are many other factors that can impact a dental practice’s value. In addition to location, we will describe other key factors that influence practice values.

Area Demographics This factor has the most significant impact on a dental practice’s value. Where you practice dentistry really counts! For example, if the practice is located in Los Angeles County, it’s conceivable that the practice value may be 100% of last year’s gross revenue! Conversely, if you practice in rural mid-America, practice values may be in the 50% range of last year’s gross revenue. Dental practices in the Northeast corridor can command values in the 65% to 70% range. Why the disparity? It’s all about supply and demand. It is becoming increasingly difficult for dentists practicing in small and rural towns to find buyers for their practices, let alone associates. In fact, new studies of recent grads have indicated that almost 90% of them prefer to practice in urban or suburban areas. So practices situated in rural areas and small towns are finding fewer dentists willing to live there. Consequently, practice values will continue to decline due to this severe lack of purchasers. Conversely, since there is an oversupply of young practitioners in many large metro areas, when a good practice comes on the market there is a rush of purchasers, with prices sometimes exceeding the practice’s appraised value. 22 WWW.THENEWDENTIST.NET FA L L 20 1 2

To make this situation more critical, the 2010 Survey of Dental Practice reported that 39% of respondents have delayed their retirement plans, further exacerbating the problem in urban and suburban markets!

Practice Facility If the practice has older equipment and has not been renovated for many years, a lower value usually results. For example, if a practice has only two operatories with no room for expansion, the practice’s value will typically be lower. Since many of you were educated in dental school with up-to-date equipment and technology, practicing dentistry using older equipment and minimal technology does not appear to be too appealing. Consequently, purchasers usually expect a lower value as they cite the need to borrow additional funds to purchase equipment and/or technology in addition to their practice acquisition loan. Patient Base Practices with a small patient base, for example, 500-700 patients, accompanied by a low number of new patients, 3-5 per month, will be valued at a lower market multiple than practices having a solid patient base, 1,300-1,700 patients, with healthy new patient inflow averaging 15-25 new patients per month. Practices with a strong recall program can command a higher value since it is assumed that patients in retention will continue to make regular visits, thus assuring a good revenue stream, similar to an annuity of revenue. Economic Variables In our experience, fee-for-service practices (including indemnity insurance) command a higher fair market value CONTINUED ON PAGE 26 >>

Dr. Thomas L. Snyder is Director, Transition Services for The Snyder Group/Henry Schein Professional Practice Transitions, a nationwide practice transitions firm. Henry Schein PPT, provides a full range of services for new dentists considering purchasing a practice, practice valuation services, associate/partnership agreements, facility sharing arrangements, and practice transition planning services. He can be reached directly at 1.800.988.5674, tom.snyder@henryschein.com, or www.Snydergroup.net.

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What Dental School Didn’t Teach You About Your Dental Office Lease BY JEREMY D. BEHAR, PRESIDENT & CEO OF CIRRUS CONSULTING GROUP

s a new dentist, you are or will likely be the sole proprietor of your practice and the person responsible for making it work as a business. That means making sure financial and tax planning is occurring consistently, equipment is regularly maintained, staff are meeting your standards for customer service and patient care, insurance policies are up to date, and your office lease is carefully monitored for upcoming critical dates. When it comes to negotiating a dental office lease, there are many difficult-to-understand and technical parts of this long and complicated document that can be challenging to negotiate. But years of research points to the fact that one of the most important ways to get better terms at renewal time is to start negotiating early. Regardless of what career stage you are at, to effectively get a better deal from your landlord during your next negotiation, consider following the tenant lease cycle (see below). As a new dentist, whether you bought a practice or started up a practice, the most valuable and practical tip anyone can give you regarding your office lease is this:

Determine when your current dental office lease expires. Track the date on your calendar, and start the renegotiation/renewal process two years before the end of the term.

TENANT LEASE CYCLE Expiry Date

8 months 12 months left

24 months Number of months to Tenant Lease Expiration

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All of our lease negotiation data point to one common theme: When it comes to renewing or renegotiating your dental office lease, time equals money. The more time you have left on your lease at

the start of negotiations, the more money you will save on your next five- or 10-year-lease commitment on behalf of your practice.

WHY TIMING IS CRITICAL Following are the three key time periods in the tenant lease cycle. Find out the best time to start renegotiating your lease. • 10 months or less left on your lease (too little, too late). Landlords know that if there are fewer than 12 months before the end of the lease term, dentists have little opportunity to relocate their businesses effectively and without risking downtime between practices. In other words, landlords know that, on average, and depending on where in the country you practice, it takes approximately 10-12 months to find a new location, negotiate a lease, design, build, and move into a new dental office. Therefore, if you have less than 10-12 months left on your lease, you are less likely to move, and landlords know this. Some dentists may try to use “negative leverage” and say they will move out if demands such as lower rents, refurbishment, or better heating or air conditioning are not met. In my experience, this tactic rarely produces positive results, and sometimes landlords will call the tenant’s bluff and carry the short-term vacancy instead of conceding to demands. Landlords know that finding new space, completing renovaCONTINUED ON PAGE 30 >>

Jeremy D. Behar, President & CEO of Cirrus Consulting Group, is widely recognized across North America as being a pioneer in the development of high-value outsourced lease negotiation solutions for the dental community. Cirrus Consulting Group is headquartered in Toronto, with offices in Florida and California. He can be reached at jdbehar@cirrusconsultinggroup.com, or by visiting the website at www.cirrusconsultinggroup.com.

DENTAL STUDENTS: What’s on Your Mind?

Indiana University Dental Student Is Lead Author of JADA Article Looking at Methods to Control Dental Impression Gun Contamination

easoned dental professors can tell you about the thrill they felt the first time their name appeared as the primary author of a research article published in a prominent journal. It’s a rite of passage in the career of academic scholars, but an achievement few experience when they are still enrolled in dental school. Indiana University fourth-year dental student Eric Westergard is one of the few. He is the published author of a research article that recently appeared in the Journal of the American Dental Association. Mr. Westergard is the first author of “Controlling Bacterial Contamination of Dental Impression Guns.” His co-authors are IU dental school professors Dr. Laura Romito,

Practice Values

continued from page 22

than practices dependent on PPOs and HMOs. Another economic variable that may impact a practice’s value is the clinical production mix. For example, practices that refer many services to specialists may command a higher value given the upside potential for the purchaser to retain more clinical production, thereby increasing practice revenue. Fee schedules may impact a practice’s value as well. Dental practices with fee schedules below the 50th percentile show greater potential to increase 26 WWW.THENEWDENTIST.NET FA L L 20 1 2

Oral Biology, and Dr. Michael Kowolik, Periodontics and Allied Dental Programs; and Dr. Charles Palenik, the IU dental school’s former director of Infection Control Research and Services, now retired, and current director of the national Organization for Safety, Asepsis, and Prevention. Mr. Westergard’s research is timely, since bacteria such as methicillinresistant Staphylococcus aureus, better known to the general public as MRSA, have become an increasing concern throughout society, including the dental profession. Looking specifically at the contamination of dental impression guns during clinical use, Mr. Westergard and his research team found that these dispensing guns had their highest reduction in contamina-

revenue quickly versus practices that are currently in the 90th percentile. If an analysis of the practice’s zip codes reveals that a significant percentage of patients are traveling a good distance for treatment, this may be a problem.

Practice Overhead Practices with a low overhead (e.g. 50%) usually command a higher value than practices with high-overhead (e.g. 70%). Simply put, if you buy a practice or become a partner in a high overhead practice, your chances of earning a decent income are greatly compromised. Staff overhead (e.g. 30-35%) is

Eric Westergard

tion – 95% – through steam sterilization followed by the use of plastic gun covers and disinfection. Information courtesy of Indiana University School of Dentistry.

usually the culprit in higher-overhead practices, along with occupancy costs, another expense category that contributes to high overhead. Banks also review operating profit margins carefully in their loan underwriting. In some cases, a loan request may be denied due to poor cash flow if the lender feels there is insufficient profit to support the practice acquisition loan as well as provide the purchaser a reasonable income.

Summary: In the end, so many factors can impact a dental practice’s value, but location has the greatest impact on what you will pay for a practice.

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Meet Dr. Charley Cheney III, Advisory Board Member The New Dentist™ welcomes Dr. Charley Cheney III to the magazine’s advisory board. Dr. Cheney is a 2004 graduate of Tufts University School of Dental Medicine and a military veteran. Shortly after graduation from dental school, he was deployed to Baghdad, Iraq, for a year as an activeduty military dentist for the United States Army. Since then he has completed his four-year active-duty tour and has served more than 11 years. Dr. Cheney notes that his tour in Iraq was an excellent opportunity to obtain widespread experience.

r. Cheney enjoys both the clinical and the business aspects of dentistry. “As the business owner, I can be creative, integrate ideas, and get direct feedback while improving the patient experience and productivity.” The changes that Dr. Cheney has implemented into his practice include becoming digitized, going paperless, communicating electronically with patients, and offering patient amenities. The ability to submit patient registration through the practice website, communicate with the office electronically, and provide other patient services have been very well received. “When they arrive in our lobby, we offer the patients and their guests a beverage. During procedures, each patient is offered a heated pillow to lie on and wireless headphones to listen to music. Upon completion of the

Dr. Cheney’s ‘Go-To Products’ Since opening his practice in Newnan, GA, Dr. Cheney says there are certain products and equipment that he would never practice without: Open Dental Practice Management Software SOTA Intraoral Camera – sotaimaging.com archerwhite.com/instrumentar iumsnapshotintraoralsensors. aspx SybronEndo Elements www.sybronendo.com

procedures, the patient is offered a warm, refreshing aromatherapy towel. These amenities do not cost a lot but we have been told that they enhance the patient experience.” When it comes to his work as a dentist, Dr. Cheney says that he most enjoys the relationships he builds with his patients. “I can look at my schedule and tell you something about each patient. Getting to know my community and my patients is the best part of being a dentist.” In terms of challenges for this new dentist, whose office is just outside Atlanta, GA, he says he felt well prepared for the challenges that come with starting out in the profession. His greater concern was adapting to a new environment. “My biggest hurdle was starting a new practice in a new city where I was not born or raised, and I knew nothing about it.” Dr. Cheney purchased a practice from a retiring doctor who treated patients only one to two days per week. Thus, retaining the few existing patients and attracting new ones was critical. Today, Dr. Cheney’s practice is ranked as one of the top 15 businesses in Coweta County, GA. He offers this advice for other new dentists: “If you have a friend who is a lawyer, make him your best friend,” he says somewhat jokingly. “There are so many contracts that affect you. It can boil down to understanding the terms of your lease or real estate purchase that you know nothing about. So how are you going to negotiate this? Your team of an attorney, advisors, and your CPA can prevent you from going down the wrong path.” Dr. Cheney can be contacted at ccheney@completedentalarts.com, www.completedentalarts.com, (770) 254-8787, or by fax at (877) 556-4889.

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Lease

continued from page 24

tions, and relocating a dental office efficiently will take time and lots of money, and therefore, a dentist is more likely to stay and accept whatever the landlord offers at this late stage. While it is possible to get reasonable terms at this stage, it is very difficult. • 12 months to 18 months (time is still limited). If you have between 12 and 18 months left on your lease, you are in a better position to leverage and get the terms you want. However, timing is still tight because negotiations with some landlords can be very slow going, taking many more months than you thought to get the renewal completed. As such, you should focus on identifying and prioritizing only those critical issues in your lease that must be changed to reflect and accommodate your updated needs. For example, if you just found out you have a health condition that now adds uncertainty to how long you’ll be able to continue practicing, then you really need a death and disability provision in your lease. Another example might be if growth in the practice is going better than you expected and you really need three to four more operatories, then having a right of first refusal to expand into adjacent space might be of real value. • 18 months to 24+ months (ideal). You may think this is too soon to be renegotiating your lease, and perhaps you’ve approached your landlord in the past at this stage, only to have him or her tell you to come back when you have only a few months left on your lease. Your landlord has already started chipping away at your leverage by sending you away. We like to refer to this landlord tactic as “running out the shot clock.” Remember, they are experts at this game and know the value of time. When we get hired to negotiate on behalf of dentists across the country, we have a number of tactics we use to get the landlord to the table – and stay there. For example, we might explain that our client, the dentist, is looking to upgrade some expensive dental equipment but that in order to finance the purchase with the bank, we need a new long-term lease. The greatest leverage to negotiate more favorable terms for your lease is found in this phase of the tenant lease cycle. This is exactly why landlords like to make you wait and often protract lease discussions in this phase. The less time you have, the more leverage the landlord has to force you into the terms he or she wants.

DENTISTS AND THEIR LEASING HABITS In the first half of 2012, we have had more dentists hire us

30 WWW.THENEWDENTIST.NET FA L L 20 1 2

with leases expiring within 30-60 days than ever before! That means that more dentists in 2011/12, than in all our 19 years in this business, realized that their leases were set to expire in fewer than two months. One interpretation of this fact is that too many dentists are still waiting too long to begin the leaserenewal process. Don’t be one of them. Start early.

Sexual Harassment continued from page 8

tion as possible, interview all the parties, and try to frame the situation to determine if there is liability or if other steps need to be taken. The worst thing doctors can do is ignore the situation or try to handle it themselves,” emphasizes Mr. Oromchian. Also, notes Mr. Oromchian, make sure that employee documents are secure. It’s particularly critical in situations in which an employee is dismissed and files an allegation of sexual harassment after s/he is fired. “Oftentimes we find that when a complaint, whatever the nature, is made, key employee documents go missing. They should be stored in a locked area. If you document employee actions or inactions and the employee files a complaint, you are in a pretty strong position. You still have to hire an attorney or human resources professional to conduct a thorough investigation, but documentation in most cases will save an employer from a frivolous lawsuit.” If the practice does not document and/or does not have an employee handbook that specifically outlines what the policies are, it gets very dicey for the practice. “We always interview the plaintiffs’ lawyers – those who sue our doctors – at the end of the case to learn more about why they pursued a lawsuit against the doctor. One thing the plaintiff attorneys always say is that if the doctor doesn’t have an employee manual, they will file a lawsuit no matter how weak the case is. They reason, how can a doctor hold an employee accountable for anything if there is no employee policy manual?” says Mr. Oromchian. Both experts emphasize that every business, no matter its size, be it two employees or thousands, needs to have an employee policies manual. The employees must know what the policies are. They need to be written and communicated, and employees should be trained, particularly in an area such as harassment, to ensure that they understand what might be construed as harassment. “Prevention is the best way to protect yourself and your practice,” says Ms. vanManen.

SKINNY

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RecordLinc RecordLinc has been called “the Facebook of dentistry.” Find colleagues, reconnect with fellow students, collaborate through Online Study Clubs, and build your network of referring dentists. RecordLinc enables you to quickly and efficiently locate referral slips, X-rays, and patient information. It eliminates the need to duplicate information and X-rays, allows you to collect patient information prior to their visit, and helps streamline appointment scheduling. RecordLinc provides a platform where all professionals involved can collaborate quickly and efficiently and within their own timeframe. And it allows for real-time seamless communication, thereby providing a more fully informed treatment plan. For more information, visit www. RecordLinc.com or call 415.749.1444.

This new line of instruments is surface engineered with American Eagle’s XP Technology™ making them sharpen free! All Double Graceys™ have a rounded toe and two cutting edges on each end. The line includes four instruments, two for posterior regions (Regular & Mini), and two for anterior regions (Regular & Mini). Practical advantages to using the Double Gracey™ include convenient adaptation to mesial and distal surfaces without switching or flipping the instrument. The Anterior instruments also adapt to buccal and lingual surfaces. The Mini versions provide even easier access into deeper pockets, for tighter interproximal areas, and furcations. Double Graceys™ are available individually, as a set of four instruments, a set of two Regular, and a set of two Minis. For more information, visit www.am-eagle.com or call 800.551.5172.

New CDT 2013! The new CDT 2013: Dental Procedure Codes is a required text for every well-managed dental practice. CDT 2013 provides standardized information and creates a common platform of understanding for health care providers, electronic health records, patients, and insurance companies. Correct coding saves time and ensures that you get reimbursed correctly the first time. Key updates include: 35 new codes, 38 revised codes, 12 deleted codes, and 7 new or revised service categories/subcategories. For more information, visit www. adacatalog.org or call 800.947.4746.

INDEX OF A D V ER TIS ER S Advertisers in this issue of The New Dentist™ have made it possible for you to receive this publication free of charge. Please support these companies. Contact information can be found below, or visit the Resource section at www.thenewdentist.net to receive information from more than one company. American Dental Association .......................p. 15 ADA.org/patientsmart 800-947-4746 Aspen Dental ....................p. 12 www.aspendentaljobs.com/395 866-748-4299 Bank of America ...............p. 23 www.bankofamerica.com/ practicesolutions 877-541-3535 Priority Code ADDMCK12 CareCredit ........................p. 29 www.carecredit.com/dental 800-300-3046

Carestream Dental, LLC ....p. 3 www.carestreamdental.com 800-944-6365

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Smile Reminder ................p. 11 www.smilereminder.com 866-605-6867

Cirrus Consulting.............p. 25 www.cirrusconsultinggroup.com 800-459-3413

Live Oak Bank ..................p. 13 www.liveoakbank.com 866-484-1223

The Digital Dentist ...........p. 19 www.thedigitaldentist.com 866-204-3398

Dental Dreams ..................p. 18 Danielle Tharp 312-274-4524 Juliette Boyce, PHR 312-274-4520

MAC Practice ....................p. 27 www.macpractice.com 402-420-2430

Wells Fargo Practice Finance................................p. 9 www.wellsfargo.com/ welcomedentists 888-937-2321

Henry Schein Nationwide Dental Opportunities .........IBC www.dentalopportunities.com 866-409-3001

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McKenzie Management .......BC www.mckenziemgmt.com 877-777-6151 Midwest Business Capital .... p. 31 www.midwestbusinesscapital.com 877-751-4622 NAPB...................................p. 1 www.napb.org 888-407-2908 Practice Cafe .......................p. 5 www.PracticeCafe.com 888-575-CAFE (2233)

Wood & Delgado Attorneys at Law..................................p. 7 www.Dentalattorneys.com 800-499-1474 XDR.....................................IFC www.xdrradiology.com 888-XDR-XRAY

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This is an Absolute must for any new start-up. This course not only gave me the confidence to start my practice from scratch but also provided a lot of material to help manage staff and run the practice efficiently. The 2-day course compiles years of McKenzie Management’s expertise in the business of dentistry, which is a huge bonus for dentists planning to own and run a practice. Totally worth it. Thank you so much for everything.” — Sasha Bhor DDS San Diego, CA www.oasissmiles.com

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Practice Start Up Program Practice Acquisition Program 2 Days, one-on-one training. | Preferred time 3 to 18 months prior to opening or purchase. 6 Months of follow up support. | Training location - La Jolla, CA or your city. Training and support materials. | 16 Hours of AGD CE credits. Available for General Dentists and Specialists. View course curriculum at www.mckenziemgmt.com/cons-startup.htm and www.mckenziemgmt.com/practiceacquisition.htm

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