New Dentist Spring 2014 by The New Dentist

THE #1 JOURNAL FOR NEW DENTISTS

FINANCIAL STATEMENT FUNDAMENTALS ‘Show Me The Money!’

PLUS When to Start Looking for a Practice to Purchase 6 Steps to Get Patients in the Chair SPRING 2014

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FROM THE PUBLISHER’S DESK

SPRING 2014 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Dear Readers,

Picante Creative http://www.picantecreative.com

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

Tess Fyalka Tess@thenewdentist.net

MANAGING EDITOR

SALES AND MARKETING

hether you own, rent, lease, buy, or

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

simply work in a practice, there are a host of financial issues to consider over the course of your career. In

this issue, you’ll find a wealth of information from some of the industry’s best financial leaders in practice acquisition, practice financing, as well as wealth management. The New Dentist™ is very pleased to feature Garrett Gunderson. This New York Times bestselling author is a champion of small business owners. Turn to p. 16 and discover what he says about growing your wealth, and be sure to check The New Dentist™ blog for posts from this wealth management expert who’s not afraid to tell it like it is and sacrifice a few “sacred cows” in the process. And central to managing your growing wealth is fully understanding what that financial statement is telling you each month. On p. 14, dental CPA Michael Blitstein will spell out some key financial details that every new dentist needs to know. Also in this issue, MacPractice CEO Mark Hollis reveals the financial and other benefits that converting to electronic dental records holds for new dentists. And Dr. Tom Snyder spells out the true costs of waiting to purchase a practice. Finally, be sure to visit The New Dentist™ website at www.thenewdentist.net; take a moment to explore. 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, as well as hundreds of FREE continuing education opportunities using interactive web-based training provided by Viva Learning™, an ADA CERP provider. 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 ©2014 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

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used as a pre-procedural patient oral antibacterial rinse, Colgate Total® Advanced Pro-Shield™ Mouthwash reduces cross-contamination—defined as the transmission of potential oral pathogens or microorganisms—from aerosols released during dental procedures using an ultrasonic scaler.

†In

a randomized, double-blind, placebo-controlled clinical trial, 60 participants were randomly sorted into one of four groups to test cross-contamination during oral procedures. Participants were instructed to rinse for one minute with either Cetylpyridinium (CPC) rinse, Chlorhexidine (CHX) rinse, water, or were instructed not to rinse. After, participants were brought into an unoccupied dental office where blood agar plates were placed on a support board, the participants’ chests, and the examiners’ foreheads to measure dental aerosols. After an oral prophylaxis of the full mouth using an ultrasonic scaler, the plates were sent to a microbiology laboratory to detect the amount of dental aerosols measured in microbial colony-forming units. CPC and CHX equally decreased splatter microorganisms vs rinsing with water and no rinsing. CPC rinse used is a bioequivalent to Colgate Total® Advanced Pro-Shield™ Mouthwash formula.

Reference: 1. Feres M, Figueiredo LC, Faveri M. J Am Dent Assoc. 2010:141(4):415-422.

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TABLE OF CONTENTS

SPRING 2014

FEAT U R ES

6 The Advantages of Owning Commercial Property Keith Merklin

8 Antimicrobial Mouthrinses for Plaque and Gingivitis Control

Rebecca S. Wilder, RDH, MS

12 A Healthy and Happy Practice By Design

Mohsen Ghoreishi, CEO and President, The Kohan Group, Inc.

14 Financial Statement

Fundamentals – ‘Show Me the Money!’

Michael W. Blitstein, CPA

16 Forewarned Is Forearmed:

These ‘Sacred Cows’ of Money and Wealth Creation Could Cost You $100,000 or More Over the Lifetime of Your Career Garrett B. Gunderson

20 What is Arrowhead Dental

Lab Doing for Today’s New Dentists?

22 When to Start Looking for a Practice to Purchase

Dr. Thomas Snyder, DMD, MBA

24 Guru Dr. Sergio Rubinstein Urges New Dentists to Choose Wisely

26 Electronic Dental Records

12 D EPARTMENTS 2 Publisher’s Message 36 Skinny on the Street 36 Index of Advertisers

(EDR), The Future of All Practices Mark Hollis, CEO, MacPractice

28 Ergonomic Design: The

Key to a Long, Healthy Dental Career Eddie Ash

30 6 Steps to Get Patients in the Chair

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The The only only official official source source for for the the most most up-to-date up-to-date and and accurate accurate Dental Dental Procedure Procedure Codes Codes and and Dental Dental Coding Coding Made Made Simple Simple training training manual manual for for your your office. office. CDT CDT 2014 2014 Kit Kit CDT CDT2014: 2014:Dental DentalProcedure Procedure Codes Codes(J014) (J014) •• 29 29 new new procedure procedure codes codes •• 18 revised procedure 18 revised procedure codes codes •• 44 deleted deleted procedure procedure codes codes •• 77 changes changes to to the the subcategories subcategories and and their their descriptors descriptors •• Fillable Fillable 2012 2012 ADA ADA Dental Dental Claim Form Claim Form Dental DentalCoding CodingMade MadeSimple: Simple: Resource Guide Resource Guideand andTraining Training Manual Manual(J443) (J443) •• 151 151 of of the the most most common common coding coding questions questions && answers answers •• Over 25 coding exercises Over 25 coding exercises •• An An illustrated illustrated implant implant section section •• Continuing education exam Continuing education exam with with 55 CE CE Credits Credits

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The Advantages of Owning

Commercial Property

ost business owners eventually confront the question of whether to purchase or lease their office space. There are many factors to consider in making this important decision. For new dental practitioners who are uncertain of future space needs and want to ensure maximum cash flow as they grow their business, leasing may be a wise option. But for new or seasoned practice owners with a strong financial profile, a clear picture of future growth, and the ability to take advantage of the tax benefits of ownership, a commercial real estate purchase can provide a solid foundation for growing the business. Following are a number of potential advantages to owning commercial property:

HISTORICALLY LOW PRICES Commercial properties for dental practices are far less expensive today than they were before the recession. In some areas, it may be ultimately less costly to purchase and outfit commercial real estate than to build out and rent a leased space. And while property values will not likely rise at the aggressive rates seen from 1998 through 2005, it is a safe bet that at todayâ&#x20AC;&#x2122;s lower prices, both residential and commercial real estate values are likely to appreciate over time. As the property owner, you receive the full benefit of that appreciation.

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BY KEITH MERKLIN

FAVORABLE FINANCING RATES The most significant cost of purchasing real estate is the mortgage interest rate. Today, rates for commercial real estate purchases continue to be at an all-time low, ultimately saving you significant funds as you pay down your commercial mortgage. However, obtaining financing can still be a challenge, so itâ&#x20AC;&#x2122;s critical to maintain a spotless financial profile and be prepared with a comprehensive business plan that makes the case for the viability of your practice. Also consider working with a lender who specializes in dental practice financing and understands your particular needs. EQUITY APPRECIATION As you build equity in your business real estate, it becomes an increasingly valuable asset that you can leverage to further grow your business without putting your practice itself at risk. This gives you greater flexibility in managing your business growth. It also gives you additional options when it comes time to retire. As the commercial property owner, you can sell the practice and underlying property outright at the time of retirement, or sell the practice only and lease the commercial property, producing an ongoing income stream.

CASH FLOW OPPORTUNITIES If you purchase commercial property that has space for tenants, you have opportunities for additional cash flow through rental income. You might use tenant income to help pay down the property purchase, thus offsetting the cost of your investment. It’s important to remember, though, that having tenants entails property management responsibilities that may detract from attending to your practice’s core business of treating patients. TAX ADVANTAGES Owning your practice allows you to depreciate your asset while writing off all of the mortgage interest paid during the year. In addition, you can enjoy the benefits of several tax deductions designed for the business or property owner: • Section 179. IRS Tax Code Section 179 allows deductions for purchases of equipment and furnishings that are put into service the same year they are purchased. For the past three years, Congress has granted a generous deduction of $500,000, which can be a significant contribution towards offsetting the cost of the property purchase. • Cost Segregation. This method of depreciation allows you to depreciate the building and components such as

•

wiring and lighting over a 39-year period, offsetting the cost of building maintenance for a significant amount of time. 1031 Exchange. Investment properties used in a trade or business can be sold and the funds applied towards the purchase of a similar or like property within 180 days of sale, without reaping any tax consequences. The purchased property must be of equal or higher value to avoid a tax penalty. This provides leverage for a practitioner to move to a larger facility as the practice grows, without being hindered by tax penalties.

Before purchasing commercial real estate, be sure to consult with your CPA or financial advisor to fully understand how a purchase would affect your particular circumstances. Keith Merklin is a general manager with Live Oak Bank. He has more than 14 years of experience as a commercial lending officer and has spent the majority of his career working with small health care practices. During his career, Mr. Merklin has originated more than $500,000,000 in loans for dentists and other medical professionals who were acquiring a practice or property, consolidating debt, or expanding their businesses. He can be reached at keith.merklin@liveoakbank.com.

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Antimicrobial Mouthrinses for Plaque and Gingivitis Control

ecent studies indicate that periodontal disease is much more prevalent than previously thought. In fact, it is estimated that approximately half of the United States (U.S.) population has some form of periodontal disease.1 Plaque biofilm is a major factor in the development and advancement of periodontal disease, so providing patients with the education and products to compact the disease

BY REBECCA S. WILDER, RDH, MS

process should be a priority in modern dental practices. This article will provide an overview of the evidence supporting the use of several antimicrobial mouthrinse products on the U.S. market. Thorough scaling and root planing is considered the gold standard for removal of plaque biofilm and calculus.2 However, routine biofilm removal by the patient between dental appointments is essential to oral health. Physical methods of at-home biofilm removal (toothbrushing, floss, interdental brushes) can be effective, but low compliance by the patient or lack of dexterity can challenge the best oral health plan. Additional methods for plaque and gingivitis control that are adjunctive to physical disruption are supra- and subgingival irrigation and rinsing with antimicrobial mouthrinses. The term â&#x20AC;&#x153;antimicrobialâ&#x20AC;? refers to agents that kill microbes or affect the growth and multiplication of microoganisms.3 Rinses with therapeutic claims address a particular disease process such as biofilm and gingivitis control. If a mouthrinse claims to reduce gingivitis, including plaque reduction, it is considered therapeutic and subject to Food and Drug Administration (FDA) regulations. If the mouthrinse also carries the American Dental Association (ADA) Seal of Acceptance,

the clinician knows that the product has undergone additional scrutiny to ensure efficacy.4 The ADA Seal of Acceptance is now only available for over-the-counter products, so rinses such as chlorhexidine gluconate no longer carry the ADA Seal. However, they are still as effective for plaque and gingivitis reduction. While therapeutic rinses do not physically disrupt plaque biofilm like a toothbrush or dental floss, they have the capacity to reduce the bacteria and assist the patient in improving their oral health. Antimicrobial agents such as mouthrinses have difficulty penetrating the dense biofilm matrix; however, planktonic (or free-floating) cells are more susceptible to antibiotic/ antimicrobial agents.5 Clinicians should be clear that antimicrobial rinses with therapeutic claims are not approved for control of periodontitis. Antimicrobial mouthrinses have become popular with patients as they are easy to use, inexpensive, and they reach the entire oral cavity as opposed to only the tooth and gingival surfaces. The ease of use of mouthrinses is also a benefit as patients are instructed to use the rinse twice per day, and most of the products do not require a prescription. The most widely used antimicrobial rinses are those containing chlorhexiCONTINUED ON PAGE 10 >>

Rebecca Wilder, RDH, MS is a professor and director of faculty development and the director of the Master of Science Degree Program in Dental Hygiene Education at the University of North Carolina at Chapel Hill School of Dentistry. She is also the editor-in-chief of the Journal of Dental Hygiene. She can be reached at Rebecca_wilder@unc.edu or 919-537-3461.

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www.liveoakbank.com/dental • 877.890.5867

Mouthrinses continued from page 8 dine gluconate (CHX), which is prescription based; essential oils (EO); and cetylpyridinium chloride (CPC). A more recent addition to the market of antiplaque agents is a product containing 0.2% delmopinol hydrochloride. Following is a description of and evidence for use of these products.

DELMOPINOL HYDROCHLORIDE Although delmopinol hydrochloride is not an antibacterial agent, it is an adjunctive product designed to interfere with the formation of plaque biofilm. The product has been studied in Europe for many years and was recently introduced to the U.S. market (PerioShield™, Sunstar Americas). Randomized control clinical trials showed that delmopinol hydrochloride performed significantly better than the placebo with plaque reduction, bleeding on probing, and gingivitis.6 It was not as effective as 2.0% CHX. The rinse has low alcohol content (1.5%). The FDA has approved the rinse as a mechanical device rather than a drug.7 Patients should be instructed to use the product twice per day for 30 seconds.

CHLORHEXIDINE GLUCONATE The antimicrobial CHX is one of the most effective antiplaque/antigingivitis agents on the market and is considered the gold standard for antimicrobial rinses. It is available in the U.S. as a prescription mouthrinse at 0.12% concentration. CHX contains approximately 11.6% pharmaceutical alcohol (ethanol), as opposed to ethyl alcohol found in alcoholic beverages. One product is available without alcohol 10 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

(GUM™, Sunstar Americas). CHX works by causing permeability of the bacterial cell membrane. Another benefit of CHX is its substantivity, which is the ability of an agent to remain in an area or site and resist being diluted or washed away by saliva or gingival crevicular fluid.8 Reductions in plaque biofilm and gingivitis with CHX have been reported from 22-61% and 18-44%, respectively.9 Patients should be aware that CHX can cause tooth staining, taste alteration and an increase in calculus deposits. Therefore, CHX is typically recommended for short-term use. The usual dose to recommend to patients is twicedaily rinsing (morning and evening) with 15 ml of undiluted CHX oral rinse, swished for 30 seconds and expectorated. Patients should be instructed not to rinse with water or other mouthrinses or brush their teeth for a while after using CHX.

ESSENTIAL OILS Essential oils mouthrinses have been on the market in the U.S. for more than a century. The mode of action involves bacterial cell wall destruction, inhibition of bacterial enzymes, and extraction of bacterial lipopolysaccharides. The essential oils are a mixture of thymol, menthol and eucalyptol combined with methyl salicylate. The pharmaceutical alcohol (ethanol) content of EO is 21-26.9%. Six-month studies have reported reductions in plaque biofilm from 14.9-36.1% and gingivitis reduction of 9.4-36%.10 While EO has been criticized for high ethanol alcohol content, meta-analyses have shown the product to be safe, with no increased risk for oral cancer with regular use.11 Contraindications for use of EO are patients with a history of or current

alcohol abuse; under the age of 12 years old; or current use of metronidazole (Flagyl®), an antibiotic, or Antabuse®, a medication for treatment of alcoholism.12 Patients should be instructed to swish twice per day with the recommended dosage. Adverse effects include a burning sensation during use, therefore patients may dilute the formulation as they gradually get accustomed to the rinse. However, to receive the full benefit of the mouthrinse, the patient must use it at full strength. Listerine® (Johnson&Johnson) essential oils have the ADA Seal of Acceptance.

CETYLPYRIDIUM CHLORIDE CPC is classified as a quaternary ammonium compound. The mechanism of action is due to alteration of the bacterial cell wall, the promotion of cell lysis, and decreased cell metabolism. Formally marketed for cosmetic use, the newer formulation of 0.07% CPC (Crest® ProHealth, Procter & Gamble) has shown plaque reductions of 16-28% and reduction in gingivitis of 15-24%.13, 14 Reported side effects of CPC are tooth staining, increased calculus formation, temporary taste alteration, and occasional burning.

SYSTEMATIC REVIEWS – THE EVIDENCE FOR ANTI MICROBIAL MOUTHRINSES A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue.15 Oftentimes a meta-analysis can be conducted from a systematic review. The benefit of a meta-analysis is that it allows for the combining of data from many different research studies rather than determining evidence from individual studies.15 Several systematic reviews, including one by Gunsolley in 2006 and Stoeken et al. in 2007, have been conducted to determine the evidence for use of antimicrobial mouthrinses.16, 17 Gunsolley concluded that CHX rinse and EO rinse had a consistent antiplaque effect, and for gingivitis,

both were statistically and clinically significant. Due to the variety of the formulations, CPC showed inconsistent results.16 Stoeken et al reviewed essential oil use in plaque and gingivitis reduction in studies ≥ 6 months. The results showed strong evidence for use of EO for plaque and gingivitis reduction.17 What this tells clinicians is that they can confidently recommend antimicrobial mouthrinses to their patients to help improve their plaque and gingivitis control. As with any recommendation, the dentist and dental team members need to be thoroughly familiar with the product and be consistent in their verbal communication with the patient.

2. Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol 1996,1:443-90.

gingivitis: a systematic review. J Periodontol 2007; Jul; 78(7):1218-28.

3. http://medical-dictionary.thefreedictionary. com/antimicrobial. Accessed December 7, 2013.

11. Gandini S, Negri E, Boffetta P, La Vecchia C, Boyle P. Mouthrinse and oral cancer risk quantitative meta-analysis of epidemiologic studies. Ann Agric Environ Med 2012;19:173-180.

References

9. Addy M. Chlorhexidine compared with other locally delivered antimicrobials. J Clin Periodontol 1986; 13:957-64.

1. Eke PI, Dye BA, Wei L, Thoronton-Evans GO, Genco RJ. CDC Periodontal Disease Surveillance Workgroup. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012, 91: 914–920.

4. Acceptance Program Guidelines. Adjunctive Dental Therapies for the Reduction of Plaque and Gingivitis. 2011 American Dental Association Council on Scientific Affairs. 5. Mah T, O’Toole G. Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol. 2001; 9:34-39. 6. Addy M, Moran J, Newcombe RG. Metaanalyses of studies of 0.2% delmopinol mouth rinse as an adjunct to gingival health and plaque control measures. J Clin Periodontol 2007; 34:58-65. 7. MSDS Sheet PerioShield. http://www. gumbrand.com/assets/675/32/PerioShield_ MSDS_07-11.pdf Accessed December 7, 2013. 8. Elworthy A, Greenman J, Doherty FM et al. The substantivity of a number of oral hygiene products determined by the duration of effects on salivary bacteria. J Periodontol 1996; 76: 572-76.

10. Stoeken JD, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and

12. Spolarich A, Gurenl ian J. Dispel the myths. Dimensions of Dental Hygiene 2013; 11(4): 22-22, 24. 13. Stookey GK, Beiswanger B, Mau M, Isaacs RL, Witt JJ, Gibb R. A 6-month clinical study assessing the safety and efficacy of two cetylpyridinium chloride mouthrinses. Am J Dent. 2005; 18:24A–28A. 14. Mankodi S, Bauroth K, Witt JJ, et al. A 6-month clinical trial to study the effects of a cetylpyridinium chloride mouthrinse on gingivitis and plaque. Am J Dent. 2005; 18:9A–14A. 15. Agency for Healthcare research and quality. http://effectivehealthcare.ahrq.gov/index.cfm/ glossary-of-terms/?pageaction=showterm&ter mid=70. Accessed December 7, 2013. 16. Gunsolley JC. A meta-analysis of six-month studies of antiplaque and antigingivitis agents. J Am Dent Assoc 2006; 137:1649-1657. 17. Stoeken JE, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. J Periodontol 2007; 78: 1218-1228.

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A Healthy and Happy Practice By Design By Mohsen Ghoreishi | CEO and President, The Kohan Group, Inc.

here is an unspoken relationship between a healthy physical environment and a healthy patient. It’s all about your physical environment and your attitude toward providing health care. This is a brief review of physical building elements affecting you, your staff, and your patients’ behavior and interactions with each other. This article explores how and what you can do with your design to soften a hard day at work and create a more pleasant working environment while simultaneously preventing cross-contamination. If you never thought your office could be healthy, think again. Cross-contamination does not only come from how you handle instruments in sterilization and the lab. You must also consider how you can best sterilize the light handles, the chair, or the delivery unit. Although this is one of the major elements in providing a healthy environment, it is not the only thing to consider. Cross-contamination is possible just from conducting daily tasks. When at the sterilization center, you need to continue moving forward and not backward. Maintaining the sequence

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of work from dirty to clean is important whether or not you are using cassettes. Cassettes will only make this fluid method of sterilization faster. Using cassettes can improve your operational efficiency for sterilization by 60%. For a general practice with five operatories at its full capacity, you need at least 100 square feet of space to sequentially sterilize instruments from dirty to clean, in a clockwise or counterclockwise motion. This amount of space allows you to move within the sterilization area when two or more staff members work simultaneously, and not get in each other’s way. CONTINUED ON PAGE 34 >>

Mohsen Ghoreish is the CEO and president of The Kohan Group, Inc. He has more than 18 years of experience in architectural/design practice working on health care facilities, specifically dental office design and construction management. The Kohan Group, Inc. Dental Office design was established in 2002 and has designed many dental offices nationally. He has won numerous awards, including the first Oral Surgery LEED Platinum certification through the United States Green Building Council. He can be reached at mohsen@kohaninc.com.

Financial Statement Fundamentals – ‘Show Me the Money!’ By Michael W. Blitstein, CPA

any of us remember Cuba Gooding Jr.’s immortal line from the movie “Jerry Maguire,” “Show me the money!” Well, that’s what financial statements do. They show you where your practice’s money comes from, where it goes, and where it is now. There are three main financial statements: (1) balance sheets, (2) income statements, and (3) cash flow statements. Balance sheets show what your practice owns and what it owes at a fixed point in time. Income statements indicate how much money a practice made and spent over a period of time. Cash flow statements reflect the exchange of money between your practice and the outside world also over a period of time. Let’s look at each of the three financial statements in more detail.

Balance Sheets A balance sheet provides detailed information about your practice’s assets, liabilities, and owner’s equity. This formula summarizes what a balance sheet reflects: Assets = Liabilities + Owner’s Equity. Assets are items that a practice owns that have value. This typically means they can either be sold or used by the practice to provide services. Assets include cash as well as physical property such as equipment, furniture, and leasehold improvements. It also includes things that can’t be touched but nevertheless exist and have value, such as goodwill. Assets are generally listed based on how quickly they will be converted into cash. Current assets are things a practice expects to convert to cash within one year. Noncurrent assets are things a practice does not expect to convert to cash within one year or that would take longer than one year to sell. Noncurrent assets include fixed assets. Fixed assets are those assets used to operate the business but are not available for sale, such as equipment, furniture, and leasehold improvements. Liabilities are amounts of money that a practice owes to others. This can include all kinds of obligations, like money borrowed from a bank and payroll taxes owed to the government. Liabilities are generally listed based on their due dates. Liabilities are said to be either current or long term. Current liabilities are obligations a practice expects to pay off within one year. Long-term liabilities are obligations due more than one year from the balance sheet date. 14 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

Owner’s equity is sometimes called capital, retained earnings, or net worth. It’s the money that would be left if a practice sold all of its assets and paid off all of its liabilities. This leftover money belongs to the owner(s) of the practice. Owner’s equity is the amount owners invested in the practice’s stock or capital plus or minus the practice’s earnings or losses since inception. Sometimes practices distribute earnings instead of retaining them. These distributions reduce owner’s equity. A balance sheet shows a snapshot of a practice’s assets, liabilities, and owners’ equity as of the date of the balance sheet. It does not show the flows into and out of the accounts during the period.

Income Statements An income statement is a report that indicates how much revenue a practice earned over a specific time period. An income statement also shows the costs and expenses associated with earning that revenue. The literal “bottom line” of the statement shows the practice’s net income or loss. This tells you how much the practice earned or lost over the period. To understand how income statements are set up, think of them as a set of stairs. You start at the top with the total amount of revenue during the accounting period. Then you go down, one step at a time. At each step, you make a deduction for certain costs or other operating expenses associated with earning the revenue. At the bottom of the stairs, after deducting all of the expenses, you learn how much the practice actually earned or lost during the accounting period. At the top of the income statement is the total amount of money brought in from sales of services. This top line is CONTINUED ON PAGE 32 >>

Michael W. Blitstein, CPA, is a partner with the firm of CJBS, LLC, in Northbrook, Illinois. For more than 30 years, Michael has worked closely with the dental community and is intimately familiar with the unique professional and regulatory challenges of creating, running, and maintaining a successful dental practice. Michael advises his clients on tax, business, and retirement planning, developing short- and long-term strategic plans designed to achieve success for dental practice principals and their businesses. He can be reached at michael@cjbs.com.

BY GARRETT B. GUNDERSON

FOREWARNED IS FOREARMED: These ‘Sacred Cows’ of Money and Wealth Creation Could Cost You $100,000 or More Over the Lifetime of Your Career

he median income of dentists surpasses that of lawyers, management consultants, computer scientists, and senior sales executives. In fact, according to Money magazine, dentistry is one of the dozen highest-paying professions in the country. That means that during your professional lifetime, if you are reasonably diligent in how you manage your earnings, you will not only make a positive impact on the oral health of many thousands of patients, you’ll get rich doing so. Perhaps then, you won’t even miss the tens of thousands or hundreds of thousands of dollars that you stand to forfeit over the next 20 or 30 years by adhering to the advice of conventional money managers and financial planners. It’s only money, after all … then again, not really. Money is an expression and a byproduct of the value that you create during your lifetime – and it’s a crime to permit any of it to be purloined.

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In the hands of dedicated dentists, wealth equates to the ability to do good in the world, to expand your practice to serve more patients in need, to explore additional professional pursuits, to squeeze maximum personal enjoyment and satisfaction out of life, and to forge a lasting legacy. Oddly, most successful dentists don’t even realize that while they are working so hard, and with such dedication, CONTINUED ON PAGE 18 >>

Garrett B. Gunderson is a champion of business owners, professionals and individual investors. He has dedicated his career to debunking the many widely accepted myths and fabrications that undermine the prosperity and joy of millions of hard-working, honest Americans. Gunderson’s company, Freedom FastTrack, coaches and empowers its members to build sustainable wealth consistent with their passion, knowledge, and life’s purpose. For more information, visit www.FreedomFastTrack.com.

THERE IS A GAP BETWEEN YOUR PRACTICE AND YOUR PATIENTS. AS TECHNOLOGY CHANGES THE WAY HUMANS INTERACT WITH EACH OTHER, WE’RE BRIDGING THE GAP. WE WILL REVOLUTIONIZE YOUR PATIENT RELATIONSHIPS BY CHANGING THE WAY YOU ENGAGE WITH YOUR PATIENTS. OUR INNOVATIVE TECHNOLOGY HAS BEEN FINELY CRAFTED TO ENSURE THAT THE RIGHT MESSAGE IS DELIVERED TO THE RIGHT PATIENT AT THE RIGHT TIME, SO EVERY PATIENT FEELS LIKE THE ONLY PATIENT. WHETHER IT IS A PATIENT THAT NEEDS THREE APPOINTMENTS REMINDERS IN ORDER TO GET THERE ON TIME OR A PATIENT THAT NEEDS TARGETED INFORMATION ON A SPECIFIC CONCERN, WE MAKE IT EASY TO GET THEM THE MESSAGE THAT’S RIGHT FOR THEM.

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BRIDGING THE GAP

Forewarned

continued from page 16

they are also getting royally hosed by Wall Street and other financial services giants that have invested literally billions and billions of dollars into brainwashing Americans to blindly place their trust (and their income) in these self-serving corporate titans. In my book, Killing Sacred Cows, a New York Times bestseller, I expose the many widely accepted myths and fabrications – perpetuated by our nation’s vast and powerful securities and banking cartels – that undercut the prosperity of hard-working, honest Americans. If you construct your financial lives around these carefully crafted fictions, you’re in good company. Millions and millions of clueless Americans pass all of their days beguiled by the powerful spell. At the core of the Wall Street and banking narrative is the idea that you – who were smart enough to earn your wealth in the first place – just aren’t smart enough to make the key decisions about how to manage and grow it. Before you even think about asking a qualified professional manager to take charge of your surplus income, dentists should reinvest in their practices, build up their savings, and pay off high-interest debt. And be wary, very wary, of those money managers who ask you to forgo your own life’s experiences and knowledge, and place your full trust (and your hardearned cash) in their hands. They’ll have you believe that wealth awaits if you’ll only retain a degreed (Ivy League alumni strongly preferred), highly skilled, professionally licensed money manager (or team of managers) who works for a well-known firm (substantiated by the fact that it advertises heavily on television and in major financial newspapers and magazines); is headquartered in office towers or other pricey real estate; and possesses the secret formula for wealth alchemy. All the gilded trappings, including the six-plus figure salaries that your money manger earns, are designed to project an air of success, stability, and reliability. It takes an exceptionally strong will and independent mind to probe past the elaborate facade to discover that the men and women behind the curtain, like the wizard in Oz, are too often masters of sound, light, and special effects. But they are bereft of magical powers. Worse, the Emerald City of wealth management is built on the naivety and unmet dreams of the very clients who it purports to serve. Who do you think pays for all that

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stagecraft – from the bombardment of advertisements to the soaring granite and glass palaces? You do. The clearest evidence of whom Wall Street and the financial services industry really work for is that they always make money – like Las Vegas casinos – whether or not you win. Even when you follow their advice right over a financial cliff, they extract their full fees and commissions for providing you the privilege. I see the world differently. And I’m very proud to say that there are thousands of business owners – including a large contingent of prosperous dentists – who’ve heard me speak, read my book and articles, or have taken my courses, and have subsequently escaped the voodoo of the commission-driven sorcerers. In future blogs for The New Dentist™, I’ll share with you some of the basic tenets of self-directed wealth building, or what I’ve dubbed the Freedom FastTrack. These include investing in what you know best, beginning with your own practice; identifying quality experts and money managers who will provide solid advice, while never putting their commissions ahead of your best interests; asking the right questions in order to ascertain the right answers; aligning your professional pursuits to a higher, deeply meaningful personal mission; embracing the power of cash flow, velocity, and utilization; and committing to lifelong education. I titled my book Killing Sacred Cows because there are so many misguided investment values and wealth-creation “givens” that most people are unaware that viable alternatives abound. You have choices in your life – great and varied choices. The right path for you may not be the correct one for your former dental school classmates or your current professional peers. Each of us must pursue our own unique road to meaningful wealth. I encourage you to question and analyze conventional wisdom when it comes to your finances and wealth building, and determine if following the pack brings you closer to, or takes you further away from, realizing your maximum potential. As a dedicated dentist, you will be rich in life – both in terms of cash in your pocket and professional fulfillment. Just how large you grow your net worth, and what you will accomplish with your wealth, will depend greatly on whether you choose to worship the sacred cows that govern money and prosperity, or join with me on my quest to eradicate them.

“With Arrowhead I was doing full arch dentistry my first year.” Dr. Cody Bauer, Mansfield, TX

And you can too!

Arrowhead Dental Lab and the Dr. Dick Barnes Group have developed a CE plan specifically designed to make new dentists more successful. Dr. Cody Bauer used this plan to more than double his income in his first three years of practice, and triple overall production in his office. Bauer says, “Arrowhead’s plan really works! It’s so easy, dentists don’t believe it!” Get the skills and support you need for success and keep your patients coming back by providing the latest in dentistry. Sign up today for Arrowhead’s New Dentist CE Plan by visiting our website at www.ArrowheadDental.com or by calling 1-877-358-0285.

Arrowhead’s New Dentist Continuing Education (CE) Plan:

Full Arch Reconstruction: Be one of the 30% of all dentists who can. • Everyday Occlusion: Common sense concepts and techniques that take •

dentistry to a whole new level.

Implant EZ: Keep valuable revenue in your practice. • Sleep Dentistry: One in five Americans have sleep disorders–expand your •

practice with the latest treatments for these patients.

•

Total Team: Give your entire team the tools they need to help you build a more profitable practice.

•

Know Your Numbers: Master business principles that will give you the competitive edge in dentistry.

All For Only: $3,995*

Details available at www.ArrowheadDental.com

What is Arrowhead Dental Lab Doing for Today’s New Dentists? The New Dentist™ magazine recently spoke to Arrowhead’s Matt Cook, director of marketing, about what this company has to offer new dentists.

What is Arrowhead’s New Dentist CE plan? Many of the established dentists who take our courses often say, “I wish I had found out about your lab and its programs 20 years ago.” Because of that reaction, we felt it necessary to design a program where new dentists – who are one to 10 years out of dental school – can be introduced to the techniques and services that will transform their practices right now instead of years down the road. This helps them provide the best-quality dentistry to their patients immediately.

PHOTO COURTESY OF ARROWHEAD DENTAL LAB

Who is Arrowhead? Arrowhead is a full-service dental laboratory started by Dr. Dick Barnes 40 years ago. Our goal is to help dentists become better with each interaction with us. We believe dentists will improve dramatically in their practices and stand head and shoulders above their competition if they start focusing on value-based comprehensive procedures instead of just costbased “drill-and-fill” type dentistry.

to call us anytime if they need help on a case. Even if they have a patient sitting in the chair and they’re unsure about a particular procedure, they can call us and we’ll walk them through any difficulty they might be having. This is particularly helpful for new dentists. Arrowhead will guide them through the process if necessary. The courses are designed to help dentists implement

Arrowhead’s six-course New Dentist CE Plan is only $3,995. This New Dentist CE program consists of six specific courses. We chose these specific courses because when taken together they provide the proper foundation on which to build a successful dental practice. In these six courses, we cover dental procedures and diagnoses such as full-arch dentistry, implants, occlusions, sleep apnea, as well as practice and team-management techniques that help dentists effectively run the business end of their practices.

What sets this CE plan apart from other plans? The answer is twofold. First, the New Dentist CE Plan is economical. Other labs’ charge about $3,000 to $6,000 per course. Do the math: It would cost $18,000 to $30,000 for six courses. Arrowhead’s six-course New Dentist CE Plan is only $3,995. In addition, our courses are not academic textbooktype courses. They are immersive courses that provide full mentorship to the dentists who take them. Dentists are free 20 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

the procedures they learned immediately. They won’t have to wait years to do an implant or a full-arch reconstruction; the minute they walk back into their offices after completing a course, they can start offering these comprehensive treatments. Dr. Cody Bauer is an excellent example of this. He started taking our seminars immediately after dental school. During his first year of practice, he was doing full-arch dentistry and implants. Many dentists think this type of advanced aesthetic dentistry is only something they can do after being in the business for many, many years. That just isn’t true. New dentists who have taken our courses can and are doing this type of dentistry right now in practices all over the country and reaping huge financial benefits.

Why is Arrowhead giving this price break to new dentists? We know that new dentists have a lot of financial obligations CONTINUED ON PAGE 35 >>

Wells Fargo Practice Finance

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

When you’re ready to purchase or start a practice, count on Wells Fargo Practice Finance to help you achieve your practice goals: · Up to 100% customized financing to help you acquire an existing practice or start one from scratch · Competitive fixed-rate loans with preferred pricing for ADA® members · Complimentary business planning tools, educational resources, and practice management consulting to help you successfully manage your transition to ownership

To get started, call 1-888-937-2321 or visit wellsfargo.com/thenewdentist to request your Practice Success Starter Kit. Wells Fargo Practice Finance is the only practice lender endorsed by ADA Business ResourcesSM.

All financing is subject to credit approval. ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association. © 2014 Wells Fargo Bank, N.A. All rights reserved.Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A.

2046-0114-New-Dentist-Spring

Get the facts with a free Practice Success Starter Kit, including our latest issue of Strategies for Success, a New Dentist Planner, and an easy-to-use business plan template.

DR. THOMAS SNYDER, DMD, MBA

When to Start Looking For A PRACTICE TO PURCHASE

he main reason why the majority of you have entered the dental profession is to become a business (practice) owner. The road to your purchasing an existing practice has become more challenging as the cost of your dental education keeps rising. As many new dentists have incurred total higher education debt of $250,000 or more, you may begin to wonder when the appropriate time will be to buy a practice. We have found, however, that delaying your purchase of a practice can be a decision from which you may never recover, in terms of lost income opportunity. So the sooner you are ready to purchase a practice, the better financial outcome it may yield for you. This is true because when you purchase a practice, you are purchasing someone’s historical income stream. Many dental graduates will enter a residency program for one to two years and then elect to work as an associate for several more years before making a purchase decision. With the rapid growth of dental management service organizations (corporate dentistry), a growing number of grads are electing to be employed in these practices, some for a few years and for others perhaps even more. For those in specialty training, the timeline for a practice purchase will be even longer. Making the decision to purchase a practice is not only based on your feeling of financial ability, but also your confidence in becoming a business owner and entrepreneur. Oftentimes this deferral of ownership is driven by a need to earn money and get established financially before considering owning a practice. Careful introspection is also critical to 22 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

ensure that you’re able to handle the clinical production of a potential seller who has a successful, thriving practice. Notwithstanding these considerations, let’s review the economics of two classmates who eventually bought a dental practice but did so at different points in time after graduating. Dr. A has decided to buy a dental practice three years after graduating from dental school. Let’s assume that the practice that Dr. A will purchase has revenue of $700,000 with a 60% overhead, so this practice has a total net income of $280,000. The practice sells for $440,000, and Dr. A will also need $90,000 in working capital, so he will need financing for $530,000. Dr. A’s loan terms are 10 years at 5.8% interest, with annual principal and interest payments of $69,635. Let’s also assume the practice will grow 5% a year. In this example, the projected net income in the first year of ownership for Dr. A before taxes, and paying the bank loan in his first year of ownership, will be approximately $224,000. In year two of ownership, the projected income before taxes will be $239,065. Dr. B, a classmate of Dr. A, is not sure if she can comfortably make a practice acquisition as soon as Dr. A. So Dr. B decides to work four more years from the time Dr. A purchased his practice. Let’s assume Dr. B earns an income of $120,000 initially with small increments annually over the four-year employment period. We’ll also assume Dr. B then decides to buy an identical $700,000 practice with the same overhead of 60% and sales price of $440,000 – now seven years after graduation. Let’s also assume that interest rates have

increased to 7.0% and Dr. B borrows the same amount as Dr. A did. The annual debt service will now be $73,417. So, in her first year of ownership, Dr. B will earn about $220,538 before taxes and in year two will earn about $235,283 before taxes. In comparing the total income earned by Dr. A over a 10-year period from the time Dr. A purchased his practice, to Dr. B’s earnings over the comparable period, the difference amounts to over $902,000! (See chart below.) In considering a purchase opportunity, both from a timing and readiness perspective, make sure that you maximize the opportunity you have in your residency program to learn as much clinical dentistry as possible, thus enhancing your clinical skills. Take continuing education courses along the way in practice management so that you can get a basic foundation in running a small business. Most importantly, remember that banks specializing in dental lending are eager to loan you money for practice acquisitions. In fact, most banks only require a two-year experience window from graduation to qualify for a loan to purchase a practice. These banks realize that you all have large educational debt, but as long as you keep your credit in good standing, meaning FICO scores between 660 and 680, and the practice you will eventually purchase is one with a good cash flow history, you will get funded for your practice acquisition. Imagine if Dr. B would have purchased a practice at the same time as Dr. A, that additional $902,000 dollars could have been used to pay off student debt as well as put her in an overall stronger financial position. The old adage “timing is everything” is quite applicable to purchasing a dental practice as well.

Dr. A (Owner Year 1)

Dr. B. (Owner Year 5)

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

$224,365 $239,065 $254,500 $270,707 $287,724 $305,592 $324,353 $344,053 $364,737 $386,451

$120,000 Associate Income $130,000 “ “ $140,000 “ “ $150,000 “ “ $220,538 Ownership $235,383 “ $250,718 “ $266,925 ” $283,942 “ $301,810 “

TOTAL

$3,001,551

$2,099,216

Your career, our mission. At Aspen Dental, you don’t have to go it alone. You can join a team that has your best interests at heart and your patients’ best care in mind. You can learn, grow and succeed alongside the best in the business. You can make a patient smile, and go home and see your family do the same. At the end of the day, it’s more than your career. It’s your life. Take the next step. Contact your local recruiter at 866.748.4299.

Net Income* includes practice debt being paid, but taxes have not been deducted. Dr. Thomas L. Snyder is director, transition services for 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, and practice transition planning services. He can be reached directly at 1.800.988.5674, tom.snyder@henryschein.com, www.henryschein.com/tsg.

Dr. Melissa Thompson

AspenDentalJobs.com

SPRING 2014

KHJ19011_ASP064_DentEnt_3.7125x9.925.indd 1

WWW.THENEWDENTIST.NET

10/3/13 12:24 PM

Guru Urges New Dentists to Choose Wisely

ractitioners today are inundated with the latest and greatest of seemingly everything. Dental technology has exploded. Restorative materials and options abound. Every new iteration brings claims that this device, material, or new way of completing a procedure is the bestever, must-have option. While huge advancements have been made and practitioners as well as patients have a host of choices, Dr. Sergio Rubinstein, an inventor, international lecturer, and prosthodontist, cautions doctors to be wary of product marketing declarations that are not backed up with testing and specific data. “Companies may claim this or that product is faster and less expensive, but you need to answer this question: Is the final outcome better? Patients trust our judgment on how to provide the best possible care for them, and if the end result is not achieved with the newest technology, stay with current treatment modalities until new technology claims are proven and documented.” He cites earlier versions of technologies that claimed dentists could complete restorations in-house, saving time for doctor and patient as well as reducing lab fees incurred by the practice. Marketing for the device emphasized the benefits of completing restorations while the patient waited. Dr. Rubinstein notes that oftentimes those restorations did not fit properly. “As dentists, our goal is to provide the patient with the best possible treatment. While that technology provided some benefits, the ultimate goal was not accomplished.” New dentists need to be cautious that their equipment and technology investments live up to the manufacturers’ claims. “Make sure there is research and testing to back up the advertising,” he emphasizes.

Dr. Rubinstein’s Go-To Products Komet Sonic tips

“This is a must to finish a clear, smooth tooth preparation and margin prior to taking a final impression.”

NSK™ Electric Handpiece

“This offers some unique advantages that place it in a class of its own.”

DentalXP

“Internet lectures are available through several companies such as DentalXP *, which for a small fee will provide you with the best speakers from all over the world at your fingertips. This site is priceless.”

Additionally, Dr. Rubinstein cautions doctors to be wary of large purchases that will become outdated quickly. “We all like to buy the newest technology, but be careful not to purchase equipment Dr. Sergio Rubinstein that will get antiquated very fast, and upgrades or updates may not be a part of the investment,” adds Dr. Rubinstein. “Not only can it be costly, but you can end up with a dinosaur on your hands. Choose the technology carefully and ask respected colleagues what their opinion is when you are preparing to make a large investment.” Dr. Rubinstein recommends that new dentists take three key steps to ensure excellent care for their patients and profitability for the practice. #1. Continuing Education: Clinical and Management. “There are a myriad of excellent lectures available through meetings and study clubs, as well as company-sponsored lectures. I am a personal fan of speakers such as: Team Atlanta (Drs. Ron Goldstein, David Garber, Maurice and Henry Salama), Drs. John Kois, Frank Spear, Gerard Chiche, Brian Vence, Lesley David, and Adriana McGregor. Attending their lectures or courses will change how you practice dentistry. They are outstanding clinicians and speakers.” Dr. Rubinstein notes that dentists have access to online continuing education through several companies such as DentalXP*, which provides ready access to dental experts from all over the world. “It is important to constantly take courses and read to form your own opinions, and differentiate between what is a sales pitch and what offers true value and is supported with scientific evidence.” #2. Hire a Practice Management Consultant. “A consultant can guide your practice in the direction and vision you wish to pursue. I used Sally McKenzie [McKenzie Management] many years ago, and still today we benefit from her valuable evaluation and changes she made to my practice.” #3. Have a Mentor. “We all need a coach, no matter how well educated and talented we are.” Dr. Rubinstein reminds doctors to surround themselves with knowledgeable, trustworthy people. Never enter into agreements without proper documentation and sound legal advice. And remember as the old adage goes, “If something sounds too good to be true, it probably is, so question it.” Finally, Dr. Rubinstein urges new dentists to strive to maintain their passion and their desire to best serve the patient. “We are always learning and evolving. The excitement CONTINUED ON PAGE 32 >>

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Experts that understand your needs. Financing that meets your goals.

2013 Townie Choice Award Winner for Best Practice and Equipment Financing

Dental practice financing from Bank of America Practice Solutions When you need financing* for your practice, you want to work with someone who understands your business needs. At Bank of America Practice Solutions, we’ve helped healthcare practices across the nation reach their goals through smart financial solutions and guidance. And we’re ready to do the same for you.

Let’s talk. Ali Karjoo

Matthew Christie

Practice Start-Up

Practice Acquisition

614.403.8295 ali.karjoo@bankofamerica.com

614.623.5768 matthew.christie@bankofamerica.com

To learn more, visit bankofamerica.com/practicesolutions

All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. The term, amount, interest rate and repayment schedule for your loan, and any product features, including interest rate locks, may vary depending on your creditworthiness and on the type, amount and collateral for your loan. † Bank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America, N.A. ©2014 Bank of America Corporation | Rev. 01/2014 *

Proudly Endorsed by:

Electronic Dental Records (EDR), The Future of All Practices

Mark Hollis, CEO, MacPractice

urrently the typical dental office goes through a lot of paper. But at some point in the future, all dental practices will use electronic health records to record and share patient health information. The History As a direct result of the government stimulus package created by the American Recovery and Reinvestment Act of 2009 (ARRA), the Office of the National Coordinator (ONC) was created to collaborate with the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to develop and implement a program to encourage the adoption of electronic health records (EHR/EDR) by doctors and hospitals in the United States. The primary objective of the program developed by the ONC was at first to provide financial incentives to primary care doctors to assist them in purchasing and implementing EHR. Electronic health records were perceived to be most critical to the success of a nationwide health care “system” in which patient health information is readily accessible to patients and is shared between providers and hospitals, and to provide incentives to support and stimulate the delivery of care to America’s underserved populations. Incentive programs were created for both Medicare and Medicaid. And what is common to both programs is that to receive incentive payments, an eligible provider (potentially YOU) must own a certified EHR system. In February 2011 MacPractice DDS became the first dental software to obtain certification (check the CMS website to see if your software is certified). The Incentive The financial incentive for Medicaid is $63,750 per provider. The Medicare program provides $24,000 per provider. Incentives are paid over three years for Medicare and six years for Medicaid for years in which a provider attests that they have fulfilled the requirements. Approximately 14-20% of all dentists accept Medicaid and Medicare and are potentially eligible for incentives.

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The Details In the first year of attestation, a dentist need only own certified software for Medicaid. Seriously, if 30% of your patient encounters are Medicaid, all you need to do is purchase the software with an intention to demonstrate “meaningful use” in future years, and you can get a check ($21,250 in the first year). However, in year two and subsequent years (and for all years to qualify for Medicare), a dentist must demonstrate meaningful use of a certified EHR/EDR. “Meaningful use” is specifically defined by the government, and demonstrating it has posed a challenge for most dentists, but the good news is that in 2014 no provider needs to demonstrate meaningful use for longer than 90 days or one quarter. Another motivator is that Medicare reimbursements will be reduced by a maximum of 5% over several years for those providers who do not adopt EHR/EDR and demonstrate meaningful use. FACT: At least two states, Minnesota and Massachusetts, CONTINUED ON PAGE 34 >>

Mark Hollis, CEO, MacPractice For more than 30 years, Mark has been helping doctors to run their practices more efficiently, first as a practice management consultant and now as CEO of MacPractice – the leading software for doctors who prefer Apple technology. Mark has spoken at seminars, trade shows, dental schools, and more than 500 small business events at Apple locations. He is an established and well-respected leader on cloud computing, dental and medical technology, and electronic health records. He can be reached at markhollis@macpractice.com.

AGD 2014 Annual Meeting & Exhibits

Rethink.Refresh.Renew. Rethink, refresh, and renew the vitality of your practice and your passion for your profession— attend the Academy of General Dentistry 2014 Annual Meeting & Exhibits, June 26 to 29, in Detroit, “America’s great comeback city.” To help you adapt and thrive in the rapidly changing world of dentistry, don’t miss: • Three days of lecture and participation courses on the hottest topics in continuing education • Some of the foremost speakers in dentistry: º John C. Kois, DMD, MSD º Carl E. Misch, DDS, MDS, PhD (hc) º Ronald D. Jackson, DDS, FACD, FAGD, FAACD • Hundreds of exhibitors showcasing the latest innovations in dental equipment, materials, products, and services

This year’s meeting promises to be a turning point in the way you practice dentistry. Register today!

Advanced registration rate ends May 2, 2014 .

www.agd.org/detroit2014/ND

Ergonomic Design:

The Key to a Long, Healthy Dental Career

BY EDDIE ASH

n recent years, dental professionals have been consistently encouraged to â&#x20AC;&#x153;do more with lessâ&#x20AC;? and to minimize overhead costs in order to maximize profits. As a result of these pressures and the overall economic climate, as well as current conditions in the insurance industry, new dentists are seeing an important aspect of the dental profession, ergonomics, rise in significance. While often overlooked as a physically demanding occupation, the practice of dentistry does demand a certain level of support and well-designed equipment in order to avoid improper tool use, awkward posture, and repetitive motions that can lead to debilitating musculoskeletal disorders (MSDs). These have the potential to shorten dental careers and reduce earning potential by limiting the number of patients that can be seen on a regular basis. There are, however, some key steps every dental professional can take to reduce the risk of sustaining these injuries. For example, when setting up a new operatory or renovating an existing space, ergonomic principles and four-handed dentistry must be considered in the design to optimize efficiency, minimize redundant movements, and increase the overall patient experience. New dentists should seek an expert within the equipment distribution industry to help them purchase equipment and cabinetry that reduce redundant movements and prevent injuries sustained during dental procedures. Today, the practice of ergonomics is gaining increasing popularity and significance as a way to more efficiently see patients and run dental practices, while protecting the dental professionals themselves from potentially damaging, lifelong MSDs. MSDs most commonly suffered by dental professionals occur in the neck and shoulders, upper and lower back, elbow and wrist joints, and knees. New dentists may already be experiencing symptoms of MSDs such as general pain, numbness, burning, cramping, stiffness, and tingling. MSDs differ for men and women depending on the type and length of procedures performed and the number of procedures completed per day. Men have been found to have more problems with their necks, and women tend to have four to five times more problems in their wrists and hands. 28 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

There are a few simple changes dental professionals of both sexes can make to reduce stress on the body right away. One is to begin paying attention to their posture and avoid leaning and slumping. Sitting upright with good back support, using a foot rest, keeping elbows close to the body, and alternating between sitting and standing will make a noticeable difference. Unnecessary reaching can be avoided by positioning dynamic, ancillary, and static instrumentation within the transfer zone of both the dentist and the assistant. Balancing longer and shorter procedures throughout the day, trading off functions with an assistant, and including rest periods is also a successful strategy for working smarter and limiting strain on the body. Posture and time management are good first steps, but choosing the right equipment and practicing true four-handed dentistry are essential to leading a long and lucrative career. When purchasing dental equipment, dentists should ask the dealer for handpieces and instruments that are made from lighter materials with larger diameters. Some tools have angulation that is easier to grip and hold, which is ideal for maximizing control while limiting MSDs. Dentists should also choose motorized tools when possible to avoid excessive manual labor for common procedures, such as scraping teeth. However, not all motorized tools are created equal. For instance, airdriven tools tend to be less advisable due to the loud and often unnerving atmosphere they commonly create for the operator and the patient. By contrast, tools with an electric motor oper-

ate at lower speed but with higher torque. Forty thousand RPMs accomplishes the same task as air-driven tools operating at 350,000 RPMs, while requiring less strength to manipulate, and making for a calmer overall patient experience. New technology is also playing a large role in making some cutting-edge procedures easier on both the dental operator and the patient. Lasers can be used to cut or vaporize tissue, which greatly reduces the need for drills and even anesthesia in some procedures, allowing the patient to enjoy a more relaxed experience. Dental professionals can also more easily see inside a patient’s oral cavity without twisting and turning and while remaining in an upright position. Cameras can be used to display areas of interest on a monitor where both the dentist and the patient can see the image, and loupes can be used to magnify a dentist’s field of view and remain upright. Microscopes provide magnified views of all four quadrants in the dental cavity, allowing a dentist to complete precise procedures while maintaining proper posture. With the right tools and techniques, dental professionals can greatly reduce their risk of sustaining MSDs. But perhaps the most important consideration when designing a new dental operatory is the placement of dynamic, ancillary, and static instrumentation. An operatory designed from the oral

cavity out provides the safest, most comfortable, and most efficient use of space. The goal should be to keep all movements at Class 3 or below for both the dentist and assistant. Instruments should be placed in the transfer zone, the two to four o’clock position on a patient’s oral cavity for right-handed operators and eight to ten o’clock for left-handed operators. This allows the assistant to hand the dentist tools as needed and reduces the dentist’s eye strain by allowing him to keep his eyes trained in the oral cavity. The benefits of ergonomic design go far beyond just the health of the operators and are a smart investment for new dentists. Combined with the efficiencies established through four-handed dentistry, dentists can see more patients per day and extend their careers by avoiding MSDs. By planning ahead and seeking expert advice before purchasing equipment and cabinetry, new dentists will ensure their offices are designed to economize their motion and protect against MSDs, while securing their long-term health and career success. Eddie Ash is the equipment and design specialist at DC Dental. Mr. Ash has over 33 years of experience setting up new dental practices. He can be reached at 410.653.1996 ext 313 or eddie.ash@ dcdental.com, or by visiting www.dcdental.com.

“Dentists are very well educated people, but they don’t teach business in dental school.” Michael Blitstein, CPA, Partner, CJBS, LLC, and member of the Advisory Board, The DentistsNetwork.net

CJBS: experience and knowledge focused on the financial needs of growing dental practices For more than 30 years, Michael and CJBS have worked closely with the dental community and are intimately familiar with the unique challenges of running a successful dental practice. Michael advises clients on a complete range of financial services, including tax, budgeting and retirement planning. Michael and the CJBS team will develop short and long-term strategic plans designed to achieve success for you as a dental practice principal, and for your business. Contact Michael Blitstein today by emailing michael@cjbs.com, or calling 847-580-5442.

CJBS – we help you keep what you’ve earned.

Offices in Northbrook, IL and Scottsdale, AZ Call 847-945-2888 ◆ www.cjbs.com

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Remember, those minutes matter. Too often dentists and their teams underestimate the true worth of each opening in the schedule. Consider this, if you’ve banked on your hourly production being $450 to cover overhead, and there are six 10-minute units per hour then each unit is worth $75. Ten minutes here, 10 minutes there add up in a hurry. Each and every minute matters. Use the daily huddle to look at both today’s schedule as well as what is booked for the next two days, and take steps to keep the schedule full.

1. Text, Email, Phone – Contact your patients to confirm appointments. It’s 2014; the vast majority of your patients want you to communicate with them electronically. When confirming the appointment, state the day, date, time, and anticipated length of the visit.

2. On Call – When scheduling patient appointments, ask the patient if they would like to be contacted if an opening occurs before the day they are scheduled. This is your “on call” list. It is an essential tool when filling last-minute cancellations. Moreover, the ability to text patients to alert them of a short-notice opening in the schedule is essential.

3. Not all Openings are Alike – If you are looking at a sizeable opening in the schedule, such as a full morning or afternoon, your target audience for these appointment times are patients with treatment diagnosed but not scheduled.

4. Check the Reports – The Treatment Plan Report identifies how many dollars are being presented to patients. Follow up with patients that have been diagnosed for treatment but have not scheduled the appointment.

5. Offer Flexible Financing – Provide an “incentive” of some type to those patients with unscheduled treatment. You might offer extended payment options or a percentage off if they are able to come on short notice and pay with credit card, check, or cash. Consider offering something extra, such as complimentary whitening treatment, at their convenience. A little flexibility and a few unconventional approaches will get patients in the chair and cash in the practice.

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30 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

6. Who’s Responsible for What – Job descriptions are essential to ensure that a specific person is charged with the responsibility of keeping the schedule full to meet production goals, and it should be clearly spelled out in her/his job description.

Financial Statement Fundamentals

continued from page 14

often referred to as net revenues. It’s called “net” because any refunds or discounts have been deducted. Moving down the stairs from the net revenue line, the next line typically reflects direct costs. This number tells you the amount of money the practice spent to produce the net revenues during the accounting period. The next line subtracts the direct costs from the net revenues to arrive at a subtotal called gross profit. It’s considered “gross” because there are certain expenses that haven’t been deducted from it yet. The next section deals with operating expenses. These are expenses that go toward supporting a practice’s operations for a given period – for example, salaries, rent, advertising, insurance, etc. Operating expenses are different from direct costs, because operating expenses cannot be linked directly to the production of the services provided. Depreciation is also deducted from gross profit. Depreciation takes into account the wear and tear on some assets, such as equipment, furniture, and leasehold improvements, which are used over the long term. Practices spread the cost of these assets over the periods they are used. After all operating expenses are deducted from gross profit, you arrive at an operating profit before interest and income tax expenses. This is often called “net income from operations.” Next, practices must account for interest income and expense. Interest income is the money practices make from keeping their cash in interest-bearing savings accounts, money market funds, and the like. On the other hand, interest expense is the money practices pay in interest for money they borrow. Then you arrive at the bottom line: net income or loss. This tells you how much the practice actually earned or lost during the accounting period.

Cash Flow Statements Cash flow statements report a practice’s inflows and outflows of cash. This is important because a practice needs to have sufficient cash on hand to pay its expenses and handle cash flow issues. While an income statement can tell you whether a practice made a profit, a cash flow statement can tell you whether the practice generated cash. A cash flow statement shows changes over time rather than absolute dollar amounts at a point in time, like a balance sheet. The bottom line of the cash flow statement shows the net increase or decrease in cash for the period. Generally, cash flow statements are divided into three main parts. Each part reviews the cash flow from one of three types of activi32 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

ties: (1) operating activities, (2) investing activities, and (3) financing activities. The first part of a cash flow statement analyzes a practice’s cash flow from net income or losses. For most practices, this section of the cash flow statement reconciles the net income to the actual cash the company received from or used in its operating activities. To do this, it adjusts net income for any non-cash items, such as depreciation, and adjusts for any cash that was used or provided by other operating assets and liabilities. The second part of a cash flow statement shows the cash flow from all investing activities, which generally include purchases or disposition of long-term assets, such as property and equipment. If a practice buys new equipment, the cash flow statement would reflect this activity as a cash outflow from investing activities because it used cash. If the practice decided to dispose of equipment, the proceeds would show up as a cash inflow from investing activities because it provided cash. The third part of a cash flow statement shows the cash flow from all financing activities. Typical sources of cash flow include cash provided from borrowing from banks. Likewise, paying back a bank loan would show up as a use of cash flow.

Bringing It All Together Although this article discusses each financial statement separately, keep in mind that they are all related. The changes in assets and liabilities that you see on the balance sheet are also reflected in the revenues and expenses that you see on the income statement, which result in the practice’s net income. Cash flows provide more information about cash assets listed on a balance sheet and are related, but not equivalent, to net income shown on the income statement. No one financial statement tells the complete story. But combined, they provide very powerful information for practice owners. And information is the best tool when it comes to managing your practice wisely.

Dr. Rubinstein continued from page 24

of dentistry should always be maintained and should never be replaced by a comfort zone of complacency. Strive to be the best dentist for the patient that elected to sit in your chair. Dentistry is a wonderful profession and must be seen as a privilege where you can actually change peoples’ lives.” *Dr. Rubinstein is a lecturer for DentalXP

is a valuable part of our “CareCredit financial system. We let all patients know we accept CareCredit so we can minimize billing and spend more time on patient care instead of trying to collect on dentistry that’s already been done.

”

Michael Stronczek, DDS, MS Indiana University – College of Dentistry, 1988 The Ohio State University – Oral Surgery, 1992 Accepting CareCredit since 2000

Practices that accept the CareCredit credit card have access to a wide variety of valuable resources to help them: 3 make financial conversations easier 3 attract new patients 3 minimize failed appointments 3 and more!

a r e

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u d i o

3 If you already accept CareCredit’s healthcare credit card as a financing option, contact your Practice Development Team at 800-859-9975, press 1, then 6. 3 If you’re ready to add CareCredit and help more patients access needed care, call 866-246-6401 to get started.

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Healthy Patients continued from page 12 Not only is physical design and space planning important, but you must also consider which interior finish materials you use. Staff training and handling within the sterilization center also plays an important role in eliminating cross-contamination. Use of solid-surface counter tops and solid-surface full backsplashes allows for easy cleaning and sterilization of the surface. Solid-surface materials can be more expensive, yet much better than plastic laminate. These materials are not porous and last for a long time. Since there won’t be any seams in the installation of this material, it can be easily cleaned with one wipe and remains new. Use of simple and solid-surface materials without patterns for the counter tops in the sterilization area and lab provides a better surface for visibility of dirty spots and can be visually inspected for dirty areas. The more patterns the surface has, the less visual inspection is possible. Remember, less is more. Under-cabinet lighting in the sterilization center and lab is a must. This will provide adequate surface lighting for easy operation and visibility for staff. Installation of bright lights on the ceiling provides a better working environment in this area. Certainly do not forget the fan in this area as well. Cabinets and floor materials can play a big role in crosscontamination. Using ceramic tile or vinyl flooring allows easy cleaning. A dental office is among one of the smallest yet most used health care facilities by staff and patients. In such an environment, it is best to use low-maintenance materials that can also last for a very long time. Refrain from using real wood or carpet in the operatory, sterilization, and lab. If you have inherited an old office with these materials, it is best to replace them. Hardwood is porous and can hold bacteria. Should you use ceramic tile, make sure your architect specifies epoxy grout and minimum seam between the tiles to eliminate bacteria accumulation. The materials for cabinet fronts should be similarly close to counter tops and not have a pattern. It always feels and looks better when you can see the cleanliness and clear surface. There are a few companies providing prefabricated sterilization centers, most of which are very good and provide you with a physical layout that has the appropriate sequence of instruments for the most effective sterilization. When designing your sterilization center and lab, it’s good to think about human height. Average human height is about 5 feet, 6 inches. Average reach is 24 inches. This means that the highest someone can reach, on average, is 6 feet and 6 inches off the ground. Typically a person cannot comfortably bend lower than 2 feet off the ground. If you

34 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 4

drew an imaginary line at 2 feet off the ground and another imaginary line at 6 feet, 6 inches off the ground, then the area in between would be what I call the work zone. You want to make sure that your cabinets and anything you need on a regular basis are in the work zone. Anything above the 6 foot, 6 inch line would be hard to reach and should be considered storage space for items you only need occasionally. In order to best fit in the work zone, countertops should be no higher than 2 feet, 10 inches off the ground. These limits provide an ergonomically correct work zone area for your staff in the sterilization area and lab. These areas are always at a high risk for cross-contamination, but an ergonomic design with the right materials will allow your staff to work comfortably in the space while maintaining a sterile and easy-to-clean environment.

Electronic Dental Records continued from page 26

have enacted legislation that will make it mandatory for all health care providers, including dentists, to exchange clinical data with health information exchanges.

The Reality Electronic Dental Records is the future and here are the benefits: • reduce or eliminate paper • remove the task of moving charts around the office • eliminate stacks of incomplete charts • remote and immediate access to dental records • greater efficiency with speech recognition software • promote asepsis A dental practice that uses a flexible, easy-to-use, and easily customizable EDR designed for use by a dentist, versus a physician, can provide better patient care and at a lower cost, and this should be the primary motivation for considering adoption. Lastly, the government provided $160 million of taxpayer dollars to create Regional Extension Centers in every state to assist doctors with the selection and implementation of EHR/EDR. You can also get good advice and assistance from your state Medicaid agency. Do a Google search for the one near you. If you have questions or want to see if your practice is eligible, email MacPractice and we’ll help you. For regulations and FAQs about the incentives, start with http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/.

Arrowhead Dental continued from page 20 right out of dental school. They are generally shackled with student loan commitments and the fiscal burdens of either purchasing an established practice or starting a new one. The last thing on their minds is taking more classes and adding an additional $30,000 to their already existing mountain of debt. They just want to get to work and start paying their bills. However, we feel that new dentists in particular are going to have a very difficult time competing in today’s world of dentistry unless they have specific tools and skills to offer advanced-level treatments. Corporate dentistry seems to be all the rage these days. Honestly, what dentist with a small private practice can really compete with the pricing that large corporate-type dental practices are able to offer for basic dentistry? That’s why new dentists need to offer higher-end services that produce the “wow” factor for their patients. Word spreads quickly, and new dentists who can provide their patients with incredible results can build very profitable and successful practices. That’s why we have developed a CE program for new dentists. We believe in new dentists. We want them to be successful. We know our courses, combined with our lab’s services, will help them achieve success.

How can dentists get started in this CE program? Visit our website at www. ArrowheadDental.com or give us a call at 877-358-0285. The six courses can be completed in any order. We’ll help you set up your own individualized plan based on where you currently are in your career and what your specific short- and long-term goals are. We’ll help tailor make your program to best suit your needs.

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The latest news on products and services for new dentists and their practices VALO Unveils Colors Premier® Implant Scalers The 137 (Anterior) and 204 (Posterior) style implant scalers are now available from Premier® Dental Products Company. These complement the original Facial (Goldman Fox) and Universal (4L/4R) to offer a full selection to dental professionals. Premier® Implant Scalers are made from fiber-reinforced graphite that will not scratch implant surfaces. The tips are thin and sharp with well-defined edges. The graphite is strong yet slightly flexible, allowing the tips to access tight areas effectively and safely. The redesigned handle has textured grips and a larger diameter for greater comfort and control. Premier Implant Scalers can be reused and are autoclavable (273⁰F / 134⁰C); available in two- and five-instrument packs. For more information, visit www.premusa.com or call 888.670.6100. PHOTO COURTESY OF PREMIER DENTAL PRODUCTS

Ultradent Products, Inc. now offers its VALO Cordless curing light in graphite, gold, fuchsia, and teal. VALO’s optimally collimated beam is capable of polymerizing any dental material, including porcelain and underlying resins. The ergonomic design of the wand-style body and large footprint of the curing head provide unprecedented access to the oral cavity. VALO’s unique unibody construction ensures durability. VALO Colors comes with easyto-replace rechargeable batteries and charger. VALO recently received The Pride Institute’s “Best of Class” Technology Award for the second consecutive year. For more information, visit www.ultradent.com or call 800-552-5512. PHOTO COURTESY OF VALO

Isovac™ Dental Isolation Adapter The Isovac™ Dental Isolation Adapter from Isolite® Systems is designed for practices and clinics that want the advantages of state-of-the-art dental isolation. The Isovac provides an easy-to-use alternative for total control of the oral environment to all operatories, especially for hygiene. The strong, ultra-lightweight unibody Control Head Assembly is constructed of an easy-to-clean, autoclavable polymer. Dual vacuum controls allow for focused, continuous, hands-free vacuum suction in either the upper or lower quadrant, delivering better control of moisture and oral humidity. The adapter quickly attaches to an available High Volume Evacuator (HVE) line in the operatory. For more information, visit www.isolitesystems.com or call 800-560-6066. PHOTO COURTESY OF ISOLITE

INDEX O F A D V E R T I S E R 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 New Dentist™ Resources at www.thenewdentist.net to receive information from more than one company. ™

Academy of General Dentistry.................................. 27 www.agd.org 888-AGD-DENT Affordable Image...................... 7 www.AffordableImage.com/007 866-961-4412 American Dental Association................................ 5 www.Adacatalog.org 800-947-4746 Arrowhead Dental Laboratory............................... 19 www.ArrowheadDental.com 877-358-0285 Aspen Dental........................... 23 www.AspenDentalJobs.com 866-748-4299

Bank of America...................... 25 www.bankofamerica.com/ practicesolutions Matthew Christie, 614-623-5768 Ali Karjoo, 614-403-8295 Brident Dental Orthodontics........................... 15 www.brident.com/careers 888-256-9976 CareCredit................................ 33 www.carecredit.com/dental 866-246-6401 CJBS.......................................... 29 www.cjbs.com 847-945-2888 Colgate....................................... 3 www.colgateprofessional.com 800-2-COLGATE Dental Dreams........................... 7 Danielle Tharp, 312-274-4524 Juliette Boyce, 312-274-4520

Freedom FastTrack.................... 1 www.freedomfasttrack.com 800-549-4532 Henry Schein Professional Practice Transitions................IBC www.henryschein.com/ppt 800-730-8883 Live Oak Bank............................ 9 www.liveoakbank.com/dental 877-890-5867 MacPractice............................ IFC www.macpractice.com/dds 855-679-0033 McKenzie Management......... BC www.mckenziemgmt.com 877-777-6151 Midwest Business Capital....... 31 www.midwestbusinesscapital.com 877-751-4622

New Dentist Website............... 11 www.thenewdentist.net Solution Reach........................ 17 www.solutionreach.com 866-605-6867 Viva Learning........................... 35 www.vivalearning.com Wells Fargo Practice Finance..................................... 21 www.wellsfargo.com/ thenewdentist 888-937-2321 Western Dental........................ 15 www.westerndental.com/careers 888-256-9976 Wood & Delgado Attorneys at Law....................................... 13 www.DentalAttorneys.com 800-499-1474 The New Dentist – New Dentist Resources, New ... http://www.thenewdentist.net/resources.htm

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This represents only a sample of our practice listings. For a complete listing, visit www.henryschein.com/ppt ARIZONA

Birmingham-Established Practice, Desirable Area, Seller Highly Motivated, GR $596K #AL108

ARIZONA

Tucson-4 Ops, 1400 SF, Dentrix & Dexis #12111

CALIFORNIA

Folsom/El Dorado Hills-4 Ops, 1200 SF, Dentrix, Digital X-ray, Intra oral Camera, GR $405K #CA103

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COLORADO

Denver-5 Ops, Great Start-Up, Location; Growth Opportunity #CA100

CONNECTICUT

Waterbury-Established FFS Practice w/Condo for Sale, Great Patient Base, GR $417K #CT501

FLORIDA

Brandon-6 Ops, Beautiful Reception Area, Lots of Space, GR $624K #FL505

GEORGIA

Atlanta-4 Op Perio Practice, Excellent Opportunity, GR $834K #GA500

HAWAII

Maui-4 Ops, 1198 SF, 4 Days Hygiene, Pano, Laser, Digital X-ray, I/O Camera, GR $572K #20101

IDAHO

Greater Boise-2200 SF Bldg, Will Sell w/Practice, 1200+ Patient Base, Great Hygiene Program, GR $383K #ID100

ILLINOIS

Berwyn/Cicero-5 Ops, $660K Gross w/Growth Potential #IL503

INDIANA

Evansville-3 Ops, Fully Digital w/Dexis, Digital Pan, EZ Dental Software, 7 Days of Hygiene, GR $435K #IN508

KENTUCKY

LaGrange-2 Ops, Bldg Available w/Practice, Room to Expand, Minimal Overhead, GR $301K #KY504

MAINE

York County-2 Ops w/Room for One More, 1800 SF, Bldg must Sell w/Practice, GR $600K+ #ME100

MARYLAND

Baltimore County-Spectacular Office, FFS, 2500 SF, Stand-Alone Bldg, Digital X-ray, Pan, GR $1M #MD102

MASSACHUSETTS

Cambridge-3 Ops-Room for 4, Desirable Location, Dentrix, Digital, Cerec #MA107

MICHIGAN

Clinton Township-Established Family Practice, Owner Retiring, GR$670K #MI108

MINNESOTA

Southern-Small Town Practice w/ Great Growth Potential, GR $364K #MN500

NEVADA

Henderson-Deceased DDS, 6 Ops, Pediatric, Dentrix, Pano, GR $766K #NV100

NEW HAMPSHIRE

Gilford-Nice GP & Condo in Lakes Region, Small Emphasis on Perio and Implant Surgery, GR $512K #NH100

NEW JERSEY

Atlantic County-7 Ops, 2100 SF, Leased Space, Paperless, Digital, Eaglesoft, Amalgam Free #NJ114

NEW YORK

Baldwinsville-4 Ops, Digital, Soft Tissue Laser, Growing Community, Bldg Available, GR $512K #NY101

NORTH CAROLINA

Asheville-5 Ops w/6 Op Plumbed & Partially Equipped, FFS, Great Opportunity! #NC101

NORTH DAKOTA

S Central-Wonderful Productive Rural Practice, GR $696K #43102

OHIO

Miami County-3 Ops, Well-Established, 24-Hour Work Week, 5 Days Hygiene, GR $453K #OH502

OKLAHOMA

Tulsa-6 Ops, Digital, Eaglesoft, Low Overhead, Great Opportunity for Growth, GR $583K #OK100

PENNSYLVANIA

Berks County-4 Ops, 2000 SF, Well-Established, Building Available, GR $475K #PA117

RHODE ISLAND

Scituate-3 Ops w/4th Available, PPO & FFS Patients, Pan, Dentrix, Dexis, GR $454K #RI500

SOUTH CAROLINA

Aiken County-4 Ops, 1750 SF, Stand-Alone Bldg, Great Opportunity! Motivated Seller, GR $250K #SC102

TENNESSEE

Coffee County-4 Ops, Well-Established, Desirable Location, Building Available, GR $400K #TN502

TEXAS

Dallas-3 Ops, Prostho Practice, 1200 SFw/Well-Designed Lab, GR $300K #TX502

VERMONT

Central-5 Ops, Outstanding Practice, Desirable Location, GR $817K #VT101

VIRGINIA

Eastern Henrico County-Good Starter Practice w/Excellent Growth Potential, GR $250K #VA105

WASHINGTON

South Snohomish County-6 Ops, 1700 Active Patients, Strong Hygiene, GR $1.2M #WA500

WISCONSIN

Madison Area Practice Wanted-Buyer Interested in Acquiring a Satellite Practice w/Owner Willing to Stay as Associate #WI500

Starting Buying

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My business knowledge prior to starting my practice was minimal. You have to make a lot of decisions and I didn’t have any experience with hiring my first employee, what my financial arrangements were going to be or even how to create a business plan. I didn’t realize how much the banks valued this service to include it as part of my start-up loan! My personal McKenzie Coach was there to help me from before I found my location to supporting me the entire first year. I am very comfortable and confident now in my ability to own a dental practice. I’m MUCH farther ahead with McKenzie Management as my trusted advisor than I would have been thinking I could do it myself. I understand, now, the difference between “I think” and “I know”. McKenzie Management - Dental Consulting, Dental... http://www.mckenziemgmt.com/cons-startup.php

Partnering with McKenzie Management was the best! They helped me get financing for my new practice which included their expertise for my first year. Honestly, I had no idea what I was doing. They helped through the acquisiton phase and then after I got the keys they were there to help get the existing staff on board. I knew that gaining the respect of the employees was not going to happen just because I signed their paycheck now. My McKenzie Coach went over all the business operations and developed a plan that enrolled them in the process, opened up the lines of communication and leveled the playing field for me as the “newbie” coming into their world. We had our new plan of action and the first year we increased the production by 23%! I haven’t worried one second about paying my loan! I have complete confidence in myself as a business owner thanks to McKenzie Management! McKenzie Management - Dental Consulting, Dental... http://www.mckenziemgmt.com/cons-practiceacquis...

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