New Dentist Winter 2010

THE #1 JOURNAL FOR NEW DENTISTS

More Dental Practices Choosing to go

Green P LU S

What to Consider When Choosing a Handpiece #1 Reason New Practices Struggle WINTER FALL 2010 2009

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Call 888-910-4376 or visit us at curvedental.com ©2010 Curve Dental, Inc. Curve Dental and Curve Hero are trademarks of Curve Dental, Inc. Life is full of changes, like politics, diapers and pricing.

A-NEWDENTIST JAN 2010

FROM THE PUBLISHER’S DESK WINTER 2010

Dear Readers,

PUBLISHER

A

s I write this message for the winter issue of The New Dentist, most of the country is in the deep freeze. And global warming skeptics are claiming that a few weeks of winter are proof that the Earth’s temperature is perfectly fine. Regardless of your personal opinion regarding global warming, I can tell you that many, many new dentists are embracing eco-dentistry and environmentally responsible dental practices.

In this issue’s feature article, we talked to new dentists across the country who have adopted a multitude of green systems and everyday habits to reduce the negative impact their practices are having on the environment. I have to say that one of the most heartening aspects of this article is the sense of personal responsibility that each individual we spoke with has. They sincerely want to do what they can to protect and preserve our planet. But we have barely scratched the surface of this topic. Eco-dentistry and environmentally friendly practice is an issue we look forward to exploring further in future issues.

Also in this issue, if you’re opening your practice and trying to determine who to hire first, the assistant or the business employee, Lois Banta of Banta Consulting and Debbie Rae of McKenzie Management, share their management expertise on this topic. And once you start hiring staff or working in a dental office there are bound to be disagreements. Dr. Nancy Haller gives proven and practical strategies for negotiating peace when the staff have declared war.

Dr. Josh Austin has sound advice for every new dentist in making the very best first impression and he’s not talking about a good strong handshake. Dr. Austin has tested a variety of impression materials in his practice, and he’s found that some definitely perform better than others. He also has several other recommendations and firsthand new dentist experiences to share on his Clinical Buzz Blog at www.thenewdentist.net/clinicalblog.php.

In addition, to expert clinical advice at www.thenewdentist.net website, be sure to visit the Management Buzz Blog. Here you can ask any practice management question and you’ll receive an answer within 24 hours or less.

Also in this issue, Dr. John Flucke shares his strategies for sifting through the marketing, the hype, the multitude of models, choices, and special features in order to choose the handpiece that will work best for you.

I hope you enjoy this issue of The New Dentist™, and I would encourage you to recycle it. Share the magazine itself or the digital version, www.thenewdentist.net/digital.htm, with a friend. The publication and our companion website, www.thenewdentist.net, offer a wealth of material to help guide you at every step throughout your career.

Fondly,

2 WWW.THENEWDENTIST.NET

WINTER 2009

Sally McKenzie, Publisher

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Picante Creative picantecreative.com Managing Editor

Tess Fyalka Tess@thenewdentist.net Consulting Editors

Tom Snyder, DMD MBA Jim Stehman, DMD Keith W. Dickey, BS, DDS, MBA, SIU, School of Dental Medicine SALES AND MARKETING

For display advertising information contact ads@thenewdentist.net or visit our digital media book at www.thenewdentist.net/ mediabook.htm 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 US dollars only).

Copyright ©2009 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 visit our website at www.thenewdentist. net to download a media kit.

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This ad is an outline only and not a contract. Benefits are provided under group policies issued to the American Dental Association, filed in the state of Illinois, and underwritten and administered by Great-West Life. All policies are subject to, governed by, and shall be construed in accordance with Illinois law. Eligible ADA and ASDA members residing in any U.S. state or territory may apply for coverage.

NDAD09-ND

Protecting your family, your income, your practice. Life • Disability • Business Overhead • Hospital & Critical Illness

TABLE OF CONTENTS

WINTER 2010

20 F E AT U R ES

6 The #1 Reason New Practices Struggle

By Sally McKenzie, CEO, Publisher

Your First 10 Make Impression Count

By Josh Austin, DDS

Dentists Choosing 12 More to Build ‘Green’

By Tess Fyalka, Managing Editor

to Consider When 14 Things Choosing a Handpiece

By John Flucke, DDS

You Conduct Employee 16 Should Background Checks?

By Andrew Paluda and Jeffrey Smolek

the Right 18 Picking Associateship

By Tom Snyder, DMD, MBA

to Hire First? Business 20 Who Employee or Assistant Laboratories, Partners 24 Dental for Your Practice

By Bennett Napier, CAE, NADL

12 DEPARTMENTS 2 Publisher’s Desk

Nets for You 28 Safety and Your Practice

11 Dental Students What’s on Your Mind?

By Leslie Franklin

22 The Not-So Simple Human | Staff Wars –Erase the Battle Lines

22 The Buzz

14 4 WWW.THENEWDENTIST.NET

WINTER 2009

30 Skinny on the Street 30 Ad Index

24

“In situations like

these, I’m glad I have CareCredit to offer.

It helps me keep patients happy and make dentistry less stressful, especially financially.

”

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THE #1 REASON NEW PRACTICES STRUGGLE:

TRAINING I

Sally McKenzie , CE O

magine the panic that would sweep over you if you learned that you had just invested a huge sum of money in a new home only to discover that those who built your house were never really trained to build homes. Not that they didn’t have any construction experience. In fact, they had plenty of experience building garages, but not family dwellings. Or what if you were lying in the hospital bed and the nurse was about to administer sedation and you heard her say, “I think I know how to do this. Dr. Jones showed me the procedure a while back when he had a few extra minutes.”

Perhaps you brush off those scenarios as examples of situations in which you wouldn’t allow yourself to be caught. Yet you have likely placed your personal and professional livelihood firmly in the hands of someone who probably has very little training in the responsibilities that s/he is supposed to carry out.

Experienced but Not Prepared When faced with hiring employees to handle the business details, new dentists simply don’t know what to look for, and they typically consider any experience to be quality experience. They look at an applicant’s resume and see that s/he has worked in a dental office before and automatically assume that person will bring a sufficient amount of know-how to the position. But just because someone has been in the ballpark doesn’t mean they are qualified to play in the game.

Typically, a newly-hired business employee comes into an office and tries to figure systems out as they go along.

They are waiting for direction, guidance, some clue as to how the doctor wants things done. But the doctor simply assumes that if the employee carries the title of business manager, scheduling director, or whatever moniker the position holds, the new recruit automatically knows what is expected and what s/he is supposed to do. After all, the 6 WWW.THENEWDENTIST.NET

WINTER 2009

TO PURCHASE

dentist carries the title doctor and s/he knows what to do.

The new employee, without direction otherwise, is forced to make assumptions that the protocols s/he followed in the previous office apply in this practice as well. Perhaps the last employer didn’t have a procedure for confirming appointments, the new employee simply doesn’t consider that this one might. The other dentist may not have had a collections policy or an expectation that patients pay at the time of treatment. Consequently, the business employee thinks nothing of waving patients out the door and telling them that the practice will bill them for the services.

Doctors, meanwhile, will dismiss the clear indicators of an untrained or poorly trained team – collections are falling, accounts receivables are up, scheduling problems are increasing, appointment failures are escalating, and so on.

Certainly, it’s much easier to assume that the daily mix-ups and frustrations are just part of life in the busy dental practice than it is to face the possibility that those inefficiencies and shortfalls indicate a serious training deficiency.

Unfortunately, as time goes on, the dentist concludes that

Realize Your True Potential The New Dentist Practice Enrichment Program is specifically designed for dentists in the first five years of practice.

“I hired McKenzie Management to help me with my practice year one into a scratch start. I would definitely do it again.

McKenzie Management helped me increase efficiency and productivity and helped to implement successful systems.

I had a gut feeling I could benefit from a practice consultant, but I was reluctant to hire one for my practice. I thought a business degree and corporate experience was all I needed for success. I’m glad I went with my instinct and called McKenzie Management. I had heard they were the best, and now I know it. My investment in McKenzie not only paid for itself by the second month, the systems put in place continue to pay dividends. I can recommend them without hesitation.

I am happy to speak to any dentist about McKenzie Management.”

- Dr. Frank Clayton • Suwanee, GA

Call or e-mail today and we’ll give you a financial motivator you can’t refuse with monthly payments as low as $388/month.

1.877.777.6151

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the new employee just isn’t working out. After all, this person came with dental office experience; s/he should know what to do. The doctor told them that they would be in charge of collections. What’s not clear about collections? The doctor had high hopes for this new recruit and is disappointed that yet another employee just doesn’t seem to get it. Similarly, the new team member came on board optimistic about the opportunities the position offered but has become very frustrated that s/he can’t ever seem to get any clear direction as to what is expected. Neither is satisfied with the employment arrangement, yet both could reap the benefits of a successful working relationship if the practice would implement a training protocol for new employees.

In-house Often = Inept The unfortunate reality is that while most dentists recognize the value of ongoing education for the clinical team, they commonly disregard the importance of educating those who have direct control over thousands upon thousands of dollars in practice revenues. What’s more, they fear that a freshly trained staff member will pack up and take their newly developed expertise to the practice down the street. In reality, the employee that has the opportunity to improve their skills tends to be much more vested in the success of the practice.

Yet, oftentimes, if there is to be any training of the business team it will have to come from the other staff. Doctors convince themselves that they can simply rely on existing employees to prep the new recruits. Realistically, how much accurate information could actually be passed down from one team member to the next when the typical educational chain runs something like this: Carol, who left the practice in 2005, trained Marci. She left the practice in 2006 shortly after training Jackie, who was fired from the practice in 2007. Jackie trained Jill who was there when the new computer system was installed and was viewed as the office expert, but Jill left suddenly in 2009.

Since then, Jo has been trying really hard to figure things out.

Somewhere in between the comings and goings of all those employees and the dissemination of wrong or partially correct information, the new employee might pick up a kernel or two of useful knowledge. But to a large extent, the new employee, without proper training, has a very slim chance at succeeding in the practice.

In the rare event that a practice actually has a staff member fully versed and able to train a new employee on all the aspects they need to know about the practice systems, when, exactly, will they have the time to do so? In reality, a busy dental team does not have the time or scope of knowledge to train a new 8 WWW.THENEWDENTIST.NET

WINTER 2009

employee to succeed. Is it any wonder that the single, biggest contributor to inefficiency and mismanagement in a new practice is a poorly trained team?

TO PURCHASE

Affordable, Efficient Staff Education So where’s the good news in this seemingly bleak training picture? There’s plenty and the best part is that staff can be trained without spending days away from the office or thousands of dollars. The marketplace today provides numerous affordable training options for dental teams. At a minimum every new employee should receive professional training on the computer practice management system, which is the central nervous system of the practice.

And, although I strongly discourage reliance on internal training exclusively, particularly with new employees, in-house knowledge sharing across the team can be highly beneficial in helping all staff understand the importance of certain practice systems and philosophies. Dental teams can reap significant rewards when they set aside time each month to educate each other on specific protocols and systems. Moreover, the sessions enable each member to better understand how s/he and others are essential to the success of the entire practice.

For example, a session in which the hygienist explains to staff why recommendations for perio treatment are made can help the larger team understand the diagnosis and reinforce that recommendation with the patients. Another session might focus on explaining the benefits of a new procedure now available to patients, so that members of the team can answer basic patient inquiries about the treatment.

Ongoing formal and informal instruction of the entire team, business and clinical, is critical to the success of the new practice. Ultimately, when the employees are given the instruction, direction, and tools to do well, they thrive, so too does the practice.

Sally McKenzie is CEO of McKenzie Management and can be reached at 1.877.777.6151 or sallymck@mckenziemgmt.com.

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1/7/10 2:27:54 PM

Make Your First Impression Count

BY Josh Austin, DDS

I

n my opinion, one of the most difficult aspects of dentistry is making an accurate master impression for fixed prosthodontic procedures. During the impression making process, the dentist must be aware of many things at one time and coordinate steps with an assistant and a patient. This is a very difficult circus to orchestrate and many times leads to lackluster results that carry on throughout the rest of the prosthodontic procedures.

The master impression is the key to successful fixed prosthetics. Without an accurate impression, the laboratory cannot fabricate a well-fitting prosthetic. None of this is earth-shattering information. Dentists have known this for many years, yet each of us struggles with it on a regular basis. Although technology is improving and will some day replace impression making with digital scanning, for most of us, that is in the future.

Most of us still attempt to make our impressions with polyvinylsiloxane impression material and will continue to do so for some time. With this in mind, we should continue to strive for perfection with our impression-making.

I will make the assumption that most readers are making impressions with either PVS or polyether impression material.

Most new dentists don’t even use rubber base for removable, much less fixed. That being assumed, I will give some standard tips regarding impression materials.

1 Know your material. Know its set time. Know how it handles at various time intervals after mixing. This is critically important. If you cannot anticipate and predict your material’s behavior over time, you are at a disadvantage when it comes time to syringe your preparation. Work with your assistant to determine the best way to time the mixing of the different phases of materials so that one phase doesn’t reach set long before another.

2 Refine your retraction method. I do not believe that one retraction technique is superior to another. Each clinician should determine what retraction technique works best in his/her own hands. However, it is essential that clinicians stay abreast of advances in this regard and be willing to try new products. Recently I adapted from a traditional two cord technique to a one cord technique with a paste. I now perform my rough prep then pack a cord and refine margins. Just before the impression is made, I apply a hemostatic retracting

TO PURCHASE

10 WWW.THENEWDENTIST.NET

WINTER 2009

paste. It sits for five minutes and is then rinsed away. There are several brands of hemostatic retraction paste, like Expasyl or Traxodent. The paste works better in my hands. After rinsing the paste, the cord stays in the sulcus during the impression.

This eliminates pulling a cord, which always causes hemorrhage in my hands. I feel like the paste gives me the same lateral retraction a second cord would with better hemostatic properties. If you haven’t tried these pastes yet, give them a shot. They work well for me in several different applications.

3 Use a rigid tray. I use all-metal non-disposable reversible hydrocolloid trays for quadrant fixed prosthodontic impressions. This eliminates the variable of tray flexure from the equation. Tray flexure can be an invisible enemy that will ruin the fit of the prosthetic. The problem is that tray flexure cannot be diagnosed until the patient has returned for delivery and the restoration just does not fit the preparation. At this point, lab time and fees have been invested, not to mention a second visit for the patient. Eliminate this from the beginning.

Use the most rigid metal triple bite tray you can find.

4 Explore surfactants. Dentsply began marketing a product called B4 for use with their Aquasil impression material. B4 is a surfactant that is painted on the preparation in a light layer just prior to impression-making. The thought is that the surfactant will break the surface tension on the prep and allow the light-body material to flow easier. I find that it works well. I have not seen any clinical science on this but in my hand, I get more flash and fewer voids around the finish lines of my preparations when using B4 with Aquasil. I am not sure of any other companies using pre-impression surfactants but there could be.

I believe that digital scanning will replace impressioning in the next five to 10 years. The accuracy of milled or stereolithographic models far exceeds that of gypsum stone models.

Until then, we must still strive to perfect our impressions in order to give our patients the best restorations possible. There is no easy way around this. We must be keenly aware of all things going on during the impression making process and work with our assistants to reach a predictable, repeatable method to ensure total accuracy.

Dr. Josh Austin is a 2006 graduate of the University of Texas Health Science Center San Antonio Dental School. After working as an associate for two years, Dr. Austin opened his own practice last fall. He is a regular columnist for The New Dentist™ magazine and website. He can be reached at jaustindds@ thenewdentist.net or www.thenewdentist.net/clinicalblog.php.

DENTAL STUDENTS: What’s on Your Mind?

The New Dentist recently caught up with Michael Meru via email. He is in his first year of the orthodontics specialty program at the University of Southern California School of Dentistry, the same school where he earned his DDS degree last spring. Here’s what is on his mind these days.

TND: What made you decide to continue on with your education rather than enter practice?

Dr. Meru: Choosing to enter into

orthodontics was a tough decision for me, as there are so many aspects of general dentistry that I truly love.

That being said, I have always had a 7.375" x 4.875 great interest in orthodontics, stemming from my experience as a child

when I suffered from a severe malocclusion that scarred my self-esteem greatly. I remember vividly that the condition of my teeth was such that I lacked confidence and was too embarrassed to interact with anyone other than my close friends. My parents noted my condition and made the monetary sacrifice that allowed me to have orthodontic treatment. After four years of therapy, my life had changed completely. Having the opportunity to change others’ lives, in the same manner that mine was changed, was ultimately what lead to my decision to enter the orthodontic profession.

TND: What do you find is the greatest challenge in making the commitment to pursue a specialty?

Dr. Meru: The greatest challenge in

making this decision was ensuring

that my wife, Melissa, would be ok to continue without income for another three years.

TND: What should dental students consider when deciding whether to pursue a specialty?

Dr. Meru: Being content in life is so

important. You should never enter into a specialty, or any field of work for that matter, for money or prestige. Life is too short to spend it doing something you don’t enjoy. So my advice would be to become familiar with all aspects of dentistry and then do what makes you the happiest.

Dental students, tell us what’s on your mind. Email Managing Editor Tess Fyalka at tess@thenewdentist.net. We want to hear from you.

WINTER 2009

WWW.THENEWDENTIST.NET 11

BY Tess Fyalka, MANAGING EDITOR

MORE DENTISTS CHOOSING TO BUILD

I

n the summer of 2008, John Boice owner of Boice Engineering and Development Inc., based in Southern California, was paying $5.00 a gallon for gas on each of the 15 vehicles in his company’s fleet. He says that was his wake-up-call. Mr. Boice was going to do whatever it took to go “green” in his business and offer his clients the option of building entirely “green” offices.

Mr. Boice has designed and constructed several dental offices during his 15 years in business, and he says he has found that once he began offering the “green” building option, dentists were very interested in pursuing it. “Many dentists have heard of eco-friendly, but they don’t know much about the LEED program, which stands for Leadership in Energy Environmental Design (LEED). That is the national benchmark for the design, construction, and operations of highperformance green buildings. “ He notes that most dentists

12 WWW.THENEWDENTIST.NET

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don’t realize how much they can do in designing a new office that is environmentally friendly and energy efficient. “But once we start talking about it and they understand how easily they can incorporate it into the design of their offices, they are very interested in pursuing it,” notes Mr. Boice.

When helping a dentist establish a green office, this developer seeks to answer a few specific questions, beginning with location. Is the doctor considering space close to public transportation? Will there be a long-term lease agreement in which the doctor can stay in this particular office for a minimum of 10 years? Is there onsite recycling or is there enough storage to hold materials until they can be collected for recycling?

And is there an area in the new office where the doctor can establish his/her own recycling system? In addition, Mr. Boice works with various vendors to help doctors establish paperless offices, incorporate digital X-ray systems, purchase recycled

Photo courtesy of Boice Engineering and Development, Inc.

‘Green’Offices

s

furniture and cabinetry, and the list goes on.

In building “green” practices, Mr. Boice says that his company uses low viscosity paints, all waste is recycled, and nothing goes to the landfill. Recycled and renewable products are incorporated into the building wherever they can be, including in the flooring and cabinetry. Energy efficient and natural lighting is used throughout the office as well as energy efficient HVAC systems, the computers have Energy Star ratings, and the restrooms are equipped with low-flow toilets.

Dr. Kendalyn Lutz-Craver, a 2003 graduate of the University of North Carolina at Chapel Hill School of Dentistry, built her first practice in 2007 in rural North Carolina. She was intent on ensuring that her new building would be LEED certified. “Once you have the design, you sit down with the architects and engineers and go through the checklist and you can be certified as silver, gold, or platinum.

You go through the list and figure out what makes sense, what is doable, what is cost effective, and what’s going to give you the best return on your investment in your facility. It’s much easier to build a LEED certified practice today because that is the trend in building,” explains Dr. Lutz-Craver.

In addition to LEED certification, dentists can also pursue GreenDOC Dental Office Certification through

RECEPTION AREA IN DR. LUTZ-CRAVER’S LEED CERTIFIED DENTAL OFFICE

the Eco-Dentistry Association (www.ecodentistry.org). The program provides standards for green dental offices, best practices, product recommendations, action plans to help establish green practices over time, as well as other services.

Susan Beck is director of the Eco-Dentistry Association.

She explains that the organization was established to provide dental professionals with continuing education, practical tips, product suggestions, and standards for going green. According to the association, each year dental practices generate 4.8

million lead foils, 28 million liters of toxic X-ray fixer, 3.4 tons of mercury waste, 1.7 billion sterilization pouches, and 680 million chair barriers, light handle covers, and patient bibs. The green dentistry approach to practice reduces waste and pollution. Saves water, energy, and money, and incorporates high tech equipment.

For Dr. Bridget Walsh, a 2003 graduate of the University of Pennsylvania School of Dental Medicine, when she and her sister, Dr. Megan Azar, a 2002 graduate of Temple University’s School of Dentistry, decided they were going to open their first practice, they knew they wanted to create an environmentally friendly practice.

“The summer before we moved into our new office, there were all these articles on the water quality in our community, (Clarks Summit, PA) and the concerns with all these emerging chemicals. We just felt we had a responsibility to consider our impact on the environment when we were setting up our office and in how we planned to practice. We used a natural linseed linoleum, which is known as Marmoleum. In the carpeted areas we used low VOC (volatile organic compounds) carpet that is recyclable. We used a no VOC paint and energy efficient lighting. Most of our paper products are post consumer recycled. We’ve tried to use preferred purchasing and consider the packaging when we order products as well as the timing. We place our supply orders only once a month so that everything comes together at one time. We’ve reduced the harmful chemicals that we use to clean and found effective alternatives for those. We also went with digital X-rays and digital charts.” She urges dentists to talk to their suppliers about product options. “When your reps know that green dentistry and eco-friendly practices are a priority for you, they will recommend products that have less impact on the environment,” explains Dr. Walsh.

Steven Koos is an MD and DDS who specializes in oral and maxillofacial surgery in Chicago. His office, ORA Oral Surgery & Implant Studio, is the first completely green oral surgery practice in the nation. “We carefully planned the construction of a green building on a sustainable site. We are members of the United States Green Building Council, and we built our practice in accordance with LEED. We utilized all green interior design finishes and textiles that are free of PBTs, which are persistent bio-accumulated toxins and VOCs. Many of the materials are made from post-industrial and post consumer waste. We also employ green business practices, which includes paperless charting, environmentally conscious purchasing, electronic claims, electronic reminders, and electronic recall.”

CONTINUED ON PAGE 26 >>

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Things to Consider When Choosing a

C

Handpiece

hoosing a handpiece shouldn’t be difficult right? Of course not, but if that is the case then why are there so many choices? Before you plunk down your hard earned (or borrowed) money, remember the handpiece is the one piece of equipment you will hold in your hands every day. It’s a decision that shouldn’t be taken lightly.

When choosing a handpiece, first decide the type of drive you want. For years, the standard air driven turbine was the only choice, but in recent years the electric handpiece has become a viable alternative. Standard air driven turbines are the most affordable and offer the most variety.

They are, by far, the most popular choice due to their easy maintenance and low cost.

Electric handpieces are more efficient since they

BY John are powered by DC driven motors. They do not stall.

Flucke, DDS They have incredible torque, and their power can be controlled by “dialing them down.” This allows for precise finishing of margins and less switching between a high speed and slow speed handpiece. However, electrics are significantly more expensive, are heavier, and have more weight and “pull” from the cord since the electrical components in the cord are thicker and heavier than the air hoses for the air driven turbine.

There is also the matter of maintenance. Electric handpieces must be meticulously maintained. Instead of an air turbine, the head of the handpiece is composed of gears driven by the DC motor. If maintenance is not done properly, the gears can become covered with a build-up of oil and debris. In an air turbine this build up would cause the turbine to lock up and fail. However, the torque of the DC motor allows electric handpieces to continue to turn in these situations. This can cause a tremendous heat build up in the head of poorly maintained electrics. There have been documented cases of patients actually being burned by electric handpieces that are not maintained properly.

My personal preference in the last year has been ProDrive. This company makes replacement turbines for many manufacturers and also has their own line of handpieces. What makes them different is their chuck design 14 WWW.THENEWDENTIST.NET

TO PURCHASE

WINTER 2009

and the design of the burs they use. The chuck is triangular in shape and holds a bur with a triangular shank. While most doctors don’t notice, the traditional round chuck/round bur has lots of slippage which creates an inefficient cut. This means less is accomplished in the same time with a standard round configuration. Using ProDrive turbines and handpieces gives much more torque and more precise margin finishing for a cost very close to a standard round chuck/round bur handpiece.

Another important consideration is the “feel” of the handpiece. Definitely don’t discount how the handpiece feels in your hand. There are numerous designs out there and you owe it to yourself to check out several. I’ve known many doctors over the years who tried to change brands and had to go back because the new one just never “felt right” in their hands. Remember you’ll be holding this instrument every day that you practice and even small annoyances will magnify over time.

Make sure you can adequately grip the handpiece. Some doctors prefer a smooth finish while others prefer a knurled surface. Go to your favorite local dental supplier and try out different types in their showroom. They’ll be happy to have you set up an appointment and try all the handpieces they sell. Make sure to bring some extracted teeth to work on and don’t forget the gloves! Testing a handpiece without gloves will not give you a true test drive. Also make sure to use the gloves both dry as well as wet. Although we don’t usually work with wet gloves, you want to make sure Dr. John Flucke is a practicing dentist in Lee’s that you can still have an Summit, MO and Technoladequate grip for those ogy Editor for Dental rare times when your Products Report. Visit his CONTINUED ON PAGE 32 >>

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Should You Conduct Employee

Background Checks?

BY Andrew J. Paluda and Jeffrey A. Smolek of Paluda Smolek P.C.

I

t is no secret that we live in a litigious society.

There is no way for individuals or businesses to completely insulate themselves from potential lawsuits or litigious individuals. There are, however, steps that can be taken to minimize the risk of becoming embroiled in a financially and emotionally draining lawsuit or administrative hearing.

This article focuses on one aspect of safeguarding your practice by performing employee background checks. Performing employee background checks is important for several reasons, including minimizing the potential exposure to lawsuits or other administrative claims initiated by unhappy patients over alleged inappropriate care, treatment, or billing issues. Employee background checks are also important for safeguarding your practice against internal theft. Finally, background checks can assist you in protecting the safety of your patients and staff.

As employers and owners of small businesses, dentists face possible claims for the negligent hiring of both associate dentists and support staff. Consequently, it is important to perform background checks in order to confirm an applicant’s qualifications and professional standing. The extent of the background check will depend on various factors, including the position for which the person is being considered.

For example, when the decision is made to hire an associate dentist, it is important to ensure that the prospective associate is appropriately licensed. It is also important to determine whether the licensee is the subject of any present or past licensing action. Confirming your hygienists and/or assistants maintain the appropriate license or certification is equally important, depending on the extent to which you intend on delegating professional services. As a dentist and employer, it is your responsibility to ensure your employees are performing only those services within the scope of their license or certification. This determination is regulated by state statutes, on a state-by-state basis.

Having a responsible and trustworthy staff is integral to the success of any dental practice.

Background checks of individuals handling administrative areas of your practice, such as billing, are important, since patient dissatisfaction often originates from billing disputes. The prudent owner should also attempt to protect the practice from internal theft, billing inaccuracies, and inappropriate communication with patients concerning their bills. Obviously, maintaining happy and satisfied patients aids in patient retention and referrals. It also helps to avoid malpractice claims. Remember, a patient that considers you more than just their dentist is less likely to file a claim of malpractice or institute some other form of administrative proceeding against you.

Developing strong relationships with patients not only applies to you as the dentist, but also your staff. Since your support staff will be regularly interacting with your patients, it is important to be sure they share a positive attitude toward your patients. Knowing the background of your employees and prospective employees can assist in determining whether a particular employee is a good fit for your practice.

TO PURCHASE

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CONTINUED ON PAGE 26 >>

Andrew Paluda has specialized in the representation of dentists in malpractice and general business matters for over 20 years. He has a Martindale-Hubbell AV rating in recognition of his preeminent legal ability and high ethical standards. He frequently is called upon to give risk management seminars and was recently named a top lawyer by DBusiness Magazine.

Jeffrey A. Smolek has been practicing law since 1995 and has been representing dentists in various business, malpractice, licensing and peer review matters for many years. He received his Bachelor of Arts degree from Michigan State University in 1992 and his Juris Doctor degree from the University of Detroit Mercy School of Law in 1995. He is licensed to practice law in the State of Michigan and is also admitted to practice in both the United States District Courts for the Eastern District and Western District of Michigan.

Mr. Paluda and Mr. Smolek can be reached at 248-740-0203 or at www.paludasmolek.com

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Picking the Right ASSOCIATESHIP

and What to do if it Doesn’t Work Out

N

ot all associateship relationships are successful and there are many reasons why they fail.

However, there are a number of steps you can take to ensure that you are well informed about the doctor and practice you will be joining before signing a contract or joining a practice as an associate.

TO PURCHASE

DO YOUR HOMEWORK Just taking a job to “earn money” is not the way to start a professional relationship in a dental practice. As much as the host doctor wants to know something about you and your background, you should do the same. During your interview, in addition to answering questions from your prospective employer, it’s equally important that you ask questions so that you can ascertain whether this opportunity is the right one for you. Here are some tips to consider in preparing for your interview and what questions to ask: Type of Practice It’s important for you to understand the philosophy of your employer as to their approach to care and management. What is the employer’s philosophy and approach toward treatment planning? Is it something you are comfortable with?

Patient Base You certainly don’t want to join a practice and not be busy.

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Having an adequate patient base for you to work with is a critical element of your success in the practice, as it is directly related to your ability to earn an income.

Ideally, you’d like to join a practice that is “saturated.”

That means your employer has more patients than s/he can handle. Saturation typically starts when a patient base reaches a critical mass of 1,500 to 1,800 active patients. An active patient is a patient who visits hygiene once every 18 months. Therefore, saturated practices offer the best opportunities for you. We have found in our research that for every 200 to 225 active patients, that should equal one associate day per year. So, for example, if you are considering a practice with 2,500 patients, you can probably expect to work three to four days per week versus a practice that may have 2,000 active patients and maybe provide you with one to two days per week.

Also, in most saturated practices there is an abundance of dentistry in the patient charts because many patients have not been participating in the recare program as the practice is extremely busy. The last thing a “saturated” practitioner wants to do is add hygiene days. It just compounds their problem.

The solution here is hiring an associate! We recommend that once patients are reactivated back into the practice that the associate perform the initial hygiene services. It’s an excellent

way to get to know the patient and if all goes well, they can become your patient in the future.

Size of Facility Be mindful that if you join a practice that only has three operatories, based on the doctor’s practice pattern, you may find yourself in a bit of a bind relative to utilization of operatories. I’ve been in practices where the associate’s patients are sitting in the reception room waiting for their appointments because the associate doesn’t have an operatory available as the employer has a hygienist and s/he may be using two operatories. So, make sure you’ll have at least one operatory at all times so you can see patients on time.

Services to be Performed Many doctors may place limitations on the range of your clinical services at the outset because they don’t know your level of clinical ability especially if you are a recent grad. Obviously, when you join a practice as an associate, you are treating someone else’s patient base with the buildup of goodwill that the employer has developed over the years.

Therefore, your employer may be wary of letting you practice without certain restrictions in order to ensure that the quality of care that you can deliver will be comparable to what the patients CONTINUED ON PAGE 27 >>

Dr. Thomas L. Snyder is Managing Partner of The Snyder Group, LLC, a nationwide practice transition and financial management consulting firm. With more than 75 years of experience in the field, The Snyder Group provides a full range of services for new dentists considering purchasing a practice, practice valuation services, associate/partner agreements, practice transition matters, and retirement planning. They can be reached directly at 1.800.988.5674.TSnyder@snydergroup.net, www.Snydergroup.net

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WWW.THENEWDENTIST.NET 19

Business Employee vs. Assistant

Who to Hire First?

Y

ou could say it’s a bit like the chicken or the egg analogy, who comes first, the business employee or the doctor’s assistant. For new dentists opening their first practices, few can afford to hire multiple employees, so they typically must choose between hiring an assistant and hiring a business employee initially.

According to Lois Banta of Banta Consulting, there are advantages and disadvantages to hiring either at the outset, but Ms. Banta recommends that dentists look for an assistant with front desk experience. In addition, she notes that if the new practice has computers in the operatories, many of the front desk duties can be handled chairside, such as scheduling appointments and collecting payments. “I see benefits to hiring a front desk person who can assist when necessary, and I see benefits in hiring an assistant who can handle the front desk duties. But if the doctor has an assistant he or she can work out of two rooms and that helps to increase production,” says Ms. Banta.

McKenzie Management Consultant Debbie Rae agrees that in a new office with no staff, the doctor’s first hire should be someone who can, temporarily, wear two hats. “But if they absolutely had to choose between hiring an assistant and a business person, I would encourage them to hire the business employee. The reason, oftentimes, recently graduated dentists have not worked with an assistant, and in a new practice, the doctor is going to need someone who can make a good first impression. They will need someone who can answer the phones and represent the practice well to patients. This person will probably have to help somewhat chairside, but being able to help establish those critical business systems early will be essential.”

TO PURCHASE

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TO PURCHASE Ms. Rae notes that if the dentist is hiring an employee to perform both jobs temporarily s/he should hire for the business skills. “That person needs to be nurturing and friendly, but they also need an analytical and logical side because they will be handling insurance, asking patients for money, organizing the schedule. A new dentist wants to look for someone that they would like to keep on staff for many years.”

Not just any employee will work out well in a new practice. New dentists need an employee who brings the “whole package.” “This person needs to be able to multi-task, they need enthusiasm, and they need almost an ownership mentality. Those with a strong work ethic and an excellent attitude tend to succeed the most in this kind of an environment because you can train for skill but you can’t train attitude and commitment,” emphasizes Ms. Banta.

CONTINUED ON PAGE 32 >>

Lois Banta is CEO of Banta Consulting, she provides her expertise to dental practices across the country and internationally. She is a regular speaker on the American Dental Association circuit and other popular venues. Ms. Banta also has written monthly columns for Dental Practice Reports and has appeared as a featured writer for the bimonthly Insurance Solutions Newsletter, the Australian Dental Journal, and numerous other publications. She can be reached at 816-847-2055 or at www. bantaconsulting.com Debbie Rae, RDH, MBA is a senior consultant for McKenzie Management. She is a widely respected expert in helping dental teams achieve peak performance by working smarter not harder. She provides clients a comprehensive evaluation of their dental practices and thorough education in the most effective McKenzie Company techniques tailored specifically for each practice. She can be reached at info@mckenziemgmt.com or by calling 877-777-6151

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THE NOT-SO

Simple Human

BY NANCY HALLER, Ph.D.

Staff Wars – How to Erase the Battle Lines

TO PURCHASE

C

onflicts between front office staff and clinical employees are common. However, the real problem in many dental offices is the tendency to avoid conflict. Dental leaders typically see these team dynamics as annoying “high school drama.” They bury their heads and hope that conflict will just go away.

But ignoring conflict doesn’t work. Bad feelings intensify.

Things get blown out of proportion. Simple workplace misunderstandings become major obstacles to efficiency and productivity. Before long, the tension between a couple of employees escalates into a staff war. This costs inordinate amounts of money in staff-hours and in hidden expenses such as turnover, recruitment, training, and poor patient service.

Tackling conflict head-on will save you countless headaches, problems, stress, and staff turnover during the course of your career. As the dental leader, your goal is not to make employees like one another but to be able to work together.

THEBuzz

Struggles and Challenges Facing Today’s New Dentists

“I will be graduating in June and relocating to Spokane, WA. Right now, I have one job offer as an associate in a smaller community in the Spokane area. I have been debating whether I should work as an associate or bite the bullet and start-up from scratch. I think there might still be room for a start-up somewhere in Spokane County. But I also see the advantages to the associateship - immediate cash flow, getting experience in a private practice, and getting to know the city better. After my one year contract I would revisit the start-up idea. If I had a part time position available to me I would be considering the start up more seriously but, unfortunately, I only have the one offer, and he is firm on full-time. What are your thoughts?”

• Soon-to-be-Doctor

Dear Soon-to-be-Doctor, Certainly, the most conservative path is to take the associate position with the understanding that it will be for one year. Be sure to read the contract carefully with legal counsel. You need

22 WWW.THENEWDENTIST.NET

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You need to help them reduce the emotions and get to a resolution.

Talk with each individually. Be impartial, eventempered and fair. Both will try to win you over to their side by blaming the other. Ask open-ended questions and set aside your assumptions. Rephrase, restate, or summarize what you think has been said. Empathize and let the other person know when you understand. Ask for examples to CONTINUED ON PAGE 32 >>

Dr. Nancy Haller is an organizational psychologist and Senior Leadership Consultant with McKenzie Management. Contact Dr. Haller at coach@mckenziemgmt.com.

to know up front if, in the future, you will be prohibited from setting up a practice within a certain mile radius of the hiring doctor’s office. In order to make an informed decision about the potential of the area you are considering, go to The New Dentist™ web-site www.thenewdentist.net/community-overview.htm and purchase the Community Overview report. It will give you demographic information on eight zip codes in the area. You’ll get information on competition, demographics of the dental community, and the lifestyles of potential patients.

Should you decide to pursue a start-up, when establishing the terms of your loan, be sure to include “working capital” so that you will have enough money to live on until the practice starts to generate income. Bank of America Practice Solutions can help you with that. You don’t mention how you acquired this one offer, but an option is to send your resume to doctors on the opposite side of town or nearby town to see if you could find a part time position. Don’t forget to contact the local dental society, the dental supply companies, and other dentists as well. Best of luck and stay in touch.

Can you help Soon-to-be-Doctor? Visit the Buzz/Blog at www.thenewdentist.net and click on the Management Buzz/ Blog. Want to read more answers to questions from dentists like you? Visit The New Dentist Buzz/Blog at www.thenewdentist.net.

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By Bennett Napier, CAE • National Association of Dental Laboratories

Partners to Help Grow Your Practice

C

urrently just over 12,000 dental laboratories are operating in the United States, based on market data from various sources including the U.S. Census. Over the next ten years, it’s predicted that number will be reduced significantly due to consolidation.

The landscape of the dental laboratory industry will be comprised of more high end cosmetic dental laboratories and larger entities that provide many models of service, including economy or price driven restorations to high end cosmetic/full mouth reconstruction departments. We will see milling centers for rapid production, digital dentistry centers, and client driven continuing education centers. There will still be what we would term mid-size laboratories, but it is likely there will be fewer of them or they will be satellite locations for larger corporate entities.

Additionally, given the utilization of domestic and off shore outsourcing and integration of manufacturing processes, it’s important for dentists to know their dental laboratories. In some cases, a dental laboratory can be a broker or distributor rather than producing restorations in house. That’s not necessarily a negative point.

All of the various business models in the dental laboratory industry can work in terms of efficiency, customer service, and consistent quality. Nonetheless, it’s a dentist’s right and duty to ask, what materials are in each restoration and where it was made. In the case of foreign made restorations, laboratories are already required under the Food and Drug Administration standards to disclose this to their customers.

Technical Training and Competency With dental schools teaching almost no dental laboratory technology today and more and more duties being delegated to dental assistants or hygienists through expanded functions, its imperative that the dental practice have a dependable and trusted dental laboratory partner.

The proliferation of technology, both in terms of dental materials and equipment in dentistry, and even more on the laboratory side, makes it crucial that there is open and consistent communication between the dentist and dental technician. Dental technicians, by and large, work closely with 24 WWW.THENEWDENTIST.NET

WINTER 2009

dental manufacturers on the development of new materials in the market as well as the technology that allows manufacturing of the substructure or the full restoration to meet the dentist’s need for the patient. Due to this dynamic, technicians are poised to offer expert guidance on material selection and help filter through the sales pitch on which brand is best to meet the patient’s specific need.

In an effort to help bridge the communication gap, the dental laboratory industry through NADL, launched the Foundation for Dental Laboratory Technology. This foundation was created to deliver cost effective and relevant web based education to all members of the dental team on the basics of dental technology. The Foundation has developed a number of courses in conjunction with The Pankey Institute CONTINUED ON PAGE 26 >> to meet this objective.

Bennett Napier is the Co Executive Director of the National Association of Dental Laboratories and the National Board for Certification in Dental Laboratory Technology. A certified association executive, he has over 18 years of experience in organizational management and public policy, with 15 years working with dental organizations both with dental hygiene and the dental laboratory industry. He can be reached at Bennett@nadl.org or by calling 800-950-1150

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Regulation of Laboratories/Technicians You may be stunned to learn that not a single state in the U.S. requires dental lab technicians to be licensed. If you’re surprised, you’re in good company. A July 2009 American Dental Association survey of its members revealed that more than one third of dentists responding believe that dental technicians and laboratories are regulated or licensed.

In actuality, only four states mandate any baseline technical competency for technicians. Those states are Florida, South Carolina, Kentucky, and Texas. In these states, the baseline competency or continuing education requirements are based on the Certified Dental Technician (CDT) designation administered by the National Board for Certification in Dental Laboratory Technology. This is the only recognized certifying body for dental technicians by the ADA. Further, dentists can seek out laboratories that also have achieved and maintain certification/accreditation as either a Certified Dental Laboratory or DAMAS laboratory. These facility standards focus on health and safety/business operations and compliance with quality system/good manufacturing practices for laboratories based on OSHA and FDA requirements.

Efforts are underway in several states to seek similar regulations in state dental practice acts. It is believed that a baseline requirement for registration of laboratories and a tie to certification standards for technicians is imperative for dentists.

This will preserve a consistent foundation of technical training regardless of what laboratory you choose to work with. This is even more important today as new dentists generally are not receiving comprehensive training in dental laboratory technology outside of continuing education opportunities.

Growth Opportunities The current U.S economy aside, the long term upside of dentistry is strong.

According to the Centers for Medicare and Medicaid Services, the demand for dental services is significantly increasing in the United States, to the tune of $167 billion by 2015. While this demand is present, the number of dentists per 100,000 citizens is decreasing and 20% of the current U.S. dental technician workforce is predicted to retire or leave the profession for other reasons by 2014, based on statistics available from the U.S. Department of Labor, Bureau of Labor Statistics.

Having a trusted technician and laboratory to work with will not only help you meet demand but also grow your practice.

For more information on the laboratory industry and seeking out a qualified partner, visit the following websites: www.nadl.org, www.nbccert.org, www.dentallabfoundation. org.

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‘Green’ Offices

continued from page 13

Dr. Koos notes that his practice also practices green health care, sustainable health care, and eco-friendly dentistry. “We are the first dental office to produce zero bio-hazardous waste. Typically, companies are hired to haul that waste off and then it is incinerated and all those products’ harmful chemicals and toxins are released into the air. We process our bio-hazardous waste on site using a system called the Demolizer II. It renders the waste safe for disposal through the regular garbage. I would hope this is something that would be commonly used in any patient facility.”

Many dentists new to practice and those already established are very concerned about the environment and reducing waste. They are taking numerous steps in their own homes and when they realize what they can do in the design of their practices, they are very interested in going green.

“This isn’t a fad. It is a necessary movement. The medical community has embraced this and it only makes sense that dental community follow suit,” emphasizes Dr. Koos.

Interested in learning more about going green and the LEED® Green Building System™? Visit the U.S. Green Building Council’s Web site at www.usgbc.org. If you’re considering building in the Southern California area and would like to know more about building “green” contact Boice Engineering and Development Inc. (951) 898-5850.

And for more information on the Eco-Dentistry Association visit www.ecodentistry.org or call 510-841-1229.

Background Check

continued from page 16

Background checks may also protect the safety of your workplace from the threat of harm by those who may be a danger to themselves or others. An individual’s history of convictions for theft, violent crimes, or the possession of controlled substances are all factors to consider when determining whether a prospective employee should be hired.

There are numerous methods of performing background checks, including obtaining credit reports, performing criminal background checks, obtaining education and driving records, checking public records and obtaining information regarding an individual’s past employment experiences. Depending on the circumstances, visiting various social networking sites or performing “Google” searches may also provide insight into a prospective applicant’s background. Obtaining proper consent

for the performance of many of these checks is recommended and, in many instances, mandatory. Careful consideration must be given before performing background checks to ensure you do not run afoul of the laws that protect the privacy rights of prospective employees and protect individuals from unlawful discrimination.

Numerous laws and regulations exist that must be closely followed to perform lawful employee background checks. Of course, a lawful background check cannot guarantee you will not have issues with your staff, but it can certainly help minimize the potential exposure and risk you face as an owner of a dental practice. Consultation with an attorney is recommended to be sure that you are in compliance with the requirements for a lawful background check.

Editor’s note: This article does not constitute legal advice. Please consult professional counsel for your individual situation.

Associateship continued from page 19

expect. In addition, find out what services are being referred to area specialists. The most common service referred is endo. If that is the case in your practice it will be to your benefit to be able to keep these services in house.

New Patient Allocation It’s important to know that you will be getting new patients in addition to patients who may be reactivated to hygiene.

How are new patients to be allocated? Will your employer want to meet all new patients first, then assign them to you?

These are questions that should be asked during the interview as well.

Staff Management Will you be assigned an experienced dental assistant when you begin your new position? We strongly recommend to our clients that an inexperienced dental assistant should not be working with a new associate at the outset. Assigning you with an experienced dental assistant affords you lots of opportunities.

Number one if you are a recent grad, experienced assistants can be very beneficial in helping you improve your time management skills. Secondly, experienced assistants usually have been with the practice for a while and therefore know many patients.

They can introduce you more effectively and make patients feel comfortable with you in anticipation that you become their dentist. Proper record keeping is also an important responsibility for you. Having an experienced assistant can make sure that you follow the protocols in your new office.

Handling Disagreements We recommend that the host doctor and the associate meet on a weekly basis, particularly during the first three to six months of employment. The purpose of this meeting is to discuss case presentations, treatment planning, and scheduling issues that may arise in the preceding week. Often times, if the communication isn’t there, problems will fester and snowball and that is when issues can really come to a head. Frequent communication prevents a lot of things from happening that can create ill will between you and your employer.

We also recommend that a formal monthly meeting be scheduled so that you and your employer can review production reports and accounts receivable reports. This meeting may prove to be an extremely important one based on how you are being compensated. For example, we often find that the new associate’s accounts receivables are not as good as the employer’s.

Sometimes staff feel overburdened when asked to work harder with the extra administration that arises with another doctor’s workload. Of course, if you are paid on collections, that can be devastating if staff aren’t paying enough attention to your outstanding account balances. Also, if you are paid a draw against commission, it’s important to track your numbers to make sure that you can cover your draw. Typically, there is a reconciliation period every month or quarter, and you certainly don’t want to have your draw reduced because you weren’t able to make the production/collection targets. Additionally, if your associate track is one that may lead to a partnership, scheduling monthly meetings to not only discuss management reports but staff issues and other management matters creates good communication habits that can carry over when you are partners.

What if the associateship isn’t working?

Unfortunately, some associateships do not work out and maybe it’s just the wrong fit from a personality standpoint more than anything else. If you sign an Employment Agreement, typically, there is a 30 to 60 day time frame by which you inform the employer particularly if you are intending to leave. This allows you to complete any patient treatment. It’s only right that if you started a case you should be able to complete it, unless it relates to orthodontics, for example. Leaving on good terms is also important because you certainly don’t want to create any ill will in the practice, particularly if the doctor has a high profile and is able to say negative things about you and hurt your future employment chances. We’ve always found that open and direct communication is the best solution if there are any problems in the practice. As previously stated, if you are meeting with your employer on a frequent and regular basis, chances are many problems that could develop will be prevented and appropriate solutions found.

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You and Your Practice:

Safety Nets for Both

By Leslie Franklin

D

isability insurance is often described as a safety net. Like the amazing pros on the flying trapeze, you don’t expect to take a fall, but if you do, you’re glad a net is there to catch you.

Now, dentistry may not be as risky as performing under the Big Top, but compared with professions like law or accounting, a disabling injury or illness could sideline you quicker because dentistry is so physically demanding. An injury to the spine or hand, for example, might not keep an attorney from working, but it could be permanently disabling for you.

Young, Determined…and Disabled And, don’t assume you are immune from a career-ending incident because you’re young and determined to practice dentistry. Of the dentists currently receiving benefits through the American Dental Association’s disability insurance plan for members, more than 15 percent were under 45 when they became disabled, and 85 percent of them are totally and permanently disabled from dentistry.

The most common reason for disability among ADA Plan participants is back/cervical disorders. But benefits have also been paid to dentists because of falls off ladders, power tool mishaps, motorcycle crashes, heart attacks, migraine headaches, mental/nervous conditions, and arthritis, among other causes.

For all these reasons, your peers will tell you that disability insurance is a “must have” from Day One of your career (see sidebar). Still, knowing what to look for can be confusing. The following tips will get you started. n Safety Net #1: INCOME PROTECTION

TO PURCHASE

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If you are disabled and can’t practice for months or even years, disability income insurance will help replace your lost income. Disability income policies vary in quality and price; these guidelines can help you spot the best coverage: • “Own occupation.” Look carefully at how the policy defines disability. Insist on an “own occupation” definition that says you will receive income if you become disabled from dentistry or your dental specialty—even if you choose to work in another profession and regardless of how much you earn elsewhere. A lower quality “any occupation” policy is only obligated to pay benefits if you cannot perform any reasonable job.

• Benefits to a high age. Make sure the policy will pay own occupation benefits to age 65 and not switch to an “any occupation” standard after a couple of years.

• Partial benefit. Get a policy that will pay a benefit if you are disabled but can still practice part-time or on a restricted basis.

• Adequate amount. Aim to cover 60 percent of your net monthly earned income after expenses but before taxes (roughly your monthly take-home pay), then acquire additional coverage as your income grows.

Dentists Speak Out About Disability Insurance n Safety Net #2: BUSINESS OVERHEAD

Many new dentists don’t realize that a second type of disability insurance exists… and it can be critical if you own a practice. Business overhead insurance reimburses a disabled dentist for certain business-related expenses.

Think of business overhead insurance this way: If you were unable to practice, how would you pay your rent, employees’ salaries, practice loans, and student loans while you recovered? How would you pay for a replacement dentist to keep your patients treated? If your business languished during your absence, what would be left by the time you got well or decided to sell? Business overhead insurance solves all these needs—by giving you the means to maintain a thriving practice when you can’t work there yourself.

And if you plan to buy a practice in the future, keep in mind that business overhead insurance can be used to meet a lender’s loan collateral requirements—and is less costly than disability income insurance for that purpose.

Guidelines for buying business overhead insurance: • “Own occupation.” Again, make sure the plan uses an “own occupation” definition of disability (see above).

• Partial benefit. Look for coverage that pays benefits whether you are partially or totally disabled.

• Benefit period. Typically, you can choose to receive benefits for either one or two years. This will give you time to recover or make plans to sell the practice at full value.

• Adequate amount. Select an amount that matches your eligible overhead expenses—this could be as little as $1,000 a month or $25,000 or more. If you can’t afford to fully insure your risk, at least cover the top three expenses: payroll, rent, and utilities.

Get It, Increase It Next to medical insurance, disability insurance is your most important health-related coverage. If you don’t have it, get it as soon as possible. If you do have it, be sure to add to it as your income and/or overhead expenses grow so your protection stays adequate over time. And always buy from a financially strong, reliable company whose safety nets will be there if you ever take a fall.

Editor’s Note: This article does not constitute legal, tax, or financial advice. Please seek professional input as appropriate to your situation.

“When I was starting out, I used to complain to my accountant about the cost of disability insurance. He said, ‘Damon, you don’t know what your future will bring. Forget about the cost and consider it a necessary expense.’ Then, when I was 41, I had to leave dentistry because of a disability. I am so thankful I had disability insurance.”

Damon Adams, D.D.S. Traverse City, Michigan “When I graduated from dental school, I had a wife, a baby on the way, and over $100,000 in student loans. I felt compelled to get disability insurance even though I hoped I would never need it.

That turned out to be the smartest business decision I ever made, because I became totally disabled at age 44. The insurance saved me from financial ruin. Without it, my family would have gone from affluence to poverty. Every new dentist should get disability insurance as one of their first purchases.”

Name withheld at request “Less than 2 years out of dental school, a car crash landed me in intensive care and out of the office for nearly 3 months. As soon as I could, I bought as much disability insurance as I could. If a disability ever happened again, I wanted something to fall back on.”

Randolph Hatten, D.D.S. Cornelius, North Carolina “A fall from a ladder left me with permanent nerve damage and numbness in both feet. I’ll never be able to practice full time again, but at least I can practice part time as my health permits.

I receive a partial disability benefit, which helps supplement my reduced earnings.”

David Chen, D.D.S. New York, New York “After open-heart surgery, I got a good-sized check from my business overhead policy, which was a big boost. It helped to pay my staff and keep my practice open while I focused on my rehabilitation.”

John Koberlein, D.D.S. Uniontown, Ohio “I got a great tip when I needed disability insurance as collateral for my practice loan. Use business overhead expense insurance, which is much less expensive than disability income insurance, to satisfy the lender’s requirement.”

Sepideh Malekpour, D.D.S. Glendale, Arizona

Leslie Franklin is Director of New Dentist Markets at Great-West Life & Annuity Insurance Company.

She meets regularly with new dentists and dental students across the country to help them understand how to use insurance to attain personal and professional goals. Great-West underwrites and administers the ADA Insurance Plans and is the sole provider of ADA-sponsored life and disability insurance to ADA members. For more information, call 888-463-4545, go to www. insurance.ada.org, or contact Leslie at leslie.franklin@gwl.com.

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SKINNY

on the Street

The latest news on new products and services for dentists and their practices Griptab by Triodent

VALO LED Curing Light VALO is a broadband LED curing light. Its sleek, aerospace body is lightweight and exceptionally durable. Because of its design, VALO accesses hard-to-reach areas like no other curing light on the market. VALO’s focused and columnar beam combined with a custom LED pack provide consistent, uniform cures without overheating the wand body. VALO also features a revolutionary plasma emulation mode that rivals plasma arc lights in its level of rapid cure. With standard power, high power and plasma emulation curing modes, VALO delivers the right power in the right place. For more information, visit www.ultradent.com/ 800.552.5512.

Griptab is effectively a small handle that is adhered to a restoration. The light-cured, flexible adhesive is strong and resistant to Silane and moisture, yet is easily and cleanly detached from the restoration at the end of the procedure. Griptab is designed for dentists, dental assistants (who can do most of the simple steps) and lab technicians, and can be used on all laboratory and CAD/CAM generated indirect restorations. It ensures precise control during try-ins, hydrofluoric acid-etching and silanation, even ultrasonic cleaning. For more information, go to www. griptab.com or call 800-811-3949.

Premier® Traxodent™ Hemodent™ Paste Retraction System Traxodent is a retraction and hemostatic system for use prior to impression making, cementation, bonding procedures or wherever hemostasis and retraction are required. Traxodent paste contains 15% aluminum chloride – a proven, effective hemostatic agent. Traxodent can be dispensed directly from the sleek syringe into the sulcus or can be used in combination with a Premier Retraction Cap for maximum tissue deflection. The absorbent paste displaces soft tissue and works synergistically with the astringent properties of aluminum chloride to create retraction. Fluid is absorbed while Traxodent occupies the sulcus. After two minutes, Traxodent is rinsed away, leaving an open, retracted sulcus. For more information, visit www.premusa.com / 888-670-6100.

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 www.thenewdentist. net Resource section to receive information from more than one company.

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WINTER 2009

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Handpiece

Hire First

continued from page 14

continued from page 20

gloves get wet.

Also check out the torque and noise. There are some models that really scream and don’t cut very efficiently while others are more quiet and will cut much better. Of course the loud and slow are more affordable, so if money is tight, you should definitely consider those models.

Take your time and be thorough. Your dealer won’t mind! My favorite supplier, Goetze Dental, has a showroom that is setup just to help doctors make the best buying decisions they can.

Once you have your choice narrowed down to about three manufacturers, ask your dealer to provide you the names of doctors that are using them. Call and see how happy they are and if they would purchase again. You can gain lots of insight from your peers and most are very happy to help.

Above all, remember this is one of the most important purchases you will make for your practice.

Be patient and perform the due diligence. With the proper selection process, you’ll be happier and more productive which will benefit both your practice and your patients.

Ms. Rae notes that in choosing the right employee for the two positions, the doctor should look for someone who is extroverted.

“The difference comes when the assistant who, generally, may be more emotionally based in what Myers-Briggs refers to as a feeling temperament, as opposed to what Myers-Briggs calls ‘thinking’ types in that they are more analytical and logical.

Clinical assistants tend to be more feeling in nature. If this person is also responsible for the business duties, she might have to stretch beyond her comfort zone particularly when handling collections, scheduling, and that. I would recommend temperament testing so that the employee understands what areas may be difficult for her. In addition, training will be essential to help this employee know what to say to patients when they discuss financial arrangements, call about unscheduled treatment, confirm appointments, etc. “ Moreover, both Ms. Banta and Ms. Rae emphasize that if the doctor is relying on one person to perform both jobs, the expectation should be that the other position will be filled in three-to-six months and definitely no longer than one year.

But which position is going to have greater impact on overhead expenses?

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Ms. Banta urges dentists to consider a few other essential variables besides cost when hiring an employee, in particular, quality of staff.

“You want to hire someone who is going to reflect the level of quality dentistry that you deliver to your patients.

That will then help the dentist to be more productive and more efficient and enable them to pay a higher wage and grow the practice.

The two do go hand-inhand.” In the short-term, a highly credentialed assistant will likely demand a higher wage than a business employee, unless that person is a business manager.

Staff Wars continued from page 22 clarify the issues when you don’t.

Next, facilitate a conversation between them. Open the conversation by reminding them about the importance of good patient care and service.

Never try to humiliate them into a resolution. Comments like, “You’re both behaving like children,” or “You both have really disappointed me” are condescending and will create further resentment.

Allow them to express their emotions. Each person needs to feel heard before they can move on. Encourage them to talk honestly and directly to each other. If they resort to judgmental labels, insist that they use observable behaviors

to describe what happened.

This maintains mutual courtesy and respect. Identify common ground. In most cases, conflicted employees do not recognize that they share many of the same ideas and convictions.

Give each employee one minute to say what they want from the other. Keep the focus on solutions. Ask each to restate the other’s solution.

Conflicts often begin over small details. Highlight shared viewpoints. Be sure they are requesting specific and realistic behaviors.

Listen open-mindedly to their suggestions since they will be more committed to solutions they come up with on their own. If their solutions are impractical, unacceptable, or not forthcoming, then offer your own opinion and solution.

Provide any support you can to make the solutions work.

Ask each of them to restate what they have agreed to do. This eliminates any misunderstandings. It’s also a way to create a more binding agreement. End the meeting by scheduling a follow-up session.

This makes it clear that you’re serious about ending their conflict once and for all.

The true payoff for conflict-competent teams is realizing the potential of conflict. The diversity of perspectives and ideas among teammates leads to discovery rather than discord. Keep your office from becoming a battleground. Confront problems calmly and quickly.

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