The Profitable Dentist Magazine Winter 2013 by TheProfitableDentist

Dentist The Profitable

Winter 2013

News & Information to Increase the Profitabilit y of Your Practice

Oral Cancer:

Early Detection Saves Lives

What The Top 1% Know That You Don’t Glutaraldehyde VS Paraformaldehyde xcellence in Dentistry

The Top APPS You Must Download Now!

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Stoneybrook manages the entire process and has proven many times that they really care about us and our results. And we DO get results ! We have more than doubled our New Patient numbers every month. We get New Patients from Stoneybrook pretty much every day, and on many occasions, more than one a day. Their service has enhanced our practice so much. Our “Hallmark Style” Special Occasion cards are mailed to your patients by their first name with a note to let them know you are thinking about them during the holidays as well as on their birthday.

Our “highly personalized,” full color Patient Education Publications are filled with interesting, current articles about dental health as well as your personal letter addressing them by their first name.

PUBLISHING, INC.

DPD 1718

Winter 2013 | I s s u e 2 4 6

PRACTICE MANAGEMENT shock@bigstockphoto.com

CONTACT US Phone: 800-337-8467 or 812-949-9043 Fax: 812-949-8535 Mail: The Profitable Dentist 3211 Grantline Rd, Ste 20 New Albany, IN 47150 Email: info@theprofitabledentist.com

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From the Editor

Editor-in-Chief William W. Oakes, DDS

Executive Vice President of Operations/Finance DELAINE STEWART

Why My Practice Loves Working Saturdays by Dr. Mike Abernathy

Five Lessons Requiring One Minute Per Lesson by Bryan Flanagan

What the World’s Greatest Dentists do Differently by Dr. Chris Griffin

Why Your Staff and Patients Hate You by Gary Kadi

Marketing for 2014 – Will You Be Ready? by Howie Horrocks and Mark Dilatush

Addressing the Confusion Surrounding Seminar Compensation Policies by Paul Edwards

Get MullinSIZED 24 Secrets to Coach Your Team to Be Winners by Chris Mullins, The Phone Sales Doctor™

What The Top 1% Know That You Don’t by Dr. Mike Kesner

Unhappy Patients’ Point of View by Bill Rossi

This Boutique Practice Is Alive and Well ... Here Is Why by Dr. Charles Barotz

Money Saved is Money Earned: Eliminating Overhead Before you Open the Door by Dr. Jake Masters

Seminar Coordinator JENNIFER JONES Front Office Coordinator/Marketing Director CHRISTY CLAYWELL Seminar Coordinator Assistant HOLLY SWITZER

Administrative Assistant Ashley Scharlow TPD Designer Leah Conder Taylor Taylor & Associates

EDITORIAL ADVISORY BOARD

DR. MICHAEL ABERNATHY Dr. Keith Dobracki DR. DAVID HORNBROOK DR. MARK HYMAN CATHY JAMESON DR. BILL KIMBALL DR. ROGER LEVIN DR. TOM ORENT DR. STEVE RASNER DR. LARRY ROSENTHAL DR. ROY SMITH DR. BILL STRUPP Dr. Joe Steven, Jr

McKinney, TX Madison, WI La Mesa, CA Greensboro, NC Davis, OK Encinitas, CA Baltimore, MD Framingham, MA Bridgeton, NJ New York, NY Tyler, TX Clearwater, FL Wichita, KS

Woody Does B-Town

Associate Editor CRAIG CALLEN, DDS

A Word from Woody

Practice Management

STAFF

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The content of this publication may not be reproduced either in part or full without the written consent of The Profitable Dentist ®.

© 2013 Excellence in Dentistry, Inc., Publisher. Copyright enforced – no part of this publication may be reproduced without written permission. This publication is designed to provide reliable information in regard to the subject matter covered. However, it is distributed with the understanding that it does not replace the need for advice from your personal, competent professional advisors.

WINTER 2013 WDG Photo@ bigstockphoto.com

CLINICAL AlfredCats@bigstockphoto.com

Advertiser Quick Guide Dental Websites Website design............. Inside Cover

Stoneybrook Direct mail & custom projects........ 3 Shatkin F.I.R.S.T. Mini dental implant training............ 5 Strickland Facelift Dentures Training program............................ 7 Quantum Leap Dental consulting............................ 9 New Patients, Inc. Dental marketing.......................... 15 X-Ray Support, Inc. X-ray film and imaging provider... 23 Mellin Dentalbackuponline.com.............. 31 Sleep Optima Dental sleep network.................... 35 Hygiene Diamonds Certified hygiene coaches............ 37 Bank on Yourself Wealth building strategies............ 39 Summit Practice management strategies..... 54 EID Spring Seminar Preview “The Godfathers of Dentistry”...... 55 Next Level Million dollar dentistry.................. 57 Paragon Dental practice transitions............ 64 EID Special Product “Is There a Hole in Your Pocket?”.. 65

Clinical 42

Pearls for More Profit & Better Dentistry! by Dr. Michael Curtis

Glutaraldehyde VS Paraformaldehyde by Dr. Alvin H. Arzt

Enhancing a Smile With E-Max CAD by Dr. Ara Nazarian

Oral Cancer: Early Detection Saves Lives by Dr. Brian Pikkula

Periodontal Disease: What are YOU doing about it? by Patricia A. Worcester, CDA, RDH and BS

The Truth about Dental Sleep Medicine An inside look at medical insurance billing in dental practices by Nick Carlone

Getting to Your Greatness 56

Financing Secrets of Successful Dentists by Pamela Yellen

Coaching Case Study #1 A Small-Town Practice With a Big Increase by Sasha Burau, MBA

The Key to Choosing the Right Gym for You by Dr. U.P. Odiatu

Great Info

Puzzle Piece “The Power of Delegation”

Products & Services

From Our Readers

EID Product Bill Rossi’s “Making the Right Moves with PPOs”........................ 67 DDS Dental Supply Dental buying group...... Back Cover

WINTER 2013 Maridav,@bigstockphoto.com

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Tell us what topics, issues or products you’d like to know more about and we’ll cover those in the upcoming issues of TPD. Email us at info@theprofitabledentist.com and put “TPD Topics' in the subject line.

A Word From Woody Welcome to the November issue of The Profitable Dentist magazine… hope you are enjoying this wonderful Autumn weather! In case you haven’t noticed, dentistry is changing rapidly. Technology is making great strides, but it comes with a very high price tag. I love technology… but as I lecture and travel the USA visiting with coaching clients, there are alarming trends. First, today I watched a 5-minute video emailed to me by my friend, Jay Geier, of the Scheduling Institute. The crux of the video is that there will soon be a great divide in dentistry… “The Haves and The Have Nots.” I agree totally that corporate dentistry has had a tremendous impact on the profession of dentistry. If I were graduating from dental school today, it would probably be a coin fly to go corporate and start paying my $300K (average) dental school debt. Second, dentists have gadgets and technology and the people who sell both love recent dental school grads for obvious reasons. Worst case scenario: recent dental grad marries another grad, builds and furnishes a new home plus a new office. But hey, I see similar “train wrecks” for dentists at any age. So what’s the solution? Well, I don’t claim to have all the answers but here are two things that I know for certain: 1) One of the most profitable dentists I know has very few gadgets and avoids debt like the plague. Oh, by the way… he does ZERO marketing and the only way to get “in” is to be referred by another patient. 2) Our worst coaching client this year increased his practice by $141,000 the last 12 months! Jay Geier knows coaching works and I know that because when I graduated from dental school in 1974… I borrowed money that I didn’t have to get the coaching that I desperately needed and it worked then just like it works now! So your future is entirely up to you… you can thrive or you can just barely survive. But without a great mentor, you’ll just be another statistic.

Dentist The Profitable

Winter 2013

Practi ce Profit abilit y of Your to Increa se the News & Inform ation

Oral Cancer: Saves Lives Early Detection

What The Top 1% Know That You Don’t

Glutaraldehyde VS Paraformaldehyde

xcellence in Dentistry

The Top APPS You Must Download Now!

WINTER 2013

At Your Home. At Your Office. On the Go. Get The Profitable Dentist right on your tablet – just email us at info@theprofitabledentist.com, put “e-magazine” in the subject line and we’ll start sending you the electronic version of TPD in addition to your valued hard copy. Just download and read – whenever, wherever it’s convenient for you. Don’t wait, email us today!

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Practice Management

“Woody Does B-Town!”

kay, I’ll admit it… I’m the first to cringe when somebody pulls out a stack of photos of their grandchildren to show me! But on the flip side, when one of my buddies starts sharing stuff about his spouse… my ears perk up. Granted there’s a very fine line between sharing information and what my daughter, Shelby, calls TMI!

So when our business coach (Bill Glazer) said, “Woody, The Profitable Dentist readers want to know more about you, the person,” I was a little surprised. But on the plane ride back from Maryland I thought more and more about Bill’s suggestion. Most of you know that People magazine is the #1 magazine in the world. The reason, quite simply, is that people love reading about other people. And, if they are famous people it’s even better. How many of us were “glued” to the TV set watching Casey (whatever her last name was?) get found NOT guilty of murder? Then I got to thinking about Bill’s suggestion again and I thought, “You know, I’d be kind of curious to know more about Dr. Gordon Christensen – the person. I know who he’s married to and he loves to ride Harleys but that’s about it.” So why not, let’s peel back the curtain and let you know more about me – the person – and my family. As some of you may know, I’m a huge Indiana University basketball fan. My dad took me to my first Indiana game when I was six months old and I took my son to his first Indiana game at six weeks old! My friendship with former coach Bob Knight started when I was a freshman in dental school, which was Knights first year at Indiana. My gang from dental school had seats in row 8 right below the basket by Indiana’s bench. Knight loved our gang from the start because we were “loud and obnoxious” just like him. Okay, I know this basketball thing is difficult to understand if you don’t live in Indiana. Even I think its “weird” that I watch the movie “Hoosiers” at least 3-4 times before the season starts. So I guess it comes as no surprise that both of my children attend(ed) Indiana? Yes, they had a choice… attend Indiana and dad pays for it… go somewhere else and you’re on your own.

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Shelby is now starting her Junior year at Indiana University in Bloomington, Indiana (B-Town). She lives at the Phi MU sorority house which is really scary because it’s way too close to my old fraternity, the Beta Theta Phi house. We won’t even go there! So this past Thursday, Georgia and I decided to drive to B-Town and spend the day with Shelby. To say I was excited was an understatement! How else could you explain that I didn’t even notice the car was on dead empty and running on fumes – and barely made it to the gas station? Fully fueled, we began the 1:45 journey to the “Promised Land.” I gotta admit I never got that excited doing the perfect crown prep or the perfect root canal.

About 20 minutes out, we called Shelby to figure out the perfect rendezvous spot. Since it was nearly noon, we decided upon Nick’s which is located on Kirkwood Avenue and is a campus legend. Just as we were seated, Shelby arrived and sat down with us. Of course she was wearing RED knowing that her dad never goes to B-Town wearing any other color. Also in town with us was our granddaughter “Riley” on loan from her parents who reside in Dallas, Texas. I guess what all of us enjoy about going back to our alma mater is that it takes us back to a more energetic time in our lives? For the record, I’ve never been back to visit Indiana Dental School, probably for the same reason exinmates never want to return to Alcatraz. Lunch arrived and the cheeseburgers and fries were as greasy and as good as always. Our waitress looked way too young to be a college student, but I guess she was. Shelby and I were into this amazing conversation about her classes and the “under-potential” students and one of her math professors who can’t speak English?! Maybe I’m “old fashioned,” but I still feel your English should be at least understandable if you are going to teach at a US college/university, or be given a license to practice

800-337-8467

dentistry in this country. (Gosh, I can feel the hate mail already!) Now, as Shelby and I are having this absolutely amazing conversation, Georgia and Riley are staring at us like we had a third eye. Wait a minute, did I say “Riley”… Riley was missing! Okay, calm down, how far can a 4-year-old go in a college town restaurant/bar? Perhaps into the kitchen real close to where those really hot stoves cook those greasy hamburgers and fries! But you gotta remember, a small, fast 4 year-old can get a long way especially when adults are enjoying one tall tale after another. Now I’ll admit, Gordon Christensen has probably never lost a 4-year-old in a college town restaurant/bar… but I’m here to tell you that Dr. Woody Oakes did! So how do you reward the “bad behavior” of a 4-year-oldrun-a-way? Exactly, you take her to the college bookstore in B-Town and buy her a bunch of Indiana T-shirts and other stuff. But anyway, the good thing is we found her and got Shelby back to her sorority house (I think). Despite the craziness of the day, it was still great to get out of New Albany, Indiana (and EID) for a long day trip. So now it’s back to reality, at least for a while. But all of that changes on October 26th which is the first pre-season basketball game or anytime I can think up a reason to visit sooner… Stay tuned… As we made it back to Georgia’s car, we discovered that the Bloomington police had given us a parking ticket! Oh well... I guess some things NEVER change.

The Profitable Dentist.com

Practice Management

Why My Practice Loves Working Saturdays by Dr. Mike Abernathy

lmost four decades ago, I began working every Saturday in order to increase my number of new patients and practice production. Keep in mind that my little town back then had a ratio of one dentist to about six thousand potential clients (1:6,000). How would you like those odds now? I was young and stupid: Who in their right mind would work Saturdays? In fact, I waited tables for two years after graduating from dental school because it paid more. In addition, I worked two

WINTER 2013

full days at McKinney Job Corps and did lab work for other doctors on the side. I definitely had on my “whatever it takes” T-shirt. I have no excuse for doing all of this other than a secret fear of dying broke. Bad news is, I never outgrew it. I won’t harp on consumerism and doing what it takes to stave off insurance companies, corporate practices, Obamacare and the locust horde of 5,200 new graduates every year, but I would like to take some time and see if I can

help soften your resistance to actually having your office open during hours that people would find convenient. If we look at when people spend money on elective purchases, we find that 80% of what we spend our discretionary income on is done after 5pm and on Saturdays. Why would you

and I avoid the malls on Saturday and Sundays? Because most people are off weekends and everybody and their dog is shopping and spending money at the malls and restaurants and “big box” stores. Why don’t we see this on Monday through Thursday from 8-5? The answer is: They are working. Just this alone should be a wakeup call when we consider that most of our patients have to pass thirty other dentists to even come to see us. Convenience, or giving our patients what they want, when they want it, at a price they can afford is huge and not having our practices available on Fridays and Saturdays is a huge hurdle to growth.

So, what are 95% of the doctors saying? 1. “Nobody wants Saturday hours: We’ve tried that before once a month and my staff says nobody wants to schedule on a Saturday.” One bit of advice for the doctor in denial: If your staff doesn’t want to do something, they will find a way to sabotage it. In fact, for those doctors who have asked, yes, if their lips were moving they were lying to you about no one wanting a Saturday appointment. Patients are just like us. In our fast paced lives, it is almost impossible to fit in everything we need to do. Add kids and it multiplies the problem. Consider that most young families are dual income and there isn’t any time except Saturdays and Sundays to get the things done that they know they should but don’t have the time to do. 2. Everyone will cancel and no-show. Cancellations and no-shows are not a problem. They are a symptom of a poor system of scheduling and financial arrangements. For almost 35 years, we had no difference in our cancellation and no-show rate on any day of the week. In fact we got and kept it below 8% and because Saturdays were so desirable, they were the easiest to fill. Practices that have problems with this on Saturdays 800-337-8467

have the same problem every other day of the week. Yes, you have to have a plan and have a system. In fact, if you will just email Max at max@summitpracticesolutions.com he can help you get a copy of our thirty-page report on cancellations and no-shows. 3. I can’t get anyone to work Saturdays. Heard this too. With unemployment and layoffs running rampant, finding people to work is not going to be a problem. Our last associate who became a partner worked 8-5 Wednesday, Thursday, Friday and Saturdays 8-2 with no lunch. We paid the staff on Saturday as if they work eight hours when in fact it was only 6. Our hygienists worked three ten-hour days each week plus one Saturday per month, which averages out to be about a 32 hour work week. Imagine this, Dr. Markham worked that schedule and had a half a day off Saturday and all day Sunday, Monday and Tuesday. The staff that worked with him loved it and would never consider going back to the weekday schedule of the other doctors. 4. My patients would never leave me. Wrong. Fortune magazine did a survey last year in which 1,000 people were asked about loyalty to their Physicians: 87% said they would change for a $5 difference in co-pay. Just in case you have not had your coffee and this slipped by you, in this new economy it seems that loyalty is taking a back seat to price. This started about 15 years ago when insurance companies and commercials began convincing us that everything is a commodity so the only reason to select a product or location should be price. It evidently is working. Every one of us has gotten letters from patients that said we were too expensive or didn’t have the services they needed. Reread

what they said about the $5 and you will realize that they had insurance and they wanted to use it. Still think it’s a great idea not to accept their insurance? It’s called the “threshold effect”: How many obstacles do you put in the way of having someone become your patient? Bottom line, your patients have become more fickle and will leave for anything. Add to this the fact that even if you did impress them, our society is more mobile and 20% of the population moves each year. That means that you have to replace 20% or more of your patients each year to just stay even. I would call these four reasons not to work Saturdays, the great myths of dentistry. Kind of like the final words of a redneck: “Hey Bubba, watch this!”

Let’s spend a moment discussing the “WHY” of Saturday appointments. 1. You will increase your number of new patients at least 20%. In our office we averaged 15 new patients a week just because we were open Fridays and Saturdays. This statistic was gathered when the patient said that they were so appreciative of us seeing them even though they were not patients of ours (they couldn’t even reach their dentist on Friday or Saturday). Is there any question why your patients don’t come back to you when we were there and took care of their emergency or need and they couldn’t even find you. 2. You can add about 15-20% capacity (the ability to see more patients and hence more production). Your goal should be to produce about $25,000-$30,000 of production per operatory per month and $20,000-$25,000 of production per employee per month. When you get close to these benchmarks, you should consider adding a doctor and/or another hygienist. Associates and hygienists are easy to find The Profitable Dentist.com

for Fridays and Saturdays which would eliminate any backlog of appointments, add valuable peak demand times and utilize a facility that is just lying dormant during those hours. 3. Differentiate your office from the competition. Heard this lame excuse the other day: “Why would I want to do Saturdays and Fridays when no one else is doing it in my area?” Dr. Phil says it best: “You just can’t fix stupid.” Today we are either remarkable in what we do or we are invisible. If you just do the minimum and follow the lead of the other mediocre dental offices, why would you ever expect to catch the patient’s eye? Services, hours, marketing, systems, staffing – they all make a difference. 4. Saturdays and Fridays are the best days to do same day dentistry. If you think about it, why do you think that dental offices get more calls on Fridays and Monday mornings? The answer is

WINTER 2013

that no one wants to go through the weekend or start the week with a tooth problem, so they call. If you have the systems and staff, capacity and where with all to bring them in while always staying on time and adding same day dentistry to your menu, you will be able to print money. There was never a

Today we are either remarkable in what we do or we are invisible. day that we couldn’t add an extra $2,000-$3,000 of collections to our bottom line. The neat thing about Saturdays is that every emergency was something that they had put off for years. It was almost always root canals, crowns and bridges and the need to make a new partial or denture. Literally, they were mostly the sweet spot of productive dentistry. This treatment that magically appeared on Saturdays was always something the patient “wanted” to fix, not something we just told them they “needed” to fix. They had the money, the time and the desire to fix it. The surprising thing that we noticed is that even though they came in on a Saturday, in almost every case they ended up being a repeat customer during all of the days we were open. It was that first visit where we inspired them and exceeded their expectations that gained the trust and had the patient bond to our practice. The ripple effect of this is that these desperate patients (seemingly unwanted by some practices) became our best referral sources.

We have a very intentional way of handling emergencies so that they feel welcomed, cared for and find that we spent a lot of time to find out what they wanted, what they could afford and give them a solution that fit their time table. When you ride into town and save the day, people talk about it and this increases referrals. 5. Saturdays are great special event days. Almost every August and December we found ourselves overwhelmed with the need for more hygiene capacity. Parents would put off the recall visit and then at the last moment would call expecting to get in the next day. Our solution was to have all 10 of our hygienists and even a couple of hygienists from a temp service come in and occupy all of our chairs for six hours. The doctors were there, schmoozing the parents while we knocked out 150 pedo cleanings in one day. The goal was to get back to where we could see a new patient in hygiene within 2-4 days (not working days) during peak demand times (7-10 and 3-6) from the time that they called in for the appointment. Note: Blockages are subtle and we need to be preemptive about providing a solution so that our momentum is not affected. We even had Santa at our offices during the holidays for our patients and their friends to come in and meet Santa, get a picture and a goody bag for the kids and have the opportunity to tell 200 or their closest friends what a great office we were. I hope this gives you a moment to pause and reflect on just how “not sensitive” most of us are to our potential patients. You may contact Dr. Mike Abernathy at 972-523-4660 or at abernathy2004@yahoo.com. Download Dr. Abernathy’s book, “The Super General Dental Practice,” for free, before the next book on transitions comes out. Each book builds on the previous one.

Practice Management

Five Lessons Requiring

One Minute

Per Lesson

by Bryan Flanagan

veryone in your practice needs encouragement today. The lessons below are intended to give each member of your team a “check-up from the neck-up.”

There are five (5) lessons. Each requires about a minute to read. Once you have invested these five minutes, share the lessons with your teammates … and with your patients.

Lesson #1: First Touch the Person, Then Touch the Teeth! Dr. Richard Chapman has a very successful family dentistry practice in Plano, Texas. When asked the secret of his success, Dr. Chapman smiles (that’s his way of advertising) and says, “My practice is built on a very simple concept. I teach my staff to first touch the person… then touch the teeth.” Dr. Chapman has built a successful practice because he addresses the people process before he addresses the dental process. In other words, he puts his patients first… ahead of the teeth. Oh, don’t get me wrong, Dr. Chapman and his staff are very interested in teeth. They do a great job with the technical side of their practice. I have been a satisfied patient for over 20 years, as have the other members of my family. However, Dr. Chapman knows he is in the dental “industry”…but he’s in the people “business.” Dr. Chapman knows that the old adage still applies: people don’t know how much you know until they know how much you care… about them!

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Lesson #2: Just Be You!

Someone once said, “To be successful, you need to be as aggressive as Donald Trump, as innovative as Steve Jobs, as analytical as Sherlock Holmes, as funny as Bill Cosby, as poised as Cary Grant, as driven as Hillary Clinton, with a smile that rivals Reece Witherspoon’s!” NOT SO! You just have to be YOU! You were hired because of YOUR values, beliefs and convictions. You weren’t hired to be someone else. The only aspect you offer that is totally exclusive is YOU! You should use this to your advantage. YOU are the only unique advantage you have each and every time you interact with a patient. And, you should communicate that unique advantage each and every time you interact with those patients. There are five (5) reasons patients don’t use you for their dental needs. Here are the first four: no want, no need, no hurry and no money. Your practice deals with those every day. The fifth reason is the most difficult to overcome. The fifth reason is NO TRUST! You win people over by sharing your values, beliefs and convictions with them. You build trust by being yourself. You win a person’s confidence by being consistent over a period of time. You’ve had a lot of practice being yourself. Use it to your advantage!

The Profitable Dentist.com

Lesson #3: You and the Golden Gate Bridge Follow me on this one. I am going to make a comparison between you and the Golden Gate Bridge in San Francisco, California. The analogy is a good one to use in a practice that is as busy as yours. At the conclusion, I wish you would think about this comparison. Here are some facts about The Golden Gate Bridge. It was first opened to traffic on May 28, 1937. It is known as one of the “Seven Wonders of the Modern World.” It was built to withstand a huge traffic load. The annual revenue generated by tolls on the bridge was $59,289,000 in fiscal year 2002! That’s a lot of quarters. The annual traffic in fiscal year 2002 was 40,694,792 vehicles. The monthly load on The Golden Gate Bridge is 3,391,233. That equates to a total of 111,493 vehicles each and every day for an entire year. WOW! This is truly an engineering marvel. The engineers who designed this structure were pretty smart. OK. Now, here is the point. The Golden Gate Bridge was designed to handle the traffic load in a systematic way. In other words, if you were to put the annual load of 40 million vehicles on the bridge at the same time, it would collapse under the weight. The bridge was not designed to handle that type of load. If you were to put the entire monthly load of 3.9 million vehicles on the bridge at the same time, it would collapse under the weight. The bridge was not designed to handle that type of load. THE BRIDGE WAS DESIGNED TO HANDLE ONE DAY AT A TIME. So are we! It is important - even vital - that we plan our year, our quarter, our month and our sales day. By so doing, we have a better chance of achieving our goals. However, we have to handle our professional career one-day at a time. If not, we will collapse under the weight.

Lesson #4: How is Your Memory? Try out this quiz: 1. Name the three wealthiest people in your state. 2. Name the last four Heisman Trophy winners. 3. Name the last five Miss Americas. 4. Name the 1993 World Series Champion. Well, how did you do? How successful were you in recalling these news-making events? We don’t fare very well on 8 0800- 0 3 -3373- 7 8 -486476 7

these, do we? Seldom do we remember the headliners of days gone past. Should we remember them? Don’t they receive the most publicity and attention? These people are the best in their fields of endeavor. However, like most things, the publicity passes, the applause fades and the awards are forgotten. Let’s try another quiz: 1.

Name three people with whom you enjoy spending time.

Name four people who have taught you about yourself or life.

3. Name a teacher or a coach who encouraged you. 4.

Name a friend who listens to you in those difficult times.

Well, how did you do? How successful were you in recalling these “difference makers” in your life? Wasn’t this a much easier quiz? Isn’t it amazing… the people who have touched us the most are the ones with heart… not headlines. “Fame and success are different. Madonna has one, Mother Teresa the other.” Erma Bombeck

Lesson #5: Avoid America’s Favorite Pastime What is America’s favorite pastime? Some people think it is baseball. After all, it is called the “National Pastime.” Some people believe golf is the national pastime. Personally, I don’t like to play golf because I stand too close to the ball… after I hit it!! However, there is another pastime that Americans are crazy about. Despite its popularity, this pastime should be avoided at all times! It is called “transference of blame.” It is easy to blame others for our condition, our problems and our state in life. We are responsible for our thoughts and our actions. We are responsible for our hits and our misses. We are responsible for our success! This 10 word, 20-letter sentence says it all: “If it is to be, it is up to me!” Bryan Flanagan presented at the April 2013 Spring Break event. He is the President of Flanagan Training Group. His company makes “learning fun.” The website is www.flanagantraining.com. Bryan can be reached at bryan@flanagantraining.com or 214-505-5109. T hTehPer P o rf iot fai b t al eb D l eeDnet inst ti .sct o. cmo m1717

Practice Management

What the World’s Greatest Dentists do Differently by Dr. Chris Griffin

t has been my great pleasure to spend time with some of the world’s greatest dentists over the past few years.

I have spent the day with a man who built no less than 27 practices. I have gone to the homes of 2 dentists who both had solo practices well into the millions and seen their libraries with my own two eyes. I played golf with a man who has the premiere sedation practice in America on a course where he had 2 aces in one round!! Amazing. That doesn’t even begin to touch the numerous breakfasts, visits, luncheons and chance encounters I have had with famous dentists, plus those anonymous gentlemen and women who quietly run their top 1% practices. Luckily for you, I have always been a laborious notetaker. As such, I have an extensive catalog of little scribbles, lists and action items from those encounters. Recently, I was asked, “What do the best dentists you have ever seen have in common.” I suppose the questioner would have liked for me to have given a quick sentence or two. That’s impossible. The truth is that each man or woman on my list has a little different take. Each one has carved out their own little niche. Some are unbelievable clinicians. Others are better managers than any CPA. Still, there is a list of commonalities that ALL of them seem to share. Here is my list of the secrets of the world’s best dentists as I observed them.

1. Delegation. Most of the World’s Greatest Dentists have one little area in which they like to get involved, but you had better believe that most everything else is delegated. The most successful I have seen manage their delegation actively. Some have their employees bring them lists with all they accomplished during the day at the end of each day or week. Others might have a lunch meeting with their management team each day, ala Rockerfeller. I personally

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have adopted email as a very efficient way for me to stay on top of things and get daily or weekly emails from the different managers on my team.

2. Genchi Genbutsu. This is the Japanese term that means, “Boots on the Ground.” What it means to you is that the World’s Greatest Dentists (WGDs) occasionally insert themselves in the details of their practice. The troops need to know that you are still aware of minute details that happen each day. There’s nothing like a little uncertainty of when the boss will show up asking questions to keep the standards of your practice moving along nicely. Whatever you do, don’t become a micro-manager! NONE of the WGDs are that. And I mean none.

3. Decide with Authority. To a person, the WGDs I know have no trouble making decisions. Some require more information than others, but all are confident in their decision once it is made. Another part of this is the seeming lack of remorse after a decision. Too many dentists out there are regretful and wishy-washy after they have made a move. If you want to be a WGD, you’d better work on that.

4. Focus Intently. Understand, this is only for short periods of time. No one can focus intently all the time. Don’t let them tell you they can. Whether they are working on a patient or working on a problem in the office, whatever they are doing, a true WGD will harness almost superhero-like focus until the task is completed. Then, they may take some time off while their trusted team puts the final touches on the project.

5. Guard their Time. I don’t know a single WGD who spends a second more of their time at the office than is required of them.

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All of them know what they want to accomplish and spend exactly the amount of time they need doing it. The thing that scared me away from my dreams of multiple offices years ago was the gentleman with 27 offices who told me that if you enjoyed golf or fishing, that wasn’t the route to take. I enjoyed both immensely, so I tossed that dream to the wayside then and there.

6. Implement Systems. WGDs have some of the most detailed standards and systems you could imagine. I think the reason that the average dentist in America doesn’t have them is that they are a good bit of work on the front end. It is my theory that dentists can make a good living so easily that many choose to neglect their systems. The problem with lack of systems is if the economy slows down, much like it has lately.

7. Define Job Descriptions. What WGDs do NOT have is a bunch of employees stepping all over each other’s tasks and duties. This is a piece of the puzzle that rewards for the length of a dentist’s career. These make it almost impossible for a weak employee to hide from their responsibilities and cause friction and resentment in the rest of the staff who take up their slack. Clear job descriptions solve a lot of strife.

8. Measure. Another no-brainer that ALL dentists should be doing is measuring their practice. A lot of dentists play at statistic keeping, but the true WGDs actually use statistics to help them make crucial decisions. A good example is marketing. Most dentists have absolutely no idea about the success or failure of their marketing efforts. That has made us prey to the predators out there who like to charge us thousands of dollars for things that we don’t need. If you track how much is spent on each marketing

campaign and how much is produced off that money, you can quickly decide if your money is well-spent. WGDs don’t waste their money.

9. Ask Questions. All the great leaders of industry ask a lot of questions. There is a theory called the “5 Why’s.” It is believed that you can find the root of any problem by asking “Why” up to 5 times. I believe that it shouldn’t take even 5 times in a dental practice. The problem is that most of us don’t ask even one. I think the underlying trait of the WGDs is that they are willing to accept the emotional pain of asking a question that may have a bad answer. WGDs don’t bury their heads in the sand when the tough questions need to be asked.

10. Watch the Money. All of the great dentists realize that their time chairside is limited and they had better put up stores while they can. There are as many investment theories as there are dentists, but all the WGDs save better than their peers. That gives them options not available to the masses at earlier ages. One last trait that I think all of them share is that they actively seek. World’s Greatest Dentists are never satisfied with the status quo. They all want to be the best they can be and they always are looking for a way to make things better for themselves, their families and their teams. I think it would be in the best interest of all dentists to put this list up on their wall and work on weaker links this next year. Once you think you’ve got them all down, drop me an email. I’d love to add you to my list. Dr. Chris Griffin is a solo practicing general dentist from Ripley, Mississippi. You can reach him at chrisgriffin@ thecapacityacademy.com

The Profitable Dentist.com

Practice Management

Why Your Staff and Patients by Gary Kadi

Hate You

Four of five dentists surveyed agree they love practicing dentistry… most believe they’d love it even more if they didn’t have to deal with staff and patients. When I first began in practice management almost 20 years ago, doctors wanted to hire me to fix their practice by firing everyone. Then sedation dentistry came into vogue and they would ask me to help them set up a great sedation practice so they could sedate their patients and their staff. If you searched your computer and found your staff meeting agenda from ten years ago, it would have the same bulleted items as it does today: •

Get rid of “Debbie Downer”

•

Get staff on the same page

•

Stop broken and canceled appointments

•

Reduce accounts receivable

•

Increase new patients

•

Eliminate hygiene holes

•

Go fee-for-service

These are all symptoms stemming from an overlooked source point. Getting your team and patients to love you is the key to realizing the picture you had that inspired you to get into dentistry in the first place.

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You remember that picture included no nights or weekends, four-day work weeks, kids’ college tuition pre-paid, retirement funded by age 50, loads of time with the family traveling around the world to great places, enjoying the spa, playing tennis and golfing. Back then, you were dreaming and you were on cloud 9. Today the only number that comes to mind is probably 911. If you missed that “half hour” in your senior year when leadership, management and business development were taught, you were set up to fail, right out of the gate. So why do you continue to stay on the same treadmill, with no “off” switch, trying to outrun the same reccurring problems? Aren’t you tired of trying ageold variations of the same tactics, only to have nothing change? In dentistry, pain is necessary but suffering is optional. Here’s why you have tried everything and every initiative has turned into the “flavor of the month.” Running a practice is like riding a bike. When I was six years old, my grandmother Vera taught me how to ride a bike. Recently, at 50, I took up cycling and started doing races. My first race, I finished 89 out of 89 in my age class, could barely walk for two weeks with back and hamstring soreness and

thought synchronized swimming may be a better idea for me. Then, however, I met with my friend Kevin, who explained to me that form matters in bike racing and riding a bike, like a horse, is not a good idea. He explained that my 35-pound Schwinn steel frame hybrid should be upgraded to a 14-pound Specialized carbon fiber machine. Oh yeah, he also said to remember water and nutrition are important. I took his every suggestion and in my next 60-mile race I placed 59 out of 174 and I could walk the next day. We take things like riding a bike and running a practice for granted. We have the ability to do it. We do it every day and hardly think about it. We think the way we do it is normal. We never consider that we can improve the way we do it, but improvement is possible and creates positive results. Consider that you’ve been doing the same thing in your practice. You got the bike and you just started pedaling and doing dentistry. Now is your chance to turn that “infection” you call staff into a team, and turn your patients into people who do more than what insurance covers, show up, prepay, teeth bump and tip you on the way out!

1. Take Your Power Back and Draw a Line in the Sand 2. Install the Triple Win Practice Business Model 3. Install the Five-Step Healthy Patient Process

Take Your Power Back and Draw a Line in the Sand Dentists have come to realize they’ve spent enormous amounts of time and effort buttering up their patients when they should have been treating their team as their number-one customer, who would then automatically take care of the external customer. They realize that speaking harshly and critically to a team member in front of a patient or other team members has been a regular part of their approach to doing business, and now they see that this approach is counterproductive. They realize they have been too controlling, micromanaging and redirecting the efforts of team members who know exactly what to do and how to do it if they only had a format to follow. Dentists would have peace of mind giving it away if they had a metric to measure each team member daily.

To turn your team and patients from haters to lovers, focus on these three areas:

Getting your team and patients to love you is the key to realizing the picture you had that inspired you to get into dentistry in the first place. 800-337-8467

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On the flip side, perhaps they realize they have been too lax, giving away far too much power to a team member who is neither trained for nor appropriately handling so important a role. They further realize they have failed to fire the “problem child” in their office — the individual whose inappropriate behavior sets the whole office on edge, destroys morale and encourages other team members to behave badly as well.

Here is how to develop trust with your team members, especially in situations where trust has been lacking. You start by drawing a line in the sand. You tell your team, “The past is over. We’re going to start fresh.” Here’s what you do: • Sit down as a group in a place where you don’t normally meet, to let them know you’re serious.

Doctors feel a momentary sense of despair at this juncture, because they suddenly realize the tongue in the shoe doesn’t match the tongue in the mouth — they’ve said things would change, but they’ve never caused the needed change. They might have had good intentions, but they lacked the ability, time, knowledge, or structure to make necessary changes. The bottom line: they didn’t keep their word. So what to do now?

• Open by saying: “I want to have a genuine conversation with you, a conversation that’s different from any we’ve ever had in the past. I am taking a new level of responsibility in leading this practice. I may have made promises that have gone unfulfilled. If you have anything from the past, any agreement I haven’t kept, that is keeping you from being fully engaged and giving your absolute best, let’s air it out once and for all and move forward from this moment on.”

Here’s the good news: It’s not nearly as hard as you might think to restore your team’s trust in you. Restoring trust requires you to first realize that 80% of the problems in your offices come from promises you’ve made… and broken. As a result, your word has no value. You can’t create a new future and you can’t solve the problems from the past. You are simply stuck if you don’t acknowledge and own this truth.

• They may not tell you everything, and indeed there may be nothing to tell. Yet the fact that you’re taking these actions will elevate your team’s trust in you. But they’ll most likely tell you at least a few things you might not want to hear, things you need to do differently if you want to gain and build their trust. • Listen without judgment to the points these individuals make. Find out what it would take to resolve these issues. Then do whatever it takes to be true to the promises you made in the past, the broken promises of which you are

80% of the problems in your offices come from promises you’ve made… and broken. 22

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being reminded now, along with the new promises you are making in this conversation. • Tell your team you will take responsibility for keeping your word and for the fact that you haven’t done so in the past. • Leadership means you go first. Once you step up and take responsibility, guess what happens next? Yes, your team begins to take ownership… and if they don’t, you have a foundation to hold them accountable. Remember that your team is going to be sharing with you their reality, not yours. Your mission here is to get the facts. Until your entire team confronts their problems about how you’ve been dealing with them, you simply can’t create a new future. Without this, you’re going to get all revved up from that seminar you took last Friday, but unable to enroll any of your people in the changes you would like to effect, simply because they don’t have any reason to believe you. You’re going to do it differently. You’re going to take responsibility for the broken promises of the past and you’re going to take responsibility for keeping your word in the future. If you want your team to give you their best, you’ve got to play it straight with them. No more broken agreements. And when it comes to acknowledging the contributions of your team, always go the extra mile. Now that you’ve established a new starting point with your team, you need to have the right people in the right places doing the right things.

Table A1

Install the Five-Step Healthy Patient Process When was the last time you purchased something that was going to cost thousands of dollars, might hurt you and will take time out of your busy schedule? Exactly! Solving this problem answers why you’re on the drill, fill, and PPO treadmill. This is why you have good intentions of getting your patients healthy and they think they have your next Porsche in their mouth.

Install the Triple Win Practice Business Model Most practices running today are some version of the 1950s practice where a doctor threw up a shingle and started yanking and grinding teeth with a band-driven handpiece. While technology has progressed, the business model being employed today has not. This is the SOURCE of why things do not change: you default into micromanaging, disempowering your team and perpetuating your patients to “do whatever my insurance will cover.” In contrast, with the new Triple Win Model, the patient receives all the care they need and want, your team grows personally, professionally and financially, and every aspect of the aforementioned picture is fulfilled. You and your team will shift from being busy to being focused on a daily outcome. You will shift from trading each team member’s time for money to rewarding direct results. This will turn your biggest expense into a profit center. You will isolate areas of improvement, training and support, and shift from managing by emotion to managing based on facts.

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Step 1. Calculate the desired collection amount that will allow you to fulfill your ideal lifestyle, personally and professionally. Let’s say $1M. Step 2. Determine the number of days you want to work. Let’s say 16 days a month with 4 weeks off each year. Step 3. Identify what we call a DPO: Daily Primary Outcome by Provider. Let’s say you are a one doctor, one hygienist office. Then your DPO for the Doctor is $5,000 and $1,000 for the hygienist. ($6,000 x 16 days per month x 12 months is over $1,000,000. Adjust up for percentage of write-offs.) Step 4. Assign DPOs to your entire team as shown here in table A-1. Step 5. Set a BBM (Bare Butt Minimum) of monthly collections that exceeds all your personal and practice expenses, debt reduction, retirement, team bonus and 10% extra to build a cash flow pool. Step 6. Offer a bonus, by position, when the DPO is met or exceeded. Bonus is calculated daily and paid out monthly ONLY if the BBM is met or exceeded, therefore ensuring you only pay out when your expenses are covered.

Do you ever have a new patient come in and tell you their last dentist, who they went to for 20 years, didn’t recommend anything and yet you are dropping a $10,000 case on them after meeting them for 15 minutes? Do you have patients who say they want to wait on the recommended treatment? Do you close the case in the back just to find out that they didn’t schedule in the front? Did you close the case and then get a call back when the patient got home to cancel? Are you tired of having patients call and cancel their hygiene appointments because the weather is nice and it’s just a cleaning? Since I am over my word count here and I don’t want Woody to get mad at me, I will go over The Healthy Mouth Baseline because it will solve all the above questions. You can download free samples you can use as models at nextlevelpractice.com.

A Healthy Mouth Baseline is a laminated patient education tool utilized by your hygienist, assistant and front desk team to let the patient know what a healthy mouth is in your practice. This solves two primary problems: A. It answers WHY the patient should care about what you are recommending. The patient has no idea what a healthy mouth is. They think bleeding is normal. If you do not establish a baseline for asymptomatic disease, they think you’re making your recommendation for your own gain or that new fountain in your reception area. This is the source of filling hygiene, increasing case acceptance and having new patients trust the $10,000 case is legit. B. It also tells the team what to do and how to do it so they can be more effective in their roles. I spent countless hours observing this fascinating old dental business model and saw that only 5% of all conversations were about dentistry and almost zero was spent on its effects on the patient’s overall health. The Healthy Mouth Baseline, when combined with the other elements of the 5-Step Healthy Patient Process, takes case acceptance from 30% to 67%, and re-care retention from 20% to 80%.

the average adult will invest in the value of a crown and buildup at about $1,000 or a total of hygiene and restorative of $1,300, for the average annual value of an adult patient. Multiply $1,300 times 1,000 active patients and you are at $1,300,000. Before the Doctor completes the three steps outlined above, they are doing about $650,000. Worst of all, their team and their patients are haters.

Gary Kadi is a well-known speaker, author and advocate for the whole of the dental community. If you would like to take your practice to the NextLevel, your first step is to call 212-388-1712 and ask about the JumpStart program. After successful completion of the JumpStart Program, you may be eligible for continuation into the NextLevel Three-Year Complete Health Dentistry Curriculum. Mention “The Profitable Dentist” and get a $1,000 scholarship.

Turn your practice, team and patients into lovers. Take the first step today.

The simple equation is to get your patients to come back twice a year for hygiene, which is worth $150 x 2 or $300. Then, while they are in hygiene,

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Practice Management

Marketing for 2014

Will you be ready?

by Howie Horrocks and Mark Dilatush

As 2014 approaches, it would behoove dental practices to plan their marketing activities for the upcoming year well in advance. But where do you start?

Start with your budget – what should it be?

Allocating the budget

To decide what your marketing budget should be for the entire year a responsible rule of thumb is:

Now that you have a marketing budget, how should you spend your marketing dollars? Keep two things in mind.

5% of last year’s gross revenues up to 5% of revenue goal for the new year. For example:

1. You should continue any marketing activity that has already been producing a positive result (why drop it if it’s working?)

2013 practice gross = $600,000 X 5% = $30,000

2. Target remaining money toward mediums that go from the least risk to the most risk

2014 revenue goal = $800,000 X 5% = $40,000 So your 2014 marketing budget should not be less than 30K or more than 40K. That works out to $2500 - $3333 per month. You want to keep some flexibility in case a great deal comes along. For example your local radio station may decide to offer spots for half price. You might decide that you want to take advantage of that.

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For the last 25 years we’ve been tracking results for virtually all mediums and what we’ve discovered is the existence of a Marketing Risk Scale: Least risk – internal, signage, website, direct mail Riskier – any print media (newspapers, inserts, magazines) Most risk – mass media (radio, TV, billboards)

Internal marketing includes patient newsletters, whether electronic or paper, appointment reminder services that go out to your patient base, in-office educational materials and any in office signage or photos. In short, any marketing communications that are targeted to your own patients. This is very low risk because these people already know you, you’ve already done work on them and they’ve already given you money. Unless you make them mad or they move or die, chances are they will be with you for a long time. Signage is a must so people can find you. It also serves as a reminder to people passing by that they need to see the dentist. You pay for a sign once and it does its job for years. There’s almost no risk. A well done, patient friendly website is also a must. For one thing all your other marketing will have your site address on it, so it acts as a support medium for any marketing you put out. Websites are relatively low cost and very low risk (unless your site scares people away or bores them to tears, but that’s another subject). Direct mail, done and targeted correctly, is also low risk. Don’t fall for the line that direct mail is “old school and obsolete” because that’s simply not true. Twenty five years of results tracking has long ago proved this medium will produce a very positive ROI if you run a smart campaign and stick with it. Direct mail gives you a big advantage over any other medium in that you can be very precise in your targeting ensuring that (mostly) only the people you want to reach will get your mailer. Any print medium contains more risk than the above. That’s not to say it’s so risky you should avoid it, but you need to know you’ll be taking an elevated risk. Probably the poorest investment you can make in the print arena is to advertise in the major daily in your city. There’s too much competition with other advertisers. Choose instead a neighborhood or community paper. It’s more local and more relevant to the reader. The least risk of the medium risk group is newspaper inserts. These give you multiple advantages over a print ad in the newspaper. A big advantage is you’ve got two sides of an 8 1/2” X 11” piece to tell your story. Inserts are often quite cheap to produce and deliver. However, there are limited targeting options (usually only by zip code). The “shelf life” is usually very short. People don’t seem to hang onto an insert the way they will with a mailer. Using a magazine for a medium contains significant risk. As with newspaper advertising you will have a lot of competition. If you choose this medium make sure there are few or no other dentists using it as well. There is a better magazine option that you may want to consider. This is a magazine that is only about you and your 800-337-8467

practice. It’s a high end glossy “coffee table” type piece that has no ads. It’s usually 8 or 16 pages of beneficial information about you, your team, and all the services you provide, patient testimonials and anything else you want to include. This type of magazine is ONLY targeted to the top income earners in your area and you only mail it to them twice a year. Mass media presents the most risk to your marketing dollars. It may be tempting to jump into radio, TV or billboards but it’s almost never a good idea unless you have the foundational marketing mediums already producing for you. In other words, a great website and direct mail program and some kind of presence in a print medium, that have all been doing well for you for at least two years, are prerequisites before you should even consider mass media. These mediums are also much more costly and require a significant amount of time to build any kind of momentum. You must have a robust budget because you’ll be in it for the long haul. That’s why you “soften up” the market with your direct mail, signage, website and internal marketing before setting your sights on mass media. So when they see you on TV there’s a very good chance they’ve already seen your mailer at their homes or have seen you in the neighborhood newspaper.

Results tracking Marketing is risky business. Please don’t believe anyone who says it isn’t. As you can see above, there are low risk ways to allocate your marketing money and high risk methods. But there’s one risk you never want to take. And what is that? The risk of not knowing if your marketing is working. That’s why we strongly recommend to all our clients that they closely track the results of anything they do throughout the year. The easiest, cheapest and most accurate way to do this is called “call tracking.” This consists of attaching a unique phone number to every medium you use that consumes more than 40% of your marketing budget. This tool will track every incoming phone call and will even record it. You can listen to how staff deal with people on the phone so it’s a wonderful training tool. You can set this all up very quickly and cheaply. Take a look at www.callsource.com for just one company who offers this. The best part is you will never again have to wonder if your marketing dollars are being wasted or if they are working hard for you. There will be no more “feeling or sensing.” You will have true data and you will KNOW. And with that knowledge it will be MUCH easier to plan your marketing in 2015.

For more information about New Patients, Inc., call: 866-336-8237 or on the web at www.newpatientsinc.com. You can reach Howie or Mark directly at whh@newpatientsinc.com or markd@newpatientsinc.com. The Profitable Dentist.com

Practice Management

Addressing the Confusion Surrounding Seminar Compensation Policies by Paul Edwards

“You are not special. You are not a beautiful and unique snowflake.” - Chuck Palahniuk, Fight Club

have good and bad news for my employer friends.

The good news is that there is clear guidance on the issue of Seminar Attendance Compensation which we all must follow. I will include the rules below in an easy-tounderstand format that you can begin to use immediately and going forward. The bad news? Contrary to common misconceptions (and your mother’s assertion that you are “special”), you cannot create your own policies regarding which types of seminar/ conferences that you will and will not pay your employees to attend. Seminar attendance is covered by federal law, and you must follow the regulations to the “T” or risk being fined or sued for Wage and Hour violations.

“There’s a Rule for that” Seminar Attendance Compensation is covered by Federal Law, under the Fair Labor Standards Act (FLSA). The FLSA is enforced by the Department of Labor’s Wage and Hour Division. Depending on your state (e.g., California), there can also be some stricter state-specific laws that apply as well. For the purpose of this article, we’re only going to address the federal rules as they apply to everyone. (For any TPD readers with concerns about state-specific rules, contact CEDR at 866-414-6056 and mention this article. We will let you know if there are any state rules you must be aware of and comply with.) Per the FLSA, in order for time spent by an employee at a seminar NOT to be compensable, all four criteria below MUST be true. (Think of it as the “One strike and you’re out!” rule.)

1) Seminar must be outside of normal work hours. Note: This does not say “days,” it says hours. Since most employees work between 9am and 5pm and most seminars occur between those hours, that means that most, if not all, hours spent at the seminar are compensable. Strike 1! You’re out!

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2) Seminar must be voluntary. Note: The word “voluntary” will not stand up if an employee can show the employer initiated the opportunity to attend and was led to believe that the training was related to their job. Strike 2! You’re out!

3) Employee performs NO productive work during the seminar. 4) Seminar is not job related. Note: This criterion is the main strikeout zone. If the seminar will at all help or train the employee to do better at his/her job, then the hours are compensable. Which brings up the question: why would you send an employee to a seminar if it wasn’t going to help them to do a better job? The answer is, you wouldn’t. Strike 3! You’re WAY out! One exception to these rules: if the employee is participating in continuing education in order to maintain his/her state licensure and would not be able to continue to work without it, you do not have to pay. That’s it! Those are the rules. You can devise any policy you want, as far as establishing who can and cannot be sent to a seminar, but in the end, the above rules trump and control compensation for hours spent in attendance. And some states, like California, have even stricter rules and benefits you must follow. In addition, the hours spent at the seminar are also subject to the 40-hours-per-week rule for overtime pay. If the employee works 38 hours at the office, then attends a seminar for an additional 6 hours, you will have to pay 4 hours of overtime at one and one-half times the established rate. By the way, travel pay is not the same as seminar pay and is equally as critical for you to understand. In the next TPD issue, I’ll explain the complex rules around that. “But what about…?” Some of you might be thinking: • Well, if what you’re telling me is true, then all the offices around me are getting it wrong, too. • I checked with my payroll company/bookkeeper/ accountant, and they didn’t say anything about it. • I got that policy from my colleague/friend/brother, and his/her attorney put it together so it must be fine. • I read a different article that told me something different, and I based my policy off that.

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• My policy is fine like it is, because I have a special form my employees agree to and sign. However, the rules are clear on the subject of seminar compensation. If the seminar falls within an employee’s normal working hours and is at all related to his/her job, the time his/ her behind sits in the chair is compensable. No policy that you or anyone else writes (including an attorney) negates that fact. I also want to refute a couple of popular myths associated with Seminar Compensation: • If the seminar falls on a “regular workday,” I can pay their day rate and no overtime. FALSE • Because they will benefit from the training, I get to decide how and what I will pay. FALSE • If I combine the seminar/meeting with a vacation destination, it makes for a special circumstance and I don’t have to pay a daily or hourly wage. FALSE • If I mention that I’m going and they can come if they want, and I’ll be willing to pay their way, then no pay is OK so long as they agree. It’s optional and a vacation of sorts, since they can bring their family. FALSE It is important for you to know and realize that compliance with federal or state rules falls solely on your shoulders as the employer. The DOL has heard all the reasons and excuses made by employers, and does not care where you received the policy from. All the DOL will look at is that you have an illegal policy that violates the FLSA, and boom, you’re in a losing battle before the fight ever starts. For your benefit, we’ve put together a short guide discussing Seminar Attendance and its compensation rules in depth, with footnotes and links to the FLSA, and have made it available on our website for a limited time. To download it, visit www.cedrsolutions.com/tpdsem. If you have any questions about the rules I’ve discussed in this article, or would like an HR expert to look at your policy for compliance issues, call CEDR HR Solutions at 866-414-6056 and mention this article. Paul Edwards is the CEO and Co-Founder of CEDR HR Solutions (www.cedrsolutions.com), which provides individually customized employee handbooks and HR solutions to dental offices of all sizes across the United States. He has over 20 years’ experience as a manager and owner, and specializes in helping dental offices solve employee issues. Paul is a featured writer for The Profitable Dentist and Dental Town Magazine, and speaks at employment education seminars, conferences, and CE courses across the country. He can be reached at 866-414-6056.

The Profitable Dentist.com

Practice Management

Get MullinSIZED

24 Secrets to Coach Your Team to Be Winners by Chris Mullins, The Phone Sales Doctor™

full two dozen secrets is probably too much for you to digest at one time, so I will share 12 secrets now and save the other 12 for the next issue…

3) Practice how to answer objections.

9) This is not an option. Provide ongoing coaching, motivation and recognition for your entire team. This is a must because you’re dealing with people. People not machines are running your business. Are you Inspecting What You Expect™? Or, are you looking the other way because things seem to be okay? But, you’re still waking up at night worried about the thousands of dollars you’re spending on marketing to get the leads to call or to opt-in to your web site and you have no real solid idea, no facts of how each call is being handled. Coaching works for you, right? You’re a member of your own Mastermind group, right? Your team needs ongoing support and coaching that never stops... that pushes them out of their comfort zone... that challenges them to inspect the work they do... that ensures they know what they’re doing right so they’ll keep doing it and know what needs to be fixed, why it needs to fixed and then shows them how to fix it. You can’t do it. That’s not your area of expertise, but you can create your own comprehensive coaching program or you can our customized Phone Success Coaching program.

4) Create scripts for everything that you do. Scripts are just checklists, guides, blueprints. Then, test the scripts and keep using the one that works the best.

10) Daily pop quizzes are a great way to keep your team focused, moving forward, motivated, sharp, excited and knowledgeable about your business.

5) Practice how to use the script.

11) Develop ongoing contests and bonuses.

6) Make sure your team members know everything about your practice before they get on the phone. Ask your team, including the doctors, this question… why should a prospect choose us over the competition? Sit down hang on tight you’ll be shocked and perhaps start to cry when you hear the answers.

12) Do the math. Track and talk about the sales numbers (appointments) daily with your team.

1) Stick to the MullinSIZED Phone Success Script. Many times the appointment coordinator, first impressions director and receptionist can get comfortable in their own routines. They start to feel confident, which is good, but for some it means they get lazy. They start to create their own phone scripts, which means they lose focus on what works. Don’t let this happen! The script that works is your best friend, influencing your prospective and established patients to buy—what they wanted to begin with or they wouldn’t have called you. If you get lazy about this and allow your team to deviate from the script, you run a very big risk of losing appointment opportunities. What ends up happening is you turn your team into the “Sales Prevention” team. Scripts work. The MullinSIZED Phone Success System script is a proven system. 2) Provide a list of common objections with the correct answers.

7) Create a success story cheat sheet that your team members can quickly refer to. This helps to build their confidence as well as share success stories with prospective and established patients. 8) Coach your team on how to use success stories; you can’t just say, “Use this.” Show them how they can

weave different stories into their conversations without identifying who the story is about.

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Chris Mullins (aka The REAL Phone Doctor) is president and founder of Mullins Media Group™, a communications and consulting firm. For TPD readers, Chris is offering a FREE Mystery Call and confidential Doctor Telephone Consultation with Chris Mullins. The doctor will hear the mystery call; and Chris will tell you exactly what to do to fix the problem areas. Email: tanya@mullinsmediagroup.com. Limited time offer.BOOK: “Monkey Business For Today’s Phone Weary Office See / Hear / Speak No Evil and Take Fridays Off!” www.GreatBottomLine. com/monkeybusiness. To get our FREE FAMOUS Monday Morning Email Stimulator™ opt-in at www.GreatBottomLine.com ©All Rights Reserved Mullins Media Group™, LLC - 603-924-1640.

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Practice Management

What The Top 1% Know That You Don’t by Dr. Mike Kesner

hy is it that some dental practices enjoy extraordinary success while so many others seem to barely get by? What are these successful practices doing that others are not? What would happen if you could find out what these top 1% practices are doing and then do those same things in your practice? Wouldn’t you get the same results? So, what do the top 1% know that you don’t?

1. Know What You Want. I have talked with hundreds of dentists about changing their level of success. They all say that they want to grow their practices and be more successful. Then when we start talking about the changes necessary to achieve this, they sometimes come to the realization that they want something else more than their success. Be honest with yourself and determine what you want MORE than extraordinary success. Some dentists don’t want to work that hard. Some dentists don’t want to change the way they present dental treatment to their patients. Some don’t want to take any risks. Some don’t want to trust their team to run the practice. Some don’t want to learn better leadership skills. Some don’t want to fire a toxic staff member. Some don’t want to hire a coach who has “been there and done that” to show them the way. If this were easy,

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then everyone would be doing it, and if you could do this by yourself, then you already would have. You need a coach to help you make the right changes, in the right order and at the right times. Mistakes are expensive, so they need to be minimized. What do you want more than success? Whatever you want more will always win. Make the decision to go “all in” and do whatever it takes.

2. Understand Marketing – Every successful practice must have a steady influx of new patients every month. Learning how to generate 100+ new patients per month requires an understanding of both internal and external marketing. You must become a great marketer by knowing what makes marketing work and why. Does it grab the reader’s attention? Does it answer in that reader’s mind… ”What’s in it for me?” Does it answer why they should come to your office instead of the dentist across the street? The top 1% dentists understand that marketing is an investment not an expense. I get a 4-to-1 return on my marketing in the first month alone. That’s not an expense but an investment. Where else can I get that kind of return on my money today?

Learn what is the lifetime value of your patient. When you get an understanding of this, it will change the way you view the cost of marketing.

3. Case Presentation – If you have gray hair like I do, then you probably remember the days when patients would say… ”Whatever you think I should do, doc.” Those days are gone. Patients want to be involved in their diagnosis. They want to be able to see what the problems are and discover these along with you. Case presentation should NOT be a process where you diagnose and formulate a treatment plan without involving the patient in the process. Understanding the psychology behind why patients say “yes” to the dental treatment you recommend is the key to case acceptance. It is NOT patient education. Put away all of the fancy models, brochures and videos that try to teach your patients dentistry. I know this sounds like heresy, but education is not what helps patients want the treatment they need. People make buying decisions based upon emotion not intellect. They don’t suddenly gain knowledge of how a root canal is done, or what a crown prep looks like and now decide they want one. Knowing how you and your team should connect with the patient emotionally vs. intellectually is the difference between a case acceptance rate of 23%, for the average dentist and the 70% that the top dentists get.

4. Profitable Hygiene – Your hygiene department should be generating around 30% of your total revenue. Hygiene should be a profitable part of your practice, not a loss leader. Make sure your hygienist is not doing prophys on patients with periodontal disease. Putting your hygienist on commission will fix this problem and greatly increase the practice revenue. I also like assisted hygiene for increased efficiency and productivity. Your hygiene schedule should NOT be booked out more than 2 weeks. This is a capacity blockage, which makes it very difficult to fit in appointments for new patients or scaling and root planing. This is corrected with either another hygienist, or an assistant for your existing hygienist.

5. Team Driven Office – A great team is the key to a decrease in stress and an increase in revenue. When the team is incentivized to run the practice, then you only have to focus on the dentistry. With the right bonus system the team is transformed from employees to business partners. Your case acceptance goes up because now it is also

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the team’s responsibility to inspire the patients to want the treatment they need. When you have the team “firing on all cylinders,” then a synergy occurs that doubles and triples the practice’s revenue.

6. Understand Overhead – As you all know, it is important to make sure your P&L categories like payroll, lab, supplies, marketing, etc., are all within the correct percentages. This is measuring overhead, but not necessarily understanding overhead. You will never create wealth by cutting costs. You will only create wealth by generating revenue. The best way to lower overhead is to dramatically increase your revenue. If you double or triple your revenue, your overhead will go up only a fraction of the increase. Dentists tend to put most of their focus on overhead reduction because they believe they have more control over their costs than their revenue. The top 1% dentists understand how to also control their revenue.

7. Consumerism – How convenient is it for patients to come see you? Does a new patient have to wait 2-3 weeks to get an appointment? Can a patient get their treatment done today, or do they have to make an appointment to get it done later? Patients want convenience. They want you to accommodate their needs and their schedule, not the other way around. If patients have to wait too long to get an appointment on your schedule, then they will often call another office that will accommodate their schedule. If new patients have to wait over 2 weeks to get an appointment, then you are probably seeing a lot of new patient appointments fall off your schedule. This is a capacity blockage caused by not enough treatment rooms and/or not enough staff. The top 1% are not afraid to spend money to fix capacity blockages. It will pay for itself many, many times over. Make the decision today to master the business of dentistry and achieve extraordinary success. Why not double your revenue in 12 months? I have done it several times for myself and for many other doctors. Take your practice to the next level, decrease your stress and make the income you deserve. Dr. Mike Kesner is a practicing dentist and author of Multi-MillionDollar Dental Practice. He is founder and CEO of Quantum Leap Success in Dentistry, a consulting company that helps dentists build the practices of their dreams in 24 months or less… Guaranteed! Dr. Kesner speaks nationally on topics related to mastering the business of dentistry. You may contact Dr. Kesner at 480-282-8989 or drkesner@ QLSuccess.com. His website is: www.QLSuccess.com.

The Profitable Dentist.com

Practice Management

Unhappy Patients’ Point of View by Bill Rossi

Let’s learn from what patients complain about online. We recently looked at negative online reviews of dentists in 20 American cities. We sampled from each city and analyzed over 140 negative reviews.

his is fresh market research because you’re seeing very raw and frank consumer reaction to their dental experiences.

It’s not fun to look at negative accounts of dentistry, but if we’re serious about understanding patient perceptions, it makes sense to tune into what bothers patients most.

WHAT PATIENTS COMPLAINED ABOUT MOST (In descending order):

Doctor and staff pushing unnecessary dental work. (Actual verbatim reviews): “I’d be wary here if you don’t enjoy having teeth unnecessarily drilled.” “I had a filling come out and they insisted that I get a $980 crown instead of a filling…”

Poor billing and insurance practices. Hidden or deceptive charges. “I have no complaints about the dental care provider but his office has billed me and my insurance company incorrectly on numerous occasions.” “They billed me eight months after a treatment they told me insurance would cover.” “This office over-charges and the billing staff consistently makes mistakes and makes me pay the difference for their mistakes.”

Poor quality dentistry, incompetent Doctor and/or staff. “Following replacement, those teeth in which the fillings were replaced hurt more now than ever before.”

“They seem overly aggressive and want to drill and fill cavities.”

“Horrible. They screwed up my teeth. I now have two teeth I can’t even floss between since they left bite molding material between them.”

“This place is horrible. I’ve never had so many cavities as I’ve had going to this dentist. Why? It has nothing to do with my teeth, just the fact that he needed to make money.

“The absolutely worst cleaning I’ve ever had. The most painful experience I’ve ever had at the dentist. The hygienist completely missed a few teeth.”

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“I got a new crown on my front tooth. It did not match the color of my other teeth.” “Not all the hygienists have their act together. One of them neglected to make sure I got my annual x-rays done and I blame her for letting a tooth get decayed enough that I had to have a root canal on it.”

Rude front desk staff.

“While she’s working, she gossips about confidential info about fellow employees and patients.”

Inconsideration of patients’ time and schedule, waiting. “They have a strange policy of not cleaning your teeth during your first visit so then you have to make another appointment.”

“The receptionist was very rude whenever I had to call them. I’m very glad I never have to deal with them again.”

“Where it’s taken every dentist in my life one appointment (cleaning and routine check-up) is taking them three appointments and they want to go to four and I refused.”

“Horrible place and they have extremely rude and disrespectful people at the front desk.”

“This wait has been as long as 40 minutes and was quite a waste of my time…”

“Shabby impersonal atmosphere setting. You are treated like a farm animal.”

Unprofessional staff behavior and discussions. “The hygienist loves to chat about dogs and kids but this comes at the expense of a thorough cleaning. Three minutes spent on polishing does not cut it.”

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Doctor not compassionate, impersonal and insensitive. “I let Dr. ___________ know my teeth weren’t fully numb and was wincing in pain during the drilling. He didn’t even stop for a moment.” “Dr. ____________ has the personality of crabby old badger. She is rude, uncaring, has no professional ‘bedside manner.’”

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Rushed or “assembly line” treatment.

Look at complaints as an opportunity to improve.

Painful treatment. Old dirty or uncomfortable atmosphere, out-of-date equipment. Now these comments are about other offices (not yours), but making sure that you and your staff are sensitive to these issues makes it less likely that someday there will be such a review on your office.

If you have technology that their previous dentist did not, make sure that they understand the difference. For example, about 45% of offices in this area have Diagnodent. If you are using this detection tool, you will find caries that there is at least a 50% chance their previous dentist (or their second opinion dentist) wouldn’t diagnose.

TO MAKE SURE YOUR TREATMENT PLAN IS TRUSTED: You can sort of see the back stories behind some of these comments, can’t you? In many of these cases the patients may have had good treatment but just did not perceive it. We certainly want people to choose the best dentistry you have to offer, get perio treatment, fluorides, etc. but we always want to make sure it’s done in a way that the patient feels no pressure at all. So, doctors and staff can’t give up diagnosing or recommending treatment but you have to be sure that your approach is credible and the patient perceives the reasons for treatment.

Tell AND Show: If they see it with their own eyes, they’ll believe it. That means actually using the intra-oral camera, mirrors, digital x-rays and taking a moment or two to actually show the patient. (The intra-oral camera is still grossly underused in most offices.)

Use “Problem Development”: The patient has to own their problem before they’ll own your solution. No doubt we’ve discussed this with many of you in our staff meetings. The steps are: 1. Show and state the problem. 2. State what caused it. 3. Scale it, (grade the problem’s seriousness), “This tooth is 50% shot!” 4. Discuss what will happen if something isn’t done.

Give Power Back to the Patient: Tell the patient something to the effect of, “It’s our job to do a thorough diagnosis and give you our best advice based on our training and experience. It’s your job to tell us what you want to do…”

Or ask, “You’ve heard what I recommend, but how do you feel about what I’ve told you…” and actually listen. Here is where you can uncover any skepticism if the patient feels that they can honestly level with you and your staff.

Speaking of that, make sure your staff reconfirms with the patient the need for the treatment. “So what are your thoughts on what the doctor has recommended so far?” Or, “Are there any further concerns or questions you have before we proceed with this?”

When recommending fluoride, high-end mechanical toothbrushes or home-care products, make sure the patient is reassured that, “We recommend this for you for x and y reasons. Of course, it is entirely up to you…” Then no patient will ever leave your office feeling judged, pressured or upsold. Last but not least, no matter how good communicators you and your staff are, there will be patients who get upset from time to time. Look at complaints as an opportunity to improve your services and, as importantly, the perception of your services.

5. Make your recommendation.

Invite Second Opinions: Especially on large treatment plans. This shows the patient that you are on their side, yet confident of your plan.

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Bill Rossi is president of Advanced Practice Management. He and his associates are actively involved in the nvolved in the ongoing management of over 250 upper midwest dental offices. You may contact Bill at 952-921-3360 or through www. AdvancedPracticeManagement.com.

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The Profitable Dentist.com

Practice Management

This Boutique Practice Is Alive and Well ... Here Is Why by Dr. Charles Barotz

here is a common misconception in the profession that in the wake of the recession the boutique style, insurance independent dental practice has disappeared or suffered immeasurably. So much of what is being put out there in the CE world these days is that the “bread and butter” practice is the only way to go if you are going to make it. When most dentists are asked, “do you take insurance or are you on any plans,” they answer that they are. When the same dentists are asked why they participate they respond that they have to. In addition, second only to staffing issues, dealing with insurance companies is a close second when dentists discuss what causes them stress in their practice lives. I have been told by very knowing people that most boutique practices have shown a 30% decline as a result of the recession. This has not been true for my practice, but rest assured, it has not been by accident. First, we must define what I mean by a “boutique practice.” I am certainly not describing a cosmetic only practice. Any practice that does strictly elective cosmetic procedures is probably down way more than 30%. I can say that through the recession those procedures have all but dried up. Thankfully, there has been a resurgence of people doing elective procedures in my practice which has accounted for 2013 being on par for a 30% increase over 2012. While my practice numbers have been somewhat flat through the last three years we

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have not shown any significant decline through the recession. Our collection figures did go down but less than 5% in any of those years. I am sure most “bread and butter” practices showed similar, if not worse, declines. If people lose their jobs they lose their insurance which is bound to affect an insurance based practice detrimentally. So what did we do that was different which poised us for the significant growth. First and foremost, we did not make the recession an excuse and accept that a decline in business was inevitable. More importantly, we did not deem it as acceptable. The realization that honing our marketing efforts was necessary to attract more of the patients that were less affected by the recession made my decision to get additional expert advice on how to do this a no brainer. This involved revamping our internet strategy as well as revisiting abandoned techniques that had worked in the past. We experimented with display ads in the newspaper and were pleasantly surprised with their effectiveness. We also got back on the air on our local “oldies” radio station since our primary preferred patient is over fifty and have success with that. We used down time to revamp systems and develop training manuals which has made the office run smoother and more efficiently. It has also made inevitable turnover easier to deal with. This was accomplished by having each staff member either write up one new protocol or modify an existing one each week. With eight staff members doing

this on a weekly basis it did not take very long to have virtually everything we do and how we do it documented. This has all been saved in a Word file and has given new and old staff members a valuable resource for smooth running phone calls and clinical appointments. We have also taken a new attitude regarding the way the phone is handled by our front office professionals. In order to maximize the positive effects of our marketing we are currently recording all of our incoming calls from our marketing. Once a week we spend one hour reviewing calls with the front office staff to ensure that they are being handled in the manner which I desire. We have a phone script and flow chart which I insist be followed. My attitude is that my front desk personnel be as accountable for their performance as is my back office staff. These sessions can either be very educational or very intimidating for the person whose call we are listening to. Those staff members who will not adapt and learn from their mistakes are urged to find their success in another office. It is interesting that many employees who handle incoming phone calls have the attitude that it is all right to handle phone calls correctly some of the time. I ask those individuals how they would feel if I, as the dentist, only provided excellent dentistry “some of the time.” Those employees who “get it” are handsomely rewarded and those who persist in “winging it” are no longer with us. On that note, I have taken a careful look at all of my employees and made a concerted effort to identify and purge our staff of all employees who do not share the core values of my practice. Before that can be done it is important to have a team meeting and identify and articulate those values. I am very clear that mistakes in techniques can be very valuable learning experiences and will rarely result in termination (if the individual does indeed learn from these mistakes). Breaches in integrity that involve lying or cheating are also mistakes but these mistakes are simply not tolerated and will always result in dismissal. During the recession we made a concerted effort to market “needs based” dentistry as opposed to elective “want based” dentistry. As always, I continue to expand the scope of my skills so that I can service more of my patients’ needs without sending them and the revenue they represent, out the door to specialists. This is the concept of SUPER DENTIST which I discuss in my book The Patient Centered Dental Practice. Having the ability to place mini implants as well as standard sized implants still separates my practice from most. More importantly has been the implementation of the Periolase into the practice which allows me to treat periodontitis with LANAP. This process gives superior healing with much less pain and discomfort than conventional flap surgery. This is another procedure that sets my practice apart from the run of the mill practice.

FREE Special Report Reveals...

The Ultimate Wealth-Building and Equipment Financing Strategy for Dentists Have you ever sat down and totaled how much you’ve spent on financing costs for your practice? Whether you finance or lease your equipment, it’s going to cost you hundreds of thousands of dollars in interest payments you’re never going to see again! But it doesn’t have to be that way. You can bypass banks and financing institutions altogether, become your own source of financing – and recapture all the interest you now pay to finance companies. Imagine being able to get your hands on the capital you need to build a cutting-edge practice and gain an almost unfair advantage over every other dentist in your area by answering only one Pamela Yellen question: “How much do you want?” Financial Security Expert 2012, 2013 Spring Break Best of all, the money you Seminar Presenter withdraw to finance your practice continues to earn interest and dividends just as if you never took it out! You’ll discover exactly how this works on page 12 of my FREE Special Report, available at: www.BankOnYourself.com/dentists I’ve spoken twice at the Excellence in Dentistry Spring Break Seminar, and this is what Dr. Woody Oakes said about my presentation: “You simply CANNOT afford to not have this information for you, your family, and your friends and team!” - Woody Oakes, DDS In my FREE Report, I also reveal... ✚ The wealth-building strategy that has never had a losing year for the past 160 years! ✚ How to access the money in your plan – with no taxes or penalties or restrictions – when you want and for whatever you want ✚ How to have the peace of mind that comes from steady, predictable growth of your money, year in and year out. You’ll know the guaranteed value of your retirement account on the day you’ll want to tap into it... and every point along the way (on page 7) Don’t you owe it to yourself, your practice and your family to at least check it out by getting your FREE Report here right away? www.BankOnYourself.com/dentists

Continued on page 62 800-337-8467

The Profitable Dentist.com

Practice Management

Money Saved is Money Earned: Eliminating Overhead Before you Open the Door by Dr. Jake Masters

Dr. Jake Masters, has recently begun his walk to become a “Profitable Dentist.” We’ve asked Jake to write a segment for each issue chronicalling his successes, failures and lessons learned. For each of us, whether in the honeymoon phase, on the road to retirement or someplace in between, you’ll reflect on or learn from his experiences.

re you spending thousands of dollars a year on something you could get for FREE?

Practice Management Software is the heart of any practice. It is the lifeblood that dictates the schedule, accounting and protects our valuable patient records. We all understand that our modern practice couldn’t survive without a solid, reliable practice management software. That’s why we don’t even think twice to pay monthly bills that come in at hundreds or even thousands of dollars. Sure you might weigh the decision of the occasional “$5-10K+ update” charge, but my guess is that you know you need it and you just pay for it. What if I told you there is practice management software that is free, easy to use and it is more flexible than your current software? Open Dental, initially marketed as Free Dental, was designed and programmed by a dentist, Dr. Jordan Sparks. He then SHARED his software with the dental community in 2003. I say SHARED because it is an open source program licensed to the General Public. This means that anyone has the freedom to develop and support the program itself. That means no more proprietary equipment or programs that the other software company uses as a license to steal, pun intended. I know what you’re thinking – you’re paying for all those convenient features. Open Dental has many of the features that you know and use with your current software system and since it is open source, the users are helping to constantly evolve the software and

integrate new features by the day. There are many program links or “bridges” that dental product companies have created to seamlessly integrate imaging software, electronic claims services, text based reminders and confirmations and intraoral camera systems. Some of the more unique features include the ability for your patient to confirm their appointment into your schedule directly via text, the ability to fill out forms online and download them directly to your patient’s record and the ability to use Windows’ built in voice recognition to do the periodontal charting for you. It is a Windows based system, but it can be set up via a virtualization program (like Parallels or Bootcamp) to work seamlessly on a Mac. The program itself is small and stable so you can run it on older computer systems without worry. It isn’t web-based, but you can easily remote-in to your computer using another program like Log-Me-In or their simple, but convenient App to check on the practice while you are on the go. You can download and try the program for FREE before you buy it via a quick download at www.opendental. com. It does have an initial contract fee of $149/month for the first 6 months to help you with the install and provide phone support as you are learning the new software, but after the initial contract you can either keep the phone support for $99/month or use the system as is for FREE. The initial setup is easy

and you can transfer your charts over for a nominal fee of $500-$2,000 depending upon the previous software system being used. The initial fee includes install on as many computers as you want and supports 1 office and up to 3 dentists. The user manual and many video tutorials are available on the website if you want to see the software in action without even downloading the trial. After spending many hours scouring the forums of Dentaltown and comparing the features and costs of other systems, Open Dental was an obvious choice. It has proven itself invaluable in our scratch practice and according to many others the same is true in their milliondollar, decade old practices. This is a company that has proven the test of time and will be a part of the dental community for many years to come. In no way are we being compensated for endorsing this software, but instead this is just one way for us to say thanks to Jordan and his team for what he has shared with the dental community. Dr. Jacob Masters is a General Dentist from Louisville, KY who practices in Floyds Knobs, IN. He is a graduate of the University of Louisville School of Dentistry.

Convenient Links: • Opendental.com • Parallels.com • Bootcamp (included with Mac OS X Leopard 10.5 and above) • Secure.logmein.com

Clinical

Pearls for More Profit & Better Dentistry! by Dr. Michael Curtis

1. Bond Costs: Are you still dispensing your bonding agent into a mixing well before you apply it? Please consider placing a half drop directly on your applicator instead. You’ll save a fortune in wasted bonding agent. Try microbrush applicators for easy use. Visit www.microbrush.com.

on 100’s of Pearls

Anesthesiaf& Pain Relie

2. E.max & Zirconia-Cement Update: What cement should you use for E.max or Zirconia crowns? Standard resin-modified glass ionomers (Fugi-Cem, Rely-X) are fine. However, if you need greater retention on short or non-parallel preps, resin cement is 2-3 times stronger.

most ances for the Amazing adv do! cedure you important pro

totally • Fast, easy and the busy practical for general dentist.

After try-in, you must re-clean the internal aspect of these crowns before cementation. Check out the following tips from Dr. Gordon Christensen’s “Clinicians Report”:

of dollars • Saves 1000’s hours in C.E. and countless ’s rls from 100 • 100’s of Pea you know of sources...Do them all?

l Dentist

For The Genera

•

E-max: Apply 5% Hydroflouric acid as if doing a porcelain repair. Spray and dry. Apply silane. Dry. Then cement

•

Zirconia: Sandblast internal of crown. Rinse. Dry. Cement

•

Preps: To clean your prep prior to cementation apply Concepsis (www.Ultradent.com)

If you don’t subscribe to “Clinicians Report (Formerly CRA), you are missing one of the best resources in dentistry! 801-226-2121 www.CliniciansReport.org

3. Facebook & Social Media: Do you know how to use Facebook, Twitter, Google +, Pinterest, Instagram, LinkedIn and other social media tools to market your practice? If not, you’re not alone. You can get a significant number of new patients from a social media campaign, but it has to be first class… and most practices need professional help.

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Who should you hire? Check out “My Social Practice” www.mysocialpractice.com. They’ve managed all my social media for about a year. We have reaped huge benefits – with little effort on our part and their program has paid for itself many times over. Some of what they provide: •

Excellent, attention-grabbing articles written and illustrated for you every week.

•

Daily ideas that engage your patients on Facebook and encourage them to like, share and comment.

•

A monthly newsletter sent to your patients, which compliments “patient reminder systems” such as Demandforce, Lighthouse, Smile Reminder, Televox, Sesame or Patient Activator. (If you don’t use these programs for email and text appointment reminders, please look into them.)

•

In-office campaigns that help build “Likes” and engagement on your Facebook page.

•

“My Social Practice” articles are posted automatically to your blog. They cover hundreds of topics and raise awareness for your practice with prospective and current patients: ➢ To see the tools they created for my office, check out my practice blogsite: drmichaelcurtisblog.com. ➢ To view their FREE Ebook on social media click on “7 Keys To Effective Social Media Marketing For Dental Practices,” visit mysocialpractice. com/2013/01/free-ebook. ➢ To view the latest video to put on your Facebook page click on www.youtube.com/ watch?v=dauV9iA4Pnk. We just put this on our site with great response! ➢ Contact Information: www.mysocialpractice.com or call 877-316-7516.

divide 50 by 150 = 1/3. Give the child 1/3 the adult dose.

5. Grinding & Clenching: Americans are under more pressure than ever. Many are clenching constantly, damaging teeth, supporting tissues, restorations... and causing a cascade of muscle tension related headaches, neck-aches and chronic facial pain. Facial muscles are very difficult to relax. Nevertheless, you can help many patients by encouraging the following exercises, when you deliver bite-guards: •

Tense the tongue against anterior palate. Hold 10 seconds and relax.

•

Tense the tongue against lower linguals. Hold 10 seconds and relax.

•

Open wide. Hold 10 seconds and relax.

•

Clench Teeth. Hold 10 seconds and relax.

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Tense forehead. Hold 10 seconds and relax.

•

Breathing techniques, progressive muscle relaxation, Botox injections, new medications and other methods can also reduce spasm significantly. For more, consider our “Anesthesia & Pain Relief” guide.

6. Sub-gingival Fillings: Have you had trouble isolating subgingival margins for posterior composites, when a crown-lengthening is unrealistic? Try placing your tofflemeyer upside down-with the slot facing occlusally. Your band will tighten at the margin better. For superior isolation, consider a greater curve “banana band” (www.greatercurve.com). You may not even need a wedge. Prep a hole in the band just under marginal ridge areas for tight contacts (football diamond or 12-flute finishing bur). Don’t worry; resin will bond weakly, if at all, to adjacent teeth. You can easily break and polish it with a metal finishing strip.

4. Drug Doses for Kids: Do you prescribe the right doses for children when you write prescriptions? “Clark’s Rule” is a simple way to figure a child’s correct dose. The formula is Child’s Weight divided by 150 x Adult Dose. For example: if a child weighs 50 pounds,

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Dr. Michael Curtis practices in Connecticut and is the author of the “100s of Pearls” books on “Anesthesia,” “Endodontics,” “Collections” & “Case Acceptance,” each with over 400 Pearls in 80 categories. For questions or to order, visit www.100sofPearls.com or call 800-427-2830.

The Profitable Dentist.com

Clinical

Glutaraldehyde vs Paraformaldehyde by Dr. Alvin H. Arzt

t has been 61 years that I have now been a dentist. In my dental school days, “cavity toilet” was a key word prior to placing any restoration. A wipe of the finished cavity floor with phenol prior to placing the restoration was a routine never forgotten.

CH²(CH²CHO)², with Paraformaldehyde HO(CH²O)nH, the solid form of the gas formaldehyde, which is also an equal disinfectant. Back in the 1950s, Dr. Angelo Sargenti researched the results from Balint Orban, a noted periodontist of his era. Dr. Orban wrote that a dilute solution of paraformaldehyde (7%), wiped deep into a periodontal pocket, disinfected that pocket and induced reattachment.

Even in those days, sealing bacteria under a filling was considered improper. This was independent of all the caries removal. Much of this needed routine may have been forgotten with the use of an acid etch, such as phosphoric acid, to prepare the remaining tooth structure to accept the new composite sealer. But the remaining bacteria in the cavity prep would be forever sealed under the restoration.

Dr. Sargenti reasoned that if this 7% paraformaldehyde could repair periodontal pockets, then it would be ideal to disinfect root canal pulpal tissue that has become gangrenous and seal the canal, with a sealant that prevents reinfection. And so, N2 Root Canal Sealant was born.

Dr. Gordon J. Christensen, the founder and director of the Practical Clinical Courses, recently stated in his “Ask Dr. Christensen” columns, the technique he favored was the use of glutaraldehyde solution, prior to placing any liner in a cavity prep, prior to placing a composite filling. The glutaraldehyde does not alter the bonding effect or may improve the bond of these agents. This reminds me of the old technique of “cavity toilet” necessary to disinfect that cavity prep prior to placing the restoration.

Dr. Sargenti developed a technique and sealant that would allow a dentist to cleanse and reshape a canal, remove the debris mechanically (engine driven), and introduce the sealant to completely disinfect the canal(s) and seal them and then the sealant would harden so it would not leak out and become the filler. In vital pulp contamination, Dr. Sargenti worked out a procedure that a portion of the apical pulp could remain and with the far reaching action of N2 the portion of vital pulp remaining, maintained its vitality and health.

And that brings us to the relationship of Glutaraldehyde formula

Recent published research (2013), by Dr. Robert Teeuwen of Germany, has

4444W W I NITNETRE R2 021031 3

proven again that the early teachings of Dr. Sargenti are true. Dr. Teeuwen’s root canal treatments extend to over 16,000 permanent teeth, and include hundreds of these with their roots still not fully formed, but with large carious lesions causing the coronal portion of the pulp to become gangrenous. He extirpated the pulp up to the level where bleeding was observed and shy of the apical nonformed root area. After a few months, his x-rays revealed that the roots continued to develop to normal length and a sclerotic membrane (walled off barrier), separated the N2 from the remaining normal pulp. This certainly proved that N2 was selflimiting and well tolerated by healthy tissue. It is no wonder that Dr. Sargenti first lectured in the US in Dallas in the 1960s, and it was not long before over 35,000 US dentists adapted this technique to their usual root canal office regime. With the bad publicity N2 has endured, it seems to have been proven contrived and not true. In the July 2008, Volume 34, Number 7S, Journal of Endodontics, an article was published that proclaimed: Reevaluation of earlier research that examined potential health risks associated with formaldehyde exposure has shown that this research was based on flawed assumptions, which resulted in erroneous conclusions. The purpose of

this review was to examine more recent research (2008) about formaldehyde metabolism, pharmacokinetics and carcinogenicity. These results indicated that formaldehyde is probably not a potent human carcinogen under low exposure conditions. In spite of all this favorable research toward Formocresol and its much reduced relative, N2 which is 5% paraformaldehyde without any caustic cresol, the antagonists refuse to retreat. N2 now contains 5% paraformaldehyde as compared to Buckleyâ&#x20AC;&#x2122;s Formocresol, which is 19% paraformaldehyde and 35% cresol. Formocresol is probably used today (2013) as frequently as it was used 50 years ago. When a patient comes into a dental office with a severe toothache pain, the dentist who is treating this patient (squeezing them into his crowded schedule) usually anesthetizes the tooth, opens up the chamber and inserts a cotton pellet with formocresol into the exposed chamber and seals the tooth temporarily. Then the patient is rescheduled when the schedule allows more time, or perhaps the patient is now referred to an endodontist to perform a root canal. Formocresol is not restricted to pediatric dentistry as dental teachers recommend, but more likely to an adult patient. What conclusions can we arrive at when Dr. Christensen recommends

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a disinfecting agent before applying the restorative material. What can we surmise when the New York University Dental School research admits that conventional root canal treatments have only an 80% success rate. Yet research shows that N2, with 5% paraformaldehyde reaches a 98% success rate. It is clear that bacteria contamination can be the criteria between successful treatment and failure. What dental procedures, including all specialties, involve procedures that can have the sites with remaining bacteria? Operative, with usual removal of decay and restoring with a permanent restoration. This restoration could be a

wipe the scaler clean from blood and debris with a cotton sponge, before the next tooth is scaled. All this could be considered impractical in actual practice. In implant insertion, the implant is obviously sterile, but is the bone site sterile where the implant is to be inserted? Antibiotics are often prescribed in conjunction with the treatment to overcome any contamination. It should be considered by all dentists, that in their treatment of a patient, that the tooth or area may need â&#x20AC;&#x153;a cavity toiletâ&#x20AC;? before they consider the job completed. Dentistry has certainly changed in the 61 years of my practice. This past March 2013, I finally retired my active dental license. It has certainly been worth it for me and I hope for my patients.

class I cavity, an inlay, a crown, or even a veneer facing. In a simple prophylaxis, where there is deep scaling, every stroke of the scaler could transport bacteria to another pocket. Does this mean the scaler should be disinfected before another area is reached? The usual technique now is to

Dr. Alvin Arzt graduated from the Temple University School of Dentistry, in 1952 and in 1969, he Introduced Sargenti N2 Root Canal into the US. He is founder and first President of the American Endodontic Society. Wrote the first article published in the US on the Reciprocating Handpiece in root canal treatment, the Giromatic. You may reach Dr. Arzt at Alvin4jaws@ gmail.com or 610-380-7944.

The Profitable Dentist.com

Clinical

Enhancing a Smile With E-Max CAD by Dr. Ara Nazarian

n today’s economy, a dental provider must meet the demands and requests from his/her patients, especially when it comes to enhancing a smile. As the economy has had its ups and downs, many practices have suffered in productivity as well as maintaining their usual patient count. However, if you can predictably provide a variety of dental services under one roof in an effective and efficient manner then your practice will prosper and your patients will be treated with the type of care they expect. We are all looking for the magic pearl that will take our practice to the next level! However, I have personally found that the secret has always been within our own practice and how we address our patients and their dental needs. This case study illustrates how

Figure 1; Retracted Pre-Op Photo showing wear (3743)

Figure 2; 3D White Wax Up from Arrowhead Dental Lab (3912)

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we were able to address the patient’s needs with E-Max restorations after her repeated failed attempts at other dental offices with whitening and bonding.

Case Presentation A woman in her early 40s presented to the practice dissatisfied with the appearance of her smile. She commented that she felt that her existing teeth and restorations were unattractive because of size, shape, wear and color (Figure 1). She also mentioned that she could feel some chips in her restorations as well as broken portions of tooth structure causing occasional discomfort and a misaligned bite. She had unsuccessfully tried whitening and bonding elsewhere and was very discouraged with her present condition. In order to illustrate the problems with her wear and bite, we simply took a picture of the patient smiling as well as retracted image of her teeth. Focusing on areas of incisal chips, disharmony of the shape of the teeth and discolor, we discussed options for correcting these issues. From the library of enhanced smiles performed in our office, an enhanced smile was selected that related the similar changes that would be

Figure 3; Temporary Template and Clear Reduction Stent (4009)

accomplished by a full mouth make-over. When reviewing this photo of an enhanced smile, the patient asked if we could in fact deliver this type of smile make-over for her. In response, I replied “absolutely,” but that we would like to render a 3D White Waxup model (Arrowhead Dental Lab) to confirm the treatment necessary to enhance her smile due to the wear in her dentition. The diagnostic White Wax-Up (Arrowhead Dental Lab) would correspond with the cosmetic simulation and show what the final case would look like esthetically and functionally (Figure 2). White Wax-Ups also include a Temporary Matrix that allows you to create beautiful chairside temps in 15 minutes, as well as a Clear Reduction Guide that makes it easy to ensure proper reduction (Figure 3). The clear reduction guide takes the guess work out of prepping a case and allows the dental provider the ability to work quickly and confidently knowing exactly how much to reduce each prep in order to get the optimal result.

Planning To develop a treatment plan and determine if the vertical dimension could

Figure 4; Full Arch Impression with Take One Advance (4036)

be increased, impressions were taken for a diagnostic White Wax-Up (Arrowhead Dental Lab). Based on information gathered from the initial consult, it was determined that all the remaining teeth should be cleaned of any caries or defective restorations, cored if necessary and crowned. All risks, benefits and alternatives to various treatments were clearly reviewed with the patient. As a result of the information gathered from the cosmetic evaluation, the diagnostic wax-up and the patient’s desires for treatment, it was determined that restoring the entire upper and lower dentition would enhance aesthetics and function. The final treatment plan would consist of IPS e-max CAD (Ivoclar Vivadent) crown restorations from teeth #3-14 and teeth #19-30, with core restorations where needed.

size, shape, color and position, was made from a Siltec (Ivoclar Vivadent) impression of the diagnostic waxup. Using Structur 3 (VOCO America) temporary material, the Siltec mold was quickly filled and placed on the patient’s prepared dentition (Figure 5). Within minutes, the temporary was fabricated and effortlessly trimmed with trimming burs and discs (Axis).

Cementation

A provisional restoration, which would aid in determining the best

Before try-in of the definitive IPS e-max CAD (Ivoclar Vivadent) restorations to verify fit and shade, the provisional restorations were removed sequentially starting from the maxillary anterior region. Any remaining cement was cleaned off the prepared teeth and bleeding from the gingival tissues controlled with Expasyl (Kerr) paste. After the patient was shown the retracted view for acceptance, the cementation process was initiated. The prepared dentition was cleaned with chlorohexidine 2% (Consepsis, Ultradent Products, Inc.) for 15 seconds and rinsed to remove any contamination during the temporary phase. The preparations were then desensitized (Gluma, Heraeus Kulzer), and the final IPS e-max CAD (Ivoclar Vivadent) crown restorations were tried in to verify marginal fit, contour, contacts, shade and accuracy. The patient was very satisfied with the look of her new restorations and approved them for final cementation. The crown restorations were seated utilizing a resin modified glass ionomer cement (Nexus RMGI, Kerr) (Figure 6). Excess cement was easily removed from the margins and accomplished within a short amount

Figure 5; Fabrication of Structur 3 (VOCO America) temporaries (4019)

Figure 6; Restorations seated with Nexus RMGI (4663)

Preparation Using a coarse grit chamfer diamond bur 856 (Axis), the maxillary teeth were prepared for IPS e-max CAD crowns. Utilizing Expasyl (Kerr) we not only controlled hemorrhaging, but also achieved gingival retraction. After approximately two minutes in the sulcus, the Expasyl was rinsed off with copious amounts of water. Utilizing a full-arch tray (Pentron) and fast-set impression material (Take One Advance, Kerr) an impression was taken for the final restorations (Figure 4). The same materials and steps were utilized for the mandibular arch.

Provisionalization

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of time. No finishing of the cement was necessary along the margins. The overall health and structure of the soft tissue and restorations was very good (Figure 7) and the patient was very pleased with her new enhanced smile.

Conclusion If dental providers are interested in taking their practices to the next level, it is essential to start offering a variety of dental services under one roof predictably and efficiently. In today’s economy, everyone wants things done immediately without several visits. The last thing they want to do is to take off multiple days of work to enhance their smile. Because of this, a dental provider who can consistently provide what they need effectively will excel exponentially. This case depicts some of the materials and services available that dentists can utilize to provide the best esthetics and function to their patients in a timely manner. In fact, this is what we teach at the Reconstructive Dentistry Institute. For more information log onto www.aranazariandds.com Dr. Nazarian maintains a private practice in Troy, MI with an emphasis on comprehensive and restorative care. He has earned a Fellowship and Mastership in the International Congress of Oral Implantologists (ICOI). His articles have been published in many of today’s popular dental publications. Dr. Nazarian is the director of the Reconstructive Dentistry Institute. He has conducted lectures and hands-on workshops on aesthetic materials and dental implants worldwide. Dr. Nazarian is also the creator of the DemoDent patient education model system. He can be reached at (248) 457-0500 or at the Web site www. reconstructivedentistryinstitute.com.

Figure 7; Retracted Post-op Photo of Restorations (43921)

The Profitable Dentist.com

Clinical

Oral Cancer: Early Detection Saves Lives by Dr. Brian Pikkula

hile there have been few, if any, true cures for cancer, the most effective method to date to increase the survival rate of cancer is early detection. Virtually for all types of cancer, if the initial diagnosis is dysplasia, Stage I or Stage II the patient has greater than an 80% survival rate at 5 years. However, if detected at later stages, III or IV, the survival rate at 5 years is < 50%. Until a cure for cancer is attained, early detection is the best method for increasing the life expectancy for those diagnosed with cancer. One example of the success of early detection is cervical cancer. In the mid20th century in the US, cervical cancer was the number one cause of death among women with cancer. Fast forward 40 years and cervical is not even in the top 10 among women in the US. This extraordinary reversal in the cervical cancer mortality is due to two major factors. First, the anatomical location of the cervix allows uncomplicated and nonsurgical visual access. Second, the medical community has made commonplace the annual well woman exam which includes a cervical screening test, the Pap smear, for all adult women regardless of risk factors. For those women who participate in an annual screening, dysplastic lesions are identified in early stages leading to a lofty survival rate at 5 years. It is interesting that the Pap smear test has never been studied in a classic randomized, controlled clinical trial. Also worthy of note is the low sensitivity of the test, reported in various studies ranging from 30% - 80% while the specificity is a respectable 90% or greater. Astonishingly, a test which does not have the requisite standard clinical studies and has

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an abysmal sensitivity has been implemented and has saved the lives of hundreds of thousands of women. With the easy access of the oral cavity, oral cancer stands to be the next cancer to reverse its low survival rate provided an annual screening protocol is observed. However, the screening examination currently employed by the majority of dentists is the conventional oral exam (COE). The COE is a visual (white light) and tactile intra- and extra-oral examination. While this is a worthwhile exam and recommended by the ADA, if oral cancer is detected by the COE, 63% of cases are found at Stage III or IV. Unfortunately in most cases, oral dysplasia and early stage cancer cannot be visualized by while light or detected by palpation. Recently, several adjunctive devices using fluorescence technology have been released to the market. These oral cancer screening devices allow detection of dysplasia and early cancers before they can be observed with the COE. Fluorescence is a property where a material produces a longer wavelength and lower energy light than the absorbed light. Many substances fluoresce such as tonic water, gems and other minerals, various petroleum derivatives, chlorophyll and currency (to detect counterfeits). Healthy mucosal tissue naturally fluoresces without the need for added dyes or other chemicals. In response to UV or violet excitation (identafi, DentalEZ), normal tissue fluoresces

blue. In response to blue excitation (OralID, Forward Science and VELscope, LED Dental) fluoresces green. The primary contributors to mucosal fluorescence are collagen cross-links and the metabolic cofactors NAD and FADH.

Similarly, a loss of fluorescence (LOF) is observed in abnormal tissue. Changes to the collagen crosslinks or an increased metabolic activity will reduce the fluorescence. The LOF from dysplasia and cancer is due to the altering of collagen cross-links by the dysplastic cells also reduce the localized fluorescence. Also, the increase in metabolic activity by the dysplastic and cancerous cells changes the NADA/FAD ratio causing a decrease in the fluorescence in that area. Fluorescence technology in medical applications is not novel to the oral cavity and is used in other tissue sites. Nearly a century ago, the Wood’s lamp was used in dermatological applications in detecting bacterial and fungal infections. In this century, fluorescence is used to assist in visualization of dysplasia and cancer of the GI tract, cervix, lung and skin. Note that a LOF may be induced by any mechanism that alters collagen cross links or metabolism such as thermal or mechanical trauma (i.e., cheek biting). Another source of LOF is tissue that absorbs the incident excitation light. Examples include amalgam tattoos and areas with higher melanin content such as the gingival margin. Since the LOF may be induced by other factors, a careful differential diagnosis with the overhead white light is essential in ruling out benign abnormalities. Additionally, a two-week follow-up is recommended as any trauma induced LOF is expected to be resolved by then. Overall, a proper training is essential for proper implementation of any fluorescence technology.

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As the dental industry needs to take a close look at the cervical model to reduce the mortality of oral cancer, there are options for the dental professional; the three fluorescence oral cancer screening devices on the market are OralID by Forward Science, VELscope by LED Dental and identafi by DentalEZ. With proper implementation, the trend of oral cancer could change as the trends of cervical cancer did five decades ago, through early detection. Understanding that the effectiveness of any device relates directly to its affordability and accessibility, the latest device on the market, OralID, has answered clinician’s concerns. With dental insurance coverage increasing, the return of investment of OralID (MRSP $995) is weeks or even days. With proper education for patients on the need for screening, a co-pay method is well received by patients, accepting fees from $30-$50, resulting in a well needed added revenue center for each office. We all know of the increasing spread of HPV in younger adults and across the age spectrum. Because of recent news media reports, your patients are hyper-aware of the real possibility of potentially developing this serious disease; adding education along with early detection, could save their lives. I would hope that you would insist on this for your own protection and the protection of your loved ones, as well as for the patients that entrust their oral health to your clinical expertise.

Brian M. Pikkula PhD, President and CTO, brings 15 years of biomedical research and medical device development to Forward Science. He earned his PhD from Rice University in bio-optics and began his career at M.D. Anderson Cancer Center as a co-director of a multi-center clinical study investigating the “optical biopsy,” which is a technology used to detect cervical dysplasia in real time using fluorescence and reflectance imaging. After this investigative work, Dr. Pikkula joined Remicalm LLC/Trimira LLC, which had licensed much of the technology he was involved in creating. Before Dr. Pikkula joined Forward Science, Dr. Pikkula was a manager at a firm that provides imaging and radiographic consulting services to medical device companies.

The Profitable Dentist.com

Clinical

Periodontal Disease

What are YOU doing about it? by Patricia A. Worcester, CDA, RDH and BS

n order to maximize a perio treatment plan, you will first need to teach medical knowledge. Explain to your patient the correlation between gum disease and total health. We now know there is a relationship between gum infections and: • • • • • • • • • • • • • • • • • • •

Heart Attacks Lung infection/COPD Strokes Gastric Conditions Colon Cancer Kidney Infection Pre-Term Babies Preeclampsia Osteoporosis Chronic Fatigue Diabetes Mouth and Throat Cancer Pancreatic Cancer Low Fertility in Men Erectile Dysfunction Brain Abscesses Alzheimer’s Carotid Artery Stenosis Rheumatoid Arthritis

Source: Manual of Clinical Periodontics and Journal of Periodontology

WOW, this is huge. Relate their gum disease to the above medical conditions and put emphasis on the importance of treating the gum infection before it causes any of the above side effects. Ask the patient: “Would it be a concern to you to know that your gum infection can influence your health in other ways, such as causing a heart attack, stroke, cancer, etc.?” Pick conditions that would be important to each individual patient. (Don’t talk about low birth weight babies to an 80-year old male.) Do not be afraid to maximize the health problems gum disease can cause if left untreated.

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I. Create ownership of the gum infection by showing the patient their mouth with its pockets and bleeding. Use a hand mirror or an intraoral camera to demonstrate and show major concern over the active infection. •

Choose the patient’s lower lingual arch to demonstrate the disease in their mouth. This area is usually very inflamed, so it bleeds easily. The patient can see into their mouth with a hand mirror or the use of the intraoral camera. It is much more dramatic when the patient sees disease in their mouth verses a flip chart. Seeing is believing!

•

Now hold the probe at 2-3 millimeters subgingivally while the patient is watching. Tell the patient this is where the ruler should be stopping. This is healthy. Now let the probe drop down into their pocket of say 4-6 mm. When the probe drops into the pocket, you must use a verbal cue with the depth. Such as, “WOW, can you see and feel how this drops down into that hole? Well, that is a hole in your jaw bone.” Drop the probe multiple times and make a little noise at each dropping into the pocket. The patient will say they can feel it drop and then they will ask you if this is bad.

•

Now you have their attention. Say, “Yes, this is a bad gum infection you have and let me show you other areas of your mouth where disease is located. Then go around their lower lingual surfaces and show the pockets with the probe dropping and use the same verbal emphasis. Next, drag the probe along the sulcus to demonstrate how their gums are bleeding.

•

This step creates ownership by the patient and they will ask you what needs to be done to help the infection. Now your job just got easier.

EXPLAIN IT THIS WAY: If you take your gum infection out of your mouth, this moderate infection would be equal to a 4 x 4 inch wound. Now

let’s lay that 4 x 4 inch wound on your stomach. It is bleeding and has pus oozing throughout. Would you want to treat it? Of course you would because you can see it, right? Well, this is what I see when I look at your mouth, a 4 x 4 inch infection with blood and pus. Even though you can’t see it, and there is no pain associated with gum infections, doesn’t it make sense to treat it just like you would treat it if it was an infection on your stomach?” II. Gum disease is the “silent” killer of teeth, just like heart attacks are “silent” killers. Gum disease is still the number one reason for tooth loss in adults. Gum disease is the number one reason for dentures. Gum disease is communicable, so families can pass from one family member to another. This, preventable and treatable disease is the dental professionals responsibility to treat and educate the patients. You must put your heart into your profession to get the patient to accept their necessary treatment. III. Treatment acceptance is easy when the patient believes in what we are explaining. Our patient will believe us when we use a concept called Belief Window developed by Kurt Hank. (Five Secrets to Personal Productivity by Kurt Hank published in 1997 by Franklin Quest.) We all have belief windows that shape how we see the world. Kurt discovered that the belief window is a naturally occurring phenomenon for all humans. And written on each window (by its owner) are a series of explanations, guides, or principles, which direct the owner’s behavior. The better you can see what is written on an individual’s belief window, the more you can predict future responses, explain past actions and encourage needed changes. By understanding this simple concept of Belief Window, you have a powerful tool that will help you deal with people more effectively. A Belief Window limits what we see or don’t see; therefore, what we do or don’t do. We need to attach our new dental information to the patient’s old beliefs. This will help them understand what we are presenting. Then the patient’s Belief Window has room to accept our information (treatment). For example, a construction person’s belief windows would be having a solid foundation, verses a crumbling foundation. A new solid roof verses patching a

800-337-8467

roof, or new pipes verses corroded pipes that cannot be repaired. Along with Belief Windows, we use EMOTIONAL WORD PICTURES to explain the patient’s treatment. An emotional word picture is when you use either an object or a story to express your feelings. EMOTIONAL WORD PICTURES simultaneously activate a person’s emotions and intellect - it’s a fancy name for an analogy or parable. The impact of using emotional word pictures is that people will remember what you’ve said for the rest of their lives. It’s the gateway into deeper intimacy. They help focus our attention. They bring communication alive. This results in a desire to do something or motivates change. How do you create a word picture? Carefully study the other person’s belief windows so that you can understand where their interests lie. Use these emotional word pictures when presenting so that the patient can understand their condition. If they understand, they will want to treat. For example, when we explain to the construction worker, they will understand when we say their gum infection is eating away at their supporting bone and destroying their foundation. Example of your conversation with the construction worker patient: “The first concern in any building is the foundation, right? A house needs a proper foundation to exist, would you agree? Well, your teeth also need a strong foundation to stay in your mouth to chew and function, just like a house. Doesn’t it make sense to go ahead and treat this infection that is destroying your foundation, making it crumble, so that it becomes stable and you can keep your teeth?” Another example: “If you have a wooden deck and a piece of that deck has a crack in it. And the deck gets a lot of use. So boards break while someone is walking across the deck, and they fall through. That would not be good, right? Well, your cracked tooth is like that piece of wood. And when you bite and chew on food, it will make the crack worse. You can split the tooth right in half, just

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like that deck. This can lead to severe pain, a root canal, or worst-case scenario, tooth loss. Just like I know you would want to replace that defective wood before an accident happens, doesn’t it make sense to go ahead and replace the split tooth with a protective crown before an accident happens?” Did you realize that people make their purchasing decisions based on the following 3 criteria? 1. Does the company have integrity?

If you use this 4-step plan, you will not only increase treatment acceptance, you will improve the dental and general health of your patient. It is in your hands to prevent major dental problems that can lead to major health issues. Daily, you face the non-informed and non-interested patient that you must rally to receive appropriate treatment. The correct treatment plan is in your hands. Your assertiveness to deliver proper dental treatment will become your daily goal. Are you ready to step up to the challenge? Are you ready to go beyond only what the insurance covers?

2. Can you back up your services? 3. What is the cost? Notice COST is #3. If you are finding your patient is frequently using cost to not accept treatment or they only want to do what insurance will pay, then you need to ask yourself if the patient really understands their problem and the need to treat. Using Belief Windows and Word Pictures will increase your acceptance rate. Source Kurt Hank, and Robert Cialdini.

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Pat is an international speaker, published author, practiced full–time hygiene for over three decades and is a trainer to dental practices across the United States, Canada and the United Kingdom. She is an Instrument and Product Analyst for DENTSPLY International and Thought Leader for Hu-Friedy Dental Instruments. Pat is founder and clinical director of Mission Possible…Best Hygiene seminars and clinical hands-on training programs. Combining working on your patients, your team and your practice for RESULTS! Healthy Patients = Healthy Profits. Contact Pat at: 954-536-0700 patworcester@comcast.net, wwwmissionpossiblehygiene.com

23rd Annual Spring Break Seminar Destin, Florida • April 10-12, 2014

Thinking About Missing Out On Next Year’s Event?

Excellence in Dentistry Is an ADA CERP provider

Fugetaboutit....

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. EID designates this activity for 16 continuing education credits. PAYMENT TERMS: Your credit card account will be charged upon registration. CANCELLATION POLICY: All cancellations must be made at least 30 days prior to the seminar and must be in writing. No refunds for cancellations within 30 days of seminar. VIDEOTAPING CONSENT: I hereby authorize the use and reproduction by Excellence in Dentistry, Inc of any and all photographs, videotapes, or other likenesses of me produced at the seminar, for marketing or any purpose whatsoever.

Early Bird Tuition Available Before December 20th! Visit www.theprofitabledentist.com

or Call 1-800-337-8467

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Clinical

The Truth about Dental Sleep Medicine An inside look at medical insurance billing in dental practices by Nick Carlone

he Implementation of dental sleep medicine programs has grown in dental practices across the country over the last few years. Many of these programs promote sleep medicine as a standalone revenue generator for practices everywhere, and with an exception to select dentists; this is not exactly a realistic expectation. The purpose of this article is not to deter dentists from implementing sleep medicine into their practice, but I hope this serves to educate on the realities of the industry and help manage expectations. This can be a very solid revenue stream, but the idea that your practice can rely on dental sleep medicine as its only offering is a misconception for the vast majority of practices. Like anything else, it ultimately is what you make of it. But there are limiting issues for every practice to think about before implementation. For this article I want to focus on the main realities of this industry when it comes to medical insurance billing. Our company serves as a third-party billing entity. We work directly with medical insurance companies while being pioneers when it comes to other procedures in

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a dental practice that may also be billed medically. Each insurance claim has multiple hoops to jump through, and each case will be handled differently. Each case will generally be broken down in these steps (though each is not always necessary): • verification of patient benefits • pre-authorizations • claim submission and denial management I will not spend much time discussing the actual process, most practices that have tried medical billing know the extensive work and time medical insurance takes vs dental. I would rather take this time to cover what each of you would like to know – how much will the insurance companies pay? The short answer is, unless you are in network with the medical insurance company is, you won’t know. I know, very helpful right? Unfortunately because you are out of network the insurance companies will not disclose the allowed amount which leads to much frustration in this industry. What all of you must understand is there are so many variables, such as state regulations, what specific

insurance company we are dealing with, and the patients individual plan. With all of these factors, how could any sleep medicine program guarantee what revenue you can add to your practice? What I hope you all take away from this article is not a definitive answer but rather a better understanding of what to expect. When we verify benefits the main information we obtain is the following: • is the procedure a covered benefit, • what is the percentage of the allowable that will be covered once the deductible has been met • the out of network deductible • what has been met of that deductible • what is the out of pocket, • how much of the out of pocket has been met • are any pre-authorizations necessary Having these questions answered will give you a better idea of what percentage the insurance company will pay, but you will never know the exact

Each insurance company and insurance plan has a different allowed amount for each specific medical procedure which they think of as usual and customary that is billed for, so even if they tell you it is covered at seventy percent, the question still remains, seventy percent of what? Note: This allowable will not be told to an out of network provider.

Let’s get to the point: We generally see allowed amounts for oral appliance therapy in the $800-$2500 range. Again this is not an absolute; it can be more it can be less. We normally see the out of network coverage at 50%-80% of the allowed amount, with the more common coverage at 60% or 70%. Note: these percentages are only covered once the out of network deductible has been met, which is another variable to account for. If the insurance specialists tell you the procedure is covered at 90% with a $250 deductible, double check that they are looking at the out-of-network benefits (happens all of the time).

800-337-8467

To sum this section up I will point out that the general ranges for oral appliance therapy code E0486 will be 50%-80% of $800-$2500. There are ways to leverage the insurance companies by including the consultations, radiographs follow up visits etc. because all of those procedures have their own allowed amounts. Again, this is not to deter you from implementing sleep medicine into your practice but to put a realistic spin on the industry. The profit margins are still very much in your favor, a general range of lab fees for oral appliance therapy will run $230-$610, while you total claim should generally average $2800-$5500. We have had claims pay much higher, but again, I am speaking in generalizations, of that $2800-$5500, only about $1500-$3500 should be billed for the oral appliance itself. Many dentists make the mistake of saying “since the insurance company pays on percentages shouldn’t we jack up the price?” NO! Bottom line, the insurance companies’ allowable will be what they deem as reasonable and customary.

The entire medical insurance process is very complicated, and there is much more than what I have written about in this article. This is why a billing specialist or third party billing entity is needed to maximize your practices reimbursement. For the few who can make this a standalone business, I can guarantee they have a strong understanding and thorough education on the medical billing side. For the rest of you, understand this can be very lucrative revenue stream while truly improving your patients’ quality of life. We understand treating the patient comes first, but understanding this is a business is crucial to your practices’ successful implementation of dental sleep medicine and medical insurance billing.

Nick Carlone is the CEO for Sleep Optima. For more information please contact us at Sleep Optima at 877.643.1613 or on the web at www. sleepoptima.com.

The Profitable Dentist.com

Malija@bigstock.com

amount the patient will be reimbursed.

Profitable Thoughts

F inancing Secrets of Successful Dentists by Pamela Yellen

ou’ve got a HUGE problem that dentists didn’t have 50 or even 30 years ago.

Back then (1930 to 2000), there was very little innovation in dentistry. But today, dental technology is improving exponentially every year, making your practice more productive and efficient and giving your patients ever-greater levels of service! Yahoo! Wait. Why is that a problem? Because you’ve got to keep up with it. A dentist starting out in 1960 could outfit his practice, go into hock for a few years until he paid it off. Then – voila! – he was done! Equipment lasted at least 20 years, or maybe even for the entire run of his practice! Today? Not gonna happen. I know there are dentists who are still trying that “use it until it dies” approach (though that guy in Tulsa probably should have popped for a new autoclave!). But if you’re the kind of person who reads this magazine, you’re savvy enough to know that you have to stay on the cutting edge to remain profitable and competitive. I’m not talking just the latest bells and whistles. I’m talking about the new technology that can make a real difference for your patients, your staff and you. And that’s expensive.

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So how are you going to handle it? Thousands of dentists and other professionals have discovered Bank On Yourself and have become their own source of financing for large expenditures. But before I tell you how they do it, let’s look at your typical options:

Option 1: Finance it. Say the equipment you need costs $100,000. You get a 7.5% 5-year loan from your friendly banker or equipment distributer. Your monthly payments are just over $2,000 and your total interest paid over the term of the loan is $20,228. So at the end of 5 years, you have a piece of slightly outdated equipment that you just overpaid by $20,000 to get! And that $20,000 is gone forever. That money is lining some banker’s pockets, not yours. (Hmmm. . . I’m not feeling the love here.)

Option 2: Lease it. Leasing sounds cheaper and your monthly payment may be lower – but beware! Say you decide to lease $100,000 worth of equipment for 5 years. Whether it’s broken out in your contract or not, there is an interest rate factored in. And at the end of it, what do you have to show for your payments? Nothing. Zippo. Except maybe the option to buy your now-outdated equipment for more than it’s worth. (Gosh, thanks a lot!)

Option 3: Save up and pay cash. Okay, this might sound like the prudent thing to do – but wait a minute: You’ve just drained a huge chunk of change out of what could be your nest egg – and you probably don’t even recognize it. How long is it going to take to recoup that? And while you’re working to recoup it, there’s a huge opportunity cost in the interest and/or appreciation on your money that you’re not getting. You’re not paying interest but you’re still losing money! Oh, and by the way: At the end of the 5 years, no matter which option you choose, you’ll probably going to have to tee it up again and purchase another $100,000 worth of equipment! Why am I visualizing a dentist on one of those hamster wheels? Going around and around and around. . .

Option 4: Bank On Yourself! Professionals and other business owners are increasingly using Bank On Yourself to become their own source of financing for business vehicles, equipment, office buildings and more. Business owners like Walt Disney and J. C. Penney successfully used this method decades ago. When you finance business expenses using Bank On Yourself, you can qualify for tax deductions for interest and depreciation. Plus this

strategy lets you recapture the interest you’d otherwise pay to banks and other financial institutions and never see again. Let me explain how it works: Bank on Yourself is based on dividend-paying whole life policies. No, not those whole life policies, the ones that short-sighted financial pundits love to hate. These policies are specifically designed to supercharge guaranteed growth. They have increased in value every single year for over 160 years in every type of economic climate from boom to bust. (By the way, can you say that about any of your current investments or assets? Nope, I didn’t think so.) With Bank On Yourself, you can borrow against your policy to finance the new equipment you need. It takes just one phone call and the only question

800-337-8467

you’ll be asked is, “How much would you like?” No credit check. No bankers asking for copies of the last 5 years’ tax returns. No P&L’s or budgets to produce. The cash is in your bank account within days. You lend the money to your practice and your practice makes lease payments to you and you pay it back to the policy. The interest charged is typically less than regular lenders and you reap the benefit of interest paid. You also get all of the tax benefits of depreciation and on interest expense. You also set up your own repayment schedule, one that makes sense for your business not a schedule set by your banker or equipment dealer. And while your practice is paying back this loan your policy continues to grow as if you hadn’t touched it!

Sound too good to be true? Dr. West used Bank On Yourself to buy into a surgery center where he performs most of his surgeries. In describing how it felt to take advantage of this remarkable feature of Bank On Yourself, Dr. West said, “You feel like you’ve been getting ripped off and now you’re not getting ripped off anymore. Knowing that your money is truly doing double duty for you, it’s just the best of both worlds.”

Pamela Yellen, financial security expert and two time speaker at our Spring Break Seminar, is also the New York Times bestselling author of Bank on Yourself: The Life-Changing Secret to Growing and Protecting Your Financial Future. For a FREE report, “The Ultimate Wealth Building and Retirement Strategy,” go to www. BankOnYourself.com/EID

The Profitable Dentist.com

Coaching 101

Coaching Case Study #1

A Small-Town Practice With a Big Increase by Sasha Burau, MBA

oody and I travel all over the country visiting the practices that we coach and while each office has its different quirks, the same general business and dental principles apply. Coaching is not a magic bean that improves production. It is a focused, accountability program that gives you another set of eyes and a sounding board for improving your practice. Dr. Doug Baxter and Dr. Julie Marshall are a brother sister-duo who practice in Winder, Georgia. Winder is a small town about an hour outside of Atlanta. They work in their dad’s former practice with their sister, Dee, who is their hygienist. They have a fantastic office, a hardworking staff and have a tremendous rapport with their patients. They already had a high producing practice and were just looking to get to the next level. Dr. Baxter and Dr. Marshall are the second generation in their “southern dental dynasty.” Their father was a dentist and their mother was a hygienist and they started the practice together. Their sister Dee took over as their hygienist when their mom retired and Dr. Marshall and Dr. Baxter joined the practice soon after. We started coaching them on May 1st and, within the last four months* they have improved tremendously: • In July they had their highest production month since starting the program. In August, they beat that number, while working 2 fewer days and being short one hygienist. • We compared their production from May, June, July and August 2012 to their production from May, June, July and August 2013 and they have improved $114,971 over 2012! Their collections improved $115,301!

May 2013 58

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June

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• Their production per day is up $1483.43 over 2012. • The average office works 200 days per year so; we would estimate that over 1 year this would be a $296,687.12 INCREASE! But the numbers mean nothing if you are not privy to the incredible hard work that went into this improvement: We started the program by implementing some phone training with Chris Mullins and doing a general evaluation of the practice. We discovered that they were very understaffed at the front desk and soon after, they hired another receptionist. Many offices are overstaffed in their clinical department but very understaffed at the front desk. This leads to a failed or non-existent recall system and the phone not being answered. This is very detrimental to a practice because your phone is so central to building and growing your practice. Dr. Marshall and Dr. Baxter have also taken steps to market their practice. They updated their website and are starting a direct mail campaign. In many offices we see that the barrier to entry for patients are lowered by free new patient exams or cleanings at a reduced cost, but

August

September

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they have looked at incorporating services into their office that get patients excited to come to the dental office. Dr. Marshall has started offering Botox and their patient care coordinator, Rhonda, is an esthetician. This has allowed them to offer many spa services to their patients following their dental treatment. They also have attracted Botox patients that have turned into dental patients. They have also implemented a “Sinful Smiles” program, which has been a staff-driven bleaching package. Sinful Smiles is an in-office whitening system that takes 20-30 minutes in the office then allows the patient to touch up for up to 50 applications. They charge $99 for this if the patient does this following their treatment or cleaning appointment. When the patient checks-in, Rachel, their receptionist explains the bleaching system and gives them a brochure. Following treatment, their hygienist or assistant administers the bleaching material. They have a few extra operatories, which helps make this possible. They average 3 patients a day that take advantage of this program and which ends up being an additional $4,752 of production each month or $57,024 each year.

Coaching is not just for practices that are struggling — this year the coaching group is comprised of a handful of high producers, start-up practices and doctors at the end of their career and doctors just looking for that extra boost. Due to the very customized nature of this program, we can only work with 20 practices this year. If you think that you would be a good candidate for this year’s program, call 1-800337-8467 or email Sasha at sasha.burau@me.com for more information. *This does not include September’s numbers due to publication deadilnes.

With 8 months of the program left*, we are looking forward to their continued success! Dr. Marshall and Dr. Baxter are two of the most focused, hardworking doctors that we have had the privilege of working with. They are self-starters and were ready to make the changes that we recommended. They also have a team that is dedicated to improving this practice.

November 800-337-8467

December

January 2014

February

March The Profitable Dentist.com

THE KEY TO CHOOSING THE

RIGHT GYM FOR YOU by Dr. U.P. Odiatu

n today’s world, careers are more demanding and personal calendars are full. Faith Popcorn, in The Popcorn Report, coined the term “99 lives” to describe the busy, high-tech life that many adults lead. “I wish I could be in two places at one time” is an often-heard lament. Unfortunately, cloning is still unavailable for today’s dentist. Consequently, optimal stamina, vitality and energy are major assets in today’s work place. How do you obtain a super-charged high performance body? Feed it the best food, read the best books, surround yourself with talented people and exercise in a top facility. Studies show that there are three types of exercisers: the first type is very social and loves group classes where they can enjoy a sense of team, the camaraderie of group interaction and morale boosting. The second type are people who are very independent and love their solo workout time and can motivate themselves. The last type... is the group on the island of “Someday Isle”… someday I’ll exercise and take care of my physical well-being. This article will help you decide on the best type of gym to exercise. Don’t get me wrong. If you are an outdoors exerciser, you certainly don’t need a gym to enjoy the benefits of regular activity. But one thing you have in common with indoor exercisers is that you value a sound mind in a sound body. There are many facilities that offer a wide variety of options for increasing one’s vitality and vigor. The challenge is in choosing the right work out facility or gym for your lifestyle. People often ask me where they should train and we advise that they need to consider the following questions when making their choice:

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What are your health and fitness goals? Stephen Covey stated in his classic, Seven Habits of Highly Successful People, that beginning any task with the end in mind will ensure success. Having a future vision of how you want to look and feel is motivating and will empower you to breakthrough old barriers. If you are in super shape already and want to try something very different, look in to Crossfit and their intense workouts in their “box” – www.crossfit.com.

What equipment does the gym offer – is there a variety of machines, cardio equipment, benches and dumbbells? Bill Phillips stresses in his book, Body For Life, that the best form of exercise for re-shaping your entire body is resistance training or weight training. New research by the American College of Sports Medicine has shown that a simple 12 week resistance training program decreases inflammation (a key player in every chronic disease) in the body. In Medicine & Science in Sports and Exercise Journal November 2012 a study showed that after just three months of a moderate intense weight training program circulating C Reactive Protein (CRP) decreased 33%, leptin 18% and TNF (tumor necrosis factor) by 29%. Don’t those numbers get your workout juices flowing? If not now…when? Is there a specific activity that you would like to master (i.e., Tae-kwon-do, Tai Chi, swimming, etc.) or are you interested in a general fitness program that includes weight training and cardiovascular training? A multi-purpose facility allows for more variety. But you might find the best instructors at a facility dedicated to karate or yoga.

Will your whole family be using the facility? What

“To keep the body in good health is a duty…otherwise the mind will not stay strong.” ~ Buddha

are their interests? There is a tremendous bond created when families exercise together. Families that play together stay together. Feel good hormones like endorphins, are released in the brain while exercising. Who better to associate these sensations with than your loved ones!

Does the facility offer child care if needed? It is always a good idea to view the actual room for space and age appropriate toys. Do you have to book the child care ahead of time? What is the child to caregiver ratio? Another option is to chase your kids around at home. You will burn 500 calories an hour without incurring child care costs. Where is the facility located? Do you need a facility that is close to home or work? Our research has shown that if your facility or gym is more than 12 minutes away it is more likely that you will find reasons not to go. Our gym – Goodlife – is 5 minutes away from our front door. I can literally drive there, exercise for 45 minutes and be back all within one hour. Not bragging. Just a fact. Is ample free parking available, or is this a cost that you might have to factor in with your membership fee? A few extra dollars a day can quickly add up over a year’s time and give you one more excuse not to go if your production goes down at the office. How safe and accessible is the facility – is the parking lot well lit and close to the gym? Will you worry about your spouse or significant other going to the gym alone or will you always need to accompany them.

What is the gym’s reputation with regard to customer service? Talking to members or the staff during your introductory visit can be insightful. A friendly, helpful atmosphere makes for a better training environment.

How clean and sanitary are the change room facilities and locker areas? Are extras provided, such as: hair dryers, shampoo, shaving cream, lotions

and other toiletries? Many people judge a restaurant’s commitment to excellence by the state of their restrooms.

Are special amenities available, such as: towels, trainers, massage therapy, physiotherapy, dietician, sauna, tanning bed, etc.? Are the fees for these services reasonable? It will be easier to take care of your total well being with some of these services at your disposal. Being a compassionate health care provider means at the end of your clinic day you will need to take care of yourself. What is the policy on holidays? If you plan on training during holiday times, it is important to ask if the gym will remain open or limit hours. This can be annoying as it’s during your downtime that you want to recreate. Will the gym freeze your membership and honor this time when you return if you will be away for an extended amount of time for illness or travel? Is there a pro-shop or juice bar where you can buy supplements or healthy snacks after a hard work out? Exercise research has shown there is a golden hour right after an exercise session where you can replenish glycogen and nutrients and encourage growth and repair. Is the gym affiliated with other facilities around the world? Affiliated gyms will often give discounts on drop-in fees when you are on the road. It is important to maintain your fitness habits while working or vacationing away from home. I know you travel to take advantage of the cutting edge sessions at conferences across the country (i.e. Excellence in Dentistry).

Do you prefer a Co-Ed facility? Who knows – if you are single, maybe you will find your soul mate at the gym! Is there a dress code? If you are a free spirit you may find it challenging to abide by strict club rules.

If you have workout equipment at home, aim to choose a gym that you can access or try different machines or different sports (i.e. rock climbing – unless the foyer in your home is big enough for the rigging…)

If you are an outdoors exerciser, try an indoor training facility. When weather gets bad, no matter how rugged you are (i.e. William Wallace from Braveheart), you may want to exercise indoors at -20F. What are the membership fees? This can vary greatly depending on the services provided and the location. Many 800-337-8467

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clubs offer specials and discounts at different times of the year (i.e., after Christmas, in the Fall, Grand openings). Some gyms offer family discounts. Ask if the gym offers a free trial period or monthly packages. There is nothing worse than being locked into a full year membership, which you never use. KEY POINT: try not to let price dictate your final choice of facility. This is a place where you will be revitalizing your body and your health. We believe that you should never look for the cheapest deal when it involves your health, purchasing a parachute, or choosing a neurosurgeon! “Picking a gym is much like buying a house or car – you don’t jump at the first one that comes along!” (BODYFitness

For Women by Thorne & Embleton). Having a gym that meets most of your needs will help you maintain a more consistent training program. Asking yourself the above questions may save you time and money. We are very fortunate in a large city like Toronto to have many excellent training facilities available. Our challenge to you is to choose one that will elevate your fitness experience to new levels!

Dr U.P.Odiatu DMD is the author of The Miracle of Health & Fit for the LOVE of It! He’s also an NSCA Certified Personal Trainer. This practicing dentist has lectured at the biggest dental conferences in North America. www.fitdentist.com

Boutique Practice... continued from page 39 In addition, in order to be able to process implant cases more quickly, we have added a cone beam CT scanner to the office. In the past, I would send my implant cases out to an imaging facility to get these surveys which I believe to be a diagnostic necessity prior to implant placement. Those who know me know that I am very leery about making huge investments in technology until I know they can be a profitable investment. This had not been the case with cone beam units in the past. This, however, has changed significantly with the advent of the new ICAT units. These new units are far more expensive than the earlier units which have served me well in the past. My imaging center provided perfectly adequate studies with the earlier generation machines. So you might ask why has the advent of the newer more costly machines made incorporating a cone beam into my practice a profitable investment. The answer lies in the fact that the advent of the newer units has created an after market for the perfectly acceptable older units that hospitals are replacing. There are now companies that will sell the earlier generation units for one third the cost of a brand new one with a full year guaranty. My total investment was sixty thousand dollars which meant that I only had to do five scans per month to make the unit break even. As an additional tip, by purchasing this unit with my American Express card, I was able to get a second year of warranty at no additional cost. This one year service contract has a value of nine thousand dollars. This tip alone has made it worth your time in reading this article. Suffice it to say, I pay for all of my equipment with American Express for this reason. Amazingly, at the very moment I was writing this section of the article a staff member

WINTER 2013

came in and informed me that the computer associated with my ICAT unit seems to have crashed. Thankfully, the repair will be reimbursed by AMEX. In summary, I have to remain silent when I listen to colleagues talk about how their practices have been detrimentally affected by the recession. I have to bite my tongue when they say to me that they are sure that I know what they mean – since I really don’t. Keeping the practice from contracting during the last few years has been challenging but it has not been an accident. The efforts and strategic plans we have instituted and described involved investments of time and money. Denver is now coming out of the recession and the elective “wants-based” dentistry market is now recovering. I have done more veneer cases this year than I have in the last three. We are on target to be up twenty percent in 2013 and I am completely insurance independent. This business model is not ideal for most dentists. It is, however, ideal for me. It provides me with the satisfaction of offering and accomplishing complex comprehensive treatment plans which continue to keep me enthusiastic and pumped about dentistry after thirtythree years. We are changing lives for the better on a daily basis and turning a very nice profit in the process.

Dr Barotz is best known for his articles, presentations and videos relating to Drop Dead Gorgeous Dentures. He is a lecturer and has presented on multiple occasions at the EID Spring Break Seminar and has been interviewed by Woody in his Driving Dentist Series in the past. He is the author of The Patient Centered Dental Practice which describes how he built a thriving fee for service dental practice by “wowing” his patients. His will be releasing a new book Beautiful Smiles, Your Smiles Impact on Your Image and Your Health for the public in the month following this article. He welcomes your feedback and questions and is best reached by email at DrBarotz@BarotzDental.com.

Puzzle Piece

The Power of Delegation by William W. Oakes, DDS

(2006) sgame @ bigstockphoto.com

Most of us have heard somewhere that “delegation” is one of the keys to having a highly successful and profitable practice. Most, however, don’t know how and when to delegate responsibilities.

There are basically four reasons to delegate: 1) If someone can do the job cheaper than you… delegate 2) If someone can do the job faster than you (while maintaining the same quality)… delegate 3) If someone can do the job better than you… delegate 4) If someone likes doing a certain job better than you… delegate The most obvious area to delegate tasks would be in the area of an EDDAs (expanded duties dental assistant). In Indiana an EDDA can place fillings, make temporaries, pack retraction cord, take x-rays, adjust appliances and take some impressions. I would like to advocate that you use these talented people to the fullest extent the law will allow. I know of practices where the staff does $100,000+/year in dental sealants! When you delegate a task to someone, give them the authority to do the task and all the glory that goes with it. And if you delegate a task and it doesn’t get done properly, before you blame the staff person, be sure you have properly communicated the task to them. Now you must decide exactly what you want to delegate. List all of your duties in the dental practice. There should be two lists: 1) everything you personally must do (prep teeth, give anesthetic, etc.) and 2) everything you want to do. Pick the handful you want to do (5-10 items). Next, display the list where you and the entire staff can see it. Then delegate everything left on the list that you don’t want to do. Give staff members the responsibility and authority for all else. Give your staff appraisal of the job done often and discuss areas that you have delegated at your staff meetings. There are numerous ways to keep track of the duties that each staff member is responsible for. In my office, we have a message board with everyone’s name on it. Right below the name is a list of their duties. Delegation is not a sign of weakness, but rather a sign of strong leadership. Your ability to lead increases when you fully understand that:

1) Your work is done through others. 2) You need the team more than they need you. 3) Your pay increase depends on how well they (your staff) do their job. When you learn, really learn, the power of delegation… you’re well on your way to adding an extra $100,000/year to your practice income! 800-337-8467

The Profitable Dentist.com

HIPPA Compliant Two-Way Radio/Voice Scrambler The CE240, by Custom Earpiece, is the smallest, lightest 2-way radio on the market. Voice scrambling capabilities meets HIPAA compliance regulations even under the strictest interpretation of HIPAA rules. When the voice scrambling is enabled, even high-end scanners are unable to interpret your in-office communications. This allows you to improve your communications by eliminating the need for radio etiquette rules that limit the use of patient names. For more information call Custom Earpiece at 800-711-7317 or visit their website at customearpiece.com. A cool side note is that this company is in Ft. Walton Beach, FL, my wife’s hometown and the site of our annual “Spring Break Seminar”!

911 Rather than take a productive day out of the office, HealthFirst now offers a training course online spanning less than one hour on how to use the medications and devices commonly found in a dental office’s emergency medical kit, as well as a bag-valvemask resuscitator and portable oxygen. The course features Dr. Don Cohen, DMD, and is appropriate not only for the dentist but also for the entire staff. For more information call 800-331-1984. They also sell the emergency kit at a very reasonable price.

Selling your Dental Practice Now? In 2 years? 5 years? or 10 years? Contact PARAGON today for your free Dental Practice Transition Guide.This practical guide will help you avoid common practice transition mistakes and can add tens to hundreds of thousands of dollars to your retirement fund!

ü NPLOANW WORRY LATER

Call 866.898.1867 or email us at info@paragon.us.com and request your free copy today.

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WIIN NT T E R 22001133 W

“Do You Have Your Green Card(s) Yet?” (Dental offices all across the USA are having AMAZING results with this simple card!)

Dear FriendDo you have your green card(s)? No, not that one…although if you reside in the USA I hope you have that “green card,” or are at least on task to get one. No, what I’m talking about is a little fluorescent green postcard that we created and perfected over the last 20+ years. It’s the AMAZING card that encourages patients with dental insurance to use all of their benefits that they have coming to them before the end of the year. This is the very same card that last year (2012) brought in an $8,000 mini-implant case to Dr. Gary “M” in Southern Indiana at the end of December! Now, I know that every dental software program on the planet comes with a nicely worded letter that you can send to all patients who have dental insurance, but have not used all their benefits for that calendar year. Most software will segment that out by individual family members while others just list it by family!? Once these letters are personalized and nicely printed…they are tri-folded, placed into a #10 envelope and mailed to your patients with unused insurance benefits. Now, the “Hope and Wait” game begins. Hey, I know how these letters don’t work that well because I used to use them myself and always felt disappointed at year’s end because I didn’t get the “insurance cash-flow” that I was expecting from our office’s efforts sending out all those envelopes. That’s when I decided there had to be a better way. What’s that saying… “Necessity is the mother of invention”? Now, I’ll admit, I had a great advantage when it came to creating a better way to get people with unused insurance benefits into the door before year’s end. After all, when you are coaching up to 20 dental practices at a time… you can test 20 ideas at once. Then, you can test the best systems against the best systems. So in a very short period of time, you learn from real data what works and what doesn’t. What we came up with is a simple green postcard that is easier to use than the computer generated letter/#10 envelope, costs less postage, has a higher ROI (Return On Investment), and creates an immediate response and there’s always an “insurance cash flow savings” before the end of the year.

But, it’s not just the postcard itself. It’s also… • The exact time it has to be mailed • Timing, the day of the week when it will arrive • Using the correct type of postage stamp • EZ drop dates, etc. Here’s the deal, we’ve had our printer print us 20,000 of these cards for our members. That may not be enough, because last year we sold out of cards and had a lot of “unhappy campers.” So, if you see the benefits of these simple, but powerful cards, you gotta order FAST!

To order you “Hole In The Pocket Cards”give us a call at 1-800-337-8467, complete and return this ORDER FORM or visit www.TheProfitableDentist.com TODAY! Regards, William W. Oakes, DDS

Is IsThere ThereA a Hole In Hole inYour Your Pocket? Pocket? Hurry... call 1-800-337-8467 to place your order today before your patients’ benefits expire! ORDER FORM YES, please send me my Hole In The Pocket Cards.

500 Cards.......................$170 (Code: EWS-HIP2) 1,000 Cards.....................$247 (Code: NEWS-HIP) (Please include $9.95 for shipping/handling fees.)

Name: ________________________________ Address: ______________________________ City: _____________State: _____Zip: _______ Phone: (____) __________ Fax: (____) ______ E-mail: _______________________________ Visa MC Amex Discover Check CC# ______________________Exp. Date: ____ Billing Address: Signature: ___________________________ For Fastest Service, Order By Phone At: 800-337-8467 or fax to 812-949-8535 To Order By Fax or Mail, Complete and Return This Order Form In The Enclosed BRE To: Excellence In Dentistry 3211 Grantline Road, Suite 20 New Albany, IN 47150 Fax: 812-949-8535 CODE: NEWS-HIP COPYRIGHT EID 2013

From Our Readers

(2008) casaalmare@bigstockphoto.com

ring if this Woody, ve been wonde ha I , es ec pi nd epot.com/p/ g electronic ha d: w w w.homed di e on e sersiv For those usin ns pe kErator- Dispo t the more ex utlet-for-InSin l-O would do wha ua ). D ht hrig itc to the SinkTop -Sw tion (pictured InSinkEratorduct _descrip ro #p 18 . 29 od 06 go STS -OO/100 und would be an audible so eat – not Coupling it with and it works gr al os sp di e th r y device, but d at my sink fo ld work with an ou w or it I have installe r fo n – I’ve c ge is specifi your suggestio sure if the volta d my thoughts – I may tr y anks. Th . w kindle r a while no fo r ila m si ng your email re ethi of making som D (D905)? been thinking id Ahearn DV av D e th of te the da Also, what is ida Steven B., Flor (2) camera setups rly Oral Vision ea ur yo of r purchase BT W, I was a n... he w way back Hey Steven, Keep me posted on the Home Depot product. The David Aheam DVD was done in 2009, but everthing on the DVD is still current.

Woody, In Dr. Lyons’ video he said he used Marathon compos ite made by Denmat. Denmat discontinu ed that product in 2005. Ple ase advise me of what to use in replac ment to the Marathon com posite or how to order it and from whom.

Thank you, Linda

Linda, I’d go with Denmat’s new com posite which replaced Marathon. Howev er, any of the top name composites would wor k. It’s mostly the technique not the par ticu lar material.

Dear Woody, What is the best set

of loupes??

Regards,

Coach Cain

Coach,

sion loupes with the Design for Vi We recommend # of the fiber tics. The model their ultra light op 3-1000. The 92 Deno uses is . Dr at th ck pa optic should be able 5- 4009 but you 34 080 is r be m nu Dental Supply st price at DDS to get it for the be d. talSupply.com/tp at ww w.DDSDen

WINTER 2013

Regards,

Send me your questions, comments or interesting observations! Email them to info@theprofitabledentist. com with “TPD Reader” in the subject line.

Breakthrough Interview

“Dental Insurance Is Changing Rapidly… Do You Know Which Plans You Can Now Afford To Accept?”

xcellence in Dentistry

3211 Grantline Road, Suite 20 New Albany, IN 47150 1-800-337-8467 • www.TheProfitableDentist.com

(Insurance, PPO Plays and Smart Practice Strategies For 2013!)

Good Morning Doctor – Well, the dental insurance world is changing again and for those of you who participated in our recent tele-seminar with Dr. Charles Blair…you’ve just heard the “tip of the iceberg.” That’s why I decided to call one of the smartest insurance guys I know – Bill Rossi – and asked if I could interview him and thus help our members. Bill is the head of Advanced Practice Management and is located in Minnesota…. a state that has been hit by insurance problems perhaps more than any state in the United States. He has superior knowledge on what plans you can afford to accept, how to evaluate plans and how to still make money on the plans you have. Once you hear this, I think you will agree that it’s some of the most outstanding knowledge and advice on the subject of dental insurance. In fact, you can’t afford to practice dentistry another day without this information.

ALL N EW 2 013 LEC From TURE Bill R ossi... The “ Ma The P n With Those lan” For Risky PPOs !

Here’s just some of what you’ll learn: • • • • • • • • • • • • • • • • • • •

The deadly, serious matter of dental insurance participation Strategies for bread and butter practices to high-end “downtown” offices Why dentists sometimes make hasty decisions about signing up with PPOs Bill Rossi What Bill has learned (about insurance) from over 200 dental practices with approximately $20M of “Ring Master” of PPOs production/month Why the above decision can be the scariest and biggest profit changing decisions dentists can make How insurance participation ties to business, new patient development, profitability and so on Dealing with dental insurance is a matter of integrity, hard work, knowledge and courage! A major employer in your town is offering a new PPO to its employees (your patients); should you join? You just started a new practice and you’re trying to decide which PPOs to sign up for (helpful tips) Negotiating fees with PPOs How to properly transition out of a PPO Assessment Fortification Transition Statistics to watch before and after joining a PPO Leadership ORDER FORM A new PPO is coming to town; should you join? YES, send me the Bill Rossi’s “Making The Right Moves Strengthening the practice before and after PPO transition With PPOs” system for ONLY....................... $97 New patients/clinical collaboration/business systems (Please include $9.95 for shipping/handling.) And much, much more!

This product contains my complete 60-minute interview with insurance guru Bill Rossi. It also contains a complete written transcript so you won’t miss a word. To order Bill Rossi’s “Making The Right Moves With PPOs” for ONLY $97 call 1-800-337-8467 or visit www.TheProfitableDentist.com. Regards, William W. Oakes, DDS PS - You cannot afford to work with dental insurance another day without the riveting information in this sensational interview. PPS - Why face dental insurance “blind” when this powerful information is available to you now?

Signature: ___________________________ For Faster Service: Call: 1.800.337.8467 Visit: www.theprofitabledentist.com Or Fax: 812-949-8535

To Order By Mail Return Completed Form To: Excellence In Dentistry 3211 Grantline Road, Suite 20 New Albany, IN 47150 COPYRIGHT EID 2013

CODE: NEWS-C213

Does

xcellence in Dentistry

3211 Grantline Rd, Ste 20 New Albany, IN 47150

PRSRT STD U.S. Postage Paid Louisville, KY Permit No. 354

SERVICE

Matter?

Dear Doctor,

“I am so happy with the service provided by DDS Dental and Jason Edson. Their service from the start has been exemplary and on a professional, knowledgeable, yet friendly level that far exceeds all other dealers I have worked with. Nothing ever seems to be too much trouble for Jason. I never feel that I am just one of many clients that he has to deal with each day. It is so refreshing to receive prompt and professional service you can trust.”

We are always looking for ways to save our members $$$... AND provide them with better service! From the feedback we get, I think the NEW TPD Buyer’s Club is doing a pretty good job. But don’t take my word for it, see for yourself. →→ When you call you will speak to a person NOT an answering machine!

Melody of Children’s Dentistry of Lake County

→→ They are an elite member of NDC Dental (Nation’s Largest Cooperative of Dental Distributors)

“Kim McGrail is a great rep. She reports to me every time your company is running an offer or savings. She has a high level of knowledge of all your products and is always willing to help me with our busy dental practice. She is not a “clock-watcher” – she presents herself well and is very patient and willing to go the extra mile for me. I find her to be consistently pleasant, tackling all my orders with dedication and a smile.

→→ They are a family-owned company focused on providing better and more personalized customer service. Their “margins” are lower, thus they can pass along more savings to you

→→ The “large” companies have 35-45% margins, while theirs is only 28-30% since they are direct dealers (no middle man). This also means you can buy products like Parkell and others that formerly you had to buy direct from the company (saves time).

Mora of Wardner Dental Care

→→ You pay ZERO sales tax unless you live in New York state. →→ You will receive your order in 2-3 business days (same day shipping available on most items)

—›

You will SAVE 8-10%+ (on average) from this A+ Better Business Bureau rated company.

The NEW TPD Buyer’s Club

Get your catalog today!!!

1-877-545-6837, ext. #125

visit www.DDSdentalsupplies.com/tpd www.amdsi.com www.ddsdentalsupplies.com