Wednesday, May 27, 2009

Dental Economics-Dental News - What a great time to be a dentist!

Original article found at: Dental Economics-Dental News - What a great time to be a dentist!

First, the demand for dental care has never been higher. Our aging population's dental needs will continue to grow. Simultaneously, the number of experienced, quality practitioners continues to decline, even as the total number of dentists increases. In fact, many doctors who have been pondering the decision to retire will take this opportunity to discontinue the expense of running a marginal practice. Others will limp along hoping to recover lost savings by extending the life of an obsolete practice, while refusing to invest in what they hope will be a relatively short extension of their career in dentistry.

Second, 90% of our working population is likely to remain employed. While this may vary by region, the fact is that the vast majority of working people will remain just that — working. These people will continue to break teeth, get decay ... and need attractive smiles even if it is for the purpose of interviewing for a new job. Yes, some patients will want to give up on teeth and get dentures. We don't control this, but we certainly can be ready to provide the best possible outcome when they make this decision. The reality is that it doesn't really matter what type of teeth patients choose, but rather that they choose us as their dental care providers.

Third, the failure of an economy based on consumer spending is likely to be followed by a return to fundamentals. One of the most basic of these fundamentals is health care. During the Internet boom, we observed a phenomenon in which young, healthy, working adult patients became so obsessed with the fortunes they were making on paper that it was almost impossible to get their attention to pursue even the most obvious investment in dental care. In their minds, every dollar that was being poured into IPOs was surely the one that was going to ensure an early retirement. After the bubble burst, it was remarkable how rapidly these individuals returned to an appreciation of what was really important — family, community, and health.

Fourth, the dental care which will be deferred by some will inevitably result in far more extensive and costly procedures. As a profession that has relentlessly pursued prevention, it is certainly not our desire to have patients increase the level of required care. However, this is an unavoidable result of the current situation. Even those who can afford care may be delaying or deferring treatment until their sense of panic has abated. The 80% to 90% of the population with reasonable job security will not delay long, and most people with dental insurance are rushing to pursue care.

Fifth, market leaders in any industry consolidate their leadership positions during times of contraction. This is simple business reality. Those practices that are the most organized, highly motivated, and best trained are positioning themselves for the inevitable growth ahead. Will America be the great single superpower that it was in previous years? That is largely irrelevant. Witness countries such as France and England, long in decline in a leadership role. World power status does not significantly affect one's ability to pursue dental health.

Sixth, now perhaps the best part of this story. Never in the history of my 25 years in dental practice have I seen the pool of highly skilled and highly motivated employees as large as we see at this moment. This is a tremendous opportunity to build a superstar team! Team members have, perhaps, for the first time in a generation, come to understand the value of a secure occupation and position. The level of satisfaction at work and appreciation for work has never been higher. We have seen a steady stream of applicants, some with decades of experience, for all positions in the dental practice. In addition, a number of highly skilled people from outside the profession are making every effort to enter into our secure, satisfying, and rewarding occupation. Imagine a practice alongside such a skilled group. I personally cannot wait!

Seventh, quality real estate has never been more available. Leasing opportunities that were never available to health-care practices suddenly are being freed up at rental rates that were previously unimaginable. Land is often available at distress sale prices. It has suddenly become possible in many areas of the country to build a new office in a location that will provide a sustainable competitive advantage for decades. As the years go by, late movers will simply be unable to capture these premier sites.

If you are willing to consider this reality — the reality of those fortunate enough to have chosen dentistry as their life's work — how do you respond to this level of opportunity?

1) Grow! You have got to make room for those who want your services. One way to do it is to consider spreading hours to accommodate patients who are reluctant to take time away from the office or factory for their dental care. An expanded schedule does produce a certain amount of inconvenience in many offices. However, the primary purpose is to obtain economic security and expand the practice's market position. For those who are timid about the opportunities at hand, this might be a good place to start.

2) Accept the new economic reality as the opportunity that it is.The increase in needs-based care — and shift away from or delays in accepting cosmetic procedures for some patients — will inevitably lower the case average for practices. In order to accommodate a lower case average, greater capacity is a requirement. Some offices merely need to optimize poorly utilized space in their existing facility. Many offices will find that by increasing room count, they can easily overcome the reduction in case average. The economics of room count are compelling, if counterintuitive. Expansion when possible clearly shows great benefit. At even the extremely low case average rate of $1,000, you would only need to treat an additional 50 to 75 new patients to offset the cost of a new room using simplified systems. Offices with higher throughput are able to easily handle significant increases in new patients. When the economy returns to a more stable balance, there will be opportunity for a return to higher case averages.

3) Consider expanding or building that new office you've always wanted now! With rates as low as they are, land costs plummeting, the availability of high quality contractors who are highly motivated to complete projects, and the decrease in construction material costs, this is unquestionably the best opportunity in our lifetime to create a new office. Patients have choices, and they are more confident than ever about their abilities to choose wisely. Outdated, inefficient, noisy — and I must say — ugly offices do not achieve the new patient referral counts that their clean, private, comfortable, and efficient counterparts do. You have the ability to create patient demand. You want to prevent the erosion of patient loyalty, and you want to lock in the lowest cost for a new office. From our vantage point, from coast to coast, the time is now!

In my next article, I will discuss proactive steps that you can take to increase profits, even as case averages decline. I will discuss the very important concepts behind the relationship of quality and productivity ... and it's not what you think! The future is ours to make. For dentistry, it has never looked brighter!

David J. Ahearn, DDS, is a full-time practicing general dentist. His office consistently ranks in the top 1% nationwide. The president of Design/Ergonomics, he lectures on cost-effective office design, design for performance, and making it easier to get dentistry done. Reach him at (800) 275-2547 or at

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Sunday, May 17, 2009

Dental Practice Owners or Hiring Authorities Interview Preparation

When interviewing for jobs, associate candidates need to ensure they are prepared as much as possible. See The Interview for All Dentists. But what about the hiring practice? If you are interviewing prospective associates you should know the answers prior to the interview, as well as the questions you want to ask.

This is not a comprehensive list, but it surely provides some insight and foundation on what candidates are expecting. Also, some of these questions go beyond a typical associate arrangement and describe things related to partnership/ownership transition. Remember, candidates are interviewing you as much as you are interview them.

First things first
  • Why is your practice opportunity better, more desirable, and lucrative than another opportunity down the street?
  • Employee or Independent Contractor
  • Employee at will?
  • Is the doctor open to restrictive covenant in case of future ownership?
  • Is the owner doctor going to stay on PT for some time or can he if needed (After purchase)?
  • Days, hours, on call, etc
  • Office hours and days per week is the office open?
  • What is the new associate's schedule expected to be?
Type of Practice
  • How is the practice set up (family, Pedo, or dentures)? Pedo: what age?
  • Age of the practice?
  • When/what do you refer out?
  • Place or Restore Implant? Which system?
  • # of operatories
  • # of Hygienists. How many days/hours of hygiene
  • # assistants
  • Will the associate have their own assistant?
  • How much is the practice overhead?
  • How long has each employee been there?
  • What does the practice do to market itself?
  • How many FT and PT staff?
  • What is the patient pool like?
  • Have the number of active patient records been reviewed?
  • Is the practice growing or declining in number of patients seen, new patients attracted, and young patients?
  • Average number of cancellations per week?
  • Average number of patients seen by associate per day?
  • How far ahead is the doctor book filled?
  • How far ahead is the associate book filled?
  • How far ahead is the hygienist’s book filled?
  • Job description or general description
  • Is the associate expected to check hygiene of other doctor’s patients?? If yes, will the associate be compensated for it?
  • Will the associate be expected to perform hygiene/prophy?
  • Does the doctor do any procedures other than regular general dentistry?
  • What were the most of the cases being done by the associate?
  • Supplies, equipment, support. Etc
  • What type of PMS (Software) is used?
  • Implant surgical set up? Who finances to get that set up if NOT already have?
  • What is the square footage of the office? Can it be expanded?
  • Average age of equipment?
  • Is the practice left handed, right handed, or ambidextrous?
Fees for service
  • Appropriate/assign billing?
  • Discounts/Bartering/payment plans
  • PPO type of insurance?
  • Insurances: accept all kinds or just selected ones?
  • How much is the discounted price of the PPO compared to the fee schedule?
  • Medicare or Medicaid acceptance?
  • How much of the practice relies upon capitation programs, PPOs, HMOs, Medicare or Medicaid?
  • What percent is FFS, cash and discounted PPO?
  • When was the last fee increase?
  • Are the fees low, High or average for the immediate area?
  • Do you offer patients credit?
Term of contract
  • How long?
  • Salary, Hourly, Draw, Minimum, Commission, Percentage, Bonus, When, How,
  • Taxes withheld?
  • What percent of production or collection will be the compensation?
  • How will the associate be paid? (Weekly/bi-weekly/monthly)
  • How much on average was the associate making?
  • What is the % of collection for the practice
  • What was the average associate production per day?
  • Does the associate production include hygiene exams and x-rays?
  • Can I get a fee schedule of the practice?
  • Medical Insurance: health and dental?
  • Malpractice insurance?
  • Disabilities insurance?
  • Required CE courses? How much and for how many hours a year? Are they paid for/reimbursed,? Is there a stipend?
  • Retirement?
  • Sick days…….. # allow per yr…..
  • Personal days/vacations…..# per yr allow……
  • Holidays?
  • What benefits are given to the staff?
  • Define, list, when paid, lab, etc…..
  • What Lab do you use? Use different lab for different lab orders??
  • Is the associate responsible for my own lab fees and expenses?
  • Will the practice support the acquisition loan (in case of future ownership), pay the overhead expenses and afford a reasonable income?
Other Questions and Notes:
  • What is your practice Philosophy and Goals? For the Practice and with new pt’s tx?
  • % of implant surgeries
  • Have you had associate before? How many? How long they stayed? What was the reason for the associate resignation?
  • Do you have a confirmation system for apts?
  • How do you deal with NO Show?
  • Digital X-ray?
  • Intraoral Digital Camera?
  • How do you advertise?
  • Will most dental insurance dictate pt’s Tx plan??
  • Do you deal a lot with EMERGENCY pt? Separate operatories for that?
  • Average number of emergencies per week?
  • Will I be doing hygiene/prophy when I don’t have pt?
  • Who determine how long I have when spending with new pt/initial exam and record?
  • Do I have an apt separate to do comprehensive exams and record…. Or do I do the TP when pt come in for cleaning?
  • How long does a hygienist spend on their recalls?
  • Is there a particular doctor in the area who is your main competitor?
  • Who sees the patient first (Doctor, hygienist, associate)
  • Why was the partnership offer turned down by an associate?
  • Will I be able to visit the office during regular working hours?
  • Does the doctor have a report showing how much treatment is treatment planned?

Friday, May 8, 2009

Curriculum Vitae (CV or Resume) for Dentist

I have been receiving a lot of questions lately on what should go in a CV and how/when to present references.

This is simply for the purpose of content. Formatting is not included. Just remember, Keep It Simple. Just because you know how to do some fancy formatting graphics and tables, doesn't mean you should.

CV’s are typically completed in detail and resumes are a summary. Most practices looking to hire want at least a resume, but would rather a complete CV. Letters of recommendation, copies of dental credentials and certifications can wait until later. Do not provide those at time of application.
Curriculum Vitae

City State, Zip
Home Phone
Cell Phone
Email address
Website (if applicable)

Dental LicensesState – Licenses number
DEA license

Professional Career GoalsWrite something that lets potential hiring authorities know what you are looking for professionally.

Dental School, City, State, Graduation Year, notable honors
Undergrad School, City, State, Graduation Year, notable honors
Do not include high school or early education. If you have another post-graduate degree you should list it. Always list degrees starting from most recent to the oldest.
Residency and/or Notable CE
Program Name, City, State, Month/Year completed
Notable CE may be LVI, Kois, Spears, etc.

Practice Ownership and/or Employment History
List by Business Name, Position, Month and year start thru Month and year end. You should also list achievements, strengths, productions, notable skills.

Professional Honors
List fellowships, distinguished awards, etc

Professional Membership
List organizations/study clubs you are part of and offices held. Include location.

Community Service
List community organizations you are involved in and offices held. Include location.

List should include people who are professional colleagues, supervisors, or someone from the community who can vouch for your character and work ethic. At least 3 but no more than 5.
Address (at least city, state)
Phone number
Email (if available)
Website (if available)
Your relationship to this person

Please, feel free to share or comment on what you look for or what you put in your CV.

Thursday, May 7, 2009

Michigan Medicaid Says "No" To Dental Care (

Wednesday, May 6, 2009

bill to help states improve their Medicaid (
Legislators drill dentists on school program ban (

Sunday, May 3, 2009

References can make or break your job search

Reference requests should not be a shock to any job seeker. Regardless of experience you should know 3 to 5 people who will be willing to give you a great review. I want to cover several items regarding references that many simply neglect to consider.

1. Notify the individuals, you will list as references, that you are doing so.

I have made many reference check calls where the reference was taken aback by my request on a job applicant. The reference did not realize that their friend/colleague was even looking for a job. In turn the information provided or given is given cautiously and much less detailed because they were not aware if they should be talking to me. This can be easily avoided by discussing with the people you will list that you are searching for a new position. As you apply and receive calls for interviews you should let your references know that they may receive a call from XYZ company.

2. Don't list family members as references.

Family members do not make good references. Several reasons for this, but most of all their credibility and bias is going to be questioned automatically. Why would they say anything bad? You should use past supervisors, business colleagues, coworkers, clients, patients, etc.

3. Stop putting "References Available Upon Request" on your resume or CV.

You WILL have to provide references. No question, it will happen. Simply save a step and put them with your CV/resume when you apply for a position. They probably will not be checked until you have met the employer for a face-to-face interview. However, providing references up front shows you are organized, serious, and committed to potentially working for the company. Never get caught up scrabbling at the last minute to get your references together. I like to look at the references of dentist I interview to see if I know any of them. Often times I or the practice I am working for does know them, and this peaks additional interest from the prospective employer.

4. Do not just list the Names and Numbers of references.

A good reference list contains at least 3 people, but 5 would be great. When listing the contacts you should put their name, title, company, your relationship to them, address (at least city & state), phone number, fax number, email, and website. Reference checks these days can take many forms. Make it as easy as possible for your potential employer to check them.

5. If you want your confidentiality to be kept, do not list co-workers as references.

Simple and obvious enough, you would think. People talk, and if you absolutely need to keep the job you have currently, then you don't need to take the chance of compromising your confidentiality. As well, you should note in cover letters that you are confidentially seeking new employment so prospective employers know that they should not contact your current employer.

6. Don't be offended because you are asked for references.

Several experienced doctors that I have worked with have asked me, "Why do I need references? I have been practicing for 20+ years, and my reputation is impeccable." That may be so, and if you have nothing to worry about then providing references that back up your reputation and career success should not be a problem.

References are vital to a smooth and successful interview process. Employers have to make sure you are the absolute right fit, and this is a good way to reassure them that you are the right choice.

Always remember that references should be chosen carefully, and they should say things that match up to what you have already told the potential employer about yourself. If in doubt about what a reference may say about you DO NOT use them.

Friday, May 1, 2009

The multispecialty practice: A unique practice model for challenging times


John Weston

April 29, 2009

by John Weston, DDS
Accredited Fellow, AACD

For more on this topic, go to and search using the following key words: multispecialty practice, diversification, specialists, staffing, Dr. John Weston.

Most dentists practice alone. In fact, the traditional model of dental practice is a single practitioner with a small staff in a stand-alone office. While there are advantages to this model, practitioners might be wise to consider other options. Group practices, for example, provide shared overhead, clinical coverage, and stability a solo practice does not offer. I like this model but would suggest an exciting and potentially more rewarding concept — the “multispecialty practice.”

This article will review the basic concepts that I believe have helped me build one of the most successful multispecialty, fee-for-service practices in the country. We have gathered certified specialists in every phase of adult dentistry at one location. This concept has helped keep our practice strong, financially healthy, and uniquely competitive.

Like investing in the stock market, diversification in a dental practice is one key to success. Most dentists refer to specialists for procedures they do not like or which prove too complicated.

We have taken this philosophy a step further by bringing skilled specialists directly into our practice. As a result, we increased the ability to treat patients, and allowed more time for me to do the cosmetic and elective procedures I enjoy most.

The concept

General dentists are referring less often. We may see this trend accelerate during an economic recession. As a result, some specialists may be significantly less busy. You might also be surprised to find they would be open to the idea of a satellite office — a sort of “second home” in which they are valued for their skills, and would appreciate the opportunity to serve patients in an environment where quality is the focus.

At our practice, in-house specialists see patients without worrying about scheduling, supplies, staff, collections, recall, or any of the other systems required to treat patients in their office.

The tangible is the paycheck, but a significant intangible is the professional stimulation between colleagues. Our doctors find it rewarding to be part of a team. There is a completeness of care by having the records, referring doctor, and treating specialists all in one location. I will often visit the specialty care area during my patients' surgeries to confirm placement of implants and other details.

Patients appreciate this, the specialists enjoy the interaction, and I learn something every time. Often, we will sedate a patient and complete all of the patient's specialty or restorative needs in one visit. I can supervise the entire effort, which is extremely rewarding.

How to begin

Finding providers who match your style and philosophy is important. Start by looking for quality-conscious doctors who are not in your immediate referral area. During the introduction call, I ask if they would consider working one day a week with us where quality is the No. 1 focus. Through the years, we have staffed our specialist positions with those who already own a practice and are excited about the opportunity to work one day a week with us. I emphasize our goal of providing a high-quality, low-stress environment.

My advice is for offices to start small. Look at areas in your practice in which you are referring out a lot of treatment, and start by hiring a specialist to support that need. This does not mean you have to bring every procedure in-house. It may be good to continue some referrals to local specialists, thus maintaining those relationships.

Periodontics and oral surgery are good specialties with which to start. In the beginning, I ask the doctor to bring any specialized instruments or equipment beyond the basics. As things progress, I do not hesitate to purchase the proper instruments and supplies for a specialist. The investment quickly pays off and the doctor is happier knowing he or she has the best.

Our oral surgeon and periodontist have been with us for more than 10 years and have no plans to leave. The endodontic and orthodontic positions tend to rotate every few years. We currently have an excellent prosthodontist one day per week who plans to stay indefinitely. When specialists do leave, they usually help us find replacements, and they have a good knowledge of other specialists in the area. In one case, we actually contract directly with a group practice and not the doctor. This ensures our specialty coverage will not be interrupted.

Staffing and scheduling

The goal is to fill chairs during operating hours. You are paying the overhead whether you have a patient in the chair or not. Adding a specialist one day per week is ideal but you may need to start with half days until the demand rises. When we hire a new specialist, we know in advance what days we are looking to fill, and this becomes part of the signed agreement. The team also understands the importance of having full chairs every day.

As an example, Friday was once a quiet day in my office. Now we have at least one or two periodontists, a prosthodontist, and a general dentist, as well as two to three hygienists. Friday has now become a very productive day — all without my being there. A key factor is balancing scheduling with demand. A day when the main producer is out of the office is a perfect day to add a provider. We also always open up extra days to our specialists when others are on vacation.

Most patients who see our specialists are referred from within the practice. It is amazing how complete treatment planning becomes when it stays in the practice. We still get referrals directly from other GPs, and encourage this. When this happens, we are essentially acting as a specialty practice. It is extremely important to make sure the patient gets back to the referring doctor so we don't lose the referral source.


Our specialists are all contract 1099 employees and the IRS requires they meet 21 criteria to be independent contractors. Most of these are self-fulfilling, if they have a primary practice location and satellite with you a day per week. Your tax attorney can make sure you are in compliance. We use standard “at will” employee contracts that allow either party to terminate with proper notice if things are not working out. All pay is based on a percent of collections, not production.

From my perspective, this is the best way to properly compensate providers. Production is easier to track but is not real money until it is collected. You want your providers engaged in the process and completing treatment that is agreed upon by patients who will pay their bills. Collections are real money — the stuff with which you pay your bills.

Compensation for restorative providers can run anywhere from 30% to 36% plus a 50% lab bill. Connecting a doctor to lab bills is important because they are conscious of remakes and quality issues. Compensation for endo, ortho, perio, and OS can run anywhere from 45% to 50%.

Just make sure implant and grafting procedures are priced properly to ensure accurate profit margins. Start on the lower end of the percentages so you have room to absorb initial costs and reward good providers.


A key factor for our success has been a focus on quality. From the first phone call and front-office experience to every point of contact throughout the practice, we focus on an amazing customer experience. We call these encounters “moments of truth.” Patients show up for appointments and pay bills when they feel a practice takes care of them. In addition, offering specialty care within your office goes along with a “patient-centered” focus and can add incredible value.

The office should never appear stressed, overworked, or understaffed. The expression “never let them see you sweat” goes a long way, and takes proper training. Attitude is not everything but almost. We hire team members based on attitude, and train them to our product. Never let a big resume fool you into hiring someone who does not seem right.


The goal in this competitive market is to stand out, find a niche, or distinguish your practice in some way. What causes a patient to drive past 25 other dental offices to visit yours? In our situation, we are the only fee-for-service, multispecialty practice in our city. We have a local, national, and international clientele which travels to our practice for high-quality care and a “one-stop” philosophy.

Simply stated, we provide top quality multidisciplinary care quickly and conveniently. The benefits and improvement in care for our patients far outweigh any challenges we faced in making this happen. Our ability to offer state-of-the-art care by certified specialists in one location is a successful model that, when properly implemented, could also help your practice stand out as unique.

Dr. John Weston, a Fellow in the American Academy of Cosmetic Dentistry, is director of Scripps Center for Dental Care, a unique multispecialty center located on the Scripps Memorial Hospital Campus, La Jolla, Calif. He writes and lectures nationally and internationally about cosmetic dental procedures. Reach Dr. Weston at

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